Patient H.M.

by Luke Dittrich

  Breasted spent nearly ten years working on his own translation of the scroll, and when he published it, in 1930, he declared the so-called Edwin Smith Papyrus “the oldest nucleus of really scientific knowledge in the world.”

  The scroll, Breasted revealed, was a medical textbook. And in its formatting, it was a strikingly modern one: The passages written in red, for example, were done to highlight the key parts of the text that the author wanted the reader to remember. But much more surprising was how modern its contents were, this despite the fact that the scroll itself was at least 3,600 years old and contained archaic turns of phrase that indicated it may have been a transcription of a text eight hundred years older than that.

  Up until Breasted’s translation, the prevailing view of medicine in ancient Egypt was that it was based in magic, not science. Previously discovered papyri about medical topics limited their prescriptions to incantations and dubious potions. And the Edwin Smith Papyrus had some of that: The scroll was organized as a series of forty-eight case studies of battlefield injuries, each with its own treatment recommendation. In case nine, a man with a bashed-in forehead, the would-be attending physician was advised to chant the following spell while standing over his patient: “Repelled is the enemy that is in the wound Cast out is the evil that is in the blood The adversary of Horus, on every side of the mouth of Isis This temple does not fall down There is no enemy of the vessel therein I am under the protection of Isis My rescue is the son of Osiris!”

  Most of the prescriptions, however, were secular. And most of the case studies—twenty-seven out of forty-eight—involved head trauma.

  For example:

  Case 6: Medical instructions for an oozing gash/cutting wound in his head that penetrates to the bone, smashing in his cranium and exposing the brain in his cranium.

  —You have to probe his wound.

  —Should you find [in] that smash fracture that is in his cranium, ripples [like] those that occur [in] copper in the smelting process,

  —and something within that throbs and flutters under your fingers like the weak spot of the crown of a child not yet fused and made “whole.”

  You should daub that wound of his with oil.

  —Do not bandage it.

  —Do not put dressings on it until you know that he has passed the crisis!

  The smash fracture is large, opening to the inside of his cranium and the membrane enveloping his brain is ruptured and its fluid falls from the interior of his head.

  Although the treatment in this case by modern standards is conservative—clean the wound and hope for the best—it’s about as promising an approach as you could hope to find in a four-thousand-year-old hospital. Sealing the wound, for example, would have probably done more harm than good, causing death through swelling or infection. The Egyptians were apparently not only restrained physicians but accomplished neuroanatomists as well: Up until the translation of the Smith papyrus, nobody had found the word brain in any prior hieratic or hieroglyphic documents. In this one, however, they didn’t just name the brain, they described it in vivid poetic detail—with its “ripples [like] those that occur [in] copper in the smelting process”—along with the membranes and cerebrospinal fluid that swaddled it. The brain, the ancients clearly understood, was a delicate and important organ. It was also an organ that, in general, should be protected and not actively messed with. In the case of a patient with a fractured skull, you might “clean it for him with a swab of linen until you see its fragments of bone,” but the brain itself should remain untouched.

  After the revelations of the Edwin Smith Papyrus, some Egyptologists argued that the Egyptian ankh—which represents the human spinal column—would make a more historically accurate symbol for the medical arts than the traditional snake-twined staff. (That symbol derived from myths about the staff-wielding, snake-revering Greek doctor-god, Asclepius, who was so good at keeping people alive that Zeus killed him to prevent overpopulation.) In any event, the papyrus seemed to prove that modern medicine had begun far earlier than was previously thought, and the cautious treatments it prescribed indicated that at least some ancient doctors were adhering to the central tenet of the Hippocratic oath more than a thousand years before Hippocrates’s birth.

  “Abstain from doing harm….”

  A simple principle, and an enduring one.

  For most of the long history of the healing arts, that principle has guided the care and treatment of our most mysterious and delicate organ.

  Protect it when possible, keep it clean, don’t muck about inside.

  That was the status quo for thousands of years.

  Until suddenly it wasn’t.

