Spinal Taps and Retinal Defects

As you may recall, we have “preceptorships” for which we are assigned to a community physician to shadow and/or assist once a month. Most students were assigned to internal medicine, family medicine, PCPs, cancer docs and the like—but I was assigned to an emergency medicine pediatrician. You may also recall my trepidation given my a priori disinterest—nay, aversion—to both pediatrics and emergency medicine. Yet my experience thus far has demonstrated that I am prone to misjudge my own interests. Pediatric emergency medicine is… amazing. Allow me to describe (while doing my best not to violate HIPAA) the coolest afternoon I’ve had all year.

[Note: patient demographics have been altered to protect privacy]

The fun started the second I walked into the ER. I arrived precisely on time.

“Good afternoon, as of… now!” I said to my preceptor physician.

She pointed to two large monitors behind me. “Andrew, look at those CT scans. What do you see?”

Even if I weren’t in the throes of the Neuroscience block I would have known exactly what I was seeing, because it was unmistakable.

“I see… a brain herniating through a skull with multiple fractures. How…”

“A car accident,” she said. “The poor kid won’t survive.”

What a way to start the afternoon. Soon after, we were standing at the computer while she discussed patients with one of the residents. Afterward, she started to scan the patient list to determine who to see next.

“Room 30, a 7 year-old boy has a foreign body. I want you to take a history.”

“Wait… what? Me?” I thought at first she was talking to the resident.

“Yes, you. I want you to ascertain the chief complaint and take a full history and report back to me.”

“Uhh… well, what’s the foreign body?” I asked, stunned.

She smiled, “That’s for you to find out. Have fun!”

I had never taken a history from a real patient before—just standardized ones (actors, really). However, my CAPS class trained me well and I gathered all the information I needed. A CT scan later confirmed that he fell on a piece of glass two weeks ago and it had recently become infected.

Amidst the myriad other things that occurred, I witnessed three spinal taps, two of which were performed on infants. In all three cases, viral meningitis was suspected pending the results of the CSF (cerebrospinal fluid) analysis. In order to perform the spinal tap on the 9 y/o girl, she had to be kept sedated with propofol so she wouldn’t jerk around too much when her spine was punctured. Yes, propofol—the drug on which Michael Jackson overdosed. It was a milky-white fluid pushed IV throughout the course of the lumbar puncture because it has very acute barbiturate effects. The girl regained consciousness almost immediately after the drug infusion was stopped. Why Jackson’s “doctor” was using it to help him sleep is beyond me.

Following a very successful Neuroscience 1 exam on Friday, I had an awesome weekend. It started that evening at the Olive Garden with Garrett (that is, after we drove to another location upon discovering that the one to which Garrett’s GPS directed us was boarded-up) and watching Boondock Saints before bed.

On Saturday a bunch of us went downtown to The Big Bang, a dueling piano bar. We stayed half an hour longer than anticipated because it was more fun than any of us imagined. I was particularly unenthused since I’m not a big pop-music person (somehow I doubted they would perform classical music), but once again I was wrong to pre-judge. I was at least familiar with most songs, and sang along to nearly half of them. Most of the fun and excitement results from the personalities of the performers. I think we laughed more than we sang…

Afterward we headed to a wine and cheese party hosted by med students, where I proceeded to over-sample different kinds of wine. Well, first we had to drive back downtown because Garrett forgot to sign his card out at the piano bar. You see, like me he’s scatterbrained--but much worse. I’ve lost track of the number of times he’s left important things at my house and other places (phone, keys, etc). The extent to which it’s endearing outweighs the fatigue on my ocular muscles from the exhaustive eye-rolling.

Sunday was another exciting day. After recovering from the wine, a bunch of us went to see Sarah in RENT, performed by the Emerald City Players. It was entertaining, except for a few very pitchy singers (not Sarah, of course). Then we celebrated the purchase of a new grill by hosting a BBQ at our place (officially called “OMGWTFBBQ!”). We had 20 or 25 people over, and lots of food. Good times were had.

