The Anatomist: A True Story of Gray's Anatomy (14 page)

By listing his measurements, Carter obviously was not trying to do historians a favor. He was taking stock of his corporeal self, I have come to see. The stark reality of Bellot’s death struck deepest as Carter put pen to paper that evening, and he reacted much as one might after a bad traffic accident, say, when you step out of your vehicle and give yourself that kind of mental pat-down, making sure you’re still all there. In the upswell of emotion, I’m not even sure he was fully aware of what he was recording on the page. After his height and weight he also notes his lung capacity (a “sound” 240 centimeters per inhalation), which suggests that he may have even gone in for a physical exam that day. In any event, I find this last detail almost poetic in its inference, as the drawing in of breath is the drawing in of life.

That the specter of death spooked him so surprised me. As an anatomy student, Carter had handled dead bodies for years, routinely carrying the scent of death in his hair and hands and clothes. As a surgeon in training, he’d certainly seen many tragic deaths, and he lived at a time when death by infectious disease, inoperable illness, or irreparable injury was common. But I suppose he also possessed the blitheness of youth, that sense of invulnerability that’s not lost until you cross irreversibly into adulthood. With Bellot’s death, Carter must have felt—and
recognized
—that cold breath on the back of his own neck, and now he couldn’t shake the feeling. One night in his diary, for instance, he sounds panic-stricken when reporting that an acquaintance is “fearfully ill with typhus fever” and that another is already “dead of the same! Fearful—fearful warnings! Why am I left so intact?”

In this rattled state, he experiences a series of stumbles, some little, some big, but all hugely amplified in his mind. For instance, Carter misses an appointment with Gray one day, “from not being
quite punctual
, a failing of late with me.” But a far more substantial failure soon follows: in mid-November, he bombs the M.B. exam—bombs it big-time. “Truly a week to be remembered in the history of my Studies,” he writes, after the fact, “for have failed when about to grasp the last and highest scholastic distinction have aimed at.” Unlike other friends and colleagues, Henry Gray shows great kindness in not even bringing up the subject of this “late failure,” Carter reports.

How swiftly his circumstances had changed. I could still envision his face lit up in the grand illuminations of the City of Light. In less than the span of a season, though, Carter had become a different person, more mature but also touched with melancholy, as evidenced in one of his final entries of the year. The date is Tuesday, December 13, 1853, and he sits alone in the dissecting room at the Royal College of Surgeons:

“Through the kindness of Mr. Queckett, [this] room—otherwise so bare, unnecessarily so, of almost all necessary accommodations—is now furnished with a lamp to eke out these dark afternoons.” In what seems like a fitting metaphor for his own changed perspective, the lamplight exposes aspects of the room he had never noticed before. “The mantel-piece looks desperately untidy,” for instance, while “the massive beams overhead remind us of proximity to the skies (in some respects no bad position). We are at least, doubtless from best intention, placed in
Attica
—the abode of poets.”

Alas, this illusion is dispelled, Carter writes, “when we approximate ourselves to the tank for injecting [filled with preserving fluid], by the unpoetical odours there abiding.”

Fixing his gaze on the specimens of distorted fetuses and animals lining the shelves, he now sees something almost sinister within: “Look at the gaunt bottles, filled with huge deformities, some in mock derision of our best and earliest state—childhood. Infants without parts—and to cap all—the brat of a Chimpanzee so like any human offspring that one doubts one’s nature,” a reference no doubt to the emerging theory of evolution.

“All nature swarms around us,” Carter adds sardonically, “the student is a very
Adam
! He is the keeper of a menagerie—of bones.”

Nine

I
F YOU THINK OF BONE AS BONELIKE—ROCK-HARD, INERT, THE
prototypical caveman’s club—you are mistaken. In the living body, bone is actually a dynamic tissue shot through with nerve fibers and blood vessels. Bone hurts when it is injured. It bleeds when it is broken. It is constantly being built up and broken down. Also, in spite of its popularity as a shade of wall paint, “bone white” is not the hue of living bone. Imagine instead a pale rose.

As part of our skeletal system, bones, in the simplest sense, keep us from being a puddle on the floor. But they also serve as cages, boxes, and basins to protect vital structures and act as incubators for new red blood cells. We are born with more than a hundred more bones than we have as adults, for many of our bones fuse together in the first years of life, such as the bones of the skull, and a final few, the bones of the pelvic girdle, don’t fuse till puberty.

There are exactly 206 bones in the adult human skeleton, and they range in size from smaller than a tooth (inner ear bones) to bigger than a forearm (the femur, the longest, largest, and heaviest bone in the body). Likewise, bone names run the gamut, from dull (the frontal bone, the nasal bone) to surprisingly clever. The hip bone known as the
innominate,
for instance, literally means the unnamed bone, “so called,” Henry Gray explains in
Gray’s Anatomy,
“from bearing no resemblance to any known object.” Many bone names come from Greek or Latin roots and are evocative even before tracing their literal meaning. When I first heard the names of the bones of the wrist, I thought of planets, a whole new solar system:
scaphoid, lunate, triquetrum, pisiform, trapezoid, trapezium, capitate, hamate.
And, in fact, the lunate bone is so named for being moon-shaped.

