Patient H.M. (39 page)

One of the lead authors of that MIT paper, incidentally, was Suzanne Corkin.

What exactly that future of psychosurgery would look like was still in doubt, though it seemed clear that new generations of psychosurgeons would focus on ever more selective lesioning combined with miniaturized brain-stimulating electrical implants. This was in many ways a realization of a prediction my grandfather made in his 1953 paper “The Limbic Lobe in Man,” in which he first mentioned Patient H.M. At the end of that paper, he speculated that “who knows but that in future years neurosurgeons may apply directive selective shock therapy to the hypothalamus, thereby relegating psychoanalysis to that scientific limbo where perhaps it belongs?”

Although my grandfather rarely indulged in introspection, during the twilight of his career he must have felt some satisfaction in knowing that the subspecialty he had devoted so much of his life to was going to endure, in one form or another. Psychosurgery of the sort Walter Freeman and my grandfather pioneered was nearly extinct, but surgery of the mind would continue to evolve.

His own life, on the other hand, was in many ways the same as it had been for decades. He still loved to operate and still spent as much time doing so as he could, even as his skills faded and restrictions piled up. He was always good at defying rules and never stopped enjoying living on the edge. His children with my grandmother had all grown up and begun their adult lives, but he'd started a new family with his second wife, and in a recent update he'd sent to his Yale class biography, he wrote that his current interests included “my new children, younger than my grandchildren.” He still loved fast cars, too. In fact, he'd sent his son Barrett a letter just two weeks earlier asking for his help in acquiring a new European sports car. Barrett lived in Frankfurt, where he worked for a pharmaceutical company.

“I am extremely anxious for you to check the car situation for me,” he wrote. “My interests have increased considerably since our last conversation and I must get it off my mind. I have spent all my time dreaming and dreaming of wonderful cars.” He listed the cars he was most interested in, which included a BMW M635CSi, a Porsche Carrera (with the Targa top), and a Porsche 944 with low-profile tires. He gave Barrett the names of some connected German friends who might be able to speed up the exportation process, and ended with an urgent plea: “Will you please put this matter in your highest priorities, for I dream of having one more good sport car before I die and these should last until then.”

He never got any of those last dream cars of his. On the way to his brother-in-law's birthday party, he missed his exit, stopped the car he'd chosen for this trip—a relatively sedate Honda Prelude—and started reversing up the New Jersey Turnpike, back toward the turn-off.

The car was hit by another vehicle. His wife was not seriously injured, but he was killed instantly.

In 1968, Brenda Milner and Suzanne Corkin co-authored a paper called “Further Analysis of the Hippocampal Amnesic Syndrome: 14-Year Follow-Up Study of H.M.” The paper detailed the minutiae of Henry's performance on a variety of new tests, like his experience with something called the Gollin Incomplete Pictures Test, which required him to try to identify drawings of an object even when the drawings were incomplete. For example, he was shown a drawing of an airplane that bore only a sketchy hint of wings and fuselage and tail. If he failed to identify it, he'd be shown a version of the same picture, only this time it would be slightly more filled in. There were five versions of each picture, with the final one complete. Henry, as expected, performed about as well as nonamnesic control subjects when first given the test. “This finding constitutes further proof that H.M.'s perceptual abilities are largely intact,” Milner and Corkin wrote. Also unsurprising was that when they gave him the test an hour later, his performance improved somewhat but not nearly as much as people with normal memories. “On the first exposure to the task,” they concluded, “H.M.'s performance was almost indistinguishable from that of the control subjects, but on retest he shows considerably less improvement than they do.”

This was one of the last papers Milner contributed to about H.M. By that point, she had already moved on, focusing on other cases and other neuropsychological puzzles. Years later, during one of my conversations with Milner, she described her relationship with Corkin as follows: “I've had all the recognition I need. I'm getting prizes and the rest of it, and I've done a lot more in my life than study H.M. And so, you know, I wish her well….There's no denying that I'm the person that did the basic work with H.M. and that she was my student.” Milner added that in her opinion, Corkin was a very competent, careful, and hardworking scientist but was “not very creative. I think she would probably admit that. I've had other students who were more creative, but I've not had students that were more dedicated.”

The 1968 paper wasn't particularly revelatory, scientifically speaking. Like most of the work Corkin oversaw with Henry over the following decades, it refined the groundbreaking discoveries Milner had made early on rather than breaking new ground itself. The paper did, however, contain one of the single most heartbreaking descriptions of how Henry actually experienced the world.

