A heart in his hands ♥

While dissecting the woman at Table 1, A medical student  finds it is still possible to think of the human body as a grand design, amazing in its ability to coordinate the thought, energy and motion needed to blink an eye or swing a tennis racket.

He marvels at subtle peculiarities — the old woman’s youthful-looking hands and His’s own, which can throw righty and bat lefty.

During the class exams at the College, images flash in his mind. He sees the lush color illustrations from Frank H. Netter’s “Atlas of Human Anatomy.”

Then, in the last week of September, His’s dissection group delves inside the old woman’s chest. What they find is anything but grand or idealized.

The Left lung sticks to the chest wall; it is not supposed to. And inside the organ lurks dark red, gelatinous material that should not be there.

What is all this stuff? He wonders.

The six students at Table 1 ask themselves if there might be some connection between the material in the lung and the grossly enlarged vein they found earlier in the woman’s arm.

Was this why she died?

Death is often private.

There are death certificates and open caskets. But few look at the certificate, and an open casket reveals little.

Imagine another view of death: You are laid out on a steel table, your demise the subject of classroom discussion.

The women is comfortable with the role, a point she stressed in the video played on the first day to the 200 students in gross anatomy. She is 80 years old. She says she knows what will happen when her body is taken to the Medical College for dissection.

Not that she dwells on the inherent eeriness of young strangers seeking clues to her death.

“Weird?” she asks, then answers quickly: “No. I hope the cause of my death is that I just wore out everything that I got.”

Like the students at Table 1, someday that woman’s group will piece together a biography from a body. They will look for unusual veins or surgical scars or damaged organs.

They will know about her death, injuries, diseases, but not the rest: the 57-year marriage, the eight children and 30 grandchildren, the sense of humor, the Catholic faith, the whole arc of her life from childhood, Ill., to her adult years.

The mission of the students working on that woman will be to learn the map of the human body, but also to track the progression of her’s health and figure out what killed her.

Here’s one thing they will learn from her: She had her tonsils out in childhood. Her missing tonsils are trivial in terms of her health but revealing in what they say about medicine. Our understanding of the body remains a work in progress.

Earlier generations of doctors removed the tonsils when they were swollen. Today, doctors usually don’t, believing they play an important role in the defense against bacterial and viral infections.

Aside from her absent tonsils, students will discover that she had a hysterectomy much later in life. And recently, at the age of 80, she had knee-replacement surgery.

Otherwise, she says, “I’m pretty much a healthy old coot.”

As the students at Table 1 follow the networks of veins and nerves, and identify each muscle, even those controlling the eyelids, they begin to see the contradiction.

One view shows a beautiful machine; the other a broken-down wreck.

“She has no major scars,” He tells one of the professors, adding later to himself, “She had lots of problems.”

The woman has no Gallbladder.

She has the artificial hip joint they found.

The muscles in her arms and legs are paltry.

Her kidneys are small, and on them He finds hard bumps, little pus-filled nodules. Inside the kidneys, the students should be able to see the medulla and the cortex, but they can’t. The interior is a mess.

This is how a body looks when it breaks down.

What looks like chaos isn’t random. The mess inside the kidneys clarifies something the students found earlier: an enlarged vein in the woman’s arm caused by a shunt. She was receiving dialysis. Her blood was carried out of the body into a machine that cleaned out waste to compensate for her failing kidneys. Then the blood re-entered her body.

To the group, the kidney problem is another clue to the woman’s death. Professor wanders over. He tells the students he made a prediction about the cause, checked the death certificate and learned he had it right.

“I’m not going to tell you the answer yet,” he says. “I want you to think about it.”

To one member of the group, however, the bad kidney is more than a clue to a mystery.

An other student had felt anxious about dissecting a human body. He had not foreseen that the body he cut with a scalpel would bring back memories of his late mother. Both women went through dialysis.

“The thing about dialysis,” the other student says, “it’s not a sudden death. They actually had time to think about it and decide, ‘OK, I want to stop.'”

The chest lies open.

A large section of the rib cage, now removed, rests at the old woman’s side like a catcher’s chest protector. He cut through a fluid-filled sac called the pericardium.

They approach the engine of the whole beautiful machine.

“You will never again get the chance to hold the heart in your hand,” the students had been told a few hours earlier by a professor in the department of cell biology, neurobiology and anatomy.

In class, the professor described the four valves in the heart. He explained systole (when the heart ejects blood into the body and the lungs) and diastole (when blood refills the heart’s lower chambers). Students gazed at the beautiful pictures in the Netter atlas.

