Anatomy exam 2 came and went. I did better on this exam than I did on the last one, which pleases me, but not as well as I would have liked (of course, anything less than a 100 is 'not as well as I would have liked,' given my inherent OCDish-perfectionist tendencies, so this is somewhat less than surprising). So the limbs are done. And the pelvis, and the perineum. On to the head and neck! Onward and upward to the Circle of Willis, I say! And on to a biochem quiz!
One problem.
I don't wanna.
Woke up at 3:30 this morning, couldn't get back to sleep, and I don't wanna. Don't want to go to my PCP preceptor's office this afternoon; don't want to study for my biochem exam (though I have been, don't get me wrong); don't want to learn physiology or biochemistry this morning. And yet I will do all these things. Because that is what adulthood in general, and professional school specifically, is about. Mostly doing things that you're excited about, but on some days, when you just want to stay in bed and look at cuteoverload.com or maybe watch an Eddie Izzard DVD or finish that painting you've been putting off...going into lecture or lab anyway. Bleargh.
Showing posts with label anatomy. Show all posts
Showing posts with label anatomy. Show all posts
Thursday, November 13, 2008
Saturday, November 1, 2008
Pelvis and perineum, you say?
Yes, sex has officially become boring. Not just because it's been reduced to memorizing the branches of the pudendal nerve, the difference between the corpus spongiosum and cavernosa, and the inferior hypogastric plexus. No, (oversharing alert) I've also started to feel the effects of the massive quantities of Zoloft I'm taking, which means that while I'm not having panic attacks every day, nor considering jumping onto the Metrolink tracks, I am also somewhat lacking in the libido department. Granted, looking at all the photos of rectovaginal fistulas and elephantiasis of the scrotum in anatomy lecture may not have been the most...titillating, either.
Anne, I hear you saying, you write about anatomy all the time. We almost never hear about physiology or histology; sometimes you write about biochem or a selective, but rarely. Is anatomy really that big of a time-suck? Does it really weigh that heavily on your mind? To which I answer: yes, dear reader. Yes, indeed it does. And the bitch of it is, you really do need to know it. It's not like, say, some of the more esoteric histology and biochem lectures, where one could argue that the majority of physicians aren't going to need to know about post-transcriptional modification of mRNA in their practicing lives (if ever...ok, maybe at a bar trivia night, but then again, there was never a damn question at Lew's trivia night--In KC--that I knew by virtue of being a hoity-toity neurosci/German studies major. Mostly it was about sports, and weird/arbitrary 'pop culture'--so you know my scores were always in the crapper. Add to that the fact that it takes one--count it, one--Bud Light to knock me on my ass, and there you have it: the reason I never won 50 bar dollars. In Ithaca, on the other hand, the questions were of...ahem, pardon me while I have a snobby, elitist liberal moment here...a higher caliber, and the Telluride group always cleaned up nicely. I spent a bare minimum of my own money at The Chapter House. Good times).
In the course of my studying, I have come across a handful of words that I've fallen head over heels (make that cranium over calcaneous) for, and here they are:
acetabulum: where the femur (thighbone) articulates (connects) to the innominate (hip bone). Sing it with me...the thigh bone's connected to the acetabulum...
infundibulum: a cavity opening either into a tube or into the outside world; there is an infundibulum in the right ventricle of the heart, one in the fallopian tubes, and one in the shaft of every one of your little hairs.
Don't they just sound like Harry Potter words, like mad incantations? Can't you see Hermione Granger shouting, "Infundibulum!" and laying out a Death Eater? Can't you see what a huge dork I am, augmenting my dorkiness further by referencing a children's fantasy series in relationship to anatomy?
Anne, I hear you saying, you write about anatomy all the time. We almost never hear about physiology or histology; sometimes you write about biochem or a selective, but rarely. Is anatomy really that big of a time-suck? Does it really weigh that heavily on your mind? To which I answer: yes, dear reader. Yes, indeed it does. And the bitch of it is, you really do need to know it. It's not like, say, some of the more esoteric histology and biochem lectures, where one could argue that the majority of physicians aren't going to need to know about post-transcriptional modification of mRNA in their practicing lives (if ever...ok, maybe at a bar trivia night, but then again, there was never a damn question at Lew's trivia night--In KC--that I knew by virtue of being a hoity-toity neurosci/German studies major. Mostly it was about sports, and weird/arbitrary 'pop culture'--so you know my scores were always in the crapper. Add to that the fact that it takes one--count it, one--Bud Light to knock me on my ass, and there you have it: the reason I never won 50 bar dollars. In Ithaca, on the other hand, the questions were of...ahem, pardon me while I have a snobby, elitist liberal moment here...a higher caliber, and the Telluride group always cleaned up nicely. I spent a bare minimum of my own money at The Chapter House. Good times).
In the course of my studying, I have come across a handful of words that I've fallen head over heels (make that cranium over calcaneous) for, and here they are:
acetabulum: where the femur (thighbone) articulates (connects) to the innominate (hip bone). Sing it with me...the thigh bone's connected to the acetabulum...
infundibulum: a cavity opening either into a tube or into the outside world; there is an infundibulum in the right ventricle of the heart, one in the fallopian tubes, and one in the shaft of every one of your little hairs.
Don't they just sound like Harry Potter words, like mad incantations? Can't you see Hermione Granger shouting, "Infundibulum!" and laying out a Death Eater? Can't you see what a huge dork I am, augmenting my dorkiness further by referencing a children's fantasy series in relationship to anatomy?
