Only a few months ago, a well-liked young physician, serving a family medicine residency at Riverside Brentwood Medical Center in Virginia, was invited to audition for America’s Got Talent.

The show’s producers had seen Dr. Brandon Rogers’ Instagram performances online and encouraged the young osteopath to try out. Last spring, he auditioned for the popular variety show, singing his way into a spot in its first round of finalists.

Dr. Rogers, a graduate of Philadelphia College of Osteopathic Medicine, was described as “the singing doctor,” and “a standout contestant” in the show. Judge Simon Cowell declared him to be “one of the best singers in this year’s competition so far.” Co-judge Heidi Klum said of his performance, “the doctor is really handsome and the doctor can sing.”

On June 9 in Maryland, not long after the audition had taken place, but before it had even aired on television, Dr. Rogers was riding in a car driven by a friend who’d just come off a long shift at work.

(It’s unclear what line of work his friend is in, so it’s unfair to assume the driver was also a healthcare professional.)

The driver fell asleep at the wheel and the car veered off the road before striking a tree head on. While the driver and another passenger in the back seat survived, Dr. Rogers was seriously injured. He died the next day in the hospital at age 29.

Producers of the talent show agitated over their decision to air the singer’s recorded audition. With the blessing of Dr. Rogers’ family, they finally decided to run his spot during the July 11 episode.

From the producers’ statement: “At the request of his family we would like to honor his memory by sharing his audition with you.”

Meanwhile, a hashtag (#TheSingingDoctor) continues to be a Twitter trend following news of his death.

Drowsy Driving: Shift Work’s Killer Occupational Hazard

The idea that most people work between the hours of 9am and 5pm is antiquated in the 21st century. Workers can be found on the clock at all hours of the day: bartenders, truck drivers, police officers, hotel clerks, grocery store employees, nurses, Internet technical support personnel, casino staffers.

These “nightwalkers” (or drivers, as the case may be) frequently work more than eight hours overnight, which makes the job appealing due to overtime benefits. Many people find night work easy enough to perform, as they consider themselves night owls anyway.

But when the dark of night yields to the light of day and they head home—or the shift they started at 2pm is officially over at 4am—they still must find a way home. Usually that means driving while they are sleep deprived.

What constitutes shift work?

Shift work includes both night and overnight shift work. It can also include work schedules that are constantly in mismatched rotation with light-dark cycles (8am to 4pm one day, 6pm to 2am the next day, etc.).

Salaried professionals working for global corporations attend teleconference meeting schedules at odd hours to satisfy their employer’s agenda. While they are not paid by the shift, they are certainly working at time periods that are not conducive to circadian health.

Work shifts that greatly exceed eight hours, which don’t take place exclusively during the day, and which require a homebound commute of at least 30 minutes afterward, could also conceivably fall under the category because of job-related fatigue.

Shift work can be some of the most rewarding and high-paying work around, if for no other reason, because it takes place when people don’t want to be at work. Therein lies the problem: job-reinforced sleep deprivation and worker fatigue have become shift work’s biggest occupational hazard.

What price, shift work?

Shift work is well known for being hazardous to one’s health. The act of repeatedly staying awake during natural sleeping periods sets these workers up for circadian dysfunction.

That imposition of off-hour activity on the body’s biological clock has been shown to increase one’s chances for becoming sleep deprived, as well as one’s risk for heart disease, obesity, stroke, mood disorders, cancer, diabetes, and much more.

If that’s not bad enough, there’s also the built-in hazard of drowsy driving. A major study published by Proceedings of the National Academy of Sciences in 2016 found that:

  • over a third of all drives performed following night shift resulted in a near-crash
  • nearly half the drives in the experiment had to be ended prematurely due to the driver’s failure to control their vehicle adequately
  • “microsleeps” in homebound night-shift workers, measured through ocular analysis, were found (not surprisingly) to be much more prevalent than compared to drivers who drove after multiple hours of sleep, and
  • prolonged driving (at least 45 minutes after night shift) was found to be especially dangerous

What is a microsleep? How does it relate to drowsy driving?

Microsleeps are instantaneous periods when the brain literally falls asleep due to chronic sleep loss. Most people who are sleep-deprived don’t know they’re experiencing microsleeps: they are too cognitively impaired by sleep debt to acknowledge how sleepy they are, and they awaken from microsleeps too quickly to notice.

