Sunday, 16 December 2012

Gross anatomy

I got the following email request from George (yes, his real name) asking about my years as a medical student:

My name is George. I’m currently in medical school in {redacted}. So I know practically nothing….
I stumbled upon your blog and it’s amazing. My friends and I now start to sit down, laugh (where appropriate) and discuss what you talk about. Plus, your entries are pretty regular for someone as busy as yourself, very impressive.
Ever thought of writing an entry reminiscing on your past life as a Med Student? Would be great to know what you experienced.

Keep up the great work
George
Well George, I would like to reflect on my years as a medical student for a moment and remember them with fondness.  I would like to do that, but I really can't because it was several years of unimaginable torture.  Ok, that's a gross exaggeration - my residency was unimaginable torture.  Medical school, on the other hand, was more...well, like a really annoying itch that you keep scratching but just won't go away. 

My father went to medical school 30 years before I did, and his father did about 30 years before that.   My grandfather liked to tell the story of his first day of medical school: The dean assembled all the students in the auditorium and then told them, "Look at the student to your left.  Now look to the student to your right.  Now remember this: two of the three of you will not be here on graduation day." 

Ouch.

By the time I started medical school, this was no longer the case.  Students were weeded out in college by such evil devices as Organic Chemistry, a full-year form of torture just slightly more painful than The Machine from The Princess Bride.  But before I started, my father told me that medical school isn't necessarily hard.  There are very few difficult concepts to learn - it isn't multivariable calculus, quantum mechanics, or special relativity.  No, what makes medical school difficult is simply the sheer volume of knowledge that medical students are forced to memorise: anatomy, physiology, biochemistry, pathology, microbiology, epidemiology, histology, embryology, pharmacology, immunology.

On my first day, I happily (and nervously) received my course schedule for the year.  And there it was on page one staring at me, taunting me:

GROSS ANATOMY

Of course I knew it would be there, but just seeing the words on the page gave me pause.  I will be dissecting a real person.  I had dissected small animals in school, but never anything like this.  This was...I didn't exactly know what it was.  But all of a sudden, medical school seemed real.

It got even more real later that day when we got our tour of the "Gross Lab".  When I first walked in, the smell of formaldehyde was so strong it may as well have slapped me across the face.  Now I know why it's called "gross" anatomy, I thought.  We split into groups of four, and we found our assigned cadaver, all of which were wrapped in plastic.  I was in charge of opening the plastic bag, and despite my trembling hands, I got it opened.  And there she was: our cadaver, Rose (not her real name).  Very thin, grey hair, arms folded neatly over her chest, eyes just slightly ajar.  Rose was an elderly lady who looked like she could have been anyone's grandmother. 

The class started with no real drama.  No one fainted, no one dropped out.  We started dissecting very timidly, but after the first day, the nervousness was gone.  The anatomy was absolutely fascinating, but over the next several months there were some oddities in the gross lab and questions that arose that simply couldn't be answered.  When we got to the chest, we could instantly tell who had smoked and who didn't.  Rose did.  Is that what killed her?  And Rose's liver was green instead of the usual rust color.  Why?  Was that her cause of death?  The cadaver next to us was hung like a porn star.  Could he have been?  Another cadaver on the other side of the lab had a transplanted kidney in his pelvis, and another was missing a lung.  Who were these people?

As the months progressed, I learned more about anatomy than I could have ever dreamed.  Muscles, nerves, arteries, veins, glands, internal organs, the brain and brainstem, tendons, bones, ligaments...and all real.  Not just pictures in a textbook.  Real.

Gross anatomy is a course unlike any other.  It isn't just memorising facts - it's memorising what structure is what and how it's all connected to everything else.  That's what makes it so difficult, but at the same time so satisfying.

Looking back at my first day of gross anatomy, it was painfully clear that no one knew exactly how to act.  Several people cracked nervous jokes, some people whispered.  But I just stared silently at the person who would eventually become the best teacher I ever had in my life.  To this day I have no idea how Rose died or why she had decided to donate her body to our medical school.  But when I first laid eyes on her, I still vividly remember my first thought was "Thanks".

3 comments:

  1. Thank you so much for sharing! Formaldehyde always leave me hungry after a session in the labs...

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  2. Thank you for sharing your experience and thank you for what you said about Rose. I am curious, however, what would cause a liver to turn green...just so I never do that. *shudders*

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  3. You know, reading entries like this always makes me think about the difference in education between doctors and nurses and how it seems to reflect or even shape the attitudes of both professions. I'm saying this as a nursing student in a bachelor's program who is about to graduate in May.

    It's just funny to me how one's the reverse of the other. I can tell you now how (in general terms, obviously) how to treat people with a lot of different diseases. I can name a ton of drugs and what they do. I took anatomy, physiology, microbiology, pharmacology... I didn't take organic chemistry because my school didn't require it, but I know that some nursing schools do require two semesters of organic chemistry at the baccalaureate level. It seems like there are at least some similarities on the surface, but before I took any of the upper-level nursing courses I was thrown into patient rooms knowing absolutely nothing about their diagnoses beyond what I had hurriedly been able to glean out of the textbook or the internet while doing pre-planning paperwork the night before clinical. That was in my very first week of the upper division of nursing school.

    By the time I graduate, I will have had so much hands-on patient care experience that any sort of residency is optional. One reason I point this out comes back to the gross anatomy course. I will be taking one within the next three years, if all goes well. My first-choice school where I intend to study to become a nurse anesthetist requires it. I will be very surprised indeed if there's much of the awkwardness you and your classmates experienced from the CRNA students, who after finishing their 1-2 years of critical care experience will have likely seen countless deaths. For medical students, it seems like a lot of the time the first exposure to a new disease, treatment, or even death happens in a controlled setting such as a classroom or laboratory. The human element of the diseases seem to be temporarily removed. As a nursing student, I have participated in codes and provided postmortem care. There is nothing scary or strange about dead bodies anymore, at least not for me, and it was a very rare occasion indeed when I had learned about a disease prior to having a patient with that disease.

    It sort of makes me wonder if the reason that nurses are the "caring" profession and physicians are generally much more "clinical" is our differing routes of learning information. Does throwing a person in a hospital room with a real patient on the first day breed empathy? Does learning about diseases and their effects on the human body in a classroom instead of while observing the effects of the diseases in person breed aloofness?

    Obviously, not every physician fits the stereotype of the aloof health care provider more interested in the disease than the person, but it seems like more physicians fit that mold than nurses. I am always grateful to come across physicians like you who care about their patients as people, but I have met a lot of them who don't.

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