This is why work-hour limits are a good idea.

I worked a sixteen-hour day--or what would've been one, had I not fallen over after the fifteenth hour--the other day. We were short-staffed and overrun with complex patients, so I stayed on for the first three hours of the night shift.

And gosh, am I ever tired. Tired, and running a low-grade fever, and with the sort of general achiness and coldness that makes you feel nasty. Not nasty enough to take medicine that might cause sleepiness, dizziness, sleeplessness, seizures, spontaneous amputation of your head, or palpitations, but nasty just the same. It must've been the schedule disruption that laid me open to this bug.

I got to thinking at about 2130 (9:30 pm for the civilians) that I'd been up since 0420. I'd commuted 45 minutes in the morning and had at least that long to go home. I'd been running my ass off all day long with five patients with fairly interesting and complex problems. My last admission needed transfusions of clotting factors, the close monitoring that goes with that, and every-two-hour pulse checks on one leg. And I was exhausted.

I was so exhausted that I forgot which medications are routinely kept in our lockup. I fumble-fingered equipment and misread orders. I stared with incomprehension at a ringing phone and cursed when my beeper went off. When I did finally get home that night, about 11:30 pm, I fell straight into bed and slept for ten hours.

Which makes me wonder how the residents do it. In the past there were no limits to how long residents could work in a week. It wasn't uncommon to hear tales of 20-hour days, week after week, with a brief break or letdown in the summertime or when a resident switched to a less-demanding schedule for a bit. Now, technically, residents are limited to 80-hour work-weeks.

Some of the older attendings are grumpy about this. They say that it makes residents soft, that they never learn how things Really Are in the Medical World. For the most part, our residents--especially the ones in orthopaedics and neurosurgery--are still tired enough to occasionally sleep straight through constant paging in the call room. I've not heard them celebrating the shorter work week. I have the distinct impression that a number of 'em just keep on working, technically breaking the law, when they're supposed to be off the clock.

I still think it's a good idea to limit the amount of time somebody can or should spend taking care of sick people. For myself, I get idiotic after about fourteen hours straight, and I'm not even incising people's bellies. I shudder to think what an underslept neurosurgeon could do.

For another thing, you get emotionally exhausted as a caregiver after a certain amount of time. Most patients aren't going to confide in their doctors the way they do in their nurses, and most doctors don't have to spend twelve hours answering call bells, but the point remains: If you're caring for people, you have a responsibility to them that's gonna weigh more heavily on you during Hour 14 than it did during Hour 1. And the more Hour 14s you have under your belt, the harder it is to be responsive to another person's needs.

And finally, if you're going to be a decent caregiver, whether it's as an MD or RN or LPN or whatever, it helps to have a life. Nobody wants a robot to take care of them. Even if you can't switch easily from discussing sports to discussing opera (depending on the patient), it's nice for the patients to get the sense that you don't spend *all* your time up to your elbows in other people's guts. Gives 'em confidence.

I'm going back to bed. I'm going to wonder as I fall asleep how on earth those residents do it. And I'm going to be thankful--*very* thankful--that I can punch out at the end of twelve or fourteen or sixteen hours and go home, leaving my beeper on the desk.