This memorial service is unique in that it is so much more.

"You'll never see this again in your career," the anatomy prof warned us.

This week's anatomy lab, our last, was a particularly unsettling one for me.

Even though we have done a number of dissections of every part of the body, most of them have retained the semblance of normal anatomy - while we've dissected the entire abdomen and thorax and arms and legs, we haven't removed limbs or anything.

So when the anatomy professors showed us an incredible way to visualize the neck components from the back of the mouth to visualize the epiglottis, trachea, larynx, and then demonstrated the technique, I had a bit of trouble watching.

That's because the dissection technique, shown to us by the anatomy instructor on the demonstration cadaver, involved dissecting through the back of the neck... to the point where the heads of our cadavers were rolled forward and almost entirely removed from the bodies.

It was true - the technique provide a fantastic way to understand the anatomy, and I learned a lot from it.

But seeing a person's body with the head nearly removed, even though I have seen them dissected in every other region, was just a bit much. I was reminded again about how these "specimens" are actually human beings who at one point cared about us and our future patients enough to donate their bodies to our anatomy program.

I don't get the chance to thank the people our cadavers once were, and sometimes I wish I could. But because I can't, I decided to post a speech I gave at the memorial service our school held for the families of the body donors...a tribute of gratefulness, in memoriam.

===

Welcome, medical faculty, the students of medicine, dentistry and rehabilitation sciences; and most of all, we would like to extend the warmest welcome and deepest gratitude to the families of those in whose memories we gather. Thank you for coming.

My name is Vitum Medicinus, and I'm a representative of the second-year medical class. I've been asked to welcome you here and to convey the feelings, experiences and, most of all, the appreciation of the students who have the incredible privilege of learning anatomy in the best way possible thanks to the incredible gift your loved ones have given us, through the anatomy program at our medical school.

This ceremony is a unique one. Many memorial services focus on celebrating the life of the individual being remembered. In that sense, this service is no different.

But this one is unique in that it is much more than that - it is a service of admiration and gratitude, in memoriam of those who have given so much of themselves, and in doing so, have taught us so much about the intricacies of science, using so few words.

Every student in these faculties would tell you that no textbook could ever equip us to understand and aid our patients in the way the donors have. The anatomy program is an educational privilege that none of us could ever take for granted.

And yet, beyond the lessons of science, through their actions the donors have taught us many more lessons.

For example, they have taught us about bravery. Thinking ahead to one's own final moments is not always a comfortable thing to do.

And they have taught us about selflessness and altruism. They have given as much of themselves as they could, to ensure that we, as tomorrow’s health care practitioners, will have the best possible preparation for tending to those who need our help.

Through their generosity, the donors have indeed set a high standard for us, in demonstrating the qualities that we future dentists, doctors, and therapists, should all hold dear when we treat of our future patients.

And so we thank them, and wish we could share with them, tell them how much we appreciate their decision.

While they have taught us so much with so few words, it would take all the words in the world for us to begin to show them our thankfulness, which is what we will try to begin to do today.

The students you see here have put together this service in its entirety in an effort to show our respect and appreciation, and in memoriam of the contributions of these generous individuals.

All parts of this service - the candlelight procession, readings and musical performances, are dedicated to the memory of those whom we have come to pay our respects and gratitude to today.

(Read more about last year's service...)

Read the rest of this entry »

It had to happen eventually: "That sounds like something I read on a blog once."

When I'm hanging out with med friends, as much as we may try to avoid it, every conversation turns to school somehow... some gross thing we saw, some cool clinic case, or general hatred or love for certain professors. (The professor who approached me and told me he reads my blog fits into the latter category, of course).

The other day I was at a classmate's house having some incredible steak, and for some unknown reason, the conversation turned to our cadavers.

We were talking about the nature of our cadavers and how some of the ones with high BMIs are really hard to dissect... some of them you're cutting through the skin and you cut and there's fat, so you go deeper and there's more fat, and you go really deep and you're in the muscle, and so you go back and realize that there isn't any distinction really between the fat and the muscle like there is on the really nice cadavers; instead, on the more fatty ones it's more of a gradient and the fat and muscle is all mixed together, making learning the muscles of the thigh and buttock a much different experience than if you had a different cadaver.

Anyway, a girl who's also in my class piped up that on some of the cadavers, at room temperature the fat is mostly liquid, and this requires suction to get rid of the extra liquid.

