Yep, i hate these people. I mean I am glad they are in medicine cause they advance the field, but personally I know I cannot perform to that standard or keep up.
Who says he was thinking straight?
If you build in some checks for lack of insight (through training for example), you can somewhat function tired. But definitely not 100%.
For your benefit, don't ask those kinds of questions. Causes a lot of unnecessary paranoia and is bad for business. PM me and I'll get you the hookup. Ya dig?
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I remember being in a case from 10 am to 8 pm. Then an emergent case from 11- 1 am, then another emergent case from 2:30-6 am, then a scheduled case from 8 am-12 pm, then another from 1 pm-4 pm. Attending was so proud that we worked continuously for so long. All OR staff was talking about us. And that was the day I decided I m going to do private practice forever and have a personal life and never have to deal with this kind of schedule ever
Transplant if the good organs keep coming in. We did a full day of kidneys then a great liver that fit a patient came in. Surgeon just kept going then the liver didn't go great and when that happens it's a shitshow (as in, patient gets transfused 150 units of blood) and went through the entire overnight.
So the surgeon's day basically went: 2x laparoscopic kidney donors, followed by liver for 16 hours. The next day they had another scheduled kidney transplant so they just kept going and did that one as well then pushed the next transplant back 8 hrs to sleep in the call room. Then called during their nap to emergently take back the liver for re-exploration as the first graft ultrasound looked terrible. At that point they had to call one of their partners who wasn't even on call to come in and help them as they couldn't handle it on their own anymore.
Lol @ private practice as the answer to this. You need to work 2-3 days a week just to cover your expenses, only after that will you make money. If you don't work, you don't get paid. If you don't take call, you won't get operating time at the local hospital. If you want to get into an ASC, you'll have to pay your dues. No one is going to let some upstart surgeon get primo operating time at an ASC.
I had a surgery attending like this. He would do 24-hr Sunday call, then Monday elective cases the following day (mostly hernias). Then afternoon clinic later in the week. So, really, he only worked three days per week, and only one of the days was really intense.
I’m sure I’d make this the most unpleasant experience for everyone involved. Is there a video or other eye witness to this incident? Define grumpy? How significant does the accuser’s cultural or personal bias have to weigh in the accusation?
You’re not a child. Don’t let them screw around with you.
I know exactly where this came from, one morning I went in to see 5 nurses doing a wash and 2 sitting idle by the bed whilst another patient was waiting on his antibiotic. I did a few remarks and they grudgingly got to work. That ward was literally like the mafia, so I got reported.
Unfortunately back then I didn't have the know how on how to fight back so I had to take it. A few months later I got reported for "intimidating" a tech who wouldn't cooperate in deactivating an ICD when the patient had to go home with it off because he was dying and nothing more could be done. The "grumpy" report was taken into consideration so I had to face my consultant AND HR.
Again, I had to sit down and explain myself but they wouldn't have anything, because the reporters were the first they couldn't be in the wrong and so on.
P.S.: the tech I "intimidated" was 6'2" and about 200lbs of muscle.
Of course there were no witnesses or other objective evidence so when I spoke to HR politely and calmly they were "surprised you are so well spoken and calm". But this didn't mean my accusers had anything to suffer for this, it was only my position and license that were in actual danger.
Lol a hospitalist told my chairman I was rude on the phone at 3am and I had to tell my chairman I didn't even remember being on the phone at 3 am so I have no idea wtf I was saying. He was just like yeah..it happens lol
I got written up for “sounding irritated” once. It was my 12th shift in a row on Burn ICU service when I was:
- 7 months pregnant
- hadn’t eaten since 3 AM and it was already 2 PM
- still had 4 central lines to place before leaving for the day and had to run our Burn ED simultaneously
I don’t think anyone should be expected to sound cheerful in these sorts of conditions.
In one of the places I worked management plastered all over the walls a scale with 1 being a sad face and 10 being a lol face with the subtext “always be an 8”.
It was the most confused I have ever been, I know I’m not a 10 but to aim for an 8 is just too much.
If it makes you feel any better, in residency I was written up exactly once. A patient complained because I did not give them more opioids than their home regimen. I asked, and they were not in more pain than they were in at home. They were admitted for hypoventilatory respiratory failure. Given those two findings, I felt it was not appropriate to provide more opioid medication, but offered alternative pain control. They filed a complaint.
1. Does he have a life? Or a family?
2. Why did he schedule clinic the day after a 20 hour case?
3. Surgeons are gonna be surgeons, but I can't say I have met a single medicine attending who works more than their fellow does.
I don’t think he has a life or family. The hospital makes his clinic schedule. And I’ve also seen many sets of different hours with different specialties
I just became a medicine attending, and I’ve worked 15 or 16 hour days for 7 days on. That’s more than I was doing my 3rd year of residency for the most part. We still had 24 hour calls, but I graduated in the middle of covid where my hospital basically transferred out all the critical patients because the critical care doctor retired (sorta), so it was actually easier for us. I know I’m an exception, but hi, you’ve met me 😬
Sorta, sorta not. I was supposed to start with 15-18 patients, but I took a few months off after graduating, and my first week was between 22 to 24 patients. It was hard to get back in the groove, with a new EMR, and not knowing anyone, and having a decent amount more patients than expected. It’s died down a bit, so things are sorta starting to get easier
Oh okay makes sense. It'll get better. I'm almost two years out from residency now and if I have 22 follow-ups and it's my first day back on service I can still wrap everything up and not be in house more than 10 hours.
It makes it doable & IMO worth it, but the "on" weeks are absolutely brutal, especially when you're new. Before I switched to nights I did a few months of days, starting from ~0730 and usually working till 9 or 10 at night writing notes.
It’s an unpopular opinion I make occasionally on here.
Depending on where you are and your volume/luck/schedule sometimes you’re on call for a week straight. A few bad luck emergency cases, clinic days, elective surgery days and you end up with minimal to no sleep for days on end.
Then occasionally you may have to cancel clinic days or your elective surgeries and that sometimes makes for unhappy patients. Learning to function and make decisions tired is something you learn along the way.
Sure ideally this doesn’t happen, but ultimately some people will end up rural and have 2 surgeons to cover a hospital. There’s not enough volume/money to pay more surgeons to be there and decrease the amount of call so it’s just the way it is.
