Patient H.M. (21 page)

And maybe, just maybe, some sweat or blood or condensation accumulated on a lense of those glasses, and maybe my grandfather asked a nurse to reach over and wipe it clean. Maybe that sight, which would have been one of the last ones ever processed by Henry's vanishing medial temporal lobes, somehow stuck with him, blurred and dreamlike and of indeterminate origin. Maybe that's why, for the rest of his life, Henry would tell people that he'd once dreamed of being a brain surgeon but had decided against it, because he wore glasses, and what if his glasses got dirty and a nurse attempting to clean them knocked them askew, causing him to make the wrong move, to cut too far, to go too deep.

If so, that meant that Henry was mistaken about what he'd seen, just as he was mistaken when he told people that he believed something had gone wrong with his own operation, that his own surgeon, Scoville, had made a mistake, had made the wrong move, and that was why he was the way he was. Because even if my grandfather did get something on his glasses, and even if they were then knocked askew by a nurse, that had no impact on the way the operation played out.

My grandfather didn't make any mistakes that day.

He took exactly what he wanted to from Henry.

He finished the operation.

He removed the tools.

He replaced the bone and stitched the flesh.

Six weeks later, he sent off a print version of his Harvey Cushing Society presentation to the
Journal of Neurosurgery
for publication. The paper contained one major addition to the remarks he'd made onstage back in April. His limbic lobe operations, he now wrote, had “resulted in no marked physiologic or behavioral changes,
with the one exception of a very grave, recent memory loss, so severe as to prevent the patient from remembering the locations of the rooms in which he lives, the names of his close associates, or even the way to toilet or urinal.
”

The italics were his, and that italicized clause transformed a forgettable, modest paper into one that will continue to be referenced for as long as we remain interested in how we hold on to the past. It became a cornerstone of the skyscraper that is modern memory science.

It was the birth announcement of Patient H.M.

It was also the obituary of Henry Molaison.

“I
t's terrible how things accrue.”

Those are the first words in the transcript of my first interview with Brenda Milner. When I read the transcript, I hear her voice, a crisp British accent, words tightly spaced, while a hazy picture of her office forms in my mind. That's what she was referring to: her office, and the clutter in it, how it had accrued over the years. The stacks of papers, the overstuffed bookshelves, the boxes full of files. It was one of those offices where it must be a struggle each morning to clear space for the new day's work. There were posters on the walls, and I think one of them had an animal on it, a
National Geographic
–style nature photo, though I can't remember what type of animal it was. There was one framed photograph on her desk, near her computer: a headshot of my grandfather in his light green surgical scrubs.

Our interview took place in 2010, and by that time things had been accruing in Milner's office for more than a half century. She was ninety-three years old, still a full professor at McGill, still teaching classes, still doing research, still living the messy, striving life of an active scientist.

Milner greeted me warmly. Somebody from McGill public relations accompanied me to her office, and before the interview began a photographer arrived and led us to another room, to take a quick shot of the two of us for a Montreal Neurological Institute newsletter. “Does he look like Scoville?” somebody asked Milner. She appraised me—I'm taller than my grandfather, with a bigger nose, closer-set eyes, and a lot less hair.

“No,” she said, “not really.”

I'd arrived in Montreal the night before and was disappointed to hear that I'd just missed a screening of the movie
Memento
that Milner had hosted for the McGill Film Society.
Memento
's protagonist, an amnesic man attempting to solve a murder mystery, was inspired in part by Henry. I told Milner I liked the film, and she said she did, too, that in general it was one of the most realistic cinematic portrayals of amnesia she'd ever seen, even though, she pointed out, the script had bungled the definition of short-term memory. People like Henry and the man in
Memento
don't have bad short-term memory, she said. On the contrary, short-term memory is all they have.

I remember Milner sitting there by her cluttered desk, a tiny woman in a woolen skirt.

“Now,” she said, “how can I help you?”

