Category: Anatomy

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Teaching

Okay, pop quiz! No seriously. I’ve already talked about my love of anatomy and my love of comic books. When I used to teach the class, I was able to combine the two in the form of test questions that would be an endless source of amusement to my students. Not really, but one can dream. So, here’s a few questions for you. Answers are at the end.

  1. Doctor Midnight has his hands full looking after the Justice League and today is no different as he assesses Wonder Woman and her swollen hand. “That must have been some punch,” he says, holding up an x-ray, “ you have a boxer’s fracture, a fracture of the 4th and 5th metacarpal bones.”With your physiology, you’ll heal in no time, but it’ll still be painful, because you have some important muscular attachments there. Do you know what they are?”

Wonder Woman’s correct reply would be:
A) “By Hera’s Bodice, the flexor carpi ulnaris attaches there!”
B) “By Zeus’ codpiece, that’s where the the extensor digitorum attaches!”
C) “By all the popcorn shrimp in Poseidon’s galley, the extensor carpi radialis has an attachment there!”
D) “Oh, I’m just a girl. How would I know of such things?”

2) Hannibal loves it when a plan comes together, but it doesn’t always come together the way one plans. That what he was thinking as they go visit Face in the hospital. The surgery to remove the bullet was a success, but now Face is complaining about his eye. “I’m glad to be out of surgery, but now it feels like I have something in my eye all the time. It’s all gritty and watering. I can’t run a con like this.”
Hannibal pats him on the back. “Ah, it’s just a corneal abrasion, Face. Man up, you’ll be fine in a few days.”
“That’s easy for you to say. It’s driving me nuts. I just want to scratch my eyes all the time.”
Which one of the following would be the most appropriate response from Mr. T?

A) “Well, don’t scratch it, fool! That sensation travels along the oculomotor nerve to the Edinger-Westphal nucleus. You’ll mess up your pupillary reflex!”
B) “Stop it with all your jibber jabber! If you scratch that, the sensation will travel through the facial nerve and you’ll develop ptosis.”
C) “I pity the fool that don’t know the sensations of the cornea travel through the trigeminal nerve!”
D) “You’d be a fool to scratch your eyes! Your watery eyes would overload the nerve signals travelling through the optic nerves themselves!”

3) It was a rousing game of quidditch, but now Harry Potter is in Hogwart’s medical center, along with Ron and Hermione. “Oh, why can’t they pad those broomsticks a little better?” moans Harry, clutching his groin.
“Just try and not move around too much. They said your pubic bone is fractured.” Ron offered, obviously uncomfortable with Harry’s anguish.
“That’s going to affect every muscle in the adductor compartment of the thigh.” Hermione observed.
“No, it bloody will not!” Ron countered, “the adductor magnus has a different attachment.”
“Well, here comes Professor Snape. Let’s ask him who’s right.”

What is Professor Snape’s answer?

A) “Oddly enough, Ron is correct for once; the adductor magnus has no attachment to the pubic bone.”
B) “You’re both wrong; only the gracillis, adductor longus and the pectineus have attachments to the pubic bone.”
C) “Hermione, as annoying as she is, is right. All the adductor muscles of the thigh have attachments to the pubic bone. Young Harry here is in for a world of pain.”
D) “Leave me alone, you vile, little children. It is the posterior compartment of the thigh that has attachments to the pubic bone.”

4) Finn drew his sword and leveled it at the Ice King. “Let Princess Kandy Korn go, Ice King, or we’ll have to get rough with you.”
“Ha, I’d like to see you try.” said the frosty monarch, “I’ve enchanted my castle. You can’t get in without answering a question.”
“Name it! What’s your question?We’ll answer it and then rescue the princess.”
“Alright, smarty pants! Tell me which one of the following nerves is a nerve of the sacral plexus. Is it the genitofemoral, the iliohypogastric, the obturator or the pudendal nerve?”

What is Jake’s (let’s face it, Finn and Jake always take on the Ice King together) answer?

A) “Aw, come on. That’s an easy one, man. It’s the pudendal nerve. Totally lame question.” 
B) “That’s a trick question, ya big dummy. None of those nerve come from the sacral plexus.”
C) “Everyone knows it’s the genitofemoral nerve, dude. Now quit rustling our jimmies and let the princess go.” 
D) “What? You think ‘cause I’m a dog, I don’t know human anatomy? It’s the obturator nerve, ya stinker.”

I love teaching. For me, teaching is like telling people, “Hey, I know this really cool thing. Let me share it with you!” The first time I realized this was right after I had earned my black belt in Kenpo Karate. One of my instructors came up to me and started talking me up. Dominic, you seem to really know your stuff, you have a great ability to relate this material to others, you have a natural talent for this, how would you like to be in charge of teaching some of your own classes? I leapt at the opportunity. Great, he said, you’re in charge of all the kids’ classes. Open the studio at 8AM next Saturday.