“Every day is alone in itself,” he's quoted as saying. “Whatever enjoyment I've had, and whatever sorrow I've had.”

Days.

Weeks.

Months.

Years.

They leave traces, some faint, some strong.

They pile up.

They order themselves into sequences in our minds, chains of causes and effects.

They become stories.

In the end, this is the difference between Henry and us: Henry could no longer hold on to the present, could no longer make new memories, which meant that he could no longer tell or even understand stories, at least ones that lasted more than a few moments.

We can.

And we can do more than that, too.

We can alter stories.

Sometimes the things you discover in the present change, irrevocably, your understanding of the past, adding new perspective, calling into question old interpretations.

These shifts might occur in the archives of an asylum, in the office of a scientist, in the basement of a library.

Or they might happen while you're sitting on a footstool in an old man's home, listening to him dredge up some impressions of your grandfather.

Sometimes just a few words can change everything you thought you knew about the story you thought you were telling.

“Everybody liked Bill very much,” Karl Pribram said. “He was a very liked person. But.”

He paused.

“I felt that anyone who did psychosurgery on his wife was sort of suspect. So I had my reservations about that.”

He told me what he knew, or at least what he remembered.

He thought the operation had taken place around 1950 and that it was an orbital undercutting procedure, the more precise, less blunting lobotomy that my grandfather had invented. He thought that the operation was performed at Hartford Hospital, not the Institute of Living, in part because he, Pribram, as head of research at the asylum, had expressed ethical reservations about the plan.

Katherine Neville and a full-time caretaker named Marlene were both sitting in on my interview, and each told me that they remembered Karl telling them the story about the psychosurgeon colleague of his who'd operated on his own wife.

“I didn't know it was your grandfather,” Neville said.

I sat there, pen frozen, mind racing. Was it possible? I thought back on the history I'd been steeping in. My grandfather had operated on hundreds of women with symptoms just like his wife's. Why wouldn't he have done the same to her? If he believed in what he was doing, if he believed he could help.

But could he have kept it a secret?

I remember Thanksgiving dinners when I was a kid, my grandfather holding court at the head of the table, his second wife to one side, my grandmother sitting mostly silent a few seats away. I'd hardly known anything about my grandmother's illness back then. It wasn't a subject the family would ever discuss directly. By the time I was in my late teens I'd picked up a few scraps of information: I knew Bambam had once had some sort of breakdown and that she still took Thorazine to deal with her symptoms. It wasn't until I began researching this book, though, that I learned any real, hard details. Most of what I uncovered was a surprise not just to me but to my mother, whose knowledge about my grandmother's troubles and treatments had been nearly as vague as my own. My grandfather's instinct to keep secret the details of his wife's illness had been present from the start: The first letter he sent to his parents after the breakdown ended with a request: “Please do not tell this to a living soul but yourselves—not even Aunt Alice. (At first unless you are sure she will not talk to the Cheneys.)” The Cheneys were my grandmother's side of the family.

But could that secrecy have run deeper than I'd ever imagined?

I knew there were precedents. Madness has always carried a stigma, and many institutionalizations are covered up. Some families are very good at keeping entire lives in the shadows: When Senator Ted Kennedy presided over those psychosurgery hearings in 1973, it was still not public knowledge that his own younger sister, Rosemary, had been lobotomized by Walter Freeman and James Watts three decades earlier, in 1941. Rosemary's operation was botched, and she remained in an institution till her death, deeply damaged.

I also knew that lobotomy patients often had no recollection of the operation and would deny having received one if asked. If my grandfather in fact operated on my grandmother, she may not have known it. Her brain may have carried a wound her mind was unaware of.

I looked at a Miró print on Pribram's wall. The print was blue and white and black, had overlapping shapes, sharp colors. I looked back at Pribram. He peered at me with rheumy eyes for a few moments before speaking again.

“It was a different era,” he said. “And he did what at the time he thought was okay: He lobotomized his wife. And she became much more tractable. And so he succeeded in getting what he wanted: a tractable wife.”

Over the next several months I would try to confirm what Pribram had told me. I looked for proof it had happened, or proof that it hadn't. I came up empty. Her medical records were gone, her body was cremated. The people I asked either didn't know or wouldn't tell me. I stared at old family photos, trying to spot faint scars. I told my mother, and it shook her, of course. She said that if he'd done it, he'd surely done it with the best intentions. I told Dennis Spencer, the former resident of my grandfather's who went on to become the head of the Yale department of neurosurgery.

“I never heard that,” he said. “But it doesn't surprise me. It sounds like something Bill would do.”

