I swear we’ve heard phrases like, “you’ll need this when you start practicing medicine” or “this will be absolutely integral to becoming a good doctor” about 50 times already. Also common are: “We’re so glad you’re here, and we love meeting new students.” So it’s always nice to hear an instructor and clinician say, “I don’t know a *thing* about molecular biology.”

Also overheard:

Q: How can you tell the difference between an undergrad bicyclist and a grad student bicyclist?
A: The grad student’s wearing a helmet. They’ve invested more in their head.

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I was slightly disturbed today by the fact that our second day of anatomy lab felt so normal all of the sudden. Tuesday was met with complete apprehension, anxiety, fear, and wonder, but today, that all seemed washed away under the necessity to complete our dissection (lung removal and finding the neurovascular bundle and interior thoracic artery). For me at least, it was a little easier acting as if this were some monotonous routine–that I had dissected humans before, like our professors; that this was “just another one.”

It’s a great feeling when things start clicking and making sense; understanding everything from lecture to basic anatomical terms. A friend who was not dissecting today noted that it was a little more difficult to see what his partners had done in his absense–as if it was more disturbing and gruesome to have only seen the end result, instead of being present throughout the entire process.

The unanswerable questions interest me the most a lot of the time, and in this case, it’s this: how much of a medical student’s behavior is truly just “normal,” and how much is done out of defense mechanism necessity?

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If you’ve never heard of RNAi (RNA interference), it may be medicine’s next “killer app” against disease. Here’s how it works (and a visual , if that helps):

Hypothetically to guard against double-stranded RNAs trying to incorporate themselves into our DNA (most of humans’ normal RNAs are single-stranded), we’ve all got an enzyme that cuts these dsRNAs into pieces. It’s aptly named Dicer . Dicer chops up these pieces into small bits of double-stranded RNA, now called small interfering RNAs (siRNAs). The siRNAs then bind to mRNAs (messenger RNAs), generally of the same sequence as the dsRNA; this then activates *another* enzyme complex that detects double-stranded mRNA, and breaks it down.

Theoretical translation? If you’ve got a gene that’s malfunctioning, or a virus that’s multiplying, or a bacteria that’s making toxic proteins, you could (again in theory), develop a double-stranded RNA that matches with the malfunctioning or deleterious mRNA, and the body’s own defense proteins would chop it up, meaning the harmful proteins would never be created in the first place.

Theory doesn’t always work out in the slow and methodical world of bench research, but there are already RNAi databases, companies sprouting up that work solely on RNAi techniques and research, and RNAi researchers around the world.

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Today being my first day of official medical school classes, I figure it’s pretty much required that I post about the Anatomy Lab experience. In short, it wasn’t as disturbing or frightening as I thought, but only because, well, cadavers don’t look like real people.

I think our whole class was anxious to start anatomy–people starting donning scrubs before class (we have an hour lecture and then a three-hour dissection about what we’ve just covered in lecture). We arrived in the anatomy lab, and no matter how well ventilated the place is, you’re always hit by the smell. It’s a mixture of latex, cleaning product, and embalming fluid (in Stanford’s case, it’s a mix of formaldehyde and alcohols that are used as the preserving agent). Some of the bodies were, to my amazement, preserved for 18 months before they became our cadavers.

I was very impressed with the lead professor’s handling of the experience. He talked to us about professionalism and that, while humor and light-heartedness is very often part of the atmosphere in the lab, we should remember the gift that these men and women have given to us. Once we all entered the lab, we also had a moment of silence out of respect and gratitude to the cadavers we were about to learn from.

We began with basic safety precautions–how to handle a scalpel and scalpel blades, how to dissect properly, etc. And then, we began. My group of four all looked at each other, unsure who wanted to make the first incision, and we unzipped the royal blue canvas bag, peeling back the sheet covering our cadaver. I was amazed at how pale and certainly unlifelike the man’s skin was, as well as the hair on his chest. We found the jugular notch (sternum notch), and I was surprised at how hard his body had become; even the side of his abdomen was wrinkled and had the exact same folds as a brown paper bag. Besides the hair, I think it was much easier for me to use the visual cues and assume that this *wasn’t* a person I was dissecting. I know it’s not the attitude I want to hold for the entirety of the class, but for the first day at least, it made the act of desecrating and mutilating a human body seem less severe and inhuman.

I hate to even mention it, but at one point, the dissection began to feel… fun, if only of the sense of wonder and amazement at the man’s body–finding a couple small arteries and nerves, and several enlarged lymph nodes. It’s a weird sensation enjoying something that, in any other context, would be completely immoral and vicious. It got to the point where it wasn’t a human’s adipose tissue and connective tissue we were cutting away with our scalpel, but just a maze of layers that we were investigating, searching carefully for a small branching nerve tube.

At the end of lab, we cleaned our dissection area, and went to clean ourselves. But apparently the mixture of latex and preserving agent sits on your skin for days. I scrubbed 3 times and still smell. I know the head and neck, hands, and genitalia will probably be much more trying days, but I was surprised at how normal I felt. My life didn’t change, I haven’t stopped eating meat, I doubt I’ll have any intrusive images in my dreams; I’m told the experience is different for everyone, and it’s just as normal to feel _normal_ as it is to be uncomfortable with the process.

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Apparently I’ve been using the wrong vocabulary for my routine movements throughout my 23 years. Everything is now dorsal or ventral, anterior or posterior, caudal or cranial. My body can now be easily dissected by three planes, sagitally, transversely, or coronally . In the medical world, my body is assumed to be in the anatomical position , even if I’m cowering on the floor, sitting cross-legged, or stretching my arms and back as I wake up in the morning.

I can already see how intimidating, confusing, and frightening medicine and disease can be to patients not in the field. How would anyone know what a myocardial infarction is, let alone anything *else* that I haven’t learned yet. The analogy of learning a new language resonates completely; I’d be just as confused if I spoken to in Portuguese or Arabic, knew it was something important or life-threatening, but didn’t understand what was being said.

I’m also curious as to what extent the medical school process is a means by which med students are taught to think that people are objectified and standardized. Granted, it only causes harm if a doctor cannot control his emotions and feelings enough to help a patient; at the same time, however, it seems like we’re being told that patients and people are a set of neurons, tissues, and molecules that, in most cases, have some sort of malfunction, bacteria, or virus that is ailing them. I think it’s too easy to forget that diseases aren’t just physical, that they affect families, communities, emotions, communication, and social interactions. Patients are people, not computers with a bad hard drive or memory chip.

I wonder how long it’ll take me to get the anatomical terms of position down. Until then, I’ll be picturing every patient in a mannequinned daVinci pose, arms slightly away from his body, palms forward. Lifelike, yes, but still lifeless in my mind. And that’s what I’m worried I’ll be losing down this path.

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