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Tuesday, July 17th 2012

Asleep At The Scalpel

I once saw a surgeon tell a family that they should delay their child’s brain tumor surgery a day because the surgeon had been on call the night before and up all night with an emergency and was not at his best. It was an impressive admission and raised my level of respect for him. The family as well seemed encouraged, not skeptical, of the admission, and so the surgeon moved his cases around for the next day and pushed the brain tumor surgery back a day.

Surgeon fatigue is a difficult thing to demonstrate for publication but anecdotally is a real issue. Even with the duty hours I’ve suffered nearly the exact same story as Dr. Youn, writing on CNN.com,

Heaviness returns to my eyelids. I’m dancing on the edge of sleep. Five minutes later, I lose the battle. My head briefly bobs down, then back up.

I immediately look around. Has anyone noticed? Apparently not the surgeon.

I look at the scrub technician, sitting to my right. She nods her head at me, knowingly. Then she digs her heel into my foot. Hard.

I suppress a yelp.

I’m awake now.

Minus the heel to the foot.

Indeed, when I was a medical student, after less than 24 hours awake I suffered a microsleep while I was suppose to be driving the camera for a lap appendectomy. The scope was out of the body at the time, but the chief resident had to reach over and punch me in the shoulder and demand, “Wake up!”

But for all that, I’m not sure regulation of resident work hours are the solution. The fact of the matter is we need to know when our limits have been reached. And especially for non-urgent care we need to be honest with patients on those very rare occasions when those limits have been reached. I’ve seen it happen at least once and it is how I want to model my future practice.