Brain Storm

by Richard Dooling

  “Take a seat,” said Rachel. “This is medical Masterpiece Theater. First, background. We found records of the initial seizure intakes down at Southwest Missouri State. Pretty ho-hum. Idiopathic seizure, followed by normal EEGs, nothing on the functional MRI scan, medication to control the seizures, seizure-free for a period of time. Can’t tell from the old records whether he’s a druggie or a boozer. He refused a urinalysis once when applying for a night-shift position as a computer maintenance technician. Couple bouts of some back trouble, blah, blah.”

  “No other seizures, after the ones in college?” asked Watson.

  “Probably not,” she said. “But it may not matter once you get a look at what else Heather came up with.”

  “A mental defect or disease?” he said eagerly. “A hard one?”

  “Easy, sport,” she said. “An HMO on South Grand had some recent records, and they had forwarded others to another HMO out in Festus, Missouri, because patient Whitlow changed jobs and insurance companies. When we faxed the release out there, they sent back records, current, right up to the week before the murder.”

  “Really?” said Watson, his eyes widening.

  “Really,” she said, “and like you, I thought—how perfect!—he sees a doctor a week before the murder to get his seizure medication adjusted, the med change results in untoward psychological repercussions. Bam! Impulsive behavior, in the form of a murder, happens. Neurochemical defect.”

  “Something like that,” said Watson.

  “Well,” she sighed. “Nothing like that. VD is more like it. Gram-stained smears positive for gonorrhea. And the next question out of the noble Mr. Whitlow’s mouth, one week before the murders, according to the nurse’s notes is—‘I ain’t gonna have to tell my wife about this, am I?’ ”

  Watson recalled his interview with Whitlow and the prisoner’s irritable plea, “I gotta piss again!… That’s some other medicine I’m needing.… It’s personal.” And Whitlow’s phone message, the one Watson had listened to when he’d called into his office voice mail the day he’d met Rachel Palmquist: “They said something about could they get the medical records from the doctor who prescribed the medicine for the infection … before I was in jail.… I don’t think they should have those because that is private shit. So can we just tell them no?”

  “The piss infection,” said Watson. “He was taking meds for what he called a ‘piss infection.’ ”

  “That’s one way to describe it,” she said. “All of which would be neither here nor there,” she added, “except for what Heather coyly refers to as a careless mistake in the transmission of medical records. The HMO in Festus sent not just James Whitlow’s records, but family medical.”

  “Family?” asked Watson.

  “That’s right,” she said. “Hers, his, little Charlie’s, the whole Whitlow clan. It’s what happens when you pay your medical records personnel minimum wage. It makes them careless and more susceptible to a skillful insinuation from someone like Heather that the authorization and release is for family medical, rather than for an individual patient. It helps, especially when we are looking for genetic markers.”

  She sorted clamped bundles of medical records. “So your client goes in on Monday complaining that he is,” she read from a page, “as he describes it, ‘pissing battery acid,’ and wondering if he has to tell his wife about a little bout of Cupid’s itch.” She put one set of papers aside and picked up another.

  “Guess who comes in to the same HMO on Friday—one week before the murder?” she asked, looking at him over her glasses.

  “No,” he said.

  “Yes. Mary Whitlow, complaining of irritation, burning on urination, and purulent discharge.”

  Watson screwed up his face. “He told her?”

  “He didn’t tell her,” she said, then read from the records. “ ‘When informed of her diagnosis, patient became angry and extremely upset. She accused the medical staff of misdiagnosis or of mixing up her lab samples with some other patient’s.’ ”

  She flipped a page. “Here’s the part you’ll like. ‘Patient tearfully stated that she could not possibly have gonorrhea or any other sexually transmitted disease because she had been married for seven years and had never had sex with anyone except her husband.’ ”

  “Ew,” said Watson.

  She peered over her glasses and smiled. “Think about that one,” she said. “And then get busy finding me another French red for our next celebration.”

  “Give me that!” said Watson, taking the HMO records and reading the notes for himself.