Monday, October 27, 2008
poetry alert
Memento Homo Quod Cinis Est
(Remember, O Man, that you are Dust)
Standing in the dissection suite,
scrubbbed and gloved
(as if latex were protection
from the knowledge of one's own mortality)
I map out veins and tributaries,
tease out secret nerves
and contemplate the possibilities
of the awful glory of God
made manifest even here.
Skinned one,
Dismembered kindred, I too
have had someone
saw through my pelvis; I have been
the lovely assistant
split in two,
still smiling as the blood begins to flow.
I too have had someone finger my heart,
probe the chambers and valves,
Squeeze it like a child's toy and not
the seat of the soul that it is, that delicate tether
Binding body to earth.
Today we skinned your left hand,
removing a lifetime of jingled quarters
and turned pages;
today we stripped away
the last time you held your wife's face in your hands,
those familiar caresses as much a part of you
as that thin skin,
those ridged white gloves.
Despite the things
that have been lost,
the loves and longings wrenched
from between my fingers,
I am still able to hold on; am not yet
so far beyond the grip of grace
they might not be restored, or found anew.
I covered you, washed my hands, and as I washed
said a small prayer of thanks
for my small life,
and yours.
(Remember, O Man, that you are Dust)
Standing in the dissection suite,
scrubbbed and gloved
(as if latex were protection
from the knowledge of one's own mortality)
I map out veins and tributaries,
tease out secret nerves
and contemplate the possibilities
of the awful glory of God
made manifest even here.
Skinned one,
Dismembered kindred, I too
have had someone
saw through my pelvis; I have been
the lovely assistant
split in two,
still smiling as the blood begins to flow.
I too have had someone finger my heart,
probe the chambers and valves,
Squeeze it like a child's toy and not
the seat of the soul that it is, that delicate tether
Binding body to earth.
Today we skinned your left hand,
removing a lifetime of jingled quarters
and turned pages;
today we stripped away
the last time you held your wife's face in your hands,
those familiar caresses as much a part of you
as that thin skin,
those ridged white gloves.
Despite the things
that have been lost,
the loves and longings wrenched
from between my fingers,
I am still able to hold on; am not yet
so far beyond the grip of grace
they might not be restored, or found anew.
I covered you, washed my hands, and as I washed
said a small prayer of thanks
for my small life,
and yours.
Thursday, October 2, 2008
First anatomy exam
The first anatomy exam was, in fact, less of a debacle than I expected it to be. Of course there was test-anxiety galore (for everyone--enough to take me out of my shell and spontaneously fear/anticipation-hug two people in the hallway outside the dissection suite), and the test itself, well, it was engineered for maximum fun--if you were a professor watching, I guess. It's what I'd imagine a social psychologist would arrange to look at the effect of stress on anal-retentive, type-A individuals.
Put 30 of them in a room at once, where they can see each other scrambling and scribbling (or, if they get to a question they do know, standing idly and making everyone nervous because obviously that kid knows everything and I don't know anything and he's going to end up head of neurology at Brigham and Women's and I'm going to have to go live in a box).
Have at least 5 parts to every question. Incorporate as many different colored strings as you can into the question--the same goes for colored pins. If you have large and small pins in the same color, use both of them (I spent 30 seconds on one of the questions yelling in my head, "There is no mother #$*^ing large white pin!")
If you pin an organ that's easy to identify, make sure that identification of said organ is not a question for which students may receive points--rather, ask about vascular structures associated with it, or disease states, or its embryonic origin (that'll show the little bastards to skip embryology lectures).
Allow only 2 minutes per question. Use a buzzer to indicate the 2-minute intervals. Make it loud, so as to destroy concentration and work anxiety up to a fever pitch. If you have a student with long Q-T syndrome, see if you can put him into fibrillation with the combination of stress and buzzer. While not quite as dramatic, you may also be able to get someone to hyperventilate or faint.
Actually, while I'm speaking tongue in cheek, the anatomy exam was tough but fair. Nothing especially esoteric or ambiguous was pinned; there weren't any questions that were nebulous. There was even a 'rest stop' during one of the 2-minute periods with a bowl of small candy bars (proof that I'm "in the army now"--I took one of the candy bars and ate it. Outside lab, of course, but still...as one of the other students said, "Dude, that's dissection suite candy." I just think it was very nice of the TAs/profs to bring it in). And I passed, well above the requisite cutoff, thankyouverymuch, and when I picked up my paper (It may have been a little obnoxious, but I don't apologize) I did a little jig in the hall.
And now it's time to start studying for midterms, week after next. Oh joy. But seriously, there's nowhere I would rather be than here.
Put 30 of them in a room at once, where they can see each other scrambling and scribbling (or, if they get to a question they do know, standing idly and making everyone nervous because obviously that kid knows everything and I don't know anything and he's going to end up head of neurology at Brigham and Women's and I'm going to have to go live in a box).
Have at least 5 parts to every question. Incorporate as many different colored strings as you can into the question--the same goes for colored pins. If you have large and small pins in the same color, use both of them (I spent 30 seconds on one of the questions yelling in my head, "There is no mother #$*^ing large white pin!")
If you pin an organ that's easy to identify, make sure that identification of said organ is not a question for which students may receive points--rather, ask about vascular structures associated with it, or disease states, or its embryonic origin (that'll show the little bastards to skip embryology lectures).
Allow only 2 minutes per question. Use a buzzer to indicate the 2-minute intervals. Make it loud, so as to destroy concentration and work anxiety up to a fever pitch. If you have a student with long Q-T syndrome, see if you can put him into fibrillation with the combination of stress and buzzer. While not quite as dramatic, you may also be able to get someone to hyperventilate or faint.
