The Anatomist: A True Story of Gray's Anatomy

by Bill Hayes

  Adding to the discomfort of the day, the school’s maintenance department is testing the ventilation system on this hot August morning, so all the windows are to remain closed for the duration of lab. In the still, thick air, it seems as if we are being put to the test rather than the air-conditioning. Everyone is sweating, making it smell like the gym of the dead. Pulling at the pocket of my scrubs, I make a poor man’s fan of my shirtfront. I am truly seeing the wisdom in the centuries-old policy of dissecting only during the winter months.

  Think of this as an archeological dig, I tell myself, trying to remain positive. True, this is probably more unpleasant than sifting dirt under a noonday sun, but at least we’re assured a discovery or two.

  “There’s C3,” says Cheyenne over Kristen’s shoulder.

  “And here’s C2.”

  We are just about to enter the suboccipital triangle, an area of dense muscle beneath the backmost lobe of the brain, when—

  A throat clears.

  Like a raven-haired cat, Dr. Topp has suddenly materialized at the foot of our table. “Today is your day,” she says, and we know exactly what that means: a pop quiz, of sorts, with an anatomical twist. The group has just thirty minutes to put together a class presentation on the “functional anatomy” of a specific movement. As for the topic, that’s up to Dr. Topp. Last week, she had Casey’s group analyze “deep respiration with upper extremities fixed,” meaning the classic just-finished-a-marathon position—bent over at the waist, hands propped against the knees. Two weeks earlier, Robyn and her team were given “the iron cross,” that astonishing strength maneuver performed by male gymnasts on the stationary rings. Another day, it was the mechanics of a yawn.

  And this time: “I want you to dissect…”—Dr. Topp pauses a moment—“a push-up.”

  Off come the rubber gloves as Kelly, Kristen, Cheyenne, and Sam head to the big chalkboard at the back of the room. As each student’s grade hangs in the balance, I will serve only in a support capacity. I pull the cover over the cadaver before joining them.

  Having spied on other groups as they prepped their presentations, I know that my table mates have a lot to do. They must figure out the exact sequence of muscles, nerves, and joints used in executing their assigned movement, which is anything but a simple task, especially given the half-hour time constraint. On the other hand, the time constraint is good training, forcing each of them to think on their feet, just as they would when assessing a new patient.

  The four of them decide to break the assignment in two. Kelly and Kristen claim the upward motion of the push-up—the push away from the ground—while Cheyenne and Sam take the downward movement, which sounds like an excellent plan but rapidly proves otherwise. They realize that the two actions don’t happen in isolation and each duo will be doing too much overlap. So, scratch that. The group regroups. Just as the body works together to create a movement, the team must work together to break it down.

  They start from the top, literally. In the push-up start position, they determine, holding the wrists stable requires four carpal extensor and flexor muscles and three spinal nerves. Maintaining slight elbow flexion relies on the triceps brachii, anterior deltoid, serratus anterior, and several thoracic muscles, plus the radial, axillary, and long thoracic nerves, as well as spinal nerves C5 through C8 and T1. Holding the neck steady and level requires another ten nerves and muscles.

  At eighteen minutes and counting, the chalkboard is a madman’s cell wall.

  As they focus on the next step, lowering the body toward the ground, they get stuck—really stuck—unable to agree on which back muscles are, and which are not, involved.

  “Maybe I should do a push-up for you,” I volunteer.

  All four look at me as if I were a cooling breeze.

  Ten push-ups later, things start clicking, and not just from my shoulder joints. The lats, the traps, the pecs, both major and minor, all come into play. Click, click, click. The scapula, humerus, and glenohumeral joint join the list—

  “And we can’t forget to mention gravity!” Sam interjects, more impassioned than I have ever seen him. To the scritching sound of chalk on a blackboard, the group has transformed from an anxious lot to a confident one. I have no doubt whatsoever that they will nail their presentation. And, sure enough, they do.

