Come sweet slumber, and shroud me in thy purple scrubs: Sleep deprivation is doing weird things to the brain of pediatrics intern KIMBERLY NOBLE.
"Hellooo?" I called into the darkness.
A man came rushing in.
"Has the baby gotten her albuterol treatment yet?" I asked.
After a pause, he asked me if someone had asthma.
I stared at him for a few seconds. What was wrong with this guy? Why did my fellow pediatrics resident not know about our patient? Why was he standing there, grinning goofily at me?
Slowly, I realized I was looking at my husband, who's not a doctor at all. I was not in the hospital -- I was in my own bed, at home. I squinted, mumbled something, and then rolled over and went back to sleep.
Now, I've never been one to talk in my sleep. But several months into my pediatrics internship -- the first of three years of my residency training -- I've found that sleep deprivation is doing weird things to my brain.
After a couple of particularly bad nights on-call -- where I might get an hour or less of sleep in the "call room" -- I tend to be more emotional, getting tearful when, say, "Desperate Housewives" is a rerun. I've also noticed that my memory is worse than it used to be -- I forget that I've already told my sister a story until I'm halfway through the second time around.
But sleep deprivation has had the strangest effects on my brain, by far, when it's trying to make up for the lost sleep.
Most days I get to work at 6 a.m., which means I go to bed much earlier than my normal-scheduled husband does. And for whatever reason, those couple of hours when he's still watching TV seem to cue my brain to hallucinate about babies and their asthma meds.
And then there was the time I awoke in the middle of the night, horrified to find myself in no way appropriately dressed for work. What would I do if the other intern on call came into the call room and found me in my pajamas? Stealthily, I crept out of bed, tiptoed across the room and put on scrubs.
At least, I thought they were scrubs.
A few hours later, when my husband crawled into what turned out to be our bed at home, he asked, "Um, why are you wearing street clothes?" Once again, I was in my apartment, not on call at the hospital. And apparently in my haze I had put on jeans and a sweater.
Plenty has been written on the detrimental effects of sleep deprivation on cognitive performance. It's why pilots have limitations on the number of hours in a row they can fly, and why educators encourage college kids to study in short bursts rather than pulling an all-nighter right before an exam.
In most U.S. hospitals, residents are supposed to be limited to a 30-hour workday -- something like 6 a.m. one day until noon the next -- and an average of an 80-hour week. (In New York, where I'm a resident, the in-a-row limit is 27 hours.)
Believe it or not, before these rules were implemented by the Accreditation Council for Graduate Medical Education in 2003, residents used to work all day, through the night and then through the next day.
Still, 30 (or even 27) hours is an awfully long time to be at work, especially when your work involves taking responsibility for other people's health.
Luckily for my patients (if not for my husband), at least in my case, the effects have been most noticeable at home. To my knowledge, I haven't yet made any mistakes at work that have hurt someone. But when you consider all the residents in all the training programs around the country -- and all the patients they take care of in the middle of the night -- it seems that medical errors are inevitable.
To be fair, there's no simple solution -- If you get rid of the long hours, patients get handed off from doctor to doctor more frequently, which can be bad for patient care.
Some residency programs have taken other approaches -- such as introducing a rotating, 12-hour overnight shift -- but most programs, including mine, have stuck with traditional on-call systems.
So at least for now, I'll be trying to squeeze in as much sleep as I can when I'm home, and doing my best to maintain a high performance level when I'm in the hospital.
And my husband will have to deal with occasionally getting paged from the living room.
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asap contributor Kimberly G. Noble, MD, PhD, is a pediatrics resident at Columbia University's Morgan Stanley Children's Hospital of New York.
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