July 3, 2020

by drplasticpicker

The medical training process can be brutal. Even in pediatrics after the 80-hour-work-week restrictions and in a more “benign” supportive program, it was hard. I think all of us tend to forget as we get older and are professionally and financially and psychologically in safer places. I wrote this post about the culture of bullying in medicine and physician burnout, which I thought was decent https://drplasticpicker.com/stop-physician-burn-out-there-is-no-house-of-god/. The other byproduct of being a doctor is that I’ve fallen asleep in odd places.

As a child I was not sleep deprived. My parents did not have a lot of material wealth from early childhood until my teenage years, but they had common sense and a wealth of generations of parenting wisdom. They made sure I slept. In college I was not sleep deprived. I was one of the few students at Crimson University and Hufflepuff House to actually wake up most mornings and have breakfast in the dining hall. I was usually alone with the kind dining hall staff. Then I remember interviewing at Johns Hopkins Medical School by a female otolarygologist. Now I realize that back then there were few female surgeons and probably she was a mother as well, with those additional time pressures. But I sat there is my navy blue skirt suit and low heel black pumps ready for my interview. And the female otolarygologist was intermittently falling asleep during my interview. She would wake up enough to answer a question, and I would start to answer. And then the poor woman would nod off intermittently. I would stop my answer, and then just continue when she was awake. It was the oddest experience. At some point we concluded the interview. I was polite and thanked her. I did tell my premed advisor when I returned to Hufflepuff House but no one else. I was admitted to Johns Hopkins Medical School, but chose to attend Crimson Medical School because Mr. Plastic Picker was already a student there.

The first two years of medical school I slept fine. The classes were actually pass/fail to reduce the perceived stress that students were under. Now into my 40s, I appreciated that decision. Even taking the various licensing exams, I always slept fine because I’ve always known how to pace myself and regulate my body. Then I started what was six years of medical training and falling asleep in odd places.

I vividly remember the first day of our general surgery clerkship in our third year of medical school. Both Mr. Plastic Picker and I knew we did not want to go into a surgical specialty, and it made sense to do that rotation first. You actually learn a lot in general surgery and it was a good decision. You learn how to write notes, how to pre-round, wound care, and how to suture. That is the one rotation we actually did together with 30 other students in our class at Boston’s Wonderful Hospital (BWH). But what I remember vividly is the clerkship director, who was a general surgeon, handing us our first pager and telling us where the medical student call room was. It was next to some sort of storage unit, airless and utilitarian. He told us we would unlikely be using it that much, but that is where it was and to try to get sleep when we could. I am not sure how as a 23-years-old that I had made it all through college, the medical school admissions process and two years of preclinical studies in medical school and not know that doctors slept in the hospitals. I was shocked. I remember that is the one time I asked a question in our large medical student group, “You mean we have to sleep here?” The other students and the clerkship director just looked at me oddly. Indeed the rotation was the beginning of mostly sleeping in various hospitals every 3-4 night for the next six years.

The pediatric call rooms at Mans Greatest Hospital (MGH) where I trained on the inpatient pediatric floors were the best. We had views that overlooked the Charles River. There was a shower that I used a decent amount, and we actually had a Night Float Junior resident that took admissions after 10pm so we did get sleep. I remember retreating to that call room to collect my thoughts before morning rounds. I remember Dr. Young-Ho Yoon sleeping in the senior call room next door, and somehow in the morning he had enough willpower to change into nice clinic clothes before morning conference. I remember being pregnant and sleeping in those call rooms, and also pumping breastmilk in between conferences.

During NICU rotations as an intern and junior/senior resident, the call rooms were very far away. I slept half sitting up with two conference chairs pushed together. Sometimes I slept under the long table that housed a bank of three computers by making a bed for myself. It was kind of gross sometimes because the resident bathroom was very close by. Mostly in the NICU and PICU, I slept sitting up with my face burried into my folded arms in the conference room or on the conference room floor. I would wake up sometimes with horrendous abdominal pain. I figured it was the pediatric resident version of gas pains. During the ED rotations when the ED quieted sometime between 1am – 5am, I just slept in one of the empty patient bays. I made sure to bring the guard rails up and that was really a glorious place to sleep. There were also unlimited saltine crackers and gingerale nearby. What else could a pregnant 26-year-old ask for?

My mom once asked me if it ever scared me to sleep where people have died. My mother most of her life has been a stay-at-home mom and she wanted to me to be a doctor yet she adhors sickness. I told her once that in third-year of medical school during my internal medicine rotation that one of our patients died and they took the body away. Environmental services cleaned the room relatively quickly, and there were now two clean beds near the patients to sleep and we didn’t expect any more admissions that night. The night-shift nurses told us it was okay, and the intern and I grabbed those two beds and blissfully slept a few hours before the chaotic morning rounds. We had just spent most of the evening taking turns manually disimpacted a very wealthy patient who was helicoptered in from Martha’s Vineyard. He had ankylosing spondylisis and had imminent colonic perforation from fecal impaction. We saved the surgeons from having to do an emergency surgery as we worked all night on this poor man. I couldn’t get the smell of the stool off for weeks afterwards, despite wearing full protection. But that night, we felt we deserved to sleep for a few hours in those comfortable beds of a different patient that had recently died because we had saved another patient.

And yesterday I fell asleep in another odd place. I’ve been mostly sleeping in my own bed for the last twelve years. Now my sleep has mostly been restful especially since litter picking and getting more exercise. But yesterday I had worked an almost full day in clinic, but had to take some time to walk over to radiology for my diagnostic breast ultrasound. I was supposed to get the 6-month-follow up in March but it was cancelled due to COVID-19. So yesterday, I kept my double-mask and faceshield on and checked it as a patient into the radiology suite. The mammography and ultrasound techs were very kind, and I think they appreciated me keeping on my somewhat elaborate facial protections. I know I present a risk to them because I have been working these last four months seeing patients throughout. Diaognostic mammograms are painful, and as I stood there and the mammogram tech positions my breasts in odd positions and the machine squeezed – I wanted to vomit and I felt very faint. It probably did not help that I was wearing my facial coverings. But she finished and led me to the ultrasound suite. And there the nice ultrasound tech had me lay on the very comfortable ultrasound bed and I was laying supine. She put on very warm and soothing ultrasound jelly on my left upper quadrant of my breast and began pressing on the area of interest. Intermittently between her finishing her work and then waiting for the breast radiologist to come give me my results, I fell asleep on the very comfortable ultrasound chair.

I woke up when the radiologist came in. She is a colleague of Mr. Plastic Picker’s and asked me how the children were doing and we chatted about life as well. She gave me the good news that it looks like a benign 5mm lesion and that we would just follow along every 6 months. But the entire time she was talking, I was thinking of all the odd places that I have fallen asleep through my medical training process.