The last time I saw Henry alive was on September 16, 2008, during my annual pilgrimage to Bickford. As before, a neurologist accompanied me to document Henry’s status. Prior to our visit, his Bickford doctor noted that Henry had declined significantly in the past year and that he was having a great deal of seizure activity. Henry was now eighty-two years old and still confined to his bed or geriatric chair. He was unable to feed himself and had difficulty chewing and swallowing food. Most of his communication was with gestures rather than words. When we saw him, he was sleepy but could be roused. He was essentially mute but attempted to say one or two words during our visit. Bickford staff members were very attached to Henry and were saddened to see his precipitous decline. I shared their sorrow.
It had been forty-six years since Henry and I first met at the Neuro. In the course of those years, he had been a regular presence in my life. We had watched one another age over the decades, although he did not know it. I had become used to his smile and kind manner, and I had heard his catch phrases and stories so many times that I could recount them myself verbatim. Many in my lab had been similarly touched by the experience of knowing Henry. He had permeated our culture, and we often found ourselves talking in Henryisms. For instance, if I asked a colleague whether she planned to attend a particular seminar that day, she might reply, “Well, there I’m having an argument with myself—should I go, or should I stay in the lab?”
One great gift that memory bestows on us is the ability to know one another well. It is through shared experiences and conversations that we form our deepest relationships—and without the ability to remember, we cannot watch these relationships grow. Although Henry had acquired many friends during his life, he was unable to feel the true depth of these connections. He could not get to know others well, and, tragically, he could not know the lasting impression he had made on all of us who knew him—and on the world.
On my last visit, I stood beside him and said, “Hi, Henry. It’s Suzanne, your old friend from East Hartford High School.” He looked in my direction and gave me a faint smile. I smiled back. He died two and a half months later.
Thirteen
Henry’s Legacy
Just before five-thirty on the afternoon of December 2, 2008, I received a call from the Director of Nursing at Bickford. Henry had died a few minutes earlier. I had just arrived home and was still sitting in my car when I got the news. Henry—the amiable, smiling man who had been a part of my life for so many years—was now gone. But at that moment, I had no time to mourn; Henry was dead, but he remained a precious research participant. It was time to put into action the brain donation plan that we had been organizing for the last seven years. My colleagues and I would have this one opportunity to study and preserve the most famous brain in the world. Our mission would be a challenging adventure, one that would allow no room for error. We would begin by scanning and harvesting Henry’s brain. I knew I had a long, intense night ahead of me.
Throughout his life, Henry served science through his willingness to undergo countless tests and examinations. The postmortem research on his brain would be a beautiful finale to his enduring contributions. Henry gave us the rare opportunity to examine in death a patient whom we had studied extensively in life. MRIs are tremendously useful but imperfect; the only way to truly understand the nature of Henry’s amnesia would be to look directly at his brain and document the damage. With MRI scans, we could estimate the lesion but could never characterize it with certainty; now, we would finally understand the anatomical underpinnings of his amnesia.1
Before Henry, only a limited number of “classic” brains—that is, brains of patients whose cases represent historic insights about localization of function—had been studied postmortem. These previous cases yielded useful but limited information. Studying Henry’s brain would give us the opportunity to make a pioneering contribution to the science of memory. Detailed planning by our dedicated team of researchers would allow us to unite five decades of well-documented behavioral research with the best possible technologies for brain imaging, preservation, and analysis, providing the most complete information yet on a single person’s brain.
After receiving the news of Henry’s death, while still sitting in my car, I called Jacopo Annese, a young researcher at the University of California, San Diego. He would be responsible for taking Henry’s brain to San Diego for preservation and further study, in close collaboration with the Mass General team and me. We had agreed that when Henry died, Jacopo would travel to Boston to be present at the autopsy. As soon as I told him what had happened, he arranged to take the redeye to Boston.