Finally, I discovered something interesting about myself at my eye exam today. Apparently, I have a small hole in the upper corner of my left retina. They told me there’s nothing about which to be immediately concerned, but they want me back in 6 months to see if there’s any change. In the meantime, I’m to be on the lookout for any flashes of light or other bogies out of the corner of my eye. Worst case scenario? My retina will become detached. Is this likely? Fortunately, no. If the hole were a small tear there would be greater cause for concern, but unless I suffer brutal trauma to the eye it’s unlikely to become exacerbated. Normally they tell patients about a quarter of what they told me regarding this anatomical flaw, but they said since I’m a medical student I could probably handle fuller detail. I appreciate that. On the other hand, as a medical student I’m already a hypochondriac and overly concerned with slight medical maladies.

In short, I’m not terribly worried about this slight retinal defect. I am worried, however, that I won’t be able to read my music at band rehearsal tonight because my pupils are still super dilated…

A Respite for the Weary

It’s been exactly three months since my last blog post. My bad. I wrote in fits and starts but never completed any of the entries (for instance, I drafted a long-winded entry on cancer during our Neoplasia unit. Perhaps I’ll finish it and upload it post-hoc).

The truth is, school’s momentum has intensified during the past three months. I realize now that the first several months of medical school were simply a warm up—an induction for the rigors to come. Gauging by the counsel of older students, it’s clear that this epoch of our education is the most ruthless of the first two years (aside from board preparation which takes place at the conclusion of Year 2). Much of what follows is a long-winded whine about medical school stress. If you don’t wish to endure that, I suggest scrolling nearer the end (after the ***) :-)

This tyrannical academic chapter is called the “Host-Defense” block, and the low exam averages during this period highlight the duress it precipitates. Aware of this oppressive chapter in our education, the school reminded us at the onset of the block where we can seek psychological support and gave us a stern, ominous warning not to fall behind (because we’d never catch up otherwise).

What is “Host-Defense?” It’s getting hit by a train and then drowned under water beneath the weight of the sunken Titanic. That’s what it feels like, anyway. Really it’s our first in-depth exposure to truly useful, relevant, scientific and clinical medicine. Host1 was concerned with blood-related pathologies (anemias, blood cancers, immunology etc). Host2 encompassed the entire month of February and early March and was concerned primarily with bacterial infections, mycology (fungal infections), autoimmune diseases, lots and lots of pharmacology related to bacteria/fungi, and many other related domains such as sepsis. Host3 begins tomorrow and seems to encompass parasitology, STDs, viruses and other miscellaneous infectious processes. In short, Host-Defense covers what can infect you, how it infects you, how it affects you, and how you can treat it. Real medicine.

So, why’s it so hard? There are two main reasons: the impossibly large and incessant volume of information, and the peri-academic demands placed upon us during this episode.

First, the academic strain: I will try to put this in some perspective. On average, we receive three 1-hour lectures each morning, each of which consists of a powerpoint averaging 45 slides worth of information (although the slide-count can range between 30 and 80). Unless specifically told by the professor, we are responsible for everything on those slides—every last detail. In Host2, there were 40 powerpoint lectures for which we were responsible. In addition to the slides, we are given a course packet, which in Host2 consisted of 329 pages. Some of this is supplementation to the powerpoint content, but we can be held responsible for information found in the course packet which was not specifically addressed in our powerpoint-driven lectures. In essence, it’s a shitload of information.

