Realization

Day 9

Four  hours of lecture again today was much easier after having slept well. I finally managed to tape down the edge of my window shade, a vital need because the light would shine into my room directly on my face every morning. This meant I was rudely awoken at daybreak. It didn't help that on Tuesday, Anatomy lab starts at 7:40 am. 8 am on Wednesday is not much better. I have a feeling that coffee may become an intimate part of those mornings.

In Anatomy lecture today we examined more closely the spinal cord. The cord itself runs from the brain down through the vertebral column, and ends (in most adults) at the second or third lumbar vertebrae. The sac of dura mater extends down to the first or second sacral vertebrae. This means that between L2 and S1 there is an area of cerebrospinal fluid that can easily be accessed without harming the spinal cord itself. Clinically, that is done through a lumbar puncture. The theory of this procedure at least, was the subject of this particular section of lecture.

Because we were seated in the back of the lecture hall, I was carrying on a side conversation about the correct level to perform a spinal tap on a child, which had come up the night before during my evening studying. The lecturer got our attention; saying the next piece of information was important.

He asked us to imagine that a patient came into the emergency room presenting with a headache. A spinal tap could help to assess if the patient had meningitis. However, if the patient had suffered a head injury, it was possible their pain was due to increased pressure in the cerebrospinal fluid. If we were to do a spinal tap under these circumstances, the resulting pressure change would cause the brain to be sucked downward out of the skull, thereby killing the patient.

I was momentarily floored by what he had said, not just because of how awful that sounded, but because I realized in that moment that this was unlike any class I had ever taken. In all my other classes, If I fail to remember information, I might get an F.

In this class, if I fail to remember information, someone could die.

Welcome to medical school.