I grabbed my purse, hurried up the stairs to my condo, and set to work. My colleagues and I had drawn up a flowchart of who needed to be contacted and in what order when Henry died. My assistant had laminated a wallet-size version of the flowchart for each of us to carry with us, and I kept copies under the wall-mounted phone in my kitchen, in my car, in my office, and on the desktop of each of my three computers. I grabbed the copy from my kitchen along with the laminated consent statement for Henry’s autopsy, and set up shop on my dining-room table.
I first called the man who would remove Henry’s brain—Matthew Frosch. At the time, he was interviewing a Harvard Medical School applicant so his phone was turned off. I paged him and he called back as soon as the interview was finished, guessing what had happened. He agreed to line up everything needed to perform the autopsy the following morning. I reassured him that I would obtain the legal permission for the brain donation.
Even though Henry and his conservator, Mr. M., had signed an Authorization for Brain Autopsy form, in 1992, I wanted to get Mr. M.’s consent after Henry’s death for the autopsy and brain donation. In search of someone to witness the consent process, I rushed next door to my neighbor’s house and rang the bell several times; she finally appeared. “I need a witness!” I blurted, and explained briefly what was happening. Without hesitating, she accompanied me to my house and stood next to me at the dining-room table, leaning in toward the phone. With a heavy heart, I called Mr. M. and told him that Henry had died that afternoon. I reached him on his wife’s cell phone, interrupting their dinner out with their teenage granddaughter. As my neighbor listened attentively, I read Mr. M. the consent form, phrase by phrase, and he repeated them back to me. He gave permission for an autopsy without restriction, and for Mass General to use “all tissues and organs that have been removed” for research or to dispose of them in accordance with its policies. I thanked Mr. M. and told him of our plans to scan Henry’s brain overnight before taking his body to the morgue in the morning.
Next, I called my assistant, Bettiann McKay, who was shocked when I told her Henry had died. She had known he was ill, but had not felt any sense that the end of his life was imminent; he had always bounced back after previous scares. I asked whether she would be willing to spend the night at my house and look after my three high-maintenance pets that needed care while I was overseeing the process of scanning and harvesting Henry’s brain. When Bettiann arrived, she quickly took over the responsibility for the dogs and cat with her usual down-to-earth demeanor, but admitted later that she felt an onrushing sense of grief. She had recently spoken with Henry’s nurses about what he would like for Christmas, and had ordered, wrapped, and sent a children’s art set, picturing his surprised smile when he opened the gift. Bettiann and other lab members were planning to go down to visit with him before Christmas and take a small tree for his room. Even though she did not know Henry well, and he never remembered her, she felt that he was part of the close-knit family our lab had become.
As the calls continued through our phone chain, our team planned on gathering at the Mass General Martinos Center, located in Building 149, which formerly served as a naval supply center. I was fortunate to have this internationally renowned imaging center two blocks from my home, and to be on the faculty there. This facility houses nine powerful MRI scanners as well as a series of other technologies used to
image brain structure and activity. The center is also a leader in developing new methods to glean information from living brains.
At around quarter to six, André van der Kouwe, a biomedical engineer who directs the programming of the Martinos Center scanners, was informed of Henry’s death. Soon after, André saw Allison Stevens, a young imaging researcher and part of our team, putting on her coat to leave.
“Aren’t you staying for all the excitement?” he asked. She gave him a baffled look. For some reason, word had not yet reached Allison.
“H.M. died,” he told her.
“What?” she yelled. “But what about the phone chain?”
Panicking, she began tracking down the rest of the team. She stopped to send a simple text message to the imaging researcher who had scanned Henry’s brain in the past: “H.M. died.” She also called one of my trusted graduate students, who told her that Henry’s body was on the way, expected to arrive at about eight-thirty, and that we needed to get hold of a tarp to cover the scanner bed in case any bodily fluids leaked out. None of us had scanned a dead body before, and we wanted to be prepared for all eventualities.
