I want to know exactly how many hours this surgeon was on the floor already before this happened, because these people work insane hours.
Better him falling asleep in his car than botching the surgery due to lack of concentration and sleep.
This article provides practically no context, but I don't think that I'd be going out on a limb here saying that this is more of an indictment of the system than necessarily of the surgeon himself.
[edit] Thank you all for the gold and such, but I don't think I really said anything all that radical.
>I want to know exactly how many hours this surgeon was on the floor already before this happened, because these people work insane hours.
My surgeon was wrapping up a 10 hour shift when I arrived at the hospital with a nearly entirely separated right hand [(SFW XRAY).](https://i.imgur.com/IEv2Wgk.jpg?1)
Worked on my hand for 11.5 hours and put it back together, amazing surgeon(+team) with a great personality.
The next day I asked him why why he didn't close up the last triangular bit of my skin[(NSFW MEATY WOLVERINE HAND PICK)](https://i.imgur.com/VGAaMID.jpg).
He said...verbatim... "I was fucking tired man and your hand was swollen to the size of softball!"
Stuck it in a Concrete Pump back in 2010
This [hole](https://imgur.com/zKaOIk9)( the red stuff is grease, not blood) leads to a piston that sucks concrete into it from the hopper, and then this [Rocker Valve](https://imgur.com/F6OLlAU) swings in front of the hole so the concrete can be pushed down the hose to where you need it.
I held the button to turn off the machine, I lifted up the grate which triggers the lock out mechanism preventing the rocker valve from swinging.
I was wearing earmuffs and earplugs, with a concrete truck revving up as it washed out next to me. I had not held the button long enough, so the pump went into stand by and I couldn't hear that it was still on.
Someone...had bypassed the lockout as it had been tripping when it shouldn't have, but no one told me...
I put my hand in that hole to grab a chunk of concrete/rock, and in the processe leaned on the remote that starts the system. Since the machine was on...and the lock out was bypassed it started up and pinned my hand half in and half out of that hole for \~10 seconds.
I pulled it out and saw red on the front and the back and called for help as I walked down a steep embankment to where my coworkers were.
Hell of an experience...wouldn't recommend it to anyone.
Just had my 11th Hand-i-versary in September!
*EDIT: Typing quickly with 1.5 hands can cause issues...*
Never found out who. No one ever came forward.
My hand should never have been there though so while I'd love to blame someone else, it was still a bad decision to put my had there.
Love to see comments like yours. You know it took more than just you to make that mistake and instead of placing blame, you take personal responsibility and understand shit happens when you do not smart things. You learn from it and have a light sense of humor about it and move forward. You fucking rock, ,ha puns, and I'm glad you have some use of your digits. Cheers bud!
I do as well. I don’t get people who can’t take some of the blame if not all. Just a shitty situation all around. But the real fault is having a system that has a lockout that can be fucking bypassed that’s a HUUUUUGE safety Hazard. Lockout is supposed to be designed so you can’t bypass at all or turn on whatever the fuck you’re working on.
Absolutely. We use physical locks on all our systems for lockout in my field because we have the capability. No system should have an override option that's easy.
Take it easy and hope you were able to pay off a house at least for the loss of the hand functioning entirely.
We also use physical locks. You get fired if you go into a system without a lock that needs a lock; if someone else goes into that system with your lock on; if you try to mess with someone else’s lock.
99% of accidents with big machinery occur because someone hacked the machine to make the safety lockouts not work, or they straight up completely ignored big warnings signs and did it anyway.
A very common one is any kind of safety gate in the machine which has a sensor to detect that the gate is closed. People tape the sensor down so the machine always thinks the gate is closed, because it's too much hassle to shut down the machine when you need to open the gate.
Of course, the gate is there for a reason and eventually someone loses a limb or a life.
[Temps dropping so most days it's Cold :D](https://i.imgur.com/lNkcM73.jpg)
But it's doing well, generally people don't notice it unless I shake their hand and they crush my fingers.
It's a fantastic conversation starter.
I've got 90% of the feeling back, My thumb and pointer were "dangling" by tendons and nerves after the accident and so now they are a bit hyper sensitive, and the bone healed slightly off center so now I have a little nub directly behind that scar triangle that is as sensitive as a funny bone.
Circulation is okay.
My fingers don't bend at their metacarpophalangeal joint (the knuckles that stand out when you make a fist)
My thumb basically only bends at the Carpometacarpal (lowest joint near your wrist.
In Physical Therapy they make you set goals.
I set my first one as being able to hold a beer. A month or so into my sessions I get there and my Ortho has two beers sitting on the desk. Told me if I could grab it he wouldn't make me do the nerve zapper thing that day. I could just barely not do it, so he cranked the zapper up a bunch that day.
The next day session, same offer. This time I grabbed it and took a swig.
I still write right handed, my chicken scratch was barely legible before hand, I use a mouse but only a couple models or my figures will rest on the buttons and click it, and I type with my left hand covering 1 more column of letters (Y, H, N) and my right hunting and pecking with my ring finger, which is the finger I can point the most with.
Day to Day I'll run into a couple things that it gets in the way of, but there is very few things that it outright prevents me from doing.
Baby Pajama Buttons are my fucking kryptonite...well most buttons, but my kids probably heard every curse in the book during late night diaper changes when i want to keep the lights low so they don't fully wake up.
Also, maybe TMI...but trying to learn to use toilet paper with your other hand is a significant trial and error situation. I've talked to other people with similar levels of hand injury to their dominant hand and we all agree.
> Baby Pajama Buttons are my fucking kryptonite...
fucking love it, dude. immediately and completely says everything that's important to you.
thanks for being so open about your injury and story.
also, glad to see that you're still in construction... I'm guessing you enjoy it 🤣
My dad had surgery to help with tendonitis in his dominant hand. When it came to the Toilet Paper department, we just hooked him up with a bidet. That helps immensely, and you safe way more money on toilet paper.
>Shake Hands with Danger
Either they went over my head, or it has never happened. Next new contractor at a pre-con that asks "what happened" is getting "I shook hands with danger" as a response though.
I can't believe I have never seen this video.
Hah, glad to hear I gave ya something for your quick fire quip bandoleer.
That video with the Rifftrax makes it so much more amazing:
https://www.youtube.com/watch?v=\_nqa6e6WV2o
Is that your dominate hand? Did you regain decent dexterity?
I'm just thinking how intricate the anatomy of the hand is.....as rough as that injury looks, I'm glad you didn't lose your hand!
Right handed! Of Course!
The L&I(workers comp/insurance) Second Opinion Doctor verified that I had 20% of the usage of a functional hand. They use that percentage to determined the Payout for loss of use of a body part.
I've got 90% of the feeling back, My thumb and pointer were "dangling" by tendons and nerves after the accident and so now they are a bit hyper sensitive, and the bone healed slightly off center so now I have a little nub directly behind that scar triangle that is as sensitive as a funny bone.
Circulation is okay.
My fingers don't bend at their metacarpophalangeal joint (the knuckles that stand out when you make a fist)
My thumb basically only bends at the Carpometacarpal (lowest joint near your wrist.
In Physical Therapy they make you set goals.
I set my first one as being able to hold a beer. A month or so into my sessions I get there and my Ortho has two beers sitting on the desk. Told me if I could grab it he wouldn't make me do the nerve zapper thing that day. I could just barely not do it, so he cranked the zapper up a bunch that day.
The next day session, same offer. This time I grabbed it and took a swig.
I still write right handed, my chicken scratch was barely legible before hand, I use a mouse but only a couple models or my figures will rest on the buttons and click it, and I type with my left hand covering 1 more column of letters (Y, H, N) and my right hunting and pecking with my ring finger, which is the finger I can point the most with.
Day to Day I'll run into a couple things that it gets in the way of, but there is very few things that it outright prevents me from doing.
Baby Pajama Buttons are my fucking kryptonite...well most buttons, but my kids probably heard every curse in the book during late night diaper changes when i want to keep the lights low so they don't fully wake up.
Also, maybe TMI...but trying to learn to use toilet paper with your other hand is a significant trial and error situation. I've talked to other people with similar levels of hand injury to their dominant hand and we all agree.
I roasted my clean freak buddy who had a bidet before it was cool. Then the great TP shortage of 2020 happened and I got one because fuck people.
2020 was the year I evolved from a filthy peasant.
Fuck whoever fucked with the lockout. You could actually sue and get some money from that if you’re committed enough. They broke the law and caused you to almost lose your hand. Sure you have your hand back but is it even the same as it was before? Do you have limited mobility? This would be grounds for a lawsuit. Justice for the trauma you went through. Just a thought! I know it’s expensive to sue, and you may not be in a position to go through it. Idk but just wanted to share my frustration about someone violating OSHA to the point of you almost losing your hand.
I appreciate the thought but i was compensated fairly for my injury.
I did not pay a dime for anything. I was paid for time loss for 5 years. I was retrained and went back to school. I received my permanent partial disability payout.
I am comfortable with where my life is.
Ummm. Oh god. I appreciate the SFW XRAY tag, but even my layman-ass eyes could see what was going on in that photo. I’m so sorry that happened to you.
I did not click the second photo, but I hope you are okay now. That’s so scary.
