Chapter 5 - An Anatomy of Grit
Medical school does not care about your trauma.
The cadaver on the steel table in the gross anatomy lab does not ask whether you were abandoned by your father or loved by a maintenance worker.
It demands that you identify the branches of the celiac trunk, the course of the pudendal nerve, and the insertions of the deep rotator muscles of the hip without hesitation.
I entered medical school at twenty-four, one of one hundred and twenty students.
Most of them arrived with pedigree.
They were the children of neurosurgeons, corporate directors, and federal judges.
They spoke of ski trips to Gstaad during winter breaks and traded tips on which clinical rotations offered the most lifestyle-friendly hours.
I lived in a third-floor walk-up two blocks from the emergency department intake bays.
The sirens were my lullaby.
Whenever the noise threatened to break my focus during thirty-six-hour study marathons, I reached out and touched the basswood chickadee that sat on the corner of my desk beside my stethoscope.
Dr. Michael Grant was now the Dean of Clinical Affairs as well as the Chief of Pediatric Oncology.
On my first day of clinical rotations in third year, I stood among six students in crisp, clean short white coats outside Room 314 of St. Anne’s.
The hospital had undergone a sixty-million-dollar renovation.
The yellow curtains were long gone, replaced by smart glass that frosted at the touch of a button.
The linoleum had been swapped for wide-plank wood-grain vinyl.
Yet the air still tasted of the same antiseptic, the same fear, the same metallic anticipation.
Dr. Grant stopped before the door.
He looked at the chart in his hands, then his eyes flicked over his half-moon spectacles and landed directly on me.
“Vance,” he said.
The other five students turned their heads.
“Yes, Dr. Grant?”
“Seven-year-old male. Admitted twenty-two hundred hours yesterday. Presenting with petechiae, hepatosplenomegaly, and a leukocyte count of seventy-four thousand. What is your differential?”
“Precursor B-cell acute lymphoblastic leukemia until proven otherwise by flow cytometry,” I answered instantly. “Secondary differentials include acute myeloid leukemia, infectious mononucleosis, and aplastic anemia, though the blast morphology noted on the peripheral smear from triage strongly points toward ALL.”
“And what is the first priority of management?”
“You stabilize the metabolic derangements,” I said, stepping forward. “Hydration at twice maintenance without potassium to prevent tumor lysis syndrome, initiate allopurinol or rasburicase, monitor the renal output every sixty minutes, and prepare the family for the induction protocol.”
Dr. Grant did not smile.
In medicine, a smile during rounds is an unnecessary luxury.
He simply gave a single, curt nod of his head.
“Take the lead, Vance. You know the terrain.”
I walked into that room.
A mother sat in the corner recliner, her face gray, her knuckles white around a paper coffee cup.
On the bed, a little boy named Toby lay with his knees drawn to his chest, clutching a stuffed dinosaur whose tail had been chewed off.
He was looking at the ceiling tiles with the same hollow, frozen terror I had worn fifteen years before.
I sat on the rolling stool.
I pulled my stethoscope from my pocket and warmed the diaphragm with the palm of my hand before touching his skin.
“Hi, Toby,” I said.
His voice was barely a squeak. “Are they gonna poke me?”
“We’re going to help you,” I told him, looking into his eyes and keeping my voice at the exact frequency Dr. Grant had used with me. “It’s going to be hard sometimes. You’re going to be angry, and you’re going to be tired. But you are not alone in this room. Do you hear me? I am going to be right here every single morning until you walk out those double doors.”
The mother broke down.
She didn't sob loudly; she just let the tears run off her jawline onto her denim shirt.
I stood up, walked to her side, and put my hand on her shoulder.
I didn't tell her it was cheap.
I didn't tell her about budgets.
I said:
“We have a team. We have a plan. You focus on loving him. We’ll carry the medicine.”
When we walked out into the corridor, Dr. Grant fell into step beside me.
“Your father called my office last month, Hannah.”
I stopped dead in the hallway.
The nursing carts rattled past us.
“Richard?”
“He heard from a former colleague whose grandson was treated on Four South that a ‘Hannah Barrett’ was at the top of the third-year medical class.”
Dr. Grant took off his spectacles and cleaned them with the tail of his coat.
“He wanted to know if that was his daughter. He wanted to send a letter of congratulations to your academic file.”
“What did you say?”
Dr. Grant put his spectacles back on, the glass catching the harsh fluorescent lights of the corridor he had walked for forty years.
“I told him that I did not know a Hannah Barrett. I told him that the only student of that name on our roster was Hannah Vance, and that her parents were Marcus and Clara Vance of Miller Street. I told him that if he contacted this hospital again regarding our students, I would file a formal harassment injunction with the county prosecutor.”
I felt a cold drop of water roll down my ribs beneath my scrubs.
“Thank you, Michael.”
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“Don't thank me,” Dr. Grant said, tapping the metal clipboard against my arm. “You’ve earned every millimeter of this ground yourself. Now go write up Toby’s admission orders. The pharmacy is waiting.”
***
