Patient H.M.

by Luke Dittrich

  Other issues were more fundamental. Chief among them was who would be put in charge of the most important part of the project: the postmortem, post-harvesting, post-MRI processing and preservation and analysis of Henry’s brain. Corkin and her group had debated the pros and cons of various approaches and the merits of various researchers. Once he died, she knew she would have to give up at least partial control, that she would have to relinquish the most valuable part of Henry into somebody else’s hands. The committee needed to find somebody worthy of that precious cargo.

  Jacopo Annese, who had flown in from California for that dinner party, eventually became the committee’s first choice. Annese was relatively young, in his early forties, and in the early stages of a promising career as a neuroanatomist. He’d begun that career at the University of Florence in Italy, then continued it at NYU, McGill, and UCLA before he finally settled at the University of California, San Diego. While at UCSD, Annese honed his innovative techniques for preserving human brains in both histological and digital form, a technique that promised to give scientists the opportunity to continue their research with Patient H.M. long past Henry’s death.

  It was after the committee selected Annese that he asked Corkin if he might meet Henry while he was still alive, which led to that 2006 visit to his nursing home, where they ate their mostly silent lunch and then wheeled Henry back to his room. On the way out, Annese noticed a snapshot of Henry tacked to one of the bulletin boards near the entrance. Nobody was looking, and he had to resist the temptation to take it, to slip it into his pocket, to keep it as a sort of totem, something he could ponder in his off hours and use to help him imagine his way further into Henry’s mind before the day he had to start digging into his brain.

  TWENTY-EIGHT

  PATIENT H.M. (1953–2008)

  New employees at the Bickford Health Care Center always received a briefing on Henry and his special circumstances. For example, they were directed never to speak to anyone outside the center about Henry, as the fact that he resided there was a closely guarded secret. If a stranger called inquiring after Henry, the staff member receiving the call was supposed to give a noncommittal response, neither confirming nor denying his presence, and then immediately phone Henry’s conservator, warning him about the snoop. The cloak of anonymity placed over Henry was effective: He had lived at the center for decades, and though he was the most famous patient in the history of neuroscience, no outsider ever found him.

  New employees were also briefed on the special rules that applied specifically to Henry’s dying and his death. Suzanne Corkin drafted these rules, and they were printed out and always attached to Henry’s chart.

  So on the morning and afternoon of December 2, 2008, as Henry began fading from respiratory failure at age eighty-two, Corkin, as per protocol, received periodic phone calls keeping her abreast of the situation. Corkin had last seen Henry a month prior, and by that time his dementia was profound, and he had become completely mute. He wouldn’t answer any of Corkin’s questions, just stared at her, blank and uncomprehending. His value as a useful living research subject had come to an end.

  When Henry’s heart finally stopped, another call was placed to Corkin, and then someone at the center rushed to the freezer and dug out the flexible Cryopaks that Corkin had ordered placed there in anticipation of this moment. By the time the hearse arrived, the ice blankets were wrapped securely around Henry’s head, keeping his brain chilled to slow decomposition.

  Everything went smoothly, according to plan, and a couple of hours and 106 miles later, the hearse pulled into the parking lot of building 149 in the Charlestown Navy Yard, the Athinoula A. Martinos Center for Biomedical Imaging in Boston, where Corkin was waiting. The body bag was unzipped and the ice blankets unwrapped. Corkin had known Henry for forty-six years, met him for the first time when she was still a graduate student in Brenda Milner’s lab at McGill. Of course, her relationship with Henry, transactionally speaking, was that she’d known Henry, not the other way around. Forty-six years of meeting someone for the first time, introducing herself to an old friend.

  And now this last meeting that only she would remember.

  During the night that followed, Corkin watched as Henry underwent a series of high-resolution MRI scans. Then, the next morning, she attended the harvesting. She stood on a chair outside the autopsy room in the Mass General pathology department and peeked through a window as a neuropathologist named Matthew Frosch, assisted by Jacopo Annese, who had flown in on the red-eye from San Diego, sawed off the top of Henry’s skull and, with the care of obstetricians delivering a baby, pulled his brain into the light. Corkin had spent the bulk of her career pondering the inner workings of Henry’s brain. That morning, she finally got to see it. Henry, a man she had known for almost a half century, had died the day before, but there, gleaming under the bright lights, was the part of him that she’d always been most interested in. As she gazed at Henry’s brain, only one word could describe the feelings that coursed through her. She was, she later wrote, “ecstatic.”

  After the harvesting, the brain sat for a while in a bucket that was inside a cooler, steeping in a preservative solution, hanging upside down, suspended by a piece of kitchen twine looped through its basilar artery. When the brain was firm enough to travel safely, Corkin rode to Logan International Airport with the cooler. She accompanied it to the gate of a JetBlue flight from Boston to San Diego. There were camera people following her. It was a self-consciously historic moment. Henry’s death had been announced on the front page of The New York Times, which described him as “the most important patient in the history of brain science” and revealed Patient H.M.’s real name to the world. Corkin already had a book and movie deal. She put the cooler down near the gate, and Annese picked it up. She watched him walk down the ramp with it and disappear into the plane.