  “From the looks of it,” continued Rachel, “they had to carefully connect dots and spell it out for her without mentioning her husband’s visit earlier in the week, which, of course, would be a breach of patient confidentiality.”

  Watson read aloud from the notes, “ ‘Patient was informed that she could contract the disease from any infected sexual partner, including her husband. When she refused to believe the results, the physician on duty showed her the gram-stained slides so she could see for herself.’

  “So Lucy Martinez was right—he was cheating on her.”

  Rachel curled her lip and served him a look. “Yes, and men have also been known to wear pants. More important for you, a week before the murder, we have her on record swearing up and down that she never slept with anyone but her husband. Seven days later, she tells the cops she was having an affair with Elvin.”

  “Lethal,” said Watson. “Myrna will force-feed her on the witness stand.”

  “Another loving couple bound for life by matrimonial vows,” said Rachel. “You got lucky, thanks to Heather, and I’ve got more good stuff to show you in his neurofunctional profile. The stuff came in the night before last from the federal medical center in Rochester. Took an hour and a half even on the T3 trunk line.”

  She pulled out a keyboard tray and began summoning scanning images onto the monitors.

  “First, the big find—we have a subarachnoid cyst. And the neurologists are recommending removal.”

  A set of sixteen ghostly images of transverse brain sections appeared. She clicked on one of them and enlarged it to occupy the screen. “Right there,” she said, using her mouse pointer to indicate a pale, gray golf-ball shape nestled somewhere between the skull and the images of brain convolutions.

  “It showed up first on the MRI, and then they did a PET to confirm that it was compromising blood flow to the frontal lobes.”

  “A hard mental defect or disease?” asked Watson.

  “Nice and hard,” she said, sounding faintly disappointed. “We won’t be breaking new ground with this one. We may not even get to it if Mary’s clinic visits come into evidence. Nothing less effective than a thoroughly discredited witness.

  “The first image is MRI, very good for structural detail. You want to see the lesion? There it is. Now, here,” she said, clicking two glowing multicolored brain slices onto screens. “If you want to see the effect the lesion has on blood flow and metabolism, you use PET or fMRI. On the left you have Mr. Whitlow’s brain, on the right an image at the same level of a normal brain from another twenty-seven-year-old white male. The color blobs represent numerical values. We could assign any color to any number, but by convention the blues and purples represent low blood flow, ascending upward through the spectrum—blue, green, yellow, with orange, red, and pure white representing maximum blood flow.”

  Watson looked at the colored slice of Whitlow’s brain, which was mostly blue or purple in the frontal lobes, as contrasted with the normal brain on the right, which was mainly red, yellow, and white.

  “That’s resting state,” she said. “The difference is even more pronounced in the presence of external aggression. Here are PET scans from the same normal control while the subject is watching this computerized video clip of a spitting cobra blown up and displayed in 3-D multimedia. It’s a standard image, so is the accompanying explanation. The researcher shows the subject a digitized, high-resolution color ima
ge of a black-necked spitting cobra, taking care to explain that it is capable of spraying venom over eight feet into the eyes of its victim, which sears the eyes into temporary and exquisitely painful blindness, while the snake moves in for a bite and injection of a neurotoxin that causes seizures, intermittent respiratory arrest, raging fever, and slow death.

  “Certain circuits become more active according to the PET images, especially those older, lower parts of your brain where things like fear—primary emotions—originate. But the frontal cortex comes into play, too, because it regulates impulses and powerful emotions by way of feedback circuits wired to the amygdala and the limbics in general. That’s just one visual stimulus. The standard protocol includes dozens more. Heartwarming images of mothers cuddling infants at their breasts. Sunrises, concentration camp survivors, crying children, blooming flowers, smiling faces, angry faces, and so on—all presented in controlled environments and accompanied by standard narratives designed to activate certain specific cognitive pathways in the human brain.

