so when i showed up in baltimore a couple of days before july 1st
i mean it still wasn't crystal clear to me that i could go
you know two days without sleeping stand in an or for eight hours at a time
all those sorts of things now that's one of the things the sleep deprivation
because people always obviously i take a lot of flack
because i don't sleep a lot and and the sleep deprivation
so what did that low what's that like when you're going through your residency
and you're just saying i mean there's days where you're going 24 48
hours no sleep and how'd that affect you what did you
think of that what do you think looking back at it
what's your opinion of it now well you know when i decided
that that i was going to go into surgery i mean i i always i'm pretty uh insecure
in general most people don't necessarily appreciate that on the outside but
always thinking i don't know if i've got what it takes here how do i figure it
out and so my my whole mo in life is test the system
hard so when i was in medical school still deciding this
i figured well every thursday night i'm gonna pull an all-nighter
in my room standing up not allowing myself to eat
sleep drink pee do anything and i'm gonna stand at my desk for eight
hours and practice suturing you know sort of try to mimic what it
would be like to be in an operating room all night
not being able to go pee not being able to drink not be able to do this thing
and so i had a little bit of confidence go you know i figured okay i can do this
like i can pull an all-nighter once a week that's you know not that that's a
good thing to do but it was like kind of a confidence thing right
so then you show up but there's no preparing you for what you're in store
for now i got to point out this is not the
way it is anymore so in 2000
i want to say like four um it's almost like labor laws came in
exactly a whole bunch of laws came in that we could spend hours talking about
how it turns out the laws haven't they haven't fixed the underlying root
problem but nevertheless a whole bunch of work requirement hours stuff got
fixed right so you couldn't work more than 80 hours in a week or 88 depending
on if your program had an exemption and you couldn't work more than 24 hours
consecutively and stuff like that but by the time those laws really kicked
in i was already gone and and so i don't really know what it's
like today but i would imagine it's um it's
less demanding from a sleep deprivation standpoint
but at the time there were no such rules and
you were at the sort of every second every third or every fourth night call
but then your post call day you would still work so
our mutual friend kirk parsley of course is how we met this is one of his
favorite stories about me because he loves this story because it's
so crazy so this is july
of 2001. so i am one month into being a doc right and i'm on an every third
night call rotation at this hospital called bayview
which is about five miles from what we call the
mother ship which is hopkins and it's out in like east baltimore it's
in a real crappy part of town not that there's it really i mean
i hate saying this but there aren't that many good parts of town at least back
then in baltimore um and uh
so i'm uh so i show up on a monday at five o'clock in the morning
so i slept in my own bed sunday night so monday morning i show up at five
to round we do our whole thing and that night i'm supposed to go home so
that's my off couch called your swing day
you show up at five you'll be home by 7 pm that night
if all goes well so you worked your you know 14 hours
and then you sleep in your own bed and then you get to come back the next day
and then you're going to be on call so so we're rounding that afternoon
so and the uh what the the one of the senior residents says hey
so and so didn't show up for their shift in the er the
the er always staffs one surgical resident full-time
and this guy just didn't show up and she's like and it's a 7
p.m to 7 a.m shift can you cover it and you know this would be like if you
asked the most junior guy you know to do something like he he he'd
be kicking his own ass to say yes like he couldn't wait
to do that right so i was like hell yes i will do
that so then i go down to the er and i work
all night seven to seven and then the next morning is now my on call day
so now i'm 7am cranking away until that night and then i'm up all
night on call so and then it's now wednesday
and it's my post call day and i'm there till
5 or 6 p.m so i've basically been up from about 4 a.m monday
and it's now 5 or 6 p.m wednesday and i get in my car to drive home and i
have to make it i have to go down this miserable
street called eastern avenue to hit the 83 to drive up to my place
and i'm driving along eastern avenue which is like
red light after red light after red light or stop sign or whatever
and every time i'm at a stop light i fall asleep
my foot pops off the clutch and i stall like i am
so tired i can't even you know handle like the gradual you
know easing off the clutch and the gas just to move up and up and up i can't do
it so finally in one moment of lucid
clarity i'm like you can't get on the freeway you're
gonna die so i was like what's the solution i was
like you gotta get over and take a nap so i pull over my car on the side of
eastern avenue right in front of this park
called patterson park which at the time i don't think i fully understood that
that was an open air drug traffic market so i got out but here's the best part
sorry the logical thing to do would have been just been stayed in the car and
take a nap but i was like you know i haven't seen
the sunlight in like days and it's the sun is still out like
i'm gonna go nap in the park so i get out of the park i'm in green scrubs that
are covered in you know blood stains because i was too
dumb to not change i go lay down in the park i take my pager
off and i clip it to my neck and i set the alarm to like
go off in one hour you know so like 7 pm it'll wake me up
and i'll feel perfectly rested and i'll be able to drive home
so i lay down in middle of patterson park and the next thing i know i wake up
it's like one in the morning two in the morning
there's needles everywhere there's i have like
