Doctors fear falling asleep on the job
What is it like to work a 36-hour shift? Maeve Sheehan met Dr John Duddy of Beaumont Hospital, who filled her in
Published 21/07/2013 | 05:00
DONE in at the end of an eight-hour working day? Spare a thought for junior doctors who often work 36 hours straight through, as Dr John Duddy, 32, did last week.
Dr Duddy is on the Irish Medical Organisation's Non-Consultant Hospital Doctors' committee, which last week launched a campaign to reduce what they say are dangerously long working hours.
The campaign – Enough is Enough: 24 No More – aims to limit shifts to a maximum of 24 hours as an initial step towards reducing the working week to the 48 hours specified in the EU's working time directive.
As the Irish Medical Organisation prepares to ballot its 2,000 non-consultant hospital doctors on strike action next month to reduce their working hours, Dr Duddy recounts an exhausting day and a half on his feet in Beaumont Hospital's busy neurosurgery department over a week ago.
5.45am: "This is when I usually get up, have a shower and breakfast before I go to work. I'm the kind of person who can't function without a proper breakfast. Today, I am on call which means I will be in the hospital for 36 hours."
7am: "We start with what's called a hand-over meeting, followed by ward rounds. Whoever has been on call the previous 24 hours, tells those of us who have just started our shift about the referrals they have received, what patients have come in. We look at the scans, and what the treatment plan is, and make a note of everything for my consultant."
8am: "Stop for a teaching session with consultants in the hospital – it is part of our ongoing training. No time for coffee."
9am: "In neurosurgery, we have an 'on call' phone, which outside hospitals ring when they need a neurosurgery opinion. Because we are a national neurosurgery centre, we get referrals from all over the country. The phone means doctors in hospitals around the country can get straight through to a registrar for neurosurgical advice or opinion. So there is someone manning that phone 24/7. Today that person is me."
11am: "After more ward rounds with my consultant, I get my first referral on the on-call phone. The doctor gives the history of the patient and can send us scans through a special link computer which we can view in Dublin. It's not just a simple two-minute phone call. It can be a 20- to 30-minute process, where you have to take in all the information and make a decision, often contacting a consultant for advice."
2.30pm: "The calls have been coming through all morning. Some mornings you have time to grab a coffee but not today. I stop for lunch. I usually try to bring my own sandwiches and I have a coffee. A lot of the time, the food is not the healthiest in the hospital canteen."
3pm: "I check on patients but from 4pm to 7pm, the phone rings constantly. By late afternoon we have accepted two patients for transfer to Beaumont. And a colleague has told me about a patient he is expecting to arrive in the emergency department later in the evening, who may need an operation."
7pm: "I have been working for 12 hours, and I know it's going to be a busy night ahead. I go to the emergency department to see one of the patients. While there, I get a call from a consultant up in the intensive care unit. He is concerned that the patient may have built up fluid in the head following an operation and wants me to monitor the patient closely during the night.
Another consultant is concerned about a patient on the children's ward who has hydrocephalus, a build up of fluid in the brain. The child will need a CT scan."
8.30pm: "The patient my colleague told me about has arrived in emergency. The patient has compression of the spinal nerves and needs an emergency operation. We set everything up to get into the operating theatre that night. We also expect two further transfers to Beaumont later in the night."
Midnight: "We are waiting to get into the operating theatre. I have had nothing to eat since lunch-time. I haven't been to the bathroom either. When you're busy you just don't think about it. I hadn't time to go to the shop earlier to buy some food and the canteen isn't open at night. The vending machine had three sandwiches in it but I didn't have any change for it. Luckily, the operating theatre has tea and coffee making facilities and they have bread to make toast. So I have some toast and some water to keep me going."
2.30am: "The operation is finished and we're happy with how it's gone. I check on my other patients – the child has had a CT scan, so I take a look. It's an improvement. I tell the consultant, who is happy with the patient's progress."
3.30am: "A patient who arrived from another hospital with a subdural haematoma, a type of blood clot on the brain, is ready to be operated on. I know it sounds like a late hour to be doing surgery but it's surgery that cannot really wait. While we are in theatre, another referral comes in – a patient with a sub-arachnoid haemorrhage, an acute haemorrhage in the brain. This is a serious, potentially life-threatening condition."
4.30am: "Finished in theatre, I go to the ward to assess the new patient. We order tests and make sure the patient is stable."
5.10am: "I finally get to a bedroom in medical residence. It is the first time I've seen the room all night. When you are that exhausted, there is no problem falling asleep."
6.45am: "Up again for the hand-over at 7am, followed by ward rounds. There's no time for a coffee, I prefer to maximise my sleeping time."
10am: "Today I am not on call, so I have time for breakfast. I have some sausages and beans and fried eggs – what they call the 'post call' breakfast. I actually had time to have a shower as well."
2pm: "After a pretty quiet morning, one of our patients in intensive care deteriorates. It was a challenging situation to deal with, as I had to explain to the patient's family that their loved one was getting sicker. Obviously, it doesn't compare to their emotional upset, but it is a challenging thing to have to do, especially when you are tired."
5.45pm: "I leave the hospital. I am home and in bed by 6.30pm. Once you have a lie down you're zonked. These hours seem crazy but they are typical for any doctor training in a speciality. Are you in the right frame of mind to be making judgements about people's health? That's what's driving this campaign."