Overwork Kills a Medical Student?

[senorsquishie]

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Sorry if this was already posted (I searched!)

http://focustaiwan.tw/ShowNews/WebNews_Detail.aspx?Type=aSOC&ID=201105050013

Taipei, May 5 A 25-year-old medical school student who was working as an intern at a local hospital in Tainan, southern Taiwan, was found dead last week after being on shift for 36 straight hours.

 

[Pons Asinorum]

Pretty sure that the autopsy will reveal that the COD was something other than "overwork." Being up 36 hours straight has never killed anyone. May exacerbate other, underlying morbidity. But that isn't a cause of death. Lucky for us, we only make our attendings work 36 hours straight these days...

 

[ozzi22]

probably suicide 😱

 

[PNAU]

My bet: an autopsy will reveal a large concentration of stimulants in his body.

 

[gettheleadout]

Pretty sure that the autopsy will reveal that the COD was something other than "overwork." Being up 36 hours straight has never killed anyone. May exacerbate other, underlying morbidity. But that isn't a cause of death. Lucky for us, we only make our attendings work 36 hours straight these days...

 

[Law2Doc]

Sorry if this was already posted (I searched!)

http://focustaiwan.tw/ShowNews/WebNews_Detail.aspx?Type=aSOC&ID=201105050013

Taipei, May 5 A 25-year-old medical school student who was working as an intern at a local hospital in Tainan, southern Taiwan, was found dead last week after being on shift for 36 straight hours.

Having worked longer hours than this in my life, I can assure you it's not typically fatal. I would suggest there is probably more to the story. As folks have suggested, there are certainly drugs one might take to stay alert for long periods of time that are known to kill people. Or he could have had some preexisting condition such as a vulnerable brain aneurysm that manifested itself while he was on call -- 33% chance of it happening on a call night when you are q3. While nobody likes staying up all night, the only way you are really going to die from only 36 hours of sleep deprivation, absent the kinds of examples described above, is if you get behind the wheel of a motor vehicle and crash into something.

 

[senorsquishie]

I don't believe for a second that overwork was the only thing that caused his death. The really interesting thing it the end of the article were the lawmarkers in that country are changing some things. Will that still happen if they discover a different cause of death?

 

[halethsonofhama]

Reminds of that story about a guy who died at his desk at work monday, and nobody noticed until friday when they invited him out for drinks.

Probably fake... but I don't have the heart to actually confirm cause I would very much like to believe it's true.

 

[Wermz]

I think it's worth saying that lack of sleep does kill though, but slowly.

 

[senorsquishie]

I think it's worth saying that lack of sleep does kill though, but slowly.

Wouldn't your body do something before then make you sleep? I don't know for sure, but I think it would. At least faint, blackout, go into a coma, something?

 

[Wermz]

I mean more slowly, like general sleep deprivation over years. Sleep is healthy.

 

[MeowMeowCAT]

Wouldn't your body do something before then make you sleep? I don't know for sure, but I think it would. At least faint, blackout, go into a coma, something?

Yes, there is a certain point where the body does go "**** it, I need sleep now!" but that goes right out the window if stimulants are involved.

As for the article, by "overwork" I am assuming it was a mix of stress and anxiety, both of which are often very energy draining. But as for the 36 hours, their was definitely some use of stimulants, be it regular caffeine. And the stimulants just increase the stress and anxiety...So in the end it might have been some sort of heart failure.

 

[senorsquishie]

I mean more slowly, like general sleep deprivation over years. Sleep is healthy.

Well I know when I am sleep deprived it has a neg. effect on other people's health!

 

[Monocles]

Dumb question, but do hospital workers really have 36 hour shifts?

 

[Taikonaut]

99% sure something else killed him and he just happened to kick the bucket after his shift.

 

[Neuronix]

Dumb question, but do hospital workers really have 36 hour shifts?

Residents used to, but they're now restricted to 24 hours per shift. I did a few 36 hour stints as a medical student, considering I started in 2003 and rotated at some programs that didn't care about work hour rules, but I think long shifts will decrease in the future.

 

[Law2Doc]

Residents used to, but they're now restricted to 24 hours per shift....

Well, bear in mind that when residents were "restricted" to 30 hour shifts, plenty of programs were not in compliance. So take that 24 hours with a grain of salt. I can assure you that even after the previous changes in duty hours there were folks in US residencies who on occasion exceeded the 36 hour mark described in the above article.

 

[Neuronix]

I can assure you that even after the previous changes in duty hours there were folks in US residencies who on occasion exceeded the 36 hour mark described in the above article.

I am aware, as I have seen it several times first hand as a medical student and sometimes stayed those long hours with the residents. That said, I think this activity will be decreasing over the next 5-10 years with increased ACGME regulation/site visits.

