The Anatomist: A True Story of Gray's Anatomy

by Bill Hayes

  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: Say Grace Before Food.”

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

  Epilogue

  TWO YEARS PASSED BEFORE I RETURNED. I WAS NERVOUS BEFORE-HAND, nervous in a way that brought to mind the very first time I had made the trip. I could easily remember stepping off the elevator, rounding the corner, and heading down that dim, narrow hall, looking for room 1320. The hallway had seemed to get dimmer and narrower the farther I got, if only because there was a bottleneck of students at the door—pharmacy students—the half of the class who’d accepted Sexton’s invitation to visit the anatomy lab a day early. It wasn’t that the door was locked. The problem was, no one wanted to go first, the unspoken fear being that an initiation was about to begin. Inside that lab over the next ten weeks, you would be forced to confront your innermost anxieties about death and dying while taking apart a dead body—an emotional vivisection, of sorts. How would you handle it? I wasn’t sure how I’d do myself.

  I remembered hearing a young guy behind me ask another, “Have you ever seen a dead body?”

  “Um, yeah, but I’ve never touched one,” guy two answered, sounding none too thrilled at the prospect.

  Henry Gray and H. V. Carter would have gotten a kick out of that. As young men, those two certainly did not enter the Kinnerton Street lab expecting to learn life-changing lessons about mortality. They did not need them. Gray and Carter had each seen and touched plenty of dead bodies before they began dissecting them. And when they did dissect, many of the cadavers were likely close to their own ages. In the early nineteenth century, in England as in th
e United States, the life expectancy at birth for a male was half as long as today—just thirty-eight years. For a female, it was only two years longer.

  Not only did people die at a younger age a century and a half ago, but death was dealt with more openly and with a greater attention to ceremony. This was particularly so in Victorian England, where the queen herself, widowed at age forty-two, set the example for mourning. People generally did not die in hospitals or nursing homes at the time, but instead where they had lived their lives, in their own homes, with loved ones at their bedsides. I will never forget a line in H. V. Carter’s diary. After receiving news of his mother’s death, Carter asks himself, “What did I feel?

  “Regret, mainly,” he answers—regret that he hadn’t been there.

  THIS TIME, I had come to the anatomy lab by myself. There was no line of students waiting outside, and, in fact, the lab itself was almost empty when I arrived just before 8:00 A.M. The class I’d come to observe was called Epilogue. It was part of an intensive “refresher” course for second-year med students before they took their board exams. Frankly, I thought it might be refreshing for me, too, a chance to reconnect with some of my anatomy teachers and to get reinspired, a coda to my experiences at UCSF.

  Though the class was set in the lab, the students would not be doing any dissecting that day. Prosections would suffice. To make room for the whole class, the dissection tables had been pushed off to one end of the lab and all the cadavers lay on top. Piled two to three to a table, they appeared to be huddled together for warmth, waiting, quietly waiting. Waiting to be of use. Waiting, it seemed at that moment, for me.

  Remember how scary they’d seemed at first? I said to myself. The thought of what was inside those bags had been so much worse than the reality. I could still picture myself filing into the lab with the pharmacy students. No one spoke. It was as if there were forty pink elephants in the room—except that all forty were encased in bright white vinyl and bore the unmistakable profile of a human being: rounded skull, nose, mound at the stomach, jutting toes. I headed to the back counter, I recalled, and put down my things. As I eyed a body on a nearby table, I suddenly noticed its small feet poking out. I crept forward. Both feet were wrapped in gauze, which elicited in me feelings of sympathy and tenderness rather than fear or revulsion. Oh, it’s wounded, I thought instinctively, illogically. With a closer look, I saw patches of mottled, brownish flesh on the shins, which didn’t bother me at all. I unzipped the body bag all the way; I was ready to see more.

  Later that same day, I started a diary. I had not kept one in well over twenty years and, unlike the diaries of my youth, this was meant to be just-the-facts. I simply wanted to get details of dissections and snatches of dialogue down on paper each night while they were fresh in my mind—an aide-mémoire for the writing of this book. It was not long, though, before I began including personal reflections. On October 10, 2004, for instance, I confided to myself:

  I have to be honest. It’s not just the body I’m fascinated by but also death. The snuffed-out, no-second-chances finality of it. The randomness of it. The nearness of it.

  Death has always seemed near to me. Even as a little kid, dying didn’t seem eighty or a hundred years away—impossible to conceive. But instead, as if it could be close. Not that it would be, but could be.

  I still think about death all the time. I keep expecting it. Not my own, necessarily, but someone’s…. I can feel it getting nearer and nearer, now and then even brushing up against me. Lying awake in bed, sometimes I feel it pressing against my body.

  Two years later to the day, at eight in the morning on October 10, 2006, Steve died in bed beside me. Though he was extremely fit and in excellent health overall, apparently a freak episode of cardiac arrhythmia led to respiratory arrest and, ultimately, cardiac arrest. I woke to the terrible sound and sight of Steve struggling desperately to breathe. Even more terrifying was the complete silence that soon followed, his body motionless. I started CPR, paramedics came, and we got him to the ER, but they were never able to get a heartbeat. Steve was forty-three years old.

