Adventures in Human Being

by Gavin Francis

  Praise for Adventures in Human Being

  “Adventures in Human Being puts a new twist on armchair travel, bringing the destination right into the chair with the reader. Gavin Francis illustrates this tour of the human body with well-chosen and well-told stories from his own medical practice. A fascinating and thoroughly enjoyable read.” —Thor Hanson, author of Feathers and The Triumph of Seeds

  “Doctors with literary ambitions write memoirs, tell stories about patients, or educate us. Scottish physician Francis successfully combines all three. In 18 chapters on 18 body parts, the author delivers no-nonsense lessons on anatomy and biology.” —Kirkus Reviews

  “[Francis] is a fine, subtle and observant writer. . . . [T]his is an illuminating and arresting book.” —Herald Scotland

  “A quietly radical, three-dimensional view of issues such as reproduction, birth, death and disability that has the power, at times, to make you stop mid-sentence and carefully reassess some of your most basic assumptions.” —Scotsman

  “Since he is both a GP and a travel writer, a better-suited guide than Francis to this bag of flesh, fluids and bones would be hard to find. There is much to astonish in [his] travel through the ‘most intimate landscape of all.’” —Sunday Express (UK)

  “Francis jumps nimbly between anatomy, history and personal experience in a way that makes the book both highly informative and compulsively readable. You have only to glance at the index to see the range of this remarkable book. . . . It promises an intriguing voyage and delivers it in great style. Thoroughly recommended.” —Daily Express (UK)

  “[This] is grand, eloquent stuff, occasionally humorous, frequently moving, and invariably informative.” —The Observer (UK)

  “So enthralling and so well written that it should win [a] clutch of prizes. . . . [I]mmensely engaging and often unexpected. . . . Some of the chapters are small masterpieces of insight and information.” —Sunday Times (UK)

  “In a series of deft essays on anatomy, starting with the head and working down to the feet, Francis moves skillfully between the scientific and the aesthetic, anatomical fact and emotional consequence, to craft a profound yet highly readable account of the intimate, inextricable relationship between the physical body and what some still call the soul.” —Irish Times

  ALSO BY GAVIN FRANCIS

  True North: Travels in Arctic Europe Empire Antarctica: Ice, Silence & Emperor Penguins

  Copyright © 2015 by Gavin Francis

  Published by Basic Books,

  A Member of the Perseus Books Group

  All rights reserved. Printed in the United States of America. No part of this book may be reproduced in any manner whatsoever without written permission except in the case of brief quotations embodied in critical articles and reviews. For information, address Basic Books, 250 West 57th Street, 15th Floor, New York, NY 10107.

  Books published by Basic Books are available at special discounts for bulk purchases in the United States by corporations, institutions, and other organizations. For more information, please contact the Special Markets Department at the Perseus Books Group, 2300 Chestnut Street, Suite 200, Philadelphia, PA 19103, or call (800) 810-4145, ext. 5000, or e-mail special.markets@perseusbooks.com.

  First published in Great Britain in 2015 by PROFILE BOOKS LTD., in association with Wellcome Collection

  Library of Congress Cataloging-in-Publication Data

  Francis, Gavin.

  Adventures in human being: a grand tour from the cranium to the calcaneum / Gavin Francis.

  pages cm

  Includes bibliographical references and index.

  ISBN 978-0-465-07967-4 (e-book)1. Human physiology.2. Human body.3. Human anatomy.I. Title.

  QP34.5.F697 2015

  612—dc23

  2015015371

  10 9 8 7 6 5 4 3 2 1

  That thrice-worthy Mercury calls man a great Miracle, a Creature like the Creator, the Ambassador of the Gods. Pythagoras the Measure of all things. Plato the wonder of Wonders … All men with one consent, call him Microcosmos or, The Little World. For his body is, as it were, a Magazine or Store-house of all the virtues and efficacies of all bodies, and his soul is the power and force of all living and sensible things.

