The Anatomist: A True Story of Gray's Anatomy

by Bill Hayes

  “You have capabilities which you may reasonably suppose are rather above ordinary,” the diary begins. “And how have you used them?” He then excoriates himself for having failed to keep his “invincible” resolutions of the previous year as well as for his immoral behavior—having a foul mouth, habitually lying, losing his temper. Carter is harder on himself than usual but also much more candid. “Your mind,” he writes, “[has been] polluted with constant visions of a sensual character,” especially at night. And this “loose kind of flirting” you’re engaging in with John Sawyer’s daughter Mary is “unworthy of a student.” You are “deceiving yourself and her, and her parents,” and, worst of all, have “no proper end in view.”

  “Really? Mary Sawyer?” I murmured when first reading this. I thought you two just played chess together.

  In spite of his suffering, I was euphoric. I felt as if my rapport with this man from another century had suddenly transformed, deepened. I had earned his trust, and now he was letting down his guard, completely.

  Truth is, this had not just happened over the course of a few pages. By this point, I had already logged countless hours poring over hundreds of Carter’s daily entries. With Steve’s code-breaking help, I’d figured out when H.V.’s Hs meant Hewett or Hawkins or Harland; that he used the German character β to indicate a double s; and that nearly every written word ending in y ran right into the next word, without a break. I had gone with H.V. the first morning he swam in the Serpentine, the winding artificial lake in nearby Hyde Park, and on every single dip thereafter. I had ridden with the young doctor in the brougham to his first case as surgeon’s assistant. He had hardly said a word then. And I had endured, as had H.V., many a “dull m.” (dull morning). But at last, all that time spent in front of the microfilm projector at the library was paying off.

  In one respect, though, I realized I had been misled. I’d gotten used to seeing his diary pages filling the view screen when, in fact, the photocopies showed both the true size of both diaries—a mere 18½ by 11½ centimeters, or about 7 by 4½ inches—and the scale of his handwriting. My word, the man had an ant’s penmanship! He could fit fifty lines on a single page.

  Carter added to Reflections about every two weeks and would do so for the next four years. Unlike with his daily diary, though, these entries were never meant as an exercise in self-discipline. Rather, like the pages themselves, he was unbound here, writing long, ruminative passages that often read like memoirs. Religion definitely drives this narrative, but he never names his denomination (though it is clearly Christian), rises up to defend its tenets, or, for that matter, lashes out at the powerful Church of England. No, the lashing is always self-inflicted. In Reflections, Carter chronicles his efforts to reconcile his moral failings with his desire to lead a strict Christian life. While he continued to chart in his daily diary such details as his attendance at church (sometimes even three times on a Sunday), here he dug deeper, confiding about the battle raging within him between “sensuality—that great bane” and “religion—that important subject.”

  By “religion” he really meant faith, an unshakable belief in God. But he really did treat faith as if it were a subject, a skill to acquire. He pursued it doggedly, as if competing for another academic prize. And this one, he really wanted to win. “’Tis just the same as with your ordinary studies,” he tells himself, “only even more perseverance is wanted.” At church, he would take notes during sermons, then write them out fully that evening. He would pore over the Christian tracts his mother sent him and reflect on her great purity of heart. Further, he took up a serious study of the Bible, “comparing texts with a view to getting precise knowledge.” And herein lay a crucial flaw in Carter’s efforts: he was trying to know his way to faith, a feat no more possible than thinking your way to love.

  The harder Carter tried to feel God’s presence, the more elusive God seemed to become. One evening in July 1851, he writes, “You had reason to think the Holy Spirit had roused you, but alas, an amazing and fearful backsliding has occurred.” In the twelve days leading up to this confession, he had tallied an entire “column of filthy sins,” while at the same time, all “thoughts of God” were “absent.” And for this, he entirely blamed himself.

