Shaking Hands with the Dead

The hand is distinctly human. A thorax is just a thorax, and a shoulder is just a shoulder. In contrast, like the heart, brain, or face, a hand is not just a hand. It’s somebody’s hand.

When prosecting the hand tissue, as we did today, it’s troublingly difficult to dissociate yourself from the gruesome reality of the task – cutting apart a person’s dead body. I felt again deeply accusing guilt of invasion, and violation.

What work did he use his hands for? Perhaps he played an instrument with them. Perhaps he penned words that have out-lasted the hands that formed that. Whose hands did he lovingly hold in his?

Now his final handshake: … me, with my stinging scalpel. I greet him again in those hands, human even in death. I’m sorry for putting you through this. I’m sorry for keeping you here. Thank you, for this last meaningful action of your – always your - hands.

 

 

Neuropathology

It makes a slick, slimy, wet-but-not-dripping sound as the knife glides through. Slice one. The texture is gelatinous and moldable, but it holds its shape. White and grey; there are patterns in the slice. Like cloud-gazing, you can make-believe that the shapes are mysterious life-forms.

It used to be alive. A day ago, maybe two. More than alive. That piece of tissue, now split indelicately on a slab of marble, felt emotions. It thought up ideas, and imagined shapes in the clouds it saw. It had an identity, and a personality. Now it sits cold; a lump of withered sponge, unable to defend itself from the blade that is slicing it apart.

The blade is wielded by a pathologist, demonstrating to us the gross anatomy of normal brain tissue, and some pathological (diseased) findings. Pathologists (in addition to other things) perform autopsies to determine causes of death. Dead bodies are regularly their domain. Unlike the neurosurgeon, who explores the brain while it is warm, pulsing, and ever dancing with electrical activity, the pathologist handles tissue more like damp tofu.

Evidently, the early anatomists perceived as much awe when they pro-sected cadaver brains. The names they assigned the structures sound like discoveries from an exploratory deep-sea dive: the geniculate nucleus; the hippocampus, which in Greek means sea-horse; the cerebral aqueduct. Shapes in the clouds…

Unexpected Meeting

So it’s September, and I find myself back in Kingston poised on the brink of another year. Today we welcomed to Queen’s the class of 2013. It was their very first day of medical school – an experience that I still remember clearly for myself. And as the first-years were making memories, … for completely different reasons, I was also having a day that I will never forget:

After a casual lunch with my mentor-ship group, I dropped into the anatomy lab for what I thought would be a brief administrative meeting with the tutors to sort out the upcoming term schedule. I was completely unprepared for what happened next. “You know that you’re prosecting today, right?” No. I did not. Neither did any of my fellow tutors. Yipes… well, I guess we can still make a try of it.

So in the space of a few minutes I went from meeting green frosh, to meeting my (literally greenish) cadaver who I will be prosecting this year for the anatomy lab. (We use the term ‘prosecting’ as a more respectful word than ‘dissecting’ when preparing human bodies.) We were nervous; the room was so quiet that I could hear my scalpel blade go through as I made the first cut.

It strikes me after being so physically invasive to his body, that I know very little about him – only what his body itself can tell me, such as that at some point in his life he had open-heart surgery. His face, hands, and feet will be shrouded for the next few weeks until those anatomical regions are being studied.

From my cadaver, I will learn much about medicine and anatomy. I look forward to the review of gross anatomy, and to practising with the surgical tools. Today included use of a bone saw – a brutish instrument that makes a shocking roar of noise, and will leave you sweating. I also look forward to teaching the first-years their material using the samples that we prosect.

Leaving the lab four hours later than I had expected to, I must say I was grateful for the experience. Unexpected yes, but perhaps that’s exactly the way it needed to be to push me off into the deep end.

Anatomy: Spelling Matters!

Rather insignificantly, I’m quite sure that I missed a point on my exam yesterday for mis-spelling the name of a body part. Spelling, often shooed under the rug and dismissed as trivial, actually matters a lot in anatomy where one letter difference can mean an entirely different body part!

For example, the mistake that I made was to confuse ileum, a segment of the small intestine, with ilium, part of the hip bone. There’s also a corocoid process on the scapula and a coronoid process on the ulna. Another pair that I frequently mix up (even though they really are quite different) are the carpals and tarsals.

Do You Know Where Your Prostate is At?

As Movember is already a few days underway, I’m starting a series of posts to learn about men’s health issues. In case you’re just joining the bandwagon: find out about Movember, read how I decided to participate, and if you are able, please donate! Thank you so much to those of you who have already donated!!

Before we start talking about prostate cancer, prostate hyperplasia, or anything else, you’ve got to ask yourself: do you know where your prostate is at?

If you happen to be a woman, then don’t worry too much about it because you don’t have one! The prostate is a male-only organ located within the pelvis. Have a look at the diagram above of a normal prostate. Try to identify the following anatomical relationships:

• Centrally in the picture: the prostate
• Above the prostate: the urinary bladder
• Below: the pelvic diaphragm, which divides the pelvis from the perineum
• Anterior (left-side of the picture): the pubic bone – part of the bony pelvis
• Posterior (right-side of the picture): the rectum
• Running straight through the prostate: the urethra

That last bullet point is crucial! The urethra is a tube that conducts urine and semen to the exterior. Before passing through the penis, it first travels straight through the prostate gland. We’ll see in a future post how this arrangement means that prostate disease can have detrimental effects on urination.