 

[loveoforganic]

http://en.wikipedia.org/wiki/Karōshi

 

[Law2Doc]

I am aware, as I have seen it several times first hand as a medical student and sometimes stayed those long hours with the residents. That said, I think this activity will be decreasing over the next 5-10 years with increased ACGME regulation/site visits.

The ACGME folks never visit at the times when in my experience the 30 hour limits are most often being exceeded (ie early in the day on the weekends), so lots of luck catching this without someone reporting it.

IMHO, the 30 hour violations are not as big a deal as the 80 hour/week average. Heck during intern year I'd happily have worked two 40 hour shifts every week if it meant my week was over by Thursday.

 

[Law2Doc]

http://en.wikipedia.org/wiki/Karōshi

From that link, "the major medical causes of karōshi deaths are heart attack and stroke". So it appears the whole premise of the article on this thread is that instead of "death from overwork" it really should have been translated into English as "death from stroke or heart attack".

 

[loveoforganic]

Yep, the Japanese just dig into the psychosocial etiology and classify accordingly apparently.

 

[yamaraja808]

I think it's worth saying that lack of sleep does kill though, but slowly.

It is possible but this have never been proven with people only animals.

 

[Law2Doc]

It is possible but this have never been proven with people only animals.

Actually, given all the years of physicians who have gone through residency training back in the day when 100+ hour work weeks and excessive call were common, and given the fact that there is no distinguishable decrease in such population's life expectancy (insurance actuaries check for this kind of thing), this has more or less been disproven.

 

[Just Joshin]

Actually, given all the years of physicians who have gone through residency training back in the day when 100+ hour work weeks and excessive call were common, and given the fact that there is no distinguishable decrease in such population's life expectancy (insurance actuaries check for this kind of thing), this has more or less been disproven.

As a doctor, you don't think there's any health risks associated with sleep deprivation?

 

[Law2Doc]

As a doctor, you don't think there's any health risks associated with sleep deprivation?

Depends what we are talking about. If we are saying is there going to be any real danger of staying up 36 hours every third day, I'd say no. If we are saying is there any real concern if an adult routinely gets only about 4-6 hours of sleep a night, I'd say no.

There probably is a point where the lack of sleep is dangerous. But you will come across tons of insomniacs and folks with psych issues, and folks who abuse certain drugs, who sleep very little and they don't drop dead very often. So the threshold of where lack of sleep becomes really dangerous is very very high -- probably measured in days, not hours. And your body will find ways of catching a nap long before that -- you will sit down to return a page and wake up 20 minutes later, etc.

I think you see a lot of premeds try to play up the health risks because they don't like the idea of having to work all night, but the fact of the matter is that they won't drop dead from the hours residents used to work, and for sure won't drop dead from the hours the residents currently work.

 

[STAT EKG]

While I was reading the original post and replies up until now, I was considering this "Zebra" case...

I somewhat recently saw a documentary about sleep phenomena, where this guy (not a med student, intern, resident, attending… a high school band teacher) went so long without sleep that the neurochemistry of his sleep cycle was irreversibly ****ed.

When he tried to sleep after not sleeping so long, he couldn't experience anything but the most primary stages of sleep (stage one and maybe stage two?).

His eyes would start tweaking and he'd intermittently experience wild hallucinations (involuntary R.E.M sleep), lost his job and family, and was institutionalized.

He went something like six months getting only smidgeons of R.E.M, stage one sleep, (possible) stage two sleep, and, over that time, he became more and more incoherent until he was a mute, his immune system gradually shut down, he slowly debilitated into a person-shaped failing set of organs, and then died.

I know technically deaths only directly result from cardiac/respiratory arrest, but this case (I know it’s real and there might be others like it) is pretty darn close to someone dying due to lack of sleep. It sounded like the WORST way to die at the time I saw the documentary too, but maybe not.

I’ll try to find the original publication where this is from… I know it’s out there. So I’ll look for that.

 

[nebratu]

FFI, the prion disease. Dunno if it's lack of sleep that causes death or something else the disease does.

 

[Law2Doc]

While I was reading the original post and replies up until now, I was considering this "Zebra" case...

I somewhat recently saw a documentary about sleep phenomena, where this guy (not a med student, intern, resident, attending… a high school band teacher) went so long without sleep that the neurochemistry of his sleep cycle was irreversibly ****ed.

When he tried to sleep after not sleeping so long, he couldn't experience anything but the most primary stages of sleep (stage one and maybe stage two?).

His eyes would start tweaking and he'd intermittently experience wild hallucinations (involuntary R.E.M sleep), lost his job and family, and was institutionalized.

He went something like six months getting only smidgeons of R.E.M, stage one sleep, (possible) stage two sleep, and, over that time, he became more and more incoherent until he was a mute, his immune system gradually shut down, he slowly debilitated into a person-shaped failing set of organs, and then died.