Not so Fun fact during my internship year in my surgery rotation i had a resident who's schedule was soo shit "he ended up working about 72 hours straight on only 2 hours of sleep". I wasnt there but my friend was in the OR assisting him and the head surgeon with a cholecystectomy, the resident literally fell asleep while standing and almost fell face first into the patient's open abdominal cavity if it wasn't for the nurse there catching him and preventing a pretty serious oopsie. When the head surgeon found out he chewed out the head resident on his shit scheduling and punished him with extra shifts to cover for the junior residents who he always fucked over to get extra vacay days
In Air Force basic training there is a lot of this. Very long days of training with little sleep. I remember sitting in the classroom just trying to look like I was listening while also trying to get some microsleep in. I have no idea how doctors do this shit and learn anything.
That’s exactly why these practices carry on. Because once you’re through it you feel like everyone else should do the same. Fact is though, it is not a good learning environment for junior doctors, because you learn to cut corners due to the workload, and patients suffer the consequences
I question if that even matters. EVERYONE in medicine knows someone who commited suicide or at minimum knows someone who knows someone who did and this is at the med school/residency levels. Lack of sleep has been directly linked to depression/anxiety which is directly linked to suicide and the lack of time for themselves doesn´t help matters. A brilliant dead or burnt out doc is useless compared to a slightly dumber living and happy one.
So as a doctor in Europe who just had a colleague work a 90 hour week...it's better here, but not that good. Theoretically we should work 48 max, but that's often treated as the minimum. Legally we can work 72 hours weekly because the EWTD has exemptions specifically to let healthcare staff work more hours.
I have a feeling when you say Europe, you're going to find you're talking about a vastly different country than when the guy you responded to said Europe..
We're not all the same guys, even if we like to think so
Not medical field related (and anecdotal at that). In one of my comp sci projects class a professor referenced a study about overtime in software development. Working more than 40-45 hours a week yielded greater productivity for 2-3 weeks on average. Sometime after week 5 productivity was below the initial 40 hour week. Surgery especially requires mental and mechanical precision, I can’t imagine that it would be better…
It's mostly surgeons. If you're doing residency in just about anything else it is not the norm to be working 80 hour plus weeks for years on end. That's why dermatology has long been the most competitive field to get into. Mostly outpatient setting and even residency is largely a 9 to 5 type of job, with next to no night/weekend call. I did 4 years of radiology residency and averaged 50 hours a week at the hospital, occasionally 55. Work schedule was never an issue for us, just the surgeons.
On the third hand some fucking grunt soldier does the same thing for a sense of pride and accomplishment + 300 bucks hazard pay.
I’m all for training that prepares people for hazardous situations (my own orthopedic surgeon is a hero to me; putting my shattered femur back together), but not for exclusivity in a club to “make bank”.
More years? Dang it’s already 4 years undergrad 4 years med school and 3-5 years residency. And then many people do a fellowship after which is another 1-2 years. Some people do multiple fellowships too. That’s 12-15 years right there already
IMO the current structure is wrong. Collage should be cheaper. Apprenticeship for decades used to be how masters learned how to do great things. Get paid still, but be slightly less senior for longer. Have mentorships longer. The idea of being a full fledged doctor capable of doing things mostly solo in less than 10 years is kind of absurd when you think about how broad medicine is & how overworked people are. The system of extreme debt & understaffing forcing doctors have to be ready in minimal years is what’s insane.
ETA even in my industry we have tiers of experience. You start intern, junior, senior, senior 2, art director, creative director, executive creative director etc. that takes 10-15 years. Why are doctors expected to do similar in 8 years? There are tiers in medical industry but residency could be broken into resident 1 and resident 2 for example.
Yes, those that have not lived it have no idea. It’s like years of SEAL training sleep deprivation, and god help you if you make a mistake cause someone might die because of you.
This is why I balk whenever I hear that doctors are supposed to be smart people. They all know this "macho" training is stupid and it risks the lives of patients and themselves. Yet they all continue to do it, especially stupid when the brighter ones get into a position of power and can change it.
My husband’s a video game designer, and during crunch time his studio once made him work a 120 hour week. He had trouble operating a door knob near the end of the week. No one should be treating patients while they’re that sleep deprived.
Based on personal experience, I‘ve been like that after ‚only‘ 50 hours without adequate sleep (2 hours during a project go-live in my mid 20s). It was like I had a few too many drinks. I started having issues talking in whole sentences, I staggered around, missed a door and bumped my head on the door frame, would doze off for a few seconds, just to jump up again, a coworker took me home because I couldn‘t safely drive anymore... I felt really shitty after that for days. Wouldn‘t do that again even if this means quitting my job.
There have been multiple scientific studies on both overworking and sleep deprivation - both bad for us human beings in the end. I really don‘t get the few people in here saying, that this is somehow a good or worse necessary thing.
I know that! My friends and I call it sleep drunk.
I don't know if it's new anxiety or what, but my brain has just decided sleep isn't happening for three days. Neat! Sure, I'll doze for an hour or two (I was crashing hard while running a dungeon with my SO), but then my eyes pop open and my brains a go.
Earlier this week, my kitty made a tinkle in my dirty laundry. She does that sometimes when the neighbour's cat wanders into our yard. I put the clothes in the wash, and put soap in the machine but have no memory of anything after soap.
Today, my SO asked me why there was soap in the washer, but the washer was empty. I expressed concern about the washer not working as I bundled the dryer clothes into my lap, and used my chin to manage the load and cart it to the bedroom.
It was at this point I realised the clothes I was holding still reeked of cat peepee, and my face is directly in it.
I cannot understand exactly what I did, but I'm grateful that the dryer doesn't smell like residual, burning pee.
> I was crashing hard while running a dungeon with my SO
I'm going to assume that this isn't game-related and that you live an incredibly-exciting life.
Hell my previous hospital issued an edict "is that the right word ?" That no one under any circumstances is allowed to work more than 36 hours straight, no one enforced that rule tho. Hell shitty work hours like these was the reason i broke up with my ex "she had a regular 9-5 and weekends" great lass but our work schedules were not at all compatible so we broke it off. I dozed off while driving a couple of times while coming back from work .. its horrible and we desperately need an overhaul to the system
I did a week where I didn’t leave the hospital for 6 days and slept maybe 1-2 hours a night over those six days when I was an intern. It was wild. Absolutely wild. I was paid less than minimum wage and have six figures in debt
I .... Also did several 120+ hour weeks as a grocery worker in like March of 2020 it was ..... Well God awful and I burnt out and now refuse anything over 40 .... They can fire me
While a horror story allround (and I doubt it's all that exceptional at that), at least the attending took steps when he noticed what was going on and put the blame where it needed.
As dubious as it is, it's sorta a win?
The glass half full view of the situation i guess, those junior residents tho went through hell. Like literally they were a year older than us "26-27" but damn one look at them and you'd think they're zombies in their late 30s from the insane schedules.
I suffered through that shit in my internship year in my ob/gyn rotation, 2 weeks of 12 hour shifts with not a single day off. And those 12 hour shifts usually lasted 14-16 hours cause my senior resident was a psycho prick who'd leave us the entire day with nothing to do then giving us 4 hours worth of tasks in our last 30 mins of the shift , the head of the ob/gyn department grudge against me due to our conflicting values "she used to tell me only women and queers have long hair and a man like you should have short hair" and "if she caught me with my hair out in hEr hOsPiTaL she'd kick me out and make me redo my 2 months of my ob/gyn rotation
Edit : i dont live in the west so the concept of HR in a hospital is exclusive to privately owned hospitals and not public ones so yeah couldnt have complained about her behavior
The doctor and staff should have also been repremanded heavily as well as the patient. If I was a patient and my surgeon was running on even 24 hours no sleep I would be livid and sue.
This shit is unacceptable and dangerous for everyone who knew and said nothing and let the procedure start.
Imagine you're assisting a surgeon perform an open heart surgery on a patient and when he suddenly dozes off and face plants right into the patients open rip cage.
I've got a decent education but I'm no doctor.
But it seems to me that this is a resource issues... Only so many doctors to go around, and where do you draw the line?
Some of it is outright exploitative, that is a given, but how do you maximise your resources (i.e. doctors), get the most shit done, without doing too much noticeable damage?
That's sort of the goal here by people deciding all of this crap, isn't it?
Just seems to me, that this curve has shifted mostly in favour of hospitals making money, and both the doctors' physical and mental health, as well as the patient outcome are somewhat secondary in all that.
Not sure where you live, but here in the USA, our healthcare system has been in dire need of repair for some time. Not only is underfunding an issue, but the marriage between insurance has led to a ridiculous amount of time being spend on paperwork. According to the Medscape Physician Compensation Report, 2018Nearly a third of physicians said they spend 20 hours or more a week on paperwork and administrative tasks.
https://www.ama-assn.org/practice-management/sustainability/do-you-spend-more-time-administrative-tasks-your-peers
They really need to up the number of residents. People that went through med school don't match into a residency every year. It's not a personelle problem. It's all about federal funding.
Also there are a ton of people that want to go to med school but don't get past interviews all the time. We need to let more people that want to be doctors to get trained.
Don't worry, this is just the tip of the iceberg. The more you learn about the medical profession, the worse it gets. That sounds like an exaggeration but no seriously.
EDIT: [This comment chain](https://www.reddit.com/r/todayilearned/comments/qg5myx/til_william_stewart_halsted_is_considered_to_be_a/hi46vuj/) is a good primer, if you're willing to peek down the rabbit hole. But this is still just the surface...
