A Day in the Life.....

Since nothing absolutely transformative has yet happened in my education, I thought it might be interesting to know what my life is like day to day (that way you might understand why I never call you back...). My day starts early, 5:30 am. It's now dark when I get up, and the sun is coming up as I ride my bike to school at 6:45 am. It's really a great time to be on my bike; there aren't many cars on the road, and there's a sense of freedom whipping down Barbur Blvd, and pedaling through the tunnel of trees surrounding Terwilliger Blvd. Now many of you might wonder why I would use up the precious 90 minutes every day to bike to and from school.

As you may know, there is absolutely no parking up on the Hill. With the medical, nursing and dental schools, as well as the VA, OHSU, Doernbecher's, Shriner's, and Casey Eye, all sharing this hill, there is little room for extra parking spaces. I always wondered why this community was created in this remote location, and not somewhere else that had more room to grow. During orientation we learned that the Marquam hill area was bought by a railroad company, sight unseen, and without accessing a topographical map. You can imagine their surprise when the company, back in the early 1900's, arrived here to see the location of what was supposed to be a train transit station. So the land was gifted by the railroad company to the public, as a place to develop both a medical school and a county hospital.

But I digress. The reasons I bike? First, it gives me much needed exercise, to help deal with the stress of medical school. Plus, I get to review in my head everything that I studied the day before. As I cruise down Barbur and Terwilliger I'm thinking, AOL.....not the ubiquitous internet service provider, but rather a fun mnemonic to help us remember Artery Over Ligament: the the suprascapular artery goes over the posterior transverse scapular ligament, while the suprascapular nerve goes under the ligament. We will learn lots of acronyms that are supposed to help us memorize the voluminous amounts of new information. (In Christine Montross's book Body of Work, she states that first year medical students will learn 10,000 new words). For example, the terminal branches of the brachial plexus, a large nerve bundle under the collarbone, can be easily remembered by A Muse Ran Merrily Uphill (I have no idea what the letters stand for yet....but I know the mnemonic!!) That's the problem with these study devices: You still need to know what they stand for!!!

OK, so besides recalling what I am learning, the bike ride is great because it frames my day. The beginning and ending of the day....and the added bonus is that I have a punch card for my commutes, and once I have received 35 punches, I get 50 bucks!! That's OHSU's way of trying to eliminate parking congestion on the hill, as well as encourage their students and employees to get their bodies moving. It's good for me right? I have been commuting by bike now for only two weeks, and it hasn't yet started raining, and it isn't yet dark when I both leave and return from school....so we'll see how long it lasts. For now I am committed to riding, and I have my sweet husband Ronando as a back up....that is, he is willing to drive me to school and pick me up on those days that I just can't do it. Oh ya, I don't ride the bus because it takes over an hour to go a mere 7 miles... I get there faster by bike.

Are you bored yet? You will be now because the next part of my day is full of class. Two hours of lecture from 8 to 10 am, where we are blasted with a firehose of information. Right now the class is Gross Anatomy, Imagining, and Embryology - a integrated class that teaches us regional anatomy (all the structures and tissues of a certain area of the body, say the back, rather than learning system by system - the muscular system, the nervous system...etc), embryology (how we miraculously go from one cell after fertilization of the egg via the sperm, to two cells, to four, to a hollow ball of cells, to.....well you don't need me to impress you with all I know about the first two weeks of development, but let's just say it's simply astounding that we are alive, and functioning. More about embryology in a later post....), and Imagining, all those devices that take pictures of the inside of our bodies.

Then we get to relearn the lecture in three dimensions, by dissecting that part of the body that we just heard about. This is the gross part of anatomy, in two senses. First gross because everything we are dissecting in the lab can be seen with the naked eye. Second, it's gross because dissecting a cadaver is messy. Lots of preservative fluid, fat, a bit of blood still in the vessels.....the process of removing the skin, digging between the layers of tissue, to find the pot of gold for that day, is well, kind of gross. Once we get to the structures we are attempting to find, (and hopefully we haven't cut them with our scalpels), the work is worth it. Yes, the end justifies the means, but the means is way way way messy.

