Flesh and Bone (Body Farm 2)

I had started slowly, but now I was gathering momentum, like a rhino on the run. “A couple hundred million years ago, our ancestors, the first mammals, began evolving from swamp lizards,” I said. “They were small mammals about the size of squirrels or shrews, called ‘preprimate insectivores’; they lived on the ground and ate bugs. They had long snouts, sort of like anteaters, and their eyes were on the sides of their heads.” I tapped both temples for emphasis. “Well, at the same time, another group of animals was emerging: the dinosaurs. Now, what happens when a tyrannosaurus or a brontosaurus steps on a preprimate insectivore?” I smacked one palm down on top of the other. “Splat,” I said. “So some of the brainier insectivores decided they’d be safer up in the trees, where they wouldn’t get stepped on. Good idea; more of those survived. But not all. If you’re skittering around in the trees, jumping from branch to branch, it’s hard to see which branch to grab if your eyes are on the sides of your head and you’ve got a big snout in the middle of your face. So some of these critters fall out of the trees and get eaten. Or stomped on.” I made the splat again. “So over time-remember, we’re talking millions of years-the survival rate, and the reproductive rate, is higher in the ones with smaller snouts and eyes closer to the front of their heads. But to lose that snout, they have to lose some teeth-if you’ve got forty-four teeth, you’re going to have a mighty big snout. So natural selection favors those with smaller snouts. Fewer teeth. The fossil record documents all these changes in great detail.”

The young man in row three raised his hand again. “But you’re assuming the fossils were formed over millions of years. What if they weren’t? Painters and sculptors can easily create works of art that look very old, even though they’re not. If they can do that on a small scale, why couldn’t God do it on a much bigger scale?”

I was dumbfounded, and didn’t even know where to begin to respond. We had just leapt from science to faith, and although those two spheres weren’t always in conflict, I could tell that in this instance, they would be.

“Okay, forget the fossil record,” I said. “Let’s talk about modern humans, people who have lived within the past two hundred years. People whose birth dates and death dates we know. The Terry Collection at the Smithsonian contains nearly two thousand human skulls, belonging to individuals born as far back as the early 1800s. Here in Neyland Stadium, in the UT collection, we have about six hundred skulls so far, belonging to individuals born as recently as twenty or thirty years ago. Comparative measurements of those twenty-five hundred skulls show that in just the past two hundred years, the average jaw is getting smaller, and the average cranium is getting bigger. We think of evolution as something occurring over thousands or millions of years, but this is an example of evolutionary change that’s almost fast enough to see in our own lifetime.”

Just as he was winding up to reply, I saw another hand go up at the back of the room. Grateful to shift interrogators, I pointed. “Yes, there in the back?”

“You mentioned ‘dumb design.’ What’s dumb about having fewer teeth?”

“Good question. There’s nothing dumb about having twenty-eight teeth instead of thirty-two, or forty-four. The way we eat nowadays, we could probably get along just fine with twenty, or even twelve. What’s dumb, or inefficient, or problematic, is that our jaws are shrinking more rapidly than our tooth count is. The two evolutionary changes are not in sync. So we wind up with too many teeth in too little space. That’s why so many of us have to have our third molars-our wisdom teeth-yanked when we’re fifteen or twenty or thirty years old. Which is a bad thing for most of us, but a good thing for those of you who are heading for dental school.” I noticed a few smiles, which I guessed might belong to pre-dent students.

“Enough about teeth,” I said. “Let’s talk about a couple of other design flaws. I won’t embarrass anybody by asking who’s had either of these problems, but I would bet some of you have, and I guarantee that more of you will: hernias and hemorrhoids. A hernia is a failure-a blowout, you might say-in the abdominal wall. Back when we moved around on all fours, our internal organs had it easier. I’ll show you why.” I clambered onto the table at the front of the auditorium on my hands and knees. “You see how my belly is hanging down here?” I heard a few good-natured “oohs” and “yucks” from the students. “The point is, when you’re in this position, the abdomen makes a nice, roomy sling, like a hammock, for the organs.” To underscore the point, I swayed back and forth a few times. Then I stood up on the table and put my hands on my belly. “But when we went vertical, what happened? Anybody?”

