Patient H.M. (22 page)

Finally, she told Henry some stories, one about a young housecleaner in Boston named Anna Thompson who'd been robbed of fifteen dollars, another about a ship that struck a mine near Liverpool during a perilous ocean crossing.

When she was finished, she waited a few moments, then asked him to repeat whatever he remembered back to her.

He looked at her curiously.

Henry scored a memory quotient of sixty-seven, the lowest Milner had ever seen.

Before the day was done, Milner also tested Henry's IQ. The tasks contained in the Wechsler-Bellevue Intelligence Scale were eclectic. There were specific questions meant to gauge one's general factual knowledge—Where is London? Who wrote
Faust
? What is the Apocrypha?—and broader, almost philosophical questions that required more elaborate and thoughtful answers: Why should we keep away from bad company? Why are laws necessary? Why are people who are born deaf usually unable to talk? One section asked for definitions of various words, ranging from the simple—
apple
—to the obscure—
moiety
—and another tested real-world arithmetic skills by asking, for example, how many pounds of sugar you could buy for a dollar, if seven pounds of sugar cost 25 cents. There were analogy tests, which asked in what ways oranges were similar to bananas, wagons similar to bicycles, and praise similar to punishment. Other tests involved pictures, not words, such as one that required the test taker to reassemble a jumble of paper fragments into their original form, a human head in profile.

Henry was good at all of them. More than good. He scored 118 points overall, far above average and well into the “superior intelligence” range. He was particularly good at the arithmetic, could work the answers out in his head quickly and fluidly, but he proved sharp and capable throughout. As Milner observed Henry tackling the IQ test, coasting through hard questions with ease, it was almost possible for her to forget the amnesia that lurked just below the surface of his bright eyes.

Henry was a tireless test taker. He focused on each new task with the same intensity, never complaining, never bored. At one point, during a pause in the testing, Milner excused herself and went to get a cup of coffee from the hospital cafeteria. It had been a long night on the train and a long day in the examination room. She returned a few minutes later armed with caffeine and ready to get back to work. Henry greeted her with a smile and a look of friendly uncertainty. He had no idea who she was, but he was pleased to meet her all over again.

The next day, Milner began visiting the psychotics in the state asylums. My grandfather provided her with a car and a driver, and phoned ahead to make sure she'd have access.

Her first visit was to Connecticut State Hospital, sixty miles west of Hartford, with its bucolic riverside setting and active dairy farm. She settled into an examination room and soon received her first patient, a woman with the initials M.B. Milner, as always, took careful notes. Patient M.B. was, she wrote, “a 55-year-old manic depressive woman, a former clerical worker.” She'd been at the asylum since December 27, 1951, when she'd been described as “anxious, irritable, argumentative and restless, but well-orientated in all spheres.” Almost exactly one year after her institutionalization, M.B. visited room 2200, where my grandfather performed a “radical bilateral medial temporal lobe resection.” M.B.'s case files recorded that “postoperatively she was stuporous and confused for one week, but then recovered rapidly and without neurological deficit.”

Even before Milner began the formal testing, it was clear to her that the asylum's conclusions about M.B.'s lack of deficits were wrong. The woman, Milner wrote, “had been brought to the examining room from another building but had already forgotten this; nor could she describe any other part of the hospital, although she had been living there continuously for nearly three and a half years.” The tests Milner administered only verified these first impressions. “On the Wechsler Memory Scale her immediate recall of stories and drawings was inaccurate and fragmentary, and delayed recall was impossible for her even with prompting; when the material was presented again she failed to recognize it. Her conversation centered around her early life and she was unable to give any information about the years of her hospital stay.” By the time M.B. was led back to her ward, Milner was convinced that she suffered from “a global loss of recent memory similar to that of H.M.”

Over the next few days, Milner met with four more asylum patients.

