30-hour day

I have not written much lately.  I have not done much of anything except work.

As part of my emergency medicine residency, I am required to complete two months of training at the University of Maryland Shock Trauma Center in Baltimore.  I enjoy being back in the city of my graduate school days, but the schedule at Shock is absurd: 80+ hours per week and call shifts in which I remain awake at the hospital–making critical life or death decisions about patient care–for 30 hours straight.  It is brutal.  It is unhealthy for residents.  It is unsafe for patients.  Yet, the culture is one of “It has always been this way.”  That doesn’t mean it should stay this way.

I tell every patient, and am now telling you, that I have often been awake for more than 24 hours when I am trying to figure out how to save a person’s life.  My brain is so tired, I frequently have trouble speaking clearly.  Patients are universally, and justifiably, appalled by this information.  I hope the reader need not require hospitalization, but if you do, ask your doctor for how long she or he has been working on shift.  The answer may not be a comforting one.

Upwards of 250,000 Americans die every year from medical errors.  The medieval, ridiculous, dangerous culture surrounding physician work hours surely is a part of the problem.  Physicians apparently refuse to heal themselves, so it’s up to readers and patients to demand change, to demand well-rested doctors, and to demand oversight and penalties for renegade providers and institutions that push physicians beyond all reason and margins of safety.

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Russell

Our family cat Russell died this week.  He was eighteen years old.

My brother and I adopted Rus from a city animal shelter in the aftermath of the May 3rd 1999 tornado in Oklahoma City.  At the time, we were 9 and 12 years old, respectively.  Russ was three weeks old.  Over the ensuing two decades, we three boys grew up together.

When we adopted him, Rus weighed less than a pound and didn’t know how to drink water from a bowl.  My brother and I took turns dipping our fingers in water and letting Rus lick the drops.  For the remainder of his life, he “drank” by putting his paws in the water bowl and then licking them dry.  We build giant Lego houses for him in our bedroom.  We dressed him up as the Pope for one Halloween.  He was the reliable constant during our turbulent adolescent years.  He was fearless, intelligent, and fiercely loyal to his two boys.  He once chased a neighborhood kid into a bathroom because the kid had pantomimed punching my brother.  He slept in our beds at night, keeping some sort of internal schedule by which he rotated between my brother and me.  His favorite toys were rabbit foot tchotchkes.  We trained him to walk on a leash, and he loved going for long explorations outside.  He was the third son of our family.  We nicknamed him “Tubbs.”

By the time I was in medical school, Rus had developed diabetes.  Because he was otherwise healthy, we chose to treat him with insulin, and he thrived for another four wonderful years.  This week, the inexorable hand of age caught up with him, and he passed peacefully of kidney failure.  He fell asleep for the last time on his favorite blanket: a red Christmas tree skirt with white fringe.

It is hard to believe that you’re not here anymore, Russell; you were a constant for so many years.  I know you loved us as much as we loved you.  Thank you for everything.

I’ll miss you, Tubbs.