  THREE

  DREAM JOBS

  In the lab at MIT, Henry was explaining, again, the many moves his family had made when he was a child. Even the scientists found his odyssey confusing. Dr. William Marslen-Wilson, a British psychologist who was interviewing him, worked hard to follow Henry’s story.

  “I see,” Marslen-Wilson said at one point. “Right. It’s all becoming clearer now. A lot of schools, a lot of houses, difficult to sort out.”

  “And from there,” Henry continued, “we moved from Franklin Avenue out to South Coventry, Connecticut. And I had to take a school bus, which stopped—I was the last one to get on it in the morning—and take me home, take me from South Coventry to Willimantic, and I think it was exactly five miles, right from our house to Willimantic.”

  “And you were in…what sort of school were you in?”

  “That was in a high school. Windham High.”

  “Windham?”

  “Windham High School.”

  “Do you remember how to spell Windham?”

  “Well, it’s W-I-N-D-H-A-M.”

  “And what grade were you in there?”

  “Second year of high…and well, half of the third year.”

  “Why only half of the third year?”

  “Because we moved from South Coventry back to Hartford, and I quit school.”

  “Yes.”

  “And it was then…well, then after that we moved from light-housekeeping rooms that we had….”

  “Lighthouse-keeping?”

  “Yes.”

  “Uh, I don’t really understand about this lighthouse-keeping. You mean your parents were working in a lighthouse?”

  Henry’s parents had not worked in a lighthouse. His father was an electrician, his mother a housekeeper. They didn’t make much money. Their savings, small to begin with, had been hammered down to almost nothing in the stock market crash of 1929. A light-housekeeping room was mid-twentieth-century American shorthand for a partly furnished tenement apartment. When Henry was a teenager, his family put their furniture into storage and lived in a string of light-housekeeping rooms in and around Hartford.

  To supplement the family income, Henry took on part-time jobs. He worked as an usher in a movie theater, a stock boy in the shoe department of the G. Fox & Co. department store, and a scrap-metal salvager at a junkyard. After dropping out of high school, he started learning a trade, training as a motor winder at Ace Electric Motors. The job involved taking small electric motors apart, eyeballing their individual parts for problems or defects, and then rewinding the copper wires that coiled tightly around each motor’s magnetic core. It was a good job, one with a future, but eventually he had to give it up. By that time, his epilepsy had become much more severe. He had his first grand mal seizure on his fifteenth birthday. He remembered driving with his father. He didn’t remember if he was in the front or the backseat, but he thought that it was probably the backseat, because when he began convulsing and fell forward his father didn’t notice at first and just kept driving. Then he had another seizure, in which he fell down someone’s front steps and awoke on a sidewalk. He began having them more and more often. Afterward he would typically remember what he’d been doing immediately prior to seizing up, but the seizures themselves were inaccessible, a blank spot in his mind. When they struck, they sen
t him to oblivion, exactly like that bicycle in Colt Park had done. Motor winding required delicacy and precision, and even when Henry wasn’t having a full-blown grand mal, the petit mals were enough to compromise his work, causing him to strip too much insulation from wires or to leave out some essential part of the motor when he put it back together.

  He eventually went back to high school, enrolling at East Hartford High and struggling his way through to a diploma. By the time of his graduation, his seizures were so frequent that the decision was made to keep him from collecting the diploma onstage. In the laboratory, he explained to Dr. Marslen-Wilson about what might have happened otherwise.

  “Well, in a way that was more protection of themselves,” he said, “so if I was to have an attack or something like that, I wouldn’t fall or something and disturb the others that were there, that were graduating, and the people in the audience.” He explained that even a petit mal would have been enough to cause a disruption. “You black out. You could be walking to get your diploma or something, and you walk right by the person that was handing out the diploma instead of stopping and getting the diploma and then walking off.”

  “That would have been a bit difficult,” Marslen-Wilson said.

  “Yes, it would,” Henry said.

