When I was a resident, I rarely stayed late post call. We worked for up to 24 hours at a time, 26 hours on a really bad day, and we went home. As a fellow, I"m not really protected by work hours limits any more.
Consequently, the strategies that I had developed for call as a resident no longer work. As a resident, since I knew I"d be in bed by 9-10am (at the worst), I didn"t take full advantage of opportunities to rest. I"d stay up and study, and when I got a little too tired to study, I"d stay up and teach medical students and junior residents. When too tired for that, I"d chat with the other residents. By that time, it was almost time to round and sign out.
I"m finding that my strategy of staying up and working as much as possible while on call is part the reason I get so exhausted when I"m taking a lot of call.
So, my new strategy: Sleep as much as possible. I"ve decided that there comes a point in the night (I think it"s around midnight) where I need to stop reading and working on research and doing extra teaching of medical students and residents. After this point, if I"m not needed to directly supervise something, I should be in bed.
I was on call last night, and as call nights go, it was average. I went into it still tired from my string of q2 calls. Anyway, when midnight came, I made sure I was in bed. And you know what? Even though I"ve been napping a lot today, I don"t have that yucky irritable anxious exhausted post-call feeling I"ve come to know and hate. And since after a string of q2 calls, I hadn"t had enough time to recover, I"d started to feel like that all the time. That"s a bad way to feel all the time.
It"s a shame it took me a year to learn that I should sleep when I can, but.. hey, nobody ever tried to pretend I"m a genius! :) I highly recommend sleeping when you can for all of the residents who are protected by the ACGME work hours rules who are graduating and making the transition to a non-hours protected attending job.
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