Thursday, June 22, 2006

Why go to Medical School: Wednesday Afternoon



It's Wednesday morning. It's Wednesday morning at 10:00 and I can't stop coughing. I should be sleeping off a hangover with the rest of my class but instead I'm in the Anatomy lab with the doors closed.

My current research concerns the arteries within the mandible. Normally, you divide a person in half by saw and explore each half of the jaw. Congress is coming though, and we need a few spectacular pictures for my presentation. So, instead of the usual, I was handed a bone saw and then a cadaver. And then a flashback.

It stinks for weeks, all of these cats. I'm supposed to pick my senior classes by 5:00 today. I want senior year to be easy. I also want to dissect those stinking cats. Screw it; I'll take AP BIO. It's a year later and Jared just stole my tail. He has quite a collection, him and his bone cutter, stalking from table to table stealing the tails. I've been vigilant which is why it took him so long to defile my Mittens. I met Mittens in a plastic bag. She had been pre-skinned from wherever she came. Skinned except for her paws. Mittens.

We're kids and we're in high school and we're dealing with death. Poorly. We've worked our way up to this: nematode, grasshopper, squid (which we then grilled and ate), frog, fetal pig, and now cat. There's the kid that's too sensitive and is very disturbed by our behavior. He doesn't think it's funny when we start quoting Lord of the Flies and dancing. We call him "Piggy." I pull on the tendons of Mittens and have her kick in the air to "Da da da-dada, da da da-dada." We cope by trying to upstage each other with our indifference. Like I said, we're handling this poorly.

It's the last week before the final and I've finished all of the dissections. With my free reign I dissect what's left. I take apart the forelimbs and the scapula. I take off the hind limbs but can't free the hips. I free the ribs and all that's left is the crooked cane of the Central Nervous System and it's protecting bones.

That's what I'm looking at right now: an empty thorax, ribs intact but flailed, the vertebrae from L2 on up and his untouched head. No arms, no legs. Mittens. I've spent so much time in a book and away from the lab that I've lost my detachment. Holy shit, there's a man cut in half on the table. But I have work to do and feeling uncomforable is a waste of time. I have tricks. I focus on one spot, one square inch where I have to cut away his skin so the saw can make contact. That one square inch isn't he. It isn't a person. It's a square inch. I can cut a square inch.

The saw is dull. It's motorized and oscillating by millimeters instead of spinning. Those tiny motions mean that it cuts bone but not flesh, and there are only two spots that still have teeth. It makes the work slow and heats the motor in my hands. I have to take breaks between my sweating lips and palms. Maybe you've never had to cut a circle around someone's head, but know this: it's dusty. That's why I'm coughing. People that walk in through the far door start coughing as well, but they're reacting to the smell of burnt bone. You have to have your face near the action to appreciate the soot.

I finish my circle, insert a wedge and torque against the seam. It makes this wild cracking sound and I wonder what I've missed. I call in a professor who inserts the wedge, torques against the seam and explains to me that I am appreciating the sounds of the separating dura. wow. WOW! That's amazing! He pulls off the top and instead of feeling jealous, I am amazed. That, right there, is a human brain and I've never seen one. I'm stupefied. That's why I jostle the brain back and forward and wonder why it won't come free. For a moment, I'm an idiot again. I forget that it's connected to every corner of the body in one way or another and won't jostle free of a damn thing.

The brain lifts in the front so you can cut the olfactory nerves. A dividing membrane travels front to back like a Mohawk splitting the brain into left and right. That gets cut. The Optic Chiasm, the trigeminal ganglion, the nerve gaggle entering the internal acoustic meatus, the membranous tent dividing the calvarium into the cerebellum's part and the cortex's part like two fighting siblings. All of it: cut. It wiggles free.

This is my own instant review of everything I've read but haven't seen. Not really anyway, not like this. To finally free the brain, I have to cut the brainstem through the reticular formation. I have so much respect for the reticular formation. It's the lizard part of our brain and it's a geographical mess but beautiful all the same. And now it's in my hands. I am holding this brain and rotating it, rattling off all the sulci, all the gyri. The arachnoid matter actually looks like a spider web. I can't believe how lucky I am. I just can't. If this man were alive, I know that pushing on this spot right here would make his lips go numb. This spot right here and he would collapse. This spot: fear. This spot: memory. It's just amazing.

Another student involved with research walks into the room. I tell her what I'm doing and watch her beam. Now I get to watch her roll it in her hands, see the relationships, and slip it into and out of the skull. For the first time we really understand epidural hematomas and uncal herniations. Of COURSE that would kill you! Transtentorial herniation? That would be catastrophic!

So, why go to to medical school? Because you've never been afraid of blood. Because cutting into something that was once alive bothers you, but not too much. Because of all the places you could ever be, it's a place where you're with people that can share and celebrate something as awesome as the human brain even when you had to tear it from someone's head. Because maybe, on a Wednesday afternoon, you're biggest problem could be holding a saw to someone's skull and choking on the dust.

But smiling.

1 Comments:

At 10:33 AM, Anonymous kim said...

You gave me goosebumps with your descriptions. Wonderful post!

 

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