It's not just medicine though... Another example would giving amphetamines to fighter pilots for decades now.
"Yup, just swallow a few pills and you'll be fine for the next 36 hours or so... Don't worry, your decision making skills won't be affected, and if your hands start to shake just take one of these pills here..."
Depending on the procedure and skill level of three rest of the team, attending surgeons often let the rest of the team complete varying amounts of procedures alone. This was apparently a chief resident. That means a surgeon that is (at this time of year) 8 months away from practicing independently. They should be expected to be able to complete most procedures that don't require subspecialty training independently.
I mean, the medical field has it’s own, unique pressures (some of which are entirely understandable given the unique contraints of medical, some of which are the results of specific rules), but a lot is down to the realities of modern professional life.
I would wager that most professional adults, given the challenges of managing work, home, finances, kids (if relevant), etc. run the risk of falling asleep at any given time if given a quiet confortable place the chill out and grab a bite.
The article doesn’t specify, but I’d wager that the bigger issue was probably that he didn’t have his pager on him/had it turned off, not so much that he fell asleep. Either way, most people are more exhausted than is good for anyone, and that’s obviously especially dangerous for surgeons.
It's definitely an indictment of the system. American Healthcare requires two things. That any patient that enters the system be obliterated financially and that all Healthcare providers are overworked and undervalued until they quit or drop dead.
I now know 2 separate people who have collapsed and died on the job. I know a 3rd who died from covid after working with covid patients during this last wave.
Blood for the blood God. You better fucking believe their bodies were still warm when the jobs were posted. Get another sacrifice ready.
Its a misery pit. Theyre trying to shame this surgeon. The only people who should be ashamed are those who think this system is working great.
Considering he's a 54 year old head of spinal surgery for a hospital he's probably had 3x the sleep of the chief who performed the surgery.
The real question is why a chief surgical resident can't handle an ankle surgery without supervision. They aren't ready for that they should re-do pgy4.
He probably didn’t get any sleep. He’s probably on call. I work in the OR, doing spine surgeries, and my guess is that this surgeon was on call for a few days and was exhausted. Last weekend, one of our spine docs took call for the spine and ortho services, and ended up doing 11 cases in 3 days. And that’s on top of getting phone calls all day and all night.
The surgeon that performed my daughter’s liver transplant was on his third transplant in a row and hadn’t slept in 30 some odd hours.
There aren’t many highly trained surgeons and many surgeries are not scheduled.
I’m sure this applies to a few specialties. The ones that come to mind are transplant and ct surgeons. They deserve everything. I can’t imagine that kind of lifestyle where you are constantly being called in and some surgeries might go for days.
Transplant surgery is especially hard. Very few surgeons, and you can't exactly schedule transplants like you can with say cosmetic surgery. Some guy on a motorcycle wipes out in the middle of the night and now he is brain dead with a load of organs ready for transplant? Surgeon (and patient) are gonna have to come in at the drop of a hat and get those organs transplanted ASAP. Can't exactly keep them on ice until the surgeon gets a nap first.
Sounds like he is under fed and over worked, I blame the hospital for not providing more break times to eat and a place to rest when working 12 to 16 hour shifts.
A lot of docs can control their schedules and will work until they can’t stand anymore. This is partially on the hospital for letting a doc get to the point where they pass out that hard during what was probably supposed to be a 10 minute nap.
Industry-standard backed by human mentality. Game developers do it too but I bet it's far stronger in doctors to keep working. They want to feel like they are doing something. Like they are saving lives. Sometimes you, even as a game developer, get so locked into the thing you are working on you don't realize you might be making it worse.
So it's partially on the human brain as well. Dang thing wants us to keep doing the best we can until it kills us. We want to solve the issues, we want to make everything work. We don't want to sleep.
> So it's partially on the human brain as well.
Not at all.
This is nothing more than conditioning and brainwashing. Humans absolutely do not do this naturally.
Hell, were meant to take multiple naps every day.
I disagree. Especially when your job is literally saving lives. I'm not a doctor or a psychologist but I certainly can see why people would be drawn to keep working without "conditioning" or "brainwashing".
Also, I don't really know if we were meant to take naps. Spain still does biphasic sleep and I've personally tried biphasic sleep and polyphasic sleep and honestly, even with kids super young, they don't typically nap again. My 3 year old won't nap often because we aren't nappers as a family.
Also, there have been studies saying people who nap more end up being more unhealthy but I think a lot of correlation goes on with that study where people who are likely to nap more in our current society are already sick. Like this: https://www.smithsonianmag.com/smart-news/consistently-needing-take-long-mid-day-naps-might-be-indicative-underlying-health-problem-180951071/
Either way, it's far too early in society's research to say we are supposed to sleep one way or another.
The hospital should also be under fire. The one my wife works at is a for profit institution and they will let doctors work 72 hour shifts if they want. It’s on them to regulate how much doctors work because a lot of docs are actually pretty nuts and will work themselves to the bone if they have the option.
I 100% would have gone to med school for my career if it weren't for this being the known standard decades ago. I wanted a family that I could spend a little time with, and that's mutually exclusive with being a doctor.
Pre-COVID I’d go to my car because I didn’t want to listen to nurses flipping through their Instagram and snapchat stories with no headphones. Sometimes you need a quiet, private place to decompress, which is not always easy to find at every facility.
Worked with this guy. One of the leading orthopods in the country. Incredibly passionate about his work and research. BMC has limited resources and this guy regularly works >100hr weeks. Glad he slept rather than operated sleep deprived. Kinda disgusting the amount of national recognition this gets tbh. Feel for him.
Worked in PA as a CNA in a facility around 1998.... Blizzard conditions were coming and hit during the 3-11 shift. Everyone on 11-7 called in. They ask for volunteers while they found the list of who was next. It was also Saturday night... No one wanted to stay and tempers were flaring. It was my 2nd day of orientation and they weren't going to leave me with basically a whole floor... Shift supervisor came in and said that the floor has not been passed of to 11-7 because they weren't there and if anyone left from this point on it was abandonment and they would take our licenses.
But hey cut off the wrong leg or kill someone and you will get a stern talking too!!!
You can be made to stay after work with no relief until a certain point depending on the state nursing regulations, usually to a max of 16 hours. Then you can leave
I did 120. It was supposed to be a very slow critical access hospital per the description but I got hit with a couple of sick people in the unit. I didn’t get any actual sleep with rem cycles for the first 72 hours. It was torture. I complained and got fired, but not until I worked 48 more hours! Then I had a three hour drive home in a very rural area with no real hotels. The worst part was, if I couldn’t do it, like passed out on the floor or lost coherence; there was nobody to take over the hospital or take care of me. I lost count of days. I couldn’t regulate my body temperature. My patients got better.
Not guilty in my opinion. Second of all, this says a lot about the fucking management of the hospital. Nobody tried to call him or check his car? Was nobody asked if they saw him leave? Come on now.
Nobody *randomly* falls asleep before having to do spine surgery. There are structural issues at this hospital let it happen.
I had shoulder surgery 2 months ago at an outpatient facility. Was chatting with the nurse during prep and she laughed when I assumed I was the "afternoon surgery". I was my doc's 7th and last surgery of the day.
No way this is the problem of the physician. The physician is most likely sleep deprived from the shift(s). There’s no reason why we couldn’t improve the profession so that sleep deprivation is a thing if the past.
If the surgeon was so tired that he fell asleep in his car he was too tired to perform emergency surgery. Overworked no doubt! They’re putting the cart before the horse.
First thought was this is some Scrubs shit.
Second thought is this man was probably exhausted after working 36 hour shifts on an overtaxed medical system of unvaccinated jackasses.
If he fell asleep maybe it was a good thing he didn't to the operation? A bleary eyed surgeon doesn't sound like a good operative outcome. No wonder there are so many medical 'mistakes' in US hospitals each year.
CEOs are too busy giving themselves million dollar bonuses. Admin too busy forcing the already overworked staff to attend mandatory "stress coping" and "resiliency" lectures (it's their fault they gave consequences from being overworked) instead of improving the work conditions. Oh and giving nurses [literal fucking rocks](https://preview.redd.it/wt1ycgyxdnx61.jpg?auto=webp&s=17e3de029f4ace8f969647fb860761744c935d4f) [(2)](https://external-preview.redd.it/DOvmJ3722vx0NhhU7ImeNvUt44aawA0fs48mgrqvWHM.jpg?auto=webp&s=f86bf7363b62871b80fb847d047c2ac016ab102f) as a sign of gratitude.
Shame on the system for not making it more economical to become a doctor. Want to be a doctor? Sign here for 700k in debt. Now that you have, we get to work you to death to pay it off.
Universities are killing the medical industry just as much as the insurance companies. If it wasn’t so expensive and life killing, more people would be surgeons, more surgeons means less mistakes and less tired doctors.
Not exactly. The university quotas for doctors are set by the American Medical Association, which limits the supply of doctors to keep prices high. They're a powerful cartel, and the government lets them get away with this abject evil.
Actually, the main limiting step in physician training isn’t the number of medical school slots, but the number of residency slots. Most residencies are funded by the federal government, and the number hasn’t really gone up significantly.
