Patient H.M. (37 page)

“You doing all right?” Annese asked, turning to me.

“I'm fine,” I said.

He picked up an electric drill, a customized device that cost nearly twenty thousand dollars. It was plugged into a nearby wall socket, and Annese kicked the cord out of the way before he got to work. When he activated the drill, it made a high whining sound. He told his assistant to grab a plastic sports water bottle he'd positioned nearby, one with a long narrow spout. He told him to use the water inside to keep the skull irrigated, to minimize the dust.

He used the drill to bore a small hole in the left temple. Imagine a mom giving her kid a simple bowl cut, snipping a level shelf around her kid's head, just above the ears. That's the basic trajectory taken by Annese's drill, cutting around the skull, up from his left ear, straight across his forehead, down the other side, around the back, then finally rising up again till it met up with the initial hole. When Annese's drill had completed its orbit, the entire top of the skull came loose. It didn't fall off, though. There were still things keeping it in place, an adhesive tangle of membranes and arteries. It wouldn't take much force for Annese to remove it completely, but before he did, there was something I wanted to do.

I found a blank sheet of paper in a printer. I drew two circles in the middle if it, each about the size of a silver dollar, with about two inches of space between them. Then I folded the paper in two so that the crease bisected each circle. I used scissors to cut along the lines, like a kindergartner making a simple mask, and opened the paper back up. It now had two silver-dollar-size holes in it.

“You got it?” Annese asked.

“Yeah,” I said.

“Okay. Put it on.”

I laid the paper across the man's forehead, positioning the holes so that each was about one inch north of the eye sockets. Then Annese began to gently pry off the top of the skull. His assistant had a flashlight, and he shone it into one of the holes. I leaned in and peered inside the cranium. I saw a jumble of pink and shadow glistening in the flashlight's shaky illumination, like when the dentist holds up a mirror and you catch a glimpse of the back of your own throat. My initial visceral impressions faded, and I started to get my bearings and recognize some of the structures I was seeing. The basic view I had was of the underside of the frontal lobes. I could see some of their convolutions, those famously intricate folds. From this angle, looking down at the frontal lobes from above, it was as though their underside were a cliff and I was peering over the edge at night. And there, in the shadows below, I could see a hint of some other structures. The temporal lobes were nearly invisible to me, just hazy forms in the depths.

“That's exactly the view your grandfather had at the beginning of Henry's operation,” Annese said.

I tried to imagine myself in my grandfather's operating room, peering through the holes that he'd just made in Henry's skull, holes the size of the ones I'd cut in the piece of paper. I tried to imagine how the view would have shifted slightly when he levered Henry's frontal lobes up and out of the way, finally getting a clear look, in the light of his headlamp, at the hidden and mysterious structures he was targeting, nestled in their moist, crepuscular cave. I'd often wondered what my grandfather had seen, standing at the head of his table, in his operating room, peering through the trephined holes in Henry's skull, right before he'd made his devastating and enlightening cuts. Now there it was. I looked through the holes for as long as I could, trying to commit the sight to memory, and then Annese removed the blood and serum-stained paper and tossed it into a biohazard bin. It was time to proceed with the harvesting.

He worked the top of the skull completely off, then laid it aside, rim up, like a bowl. The brain was now completely exposed, and Annese placed one hand underneath it, then reached below with a scalpel and neatly severed the top of the spinal column. He put the scalpel aside and placed his other hand underneath the brain. He tugged gently, making sure it was completely detached, that there were no other arteries or membranes or bands of nervous fibers that he'd missed. Then he pulled the brain out into the light.

