Patient H.M. (26 page)

While he puffed on his cigarette, he pulled out his phone and opened the photo app. He scrolled through the pictures, looking at some of the events of the past few days, the airplane view of San Diego, a sunny beach, the outside of the laboratory, Ruth the psychologist. And a few pics from home, of pickup trucks and friends. He looked at the pictures and described them to me, then got to the last one and scrolled to the right and the first picture popped up again and he described it to me again, just as he did before.

Jason is more independent than Henry was. He lives on his own. This has caused complications: Some old friends of his took advantage and repeatedly stole small amounts of money from him, transgressions he would always forget so never have to forgive. Each time they'd show up at his door he'd let them back in. When we met, his mother was in the process of installing a high-tech surveillance system so that she could see a video feed of anyone at his front door and have final say on who gets to enter. Still, he has a great degree of independence. GPS has even made it possible for him to drive on his own. Once he has a destination programmed, he'll follow it to the end, even if by the time he arrives he's forgotten why he set off on his journey in the first place. The moment-by-moment mechanics of driving, all those little on-the-fly decisions, are no problem for him. And he even reads novels, something Henry never did. He enjoys Stephen King. As he reads, he writes up compressed plot summaries every couple of pages in the margins. The fact that he can do this is amazing. But these are compensatory devices and habits, coping mechanisms, not solutions. The central problem they're designed to tackle remains: Jason cannot remember what happens to him.

We talked about videogames, about his favorite brand of cigarettes, about the cars he wants and a fight he got into while he was in high school. It was in the hallway, and he got suspended. We talk about an old girlfriend of his and about his favorite bands. I liked Jason. He was a good guy, open and enthusiastic, pleasingly geeky. We shared some of the same interests. It felt like we were connecting, bonding somehow.

But we weren't. Or he wasn't. Because by the end of the day, Jason wouldn't remember me. I would leave his mind without a trace.

There's something liberating about talking with an amnesic. I suddenly realized that I could tell him anything at all, my deepest secrets, my most embarrassing hopes, and he would listen and respond, giving me input, perhaps even advice, but would never be able to tell anyone else. Jason was like a priest that way, or a therapist, or a diary, only even more secure.

There was something heartbreaking about it, too. This young, open man, taking in the world around him, with nothing ahead of or behind him, walking forever on a long, long tightrope between a clouded past and an unreachable future.

He finished his cigarette and lit another and offered me one for the second time, and for the second time I told him I didn't smoke.

“We have to get back to the laboratory,” I said.

He let me lead him there, not really understanding where he was going, not asking any questions, smoking the moment's first and last cigarette.

M
y grandfather always scheduled his lobotomies on Saturday mornings, is how Dr. Dennis Spencer remembers it. A little past nine
A.M.
They were kind of “surreptitious,” that's the word Spencer uses. They weren't placed on the regular schedule at Hartford Hospital, and they always happened on those weekend mornings when the neurosurgical suite was quiet, staffed with just my grandfather's longtime OR crew as well as any neurosurgical residents, like Spencer, who happened to be on hand. Usually the patient would be wheeled to the operating room straight from the Institute of Living next door. That's where most of them came from, back in the mid-1970s, though Spencer recalls that my grandfather also had some sort of deal with a psychiatrist in New Jersey and got plenty of referrals from him. Spencer watched my grandfather perform a lot of lobotomies during his residency, but the one he remembers best, the one he wants to tell me about, was one my grandfather performed on a woman in her early forties who had Tourette's or OCD, something like that. Whatever it was, it made her say, “son of a bitch, son of a bitch, son of a bitch” over and over and over again.

This was 1973 or 1974. Spencer had been a resident for two or three years. He was a student at the Yale School of Medicine and spent most of his time there, in New Haven, but he also regularly made the one-hour drive to Hartford to work with my grandfather. The two hospitals—Hartford Hospital and Yale–New Haven Hospital—had an unusual arrangement back then, sharing residents drawn from a combined pool of neurosurgery students at Yale and the University of Connecticut. By the time Spencer began his residency, that arrangement was beginning to strain at the seams, and within a few years it would collapse altogether. The problem was that the cultures of the two hospitals were very different, a direct by-product of the huge differences between the two chiefs of neurosurgery. At Yale, the chief was a man named Bill Collins. He was a solid, careful, smart surgeon, though even his admirers, Spencer among them, would admit he was maybe conservative to a fault. He didn't like taking risks. For him, neurosurgery was about finding the best, most efficient, safest solution to whatever the problem at hand was, then sticking to it. My grandfather…my grandfather wasn't like that.

Spencer started hearing stories about my grandfather as soon as he arrived at Yale. Wild stories. Stories that were hard to believe until you met him, like the one about my grandfather and Enzo Ferrari. Here's how it goes: Back around 1958, my grandfather was attending a medical conference in Europe when he decided, as he often did, that he needed a new sports car, stat. He drove to the Ferrari factory in Maranello, Italy. At the time, the company's founder, Enzo Ferrari, would only sell his vehicles to men he thought were good enough drivers to handle them. My grandfather and Ferrari set out on a test-drive together, and after a white-knuckle half hour on the hairpin highways near the factory, Ferrari turned to his prospective customer, his face drained of color but his voice firm.