  WE HAD BEEN together for sixteen years. Steve was my partner not only in life but in writing, especially on this book—the Carter to my Gray, as I would affectionately say. (“No, make that the Gray to your Carter,” he would tease in return.) After his death, going back and completing the final draft of the book seemed daunting. I wasn’t sure if I could do it without him.

  Though Steve never set foot in the anatomy lab, I even sensed his absence at Epilogue that morning. He used to drop me off before every class and pick me up after every lab and listen to my daily debriefings on the ride home. After the Epilogue class, I would have told him how I’d seen Dana and Kim and Dhillon and Charlie; how Sexton had retired, Anne had been promoted, and Andy had taken a new job; how all the med students were unfamiliar to me (Meri and Kolja and the others I’d studied with were already in their third year); and how, just as in the past, I was repeatedly mistaken by the students for a TA. When I told them I was writing a book about Gray’s Anatomy, most students assumed I was talking about the TV show. “Yep, that’s right,” I’d say teasingly, “I’m telling the true story of Meredith Grey and Dr. McDreamy.”

  Finally, I would have told Steve that I’d been nervous to see the bodies, afraid that they might stir up upsetting memories of his death. By the way, I think that is one of the strangest things about losing a longtime partner: the very person you most want to talk to about your loss is the person who is gone. Well, it doesn’t always stop me; sometimes I talk to Steve anyway.

  “Honey-pie, you would’ve been proud of me,” I told him as I drove myself home from UCSF. “Before class got started, I just took a deep breath and marched over to one of the tables and unzipped a body bag.” The cadaver looked like a cadaver, I told him, and nothing at all like you. I laughed aloud, unsure how that had come out. “Well, you know what I mean,” I said, and I was sure he did.

  “It was like when I brought your ashes home,” I continued. “To me, it was so clear that it wasn’t you in that nice cedar box; it was just…your remains.” He had long since left his body, I believed. I had seen it happen with my own eyes—life leaving him with his last breath.

  You are dust, and to dust you shall return.

  Officially, Steve was declared dead at the hospital. Declared dead—what a strange phrase. That makes it sound like an announcement was made over a loudspeaker. In fact, it was more like an unspoken exchange between the attending physician and myself. He left his position at the head of the gurney and approached me at the other end, where I was cradling Steve’s feet. The doctor’s pained expression told me everything I needed to know. I nodded, and practically in a whisper, he gave directions to his team. The medic, by now drenched in sweat, stopped CPR. A nurse shut off the respirator. And with that, everyone in the room quietly filed out and left me alone with Steve. Less than an hour after I’d awakened, I found myself performing a last rite, sacred in its intimacy: shutting Steve’s eyes entirely closed with my fingers. I removed his rings, put them on, and said what he had not been able to say to me: Goodbye.

  Nothing I’d learned in anatomy class prepared me for that moment. Nothing. Even being able to understand precisely what had happened to Steve anatomically and physiologically—I was easily able to read and interpret his autopsy report, for example—did not make it any easier to bear or grasp the fact that he was so suddenly gone. Which I see now as the painful final lesson of my education in anatomy. True, in a literal sense, I had never been nearer to death than in the lab itself. Over the course of a year, the result of a journey that began with Henry Gray and H. V. Carter and their book, I touched and felt and dissected dead bodies with my own hands and was constantly surrounded by dozens of them, to the point that I became inured to the sight. I gained a keen understanding of the fabric of the body—the raw, organic nature of flesh and bone and blood. But you don’t learn about death from dead bodies. Just as you learn about the body
by dissecting one, you learn about death by experiencing a death, by losing someone you love.

  Conversely, what you learn about in Gross Anatomy is life, human life, clichéd as that may sound. In one of the last dissections I performed, I remember, I anatomized the knee, shoulder, and elbow joints, in effect dissecting the mechanics of human movement. And what is life—or, a defining sign of life—but movement? Whether the blinking of an eye or the wiggling of fingers or, with arms and legs pumping and lungs heaving, the running toward something in a great burst of speed—toward a goal, toward a finish line, flat out to the very end.

  THE END.

  Appendix

  HENRY GRAY

  1827–61

  Gray’s final resting place is London’s High-gate Cemetery, where he shares the same grave as his mother, Ann, who died five years after him. Gray’s Anatomy, now in its thirty-ninth edition in England and thirty-seventh in the United States, has never gone out of print and has sold an estimated five million copies to date. The year 2008 marks the 150th anniversary of Gray’s Anatomy.

  HENRY BARLOW CARTER

  1803–68

  The patriarch of the Carter family, artist Henry Barlow Carter, died of bronchitis on October 4, 1868, at age sixty-five. As described in his obituary, Henry Sr. sounds very much like his eldest son: “There was a natural reserve about him that rather prevented an extensive friendship, but those admitted into that circle were often charmed with the geniality of his spirit and the originality of his ideas.”

  JOSEPH NEWINGTON CARTER

  1835–71

  In 1859, H.V.’s free-spirited younger brother began teaching art and, along with sister Lily, converted to Christianity. “She and Joe walk as fellow Christians,” a happy H.V. wrote at the time. In May 1871, Joe, a working artist, married longtime love Elisabeth Smith Newham, who was widowed three months later. Joe died of double pneumonia at their Scarborough home on August 16, 1871.