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June, 2003


by Larry

Thirty-seven years ago I was working at Herrick Memorial Hospital, in Berkeley, CA, when one of my depressed patients - let's call her Mary Heller - was treated using a surgical procedure, transorbital lobotomy, performed by the founder of the operation, Dr. Walter Freeman. As Mrs. Heller's psychiatric ward attendant, I was not technically needed for the occasion, but the staff knew of my interests in medicine and agreed to my request to be there.

This had been Mrs. Heller's third stay with us. Each time she would be admitted to my ward in a quite withdrawn state and showing minimal emotion. After a couple or three weeks of care, attention, and expensive therapy twenty-four hours a day, however, she would always perk right up. By the third day her smile would be resurrected. Around the end of the first week she would be actively socializing again, both with the staff and other patients. Then it would be all uphill from there. During her third week she was usually laughing at little jokes, playing cards or participating in crafts, showing interest in more severe cases, especially the young people who often came in following drug overdoses, attempted suicide, or other acute traumas. She was by then becoming part of our small community, for all the world as if she were at summer camp or perhaps, like someone's lonely great aunt, had been taken in and had joined a family again.

We would call each other by our first names by then and chat at length of this and that. Mary was in her mid-fifties and twenty years older than her husband. Who knows how that came about? They may well have loved one another. He was always, when I saw them together, considerate, if in a rather distant way. He handled their finances and perhaps was distressed by the recurrent hospital bills.

I think Mary, when on her own, was kind of adrift, cut off from friends or family she may have known and about whom she might have cared before, and that she lacked the inner resources by herself to go out and make or maintain new acquaintances. Mr. Heller would go to work each day and she'd be totally alone. In the evenings too they may no longer have connected, if they ever really did.

She perhaps then seemed old and uninteresting to him. He might have even had affairs. Who can say? His facial expressions at the hospital betrayed a certain mild impatience or exasperation with her, though in front of others, at least, he remained reasonably polite and solicitous. If I hadn't read her chart and known they were husband and wife, I would have assumed he was her son.

Mary was not seriously malnourished, though she was thin and usually a little uninterested in eating. Her chief complaint, surprisingly, was never of the sadness she clearly felt but that she was "nauseous." As her time with us would continue, she'd often forget this symptom, eat regular meals, and get "into" things just fine. But invariably, at the outset of her inpatient periods, she would almost always report being "nauseous," though I never saw or heard of her throwing up her food.

The nurses and I had a pet theory that in her melancholy at being in an unhappy marriage and no longer really connected socially she had developed this hysterical nausea, just as occasionally others have hysterical blindness, amnesia, or loss of the use of a limb for no particular reason. It got her at least a minimum level of attention, indeed quite a lot of concern and caring focus on her needs while she remained with us. We thought she'd soon be just fine if she got herself a job of some kind and began to develop a regular circle of friends again.

But her husband was getting tired of these costly vacations. He asked the hospital or doctors if there wasn't some way to effect a more permanent cure and, eventually, was put in touch with Dr. Freeman, a really big name in the mental health world at the time.

The good doctor paid Mary a couple visits and then talked at greater length with her husband, who wrote the checks and had her power of attorney. He assured Mr. Heller that his wife's problem was that there were disordered neural pathways connecting the seat of her emotions with her consciousness and that if he were allowed to sever those connections she would be restored to good health. So, hearing what he wished, Mr. Heller agreed and signed the right forms.

Things now progressed with the inevitability of a military conquest. Dr. Freeman arranged use of one of the hospital's operating theaters on the next available date for both him and our facility, a few days later. Mr. Heller informed his wife that he had arranged a way to get her better for good.

I did not hear him tell her she could die in surgery or suffer catastrophic brain damage or that she would lose most awareness of her feelings, those sometimes inconvenient but precious factors of personality that give each moment its special nuance and meaning. Would she ever again experience joy, wonder, love, pique, or amusement?

At the Austin State Hospital, where I had worked before, I had met a couple patients who had been lobotomized. They seemed dull, robotic creatures for whom a special form of purgatory had apparently been arranged.

The day before her surgery, Mary, now in her third week of the current stay, seemed especially upbeat and content. Perhaps it was partly due to her husband's promise that she'd soon be well.