By the time I arrived at the Martinos Center around eight, the imaging team had just finished eating dinner and was ready to spend the entire night scanning Henry’s brain. His body, still en route from Connecticut, would arrive soon. I had asked the driver to call me when he neared the building, and when I realized I had no cell phone reception in the building, I went outside to wait for the hearse, huddled against the frigid Boston weather in a full-length down coat, hood, and mittens. At around eight-thirty, I saw a vehicle rounding the corner through the darkness, moving hesitantly. I ran toward it, waving my arms over my head.
“I’m Suzanne Corkin! I think you’re looking for me.”
I guided the driver to the ramp of Building 149, where a Mass General police officer waited. My colleagues hurried out of the building to assist the driver in rolling the gurney inside. As Henry’s body emerged from the hearse, I noticed that he had been covered with a patchwork quilt with a hood that covered his head, and another hood over his feet. Somehow, I felt comforted by this homey touch.
Luckily, the building was deserted, so no one would be alarmed at the sight of a dead body being wheeled across the atrium. Mary Foley, the technologist who keeps the Martinos Center running, had already gotten permission from security to transport Henry’s body. She and Larry White were part of the team who had scanned Henry years before, and they were waiting in a suite of the building called Bay Four, which houses a scanner with a powerful three Tesla magnet. This suite would be the site of our all-night marathon to obtain many different kinds of MRI scans of Henry’s brain.
The cylindrical scanner had a tunnel with a bed for the participant. Outside the scanner room was an anteroom, where technologists and researchers could view the scanner through a window while controlling it from a computer console. Before Henry entered the scanning room, we had to transfer his body to a nonmagnetic gurney; the scanner’s powerful magnet could easily suck even large metal objects into its cavern. Concerned about Henry’s large size, we had made sure that half a dozen strong men were available to lift him onto the scanner bed.
Beneath the quilt, Henry’s body was encased in a black body bag over another clear bag. Our team unzipped the bags and peeled them down to expose his head and torso. We then removed the ice packs that had been placed around his head at Bickford to help preserve his brain tissue. For some of my colleagues in the room, this meeting with the famous H.M. was their first. For David Salat, who had known Henry in life, the reality of this moment hit him with his first glimpse of Henry’s impassive face. Outwardly, we were calm and composed; inwardly, we were nervous, knowing this was a historic event in the annals of neuroscience, and we had one chance to get it right.
With a feeling of fondness, our team gently hoisted Henry’s body to the stretcher. His illness had resulted in weight loss, so lifting him was easier than we had anticipated. We rolled him into the scanner room and transferred him to the bed. Mary pushed a button, and the bed glided into the bore of the magnet.
Even though we had scanned Henry’s brain many times during his life, it was important to collect MRI images after his death—first in situ (with the brain still in the head) and later ex vivo (with the autopsied brain in a custom-made chamber). Scanning after death has several advantages. Living people who get MRI scans are instructed to lie perfectly still because any motion interferes with the quality of the scan, but even with a cooperative participant, MRI researchers must correct for natural motion—breathing, pulses of blood, and other minor movements. Now that Henry was dead, we would have no motion interference and would be able to obtain extremely clear images. Scanning living people is also limited by their tolerance for the procedure. They are confined inside the bore of the magnet, which often makes people feel claustrophobic and antsy, and even the most easygoing participants can tolerate the scanner for only two hours at the most. That night, without these impediments, we had the opportunity to scan Henry for nine hours, and we could gather an unprecedented amount of pristine data.
