Why go to Medical School: Wednesday Afternoon

It’s Wednesday morning. It’s Wednesday morning at 10:00 and I can’t stop coughing. I should be sleeping off a hangover with the rest of my class but instead I’m in the Anatomy lab with the doors closed.

My current research concerns the arteries within the mandible. Normally, you divide a person in half by saw and explore each half of the jaw. Congress is coming though, and we need a few spectacular pictures for my presentation. So, instead of the usual, I was handed a bone saw and then a cadaver. And then a flashback.

It stinks for weeks, all of these cats. I’m supposed to pick my senior classes by 5:00 today. I want senior year to be easy. I also want to dissect those stinking cats. Screw it; I’ll take AP BIO. It’s a year later and Jared just stole my tail. He has quite a collection, him and his bone cutter, stalking from table to table stealing the tails. I’ve been vigilant which is why it took him so long to defile my Mittens. I met Mittens in a plastic bag. She had been pre-skinned from wherever she came. Skinned except for her paws. Mittens.

We’re kids and we’re in high school and we’re dealing with death. Poorly. We’ve worked our way up to this: nematode, grasshopper, squid (which we then grilled and ate), frog, fetal pig, and now cat. There’s the kid that’s too sensitive and is very disturbed by our behavior. He doesn’t think it’s funny when we start quoting Lord of the Flies and dancing. We call him “Piggy.” I pull on the tendons of Mittens and have her kick in the air to “Da da da-dada, da da da-dada.” We cope by trying to upstage each other with our indifference. Like I said, we’re handling this poorly.

It’s the last week before the final and I’ve finished all of the dissections. With my free reign I dissect what’s left. I take apart the forelimbs and the scapula. I take off the hind limbs but can’t free the hips. I free the ribs and all that’s left is the crooked cane of the Central Nervous System and it’s protecting bones.

That’s what I’m looking at right now: an empty thorax, ribs intact but flailed, the vertebrae from L2 on up and his untouched head. No arms, no legs. Mittens. I’ve spent so much time in a book and away from the lab that I’ve lost my detachment. Holy shit, there’s a man cut in half on the table. But I have work to do and feeling uncomforable is a waste of time. I have tricks. I focus on one spot, one square inch where I have to cut away his skin so the saw can make contact. That one square inch isn’t he. It isn’t a person. It’s a square inch. I can cut a square inch.

The saw is dull. It’s motorized and oscillating by millimeters instead of spinning.  Those tiny motions mean that it cuts bone but not flesh, and there are only two spots that still have teeth. It makes the work slow and heats the motor in my hands. I have to take breaks between my sweating lips and palms. Maybe you’ve never had to cut a circle around someone’s head, but know this: it’s dusty. That’s why I’m coughing. People that walk in through the far door start coughing as well, but they’re reacting to the smell of burnt bone. You have to have your face near the action to appreciate the soot.

I finish my circle, insert a wedge and torque against the seam. It makes this wild cracking sound and I wonder what I’ve missed. I call in a professor who inserts the wedge, torques against the seam and explains to me that I am appreciating the sounds of the separating dura. wow. WOW! That’s amazing! He pulls off the top and instead of feeling jealous, I am amazed. That, right there, is a human brain and I’ve never seen one. I’m stupefied. That’s why I jostle the brain back and forward and wonder why it won’t come free. For a moment, I’m an idiot again. I forget that it’s connected to every corner of the body in one way or another and won’t jostle free of a damn thing.

The brain lifts in the front so you can cut the olfactory nerves. A dividing membrane travels front to back like a Mohawk splitting the brain into left and right. That gets cut. The Optic Chiasm, the trigeminal ganglion, the nerve gaggle entering the internal acoustic meatus, the membranous tent dividing the calvarium into the cerebellum’s part and the cortex’s part like two fighting siblings. All of it: cut. It wiggles free.

This is my own instant review of everything I’ve read but haven’t seen. Not really anyway, not like this. To finally free the brain, I have to cut the brainstem through the reticular formation. I have so much respect for the reticular formation. It’s the lizard part of our brain and it’s a geographical mess but beautiful all the same. And now it’s in my hands. I am holding this brain and rotating it, rattling off all the sulci, all the gyri. The arachnoid matter actually looks like a spider web. I can’t believe how lucky I am. I just can’t. If this man were alive, I know that pushing on this spot right here would make his lips go numb. This spot right here and he would collapse. This spot: fear. This spot: memory. It’s just amazing.

Another student involved with research walks into the room. I tell her what I’m doing and watch her beam. Now I get to watch her roll it in her hands, see the relationships, and slip it into and out of the skull. For the first time we really understand epidural hematomas and uncal herniations. Of COURSE that would kill you! Transtentorial herniation? That would be catastrophic!

So, why go to to medical school? Because you’ve never been afraid of blood. Because cutting into something that was once alive bothers you, but not too much. Because of all the places you could ever be, it’s a place where you’re with people that can share and celebrate something as awesome as the human brain even when you had to tear it from someone’s head. Because maybe, on a Wednesday afternoon, you’re biggest problem could be holding a saw to someone’s skull and choking on the dust.

But smiling.

Related Strangers

I have ants in my pants. I have them in my computer. And in the apartment. I’m trying to build up a head of steam in these last days in Grenada and it’s tough with all of these ants. I’ve discovered a lot about myself in the process. I am, if nothing else, an unflinching murderer of ants. I go to brush my teeth and they are swarming around the cap of my whitening toothpaste. They grin at me with teeth three shades whiter than before. I mash them.

