SMS ("Stanford Medical School") Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.
I first saw it on the face of a resident at the end of a 24-hour shift. And then again on the weary visage of a nurse after a whirlwind shift in the emergency room. Soon it was written across my own brow: The expression that said, It’s time to take a break. But as I soon realized, it wasn’t just the students, doctors and nurses who were struggling to get enough rest.
“It’s impossible to get any sleep here,” remarked one patient whom we awoke on early morning rounds. “There’s just constant disruption. I don’t feel like I’m healing.”
“Is there anything we can offer him besides sleep medications?” I asked the supervising physician after we left the room.
“Everyone says they can’t sleep,” he replied. “Unfortunately it’s just part of being in the hospital.”
I often ask patients to suggest one thing we can improve in their medical care. An overwhelming majority of them comment on the lack of peace and quiet. Perhaps the most memorable example was an elderly gentleman hospitalized for tuberculosis. Even in an individual room with airtight separation from others (“respiratory isolation”), he couldn’t go more than a few minutes without being disrupted. Doctors and medical students started their morning rounds before sunrise, vital signs were measured every four hours (including at night), and nurses constantly came in and out with meals and medications. He lamented, “The only thing I want to do is sleep. But as soon as I do, someone else comes in.”
Hospitals didn’t always used to be hectic. In fact, restful environments were long thought to have healing properties. Early in the 19th century, the French physician Laennec noticed lower rates of tuberculosis in seaside communities away from the hustle and bustle of the city. Wanting to bring a piece of that environment to his urban-dwelling patients, he began putting ocean seaweed under the beds of Parisians. More recently in the 1940s, a popular treatment for tuberculosis and other serious illnesses was the ‘sanatorium.’ Patients enjoyed the fresh air of the countryside, where it was thought they could rest and give their bodies a chance to build protective ‘walls’ around the infected nodules in their lungs.
The advent of antibiotics around the time of World War II brought a rapid end to seaweed, sanatoriums and other similar remedies. Nowadays, it’s easy to look back and chuckle at the idea of trying to cure tuberculosis by lying in a bed on the seashore. But it's also increasingly difficult to justify the (somewhat) controlled chaos of today’s hospitals – an environment that is at best claustrophobic and at worst dangerous. After all, the benefits of a good night’s sleep have been proven beyond the shadow of a doubt. And numerous studies show that many people live longer and healthier if sent home instead of staying in the hospital with the exact same disease. Granted, much of the benefit of going home lies in avoiding exposure to others with contagious infections. But after seeing innumerable patients exhausted from being poked and prodded around the clock, it’s hard to shake the thought that the hospital environment itself may be more pathologic than we once believed.
Many of our clinical mentors came to this realization long ago, and teach us on a daily basis how mindful doctors can buffer patients from the stresses of a bustling hospital. Of course, helping someone to rest comfortably is more easily said than done. But as students, we can at least identify role models who are the kind of physicians we want to be – physicians who notice when a patient is sleeping and decide, “I’ll come back later.” Or those who notice when someone is exhausted and ask, “What can we do to help?” And if we can help patients sleep a little better, maybe – just maybe – their doctors will too.
Mihir Gupta is a third-year medical student at Stanford. He grew up in Minnesota and attended Harvard College. Prior to writing for Scope, Mihir served as co-editor in chief of H&P, Stanford medical school's student journal.
Photo by oddmenout