It smells of burnt hair

14 01 2012

The skull is perhaps the most important protective bone in your body. It’s thick, hard, and nearly continuous, save the small exit holes it provides for nerves and blood vessels to communicate with the rest of the body. It protects you—your brain, a delicate ball of cellular mush—from all the bangs, bumps, and knocks you experience day in and day out. It’s safe to say that the skull, functioning properly, does not want to be opened.

Our cadaver’s skull was built in 1911. For a hundred years, it kept the brain of a huge, fridge-bodied man safe from the dangers of everyday life. And in death, this man’s skull did all it could to save his brain from the peering eyes of four first year medical students.

In theory, extraction of the brain from the skull is rather straight forward. The idea is to make a circular cut around the skull that is low enough to provide an opening for the brain (the skull is actually egg shaped, so the trick is to make the cut so that you have the widest possible opening). While this sounds easy, it can be complicated by several other constraints. First, the skull isn’t uniform in its thickness or shape; it’s actually composed of many bones that fuse together at irregular, suture-like joints early in life. Some of these bones are quite thin, such as the porous cribiform plate of the ethmoid bone that allows your olfactory bulb to project smell receptor neurons directly into your nasal cavity. Others are extremely thick. The petrous bone is one of these.

It’s a thick slab of bone that conducts your external ear canal into the depths of your head. Laying just at the level of the ear canal, the second trick to taking out the brain is to make sure your cut is also above the petrous bone, which is thick enough to resist even some of the most aggressive sawing. This becomes complicated when certain landmarks are missing, such as when an ear (or both) has been removed in a previous lab. With nothing more than a small external ear hole to set your landmarks, it’s easy to make trace an erroneous cut-path and not realize until it’s too late.

The tool we use to cut into bones is a wedge-bladed plaster saw. Rather than using a rotary blade, it vibrates a wedge shaped saw in a back and forth motion. This supposedly allows one to cut dense materials (like bone) and without damaging softer tissues (like brain). In practice, however, it acts a bit different. As the saw is meant to cut through plaster casts, cutting through a denser material like bone requires a lot more force to be applied to make the cut. For cylinder shaped bones (like in the leg and rib), it’s easy to see what lies beneath the bone and when your cut is through. This is not the case for the skull.

The first pass over was delicate; we wanted to try our best to avoid damaging the dura (a leathery covering over the brain) and the various cerebral structures below. After a few minutes, however, we found that this barely made a dent in the skull’s surface. Okay then, a little more pressure. As the saw makes its way deeper, you first see the smoke produced from hot metal grinding on white bone. It smells of burnt hair—which isn’t so bad, until you realize it’s small particles of a dead man’s bone that is literally wafting up to your own olfactory receptors. As you go deeper chips of white fly out. The sounds the saw produces become lower in frequency and feel more labored. Shielding your eyes is a good idea, to make sure any stray chips don’t make their way into you your cornea. A second pass through, much deeper, but the skull still does not budge. Now a third pass, to ensure nothing is missed. There’s a distinctive change in sound as the saw passes through the last of the bone and plunges into the dura and brain matter; it doesn’t belong there. Third pass complete, and still, it does not come off.

Other labs are finished at this point. We get the chisel and hammer, a set of tools that provides more force at the cost of specificity. We chisel around, separating most of the skull except for one part. It’s clear we’ve run ashore of the petrous bone, but by now there’s little that can be done. More banging, larger bone chips. I can see where we’ve pierced the dura now, clearly, along the edges of the entire brain. That wasn’t how it was supposed to go. With a few final blows the petrous is separated, along its most resistant portion, and the skull is completely free. Well, sort of.

The dura, the leathery tissue I mentioned before, also attaches to the inside of the skull to anchor the brain. The idea is to cut through the bone just to the level of the dura so that, once the sawing is done, you can use a small flat tool to scrape the dura off of the inside of the skull. Since we had cut the entire dura during our sawing and chiseling, there was nothing to get underneath. Another cut had to be made, a small wedge, up, to try and get an edge of dura for us to pry under. More sawing, more delicately, more time consuming. The dura gets cut, again.

The only other option is to probe under the edge of the skull, blindly, and hope to get an edge of the dura. It’s like fishing under your couch for a lost remote; you’re not sure exactly where it is, and you touch a lot of other weird things, but once you get it, you know. We finally get an edge and start prying the dura off of the skull cap. This also takes time and if you go to fast you risk ripping the dura. With some luck, we finally get the skull cap off, leaving the brain exposed but still seated in the bottom half of the skull. It’s a truly odd look.

