Patient H.M. (35 page)

By 1992, as Corkin described it later, Henry's “difficulty in retaining new information raised the nagging question of how we obtained informed consent.” In July of that year, Peter Reich, the chief of the psychiatry department at MIT, was asked by Corkin to interview Henry, and afterward Reich wrote a reassuring letter in which he said that Henry “appeared to understand the nature of the procedures he has been undergoing as a CRC subject and expressed his willingness to undergo these procedures.” This was not enough, however, to allay everyone's concerns. The standards governing human research, not to mention governing the funding of human research, had changed considerably in the decades since “the MIT Research Project Known as the Amnesic Patient H.M.” began. By the time Reich interviewed Henry, Corkin had already initiated the search for a conservator, someone who could provide the rock-solid informed consent that Henry himself could not.

Thomas Mooney was the second person to apply. A year earlier, in 1991, Corkin had arranged for a physician named John J. Kennedy to submit his conservatorship application to the Windsor Locks Probate Court, which oversaw such matters. Kennedy was on staff at the Bickford Health Care Center and was Henry's personal physician there. The application required that Kennedy describe the “mental, emotional and/or physical condition which prevents respondent from performing necessary and proper functions for his or her well-being,” and Kennedy wrote that Henry “has had a lobotomy and is presently mentally unable to perform daily functions properly.” The application also asked Kennedy to list Henry's closest relatives as well as any other “interested parties.” In Connecticut's probate practice book, an interested party is defined as any “person having a legal or financial interest” in the proposed conservatorship. Apart from himself, Kennedy listed only one such party: Suzanne Corkin. He also wrote that Henry had “no close relatives.” After submitting his application, Kennedy received a confidential memo from the probate court, and shortly after that he withdrew his application. It's unclear why, though his conservatorship might have been legally problematic at best, since a clear conflict of interest exists when a person's physician is given complete authority over the patient's healthcare decisions.

A year later, at Corkin's request, Thomas Mooney—the son of Henry's old landlady Lillian Herrick—submitted his application. It was drafted on the same boilerplate form as Kennedy's had been, though some of the information was different. Henry's debility was described in greater detail as follows: “Henry G. Molaison has a neurological condition known as global amnesia, a severe memory impairment that prevents him from being mentally able to care for himself.” Also, while Kennedy's application claimed Henry had no close relatives, Mooney's application claimed that he himself was Henry's cousin. One thing remained the same in both applications, however: Suzanne Corkin was listed as the only “interested party” apart from the proposed conservator himself.

During the meeting between Henry, Mooney, and the attorney McGuire, Henry charmed McGuire. “I was impressed with Mr. Molaison's congeniality and gentleness, his sense of humor and obvious native intelligence,” McGuire wrote afterward. Corkin had briefed McGuire extensively on Henry's case prior to the meeting, speaking with him on the telephone and sending him a letter and a copy of a recent journal article, so McGuire was aware that Henry was, as McGuire wrote, “a unique person. He is apparently the most thoroughly studied and described neurological patient in the world.” McGuire remarked that during the meeting, Henry “spoke clearly of recollections from his youth, including his schooling, places where his family had lived, the injury when he was 7 years old which may have, at least in part, precipitated his epilepsy, and his work experience. His particular amnesia was also very evident, as he repeated his recollections several times, obviously not recalling that he had just said the same thing. However, each time he repeated a recollection, the details were the same. Mr. Molaison conversed easily and comfortably. When I asked him if he would like Tom Mooney to have the responsibility of making sure that he is well taken care of, his reply was that he would be glad to have the help, as long as it would not be too burdensome for Tom.”

In paperwork filed with the court, Mooney was referred to alternately as Henry's cousin and his nephew. Henry, when asked by McGuire, said he thought Mooney might be his second or third cousin. In fact, if Mooney and Henry shared blood ties, they were thin ones, undetectable even by following Henry's family tree for several generations. Nevertheless, from McGuire's account of the meeting, it's clear he had been led to believe that Mooney was, as he put it, “Mr. Molaison's only known living relative.” This was an important point, one that would make Mooney a suitable candidate for conservatorship. A person's next of kin, after all, might be expected to take a sincere interest in that person's well-being. The problem was, it wasn't true. At the time of their meeting, Henry had at least three first cousins—Frank Molaison, Marjorie Ramsdorf, and Myra Crowley—living in Connecticut, all more closely related to Henry than Mooney. None of those cousins had been contacted.

