Chinese buffet 640 x 480 px

I know first-hand that anatomy is a major part of the first year medical student experience. Whether I like it or not, anatomy ends up pervading my thoughts more often than I think it should, indiscriminately and unprompted by context. Tonight, as I follow my parents into our favorite Chinese restaurant and all-you-can-eat buffet, I marvel not at the quantity and variety of Asian cuisine but rather at the peculiarity of an education in medical anatomy.

Most people conceive of human anatomy through a Hollywood lens: blood, guts, heart, liver, kidneys, and stringy bits of whatever. Before medical school, I wasn’t aware of where the spleen is or what it looks like, and I had never heard of “fascia”. Many schools of medicine believe the best way to unravel the curious mystery that is human gross anatomy is in the laboratory: grueling four-hour sessions of careful poking and brusque yanking and a surprising amount of skinning. Thumbs cramp from clutching scalpels too tightly, backs ache from hunching and neck-craning, and a thick white film builds up on lips from dehydration and stench-dodging mouth-breathing. Gross anatomy lab is as much a physical experience as it is an intellectual experience. After all that time and effort spent, medical students are forced to face the plain and simple fact that, on the inside, we are all basically the same.

Medical students spend a significant amount of time in gross anatomy lab with one particular specimen of human anatomy: “their” cadaver. This cadaver has an age, a cause of death, and corporeal variations and alterations that gradually unveil its medical history.

At first, I had to consciously tell myself over and over again that the thing lying on the table is simply a learning tool—a well preserved, a model specimen of human anatomy. Still, every time I would shake my focus and step back from the table, I would catch a glimpse of curved palms or freckles or sparse gray hairs that would remind me otherwise. A neighboring cadaver had painted pink fingernails and silicone breasts, making her humanity even more undeniable.

 

Thoughts on food and the anatomy lab

It’s incongruous and unsettling to think about all this as I wade through aisles of food, perusing the trays of glistening sweet and spicy delight, melt-off-the-bone braised to perfection, and the lightly breaded salt-and-peppered nosh. I don’t think this happens to most people, but medical students will oftentimes be halfway through an appetizing meal when they realize they’re talking about something morbid and nauseating related to anatomy lab. Funnily enough, by the end of some of our longer anatomy labs, most of my classmates are wailing with hunger, establishing an unnatural association between picking over cadavers and pining after food.

I heard a factoid (more like a rumor) that formaldehyde stimulates appetite, but after lab, all I want is a diet soda. To me, this is despicable. Before medical school, I was vegan, totally off packaged, processed foods, and I wouldn’t even think about drinking soda, diet or not. I was also ten pounds lighter. It used to break my heart every time I had to grab lunch from a vending machine due to a hectic schedule or limited resources. Nowadays, I don’t give it a second thought. When it comes to food, my resolve has vanished because being hungry means being distracted and not doing quality work.

Medical school has turned out to be the busiest time of my life. In addition to four-hour blocks of gross anatomy lab and class time, there are extracurricular lunch meetings, the occasional volunteer shift at the student-run HOYA Clinic in south-east Washington DC, and then there’s the actual studying that is so central to being successful in medical school.

I have a Mind-Body Medicine session every week because I need a block of course time dedicated to relaxing. At least being hungry is something I don’t have to think about because food is everywhere. I am usually hard-pressed to find food that is affordable and healthy enough to meet my standards, but there is never a scarcity of food itself, and this could mean serious health problems for me in the long term.

Food nourishes you, energizes you, keeps you from being hungry, and most of the time it’s yummy. Food is a pleasant experience; it brings together families, friends, and acquaintances. Food is a major part of your lifestyle.

Unfortunately, the food culture in America has affected the lifestyles of many Americans for the worse. Take diabetes, for example. Everyone knows about diabetes; it has pervaded our lives, our culture, and our healthcare system. It is not news that this pervasion is connected to our changing relationship with food. After years of consuming Coca-Cola, fried food, and excess carbohydrates, my own mother found herself in the emergency room recovering from a stroke and a blood sugar level of over 400. When food and lifestyle give us problems, we turn to medicine for solutions.

 

Needles and lancets in her purse

Medicine is a chore. Medicine is the pills you have to take every morning with a full glass of water an hour before breakfast. Medicine is my mother having to carry around needles in her purse, wherever she goes.

Settling down to all-we-can-eat is her cue. My mother pulls out a bright orange needle from her Louis Vuitton. The needle is cleverly disguised to look something like a pen, but she still keeps it under the table, out of sight of the hovering waitresses and fellow restaurant patrons nearby.

