easier than writing by hand…

my dad told me the other day about a report he heard on NPR the other day about a medical school back east (dartmouth?) that held a memorial ceremony at the end of the year for all of the body donors.  for each person, somebody reads a short description of their life, something about who they were and what they accomplished in life.  i suppose the point is to re-humanize that hunk of flesh that you spent the quarter taking apart like a beef carcass and to say thank you to the families of those individuals.  UW apparently doesnt do anything like that.  there’s a memorial ceremony for the families, but not for the public.  when i asked about it,  dr. g told me that maybe 10 years ago, some sophomore med students started having their own memorial services for the cadavers at the end of the year.  not that anybody knows what these people did for a living.  the university only gets their name, age and cause of death and we the students dont even get that much.

we have our theories tho.  for instance, team eastern europe (aka team moose) named their cadaver “the sarge” because they think he looks like an old drill sergeant.  based on our dissection of phil’s shoulder, we had a feeling that he was some kind of laborer for most of his life.  either that or he was a weight lifter.  even at the well seasoned age of 92, his deltoid muscle was immense as were the rest of his shoulder muscle, which we discovered when we filleted back the pectoralis minor, cut out the clavicle, and started scraping fat to observe the brachial plexus.  the brachial plexus is a large nerve complex where spinal nerves C5-T1 converge, split, converge, and then split again to send nerves to muscles in the arm and shoulder.

for some more interesting images, check here and here

next, we cut open the joint capsule on his right shoulder and practically pulled his arm out of its socket to see how the joint moved.

then, before lunch, we flipped them over to dissect the back.  believe it or not, this was hardly a trivial task.  and not just because these are stiff, heavy corpses.  in the previous labs, we had completely dissected the abdomen and thorax, but rather than discard the organs we had removed, we packed everything back into the body cavities and folded the skin back over them.  therefore, in order to flip them over, we had to make sure that all that stuff wouldnt just spill out onto the table and floor.  the first one i helped roll, we didnt think far enough ahead to wrap her up in the sheet she was covered in, so i almost got my hand pinned underneath her, holding her chest plate on.  by the time we got to phil’s heavy butt, we were working a little bit more efficiently.  once they were laying face down, we reflected back the skin to observe the musculature of the back and posterior of the arm.  of course, since these folks had been embalmed lying face up, all of the blood had pooled to their backs, so unlike the muscles on the front of the body, the ones we now saw were more colorful, almost as if they were bruised.  one interesting thing that was pointed out to us was a layer of darker, brown fat in the upper back that was different from the custard yellow we had seen before.  apparently, all mammals have this special fat that is used for energy and  fluid storage.  in fact, bears, camels and dromedaries have particularly large deposits of brown fat that make up the humps on their backs.

camels have one hump.  dromedaries have two.  good tip.
 
the last operation of the day was to dissect the knee.  in a brilliant show of planning, rather than do all of the anterior lab exercises first, and then flip the bodies over, i guess it made more sense from a learning standpoint to go from front shoulder, to back shoulder and then move on to the knee.  sooooo, we once again wrapped our dead friends up in sheets, soggy with embalming fluid and clotted blood, and man-handled them back over into a supine position so we could abuse them ONE LAST TIME!

cutting open the knee was something that i had been looking forward to for a long time.  given the 5 times that mine have been put to the knife, i figured now was my chance to play surgeon and exact my revenge on some dead people.  i never reckoned with the sympathy pains.  i dunno if they’re normally that tight or if it was mostly due to the stiffness of embalmed tissue, but those ligaments hold that joint together with extreme prejudice.  now i definitely have a better appreciation for what’s involved with doing an ACL reconstruction.  that explains why my hip is always killing me more than my knee after that surgery.  all the torquing and twisting necessary to get the joint open for the tools is pretty heavy and it all transmits down the femur to the hip joint.

and speaking of hip joints, here are the first and only pictures we were allowed to take in this lab.  at least one of our cadavers had a full knee replacement, but these hip joints were in a specimen bin.  these are highly polished titanium forgings, so even after a few years in the harsh evironment of the human body and going through the embalming process, they’re still shiny.   alex noticed it first and was looking around for a camera.  unfortunately, the one in my smart phone was the only one handy.  still… they came out alright.

ahhh the limitations of the worthless camera phone.  the other’s are here.

this was the last lab of the quarter, so we took a picture with in the hall at the end of the day with the skeleton of some poor, malnourished indian untouchable.

not everybody is in this picture.  some were still inside cutting up bodies.  guess they just couldn’t pull themselves away.  thx iman! =D

personally, i think the greatest tragedy is going to be the end of this anatomy series of blog entries.  in fact, one of you was so impressed,  he gave me an honorary degree in medicine from the NEJM.

guess we’ll just have to wait till i go to med school for the continuation.

now i can finally read angela’s write up.  she’s been waiting.
 

