The Last Anatomy Lab

Last Wednesday I walked out of the anatomy lab for the last time. To my surprise, I wasn't thinking deeply about it at the time. I remember the last time I was in the anatomy lab as an M1, I felt and thought a lot leading up to it. Even if I didn't feel momentous surges of emotion as I walked out, I stored the moment with resolution I would usually use for hugely important things. I remember what I was wearing, I remember which exit we used, etc.

This time I actually forgot it was my last time walking out until I was already in the hallway walking away. Then, I calmly walked to the lab management office and said to the lady who works there, "I'm not going to use this coat any more. Could you [i.e. the anatomy department] use it?" And I left it with her. (I had noticed recently that our professors use lab coats with unfamiliar names embroidered on them. Fun to think of who will use my lab coat, which has my name in sharpie on it.)

But now I think of the magnitude of things: unless I am invited to participate as a professor or physician (e.g. during our pelvis lab an OB/GYN was invited; during our leg lab a sports medicine doc came in), I will never legally reenter an anatomy lab.

Penultimate Anatomy Lab and Human Dignity

It's been a long time since I've been in the anatomy lab for the peer teaching program I took up last year. (I was off by my request in September because I knew that Cardio was an intense block and that I had a big MedSFL event then; my October lab was cancelled due to a campus emergency/evacuation.) I went in last week for the dissection of the triangles of the neck (this is the front and sides of the neck). It was a remarkable experience for several reasons.

Anatomy: a Complete 180

Gross anatomy has completely changed. Last year it was distressing; this year it is invigorating.

Last week I was in the lab again as a peer teacher, and the hours floated by like minutes--an experience I've only had a few times in my life. Three hours into the lab, one of the anatomy teachers said, "say, you can go," and I spontaneously replied, "no, I like it too much."

I'd been walking around the room, helping different groups with whatever they needed, and quizzing them. (What is the blood supply to that muscle? What spinal segments supply the greater occipital nerve? Is it motor or sensory? What is lordosis? What ligament is displaced in a herniated nucleus polposus?) Later, I went into the dry lab and quizzed a group or two on bones. I'd hold up a scapula and ask them where it was a left or a right scapula, and how many muscles attached to it; I'd select vertebrae and ask whether they were cervical, thoracic, or lumbar; I'd grab another and ask which ligaments ran on various surfaces. And later, when the lab began to empty out, I helped the groups that were a little behind (or a little too obsessive) find all the structures they needed. I answered a few questions about what to expect on the test. And I gloriously found a dorsal root ganglion (well, I cleaned off one that they weren't sure about).

Ah, so much fun!!

What's changed?

I've known for some time that I love teaching. I admit that I love the security of being knowledgeable, but I also know I love freely giving that knowledge to others. There's a high that comes with answering questions well, reducing test anxiety, or focusing their studies, or cleaning off a DRG.

I guess it all boils down to: I like comforting people and feeding people (here, metaphorically speaking). In fact, I suppose these are two of the reasons I'm becoming a doctor in the first place.

So, anatomy is different because I'm doing what I was made to do, instead of doing what feels unnatural? I'm still not sure, but I'll let you know in October. I don't serve in the lab until then, because September is the home of...

CARDIOVASCULAR BLOCK.

More soon.

Anatomy: Reverence for the Body

Source. (Not our school's lab.)

Yesterday I got an email inviting me to participate in a program my medical school has for the M2s, a teaching opportunity in the anatomy lab. This is a program by faculty recommendation; twelve of us were selected.

Last semester (as a new M1) I noticed the M2's rotating between tanks, helping groups find the phrenic nerve or the thoracic duct. The gunner in me thought gee, that would be cool, but my overwhelmingly negative feelings about anatomy lab made me never want to set a non-required foot in the place.

As I read the offer I had occasion to complete my thoughts about anatomy lab. Why did I have such a rough time in anatomy? One word...