I knew I had been conned, he hated teaching kids, but I didn’t care. I was an instructor. I don’t know how I did it, I was only 18 at the time, and completely inexperienced, but I knew enough to make it fun. The parental units weren’t paying us to turn their children into deadly kung fu masters, they wanted an hour of peace and quiet while we tired their little darlings out. The youngest student I’ve taught was 2 ½ years old and the oldest, when I started teaching all the classes, was around 60. I co-ran a studio in Concord, NH for about 2 years, before leaving to go out to school in California.

After that, I tutored calculus, chemistry and anatomy in college, earned a teaching fellowship in medical school and taught anatomy for 8 years at a naturopathic medical school. Whatever form it has taken, I have always found teaching to be one of the most gratifying activities I have ever known. The experience of being able to expand one’s understanding of a subject is indescribable, and I am eternally grateful that I have been able to do this. It’s tough to judge one’s self, but the feedback I have received about my teaching has been for the most part favorable. I attribute this to two techniques I use while teaching. I’ve already said the first one, keep it fun. The second is to use stories.

As humans, we have an innate affinity for stories. We remember them better than just dry facts and figures, and they attach a narrative to knowledge imparted this way that allows one to extrapolate upon this knowledge better. If I just tell my class that the gluteus medius muscle is innervated by the superior gluteal nerve, how the hell are they supposed to remember that? But, if I talk about the police officer I knew, who shot herself in the ass, damaging her superior gluteal nerve, now walked with a limp and had a positive Trendelenburg’s sign, well that’s a story to remember. This story describes the innervation to the gluteus medius, as well as the action of the muscle and the physical exam finding (positive Trendelenburg sign) if there is dysfunction. If I can get the students themselves to come up with a story that relates to them personally, then I know the knowledge will stick with them, though I truly hope all of my students’ superior gluteal nerves are intact.

But, enough about teaching; how about them answers:

  1. A
  2. C
  3. C
  4. A
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Emergency: Hand Laceration!

During my internship, my fellow interns and I were assigned a different service each month. It was part of a family practice residency, so we rotated through most of the basic things we would be expected to deal with. A few months of pediatrics, a few months of OB/GYN, a few months of internal medicine, etc. Four months out of the year, we were house docs, just staying in house (in the hospital) and taking care of whatever needed a doctor, or to be more accurate, a doctor’s signature. Mostly, this was just keeping things on an even keel. The patients were stable for the most part, with orders written already. We were there in case something came up; complaints of constipation, keeping blood sugars in check, talking with family member who wanted info if the attending wasn’t around, stuff like that.

Two of these months were the day shift, coming in at 6AM for morning report and working until 6PM. Two of those months were night shift, coming in at 6PM and leaving, usually, after morning report, around 7AM. The nights were quiet for the most part, but whoever was on was the only doctor in the hospital. That’s not entirely true; there was an ER doc on overnight, too, but, except for the most life threatening of emergencies, he was never seen. And while the hospital was not large, it consisted of a standard medical/post-surgical floor, an ER, a rehab unit (occupational/physical therapy rehab, not drug rehab), a geropsych lockdown unit and a 5 bed ICU. I loved working nights. I’m a night person, so I never slept when I was working nights and I made sure everything ran smoothly.

I would come in at 6PM and meet with whoever was on day shift and get the report. How many patients were in each unit, what needed to be done, what problems should be anticipated; that sort of thing. Then, and this is the important part, I would meet with the nurses on each unit. They are the boots on the ground and could usually tell me more about the patients than the doctors’ notes. If things were quiet, I’d go back to the residents’ break room and get some food in me. There was cable TV and internet, so I could occupy myself quite well, but I knew that an emergency could arise at any second. So I would round every 3-4 hours, visiting each unit, talking to the nurses, preemptively taking care of whatever I could. For the vast majority of the time, things worked great. Every now and again, however, I would get something story worthy.

One such night was going swimmingly. Quiet Med/Surg floor, empty ICU, empty rehab unit. I was happily surveying our empty ER when I saw two men standing at the admitting desk. Both swayed ever so slightly, one of whom was holding his arm up, a crimson towel wrapped around his right hand. I was slow to realize that the towel had originally been white. Once back in the ER, I learned that the gentleman in question had just recently been fired. He had been a cook at a local bar and, after getting his walking papers, decided a day of drinking would be in order. Evidently, he had drunk enough, with his companion, that it had seemed like a good idea to go back to the fine establishment he had been fired from, to continue his inebriation. Upon encountering the manager that had fired him, my patient had decided that it would be better to put his fist through a plate glass window, rather than his former manager’s face, leading to him now sitting before me.

Unwrapping the bloody towel, I found his hand to be a gory mess, oozing red, with a single, pulsing jet of arterial spray providing dramatic effect to the whole scene. I rewrapped the hand and excused myself, swiftly walking to find the ER doc. Explaining to him that I felt that this man needed more than what I could provide, that he needed an orthopedic hand surgeon, he groggily followed me to inspect the damage. He was nonplussed. Pointing to the spouting arterial, he said, “Tie that off first, then repair that tendon, and that one, and then sew him up. He can follow up with a specialist later.” With that, he wearily went back to bed.

