My caffeine-free residency

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A kind resident or attending asks me, “I’m going for a coffee run. Can I get you anything?” I politely decline. “You sure?” “Yeah, I’m actually doing a caffeine-free residency.” A mix of utter disbelief and disgust crosses their faces, probably yours too. With skepticism, people ask: “Why?” I actually hate the taste of coffee. (That is absurd in Seattle, where I’m doing my residency training.) Whenever I try a coffee drink, I imagine how much better it would be without the aftertaste.

I’ve always drunk caffeine sparingly. I can count on two hands the number of cups I drank in college and medical school combined. It was my final resort to stay up until sunrise for last-minute writing assignments or brutal night shifts.

Pre-residency, I would fall asleep on my own and wake up with the sun, like clockwork. I never needed caffeine to start my day, and I was determined not to forfeit that ability because of residency, even with its 80-plus-hour weeks or 24-hour shifts every four days. I honestly like taking on challenges and finding creative ways to maintain a long streak. It helps transform stressful work into a fun competition.

Intern year, whenever I had a week of nights, I flipped my schedule to staying awake all night and spent my days either asleep or resting in bed. I was too afraid to sleep at work, worried I would miss an important page or call. The struggle was switching back. I would lay wide awake at 2 a.m. only to have a full 12-hour day ahead of me, attempting to maintain coherence while presenting on rounds.

Second year, with the addition of 24-hour shifts, I accepted the possibility that my experiment would end. How could I possibly survive 24-hours in the hospital without caffeine? I even bought an insurance policy: a can of caffeinated soda to keep in the fridge with a sticky note reading: “In case of emergency.”

The challenge taught me to find opportunities for rest during my shifts and openly express my needs. I started off my night shifts explaining my avoidance of caffeine to my attending or fellow, “I’m going to take a nap for an hour, but I have my pager and phone. Please call me if anything comes up.” At first, I was so nervous and slightly embarrassed disclosing my need for rest. I worried that I was being perceived as a weaker resident for not being able to “cut it” and stay up literally all day. Napping, while necessary for me, felt like a crutch. I stated my truth anyway, and the more times I explained it, the more confident I became. That soda can survived the whole month unopened. In future months, I stopped asking for permission to sleep and started trusting myself to find nap breaks in my day at appropriate times while still keeping up with my clinical responsibilities. I completed 29 24-plus-hour shifts my second year.

My caffeine-free residency became more meaningful than just a challenge during my first Pediatric ICU rotation. On my first 28-hour shift, one of my patient’s health status took a sharp downward turn. Late into the night, we were getting labs every hour, watching the results worsen and worsen despite our best efforts. Every hour, the nurse paged me, I called my fellow, and she called the attending. By 3 a.m., my team and the parents all stood around the patient’s bed, speechless. That night was the only all-day shift where I did not find time to sleep at all. Around 4 a.m., I took a break for 15 minutes to lay awake in a dark room. That little break kept me functional enough to keep going. The following morning, I had to stay until 10:30 a.m. to present on rounds. I felt nauseous and dizzy and found some comfort from leaning against walls to present patients or finding the nearest chair to sit in during my co-residents’ presentations.

We paused our discussion of patients to return to the room of the child I spent the night worrying about to notify two loving, scared parents that their child was imminently dying. At that moment, the parallel struggle crystallized. Both the parents and I had endured a sleepless night with hourly updates and no good news. While I was pushed to my physical limits, they were beyond theirs: faced with the unimaginable task of accepting their child will die soon.

My temporary physical pain connected me to their deeper emotional suffering.

Supporting those parents through their child’s final days inspired me to reach out to other families. The pediatric ICU can be an unsettling place. Parents hold onto their sedated, intubated children while also holding onto hope that they will return to their former healthier selves. Pictures of their child’s better days often adorn the hospital room walls. I dedicated my afternoons to sitting with parents to get to know them, their values, and their child through stories and videos.

On another 24-hour shift, I sat with three different families in one afternoon as they revealed and unloaded their stresses and fears about their child’s illness. I was honored to be a sounding board, but also emotionally drained only 12 hours in. I couldn’t sleep, so I found a quiet room where I could give myself mental rest by decreasing the amount of light and sound stimulation. Again, I realized the ability to step away from the experience of illness was a privilege.

The parents of my patients do not have that same option. I often encourage them to take breaks from the hospital to eat a meal or take a nap, but they are still in the battle with their child continuously. I hope through my regular check-ins, families feel less alone in their plight and some moments of relief.

Being caffeine-free keeps me mindful of my limits. I learned to recognize the peaks and dips in my alertness, noticing when I need to sleep or to step away for a minute. I have learned to conserve energy early in the day by muting my extroverted personality, so I don’t run out by the following morning. My brain does not have the capacity to focus on late-night teaching sessions, and I let my supervisors know without fear of seeming dumb or weak. My go-to joke: “I can’t answer questions after midnight.”

As a resident, I perform some incredible and intense tasks, like being the first person to respond to the room of a sick child and translate years of medical education into a solution to life-threatening problems in a matter of seconds. The weight of that responsibility can feel heroic, even “superhuman.”

Being caffeine-free keeps me humble — it allows me to embrace my humanity and give myself grace. I cannot be perfect. I have made clinical mistakes. I cannot be stoic. I cry when a patient dies and devour a pint of ice cream after a bad day. I cannot stay up forever and be functional. I too need sleep.

I am not a superhero, regardless of the extraordinary demands that residency requires and the strength my friends and family admire. I actually hate being sleep-deprived. It makes me cranky and hungry. I’m not pre-conditioned to better tolerate long hours than my friends outside of medicine. Yet, I completed 48 24-plus-hour shifts and countless nights because pediatrics is how I can best impact child health. This rigorous schedule is a part of the process.

One of my attendings commented about my caffeine-free residency, “It’s like natural childbirth.” I laughed, “I guess so, but when that time comes, I’ll take the epidural.”

Rebekah Fenton is a pediatric resident.

Image credit: Shutterstock.com

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