The Anatomist: A True Story of Gray's Anatomy (7 page)

So extreme is his self-criticism—and so contrary to the record of his achievements—I actually wonder if Carter had a kind of personality dysmorphic disorder. His diary is the mirror he looks into at the end of each day, and all of his accomplishments appear distorted. However, in his writing, I also hear the voice of a young man who is trying to push himself, to prove himself, to break the mold. A young man who is determined not to be like his father.

Henry Barlow Carter does not make many appearances in his son’s diary, but when he does, he leaves an unforgettable impression. One need turn back only a few pages to find a choice example. It is a month earlier, May 24, 1850, and Carter has just learned that his father is going to be “in town” the next day. But the visit gets off to a rocky start. Rather than contacting his son directly with the details of the two-week visit, Mr. Carter instead notifies Dr. Sawyer. “Don’t see why Father not write to me,” H.V. complains on the eve of Henry Carter Sr.’s arrival.

Carter had lived in London for two and a half years by this point, and although he did not consider himself as worldly as other Londoners, he had matured considerably. Just working at St. George’s, its wards crowded with the sick and dying, had been a crash course in growing up. Nevertheless, his father still treats him as if he had never left Scarborough. On their third evening together, for instance, he sits his son down and gives him a “lesson and hints” in art, just as he had throughout H.V.’s childhood. I am sure Mr. Carter felt this was a fine way to spend the time. If his son did not, though, I can’t blame him. After all, he no longer considered himself a “student” of drawing; Dr. Hewett and others at St. George’s certainly did not think so. Further, he was working in a completely different style from his father.

Even from a vantage point of a century and a half, it is easy to see that the two Carters are headed for a blowout. Two days later comes the damage report: “Have acted foolishly, hastily and improperly…. Father much put out. Say hard things.” Next comes the silent treatment: Henry Sr. tells Henry Jr. that he does not wish to see him for a few days. By the end of the week, they have made peace, attending church together, but soon thereafter hackles are raised anew. “He, irritable and annoying,” Carter scribbles on the night of Wednesday, June 5. “Self, irritated and hasty.”

If Henry Barlow Carter had kept a diary, I would bet his entry of the same night would have read something like, “He, sullen and ungrateful. Self, short-tempered and harsh.” These two were following a script that’s been played out since the dawn of civilization: teenager wants to be seen as an adult; parent thinks teenager has a long way to go. In a bittersweet final scene, our two protagonists meet the night before the father leaves London, and they reach an accord. With that, “Bade good bye,” the son writes in his diary.

Whether Carter’s father said all the right things or all the wrong things that last night, one thing is certain: the effect on H.V. was galvanizing. Soon after his father’s departure, he added a new “must” to his running list: “Must depend on self.” Within a forty-eight-hour period, he formed the collaboration with Henry Gray and made two telling moves: He designed an elaborate box to hold his art supplies and ordered “calling cards” for himself. “HENRY VANDYKE CARTER, SAINT GEORGE’S HOSPITAL,” they read. With every letter he paid to have printed, it’s as though he were underscoring his new identity:
I Am
My
Own
Man
.

No doubt about it, Henry Gray, whom Carter always characterizes in glowing terms—“capital worker,” “nice fellow,” an “example of industry and perseverance!”—is the kind of person he aspired to be. Yet it is also clear that Carter was following his own distinct path. For instance, he was studying for an apothecary license, a credential Gray never pursued. To modern ears,
apothecary
sounds like a quaint synonym for
pharmacist
or
pharmacy,
it being one of those odd nouns that applies equally to both a person and a place. And, in fact, in England and in much of Europe from the early to the late Middle Ages, an apothecary was exactly that: a druggist who sold drugs in a retail shop, an apothecary. By the time Carter was in medical school, however, this definition was already antiquated. Being an apothecary was actually more like being a modern-day general practitioner, a doctor with a broad knowledge of diagnosing and treating diseases. Whereas Henry Gray was well on his way toward a career in clinical surgery and research, H. V. Carter ultimately hoped to be a country doctor.

By the summer of 1850, Carter had successfully completed two years of medical school. While he had excelled at anatomy, chemistry, and botany, winning top class prizes in all three subjects, one of his prouder achievements had occurred with far less fanfare: “Made
coup d’essaie
at bleeding,” he noted on April 9, meaning he had made his first attempt—or, stab—at bloodletting a patient. As he went on to detail, he had divided the procedure into two “operations”: cutting into the skin to expose a vein, then slicing it open. “Not a favorable subject,” he added, suggesting that the patient was none too thrilled with being Carter’s guinea pig. Other days found Carter practicing other necessary skills: “Pulled out tooth of soldier. Tugged at another.” Over the next few years, he would have to master minor surgeries such as these, a routine part of an apothecary’s practice, and he would need to earn a degree in surgery. Finally, in order to obtain an apothecary license, Carter would have to complete a five-year apprenticeship. He was now more than halfway there.

John Sawyer, the doctor to whom he was “indentured,” was a surgeon and an apothecary and something of a holdover from earlier times. Along with his medical practice, he ran an apothecary—excuse me, a
dispensary,
as retail drugstores were now called. While a patient would typically get a written prescription from his apothecary and take it elsewhere to be filled, Dr. Sawyer still offered the traditional one-stop shopping. If you happened to step into his shop at 101 Park Street, you might have found his apothecary apprentice behind the counter. H. V. Carter occasionally filled in as the dispensary’s
dispenser,
the person who counted pills and filled prescriptions for laudanum and tincture of belladonna and black draught and so on. Not that he liked it. “Am determined to have as little as possible to do with shop and prescriptions,” he once wrote, “which [I] consider as altogether foreign to duty and [a] source of much annoyance.” There was, however, one order he always filled without complaint: his mother’s.

