1 a.m. - Las Vegas, Nevada (Present day)
Las Vegas: the city that never sleeps. And that may as well be true for Summer Hsia, after he lies awake in bed restless trying to catch some sleep. Hsia, a retired physician in Taiwan, is a man in his 80s with a calm demeanor and a steady tone of voice. He immigrated to the United States with his wife 10 years ago after obtaining citizenship. He traveled back and forth between Taiwan and Las Vegas, where his two daughters lived for years. He now lives mainly in Las Vegas, returning to Taiwan every two years.
On Hsia’s bedside table lie antihistamine pills, which work by blocking a chemical in the brain that makes you feel alert to help fall asleep. He makes sure to add that these tablets are not to be mistaken for sleeping pills, which result in “dependency” which Hsia aims to avoid.
According to Cleveland Clinic, sleeping pills stimulate a different chemical that slows down activity in the brain and makes you feel drowsy. Hsia has set a strict benchmark, if he can’t sleep by 1 a.m., he takes a tablet. He says lying awake while watching the clock tick from 1 to 2 to 3 a.m. is uncomfortable.
“When you can’t sleep, even the smallest sounds seem so loud and clear,” Hsia said.
“When you can’t sleep, even the smallest sounds seem so loud and clear,” Hsia said.
6:30 a.m. - Kinmen, Taiwan (1961)
After graduating from the National Defense Medical College, Hsia was obligated to serve in Taiwan’s military as a physician immediately to fulfill his ten years of service — one year of front line service with nine years at the district hospital — in exchange for free education. This made it possible for him to become a doctor, as the financial burden would’ve been beyond his family’s means. He happily mentioned that they gave him a small stipend, which he would send back home.
Before the military, life at medical school had already shaped Hsia into someone who thrived on structure and strict regimens. The teaching hospital was also only a five-minute walk away, and he had the freedom to attend any conferences or watch any procedures any time he wanted. He took full advantage of it.
“I wanted to learn everything,” Hsia said.
“I wanted to learn everything,” Hsia said.
Hsia carried this discipline to his time serving in the military.
During his first year of military service at the front lines of Kinmen, that same discipline governed his days. Waking up at 6 a.m. on the dot was mandatory. What followed was morning roll call, military drills and clinic hours, followed by evening roll call at 9:30 p.m. and lights out at 10 p.m.. He mostly saw young soldiers with minor complaints such as colds or pneumonia, and would sometimes perform minor surgical procedures.
2 p.m. - Kaohsiung, Taiwan (1961)
After serving actively at Kinmen, Hsia moved on to work as an attending physician at a civilian district hospital. The work encompassed a broader range of knowledge where “you had to know a little of everything,” he said. He speaks about Taiwan’s health care system during those years with appreciation. At the time, it was very convenient as he could see the patient, and prescribe and dispense their medication at the same time.
6 p.m. - Las Vegas, Nevada (Present day)
At 80 years old and across the continent, Hsia is no longer the one
in the white coat.
Where he once stood on the other side of the examination table reading charts, examining patients and ordering labs, he now sits on the paper-lined exam table. In Las Vegas, Hsia sees a physician twice a year for bloodwork, vaccinations and other standard maintenance procedures. It is a particular kind of role reversal that he takes in stride.
“You get used to it,” he said. Despite this, he still chose not to tell his physician about his insomnia.
“There’s no point, if I told her she would just prescribe me sleeping pills,” Hsia added. “I don’t want those.”
He says this with a calm certainty, in a matter-of-fact
way of a doctor who had spent decades making these
kinds of decisions. Because somewhere beneath being a patient, the physician's side is still very much present, still assessing and making judgments for himself.
Before bed, Hsia often watches the news. His wife has noticed a particular pattern: he can’t sleep if he watches the news, goes out for groceries, or is simply exhausted. On the days he stays home, this doesn’t happen. He has accepted this trade-off, reducing his activity as an adjustment to living with his condition. However, he does reflect on his youth when he was able to go out and soak up the sun without risking being unable to sleep afterwards. As you age, he said that the body naturally secretes less melatonin, which is a hormone that regulates our sleep.
Hsia understands this is what he experiences and that the best he can do is manage it.
10 p.m. - Las Vegas, Nevada
In the military, 10 p.m. meant the end of the day. The lights were turned off and the body, after being trained by years of repetition, soon followed. Now, on days where he stays home he might be able to make this window. But on days after errands and going out, he remains awake.
In this moment, exhaustion and wakefulness coexist with neither side backing down. The structure that shaped his life is now gone, but the biological clock it trained for decades is still here and trying to work within the rhythms it was given. The lights no longer go out on command at 10 p.m., but by making negotiations and small changes Hsia has come to settle in this new routine — living with insomnia — that has come to define this stage of his life.