Medical School Pre-Clinical Years: Twenty Questions (Part 2)

What About “Early Patient Contact?” Is It Important?

No. “Early Patient Contact,” like “All Natural” and “Holistic,” is a marketing phrase designed to entice earnest pre-meds into one medical school over another. Like “Problem Based Learning,” another slick marketing phrase, if I had my choice I’d flee as if from the Devil himself a school that touted this sort of thing. As if it’s not bad enough that on the first day of third year you have to march around the hospital like a big, fat, ignorant dork, at a school with “Early Patient Contact” you will not even have the benefit of a couple of years of medical knowledge crammed into your head when, like a cheap poseur, you will flit around in a sack-like short white coat, bestowed no doubt in some retarded White Coat Ceremony, trying not to spook the patients.

What’s the point? You will get, like God intended, plenty of patient contact during third and fourth year. The brief exposure to real patients in first and second year will be like studying during the summer before medical school, something anyone will tell you is a useless because even if you studied the right material, you will blow through your entire summer of effort in a few days once you start. In a similar manner, all of third and fourth year will be spent in contact with patients. The little bit of play-acting you do in your pre-clinical years will be a drop in the bucket and not worth the effort. Either that or they will give you a lot of Early Patient Contact and it will seriously intrude on your study time or anything else you wanted to do besides stutter your way through patient encounters with people who have diseases you have never heard of.

I would definitely run from a school that promised some sort of student-run clinic (usually for the indigent who are not particular about their food, sleeping arrangements, or doctors) during first and second year. Maybe I’m a purist but your first two years are best spent learning the theoretical basis of the medical profession, not playing doctor. I know that many of you feel that it is important to “keep your eye on the prize.” You believe that by seeing patients early you will stay motivated for the long struggle. For my part, I saw plenty of the motherfuckers hobbling into the building as I drove past them every morning on the way to the parking lot and that was enough. I like being a doctor but first and second year are probably the last time in your working life you will not spend your day listening and responding to someone’s complaints. Relish it.

Bottom Line? Early Patient Contact is unnecessary. At best it is an annoying distraction but if overdone, has the potential to really eat into your otherwise valuable time.

How Will I Handle Gross Anatomy Lab? Is It As Disturbing As I Imagine?

The hardest part about gross anatomy lab, at least from a psychological perspective, is maintaining the proper respect for your cadaver. Although the body you will be dissecting was once someone’s husband, wife, son or daughter, after a couple of days you will be so used to anatomy lab that the cadaver will begin to seem more like a piece of rancid meat than anything else. This is not to say that anyone is overtly disrespectful to the body. I believe that stories of medical students stealing body parts for use in elaborate practical jokes are mostly apocryphal and I never saw anything of the sort in my class. Rather, you will develop a casual relationship with your cadaver and you will find yourself leaning nonchalantly on the body, idly picking away at some scrap of flesh or another, as you daydream about what you’re going to do over the weekend or about the dinner party you are planning.

As for the initial weirdness of the situation, the sensation that you are doing something completely beyond the pale, that will last about five minutes as will any sensation of revulsion. Familiarity, after all, leads to acceptance and people have gotten used to and even grown comfortable with practices many times worse than dissecting a cadaver. You will, of course, dread your first encounter with the embalmed body of a real human being. Everybody does. It is often the biggest worry of new first year medical students and as you file into the lab for the first time, the tension, manifested by strained jokes and nervous laughter, will be obvious. It will quickly dissipate however as you expose your cadaver for the first time and get to work. To lay hands on the a cold, dead, naked body for the first time and to feel the rubbery texture of long dead muscle is the big hurdle. Once done their is nothing more to it. Certainly in the future you will step back from some particularly revolting procedure, sawing the head and neck in half and opening them like a book for example, to marvel at the creature that you are mutilating but it will be more appreciation than disgust.

As a precaution, you will probably not have eaten breakfast on your first day of gross lab. As the morning wears on you will forget that you were ever worried and look forward to lunch.

What’s Gross Lab Like?

At my school, the lab was in a large, bright, tiled room. There were about thirty “tanks” in the room, something like large stainless steel bathtubs on legs, that held the cadavers. The tanks had mechanisms to raise the cadaver out of the tank. At the end of the day the cadaver was lowered back into the pool of embalming fluid to keep it moist. A dried-out cadaver is hard to dissect and can still rot even though it is “preserved.” We had spray bottle of embalming fluid to periodically wet the areas we were dissecting. We kept the rest of the body covered with an embalming fluid-soaked sheet, not from any sense of propriety but to keep the cadaver, particularly the face and fingers, in good condition.

We had four students assigned to each cadaver. The cadavers themselves were mostly elderly people but there were a few relatively young bodies. Some were obese which makes for difficult and messy dissection as adipose tissue is greasy and difficult to dissect through or around. Some were better preserved than others. The tank next to mine opened their cadaver’s abdomen and were greeted with a flood of putrid goo, all that was left of the body’s internal organs.

Dissecting can be difficult and, particularly for delicate structures like nerves and small blood vessels, can also be extremely frustrating. Imagine trying to pick through a piece of chicken or roast beef looking for something the size of a thread. That’s what a lot of your time will be spent doing. Certainly you will easily appreciate large structures like internal organs and big muscles but the bulk of your time will be spent picking away at little things. You want to avoid using a scalpel for this as much as possible because it tends to cut across planes and distort anatomy. Blunt dissection with your fingers or a small instrument is the preferred method.

I was never very good at dissection. I don’t have the patience and I didn’t like anatomy lab very much so I spent as little time as possible there. In second year I skipped a lot of labs because, well, I was tired of picking at the damn things and smelling like embalming fluid. My wife refused to drive my car because even if you change scrubs, the smell gets into your pores and everything you touch is contaminated. My wife made me strip in the garage when I got home and proceed to the shower without touching anything.

Riding in an elevator with students just out of lab is unbearable and many people get one whiff when the doors open and decide to wait for the next one.

Anatomy lab was low-yield for me. I did very well on all the tests however because I had a good photographic atlas that showed perfectly dissected specimens. Gross Anatomy tests, you understand, are “practicals” where you circulate through the lab from tank to tank, identifying tagged structures on other people’s cadavers. The instructors looked for well-dissected structures that usually looked almost exactly like those in the atlas. If they couldn’t find a good example they dissected one themselves. So you see, my photographic atlas was like anatomy lab without the bad smell.

I did better on the practicals than many people who came in on their own time, after hours and on the weekends, to dissect. You are certainly allowed and even encouraged to spend as much time in lab as you want.

Get some cheap scrubs to wear in lab. We were not allowed to wear street clothes in our lab but even if you are resist the temptation unless you don’t mind throwing them away. I discarded all of my gross lab scrubs when I decided to stop going as well as my shoes.

Your group should get an anatomy atlas to keep in the lab as well as a “dissector,” the book that gives instructions for dissection. We kept ours in a plastic bag in the tank on top of the cadaver. The reason for this should be obvious. Do you really want to study on your kitchen table with a book that is soaked in corpse juice and may have small bits of human flesh stuck to it? Not to mention that it will stink up whatever library or Starbucks in which you decide to study.

Get a turkey baster. keep it in the tank. Trust me, there is nothing better for draining fluid out of body cavities and it beats rolling the body to drain it.

Next: USMLE

Medical School Pre-Clinical Years: Twenty Questions (Part 2)

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