End of Anatomy Block

Today, we had our anatomy lecture final, concluding the anatomy block of medical school year one!
I thought about this for a while, but I won't be holding and observing the body's internal organs for a long time... maybe never... definitely never for those students not interested in surgery of any type. From now until the third year when clinical rotations begin, we'll be studying from books and lectures, with the occasional patient interview and clinical skills lessons (giving physical exams, taking blood pressure, phlebotomy next year...).

Now that anatomy (and the stress of the exams) is over, I'm beginning to miss it already and am developing an even greater appreciation for this course.

Really and truly, I don't think I would have been able to learn half as much if we had learned anatomy by lectures and anatomy atlases alone. First, how do you truly visualize depth perception? Orientation of all the organs and blood vessels? When I think about anatomy, I actually think about the dissections I've done, where I saw the structures, to what they were connected, and their general orientation. Also, Netter's Atlas may show the typical body, but there is a lot of subtle variation that I think is important to understand.
And then, there is nothing like holding a heart in your hard, looking at it from all angles, and connecting what we see with the functions we've learned through lecture. Now that's real integration.

This week, our class is holding a vigil for our donors and their families. My tank mates are to write a note of some sort to "Gertrude," to be cremated with her, and hopefully we'll also write a letter of gratitude to her surviving loved ones. It must have taken great courage for them to allow the body of a loved one to be used for our learning. Because we've learned a lot from her. Head to sole of the foot, we've dissected and looked into ever space and crevice.

Hopefully what I've learned these past few months will stay with me for a lifetime.

Waimea Canyon - Kauai, Hawaii

End of Blacktober!

End of the so-called Blacktober (Where we have our last Biochem exam, the anatomy practical, and anatomy lecture exam all in one Mon-Mon week).

To be honest, college finals period was much more stressful... but it's sometimes fun to get stressed and anxious about something just so that the after-celebrations are more satisfying. :D

first anatomy practical

We had our first anatomy practical today.
The general style is like this: The professors and TAs set up stations within the two laboratories, displaying good bodies as well as bones, skulls, and radiographs. Each station had maybe 2-3 things to identify. We have 50 seconds per station. Structures can be pinned, wrapped with string, or anything really to identify it well. We may be asked to identify the actual structure or describe what innervates or supplies blood to it. Some questions included: What ganglion does parasympathetic nerves pass through to supply special sensory to THIS organ. Things like that. The entire test took about 2 hours.

I felt prepared, but I definitely still missed quite a few.
Next time, I plan on going down to the anatomy lab more often before the exam to really look at every single structure that may be tested - that kind of dedication and persistence is probably necessary. But also, it's really helpful to just study with a partner. Not only does it keep your motivated, you really help each other. And, if you can identify and explain to someone else, that means you really know it. This probably really applies to most subjects in medical school. We have our lecture exam on Monday, and I plan to spend most of my time at the carrels to ask questions to my colleagues (who i've gotten quite close too... :) )

Tutoring sessions with the TAs are definitely useful. A lot of the TAs are part of the OMFS (oral and maxillofacial surgery) program, which is pretty elite. At our school, you enter the competitive program after 4 years of dental school, and it involved a 6 year mixed program of medical school (years 2, 3,4) with residency. So these TAs are both students and residents as well.

They also make quite a few dollars being TAs. I heard one tutor earned $11,000 during the anatomy course (september-november). The TA that our group uses earns $40 an hour on private tutoring sessions alone. And the thing is, the TAs actually benefit from this because they will really know their anatomy. My TA was saying how he performed a surgery in the occipital region of the head, and what he teaches us really comes in handy. One word: Baller.

I can't wait until I work with a real body (or a fresher cadaver...)

Ratatat Concert - Palladium Ballroom. 28Sept2010

Her brain

Now this was pretty awesome.
On Monday we dissected out the brain and identified various cranial arteries, nerves, and non-brain structures. The skull had already been sawed for us, exposing the brain. We essentially have to snip some nerves, cut the brain-stem, and roll the brain out. When do people ever get to the roll the brain out?
We all took turns holding the brain -- absolutely crazy. So much of what makes humans human - unique in our complex thoughts, advanced creations, and metaphysical pondering - is in that brain! In my hands! With just a lesion there or a cut there, you can completely change the personality and identity of an individual!


And we found the masticles.

Let me share the story of the masticles (which isn't an anatomical part).
While we were dissecting the face, we kept getting confused with the masseter muscle and the zygomaticus. One guy at my team slipped up and said "masticles." We laughed because of the sound of it... and we all wondered if there is a body part called masticles. Must be. Sounds like such an anatomical name.

And so, when we rolled out the brain, the guy yelled: "hey i found the masticles!" *roar of laughter*
He was absolutely right. The cerebellum looks awfully like some testicles.
Isn't it amazing how goofy and immature med school students can be.... :D

Elephant Orphanage - Nairobi, Kenya

Her face

We unveiled the cloth covering Gertrude's face today to begin the head dissection.
Again, I wasn't as provoked as I thought I would be. She did seem like a nice, old lady that one would see maybe sitting on the porch, drinking southern lemonade. She didn't have any teeth either. But, her lips were white, tongue discolored and deformed, eyes were glossed over, and her face was flat (perhaps because she had been on her stomach for so long.

