A heart in my hands: Anatomy for beginners

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in 2010 Andrew Stemler and Kate Pankhurst  took a series of courses in anatomy which utilises human cadavers. The location of the hospital has been kept confidential in respect of the Human Tissue Act, and names have been changed. The following is a personal account of our first practical lecture, and contains graphic descriptions of human remains which some may find disturbing.

The locker room is like any other. You’ll find one just like them in every gym, sports club, swimming pool. This locker room is different. Instead of chlorine, there’s another chemical smell, not unpleasant, but you can’t quite put your finger on it. And in the middle of the room, piled on top of each other and still shrink-wrapped in plastic, are three coffins.

Andrew and I, part of a small group of students drawn from various physical therapies, chat nervously while putting away bags and coats. We stow into pockets the items we’d been advised to bring: tissues and olbas oil. We’re told the cadavers can get pungent when they begin to dry out, so a whiff of Vicks can be a welcome relief. I’ve brought both – and I cling to them as you would a crucifix under a circling vampire. It’s a pathetic defense between my innocent experience of life up to now – and the imagined horrors that lie beyond the anatomy room doors.

A few weeks ago  we were offered a series of cadaver anatomy lessons, culminating in two days of actual dissection. “Wow, awesome, yes!”, we cried. How incredible and exciting – a once in a lifetime opportunity. We paid up, booked the time off work, and gave it hardly another thought. Until today.

Now it all seems too real, in this locker room, waiting for our hostess Molly (a bubbly Pilates instructor, today rocking a low-cut long dress and flying jacket) to check all was ready for us. She has a gift for setting people at ease, and with some final words of reassurance, she leads us into The Room.

Our eyes flick around furtively. This is no basement morgue: It’s on the 14th floor of the building and unexpectedly bright, but the wind outside keeps up a howling background monologue. A big room, and around the edges we glimpse a dozen metal gurneys with a white bundle on each. Strange bundles, different sizes and shapes – but nothing that looks obviously like a body. A relief. I’ve only ever seen one dead body before – many years ago and dressed and peaceful in his coffin. It was an unnerving experience for a teenager, and I never imagined willingly doing it again. But this is another thing entirely.

We’re instructed to put on plastic coats and purple latex gloves, and sit in a semi circle to await further instructions from our teacher. The Professor is a reassuring, avuncular man in white coat and bushy mustache. Like a tidy Einstein. He begins with a summary of the Human Tissue Act, which states that those who leave their remains for medical study must do so in writing. Unsuitable donors include those who have been significantly affected by certain diseases, amputees, have donated organs or undergone an autopsy. The result is that all the volunteers were between 80 and 100 years old at death, and with the added filter of religion and culture, are almost exclusively white Anglo Saxon Christians. He makes a final point from the Human Tissue Act: that all human remains are to be treated with dignity.

There follows a whistle-stop tour of anatomy, using a dangling skeleton. The ones we use on our massage course are plastic, with missing fingers and legs bent out of shape. This one is obviously of better quality. A closer look reveals marvellous detail in the teeth and jaw – and then it hits me. This is a real skeleton. Everything in this room is real. My stomach flips over.

Our anatomy discussion has thawed us somewhat, and helped us acclimatise to the fearful environment. But at long last, the Professor invites us to gather around a nearby gurney. This is the big moment, and another frisson of excitement mixed with deep unease gets hold of my guts. I secretly search for Andrew’s hand as we approach one of the white bundles we saw earlier. We students exchange nervous smiles, but the eyes tell it all.

The damp white cloth is peeled back to reveal a torso.

Just that. No head, arms or legs. And it’s a brown, leathery colour. It looks like it’s made of rubber, so I retreat a little into the safety of unreality. It would almost be underwhelming, but for the fact her chest (it is a lady) has a deep incision down her sternum, and the skin is tied together with string. In neat bows.

The Professor undoes the top bow, and carefully lays back the flaps of skin. The pectoralis majors and minors are revealed. All are paper thin and delicate – not the rippling, juicy pecs you see on bodybuilders. These too are carefully set aside, and the anterior ribcage is removed in one piece. We stare down in amazement at the contents of the thorax.

There’s no wasted space in your body. The heart and lungs nestle together like chocolates in a box. The professor removes the organs (each carefully tagged to prevent being mislaid) and holds them up in turn, pointing out vessels and nerves and chambers. Fascinated now, the students ask questions, marvel at the size and intricacy of the parts. The professor dares some courage, and invites us to carefully feel into various cavities. In my turn, I poke a reluctant finger into a space by the ribcage. Cold, unpleasant, as expected. But okay. No need to faint.