Dr. Carl Stepnowsky, Chief Science Officer for the ASAA, suggests we first understand sleep in order to appreciate what it means to microsleep.

Stepnowsky, who is Associate Professor at the University of California-San Diego and a research scientist for the VA San Diego Healthcare System, points to the original clinical definition of sleep drafted by Drs. Mary Carskadon and William Dement. It was published in the seminal sleep medicine text, Principles and Practice of Sleep Medicine:

“Sleep is defined as a reversible state of perceptual disengagement from and unresponsiveness to the environment.”

“What this means in the context of driving,” says Dr. Stepnowsky, “is that a microsleep is particularly concerning while driving because the driver is not seeing the road and is no longer actively driving.

How long does it take to lose control of your car if you’re drowsy? One, maybe 2 seconds? Stepnowsky suggests a quick calculation for perspective:

“When a car is going 65 miles per hour, in 1 second it covers 95 feet and in 2 seconds it covers 190 feet. Even at 35 miles per hour, 51 feet is covered in 1 second and 102 feet in 2 seconds. The typical road shoulder is no more than 15 feet wide, and many country roads do not have a shoulder. [You can verify the math here.]

Indeed, that’s not a lot of stopping time or space to correct a driving mistake while awake and alert.

But in that split second of time, a driver who has fallen asleep (or is at the brink of falling asleep) will literally lose both conscious awareness of their surroundings and control of their motor skills.

The result? A single-vehicle accident, off the road, often without skid marks. The crash will likely include damage to the car, damage to other property if physical obstacles persist (another car, a ditch, a utility pole, a building, a tree), as well as potential injuries to the driver, passengers, or pedestrians, and even loss of life.

Combating driver fatigue

Various industry leaders have developed protocols for preventing drowsy driving in their work forces.

Transportation organizations have been more active about protecting their workers: the aviation industry has Fatigue Countermeasure Training, for instance, and the rail industry offers The Railroaders’ Guide to Healthy Sleep. There are multiple efforts to keep truck drivers awake and alert on the road (in example, the North American Fatigue Management Program: A Comprehensive Approach for Managing Commercial Driver Fatigue).

But drowsy driving isn’t a problem only for transportation workers. Retail workers can expect some training for those overnight sales blast shifts during key seasons. Coaches during state contents, teachers grading papers in late hours after finals week, might need to review their sleep habits. Even over-tired parents of infants should be careful when getting behind the wheel if they’re losing sleep over midnight feedings.

Our health and safety service workers are also at risk

Two other sectors with a compelling need for safety protocols regarding fatigue are healthcare workers and emergency responders. They definitely encounter demanding off-hours schedules that should be informed by CDC-endorsed worker safety training for fatigue prevention programs.

But changes to shift-length protocols last spring, which lengthened doctor shifts from 24 to 28 consecutive hours, have launched new protests and awareness-raising efforts within the healthcare field to expose what medical blogger Pamela Wible MD recently termed “The Secret Horrors of Sleep-Deprived Doctors” in a post for KevinMD.

Wible’s curation of personal stories shared by anonymous doctors is eye-opening, if not terrifying:

“I ran a red light driving home in residency after a 36-hour shift,” shared one MD. “Got pulled over. It was sobering: I was not fit to use my driver’s license, but I had just been using my MEDICAL license for over a day non-stop!”

The Atlantic also ran an exposé foreshadowing these very dangers last December, leading with this scary anecdote:

“When Larry Schlachter was a 31-year-old neurosurgeon, he was driving to the hospital early one morning and ‘just blacked out.’ He crashed his car and crushed his chest; broken ribs punctured his thorax, which filled with air and blood. ‘I almost died.’ “

Takeaway from the Brandon Rogers tragedy: Please don’t drive if you’re sleepy

Which leads the narrative back to Brandon Rogers, a brand-new osteopath who said he “sang to his patients.” His voice was likely silenced by a microsleep. Millions of people are left to wonder, “What if?”

The American Sleep Apnea Association offers its heartfelt condolences to the Rogers family, to a fine life cut short. We hope we can deliver more and deeper awareness of this American workplace culture dilemma (“work before sleep,” or, classically, “I’ll sleep when I’m dead”). Let no other life be tragically cut short by unintended, but unrelenting, and preventable, driver fatigue.