I did enjoy the facial dissection - all of the careful cuts and maneuvers we had to do to clean around nerves, veins, and arteries was... fun. I think I'm pretty good at these detailed procedures. I was able to expose and preserve the internal jugular vein and its branches to the facial vein and retromandibular vein. I was able to find the common carotid artery and its branches into external and internal. And, with the help of David (TA), I was able to clear out most of the branches of the external carotid artery. What's cooler, I was able to take the facial artery from its branch-point from the external corotid and trace is up through the submandibular duct, across the mandibles, and into the cheek. It unfortunately got severed and my other tank mates started peeling away the facial skin. I'm pretty proud of that handiwork.

I'm also beginning to be able to immediately recognize a vein versus artery versus nerve. Small nerves and arteries are still a little tricky.

And here is a good mnemonic for branches of the external carotid artery:

SAL FO PMS
S = superior thyroid artery
A = ascending pharyngeal artery
L = lingual artery
F = facial artery
O = occipital artery
P = posterior auricular artery
M = maxillary artery
S = superior temporal artery



this post was more of an anatomy self-review than a reflection...
I do have a lot more acronyms for anatomy (many of them dirty for bigger mental impact).
I'll post those up later

View of Paris from Pompidou, May 2009

my first patient

I will try to describe as honestly and accurately as possible my first experience with my "first patient." I say that this 84 year old woman who died of pancreatic cancer however many weeks, months, years ago as my first patient because she was introduced to me as so by my anatomy lecturer. And I really believe we should feel this way. With the care and respect that we should interact with our first living patient, we should approach our first cadaver. Yet she is and will also be an important teacher. She may not be able to show the dynamical aspects of physiology as her blood no longer flows, muscles no longer contract, no pain is felt, but no smile is shared... But, she will show us - intimately, grossly, finely - the workings and failings of the human body.

It really is a privilege to be able to study the human body with an actual human body. Ethically, many people still can't believe such a class exists - how can we cut and probe, slice and pull, peal and tear apart the human body which is the temple of the soul? Perhaps before the first anatomy lecture, I had become desensitized to potential moral audacity of this process of learning because it has become such a standard in medical school, and I have been expecting this as a medical student. Perhaps I can't see the atrocity because I myself would like to see every bodily part of me that can be of any use to anyone -- to be used. And I deliberately say the word "used" because something of use has a purpose, has a function. My dead body will have no function or purpose after my death - it will only go along the natural trajectory of decomposition or be burned to ashes - unless the living use it.

However, during the first anatomy lecture, I was re-sensitized to the honor and emotional weight of dissecting a cadaver. The professor read to us a letter written by a a dying man who in his living will dedicated his body to my medical school and hospital. He asked for the physician to not preserve his life through machines and tubes, but rather take his death bed as a start of new life and opportunity. Some thought the letter was cheesy. I was moved; even got a little teary-eyed. With that sort of reaction, I was worried how I would be once I stepped into the anatomy lab and met my own first patient for the first time. The instructor said he fainted his first day. Some people get nauseous. Some people carry a heavy weight when it comes to the death and the dying.

Turns out, I was just fine.

Without a doubt, I was excited, heart did race a little, and I was (still am) amazed. Anatomy is one lab that I really don't ever want to miss. But I didn't have any sort of emotional break-down or feel queezy. The color and texture of the skin had already become a brownish discolor that the humanness factor dipped a bit. But, I remember seeing the head wrapped in a green plastic bag and thinking, oh my god, this is beginning. I remember looking at her individual physical markings - a scar on her calf, a freckle on her shoulder - and just thinking how unbelievable this is, feeling a sense of curiosity and care. Who else knew about that scar or that freckle while this lady was alive? In fact, it was the little things that pulled an emotional string. Her hair, her ear, the wrinkles of her elbow. It's hard to actually describe how it feels, but I was in fact eager to use my dissection tools and make my first incision. Is this wrong? I don't know. But it perhaps is important to be able to detach a little and really take this experience as one of the most amazing learning opportunity that anyone could ever offer. And I should never forget that this opportunity was given to me by the individual laying face down on the table in front of me.

My tank mates (we call the resting place of our first patient cadaver The Tank) decided to name our cadaver Gertrude. Thought it was a name that suited her age and plump figure. She does have a lot of fat in her body, making the dissections and isolation of nerves, vessels, and other delicate organs a little difficult. But this is an obese nation so what can we expect? But now I know what the obese body looks like inside - the fat deposits and globules. It gives a strong enough motivation to stay fit and healthy even with age. And the muscles really look like meat. Cutting off and shredding away a segment of the rhomboid muscles, we really thought it looked like pulled pork. (Oh, and all of us were starved by the time that first four hour lab was over. I doubt anyone ate bbq that night but I did eat some canned salmon...)

So far, we've done the superficial and inner muscles of the back and neck. Today, we study the spinal chord and nerves. I still haven't seen her face - the part of the human body that makes her a real individual with a name, family, memory. The part that reminds us medical students that our cadaver was really a person. I feel that will be the most moving moment.

More updates on Gertrude and Anatomy as the class progresses.


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Perhaps a suitable photograph

Otoro (Fatty Tuna) at a Hot Hprings Inn. Izu, Japan Winter 2010