Patient H.M.

by Luke Dittrich

  H.M.: Yes…

  MARSLEN-WILSON: Do you think about this a lot?

  H.M.: In a way, yes.

  MARSLEN-WILSON: In what sorts of situations does this come up?

  H.M.: Well, I don’t think of any particular situation…and then you have the argument with yourself. Then you wonder to yourself, well: One way is better now…then you argue, of course, that argument. And…you wonder. Really wonder, to yourself, which is which. Because maybe the way that you said, that he said, is the way you thought. And vice versa. You know, just vice versa, in a way? And, just the way it turns around. And the way, well, you wonder to yourself….

  MARSLEN-WILSON: Okay, well…

  H.M.: That’s what I think of right off, too: Is the best thing to do…Is the best…Is the right thing right?

  TWENTY-SIX

  A SWEET, TRACTABLE MAN

  One day in late December 1974, an acquaintance of the Molaisons named Lillian Herrick stopped by the home that Henry shared with his mother at 63 Crescent Drive, in Hartford. She found Henry’s mother, Elizabeth, lying on the floor, “completely out of it.” It wasn’t clear what had happened, and Henry, sitting nearby, appeared oblivious to his mother’s distress. There was a terrible stench, since neither Henry nor Elizabeth had showered or washed for days. Herrick called an ambulance, and the doctors who examined Elizabeth determined she showed signs of dementia. Herrick was a retired psychiatric nurse from the Institute of Living who now earned additional income taking in elderly people at her own house. Arrangements were made, and the following month Henry and his mother moved into Herrick’s home, a large three-story house on New Britain Avenue in West Hartford.

  As soon as they moved in, it became clear to Herrick that Henry and his mother had a difficult, unpleasant relationship. They fought a lot. Henry, Herrick told one of the MIT researchers, was “not nice to his mother. She nagged him, he retaliated.” This retaliation sometimes became physical. Henry would kick his mother in the shins or hit her on the forehead.

  This was not the first time Henry had demonstrated a violent streak. Four years before, for example, on a Sunday afternoon in the spring of 1970, after yelling at his mother repeatedly to leave him alone and stay out of his way, Henry slammed his fist against a door so hard that he broke his hand. Not long after that, Henry had an even more extreme outburst. At the time, Henry had been spending his weekdays at a place called the Hartford Regional Center for the Mentally Retarded, a state-funded organization that provided menial jobs to people who might otherwise have trouble finding employment. Sometimes Henry would mount key chains on cardboard display cases, and other times, such as on the day in question, Henry’s task was to fill plastic bags with a specific quantity of uninflated balloons. It was a simple thing, but his amnesia sometimes made even simple things—such as keeping count of how many balloons he’d packed—frustratingly difficult. Maybe that’s why he suddenly leapt up from his workbench and started yelling at nobody in particular, saying, according to one account, “that he had no memory, was no good to anyone, was just in the way. He threatened to kill himself and said he was going to hell and would take his mother with him.” The people at the center tried to calm him down, but Henry kicked at them and shoved them away. He ran to a wall and started smashing his head against it, until a doctor arrived and injected him with a sedative.

  After seeing how difficult Henry’s relationship with his mother was, Herrick decided that the best way to deal with the conflict was to separate them. She moved Elizabeth to an upstairs bedroom, while Henry stayed downstairs. The separation seemed to work. After about six months, “he quieted down,” Herrick said. She also tended to Henry’s hygiene, trying to instill better habits. She made sure he remembered to shower, to brush his teeth, to comb his hair, and to be ready to go at nine-thirty A.M. on workdays. “He never protests,” Herrick said, “but he wouldn’t do these things if you didn’t get after him.” She left little notes for him around the house. There was one on the television reminding him he had to turn it off by nine-thirty P.M. every night. Herrick also made sure that whenever the folks from MIT wanted to continue their experiments with Henry, they could. She’d pack his suitcase, drive him to Cambridge, and drop him off at the Clinical Research Center.

  —

  Henry’s occasional violent episodes in Hartford contrasted with the way he behaved in Cambridge. According to Suzanne Corkin, Henry was always, to her, a “sweet, tractable man.” Here’s a sampling of a few of the other ways Corkin has described him in writing:

  “He was a pleasant, engaging, docile man with a keen sense of humor, who knew that he had a poor memory and accepted his fate.”