“now!  how do we get  the vaginal juices flowing?”

but… it was not to be.  instead, i had to make due with cranial nerve X.  below are the guts of my talk.  of course, i didn’t manage to make it all the way thru in thee minutes, but i was close enough to get full points.

refer to the diagram

I’ll be talking about the tenth cranial nerve.  using the mneumonic that matt taught us the other day, “OOO-to touch and feel virgin girls’ vaginas – ah heaven”  the tenth word “vagina” reminds us that the 10th cranial nerve is indeed the vagus.  so, in the end, even though i wasn’t assigned the female genitalia for my topic, i still managed work the word “vagina” into my talk.



“thank u dear!” - john clese


the vagus is cranial nerve 10 of 12 because somebody decided to start counting anterior to posterior, but i like to think it’s a 10 because it’s got it all.   it is a cranial nerve with efferent and afferent neurons.



•    it has a branchial motor component with cell bodies in the medulla that innervates the constrictor muscles of the pharynx, the larynx and the palate.

•    it has a viceral motor component with presynaptic cell bodies in the medulla supplying parasympathetic innervation to smooth muscles of the trachea, bronchi, digestive tract and cardiac muscles in the heart.

•    it has a viceral sensory component with cell bodies in the superior ganglion that recieves viceral sensation from the base of the tongue, pharynx, larynx, trachea, bronchi, heart, esophagus, stomach and intestines

•    it has a special sensory component with cell bodies in the inferior ganglion that senses taste in the epiglottis and palate.

•    and it has a general sensory component with cell bodies in the superior ganglion that brings sensation from the aruicle, external acoustic meatus and the dura mater of the posterior cranial fossa.

•    the only type of neurons it lacks are somatic motor.



the vagus arises by a series of rootlets on the side of the medulla and exits the cranium through the jugular foramen.  the superior ganglion is in the foramen and is associated with the general sensory component of the nerve.  the inferior ganglion of CN X is inferior to the foramen and is concerned with the visceral sensory component.



the nerve continues inferiorly in the carotid sheath to the root of the neck and through the superior thoracic aperture into the thorax.  once in the thorax, the right and left vagi take different paths.  in the neck and thorax, the vagus supplies branches to the pharynx, larynx, trachea, lungs, heart, and esophagus.  the vagi eventually join and contribute parasympathetic fibers to esophageal plexus surrounding the esophagus.  the plexus follows the esophagus through the diaphragm into the abdomen where the anterior and posterior vagal trunks break up into branches that innervate the esophagus, stomach and intestinal tract as far as the left colic fissure.

and that was it!  10 pts biatch!


in case anybody cares, here’s the rest of the 12 nerves.

1. O - olfactory nerve (CN I)
2. O - optic nerve (CN II)
3. O - oculomotor nerve (CN III)
4. To - trochlear nerve (CN IV)
5. Touch - trigeminal nerve (CN V)
6. And - abducent nerve (CN VI)
7. Feel - facial nerve (CN VII)
8. Virgin - vestibulocochlear nerve(CN VIII)
9. Girls’ - glossopharyngeal nerve (CN IX)
10. Vaginas- VAGUS!!! (CN X)
11. Ah - accessory nerve (CN XI)
12. Heaven - hypoglossal (CN XII)

apparently, (according to cheryl) this mneumonic is taught to every med student and undergraduate biology student.  with mneumonics it seems, the dirtier, the better.  just means you wont forget it.  i’m gonna start making up dirty mneumonics for fun.  maybe i’ll make a category for them.

getting in touch with my feminine side

personally, if i have to live with a remnant of female physiology, i would have preferred multiple orgasms. but oh, NOOOOOOOOooooo!  decided to keep that one all to themselves!  still, at least i dont have to deal with menstruation and pregnancy, so i consider it a fair trade.

