How I Became a Neurologist by David Pratt #shortstory #fiction #amwriting #history #mentalhealth


Set in the summer of 1949, the first woman intern at a southern state hospital faces ethical and professional problems when one of her patients is threatened with lobotomy.

How I Became a Neurologist

by David Pratt

The leucotome in Dr. DeWitt’s right hand looked something like a stainless steel ice pick.  The patient on the table was a 43-year old male schizophrenic, rendered unconscious by three rapid electroshocks.  The doctor lifted the man’s upper right eyelid and inserted the instrument between the eyelid and the eyeball.  The nurse handed him a small hammer with a rubber head and he gave the leucotome a sharp tap.  There was an audible crack! as the point of the instrument broke through the thin upper bone of the eye socket.  The doctor pushed the plunger to obtrude the wire cutting arm, and rotated the leucotome, slicing through brain tissue with a sound like tearing cloth.  What happened next I can’t say, because I passed out.

Art: SMC.

I was out only a few seconds.  The nurse had an arm around my shoulders and was helping me to a seat outside the room.  I choked back a wave of nausea, knowing that if I spoke, I’d start babbling about never having fainted before, even while watching surgery.  One more strike against Dr. Sheila Hoskins, the first and only female intern at the South Carolina State Hospital, back in the summer of 1949.

I stood up, steadied myself, thanked the nurse, and went outside.  The heat of the July day hit me like a bludgeon.  My office was in the Administration Building, a short walk under the oak trees.  I turned the fan on full and sat at my desk in front of the draught, wondering for the hundredth time whether neurology would not be a better option than psychiatry.  My office was two doors down from that of the chaplain, an easy-going Baptist who seemed to know all the patients and staff by first name.  People constantly passed my door, and I usually kept it closed.  Otherwise, patients would walk by, glance at my nameplate, look at me, look back at the nameplate, and murmur “Lady doctor!” in amusement or disbelief.  But I was still sensitive about my fainting spell, and did not want to seem to be hiding, so for once I left the door open.

Art: SMC.

“How are you feeling, Sheila?”  Dr. DeWitt stood in the doorway.

“Perfectly fine, thank you, doctor,” I lied.

“Nothing unusual about lobotomy witnesses passing out.  I’ve known it happen to combat surgeons.  Why don’t you come and have a coffee?”

It was the third time he’d invited me for coffee, and for the third time I declined, this time on the grounds that I needed to look over my notes prior to the medical meeting.  Dr. DeWitt was my supervisor, and I intended to keep my relationship entirely formal with the handsome, successful, twice-divorced Head of Medicine, the number one heart-throb of all the nurses at the State Hospital.

Not that DeWitt was a light-weight.  Still in his forties, he had a national reputation in his field, and was a personal friend of Dr. Walter Freeman, who himself was a disciple of the celebrated Portuguese surgeon, Antonio Egas Moniz.  Like Moniz and Freeman, DeWitt was a leading advocate for psychosurgery.  At that time, before the development of psychotropic drugs, half the hospital beds in the US were occupied by mental patients.  Prefrontal lobotomy, De Witt maintained, was a humane means to attenuate a host of psychiatric symptoms and restore the sufferer to a semblance of normality.  True, many patients seemed to lose much of their ambition and initiative after the surgery, and even part of their personality, but without the surgery, many of them would be condemned to hospitalization for life.

The Worst Nobel Prize Ever Awarded [To Antonio Egas Moniz] by the SciShow¹

 

I opened the file and began to review the dozen cases for which I had responsibility.  Footsteps went by, then stopped and came back.

“That’s a Hopper, isn’t it?”  The woman, in her thirties, had dark hair and a pleasant face.  She was wearing a calf-length mauve dress in a paisley pattern with long sleeves.

“How did you know?”  It was a fairly recent work.  I’d bought the print at the Philadelphia Museum of Art, and had pinned it up to soften the sterility of the office.

“He’s one of my favorite artists.  I have a copy of “Cape Cod Evening,” at home.  We haven’t met.  I’m Mrs. Tutwiler, June.  Excuse me interrupting you, doctor.”  I knew she wasn’t on the medical staff, but she left before I could ask.  I jotted down, “June Tutwiler, Social Worker?  Old money accent.”

