By Dan Henderson
You arrive at 5 am, perhaps hoping to show up before some of your classmates or your resident. You power through the morning’s rounds, cases, and notes, slowing, perhaps slightly, during the afternoon low around 2 or 3, before the pressure is on to finish up before your teammates sign-out their patients to you and return to the world outside. A handful of lists and well wishes later, you’re officially on call.
Things quiet as the din of a busy hospital gives way to a wave of shift changes throughout the building. To me, this calm was noticeable, and almost unnerving to me. It’s like standing next to a snow-covered hill in utter silence, knowing that the next small break in the quiet could mean the start of an avalanche.
Classically, that avalanche hits you while sitting in the residents’ lounge, scarfing down cafeteria food before a small TV showing Seinfeld reruns. Then, inevitably, the calm is pierced by the cry of a pager. Then, “Damn. Emergency department.” Then another, “Right behind you.” And so on.
Depending on the hospital, service, weather, day of the week, and lunar calendar, what follows is a deluge of pages, tests, admissions, consults, and notes that either ends somewhere around 2 AM, or when you leave the hospital the next day. Though an established tradition, nearly every trainee who’s worked an overnight shift has wondered, “Why do we do this?”
We might assume it helps train better doctors – it doesn’t. Staying up all night means not having time to study, to read up on the pathology we observe on the wards. It’s also clearly bad for doctors’ health – linked to depression, medical illness, and especially, pregnancy complications. On top of that, drowsy doctors, the evidence and anecdotes agree, have a much greater risk of needle stick injuries (and accompanying risks of exposure to HIV and Hepatitis C) as well as deadly car crashes. Add some real tragedies – the car crash death of a cardiology fellow, an experienced resident, in 1999 in Boston, and the permanent incapacitation of pregnant woman hit by a sleepy resident in Chicago in 2000 (see here for more)– and it becomes clear that long hours are bad for doctors.