Ask the right question

July 10, 2009 at 12:36 am | Posted in Uncategorized | Leave a comment

I survived my first call.   There was one death on the service, an assault victim-turned-homicide for whom there was nothing we could have done.  And one ICU transfer that I’m not entirely sure was inevitable.  As far as I can tell, the rest of the patients were not worse off in the morning for the decisions I’d made overnight, although there were a couple of instances where I wasn’t able to defend myself adequately when put on the spot, though that doesn’t necessarily mean I was wrong.  The number of consults was about what you’d see on a light night in Seattle, but the process is far less streamlined here, so it seemed like a lot more work.  In fact, pretty much everything here seems take a lot more effort to get an acceptable result.

And then list is pretty long right now, which meant that there was a lot of work aside from the consults, and there were a couple of things that didn’t get done.  Which is never a happy thing to have to report in the morning.

And now I need to come up with a research project.  I was hoping that I’d be inspired by some case that came in while I was on call.  But frankly, the question that kept popping up in my head was, how many days is one’s life shortened by each overnight call?  Does it age you an extra week or so?  Or does it just feel like it ages you excessively, without actually doing so?

By far, though, the biggest surprise was how much energy I still had the next day.  I didn’t sleep, and yet physically I could have gone at least another full day.  Mentally, probably not.  But that has more to do with where I am on the learning curve with all this stuff than anything else.  In time, there’ll be fewer things I have to think my way through from scratch, and I’ll become physically exhausted well before I run out of gas mentally.

As an aside, that’s why I think hour limitations aren’t such a bad thing overall for interns, and why I don’t think they work as well for senior residents and chiefs.  People don’t usually make mistakes because of physical exhaustion.  They do so because they’re mentally exhausted.

I read recently that when asked how he would spend an hour, if that was all he had in which to come up with a way to save the world, Einstein said he would spend 55 minutes formulating the problem into a question, and only 5 minutes answering it.

Perhaps if we made that distinction between mental and physical exhaustion in our discussion of work hours vs learning vs patient safety, we might come up with better and more workable solutions for all aspects of the problem.