Dr. DeWitt opened the meeting by showing a film about Antonio Egas Moniz.  Born in Portugal in 1874, Antonio Caetano de Abreu Freire Egas Moniz earned his medical degree in 1899.  He published one of the first textbooks on sexual pathology, and was the originator of cerebral angiography.  But he was best known for his pioneering of leucotomy, later called lobotomy.  Elected to Parliament in 1911, he served as Portugal’s Ambassador to Spain and then as Foreign Minister, leaving politics after fighting a duel with a political opponent.  In 1939 a schizophrenic patient shot him in his office, and for the last ten years he had been in a wheelchair.

The subsequent discussion among the three psychiatrists, the two residents, and myself, was somewhat muted.  The hospital did not have a big staff for three thousand patients, and we also served the Black asylum, five miles out of town.  The six of us pretty well knew by now where each stood with regard to psychiatric theory, and we soon moved on to the case list.  I gave a start when Dr. DeWitt mentioned the first name.

“Mrs. June Tutwiler.  Obsessive-compulsive.  Admitted with a history of self-injury.  Thirty days observation, renewed once.  We all know how resistant self-mutilators are to therapy.  Ten ECT treatments have not been effective, and psychotic episodes continue at irregular intervals.  In the last, ten days ago, she came close to severing the brachial artery.  Very upsetting for the ward.  Cannot be discharged as long as her condition persists.  I propose lobotomy.”

Dr. Johnson, the Freudian, was looking out of the window.  Paul and Derek, the two young residents, exchanged glances, but said nothing.  Only Dr. Engelhart, whose favorite saying was, “No crooked thought without a crooked molecule,” looked at DeWitt and nodded.

We had a long case list to get through.  DeWitt took a pen from the breast pocket of his white coat, and looked at each of us round the table.  He had a very direct gaze, which, with his handsome face and silvering hair, contributed to his undeniable charisma.  “I take it we’re—“

I found myself speaking before I knew what I was going to say.  “I’ve met Mrs. Tutwiler.  I wonder—I wonder if I could work with her a bit before we make this decision.”

All eyes were on me.  At no previous meeting had anyone challenged a recommendation by Dr. DeWitt.  But he lost none of his aplomb.  “I’m very glad you’re taking an interest in this case, Dr. Hoskins,” he said.  “Normally at the end of 60 days, if not discharged, the patient would be transferred to a permanent ward.  Why don’t we table this case?  Do you think you could report back to us two weeks from today?”

I took Mrs. Tutwiler’s file home with me, and read it after I’d watched the ten o’clock news with my mother.  It was August 11, and the television was full of the death of the South’s favorite writer, Margaret Mitchell, author of Gone with the Wind.  That afternoon she had been struck and killed by a drunken taxi driver when crossing Peachtree Street in Atlanta.

Name:  June Abigail Tutwiler.  Sex:  Female.  Race:  White.  Date of birth, 05-06-1917.  Marital status:  Married.  Children:  Two.  Religion:  Baptist.  Education:  High School and Teachers’ College.  Occupation:  Art Teacher.  Appearance:  Normal.  Admitted:  06-11-1949.  Symptoms:  Self-injury (cutting).  Diagnosis:  Obsessive-compulsive with impulse control disorder.

The medical report showed no abnormalities.  In the admission interview, the patient had expressed anxiety and perplexity about her condition.  She denied experiencing problems in her marriage, and claimed her only concern was an ongoing struggle with her weight.  The psychiatric interview showed essentially normal patterns of gestures, mannerisms, perceptual and intellectual functions, feelings, defenses, speed of conversation, and logical progression of thoughts.  Patient’s symptoms had begun to manifest two years earlier.  No discernible pattern was apparent.  She would become tense and withdrawn, then cut herself on the upper arms, usually in a bathroom or bedroom, using nail scissors or a piece of glass.  There had been three self-cutting episodes since her admission to hospital.

I interviewed Mrs. Tutwiler the following day.  She came into my office quite composed, open, and responsive.  Her dark hair was attractively cut, probably done for twenty-five cents by one of the patients who had been a hairdresser.  We went over her childhood and her marriage, and her career as an art teacher.  She showed me a photograph of her two children with a slim blonde woman.  “Your sister?” I asked.

“No, that’s Adèle, my best friend.  I don’t know what I’d do without her.  She’s just so supportive.  Goes by my home every day to check on the babysitter and see how the children are doing while I’m here.”

