Your Schedule Could Be Killing You

Modern lifestyles are at war with the way our bodies evolved to function, and the battle is wiping us out. Chronobiology could help us get back on track.

- Leslie Kaufman

It is 7 p.m. on a spring Friday, and the Highland Hospital emergency room in Oakland, one of the busiest trauma centers in northern California, is expecting. When the patient—a young bicyclist hit by a car—arrives, blood is streaming down his temples.

From a warren of care rooms, a team of nearly a dozen doctors and nurses materializes and buzzes around the patient. Amelia Breyre, a first-year resident who looks not much older than a college sophomore, immediately takes charge. As soon as the team finishes immobilizing the victim, Breyre must begin making split-second decisions: X-ray? Intubate? Transfusion? She quickly determines there is no internal bleeding or need for surgery and orders up neck X-rays after bandaging the patient’s head.

Breyre will make a half-dozen similar critical choices tonight. Highland, a teaching hospital, is perhaps the most selective emergency-medical residency in the nation. To be here, she must be outstanding.

To succeed, though, she must stay sharp.

That quality of focus—amid the chaos and battered humanity that comes through Highland’s doors—is itself in need of urgent care. Andrew Herring, an emergency-room doctor who supervises Breyre and 40 other residents, is worried about the team. ER doctors are shift workers, and their hours are spread over a dizzying, ever-changing schedule of mornings, afternoons, and nights that total 20  different shifts a month. That’s meant to equally distribute the burden of nocturnal work across an entire team of physicians. But despite those good intentions, Herring says, the result is that every single one of them is exhausted and sleep deprived. That’s dangerous for doctor and patient alike.