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Warning: This is another graphic dissection-related post and possibly contains some of the grossest descriptions yet. I also might ruin oranges, cottage cheese and s’mores for you forever. Read at your own risk.

Do you know what you get when you send out an email asking medical students if they would like to give up an afternoon to assist with an optional brain removal dissection? A lab full of medical students wielding bone saws and chisels.

Where do we cut? The top part, right?

(If you’re already rethinking your commitment to reading this post, the back button should be at the upper lefthand corner of your screen.)

We’ve started our unit on the central nervous system, which means I am in full neuro-nerd mode. (Another student called me that earlier today and I like the alliteration so well I decided to keep it.) We’re not actually doing a lot of cutting in our dissections for this unit, but the brains did need to be retrieved from their usual location. The idea was to use all of the brains from our cadavers along with a few supplemental brains* from surgical pathology so that we won’t have to alternate dissection groups like we have been doing with our cadavers.

Here is how to remove a brain:

First you have to remove the skin of the cranium. You do this by making an incision from between the eyes to the back of the head and from one ear to the other and then peeling back the flaps. This was a bit more intimate than I was expecting, given that we had covered the face of our cadaver on the first day of lab and had not uncovered it since. The rest of his body was devoid of skin except for the soles of his feet and the backs of his hands. In many ways our cadaver had ceased to feel like something that had once been a person. Uncovering his face and making that first incision between his eyes was different. I have a hard time attaching an emotion to it–I didn’t find it sad or gross or creepy–but I noticed it.

Peeling the skin off the bone of the scalp is like peeling an orange. It comes away with a good solid tug and makes that same soft unsticking sound The deep fascia underneath even looks like the white inner rind. Underneath, the top of the skull looks just like every skull you’ve ever seen, off-white and smooth. The temporalis muscle on each side (the thing that tightens up at your temple when you clench your teeth) is the only non-boney landmark. We reflected them back as well so that we would only be sawing through bone.

The striker saws have small, semi-circular blades. They cut through the bone pretty easily, but they are just unwieldy enough that it’s hard to judge how deep you’re going. The goal is not to saw through the entire bone, but rather a few millimeters deep and then to crack the rest of the way through with a chisel and hammer. Halfway through this process you have to flip your cadaver over to make a complete circle around the head. Then you flip it onto its back and saw across the top like a headband.

The bone saws kick up a lot of bone dust and the friction creates a bit of smoke. It smelled to me like burning marshmallows. (No, I wasn’t hungry during this dissection, I swear! I reasoned it out with another student later: marshmallows and bones are both made of gelatin, after all.)

Some of the cadaver brains weren’t properly embalmed, which brought a whole new meaning to the phrase “my brain is mush.” They were the consistency of cottage cheese and oozed out of the new opening in the skull. Even the anatomy professor was grossed out. Those brains were left in their respective cadavers with several layers of wrapping around them both.

Our brain was well-preserved. The skull cap made a ripping/popping noise as it came free: the sound of the dura mater (the tough, protective coating of the brain) pulling free of the bone. Then we sawed through the occipital bone at the back of the head so that the spinal cord could be severed.

Even then, there was a lot more to be disconnected: the roots of the dura mater, the vessels that carry blood into the brain, all of the cranial nerves (there are twelve pairs.) Then we were done, and the brain came free like it was never all that attached in the first place. What, all that work just for me?

Strange to think that the object I was cradling carefully in two hands (not-dropping a brain on the first day was pretty high on my to-do list) had held all of the thoughts, the memories, most of the personality of the person it once belonged to. It is dead now, fixed and quiet, but I wonder if someday we might be able to look at all of the connections that existed and see something of the thoughts that passed through it once. Or maybe we’ll discover that to be something completely unknowable, something greater than the sum of its parts. It sort of hurts my own brain to contemplate. In a good way.

Ze Brain

*Every time I say the phrase “supplemental brain” I want to make a joke about borrowing one for the next exam. I know, it’s terrible, but I just can’t resist.

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Okay, so this isn’t a blood draw needle, but you get the idea.