I had intended the interview to be general, but toward the end of the hour, I noticed Mrs. Tutwiler beginning to clutch her white purse more tightly, and her accent becoming more pronounced.  Eventually she asked, “Do you have any ideas, doctor, about what could be the causo ma case?  It’s the not knowin’.  Somethin’ comes over me, I begin to feel outa touch, sorta numb, then I get more’n more tense until I cain’t stan’ it and I come out of it findin’ I’m bleedin’ like a stuck pig.  Ema goin’ crazy, doctor?  Ema gone spen’ the resto my life in here?”  She took a tissue from her purse and pressed it to her eyes.

I didn’t want to say that I had absolutely no idea about the cause of her illness.  I said, “Whatever happens, you’re not going to end up on a back ward, Mrs. Tutwiler.  We’ll make sure of that.  You’re coming up for a weekend pass, I believe?  Let’s talk again after you get back.”

As she stepped out of the office, I had an idea, and called her back.  “You’re a voluntary patient, aren’t you, Mrs. Tutwiler?”  I asked.  “I’m going to the State Park for a picnic tomorrow with one of the social workers and a small group of patients.  Perhaps you’d like to come?”

“Well, I’d love to, but I’m only Step 4.”  That meant, restricted to the grounds of the hospital.

“I’ll arrange it,” I said.

We took two cars, driving the fifteen minutes to the park with all the windows open.  The humidity and temperature were both in the nineties, so we stayed by the lake and spent a lot of time in the water.  While we were soaking up the sun after a swim, an argument broke out between two of the patients.  It started when John, a twenty-five year old auto mechanic, claimed that the Last Judgment would occur on July 1st of the following year.

“How do you know the Messiah’s coming then?” Maureen asked skeptically.  She was about twenty, not especially pretty, but with long black hair that she’d twisted into a kind of Greek knot behind her head.

“Because I am the Messiah,” John said.

“That’s ridiculous,” Maureen exclaimed.  “You know you’re not.  You can’t be.”

“Why not?”

“Because I am.”

“That’s not true!  You weren’t born in a stable.  Your parents weren’t Joseph and Mary.  You didn’t grow up in Nazareth.”

“Sure as shootin’ I did.  I fed the five thousand.  Did you ever change water into wine?  Did you ever walk on the Sea of Galilee?”

“You bet I did.  What’s more—“

“I have an idea.”  June Tutwiler said.  She was in a cheerful mood, wearing a stylish one-piece swimsuit with diagonal black and white stripes.  “Why don’t we do a little experiment?  You say you’ve both walked on water.  Well, let’s see you do it.  Then we’ll know who’s the true Messiah.”

“Right, no problem,” John agreed.  “Let’s both swim out to the raft—”

“Then we’ll walk back,” Maureen said.

Everyone sat up.  Both contestants were strong swimmers, and they got to the raft, some fifty yards from shore, about the same time.  They stood for a while conversing.  Then both stepped simultaneously off the raft from adjacent sides, and both sank.

I must admit to some disappointment.  Not so the two claimants to divinity.

“You know the problem?” John said, standing in front of us, toweling himself off and breathing heavily from the fast swim back to shore.  “The problem is your lack of faith.”

“That’s right,” Maureen added.  “O ye of little faith.  That’s what stopped us doing it.”

“Personally,” Mrs. Tutwiler said to me, “I think there was a cold snap in Palestine, and Jesus was walking on ice.”

John and Maureen were moving away.  “Absolutely,” Maureen was saying, “And how about the blind?  Did you heal many of them?”  They stopped out of earshot and spread their towels on the sand.

I lay back and closed my eyes.  I was chronically short of sleep.  I lived with my mother, who was in poor health, forty minutes from the hospital, out among the pines and red sand.  I tried to spend some time with her every day, and I walked my dog after supper before getting down to three or four hours reading in psychiatry and neurology.

It was probably only a few minutes later that I woke up, but I was alone.  I sat up, stunned by the heat and the light.  The others were in the water.  But I could see neither John nor Maureen.  I wasn’t worried that they had gotten in trouble in the lake.  Even if they couldn’t walk on water, they could swim in it well enough, and in any case the life-guard was in place on his platform.  Now I noticed that Mrs. Tutwiler wasn’t in sight either.  I scanned the beach in each direction.  As the only doctor, I was the senior person in the party.  I got up and walked to the top of the beach, where a path led into the woods.  I saw the two Messiahs quite soon, not very far off the path, naked and tangled in one another’s arms.