  Helkiah Crooke, introduction to Microcosmographia (1615)

  for life’s enthusiasts

  CONTENTS

  A Note on Confidentiality

  Prologue

  Brain

  1. Neurosurgery of the Soul

  2. Seizures, Sanctity & Psychiatry

  Head

  3. Eye: A Renaissance of Vision

  4. Face: Beautiful Palsy

  5. Inner Ear: Voodoo & Vertigo

  Chest

  6. Lung: The Breath of Life

  7. Heart: On Seagull Murmurs, Ebb & Flow

  8. Breast: Two Views on Healing

  Upper Limb

  9. Shoulder: Arms & Armor

  10. Wrist & Hand: Punched, Cut & Crucified

  Abdomen

  11. Kidney: The Ultimate Gift

  12. Liver: A Fairy-Tale Ending

  13. Large Bowel & Rectum: A Magnificent Work of Art

  Pelvis

  14. Genitalia: Of Making Babies

  15. Womb: Threshold of Life & Death

  16. Afterbirth: Eat It, Burn It, Bury It Under a Tree

  Lower Limb

  17. Hip: Jacob & the Angel

  18. Feet & Toes: Footsteps in the Basement

  Epilogue

  Acknowledgments

  Notes on Sources

  List of Images

  Index

  A NOTE ON CONFIDENTIALITY

  THIS BOOK IS A SERIES OF STORIES about the body in sickness and in health, in living and dying. Just as physicians must honor the privileged access they have to our bodies, they must honor the trust with which we share our stories. Even as long as two and a half thousand years ago that obligation was recognized: the Hippocratic Oath insists “whatsoever in the course of practice you see or hear that ought never to be published abroad, you will not divulge.” As a doctor who is also a writer, I’ve spent a great deal of time deliberating over that use of “ought,” considering what can and cannot be said without betraying the confidence of my patients.

  The reflections that follow are grounded in my clinical experience, but the patients in them have been so disguised as to be unrecognizable – any similarities that remain are coincidental. Protecting confidences is an essential part of what I do: “confidence” means “with faith” – we are all patients sooner or later; we all want faith that we’ll be heard, and that our privacy will be respected.

  PROLOGUE

  If a man is made of earth, water, air and fire, so is this body

  of the earth; if man has in him a lake of blood … the body

  of the earth has its ocean, which similarly rises and falls.

  Leonardo da Vinci

  AS A CHILD I didn’t want to be a doctor; I wanted to be a geographer. Maps and atlases were a way of exploring the world through images that revealed what was hidden in the landscape, and were also of practical use. I didn’t want to spend my working life in a lab or a library – I wanted to use maps to explore life and life’s possibilities. I imagined that by understanding how the planet was put together I’d reach a greater appreciation of humanity’s place in it, as well as a skill that might earn me a living.

  As I grew older that impulse shifted from mapping the world around to the one we carry within; I traded my geographical atlas for an atlas of anatomy. The two didn’t seem so different at first; branching diagrams of blue veins, red arteries and yellow nerves reminded me of the colored rivers, A-roads and B-roads of my first atlas. There were other similarities: both
books reduced the fabulous complexity of the natural world to something comprehensible – something that could be mastered.

  The earliest anatomists saw a natural correlation between the human body and the planet that sustains us; the body was even a microcosm – a miniature reflection of the cosmos. The structure of the body mirrored the structure of the earth; the four humors of the body mirrored the four elements of matter. There is sense to this: we are supported by a skeleton of calcium salts, chemically similar to chalk and limestone. Rivers of blood wash into the broad deltas of our hearts. The contours of the skin resemble the rolling surface of the land.

