Patient H.M. (25 page)

My grandfather responded with uncharacteristic humility.

“With all due respect to Dr. Delgado,” he said, “I work almost wholly on humans, and we are more aware of the disastrous effects that sometimes occur in neurosurgery.”

Mishkin told me he had to leave soon to attend a talk by a colleague. The talk was called “FMRI Correlation Maps from Spontaneous Recordings of Single Neurons,” and he tried to explain to me what that meant, but I got a little lost. Earlier, when we were talking about amnesia, he'd complained that his own memory was beginning to fade and that he suffered from anomia, an inability to recall the names of everyday objects. I hadn't noticed. Instead speaking with Mishkin reminded me of something Brenda Milner had told me when I asked what accounted for the enduring sharpness of her own remarkable brain. “Curiosity,” she said. Every day she woke up with a genuine passion to discover something new, and that's what kept her mind so quick.

I asked Mishkin if he felt that same driving, undying curiosity. He smiled, nodded.

“It is a really interesting adventure, what we are into,” he said. “Trying to discover how the brain works! How long is it now? Over sixty years. There's nothing more interesting.”

He laughed and pointed at his earthrise poster.

“Well, except the cosmos,” he said. “The two great mysteries: the cosmos and the brain!”

I
n a quiet conference room in a busy laboratory complex in San Diego, I placed the tip of a ballpoint pen on a piece of paper. A young German research psychologist named Ruth Klaming was at my side, a stopwatch in her hand, telling me what to do. A small metal stand hid my hand from my direct view, though I could see it in a mirror that was propped on the table in front of me. The piece of paper had a single large five-pointed star printed on it. The star had a double outline, and there was approximately a centimeter between the inner line and the outer one. My task, as Ruth explained it, was to trace a line all the way around the star, starting at the top and moving counterclockwise, between the inner and outer borders, trying not to touch either. Ruth pressed start on her stopwatch and I began. I looked at my hand in the mirror and moved it, one short tick, and watched as the pen in the mirror moved in entirely the wrong direction, toward the outer border. Then I stopped. I prepared to move the pen again but when I started and saw the line moving once again in the wrong direction, this time straying outside of the star, my hand froze. I sat there gripping the pen, staring at the mirror, trying to work out the puzzle. Obviously the problem was the mirror. I needed to move my hand in the opposite direction to what it was telling me was the right direction. In other words, if the image in the mirror indicated I should move the pen down toward me, in reality I needed to move the pen away from me. I steeled myself—it was almost physically uncomfortable to go against the visual cues provided by the mirror—and pulled the pen shakily down and to the right for an inch or two until it reached the star's first juncture, its second vertex. Then I froze again, trying to figure out which way to move my hand next. I got it wrong again, breaching the border, before recovering and moving slowly down toward the third point. This process repeated itself for the rest of the journey around the star until I reached the spot where I'd begun. Ruth pressed a button on the stopwatch.

She told me my time, not even bothering to pretend that my score was good. Then she removed the paper and replaced it with a fresh one, and I started over. Four more pieces of paper, four more stars. My times improved slightly with each one, until by the fifth star I felt almost comfortable, almost confident, almost able to overcome the odd disjoint between what I saw and what I felt.

Ruth gathered my papers and filed them in a binder, then placed a fresh sheet in the device. She left the room for a minute and I moved to another seat at the table. When Ruth returned she was accompanied by a man I'll call Jason, and Jason took my former seat. He was wearing baggy jeans and a red T-shirt with the lightning bolt symbol of the Flash printed on it. Around his waist he had a fanny pack, which was where he kept his smartphone along with a modded Game Boy filled with classic Nintendo games. Jason was in his late twenties and looked younger than that, with a wispy mustache and a hairstyle verging on mulletish.

Ruth explained the test to Jason and gave him a pen, and he placed the point at the top of the star. Then she clicked the stopwatch and he began. His first try was faster than mine—and his second even faster. He improved steadily until by the fifth try he'd made it around the star blazingly fast. Ruth congratulated him, gathered up all the stars, and filed them away in her binder.

We ate lunch in the same conference room, sandwiches and soda. Ruth was there, as was Jason's mom.

I introduced myself to Jason. He asked me where I was from, and when I told him I was living in the Yukon Territory, he nodded.