“Everything sank down to the bottom,” ventured a girl on the front row.

“Exactly,” I said. “And that increases the pressure on the lower abdominal wall. So it’s more prone to tear. Same thing with hemorrhoids. The lower end of the large intestine gets more pressure now than it did in our four-footed ancestors, so it’s more susceptible to blowouts, too, which is basically what hemorrhoids are.” I heard more exclamations of disgust. “Varicose veins-how many of you have seen varicose veins?” A lot of hands went up. “Now that we’re upright, the heart has a lot more work to do. It has to pump blood with enough force to push it from the bottom of your feet all the way up to the top of your head, a distance of five or six feet, or even more. That’s a lot tougher than pumping it three feet uphill, which is about how tall we are when we’re on all fours. It’s interesting,” I said. “To try to compensate for the circulatory problem we created when we stood up, we’ve evolved this complex system of tiny flaplike valves in our veins, whose job is to keep the blood from flowing back downhill in the pause between heartbeats. But as we get older, those little valves tend to leak a bit, so blood pools in the legs, and the extra pressure makes the veins swell up and sometimes burst.”

An especially tall young woman-she was one of the star players on the Lady Vols basketball team-raised her hand. I pointed to her. “Yes?”

“So do other mammals-dogs and lions and whales-not have those little valves in their veins?”

No one had ever asked that before. I had never asked it myself. “To be honest,” I said, “I don’t know. I’ll find out before our next class. Good question.” She beamed; it was considered a coup to stump me.

“Okay, now let’s talk briefly about the pelvis and the spine,” I said. “Some of you women will doubtless have babies at some point. The good news is, obstetric medicine is getting better all the time.”

“What’s the bad news?” a female voice called out.

“The bad news is, babies’ heads are getting bigger and bigger,” I said.

“Ouch, man,” the same voice said. “C-section, here I come.”

“Lots of women are having cesareans these days,” I agreed. “Purely as elective surgery, not because there’s any medical complication that calls for it. And frankly, skittish as I am about the idea of having my belly sliced open, if I were a woman, I might consider it, too.”

“If you were a woman, Dr. Brockton,” called out a guy who had emerged as the class clown, “I don’t think pregnancy would need to be high on your list of concerns.” Much laughter ensued, including my own.

“Okay, last dumb-design feature,” I said, opening the box I had brought with me. “There are others, but we’ll stop with this.” I reached into the box and fished out an articulated pelvic girdle, the bones held together with red dental wax. The pubic bones arced together in the front; in back, the sacrum-the fused assemblage of the last five vertebrae-angled between the hip bones. “Notice the shape of the sacrum,” I said. “As you get down to the end of the spine, the vertebrae get smaller and smaller. So it’s shaped like a triangle, a wedge. Now, what do you use to split firewood?”

“Um, an ax?” offered someone.

“Well, yes, but I was thinking of a wedge. When you apply pressure to a wedge, it tends to force things apart, doesn’t it? You see where the hip bone, or the ilium, joins the sacrum here on each side? That joint is called the sacroiliac

joint. When you put pressure on this wedge, the sacrum-with the weight of your entire upper body-it pushes down, and it tends to force these hip bones apart, and strain that sacroiliac joint. That’s a common cause of lower-back pain in people my age and older.”

I looked directly at the intelligent-design proponent in the third row. “So you see,” I said, “there are all sorts of structural features in the human body that suggest slow, imperfect evolution, rather than instantaneous, intelligent design.”

He raised his hand, his face showing a mixture of regret and defiance. “But think about the eyeball, and the brain, and the heart. Those are complicated and amazing structures. The eyeball is a marvel of optical engineering. The brain is more sophisticated and powerful than any computer on earth. The heart makes any man-made pump look flimsy and crude.” I nodded, trying to acknowledge that we shared an admiration for those organs. “Besides,” he challenged, “what’s wrong with teaching both theories? Isn’t that what education is all about? Let both sides of the controversy make their case, and let people make up their own minds?”