Resigned to the task at hand, I set up my sterile field, gloved up and injected his hand with anesthetic. Luckily, both of the men were so inebriated that I don’t think either of them were feeling much of anything. It took me roughly 90 minutes to put his hand back together. After it was done, I was convinced that I had mutilated and crippled this man. I urged him to follow up with some doctor (any doctor, for the love of God!), fearing infection, fearing disability, and sent him on his way. It was one of the more trying experiences in my life and it remains vivid in my mind and I’m not sure I would be telling anyone any of this, if this were the ending I had. As they say in the infomercials, however, but, wait, there’s more.

Years later, after I had left medicine, I was working out at some gym (I don’t remember which one I was with at the time) and I heard someone say, “Excuse me.” I didn’t recognize the man, but he asked if I was a doctor. After a few more questions, we had determined that I was, indeed, the man that had sewed his hand up. I openly expressed how convinced I had been that I had ruined his hand. He showed me the appendage in question and there wasn’t a single scar upon it. His take on the night, though fuzzy, was very different. He felt very well cared for and said his hand healed better than he expected it would. I don’t live in a world of black and white, but his words allowed me to chalk this experience up to a win. The whole reason for me to go into medicine was to feel like I was helping people, and his thanks to me is an experience I will always cherish.

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Anatomy

I love human anatomy. I think that we are one of the most beautiful things in the world, particularly the female of our species. It’s one of the first things that got me into art, but it’s led me down many other paths. Early on, I got the book The Atlas of Human Anatomy for the Artist by Stephen Rogers Peck and drew from that obsessively. Then something else happened to reinforce this love. I began taking martial arts classes. Suddenly, anatomy wasn’t just something pretty to look at, it was a weapon, a tool, a construct to be strengthened with a whole host of weaknesses. Pressure points, nerve centers, how a joint moves and how to lock one up; new avenues of study opened up before me and I was in heaven. In addition to the structure of the human body, now I also had reason to learn about physiology, the workings of the various organs. I studied diet, exercise, breathing techniques, stretching, even starting some basic yoga poses and meditation. You may already have logically concluded that this path is what led me to medical school, and you’d be part right, but it’s not quite that simple.

I studied Kenpo karate for about 8 years, earning a black belt and working as an instructor for 2 of those. But I travelled out of state for some of my college and stopped training for a while. The next time I studied, it was a school that taught tai chi and qi gong. I loved these disciplines just as much as I did my former hard style art. Mandatory reading was The Tao of Tai-Chi Chuan by Jou, Tsung Hwa, which is excellent. He has a series of three books, the one on tai chi, another on meditation and a third on the I-Ching and I would recommend all of them. While taking classes, I also began learning about tui na, a form of Chinese bodywork, the chakras, the meridians, herbal remedies, etc. I never intended to be a doctor, I was working to enter an acupuncture school.

As fate would have it, the schools I was looking at required MCAT scores as a prerequisite for admission. To be perfectly honest, I don’t really remember much about the MCAT, AKA the Medical College Admissions Test, but I seem to recall it consisted of two 3-4 hour sessions, with four parts. The physical sciences, biologic sciences and verbal reasoning parts were multiple choice and then there was a written essay part. I don’t remember my score either, but, evidently, it was good enough that a few medical schools sent me information packets for their schools. One of these was the University of New England, College of Osteopathic Medicine. So, while I never intended to be a doctor, this school allowed for far more financial aid than any of the acupuncture schools and was located much closer to my family and, to be frank, graduating with a medical degree did seem to offer a more reliable future. I went to medical school and I loved that, too.

One of the first classes was anatomy. I had had anatomy class in college and the lab had a cadaver, but we never got to touch it. It had been pre-dissected. Now in medical school, four medical students were assigned a cadaver and were responsible for its dissection. We even got a box of human bones we could check out of the library and take home to study with. That lab was challenging. I don’t mind saying that I was horrible at dissection when I first began. Nonetheless, we persevered and passed the course and continued with the rest of the curriculum. Most doctors never set foot in the lab again, but I have rarely followed the common path. I was awarded an anatomy teaching fellowship while at the school and spent a year helping to teach and dissect in the cadaver lab. Even this wasn’t enough for me, however.

More recently, I taught anatomy at the National College of Natural Medicine, though now, it’s the National University of Natural Medicine, and was in charge of the cadaver lab. The lab had 6 cadavers, all of which needed to be dissected. I usually had between 4-8 students that assisted me in dissection, but that still left a lot of work for me. I’m not going to lie, I enjoy dissection. There’s a meditative quality to the act that focuses and relaxes me at the same time. And then, through everything I’ve learned and experienced, I still love anatomy. That has stayed with me throughout my entire life. I still refer back to my Netter’s (one of the most commonly used anatomy atlases), I still go life drawing sessions, the human body still fascinates me. Even if it doesn’t seem like that love is reflected in my art.