  Though I hate to play favorites, I must concede that my favorite in-class presentation does not come until two weeks later. It is “the queen’s wave,” as analyzed by Adrienne and company. Watching these four energetic young women deconstruct this signature of royal reserve is a delight. Somehow, the white lab coats and ponytails add to the charm. I also find the movement itself fascinating; it barely squeezes into the dictionary definition of the word wave, for the fingers do not wag. Rather, the queen’s wave is an upright hand performing what looks like a slow stirring of the air.

  Such subtlety does not come simply, as the team explains. In one motion, the clavicle elevates, the scapula rotates, and the shoulder abducts, all in service to the arm as it rises fluidly into the air. At the same time, the hand cups and the forearm supinates ever so slightly. The queen, remember, waves with the back of her hand rather than the palm. Of course, the greeting is impossible without a great interplay of muscles and nerves, but what really makes this movement majestic, it strikes me, occurs in the carpal region. In other words, it’s all in the wrist, which must be held perfectly still, as if it were an anatomical exemplar of monarchical stability. This is where a wave becomes a wave becoming of a queen.

  JUST AS A chance encounter with Joseph Bellot “gave an éclat” to H. V. Carter’s “entrée into Paris,” as he had told Lily, a brush with royalty brought his stay to a memorable close. On Sunday, January 30, 1853, two days before Carter packed his bags for home, he joined the crowds lining the streets for the grand procession of Napoleon III and his betrothed on their way to Notre Dame to be married. The forty-four-year-old emperor, a nephew of Napoleon Bonaparte, had chosen as his bride a Spanish-born beauty named Eugénie, who was almost twenty years younger.

  “Whole scene exciting. All Paris out,” Carter reports in his diary.

  The festivities continued into the night. The City of Light shone as never before, with the Place de la Concorde aglow with “electric lights” and “illuminations very brilliant everywhere.” Even so, it was Carter’s glimpse of Empress Eugénie earlier in the day that still burned most brightly: “Nose aquiline, chin small, upper lip [a] little curved,” he notes, with an artist’s eye for detail. Watching her greet the throngs, Carter had not seen joy in the twenty-six-year-old’s lovely face. Instead, “expression quiet and resigned.”

  Drawing upon this memory, he would create a portrait of Eugénie shortly after getting home. But first things first. As per tradition, he marked his return to London life by checking in with Henry Gray. They met up in the Dead House and swapped stories, Carter reports in his diary, he of his Parisian adventures and Gray of his own encounter with royalty of sorts. No less a luminary than Dr. Caesar Hawkins had paid him a recent visit, Gray told his friend. Hawkins, who was known around St. George’s as “the Emperor,” not for lording about the place but for the great respect in which he was held by hospital staff (not to mention his imperial-sounding first name), had heaped upon Henry some glowing praise: your anatomical preparations, he told Gray, “are a credit to England.” (Hawkins was certainly qualified to make such a pronouncement. Not just one of the hospital’s chief surgeons, he was also the newly retired president of the Royal College of Surgeons and would one day be named sergeant-surgeon to Queen Victoria herself.) Though the doctor’s compliment had come a couple of days earlier, it is clear through Carter’s recounting that his friend was still floating on air.

  Gray had also just been named head of the Anatomy Museum, a well-deserved promotion in Carter’s eyes. Gray “is well-placed as curator and fully alive to his advantages,” he writes that evening. “Envy him.” Not that he was wallowing in self-pity, mind you. On the contrary, Carter, who�
��d scarcely had time to resettle into his old flat, was already taking decisive steps in shaping his own destiny. While still waiting to hear back from the steamship company, he had decided to pour his energy into his artistic work. His first move was to assemble a portfolio of his anatomical drawings and paintings—a “specimen” of his work, as he called it. As a student, he’d never had the time or inclination to promote himself as an artist for hire, or the financial need. Sure, occasional jobs had come to him through Gray and other faculty, but, simply happy to contribute, he had nearly always done the work for free. As of now, that policy would have to change.

  Carter, ever the anxious soul, had not made this decision lightly. For guidance, he’d turned to Prescott Hewett, one of a handful of father figures in his life. It seems that the question he brought to Dr. Hewett was not whether he could make money as an anatomical illustrator but whether he should.