At one point during the meeting, Henry told one of his oft-repeated stories about a childhood trip he'd made to Buffalo. Mooney asked him if he'd seen Niagara Falls during his Buffalo trip.

“No,” Henry said, “Niagara Falls cannot be seen from Buffalo. It is necessary to go to Niagara to see Niagara Falls.”

Mooney and McGuire laughed, and four days later, on November 17, 1992, the Windsor Locks Probate Court officially appointed Tom Mooney as Henry's conservator.

Mooney stayed Henry's conservator for the rest of Henry's life. It was not, as Henry had fretted it might be, an overly burdensome position for Mooney: All of Henry's day-to-day needs were handled by the nursing home, and Mooney had few responsibilities and did not appear to go one step beyond what was required. Indeed, when the probate court conducted a mandated follow-up review of Mooney's conservatorship four years later, in 1996, an attorney named Mary T. Bergamini submitted the following report:

“Mr. Molaison's condition has not changed in any significant manner. He is currently a resident at Bickford Convalescent Home. He has been a recipient of Title 19 benefits as of 1992 and Bickford currently receives both his Social Security and State payment directly. He is given $30.00 per month on account for his personal needs. The records indicate that Thomas F. Mooney was appointed Conservator on November 17, 1992. I attempted to contact Mr. Mooney without success. The nursing home has indicated to me that they also have had no contact with Mr. Mooney. However, it appears that Mr. Molaison's financial and personal affairs are cared for by the administration at Bickford. There is certainly the need for a continued Conservatorship of Mr. Molaison. The question appears to be whether or not Mr. Mooney should continue in this capacity. I have no objection as the respondent's current situation is stable; that is both his personal and financial affairs are taken care of.” After a brief hearing on the matter, a probate court judge agreed to Mooney remaining Henry's conservator, despite Mooney's lack of involvement in Henry's life.

In one important respect, however, Mooney did remain diligent: From the beginning of his conservatorship until the end of Henry's life, he never failed to provide consent to Suzanne Corkin for the continuation of “the MIT Research Project Known as the Amnesic Patient H.M.” Whatever experiments Corkin and her colleagues wished to conduct, Mooney always signed the consents. Likewise, when the question arose of whether scientists could continue to experiment on Henry
after
his death, Mooney raised no objections. In fact, just one month after becoming Henry's conservator, Mooney returned to Henry's nursing home for another three-way meeting. This time, the third party was Suzanne Corkin. She explained to Mooney that now that he was Henry's conservator, he could legally authorize, in advance, the posthumous donation of Henry's brain to MIT and Massachusetts General Hospital. She'd brought along all the necessary paperwork, including an “Authorization for Brain Autopsy” form. At the bottom of the form were the following lines:

I, Thomas F. Mooney, am the court-appointed guardian of the person of Henry G. Molaison. I also presently am Henry G. Molaison's closest living next-of-kin, and as such I am entitled by law to control Henry G. Molaison's remains upon his death. I hereby authorize the removal, retention and use of a whole brain specimen for diagnositic and/or research purposes by the Massachusetts General Hospital and the Massachusetts Institute of Technology's Department of Brain and Cognitive Sciences (or other agents), in the interest of determining Henry G. Molaison's cause of death and of advancing medical knowledge.

Mooney signed.

In 2002, Suzanne Corkin hosted a dinner party at her apartment in Boston's Charlestown neighborhood for the first of a series of meetings to determine precisely what should be done with Henry's brain after he died. Although Corkin was a neuropsychologist, she was not accustomed to working with actual brains. The wet work of neuroscience, the examination and analysis of those mysterious three-pound engines in our skulls, was not her area of expertise. The group she assembled that night was meant to address this deficiency. Present were neuropathologists, systems neuroscientists, and neuroanatomists, all more experienced than Corkin at working with gray matter itself rather than just analyzing the behavior the gray matter produced.