  After high school, Henry got the last job he remembers, working on the assembly line at the Underwood Typewriter factory. Again, his illness became an issue. He was in the middle of the line, helping put together the frame of the typewriter before another worker attached the keys. This required less skill than motor winding, but still, sometimes the parts of the typewriter might be laid out in front of him, ready for assembly, and he would suddenly go absent, frozen, eyes open but looking at nothing, and the line would back up behind him until he came to.

  —

  I recently found a moldering cardboard box in my mother’s basement. Inside was a stack of letters wrapped in twine. The letters had all been sent by either my grandfather or his older brother, Gurdon, to their mother in the late 1920s. Most were in their original envelopes, and on a few of these envelopes my great-grandmother had scrawled little notes to herself. Sometimes the notes were just hints about the contents—“About graduation”; “My birthday”—but sometimes they were more like mini-reviews: “To be kept always in my lifetime, this letter of Gurdon’s”; “About our beloved home, Treetop”; or “A beautiful letter to be kept from Gurdon.”

  Usually, she would only add those extra heartfelt little notes to Gurdon’s letters. And reading the letters themselves, it was easy to see why. Gurdon was so effusive in his love for his mother that it was almost creepy. Here’s a typical passage, written when he was several years into seminary school and already sounding like the minister he would become:

  I have never felt before what I feel at this moment—the union of our hearts and souls in a way that has broken all the barriers of distance and brought me into a sudden new understanding of what love between two persons really can be and how it lifts them into the realm of the eternal beyond the mile posts and clock ticks of our little earth. You must be thinking of me, Mother darling, and praying for me this morning—you have given me just as I have been writing this letter something more than I ever before had—a feeling of how we cannot ever be separated that I will always count one of my sacred experiences.

  The letters from my grandfather were different. They, too, were loving—both sons clearly adored their mother—but my grandfather’s letters tended to be maudlin, full of apologies.

  “My mother darling,” he wrote toward the end of his senior year at Yale University, “I have just written father about 42 pages, but seem to be just as discouraged, so will continue with you. After reviewing all of your last letters and his, the world has become darker and darker, letter by letter. I am sorry about everything I have done, for I don’t mean to be so selfish and mean. I have been awfully wrought about money matters, and am trying to work it out all right.” He laid out the various ways he was trying to supplement his “allowance,” ranging from tutoring to selling jewelry he had imported from China. “I am working my head off with this jewelry in an effort to be self-supporting,” he wrote, then added a clause that said a lot about the privileges of his upbringing, “and am giving the Rolls back to Pen without using it, as you wished.” Toward the end of the letter, he unleashed a fusillade of self-pity and self-recrimination. “I am more sorry than I can say that I disappoint you both with my carefree-ness and thoughtless selfishness. I have worried too much to be exactly carefree. I love you so much and think of you so much and your goodness to me and in you—as I grow older—that I feel very miserable when I hurt you so—please forgive me.”

  The painful insecurity on display in this letter was present in several others from that same year as well. In one he sent to his mother on her thirty-ninth birthday, he wrote, “I want all of my friends to see what a mother I have—then they will realize that even if I am not going to be a success in life, it was not my mother’s fault.”

  It was hard to know what to make of this. People I’d spoken with over the years had applied a lot of adjectives to my grandfather—brilliant, arrogant, dashing, reckless—but insecure wasn’t one of them. The man berating himself in these letters didn’t match the image I had of Dr. William Beecher Scoville. But maybe that was the point. The person writing these letters was still just Bill Scoville, a rich kid from Philadelphia, struggling through college, trying to decide what to do with his life. He was smart and ambitious, and possessed certain talents—he was, for example, good with his hands, loved tinkering with cars, taking them apart and putting them back together to understand their inner workings—but he didn’t yet know what he wanted to do with these skills.

