Doc in Training Learn Medicine with a Medical Student

Thoughts on Anatomy and Dissection

The most iconic component of medical education may be dissection of the cadaver for anatomy. In short, an intact body preserved in formaldehyde is systematically opened to inspect organs, muscles, nerves, and blood vessels, literally from head to toe.

A top concern of the premedical student is contemplating his tolerance of the sometimes gruesome process of dissection. Early in the semester we, too, split off into groups of four for each cadaver and nervously peeked within the black body bags, the pale lifeless body covered by a damp cloth. But it's true, one becomes quickly inured to the frankness with which we (respectfully) explore the body.

Dissection is a long process, taking roughly 3-4 hours three days a week over a dozen weeks, resulting in roughly four hundred hours total. Each day's dissection covers a specific part of the body - we might study the rib cage and the lungs one day and the heart another. Slowly we move throughout the body, placing organs in plastic bags and exposing muscles until what remains is a far cry from the intact human at the beginning of the term.

Fat is an everpresent barrier, and indeed much of the day is spent digging through preserved globules of fat for items of interests (one of HST's groups had the fortune of dissecting a cadaver with virtually no visible body fat, which incidentally allows them to complete dissections more quickly). I therefore often find myself questioning the utility of dissection as we spend 20 minutes trying to distinguish the glossopharyngeal nerve from the vagus nerve in the neck and ultimately discovering that we nicked the glossopharyngeal earlier. In a three hour dissection, we could have potentially memorized far more than we discovered in the body that day.

Indeed, some medical schools are dispensing with cadaver dissection altogether and moving to an electronic modeling system. Arguably having a three-dimensional representation vividly memorized in one's head is as practically useful as seeing it on an actual body.

Yet there are some moments of profound discovery that redeem every last hour on the dissection. One came early when I cut the connections of the right lung to the body, lifted it out of the body, and held it in my hand, spongy and surprisingly heavy. A perforation of the lining of the lung - from a stab wound, say - would immediately collapse it, preventing air from entering. Bacteria can infiltrate them quite easily and build up fluid in the lungs. Yet it otherwise functions perfectly every normal day, supplying crucial oxygen throughout our bodies, without which we would die within minutes.

Another moment came from dissection of the arm and hand. Consider for a second all the possible motions of each finger. With your fingers outstretched and palm up, you can move your fingers left, right, up, down; curl and uncurl them; and all combinations of these. Think about what a complex task typing on a keyboard is, moving multiple fingers to precise locations in sync over and over again.

Each individual motion of the finger is controlled by a single muscle, such that operation of the hand requires over a dozen muscles. Yet the anatomy of the hand makes perfect sense. By pulling on the specific muscle, I could make each finger move according to the muscle's function. This reminded me of a very complex marionette, with an overseer rapidly pulling strings to make me type an email.

The overseer is the brain, and when we recently cut out the brain from the cadaver's skull and held it in our hands, I realized that this pale, spongy mass was responsible for our recognition of our existence and all subsequent behaviors. Somewhere in this dense mess, neurons were connected with each other such that we could actually reason theoretically and make extraordinarily complex decisions. Yet you break open the skull or put a bullet through it, and that can all disappear. The brain begins to die irrecoverably from lack of oxygen within 5 minutes.

Dissection and anatomy have taught me a vast body of material that may be practical in the future. But more powerfully, it has also made me appreciate simultaneously the human body's complexity and fragility. I think it is a wonder that such a complex being resulted from gradual improvements from microbes, even if it took a billion years. That a spinal cord the thickness of a quarter can relay messages from the spongy mass of the brain and control millions of processes in the body is still astounding to me.

Knowledge of human anatomy is arguably more important in some specialties - surgery, radiology, pathology - than in others - anesthesiology, medical oncology. But a respect for the body is indispensable in all.

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Everyone is Exhausted

We've been in school for just two months now, but the signs of fatigue are starting to show. In any of our nine classes each week, I can look around and see some students dozing off, their heads bobbing up and down rhythmically like a drinking bird. Some students stare blankly at the lecturer with little sign of comprehension, bleary eyes transfixed at some infinite point in the distance. Some students even just capitulate and leave class early to catch a nap before a three-hour dissection later that afternoon. I have been guilty of all of these at some point.