Any tissue we cut off the body goes into a white bucket underneath our tables. It is imperative that all the tissues remain with the body they came from, as after we are done, the bodies are all cremated, and the ashes returned to the donor's family. Every day we have to empty a drip pan under the table that's collecting fluid draining from the body....and did I mention the smell? We all have a special set of clothes or scrubs, including shoes, bra and underwear (well the guys probably omit the bra), that are kept in a separate locker room, because everything, everything, you take into the lab will smell. At the end of the 11 week class we will burn our clothes and shoes. Even your hair smells, although today I'm going to try and cover it with a bandanna to see if my hair will absorb less smell. All vanity disappears when you are in the lab; obviously, as there is no other place I would allow myself to be seen with an Aunt Jemima head.

OK, after lab, which is supposed to end at noon, but will carry over if you haven't gotten to the lab objectives yet (the first day we were there until 1:30 - now we are faster cutters and diggers....), then it's a quick lunch. Since it's still sunny, I sit out on the grass by the fountain and eat a lunch I brought from home. Then it's study time. I go to the old Library with my books and study what was taught that day. I have learned that your ability to recall information increases greatly when you review it within 24 hours of first hearing it. I study until about 6, then hop on my bike for the refreshing commute home.

12 hours after closing the door behind me, I now open the door of my condo, to see my family, who are all happy to see me. The cats Mango and Shadow meow incessantly. Mango wants food (as always), and Shadow wants to play with his toy. My husband and daughter are usually there since Ronando works from home, and dinner is in some state of cooking. (great since by now I am starving). It's dinnertime and catching up with Erinna and Ronando, finding out what filled the 12 hours since I saw them last. Ronando made the mistake the first day of asking me, while I was cutting into my chicken breast, what the dissection was like that day. I closed my eyes and asked...please, please, please, let's not talk about lab while I am eating the flesh of another animal....(I don't think I finished the chicken that day - couldn't get the lab images out of my mind). I love this part of my day. I adore my family, and recognize the great sacrifices they are making to support my dream (like doing the cooking and cleaning and housework). Thank you Ronando and Erinna.

So, I have learned something early on about how to survive medical school: one day at a time, one lecture at time, one page at a time, one concept at a time, one word at time. This way I am living moment by moment, which is part of the joy of being alive! Cheers!

No Turning Back

After our first two days in the anatomy lab, I realize that I will never be the same. I have crossed a threshold, one that feels more like a monstrous cliff rather than a fine line. I have joined that group of people, physicians, nurses, physical therapists, naturopaths, and all the other health care providers, who have gone through that hands on initiation of medical school science: the cutting of a dead human.

It was only two minutes into the first lab and I was already able to separate myself from the notion that I was going to dissect this sweet old man. It could have been because we immediately turned him on his back, obscuring his face, that clear reminder of his humanity, in order to start on the back muscles. It could have also been because he did not feel at all like the bodies I have been rubbing for the last nine years in my profession as a massage therapist; his pale skin was cold, hard, and felt like what I imagine elephant skin feels like. But maybe I was able to detach myself because I had to in order to complete the tasks at hand, to learn the muscles, nerves and blood supply of the back.

Once the skin was removed, a task that took a very very long time, I was completely and utterly fascinated and absorbed. To actually see the muscles that I have been massaging for nine years was incredible. We started with the most superficial muscles, and retracted them back, to discover the intermediate and deeper muscles. It was so instructive for me to see the relationship between all the muscles, instead of learning them in isolation as we did in massage school. The tendons were truly beautiful, with a fine pearly opalescent sheen, as if a master painter brushed on layers of paint to illustrate the nuances of light. The individual fibers of the tendons lined up perfectly, one after another, doing their job of anchoring the muscles to bone so flawlessly.

