The Joys of Research

December 17, 2006

I’ve got two days left to finish writing a research paper concerning the coronary arteries. Unless you’re in it, I don’t know if many aspiring students know what research is really like. When you’re not collecting data or bent over a dissection for hours on end, you spend the rest of the time reading the literature and trying to find the connections between different ideas about how something works (vague, right?).

And unless you’re the type to find the fun in anything, it can be a real pain in the ass. Publications have their own stale version of english where nothing can be said that someone hasn’t already said (citations) and when two papers offer conflicting results the most that one can say about the other is something like, “we attribute the difference in findings with X to be due to criteria for inclusion and dissecting technique.” Translated: “The other guys can’t dissect for shit so missed this important finding.” It’s all very WASP-y.

But sometimes you find authors that are not afraid to drop the pretence or (and more rewarding) use the sweet tact to deliver posion. Of course, these authors are British.

  • The Elusive Coypu: the importance of collateral flow and the search for an alternative to the dog.
    • “There are several ‘villains’ in this story: (i) researchers who convinced themselves that myocytes could stay alive without blood; (ii) authors who discarded (or journal editors who refused to publish) negative studies; (iii) dogs that had too much and too variable collateral flow; (iv) legislation and animal suppluers that made the use of canine preparations) and an intriguing alternative [the coypu] impossible or prohibitively expensive; and (v) a UK government plot to exterminate the coypu (nutria).”
    • “Interstingly, the guinea pig heart was found to be totally collateralized making it impossible to induce infarction in this species — how great it would be if the human had the coronary artery anatomy genes of the guinea pig!”
  • Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials
    • Conclusions As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.

Severed Vacation

August 17, 2006

facial nerve illustration I do not enjoy vacation. Studying medicine makes me feel so useful that I go into withdrawal outside of it. Reading Atlas Shrugged with all my spare time doesn’t help matters any. I try everything I can. I cut my vacation short by starting a week late, electing to stay in Grenada to dissect cadavers for research. I cut another week by going to Milwaukee for the Annual Congress of Clinical Anatomists. I lose a week to a Michigan trip with my family, and I leave that early to spend a week at the University of Alabama at Birmingham (UAB). Why? To dissect for research, of course.

Working at UAB is my first time in the South and it’s everything with fresh eyes. Southerners chew gum lazily. Without wind, you’re under a heavy hot blanket. When walking for coffee in scrubs, everyone says, “Good morning, Doctor.” It’s pleasant.

I am at the UAB with other members of my group to finish dissecting projects in the hours between the classes of their first year students. We have complete access to 35 bodies and we all feel like kids in the dead people store. Each of us has come a long way from those first heady days of Anatomy Lab. After all, we have chosen to be here without threat of a grade.

We’re cutting into people? I don’t want to; I’ll just watch. I’m glad they put bags over their heads. Should we name her? That’s disrespectful! No it’s not. I’m naming her ‘mittens’. Should we say a prayer first? Oh, god. Give me the goddamn scalpel, Amen. How’s that?

For all the posturing, it was a special thing to watch my hand cut into someone for the first time. It was my hand that did it, by the way. I had nothing to do with it. After so many bodies, it losses its specialness. When it’s time to work, you approach, address the body, and then dive in for cleaning and measurement. A few minutes later you zip up your work and it’s time for the next axilla.

Most of us have been the ones quick through the door when it came to cutting, the ones that called for the scalpels. But here at UAB, it is a little different. Their cadavers are fresher, fixed with less formalin, smelling less, more robust. It feels like walking into a house so clean that you kick of your shoes even though that’s never been your custom.

Most of the students that flew down can give a few days or a week. We would stay longer but our classes are starting in a couple days, a few thousand miles away in the Caribbean.  A few students say, “screw it”  and decide to miss a few days of the first week, this being such a great opportunity for work.  It’s only because I decided to stay that I get this morning call,

“Marios, what am I dissecting this morning?”
“Severed head.”
Choking, “What was that?”
“Ask Vince to show you the severed head. Skeletonize the Facial nerve and clean away all fat and fascia.” Hearing my held breath, “Tophy, you okay?”
“Fine Marios. Just fine.”
“Congratulations. It’ll be fun. You’ll do fine.”

I find Vince. He takes me into the cooler where they keep the fresh cadavers. These people died a few days ago or a few weeks ago and have donated their bodies to the university. At UAB, there is abundance. I wheel a small bin into the prosection room and remove the lid. Thomas is staring straight at me.

I reach down to pick him up and can’t at first. Not expecting the extra weight, I give my arms a moment to recruit more fibers before he moves.  I hold him in the air while another student helps me clamp the vise grips into either side of his head. Of his head. I adjust the lights, pull up a stool, and grab my scalpel.

I can’t do it.

I push his cheek and it moves. I try to draw the backhand of the blade against his scalp to mark my incision and I scratch some of his skin. Before, I thought that cutting a fixed cadaver was the great big leap, and I was wrong. I stare at Thomas some more.

If you’re going to be a surgeon, you have to do this. How many people get to work on a fresh cadaver? What opportunity are you wasting?! Do it, topher. DO IT!

I let the blade sink in and I begin to draw the curve of his hairline down to the front of his ear, then drop to the bend of his jaw and forward to the point of his chin. I pull the line upwards and around the mouth, into the sweep of his cheek where tears would have slid and then around his socket and up, until I meet again at the widow’s peak. He’s bleeding, not in force, but in an ooze that marks each position of a superficial vessel. It’s creeping me out.