  Carter did have faith in some things—faith that faith existed, faith that other people had faith in God—but he had at least as many doubts. Nowhere is this more apparent than in an intricate chart he created in Reflections. Here, he put his internal debate down on paper, weighing the pros and cons of being a devout Christian. To begin, he listed thirteen arguments in favor of choosing such a life and then, in a corresponding column to the right, an equal number against, each one effectively canceling the other out. For instance, number 8: he would have “general serenity of mind” as a Christian and, yet, “frequent mental conflicts.”

  On first glance, I was amused by this elaborate entry, dated October 1851 and spilling over onto two full pages. The rambling title scrawled atop the chart made me smile: “In Deciding for a Christian Life in Future: A comparative statement of arguments For and Against, Advantages and Disadvantages, Encouragements and Discouragements, in a worldly point of view.”

  “Worldly” it was not, to my eyes. On the contrary, the chart looked like the work of an endearingly naïve young man. It reminded me of a similar chart in Carter’s daily diary that served as a ledger of correspondence, letters received scrupulously balanced against each one sent out. But the more I studied this entry, the more heartbreaking it became. Along with his concern about whether he would ever be a good Christian was a second painful issue, though he intertwined the two: the repercussions of being a Dissenter. The term Dissenter applied to any non-Anglican denomination, but certain religions at the time were far more marginalized and despised than others, such as Evangelicalism, considered the most extreme, conservative branch of Christianity. Whatever his specific faith, Carter definitely saw himself as part of this minority, or, in other words, as a religious outsider. If publicly identified as such, he would suffer “jeers and ridicule,” “persecution—open and concealed,” “constant humiliation,” “no sympathy with many,” and on a personal level, “depression.”

  As I read of his fears, I felt great sympathy; moreover, I found myself identifying with this tortured Christian English Victorian diarist, a man both 25 years younger and 155 years older than I am right now. The question he was agonizing over, boiled down to its essence, was the same question that had plagued me as a young man: should I come out? In his case, should I come out as a Dissenter? Pausing over these two pages, I wished for him what I myself had desperately wanted at age twenty: for that perfect, knowing someone to show up and say that perfect, knowing thing—the answer to everything. Absent that, I was glad that, like me, Carter had a place to pour out his soul.

  Compounding his isolation, Carter was unable to speak of his struggle with friends such as Henry Gray. He feared jeopardizing his standing at the hospital. (Henry Gray, as the son of an employee of the royal family, was presumably a loyal son of the Church of England.) Nor did he confide to John Sawyer and his family. (Though Dr. Sawyer was not religious, his wife and daughters were Dissenters, though, as Carter implies, of a diametrically opposed denomination.) And to his fellow parishioners, he did not dare voice his doubts, lest he be labeled a skeptic.

  While it doesn’t lessen the poignancy of H. V. Carter’s situation, with hindsight one can see that his intensely private struggle was a reflection of larger conflicts arising during the mid-Victorian era. Increasingly, religious belief was being challenged by the new science, Charles Darwin’s emerging theory of evolution particularly. At the same time, however, the faithful were in some cases turning to science—and to scientists—searching for ways to reconcile science and religion. H. V. Carter was a particularly avid reader of the work of William Paley (1743—1805), for instance. Paley, an English scientist and theologian, claimed that proof of the existence of God could be found in our physical bodies.

&nbs
p; Though Paley wrote chiefly in the late eighteenth century, his words resonated well into the nineteenth and, in fact, can still be heard today in the “antievolution” movement advocating intelligent design. With Paley, it is important to bear in mind, however, that he was writing before Charles Darwin was even born, not in reaction to Darwin’s theories.

  In his most popular and influential work, Natural Theology; or, Evidences of the Existence and Attributes of the Deity, Paley introduced his now-famous metaphor of the watchmaker: if you had never in your life seen a watch, then found one lying on the ground and examined it, you would come to the inevitable conclusion, Paley writes, “that the watch must have had a maker—that there must have existed, at some time and some place or other, an artificer or artificers who formed it.” One must come to the same conclusion, he argues, regarding far more complex structures—plants, animals, and human beings. In short, only an “intelligent Designer” could have created them, just as only an “intelligent watchmaker” can make a watch. “That Designer must have been a person. That person is God.”