Until coming to the Neuro in 1950, Milner had not had a major interest in memory. She was deeply curious about the brain, of course, and all the mysterious ways its structure correlated with its functions. And she understood how lesion patients had contributed to our understanding of those functions: During her final examination in psychology at Cambridge University, as she sat in the historic Senate House, one of the questions asked for a summary of the current knowledge about the localization of function for sight and hearing and speech. That was in 1937, and though she doesn't remember her precise answer, she imagines she would have written about Phineas Gage, Monsieur Tan, and all of those other fascinatingly broken men and women. She would have had no reason to mention memory, though. In 1937, the general consensus was the same as it would be more than a decade later, when Milner began working with Penfield's patients: Memory was not associated with a particular structure in the brain but was instead distributed equally, equipotentially, across the whole cerebral landscape. According to that view, trying to find a seat of memory was the neurological equivalent of a snipe hunt: It didn't exist. Milner's own views on memory didn't change much until she sat down with Patient P.B. and Patient F.C., those two men with their two unilateral medial temporal lobe lesions, and told them some stories, and asked them to repeat them back to her. When they looked at her blankly, when it was clear they weren't retaining anything she told them, she realized that something significant was happening. She didn't believe in the seat of memory, that is, until she found it.

But had she?

If removing the left hemispheres of the hippocampi of these two men had caused profound amnesia, which it clearly had, then it should have done the same to the other patients who had received the same operation, which it clearly hadn't.

Milner and Penfield discussed that paradox at length. Eventually they arrived at some tentative conclusions.

Yes, Penfield had performed the same operation on the two amnesics that he'd performed on at least ninety other patients. And yes, the brains of those two patients, postoperatively, appeared to function very differently from the brains of the others who'd received the same lesions. And no, that didn't make any sense. Unless the brains of the two amnesics had been different to begin with.

They concluded that the only reasonable explanation for such different results from the same procedure was that the medial temporal lobes of the two amnesics must have already been damaged prior to the operations. The hemispheres opposite to the hemispheres that Penfield targeted must have been dysfunctional. Perhaps this damage had taken place during birth, if tongs had been used to extract them from the womb, or maybe they'd suffered undetected strokes later in life. This would have meant that Penfield's unilateral lesioning of their hippocampi would have been equivalent to bilateral lesioning. In effect, though Penfield had targeted only one hemisphere, he would have been destroying both.

If this turned out to be true, it meant that normal memory function depended on the hippocampus and other medial temporal lobe structures. Although Penfield and Milner both felt that they were on the verge of finally zeroing in on the seat of memory in the human brain, they also knew that they lacked proof. The brain imaging technologies of the day could not detect damage to the remaining hippocampi of the two amnesic patients. And even if Penfield had decided to reopen their skulls to look inside, the damage might not have been visible to the naked eye. To upend prevailing views of how memory worked would require more than just a hunch.

Were Penfield willing to test the theory by actually removing both hippocampi of a patient bilaterally and seeing what happened, he and Milner might have been able to obtain the evidence they needed. But Penfield would never do that. He was too wary of causing unnecessary harm. Despite having revolutionized the field of epilepsy surgery, he was fundamentally a conservative, cautious doctor. He viewed all novelty with skepticism. Psychosurgery, for example, appeared to him to be a technically interesting but therapeutically unsettling practice. In his long career Penfield had still never performed a lobotomy, and he sometimes obliquely criticized the doctors who did, making pronouncements about the “vainglory” of “young surgeons who have learned to use a scalpel so expertly that they can take anything out of anywhere without a fatality, to cut the pathways of the currents of intellect and leave a man who is still capable of walking.”

Penfield's conservatism was both a boon to his patients and a barrier to progress. By the mid-1950s, several years had passed since Milner's testing of Penfield's first amnesic, and though they planned to write a paper based on these cases, they still hadn't published their findings. Their data felt incomplete, their evidence too easy to dismiss. They were, in the scientific sense, stalled.

Then, during a neurosurgical conference in New Mexico in May 1954, Penfield ran into just the sort of young, ambitious, mechanically gifted psychosurgeon he often accused of vainglory. My grandfather and Penfield discussed their respective experiences operating on the medial temporal lobes. Despite the fact that these operations had mostly been done for very different reasons—my grandfather performed them almost exclusively on asylum patients, Penfield almost exclusively on epileptics—what they found interesting was not their differing motives but their similar results. Penfield told my grandfather about the amnesia he and Milner had documented in Patients P.B. and F.C. and about their hunch that the limbic region must therefore be crucial to memory. Penfield was repulsed by psychosurgery, but he was fascinated when my grandfather told him that he, too, had encountered cases of postoperative amnesia. Not only that, but the younger surgeon's operations, unlike Penfield's, had all targeted both hemispheres. When Penfield returned to Montreal he told Milner what he'd learned.

Eventually, on March 22, 1955, he wrote my grandfather a letter.