***********

His face flap is in the bucket. It took an hour to do, pulling up a corner and separating it from all the anchors of fascia. The beauty of dissecting is that you’re only as fast as your mind. I was trying to save every vessel and nerve fiber early on, terrified of doing harm, until I remembered that the Facial nerve has no cutaneous branches. At that point it became snip, snip. Finding the target nerves leaving the parotid gland was magic. Pulling against the fat to see all of the brilliant colors of muscle, nerve, artery and vein is something that my fixed cadavers could never do for me. I’m no longer bothered by how real this all is; I’m too busy being hypnotized. The nerves branch and split, branch and split until they are thinner than hairs and I can’t believe that I haven’t destroyed them yet. They’re so strong and wet and alive.

Gross, messy, scary, morbid.

Say what you want about dissecting the face of a man that died days ago. Just don’t leave these out:

Amazing, glistening, beautiful, perfect.


My First Speech

July 16, 2006

My First Speech Preparing for my oral presentation was awful. I’ve never spoken in front of a large crowd, let alone a crowd of MD’s and PhD’s that specialize in the area that my little research project concerns. I’m going to get up on stage, my voice will crack, my hands will shake, I will flub one of my pre-recorded sentences and the pin will skip. I will sweat halos around my arms and neck and then take the audience along the agonizing journey that is reading straight from the PowerPoint as they also read along with the PowerPoint. “Thank you for your time. Please no questions?”

Arriving at the Hotel, I slowly bump into the other 20 students from SGU. We each have practiced our poster presentations to our unjudging mirrors, but not to our Research Professor. He arrives, having printed out the posters from kinkos and flying them here. We grab a room and he marches us one-by-one to the front of the room and says, “You have two minutes. GO!” It rattles people but we get the point: we have to be flawless and unthinking. Everyone has a lot of work to do before our next drill sessions tomorrow morning and night. Becuase we do not have a projector, I cannot rehearse and recieve feedback with everyone else. I’m nervous about my speech and won’t sleep well till Wednesday night.

Tuesday is spent rehearsing, running errands, and socializing. One of the big reasons for coming to this Congress is to meet physicians and professors in research or at schools for arranging clinical rotations. As a Caribbean medical student without a campus or hospital in the states, there are huge issues with reciprocity. This makes any clinical rotation outside of our “safe” hospitals nigh impossible. You have to know someone inside.

Reciprocity: You want to send a student to our hospital? Sure! Just so long as we can send students to your hospital. No hospital? Then no.

The first opportunity to meet people is tonight at the wine/cheese social. I’m not very practiced at this and balk quite often. All 20 of us have 50 business cards made up for this trip in case anyone should want to contact us. We feel pretty ridiculous owning them.

Keith Moore, Art Dalley and Anne Argur are here (writers of Clinically Oriented Anatomy). Holy shit! These people are Anatomy rock stars to me. Kyung W. Chung is here of BRS fame. If I had panties I would throw them at him. I CITE these people! EVERYONE cites these people! I have to come up with a word for nerd-groupies.

ANATARDS will do.

***If you’re in a room where you are unknown, where a bright Peach, Aqua, or Royal Blue Oxford shirt. Introduce yourself to people on the far left, tell all your funny stories and charming one liners in three minutes and listen to them for ten. Then repeat on the exact opposite side of the room. Now, get a drink and stand in the middle. Strike up a conversation with someone very attractive and hold their attention. Wait fifteen minutes for the plan to set and watch as people know your name and are introducing themselves to you. I saw this executed to perfection THRICE!***

Tonight after the social we rehearse again. It is amazing how much everyone has improved. Presentations that were choppy, unsure and peppered with like’s, um’s and uh’s are now crisp and professional. I’m incredibly proud of the group. Everyone heads to bed leaving me with three other people. I turn on the computer and, sitting, give my presentation to them. They say it’s perfect and I’ll do fine. I want to believe.

D-Day. Wednes-Day. I put on my nice suit with the tie that matches my slides. I rehearse the speech three more times at an average of eight minutes. I walk downstairs. The fruit bowls and bagels aren’t really helping. What I need is a nice cleansing vomit. I cannot stop my hand from shaking and my heart is up in the 120s at a sit. Whenever anyone wishes my luck or mentions my presentation, the muscles of my face tighten up and I forget to breath. My voice cracks on “Thanks.”

I kill a few hours with the rest of my group. They are in the other room presenting their posters. They tell me that someone was just looking for me. He asked about the student giving the mandible talk. He said he was an oral surgeon and couldn’t wait to hear it, and that there were a few other Head & Neck people in the audience. My face tightens and I excuse myself. Up on the 18th floor I open my Netter and proceed to draw out all the arteries, muscles and bones of the Head & Neck and I go over in my mind how I will describe my approach on dissection, perchance I get a question on it. I am now a nervous wreck.

I go back downstairs to listen to a few of the oral presentations. The first one is amazing. The second one is even better. The third one is horrible. I feel so much better knowing that I’m no longer in the running for first or last place. I sit in the dark and deliver my speech to the back of everyone’s head. It goes well.

As my time comes, everyone from SGU stops what they are doing to come watch. They call my name, I walk on stage and I can feel my heart rate dropping. I fumble with the video cord, plug in my computer, and manage to get the first sentence out of my mouth. The rest is a black haze. People are clapping and a woman in the front offers a comment. “I agree with your comment, and thank you.” I have no idea what she just said.

I walk off and meet my Research Professor and friends in the back. They all have flattering things to say and each offer me a drink. I take them up on it, one by one.