The Silent Teacher Special

TAPP Radio Ep. 49 TRANSCRIPT

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Episode 49 Transcript

The Silent Teacher Special

Introduction

Kevin Patton: In her book, Stiff: The Curious Lives of Human Cadavers, Mary Roach wrote, “The way I see it, being dead is not terribly not far off from being on a cruise ship, most of your time is spent lying on your back. The brain is shut down. The flesh begins to soften. Nothing much new happens and nothing is expected of you.”

Aileen: Welcome to The A&P Professor, a few minutes to focus on teaching human anatomy and physiology with host, Kevin Patton.

Kevin Patton: This is a special episode featuring classis segments on using human remains in teaching and learning.

Introduction to the Special Episode

Kevin Patton: This episode is the second of a series of specials in which I’ve gone back to the secret underground vault containing segments from other past episodes. I comb through my library of segments and draw together those with a recurring them that seems the resonate with all of you, then I mash them together into a singe episode so you can hear them again, back to back, or perhaps you’re hearing one or more of them for the first time. Either way, it’s a chance to reflect on ideas that may helps us evolve as A&P teachers.

Kevin Patton: In this episode, we revisit some ideas related to the use of human remains and reproductions of human remains in teaching anatomy. In the first segment we go back to episode 29 which we called The Silent Teacher, and that featured a conversation with A&P professor and speaker, Aaron Fried, about human body donors. There’s also a segment called Situs Inversus, and that was from a recent episode, episode 43, that was all about anatomic variation, and this segment involves an experience that I had with a human body donor. And I have another segment that is several recommendations from The Book Club that are mushed together, one of them is mentioned by Aaron Fried in that first segment and one of them is mentioned in the previewed episode 44.

Kevin Patton: By the way, once we get back to the regular episodes, that is after this series of special episodes is over, new entries into to The A&P Professor Book Club are always introduced in the preview episode, not the regular episode. So if you skip the previews, well, you’re missing a lot of content. I’m just saying. Also in this special episode will be another segment that involves a second conversation with Aaron Fried, and that one was called The Nazi Anatomists.

Kevin Patton: Now, something I didn’t mention about my conversations with Aaron Fried the first time these aired in episodes 29 and 30, is that the original idea was to have one long conversation, and we did, but something happened. I don’t know, maybe I simply forgot to press the record button, but whatever happened, none of that long conversation was recorded. None of it! Which was to bad because it was a great conversation. And, Aaron, being the nice guy that he is, he agreed to record again on a different day. And we got to thinking that there was a natural break in the two main themes that he was talking about so we decided to break it into two segments, each to air in a different consecutive episode, and I think that worked out great. And I think the fact that we got to rehearse the whole thing once, yes, I’ll call that first one a rehearsal and that way I can avoid calling it a screw up on my part. Anyway, I think we ended up with a better conversation the second time. You know, sort of like how in your course that second time you lecture on a new topic it always goes much more smoothly than that first time you did it. Okay, enough of the backstory. Let’s get moving.

The Silent Teacher | Aaron Fried

Kevin Patton: Well, hi, Aaron. It’s really great to talk to you again and welcome to the podcast.

Aaron Fried: I’m excited to be here.

Kevin Patton: Well, I think we need to just jump right into it. This is going to be a two part conversation, so we’re going to do the first part in this episode and then in the next episode we’re going to do the second part. And the two parts do hang together, but you’ll need to listen to both parts to see how they hang together and where we’re going to with this.

Kevin Patton: You know, at some level I think we all know that cadavers used in anatomy education are the remains of real people with real lives, and real families, and friends, but I wonder how much of that really sinks in. I know you’ve given a lot of thought to that and even speak about it to anatomy educators, what is it you feel that’s important to share about using human remains in teaching anatomy?

Aaron Fried: That’s a question I always love to answer, and the other thing I always like to catch people in a trap and not tell them beforehand, but I actually don’t prefer the use of the word cadaver. We try to work with our students and have them describe them as human donors, and I’ll circle around to that in a little bit.

Aaron Fried: I’ve been lucky enough when I took anatomy as an undergraduate, worked in a program where we had one human that we worked with as a procession and then at I’ve been at Mohawk Valley Community College for the last 9 or 10 years and we are gifted to have this program at our school where we get, every year, four of five donors that we get some of our best students to come back from the year and they go through a course with us where they do the dissection and then we have those donors as prosections to work with our anatomy I and anatomy II students over the course of a year. We have this program where we call those our silent teachers and that’s actually something that originates well before my time here. A HAPS member retried from our campus, Bill Perrotti, actually brought this into the program when they started this, the idea that these are individuals how donated their body after they died in order for us and for our students, that especially we have a lot of students who are going to go on and become health professionals, nurses, radiology technicians, respiratory therapists, to learn form and to be able to continue this knowledge that we gain in anatomical sciences as a foundation for health professions.

Aaron Fried: And so we actually go so far as to give our students the first names of our donors to show that there is a dignity and a respect to what we’re doing and that it’s important for us to both honor and respect as we learn from their tissues.

Aaron Fried: And the story goes from when the first year they had the donors and other former HAPS member, Sam Drogo, passed away a few years ago, the first year that we had donors in our lab, one of the donors was his father’s roommate in palliative care and then in the fall of last year actually had a student who was a C&A in a palliative care facility to care of one of our donors at end of life. I mean, it’s really hits home when there’s a huge human connection when you can look around the room and say to the other students, this is an important gift that someone gave us after they were done with their bodies so that we could use it to learn.

Kevin Patton: Yeah. I kind of had an experience like that myself in that I’ve had family members, including my own father, when they passed away they left their bodies for medical education. Actually, at the university where I was teaching I was teaching in the physiology department at the time so I was never in the lab, but I thought about them being over there and being used that way and even though I, looking back, I feel like I’ve always tried to be respectful of the lives of the people who made these donations so that we could use them in teaching and learning, it wasn’t until I had family members that I knew were over there in the lab and I knew were being used this way that that idea really deepened in me and I really can’t not think of that when I’m dealing with human tissues.

Kevin Patton: Now, you have the opportunity to use cad … Well, I almost said cadavers.

