Excisions

William Gadea
Feb 22, 2018 · 19 min read

By William Gadea

The death was announced, with respectful irony, on the front page of The New York Times: “Henry Molaison, An Unforgettable Amnesiac, Dies at 82.” Before that day he had been known to the annals of neuroscience, and to me, only by the identity-cloaking initials of H.M. I never met the man — but still, it felt like I had lost an unknown cousin.

Who was H.M.? And who was he to me?

Henry Molaison was knocked over by a boy on a bicycle when he was nine, gashing his head badly. The injury led to a series of debilitating seizures which continued and worsened until, at the age of 27, they were impeding his livelihood as a motor repairman. In 1952, he went to the Hartford office of Dr. William Beecher Scoville, a patrician neurosurgeon related to the author of Uncle Tom’s Cabin. After exhausting other treatment options, Scoville decided that some experimental surgery was in order. Using only scalp-deep local anesthetic, he peeled the skin on H.M.’s forehead over his eyes, drilled two silver-dollar-sized holes through his skull and — with a spatula-like retractor — lifted the frontal lobe out of the way so that he could access the limbic area of the brain. Then, with a silver straw, Scoville sucked about two-thirds of H.M.’s hippocampus out of his head.

Scoville’s surgery actually did reduce the frequency of the seizures — but it also created history’s most famous amnesiac. The memory-formation processes in H.M.’s brain were permanently damaged. For the rest of his life he would encounter every name, every face, every object, every event as if it were new and previously unknown to him. What the rest of us see as a vast landscape of time was, for him, just the thin 20-second slice his short-term memory could retain. All that came before was a confusing void; all that came after (since mental plans would soon be forgotten) was a dark limbo too. Till his death H.M. would need caretaking — first from relatives, and finally in an institution.

My first name is William. I was named after the surgeon who crippled H.M.’s brain. That obituary made some family history surface in my memory — and it prodded me to find out more about the man whose name I took. Behind my investigation was a nagging wonder… was I named after a neurological cowboy? Was William Beecher Scoville a gambler with a scalpel, willing to risk his patients’ faculties for his own surgical glory?

To answer that question, I must first do what H.M. couldn’t… remember how I got here.

* * *

The story begins in Lima, Peru — it is 1960, about a year and a half before I was born. Jorge A. Gadea, a young father of four, is diagnosed with a herniated disk. A respected local neurosurgeon, Dr. Fernando Cabieses, operates. Within days the patient’s condition is deteriorating and he is soon paralyzed from the neck down.

Cabieses didn’t know it, but the problem wasn’t a disk. A congenital cyst, present in the spinal column since before birth, had begun to grow and pressure the cord. Cabieses’ surgery allowed the cyst room to grow and bloom, causing the paralysis.

Years later, my father would paint Cabieses as the bad guy in the episode: “After I was paralyzed we went to Cabieses and asked — what can we do? He says ‘look, there’s no hope. Pretty soon your organs will fail and you’ll die. If the spasms are so bad, maybe we should take out the muscles in your body so you can die peacefully.’ I said no, ¡basta! Is there some other doctor we can consult? He said the only one who might be able to cure you is my teacher in America, Dr. William Beecher Scoville.”

And that’s how it was that my father and mother (with financial help from my extended family, my father’s Masonic lodge, and a generous American church) flew to Hartford, Connecticut, to place themselves in the care of (the soon-to-be miraculous) Dr. Scoville. I’ll let my father continue the story, as he told it to me many times:

“Once we got to Hartford things moved very fast. We met Scoville — he did his tests. He injected this liquid into my spine that showed up on x-rays, and he put me on a special table that tilted from one end to the other. That way he could see, from the way the liquid flowed, where the obstruction was in my spine. He operated and found the cyst. It was about the size of a grape, he said. This was a very rare condition, and this was one of his greatest operations. There were three or four operations in his career he was most proud of, and this was one of them.

“The very first day after the operation I was walking again. And except for my left arm being a little weaker than my right, I made a full recovery. A few months after that, you were conceived. And we called you William… en honor al doctor.

“Scoville asked me not to sue Cabieses, so I didn’t. But some people we knew said they had seen him drinking out late the night before the operation.”