  While nature offers multiple proofs for the existence of God, Paley singles out one as definitive: “For my part, I take my stand in human anatomy.” In making his case, he moves beyond the biblical teaching that humans are made in God’s image. Paley presents what amounts to an anatomical travelogue of faith, pointing out those parts of the human body so perfect in design and purpose that God’s hand is obvious: “The pivot upon which the head turns, the ligament within the socket of the hip-joint, the pulley or trochlear muscles of the eye,…the knitting of the intestines to the mesentery,” and on and on, as if he somehow sees each piece of evidence right through the skin.

  Part sermon, part anatomy lecture, this passage sounds as if it were written expressly for Carter, who, of course, knew these places well. It also contains the key to understanding a puzzling diary entry, which, in turn, unlocks a secret to understanding the young H.V. The entry comes in the first pages of Carter’s first diary. On Sunday, January 7, 1849, the seventeen-year-old reports going to chapel twice and spending time reading Paley’s Natural Theology. On the left half of the page, he jots, “Acquired a new idea from it,” underscoring his excitement. And just to the right, he places a quote I recognize from Ecclesiastes, the most dour book of the Old Testament: “‘With much wisdom is much grief and he that increaseth his knowledge, increaseth troubles.’” The one thought is shoved to the left side, the other to the right—For and Against, I realized. But why? Why the opposing thoughts?

  Like Paley, he could see the divine in the body. But here’s the rub, as Carter might say. Even at this early date, he knew too much—too much about human anatomy—not to also see the imperfections, the flaws in the body’s design (for instance, the single passageway that both food and air share, which can result in choking). Hence, for H. V. Carter, the conflict between faith and knowledge was embodied in the body itself. The Christian within him could see what Paley could see. But the anatomist knew better.

  Seven

  AFTER THREE WEEKS OF CLASS, I AM SERVING AS A DEMONSTRATOR of anatomy.

  My duties are quite different from Henry Gray’s when he was demonstrator of anatomy (one of his many roles at St. George’s). He would stand in front of the class, behind a cadaver, showing students the parts of the body being described by the lecturer. The anatomy I am demonstrating, by contrast, is my own.

  With my shirt off, I have assumed what is called the anatomical position: standing upright with feet together, hands at the side, palms forward, with eyes directed toward the horizon, or, in this case, toward the Golden Gate Bridge, visible due north out the lab windows. The anatomical position, used in all medical disciplines, is the standard body position for referring to the location of any structure. In this pose, the subject becomes an object.

  Following Dr. Topp’s directive, the eight PT students grouped around me have to find the “bony landmarks” of the surface anatomy of the upper body, all fifty of them. Some are clearly visible, such as the shaft of the clavicle or the spine of the scapula (the collarbone and the sharp edge of the shoulder blade, respectively), but most need to be palpated. The gloves come off, the better to feel what is just under my skin. An easy one to find right away, on me as well as on most people, is the C7 spinous process. Translation: the bump at the seventh cervical vertebra. To most of us, this is the knobbiest knob you feel when massaging the back of the neck. To a physical therapist, it is the starting point for locating any of a patient’s thirty-two other vertebrae. Counting upward, there’s C6 to C1, while downward from C7, the remainder are grouped by region, with twelve thoracic, five lumbar, five sacral, and, finally, at the tailbone, the three to four coccygeal vertebrae.

  Just as landmarks are handy when one is driving—Take the second right after the movie theater, for instance, or, If you pass Millie’s Diner, you’ve gone too far—the landscape of the human body is more readily navigable for its markers. One of the most clinically important is the sternal angle, a slight ridge of bone near the top center of the sternum, or breastbone. If you’ve ever pointed at yourself while asking someone, “Are you talking to me?” you have probably pointed right at it. Its exact spot is most easily found by first slipping your finger into the groove at the very bottom of the throat, which is the very top of the sternum. This is the jugular notch, and the tip of the finger seems to fit perfectly in it. Now slide your finger down the sternum about 1½ to 2 inches (4 to 5 centimeters) to the first tiny bump or ridge. You have found the sternal angle. Just behind it, along the same horizontal plane, the arch of the aorta begins its arching, the trachea splits into the bronchi, and, deeper still, the thoracic vertebrae 4 and 5 are situated.

