22 February 2011

Zionism (originally 16 February 2011)

In 1984 Libby Zion, a teenager in New York, died shortly after being admitted to the hospital. The doctors who cared for her that night were overextended and likely overtired. Libby's father was angered by the possibility that his daughter's death might have been prevented had staffing at the hospital been different. The media coverage and ensuing court case were the impetus behind New York State's Bell Commission Report, which as of 1989 would regulate resident work hours for the very first time.

Residents would be allowed to work for no more than 80 hours a week and 30 hours at a time. No longer allowed were the afternoon clinics that might stretch to 7 or 8 on the day after you got up and came to work. The ACGME (American College of Graduate Medical Education) enacted similar reforms nationwide in 2003. By the time I was an intern in 2006 the system was still riddled with kinks, but it was widely accepted. On non-call days I came into the hospital to pre-round at 6 or 6:30 and stayed (ideally) until 5 or 6. Every fourth day I would come to work, then work overnight, then go home the next day at around 1pm. Weekends were the same.

My final year in residency my parents and my in laws still did not understand this. Monday: work. Tuesday: work. Wednesday: work until Thursday. Friday: work again.

I don't do this any more. I don't do anything close. But walking the floors of the hospital today, avoiding the bizarre robots that wheel themselves along the halls moving paper or medical records from place to place, I am still tired. I am tired enough to wonder how my friends who are still residents and those young doctors in our training program whom I've never met, I wonder how they are surviving.

I've run into a few still-resident friends today and they all have smiles on their faces. So I don't think those years are as bleak as I sometimes remember them being. But still they are hard. I had to write a book to wrap my head around how hard and even so I don't have it entirely figured out.

For those of you with children or brothers or sisters or friends or husbands or wives who are doing their residency training right now, remember it's not their fault they've forgotten about you. There were times when I was so tired I couldn't remember my own name. And also remember, it does get better. It actually gets rather wonderful.

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