Aaron Fried: Yeah. It’s hard and we struggle all the time. We say it and … As a little bit of background, and I know this is going to be the second part of our talk, so I do research into Nazi anatomists, and as I was talking to a specialist in the field, Sabine Hildebrandt, who’s actually from Germany, she said the reason that she doesn’t prefer the use of cadavers is because the way that they would view that in Germany is that cadaver is a term that it’s like refuse, it’s like trash, it’s like something you throw away. And so I actually went after that interview and I looked up the etymology of cadaver and I think, this is always disputed and I’m not a linguist, but I think you go far enough back and now we say a cadaver from some translation like from the remains, but I actually think it means something more like from the earth or something a lot more like that, from the trash kind of connotation. So it’s tough but that’s why we try to … And I’m actually shocked this year with our students that because they’ve never really had the use of that term cadaver so much they use the word donor almost effortlessly, so it’s nice to be able to see that once we put that emphasis on it it’s easier for the next generation to pick that stuff up.

Kevin Patton: I think that’s a great approach. I mean, you’re right, it is kind of hard to shed what we’re used to, but on the other hand it really is important how we say things. I mean, that really does imply some thoughts, and feelings, and attitudes when we do that, so I’m all for it. So I’m going to really focus on using the term human donors. And you have human donors, but we don’t have human donors in our school except … I guess we do. I think we still do have one human skeleton and actual skeletal material, and I think we have some skulls, natural skulls, most of that has been replaced over the years with plastic reproductions, and even in using those plastic reproductions it’s a replica. And I use models and so on but those are all based on cadavers and much of the art we use in our lab charts, and our text books, and anatomy out lists, those are drawn directly from our, or at least indirectly, from the remains of real people.

Kevin Patton: Aaron, do you see any issues regarding what we ought to think about as we use these sort of derivative materials?

Aaron Fried: This is one of those things where sometimes I always wonder if I’m searching for ethical issues because I’ve been studying the Nazi … So I should have described my desk because I answered this question because, as I look straight in front of me … Halloween is the best holiday for anatomists because I can go anywhere and look at what would be a great anatomical specimen for me to put on my desk. I have a fake skeleton hand on my index card holder, I have a skull that I picked up, I think I was with my wife at Michael’s, and the reason I grabbed this skull is because it is, suture to suture, almost a perfect replica of an actual skull and it’s labeled well.

Aaron Fried: And you’re right, these are things that come from … They’re derivative at some point of an actual individual, so sometimes I’m always wondering, especially when I travel I try to go a lot of anatomical museums or you’ll run into oddity shops where people are actually selling human tissues. I was actually in Baltimore this summer and I bought a student box of brain tissue from an oddity shop that, in a way, I felt like I was rescuing because I was at least able to bring back into education so that we could use these slides. But, I mean, these are human pieces of tissue, real human beings in that slide box, in that brain slide box, that you … I always wondered, did this person intend for that to be the case? I see images of a skeleton posed in certain way, a real human skeleton posed in a certain way, and I think of … There’s some dubious history to where specimens came from at certain times in our past.

Aaron Fried: With skeletons, you said you have a human skeleton in your lab and we have as human tissues in our labs as possible, we have plastinations, but with skeletons there was a whole period of time where in India there was a bone trade where people were being murdered so that they could clean the bones and sell the bones, and it’s likely that in collections all across the United States there are individuals who potentially were part of that unsavory bone trade.

Aaron Fried: With plastinations, for example, we actually just got some new plastinations in our lab and they’re wonderful because it’s real human tissue, you can see the real variations, you can see the real contours, the real lines, but it also makes me think of the body worlds and bodys the exhibition, and all of those plastination exhibits, and there’s lots of anatomical drawings that have been done historically … I think originally a lot of artists who were drawing anatomy, trying to be anatomists, were drawing art to get away with doing anatomy, and so that’s led to this looking at the human body in the form as this beautiful artistic representation. So you go to this plastination exhibit and you’re looking at real human bodies, but we see it as this breathtaking artwork and we don’t think about, well, hey, where did those bodies come from? Is this an actual individual who consented that this is what their tissue should live on for? Does creating an artistic representation kind of degrade the humanity of the subject?

Aaron Fried: I’m constantly thinking of that and over the summer I wanted my … I always think it’s funny to tell people that my for-fun-reading I read about anatomy, but I read a biography of Gray’s Anatomy, which is a historical, anatomical atlas. It was interesting for a couple different reasons, one, it was common at the time for … So, Gray’s Anatomy, the anatomist, is the story of a two Henries that were involved in creating the first Gray’s Anatomy. Henry Gray, who we actually don’t know much about because he didn’t keep a diary and, Henry Vandyke, who was the artist who kept detailed diaries. And that’s really what the story told, but the author, Bill Hayes, actually went to the University of San Francisco Medical school and took several dissection courses, and one of the things that’s interesting is to think about someone who’s not necessarily an anatomist going through this experience and, one, seeing the amount of information he learned from actually doing dissections which is one importance, but two, the revelry that you get from working with a human, realizing it’s a human.

Aaron Fried: It’s kind of a constant thing in my head as I look at specimens … So even as I’m describing this skull on my desk that I’m looking at, it’s clearly modeled after a real human skull, it’s not an actual human skull but is this an artistic statement that inspires people to think that this is a macabre oddity that I should strive to put on my desk or have and cherish, and it creates an ethical question. And I won’t say dilemma, but question about what the effect of these drawings have outside of learning.

Kevin Patton: Yeah, that’s a really good point about this dilemma that we have, and I feel that because in a way there are these cultural things that we do, not just with Halloween, but there’s The Day of the Dead, and various other ways that we use representations of human remains that we can’t dismiss that, these cultural traditions and so on. But on the other hand, I think when we put on the hat of an anatomy teacher and the hat of an anatomist, then maybe we have some extra responsibility to think harder about that and especially in the way that we relate that.

Kevin Patton: So I know that in my own courses the rule in my lab and in my class, and that was we don’t put silly hats on the skulls and take selfies with them and so on because that’s not respectful. We need to really get into that mindset of thinking of these silent teachers and being respectful and so on. I don’t tell my students don’t go out and not celebrate Halloween and things like that, but while we’re in here and while we’re doing this this is the mindset we want to engender, and I think that’s important too. Getting back to my own family history, my dad donated his body, my mom is not at all comfortable with that idea, she’s not going to do that, and I’m not sure she was all that comfortable with my dad’s decision to do that, but I know that if she would see a medical student or a nursing student in an anatomy lab with skeletal remains with a silly hat on it, she’s going to think of dad and she’s going to think of what happened to his body, and that’s not the kind of message we want to be sending, not only to the families of the human donors, but for potential new donors. I might think I was going to do that but if this is what happens in the lab at that school, I’m not donating my body there.

