Transformation

In re-reading over some previous entries, I notice that my ponderous-thoughts tend to use sexy words like "enshroud" and "mystery" to describe the new classes and adventures I am introduced to in this process of becoming...

Let me take a moment to underscore that gross anatomy is gross.

Last Friday, we dissected the "perineum". What's that, you say? Perineum is akin to "private parts", "unmentionables", or my personal favorite "baby makers"; all euphamisms for the penis, the scorutum, the clitoris, the vagina, and the anus.

This lab was doomed both to fail and to leave permanent scars on the psyches of all my first year classmates. First, the lab didn't get posted until the last minute, meaning that no one was able to prepare by reading grey's anatomy and at least being empowered with facts. Second, our time was cut in half, meaning that we had to rush through a three hour lab in 90 minutes.

Next, these "private areas" are very difficult to gain access to; to even "open" up the area requires raising the cadaver onto plastic blocks, and putting the legs into the "spread eagle" position. But wait, there's more. Because of the overall stiffness of each cadaveor from the embalming process, the legs have to be tied down with rope and secured to the ends of table in order to keep the cadaveor in a somewhat function-fitting position.

Got that image in your mind? Then, we were ready to begin...

Up until this lab, gross anatomy had been somewhat of a detached experience. Work in any given area allowed you to drape the rest of the body with cloth, much like surgeons do, in order to disconnect yourself from the whole person. We instead focus on the smaller structual anatomy, and feel incresingly confident in our chosen career path as we master nerve plexi and muscle function.

But Friday, much like our special lady, our emotions and insecurities lay exposed for everyone to see. No longer capable or in control, visceral emotions took over. Julia found herself struggling to contain her laugher while Sam struggled to contain his breakfast. We muddled through the lab, and mutually decided to skip over instructions such as "palpate the clitoris" or "insert two fingers into the vagina to simulate a bimanual exam". As Spencer remarked, "Thanks, but no thanks... I don't want to add 'fingering a dead lady' to my list of medical school firsts."

Later, out of the anatomy lab, I felt sick to my stomach. Long after the smell of formaldehyde had left my skin, the feeling remained that I had done something brutish, invasive, and disrespectful. I went back over each moment of the lab in detail; what I had said, what I had felt - what in the world had gone on in there? It was perhaps the first time since getting going that I paused to reflect on what a crazy thing it was that I was doing in this class - I had chosen to become a doctor to heal, hand't I? What was happening to me instead?

Unable to concentrate, I went back up to the lab. Alone in the morgue-like room I stood with our lady and tried to remember what she had looked like when I first saw her. Most of her skin is now detached, and her muscles, stolen of their protective covering, have begun to dessicate. In the quiet, I let my thoughts wander to people that she had loved, places she had lived. What had she seen in her life? What had she enjoyed? Her fingernails are covered with delicate pink nail polish - I hoped that it was a signal of the love which had been given to her by a caretaker.

What promted me to do what I did next, I am not sure. Maybe it is that deeper inner feeling - that still small voice - the one that has pushed me to stay on this life path. Maybe it was to attempt a reconcilliation from the "invasion" that was Friday. Or maybe it was only a moment in which I realized that this woman is not so different from the other grandmother like women I have loved.

Over the next hour, I wrapped each section of her muscles in damp cloth and then sutured her skin where it had been cut open. At the end, aside from the occasional patches of clumsily woven stiches, I could recognize her as I did that first day.


I turned out the lights to leave, and felt releaved. Despite this transformative indroduction to the profession, I can still recognize myself.

post-life

Our fourth anatomy lab today. Anterior thigh and and crus. 90 minutes in and I was super woozy - I had to leave for a few minutes. Working at the upper thigh, streams of formalin and what is disgustingly named "body juice" poured out from my person. Layers of globulous adipose tissue clung to the fascia and muscles I clumsily and frustratedly tried to separate. Muscles zig-zagged over and under each other; arteries nerves and veins obstructed each place I attempted to make incisions - is it possible to be angry at a cadaver?

