The Anatomist: A True Story of Gray's Anatomy (16 page)

Two weeks go by before Carter brings up the subject again, this time in oddly formal language, even for someone as formal as Carter. It reads as if he were submitting a petition for God’s approval rather than writing a diary entry: “An employment has been offered by one of the Lecturers, a young man whose character as a man of science furnishes all needful example, which will both be profitable for body and mind and enable me to exercise the power of drawing which is perhaps my main and best standing point.” Terms of the arrangement had been discussed. “Mr. Gray has acted fairly,” Carter reports, “and probably £150 might be gained within the next 15 months.”

Still, he has yet to accept the offer, and not because of nerves. Rather, he was praying about it every night, seeking God’s guidance, waiting for a sign. And then, just before Christmas, he realizes that the sign is already before him—the proposal itself.

“Renewed conversation with Gray as to the proposed ‘Manual of Anatomy,’ which am to illustrate,” H. V. Carter records on December 22, 1855. “May end in something. Gray shrewd, but considerate. The proposal seems Providential.”

Ten

H
ENRY GRAY CALLED IT THE
MENTAL PROCESS
.

Modern-day anatomists call it the
mental protuberance.

Either way, I call it confusing.
What does the bump of bone at the base of the chin have to do with using your mind?

I ask Dr. Topp one day as she passes by our dissecting table, and she answers the question with a visual. “Think of Rodin’s
The Thinker,
” she says, clearly trying to be helpful, though it seems she’s just adding feathers to my pillow fight.

She then adopts the classic pose of deep thought—chin resting on fist—and the air is immediately clear.
Of course.
But then—

“Well, that’s not literally why.” She explains that
mental
actually comes from
mentum,
the Latin word for “chin,” but by this point, the mnemonic has stuck.

“Now you’ll never forget it.”

I have come to love this quality about Dr. Topp—Kim, as she has said we can call her. She is pro-mnemonics, pro-etymologizing, pro-whatever-it-takes to get you to remember the correct anatomical term, which I consider a very Henry Gray–like trait. He often supplies in his text the derivation or translation of terms as well as memorable visual descriptions. At the same time, though, this makes Kim the polar opposite of Dana, who is anti-mnemonics. Too often students use them as a crutch, as a shortcut that bypasses true understanding, Dana believes. But the two instructors are of one mind when it comes to the end result. If the phrase “
T
om,
D
ick,
A
nd
N
ervous
H
arry” helps you remember the
T
ibialis posterior muscle, the flexor
D
igitorum longus muscle, the posterior tibial
A
rtery, the tibial
N
erve, and the flexor
H
allucis longus muscle—the anatomical mouthful that converges in the lower leg—that’s fine, but don’t stop there. You have also got to be able to identify these structures in a body, know their function, their point of origin, and so on. As for myself, once learning becomes knowing, mnemonics become superfluous, I have found, and at the end of the day, nothing makes knowing come faster than doing a dissection yourself.

I make the first cut for the four of us, a shallow incision from the top of the forehead down to just below the Adam’s apple. In a sense, this is like the imaginary line drawn down the center of a room that siblings must share—Becky and Jenny have their side, and Rachel and I, ours—but there is no rivalry here. Indeed, we share a bond forged by the intensity of what lies ahead: taking apart the face.

Becky and I wield the scalpels for our teams. We both start at the same place, the skin at the cleft of the chin, and cut in opposite directions. The underlying bone here is the mental process. About an inch below each of the lower canines (the pointiest teeth of the lower jaw) is a tiny hole—the mental foramen—through which passes a tiny nerve, the mental nerve. We burrow for our respective holes. The nerve at each site supplies the lower jaw and lip, and when anesthetized during a dental procedure, for instance, causes localized sensory loss. Becky finds hers first, though I am soon behind. Each looks like a threaded needle, a small white fiber poking through a tiny eye.

The next procedure is more delicate: exposing the facial artery, the major blood vessel supplying the face. Just as Henry Gray describes, “This vessel, both in the neck and on the face, is remarkably tortuous,” though, for the dissector, “torturous” could apply as well. An offshoot of the carotid, the facial artery starts in the neck, curves over the mandible, gives off branches to the lips and nose, then terminates at the inner “canthus” (from the Greek
kanthos,
meaning the corner of the eye). For Becky and me both, dissecting its winding branches takes considerable time and care. But once finished, what is revealed is far more than the twisting vessels themselves. Her side and my side mirror each other, an unexpected and remarkable display of the body’s inner symmetry.

Next, we go our separate ways. This is the last lab of the course and, for the students, a chance to review areas of difficulty before the final exam. Rachel and Jenny head to the feet and Becky focuses on the brachial plexus. For me, this is a last chance to explore. I decide to examine the TMJ (the temporomandibular joint, also known as the jaw joint), a dissection we’d not had time to perform.

I immediately hit an obstacle: the ear.