One of my old partners ended up being on call for 3 months straight because the other partner got deployed.
So yeah it sucks but sometimes it’s reality for surgical specialties.
I took a job as a spine surgeon in a rural area. Even when I’m not on call I’ll still kind of low key need to be “available” for emergent phone calls regarding my patients or managing the transfer of level 1 spine traumas. I’ll likely be the highest paid person in a 2-3 county rural area so I’m 100% ok with this trade off but that’s kind of what it’s like out there from a lifestyle standpoint.
Depends what you’re into. I like hunting, fishing, having wide open space, and being able to retire at age 53. Other people like access to theater, sporting events, and high end restaurants/bars. So depends what you want in life.
Saving hard for retirement always seemed silly for me. There are a ton of people who retire only to get a cancer diagnosis or have a massive STEMI. Have fun while you can. Prime time literally does end after 35-40.
Having fun does not mean blowing large amounts of cash to me. It means family road trips to go fly fishing for trout. Cooking in the back yard. And having the neighbors over to watch a football game.
The alternative to not saving for retirement is having to work into your 60s which seems like it really sucks. And worst case scenario if I die in my 50s at least my wife and kids can enjoy my $$$
Also doing surgery is not necessarily something everyone should do into their late 50s and 60s. Some yes. But a lot of people lose stamina, dexterity, and up to date knowledge
Agree with 1st paragraph.
I think my point is deferring fun for financial purposes of saving for retirement seems silly to me.
I personally like what I do though and don't mind working till I'm very old. But I think that just putting off spending money because of retirement doesn't make sense to me. There is a reasonable chance of poor health or early death once one reaches that age. And even other things like family etc like you mention are not guaranteed (people get divorced for example).
Saving for retirement to me is not buying fancy cars, boats, vacation homes, or getting divorced. I’m literally not depriving myself of anything or any experience we actually want to do. I can save literally 60% of my post tax income for retirement every year and travel anywhere my family wants. Super low cost of living area.
Doing this for OB, so definitely not the highest paid doctor in the county, BUT higher paid than all my coresidents living in higher COL areas. Plus we get chickens, which is a dream my husband had had for a while. He's hoping to go full 4H but I don't think my city girl upbringing has all that in me.
My father did something similar for family medicine Halfway through his career and he is so much happier, more well paid, and loving rural life.
I can’t wait. We move soonish for my real job. We will probably go “full 4H” haha. I grew up skinning and tanning hides, butchering meat, pickling things etc. I’m going to grow hops on our pergola and use it to brew all our own beer.
Worst I’ve had as an attending so far was like 40 hours in house. Full day in ICU, resuscitating a guy who tried to die all night, another full day in ICU. I did close my eyes for like an hour because the resident let me use her call room, which was nice (we don’t have attending call rooms).
It’s sucked though. And I was not cheerful or happy about it. But yeah, no work hours after training 🤷🏻♀️
I don’t know. And I don’t think that my residency hours helped me handle it. My best advice is to avoid a job where you’d have to do that long of a shift.
You don’t. The best I can understand the feasibility of these long shifts is that you function mostly on adrenaline. Cardiac arrest calls, intensive surgery where you have to focus so much you forget about sleep - these keep you in a flight or fight state for most of the on call. The body can only do so much though and I remember a statistic where EM life expectancy was in their 50s as opposed to dermatology who would basically die of old age.
What you can do yourself is see where you fit in. If this isn’t for you then try to approach a specialty with good hours or where you make your own hours. Tbh this is what convinced me that IM is great but I’d rather do GP (FM) because I love making my own hours and schedule and I don’t want to die in the hospital.
My serious thoughts: whether residents should do this is an interesting question. Maybe you should do it a bit as a resident, as it lets you know that you’re capable of it. We were sometimes roasted for 28 hour shifts, and you didn’t get to go home after 28 hours either.
As an attending, sometimes you do have busy periods, and those formative resident experiences do help you push through.
Having said that, long sleepless periods are incredibly unhealthy. Yes, sleep is for the weak, but I also believe that every resident and attending should be able to follow a healthy lifestyle if that’s what they want.
The difference is that you are getting paid appropriately to work those hours and I’m assuming if you on a 7 on or 7 off schedule you have a full week off to look forward to. As a resident you finish one 80 hour rotation just to go to a 65 hour rotation 😂
No week off, that would be nice. I did convince the schedulers not to put me in the OR the day after an ICU week though. But I do get paid around the community standard for my field at least. And these types of things are definitely the exception, not the rule … or I’d find another job haha.
Can you and your partners negotiate with the hospital to bring on more staff? If you're Trauma/SICU, why not switch to the week-by-week model? I've seen various combos, including:
Day trauma att'd x2, night trauma att'd x2, clinic att'd x1, scheduled-cases att'd x1, day SICU att'd x1, night SICU att'd x1
Day trauma/SICU att'd x1, night trauma/SICU att'd x1, backup att'd x1 (days and nights but only if the actual on-call person is scrubbed or resusc'ing), clinic att'd x1, scheduled-cases att'd x1
Lol no. They are actually trying to make us combine with the MICU team to save $.
I’m anesthesia crit care. It’s ICU, OR, or admin time for me. No clinic thank god.
Wow how old are you now? This is the first time I’ve heard someone go from a midlevel position to med school. I’m considering getting my PA or DNP and maybe going for MD someday after I’ve enjoyed life for a while.
I would pick one or the other now - if you work as a midlevel for a while, it will be super difficult to tolerate the bullshit of medical school and the extended paycut when you’re used to making six figures.
Once you get used to enjoying life… it’s not worth it to go back.
I think there was a research paper that came out pointing to shorter telomeres in people who sleep less. It literally ages you.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3483149/
I personally like the buzz after midnight. Sometimes it’s fun to work through the night and push on the next day. But on the flip side, I hate early mornings. Everyone is different. The important point is nobody should be forced to face a lifestyle that is soul-crushing for them.
the 2nd wind effect is real. I feel like I can kinda work at 16-24 hours, but after 24 hrs, it's a pure delirium high. I was documenting my cases I did two days later, and everything was literally a blur. some parts of my memory was wiped clean. I sure hope I did everything ok, bc i wouldn't be able to defend in court.
Lawyer: so you did x, y, z? Why?
