Morbid Cartoon Anatomy

You know what’s awesome about fourth year? The lecturers go through so much effort to teach us. They put together nice slideshows, they share interesting tid-bits and they are friendly. They could have saved us all a lot of grief if all lecturers were this nice from first year. But I digress.

Anatomical art, which once took the world by storm (think: Frank Netter) is back and cooler than ever. Our lecturers have been alluding to some artists in their presentations. Here are some examples. I include links to the artists’ sites where I was able to find them. Please visit them, I will only include one example of each here.

Michael Paulus has an entire series of popular cartoon anatomy:

Jason Freeny has some really cool digitally animated anatomic drawings and cutaway sculptures. They include Mr Potato Head, Gummie Bears and Kewpie Dolls.

Perhaps the most realistic-looking (and slightly freaky) is done by South Korean Hyung Koo Lee. I couldn’t find his site, but this one is relatively good. He has sculptures of Goofy, Bugs Bunny, Tom and Jerry…

I find that these are a very different (albeit fascinating) look at characters from my childhood. I have to wonder how non-medical individuals feel about these. Let me know what you think!

Latin, Law and Medicine

We are doing some forensics theory for two weeks. It’s a lot more work than the practical rotation I had at the beginning of the year, but also a lot less disturbing.

One of the specialists also has a law degree. They taught us something interesting: we can prevent justice from occurring. In a bad way.

Novis Intervenus Artis is a Latin term which directly translates to “by intervening with new art”. In medical law, it refers to the effects on a new intervention on a patient.

Here’s where it gets interesting:

You are on call in the ER. A patient is brought in with severe stab wounds and blood loss. He is unconscious. As part of resuscitation, you order two large-bore IVs. But because it is late on a Saturday evening, you forget in the rush to run the fluid through the line to eliminate air bubbles. 

A few seconds later the patient dies from a massive air embolism – which you inadvertently caused. 

It is likely that this patient would have died and that the person who assaulted him would have been found guilty of murder or manslaughter. But now he won’t, because your “new intervention” caused the death.

Do I sound like a fear monger? I don’t mean to be.

This scares me. Because I have lost loved ones to violence and because I believe in justice. And because I am a young medical student, soon-to-be a young professional: prone to mistakes.

Matryoshka (disambiguation)

Medical Students quickly become desensitised. It is a coping mechanism and it works well – not the least because it makes us laugh. Nevertheless, it’s no wonder people think we are weird.

Case in point:

Clinical Partner and I discuss our feelings on autopsies.

He says,

“Wow… doing that autopsy on the pregnant woman was like having one of those Russian dolls”.

“Interviewing” our Forensic Pathologist

The Forensic Pathologist in charge of our clinical group these past two weeks was one of the best doctors that has worked with us.

She gave us confidence and got us to such a point that we were willing to ask questions.

We asked her why she decided to go into this field, and she said that it is always intellectually stimulating and that the hours are, for the most part, conducive to a good family and social life.

She says that she also loves paediatrics, but the periods on call are inhumane, and easily squashes the most passionate paediatrician.

We asked her if she misses patient contact, and she admitted that she does – but that there are also many things she doesn’t miss.

We also asked her if she eats meat: she does.

I have rarely met a doctor who manages to cause such enthusiasm in a group of tired medical students.

She realised soon enough that our knowledge of anatomy was poor, but instead of making us out as lazy, she went out of her way to give us a crash-course.

On Friday, our last day of the rotation, she ensured us that we would always be welcome to approach her with questions, even one day if we are family physicians in rural areas (where GPs perform autopsies).

I may actually be interested in this specialisation now. There are still many years to decide, and many matters to consider, but I am so thankful for her enthusiasm.

Delivery in the Lab

A page from William Hunter's 'The anatomy of the human gravid uterus exhibited in figures', published in 1774.

Our last day of autopsies today and I finally took a deep breath and asked my question: “Do you ever get pregnant mothers? Do you look at the babies?”

Yes.

Sometimes the pregnancy is an incidental finding, tiny 12-week old fetuses.

Sometimes they pregnancy is almost term.

They won’t usually dissect the fetus, but they look at it: take measurements and inspect the placenta.

Coincidentally, there was such a mother today. She died at home of massive haemoptysis (most likely TB-related) and the healthy baby died along with her.

They brought the uterus to us, unopened. Another amazing bit of anatomy, seeing it lying in relation to the other organs.

An incision was made as if a normal caesarian section. There was something heart-breaking (call it my own broodiness), when baby’s head popped out, covered in vernix.

The forensic pathologist announced, “It’s a girl” and my heart ached for the father (if he is around) and the deceased mother, and even for the baby girl who was never held.

Brain Cut: Fatal Fall?

We are privileged to have weekly tutorials from the only forensic brain pathologist in Africa. He is retiring soon – which is sad, because he is clearly a genius. He also teaches with passion, which seems rare in our field.

Anyway, we had an interesting case during brain cut today.

A 22-year-old man fell. The Professor’s first question was, “And how do 22-year-old’s fall? From ropes, and buildings, and hang gliders.”

He was a little disappointed to hear that our brain fell while being arrested by the police. Even more so when it was said to be an “alleged fall” – seems reminiscent of our country’s Apartheid era, where many inmates died after slipping on a bar of soap.