It loses something without my father’s performance, but that was the gist: a bad doctor/good doctor tale. In the process of writing this, I dug up a medical paper that Scoville and Cabieses jointly wrote about my father’s case. The first thing that struck me was seeing my father referred to as J.G.; here he had attained the same initialed anonymity as H.M. The article puts the doctors on parity in one way: Scoville’s initial diagnosis was no different than the one Cabieses gave: a herniated disk. Scoville just had the wherewithal to fish around until he found the actual problem, the cyst. The paper confirms what my father used to say, that Scoville was proud of his operation. The article heralds a first-ever surgical recovery from a rare condition. (A somewhat sheepish footnote, added months after the initial writing, reveals that neither the condition nor the recovery from it was quite so rare.) The story about the Cabieses’ drinking is, of course, just a rumor. But if the rest of my father’s story is true, then Cabieses didn’t just miss the cyst, he gave my father a post-operative prognosis and palliative treatment option that, if heeded, would probably have killed him.

William Scoville, on the other hand, gave my father his life back, and for that he became something of a demi-God in my family. The Doctor stayed in contact with us, even visiting us in Peru once in the mid-60s.

I was too young to remember the visit, but my father told this story about it: “I took the doctor to the Inca museum. He stood in front of one exhibit for a long time. There were some Inca skulls with round cuts in them like they were made very carefully. Scoville says that looks like brain surgery. Not just that, but he is noticing that the bone got healed, meaning the patients survived the operation. And — here’s where it gets interesting… ¿sabes lo que dijo? Judging from the part of the brain they were working on, they were probably trying to affect personality. Something even today’s surgeons haven’t achieved!” My father loved that story because it incorporated two of his favorite themes: the genius of the Incas and the genius of Scoville. With the information I received later about Scoville’s interest in psychosurgery, I wondered whether the doctor wasn’t a little envious of his Inca counterparts.

My mother liked a different story: “Scoville was visiting around the same time Granpa was with us. Granpa had been having trouble with his legs. Scoville is sitting in the living room, seeing my Dad’s leg twitch — and it’s bothering him, he can’t take his eyes of the leg. Finally he can’t help himself anymore and he gets up, takes that glass ashtray” — and at this point, my mother would usually point to the actual ashtray that we still had — “and he tests my grandfather’s reflexes. He asks a couple of quick questions, and he says: here’s your problem. One of my father’s feet was swollen, and he had taken to wearing two different shoes… because one was looser and more comfortable for him. Scoville says the trouble is that one sole is thicker than the other, and that causes a tilt in his carriage. And the tilt is what puts pressure on the nerve… back here.” She points to her lower back. “And you know what — my father started using the same kind of shoe on each foot. The problem went away. He was right!”

After the company this story was told to left, I would hold the glass ashtray that Scoville used like it was the artifact of a saint. The ashtray had a chip off one of its edges… did the doctor use the sharp edge or the smooth edge to tap my grandfather’s knee? I was too young to remember the Lima visit, but we still have photos of it. One shows the surgeon with his young namesake by his side.

Allow me to pause and point out what might be obvious. My family at this point knew nothing about H.M. or his operation. I didn’t find out until the mid-nineties. I was leafing through my Sunday paper when Scoville’s name jumped off the page and ambushed me. It was a review of Philip Hilts’ Memory’s Ghost, a book about H.M. The review made Scoville seem craven, even joking to his wife about the mishap. I remember so clearly thinking: ‘I wish Papi were alive so I could see what he thought of this!’ It’s only when I was writing this piece that I constructed a timeline and soon realized… that would have been impossible. The book came out in 1995; my father did not die until three years later. Why didn’t I tell him? To protect him from being disillusioned? To protect me from unpleasantness?

Which leads to the question: how does memory get bent? It’s as if we have event dots in a mental graph of our life, and we draw a regression line through them. This line is who we are, where we’ve been, what our strengths and weaknesses are: our character, our story. We extend that line with a confident, dotted projection that leads to the glory or tragedy or oblivion we anticipate for ourselves. And when no one’s looking — and we’re not looking — the event dots get shifted a little closer to the regression line so that our story is a little tidier, a little more dramatic. It doesn’t matter why I failed to tell my father; I was embarrassed that I didn’t. So I changed the memory.

But here is where I have to wonder: what must it have been like to be H.M.? If you cannot produce memories any more, then how can you produce a narrative? And is this “self” we have anything more than just a narrative? They say that when he was uncertain of something H.M. would often remark, sometimes several times a day: “I’m having an argument with myself.” When his memory was removed by suction tube, did a unitary sense of his self go too? Of course, he recognized the package of sensation bundled in his skin — but did he see a character? Was there a Henry in Henry’s mind?