I stopped, at a loss what to do, but before I could make a decision, I heard my name being called.  John raised his head, and I retreated before he saw me.  Janice, one of the patients, was running out of the wooden building that housed changing rooms and showers.  She saw me and ran up, her face full of alarm.

“Dr. Hoskins,” she cried breathlessly, “It’s June Tutwiler, she’s in the shower bleeding all over.”

“Get my black bag from my car, please,” I asked, handing her my keys, and dashed to the showers.

Mrs. Tutwiler, still in her swimsuit, was standing under the shower in a pink pool of water, a pair of cuticle scissors in her hand, and half a dozen slashes on her upper left arm.  I saw immediately that although the cuts were bleeding profusely, they were not particularly dangerous.

She seemed to be disassociating, so I didn’t say anything, just took her hand and led her out of the shower, sat her down on a bench, grabbed her towel, and applied pressure to the cuts on her arm.  Janice appeared in the doorway with my bag.  I taped and bandaged the arm, then helped pull her sundress over the damp bathing suit.

It was only when we were halfway to the hospital that Mrs. Tutwiler, sitting in the passenger seat, spoke.  “I’m sorry, doctor,” she said in a small voice, and began to cry.

Dr. DeWitt was entirely supportive about the episode.  But the fact was I had sought permission to take a Step 4 patient out of the hospital, and had then been obliged to file an incident report.  A reputation for poor judgment is easy to gain in the internship, but very hard to shake.

I had a long meeting with Mrs. Tutwiler as soon as she came out of the infirmary.  We went back over her childhood, her marriage, whether she was at some level afraid to go back home, who it was she might be wanting to attack rather than herself, what special significance cutting, skin, blood, wounds, might have for her.  None of these lines of inquiry were productive.  She was tearful, embarrassed, apologetic, and not a little afraid.  At the same time, she was totally rational and cooperative.

That Saturday, I walked my dog at five in the morning, made a pot of soup for my mother’s lunch, then drove the hundred miles down to Charleston, where I spent nine hours in the library of the Medical College.

Art: SMC.

At the library, I read everything I could find on self-mutilation.  I read about slashers.  I read about skin-burning, hair-pulling, and bone-breaking.  I read about patients rubbing glass fragments into their faces, and others carving initials in their skin.  I read a case study of a man who castrated himself and another of a woman who enucleated both eyes.  I read about the relationship between self-mutilation and childhood sexual abuse, and about cases where self-injury developed after rape.  The only thing missing in the literature was any account of successful treatment.

Then, when I was about ready to give up and go home, I came across an article in Acta Scandinavica Psychiatrica, on “Phobic Episodes in Response to Gluten Intolerance.”  It described a Swede, a stage actor by profession, who would periodically suffer disabling stage-fright, which, when working without an understudy, resulted in cancellation of performances and threatened his career.  Lengthy investigation revealed that he was suffering from undiagnosed celiac disease.  The panic attacks ceased once he went on a gluten-free diet.  This was 1949, and it was the first time I’d come across the terms celiac or gluten.  The article cited two other studies on psychological effects of food allergy in previous issues of the same journal, which I also found and read.

My uncle was an internist in Philadelphia.  I liked him very much, and it was his example that had led me to medical school at the University of Pennsylvania.  I phoned him the next day and asked him about celiac disease.

“We studied nothing on diet in med school,” I said.  “I’ve heard of allergies to eggs and peanuts, of course.  But wheat?”

“The intolerance is due to lack of an enzyme, resulting in inability to digest gluten, which then acts as a poison.  Almost always misdiagnosed.”

“My patient seems to have no other physical or psychiatric symptoms.  Could celiac disease be the cause of obsessive-compulsive episodes?”

“I have heard of such cases.  Celiac disease produces all kinds of idiosyncratic symptoms.  Only sure diagnosis is by means of a small bowel biopsy.  You know how they discovered the disease?  Pediatricians in Holland noticed a decline in infant colic during the war.  They figured it might have something to do with a change in diet.  With the interruption of wheat shipments across the Atlantic, the Dutch were living on potatoes rather than bread.  So we can thank Adolf Hitler for that discovery.  The ironic thing is, I’ve always believed Hitler himself was a celiac, judging from the symptoms reported.”

“Would you recommend a biopsy?”

“If there are no GI symptoms, Sheila, I think I’d take a conservative course.  Try a change of diet first.”

“Like excluding wheat?”