So anyway, while he was alive, it was determined that he had no skull fractures, but a sub-arachnoid haemorrhage and haemato-hydrocephalus. They then started investigating for a ruptured sacular aneurysm. None was found. The bleeding in all ventricles continued and an external drain was placed.

He started improving, and then quickly deteriorating. CT revealed first a small area of infarction in the temporal lobe. Two days later it had progressed to a large middle cerebral infarct. He died shortly afterward.

So interestingly, our Professor was tutoring us on aneurysms before we started slicing the brain. Then we got to the middle cerebral and anterior communicating arteries and, presto, nothing. No aneurysm. No sign thereof.

The brain was falling apart though. Infarcts are annoying.

More or less what the brain looked like. Image by Dr K. Mason, Iowa State University

For the first time the external appearance of the brain intrigued us. The vessels were extremely engorged. In between them were small, thin venous bleeds. Our Prof says the only time he had ever seen something similar was with viral meningitides. (Good thing the brain had been placed in formalin).

Our Prof seemed a little annoyed still. Partly, most likely, because it became clear that our understanding of neuroanatomy sucked.

Interesting case though. Even more so since we managed to cover a few diagnoses before finding the one of best fit.

Not all babies grow up

I enjoyed obstetrics so much last year, not for the “miracle of new life”, but for the influence one might have. I keep thinking: There are 15 babies learning to walk in this province, and the first person to touch them, to see that they are perfect, was me.

We performed an autopsy on a two-month-old baby who was born at 32 weeks gestation. It seemed like a SUDI – Sudden Unexpected Death in Infants – but the initial doctor queried negligent parenting.

The baby was small – extremely small. About half the size of a term baby. I don’t know if the inquest will determine that there was some negligence. The educational worth here was more morphological.

We could see six occification centres on the sternum – six! A term baby may have two or three.

We saw an almost-closed ductus arteriosus.

We saw perfect organs. A small, but normal-looking brain. Kidneys the size and shape of large beans. The tiniest little heart, but everything where it should be.

There was milk in the baby’s stomach – so for what it’s worth, the mother did apparently try to keep her fed. Poverty does not automatically constitute negligence.

There is something breathtaking about such tiny, perfect organs. All of them perfect, until they weren’t.

We found milk in the lungs.

I am not to postulate about the pathologist’s findings, or what will happen to the mother. These situations are sad, and can bulldoze you if you let it. To some extent you have to let it touch you, I suppose. But to some extent you must also learn from it as much as you can.

Instant Accidents

WARNING: NOT FOR SENSITIVE READERS

There are very few things that kill you immediately. An atlanto-occipital fracture. A brain-stem injury. The other things that Hollywood tells us are instant, gunshots or stab wounds to the chest or head: not so much after all

We performed an autopsy on a four-year-old who landed head-first under a truck.
His skull didn’t have to be opened. It wasn’t flat as one would think either. His liver was split in two, but he had no broken ribs. No broken bones. Massive blood loss. His kidneys and lungs were too pale.

There was little to see of his brain. I am trained to deal with that, but I cannot begin to imagine the shock for the truck driver. A truck driver who was wise enough to stop when he heard the awful crunch under his tires.

What we know is that the atlanto-occipital fracture and the severe brain injury killed him just about instantly – which is fortunate, because the liver laceration would have been a painful last minute.

What we don’t know is what a four-year-old was doing on a major roadway in the middle of the night. We don’t know where his mother is, or if she knows

That is not for us to know.

A Tainted World

My world changed overnight.

Not that it was peaceful before. Oh, there was fear. There were statistics. There were the horror stories, and my own family’s horror story of loss.

But my world became scarier now. There is danger everywhere. Even the benign is two-faced. My world has become one where jealous boyfriends stab little girls to prove a point. A world where brothers kill brothers with a force that destroys the entire thoracic compartment.

Nobody is safe in this world – not from harm, nor from tragedy.

It has become a world where day-old babies are drowned, where old men are attacked brutally, where suicide is discovered only when the deceased is barely recognisable.

So many people who couldn’t be saved by doctors – it is the very picture of the shortcomings of this career.

It is a world of morbid fascination – somebody’s gotta do the job.

It is the boogieman of adulthood.

The Thing About Kiwis

The amazing thing about kiwi fruit is that they do not resemble any part of the human anatomy, whether dead or alive.

I though Forensic Pathology would be relatively easy, considering I had survived two years of cadaver dissection without queasiness.

But the thing about forensics is that it doesn’t smell like formalin. We had two decomposing bodies come in today. And they did not resemble formalin.

The thing about cadavers was that you did not know how they had died – you were not allowed to know. But you did know that no foul play had been expected, otherwise there would be little left to dissect. Now we get to know what happened to the freshly (or not so freshly) dead: in fact, it’s our job to figure it out.

The flipside is this: I have never grasped anatomy quite like I do now, after only two days in the Forensic Pathology laboratory. Organs look like they should (unless they don’t, like eviscerated bowl or oedematous brain). They look very close to what Netter tells us they should.

I said before how fortunate we are that we get to dissect cadavers. Perhaps now I feel a little different. Blasphemous as it feels, I wonder if two years of dissection helped me any at all. Because organs doused in formalin look nothing like this. I used my imagination more than I probably should have. And they wonder why we suck at anatomy?

But organs doused in formalin look like soft plastic, unreal. Fresh organs move and squelch and yield softly under a knife. And I had just recently overcome my fear of cooking.

So it’s kiwi fruit, for now…