  “When my colleagues and I interacted with Henry he was always friendly but passive.”

  “At the CRC he was always docile and friendly.”

  “For someone with such a severe memory problem, Henry was surprisingly easygoing. He was cheerful and never seemed uncomfortable or nervous.”

  “During our conversations with him, he seemed happy and content; he smiled often and rarely complained.”

  Henry was, in other words, the perfect research subject. Docile, passive, uncomplaining. Researchers noted that if you asked him to sit somewhere, he would remain there indefinitely, that he would only speak when spoken to, that he would almost never complain of hunger or thirst or pain. Corkin tended to attribute this to some sort of innate tractability. “From what we know of Henry,” she wrote, “he had always been an agreeable, passive person.”

  There was, however, another explanation for Henry’s behavior, one which Corkin downplayed but other researchers did not. Simply put, primates that undergo bilateral medial temporal lobotomies similar to Henry’s, such as the macaques that Klüver and Bucy operated on, always became tamer, more tractable, more docile. Most of the scientists who worked with Henry assumed there was a relationship between Henry’s cooperativeness as a research participant and his operation. When I asked the neuroscientist Howard Eichenbaum whether he believed that Henry’s brain lesions contributed to his passivity, he was certain of it: “What was removed along with his hippocampus and his cortical areas was the structure of his amygdala,” he said. “And it’s known that those kinds of lesions in animals make them very passive. And it’s generally thought that his sort of passiveness, and maybe some of his other features, like his lack of emotionality and pain and hunger and so on, were all due to the amygdala.”

  Henry’s passivity, then, was not surprising. What was surprising was the fact that sometimes he was not passive, that sometimes, despite his surgically created tameness, he would lash out. What explanation could there be for those outbursts, for those sudden storms?

  To understand the answer, it’s important first of all to point out that Henry did in fact often feel anxious and worried and unhappy while at MIT. During some of his long stays at the Clinical Research Center, researchers would administer tests that revealed high levels of internal strife. To take one example, on August 10, 1982, they presented Henry with something called the Beck Depression Inventory. It was a questionnaire, multiple choice. Here are a few of the statements Henry circled when asked to describe how he felt at that moment:

  “I feel that the future is hopeless and that things cannot improve.”

  “I feel that I am a complete failure as a person.”

  “I am dissatisfied or bored with everything.”

  “I feel guilty all the time.”

  “I feel I may be punished.”

  “I am disappointed in myself.”

  Other questionnaires, given to Henry at other times, revealed a similar state of mind, such as one in which he was asked to document his internal feelings by ticking “yes” or “no” next to a series of descriptors. Henry ticked “yes” next to “enraged,” “terrified,” “frightening thoughts,” and “cannot relax.”

  None of those personality questionnaire results have ever been published, although in one paper, from 1996, Suzanne Corkin did mention that Henry
had been administered the questionnaires, and she summarized her interpretation of Henry’s answers by saying that they provided “no evidence of anxiety” or depression. In general, Corkin tended to put the sunniest possible spin on Henry’s condition, depicting him as a sort of avatar of enlightened contentment. “We can be so wrapped up in memories that we fail to live in the here and now,” she once wrote in a discussion of Henry, adding that “Buddhism and other philosophies teach us that much of our suffering comes from our own thinking, particularly when we dwell in the past and in the future,” and noting that “dedicated meditators spend years practicing being attentive to the present—something Henry could not help but do.” She went on to speculate about “how liberating it might be to always experience life as it is right now, in the simplicity of a world bounded by thirty seconds.”

