Sleep ethic


I was drinking my coffee unawares the other morning when I somehow got roped into a rather unpleasant exchange. 


“I don’t know if anyone’s told you yet,” said the blonde-haired senior resident who comes from money, “but your role in the NICU is to stay awake. Don’t ever, ever go to sleep when you are on call. You need to be available to answer questions about the patients you’re covering.”


“That’s bullshit,” said the brown-haired senior resident with the eating disorder. “It’s not like anyone ever comes to us with questions about our patients—they go straight to the nurse practitioners, who rarely have any interest in teaching us, anyway. And there really are long stretches of time when nothing happens. Sleep whenever you get the chance.”


The blonde ignored her. “As an intern,” she insisted, “staying awake is the least you can do.” She indicated in her way that this was the end of the conversation, and I went back to drinking coffee. But I thought to myself, the least I can do? In what sense is being awake actually doing anything?


It’s a pretty common thing for residents on call to stay awake in order to stay awake, with the endpoint of saying to their colleagues, “I stayed awake.” I suspect they are confusing their sleep ethic with a work ethic, and responding to an institutional trend toward mistaking alertness for actually caring about anything, especially patients.


I bought into the ethic for about five minutes. The first night I was on call, I accidentally slept 4 hours, and felt terribly guilty the next day. I stayed awake the next call night, after which I decided I was being ridiculous. On my third call night, with absolutely nothing to do, I slept for four hours and woke up at 4:30 a.m. Before I left that morning, one of my sicker patients took a turn for the worse, and I stuck around for an extra hour past my work-hour limit to round on him with the team and explain his situation to his parents. I was aware at the time that I felt able to do this because I wasn’t dead to the world–because I had slept when I could.


A few days later, my attending pulled me into his office. “Dr. Signout,” he said, “I really appreciate your commitment to Baby Totally-Gonna-Die. When you stayed past work hours the other morning to help take care of him, it showed the kind of commitment to learning and patient care that we love but are not allowed to encourage any more.”


I didn’t tell him that it hadn’t been that bad because I’d been pretty well-rested. I didn’t want my having slept to somehow diminish what he saw as good patient care.


Of all the things to be secretive about doing at night, I never imagined sleeping would be one.



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8 Comments on “Sleep ethic”

  1. EGM Says:

    secretive about sleep my ASS! Sleep in the NICU is like finding the last golden ticket: Grab it and run! I only kept my NICU sleep a secret from (well, let’s say “didn’t flaunt it in front of” instead of “kept it a secret from,” shall we?) the other interns who were jealous that I got to sleep while they were kept running back and forth to deliveries on their call nights.
    Ahhh… sleep. I could go on, but I’m post call 🙂

  2. Avital Says:

    …especially when u sleep with yourself..
    Well said. So what happened with the bothersome blonde?

  3. signout Says:

    She actually turned out to be the exact opposite of bothersome–just a little nutty about the sleep thing. Who knew?

  4. Dr. de Asis Says:

    Everybody sleeps, dear! It’s just a matter of not getting caught. I remember the surgical consults used to catch zzz’s in the medical wards (and our call rooms) so as not to be caught by their seniors. Being alert enough to have good medical judgment because you had a few hours of sleep is more important than staying awake 24 hours. In my opinion, anyone who is capable of 36 hours of alertness is a mutant or probably taking something illegal.

  5. girlMD Says:

    awesome blog. just found it.
    sleep is precious. there is no badge of honor in sleep deprivation. it just means you had a sucky night. if i am up and on the ward, i’ll often handle some of the random questions that the nurses have so that my intern can keep sleeping. once they get the parent pager in april, those nights are long-gone.
    i wish for you many more nights of restful on-call slumber.

  6. Judy Says:

    I’m glad my hospital has always encouraged residents (and for that matter our nurse practitioners) to grab a little sleep when they can. So long as they come when I call, I’m happy for them to get a few zzz’s.

    Same thing we tell new moms. Sleep when you can.

  7. NephSpouse Says:

    As the husband of a survivor of the whole system I can say with some authority that nurses and other staff members that are on the night shift, often forget that the on call physician or intern is NOT on shift, and will not be able to go home to sleep all day tomorrow, or were required to be there all the previous day. They are not on the night shift, they are working through the night. THere is a HUGE difference.

    Your job is to catch as much sleep as you can so that you will be alert and aware when someone on shift work needs to call you to do something important. Never feel guilty about that cat nap.

  8. signout Says:

    Thanks, guys, and welcome to the new readers! I appreciate the support for snoozing, and will continue to nap when I can–although perhaps with a bit less guilt from now on.

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