Anatomy; ICM; sleep.

"Identify the teres major and suscapularis but do not clean them at this time." "Describe arterial anastomoris around the shoulder, list the terminal branches of the brachial plexus."

Suprascapular nerve.

Quadrangular space. Basilic vein. Medial cubital vein. Antebrachial fascia. Spinous fossa. Glenoid cavity. Supraglenoid tubercle. Infragenoid tubercle. Coracoid process. Greater, lesser tubercle.

The scalpel is mainly for skin incisions, reflecting the skin...Fine disection should be done with your scissors, probe and forceps [...] Blunt dissection is best done with your fingers. With your fingers.

Show proper respect for each cadaver.

Hypertrophy. Hyperplasia. Metaplasia. Neoplasia.

Zonula occludens. Adhering junctions. Dermatome. Intervertebral foramina. Spinal nerves have arabic numbers. 12 Cerebral. 31 Spinal.

My hands smell (make that reek) of formaldehyde. I will double glove tomorrow for sure. Or whenever our next anatomy day is. I do think that finding the nerves, arteries, and muscles help with the memorization. But do we really need to memorize all that? I mean, I am 80% sure that I am forgetting 80% of all this coming December 19th (that is the day after my final), to be never remembered again.

So I almost despise Anatomy. Make that I hate it. BUT I love learning clinical skills. My standardized patient yesterday said I did a really good job with the interview, he felt very comfortable with me. That matters more to me than retaining where profunda brachii artery is. I just think that it is so much more interesting to learn about things that make you think, rather than plain memorization. For instance, we learned to transmit information to the patient yesterday. As in, do I tell Ms. Doe that she has a 70% chance of relapsing if she doesn't take the drugs, that she has a 30% of not relapsing if she doesn't take the drugs, that I think she should take the drugs given her family history and symptoms, or that it is very likely that she will relapse if she doesn't take the drugs? How much is TMI?

We are also learning to engage the patient in her own care so she complies, learning to show empathy and that is OK to show sympathy--if it's honest.

We are also prompted to think of pro-bono work, of what would happen if we decided to treat that one friend of ours that doesn't have insurance (for free), and he went and told his buddies, and eventually our clinic became a madhouse. How would we deal with that?

I just learned today that if I am to convince a surgeon to take up one of my patients pro-bono, it will be more effective if I make the call. Funny, I always thought it would be more effective to have some PR/fundraiser specialist do that. I am horrible at asking for favors. Guess I better learn...

I think constantly of the two doctors I shadowed, of all the real-life situations I saw with them, of their mastery of medicine and of how artful they were in being humanistic, philanthropic scientists.

And I think of my students, of how they must have struggled with the Chem new vocab as I am struggling now with all this Latin. At least you can derive Chem equations. Latin is just plain nonsense.

So between now and December 18th, I see myself studying and studying and studying just to stay afloat. I do have really bad memory. Since I am not willing to fore go all my social/workout activities, this translates into less and less sleep. O well...that's what Med School is all about, right?

Time for some hillwork.

~e

The freckels

Today we were introduced to the bodies that are to serve as our anatomy "hands-on" models. Each group of 4 "gets to" dissect a body that has been very generously donated by someone that has passed on, and that thought that our trampling with their tissues, bones, and who knows what else, is worth it for the benefit of a greater good.

I think I have a woman (she was facing down and partially covered), I am guessing 60's, a little plump. Her skin is mostly tight (which wasn't true of all bodies), and because of the stuff they put in when embalming, she has reddish skin in some areas. She is also grey in other areas, and in some spots the two are mixed. So I couldn't tell if her complexion was yellowish, tannish, reddish, pinkisk, or simply pale by looking at her. But I could tell that she had a few freckles in her thighs and her calves. They were large, round freckles, a darker shade of gray than the rest of the skin. I thought they were unusual because there were none in her back. Maybe she got more sun in her legs than in her back?

And as I looked at the palm of her hand, ackwardly facing me while her body faced the table, I wondered if in a few weeks I will be this curious about her life, her death, and her reason to let us do all we are going to do to her body. All in the name of medicine.

I've been queasy since then, and my stomach was ready to bolt. And we haven't even started dissecting. That, too will pass. Right?

~e