More dura prying is required to remove the brain from the bottom of the skull, as the dura wraps around the brain completely. There are also nerves and arteries and veins at the base, the brains only life-lines to the outside body from it’s cozy, isolated cavern. These have to be carefully revealed and cut, as they are some of the most important anatomy to be studied about the brain. Then, there is the spinal cord, which also sits attached to the caudal (rear) portion of the brain. A laminectomy has to be performed, which means cutting into the vertebral bones just below the bottom of the skull. More bone sawing and chiseling. Only after transecting the spinal cord is the brain truly free and able to be removed.

It’s an extremely strange feeling, holding an object so delicate, intricate, and mysterious in the palm of your hands, exposed to air and light under which it has never, ever been before.


“Exhausted” State

15 09 2011

Sorry about the long long pause in entries… its been a crazy last couple weeks. Our workload has increased–massively–mainly due to the beginning of our “real” anatomy labs. Labs are long, detailed, and incredible. In the last two weeks I’ve:

  • Sawed into the ribs of a 100 year old cadaver
  • Held human heart, lungs, and numerous muscles in my hands
  • Cut open the vertebral column to directly look at the spinal cord
  • Touched every muscle in the human back
  • and much, much more

The work we do is fascinating and instills a profound appreciation for the beauty of the human body. It’s also time-consuming, difficult, and exhausting. Labs are from 10:30 – 5pm with a short, optional break for lunch. During the brachial plexus dissection I went straight until 3pm until I started getting light headed and had to sit down and eat. It’s also frustrating. Our cadaver is not well preserved and finding the structures we’re supposed to find can be an incredible challenge. The back was the worst. While most cadavers had nice pink, semi-dry muscles that could be easily separated, ours was mostly a raw, fresh-from the butcher looking mush of red.

All the anatomy labs have made for extremely long days. After getting out of lab at 5 I then stick around and study what we just saw from the dissector guide we have. Then there’s pre-reading to do for the next day. By the time I get home its usually around 8, 9, even 10. Dinner fits in wherever it can. My biggest goal right now is to keep up with both study and sleep at the same time; it’s difficult.

There’s so much else going on as well. I had my first session volunteering at the Rhode Island Free Clinic on Tuesday. I work to help people without jobs and health insurance get the prescription medicines they need. Interest group meetings are frequent and often consume lunch time—I heard a talk from an ER physician here in Rhode Island who goes abroad regularly to help deliver care in Rwanda… really inspiring stuff. I emailed him and he’s going to let me shadow him at the Rhode Island Hospital in October. Can’t wait for that.

Parents weekend is coming up too. It’ll be great to see the folks and show them exactly what all that tuition is going for. I hope they like it.

Quickly losing my train of thought here so I’m going to sign out. I’ll try to be more regular in my updates in the near future.



22 08 2011

Rhode Island is a different world. It’s been difficult to acclimate to the whole setting so far—the driving, the people, and simply being so far away from “home.” The people—and by “the people,” I mean, the townies—are strange. Everyone acts like they have something to prove… and most do it stupid and ridiculous ways. Revving bike engines, shouting in the streets, cutting out you off for the sake of cutting you off… its daily here. Pedestrians make cars their bitches here. Yesterday I had a guy walk out in front of me right as the light turns green (pretty common), then continue to block me off as he crossed the other side of the street (I was making a right) as slowly as possible. People let their kids perch right next to the curbs of busy mainstreets. Weird man, I tell you.

Class is interesting but draining. A lot of the material is review right now, but they keep adding on new proteins and molecule names we’ve never studied before. I understand the big picture of it all, and most of the major details, but worry about how much of the minor details I’ll be expected to remember for the test (which is on Friday next week—ergh). What I do like is that we’re starting to transfer into the “real” schedule, away from the full-lecture based schedule. Tomorrow is day two of Doctoring, where we learn to interview patients, take physical exams, etc. I’m really looking forward to it since I feel it should come naturally to me, after all the time I’ve spend watching doctors do it. It’ll be fun to finally be the one asking ALL the questions (and not just , “do you smoke?”).

We also start *real* anatomy this week. I got my cadaver information today— apparently he was college educated engineer that lived to the ripe age of 100 and died of cardiac arrest. We also got… well, you can see below. Pretty nifty, and 100% real.