“If it is a food allergy, it may not be gluten.  I’d do a rotation diet, if the hospital will cooperate.  Distilled water only for two days, then add one food per day, starting with, say, glucose.  Keep a complete record of everything consumed and prevent any deviation.”

He called me back a few minutes later.  “Sheila, love, there’s a small conference on internal medicine right here in Philadelphia next month.  I’ve just been looking at the program and there are a couple of sessions on diet and psychopathology.  Come up and stay with us, if you can get time off.”

Dr. DeWitt clearly thought I was on a wild goose chase, but he gave me leave to attend the conference, and approved Mrs. Tutwiler’s transfer to the medical ward, where her diet could be controlled and monitored.  She found the first week of the diet rigorous, but she appreciated the fact that she lost weight and experienced no recurrence of symptoms.

After two weeks, we added wheat to her diet, and monitored her closely.  Nothing happened.  That ruled out celiac disease.  Nor did eggs, strawberries, or nuts have any effect.  After almost a month, her diet pretty well returned to normal.

It was encouraging that she had not experienced any further attacks, but we were no nearer to an explanation for her condition.  Dr. DeWitt was unfailingly cooperative, but as I continued to request unprecedented extensions of Mrs. Tutwiler’s admissions status every two weeks, I sensed a growing impatience beneath his polished charm.

Our paths crossed one morning outside one of the back wards.  “Come with me for a moment, Dr. Hoskins, if you will,” he said.  We walked over to the building, and DeWitt opened a series of doors with different keys.  We were greeted by the odor of feces and disinfectant, an odor I have never ceased to associate with mental institutions.  It permeated the entire hospital, as well as my clothes and my skin, and while it was subtle in most buildings, in this one it was overwhelming.

Art: SMC.

The ward we entered was a world of its own.  In the stifling heat and the dim light from a few windows above head-height, three or four dozen women, mostly barefoot on the wooden floor, and wearing aged house coats, wandered around or sat or slept on benches against the walls.  They were observed by three female aides in white uniforms.  As we came in, a woman of about thirty ran up and embraced Dr. DeWitt, laughed uproariously, sat down at a piano next to the door, began to play a Strauss waltz, then stopped and burst into tears.  A white-haired lady walked in circles, uttering intermittent cries like those of a Northern Loon; her hospital gown, unfastened at the back, showing an open wound from a botched lumbar puncture.  An obese woman strode from one end of the long room to the other, at each turn uttering a cheerful “Merry Christmas!”

Dr. DeWitt exchanged pleasantries with the aides and a number of patients, greeting them by name.  I felt a tug at my sleeve.

“May I ask you a question, doctor?”  A bespectacled young woman with a pony-tail was looking earnestly at me.  “Do you believe in ontology or in teleology?  What’s the temperature today?  Lemme ask you, do you think President Roosevelt committed suicide when he found he was impotent?  Have you heard of Susan Belle Dawkins?”

She paused after this question.  I said, “No, I don’t believe I have.  Who is she?”

“Me!” the young woman exclaimed triumphantly.  “Hey, you know what, is Coca-Cola habit-forming…?”

As we exited, my feelings were a mixture of hopelessness and compassion.  I waited for DeWitt to speak.  “That’s where your Mrs. Tutwiler will end up if we can’t do something for her,” he said.

“Do they never get out?”

“Only in a box.”

***

Then Mrs. Tutwiler slashed herself again.

She used glass, a broken tumbler, and she cut both arms.  She did it at night, in the room she shared with two other patients.  Although an orderly discovered her fast, she needed two units of blood.  She was asleep by the time I got to the hospital.  I prescribed Nembutal, knowing how distraught she would be when she came to.

I held her hand as I sat by her bed the next morning.  She was trembling, her face almost as white as the bandages on both arms.  “This is actually good news, Mrs. Tutwiler,” I said.  “You had no symptoms for four weeks.  Now if we can find something new in your diet in the last 24 hours, we may be on to something.”

The list did not look very promising.  Meals at the state hospital were limited by a food budget of 27 cents per patient per day.  Breakfast the previous day had been eggs, grits, and coffee.  Lunch:  fried chicken with batter containing egg and wheat flour, potatoes mashed with milk, okra, Jell-O, tea with lemon and sugar.  Supper consisted of baked ham, french fries cooked in sunflower oil, collard greens, cornbread, and peach cobbler with ice cream.