Actually, while I'm speaking tongue in cheek, the anatomy exam was tough but fair. Nothing especially esoteric or ambiguous was pinned; there weren't any questions that were nebulous. There was even a 'rest stop' during one of the 2-minute periods with a bowl of small candy bars (proof that I'm "in the army now"--I took one of the candy bars and ate it. Outside lab, of course, but still...as one of the other students said, "Dude, that's dissection suite candy." I just think it was very nice of the TAs/profs to bring it in). And I passed, well above the requisite cutoff, thankyouverymuch, and when I picked up my paper (It may have been a little obnoxious, but I don't apologize) I did a little jig in the hall.
And now it's time to start studying for midterms, week after next. Oh joy. But seriously, there's nowhere I would rather be than here.
Friday, September 26, 2008
Fistulas and atresias and surgery, oh my!
So I'm learning about all kinds of cool (but sad) defects that can occur when there are failures in embryonic development--things that don't close that are supposed to close, things that close when they aren't supposed to, or close in the wrong place...
Considering all the things that can go wrong, as I've said before, it's a miracle any of us make it. There are duodenal atresias, where the intestines just stop (ending in a pouch) after the stomach...obviously, that's life-threatening; there are fistulas (ie, communicating tracts that shouldn't be there) between trachea and esophagus sometimes, which means you can get air in your gut where it shouldn't be (not that big of a problem) or food in your lungs where it shouldn't be (obviously a much bigger problem).
Then there are all the fistulas and atresias (atresia=something isn't there, or is blocked off) associated with the, ahem, genital and rectal region. I'll just say that the picture of a recto-vaginal fistula that I saw in lecture today is something that will probably be with me for a long time, haunting my dark moments. There's also something called imperforate anus, which is exactly what it sounds like: no anus. Just born without one. The large intestine doesn't go all the way down. I don't know why, but those were particularly 'what the hell?' pictures for me too--I mean, you hear all the time of people having heart defects, or spina bifida, or whatever, but no anus? I mean, c'mon, Mother Nature, quit having those three-martini lunches and get with the program here. There's a fairly standard design for a human body. Let's stick to it and not be adding or subtracting ESSENTIAL parts, shall we?
There's also something called gastroschisis (which I probably misspelled--Google it and check on me, since my brain is so full of anatomy right now that I don't have room for petty things like spelling or grammar) where a baby is born with intestines outside the body wall. Just hanging out there, chillin, as if they were on the front stoop with forties and cigs. And what's the solution, you ask? It's so simple I didn't believe it at first, but the pediatric surgeon said: "You just keep them in the hospital a few days, keep the intestines enclosed in a plastic bag so they're moist and protected from bacteria, and then roll the bag down like a tube of toothpaste." Like a tube of toothpaste, I swear to Goddess that's what he said. And gradually the body wall expands to encompass the intestines, and they all fit in there eventually, and the kid gets sewn up and gets a surgically-made belly button and everyone's happy. It really is amazing that after a period of a few weeks what were these tremendous, striking abnormalities could be almost completely resolved...that's the appeal of surgery, I guess: quick fixes. You do something, and you immediately see results. The inflamed appendix is gone and the patient recovers. The intestines go into the body wall, the blocked artery gets bypassed, the compound fracture is reduced and set. Psychiatry is on the complete opposite end of the spectrum, but somehow I think it's edifying in a different way. After seeing those pre-and post-surgery pics, though, I guess I understand a bit more why surgeons rag on psychiatrists. Of course, then the psychiatrists get to retort with hypotheses about God complexes and sublimated hostility and aggression. So everyone has fun.
Considering all the things that can go wrong, as I've said before, it's a miracle any of us make it. There are duodenal atresias, where the intestines just stop (ending in a pouch) after the stomach...obviously, that's life-threatening; there are fistulas (ie, communicating tracts that shouldn't be there) between trachea and esophagus sometimes, which means you can get air in your gut where it shouldn't be (not that big of a problem) or food in your lungs where it shouldn't be (obviously a much bigger problem).
Then there are all the fistulas and atresias (atresia=something isn't there, or is blocked off) associated with the, ahem, genital and rectal region. I'll just say that the picture of a recto-vaginal fistula that I saw in lecture today is something that will probably be with me for a long time, haunting my dark moments. There's also something called imperforate anus, which is exactly what it sounds like: no anus. Just born without one. The large intestine doesn't go all the way down. I don't know why, but those were particularly 'what the hell?' pictures for me too--I mean, you hear all the time of people having heart defects, or spina bifida, or whatever, but no anus? I mean, c'mon, Mother Nature, quit having those three-martini lunches and get with the program here. There's a fairly standard design for a human body. Let's stick to it and not be adding or subtracting ESSENTIAL parts, shall we?
There's also something called gastroschisis (which I probably misspelled--Google it and check on me, since my brain is so full of anatomy right now that I don't have room for petty things like spelling or grammar) where a baby is born with intestines outside the body wall. Just hanging out there, chillin, as if they were on the front stoop with forties and cigs. And what's the solution, you ask? It's so simple I didn't believe it at first, but the pediatric surgeon said: "You just keep them in the hospital a few days, keep the intestines enclosed in a plastic bag so they're moist and protected from bacteria, and then roll the bag down like a tube of toothpaste." Like a tube of toothpaste, I swear to Goddess that's what he said. And gradually the body wall expands to encompass the intestines, and they all fit in there eventually, and the kid gets sewn up and gets a surgically-made belly button and everyone's happy. It really is amazing that after a period of a few weeks what were these tremendous, striking abnormalities could be almost completely resolved...that's the appeal of surgery, I guess: quick fixes. You do something, and you immediately see results. The inflamed appendix is gone and the patient recovers. The intestines go into the body wall, the blocked artery gets bypassed, the compound fracture is reduced and set. Psychiatry is on the complete opposite end of the spectrum, but somehow I think it's edifying in a different way. After seeing those pre-and post-surgery pics, though, I guess I understand a bit more why surgeons rag on psychiatrists. Of course, then the psychiatrists get to retort with hypotheses about God complexes and sublimated hostility and aggression. So everyone has fun.
