March 2023 Pick of the Month

More Powerful Than Are We

Tap-tap-tap. TAP-TAP-TAP.

I woke up and saw the officer. He was tapping his firearm on my window. I rolled it down. He holstered his pistol. “Sir, can I see your license and registration?” He peered around in my car. “Sir, have you been drinking?”

“No sir, I just got off a night shift in the ER.” I showed him my badge.

“It looks like you fell asleep, doc. I’ll follow you home.”

Which is what he did. And I appreciated it. Of course, by then my heart rate was 110 and there was no way I would have fallen asleep again.

I was driving home on Brookshire Boulevard in Charlotte, after a night shift at Carolinas Medical Center, and of course, naturally, the train came and I had to stop. As I waited, REM projected up into my consciousness, overpowering it, overpowering me. I was drooling by the time the cop came a tapping. I am still alive. But other ER docs have not been as lucky.

This is why I chose “Objective assessment of sleep and fatigue risk in emergency medicine physicians” by Fowler and colleagues as the March 2023 POTM. The authors present novel data from a large sample with a powerful (in my view astounding) inference about patient safety:  “Participants spent 725 h (23.52%) on shifts with fatigue scores indicative of significant impairment (equivalent to BAC of .05%).”

I would assume that inference extends to the drive home as well.

Jeffrey A. Kline, MD
Editor-in-Chief