Finding My Chi?

So, today I found my chi in the Alternative Med class. We were learning about Tai Chi as a means of healing and then we did this interesting thingymajiger by holding our hands out in front of us and then it felt like this fuzzy, static feeling in the distance between our hands and that, my friends, was my internal energy. Wanna feel yours?

Taken from: Chi Gong 101

I'm not going to undermine the art of tai chi and hundreds of thousands of years of ancient Chinese history and practices by suggesting scientific explanations for that staticy feeling between my hands. But, if that fuzzy feeling really baffles you, it might make you feel better to think of it as your personal bubble.

A Poem for Cardiology

I've spent hours studying, but despite all our efforts, some things remain unrequited...

Thus much and more, and yet thou lov'st me not,
And never wilt, Love dwells not in our will
Nor can I blame thee, though it be my lot
To strongly, wrongly, vainly, love thee still.
-Lord Byron

Your Eyelids Are Getting Heavy...

So I signed up for this random Alternative Medicine class this semester, mostly because I wanted to get elective credits for 4th year, but it turns out this class is actually kind of interesting.

Today, we learned therapeutic self-hypnosis and the speaker told us about how she actually hypnotized herself before she underwent a surgery for an ulcer repair. She told herself that she would bleed less and feel no pain. And then she actually showed us the video of her surgery, without ANY anesthesia, and she was totally fine, talking during the surgery about how she could feel pressure in her abdomen, but no pain at all. She even helped the surgeons realize that they were tugging too hard on something INSIDE OF HER. HOW STRANGE. How can you tell yourself consciously or unconsciously to control an autonomic process of the body? How can you control bleeding or hemostasis? What in the world?!? I'm so confused. And if it's possible, then wouldn't that be incredibly helpful for patients who don't want to experience side-effects of anesthesia during surgeries?


And THEN she hypnotized us. I GOT HYPNOTIZED. WHAT?! It sounds so mystical and other-worldly, but the speaker basically told us that self-hypnosis just entails entering into a trance state. Like for example, when you're driving and then 20 mins later, you don't remember the exact specific details of how you got to that particular portion of the highway, but some part of you was still consciously in control, enough to successfully maneuver the car. Still don't get how hypnosis can induce clotting. Anyway, I can't fully wrap my head around it. I've always been somewhat of an alternative medicine skeptic, but maybe I've just become a product of the intensely scienci-fied (yeah I made that word up) academic environment that I've been exposed to. Either way, very interesting stuff.

Did you know...

...amniotic fluid is actually baby pee?

So the fetal kidneys excrete urine into the amniotic sac and then the fetus ingests that back in and this process promotes normal fetal growth. So if the fetal kidneys are underdeveloped, the fetus can have significant problems because it doesn't have enough amniotic fluid supporting its growth. Crazy, right?! Bet you never made that connection.


P.S. Oligohydromnios = reduced amniotic fluid; This photo just shows different problems that can cause oligohydromnios.

Lethal Injection

I killed my first patient today. As the tiny heart pumped away beneath my fingers, I felt for the bottom of the ribcage with one hand and slowly pushed in a syringe full of potassium chloride with the other. The needle punctured the skin. As I aspirated, bright red blood flowed into the syringe mixing with the clear fluid I would soon be injecting in, indicating that my syringe had properly reached the heart. I slowly injected in the fluid and almost instantly felt the heartbeat slowing down, the fingers tightened, a subtle paleness engulfing the face which was teeming with life only moments earlier. Then there was a silent stillness. His heart had stopped. I had made it stop.

Okay, so I have a slight flair for the dramatic - my 'patient' was actually a small gerbil which we had just operated on a few hours earlier, but nonetheless I administered a lethal injection to a living being and directly caused its heart to stop beating. It might have sent a chill down my back in the moment, but in the long-run I have a feeling these poor gerbils will be dying for a greater cause, for the advancement of science, for medicine, for the improvement of human life...okay before I get carried away..

...a little bit about my summer research project:

Literally everyone told us first years to enjoy the summer between our first and second year of medical school, how this is the last summer of our lives, etc. etc. And so far, I can't complain - I've been having a pretty nice summer. I'm working on cochlear implantation research in the ENT department at UNC, using a gerbil model to try and find a method of detecting potential damage caused by the cochlear implant electrode while it is being inserted in a partially-deaf gerbil. Sounds like a lot of words, but basically the ideal patients for cochlear implants are individuals who are hard of hearing high frequency sounds, which are localized at the base of the cochlea. These patients usually retain lower-frequency hearing, which are more towards the apex of the cochlea. Here are some visual aids:

What a cochlear implant looks like (on an adorable baby):

This is a general photo of the position of the cochlea within the inner ear:
And inside the cochlea, there's a tonotopic organization, with the highest frequencies of sound heard at the base of the cochlea, and the lowest near the apex:
As we get older, we naturally lose our ability to hear some of the higher frequency sounds. Even by our teen years, we can't hear some of the more higher frequencies - and we just lose more and more of that as we age. If you want to see what frequency you can still hear, here's a fun website: How well can you hear?