  Deeper in the same box the letters had been hiding in there was a brown-jacketed photo album with yellowing pages, and in the album was a photograph of my grandfather. He was probably two or three, wearing one of those frocks that toddler boys wore in the early 1900s, reaching a tiny hand up toward the mouth of a live rattlesnake that had wrapped itself around the staff of his father’s arm. (His father was an eccentric polymath—a lawyer, a writer of children’s adventure books, and an amateur naturalist—and used to keep a variety of venomous serpents as pets until his wife forced him to stop.) Seeing that photo, I got a cheap little jolt, since the obvious symbolism of it—the snake and the staff—seemed to portend my grandfather’s eventual choice of career.

  Within a year of writing those letters to his mother, he had moved back to Philadelphia, enrolled in the University of Pennsylvania’s medical school, and thrown himself into his studies.

  —

  Sometime around 1969, in the middle of taking some tests, Henry stopped and looked up at his examiners.

  “Right now,” he said, “I’m wondering, have I done or said something amiss? You see, at this moment, everything looks clear to me, but what happened just before? That’s what worries me. It’s like waking from a dream.”

  Henry often described his inner state that way: a constant feeling of having just emerged from a dream. There’s a psychological term used to describe that feeling: hypnopompia. It derives from the Greek hypnos (sleep) and pompe (sending away), and it’s a common sensation, experienced as our minds dispel our dreams and snap us back to reality. In Henry’s case this feeling never went away.

  As it happens, Henry’s dreams, like so many other aspects of his life, were also a subject of intense scientific inquiry. He once spent several nights in a sleep laboratory at MIT, hooked up to sensors. Whenever he entered REM sleep, a researcher would shake him until his eyes opened and then ask him what he’d been dreaming about. In the end, the researchers never published their dream studies, in part because nobody could decide whether Henry was actually dreaming at all, in the normal sense, or whether he was even capable of dreaming, since many scientists consider dreams to be patchworks constructed out of recent memories. But some of the transcripts survived. In them, he usually just talked about the sam
e sorts of things he liked to talk about when he was awake—boyhood recollections of a road trip to Florida with his parents, of shooting targets in his backyard, of fishing with his dad. Occasionally, he would talk about what he claimed were old childhood ambitions.

  “Henry, Henry, Henry?”

  “Oh!”

  “Were you dreaming?”

  “Yeah.”

  “What were you dreaming about?”

  “I was having an argument with myself….”

  “About what?”

  “What I could have been…I dreamed of Pennsylvania. I dreamed of being a doctor. A brain surgeon. And it was all quick. Flashlike, being successful. And living down that way…tall straight trees.”

  It’s doubtful that Henry ever shared my grandfather’s aspirations. Instead he probably just imagined himself into his shoes. Even from the depths of his perpetual hypnopompic murk, some part of Henry saw things clearly enough to know that the nearsighted child of an electrician and a housekeeper would have had trouble pursuing that particular goal. A decade after the dream study, fully awake, Henry explained to another scientist that he had eventually decided against becoming a neurosurgeon due to his poor eyesight.

  “Because I know, in brain surgery”—maybe Henry gestured with one of his hands as though he were holding a scalpel—“that wearing glasses, these little…”

  Maybe he made a slight twitch with his hand then, pantomiming the scalpel going a little too far, cutting a little too deeply.

  “That person is gone,” Henry said of his imaginary patient.

  FOUR

  THE BRIDGE

  On September 21, 1930, just before dawn, a twenty-four-year-old man from Pennsylvania named Norman J. Terry snuck past the watchmen for the still-under-construction George Washington Bridge, then climbed to the top of the enormous steel tower on the Manhattan side, bypassing the elevator for the stairs. Once at the summit, six hundred feet above the Hudson River, he edged out onto one of the four steel cables that hung between the tower and its twin in New Jersey. The distance between the two towers was precisely 3,600 feet, but the cables were far longer than that; they hung down in gentle parabolic arcs, creating the bottom halves of enormous bowls that, if extended into complete circles, could have swallowed the Empire State Building whole. Each cable contained 26,474 pencil-thin strands of steel, forged at a factory near Trenton and woven together into one mammoth braid three feet in diameter. If you unspooled the individual wires in all the cables, you would have a length of metal rope long enough to circle Earth four times or reach halfway to the moon, depending on your taste in superlatives.