“Do the people up there constantly try to deceive you?” he asked.

I looked puzzled, and he paused a beat before delivering the punch line with a wry smile.

“Or do
you con
them?”

I laughed and then changed the subject, asking Jason about his modded Game Boy. He showed it to me and explained how it worked. It contained a sort of extra-large bootleg cartridge that gave him instant access to some of his favorite games:
The Legend of Zelda, Super Mario Bros. 3,
several of the
Final Fantasy
RPGs. He put the Game Boy down and we ate in silence for a minute or two. Then his mom spoke up.

“That's Luke,” she said to Jason, inclining her head in my direction. “Do you know where he's been living?”

Jason gave me a searching look, as though fishing for some sort of prompt. I waited. Finally he smiled, and I knew he was about to crack another joke.

“Planet Earth,” he said.

When I told him the Yukon Territory, he nodded, and a second later I saw the hint of another smile.

“Do the people up there constantly try to deceive you?” he asked.

When Jason was in his teens, he contracted a severe brain infection, which marched through his medial temporal lobes, destroying, one after another, most of his hippocampus and amygdala and uncus and entorhinal cortex. Once the infection had run its course, the lesion it left behind was uncannily similar to the one my grandfather made in Henry. And, like Henry, Jason was profoundly amnesic. His memory tended to last for exactly as long as he kept an object or idea or name or face in his attention. Once his attention shifted, whatever was there before disappeared. Jason coped with his amnesia like many amnesics did: Unable to draw on the past, they pay acute attention to the present, searching for cues and clues to help them make sense of their surroundings. This surface quickness can make it hard to see the underlying dysfunction: If I hadn't known who Jason was before I met him, I probably wouldn't have suspected anything was the matter with him until he repeated the Yukon joke.

After lunch, Ruth ran me through the mirror tracing test again. I did better right from the start. My hand just seemed to know which way to go and how to compensate for the visual discord. I was still a little clumsy, the line a little shaky, but the earlier paralysis was gone. By the end of the second round of five stars, I'd made it around much quicker than before, with fewer errors.

Then I watched Jason take the test again. He sat where I'd been sitting.

“Have you seen this test before?” Ruth asked him.

“No,” he said.

Ruth jotted down a note, then explained the test protocol to him again, just as she had an hour earlier. Jason picked up a pen, placed the point at the top of the star, peering intently into the mirror. Ruth tapped the stopwatch, and he began.

As before, Jason completed the task more quickly and accurately than I had, and by the fifth star he was able to lay down one of the highest scores Ruth had ever seen.

Jason had absolutely no memory of the first time he took the test, and by the time he left the conference room he would have no memory of the last time he took it. How was he able to improve his performance on a task without remembering having performed it?

To answer this question, it's necessary to jump back a half century to another testing room, and another bundle of scribbled-on stars.

After the publication of the 1957 paper she wrote with my grandfather, Brenda Milner continued making trips from Montreal to Hartford as often as she could, riding the night train, spending a few days at a time with Henry, plumbing the depths of his amnesia. Initially those depths seemed boundless. For Milner, it was always a little shocking to see that blankness in Henry's eyes whenever they met, that utter lack of recognition. She was getting to know him so well, but to him she was always a stranger.

She ran a huge variety of tests on him, tests of intelligence, vocabulary, facial recognition, and more. Once, during an informal quiz, she asked Henry to remember the numbers five, eight, and four, then left the testing room for twenty minutes. When she returned, she asked him if he remembered the numbers.

“Five, eight, four,” he said to Milner's surprise.

“Oh, that's very good! How did you do that?”

“Well, five, eight, and four add up to seventeen,” Henry answered. “Divide by two, you have nine and eight. Remember eight. Then five—you're left with five and four—five, eight, four. It's simple.”

Milner then asked him if she remembered her name.

“No,” he said apologetically.

“I'm Dr. Milner,” she said, “and I come from Montreal.”

They then chatted about Canada for a minute or two.

“Now,” Milner said finally, “do you still remember the numbers?”

“Number?” Henry said, “Was there a number?”

In other words, he'd played with them, keeping the numbers at the top of his mind, not allowing them to slip into the abyss. Milner's shock—was his amnesia not as grave as she'd thought?—turned to understanding as she realized that he hadn't actually been able to remember the numbers she'd given him, since the numbers had never really left his present moment. Two minutes later, after they'd moved on to other subjects, she asked him if he still remembered the numbers, and he gave her his usual blank look.