Wednesday, September 17, 2008
Ativan, much?
So last weekend was our first official quiz in Molecular Foundations of Medicine (ie biochem).
The first time I went to take it (I was really hoping to only take it once, but we're allowed to retake them once if necessary, which turned out to be a very good thing) I totally psyched myself out. I was concerned with making it the best possible time to take it--that I'd gone for a run and had the post-workout sense of well-being, that I'd had a protein/carb snack to get those neurotransmitters in top shape (speaking of which, I really need to start taking my fish oil again--those omega 3s and 6s really are good for brain function, as I'll prove to you by posting a link to an actual scientific article when I can be assed to do it), that I'd had the optimal nicotine to caffeine ratio--not so much as to be jittery, but enough that the neurostimulant effects were out in full force. There was an article in the NY Times recently that said caffeine has both mood elevating and cognitive enhancing effects--to which any college student or working person will respond with an exasperated "duh."
So I put on my white noise machine to block out the workaday sounds of my apartment complex (and my roommate, who had family visiting) and sit down to take the quiz online. Yes, it's online. Closed-book, do-it-alone, online. I don't know how many of my classmates actually did it that way; I don't know if the professor is really that inherently trustful of human nature (though one would imagine that with 40 plus years of experience on planet Earth she must have considered the remote possibility that driven, type-A people, which medical students are almost by definition, might...bend the rules) but I did the quiz myself, just me and my computer, and lo and behold--I bombed. I literally felt like I'd been gutshot. I went downstairs to get myself the beer I'd been planning to have (either in a congratulatory or consolatory capacity) and damned if my roommate didn't ask me, "Are you ok? You don't look so good." I looked over my answers--the program lets you review them after you've taken the exam--and I had clicked the wrong boxes, I had missed words in the questions...a fustercluck. I'd just been so freaked out; about halfway through, I started thinking, "This is the first thing that really counts. This will be recorded for a grade, for posterity. This determines whether or not you will be able to pursue your chosen career." And of course I froze, and screwed up. At the same time, the sane and rational part of me (it exists, despite the numerous neuroses I vent here and the voluminous evidence to the contrary) was yelling at this critical, needling voice: "Shut up shut up shut up for Chrissake shut UP!" Did I say sane and rational? Sorry.
So I spent part of Saturday considering whether I should call the dean Monday and go in to say, "I'm sorry, I'm too stupid to be here. Obviously there was some sort of mistake. I should probably go." But instead, I studied up a bit more, did some yoga and meditation before I took the quiz again, and lo: my grade went up 20 points. Which goes to show: there is not a single human situation that cannot be helped dramatically by chilling the eff out. In fact, I repeat it to myself, mantra-like, sometimes: Freak not. I've always imagined that if angels came to people nowadays, like they did back when Jesus was roaming around, they'd have updated their language--and instead of saying "Fear not," like they told the shepherds at the first Christmas, they'd say, "Freak not."
So the anatomy exam is in less than 2 weeks. It's on the 29th, a day that for various reasons is one of the crappiest days I can imagine to have to really crank out a good performance. I spent several hours today going over the material (ie, two days' worth of lecture notes...which means I only have another 5,000 hours of material to get through). For me, the real sticklers are the heart and the autonomic nervous system. First, just the idea of the autonomic nervous system: that my brain is getting up to things without me being aware of it (though I guess it's good I don't have to think about breathing or having my heart beat--hey, cerebellum and brainstem, I'm not being ungrateful, I'm just saying...). And the heart, well, there's just a lot going on, especiallywhen you throw embryology and congenital defects into the mix. But I'm sticking with my mantra. And taking Ativan occasionally.
The first time I went to take it (I was really hoping to only take it once, but we're allowed to retake them once if necessary, which turned out to be a very good thing) I totally psyched myself out. I was concerned with making it the best possible time to take it--that I'd gone for a run and had the post-workout sense of well-being, that I'd had a protein/carb snack to get those neurotransmitters in top shape (speaking of which, I really need to start taking my fish oil again--those omega 3s and 6s really are good for brain function, as I'll prove to you by posting a link to an actual scientific article when I can be assed to do it), that I'd had the optimal nicotine to caffeine ratio--not so much as to be jittery, but enough that the neurostimulant effects were out in full force. There was an article in the NY Times recently that said caffeine has both mood elevating and cognitive enhancing effects--to which any college student or working person will respond with an exasperated "duh."
So I put on my white noise machine to block out the workaday sounds of my apartment complex (and my roommate, who had family visiting) and sit down to take the quiz online. Yes, it's online. Closed-book, do-it-alone, online. I don't know how many of my classmates actually did it that way; I don't know if the professor is really that inherently trustful of human nature (though one would imagine that with 40 plus years of experience on planet Earth she must have considered the remote possibility that driven, type-A people, which medical students are almost by definition, might...bend the rules) but I did the quiz myself, just me and my computer, and lo and behold--I bombed. I literally felt like I'd been gutshot. I went downstairs to get myself the beer I'd been planning to have (either in a congratulatory or consolatory capacity) and damned if my roommate didn't ask me, "Are you ok? You don't look so good." I looked over my answers--the program lets you review them after you've taken the exam--and I had clicked the wrong boxes, I had missed words in the questions...a fustercluck. I'd just been so freaked out; about halfway through, I started thinking, "This is the first thing that really counts. This will be recorded for a grade, for posterity. This determines whether or not you will be able to pursue your chosen career." And of course I froze, and screwed up. At the same time, the sane and rational part of me (it exists, despite the numerous neuroses I vent here and the voluminous evidence to the contrary) was yelling at this critical, needling voice: "Shut up shut up shut up for Chrissake shut UP!" Did I say sane and rational? Sorry.