Since we, as medical students, are better understood as “professional studiers,” this wouldn’t be such a big deal (though still formidably knee-knocking) were it not for the ancillary demands and pressures place upon us. I won’t describe them in detail, since I have done so in previous posts, but I will enumerate them (at least as they apply to me):

1. CAPS class (Clinical Assessment and Problem Solving): Our weekly 3-hour afternoon class that dicates additional assignments for us including:

a. Preceptorships (I will discuss this later in the entry)

b. Senior Partners Program assignments

c. OSCE examinations (clinical skills practicals)

d. Community Projects (for which I volunteer at Goodwill and teach Pilates, give trumpet concerts and conduct nutritional seminars)

2. The deadlines for several extra-academic projects take place during the month of February. The application for summer research scholarships demanded a significant amount of time from many students because of its exhaustive nature. Countless hours are committed to this that would be useful in preparing for the Host2 exam. Additionally, tax forms must be filled out (thanks, dad) so the FAFSA application can be completed by March 1^st. These things become a nuisance when you have over 300 pages of information to commit to memory.

3. Concert Band rehearsals and concerts. These are mostly welcome, but sometimes feel like an impediment. Often during the week of an exam (and in the two weeks leading up to the Host2 exam in particular), I would be extremely and embarrassingly out of shape for rehearsals because I couldn’t spare the time to “put horn to face,” as my dad says. As principal trumpet of the ensemble, I shouldn’t be so inconsistent in my adroitness, but I don’t have the capacity to practice for several hours a day unlike the music majors in the group. I know as lead trumpet I shouldn’t make any excuses; I take comfort knowing that this is the roughest it will get, and that my playing will be more reliable in the future.

4. Living life. I try not to be one of those medical students who studies all day every day much to the detriment of their development as an individual. I try my best to stay abreast of current affairs, stay fit by attending the gym several times a week, have an active social life that doesn’t revolve simply around studying—and I even started dating again. I want desperately both to stay in touch with “reality” and stay well-rounded.

5. Finally, I was very ill at the beginning of the block, and fell behind early. Stuck in bed trying to recover, I didn’t have the wherewithal to study and I was forced to reschedule several events, like my preceptorship.

***

This brings me to the Host2 exam. Kelsey (my splendiferous study buddy) and I worked very hard together (and had a lot of fun, per usual) preparing for this exam. It paid off. Especially considering the daunting nature and infamous reputation of this exam, I’m happy to say I scored far above the average. I hate to brag—I really do—but I worked my ass off during this particularly grueling period (certainly the most demanding of my life thus far, considering the duration of the strain). By the way, it was 110 questions and 2.5 hours long. I’m thrilled to enjoy the first free weekend I’ve had since… perhaps since winter break. And it’s sunny!! It feels as if the universe is smiling at me.

I want to talk briefly about my preceptorship. Firstly, what is it? It’s a hands-on clinical learning experience for which we’re matched with a physician with whom we meet monthly. I was assigned to work with a pediatric emergency department physician. At first I was very anxious; the two fields in which I was almost certain I didn’t want to work were pediatrics and emergency medicine. So, naturally, I got both in one. Then I realized how this could benefit me—it’s good to expose yourself to that which you consider to be most uncomfortable.

After rescheduling (owing to being sick), I worked for 9 hours in the ER of Nationwide Children’s Hospital… and had a blast. I couldn’t believe how much fun it was (aside from seeing some horrifying things). At this time I’m not certain about which I am permitted to write due to HIPAA, but suffice it to say I’m much more interested in pediatrics and emergency medicine than I was before. I also really like my preceptor. She’s an exceptional physician—great with kids, a fantastic teacher, and she asked me excellent questions (I was stunned to realize how much I knew. I guess medical school is working).

I’ll ask around to see how much detail I can describe concerning my preceptorship experiences (my next one is scheduled for this Friday), so until then I’ll hold off.

Now for something cool. I want to share one of the grossest pictures we came across in Host2. Unfortunately, I cannot reproduce the image here in full due to copyright infringement, so I had to find a weblink for it. However, it’s low resolution and has an annoying graphic on it. Hopefully you’ll get the gist.