But the words and the textbook pictures cannot compare with the organ itself in the palm of your hand.Image

The old woman’s heart is a muddy beige. The size of a large fist, the organ is lighter than expected; it is filled, not with blood, but air. At the back, the heart is dense and fibrous.

Now, pinch the tissue; feel its oily-leather texture. Peer inside the dark left atrium, one of the chambers.

Picture the choreography of valves opening and closing. The parallel pumps sending blood in need of oxygen to the lungs, and blood with oxygen to the rest of the body.

“It’s just amazing that it can run on its own. It knows exactly what it needs to do,” He says. “You grow up drawing pictures of hearts on Valentine’s Day, but seeing the heart firsthand, I’d never been able to appreciate the four chambers before. I could hold it and imagine it pumping and blood going wherever it needs to go.”

As he holds the organ, peering at the ventricles and the atria, he thinks that everyone should get to see a heart up close. But just as he’s contemplating the complexity of the human body — from somewhere in his subconscious

He can’t help himself. He thinks of that scene from the “Temple of Doom” movie in which a man’s heart is plucked right out of his chest, still beating. And the guy stares at his own beating heart, eyes wide in fear and disbelief.

When the heart reaches him he pushes the valves with his fingers. He thinks of how much goes on in a single heartbeat, and then tries to imagine it running 60 to 100 beats every minute of every day of every year, on and on for 70 years.

“It’s crazy,” he says.

She has never had the opportunity she is making possible for students.

“I would be so in awe,” he says. “To hold somebody’s heart in your hand … This is something that God has created and you have it in your hand.”

It’s not just the heart’s role, but its mythology. The heart is where love resides. The heart is where we place our hand during the national anthem or Pledge of Allegiance. Is there anything that hurts more than a broken heart?

The organ has become a symbol for something so strong we can find no other word for it.

As the mother and grandmother of doctors, she is familiar with what the heart does, how necessary it is to life. She remembers feeling hers race the one and only time she got in a car accident, a fender-bender 15 years ago. She remembers feeling an awareness of the pulsing heart inside her during weddings and visits from grandchildren.

Someday when her heart no longer beats, a group of students at the Medical College will take turns holding it.

“I would want them to feel that this is something beautiful, not icky or gross,” she says, “that it is very large — not necessarily in size.”

In the middle of the first exam, He feels acutely aware of his own heart. It is late September and the students stand in the lab amid all the cadavers. A beeper goes off every minute, signaling that each student must move to the next body and identify the next tagged structure.

The lab is crowded yet so quiet. All he hears is the shuffling of feet, the rustling of exam papers and the sound of his heart beating inside his chest. Then the beeper sounds. Next question.

Their hearts are laboratories for the study of stress. There are twice-weekly labs and lectures, textbook chapters, long lists of structures they must know — as many as 60 on a single page of the atlas, 3,000 in all.

Before each exam, “midnight ‘ emails” land in Professor’s inbox. They come from students pleading for more time to study, or explaining why tomorrow’s result “will not reflect my true ability.” Afterward, a few sit in the professor’s office, emotional wrecks.

Professor talks to them gently. Often he finds they are falling apart because they passed with a 75 instead of their customary 95.

Congratulations on passing, he tells them. This is a class of exceptional people. I’ll take passing any day.

Shortly before Thanksgiving, he drives towards hills and woods, to hunt deer.

Early one morning as the sun rises over a quiet field, he shoots a seven-point buck.

He begins field dressing the deer with a hunting knife. He works at the treeline where it meets a large meadow. There are only bird calls to break the stillness.

Usually, field-dressing is a task he performs at a brisk pace.

This time he lingers over it. He finds himself not just dressing the deer, but dissecting it, noting the layers of connective tissue and muscle, the layout of the vessels, the organ structure. He looks at the liver and the spleen.

The deer’s heart doesn’t look that much different from the human heart he held in his hand — just a little bigger. He dresses the deer’s body for almost half an hour.

He ponders the intricacy of not just humans but all living things. He views dissecting the deer as an act of respect. “I’m eating the meat,” he says, “but I’m also learning from it.”

Looking out on the meadow, he utters a prayer of thanksgiving for the deer.

It is a few weeks before winter break and they are closing in on the old woman’s face. Another students feels uneasy.

Months ago the towel slid off the face as they were turning over the body. Some of the students at Table 1 looked. some, who were working at the feet, did not.

Soon they will have no choice. And this time the students won’t just be looking. They begin dissecting the skull and face right after the holiday break.

they dislike the idea that this will be how they introduce themself to the woman on the table. So, one day just before the break, as he’s putting the body away following dissection, he pauses.

And lifts the towel.

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By Dr.Himanshu Dubey

One comment on “A heart in his hands ♥

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