Aaron Fried: Absolutely. And I think you brought up cultural differences, and I think one thing that’s interesting is you look at … You mentioned Dia de Muertos, and that’s an interesting cultural … It’s like a celebration, it’s a connection that the people of Spanish heritage have with their relatives and ancestors, and in the US I think one of the things that makes some of this stuff that we do with the bodies so odd is that when people die we immediately … We take the body away and it disappears and it doesn’t come back until, sometimes it never comes back if people aren’t viewed before cremation for example, or it doesn’t come back until it’s been prepared at a funeral home, so death is like this weird thing. And I find that a lot of times people will look at what I do as an anatomist who does dissection of humans as this weird thing, and it really isn’t. But as people culturally view it differently is some weird thing to them. So the more we can make it a real normal thing when we talk to people but also a serious thing, hold ourself to higher levels of ethics, higher standards, when we do that type of stuff.

Kevin Patton: Sure. Well, the lab in your school, I’ve never actually been on your campus to see it, and I’ve seen pictures and I think even some videos when it was first built, I think Bill Perrotti was sharing some of those at HAPS and I’ve seen presentations that you’ve done where you’ve shown us some parts of the lab, and there’s kind of … I mean, you folks have been very conscious about this whole idea of respect for the human donors in even the design of the lab in that you’re entering a sacred space, and even have some signage and so on that sort of prepares the student before their first visit on sort of the kind of thought processes and conscious framework ought to be developed before they go in.

Aaron Fried: We’re a pretty small community college and we’re in a pretty small city in upstate New York, and so it’s no surprise that we have a donor lab on campus, everyone knows about it. When we were able to design our lab we got very, very lucky, we have two separate … We actually have three separate rooms, we have an outer lab that students come into first where we do our physiology or where we work through our skeletal remains, and then from there you walk into our inner lab where the donor room is and we have … Hospitals have donated us old surgical lights, or overheads, we have a walk-in cooler for storage, and then we actually have a third prep room behind that that we can store chemicals and store materials in. But when students walk in from the hall, the first thing they’re greeted by is a silent teachers memorial plaque that was actually donated by one of our students a couple years ago, that we’re lucky enough to have the names of all of our donors that we’ve ever had here. So that’s the first step that students have.

Aaron Fried: And then as you walk from our outer lab into the actual donor room where we work with the donors we have a couple of important signs, we have a silent teachers message and a … “From the dead we teach the living,” and that’s that respect step as we go into that space where …

Aaron Fried: And this is another idea, I know I already mentioned Sabine Hildebrandt, she liked this idea because in medical school when they do gross anatomy a lot of times they refer to the donor as first patient, and she actually thinks that that increases the anxiety and stress for a medical student because patients are real and living and there are consequences to your decisions. She likes the idea of silent teacher because they’re not able to talk to you but what you do is you learn from the actual anatomical dissection, you learn from doing … A patient will come in and we have their death certificate and it says, because of the way that a donor is prepared after they die for the preservation, a person has to die in, usually palliative care or in a hospital attended death, the body has to be processed within a short period of time, so a lot of times there can’t be an autopsy so a lot of times that certificate says person died of cardiac arrest or person died of respiratory arrest, and essentially that’s the way everyone dies is their heart stops or they stop breathing, but sometimes we’ll have some indication of they had these symptoms, or they had this condition they were being treated for, but essentially what we get to do is go through and say, well, what can we see? What do we notice about this individual? What can this individual tell us?

Aaron Fried: And I think that’s an important idea in terms of … Part of is respect, we respect them as a teacher, but part of that is they don’t have a voice anymore so the best we can do is we can learn from what their anatomy shows us.

Aaron Fried: And again, I think we’re gifted to not … We don’t use the anatomical models, which I don’t think are bad, but they’re almost perfect representations, they can be corrected, they can be fixed, they’re color-coded. And then when you go to our donors, you go in and you look and this stomach isn’t blue and the liver isn’t brown, and the … Well, I guess that’s a bad choice because the liver is kind of closer to brown, but you get the idea that there’s not exactly this perfect representation and we have to know, well, where are we looking? What type of things should we be looking for? Well, this is very different than what we were expecting, what might that mean? So those are the types of things that we try to pick up on. There’s a surgical scar here, where does that lead to? So there’s all of this teaching that those individuals are doing for us year to year that we are able to pass on to the students, which is, I think, way more beneficial than just focusing on … We try to get our students there like this doesn’t look anything like the book, yeah, of course it doesn’t look like the book because the book is perfect. So it’s this great teaching tool and we’re wonderful to have that opportunity.

Kevin Patton: Yeah, I agree with you. And I think it was the last time I heard you speak on this topic I caught myself, afterward, a few times, as I’m doing my exercise routine and so on and I’m thinking to myself … I have a body donor card in my pocket, I’ve made arrangements to donate my body to medical education, so after hearing you talk about this I’ve caught myself thinking, well, I’m exercising like I have to build up those muscles because muscles are hard to figure out in a cadaver that’s not very … Where the muscles are not very well developed, so I want to build them up because I want to be a good teacher. I sometimes think about my own body like, well, what are these students going to be seeing when I pass way, I need to take care of myself.

Aaron Fried: Yeah, take care of yourself. I went and visited Mark Nielsen out in Utah last year and they have a wonderful donation program out there, but it was probably one of the younger donors I’d ever seen, and I think he was like a 56-year-old male, but when he passed away his muscles were just in incredible shape. And so I was looking at this gentleman and I’m thinking to myself, wow, I’ve seen pictures, but wow, is this really what this is supposed to look like? You’re used to looking at a lot of elderly people who a lot of times have been bed-ridden for a period of time and the muscles are difficult, so yeah, it’s interesting to see how things vary from person to person.

Kevin Patton: Well, I could talk about this kind of stuff all day but we have limited time, and that’s it for it for now, and as I mentioned at the beginning, we’re going to have a second part. And Aaron has already mentioned he’s done a lot of work looking into some of the Nazi anatomists and some of the ethical issues involved with that, and so that’s what we’re going to explore in the next episode. I hope you can tune in then. Thanks, Aaron.

Aaron Fried: Thank you.

Kevin Patton: By the way, Aaron is available for speaking engagement anywhere so feel free to contact him using the information in the show notes and at the episode page at theAPprofessor.org.

Situs Inversus

Kevin Patton: Regular listeners to this podcast know that I love to tell stories about the olden days and, well, this being a podcast, there’s nobody here to stop me so I’m going to do it again.