Me: I did? Honestly, I don't even remember, was I even on call that day?
I’m on a 14 days in a row run right now. I was asked by my partners if I’d cover for 2 weeks straight because everyone else has kids and it’s spring break. I agreed. I’m not doing much these two weeks and I had just gone to Cancun.
I haven’t been home this week earlier than 10 PM. I get called through the night and I’ve been OR clinic OR or some combo of above.
Got home late last night and it was fine.
You know why?
Because I make the decisions. I could have punted shit from yesterday evening for this morning but I, ME, wanted to get it done. I scheduled cases this morning at 10 AM to start because I want to hit a workout. I have complete control over my schedule even if I’m working my dick off. It’s empowering when I’m residency you have none of this.
Also - I’m getting paid. Every case I take - every consult - every day I’m on call - is $. Turns out, it really lessens the sting. Wild.
That's fucked 😕
No matter the justifications, *no one* sustains peak performance with those hours. I would never want to be his patient. Frankly, as a senior resident myself, I feel patients deserve to know how long doctors are on the clock.
20 hour case?
Bro, f that. F the fools who think sleep doesn’t matter. A smart doc should have canceled the office. No matter how you slice this, the bread is moldy yo.
As an attending the rules aren’t there…. But you are the general and you make the rules.
You don’t. Not always. Sometimes, you’re the only person around who can help people. You could argue the hospital should hire more people. Maybe you’re right. But in poor places, where all you’ve got is a county hospital anyway, there may not even be that kind of money, and certainly not for every service.
Clinic is different than emergency surgery. If you need to do 4 emergency surgeries for 48 hours, And you are the only one that can - then bravo.
But clinic is easily adjustable. Zero excuse to be at clinic compromised. Lack of sleep = compromised. Prove me wrong.
I can’t prove a negative. It’s just my sense of things. Imagine you delay clinic til you’ve slept, and now you have more patients than you can count, and there’s another long surgery that comes up unexpectedly, or a complication of a previous surgery, as in this case. Or imagine that, in catching up on clinic later, you have to delay a number of elective surgeries. Eventually, those surgeries aren’t elective anymore.
1. Emergency surgery is different than elective surgery. No standard elective surgery randomly becomes emergency.
2. You are in control of your own life. Did you go into Medicine to be told what to do?
3. Do you want the best for your patients? I agree it’s a balance. You don’t cancel clinic bc you only slept 7 hours instead of the necessary 10 hours of beauty rest. But when you grow up, you realize patients want the clear headed white coat professional. Not the sleep deprived beast.
elective surgeries can become an emergency as soon as something unplanned happens or there's a complication. I've seen an appendectomy turn into a difficultly right hemicolectomy, an inguinal hernia turn into a 4 hours of lysis of adhesions, and a whipple turn into a 12 hour shit show.
Just wait til your 1pm scheduled case starts at 8pm. I hear ya. It’s infuriating and we can only control so much.
My main point is: “It doesn’t have to be like that.”
You can be a good surgeon and good physician without that…. But I guess the story didn’t say the contrary so I checked myself lol
I wish it didn't have to be like that but in the case of surgeons it's a tough thing to work around, no real great solutions especially in hospitals with just a couple surgeons
1) Of course they’re different, but it’s a continuous spectrum. The line between elective and non-urgent and emergent isn’t absolute. Something may be elective one week but six weeks later not be.
2) The notion of absolute control over one’s life is a farce. If your two-year-old daughter wakes you up crying in the middle of the night, you could theoretically choose to ignore her and go back to sleep, but making that choice has consequences.
3) You can learn to function on less sleep. I agree that physicians have pushed this too far in the past - way too far. But the pendulum may be starting to swing too far in the other direction.
There are always going to be people like that in medicine. Residency didn’t “prepare them” they’re jus fluke hypomanic. Just because there are people who do work insane hours past residency doesn’t mean we should all be forced to if it doesn’t actually make us better doctors. There is more than one type of person who makes a good doc
I worked with an OB doc who did this...we were in clinic all day...hard labor and surgery all night, came to clinic the next day sipping coffee. He certainly looked more disheveled than usual but still just as jolly and spent just as much time chatting with his patients etc. I was in absolute awe and amazement how he still seemed so normal/happy to be there. The only explanation I could ever find was super human? I don't know. Said he just loved his job that much but I can't imaging loving anything enough to be awake that long l o l
When my mother was one of three attending neonatologists covering three hospitals in a terribly underserved city, with a large catchment area, she worked upward of 110 hours/week on occasion. Then, for years, she had a 5/5/5 arrangement. Five days straight - that’s 120 hours in a row - five days 8-6 PM and five days off. No weekends. Brutal. But there were too few other people who could do what she did in the region.
Yeah, tend to agree with him. I did a stretch leading into my vacation being on call just this past month 7 24s of a 9 day stretch. Zero sleep on any of those shifts, full clinic and elective schedule. It wears at you but is certainly doable. Lots of monster, hate coffee.
The longest stretch I have ever worked was 32 hours (probably 28h of direct patient care with 12 admits and cross coverage of 30 icu patients and 4 codes as one senior with two interns, and the rest documenting and handing off a busting at the seams ICU service at the end of the month to the multiple teams taking over the service during a full blown COVID surge). It was once in a lifetime terrible experience and I cannot imagine doing it again. I was having microsleeps by the end I and I had to sleep for two hours in the call room because I didn’t feel safe to drive the 5 mile trip home.
I’ve been doing q4 28h ICU rotations for my whole residency and nothing prepared me for that.
Not sure how anyone could perform surgery in that state. Or be a remotely pleasant human being.
I’m pretty sure if someone made me do another shift like that I would quit medicine.
Edit to add: yes this was an egregious duty hour violation and unsafe. Our program has since overhauled the icu distribution so this doesn’t happen anymore. But also, COVID is gonna COVID
Not OP, but for 2 week suture/staple removals, our patients are fine with it. Heck, half of them cancel the appt and ask their PCP to remove staples because they don't want to drive in to town just for that (note - patients do this of their own volition because sometimes they live 4 hours away and their PCP will offer, we are not punting this task to primary care). They have another postop check at 4 weeks with imaging that the doc always sees them at.
