The Anatomist: A True Story of Gray's Anatomy (25 page)

If one were looking just at H. V. Carter’s curriculum vitae, his interest in leprosy would seem to have sprung directly from that mound of raw data. Perhaps he had also encountered cases in Satara, one might surmise. But, in fact, a casual mention in his diary a decade earlier shows that Carter had begun looking into leprosy long before. From a public health perspective, there were certainly compelling reasons for him to study leprosy, but I am sure it resonated in a personal way as well. Leprosy is invoked many times in the Bible—the prophet Elisha bathing a leper, the parable of Lazarus, Jesus and his disciples healing the afflicted—and the chance to make an impact on the lives of lepers would have struck him as a worthy, Christlike endeavor.

After completing his term in Satara, Carter was granted a three-year furlough, which he used to conduct a fact-finding mission on how cases of leprosy were managed in other countries. He traveled to western Turkey and southern Europe but spent much of his time in Norway. During this remarkably productive period, 1872—75, Carter also wrote two influential books, both of which he illustrated: a monograph on mycetoma (1874) and a volume on leprosy (1874), one of the first scientific treatises on the disease. What makes this latter book historically significant is Carter’s advocacy for the findings of a fellow scientist, Gerhard Hansen, whom he had met during his furlough. Hansen, a Norwegian physician, had accumulated convincing evidence that leprosy was caused by an acquired bacterial infection and was not, therefore, a hereditary disease, as was widely believed and reported at the time. Carter’s book included translations of two of Hansen’s latest research papers (the first time they would appear in English), which helped disseminate the findings to a broad scientific audience.
¹

Six years later, H. V. Carter had the stage to himself. The setting was London, August 1881. At age fifty, he stood before an audience composed of the leading scientists of the day, delegates to the seventh International Congress of Medicine, Louis Pasteur, Robert Koch, and Joseph Lister, among them. These men were his peers. (And they were exclusively men. Queen Victoria, fiercely opposed to equal rights for women, had threatened to withdraw her royal patronage if any “medical women” were admitted to the congress.) Carter, now the principal of Grant Medical College, head physician of the Jamsetjee Jeejeebhoy Hospital, and a surgeon-major in the Indian Medical Service, had earned a spot in “the genus” above, to borrow his earlier phrasing, whether or not he saw himself thusly. He had been invited here to give an address on his recent discovery of the organism that caused “relapsing fever,” an often deadly illness that had swept through Bombay during the Great Indian Famine of 1877, and on his related findings on another blood-borne bacterium. This body of research, which would become the subject of Carter’s next book, a treatise of nearly five hundred pages, had already cemented his reputation as one of the world’s leading experts in epidemic disease. By now, the fact that H. V. Carter was the original illustrator of
Gray’s Anatomy,
currently in its ninth edition in England, had become just a footnote in his career.

H. V. Carter, artist and date unknown

Despite the prestigious setting, Carter’s moment in the spotlight must have been rather bittersweet. In his personal life, he was now very much alone. Harriet had recently died (apparently suddenly, though the cause and date of her death are unknown), and during his twenty-three years away from England, Carter had lost not only the few close friends he’d once had but family members, too. Both his father and brother had passed away—Joe at just thirty-five and only three months after marrying his longtime love. And now, his own health was poor. While investigating the nature of relapsing fever, he’d “had the benefit,” as Carter once wryly put it, “of repeated personal experience of this fever.” What’s more, he had contracted pulmonary tuberculosis. But the trip would at least end on a high note. After spending several weeks in London, he would take the train to Scarborough to see his dear sister, now Mrs. William Moon and the mother of a small brood.

Carter did subsequently return to Bombay and resume his responsibilities with the college and hospital, but following his retirement at age fifty-seven in July 1888, he came back to Scarborough for good. Brigadier-Surgeon H. V. Carter, M.D., was granted the honorary rank of deputy surgeon general for his “eminent service to medical science” and appointed honorary surgeon to the queen. He bought a large house within a stone’s throw of Lily’s, and within a few years, he had a new family of his own to fill its many rooms. In December 1890, at age fifty-nine, he married Mary Ellen Robison, twenty-five years his junior. The couple had two children, a son named Henry Robison (born 1891) and a daughter, Mary Margaret (1895). But Carter’s late-blooming happiness was cut short. He had never fully recovered from tuberculosis and died at home on May 4, 1897, just shy of his sixty-sixth birthday.

OUR TIME IS
almost up. We have been here four days in a row and are going home tomorrow. The library is closing in twenty minutes. The romance novelist has gone, leaving just Steve and me at the table. Still, we speak in whispers, purely out of respect for the reading room itself.