Kevin Patton: Way back in 1995 I was the Conference Director for the HAPS Annual Conference in St. Louis, and I had set up some little mini-field trips within the workshop portion of the annual conference, and one of those was a field trip to the Medical School at Washington University in St. Louis. They have a very widely know medical school there and I had heard that there was an anatomical museum within the med school that was open to the public but only by appointment, and I couldn’t find anybody that had ever been to it so I called up the med school and got a hold of the person in charge of it and found out that really what it was was a set of exhibits that they had set up in their dissection lab. I said, “Well, can I have my colleagues come in small groups during our conference and take a look at what’s going on?” And said, “Yeah, sure. We’d love to have them.” And I said, “Well, is it okay if I come and check it out first, myself, and kind of get a feel for what to expect in case I get questions?” And they said, “Yeah. Come on down.” “When’s a convenient time?”

Kevin Patton: And so I went down there and met the person who was in charge of it and he walked me down the hall and unlocked the door and let me in there, and said, “Whenever you’re done just close the door, make sure it locks behind you and I’ll see you around sometime.” And so I thought, well, okay.

Kevin Patton: As I walked in there and, oh my gosh, it was amazing, but I’ll never forget the first thing I saw, I sort of turned away from the door and looked straight ahead and there was a big shelving unit, and it’s that old style museum shelving where it’s a glass enclosed case but it was really big, and right there at eye-level wast what looked like two human torsos. At first I thought it was a human torso model like we have in our community college lab where the legs are cut off and sometimes the head is removed, but you can see a little bit of what’s left of the shoulder and then you see the torso and it’s opened up and you can see the lungs, and the heart, and the abdominal organs and so on from an interior perspective. And so that’s what I thought I was looking at first but then I realized, well, this is like an old style model because it doesn’t like all shiny and bright like the usual models, and then I realized, no, that’s a museum jar that has an actual human torso in it that’s been preserved and it’s been prospected so I can see those organs like I would in a model. And what I thought was two big class jars that contained two torsos, it turns out there was one torso and a mirror, and I thought, well, what’s the point of this?

Kevin Patton: And so I start looking more closely at it and considering it, sort of like when you’re at an art museum, sometimes I’ll glance at a piece of art and it won’t really suck me in, but if I take a moment to look at a painting it kind of draws you in and you start to see things you would never have seen at just a glance. Well, that happened to me and I realized, oh my gosh, this is situs inversus. This person’s organs are completely flipped around in mere image and that’s why they had a mirror set up. They were at an angle, almost a 90 degree angle … Well, actually maybe it was a 90 degree angle, I don’t know, it was 1995 I can’t be expected to remember every detail. But it was set up in a way that you could see by looking in the mirror, you could see what would look like a normal arrangement of organs. And then when you look at the actual specimen you could see everything was flip-flopped around, situs inversus.

Kevin Patton: Clearly that was a dramatic and enlightening moment for me because I still remember it from all the way back in 1995. And there were a lot of other interesting specimens in there, you can imagine over the course of decades upon decades of work at Washington’s medical school that they would have come across some very interesting variations in human anatomy and they preserved some of those. This one happened to be from, I think, the last half of the 19th century, and it was still very well preserved.

Kevin Patton: Now, in the preview episode prior to this full episode, we dissected the terms situs inversus and situs solitus and the related terms, dextrocardia and levocardia, and we’re going to get to those terms in a couple of minutes and I’ll explain them again very briefly, but I also want to bring up, before we do that, a recent news item about a 99-year-old woman from Oregon who donated her body for dissection and ends up that she had situs inversus with levocardia, but she never knew it. Nobody. Her doctors, nobody ever knew that she had it. It wasn’t until they got it at the Oregon Health and Science University that they discovered this situation where she had reverse organs, except her heart was still facing toward the left, so it wasn’t quite like that specimen I saw at Washington, but it was still a case of a variety of situs inversus. So those anatomy students at Oregon Health and Science University, they got the explore this very unusual variation in human anatomy. Some of you may have seen the poster about this case at the AAA meeting last month, Cam Walker and Mark Hank had a poster called An Unusual Case of Situs Inversus with Levocardia.

Kevin Patton: So, what do we mean exactly when we say that this donor had situs inversus with levocardia? We’ve already mentioned that situs inversus is a variation of human anatomy where the viscera are flipped over into a mirror image of the typical arrangement of organs, what’s usually on the left is now on the right and what’s typically on the right is now on the left. Oh, by the way, situs inversus is sometimes called situs transversus or situs oppositus, whatever you call it, this condition is congenital, meaning that it shows up during prenatal development, not something that happens later in life as a result of, oh, I don’t know, doing too many spins on the dance floor. It’s not that. It’s not due to environmental influences like that. It’s found in about one of every 10,000 people in the population, so it is rare. It’s not super-duper rare but it’s pretty darn rare.

Kevin Patton: Most of those who have this variation have what’s called situs inversus totalis, meaning that one’s entire set of visceral organs is flipped over left to right, or right to left if you want to look at it that way. There’s not any particular danger in having this variation, well, except healthcare providers may get really confused when they’re assessing [inaudible 00:37:48] and we know that confusion among healthcare providers could lead to complications, could lead to maybe even some very serious complications. So, yeah, there’s that downside.

Kevin Patton: Now, going back to that young man with situs inversus at the Washington med school from the latter half of the 19th century, when I read the information in the little exhibit there I found out that he had died of complications of appendicitis. Remember, his appendix was on the wrong side, at least compared to everybody else, his appendix was on the left, not on the right. I’m wondering if left-sided pain and tenderness didn’t contribute to an initial misdiagnosis where somebody said, no, that can’t be appendicitis, it’s on the wrong side. Maybe that, yeah, that could have ended up costing him his life. I mean, there’s that somewhat well known case of Donny Osmond who was a popular singer and actor of my generation, he had appendicitis when he was 15 and it could have been treated before it got as serious as it did, if anyone had known that he had situs inversus … As a matter of fact, he was in fact misdiagnosed early on in that episode and it wasn’t until it had progressed to a very serious stage that he got some treatment.

Kevin Patton: But I guess having situs inversus could have some advantages, I don’t know. I mean, there’s probably advantages to anything, right? One of the villains in a James Bond novel claims to have survived an assassination attempt because he has situs inversus and the assassin’s bullet missed shooting him in the heart for that reason. No, I don’t know, that’s pretty far fetched as is just about everything in a James Bond novel, but I don’t know, man, I guess could happen.

