Writing Blind

When I have to touch-type because I'm so sleepy that my eyes collapse shut, I know I'm serious about keeping up my blogging. Throughout my life, slumber has trumped eating, sex, entertainment in my heirachy of needs. The undending run of allnighters in residency almost kept me from being a doctor. But, I figure, if I could give up sleep for my job, I can certainly give it up for my craft.At some point I need to write about the medical problems I've had while I'm a resident, which are numerous. Dauntingly so. Yes, the girl who won "Perfect Attendance" certificates every year from kindergarten to tenth grade has become a hypochondriac slacker, and at the worst possible time - a time when my absences and sick leave not only screw my fellow residents (who have to cover my call) but also my patients, who get suboptimal followup because their continuity of care is disrupted.

I used to be such a nerd that I would go to school with a cold and the stomach flu, preferring class to sitting at home being ignored by my grandmother. I managed to get the chicken pox during summer vacation, and one year got the flu the week of Christmas break. But until this past year I have never been hospitalized and, much to my disappointment, never had a broken limb requiring a cast that people could sign. Now all of a sudden I need a pillbox to organize my daily medications. The same girl who didn't get a formal physical exam until she was sixteen (my grandfather, a family practice doctor, would sign off on all of my school physicials without even touching me with a stethoscope) is now the person whose primary care doctor knows her by name. I've had MRIs, sleep studies, transesophageal echocardiograms (where they look at your hear by sticking a probe down your gullet). I've become the neurotic patient that I've always hated, the patient who comes in with her own premade diagnosis and asks for specific tests.

When I first came to Dr. J worried that I had sleep apnea, I rattled of the symptoms I remembered from medical school: daytime sleepiness, loud snoring, periods where my breathing stopped.

"Hmm. You know if you have the right symptoms you'll get the test you want, huh," she said as she filled out the referral form with noticeable reluctance.

I met with similar skepticism when I went to have the sleep study. "They think you have sleep apnea?" the tech asked me. "Well, I can guarantee from looking at you that you don't have it," referring to what health professionals tactfull term my "body habitus": usually sleep apnea occurs in the obese, in big boned people whose excess flesh in the back of their throats falls back when they get relaxed, causing obstruction of their airways.

When the ear nose and throat doctor at Yale read my sleep study report he told me I was fine. "Just a little elevation in your RSBI, but I don't think that means anything." He wished me good luck in residency.

A year later, I was nodding off each morning at the wheel and snoring through each Tuesday's grand rounds. Something was wrong, and when I finally got to the sleep center at Stanford they looked at the numbers in my study and asked me what I wanted.

"What do you mean?"

"Well, we already know that you have sleep apnea, what treatment would you like?"

I suddenly understood the relief of the diagnosed, the sweet vindication of the hypochondriac. I was sick! I had an ailment, yes, but it could be treated! My new favorite doctor explained that elevated RSBI had been a controversial parameter until recently, but that it was undoubtedly a form of sleep apnea that could probably be treated with a CPAP machine, a little nose nozzle that you wore at bedtime to administer "helper breaths" of air as you slept.

The night I first put the machine on I stopped snoring. It was still difficult to wake up in the morning, but not nearly as bad. The CPAP equipment doesn't allow me to sleep on my side, and sometimes my unconscious self takes it off in the middle of the night. But most evenings, I sleep the sleep of the justly pushy patient.