I, like many of my peers in medicine, am a terrible sleeper.
And it’s no wonder, after all. I spent the better part of my twenties and thirties training my brain not to give in to sleep when I needed it. Then, in the rare hours I did sleep, I was forced to wake at a moment’s notice and go from deep sleep to high alert. Sometimes, I was asked to solve complex life-and-death scenarios within seconds of waking, and other times, I was startled awake by a particular alarm that had me running to save a life before my mind was fully conscious. I trained my body to enact the proper motions while my brain was still struggling out of a sleep state, my feet pounding, arms churning, until the adrenaline hit my brain.
“That sounds terrible,” you might say. “Were you in some sort of cult? A military experiment? A secret prison?”
None of the above. I was in the U.S. medical school and residency training system. And, at the time, I loved it.
Wait, come to think of it, maybe it was a cult.
Now, even decades later, my poor brain doesn’t trust when I tell it that it’s safe to relax and go to sleep.
“I know what you’ll ask of me,” it says, “and it’s distressing. So I’m going to remain on high alert, thank you very much.”
I cannot simply lie down and close my eyes. I know I once did this, but it feels like a lifetime ago. Come to think of it, it was over half a lifetime ago.
In fact, ironically, I’m writing the draft of this essay on my phone while my spouse sleeps beside me. We’re on vacation, but my brain didn’t get the message.
My brain that still can’t undo the conditioning I voluntarily put it through starting at 23 years old.
I still remember my first on-call rotation as a third-year medical student. (For non-medical readers, the third year of medical school is when we start taking overnight duty in the hospital with a clinical team, also called “rotations”). I’d been both dreading it and intensely excited about it, this next step in my journey toward becoming a physician. I worried about whether I’d be “strong” enough to forego sleep and work for 36 hours in the hospital. It was like skydiving or bungee jumping. You knew other people had done it and survived, so somehow, you would, too.
I trailed my intern around the hospital that night like a faithful puppy. And when morning arrived, I marveled at my accomplishment. I’d done it. My initiation was complete. I’d proven myself worthy, and I belonged. I was beyond the need for mortal sleep. Part of an elite few.
Only I wasn’t, of course. I was still human. And human bodies—and brains—need sleep. That the entire profession of medicine pretends otherwise and that trainees must endure years of sleep deprivation is one of the biggest and cruelest deceptions inflicted upon us.
Another sleep-related memory that stands out from my third-year rotations is that of a kindly surgical intern who couldn’t stay awake during a patient’s cancer care conference. On one side of the table sat the patient and her spouse. On the other sat the entire team in full hierarchical display—the attending surgeon, fellow, resident, intern, 4th-year medical student, and 3rd-year student (me).
The patient and her husband kept darting glances at the intern nodding off during what was probably one of the worst conversations of their lives, clearly—and understandably—offended. Having worked with this intern for the month, I knew he’d never callously take a nap in front of a patient. For him to fall asleep in this setting meant he was truly beyond his limits. I knew he’d be mortified, as any of us would. How dare the frail human body succumb to a physical demand?
When the attending noticed, his frown grew deeper until he finally leaned behind the backs of the resident and fellow to whisper in the intern’s ear. The intern startled, flushed, and then got up and left the room.
The rest of us pretended this was normal.
Worse than that, throughout training, we pretended we were somehow special. Singular. Beyond the needs of the body. And if you complained about tiredness, you were made to feel ashamed. As if maybe you didn’t belong. A whisper in the ear one day, and you’d be out.
At the time, I remember thinking the attending must have whispered a reprimand. Perhaps, “Go get some coffee and pull yourself together!”
But now, I wonder, could he have instead said something kind? Like, “Go to the call room and get some rest.”
I’d like to believe it was the latter, but my experience tells me it was more likely the former.
But here’s the thing. There’s a reason why sleep deprivation isn’t a mark of superiority but a form of torture. Decades later, I think that forcing our brains to function, for years, on low sleep in our early adulthoods perhaps did something irreversible to our neural pathways.
Now, when I lie down to sleep, a part of my brain subconsciously signals danger, danger, wake up, you weakling, what do you think you’re doing? We don’t sleep; we’re doctors. We get up and get back to work.
“Are you sure you want to stay up reading?” my spouse will ask, knowing I’m exhausted.
I don’t know how to explain that it’s how I distract my miswired brain to eventually accept sleep.
Oh, don’t get me wrong. I do everything else that’s supposed to help with insomnia, too. I breathe, and I meditate. I stay away from alcohol, and I never have caffeine after 4:00 p.m. I exercise in the evening but not too late in the evening. I bought a weighted blanket. I take melatonin.
But over twenty years out from medical school, I still cannot sleep until and unless I’m exhausted enough to trick my brain into finally shutting off.
And it’s exhausting.
Jennifer Lycette is a novelist, award-winning essayist, rural hematology-oncology physician, wife, and mom. Mid-career, Dr. Lycette discovered the power of narrative medicine on her path back from physician burnout and has been writing ever since. Her essays can be found in The Intima, NEJM, JAMA, and other journals. She can be reached on Instagram, LinkedIn, Facebook, and Mastodon.
Her books explore the overarching theme of humanism in medicine. Her first novel, The Algorithm Will See You Now (Black Rose Writing Press), a near-future medical thriller, is available now. Her second novel, The Committee Will Kill You Now, a prequel in the form of a near-historical medical suspense, is available in paperback and on Kindle.