"Mine's a lot like that," I said. "It seems like every lab I'm suctioning the fluid... the dead human body fluid... mine had so much I ended up with it dripping all over my leg once."

At this point, my buddy's brother, piped up. He's not in medical school but is interested in going; otherwise he probably wouldn't be able to stand hanging out with med students and listening to their med chatter. He was apparently interested - not grossed out - by my story. "How did that happen?" he asked me.

I explained the story that I've written here before under the heading of Great Moments in Anatomy Lab, where I had proceeded upon a course of actions that resulted in DHBF (Dead Human Body Fluid) dripping down my leg.


This is where things started getting weird. Not dead body weird, but, well, read on.

After I told him the story of how I ended up with DHBF dripping down my scrubs pants, he looked at me and said, "That's funny, there's this medical blog I read, some medical student somewhere in the Carribean - the exact same thing happened to him."

I knew right away where this conversation was going to end up.

"Vitum writes a blog," said his brother. "Maybe you read it there."

"No," he replied, "this one I read was from a student in the Carribean, I think. The exact same thing happened to him - he ended up with DHBF all over his leg."

Either somebody is plagiarizing my blog, I thought, or he's referring to my story. "Yeah, I think that's my blog," I said.

"No, no," he insisted, "I really think this was some medical student in the Carribean that wrote the story."

I loaded up my blog on my mobile phone's web browser and said, "Read this."

Before he read it, he said, "Okay, okay, the story I read on this blog ended up saying the guy was upset that he had cadaver juice running down his leg, but the worst part was that this was the second time it had happened."

Which is exactly the premise of my story.

I handed him my mobile phone and stood back, watching it sink in.

He finished reading and looked up. "Weird... so that's you... well, I've read a fair bit of your blog. I had no idea."

I thought it was funny but he seemed a bit weirded out. Ten minutes later he was still talking about how weird it was that he'd been reading my blog all along, and he knew me, yet didn't know I was the author.

I did warn him I'd be writing about this. Still, I hope that reading about himself here won't be too weird.

Read the rest of this entry »

Great Moments in Anatomy Lab

Today in anatomy lab I was using the suction to clean the fluid out of the body bag. This fluid, scientifically known as DHBF (or Dead Human Body Fluid) is comprised of melted fat, extra embalming fluid, and random juices from the cadaver.

Unfortunately, I had an accident.

While I lifted up the body bag to try to get the DHBF to pool for easier suctioning, I accidentally inverted the corner, releasing a hidden pocket of DHBF which streamed directly for my leg.

As I stood there, feeling somebody else's fat running down my leg, I thought to myself,

"The worst part about this isn't the fact that I have DHBF running down my leg.

"It's that this is the second time I've done this to myself."

Read the rest of this entry »

Top 10 list: Things that make me feel like I'm becoming a doctor (as of First Year)

EDIT (11/21): I had to add a number 11. Find it here.

I kindof had to make this list to convince myself that I'm actually in med school. Like I've mentioned before, our first semester is a lot of just basic biology, things I learned in undergrad (biochem, physiology, etc.), so I can't help but feel that I'm still just taking more biology classes. Until I get to third year, where I report to the hospital every day (and on weekends...and I am given evening shifts...And I'm put on call...) it still seems kindof like school, still. Hopefully this changes a bit in January when we start going through the body organ systems, block by block. Until then, I have this list to go by:

10. Got my second issue of the CMAJ today
It always makes me feel like a member of the profession.

9. Calculating IV infusion rates
Finally, there is an applicable use for algebra and natural log calculations. Boy, was I rusty on those for a while, though!

8. Getting my ID tags
I wear these a bit too often, my excuse being because they're on the same retractable carrier as my bus pass. The third-years make fun of me.

7. Being allowed to shadow doctors in the area
It's hard to arrange this when you're a pre-med!! I've already shadowed an ER doc back home, an ER doc here, and going to shadow a surgeon next Monday.

6. Learning how to interview actor patients in my interviewing class

5. Interviewing real patients in the family practice clinic

4. Getting sworn at by a patient in the family practice clinic for asking questions I was told to ask in my interviewing class
I'll definitely tell this story soon!! EDIT (11/20): This post is now available here. (Title will be: "Don't ask shit questions" - To FIFE or not to FIFE. Another time, though; I'm keeping busy and don't have the time right now).

3. Cadaver lab
Partly because I get to wear scrubs, and partly because this was something I envisioned doing when I got to medical school, since not many people get this privilege.