Peaches!  I’d never heard of intolerance to peaches, but that was the only new item in the menu.  I gave instructions for Mrs. Tutwiler to have a large bowl of sliced peaches at breakfast the next day, and to be checked every ten minutes for the next 24 hours.

Nothing happened.  I called my uncle.  He listened carefully.  “You might want to go back more than 24 hours,” he said.  “There could be quite a delay between the offending item and the onset of symptoms.  If nothing shows up, diet’s probably not involved.”

The only new item Mrs. Tutwiler had ingested on the day before her last slashing was chocolate brownies, which contained butter, sugar, salt, vanilla, and chocolate chips.

“Tell me about chocolate,” I asked Mrs. Tutwiler.

“It’s my weakness.  I adore it.  That’s why I can’t lose weight at home.  The only time I get it here is when we have brownies.  Then half the ward gives me theirs, they know I like it so much.”

“What kind of chocolate is your favorite?”

“English.  Cadbury’s milk chocolate.  Belgian is even better, but you never see it in the stores.”

The next afternoon I brought an eight-ounce bar of Cadbury’s milk chocolate and two cups of coffee to my office.  Mrs. Tutwiler ate the chocolate while we chatted.

I was at home the next evening, watching the ten o’clock news with my mother.  The phone call interrupted an account of the latest atomic test at Bikini Atoll.  Mrs. Tutwiler had gone to sleep early, the nurse said, but had woken after an hour or so.  Almost immediately, she had broken the window beside her bed, cutting her hand badly, and begun to slash her arms with a piece of glass.  The staff rushed to her room as soon as they heard glass break.  She had not done much damage to herself, but breaking the window had opened the artery in her thumb.

Art: SMC.

They knocked her out with scopolamine, as she was, as the resident put it, right out of her tree.  When she came to, a couple of hours later, I said, “I think we’ve nailed the problem, June.  But I’m afraid you’ll never be able to eat chocolate again.”

I discussed the breakthrough the following evening with Paul and Derek.  Paul was the Resident and Derek Assistant Resident.  They were only one and two years ahead of me, and we often made up a threesome.

The staff cafeteria served the same food as that provided to the patients, and when we could no longer stomach it, we’d head downtown to Shimmy’s.  There the air conditioning was cranked up to the max, the burgers were hickory-grilled, the Coca-Cola was ice-cold, and the jukebox played Perry Como singing Some Enchanted Evening and Hank Williams I’m So Lonesome I Could Cry.

I’M SO LONESOME I COULD CRY (1949) by Hank Williams²

“You got yourself a publication there, Sheila,” Derek said.  “Leastways a conference paper.  It’s a comin’ field, allergy medicine.  Have you thought about it?  Or has DeWitt convinced you your future lies at the funny farm?”

“I’m keeping my options open.  How about you, Derek?  Do you see yourself at a hospital, or in private practice?”

Derek waved to a waiter and ordered more cokes. “I’m fixin’ to devote my life to sexual perversion.”

“A noble ambition,” Paul observed.

“I work on the male ward for the criminally insane.  Half the patients are in for buggery.  Their families pulled strings to keep them out of jail, so they end up enjoying our hospitality.”

“I didn’t realize South Carolina had so many perverts,” I said.

“Well, the South Carolina criminal code is the only one that uses the term buggery.  It doesn’t define it, because they figured to do so would make the code itself obscene.  So it’s left up to the judges.  And most of them define it as any sexual activity other than conventional intercourse.  So a lot of homosexuals end up in the hospital.  There are even one or two young guys in there for excessive self-abuse.  Most of them would prefer prison where they’d at least have a definite release date.  Anyway, let’s say Winston Beauregard III has this little problem.  He’s developed an unnatural affection for the family dog.  His family, old money, is freakin’ out it will end in court, so they hasten him off to their friendly neighborhood shrink.  That’s me.  Name your fee, doctor.”

“Beats the ice pick solution,” Paul said.  “DeWitt whips it through your brain like he’s scrambling eggs.”

“Paul is underwhelmed by psychosurgery,” Derek said.  “But lobotomy’s no big deal.  A black eye and a temporary headache, and you’re back home the next day.  Think about the alternatives.  Insulin coma therapy.  Malaria therapy to heat up the brain and kill the insanity germs.  You know, they stopped bowsenning at the hospital only five years ago.”

Bowsenning?” I asked.

