A Budding Emergencist
Wednesday, August 05, 2009
  To Sleep, You Must Cold

NYT Article--to sleep, you must cold

I remember during my internship year, the crucible, I was rotating in the ER. I was very excited to rotate there, as I had recently discovered the thrill of the emergency room in one of my last 4th year rotations as a medical student. My dreams of becoming a psychiatrist sloughed off me like I was molting.

I was on a string of nights, in the middle of a hot summer. Despite having lived in my apt for nigh on 2 years, I had yet to invest in an air conditioner. Hey, I was a tough guy, living au naturel, windows and fan only, thank you very much. I could take it. I finished my third of four nights, increasingly sleep deprived, because, well, it's hard to sleep, drenched in sweat, during the daytime.

I bought an air conditioner. I bought a strong model--hey, maybe I could cool the whole house! After it was installed and began producing a cool, cool breeze, I went to sleep. I set my alarm clock, and slept very, very well.

I woke up, and it was mostly dark. Not the winding down twilight that preceeded my upcoming night shift, but the silent crepiscule that heraled the end of my shift. Slightly uneasy, I was. The analog clock above my bed read 6:15. Perfect, I thought. Just enough time to get ready for work in my preferred leisurely fashion.

Beep! goes the cell phone. Gee, I missed the alarm, that's weird. Oh hey, I've got some messages. Let's check.

"Hey Dex, it's the chief resident. Just wondering when you're gonna make it to your shift."

"Dex. What's going on? It's two hours past your scheduled start time, and no show, no call. What gives?"

Uh oh.

I check the time on the computer. 6:20, indeed. Okay. I check the date. One day later. That sinking feeling turns into a vortex, sucking my stability away. I am suddenly aware of my heartbeat, which has been pounding away for a while now. Idly I realize that I am unusually refreshed and alert. Too alert. I just slept for 16 hours.

I frantically call the chief; forcing calm into my voice I definitely do not feel. I tell the chief I just got his messages. I tell the truth about my heat induced sleep deprivation and the marvelous benefit of air conditioning on the quality of my sleep. I apologize profusely.

I show up for my next shift. Early, of course, and eager. Very eager. Everything seems to blow over.

Months later, at residency match time, I am so confident and sure of my assured spot as a resident in the next year's class that I only interview at one other place, just to get some perspective on what other ERs look like. It seemed okay, but a bit of a hike from my current digs, which are perfectly serviceable now that my sleep is blissful. Confidently I check my status on the match website. Rejected.

I am shocked, hurt, and victimized that my first choice for residency, the hospital where I sweat blood to get through, the epitome of The House of God, where I know Everybody, has rejected me. I barely made it onto their list. I was not going to be an ER resident there.

There was a bright spot, however. My second, and only other choice, ranked me high enough to match. I had a residency spot. And Lo! though with His Left hand he Taketh Away, with His Right hand he Giveth. In my hurt I question my would be friends and mentors about why I wasn't ranked higher at my own institution. Well, They Replied, you failed to show up or call for a shift, and it was felt that endorsing such an unreliable precedent would be unwise.

So yes, I am intimately familiar what a benefit to sleep a cool room can be. Painfully aware. And now you know too.

Emergency medicine, from the beginning of a new doctor's career.

Location: Big City, Metropolis, United States

Walk softly and carry a big vocabulary. Don't be inhuman. Find and greet God in every person you meet. The patient is the one with the disease. Do not get distracted. Charity begins at home. Do good and be happy. Don't just do something, stand still. Wear sunscreen. Don't get anyone pregnant, and don't go to jail, young man. Budget your luxuries first. You don't know what you don't know. People like learning, they just don't like being taught. When in doubt, go out. When life gives you lemons, make lemonade. Honey attracts more flies than vinegar.

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