Some of the subjects the group debated were very specific. For example, it was clear that Henry's brain should be scanned again in an MRI machine after his death, but the precise number of scans, and the power of the machines used to scan it, was a matter of contention. The strength of the magnetic fields in MRI machines is measured by units known as teslas, and the machines available to Corkin ranged in power from one to seven teslas. While the higher-tesla machines were capable of producing more detailed imagery, they also produced greater amounts of heat in the tissues they were scanning. The team planned to scan Henry's brain for many hours to obtain the most accurate images possible, but they also wanted to make sure they didn't heat it so much that its physical integrity was damaged. At the same time, they wanted to scan it fast while it was still in Henry's skull, to be able to harvest the brain before any decay had begun to set in. There were clearly going to be trade-offs.

Other issues were more fundamental. Chief among them was who would be put in charge of the most important part of the project: the postmortem, post-harvesting, post-MRI processing and preservation and analysis of Henry's brain. Corkin and her group had debated the pros and cons of various approaches and the merits of various researchers. Once he died, she knew she would have to give up at least partial control, that she would have to relinquish the most valuable part of Henry into somebody else's hands. The committee needed to find somebody worthy of that precious cargo.

Jacopo Annese, who had flown in from California for that dinner party, eventually became the committee's first choice. Annese was relatively young, in his early forties, and in the early stages of a promising career as a neuroanatomist. He'd begun that career at the University of Florence in Italy, then continued it at NYU, McGill, and UCLA before he finally settled at the University of California, San Diego. While at UCSD, Annese honed his innovative techniques for preserving human brains in both histological and digital form, a technique that promised to give scientists the opportunity to continue their research with Patient H.M. long past Henry's death.

It was after the committee selected Annese that he asked Corkin if he might meet Henry while he was still alive, which led to that 2006 visit to his nursing home, where they ate their mostly silent lunch and then wheeled Henry back to his room. On the way out, Annese noticed a snapshot of Henry tacked to one of the bulletin boards near the entrance. Nobody was looking, and he had to resist the temptation to take it, to slip it into his pocket, to keep it as a sort of totem, something he could ponder in his off hours and use to help him imagine his way further into Henry's mind before the day he had to start digging into his brain.

N
ew employees at the Bickford Health Care Center always received a briefing on Henry and his special circumstances. For example, they were directed never to speak to anyone outside the center about Henry, as the fact that he resided there was a closely guarded secret. If a stranger called inquiring after Henry, the staff member receiving the call was 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 was effective: He had lived at the center for decades, and though he was the most famous patient in the history of neuroscience, no outsider ever found him.

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

So on the morning and afternoon of December 2, 2008, as Henry began fading from respiratory failure at age eighty-two, Corkin, as per protocol, received periodic phone calls keeping her abreast of the situation. Corkin had last seen Henry a month prior, and by that time his dementia was profound, and he had become completely mute. He wouldn't answer any of Corkin's questions, just stared at her, blank and uncomprehending. His value as a useful living research subject had come to an end.

When Henry's heart finally stopped, another call was placed to Corkin, and then someone at the center rushed to the freezer and dug out the flexible Cryopaks that Corkin had ordered placed there in anticipation of this moment. By the time the hearse arrived, the ice blankets were wrapped securely around Henry's head, keeping his brain chilled to slow decomposition.

Everything went smoothly, according to plan, and a couple of hours and 106 miles later, the hearse pulled into the parking lot of building 149 in the Charlestown Navy Yard, the Athinoula A. Martinos Center for Biomedical Imaging in Boston, where Corkin was waiting. The body bag was unzipped and the ice blankets unwrapped. Corkin had known Henry for forty-six years, 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, transactionally speaking, was that she'd known Henry, not the other way around. Forty-six years of meeting someone for the first time, introducing herself to an old friend.

And now this last meeting that only she would remember.

During the night that followed, Corkin watched as Henry underwent a series of high-resolution MRI scans. Then, the next morning, she attended the harvesting. She stood on a chair outside the autopsy room in the Mass General pathology department and peeked through a window as a neuropathologist named Matthew Frosch, assisted by Jacopo Annese, who had flown in on the red-eye from San Diego, sawed off the top of Henry's skull and, with the care of obstetricians delivering a baby, pulled his brain into the light. Corkin had spent the bulk of her career pondering the inner workings of Henry's brain. That morning, she finally got to see it. Henry, a man she had known for almost a half century, had died the day before, but there, gleaming under the bright lights, was the part of him that she'd always been most interested in. As she gazed at Henry's brain, only one word could describe the feelings that coursed through her. She was, she later wrote, “ecstatic.”

