Can I do residency again in a better rested environment?

“How are residents supposed to prepare for real life as a surgeon if they can’t even work twenty-four hours straight now?”

I hear this complaint about once a month from a someone trained in the Golden Age of hazing. Outside of anecdote, we’ll never know if surgeons are better trained now or twenty years ago, or fifty. But it’s too painful to imagine every-other-night-call wasn’t of critical importance.

Residency resembles the real life of a surgeon in important ways, but working thirty-six hours straight all the time isn’t one of them. You pick your lifestyle after residency. The frequency of your thirty-six hour days is determined by this choice, not by the commitment you made as a third-year med student.

Besides the work routine, other pleasant surprises awaited me after residency. The first was a return of cognitive function. The second was the freedom of choice. Third was that a surgical career was not like managing a patient factory.

For me, chronic under-rest was like living with a head injury. The bits I recall went like this.

Chief, grabbing unfamiliar chart on rounds: Who’s this patient? Porter, did you admit Mr Jensen?

Me: Nope. Must’ve been the off-service intern.

Chief, pointing at admission note in my handwriting: Isn’t this you?

Me: Uh, yes. Hold on.

I’d pull a half page of scribbled notes on Jensen from my pocket to jog my memory. Still nothing. I’d read straight from my notes for three minutes, having no independent recollection of the two hours I’d spent with the man.

I’d walk in the room with the chief, see the patient’s face and boom – oh yeah, this guy. He’s the owner of the Chili’s on Woodward. His wife is worried he’ll miss his thirtieth class reunion. Every time he gets a lab draw somebody wants to work him up for polycythemia vera, which was ruled out at Mayo in the eighties.

End of the day, our team is reviewing our patient list.

Chief: Porter, anything new on Jensen?

Me: On who?

Chief: The diverticulitis patient you admitted, that you couldn’t remember this morning.

Me: That must’ve been the off-service intern.

Later, I open my Schwartz textbook to start a chapter I’d been meaning to read. Finding yellow highlighter streaks all over, I wondered: Who the hell …? I turned to the cover page to make sure the book was mine. Sure enough. So I started again with blue highlighter. A month later, pink.

When residency mercifully ended, I spent two months doing no thinking whatsoever. For fun, I resumed my old college summer job as a whitewater guide. I’d leave my neomammalian brain behind at headquarters and we’d go out camping and splashing for a week at a time. There was absolutely no call for higher cortical function in the rapids of the Middle Fork of the Salmon. Brainstem, spinal reflexes, and some parahippocampal gyrus and you’re good to row.

When summer ended, I started my surgery job and hit the books in prep for boards. I felt like Charlie in Flowers for Algernon: I’d picked up about thirty IQ points over the summer. Not only did I recall having highlighted Schwartz the day prior, I remembered the topic and some of its substance. And my patient list was almost superfluous – I remembered admitting them, their names, their labs.

Can I do residency again, I wondered, in a better rested environment? It would be nice to recall what I’d learned.

Chris Porter is a general surgeon and founder of OnSurg.com.  He blogs at On Surgery, etc.

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  • http://www.facebook.com/profile.php?id=558041620 Vikas Desai

    my cousin is internship now, and it is almost nothing like what i dealt with and i graduated residency in 2005! Its a different world now, I personally don’t condone the torture like environment of residency in the past, its all about learning, there is no reason for a 26-36 year old who worked hard their whole life to treated to less than minimum wage pay it was a very long time coming. I wish that I did not have to spend many of prime years working 30-33 hours at a time. 

  • Anonymous

    Thanks for sharing! I wish more physicians would blog regarding the grueling and demanding nature of their training, because I believe it is incomprehensible for the general public to understand – take your WORST day at work, multiple it times 100, and don’t sleep for 24-36 hours. And that’s not counting med school. Maybe then they can understand why we deserve to compensated, but probably will still call us greedy.

    • http://pulse.yahoo.com/_MKTIVWFKCAZZA7CE74HC6ECONE Jop

      Lol, if residents put up with it, why not?
      Medicare reimbursements are going to get cut, if not this January, then next Jan and again the next Jan. American doctors still make substantially more than their English, French and Australian counterparts.
      Students are still flowing into the medical profession and until the supply decreases or residents demands change, long, grueling, cheap labor will remain the status quo.

  • Anonymous

    I remember falling asleep during a OB/GYN lecture one post-call morning in internship.  I was of course drooling and apparently breathing heavily because one of the other interns said I was breathing like Darth Vader, which was my nickname the rest of the year.  But dang that shuteye felt good at the time.

  • http://www.maleenhancementguide.org/ Janice Smith

    Its ideal to read something like this. I do appreciate you work. I find it informative and your choice of topic discuss you in a brilliant way. Good job!

  • http://twitter.com/ChrisJohnsonMD Christopher Johnson

    I was a resident during the golden age of hazing, although not in surgery. I was on call every other night as an intern, so those 36 hour stretches were pretty common. The department head’s standard line was: “the bad thing about being on call every other night is that you miss half the interesting patients.” And he meant it.

    But I do worry a bit about shortening duty hours in the same total residency period — it really does mean you see less during your training. Nobody wants to extend the years of residency, of course. I think right now we’re groping for the proper balance.

  • http://profiles.google.com/molly.ciliberti Molly Ciliberti

    Time to stop the hazing and have well rested, awake residents able to focus and concentrate on learning. Since they are learning on real patients it helps if they are awake and functioning. As a nurse, i remember many residents sleeping through much of grand rounds; there was no learning going on just exhausted people getting some well deserved shut-eye.