So I spent part of Saturday considering whether I should call the dean Monday and go in to say, "I'm sorry, I'm too stupid to be here. Obviously there was some sort of mistake. I should probably go." But instead, I studied up a bit more, did some yoga and meditation before I took the quiz again, and lo: my grade went up 20 points. Which goes to show: there is not a single human situation that cannot be helped dramatically by chilling the eff out. In fact, I repeat it to myself, mantra-like, sometimes: Freak not. I've always imagined that if angels came to people nowadays, like they did back when Jesus was roaming around, they'd have updated their language--and instead of saying "Fear not," like they told the shepherds at the first Christmas, they'd say, "Freak not."
So the anatomy exam is in less than 2 weeks. It's on the 29th, a day that for various reasons is one of the crappiest days I can imagine to have to really crank out a good performance. I spent several hours today going over the material (ie, two days' worth of lecture notes...which means I only have another 5,000 hours of material to get through). For me, the real sticklers are the heart and the autonomic nervous system. First, just the idea of the autonomic nervous system: that my brain is getting up to things without me being aware of it (though I guess it's good I don't have to think about breathing or having my heart beat--hey, cerebellum and brainstem, I'm not being ungrateful, I'm just saying...). And the heart, well, there's just a lot going on, especiallywhen you throw embryology and congenital defects into the mix. But I'm sticking with my mantra. And taking Ativan occasionally.
Sunday, September 14, 2008
Syncope is funny. Until it happens to you.
So I fell out during anatomy lab on Monday. I wasn't anywhere near the cadaver--we hadn't even uncovered him yet--and I was just listening to the professor talk about the sympathetic nervous system. It was interesting, enthralling even, so it wasn't like I was short on sleep and fell into a mini-snooze (I was short on sleep, true, but also highly caffeinated...to the point of buzzing, in fact).
I remember what he was talking about--the sensory innervation of the diaphragm, and the tests they do for fallopian tube patency (they inject some air into the uterus, the woman stands up, the air leaks out the openings of the fallopian tubes and impinges on the diaphragm, and the woman sometimes feels a little pain in the region of her shoulders or neck...because the fibers that innervate the diaphragm actually arise at the cervical--read: neck, not the 'downtown' cervix--level. Which is actually good, because it means that at least the fallopian tubes aren't scarred shut, which is a fairly common cause of infertility). I had to sit down. Stood up again, sat down again. Went out into the hall, sweating and nauseous, and prostrated myself (note my cunning use of vocabulary to avoid the lay/lie difficulty--something I still don't have a complete handle on after all my years as what I would consider an English speaker of some facility) on what is probably one of the nastiest floors--make that nastiest surfaces, period--I've ever been privileged to make contact with. So of course one of the professors/lecturers/coursemasters/whatever the hell we're supposed to call them now happened upon me, which was probably good considering the fact that I was horizontal and still felt like I was losing consciousness. Why me, dammit? I'm not especially squeamish (though the bone saw did make me flinch). I'm not some consumptive Victorian who keels over at the first sign of stress or pressure. So what gives?
Anyway, it was an embarrassing albeit unique opportunity to be escorted to and chill on the floor of the prof's office for a few minutes, eat a granola bar, and get my blood sugar up into range (I've decided it was probably an, ahem, glycemic control problem, which is a way of conveying the issue without getting all up in my business). This was the coursemaster who scared the hell out of me at the beginning of the year; I still have a healthy respect-to-fear ratio, since she comes around the lab and fires questions like bullets ("And what's this structure here, just posterior and medial to the thoracic duct?" [Silence, as the table collectively tries to remember what medial means in this context]), but she's also phenomenal at explaining things and was quite nice when she could have just shipped me to student health or something. So there's that. And the fact that I almost wanted to say, when she asked me what was wrong, "I'm either having an exaggerated vagal nerve response to stress, a particularly intractable bout of orthostatic hypotension, or a brief period of hypoglycemia that will probably rectify itself once the epinephrine from talking to you mobilizes the glycogen stores in my liver." Maybe I'm learning some of this stuff after all.
I remember what he was talking about--the sensory innervation of the diaphragm, and the tests they do for fallopian tube patency (they inject some air into the uterus, the woman stands up, the air leaks out the openings of the fallopian tubes and impinges on the diaphragm, and the woman sometimes feels a little pain in the region of her shoulders or neck...because the fibers that innervate the diaphragm actually arise at the cervical--read: neck, not the 'downtown' cervix--level. Which is actually good, because it means that at least the fallopian tubes aren't scarred shut, which is a fairly common cause of infertility). I had to sit down. Stood up again, sat down again. Went out into the hall, sweating and nauseous, and prostrated myself (note my cunning use of vocabulary to avoid the lay/lie difficulty--something I still don't have a complete handle on after all my years as what I would consider an English speaker of some facility) on what is probably one of the nastiest floors--make that nastiest surfaces, period--I've ever been privileged to make contact with. So of course one of the professors/lecturers/coursemasters/whatever the hell we're supposed to call them now happened upon me, which was probably good considering the fact that I was horizontal and still felt like I was losing consciousness. Why me, dammit? I'm not especially squeamish (though the bone saw did make me flinch). I'm not some consumptive Victorian who keels over at the first sign of stress or pressure. So what gives?