* * *

We moved to the Dominican Republic in 1976; Dr. Scoville had occasion to visit us there not long after we arrived. Before I describe how I remember him, let me share some descriptions I’ve come upon of the younger man. Everyone describes Bill Scoville as exceedingly handsome — and photographic evidence confirms it. He was a high-spirited man who met his first wife by jumping onto the running board of the moving car she was in. A colleague recounts other daredevil anecdotes: how he climbed a cable to the top of the George Washington Bridge at night, and how another time he jumped into a Spanish bullring with a live bull. In his youth, Scoville wanted to be a mechanic instead of a doctor, but his father prevailed on him to choose a proper profession. His mechanical proclivity led to his inventing and refining many neurosurgical instruments, but cars remained an enduring passion; he loved working on them and he loved driving them very fast. He owned a string of Jaguars, which he kept shiny and in excellent condition. And he applied his sense of adventure to his profession too: the same colleague describes him in a written tribute as “a free spirit, unfettered by rules and regulations…he is an innovator, never willing to accept the status quo… driven by an insatiable ego, seeking better ways of doing things and espousing new ideas with their frequent and often angry confrontations.”

The man I met was more mild-mannered — by the time you’re 70 years old, perhaps everyone is more mild-mannered. He had a second wife by then — a handsome, French-speaking woman — and two young children. We took their family to the then-best restaurant in Santo Domingo, Vesuvio — an Italian place on the Malecón. I remember his son more than him. I was a precocious 15-year old and he was a just-a-bit-more-precocious 12-year-old. Like me, he had been given Dr. Scoville’s first name.

For the most part, the Doctor seemed a little detached, a little distracted. But there was a point after dinner when the tone on the adult side of the table firmed. My father had lit up a cigarette after his meal and Scoville had admonished him, urging him to give up the habit. He was a man not prone to being chastened, but my father smoked his last cigarette that night. I’m sure he must have long known the insalutary effects of smoking, but the message gained force when it came from Scoville. (Curiously, he was too proud to remember it that way. In coming years, when he talked about giving up smoking he would say: “I woke up one morning and los cigarillos disgusted me. Just like that I quit.”)

Knowing that Scoville was something of an adventurer, my father had talked a wealthy friend into taking us deep sea fishing. It was threatening to rain, so our host wondered whether we should perhaps call it off. Scoville would have none of it. You could tell the prospect of wrestling with a marlin a la Papa Hemingway had captured his imagination. I was pretty excited too, so I was glad he was game. Unfortunately, we didn’t even get a nibble on the line, and had a rough ride on some choppy seas. By the time we were back at the dock Scoville was disappointed and a little seasick. I remember him bumping his head as he climbed out of the boat, and seeing him hold on to the part that hurt. The image of him I was left with was of a fragile old man: discouraged, queasy… and now injured.

As we were saying goodbye on that visit, Scoville addressed me, the pimpled teenager who was named after him. “If you decide on a medical career, I would be glad to write you a recommendation to Yale Medical School, where I teach,” he said. This pleased my father immensely. “Yale Medical School is one of the best medical schools in the world, if not the best!” he gushed after the doctor left. “And Scoville is willing to write you a recommendation!” He might have thought this was a sufficient condition for admission; my father had the Latin American view (which was proven correct often enough) that the world turned on an axis of personal connections. Of course, a medical career was the last thing on my mind.

The next time I saw Scoville was under a less happy circumstance.

I was 17 and very excited about going off to college at NYU. I was literally counting down the days in my head. Around the time I was down to single-digits, the Dominican Republic was hit by one of the worst tropical hurricanes of the century: Hurricane David. Our ground floor apartment was flooded with a foot of water. Looking out the taped windows it seemed like you were peering into contents of a blender. Trees were uprooted within our view. The next day we would learn that the eye of a category 5 hurricane had passed almost directly over us. 2,000 Dominicans had been killed.

My father was working for a non-profit at the time. It was quickly decided that, in order to solicit funds for hurricane relief, he would take the trip to the U.S. with me. While he was up north, he would take advantage of the opportunity to get a check-up with Scoville at Hartford Hospital.

We arrived in New York and took a hotel room in the east 20s. Our first night in town we decided to go see a movie. When we walked to the theater my father asked me to hold his arm while he negotiated the curbs. His check-up with Scoville was not customary; there had been a marked deterioration in his condition over the last few months. That night we saw Woody Allen’s Manhattan, which was late in its initial run then. It seemed to me like a preview of my new city’s secrets and sophistications.

