Tuesday, July 27, 2010


About a year ago, after some 20+ years in practice, I was working harder than I ever have, and this includes my residency and yes, even internship.

Internship is marked by uncertainty more than absolute work, since at that stage, you never know what's coming.

The scenario of this late in career period of time was that I was the lone member of my group covering a particular hospital. Over the years the number of neurologists, neurology groups seeing inpatients had shrunk, so that the bulk of the work was being done by some self-proclaimed neurologist hospitalists, in other words, they were not under contract with the hospital, but having announced themselves as such, had adsobed much of the inpatient work.

A series of events ensued, one of which was that my group became employees of said hospital corporation. The other shoe dropping was that this hospitalist group of 2 broke up from internal issues, and the remaining member, "disenchanted", decided to abandon ship, i.e., leave this hospital for coverage.

Suddenly, a 400+ bed hospital had for all intents one neurology group for neurology consultations, and de facto I was the sole recipient of these daily consultations. As if a switch were flipped, my days were driven by the steady yet erratic influx of double-figure consultation requests. So my days began earlier and ran later, starting at 6am, running to 9pm, 10pm, 11pm, and even later as I tried to keep up with the influx. I might technically be done at 9pm, but then get a request at that moment, and yes, I could put it off until tomorrow, but overnight there might be 3, 4, 5 more, so better to just see that 9pm consult tonight so I go to bed with a clean slate.

At the time and even in retrospect, the most disturbing thing to me as this materialized was the content of my dreams was replaced by dreams of being in the hospital seeing patients. Entirely. I found this disquieting, since this became a 24/7 experience for me. I have to say, I would not have believed that daytime behavior could so radically affect dreams. One begins to fear for sanity.

I don't know what signs became apparent, but finally the other members of the group stepped in to pick up some of the pressure, and once again dreams were transformed, to something more recognizable as normal, but of course what is a normal dream?

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