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How Do Medical Residents Stay Awake During Long Shifts?

What happens in the hospital stays in the hospital. Mostly because these doctors were too tired to remember any of it.

Emily Cassel

Emily Cassel

Peter Dazeley / Getty IMages

Day-old coffee, Cheetos, Sour Punch Straws… it sounds like the diet of a gamer who hasn't stepped away from their console for days, but it turns out junk food is practically a dietary staple for many medical residents—yes, the future MDs who will someday tell you to eat healthy.

And can you blame them? When you're trying to stay on your feet through a 30-hour shift while handling literal matters of life and death, candy and caffeine go a long way. It's not the only way students stay awake, of course—you need an arsenal of coping mechanisms when you're regularly working for an entire day (or more). We asked a handful of residents (and one surgeon who lived to reminisce) to tell us how they keep from passing out mid-procedure.

Megan Shaner*, Seattle, Washington

I think when you're new, you're nervous, and the adrenaline of the situation keeps you awake. You show up with a grocery bag full of snacks and always end up eating. That's why people gain weight during residency. It's like… Cheetos. Nobody is eating anything that's good for you at 3 am. I would drink caffeine—probably like three Americanos a day. If you pushed through, it got a little easier in the morning because there are people coming on and they're fresh and they smell like they've showered and their energy can kind of carry you through. Plus, in the morning, the attending would usually bring us breakfast: bagels, donuts, that kind of thing.

Derek Anderson*, Boston, Massachusetts

I've tried chocolate-covered espresso beans and caffeinated drinks. I've seen residents chew nicotine gum over long shifts—it's a stimulant. It'll keep you alert, theoretically. Unlike caffeine, it'll gives you a basic, low, steady dose that lingers. Caffeine has highs and lows. Also, if you don't keep getting more caffeine, you crash. Adversely, nicotine keeps you awake over long periods of time.

Some shifts can sometimes go even a little longer [than 30 hours] if there are transitions of care, like if you are handing off a patient to someone else. Peanut butter is good just because you go long periods without eating. You grab peanut butter and graham crackers—these are ubiquitous hospital foods. Peanut butter, crackers, and ginger ale are on every floor. You need to grab that stuff in between, otherwise you will die because you're hypoglycemic. Everyone who's a resident understands that's the diet on the particularly busy or bad days.

When I'm proactive, I carry around bars and nuts and crap. But you have to have time to buy that stuff and when you're on a challenging or long rotation, you generally want to go home and fucking go to sleep. Life stuff like laundry, groceries, and cleaning your apartment doesn't take priority anything. You can always tell what service I'm on depending on my apartment. Sometimes it looks like a war zone.


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Tamara M. Johnson, Newark, New Jersey

The longest shifts I've worked have been 27 to 28 hours. As long as there was work to be done or patients to see, I didn't have an issue staying awake. Once things calmed down and the hospital was quiet, I just kept moving and consumed a lot of candy. Sometimes I'd even run up and down the staircase. Go outside and let the crisp air awaken you. When all else had failed, I had a playlist of my favorite songs and I'd listen to music and dance in the call room.

Manish Shah, Denver, Colorado

As a surgery resident in the late '90s, before mandatory limits were placed on resident hours, I had weeks where I worked 130 hours. My longest time having to stay awake was 48 hours during my chief year in general surgery when I was on the interview trail for a plastic surgery residency. My surgery service wouldn't let me take time off, so I had to double up my shifts so no other surgery resident was inconvenienced.

I kept awake by getting out and walking the hospital grounds. I drank coffee, hung out with the nurses and talked, watched TV in my call room, and took micro-naps to recharge. I did all this—and then went home to help my wife with our three kids under 20 months of age. It was a brutal time, but I survived it.

Daniel Becker, Voorhees, New Jersey

During my internship year, we were on call every other night. Approximately 120 to 125 hours out of the 168 hours in a week were spent in the hospital. Essentially we were living in the hospital. Our entire life—work, friends, meals—took place in the hospital. If you accept the concept, then it is fun—that is, if you are single and have no responsibilities outside of the hospital. If not, for instance if you are married, then it would be a miserable experience.

There was a saying: "Eat when you can, sit when you can, sleep when you can." Everyone did it, and we all got through. You develop survival skills.

Carole Lieberman, Beverly Hills, California

I was a psychiatric resident at NYU-Bellevue Hospital—and the nights covering the emergency room were something out of Cuckoo's Nest. The patients were typically brought in by police after having been rescued from a bridge in the midst of a suicide attempt, or from walking in traffic in the midst of a psychosis. More often than not, they were strapped to a chair, shouting things to imaginary people that I had to interpret to figure out what childhood trauma was at the root of their distress.

The shifts were long—basically two full workdays since I would get little to no sleep. What got me through them were catnaps on a creaky cot in an odd little room on a top floor with a haunted hallway, lots of chocolate, and the exciting, fulfilling challenge of treating the most seriously mentally ill patients on the planet.

*Source preferred to use pseudonym.

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