Gavin Francis is not a traditional traveler. The landscape he explores is human anatomy, his maps are x-rays. “I journey through the body as I listen to my patients’ lungs, manipulate their joints, or gaze in through their pupils,” he writes in his new book, Adventures in Human Being: A Grand Tour From The Cranium to The Calcaneum.
Drawing on medical history and his experience as a doctor, he takes us on an intimate tour of the human body, revealing its complexity, beauty and frailty.
Speaking from his home in Edinburgh, he describes how altruistic organ donor circles in Britain are saving lives; why Javanese women eat their placentas; and how Christian art got it wrong about the crucifixion.
You open the book with the words, “As a child I didn’t want to be a doctor; I wanted to be a geographer.” How did that early passion segue into a medical career and are there any parallels?
I was one of these children who always had little jars of creatures around the house. That love of biology accelerated when somebody gave me a human anatomy book. There were extraordinary similarities between the atlases of anatomy and the atlases of geography, in terms of the patterns and the way they seemed to offer this marvelous simplification of the complexity of the world.
I became enthralled by that, so my initial impulse to be a doctor was really to understand anatomy and to learn a trade that would be useful and let me travel, because I love to travel.
As a young doctor, you went on an expedition to Antarctica. Tell us about that.
I was the medic at one of the most remote research stations in Antarctica, a British base called Halley. I was stationed there for 14 months. To train, I went to the British military hospital in Plymouth for six months, where I learned the kinds of things I might need to do on my own, like take x-rays, or physiotherapy and ophthalmology.
I set sail on a cargo ship as the ship’s doctor and it took me two and half months to get to the Antarctic. The base is isolated for ten months of the year. Nobody can get in or out, which is why I had to undergo such intensive training, because medical evacuation wasn’t a possibility in winter.
It was a very elemental landscape composed only of ice and light. There were no rocks and hardly any creatures. It was like the earth at the beginning of time, like that moment in Genesis where God says, “Let there be light.” It was wonderful.
You write, “When faces are available we pay more attention to them than to any other part of the visual world.” Explain why this is so – and why Leonardo da Vinci’s “The Last Supper” is the ultimate face painting.
There have been lots of psychological experiments on newborn babies that show how much they fix on the gaze of a face, even before their eyes can adequately focus. And we continue to do that as adults, to read not just the people around us but to try and gauge their intentions.
The reason I wanted to explore Da Vinci’s “Last Supper” in my chapter on the face was because da Vinci was an amazing anatomist. Indeed, it’s a tragedy that he didn’t publish his anatomical findings during his lifetime because he would have advanced the science of anatomy by a couple of centuries. They show an extraordinarily intimate knowledge of the muscles of the face.
Da Vinci called the different muscles of facial expression by the emotion they would cause. So, for example, he called the muscle that causes our lip to raise and snarl the muscle of anger.
When he came to paint “The Last Supper”, he didn’t follow convention, which at the time was just to paint all the apostles sitting around enjoying their dinner. He paints that moment when Christ says, “One of you shall betray me.” So he gets this extraordinary range of emotions from fury to disbelief to fear. St. Andrew, for example, over on the left side of the painting, has thrown up his eyebrows and palms, so he looks shocked and frightened by what’s going on. James, who is sitting on Jesus’ left, is furious. His arms are thrown out, he’s knocking over everything on the table, and his eyebrows are furrowed towards his nose.
Sometimes medical breakthroughs can arise from low-tech experiments. Tell us about Epley’s maneuver.
John Epley is an ear, nose and throat specialist, who, in the sixties, was one of the pioneers of cochlear implants. In the eighties, he developed a new theory as to why episodes of severe, incapacitating dizziness happen. In medical language, vertigo isn’t fear of heights. Vertigo is the sensation that the room is spinning, like seasickness on dry land. At the time, the treatment involved a risky operation, where the skull would be opened and part of the nerve of the balance organ would be cut. It risked deafness and all sorts of problems.
Epley disbelieved the theories prevalent at the time, which were to do with some part of the inner ear not working properly. He thought the problem was small pieces of grit that build up within the channels of the ear canals and roll around. So he developed this model of the inner ear in his garage with some bits of hose pipe, and rolled around little balls in it to figure out which sequence of movements you would need to put the head through in order to get the pieces of grit out of the canals and into a place they wouldn’t cause trouble.
