chapter one

Bone Box

There we found a rich supply of bones, which we examined indefatigably…until,…blindfolded, we could identify by touch alone any bone which [our fellow students] pulled from the piles…and handed to us. We were forced to these lengths because, though eager to learn, we had no teachers to assist us in this aspect of medicine.

VESALIUS, ON STUDYING AT THE
CEMETERY OF THE INNOCENTS IN PARIS,
ON THE FABRIC OF THE HUMAN BODY

The syllabus says, “Week One—5 P.M. Pick up bone boxes.” The anatomy lab is empty, and yet it’s just eighteen hours or so before our class. The cadavers have been prepared for months, if not longer, and as we will learn early in the term, their formalin embalming would permit them to sit at room temperature for as many as twenty years without the slightest trace of rot. They could be lying here awaiting our morning dissection, but the faculty is administering this intimacy with death in small doses. The absence of dissecting tables and bodies allows us to resume our social banter, to continue to introduce ourselves to one another before we undertake our strange new trade in the morning. Since the semester has not yet officially begun, it is the first day that we have all formally gathered, and we’ve come straight from an afternoon barbecue on a university playing field. Though many of my classmates know one another from their undergraduate years, I am meeting almost all sixty-some of them for the first time. Our conversations are friendly, a jumble of small talk about how we’ve all just moved and are still unpacking our belongings, polite questions about what we were each doing before medical school and what fields of medicine we think we might pursue. My partner, Deborah, and I were both teaching high-school kids in California, I say, over and over. I repeat the same joke: So I’m obviously interested in psychiatry.

Our talk is frivolous, but I’m aware that this moment is the real beginning of what will be four grueling years of work and study. Deborah and I moved across the country for this day. (Not only have I never been to Rhode Island, I said in a moment of uncertainty after the decision had been made, I don’t even know anyone who’s ever been to Rhode Island.) And yet here I am, with my new classmates, in an otherwise empty human anatomy lab.

We form a line, pose for Polaroid photographs that will help the professors associate our names with our faces. After the pictures we each pick up a wooden, handled box a little larger than a briefcase. The box has my name imprinted on a label by the handle. It is the kind of box that, in an academic community like ours, would be assumed to hold a telescope, or microscope, or collection of fragile documents. It will hardly be noticed, I discover, as I walk down the main drag of campus, past the falafel joint, the copy shop, and the Starbucks, carrying two-thirds of a human skeleton.

The box bumps against my leg as I take it to my car. During the entire walk, I am thinking, This used to be a person. I am carrying parts of a person in this box, and no one knows it. On the street, girls compliment one another’s shoes, and a man in his twenties sings Dylan on the curb for quarters. When I reach the trunk, I hesitate for a minute and wonder if I should put the box on the seat beside me instead, and then I decide I am being ridiculous. I do not look at the box again until I have been home for over an hour, have unpacked my weighty new books and arranged them on my shelves. I do not look until there seems nothing left to do but unfasten the clasps and lift the lid.

Inside is a whole skull, at once eerie and beautiful. On close inspection the individual bones of the skull are visible, and their lines are fluid and lovely—the winging curl of the zygomatic bone that can be traced from the cheekbone to the ear, the bony hinge of jaw, the whorled external acoustic meatus, through which sounds travel to our brains. The lower jaw, or mandible, is held in place by small wire springs and screws and can therefore be carefully opened and closed. The top of the skull has been sawed off and reattached with removable fasteners to allow study of the internal cavities and structures of the head.

Incomprehensibly, there are twenty-eight bones in the skull alone. I will learn that there are fourteen bones that form the face, six auditory ossicles—the bones of the ear—and eight bones of the cranium, the “vault of the brain.” The bones join together at irregular lines called sutures, and the look of them is half that of sewn fabric, as the name implies, and half plate tectonics; the ragged and uneven lines imply an ancient and irreversible joining. When I unhinge the top and look inside, the landscape is not the glorified basin I had imagined—it is lunar, with deep pits and sharp protuberances. Symmetrical sets of holes mark tunnels through which nerves and arteries once traveled, carrying signals and sustenance. At the base is the foramen magnum, literally “big hole,” where the brain stem and spinal cord emerge from the brain to run down the body.

