The Challenge of Rest

September 7, 2010

I have mixed emotions about constricting resident work hours even further. I understand the rationale, and certainly in a perfect world, no one would ever work fatigued. But, in our imperfect world, maybe there is some logic to (borrowing a phrase from the military) train like you fight.

Ahh...Labor Day Weekend. A chance to relax, unwind, enjoy the last lazy days of summer. Or, if you're like me, a chance to get everything done you've been meaning to do all summer long. Saturday and Sunday passed in a blur of frenetic activity - gardening, mowing, cleaning, cooking, laundry. But Labor Day found the yard work done, the house clean, the laundry caught up. Not much to do (okay there's still a lot to do). I actually rested from my labors. It is hard for me to do, much harder than fitting 10 hours of chores into six.

As the IOM and ACGME organizations debate the newest version of resident work hours, I ponder the training I've received. It often was fatiguing - emotionally, intellectually, and physically. I guess in a way it did prepare me to do things fatigued. Even now, I find it easier to admit a patient to the hospital at 3 a.m. than to soothe a restless child back to sleep. I have much more experience with the former. 

I have mixed emotions about constricting resident work hours even further. I understand the rationale, and certainly in a perfect world, no one would ever work fatigued. But, in our imperfect world, maybe there is some logic to (borrowing a phrase from the military) train like you fight. As attending physicians nationwide know, there is no big brother organization out there making sure you work no more than 80 hours a week or pull more than 24 hours of consecutive call. So, unless we overhaul the whole system, it is likely that we will train a generation of physicians who face significant challenges meeting on-call responsibilities once they graduate from residency.

This is not to say that we should work residents into the ground just because we have a broken system. It is an argument for an overhaul of more than just resident duty hours. I think we need to look at the entire way physicians balance their lives - time at work and time off of work. As I mentioned above, it is easier for me to do work than to rest. I've been trained in a high-pressured, constantly busy, ever-demanding profession. I'm used to it. I have not received any training in how to “turn it off” when I get home, how to balance professional and personal demands, or when to say no to work so that you can say yes to life.

Nevertheless, an ability to rest, relax, and just be still is a lost art in our fast paced society. It is a skill I am slowly but steadily teaching myself. I am learning to be comfortable with unclaimed gaps of time in my day. So, this Labor Day, I forced my “to-do” list from my head while I sat in the toy room watching my kids play, reading a novel, and getting the occasional hugs from my toddler. It was a great day.