Guest Post: 'Grab the Bone Saw'
In which Spring '21 Medical Narratives student Jason Miller reports from a room we all think we know
It was the first day of class. In Travel Writing, a student expressed ambivalence about a so-called “study abroad” essay. “It’s so cliche,” she said, or something like that, gesturing I think at the privilege of such a trip, the well-worn narrative grooves, those easy epiphanies.
It’s not hard to imagine that piece, right? Getting off the plane, you’re scared to hail a taxi. In the winding alleys you get lost. That first night, there’s the experience of ordering an alcoholic drink in a new place. Then the surprising camaraderie of your fellow students. The next day: homesickness, and a week later, that moment when you aren’t lost, when a shopkeeper recognizes you, the time someone speaks the native language to you. They think you are a local. And maybe you do too.
Boring. Typical. Not worthy.
And yet. We write that study abroad essay. I make you write that study abroad essay. We figure out how to make it new. By being precise and specific, by working hard to put human bodies on earth, by doing all these things, we try to build a new version of an old story. Maybe it’s a love story. Or a loved one’s struggle with cancer. That super tough breakup. Grandma doesn’t remember you. I’ve read them all. I’ll never get tired of it.
Enter Jason Miller, and another old saw. (Sorry, you’ll see, that’s a dad joke.) He’s a wonderful former student from Medical Narratives 2021. (Did I ever actually meet Jason in person? I don’t recall! Is he 6’5 or a short king? Who knows!) It doesn’t matter.
What’s important is he’s a hell of a writer and thinker, a young man in his first year of medical school at Tufts. Reader: he’s been in the cadaver room. Find out what happens next. (Even if you think you already know.)
Grab the Bone Saw
By Jason Miller
NEEEEREREERERE! The sound of 40 bone saws harmonizing together in the cadaver lab was nearly deafening. Not only was the sound enough to cause sensory overload, but there was also a stench akin to sticking my nose in a bag of Flamin’ Hot Cheetos.
One of my lab members called to me as I was staring into the distance of the bright white lab through my clear goggles: “Jason, are you ready?” I gathered my thoughts and the bone saw in my right hand, “Yeah, sorry.”
I turned on the saw and immediately my hand started vibrating. The adrenaline rush from my 6:40 AM alarm is nothing compared to this. As I took a deep breath, I applied light pressure to the vertebral column with the blade’s jagged edge. My hand suddenly shifted a couple centimeters downward through bone and ligament. Hello, spinal canal. I was near millimeters away from the spinal cord. Careful, that’s the star of the show, I thought to myself. Gliding the blade through six vertebral levels, I had reached the segment containing the tapered end of the spinal cord - the cauda equina (aka - horse’s tail). Our work was not done yet.
One of my labmates grabbed the shiny, metal chisel, a tool I imagine Michaelangelo used to build his famous, marble David. In order to separate the bony shield to isolate the spinal cord, they started hacking away. Chip, chip, chip. You could hear the bone crack with each metallic strike. Eventually, the rectangular section of bone from multiple vertebrae was ready to be removed. One of my partners and I took our gloved (of course) hands to both sides of the interwoven vertebrae. As we both pulled, bodily fluid was spilling through the intervertebral foramen and a sound similar to stepping on a tree branch was heard.
Voila! The cauda equina was unveiled with its gray, sinuous strands of nerve fibers multiple centimeters in length. The professors were not joking: it really does look like a horse’s tail. Why did human evolution leave it up to this easily damaged cord to control our body movements, sensations, and so much more? For every seemingly illogical structure or function in the body comes a marvelous compensation. In this case, the vertebral column saves the day. A Medieval Period Moat has nothing on this bony armory.
To date, dissecting to the level of the spinal cord was the most visceral, gut-wrenching experience of medical school. Though the anatomy lab tests the limits of human nausea, it is exactly what I envisioned a medical school anatomy lab would be like. I love it.
I was repulsed by the idea of doing colonoscopies for a living until I took this course.
I, and pretty much anybody that hears that I go to medical school, ask “What type of medicine do you want to specialize in?” I have a rehearsed answer: “Oh, you know, at this point, I am thinking about cardiology, but I could see myself doing pretty much anything.” Honestly, that is the truth - I have no idea! But that is not what people want to hear. As a first-year medical student, I am not supposed to know; unless, of course, I wanted to do neurosurgery. Based on my anecdote above, you would probably think some surgical field would be my top choice. That is precisely the problem - they are all great!
I said it from the beginning, and I maintain the position: go into medical school as an open book and let the education and the experiences write the pages. This rang true for me just three months into medical school when we learned about the gastrointestinal system. From the outside looking in, this field does not sound very glamorous. I was repulsed by the idea of doing colonoscopies for a living until I took this course. However, after learning the physiology, anatomy, pathology, and histology, I realized there is far more beauty and desirability of the GI system than I could have imagined before medical school. Add that to the growing list of potential future specialties for me.
The common theme amongst all of these specialties is that I am here to help people in some capacity, whether that is replacing a hip, stenting a coronary artery, prescribing antihypertensive medications, administering dialysis…the list is truly innumerable.
As I near the end of my first year, I am blessed to be in the position that I am in and do not take a single moment for granted. There is an unlimited amount of information left to be learned. Mount Everest does not pale in comparison to the sheer size of this uphill battle. I imagine when one finishes a climb up a precipitously steep mountain a large exhale is let out. At this rate, my exhale will not come for many years as I look to become the first board-certified cardiologist, dermatologist, gastroenterologist, pulmonologist, oncologist, surgeon.
PS. Thank you Nathan for teaching an awesome Medical Narratives class in the spring of 2021. Any budding physician should take this class!