One, a “paranoid schizophrenic with superimposed alcoholism,” told Milner that she could “remember faces” but forgot “many daily happenings.” Milner noted that during their conversation this patient “showed little knowledge of recent events.” Another was a little less impaired, and “knew that her daughter had caught a 7 o'clock train to New York City that morning to buy a dress for a wedding the following Saturday. She could also describe the clothes worn by the secretary who had shown her into the office.” A third patient fared poorly on memory tests, though she was aware that “she had been working in the hospital beauty parlor for the past week and that she had been washing towels that morning.” The final patient was able to remember Milner's “name and place of origin 10 minutes after hearing them for the first time” but was “still subject to delusions and hallucinations” and “was found to be too out of contact for extensive formal testing.”

Up until that week, Milner had never even been to an asylum. When she talked about these visits a half century later, the frustration of trying to gather useful data in those difficult environments still seemed fresh. The patients, she said, were mostly pathetic people from the back wards of the asylums, and she could, she said, “do very little with them. I could just establish that they had essentially the same kind of impairment….But I couldn't do very much with them in terms of formal testing.”

Still, it was clear that most of the asylum patients she met displayed some degree of memory loss, even if that degree was challenging to quantify. Most important, the severity of the loss appeared roughly proportionate to the amount of hippocampal tissue my grandfather had removed from their brains. That was the key.

At the end of the week, she boarded the train back to Montreal. The tentative ideas that she'd brought to Connecticut had grown into something stronger.

By that time, the bilateral medial temporal lobotomy that my grandfather developed, like his orbital undercutting lobotomy before it, had spread beyond Connecticut. Other neurosurgeons, in other states, in other asylums, had begun to experiment with it. Sometimes they would invite my grandfather to come demonstrate the operation.

Which is why, in May 1954, about nine months after operating on Henry, my grandfather traveled to Manteno State Hospital in Illinois, a little south of Chicago. By the time he arrived, the patient was already anesthetized and on the operating room table. My grandfather knew virtually nothing about him besides the obvious fact that he—unlike most of the asylum inmates my grandfather had operated on in Connecticut—was a man. He proceeded with the operation, cutting open the inmate's skull and removing most of his medial temporal lobes bilaterally in the presence of a young neurosurgeon named John F. Kendrick, who subsequently began performing the operation on his own.

After Milner's visit to Connecticut, it occurred to my grandfather that she might like to visit the man he'd operated on at the Manteno asylum. He wrote the asylum superintendent a letter, asking that he grant Milner access to the patient, then sent a copy of the letter to Wilder Penfield, along with a note musing that the case “might prove of intense interest.” Penfield provided a copy of both letters to Milner, along with a handwritten note:

“To Dr. Milner: Where angels fear to tread…”

Two months later, Milner arrived in Illinois. The patient in question had, she learned, recently been transferred from Manteno State Hospital to another nearby asylum called the Galesburg State Research Hospital. On January 12, 1956, Milner was provided with an examining room at Galesburg, and the man she would later describe in scientific papers as Patient D.C. was escorted to meet her.

“Did my grandfather ever feel guilty?”

Milner seemed surprised by my question.

“I don't think he felt guilty,” she said. “I mean, we did not know what these structures did. And I don't really think he should have felt guilt about H.M., because H.M. was so desperate. He was having an absolutely miserable life.” She paused. There was one patient in particular, it struck her now, who had weighed on his conscience, who had made him feel guilty.

“D.C.,” she said. “The doctor in Chicago.”

That was one of the first things Brenda Milner learned about D.C., sitting in that examination room at the Galesburg State Research Hospital reviewing his case history: He'd been a doctor. A practicing doctor, in Chicago. And then something had happened to him. A breakdown. The breakdown was precipitated, perhaps, by the loss of a lawsuit. Or maybe it was inevitable: He'd had a history of paranoid thoughts and violent outbursts, which started before he finished medical school. Regardless, the breakdown in question had been extreme: He tried to kill his wife, with an ax, unsuccessfully. That was in 1950, when he was forty-one years old. For the first four years of his institutionalization, he received many of the standard treatments from the armamentarium of contemporary asylums, including repeated rounds of insulin coma therapy and electroshock therapy. His condition did not appear to improve. And so eventually a call was placed to my grandfather.