16 08 2011

It’s been a bit difficult getting into the new routine of things, but I’m trying my best to embrace it. Time really does seem to fly, or has at least for the past two days. Lectures crawl by while you’re in them (at least the biochemistry), but seem like a blur once you’re done. The past two days I’ve finished the day going, “Really? Time to go home?”

Once I get home I try to take a load off and just dick around for an hour or so. Catch up on emails, read some news, grab a snack. Then study time. Review each of the lecture notes in detail; usually three or four lectures of material. After that, make some dinner and then relax. I feel pretty on top of my game thus far–but not ahead. My goal is to get it so that I’m previewing the lecture notes (they’re given to us in advance) the night before, going through and annotating them in lecture, and then reviewing and clarifying that night while previewing the next days. It’ll take some fine tuning but I think its definitely possible, and if done right, should save me a lot  of study time and effort when the exam comes.

The whole iPad thing is pretty interesting so far. I was relatively skeptical at first, but in just a few days I’ve really come to like it. I’m the type of person who likes to both scribble on notes while taking few extensive clarifying notes. In the past laptops have been all but useless in science classes due to their lack of a good way to draw. I’ve usually used a spiral notebook, but that can get tiring especially if theres a lot to write down. Having the lecture notes open on the iPad, where I can both draw on them and type (albeit with the onscreen keyboard; I’m not down to pay $50 for the wireless keyboard yet) has been pretty nifty. I’m really starting to see the power in the whole system, how I can have all of my notes in one tiny notebook for the entire semester (year? four years?), along with textbooks and access to internet (wikipedia is great for clarifying things I’m too afraid to ask in lecture).

Oh, I forgot to mention—got to meet Rhode Island state senator Jack Reed yesterday during the opening ceremony for the building. I’m looking forward to see what kind of influence I can have (or at least how I can get involved) politically in this tiny state. I know that I won’t be satisfied in my career unless I have some sort of role beyond that of a pure clinician.

That’s it for now; time to get some sleep. Until next time—

Day Zero

14 08 2011

Tomorrow I begin my medical training—kind of weird huh? All the premed classes, MCAT studying, primaries, secondaries, interviews, and post-interview letters lead to this. I feel like Homer in that episode of The Simpsons, getting to what seems to be the peak of my climb only to find out it’s just the beginning. Only up from here.

I’m incredibly excited. We had orientation this week and it reminded me of all the reasons I’ve chosen this path. Brown is an amazing place where I believe amazing will happen. The curriculum is all integrated and we begin doctoring in just a few weeks. All of my peers are extremely accomplished individuals; future leaders, no doubt. I can’t wait to get to know them better.

You can see the brand new building we get to learn, study, and practice doctoring in up above. It’s fantastic. They’ve also introduced a new “academy” system such that the entire school is broken into one of three academies—Blue, Green, or Red. I’m Red. We each get our own study space/kitchen/hang out area in the new building—it’ll be interesting to see how it plays out, if it actually fosters a more collaborative environment or just becomes a novelty.

The building “officially” opens tomorrow so our class schedule is light—only about 4 hours tomorrow. From there on out it’s about 6-7 hours per day; 9 to 4pm. I’ll do my best to post regularly and give a look at what exactly I’m doing, or even better, thinking. Stay tuned.


8 07 2011

I didn’t end up updating anything past the third day of the trip–sorry! The good news is that I’ve been inspired to keep using this blog and update things as I go through med school. I saw another students blog from five years ago that he kept all the way up through residency, which is pretty cool if you ask me. I’ll also use it to give all of my family and non med-student friends an inside look at what I’m going through (if they want to read it anyways).

The whole process of getting up to medical school was fascinating, and I’m sure going forward it will be as well (well at least to me). Maybe it will be to others too. Stay tuned.

What. The. Phuck.

12 06 2011

Day 3: 800am

After very little sleep on the bus we got into saratthani at  7am. The whole directionality of getting around here is really confusing. As I watched the sun rise to the left of me, I realized we were going north, not south as common sense would suggest. Not sure how or why that is.

We finally got to a random stop point and transferred into a tiny tuktuk for people going to Phuket. 10 minutes later we are at another nondescript stop waiting for a mini-bus. The man in charge says it’ll be here at 830. So until then we wait. I can’t wait to take a shower. 

Still on the bus. Turns out there was no minibus and we were simply waiting for another big charter.  We were first on, which was nice I guess, except we spent the next hour waiting for the bus to fill more, and then an hour after that driving around town untill we could find enough to completely fill. We’re at some random stop now on a 15 min bathroom break. I just want to be in Phuket at our hotel. I think its going to be  another 1.5 hrs.