The Anatomist: A True Story of Gray's Anatomy (2 page)

At the time of his death, Gray reportedly had completed a substantial portion of a major new book, though this unfinished manuscript has never turned up. Even the original manuscript and drawings for
Gray’s Anatomy
have disappeared (most likely, I learned, they had gone up in flames when a fire decimated the British publisher’s archives the year Gray died). I probably would have left it at that—my curiosity about Henry Gray more than satisfied, my dream of contributing to medical history properly deferred—had I not come across one last thing: a photograph included in the one hundredth–anniversary edition of his
Anatomy.

Taken fifteen months before his death, the photo shows Gray and two dozen young men grouped in what looks like a large art studio, with a high vaulted ceiling and drawings pinned to the walls. Sunlight pours down through the banks of skylights. Some standing, some seated, many of the young men have on long white smocks over their suits and ties—one even sports a beret—yet they wear uniformly solemn expressions, as if bearers of grim diagnoses. None is more serious, though, than Henry Gray. He is seated on a stool in the foreground, next to one of several low tables. A diminutive man with dark, deep-set eyes and thick, wavy hair, he looks like a pint-sized Heathcliff. Brooding and intense, he stares at the camera, waiting the long seconds for the shutter to close. This is, of course, a class photo, and no one holds the pose better than the cadaver lying just to Henry Gray’s right. Poking out from under a covering, its pale, narrow feet protrude over the table’s edge.

I could not get this picture out of my head: the spacious chamber bathed in daylight; the dead body on the table, its upper half sliced off by the picture’s edge; and, most of all, the anatomist himself. Something about the look on Gray’s face seized my imagination in a way that I can only compare—odd as this may sound—to love at first sight: an overpowering desire to get to know this man as thoroughly as possible. My course of action then seemed perfectly clear: I would come to know Henry Gray by coming to know human anatomy.

Henry Gray and his anatomy students, St. George’s Hospital, 1860
P
HOTOGRAPH BY
J
OSEPH
L
ANGHORN

PART ONE
THE STUDENT

Self-knowledge can, and ought, to apply not only to the soul, but also to the body;
the man without insight into the fabric of his body has no knowledge of himself.

—J
OHN
M
OIR,
student of anatomy, notes from opening lecture,
Anatomical Education in a Scottish University,
1620

One

O
N THE FIRST DAY OF CLASS, I AM MISTAKEN FOR A TEACHING
assistant six times, which, on the one hand, simply tells me I’m old—a good twenty years older than the average student—but, on the other hand, seems to imply that I look as if I belong. Choosing the glass half full, I smile through each mistaken identity.

The class size is 120 (150 if you count the cadavers). We had been warned that some students are overwhelmed by the first sight of the dead bodies. And sure enough, some students clearly are. But I am more freaked out by the woman in the gas mask.
What does she know that the rest of us don’t?

“Class? Hello?” comes a disembodied voice, tinnily amplified. This is Sexton Sutherland, one of the three professors, although I cannot see him for the crowd. “Before we get started, some housekeeping rules…”

The first thing he mentions is the color-coded wastebaskets: red is for tissue (the human type) and white is for regular garbage, and, please, please don’t mix them up. Likewise with the sinks: use only the stainless steel for this and the porcelain for that, though I cannot catch the specifics for all the rustling. The mention of first-aid protocol finally brings the room to complete silence. And when Dr. Sutherland directs everyone’s attention to the emergency biohazard showers in each corner of the lab, I find a sea of eyes sweeping over me, as I happen to be standing right next to one of them.
Towel, anyone?

“Finally, just some basic etiquette for the weeks to come: No eating your lunch in here.” This elicits a collective
ewwwww.
“No music. Please don’t take any pictures. And try to keep your voices down. Laughter’s okay,” Dr. Sutherland adds. “We love laughter in the lab—it’s a great way to release emotions. But not at the expense of the wonderful people who’ve donated their bodies to our program.” He lets that sink in for a moment. “Okay, let’s get going.”

A class orientation had been held the day before in a lecture hall downstairs. Afterward, we were invited to check out the lab and, as Dr. Sutherland had said in a masterful sweep of understatement, “to get comfortable with ‘the surroundings,’” by which he meant the reclining dead. About half the class had made the trip up to the thirteenth floor, myself included. I was anxious to put glimpsing the cadavers for the first time behind me. And I am glad I did.

