Patient H.M.

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Patient H.M. Page 21

by Luke Dittrich


  H.M.: At one time that’s what I wanted to be.

  RESEARCHER: Is it? What?

  H.M.: A brain surgeon.

  RESEARCHER: A brain surgeon?

  H.M.: Yeah. And I said no to myself. Before I had any kind of epilepsy.

  RESEARCHER: Did you? Why is that?

  H.M.: Because I wore glasses. I said, suppose you are making an incision in someone, and you could get the blood on your glasses, or an attendant could be mopping your brow and go too low and throw your glass off.

  RESEARCHER: That would be bad, wouldn’t it?

  H.M.: Yeah, ’cause you’d make the wrong movement then.

  RESEARCHER: And then what might happen?

  H.M.: And that person could be dead or paralyzed.

  RESEARCHER: Yes. So it’s a good job you decided not to be a brain surgeon!

  H.M.: Yeah. I thought mostly dead. But could be paralyzed in a way. You could be making the incision right, and then a little deviation. Might be a leg or an arm. Or maybe an eye, too. On one side, in fact.

  RESEARCHER: Do you remember when you had your operation?

  H.M.: No, I don’t.

  RESEARCHER: What do you think happened there?

  H.M.: Well, I think I was, I’m having an argument with myself right away, the third or fourth person to have it. And I think they, well, possibly didn’t make the right movement at the right time, themselves then. But they learned something that would help other people around the world, too.

  RESEARCHER: They never did it again.

  H.M.: They never did it again, because by learning it. And a funny part is, I always thought of being a brain surgeon myself.

  RESEARCHER: Did you?

  H.M.: Yeah, and I said no to myself.

  RESEARCHER: Why’s that?

  H.M.: Because I said, an attendant might mop your brow, and might knock your glasses over a little bit, and you make the wrong movement.

  RESEARCHER: What would happen then if you made the wrong movement?

  H.M.: And that would affect all the other operations you had then.

  RESEARCHER: Would it? How?

  H.M.: Because that person was paralyzed on one side. Or you made the wrong movement in a way, and you possibly couldn’t hear on one side. Or one eye, tight. You would wonder to yourself then, and it would make you more nervous.

  RESEARCHER: Yes it would.

  H.M.: Because every time you did, you’d try to be extra-careful, and it might be detrimental to that person. Perform the operation right on that time. Because you’d have that thought and that might slow you up then. As you make the movement. And you could have continued right on.

  RESEARCHER: Do you remember the surgeon who did your operation?

  H.M.: No, I don’t.

  RESEARCHER: I’ll give you a hint. Sco…

  H.M.: Scoville.

  By 1953, it was obvious that the drugs hadn’t helped. Henry was on massive doses of powerful, brain-dampening epilepsy medications—Dilantin, five times a day; Mesantoin, three times a day; phenobarbital, twice a day; Tridione, three times a day—and they hadn’t helped, or at least they hadn’t helped enough. Henry was still seizing several times a day, sometimes falling to the ground, sometimes just falling silent. Those second type of seizures, the petit mal ones, were often described as “absences.” When he was in their grip he became, briefly, a human husk, his lungs working and his heart beating but his mind on pause. The truth was, though, that even when he wasn’t seizing, Henry was never entirely present, in the sense that his epilepsy had caused him to withdraw from the richer life that might otherwise have been his.

  He was a smart, strong twenty-seven-year-old man, but he existed within borders as circumscribed as a child’s. Weekday mornings he’d catch a ride downtown to the Underwood factory, on Capitol Avenue, where he’d sit on the line and help assemble the typewriters, a blue-collar worker making white-collar tools. In the afternoon he’d catch a ride back home to his parents’ house in East Hartford. He was unable to drive a car, of course, just as he was unable to go off to war, or to college, or to any of the other places that his old friends had gone. Instead he just stayed home, where his parents could take care of and watch over him. He would spend evenings listening to the radio. He liked the big bands—Benny Goodman, Duke Ellington—and he liked some of the new rock and roll—the jive music, as he called it—that tinned through the speakers. He liked dance music but he never danced. He read magazines, soaked up Hollywood gossip, learned about scandals and successes of the sort he knew he would never experience. On a good weekend he would take a rifle a short walk into some nearby woods, heft the stock to his shoulder, sight down the barrel at a target, pull the trigger, and feel the kick. On a bad weekend he wouldn’t do much of anything at all.