Last anatomy lab

Parts of this post are hidden and contain graphic recollections of cadaver dissection. 12/2/11 was my last day of dissection. (I'll go into lab to study for the test a week from today, but I will never again take scalpel, probe, forceps, scissors, box saw, chisel, spoon, baster, or hand to a cadaver again.) We dissected the oral and nasal cavities by hemisecting the head. My partner actually broke a hand saw while dividing the bone. As we were washing our instruments and closing our tank, Semisonic's "Closing Time" came on (we almost always listen to music, courtesy of Pandora, during lab).
How wrong this has seemed! Only my facade has changed over the past five months. Fascinating? Yes. Disturbing? Yes. I am grateful to be through with it. Another thing I am grateful for: I was told it was inevitable to dream about one's cadaver, but this did not happen to me.
I dreamt I was a cadaver and I also dreamt of dead children coming to me and holding my hands, but I never dreamt about my cadavers.)

In the past five months, I have watched twenty persons' bodies be picked down to ghoulish parts. Much of what horrified me were cuts to bone, as we sawed off a leg to see a hemisected pelvis. But not everything awful was orthopedic: we cut little vertical slits below the lower eyelids, like the makeup on a mime, to see intraocular muscles.

I did not like opening ribcages like mailboxes, cutting out organs, peeling off skin like old linoleum. I did not like to hear people calling parts of bodies "junk" and "crap." I did not like some of the music they played in lab (I marched to the front of the room and skipped a track from Rocky Horror Picture Show once.) I hated the way people spoke about this body or that—"the old girl was well-fed," or "that's just sad" (male external genitalia dissection). I hated the sound of saws, the smell of open bone, the stench of preservatives, the stinging hands and eyes. I will try to forget holding skeletal hands and arms that bent back from rigor mortis; I will try to forget emptying the rectum; I will try to forget our penultimate cadaver molded and the bleach added to the smell.

And I will be all right. Oddly, I like to dissect: to cut is fun, to clean is satisfying. (To stitch is wonderful, but we didn't do that in class.) But I thank God it is finished.
Today (12/9/11) was our last exam in our anatomy class. I walked out of the lab at about 5:00pm in a mix of fatigue and shock, unable to feel the emotions I had built up for that moment. Again, although I might not feel much, I reiterate: Deo gratias!

Partes huius celatae sunt, quia recollectiones dissectionis cadaveris pavefactae continent. Ut articulus in toto videre, vise legem parentem. Ad fraterculos meos: non id legere...mox id vobis intimabo.

Anatomy is almost over!!

As I approach the end of the semester, I find myself counting down anatomy labs. (As of 3:30 today, five left, and I am only dissecting for two of them, orbit and nasal cavity!) Today, we sawed a crown-like cut through the skull and removed the brain. I tolerated seeing the cadaver's face (last Monday) pretty well. He had been a handsome, older man. I noticed that his brows were slightly knit in an expression of effort or light pain; otherwise, his countenance was peaceful.

Also of note: this morning I spoke to the professor I saw at Planned Parenthood. (It turns out, he hadn't recognized me.) He was as polite as ever, explaining that he'd read pathology reports from before Roe vs. Wade, and never wanted someone to die such a horrible death. He and I acknowledged that we both care about women, but that the battle across the fence was nevertheless real. He even called it "ferocious." I told him in parting to keep caring about women, and that I would do the same.

The brevity of this post is hardly excusable, but I hope you'll believe me when I judge it inappropriate to spend much longer online--I have a comprehensive histo quiz, an ethics test (gah) to take, and an exam (the penultimate of the semester!) next week.

Anatomy

Gross lab is getting a little easier because I'm growing a psychological callus: I can touch anything and it doesn't bother me, I can stand for long periods, skeletal hands and shoulders don't faze me....

We're in the abdomen now, which is more familiar to me from dissections in college. I've also noticed I have better days when a certain pair of lab partners isn't there. In fact, the better days are the days when everyone around the tank is Catholic. The conversation is cleaner, I feel more confident, etc. I still get exhausted afterwards (I'm posting right now because my brain is good for nothing else; I was going to study, but just can't).

Today my eyes are full of fumes--the entire surface of my eyeball, all the way back into the orbit, is sore. The body we've been assigned (our third--we rotate after each major region) is developing mold, and bleach + phenol + fat + bile is pretty strong. One of my tankmates is just recovering from a stomach bug. He just got his appetite back today, and he comes into lab to a putrid tank and an open gallbladder! So I can't complain. All A.M.D.G. Time for histology.

