Patient H.M.

by Luke Dittrich

  —

  We ate lunch in the same conference room, sandwiches and soda. Ruth was there, as was Jason’s mom.

  I introduced myself to Jason. He asked me where I was from, and when I told him I was living in the Yukon Territory, he nodded.

  “Do the people up there constantly try to deceive you?” he asked.

  I looked puzzled, and he paused a beat before delivering the punch line with a wry smile.

  “Or do you con them?”

  I laughed and then changed the subject, asking Jason about his modded Game Boy. He showed it to me and explained how it worked. It contained a sort of extra-large bootleg cartridge that gave him instant access to some of his favorite games: The Legend of Zelda, Super Mario Bros. 3, several of the Final Fantasy RPGs. He put the Game Boy down and we ate in silence for a minute or two. Then his mom spoke up.

  “That’s Luke,” she said to Jason, inclining her head in my direction. “Do you know where he’s been living?”

  Jason gave me a searching look, as though fishing for some sort of prompt. I waited. Finally he smiled, and I knew he was about to crack another joke.

  “Planet Earth,” he said.

  When I told him the Yukon Territory, he nodded, and a second later I saw the hint of another smile.

  “Do the people up there constantly try to deceive you?” he asked.

  When Jason was in his teens, he contracted a severe brain infection, which marched through his medial temporal lobes, destroying, one after another, most of his hippocampus and amygdala and uncus and entorhinal cortex. Once the infection had run its course, the lesion it left behind was uncannily similar to the one my grandfather made in Henry. And, like Henry, Jason was profoundly amnesic. His memory tended to last for exactly as long as he kept an object or idea or name or face in his attention. Once his attention shifted, whatever was there before disappeared. Jason coped with his amnesia like many amnesics did: Unable to draw on the past, they pay acute attention to the present, searching for cues and clues to help them make sense of their surroundings. This surface quickness can make it hard to see the underlying dysfunction: If I hadn’t known who Jason was before I met him, I probably wouldn’t have suspected anything was the matter with him until he repeated the Yukon joke.

  —

  After lunch, Ruth ran me through the mirror tracing test again. I did better right from the start. My hand just seemed to know which way to go and how to compensate for the visual discord. I was still a little clumsy, the line a little shaky, but the earlier paralysis was gone. By the end of the second round of five stars, I’d made it around much quicker than before, with fewer errors.

  Then I watched Jason take the test again. He sat where I’d been sitting.

  “Have you seen this test before?” Ruth asked him.

  “No,” he said.

  Ruth jotted down a note, then explained the test protocol to him again, just as she had an hour earlier. Jason picked up a pen, placed the point at the top of the star, peering intently into the mirror. Ruth tapped the stopwatch, and he began.

  As before, Jason completed the task more quickly and accurately than I had, and by the fifth star he was able to lay down one of the highest scores Ruth had ever seen.

  Jason had absolutely no memory of the first time he took the test, and by the time he left the conference room he would have no memory of the last time he took it. How was he able to improve his performance on a task without remembering having performed it?

  To answer this question, it’s necessary to jump back a half century to another testing room, and another bundle of scribbled-on stars.

  —

  After the publication of the 1957 paper she wrote with my grandfather, Brenda Milner continued making trips from Montreal to Hartford as often as she could, riding the night train, spending a few days at a time with Henry, plumbing the depths of his amnesia. Initially those depths seemed boundless. For Milner, it was always a little shocking to see that blankness in Henry’s eyes whenever they met, that utter lack of recognition. She was getting to know him so well, but to him she was always a stranger.

  She ran a huge variety of tests on him, tests of intelligence, vocabulary, facial recognition, and more. Once, during an informal quiz, she asked Henry to remember the numbers five, eight, and four, then left the testing room for twenty minutes. When she returned, she asked him if he remembered the numbers.

  “Five, eight, four,” he said to Milner’s surprise.

  “Oh, that’s very good! How did you do that?”