  A love for geography never left me; as soon as the demands of medical training lessened I began to explore. Sometimes I found medical work as I traveled, but more often moved just to see each new place for myself – to experience variety in landscapes and peoples, and become acquainted with as much of the planet as I could. When writing about those travels in other books, I’ve tried to convey something of the insights those landscapes have given me, but my work has always brought me back to the body, as my means of making a living, and as the place from which all of us start and end. Learning about the human body is different from learning about anything else: you are the very object of attention, and working with the body has an immediacy and transformational power that is unique.

  After medical school I intended to train in emergency medicine, but the brutality of the night shifts, and the fleeting contact with patients, began to erode my sense of satisfaction with the work. I’ve taken jobs as a pediatrician, an obstetrician, and a physician on a long-stay geriatric ward. I’ve been a trainee surgeon in orthopedics and neurosurgery. In the Arctic and the Antarctic I’ve been an expedition medic, and in Africa and India I’ve worked in simple community clinics. These roles have all informed the way I understand the body: emergency situations are extreme and offer a heightened awareness of human lives at their most vulnerable, but over the years some of the deepest and most rewarding insights medicine has given me have been from quieter, everyday encounters. Of late, I’ve worked from a small, inner-city clinic as a family doctor.

  Culture continually reshapes the ways we imagine and inhabit the body – even as doctors. Through my encounters with patients, I’m often aware of how some of humanity’s finest stories and greatest art have relevance to, and resonance with, modern medical practice. The chapters that follow look deeper into some of those connections.

  Some examples: when assessing someone with paralysis of the face, I’m reminded not just of the frustration of being unable to express oneself, but of the age-old difficulty artists have had in accurately portraying expression. When thinking about recovery from breast cancer, I’ve been conscious that perspectives on what constitutes healing are different for each patient. Three-thousand-year-old texts like Homer’s Iliad can give insights into shoulder injuries, both ancient and modern, and the fairy tales we learned in the nursery eloquently explore ideas of illness, coma and transformation. The customs we bring to bear on our bodies are wonderfully diverse, something that struck me when thinking about the ways in which we dispose of the placenta and umbilical cord. Myths of struggle and redemption echo the convalescence stories going on in orthopedic wards all over the world.

  The word “essay” comes from a root meaning “trial” or “attempt,” and each chapter in this book is an essay attempting to explore just one part of the body, from just one of many perspectives. It hasn’t been possible to be comprehensive – we are composed of a multitude of parts, and scores of ailments afflict every one of them. I’ve ordered the chapters from head to toe, like certain anatomy texts, though they can be read in any order. Head to toe is probably the most appropriate way to approach them – journeying alongside me the length of the human body.

  Medicine has been my livelihood, but working as a physician has also delivered me a lexicon of human experience – I’m reminded every day of the frailties and strengths in each of us, the disappointments we carry as well as the celebrations. Beginning a clinic can be like setting out on a journey through the landscape of other people’s lives as well as their bodies. Often the terrain is well known to me, but there are always trails to be broken, and every day I glimpse a new panorama. The practice of medicine is not just a journey through the parts of the body and the stories of others, but an exploration of life’s possibilities: an adventure in human being.

  IT’S A TYPICAL MORNING in the clinic, my coffee cooling as I look down a list of thirty or forty names on a screen – my patients for the day. Many of the names I know well, but the first on the list is new to me. With a click of the computer his medical records pop up, and at the top-left corner I notice that his date of birth was just last week. He’s only a few days old; our encounter today will be the first entry into medical notes that, all being well, will follow him for the next eight or nine decades. The emptiness of the screen seems to shimmer with all the possibilities that lie ahead of him in life.

  From the waiting-room doorway I call the baby’s name. His mother is cradling the boy to her breast; she hears me and gets gingerly to her feet. She smiles and makes eye contact, then, with the baby in her arms, follows me back to the office.

  “I’m Gavin Francis,” I say as I show her where to sit, “one of the doctors. How can I help?”

  She glances down at her son, with a look of both pride and anxiety, and I watch her deciding how to begin.

