A Winning Hand

THE FIRST MONTH OF MY THIRD YEAR of medical school began on the pediatric wards. Being the youngest in a small family, I had little experience with kids. It being the beginning of my clinical education, I also had little experience with hospitals. Though I had spent years preparing for this role, I had no idea what to expect.

What I found were lots of kids with seizures, lots of diarrhea and vomiting, lots of asthma exacerbations, and a whole lot of random illnesses that I've read about but assumed no one really had. Within days I was working longer hours than ever before but, amazingly, time zipped by.

Trying to grapple with the incongruity between my perception and the actual speed of time, I was overwhelmed with a sense of déjà vu. Where had I felt this way before?

And then it hit me. The hospital evoked one of my favorite college vacation spots: Las Vegas.

Let me explain. I work from about 5 a.m. to 5 p.m. except for every fourth night, when I'm on call. On those days I still arrive in the early morning but spend the night at the hospital, usually managing only a catnap before waking up to round on my patients, and leaving by noon that day.

If you calculate the hours (which I refuse to do for sanity's sake), this usually works out to be pretty close to the legally allowable 80 hours per week. But if you cut down on your time, you either leave more work for your colleagues or undermine patient care. Neither one makes for a happy hospital experience. So people work hard; they stay late.

And here comes the Vegas part: the hospital has lights on all night. While you can find windows if you go looking, most of the "doc boxes," the small rooms where doctors and student doctors like me hang out, have no windows.

There is also this strange artificial conditioned air that circulates. I don't think they pump in the oxygen that is rumored to keep people awake in casinos, but there is definitely an unnatural quality to it. It dries you out, leaving you with cracked lips and bloodshot eyes.

There are all kinds of blinking lights and beeping machines. No clinking of silver coins against metal slot buckets here, but I do hear the two-tone nurse call alarm for hours after I've left the building. We don't have cocktail waitresses delivering a constant stream of free-flowing alcohol, but I swear the high of sleep deprivation is not so far from the high of Makers Mark on the rocks.

On the pediatric ward, it's not old men gambling away their life savings, but little people trying their damndest, gambling for their life. I don't work with the really sick kids. The kids with cancer, on the Heme/Onc service, are on the same floor but are taken care of by other teams. They've got no hair, look like they've been through an adult lifetime worth of sickness, and are the bravest people I've ever encountered. My patients are usually not so bad, but they're still under 18 and spending their summer days in a hospital.

Just like Vegas, all the lights, all the noise, and all the illness are surprisingly not that tiring, or that depressing. From the dosing of a multi-drug anti-epileptic regimen to making a 2-year-old sit still for an ear exam, to making a teenage girl with severe muscle pain smile, to telling her parents we have no idea what's wrong, every day is a whole world of newness.

There are rules to this game, and like the novice card player, you have to concentrate or you lose. Perhaps it's this concentration on the details that distracts me from the real life hardships that lie in each bed.

While learning the rules, the culture, and the language of the hospital, I'm realizing that doctors are just regular people who started as beginners like me. It's easy to be blinded by the glamour and the glitz, but behind it all, there are just a lot of hard-working people.

Some of my more enlightened colleagues may have known this coming in, but for me it's been incredible to watch the mental processes of medical diagnosis. Most of my "seniors" are my age or younger. They are not magicians, just smart people consolidating bits of information with past experience and making a coherent picture of an illness. It will take time and lots of effort to beat the odds here. But each day, it seems to be slightly more within my reach.

rmtelerant@ucdavis.edu