Kevin Patton: So let’s look at the heart when one has situs inversus. First of all, the heart, like many of our organs, is chiral. Chirality literally means handedness, which I mentioned way back in episode 30 where I discussed the chirality of cells. Put another way, organs such as the heart do not have the same structure when you flip them around. It’s like your two hands, they’re not interchangeable because they’re flipped over versions of each other. In situs inversus totalis that would include having the heart flipped over so that the apex is pointing toward the right, not the left. Ordinarily, in most of us, about two-thirds of the heart is to the left of the body’s medium, that is to the left of a midsagittal plane, but when it’s flipped over the heart is mostly on right. This situation is called dextrocardia, meaning heart to the right. I suspect that the dextrocardia often seen in situs inversus does not really decrease your chances of being assassinated, I’m just saying, but I’m not an expert in assassination so we’ll just have to leave it there.

Kevin Patton: But sometimes situs inversus occurs where the heart doesn’t flip over, it still points toward the left as it does in most of us. When one has a left pointing heart it’s called levocardia. That’s what I have. I know because I’ve seen medical images of my heart and it’s pointing to the left just like I expect it. That’s probably what you have too, probably. I mean, it’s what 99.99% of us have.

Kevin Patton: By the way, I sometimes make use of this fact, that I have levocardia, I have a left-pointing heart. For example, if someone asks me to do something I really don’t want to do, I may say to them, “I’d love to help you move all your furniture up to the fourth floor, but, oh, I’m sorry, I have levocardia.” Okay, that doesn’t usually work, but I have tried such things.

Kevin Patton: About one in 22,000 people have situs inversus with levocardia, so that’s a little bit more than twice as rare as plain, old, ordinary situs inversus totalis. Having situs inversus with levocardia is a weirder situation than regular situs inversus because here you have everything but one organ, a complex vital organ, flipped over. I don’t know, sort of like having a left hand on a right forearm, things aren’t going to work as expected I would think. In some cases, the crossing-over of the aorta, pulmonary trunk, and perhaps some other structures get so messed up it can make one more vulnerable to cardiac problems, but as in the case of that 99-year-old body donor in Oregon it doesn’t have to cause any problems at all. Heck, it may be that’s what made her live so long.

Kevin Patton: By the way, there is another even rarer situation called situs ambiguus, it’s also called heterotaxy, that’s where things are not a neat mirror image of the typical layout of organs. The liver may be on the midline, the gut may be oddly rotated from its normal position, all kinds of things could be messed up. As you can imagine, situs ambiguus, depending on exactly what’s out of place and how different from normal it is, is more likely to put a person at risk for medical complications. Situs ambiguus is by the way, a lot more rare than situs inversus, which is already pretty rare.

Kevin Patton: Now, you’ve probably been thinking, what causes situs inversus? It happens when a mother looks into a mirror during pregnancy. No, no, no, no, no, we’d all have situs inversus if that were true. It’s when she breaks a mirror during pregnancy unless she throws salt over her shoulder. Okay, okay, none of that is true. I think there are still some unanswered questions about how situs inversus develops, but the last best story states that usually in the genes. It’s considered to be an autosomal recessive condition in which both parents have to be carriers of an altered gene that results in situs inversus. But in some cases it seems to be X-linked, not autosomal, but either of these patterns of inheritance helps explain why it’s so rare.

Kevin Patton: But the next question is, at least the next question that occurs to me is, what is that altered gene doing or what is it supposed to be doing that it’s not doing? From what I can tell we can’t really say for sure, probably it’s any of several different genes that are involved so there are likely there are several different mechanisms that could be at play. One mechanism likely involved in at least in some cases is primary ciliary dyskinesia sometimes called PCD. Primary ciliary dyskinesia. During embryological development, the normal functioning of the Primary cilia of cells is necessary for normal positioning of internal organs, about half of embryos with PCD develop situs inversus. Individuals that have PCD account for about a quarter of all the cases of situs inversus. So it does seem clear that PCD is not the sole cause of situs inversus, but maybe the primary cilia are somehow always involved, or maybe a lot of times they’re involved even if it’s not full-blown PCD, or maybe there are other things affecting positioning during organ development that cause situs inversus. Anyway, summing up, situs inversus, a really interesting, dramatic, fun kind of variation to look at even though it’s very rare.

Book Club x 3

Kevin Patton: As I mentioned earlier, I have three book recommendations from The A&P Professor Book Club to revisit. The first one is The Anatomist by Bill Hayes. The classic medical text known as Gray’s Anatomy is one of the most famous books ever created and it’s well known to most A&P teachers. In this work of creative non-fiction, Bill Hayes uncovers the extraordinary lives of the Gray’s Anatomy author and illustrator while providing a scalpel’s eye view into the ingenuity of the human body. It’s a story that many A&P teachers will enjoy and will probably deepen their appreciation of anatomical illustration in general. It certainly will give context and background that can be shared with A&P students.

Kevin Patton: I was most fascinated with the story of Henry Vandyke Carter, the illustrator of Gray’s Anatomy. That story gave me even greater appreciation of the amazing quality and accuracy of the images in the original book. This book has been around for a while, a long while, but it’s a timeless story that doesn’t lose its value. Aaron Fried brought this up in his conversation with me, replayed in this episode, in which he discusses the book and the context of human body donors and anatomical illustrations made from human specimens. Check it out in the The A&P Professor Book Club that’s at theAPprofessor.org/bookclub.

Kevin Patton: By the way, related to the topic of human body donation, I want to mentioned a book I’ve been reading and which I highly recommend, it’s called the Silent Teacher: The Gift of Body Donation. It’s written by Dr. Claire Smith who’s head at anatomy at Brighton and Sussex Medical School in the United Kingdom. The title of her book incorporates the term silent teacher, which was how we referred to human body donors in episode 29. This term stresses the humanity of the donor and the critical role that donor plays in society, and that’s the core message of this book, I think, that critical role of our silent teachers in teaching health professionals, which in turn translates into assisting in the health and wellness of countless millions of us who benefit from healthcare strategies.