  Propriety told him no. Wouldn’t he be “encroaching” on other artists’ territory? This concern stemmed from H. V. Carter’s upbringing, I believe. As the child of a working artist only now finding fame, he knew firsthand what a struggle it could be to make a name for yourself, to become established. He would not want to threaten another artist’s livelihood or, for that matter, to be viewed as a dilettante—a physician who simply dabbled.

  Dr. Hewett absolved Carter of these concerns, assuring him that drawing was in fact a “perfectly legitimate” enterprise. By all means, young man, use your talent! And like a racehorse on Derby Day, he was off and running.

  True, he did stumble right out of the gate—Carter’s first job prospect fell through, leaving him “disappointed and put out”—but he recovered quickly. The next day, in fact, less than two weeks after returning from Paris, he showed his portfolio to three separate doctors, all of whom promised him work.

  “Hence,” he writes with brio that night, “have regularly set up as a Medical Artist and have little doubt, D.V., (Deo volente, or, God willing) [that] in a little time might make it pay well.” Carter sounds full of confidence, as well he should be, and yet he cautions himself never to lose sight of his top priority: “The exercise of the profession is the chief end…of [my] medical education,” and “the artist’s position is but subsidiary.” He adds, “Pro tempore!” meaning “for the time being.”

  After four weeks back in town, he earned his first fee, £4.7s for several days’ drawing for a Dr. Heale, an encouraging amount. Heale offered additional work, as did Gray, but already Carter was growing restless. “[I] am constantly feeling want of fixed and full employment.” He was not willing, however, to take just any job.

  Twice, he is offered a full-time “assistancy” position, the kind of entry-level job most freshly minted doctors had to take, and he turns them down. One offer had actually been forwarded by his father from a medical practice in Scarborough, no doubt along with a fatherly nudge. “Hardly know how to treat offer,” he writes, showing a moment’s hesitation before again standing firm: “I am fit for a higher office.” Of course, I know that he knows that he still has a dream job in mind. Carter remains hopeful for a berth on a steamship.

  One day in early March, he stops by the London office of the General Screw Steamship Company. Though his name has apparently been “on the list” for an interview since the previous October, “appointments are slow,” he is told. But this does not sit well with an eager young man. After weeks of forced patience, Carter writes a letter to the company’s chief officer, asserting his earnest “desire to enter service.” He posts the letter on the nineteenth of March, the very same day, coincidentally, that an ad he had purchased appears in the distinguished medical journal The Lancet.

  Medical Artist.—A young gentleman,

  M.R.C.S., and acquainted with Pathology, the Microscope, &c., is desirous of assisting gentlemen engaged in scientific research by making Drawings. Specimens will be furnished on address to H.V.C., No. 85, Upper Ebury-street, Pimlico.

  This was his calling card, presented on the newsprint equivalent of a silver platter, to the entire medical community of London. He had fussed over each word, checked the proof for typos, and when the ad came out, pasted a neatly clipped copy into that day’s diary entry. For him, the nineteenth was a day to imagine, and savor, all the fantastic possibilities ahead—the flood of responses to his ad, the encouraging reply from the steamship company, the subsequent interview and job offer, his first journey out to India, and on and on. The future looked bright. With the turn of a page, however, come the gray clouds. The steamship company informs Carter that his “age and inexperience” make him an unsuitable candidate for a ship’s surgency. Adding to his disappointment, it soon becomes clear that The Lancet ad fails to generate any new work. But why? Was the advert too genteel?

  Carter doesn’t give up but rather changes focus. He now sets his sights squarely on a Studentship in Human and Comparative Anatomy offered by the Royal College of Surgeons. This was essentially a full-time internship of two years’ duration and was awarded every June to the winner of a highly competitive qualifying exam. This meant he had just over two months to prepare.