The skull has a full set of teeth, and one of the incisors had been crowned, as I can see from the whittled shape. I think, Someone kissed this mouth; someone touched this chin in love.

I lift from the box one of each of the bones in the arm—humerus, radius, ulna—and one of each of the bones in the leg—femur, tibia, fibula. I hold in my palm the bones of one hand, then the bones of one foot. My skeleton is male, I am sure. The bones and feet and hands are long. If you fit the bones together, you learn the size this man was. At the elbow the radius and ulna meet the humerus in perfect, well-worn curves and grooves. I hold the three bones in place in a straight line, then bend them at the joint. When I do this, I am unnerved and put the bones down on the floor. The movement is utterly human. Unquestionably so. I look at them, now separated on my carpet, and think, Bones, just bones. I pick them up, join them again, raise the lower arm from where the wrist would be toward the absent shoulder, and they are not bones, they are an arm. The proportions are exact, of course, the movement something I have never noticed or defined before, but something I innately know—the movement that a human arm makes. The flex, the bend and swing, the slight inward turn toward the body, even when straightened and at rest.

A whole spinal column lies in the box beside the skull, each vertebra strung with fishing line in its proper order to form a chain of bones. When held aloft they form a skeletal silhouette of this person’s back. The column strikes me as prehistoric-looking, reminiscent of the bones of large fish that hang in natural-history museums. At first the vertebrae look identical, a stack of round disks, their bony prominences fitting neatly into one another. But in fact the shape of each vertebra differs slightly from those above and below it, and to run the eye down the full column is a bit like watching a time-lapse film of a budding flower or a developing fetus, a gradual metamorphosis from one distinct shape into another.

A single hip bone sits to one side. The bone is odd and asymmetrical alone, only half of the pelvis, unable to form the perfect bowl that holds the entrails. Yet it is elegant and curving and alien. Its inner lines rise and flare and become its outer edges, like the bloom of a calla lily. A fistful of ribs nestle, curved into one another, and they look thin and fragile and almost translucent. The final two bones in the box are responsible for some of the most striking bodily shapes: the clavicle and the scapula. The clavicle is a nondescript bone the size of a thick pen, and it is hard to imagine that it traces the insistent line reaching from a woman’s throat out to her shoulder. The scapula, or shoulder blade, is winglike and twisting. Its graceful shape barely alludes to the way it firmly roots the shoulder muscles and the upper arm.

Beneath all of these in the box is the patella, or kneecap, a large, misshapen lentil that has the singular distinction of being a sesamoid bone—a bone formed in response to shear forces within the tendon that surrounds it.

The bones of the hand and foot are also held together by fishing line to show how they “articulate” or join. The number of small bones in the hands and feet exceeds all the rest in the body combined, and the names, I will learn, are lovely and evocative: distal phalanx, capitate, scaphoid, triquetral, hook of the hamate. Some etymologies seem comprehensible: The lunate is moon-shaped if you squint a little; pisiform means “pea-shaped” in Latin. But as the semester wears on and we peer through flesh at these little bones, look at them on black-and-gray transparent sheets of imaging, hold these bone hands in our own hands and memorize the shapes and names and the muscles that move them, we will hypothesize and confabulate, in seriousness and utter lack thereof, about those that are less self-evident. Perhaps the hook of the hamate, a protuberance of one of the hand bones, dates back to the stigmatized descendants of Ham in the Bible; perhaps the styloid process, a bump in the wrist, denotes the exact spot where stylish women wear bracelets. Learning the nomenclature will become a vast game of memory. And as I sit on the couch with these bones whose names I do not know, all I think is that, of everything beside me, the teeth are what make the body seem the most real.

Stacked beside me on my sage green couch: this spinal column that wraps into a coil without muscle to hold it upright, hands and feet tied together with floss, this skull hinged and empty. A man’s teeth.

I stand, and with my right hand I hold the knobby end of the skeleton’s femur at my left hip. With my left hand, I join the tibia to the femur where the knee cartilage would have been. I am comparing his body to my own tall form. His legs are shorter than mine. His ribs too narrowly curved to wrap around me. I hold the threaded bones of his left foot against my right sole. Our feet are the same size.

Here is what I will learn: The most alarming moments of anatomy are not the bizarre, the unknown. They are the familiar.