  In 1953, Henry’s past was still clear to him. It was his future that was growing dark. If things continued as they were, if his seizures continued to increase in frequency and severity, it wasn’t hard to imagine that he would soon become too big a burden for his aging parents. If he became unable to work, unable to contribute, Gustave and Elizabeth might have to let him go. They might have to send him someplace like the nearby Mansfield Training School, an institution founded in 1930 through the merger of two older institutions, the Connecticut Training School for the Feebleminded and the Connecticut Colony for Epileptics. There the strictures that bound his life would be cinched even tighter. Like many of the other residents, he might be put to work in the onsite factory, making bricks. Or he might just sit in one of the crowded wards, becoming more and more absent, continuing his slow slide toward an uncertain fate.

  Unless.

  —

  In a large banquet hall at the Hollywood Beach Hotel, in Hollywood, Florida, on the afternoon of April 23, 1953, my grandfather stepped to a podium to give a speech to the Harvey Cushing Society, America’s preeminent association of brain surgeons. It was the closing address of that year’s neurophysiological symposium. A little earlier, John Fulton had given the symposium’s opening remarks, during which he’d made a joke about Becky, the chimpanzee from his laboratory who had inspired Egas Moniz to begin lobotomizing humans seventeen years before. “Was this the face that lopped ten thousand lobes?” Fulton asked, referencing a photo of Becky’s wrinkled features. Then Fulton made a now familiar entreaty, urging the many psychosurgeons in the crowd “to study their patients with the same thoroughness with which chimpanzees are studied, for you have a much finer opportunity to gain insight into some of the basic problems of frontal lobe function than we who are limited to gaining information from inarticulate beasts.”

  Paul MacLean, another Yale researcher, spoke after Fulton. MacLean was considered the world’s leading authority on the limbic region in animals, and his speech opened with a literary flourish: “Today, with the annual celebration of Shakespeare’s birthday, it may be expected that the occasion will arouse renewed discussion among those interested in English literature as to whether Shakespeare or Bacon wrote the plays. This points up for contrast an equally bewildering problem that faces those whose major concern is with the functions of the brain. In the brain, the authors of function—the structures themselves—are easily identified. But what do these authors write? That is the question. This is no better illustrated than by our lack of knowledge regarding the functions of parts of the limbic system that will concern us here, particularly that sizable author known alternatively as the hippocampus or Ammon’s horn.”

  MacLean then gave a comprehensive survey of how very little was known about the true functions of the hippocampus, before ending with a complaint and a Fulton-esque challenge: “Animal experimentation can contribute next to nothing about the ‘subjective’ functions of the hippocampal formation,” he said. “To corrupt a statement by Wiener, psyche is information, not matter or energy. The animal cannot communicate how he feels. Here is the rub for the physiologist. Realizing that Aladdin’s lamp is not for him, he obviously looks, as he has long been accustomed, to the ne
urosurgeon!”

  The stage was set for my grandfather.

  My grandfather looked up from the podium and out over the group of surgeons and scientists. Many giants of his field were there: Bill Sweet, Leo Davidoff, Gilbert Horrax. As for my grandfather, he was forty-seven years old, no longer the ambitious young striver he’d once been. He was now a peer, or more than a peer, of many of the people here, a teacher as much as a student. The neurosurgical residency programs at Yale and the University of Connecticut had recently merged, and he had become the co-director, training the next generation from his old alma mater, teaching them the brutal subtleties of his craft, instructing them in the use of the numerous techniques and tools that he’d invented and that many of the men in that ballroom had begun to use in their own practices. He had become, in the eyes of the neurosurgical community, something of a giant in his own right.

  “For the past four years in Hartford,” my grandfather began, “we have been embarked on a study of the limbic lobe in man.”