The next day we took the bus to Hartford and a taxi to the hospital. Dr. Scoville greeted us in a warm but brisk manner. Here in his habitat, the Doctor no longer seemed as vulnerable as he did back on the Caribbean dock. After running some tests, his verdict was curt: “I’d like to operate again.” He explained that he would need exploratory surgery to see what was going wrong. My father wasn’t expecting this. “Do I have time to return to Santo Domingo and put my affairs in order?”
“I’d prefer to do it sooner rather than later,” Scoville replied.

The operation went for longer than expected. Being in the waiting room felt a little surreal… like I was in a too-melodramatic movie. I remember a kind nurse asking if I needed anything. And my memory of this is hazy but I think that after many hours Scoville came out and said something non-committal.

Scoville had only found adhesions, the scarring from previous operations, which he tried to remove as well as he could. However, my father woke up largely paralyzed from the neck down and would remain so for the rest of his life. He would retain limited use of his hands and a bit of feeling in his legs.

Years later, after Scoville’s death, my father would travel to Los Angeles to be examined again — this time with the benefit of an MRI, a diagnostic tool not commercially available at the time of Scoville’s operation. The doctors would tell him that Scoville had operated in the wrong place. The cyst had regenerated, but in a new location. Scoville had missed it altogether. Perhaps the operation itself did damage to the spinal cord, or perhaps it aided the progression of the cyst, as Cabieses’ operation apparently did. Either way, it seems likely that a better outcome was possible.

Looking back on those days since, I’ve often thought: if the boy that accompanied my father to Hartford Hospital had been a man, he might have had the presence and maturity to worry whether an operation that so depended on motor skills should be left to a septuagenarian. He might have had the sense to suggest that they seek out a second opinion, even if Scoville was good. Truthfully, I don’t feel guilty about the judgment I did not contribute to — the judgment to operate in Hartford with Scoville. I find it highly unlikely that the 17-year old boy could have stood up to the family God.

My father used to say that he had never been prouder of me than the day he took me to kindergarten and I was the only kid in the class who didn’t cry. The proudest he ever made me was in the days of his post-operative convalescence, when he arranged for some executives from a charity in Hartford to visit him in the hospital regarding hurricane relief. I had seen these performances before. When my father asked for money, he was never a beggar… he was a salesman. He didn’t ask pity for a weather-torn nation; he offered opportunity! — a chance to do good, to help rebuild. It was a great pitch. Even flat on his back in a hospital bed — his limbs no longer under his command, his life to come under a dark shadow — he could still cast a spell over these stoic New Englanders.

William Beecher Scoville

So what is the verdict on Scoville?

It would be unfair to write of the H.M. operation without providing fuller context. When he came to Scoville, Henry Molaison’s condition was dire. Prior to the operation he was having around ten minor blackouts a week; the grand mal seizures came as often as once a week. The disease was disrupting every facet of his life: work, family, social. He was not allowed to rise to the stage for his high school graduation, for instance, because it was feared he would have a fit. Drug therapy did not work for him.

Also, we must put the event in its period: this was the heyday of psychosurgery. Only four years earlier, António Egas Moniz had been awarded the Nobel Prize in medicine for his work in developing the prefrontal lobotomy. And while nowadays the establishment might look askance at what Scoville himself called a “frankly experimental” procedure, the ethical protocols of current medicine had not been developed yet: no informed consent forms, no institutional review boards.

Having said that, Scoville performed an irreversible procedure on an organ even our current science understands poorly. It is a medical doctor’s first principle: first, do no harm. Scoville would argue that in his opinion the potential benefits outweighed the risks, but at least one of his contemporaries found the operation questionable; when Scoville shared the results over the phone with Dr. Wilder Penfield, an eminence gris in the field, his colleague is said to have exploded in anger.

Providing fuller context also forces fuller accounting. Scoville was one of the pioneers in bringing the lobotomy to the U.S., one of the more dismal procedures of 20th century medicine. It is true, he was more sensitive to the side effects of the operation than others were. While the huckster Walter Freeman was streamlining the procedure into a 10-minute-long ice-pick-poke-through-the-eye-sockets that he even performed in hotel rooms (disabling patients that included JFK’s sister Rosemary,) Scoville was refining what he felt was a subtler, less damaging method called orbital undercutting.

Yet Scoville was complicit in the big problem with lobotomy: it was the lobotomists who decided how successful they were. Even in our day of evidence-based medicine, clinical trials for new surgical techniques are a rarity. That’s problematic, but less so when the results can at least be measured reliably; an orthopedic surgeon trying a new knee operation, for example, can measure the flexibility and strength of the post-operative joint to the degree and pound-of-pressure. Measuring psychic pain is more difficult. And crucially, weighing alleviation of pain against loss of intellect and higher functioning is exceedingly difficult. That is as much a philosophical as a medical problem, and that is what psychosurgeons needed to decide. Such a subjective call should not be left to doctors with a possible attachment to their handiwork.

