Beef tongue is usually discussed within the context of cookery. Some people consider it a delicacy, while others can't stand the thought of looking at it, much less consuming it. While I have eaten beef tongue and enjoyed it, these days when I hear the words or see it shrink-wrapped onto one of those styrofoam trays in the store, my thoughts turn to needles, not food.

You see, one of the courses I took in graduate school had a lab in which we were taught how to suture flesh.

The lab was fitted with everything you'd expect of an older chemistry lab: black soapstone countertops, tiny sinks and gas and oxygen spigots, ring burners, blackboards, chalk, scads of Pyrex beakers, and a dingy hood in back. Little of that had import for the course, but locked in one of the cupboards was stored a suitcase-like box. It contained a delightfully fake human "arm" made of self-healing plastic. There are many such scholastic anatomical tools which are intended to be practiced on. The self-healing aspect allows you to slice it or stick a needle in it many times. The old holes mostly go away, though a heavily used one looks leprous and does not take stitches all that well.

That first day of lab, our professor (a Vietnam veteran medic) showed that ratty old arm to us, and then put it away again. He told us that aside from learning how to inject local anesthetics, we would not be using it at all. Instead, we would be required to purchase raw beef tongue to practice on. I didn't realize the consequence until I got to the store, but as it turned out, this requirement created an unexpected and significant financial hardship for me that quarter. Beef tongue is expensive, especially on a grad student's budget, and especially when you go through a few of them a week. At the time I took the lab, a single decent-sized beef tongue cost around $11-13 US apiece. Ouch!

You may be wondering, "Why beef tongue?" The answer, so we were told, was this. For starters, tongue comprises both skin and muscle. Cutting and suturing skin and muscle are not at all the same. Better yet, tongue is unusual in that the skin thickness varies quite a bit from the front to the back, and along the sides as well. Different regions of the tongue's surface effectively mimic human skin as found on varying parts of one's body, from the delicate skin of the face to that tough hide you are sitting on. And, if you're trying to learn stitchery, realism is a good thing. To top it off, beef tongues are the only animal tongue readily available in a typical supermarket, and they are also large and easy to handle.

Unsurprisingly, when that class started, the beef tongue market got cornered overnight, and I had to bribe the local butcher to ensure I got my stash on time. Once acquired, I'd slice these precious gems crosswise into thirds or fourths and then freeze the pieces quite carefully. If I had a lab the next day, I'd take one or two sections out of the freezer and put them on a plate in the refrigerator to thaw overnight, then double bag them for transport to the lab hours later in the day. Note: Do not, under any circumstances, fail to double bag them. Unless, of course, you're deeply interested in developing advanced methods for removing raw beef juices from the pages of your $350 US textbook. (I didn't ruin any textbooks, but a classmate of mine did, and we were all paranoid after that.)

After the teaching portion of the lab, our prof would come by each of our stations with a scalpel and cut the crap out of our beef tongues. We would then sweat and labor mightily to repair the damage. This damage started out innocently enough with straight, shallow cuts. Then it progressed, in stages, to corner flaps, jagged tears, deep gouges and ragged, excavated hunks of flesh. We learned to use Iris scissors to undercut the skin around a jagged wound and stretch it as best we could without killing it, to create the best possible scar appearance. Then deeper wounds and mattress sutures. We learned that in some cases, you actually have to make a wound bigger in order to clean it up and suture it properly... trimming off flesh and skin that would otherwise die. We also learned to do numerous other related tasks like the afore-mentioned injection of anesthetic. I never thought about it before that class, but there is a very specific way you must put on sterile surgical gloves if you are not to contaminate them instantly.

The final exam, I remember, included a requirement to make a certain number of sutures within a given time frame, with a really nasty cut. Once you finished, the prof tested each suture with his forceps, and if one didn't hold, it didn't count toward your total. Sadly, I don't remember the number or the time frame, but if I had to guess what I did, myself, it was something like 11 or 12 sutures in 15 minutes. (One of them was a bit loosey-goosey, but it held, thank goodness.) That sounds slow, but remember, we were beginners, and it's not just sewing. You have to do a lot of trimming, plan where you're going to go, keep your spacing even, the ends of the tied off knots should all be the same length, and oh yes, don't stick yourself with that damn needle! Whatever my count was, I was sweating profusely by the time I was done. I remember sitting back and wiping sweat off my nose with my shoulder -- waiting for the prof to come by and check my work -- all the while thinking some rather sober thoughts about the television show M*A*S*H. How the wounded were always piling up while those surgeons worked frantically, and yet it never seemed that they worked fast enough. I finally understand...dimly.

I'll never forget what my prof said to me after that exam wrapped up. He shook my hand and said, "You can sew up my ass anytime." He was entirely serious. And to have that come from a 'Nam medic! Those words mean a great deal to me. Right up there just under my marriage vow and the Hippocratic Oath.

The scary part is that I was told by a visiting M.D. that I had more surgical experience -- meager though it was -- than any 4th-year medical student, since I spent 2+ hours a day once a week sewing up tongues for an academic quarter, swearing over silk, monofilament, and gut sutures. (Monofilament is a bitch, by the way. If it can find a way to unwind itself, it will. Imagine trying to tie good, tight knots with fairly heavy plastic fishing line.) Surgeons in training don't sew a stitch in medical school, from what I've heard. They get all that experience as residents. They don't practice on tongue...they practice on YOU.

I'm a retired chiropractic physician, among other things. In the state of Oregon, and only in Oregon, a chiropractor may perform minor surgery with additional post-graduate certification. Regardless of whether you want to do that, Oregon state licensure requires basic understanding of minor surgery. Interestingly enough, it all seems to date back to Oregon's pioneer state history. Apparently there was a great dearth of M.D.s early on, and chiropractors filled in the gap. Since they were there, they got the business and the entrenched backing of the state. Supposedly some remote areas still exist where the only doc within a few hundred miles is a chiropractor, and they'll treat even gunshot wounds if they have to. Indeed, years back you couldn't have graduated from my college if you hadn't delivered at least one baby...and you still have to know quite a bit about obstetrics to pass that state exam for licensure. A graduate certification for obstetrics also exists, similar to the one for minor surgery, but as far as I know, no chiropractors currently practice obstetrics in Oregon due to the potential liability involved.

As for my former professor, yes, his chiropractic practice includes minor surgery and is one of the very few which does. He once told me something along the lines that once back from 'Nam, he wanted to get away from blood. He couldn't stay away from medical work, though, and eventually, he found an avenue in which he could both heal and teach. He is a deeply religious man. He'll give you the shirt off his back if you need it, and I respect him immensely. I also respect his son, one of my classmates; he has joined his father's practice and is following in his footsteps. Me, I've never touched a scalpel since that last day in class, but I enjoyed the experience greatly.

Many thanks to JohnnyGoodyear and WiccanPiper.

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