After some time in fascinated discussion, the Professor turn to me and says casually “I’ve taken my gloves off. Would you pick that up for me please…” With a deep breath, I comply. Between slightly trembling hands, I find myself holding a human heart. It seems huge and heavy. The lady was elderly, and her heart had swelled in her declining years. He indicates the atrium, the ventricles, the aorta, the vena cava – an incredible thing that had beat a million times in life. It kept her alive for almost a century, and most certainly broke a few times. And I’m holding it in my hands.

The heart is reverently passed around the group, as are the individual lungs (one lung is much bigger than the other). Finally, all are tucked back into the thorax and the ribcage replaced. Then it was the turn of the organs below the diaphragm to be revealed. We see the stomach, liver, gall bladder, intestines, womb, ovaries. The Professor wants to show us a male specimen too, so moves off to a large freezer-style chest with a prominent label announcing its contents: “PELVIS”. I hadn’t noticed the coolers before, but there are several: “SPINE”, “LOWER LIMBS” and most disturbing, “HEAD AND NECK” We have five more anatomy lectures to come, so there seems little doubt we will be working our way through all the storage chests.

Three hours have disappeared. Fascination has triumphed over terror, so I’m much more confident now. There’s something I’m compelled to do before leaving, so I return to our patient lady specimen. I fold back her pectoralis and skin, and carefully do up the string ties again. A bit like doing up a cardie, against the chill.

That word: awesome. How overused is this faux Americanism, especially in Crossfit? “Awesome workout!”, “Awesome effort!” But it is a word I will snatch back and use to describe this experience. I am filled with awe, with pity, with respect – gazing down on these specimens of humanity who were once just like us. They lived, they laughed, were lonely, had kids, grew old and died. And somewhere along the line, signed a paper that meant, after they’d burned up their existence, their tired outer shells could be divided and examined by people like me. The responsibility is overwhelming.

We leave the hospital, taking a short cut back to the station through a cemetery. It’s a sunny autumn day, in this park with angels and crosses to each side of the path. Andrew’s hand feels warm and alive in mine. My thoughts sound like such cliches when written down: Our time is short – take care of your body, it’s an incredible machine for producing and prolonging life. Feed it well. Give it challenges to overcome and make it strong. Don’t abuse it, at least not too often or for too long. Give it rest and care and comfort and love.

That’s the thing about cliches. They’re so true.

Avoid extremes

Part of the programme we will teach you is to maintain a natural lordosis , most of the time, especially when squatting or lunging. However its possible to attempt to over engage  your lordosis and crush joints together. the flexibility for squats and lunges comes through the hips, not by excessively arching your lumbar curve. The mantra is “find the problem, fix the problem”.  If when squatting you find ankle and hip flexibility issues, do not compensate in your back.

Back Pain, Pain killers

I think its pretty essential, especially when the pain gets acute to be able to switch it off, otherwise you start getting psychological issues too, like depression and misery. Pain wears you down!

This blog article will grow over the next few weeks as we ask, whats the best over the counter pain relief you can get! If you have  insight, please put in in comments. I must admit, I found Naproxen, not that good ( although its a prescription drug)

Obviously, see your doctor and don’t get addicted and get to understand “Red Flags”

The role of axial torque in disc herniation.

Marshall LW and McGill SM. (2010) The role of axial torque in disc herniation. Clinical Biomechanics, 25(1):6-9.  you can review an abstract here

Which is worse  lifting and twisting or twisting alone ? Or was the 10960’s dance, the twist, actually safe as long as you didn’t lean forward

This study investigated the role of “repeated dynamic axial torque/twist combined with repeated flexion on the disc herniation mechanism”

1) Axial torque/twist in combination with repetitive flexion extension motion, regardless of order, encouraged radial delamination within the annulus .

2) Alternatively, repetitive flexion motion alone encouraged posterior or posterolateral nucleus tracking through the annulus.

3)  Axial torque/twist alone was unable to initiate a disc herniation.

4)   X-ray images with (contrast and computed tomography) are   not good at detecting radial delamination

The problem this paper gives me is whether or not “twisting exercises” ( without flexion) should be removed from back exercises . It concludes afterall that “Axial torque/twist alone was unable to initiate a disc herniation”. Ill try and find out

The value of Aerobic capacity

This post may sound like  a throw back to the  aerobic era of the 80’s and 90’s, but based on over 15 years of clinical training experience, I’d say its an error to factor out of your training an effective aerobic component.

It should always be there.  In the issue of bad backs, its essential that you commit to regular physical activity,  preferably outside.  At the very least, if you are walking around with a locked down core,  a natural curve in your back, you are not sitting slumped!

This does not mean hours of Long Slow Distance, but it certainly means 20- 30 minutes of low to moderate  back sparing “cardio” every day. This could be cycling to work, a fast lunchtime walk, or a jog or a run. There are lots of  benefits to underpinning cardio activity, but, when you are suffering from back pain, a few natural endorphins  pumping around won’t harm you