Here's what I do know for sure: My grandmother was not a tractable wife. Pribram was wrong about that, at least.

Despite everything. Despite whatever happened before her breakdown. Despite whatever happened after. The electroshock treatment. The hydrotherapy. The fever room. The Thorazine.

The operating room?

Whatever they did to my grandmother at the asylums, however bad it got, whatever they took, whatever
he
took: What remained was strong.

In 1957, the same year my grandfather and Brenda Milner published their paper about Henry, my grandmother took a trip to Reno, Nevada. She walked into one of the local shops that specialized in quick, no-contest divorces. She filled out each of the forms they gave her. The man working there took advantage of her, told her that it was a good-luck tradition to leave her wedding ring behind, to just drop it in the cardboard box behind the counter, and she did so, even though she could have made good money selling it. But maybe it was worth it, just dropping it in the box and walking away.

She left my grandfather, moved to New York City on her own.

By that point, her children had all gone off to college.

She started over.

She got a small apartment on the Upper East Side, landed a job as an assistant at an advertising agency. Eventually she pursued a master's degree in remedial reading, and taught at a school for children with special needs.

Her children grew older, had children of their own. She was a good grandmother. I remember how, during one visit to New York when I was twelve years old, I begged her to take me to the new Arnold Schwarzenegger movie,
Commando,
because it was R-rated and I couldn't go alone. She didn't enjoy it, but she went. I remember her leaning over and asking me if his muscles were real.

During her free time, she volunteered at an organization called the LightHouse, reading books aloud to blind people, men and women whose losses were clear for everyone else to see.

Some of our losses are more subtle, more hidden, more secret.

Some of our strengths are like that, too.

S
uzanne Corkin's office was on the fifth floor of MIT's Brain and Cognitive Sciences Complex, a $175 million facility that opened in 2006. The buildings were part of a recent MIT construction boom, right across the street from the $300 million Frank Gehry–designed Stata Center, which was packed with AI researchers. The Brain and Cognitive Sciences Complex had the feel of a modern corporate headquarters, perhaps one belonging to an Internet firm, its gleaming metal and polished marble leavened with touches of playfulness like the foosball table that sat on a fifth-floor balcony overlooking the cavernous central courtyard. High-definition TVs hung everywhere, advertising daily lectures and symposiums. Several architectural firms were involved in designing the individual buildings that made up the complex, and its website boasted it was an “exemplar of collaborative design, and is designed to inspire future collaboration.” Many of its laboratories had glass walls facing the hallways, and anybody walking nearby could watch the researchers inside at work, huddled over their pipettes or their laptops, all pursuing their own private mysteries.

Corkin's office sat at the end of a long red hallway. It was actually more of a suite: There was a front office with a desk for a secretary, a coatrack, and a bookshelf stacked with the latest issues of various scientific journals. I walked through the front office and into the larger one beyond it. I sat at a small round table, and Corkin took a seat across from me and offered me a French chocolate from a glass bowl. She was fighting a serious illness, and appeared physically frail. Her dog, Trooper, got up from a dog bed and wandered back out to the first room. Corkin asked if I could go check that the door to the red hallway was closed. She told me a story about how Trooper had once gotten out of the office, descended five stories, and walked out the front entrance and onto the street, which presumably she could have done only if somebody held the lobby door open for her.

“It's MIT and you'd think people here would be smarter than that,” Corkin said.

This was our second interview. The first had taken place the week before. She agreed to that interview after many denied requests, and I was looking forward to finally getting the chance to ask all the questions that had been building up. That first interview, Corkin had shown up a few minutes late for our one
P.M.
appointment, and at about one-fifty
P.M.
somebody poked his head into the office and reminded Corkin that they had a two o'clock meeting scheduled. I'd been expecting much more time, and when that first interview came to a close we'd barely had a chance to edge past Corkin's childhood in Hartford and into the early years of her career at McGill and MIT. None of those first questions had been particularly tough, but her answers were generally curt, offering up the bare minimum of information in a clinical and dispassionate way, even when they dealt with major milestones in her past. When I asked if she could describe for me any details of the first time she met Henry, to help me set the scene of that initial encounter with the man who would go on to define her life's work, this was her response:

“No, but that's not surprising. Because what you're asking for is an episodic memory, and episodic memories typically don't last that long, no matter what the situation is. Now, I'm sure there are exceptions, when, you know, say, somebody's being
raped,
and she remembers every little detail of that event. But what probably happens in cases like that, that are very emotional, is that they were repeated many times after. They were rehearsed, mentally, and became semanticized. So no, I don't remember what it was like to first shake hands with Henry, but if I did it would probably be fiction rather than fact.”