Sue, our favorite Ms. Wheat—a Mary Tyler Moore with an English accent—delivers two last archival boxes, one for each of us. We have already read everything—every page of every extant item, down to Henry Vandyke Carter’s last will and testament—but we cannot leave London without seeing H. V. Carter’s actual diary.

The second volume is slightly larger than the first, as if he had splurged on the extra half inch, but, my word, they are both so small. How did he fit so much life onto such tiny pages?

“Thank goodness we saw this on microfilm first,” I say to Steve, “or I don’t think I’d have gotten much past the first page.”

Carter’s handwriting, an endless series of trembling lines, looks more like an EEG reading, one that only we know how to interpret. There is his opening note on the fate of his first diary, how he’d had to destroy some of those early pages, followed on the next page by his peppy epigraph: “Let the same thing, or the same duty, return at the same time everyday, it will soon become pleasant,” which has always struck me as absurd.

Both volumes have been rebound, replacing what must have been tough original covers, for the pages show little wear and tear. Carter himself was not just neat but freakishly neat. There are no stains, scarcely a smear, and not a single dog-eared page. None of the ink has ever run, as if the man never shed a tear.

Steve and I trade volumes. I turn to Carter’s last diary entry, written on January 9, 1862, such a bleak, unhappy time. “The unfolding of the future—the immediate future—remains, and the present hardly improves,” it begins. The entry is a page long, the tone desultory. You can tell his heart’s not in it anymore. “Working incessantly—the only relief,” he writes in his closing paragraph.

It’s a wonder that the diary has survived, I cannot help but feel, that the volumes weren’t destroyed, whether purposely or inadvertently, or lost; a small miracle, perhaps even Providential, that they ended up in my hands.

I carefully thumb through the diary one last time. As the thousands of words fly by, it is not a line of H.V.’s but instead one of Joe’s that comes to mind:

What is past—the past—does not, nor
will
it, detach itself and remain where it was (or where it might have been
intended
to have remained) but it must bring itself forward, and smilingly, or otherwise, present itself as an old friend.

Seventeen

L
AST NIGHT I HAD ONE OF MY REOCCURRING DREAMS. NO, NOT
the one where I’m doing house chores with celebrities, but the dream of flunking my high school geometry exam. It’s a classic anxiety dream, in which I have completely forgotten that the final exam is today—right
now,
in fact—and I have not studied at all. In a variation on the theme, however, this one was set not at Gonzaga Prep but instead in UCSF’s Cole Hall. Upon waking, I felt panic and relief—such a sour mix of emotions—then bemusement. What I’d had was a
sympathetic
anxiety dream, I realized. Tomorrow is the med school anatomy final, you see, and today, I am helping Meri study for it.

We meet at 3:00
P.M
. and find the lab filled with fellow cramming students. Dana, Kim, Dhillon, Charlie, and the other teachers move among them, tutoring small groups. Our table, number 24, has been taken over by a group of guys studying our cadaver’s shoulder joint, so Meri and I find a spare prosection of a leg to work with. This is one sorry-looking specimen. Were it not already dead, I would say it looked studied to death.
Well-utilized
is perhaps the better phrase. I can’t help wondering how many students over the years have performed the anatomical equivalent of musical scales on this severed leg, calling off the sequence of muscles, nerves, arteries, and veins.

Meri, continuing the tradition, gamely takes the long limb into her hands. “Rectus femoris,” she states confidently, plucking the prominent muscle running straight down the front of the thigh.

“Indeed,” I confirm.

“Okay, and this”—Meri fingers an inner thigh muscle—“vastus medius?”

“Medialis,” I correct.

“Right, right, right. Vastus medialis. So this one”—she moves to the outer side of the leg—“is vastus lateralis. And then, down here, underneath rectus femoris, is”—she points to a slender slab of muscle—“vastus intermedius.”

“Exactly. You’ve got it.”

From here, I steer Meri through the arteries and veins, but honestly, by the time we get to the nerves of the lower leg, we have switched roles, with Meri teaching me the material I missed while in London. And as we move on to prosections of the arm and hand, it is clear that she knows far more about these parts than I do. Through her other classes, Meri, like all the other med students, has learned about myotomes and dermatomes and the actions of each muscle group and the clinical implications of injuries to various parts. In the lab, I now have little more to do than hold the prosected hand and, in a figurative sense, Meri’s hand as well, offering her exam-eve encouragement. Really, though, there is no reason for her to be nervous. She’s going to ace the final, I can tell.

