Libby Zion was 18 years old when she was admitted to New York Hospital.
A freshman in college, Libby took a daily antidepressant called phenelzine and up until March 5, 1984, had not encountered any problems.
But suddenly she came down with a flu-like illness, which included strange jerking motions. Dr Raymond Sherman, the family physician, recommended she be admitted to hospital for evaluation and observation.
Two residents (a doctor in training supervised by an attending physician) assessed Libby and were unable to identify the cause of her illness. One of the residents, Gregg Stone, suggested perhaps she was overreacting.
The decision was made to prescribe the 18-year-old student pethidine, an opioid pain medication to control her unusual jerking movements.
In doing so, the doctors were responsible for a critical oversight.
Antidepressants along with some anti-anxiety medications may interact catastrophically with other prescription drugs that effect serotonin levels and cause something called serotonin syndrome. The combination can be lethal.
When she began to react, her fever worsening, the resident made the decision to tie her to her bed.
Her parents were understandably devastated and desperate for answers. That’s when Sidney Zion uncovered the disastrous conditions into which his daughter had been admitted.
The medical residents were receiving virtually no supervision because they were so understaffed. But the most concerning factor, was the absurd and inhumane work hours being expected of new doctors – a practice that extended all over the world.
According to a story published in The New York Times in 1987, jobs were designed to challenge the “physical and mental stamina” of medical school graduates, with some hospitals demanding, “stretches of 40 hours or more on duty with only snatches of sleep”.
The article explained: “After days without rest, the most disciplined mind may have trouble properly interpreting an electrocardiogram or remembering all the side effects of a new drug.
“In today’s complex medicine, even slight oversights can be lethal.”
How do you know when you’re sleep deprived? Post continues.
As a result of Zion’s tireless advocacy, the law was changed in 1989, meaning that residents could not work for more than 80 hours a week, or for more than 24 consecutive hours.
But the circumstances that led to Libby’s death still exist today.
The audit concluded that half of Australian doctors in public hospitals were working hours deemed unsafe. Among the most overstretched, were intensive care physicians and surgeons.
Professor of neuroscience and psychology at the University of California, Matthew Walker, says that sleep deprivation – as is common among physicians – is as detrimental to brain function as being intoxicated.
“We know that after you’ve been awake for 19 or 20 hours, your mental capacity is so impaired that you would be as deficient as someone who was legally drunk…” Walker says.
In a recent interview on podcast The Joe Rogan Experience, Walker asked if we would trust a surgeon who was consistently swigging whiskey.
Rogan himself shared an anecdote of a friend who is an ophthalmologist. While a resident, he fell asleep on the toilet, while eating a meal, and was interrupted because they needed him back on the floor.
That was the man, Rogan emphasised, who was operating on people’s eyeballs.
When people get less than seven hours sleep, Walker maintains, the likelihood of them making a mistake increases considerably. The latest data indicates that one in five medical residents will make a serious medical error due to sleep deprivation, and one in 20 will cause a fatality as a result of a “fatigue related error”.
Though these statistics are drawn from the United States, Australia’s record isn’t much better.
In the Australian Medical Association’s 2016 audit, the longest reported working week was 118 hours, while the average was 78 hours.
The president of the AMA, Michael Gannon, said in a statement: “It is disappointing that work and rostering practices in some hospitals are still contributing to doctor fatigue and stress, which ultimately affect patient safety and quality of care and the health of the doctor.”
The result can be lethal.