  It was hard to let go.

  —

  Henry’s brain sat on a small rectangle of formaldehyde-slick green marble, under a sheet of plastic wrap. Annese was wearing a medical smock, blue rubber gloves, and safety glasses. He plucked off the plastic wrap, picked up a scalpel, and began to peel away the pia mater, a thin, sticky membrane that covers the brain. He was alone, music on—it was a Beatles kind of night—and everything went perfectly. He removed the oxidized clips my grandfather had left behind fifty-five years before, set them aside. Then the membranes, the blood vessels, all the obstructing tissue, stripping everything away until he was left, finally, with Henry’s naked brain. His peelings usually lasted three to four hours, but with Henry he took his time, made sure everything was just right. He peeled for five hours straight.

  He was still on a bit of a high, still pinching himself. He was part of the group that Corkin had convened years before to decide what to do with Henry’s brain postmortem, and so of course he had known for a while that the group had decided to give the brain to him as the cornerstone of his Brain Observatory. But it was still a shock to actually have it in his possession. This prize, this valuable artifact, this revolutionary brain. Despite all the planning, all the verbal agreements, he hadn’t been absolutely sure he’d wind up with it until he boarded the flight with the cooler in hand. A part of him, the fatalistic Italian part, thought that something would happen at the last minute, that Corkin would change her mind, take Henry back.

  But she hadn’t.

  He presented the gate agent at Logan with two tickets, boarded the plane with time to spare. He gave Henry the window seat. He’d penned words on the cooler with a black Sharpie, along with his phone numbers and email address: “Diagnostic specimen. Fragile. If found, please do not open. Contact Dr. Annese immediately.” He landed in San Diego, and a UCSD official escorted him and Henry straight to his lab.

  So far, everything seemed to be going just as smoothly as could be. After the peeling, he embedded Henry’s naked brain in gelatin, froze it solid. The freezing had to be done quickly, using a liquid-cooled, custom-built device steaming with dry ice vap
ors, like a witch’s cauldron. The embedding was, he’s not too modest to say, a masterpiece.

  But it was only the prelude to what came next.

  For the fifty-five years following his operation, Henry had lived mostly in seclusion and anonymity. During most of that period, a select coterie of scientists had shielded him from the prying eyes of the outside world.

  That was about to change.

  —

  I was sitting at a high table at Alpine Bakery, in Whitehorse, the capital city of Canada’s Yukon Territory, eating a scone and drinking coffee. It was one of those cold, clear subarctic December days, a time of year when the sun barely nudges itself above the mountains, spraying weak light through the trees, giving everything a shadowy purplish tint. Outside, people with cold red faces hurried down Main Street, their bodies swaddled in expensive garments made from goose feathers and lamb hair. Inside it was warm and homey. I cradled my coffee in one hand, cracked open my laptop, and logged into my email.

  I’d been living in the Yukon for more than three years. I moved up there from Atlanta shortly before my daughter, Anwyn, was born at Whitehorse General Hospital in September 2006. Long story. Her mom and I had known each other almost our entire lives, ever since we became playmates as expatriate toddlers together in Mexico City, but we’d been out of touch for most of our adult lives. She got married and moved to Whitehorse in the 1990s, then got a divorce but decided to stay in the Yukon. We reconnected during a tumultuous trip to Ecuador in the fall of 2005, a trip that started out platonic and ended with us becoming trapped together for three days in a little oil town on the Colombian border called Lago Agrio (Bitter Lake). Anti-petroleum-industry protesters had taken over the town the day we walked into it, and they sealed off all access, dismantling bridges and barricading the airport. Eventually the army was called in to handle the situation, which made it much worse. Molotov cocktails, tear gas, the acrid smell of burning banks. A shared hotel room. Our friendship turned into something else.

  We saw each other again a couple of months later, when she flew down to Mexico over Christmas break while I was on assignment there. A few weeks after she left, I called her from a pay phone in Catemaco, a small town near the city of Veracruz famed for both its lake snails and its history of brujería, witchcraft. I had a digital camera with me, and when she told me she was pregnant I snapped a picture of myself with the phone pressed to my ear, wanting to document a moment when I knew my life had just changed forever.

  One of us had to move. My job was portable.

  We lived together for two years after Anwyn was born, and then we didn’t. I moved into a small place of my own. I had a steady stream of assignments and commuted for my stories, usually a long way. I went to Antarctica and ran a marathon. I went to Laredo, Texas, and interviewed a teenage cartel hit man. I went to Wasilla, Alaska, and got frostbite snowmobiling with Todd Palin. That December afternoon, I’d recently returned from Jamaica, where I spent a week with Usain Bolt, the fastest man in history, who spent most of our time together eating junk food and playing Call of Duty and practicing his turntable skills, leaving the impression that everything I’d ever heard about how success is the result of hard work and dedication might simply be untrue.

  I’d kept tabs on Henry’s story over the years, reading the new papers that came out about him. When he died, and the veil was dropped from his name, I waded into the flood of published tributes. Eventually the tributes slowed to a trickle. I set up a Google Alert for “Henry Molaison,” and in the months that followed his death it would only periodically ping me, advising me of some new Henry-related tidbit.

