Fatigue Has Been a Problem for Many Years – Time for a Change

Terring Heironithus III, MD

Letter to the Editor:


Time for a Change

To the Editor:

Your article, “Fatigue and the Practice of Anesthesiology” is not oniy timely, but struck a personal note with me.

As an intern at the University of Pittsburgh Health Sciences Center from July 1955 to June 1956, I worked 36 hours on, 12 hours off, for 365 days—no holidays, no vacations, no sick time. This resulted in 126 hours a week, or 540 hours a month. It took some getting used to, but we all survived, and to the best of my knowledge, so did our patients. But the quality of care had to be seriously compromised toward the end of those 36 hour shifts.

Years later, as a full Professor at the University of Virginia Medical Center, I was still, at age 50, pulling 48 hour weekends on a routine basis. On the fourth of July weekend, 1976, that involved 21 back-to-back major emergencies, which allowed me a total of 45 minutes of sleep (in 3 periods of 15 minutes each) on a stretcher, and 1 cold cheeseburger in 34 hours of virtually constant anesthesia administration. I realized my fatigue and faltering competence when an answer to a simple telephone question came out in the wrong sequence of words, and an attempt to go from one room to another resulted in my walking into the door frame. At this period, I called for back up, and went home to bed.

There can be no conceivable legitimate excuse, short of a mass casualty disaster, for ever requiring people to work such hours. One hopes the people who make out such schedules will read, and heed, this article. How I wish the APSF Newsletter had been published back in the 60s and 70s! Well done!

Terring Heironithus III, MD
Professor of Anesthesiology (retired)
University of Virginia Medical Center
West Virginia University HSC