Vacation Time

During clerkship at my school, we get a grand total of 3 weeks off during the year and no, we don't get to set when they are. Today I start my first week of vacation! Unless you count the time I was sick and on the floor with stomach flu (and I don't) this is the first time in 4 months I'm even getting a full 72 hours away from the hospital.

And wow, did I need a break. I've worked far longer than 4 months straight before without much difficulty before, but there's a huge difference between working 40 hours a week with weekends off, (or being in school 25 hours a week with an extra 30 for studying/ECs set on your schedule), and working 60 hours a week, including nights and weekends regularly, with another 15 devoted to studying/ECs, all mostly out of your control to schedule. I'm tired. I've probably had 4 weeks in the last 4 months where I wasn't chronically tired, and only a few days where I felt truly rested.

I thought I'd take this opportunity to go through some of my fatigue-coping strategies. None of these are overly unique, most of them have an evidence base behind them, but I think they're worth highlighting.

#1) Make Time For Sleep

The average person should sleep 50-55 hours a week, ideally on a regular schedule. Some people can get away with less, maybe 45 or even 40 hours on the low end, but less than that generally means chronic sleep deprivation. I need sleep on the higher end of the spectrum - if I start dropping below 50 hours of sleep in week, I'm exhausted.

So I put the emphasis on sleep. If I'm tired, I try to go to bed an hour or half-an-hour early. I set my alarm as late as I can get away with. If I have a choice between getting an extra hour of studying and an extra hour of sleep, I choose sleep.

I know classmates who don't make this choice, and you can see the fatigue. Maybe they handle fatigue better than I do, most are a few years younger than me, but I can't imagine the difference is that great. Chronic fatigue makes us worse students and worse physicians-in-training, so I make time for sleep.

#2) Exercise!

The benefits of exercise as numerous and its effects on fatigue and alertness are well-established. It's tough to get enough exercise when you're lacking time and are already low-energy, but it's important to remember that exercise is an energy investment - you give up some energy now for more energy overall.

I walk to work. I walk from work. I walk the dog at least once a day, often twice, and I have a big, active dog. I take stairs in the hospital when I can. It all adds up to a good amount of activity.

Nevertheless, that's probably not enough. I should be getting more moderate- or high-intensity exercise on a regular basis. In contrast to my sleeping patterns, I know classmates who do a much better job of prioritizing exercise than I do. I should really be hitting the gym. This is on my to-do list of things to work on moving forward.

#3) Taking Little Breaks

There's no time in clerkship for long breaks, especially if you have obligations at home. Even an hour away from any responsibilities is hard to get on a regular basis. That's where small, 5 to 15 minute breaks can be a huge help. The key is to make it a true break - to get away from all stressors and to let your mind rest or work through whatever it needs to work through. Sometimes that's taking 15 minutes before bed to just process what happened during the day. Sometimes that's taking 5 minutes in the morning to relax and just have a clear head for the coming day.

Like most people, I use music to help take a quick break. Music, especially familiar music, is naturally calming (even if it's high-intensity music) and helps screen out other distractions without taxing your brain. I tend to draw on a small number of songs that I listen to ad nauseam. My go-to song is Matthew Good's Sort of a Protest Song:

Besides just being a good song with a relatively calming melody, I listen to it because its theme generally matches my mood when I need a quick break. Between the lyrics and what has to be my favourite title for any song, it expresses my sentiments all too well - that I'm tired from being "on" for too long, it sucks, I don't like it, I'd really like to stop, but I have to keep going and I know it.

Alright, not just that I have to keep going, but I want to keep going. As much as I complain about medical school, that I definitely don't want to do what I'm currently doing for the rest of my life, and that I'm incredibly frustrated by so many aspects of my medical training right now, I want to see this through to the end. I still value the end goal and would hate myself if I gave up.

So, I take 6 minutes to listen to Matt Good and have my little non-protest protest against my current situation. And then I put my jacket on and head out the door, just a little bit more rested.