  “Well, five, eight, and four add up to seventeen,” Henry answered. “Divide by two, you have nine and eight. Remember eight. Then five—you’re left with five and four—five, eight, four. It’s simple.”

  Milner then asked him if she remembered her name.

  “No,” he said apologetically.

  “I’m Dr. Milner,” she said, “and I come from Montreal.”

  They then chatted about Canada for a minute or two.

  “Now,” Milner said finally, “do you still remember the numbers?”

  “Number?” Henry said, “Was there a number?”

  In other words, he’d played with them, keeping the numbers at the top of his mind, not allowing them to slip into the abyss. Milner’s shock—was his amnesia not as grave as she’d thought?—turned to understanding as she realized that he hadn’t actually been able to remember the numbers she’d given him, since the numbers had never really left his present moment. Two minutes later, after they’d moved on to other subjects, she asked him if he still remembered the numbers, and he gave her his usual blank look.

  And then, one afternoon, Milner sat Henry down at a table and placed in front of him a sheet of paper with a double-bordered star on it. It was a task that had recently been invented, and as far as Milner knew it had never been administered to an amnesic. She was curious to see how Henry would fare on it but expected him to do poorly, allowing her to measure yet one more dimension of his memory deficits.

  Just like Jason, just like me, and just like Milner herself, Henry struggled on the first star but by the fifth had improved. This did not surprise Milner. Henry had done the first five stars right in a row, which meant that, much like the numbers five, eight, and four had on that previous occasion, the task had never had a chance to slip from the top of his mind.

  The next day, Milner placed another blank star in front of him.

  “Do you remember seeing this before?” she asked him, and he shook his head.

  “Nope,” he said.

  She explained the task, and he did it. Well. Very well. Just as well as the fifth star the day before. Henry seemed surprised at his own facility with the task.

  “Gosh, that wasn’t as hard as I thought it would be,” he said.

  Milner, on the other hand, was more than surprised. Watching Henry’s hand trace an assured path around that star, a star he had no conscious memory of, was the most memorable moment of her scientific career. It hit her with the force of a revelation.

  Henry couldn’t remember taking the test. But he’d improved on it nevertheless. Milner knew this didn’t mean that Henry actually retained some dim memory of his previous circuits around the star. She was confident by now that the events of Henry’s life were indeed gone almost as soon as they happened.

  What it meant, she realized, was that although Henry’s brain lacked the ability to record the specific experiences in his life, it apparently was nevertheless able to retain some aspects of those experiences at an unconscious level. In other words, there were apparently at least two different and separate memory systems in the human brain. The system responsible for laying down specific occurrences, or episodes, was hopelessly compromised in Henry. The other system, the one that allowed one to acquire and improve upon learned skills, appeared to be intact. Henry might on a day-to-day basis never be able to remember having done something, but he was apparently able to remember how he did it.

  Milner’s initial studies of Henry had alrea
dy formed the foundation for modern memory science, zeroing in on the seat of memory in the human brain. Now her further studies of Henry unexpectedly led to a second revolution: the notion that the brain contained at least two distinct and independent memory systems, one that was intact in Henry and one that was not.

  In years to come, people would apply various names to these systems—procedural versus declarative, implicit versus explicit—but at that moment, watching Henry’s hand trace that unexpectedly assured line around that mimeographed star, Milner had no name for it. She just watched in silent wonder.

  —

  Jason and I took a walk near the laboratory. He lit up a Kool and we wandered down a quiet street. Henry was a smoker, too. Things are different now, though, and it isn’t every day you accompany someone on a smoke break. I found myself wondering whether there might be some sort of connection between amnesia and smoking. Whether amnesics might be more likely to pick up the habit. I used to smoke, and the thing about smoking is that it’s something you do, no matter how many times, in the moment. It’s a meditative, quiet, undemanding act. The problem is, eventually the ability to look behind or beyond the present makes smoking less appealing. I quit, finally, because I remembered myself with clearer lungs and could imagine them clogging more and more as years went by. People like Jason and Henry have limited access to their past selves, and most scientists think they can’t really project themselves into the future, either. So why wouldn’t they make every passing, soon-to-be-lost moment count, make it as pleasurable, as quickening and sharp, as possible?