I’m thinking of creating a version of the Who Said It game called “Medical Students or Burgeoning Serial Killers?” Here are some approximate quotes I’ve collected over the past several months.

  1. “I’ll just keep all of the blood vials in this basket here until I can figure out how to dispose of them.”
  2. “Skinning a human cadaver is harder than I expected.”
  3. “We should get some pig’s feet to practice on. It’s more like human flesh.”
  4. “He gets all the supplies by telling the clinic staff we’re planning to practice blood draws.”

Okay, since I don’t actually know any serial killers in training (I hope),  the game is pretty one-sided for now.

For a bit more context (lest you think perhaps a quick call to the FBI might be in order), this week marked our foray into cadaver dissection, and also the third so-called phlebotomy party.

The phlebotomy parties came about around Thanksgiving after a primary care conference where students were able to practice skills like suturing and blood draws. I wasn’t there, but from what I heard, many of the blood draws were not terribly successful.

I don’t know about my fellow students, but practical skills in medicine make me nervous. I know that I can memorize pages of information and answer multiple choice questions with reasonable accuracy, but none of that guarantees I will be any good at basic medical skills like lumbar punctures or taking blood pressures. The latter I can practice whenever, at least. Mostly of my family and friends have been subjected to me brandishing my stethoscope and sphygmomanometer. But the stuff involving needles? At best you might get to practice them on a dummy, which is really not going to prepare you for a terrified patient, angry at being used as a training tool.

Blood draws, at least, are fairly straightforward. So with a few donations from a local clinic, one of my small-group classmates with some phlebotomy training gathered together everything we might need and had six of us over for dinner and bloodletting. After all, if you’re going to mess up poking someone with a needle, it might as well be someone who is planning to stick you right back.

The first stick is, in a word, terrifying. There was this moment before I slid the needle in that I was thinking to myself, “I can’t do this. How could I ever think that I could do this?” Then bam, a minute later I was triumphantly holding a full vial of blood, my heart pounding in my chest and a general feeling of “Holy crap, I can’t believe I just did that.” Then I turned around and offered my own arm up for some first-time needle sticking.

Our first session was such a success that the host has had two more since. They are well-attended and it is a relief to watch everyone go through the same spectrum of emotions each time: terror, followed by determination, and then elation at their eventual success. We can do this! It’s for real.

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Uh…now what do we do with it?

A friend of mine pointed out that as physicians we probably won’t be taking a lot of blood. That is more the purview of nurses and techs, even if we will eventually learn the skill. Still, it is a relief just to know that I can handle the basics. For the first time I was able get past the literal barrier of the skin, into the parts of a living person that we generally never see. I don’t expect this will make me less terrified or apologetic when I finally do have to practice on a stranger for the first time. But at least now I don’t have to wonder if I am even capable.

And, even if it’s only the barest of comforts, at least I can say, “I’m new to this, but I’ve done it successfully a few times before.”

Okay I’m going to say it. God may strike me down and the earth may cease to revolve around the sun, but here it goes:

I like organic chemistry.

Whew! That was easier than I thought. I’ll undoubtedly be made to regret my words before too long—next Tuesday I’ll find out that I have to memorize all 4,347 isomers of pentadecane or my model kit will try to eat me in the night—but for right now I’m honestly enjoying organic chemistry.

I’m not alone either. In the face of the evil, looming monster that is physics, organic chemistry has become a safe haven for most of the postbacs. My suspicion is that this may be due to it being the only class in which we get to play with toys. Okay, technically they’re called “Organic Model Kits,” but really they’re just tinker toys for nerdy people. My inner six year old is having a blast.

Unfortunately, even though I’m enjoying organic chemistry and maintain my deep abiding love for biology, I’m spend an absurdly disproportionate amount of time on the one subject I would gladly avoid altogether. That’s another aspect of this program that seems to be pretty universal: physics is difficult and unrewarding. It can be Newton’s fourth law.

