The Best American Science and Nature Writing 2011 (12 page)

Henry, Henry, Henry!

Oh!

Were you dreaming?

Yeah.

What were you dreaming about?

I was having an argument with myself...

About what?

What I could have been ... I dreamed of Pennsylvania. I dreamed of being a doctor. A brain surgeon. And it was all quick. Flashlike, being successful. And living down that way ... tall straight trees.

My grandfather grew up in Pennsylvania, got his M.D. at U Penn.

And yes, he was successful.

You could argue that Henry gives his career, like the careers of many other people, a boost. Gets his name out there, at the top of one of the most important scientific papers of the era and in the citations of thousands of others. He goes on to become clinical professor of neurosurgery emeritus at Yale and serves as president of both the American Academy of Neurological Surgery and the World Federation of Neurosurgical Societies.

Unlike Henry, he can move on. New patients, new procedures, a life steadily unfurling. A sustained narrative. Henry is an important episode in his past, but other episodes follow.

Still, he never performs another operation like the one he performed on Henry, and his characteristic hubris is, I like to think, tempered by a deeper appreciation for the dangers inherent in opening a man's skull. In 1973, during a conference about the ethics of brain surgery, he listens while a younger colleague of his, Dr. José Delgado, a professor of neurophysiology at Yale, advocates for the widespread use of corrective neural implants. Dr. Delgado, in an earlier publicity stunt, stopped a charging bull in its tracks by remotely activating electrodes he'd planted in its brain. "The question," Dr. Delgado declares, "rather than, What is man? should be, What kind of man are we going to construct?"

"With all due respect to Dr. Delgado," my grandfather responds, "I work almost wholly on humans, and we are more aware of the disastrous effects that sometimes occur in neurosurgery."

He died in a car crash on the New Jersey Turnpike eleven years later, in 1984. He was seventy-eight years old and still operating on patients at least once a week.

 

Winter 2008. New employees at the Bickford Health Care Center always receive a briefing on Henry and his special circumstances.

For example, they are directed never to speak to anyone outside the center about Henry, as the fact that he resides there is a closely guarded secret. If a stranger calls inquiring after Henry, the staff member receiving the call is supposed to give a noncommittal response neither confirming nor denying his presence and then immediately phone Henry's conservator, warning him about the snoop. The cloak of anonymity placed over Henry is effective: he has lived at the center for decades, and though he is the most famous patient in the history of neuroscience, no outsider has ever found him.

New staff are also briefed on the special rules that apply specifically to Henry's dying and his death. Suzanne Corkin drafted these rules, and the rules are printed out and always attached to Henry's chart.

So on the morning and afternoon of December 2, as Henry froths and gasps, fading from respiratory failure at age eighty-two, Corkin, as per protocol, receives periodic phone calls, keeping her abreast of the situation.

When his heart finally stops, a final call is placed to Corkin, and then someone at the center rushes to the freezer and digs out the flexible Cryopaks that were placed there in anticipation of this moment. By the time the hearse arrives, the ice blankets are wrapped securely around Henry's head, keeping his brain nice and cool.

Everything goes smoothly, according to plan, and a couple of hours and 106 miles later, the hearse pulls into the parking lot of Building 149 in the Charlestown Navy Yard, the Athinoula Martinos Center for Biomedical Imaging, in Boston, where Corkin is waiting.

The body bag is unzipped and the ice blankets unwrapped. Corkin has known Henry for forty-six years, having met him for the first time when she was still a graduate student in Brenda Milner's lab at McGill. Of course, her relationship with Henry, transaction-ally speaking, was just like Milner's: she knew Henry, not the other way around. Forty-six years of meeting someone for the first time, introducing yourself to an old friend. And now this last meeting that only she will remember.

During the night that follows, Corkin watches as Henry undergoes a series of high-resolution MRI scans. Then, the next morning, she attends the harvesting. She stands on a chair outside the autopsy room in the Mass General pathology department and peeks in through a window as Jacopo Annese and two other men saw off the top of Henry's skull and, with the care of obstetricians delivering a baby, pull his brain into the light. Corkin has spent the bulk of her career pondering the inner workings of Henry's brain. Now she finally gets to see it.