The lab manual contains no instructions on how to remove an ear, so I operate on instinct only. I pull the pinna away from the scalp and slice in a slow circle. I dig at a sharp angle as if cutting a weed at its root. This proves startlingly effective. The ear comes off in one piece, and now I face a dilemma I had not anticipated:
What does one do with an ear?

Becky suggests I just throw it away, but that seems a little rash.

“You could send it to someone,” Jenny offers wryly, making an allusion to Vincent van Gogh, who put his ear in an envelope and gave it to a prostitute for safekeeping.
(Wasn’t her name Rachel?)
For now, I fold the ear inside a towel and set it aside.

Where the ear had been is now a hole in the head the size and shape of a kidney bean. This is the entrance to the ear canal, which runs just posterior to the TMJ.
No wonder my clicking jaw
sounds
so loud,
I say to myself. For many years, I have had what’s officially called TMJ disorder—TMJ, for short—a catchall phrase for various problems at this juncture of two bones. Mine, exacerbated by teeth grinding while I sleep, mainly manifests as a
pop
or
click
whenever I yawn or chew or open my mouth too far. In my head, the sound is huge. I am always surprised people don’t hear it.

Having TMJ has made me hyperaware of my jaw, which, for the first time in my life, I am finding to be an advantage. The clicking is like a TMJ sonar pinging in my cheek, guiding my hand as I dissect. I cut back the parotid duct and gland, then gently slice through the powerful muscles of mastication. Next, alternately feeling with my fingers and using both the blade and the butt of my scalpel, I peel off the layers of fascia covering the joint itself. This is like peeling the skin from several stubborn cloves of garlic—tedious work, but I am utterly absorbed. I am a
ping
hunting a
pop
to its source.

After almost two hours, I have exposed a near flawless specimen of the temporomandibular joint, including one of its most delicate features: the tiny cartilaginous disk that acts as a kind of shock absorber between the temporal (upper) and mandible (lower) bones. When this disk is damaged or, as in my case, abraded, TMJ disorder results.

Stepping back from the lab table to appraise my work, I have no qualms about praising it aloud: “That is beautiful.” My lab partners heartily agree, as does Kim, who moves about the room telling other groups to come see my dissection. I am doing a final cleanup of the surrounding tissue when I see over my shoulder a wash of inquisitive faces. They have been quietly looking on, as if I were a sculptor brushing the dust from my latest work and they did not want to disturb me.

“Nice job,” Casey remarks, breaking the silence. “How’d you do that?”

With that, I become the go-to guy for the TMJ. Three groups invite me to their tables, where I tug at ears and talk through the procedure.

By the time lab is over, I feel as though I have truly graduated from this course in anatomy. Even so, I am not content. Too many gaps in my knowledge—
mental foramens
of the metaphorical kind, to coin a phrase—remain to be filled. I have never studied the brain, for instance, and I am still trying to work my way through the nervous system. Kim suggests that I take one last anatomy course—this one, for medical students. She promises to e-mail me the details as well as an invite to a postfinals celebration party she would be throwing at her home in a couple of weeks.

NEARLY EVERY STUDENT
comes, a testament to the fact that I was not alone in the affection I had formed for Kim. The sole absentee, Rachel, had opted to take the course as an incomplete rather than risk getting a failing grade. She will have to retake PT anatomy next summer. Becky and Jenny got As, though, as did most of my earlier table mates. As it turns out, I had gotten a passing grade of my own: Kim had used my TMJ dissection in the lab portion of the final, where test cadavers have numbers pinned to specific parts.
Name the muscle at pin A and describe its role in the movement of the TMJ.

“You saved me from doing that dissection myself,” Kim says, clinking a Snapple bottle to my Heineken. “So, thank you, Bill!

“Come on,” she adds, “it’s time for a tradition.” Sam has set up a digital camera on the deck railing for a class photo in the backyard. He sets the automatic shutter, then hops down and squeezes in next to Kim and me.

Click.

In the moment, I cannot help but flash on the photograph that launched me on this journey six months ago—Henry Gray and his students in the St. George’s dissecting room. I look at that collection of faces several times a day, as I have made the photo the wallpaper on my computer. It never fails to seize my attention. I no longer zero in only on Henry Gray but notice other characters: the gentleman seated directly to Gray’s left, for instance, who, with his muttonchops and formal black coat, looks like the heir to a cough-drop fortune; and, just behind him, the younger fellow, arms crossed at the wrist, who appears to have lost his left hand. Then there are the two scamps at the very back who stand on either side of a human skeleton. Is the one on the left holding the skeleton’s hand? But what I mostly see in this picture now is a missing person—H. V. Carter.

By the time this photo was taken, March 1860, Carter was no longer the demonstrator of anatomy. He was no longer even affiliated with St. George’s Hospital or, for that matter, a resident of London. In fact, he would not come to call England his home again for thirty years.

What had happened in the interim? Where had Carter disappeared to and why? Well, the full, tortuous story comes complete with a torrid scandal straight out of a Victorian novel. But first things first. The two Henrys still have a masterpiece to create. And just two weeks into their collaboration, Henry Vandyke Carter has hit a major obstacle.