Creepiest Powerpoint

I now present to you the creepiest powerpoint slide I have seen all year. There's been gorier! clinical correlation in anatomy? yea, I've seen someone without a nose! There's been grosser! dermatology seems like a fluffy speciality.... but oozing pustules? sign me down! But this, seemingly unimposing slide, wins the prize for the most terrifying yet!

There is something about the simple black, white, and red lines that really calls your attention to the abject horror of having to look at a dissected skull and a set of subtly disfigured quadruplets with various intensities of "disarming stare." I was pre-reading this last night, too late at night, and I had to stop. Sorry cranial nerves... my sanity is worth more than a perfect understanding of trochlear nerve palsy (though it does cause trouble walking down stairs and a head tilt towards the side of the lesion). FTW!

Seriously though, eyes are creepy as f*%#. Number one reason I would never go into ophthalmology: eyes are terrifying.

Although to be fair, there have been other, equally disturbing slides. yesterday we had one about leprosy. Monty Python jokes aside, I wasn't quite sure what I was looking at... the leprosy afflicted individual... appeared to have his hands in gloves... but they weren't quite gloves because they seemed to have the texture of skin. Oh? What's that? Leprosy causes auto-amputation? THOSE ARE HIS HANDS?! He just lost all his fingers?! HORROR UPON HORROR.

Oh medicine! You are terrifying!

Pretty Interesting

Today I learned something pretty interesting. We are one week away from being done with anatomy. But that's not the pretty interesting something I learned about. We are studying cranial nerves one more time. Today I learned many things about cranial nerves, but the most interesting thing I learned is that the olfactory nerve, or CN I, rests on your cribiform plate. Your cribiform plate is a really interesting bone, because it looks like a thin cheese grater and just lays within your ethmoid bone. All these things, by the way, are in your skull, which is actually a ridiculous thing to look at when it's not covered in skin and hair. I'm still shocked that we have styloid processes, which look like sharp little toothpicks sticking straight down from around your ears.

Regardless, the reason why your cribiform plate is all holey is because the sensory fibers of your olfactory nerve pass between those holes to gain access to the outside world right next to your superior nasal conchae. Only cranial nerves I (olfactory) and II (optic) are directly in contact with your brain (all the others communicate with your brain stem) but only your olfactory nerve is also in direct contact with the outside world. That's right, if you really, and I mean really pick your nose, you can touch your brain.

But that's not even the coolest thing I learned today. THE COOLEST THING I LEARNED TODAY WAS.... from my mom, who teaches an essentials of clinical reasoning course. The fact that your olfactory nerve is the closest your brain gets to the outside world means that it can occasionally screw you up (and by screw you up, I mean kill you). So over the summer, a few people from Louisiana died when amoebas began eating away at their brains. The cause? They had been using Neti pots--a wonderful invention that lets you irrigate your nasal canal--filled with regular tap water... regular in that it had amoebas in it. Usually, drinking such water would just give you an upset stomach. But because the water was getting into their noses, and I mean really up into their noses, they ended up getting the equivalent of an upset stomach in their brains.

BAM! My mind... figuratively BLOWN! Not slowly eaten away by protozoans.... No. BLOWN! And that's why anatomy is interesting by itself, but it isn't fascinating until you make it clinical.

Guilting Eyes

Anatomy practical is coming up. Since I failed the first one, I kind of need to do well on this one. B is a must. So I went into the lab today. It was a scheduled event, so it's not like I put too much effort into it. But as soon as I started reviewing with a group of my peers and an instructor, I realized how many details of anatomy I had let my group completely gloss over during our dissections. Panic has now descended.

I am not too worried about the abdomen, because everything is more or less straightforward. Hey! That vessel going to the spleen? It's either the splenic artery or the splenic vein. 50% chance of getting that right! Yay! The neck is another story. And I do not know how fond of studying it I will be since I made a horrible discovery today.

Our body, Debbie, is absolutely wonderful. Which is why I am so ashamed we have done such a "just okay" job with her. One of the nice things about Debbie, however, is that her eyes are completely shut.

The first cadaver I was at today--as the instructor pulled the two halves of his head every which way to look at his neck and then his oral cavity--seemed to enjoy giving me the eye. That's right. I could see its eyes. It was absolutely horrifying. I tried to look away, but how do you look away from something looking at you? Especially when it's so human?

But he wasn't even the worst one. There was another cadaver who had a really interesting amber eye color. I wanted to look more at it, but when I realized that I was essentially gazing into this person's last unadulterated possession, I kind of lost it.

