Doctors of the old school tend to be rather proud of how hard they worked when they were young, and to attribute their current enormous technical competence as well as the magnificence of their character to the long hours that they then endured. They were not much fun at the time, perhaps, but it made them what they are.
I remember those long hours well, and how at the end of a forty-eight hour shift my head felt as if it contained nothing but lead shot, as if it might just fall off my body. Leaving the hospital was like leaving prison after a long sentence; the starving man dreams of food, but the sleepless man dreams of bed.
It has long been suspected that such exhaustion cannot be good for patients; no one in his right mind would wish to be flown by a pilot who had gone two days without sleep, for example. Why should doctors be immune from the normal effects of fatigue on performance?
A study in a recent edition of the Journal of the American Medical Association attempted to demonstrate the effects of a protected sleep period on interns and residents when they were obliged to work shifts longer than 30 hours. On some such shifts they were given five hours, between 12:30 am and 5.30 am, when they could not be interrupted except by the direst emergency, and when they were given the opportunity to sleep. This might not be what most mothers would call a good night’s sleep, but it was better than what was normally available to such interns and residents.
The subjects of the experiments acted as their own controls: half the time they had protected sleep periods, and half the time they hadn’t. Unsurprisingly, they got more sleep (about an hour more per night) when they were given such a protected period rather than when they were not. They were more alert, both subjectively and objectively, when they had slept 3 hours a night instead of only 2. Three hours is hardly enough to make one feel fully rested, but slugabeds know that even a quarter of an hour of extra sleep can seem the most luxurious thing in the world.