  BRAIN

  1

  NEUROSURGERY OF THE SOUL

  Thus strangely are our souls constructed, and by such

  slight ligaments are we bound to prosperity or ruin.

  Mary Shelley, Frankenstein

  I WAS NINETEEN YEARS OLD when I first held a human brain. It was heavier than I had anticipated—gray, firm and laboratory-cold. Its surface was slippery and smooth, like an algae-covered stone pulled from a riverbed. I had a terror of dropping it and seeing its tight contours burst open on the tiled floor.

  It was the start of my second year at medical school. The first year had been a helter-skelter of lectures, libraries, parties and epiphanies. We’d been asked to learn dictionaries of Greek and Latin terminology, strip a corpse’s anatomy to the bone and master the body’s biochemistry, along with the mechanics and mathematics of each organ’s physiology. Each organ, that is, except for the brain. The brain was for second year.

  The Neuroanatomy Teaching Laboratory was on the second floor of the Victorian medical school building in central Edinburgh. Carved into the stone lintel over the entrance was:

  SURGERY

  ANATOMY

  PRACTICE OF PHYSIC

  The greater weighting given to the word ANATOMY was a declaration that the study of the body’s structure was of primary importance, and the other skills we were engaged in learning – those of surgery and medicine (“physic”) – were secondary.

  To get to the Neuroanatomy lab we had to climb some stairs, pass under the jawbone of a blue whale and slip between the articulated skeletons of two Asian elephants. There was something reassuring in the dusty grandeur of these artifacts, their cabinet-of-curiosities oddity, as if we were being initiated into a fraternity of Victorian collectors, codifiers and classifiers. There was a second set of stairs, then some double doors, and there they were: forty brains in buckets.

  (Shake up before use)

  Our lecturer, Fanney Kristmundsdottir, was Icelandic and doubled as a welfare officer, so she was also the person you were sent to see if you found yourself pregnant, or had failed an exam more than once. Standing at the front of the class, she held up a half-brain, and began to point out its lobes and divisions. Seen in cross section, the brain’s core was paler than the surface. Its outer surface was smooth but its interior was a complex series of chambers, nodules and fibrous bundles. The chambers, known as “ventricles,” were particularly intricate and mysterious.

  I lifted a brain from its bucket, blinking at the fumes that rose from the preserving fluids. It was a be
autiful object. As I cradled the brain in my hands I tried to think of the consciousness it had once supported, the emotions that had once crackled through its neurons and synapses. My dissection-mate had studied philosophy before switching to medicine. “Hand me that,” she said, taking the brain in her hands. “I want to find the pineal body.”

  “What’s the pineal body?”

  “Have you never heard of Descartes? He said it’s the seat of the soul.”

  She put her thumbs between the two hemispheres, as if to open the pages of a book. At the seam that ran through the middle she pointed out a little lump, a gray pea, toward the back. “There it is,” she said. “The seat of the soul.”

  Some years later I became a trainee neurosurgeon, and began to work with living brains every day. Each time I walked into the neurosurgical room I felt an urge to slip off my plastic clogs out of respect. The acoustics played a part in it: the clatter of a gurney or the whisper of an orderly seemed to echo and reverberate around the space. The room itself was a hemisphere, an upturned bowl of geodesic panels built in the 1950s. It looked the way I imagine Cold War radar domes or Dounreay’s spherical nuclear reactor would appear from the inside. Its design seemed to embody that decade’s belief in technology’s promise of a future – an imminent future – without want or disease.

  But there was still a lot of disease. I worked long days and nights with injured brains, and soon came to treat them as bruised or bloodied organs like any other. There were the victims of strokes, “struck” dumb and paralyzed by blood clots. There were creeping invasive tumors, wearing away at skulls and squeezing out personality. There were the comatose and catatonic, the car-crashed and gun-shot, the aneurysmal and hemorrhagic. There was little opportunity to think about theories of the mind, or the soul, until one day the professor – my boss – asked me to help out on a special case.