Everything I Learned in Medical School: Besides All the Book Stuff (8 page)

Chapter 18

Off With Their Heads

During our third year of medical school, our curriculum takes a unique turn. Most schools are organized so that students get two years of classroom education and two years in the hospital. Our school condenses two years in the classroom into one by simply teaching the basic materials. We do our two years of hospital training during our second and fourth years. But wait, you say, if you do only one year of classroom lectures whereas other schools do two, don’t you learn half as much? Yes, one could argue this. However, the reality of medical school, and essentially all of classroom learning, is that we memorize enough to do well on the test, and then press the “delete” key in our brains to make room for material we have to memorize for our next exam. None of us truly remembers the details of high school calculus, right? So really, one less year of memorizing and forgetting was fine by me.

So, we are left with a wide open third year, during which time we are let loose to explore research interests for the entire year. Whether it be sitting at a laboratory bench doing work in basic science, or collecting data on actual patients through clinical research, the year is wide open with possibility. And for those that aren’t inclined to spend the year doing research, they are allowed to take the year and work towards a second degree.

For me, I decided to participate in basic science research. I spent the year working at a laboratory bench, exploring a very specific topic with hopes of discovering something new and being able to publish my findings in a scientific journal. I had already decided that pediatric neurology would be my future career, so I chose to work on epilepsy research. My goal was to study a particular part of the brain known as the hippocampus. This was the region of the brain which was thought to hold the key in understanding how we develop seizures. In order to study the brain and how it changes during seizures, we used the brains of mice. The year was very mind opening.

Working with animals is difficult. Personally, my opinion of animal testing in laboratories has been mixed. On the one hand, it is unfair for us humans to take advantage of helpless animals and use them for our own gains in medicine. On the other hand, there are people suffering from diseases which we can potentially treat one day, and animal studies often provide useful data to help unlock clues to future treatment. Isn’t it better to do experiments on animals instead of on humans?

To start our research, we walked over to a nearby building which held all of the research animals. We would pick out a group of mice for an experiment, and cover their cages with sheets when walking out of the building so as not to anger any animal activists that may be walking by. The mice were then given injections that caused them to start seizing. Once they seized for long enough, they were given injections to stop the seizure. If they survived this process, their brains had to be collected to evaluate for changes. This is where it got tricky, and disgusting. To make this humane, the mice were injected with ketamine, a chemical which would prevent them from feeling any pain. Once we thought they were sufficiently doped up, I had to place the mice one at a time into what is best described as a tiny guillotine. But instead of a blade falling down, I had what was essentially one of those paper cutters we used in elementary school to cut large pieces of paper. So down came the blade, severing the mouse’s head. When the blade was dull, this would take two or three gruesome swings of the blade. And the most difficult part was sometimes watching the headless body start jumping and twitching as impulses from the severed spinal cord were sent shooting through the body. Even the severed head would sometimes move, as the muscles in the head contracted for one last time. It was horrendous. But as soon as the head was chopped off, it was immediately stuck into liquid nitrogen in order to freeze the brain, thereby preventing further damage to brain tissue from lack of oxygen. I then had to cut open the head and delicately remove the brain, hopefully intact. I must have cut off the heads of 100 mice during my year. I hated doing it every time, and kept justifying it with the hopes that my work would someday help patients.

But not all of the work was this gruesome. Eventually, once the grunt work was done, I began to look at one particular structure in the neurons of these mice known as actin, which I hypothesized played a role in epilepsy in a location of the brain called the hippocampus. Actin is the skeleton of the neuron, helping it keep its shape. It was a structure no one had looked at before in epilepsy. There was a chemical that was used to beautifully stain molecules of actin, and I stained lots of brain slices in hopes of seeing a difference between mice with seizures and normal mice. I never thought this type of thing could get me excited, but one evening, late in the lab, I had just stained a large number of slides, and was about to look under the microscope for the first time. It was then that I realized I was likely the only person in the world to look at this particular part of the brain, at this particular structure, in this particular disease. This would be a peak into the mystery of how we are made, the very goal of research. As I loaded the slides into the microscope, I could actually feel my heart pounding. And lo and behold, there was truly a difference between the normal mice and ones that were seizing! It was amazing.