Whether delicate, dislocated, fractured, shattered, arthritic, or amputated, bones figure prominently in the daily life of the average physical therapist. Consequently, osteology, the branch of anatomy focusing on the bones, has been a large part of this course, especially in lectures. In lab, we always dissect down
to
the bone but not necessarily into it, as our primary objective is to examine in context the muscle, tissue, tendons, and ligaments that may sustain damage when bones are diseased or injured. We have become well acquainted with many parts of the skeleton by this point, just a couple of weeks shy of the final. But by lab’s end today, we will uncover twenty-seven more bones, all of which can neatly fit inside a glove, and do: the bones of the hand.

Anyone peeking through the lab door might easily mistake the lot of us for the world’s most serious manicurists. Two students hover over each hand at each body, cutting and tweezing small strips of skin. I am paired with Rachel, while on the other side of the table, Becky and Jenny handle the left appendage. These are a man’s hands, big and meaty.

I have taken the place of Liz, the self-described surfer chick from Santa Cruz, who dropped out of school just yesterday. I get the feeling I make a better Liz than Liz did. According to Rachel, she had found this class “‘too sciency,’” the very thing I love about it, and Rachel seems awfully glad to have a new partner. She welcomed me this morning by putting a fresh blade on a scalpel for me.

One might think that skin removal would be old hat by now. It is not. The process is tedious but at the same time allows the opportunity to marvel. As the point of contact between our insides and the outside world, the skin, the body’s largest organ, differs dramatically depending on what it is covering. Consider the back of the hand, for instance. In fact, consider your own. The skin here is loose and supple, to allow for the tightest balling of the fist. When the fingers are relaxed, you can pull up folds of the eyelid-thin skin, something you cannot do anywhere on the reverse side of the hand, the palmar surface, where the skin is not only thicker but tightly enmeshed with the underlying fascia. This fixed flesh makes it possible to grip without the skin’s sliding in place. The sole of the foot is likewise fixed, so you literally don’t slip on your own skin, while the skin on top is loose.

Once the back of our hand is stripped, Rachel and I try supinating the arm so that we can move on to the palm, but we don’t get very far. Rigor mortis and embalming have made the limb so stiff, we’re afraid we might break a bone in the forearm. Not wanting to hear that horrible
snap
—no doubt deserving of several demerits, I imagine—neither of us wants to twist too hard. Using gentle pressure, we slowly maneuver the cadaver’s arm into a fairly workable position, jutting just over the edge of the table. I brace it while Rachel begins removing the skin of the palm. This is a much slower process than the back of the hand but also more conducive to chatting. To my surprise, I discover that Rachel and I have something in common: we are “the elders” of the class. At thirty-four, though, Rachel, an avid long-distance runner, looks a decade younger. She is so petite, she has to use a step stool to work on the hand.

When Rachel reaches the crease at midpalm—the fold palm readers call your lifeline—we switch places. Continuing with her story, she explains that she is a former accountant, a CPA with a downtown firm, who’s making a complete career change. As she says this, two options pop up in my mind: either Rachel was too good at her job and therefore too unchallenged, or the opposite. “I wasn’t a very good accountant,” she admits, ending the debate.

I move from the palm to the fingers. Hardest of all to remove, I find, is the patch of skin containing the fingerprints, which almost seems epoxied in place. It is as though the body refuses to give up these marks of identity. But finally, the scalpel wins out.

Denuded, our hand is a handsome specimen, carpeted in plush, pinkish fascia. I now use the back of a probe to separate the trio of muscles nestled in the ball of the thumb. This plump part of the palm is known as the thenar eminence, or, in palmistry, as the Mount of Venus. Two muscles run on top and another beneath, this deepest one being one of the most important in the entire human body, the opponens pollicis, the muscle that makes the opposable thumb possible. It is shaped like a small feather and is the distinctive anatomical feature that allowed our primate ancestors to handle tools and manipulate their environment in ways other mammals could not.

It gives one pause—
This slip of a muscle,
I think,
helped advance our species
—but just a pause. Then a snip.

I cut it in half to more readily find the tiny nerve that activates it, a small branching of the median nerve. Given time, Rachel and I could trace the median all the way to its point of origin, over an arm’s length away, deep within the neck. But today, we focus on just this small section, often referred to by hand surgeons as the “million-dollar nerve.” No, the dollar amount is not a tribute to the nerve’s value but is more of a penalty. If it is accidentally severed during a procedure—a carpal tunnel release, for instance—the patient will no longer have a functioning opposable thumb. The million dollars is a likely starting point for a malpractice settlement. (Far more often, I should point out, it is the patient who accidentally damages this nerve, cutting it when slicing a bagel, say, or shucking an oyster.)

