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Wireeeee t1_j1yw1qa wrote

Reply to comment by bananaforsteve in How do shifts work on really long medical operations? by TerjiD

This, I don't understand. Surely, anything above even 15+ hours of concentration is counterintuitive, right? Like, what about the loss of focus, accuracy, and drowsiness? Maybe 24 hours is doable since they've had a lot of practice, but 36 hours is insane.

Like, I start going delirious and dissociating from reality at 30 hours mark (without any stimulant drugs), can't imagine a surgeon not tripping balls from the sleeplessness haha.

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przyssawka t1_j1z1sdu wrote

Head and neck surgeon here. 24h shifts are the norm, it’s something you just get used to. It sucks but that’s the reality of it. 36 hours of nonstop work does happen, especially in residency. It’s definitely taxing and impacts your productivity especially during low stake work like charting. I had instances of my prechart notes being absolute gibberish due to sleep deprivation. But when it comes to procedures your body runs on adrenaline, tired or not it feels like a reset button was pressed, even during longer procedures like laryngectomies. Getting distracted doesn’t really happen unless you are a med student holding the retractor then all you have left is praying for mercy and sweet release

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Wireeeee t1_j1z2ub0 wrote

ah, that's amazing, some superheroic stuff. Crazy what the human body and brain can achieve with practice beyond limits. Do you have sugar/caffeine too intermittently during these work hours or is it just adrenaline/chronic stress

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przyssawka t1_j1z3ra4 wrote

We eat and drink coffee during shifts, nothing different compared to an office job. Part of resilience is definitely adaptation though, residency is exploitative. My speciality doesn’t have those 20-ish hour procedures (at least none that would be all-HNS team) so no surgeon rotation, if it’s 4-5h in the OT you’re stuck there for 4-5h. Then again, hunger or sore legs is the last thing you’re concerned with assuming you’re actively participating, even more so if you’re the primary surgeon.

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skisushi t1_j1z6n2a wrote

Head and neck surgeons do orchestrate some of the most complex and difficult surgeries though. You may have several teams doing different parts of a surgery and take turns. I have seen as many as 4 or 5 teams work together. Neurosurgery, ophthalmology, plastics, OMFS and ENT/ HNS all can participate on some large tumor resections and reconstructions. When actively involved you can get so focused that food, pee breaks, etc don't cross your mind for 8 to 12 hours. Then you finish and it all catches up to you.

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przyssawka t1_j1z731i wrote

Yes but as you mentioned for stuff like anterior or lateral approach skull base surgery or large tumor dissections we do take turns. it’s usually a combined effort by neuro, maxfac and ENT. Compare it to stuff like transplantology where one team usually handles the entirety of the procedure.

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DukeSuperior_Truth t1_j21d1m5 wrote

Exactly. Just because people can’t imagine doing something extraordinary, doesn’t mean it’s crazy or dangerous. People do ultramarathons that run 36 hours with no sleep as well. Adaptation is the operative word here.

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Parappappappa t1_j21pubh wrote

Running a marathon is not a daily occurence though. Pulling an all nighter once in a while is very different than constant sleep deprivation. Also if someone chooses to run an ultramarathon but they lose focus the only person whose wellbeing is at risk is themselves - however if a doctor (or other staff) loses focus and make a mistake it impacts the patient as well.

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DukeSuperior_Truth t1_j23ls9o wrote

Good points! I really just mean the analogy to be about how people can do extraordinary things when they are trained over time to do them. Surgery very difficult to get into, training excruciating and those factors help weed out most. The few left in the subspecialty surgery groups really love it, really deserve to do what they do and are of a different breed. Even among doctors, who are all pretty good at working hard and focusing.

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Larrygiggles t1_j20aw82 wrote

Does stuff like polyphasic sleep ever come up as a possibility?

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przyssawka t1_j20bd9t wrote

Polyphasic as a necessity more like. Jokes aside not really, the work is structured in a way that wouldn’t allow for the polyphasic sleep cycle outside of on-calls (and even then ER can wake you up at any moment). Not to mention I have yet to see research that proves that it’s a valid and sustainable alternative to regular cycle.

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drerw t1_j211f4m wrote

That’s why you’re not a surgeon, right? I’m imagining this whole thread being about Navy Seals. They’re just different. It makes sense that someone who started an operation finishes it. It’s like learning an entire machine no one has ever seen, working on it, and then handing it off halfway through to someone else who has never seen it. Except the machine dies if you take to long to figure it out again.

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Iced____0ut t1_j214ix9 wrote

30 hours without sleep should not have you going delirious and disassociating.

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Wireeeee t1_j21kulk wrote

Thank you for knowing more than me about how I’ve felt when I’ve got 30 hours without sleep

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Iced____0ut t1_j21tcqz wrote

Just have to make yourself a victim? I said you should not, as in that isn’t a typical symptom of 30 hours awake.

You might want to look into your health if you are having that response to 30 hours awake.

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