She and I enjoyed several games of ping-pong that afternoon. Mary was charmingly gleeful when she beat me a couple times.

It would have done no good for me to try to intervene. Who would have listened to an orderly? I would just have been fired.

The next morning Mary Heller was prepared early. I wheeled her down to the operating room. She was a little nervous but seemed very trusting. She was given only local anesthesia, the doctor insisting that this improved the results. However, at some point during the surgery she lost consciousness, not regaining it for two or three hours.

Dr. Freeman entered the operating theatre with a flourish. He was an older gentleman, appearing to me then to have been in his sixties. He had developed this technique about thirty years earlier, had taught it to many other doctors, and in his lifetime performed it himself over 3400 times. According to "23 NL People," during the 1940s about five thousand transorbital lobotomies a year were being performed. Dr. Freeman had no formal training in surgery. He would do his last procedure a year after the operation I observed. That patient died after Dr. Freeman had severed an artery in his head. The doctor himself succumbed, to cancer, in 1972. Lobotomies have continued, though physicians today maintain they are done humanely and with few ill effects.

Dr. Freeman's instruments had an industrial simplicity: a pair of fancy metal probes, that looked like heavy-duty ice picks, plus a shiny hammer. ("Bang! Bang!" sang the Beatles. "Maxwell's silver hammer came down upon her head...")

He conducted the operation as though he were giving a lecture. Perhaps he had done it in medical teaching facilities so many times that this came naturally to him. I do not flatter myself that his running commentary was for my benefit.

As he deftly inserted one probe, sharp end first, between the eyelid and the top of one of Mrs. Heller's eyeballs, he explained that the orbital bone that surrounds the eye is relatively strong on the sides and toward the front but thin and weak like an eggshell behind the eye. By placing the probe in the current position, he taught, he would, with very little force, be able to break through the thin part in back and so thrust the probes on through to the correct depth. A small metal ridge circling each probe, about two or three inches up from the tip, showed when the proper depth would be reached.

Next he picked up his little hammer and rapped it gently against the butt of the first probe until the metal ridge was roughly flush with her eyeball, which was now compressed somewhat downward from its usual position, so that I feared it might pop out of the surrounding orbital bone. At the other socket, he repeated these steps with the second probe. I had the vivid image of a Roman soldier detachedly pounding nails through a crucifixion victim. I wondered what entered the mind of the till then still aware Mary Heller as the probes were thrust into her brain.

Once both metal ridges showed the probes to be correctly placed, standing alone now against the surrounding bone like a couple fence stakes lodged upright by rocks wedged into the holes with them, I saw that there was a tiny hole sideways through the metal handle of each probe. Dr. Freeman had inserted the probes in such a way that the holes were now perfectly aligned. One could thus see through both probes at once. Considering how little we knew of the effects of the surgery about to be completed, I found this detail a little compulsive, but he indicated it was a second way of assuring the probes were correctly positioned. He then took a camera out of his valise and photographed the probes from two or three angles, presumably later if necessary to be able to establish in a court of law that any negative consequences could not be his fault. After all, he had confirmed that the probes were initially in the right position on both "x" and "y" axes!

He then took hold of both probes at once and for a number of seconds, up to a minute or so it seemed, rotated the handles so as to assure that their tips, both at once, moved rapidly in wider and then smaller egg-beater circles inside the front of the lady's brain. He said something as he was doing this about scrambling the neural connections and the positive results this would have and why. I missed the significance of this part of the lecture as I was struggling not to faint and was then being caught from behind by one of the nurses who eased me to the floor and suggested I put my head between my knees, which helped.

When he had finished stirring, Dr. Freeman gripped each probe firmly and simply pulled it out of her head. Dealing then with my embarrassing wooziness, I missed such subtleties as how it would be assured no infection could now get into her brain through the extra holes he had created into her head or how or if those cavities would be sealed. It seemed he did not address those issues at all, perhaps leaving them to the miraculous durability and self-healing qualities of one's body in spite of so many assaults it may receive.

I was there and fully recovered myself when Mrs. Heller awoke in the recovery room. Though she had terrible black eyes, I thought her appearance remarkably good in view of what had been done to her.

She looked about tentatively and found and focused on her husband's face, as he was now standing near her bed and leaning a little toward her.

"How are you feeling, Mary?" he asked. "Nauseous!" she said.

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