medicine


Well, here’s what’s going up in the anatomy department. Pretend in your mind’s eye that all of the names and initials are in brilliant metallics.

Convocation Tree

Convocation Tree

As usual, there is a higher-res image up on my DA page, which you can find here. Also, a thought for the day: Go Hokies.

I’m not really sure how this keeps happening. It started with me being guilted into joining two committees – I figured I’d show up, cast a vote or two, and maybe do two hours worth of work calling up a caterer or printing invites. But noooo. Somehow, I got myself landed with being the contact person for one, and being in charge of taking on the university administration for the other. At least I’m grant-supported, so they can’t fire me. Still, this is not going to be a fun week.

Oh, and I also got two unpaid commissions out of it. Here’s the first: invites to the memorial for our cadaver-patients.

convocation invites

convocation invites

As usual, there’s a higher-resolution image up on my DA page, if you feel like taking a look.

Amusingly, the s in “Thanks” wasn’t supposed to look like that at all. I was sick when I inked this, and my hand was shaking so hard that I screwed up the lettering. I then tried to fix it…

The goal was to create something tasteful and appealing that nevertheless spoke directly to the role in which we had met these extraordinary people. Given the nature of the interaction, that was a tall order.

Looking over the work from past years, I was fairly unimpressed. Lots of skulls, anatomical hearts, a few roses, and a sketch of the hand. All of the designs seemed to address the students, not the humanity of the donors. After 5 months at the dissecting tables, I know more about these people’s lives than their families probably ever did. I certainly know their medical histories better than my own. A few must have died suddenly or quietly, but some were in intense pain for the last months – even decades – of their lives. Many were crippled by it, and others defied it with extraordinary courage. My primary lady led a wild life, and refused to die on the terms of her disease. She donated her eyes and body to science and went out with, it seems, very few regrets. I suspect she would have celebrated with some bubbly…or maybe a PBR.

In honor of that, the last thing I wanted to do was something dry and clinical. No textbook illustrations. No black-and-white sorrow. Let them get back outside and escape the institution. Let them be whole again. Have some fun.

Well, I had fun abstracting the major muscle patterns of the back and legs (isn’t that a nice thoracolumbar facia? and how many times do you actually get to point out the superior nuchal line attachments?) and trying to blend that with elements of 19th/20th C book cover design.

Finally! The awesomest upper limb mnemonic is fit for print! So are the branching mnemonics, though they are less fun. I have also added one of my own devising to help me remember how all the bones/VANs/compartments relate in the forearm. Happy studying?

Real Therapists Drink Cold Beer

The brachial plexus gives rise to the set of nerves that supply the arm and forearm. I wish you could dissect it for yourself, because let me tell you, this thing is beautiful! The brachial plexus is as intricate as the cranial nerves are dizzying. Tracing its reticulations is fairly straightforward, but sometimes it is difficult to keep track of all the functional parts of a 3D network. That’s where real therapists help us out; each of these first letters stands for a successive functional portion of the network: Roots (C5-T1 ventral rami), Trunks (upper, middle, lower), Divisions (anterior/posterior), Cords (med., post., lat.), and Branches (godawful lots).

So, how does one address the godawful many branches? Behold:

LML (lateral cord): lat. pectoral nerve, musculocutaneous nerve, lateral root of the median nerve. Frankly, I prefer remembering it as LLaMa.
ULTRA ULNAR (posterior cord): upper subscapular, lower subscapular, thoracodorsal (nerve to latissimus dorsi), radial, axillary
M4U (medial cord): just in time for Valentine’s day, eh? Medial pectoral, medial cutaneous nerve of arm, medial cutaneous nerve of forearm, medial root of median nerve, ulnar

And all that stuff about compartments? Here’s how I began:
Um, Right or Left?

In anatomical position, the ulna is medial and the radius is lateral. Once you start pronating and all that good stuff, all bets are off, so know your stuff! 😉

Here’s take II. I’ll post more as I encounter socially acceptable ones (not that many of these :/).

Two Zebras Bit My Cookies – Your head is a complicated place. All nerves lead to the brain, just as all roads lead to Rome. Here, however, it looks more like traffic in New York City Boston. Among the zigzaggy roads is the facial nerve, which is responsible for all the muscles of facial expression. Although it also has some funky side-roads, there are 5 main branches fanning out across the face from somewhere just south of each ear: Temporal, Zygomatic, Buccal, Mandibular, and Cervical.

