From our anonymous insider…
Each week our class discusses a new patient that parallels the scientific theme(s) from lecture. Most medical schools are pushing away from the conventional medical school format: two years of basic science education followed by two years of clinical rotations in the hospital shadowing residents and attendings. The newer approach is integrating clinical experiences and lectures during the first two years.
This week we reviewed a patient with a metabolic muscle disorder who became addicted to pain medications and heroin. The case paralleled this week’s lecture topics of muscle structure, contraction and metabolism, including the dreaded Krebs cycle. A public health official came in to discuss the country’s opioid epidemic. In 2014 the CDC recorded 28,647 deaths, triple the 2010 number, from opioid overdoses (prescriptions and heroin combined). We learned that “among new heroin users, three out of four report having abused prescription opioids prior to using heroin.” (http://www.cdc.gov/drugoverdose/data/heroin.html) Most heroin comes from Mexico: “Researchers believe the border detection rate hovers around 1.5 percent — favorable odds for a smuggler.” (Washington Post). Mexican heroin is unlike the “black tar” Southeast Asian variety of the 1970’s. Mexican heroin is close to pure and frequently laced with potent fentanyl, a synthetic opioid over 100x as powerful as morphine manufactured in cartel labs. (Prince overdosed on fentanyl.) Overdoses rise when fentanyl is in the mix.
Week 3 went by fast because of a few firsts in anatomy. We continued dissection of the gluteal region and the posterior lower leg. I saw a nerve for the first time — it was huge! The sciatic nerve runs through the thigh until it branches into the tibial and fibular nerve at the popliteal fossa (posterior knee joint). The sciatic nerve is about the diameter of a large pen with translucent threads firm to the tough running along its axis. This observation shattered the notion that nerves interact only at the microscopic level. I can imagine how hypertrophy or herniation of nearby muscles could constrict the sciatic nerve causing radiating pain down the leg. Interestingly, the tibial nerve lies superficial, above the arteries/veins, at the back of the knee. You do not want to cut yourself here… One of my teammates for our cadaver cut her hand with a scalpel, the fifth incident in three dissections. She was trying to isolate semitendinosus, a muscle of the hamstrings, with a scalpel and her hand instead of a probe.
Statistics for the week… Study: 8 hours (5 hours devoted to anatomy); Sleep: 6 hours/night; Fun: 4 nights out. Example fun: A fellow classmate (let’s call her “Jane”) and I joined the Hawaiian-shirted locals at the weekly outdoor swing-dance downtown. Dancing to the brass-heavy “beach music” band and wearing a thrift-store Hawaiian shirt, I would have fit in except for being 35 years younger than the average dancer.
The Whole Book: http://tinyurl.com/MedicalSchool2020