Anyway, it was an embarrassing albeit unique opportunity to be escorted to and chill on the floor of the prof's office for a few minutes, eat a granola bar, and get my blood sugar up into range (I've decided it was probably an, ahem, glycemic control problem, which is a way of conveying the issue without getting all up in my business). This was the coursemaster who scared the hell out of me at the beginning of the year; I still have a healthy respect-to-fear ratio, since she comes around the lab and fires questions like bullets ("And what's this structure here, just posterior and medial to the thoracic duct?" [Silence, as the table collectively tries to remember what medial means in this context]), but she's also phenomenal at explaining things and was quite nice when she could have just shipped me to student health or something. So there's that. And the fact that I almost wanted to say, when she asked me what was wrong, "I'm either having an exaggerated vagal nerve response to stress, a particularly intractable bout of orthostatic hypotension, or a brief period of hypoglycemia that will probably rectify itself once the epinephrine from talking to you mobilizes the glycogen stores in my liver." Maybe I'm learning some of this stuff after all.
Thursday, September 11, 2008
The heart of the matter
So we finally got to look at the heart. You'd think it'd be a fragile thing, especially after eighty-odd years of pumping, but at least in our cadaver it wasn't. I almost said 'specimen,' something some of our professors do from time to time...I'd like to avoid thinking of human bodies as specimens; for that matter, I like to think of even plant and animal exemplars as more than 'specimens'...to quote Mary Oliver,
"Is the soul solid, like iron?
Or is it tender and breakable, like
the wings of a moth in the beak of an owl?
Who has it, and who doesn't?
I keep looking around me.
The face of a moose is sad as the face of Jesus.
A swan opens her white wings slowly...
One question leads to another.
Does it have a shape? Like an iceberg?
Like the eye of a hummingbird?
Does it have one lung, like the snake and the scallop?
Why should I have it, and not the anteater
who loves her children?
Why should I have it, and not the camel?
Come to think of it, what about the maple trees?
What about the blue iris?
What about all the little stones, sitting alone in the moonlight?
What about the roses, and lemons, and their shining leaves?
What about the grass?
--Mary Oliver
His heart was thickened, as you'd expect perhaps in someone with heart disease; his left ventricle had been pumping against high blood pressure so long it was enlarged. When we cut the ventricles open, you could scarcely imagine they ever HELD any blood, the muscle was so hypertrophied. It was as if the thing itself had become so great, its function had all but been forgotten...how often does that happen?, I thought to myself. A cathedral becomes so glorious, overwrought with spandrels and flying buttresses and teeming masses of gilded figures, that the still, small voice it was meant to glorify is lost in the noise (of course, there are places--like St. Patrick's Cathedral in New York, or the Cathedral of Peter and Paul in Philadelphia--that are gilded and Romanesque but which do feel prayed in and USED rather than just admired...where the architecture feels like a solidified prayer rather than a distraction). A habit begins, to comfort and console, or perhaps to celebrate--champagne here, a cigarette to accompany a drink, five pounds lost to overcome a college freshman's feelings of ugly-duckling unbelonging. But it blossoms, and grows, and becomes more than it was ever meant to be, an ugly compulsion with a life of its own, the consoling or celebration or comfort lost in the cacophony of drive: alcoholism, addiction, anorexia.
So I have seen the inside of someone's heart now, the fantastic architecture, the membrane-thin walls of the atria and the thickened, hardy ventricles. I've seen the muscles that hold the valves in place, have run my fingers over the valves that even now are billowing diaphanously together in my chest maybe sixty times a minute (I'm always teetering on the edge of bradycardia--it's all the running). The valves are more like parachutes than valves as we think of them--phenomenally unmechanical, not at all stiff or thick (when they are stiff or thick, in fact, it causes problems and as such is labeled either insufficiency--if the edges of the 'leaflets' don't come together--or stenosis, if the valves are hardened and calcified). We're literally a few layers of cells away from dying at all times--it's amazing the ballet of our bodies doesn't get botched more often, that anyone manages to survive for any time at all.
"Is the soul solid, like iron?
Or is it tender and breakable, like
the wings of a moth in the beak of an owl?
Who has it, and who doesn't?
I keep looking around me.
The face of a moose is sad as the face of Jesus.
A swan opens her white wings slowly...
One question leads to another.
Does it have a shape? Like an iceberg?
Like the eye of a hummingbird?
Does it have one lung, like the snake and the scallop?
Why should I have it, and not the anteater
who loves her children?
Why should I have it, and not the camel?
Come to think of it, what about the maple trees?
What about the blue iris?
What about all the little stones, sitting alone in the moonlight?
What about the roses, and lemons, and their shining leaves?
What about the grass?
--Mary Oliver
His heart was thickened, as you'd expect perhaps in someone with heart disease; his left ventricle had been pumping against high blood pressure so long it was enlarged. When we cut the ventricles open, you could scarcely imagine they ever HELD any blood, the muscle was so hypertrophied. It was as if the thing itself had become so great, its function had all but been forgotten...how often does that happen?, I thought to myself. A cathedral becomes so glorious, overwrought with spandrels and flying buttresses and teeming masses of gilded figures, that the still, small voice it was meant to glorify is lost in the noise (of course, there are places--like St. Patrick's Cathedral in New York, or the Cathedral of Peter and Paul in Philadelphia--that are gilded and Romanesque but which do feel prayed in and USED rather than just admired...where the architecture feels like a solidified prayer rather than a distraction). A habit begins, to comfort and console, or perhaps to celebrate--champagne here, a cigarette to accompany a drink, five pounds lost to overcome a college freshman's feelings of ugly-duckling unbelonging. But it blossoms, and grows, and becomes more than it was ever meant to be, an ugly compulsion with a life of its own, the consoling or celebration or comfort lost in the cacophony of drive: alcoholism, addiction, anorexia.
