Cheating the clock

“I wish I had more time for quizzing.” For a 26-year-old, Panjim resident Dr Adish Talwadker’s wish-list sounds pleasantly simple and modest. Long hours of restful sleep is the next best thing for him, but this junior resident at Goa Medical College (GMC) — also in Panjim — would any day trade it for the mindsport he is passionate about. Straight out of a shift that has stretched beyond 48 hours, Talwadker is surprisingly chirpy during the phone interview with BL ink .

“Eat when you can. Sleep when you can. That’s the mantra we (residents) follow,” says Talwadker. “The body takes time to get used to this system, but all sane ideas about regular sleep and diet fly out the window right from the time we enrol for MBBS. The course is so intensive that we are kind of wired into this pace of life from day one,” he says, adding that the facilities for doctors and residents at GMC, founded in 1842 by the Portuguese, are better than what he has seen or heard of in government hospitals in other parts of India. “We have a decent canteen, hostel and rooms for rest and sleep. Some of those rooms are also air-conditioned,” he says, between bites.

Talwadker is also quick to admit that his specialisation — radio diagnosis — is less demanding than emergency medicine or paediatrics, but that’s not what influenced his choice. “I have enough doctors in the family and that’s how I came to know about radio diagnosis. It is a speciality that helps doctors determine the line of treatment and plan of action — be it a pregnancy, a road accident case or an infectious disease like tuberculosis,” says Talwadker, whose younger brother has just completed MBBS.

The junior resident doesn’t know which speciality his sibling would choose. But what he is sure of are the “benefits of residency at a government hospital”. “The number and range of cases at a government hospital give you the exposure you need at the learning stage. Because treatment is either free or highly subsidised, we are dealing with patients from various backgrounds. In a country like India, some diseases are mostly restricted to certain living and working conditions. And when your learning is largely on-the-job, government hospitals are notches above private institutions,” says Talwadker.

He goes on to add that seminars and workshops, too, are important for residents, but the opportunity to watch and learn from a senior outscores all else.

But how far is a sleep-starved, overworked resident willing to go, say, to watch a live surgery? “Quite far,” says Talwadker. “Especially if the surgeon is a big name in the industry, you will sacrifice sleep and stay extra hours. But there also comes a point where you know you are pushing yourself too far.” He later points out, through a WhatsApp message, that the World Health Organization has classified graveyard shifts as a possible carcinogen. The reason behind this is circadian (what we know as the ‘internal body clock’) disruption.

But what exists on paper often remains only on paper. And no one understands this better than Talwadker and his batchmates, or the doctors they train under. Every alternate day brings a 36-hour shift, which might extend beyond 48 if you’re filling in for a colleague. The regular shift — 8 am to 5 pm — easily spills over by two hours. And quite often the residents are summoned to work by seven in the morning. “On night shifts, sometimes I get two to three hours of sleep. But it’s better to avoid deep sleep because we get many emergency cases at night, especially trauma or pregnancy-related. And doctors need ultrasound reports, CT scans and so on,” says Talwadker. According to a conservative estimate, around 200 cases a day are referred to GMC’s department for radio diagnosis. The risk of infection, though much higher among doctors of internal medicine, paediatrics and surgery, is a cause for concern. Talwadker mentions instances of residents and doctors contracting pulmonary tuberculosis from government hospitals in Mumbai and Delhi.

Apart from lack of sleep and rest — as well as the hazards of an irregular diet — junior residents also grapple with the near-loss of social life. “When I am on duty, I am cut off from my phone, which, you will agree, is very much the window to the world these days. The equipment in the department requires us to keep our phones away. I miss out on a lot of things that people my age are instantly clued into, but we (residents) build our own social system. Yes, most of our friends end up being from work, but that’s better than being friendless,” says Talwadker.

As for the road ahead, Talwadker is clear that he wants to study further. “I could continue here as a senior resident, or even consider getting a business degree,” he says, before excusing himself for the night. “I have to be back at 7am.” A quick calculation shows that he will have less than seven hours of sleep before that.