Patient H.M.
Page 1
Copyright © 2016 by Luke Dittrich
All rights reserved.
Published in the United States by Random House, an imprint and division of Penguin Random House LLC, New York.
RANDOM HOUSE and the HOUSE colophon are registered trademarks of Penguin Random House LLC.
This work is based, in part, on “The Brain That Changed Everything,” by Luke Dittrich (Esquire, November 2010).
PHOTOGRAPHY CREDITS
This page: Author’s collection; this page: Reproduced by permission of the Osler Library of the History of Medicine, McGill University; this page: Courtesy of the Institute of Living Archives; this page: © Luke Dittrich; this page: © Spence Lowell
LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA
Names: Dittrich, Luke, author.
Title: Patient H.M.: a story of memory, madness, and family secrets / Luke Dittrich.
Description: New York : Random House, 2016.
Identifiers: LCCN 2015048638| ISBN 9780812992731 (hardback) | ISBN 9780679643807 (ebook)
Subjects: | MESH: H. M., 1926–2008. | Scoville, William Beecher, 1906–1984. | Amnesia, Anterograde | Epilepsy—surgery | Memory Disorders | Memory, Long-Term | Biography
Classification: LCC RC394.A5 | NLM WM 173.7 | DDC 616.85/232—dc23 LC record available at http://lccn.loc.gov/2015048638
ebook ISBN 9780679643807
randomhousebooks.com
Book design by Simon M. Sullivan, adapted for ebook
Cover design: Evan Gaffney
Cover photograph: Photograph of H.M. Copyright © Suzanne Corkin, used courtesy of Suzanne Corkin and by permission of The Wylie Agency LLC.
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Contents
Cover
Title Page
Copyright
Epigraph
Prologue
Part I: Origins
Chapter One: The Fall
Chapter Two: Crumpled Lead and Rippled Copper
Chapter Three: Dream Jobs
Chapter Four: The Bridge
Chapter Five: Arline
Part II: Madness
Chapter Six: Pomander Walk
Chapter Seven: Water, Fire, Electricity
Chapter Eight: Melius Anceps Remedium Quam Nullum
Chapter Nine: The Broken
Chapter Ten: Room 2200
Chapter Eleven: Sunset Hill
Chapter Twelve: Experiment Successful, but the Patient Died
Chapter Thirteen: Unlimited Access
Chapter Fourteen: Ecphory
Chapter Fifteen: The Vacuum and the Ice Pick
Part III: The Hunt
Chapter Sixteen: It Was Brought into the Sea
Chapter Seventeen: Proust on the Operating Table
Chapter Eighteen: Fortunate Misfortunes
Chapter Nineteen: Henry Gustave Molaison (1926–1953)
Part IV: Discovery
Chapter Twenty: Where Angels Fear to Tread
Chapter Twenty-one: Monkeys and Men
Chapter Twenty-two: Interpreting the Stars
Chapter Twenty-three: The Son-of-a-bitch Center
Chapter Twenty-four: The MIT Research Project Known as the Amnesic Patient H.M.
Part V: Secret Wars
Chapter Twenty-five: Dewey Defeats Truman
Chapter Twenty-six: A Sweet, Tractable Man
Chapter Twenty-seven: It Is Necessary to Go to Niagara to See Niagara Falls
Chapter Twenty-eight: Patient H.M. (1953–2008)
Chapter Twenty-nine: The Smell of Bone Dust
Chapter Thirty: Every Day Is Alone in Itself
Chapter Thirty-one: Postmortem
Epilogue
Dedication
Acknowledgments
About the Author
Man is certainly no poorer as an experimental animal merely because he can talk.
—PAUL BUCY
Every day is alone in itself. Whatever enjoyment I’ve had, and whatever sorrow I’ve had.
