{"id":2683,"date":"2014-05-02T14:51:24","date_gmt":"2014-05-02T18:51:24","guid":{"rendered":"https:\/\/www.med.unc.edu\/iris\/iris\/archives-1\/2014-2\/flip-2014\/imagination\/"},"modified":"2018-08-03T15:45:37","modified_gmt":"2018-08-03T19:45:37","slug":"imagination","status":"publish","type":"page","link":"https:\/\/www.med.unc.edu\/iris\/2014-2\/flip-2014\/imagination\/","title":{"rendered":"Imagination"},"content":{"rendered":"
\n

Yemeng Lu, MS3, Otolaryngology<\/p>\n

\n

Mr. Charles is lying there, so still, it? looks like he is just sleeping. My mind drifts off to another world, a more ideal one, perhaps one where Mr. Charles would not be\u2026sleeping\u2026<\/p>\n

\u201cThis is a new patient for you, he\u2019s in room 3\u201d The nurse informs me. <\/i><\/p>\n

My first impression of Mr. Charles is that he is a quiet, reserved man. He says very little, even when prompted. He came in for a prescription renewal of his thiazide to manage his hypertension. He is ordinarily managed by another physician who is currently out of the office. <\/i><\/p>\n

We talk about his hypertension and his efforts to change his diet and lifestyle. He works as a nurse anesthetist and have trouble finding time to eat regular and balanced meals. <\/i><\/p>\n

\u201cI go from surgery to surgery and sometimes don\u2019t end up eating till I get home around 10 at night\u201d, he says. <\/i><\/p>\n

\u201cI completely understand, have you tried perhaps eating a larger breakfast before you leave in the morning?\u201d <\/i><\/p>\n

\u201cOh yeah, that\u2019s not a bad idea\u2026\u201d<\/i><\/p>\n

I am a bit concerned about his stress level at work, but it\u2019s perhaps unavoidable in his profession. So I continued with the social history. I want to establish good rapport with him in case I see him in the future. <\/i><\/p>\n

\u201cWho do you live with at home?\u201d<\/i><\/p>\n

\u201cJust the wife and kids. Two. Teenagers\u2026\u201d <\/i><\/p>\n

\u201cI see, that can be very difficult\u2026.\u201d we both chuckle. <\/i><\/p>\n

\u201cIs life at home safe and happy?\u201d It still feels strange to ask a 250 Ib man whether if he feels safe. <\/i><\/p>\n

He looks at me for what seemed like a long time and sighs. \u201cI guess they are okay\u2026I suppose\u2026\u201d<\/i><\/p>\n

\u201cDoes anything trouble you in particular?\u201d I want him to elaborate on his very non-committal answer. <\/i><\/p>\n

\u201cEverybody\u2019s got problems. It\u2019s just a normal part of life\u2026you know.\u201d He shrugs. <\/i><\/p>\n

\u201cMr. Charles\u201d I lean in a little closer and meet his eyes, \u201cwe can talk more about it if that\u2019s what you would like and I am happy to help if I can\u201d <\/i><\/p>\n

\u201cOh thanks Doc\u2026\u201d he looks down at his tennis shoes. \u201cI just have been feeling so lost lately.\u201d<\/i><\/p>\n

\u201cHow so?\u201d I wish he would tell me more without me digging for it. Then again, I wouldn\u2019t trust somebody I\u2019ve just met either. Even a physician. <\/i><\/p>\n

\u201cIt seems like everyone\u2019s unhappy with me, nothing I do is right these days. Especially Mary, my wife.\u201d He stopped, perhaps to see if I was still listening or interested. I nodded. <\/i><\/p>\n

\u201cWe\u2019ve had problems for a while, but not nearly as bad as recently. I have no idea what to do anymore. I\u2019m just so exhausted. She has actually filed for divorce and already moved out and wants to take the kids\u2026 I don\u2019t know what I\u2019m going to do without them\u2026.I can\u2019t bear to think about it\u201d he trails off. We talk a bit more about their marital issues and he seemed so depressed and overwhelmed. I ask him if he ever had thoughts of hurting himself or other people. He says he usually just drinks a lot and one time thought about ending it all after he\u2019d had half a bottle of scotch. <\/i><\/p>\n

At this point, I think it best to elicit some professional help, maybe a psychiatrist, especially because of the suicidal ideations. <\/i><\/p>\n

\u201cI often find that it helps people to have someone to talk to, someone to help them figure out their problems and deal with their emotions. Is that something you can do, Mr. Charles?\u201d <\/i><\/p>\n

\u201cI don\u2019t think that really will change anything, to be honest. Not much can at this point\u2026\u201d<\/i><\/p>\n

\u201cWell, sometimes you don\u2019t know until you have given it a try. I really want to help you through this. And you WILL get through this, with some help. Please let me set you up with a colleague of mine, just to talk.\u201d I almost pleaded\u2026<\/i><\/p>\n

\u201cMaybe another time\u2026\u201d he started to pack up his things.<\/i><\/p>\n

\u201cMr. Charles, please just consider it. I\u2019ll have the nurse give you a call to see if you have any time later next week to come in, is that alright?\u201d I pleaded some more\u2026<\/i><\/p>\n

\u201cSure, if I can get out of work\u2026\u201d I walked him to the front desk and sent him home with my card and advised him to call if he needed anything at all. <\/i><\/p>\n

I call to follow up a week later and learned that he had gone to see the psychiatrist and had already been to 2 sessions. I finally sigh in relief. <\/i><\/p>\n

