The Calling

According to a recent study, people over 40 have better-functioning brains when they work no more than 25 hours. I’m sure this finding is popular with everyone over 40.

People under the age of 40 would also benefit from shorter working hours, although perhaps not cognitively if they use their off-work hours to actively impair their cognition (with chemicals, video games or other addictions) as many young humans do. Perhaps the young would not feel so driven to numb themselves, if their elders were seen living enjoyable lives. Middle-aged people need to set youth a good example by having fun. All the more reason for that 25-hour work week.

In the nineties, a Scandinavian study found that having a nap in the middle of the day reduces a person’s risk of heart disease as much as giving up smoking. More research has been done since then.  I am still waiting for the public health campaign promoting the benefits of a siesta lifestyle. And I am definitely not holding my breath for the 25-hour work week.

But, if wishes were horses, what would you do when you have a twenty-five hour work week? Campaign to save the Barrier Reef? Write a novel? Become an expert in home-made sorbets and gelato? Spend more time with people you love? Sit and look out the window at the trees? Perhaps you’d spend the first three months catching up on sleep and developing a pleasurable exercise routine.

The study found that there was a marked decline in the cognitive functioning of middle-aged (and older) workers when they worked a 55-hour week, as many of us do. In healthcare, many of us work more hours than that. I have a well-chosen position in my current workplace. Although I am presently the only doctor, I’m not on call except for unusual emergencies. That is, I sleep through the everyday emergencies — the heart attacks, obstructed gall bladders and car roll-overs — that my colleagues, the Remote Area Nurses (RANs) deal with at night. This week there are two of them here with me — for a town at its peak population of around five or six thousand. Four or five thousand of those are visiting travellers and tourists. In better weeks we have another RAN to help with the on-call roster. Then they get off one night in three to try to recover, socialise and sleep like an ordinary person.

With RAN Rob Atkinson on a brighter day. Pic (c) Claudia Jocher 2015

Being on call means sleeping next to a phone and waiting to be woken by a story of grief and suffering. Jolted from sleep, it can take a minute or three to process what you are hearing. One prays for the ordinary: chest pain, an asthma attack, a cut on the head after a fight. But there are enough grim awakenings to scar my brain: the hangings, serious car accidents, critically ill people. It's harsh to be woken up by a nurse or another doctor with fear in his or her voice. But you want your colleagues to have someone to call.

Then there are the nights when you don’t sleep anyway. You're tossing and turning when the phone rings and you have to get dressed and make your way to the clinic or hospital. On those nights you almost feel relieved to go and stitch someone’s head up. If you can’t sleep you may as well be useful. Some jobs pay small amounts to be on call — perhaps five or ten dollars an hour. But many others don’t pay you to be on call at all, and so if you get called in, at least you get paid. It is perverse to be glad that someone needs your help for the sake of money. But the pay compensates a bit for those lost hours.

It’s never enough, though. Partners and other family are affected by on-call work, too. A couple of years ago, my wife Claudia encouraged me to take a job without on call duties during after-work hours. She’s seen me do it for years and knew what it did to me. She’ll tell you about when I started to hallucinate that there was someone knocking at the door, and started rushing to get dressed in the middle of the night. Or the times I interrupted my meal because I imagined that I heard the phone ring and ran to get it. In those years, Claudia never slept when I was out on call, always waking when the phone rang and sitting up through the long hours waiting for me to return home. I often came home completely drained. She comforted me and grounded me.

I feel deeply for the RANs who go out at night to care for sick and injured people in the remote communities in Australia. They are dedicated, smart, hardy people. Shockingly, a RAN was murdered in a town not far from here last month. In a photo taken of her before death, I could recognize the love and intelligence in her eyes. I say “recognize” because I see the same warmth and compassion in so many of my friends and colleagues. Imagine the horror and grief felt by the people in the community she had cared for. I feel especially for her husband, so used to years of dedicated service that he slept through his wife’s call out and didn’t even know she was gone until the morning. Grieving people are campaigning for the safety of the RANs, pushing to have all RANs be accompanied when they are called out in the night. More power to them.

Last night I was up until midnight with our own RANs and it was a glimpse into the long hours and extreme demands of their work. Claudia, who works as an on-call ambulance driver for the clinic (usually through the day) was up after midnight too. Recovery time was important for all of us today. Thankfully, in our small town, regular patients are remarkably understanding when their long-awaited appointments are rescheduled. Our health and their health go together, after all. Sometimes the doctor needs to sleep in.