undead astronauts

http://www.techcrunch.com/2010/01/31/in-the-limelight-an-american-entrepreneur-in-china-talks-about-startup-culture/

“There has been much hand-wringing over the dangers of medical residents’ grueling schedules. Doctors-in-training often forgo sleep entirely, racking up as many as 30 work hours in a single stretch.”

Full article: Are residents overworked?

While there seems to be no easy solution or answer to the continuous hours that medical residents are on call, there still needs to be taken to consideration what life after residency is like.

Hours have been reduced to 80/week, and 30/shift; which I believe to  be agreeable. However, if plans to further reduce hours to is put into place, the rules will have unforeseen effects that could possible ripple through the entire health system. It could result in residencies taking longer to complete; 3 years coming 4, 4 becoming 5….which would result in a gap in graduating residents. And true, it is most likely that a person on hour 20 is less efficient than they were on hour 2. But life after residency, as a full fledged licensed physician, has hours that are also painstakingly long, without the controversy.

Will less hours cause less mistakes/less cost? Maybe..Maybe not.

No easy solution.

What you think?

After being here for 3 weeks, I am beginning to understand some of the finer points of working for a local Chinese firm.

Authority and status is very important here. Its always crucial to know your place in the firm. For instance, every attorney here is referred to by their last name and the attorney title (Chen “lv shi”, Li “lv shi”, etc). Unfortunately for the accountant, she is simply referred to directly as ”kuai ji”, or “accountant”. Her name isn’t even mentioned, but she doesn’t seem to mind. The cleaning lady is referred to as “ah yi”, which means something like auntie. I have tried to ask everyone to simply call me by my first name instead of the full ”lv shi” title, but i now feel that in doing so, I may have reduced my status and authority in this firm from attorney to perhaps an assistant or intern. 

Of course this all makes sense. The US is founded on individualism, and we like to be distinguished by our person rather than our current placement in life.  We don’t like generalizations because we find them limiting. But China is a place of structure and tradition, and understanding your place in that structure allows everyone to save face, lest you tread upon the toes of a superior.

So the logical way to think about working in China should be to 1) know your place then 2) do your job.

Of course situations occur when doing your job may require you to abandon your station; such as when you are proposing certain changes to the current business model or concept. Well tread lightly when you do so. While in your mind you are only thinking about improving the company, your superiors may perceive it as an effort to undermine their authority by uprooting the work they have done. Chinese employers are often extremely defensive and very slow to change due to this.

I have noticed that Chinese employers often allow a certain leeway to a foreign who looks distinctly un-Chinese. I believe in this case the Chinese employer feels that because the foreigner is not really a part of the Chinese social structure and therefore nonthreatening. In this case the Chinese employer might even manage to get to know the foreigner as an individual person rather than just another minion. Its all about expectations. If your boss expects you to be a part of the structure but you don’t adjust well, then you are going to struggle. If the boss doesn’t expect you to be a part of the structure, then you are suddenly free to fully utilize your own creativity.

The end of night has arrived. The dream of an uneventful night came to fruition once over the 31 nights, but did happen. Now is time to move on to different responsibilities. Now is time to integrate back with civilization, during the times when the sun arises. And enjoy the comfort of my own home and mattress. Alas back to normal circadian activity.

During this month, this popped up in the news:

“Women in Denmark who developed breast cancer after many years of working night shifts have received compensation…”

http://www.bmj.com/cgi/content/full/338/mar18_1/b1152

Does this mean that every single physician, whom in training and in practice, have frequently worked night shifts, or any other job that has required night shifts, will be compensated in some way?

At last, my dream has come along. The hectic darkness at rest tonight. It could come at not a better time. As there is a balance of sleep that needs to be compensated. Now that the dream has come to fruition once, I know that it exists. The hope of it coming true again is slim, but there is hope.

The night is young, the work is persistent. The month long theme continues. Myself growing tired, but resilient. Trying not to get the blues. The downpour of rain. Seems to have calmed the night. Has helped keep me sane. And keep alive the light. I will continue to dream. For that night uneventful No matter how futile it may seem…

The continuous influx of those in need continue to bombard the gates of my fortress. The full moon continues to energize the creatures of the night. No rest amongst us. As the moon hints of fading away, the door open to the feared Friday the 13^th. The bizarre, eerie, and disorderly in the midst.

The dream for all to rest in the night, once again shattered. As I ponder, I can not help but we wary of the Ides of March. Dream on…

Arriving to work, we noticed the moon was full and bright. The feeling of a rousing night was imminent. The premonition held to be true. Every dimension of the workplace was bustling. We could only put our heads down, center our own chores, and do it. Winding through the stench of burnt flesh, cries of insanity, on top of the usual commotion, we only hoped for time to pass, for this night the ailing were relentless; not even a chance to sit. The dream of a quiet night, everyone staying home…tonight this dream has been drugged, penetrated with bullets, hit by a car, disseminated with bacteria, to be left for dead….we pray the dream will endure the night and give us hope for a quiet tomorrow.

Finally a night that where it seems the most, not everyone but most, are enjoying their humble abodes. At the least, not infiltrating the doors of my fortress. This is a greatly appreciated detour from the previous nights.

