Tuesday, October 14, 2003

Get It Off Your Chest

Palpating ourselves to confirm the location of the angle of Louis and the xiphoid process; peeling back the skin, pec major, and pec minor to expose the ribs. Count them--1, 2, 3, 4...We scraped down the chest wall to the intercostals and explored IC4 all the way down to the parietal pleura, a shiny, single-layer cell sheath that encloses the lung cavity and can go haywire with cancer when exposed to asbestos. Is that the lung? Probing blindly with a gloved finger into the excavated intercostal space, I felt the spongy mass of lung tissue and nearly shrieked with excitement. We practiced CPR (sans mouth-to-mouth, of course) on the sternum and watched the lungs balloon in and out before our eyes. Then, it was bone cracking time.

As the only left-hander in the group, I was chosen to saw the left ribcage. Bright red marrow (or was it just blood?) squirted out of the bones as I cut, leaving jagged edges. One slice at the manubrium, another at the xiphoid, a quick snap through ribs two through six. Finally, the moment of truth--lifting the whole segment up and out, like lifting a grouted tile off a bathroom floor. With just a snip here and a swipe there, the bone spider came off.

Pablo, I was surprised to see, has healthy, pink lungs. They felt spongy like Ethiopian bread, elastic but delicate, engineered to absorb. Nestled between them sat the heart, a big, juicy red pepper stuffed solid with muscular tissue. Pumping from Day 1 to the Last Day; faithful and stolid. The liver bulged up from the abdominal cavity covered by the diaphragm, and the fatty thymus curled its yellowing adipose fingers round the heart and lungs.

Over at another table, a body told its story of devastation. Metastatic breast cancer spread to the lungs, leaving two small bags of rocks where the lungs used to be. Cancerous nodes splotched up the entire chest cavity like barnacles on the underbelly of a boat. I wonder what it was like to live in her body, to breathe with those lungs, to battle that cancer. I think about my mother's mother, who let her cancer spread before going to the doctor, who never got to know the beautiful women her daughters are today.

Time's up. Replacing the layers in reverse, we put the ribcage back on and close the chest. Now it's off to dinner, our pre-clinical clerkship barbecue. I hope they're not making ribs...

Thursday, October 09, 2003


"Most organic Nitrogen has been in circulation for some time, passing from one living organism to another." Alberts, p. 73

We are all part of one life process. There really is no difference between you or me, except for this illusion we call the ego; and the distortion of distance and separation provided by the mixed blessing of sight.