Chapter 17 and 18: The first classes, The first dead body

Chapter 17: The first classes

              The next day is the first day of lecture classes. Each day starts at 10 AM or so, and we have lecture until 4 pm at the latest, sometimes with small groups, and encouraged to use the other time to study on our own. They call it a flipped-class model. I get a text from Elizabeth the night before, we had been becoming nice friends. She asks if I’ve studied or read anything. I tell her that I did a little, just skimmed it really. She asks which parts she should read. I tell her to look at the pictures because I thought they were much more helpful. The next morning I wake up early, I read some more of the syllabus while eating breakfast before getting ready and walking to the lecture hall. The hall is mostly full by the time I arrive. I take my characteristic seat in the front and set out my laptop. Elizabeth sits next to me. I download the powerpoint that we will be using so I can take notes on it during lecture. The lecture begins, it’s cell-biochemistry. They try to make it interactive with questions. I avoid answering as much as possible because I don’t want to come-off as a know-it-all. Luckily they also have some poll questions that are fun to answer without needing to stand out. I’m incredibly excited to be in lecture and learning. It motivates me. It makes me want to finish reading the syllabus when I get home so that I can be prepared for the next lectures. I generally try to avoid taking notes during lectures because I find it distracting and I would rather just try to absorb and process the information.

              Lectures continue. I feel that I’m learning a lot and it excites me. We’re told that there will be our first exam at the end of the week. People are nervous, understandably. Elizabeth asks if I want to study together. We do that, I’m happy to have a teammate in the learning process. I try to make a study-guide beforehand that summarizes all the information from the week. Hand-drawn in One note. Elizabeth likes the study guide quite a bit, she suggests that I share it with the class, and so I post it to the Facebook group. At first I worry that people are going to think that I’m showing off or something, but the overall response is positive. It would start a trend where I would post a study guide at the end of every week. It was an incredibly helpful way to study, to summarize the information at the end of each week in a way that was easy to understand and well-explained greatly helped me understand and absorb the information more effectively.

              The test came. We had to take it on special software on our laptops. It was a stressful examination, quite difficult. Most people felt defeated afterwards. After the exam someone brought up board examinations and study materials. This was the first I had heard about it. Apparently at the end of second year there was an enormous examination called “Step 1,” and your score on it was incredibly influential for your future in medicine, and there were other large important exams later on too. Some classmates shared materials that they had heard about to help study for these exams early, one called “Firecracker.” And then a summary book called “First Aid” that was good to have early. It seemed like most of the class bit the bullet and bought firecracker as well as First Aid, among other resources. I was incredibly anxious about it all, I had wished I had known about this early. I got the free trial of firecracker, but ultimately felt that it was unhelpful. It focused greatly on route memorization. I bought first-aid so I could use it as a grand reference and add extra helpful notes into it as I went for reference later when it would be time to study for this big exam.

              We got our test scores the next week. Thankfully the first two years of medical school were pass-fail, which was a weight off of all of our shoulders. In general the class did poorly on the test. The other medical school sites also did poorly, and we were informed that our site actually did among them best. I had a secret worry that all the smartest staff and students were in Seattle, and this information calmed me. I also did not do well on the exam. It terrified me. How was I going to do well in Medical school? This was the very first examination? But I was happy to not be alone. Given that I wrote those study guides, the other classmates were surprised to hear that I had done poorly. Next the faculty went over the exam questions over power-point with us. They gave us tips on how to approach the specific types of questions and wordings used in medical examination in order to narrow any guesses. They then went through a couple questions that they informed us were actually miss-scored due to being poorly written, we all got some points back due to that. That made me feel a little better; however, I still vowed to myself to do much better on the next exam. I was still competitive and I had come from being a big-fish in College, I wanted to be doing among the best in the class. The rest of the day was relatively somber. No one was very excited to be learning after the exam scores. Tomorrow would be our first day in the Anatomy lab. They explained where we would go and how it would work. We were instructed to bring our own gloves.

Chapter 18: The first Dead body

              The night before I attempted to read the anatomy syllabus. Apparently we were going to cut out the heart and examine it. It was incredibly difficult to read. I could already feel that anatomy was going to be a weakness for me. I went on Youtube to try and find explanatory videos after giving up on the reading. I watched the video while looking at the list of structures I was supposed to be able to identify. It all blurred together. I was nervous. I went to bed. The next morning I drive to the anatomy lab with my box of gloves and scrubs. We change into scrubs and then enter the lab as a group. It’s a cold, sterile room with white linoleum floors and lines of metal tables. It smells of formaldehyde and chlorine. The anatomy professor introduces himself. We’re split into groups and assigned a cadaver. He explains how the bodies were generously donated and that we need to be respectful to them. The cadavers are apparently inside the tables, and there is a mechanism to open the top and an inner portion is raised with a crank to bring the cadaver into the work-space. We are assigned our groups and tables, I’m in a group with Elizabeth and a guy named John. We sit down next to the table. We’re shown how to bring up the syllabus and anatomy guide on the computer that hangs over the table. Then we sit down and our anatomy professor gives us a quick lecture about what we’ll be doing and what we’re looking for and how to approach the task at hand. He tells us that when we get to the cadavers, they’ll be in body bags that we need to unzip. He tells us that there will be a cloth over their faces, which we are welcome to remove if we like, but that it can be startling.

