The Name Game Jan 11, 2014

by RICK RADER, MD * EDITOR-IN-CHIEF

The third year of medical school is the time when the student gets to play doctor. He or she wears a white coat, dons a stethoscope around their neck and has (or had, before the electronic hand-held universe) a stack of index cards (patient notes, tips and check lists) occupying every available pocket. It's also the time when they are expected to know things beyond "always, sometimes, never," or "a & b," "a, b & c," "a & d," or "all of the above". The day of reckoning comes when the professor poses the question, "And what do you think it is?"

My first rotation was surgery, the most rigorous of the clinical rotations. Rigorous in terms of hours in the hospital, scut work, reading, chasing after lab reports, performing procedures, absorbing facts, learning protocols and, of course, interacting with a variety of personalities, egos, fiefdoms and hierarchies. The scuttlebutt was quickly provided to us regarding how to survive the intimidation provided by our high powered professor of surgery: "Know your anatomy."

Anatomy, the first course in the first year. Identifying structures, appreciating relationships, learning rules and exceptions, imagining things hidden by other things and, of course, eventually figuring out what those things are doing there. Those things had names. Names beyond the biggies like the heart, lungs, brain and the liver. The little things had big names—names like "lingamentum inguinale," "arteria radicularis magna" and "vena magna cerebri".

"Know your anatomy" was the key to surviving being intimidated, ridiculed and ostracized by The Man. Here is how it played out. Several students were placed in the surgical field along with The Man and a host of assistants, residents and interns. The Professor would point to a structure and mutter, "And what do you think this is?" The students, who could barely get a clear view of the crowded surgical field would throw out some half-baked answer, "Might it be the external abdominal oblique aponeurosis?" The professor would then simply point to the structure twice (the surgical equivalent of "double click") which translated into "that was both dumb and wrong; who's next?" Know your anatomy was the key.

The Man preferred that you provided an eponym answer. He didn't want to hear, "That sir is clearly the inguinal ligament," for that wouldn't cut it and wouldn't prove that you "know your anatomy." The man wanted to hear, "That sir is clearly Poupart's Ligament." He didn't want to hear that you were confident that you knew he was pointing to "the great cerebral vein," but that you knew it was "the vein of Galen." Too bad if you only knew it (a blood vessel) by the name, "the arteria radicularis magna," you needed to announce it was "the Artery of Adamkiewicz"." There was no "life line" to call if you didn't know the answer. To ratchet up the stress, he might ask (if you provided the correct answer), "good student, and who was Dr. Adamkiewicz?" or "tell me about Francois Poupart." Know your anatomy.

There was certainly a romance to learning about the physicians, surgeons and anatomists who laid claim to the anatomical parts, structures, ligaments, vessels and related architecture. In the earliest days of learning about the body, every dissection revealed new structures, all ripe for the naming rights. The study of anatomy begins at least as early as 1600 BC in Egypt. In some instances they blew it, believing that a number of vessels carried all the fluids of the body – blood, tears, urine and semen—to the heart.

There was a "naming" frenzy during the 16th, 17th, 18th and 19th century, where every nodule, protuberance, nook and cranny was named after the person who first got there or who offered, "Did anyone of you ever see this before?" That was the road to anatomical immortality. It wasn't only body parts that got named; we have eponyms relating to syndromes (Down), signs (Hahn's), fractures (Colles), tests (Aalsmeer's), symptoms (Abadies) and reactions (Abderhalden's) among others.

One would think that after over a thousand years of peeking and poking around the body, all that was there was identified long ago. In fact, there have been few newly discovered "islands", "jungles" and "oceans" in the last hundred years. The body doesn't exactly sprout new structures when the need arises (it actually does, however, the needed parts take awhile to appear).

One can imagine the excitement (at least in the field of human anatomy) when it was recently announced that a new body part was discovered. Researchers in Belgium described the first-ever dissection of the "anterolateral ligament," an entirely "new" body part located within the muscles and tendons of the knee. The findings promise new surgical procedures in the treatment for the famous anterior cruciate ligament (ACL) tears that have plagued athletes in pivot-heavy sports such as soccer, basketball, skiing and football. The "new" part will be known as the ALL. The "discovery" was published in the Journal of Anatomy. The Anatomical Society praised the research as "very refreshing" and "commended the researchers for reminding the medical world that, despite the emergence of advanced technology, our knowledge of the basic anatomy of the human body is not yet exhaustive." No plans are to name the ligament after "Claes and Belleman," the two orthopedic surgeons who described the structure.

So why call attention to anatomical eponyms in the leading publication devoted to the special needs community? The connection is clear to those of us who have dedicated their professional lives to this arena. We have long been familiar with "EP digit magna," the hyper extended, pronounced finger that is exhibited by Exceptional Parents after years of using the phone's dial to call clinicians, principals, therapists, administrators, politicians, researchers, payors and reporters. We are well acquainted with many opportunities to "name" numerous anatomical structures that are found exclusively in the sensory organs of parents that are hyper sensitive and hyper tuned to hearing, seeing, feeling, tasting and smelling injustices, inequities and inadequacies in rights, services and supports that their children not only need, but deserve.

Know your anatomy. There are new structures waiting to be named.

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