by Paul Goldfinger, MD, FACC
(Special to the Ocean Grove Record.com)

“C’mon doc…let’s take a walk.” Ordinarily this request wouldn’t seem odd, but it was 2 AM, and the idea of getting some sleep seemed much more sensible. But he was my boss, and such a request from the chief medical resident was not to be ignored. “Sure, John; that sounds terrific.” John was an insomniac, with an insatiable love for the excitement of the big New York City hospital where we worked.

I was a twenty five year old intern, and we had just finished admitting seven acutely ill patients to the medical floor. My white jacket was wrinkled, and the tunic shirt, which had been clean, starched and buttoned up to the neck, was now sweaty and open at the throat. My pockets were stuffed with pieces of paper containing hurried notes scrawled as we put out one fire after another. Now it was time to catch up and do chart work. We sat at the nurses’ station, which was strangely empty, except for the rustle of an occasional nurse buzzing by.

My internship had just begun, and those long summer nights “on call” were extraordinary times of intense learning, exhilarating joy, crushing sadness and profound fatigue. We usually were up most of the night and had to work all the next day before finally getting some sleep. This was not a job for anyone over the age of thirty.

The interns came from all over the country, and each one seemed to have certain strengths which reflected where he went to school, so we learned from each other. My med school had emphasized practical “how to” knowledge, while others stressed theory. The latter group didn’t know which end of a suppository was up, but they knew all about the latest research trials. By the end of the year, it had all evened out.

Despite the hard work, everyone was very enthusiastic. Many times, someone would come in on their night off. I recall one time when a first year resident strolled in at 1 AM wearing a tux, followed by his date in a long gown. He went in to check an interesting new admission. The patient was quite impressed (as was I) and thought that we had a very classy staff.

The hospital by night was much different compared to its daytime demeanor. All the frills and frenzy were gone. There were no rounds, no conferences, no visitors, and no noise…only the bare necessities: people caring for people. It seemed like the place had been transformed into a sanctuary where a sort of medical swat team had formed to stand guard and make sure that everyone got through the night. I liked to step outside in the early morning and breathe the fresh air blowing off Central Park across the street and watch the lights twinkling and the taxis cruising along the nearly deserted avenue. You needed to do that to clear your head of the hospital’s heavy atmosphere, even if only for a minute before the beeper went off.

As chief resident, John liked to wander about and make sure that things were going well. He and I walked through the underground tunnel that connected the various buildings, carrying paper cups of warm coffee. The sounds of our steps and voices echoed through the halls as we approached the emergency room.

En route we met the “dirty half dozen.” This was the night surgical crew prowling about like a wolf pack looking for fresh meat. The surgical residency lasted five years, so there were five on each night plus a surgical intern. They were a motley assortment, dressed in green, all male, given to grunts, low humor and two day beards. “Hey Finger…got any hot gall bags for us?” These guys were always hunting for OR cases and would operate on a salami if they could get consent.

The ER was a brightly lit, nonstop, wild and crazy place populated by drug addicts, policemen, drunks, crying kids, bag ladies and, of course, a textbook collection of patients. The interns who worked there seemed to be more cocky and raunchy than most, and the nurses were a hardened bunch who had no fears and who were incapable of being shocked.

John was asked to see a beautiful young European woman who stood out in that crowd. She had been partying and was due to fly home the next day. She was nearly hysterical about a small sore on her lip. John knew that it was a harmless cold sore and he told her so, but just to make her feel totally confident and happy, he gave her a shot of penicillin. I was learning the art of medicine and witnessing a small triumph.

Our next stop was the cardiac surgery ICU. John had been a cardiology resident the year before, so he liked to stop there. Another reason had to do with a certain charge nurse who worked the night shift. While they chatted, I gazed about at the blinking monitors and listened to the humming and buzzing of respirators, suction machines and other assorted devices. The soft sounds of the machines and the voices of competent medical people were reassuring even to me, so I supposed that the patients sensed it also.

We returned to our floor at about 4 am to check in on our “sickies” and to discuss some of the cases. It was traditional for the resident to “teach” the intern prior to wrapping it up for the night. It was painful trying to stay awake during those early morning lectures, but the personal attention was amazing, and, besides, interns weren’t supposed to sleep.

Finally I was able to drag myself to our “on call” room. I would become unconscious even before my head actually collided with the pillow. If I were lucky, the phone wouldn’t ring for an hour or so. At 6:30 am we had to be on the floor to do “scut work” which included drawing blood, starting IV’s and running ECG’s before the 8 am start of rounds, where we had to present the new cases to the whole staff.

In recent years, there were complaints in the press about sleep deprived hospital interns and residents. Laws were passed requiring “house staff” to work reasonable hours. I didn’t agree with imposing those rules on a profession that knows how to teach young doctors in ways that go back to Hippocrates. Yes, we were sleep deprived, but we had so much to learn, and working long shifts was a time honored way to become a competent physician. No one in our hospital was harmed by sleepy interns. The adrenaline kept us going, and there were wonderful residents, attending physicians and nurses to make sure that we did the right thing. We didn’t care about the sleep issue. What we wanted was the action, and you don’t get in the game if you’re asleep.

(Dr. Goldfinger trained for five years in internal medicine and cardiology at The Mount Sinai Medical Center in New York, where they had been training doctors for over 100 years and where he became a member of the first faculty of the Mount Sinai School of Medicine. He eventually got some sleep and now he is enjoying retirement in Ocean Grove.)