An apothecary in an apothecary, c. mid-nineteenth century

Eliza Carter is a mysterious figure in her son’s diary. She never comes in person to the dispensary and, in fact, has never even visited H.V. in London. She is apparently too ill to leave Scarborough, though what’s wrong with her and what drug she needs are not yet spelled out. She exists on the page only as
M.
“More pills for M.,” Carter might jot, meaning he had received a letter from her with a request for medication. In response, he does something that is almost impossible for me to imagine a pharmacy student today doing: he makes the pills himself.

How? He doesn’t say. But then, for good or bad, a diarist is beholden only to his own inner narrative. He does not need to explain such things to himself.

Thankfully, the details of nineteenth-century pharmacology are well documented. Pills began as a paste. The dutiful son would have carefully measured his medicinal ingredients, ground them with mortar and pestle to a fine powder, and added a liquid binding agent. Then he would mix. The importance of thorough mixing could not be overstated because each small pill had to have the same potency when the process was completed. Next came the “pill machine,” a simple, hinged apparatus that operated like a waffle iron, albeit without the waffle pattern or the heat. The machine pressed and molded the paste into neat rows of pencil-thin pipes. Finally, perhaps after some hardening had occurred, Carter would use a separate instrument to cut the pipes into their proper lengths, thus creating identical-sized pills. These had to dry before he could package them.

To think about each step Carter took is to be reminded that
Rx,
the symbol for prescription, is a Latin abbreviation for
recipe,
a word that, to me, always conjures up home-cooked meals and a mother’s love. There is something so poignant about the role reversal at play here, the child being a provider of sorts. No doubt, it gave the young Carter great pride to help his mother, even though he was far from home. Whenever he mentions the pill making, he comes across as efficient and capable—professional. Even so, the intensely personal nature of the task could not have been far from his mind. After all, these were pills destined for his mother’s body, and I get the sense that she needed them urgently. Carter moves as quickly as the process allows but, as indicated in his diary, always takes the time to write a letter to his mother to accompany them. The following morning, without fail, the package is on its way to Scarborough.

ONE CANNOT PICTURE
the path of a pill through the body without studying the mouth and throat. Which means seeing the cadaver’s face, something we had managed to avoid until now. Though I’m not looking forward to this unveiling, I am curious, frankly. Over the past eight weeks, I have constructed a mental image of this frail tiny old woman. I am sure Massoud, Laura, and the others have done the same. Unlike other groups in our lab, though, we have never named our cadaver; that seemed inappropriate somehow. Perhaps my lab partners thought as I did: How can you name someone without looking into their eyes? How can you ever thank them?

Massoud lifts the cheesecloth veil, folds it back over her hair, and takes a step back. Before us is not a face like any we could have imagined. Instead, we are looking at what an anatomist would call the underlying anatomical structure of the anterior aspect of the head. Translation: a face without the skin. Like all of the cadavers in the room, our body had been partially dissected in another class, but none of us had anticipated the extent of that work. The eyes are closed and intact, as are the lips, but the fat that typically pillows in the cheeks has all been cleaned away. What remains is a mask of musculature, forehead to chin, ear to ear. Running over this is a latticework of blood vessels (empty of blood), facial nerves, and lymph ducts, all in faded shades of white. The dissection is flawless, worthy of a fine-ink drawing by H. V. Carter, and, as Gergen is quick to point out, way too good to have been done by a first-year pharmacy student. Our job for the first hour of lab—identifying specific parts of the face, such as the nerves behind a blink and the muscles that make a yawn possible—has been made textbook-easy.

In front of each ear we find a body part that almost begs a description in the form of a riddle: what lies unseen just under the skin of the face and produces a clear, tasteless, odorless fluid? If you answered, salivary gland, you are half right, but if you said, parotid gland, you’re dead-on. The parotid, the largest of the three pairs of salivary glands, is surprisingly huge. I lift my fingers to my face just to confirm that I have a pair, and feel a distinct padding over the back curve of my lower jaw. I had always mistaken this for facial fat when, in fact, these are saliva factories. They provide our natural mouthwash, make it possible to lick our lips, and play a major role in the ability to taste. At the same time, they can be defeated by a saltine and, when their function is inhibited by certain medications, can cause dry or “cotton mouth.”

To locate the next several items on our lab list, we have to turn to Dana, who arrives at our table with a very large sealed Tupperware container and the sound of sloshing. She first warns us that what lies within may be upsetting to see. Even so, I am nowhere near prepared for what follows. Setting the lid to the side, Dana reaches down with gloved hands and lifts out what I can only describe as a horror: a severed head, split clean down the middle. A human profile from the inside out. I can see between her carefully placed fingers that the face, male, is intact.

“
This
is a hemihead,” Dana says, as if making a formal introduction. “Sometimes it is called a sagittal section or a median section…”

The visual drowns out her words.

Clear embalming fluid flows down the exposed lobes of the brain, through the nasal labyrinth, down the throat, and over the edge where the neck ends. Dana waits for the last drops to drip off and sets the head face-side-down onto a towel draped against our cadaver’s lower legs.

Amy and Gergen physically turn away from the scene, and I think,
Well, that’s a mistake; they’re gonna have to turn around eventually.
And eventually, they do, but Laura is the first to press in. In my need to focus on something—anything—I land on the brain, with its familiar whorls of gray matter.

“Can anyone identify the root of the tongue?” Dana asks from the distance.

I move down to the mouth area and see what looks like a gargantuan mushroom rooted in the lower jaw. Laura uses a metal probe to point at the base of this mass, and Dana nods.