  Why wouldn’t they smoke?

  Their vices and their brain lesions weren’t the only things they had in common. Jason was around the same age Henry was when Henry’s story was about to be revealed to the world, and now Jason, too, was on the verge of becoming a Patient with a capital P. Some scientists were preparing a paper about Jason, and its working subtitle was “A Modern-Day Patient H.M.”

  Still, to be an amnesic in the 2010s was very different from being one in the 1950s. Take smartphones, for example. Every smartphone user recognizes how the devices become memory supplements, shoring up the leaky containers in our heads that would otherwise let facts and names slip away. For a modern amnesic, however, a smartphone can become not so much a supplement as a substitute, a prosthetic hippocampus. Jason keeps his phone always on hand and is always using it to take pictures. He downloads the majority of these pictures to his laptop, storing them away and clearing space, but he also always keeps a few dozen on his phone.

  While he puffed on his cigarette, he pulled out his phone and opened the photo app. He scrolled through the pictures, looking at some of the events of the past few days, the airplane view of San Diego, a sunny beach, the outside of the laboratory, Ruth the psychologist. And a few pics from home, of pickup trucks and friends. He looked at the pictures and described them to me, then got to the last one and scrolled to the right and the first picture popped up again and he described it to me again, just as he did before.

  Jason is more independent than Henry was. He lives on his own. This has caused complications: Some old friends of his took advantage and repeatedly stole small amounts of money from him, transgressions he would always forget so never have to forgive. Each time they’d show up at his door he’d let them back in. When we met, his mother was in the process of installing a high-tech surveillance system so that she could see a video feed of anyone at his front door and have final say on who gets to enter. Still, he has a great degree of independence. GPS has even made it possible for him to drive on his own. Once he has a destination programmed, he’ll follow it to the end, even if by the time he arrives he’s forgotten why he set off on his journey in the first place. The moment-by-moment mechanics of driving, all those little on-the-fly decisions, are no problem for him. And he even reads novels, something Henry never did. He enjoys Stephen King. As he reads, he writes up compressed plot summaries every couple of pages in the margins. The fact that he can do this is amazing. But these are compensatory devices and habits, coping mechanisms, not solutions. The central problem they’re designed to tackle remains: Jason cannot remember what happens to him.

  We talked about videogames, about his favorite brand of cigarettes, about the cars he wants and a fight he got into while he was in high school. It was in the hallway, and he got suspended. We talk about an old girlfriend of his and about his favorite bands. I liked Jason. He was a good guy, open and enthusiastic, pleasingly geeky. We shared some of the same interests. It felt like we were connecting, bonding somehow.

  But we weren’t. Or he wasn’t. Because by the end of the day, Jason wouldn’t remember me. I would leave his mind without a trace.

  There’s something liberating about talking with an amnesic. I suddenly realized that I could tell him anything at all, my deepest secrets, my most embarrassing hopes, and he would listen and respond, giving me input, perhaps even advice, but would never be able to tell anyone else. Jason was like a priest that way, or a therapist, or a diary, only even more secure.

  There was something heartbreaking about it, too. This young, open man, taking in the world around him, with nothing ahead of or behind him, walking forever on a long, long tightrope between a clouded past and an unreachable future.

  He finished his cigarette and lit another and offered me one for the second time, and for the second time I told him I didn’t smoke.

  “We have to get back to the laboratory,” I said.

  He let me lead him there, not really understanding where he was going, not asking any questions, smoking the moment’s first and last cigarette.

