at ease
nine medical residents post call

The 24-bed medical intensive care unit (MICU) at the Hospital of the University of Pennsylvania (HUP) in Philadelphia serves  as the court of last resort for the region. The unit admits critically ill patients day and night from other inpatient services in the hospital, from a busy inner-city Emergency Department and by ground or air ambulance from intensive care units across the mid-Atlantic region of the United States.

The HUP MICU is staffed continuously by 9 medical residents, 1 or 2 medical students, 2 fellows, 2 attending physicians and 14 nurses. The residents and the students take call in-house every third night. They do not leave the ICU. Meals are served in a conference room.

Historically, residents started work during on-call days before 7:30 am, worked straight through the night, and went home when their work was done the next day, often after 5 pm. Young physicians routinely worked more than 100 hours a week in the MICU for four weeks before they rotated out to some other inpatient medical service.

On February 13, 2003, the Accreditation Council on Graduate Medical Education  adopted rules limiting resident tours of duty to 30 hours. Work weeks are not to exceed 80 hours. Residents are to have one day off in seven.

I served as the attending physician in the MICU in January, 2003 during the last rotation before the new rules took effect.  That month, I photographed all nine MICU residents who served with me between 31 and 32 hours into their work days. All of the residents returned to work after I photographed them. Four patients died under the care of those residents during the three consecutive tours of duty.

These photographs commemorate the end of unlimited work duty hours for residents and medical students in the U.S. They are on permanent display at the American Board of Internal Medicine on Independence Mall in Philadelphia.

at ease