So, when doctors insert cochlear implants, they aim to insert the implant electrode into the cochlea far enough so as to cover all the damaged hair cells (the sensory receptors of the auditory system). If the spiral cochlea was rolled out, it would look like this photo below - contrary to what you'd think, the cochlea is actually narrower at the base and widens as it gets rolled out towards the apex:

However, there's a huge risk of damaging the existing non-damaged, normal-functioning hair cells as the electrode is slowly advanced forward causing further hearing loss than the patient originally presented with.
So in this case, once the surgery is over, the patient will have better high-frequency hearing because of the implant, but will have lost the low-frequency hearing he had before, because the implant itself damaged the hair cells at the apex of the cochlea.

Currently, there does not exist a method of detecting whether the existing lower-frequency area hair cells have been damaged during the insertion process as the surgeons are doing the cochlear implantation surgery. This research project hopes to take a huge step towards providing that technology to the surgeons so if they detect the damage they have just caused, they can either know how far to precisely advance the electrode or if they've already caused irreversible damage, they can advance the electrode all the way to the apex of the cochlea, so the patient can have full use of the implant even at the portions near the apex of the cochlear, which the surgeon just damaged via the insertion procedure.
I know it sounds a little confusing at first, but is actually a pretty cool project. We basically advance electrodes within the cochlea of noise-exposed gerbils (whose high-frequency hearing has been wiped out), and try to see whether the electrode can detect the extent of the existng damaged hair cells before the electrode passes beyond them to potentially cause damage to normal hearing hair cells.
Bottom line: I get to do surgery on gerbils. And that makes me very happy.

+

= SUMMER FUN!

Long post, I know, but we're finally at the end. Hope everyone is enjoying their summers!

Quarter Past Med School

YESSS!! Just finished first year of medical school! We took our last exam this morning and then just wandered around campus doing random things. It's so odd to have that feeling of impending studying doom lifted from your chest. The rest of the day, I found myself returning to the library without even realizing it. Over the year, the Health Sciences Library had become my home base - studying consumed my life. And although it was difficult at first to be in a constant state of continuous studying, it became second nature very easily. Now, as much as studying had become a chore, I almost miss it. A few hours out - and it feels so strange to have no deadlines, no lectures to capture, no highlighting to do, no more structure, just freedom. I don't know how everyone else feels, but I'm totally loopy right now - I got 2 hours of sleep last night and I am off the charts excited to be done with this year. Did we learn a lot? Yes. Did I study my brains out? Definitely. Will I need to do a heavy duty review in the near future to solidify everything we learned this year? You bet. Is this going to be a fun summer? YES IT WILL. Have I asked enough rhetorical questions? Maybe. Am I on a post-exam-end-of-year high? There's no better way to describe it.

Cause of Death

Our final unit of Physiology block is GI and reproductive physiology. Physiology in general is full of more specific details about organ functions that although mundane at times, are at the very core of the understanding required to treat diseases. As exciting as anatomy was, knowing locations of nerves, vessels, organs is only helpful to a certain extent - knowledge of how they work and more importantly - what goes wrong when they stop working is crucial in trying to treat and heal.

GI Fun Fact

As much as I would love to share all the minute details we've learned so far in GI physiology, here's just one fun fact: did you know your intestines have taste buds? But why don't we taste food in our intestines? Because once broken down, you realize that taste is nothing more than the detection of molecules - pH detectors cue us in as to whether the food we're eating is sour/acidic and so on. Combinations of different molecules create wonderful tastes detected by our brains as such. When I say intestines have taste-receptors - it just means that they detect molecules like pH in our food in order to absorb necessary nutrients. How cool is that?

Penny's Peculiar Colon

So, upon reaching the GI/Reproductive portion of physiology, I realized I never blogged about dissection of the abdomen from anatomy block. Basically, once we'd finished the thoracic cavity dissection, we moved down into the abdomen. We cut the surprisingly thick diaphragm muscle separating the thoracic from the abdominal cavity and used our by-now expert scalpel skills to cut apart the skin and muscle over the abdomen. The most prevalent organs here were the small and large intestines - neatly sprawled across the cavity just like you'd see in an anatomy book. We found the pancreas, kidneys, very large liver and followed the path of a bolus of food from the esophagus all the way down. It was interesting to note that Penny's stomach was significantly smaller than other cadaver's stomachs. She had very distinct rugae (folds) within her stomach and the stomach was higher up - pushing into the abdominal cavity than it was supposed to be. Some surgeons walking around deduced that she might have had a procedure done to reduce the size of her stomach or maybe she hadn't been eating enough. We remembered that Penny didn't have a belly-button - most likely taken out during a similar procedure. (Although we had our fun convincing some gullible first-year medical students that her lack of belly-button was because she was born without one as a test-tube baby).