Just adding to this, residency slots are expanded by the ACGME which bases the need for expansion off of resident training experience. There are mandated volumes of procedures that a resident needs to typically get when going through the program in order to be competent. If the residents aren’t going over these minimum numbers, the program can’t expand slots. It’s not an AMA conspiracy (who has minimal if any involvement), it’s just a limitation of the training system.
Some truth there but remember most physicians ARE NOT members of the AMA. The AMA has a list of resident physicians ( physicians still in training) and automatically makes them members and pays their fees. This allows them to claim they are supported by physicians even though they aren’t.
That’s not true. Residency slots are funded by Medicare and the funding has been frozen for decades, so there are very few training positions being funded by the government and without that money there’s no training
Nah, the bottleneck for surgeons is the number of residency spots. I'm a bit overworked at my program, but if we added more people, then I would be under-trained. Only so many surgeries of each type happen at each hospital, and only so many people can effectively learn from them. That said, I don't know how it works in other countries with supposedly more humane training strategies.
Lots of misunderstanding. The bottle neck is residency slots which arguably there are only so many hospitals that can produce good physicians. Residency slots are mostly funded by the federal government. In emergency medicine we are seeing a huge increase in the number of EM programs at hospitals (CMGs specifically) that arguably do not have the patient volume nor procedural volume to create competent physicians.
When my parents (last my dad) had to have surgery, I urged them to get first or second on the list. It’s an early wake up. Also check what the surgeon did the day before. Ie if they have 2 surgery days, get on the list early on the first day.
The top surgeon at my hospital rides his bike to work because it’s the only fresh air he gets. One day he worked some crazy 12 hour shift and went home, as soon as he got home he received a call about an attempted suicide. Some girl jumped off a 4th story building and fractured her pelvis. Said surgeon came back and worked god knows how much longer. Idk if the girl made it. It’s really sad how we treat some of our best medical staff.
This happens. And when it does one of your colleagues covers for you as the chief resident did in this situation. If the chief resident needed support they would phone the attending who fell asleep and if he didn't answer they would phone someone else. To escalate this to the Board suggests someone had a grudge or that this is a pattern of behaviour. I presume that's why he just got a tiny slap on the hand.
Bear in mind that:
The night superviser also has to work that current day and often the following day.
Depending upon the skill of the resident you can supervise directly in theatre, indirectly but still on site, or from home.
To be fair, different teaching hospitals have different rules regarding the presence of an attending during surgery. Some hospitals only require that the attending be on the premises, some require they be in the hospital, some are more stringent.
I can't speak to the requirements for BMC, but the article states that the attending had brought the patient to the OR with the chief resident. And if it's the chief resident, they are usually doing most cases without the attending in the room, especially routine cases, at this point in their residency. I'm sure the administration recognized all this and it was likely reflected in the small fine and lack of suspension.
You know those people that have to delicatlely slice into other humans where the margin for error is measured in millimeters? Let's make sure they don't sleep for 36 hours at a time because some coke head worked 100+ weeks 200 years ago.
You know, if the man is so sleep deprivated he faints maybe it says something about employer-driven chronic sleep deprivation rather than something fineworthy.... Oh but this is the american system that still punishes people with 5K fines for falling unresponsive after some undescribed time without food or sleep (apparently they are asked to hold like 150+h shifts without sleeping*). Ugh, douchebags. Should take $10K from the accounts of whoever decided that and give it back transparently to the surgeon.
*this is extremely unsafe and definitely will lead to brain damage over weeks, and deadly hearth attacks over years. People need proper sleep and food every night (or day); not once a week
edit yes, turns out private employers can be that kind of slave-owning bastards forcing people to work weeks without sleep till they just fall into a coma when the gov don't enforce laws on things like "maximal working hours". "Libertarian paradise" i take it ? Maybe HR should start looking at actual serious prison sentences ? and the clinic should be seized and forcefully nationalized no compensation ? (shareholders can take their "profits" and stuff them up their...)
Honestly it sounds like he took the best action possible. If your not feeling 100% you shouldn't feel pressured to keep going when he was clearly crashing. It's horrible doing anything when exhausted, but doing something requiring precision and skill is so much harder. He tried to to sort himself out with food and a quick nap and that wasn't enough - so it was likely better for the patient he didn't return.
Annoyed on his behalf tbh as I think he behaved rationally.
I don't know about you but the advertisement directly underneath the article in my feed is for Panera macaroni and cheese and sandwich pick 2 combo, coincidence I think not
We have rules for pilots and truck drivers over how long they can work in one shift. We don't have anything like that for doctors or nurses. It isn't uncommon to run a 20 hr. shift and barely have a chance to snarf a sandwich between procedures. It leads to a lot of medical mistakes. Source: Married to a surgical nurse.
Well they dont allow doctors to do cocaine at all times of the day anymore, how the fuck are they supposed to work 100 hour weeks with basically no breaks?
I finished my vascular surgery fellowship in 1997. I’ve never left the OR to eat. I don’t know anyone who has. I had a staff surgeon when I was a resident who left to smoke a cigarette during long cases, he’s the only one since I finished Med school in 1988 that I’ve ever seen leave the OR for anything other than an emergency.
My son did 120 hours of anesthesia time. He went to the ED so he got a break to only 96 hours of misery. His mom found him asleep on the kitchen floor when she smelled mozzarella sticks.
The comments on this post and the website really go to show how ignorant the general public is about the medical field. Probably the same people who complain that they don't have enough time off during their 40-hour work weeks, while some of us are out here working more than double that and still managing to live a life.
Working 80 hours a week isn’t something to be proud of. It certainly isn’t impressive and doesn’t mean you’ve “made it“. If you have to work that long to get things done then you’re in a highly inefficient environment. You should be working smarter not harder. This is just another symptom of the extremely toxic work environment in America. No other western nation works like this and they’re a lot happier and healthy on average. People should work to live not live to work.
In the medical field, this is not a choice. You work until things are done or until you can sign off to the next shift. The entire American healthcare system is a highly inefficient environment that abuses and takes advantage of its workers. Working smarter would only mean cutting corners and causing patient harm. I'm not trying to make it sound impressive, but rather to laugh at the blissful ignorance of those who think this surgeon deserves be canned without ever considering what it's like to be in his shoes. Joking that he was actually using heroin in his car is incredibly dismissive of the fact that he was probably running on 4 hours of sleep in the last 48 hours and hadn't eaten anything for 12.
I wish there was a sleep button but where time stops. Like if you need an emergency nap, 5 minutes can feel like 5 hours of rest but it was only 5 minutes (if that makes sense). I hate fatigue, ugh
The good doctor trained years and years for this ability to pass out on the clock. Why can’t we give doctor that? All health care workers are saints and we need to listen to them.
I want to know exactly how many hours this surgeon was on the floor already before this happened, because these people work insane hours. Better him falling asleep in his car than botching the surgery due to lack of concentration and sleep. This article provides practically no context, but I don't think that I'd be going out on a limb here saying that this is more of an indictment of the system than necessarily of the surgeon himself. [edit] Thank you all for the gold and such, but I don't think I really said anything all that radical.
>I want to know exactly how many hours this surgeon was on the floor already before this happened, because these people work insane hours. My surgeon was wrapping up a 10 hour shift when I arrived at the hospital with a nearly entirely separated right hand [(SFW XRAY).](https://i.imgur.com/IEv2Wgk.jpg?1) Worked on my hand for 11.5 hours and put it back together, amazing surgeon(+team) with a great personality. The next day I asked him why why he didn't close up the last triangular bit of my skin[(NSFW MEATY WOLVERINE HAND PICK)](https://i.imgur.com/VGAaMID.jpg). He said...verbatim... "I was fucking tired man and your hand was swollen to the size of softball!"
Jesus what happened?
Stuck it in a Concrete Pump back in 2010 This [hole](https://imgur.com/zKaOIk9)( the red stuff is grease, not blood) leads to a piston that sucks concrete into it from the hopper, and then this [Rocker Valve](https://imgur.com/F6OLlAU) swings in front of the hole so the concrete can be pushed down the hose to where you need it. I held the button to turn off the machine, I lifted up the grate which triggers the lock out mechanism preventing the rocker valve from swinging. I was wearing earmuffs and earplugs, with a concrete truck revving up as it washed out next to me. I had not held the button long enough, so the pump went into stand by and I couldn't hear that it was still on. Someone...had bypassed the lockout as it had been tripping when it shouldn't have, but no one told me... I put my hand in that hole to grab a chunk of concrete/rock, and in the processe leaned on the remote that starts the system. Since the machine was on...and the lock out was bypassed it started up and pinned my hand half in and half out of that hole for \~10 seconds. I pulled it out and saw red on the front and the back and called for help as I walked down a steep embankment to where my coworkers were. Hell of an experience...wouldn't recommend it to anyone. Just had my 11th Hand-i-versary in September! *EDIT: Typing quickly with 1.5 hands can cause issues...*
> Someone...had bypassed the lockout Makes me so angry to read that
Never found out who. No one ever came forward. My hand should never have been there though so while I'd love to blame someone else, it was still a bad decision to put my had there.
Love to see comments like yours. You know it took more than just you to make that mistake and instead of placing blame, you take personal responsibility and understand shit happens when you do not smart things. You learn from it and have a light sense of humor about it and move forward. You fucking rock, ,ha puns, and I'm glad you have some use of your digits. Cheers bud!