  “We compile those images of brain activity and assemble an individual neurofunctional profile for each subject. We capture and record images of how the individual brain responds to stimuli, the very same stimuli and the very same test we administered to five thousand other people, including one or two thousand repeat felons, who heard exactly the same voice describe exactly the same snake, under exactly the same controlled circumstances.

  “We assemble a database of such profiles. Then, we teach a computer to catalog the profiles, looking for similarities and differences. We teach it to sort and compare and compare again, using the same kind of compare-and-contrast cycles the brain itself uses—what we call recurrent networks—and we find out who has certain predispositions and who doesn’t. Then we measure how well the subjects control those predispositions, by looking at the prefrontal cortex and the way it is wired to the limbics, specifically, you guessed it, the amygdala.”

  Watson stared at the PET image of Whitlow’s brain. “Can those colored blots tell us just why he shot this deaf black guy?” he said with a chuckle.

  “Not quite,” she said, “but I can tell you plenty about him. As you’ve already seen, he exhibits hypometabolism in the forebrain, which means his frontal cortex doesn’t get quite enough blood and oxygen to control those impulsive behaviors we talked about earlier.

  “Male. Unformatted. Biological markers for sex and violence found in tissue biopsies and cerebral spinal fluid, including low serotonin metabolite levels in his CSF. He has genetic Type-2 alcoholism—the worst kind—check the low P-300 brain waves. Dysfunctional D2 dopamine receptors. Low MAO platelet levels. There is evidence of transient depression, no surprise for an accused murderer awaiting trial.”

  Watson stared blankly into the images of colored brain slices on the monitors.

  “Got all that?” she asked, with a sly, sideways glance.

  Monitors sprang to life with more vivid color images. She pointed at one screen after another. “PET, CAT, echoplanar fMRI, MEG, SPECT, and EEG. Visual depictions of glucose consumption, electrical fields, magnetic fields, and blood flow—all capable of individual display or superimposition. What do you want to know?”

  “Is he crazy?” asked Watson. “I mean, in addition to having a hard mental defect.”

  “The lesion is confirmed by scores on the Halstead-Reitan and Luria-Nebraska Neuropsychological Batteries. Multiphasic personality inventories show elevated antisocial tendencies. Modern Racism Scale in the upper five percent. Solipsistic, narcissistic, atavistic, autistic, sadistic, in short some of the worst istics we’ve seen since the government started reimbursing us for finding them under the Federal Omnibus Scanning Technology and Forensic Applications Act of 1999.”

  She winked at him.

  “Final diagnosis?”

  “A classic Mitgang-Munchausen subanthropic homunculapathy. He’s even worse off than you are.”

  Watson looked at her uncertainly.

  She kicked him under the table. “I made up the last part, ya big dope. Just kidding.”

  She rolled a pencil between her lips and smiled at him. Her lips … “Stop me!” cried child Watson’s inner adult, as he felt himself lean forward, quelling the urge to gorge on ripe, moist crescents smudged with burgundy lip color. She leaned over a printout of James Whitlow’s EEG and read the interpretation to him. He wanted a peek at the pewter-colored lace nests where his twin obsessions were hiding out. A glimpse past the collar of her lab coat, down her throat, and into the neckline of her blouse revealed burgundy lace—a new color scheme—that matched her lips.

  “Elsa,” he said, “we need to go somewhere, for some grooming and maybe lice picking?”

  “Can’t,” she said. “Too many other primate scientists still working, and I don’t think you’re ready for group sex.” She raised an eyebrow. “Besides, last time you spent half the night complaining about how we needed to get to work and the other half asking your brain why it wanted to get laid in accordance with the Coolidge effect. So this time we are doing our work first. And if you fire up the guilt networks again, I’m putting you in the tube and taking some functional MRI films, so I can show them to my students.”

  “OK, what do the government’s experts want to do?” asked Watson.

  “The government’s neuropsychologists are going to be saying that the lesion does not affect Mr. Whitlow’s ability to appreciate the consequences of his actions. All these frontal lobe theories we’ve been throwing around are still new and arguable, but I’m pretty sure that we’ll get our evidence in, and they will try to refute it with their experts.”