bites on my arm that look like they're from rats because they're like nothing
i've ever seen before like these bites all over me
and i'm just thinking myself like how did i not get killed here
like the only thing that prevented me from dying was how ridiculous the sight
was you know if something's so strange like
nothing you know so i was like god damn it man so i get back
in my car and drove home and when i tell parsley that story he loves
it because he's like that's the classic example of how
complete deprivation of sleep impairs your judgment
um so you know there were a couple stories in residency where i had to do
like those three night back to back to backs
another time it happened i remember was an o5 do you feel like though okay
driving a car is kind of boring right stop lights but when you're really tired
but then all of a sudden something happens like
boom i feel like when that happens i feel i can lock on
there's almost no amount of sleep deprivation that will stop me from
functioning and getting something done that's important
on task on time absolutely is that true does that mean
yeah i know i think i think an adrenaline rush in the moment can
provide any amount of clarity and focus that's necessary
the problem is very few things are life or death that way
now in your world there were plenty of things but in my world not and this is
the actual story i was gonna tell was in uh probably my third year
uh i think it was my third year um i was the same same sort of deal i ended
up covering for somebody and then covering for two people and two
consecutive nights and then it was my turn so that
was like three straight nights of not sleeping
and it's the middle of the night and this guy comes in the er who's
you know got a really diseased gallbladder and in retrospect it should
have never come out that night but a lot of times the dirty little secret
is surgeons want to operate at night because they can get better or
time electively as opposed to waiting the next day if it's not emergent so
sure enough we're in the middle of the operating room doing a laparoscopic
gallbladder removal at two in the morning when we don't
really need to be there two in the morning we could have
slept and done it the next day um and sure enough so so in a lab removing
the gallbladder is a two surgeon procedure
so there's the main surgeon which because we're teaching hospital i'm the
main surgeon i'm actually doing the operation and then there's the attending
who's holding the camera and retracting for me so i'm you know like i'm doing
this and yeah that's a stimulating activity
but of course i've done a hundred of them so it's not that stimulating
well i can't stay awake and i finally somehow managed to fall asleep on this
patient like i face plant into the patient wow luckily
it was laparoscopic so i didn't contaminate the surgical
but so even something as stimulating as surgery
right because look if the guy's aorta was bleeding right right
i'm sure i would have guessed that yeah exactly but all you're doing is falling
out yeah bladder is no big thing yeah yeah
it wasn't stimulating enough to overcome three days of sleep debt
did you do did you figure out any tricks any
you know for instance i can't when i was going through seal training and even my
whole career and even to this day i take these i take little power naps if
i'm feeling that tired i elevate my feet and i sleep for like
six to eight minutes and it totally recharges me did you do
you take power naps no aside from your power now there's a
park that lasted seven hours it almost got you killed
i do i once took a power nap in my car again same thing i was like
it was like eight o'clock at night i got to the pool
i had a rule which was after you left the hospital you never went home
because i knew if i went home i wasn't gonna leave so i would always go from
the hospital to the gym or the pool or whatever i was
doing and on this particular night i get there it's eight o'clock at night
i am so tired i'm nauseous like the thought so you didn't want to go home
just because you knew you'd go don't go to sleep and you didn't want to
go to sleep because you've been awake for three days why didn't you
why did you want to go and fall asleep well because i you know it's really
funny a good friend of mine who again a couple years ahead of me gave me
interesting advice whether it was right or wrong i don't know he said look
you're going to be tired no matter what in residency
don't stop doing all the other things in your life because you'll still be tired
now i don't know that was the right advice but i took it i heard that advice
and my view was i'm going to continue to
work out every day i'm not on call i'm going to you know do all the stuff i
want to do and unfortunately sleep always took the brunt of it
so yeah so it would be to the pool and so same thing i got there but on this
particular night i was so tired i was so nauseous like i couldn't
suppress the desire to vomit and i was like i'm not gonna i can't if
i puke in the pool they'll kick me out i won't get to swim it's just not gonna be
worth it so i was like just sit here for like 30 minutes
and take a quick nap so same thing took the pager out which normally could wake
me up clip it here and it was freezing because
it was like the winter so i left no it wasn't cold but i remember i
wanted to leave the radio on like a dumb ass so the car is off so
alternator's off radio's on well you know how the story
ends i wake up at two in the morning battery's dead i'm in the middle of the
parking lot i can't you know had to call my girlfriend to get jumper
cables to get me out that's a one that girlfriend went on to
become my wife by the way um so short answer no i didn't have a
great strategy i did have a friend who and i never tried this but
he told me he would put coffee grounds in his eyelids and apparently it hurts
so much that you couldn't close your eyes
you know that's i mean i would not that but i've told people this all the time
too you know do do a little bit of physical exercise if
you're super tired that definitely picks you back up there's got to be some
reality or some scientific reason for that
happening that's another thing you can do