This is mucopurulent cervicitis (pus-filled, infected cervix) colonized with Chlamydia trachomatis. This is why you should have protected sex, ideally not with strangers. Chlamydia is the most common STD, beating out both gonorrhea and syphilis.

Our un-indefatigable sink

I came home from lecture last week to discover that our smaller kitchen sink (the one connected to the garbage disposal) was clogged, and there were 6 inches of turbid coffee-ground water staring up at me.

“Oh, that’s fun,” I muttered to myself.

I won’t name names, but someone regularly dumps coffee grounds down the disposal drain despite clear and abundant warnings not to do so. Incidentally, this is the same person who just moved out of the house, leaving us to find another 4^th roommate. Figuring that the individual responsible for the clog would return to restore order to the plumbing, I left the house to study. Upon my return I noticed that the entire kitchen floor developed a lake of brown water. Apparently, after the dishwasher was run, the water attempted to drain through the disposal pipes but was promptly impeded, backing up to the dishwasher and spilling out onto the floor.

“Marvelous,” I sighed, my socks drenched with coffee water.

Long story short, the responsible individual acknowledged the mistake but failed to adopt onus for addressing the issue, leaving the rest of us to dry the floor and fix the clog. Is this the end of the world? No. Should we be indignant toward flippant disregard for personal responsibility? Yes.

It’s a good thing I find our current material both bearable and digestible, because this past week I had four concert band rehearsals and three concerts, for one of which I had to miss lecture. One of the concerts was a salute to Michael Daughtery, a talented composer, during which each band ensemble performed one or two of his compositions. On Friday there were two “Celebration Concerts,” a large-scale tandem performance of most of the musical groups that comprise the school of music.

I came across the most awesomely hideous medical entity recently. It’s called a teratoma. It results from “uniparental disomy” of the entire genome. In other words, the offspring inherit both sets of homologous chromosomes from the same parent. In the case of a teratoma, the chromosomes come entirely from the mother (if they are from the father it results in a hydatidiform mole, which is less gross). It results in a tumor consisting of tissue derived from all three germ layers, including hair, teeth, bone, and in some cases more complex organ structures (eyes and limbs). Take a gander:

Best Lecture So Far... plus some random stuff

Today I had the best lecture to date in medical school. Rather, I had the best lecturer; the content (epidemiology) isn’t terribly interesting on its own—although it’s highly important. If you’re curious what it is, here is the official definition from my lecture notes: “The study of the distribution and determinants of health related states or events in specified populations and the application of this study to the control of health problems.”

Why is my instructor so awesome? In addition to more customary lecturing skills (talented oration, lucid enumeration, logical flow etc) and his use of television examples (from Seinfeld, Southpark, Maury Povich), he illustrates principles with examples from reality that highlight patterns of magical thinking that are rampant in society. In other words, I can tell that he champions critical thinking and skepticism—subjects near and dear to my heart.

For example, to emphasize the importance of validity in evaluating a treatment strategy--despite it having high sensitivity or reliability--he called attention to the use of so-called “facilitated communication” which purports to allow communication with an autistic individual (or anyone else with limited-to-no communicative faculties) through a “trained” facilitator. You can read more about it here. Though this “skill” can sometimes appear convincing, it fails utterly under even the slightest amount of scientific scrutiny. If you want to see the damage of which this kind of pseudoscience is capable, go here. By the way, while I’m on the topic of autism, vaccines do not cause autism, nor is there any evidence whatsoever to suggest that they do.

When I have my medical degree, I plan to devote much of my energy to fighting the insidious infestation of pseudoscience masquerading as medicine running rampant in this country. This includes facilitated communication, therapeutic touch, reflexology, homeopathy, faith healing, reiki etc. For a fairly comprehensive encyclopedic entry of these and other forms of quackery, visit this site.

