Friday, August 21, 2009

The First Cut

I've only had two classes thus far: genetics and clinical human anatomy.

Ugh, this class is taught sooo poorly! We haven't really learned anything about genetics, just the biochemical mechanisms of genetic processes (like replication, transcription, translation, etc). This class is really biochem pretending to be genetics. This material isn't the important part about genetics!! It's not necessary that we know all the details of processes because 99% of us will NEVER use that info!

We should be learning about inheritance patterns (more than the grossly simplified Mendelian dominant/recessive inheritance), how to recognize genetic abnormalities, how to prevent them, etc. We do not cover things like: co-dominance, incomplete dominance, penetrance, expressivity, multigene traits and diseases, etc. One of our lecturers even oversimplified the definition of "allele" to the point that it was just wrong info. Honestly! Nothing in this class thus far is of clinical importance, unless you're a pharmacist and want to know how every drug mentioned in our notes thus far kills cancer. Always cancer. -_-

There are CLASSIC examples of genetic diseases that aren't even going to be mentioned (I know, I've flipped through all the notes already). Diseases like Huntington's corea, sickle-cell anemia, fragile-X, HNPCC, FAP, as well as multigenic ones like Alzheimer's and diabetes. We don't go over newborn blood screening and the metabolic and genetic diseases detected therein. In my opinion, we've learned very little useful info thus far. It gets marginally better, but not by too muich.

Ugh. No wonder why so few med students go into medical genetics. If I hadn't had such a strong genetics background, if I didn't already learn the clinical relevance and application of genetics, and if this was my first and only "real" exposure to genetics, I would NEVER go into medical genetics. This is just awful, truly. Again, this class is NOT genetics, it's biochem dressed up as genetics. I know there's a point where the two fields intersect, but what I think is more important simply isn't emphasized. It doesn't help that our professors are from the biochem department.

/end rant

Clinical Human Anatomy
This class is . . . I'm not sure what to think about this class. All of our professors are ancient. Omg, there's this one professor who's been teaching the course for 50+ years. He's been teaching this class at this institution way back when it was under a different name! He taught one of the other professor's dad as well as the other professor himself (and that guy isn't young either). He had to be at least 30 or so before he got his teaching position, so that makes this guy at least 80+ years old. And you know what's creepy? I think he's older than some (many?) of our cadavers. >.>

Now as for cadavers, we began dissection on Wednesday, the 3rd day of classes. It's truly a strange experience. To see all the humidors (yes, like the thing you keep cigars in, that's what the bodies are kept in to keep them moist) lined up in rows in a really large room. Then to see med students open the lids and slowly raise the cloth-covered bodies up, it's like watching the ressurection of mummies.

And then you're hit by the smell - the smell of formaldehyde (I had SO wished they used an alternative preservative). It's a strong odor that makes the saliva well up in the back of your throat, a similar feeling you might get right before you're about to vomit. And it burns the eyes if you lean too close, and gives you a headache that lasts hours if you inhale too much (which I think I did).

Then you pull back the cloth, uncovering the part of the body you're working on. In our case it was the chest. You see this leathery thing that somehow doesn't look quite human. You make the first cut, squirming at the easy with which your scalpel pierces and slices through skin and fat. Two of you grab the flap of skin you've just created and pull back, as someone on the other side lances away the connective tissues with scalpel and blunt probe. With each cut, with each peeling back, the body becomes somehow less human and you distance yourself - somehow it becomes easier to cut the deeper you go.

You encounter the muscle, the pectoralis major that you need to peel back (reflect) from the pectoralis minor. It has a curious red-brown color, with the muscle fibers looking even more curiously like the dark meat chicken. Someone remarks how they will become vegetarian for the duration of the semester as a result. You continue, removing the fascia from the muscles, going slowly and hoping you haven't severed important nerves, arteries, and veins. After all, for the 5 of you there is only one body, and you only have two chances to get it correct - once on the left side and once on the right.

You find the structures you're interested in and are ecstatic that you didn't eviscerate the body for nothing. Someone at a table further away yells out they encountered breast implants in their female cadaver (awkward . . .). You are thankful that your body is skinny with very little fat, as you look at the table across from you with the yellow fat dripping off the inner flesh. You wonder at the identity of this body but you dare not pull back the cloth that covers the face, for fear that the experience becomes "too human."

Today we proceeded further with the dissection of the chest and upper arm area. We had to tie up the arms of our cadaver to the sides of the humidor with rope. With the armpit area splayed open, the brachial plexus (nerves) and the assorted arteries and veins stretched out like cords, there was a disturbing Christ-like appearance to our cadaver. I refrained from much cutting because I discovered (not surprisingly) that I do not have "surgeon hands."

We sawed through the clavicle (collar bone) in order to expose the nerves, veins, and arteries hidden behind it. With an electric saw and much snapping and twisting, the sound of breaking bone is oddly familiar. The chicken analogy again works well. Another night of vegetarian for me.

We discovered a gash or some kind of laceration/puncture wound to our cadaver's skull. We wonder if that was how he died or if it was perhaps a part of the embalming. We have no idea who our person was, what his life was like, how his family was like, how he lived, and how he died. I suppose this was designed to distance us so that we may literally dig into his innards without much hesitation. When this is all over, when this is all said and done, then his identity will be revealed to us.

Anyway, to end on a completely different note to distract from the gruesomeness above, Courage from the (now finished) blog, A Beautiful Addiction... linked me to the following YouTube vid:

(D) Rep. Barney Frank SLAMS woman comparing Obama to Hitler at town hall

Rep. Frank's response is pretty epic, I must say. :P Ugh, people are being rude and really stupid at these town hall meetings. It's difficult to take away what's true and what's false about health care reform. Damn Palin for her "death panels" statement that ignited the flames. Someone should bitch-slap her for her idiocy.

