- Wife of the Gods
- Children of the Street
- Murder at Cape Three Points
- Gold of our Fathers
- Death by His Grace
- Death at the Voyager Hotel
Doctor in training: The beginning
A brand new medical student may not think of it in this fashion, but he or she is actually a very young and green doctor in training. In medical school, there are certain main subject categories like Anatomy, Physiology, Biochemistry, Pharmacology, Pathology, and so on. A med student has to study a lot, although there isn’t as much dry reading as there is in law school, for example. In case law, you might read a case Mr. X versus the State that is page after page of long, wordy paragraphs. In medicine, cases might have images to support clinical situations and break up the tedium.
In Neurology, for instance, you have diagrams of neural pathways that you must learn in order to understand a particular neurological mechanism or disorder, as in the simplified example below. It makes understanding the pathology easier, although it doesn’t necessarily give you less to memorize.
Among the subjects a medical students, aka a young doctor in training, have the most anxiety about, Anatomy is probably the mother of them all. It’s the study of the structure of bodily parts and their physical relation to each other, and the study of human anatomy traditionally involves dissection of the human body much the way many of us dissected frogs or mice in high school or college. For most freshmen and fresh-women in medical school, human anatomy is the first time to see and experience a dead body. I remember I was a little apprehensive about what it would be like, but I recall some other students who were almost paralyzed with anxiety.
I remember the dissection hall as a large room with two long rows of stainless steel tables upon each of which was a male or female cadaver. My reaction to the bodies was surprisingly muted. They had an unreal, waxy, Madame Tussauds appearance. The skin texture was nothing like a live human. They reeked of the formaldehyde preservative, and sometimes it was so strong as to make my eyes water. In the end, I think even the students who were most worried about the cadavers got used to the idea pretty quickly, and two or three weeks in, no one batted an eye.
Each student is usually assigned to a pod of 7 to 10 colleagues who stay together as a group with the same cadaver for the duration of the semester. Each pod follows the syllabus under supervision by a preceptor, usually a junior staff physician. The study of the cadaver’s anatomy follows major regions or systems of the body: head and neck, upper limbs, chest, abdomen and so on. But within each of those are subdivisions: for example, the head and neck will include the lymphatic, neurological and muscular systems. Whether you get a male or a female cadaver is luck of the draw, as is the amount of adipose tissue your cadaver has. Consider yourself lucky if you have a lean body. They are much easier to work with.
The amount of material to learn, absorb and memorize in Anatomy is staggering. A student needs to know where every nerve begins and ends, which muscles the nerve controls, the origin of every skeletal muscle and the bone on which it ends, and so on. Remember that there are something like 650 skeletal muscles in the human body. All of this information can become overwhelming, and the practical exams in which you’re faced with an unidentified organ, muscle or bone are nerve wracking. For all these reasons, Anatomy is almost certainly one of the most stressful subjects in the medical school years, but it can be also enjoyable. Most of the anatomical knowledge the medical student gains in Anatomy will stay with him or her throughout his or her life as a practicing doctor, and for those who go into surgery of any kind, whether it’s general surgery, orthopedics or neurosurgery, Anatomy is of the highest necessity.
The original “Grey’s Anatomy”
The name of the TV series “Grey’s Anatomy” originates from the all-time classic textbook, Gray’s Anatomy by British surgeon Henry Gray, with its iconic illustrations by Henry Vandyke Carter. Dr. Gray was born in 1827 and died of smallpox in 1861 at the tragically young age of 34. While still a doctor in training, Gray secured the triennial prize of Royal College of Surgeons in 1848 for an essay about the nerves supplying the human eye. His 750-page textbook, first published in 1858, is highly acclaimed to this day for its masterful descriptive detail accompanied by some 365 extraordinary diagrams.
The TV program spells “Grey” with an “e,” while the textbook “Gray” is with an “a.” The 41st edition, the latest, was published in 2017. Modern versions of the textbook connect anatomy more with clinical scenarios than the old editions. By the way, I’ve never seen an episode of “Grey’s Anatomy,” where all the physicians, from the youngest doctor in training to the most senior and seasoned, are annoyingly and impossibly attractive, but I have used the textbook!
Just as in other fields like astronomy or engineering, the volume of knowledge and information in medicine seems to have increased several fold over the past decades, and has the way that knowledge is shared has also changed. In my next podcast, I’ll talk about how learning has evolved with the advent of a pocket-size device that can hold a lot more textbooks than you can lug around under your arm: your smartphone.
In a future blog I’ll tell you about the very tough years of internship and residency of a doctor in training.