“There is no controversy,” I thundered. “Evolution is no more controversial than the Copernican theory of the solar system, or the ‘theory’ that the Earth is round. Just because a few people make an opposing claim, loudly and often, that doesn’t make the issue a legitimate scientific controversy. There is nothing scientifically testable or provable about creation theory. Hard-core creationists claim the fossil record-fossilized evidence showing that animals and plants evolved over many millions of years-was created right alongside Adam and Eve. That’s hocus-pocus, a fictional geologic backstory, conjured up out of nothingness: ‘Fossilized remains just look millions of years old’-you said as much yourself not thirty minutes ago-‘because God made them look millions of years old.’ Logically, you can’t argue with that. It’s perfectly circular reasoning, the ultimate ‘because God said so.’ Only it’s not really God who’s saying so. It’s people claiming to speak for God. Well, maybe God spoke to me this morning as I was reading the paper, and told me to tell everyone that Charles Darwin was right, and that anybody who says otherwise just isn’t paying good attention.

“Don’t get me wrong,” I said. “I’m not dismissing the possibility of some higher principle or higher power operating in the universe, something that’s far beyond my meager powers of comprehension. I can’t explain the ‘why’ of evolution, but the fact that I don’t fully understand how it works doesn’t keep it from working. I don’t begin to understand how pictures appear on my television screen, but that doesn’t keep them from showing up. And it doesn’t mean God put them there. The laws of physics-and people who are smarter about those laws than I am-put them there.

“And if we need any further proof of unintelligent design,” I said, really getting wound up, “all we need to do is look at the Kansas Board of Education. Those people are the very incarnation of dumb design.” I waved the morning newspaper.

My opponent was not ready to give up. “We are made in the image of God,” he insisted.

“Then God must be evolving, too,” I snapped. “And I hope he’s got some divine dentist up there in heaven to extract his wisdom teeth, because once they get impacted, God’s gonna have one hell of a toothache.” I wadded the newspaper into a ball.

I heard a gasp, and then a snicker, and the class jester called out, “Amen, brother!” And then someone at the back of the room began to clap. Slowly, steadily. Soon more of the students began to clap, and before long, almost all of them were clapping.

The young man in row three stood up. I opened my mouth to tell him to sit down, but then I noticed his face. It was a bright mottled red, and he looked on the verge of tears. He stared at me for a long moment, with eyes full of hurt and betrayal. Then he walked up the aisle and out of the lecture hall, accompanied by catcalls and whistles.

I gathered up my notes, the pelvis, and the crumpled newspaper, and exited by the lower door. As I traipsed down the sidewalk from McClung Museum to the underbelly of Neyland Stadium and the stairwell to my office and my collection of still-evolving skeletons, I accused myself of going too far, speaking too harshly, because I’d gone into class already mad about the newspaper article. It was important for scientists to defend good science and expose pseudoscience. But it was also important to do it gently, at least when students were involved. “Damn, Bill,” I said to myself, and at myself. “Damn.”

CHAPTER 9

TESTIFYING AT A HEARING to revoke a physician’s medical license wasn’t exactly the same as testifying in court, but it was damn close. This hearing looked like a trial and it quacked like a trial, complete with lawyers and oaths to tell the truth.

The Tennessee Department of Health and Environment had a lawyer whose job was to ask me easy questions, and Dr. Garland Hamilton-the medical examiner whose license was on the chopping block, so to speak-had a lawyer whose job was to chip away at my answers.

The case that had prompted the state to try to revoke its own regional medical examiner’s license was a fascinating one. A man named Eddie Meacham called the 911 dispatcher in Knoxville one Saturday night to say that his friend had just collapsed. By the time the ambulance arrived, Billy Ray Ledbetter was dead, with a bloody wound in his lower back. Dr. Hamilton performed an autopsy, found copious amounts of blood in Ledbetter’s right lung, and pronounced the cause of death to be a stab wound in the lower back, with the blade penetrating the lower lobe of the right lung.

