Mind Maze

Although he had no way of knowing it, a kind, older man and his simple crossword puzzles allowed me to discover how fragile memories can be and how easily they can by lost.

 I watched eagerly as a congenial seventy-two-year-old man, seated at a small rectangular table with a sharpened number-two pencil in hand, slowly and meticulously printed "Lincoln" into my black-and-white checkered conundrum. "You see," he explained, "Lincoln was nicknamed Honest Abe and that fits for 18 Down." Working his way through the crisscrossing clues, the man gradually transformed my vacant crossword puzzle into an alphabetical mind maze.

Yet as he persisted, I noticed that several boxes were left unmarked and many clues remained unanswered. "The current president of the United States" was among the first clues to stump this longtime crossword guru. He could neither name the husband of Jackie Onassis nor the former British princess who recently died in an auto accident. Unfortunately, "forty-eight" did not fit for the number of states in the United States, and terms like "laptop" and "computer virus" seemed to elude him. As a matter of fact, any clue with reference to historical events after 1953 was unusable, and only my omniscient answer key seemed able to supply those magically correct letters.

More than just forgetful, this humble, soft-spoken, grandfatherly figure has become one of the most famous patients in the amnesia literature; he is now featured in countless textbooks studied by undergrads and fourth-year med students. My invitation to the Massachusetts Institute of Technology, which sprang from Duke's "Focus"--a first-semester

program in which freshmen of similar intellectual interests take courses together and live together--allowed me to take a first-hand look at this man, known by researchers across the country as "H.M." Along with his old, worn-out, pencil-smudged crossword books, H.M. may hold the answer to one of medicine's biggest mind-teasers--memories.

Unlike the answers "Clinton" or "JFK," my adventure was simply unforgettable. It allowed me to partake in cutting-edge research with one of the country's top behavioral neurobiologists.

1 Across: Feeling of Wonderment

I had first taken an interest in H.M. from Gillian Einstein's "Exploring the Mind" Focus, which offers a concentrated approach toward neurobiology. Throughout the semester, I studied, along with my classmates, the numerous research projects of Suzanne Corkin, a behavioral neurobiologist at M.I.T. Until that point, I had not even heard of H.M.; nor could I even name specific parts of the human brain.

Yet, as Einstein began to lecture about the whole dictionary of terms describing memory, I became increasingly curious. I had always taken my memories for granted. Of course,

I had heard of amnesia patients forgetting their pasts after tragic accidents--but they always got better, right? My grandparents would always joke that they were forgetting more and more as they got older--but they were only kidding, right? As I began to delve deeper and deeper into the amnesia literature, I started to realize that memory problems can be real and serious.

In my interdisciplinary course, taught by Larry Tupler, a behavioral psychologist at

Duke Medical Center, I had the opportunity to meet an older man who was diagnosed with Alzheimer's disease. I listened in awe as this kind man fumbled to recall his recent past. Questions about his children, current home, and most recent vacations produced a look of confusion. He strained to remember these once familiar facts. I could not believe that information so essential could escape anyone's memory; I was amazed that memories could be so fragile.

2 Down: Feeling of Sympathy

As the culmination of an eye-opening semester filled with presentations, papers, readings, and group discussions, Einstein and the other Focus professors asked Corkin to speak to our now-intrigued group during a one-day retreat at a local bed-and-breakfast. I could not wait to confront Corkin with all my questions, all my worries, all my ideas. Armed with carousels of slides, she dazzled our group with updates on H.M. and her most recent neurological projects.

As she began to describe her famous patient, all my feelings of awe soon turned to a deep compassion. During his teenage years, H.M. suffered from severe, frequent epileptic seizures that unfortunately induced mockery from his classmates and ultimately forced him to withdraw from high school. The seizures, originating in a sea-horse shaped portion of the brain known as the hippocampus, soon became so intolerable that H.M. needed to quit his job and seek medical care. Because he failed to respond to any anti-epileptic drugs, he and his neurosurgeon soon became desperate for almost any cure.

As a result, in 1953 at the age of twenty-seven, H.M., his family, and his neurosurgeon opted for experimental surgery, removing both hippocampi, as well as several neighboring cerebral structures. At the time, researchers had done almost no animal studies of the hippocampus, and no one could predict the outcome of the surgery.

Fortunately, the epileptic seizures seemed to vanish altogether from H.M.'s life. After the surgery, his personality and intellect remained intact, and his I.Q. score even increased slightly. Unfortunately, H.M. immediately demonstrated difficulty recalling past events. After the operation, he could not remember how to get to the bathroom, nor could he describe a story after reading it. When his parents moved to a new address, he had major difficulties finding anything within the house, and he could not find his way home from a distance of more than two blocks.