When we reached the lower-part of the colon, a surgeon helping us dissect, pulled out the entire lower part of the large intestine and showed us a rock-hard portion of the colon that wasn't supposed to be there. 'She must have had colon cancer' - he told us. We all took turns holding the mass in our hands - harder, stiffer than the rest of the intestines and very large - the size of a small fist - it was sticking out of the lower part of Penny's colon. We wondered if this was what had ultimately claimed her life.

'I feel like a serial killer'

In the next anatomy dissection unit - we dissected the pelvis. This was a fairly intense dissection - we had to saw down the middle of Penny's body (using a handsaw - see photo) separating the top half and the bottom half. And then the bottom half was further sawed in half to separate the two legs. This was the point in our dissection unit, where Penny was nothing more than the sum of her parts - body pieces placed all over. Sometimes, when we needed a better dissection angle, we would place her leg on her chest - so surreal.

Missing Parts
We dissected the pelvis and found out that Penny had had a hysterectomy - a surgery to remove her uterus. However, her cervix was still intact - and upon our initial inspection we concluded that her colon cancer had invaded her cervix as the large solid mass was taking up such a large portion of the area where Penny's uterus should have been. We wondered whether this was the reason her uterus had been removed.

Cause of Death Revealed
The last day of Anatomy class - we were supposed to find out the age and cause of death of our cadavers. Our group was fairly convinced that Penny had had colon cancer which had spread to her cervix. It turned out that it was the other way around - Adenocarcinoma of the cervix. The tumor in her cervix had spread upwards into her colon - because we had dissected the colon before the pelvis - we'd assumed it had been the colon first. It was a bittersweet kind of day - through clues we learned of during our dissections we had pieced together parts of Penny's life - and here just like that we had discovered the reason for her death. Another interesting fact we learned that day was her age at the time of death. We'd always assumed she was in her early 50s - 60s. She had lean muscles, albeit with a certain amount of fat, incredible calves telling us she must have been an athlete - her heart was in good condition, and her overall appearance was a fairly healthy one. It turned out she was 89 years old - one of the oldest cadavers in our entire class. Impressive, huh? Penny must have taken really great care of herself - and I'm proud to have had this interaction with her.

How Cardio Broke My Heart: Highs and Lows

High: Anatomy of the Heart. I loved everything about Anatomy block. And the heart dissection was one of my favorites. After using the autopsy saw to cut through Penny's ribs (we made a big U-shape - cutting up the left side, across the very top near the clavicle and then down the right side), we slowly pulled back the large flap we had just created. Using all of our man/woman-power, we were able to cut through all the fascia and tissues connecting the inside of the ribcage to the thoracic cavity.

Once it was pulled far back enough, we stood in awe at the inside of Penny's body. We were witnessing a part of her that no human on this planet had ever seen before. We were seeing a part of her that not even she had seen herself. Two big masses on either side completely covered the gem underneath, the lungs provided a cushion with the texture of a sponge. For a second, we were confused though - where was her heart? With help from a 4th-year medical student, we moved back the lungs and froze - for a second, none of us moved, our breaths stuck, our eyes fixated at that beautiful, colorful, surprisingly large organ we had been anxious to find. This incredible lifeless organ had vivaciously pumped repeatedly every second of every day of every year that Penny had lived. In fact, ours are pumping this very second and yet we will never see them in action within ourselves, but Penny allowed us to peer within her body and hold her heart within our hands. A truly beautiful dissection.



Once we cut the heart out of the body, I felt like a mother holding her newborn child. I was cradling it, staring lovingly into its angelic recesses, feeling a sense of astonishment and wonderment at this incredible creation. Looking around, we soon realized that each group had become very possessive of their cadaver's hearts. You couldn't hold any heart for more than a few seconds before someone came to reclaim their property. That was the newborn-phase, the this-heart-can-do-no-wrong phase. I will love it forever phase. Little did we know how our relationship was about to change....

