I've got a bonechip in my eye...and more substantive updates

We cracked open the head today. "Crack" really isn't the operative word here, since it was more like a wet, sloppy sound as the calvaria (skull cap) was being removed. As any shellfish eater can tell you, it's the sound made when opening a crab or severing a lobster head from its tail. Yeah, that sound. Aside from the prerequisite mechanical saw, a hammer and a chisel were also involved. While the saw was a lifesaver (I can't imagine doing it with a handsaw), it came with a spray radius of approximately 4 feet as bone dust flew literally everywhere. In retrospect, I could also compare the process to opening a coconut, because approximately the same amount of liquid came pouring out, to the delight of our professor wielding the saw, as the rest of us try to hide our grimaces and not think about cleaning up the mess later. At least Barbara's keeping herself hydrated.

It's been brain back-to-back these past 2 days, what with open head surgery yesterday and the cadaver dissection today. I wish the order were reversed, so that at I had more of a clue while watching the surgery. Well, probably not. I still don't have much of a clue, although I did learn that the absorbent pads the surgeon, Dr. M, placed between the brain and the suction tube were there to prevent him from accidentally sucking out the brain. Yep. Accidentally sucking it out. I'm glad he thought of everything.

The most interesting episode during the past 2 days for me actually came from watching how this surgeon dealt with delivering bad news. The surgery mentioned before was actually considered a 'heroic effort' by Dr. M, or as one of his colleagues put it, 'an academic exercise' because of the extremely low survival rate predicted due to the condition of this patient. That explains why Dr. M didn't react when the anesthesiologist reported that the patient's pupils were bilaterally dilated and unresponsive, as this is never a good sign (the brain is dying). As I later found out, the family had requested the surgery even though the patient was found in this state, and had remained there for at least 4 hours, possibly more, at another hospital. The surgical part was easy--it went by without a hitch. Telling the family afterwards that there is less than 10% chance of recovery was hard. Very hard. Lots of crying, tissues everywhere—confusion abounded. I applaud Dr. M for his textbook delivery of the news, despite the fact that he was addressing a crowd of 14 very distraught family members. Still, he sweated a lot.

We grabbed an ABP break. Dr. M devoured a chocolate covered pastry. We went back to his office where he began to review the next case. With a few clicks, his computer screen flowered with images, scans of all sorts, from all different angles. I'm flabbergasted by all the imaging technologies available. From a distance, it looked as if Dr. M was playing Zelda on his computer.
Another patient soon came in. It was more bad news: a brain aneurysm. That meant more tests, and possibly open head surgery. The patient and his wife were young: mid-forties, maybe even less. The wife asked all the questions. Dr. M spent 40 minutes explaining procedures. He had to rush it; the patient wanted to leave to pick up his daughter from school. They nodded awkwardly to me as they headed for the door. I think I smiled, although in retrospect, that was probably inappropriate. How do you smile to someone who's just been told that his aneurysm could pop any moment, and that'll be it? Dr. M, meanwhile, is back on the phone. He had another case coming in. And I was on my way out.

Hilarity

There is a tendency for hilarious things regarding bodily functions that seem to always happen around me. I admit, I most often am the gifted engineer, the blind watchmaker, if you will, guiding such events to fruition to the delight of everyone around me, or at least, myself. Our PBL seminar class was covering a case last week involving infertility, and it was my job to deliver a mini presentation on the causes and diagnostic signs of male infertility. The conversation that began as soon as I opened my mouth, went like this:

Me: "....On average, the sperm count of a normal fertile male should be around 20 million/cc, and our patient has only 10 million/cc. In total, the typical male produces 100 million/cc per ejaculatory period, with 5 cc being the average...and"

Girl : [interuppting me] "Oh wait...really? Only 5 cc? Because I swear it's more, sometimes, I mean..." [turning bright red] "Oh, god, well, that's... I'm going to stop talking now."

The fact that she was the only married person in our seminar made it abundantly obvious about to whom she was referring. My group leader, a 4th year med student, added a final comment:

"Well, I'm sure it depends on how often the guy gets off and how much gets emitted. Phil, you wanna research that too?"

boredom, continued

This roll came out better than expected.

boredom with camera

BGLT issues in health care

There are many. Below is a sampling of shocking findings that (if true) are just really sad.

1990: survey of lesbians in Michigan: 61% would not disclose sexual orientation to their health care providers

1996: survey of physicians in New Mexico: 4.3% would deny gay and lesbian people acceptance into medical school; 10.1% believed gay and lesbian physicians should be discouraged from OB/GYN training

1998: survey of nursing students: 13-24% 'despised' LGB people or thought they were 'disgusting'; 40% believed LGB people should keep their sexuality private (from their health care providers)

I got these stats from a conference talk on BGLT issues in health care delivery yesterday at school, and while I've not had a chance to verify the stats above (sampling error? investigator bias? how were questions phrased?), they are from a credible source. I hope the future looks better.

delerium

Freedom, horrible, horrible freedom!

The 3rd anatomy exam is over.

Now I have to start studying for physiology and pathology exams next week.

It never ends....

S2, 3, 4...!

Anatomy can be a huge drain. Its effects on the student body here are varying, but the quotes below, I think, capture our sentiments up to now:

***A female 2nd year anatomy lab tutor:
"You know what, that's the one thing about taking antomy that makes me sad. It takes all the mystery out of sex. I mean, take the cremaster reflex. I thought it was so cool when I tried it 'for real' and saw that it works. And then you realize that it's an automatic response, and that just kills it."

note: cremaster reflex: the reflexive action of the cremaster muscle to retract the testicles if the inner thigh is slightly stroked, presumably to protect them.

***A fellow classmate, enacting a 'cheer' thought up as a memory device for the nerve roots of the pudental nerve:

"Ready.....S2, 3, 4, keeps the penis off the floor!"

Priceless.