Unsure I'd get another chance to talk with her, I told Corkin that there were a number of documents she presumably had in her Patient H.M. files—including some of Henry's specific testing data, his brain donation form, certain unpublished transcripts of interviews with him, and my grandfather's original operative report—that I hoped she'd let me take a look at. She responded with a list of reasons that might not be possible, saying that she wasn't sure where all those documents were, and that she'd have to check with the MIT lawyers and her literary agent before sharing anything. Also, the idea of providing unfiltered research data to a layperson such as myself made her uncomfortable.

“I mean, you're not a psychologist,” she said. “You're not trained to administer or interpret these tests. So there's always the danger that you will misinterpret things.”

I decided to conduct this second interview somewhat differently. Knowing that I might not have much time, I skipped straight to my most pressing questions. Some of those had to do with Jacopo Annese. I'd learned of a surprising conflict that had flared up between Corkin and Annese, and I wanted to hear Corkin's side of it. When I brought up Annese's name, Corkin's expression, which tended to be fairly flat, visibly soured, as though she'd just tasted something unpleasant.

“He was technically good,” she said. “Good with his hands. He's a high-level technician.” Then, referring to the period leading up to and during Annese's slicing of Henry's brain, Corkin said, “At this point I still trusted him. We were friends. I thought this was a legitimate collaboration all in good faith….He prepared in advance for the brain and got all sorts of fancy equipment, and refrigerators and backup freezers and alarm systems.”

I asked the obvious follow-up question: What had happened to make her stop trusting him?

“I'm not going into this at all with you,” she said.

“Not at all?” I said. “Because I'd like to…”

Corkin cut me off.

“You would and so would everybody else.” She laughed. “
The New York Times
would
love
to have this story.”

Funny thing is,
The New York Times
did have the story. They just didn't know it. The first crack in the relationship between Corkin and Annese, at least as best as Annese can tell, was literally chronicled in the pages of the
Times
in the form of a tiny, unheralded correction to one of its articles.

Here's what happened. On December 22, 2009, the
Times
published an article on the cover of its science section. The article was called “Building a Search Engine of the Brain, Slice by Slice,” and it was about the project to preserve and archive Henry's brain, digitally and histologically, at the Brain Observatory at UCSD. A reporter had traveled to San Diego for the slicing, and his piece was solidly reported and evocatively written. At one point he described how, as the blade cut ever deeper into the block of milky-white frozen gelatin that encased Henry's brain, revealing more and more of it, the visible part of the brain appeared to be “growing with every slice like spilled rosé on a cream carpet.”

Annese and his laboratory were clearly at the center of the piece, but Corkin had come to San Diego to witness the slicing, and the piece included a few quotes from her. In the sixth paragraph was the following line: “The dissection marked a culmination, for one thing, of H.M.'s remarkable life, and of more than a year of preparation for just this moment, orchestrated by Suzanne Corkin, a memory researcher at the Massachusetts Institute of Technology who had worked with Mr. Molaison for the last five decades of his life.”

Annese liked the article, but that particular line puzzled him. Truth be told, it got under his skin, as he was not a man without ego. It was true, Annese knew, that Corkin had played a critical role in making that day happen. Without Corkin, Annese would never have had Henry's brain to work with in the first place. But to say that over the past year she had “orchestrated” the work that culminated in Henry's historic forty-eight-hour live-streamed dissection—a dissection that certainly represented, among other things, the most prominent single moment in Annese's career—well, that just wasn't accurate. A year before, at that JetBlue gate at Logan Airport in Boston, in front of those television cameras, Corkin had handed off Henry's brain to Annese, and ever since then she'd actually
kept
her hands off. Annese received the occasional email from her during the year that followed, but he was basically left to his own devices, assembling his team, applying for grants, acquiring equipment. The fact was, Annese worked harder than he ever had in his life, to make sure the slicing went off without a hitch and to lay the groundwork for the critical tasks that still lay in the future, and Suzanne Corkin had very little to do with any of it.

Annese wrote the
Times
reporter an email. He laid out, in diplomatic terms, his problems with that particular line of the article. He didn't want to minimize Suzanne Corkin's role in the project; he just felt that the article had overstated it. “I think of it this way,” Annese wrote. “Suzanne is writing the personal and scientific biography of H.M.; we at the Brain Observatory are writing the anatomy. At some point in 2010 we'll compare notes and knock memory researchers off their chairs!” Annese didn't want to feel like he was doing anything behind Corkin's back, so before he pressed send, he cc'd her on the email. The following day,
The New York Times
made a small change to the online version of the article.