  Those questionnaires, by contrast, indicate that rather than feeling liberated, Henry, when he engaged in introspection, was sometimes anguished by his absent past, by his muddled present, by his unimaginable future. It’s true he didn’t often complain about that anguish, but those passive, uncomplaining tendencies are known by-products of the sorts of trenches my grandfather cut in his brain. As for why his outbursts always occurred while he was in Hartford rather than at the Clinical Research Center, bear in mind that whenever Henry was at MIT, he was in a place that was and would forever remain alien to him. He would have been kept occupied by a procession of strangers, plying him with an endless battery of stimulating tasks. The whole environment—a university bustling with scientists and brimming with sophisticated testing equipment and technology—was unlike anything he’d ever experienced in his preoperative life. It was a place stripped of the people and environments that connected Henry to his past, a place apart. While at MIT, Henry appears to have experienced feelings of worthlessness, and confusion, and hopelessness, but those feelings may have been less acute than in Connecticut, where Henry would have been constantly reminded of the eternal limbo to which my grandfather’s operation had sentenced him.

  Imagine what it was like for Henry to see his mother as she aged, to witness the relentless march of time across her face as her hair grayed and her wrinkles deepened. Each and every time he saw her, he would have to grapple with her instant transformation from the young woman he remembered to the older woman she had become, while grasping at the blank abyss of lost years that separated the two.

  Or imagine what it was like for Henry during his workdays at the Hartford Regional Center for the Mentally Retarded, a smart man surrounded by strangers who weren’t. He was doing work he was overqualified for—packing balloons, mounting key chains—but that his amnesia nevertheless made difficult. Every slippery moment he spent at the center would remind him of the terrible and mysterious fact that his life had come to a standstill.

  It is impossible for anyone to ever know what it was really like to inhabit Henry’s mind and to live in Henry’s world. There is no evidence, however, to support the conclusion that it was anything like nirvana.

  —

  In 1978, Henry’s mother’s increasing dementia forced her into a nursing home. Henry remained behind at Lillian Herrick’s home until Herrick herself became ill with cancer. In December 1980, Herrick decided she could no longer care for Henry, and she moved him into Bickford Health Care Center, a nursing home owned by one of Herrick’s brothers. Henry was fifty-four years old, decades younger than most of the other patients there, and he still believed, of course, that he was decades younger than his actual age. Once again, he was in an environment that couldn’t help reminding him of the fundamental vacuum at his core and the missing chapters of his life. And once again, he would have outbursts. He threw things, he yelled, he threatened to jump out of the window.

  In 1982, he had a particularly violent episode, taking a poorly aimed swing at an employee of the nursing home, hitting a wall with his balled-up fist. Staff called the police, and two officers arrived on the scene. They decided not to make an arrest. Instead a nurse gave Henry antianxiety meds, and he eventually fell asleep. The following day, someone asked him what he recalled of the night before.

  “I don’t remember—that’s my problem,” he said. “Sometimes it’s better not to remember.”

  TWENTY-SEVEN

  IT IS NECESSARY TO GO TO NIAGARA TO SEE NIAGARA FALLS

  The neuroanatomist Jacopo Annese usually drove a red Porsche 944, but on a summer day in 2006 he was a passenger in an unmemorable sedan, watching the redbrick husks of old paper mills glide by his window. He was on Main Street in Windsor Locks, Connecticut, a few blocks from Bickford Health Care Center, where he was going to meet Henry for the first time. Bickford Health Care Center was a single-level complex that used to be a motel. A little canal ran alongside it, as did some railroad tracks. It was west of a highway. Annese was surprised, to be honest, that Suzanne Corkin, who was driving, didn’t make him wear a bag over his head. Even before he met her, Annese knew by reputation how protective of her prized test subject Corkin was, vetting researchers exhaustively, demanding the signing of nondisclosure contracts, disallowing tape recorders, that sort of thing. She’d built a good portion of her career on her access to Henry and wouldn’t let just anybody in.

  But when Annese requested that she set up this meeting, when he told her that he’d like to see Henry at least once while Henry was still alive, she consented.

  The car pulled into the parking lot of the nursing home and nosed into an empty space. Annese and Corkin got out and walked inside together into the lobby. Annese got his first glimpse of Henry there: an old man, overweight, sitting in a wheelchair. Henry looked up at them with a dull expression on his face and no hint of recognition in his eyes. He responded to their greetings, but just barely. He was still on massive daily doses of anticonvulsants, as well as antipsychotics, anxiolytics, antidepressants, blood thinners, and various other medications including Xanax, Seroquel, Oleptro, Mellaril. He’d fallen and broken his ankle at least twice in the past two decades and had his hip replaced in 1986. His bones were brittle. He’d had a stroke two years before. Profoundly amnesic since 1953, Henry now also suffered from dementia, which brought with it a general blunting of his intellectual faculties, a blunting only exacerbated by all his medications. He had become what Corkin described as a “pharmacy in a wheelchair.” Incidentally, Henry’s increasing decrepitude had itself suggested some new experiments to Corkin. During another meeting, she’d quizzed Henry on how old he thought he was. He guessed that he was perhaps in his thirties. Then she handed him a mirror.

