Although it is not his actual name, Rich Retractor, M.D., Ph.D., is a surgical resident at a large U.S. academic medical center. Descriptions of clinical events are fictionalized and meant to represent typical events that occur; any resemblance to actual patients is coincidental.

I wonder what Tulon Ethabathel the Dwarf is doing right now.

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It’s 4:15 a.m., and I’m hitting the snooze button one more time before I finally get out of bed at 4:30. Last night I managed to play through about 15 minutes of Dwarf Fortress after I prepared my cases for the next day, worked on my presentation for next week’s grand rounds and read the latest journal articles, all of which took me hours to complete. But I wasn’t about to go to sleep until I played through the goblin invasion, because I knew it was coming for the past month – call it a special occasion.

Pre-rounds are at 5:30, radiology rounds at 6:00 and by 6:20 walk rounds are starting. We need to have seen the entire service by 7:25 so we can start our first OR cases at 7:30. I have a short case this morning for which I prepared last night, and then I’ll take the on-call pager. Number of times I’ve thought about gaming since I got to work: zero.

That’s not to say I don’t ever think about gaming. I spend a lot of free time reminiscing about old games I used to play. Heroes of Might & Magic. The Imperialism series. The Railroad Tycoon series. I love the Warhammer 40K universe and was looking for my old copy of Chaos Gate the other day, because I really can’t think of anything more worth a few hours of leisure than a turn-based Space Marine game. I sometimes even wonder what Grunty and Carlos are up to in Jagged Alliance. But there’s a time and place for that, and it isn’t now.

The first consult after I get out of the OR at 10 a.m. is a motor vehicle trauma with both spine and closed-head injuries. The trauma surgery team is taking the unstable patient to the OR immediately to control abdominal bleeding, so our involvement will be limited for now. Meanwhile, the neurology service asks for our input on a stroke patient who may need a decompressive surgery if her condition continues to deteriorate. The ICU pages me continually with updates and management questions, all of which I answer within minutes. The Emergency department has another patient, this time with a possible aneurysm that I need to see immediately.

There isn’t any time for breakfast.

My friends who aren’t in medicine don’t really get the idea of not having any time. Not the kind of “no time” where you are busy and have a lot to do but can take a break when you need to talk to your wife or check in with a co-worker about last night’s NFL scores. Yes, it only takes a minute – the problem is that in my line of work there isn’t a minute to spare. At any given second, I may have multiple pages to answer, or a patient’s family may ask me to stop and answer their (very justified) questions, or I may need to perform an emergency bedside procedure that puts everything else on hold. And that’s if I’m not in the OR, operating. I’m not safe from pages or questions there, either.

There isn’t any time for lunch.

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It’s hard to reconcile this lifestyle with my love of gaming. A lot of people who don’t have enough time to play games still manage to stay current by browsing through gaming forums at work or reading gaming news via RSS feeds. I, on the other hand, often go 36 hours without ever touching the Internet except for the hospital medical records system. I’m not complaining, and I don’t feel the least bit sorry for myself, because no one is forcing me to do this. If I wanted to work less, I’d get a different job. But sometimes introspection can be dangerous.

Surgery often involves the placement of drains. The theory is simple: If you make an incision, you need to take the pressure off the surgical wound by re-routing blood and serous fluid to an alternate drainage path so that the tissue at the surgical site can approximate and heal. Neurosurgeons place lumbar drains after repairing cerebrospinal fluid leaks so that pressure on the leak closure is relieved long enough for the dura mater to heal. One day, on the way home after having placed just such a lumbar drain on a patient, it hit me: That’s exactly what I use gaming for.

When it comes to what makes people gamers versus non-gamers, I think a lot has to do with finding an outlet for your imagination. How else do you explain the amazing bursts of creativity that lead to games like Europa Universalis, Armageddon Empires or Dwarf Fortress? And what about all the Neverwinter Nights modules I’ve collected but never played? Gaming provides designers and players alike with an imaginative outlet that, if left untapped, would make their brains explode – figuratively, of course. I know that people like me need games, because without them our imaginative energy has nowhere to go. And that’s a more serious situation than you might think.

I haven’t eaten anything more than a granola bar since last night, so I grab a slice of pizza from the cafeteria at around 4 p.m. This has the advantage of being very fast, so I only get paged three times while I eat. One of the pages requires my immediate presence, though, so I gulp down my dinner while walking.

We don’t start afternoon rounds until our chief is out of the OR, and by the time we’ve seen all the patients, answered all the family questions, completed all the post-operative checks and resolved the outstanding issues of the day, it’s 8 p.m, 15 hours after I got to work. I am not on call tonight, so after making sure none of my coworkers need any help – you never leave anyone hanging – I head for the locker room, change out of my scrubs and grab my iPod for the walk to the parking deck. Tomorrow I’m on call, so I’ll be in the hospital for 30 straight hours, and I need to sleep beforehand. After grabbing a Big Mac on the way home, I walk in the door around 8:40 and promptly collapse onto the sofa. I think I TiVo-ed the Monday Night Football game from four days ago. Still haven’t watched it.

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Finally, after three consecutive weekends of being on call and 26 straight days of work, I have a weekend off. There are a lot of things to do, including shopping that I haven’t taken care of since last month, the household chores that I’ve put on hold, the presentation I’m still working on for next Monday and all the journal articles I haven’t yet read that I will nonetheless be responsible for knowing. One luxury I permit myself, though, is watching two episodes of a 10-part documentary on the First World War, done by Channel 4 a few years ago.

Ten minutes into it, I’m already thinking about good World War I computer games. Are there any? I remember that Matrix Games released Frank Hunter’s The Guns of August a few years ago, and I might still have a copy in my big box of game CDs stashed away in the closet. But after a few more minutes of consideration, I remember that it was pretty complicated, and I just don’t have time to spend hours learning a game system anymore.

I spend Sunday evening preparing for the week’s cases, especially Monday’s. I need to look at the patient histories and memorize the scans that will guide the next day’s surgery. This is a constant problem: One person told me that while he would like his brain surgeon to have read War & Peace, he doesn’t necessarily want his brain surgeon to be reading War & Peace. That’s certainly fair: Any time I spend not reading about angiography, neuroanatomy or critical care is that much less I’ll know when it counts. I owe my patients all my attention; how much do I owe myself?

I decide to make time for another 15 minutes of Dwarf Fortress.

Not That There’s Anything Wrong With That

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