Thursday, October 16, 2008

Thanks for the memory...

Thursday afternoons are always the highlight of my week. My weekly schedule normally goes something like this: For about three hours every morning, my entire class (or those of us who choose to attend) sits in a large lecture hall, listening to various professors expound upon the intricacies of their chosen fields. Biochemistry is the designated (and much disliked, in my mind) topic on Tuesdays, Thursdays, and Fridays, while Mondays and Wednesdays are filled with gross anatomy. Monday and Wednesday afternoons are spent in the anatomy lab dissecting out the various structures that were covered in the morning lecture session. As an aspiring surgeon who enjoys nothing more than wielding a blunt probe and pair of small, slightly curved scissors in the battle for anatomical knowledge, I enjoy anatomy a great deal. There is nothing more remarkable than the intricate layering of the various muscles and tendons in the hand and forearm, or profound zigzagging of the brachial plexus nerves, which appear muddled when seen for the first time but gradually yield their own logic when revisited dozens more.

Occasionally, the dissections prove more frustrating than didactic, and yesterday was no exception. My lab team and I were scheduled to observe the abdominal viscera in situ, expose the vasculature of the gut, and delineate the main vessels that branch off the abdominal aorta. We are assigned to cadavers in groups of eight, with four people dissecting at any one time. For this section--thorax, abdomen, and pelvis--we work in groups of four for two hour shifts, with the second group continuing the work started by the first. I was in the second group yesterday and expected to find a colon and a small intestine with vasculature exposed upon my arrival in the lab. Instead I spent two hours sorting through the remnants of Beatrice's (her nom de guerre) bowels, which had undergone quite extensive surgical alteration. The entire colon was missing, with the end of the ileum anastomosed to the cecum, which had been sewn to the rectum (sub-total colectomy?). The previous groups had spent an entire two hours clawing their way through the mess of adhesions that was the small intestine. What was left of the superior mesenteric artery and its branches in the small intestine had been exposed, but there was still a great deal of work to do. So we jumped right in and attempted to find the inferior mesenteric artery braching from the aorta. I say attempted, because we discovered that it had been cauterized and removed in its entirety, save the superior rectal branch. Following that morass was a two hour struggle to expose the portal triad (portal vein, common bile duct, common hepatic artery). We scratched our heads for a hour or so while we revealed branches incorrectly branching off of other braches, which looked nothing like any of the variations that Netter so masterfully depicted. After some oooohhhhs and aaaaahhhs along with the anatomy professor at what we'd found, we concluded that we had another unique variation on our hands, and left the lab exhausted.

I am constantly amazed by the extent to which the body serves as a record of all life's occurrences, from the catastrophic to the imperceptibly minute. I'm not talking about the obvious here--years of smoking, major surgery, traumatic injuries, etc--but about the tiniest of tiny things. My foray into the anatomical variation of the celiac trunk and superior mesenteric artery was the product of an event that began approximately seventy-four years ago, when a few cells migrated a few micrometers in a strange direction during the embryonic stage of development. I doubt Beatrice felt any adverse effects from this event during her lifetime, and yet I, humble student, was privileged enough to discover its record almost three-quarters of a century later. Sometimes being an anatomist, even an inexperienced and occasionally bumbling one, provides the opportunity to play archaeologist for the afternoon.

But I digress. Back to my weekly schedule. Most of my Thursday afternoons are spent in the hospital playing archaeologist of a different sort, sorting through the physical and emotional events of patients' lives as my fellow students and I nurture our nascent interview skills. My group of five fellow students and I have conducted only about ten interviews so far, but we've encountered some fascinating stories. Today was no exception. We interviewed an elderly woman struggling with Parkinson's, once a healthcare provider herself. Despite what appeared to be a slight pharmacologically-induced delay in her cognitive processes, she was sharp as a tack, remembering well and maintaining her dignity and bearings while six rather green medical students peppered her with questions. I was reminded of my grandfather--a truly great man--who suffered from debilitating Parkinson's for many years before passing away about six years ago. So thank you Mrs. X, for our encounter today. Though you didn't know it, talking with you elicited the most pleasant of memories and certainly brightened my day.

Damn, I'm lucky to be doing what I'm doing.

No comments: