I actually kind of like working nights. Granted, it kills my sleep schedule for the next three days, but it’s still pretty fun. The hospital has kind of a peaceful quiet to it at night, which is a rarity around here. It’s also when residents get to practice being a grown-up doctor. Of course, there are always supervising doctors on call, but they’re not always physically in the building. So it keeps me on my toes and forces me to think on my own. Again, fun but terrifying.
The call schedules for residents used to be brutal. We were essentially on call all day everyday. But 10-15 years ago, the feds started to lean hard on residency programs to start implementing duty hour limits. It seems like common sense, but there is a deeply ingrained culture in our field that new doctors need to see and do as much as possible during residency. There’s some truth to that, but clearly mistakes can be made after a couple of days without any real sleep. But don’t worry, patients. We’re now required to go home after just 28 straight hours in the hospital. Easy peasy.
Of course, a 28 hour stretch is not exactly OSHA compliant*, but it was the compromise between getting lots of experience and letting residents maintain some semblance of humanity.
*Interestingly, there is no such thing as an OSHA-compliant resident work schedule, since medical residency is one of the few hazardous jobs that don’t fall under the agency’s purview. In 2011, OSHA was petitioned by a watchdog group to start overseeing resident work conditions. But they denied the request after input from the American Medical Association and other industry groups. They decided (and probably rightfully so) that medical training is a very unique process, and is best regulated from within. And in defense of my medical overlords, there isn’t much evidence that limiting work hours actually prevents medical errors. Of course, decreasing the hours from unlimited to 28 still leaves plenty of room for fatigue. But the increased handoffs from one doctor to the next are far more likely to cause errors than a sleep deprived resident.
But back to the baby. It’s now 5am and I just delivered a healthy, happy 7-pounder. About a paragraph ago, I got a call from the nurse calmly but firmly requesting my presence. And when a Labor and Delivery nurse says now, she means now. So I ran-walked my way though the hospital to find the familiar tray of delivery tools set up and ready to go. I put on my gown and gloves, and got the patient into position. Many of you know that there is A LOT of biology happening at these deliveries, and the gown and gloves (and occasionally face shield) are critical. I try to not make each laboring mom feel like an ebola patient, but there are few grosser experiences than catching a face full of amniotic fluid. I’ve been lucky so far, but it’s only a matter of time.
This particular baby was probably a 6/10 on the difficulty scale. I had to do a small amount of work to guide the shoulders through the birth canal, but the baby came out without much trouble.
After each delivery, when the baby is safely out and the mother has stopped bleeding, there’s nothing quite like placing a new baby in his or her mom’s arms. And just like that, both she and I have forgotten the trauma of childbirth. But hopefully she’ll wait a year or two for her next one. I’ll probably be back in an hour.