Trouble was, it turned out that the “stab wound” was inflicted by a big shard from a glass-topped coffee table, which Billy Ray had shattered when he collapsed onto it. I had the dubious plea sure of getting involved when I did an experiment at the Body Farm that showed it would have been impossible for a knife blade-even if there had been a knife wound, which there wasn’t-to puncture the back on the left side, cross the spine, and then veer ninety degrees into the right lung. The real cause of the lung hemorrhage, it turned out, was a bar fight a couple of weeks before Billy Ray’s death, when he got severely boot-stomped, breaking multiple ribs and puncturing the lung with a sharp piece of bone. My testimony had served the dual purpose of clearing Billy Ray’s friend of an unjustified murder charge-which pleased me-and of spotlighting Dr. Hamilton’s incompetence-which displeased me on two counts: first, that he was incompetent, and second, that I was now part of the effort to strip a longtime colleague of his license to practice medicine.

Hamilton had confronted me furiously after the trial, so I was prepared for the worst when I entered the hearing room. He stood up and stepped toward me; I braced for an assault, verbal or even physical. Instead, he stretched out his right hand. Startled, I took it and shook. “No hard feelings, Bill,” he said with a smile and a squeeze of my hand.

Surprised at his change of tone, all I could come up with was, “I hope not, Garland.”

Up at the front of the room, which was just a large conference room in one of the state office buildings in downtown Knoxville, a panel of three physicians-members of the Board of Medical Examiners-sat behind a long table. To one side, a stenographer perched at a much smaller table, her fingers poised over the odd little machine she used to transcribe words. I was fascinated by the technology. Her machine, a stenograph, looked more like an old-fashioned adding machine than a computer or typewriter; as she typed, though, she would often press two or three keys at once, like playing a chord on a piano. I had once asked a court reporter to explain and demonstrate the technique to me. “I’m transcribing sounds, not words,” she’d said, and she had me speak a few words at a time. She showed me what combinations of keys she used to transcribe the various sounds I had uttered-sometimes a “chord” represented a syllable; sometimes an entire word; in one case, even an entire phrase. It beat the hell out of anything I’d ever seen: as if she’d had to master a new language and a musical instrument all at the same time. Ever since, I’d had great admiration for court reporters’ abilities.

“Dr. Brockton, are you

ready?” The state’s lawyer brought my mind back to the business at hand. He had already briefed me on the charge against Hamilton: “significant professional incompetence, with actual or risk of immediate harm,” the most serious charge possible. In this case, the harm was not to the patient, since Billy Ray was long since dead by the time Hamilton got to him; the harm was to the friend who faced life in prison for an unjust charge of murder. Pretty harmful, all right. If the examiners upheld the complaint, Hamilton’s license could just be suspended temporarily, but it was more likely to be revoked for good. And it would be good, judging by some other shoddy autopsy reports I’d seen.

I’d brought diagrams of the spine, rib cage, and lungs, showing the impossible “wound path” Hamilton had described the knife taking; I had also requested that a teaching skeleton be on hand so I could further illustrate the impossibility in three dimensions. The state’s lawyer led me swiftly through a recap of the experiment I’d done, in which I had been unable even to approximate the path Hamilton had described. He ended by having me describe finding the shard of bone, from Billy Ray’s own splintered ribs, that had pierced the right lung. The examiners on the panel asked a few questions: Might a thinner blade have been able to make the requisite turns? Was there any sign of a knife mark on the detached bone shard? Was there any possibility the shard had punctured the lung during postmortem handling of the body? — but they seemed satisfied with my answers.

Then Hamilton’s lawyer got his turn. I had been cross-examined by the Knox County district attorney about this same case, so I felt reasonably confident, well prepared, but his first question threw me off-balance. “Dr. Brockton, did you examine the decedent, Mr. Ledbetter, for evidence of scoliosis? Curvature of the spine?”

“Well, no,” I said, “but I think I would have noticed-”

“I’m not asking what you think you would have noticed, Doctor; I’m asking whether you took measurements or X-rays or conducted any other sort of investigation that would have yielded an objective indication of scoliosis?”