  That afternoon in the coffee shop, however, Google had flooded my in-box with stories. Most of them contained a link to a UCSD-hosted website for the Brain Observatory. I clicked on it. It took a few moments to open. In the center of my browser, the throttled Yukon bandwidth was churning out a pixelated and choppy live stream video. The video was dark, so I amped the brightness on my screen. There was a white square in the center of the video, taking up most of the space. Around the square was a misty fog of billowing dry-ice smoke, like something you’d see during a magic show. In the center of the white square was a rough oval blob, and it was pink. A silver metal bar moved slowly across the square, from the bottom of the screen toward the top, and as it moved, the pink blob curled up ahead of it, crumpling and furrowing unpredictably, like the breaking edge of a wave, but in super-slow motion. When the bar approached the top of the block and had run the entire length of the pink blob, a human hand would appear, wearing stylish purple medical gloves and holding a paintbrush. The paintbrush dabbed at the pink stuff, disengaging it from the white block completely and then lifting it into an individually numbered tray filled with some sort of clear solution. Then the bar returned to the bottom of the block and started again.

  Despite all my efforts years before, I had never met Henry while he was alive.

  But now, with the click of a trackpad, I, along with hundreds of thousands of other people around the world, was getting a live view of his brain’s dissection.

  Just like that, I was back on the Henry beat.

  I sat and drank coffee for a while longer, watching Henry’s brain being slowly sliced apart. The video stream was quiet, but occasionally the purple-gloved hands would put a little yellow Post-it note on a stick held in front of the camera, giving some sort of tidbit or trivia or shout-out.

  “Listening to the White Album now,” one of the notes said. Behind it, the dissection continued.

  —

  When I first visited the Brain Observatory shortly after the cutting was completed, there was a slim book sitting on a shelf right next to Jacopo Annese’s desk in his glass-walled office. Unlike a lot of the other books in this place—A Study of Error, Serial Murder Syndrome, Man and Society in Calamity, Flesh in the Age of Reason, The Open and Closed Mind—this one didn’t have a very lively title. But Localisation in the Cerebral Cortex, by Korbinian Brodmann, is to Annese as vital a book as can be. It was originally published in 1909 and contains a series of meticulously hand-drawn maps of the human brain, divided into fifty-two so-called Brodmann areas, each unique in its neuronal organization and, consequently, its function. Brodmann gleaned the borders of his areas through a rough and painstaking combination of microscopy and histology, and he did a great job, all things considered. Out of an uncharted cerebral wilderness, Brodmann created an enduring Rand McNally road atlas of the mind, one that my grandfather used to direct his surgeries and that most neuroscientists and neurosurgeons still use today.

  As a fellow anatomist, Annese admired Brodmann’s work immensely and had even written a glowing tribute to him that appeared in the journal Nature. But he hoped to make Brodmann’s old maps irrelevant.

  That’s what the Brain Observatory was all about.

  If Korbinian Brodmann created the mind’s Rand McNally, then Jacopo Annese was creating its Google Maps.

  A short walk from Annese’s office, past an imported espresso machine and through a secure, airtight door, was the wet lab. At the far end of the lab, a number of tall, glass-fronted refrigerators stood against a wall. Many of them contained plastic buckets, and though the plastic was murkier than the glass, it was still possible to see what was inside. Most of the brains were human, but there was one from a dolphin. The dolphin brain was huge, significantly bigger than any of the human ones, though Annese cautioned that it would be a mistake to read too much into size.

  What’s true of individual brains is true of brain collections as well. With his Brain Observatory, Annese was setting out to create not the world’s largest but the world’s most useful collection of brains. Each specimen would, through a proprietary process developed by Annese, be preserved in histological and digital form, at an unprecedented, neuronal level of resolution. Unlike Brodmann’s hand-drawn sketches, Annese’s maps would be three-dimensional and fully scalable, allowing neuroscientists to zoom in from an overhead view of the hundred-billion-neuron fores
t all the way down to whatever intriguing thicket they liked. And though each brain is by definition unique, the idea was that as more and more brains came online, the commonalities and differences between them would become increasingly apparent, allowing, Annese hoped, for the eventual synthesis of the holy grail of any neuroanatomist: a modern, multidimensional atlas of the human mind, one that conclusively maps form to function. For the first time, we’d be able to meaningfully compare large numbers of brains, perhaps finally understanding why one brain might be less empathetic or better at calculus or more likely to develop Alzheimer’s than another. The Brain Observatory promised to revolutionize our understanding of how these three-pound hunks of tissue inside our skulls do what they do—which means, of course, that it promised to revolutionize our understanding of ourselves.

  And what could be a better cornerstone for the Brain Observatory, a better volume for Annese’s collection, than the brain of Patient H.M.? The boxes filled with the cryogenic vials containing the slices of Henry’s brain sat in their own freezers, to the left of the others, under lock and key. Precious cargo. San Diego is earthquake-prone, but there were backup generators and sensors that would automatically dial Annese’s home and cellphone in the event of an emergency, so that wherever he was, he could jump into his Porsche, rush over, protect Henry.