  She opened a folder and went in search of a report. Watson tried to catch her eye, but she was all business in a chilly way, and he wondered if it was only because it was daytime and business hours at the institute.

  “They will also try to get some new-wave stuff in. You heard me mention the Modern Racism Scale? Pretty soft stuff. It’s a tricky test designed to deceive the subjects into confessing their true racial attitudes. Still very subjective. So a new test has recently been devised.”

  “To measure racism?” asked Watson. “C’mon.”

  “It can be done,” she said levelly. “No question about it. In fact, we can measure your attitude about almost anything, noninvasively.”

  “How?”

  “Remember the first three hundred milliseconds? The gap between stimulus and response, between intention and deed? The preconscious?”

  “Yes.”

  “I sit you in a chair in a controlled environment with a color monitor in front of you. I put what we call a good-bad response box in front of you, which is an input device to the computer. It has two buttons, one for your right index finger, one for your left. I start showing you words—good ones, like beauty, peace, friend, flowers; or bad ones, like nausea, evil, cancer, death. I measure exactly, in milliseconds, how long it takes you to judge the valence of the word, usually about five hundred milliseconds, half a second.”

  “OK,” said Watson.

  “Now, guess what happens if, a hundred milliseconds before I present a good word or image, I flash a bad word or image on the screen for two hundred milliseconds, just long enough for you to see it, but not long enough for you to think about it, and then I present the good word or image?”

  “I throw up?”

  “No.” She laughed. “It takes you longer to decide that the good word or image is positive. It’s called stimulus onset asynchrony. Let’s keep it concrete. When we showed Whitlow a gorgeous high-res photo of a blooming orchid, it took him half a second to punch the good button. If we flashed a picture of a white face for two hundred milliseconds just before presenting the orchid, it still took him only about five hundred milliseconds to punch good for the orchid. If we flashed a black face for two hundred milliseconds before presenting the orchid, it took him almost one whole second to make his decision, because his brain must first override the initial negative associations of the first image.
”

  “He’s a racist because he can’t push buttons fast enough?” asked Watson.

  “It’s good science,” she said. “John Bargh at NYU. Russell Fazio at Indiana. If the subject has positive feelings about the first image, or ‘priming image’ as we call it, and has the same positive feelings about the second image, the ‘target image,’ then he responds quickly. If one is negative and the other positive, there is a measurable delay. Furthermore, the longer the delay, the more powerful the positive or negative associations adhering to the first, or prime, image.”

  “This is all going to mean something soon,” said Watson. “I can feel it.”

  “Whitlow is a Pavlovian racist,” she said, “with powerful, immediate negative reactions to black faces. That’s no crime in itself, I guess. But I think the prosecutors will attempt to bundle these test results in with their psychological assessments, to show that any impulsive act undertaken by Whitlow against a black person would be accompanied by intense racial animus.”

  “But wait,” said Watson. “Doesn’t that mean he can’t help it? His racism is involuntary?”

  “Look at your statute,” she said. “It makes it illegal to intentionally select a victim because of the victim’s race, color, religion, national origin, ethnicity, gender, disability, sexual orientation, et cetera. It’s a two-headed crime. There’s the selection, which can be intentional, and there’s the motivation, which, according to the government, may be voluntary, involuntary, conscious, unconscious. Doesn’t matter.”

  “You’re sure you aren’t a lawyer?” Watson asked. “This stuff is science fiction,” he said.

  “The science is not fiction,” she replied. “The only question is whether it is admissible evidence in a federal murder trial. If it comes in, I can’t take the stand and say it’s bad science, nor can I prove that Whitlow has automatic positive feelings about black people, because he doesn’t. He has automatic, powerful negative feelings about them.”

  “More evidentiary theory,” moaned Watson.

  “You got it,” she said. “And now that you understand automaticity testing, if you’d like to make an appointment, I’ll rig you up and test your automatic, preconscious attitudes about your wife by slipping in a photo of her two hundred milliseconds before I show you a picture of that spitting cobra. You want?”