WILTIMS #53: Brains and lightsabers

Yesterday was a dramatic day that concluded months of waiting on a couple fronts.

First up was learning how to perform an HEENT (head, eye, ear, nose, throat) exam, which meant finally getting to use the most expensive single item we've had to buy for medical school: our ophthalmoscope/otoscope (eye/ear scope). The cost was particularly annoying because it's not obvious why we need to buy one of these devices in the first place, as they are provided in every exam room and hospital unit in the country. Now, we didn't need to buy the fanciest model, but it was part of a bundle with our blood pressure cuff, reflex hammer, tuning forks, etc, so I splurged. Anyways, it was nice to finally get to use some of this doctor-y stuff!

To examine the eye with an ophthalmoscope, you start out about a foot away from the patient and place your thumb above their eye (to reassure them that you won't smack them in the head with the scope as you move in). You then align the beam of light with the pupil by looking for the “red reflex” which is weirdly named as it is merely the light reflecting off the retina on the back of the eye. This same phenomenon causes red eye in photographs. After finding the red reflex you move closer to the eye, being sure to keep the light centered on the pupil. Once you get close enough, you can see the blood vessels in the back of the eye. In order to see the vessels clearly, you have to counteract the lens of the eye by focusing the lens in the scope. Interestingly, people with different glasses prescriptions will need a different focus setting on the ophthalmoscope.

In anatomy lab yesterday, we finally reached the apex of the class: cutting open the skull and removing the brain. The day before, we had removed the scalp, so we started by placing a rubber band around widest circumference of the skull to mark out our planned cut. We then took an electric oscillating circular saw and cut through the bulk of the skull, trying to leave a small part of the inner surface intact to protect the brain. Oscillating saws, rather than rotary saws are used to cut through bone and casts because they have a much harder time ripping through soft tissue. Next we used a rubber mallet and chisel to break the remainder of the bone and finally expose the brain.

One cool thing about the interior of the skull is that it has indentations in the bone from the blood vessels of the dura mater (outermost meninx). These meningeal layers are the last thing we had to remove to see the brain, which looked... exactly like you'd expect a brain to look. It felt rather rubbery and stiff as a result of the preservation process.

Literally 5 minutes after I was touching the brain of a dead person amidst the smell of burning bone and flesh, I was waiting at a bus stop to leave town for the weekend. More than anything I wanted to turn to the other bus-riders and shake my smelly hands at them yelling, “Brains!” I managed to hold back my impulse, but let this be a lesson to you - you never know if the guy next to you on the bus was touching brains five minutes prior.