This time has allowed a brief reflection of the journey to my current state. Four years of undergraduate schooling, of which good friends were made. The examination used for entry into the next level was barely sufficient, but allowed me to stumble into the next stage. Slipping through the cracks and into medical school, nothing could have prepared for the hardships of attempting to drink from the fountain of knowledge. Only to discover the fountain was akin to an open fire hydrant, spewing information relentlessly and mightily, unwary of what was in its way. The assessment they call Step 1 was completed. Some comrades were left behind, myself almost victim. By the grace of few, I was permitted to resume my journey. Again, along this journey, another assessment, Step 2. This was a hurdle that I tripped upon many a time, but conquered. Finally scrapping through into the next trial…Residency. Now, once again, another evaluation they call Step 3. Again, I have stumbled, and again I must focus for this is key in completion of my journey, although not the last assessment.

Many have chosen this journey. There are many paths, but one entity is shared-The voyage is long. For such an extended expedition, one must, on occasion, be able to take a breath, relax, and cherish the moment. Thinking of the plight that awaits, sitting tired in an uncomfortable chair, in a room with a peculiar aroma, in a building full of illness, I am…appreciative.

Springing forward in time as daylight savings rolls into effect. I hope that as daylight lingers longer, less people are inclined to fall prey to the perils of the night. Fairly quiet thus far, we have been able to settle down after a little work tonight. Much appreciated.

As I hope to enjoy the extended sunlight, I am reminded of an interesting article I came across last year(MI=myocardial infarction, a.k.a heart attack):

Researchers reporting a link between acute MI and daylight saving time say their findings may also explain why more heart attacks occur on Mondays.

AMI rates among Swedish men and women, recorded in the Swedish AMI registry, increase by 5% during the first three weekdays after daylight saving time begins in the spring but decrease slightly, by 1.5%, for one day after the end of daylight saving time in the fall (as compared with weekdays two weeks before and two weeks after the time changes). The net effect of this time shift is likely negative, they say, since the increased risk in the spring is greater and persists longer than the slight reduction in AMI rates in the autumn.

Their data are published in the October 30, 2008 issue of the New England Journal of Medicine.

http://www.theheart.org/article/914557.do

Sometimes we take for granted the many layers of autoregulation that occur constantly, as well as the abuse that the body endures.  Watch yourself.

It seems that there will never be a time when everyone will be content on enjoying the night in there own quarters, wherever that may be. Tonight starts out as what has become typical…busy. Luckily, another occurrence that has become recurrent is my companionship. Every night it is somebody new, but every night the company is enjoyable.

Everyday I am amazed at the tribulations and triumphs that the body endures. Today to be reminded and humbled by variance and unpredictability. The nonagenarian that appears so frail has triumphed the trials of time; for to remain amongst us today, must be undoubtedly resilient in a manner my youth cannot understand. Yet in the same building, an anxious spirit whom has barely endured one fourth that time has drifted away, now calm.

As an bystander, I can only observe, for trying to make reason for such things will never be accomplished.

I now wonder if the dream I have set forth is achievable. As one man’s garbage is another man’s treasure; the time of the night I have accustomed to peace and quiet, is another’s darkness for upheaval and commotion. I can only hope that the commotion stays away from here.

As daylight draws upon us, the dream fades once more…..

I walk into work as usual. Arriving into the lounge, I see not a soul from the day shift. This could mean one of two things. 1) They are just busy. 2) They are really busy. I take my chance to sit and relax a little, as I feel the night will again be active.

Not five minutes after hitting the chair, the pager erupts. A new night, the same story. Tonight I am working with an old colleague, we decide to knock ‘em out and get done as soon as possible. As we are burning the midnight oil, it seems new arrivals are entering constantly. Poor prognosis for some.

It seems no one is home tonight, no one is sleeping….my dream…definitely not today.

Another night of admissions. The dream of everyone staying home and sleeping well is ongoing. As tonight is another busy one. Ended up with a full house today. But, as with last night, tonight’s company was great, my job made very easy. We were able to get the patients tucked in quickly and be done.

The dream of a night where everyone stays home, and sleeps well…hopefully to be fulfilled sometime this month.

As I walk into work tonight, I am greeted by the exiting team that there are already patients ready waiting for me. The hopes of an uneventful night dashed before a neuron could begin the process of trying to commence the thought. Let’s get to work.

Progressing through the night, it was evident that tonight’s company would be pleasant. We sprinkled the night with conversation and laughter, with little jabs at society here and there. Eight hours later, it seems the pressing issues have been taken care of. It was time to slow down. Quite relieved that nothing unexpected has happened so far tonight.

I realize that I must slightly modify my dream for the month, as looking back, it has been a relatively uneventful night, and with tonight’s company, even pleasant; however it was long. Work was done with no surprises. So as I continue to morph the dream of the month, I think of…

I dream of a night where everyone stays home, and sleeps well.

It is now 2am in this cold night. It has indeed been quiet. In a place such as this, the silence is greatly appreciated…..what’s that……oh… I have spoken too soon.
The announcement of misfortune has declared itself. Ahhh!!…the noisemaking messenger they call a beeper upon my belt now screams for attention. Alas, it seems as though the dream of an uneventful night will have to be postponed.

The first being we examine may shock some at first. Her lips bright red, with dark, dried, remnants outlining, as well as on her teeth. I observed as my colleague interrogates.

Then my colleague states she is not feeling to well…need to sit…I open the door for her, glance away, and catching up to her, realize that is about to go limp. I catch her, in much surprise, calling her name….no response…she has turned white…I carry her to the nearest chair and call for aid. We carry her to the nearest bed and intravenous fluids are administered. Reassuringly, she promptly awakens. My mind now at ease, I continue to our, well now, my work.

The dream of an uneventful night….maybe tomorrow.