I left the lab that first day feeling ecstatic. I had done it! I had successfully dissected the back muscles, enjoyed it, and was not feeling the anticipated uneasiness or discomfort. The reality of dissection however soon hit home; unlike undergraduate science work, where you have one lab session per week, our anatomy lab will be every single day for the next 11 weeks. The next day we were all there once again, to complete the next dissection: opening up the spine in order to study the spinal cord.

This lab was truly brutal, both physically and emotionally. The bones of the spine, and I imagine of the whole body, are incredibly strong, and quite resistive to any attempt to break them. The amount of force we needed to take off the back of the spine in order to reveal the cord was astounding. I could not pick up the chisel and hammer, nor could I use the saw. At one point, I looked up and around at the 30 lab stations, saw the focused concentration of students trying to open up the spine, heard both the pounding of mallets as well as the buzz of saws, smelled the odor of bone mixed in with the formalin preservatives, and felt like I was in the middle of a horror movie. I sat back and watched my lab mates do the dirty work (thank you). Gone was the fascination that I experienced with the upper back muscles; this work was so destructive, and yet I knew, necessary in order to learn about the spine and spinal cord.

After an hour and a half of pounding, we finally lifted off the bone, to unveil the most amazing anatomy that I have seen thus far: the spinal cord. It was so......so......beyond words actually. That structure, in the very center of our bodies, responsible for all of our sensation, all of our movement, all of the communication that goes on between our brain and the rest of our bodies,

is an indelible image in my mind. One that I will easily recall when taking the practical exam, when answering multiple choice questions on the written exam, but most importantly, one that I will use when listening to a patient talk about their symptoms. I can now close my eyes when I run my hands over someone's back and spine, and see what is under the surface; see the relationships between the different tissues and structures, see the nerves leaving the spaces between the vertebrae, see the nerves traveling to their final destination of muscle and skin. So despite this day's brutality, I am grateful, once again, to the man that has allowed me to put my anatomical medical knowledge into 3 dimensions. Thank you again, Mr. Old Man.

The Gift

Yesterday we were introduced to the anatomy lab, and with it, our cadaver that will be probed and explored in the next 11 weeks. It wasn't as traumatic as I had anticipated. As I entered the lab, I looked around to the 30 work stations: large stainless steel tables, containing drawers with all of our dissecting supplies; polished clean white floors; red bagged hazardous containers all around the room; 30 cadavers wrapped in white cloth and covered with plastic sheets; and two white coated physicians who are responsible for taking care of our cadavers. I'd like to think of them as the undertakers of our gifts.



Last week, we had an introduction to the Oregon Body Donor Program, to answer our questions about where these cadavers have come from. For our program, all of the cadavers were individuals from Oregon, or Vancouver WA, who specified prior to their death they wanted to donate their whole bodies. The average age is somewhere in the 70's, as younger bodies are usually harvested for healthy organs and tissues. There is a 50-50 mix of women and men, in order for us to learn and understand the anatomy of both sexes. Unfortunately for us, the donors at this time are primarily caucasian, although I'm happy to discover that the lab table next to mine has been gifted an African American male.

What do we know about our cadavers? Not much. We are only told the age, sex, (pretty obvious), and cause of death. Our cadaver died of respiratory failure. Although the aim of our first class is to learn the normal anatomy of the systems and tissues of the body, it is inevitable that we will also start to learn about pathology as we open up our cadavers and see evidence of disease.

So after we entered the lab, as I'm waiting for the shock to hit me, my 3 lab mates and I surround our body, looking around wondering what to do next. We don't actually start dissecting until Thursday so it's with trepidation that we stand there, until my wonderful enthusiastic lab mate grabs a pair of gloves and asks, shall we take a look? All the bodies are covered first in a white cloth, with a separate shroud for the head. The bodies are also face up, ready to receive all that we are soon to deliver. As Markus lifts off the sheet near the shoulders, I am surprised by two things. First, how life like the cadaver looks, and second, how non-life like he looks. The skin looks like skin, but is gray. The body looks soft, but is actually firm to the touch (according to my lab mate - I haven't yet touched him - one step at a time....). We confirm that our body is male (no breasts), and cover him reverently back up. I say outloud "Thank you Mr. Man", as we have yet to come up with a name for him, a ritual I understand many students adopt as the weeks move forward.