Alright, I’m hopping down from my soapbox now. The Cell1 exam was 2 weeks ago and I survived! To celebrate, my housemates and I hosted another brunch—and it was heaven. I think there were about a dozen people altogether, and we made a ton of food. I experimented with the scrambled eggs by adding milk and pancake mix (I remembered seeing this on the menu of an IHOP) and it made them super-ultra fluffy and delicious! I recommend this for all of your future scrambled egg endeavors.

Concert band is making my life crazy and sucking all kinds of study time from me. Not only was our first big concert the night before the Cell1 exam, but my Thanksgiving break was truncated due to rehearsals I had to attend, causing me to leave late and return early. In addition, there are two extra rehearsals this week and three more (mini) concerts. Agh! I have crap to learn, people! On the bright side, the lecture material for Cell2 is much more palatable, and studying is much more tolerable. On an even brighter side (there are three sides, OK? Get over it), my director offered me a paying gig on December 13^th, woohoo! Money! I can use that!

My dad has informed me that we’re changing the dynamics of our Sprint family plan; I will soon be getting a smartphone for the first time in my life (and I’ll finally have the capacity for internet usage and unlimited texting!). I can’t wait for my new phone. My current one is only nominally functional. It only rings/vibrates when it feels like it, so I often have missed calls/alerts. I’m planning to get the HTC Hero with Google as my new phone.

Here are some random thoughts upon which I would expound had I been updating my blog more regularly:

1) Stacy is moving out. We need a new roommate. ASAP. Pain in the butt.

2) Something is wrong with our sink drain and/or disposal unit. Annoying.

3) Obama is doing many things to disappoint me.

4) Just when I think my disgust with Sarah Palin can’t possibly intensify further, she proves me wrong.

5) I drink waaaay too much coffee.

6) All of the med students are required to render a piece of art somehow illustrating professionalism or humanism. Yes, Required. No further comment.

7) I went to the Melting Pot for the first time last week. Wow. Me gusta.

8) I love Glee. Like, a lot. Also, I recently discovered that I love Lada Gaga. Who knew?

I’ll do my best to update more often. I forget 98% of the stuff that happens to me. Perhaps I have beta amyloid plaques and neurofibrillary tangles of tau protein…

Mounting Momentum... and a logical Halloween

A recent conversation with my “study buddy” Kelsey sums up my feelings regarding recent weeks:

Kelsey: “Remember when we thought we were going to fail the head and neck exam?”

Me, forming a wistful expression: “Ah yes. Those were the good ol’ days.”

I thought that once the Anatomy block was over, life would become simpler. I would awake to the sound of birds singing while they prepped my shower, and the neighborhood squirrels would help me get dressed while the fluffy bunnies from the forest would cook my breakfast. This fantasy was eviscerated on the morning after our last Anatomy exam when we began the Cell Block.

I’m getting ahead of myself again. Let’s step back a couple more weeks…

*Wayne’s World-style flashback sound effect –doodaloodaloo—doodaloodaloo—doodaloodaloo…*

Although head and neck anatomy (Anatomy unit 3) had the most difficult material to master, in the end I (and many others) performed the best on the exam/practical in comparison to the other two units. There are 3 reasons for this: (1) Our anatomy lernin’ skillz improved significantly over the Anatomy block, (2) The exam was (I think) designed to be slightly easier given the difficulty of the material, and (3) I partnered up with Kelsey—the most symbiotic learning relationship I ever could have imagined. Thanks to her, we pulverized the exam—and ended up getting the same score! Imagine that.

The Cloud 9 we were riding started to rain the next day and we fell through it, hitting the ground hard as we began Cell Block. I thought it would be a comfortable review of undergrad basic sciences. It’s so much more than that. Some of the broad topics include bioenergetics, pharmacokinetics and pharmacodynamics, carbohydrate metabolism, histology, pathology, and a high-powered review of biochemistry. The subject matter isn’t hard. There’s just a lot. And the lectures—on the whole—aren’t half as interesting as the anatomy lectures. In other words, given that the anatomy lectures put me to sleep, these lectures are coma-inducing. Many students have elected the “IP-ISP pathway.” Translation: they’re in the Integrated Pathway Program, but stay home and podcast the lectures (hence “Independent Study Pathway” hybridization).