I am in a love-hate relationship with anatomy lab. In most aspects, it is such a holy place. We are allowed vision into a world most will never see (or want to see). I am transfixed by the interplay of form and function; the meticulous organization of each muscle, nerve, artery, vein in the human person. It is at once extremely detailed and complicated with the sheer amount of structures, while simultaneously elegant and simple as almost any function can be guessed by examining joints and attachments.

In the beginning of our course, we were given a letter in our course pack from the person who donated their body for our learning. In it, the woman described her full knowledge of the gift she was giving to us, and her great hope that her gift would benefit us, so that we could benefit others. At the close of her letter, she told us that each day since she made the decision to donate her body, she had prayed for us.

Reading that last line, I started to cry.

Much like I started to cry just several moments before. Tied into working with my very-committed and generous cadaver, I am reminded in a grossly-awesome way of the knowledge that all life is a gift; one that we are loaned temporarily. No function that we have is ours to keep; and for each person, a real and precise time will come when the loans must be returned. I am a doctor to heal people, but I am thinking more and more about how I will mostly be a doctor to accompany people as they face the loss of function, themselves, and their lives.

I do not want to make my career path out as being the grim reaper; in fact, I am certain that most of what I do in the day to day will be simple nuts-and bolts medicine and healing. But life, even a life well lived and long lived, is a painful thing to part with (at least, that is the only way I can view it now).

These entries are incomplete thoughts, but I have to return to my Netter's.

Commitment

It is a brisk autumnal Sunday night. This past Friday was the final exam for my first medical school class - Biochemistry. It ended, and ushered in the first free weekend I have had since medical school began. I am recharged on time to sleep in, laughter with friends, freshly picked apples and sundappeled pumpkins...

Yet, palpably, there is a pit in my stomach. Tomorrow starts my first day of anatomy.

In part, my nervousness comes from the rumors enshrouding the gross anatomy course. legends run wild concerning the antics and outrageous events that happen in the class, and i find myself wondering what the practical reality will end up resembling...

But, much more so than the fantastic, I think that pit comes from knowing that I am entering into another seven-week period sans stopping. Do not get me wrong; I love medical school, I love what I am learning, I love the environment I am able to learn within. Yet, there is a strict regimen that must be kept to maintain adequate standing as a student, and huge parts of myself resist being tamed to one specific focus for such long periods of time.

Palpable also is the temptation to go even further beyond these next 7 weeks, into the next 7-10 years, wherein (again) days of break from the schedule will be few in number and far between in spacing.

And here, I remember to stop pushing so far ahead, and to call myself back to this moment. Medicine cannot be learned in one night; but instead, little steps must be taken, spread over a lifetime of learning, observing, processing.

Maybe, for the first time, I am learning what the gritty parts of real commitment look like: moving forward, focusing, and doing what you promised you'd do, even when your physical body and mental concentration are no longer engaged.

I am not at such extremes yet, but in these early days I am trying to find resolution to build upon... more on all of this later

Steady Rhythm

An autumnal Tuesday afternoon. I see it only from a chair in one of the many HMS skill areas where I have taken residence. On one side of me sits a bag of granola that I occasionally munch on; the other side holds a tray of human brains extracted from cadavers, and in use by the second year neurology class.

The learning curve in these first few weeks has been tremendous. Daily I absorb more information than I previously absored in semester in college. While I am still so near to the beginning of my education, a part of me is concerned for my future patients: will I remember the biochemical causes of Type II diabetes years from now, when this day is just a distant memory? I make the conscious effort to will my mind to remember these details and nuances, knowing that someday it could make the difference, but I am doubtful that this has any affect on the actual knowledge I will take away.

This is not to say that I don't enjoy the pace and bustle of life here; quite the opposite. Everyday I am challenged to wrap my mind around biochemical mechanisms of disease - to grapple with complicated health policy and the social factors which exacerbate illness - to search for new and meaningful ways to lead and collaborate. While there is still the inborn insecurity that I could never stand amidst the giants (in mindpower, leadership, and clinical practice) who surround me, there is also my great hope in the process of education here: I am not sure it is possible to walk away from here in four years not charged to contribute in meaningful ways.

Fulfilling a promise

In return for Geoff writing a blog chronicling his year in Peru working for Partner's in Health, I agreed to keep my own, to record my impressions of my entrance into the medical world.

I'll be back with more soon,
Kat