It worked! But it took him ten years to get it published in a respected medical journal. People just didn’t believe anything so simple could work.
French surgeon Pierre Barbet performed what must surely rank as the most macabre of medical experiments. Lift the curtain for us and explain why Christian art has got it all wrong about crucifixion?
Pierre Barbet was a zealous French Christian and surgeon in the 1930s, who became morbidly obsessed with whether Jesus was nailed through the palms or not. He took cadavers and nailed them to makeshift crosses to see whether the tissues of the hand were strong enough to support the weight of a human body.
He came to the conclusion that they weren’t and that therefore crucifixion as practiced by the Romans must have been carried out with nails through the wrists or forearms.
I explore this story because of a case I encountered of a chap who fired a nail gun right through the middle of his palm. He joked to me that he would end up with stigmata on his hand when the wound had healed. I told him that stigmata should really be on your wrists.
Recently archaeologists found new evidence of Roman crucifixion, which suggests that just the feet were nailed with one nail through each heel bone into the side of a piece of wood, and the arms were just tied.
It was recently announced that doctors in the UK will perform womb transplants, after the success of the procedure in Sweden. Tell us about the history of transplants and your own experience.
The first ever tissue to get transplanted was skin. They’d realised very early on that the immune system would reject foreign tissues. But experiments on skin showed that that didn’t happen between identical twins. The first organ to be transplanted was a kidney, in Boston, in 1954, between identical twins. One of the twins had suffered kidney failure, and the other one donated a kidney to his brother.
As a doctor, I have never carried out a transplant but I have watched them happen; it is the most incredible sight to see a grey, shrunken organ, which arrives packed in ice in a polystyrene box, plumbed into a new body. It’s like seeing reanimation as the tissue that’s grey and shrunken suddenly fills out with each beat of its new recipient’s heart.
In the UK you can’t pay anybody for a kidney, so it remains one of the most precious gifts that can be given in the sense that it really does give life and yet it is impossible to attach any kind of financial value to that. I’m fascinated by the idea that the most precious things are beyond financial value.
In fact, when you do interpose some kind of financial value into the situation, it often diminishes and sours the relationship. There are stories of people asking for money for a kidney, even between a mother and daughter, and the relationship becomes completely soured.
There’s this wonderful new development of altruistic gift circles being generated from unrelated donors. You line up a series of five or six individuals, all of whom will benefit. Computers can match the tissue types so that there will be a minimal chance of rejection. All you need is one individual to altruistically donate a kidney to someone else, then relatives who wish to donate a kidney to their loved one, but can’t because of incompatibility, can then donate a kidney to another individual.
You end the book at the beginning of life, with birth. Explain why Javanese women eat the placenta and why our own, previously squeamish, attitudes to afterbirth have recently been transformed by stem cell technology.
Many different cultures have traditionally eaten the placenta of a baby after it is born. There are various theories why. The placenta is full of progesterone, the hormone that promotes and maintains pregnancy, and some have theorized that a crash in progesterone levels after birth can trigger post-natal depression. By eating the placenta, a mother can help the body come down slowly from that high of progesterone during pregnancy.
When I started out in medicine doing obstetrics and delivering babies, we would put the placenta in a yellow bucket and the following day it would get burned in the incinerator. That was the standard way of dealing with it for decades.
But in the last few years it’s become obvious that the umbilical cord, in particular, contains stem cells that are genetically identical to the baby. If these can be preserved and cryogenically frozen, in the future tissues could be regenerated for the baby’s benefit.
Our attitudes to our bodies and parts of our bodies are always in transition and revolution. I find it fascinating that in just a few years we’ve gone from throwing the placenta out with the trash to arranging for specialized companies to be present at your birth to protect the umbilical cord. But the jury is still out on how effective this is.
What do you value most about being a doctor?
The thing I value most is the great privilege of being able to stand witness to some of the most extreme moments of [patients’] lives and do what I can to offer assistance. It sounds melodramatic, but at base being a doctor is about attempting to ease suffering and promote flourishing for human beings. It’s endlessly fascinating and endlessly surprising to be in that position day after day.