Even though I (and everyone else, from what I gather) am lagging behind in my digestion of the material, I’m still making room for fun and staying on top of my extra-curriculars. This past Friday I went to Cheesecake Factory and a movie (Zombieland—hilarious!) with Mike. We also went to gymnastics the night before. I had been aching to go for months; it felt good to do some flips again.

My Pilates classes at Goodwill are going well—much better than I anticipated. I have more people attending each week, and they want to record me so the satellite locations can engage in the class as well. Weird? Yes. Flattering? Yes.

I’m desperately in need of a break, and so is everyone else. I can’t wait for Thanksgiving so I can see my cats again—especially Chopin! I miss him so much! Oh, yeah--and family too, I guess.

I’ll leave you with this picture of my Halloween costume that I took with my computer’s camera. I broke my digital camera (Long story. Too mad to talk about it...) Anyway, I was a Star Trek StarFleet Science Officer. Science officers wear blue. I like science. I also like blue. Hence, in the words of Spock, it was only “logical.”

Chaotic Confluence

Although I’m delighted that all of my aspirations are knitting together beautifully, the resultant masterwork is a convoluted nightmare.

Let’s step back 2 weeks. I decided long ago to pursue a creative outlet by performing with one of OSU’s concert band ensembles (of which there are four). I auditioned for the highest band that would fit my schedule (two of them rehearse in the mornings during my lectures, the other two rehearse in the evenings). Although I gave the worst audition of my life, I still managed to secure the principal trumpet position (I don’t know what I’d do if someone else played all the solos. I’m greedy and conceited, OK? Get over it). So that was a good thing. A very good thing.

…Maybe.

I was also fretting about the second exam, which promised to be much more difficult than the first given the material. It turns out my score improved 5% compared to the first exam. If I only knew what the future held in store for me, I could save myself potential stress ulcers from the amount of needless worrying I do. No, so far I haven’t had any psychosomatic manifestations, but perhaps it’s only a matter of time.

I’ve also resolved my community project. I’ve decided to volunteer at Goodwill Columbus on Wednesdays. On the first Wednesday of the month, I will conduct seminars during which I’ll try to educate participants and employees about proper nutrition and other health and wellness topics. Every 2^nd/4^th Wednesday I will lead group fitness activities (yoga and Pilates), and I will give a little trumpet concert every 3^rd Wednesday of the month.

I failed to mention previously that I enrolled in an elective course entitled “Surgical Clinical Correlates in Anatomy.” In essence, we spend a couple hours with different surgical specialists wherein we learn about their surgical specialty and observe them perform various surgical techniques on cadavers. Often, they will let us use some of the cool (and expensive as hell) tools. Some of the classes we’ve had so far include orthopedics, general surgery, abdominal/thoracic/pelvic, urologic, general surgery and head & neck.

These are just a few of the many awesome things I have going my way. The only problem is that my “free” time (“free” is in quotes because any time not spent in class is best spent studying) is rapidly dissolving. Amidst all these and other commitments (CAPS lectures, physical exam evaluations, learning community meetings, various informational seminars), the clean space on my calendar is going extinct. Soon I’ll be left with scant study hours and negligible social opportunity. Not to mention Andrew-time. Sometimes I just like to veg-out, watch TV and eat junk. I really, really miss that. I still eat junk, of course, but only when I’m studying.

I’m excited that my dad and Uncle Dave are visiting me this weekend. Hopefully it will provide me with an opportunity to step outside the confines of school and cast a refreshed perspective on my new life.

