By Dr. Sujay Kansagra
My body jolts awake to a familiar sound. After a few blind swipes, my blows hit their target, and once again, there is silence. The air in the room is cool and crisp, and every fiber of my being wants me to remain in the welcoming warmth under the covers. It is Saturday morning. On any other Saturday of my life, I would be waking only when my body is ready. But this month is different. My body no longer calls the shots.
I clumsily make my way around, grab my towel and clothes, and walk out of the room, squinting at the bright lights in the living room.
My roommate, still up playing video games, looks at me, then his watch, then back at me. “Wow, one of us is pretty pathetic.”
“I think we both are,” I reply.
It is 3:00 a.m. As a second year medical student, rotations have taken over my life. This particular month happens to be dedicated to pediatric surgery, one of the many fields through which I would rotate this year. I’m quickly learning that the popular notion that medical students are sleep deprived is popular for a reason. I’m also beginning to realize that life’s priorities have a funny way of coming full circle. When you’re first born, your main priority in life is sleeping. When you’re nine, the priorities are Saturday morning cartoons and baseball cards. In college, they are friends and beer. But in medical school, your priorities go back to the beginning—sleeping. This becomes more evident the longer you’re on the wards.
Sleep deprivation is a unique experience. Imagine falling into a pool filled with caramel. You try desperately to swim out but slowly sink to the bottom, and there you are, looking up to see a brown-tinged world. Despite all of your best efforts to swim out, the caramel is just too thick. You barely get halfway to the top before you give up, defeated, and find yourself sinking back to the bottom. This is how sleep deprivation feels. There is a constant fog over you. The minute you sit down to relax or for a lecture, it starts. You become one with your chair as you feel yourself settling in. Your eyelids feel as though they are attached to lead weights. Your body goes into shutdown mode, and, slowly but surely, you start sinking into the caramel pool. You can do nothing to swim out of it.
I’ve tried it all. Caffeine is of little use. A few times, I’ve pinched my leg as hard as possible when no one was looking. It helps for about thirty seconds, and then I’m back to where I started. One time I tried asking a question during a lecture to force myself to wake up and pay attention, only to have the lecturer reply that she had been answering that very question for the last ten minutes, making me look very foolish. That worked at waking me up, but I paid the price.
The lack of sleep plays a larger role during some rotations, namely, internal medicine and surgery, than it does in others. Shifts in excess of thirty straight hours are commonplace for residents in these fields. Despite regulations that mandate a maximum of eighty hours of work per week, logging false duty hours and working more than one hundred hours is not unheard of. It is all part of the “suck it up” mentality that runs rampant in medicine. During this pediatric surgery rotation, I finally reached my limit.
We spend most of our time in the operating room during this month. For a medical student in the operating room, the job consists of three tasks: cutting, holding, and suctioning. We cut suture when the surgeon is finished tying, we hold back flaps of skin with equipment called retractors, and we suction fluid and blood using a small vacuum tube. After days and days of waking up early, this can quickly become unsatisfying.
One particular day at 9:00 a.m. we were already on our third surgery case, a simple inguinal hernia repair. Unfortunately, there was no suctioning, cutting, or retracting to be done, so I stood there with arms crossed so as not to touch something accidentally and contaminate the entire surgery. About ten minutes into the case, I heard the sweet voice of sleep calling my name, but I hung on. The case continued as the surgeon operated on a very small area that I could barely even see. My mind wandered, and I thought of how nice it would be if I were anywhere else. The image of my room and my warm bed arose, almost like an oasis for a bone-dry wanderer through the desert. And just then, out of nowhere, my body felt a unique sensation. A numbness went through me followed by the sensation of falling. But just then, I felt my body jerk, and as quickly as they had started, the numbness and falling sensation stopped. For the first time in my life, I had fallen asleep standing up! But not long enough to fall over, just enough to jerk to one side and catch myself, not unlike the head jerks you see people doing in the classroom. Except this was a full-body jerk. Luckily, the movement was subtle enough that no one noticed. I guess they were too busy operating.
After this, the sleep-while-standing incidents (which I call “steeping”) happened regularly in the OR. During just about every surgery, I would have the now-familiar sensation of falling and quickly jerking awake. Even if there was a retractor in my hand, I slowly faded out, and the tension on the retractor slowly gave way, only to be reapplied by the surgeon, who grabbed the retractor and repositioned it. Despite this, no one noticed that I was actually falling asleep, not even the nurses who handed the surgeon various instruments. On one occasion, I actually fell toward the surgeon and bumped him while he was operating. Luckily, the senior resident had the scalpel at the time, and I disguised my bump as an effort to get a better look at the surgery. That was a close one. Thankfully, this was near the end of my rotation, and there was never a serious incident.
The battles with sleep are well known to medical students. One of my fellow students was standing at the foot of a patient’s bed while the entire medical team was in the room talking with the patient. This six-foot-four guy fell asleep and landed directly on the patient! Luckily, there were no injuries, except perhaps to the student’s grade (and pride). I quickly learned that sleep cannot be cheated; it always gets its just due, one way or another.
Hopefully, when I finish my training and become an attending physician, the priorities will shift back in the cartoon direction. But the huge pool of caramel known as residency is around the corner, and there are no lifeguards on duty.
Dr. Kansagra is a Duke Medical School graduate and the author of the very popular book Everything I Learned in Medical School: Besides All the Book Stuff by Sujay Kansagra. The book can be found on Amazon, and is available for Kindle, Nook, and iBook. You can also follow Dr. Kansagra on twitter (@medschooladvice) where he shares advice about medical education.