Anatomy of a dream
A journey to medicine in the land of the Living Bible
Eric Michael Schultz, MD
Cover Art by Tiffany Kamerman, DO
Copyright 2012 Eric Michael Schultz
Table of Contents
Week One
Week Five
Week Nine
Finals Week
Week One:
I was stripping layers off of my brain when the Bird Man returned.
I held a brain in my latex-gloved hands. My brain wasn’t covered with blood or gore as I’d imagined it would. It was gray and lumpy, about the size of a honeydew melon. It smelled like vinegar, having been pickled in formalin for several weeks after being removed from an undeserving skull. It looked like a Play-doh model of a dinosaur shaped by the borderless imagination of a pudgy-handed three year old.
I had stripped off the grey cortex of the insula, the island between the temporal and parietal lobes, with a broken popsicle stick. Underneath the nerve tracts of the internal capsule looked like white damp hemp. These tracts ascended to become the corona radiata, connecting the cortex and subcortical structures. They were telephones lines between Heaven and Earth, man and God.
There were seventy of us trapped in the basement of Tel Aviv University, illuminated only by dead florescent lights, all wearing white coats and bent over brains similar to mine. The silence of the tomb was broken only by the sleepy murmuring of tutors describing brain structures and the clink of scalpels dropping on steel tables.
It was our first week of medical school. We had toiled thousands of hours in early morning physics lectures, foul-smelling chemistry labs and midnight reviews for the MCATs in order to be here. We had made our pilgrimage to the land of the Living Bible to become student-doctors.
“Each moment has a history...” the memory of the Bird Man's voice echoed through my mind.
The dead fluorescents seemed to fall away as my mind drifted back to the dream. The world was empty, quiet and dark. A shape appeared against the backdrop of darkness, a shape of arms and legs and an inhuman head. He was tall, broad in the shoulders, and covered head to toe in robes. He had a bird mask with a long beak like an ibis and enormous cloth eyes. In his hand he carried a staff of wood, thick as a baby’s wrist. As alien as he was, he somehow felt also familiar.
The musical fanfare of oder Sonnenaufgang grew in the background. The iconic theme to the movie 2001, a Space Odessey started with three double bassoon calls, each ascending higher than the last. Then the drums surged forward, thumping, primordial, followed by three more calls.
The Bird Man raised his staff as the drums thundered. He opened his mouth to enlighten me:
“Each moment has a history and a personality all to its own.
It is decisions and consequences--”
--BEEEP BEEEP BEEEP!!!
The alarm clock had cut him off. His wisdom was denied by eight am Neuroanatomy. I had struggled to awaken, as I now struggled to come back to my dissected brain lying on a tin tray.
Josephina, my lab partner, cleared her throat with hands impatiently on hips.
“Aren’t you going to identify the arms of the internal capsule?” she said.
Her high-pitched voice brought me back to the lab, back in the world of white and chrome, Greek and Latin, brains and scalpels.
***
Preparing for a career in medicine was a process of neurosurgery. At the University of California at Berkeley, close enough to hear the hum of the cyclotron and the discontented murmurs from the homeless, I learned to slice midsaggitally down my brain. Parts of the tumor called identity were resected, quivering bits of individuality that were discarded in the bin marked BIOHAZARD - BODY PARTS ONLY. Facts were sewn in. The wound was closed with catgut of childhood dreams, of smiling doctors in white coats and nubile nurses and perfect patients.
We were premeds: brilliant, determined, ideological. We were the best of the best, who wanted to save the world, to heal in others what we could not heal in ourselves. Premeds. The word was synonymous with competitive, ruthless and anal retentive. We knew that only one out of three of us would be accepted to medical school. We were competing with the sharpest minds in the best Universities. We were competing with each other.
Like our Cell Physiology professor said: “If it can’t be measured, it doesn’t exist.”
Medical school applications are quantified at every level: MCAT scores, grade point averages, and extracurricular activities, measured in hours per week. They even have a score for brown-nosing measured by letters of recommendation. You become a number, which is measured against the numbers of your peers. The biggest wins. Size does matter.
The lucky few were privileged to display themselves in front of admissions committees. Making a central slice down the skull, I pulled away layers of bone, dura, arachnoid, and pia mater, to reveal the gleaming pathology inside me. It was a process of exposing yourself violently, like flashing old ladies on the street wearing only tennis shoes and a trenchcoat.
