Oh boy! Three new posts!

I’ve been busy and have neglected my blog. Instead of busy this evening though, I am procrastinating so posted several days worth of cadaver chronicles. Please forgive me as I am surely leaving out delightful ditties in my recap tonight – enjoy!

Exam One:

When I say that I had the worst headache of my life on the eve of my first exam I am not joking. It started around 4:30. I had spent the last 30 minutes of so making finishing touches on a birthday card I put together in photoshop, my eyes were a little tired and my neck hurt a wee-bit. My dad called and we chatted and I said, “I think I’m getting a headache.” He hung up and I decided to go lie down at the beach. But I forgot my sunglasses so after drifting in and out for an hour in the sand, half listening to the annoying high-school aged lifeguards boast, I gave up and returned to the office, where I promptly took an imitrex. This was at 6:30 – at 7 I was on the couch in agony – at 8 I was dry heaving in the women’s room – at 8:15 I took a second imitrex and tried to sleep again – by 9:15 I needed to go home and felt well enough to drive. I braced myself for the elevator ride down 6 floors but was not prepared enough. Thank goodness nobody stood in my way – I b-lined to the women’s room on the 2nd floor and proceeded to vomit for the next 10 minutes or so . With secretions that are supposed to be limited to the 2nd part of the duodenum (day nine) now up my nose, I was tearing and coughing, wishing desperately for a toothbrush. A couple rinse-and-spits later, I was staggering my way to the car where to my unbounded relief, I found dentine-ice gum that had been in my brother’s car no less than one year and devoured two pieces. I made it home in one piece, dove into bed, and woke up the next morning eager to take my exam. That is until my migraine started to return around lunchtime! I took another imitrex, ate a little food so as not to faint, and went to the lab. Two hours later I was done with the practical and felt sure I’d effed up more than handful of questions because of the cloudy state I was in. The lecture exam was good though and I walked away from that pretty pleased. I am happy to report that I missed only 4 on the lab – two because i wasn't specific enough, one i second guessed myself (curses), and one because i didn't know. i missed one dumb question on the written and two i honestly didn't know. So, all-in-all, I didn't f-up... I finished the Thoraco-Abdominal Module and i scored a 93.8% on that final – I’m hoping for over 95% on the next exam.

Days Eleven and Twelve: The Pelvis

To start day eleven, we had to split the body in half through the pelvis. The instruction manual said to “start at the right of the clitoris and stay to the right going through the vulva." It was me, 3 other girls, and 1 guy. I start cutting and was like "where do i go next?" the girls were all "where's the vulva?" Under one girls breath I hear "My mirror stays in the drawer." And who knows -- maybe the guy just didn't know what he was looking at before then... After we got over the laughing, I decided to walk over to another table to see what they did. There was a young looking guy there and he said, "well we cut kinda wrong. cuz we went to far away from the cli... -- I can't say that word" and he turned beat red and started giggling. I looked at him and said "Cli-to-ris?" i told the group to make him say it seven times out loud. Lots of blushing that day by the young men in that class. Well, after satisfactorily determining where to cut, I made a nice bisection through the right crus of the clitoris, the anterior and posterior walls of the vagina and stopped just before the anus and rectum, cuz it was still full. BUT – one of the professors, my new hero came over and wiped her clean and we proceeded to examine the rest of the urogenital organs.

On day twelve we discovered that Penny’s cancer must have spread. She was missing her right ovary and there were hundreds of small cell masses surrounding her uterus and body wall all the way up to her diaphragm and ribs. We therefore worked on her left side for once. I forgot to not that during work on the abdomen, we bisected her kidneys. The left kidney was only half the side of her right and this was on par with the missing left lung and asymmetric body thus far). The ovary was pretty cool – surrounded by scar tissue for decades of ovulation. Her fallopian tubes were small and sinuous and her uterus was normal (about the size of a hockey puck – don’t get me started on what it expands to during pregnancy).

I learned this region pretty well and spent the remainder of the lab teaching other people this system because EVERYBODY came to our table to view the female urogenital system. I was exhausted by the end but new the va-j-j and friends so well that I described them again during the weekend review session – a student called me the TA in front of the professor actually holding the review. SWEET! Later that night, my mom got a KICK out of me describing this to her, especially when I said I told people to pinch the clitoris between their fingers so they could find it and said “Here it is!” I’m glad she has an open mind and doesn’t freak out when I say things like “find the clitoris.”