  A landmark to other clinical landmarks, the sternal angle is indispensable for correctly identifying the ribs, which are counted top down, with twelve on each side. The first rib, embedded under the clavicle, cannot be palpated. The second, however, lies to the right and left of the sternal angle, though the bump can be subtle. From here, moving downward and sideways, you can count ribs 3 through 10, all of which connect to the sternum via a small portion of cartilage. The last two ribs on each side are unique in that they end roughly halfway around the torso. These are the “floating ribs,” and their tips can be felt just above the waistline.

  Now, repeat eight times, without squirming, and you’ll have an idea of what my morning has been like. As it turns out, my rib cage is good for counting because I don’t have a lot of body fat. My arteries are easy to palpate, veins easy to see. The students tell me I have a very well defined bicipital groove and impressive biceps, too. But compliments gradually give way to a sharper truth: my body serves as a primer on being middle-aged.

  Both my scapulas wing a bit too prominently, a possible sign of weakening serratus anterior muscles. My collarbones are uneven, probably from shouldering my gym bag on my left side for the past twenty-odd years. And my right shoulder joint makes a clicking sound as it rotates, apparently an early sign of arthritis. Once this is discovered, the entire class descends and I become the morning’s star attraction: Come, see the man who clicks! I am glad we are not going to move on to the lower limbs today—the hip joints, knees, and arches—where I have more serious problems, thanks to years of running and working out. Instead, we shift from the living body back to the dead for the remainder of lab.

  We have to perform a blunt dissection, meaning that the focus is on the destination, not the getting-there. All that’s required is a large scalpel blade, a deep breath, and an extra-deep cut. It takes half a minute, maybe less. For this particular dissection, you just slice straight across the crease at the crook of the arm (you being me, in this case, with Kristen, Sam, Kelly, and Cheyenne looking on), then make small perpendicular incisions at either end, peel back the flesh, and—

  “Wow.”

  The five of us are a choral group of exclamation, though we know only one song. We sing it again: Wow.

  Peeking through the crevice of mud-co
lored flesh is a glint of ivory, our truck driver’s elbow joint, our destination. I finger away the fascia till the joint capsule is fully exposed, then snip away its papery protective membrane.

  Even in a long-dead body, a joint remains a thing of beauty. It is smooth and shiny and still gleams with synovial fluid, the clear substance that keeps the joint lubricated or, if you will, greased. In Gray’s Anatomy, Henry Gray describes synovial fluid as “glairy, like the white of an egg,” and “having a slightly saline taste,” a phrase that begs a question that is perhaps best left unanswered: did he actually put a dab on his tongue?

  I take a step back as my lab mates take turns digging a little farther, exposing the three long bones that meet, or “articulate,” here at the elbow: the humerus, the single bone of the upper arm; and the radius and ulna, the two bones of the forearm. Like all joints in the skeletal system, the elbow joint is not a part per se but a place where parts come together. However, unlike the simple hinge of a knuckle joint, for example, the elbow joint is tripartite, a three-way intersection of bone. Here, the radius and ulna articulate with each other and, separately, sometimes simultaneously, with the humerus.

  A joint is usually powered by muscle and nerves. This one is powered by Kelly. She pronates the cadaver’s arm, and we are all floored.

  Pronating is rotating the forearm so that a palm facing upward turns downward. A person does this countless times in a day without a moment’s thought, as when you turn your hand over to look at your wristwatch. Yet, seeing the inner workings of this simple act is nothing short of profound. Kelly turns the arm again. In a single, perfect movement, the head of the radius spins in place on the humerus while the shaft rolls over the ulna. They return just as gracefully to their side-by-side position during supination, the reverse action, which again turns the palm upward. That a bit of life seems to linger in this dead body is surprisingly unghoulish.