The Anatomist: A True Story of Gray's Anatomy (8 page)

A tongue in profile does not remotely resemble the one you see in your bathroom mirror; it is far thicker and longer than you would ever expect. Beyond the pebbly portion at the back of the mouth, there is a full third you never see, which curves down into the pharynx, the top of the throat. The tongue is composed of hundreds of taste buds and eight different muscles and is animated by a major cranial nerve. Best known as the organ of taste, the tongue is also a natural contortionist, able to roll and fold, in many cases, and to wag and probe, making it ideally suited for its supporting roles in chewing, mouth cleaning, speaking, and swallowing.

The act of swallowing had taken up a good deal of Dana’s earlier classroom lecture. Sitting in the lecture hall, I had tried to record every detail as she spoke, but this was like trying to notate the choreography of a dance while watching it for the first time. I finally set my pen down and tried a new tack, swallowing while I listened and listening while I swallowed, trying to feel each step Dana described. Still, I could not quite visualize a gulp from start to finish.

But with the hemihead to illustrate, I can now see how the various parts all come into play, how, in order to swallow something—say, a pill—the tip of your tongue first presses up against the roof of your mouth, nudging the pill backward. Next, the back of the tongue rises up to force the pill to the back of the mouth. This automatically stimulates nerves that send your soft palate (the fleshy parts at the back roof of the mouth) upward, sealing off the nasal passageway. Now the pill and the water you are swallowing it with won’t shoot out your nose. But in order for it to go down your throat, a number of complicated maneuvers still have to occur. As the hemihead shows, the pharynx is a common pathway for both air and food, but the epiglottis, just below the far curve of the tongue, closes off the opening into the windpipe so the pill does not head to the lungs. At virtually the same time, the voice box moves up and the muscles of the pharynx contract, pushing the pill past the epiglottis and—
gulp
—into the esophagus, the muscular tube feeding into the stomach.

By the time the imaginary pill drops into my hypothetical abdomen, a very real but unexpected transformation has taken place: the hemihead has lost much of its gruesomeness—so much so that, when Dana proposes, “Okay, now let’s talk about the gag reflex,” I think it a fine idea. Which is not to say I suddenly find it pleasant to look at. But, by comparison with our adventures in the abdominal cavity, the hemihead is neat and clean, practically free of fat, and looks carefully packaged. Each part has its own tidy little chamber. It is hard to imagine how a headache could ever fit in there.

After Dana leaves to work with another group, we make our way through all twenty-eight items on the lab list, from the sphenoid sinus (the deepest part of the nasal cavity) to the dangling uvula to the vocal cords. Before going home for the day, though, we have one last bit of business: returning the hemihead to its container. I offer to take care of this while Massoud and the others agree to clean the instruments and rewrap the cadaver.

I gently lift the specimen with both hands. It is heavy, which surprises me. A typical human head weighs about twelve pounds; this feels closer to a twenty-pound dumbbell. To protect the hemihead for storage, I need to bundle it in gauze, but first I turn it just enough so that I can look at the face. A pale bushy eyebrow perches above the closed eye. The nose must have been impressive in its entirety.
This was someone,
I think, caught in an upswell of awe,
a thinking, dreaming person.
Judging by his wrinkled skin, I would guess he was around eighty at the time of his death. Who knows if he lived a good life or not? Maybe he had been a criminal, maybe a doctor. Maybe a criminal doctor. I would never know, and, in truth, that was neither here nor there. What mattered was that he had donated his body so that others could learn.

I make quick work of the gauze, then carefully lower the head into its bath of embalming fluid. The lid makes a
thoomp
sound as I press it closed.

Five

B
ETWEEN THE BOTH OF THEM, THE TWO HENRYS WON JUST
about every academic honor offered at St. George’s during their years in medical school. For the year 1850, for instance, Carter received the annual Botany Prize—meaning he was his class’s top-ranked student in the subject—as well as smaller prizes in three other subjects, including, no surprise, anatomy. The awards were distributed during the opening ceremony for the school’s winter session.

In Carter’s diary entry for that October day, he sounds less than thrilled about having had to attend the “affair.” This was his third year in a row as a prizewinner, plus, even though classes had not yet begun, he was already deeply immersed in work. He had just started a new collaboration with Gray, an investigation into the development of chicken embryos, which involved much cracking of eggs, and he was also busy with his own studies. In fact, attending the ceremony meant setting aside a fascinating dissection at Kinnerton Street, changing into dressier clothes, and trudging over to St. George’s. Nevertheless, Carter reports being quite impressed with the closing speech given by Benjamin Brodie, who presided over the event. The revered doctor “excited ambition and,” Carter adds cryptically, “gave warnings.”

