You can sleep in your bed when the sun is setting.  You can hug your teddy bear or hold your woman close at night.  But don’t sleep in the stock room between patients when there are more of them waiting in the waiting room.  Catch a few zzzz’s in between Jay’s monologue and his second guest tonight, the most dominant force in the NBA, Shaquille O’Neil of the world champion Los Angeles Lakers.  But don’t do it during Professor Snow’s student lecture.  There are only fifteen students in the room.  He’ll notice!  You can do it in the bathroom on the john.  You can do it in your car; but not when it’s moving while in a school zone or within three seconds of the cross traffic light’s turning red.  And definitely, positively, beyond debate, not when there’s a patient in the car with you!  That’s a no-no.

“But student-doctor Chou,” you ask, “sometimes the patient falls asleep when you ask him a question.  Is it all right to take a nap then?”  No!  Such an infraction would cause the loss of your meal ticket for that day.  Better to keep the flow of the interview.  If the patient is not arousable enough to give a complete history, you can skip to accessible parts of the physical exam, such as the cardiac exam, until he wakes up.

“What about during tests?”  Well, if you finish earlier than ten minutes before the end, you can leave teh room and curl up’n a study-cubby, I suppose.  But keep your pager on.  Someone may need a blood culture STAT.  Also–and this goes only for the USMLE–learn to fall asleep quickly so you can recharge in between sections.  By the way, falling asleep quickly is a skill you must develop before our residency begins.  It could be the difference between life and death.

“I’m having a little trouble integrating the material.  So in general, never sleep in the presence of a patient, and learn to sleep whenever there’s a chance otehrwise?”  Yes!  But also, you must learn to abandon the whole concept of “otherwise.”  Patients can be out of sight but not out of sound.  You never know when that pager is going to go off, whether you’re delivering a baby, delivering your OWN baby that is, or whether you’re grappling with that awkward position of trying to drop three coins into the tollbooth with the same hand that’s holding a McDonald’s twelve ounce coffee because you think you’ve been trained to work with your hands well enough for such a pedestrian task.  Yes, my fellow underclassman.  Sleep when you can, but never fall complacent to the idea that you can do so guilt-free.  Germs don’t give you the courtesy of vacation time.  Angry dogs don’t adjust when they harbor the potential to become rabid to your slumber schedule.  And hearts don’t get attacked only when you’re ready for them.  Guys, I know I’m acting like a hard-ass.  I know I’m on a soap box here.  But please ignore my attempts at humor.  I’m not really so cynical about it.  The truth is this: We are fortunate enough to be part of the most noble fraternity human-kind has ever created as a profession.  Few groups are as dedicated.  Fewer are as skilled.  It goes without saying that the natural consequence of this whole process is that our time has become more valuable.  That’s an economic fact.  And that’s the point of this whole lecture, whether you embrace it begrudgingly or with epiphany.  But you should ask yourself before you leave, which attitude you hold.  Perhaps it will tell you about how comfortable you are with your choice.



Bruce Chou, Chicago, Class of 2002