2. Giving injections
This isn't #1 because some of my friends who were in nursing when I took my undergrad were giving injections way before me, so I was jealous of them and when I got to do it I only felt like I was caught up to them.

1. Getting my stethoscope
The excitement of this has started to wear off, but the day I got it I felt like I was pretty much ready to graduate and be called "Doctor". Don't laugh. Small things amuse small minds. And when you pay that much for something, you may as well appreciate it.

Read the rest of this entry »

Top 10 list: Things you don't want to hear in the cadaver lab

Our group got a little carried away with our lab the other day, in a good way. Tasked to find the part where the thoracic duct drains into the bloodstream, as well as perhaps the vagus nerve and its branch the recurrent laryngeal nerve, instead of being one of the first groups done - our usual reputation - we chose to be thorough.
It was worth it, too. We learned so much. We impressed even the lab instructors. And we were really into it. So into it, in fact, that at the end of it, my lab partner told me he might have been a little too close to resting his chin on an exposed surface of the cadaver while peering in at the details of the mediastinum. So close, in fact, that the #2 on the list below was actually said to me. (I wish I could give him the coveted #1 spot...but you'll probably agree that the premier location has been rightfully assigned.)

And so, amidst this outstanding level of learning which will undoubtedly make us better clinicians due to our increased level of knowledge thanks to our body donor, was born the idea for the latest Top 10 list, Things You Don't Want to Hear in the Cadaver Lab. I encourage you to not read on should you be sensitive or assume that humour in the cadaver lab is unconditionally synonymous of a lack of respect. That being said, the list lies below, complete with colour commentary.

10. "Um, you got me in the eye with that splatter."
Actually heard.

9. "Um, you got me in the mouth with that splatter."
Actually heard. Not by me, fortunately. But it's a horror story that still looms from last year's class. Maybe I'll tell it in its entirety sometime.

8. "It happens."
The anatomy prof's actual response to a student uttering number 10 to him, said while he kept chiseling at the vertebrae without so much as looking up.

7. "Hey! That looks like pulled pork!"
Actually heard. I haven't eaten pulled pork...or spare ribs...since.

6. "OUCH"
Bad enough if it's a student saying this. The person who suggested this as an addition to this list, though, was thinking, 'what if the cadaver...' - - - nevermind. That being said, one person in my group did get the cadaver's hand caught in their lab coat last time...it was somewhat eerie how the cadaver apparently 'grabbed' her, with enough force to undo a button on her lab coat...

5. "Let me just tug a bit on this spermatic cord."
Actually heard. Fortunately, the prof was not referring to a body part other than the spermatic cord.

4. "This might make you a bit squeamish..."
Actually heard. The prof was right. Whenever the scalpel meanders over to the inguinal area, brace yourself.

3. While putting a foot into the body cavity: "I'm going to jump right in, swim down the aorta, and take a look. No, it's okay - I saw this on the Magic Schoolbus once."
This one didn't happen. Fortunately.

2. "Do I have a piece of pleura in my teeth?"
Actually heard.

1. "Grandma?!"
...upon removal of the bags on the cadaver's heads. I wouldn't wish this upon anyone.

Read the rest of this entry »

Some advice for future cadaver dissectors: Smell

Or, What I Have Learned Thus Far through Observation, Experience, or Trial and Error

Sorry for all the cadaver-related posts; that's all I've done so far that's really 'doctor-ish.'

Anyways, as far as cadaver lab advice goes, here's what I have to offer so far (I can forsee myself adding to this list in the future),

Today's entry is on Smell. On the way out of lab, I was chatting with a fellow classmate, who commented to me that the excitement of anatomy lab is starting to wear off, due in large part to the odours thereof.

As I learned while witnessing an autopsy a few years back, and through my now more frequent cadaver experiences throughout my medical education, I can assure you that the odours of a cadaver lab, and the changerooms preceeding entrance to said lab, are like none other. Though our school uses the chemical Infutrace to neutralize the formaldehyde odour (breaking the formaldehyde down into an alcohol), as can be expected, the inside of what was a long time ago a living, breathing person does not exude the most pleasant odour in the world.

To make it worse, some of the bodies are less well-preserved than the others, and in addition to organs being dark and crumbly, as can be expected, there is an increased intensity of questionable aromas which grace the nasal passages.

There are some strategies available to combat this unpleasant aspect of anatomical education.