  Coming as it did immediately after MacLean had outlined both the enduring mysteries of the limbic lobe and the difficulty of solving those mysteries through animal research, my grandfather’s announcement was bound to cause a stir. Hearing it, the attendees may have hoped that he was about to announce a breakthrough, a revelation of some sort.

  If so, he dashed those hopes right away.

  After describing the operations through which he’d conducted his study—the uncotomies, in which he lesioned just a part of the limbic region; the medial temporal lobotomies, in which he lesioned almost all of it—my grandfather gave a gloomy general assessment of his results. “I speak with all humility,” he said, “of the small bits of passing data we have accumulated in carrying out these operations on some two hundred thirty patients.”

  He had reason to be humble. The cuts he’d made in the brains of hundreds of human beings truly hadn’t contributed much useful knowledge. He dutifully recounted some of the more interesting phenomena he’d encountered over the course of his experiments, such as the fact that “vomiting and temporary loss of consciousness occurred commonly during manipulation of the uncal region, but following resection they disappeared,” and mentioned that one of his psychotic patients had suffered postoperative memory problems, but he didn’t pretend that these scattered tidbits did much to illuminate the larger questions of what the limbic lobe—or medial temporal lobe or hippocampal region or whatever you wanted to call it—actually did.

  One explanation for my grandfather’s unimpressive results had been best articulated more than a decade before, in one of those letters between Paul Bucy and John Fulton, the one in which Bucy complained that psychosurgery-based research was hobbled by the fact that one never “starts with a normal organism.” This was certainly the case for my grandfather’s limbic lobe investigation, in which his subjects had all been “long-standing, seriously deteriorated” asylum residents. If it was true that it was difficult to understand how the human mind worked by operating on animals, it was also true that attempting to understand how the normal human brain worked by lesioning the deeply abnormal ones belonging to hopeless psychotics was challenging at best, a fool’s errand at worst.

  And when it came to treating mental illness—which after all was what these procedures were designed to do—my grandfather’s medial temporal lobotomies had proved equally useless. They’d produced, he told the audience, only “meager” psychiatric improvement, and “no marked physiologic or behavioral changes.”

  An observer listening to my grandfather describe the therapeutic and scientific failures of his limbic lobe studies that day might reasonably conclude that these studies had hit a dead end and should be abandoned. Instead my grandfather told the audience that although his project had so far failed to provide much useful information about the mechanics of the mind, he hoped that “continuing limbic lobe studies may bring us one blind step nearer to the location of these deeper mechanisms.” And at the end of his talk he hinted that he’d already begun thinking of a way to expand his studies, a strategy that would also avoid the scientific pitfalls that were inevitable when you worked with asylum-sourced research subjects. He described how some of his psychotic patients had also been epileptic, and how his operations had seemed to provide them relief from their seizures. Now, he said, “an interesting query comes to mind—could bilateral resection of such known epileptogenic areas as the uncus raise the threshold for all fits, as do pharmaceutical anticonvulsants?” Or, to put it another way: What would happen if, rather than performing his limbic lobotomies only on the mentally ill, he began performing them on perfectly sane people who suffered only from epilepsy?

  It was an open question, one awaiting an answer.

  Or, at least, a patient.

  —

  In March 1953, the month before my grandfather traveled to Hollywood, Florida, for the Harvey Cushing Society meeting, he had another consultation with the Molaisons. Although a detailed record of this consultation doesn’t exist, it’s reasonable to make certain assumptions. He would have questioned them about the progress, or lack of progress, of Henry’s treatment, and they would have told him about Henry’s increasing difficulties. They would have made it clear that the drugs hadn’t helped—or hadn’t helped enough. Given the frequency of his petit mal seizures, it’s possible that at some point during the consultation Henry experienced one of them, his mouth going slack, his head tilting to one side, his eyes open and blank, his fingers scratching listlessly, repetitively, mindlessly at his pant leg. If so, my grandfather would have watched closely, waiting for Henry to come to. By the end of the consultation, my grandfather would have been able to take full stock of the Molaisons’ hopelessness.

  Then he would have offered them hope.

