What's that Lassie? You want your heart stopped?!

Spring semester drags on here, with spring break officially beginning today. However, as we might have expected, hordes of material has been dropped on us in the 8 days of class since the last block of exams, and many of us will likely spend a great deal of time trying to nail down the details of renal physiology or even trying to get the first clue what our profs are even talking about in neuroscience. Me, I'll be doing both of the above, as well as shadowing my mentor a couple of afternoons next week (part of a mentor experience class) and hopefully watching a cardiologist perform some catheterizations. Really excited about the latter experience, and my mentor is a really cool doc, so those should be fun. Hopefully they'll recharge the batteries a little bit, because I definitely feel like the monotonous material we've been covering this semester has taken its toll on my work ethic.

Anyways, let me explain the title of this entry. There seems to be a controversy brewing here at school about a physiology lab that we recently completed, which endeavored to teach us the cardiovascular system, as it might be found in a living dog. Put a little more simply, the faculty brought in about 50 dogs for our class of 200 students, and we placed catheters in their hearts, cut their chests open, and proceeded to conduct a variety of experiments, including nervous system stimulation of the heart and electrical excitation of the heart muscle. The experiment ended terminally, with us inducing ventricular fibrillation (the kind of heart (a)rhythm that is often behind sudden cardiac death in humans) and trying to "shock" it back into rhythm with defibrillator paddles. If the dog was able to survive that step, they were injected with potassium, which quickly ends their life.

Now, let me preface the following by saying that the lab was optional (as are all of our physiology labs). The faculty pointed out several times that they were not going to track who showed up and that they understood how some might have ethical objections to ending another living beings life for the sake of their education. HOWEVER, we were tested on the material presented in lab (which, to be fair, was covered in a follow-up lecture to the lab) and the professors stated over and over how valuable they thought this experience was going to be. As a result, there was a 90% attendance for the lab. I attribute this to two major factors: first, most medical students are intensely afraid of failure, and quite paranoid about making sure that they have the same resources and capacity to succeed as their classmates. Gunners or not, we all want to make sure that we are not disadvantaged when we enter a test. Many of us felt that we would be disadvantaged when tested on the "dog lab" if we were not in attendance. Secondly, most of us hold our professors up as authorities on learning. If they tell us that the dog lab is where cardiovascular physiology will truly come alive for us, and everything will finally "click" (which, interestingly enough, is a moment that all of my friends say comes at one point or another while studying exam material), then many of us will take them at their word and trust that this will be an educational experience not to be missed. I have to say that I fell prey to both of these errors in thought, and attended the lab despite my ethical misgivings. In retrospect, I think this was a mistake.

I should probably describe what I actually learned while in lab. I learned that arteries bleed ALOT. When nicked by a scalpel, they bleed fast, and they bleed a great amount. That was news to me. Next, I learned that making a simple incision down a dog's chest will sever many such minor arteries, and that without cauterization, it can be a big mess. Messes were made, classmates were drenched--lesson learned. I also learned what holding a beating heart and touching breathing lungs felt like. That was a really cool feeling for someone who has spent their whole academic life studying living systems without much exposure to the inner workings that make us "tick". Definitely one of those moments where you feel lucky to be a med student. Finally, I learned a little bit about suturing, which to me was completely foreign. Seemed pretty cool, if on the surface technically challenging. At the time, I felt very lucky to have a chance to get such hands-on experience, especially during first year where we plant our rear-ends in the lecture hall and library for hours daily.

Now let me tell you what I DIDN'T learn: cardiovascular physiology. Sure, we covered some real basics such as what epinephrine does to the heart, what happens to cardiac output when you completely block off venous return into the right atrium (doesn't take a brain surgeon to figure that one out), etc. But it seemed that whenever we injected a chemical agent that should change heart function, the response was depressed or otherwise abnormal. Sure, you might say that real biological systems do not respond in textbook fashion, and that's true, but how are we expected to be any more prepared for exams of our knowledge of physiological theory if none of the theories are demonstrated in a tangible sense. Seems to me that simply telling us these physiological principles don't always work the ways you expect them to could have saved us the trouble. So, when it came to advancing my knowledge of physiology, I felt that it was time better spent in the library with my textbook.

After the thrill of cutting stuff open wore off a few days down the road, I realized that I was left with an empty pit in my stomach. I reflected on why I felt guilt about this experience and realized that my biggest problem was compromising my ethics as a future physician who values life above needless suffering and death. The dog felt like my first patient while it was on the table and I monitored its heart rate, rhythm, and oxygenation--yet I was expected to just sit there and watch it die of ventricular fibrillation. I felt hopeless (which, I'm sure, will be a feeling that I experience more often on the wards come third and fourth year) and that I had made a conscious decision valuing my own education over the life of another living creature. Weeks later, I still feel guilt over this decision, and hope to take this experience with me by never placing priority of my own knowledge or idea of medical advancement over the life or suffering of another. Don't get me wrong, I stand in support of responsible, supervised use of animals in medical research that could save human lives, but at the end of the day I think that physicians are better served abstaining from conduct that harms another when it is not called for in medical treatment (I'm thinking chemotherapy here).

Call me old-fashioned if you like, but I guess I'm just one of those guys who still finds value in that whole "First, do no harm" thing.