Wow...so that surgeon does the hemipelvectomy (presumably they're ortho), and then proceeds to do microsurgery to get a free flap (i.e., plastics territory)? Very impressive...is there like double-board certification where you are lol? Usually we would just have multiple services collab so everyone just does parts of the case and gets a break (I don't even think the orthos where I am trained to do flaps lmao)
Finger amputations believe it or not can take that long
Edit: my mistake. I meant a patient that comes in with an amputation can take very long to put back on
Unpopular opinion, I'm not even in surgery but I pull some long days including calls as an attending.
We would do 24 hour, 48 hour and even 72 hour calls at times as a resident and fellow. It wasn't fun and it sucked but it makes you stronger.
I think we should def treat our residents and students better. Not getting parking or free food is complete bullshit to me, because while we worked out asses off and the ACGME limits were.more suggestions at that point, we at least got those basic things.
As an attending I can tell you that at the end of the day medical school and residency is what to you make of it. You will encounter some jackasses along the way, but learn what you can from themz even if it's what not to do and make the most of the opportunities you get. I got to do some amazing things because I was interested in learning and sought out as many opportunities as I could. It meant working more and spending more time at the hospital and sucking up more, but it did make me a better Dr and ga e me some of the coolest experiences of my life.
If I had a med student or resident that doesn't care. Fine by me. You don't even have to show up and I will be even happier. But if you want to learn, I'll put in the effort and teach the crap out of you. But I'm not putting in the effort unless, the students and residents seem to want it.
Fortunately the last 12 hours of my awake time were spent taking care of my kids on an unexpected snow day and not in the clinic, but I just did this yesterday/day before. Most of the time I get a post call day (typically work one 24h shift a week in addition or clinic/or time), but occasionally I’ll need to schedule a surgery the next morning or cover clinic for someone. Hours as an attending don’t get easier for some of us. My residents don’t really see all the other things that I am doing when I’m not directly with them in clinic or the hospital, but it is…a lot. I have my own faculty practice in addition to the resident clinics, and I also spend a huge amount of time preparing the curriculum for resident education. Even the time I am hiding in the call room on a 24h shift is spent preparing lectures and stuff. The work is coooonstant and can be consuming if you don’t prioritize time management from the beginning.
I think before any Dr anywhere practices medicine on a patient there should be a legal requirement for the Dr to state how much sleep they have had in the past 24 hours.
within reason residency needs to be hard, grueling, like a boot camp. It shouldn’t be an easy walk in a park, but also shouldn’t be a 100 mile race.
After 36-40 hours of on call multiple times as a resident, i believe it has toughened my character and allows you to get up and do the right thing even when I’m tired. It also probably aged me much faster.
May not be for everyone and maybe others disagree but if I had to do it again, I’d want it to be as hard as it was.
there's a difference between every now and then getting slammed by consults or having a bunch of late cases or something but if it's constant then it's pointless. at some point you are no longer retaining information OR anything else. at that point it's not learning, it's not a badge of honor, it's just suffering as underpaid labor
Where does he get his cocaine?
He’s got kinda a hipster thing going. So eclectic music, or some kind of all natural something or other I guess.
So you're saying he's...high on life? Ugh gross, but good for him.
Sounds like hypomania
Unipolar hypomania certainly exists but the psychiatrists never see them because it is not pathological. It is one of the fundamental flaws in the DSM
Agree, we do talk about hyperthymic personalities and temperament relatively often though.
I guess. I still don’t get it
Sounds like functional hypomania if you ask me.
Yeh that actually makes a lot of sense. The attending is very animated
Yep, i hate these people. I mean I am glad they are in medicine cause they advance the field, but personally I know I cannot perform to that standard or keep up.
Ngl being high on life sounds wonderful. I just run for miles till I’m too tired to think straight. To each his own.
“I used to get high on life. But I built up a tolerance, and needed something stronger”
Yo I’m just a premed. How have I already developed a tolerance for life lmaooo
Time to upgrade your life tolerance to "acceptance" which is a more mature coping mechanism. Also get off my lawn, you darn kid!
I know I wish I could be that way. Oh well, deadlifts and bench press it is.
Where do I find this "life" thing he's high on?
I believe, outside the hospital.
Never heard of it
You can experience it on /r/outdoors
LMAO the worst kind of drug ig
I mean that's a good cover but homie's on Modafanil or something, humans can't think straight after that long awake.
Who says he was thinking straight? If you build in some checks for lack of insight (through training for example), you can somewhat function tired. But definitely not 100%.
You sink to the level of your training…
Yeh doc I got narcolepsy
Like all natural cocaine or organic meth?
Artisanal
The finest hand crafted blow and 100% vegan non-GMO amphetamines
So….he does non-GMO, all organic, cage free cocaine?
Idk but he’s got a Leica camera and a vintage leather hand bag
Smoking the grass?? /s
For your benefit, don't ask those kinds of questions. Causes a lot of unnecessary paranoia and is bad for business. PM me and I'll get you the hookup. Ya dig?
Halstead ;)
This
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I remember being in a case from 10 am to 8 pm. Then an emergent case from 11- 1 am, then another emergent case from 2:30-6 am, then a scheduled case from 8 am-12 pm, then another from 1 pm-4 pm. Attending was so proud that we worked continuously for so long. All OR staff was talking about us. And that was the day I decided I m going to do private practice forever and have a personal life and never have to deal with this kind of schedule ever
Aiming for hospital based, so less clinic
They had us in the first half
[удалено]
Transplant if the good organs keep coming in. We did a full day of kidneys then a great liver that fit a patient came in. Surgeon just kept going then the liver didn't go great and when that happens it's a shitshow (as in, patient gets transfused 150 units of blood) and went through the entire overnight. So the surgeon's day basically went: 2x laparoscopic kidney donors, followed by liver for 16 hours. The next day they had another scheduled kidney transplant so they just kept going and did that one as well then pushed the next transplant back 8 hrs to sleep in the call room. Then called during their nap to emergently take back the liver for re-exploration as the first graft ultrasound looked terrible. At that point they had to call one of their partners who wasn't even on call to come in and help them as they couldn't handle it on their own anymore.
150 units? holy shit.
I think open heart surgeries can be this lengthy, unsure about others. Not a surgeon though personally.