Kevin Patton: As I’m reading the book, I was thinking that because I’ve had family members who became body donors, and both my wife and I have made arrangements to do that ourselves, this would be a great book to help other family members understand our decision and, not only accept it, but embrace it. But as I continue to read the book I’m also thinking this would be great for A&P professors to read too. For those of us who don’t do human dissection in our program, it’s a good background so that we can accurately explain the process to our students. For those of us who do use human body donors, this book will help us understand the perspectives of the different stakeholders involved so that we can effectively explain what we do with our students, our colleagues, and the community at large. But that gets me to thinking that this book would be great for our students too, it will help prepare students as they get ready to have their first experience with a human body donor. But even students who don’t have that opportunity will see how human science works, why human body donors are important, what actually goes on in anatomy, and perhaps even become interested in anatomy as a career or even becoming a body donor themselves.

Kevin Patton: You probably didn’t even know that The A&P Professor Book Club even exists, but it does, and this book is definitely on the recommended list. Check out the links in the show notes or go to theAPprofessor.org and find book club in the menu.

Kevin Patton: I have a book recommendation for you from The A&P Professor Book Club, this one is called Stiff: The Curious Lives of Human Cadavers, written by Mary Roach. Now, this was brought to mine recently by a tweet from my friend Krista Rompolski, and she was tweeting about the possibility of using it in an assignment for her A&P students and she wanted to get some input and discussion around that. And this book has been around for a while, about 15 years, and until Krista mentioned it I had kind of forgotten about it. Well, except when I remember it odd times and places that I’ll talk about in just a minute. It turns out that I have used this as an assigned reading for undergraduate A&P students and they loved it. What I did was I asked them to read it and then write a couple of pages about what in the book struck them the most. What was particularly interesting to me is that their picks of what struck them the most ranged all over the place, and it turns out they loved it they love, love, loved this book. That’s three loves. They were as surprised as I was that an assigned reading would be so well loved.

Kevin Patton: Now, when you take a look at this book you’ll see that it starts out with a description of Mary Roach, the author, going into this medical school lab where they had a bunch of heads of cadavers set up so that some surgeons could practice some brain surgery. And then it goes on and talks about the history of dissection, and she brings up the whole process of decay and more than you ever wanted to know about how all that works, she talks about how bodies are used for research and all kinds of research, I mean taking us way beyond what we might expect, and there’s various aspects of how a body might be handled for funerals. She discusses what exactly is the point of death, at what moment are we dead and all of the problems and issues surrounding that question. And, well, there’s just all kinds of interesting stories and useful information in the book.

Kevin Patton: Now, one of the things I like about Mary Roach’s books, and I’ve read several of them, relates to today’s featured word of the day on dictionary.com, at least for the day that I’m recording this, the word of the day is expatiate, which means to move or wander about intellectually or imaginatively without restraint. That’s kind of how she writes, that’s kind of how I think, that’s kind of how my podcast goes isn’t it? Where I just kind of bounce around from one idea to another. So no wonder I like Mary Roach’s writing because she kind of writes like I think, kind of all over the place, just wandering here and there.

Kevin Patton: Now, I’m thinking that 15 years after I read the book I probably ought to read this book again, so I’m going to do that, it’s on my list. But there are bits of information that have stuck with me over those 15 years and they still pop into my head from time to time, sometimes kind of unexpectedly. For example, sometimes when I put in my rigid contact lenses, it pops into my head, I think about how she described these little plastic disks, sort of like rigid contact lenses but with little spikes in them, that funeral directors use to keep the eyelids closed. Now, what a thought to pop into your head in the morning as you’re getting ready for the day and getting your contacts in, but, well it happens. That’s how my brain works. Sorry. And sometimes when I’m doing my slow cadence resistance training at the gym, it’ll pop into my head about how I need to keep my muscles reasonably well defined in my old age so that they’ll be useful when I’m dissected later, something I’ve already arranged for.

Kevin Patton: Now, Mary Roach’s books in general, and this one in particular, is both informative and hilarious, and for me that’s all I need and want in a non-fiction book. So in The A&P Professor Book Club I’m recommending Stiff: The Curious Lives of Human Cadavers, and the author is Mary Roach, R-O-A-C-H.

Podcast Award Nomination

Kevin Patton: The The A&P Professor podcast has been entered into the People’s Choice Podcast awards, but I need a lot of nominations from listeners to get this podcast into the final slate of nominees. It only takes a minute or two to nominate and it must be done by the last day in July. Just go to podcastawards.com and nominate The A&P Professor. That’s it. I’m in the education category. You’ll also have the opportunity to opt into the pool of judges if that’s something that you might be interested in. That’s podcastawards.com or just click the link in the show notes or episode page before the end of July. I really do appreciate your help with this.

The Nazi Anatomists | Aaron Fried

Kevin Patton: The featured segment of this episode is the second of two chats I had with my friend, Aaron Fried. Aaron is an Assistant Professor of anatomy and physiology at Mohawk Valley Community College in upstate New York. Besides a lot of experience teaching A&P, instructional design and teaching methods, Aaron is dedicated to the use of human donor dissection and human and animal tissues for learning and instruction, and is a national speaker on the history of body donation, specializing in the history of body use in Nazi Germany.

Kevin Patton: In episode 29 we talked about some issues surrounding human body donors, which Aaron likes to call silent teachers. In this episode we talk about what he’s learned about some of the Nazi anatomists and how that directly impacts A&P teachers today.

Kevin Patton: Well, we’re here once again with Aaron Fried who’s been talking to us in the previous episode about the attitudes that we have in using human donors and we learned about why he doesn’t like the use the term cadaver and some of the various issues of having respect for the human people, the real human people who have donated their remains so that we can use it for anatomy education, and even in derivative ways such as in various replicas and models and even the drawings that we see in anatomy atlases. Aaron, I know you’ve done a lot of research on a series of anatomical drawings done by Eduard Pernkopf and some of his colleagues, and they’re still found in anatomy atlases today, so what’s the story behind those illustrations and why is that story important for A&P teachers like me to understand?

Aaron Fried: Kevin, you’ve opened Pandora’s box because once you ask me questions like this sometimes it’s hard to get me to stop talking, but-

Kevin Patton: Well, I have the recordings switch at my end so.

Aaron Fried: Yeah, well, you cut me off if you need to. So before I talk about Pernkopf I think a generic intro to this is I’ve been lucky enough to work with human donors for a long period of time and I think part of studying Nazi anatomists is why I prefer the term human donor. We use that here at Mohawk Valley Community College because we’re really trying to emphasize a choice, a decision, that individuals made.

