Horror Stories From the Wards: The Five Worst Places I Slept During Medical School

By Bret Stetka | 3.05.07

One of the more valuable lessons I learned during my four years in medical school is that, when on overnight call in the hospital, sleep can be an evasive, yet critical pursuit. It's kind of like that game with the dangling metal claw where you try to pick up stuffed animals – it rarely happens, but when it does, the sense of reward is outstanding. Finding time for that extra 15 minute catnap might make the difference between nodding off during rounds – thus having to ask your attending physician to repeat the question because you were too busy sleeping to listen – and showing up your colleagues by quickly rattling off the most frequent causes of an elevated anion gap metabolic acidosis.

In response to growing public concern regarding patient safety, in July 2003, the Accreditation Council for Graduate Medical Education mandated that no resident physician, regardless of specialty, can work more than 80 hours per week, or more than 30 consecutive hours in a single shift. While this initiative makes no mention of medical student hours specifically, the rule essentially trickles down to students, who rarely exceed resident hours. Specifically, the ACGME expressed concern that sleep deprivation among residents can have serious negative effects on performance, education, and patient well-being. In addition to patients, the new guidelines were meant to benefit residents as well. Studies have linked chronic sleep loss, and sending residents home during their so-called "circadian nadir," a sort of biologic downtime in which the body experiences diminished alertness, with an increased risk of motor vehicle accidents. Leana Wen, past President of the American Medical Students Association (AMSA), states, "Numerous studies have now shown that anyone working past 70 hours a week [is] working at the capacity of being legally drunk, which is not safe for their patients and probably not safe for themselves."

Despite concerns that limited resident hours result in discontinuity of patient care – as in, cases get passed back and forth as well-rested residents come and go – and an overall dearth of educational experience, there is strong evidence to support the contrary. Well-rested residents have been shown to experience decreased attentional failures and have more time for effective reading and learning, all while maintaining exam performance and quality of patient care. So while it seems the new era of humane resident hours is proving a success, 80 hours a week is still a crap-load of time to spend in a hospital (unless you're a neurosurgeon, who, at least in my experience still pull 100+ hour weeks and simply enter 80 on his or her time sheets). And when you're in the final leg of a 30 hour shift, all appreciation of the new regulations goes out the window. So what I'm saying is, despite the reform, sleep is still a major concern among residents and medical students.

When it comes to getting sleep on the wards, med students are at the bottom of the totem pole. First dibs on bed-space goes to the upper level residents, followed by the interns (first-year residents). Once these two populations are sleeping soundly, med students get to fight for the scraps. Now more often than not, at least where I went to med school, there's enough call rooms for everybody. And in some cases an intern will be so kind as to let a student inhabit an un-used tier of their bunk bed. But every now and then students end up either in a particularly crowded hospital wing, or on a lousy rotation with dismal all-night accommodations, at which point sleep becomes some unobtainable, longed-for concept, that not through lack of trying is never achieved. And although my med school days are behind me, and I'm now able to get a full eight hours with regular frequency (primarily through writing crap like this rather then opting for a residency), all those groggy nights and red-eyed mornings made a profound impression on me, resulting in a lasting appreciation of the wonderful restorative powers of sleep. So without further ado, here are the top-five, all-time worst places I was forced to rest my head during medical school.

5) Bombed-Out Nursing School Dorm - Just when I was getting comfortable with the sizable academic expectations and inhumanly-long hours of my third year of medical school, my university decided to ship me and five other unlucky pupils off to a cold, industrial coal town, which, to maintain its anonymity, we'll refer to as the "Star City of the South," to perform vaginal exams and help remove babies from their respective mothers. Our lodgings were turn of century nursing school dormitories that from the outside resembled a crumbling civil-war armory, and from the inside, looked like a Freudian-era mental hospital with stale white decor and barren hallways.

There were two communal bathrooms, one for the men and one for the women, to which every morning we'd stumble wearing nothing more than a towel in hopes that one of the two showers would be free. They usually weren't. At night, after a long day of painful speculum manipulation, we were relegated to firm, rectangles of hard, shiny plastic which were meant to pass as cots. They had a toxic chemical odor and were rendered even more uncomfortable than they should have been by the stiff plank of plywood on which they sat. Periodically throughout the night there'd be a gut-churning metallic clang outside my window which I think had something to do with passing trains. After six hours of trying somehow to catch zzzzz's in this prison camp environment, my alarm would go off at 4:45 AM and the whole miserable cycle would start again. I think I slept a total of 12 hours throughout the entire six week rotation.

4) Dialysis Unit – One night, after a particularly busy evening of admitting patients and re-bandaging diabetic foot ulcers, it was finally time to free myself from the woes of my internal medicine rotation with a few hours under the covers. I tried every call room I could think of, only to be met with drowsy proclamations like, "Get the hell outta here! I'm sleeping," and, "What the fuck dude, I'm trying to sleep." I tried every couch, in every lounge and every conference room I knew of, but they were all taken by sleeping colleagues.