The problem is not that we lack interest in what is being taught, that the lecturer is monotonous, or that our water supplies have been poisoned with opiates. Instead, there simply isn't enough time in the day. When we finish the day at 6PM, having been in class since 8:30AM, the last thing we want to do is hit the books. So with dinner, a TV show, and some dilly-dallying, suddenly it's 8PM. There's the day's material to review, the next day's dissection to prepare for, problem sets to complete, cases to research. Now it's 1AM and time to sleep, but I rarely feel like I have had enough time to enjoy for myself.

A few older medical students warned me that there is simply too much medical knowledge coming in the first year to be able to learn everything. Instead, I would have to be selective and choose what I was most interested in. I was incredulous, as this had never happened before, even with some demanding schedules at Harvard as an undergrad. But it is slowly becoming more apparent.

I should stop whining about this since this is just the very beginning, and clinical rotations and residency should be far worse. But what a toll medical school can have on our daily lives, and how much stronger we will be (maybe in worse health) after we leave.

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Reflections on Being Sick

About two and a half weeks after I first reported an illness, I've just about recovered. There is the last remnant of a sore throat and a dry cough, but it will probably disappear in a few days.

It's been a painful and long illness, and I have two salient thoughts on it:

• People actually want to avoid you. This is somewhat obvious and logical, but it actually made me feel alienated. I would quarantine myself in a corner of the classroom, but other times students would purposefully avoid being around me. This is nothing compared to the stigma HIV/AIDS patients faced in the 1980s/90s, and I am so happy that education has changed much of that, at least in some areas. Experiencing what a patient endures can really make you a more understanding doctor.
• An itchy throat is annoying, the tiny little scratch in the back of the throat that forces you to cough but won't disappear even when you do. I was often in situations when I really did not want to cough repeatedly - in lecture or in public - and could go red in the face just trying to suppress the cough. Fun fact: this itchy sensation is caused by irritation of the mucosal membrane, often when there is insufficient mucus.

I'm glad to be somewhat healthy again, and I hope it doesn't repeat later in the winter.

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I Am Fully Sick

I last reported on a sudden illness and its disappearance. Now later in the week, different symptoms have erupted and I now have an actual disease. I have a productive cough (coughing up phlegm), swollen lymph nodes, and a very sore throat without white exudates (pus, which would be a sign of strep throat). I'm thinking it's a viral infection, which means I can't do all that much about it.

There's a slight possibility that it's the dreaded H1N1. In April, a few students at Harvard Dental School were verified to have H1N1. The (unverified) story goes that a student's boyfriend had visited Mexico, returned, and the two of them visited parties without showing symptoms. In response the school was shut down for several days.

The H1N1 flu is common enough now that cases do not need to be sent to the Centers for Disease Control (CDC) for verification, but it is still a looming threat in the coming flu season.

In any case, I'm going to take it easy for a while until I recover more.

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I Am Sick

On Friday, I played basketball with several friends. Being out of aerobic shape, I was short of breath by the end of the game.

On Saturday, I woke up with a sore throat. I thought nothing of it and went to a review session (class on Saturday!) but became increasingly feverish over the day. By night, I had a full-blown fever with chills and a raging sore throat. I slept throughout the night and had some delirious dreams as typical of a fever, and I woke repeatedly in the night.

Today I rose perfectly fine, a mild sore throat but no fever. I was surprised by this as I had never developed and resolved fever so rapidly. Like a proper medical student, I began reaching from my (limited) knowledge. We had learned in immunology that when the immune system fights off an infection, the next time it sees that disease the response is much swifter and fiercer. Maybe that was what happened? Did the basketball play have anything to do with it, perhaps increasing respiratory distress?

Usually I tell people (my parents especially) that I haven't been sick in years and that I'll be fine in flu season. Can't be quite so smug now.

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