Whatchu talkin' about [Circle of] Willis?!

"Note: do NOT decapitate the cadaver" - Anatomy dissector guide.

Easier said than done, actually, when you consider that the last several weeks have involved sawing through the skull to peel out the brain, disarticulating the skull from the spinal cord to expose the back of the larynx, removing the skin to visualize the muscles of facial expression, sawing again to bisect the face, and removing an eye from its socket.

This of course is in addition to previously removing all the organs, sawing the thorax apart from the lower body, bisecting the pelvis, and more recently, slicing the brain into tiny pieces.

Barbaric? A bit. Tiring, frustrating, tedious and serial killer-esque? At times. But our now completed gross anatomy course was also a pretty phenomenal experience - humbling, challenging, rewarding and (literally) eye-opening.

I can't say that I'll miss the smell of formaldehyde, but I remain incredibly grateful to the women and men who donated their bodies to further our education.

To them and their families: Thank You.

Homeopathic ER

In case I don't pass this mega neuro block that has dominated the past month, I suppose I could always try working here...

Friday's Food For Thought

Typically sage wound care advice from The Onion's health desk: pick at it.

"If it doesn't smell like cheese, don't worry: You just need to pick at it some more. "

"Remember, the two best doctors in the world are right there at the end of your hand: your thumb and your index finger. So get in there and pick it!"

I'll try recommending that next time I'm in the ER.

A Friendly Reminder from the ER

As much of the country begins cleaning up from the snowstorm, just remember: hands and snowblowers don't mix.

Update: Shoveling can be pretty dangerous, too, says the American Journal of Emergency Medicine.

Open Wide

Popular imagination aside, in my years spent working in the emergency department, foreign body removals just really weren't that common. Of course there were occasional instances where objects found themselves in unlikely places -- "Sir, either we wait for the laxative to help the golf ball out, or I'm afraid you'll need surgery" -- but they really weren't a frequent occurrence.

I can also dispel any rumors of a "hall of fame" of removed objects... you'll find no drawer of lightbulbs or Coke bottles in the Big City ED. You will, however, find a very impressive collection of foreign bodies detailed in a new book about a pioneering endoscopist. Profiled in the NYT, Swallow tells the story of a turn of the century physician who removed (and kept) everything from keys to miniature binoculars from inside his patients.

Makes the pen I once saw fished out of a patient's throat seem not nearly as impressive.

Art Imitates Life

Stolen via facebook from a friend of mine, a cartoon guide to becoming a doctor. Very funny, and from what I've experienced so far, scarily accurate.

Just One More Question

In addition to our love of distinctive coats, Lt. Columbo and I share something else in common: we're always asking one more question. As a first year medical student, I practice taking a history and physical on patients in the emergency department. It's a great learning experience and a needed counterbalance to the hours spent in the library, but it requires some patience from the patients.

A typical ED patient will be likely be asked a similar set of questions by a triage nurse, their actual nurse, a resident, maybe a 3rd or 4th year medical student, and the attending. At the end of a long and uncomfortable visit, plucky Second Shift, MS-I might not be exactly what the doctor ordered.

Which is why my mentor and I always ask the patient's permission before I take their time, explaining that this opportunity is a valuable part of my education. If the patient looks too sick, or would rather not be bothered, we thank them for their time and move on. A few are annoyed at the interruption, some respond only with terse replies, but the overwhelming majority generously give of their time and eagerly participate.

While reconnecting with family over the holidays, one older cousin asked if I had begun interviewing patients yet. He angrily recounted how a medical student once asked him about symptoms that he never had, accusing the student of being lazy and not taking the time to actually read his chart. I tried to explain things from the med student perspective, but whether the student was actually lazy or just conducting a review of symptoms, we'll never know.

So, to anyone who has ever endured a barrage of seemingly random questions from a neophyte medical student: Thank You. It may be a bit of a hassle, but you really are helping us become better doctors.

Friday's Food For Thought

Identifying structures in the murky, monochromatic mess of an MRI of the brain is just one of the many challenges of our recently begun neuro block. (Memorizing hundreds of new anatomical terms would be another.)

While a career in neurology is almost certainly not in the cards, I have looked at enough scans to recognize that the above image is not -- despite its slight resemblance -- a human brain.

It is, however, an MRI of a bell pepper.

Thanks to a friend who trolls the internet to find awesome sites like these, I have been procrastinating lately by spending time on the "Inside Insides" blog, which features MRI scans of food (check out CT scans of a chicken McNugget here).

And now, back memorizing those cranial nerves...

Hmm, You Should Ask a Doctor

Typically when I gather with my family around the holidays, everyone enjoys retelling the same embarrassing stories of yesteryear. That time when I vomited out of a moving vehicle. The trip where I ripped my baby brother's stuffed animal out of his hands because I was scarred of the baggage claim at the airport. And who can forget the day when wee little Second Shift got so excited at Discovery Zone, he found himself in need of a dry pair of scrub pants? Ah yes, the memories.

This year, however, was the damnedest thing. Rather than the 20th recounting of how I very nearly burned the house down with a birthday candle, family members were instead seeking my expert medical advice. Now, they warned us that this would happen when we received our white coats, but I thought if anyone could see through that charade, it would be the same folks who remember me from my too-fat-to-wear-a-turtleneck-because-it-would-strangle-me days. I was wrong.

"I've had a pain in my back, but today it moved to the front, why is that?" "Can I take medicine X with medicine Y?" "You're the doctor, why do I sometimes wake up with a stuffy nose and sometimes not?" "Hey cuz, can you write prescriptions yet?"

Folks, if it doesn't involve one of the enzymes of glycolysis that I've long since forgotten, you're out of luck. Predictably, the only one not to get caught up in the collective madness was Uncle Jerk. As my father pushed him to seek my advice on his treatment options, Uncle Jerk replied that unless I had taken out a few hundred prostates in my first few months of med school, he'd stick with the real doctors.

Glad we're on the same page for once, Uncle Jerk.