Lastly, a song that rather warmed my heart, "Funny Little World" by Alexander Rybak.

It's such a cute song. I wish something like that would happen to me in real life. Ah well, I suppose such things might only happen in fairy tails. :-/ You can see a YouTube vid with lyrics here and a YouTube vid of him performing it live here.


Randy said...

God, the oversimplified allele, and they're teaching Mendelian inheritance? What amateurs! :P

BTW, I creamed myself when Frank told that dummy off!

Anonymous said...

OK, I've refrained from commenting in the past, but I simply have to do so now.

I'm a physician, in practice. I understand your skepticism at the biochemical info, but like it or not, you will use it--more often than you can imagine. Especially once you're out of medical school. I suggest you learn it well now, because you will never again have the kind of time you now have to do so.

As for the inheritance patterns and the like, you won't know enough medicine to be able to understand such material until you're almost through your second year. Some schools start teaching this stuff in first year, but it's most schools' experience that few student can assimilate the information until they have a fair bit of pathology under their belts. For example, there's a lot more to sickle cell than just that the cells sickle in hypoxic conditions. No doubt, you'll argue that statistics isn't worth your time either, and epidemiology is a bore--though it will determine much if not most of how you will practice and be compensated. The pharmacology course won't cover drugs, because you really can not learn them until you're on the wards and in the clinic. I think U of Penn tried to bring drugs into pharmacology several years ago for about 3 classes, and it was little short of a disaster. As for why few med students go into genetics, it isn't a function of the way the material is taught. (Don't believe me if you don't want to, but that's the reality. Choice of speciality is entirely personality driven.)

Anonymous said...

As for Gross, ancient is good. Those are the folks who really know the material cold. And that's what you need during the dissection. As for the formaldehyde, you will survive. Everyone does. And it beats being exposed to some undiagnosed virus, which is the alternative.

The dissection may seem inhuman (and inhumane), but the reality is that the first step of becoming a physician is learning to detach yourself from your patients. Empathy is good, for sure, but unless one can objectively assess what's going on in a given situation, one is set up for failure as a physician. As you assemble the "pieces" back together when you get to the wards, you'll begin to look at your patients as people, but you'll also be able to take a step and figure out what's going on with them in a dispassionate way. That may sound cruel or like gobbly-gook, but it is what happens, either in medical school or, for some, during their internship. And it DOES happen.

And if you really think I'm full of it and have absolutely no idea what I'm talking about (and I remember thinking exactly the same as you), go volunteer as a med student in the ER for a weekend, or even just a Friday or Saturday night (as in when the Knife and Gun Club has its meetings/activities). Objective observation is often critical for saving someone's life, or at least making certain that nothing has been missed.

Anonymous said...

Enjoy this year. You'll never have the opportunity to learn this material the way you do now. Though I wouldn't want to go through med school again (three relationships lost in the first year alone), I'd do a lot to have the opportunity to learn that material again.

Oh, and with regard to the wasted info they're making you learn, hey, 50% of what you learn in med school will be out of date if not outrightly wrong within 5 years of your graduation. Which 50%? That's something no one knows.

Anonymous said...

Oh, one more thing--memorize the brachial plexus. It seems stupid to do so, but that shake one of your classmates' hands and ask them to pretend they lost innervation (through a lesion of the plexus) of one or two specific muscles. Then use what you memorized to figure out where the injury took place. Even with CT scans, knowing how to diagnose a neural injury based on simple things like where an injury took place in the plexus is quite important.

J said...

Your post reminds me of a one paragraph newspaper story I read.
A funeral home was suing the publishers of a telephone directory that listed its business under the heading "Fresh Foods-Wholesale". Eat it up, kid!

Anonymous said...

Dem. in general should act the way Barney Frank did to that idiot.

Pilgrim said...

When I started Microbiology like 5 yrs. ago, we started right in these stuff of genes and gentic issues as well as in genetical induced illnesses even w/cancer research on the behalf of genetical involvement. This was my first year, later we only intensified these studies. Come to Paris Sorbonne V. :-) Propz Pilgrim

Mike said...

OH, The DETAILS! Details are good, but you were talking about dead bodies! Yucky, icky! I had to stop reading there just beyond the formaldehyde portion.

That is pretty crazy to see your professor has been teaching so long. 50+ years... wow...

Aek said...

Randy: Lol. :P Yes, I kinda creamed myself too at that clip. XD

Anonymous: Thank you for commenting and providing me with your insights and thoughts. I will respond to your comment(s) in a post because I feel it warrants such recognition. I wish you had commented in the past though, but I understand that you must be incredibly busy.

J: o_O? Ewww.

Formysake: Hehe, I suppose. Rep. Frank certainly had a particular bite to his words.

Pilgrim: That's cool. :) Who knows, maybe I'll get more genetics in microbiology next semester. I would love to visit Paris though.

Mike: Yeah, it's pretty gruesome. But you get used to it REALLY fast (as if you have a choice).

Tyler said...

i would defo comment, with something worth while....

except my brain exploded after the first paragraph



tracy said...

Dear Aek,
i am not smart enough to comment on all the bio-medical things that came before, but i truly wanted to thank you for the new video from Alex... thank you and from my mom too!

Anonymous said...

I'm fixing to start med school in the next couple years and I'm EXTREMELY freaked out.