The records indicated that Patient D.C.'s recovery from the operation was “uneventful,” with “no neurological deficit,” though at least one asylum employee noted that “since the operation he had been unable to find his way to bed and seemed no longer to recognize the hospital staff.”

Milner administered D.C. the Wechsler intelligence test and found that he was extremely bright, even brighter than Henry, with an IQ of 122. Then she began testing his memory. Very quickly she realized that he “presented exactly the same pattern of memory loss as H.M.” When she asked him where he was, he said he had no idea but explained that that was only natural, since he'd arrived there just the night before. He'd actually been there six weeks.

She ran him through the usual gauntlet of memory tests and tried a few new ones out. She asked him to draw pictures of a dog and an elephant. Then she put them aside. A few minutes later, she showed him the drawings. He was not a good artist. She asked him what animal the drawing of the dog was supposed to be. He squinted at it, then took a guess.

“A deer?” he said.

Then she asked him who had drawn the pictures.

He had no idea.

Those drawings, fifty years old now, are among the things that have accrued in Brenda Milner's overstuffed office, although she can't find them during my visit.

She does remember a phone call she made the day after she met D.C., though, before leaving Chicago.

“I called Dr. Scoville,” she told me. “It was his birthday. His fiftieth birthday, I think. January the thirteenth, wasn't it?”

She called him, wished him a happy birthday, and told him about the tests she'd run on Patient D.C. and how they had revealed an amnesia just as profound as Henry's. Then she told him a little bit about D.C.'s history, specifically the fact that he had been a medical doctor.

“This was the thing that got to him,” Milner told me. “You know, the professional thing. I'm sure if he had been something else than a doctor—even a high-level something else—it wouldn't have bothered him so much. A lawyer or something. But this was a doctor. And it shook him.”

In May 1957, the
Journal of Neurology, Neurosurgery & Psychiatry
published an article by William Beecher Scoville and Brenda Milner titled “Loss of Recent Memory After Bilateral Hippocampal Lesions.” The paper introduced Patient H.M. to the world and detailed the depths of his deficits.

The paper also described a variety of institutionalized men and women my grandfather had performed similar operations on—Patient M.B., Patient A.Z., Patient A.R., and Dr. Patient D.C., among others—but the clear focus was on Patient H.M., who combined a mind unmuddied by mental illness with bilateral medial temporal lobe lesions as extensive as any performed on the psychotics. The important takeaway was a broad one: “In summary, this patient appears to have a complete loss of memory for events subsequent to bilateral medial temporal lobe resection.” By extension, H.M.'s case pointed “to the importance of the hippocampal region for normal memory function.” My grandfather and Milner concluded with the stark, unequivocal, and deceptively revolutionary declaration that “bilateral medial temporal lobe resection in man results in a persistent impairment of recent memory” and that the medial temporal lobe structures must therefore be “critically concerned in the retention of current experience.”

In other words, the location of the seat of memory, that ancient mystery, had been revealed. And it is that revelation, borne out by more than a half century of subsequent research, which made this paper the single most cited paper in memory science. It is in many ways the field's founding text.

Brenda Milner is ninety-three years old. Most of the people she's ever known are gone now, of course.

Wilder Penfield.

My grandfather.

Henry.

But sometimes the memories they created are so strong that the fact of their absence is hard to process.

“People ask if he was unhappy,” Milner said to me at one point, talking about Henry. “I think he'd never known happiness. I mean, this is the thing about H.M. Any of these other patients, one would say, ‘This thing that happened is catastrophic.' I mean if you've got a real life with a family, and you're interested in politics, and you're good at your job, and so on, and you suddenly can't remember what you had for breakfast, then this is a catastrophe. But if you had major convulsive seizures in spite of heavy medication for years and years and years, so that although you were potentially bright you couldn't think clearly, and it took so long to get through school, and you were rejected….You can imagine that he did not really have a very good life with all the medication and all the seizures and the isolation. And since the surgery, since he is so amiable, and since he really likes doing tests, he likes doing something for science…”