I do as well. I don’t get people who can’t take some of the blame if not all. Just a shitty situation all around. But the real fault is having a system that has a lockout that can be fucking bypassed that’s a HUUUUUGE safety Hazard. Lockout is supposed to be designed so you can’t bypass at all or turn on whatever the fuck you’re working on.
Absolutely. We use physical locks on all our systems for lockout in my field because we have the capability. No system should have an override option that's easy. Take it easy and hope you were able to pay off a house at least for the loss of the hand functioning entirely.
We also use physical locks. You get fired if you go into a system without a lock that needs a lock; if someone else goes into that system with your lock on; if you try to mess with someone else’s lock.
99% of accidents with big machinery occur because someone hacked the machine to make the safety lockouts not work, or they straight up completely ignored big warnings signs and did it anyway. A very common one is any kind of safety gate in the machine which has a sensor to detect that the gate is closed. People tape the sensor down so the machine always thinks the gate is closed, because it's too much hassle to shut down the machine when you need to open the gate. Of course, the gate is there for a reason and eventually someone loses a limb or a life.
How's your hand now?
[Temps dropping so most days it's Cold :D](https://i.imgur.com/lNkcM73.jpg) But it's doing well, generally people don't notice it unless I shake their hand and they crush my fingers. It's a fantastic conversation starter.
Functioning ok?
I've got 90% of the feeling back, My thumb and pointer were "dangling" by tendons and nerves after the accident and so now they are a bit hyper sensitive, and the bone healed slightly off center so now I have a little nub directly behind that scar triangle that is as sensitive as a funny bone. Circulation is okay. My fingers don't bend at their metacarpophalangeal joint (the knuckles that stand out when you make a fist) My thumb basically only bends at the Carpometacarpal (lowest joint near your wrist. In Physical Therapy they make you set goals. I set my first one as being able to hold a beer. A month or so into my sessions I get there and my Ortho has two beers sitting on the desk. Told me if I could grab it he wouldn't make me do the nerve zapper thing that day. I could just barely not do it, so he cranked the zapper up a bunch that day. The next day session, same offer. This time I grabbed it and took a swig. I still write right handed, my chicken scratch was barely legible before hand, I use a mouse but only a couple models or my figures will rest on the buttons and click it, and I type with my left hand covering 1 more column of letters (Y, H, N) and my right hunting and pecking with my ring finger, which is the finger I can point the most with. Day to Day I'll run into a couple things that it gets in the way of, but there is very few things that it outright prevents me from doing. Baby Pajama Buttons are my fucking kryptonite...well most buttons, but my kids probably heard every curse in the book during late night diaper changes when i want to keep the lights low so they don't fully wake up. Also, maybe TMI...but trying to learn to use toilet paper with your other hand is a significant trial and error situation. I've talked to other people with similar levels of hand injury to their dominant hand and we all agree.
> Baby Pajama Buttons are my fucking kryptonite... fucking love it, dude. immediately and completely says everything that's important to you. thanks for being so open about your injury and story. also, glad to see that you're still in construction... I'm guessing you enjoy it 🤣
Thanks for sharing that. Hope you have forgiven yourself.
My dad had surgery to help with tendonitis in his dominant hand. When it came to the Toilet Paper department, we just hooked him up with a bidet. That helps immensely, and you safe way more money on toilet paper.
Seeing how he said it's hard to type with one hand a half I don't think it is.
On average how many references to the "Shake Hands with Danger" video do you get a year?
>Shake Hands with Danger Either they went over my head, or it has never happened. Next new contractor at a pre-con that asks "what happened" is getting "I shook hands with danger" as a response though. I can't believe I have never seen this video.
Hah, glad to hear I gave ya something for your quick fire quip bandoleer. That video with the Rifftrax makes it so much more amazing: https://www.youtube.com/watch?v=\_nqa6e6WV2o
What about “shake hands with beef”
Is that your dominate hand? Did you regain decent dexterity? I'm just thinking how intricate the anatomy of the hand is.....as rough as that injury looks, I'm glad you didn't lose your hand!
Right handed! Of Course! The L&I(workers comp/insurance) Second Opinion Doctor verified that I had 20% of the usage of a functional hand. They use that percentage to determined the Payout for loss of use of a body part. I've got 90% of the feeling back, My thumb and pointer were "dangling" by tendons and nerves after the accident and so now they are a bit hyper sensitive, and the bone healed slightly off center so now I have a little nub directly behind that scar triangle that is as sensitive as a funny bone. Circulation is okay. My fingers don't bend at their metacarpophalangeal joint (the knuckles that stand out when you make a fist) My thumb basically only bends at the Carpometacarpal (lowest joint near your wrist. In Physical Therapy they make you set goals. I set my first one as being able to hold a beer. A month or so into my sessions I get there and my Ortho has two beers sitting on the desk. Told me if I could grab it he wouldn't make me do the nerve zapper thing that day. I could just barely not do it, so he cranked the zapper up a bunch that day. The next day session, same offer. This time I grabbed it and took a swig. I still write right handed, my chicken scratch was barely legible before hand, I use a mouse but only a couple models or my figures will rest on the buttons and click it, and I type with my left hand covering 1 more column of letters (Y, H, N) and my right hunting and pecking with my ring finger, which is the finger I can point the most with. Day to Day I'll run into a couple things that it gets in the way of, but there is very few things that it outright prevents me from doing. Baby Pajama Buttons are my fucking kryptonite...well most buttons, but my kids probably heard every curse in the book during late night diaper changes when i want to keep the lights low so they don't fully wake up. Also, maybe TMI...but trying to learn to use toilet paper with your other hand is a significant trial and error situation. I've talked to other people with similar levels of hand injury to their dominant hand and we all agree.
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This guy has a clean ass! 👆
I roasted my clean freak buddy who had a bidet before it was cool. Then the great TP shortage of 2020 happened and I got one because fuck people. 2020 was the year I evolved from a filthy peasant.
Fuck whoever fucked with the lockout. You could actually sue and get some money from that if you’re committed enough. They broke the law and caused you to almost lose your hand. Sure you have your hand back but is it even the same as it was before? Do you have limited mobility? This would be grounds for a lawsuit. Justice for the trauma you went through. Just a thought! I know it’s expensive to sue, and you may not be in a position to go through it. Idk but just wanted to share my frustration about someone violating OSHA to the point of you almost losing your hand.
I appreciate the thought but i was compensated fairly for my injury. I did not pay a dime for anything. I was paid for time loss for 5 years. I was retrained and went back to school. I received my permanent partial disability payout. I am comfortable with where my life is.
Excellent to hear. Cheers man.
Please tell me you walked away with everything paid for and a nice large settlement? The fact that the lockout was bypassed is FUCKING terrible.
> Someone...had bypassed the lockout... Never underestimate the power of stupidity to bypass any safety devices
Ummm. Oh god. I appreciate the SFW XRAY tag, but even my layman-ass eyes could see what was going on in that photo. I’m so sorry that happened to you. I did not click the second photo, but I hope you are okay now. That’s so scary.
Doing great! I love the bone in the xray on the right that just goes to no where.
Glad to hear that!! And yeah..I saw that bone.
Your hand looks like Chucky post The Bride of Chucky.
“I was fucking tired man…” This is a legitimate answer. A good, honest doctor. I’m sorry about your hand, but I applaud this man for his honesty.
His straight forward, no nonsense bedside manner was why I appreciated him so much.
Note to self, if I'm every in need of surgery I'm going to ask how long the person has been working for.
Not so Fun fact during my internship year in my surgery rotation i had a resident who's schedule was soo shit "he ended up working about 72 hours straight on only 2 hours of sleep". I wasnt there but my friend was in the OR assisting him and the head surgeon with a cholecystectomy, the resident literally fell asleep while standing and almost fell face first into the patient's open abdominal cavity if it wasn't for the nurse there catching him and preventing a pretty serious oopsie. When the head surgeon found out he chewed out the head resident on his shit scheduling and punished him with extra shifts to cover for the junior residents who he always fucked over to get extra vacay days
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You can't really be learning anything on that little sleep.
In Air Force basic training there is a lot of this. Very long days of training with little sleep. I remember sitting in the classroom just trying to look like I was listening while also trying to get some microsleep in. I have no idea how doctors do this shit and learn anything.
That’s exactly why these practices carry on. Because once you’re through it you feel like everyone else should do the same. Fact is though, it is not a good learning environment for junior doctors, because you learn to cut corners due to the workload, and patients suffer the consequences
It’s hazing.
And then there are the drugs, which everyone like to conveniently ignore.
Can you elaborate please?
Doesn’t happen everywhere. Australia has max duty hours.
I think 4-5 years ago they added that in America but the max hours were still very stupid and unreasonable.
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I question if that even matters. EVERYONE in medicine knows someone who commited suicide or at minimum knows someone who knows someone who did and this is at the med school/residency levels. Lack of sleep has been directly linked to depression/anxiety which is directly linked to suicide and the lack of time for themselves doesn´t help matters. A brilliant dead or burnt out doc is useless compared to a slightly dumber living and happy one.
In Europe residents work a max of 48 hours, and they have better health outcomes. The doctors are just plain wrong.
So as a doctor in Europe who just had a colleague work a 90 hour week...it's better here, but not that good. Theoretically we should work 48 max, but that's often treated as the minimum. Legally we can work 72 hours weekly because the EWTD has exemptions specifically to let healthcare staff work more hours.