After the harvesting, the brain sat for a while in a bucket that was inside a cooler, steeping in a preservative solution, hanging upside down, suspended by a piece of kitchen twine looped through its basilar artery. When the brain was firm enough to travel safely, Corkin rode to Logan International Airport with the cooler. She accompanied it to the gate of a JetBlue flight from Boston to San Diego. There were camera people following her. It was a self-consciously historic moment. Henry's death had been announced on the front page of
The New York Times,
which described him as “the most important patient in the history of brain science” and revealed Patient H.M.'s real name to the world. Corkin already had a book and movie deal. She put the cooler down near the gate, and Annese picked it up. She watched him walk down the ramp with it and disappear into the plane.

It was hard to let go.

Henry's brain sat on a small rectangle of formaldehyde-slick green marble, under a sheet of plastic wrap. Annese was wearing a medical smock, blue rubber gloves, and safety glasses. He plucked off the plastic wrap, picked up a scalpel, and began to peel away the pia mater, a thin, sticky membrane that covers the brain. He was alone, music on—it was a Beatles kind of night—and everything went perfectly. He removed the oxidized clips my grandfather had left behind fifty-five years before, set them aside. Then the membranes, the blood vessels, all the obstructing tissue, stripping everything away until he was left, finally, with Henry's naked brain. His peelings usually lasted three to four hours, but with Henry he took his time, made sure everything was just right. He peeled for five hours straight.

He was still on a bit of a high, still pinching himself. He was part of the group that Corkin had convened years before to decide what to do with Henry's brain postmortem, and so of course he had known for a while that the group had decided to give the brain to him as the cornerstone of his Brain Observatory. But it was still a shock to actually have it in his possession. This prize, this valuable artifact, this revolutionary brain. Despite all the planning, all the verbal agreements, he hadn't been absolutely sure he'd wind up with it until he 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.

But she hadn't.

He presented the gate agent at Logan with two tickets, boarded the plane with time to spare. He gave Henry the window seat. He'd penned words on the cooler with a black Sharpie, along with his phone numbers and email address: “Diagnostic specimen. Fragile. If found, please do not open. Contact Dr. Annese immediately.” He landed in San Diego, and a UCSD official escorted him and Henry straight to his lab.

So far, everything seemed to be going just as smoothly as could be. After the peeling, he embedded Henry's naked brain in gelatin, froze it solid. The freezing had to be done quickly, using a liquid-cooled, custom-built device steaming with dry ice vapors, like a witch's cauldron. The embedding was, he's not too modest to say, a masterpiece.

But it was only the prelude to what came next.

For the fifty-five years following his operation, Henry had lived mostly in seclusion and anonymity. During most of that period, a select coterie of scientists had shielded him from the prying eyes of the outside world.

That was about to change.

I was sitting at a high table at Alpine Bakery, in Whitehorse, the capital city of Canada's Yukon Territory, eating a scone and drinking coffee. It was one of those cold, clear subarctic December days, a time of year when the sun barely nudges itself above the mountains, spraying weak light through the trees, giving everything a shadowy purplish tint. Outside, people with cold red faces hurried down Main Street, their bodies swaddled in expensive garments made from goose feathers and lamb hair. Inside it was warm and homey. I cradled my coffee in one hand, cracked open my laptop, and logged into my email.

I'd been living in the Yukon for more than three years. I moved up there from Atlanta shortly before my daughter, Anwyn, was born at Whitehorse General Hospital in September 2006. Long story. Her mom and I had known each other almost our entire lives, ever since we became playmates as expatriate toddlers together in Mexico City, but we'd been out of touch for most of our adult lives. She got married and moved to Whitehorse in the 1990s, then got a divorce but decided to stay in the Yukon. We reconnected during a tumultuous trip to Ecuador in the fall of 2005, a trip that started out platonic and ended with us becoming trapped together for three days in a little oil town on the Colombian border called Lago Agrio (Bitter Lake). Anti-petroleum-industry protesters had taken over the town the day we walked into it, and they sealed off all access, dismantling bridges and barricading the airport. Eventually the army was called in to handle the situation, which made it much worse. Molotov cocktails, tear gas, the acrid smell of burning banks. A shared hotel room. Our friendship turned into something else.

