Exhaustion that Kills.

• Author: WORTH, ROBERT
• Position: Medical residents suffer chronic sleep deprivation

Why residents are still overworked--and what we can do about it

By the time they wheeled me into the operating room I was so doped up on morphine I could barely see. But I did notice the young resident I had met earlier, a small guy with thick glasses and curly brown hair who looked as if he was stoned out of his mind. And I couldn't help overhearing it when he began to botch my spinal tap. "No, no--too slow!" said the attending surgeon, as the resident sucked out my spinal fluid with a syringe, then stuck another needle between the vertebrae at the base of my spine and shot me full of Novocain. "No--Start again!"

It seemed like a harmless mistake at first. Lying on my stomach, I waited for the numbness to creep up from my toes to my hips, as the doctor had said it would. I had liked the idea of a spinal tap, since it would allow me to remain awake and listen to the doctors operate on my knee. Sure enough, the numbness crept upward. I thought drowsily of Socrates drinking his poison and dying from the feet upwards.

Only it didn't stop at my hips. Thanks to the resident's fumble, it kept going. Soon it engulfed my waist, my belly, then my chest. I told the doctor, who sounded concerned, and assured me it wouldn't go any farther. But it did. My shoulders disappeared, then my arms, my hands. Now the tingling was in my neck, lapping at my head like a torrent of dark water. Suddenly I felt a powerful wave of nausea. And then I panicked. Even in my drugged state I knew that if I were to vomit I would surely choke on it, since I could not move my body any mole than I could feel it.

I told the doctor, and this time I could hear the anxiety in his voice when he answered. He barked commands at the residents and shot something into my IV. The white coats scurrying around me faded to a blur, and before I knew it I was in the post-op recovery room, where I shuddered like an epileptic for what seemed like days as the overdose of anesthesia slowly drained out of my body.

It's possible that my little medical misadventure had nothing to do with the fact that the guilty party. looked like he'd just emerged from a three-day bender. But with residents at major hospitals logging well over 100 hours a week, it's not likely. As it turned out, I left the hospital more or less unscathed (unless the back pain I've suffered ever since had something to do with the operation). Others are not so lucky. "Thousands of people are killed every day by young doctors who are exhausted and unsupervised," says Dr. Bertrand Bell, who chaired New York state's 1989 effort to change the current residents' training system. A growing body of research has provided evidence to back up Bell's claim. Most of these incidents aren't the eye-catching disasters that attract lawsuits and talk-show hosts, such as the case of the resident who fell asleep while sewing up a woman's uterus and then toppled over onto the patient. They're quieter and more insidious. At teaching hospitals all over the country, red-eyed residents and interns (another term for first-year residents) are stumbling through life-or-death decisions while the doctors who should be supervising them slumber at home. Talk to any young doctor and you'll hear more than you ever wanted to know--off the record, of course. One first-year surgical resident, less than three months in, told me she had already witnessed an older resident nodding off repeatedly as he sewed up a patient's abdomen during a late-night operation.

Only one state in 50 has made any serious effort to crack down on this situation. Since 1989, it has been illegal for hospitals in New York to work residents more than 80 hours a week, to give them shifts more than 24 hours long, or to leave them without adequate supervision. In most professions these rules would be viewed as a sick joke--how many of us can work almost 12 hours a day, seven days a week? Yet senior doctors and hospitals around the country view them as an outrageous restraint, and in New York they flout them openly. When the state's Department of Health raided 12 hospitals last spring to check up on compliance, they found that 37 percent of residents were working more than 85 hours a week, while 20 percent worked more than 95 hours a week. One resident worked 136 hours. Remember, these are the people we trust our lives with. "This is a wake-up call," the state health commissioner told The New York Times and The Wall Street Journal. But four months later, the alarm was still being ignored. In September a doctor stood before a group of applicants for surgical residency in New York City hospitals and told them: "You've probably heard that New York forbids you to work more than 80 hours a week." He paused, and looked around the room. "Forget it. You'll be working 120 to 140."

Yet what's really shocking is that these stories have become cliches, a regular feature on ER and in cocktail conversation. Everyone seems to know that we treat our medical trainees like galley slaves, and that next to nothing has been done about it. What fewer people know is that Uncle Sam has a lot of money riding on this problem, as well as a hefty share of the responsibility. New York State has paid its teaching hospitals almost $2 billion since 1989 to comply with the Bell regulations--or rather, not to comply with them. Nationally, the federal government pours nearly $7 billion a year into graduate medical education, with almost no oversight. "There's enough money within the system to fix the problem," says Alan Sager, a professor of public health at Boston University. In other...