There is evidence to question whether Scoville’s judgment was always sound in this regard. On H.M.’s chart prior to discharge, Scoville marked his patient’s condition after the operation as “Improved.” And in a 1961 paper he writes that total lobotomy is more likely to be indicated in the case of patients with a “low cultural background.” Presumably, this is because he believes that people with a lower educational level are less likely to miss the higher intellectual capacities that a lobotomy might damage, but really… isn’t that presumptuous?

Scoville didn’t just begin psychosurgery earlier than most, he held onto it longer too. By 1973, lobotomies had almost disappeared, made obsolete by drug therapies and electro-shock treatment, but a New York Times article of the time introduces Scoville as having “possibly performed more lobotomies than any other surgeon alive today.” Even at that late date Scoville is a proponent, claiming a 50% improvement rate, and admitting there is a price to pay: “the blunting of higher sensibilities, such as intelligence, abstract thinking, and the ability to fantasize.”

How should we judge Scoville? I’m sure he was a man who tried to do good, and I’m sure that for many patients he succeeded. Still, there is arrogance in his ambition. I have to suspect that his dreams of beneficent glory sometimes overshadowed the frail specimens of humanity before him. I have to imagine there were times when his story told him, when the shadows cast their caster. Scoville coveted the power to reshape the brain, the seat of the soul, the source of our suffering. He sought the power of a God. And like Icarus and Prometheus and all the other fellows who got too big for their britches, in the case of Henry Molaison he had a comeuppance — a very gentle one by mythological standards.

My father rebelled against greater authority too. Soon after he returned to the Dominican Republic as a quadriplegic, it seemed like he engineered a rupture with his employer, an organization that had been remarkably caring about his condition and accommodating of his handicap. His story would not be stymied by tragedy; indeed, he would send them to hell just to show them he was as capable and self-sufficient and fierce as ever. Underestimating his will was always dangerous: even after having lost that job, and even from a wheelchair, my father made substantial sacrifices and managed to put me through college — albeit with the help of a scholarship I was very lucky to receive.

That personal narrative which was forever quieted in H.M. — it must have been a raging, heroic symphony thundering in the minds of both Scoville and my father. It must have made the wispy music of the world sometimes hard to hear. The best defense I can make for whatever hubris either man had is emotional: that I owe so much to it. If my father had not recklessly disregarded obstacles, would I have received the education I did? Would I be forming these same thoughts? If William Beecher Scoville had not been too confident of his abilities, would he still have had the verve to cure my father? Would I have even come onto this earth?

* * *

Scoville was killed in an automobile accident in 1984. I wonder whether he was driving? I wonder whether his love of fast cars finally did him in.

My father spent the last 19 years of his life in a wheelchair. He died in 1998. The cause was complications from bed sores, the bane of paralysis patients.

Henry Molaison — the famed H.M. — outlived them both. He died on December 2, 2008, sparking many wonder-filled obituaries.

Ironically, today I find myself striving to achieve H.M.’s condition. It’s not that I want to lose painful memories. I want to discard burdening narratives: quiet the voices that grieve for loves lost and promise unfulfilled; quiet the whispers of sweetness to come, grandness to come. I want to live my life — not a story of my life. I spend a half-hour each morning sitting, watching my breath. It helps bring H.M. a little closer. In the Zendo I frequent there is a statue of the Buddha holding a knife; I’m told he uses it to surgically remove attachments.

Of course, I don’t literally wish for H.M.’s loss of faculties. Scoville took much of his life away from him: the ability to form relationships, to care for himself, to observe himself. Yet if we see him as just the victim of a horrible surgical mishap, we don’t do his life justice. They say that apart from his disability he was personable, humorous, intelligent. And importantly, H.M. was a teacher to humanity. The studies of him by Brenda Milner and Suzanne Corkin have opened up a new era in memory science. Henry was, at least intermittently, aware of this role. In an audio recording from the 90s he is heard saying in an earnest, middle-aged voice: “The way I figure it is, what they find out about me helps them help others.” It was a ravaged life, not a wasted one.

For H.M. and for me, Scoville was Shiva… a creator and a destroyer. Rest in peace, Henry, known to the world as H.M. Rest in peace, William, who’s name I took. Rest in peace, Jorge, whom I called Papi.

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