The tough thing about basic science research is that in order to truly claim a new discovery, you have to prove you’ve found something with lots of different experiments. Unfortunately, I could not replicate my results with other experiments, and therefore, could not share my findings with the world through a publication in a science journal. Yet, I know this was something significant, and am sure someone will prove it someday.

All in all, it was an amazing year in the lab. I realized I lacked the patience to do this type of research my whole life, but gained an admiration for those that dedicate their lives to the lab in hopes of advancing our field.

Chapter 19

Every Student’s Enemy

There is a voice that constantly speaks to you. The voice pops up at the most inconvenient times. It brings up past failures, and weighs you down with pessimism. The voice follows you every moment of the day, and is impossible to avoid. This voice is the self-conscious of the medical student. For some, the voice speaks much louder than for others, and for the ones fortunate enough to have a quiet self-conscious, medical school becomes much easier. But every student has this voice, and it can become a true burden for some.

The simple fact of medical school is that you end up throwing together a bunch of over-achievers, those that excelled during their undergraduate years and were at the top of the class. But all of the sudden, they are placed into an environment where everyone is bright, and they become simply “average”. The change from superstar to mediocre leads to a great deal of self-doubt for the typical student. No one really talks about these feelings, but it happens to everyone.

Take myself for example. There were multiple times during my first year where I worked relentlessly to learn the minutia of basic science. But when it came time for the exam, I would end up doing only average. “How did they do it?” I’d ask myself of those that were at the top of the class. After all, I was working constantly, so how did they know more than I did?

We would have smaller group discussions a few times a week in which we would discuss topics with a professor. The 15 or so students would go over the material and ask questions. Every now and then, the professor would throw out questions to the group, and for the majority of these questions, I had no idea what the answer was. But someone in the lab always knew the answer. And with every answer I didn’t know and someone else did, I felt progressively more stupid.

Given the fact I felt this way, I can only imagine how those that were doing worse than the average felt. The medical student brain does not accept average, and below average is usually not even on the radar, but someone in medical school has to be below average. In fact, half of us have to be below average.

I eventually developed ways to come to terms with the voice in my head telling me that I wasn’t cut out for a life in medicine. For example, sitting in lab, I realized I was putting myself up against the entire lab. If I didn’t know the answer to the question, and someone else did, that did not mean everyone knew the answer. Chances are, the majority of my classmates also didn’t know the answer. And there were obviously a few times I knew the answer when no one else did. Everyone was in fact probably on very similar levels, but by placing myself against the entire lab, it was easy to make myself feel inadequate.

When all was said and done, I found myself in the upper 25% of my class. I have no doubt that even those that ended up in the top 10% doubted themselves on multiple occasions during medical school. It’s a completely normal part of being in a competitive atmosphere. But I learned the importance of doing things at my own pace, and trying to focus on the finish line rather than on the other racers.

Chapter 20

The Anatomy Lab

The popular media has an interesting perception of the anatomy lab. Dissecting the human body is glorified as some kind of right of passage for a medical student. It weeds out the weak ones that can’t handle the gore and blood, right? Well, not exactly.

We began work in the anatomy lab just a few months into our first year of medical school. Our entire class was divided into smaller groups so that there were six students for each cadaver. Before our work in the lab began, we had a session with our professors to get us geared up for the months ahead. The lecturers spoke philosophically about spirituality and the questions about our own mortality that would eventually arise by working with cadavers. They discussed the privilege we had as medical students to see the human body in such a unique way. This session probably made me even more nervous about what was ahead for us.

The first day arrived, and we hit the locker room to change into scrubs. As we entered the lab itself, there was an eerie quiet, with tables stretched in every direction, on top of which lay the bodies wrapped in large, black plastic sheets. Everyone knew what was underneath, but it’s as if no one wanted to believe it until they actually saw it. We gathered around the table and were asked to uncover the cadaver. Ours was a slightly obese woman who was likely in her mid 50s, younger than most of the other cadavers. She looked fake at first, like a giant plastic doll, with a pale color and blank stare. But as we uncovered more of her, and saw her arms, her legs, all the parts constructed so precisely, so intricately, she soon became very real.

