I recently had the opportunity to go to the anatomy lab and help the first years go through the pelvic anatomy. What a blast! There is nothing like dissecting a cadaver to tune up one’s surgical anatomy skills, and helping young eager medical students through it is a great experience.
Prior to going into the lab, I spent many hours going through Netter’s atlas to brush up on the anatomy so I could accurately help the medical students. Its amazing what one can learn reviewing what one used to know. Here’s a few examples:
1. The small vessels we like to cut at cesarean have names, and we can avoid them.
Everybody that does cesarean deliveries knows that there are small vessels in the path of entry that sometimes get cut, but not everyone knows what they are called. So for the record, the small vessels in the subcutaneous fat that get cut are superficial epigastrics (most people know this one) and the vessels that sometimes go during the lateral extension of the fascial incision are ascending branches of the deep circumflex iliac artery. One can see that these ascending branches lie between above the transversalis muscle but beneath the obliques, which explains why sometimes taking the fascial layers separately allows one to miss them. I’ve always felt that the routine sacrificing of these vessels was a surgical faux pas, and knowing this anatomy helps one to avoid it.
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When one is a medical student, pretty much everything one does is directly supervised. Though a student is allowed to assess patients and make recommendations, rarely is a student given the autonomy to make decisions that will affect patients. They practice these decisions, but there is always someone more senior ratifying them.
Once a student becomes a resident, things start to change. As residents are physicians, they have the power to write orders and have them executed without anyone else approving of them. In the beginning, this is a scary power for the resident, as they are terrified they will hurt someone. At the same time, it a welcome reward after years of having to ask someone’s permission to do anything at all.
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When I was a high school math nerd I looked forward to the AP calculus class I would take my senior year, because once I had done that I really would have achieved the tops that mathematics had to offer. Once I finished that class, I remember thinking “now I really understand math.” When I studied mathematics and computer science in college I realized how wrong I had been. I realized then that calculus was not the end of the mathematics – it actually was just the beginning. In fact, it was the first thing I ever learned that could even be called mathematics at all. The rest was just arithmetic.
As an academic gynecologic surgeon, I often get asked a question that reminds of me of my calculus realization, and that question is “Who will be doing my surgery?”
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On January 12, 2010, a magnitude 7.0 earthquake rocked the island country of Haiti, destroying much of the capital Port Au Prince and leading to the deaths of as many as 200,000 people. Since this time, thousands of images of the resulting carnage have been published in both traditional media and on internet sites.
Recently there has been some discussion about the appropriateness of some of these images, particularly those that depict individual humans in despair or even in death. Some have argued that such images should not be published without the express consent of the person depicted, or with the consent of the next-of-kin in cases of the dead. Media, for the most part, has held that in cases of extreme human events the benefit of publicizing the truth outweighs whatever emotional harm might come to an individual through publication of their plight. They argue that the many outweigh the few, in this case.
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This is a rerecording of a recent workshop on D and C procedure that I did with my residents. Enjoy!
If you would like to use this prezi for your residents, let me know and I can send you the file. All I ask is a mention of the blog in your presentation!
Enjoy!