Gross anatomy is still hard. We have had three labs now, but it has not gotten much easier for me. My sheen of nonchalance has gotten more convincing, and my tankmates even think I am a decent dissector (at least, they tell me so—perhaps it is more encouraging talk). But when I go into the lab after-hours to identify structures on different bodies, the smell still makes me ill. One body I opened tonight was particularly strong: a wave of plasticky chlorine, sick-sweet, hit me like a railway tie as I reflected the rib cage. My skin smells like it, too. And anything I lift to my nose smells like it for a few hours after I leave the lab. And because the water is soft here, I feel like I’m drinking that smell whenever I drink.

Cadaver paper

I thought I would share one of my assignments with you. We had to write a paper for Medical Humanities about our cadaver. This will repeat some of the content of the August 3 post, but perhaps you will enjoy it anyway.

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I was glad for the long orientation before the first Gross Anatomy lab, because I was afraid. I stood among my new friends around an object of some horror to me: a metal coffin—half gurney, half grave.

Outwardly I was very collected about this lab, because I am a Catholic Aristotelian. A Catholic knows that death is not our end, that the body is an inferior part which decays and will be regained miraculously. An Aristotelian knows there is substantial change, so a corpse is not a man and not of a man. No problems with dissection; no cause for fear.

Inwardly, I was a mess. I can’t say why. I have survived peers, professors, and relatives and never been so disturbed.

We opened the tank and raised the body. A skeletal figure showed through the towel, stiffened and slightly contorted. I saw the outline of a forehead, a nose, a chin. Arms, pelvis, legs. Then, I helped peel back the towel and I saw more. This body belonged to an old man: his skin was mottled on his arms and shoulders. His belly was sunken. I expect he lived some years in a nursing home. I spent a year or so of Sundays in a nursing home, visiting several residents. I was close to one woman in particular. She had the same skeletal frame and mottled skin.

He had a scar running along his midline, beginning four inches above his navel and curving around it. Someone suggested an abdominal aortic aneurysm, and my mental picture of this man’s life broadened, borrowing pieces from the story of my friend in the nursing home.

She came to the home following an ICU stay of two weeks for an emergency I can’t remember. “I died,” she would say when she told me the story. “I woke up and couldn’t remember any of it; I woke up and I was here.” She woke up with a colostomy. Later, they would remove all her teeth. She had not been outside in the intervening eighteen months. (Her family was not proactive about moving her home.)

But she was vibrant. She had been a WWII pilot’s wife and a Hollywood beauty. She had stories about Errol Flynn and D-Day (her husband flew over Normandy that day.) I sat enraptured whenever she talked. She like bright lipstick and nail polish. She loved art and history books. I loved her.

“People come here to die,” she observed one day. It was an uncharacteristic comment for her. I waited for her to say more, but she only repeated herself, then perked up again and asked me to read her WWII book aloud. A few weeks later, she died.

Maybe this man was like her: perhaps he changed his home and friends for a bed and CNAs. I’m sure he had a fantastic life story, and could tell of many sufferings.

In the lab, these thoughts did not erase my fear. I found some of my tankmates’ eagerness to dissect repulsive. Faced with any other body I would reverently pray. This seemed totally wrong.

But this man, like my friend who died, was generous. And I accept his gift—though not with ease—because of something my friend told me the last time I saw her. That Sunday, I told her I was accepted to medical school, and she began to cry. “Be a good doctor,” she charged. And I begin now.

First day of Gross Anatomy

The first day of Gross Anatomy. This morning I put the hundredth mile on my second tank of gas. I put on old clothes. I had already made a trip to my locker at the Gross Lab building, so my coat and goggles and gloves awaited me. I packed my computer (et cetera) for morning classes, and left.

We had a late arrival and a short lecture before lunch. I had packed lunch and dinner because I planned to stay into the evening in the library to study. My lunch was a ham and cheese sandwich, which I ate as I reviewed the lab material (and copied ebooks off of one of my classmates’ USB keys). I felt all sick and solid inside, but tried to act normal and eat. It was a good thing the ham was the sliced-super-thin kind: it didn’t look much like muscle. And I tried to eat sort of fast, so that I could be finished (and have things into my duodenum) before the dissection.

