On Residency

Friday, September 03, 2004

Just over 24 hours until the test begins. I still have more material to go over than I can possibly do, but that's okay. I know a lot more than I think I do. I made sure to eat a good breakfast this morning. It's really hard to get up and eat. It's really hard to eat at all. Yesterday I didn't eat until after 5:00. I had some orange juice in the morning but that's it until dinner. I didn't expect to be at school as long as I was.

Chris and I both hate embryo. Well, it's not embryo that we hate but looking at the pictures of the abnormalities. Since we are studying neural tube formation we have seen more images of anencephaly, hemicrania, and menengiocele spina bifida than we'd like to see. There are also a couple of pictures of lateral folding problems where the front of the body cavity does not enclose everything it is supposed to. Very disturbing. It all happens within the first month to 5 weeks of development. We have had a very good ethical issue raised. Anencephaly results in the formation of the brain stem, which sustains basic life functions like breathing and heart beat, but without the cerebral halves. This abnormality results in infant mortality very quickly - within a few days at the very longest. The internal organs of the infant are without abnormalities. Families who want to donate organs sometimes aren't allowed to do so because of the body farming implications. Anencephaly is easily identifiable on ultrasound, so is it ethical to encourage the parents to allow the pregnancy to continue until birth knowing that the baby will not be viable and that they are growing organs?

I learned something interesting about the placenta and twins. Dizygotic (fraternal) twins can share a placenta, and the nutrient share can be uneven. Although rare, this happens when the two embryos attach to the uterine wall too close together and the two placentas fuse into one.

I have half an hour to read through all the blue boxes in my text. These boxes are all about injury and stuff and are important for the test. Better get started.

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