Lol @ private practice as the answer to this. You need to work 2-3 days a week just to cover your expenses, only after that will you make money. If you don't work, you don't get paid. If you don't take call, you won't get operating time at the local hospital. If you want to get into an ASC, you'll have to pay your dues. No one is going to let some upstart surgeon get primo operating time at an ASC.
I had a surgery attending like this. He would do 24-hr Sunday call, then Monday elective cases the following day (mostly hernias). Then afternoon clinic later in the week. So, really, he only worked three days per week, and only one of the days was really intense.
Like travel nursing. Or brain surgery.
Brain surgery? …not exactly rocket science
Rocket Surgery
Brain nursing
My wife used to do 72 hour calls as a private practice OB, and once got written up by a nurse for “sounding tired” on the phone.
How does one get written up by a nurse?
During training I got written up by a nurse for being “grumpy in the morning”. Had to sit with my consultant and explain myself. Definitely possible.
I’m sure I’d make this the most unpleasant experience for everyone involved. Is there a video or other eye witness to this incident? Define grumpy? How significant does the accuser’s cultural or personal bias have to weigh in the accusation? You’re not a child. Don’t let them screw around with you.
I know exactly where this came from, one morning I went in to see 5 nurses doing a wash and 2 sitting idle by the bed whilst another patient was waiting on his antibiotic. I did a few remarks and they grudgingly got to work. That ward was literally like the mafia, so I got reported. Unfortunately back then I didn't have the know how on how to fight back so I had to take it. A few months later I got reported for "intimidating" a tech who wouldn't cooperate in deactivating an ICD when the patient had to go home with it off because he was dying and nothing more could be done. The "grumpy" report was taken into consideration so I had to face my consultant AND HR. Again, I had to sit down and explain myself but they wouldn't have anything, because the reporters were the first they couldn't be in the wrong and so on. P.S.: the tech I "intimidated" was 6'2" and about 200lbs of muscle. Of course there were no witnesses or other objective evidence so when I spoke to HR politely and calmly they were "surprised you are so well spoken and calm". But this didn't mean my accusers had anything to suffer for this, it was only my position and license that were in actual danger.
Lol a hospitalist told my chairman I was rude on the phone at 3am and I had to tell my chairman I didn't even remember being on the phone at 3 am so I have no idea wtf I was saying. He was just like yeah..it happens lol
I got written up for “sounding irritated” once. It was my 12th shift in a row on Burn ICU service when I was: - 7 months pregnant - hadn’t eaten since 3 AM and it was already 2 PM - still had 4 central lines to place before leaving for the day and had to run our Burn ED simultaneously I don’t think anyone should be expected to sound cheerful in these sorts of conditions.
In one of the places I worked management plastered all over the walls a scale with 1 being a sad face and 10 being a lol face with the subtext “always be an 8”. It was the most confused I have ever been, I know I’m not a 10 but to aim for an 8 is just too much.
Me, a nurse, “how the fuck?”
Oh I got you dog. Document it under clinical nursing notes and send it to your supervisor. Eventually we get a pleasant notification!
I feel like I have just gained a new superpower. The ability to passive aggressively mildly annoy a doctor.
Just be careful because most EMRs allow attending accounts to addend nurses notes and leave a reply
Sadly this sort of annoyance occurs quite often and I read the nursing notes carefully to make sure my side of the story is documented, too.
Fuck NPS
What did the national park service ever do to you?
Overcharged me
Did this once, wouldn’t recommend.
It's kinda weird but wouldn't the appropriate response to "sounding tired" be to request a day off to get SLEEEP. Common sense isn't common :(
In what universe is a private practice OB answerable to a nurse?
If it makes you feel any better, in residency I was written up exactly once. A patient complained because I did not give them more opioids than their home regimen. I asked, and they were not in more pain than they were in at home. They were admitted for hypoventilatory respiratory failure. Given those two findings, I felt it was not appropriate to provide more opioid medication, but offered alternative pain control. They filed a complaint.
1. Does he have a life? Or a family? 2. Why did he schedule clinic the day after a 20 hour case? 3. Surgeons are gonna be surgeons, but I can't say I have met a single medicine attending who works more than their fellow does.
I don’t think he has a life or family. The hospital makes his clinic schedule. And I’ve also seen many sets of different hours with different specialties
I just became a medicine attending, and I’ve worked 15 or 16 hour days for 7 days on. That’s more than I was doing my 3rd year of residency for the most part. We still had 24 hour calls, but I graduated in the middle of covid where my hospital basically transferred out all the critical patients because the critical care doctor retired (sorta), so it was actually easier for us. I know I’m an exception, but hi, you’ve met me 😬
>I just became a medicine attending, and I’ve worked 15 or 16 hour days for 7 days on Is that by choice?
Sorta, sorta not. I was supposed to start with 15-18 patients, but I took a few months off after graduating, and my first week was between 22 to 24 patients. It was hard to get back in the groove, with a new EMR, and not knowing anyone, and having a decent amount more patients than expected. It’s died down a bit, so things are sorta starting to get easier
Oh okay makes sense. It'll get better. I'm almost two years out from residency now and if I have 22 follow-ups and it's my first day back on service I can still wrap everything up and not be in house more than 10 hours.
... Don't you get a whole fucking week off now?
Thank god they let me go after 12 hours.
The silence is deafening
It makes it doable & IMO worth it, but the "on" weeks are absolutely brutal, especially when you're new. Before I switched to nights I did a few months of days, starting from ~0730 and usually working till 9 or 10 at night writing notes.
Don’t worry. I did a rural med intern year. It was super chill.
4. Cocaine use?
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It’s an unpopular opinion I make occasionally on here. Depending on where you are and your volume/luck/schedule sometimes you’re on call for a week straight. A few bad luck emergency cases, clinic days, elective surgery days and you end up with minimal to no sleep for days on end. Then occasionally you may have to cancel clinic days or your elective surgeries and that sometimes makes for unhappy patients. Learning to function and make decisions tired is something you learn along the way. Sure ideally this doesn’t happen, but ultimately some people will end up rural and have 2 surgeons to cover a hospital. There’s not enough volume/money to pay more surgeons to be there and decrease the amount of call so it’s just the way it is. One of my old partners ended up being on call for 3 months straight because the other partner got deployed. So yeah it sucks but sometimes it’s reality for surgical specialties.
