Tuesday, March 20, 2007

"Medicine and Laughter"

A woman told the vet that something was wrong with her dog. He examined the animal and told her the dog was dead."I don't believe you", she said, "I'd like a second opinion"The vet said that would be fine. He went into the other room and got a cat. He put the cat up on the table with the dog. The cat sniffed the dog and jumped down. The vet then got a golden lab, put him on the table and the lab sniffed and jumped down.The vet tells the lady again, "I'm sorry, but your dog is definitely dead. That will be $600 for the exam.""$600 is ridiculous, what are the charges for?" she exclaimed."$600 is a bargain," the vet explained. "$50 for me and only $550 for the cat scan and lab work."

Saturday, March 17, 2007

How Medical Is Death?

How Medical Is Death?
I guess the “medical-ness” of death depends on your attachment to the deceased and perhaps if you have any familiarity with medicine at all in any form. So perhaps my view of a recent funeral experience allowed me to view death as both medical and emotional, and the funeral if not fun, enlightening, maybe because I am both a medical professional and had minimal attachment to the deceased.

Now having assisted on three autopsies in my lifetime and all three in 1989-1990, I have gained an appreciation of viewing humans from the inside out rather than of course our two dimensional mirror view of ourselves from the outside in. The first two autopsies were both from the same accident. Actually six tree planters were killed in a van rollover on the way to their planting site. The pathologist I was helping at the time was filling in for our regular guy and was an older gentleman sixty or seventy years young and just was not moving with the finesse, grace or speed that I am sure he exhibited in earlier years. This equates to the body being exposed to air for longer than what would normally occur. It took some four hours. It got smelly.

The mask did not or could not hide the stench that emanated from the decaying body. There was no suction or refrigeration in our post mortem room so time was of the essence. After I was taught the typical “Y” incision on the chest I was instructed on how to cut the ribs to remove the rib cage and the sternum, as well as the technique of using a “Dixie cup” to scoop out blood that had pooled in the abdomen from a major abdominal bleed that had leaked into the cavity of the deceased, had pooled there and had to be measured. I felt like I was in some macabre movie, very uncomfortable I remember but determined to learn my part in this procedure.
What struck me the most during my gruesome tasks was how compact we are inside and how nicely and snugly everything fits together. The frog dissection in biology 101 did not prepare me for this. Having studied anatomy in 2 dimensions from text books definitely is not the same emotional feel you have from hands on, so to speak.
As we continued to saw a skull, remove a brain, a heart, and other organs my detachment to the human experience became all too clear. We are merely tissue and will no doubt one day be dust again. There was no personality to excise, to save in a bottle or to examine on a slide. There were no memories to collect from the deceased and label with his belongings. There was no internal meter declaring how many times that heart had beat or skipped a beat for that matter. All declaration of self and psyche were vacant, from a medical point of view anyway.

My first exposure to death came in the form of a pigeon named after my oldest sister Gail. Now one day Gail took it upon herself to land on the back of our Dalmatian, figuring all is well, since she had ridden on the back of our Collie cross old Smokey numerous times. I heard a bit of commotion outside this day and opened the door to see Sparky, the Dalmatian, sitting erect and innocent with one small feather protruding from her mouth and no Gail was ever seen again. I made my own conclusions.

A pigeon death, however it met it, is no comparison to that which extols emotional wrath in the human arena of death and coping. I thought during this funeral, of all I could remember who had died that I had been close to; My uncle when I was 14 years old, my brother, my best friend, my nephew, my daughter, and my mother. All who exacted different emotions in different ways? I actually saw my brother take his last breath and wondered years later if I should have saved it, for what purpose I cannot be sure but it might have been nice to have that last bit of life, when everything else was gone.

My medical experience with death happened when I first started working in Nuclear Medicine. I was at the Isaac Walton Killam Hospital for Children in Halifax in the mid 1980’s. Lots of cancer patients came and went thru the doors of our department. On one such occasion I had injected a 7 month old with a tumour imaging agent called 67 Gallium Citrate on a Tuesday and would image two days later on Thursday. I called for my patient on Thursday anticipating what may or may not show on the scan. After all I was 6 months new to this job, just graduated and wanted to be keen. There was a knock on the door and in walked a nurse carrying a red tool box, you know the kind I mean, the ones from Canadian Tire, red tin with the black handles. I asked how I could help her and she opened the tool box to reveal my patient. The tube from the respirator was still inserted in her little mouth and I was shocked and horrified. I was angered at the coldness of how she was delivered to me and dumbfounded by the emerging events. I was going to have to pick up this little dead body and scan it. They wanted the procedure done to see where her tumour was. I understood about that. It may help in understanding disease in others. I also understood the means of delivery to us, a most inconspicuous way to move a dead little body about the hallways of an extremely busy facility with wondering eyes everywhere, its human nature. This would be my first experience in touching someone dead. I was struck by the coldness of the skin but the experience would not be my last.

At a recent wake and funeral, I became detached from my surroundings and began to drift in thought to past experiences with death and of all things autopsies. Most of what I reminisced has been written above. I used to observe funerals as an altar boy. I remembered we got $5.00 for serving at one. I never quite understood however, why people spent time coming together during death but so often did not spend time with the deceased in life. Respect and courtesy to the survivors and deceased I guess. Since I am here at the wake and the deceased has brought us all here with her untimely death, as most seem to be, no matter what the age, I decided to learn more about her through those around who had come to share in her passing. It was sad of course but not overwrought with bursts of emotions as some times is the case during tragic losses, but a much more understanding and accepting departure with intersperses of laughter which at times allowed me to think on autopsies, deaths of bygone years, finger foods and where all guests would be gathering for a post luncheon after the funeral tomorrow. Haemostat.

Tuesday, March 13, 2007

I love this quote by Mary Wollstonecraft,the mother of Mary Shelley, author of Frankenstein:

"It appears to me impossible that I should cease to exist, or that this active, restless spirit, equally alive to joy and sorrow, should only be organized dust-- ready to fly abroad the moment the spring snaps, or the spark goes out, which kept it together. Surely something resides in this heart that is not perishable--and life is more than a dream."

Nuclear Medicine Imaging......what is it?

This is a Gamma Camera. It is Gamma rays as opposed to X-rays that we detect. The only difference between the two is where they originate. X-rays come form orbiting electrons of an atom that are knocked out of orbit or moving to a different orbital level. Gamma rays come from the nucleus of and atom during radioactive decay. Radioactive decay is simply a physical process whereby an atom has too many protons or neutrons and is very unstable and in an attempt to become stable emits radiation. Nuclear medicine likes the Gamma rays which we use for imaging and the Beta particles which we use for therapies. The radiation that we use is 99mTechnetium usually attached to a drug to deliever it to the organ we want to scan. Once the drug radiation-combination is incorporated into the organ of interest, we image. Sometimes we image as the radiation is being delievered and sometimes there are delays of up to two or three days for some studies. Our studies are functional which allows us to get an indication of organ function over a period of time. This is where I will hemostat. If you want more info you can always google. If you would like to ask me a question concerning nuclear medicine drop me an email. I am sure that this discipline will come up again in topics once we get going.