Tuesday, December 8, 2009

Jennifer Frank, MD: On sleep and coffee

As I was driving to work this morning, I thought about the cup of coffee that waits for me at work. I need that coffee this morning. I stayed up too late last night and am facing a full day of work with a little (okay, a lot) less energy than I need. Coffee is the answer. Well, actually, a better night sleep is the answer, but coffee will have to do.

Motherhood and medical training compete, fairly equally in my book, for the degree to which they can drive a person to utter fatigue. Being a physician who still takes call and does OB, I occasionally have an all-nighter with a patient. As a resident, this happened every third or fourth night for three years. I was chronically fatigued. I am still trying to work off a sleep debt that I started accumulating over 10 years ago.
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As a mother to young children, I experience sleep deprivation in a different way than I did during residency. It is less like the flood of an all-nighter and more like the constant drip-drip-drip of a leaky faucet. I get some sleep every night, but it is always interrupted at least once or twice and frequently three or four times. The baby is the most likely to wake me up but the other three take turns as well with bad dreams, nighttime accidents, and requests for water.

Like many parents I have spoken with, the mind-numbing fatigue that is present from the time I wake up until the time the last child is in bed lifts as that last little person whispers “good night.” Suddenly, I am free. Free to do laundry. Free to exercise. Free to spend my precious time surfing YouTube for the latest funny cat video. This freedom is energizing and often pushes me past a reasonable bedtime to the barely-going-to-make-it-through-the-next-day bedtime.

It is a careful balance and one each must cultivate personally. For me, the minimum time in bed (minus interruptions) is six hours. My husband, having carefully cultivated sleep deprivation over many years, can get by on four.

So, I rely on coffee. One cup is my usual when life is in perfect balance. More recently with a new baby at home, I am up to two cups. The dose-response curve beyond two cups is not friendly to me and there is nothing more to be gained from a third or fourth cup except jitteriness and a hangover.

What amazes me, though, is how well I can function on so little sleep — both in my role as a doctor and my role as a mom. Somehow, despite being fatigued, I can remember the details of my kids’ homework. “Weren’t you supposed to finish your poster project this week?” I also can perform procedures in the office, recall distantly-learned factoids, and remember that I forgot to order the lead screen for the 1-year-old I saw at 3 p.m. yesterday.

This is not to say that I am operating at my best. I still call home, in the haze of my exhaustion, and leave cryptic messages like the one I left for my husband last week: “Honey, when I get back from the conference I’ll be ready to leave for the conference.” I still don’t remember what I meant. But I do remember making the call.

As the ACGME and other organizations try to solve the problem of physician fatigue, I struggle with my own experiences as a fatigued physician. For me, the most important part is recognizing when I am so tired that I can no longer be a safe physician or an effective parent. That sometimes requires me to go home early post-call to sleep or bargain with my husband for a Sunday afternoon nap. It also means that while I can occasionally push my bedtime later, that I have to try to get eight hours of sleep most nights.

However, it also makes me recognize two truths about sleep deprivation and fatigue. First, things that are really important have a way of pushing their way forward in your mind and grabbing hold of your attention so that you can kick into the stress response and get the emergent job done. Second, you are able to perform rote things pretty well. As a physician, this can include some pretty complex tasks.

The bottom line is that fatigue is a part of life, maybe just a little bit more so for moms and doctors. It remains imperative to care for oneself by (among other things) resting so that you can care for others. However, the ongoing ability of both moms and doctors to function well on little sleep indicates that our understanding of the effects of sleep deprivation on, for example, patient safety is far from complete.

Jennifer Frank, MD, FAAFP, is an assistant professor in the University of Wisconsin Department of Family Medicine and a faculty family physician at the Fox Valley Family Medicine Residency Program in Appleton, Wis. She is a mother of four, whose husband, also a physician, is a stay-at-home dad.

1 comment:

  1. There is a reason that Starbucks and Dunkin Donuts do so well. You 'kin do it :).