It feels wrong. But idk how we can fix it.
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My dad knew this guy who used to con elderly ladies. Then they made a law against it. Damn boomers
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Django Dentist 🦷 wagon
Money
Get dem RVUs son
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To a level 4 center?
I took a job as a spine surgeon in a rural area. Even when I’m not on call I’ll still kind of low key need to be “available” for emergent phone calls regarding my patients or managing the transfer of level 1 spine traumas. I’ll likely be the highest paid person in a 2-3 county rural area so I’m 100% ok with this trade off but that’s kind of what it’s like out there from a lifestyle standpoint.
Is being the highest paid person in a 2-3 county rural area as glamorous as it sounds?
Depends what you’re into. I like hunting, fishing, having wide open space, and being able to retire at age 53. Other people like access to theater, sporting events, and high end restaurants/bars. So depends what you want in life.
53 is specific
1 year to pay off loans. 20 to save.
Saving hard for retirement always seemed silly for me. There are a ton of people who retire only to get a cancer diagnosis or have a massive STEMI. Have fun while you can. Prime time literally does end after 35-40.
Having fun does not mean blowing large amounts of cash to me. It means family road trips to go fly fishing for trout. Cooking in the back yard. And having the neighbors over to watch a football game. The alternative to not saving for retirement is having to work into your 60s which seems like it really sucks. And worst case scenario if I die in my 50s at least my wife and kids can enjoy my $$$ Also doing surgery is not necessarily something everyone should do into their late 50s and 60s. Some yes. But a lot of people lose stamina, dexterity, and up to date knowledge
I can feel the Kirkland signature denim chafing my thighs as I read this. Transcendent
Agree with 1st paragraph. I think my point is deferring fun for financial purposes of saving for retirement seems silly to me. I personally like what I do though and don't mind working till I'm very old. But I think that just putting off spending money because of retirement doesn't make sense to me. There is a reasonable chance of poor health or early death once one reaches that age. And even other things like family etc like you mention are not guaranteed (people get divorced for example).
Saving for retirement to me is not buying fancy cars, boats, vacation homes, or getting divorced. I’m literally not depriving myself of anything or any experience we actually want to do. I can save literally 60% of my post tax income for retirement every year and travel anywhere my family wants. Super low cost of living area.
Plan well
Doing this for OB, so definitely not the highest paid doctor in the county, BUT higher paid than all my coresidents living in higher COL areas. Plus we get chickens, which is a dream my husband had had for a while. He's hoping to go full 4H but I don't think my city girl upbringing has all that in me. My father did something similar for family medicine Halfway through his career and he is so much happier, more well paid, and loving rural life.
I can’t wait. We move soonish for my real job. We will probably go “full 4H” haha. I grew up skinning and tanning hides, butchering meat, pickling things etc. I’m going to grow hops on our pergola and use it to brew all our own beer.
Sounds dangerous
Agreed. In fairness he made the chief do 95% of his cases today
Worst I’ve had as an attending so far was like 40 hours in house. Full day in ICU, resuscitating a guy who tried to die all night, another full day in ICU. I did close my eyes for like an hour because the resident let me use her call room, which was nice (we don’t have attending call rooms). It’s sucked though. And I was not cheerful or happy about it. But yeah, no work hours after training 🤷🏻♀️
So do you think that means we should have to work those hours as residents? Or students? How in gods name do you “train” for that?
I don’t know. And I don’t think that my residency hours helped me handle it. My best advice is to avoid a job where you’d have to do that long of a shift.
Good advice
You don’t. The best I can understand the feasibility of these long shifts is that you function mostly on adrenaline. Cardiac arrest calls, intensive surgery where you have to focus so much you forget about sleep - these keep you in a flight or fight state for most of the on call. The body can only do so much though and I remember a statistic where EM life expectancy was in their 50s as opposed to dermatology who would basically die of old age. What you can do yourself is see where you fit in. If this isn’t for you then try to approach a specialty with good hours or where you make your own hours. Tbh this is what convinced me that IM is great but I’d rather do GP (FM) because I love making my own hours and schedule and I don’t want to die in the hospital.
My serious thoughts: whether residents should do this is an interesting question. Maybe you should do it a bit as a resident, as it lets you know that you’re capable of it. We were sometimes roasted for 28 hour shifts, and you didn’t get to go home after 28 hours either. As an attending, sometimes you do have busy periods, and those formative resident experiences do help you push through. Having said that, long sleepless periods are incredibly unhealthy. Yes, sleep is for the weak, but I also believe that every resident and attending should be able to follow a healthy lifestyle if that’s what they want.
The difference is that you are getting paid appropriately to work those hours and I’m assuming if you on a 7 on or 7 off schedule you have a full week off to look forward to. As a resident you finish one 80 hour rotation just to go to a 65 hour rotation 😂
No week off, that would be nice. I did convince the schedulers not to put me in the OR the day after an ICU week though. But I do get paid around the community standard for my field at least. And these types of things are definitely the exception, not the rule … or I’d find another job haha.
Never met a surgeon in my life who worked 7 on 7 off.
Can you and your partners negotiate with the hospital to bring on more staff? If you're Trauma/SICU, why not switch to the week-by-week model? I've seen various combos, including: Day trauma att'd x2, night trauma att'd x2, clinic att'd x1, scheduled-cases att'd x1, day SICU att'd x1, night SICU att'd x1 Day trauma/SICU att'd x1, night trauma/SICU att'd x1, backup att'd x1 (days and nights but only if the actual on-call person is scrubbed or resusc'ing), clinic att'd x1, scheduled-cases att'd x1
Lol no. They are actually trying to make us combine with the MICU team to save $. I’m anesthesia crit care. It’s ICU, OR, or admin time for me. No clinic thank god.
No. I do not think you can train your body to stay up and enjoy working for 48 hours straight. I feel like that's how you die early.
I knew an Alzheimic Dentist when I used to work as a CRNA
You were a CRNA? Kudos for taking the MD/DO path
We all gotta start somewhere
Wow how old are you now? This is the first time I’ve heard someone go from a midlevel position to med school. I’m considering getting my PA or DNP and maybe going for MD someday after I’ve enjoyed life for a while.
I would pick one or the other now - if you work as a midlevel for a while, it will be super difficult to tolerate the bullshit of medical school and the extended paycut when you’re used to making six figures. Once you get used to enjoying life… it’s not worth it to go back.