And then, one afternoon, Milner sat Henry down at a table and placed in front of him a sheet of paper with a double-bordered star on it. It was a task that had recently been invented, and as far as Milner knew it had never been administered to an amnesic. She was curious to see how Henry would fare on it but expected him to do poorly, allowing her to measure yet one more dimension of his memory deficits.

Just like Jason, just like me, and just like Milner herself, Henry struggled on the first star but by the fifth had improved. This did not surprise Milner. Henry had done the first five stars right in a row, which meant that, much like the numbers five, eight, and four had on that previous occasion, the task had never had a chance to slip from the top of his mind.

The next day, Milner placed another blank star in front of him.

“Do you remember seeing this before?” she asked him, and he shook his head.

“Nope,” he said.

She explained the task, and he did it. Well. Very well. Just as well as the fifth star the day before. Henry seemed surprised at his own facility with the task.

“Gosh, that wasn't as hard as I thought it would be,” he said.

Milner, on the other hand, was more than surprised. Watching Henry's hand trace an assured path around that star, a star he had no conscious memory of, was the most memorable moment of her scientific career. It hit her with the force of a revelation.

Henry couldn't remember taking the test. But he'd improved on it nevertheless. Milner knew this didn't mean that Henry actually retained some dim memory of his previous circuits around the star. She was confident by now that the events of Henry's life were indeed gone almost as soon as they happened.

What it meant, she realized, was that although Henry's brain lacked the ability to record the specific experiences in his life, it apparently was nevertheless able to retain some aspects of those experiences at an unconscious level. In other words, there were apparently at least two different and separate memory systems in the human brain. The system responsible for laying down specific occurrences, or episodes, was hopelessly compromised in Henry. The other system, the one that allowed one to acquire and improve upon learned skills, appeared to be intact. Henry might on a day-to-day basis never be able to remember having done something, but he was apparently able to remember how he did it.

Milner's initial studies of Henry had already formed the foundation for modern memory science, zeroing in on the seat of memory in the human brain. Now her further studies of Henry unexpectedly led to a second revolution: the notion that the brain contained at least two distinct and independent memory systems, one that was intact in Henry and one that was not.

In years to come, people would apply various names to these systems—procedural versus declarative, implicit versus explicit—but at that moment, watching Henry's hand trace that unexpectedly assured line around that mimeographed star, Milner had no name for it. She just watched in silent wonder.

Jason and I took a walk near the laboratory. He lit up a Kool and we wandered down a quiet street. Henry was a smoker, too. Things are different now, though, and it isn't every day you accompany someone on a smoke break. I found myself wondering whether there might be some sort of connection between amnesia and smoking. Whether amnesics might be more likely to pick up the habit. I used to smoke, and the thing about smoking is that it's something you do, no matter how many times, in the moment. It's a meditative, quiet, undemanding act. The problem is, eventually the ability to look behind or beyond the present makes smoking less appealing. I quit, finally, because I remembered myself with clearer lungs and could imagine them clogging more and more as years went by. People like Jason and Henry have limited access to their past selves, and most scientists think they can't really project themselves into the future, either. So why wouldn't they make every passing, soon-to-be-lost moment count, make it as pleasurable, as quickening and sharp, as possible?

Why wouldn't they smoke?

Their vices and their brain lesions weren't the only things they had in common. Jason was around the same age Henry was when Henry's story was about to be revealed to the world, and now Jason, too, was on the verge of becoming a Patient with a capital P. Some scientists were preparing a paper about Jason, and its working subtitle was “A Modern-Day Patient H.M.”

Still, to be an amnesic in the 2010s was very different from being one in the 1950s. Take smartphones, for example. Every smartphone user recognizes how the devices become memory supplements, shoring up the leaky containers in our heads that would otherwise let facts and names slip away. For a modern amnesic, however, a smartphone can become not so much a supplement as a substitute, a prosthetic hippocampus. Jason keeps his phone always on hand and is always using it to take pictures. He downloads the majority of these pictures to his laptop, storing them away and clearing space, but he also always keeps a few dozen on his phone.