  The drugs hadn’t helped, but something else might. Maybe he told them about Wilder Penfield’s operations, the unilateral ones pioneered at the Montreal Neurological Institute. Maybe he told them about his own bilateral operations, the ones he’d honed at asylums around New England. Maybe he gave the Molaisons a quick primer in neuroanatomy, leaning in and tapping gently at the sides of Henry’s head, just behind his temples, just above his ears, explaining that the source of Henry’s affliction probably lay somewhere in his medial temporal lobes, a couple of inches beyond the tips of my grandfather’s fingers. Maybe he told the Molaisons that he might, if they’d let him, be able to remove that affliction altogether.

  The Molaisons—Henry, Gustave, Elizabeth—thought it over. They must have been frightened, as there is no medical prospect more frightening than brain surgery. They must also have been trusting, as my grandfather was an esteemed doctor in a position of authority, a professor at Yale, a man radiating competence. Whatever calculus the Molaisons used, however they weighed the pros and cons, debating the opaque risks of future surgery against the clear desperation of the status quo, is unknown. They may have taken their time, arguing among themselves, interrogating my grandfather. Or they may have come to a decision quickly.

  What is known is this: They said yes.

  —

  The surgery was scheduled for August 25, 1953.

  The week before, on August 17, Henry returned to Hartford Hospital to receive an electroencephalograph. Unlike the excruciating pneumoencephalograms, which had required the draining of his cerebrospinal fluid, the electroencephalograph, or EEG, as it was known, was painless. Henry lay on his back on a gurney, and a number of electrodes were affixed to his scalp. The electrodes registered Henry’s brain activity, picking up on the faint currents passing between his neurons. The operator of the device was able to see that activity in real time, conveyed in visual form in spikes and waves that a pen made across a roll of crosshatched paper like a seismograph. An unusual amount of spikes coming from one hemisphere of his medial temporal lobes would be evidence that Henry’s epileptic focus lay there, which would be evidence that surgically lesioning just that particular hemisphere might bring Henry relief. At one point durin
g the exam, Henry had one of his petit mal seizures, going absent right there on the table. Despite this, the EEG failed to reveal an epileptic focus.

  A psychologist named Liselotte Fischer met with Henry on August 24 to administer a battery of psychological tests, a baseline against which the effects of the operation could later be measured. Henry, Fischer noted, “admits to being ‘somewhat nervous’ because of the impending operation, but expresses the hope that it will help him, or at least others, to have it performed. His attitude was cooperative and friendly throughout.”

  When Fischer gave Henry a pad and pen and asked him to draw a man and woman, he drew the man first: a hospital patient, in a hospital gown, with a “crosspatch” mark on his temple. Fischer interpreted this as a manifestation of Henry’s “acute anxious involvement with the impending operation.” Then, Henry began to draw the woman.

  “She ain’t going to be pretty,” he said as he sketched out a figure with an oversize head and bulging breasts. Fischer eyed the drawing and wrote that “with its aggressive stance and domineering features it is in glaring opposition to the male figure, and invites the interpretation of ‘aggressive, castrating mother figure.’ ”

  Fischer gave Henry a Rorschach examination, showing him a series of inkblots and asking him to describe what he perceived. Looking at one splotch, Henry said he saw a deer without horns, which turned into a doe. Fischer saw that as further evidence of Henry’s preoccupation with castration. Another inkblot spurred a description of “a lion who moves away from the subject, so that his tail is oversized and ‘right in my lap,’ ” which Fischer interpreted as an indication of “sexual confusion” and a “homosexual trend.” She also noted “some repetition of the concept of fleeing,” and of “concepts of mutilation.”

  Finally, Fischer administered an IQ test. Henry scored 104, higher than average but lower than he would score postoperatively. This may or may not have had something to do with the fact that he’d been taken completely off his antiepilepsy medications in the weeks leading up to the surgery and had experienced as many as twelve petit mal seizures during the hours he spent with Fischer. She’d watch and take notes as he’d go absent for ten to fifteen seconds, swaying and breathing heavily, scratching at his arms, his clothes, his belt, before regaining his senses.

 

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