dr.102 “Even though I wasn’t actively doing harm,…I was praying that the patient would die.”
DR. 102
“I felt terrible about myself because I took an oath, a Hippocratic Oath to do no harm”
Dr. 102 is a specialty surgeon at a large private practice in a metropolitan area. The events of this story took place prior to the Accreditation Council for Graduate Medical Education (ACGME) rule limiting work hours to a maximum of eighty hours per week. This interview has been edited and condensed to create the following story. Enduring Caduceus commentary immediately follows.
I worked in a lab after I graduated from college, but the job wasn’t people-oriented enough. I was making better friends with hamsters than with humans. This became a problem after about two years.
Meanwhile, I would visit my brother, who was in medical school, and sit in on his classes. The material was really intriguing, and I knew this was a field where I’d get to help people. At the time, my career was at a standstill, so I decided to go for it and apply to medical school.
I had an undergraduate degree in chemistry, so I knew it wouldn't take long to catch up on the prerequisites, take the MCAT, and apply. A lot of my friends, and even my brother, felt a calling to medicine.
My brother knew he wanted to be a doctor when he was a kid. He was a healer right out of the gate—always the guy who’s helping people and trying to fix situations for friends. For me, it was more of: this is interesting, it sounds like a better career, I'm at a standstill, I'm going to switch to medicine.
I had a few personally traumatic experiences throughout my third year of medical school, but this one happened while I was on-call during the trauma rotation.
Being on-call for trauma meant surviving off an hour of sleep. I remember working 126 hours one week and thinking, ‘how are there even that many hours in a week?’ You don't even realize that there are. That's three times the normal workweek for a typical human being.
After being up all day and most of the night, you feel exhausted with entire-body pain and everything, including your brain, is tired. Every time you try to close your eyes and fall asleep in the on-call room, the beeper goes off.
Your first inclination is to take the beeper and chuck it out the window, break it into a million pieces. But it's the ER calling, and that means somebody's coming in. You're on the trauma team so you have to run down as fast as you can to do the primary and secondary surveys.
“After being up all day and most of the night, you feel exhausted with entire-body pain and everything, including your brain, is tired. Every time you try to close your eyes and fall asleep in the on-call room, the beeper goes off. ”
But you're disgusting: you haven’t brushed your teeth; your hair is like a pile of moss; your contacts burn; your eyeballs are red and irritated; and you can't see. It's a nightmare, but you go down anyway and deal with the patient.
You spend hours trying to figure out what you're looking at with barely any sleep: Is this a tid fib fracture? Are they stable? Are they going off to surgery?
You do your best and finally the resident says, “Okay, you've done enough, go back to the on-call room and we'll see you later.” Relieved, you go back upstairs and lie down.
After closing your eyes for only a few moments, the beeper goes off again. And now, you're just mad. You have all these feelings boiling up inside and everything in your body tells you to be angry.
I remember this happened to me one night. I sat there on the edge of my on-call bed and I prayed to God saying, “Can you just let this person die so I don't have to go downstairs and deal with this trauma right now? I just can't take it; I’m tired; I can't handle it.”
Then it hit me: I just prayed that somebody's loved one would pass away because I'm too tired to handle going down there to do my job. I felt terrible about myself because I took an oath, a Hippocratic Oath to do no harm.
And even though I wasn’t actively doing harm, like killing the patient with my own hands, I was praying that the patient would die. I immediately felt depressed. I was sleep deprived, my anxiety levels were high, and I became so overwhelmed that I had to call my brother.
“Then it hit me: I just prayed that somebody’s loved one would pass away because I’m too tired to handle going down there to do my job. I felt terrible about myself because I took an oath, a Hippocratic Oath to do no harm.”
He told me that the exact same thing happened to him. He was on-call doing cardiology and every time there was a STEMI, he would have to go down to evaluate the patient, then go to the cath lab and run all the tests. Back and forth. Back and forth. Back and forth, all night.
When the next patient came in with the same thing, he thought, ‘I hope this patient doesn’t need to go to cath’. A few minutes later, he got a call saying the patient had expired.
My brother told me that he felt relief. I don’t think he prayed like me. He didn’t take it to that extreme. But he remembers being relieved that he didn't have to get out of bed to go to the cath lab and deal with a patient.
Hearing this made me feel better, then worse. I felt better because even my brother, with the spirit of Mother Theresa in his body, felt relief that somebody died.
But then I thought, why did that make me feel better? It should make me feel worse that my saint of a brother felt relief at the death of somebody’s loved one. It’s so messed up.
I remember reading The House of God as a first-year medical student. Thank God I read it because there were moments in that book that I couldn’t believe happened behind closed doors in medicine. It helps to know there are other people out there experiencing what I’m experiencing.
My words of wisdom would be: you're never alone. Reach out and let people know how you're feeling. You will find the support if you voice how you feel.
Enduring Caduceus Commentary
Sleep deprivation has been used around the world and throughout history as a form of torture and a means for interrogation (also called an enhanced-interrogation technique).
Even though medical students and residents aren’t kept awake for 180 hours at a time with their hands shackled above their heads, the sleep deprivation we experience still affects our mental and physical health.
There is evidence showing long work hours put medical trainees as well as patients at risk.
During our interview, Dr. 102 recalled being initially angry when the ACGME reduced work hours to eighty maximum per week with no more than thirty hours allowed in a row, and no more than every third night on-call.
“I had to deal with all that and they should have to deal with it too,” was Dr. 102’s initial reaction, referring to the extremely long work hours endured in medical school and internship.
Unfortunately, this way of thinking perpetuates many problems in medical culture. But then Dr. 102 told me that, “Nobody should have to deal with it.”
After hearing stories of friends getting burned out, doing stupid things, and having terrible thoughts because of unimaginable work hours, Dr. 102 realized this is where the depression and anxiety comes in.
According to the ACGME website, “Long hours are a component of medical residency and preparation for an occupation that requires hard work and dedication.”
I’m sure most doctors and doctors-in-training recognize that medical school and residency require very hard work. But I don’t think we expected that the toll might bring out the worst in ourselves. I certainly didn’t.