After nearly an hour of walking around, hopelessly trying to find an acceptable sleeping situation, I finally stumbled upon an un-occupied location. And while too cold and uncomfortable to afford a tired med student even a minute of sleep, it would have to do. I dropped my belongings and shed my white coat, settling in for a long night of misery in the dreary confines of the dialysis unit, the haven of artificial renal function for those whose kidneys don't work.

My bed consisted of two wooden chairs pushed together so that my ass rested in one seat with my feet draped over the co-joining arms into the other. The back of my head rested on a freezing, metal dialysis machine. It must have been around 50 degrees in the place and save my white coat, I had nothing in the way of covers or a pillow. Thus, at any particular time I was afforded only one comfort – I could either cover up and be warm, with my head resting against hard, angular steel, or I could wad up my coat into a makeshift pillow in exchange for freezing my ass off all night. After three hours of tossing and turning I ventured out and found a sympathetic nurse who gave me a sheet and a pillow. At that point I realized it was already time to start pre-rounding on my patients, so my new friend's generosity was all for naught. This was the last time I set foot in the dialysis unit.

3) Inside a 1929 Drinker iron lung – Granted this was just an exhibit at my schools health sciences library, but when a librarian helping set up the gargantuan mechanical respirator said to me, "Imagine trying to sleep in one of these things!" I couldn't help myself.

2) While assisting with breast cancer surgery – First off, I'd like to make it clear that I'm not making light of a serious situation. The patient I'm referring to had an early-stage tumor which was easily removed through lumpectomy (a "breast-conserving" operation in which only the tumor is excised, as opposed to a mastectomy, in which the entire breast is removed). At her three-month follow-up visit she was completely cancer free and had no complaints.

Now there's a certain amount of bravado that goes along with being a surgeon, which often manifests itself through marathon sessions in the hospital and by staying up as long as humanly possible while still managing to scalpel and suture patients. And there's nothing a surgical resident physician enjoys more than dragging a weary medical student along for the sleep-deprived ride. Which is why I wasn't surprised when, after staying up most of the night ganking sodas from the nurses stations and helping repair ruptured spleens (by "helping", I mean holding intestines out of the way so real surgeons can better assess the damage), the resident I was working under suggested I scrub in on that afternoon's cases. Rather than risk a poor evaluation, I reluctantly slipped into a sky-blue surgical gown and slapped myself awake for another full day in the OR.

The first two surgeries went fine, as the gravity and intensity of actually cutting into a real-live human being generally triggered from my adrenal glands an ample burst of adrenaline. But at this point I'd gotten maybe two hours sleep over the previous 36 hours and by the start of the third procedure my energy reserves were shot. To make matters worse, the attending surgeon could tell I was fading, and though he'd previously let me excise entire tumors on my own, this time I was relegated to retracting skin and subcutaneous fat with a hook-like tool while he did the bulk of the work. So with only menial surgical duties and no external stimulation, save the faint yelp of the Talking Heads (a favorite with this particular surgeon), there was no way I would make it through un-slumbered.

"Are you sleeping?!!" yelled the surgeon. He'd caught me. I'd actually nodded off while standing there exposing the innards of a malignant breast. Imagine the ramifications of a patient accidentally awakening to find one of their "surgeons" asleep? Irate family. Formal complaints against the hospital. Lawsuits. And while extreme exhaustion is all part of the complex hazing process med students must endure, it's instances like this that make the argument for limited resident and medical student hours seem all the more logical. However, I'm pretty sure the attending surgeon knew the whole time I was incapable of offering any dexterous surgical assistance that day, which is why he stuck me with such a trivial role. His smirk told me that at least part of him thought the whole incident was funny.

1) Nowhere, because there's no time to sleep - This happened far too often to speak of one particular incident, but they all share a common theme, that being complete and total bloodshot misery. These are those nights when the moment your head hits the pillow, your goddamn pager goes off because someone's glucose is too high, or another crying baby's decided it's time to become an autonomous member of society. It's at this point that care-givers must exert some woozy self-control, as the patient can easily become the enemy, with his/her complaints the only barrier between you and a night's rest. Medical students in particular must hone the skill of getting out all disgruntled sighs and vulgar proclamations before entering a patient's room and instead put on airs of confidence, compassion, and alertness. The following day is generally a blur – lost forever from the confines of the brain like a late-night Jack Daniels bender. Once home, the student is free to collapse in exhaustion and revel in the fact that there's one less call day to worry about before graduation.

References

Lockley WS, Cronin JW, Evans EE, et al. 2004. Effect of reducing interns' weekly work hours on sleep and attentional failures. N Eng J Med. 351(18): 1829-1837.

Vidyarthi AR, Arora V, Schnipper JL, et al. 2006. Managing discontinuity in academic medical centers: strategies for a safe and effective resident sign-out. J Hosp Med. 1: 257-66.

Accreditation Council for Graduate Medical Education (ACGME) Web site. The ACGME's approach to limit resident duty hours: the common standards and activities to promote adherence.

Jagsi R, Shapiro J, Weissman JS, et al. 2006. The Educational Impact of ACGME Limits on Resident and Fellow Duty Hours: A Pre–Post Survey Study. J Med Education. 81(12): 1059-68.