—HENRY MOLAISON
PROLOGUE
The laboratory at night, the lights down low. An iMac streams a Pat Metheny version of an Ennio Morricone tune while Dr. Jacopo Annese, sitting in front of his ventilated biosafety cabinet, a small paintbrush in his hand, teases apart a crumpled slice of brain. The slice floats in saline solution in a shallow black plastic tray, looking exactly like a piece of ginger at a good sushi restaurant, one where they don’t dye the ginger but leave it pale. Annese takes his brush and, with practiced dabs and tugs, gently unfurls it. The slice becomes a silhouette, recognizable for what it is, what organ it comes from, even if you are not, as Annese is, a neuroanatomist.
He loves quiet nights like these, when his lab assistants set him up with everything he needs—the numbered specimen containers, the paintbrushes, the empty glass slides—and then leave him alone with his music and his work.
Annese coaxes the slice into position on the slide that lies half submerged in the tray, cocking his head, peering at it from different angles, checking to see that he has the orientation right. When you’re looking directly at the slide, the left hemisphere must be on the right side of your field of view, just as it would be if you were you staring into the eyes of the brain’s owner. Although brains are roughly symmetrical, they are not entirely so, and Annese has become familiar with the topography of this one, all its subtly asymmetrical sulci. At the very center of this slice, in an area that would normally contain a buttressing framework of neural tissue, there are instead two gaping holes, one in each hemisphere. Annese takes extra care not to tear the edges of the holes or distort them, dabbing painstakingly at their frayed perimeters with the tip of his brush. The holes are historic, precious in their own way. Annese does not want to become famous as the second doctor to desecrate this particular brain.
A few more prods and Annese begins to pull the glass out of the tray. Before he trained as a scientist, he worked as a cook, and he often uses cooking analogies to explain his techniques. The art of histology is a lot like baking, he says, since in both everything must be finely calibrated, with little room for improvisation. Soon the slide, with its burden perfectly positioned, is resting safely on the tepid surface of a warmer, where it will be left to dry overnight.
Annese reaches for another cryogenic vial, number 451, screws off the lid. Just before he tips the next slice into the tray, he turns to me and smiles.
“See how much work I have to do to clean up the mess your grandfather made?” he says.
—
There were things Henry loved to do.
He loved to pet the animals. Bickford Health Care Center was one of the first Eden Alternative facilities in Connecticut, which meant that along with its forty-eight or so patients, the center housed three cats, four or five birds, a bunch of fish, a rabbit, and a dog named Sadie. Henry would spend hours sitting in his wheelchair in the courtyard with the rabbit on his lap and Sadie by his side.
He loved to watch the trains go by. His room, 133, was on the far side of the center, and from his window, several times a day, he could watch the Amtrak rumble past the abandoned redbrick husk of the old paper mill across the street.
He loved word games. He’d sit for hours and hours and work through books full of them. Many of the scientific papers that have been written about Henry over the past six decades describe his avidity for crossword puzzles, though in his later years he found them too great a challenge and started doing simple find-a-word puzzles instead.
He loved old movies. Bogart and Bacall, that era. The African Queen. Gone with the Wind. North by Northwest. We call them classics, though of course they were not classics to him. He’d ask to see one of these movies, and a nurse or attendant would pop in a videocassette. Television s
ets were no shock to him, TV being a technology that developed during his time. But he never did figure out how to operate a remote control.
He loved talking to people. He’d tell them stories. He told the same stories, over and over, but he always told them with equal enthusiasm. When people asked him if he remembered meeting them before, he’d often tell them that yes, he thought they’d once been friends. Hadn’t they gone to high school together? Even when his uncertainty about these sorts of things frustrated him, he usually remained courteous and cheerful. Compliant, too. When the scientists would come to pick him up and take him to the laboratory, he never objected. And he almost always took his meds when the nurses asked him to. On the rare occasions that he refused, the nurses knew of an easy way to get him to cooperate. It was a trick passed down over decades, from one nurse to another.
“Henry,” a nurse would say, “Dr. Scoville insists that you take your meds right now!”