Low: Physiology of the Heart (as was taught/presented to us). Valentine's Day was this past Monday and it just so happened to be our Cardiac Electrophysiology exam. I'm sure the Course Directors planned that - heart exam on v-day. But as important a subject as Cardiology is, I just wish it was presented to us in a better way. I usually never complain about medical school related-anything, because this is what I signed up for. Everything I'm learning now is going to be relevant to my future career in one way or another - and I love learning about all (read: most) of it. But I was absolutely disappointed by the heart physiology unit. It is a difficult subject as is, is a lot more concept-heavy than detail-oriented. My strong-suit has always been memorization of facts, details, clinical scenarios, so this was hands down, the most difficult unit for me thus far and my grade on the exam reflected that. Nonetheless, advice to future medical students: take the Cardiology block seriously, study hard no matter who teaches it, figure out how best to understand coneptual ideas and make sure to get it down -this is important stuff bound to show up again and again not only in your medical school career and BOARDS but in your profession as well.

Example of the confusion that was Cardio:

Yeah, I don't exactly know what this is - but our class material from cardio unit is copyrighted so I can't post that here - so I googled stuff and came up with his fairly scary-looking graph. I see this and my brain shuts down - which is pretty much what happened throughout the entire cardio unit. It's okay though - I still love that beautiful pumping machine- sometimes it's hard to love it, but I can't turn my back on it now - no matter how much it breaks my heart.

Through Death, We Learn of Life

Memorial Service

This past Friday we had a memorial service for all the individuals who donated their bodies for our medical education. Their families attended in attempts to gain closure, while we came to express our gratitude for the incredible gift that these individuals gave to us. We just finished Anatomy block in December, and I have been meaning to post about what a whirlwind experience it has been. After the somber mood set by the memorial ceremony on Friday, I feel odd chronicling about how much I enjoyed this experience, but this was in truth, the one course I had been waiting for ever since my very first dissection in middle school.

I can say for certain, however, that beyond the knowledge gleaned from this experience, the memories formed with my classmates and with our cadaver, will always remain with me. Penelope, Penny for short, (as we called her) allowed us to do the most disturbing things to her body. She donated herself for the medical education of complete strangers, but little did she know that we would leave having formed unbreakable bonds with her.

First Impressions

We were introduced to Penny on the first day we walked into Anatomy lab. With four students per cadaver, we walked into a room full of about 25 bodies covered in blue body-bags. Much like I imagine a surgeon meeting with his patient the day before a major surgical procedure, this first day was dedicated to getting to know our lifeless patient. The next day, we started our Back and Upper Limbs unit. Armed with my razor-sharp scalpel, I made the first cut - I still remember thinking how easy it was to cut through skin, fat, muscle, but at the same time wondering if she felt any pain.

Intricately Beautiful

Pretty soon, it became second-nature to forget about the possibility that I was hurting her. I became a little obsessed with dissection, going beyond what the lab manual directed us to do - intrigued by the incredible beauty of the human body, the intricacies, complexities, and even discrepancies. Following a regional approach to the body, instead of learning about each body system at a time, we studied all the systems related to a certain area of the body. So for the first unit, Back and Upper Limb - we learned about the muscles, vessels, nerves, and bones. We used autopsy saws to saw through the back bone - to study the vertebrae, spinal cord, nerves and ligaments. The most breathtaking part of this unit and one of my favorite segments of the entire block was dissecting the hand. Look at your hand right now and you'll see the tendons that run to each of your fingers. Bend your joints and you'll do so without even realizing the incredible harmony with which these tendons work together.
Here is a general Anatomy photo of the muscles and tendons of the arm and hand:

Here's a more zoomed-in photo of just the hand:

If you look at the second picture - at the FDS (flexor digitorum superficialis) and FDP (flexor digiotorum profundus) - you'll see how the FDP comes out from in between the FDS. And it is exactly like that in the real human hand. These Anatomy photos don't do it justice, but literally the FDS just splits into two to let the FDP come through it and then the FDS joins back up again. So beautiful. Here's an actual photo of a hand dissection, but this one shows the back of the hand:
Look at those tendons running to the knuckles. You and I have the same tendons - I'm using the muscles of these very tendons to type these words. It was one of those few moments in lab when I was dissecting the exact muscles that I myself was using to dissect with. I was using my hands to discover the mechanics with which my hand was working. I think I've said it enough times now, but still: absolutely mind-blowing, right?

More to Come

I wasn't planning on writing so much about just the hand, but each and every single day in Anatomy lab was such an adventure and each unit deserves a thorough post. So, over the next few days I'll try to add a couple more posts about our heart-stopping Abdomen and Thorax unit (where we dissected out that beautiful machine that pumps blood to your entire body), the Lower Limbs and Pelvic units, and of course the Head and Neck unit with all of its microscopic anatomy. I am entirely indebted to Penny and the rest of her friends for teaching us so much in the last few months - please say a little prayer for them - may they rest in peace.