warning:  sexual humor and innuendo follows.  oh and several references to intestinal contents.

there’s nothing quite like walking into the lab at 8:00 in the morning to be greeted by the sweet aroma of formaldehyde.  enchanting!  mesmerizing!  enough so, to break a person’s concentration.  take for instance the delicate operations of the first part of the day, removing the bladder and prostate.  of course, in order to access the bladder from the abdomen, one must first face the colon: the anatomy student’s deadliest foe.  the procedure is pretty straight forward.  tie off upstream, tie off downstream, cut in the middle.  when executed correctly, you should end up with two nice clean pieces and free access to the pelvis.  i have a feeling that the fumes and lack of sleep may have caused a bit of forgetfulness on the part of team eastern europe.  they forgot an important step in the process and cut into a full tube of crap.  not once, but twice before the end of the day, they ended up with feces floating in the embalming fluid soup in the back of the pelvic cavity.  there’s a lesson to be learned here kids.  always, ALWAYS, ALWAYS palpate contents down the colon to below the 2nd ligature before you cut through it!

of course, our table wasn’t flawless either. inexperienced as we are, we again mistook the fatty, hard portion of his sigmoid colon for his rectum and made our first attempt at tying off at least 6 inches too far up stream.  after making a second double ligature, tied extra tight, and cutting again, we ended up with a 10 inch long, semi-rigid, muscular tube of crap.  strait into the tissue bucket with that bad boy!  but at least we didnt spill any.  bladder and prostate came out extremely unwillingly, but when our instructor opened it up, we discovered another one of phil’s aging issues.  he had had the entrance to his urethra from his bladder burned out more than once to reestablish flow.  a procedure that i’m sure i can look forward to myself some day.  joy!

ouch

after lunch we moved on to the reproductive organs.  it’s pretty amazing how quickly everything backslides into frat house mentality and locker room humor.  of course, everybody starts out the day trying to maintain a relative level of professionalism and clinical distance, but all it takes is one comment on relative size and the next thing you know, it’s all hotdogs, penis enlargements and speculations about sexual prowess. when we originally covered this material in class, and talked about the dissections planned for lab, i had my doubts about how much we would have to work on with.  just from the brief looks i’d discretely made at phil’s nether regions, it looked like he had less than an inch of external genitalia.  compared to the moose man on one of the other tables, we really didn’t have much to work with to examine his erectile tissues.

as usual, we could count on phil to make things simultaneously interesting and infuriating.  unlike the other 3 male cadavers we had in the room who, if not necessarily well endowed, had what i always considered typical genitalia, phil had a ridiculously small penis.  lengthwise at any rate.  the thing that was remarkable about it was that the base of the glans (head) was attached directly to his scrotum.  attempts at stretching it out proved unsuccessful.  more than once, after i gleefully showed this to people, i was told,


“you know there have been numerous studies that have shown…”

at which point i would interrupt and say, “that only the first three inches of the vagina need to be stimulated to for a woman to orgasm?”

“that the flacid size of a penis is not a reliable indicator to its erect size.”

i was actually telling team eastern europe (the ones with the moose man) about it before i brought them over and they thought i was just exagerating for effect.  i said, “seriously guys, i’m being clinically objective here, i’m not just being a dick!  i mean… a jerk!”

yeah… it’s a groaner.

when it came time to actually dissect the penis, i stepped aside and let the girls at our table take over.  i suppose a lorena bobbit reference is obligatory at this point.

i couldnt find any pix of her on google.  can u believe that?  this is john

as you can see from the diagram below, the penis has two sets of erectile tissue.  the corpus cavernosum of the crus is the superior sleeve and the corpus spongiosum forms the bulb and glans that are seated in the crus.  the goal of this part of the dissection is to separate one from the other.  you basically stick a probe between the two parts at the base and rip upwards towards the tip.  then you make a cut from the superior part of the base of the glans downward and pull the whole thing apart.  u know, i read a lot about women complaining that men don’t know their way about the female anatomy (personally, i’ve known where the clitoris was since i was 13), but phil got his helmet cut off a little two far forward and clean thru at that.  i would love to pop the obvious joke in here, but would hate to have it taken seriously and piss somebody off.  to be fair, it was kinda hard to tell where his junk started and ended.  

