Wednesday, October 03, 2007

wakeup call

i once heard someone say surgery can be summed up in one sentence. eat when you can, sleep when you can and don't f#@k with the pancreas. this is true. but when you steal a quick shuteye here and there, this dictum doesn't tell you how to wake up on time. (pancreas can wait for later). i discovered a neat trick. actually this is a copyright secret, so everyone who reads this post, please forward money to me. thank you.

i was in vascular. i was doing 15 calls a month. (there were two of us). it was tough. often i would work up to 72 hours with as little as about 4 hour's sleep during that entire time. the operations were long and sometimes in extreme fatigue it was difficult not to resent the drunk with a shot off femoral artery who needed surgery at midnight in order not to lose his leg. the fellow was even more over worked and cantankerous at the best of times. in the immortal words of charles dickens:- "it was the worst of times" (he also prattled on about the best of times but i wasn't listening)

so it happened more than regularly that i would walk out of theater at about 5 in the morning and need to be at work at 7. clearly if i went to sleep i would rise from a comatose state long after i was supposed to be at work, bright eyed and bushy tailed and in deep trouble (or water?).
i was faced with a dilemma. grab a quick nap and be late or somehow fight overwhelming sleep off and be at work on time, but in a zombie state. then i stumbled on a solution.

i got home after not sleeping for who knows how long, with about 2 hours at my disposal before work. bed was not an option. my gcs would drop and someone might try to take my kidneys. so i decided to take a bath and get ready for work early.
i ran a warm bath and sank into it. moments later i was fast asleep. i couldn't help it. i was dead to the world.

and thus i slept soundly. and here lies the secret. the bath water slowly got colder. i was too far gone to notice this though. finally the water was so cold i could no longer stand it and i would wake up. there would be no choice. i would have to get up. it was impossible to warm the water up again (mainly because i couldn't feel my fingers and they wouldn't obey my brain's commands to open the hot tap). only rough actions could be carried out, like to drag myself out of the bath and collapse on the cold tiled floor of the bathroom (which felt comfortingly warm).

this whole process (including fumbling of warm clothes over my body and gradually emerging from hypothermia) took about 2 hours. just enough time to get to work, awake and on time, if somewhat grumpy.

so for those thinking of going into the wonderful career of surgery, spare a thought for your consultant. if he seems cold to you, there might be a reason.

warning, unless you are tall and will therefore not sink below the surface unconscious in a bath, this may not be a good idea.


rlbates said...

I'm not tall enough to try that trick. Glad it worked for you. Hope you don't have to use it often anymore.

Sid Schwab said...

Looking back, I don't know how I did it. In my youth, I guess, catching an hour here and there did the trick of re-charging for another several hours. Vascular, as an intern, was a single intern service (as were several others that year), which meant staying in the hospital for 12 out of 14 nights; on the weekends we'd be off, or on covering another one intern service along with ours. Didn't have a tub in the on-call rooms, but it sounds like a good idea. I'm tall enough, but really, I hate baths.

Karen Little said...

I've also used this trick, although it works a bit differently for me because I'm really short. I get in the bath, doze off, and then wake up when my mouth sinks below the water and I aspirate.

Some people think it's better to get no sleep at all than to sleep for just an hour, but I find even an hour makes a world of difference.

amanzimtoti said...

I must say, a bath can be very relaxing, but i have a bit of OCD and I can't help thinking that when you're soaking in the water, you're also soaking in the dirt that you've accumulated that day plus your dead skin cells. Not to mention things like e-choli. Yip, you're definitely not bathing alone.

Jeffrey said...

i might not have stepped into the wards, or led any kind of life even remotely close to a surgeon's. but when i was in the military, the "sleep when u can" rule always works. a 10min power nap during 72 hr exercise can often help recharge for another few hrs, till the next power nap. in between, the action, adrenaline, map reading, voice procedures over the signal network helps keep me awake.
too bad they had no bath tubs even for the highest ranking commanders. (maybe not that i know of, but highly unlikely)
and perhaps, the dirt and grime kept me awake

Anonymous said...

Well at least now we know you are tall. Gosh, I don't know how you guys do it. I'm grumpy if I don't get at least 6 hours of sleep!

Anonymous said...

My strategy to wake up was to drink a lot of water so my full bladder would wake me up. If that didn't work (a couple times it didn't) then wetting the bed would wake me up. I don't know if that would work as well for a male-- with actual bladder sphincter ;)

I don't know how you do 72 hours either. After about 48 I would start to have auditory hallucinations (mostly flute music.)I discreetly asked a neurologist who told me it was "Just REM sleep deprivation--but all residents have that."

Craig Taverner said...

I've tried this, but am too short, so I get the concise version like Karen. Another trick I've used was to have a small mattress in a spare room at the office (if such exists) and take a one hour nap. Feels great. Anything longer however, and you feel worse.

The best trick of all only works if you are not a heavy coffee drinker (no more than one or two cups a day) is to take a nice strong coffee (I know that's hard to come by in SA, but it can be done) and go to bed. Coffee seems very relaxing in the short term, so you sleep, and it then wakes you up not long after. Quite cool really!

Greg P said...

There is just so many ways this is/was unhealthy. I always sensed that there was something of the boot camp mentality about many surgical programs.

If someone tolerates this are they a better surgeon? Or if they don't not worthy to be one?

I think if a practicing surgeon pushed himself like this it would quickly lead to loss of privileges, may license. So why is it good in training?

Bongi said...

greg, the common or garden surgeon is a dying breed. we do it not because of some macho sh!t, but because there is simply no choice. the last selfish bastard of a gunshot wound i did in the wee hours was trying really hard to die. and, in case you are wondering, there was no magically rested surgeon to come out in my stead.

he survived and i didn't lose my license.

Amanzi Down Under said...

If I'm grumpy at the best of times, catch me after a busy night on call and I make Hitler look like a Sunday school teacher. So in the effort of maintaining global peace, I resigned from those inhuman jobs and now actually get time off. A fantastic rare pleasure I'm sure, for those of you still punished by such ungodly hours. Highly recommended!

make mine trauma said...

I've had the no sleep experience from time to time (nothing as brutal as a 72 hour stint), but I will have to rely on my five alarm system. Pager alarm, cell phone alarm, nature sounds alarm, music alarm, and TV wake up timer. I hate to be cold, but to be cold and wet, NO WAY! I am tall enough not to sink but, brrrr!
I agree, that one hour is better than no hour. It can sometimes carry you on for another 16 hours.
Thank goodness I don't have to do rounds or clinic or any other of those time consuming Dr. chores! I get to do the best, then rest.