Days Seven - Ten: The abdomen.

When you open up an abdominal wall for dissection you make three large cuts; one along the midline of the abdomen, skirting around the bellybutton then two additional cuts from the bellybutton to the side of the body, creating four quadrants of fascia, fat, and skin. After examining what occupies that space above the muscles during day seven, (and uncovering a textbook external inguinal ring, round ligament, and ilioinguinal nerve I shall add) we dove deeper past muscle fibers, tendons, and more facia on day eight. This needed to be done carefully too because what lies beneath these layers, though in principle identifiable, could be all to unmistakably horrid and rancid. DO NOT CUT THE INTESTINES!!! We did not cut the intestines but we were still incredibly confused by what we found yet AGAIN!

Normally a relatively large sheet (greater-omentum) of fat and other tissue with a network of blood vessels passing through it blankets the majority of the gut tube. So we were confused to see no such sheet covering Penny’s contents. We prodded a greenish-blobular mess in the upper right quadrant and we all thought it could be the gallbladder – an ENORMOUS gall bladder – but we were at a loss to find the liver which should be right next to it… Hmmm??? Turns out that for some unexplained reason, Penny’s greater omentum was reflected superiorly over her stomach and liver, shielding it from our view. We were poking at her cecum, aka large intestines, and that could have been bad… very bad.

I really enjoyed this lab but had a hard time grasping all of it so I went back the next day (Saturday) to review and re-pin all the structures we needed to know. I learned A LOT that way and was again fascinated by the vascularization of the body – there is something stupendously satisfying about tracing the course of blood flow throughout the body; deciphering the roads most often traveled and those taken when driven off course – the abdomen is filled with an astonishing network of conduits what are not prepared to give up easily, but alas, they will fail if you treat your body poorly – I’m not saying you have hemorrhoids because you drink like a fish and eat like salt like a deer on a hunting range… but if you do, think twice… I hear those things are painful. By day nine I was familiar with the alimentary tract and it’s innervations – after cutting it out of the body it became more difficult to conceptualize though. With mesentery in place, tracing the path your food takes post-stomach is a lot more difficult on a lunch tray than it is when connected to the body properly…

Day ten we were finally past the ‘guts of the course’ and on to striated muscles and nerves again. What a lesson in variation this lab was. Lumbar nerves are NOT textbook. Nor are the arteries and veins that descend and ascend the trunk and legs. It took me two days to clean Penny’s vessels and didn’t I find some tricky situations. Lesson learned – look to where the vessel goes, not where it came from. (As I write this post exam I say assuredly, people lost points on Penny because they pinned the obturator artery on her – and she don’t have a normal branching obturator at all – fortunately for me, I know my body).

Days Four - Six

I’ve got a little time before review session so here’s what happened on day four.

Pleural Cavity and Lungs – after a short lecture complete with demonstrations using balloons and fists to visualize the sac enclosing the lungs, my group and I were ready to remove Penny’s ribcage and see what she was made of. It’s a simple procedure involving one of two methods. Option A: A small rotary bone saw. Fast, clean edges, with the potential to cut too deep too quickly (also, every table wanted to use them). Option B: Giant hooked forceps with a scissor like blade and the free end instead of serrated pinchers (see this website for an example http://www.htasurgical.com/products/p_13.jpg).

We elected option B and I started clamping down on her ribs about where her arms would rest naturally. It was surprisingly easy to do until I got to the clavicle (collar bone) which was tougher – I naturally loosened it and let the strong guy in the group finish that part. Another girl proceeded to cut the left side of her ribcage and soon we were ready to clip the sternum and open her up. One snag though – we couldn’t left the ribcage… We pulled, expecting that part of the pleural cavity lining (that balloon I mentioned) would be attached but this was just wrong. The right side loosened up just fine with a little help from our hands, but the left side was in no mood to be parted. I am definitely the ‘cutter’ in the group and there is another girl who has become an excellent digger – she shoved her hands in there and even she couldn’t get it to separated. (We were trying to be delicate of course). Finally a professor came over and yanked, revealing a remarkable anti-smoking campaign of a lung that was nothing more than a shredded mess of wet, brownish, scar tissue. Which I will mentioned fused not only to the front of the ribcage, but to the sac around her heart and the back of her ribcage as well. Digger had her work cut out for her over the next couple days while the rest of us cleaned up the ribs and right lung – which by the way was ENORMOUS most likely as a way to compensate for the mess her left lung was in. And though the right lung was more spongy like it should have been, it was really heavy and dense – not a good thing.

