Last day of classes!

I just finished my last class of my first year! Woo hoo! Six days from now, after I finish the renal (kidney) exam, I will officially be a second-year medical student. I'm ready for a break.

Donor Memorial Service

Last week, a donor memorial service was held for all the people who donated their bodies to medical education. This was a joint effort put on the the Schools of Medicine, Dentistry, Physician Assistants, and Physical Therapists, all of which use cadaver dissection to teach anatomy. The service was meant to give thanks to the donors and provide closure to their families, who it should be noted had to endure a prolonged period of mourning necessitated by the donation process.

The service also provided closure for students - for myself. It feels like such a long time ago when we were up in the cadaver dissection lab, but in actuality it has been just half a year. The experience of dissecting a human being strongly affected me, which is probably why I avoided even thinking about the memorial service until it was suddenly upon me.

The service was beautifully done thanks to a lot of hard work put into it by a lot of people, including our class vice-president Ramya.

One highlight of the service that I found most meaningful was listening to the families of donors talk about their loved ones who made such a selfless gift. Not just their words but their very presence - seeing that the woman whose body I dissected left behind family who mourned her passing - finally revealed the depth of her humanity that was so carefully and purposefully hidden from us during the actual dissection.

A second highlight of the service was the speech given by my friend and classmate Evelyn, who delivered it with such sincerity that I was literally moved to tears. I am sharing Evelyn's speech here (in full, with her permission) because it so accurately reflects my own experiences and sentiments.

Hello, my name is Evelyn. I’m a first year medical student and it is my honor to share some thoughts on behalf of my class in the School of Medicine. I’d like to start by telling you a couple of anecdotes, a window into the lab so to speak for a few moments, so that you might know how incredible and meaningful this experience was that your loved one gave us.

Our donors’ bodies are carefully prepared and protected and we newbies have some trepidation meeting them for the first time. There is a tradition that dissection starts on the torso, and the person’s head, hands and feet remain “covered” until last. These are considered the most human parts of the body and so most likely to engender discomfort initially for us dissectors.

Yet it felt strange to me to make incisions into this person’s body without having any sense of who she was. So I asked the professor if I could unbind her head to see her and meet her before we started. Happily, he agreed. It made all the difference in the world to me. Quiet and peaceful now, she still had a band-aid on her forehead, a bruise where she had bumped into something unexpectedly, a gold tooth and an ethnicity different from my own. Here were the signifiers of a story, her narrative, her life that I was now privileged to enter.

Since real names are protected, somehow the name Doris emerged as a fitting way for our group to relate to her as a person. As we worked on her back, she showed us see how all the muscles that help us stand and bend and twist are arranged, and under those the vertebrae with those discs between them that can slip out of position and trouble us.

Then we came to the inner sanctuary of the spine. We opened up the dura mater covering, and there lay the spinal cord, soft and glistening, with a perfectly formed cauda equina of nerve roots at the end. It took my breath away. It was simply beautiful and strangely seemed so alive.

A thought flashed into my mind that she hadn’t ever seen this and I caught myself literally almost tapping her on the shoulder to say, “Look at this – it’s amazing!” even though she couldn’t really lift her head and peer down her own back to see the beauty that was hers.

In the coming years, whenever I perform a spinal tap procedure to get clues from a patient’s fluid for diagnosis, I will remember to be careful about positioning the needle to protect these vitally important nerves that Doris showed us.

Another afternoon, I got to dissect her heart. The heart is superb and well sheltered inside a resilient pericardial pouch and layers of fatty tissue. Holding it in this shapeless state I felt like a sculptor facing a block of stone, before those patient hands chisel away to reveal a hidden treasure.

I settled in beside her head at the dissection table, and with her heart in my hands, carefully removed these protective layers to expose the shape we know - the four chambers and the coronary arteries that surround and nourish it with oxygen.

Then I opened it up to reveal the clever valves inside and stunning chordae tendineae – literally the “heart strings” - that tug on these valves to keep them tethered as they do their work, opening and closing to help the heart pump blood around the body.

For four hours, it was Doris and I in a world of our own, this silent teacher showing me a wondrous vista. As I worked, I realized that this heart beat inside her chest for more years that I’ve been alive and how it symbolically held her stories of love given and received. I wished I knew those too.

And to each of you sitting here today I would like to recognize the huge gift you too have given us. I lost my own mother a few months ago. She was somebody I was very close to. And I recall how protective I was of her handing her body over to the morticians for a mere two days to prepare her for the viewing and funeral. But all of you have waited graciously for up to two years for us to do our work before you could get your loved one back. I can only imagine what effect that has had on your grieving and that it perhaps delayed closure for you. I do hope today brings comfort to you and to that process.

And in this time that you have waited so patiently, have you ever wondered, what’s going on over there? How are they treating my mother, father, brother or sister? Are they being gentle and kind to them? Do they value what they’ve been given? Are they being respectful? Are they learning anything meaningful? And don’t they know that that’s my kin, and are they treating them well?

I’d like to tell you today that the answer is “Oh yes. Oh yes indeed – as if it was our own mother, father, brother, sister, grandmother, or grandfather.” On behalf of my class, we sincerely thank you and your loved one for the extraordinary gift you chose to give us.

As we go forward in our careers, the technical aspects of anatomy that we learned through your generosity will most assuredly come with us and help us be better doctors. But just as importantly, it has shaped us as people, who understand just how unique each person is on the inside as well as the outside and accordingly how they might respond differently to our treatments. And who know now just what it is to value, respect and care for those who can no longer speak for themselves.

The last time I saw Doris was to take the final lab exam in Anatomy. Arriving at her table was like meeting a friend. I smiled seeing her and at knowing so intimately the structure on her body that was pinned for identification. At the end of these ten weeks, she was helping me one last time in the exam. I brought flowers that day and placed them in her dissected hand. I felt it was the least I could do to honor her - and to say goodbye.

Wherever you are, thank you Doris - and thank you to each of you.

Pulmonology, Denver style

I have run across an unforeseen complication of going to medical school in Denver. We're in the middle of the pulmonology section right now, and it turns out that altitude has an effect on lung function. Who'd have thunk?

Up here in the mile-high city, the atmospheric pressure is appreciably lower (thinner air) than the atmospheric pressure at sea level. Since this has real-world clinical relevance, especially during our third and fourth year clinical rotations, we have to know - and will be tested on - physiological values based on Denver's altitude.


PB = Barometric pressure (Torr)
PiO2 = Partial pressure of oxygen in inspired air (Torr)
PaO2 = Partial pressure of oxygen in arterial blood (mm Hg)
PaCO2 = Partial pressure of CO2 in arterial blood (mm Hg)
SaO2 = Saturation of oxygen in arterial blood (%)
CaO2 = Oxygen concentration in arterial blood (mL O2 / 100 mL blood)
CaCO2 = CO2 concentration arterial blood (mL CO2 / 100 mL blood)
[HCO3-] = Bicarbonate concentration in arterial blood (mM)

To be fair, every medical student in America has to learn (hopefully) a set of equations that relate all of these terms with each other. That means a medical student in Boston or New York or Los Angeles should be able to derive these values for a patient at any given altitude. The catch is that, here in Denver, we have to memorize two sets of values. It's worth noting that most USMLE Step 1 board questions will likely specify that the patient is at sea level.