This week we have our first two exams of the semester. The nervousness is palpable; by this time in the summer semester we were gearing up for our final exam. Now we’re facing two unknown quantities and trying to determine the best mode of attack. It’s comforting to be doing this as a group; no matter how confused or terrified I feel after a lecture or a quiz, there always seems to be another postbac who is in exactly the same mindset. Perhaps it’s a case of misery loving company, but when you’re surrounded by twenty-four intelligent, driven individuals who all still find physics utterly impenetrable…well we’re not going to be the first round of postbacs to all fail to get into medical school, now are we.

So keep your fingers and toes crossed for us this week. I’ll be back after the we show the laws the physics who’s boss. (The boss being physics obviously….)

Today I went out and bought a book.

I realize that this isn’t normally blog-worthy news, but to me this book, as well as the journey to purchase it, was my way of marking the end of chemistry and summer classes and the start of a well-deserved two week break.

Our final exam for general chemistry was last Friday. Grades were sent out today around three. I spent most of the intervening time checking my email like a junkie. Once I had my grade in hand, it was time to start on the million-and-one things-I-would-get-to-when-I-had-the-time.

Apparently the most pressing thing on the list was to get myself to Barnes and Nobles.

I have no self-control when it comes to book stores. The minute I walk in I want to buy the place. Everything looks good; the cheap shiny pulp novels, the somber looking classical works, even the cook books and travel guides. Never mind that I probably don’t even have time to finish the two books I was in search of, I just want to start in one corner of the store and work my way through until all the stories contained within the four walls are crammed into my brain. Today I felt like a starving person at a feast; so many delicious books to consume and only two weeks and twenty dollars to spend!

So if you’ll pardon me, I’m going to go delve into some fantastic writing and ignore that list of things I should be accomplishing now that I’m free from schoolwork for a bit. Cheers!

Saturday I turned twenty-five and took my first final exam of the year. Which sounds like it would be pretty miserable, but it worked out remarkably well. By 10:30 AM I was done with everything chemistry related for at least the next 24 hours.

Of course you can take the girl out of the chem. class, but it’s much harder to take the chem. class out of the girl.* Eight hours later found us attempting to organize picnic tables out front of a local restaurant and talking about…chemistry? And physics, and bio, and the exam, and the upcoming semester and…well, you get the idea. After doing almost nothing but eat sleep and live science for the past four weeks, it was hard to think of much else to talk about.

Today is my reset day; a day when I can clean and shop and wind myself back up for another four weeks of immersion. It feels a little like the slow ride to the top of a roller coaster you just got off of; the gut anticipation isn’t quite as intense as the first time around but your brain knows that the ride will be just as crazy.

*I’m twenty-five, can I still refer to myself as a girl? I keep expecting to wake up some morning and feel like and adult, but so far no dice.

I’ve never been the work hard, play hard type. I’ve got the first part of the equation down, but when all that hard work is over I pretty much shut down. I am a certified expert at wasting large blocks of time. Give me the internet and a comfy chair and I can be effectively dead to the world for five hours out of the day. Granted this isn’t my preferred state of being (actually I really hate it), it just seems to be my default. Inertia: if I keep moving I’m fine, but once I have down time, I stay down.

That’s actually a large part of how I decided I could handle the workload necessary to become a doctor. Sure I would be working day in and day out, but that would just keep me moving and as far away from my room and my computer as possible. School and work could fill all the empty hours of the day, and the leftover time would be enough to continue to meet my small social quota.

Which is why I’m really confused right now as to how much fun I’ve been having since I started the postbac program. Maybe it’s just that the concept of “weekends” is something that hasn’t existed me since my junior year of college, or that my momentum from studying all week is carrying over into my free time. More likely it’s the people I’m surrounded by, who all seem to fit that work hard, play hard stereotype to a T.

Regardless of the reason, I am having a lot of fun. Sake bombs Friday night, tubing yesterday. Exhaustion and sunburns have forced me to decline invitations to a party last night and polo match today. It’s ridiculous! I didn’t have weekends this full when I had twice as much free time!

I’m pretty sure this won’t last. School is going to get harder; volunteer work and shadowing are going to steal weekends, and when winter hits my energy will inevitably crash. But for now, I feel awake and engaged in my life in a way that I haven’t for some time.