I know technically deaths only directly result from cardiac/respiratory arrest, but this case (I know it’s real and there might be others like it) is pretty darn close to someone dying due to lack of sleep. It sounded like the WORST way to die at the time I saw the documentary too, but maybe not.

I’ll try to find the original publication where this is from… I know it’s out there. So I’ll look for that.

Don't believe everything you see on TV...

 

[link2swim06]

Actually, given all the years of physicians who have gone through residency training back in the day when 100+ hour work weeks and excessive call were common, and given the fact that there is no distinguishable decrease in such population's life expectancy (insurance actuaries check for this kind of thing), this has more or less been disproven.

Its funny because its a pretty popular myth. I remember when interviewing for med school, I was told by two separate interviewers that it would "decrease my lifespan."

However, the data sides with you on this one http://www.ajpmonline.org/article/S0749-3797(00)00201-4/abstract

I am pretty sure med students and physicians do have much higher suicide rates, but not sure how that affects the total life expectancy.

 

[Law2Doc]

Its funny because its a pretty popular myth....

It's popular because people want it to be true. It's a better argument against having to stay up all night than "I don't wanna".

 

[loveoforganic]

There are other good arguments too, though.

Surgeons awake all night made 20% more errors and took 14% longer to complete the tasks than those who had had a full night's sleep (denominator as overall mean for errors=3.48 and for time=10.1 s) and also showed increased stress and decreased arousal (F[1,20]=17.52, p=0.001; F[1,20]=80.08, p=0.001, respectively; figure), which paralleled the decrease in operative dexterity. Stress and arousal correlated (r=-0.640, n=72, p<0.001). The decline in performance remained significant after arousal was taken into account as a covariate (p=0.011), but not after stress was used as a covariate (p=0.105), suggesting that sleep deprivation mediates its effect via increased stress rather than decreased arousal.

 

[RapplixGmed]

When Navy SEALs go through hell week in training, they go through an ENTIRE WEEK with a cumulative 2-4 hours of sleep. The entire time that they are awake, they are doing physically intense drills, exercises, or freezing their butts off in the water.

That very few of these people die in the process is testament to the fact that we can get through at least a week without much sleep.

 

[MedStudentWanna]

It's popular because people want it to be true. It's a better argument against having to stay up all night than "I don't wanna".

Or it's popular because most people don't suffer from Stockholm Syndrome and know when something isn't right.

 

[MedStudentWanna]

When Navy SEALs go through hell week in training, they go through an ENTIRE WEEK with a cumulative 2-4 hours of sleep. The entire time that they are awake, they are doing physically intense drills, exercises, or freezing their butts off in the water.

That very few of these people die in the process is testament to the fact that we can get through at least a week without much sleep.

And if residency was a week long, I'd agree with you. Sucks for those in residency for 7 years though, huh?

 

[STAT EKG]

FFI, the prion disease. Dunno if it's lack of sleep that causes death or something else the disease does.

You're right. Fatal Familial Insomnia is what he had. This video educational material shown in my physiological pysch class, and I think it was slightly dated to where science either hadn't made the connection that FFI was genetic, CJD, or both. The guy was a middle school band teacher in the 1970s and back then they had no f'n clue. Currently they estimate 40 families worldwide are afflicted with FFI... at least from the most recent neuro journal I read through PubMed.

...But yeah, FFI is 100% real; it's just genetic CJD, so it's obviously not caused by lack of sleep

I really thought I had ground to stand on, but nope.

 

[Law2Doc]

Or it's popular because most people don't suffer from Stockholm Syndrome and know when something isn't right.

"Stockholm syndrome" and "drinking the Koolaid" are bad cliche responses repeatedly seen in pre-allo by folks who have no real argument to stand behind. You can always say -- you are wrong, you have drunk the Koolaid, or been brainwashed -- to any post you don't like, but to what point? These comments come up over and over again, and, like "Burnett's law" simply don't advance any sort of argument. The logical inference is that you have none.

 

[Neuronix]

"Stockholm syndrome" and "drinking the Koolaid" are bad cliche responses repeatedly seen in pre-allo by folks who have no real argument to stand behind.

I still think this about your argument, but I have no need to argue with you. The ACGME has made my argument for me.

 

[Parietal Lobe]

"Stockholm syndrome" and "drinking the Koolaid" are bad cliche responses repeatedly seen in pre-allo by folks who have no real argument to stand behind. You can always say -- you are wrong, you have drunk the Koolaid, or been brainwashed -- to any post you don't like, but to what point? These comments come up over and over again, and, like "Burnett's law" simply don't advance any sort of argument. The logical inference is that you have none.

Weren't you hit with that in allo, not pre-allo, a few weeks ago on this same topic?