O
n a hot July morning I drove an hour west of Washington, D.C., to the small town of Warrenton, Virginia, to meet with Karl Pribram. I'd first come across Pribram's name in the original 1957 Milner/Scoville paper that introduced Patient H.M. to the world. It was just a glancing mention, used to illustrate the severity of H.M.'s amnesia, and came during a description of the day in 1955 when H.M.'s formal testing began: “Just before coming into the examining room he had been talking to Dr. Karl Pribram, yet he had no recollection of this at all and denied that anyone had spoken to him.” From that point on, Pribram seemed to pop up everywhere I looked in my research. He interned as a neurosurgeon under Paul Bucy in Chicago in the late 1930s, went down to Florida to work under Karl Lashley—the man who came up with the theory of equipotentiality, which Brenda Milner and Patient H.M. helped overthrow—in the early 1940s, then moved to John Fulton's laboratory at Yale in 1948, helping to oversee much of the psychosurgery-related work there, including the Connecticut Cooperative Lobotomy Study. Then, in 1949, he moved to Hartford and became the director of research at the Institute of Living, my grandmother's asylum, overseeing Mortimer Mishkin, the man who would eventually develop the first monkey models of H.M.-like amnesia. In the late 1950s, Pribram left Connecticut and moved to Palo Alto, California, where he headed up the neuropsychology department at Stanford. He remained a professor emeritus there and also held a professorship at Georgetown University.

I knocked on Pribram's door. His longtime partner, Katherine Neville, a writer, philanthropist, and former model three decades his junior, opened the door. She was on her cellphone and she smiled and waved me into the living room to wait. Like my grandfather's old house, Pribram and Neville's was stocked with all sorts of things that wouldn't look out of place in a museum, including, at the far end of the living room, an eight-foot-tall carved wooden sculpture from Thailand, of a mythological creature called a Naga. Neville was on the board of directors of the Smithsonian.

I waited on an overstuffed couch for a while, reviewing the questions in my notebook. There was an urgency to this meeting: When I'd spoken with Neville on the phone, she warned me that Pribram was very ill with colon cancer, that he'd almost died several months before and still hadn't recovered.

Eventually Neville came back into the living room. Karl was ready to meet me, she said, and led me back to the ground-floor room he'd been using since his latest round of chemo had made him too weak to climb the stairs. I'd seen pictures of Pribram online, and in those pictures he always looked like God as wrought by Michelangelo: long white locks, a broad face, a thick, well-trimmed beard, piercing eyes, a gaze brimming over with raw knowledge.

Now Pribram sat in a bamboo chair, ninety-three years old, his hair and beard still regal but everything else looking shrunken and fragile. We shook hands, and I was careful not to squeeze too hard. He had pushed himself forward a bit for the handshake, and when he settled back into the chair he gave a soft groan.

I sat on a footstool near the chair, leaned in toward him, and began asking him questions. Neville had warned me that Pribram had been slowed by his latest round of chemo. He was still all there, she told me, but I had to be patient and give him time to answer. This seemed good advice, not least because Pribram was irritable; several times he snapped at Neville or his caregiver if either interrupted him while he was speaking, or at me whenever he thought my questions were inane or unclear. Every time he got distracted, either by an interruption or a fearsome attack of thrushy coughs, I had to remind him what he'd been talking about. Still, the memories he was able to pull up seemed vivid and clear, and his vocabulary was formidable. I got the sense his mind was working, just at a much different pace.

In some ways, it seemed like his memories had been worn down until only the sharpest, most salient facts and anecdotes remained. The impressions he had left were the impressions that had hit him hardest.

“What are your recollections of John Fulton?” I asked.

“John Fulton?” he said, then paused, looking up at a point in the distance for a full twenty seconds, while I fought the urge to fill the silence.

“John Fulton,” Pribram said finally. “Brilliant. Financially dependent on his wife. A drunk. Bitter that he never won the Nobel Prize. Ran one of the world's great laboratories.”

Then he stopped and waited for my next question. Later, when I asked him about Fulton again, fishing for more details, he told me the exact same thing, no more, no less. That was Fulton for him: brilliant, great lab, wife-dependent, bitter, Nobel-coveting drunk. Those impressions, and those alone, seemed to be what remained of Fulton in Pribram's mind. The rest had slipped away.

And so I threw other names at him, waited for the gears to turn, and listened.

Paul Bucy. Karl Lashley. Brenda Milner. Charles Burlingame. Walter Freeman.

He had something to say about each of them, some little thumbnail sketch, accurate, minimalistic, often cutting.

Eventually I asked him about my grandfather.

“Do you remember Bill Scoville?” I asked.

“Yes,” he said.

“What were your impressions of him?”