The ultimate goal of biomedical imaging is to give doctors and researchers detailed pictures of the particular body structures that are the focus of their treatments and research. The human body is not a map with clearly marked borders and road signs; it is often difficult to distinguish one tissue or cell type from another. MRI, however, enables us to do just that. When a participant enters an MRI scanner, he is exposed to a strong magnetic field, which causes the spins of the hydrogen nuclei in his body to line up with the magnet. The technician introduces radio frequency pulses into the field, briefly knocking the spins out of alignment with the magnet. As the spins realign with the magnetic field, they transmit a signal that is detected with a coil and used to create an image of the body. Additional magnetic-field pulses further manipulate the spins to encode spatial information in the images (to detect where tissues are located) and to vary the contrast in the images. The series of radio frequency and magnetic field pulses is called an MR sequence. MR sequences have distinctive sounds that the participant experiences in the magnet, and these sequences generate images with characteristic tissue contrast. Brain imaging is typically done with a variety of MR sequences designed to illuminate different properties of brain tissue—gray matter, white matter, cerebrospinal fluid, and the borders between brain structures.
One question we had was whether the sequence of radiofrequency pulses and magnetic gradients we would use to generate images of Henry’s brain should differ from those typically used on a living body. A month earlier, I had given a short presentation describing Henry’s case at the annual breakfast meeting of the Dana Foundation, which had given partial financial support for these planned postmortem studies. At the end of my talk, I asked anyone who had experience doing MRIs of dead brains to let me know what sequences they used. A colleague suggested that I contact Susan Resnick, who had been scanning the brains of corpses as part of the Baltimore Longitudinal Study on Aging. Before we started scanning, I phoned Susan and was relieved when she told me she used the same sequences for dead brains as for living ones. At least we could obtain useful data from routine clinical scans before proceeding with more experimental studies.
Our MRI team began with standard scans that would be performed on a living patient in a clinic, and then progressed to increasingly high-resolution scans that would show the anatomical details of Henry’s brain, first at the level of a millimeter and finally down to a few hundred micrometers, showing large groups of brain cells. As the images began to emerge, André was struck by their beauty: the borders of brain structures were unusually sharp. At the highest resolution, even the walls of tiny blood vessels in the brain—usually distorted by the movement of blood—were easily visible in the stillness of death. He could also see clearly the gaping holes on the left and right sides of Henry’s brain, where the lesions were.
As my colleagues gathered d
ata from the MRI study, I turned my attention to other pressing matters. A nearby funeral home in Charlestown had agreed to transport Henry’s body the short distance from Building 149 to the Mass General morgue in Boston, where his brain would be removed. The funeral home balked at the last minute, however, saying it would not move a body without a signed death certificate—the nursing home had rushed his body to us before getting a signature. We worried that if the autopsy were delayed, the brain would lose its firmness and become difficult to extract and preserve. At one point, we half-joked about whether we would have to resort to putting Henry on a stretcher and rolling him ourselves across the bridge to the hospital’s main campus. Then, in the same spirit, I remembered walking past a funeral home in the North End. I called the home and, although it was now late at night, a man answered. In my most professional voice, I explained that I needed to transport a body from the Charlestown Navy Yard to the Mass General morgue. He said he would consult his boss and get back to me. A few minutes later, the boss called back and agreed to have a hearse there by early morning.
By dawn, my colleagues had generated eleven gigabytes of brain images. To put this amount of information in perspective, a typical MRI scan with a living participant generates a few hundred megabytes of data, enough to fit comfortably on one CD. We would need sixteen CDs to hold all the information we had collected from Henry’s brain that night. We were lucky that the scanner—a finicky machine with frequent mechanical problems—had held up throughout the nine-hour session. As it turned out, it broke down mere hours later.
Henry’s body needed to be out of the building by six a.m., before hundreds of researchers began filing in. The hearse arrived at five-thirty; at six, with Henry’s body strapped on, we rolled the gurney through a backdoor and down a ramp to the hearse. With the hearse en route to the Mass General morgue, I jumped in my car, accompanied by a former lab member, then a Tufts University medical student. We hustled to Logan Airport to pick up Jacopo, who by then had arrived from the West Coast. On his flight, Jacopo later told me, he reread some of the seminal papers on Henry and mentally rehearsed the autopsy procedure he had been taught as a graduate student. He outlined the details of his plan to create, preserve, and disseminate an anatomical library of large-format glass slides and digital images, together representing Henry’s entire brain.
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