 <\/p>\n

\u201cI\u2019m sure the tech has told you a bit about him already, but just some more details. So, we have here a 40 year old male, the body was found in a hotel room this morning by the police. He had an IV bag full of Rocuronium bromide hooked up to him and a mask over his face holding down a bunch of gauzes, that are likely full of some inhalation anesthetics\u2026 have y\u2019all learned about anesthetic agents? it\u2019s going to be on STEP 1, you know!\u201d The pathology fellow laughed.<\/p>\n

I finally snap back to reality. I am standing in the ME\u2019s office on the 11th<\/sup> floor of Brinkhous-Bullitt observing an autopsy. \u201cYeah, we don\u2019t remember too much of it though\u201d one of my fellow classmates responded.<\/p>\n

\u201cWell, as a nurse anesthetist, I\u2019m sure this guy really knew his stuff. We\u2019re going to need to send a lot of these chemicals down to toxicology to get analyzed. The police will probably want to know what kind of compound he used. Most likely a suicide, since he left a note about troubles with wife, but we can\u2019t rule out homicide yet\u2026\u201d the fellow continues to slice into the liver, \u201cbread loaf\u201d style, he called it.<\/p>\n

The autopsy assistant, Peggy, is now starting to work on the head. I am staring at the bloody lung sections and trying as hard as I can to not let the smell get to me. It\u2019s a lot different from the cadaver labs. Fresh blood had this disgustingly sweet and fruity smell to it. I tried to breathe through my mouth. Last thing I want is to throw up, especially when the observing police officers on the other side of the glass window have already taken bets on which one of us med students will faint first. I\u2019ve been standing here for close to an hour and I am still in a state of shock.<\/p>\n

Mr. Charles\u2019s body lays 2 feet away from me. His chest and abdominal cavity have already been emptied. His face still looks so much alive. I didn\u2019t know what to make of this horrifying image, so I shifted my gaze to the tattoo on his chest. It seems like it\u2019s in Russian and it looked like a poem.<\/p>\n

Peggy is now peeling back the scalp. It made noises like peeling apart Velcro. I look down at his hand instead. He\u2019s still wearing his wedding ring! Does that mean he still loves his wife? Or he just forgot to take it off. I had a strange overwhelming urge to hold his hand. It looks slightly cyanotic but still retains most of its color. These are hands that held his kids, if he had any, hands that touched his loved ones and worked as a skilled nurse helping people in their more vulnerable times. They were once warm. Maybe he would feel better if somebody held his hand right now. I start to be disturbed by my strange thoughts.<\/p>\n

My attention quickly shifts as the brain is slowly being removed from the cranial cavity and Peggy is teaching us all the cranial nerves. It\u2019s pretty amazing to see the optic chiasm and all the nerves attached to the brain. She then shows us the coolest thing yet \u2013 breaking the bone overlying the sella turcica to see the pituitary. Such a small organ with a whole category of diseases attributed to it. It looks like a tiny garbanzo bean. We each hold the brain to feel its weight and texture. I wonder if a lifetime of memories is stored in his hippocampus and if his personality is sitting in the frontal cortex. I can\u2019t seem to see it at all in the brain that I\u2019m holding.<\/p>\n

We step back as Peggy carries the brain over to the pathology fellow. I almost trip over the pile of clothe on the floor that Mr. Charles once wore. It\u2019s a really nice Lacoste polo shirt, I wonder if his wife bought that for him, perhaps before they started fighting. I suppose he also wanted to look his best when he went, I think to myself.<\/p>\n

The fellow starts to teach us the anatomy of the heart. I have given cardiology a lot thought as a future career, so I nudge a bit closer to get a better view. You can see every coronary artery, all the valves, and the dark striated muscle on each of the slices. \u201cThe heart is slightly enlarged, especially the left ventricle. He probably had hypertension. His coronaries are relatively clean though, pretty impressive for a big 40 year old guy. I\u2019m probably not so lucky on the other hand\u201d the fellow said. Who is the lucky one here anyways?<\/p>\n

I held the heart slices and thought to myself \u2013 the heart is truly an amazing organ. \u201cYou probably won\u2019t see any signs of COD on the heart since he mostly likely died of respiratory depression from muscle failure\u201d the fellow said, \u201cthe lung on the other hand is very congested looking\u201d. He picks up the right lung and plops it on the cutting board and spread it apart. It reminded me of the butcher shop that was down the street from where I grew up. Honestly, from the looks of it, not much is different\u2026<\/p>\n

I\u2019ve never shook this man\u2019s hand or looked at him in the eyes, but I\u2019ve held his heart. I couldn\u2019t comprehend the meaning of it and my mind drifted to another place replaying the same scenes over and over again, \u201che\u2019s waiting for you in room 3\u2026\u201d <\/i><\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Yemeng Lu, MS3, Otolaryngology Mr. Charles is lying there, so still, it? looks like he is just sleeping. My mind drifts off to another world, a more ideal one, perhaps one where Mr. Charles would not be\u2026sleeping\u2026 \u201cThis is a new patient for you, he\u2019s in room 3\u201d The nurse informs me. My first impression … Read more<\/a><\/p>\n","protected":false},"author":80868,"featured_media":0,"parent":2417,"menu_order":7,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-2683","page","type-page","status-publish","hentry","odd"],"acf":[],"yoast_head":"\nImagination - Iris: The Art and Literary Journal - UNC School of Medicine<\/title>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Imagination - Iris: The Art and Literary Journal - UNC School of Medicine\" \/>\n<meta property=\"og:description\" content=\"Yemeng Lu, MS3, Otolaryngology Mr. Charles is lying there, so still, it? looks like he is just sleeping. 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