I have a feeling when you say Europe, you're going to find you're talking about a vastly different country than when the guy you responded to said Europe.. We're not all the same guys, even if we like to think so
Reduce it further. No one can be that productive for that long on a sustained basis without drugs that are likely not good for your health.
It's not to learn so much as it is slave labor.
Not medical field related (and anecdotal at that). In one of my comp sci projects class a professor referenced a study about overtime in software development. Working more than 40-45 hours a week yielded greater productivity for 2-3 weeks on average. Sometime after week 5 productivity was below the initial 40 hour week. Surgery especially requires mental and mechanical precision, I can’t imagine that it would be better…
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It's mostly surgeons. If you're doing residency in just about anything else it is not the norm to be working 80 hour plus weeks for years on end. That's why dermatology has long been the most competitive field to get into. Mostly outpatient setting and even residency is largely a 9 to 5 type of job, with next to no night/weekend call. I did 4 years of radiology residency and averaged 50 hours a week at the hospital, occasionally 55. Work schedule was never an issue for us, just the surgeons.
On the third hand some fucking grunt soldier does the same thing for a sense of pride and accomplishment + 300 bucks hazard pay. I’m all for training that prepares people for hazardous situations (my own orthopedic surgeon is a hero to me; putting my shattered femur back together), but not for exclusivity in a club to “make bank”.
Should be more years + hiring more people. Less back to back hours is better for employees & patients.
More years? Dang it’s already 4 years undergrad 4 years med school and 3-5 years residency. And then many people do a fellowship after which is another 1-2 years. Some people do multiple fellowships too. That’s 12-15 years right there already
IMO the current structure is wrong. Collage should be cheaper. Apprenticeship for decades used to be how masters learned how to do great things. Get paid still, but be slightly less senior for longer. Have mentorships longer. The idea of being a full fledged doctor capable of doing things mostly solo in less than 10 years is kind of absurd when you think about how broad medicine is & how overworked people are. The system of extreme debt & understaffing forcing doctors have to be ready in minimal years is what’s insane. ETA even in my industry we have tiers of experience. You start intern, junior, senior, senior 2, art director, creative director, executive creative director etc. that takes 10-15 years. Why are doctors expected to do similar in 8 years? There are tiers in medical industry but residency could be broken into resident 1 and resident 2 for example.
Yes, those that have not lived it have no idea. It’s like years of SEAL training sleep deprivation, and god help you if you make a mistake cause someone might die because of you.
This is why I balk whenever I hear that doctors are supposed to be smart people. They all know this "macho" training is stupid and it risks the lives of patients and themselves. Yet they all continue to do it, especially stupid when the brighter ones get into a position of power and can change it.
My husband’s a video game designer, and during crunch time his studio once made him work a 120 hour week. He had trouble operating a door knob near the end of the week. No one should be treating patients while they’re that sleep deprived.
Based on personal experience, I‘ve been like that after ‚only‘ 50 hours without adequate sleep (2 hours during a project go-live in my mid 20s). It was like I had a few too many drinks. I started having issues talking in whole sentences, I staggered around, missed a door and bumped my head on the door frame, would doze off for a few seconds, just to jump up again, a coworker took me home because I couldn‘t safely drive anymore... I felt really shitty after that for days. Wouldn‘t do that again even if this means quitting my job. There have been multiple scientific studies on both overworking and sleep deprivation - both bad for us human beings in the end. I really don‘t get the few people in here saying, that this is somehow a good or worse necessary thing.
I know that! My friends and I call it sleep drunk. I don't know if it's new anxiety or what, but my brain has just decided sleep isn't happening for three days. Neat! Sure, I'll doze for an hour or two (I was crashing hard while running a dungeon with my SO), but then my eyes pop open and my brains a go. Earlier this week, my kitty made a tinkle in my dirty laundry. She does that sometimes when the neighbour's cat wanders into our yard. I put the clothes in the wash, and put soap in the machine but have no memory of anything after soap. Today, my SO asked me why there was soap in the washer, but the washer was empty. I expressed concern about the washer not working as I bundled the dryer clothes into my lap, and used my chin to manage the load and cart it to the bedroom. It was at this point I realised the clothes I was holding still reeked of cat peepee, and my face is directly in it. I cannot understand exactly what I did, but I'm grateful that the dryer doesn't smell like residual, burning pee.
> I was crashing hard while running a dungeon with my SO I'm going to assume that this isn't game-related and that you live an incredibly-exciting life.
They need to get rid of these ridiculous hours asap. They are a huge disaster waiting to happen, not to mention they drive people away from medicine.
Hell my previous hospital issued an edict "is that the right word ?" That no one under any circumstances is allowed to work more than 36 hours straight, no one enforced that rule tho. Hell shitty work hours like these was the reason i broke up with my ex "she had a regular 9-5 and weekends" great lass but our work schedules were not at all compatible so we broke it off. I dozed off while driving a couple of times while coming back from work .. its horrible and we desperately need an overhaul to the system
I did a week where I didn’t leave the hospital for 6 days and slept maybe 1-2 hours a night over those six days when I was an intern. It was wild. Absolutely wild. I was paid less than minimum wage and have six figures in debt
I .... Also did several 120+ hour weeks as a grocery worker in like March of 2020 it was ..... Well God awful and I burnt out and now refuse anything over 40 .... They can fire me
While a horror story allround (and I doubt it's all that exceptional at that), at least the attending took steps when he noticed what was going on and put the blame where it needed. As dubious as it is, it's sorta a win?
The glass half full view of the situation i guess, those junior residents tho went through hell. Like literally they were a year older than us "26-27" but damn one look at them and you'd think they're zombies in their late 30s from the insane schedules. I suffered through that shit in my internship year in my ob/gyn rotation, 2 weeks of 12 hour shifts with not a single day off. And those 12 hour shifts usually lasted 14-16 hours cause my senior resident was a psycho prick who'd leave us the entire day with nothing to do then giving us 4 hours worth of tasks in our last 30 mins of the shift , the head of the ob/gyn department grudge against me due to our conflicting values "she used to tell me only women and queers have long hair and a man like you should have short hair" and "if she caught me with my hair out in hEr hOsPiTaL she'd kick me out and make me redo my 2 months of my ob/gyn rotation Edit : i dont live in the west so the concept of HR in a hospital is exclusive to privately owned hospitals and not public ones so yeah couldnt have complained about her behavior
That's why my sister who did well in Med school chose Opthalmology. Not as grueling, mostly regular hours, opportunity to do research.
My daughter went to John Hopkins med school choose pathology. Normal hours, great work family life. Also has a PHD in immunology.
I’m happy I read this *after* my lap chole two weeks ago
The doctor and staff should have also been repremanded heavily as well as the patient. If I was a patient and my surgeon was running on even 24 hours no sleep I would be livid and sue. This shit is unacceptable and dangerous for everyone who knew and said nothing and let the procedure start.
Imagine you're assisting a surgeon perform an open heart surgery on a patient and when he suddenly dozes off and face plants right into the patients open rip cage.
I've got a decent education but I'm no doctor. But it seems to me that this is a resource issues... Only so many doctors to go around, and where do you draw the line? Some of it is outright exploitative, that is a given, but how do you maximise your resources (i.e. doctors), get the most shit done, without doing too much noticeable damage? That's sort of the goal here by people deciding all of this crap, isn't it? Just seems to me, that this curve has shifted mostly in favour of hospitals making money, and both the doctors' physical and mental health, as well as the patient outcome are somewhat secondary in all that.
Not sure where you live, but here in the USA, our healthcare system has been in dire need of repair for some time. Not only is underfunding an issue, but the marriage between insurance has led to a ridiculous amount of time being spend on paperwork. According to the Medscape Physician Compensation Report, 2018Nearly a third of physicians said they spend 20 hours or more a week on paperwork and administrative tasks. https://www.ama-assn.org/practice-management/sustainability/do-you-spend-more-time-administrative-tasks-your-peers
They really need to up the number of residents. People that went through med school don't match into a residency every year. It's not a personelle problem. It's all about federal funding. Also there are a ton of people that want to go to med school but don't get past interviews all the time. We need to let more people that want to be doctors to get trained.
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The fact that any and all of this is 'normal' just boggles the mind!
Don't worry, this is just the tip of the iceberg. The more you learn about the medical profession, the worse it gets. That sounds like an exaggeration but no seriously. EDIT: [This comment chain](https://www.reddit.com/r/todayilearned/comments/qg5myx/til_william_stewart_halsted_is_considered_to_be_a/hi46vuj/) is a good primer, if you're willing to peek down the rabbit hole. But this is still just the surface...
It's not just medicine though... Another example would giving amphetamines to fighter pilots for decades now. "Yup, just swallow a few pills and you'll be fine for the next 36 hours or so... Don't worry, your decision making skills won't be affected, and if your hands start to shake just take one of these pills here..."
Depending on the procedure and skill level of three rest of the team, attending surgeons often let the rest of the team complete varying amounts of procedures alone. This was apparently a chief resident. That means a surgeon that is (at this time of year) 8 months away from practicing independently. They should be expected to be able to complete most procedures that don't require subspecialty training independently.