hotdog in a bun?  thx for the visual ang.

just as an aside, after class, a group of us went to go see the hitchhikers guide to the galaxy.  i tried to coerce them to go get dinner and twisted flix with me afterwards, but they all balked, citing the desire to go home and take a shower (individually, i assume). still, if i hadn’t already been late, i would have done the same thing.  when u spend all day handling a dead man’s penis and rummaging around in his bowels, u wanna take a shower.  when u spend all day staring at the dried out, withered genitals of a 96 year old dead woman, you’re gonna want to take a shower.

if i were inclined to believe in an afterlife, i’d be worried that phil would come back and haunt me for the rest of my life for all the jokes i cracked about his penis. still, i am reasonably certain that despite his “shortcomings” phil had a happy sexlife and fathered many children.  i know this because i am also reasonably certain that angry people don’t donate their bodies to science.

happy people.  happy.

the green gall bladder

if anything, the split-pea or jade tones i’ve seen in the drawings didn’t do the color justice.  the real thing is a candy apple green, almost fluorescent, and after death, as the active transporters in the cell membranes cease functioning, the color leaches out to stain all of the surrounding tissue.

at any rate, speaking then from the standpoint of a student hovering over a corpse, there are two big problems to deal with.  the chief issue with working on phil is that nothing is where it’s supposed to be.  at 92 years old, the man was a ticking time bomb of pathologies and it looks like it was just a question of which one got him first.  official cause of death was chronic obstructive pulmonary disease, but other candidates waiting to do him in included polycystic kidneys (which i describe later) and an aortic aneurism in his lower abdomen that was so large and stiff that we initially mistook it for his rectum.  the plaque in the wall was over a half inch thick. he also had a hydro-ureter that lead to a kidney perforated with vacuous watery cysts the size of golf balls.  my guess is he was on the verge or total renal failure as well as ready to bleed to death when his aneurism blew.

note:  i contemplated putting a picture of a polycystic kidney in here, but decided that it was too, shall we say, unappetizing.  if you want to see one, click on this link.  make sure you do it well between meals.

the other problem is finding and identifying blood vessels and nerve bundles buried in fat gorged spaces between the organs.  the way the instructor frees these things up and makes them visible is by ripping away rather violently at the fatty tissues they invaginate with the blunt end of a scalpel or a pair of clamps.  this was great up in the thorax, but in the abdomen, all that poking and pulling had me scared shitless about puncturing a bowel.  no pun intended.  we had been thoroughly warned against it both by the instructors and by other people in the class that have dealt with the bowels of other animals in other classes.  i didn’t want to be the one responsible for fumigating the class with colonic gasses and causing mass exodus of the anatomy lab.  incidentally, phil’s colon was full of gas and it burbled at us constantly through the course of the day.

my fears were not unfounded either.  at one point, we had to remove the stomach in order to get at the pancreas, spleen and left kidney.  the procedure here is to tie off the duodenum (first part of the small intestine) just below the pyloric sphincter, massage the feces down the small bowel like a tube of toothpaste, tie it off again an inch or so below the first tie and then cut the tube.   sounds simple enough, right?  let us itemize the issues…

mistake number 1:  doing this 5 minutes before lunch
mistake number 2:  doing it at all.

for some reason, i volunteered to do this stunt.  after i made the first tie, i put the intestine between my thumb and forefinger and started pushing stuff down the tube.  you want to go well below the next tie-off point so that there is no chance of anything being left in the section you cut.  what i didnt realize was that obese people generally have thinner walls on their intestines and about an inch down, as i was pushing along, the tube tore on me and started leaking copious amounts of brown fluid.  a mad scramble ensued as laya ran away from the table and dale and i started flailing about looking for forceps to clamp it off with.  meanwhile, everybody else was washing up and leaving for lunch, so dale and i were abandoned to fight our battle with the bowels by ourselves.  in the end, i ate by myself.  tofu pho and a bubble tea.  yum =)

alex wrote a beautiful and poignant description of the lab and the people in it.  he worked in all of the anatomical names without sounding pretentious or presumptuous.  i am in awe and not just a little bit embarrased by the crap that i wrote.  he definitely has an eastern european ethos here.  reads a lot like andre codrescu, although maybe it’s just because i can hear his own russian accent as i read it.

wonderfully done.