The hand is a minefield of nerves. Rachel adjusts the overhead lamp for better viewing. It is also crawling with veins and arteries and lumbricales, the long, winding muscles that help us stretch and extend the four fingers. (
Lumbrical
means “wormlike.”) Like all muscles, lumbricales would be useless were it not for tendons, the fibrous cords that unite muscle with bone and, like the strings of a marionette, make movement happen. Certainly the most astonishing tendons we have uncovered are the long, slender pairs running up each finger. They look like delicate reeds yet are obviously tough enough to last a lifetime—and beyond. They still work. By bending and unbending the cadaver’s index finger, Rachel and I see one tendon sliding over the other.

The topmost takes its name, as tendons tend to, from the muscle from which it emerges, the flexor digitorum superficialis, located way up in the forearm. This muscle also has an old-fashioned name, which I personally think is a better name, one that had persisted for five centuries and found its way into
Gray’s Anatomy:
the flexor digitorum
sublimis.
Why “sublime” rather than “superficial”? Well, purportedly, because the flexor digitorum sublimis sends its tendons to the fingers, including the single digit a romantic would consider the most important, the ring finger, and of course, marriage leads to sublime happiness, no?

As Rachel and I scrape off the last bits of fascia, she spills the remainder of her story: She’s married. She and her husband have a home in the Oakland hills, two dogs—a nice life. “But I wasn’t totally happy.” She hated her job and really wanted to work with people rather than numbers. Years ago, a wonderful physical therapist had helped her recover from a horrific auto accident, and having been on the receiving end ultimately led her along the path toward today. But oh, that physical therapist neglected to say how much work becoming one would be! Rachel’s midterm grades weren’t so hot, she confides, and she is already stressing about the upcoming finals. “I have
got
to know these bones,” she says, sounding like an accountant determined to make the numbers crunch.

“Well, let’s make it happen.”

I go to retrieve one of the five hanging skeletons positioned around the lab, to use for comparison.
I love these things,
I think as I wheel it to our table, how they are wired together like some crazy Calder mobile; how the bones rattle as you roll them; and, not least, how these are the real McCoy, not those bright white plastic clones made nowadays. Each skeleton is unique, different in size, coloring, and subtle surface markings, the bones themselves bearing a permanent imprint of the person who once was.

“
I SEEM TO
be always dreaming of writing or publishing some great fact—or facts—always hovering about, watching the adventurous ones and thinking of essaying to fly,” yet at the same time, “very much disregarding the preparatory hops and short flights of those who now fly high,” H. V. Carter begins his entry for March 18, 1854.

He could have stopped right there, as far as I am concerned. His words, at once somber and playful, soulful and angst-ridden, describe Carter so perfectly at this stage in his life that each time I read them, I find myself literally nodding in agreement.
Yes, this is the you I’ve come to know.
The wall between diarist and reader gives way, and I can see him as clearly as he is seeing himself. He sits in the Royal College of Surgeons library, his words suggest to me, taking refuge from the fumes of the laboratory and stealing a few minutes to write and think. Seated by an open window between banks of books, breathing in the fresh air, he watches people strolling in the park below, birds flitting about, carriages carting away the latest visiting Dr. So-and-So. Carter dips his pen again.

Over the past nine months, he writes, he has met here at the college many luminaries of the London medical world, many of whose works share space on the library’s shelves, but the experience has not always been all he had hoped for. A person may think he knows a man “by his book, or published lectures, etc.,” the twenty-two-year-old observes, but when you “see the man himself, hear him, speak to him, watch him,” your opinion is “commonly somewhat shaken.” In sum, “The whole resolves itself into this: The more one knows of a man, the more difficult it is to retain [a] favourable opinion, or implicit reliance on, him.”

This seems to be one of those days when Carter can write no wrong, when he displays an insightfulness well beyond his years. The closing line of this short entry is also a beauty. “Two persons are generally concerned in every fact,” Carter notes, “one discovers part, the other completes and corrects.” The sentence has the pleasing concision of a maxim, one that could as easily apply to the two Henrys as it could to me and Carter, narrator and subject. Sometimes, though, I am baffled by facts he brings to light. Three months following this last entry, for instance, he makes a painful discovery in Henry Gray’s just-published book on the spleen: he finds page after page of his artwork but no credit whatsoever for himself as the artist. Stunned, Carter takes to his diary. “See Gray’s Book on Spleen,” he jots. “Takes
no
notice of my assistance though [he] had voluntarily promised [to do so]. Rather feel it”—slighted, that is, and justifiably so. In a preface written expressly for the book, Gray had thanked by name the other colleagues from St. George’s who had assisted him in various ways, warmly referring to each as a friend, which surely must have made the omission sting all the more. Even so, Carter doesn’t seem to hold a grudge for more than a sentence; immediately he goes on to praise Gray’s book as “very creditable.” And that is where it’s left. He never confronts Gray about the matter, and Gray never brings it up.