Last session we met Maxwell, a P.A. whose boss referred him for counseling. Little was pointedly discussed about a patient complaint about Maxwell. He had fallen asleep while attending to a patient in an examination room. The patient left upset and later complained to the PCP.

Here reluctantly, Max began to ease into a discussion about his workday and weekend schedule demands. An early riser, by 5 a.m. he was gathering eggs from his chickens and milking two dairy cows. He would shower, eat breakfast and off to work he goes. By 8 a.m. patients filled his exam room until 5 p.m. Some E.R. rotation augmented a tight schedule. Time on weekends was spent with family including grandchildren. Help me out here, Max, what’s your age?

“I’m 63-years-old.”

Have you always worked in the medical field?

“No, I’m a late bloomer.”

How do you mean?

“I ran a dairy for years. Seeing the decay of small-time farms, we had no children interested. Yes, they helped out but they went their own way. They expressed no interest in carrying on the farm. I studied biosciences and chemistry in college, then took to farming. Got used to long hours. I had an aptitude for patching up injured workers, my kids, and friends who got hurt. I took a leap you might say and went to R.N. school. Then I decided to further advance and got accepted to P.A. school. Along the way, I must say, my wife was a constant support and good sport. Even then, we took care of animals for food and fun. I thought about veterinary school but quickly realized it was over my head. After completing coursework and a residency program, I worked E.R. Oh the stories I could tell. The shifts were long, the demands great, and the stress overwhelming. Oddly enough, I went for a couple of beers after a difficult shift and played pool with a guy who beat me up on the table. That was Bert. We talked in between pool shots and I told him about my job. Sleep was necessary; however, a challenge. Seems by the time I crashed it was time to get up again. I have to admit, I questioned my vocational pathway. Bert left to go to work. The pool place opened early. Seems he sometimes began the day with a couple of games of pool, hot coffee, a cinnamon bun, and juice. Guess he and the pool establishment owner were friends and had an understanding. Before he left, he offered me a business card. Call him if I wanted to work in his clinic. After some discussions with my wife, I resigned from the E.R. job and began with Bert. My work schedule has consistently been demanding. Days are long and generally satisfying.”

Max, can you remember if and when sleep interfered in your job?

“Oh, yeah. One time we were slow in the E.R. I was caught up with my paperwork. Supplies were completed. I retreated to a room just to rest. Two hours later one of the nurses found me. Seems the E.R. got filled up from a terrible accident. She got angry with me and threatened tell the administrator if I repeated that infraction. The insecurity of losing my job awkward my sensibility. I couldn’t handle the demands. Fortunately, I met Bert and the rest is history. Sometimes I take a power nap rather than eat lunch. Most of the time a 15-20 minute snooze energizes me for the afternoon demands. My wife usually has dinner ready when I get home. She takes the evening milking and feeds the animals. She has more energy than me.”

Is she aware and supportive of this recent matter? “She is. She knows I have trouble getting to sleep or returning to sleep after getting up to pee. Like clockwork, I get up at 5 a.m.”

Max, have you considered a sleep study? Did Bert mention it?

“He did. Guess I shrugged it off. I didn’t know. Well yeah maybe. Do you believe it might help?”

Sure, Max. Max agreed to sign a consent form to allow consultation with Bert. A couple of days later, Bert provided an outley to assess whether Max had developed a sleep disorder, unspecified for now.

Max and I decided to meet after the study was complete. The results might clarify any problems and offer a pathway to health silently. I wonder if Max would follow the protocol of the study was proof positive of a sleep disor er. Yes, even medical practitioners have medical problems to face. Max gave Bert permission to send me a copy of the results for my records.

With the introduction of second and third-shift hours, 12-hour medical shifts, farmer’s lifestyle schedules, at the very least, we have a growing epidemic of sleep problems. Sleep centers have cropped up and sleep specialists have risen to the head of other specialists facing old and new found sleep problems. I was happy that Max agreed to this intervention.

Not only might his livelihood be at stake, but his overall health. Max’s work life demands perhaps have tapped him on the back, opened up his consciousness to face medical problems of his own. The proverbial shoe-maker’s kids have holes in their shoes. This study and follow-up might improve Max professionally and improve him holistically. Let there be peace on earth and let it begin with me.

Marshall Greenstein holds a master’s degree in marriage and family counseling and is a licensed marriage and family counselor and a licensed mental health counselor in New York state. He has regular office hours at Hutton and Greenstein Counseling Services, 501 E. Third St., Suite 2B, Jamestown, 484-7756. For more information or to suggest topics, email editorial@observertoday.com.