The next day was the heart. I consider myself fairly well versed in the dynamics of the cardiac system – ask me to draw you a blood flow diagram sometime. But as I mentioned, on day three we learned that her lung had fused to her pericardium. Lots of scar tissue removal did open up to a small heart roughly the size of my fist surrounded by fat making it a little difficult to observe the blood vessels. It got done though and it was the easiest lab we had thus far. Well, maybe until day six and the mediastinum (that is, the remaining part of what was inside her thoracic cavity. I don’t recall anything super exciting here – her left side was shot, yadda yadda yadda, and her right side was pretty well defined. Oh – we did learn what she died of though. She did suffer from Lung Cancer but it was a cardiac arrest that finally did it.

Day Three

We flipped the bodies over on day three. ‘P’ is a large person so this required skill and grace. With six of us counting to three, we had success. Once supine, it was revealed certainly that we were learning from a woman. As I carefully remove the skin from her pectoral region the group wanted to name her. “How about Penny?” I said, now intimate with the facia over her ribcage. “I like that,” said another. “Penny she is then.”

The pectoral region was pretty dull to start with. Not many muscles of great interest. Her breasts were asymmetrical and there was a definite distortion in her left one. We split that down the center to reveal the mystery behind what makes a boob. Straight through the nipple and the areola, then through sinuses and ducts, past shriveled mammary glands now replaced by fat, our cross section was a success and served as a teaching specimen for several other groups. It’s not as ‘magical’ as I thought it would be. It really just looks like a lot of fat tissue. Apparently on younger women, there is less fatty tissue and the suspensory ligaments weaving throughout are more taught keeping the weight of the fats and glands ‘up’ – I commented how in a few years, anatomy students will most certainly begin to encounter big bags of saline instead of real breasts.

After getting through all the superficial stuff, we started tracing arteries. I am not sure that any of us competed the reading for that days lab, so when the professor assigned to our table came over and started rattling things off, we were less than impressive. In case you were wondering though, the axillary artery is a continuation of the subclavian. Off of the axillary branches a small trunk called the thoraco-acromian artery which in turn gives off four other arteries we are not responsible to identify on the practical, though we can now. The professor worked out the relationships of veins, nerves, and arteries for us on the left shoulder and I got to work on the right. We had a bit of a head start there, because Penny had a port in her right shoulder with a tube going into her cephalic vein continuing into the right brachicephalic vein. Deep to the veins should have been arteries, but I had trouble clearing away the tissue – I had an idea! I grabbed a trash bag and threw in over my shoulder, letting it hang down over my chest. Then, I grabbed Penny’s right arm and propped it up against me – hand waved in the air, Penny was poised for a new view into her pectoral vessels.

The port in her veins and the distorted breast tissue got us hypothesizing about her cause of death. We began to suspect cancer but we still weren't sure.

Day Two

Woooo – The Thai food I picked up for lunch was spicier than I expected it to be. My choice of beverage was limited when I got home too – water (which would inevitably spread the spice and cause additional pain) or red wine (better for dulling senses of course). The choice was obvious, and the rest of the Robert Mondavi Cabernet Sauvignon was consumed. It made me feel great but I’ll admit my focus is off and thus, while I regain my full senses, I write a quick blurb about day two before heading into the lab to review the thoracic cavity.

Day two – After a short break for Independence Day, it was back to the grindstone. Well, more hand chisels and hammers really. That’s right folks, in order to see a spinal cord, you need to remove the ‘spine’, and there is no better way to do that than with good ol’fashioned elbow grease. So on day two, we hacked through the backbone... With careful force applied to a chisel precisely placed on the arches of five vertebrae *cough*, my group performed a laminectomy – well, at least that was our intention; to remove the top of the neural arches to see within the vertebral canal to the spinal cord. My group received different suggestions about where to cut from the different instructors circling our table and we sorta 'missed' the target. Fortunately, we undershot rather than over shot and removed the top most part (spine proper), so we were able to clear away more and see got a bird’s eye view of the spinal cord, i.e., fricken rad afternoon.

