Two years ago when she was an intern at Montefiore Hospital in the Bronx, Adriane Fugh-Berman was convinced that something she had forgotten to do for a patient she'd been caring for during a 36-hour shift without sleep had caused his death. Fugh-Berman says she didn't realize she'd been dreaming until she returned to the hospital the next day and found he was still there. She recalls that she barely restrained herself from blurting out, "You're alive!' "

Kenneth Burke, chief resident at Prince George's Hospital Center remembers several times in the past two years waking up in his car, screaming as he slammed on the brakes. It took him several minutes to realize that, too exhausted to drive home after 36 hours without sleep, he had pulled over to the side of the road and parked.

Joachim Hertel, a post-residency fellow in nephrology at Georgetown University Medical Center, says he fell asleep behind the wheel of his car after a sleepless 36-hour shift at a New York City hospital. Luckily, he had stopped in a traffic jam. When he awoke, he said, his car was standing in the middle of FDR Drive in Manhattan. The bottleneck had evaporated and cars were just driving around him.

Practically all residents have asleep-at-the-wheel or other horror stories about the effects of chronic sleep deprivation, one of the most controversial aspects of medical training.

Although defenders, among them officials of the most powerful organizations in medicine, insist that an essential part of becoming a good doctor involves ignoring exhaustion, there is a growing belief, in Fugh-Berman's words, that "long hours are bad medicine."

A 32-year-old general practitioner in the District, Fugh-Berman is a spokeswoman for the Committee of Interns and Residents, a national union for physicians-in-training that is seeking to limit the on-duty hours of the nation's 70,000 fledgling doctors, many of whom routinely work 100 hours per week.

Founded in 1957, the committee has been especially active in New York, which trains more doctors than any other state. Last year, New York adopted new rules limiting to 80 hours the work week of residents and requiring continuous on-site supervision of interns, also known as junior residents. The rules were prompted by the 1984 death from pneumonia of 18-year-old Libby Zion, hours after she was admitted to the prestigious New York Hospital, where she was treated by an unsupervised intern and a second-year resident.

In the Washington metropolitan area, says Prince George's Hospital's Burke, many residents work between 110 and 120 hours per week, particularly those training in surgery. At Georgetown University Medical Center, it is recommended, but not required, that residents work 80-hour weeks -- the equivalent of two full-time jobs -- and be on call no more than 16 hours at a stretch.

The subject of residents' hours and medical care will be explored at a conference sponsored by the committee scheduled to be held Saturday in downtown Washington. Among the participants will be Bertrand M. Bell, a physician who is chairman of the New York Commission on Resident Hours, which drafted that state's new regulations.

Although about 10 states are considering limits similar to New York's, such proposals have powerful opponents. Last month, the California legislature defeated a bill that would impose an 80-hour limit, after opposition by hospital groups, whose officials said that it would pose a severe financial hardship and increase the cost of care.

Recently, the American Board of Internal Medicine set 80 as the limit for weekly hours in that specialty, but the American Board of Medical Specialties just vetoed a proposal that would have imposed major reforms in hours required by residency programs nationwide.

Among the most vociferous opponents of limiting hours are surgeons such as Roy Sessions, chief of Georgetown's department of otolaryngology. "Medicine requires a dedication, and working long, hard hours is a preparation, really, for the rest of your life," he says.

Sessions, who runs a six-year residency program in head and neck surgery, says he sees nothing wrong with asking residents to work up to 100 hours a week. "This isn't a fighter pilot macho mentality. It's not a strength test because the bottom line is patient care and safety."

"I think it bothers people who are dedicated to {medicine} to think in terms of 'I can only work X number of hours, and I then get to take off X amount of time.' It's not philosophically in tune with the dedication necessary to be a doctor."

Burke, a resident at Prince George's Hospital, disagrees. "We have limitations on the hours people in other professions work -- pilots, truck drivers -- yet we turn our lives over to someone who has been up 36 hours straight. What kind of sense does that make?"

Although older physicians who trained under grueling conditions are generally reluctant to find fault with the system, increasingly the "we did it so why shouldn't you?" argument is being rejected by both training physicians and the public.

In a 1989 editorial in the Journal of the American Medical Association, physician Timothy B. McCall wrote, "The medical community debates the merits of the present system, but the general public overwhelmingly disapproves of it and expects residency reform . . . Hospitals that continue to overwork residents can expect lawsuits alleging that tired residents provided poor care."

In fact, although there are many "near miss" accidents resulting from sleep-deprived doctors, few studies, or physicians, can identify cases of serious injuries or deaths that resulted. Even in the case of Libby Zion, neither of the doctors who treated her had been on duty more than 24 hours.

"Lack of sleep rarely seriously compromises patient care," says Fugh-Berman. "We don't usually forget the dosage of a medicine. What it really compromises is your attitude toward patients.

"For one thing," she says, "you lose empathy." Imagine a patient comes to you complaining of fatigue, she continues. "You've been up 36 hours, and you want to scream at them, 'Listen, let me tell you something about fatigue . . .' "

Emanuel E. Garcia, a Philadelphia physician, writing about his internship in the New York State Journal of Medicine, observed that "the patient comes to be regarded more as a 'torture machine,' ceaselessly bothering residents with demands for care, than as a suffering human being. The goal of treatment becomes disposal {getting the patient out of the hospital} instead of palliation."

Fugh-Berman says she believes that the reason established physicians do not want to see the system changed "is the same reason abused children grow up to be child abusers. It's very much of a caste system. The people above abuse everybody below them, and the person at the bottom kicks the cat."

Once, she says, a colleague fell asleep interviewing a patient in the clinic as the patient was explaining her problem. The patient woke the resident gently and said, "Look, doc, I'll come back tomorrow. You go home and get some sleep."

"It was sweet," says Fugh-Berman, "but it's not really the patient's job to take care of us. Sometimes, your perceptions really get skewed. I'd look at a patient in the hospital with genuine envy. There they were, lying in a bed, having somebody bring them their meals . . . what luxury."