Here's how the new line read: “The dissection marked a culmination, for one thing, of H.M.'s remarkable life, which was documented by Suzanne Corkin, a memory researcher at the Massachusetts Institute of Technology who had worked with Mr. Molaison for the last five decades of his life.”

It was such a subtle change that you might have to read the two lines one right after another to notice that the clause where Corkin was said to have “orchestrated” the dissection no longer existed. Annese was happy with the change at the time, but looking back, he believes that tiny tweak may have been one of the sparks for what would eventually become a secret custody battle waged between two major universities—MIT and UCSD—over one singularly famous human brain. Like all custody battles, this one would have victors and casualties, and among those casualties would be Annese's career, or at least his career as he knew it.

How to chart the death of a relationship?

In the case of Suzanne Corkin and Jacopo Annese, what may have begun as a minor unvoiced grievance slowly festered into something much worse.

Annese kept in touch with Corkin after the slicing, sending her updates addressed “Cara Sue” and receiving back smiley emoticons pecked out on her BlackBerry. On the surface, at least, things seemed as collegial as ever. Then, five months after the slicing, in April 2010, Corkin asked Annese to send her all of the block-face images he'd taken of Henry's brain. These were the high-resolution pictures made during the slicing, when a camera mounted above the microtome snapped a shot just before each pass of the blade. Corkin explained that Jean Augustinack, a young postdoc at the Martinos Imaging Center in Boston, where Henry had received his MRI scans, needed the images because she was planning to write a paper analyzing the anatomy of Henry's lesion.

Annese wasn't sure what to do. The block-face data set was one of the first products of his ongoing work with Henry's brain, which so far represented thousands of hours of toil, not to mention almost $750,000 in grant money. His plan had always been to make the block-face images public, accessible to anybody, but he intended to first write his own paper based on the data. In science, as in journalism, being scooped is a real fear, and the idea of giving up his data before he had a chance to publish made Annese's stomach turn.

After exchanging several emails, Annese phoned Corkin to discuss the matter and try to plan a way forward, and in his recollection she informed him, ominously, that
all
of the data he'd produced in San Diego ultimately belonged to MIT and Massachusetts General Hospital, not UCSD, and that his hesitancy to promptly turn over any of the block-face imagery she'd requested, along with portions of the tissue needed for a neuropathology exam, might end up damaging his career. Corkin also let him know that, in her view, he didn't have the “neuroanatomical competence” to do an effective analysis of Henry's lesion, and she mentioned that in certain press reports about his work with the brain, he had given short shrift to Corkin's role.

Up to that point, Annese had felt that his laboratory and Corkin's group were equal partners, bound by mutual respect. It suddenly was very clear the feeling hadn't been mutual.

After the phone call, Annese wrote Corkin an email defending his competence and stressing that it was his “responsibility to define the most opportune use of the data produced in my laboratory and the timing of its release….We have the expertise to explore this complex data and I plan to share the results of the analysis as soon as the work is complete.” He added that he would love for her to collaborate on any resulting papers, and that he hoped they could “always reach agreement about content, interpretation, and author listings.” As for how reporters had portrayed Annese in the media, he told Corkin that he had always praised her work with H.M., and her foresight, and that if she was “concerned with instances in which I took unmerited credit for ideas, methods, or any science related to the project, I ask that you share these with me openly and freely.” He ended with a plea for reconciliation: “I hope this clearly expresses my scientific and academic principles and what you should expect from me and my team. It would be a shame if misunderstanding polarized a potentially very productive collaboration; so I hope this can be avoided. As must be obvious, my enthusiasm and that of my lab for this project is second to none.”

Corkin and Annese were both going to be attending the upcoming meeting of the Society for Neuroscience, at the San Diego Convention Center, in late November 2010, and at the end of October Annese sent Corkin some images she'd requested for use during her keynote presentation. Annese also provided a USB drive containing block-face images from Henry's medial temporal region. He did not, however, send the complete block-face data set or any of the tissue for the neuropathological exam. In the meantime, Annese and his lab mates continued the Henry-related work of the Brain Observatory, processing slides, building a three-dimensional digital model of the brain, and developing the software for the Web-based brain atlas. Annese knew there were unresolved tensions between him and Corkin, but he chose to put them out of his mind, hoping he could figure out a way to smooth things over down the line.