“Dr. Scoville,” Ferrari said, “if I sell you this car you'll be dead within the year.”

My grandfather returned home with a Mercedes Gullwing instead.

Hard to believe, right? Hard to believe until the first time you saw my grandfather come rushing into the neurosurgery ward yelling at the nurses and the secretaries and anyone who'd listen that he'd just led some Connecticut state troopers on a high-speed chase and he thought he'd lost them, but that if they came looking for him to tell them that he was in the OR performing an emergency craniotomy or something.

Wild Bill, that's what some of the residents took to calling him.

Was it a surprise that Wild Bill and his counterpart at the Yale hospital, staid Bill Collins, didn't get along? Collins thought my grandfather was a bad influence on the Yale residents, and my grandfather thought Collins was too careful for his own good, that nobody made progress by doing the same thing over and over. Neurosurgery, for my grandfather, was an adventure, an ever-changing one, and should never be made into some by-the-book slog.

Collins wasn't the only guy my grandfather didn't get along with. As soon as Spencer began his residency, people warned him about a long-standing, bitter turf war being waged between my grandfather and James Foster, Hartford Hospital's chief of general surgery. Foster had his hands on the hospital's purse strings, and as far as my grandfather was concerned he was always trying to limit his goals for the neurosurgery department, tamping down the expansion of equipment, of staff, of space. Limiting
him,
in other words. He hated to be limited. He fought hard against Foster, demanding and often getting his way: The neurosurgery department had grown a huge amount since my grandfather founded it three decades before. Still, he always wanted it to be bigger, better.

For my grandfather, the conflict between him and Foster wasn't just professional, wasn't even just personal: It was literally a matter of life or death. Exactly what that meant was another story, one that began at a party, a big blowout at my grandfather's house. He hosted these parties every year for all the neurosurgeons and neurosurgical residents from both Hartford Hospital and Yale–New Haven Hospital. (Not that Collins would ever come, of course. They'd get wild, these parties. Collins wouldn't have approved.) Anyway, this particular party took place just a few days after my grandfather had bought himself a new motorcycle, a souped-up BMW. His wife was out of town. He wanted to show it off. He got on, and one of the residents got on behind him, and my grandfather started riding the two of them, fast, all over his big front lawn. Then he decided to try doing a wheelie. He wasn't used to popping wheelies with the weight of somebody else riding behind him, so the front wheel went up, then it just kept going up. Up and over. Bike flipped backward, high speed, dumping the two of them onto the lawn. No helmets, of course. The resident was fine, my grandfather was knocked unconscious, and the bike landed on top of him. Picture a lawn full of inebriated neurosurgeons standing around in sudden shock looking at Wild Bill sprawled there with a head injury.

He came to after a minute or so, and then the ambulance arrived and carted him off to Hartford Hospital, with a whole armada of surgeons following closely behind. He was wheeled straight to a private room, and he said he was feeling fine, but somebody noticed a suspicious swelling in his stomach area. A ruptured spleen is what they suspected. Word spread, and a few minutes later James Foster himself came into the room, looked him over.

“Bill,” Foster said, “you've got a busted spleen. I'm gonna have to operate.”

My grandfather, lying there in that hospital bed, looked up at his nemesis.

“Hell no,” he said.

Foster's eyebrows rose, and my grandfather continued.

“I know what you're planning,” he said. “You're planning to let me die on your table. You want me out of the way. That's not gonna happen. My spleen's fine. My spleen stays where it is.”

They went back and forth, arguing heatedly, my grandfather refusing to budge, refusing to consent. Eventually Foster left, shaking his head, and told all the neurosurgeons waiting outside that they
had
to convince my grandfather to consent, that he'd die otherwise. And so they marched in, one after another, trying to persuade my grandfather to let his enemy save his life. Nothing worked until finally Ben Whitcomb, my grandfather's second-in-command and longtime best friend, pleaded with him. You've gotta do this, Bill, he said. You've gotta let him operate.

My grandfather looked at Whitcomb with hurt and confusion in his eyes.

“I don't know what he paid you, Ben, to make you betray me, but you're my best friend in the world and if I can't trust you I can't trust anybody.”

He consented and was wheeled off to surgery. Foster opened him up and removed his spleen, which was indeed ruptured, and it all went smoothly; a couple of hours later my grandfather was in the recovery room, waking up, still groggy, when one of his residents, Norman Gahm, came in holding a glass jar. The jar was full of formaldehyde, and there was something dark and fibrous floating in it, with a long ragged split down the middle.

“See?” Gahm said. “It was ruptured!”

And yeah, that story might sound hard to believe, too, until you saw the glass jar, with its cargo still floating within it, on a shelf in the office of Gahm, who held on to the damn thing for decades: Wild Bill's ruptured spleen.