Aaron Fried: And I think probably six, or seven, or eight years ago when I started studying the Nazi anatomists I read an article at the time … It’s an Emily Bazelon article that was written, it was an online magazine, it was about a senator, Todd Akin, who made a claim about rape where women who are legitimately raped have a mechanism to shut that down, and the interesting part of the article to me, other than that absolutely not being true, is that that research actually comes from a handed down set of citations from a Nazi anatomist named Hermann Stieve who during Word War II, under Nazi power, was doing research on the female menstrual cycle. I mean, essentially what he was able to gain access to during that time, as he was able to gain access to these individuals who were being executed by the Nazis and he was able to gain these fresh tissues … The problem, if you have any experience with human donors, the problem is that the age of donation is usually very much in the top ages for humans. I mean in our lab right now we have a 96-year-old female donor and we have a 89-year-old female donor, and so if you want to study normal reproductive age reproductive systems you don’t get to see that.

Aaron Fried: As an interesting aside to that story, I expected I was going to go into this studying Nazis and find out all sorts of information about horrible things that were happening in concentration camps, but what I found out is that … Picture that these Nazi anatomists are working under a eugenics model, and so the people in the concentration camps are essentially lesser humans, they’re not the most powerful traits in the population, and so they wouldn’t have used them for study, so these were actually executed Germans citizens. The women that Hermann Stieve was using were executed mainly for political dissidents. So essentially, they had political views that were the opposite of the Nazi Reich and they were executed because of those beliefs, and anatomists found great benefit from being able to get those tissues and use those tissues for study.

Aaron Fried: I think, to get back to Pernkopf, Pernkopf is a slightly different story because Pernkopf is in Vienna, so that’s Austria, and after World War I Austria is separated from the Germanic empire, still a lot of the same conditions in Germany, still fairly fascist regime before World War II, and around 1936 or ’37 Hitler annexes Austria and he says it’s part of the German Reich again. At that time, Pernkopf, Eduard Pernkopf, becomes the Dean of the medical school. Not unlike a lot of pother places in Germany at time, a lot of progressive faculty were kicked out and I think the University of Vienna that was upwards of like 70% of the faculty is kicked out just because they’re Jewish or sympathizers, or just dissenters in general, and so it creates this real center of eugenic studies. And Pernkopf at the top as the dean is in charge of acquiring bodies for the medical school and at the same time is also starting to put together a plan to create several atlases.

Aaron Fried: The original plan, it was a big plan, they ended up publishing, before he died, I think seven volumes of the atlas. Each volume was revised over time and they were very detailed drawings. I think one of the things that makes the books unique is that they brought in artists who were water color painters but instead of just looking at dissected specimens they worked with Pernkopf, who was an excellent dissector, and so they understood the anatomy and they were able to very accurately capture three dimensional characteristics in their two-dimensional paintings. And one thing that Pernkopf really wanted away from normal is he urged the painters to use very vivid colors so these paintings are described as being very artistic. In fact, one of the reasons the atlases are sought after today is because people view them as these controversial works of art.

Aaron Fried: So where the book starts to become controversial is that during the war, just like Hermann Stieve, Pernkopf is able to gain access to a supply of people who were executed as prisoners of the German Reich, and again, a lot of these people were not capital murders, these were individuals who just disagreed with the Reich and were executed for their beliefs and ended up being dissected at the University of Vienna. These atlases … So after Pernkopf dies, somewhere around the 1960s is when the publisher has some of Pernkopf’s colleagues edit the books and, probably much to Pernkopf’s dismay, they took out pages and pages of his text and all that remained in the final publications were his artist’s work. They widdled it down to two volumes that were published three times in English, they were published, in addition to German and English, they were published in Japanese, they were published in French, Spanish, they were published in Italian, they were published as inserts for medications. They were actually using these to sell pharmaceuticals to people in different languages as a professional development opportunity for physicians.

Aaron Fried: And one of the things people noticed is that the artists did things like sign these paintings with … It was common for people to sign the paintings and their artwork, but they were putting swastikas in their signatures or they were putting the SS-lightning-bolts in their signatures, and it really wasn’t until the 1990s … So the first editions of Pernkopf was published in 1938, 1939, first time anyone ever really started to raise big questions was around the late 1980s, early 1990s, and it wasn’t until then that people started to look at into what was going with these books.

Kevin Patton: Wow. Yeah. You know, I have a couple of books where there’s some of those in there, and this is something that I’ve talked about to my students before. At the beginning to anatomy and physiology I have a little intro discussion of how we know what we know in anatomy and physiology, and with the anatomy clearly it’s dissection, that’s the root of all that we know, but I talk about the history, the culture, the social setting of any one time sort of determines what kind of experimentation we do, and that operates today. There’s all kinds of questions being raised in our society about what is appropriate or not appropriate to do in terms of research and education and so, and we touched on some of that in the previous episode when we had our earlier discussion. But I did bring up this sort of thing like, “Okay, there are known cases where there are obvious ethical questions about how this material was produced, and yet it’s still in our material. Here’s an atlas that has some of them in it.” So my question for you, Aaron, is do you use those atlases in your own teaching? Should we be using them in our own teaching? What’s a good way to think about that given their history?

Aaron Fried: That’s an interesting question. I think one of the things that brought me into studying Pernkopf in particular, and think I’ve been hyper focused on Pernkopf for probably the last year, the problem came up … So as I’m studying six or seven years ago I’m thinking about these Nazi anatomists, and I’m reading, and I’m reading about this Pernkopf atlas controversy and I come across this one references that says, “Hey, by the way, these Pernkopf images are also in an atlas that was published in the US by Carmine Clemente,” and I’m like, wait, what, we have that in our lab. I’ve been talking about these Nazis for two years, we have these in our lab? And I went into the lab the next morning and I went, started flipping through the book, and I was like, oh, that is totally one of the images, one of the author’s signatures, and right there in one of the additions of the Clemente atlas was the signature where one of the swastikas had been erased. So it had been doctored so that it didn’t look like that was an issue.

Aaron Fried: So I spent a lot of time digging into Pernkopf within the last year so … I want to say last fall I was invited by our colleague Mark Nielsen, who has a great dissection program out in the University of Utah, to give my Nazi anatomy talk, and I mentioned Carmine Clemente, these images are in his book, by the way there is a whole series of atlases by another German anatomist, Sobotta, who the same art has been pulled into those books. Someone sent me an image from one of the most recent versions of Gray’s Anatomy where one of the images is in there from one of those artists. I mean, these images have kind of worked their way into a series of different books.

