“Build me a son, O Lord, who will be strong enough to know when he is weak, and brave enough to face himself when he is afraid, one who will be proud and unbending in honest defeat, and humble and gentle in victory.” ~Douglas MacArthur
I trained prior to the 80 hour work week. I remember my first week of orientation. All of the interns went through all of the initial paper work and getting acquainted with the hospital. It was a great week. We met all the previous year interns. Life was good. I was finally out of medical school; I could finally officially call myself doctor. It was all good until the evening prior to our official first day. We went into a room and the previous years interns came into the room with the new chief surgery residents. We had been all well rested and most of us tanned from our month of relaxing and celebrating our graduation from medical school and matching into our residency program. We watched the previous years interns walk to the front of the room. They were all pale from the lack of sun; black circles were under their eyes. They looked tired. They proceeded to go through what needed to be done, what a normal day was like, how not to get into trouble, some basic survival tactics. But, there was only one thing that stuck out in my mind. It was this one statement, "Don't quit in February." That scared me, as well as many of the other baby faced new medical grads, half to death.
It was a tough year. There were months of every other night call. Times were time I took days of in house call in a row to get a full weekend off. It was hard. We could sleep anywhere. My wife still teases me and my friends about it today. She still tells people about the time my friends and I were all sleeping sitting up in a restaurant; or the time I was answering the alarm clock instead of the phone. At the time, I thought it was awful. When I look back at that period in my life, it was one of the best years in my life. My fellow interns are still some of my best friends to this day. Regardless of our specialty, general surgery, neurosurgery, urology, orthopaedics, ENT, and plastics, we all had gone through the same aches and pains, and it made us closer.
In the military, there are values that instilled into each soldier. These are things that are driven into every soldier in basic training and important ultimately for the development of that soldier into a leader. They are put though grueling tasks made to do many things that most of which seems senseless. But, over time, they develop a sense of:
- Loyalty - a faithful adherence to a person or unit
- Duty - a moral obligation to accomplish all assigned or implied tasks to the fullest of you ability
- Respect - treating other with consideration and honor
- Selfless-service - placing your personal duty before your personal desires
- Honor - being honest with one's self and being truthful and sincere in all of our actions
- Integrity - adhering to a code of moral and ethical principles
- Personal Courage - overcoming fears while doing what is right even if unpopular
The 80 hour work week has change the attitude of the "New breed" of resident. It has created shift workers. Once their time is up, they are gone. Lost is the sense of loyalty, duty, and selfless-service. Character traits that are I feel are essential when taking care of patients. Getting the work done no matter what it takes and not leaving it up to others. It is your patient, complete the task. Today's resident is more likely to pass over a case that they admitted to go home rather than stay to see the interesting case. It is not their fault; and I am in favor of the work hour restrictions. It is the implementation with which I have a problem. It has helped change the face of American residency as did the insurance companies rules on number of hospitals days allowed. But, remember the back lash from the woman forced out less than 24 hours after delivering their baby?
Residents need time for study. They need rest. They need a life. They need camaraderie. The question I have now is how do we teach them to complete the care of patients and not hand it off? There is no one that scrubs me out of a case. How can we train to have more stamina for the long days? When you are in practice, if you are up all night, will you cancel you next days cases or clinic? These are questions I think many people have. When the 80 hour/weekers graduate and come to your practice, will they leave work left undone because it's "not their shift?" Or, will they step up and do what is best for the team and group? This will be seen in the coming years. For now, I will keep working on trying to instill the values that were given to me in that year of internship and my army training; and I will hope some of that rubs off on our new physicians.
“The trick is in what one emphasizes. We either make ourselves miserable, or we make ourselves happy. The amount of work is the same." ~Carlos Castaneda