You can live without a stomach

This week we started dissecting the abdomen. We cut through all the layers of muscle holding our abdominal wall in place and protecting our organs, including the rectus abdominis (yeah six pack!), and several layers on the side like the external obliques, internal obliques and transversus abdominis muscles (yeah new words!).


Today, we started looking for the liver, stomach, spleen, pancreas, gall bladder and the veins and arteries running to and from these organs. Well.... to make a long story short: SHE HAS NO STOMACH! Crazy. Luckily, a wonderful thoracic surgeon happened to be in lab today and described the full gastrectomy that removed her stomach, spleen and the greater omentum that covers these organs. The pictures below helps to explain how the surgeons removed her stomach and hooked up her esophagus to her small intestine. Needless to say, we had a rough time in lab identifying all of the abdominal viscera because everything was shifted, reconnected and unexpected!




Here is a blog entry from a person living with a full gastrectomy: Living with a Gastrectomy: One Researcher's Experience.

Hey Med School! I thought that was you!

Thank god for clinical correlation lectures, teamwork in the anatomy lab, simulation centers, and observations of the patient interview! I'm writing this today... but it was actually yesterday that made me say, "YES! This is why I'm here!" Everything we had been learning about and dissecting in the thorax started to make sense and became relevant medically.

Dr. Yang, a top thoracic surgeon, did some show-and-tell about common, and crazy, surgeries of the lungs and heart. He gave the history of the surgery (they used to fill an empty lung sac with ping pong balls) and then gave us the run down of how the problems are fixed now. The amazingly cool part was that I followed what he was saying!!! I'm sure he didn't use every medical word he could have - but he did describe how the internal thoracic artery running just laterally to the sternum can be removed and used in coronary artery replacement surgery to repair the blood vessel that supplies blood to the heart muscle itself. Anyway... Dr. Yang's lecture made me feel like I was finally learning something :)

Working on any team is a challenge, and in anatomy lab, we are working on a team standing over a cadaver, dissecting tiny nerve in a rather small thorax. Sometimes there are too many cooks in the kitchen (yes, we wear white aprons!). Yesterday (and actually today also) we worked so well together! We found and cleaned off the aortic arch and the branches to the rest of the head and neck, we found both vagus nerves, the carotid arteries, and many other really cool structures! The excitement and cohesion were palpable (as were the arthritic vertebra).

The simulation center did not disappoint. First we were taught and practiced CPR on an adult, child and infant mannequins (compressions should be 100 times per minute, or to the song Stayin' Alive, demonstrated here in The Office). Then we saw how use a laryngoscope to insert a breathing tube into a patient along with the fiberoptic bronchoscope that's used to visualize a patient's trachea, bronchi and lungs. The last station introduced us to Sim Man, a breathing mannequin that has a medical problem and responds to your attempt to fix it. He had a collapsed lung and we practiced inserting a needle between the ribs (intercostal spaces) to allow the air to escape! As of today, I can't imagine doing that to an actual patient in distress, but Sim Man was good practice :)

Lastly, we observed a doctor interview a patient to learn proper communication techniques. This completely rounded out the day that made med school real. This was a 57 year old woman with bone marrow cancer. She told her story from beginning to end over 45 minutes. It was clear that she placed a lot of trust in Dr. Shochet, and that she respected him. I feel grateful to have these experiences to help me learn how to be a compassionate and competent doctor.

And after a long day, I even got some quality time with my husband! Of course, knowing that I hadn't yet showered after spending a good 4 hours in the anatomy lab, he did say, "Um, you smell a little bad..."

Abnormalities of the chest

We watched this video in class today! Which was funny... but then I found the surgery to fix it... not as funny, but still fun :)

Why am I dissecting a human?

Apparently I should be practicing on a sea turtle.

Today I used a bone saw to cut through the ribs and sternum and removed the rib cage. We then removed the lungs. Tomorrow: heart.

Anatomy

I did not sleep well last night. Sweat was pouring off of me, I was uncomfortable, and I couldn't stop thinking about what my first day in Gross Anatomy would be like. A human cadaver. Lots of human cadavers in the lab... 24 dead bodies. What would it smell like? Would I be able to cut into the body?

"This will be your first patient. This person wanted you to learn from their body. They will teach you more than any textbook every could." - Dr. T

After a brief lecture about the thorax and what to expect in the thoracic cavity, we changed into our scrubs and headed to lab. The 6 of us stood around our body - it was covered in a green plastic sheet, but I knew underneath was a clear plastic bag, and the body was shrouded in cotton cloth. What parts of the body do we think of as being most "human?" The face. The hands. The feet.

I am nervous, but I am so grateful to have this opportunity, to stand where few can and to learn. My responsibility is to this patient, to my partners, and to my future patients.

"Your responsibility is to learn from this body the things that will help to save the lives of other people." - Dr. K

As a group, a medical team, we started by uncovering the feet and then the hands. We observed the age of the skin and the joints. The coloring was off. Preservatives. You could smell them.

We uncovered the face. This was the strangest thing I've ever done. It wasn't scary, but it was so unusual that it was only natural to feel very uncomfortable. This person is Asian. Small in stature, thick lips, heavy creases around the eyes. I thought about our trip to Thailand, Cambodia and Vietnam - this person could have lived there. It became real.

Our group collectively guessed this person to be a 75 year old male, but after uncovering the entire body we were surprised to find a female. Her knees were bulging: arthritis. She did not have much fat at all - her legs and arms looked pretty good, even toned. Dr. K then reveiled that her age was 91! 91! I hope I look that good at 91!

We broke into our groups of 3 and I stayed to disect the breast, skin and pectoral region with 2 partners while the other group members went to learn about imaging. Then we flip flop. We will do this every day for the next 8 weeks. The three of us will teach the other group what we learn in lab and vice versa. We will all disect every day, for about an hour and a half each day - 3 hours total between both groups. We will learn about the entire body: every organ, muscle, nerve, vessel and bone.

Today we uncovered the pectoral muscles (major and minor) and found lots of great nerves, veins, arteries and connective tissue. We saw the striations of the muscle fibers and found where they connect to the bones.

The pectoralis major connects to the humerus to allow us to lift our arm. It's true. I saw it!

Bones

This week has been wonderful! I'm having a blast getting to know the amazing, accomplished and impressive students that I'll be learning with over the next 4 years. After taking some time to reflect, I'll write a longer post about the Health Disparities Intersession we've been exploring this week (the health issues in the East Baltimore community, how to think cross culturally, etc)... but I just wanted to mention the box of bones that is now in our living room.

I was planning to walk home on Tuesday, but instead I had to call Matt to come give me and my bones a ride :)

Budgets

Following the "Live like a student now" theme, Matt put together a budget and subsequent spreadsheets that will help us follow that budget. We are going to be "proactive" as opposed to "reactive."
Then he printed them in color and put them on the refrigerator. And apparently they will be updated, printed and re-posted on the fridge each Tuesday. Ladies, if you can, marry a financial planner. And if you can't, you can borrow mine for the day. He'll make you nice spreadsheets to keep your spending under control.