For Meri, Kolja, Marissa, and the others, the conclusion of this course marks a mere first step in their studies, a foundation they are already rapidly building upon, but for me, this is an epilogue of sorts. I am not interested in studying more anatomy, going further in the field. Instead, I would like a better understanding of how the human body came to
be,
how it became what it
is,
this complicated, magnificently designed structure. I would like to study evolution.

Knowing I am not really helping Meri much, I suggest that she join one of the tutored groups, and at a nearby table, we find Kim quizzing a clutch of students gathered around a brutally dissected body. I watch for a while as Kim, gently, wryly, authoritatively, puts them through their paces: “David, which nerve innervates this muscle…here?” “And, Meri, what spinal nerve segment would you say it originates from?”

I slip away to take a last walk around the lab. In one of the back corners, I meet a fourth-year med student, Barry, whom I’ve never seen here before. Barry, the kind of heavyset, apple-cheeked guy you might call roly-poly, explains that he is doing a monthlong elective in dissection as preparation for his upcoming surgery internship. Splayed out before Barry, who’s seated on a low stool, is the upper half of a cadaver, transected at the waistline. He has slit open the abdominal cavity, revealing half the stomach, the small intestines, and half the liver. At this moment, he is examining the ducts of the gallbladder. “Getting some practice,” Barry tells me. “I’m planning on being a general surgeon, and taking out gallbladders is your bread and butter.”

Something about his food metaphor doesn’t quite sit well with me, given the gruesome sight laid out before him, but I know what he means. “Of course,” Barry adds, “in the OR, it won’t be anything like this. With laparoscopic surgery—which is how gallbladder surgery and a lot of procedures are now performed—you don’t need to cut open the whole abdomen. You just make tiny incisions into the stomach, thread in the cameras, snip out the organ, and you’re done.” Barry glances at the disemboweled cadaver with a rueful look. “Hardly ever see things like this nowadays. In fact,” he points out, “transplant and heart surgeries are some of the only times you’ll ever open up a body like this.”

I ask if he remembers learning a lot in his first-year gross anatomy course.

“Well, the thing is, you don’t really
learn
it till you have to
use
it. Before that, you’re just memorizing great bodies of information without being able to apply it—”

“But
that’s
not all that studying anatomy is about,” I counter, a bit more emphatically than I had intended.

“Yeah, true, there’s a ‘rite of passage’ to it—going through someone’s
body
with your hands. Your own two hands. Almost a ceremonial aspect to it.” Hundreds of years ago, he adds, they didn’t even wear gloves. “Students had to dissect bare-handed.”

“Well, I’m glad I missed that era,” I admit. As for Barry, he doesn’t look quite so sure.

I cross to the other end of the lab, where Matt, a classmate who’d worked at table number 22, is studying by himself with a lower limb prosection. I ask Matt how the class had gone for him.

“Fine, I think I’ve done all right,” he answers reflexively, then pauses and gives it more thought. “It’s amazing you can get into medical school and
not
know what side of the body the liver’s on,” he says—by “you,” clearly meaning himself. “Or how big the lungs are—”

“But now you do,” I say.

“Yep.” Matt, blond and blue-eyed, the epitome of a midwestern all-American boy, shakes his head sheepishly. “And now I know, if someone has a pain on this side”—he jabs at the left of his stomach—“well, it sure isn’t appendicitis.”

I ask him what kind of medicine he’s planning to study.

“Pediatrics, probably.” He glances down at the prosection. “Definitely not surgery.”

I wish him luck and go over to the sink to wash up. All around me, from every corner of the room, I hear the sound of
teaching,
the clear, impassioned voices of the instructors and TAs: “The radial artery goes through the snuff box and gives rise to the…” “Also, your thenar eminence performs this motion….” “There are eighteen intrinsic muscles of the hand, but they’re in groups, so they’re easy to…” “What’s the mnemonic for the rotator cuff? Right, SITS….”

And rising above the clatter of voices, I hear the distinctive sound of my first anatomy instructor, Dana, the passionate anti-mnemonicist: “‘Why?’ Well, first of all, you can’t ask why,” she is saying in a high-pitched stampede. “It just
is.
That’s how we’re made, but…”

Smiling, I head for the back corner to retrieve my bag. Just as I am gathering up my stuff to leave, a group of students converges around table number 24. “Okay, now the three muscles that attach here at the pes anserinus?” the TA asks them, pointing to the knee dissection I had performed.

“Sartorius, gracilis, and biceps femoris,” I whisper to myself.

“That’s right,” I hear him say as I walk toward the door. “And the mnemonic is SGBF:
S
ay
G
race
B
efore
F
ood.”

Amen,
I think, as the door to the anatomy lab closes behind me.