Everyone I spoke to was excited. Some were excited but a little apprehensive, like I am before TAC finals. Some were excited and impatient—“I just wanna cut” was one man’s phrase. I found that repulsive, even though that’s how I was before cat dissections in college. (For the record, I never said, anything like “I just wanna cut.”)

I was only afraid, but I kept saying “excited” when people asked me. I wonder whether others were afraid.

We went into the lab. I felt like we were going to gas chambers: all lined up in a hallway, going in grouplets of six or nine into the Lab’s anteroom. (The anteroom , I believe is a precaution to protect the identity of those who donate their bodies. You must go through the first door into the anteroom, then wait for the first door to close before opening the door to the Lab. As a result, the suspense of the First Entry was hiked up to ridiculously high levels.) We must scan an ID to open the door, even during Lab hours. (After hours, we must scan it just to get into the building.)

I had seen the lab once, during interviews. It did not seem real then—just another room we were touring. All the tanks were closed (as they were when we walked in), and I didn’t give a thought to what was inside. Now, my brain was full of those thoughts. In each tank—a metal coffin on wheels surmounted by a computer stand—was a body. And I knew that they would look like the cats I’d dissected: stiff, strange, skeletal. Like death.

My tankmates raised our cadaver. (you depress levers at the head and foot of each tank to raise the body off the floor of the coffin and up to an operating-table height.) The body was covered in a thin white towel—thin enough so that they body could clearly be seen, especially the bonier prominences: long feet, knobby knees, the iliac crests, the ribs, shoulders, and the face. I was standing at the left shoulder of the body, and saw where the towel did not quite cover the left arm. It was a white arm with many dark freckles and fair, course hair. I knew it to be the arm of an older person. And I knew that our cadaver was a male from the outline beneath the towel. (Because the first dissection is the anterior chest, I was hoping that I would not be assigned to a female’s body.)

We had orientation for a long while, then the lab began. I wanted to busy myself fetching a computer for us to use, but I couldn’t delay the inevitable. Because I was at the head of the tank, I helped pull the towel off of the body to the waist. (The head, hands, and feet) were still wrapped in gauze; for this, I was very grateful.)

The smell invaded me. I felt ill and weak. I felt that it would be wonderful to lose consciousness, wake up, and find out that I would never have to do this again: you’re not in medical school, you’re here in the novitiate—what funny dreams you have! Nothing went away. I did not want to touch the body, but because of some funny streak in me I think I was the second to palpate the jugular notch and sternal angle. But throughout the entire lab, I was distracted and silent. I could tell that my tankmates gathered that I was timid and shy by nature, because their suggestions and tones were trying to gently tease me out. (“Here, you try; right there. Hey, that’s great. There you go!”)

The lab was mercifully short, because there weren’t many structures to identify, and one my tankmates has done human anatomy with cadaver dissection before. I went to wash my hands and could not wash them enough. I must have washed for a full minute (at least.) and after I left the lab and hung my coat in my locker, I went to the ladies’ room and washed my hands again.

I put a scrub top over my T-shirt and went to Mass. I slumped in the back of the church because I felt unclean. My mind was full of bodies and death, and those two ideas feature rather prominently in the Mass. This did not help me. After Mass, I sat, crumpled in my pew, and cried.

Two girls were sitting about ten pews in front of me, talking and laughing quietly. How interesting our lives are! When we are in heaven the three of us will look at this day and say that though our days were so different and our emotions so various, we were both sharing those minutes with Christ, all alone with His Heart.

After that, the day wound down. I went to the medical sciences library. I had no appetite at all, but realized that my packed dinner had gotten too warm to rerefrigerate at home. So I ate it in the café (which is undergoing construction or something—there’s some lovely exposed drywall where they ripped out the counters and food prep area entirely).  The previous weekend, I’d made up dinners for the whole week and I’d brought one of these.

I am stupid. I knew that we would have our first Gross Anatomy lab. I knew that we would dissect the pectoral region. What did I pack? Chicken breast.

It was dry and bland and awful, and it made me sick and solid inside again. I didn’t even have a knife.

I dragged myself upstairs to study, and sunk into one of the big, poofy lounge chairs in the silent study area. What relief after standing for four hours in lab! I studied until ten and forgot all about it. I went home; Vespers was comforting; and I fell into bed.