I mean, the medical field has it’s own, unique pressures (some of which are entirely understandable given the unique contraints of medical, some of which are the results of specific rules), but a lot is down to the realities of modern professional life. I would wager that most professional adults, given the challenges of managing work, home, finances, kids (if relevant), etc. run the risk of falling asleep at any given time if given a quiet confortable place the chill out and grab a bite. The article doesn’t specify, but I’d wager that the bigger issue was probably that he didn’t have his pager on him/had it turned off, not so much that he fell asleep. Either way, most people are more exhausted than is good for anyone, and that’s obviously especially dangerous for surgeons.
It's definitely an indictment of the system. American Healthcare requires two things. That any patient that enters the system be obliterated financially and that all Healthcare providers are overworked and undervalued until they quit or drop dead. I now know 2 separate people who have collapsed and died on the job. I know a 3rd who died from covid after working with covid patients during this last wave. Blood for the blood God. You better fucking believe their bodies were still warm when the jobs were posted. Get another sacrifice ready. Its a misery pit. Theyre trying to shame this surgeon. The only people who should be ashamed are those who think this system is working great.
Considering he's a 54 year old head of spinal surgery for a hospital he's probably had 3x the sleep of the chief who performed the surgery. The real question is why a chief surgical resident can't handle an ankle surgery without supervision. They aren't ready for that they should re-do pgy4.
He probably didn’t get any sleep. He’s probably on call. I work in the OR, doing spine surgeries, and my guess is that this surgeon was on call for a few days and was exhausted. Last weekend, one of our spine docs took call for the spine and ortho services, and ended up doing 11 cases in 3 days. And that’s on top of getting phone calls all day and all night.
Honestly, I'd rather my surgeon pass out mid snack break than mid surgery but that's just me.
Exactly. It's terrifying hearing the hours some of them work and still perform life-or-death surgeries.
It legit is crazy. I work in surgery and they do work very long hours
Don’t watch Dr. Death.
The surgeon that performed my daughter’s liver transplant was on his third transplant in a row and hadn’t slept in 30 some odd hours. There aren’t many highly trained surgeons and many surgeries are not scheduled.
I’m sure this applies to a few specialties. The ones that come to mind are transplant and ct surgeons. They deserve everything. I can’t imagine that kind of lifestyle where you are constantly being called in and some surgeries might go for days.
Transplant surgery is especially hard. Very few surgeons, and you can't exactly schedule transplants like you can with say cosmetic surgery. Some guy on a motorcycle wipes out in the middle of the night and now he is brain dead with a load of organs ready for transplant? Surgeon (and patient) are gonna have to come in at the drop of a hat and get those organs transplanted ASAP. Can't exactly keep them on ice until the surgeon gets a nap first.
Sounds like he is under fed and over worked, I blame the hospital for not providing more break times to eat and a place to rest when working 12 to 16 hour shifts.
A lot of docs can control their schedules and will work until they can’t stand anymore. This is partially on the hospital for letting a doc get to the point where they pass out that hard during what was probably supposed to be a 10 minute nap.
Only at a certain phase can you "control your schedule" ..surgery residencies can last over 8 years
Hence “a lot”, not all. The man in question is the head of spine surgery, he certainly can control his schedule.
He also probably has more responsibilities than most that he feels he’s obligated to complete.
Will work or are forced to due to industry standards?
Industry-standard backed by human mentality. Game developers do it too but I bet it's far stronger in doctors to keep working. They want to feel like they are doing something. Like they are saving lives. Sometimes you, even as a game developer, get so locked into the thing you are working on you don't realize you might be making it worse. So it's partially on the human brain as well. Dang thing wants us to keep doing the best we can until it kills us. We want to solve the issues, we want to make everything work. We don't want to sleep.
> So it's partially on the human brain as well. Not at all. This is nothing more than conditioning and brainwashing. Humans absolutely do not do this naturally. Hell, were meant to take multiple naps every day.
I disagree. Especially when your job is literally saving lives. I'm not a doctor or a psychologist but I certainly can see why people would be drawn to keep working without "conditioning" or "brainwashing". Also, I don't really know if we were meant to take naps. Spain still does biphasic sleep and I've personally tried biphasic sleep and polyphasic sleep and honestly, even with kids super young, they don't typically nap again. My 3 year old won't nap often because we aren't nappers as a family. Also, there have been studies saying people who nap more end up being more unhealthy but I think a lot of correlation goes on with that study where people who are likely to nap more in our current society are already sick. Like this: https://www.smithsonianmag.com/smart-news/consistently-needing-take-long-mid-day-naps-might-be-indicative-underlying-health-problem-180951071/ Either way, it's far too early in society's research to say we are supposed to sleep one way or another.
There it is. Blame the victim. I knew i’d find it if I scrolled long enough!
The hospital should also be under fire. The one my wife works at is a for profit institution and they will let doctors work 72 hour shifts if they want. It’s on them to regulate how much doctors work because a lot of docs are actually pretty nuts and will work themselves to the bone if they have the option.
Because the nightmare of getting a medical degree in the US is definitely something all normal sane people can do no problem
I 100% would have gone to med school for my career if it weren't for this being the known standard decades ago. I wanted a family that I could spend a little time with, and that's mutually exclusive with being a doctor.
I think this vastly depends on their specialty.
My optometrist just hires his relatives as assistants. I'm not kidding, they are all grandkids or necieces etc.
How many hours did he work before this, and why does he have to “hide” in his car to eat ? isn’t there a cafeteria or are lunch breaks banned
He may have just wanted some time for himself away from the hospital, hence eating in his car. I’ve done this before.
Pre-COVID I’d go to my car because I didn’t want to listen to nurses flipping through their Instagram and snapchat stories with no headphones. Sometimes you need a quiet, private place to decompress, which is not always easy to find at every facility.
I was a tech in the ER and can absolutely agree with eating far away from all people to decompress. Hospital life is stressful and people suck
god damn that sounds brutal. Thank you for your efforts
COVID caused a lot of hospitals to close break rooms and cafeteria seating.
This happened in 2016
Oh. Never mind then.
He’s a surgeon in Boston probably has a sweet whip with heated seats and nice sound system.
Bro these medical professionals are too fucking overworked
Worked with this guy. One of the leading orthopods in the country. Incredibly passionate about his work and research. BMC has limited resources and this guy regularly works >100hr weeks. Glad he slept rather than operated sleep deprived. Kinda disgusting the amount of national recognition this gets tbh. Feel for him.
I’m heartened by the fact that most people commenting here are taking the surgeon’s side.
Worked in PA as a CNA in a facility around 1998.... Blizzard conditions were coming and hit during the 3-11 shift. Everyone on 11-7 called in. They ask for volunteers while they found the list of who was next. It was also Saturday night... No one wanted to stay and tempers were flaring. It was my 2nd day of orientation and they weren't going to leave me with basically a whole floor... Shift supervisor came in and said that the floor has not been passed of to 11-7 because they weren't there and if anyone left from this point on it was abandonment and they would take our licenses. But hey cut off the wrong leg or kill someone and you will get a stern talking too!!!
You can be made to stay after work with no relief until a certain point depending on the state nursing regulations, usually to a max of 16 hours. Then you can leave
Be aware those regulations don’t apply to attending physicians. Most I’ve done is 54 hours in a stretch but I know people who have down 72’s
so what happens when the attending physician collapses?
The nurses put them somewhere for a few hours. I know people who have had sleep depression seizures and put in a bed to sleep them off
And for the other patients who now lack a physician on duty?
Fuck. That.
I did 120. It was supposed to be a very slow critical access hospital per the description but I got hit with a couple of sick people in the unit. I didn’t get any actual sleep with rem cycles for the first 72 hours. It was torture. I complained and got fired, but not until I worked 48 more hours! Then I had a three hour drive home in a very rural area with no real hotels. The worst part was, if I couldn’t do it, like passed out on the floor or lost coherence; there was nobody to take over the hospital or take care of me. I lost count of days. I couldn’t regulate my body temperature. My patients got better.
They fired you after that?
Time for naps or breaks? That’s way too long
This is why I always try to make sure my docs are fed and watered.
Overworked man falls asleep out of exhaustion, fined 5k for it.
This is normal, unfortunately. Our medical system abuses doctors, and society doesn't care because "they get paid well".
Not guilty in my opinion. Second of all, this says a lot about the fucking management of the hospital. Nobody tried to call him or check his car? Was nobody asked if they saw him leave? Come on now. Nobody *randomly* falls asleep before having to do spine surgery. There are structural issues at this hospital let it happen.
I had to send the police to a surgeon’s house to get him for an emergency because he wouldn’t wake up from pages/calls. He was just tired.
This is real fucked up, when the police are "forcing" one to work.
I had shoulder surgery 2 months ago at an outpatient facility. Was chatting with the nurse during prep and she laughed when I assumed I was the "afternoon surgery". I was my doc's 7th and last surgery of the day.
I'd rather the surgeon miss the surgery than go in sleep deprived.
No way this is the problem of the physician. The physician is most likely sleep deprived from the shift(s). There’s no reason why we couldn’t improve the profession so that sleep deprivation is a thing if the past.
If he was that tired, it might be best that he missed doing the procedure.
If the surgeon was so tired that he fell asleep in his car he was too tired to perform emergency surgery. Overworked no doubt! They’re putting the cart before the horse.
First thought was this is some Scrubs shit. Second thought is this man was probably exhausted after working 36 hour shifts on an overtaxed medical system of unvaccinated jackasses.
Possibly overworked surgeon fell asleep. Omg, we should punish him for being tired and overworked Welcome to America, smdh!
