Why sleep is sometimes overrated:

2:30AM and so far it's been a quiet call night. I'm on with one of the "bad" residents, the kind who doesn't like to call medical students. It's good studying time, early to bed, and maybe I'll get a good night's rest and be able to go to the OR the next day. The pager goes off. There are two operations going on at the same time, both need assists. The first is a trauma, the resident wants to be part of that one. The second is an organ harvest, a much longer operation, you will never directly see the benefits of the long hours you put in that night; he wants me to assist in the second. I walk in and they've obviously been very hard at work. Her chest and abdomen are already wide open, the heart and lungs are exposed and I can see her heart beating in her chest. The thoracic surgeons have gone to hide in a corner somewhere while they wait for the general surgeons to adequately expose and control all the relevant blood vessels.

She's a big patient, her face is covered and I never will get to see it. They tell me she tried to commit suicide; her lack of success means that at least 2 other people will get a chance to live. Finally the general surgeons are ready, I watch them clamp her aorta from below, slice through the superior and inferior vena cava (the major veins which drain most of the body), and slowly she bleeds out and dies. They frantically scramble to pack her chest and abdomen with crushed ice. They flush all of her coronary vessels, then cut the rest of the vessels and the connective tissue, the heart is out. They dissect around the lungs, inflate them completely and then use a cutting stapler to cut across the trachea. Soon both the lungs are out and both the thoracic surgeons are going back to their beds.

The cutting stapler is used to remove the small bowel at its root. The liver, pancreas and spleen are shelled out of their beds and the relevant vessels ligated. Soon they're sitting in a basin on the side and again, the vessels are flushed. After covering them with solution, they go to sit in the fridge in a bowl of ice for a few hours. Early this morning another man, someone whose admission history and physical I did earlier today, will go to the OR and receive that liver. Lastly, the urologist comes in and in less than 10 minutes, the kidneys are removed and put on ice. The general surgery fellow and I are asked to close the skin. She has a huge cross-shaped incision extending through her chest and abdomen. We use the biggest suture we have and take turns closing her incisions, without her internal organs the skin tends to flop down into the middle and it's a little bit of extra work to get the edges to stay together. The fellow is a little cranky, there's another harvest waiting for him in Regina and he probably won't sleep at all tonight. I'm not a surgery buff and for me, this will probably be the only harvest I'll ever see in my career.

Now, half an hour until I need to be up and doing rounds. The bottom of my sneakers have an unpleasantly sticky feel to them, a mix of blood and solution. I'm trying very hard not to think about it. As soon as the laundry room opens, I'll be changing my scrubs because the same solution is clinging to the bottom of my pant cuffs. I won't go to the OR today, which is too bad because they're doing a procedure I haven't seen before. I'll sleep and shower and eat and digest some of what I saw. Part of that ruminating will be academic but most will be emotional and spiritual. And maybe later I'll cry, I tend to cry pretty easy, but right now it's all still sinking in.

Friends are good. This may seem like a simple, obvious and somewhat unnecessary statement but every now and again, I'm struck by the truth of the statement. This year has been in no way terrible. I feel like I'm learning a ton every day, seeing lots of interesting and bread-and-butter medical conditions, and enjoying the company of those I work with. But the toll it's taken has been sometimes obvious, often subconscious. A lot less sleep than I'm used to, more criticism than what I'm used to, high standards, big expectations, constant assessment, a horrible diet, lots of coffee and no exercise. It adds up. And today I didn't really realize how tired I'd become until I spent just a few great minutes catching up with some really good friends. And with a sigh of relief you realize that underneath the sleep deprivation and the crankiness, you're the same person you were 2 short months ago.

Feeling like it would be nice to have a life outside of the OR/clinic/ward.