Tuesday, March 27, 2007

Bringing Culture Club to the Anatomy Lab

It's difficult for me to describe what it's like to dissect a cadaver. I learned in college that when a project appears difficult, one should do that project poorly or not do it at all. Accordingly, I haven't written anything about gross anatomy. But now, after hearing the outcry of one voice (hi Mom!) wondering forlornly why I haven't posted in WEEKS, I've decided instead to complete my project poorly. Prepare to be either underwhelmed or offended. Maybe even both.

I've been hesitant to write about the dissection of my cadaver, because my description might appear as though I'm unappreciative of those people who've generously donated their bodies to medical schools. That is certainly not the case. Inside the lab, it's almost imperative that the body itself be depersonalized. That's one of the reasons why I consider a whole-body donation such an tremendous act of generosity. Organ donation seems inherently less personal. Most people draw a clear distinction between their liver and their self. Organ donors often rationalize their gift by saying something like, "why not? I'm not using it anymore." It's much harder to draw the same distinction between your body and your self. If your family sees your body on a table, they'll say, "hey, that's Joe! He was a nice guy. I miss Joe." If they see your kidneys there, not even your family would say, "hey those're Joe's kidneys! Those little suckers could really concentrate Joe's urine when he needed it. I really miss Joe's Kidneys." But when a medical student sees either a body or some kidneys, they're not thinking about either in an emotional context. Body donors know this. They know that the student of anatomy, a perfect stranger, isn't remembering the self that once animated their body. Whether or not this makes a prospective donor uncomfortable, they view the education of future healthcare professionals as a more important goal than the clean and pretty burial of their intact husk.

For me and most of my colleagues, dissecting a cadaver has felt peculiarly unstrange. Navigating my way passed 26 tables of corpses on the first day of anatomy, evoked more emotional discomfort than actually working on the bodies. Before the covers were lifted from the cadavers, we were all very aware that underneath lay recently deceased people. We wondered about those people's names, their ages, their lives, and their causes of death - the kinds of things that most people outside of medical school ask me about my cadaver. But once the covers were removed and we started working, those questions rarely came up. Only once has a classmate described to me any emotional connection to the dissection. That student was working on the upper extremities of a cadaver whose fingernails still shone with bright red nail polish.

For the most part, however, cutting those bodies open and identifying, isolating, and cleaning off relevant structures is nearer to boring than emotionally taxing. Sometimes it feels like I'm carving a turkey, but more often it feels like I'm rooting around in an overfull toolbox looking for an instrument that does a job I'm only vaguely familiar with. It's as if someone were rebuilding a car engine and said, "hey, go into my toolbox and grab me a gasket scraper. Oh, and this morning I poured 10 liters of oatmeal in there. My bad."

Cutting people open is a privilege afforded to a very few people. If an MD does it, it's applauded. If an MFA does it, it's assault. Similar rules apply regardless of whether the person being cut open is dead or alive. MFAs aren't allowed to tinker with a corpse without being arrested. Clearly this has nothing to do with the safety of a patient. An MFA couldn't do any harm to my cadaver. IT likely stems from a collective belief that the human body is, at least sort of, sacred. We want to ensure that corpses aren't picked apart unnecessarily. Healthcare students and professionals can learn on bodies, because that's a good enough reason to desecrate a corpse. Funeral directors can cut open a corpse to make it look nicer for the funeral. But nobody thinks it's ok to be opened up by a some guy just because he always wanted to know what someone's insides look like.

So, is it wrong to think of another human as a toolbox filled with oatmeal? Maybe. Should I have restrained myself from speaking to my classmates through the two halves of a sliced-open kidney for an entire 2 hours lab session? Almost certainly. Was singing through the kidney an irrefutably bad idea ("Do you really want to huurt meeee... do you really want to make me cry...)? Of course. But if I were constantly aware of the person on the table, I don't know how effectively I'd be able to teach myself the relevant anatomy. If I were overly concerned with how my cadaver's liver tumors may have affected her relationship with her family, I would be distracted from identifying the vessels supplying that liver. In a sense, I'd be thwarting the intentions of the woman who chose to donate her body to educate medical students.

Monday, March 12, 2007

Five reasons why I almost passed out while watching my first surgery, and a rebuttal by interested parties

#1 It was way too hot in that operating room. Anybody would have felt faint in that heat. Sure the patient was shivering, but she was in surgery. She was losing blood. The rest of us, those of us with all of our blood, we were way too hot.

You only lasted about fifteen seconds into the surgery. By the time you were squatting in the corner, all they’d done is nicked her skin. You lose more blood every time you shave.

#2 And I’m always cold after I shave. Plus, I was wearing one of those gowns. And two pairs of gloves. And these absurd space boots up to my knees. And a face mask with a plastic shield that covered my eyes. It was sweltering under there. As soon as the surgeon made the first cut, that whole shield fogged right up and I couldn’t see. That’s hardly my fault. Those things are a liability.

Those things? The sterile surgical masks? Those are a liability? Were the other folks in the room wearing the same masks?

#3 Of course they were, don’t be ridiculous. That doesn’t mean it’s a good idea that they were wearing them. I mean, what if all of those masked folks overheated and passed out? What then? You have an anesthetized patient lying on a table with unconscious surgeons and nurses splayed out on the floor all around her.

Did everyone else wearing a mask pass out, too?

No, but can you imagine if they did? It’s like that episode of Gray’s Anatomy, when that patient was taking some sort of herbal supplement, and it combined with the drugs in her body and made her blood toxic and it almost killed all of the surgeons at Seattle Grace. It’s like that.

…you should never be allowed in an operating room ever again.

#4 I know, I know. Nobody actually passed out. And most of the surgeons and nurses in the room made it through the whole procedure. BUT! the scrub tech felt nauseous, and she ran out of the room to throw up.

What? Really? Was she overheated? Did her face shield fog up?

#4 No, she wasn’t wearing a face shield. But she said she’d had fried fish for lunch, and SO DID I. I'm not denying that fish and chips is a terrific meal, but probably too heavy for this particular occasion. I ate it way too quickly and didn’t drink anything with it. So I was dehydrated with a stomach full of fish batter.

So you’re saying that the reason you felt squeamish is because of the fish you ate for lunch?

#5 Yeah, mostly. And because cutting people open is disgusting.