I'm a Doctor...I was 'Tortured'

Last week, the Senate Intelligence Committee released its “CIA Torture Report.”  The media, eager for another shot at Bush, Cheney, and their policies, went all out dredging up “torture” stories from ten years ago, including interviews with many former Bush administration officials.  

Sixty Minutes' Lesley Stahl was shocked.  “So sleep deprivation, dietary manipulation,” she said to Jose Rodriguez, former head of the CIA’s Clandestine Service.  “I mean, this is Orwellian stuff.”

Orwellian to her, maybe, but not to most doctors.  These two methods of “torture” are normal work conditions for the better part of a decade for most physicians.

Internship and residency, especially in surgical specialties, involved being on call every second or third night, meaning 36 hours without sleep, with a night or two of rest before repeating the cycle.  And those 36 hours were not sitting in a room.  Life-and-death decisions were being made on a constant basis during these periods of sleep deprivation.  Even this is far better than a hundred years ago.  “William Halsted, the first chief of surgery at Johns Hopkins in the 1890s and a founder of modern medical training, required his residents to be on call 362 days a year.”  Talk about sleep deprivation.

Times have changed from the days of Halsted and from even the training days of most middle aged physicians practicing today.  In 2003, the residency accreditation board imposed an 80-hour-per-week work limit over concerns about medical errors due to sleep-deprived physicians.  But torture was never mentioned in these discussions.

Stahl also hyperventilated about Ensure being given to detainees.  As for the medical field, Ensure was indeed given to hospital patients as a source of nutrition.  But it was also a welcome snack for physicians working at night.  During my training, when midnight rolled around and I was about halfway through my nights work, I was hungry.  Hospital cafeterias were closed.  The surrounding neighborhood was not the place to find a quick bite unless I wanted to be a patient in my own hospital or else in the morgue.  A chilled can of Ensure, readily available on the hospital ward, hit the spot for a late-night snack and energy boost.  Torture?  Hardly.

Don’t forget the verbal abuse and humiliation.  When directed at terrorists, “[t]his is the kind of torture that leaves deep psychological wounds.”  What about when directed at physicians-in-training?  An attending surgeon at my medical school routinely reminded students, “Medical student worse than dog.”  Verbal castigation was fairly routine if as a resident you didn’t know the latest pertinent lab result or the correct diagnosis.  And always in front of your classmates and peers, perhaps even in front of the patient you were caring for.  I never served in the military, but I expect that boot camp was similar for military recruits.  How much sleep do SEAL candidates get during their hell week?  Abuse and humiliation, yes; torture, no.  We all developed thick skin along the lines of “sticks and stones may break my bones, but names will never hurt me.”

Reasonable people can disagree about waterboarding, if it should be used, and under what circumstances.  But sleep deprivation, humiliation, and Ensure are hardly the stuff of George Orwell.  Otherwise, most physicians should be on disability for post-traumatic stress disorder due to the “torture” they endured during their training.  Instead, we have Obamacare, meaningful use, PQRS, preauthorizations, and other mandates.  Now that’s real torture.

Dr. Joondeph is a retina surgeon at Colorado Retina Associates and serves on the faculty of Rocky Vista University School of Medicine.  Twitter @retinaldoctor.

Last week, the Senate Intelligence Committee released its “CIA Torture Report.”  The media, eager for another shot at Bush, Cheney, and their policies, went all out dredging up “torture” stories from ten years ago, including interviews with many former Bush administration officials.  

Sixty Minutes' Lesley Stahl was shocked.  “So sleep deprivation, dietary manipulation,” she said to Jose Rodriguez, former head of the CIA’s Clandestine Service.  “I mean, this is Orwellian stuff.”

Orwellian to her, maybe, but not to most doctors.  These two methods of “torture” are normal work conditions for the better part of a decade for most physicians.

Internship and residency, especially in surgical specialties, involved being on call every second or third night, meaning 36 hours without sleep, with a night or two of rest before repeating the cycle.  And those 36 hours were not sitting in a room.  Life-and-death decisions were being made on a constant basis during these periods of sleep deprivation.  Even this is far better than a hundred years ago.  “William Halsted, the first chief of surgery at Johns Hopkins in the 1890s and a founder of modern medical training, required his residents to be on call 362 days a year.”  Talk about sleep deprivation.

Times have changed from the days of Halsted and from even the training days of most middle aged physicians practicing today.  In 2003, the residency accreditation board imposed an 80-hour-per-week work limit over concerns about medical errors due to sleep-deprived physicians.  But torture was never mentioned in these discussions.

Stahl also hyperventilated about Ensure being given to detainees.  As for the medical field, Ensure was indeed given to hospital patients as a source of nutrition.  But it was also a welcome snack for physicians working at night.  During my training, when midnight rolled around and I was about halfway through my nights work, I was hungry.  Hospital cafeterias were closed.  The surrounding neighborhood was not the place to find a quick bite unless I wanted to be a patient in my own hospital or else in the morgue.  A chilled can of Ensure, readily available on the hospital ward, hit the spot for a late-night snack and energy boost.  Torture?  Hardly.

Don’t forget the verbal abuse and humiliation.  When directed at terrorists, “[t]his is the kind of torture that leaves deep psychological wounds.”  What about when directed at physicians-in-training?  An attending surgeon at my medical school routinely reminded students, “Medical student worse than dog.”  Verbal castigation was fairly routine if as a resident you didn’t know the latest pertinent lab result or the correct diagnosis.  And always in front of your classmates and peers, perhaps even in front of the patient you were caring for.  I never served in the military, but I expect that boot camp was similar for military recruits.  How much sleep do SEAL candidates get during their hell week?  Abuse and humiliation, yes; torture, no.  We all developed thick skin along the lines of “sticks and stones may break my bones, but names will never hurt me.”

Reasonable people can disagree about waterboarding, if it should be used, and under what circumstances.  But sleep deprivation, humiliation, and Ensure are hardly the stuff of George Orwell.  Otherwise, most physicians should be on disability for post-traumatic stress disorder due to the “torture” they endured during their training.  Instead, we have Obamacare, meaningful use, PQRS, preauthorizations, and other mandates.  Now that’s real torture.

Dr. Joondeph is a retina surgeon at Colorado Retina Associates and serves on the faculty of Rocky Vista University School of Medicine.  Twitter @retinaldoctor.