“Did you know that sleep walking will get you disqualified from the Navy?” I asked my wife in response to her usual “What did you do today?” interrogatory. It was drill weekend and I had just finished one of my rare day shifts serving at the Naval Academy clinic.
“Really? That’s hard to believe,” she responded, suggesting that she had for once really listened to my answer.
“It’s true. Think about it,” I pontificated. “You can’t have sailors wandering around the ship in their sleep. They could fall off.”
“I had an episode of sleep walking once when I was a kid,” she said. “I went in to my parents bedroom and threw the bathroom scale on the bed.”
“That’s pretty funny”
“They didn’t think so,” she said. “At least my dad didn’t.”
“He’s never had much of a sense of humor.”
“The scales hit him in the head.”
“Ooof,” I said, feeling his pain. “I’ll bet that got you paddled.”
“He washed my face and woke me up.”
“Now that IS hard to believe,” I said incredulously. “My dad wailed on my brother when he had an episode of sleep walking,” I said with a chuckle.
“That’s awful.” My wife just shook her head with disgust at my gleeful recall of his corporal punishment.
“Honey, he was peeing on the TV set. It was a console set and our first one with color. It was a wonder he didn’t get electrocuted. It took my mom the whole rest of the night to get it clean so the den wouldn’t smell like a urinal. Anyway, as I was saying, sleep walking will get you kicked out of the Navy. Or if you don’t happen to like the military, it’s a free pass to ‘get out’ of the Navy.”
She tilted her head and thought about this for a moment. “That’s interesting. Is there a way to tell if it’s real sleep walking short of seeing if someone walks off the ship.”
“I don’t think so. They put them through a sleep lab and a psychiatric evaluation. But I’m not sure they can really tell for sure. I heard about one guy who wanted to stay in and was afraid someone would discover that he was a sleep walker. So he tied himself to his rack every night. They caught him when there was a fire drill. He jumped out of bed and almost hung himself.”
“That’s really sad.” My wife thought of all the enlisted boys as if they were her sons.
“Yeah, that’s too bad for him. But think about all the guys who got out by faking it. It got me thinking. It’s the perfect excuse.”
“You are such a lame brain. You are always looking for an excuse for something.”
“Not for me, oh dear wife-who-always-believes-in-her-husband. I get no respect.” I gave her my best Rodney Dangerfield look. “I’m talking about all those ‘lame brain’ attendings that I have to call every night.” She just shrugged and rolled her eyes.
“When I first went into practice I got so tired of the medical staff arguing with me about admissions that I would just fly through the case and if I heard a grunt at the end, I just took that as agreement, wrote the orders and the patient went upstairs. The system worked great. But then an attending lost a patient in the hospital and for almost a week blamed it on me. He said I didn’t tell him about the admission.”
“Duh,” my wife said.
“Ok, so now I give everyone a complete H and P on every patient I talk to them about and half the time, they still complain that I didn’t tell them some critical detail. Then when I show them the note detailing our conversation, they just claim they must have been asleep.”
“Don’t be so hard on the medical staff. Didn’t you tell me that one time you fell asleep while you were taking a patient’s history?”
“That was different. It was four o’clock in the morning and it was the fifth belly pain I had seen that night. And I didn’t really fall asleep. I just laid my head down on the bed rail while I listened to her drone on and on. She just wouldn’t stop talking.”
“You told me you woke up with drool on your chin and a rail mark down the side of your face.”
“And she was still talking,” I said, shaking my head. “Can you believe that?”
“Did you figure out what was wrong with her?”
“No, I called the resident down. I wasn’t about to ask her to repeat her story.” I paused for a moment. “I guess you’re right, though. I can’t really use that excuse myself either. “Doctor,” I said, putting on my best attorney voice, “Is it true that you wrote for the patient to receive 1000 milligrams of IV dilaudid when you really meant to write dilantin? That’s right counselor,” I said, changing my voice, “but it was all because I was sleepy.” My wife just looked at me incredulously.
“Seriously,” she said, “how can you avoid all the mistakes that occur from people walking around in their sleep? Everyone knows it’s a real problem.”
“I think we should shut the ER down from midnight to six am. That’ll take care of the problem.”
“Right. ‘Your honor, the defendant appears to be insane’.”
“Now I’m serious. I don’t see any way to avoid a certain number of problem situations that will occur as the result of working at night.
Man was not meant to be nocturnal. If he was, God would have given him a different kind of eyes.”
“Well, if the Navy feels that sleep walking is such a dangerous situation that they would discharge sleepwalkers from the service, maybe the medical profession should take a cue and get serious about mistakes secondary to fatigue.”
“Wait a minute. I wasn’t saying that docs should be punished for being sleepy.”
“How would you feel if the pilot on your next flight took just a little teensy weensy nap while he was flying your plane?”
“OK, OK, I agree that fatigue is a problem. I think I was the one who told you that to start with. But I don’t know what we can do about it.”
“You don’t?” she said with the look she used to interrogate the kids.
“Honey, you’re talking about changing a whole system that has been sleep deprived for a hundred years, and proud of it. I can’t do anything about it.”
“You can’t? Or you won’t try?”
“I hate it when you do this to me,” I said. “I feel like the last kid in a room full of toys that are left on the floor. And you expect me to pick them all up. How am I suppose to do that, huh?”
“Just like I tell the kids: Pick them up one at a time. Has your group ever talked about how many hours of sleep you need to have before coming on to work all night? I heard one time that long haul truck drivers have to log the hours of sleep they get on a long trip. Ever thought of anything like that?”
“Why don’t you come to our next staff meeting and suggest that?”
“I’m not telling you what to do, I’m just challenging you to do something about the problem instead of just whine about it.”
“So you think I’m whining?”
My wife said nothing as she folded her hands and gave me her ‘I rest my case’ look.
“Honey,” she said, finally breaking the silence. “You need to go upstairs and get some sleep. You still have to work tonight. And I don’t want you drooling on any patients.”