It’s hard cutting into a cadaver for the first time. We stood around, read over our instruction manual a few times to ensure we were cutting in the right place, and then I eventually volunteered to make the first cut. Might as well try to be bold, or at least pretend to be, I thought. I gripped the scalpel tightly, and moved slowly, not wanting to make a mistake. My hand trembled slightly, but inside, it felt as if it was shaking uncontrollably. My hand came to a rest on her skin, steadying it. I put the scalpel to her skin for the first time, and began pressing down gently to begin my incision. Suddenly, she bolted upright and let out a blood curdling scream! Well, in my mind she did, but I tried to brush those images aside. The skin was tougher than I had thought it would be, and I found myself really working hard to cut through it. But eventually I made it through, and the most difficult cut of the entire month was over. We made small jokes throughout this first day, which were all quickly followed by nervous laughter. This became our lab group’s defense mechanism of sorts. It was a way for us to get through the dissection without constantly thinking about the fact that we were cutting into another human. But despite this, every now and then, there were times of reflection, when thoughts about our cadaver drifted from the dissection to questions about her life. Was she a mother? What kinds of food did she like? Did she wonder what students would be dissecting her after she died? Would she have been happy with the way we were treating her? What would her family members think? What was her name? These human questions made it more difficult to cut into her day after day. The more difficult it was, the more we would laugh.

There were days that were particularly difficult, one of which was dissecting the hand. Maybe it’s the uniquely human features of the hand that made it so difficult. We would pull on the tendons of the wrist and watch the fingers bend, giving motion to the lifeless body. It was amazing to see how a truly human action can be broken down into simple mechanics.

Another difficult day for me was dissecting out the brain. The first part involved removing the skull from the top of the head. We cut around the head with a buzzsaw. When we finally got all the way around, the skull was ready to be lifted off. It was as if we had cracked the lock on an ancient treasure chest, and would now see the riches inside. And there it was, the center of human life as we know it, the brain. We delicately cut the spinal cord attached to the bottom and all the various nerves attached to it. The brain was eventually completely loose. I pulled it out of the bony skull where it had faithfully resided for the past 50 years. I held it for a few seconds. There, in my hand, was the entire existence of this person. All of the memories of a lifetime, all of the knowledge, all of the love and emotions that made her who she was, all within this small object. The most advanced computer system ever built, and I could hold it in the palm of my hand. Unbelievable.

I don’t consider myself a spiritual person. All of the classes that taught of the biology behind life, of evolution, and of the basic science behind our universe made me question the existence of a higher being. But ironically, in this anatomy lab, a place one would imagine as the epitome of hard science, I found myself thinking more spiritually than ever before. With each dissection came more fascination with the wondrous and intricate construction of the human body. Every muscle, from the large muscles of the legs to the small muscles of the eye, lay in the exact same place in every cadaver. Each kidney, with millions of tiny threadlike nephrons, had at one point relentlessly worked to filter blood. Each brain, with its billions of neurons and hundreds of nerves that connected it to the rest of the body, lay in perfect harmony to create a beautiful network to control every process of the body. I couldn’t help but think that such a perfect creation could only have come about through the work of a higher being. It was just too perfect.

The anatomy lab was undoubtedly a challenge. But no one dropped out of school because they couldn’t deal with dissecting cadavers. No one fainted. No one vomited because of the gore. It was in no way a right of passage, but truly a privilege. For the first time, it became obvious that the field of medicine would allow me and my colleagues to see the human body in a way not many others ever would. And by getting this intimate look into the structure of the human body, we not only learned anatomy, but learned to appreciate the intricacies and precision within the human body. Along with this came the humbling realization that not even a lifetime of work as a physician would allow us time to learn about all of the body’s complexities.