Thursday, April 19, 2007

Is It Any Wonder?

Rat cerebellum from Nikon Microscopy U
Although Brain, Mind, and Behavior (BMB) has only started, this course already seems like it will be one of the most incredible courses of my academic career. At UCSF, we tend to study the body as organ systems, and for the longest time, our cadavers in lab seemed to reflect that piecewise academic philosphy. Our cadavers have always had their heads and hands wrapped tightly in white gauze, perhaps to obscure the most poignant and human aspects of the body until we medical students were more accustomed to working with dissection. Similarly, our courses on the heart, lungs, kidneys, and GI system have always shied away from the brain, the nervous system, and anything existing above the neck. Therefore, in my mind, the brain has existed as this black box throughout the first year of medical school, a topic that "we'll learn later in BMB."
BMB has already given me several mind-blowing experiences, but I will focus on two of them and they both occurred in the anatomy lab. The first one occurred when my anatomy group and I were inspecting the gross specimens of the brain, floating in buckets of formaldehyde. One of the brains was cut lengthwise, allowing us to see the cross-section. The cerebrum was interesting, but it was the intricate, leaf-like pattern of the cerebellum that caught my breath. Like parents amazed at how a little baby has dainty, perfectly formed fingers and toes...I was amazed at the precision and detail present on the inside surface of the cerebellum, patterns of loops and ridges that looked like perfectly sculpted branches of ocean coral or vivid fern leaves. Since I could not find a photo of a gross pathology specimen that could convey the beauty of the cerebellum, I had to settle for a fluorescent confocal microscopy image. In neurohistology today, we learned that early scientists called the cerebellum "the tree of life," and this reverence has also captured me in the same way.
The human body reminds me of the earth in many ways. A few months ago when we looked at the spinal cord, we cut a piece out and saw the nerve endings exiting the spine like little white roots (in fact the nerves are called rootlets). The white axons sprouting out of the brown, cakey flesh reminded me of seeing roots coming out of the dirt, and serves to remind me that we all return to the earth eventually.
My second epiphany occurred when I was watching the anatomy video in preparation for the second lab. It was 8 a.m. and I was sitting in my room at my desk wearing scrubs and eating breakfast and watching our professor pointing out different anatomical landmarks on a cadaver on my lap top. When I least expected it, the anatomy professor lifted away the skull cap and revealed a curtain-like dura mater. It was a whitish film. Then, the professor lifted away the dura to show us the BRAIN, and seeing that reddish, pinkish, purplish mass safely ensconced within the skull, finally exposed and radiant in all its brainy glory, made my whole mind stop in wonder for 10 seconds and I exhaled a long, breathy, "Wow." It was a moment of wonder, and I realized again medicine is the right choice for me. When we uncovered the skulls of our own cadaver during anatomy lab later that day, I was prepared to witness the brain's exposure, but it was still exciting to use a "brain knife" (ours looked like an oversized pate knife or butter knife) to cut our cadaver's brain in separate cross-sections. It was the best anatomy lab this year so far.
However, it was also the first lab in which we finally got a good view of the cadaver's face, which was a sobering moment because it makes me realize that every patient whom we interact with is a person with their own thoughts, emotions, and souls. Sometimes it bothers me that we have patient interviews with a "diabetes patient" or "mentally ill patient," because it restricts that person to the one dimension of their disease. Hence my internal battle between utilizing the utmost clinical concentration and the utmost compassion continues on.


Oregon ER Doc said...

11 years later, I still remember seeing my cadaver's face for the first time. (I was a 1st year at UCSF in 1996). I also remember discovering that my 106 year-old cadaver had penile implants--that was a shock! Anyway, you described the feeling so well, I had to comment. Sometimes, during a busy ER shift, a patient's true experience will suddenly become unveiled in the same way. That's when I step out for a cup of coffee and reflect on what a strange trip it's been. Keep up the great blog.
Brian Phelps (class of 2000)
(also I was Synapse Arts Editor 1997)

P.S. Dan Lowenstein was my Neurology teacher. Sounds like he is still doing a fantastic job. We didn't call him D. Lo (because at the time, there was no J. Lo!)

Edson Ivan said...

Hi Brian,

My Name is Ivan Quispe, M.D. I'm from Lima-Peru. I was wondering if you are the medical student that visited me 8 years ago to study infectology at Cayetano Heredia University. If not, excuse my comment.

yogi said...

Hello Stephanie, thank you for your openess and aspiration for the wonders of nature. I made a collage with these patterns if you'r like to see: * you can also watch this galery: ~ Best, Dominik