As I'm ready to turn and leave the lab, my lab mate, still gloved, states "Shall we look at his face?" I look around to the other students, and numbly nod OK. I understand from reading Body of Work by Christine Montross, that the faces are covered so that students can initially be as comfortable as possible during dissection (same reason why we dissect the head and neck last). I am expecting yet again to be somewhat disturbed and shocked. We remove the shroud, and staring up at us is an old man, sleeping his eternal sleep, and again looking both alive and not alive at the same time. The only other time I have seen a dead person is when my grandpa died when I was six or seven. I barely remember seeing his face in the coffin, and as five seasons of "Six Feet Under" taught me, my grandpa was made up to look very much alive, like he was soon to wake up from a nap.

No comparisons here. Mr. Man is definately not alive, will definately not wake up, and yet, I am not shocked, not disturbed, but instead deeply moved that he has gifted his whole body to me so that I can learn to become a physician. I'm sure that the following weeks will push and pull me in many directions, but for now, I am left with a great sense of awe and gratitude to him and his family, and for all the others individuals in the world that give this gift to medical students.I leave you today with a quote from a previous donor:

The Gift

I am lying here in front of you now because of those doctors that saved me the first two times. They gave me 15 years I would never have had. Fifteen years to make things right with Elsie. To care for her after her stroke as she cared for me and the children those years when I was running around. Fifteen years to witness the births of my grandchildren. Fifteen years to spend time with my kids as I never did while they were growing up. Some might call me lucky, but I call that a gift. A gift from God, sure. But also a gift from those doctors. My body is my gift back to them.
As you examine me here in Gross Anatomy, I would like you to do a few things. When you look at the scars on my hands, remember I was a butcher for 45 years. When you examine my liver, remember I was a drinker. When you hold my heart in your hands, remember how I ate and my quadruple bypass. But most of all, when you are with me, learn, so that you too may be able to keep giving the gift that I was given.

Micheal A Grassi, Chicago, Ill
from "The Gift", JAMA 276:854, 1996

The First Week of a New Life

Well friends, family, and clients, the time has finally come: the moment I have been striving towards for the last four years - the beginning of medical school. The first week was much like the last four years: a true test of patience (we are still waiting to actually start class), of dedication (biking up the hills to and from the Marquam Hill campus on my commute), and of excitement (I've met so many incredible people already!).

Yes, it was orientation - a week of meetings pouring over all the information we need to know in order to not only survive medical school, but to have sanity and balance in the process. OHSU really excels in this arena - that we have spent a whole week just making the transition to medical school solidifies my belief that this school is the perfect place for me to gain both the knowledge and skills to become a competent physician. After only one week I am confident that although the medical school process will definitely challenge me, and my family (bless them), it will only be an evolution of myself, a digging deeper into the core of who I am.

The end of orientation concluded with the White Coat Ceremony. All 120 of my fellow students in the class of 2011 walked across the stage and received our White Coat, the symbol of our profession. We also took the Oath of Geneva, a modern day version of the Hippocratic Oath. And as I made this promise to myself, I also make it to all of you: my supporters, my cheerleaders, my tribe, my foundation. Thanks for holding me up.

The Oath of Geneva

At the time of being admitted as a member of the medical profession:

I solemnly pledge myself to consecrate my life to the service of humanity;

I will give to my teachers the respect and gratitude which is their due;

I will practice my profession with conscience and dignity;

The health of my patient will by my first consideration;

I will respect the secrets which are confided in me;

I will maintain by all means in my power, the honor and the noble traditions of the medical profession; my colleagues will be my brothers and sisters.

I will not permit considerations of religion, nationality, race, party politics, or social standing to intervene between my duty and my patient;

I will maintain the utmost respect for human life, even under threat;

I will not use my medical knowledge contrary to the laws of humanity.

I make these promises solemnly, freely, and upon my honor,