Telling the spleen story reminds Spencer of
another
great story, about the only other time he knows of that my grandfather was himself operated on. It was to treat a slipped disk in his back. Now, my grandfather developed a lot of the basic tools that spinal surgeons use when they're treating slipped disks. The Scoville retractor. The Scoville clip. He also pioneered the so-called keyhole approach, through a tiny incision, which became the standard. As it happened, keeper-of-the-spleen Norman Gahm was scheduled to perform the disk operation on him, and on the day of the operation my grandfather got to the hospital early and started ordering people around. What he did was he got them to set up this elaborate system of mirrors in the OR so that later, while he was lying on the table, his back cut open and his spine exposed, with only a local anesthetic, he could look over his own surgeon's shoulder. He supervised his own operation. Spencer never heard of anyone else doing that, before or since.

The thing was, he could get away with it. With everything. Partly it was the era—those were different times—and partly it was that Spencer didn't think there was another neurosurgeon in the state of Connecticut as skilled in the operating room as Bill Scoville. Those hands of his: quick, adroit, steady, creative. Spencer loved to watch him work.

So on that morning in question, the one he wanted to tell me about, after the lady was rolled into the OR and my grandfather was getting all prepped and ready to go, Spencer was eager to watch him do what he was going to do. You could call him wild, you could say he took chances others didn't, but before you criticized him too harshly you needed to take a look at him scrubbing up. Spencer never saw a surgeon take as much care as my grandfather did scrubbing up. He didn't just wash his hands, he dipped them in a tub of hydrochloric acid! Spencer had never seen anything like it. Must have been hell on his skin. Also, his surgical mask. Same mask that everyone else wore, paper-thin, with the elastic around the back of the head. But if you looked closely you'd see that underneath the mask my grandfather had two rubber tubes, one in each corner of his mouth, and they snaked out from his mouth and curved around behind the mask like snorkels. So that when he breathed, even through the mask, those exhalations didn't go anywhere near the exposed insides of his patients. That level of care was rare.

Sometimes things still went wrong, of course. One of the first things Spencer learned when he began his Hartford Hospital residency was that all of my grandfather's residents were expected to regularly head over to the Hartford veterans' hospital nursing center and check in on a guy there named Gunner. Gunner had been a patient of my grandfather's with a ruptured disk. The operation itself was usually easy enough, but in Gunner's case my grandfather decided to perform it in an unusual way, with Gunner sitting in a chair instead of lying on a stretcher. Which would have been fine except that an air embolism got into his bloodstream and rose up and blocked off Gunner's basilar artery, causing a massive stroke in his brain stem and obliterating his motor functions. From then on all he could do was move his eyes, right for yes and left for no. He still could think fine, but he was totally locked in. My grandfather would always send residents to check up on him, to make sure he was being tended to. And my grandfather would go himself, too, sometimes. He'd bring flowers.

But back to the story he wanted to tell me. The lobotomy story. So there the woman was, lying on her back, muttering,
“Sonofabitchsonofabitchsonofabitch.”
And there my grandfather was, scrubbed and ready to go. Spencer watched as my grandfather prepared, watched as he began, watched him slice two little slits right above her eyebrows, watched him pry them open with retractors, exposing the skull beneath. Those eyebrow slits were a bit of a novelty, incidentally. A little tweak: Rather than slicing that half-moon arc across the top of their heads and rolling their foreheads down, like he used to, he'd started making just those two little slits, slits that would be concealed by their eyebrows. That was another example of his constant tinkering, of his constant attempts to improve even his oldest procedures. His orbital undercutting lobotomy
was
a very old procedure by then, in the mid-1970s. A quarter century old. Not only was it old, it was rare. People weren't performing many lobotomies by then. They'd fallen out of favor, become stigmatized.
One Flew Over the Cuckoo's Nest, A Clockwork Orange,
Planet of the Apes:
Popular culture, and popular opinion, had turned against it. Even within the medical community, it had become a sort of black sheep. That was another reason for the friction between my grandfather and the Yale chief of neurosurgery: Collins hated lobotomies, and he hated the fact that my grandfather was making his Yale residents, like Spencer, accomplices to them.

As for Spencer, he didn't know what to think. He was just there to absorb, to learn. He stood on that stool behind my grandfather, watched him bring his trephine drill down onto the woman's forehead, watched him cut out those two plugs of bone and put them to the side, watched him pick up the suction catheter and the flat brain spatula and lean in and begin the work. He watched my grandfather lesion the right hemisphere of the woman's brain first, and he listened as she continued her incessant cursing, lying there under the bright lights:
“sonofabitchsonofabitchsonofabitch.”
Watched as she kept it up throughout the first half of the operation and that first hemisphere. Watched as my grandfather carefully withdrew his tools, then inserted them into the second hole in her head and started in on the left hemisphere. My grandfather carefully measured how far in he'd inserted the suction catheter, then began to slowly pivot the tool, starting to make the second lesion. She was still cursing as he began to cut—
“sonofabitchsonofabitchsonofabitch”
—and then suddenly—
“sonofabitchsonofabitchsonofabi…”
—she stopped. My grandfather paused, waited to see if she'd start in again. She didn't. Then he turned and looked back at Spencer.