Aaron Fried: So as I’m talking about Pernkopf and the connection to Clemente that’s it’s in our lab, one of Mark’s students raises his hands and he says, “Well, what do you do about those atlases?” And then I kind of took a deep gulp and I said, “You know, I’ve had these atlases in our lab for the last seven years and I don’t know. I don’t know what we should do about them.” It’s a very difficult, to me, decision. First off, I’m not an ethicist, I’m an anatomist, I think of ethical questions all the time, but how do I solve this problem? I spent probably the first couple of months making appointments and going to … It was kind of my tour of IV league schools near me, I went to Yale and I saw some of the original editions, I’ve been to Harvard, I’ve been to John Hopkins, just trying to look at what these books looked like, see if there’s any clues in there, reading everything I could, and so I actually ended up … I have a collection of the Pernkopf atlases in my office, we still use the Clemente atlases.

Aaron Fried: Around the same time though, I read some work by a woman, Sabine Hildebrandt, who she’s an anatomy professor, she actually became an MD in Germany, she taught in Michigan for a while and now is at Harvard. She has a big emphasis studying these Nazi anatomists. And just one day, out of the blue, sent her an email and said, “Can come and talk to you about this? I have some questions that you might be able to answer or at least point me in the right direction?” And she said she would absolutely love to talk to me but said, “You need to look this over.” She had been working with ethicists, and rabbis, and clergy to try and figure out, is it possible that we can figure out what to do with … I think the big problem that they started with was they’re trying to figure out what can we do with these big books … They, over in Germany for example, if they’re digging for anything new they come across these graves, what do we do with these discovered remains?

Aaron Fried: So there’s this very specific protocol they developed called the Vienna Protocol, and in there there’s a recommendation about Pernkopf, and it’s long, and it goes on to say, well the people probably wouldn’t have consented to display of their body, but in this case because things have already been done, and it kind of goes on to say if you use this with people who are going to use their training to do better in the world and if you use the idea of exposing what Pernkopf did and using that as a way to talk about ethics in how not just being a good medical professional doesn’t just mean doing good work in your profession but also making good, ethical choices that there’s a path to using these materials as long as you acknowledge.

Aaron Fried: And so what we’ve done is we had a big ceremony last semester where we did a talk on campus about Pernkopf, we created a plaque that acknowledges that we’re not getting rid of the materials because getting rid of the materials is something that the Nazis stood for and we don’t stand for that censorship. And so essentially, we acknowledge and we have a plaque outside of our donor lab that says on the way in, “We acknowledge that this has happened, we can’t undo it, the best thing we can do is learn from it and going forward, make our promise to do as good as we can going forward.” So we use the materials but we try to acknowledge what they are and work with them.

Kevin Patton: I wonder if by acknowledging that and making people aware of, it doesn’t them more informed that things like this have happened in the history of the world and maybe can stand as a warning to not let it happen again. I have those thoughts when I think about history of these things is that it’s important to know about them so that we don’t repeat that again.

Aaron Fried: Yeah. My guess is it’s not the last time it’s going to happen. I mean, even if you look at the story of Henrietta Lacks, I mean that’s a very much more contemporary example of a woman who her cells were harvested, she thought, for just a routine medical procedure but they were kept alive and people … Not only did they end up coming up with good medical treatments, but people made money off of that. There’s kind of this conscious effort that I think especially as anatomists we have to make to do better than maybe a normal person would.

Aaron Fried: I have lots of friends who are academics and I talk to them about this, and people will say to me, well, these people already dead, it doesn’t necessarily mean that you should use them, I mean they’re already there. And I say we owe a better debt to the people who make conscious donation, that we understand and recognize that we have to be better.

Kevin Patton: That’s a great point. You know, Aaron, I’ve really enjoyed this conversation. It’s a fascinating story with these illustrations and the history behind them, and I think it brings up some important points and I really appreciate you sharing your perspective on those.

Aaron Fried: Yeah, thanks for having me, Kevin. I’ll make sure I get you the link to my website and I’ll put some materials up. I know it’s tough to talk about visual stuff and not be able to actually point to them, but I’ll get some of that stuff up there so that if your listeners are interested they can see some of this stuff we’re talking about, but especially the plaque, I think that’s an important message. So yeah, I’m always interested to talk about this stuff so.

Kevin Patton: Yeah. Okay. Well, I’ve already talked to Aaron before we chatted today about him coming on the podcast again in the near future so look forward to that. And I will have a link to Aaron’s website in the show notes on the podcast and also on the episode page at theAPprofessor.org.

Kevin Patton: But in the meantime, go ahead and give us a call at 1-833-LION-DEN. That’s L-I-O-N-D-E-N. Or 1-833-5466-336. Or send an email at podcast at theAPprofessor.org and give us your reaction to what Aaron’s been taking about or maybe share some additional information, or perspectives, or resources that we can link to.

Kevin Patton: Aaron, again, thank you very much.

Aaron Fried: All right. Thanks, Kevin.

Kevin Patton: I have some links to Aaron’s website and Instagram in the show notes and at the episode page at theAPprofessor.org. Aaron is available for speaking engagements anywhere so feel free to contact him using that information.

Kevin Patton: Well, I hope you enjoyed exploring some of the issues and controversies concerning the use of human remains, including reproductions, in the teaching of human anatomy. This was a special episode featuring related clips from the podcast archive. Our regular lineup of new preview episodes and full episodes will resume again in a few weeks.

Kevin Patton: Hey, don’t forget that I always put links in the show notes and at the episode page at theAPprofessor.org in case you want to further explore any ideas mentioned in this podcast or if you want to visit our sponsors, which I’d love to see you do.

Kevin Patton: There are many ways to stay connected to this podcast and get new episodes as soon as they’re released, just go to theAPprofessor.org/listen to explore the many ways you can do this.

Kevin Patton: And I want to remind you that if you phone in or send in a recording of your suggestion for The A&P Professor Book Club, I’ll send you a $25 Amazon gift certificate and, if you are among the first contributors in this promotion, you’ll be put into a drawing for a free Amazon Kindle Fire HD 10 tablet.

Kevin Patton: As of the moment of this recording there’s still room in that first five list or you’re welcome to call in with your questions, comments, and ideas anytime at the podcast hotline. That’s 1-833-LION-DEN. That’s 1-833-5466-336. Or send a recording or written message to podcast at theAPprofessor.org. You can follow this podcast in Twitter, Facebook, or Instagram, using the handle @TheAPprofessor. I’ll see you down the road.

Aileen: The A&P Professor is hosted by Kevin Patton, professor, blogger, and text book author in human anatomy and physiology.

Kevin Patton: This podcast is not to be used as a personal flotation device.

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