• Lip Treatment. Spread a swath of Vapo-Rub or similar menthol lotion on your upper lip before entering lab. By the time this odour has faded, you will have mostly adjusted to the smell.
  
• Hand Protection. While the gloves are the obvious universal means of maintaining a healthy barrier between one's hands and the items those hands are caressing, they can - IF used properly - play a crucial role in odour protection. In my zest to appear macho or non-squeamish during my past anatomy lab experiences, I used to only wear one pair of latex gloves; however, I was unwitingly exposing my hands to a great amount of odours, many of which were retained for hours after leaving lab and even making numerous visits to the sink.
  
  I have since learned that this amount can be significantly reduced, shouldst one use the Vitum Medicinus patented double-glove technique. Instead of simply using two layers of Latex gloves, avail yourself of the nitrile gloves, but make use of these underneath a pair of latex gloves. This specific arrangement serves a number of purposes.
  
  First, I have found the nitrile gloves to be effective in odour-penetration preventance when used in conjunction with latex.
  
  Second, limited direct exposure to latex is a good thing; more and more people are developing hypersensitivities each and every day, and God knows we'll be exposed to plenty of latex throughout the course of our medical careers.
  
  And third, while the nitrile gloves should be closest to the skin, an overlying layer of latex glove will allow the gloves to fit tighter to the hand, improving grip, accuracy, and dexterity.

Although the preceding exhaustive and unquestionably useful description will undoubtedly lead you to believe that I an expert on odour control in the cadaver lab, I will make this honest confession; I have actually a lot more yet to experience as far as the anatomy lab is concerned. We haven't yet dissected deep into the abdominal cavity. That being mentioned, I'll confide in you that I am not looking forward to dozens of individuals using their scalpels to penetrate the membraneous containers that the good Lord intended never to be opened - let alone months after the spirt has left the body - due to the odorous nature of their contents.

Indeed, the worst is yet to come.

Read the rest of this entry »

In Loving Memory of our Cadavers

"My mother never liked to waste anything."

So, he told me, that's why his mother wanted medical students to be able to learn from her body.

"She never threw anything out, really. And even when she was dying, she didn't want to be buried or cremated. She thought that was a waste. And she never liked to waste anything."

I don't usually leave a memorial service really impacted by the things that were said.

Then again, I don't usually go to memorial services for people whose bodies I have seen fully exposed internally and externally, for people whose organs I have held in my hands, people who have taught me so much more than some teachers ever could. What a fascinating and unusual experience.

Among a couple choir songs, a piano performance and a candlelight procession, there were a few reflections and readings of poems. One of the student speakers talked about the courage that the body donors showed by giving their "most personal possession" to us. We med students often discuss whether or not we think we could donate our bodies, knowing what is done to them - even though they are treated with the utmost respect (as I mentioned earlier), and what we do is done all the time in routine autopsies, it is still so generous of them to grant amateurs the opportunity to learn so much from them.

Another speaker said the following:

When I study their eyes, I wonder about the things they saw.
When I their arms, I wonder about the people whose lives they touched.
When I study their hearts, I wonder about the people they loved.

I can relate. I thought I'd get desensitized, and I have in a sense, it's not like the first day where I didn't know what to expect. But still, each week in anatomy lab I spend a good part of the time there overwhelmed by the fact that this isn't a "specimen" but a person.

I wish more of the students in our class showed up. Of a few hundred first- and second-year students, only about 30 showed up, and half of them were directly involved. Being there, and actually talking to the families was a great experience. It makes the donors more human. The only identifying characteristic to date is that my cadaver is the one on table 32.

Even before today I know I will never forget what I've already learned from my cadaver, which is already in a quanitity much greater than any anatomy book has ever taught me. By going to this service, I developed a whole new level of respect and gratitude for the body donors. Even though I knew they were people who lived lives and had loved ones cry at their deaths, I had never seen the people who they lived their lives with, nor watched their loved ones cry. Until today.

Read the rest of this entry »

Did we mess up? Our cadaver's heart is on the RIGHT...

"Now that we've gotten past the superficial muscles, you're going to start seeing differences from one cadaver to the next," said our anatomy prof.

Boy was he right!!

Some of the crazy / cool stuff we've seen already:

• Situs inversus with dextrocardia

This is a rare condition in which the person's heart was on the RIGHT hand side of their body, and all of their internal organs were reversed! (Liver on the left, spleen on the right, etc.) You gotta see it to believe it. Our anatomy profs hadn't seen this one in person before and they were so excited they were freaking out.