Pribram looked off into the distance. By now I was used to the pace and waited in silence for his memories to coalesce.

He shifted his eyes back down and met mine. He paused again. And then he told me.

The first story I ever sold to a publication was the one I'd first told to my grandmother in one of the many letters I sent home from Egypt. I remember the act of writing that letter, almost twenty years ago on my rented houseboat, tapping the words out on a clunky old laptop. Earlier that afternoon, while rowing a single scull on the Nile, I'd found a body floating facedown in the river. The letter was about that, and about what happened next, how I'd drifted alongside the corpse for a half hour, hollering in awful Arabic at strangers on the shore, trying to get help. I'd never seen a dead body before, and to this day the sight remains vivid in my mind: the wet jet-black hair of a teenage boy, the tops of his ears, his collared patterned shirt. The rest of him was invisible in the murk of the river. After I wrote the letter and sent it off, I decided I'd try to get it published. I didn't change much, basically just dropped the “Dear Bambam” at the beginning and gave it to the editor of a Cairo-based newspaper called
The Middle East Times
.

Many years later, I sat beside Bambam during Thanksgiving dinner and told her about a different story I'd begun working on, one about a man my grandfather had once operated on. Bambam was by then ninety-eight years old, a tiny woman in a blue dress. I asked her what she remembered about the saga of Patient H.M. She leaned toward me, inclining her hearing aid. I repeated the question, and she shook her head.

“I don't remember anything,” she said.

I changed the subject. I'd recently spent the night in a monastery, reporting a story for
National Geographic.
I told her about the novelty of sleeping in a cell and waking early with the monks for dawn services.

She nodded. I couldn't tell if she had heard or understood much. Then she leaned toward me again and began to speak.

“There once was a monk from Siberia,

Whose life grew drearier and drearier.

He leapt from his cell with a terrible yell,

And eloped with a mother superior.”

She finished the limerick, smiled, and settled back into her chair.

The next day I visited her at her assisted living home in Lexington, Massachusetts. We ate in the cafeteria, had a terrible lunch of watery scrod. She poured salt in her coffee, thought it was consommé. I'd brought along some old letters that her son, my uncle Barrett, had written to her. Barrett loved her deeply, and they corresponded a lot. She kept a bag of these letters by her bed, and visitors would read them to her, over and over. I'd grabbed a handful before we walked to the cafeteria. I opened one up, unfolded it on the table, read it aloud.

It was a letter Barrett had written shortly after my grandfather died, in 1984. He wrote about his grief, about the immensity of it. “If things go as are natural,” he wrote, “you also will die before me, and then my heart will truly break.”

Things did not go as are natural. Barrett died in a plane crash three years after he wrote that letter. My grandmother named Barrett after her younger brother, who also died too young.

I read a few more letters to her, and then before I left I reminded her of the monastery limerick she'd recited the night before and asked if she knew any others.

There was a long pause.

“There once was a man with a beard,

Who said it's just as I feared…”

She trailed off.

She didn't remember how it ended.

Karl Pribram settled his eyes back on mine. “Everybody liked Bill very much,” he said. “He was a very liked person.”

He paused.

“But,” he said, and paused again.

I leaned in closer, waiting to hear what he would say next.

From the beginning of his career, Pribram always rubbed certain people the wrong way. In 1948, for example, while weighing whether to hire Pribram on at his Yale laboratory, John Fulton asked Paul Bucy for his opinion of Pribram, and Bucy responded with a deliciously sharp sketch. After noting that Pribram was the son of “an outstanding Jewish Austrian bacteriologist,” he described Pribram's years as an intern under Bucy during medical school, where, according to Bucy, Pribram “was very immature in almost every way. His behavior was very irritating to many people. He was like a puppy that is always under foot.” Bucy did note that Pribram “is not unintelligent and has had an unusually extensive training in neurology and neurological surgery,” but stressed that “most people are very irritated by his personal manner” and that “the greatest difficulty, if there were any, would be his irritation of you and the other people in the laboratory.”

