Fatigue

Before, when things got tough, my approach was to put my head down and push along. As things got harder, I kept at it. I would flog my body and my mind harder to keep up the pace.

Before medical school, I had experienced the usually fatigue. The sleepless nights of a newborn. The occasional all-nighter before a college final. The long road trip. Most of my fatigue was easily managed by a few extra hours of sleep on the weekend or going to bed a little earlier.

And then came medical school. Early classes, late evening labs, and then the studying. The 4-8 hour a day studying. My time to sleep was cut back. From 8 hours to 6 hours, and then to 4-5 hours of sleep a night. Obviously, my ability to stay awake in lecture decreased in direct correlation to my lack of sleep. So, naturally I turned to a cheap legal stimulant. Caffeine. Yes, I was a caffeine consumer before this. I enjoyed my diet Coke, I loved the occasional latte. But now, caffeine wasn't an occasional enjoyment. It was a daily essential. I started drinking Coke after Coke. Then it was coffee after coffee. Enough that Hubster accused me of keeping Starbucks in business.

I was rewarded for flogging myself harder. I got fantastic grades, top marks on exams, flew through boards with amazing scores. Because I had realized early on in medical school that, unlike in undergraduate classes where I was unquestionably the smartest person in the class, in this academic arena, I was only an average smart person. My ego and my view of myself were at risk. I could never out-compete my fellow medical students on sheer brains. I would have to out-compete them with effort. So I studied, beat my body with lack of sleep, beat my brain with caffeine, and succeeded.

And then things got worse. Monkey was born (okay, that's not the "worse" part, that was the joyous part, but still, newborns are hard). I started clinical rotations and started taking overnight call every fourth night. I started working 80-120 hours a week. And still studying. I cut my sleep from 4-5 hours to 3-4 hours. I went every fourth night without sleep. I was a zombie. Coffee, no matter how strong, wasn't cutting it. So I turned to caffeine tablets. 200 mg of caffeine a tab. Multiple tablets a day. So much caffeine in my system that I had horrific withdrawals.

This is where the story could become tragic. I've seen it happen before. I've watched it happen. But I had made Hubster a promise that I would never take anything illegal. That I would never use something that wasn't available at Wal-mart.

This is where I also grew up.

Residency is similar in its demands on my time. There are still plenty of sleepless nights.

But as part of growing up, I'm gentler with myself. Instead of whipping myself to go harder, go faster, do more, I find ways to make my time more efficient, my life less stressful, my schedule more manageable. Yes, a cup of coffee is still necessary occasionally during a bad call night. A diet coke is sometimes still needed to get me through lecture. But when I get tired, I think about how I can change things at home to get more sleep. As a teenager I thought that sleep was such a waste of time. All it did was eat hours of potentially productive time out of my day. Now, I see sleep as healthy, and honestly, enjoyable.

I've also changed my priorities. My family is infinitely more important to me. Yes, I want to be a good doctor. Yes, I want to do well on boards and in-training exams. But I'm not willing to sacrifice my health and sanity for it any more.

I'm perfectly okay being just an average smart person.