So I have seen the inside of someone's heart now, the fantastic architecture, the membrane-thin walls of the atria and the thickened, hardy ventricles. I've seen the muscles that hold the valves in place, have run my fingers over the valves that even now are billowing diaphanously together in my chest maybe sixty times a minute (I'm always teetering on the edge of bradycardia--it's all the running). The valves are more like parachutes than valves as we think of them--phenomenally unmechanical, not at all stiff or thick (when they are stiff or thick, in fact, it causes problems and as such is labeled either insufficiency--if the edges of the 'leaflets' don't come together--or stenosis, if the valves are hardened and calcified). We're literally a few layers of cells away from dying at all times--it's amazing the ballet of our bodies doesn't get botched more often, that anyone manages to survive for any time at all.
Sunday, August 31, 2008
The Thorax
It sounds like a Dr. Seuss story, doesn't it? Anyone remember the Lorax? Anyone?
But it's not...no Sneeches, no clear-cutting, no Grinch. Just the human trunk--the thorax, which is what we're currently looking at in anatomy.
On Friday we opened up the rib cage to get at the stuff inside. It was simultaneously fascinating and off-putting in that 1) It's not every day you get to look at real, honest-to-Buddha lungs and hearts, but 2) It's also not every day that you go at a human body with a SAW. And bonecutters, which are essentially larger and more specialized versions of wire-cutters. And in a way, it did feel like to sort of breaking and entering people generally get up to with wire-cutters (I can't say I've ever heard of anyone using wire-cutters for anything respectable, thought I'm sure it must happen--It can't all be stealing bikes and getting into chain-link fences). Instead of entering someone's compound, however, we were entering someone's chest. I was elected by our group to do the first few cuts of the ribs (again with the if-you're-squeamish-skip-down-a-bit warning) and I have to say, it was hard work, and made a sound that could be described as either disgusting or highly satisfying, depending on your bent. The clavicles and xiphoid process (the end of your sternum) we went after with a saw, since apparently they're too tough for even bonecutters to work (yes, it was essentially a saw just like the kind you'd use on wood, with the exception that it was bright yellow and due to someone previously doing a less-than-stellar cleaning job had bits of...something organic on it). I'll admit it made me a little woozy, and I handed over the cutters as soon as I'd done my requisite couple of ribs.
I didn't actually see the heart; it's covered by pericardium, really very well veiled by filmy white tissue, which seems appropriate--who wouldn't guard their heart a bit? Don't we all do that, not just anatomically but metaphorically and emotionally? The lungs were on full display, however, with their covering of slippery, whisper-thin pleura, and as springy and pink as the various preservative solutions would allow (soft tissues have a tendency to harden in the presence of preservatives, which is advantageous in many ways but not so great in others). One of the neighboring tables' cadavers was a long-time smoker...needless to say, there were dark spots all over and the lungs weren't nearly as pink and spongy as ours. Perhaps medical school will finally cure me of my smoking addiction once and for all--nothing like looking at the actual, physical results of your particular vice to get you to "straighten up and fly right," as my father would say.
But it's not...no Sneeches, no clear-cutting, no Grinch. Just the human trunk--the thorax, which is what we're currently looking at in anatomy.
On Friday we opened up the rib cage to get at the stuff inside. It was simultaneously fascinating and off-putting in that 1) It's not every day you get to look at real, honest-to-Buddha lungs and hearts, but 2) It's also not every day that you go at a human body with a SAW. And bonecutters, which are essentially larger and more specialized versions of wire-cutters. And in a way, it did feel like to sort of breaking and entering people generally get up to with wire-cutters (I can't say I've ever heard of anyone using wire-cutters for anything respectable, thought I'm sure it must happen--It can't all be stealing bikes and getting into chain-link fences). Instead of entering someone's compound, however, we were entering someone's chest. I was elected by our group to do the first few cuts of the ribs (again with the if-you're-squeamish-skip-down-a-bit warning) and I have to say, it was hard work, and made a sound that could be described as either disgusting or highly satisfying, depending on your bent. The clavicles and xiphoid process (the end of your sternum) we went after with a saw, since apparently they're too tough for even bonecutters to work (yes, it was essentially a saw just like the kind you'd use on wood, with the exception that it was bright yellow and due to someone previously doing a less-than-stellar cleaning job had bits of...something organic on it). I'll admit it made me a little woozy, and I handed over the cutters as soon as I'd done my requisite couple of ribs.
I didn't actually see the heart; it's covered by pericardium, really very well veiled by filmy white tissue, which seems appropriate--who wouldn't guard their heart a bit? Don't we all do that, not just anatomically but metaphorically and emotionally? The lungs were on full display, however, with their covering of slippery, whisper-thin pleura, and as springy and pink as the various preservative solutions would allow (soft tissues have a tendency to harden in the presence of preservatives, which is advantageous in many ways but not so great in others). One of the neighboring tables' cadavers was a long-time smoker...needless to say, there were dark spots all over and the lungs weren't nearly as pink and spongy as ours. Perhaps medical school will finally cure me of my smoking addiction once and for all--nothing like looking at the actual, physical results of your particular vice to get you to "straighten up and fly right," as my father would say.