              It’s time to get started. I’m nervous. I’ve never seen a dead body before. And now as I write, I wonder if having gone through the process of learning from another person’s body, rather than returning to the earth should I be donating my own body to medical students so that they too can learn from it. To pass the torch, in a sense? It feels a bit like a duty. We open the table. There is a pungent smell of formalin and decay. There is a large body bag inside. We use the crank to raise it up. I take the zipper at the end of the body bag and begin to open. It’s a man with straw-thin brown hair. His skin his pale, nearly translucent, with a texture that may resemble leather. His nipples look like two stickers applied to his chest. His nails are pale and brittle. This isn’t just death, this is death multiplied by time. I finish unzipping him, revealing a half-erect penis in a bed of brittle pubic hair. I feel embarrassed. Have I disrespected this cadaver already? There’s no way around it. We put a small cloth over his penis for decency. I touch his skin, even with gloves it’s strange. The feeling of skin without life—like an empty vessel. I wonder if this is what we’re trying to prevent in medicine? This transition of a man into an empty container? We learn that his name is Frank. We begin addressing him by name, although it feels strange. I feel strangely connected with him, even though I know that there is nothing inside, no light on in the house. I start to wonder what it actually means to be alive. Sure this man had no sense of personal existence, and so maybe he weren’t alive. But he was about to be an incredibly active part of all of our lives, and we were forming a sort of relationship with him, and we were going to spend time together, and we called him by name, and in a strange sense it felt like maybe he was alive when he was with the three of us, even though he was technically dead. I thought about what it meant to live after death, to leave a legacy. If you continued to bring good people together in a meaningful way despite loss of a “soul” as it were, were you not still alive to the world and to others in some sense of the word. And as I write now, I feel that I desperately need to believe that this is true, because in these final weeks and months I seem to have all I want desperately is to bring people together and form strong lasting communities that will remain when I’m gone—a sort of legacy of relationships and connections—and maybe through this writing I will continue to bring people together. I guess nothing can prepare you for your first dead body. It was a surreal experience.

              John asks if we should remove the cloth over his face to look at him. I say yes, I want to know what this man looked like, I want to know who he was. John removes the cloth. Elizabeth says she feels a little sick, but that she’ll be OK. Frank has a large bulbous nose, his eyes are closed, he has shaggy straw-like grey-brown hair, he has a bit of a five-o-clock shadow that extends to his mid neck. We don’t see any piercings or tattoos. I raise his eyelids. He’s got bright white sclera with hazel eyes. His pupils look like tiny dots. I feel a little nauseous looking into his eyes and close them again. “That’s good, thanks John,” I say.

              Now that we’re acquainted with our cadaver, Frank, it’s time to get to work. I don’t want to do any cutting, I don’t want to feel like I’m hurting Frank. We are given a collection of tools, including a bone saw in order to crack open the chest to get to the heart. We bring up the dissection instructions on the computer. John agrees to do the initially cutting, he says he’s considering surgery. I’m grateful that he is taking the lead. We grab the bone saw. John cuts through Frank’s Sternum. Bone dust flies through the air. Elizabeth and I get some retractors and help pull apart the rib cage as soon as john is done. The ribs make a snapping sound that sends shivers down my spine. Frank’s chest cavity is now exposed. In the center lies his heart, with lungs on either side. There is a grayish discoloration to the organs. The lungs have black spots and streaks. We suspect that Frank was a smoker. We take the scalpel, john reads the instructions aloud while Elizabeth and I cut out the heart. I hold it in my hand, then set it on Frank’s stomach. It’s surreal holding another person’s heart in my hand, as though I’m holding someone’s life-force. I think about what a gift an honor it is that someone would donate their body so that we could do this and learn. It’s truly a privileged position. There is a lot of yellow fat around the heart, it does not appear healthy compared to the pictures I had seen. We examine the heart together and try to identify the vessels around it. Some of the vessels feel hard a stiff and calcified. This man certainly had some element of heart disease. Next we read the instructions to cut open the heart in order to observe the inner architecture. We cut open the heart, revealing the valves and trabeculations of the ventricles where blood would pool and be jetted out to the rest of the body in order to sustain life. We found a large clot in the left atrium. The anatomy professor came by and told us that that was common. When people died their blood stopped moving and pooled, and so the blood tended to clot in the larger spaces. He also explained that the hardness of the outer vessels of our heart could also be clots from a similar process. He stayed with us and made sure that we were able to identify all of the structures on our anatomy list. We were able to. He asked us questions about the function. As a group we did fairly well. It was an incredible learning experience. I don’t know if I ever learned more in two hours as I did that day. I felt like I needed to thank Frank again for donating his body for our learning. I secretly wished he knew that he was basically still alive in my eyes, creating community and growth in our group. We finished identifying structures, reviewed what we had learned, then placed Frank’s heart back into his chest cavity. We cleaned him up. We used a wet cloth to wipe up the scraps from the dissection and throw them into a gallon bucket to be disposed of. We put the cloth back on his face and zipped him up. It was time to clean up. We lowered him back into his table, went to the sink and got cleaned up. I told John and Elizabeth that I was glad that they were part of the group, and that I enjoyed working with them both and thanked them for the help. They shared similar feelings. We went and got changed, then it was time to go home. I had so many thoughts and wanted to process. I went on a long run as soon as I got home. I listened to my Japanese playlist on the run, it reminded me of the importance of being in new situations and developing new perspectives. I felt that this day had accomplished both. I was both nervous and excited for the next anatomy lab. I still felt weak on the subject, but emotionally I would be more prepared this time.