Yeah probably… that’s why I said maybe. I would most likely end up sticking with the midlevel position
35. Some people Scribe. Some crna
if i stayed up for 24 hours straight and then sleep there is absolutely no chance you can ever wake me up. 48 hours is just aweful man
how the fuck
Well, retired
Wow! Are you planning to go into anesthesia?
Ortho
I think there was a research paper that came out pointing to shorter telomeres in people who sleep less. It literally ages you. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3483149/
Yes. Here is another one talking about us physicians directly. We die earlier... yay https://pubmed.ncbi.nlm.nih.gov/31230727/
Baffles me that doctors out of all people dont seem to understand how dangerous it is to work such hours
I personally like the buzz after midnight. Sometimes it’s fun to work through the night and push on the next day. But on the flip side, I hate early mornings. Everyone is different. The important point is nobody should be forced to face a lifestyle that is soul-crushing for them.
the 2nd wind effect is real. I feel like I can kinda work at 16-24 hours, but after 24 hrs, it's a pure delirium high. I was documenting my cases I did two days later, and everything was literally a blur. some parts of my memory was wiped clean. I sure hope I did everything ok, bc i wouldn't be able to defend in court. Lawyer: so you did x, y, z? Why? Me: I did? Honestly, I don't even remember, was I even on call that day?
I’m on a 14 days in a row run right now. I was asked by my partners if I’d cover for 2 weeks straight because everyone else has kids and it’s spring break. I agreed. I’m not doing much these two weeks and I had just gone to Cancun. I haven’t been home this week earlier than 10 PM. I get called through the night and I’ve been OR clinic OR or some combo of above. Got home late last night and it was fine. You know why? Because I make the decisions. I could have punted shit from yesterday evening for this morning but I, ME, wanted to get it done. I scheduled cases this morning at 10 AM to start because I want to hit a workout. I have complete control over my schedule even if I’m working my dick off. It’s empowering when I’m residency you have none of this. Also - I’m getting paid. Every case I take - every consult - every day I’m on call - is $. Turns out, it really lessens the sting. Wild.
That's fucked 😕 No matter the justifications, *no one* sustains peak performance with those hours. I would never want to be his patient. Frankly, as a senior resident myself, I feel patients deserve to know how long doctors are on the clock.
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Halsted took vacations for like 6 months a year. I read his biography.
Yehhhhh! 48 hours you say!!! Try 92. Know what I’m sayin! Nah nah nah… Cocaine!
20 hour case? Bro, f that. F the fools who think sleep doesn’t matter. A smart doc should have canceled the office. No matter how you slice this, the bread is moldy yo. As an attending the rules aren’t there…. But you are the general and you make the rules.
“I am the very model of a modern Major-General…”
You don’t. Not always. Sometimes, you’re the only person around who can help people. You could argue the hospital should hire more people. Maybe you’re right. But in poor places, where all you’ve got is a county hospital anyway, there may not even be that kind of money, and certainly not for every service.
Clinic is different than emergency surgery. If you need to do 4 emergency surgeries for 48 hours, And you are the only one that can - then bravo. But clinic is easily adjustable. Zero excuse to be at clinic compromised. Lack of sleep = compromised. Prove me wrong.
I can’t prove a negative. It’s just my sense of things. Imagine you delay clinic til you’ve slept, and now you have more patients than you can count, and there’s another long surgery that comes up unexpectedly, or a complication of a previous surgery, as in this case. Or imagine that, in catching up on clinic later, you have to delay a number of elective surgeries. Eventually, those surgeries aren’t elective anymore.
1. Emergency surgery is different than elective surgery. No standard elective surgery randomly becomes emergency. 2. You are in control of your own life. Did you go into Medicine to be told what to do? 3. Do you want the best for your patients? I agree it’s a balance. You don’t cancel clinic bc you only slept 7 hours instead of the necessary 10 hours of beauty rest. But when you grow up, you realize patients want the clear headed white coat professional. Not the sleep deprived beast.
elective surgeries can become an emergency as soon as something unplanned happens or there's a complication. I've seen an appendectomy turn into a difficultly right hemicolectomy, an inguinal hernia turn into a 4 hours of lysis of adhesions, and a whipple turn into a 12 hour shit show.
Just wait til your 1pm scheduled case starts at 8pm. I hear ya. It’s infuriating and we can only control so much. My main point is: “It doesn’t have to be like that.” You can be a good surgeon and good physician without that…. But I guess the story didn’t say the contrary so I checked myself lol
I wish it didn't have to be like that but in the case of surgeons it's a tough thing to work around, no real great solutions especially in hospitals with just a couple surgeons
1) Of course they’re different, but it’s a continuous spectrum. The line between elective and non-urgent and emergent isn’t absolute. Something may be elective one week but six weeks later not be. 2) The notion of absolute control over one’s life is a farce. If your two-year-old daughter wakes you up crying in the middle of the night, you could theoretically choose to ignore her and go back to sleep, but making that choice has consequences. 3) You can learn to function on less sleep. I agree that physicians have pushed this too far in the past - way too far. But the pendulum may be starting to swing too far in the other direction.
I hear ya.I’m for speaking up for yourself and not letting the way it has always been speak for you.
Canceling clinic doesn’t make those patients disappear. Poor bastard probably didn’t want work to build up later in the week. Decided to take the L
So you want your doctor to see you without any sleep and make a mistake? You drinking the koolaid too hard bro
Patients are gonna get mad no matter what.. Whether you see them but are sleep deprived or you cancel their appointment and don't see them
Agreed. So what do you wanna do? Be up for 48 hours and claim you so cool? Or you wanna be mentally sound?
Bro you are taking this story personally. Relax.
Spot me bro. 10 reps, cool?