Monday, August 25, 2008
Cadavers, Humanity and Faith
So our first day in the anatomy lab was today.
Today I made my first incision into another human body.
It was at once sobering and exciting, this rite of passage, a threshold every future physician has to cross and probably remembers for the rest of her life. It was also just incredibly, utterly cool.
The face, hands and feet--probably the most human parts of any body--were covered with stockings, both to make it easier for us to do what we had to do and to protect them from desiccation.
The body itself was that of an eighty-ish man, who died of complications of heart disease; he was a middling-sized man, not the wasted habitus you sometimes see in old age or advanced infirmity, but not huge. I thank him for his gift to my learning.
We began by cutting flaps of skin on the chest and reflecting them back, then working away the fat until we could see the superficial fascia (tough coverings) on the pectoralis major, serratus muscles, and deltoids. There was a fair amount of fat to cut away from the ribs; we worked a little too far inferiorly and ended up exposing a little bit of the rectus abdominus as well (the abs, for those of you with any passing familiarity with SHAPE magazine et al). I never realized how much fat there is in the average body--not just in a large person, but in a person period. It made me feel a little better about my latest body composition stats. The people with female cadavers sectioned the breasts to get a look at the lobules and such that comprise the milk producing tissue--no one found much, considering that most of the donors were fairly advanced in age and the lactation apparatus etc. sort of atrophies (ie shrivels up) with age--nature is quite parsimonious, and what you don't need you generally don't keep. One group did have a female cadaver with breast implants--I lacked the wherewithal to actually handle one, first because I think breast implants are gross in general, second because (spoiler alert, if you're squeamish skip to the next paragraph) they were covered with grease from the aforementioned abundant fat.
It's difficult to walk the line between remembering that these were once human beings aand as such are inherently due respect and compassion (and depending on your religious and moral bent, still are people--I got called out on this at the Christian Medical Association meeting, where one of the participants 'reminded' me that "They aren't people anymore--the soul has departed, they're corpses." I'll write more on the CMA later--it's not the best fit I could have hoped for, as it seems populated primarily by mainline and right-leaning Protestants that would probably have heart attacks if they knew the extent of my interfaith Episcopal/Quaker/Wiccan/Buddhist hippy-dippiness. However, they're nice folks, and when I go to their meetings they feed me, and the lingo--"glorify the Lord," "the things of the world," "being a witness for Christ"--reminds me of the church I went to in elementary/ middle school, which is simultaneously comforting and kind of painful) and jsut focusing on the anatomy, doing what you need to do, and forgetting for a little while that you're working on a person. Selective attention, I guess you could call it, or selective numbing. You can only focus on so much, and while of course I never want to treat anyone or any body (pun intended) I meet as just a hunk of flesh, for the purposes of this course I think I'm going to have to depersonalize the cadaver, at least a little, at least for a while.
Today I made my first incision into another human body.
It was at once sobering and exciting, this rite of passage, a threshold every future physician has to cross and probably remembers for the rest of her life. It was also just incredibly, utterly cool.
The face, hands and feet--probably the most human parts of any body--were covered with stockings, both to make it easier for us to do what we had to do and to protect them from desiccation.
The body itself was that of an eighty-ish man, who died of complications of heart disease; he was a middling-sized man, not the wasted habitus you sometimes see in old age or advanced infirmity, but not huge. I thank him for his gift to my learning.
We began by cutting flaps of skin on the chest and reflecting them back, then working away the fat until we could see the superficial fascia (tough coverings) on the pectoralis major, serratus muscles, and deltoids. There was a fair amount of fat to cut away from the ribs; we worked a little too far inferiorly and ended up exposing a little bit of the rectus abdominus as well (the abs, for those of you with any passing familiarity with SHAPE magazine et al). I never realized how much fat there is in the average body--not just in a large person, but in a person period. It made me feel a little better about my latest body composition stats. The people with female cadavers sectioned the breasts to get a look at the lobules and such that comprise the milk producing tissue--no one found much, considering that most of the donors were fairly advanced in age and the lactation apparatus etc. sort of atrophies (ie shrivels up) with age--nature is quite parsimonious, and what you don't need you generally don't keep. One group did have a female cadaver with breast implants--I lacked the wherewithal to actually handle one, first because I think breast implants are gross in general, second because (spoiler alert, if you're squeamish skip to the next paragraph) they were covered with grease from the aforementioned abundant fat.
It's difficult to walk the line between remembering that these were once human beings aand as such are inherently due respect and compassion (and depending on your religious and moral bent, still are people--I got called out on this at the Christian Medical Association meeting, where one of the participants 'reminded' me that "They aren't people anymore--the soul has departed, they're corpses." I'll write more on the CMA later--it's not the best fit I could have hoped for, as it seems populated primarily by mainline and right-leaning Protestants that would probably have heart attacks if they knew the extent of my interfaith Episcopal/Quaker/Wiccan/Buddhist hippy-dippiness. However, they're nice folks, and when I go to their meetings they feed me, and the lingo--"glorify the Lord," "the things of the world," "being a witness for Christ"--reminds me of the church I went to in elementary/ middle school, which is simultaneously comforting and kind of painful) and jsut focusing on the anatomy, doing what you need to do, and forgetting for a little while that you're working on a person. Selective attention, I guess you could call it, or selective numbing. You can only focus on so much, and while of course I never want to treat anyone or any body (pun intended) I meet as just a hunk of flesh, for the purposes of this course I think I'm going to have to depersonalize the cadaver, at least a little, at least for a while.
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