After the second long flight on the trip, from Tokyo to Singapore, we arrived in the Lion City about 1 a.m.  Fortunately, we had booked a hotel at the airport, and all we had to do was find it.

Biologically, it was about 10 a.m. the next day for me, and I had not slept well on the plane.  I seldom do.  Usually, my head flops over and wakes me up, and I couldn’t find a way to rest it elsewhere that worked.  Yet, I felt surprisingly sharp, as we walked through the terminal.  The terminal wasn’t quiet; indeed, the world isn’t quiet, even when it ought to be.

I wasn’t sharp,  although I didn’t realize it.  I had trouble finding the right tram, and the “T2” sign didn’t click with me as meaning “Terminal 2.”  I thought it meant “Tram 2.”  Nevertheless, we got to the hotel and slept a little.

The next morning, I realized how much clearer I was after even 5 hours of sleep.  There was so much I had missed in the airport the prior night.  I didn’t realize the shortness of the tram and the various shops present.  It wasn’t like I was totally stupid the night before, but I thought I had been functioning well, and instead I had acted like I was mildly drunk.


Being sleep deprived for 24 hours is akin to being drunk.

When I learned German online, I was often teaching English to people all over the world.  I was amazed at the hours when they were awake.  No, not the hours in my time zone, but hours in theirs.  People were up at 2,3 or 4 a.m.  I can’t fathom this.  I have often wondered if the one of the big problems in the world is that a good share of humanity is functioning half or fully drunk because they aren’t sleeping enough.  It sure would explain a lot of the world’s problems.

If I am separated from the felines who live with me, like when I take a canoe trip, I find I sleep even more than the 7 hours I usually get, although eventually I return to that number.

I knew sleep deprivation was bad when I was a physician.  I felt awful, the telephone’s ringing jarred me, I occasionally dozed, and I often sat writing a note on a patient, only to realize I was staring at the paper and nothing was appearing on it.  Had I been drinking and practicing medicine, I would have been thrown off the hospital staff.  Instead, they tolerated me for years functioning at a sub-optimal level, called “not enough sleep,” and actually expected it.  My partners did, my colleagues did, my teachers did, for the “giants” of medicine, those who in my view made the mess American medicine is, were purportedly able to function without eating, sleeping, or vacations.  They were held up as paragons of medical virtue.

The only bad evaluation I received as a medical student was when I gave the wrong order at midnight and fell back asleep.  The next day, the patient needed a ventilator.  I felt badly, for good doctors give the right order any time day or night.  I obviously was not good.

Eventually, medical programs recognized the need for doctors in training to get enough sleep.  Pilots have known about sleep deprivation for a lot longer.  The airline disasters in the Marianas and Colombia were in large part due to pilot fatigue.  Pilots take brief naps on long haul flights, for a nap has been shown to improve performance.  I wonder sometimes how many errors I made because I was too tired.  We all gave orders over the phone at night and had in the future to sign off our phone orders.  There were always orders I gave at say 3:27 a.m. that I had no recollection of  giving.  No recollection.  That’s scary.

More than one has teased me for the brief 10 minute afternoon nap I often take and have taken for years.  Because I have animals, I am up at 5.  I am in bed by 9, when most I know go to bed a lot later.  Indeed, I often wonder if they go to bed at all.  There appears to be a gap between 2 and 5 in the afternoon on the US West Coast, when the rest of the world is quieter.  Three hours.  Then in the evening the messages start, and when I awaken at 5, there are often messages sent to me at 1,2,3 a.m. as if I were awake at those hours.

Nope.  I’m not.  I can’t function awake at 24 hours.  Nobody can.  Oh, people can be awake that long, but they are kidding themselves if they think they can function.  They are missing things in life, because we just aren’t able to function normally.

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