Invariably he would comply.
This strategy worked right up to the end, until Henry died. The fact that Scoville had died decades before then, and that they’d had no contact for decades before that, made no difference. Scoville remained an authority figure in Henry’s life because Henry’s life never progressed beyond the day in 1953 when Dr. William Beecher Scoville, my grandfather, removed some small but important pieces of Henry’s brain.
—
I remember following my grandfather up a snowy hill during his last winter.
I think he was wearing a light blue parka, and in my mind the parka is worn and threadbare, though that would have been uncharacteristic of him. This is a man who was once described by a New York Times reporter as “almost unreal in his dashing appearance.” But there it is in my memory: a threadbare blue parka. Maybe he even had a woolen cap, one with a pom-pom top, pulled down over his pomaded hair. He always combed his hair with olive oil, that’s what my mom says.
We were going sledding.
I remember snow, a white sky, some trees. Cold. Tramping up the hill together.
He was dragging an old-fashioned wooden toboggan behind him, big enough for the two of us. When he reached the top of the hill, he stopped, looked back toward me, and waited.
Why do I remember any of this?
I remember because when the cascade of impressions from my eyes, ears, and skin bombarded me with sights and sounds and textures, with leafless trees and my grandfather’s hat and the crunch of our boots in the fresh snow, those impressions were channeled to some small but important parts of my ten-year-old brain. Then my brain went to work, processing raw sensation into something else: a memory, one that still resides inside me, three decades later, to be called up on occasion and dragged, blinking and uncertain, into the light.
I’m getting ahead of myself.
Memories make us. Everything we are is everything we were. This has always been true and is so obvious that it hardly needs to be said. But though memories make us, we’ve only recently begun to understand how we make memories. The story of how we’ve gained this understanding is the story I’m telling in this book. It’s a story with heroes and villains, tragedy and romance, violence and tenderness. My grandfather plays a part, but it’s much bigger than my grandfather.
It’s a story about science, and about nature, human and otherwise.
And it begins, like a lot of stories do, with a fall.
PART I
ORIGINS
ONE
THE FALL
In the northwest corner of Colt Park, in downtown Hartford, Connecticut, a ten-foot-tall bronze statue of the park’s namesake rose from a granite pedestal. Engraved tributes to Samuel Colt, inventor of the Colt .45, covered one side of the pedestal, but the boy trudging toward it wouldn’t have been able to read them even if he’d wanted to, since he wasn’t wearing his glasses. It was dinnertime, July 3, and it was probably 1933 or 1934, though the exact year would be one of the things that scientists would argue about in the decades to come. His family’s second-floor walk-up apartment was about a quarter mile away. He was seven or eight years old and already he’d moved at least three times. His father was an electrician, didn’t make much money, had to go wherever the work was. It must have been confusing sometimes for the boy, all these homes flashing by, all those fresh starts. He had blond hair and bright blue eyes and a sweet, uncertain smile.
A steep road skirted the northern edge of the park, and if the boy cut across it and down some backstreets, he could shave a little time off his walk home. The boy’s eyesight may have been bad, but there was nothing wrong with his ears. He didn’t hear any cars coming. He stepped off the sidewalk and started crossing the road.
The bicyclist, coasting down the hill, didn’t see Henry until it was too late.
—
Hippocrates Asclepiades, a Greek physician born on the island of Cos in the fourth century B.C.E., is widely regarded as the father of modern medicine. Although his last name indicates a claimed family connection to Asclepius, the revered doctor-god of Greek myth, Hippocrates became famous by advancing the revolutionary argument that the gods had no place in medicine. Healers of one sort or another have existed for as long as humans have, but Hippocrates was one of the first to reject the magic and spiritualism and religion that most who came before him relied on. Instead he attempted to localize the sources of our ailments in our physical environment and inside our bodies themselves.