If that was the orientation, however, this is more like disorientation. I am not sure what to do or where to go exactly, so I grab the crisp new scrubs from my gym bag, pull them over my head, and join the large group being led by Dana Rohde, interim director of the anatomy course for the University of California–San Francisco School of Pharmacy, whom I had met earlier. Using one cadaver as a demo model, she gives a brief overview of the afternoon’s assignment; pauses to explain how to put a fresh blade onto a scalpel; does a quick scan to see that we are all wearing the mandatory rubber gloves; and adds finally, “I’ll be back to see how you’re doing in half an hour.” Dr. Rohde then stands there for a moment, wearing the look of a swimming instructor who finds her class still standing on the deck of the pool:
Why aren’t you wet yet?

Six of us arrange ourselves around cadaver number 4, but rather than looking at the naked female body lying before us, we all stare at one another.

“I haven’t dissected anything since high school biology,” one of the three women admits, breaking the ice. “And that was a frog.”

This seems like the right moment to make an admission of my own: “I should tell you, I am not a student here. Dr. Rohde gave me permission to come to your lectures and labs. I’m just going to be an observer.”

All but one of them look as though they would pay to change places with me. Gergen, the exception, a tall, husky, hairy guy who says he has never dissected anything in his life, cheerfully volunteers to begin the dissection. Now, technically, it will be Gergen’s first cut, but not this body’s. Like all the cadavers used in this ten-week class in gross anatomy, it was worked on during a previous course. Instead of fresh bodies like those routinely autopsied on
CSI
—blue-lipped and gray but still lifelike—these are closer to something from a Discovery Channel special. The cadavers are shrunken like unwrapped Egyptian mummies. The skin, where still intact, is tan and leathery, and the exposed inner flesh is as dark and dried as beef jerky. The heads, hands, and feet are wrapped in strips of gauze, which gives the impression that they had been badly burned. As Dr. Sutherland explained during the orientation, the gauze serves two functions: it helps preserve the delicate parts for a longer period, and it also protects us, in a sense.

“It’s usually most
impactful
to see the hands or the face,” he had said, treading carefully with his words, “because that’s really what represents a person’s identity.” When dissecting other parts, one quickly learns to dissociate, but this is much harder when you see the eyes or the mouth. Emotions can come up unexpectedly, he then added. “Sometimes, you’ll be dissecting away—maybe you’re halfway through the course—and then you’ll remove a piece of gauze and there’s a tattoo and you just stop cold. Or maybe you see nail polish.” Any individualizing mark is a stark reminder that this is not just a body but
some
body. As Dr. Sutherland had explained, this is one reason why the first dissection is in a relatively neutral location, the thorax, otherwise known as the chest.

Though I am the sole spectator here today, I take comfort in knowing I am well represented in history. Human dissection has been a riveting spectacle for centuries, and the curious, whether by invitation or paid ticket, have long pressed into crowded rooms, craning necks and breathing through perfumed handkerchiefs, to witness that first ghastly slice, then the next, and the next. In Europe, the need to create a space conducive to teaching, learning, and observing resulted in the Western world’s first “anatomical theater,” built in Italy in 1594 at the University of Padua. A steeply raked amphitheater that accommodated three hundred, it became the model for other facilities that sprang up at competing schools, including the College of Physicians in London. Always at the center was the dissecting table, with the first circle of spectators barely a blood spurt removed. At UCSF, I and my fellow novice anatomists stand not in a theater but in a no-frills lab. In order to get the best view of what is being dissected at our table, I have to perch on the rungs of a metal stool.

Theater of Anatomy, London, 1815

Our cadaver, who in life probably stood no more than five foot two, does not bear the classic “Y” incision of an autopsy (shoulders to sternum, then straight down the abdomen to the pubis). Instead, a kind of double doorway was incised in her chest: the skin cut across the collarbones as well as beneath the ribs—roughly marking the top and bottom of the thorax—and then sliced down the middle. Before making a new incision, we need to “unpack” the previous work. As Laura reads instructions from the lab guide, Gergen folds back the two large panels of skin, then grasps the edges of the underlying breastplate, a solid shield of ribs and muscles that had been precut with a surgical saw. Gergen lifts, and a fresh wave of fumes escapes from the cadaver, making all of us flinch.

Peering down, I can see why the thorax was once known as the “pantry” of the body. It is a deep, squarish cavity packed full of various objects, one of which Gergen must now remove: a lung. He slips his left hand into the cavity and feels for “the root of the lung,” a short, fat tube that is not at the bottom of the lung, as one might imagine a root should be, but toward the top, connecting it to the windpipe. “Now what?” Gergen asks.

Laura, who is as small and slim as Gergen is large, scrambles to find the next instruction. “Let’s see here—‘Cut through the root of the lung superiorly and continue inferiorly through the pulmonary ligament.’”

“Translation?”

“Top to bottom—slice it off—I think.”