I better go. I’m really behind on my understanding of the neck’s neurovasculature, not to mention embryology. I will leave you with this lovely congenital disease. It’s called a congenital omphalocele. As a normal part of development, the intestines extrude into the umbilical cord for a period of time as they grow (this is called physiological herniation) before retreating back into the abdominal cavity. If the herniation persists, the baby will be born with its GI tract still inside the umbilical cord outside of the body. It’s non-life-threatening, but it sure is disturbing.

Vile Bile

I knew something was wrong when I saw the green goo, but I significantly underestimated how severe our problem was.

Today in anatomy lab, our task was to cut into the abdomen and explore the structures inside (e.g. mesentery, intestines, stomach, liver, spleen etc.). It sounded so simple. The first few steps involved making a cross-shaped incision in the abdominal wall out through the umbilicus (belly button) and reflecting the layers back to reveal the viscera.

Carefully trying to avoid damaging the underlying omentum, I made my first incisions very superficial. Then, on the third stroke:

“Whoa…”

Green goo. Oozing out of the incision.

“Is that bile? That’s impossible! There’s no way I cut that deep!” Bile is stored in the gall bladder, which is located on the inferior surface of the liver.

The four of us stared at each other with bemused expressions.

We continued to open the peritoneal (abdominal) cavity, becoming increasingly aghast at the deep green soup saturating the intestines and pooling in the crevasses between.

“This doesn’t make any sense. Maybe her gall bladder exploded post-mortem?” one group member suggested.

We called over one of the doctors, who explained that the embalming process sometimes increases the pressure inside the gall bladder, causing it to burst.

I sighed some relief. At least it wasn't my fault.

Noting that our misfortune was par for the course, we continued the dissection resigned to the fact that our internal organs would be dyed green. No big deal, right?

“Wait, what is that thing? It can’t be the omentum. Wait… where is the greater omentum? It should be right here on top!”

Rather than seeing the expected fatty, vascularized extension of peritoneum that covers the intestines, we saw this huge, hard, green (from the bile spill) brick-like thing just under the peritoneum.

After some wild conjecture, we looked at one another with hopeless expressions and called the doctor over once more.

“Whoa,” he said. Glad we weren’t the only ones with that reaction.

He spent a few minutes exploring the cavity, trying to understand what we were seeing. Eventually he reached several conclusions:

1) The huge brick-like object was impacted colon (it must have more than quadrupled in diameter).

2) The omentum had fused to the parietal peritoneum and begun to disintegrate, which is why we didn’t see it.

3) It was a mess.

For whatever reason—perhaps related to metastatic ovarian cancer—Bertha was extremely constipated. Perhaps for the same reason, the omentum tried to contain this growing mass in the abdominal cavity by growing around it to seal it off from the rest of the viscera. We actually learned earlier that day that this is a useful function of the greater omentum: it can form adhesions to adjacent inflamed organs to partition it from the other viscera.

At any rate, what ensued was the most horrific sequence of events I hope to experience in anatomy lab. We had to remove the impacted colon so that we could gain access to the rest of the abdomen and—hopefully—continue with our dissection.

It’s difficult to be sure, because the anatomy was altered so much, but we think the affected portions of colon included the transverse, descending and sigmoid segments (altogether a significant portion of large intestine). The rest of the colon was impacted as well, but not as distended as the more distal regions.

We tied off the most obstructive part of impacted colon with string and used a scalpel to snip it out. Perhaps “snip” is the wrong verb, though. It was about the diameter of a lower leg.

But the knots of the string didn’t do the trick. They slipped off the cut edge. What now?

We milked the feces out of the colon in order to better tie it off.

Yes. I helped to milk several pounds of green, bile-stained feces out of an impacted colon.

Although the experience totally grossed me out (though we all kept our equanimity), I couldn’t help thinking about how much pain the living Bertha suffered. “Excruciating” would surely be an understatement. This sobering notion helped to remind me of the respect we must afford the cadavers. One of the most offensive things we can do is to lose our composure.

(Normal abdomen, courtesy www.NetAnatomy.com)