  Already licensed to practice surgery, he was not lacking in impressive academic honors and credentials. In fact, he had returned from Paris with six new “certificates” attesting to the specialized work he had done in hospitals there. And the studentship would not give him the kind of on-the-job experience the General Screw Company thought he was lacking. One could even argue that the position would be a step backward for him. Indeed, while casting this last line of thought, I believe I found the likeliest explanation. The previous June, just a few weeks after earning his M.R.C.S., Carter had come in second in the studentship exam—so close!—but second place got you nothing, not even a certificate. This time around, he would redeem himself and claim the crown.

  And June 14 was the day. “I was called in, as [the] successful candidate for [the] Studentship of Anatomy to [the] College!” he tells his diary, skipping his articles in his excitement.

  One of the very next to hear the news was Henry Gray, whom Carter visited at work. Not only pleased for his friend, Gray offered further encouragement, suggesting that he now go for the Royal College of Surgeons’ Triennial Prize. Gray himself had won this award four years earlier for his study of the nerves of the human eye. You’ll have access to the lab and the library, so why not do some independent research?

  “Might—shall see,” Carter notes, and his reluctance is understandable. This would be a major undertaking, requiring an effort comparable to a master’s-level dissertation, and he has already got a lot on his plate with the upcoming M.B. (bachelor of medicine) exam. (He must pass the M.B. before then working toward his final accreditation, the M.D.) Carter being Carter, I am sure he was just worrying about surviving his first day on the job, whereas Gray, also true to form, was thinking years ahead.

  They pick up the same conversation several days after Carter has begun the studentship, and this time, the subtext is much clearer. Perhaps Gray knows that the position won’t be as challenging as Carter might want and, knowing his friend as well as he does, believes he needs a fixed goal to work toward. Gray presents his concern in “a considerate and encouraging way,” but Carter is still in wait-and-see mode.

  Already, though, Gray seems to be right. Over the previous six days, Carter had done nothing beyond a little dissecting and had yet to even see Mr. Queckett, the professor he was meant to assist. One person he had not been able to avoid, however, was an insufferable chap named Sylvester, the first-place winner in last year’s exam. Now the senior student to Carter’s junior, Sylvester sounds like the anti-Gray. “Hasty and spiteful,” he had made nasty little digs at Carter, telling him, for instance, that the dissections he had done for the exam were inferior to another candidate’s.

  Making an uncomfortable situation worse, Carter is under the impression that Caesar Hawkins and the other higher-ups at St. George’s are upset with him for taking a studentship at what is essentially a
competing school. But this is sheer poppycock, as Lily might say, another instance of Carter’s letting a neurotic sense of propriety get the better of him. Henry Gray, to whom he turns for counsel, assures him likewise.

  Always there to buck him up, Gray is the ever-friendly port in a storm, whether said storm is imagined or not. He makes everything seem, well, not easy by any means, but within reach, so long as one works hard. To someone as impressionable as Carter, however, there is a clear distinction between an everyday role model and a paragon, a being kissed by destiny, and, as of July 25, 1853, Henry Gray appears to have crossed over. Of his friend, Carter writes that evening, “Gray got [the] Astley Cooper prize—beating good men.” He seems a bit incredulous, as if thinking, How does Gray do it? “Clever fellow,” he cannot help but marvel.

  Along with the £300 cash prize, Gray would be accorded an even greater reward. His treatise on the spleen had attracted the attention of a London publisher who would release it as a book the following year. In a small way, Carter shares in this victory because, of course, he had created the illustrations for the project.

  Unfortunately, he doesn’t hear the good news from Gray himself, for Gray has been “down in [the] country—[He] has been very ill.” Ill with what, and how serious the affliction, Carter does not say, but, as I’ve learned through St. George’s administrative records, Gray’s illness was serious enough that he requested a leave of absence from his curator duties. Further, he arranged to defer receipt of the Astley Cooper Prize until he had recuperated.

  Hardly two weeks pass before Carter loses another anchor in his life, his brother and roommate Joe, who suddenly falls ill and is bundled off to recuperate in Hull, with the boys’ aunt, uncle, and grandfather. “Somewhat alarmed—choleric symptoms,” he jots that night in his diary.