  “What do you think about how you look?” she asked while he stared back at his own wrinkled, uncomprehending face.

  “I’m not a boy,” he said eventually.

  Corkin and Annese wheeled him to the cafeteria, where Henry drank a smoothie from a straw. Annese was a voluble, extroverted man and tried to engage Henry in conversation, but Henry hardly responded. He sat and drank mostly in silence. Eventually somebody took the smoothie away, and Annese and Corkin got up and wheeled Henry back to his room. They said goodbye to him, speaking loudly and firmly to make sure he understood. His hearing was going, too. He’d suffered from severe tinnitus since 1986, probably a side effect of Dilantin, and it sometimes got so bad—a relentless, inescapable, excruciating buzzing sound at all hours of the day and night—that he would plead with the staff at the nursing home to bring him a gun so he could blow his brains out.

  Henry’s brain, of course, was what this visit was all about. It was why Corkin had allowed Annese to come here, why she had parted the veil. She needed a man of Annese’s particular skills. Annese, for his part, was grateful to Corkin for letting him in, glad to get a chance to meet Henry and spend a little time around him. Ever since graduate school, he’d found anonymous cadavers the hardest to harvest. It made it much easier if you knew the person as a person before you dealt with the person as a corpse.

  —

  Scientists had been trying to get a look inside Henry’s skull almost e
ver since the moment my grandfather replaced the bone plugs and sealed it back up. In the first three decades following the operation, Henry received numerous CT scans and X-rays, and although these different technologies each had individual strengths and weaknesses, none were entirely satisfactory. They provided the scientists what was, at best, a blurred view of Henry’s brain, like looking through a lense smeared with Vaseline.

  Magnetic resonance imaging, a technology developed in the late 1970s and widely used at MIT throughout the 1980s, promised a clearer picture, but Henry didn’t receive his first MRI scan until 1992. The delay was due to a fear that putting Henry in an MRI machine might cause him serious injury or even kill him, owing to the fact that MRI machines work through the use of extremely powerful electromagnets, and my grandfather had left behind several metal clips inside Henry. These clips were used to pinch shut veins and membranes in Henry’s brain and to help determine the depths of his lesions in postoperative X-rays. When a person walks near an MRI machine holding a set of keys, those keys might be wrenched away and rocket at high velocity toward the interior of the machine. If the clips inside Henry’s head were magnetic, something similar might happen to them, with obviously catastrophic consequences. Even if the clips were not magnetic, metallic objects of all sorts heat up when placed within the intense fields of an MRI machine, and if Henry’s clips became too hot, that, too, could cause problems.

  On the other hand, there was a good chance that the clips were safe. A neurosurgeon who had worked with my grandfather told Corkin that he believed the clips my grandfather used at the time he performed Henry’s operation came from a manufacturer named Codman & Shurtleff, the same company that built my grandfather’s custom trephines. A call to Codman & Shurtleff revealed that the clips they sold back in the early 1950s were typically made of either silver or tantalum, which are both nonmagnetic, and a review of journal articles indicated that nonmagnetic clips were unlikely to heat up to dangerous temperatures during MRI scans. There may have been a risk, then—it’s hard to imagine there was not—but the team decided that if there was, it was one worth taking. So in May 1992, at Massachusetts General Hospital’s Martinos Imaging Center, Henry lay down on a stretcher and was wheeled into the hollow, super-magnetized core of a 1.5-tesla MRI machine, where the steady thrum of rotating magnets filled his ears, loud enough to drown out the persistent buzzing of his tinnitus. He expressed no discomfort: The clips inside his head, apparently, were staying put and staying cool. Corkin would later say she hadn’t thought there’d been a risk at all, even a slight one.