• Pulmonary Atrophy

One of the cadavers had a left lung that was very tiny, and the right lung was MASSIVE

• Pacemakers

Right after cutting back the skin of the chest, a few of the cadavers had stainless steel pacemaker implants

• Sutured sternum

Those individuals who had cardiac surgery have their sternum sliced down the middle; following the surgery, the surgeon uses stainless steel sutures to bring the sternum halves back together.

Read the rest of this entry »

Cadavers Day 1, or, I Still Have The Smell Of Dead Person On My Hands

Mortui Vivis Docent
The Dead shall Teach the Living

Today was our first human dissection day. Though I’ve gotten a lot of dissecting experience starting with fetal pigs in high school to a number of different species in physiology and zoology courses, I’ve never had the chance to dissect human bodies before. It’s a rare privilege that a very small percentage of people ever get to do, as it should be; it’s not something to be taken lightly.

By no means did we take it lightly. Even before we were allowed near the bodies, the professors instilled in us a strong sense of respect for the body donors and their families. Though we're allowed to wear whatever we want into the lab (a set of scrubs used solely for this lab is recommended because the clothing 'picks up the scent'), we are required to wear a white lab coat over top, as a way to maintain professionalism out of respect for the body donors and their families.

This consideration of respect comes up in a few other ways as well. We don’t discard any portions of the body when we’re done with them; all of the remains go into a bag in a large bin under the body, which will get cremated with the body so the families can be given back the entirety of the ashes.There’s obviously an uneasy aspect to dealing with human bodies, and our faculty went to considerable lengths in an attempt to prep us for the event. Before we went into the football field-sized lab filled with body bags, the prof showed a short 360º video of the room. They went over a few guidelines (for example, if we take photos or bring unauthorized people into the body lab, we could be expelled), and showed another brief video of unzipping the bags and spraying them to keep them moist.

They then talked a bit about the body donor program. Our school had been successful this year with the donation program, allowing us to keep the student-to-body ratio at about 6:1. While most of the specimens come from elderly people, the cut-off age is 35, and occasionally they will receive donations at that age. There are no specimens which died of infectious diseases, and none of children.

After answering some student questions about the embalming process, it was time to go downstairs to the body lab. They did a demonstration on one body that we all watched over the TV monitors above our stations. Even after all that prep, during the demonstration, right after the instructor folded back the flaps of back skin revealing the underlying muscle and fascia, one student - a big, buff Italian guy – passed out. And after, one of my small group members told me that even after all the preparation, he still wasn't sure what to expect when the bag was unzipped and the sheet came off; he was still a little flustered that there was a person in there.

In some ways, the bodies look very little like humans. When we unzipped the bag, the bodies were wrapped in a sheet and had a canvas bag over their heads. They have picked up a grayish hue, and many of them have large flat sections on their backs with pooled blood visible through the skin from the way they had been laying. Rigor mortis is obviously prevalent, and the skin has become tough and leathery, very much unlike the skin of anyone I know. If you really want to see what a cadaver looks like, the University of Michigan medical school has medical gross anatomy dissection videos online that anyone can access.

I had heard before that people often name their cadavers. I was very disappointed when I proposed this idea and it did not seem to go over well with the other people in my group…

Our dissection today was of the back. We peeled back the skin, revealing the muscle, and identified the trapezius, the levator scapulae, the neurovascular bundle supplying the trapezius, the rhomboid major and minor, and the latissimus dorsi. Over the next two years, we’ll spend a lot more time learning anatomy from cadavers.

I was once told by a doctor, “Becoming a physician is a privilege even more so than it is a profession.” It’s true. Society generally holds physicians in high regard, as valued members of communities, and as individuals in whom some people will confide their deepest and darkest secrets. The privilege of working with cadavers in our training is one more thing that I feel honoured to be a part of, and I’m grateful to my medical school, my body donor’s family, and my body donor for the gift of education in such a unique format.

Postscript ::: According to one medical student, the use of cadavers could eventually be a thing of the past. While I may not agree with his comments, his article in the Student BMJ presents the opinion of a student against the use of cadavers in training, but not using reasons of ethics or the gruesome nature of the procedure. He indicates that not a lot of anatomical detail is that effectively learned, the costs are fairly high, and while anatomy is important for surgeons, only 5% of medical graduates become surgeons and cadavers don’t feel anything like performing surgery on a living person.

Read the rest of this entry »