Another prominent neurosurgeon who'd taken Pribram under his wing, Percival Bailey, wrote a similarly caustic letter to Fulton:

“I can tell you a great deal about Karl Pribram,” he wrote. “He is, as you say, intensely eager to do investigative work. He is, in fact, so eager that he succeeds in making himself intolerable to whomever he works with. He comes, unfortunately, of a long line of rather distinguished physicians in Vienna and he feels that he is letting the family tradition down by becoming a mere practitioner. He will certainly work hard. What he will accomplish I do not know since he has never shown any evidence of originality. I should hate to have him drive you to drink on my recommendation.”

Eventually, however, Karl Lashley came through with a glowing recommendation, declaring Pribram “one of the three or four most promising research men that I have had to work with me,” describing “a quick, keen mind, a genuine scientific curiosity, and an enormous capacity for work.”

Fulton took a chance, hired him on. And he never seemed to regret it, although he did write Pribram a pointed and fairly reproving memo six months into his tenure at Yale. The memo was titled “Thoughts on Secretaries,” and in it Fulton told Pribram that although he had “come to admire your industry and enthusiasm,” he had also “become aware of the fact that you have considerable difficulty in getting on with those who are serving you. I am convinced that you are unconscious of the basis of your difficulty.” He listed a number of rules he wanted Pribram to follow from then on. “Whenever you ask any of the gals in the Department to do something for you, approach them as though you were asking a special favor,” Fulton wrote. “Never give them work just because you have to keep them busy.” Fulton stressed to Pribram that “you lose caste with everyone in the Department whenever you raise your voice with animal boys, secretaries, or anyone else in the group,” and advised him that a new secretary would be joining the lab the following morning. “I feel that you, rather than she, is on trial,” he wrote. He ended on a warm note, though, sending Pribram “every good wish for the success of the Lobotomy Project.”

As it turned out, Pribram wouldn't be irritating secretaries or animal boys or anyone else at Fulton's lab for much longer. A few months after Fulton sent that letter, Pribram moved to Hartford, where he started his own laboratory, becoming the director of research at the Institute of Living. And among the people he would get to know while in Hartford was a fellow neurosurgeon who, unlike him, was a very liked person.

In June 1972, my grandfather invited a reporter from the
Hartford Courant
to his office and gave an extended interview, which formed the basis for a three-part series of front-page articles. Walter Freeman had died the month before, and with Freeman gone the country's most passionate lobotomy advocate, and most prolific lobotomist, was my grandfather. The interview was a calculated attempt to haul the reputation of the lobotomy out of the gutter. Long after the majority of neurosurgeons stopped performing lobotomies, my grandfather continued to do so on scores of patients, ranging from psychotics to neurotics, in asylums and in his private practice. Even as the 1950s turned into the 1960s and 1970s, he continued, though the numbers dwindled significantly.

In 1970, my grandfather founded the International Society for Psychiatric Surgery. Composed of several dozen like-minded lobotomists, the organization was a self-conscious attempt to bring respectability to the widely disparaged field. In a “Letter from the President” to the entire membership regarding an upcoming meeting of the society that would be taking place in London, my grandfather stressed the importance of seeking “basic scientists rather than surgeons for our guest speakers in order to convince the world, and ourselves, that we indeed are a Society of dedicated scientists rather than trigger-happy barber surgeons.” His continued advocacy for psychosurgery didn't have any clear financial motive: Lobotomies by that time constituted only a very small percentage of his total surgical work, and his bread-and-butter jobs, as for many neurosurgeons, were spinal surgeries on slipped disks. His reputation by that point also rested on far more than his history as a lobotomist. He had been the president of the American Academy of Neurological Surgery and was the founder and honorary president of the World Federation of Neurological Societies. He was a professor of neurosurgery at Yale, remained the chief of neurosurgery at Hartford Hospital, and had accumulated a number of other honors, including a teaching chair in his name at the University of Connecticut. His reputation among fellow neurosurgeons was almost unparalleled and was helped by his constant travel and networking: One neurosurgeon I spoke with recalled visiting a prominent neurosurgeon in the Soviet Union during the height of the Cold War. Hanging behind the man's desk were three framed portraits: one of Vladimir Lenin, one of Ivan Pavlov, and one of William Beecher Scoville.