“Dear Bill,” he began, “Dr. Milner and I have been putting together our projected paper on loss of memory in relation to the hippocampal area. I have thought many times of our discussion out at Santa Fe, and it seems to me that the cases you referred to throw a very important light on the whole problem.” He specified the most important cases as the three patients “in whom you made a removal bilaterally back to a distance of 8 or 9 centimeters in the temporal lobe,” and asked whether it would be possible for Brenda Milner to travel to Connecticut to meet with them. “I remember that they were all psychotic,” Penfield wrote. “I suppose you must feel as hesitant in regard to these cases as I do in regard to the two patients in whom I have produced a gross loss of memory. Actually, I should feel much worse inasmuch as the patients I operated upon were not psychotic and had a much better outlook on life than yours could possibly have had.” Milner, Penfield continued, was willing to go to the patients “wherever they are.”

“I have pulled all the pertinent charts and am delighted to have Dr. Milner come down and go over the cases,” my grandfather wrote back. He corrected Penfield's assumption that all of his medial temporal lobe cases had involved psychotic patients, and then described Henry. “The only non-psychotic epileptic case will come into our office,” he wrote. “He is one and three-quarter years post resection of the medial surface of the temporal lobes including the uncus, amygdala and hippocampal gyrus, and according to his mother, over the phone, ‘his memory is absolutely no good; cannot even be sent to the store alone for purchases.' ”

As for the asylum patients, he would ensure that the institutions granted Milner full access to them, though he warned that they might not be as easy for her to glean useful data from as Henry. “These cases,” he wrote, “are all available for study but, of course, are complicated by other damage.”

On April 25, 1955, Milner boarded the night train from Montreal to Hartford. She traveled light: a few changes of clothes, some toiletries, and a small collection of psychological tests. Of course the most important thing she carried didn't weigh anything at all. It was an idea, a theory, one that had been taking shape for years but had until now remained frustratingly hard to pin down. The train pulled out of the station and began pushing south, picking up speed, crossing the border and skirting the edge of Lake Champlain. The foothills of the Adirondack Mountains rose in the distance, and Milner tried to sleep in the hurtling darkness.

She met Henry for the first time the next morning, at Hartford Hospital. My grandfather introduced them, and Henry greeted Milner with a smile. He was twenty-nine years old, boyish, affable, polite. After the introductions, my grandfather left to perform a surgery, and Milner excused herself to prepare her testing materials at a table in a nearby office, leaving Henry in the hallway outside with Dr. Karl Pribram, the head of research at the Institute of Living. Pribram had come to the hospital because he, too, was curious about Henry. When Milner finished setting up, she found Pribram and Henry still engaged in conversation. She interrupted them, then led Henry into the examination room.

“What were you and Dr. Pribram talking about?” she asked.

Henry looked at her curiously. She was mistaken, he said. He hadn't been talking with anyone.

They sat at the table, and Milner pulled out a copy of something called the Wechsler Memory Scale. The WMS, as it was known, was the standard diagnostic tool used to test memory. She'd used the same test with Patients P.B. and F.C. It was published by a firm called the Psychological Corporation and was written and conceived by a Bellevue psychologist named David Wechsler, who was also the author of the most popular IQ test at the time. Finding Henry's “memory quotient” was a simple matter of presenting him with the tasks listed on the form, recording his answers, and then tabulating the results. The interpretation of a person's memory quotient and intelligence quotient were roughly analogous: A score of one hundred was considered average, while anything above or below one hundred would be considered superior or inferior to some degree. The test began with a series of very basic questions, which Milner posed to Henry one after the other, pausing between each to note his answer. Henry said he was twenty-seven, that the year was 1953, that the month was March, and that the president of the United States was Harry S. Truman.

Most of Henry's answers were not exactly incorrect, factually speaking. Instead they were simply wrong chronologically. Everything he said had been true, at some time or another, just not at the present. As she listened and took notes, Milner tried not to betray any surprise or shock that might influence Henry. (This was a standard diagnostic strategy: In a copy of the WMS testing manual that I acquired, another psychologist had written across the top of one page that while presenting the test it was a good idea to “pretend you are Jack Webb of
Dragnet
.”) She proceeded through the questions without comment, even as the depths of Henry's amnesia became clear.

Milner then tested Henry on his ability to reproduce simple geometric drawings from memory and to remember unusual pairings of words, such as
cabbage/pen
and
obey/inch
. As Henry struggled, repeatedly coming up blank, Milner continued taking careful note of his errors, focusing on the protocols of the test, trying not to be distracted by the dawning sense that she was in the presence of an extraordinary patient.