This is focus: At 6, as her sister sobbed over a bad gash in her knee, little Serineh Voskanian examined the wound and wondered about the best way to treat it.

At 11, she watched as family friends who were doctors left immediately for Armenia to help victims of the 1988 earthquake, but her father, a civil engineer and general contractor, could help only after rebuilding began. It was then that Voskanian realized that being a doctor meant being first to help those in need--and she wanted to be part of the action.

At 12, the curious prodigy showed up at Glendale Adventist Medical Center asking if she could watch emergency physicians at work. The neighborhood girl volunteered three days a week, splitting her time between being running errands around the hospital and helping out in the ER, where she would follow around the doctor on duty, asking questions. Fluent in Armenian, she also helped translate for patients with poor English skills.

Voskanian attended USC for her undergraduate degree, then went to medical school at the prestigious Tufts University in Boston. She returned to Fresno for an internship with the UC San Francisco-Fresno internal medicine program. Then she completed her residency in Southern California at Los Angeles County+USC Medical Center, graduating on June 30, 2007. And coming full circle, Serineh Voskanian, MD, is now an ER doctor herself at Glendale Adventist.

Her intense focus on medicine notwithstanding, Dr. Voskanian is also intent on making sure the career she's planned for since she was a little girl leaves room for a family. Her future? "We'll see how it goes," she says, with an uncharacteristic lack of specificity about what comes next. "What's most important is having a family. I chose emergency medicine in part because I don't want the kids I have some day to say, 'Mom's always on call. She always has to go.'"

One of her definite plans for the future is a return trip to Armenia, perhaps as early as this summer. In 2000, between her first and second years of medical school, she volunteered for six weeks at the American University of Armenia, Yerevan. Now, she's been invited back to Armenia to help set up an emergency department for a new hospital.

Even so, she is still adjusting to the reality of being a physician. "I went through the rigors of pre-med classes, so I knew what I was getting into academically," Dr. Voskanian says. "And because I'd volunteered at Glendale Adventist, primarily with residents, I could guess at what it was like being a medical student seeing patients." But it turns out there's a big difference between watching someone do it and actually doing it, especially when it comes to caring for the very specific, very scared person in front of you. "I didn't appreciate the impact of the emotional part of it, of letting go of a patient and treating him or her like just another person. That is hard," Dr. Voskanian says. "I don't know if you ever get used to it."

Remember this revelation from early in your career? "There's a time when you realize you are treating patients as if they were just other 'beings'--and you even start doing that to your own family members. That's a struggle," Dr. Voskanian says. "Appreciating what that means came to me at the end of my fourth year, when my aunt passed away after cancer surgery and then renal failure. We had the DNR discussions, and I realized I was talking about not resuscitating my own father's sister."

Despite the difficulties, Dr. Voskanian's only remaining career move is board certification. The dream has come true. So what does she think? There's been a lot of ink spilled about how hideous it is to be a doctor these days, about how MDs from coast to coast are selling their practices, and about how vexing financial and patient management issues can be for ER docs. Any regrets? "I love it," Dr. Voskanian says. "I'm still getting used to it, of course. I have patients who question this little girl who's calling herself 'doctor' and ask if they can call me 'Serineh.' And I've experienced offering a family member advice and being informed that I'm not really a doctor."

The rewards, of course, are lovely. "Medicine is definitely a lot of fun," Dr. Voskanian says. "Maybe you don't get reimbursed adequately all the time and all the other things you hear about. But I couldn't be happier. The art of medicine hasn't changed since I was a fascinated little girl. And that is still beautiful to me."