It’s probably better that she keeps her insulin injections hidden. We’re in a crowded family buffet, after all, and no one wants to see that. She clicks the needle’s plunger then rubs her belly, wincing. She has to stab herself with needles and lancets every day, in the morning, at night, every time she eats, and there are only so many pricks a patch of belly or fleshy fingertips can take.

As I watch her soothe the injection site, my thoughts linger on the pain, but then the needle swiftly disappears back into her purse. The medicine’s in her body and the chore part is all over. Now she’s ready to dig into the dinner plate in front of her, which has been pre-loaded with food. The huge pile of hot and tasty is the instant reward she deserves for having to endure her tiny pains, needle clicks, and lancet pricks.

My mother hones in on her dinner, and I can’t help but think about the medicine of it all. Diabetes was one of the first things we learned about in medical school. There was a time, way back in the fall, when I was all too familiar with the specifics of insulin receptor desensitization, the most common sites where glucose can accumulate and result in organ failure, and the whole mess that is the pathophysiology of diabetes and its comorbidities. It was painful to learn about all of that because every mention of blindness, end-stage renal disease, or toes being amputated made me think of my mother, her orange needles, her over-pricked belly and fingers, and her plates of food.

She relishes in the duck. She loves duck because it’s flavorful and primarily consists of protein and fat, but most importantly it is very low in carbohydrates. I encourage her to eat more vegetables and avoid breaded, fried, starchy, processed things. To my mother, this boils down to keeping her glucometer reading from exceeding 120, either by cutting out several foods she enjoys or by simply injecting a few more cc’s of insulin a day.

It takes patience and persistence to constantly remind someone that her health is more important than how enjoyable a snack or meal is. Sometimes I lose my patience and reprimand her as if she were a child. I know I shouldn’t scold her. She knows she shouldn’t eat the muffins from Starbucks or the butter croissants from La Madeleine. To me, this is family medicine.

 

Enjoying dinner is all she does

Maybe she’s had a particularly stressful day. I try not to imagine her at work because it stresses me out too. I know she spent her day, like any other day, sitting in her cubicle, staring at a computer screen, skipping lunch and eating whatever at irregular intervals, sitting in traffic for the tiresome hour-long commute from downtown back out to the suburbs.

After going through all that, surely she deserves some relief from the formidable demands on her mind and schedule to just enjoy dinner. And enjoying dinner is all she does. For most of our meals, she barely even speaks. She never talks about work because she already has to think and talk about it so much. And, unfortunately, it follows that because of work, she’s had little time to experience anything else she might want to talk about. She never asks me questions about how my day went, except maybe whether or not I’ve gotten any grades back. This communicates nothing to me except the fact that, at that moment, my aspirations to become a well-rounded physician do not hearten her more than food does.

The busier I get, the easier it is for me to understand my mother’s silence at the dinner table, and just how mindlessly rewarding food can be. I sigh, reminding myself to be patient with her, telling myself she has come a long way from Coca-Cola, fried chicken fingers, and funnel cakes.

We are lucky to have access to all the medications she needs to maintain her blood sugar and blood pressure within acceptable ranges. We are lucky to live near grocery stores that sell fresh produce and lucky to have the money to afford these things on a regular basis. I push around the saucy mushrooms and bok choy on my plate and hope my mother will be lucky enough to see me graduate from medical school with all of her toes.


TDWI Writer’s Group member, Margaret Cary developed and teaches the Narrative Medicine/Personal Essay course at Georgetown University School of Medicine. Her students’ essays reflect their thoughts on being in medical school and becoming physicians.
Stephanie Van
Stephanie Van wrote this piece while she was a first-year medical student at the Georgetown University School of Medicine. She served as the Education Coordinator at the HOYA Clinic from 2012-2013, which continues to increase accessibility to healthcare and health resources in Washington DC. She is now a third-year resident at the Johns Hopkins Department of Physical Medicine & Rehabilitation. She sees all kinds of patients, including those who have had strokes, spinal cord injuries, and amputations as complications of diabetes. She is pursuing a career in pain medicine and has interests in quality improvement, functional outcomes research, and provider and patient education. Her mom still has all of her toes (so far).

6 COMMENTS

  1. Stephanie – it really is about family medicine, in many ways. Thank you for writing this essay and sharing your reflections with us.

  2. Stephanie, I love the characterization of your mother here. It’s so real and compassionate. Having diabetes is such a hard thing to live with. I think doctors forget or don’t realize how it really is to monitor every bite of food you put in your mouth.

  3. Very nice post. It’s funny, I still have vivid memories of gross anatomy. It’s something you never forget. Food is definitely rewarding for me when feeling down or stressed.

  4. Thank you. This reminds me why I like TDWI so much – and also to remember to always keep the family in medicine.

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