Dr. Mary Lombardi in action
PHOTO: CLAUDIO CALLIGARIS
All in a night's work
SYLVAIN-JACQUES DESJARDINS | "It was a good night," Dr. Mary Lombardi says with a wide, satisfied smile about the five straight hours of sleep she managed to squeeze in during her night on call at the Jewish General Hospital's neonatal/critical care unit. "It was a really good night!" she repeats, beaming.
Lombardi, a third-year pediatrics resident whose training rotates between four McGill teaching hospitals -- the Montreal Children's, Royal Victoria, Montreal General and Jewish General -- admits her sleep is usually fractured when she's on call. While she is provided with a room to rest in during part of her working nights, most times she is awakened if prescriptions need to be filled or if there's an emergency. This means she can spend 36 continuous hours on the job.
Like other residents throughout Quebec, Lombardi spends an awful lot of time in hospital corridors. Residents are expected to work a minimum of 10 hours each workday and every second weekend is sacrificed to their jobs. Seventy- to 80-hour weeks aren't unusual.
Add obligatory courses, hours of standing and only a few minutes to grab a quick bite during shifts and this kind of gruelling schedule can really eat away at a person's nerves.
But this is the reality of residency training, an exhausting period that can last from three to five years, where residents willingly put their personal lives on hold for the sake of their careers. And for their love of medicine.
"I have no social life," Lombardi, 27, admits, chuckling. Tongue-in-cheek, she adds that residents are too busy working like slaves to have fun and that she rarely sees her engineer boyfriend, Chris. "If we didn't live together, I don't know when we'd have the opportunity to see one another."
However, Lombardi is quick to point out that residency isn't as bad as an outsider may perceive. "I love what I do, it's rewarding and every year it gets better," she says, noting her residency ends in one year. What's stressing her now is not her job; it's finding the time to prepare for her upcoming licensing exam from the Royal College of Physicians and Surgeons of Canada.
Lombardi forgets about her problems, however, when a patient's mother walks into the neonatal unit. After dashing out of her chair to speak with the distraught parent, whose baby is being transferred to the Montreal Children's following complications to its premature lungs, she offers the mother a soothing hug. Sitting down again she is modest about her caring ways. "She needed a little hug to make her feel better," she says. "I find that a hug and a few words of encouragement really helps parents."
In the neonatal unit -- a brightly lit room where premature or sick babies lie in clear plexiglass cribs, connected to beeping monitors and oxygen tubes -- the anxiety is palpable. The teary-eyed parents keeping vigil over their infants long to have their children safe at home.
In this charged atmosphere, Lombardi says, hugs and compassion serve two functions: to break tension and to keep her from shutting off. "Helping kids keeps me human, too," she says. "How can working with children not keep you human?"
Yet wouldn't it be easy to forget compassion under the kind of duress residents face? To forget the "care" in healthcare? "Not if you enjoy medicine," says Dr. Kashif Irshad, 24, a first-year surgery resident. "You can never take for granted that it's a privilege to help sick people and to see them at their most vulnerable."
Since residency is the fulfillment of a dream to become a doctor, Irshad says, he can hardly begrudge the hectic training. "You have to enjoy getting there," he says, "otherwise you become bitter."
Dr. Judith Trudel, who as director of surgery at the McGill University Health Centre supervises surgery residents, says there's a reason why hospitals are so demanding of residents. "The quantity of information and practice doctors must acquire during training is enormous," she says. "We try to maximize the time we have with our residents, to allow them to put into practice, daily, what they learned in theory."
Doctors, she adds, have the longest and "most demanding" training period of all professionals -- an absolute necessity considering they are dealing with human lives. Yet Trudel concedes residency working conditions (read: long hours) are not always ideal. "But there's a huge difference in working conditions from when I was doing my residency at McGill 15 years ago," she says, "when residents were expected to work 36 hours straight and only be off for 12 hours throughout the week."
Dr. Mark Boyd, director of gynecology and obstetrics at the Royal Victoria Hospital and director of McGill's obstetrics residency program, agrees training conditions have improved.
"The average hours and working conditions for Quebec residents are the best in North America and perhaps the world," he says. Boyd adds that residents' rights are protected under Article 12, a "very forward" provincial law passed a decade ago, which guarantees residents one month's vacation per year and regulates the number of hours they work.
Recalling his own residency in Europe, where residents were worked to the bone, routinely fired and had to be on call for six months without a day off, Boyd says McGill is a far cry from that "cut-throat period."
The main goal of the University's teaching hospitals, he says, is to see all residents succeed and learn as much as they can. "Our residents are much better trained than they ever were. The emphasis is on education, not just having them (work)."
Dr. Allan Peterkin, author of Staying Human during Residency Training, says the enviable working conditions of Quebec hospital residents, however, could "stand to worsen" if the provincial government continues slashing its health budget.
"Every time a nurse or technician's position is cut, it's the residents that have to fill the void," he says, which translates into more hours.
Peterkin completed his residency in psychiatry and family medicine at McGill. He now teaches psychiatry at the University of Toronto and is a psychiatrist at Mount Sinai Hospital. He says hospitals often overwork their residents to save money. "That's the bottom line," he says. "Nobody can ever justify how working excessive hours can promote learning. In fact, there are many studies that point to the opposite and that overworked residents make [more mistakes]."
Working long hours can also cause residents to develop poor nutritional habits, increase their mood swings and prevent them from obtaining adequate exercise.
"Too often," Peterkin says, "residents are so busy thinking about their patients and bosses that they forget to think about themselves."
Both Irshad and Lombardi admit to periodically neglecting exercise because of their crazy schedules. "When I get home, all I want to do is have dinner and go to bed," Lombardi says, while Irshad points to his faint "potbelly" as a consequence of poor, job-related eating habits and infrequent workouts.
Yet the two stress that learning as much as they can during their residency justifies long hours. "If I was to leave directly after my night shifts, I'd miss assisting on most surgeries since the majority are performed during the day," Irshad says. "It's a choice -- you stay to improve."
Not even illness, which fatigued residents are prone to catch when various viruses circulate through hospitals, can keep them away from their jobs. Unless a resident is deathly ill, they are expected to work. "You bite the bullet and work on," Irshad says.
Residency's main fallout, Irshad admits, is that he rarely sees his old friends, most of whom also studied medicine at McGill, and whose schedules are incompatible with his own. As a single man, dating is also complicated by his busy job. But ever the optimist, Irshad manages to put a positive spin on sleepless nights when he's on call. "It's like a big slumber party where you can develop new friendships with your colleagues."