By the time I’ve finished, I’m too worked up to sleep. The breast helps. I’ve learned that nothing is so boring as female pathology. If everything else fails, I read and write. I’ve read so much lately since discovering GoogleReader. I’ve discovered that an entire world of medical writers exists online. Students, residents, attendings and retired. They all have interesting things to say and many have published their work. I started reading one journal and lost a week of my life to depression. You see, his writing is much better than mine. Painfully so. I went back to his archives over the last three years and read it all. Exhausted, I decided I would could never write as well.

Or I could just copy him. So I started writing online as well, a second blog to the one that keeps the record of all of these emails. Sorry for cheating on all of you. The material is a little more stream-of-consciousness and a little less appropriate for mass emails. I write about wearing sheepskins and kicking wildly, you know: pagan things. I started writing a few medical essays and have submitted them to an online magazine of medical writing. I had two articles accepted and, feeling worth something again, have stopped writing so frequently.

I have a piece of software that tells me how people find my site. Search items include:

(1)the greatest pair of shoes
(2)inguinal hernia video exam
(3)coax feces from anus (Can’t. Stop. Laughing)
(4)yellow jealousy
(5)”why go to medical school?”
(6)reasons not to go to medical school
(7)shiny scalpel gonna cut you open
(8)where is the hanging statue of Lenin in Prague?

Back to the books. I have learned that in Rheumatoid arthritis a painful growth of the joint occurs and this is called a “pannus” which makes people want to walk less, become obese, and develop an apron of fat that hangs over their knees, called a “panus.” I have no idea how my dyslexic friend is cutting it here.

In Clinical Skills I keep getting the same tutor. Most students hate this guy because he’s unprofessional. He cracks jokes where every punch line is “that’s what SHE said!” He offers to meet all of us at Angie’s after class which, from what I’ve pieced together, is a whorehouse behind the Grand Anse Bank. He sits nervously, rocking back and forth always stealing peaks outside the curtain. Whether he’s checking out a student, watching the clock or high as a kite I don’t know. He describes a certain type of gait as “Clarke’s Ataxia,” after his favorite rum. In a previous life he inspired A Confederacy of Dunces.

Why don’t we complain? Why do we continue to let him be our tutor? Well, this is Clinical Skills after all and each of us thinks that he’s making us better at handling unprofessional people. We’re also trying to diagnose him. My money is on “Henry the VIII’s Affliction” otherwise known as alcoholism with a splash of tertiary syphilis.

Still in school, my family threw a reunion in the Poconos. I took the weekend off to meet related strangers. Off the plane and into the rented van, we quickly fall into our old roles: passive-aggressor, attention-seeker, policeman, frayed nerves, joker, instigator, smartass, complainer. I should give my family more slack since I’d forgotten how funny they all can be, when drunk. Two drinks in at dinner and we’re laughing about our own idiocy and the tiny miracles of iPod Jesus.

All’s well. I have my Path final in three days, so I’m wrapping this up. I’m embarrassed that my arm is sore from playing a video game where I had to hold a plastic gun at eye level for twenty minutes. I am not embarrassed that I spent twenty dollars to beat it (not an exaggeration). Of course, money was spent on dumber things.

The Larkin Clan was 6 tables strong in the banquet hall, and my brother and cousins were sitting at a table with a pitcher of beer to a man. Wasn’t too long before every other chair was in concentric circles around the booze and people were trying to eat seven saltines in a minute. I’ve never been to a race track, but this is what I imagine happens: Everyone sits around with money, someone emerges as an “expert” on how to pick a winner, and then people make twenty dollar bets while the horses choke on saltines. One horse can only finish two saltines and is put down while everyone mutters that, “it would have happened sooner or later.”

This was the same evening where I accused a relative of being too shy. Turns out her jaw was wired shut. In good company, My uncle wondered on a crowded elevator if this was some kind of “wheelchair convention.” Close, it was a retreat for people with Multiple Sclerosis. Yeesh.

By far the biggest event of the weekend was Karaoke. I cringe whenever I see that word but my family did a fine job. One of my related strangers is an actress getting her masters. She went up and brought the house down with “Material Girl” and “Genie in a Bottle.” My cousin Ryan took a different approach: gusto. 6’4″ monster that he is, it’s hard not to cheer.

Karaoke singer’s are fascinating and I’ve tried to classify them.

The singer: this person has some pipes. They can pick a song, do everything correctly, and walk off to applause.

The shower: this person is delusional about their pipes. With a singer’s swagger, they pick a song, match it note for note until you don’t, at which point it’s jarring and painful for everyone. They didn’t know this would happen since they usually have the backup singers inside the radio to carry them. You feel awful and pity clap.

Guy singer: rumored.

Average guy: plays his strengths and avoids the weakness. For most, this means picking a song were the singer “talks.” REM’s End of the World or Billy Joel’s We Didn’t Start the Fire fit the bill. You talk, louldly with gestures, and fool everyone. Don’t be fooled by Johnny Cash’s Ring of Fire. That’s a hard song.

The Calvin: you’re particularly awful at carrying a tune but by the grace of God you know this already. You pick a “talkie” and then butcher it, all in good humor. It’s better if everyone knows this song so that they become involved and share in the joke. You then sing Billy Joel’s Piano Man and manage to sing “La, did de da, did de da-ahhh!” off key. People laugh. People cry. You’re the hero of the night. Nice job, Cal.

That was the reunion. Cheers, topher.

Addendum:
(1) the journal that is hauntingly well-written: http://tomwaitsatemybaby.blogspot.com/
(2) the online medical magazine is Grand Rounds. The archives are here.
(3) My youngest sister just graduated from High School and received an iPod Nano. Supposed to hold 1000 songs, she was boasting that hers held 1050. I asked her how many of the songs were about Jesus (she’s very religious). “Around 400.” It’s a miracle.

Grand Rounds 3.27

Grand Rounds 3.27 are posted at the Medical Blog Network. For those that don’t have the time to read everything out there, it’s a great crib sheet.