That approach was well illustrated in an essay he wrote called “On the Sacred Disease.” The title was a little misleading, since Hippocrates preferred to call the disease in question by a different name: epilepsy, from the Greek epilambanein, which means “to seize.” And the disease of epilepsy, he wrote, was “no more divine than others; but it has its nature such as other diseases have, and a cause whence it originates.” He criticized the “conjurors, purificators, mountebanks, and charlatans” who used “divinity as a pretext and screen of their own inability to afford any assistance,” and he ridiculed them for blaming the gods for the various ways epilepsy manifested itself in their patients: “For, if they imitate a goat, or grind their teeth, or if their right side be convulsed, they say that the mother of the gods is the cause. But if they speak in a sharper and more intense tone, they resemble this state to a horse, and say that Poseidon is the cause. Or if any excrement be passed, which is often the case, owing to the violence of the disease, the appellation of Enodia is adhibited; or if it be passed in smaller and denser masses, like a bird’s, it is said to be from Apollo Nomius. But if foam be emitted by the mouth, and the patient kick with his feet, Ares then gets the blame.”
After rejecting all the sacred explanations, Hippocrates presented a startling explanation of his own: “The brain is the cause of this affection,” he wrote, “as it is of other very great diseases, and in what manner and from what cause it is formed, I will now plainly declare.”
The details of Hippocrates’s subsequent explanation of the aetiology of epilepsy, of course, haven’t stood the test of time. In his view, the brain was a pneumatic organ, alternately pulsing with phlegm and bile. It was delicately attuned to the winds, and the wrong wind blowing on the wrong person at the wrong time could wreak havoc. If the west wind buffeted a constitutionally phlegmatic child, for example, it might cause the child’s brain to temporarily “melt,” at which point epileptic fits would occur. Hippocrates’s prescription for such children would be to shield them from the west wind and expose them instead to the north wind, which would, presumably, recongeal their brains and set them right.
What’s important about Hippocrates isn’t that he figured out epilepsy’s origins or its treatment—he did neither—but that he began looking in the right place: not up to the heavens or Mount Olympus but into the even more mysterious terrain inside our skulls.
In the years since, many doctors grappling with the problem of epilepsy followed Hippocrates’s lead, venturing deeper and deeper into the brain, seeking a secular understanding of the “sacred disease.”
—
Let’s imagine ourselves inside Henry’s skull.
Let’s imagine the moment after the bicycle hit him and before he hit the ground, when he was neither standing nor lying down but was instead floating through the air.
His brain was floating, too. It was nestled in a warm pool of cerebrospinal fluid, while vivid sensations of every sort coursed through it. The pain from wherever the bicycle impacted him, the shards of scenery as he was knocked off his feet, the view of the fast-approaching ground, the sound of his own involuntary gasp, the feel of his wavy hair ruffling as he fell through the air—all of these sensations and more were relaying from the nerves in his retinas, his auditory canals, his skin, his vestibular balance system, and buffeting his brain, which processed them into the multidimensional stew we experience as in-the-moment consciousness.
Now let’s imagine the impact.
Henry landed on the left side of his head, hard enough to tear a deep inch-long gash in his forehead just above his eyebrow. His brain then experienced what are known as torsional forces—that is, forces that caused it to twist inside his skull, in this case from left to right. At the same time, it sloshed forward in its watery womb, pushing up against the thin membrane of the pia mater and the thicker membranes of the arachnoid and dura mater, its weight compressing them all until it crashed against the unyielding barrier of his skull. His brain deformed. It changed shape exactly like a rubber ball does when it hits a hard surface, and then rebounded. If it was moving fast enough, if the rebound was strong enough, it again compressed the various layers of insulation that usually kept it safe, this time on the opposite side of his skull. This second impact would have been somewhat less violent than the first. And if it rebounded again, to make a third transit, it would be moving even more slowly. Within a second, it stopped its bouncing. The force of the impact dissipated, and Henry’s brain was again floating serenely in its warm pool of cerebrospinal fluid.