Toni Schoenleber couldn’t do her job as a stroke clinical coordinator at UCHealth University of Colorado Hospital (UCH) if she didn’t have brains. In fact, it’s because she has brains that she knew just where to go when she needed more brains.
She called Alison Grice, who manages the Medical Teaching Lab at the University of Colorado School of Medicine. Schoenleber picked up six brains and, on March 15, gave two dozen Emergency Medical Services providers from across Colorado a chance to see what actual stroke-damaged brains look like.
Conceptualizing a stroke isn’t hard for those in her line of work. They’ve all seen CT scans of them, too. But, Schoenleber says, “Being able to see what it actually looks like and holding it in your hands puts it in a different perspective.” When the feedback forms roll in, she adds, “It’s actually everybody’s favorite part.”
That’s exactly what Grice and CU School of Medicine Pathologist Carrie Marshall, MD, hoped would come of a four-year effort to revamp, reorganize and grow the trove of educational organ specimens they manage. (Pathologists at UCHealth and elsewhere focus on diagnosing disease via lab testing and biopsy samples – a big, white Olympus microscope lords over the desk in Marshall Anschutz Inpatient Pavilion office.)
The organs – brains, livers, pancreases, stomachs, hearts, lungs, skin, bone, ovaries, intestines and others – have been a mainstay of medical school education since well before Marshall herself studied them as a CU medical student in the early 2000s. Now she’s using them as a teacher, where she leads small group sessions of first- and second-year medical students who are getting to know the symptoms of and treatments for things like cancer. Marshall might describe a set of symptoms, say, hinting at lung
cancer. When the correct answer comes, she then removes from a bucket sloshing with cancerous organs a lung with enormous, fatal tumors for the students to observe and, if they like, hold.
“It’s an experience you don’t forget,” Marshall says.
In the Organ Room
She says this in what she and Grice call the Organ Room. It’s in CU’s Research Complex 1 North building, a short walk across 17th avenue from UCH. Inside are tall metal racks. On their shelves are hundreds of yellow and white buckets and dozens of semi-translucent, Tupperware-like tubs. The buckets are taped with labels including ID numbers and descriptive labels such as inflammation & repair, Pulmonary, Renal, Heart, Placenta & Pregnancy, Lung, and Lower GI. They contain lungs with cystic fibrosis, ulcerated esophagi, ruptured spleens, diabetic kidneys, post-heart-attack hearts, brains with multiple sclerosis and Alzheimer’s disease – as well as healthy organs for comparison.
In clear-plastic sheaths hang “bucket lists” describing the contents of many of the buckets in more detail. Marshall pulls a white bucket associated with a 2017 CU medical school course called Disease and Defense. It’s a bric-a-brac of neoplasia – tumors. She snaps on purple rubber gloves and, at a deep stainless-steel sink, begins a show-and tell of lung and liver cancers, a cancer of the larynx, a tumor-riddled liver, leukemia-engorged lymph nodes. There’s a slice of liver, mottled and pale compared to the healthy burgundy of the reference sample in the same bucket. It’s about four times the size of a healthy liver, Marshall says. There are no patient names – just notes such as “55 year old woman with lung adenocarcinoma and widespread metastases.”
The samples’ ages vary widely. This bucket includes ones harking back to 1984 and as recent as 2017. Part of the organizational effort was to inventory the buckets’ contents and discard samples ruined with age or excessive handling.
“We had to discard several hundred pounds of organs,” Marshall says. “The Environmental Safety folks came by the lab and asked, ‘Is everything OK?’ It was my spring cleaning.”
Past meets future
Marshall has also made strides in enhancing and renewing the collection. Surgeries are one source; another is clinical autopsies of the sort Marshall regularly does. Patient and families have consented in all cases. Marshall herself performs clinical autopsies, whose purpose is to advance medical science through a thorough understanding of the disease processes that led to the patient’s death (not to be confused with the CSI-dramas forensic autopsies of looking for signs of foul play).
“Other than providing information to the family of the deceased person about their whole health picture, this is another benefit of consenting to an autopsy,” Marshall says. “It really does benefit the whole next generation of health professionals.”
Others benefit too, adds Grice. In addition to targeted samples such as Schoenleber’s six brains and those used for CU School of Medicine teaching, there are more diverse buckets for onsite workshops for middle school and high school groups arranged through CU’s Office of Inclusion and Outreach. Grice and two graduate students, Sanjay Ranganathan and Jessie Geer, do the show-and-tell.
Marshall has also created “student buckets” for loan to UCHealth nurses, medical school students and others. Among the samples in these buckets include sections from normal lungs and from those of a man with a long smoking history, blackened and with emphysema and squamous cell carcinoma; a healthy liver and that of a man with alcohol-related cirrhosis, and a healthy heart and one that had stopped beating after a heart attack. The aim is, in part, to “scare kids into practicing good habits,” Marshall says.
If a recent thank-you note from a fifth grader is any indication, it seems to be working. “I learned that when you’re unhealthy bad stuff happens to your body,” the child wrote.
To borrow a bucket, one can can fill out an online form and, soon enough, show a son’s football team what a brain with CTE looks like, Grice says. CU medical students Whitney Sumner and Alexander Schulick recently checked out three buckets and brought them to an annual event at Breakthrough Kent Denver, a nonprofit program for underserved middle school students in Denver and Englewood. They put organs on trays to look at and even touch, Schulick says. Then, at an ultrasound station next to it, they could see images of those same organs in their own bodies. Schulick and Sumner pointed out diseases and answered questions.
“Some of them were super-psyched,” Schulick says. “And some were saying, ‘I’m not getting even close to that.’”
Regardless, Schulick adds, they definitely made an impression.