Day two made me say, thank goodness I am a researcher and have no plans to be a surgeon – I’m too clunky and I like to take things apart a lot before putting them back together. Thus, I will stick to the specimens that no longer require active neurons to be informative.

Prologue and Day One

This afternoon (Saturday) I spent three hours examining a few cadavers. None of my group showed up despite three of them saying they would be here this afternoon… ‘Oh well.’ It was quiet, as I was the only one in the giant white room that could be a supermarket butcher shop at first glance. I spent my time re-doing the last two labs on my cadaver (a 61 year old woman) and two additional male cadavers. But I’ll get to what I saw today later – I should start to bring you up to speed on the first two weeks worth of class.

Prologue – I study fishes, Recent and fossil ones. My favorite group to work with is the batoids (sharks, skates, and rays) – yes of crocodile hunter death fame, please can we drop that now? It’s not so easy to get a job as a fish freak, however, so to make myself more marketable, I challenged myself to study human anatomy. With that tool in my belt I open up a few more doors for teaching opportunities (e.g., comparative evolutionary anatomy). But I am a PhD student in a geology department and there is no medical school at my university, so I finagled my way in to my undergrad institution as a non-matriculated grad student. I arrived there a day before classes started, nervous and high like the first day of kindergarten. I picked up textbooks, two pairs of scrubs, a lab coat, and a copious amount Kimberly-clark Safeskin Purple Nitrile Gloves, size small. I was going to cut up dead people the next day…

Day one –My enthusiasm began to manifest itself as migraine and nausea – boo to that. I didn’t eat a good lunch for fear that I would ‘lose it’ upon opening up a body bag containing one human cadaver who bequeathed his or her body to anatomical study. I had no idea where to go because I was not part of a program (OT, PT, PA, etc.) so I was not on a mailing list and attended no orientation. Instead, I found my undergrad advisor and she said we’d walk downstairs together for lecture. Lecture lasted one hour and it mostly pertained to logistics. But lab, however, that was hardcore right away. I changed quickly into said scrubs, gloves, and labcoat and got prepared to cut.

Bodies were face down because it is most efficient to work on the back and back-muscles first. Most of the students, including myself, were grateful for this because without faces it was much less personal than it could have been. Slice one, straight down the spine. Time to remove the skin from the back and take a look at some muscles! It was emotionally much more easy than I thought it would be. I even tolerated the smell very well. So prone to migraines as I am, I was sure I would rather die than be there within a half hour, but adrenaline kept me in the game and I was a dissecting fool.

All I really remember of my lab group that day was one girl repeatedly saying, “Doesn’t this make you never want to eat fat again?” – You see, Lady P (we were at table P and affectionately named her P for the time being), ‘P’ was a big woman – Truthfully, we weren’t even sure if ‘P’ was a woman. For all we knew, we had a transgendered individual and weren’t prepared to make any assumptions. But ‘P’ was bigger than some, and thus a little oily and rather moist. Ewww you say – well, yes, but I am obliged to ‘P’ because it makes differentiating layers a little easier as we are not working with people-jerky as some unfortunate students are this summer.

OK… I think I’ll leave you with that image for now. I’ve got a date tonight – with Harry Potter :-p

'Stiff' Summer Challenge

I find myself currently distracted and completely unable to concentrate on what one could consider important things, e.g., the chapter I should have completed for dissection today. I’ve completed six days of the summer human gross anatomy course I enrolled in and today was the first ‘quiz’ – i.e., lets see what you’re made of kids, name that pinkish, shriveled, non-descript piece of flesh with a pin in it. Fortunately, quizzes do not count for a grade, they only serve as a proxy for how I’ll do on the module exam… Better – I will do better on the module exam.

This class should be consuming me, and it is, but not entirely – it's got competition hardcore, thus, I am distracted whenever I am not in the classroom. Like now, as I’m up in my office before lecture begins, trying to prepare for the abdominal dissection. Grumble Grumble… I am not myself. What’s that… violins? Thank you for that show of support! That’s just why I started this little blog – It’s time to get the priorities straight.

Item 1 – stop feeling stupid.
Item 2 – no seriously, stop feeling stupid.
Item 3 – tell you all about my ‘stiff’ summer challenge – but it’s time to go to lecture now, so that will need to wait a little longer.