Curious about what Brodie might have said that so roused the nineteen-year-old, I make another visit to the Special Collections Room at UCSF. The library houses a first edition of
The Works of Sir Benjamin Collins Brodie,
a rare three-volume set from 1865, and I am hoping it will contain some mention of Brodie’s long-ago speech.

I arrive to find that Ms. Wheat has already retrieved the books I’d requested and placed them, along with a clean pair of white gloves, on the broad reading table. As on past visits, I have the room to myself. I am prepared to spend hours searching through the thick volumes, all eighteen hundred pages, but no sooner have I taken the first from the stack and turned to the table of contents that I find exactly what I am looking for, even listed so that I cannot possibly miss it: “Address on Delivering the Prizes to Pupils of St. George’s Hospital.”

“
Wow,
” I exclaim in my loudest quiet voice. Ms. Wheat, tapping at her computer, shoots a smile in my direction.

Turning to page 532 almost makes me a believer in psychometry, the ability to pick up impressions from an object simply by touching it. I begin reading Brodie’s speech and can picture the whole scene: the crowded auditorium, the stage where Carter and his fellow prizewinners are seated, and Dr. Brodie at the podium, with his Ich-abod Crane face and wavy mane of gray hair. He addresses the student body collectively. “First, let me impress on your minds that the next few years are the most important and critical period of your lives. You are now to lay the foundation of that knowledge on which your future character—nay, your very subsistence—is to depend.

Let these years be wasted, and you will never be able to redeem the loss. Ceaseless but unavailing regrets will haunt you during the remainder of your days—”

Yeesh.
There are those “warnings” Carter mentioned.

Sir Benjamin Collins Brodie

Soon, though, Dr. Brodie’s tone softens. “I leave it to your respective teachers to tell you what lectures to attend, what time to devote to the dissecting-room and hospital,” and so forth. But he had one sage thought to add: Get in Sir Benjamin Collins Brodie the habit of taking clear, careful notes of all lectures and cases. “The notes thus taken should [then] be transcribed in the evening, and preserved for future use. You will find them the best things to refer to—as far as they go, much better than books—in after life,” by which he means life after graduation. So important does he consider the practice, Dr. Brodie tells the audience, he awards his own yearly prize to the St. George’s student with the “best series of clinical notes.”

Judging simply on penmanship, Carter would never have stood a chance of winning this particular honor, in my opinion. Still, I find the idea of a Note-Taking Prize enormously appealing. Were UCSF to resurrect it, I have no doubt the winner would be Ming, a pharmacy student I’ve gotten to know over the past couple of months. Her notes make mine look feeble, although, granted, our styles differ greatly. During the minilectures in lab, I simply jot words and phrases onto a small pad that fits into my scrubs shirt pocket while Ming records sentence after sentence on sheets of graph paper in tiny, perfect print. She uses a four-color Bic pen, the kind I have not seen since junior high—red ink for notes on blood vessels, black for nerves, green for muscles, blue for organs—clicking from one to another with barely a glance up.

It was over the topic of note taking, in fact, that Ming and I bonded during one of the first labs. I happened to be standing next to her and saw her in action.

“Those notes are beautiful,” I said in all sincerity in a pause between her clicks.

“Oh, these are just rough,” she replied, and not out of false modesty. Ming planned to rewrite them once she got home, combining her lecture and lab notes and supplementing them with snippets from the textbook. She would then transfer those to a three-ring binder, color-coded by course subject. Now that’s my kind of obsessiveness.

From this meeting on, I would regularly drop by her table and say hello. Ming had a sense of style as quirky as her personality—bohemian chic meets Tokyo pop. She loved hunting for vintage clothes on nearby Haight Street. Up in the lab, though, beneath oversized goggles, rubber gloves, and a disposable full-length smock (thrown out after each lab), she looked like a holdover from the film
Outbreak.
She had made it her job to take notes, holding her Hello Kitty clipboard like a shield in front of her chest. This left her no time to actually participate in dissections. But, as I came to understand, this was fine by her. The copious note taking was, intentionally or not, an avoidance strategy.

Sometimes I would spot Ming at the opposite side of the lab, standing at such a remove from her group that I’d feel the urge to walk over and give her a gentle push from behind, just so she would actually be in the huddle. And once she took that actual step, I felt a genuine sense of brotherly affection for her. Late one afternoon, after most of our fellow students had left, I pulled Ming over to my group’s cadaver. I suggested we review the vessels of the neck together. At one point, she got so caught up that she set her clipboard down and, without really thinking, used her prize pen to poke at the artery we had been searching for.

“I cannot believe I just did that!” she said, laughing and brushing it off on her smock. On second thought, she went over to the sink and washed it. Returning to the table, Ming picked up a metal probe with a tiny flourish and we continued studying. The following week, she told me with pride, she performed a dissection by herself.

