Tuesday, November 11, 2014

My First Patient Was A Mouse

I didn't think much of it at the time.

Most physicians can trace back and recall their first patient.  For some, it is a clinical encounter the third or fourth year of medical school.  The more creative may point to their cadaver during first year anatomy and nod knowingly.  My first patient was a mouse.   Or shall I say a group of them?

My freshman year of college, I volunteered in the lab of a prominent endocrinologist and studied a new drug to reverse the course of type 1 diabetes.  We monitored genetically bred, non obese, diabetic mice.  Every day we would reach into their cage and grab them as they scurried about.  Then we would rub their bellies inducing urination, swab the urine, and test for glucose. The unlucky creatures with a positive urine test needed to have blood drawn.  The thing about mice is that they don't have obvious vessels like you and I.  In order to get a drop of blood, we had two choices: either cut a portion of the tail or tap the choroidal plexus behind the eye.  The latter approach, while more brutal, was less maiming.

I would take a swab and dip it in ether.  The swab would be applied to the mouses nose inducing anesthesia.  The tough part, while applying pressure to the orbit causing the globe to pop out of the socket, I would slip a pipette behind the eye and turn until blood shot up the tube.  Then, if we were lucky, the mouse would wake up.  If not, we used our fingers to compress the chest performing mouse CPR.  Those mice proven to have diabetes would be randomized to two separate groups.  One would get the experimental injection while the other would get placebo.

I passed many days and weekends alone in the lab.  One sleepy Saturday,  I approached a mouse in preparation for a blood draw.  Mice can be slippery creatures.  The technique most favored was to grab them by the scruff of the neck with the thumb and forefinger, and hold the back tightly with the base of the hand.   So I thrust forward like I had done dozens of times.  I got a good hold, and flipped the mouse around to face me.  But something went terribly wrong.  I must have grabbed too high, or maybe too roughly.  The mouse's body quivered and then shuddered in such and odd and frightening manner.  I reflexively released as the mouse fell to the table.  Dead.  With horror, I realized that I accidentally snapped it's neck.   I will never forget the feeling of life passing so quickly and unexpectedly in my hands.

I occasionally think about this as I watch family members cradle their loved ones in those passing moments before death.  Do they feel the shudder?  Do they experience revulsion or relief?

And I sometimes have fevered dreams about that mouse.  When I toss and turn, unable to sleep because of the crushing pressure of some clinical decision or another.  That poor creature.

That poor creature who succumbed under the weight of my thick, clumsy hands.


Kim said...

My first thought while reading this was that the mouse had a cardiac arrest, not a snapped neck.

We had a little white lab mouse as a pet for my then 7-year-old daughter. The little guy had OCD (or something) and would bite himself. We had the wound sutured and he wore a tiny little vest made of gauze.

He ate through the gauze and opened the sutures, so we were back at the vet when all of a sudden he shuddered and fell onto his back - he had a cardiac arrest on the table right in front of my daughter. The vet actually tried to CPR and give oxygen in the back - on a mouse about what, 4 ounces?

I figured it was stress. Maybe it was the same thing with your little guy.

Never Again said...

How do you deal with this kind of sadness? I remember once I was trying to train my mothers little poodle and I smacked him so hard he gave a little squeak and fell backwards. I was about 9 years old and the memory still causes so much fresh pain. (I have others just as you do) How do we cope with a lifetime of memories? The time I got angry with my daughter for wanting me to play a board game with her. My favorite uncle dying without ever seeing me again like he begged me to, simply because I am failure as a person and didn't have enough money to fly to a foreign country. What do you do?

Anonymous said...

I wanted to let you know that I really appreciate your writing, and honest reflections and insight. After being exposed to years of death and dying, and witnessing the negligence of those in the medical profession, while trying your best to be the doctor embodied in the Hippocratic oath, one is naturally a suffere of battle fatigue. Believing in a world built on maxims and slogans and oaths, I finally saw the truth, and it ripped me apart in many ways. Doctors, lawyers, and clergy with a conscience, are bound to feel the effects of constant exposure to the human condition and the unfairness of those with the power to make a difference. It makes it more difficult when your colleagues would rather bury their heads in the sand, than have honest dialog about what medicine has become, from the weight of health care on its back. I wish you the best in struggling with your depression and implore you to read the book, and spread the message regarding B12 deficiency. That knowledge alone can help you save the lives of those who would otherwise succumb to our poisons and mistakes. The Book- Could It Be B12?