We saw each other again a couple of months later, when she flew down to Mexico over Christmas break while I was on assignment there. A few weeks after she left, I called her from a pay phone in Catemaco, a small town near the city of Veracruz famed for both its lake snails and its history of
brujería,
witchcraft. I had a digital camera with me, and when she told me she was pregnant I snapped a picture of myself with the phone pressed to my ear, wanting to document a moment when I knew my life had just changed forever.

One of us had to move. My job was portable.

We lived together for two years after Anwyn was born, and then we didn't. I moved into a small place of my own. I had a steady stream of assignments and commuted for my stories, usually a long way. I went to Antarctica and ran a marathon. I went to Laredo, Texas, and interviewed a teenage cartel hit man. I went to Wasilla, Alaska, and got frostbite snowmobiling with Todd Palin. That December afternoon, I'd recently returned from Jamaica, where I spent a week with Usain Bolt, the fastest man in history, who spent most of our time together eating junk food and playing
Call of Duty
and practicing his turntable skills, leaving the impression that everything I'd ever heard about how success is the result of hard work and dedication might simply be untrue.

I'd kept tabs on Henry's story over the years, reading the new papers that came out about him. When he died, and the veil was dropped from his name, I waded into the flood of published tributes. Eventually the tributes slowed to a trickle. I set up a Google Alert for “Henry Molaison,” and in the months that followed his death it would only periodically ping me, advising me of some new Henry-related tidbit.

That afternoon in the coffee shop, however, Google had flooded my in-box with stories. Most of them contained a link to a UCSD-hosted website for the Brain Observatory. I clicked on it. It took a few moments to open. In the center of my browser, the throttled Yukon bandwidth was churning out a pixelated and choppy live stream video. The video was dark, so I amped the brightness on my screen. There was a white square in the center of the video, taking up most of the space. Around the square was a misty fog of billowing dry-ice smoke, like something you'd see during a magic show. In the center of the white square was a rough oval blob, and it was pink. A silver metal bar moved slowly across the square, from the bottom of the screen toward the top, and as it moved, the pink blob curled up ahead of it, crumpling and furrowing unpredictably, like the breaking edge of a wave, but in super-slow motion. When the bar approached the top of the block and had run the entire length of the pink blob, a human hand would appear, wearing stylish purple medical gloves and holding a paintbrush. The paintbrush dabbed at the pink stuff, disengaging it from the white block completely and then lifting it into an individually numbered tray filled with some sort of clear solution. Then the bar returned to the bottom of the block and started again.

Despite all my efforts years before, I had never met Henry while he was alive.

But now, with the click of a trackpad, I, along with hundreds of thousands of other people around the world, was getting a live view of his brain's dissection.

Just like that, I was back on the Henry beat.

I sat and drank coffee for a while longer, watching Henry's brain being slowly sliced apart. The video stream was quiet, but occasionally the purple-gloved hands would put a little yellow Post-it note on a stick held in front of the camera, giving some sort of tidbit or trivia or shout-out.

“Listening to the White Album now,” one of the notes said. Behind it, the dissection continued.

When I first visited the Brain Observatory shortly after the cutting was completed, there was a slim book sitting on a shelf right next to Jacopo Annese's desk in his glass-walled office. 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 didn't have a very lively title. But
Localisation 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 meticulously hand-drawn maps of the human brain, divided 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. Out of an uncharted cerebral wilderness, Brodmann created an enduring Rand McNally road atlas of the mind, one that my grandfather used to direct his surgeries and that most neuroscientists and neurosurgeons still use today.

As a fellow anatomist, Annese admired Brodmann's work immensely and had even written a glowing tribute to him that appeared in the journal
Nature.
But he hoped to make Brodmann's old maps irrelevant.

That's what the Brain Observatory was all about.

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

A short walk from Annese's office, past an imported espresso machine and through a secure, airtight door, was the wet lab. At the far end of the lab, a number of tall, glass-fronted refrigerators stood against a wall. Many of them contained plastic buckets, and though the plastic was murkier than the glass, it was still possible to see what was inside. Most of the brains were human, but there was one from a dolphin. The dolphin brain was huge, significantly bigger than any of the human ones, though Annese cautioned that it would be a mistake to read too much into size.