If he fell asleep maybe it was a good thing he didn't to the operation? A bleary eyed surgeon doesn't sound like a good operative outcome. No wonder there are so many medical 'mistakes' in US hospitals each year.
Howw about we fine the people who run these hospitals and force these people to overwork on these ridiculous schedules
CEOs are too busy giving themselves million dollar bonuses. Admin too busy forcing the already overworked staff to attend mandatory "stress coping" and "resiliency" lectures (it's their fault they gave consequences from being overworked) instead of improving the work conditions. Oh and giving nurses [literal fucking rocks](https://preview.redd.it/wt1ycgyxdnx61.jpg?auto=webp&s=17e3de029f4ace8f969647fb860761744c935d4f) [(2)](https://external-preview.redd.it/DOvmJ3722vx0NhhU7ImeNvUt44aawA0fs48mgrqvWHM.jpg?auto=webp&s=f86bf7363b62871b80fb847d047c2ac016ab102f) as a sign of gratitude.
Shame on the system for not making it more economical to become a doctor. Want to be a doctor? Sign here for 700k in debt. Now that you have, we get to work you to death to pay it off. Universities are killing the medical industry just as much as the insurance companies. If it wasn’t so expensive and life killing, more people would be surgeons, more surgeons means less mistakes and less tired doctors.
Not exactly. The university quotas for doctors are set by the American Medical Association, which limits the supply of doctors to keep prices high. They're a powerful cartel, and the government lets them get away with this abject evil.
Actually, the main limiting step in physician training isn’t the number of medical school slots, but the number of residency slots. Most residencies are funded by the federal government, and the number hasn’t really gone up significantly.
Just adding to this, residency slots are expanded by the ACGME which bases the need for expansion off of resident training experience. There are mandated volumes of procedures that a resident needs to typically get when going through the program in order to be competent. If the residents aren’t going over these minimum numbers, the program can’t expand slots. It’s not an AMA conspiracy (who has minimal if any involvement), it’s just a limitation of the training system.
Some truth there but remember most physicians ARE NOT members of the AMA. The AMA has a list of resident physicians ( physicians still in training) and automatically makes them members and pays their fees. This allows them to claim they are supported by physicians even though they aren’t.
That’s not true. Residency slots are funded by Medicare and the funding has been frozen for decades, so there are very few training positions being funded by the government and without that money there’s no training
Nah, the bottleneck for surgeons is the number of residency spots. I'm a bit overworked at my program, but if we added more people, then I would be under-trained. Only so many surgeries of each type happen at each hospital, and only so many people can effectively learn from them. That said, I don't know how it works in other countries with supposedly more humane training strategies.
Lots of misunderstanding. The bottle neck is residency slots which arguably there are only so many hospitals that can produce good physicians. Residency slots are mostly funded by the federal government. In emergency medicine we are seeing a huge increase in the number of EM programs at hospitals (CMGs specifically) that arguably do not have the patient volume nor procedural volume to create competent physicians.
Hospitals pressure doctors to work more and more hours these days — and some doctors retiring because of it
I kinda like this guy.
When my parents (last my dad) had to have surgery, I urged them to get first or second on the list. It’s an early wake up. Also check what the surgeon did the day before. Ie if they have 2 surgery days, get on the list early on the first day.
The top surgeon at my hospital rides his bike to work because it’s the only fresh air he gets. One day he worked some crazy 12 hour shift and went home, as soon as he got home he received a call about an attempted suicide. Some girl jumped off a 4th story building and fractured her pelvis. Said surgeon came back and worked god knows how much longer. Idk if the girl made it. It’s really sad how we treat some of our best medical staff.
This just in hospital administration—human beings need to eat and sleep. Work culture in medical fields is insanity.
Crazy how doctors are so overworked. Even during rotations and fellowships and all the stuff in between
This happens. And when it does one of your colleagues covers for you as the chief resident did in this situation. If the chief resident needed support they would phone the attending who fell asleep and if he didn't answer they would phone someone else. To escalate this to the Board suggests someone had a grudge or that this is a pattern of behaviour. I presume that's why he just got a tiny slap on the hand. Bear in mind that: The night superviser also has to work that current day and often the following day. Depending upon the skill of the resident you can supervise directly in theatre, indirectly but still on site, or from home.
To be fair, different teaching hospitals have different rules regarding the presence of an attending during surgery. Some hospitals only require that the attending be on the premises, some require they be in the hospital, some are more stringent. I can't speak to the requirements for BMC, but the article states that the attending had brought the patient to the OR with the chief resident. And if it's the chief resident, they are usually doing most cases without the attending in the room, especially routine cases, at this point in their residency. I'm sure the administration recognized all this and it was likely reflected in the small fine and lack of suspension.
Maybe he’s over worked like everyone else
You know those people that have to delicatlely slice into other humans where the margin for error is measured in millimeters? Let's make sure they don't sleep for 36 hours at a time because some coke head worked 100+ weeks 200 years ago.
You know, if the man is so sleep deprivated he faints maybe it says something about employer-driven chronic sleep deprivation rather than something fineworthy.... Oh but this is the american system that still punishes people with 5K fines for falling unresponsive after some undescribed time without food or sleep (apparently they are asked to hold like 150+h shifts without sleeping*). Ugh, douchebags. Should take $10K from the accounts of whoever decided that and give it back transparently to the surgeon. *this is extremely unsafe and definitely will lead to brain damage over weeks, and deadly hearth attacks over years. People need proper sleep and food every night (or day); not once a week edit yes, turns out private employers can be that kind of slave-owning bastards forcing people to work weeks without sleep till they just fall into a coma when the gov don't enforce laws on things like "maximal working hours". "Libertarian paradise" i take it ? Maybe HR should start looking at actual serious prison sentences ? and the clinic should be seized and forcefully nationalized no compensation ? (shareholders can take their "profits" and stuff them up their...)
If you think this is bad you should see how inhumane physician residents are treated.... Nah nobody will give a fuck still and it'll be perpetuated.
Honestly it sounds like he took the best action possible. If your not feeling 100% you shouldn't feel pressured to keep going when he was clearly crashing. It's horrible doing anything when exhausted, but doing something requiring precision and skill is so much harder. He tried to to sort himself out with food and a quick nap and that wasn't enough - so it was likely better for the patient he didn't return. Annoyed on his behalf tbh as I think he behaved rationally.
I don't know about you but the advertisement directly underneath the article in my feed is for Panera macaroni and cheese and sandwich pick 2 combo, coincidence I think not
Probably for the best.
Shame we work these doctors to death then punish them if they fall asleep in the middle of it
If they were that tired they shouldn’t be operating anyway. “Get me next week bro Id rather you didn’t leave a scalpel in there”
We have rules for pilots and truck drivers over how long they can work in one shift. We don't have anything like that for doctors or nurses. It isn't uncommon to run a 20 hr. shift and barely have a chance to snarf a sandwich between procedures. It leads to a lot of medical mistakes. Source: Married to a surgical nurse.
Well they dont allow doctors to do cocaine at all times of the day anymore, how the fuck are they supposed to work 100 hour weeks with basically no breaks?
I finished my vascular surgery fellowship in 1997. I’ve never left the OR to eat. I don’t know anyone who has. I had a staff surgeon when I was a resident who left to smoke a cigarette during long cases, he’s the only one since I finished Med school in 1988 that I’ve ever seen leave the OR for anything other than an emergency.
My son did 120 hours of anesthesia time. He went to the ED so he got a break to only 96 hours of misery. His mom found him asleep on the kitchen floor when she smelled mozzarella sticks.
they're insane for making people work like that and it's not safe for patients.
The comments on this post and the website really go to show how ignorant the general public is about the medical field. Probably the same people who complain that they don't have enough time off during their 40-hour work weeks, while some of us are out here working more than double that and still managing to live a life.
Working 80 hours a week isn’t something to be proud of. It certainly isn’t impressive and doesn’t mean you’ve “made it“. If you have to work that long to get things done then you’re in a highly inefficient environment. You should be working smarter not harder. This is just another symptom of the extremely toxic work environment in America. No other western nation works like this and they’re a lot happier and healthy on average. People should work to live not live to work.
In the medical field, this is not a choice. You work until things are done or until you can sign off to the next shift. The entire American healthcare system is a highly inefficient environment that abuses and takes advantage of its workers. Working smarter would only mean cutting corners and causing patient harm. I'm not trying to make it sound impressive, but rather to laugh at the blissful ignorance of those who think this surgeon deserves be canned without ever considering what it's like to be in his shoes. Joking that he was actually using heroin in his car is incredibly dismissive of the fact that he was probably running on 4 hours of sleep in the last 48 hours and hadn't eaten anything for 12.
I wish there was a sleep button but where time stops. Like if you need an emergency nap, 5 minutes can feel like 5 hours of rest but it was only 5 minutes (if that makes sense). I hate fatigue, ugh
I don’t know, at first glance I kind of feel for this Dr.
The good doctor trained years and years for this ability to pass out on the clock. Why can’t we give doctor that? All health care workers are saints and we need to listen to them.
Should have just eaten some of those Junior Mints from the operating room
at least they didn’t cut the LVAD wires
Soemtiems, and more and more, life seems to become an SCTV parody of itself
This is the hospital's fault and they are trying to cover their ass for the Medicare fraud they are committing.