Later the brain sits for a while inside a bucket that's inside a cooler, steeping in a preservative solution, hanging upside down, suspended by a piece of kitchen twine looped through its basilar artery. Eventually, when the brain is firm enough to travel safely, Corkin rides to Logan Airport with the cooler. She accompanies it to the gate of a JetBlue flight from Boston to San Diego. There are cameramen following her. It's a self-consciously historic moment. She already has a book and movie deal. She puts the cooler down and Annese picks it up. Corkin thinks of Henry's brain as a treasure. She watches Annese walk down the ramp with it. She watches them disappear.

It's hard to let go.

 

There's a slim book sitting on a shelf right next to Annese's desk in his glass-walled office at the Brain Observatory in San Diego. Unlike a lot of the other books in this place—
A Study of Error, Serial Murder Syndrome, Man and Society in Calamity, Flesh in the Age of Reason, The Open and Closed Mind
—this one doesn't have a very lively title. But
Localization in the Cerebral Cortex,
by Korbinian Brodmann, is, to Annese, as vital a book as can be. It was originally published in 1909 and contains a series of meticulous hand-drawn maps of the human brain, divided up into fifty-two so-called Brodmann areas, each unique in its neuronal organization and, consequently, its function. Brodmann gleaned the borders of his areas through a rough and painstaking combination of microscopy and histology, and he did a great job, all things considered. He created an enduring Rand McNally road atlas of the mind, one that my grandfather used to direct his surgeries and one that most neuroscientists and neurosurgeons still use today.

As a fellow anatomist, Annese admires Brodmann's work immensely and recently wrote a glowing tribute to him that appeared in the journal
Nature.
But he will soon make Brodmann's old maps irrelevant.

That's what the Brain Observatory is all about, really.

If Korbinian Brodmann created the mind's Rand McNally, Jacopo Annese is creating its Google Maps.

A short walk from Annese's office, past an imported espresso machine and through a secure door, a number of tall, glass-fronted refrigerators stand against a wall. Many of these refrigerators contain plastic buckets, and though the plastic is murkier than the glass, you can still see what's inside. Most of the brains are human, but there is one from a dolphin, too. The dolphin brain is huge, significantly bigger than any of the human ones, though Annese cautions that it would be a mistake to read too much into size.

And what's true of individual brains is true of brain collections as well. With his Brain Observatory, Annese is setting out to create not the world's largest but the world's most useful collection of brains. Each specimen will, through a proprietary process developed by Annese, be preserved in both histological and digital form, at an unprecedented, neuronal level of resolution. Unlike Brodmann's hand-drawn sketches, Annese's maps will be three-dimensional and fully scalable, allowing future neuroscientists to zoom in from an overhead view of the hundred-billion-neuron forest all the way down to whatever intriguing thicket they like. And though each individual brain is by definition unique, as more and more brains come online, both the commonalities and differences between them should become increasingly apparent, allowing, Annese hopes, for the eventual synthesis of the holy grail of any neuroanatomist: a modern multidimensional atlas of the human mind, one that conclusively maps form to function. For the first time, we'll be able to meaningfully and easily compare large numbers of brains, perhaps finally understanding why one brain might be less empathetic or better at calculus or likelier to develop Alzheimer's than another. The Brain Observatory promises to revolutionize our understanding of how these three-pound hunks of tissue inside our skulls do what they do, which means, of course, that it promises to revolutionize our understanding of ourselves.

And what could be a better cornerstone for the Brain Observatory, what could be a better first volume for Annese's collection, than the infinitely pored-over brain of Patient H. M.? The boxes containing the cryogenic vials containing the slices of Henry's brain sit in their own freezers, to the left of the others, under lock and key. Precious cargo. San Diego is earthquake-prone, but there are backup generators and sensors that will automatically dial Annese's home and cell phones in the event of an emergency, so that wherever he is, he can jump into his Porsche, rush over, protect Henry.

