September 3, 2015 3:00 AM EDT

The photographer Balazs Gardi spent almost a decade in Afghanistan, covering the conflict between U.S. forces and the Taliban. He was in the Korengal Valley when the U.S. hunted Osama Bin Laden in 2004. He was with the 1st Battalion, 8th Marines in Helmand Province as the war was at its most intense. He’s no stranger to high stress situations and to working long hours with little sleep.

And yet, he tells TIME, one of the toughest experiences he’s had as a photographer was one closer to home: shadowing Dr. Arghavan Salles on rotation at Santa Clara Valley’s Medical Center.

On assignment for TIME, Gardi was up at 3:00 a.m. to meet with the chief surgical resident in General Surgery and Trauma as she woke up for the first of two 18-hour shifts. “I’ve worked with a lot of firefighters and doctors when I was a newspaper photographer in my native Hungary, so the hospital environment wasn’t new for me,” he says. “But the U.S. is still relatively new for me — I’ve only lived here for four years — and I had, so far, avoided visiting hospitals in this country.”

What he saw didn’t just surprise him — it shocked him. He witnessed exhausted and dehydrated doctors forced to power through back-breaking shifts, performing grueling surgeries one after the other and spending short-lived moments of respite with the lingering knowledge that at any moment they might be called back for an emergency.

Gardi knew exhaustion was part of a doctor’s life but, as he followed Dr. Salles, he was surprised at how quickly it set in. Plus, he says, many doctors purposely under hydrate themselves ahead of complex surgeries in order to avoid having to use the restrooms in the middle of an operation. “The combination of exhaustion and dehydration is dangerous,” he says “And what I saw was just 48 hours in the life of a doctor. For them, it’s their life cycle for many years. There’s no way I could do that.”

While Gardi knew that the life of an emergency doctor was a difficult one, he now says he has a newfound appreciation for the sacrifices they make every day. “They deserve better,” he says.

Balazs Gardi is a freelance photographer based in Oakland, Calif.

Tara Johnson, who edited this photo essay, is an Associate Photo Editor at TIME.

Olivier Laurent is the editor of TIME LightBox. Follow him on Twitter and Instagram @olivierclaurent

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