The First Cadaver and Other Reflections

So I have now completed a total of six days of medical school and it seems like a lot more than that - we have definitely jumped right into the program. That being said we are still being introduced to courses that will run longitudinally throughout the year. Thus far med school has been very organizedly unorganized or perhaps unorganizedly organized. Everyone seems to know more or less what is going on except for the students, that would be me. Like a herd of sheep we simply follow the other 20 year olds that look somewhat lost and have a red backpack. We all got backpacks on free day and they are a great way to recognize a person who you realize is in your class, that you have probably met but have no recollection of ever actually talking to. However, we are definitely learning. I can tell you most of the components of a complete blood count (CBC) and discuss the primary causes of Upper GI bleeds. I also know that you are supposed to hear all sorts of things through your stethoscope, and perhaps one day I'll even know what I'm listening to. The learning curve is steep, and I think next week it will get even steeper.

It may come as a surprise to some but lectures at medical school (of which we have a decent number) are very similar to lectures in an undergraduate degree. You might even say shockingly similar - there are good lecturers and not so good lecturers. People come late, other people (I might add that most of the med class are keeners) show up early. After four hours of lecture it doesn't matter how interesting it is but you are starting to doze off and your focus is slipping rather badly. The up side of these lectures is that they prepare us for the much more stimulating small group sessions. The lectures provide the background and then the small groups provide the reinforcement to make sure you've actually sorted out what you need to know. Our preceptors (doctor teachers) guide our small groups and are actually amazing people at the top of their game! We are also seeing our 'circle' of peers shrink a bit. By the end of the year we are going to know the people in our small group well but the rest of the 180 we simply don't have the inclass time to become acquainted with, that will have to happen outside of class time.

The list of recommended textbooks keeps growing - physical exam texts, general medicine, anatomy, physiology, pathology, haematology, and so forth. If I buy them all I'm going to need another room in my apartment just for the texts. Unsurprisingly these books cost an arm and a leg, but at least we'll learn how to justify an amputation in Course 2 where we talk about the musculoskeletal system.

We are already being inducted into a profession that is by its nature somewhat closed - we are gaining a very specialized body of knowledge that is necessary to do our job. For example in a recent lecture on transfusion reactions - problems associated with transfusions of packed red blood cells, platelets, clotting factors, etc that the public's largest concern is with viral transmission. The spectre of the HIV transmitted to haemophiliacs in the '80s still haunts the public. However, for the medical professional viral transmission, as a risk associated with blood transfusions is down at the bottom of the list of concerns. There is a whole raft of other problems that are far more likely to affect a patient than HIV. The statistics are something like - you are more likely to be hit by lightening than to be infected with HIV from a blood transfusion. Adding to this 'professional mystery' is the jargon that we are picking up. We will learn it to interact with other professionals but when dealing with patients we will have to remember to phrase it in understandable terms. One does not ask a patient if they are suffering from dyspnea or nocturnal diaphoresis. There are a multitude of wonderful terms that are perfectly accurate - exsanguination, hematochezia, hematemesis, polycythemia and yet disguise the problems one would be experiencing or the fear you might feel at (exanguination 'bleeding out'), seeing a toilet bowl red with fresh blood (hematochezia - blood by rectum), or vomiting up bright red blood (hematemesis). In contrast polycythemia (abnormal increase in the number of new red blood cells) seems less severe but also is a symptom of problems!

This afternoon we spent several hours in a series of stations to become acquainted with the anatomy laboratory. We looked at specimens of ulcerated and cancerous stomachs and then examined microscopic samples of these tissues (this is known as histology). This was followed by an examination of blood smears - both normal and abnormal. Then we spoke with some phlebotomists (people who collect blood) about blood typing (determining whether you are A+ or B-, etc) and transfusions. This was followed by our first exposure to a cadaver.

Because of the structure of Calgary's program we will not be following the traditional 'get a cadaver and cut it up' methodology sometimes associated with medical training. Instead we will look at prosections (prepared sections) and other specimens that are associated with the specific unit that we are learning. We will still learn anatomy and physiology but it will not be the traditional independent classes that you sometimes hear about.

The first cadaver I've ever seen was a male - his face and lower extremities were covered and his abdomen was opened so we could see the GI tract which is the topic of our study at the moment. Our excellent anatomy instructor pointed out the various parts of the GI tract, showed us where and how hiatus hernias develop, the various parts of the stomach (where different kinds of ulcers and cancers grow), and then the parts of the large and small intestine. We also discussed blood supply to the guts through the celiac, superior mesentary, and inferior mesentary arteries which branch off of the aorta at the celiac trunk. One thing that struck me is the size of the aorta, especially incomparison to the size of other components of the peritoneal cavity (most of the abdomen). It made it very clear why problems with the aorta are VERY serious. Another thing I noticed is how far into our body the spine protrudes. I tend to think of the spinal column being relatively flat but anyone who has seen a spine assembled (just the bones) knows it is not this way. The oesophagus or esophagus and the aorta run right along the bones of the vertebrae and it sticks up into the thoracic and abdominal cavities separating the various organs from one another. Suffice to say seeing a cadaver puts things in perspective in a way that a text book simply cannot!

Our final station was a discussion of endoscopy. Endoscopys are a procedure to look at the upper GI tract. There is an endoscopy simulator that was used to demonstrate a normal endoscopy and then repair an ulcer - this is a pretty cool piece of equipment (for around $90 000 you should be able to get an amazing piece of equipment)!

Today we received contact information for our Clinical Correlation preceptors. These are practicing physicians that are going to take us into the ward and introduce us to patients who are relative to the content we are learning at present. Thus, by the end of the month we will be interacting with real live patients, on the wards - Med school is COOL!

However, at this point in time this narrative has wondered on for too long as is. My alarm is going to go off too early tomorrow and it is difficult to learn when you keep falling asleep.