My scars were approved. I was accepted.
But the biopsy proved that the cancer had spread dangerously. The operating room was ready. Bit by bit, my diseased identity would be cut out. Shiny, perfect facts would be put in its place.
Medical school would begin.
Week Five:
We began sectioning the brain in vertical slices to see the structures underneath. In one slice we saw the amygdala, the almond that gives us the ability to fear, and the head of the caudate nucleus, which lets us move without flailing our bodies like disco dancers. The next slice showed us the hippocampus, named after a seahorse, which allows us to store memories, to realize the significance of each moment and know that it was different than the last.
Slice: the thalamus, the gateway of the senses.
Slice: the corpus collosum, connecting the two hemispheres of creativity and precision.
I knew intellectually that this was a human brain, supposedly the seat of consciousness and the soul, but it was hard to reconcile those lofty ideas with the corpulent structure in front of me. The slices looked like olive loaf, neatly arranged on the side of the tray as if in the butcher’s display window. It was hard to be sentimental about something that looked like lunchmeat.
The Chef walked over to examine my work. The Chef was a portly Russian lab assistant who wore a white paper chef’s hat. He didn’t speak much English, but he knew his brains well. According to rumor the Chef had been a famous neurosurgeon in Russia, but had fallen to a lowly anatomy lab technician after immigrating because of his lack of facility with Hebrew.
“Visual signal in one eye, cross over…contralateral side…” he explained in heavily-accented English.
“Through the optic chiasm, right?,” I said.
“Good! Good! Yofi!,” the Chef replied enthusiastically while pointing with a scalpel. I tried to be appreciative of his complements while dodging the brain-stained blade. The Chef turned back to his brain, “Look here now, optic tracts…”
With the Chef’s guidance, a mundane lump of neural tissue took on magical life once again. Time faded away and space narrowed into a tiny tract of land no bigger than a football, but with all the landmarks and pitfalls of darkest Africa, as we continued our cortical safari.
We followed the optic tracts into the back of the thalamus known as the lateral geniculate bodies, into six layers of processing, then through the optic radiation into Meyer’s loop which lead us into the primary visual cortex in the occipital lobe and later to other association areas...
Hours passed. I smudged some brain off of my notebook and yawned. Any subject, no matter how fascinating, loses it’s brilliance after two or three hours of intense st
udy. We’d been in class for a total of seven hours that day. Ground brain congealed on my stick. Little bits of brain were spattered here and there. I rubbed my temples. The gyri and sulci were starting to swim around like waves in the ocean. My own brain hurt. I could feel the synaptic connections being severed and resewn, as the experience was starting to mold me.
Phrenology was a branch of neuroscience quackery from the nineteenth century. Phrenologists believed the brain pushed out on the skull, and therefore careful examination of the skull could determine a person’s personality. For example, if you had two little bumps on top of your skull like horns, you were possessed by evil.
Now we know it’s the other way around, that the skull pushes in on the brain to make the lumps and folds that are unique to each person. Like life. Freud said we only grow by frustration. When we reach the walls of our little reality, we sort of conform to fit them, but each of us conforms in our own way.
Medical school was the skull that crammed us all in together under high pressure, and we learned our personalities in relation to each other. Like learning the names of esoteric structures that are all different and yet somehow alike, I have to learn the names and personalities of my fellow students. We were crammed into a very short space, constantly bumping elbows in the classroom, the library, the lab. We soon learned our relationships to each other.
George was the class clown. He had the deep voice of a radio jockey, and he wanted to go into the Air Force. Then there was Julia, blond and long of limb, who could easily pass for a Nordic stewardess. Julia liked learning languages. ‘And I like steak,’ she would say. ‘I could eat a steak for breakfast and another for lunch’.
Some of us were even farther out. Byron has a Ph.D. in jellyfish studies. Janice had been a graphic designer. Wallace had been a professional dominator, complete with whips, leather and female submissives. I had been a martial arts instructor and Taoist priest.
It wasn’t as strange as it sounded. Doctors were really a fanatical monastic order ordained by the AMA. Who else but monks or medical students would give up the best decade of their lives working ten to eighteen hours a day, forsaking food, sleep, even sex? Why was I memorizing irrelevant structures on the inside of the brain that ninety-nine percent of humanity had no knowledge or interest? I started to wonder what the hell I was doing there.