Although Gergen does the actual cutting, the rest of us, in spirit at least, help him hold the scalpel steady: Laura, Amy, Miriam, and Massoud are the fingers folded in around him, and I, opposite them, am the thumb. Gergen then steps back, indicating to Laura that she may do the honors. Biting her lower lip, she reaches into the thoracic cavity and, after a little tugging, frees the right lung. The size of a wadded-up T-shirt, it looks like a wet mound of gray taffeta. All six of us wear identical triumphant smiles, as if we have delivered a baby.

But it turns out our baby is ugly. Dr. Rohde returns and points out that the cut was “too lateral,” which means the bronchus (an offshoot of the windpipe) is not clearly exposed. But she immediately tries to reassure us. “The only way you learn is by doing it, by making mistakes. Anyway, there are a lot of bodies here to look at, and, luckily, you’re not being graded on your surgical skills.”

Before moving on to the next table, Dana instructs us on the next task: resection of a half-foot-long section of the phrenic nerve, a narrow fiber running through the thorax, a portion of which is visible now that the right lung is out of the way. Explaining the nerve’s primary function in the living, she breaks it down in simple terms: “If it’s damaged, you can’t breathe.” Likewise, if you sever your spinal cord
above
the level of the phrenic, she adds, you lose all use of this nerve. “That’s what happened to the actor Christopher Reeve, which is why he had to spend the rest of his life on a ventilator.”

At this moment, everyone at our table is having the same illogical reaction: terror that we might render our dead body a quadriplegic. It is halfway through our first three-hour lab, and none of us feels any detachment whatsoever.

Massoud, taking over from Gergen, does not wear the expression of a lucky man, and yet the opportunity before him—to dissect and, yes, even make mistakes—truly is a privilege. To put this into perspective, Hippocrates, the “Father of Medicine,” for instance, never dissected a human body because the practice was forbidden in ancient Greek society. Aristotle, too, never broke this taboo, and, jumping ahead to the second century
A.D.,
neither did the revered Greek physician Galen. Galen, whose writings remained medical gospel for fourteen hundred years after his death, had gained his knowledge of anatomy from dissecting pigs and cats. Brilliant but mistaken, he believed that animal and human anatomy were often interchangeable. And like a dropped figure in a checkbook registry, this error only compounded with time.

Human dissection continued to be forbidden in virtually every society on through the Middle Ages. Not that it was not done, I’d wager—the dead body of a stranger surely must have proved too tempting for some unscrupulous practitioners—but how would you share your findings without implicating yourself? In parts of Europe, even dissection of animals eventually fell into disrepute because of its association with sorcery. In the year 1240, however, a radical change in policy took effect. Frederick II, emperor of the Holy Roman Empire, decreed that, for the sake of public health and the training of better doctors, at least one human body would be dissected in his kingdom every five years. For this bold move, Frederick II is credited with single-handedly pulling the field of anatomy out of the dark ages.

By the beginning of the fourteenth century, human dissections were conducted as often as once a year at the top European universities. The corpses used, male and female alike, were almost always those of executed criminals. The leading anatomist of the time, Mondino dei Liucci (c. 1270—c. 1326), a professor at the University of Bologna, became the Henry Gray of the late Middle Ages. His dissection manual,
Anathomia,
completed in 1316, was used in nearly all medical schools throughout Europe for the following two hundred years. After the invention of printing, Mondino’s
Anathomia
went through thirty-nine editions, a number that the British version of
Gray’s Anatomy
has only just matched.

Mondino earned a place in medical history by performing the first “properly recorded” dissection of a human corpse, but he is also remembered for sparking a revolution in the teaching of anatomy. Mondino systematized the process of dissection, providing a step-by-step method for exploring the human body. Following his lead, later pioneers would eventually overturn many of the fallacies of Galenism. In a sense, Mondino provided the map, allowing his successors to uncover a string of treasures.

In the Mondino method, a human dissection followed a strict schedule dictated by a grim fact: the process was a race against putrefaction. In an age when cadavers were not embalmed, only the cold could slow decomposition, but only somewhat, so the procedure would be carried out during the coldest time of the year and at a rapid clip, over four successive days. Rather than beginning with the outer chest and progressively moving deeper into the body, as one would today, Mondino always dissected from the inside out, starting with the intestines, since they rotted quickly and smelled worst first. Seated above the cadaver on a pulpit, he would recite from his text while the actual cutting was done by a trained assistant. The students never dissected. A second assistant, called a demonstrator, would hold aloft or point out the body parts described. Incidentally, Henry Gray was a member of a similar three-person team at St. George’s and over his tenure filled each of these roles.