  TWENTY-THREE

  THE SON-OF-A-BITCH CENTER

  My grandfather always scheduled his lobotomies on Saturday mornings, is how Dr. Dennis Spencer remembers it. A little past nine A.M. They were kind of “surreptitious,” that’s the word Spencer uses. They weren’t placed on the regular schedule at Hartford Hospital, and they always happened on those weekend mornings when the neurosurgical suite was quiet, staffed with just my grandfather’s longtime OR crew as well as any neurosurgical residents, like Spencer, who happened to be on hand. Usually the patient would be wheeled to the operating room straight from the Institute of Living next door. That’s where most of them came from, back in the mid-1970s, though Spencer recalls that my grandfather also had some sort of deal with a psychiatrist in New Jersey and got plenty of referrals from him. Spencer watched my grandfather perform a lot of lobotomies during his residency, but the one he remembers best, the one he wants to tell me about, was one my grandfather performed on a woman in her early forties who had Tourette’s or OCD, something like that. Whatever it was, it made her say, “son of a bitch, son of a bitch, son of a bitch” over and over and over again.

  This was 1973 or 1974. Spencer had been a resident for two or three years. He was a student at the Yale School of Medicine and spent most of his time there, in New Haven, but he also regularly made the one-hour drive to Hartford to work with my grandfather. The two hospitals—Hartford Hospital and Yale–New Haven Hospital—had an unusual arrangement back then, sharing residents drawn from a combined pool of neurosurgery students at Yale and the University of Connecticut. By the time Spencer began his residency, that arrangement was beginning to strain at the seams, and within a few years it would collapse altogether. The problem was that the cultures of the two hospitals were very different, a direct by-product of the huge differences between the two chiefs of neurosurgery. At Yale, the chief was a man named Bill Collins. He was a solid, careful, smart surgeon, though even his admirers, Spencer among them, would admit he was maybe conservative to a fault. He didn’t like taking risks. For him, neurosurgery was about finding the best, most efficient, safest solution to whatever the problem at hand was, then sticking to it. My grandfather…my grandfather wasn’t like that.

  Spencer started hearing stories about my grandfather as soon as he arrived at Yale. Wild stories. Stories that were hard to believe until you met him, like the one
about my grandfather and Enzo Ferrari. Here’s how it goes: Back around 1958, my grandfather was attending a medical conference in Europe when he decided, as he often did, that he needed a new sports car, stat. He drove to the Ferrari factory in Maranello, Italy. At the time, the company’s founder, Enzo Ferrari, would only sell his vehicles to men he thought were good enough drivers to handle them. My grandfather and Ferrari set out on a test-drive together, and after a white-knuckle half hour on the hairpin highways near the factory, Ferrari turned to his prospective customer, his face drained of color but his voice firm.

  “Dr. Scoville,” Ferrari said, “if I sell you this car you’ll be dead within the year.”

  My grandfather returned home with a Mercedes Gullwing instead.

  Hard to believe, right? Hard to believe until the first time you saw my grandfather come rushing into the neurosurgery ward yelling at the nurses and the secretaries and anyone who’d listen that he’d just led some Connecticut state troopers on a high-speed chase and he thought he’d lost them, but that if they came looking for him to tell them that he was in the OR performing an emergency craniotomy or something.

  Wild Bill, that’s what some of the residents took to calling him.

  Was it a surprise that Wild Bill and his counterpart at the Yale hospital, staid Bill Collins, didn’t get along? Collins thought my grandfather was a bad influence on the Yale residents, and my grandfather thought Collins was too careful for his own good, that nobody made progress by doing the same thing over and over. Neurosurgery, for my grandfather, was an adventure, an ever-changing one, and should never be made into some by-the-book slog.

  Collins wasn’t the only guy my grandfather didn’t get along with. As soon as Spencer began his residency, people warned him about a long-standing, bitter turf war being waged between my grandfather and James Foster, Hartford Hospital’s chief of general surgery. Foster had his hands on the hospital’s purse strings, and as far as my grandfather was concerned he was always trying to limit his goals for the neurosurgery department, tamping down the expansion of equipment, of staff, of space. Limiting him, in other words. He hated to be limited. He fought hard against Foster, demanding and often getting his way: The neurosurgery department had grown a huge amount since my grandfather founded it three decades before. Still, he always wanted it to be bigger, better.