C3,4,5 Keeps the Diaphragm Alive – As amazing a place as the head is, it wouldn’t be much without the lungs. And the lungs, well, they kinda need the diaphragm to do their job. The diaphragm is the big trampoline of muscle under your ribcage that pulls air in (and pushes it back out, if you’re panting). It’s innervated by the phrenic nerve, which comes from cervical (neck) vertebrae C3, C4, and C5. This is right above where the nerves to your arms come out, which is why some quadriplegics can still breathe on their own. It’s also why neck injuries are so dangerous; cut this puppy and you stop breathing.

Just when I thought that med students couldn’t take a joke to save their lives (the immuno jokes come from a guy who swapped the clinic for the lab years ago), Dr. D introduced us to the rich tradition of mnemonics.

There are thousands of essential things to remember for clinical anatomy. It’s not just knowing the names of the bones or the muscles, but understanding the development, the interactions, the variations, and how it can all go wrong. Sometime later we’re supposed to learn how to put this Humpty Dumpty back together again. In the meantime, the mantra is simply “don’t kill the patient.” It helps that this is not a concern relevant to our first patient.

As we go through the process of cramming all of the information into our leaky skulls, it’s useful to have a few phrases handy to jog your memory. The older students and professors pass these down with great zeal and ceremony. I’d love to share them all with you, but all the best ones are extremely dirty. Here are a few of the more drab, socially acceptable examples:

  • C5,6,7 keeps the wings from going to heaven
    • The serratus anterior muscles are what keep your shoulder blades flat against your back. Without them, your shoulder blades would fan out like wings whenever you pushed on anything, hence the term “winged scapula.” It’s also responsible for the alarmingly rippled, triangular chest of the western superhero. Yeah, Batman! They’re innervated by the imaginatively titled “long thoracic nerve,” which arises from the 5th, 6th, and 7th cervical nerves. This is one of the few nerves that actually runs on top of the muscle, so it is very easily damaged. The moral of this story is: don’t get into a knife fight…unless you’re Batman. That armor’s better than kevlar.
  • I ate ten eggs at twelve
    • In order for you to breathe, you have to be able to manipulate the pressure in your lungs. Part of this is done with the muscles that run between your ribs, but most of the work is done by the diaphragm, a big muscle that seals the bottom of your ribcage. However, you can’t have a perfect seal; you still have to get food to your stomach and blood to the lower part of your body! To do this, 3 tubes have to pass through the diaphragm: the esophagus, the aorta (the major artery), and the inferior vena cava (the major vein). They do these at different points relative to the vertebrae, which are numbered. The IVC crosses at the spinal level T8. The esophagus goes through at T10, and the aorta goes through at T12.
    • As a bonus, this is how you get hiccups. The only one of those three structures that passes through the muscular part of the diaphragm is the esophagus (the IVC goes through the tendon, and the aorta kinda sneaks in behind everything, right along the spine). The contractions of the diaphragm and the contractions of your esophagus have to be coordinated so they don’t work at cross-purposes. When they get out of synch, you hiccup.
  • The poo-dendal*
    • I bet you can guess where the pudendal nerve is.

*This is actually a new one this year, courtesy of my friend Raven.

Accomplishments so far this week:

  • Correct conversational use of the word borborygm – the grumbling of the bowels
  • Ability to find a stranger’s aorta without cutting them open (note: it does help to introduce yourself first)
  • Identification of the tenderloin, which looks suspiciously like what you find in the grocery store.
  • Ability to make jokes about nitrous oxide and the SodaStream, thanks to a strange confluence of muscular physiology and Bed Bath & Beyond catalogs
  • Snickerdoodles

Also, good luck to my little buddies-by-association, Nate & Theo. Within a week of life, you have achieved the dream of my wannabe-cyborg generation. However, we would like you back. Don’t get too ahead of yourselves, there.

I now have two skeletons in my closet.

Well, most of two, anyway, and only one actually fits in the closet. I’ll have to do some rearranging before his buddy can join. While munching cookies and contemplating the storage situation, I found myself wondering what it says about your life & livelihood when you have to pack away dress clothes to accommodate your bone collection. The answer? Your life is badass!

On the possible downside, it will be dominated by Latin and bone jokes for the next four months. This is all in good fun, but does limit one’s social interactions to ~190 new best friends in the linguistic lazar house. Still, as the bonekeeper, I get to host tea parties with cookies and skeletal rearrangement! Any excuse for cookies is a good excuse.

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