How does a surgeon stay sharp for 12 hours? “I only drink water.”

A 35-year-old woman performed her first transplant and underwent a combined transplant at the UMCG in Groningen. The hospital has a lot of experience with complex operations, but this also had many intricate details for the specialists.

So the operation took no less than 24 hours and was performed by 17 specialists and 30 supportive care providers. “There were different services—the specialists substituted for one another,” says Kevin Damman, MD, chief medical officer for heart transplantation at UMCG. “But some specialists still have to work for a very long time.”

trainee

Cardiac surgeon Massimo Mariani was one of these specialists. “I got off the night shift at eight in the morning and got off somewhere in the evening,” he told Editie NL. All those hours he had to be extremely focused, of course. “This is something I’ve developed over the years. It works as a kind of training. And the adrenaline will undoubtedly play a part. Everyone is excited about making the process go well.”

He needs a little to be able to work for a long time. “Just a little water. You drink it through a straw under your face mask.” He does not need to go to the toilet. “The room is completely dry, so you’ll get dehydrated sooner than you need to pee.”

Sometimes it falls off after that. “Then you feel so exhausted. The first thing I do is eat. Then I lie down.”

Four hours of sleep

A lot of objective research has been done on when surgeons decrease concentration, reaction time and hand-eye coordination, says Nicole Bovey, professor of surgery at MUMC in Maastricht. “It shows that they don’t do significantly worse on four hours of sleep. These surgeons also did well in terms of mood and alertness.” Surgeons perform worse if they sleep less than four hours.

There are no rules about the number of hours a surgeon can work. However, the Dutch Association for Surgery, of which Bovey is secretary, has established guidelines to ensure that surgeons are qualified to begin an operation. “For example, two shifts with long operations in a row are not a good idea. Another surgeon should be available if someone sleeps less than four hours.” Once every five years, hospitals are checked to see if they are complying with the guidelines.

On Massimo Mariani’s team, they agreed to work a maximum of twelve hours at a time. “We don’t think she’s responsible anymore,” he explains. “Not even during such a special case. But sometimes I may have worked longer than that.”

legislation

According to the Hours of Work Act and the Working Hours Ordinance, adults are not allowed to work more than twelve hours a day and sixty hours a week, says Bobby den Heeten, an employment attorney at Dirkzwager. “But there is an exception for medical professionals. The number of hours a doctor works depends on the collective labor agreement and whether the doctor works independently or as an employee. But a 24-hour shift may be possible.”

It is difficult to set a specific maximum number of hours. “Sometimes there is only one person who can perform a certain operation. And you can’t see the complications coming in advance.”

However, the exception does not apply to all physicians. “This is not the case for physicians in training or primary physicians.”