Henry, just by being Henry, helps bring Annese's larger ambitions closer to reality. People who've read newspaper articles about Annese's work with Henry's brain have already called him up, made direct arrangements to donate their own. One of them, Bette, a feisty eighty-one-year-old who was one of the original flying monkeys in
The Wizard of Oz,
will be dropping by the Brain Observatory soon to get her second set of MRI scans. Annese knows the publicity will continue, hopes it will continue to inspire donations. He had wanted to get the brain of the guy
Rain Man
was based on, but that hadn't worked out. Eventually he'd like to get somebody really big, a household name, Bill Clinton, someone like that.

But Henry's brain is more than just an attention-garnering curiosity. And it's more than just a proof of concept, something Annese can use to demonstrate to the world the power of his methods.

It's an object—2,401 objects now—that contains enduring mysteries still waiting to be solved.

 

I remember following my grandfather up a hill. He was usually a sharp dresser—a
New York Times
reporter once described him as "almost unreal in his dashing appearance"—but on that particular morning I believe he wore a simple gray scarf, a floppy blue hat, and a threadbare ski suit. He was hauling a wooden toboggan behind him. It was either Christmas or Thanksgiving, one of the two holidays when the whole family would get together at his artifact-stuffed house in Farmington, Connecticut. I don't remember the slide down the hill, just the walk up.

I remember midway through one Christmas dinner, maybe his last one, when he pushed himself up from his chair at the head of the table, wandered back to his study, and came back a few minutes later with a crumpled bullet in his hand. He placed the slug down beside his plate, told us the story behind it. Stamford, Connecticut, turn of the century, a burglar breaks into the home of a young bachelor. The bachelor keeps a pistol by his bedside table but his pistol jams. The burglar's doesn't. A bullet enters the bachelor's chest, where it encounters a deflecting rib, skids away from a lucky heart. The bachelor survives and keeps the bullet as a memento. He eventually passes it down to his son.

The bullet just sat there for the rest of the dinner, beside my grandfather's plate, and like some of the other artifacts in his home, it was both fascinating and terrible to contemplate. Had it found its target, had its aim been true, then my grandfather, his children, his children's children, most of the people sitting around the table, myself included, would have never existed. It was a matter of centimeters, a fluke of aim, bone, ballistics, and it had made all the difference, its repercussions rippling down through generations.

 

An intact human brain sits on a small rectangle of green marble, under a sheet of saran wrap. Annese is wearing khakis and a black button-down shirt, plus a medical smock, blue rubber gloves, and safety glasses. Brains can be full of pathogens. He plucks off the saran wrap, picks up a scalpel, and begins to peel away the pia mater, a thin, sticky membrane that covers the brain.

He had never met the owner of this brain while she was alive, but he had performed the harvesting himself, so he knew what she had looked like, at least. She was a small lady, in her seventies, had reminded him a bit of a friend of his, and he likes to imagine that their personalities were similar.

He'd performed Henry's peeling on this same table, on this same slab of formaldehyde-slicked marble. He'd been alone then, music on—the Beatles, mostly—and everything had gone perfectly. He had removed the oxidized clips my grandfather had left behind, set them aside. Then the membranes, the blood vessels, all the obstructing tissue, stripping everything away, until he had been left, finally, with just Henry's naked brain. Peelings usually last three or four hours, but with Henry he took his time, made sure everything was just right, peeled for five hours straight.

He'd still been on a bit of a high then, still sort of pinching himself. He was part of the group that Corkin convened years ago to decide what to do with Henry's brain postmortem, and so of course Annese knew that the group had decided to give it to him as the cornerstone of his brain observatory—the most important brain of the twentieth century catalyzing a new era of brain research in the twenty-first. But despite all the planning, all the verbal agreements, he hadn't been absolutely sure he'd wind up with his prize until he actually boarded the flight with the cooler in hand. A part of him, the fatalistic Italian part, thought that something would happen at the last minute, that Corkin would change her mind, take Henry back.