Sunday, November 26, 2006

Simple tasks (at 04:30)

It sounds simple enough. Every night before the other residents arrive in the morning, it is the duty of one of the on-call residents to update the team census (a spreadsheet containing an enumeration of the team’s patients) with the new patients from call and to assign patients to residents for the coming day. Rules must be followed: the post-call residents (referred to as on-call above) are to take only their new admissions from the night before; the short-call residents should not be assigned patients as they will be called away from rounds to admit new ones; the pre-call residents when possible are given a reduced patient load to help them have an early day before their impending call; and the new on-call residents, who have no chance of escaping the hospital anyway, are to carry the brunt of the patient load. Usually the task of updating the census and assigning patients is performed in the wee hours of the morning, around 04:30, after all of the night’s admission (fingers crossed) have been tucked in. Compared to the other tasks that we perform as residents, this task is remarkably simple; it requires no analytical or deductive thought and demands little in the way of computation. Yet, as often as not the census contains mistakes – a resident gets assigned too many or too few patients, the wrong patient goes to the wrong resident, a patient somehow goes uncovered – any number of mishaps can occur.

You see, 04:30 is an hour inhabited naturally only by insomniacs, whose charged, restless minds mercilessly repel the sleep that their bodies so need and crave, and by new lovers, whose irrepressible affection for each other transcends the need for sleep, allowing them time to blissfully and tenderly dissect each other’s bodies in consummation of their nascent love. It is an hour proscribed from others, and to venture there uninvited is to struggle against the laws of God and nature. Like petting an animal against the grain of its hair, hyper-extending a joint, or building a sand monument on a windy shore, persisting in wakefulness to 04:30 is only to court disaster. The simplest task becomes painful and unbearable as the mind, weighed down by a thick coat of dullness, struggles to function. It enters a dream world, a state of half-wake and half-slumber where every suggestion contains hidden pitfalls and sustaining a thought becomes like trying to harbor a ship in port without anchor: unseen currents inevitably carry it toward a precipitous and calamitous end.

As residents we invade this no-man’s land every fourth night, intrepidly but vainly attempting to swath a path through the fog in order to care for a patient, or to finish our work. We are not, however, blessed with Herculean strength, and although we may rage against the taunting sirens that beckon us with sleep, our endurance is limited. Eventually, and insidiously, our minds becomes clouded enough that we can’t perform even the simplest of tasks without error. Yes, I want you to ask it, I demand that you ask it: what about the complex ones?

The luxury of being half asleep, Ian McEwan writes, is that it allows you to explore the fringes of psychosis in safety. Perhaps from the cozy confines of your Saturday morning bed, but how untrue, how devastatingly untrue at 04:30 in the uncomfortably bright lighting of the hospital ward.