Several weeks later, the day before my visit to the library, I ran into Ming as I was heading up to the lab. This would be the last lab before the final exam, so it seemed natural to ask how she thought she had fared in the course.

A sheepish look washed across her face. “Well, I kind of had a hard time at first.”

Yeah, I conceded, I kind of noticed.

While I’d assumed that Ming planned on working at a Walgreens or someplace similar, she confided that, in fact, she hoped to be a clinical pharmacist in a hospital. Deep down, though, she hadn’t been sure she was cut out for it. “This may sound really weird, Bill, but working with the cadavers has actually made me feel more comfortable about working with patients, if that makes any sense.” She smiled to herself. Then, in a manner that told me she absolutely will, Ming said, “I think I’m going to do fine.”

“I do, too.”

I had come by the lab mainly to say some goodbyes, since I would not be coming to the students’ final exam. I chatted with Massoud and Laura but didn’t see most of the others I had gotten to know. This was an optional review session, and on this beautiful afternoon, many had exercised the option to skip it, understandably. I, too, decided to cut my stay short. I waved to Dana and Sexton, who were bouncing back and forth among three small groups—I would catch up with them sometime later—and went to retrieve my bag from the windowsill. A couple of steps away, Dhillon was supervising two students I did not recognize. “What are you guys working on?” I asked.

One of the two explained that they were third-year med students practicing surgical techniques. He told me wryly he was trying his best “not to make too much of a mess” of the head. From where I stood, it did not look as if he was succeeding. As for his friend, he was a slight young man holding an electric bone saw above the chest of a massive cadaver, aiming for the sternum. He was the very picture of apprehension as he turned on the saw, which I took as my cue to move on.

At the far end of the lab, I saw another curiosity: seven people in street clothes sitting on stools in a semicircle, holding sketchpads in their laps. They were from the Art Institute of California. Once a quarter, they come here to sketch as an adjunct to their life-drawing class. Laid out on the table before them was not a cadaver but a selection of expertly dissected specimens—prosections, they are called (a shortening of the term
professional dissections
)—a still life of preserved arms and legs, a torso and a head, their muscles and vessels bared.

“It really helps to be able to see what’s under the bumps,” a young woman told me in all seriousness.

I couldn’t help smiling:
bumps.
I liked that.

I asked the student nearest me if I could see his sketches. He was a big pasty-skinned guy, the kind one would guess spends an inordinate amount of time playing video games. And, in fact, he told me that he is studying character modeling at school, with the hope of becoming a video game designer. He flipped back a couple of pages on his pad so I could take a look. His sketches were good—not H. V. Carter good, mind you, but they had dimension. In one drawing, he had reassembled all the separate parts before him into a full anatomical figure.

I complimented him, but he shook his head and looked up from his pad with doleful eyes. “Drawing at the zoo was a lot easier,” he said.

The UCSF staff person overseeing the art students’ visit was a woman named Andy, whom I had seen many times but never met till now. Andy explained that she does everything from ordering the cadavers and lab supplies to scheduling classes and cleaning up. Just then, the lab’s wall phone began ringing. “Oh, and I answer the phone, too,” Andy said as she rushed to get it.

After a minute, she rejoined me. I told Andy that I had been attending Dana’s class and had learned more about anatomy than I ever could have imagined. “I’m actually going to kind of miss coming to the lab,” I admitted.

Andy nodded, as if she knew exactly what I meant. Her eyes sparkled behind small, thick rimless lenses.

Before leaving the room, I clutched the doorframe and took a last look around. Even with the harsh lights, the well-scrubbed linoleum, and the funk of formaldehyde, it seemed less like a lab than like a library—a place where not only human anatomy but the spirit of anatomical discovery is preserved. And there, in the far back corner, I could easily imagine a small man in a black coat, Henry Gray. He had been here all this time, silently working.

BACK ACROSS PARNASSUS STREET
, inside the Special Collections Room, Dr. Brodie is bringing his speech to a close. He turns to H. V. Carter and his fellow honorees: “To you, Gentlemen, who have been the successful competitors for the prizes given annually by the different teachers of this school, I offer my sincere congratulations. If you have gained honour for yourselves, you have also done good to others, for example is better than precept; and there is no one among you who has not exercised a wholesome influence on his fellow students.”

At this, I can imagine applause breaking out in the St. George’s auditorium.

Dr. Brodie waits for silence to return. He then adds, in a voice so resonant, so full of wisdom, that it carries across the centuries and reaches me here: “Let me advise you to pursue the same course through life, recollecting that, even as practitioners, you must still be students. Knowledge is endless, and the most experienced person will find that he has still much to learn.”