I feel a lot of guilt in anatomy lab. If I do poorly, I'm not only letting myself down, I'm essentially telling the recently deceased that I don't really care about them at all. They are clearly still human. We've removed a lot of fat and skin and muscle. We've carelessly, idiotically removed many a vessel and nerve. Yesterday we removed their legs! But they are still clearly human. And as such, I should probably feel more than just helplessness every time I walk into lab. Anatomy is by far my hardest class. But not simply because it's difficult material for me to process. It is difficult because I consciously recognize its import. Technically, Biochemistry is my hardest class, if we look only at my exam averages. But anatomy makes me feel horrible in a way I can't just argue away with simple logic. Anatomy appeals to my darkest human emotions: the image of myself, a body--one among many--laying in the various deconstructed poses of post-mortem torture is much more excruciating than knowing that I may never memorize the complete citric acid cycle*.

So I've thrown myself into studying for this lab practical. I will report on how I did the morning after Valentine's Day. That's right, we have a lab practical on Valentine's Day. Because I guess the guy who organizes exam dates figured it wasn't enough for us to just be stressed out medical students. He also wanted to make sure we wouldn't be able to enjoy the holiday. Try eating a copious amount of chocolates, or ice cream, or smelling roses, when you're bathed in the clinging stench of formaldehyde.

*Fun fact: I have memorized the citric acid cycle. It is interesting.  One of those last two sentences is a lie. Apologies.

Today in Anatomy...

We removed our cadaver's leg. It was pretty gruesome. Possibly more gruesome than sawing her skull in half with a hand saw. Life is sometimes weird like that. The weirdest things will gross you out. Like, the third week in anatomy lab, we were covered in flesh and embalming fluid--formaldehyde. One of my lab partners burped and I yelled "Ew, gross," because I find burping in someone else's face distasteful. In reflection, that was probably one of the "cleaner" things I did that day.

Other than that, I now love anatomy. I do not know if that is because I am doing poorly in it and need to straighten out my act to pass the course, or if because we are finally covering the abdomen, and all your organs and mesentery form the most intricate, beautiful patterns I have ever seen. I spent a good hour losing myself gently separating connective tissue from the small intestine and associated organs. It was mesmerizing. It seemed like everything was an artery, a vein, or a nerve, forming crazy plexi and complex associations.

Much more interesting than your limbs. I swear, your forearm has seventeen muscles in it, and I think the majority of them are useless. Another point, you can survive without an arm. Hell, you can survive sans-limbs. It's not fun, but you can live. You can't live without your liver. Or your heart. But your life would also suck without your kidneys, pancreas, spleen, or your intestines.

Yes. I am really excited that we are finally learning something important in anatomy.

Sadly, my podiatry student lab partner does not feel the same way. If he's not working on the legs, he gets a tad restless. Restless leg syndrome, I'd call it.

Was that a good pun? I'll keep working on them. I don't think I can be a good doctor if I'm not good at puns.

Ambiguus

In the wise words of our anatomy professor, Dr. Manion:

"If you really don't know exactly what something does, you probably shouldn't take it out."

...and that's why you have tonsils.

Discomforting

For the last two weeks in anatomy lab we have been sawing through a human head. It's discomforting. At first we were just sawing through the occipital and temporal bones. But then we started skinning the face. At first I found it amusing that our body, Debbie, was still very attractive with only dermis covering her face. But then we cut through her, straight down--through the chin, lips, nose, forehead. Between the eyes. Still pretty. But then we took a hand saw to her face. When we opened her mouth we looked around her palate. She was missing teeth. A lot. She only had 22. Most people have 32-36 (wisdom teeth are obnoxiously removed). I noted a cavity that hadn't been filled. No fake teeth had been added to her alveolar plate.

Someone suggested that perhaps Debbie was homeless. That did not sit right with me.

So I forgot about it.

It's really interesting, getting to know someone on a rather intimate level. Debbie, this entire year, has seemed very real to me. I have enjoyed getting to know her. But it has made me think. I'm thinking about the patients I might one day have. I'm thinking about all the information they'll give me that I'll have to file away under "TMI" and all the information I will be legally obligated to write down. And then there will be things I will want to forget but can't. I am sure even in this I will be happy I chose the profession. People are fascinating. I could observe people all day. I am excited for that part of medicine. What I am worried about is that I may one day be able to handle discomforting information much more readily than I do now. And if I no longer feel  can I still be capable of empathizing? Because whenever something bad happens to someone, the natural response is to imagine how you would feel if you were them--mirror neurons fire away and all that jazz. That's why when you see someone break their ankle, you're suddenly much more aware of the weight pressing down on your feet.

Which is why I should be wincing in pain as my lab partners hack at Debbie's skull. But I no longer feel like something is horribly wrong when I probe through her nerves and vessels, peel away connective tissue, rub my fingers on exposed bone. I feel like a serial killer.

Now that's discomforting.