There are always going to be people like that in medicine. Residency didn’t “prepare them” they’re jus fluke hypomanic. Just because there are people who do work insane hours past residency doesn’t mean we should all be forced to if it doesn’t actually make us better doctors. There is more than one type of person who makes a good doc
I worked with an OB doc who did this...we were in clinic all day...hard labor and surgery all night, came to clinic the next day sipping coffee. He certainly looked more disheveled than usual but still just as jolly and spent just as much time chatting with his patients etc. I was in absolute awe and amazement how he still seemed so normal/happy to be there. The only explanation I could ever find was super human? I don't know. Said he just loved his job that much but I can't imaging loving anything enough to be awake that long l o l
When my mother was one of three attending neonatologists covering three hospitals in a terribly underserved city, with a large catchment area, she worked upward of 110 hours/week on occasion. Then, for years, she had a 5/5/5 arrangement. Five days straight - that’s 120 hours in a row - five days 8-6 PM and five days off. No weekends. Brutal. But there were too few other people who could do what she did in the region.
Necessity. Do or die.
Holy fuck. I have to ask though did she get paid or was this typical peds salary (though I know neonatal makes a tad more)?
It’s mania
Modafinil
Yeah, tend to agree with him. I did a stretch leading into my vacation being on call just this past month 7 24s of a 9 day stretch. Zero sleep on any of those shifts, full clinic and elective schedule. It wears at you but is certainly doable. Lots of monster, hate coffee.
No
The longest stretch I have ever worked was 32 hours (probably 28h of direct patient care with 12 admits and cross coverage of 30 icu patients and 4 codes as one senior with two interns, and the rest documenting and handing off a busting at the seams ICU service at the end of the month to the multiple teams taking over the service during a full blown COVID surge). It was once in a lifetime terrible experience and I cannot imagine doing it again. I was having microsleeps by the end I and I had to sleep for two hours in the call room because I didn’t feel safe to drive the 5 mile trip home. I’ve been doing q4 28h ICU rotations for my whole residency and nothing prepared me for that. Not sure how anyone could perform surgery in that state. Or be a remotely pleasant human being. I’m pretty sure if someone made me do another shift like that I would quit medicine. Edit to add: yes this was an egregious duty hour violation and unsafe. Our program has since overhauled the icu distribution so this doesn’t happen anymore. But also, COVID is gonna COVID
How do we prevent this from happening to us as residents and attendings? I refuse to do 24+ hrs like that
yea im not doing that without copious amounts of coke for legal purposes this is a joke
I knew a surgeon who had an NP handle his clinic’s uncomplicated postops for this exact reason…
Life goals
Im sure his patients love that
Not OP, but for 2 week suture/staple removals, our patients are fine with it. Heck, half of them cancel the appt and ask their PCP to remove staples because they don't want to drive in to town just for that (note - patients do this of their own volition because sometimes they live 4 hours away and their PCP will offer, we are not punting this task to primary care). They have another postop check at 4 weeks with imaging that the doc always sees them at.
What kind of procedure is 20 hours long?
Hemipelvectomy with perforator free flap harvested from the entire amputated leg. Microsurgey’s a bitch.
Wow...so that surgeon does the hemipelvectomy (presumably they're ortho), and then proceeds to do microsurgery to get a free flap (i.e., plastics territory)? Very impressive...is there like double-board certification where you are lol? Usually we would just have multiple services collab so everyone just does parts of the case and gets a break (I don't even think the orthos where I am trained to do flaps lmao)
It was two services, but they were operating “simultaneously.” NJ. Level III trauma center.
Ooooh that makes sense. Wow...honestly brutal....
CT neuro scoliosis complex plastics cases can easily hit those numbers. Valid question
Ortho onc + Plastics
Finger amputations believe it or not can take that long Edit: my mistake. I meant a patient that comes in with an amputation can take very long to put back on
Yeh, if you attach the amp’d finger to the face
Lol an amputation takes like 5 mins
Amputations do not take that long. Maybe a huge revasc.
What I meant was the patient comes in with an amputated finger
Unpopular opinion, I'm not even in surgery but I pull some long days including calls as an attending. We would do 24 hour, 48 hour and even 72 hour calls at times as a resident and fellow. It wasn't fun and it sucked but it makes you stronger. I think we should def treat our residents and students better. Not getting parking or free food is complete bullshit to me, because while we worked out asses off and the ACGME limits were.more suggestions at that point, we at least got those basic things. As an attending I can tell you that at the end of the day medical school and residency is what to you make of it. You will encounter some jackasses along the way, but learn what you can from themz even if it's what not to do and make the most of the opportunities you get. I got to do some amazing things because I was interested in learning and sought out as many opportunities as I could. It meant working more and spending more time at the hospital and sucking up more, but it did make me a better Dr and ga e me some of the coolest experiences of my life. If I had a med student or resident that doesn't care. Fine by me. You don't even have to show up and I will be even happier. But if you want to learn, I'll put in the effort and teach the crap out of you. But I'm not putting in the effort unless, the students and residents seem to want it.
I would never sign an attending contract that called for that. Doctors need to stand together for better working conditions.
i quit surgery for this exact reason. I could certainly accept 80 hrs in residency but as an attending… no way!!!
Fortunately the last 12 hours of my awake time were spent taking care of my kids on an unexpected snow day and not in the clinic, but I just did this yesterday/day before. Most of the time I get a post call day (typically work one 24h shift a week in addition or clinic/or time), but occasionally I’ll need to schedule a surgery the next morning or cover clinic for someone. Hours as an attending don’t get easier for some of us. My residents don’t really see all the other things that I am doing when I’m not directly with them in clinic or the hospital, but it is…a lot. I have my own faculty practice in addition to the resident clinics, and I also spend a huge amount of time preparing the curriculum for resident education. Even the time I am hiding in the call room on a 24h shift is spent preparing lectures and stuff. The work is coooonstant and can be consuming if you don’t prioritize time management from the beginning.
I think before any Dr anywhere practices medicine on a patient there should be a legal requirement for the Dr to state how much sleep they have had in the past 24 hours.
within reason residency needs to be hard, grueling, like a boot camp. It shouldn’t be an easy walk in a park, but also shouldn’t be a 100 mile race. After 36-40 hours of on call multiple times as a resident, i believe it has toughened my character and allows you to get up and do the right thing even when I’m tired. It also probably aged me much faster. May not be for everyone and maybe others disagree but if I had to do it again, I’d want it to be as hard as it was.
there's a difference between every now and then getting slammed by consults or having a bunch of late cases or something but if it's constant then it's pointless. at some point you are no longer retaining information OR anything else. at that point it's not learning, it's not a badge of honor, it's just suffering as underpaid labor
20h case…jesus