In 1980, H.M. moved to a nursing home when his parents could no longer care for him. According to Corkin, four years later H.M. could still not say where he lived or who cared for him. Moreover, for several years after the operation, he continued to respond "twenty-seven" and "1953" to questions about his age and the date. Now, he just hazards a guess, often underestimating by more than fifteen years.

How extremely sad, I remember saying to myself. What if my own grandparents--or even my own parents--always forgot what I was doing? Or worse yet, what if I could not recall any of the wonderful events in my life--my surprise eighteenth birthday party, my high-school graduation, my now-deceased grandfather and his delicious Slovak delica-

cies? How tragic it must be to forget life's precious moments!

3 Across: Feeling of Joy

The highlight of the retreat came when we all sat in a small circle in a cozy room adorned with tinsel and colored lights while Corkin entertained our questions. After about thirty minutes of listening to our inquiries, suggestions, ideas, and curiosities, she suggested that one of us should visit her lab to test our ideas. At the magical moment, I knew that this was my chance!

After winter break, Einstein suggested that I write Corkin to see whether her offer still held. "Sure," she responded, "H.M. is visiting the lab in two weeks. Can you come?" What a surprise! Of course, I could come; but two weeks were so soon, and I seemed so unprepared. Corkin even invited me to administer a test to H.M. The excitement was overwhelming--but what test, in what form, and for how long?

During the retreat, Corkin had mentioned that H.M. had a true passion for crisscrossing word games. In fact, H.M. and his puzzles were almost inseparable. Even his walker had a pouch filled with old crossword books whose pages were crumpled and worn-out from constant handling. A classmate of mine, Allan Stevens, suggested we administer a test in the form of these puzzles. Duke psychology professor David Rubin pointed out that crosswords are ripe for psychological literature, in that they involve procedural memory (learning to do a puzzle) and declarative memory (factual recall).

Although H.M. had enormous difficulty learning new facts, he could still acquire new skills. Consequently, the development of his motor skills, or procedural memory, appears to remain intact. Ironically, however, he does not remember learning these skills, suggesting impaired declarative memory, the ability to state memory in words. Perhaps the procedural process of a crossword puzzle could improve H.M.'s declarative memory. It was worth a try, I thought.

After a hectic two weeks of brainstorming, puzzle-making, meetings, phone-tag, and fax-machine snafus, I developed my puzzles for H.M. I then received an extraordinary message that the Focus program would fund my trip. "Fantastic!" I yelled. H.M., here I come!

4 Down: Feeling of Astonishment

As soon as I arrived in Boston, I went to visit H.M. at the M.I.T. Clinical Research Center. After reading about this extraordinary figure and studying him for many months, I was somewhat speechless finally to have met the "king of crossword puzzles," as I called him. Oblivious to his international recognition, H.M. was humble and talkative, and took a genuine interest in meeting me. We chatted about his love of crossword puzzles while he proudly showcased his worn-out books. "I fool around with these things all the time," he boasted.

While I administered my crossword-puzzle memory-recognition test, H.M. entertained me with stories about his family, childhood, school days, and hobbies. About halfway through the experiment, however, he repeated the same story about his aunt that he had mentioned less than two minutes earlier. I had prepared for his. I knew this was going to happen. I had read extensively about this, and Corkin talked about this on the retreat. Yet nothing could have prevented my initial shock when this otherwise intelligent, interesting, and warmhearted man started to forget. At first, I felt uncomfortable, odd, rather peculiar--as if I were somehow responsible for H.M.'s brief memory lapse. As he continued to finish the story for the second time, I began to tune out. I thought of my grandparents, my own parents, my closest relatives again. But H.M. continued to smile and merrily continue on about his aunt.

5 Across: Feeling of Amusement

As I made my way to M.I.T. the next day to administer the same test to H.M., I realized that he would not remember me from yesterday: You can make a first impression twice! Although he had not changed a bit and was the same congenial man as the day before, I was much calmer. When he began to tell me the story about his aunt, I began to smile. As a matter of fact, I had to bite my lip to prevent an imminent explosion of laughter. Nonetheless, H.M. had an intriguing way of captivating me, making me more interested despite the numerous repetitions. After hearing the story for the third and fourth time, I began to realize that I was hearing something special. I was listening to a legend tell one of his favorite stories; I was listening to a man who has defined medicine's knowledge about memories.

As I sat there for the second and third time, I realized that I had become part of an incredible adventure that was much larger than just 3 Down and 4 Across. I had been invited into a professional world of researchers and research labs. Moreover, I had learned that researchers must have empathetic personalities: Patients like H.M. were not just subjects read about in research journals--they were individuals with detailed pasts and unpredictable futures. As I listened to H.M. recite that story about his aunt, I felt deeply connected to him, privileged to get another glimpse into his life. I again felt that compassion I had discovered during my retreat. I did not necessarily need to laugh, talk, or become emotional; I just needed to listen.

Skotko is an A.B. Duke Scholar.

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