A healthy prostate functions to produce fluid secretions for the semen. Sperm that are secreted with prostatic fluid are more mobile and survive longer, illustrating the importance of the prostate to fertility.

Oh, that? That’s just fascia.

Recently an anatomy instructor shared with us one of the fraudulent little secrets to his trade. When presented with a confusing, indiscernible, little mass of tissue, you must simply state with a confident tone “Oh, that? That’s just fascia.” People around you will usually nod knowingly, and proceed without challenge. In their minds, you’re an instant sage. Fascia refers to connective tissue that is widely distributed throughout virtually every part of the body. It’s sort of a catch-all term. Is that unidentified tissue really fascia? Who knows ! But by claiming that it is, you’ve evaded admitting any incompetence and usually no one will think twice about it!

So the expression “that’s just fascia” has now taken on affectionate application by our class. Don’t know the answer to the question? Why, it’s fascia!

This got me thinking about what the “fascia”s and catch-all terms of other disciplines are… (all of which are basically versions of “I DON’T KNOW!!!”)

• Languages: Oh that verb? It’s irregular.
• Statistics: What’s the correlation? Well, it’s multifactorial.
• Embryology: Why does the baby look like that? Must be a congenital abnormality.
• Theology: That’s one of God’s great mysteries.
• Field science: My results are off because of statistical variation.
• Lab science: My experiment didn’t work out because of measurement error.
• Fine arts: Why did they use that technique? Well, it’s up to their artistic license, isn’t it?

I’m sure that you can think of more of your own!

Anatomy in the Park

I love Saturdays! Nothing beats sitting beneath a tree in the park, soaking up the sun on a colder day while studying anatomy.

There’s the beauty of the greenery around you, illuminated by slanting rays of sunlight through the branches above. Then there’s the beauty of the reddened muscles, vessels, nerves and fascia, coursing through their channels in perfect arrangement.

There are also sounds: birds singing, children playing frisbee, and the rustling of leaves in the wind. As I read, I add to these the sounds of arteries pulsating, tendons snapping, and air rushing in and out of the lungs. It’s the ballad of life, both from the outside and the inside simultaneously.

I feel the hard bark of the tree behind, rubbing against the stubby spinal processes of my vertebrae. My fingers toy with the pages, compressing the superficial layers of skin such that touch and pressure sensors beneath are triggered.

The physical transition from the outside to the inside of my body is seamless, all composed of simple matter. It’s only my cognition that makes a distinction between my own anatomy, and the “anatomy” of the park around me. By material standards, there is no difference – just a continuum of structures arranged into functional objects. 

I love Saturdays; time enough to enjoy the simple pleasure of anatomy in the park.

Left Recurrent Nerve of a Giraffe

I learned something neat in anatomy today:

The left recurrent nerve branches off of the vagus nerve, which descends from the brain down through the neck towards the heart. After branching off, the left recurrent nerve ducks under the arch of the aorta and heads all the way back up the neck to the larynx. The result, is that this nerve forms a giant loop down the neck, and back again.

The consequence of this anatomical arrangement is that the longest nerve in the animal kingdom is the left recurrent nerve of…. the giraffe !

O-Week: Day 4, Friday

At 7:30 this morning I was sitting at my kitchen table, having a coffee and eating a bowl of cereal. At 9:30, two hours later, I was holding a human lung. What a remarkable day!!

As you’ve already guessed, we had our first session with the cadavers this morning. The experience was incredible – it truly brings the material to life when you see it within the body. I learned so many new things, and corrected many of my false expectations:

• The lungs actually extend above the ribs and clavicle into the neck region. The consequence of this is that you can risk puncturing a lung from a neck injury. 
• The heart is big and the left lung is small (compared to how I imagined them). The left side accommodates the heart, meaning that there’s a large chunk of the left lung “missing”.
• The thoracic cavity is tightly packed – everything fits in just right like a jigsaw puzzle.
• Anatomy varies from person to person: some people have 13 pairs of ribs (12 is “normal”)
• You can’t know everything. Not even the anatomists do. It’s about knowing enough to treat patients effectively and communicate about the body.

Well, there’s a sampling. I’m really looking forward to spending many hours in the anatomy lab this term!!

Today had many firsts. Over lunch, I bought life insurance and disability insurance. That sounds tremendous, but the life insurance was free (provided by the Canadian Medical Association) and the disability came at a trivial cost. Still, it makes me feel old and responsible. Or, at least, like I should be responsible now, but mostly I’m just pretending.

This afternoon we had a fantastic session titled “Pearls of Wisdom”. Quite a number of doctors from the community came in to offer us advice and tips on surviving the next four years. I never anticipated how much medical school might change me. It seems to be a transforming experience, and I now realize that I may emerge a different person than I am now. It’s good to be conscious of that, since then I can control the direction in which I will be changing.

Finally Friday, the first week of medical school is completed! It’s been hectic at times, and I’ll need this weekend to get myself organized, established, and “on top” of things.