The glory of sleep deprivation

Nostalgia. I could feel it in my bones as I read Work hours, sleep deprivation, and fatigue: A British Columbia snapshot (BCMJ 2007;49:387-392), and remembered with pride how we used to work ourselves to a frazzle, as if charging up the beach at Normandy against unrelenting odds, we could do it. In the good old days, hard, long work hours were a trial of pride, a chance to prove oneself. I remember one 1965 Easter long weekend at VGH when everyone signed off to me, the junior intern for obstetrics. For the next 80 hours straight, I never left the case room, with nurses pulling down my mask at unannounced times to pop a straw of chocolate milkshake into my mouth. Every delivery that weekend was mine. I was lucky; they all went well. After a while you get pretty good at functioning on rote, with absolutely no short-term memory at all. When the sun rose on Tuesday morning, the senior resident arrived to find me still standing. “Go to bed,” he ordered. On my way to my residence hovel, I had visions of my bed dancing in my mind, and the next thing I saw was a group of worried medical staff standing over me in the hall. I’d fallen to sleep and tumbled to the floor while walking to my room. I happily fell asleep while two hulks dragged my flaccid body into my room and dropped me on the bed; at least that is what someone told me they did.

For a while, I was the jealous talk of the resident staff, “Did you hear...?” That sort of nonsense was the expected norm in those days; there were no limits to an intern’s endurance! It was also the incident that prompted the senior staff at VGH to reassess weekend call policy, and the potential for incompetent acts by sleep-deprived interns and residents. The current snapshot by Fok and colleagues shows that some sense has enveloped the scene, with about 80 hours per week being the average, but definitely not 80 hours per weekend. Thank God for the nostalgia of the good old days, but thank God we don’t have to relive it.

—Murray Allen, MD
North Vancouver