“You didn’t study bowsenning at that Yankee school of yours?  Blows to the head alternating with submersion in ice-cold water.  Knocks the cow-walkin’ hell out of you.”

“But it worked,” Paul commented.  “They had the stats to prove it.  Forty per cent recovery among depressives.  They neglected to mention that fifty per cent recover spontaneously.”

The conversation was diverting, but my gaze kept wandering back to a couple in a booth on the other side of the restaurant.  They were deep in conversation, leaning toward each other across the table, their heads almost touching.  The man was unfamiliar, but I thought I had seen the woman somewhere.  Some connection with the hospital.  One of the nurses?  Nonmedical staff?  A patient?  Suddenly it came to me:  Adèle!  She was Adèle, Mrs. Tutwiler’s best friend.  A little older than in the photograph Mrs. Tutwiler had showed me, but the blonde hair still very blonde.

***

September ended, and the stifling hot weather finally broke.  My spirits rose with the clear blue skies, and with the satisfaction that came from resolving a clinical problem.  Dr. DeWitt also had something to celebrate.  Dr. Egas Moniz had been awarded the Nobel Prize.  For the invention of lobotomy.

DeWitt got a call at 6:00 in the morning, shortly after the announcement in Stockholm, from his friend Walter Freeman, who had nominated Moniz for the prize.  By 9:00 AM, DeWitt had exuberantly passed on the news to his medical colleagues and invited them to a celebratory barbecue at his house that evening.

I tried not to be impressed by Dr. DeWitt’s place, which was a few miles outside the city.  It had acres of deer woods, pasture with a couple of quarter horses, a fishing pond, a big swimming pool, and a colonnaded mansion.  At the barbecue, two silent and attentive Black men in red jackets served as waiters.

A young pig was turning on a spit over a bed of charcoal.  DeWitt carved it himself with surgical precision.  I couldn’t resist going back a second time, and congratulated him on the sauce.

“My own prescription, Sheila.  Key ingredients are oranges and curry powder.”

“How did you ever get this party organized so fast?”

“Other than the sauce, Piggie Park Restaurant did it all.  Second best barbecue in the South.”

I asked the expected question.

“Lafitte’s.  You don’t know it?  They don’t advertise.  Tell you what, how would you like to go out there one evening?  It’s about an hour north of here.”

“I’d love to,” I said brightly.  “Especially if I could bring my mother along.  She adores barbecue, and doesn’t get out that much.”

***

After the next medical meeting had approved a weekend pass for Mrs. Tutwiler, I called her husband and asked him to come in for a family conference.  He was in his late thirties, brush cut, narrow tie, white shirt, button-down collar.  He called his wife sugarplum and honeybun, and averred that his dearest wish was for her to return home as soon as possible, cured of what he called her bad habit.  None of this was surprising.  What did surprise me was that I recognized him as the man whom I had seen the other evening at Shimmy’s in intimate conversation with Mrs. Tutwiler’s best friend.

“I suggest that you remove all chocolate from the house before your wife comes home,” I said.  “Don’t forget chocolate milk, chocolate chips, chocolate liqueur.  Ask the children not to bring chocolate home, ever.”

“I agree with you, doctor,” Mrs. Tutwiler said.  “I’m afraid if I saw chocolate even now, I’d give in to it.”

“It’s been a difficult time for both of you, but I think we can be pretty sure that’s all behind you now.  I’ll be away in Philadelphia until Wednesday, Mrs. Tutwiler.  Perhaps you could come by my office at nine on Thursday morning.”

I was getting ready to leave around five, when Dr. DeWitt put his head round the door.  “Come to my place and have a swim,” he offered.

It was a fine evening, and it had been a long week.  For a moment I visualized cocktails by the pool, then I declined, saying I needed to get ready for an early flight next morning.  He smiled and wished me a good trip.  But I felt—though this may be hindsight—that this was the last invitation he would give me.

It was wonderful to spend time with my uncle and aunt, although the conference proved less interesting than I’d hoped.  I made a couple of useful contacts with doctors working in the new field of environmental medicine, and I determined to submit a proposal on the Tutwiler case for the meeting the following year.

I arrived at my office just before 9:00 on Thursday.  A pile of messages waited on my desk, including one from Dr. DeWitt asking me to call him.  I decided to hold my telephone calls until I’d seen Mrs. Tutwiler.  But she did not appear on time.  At 9:30 I went over to the medical ward.

She was sitting on her bed, fully dressed.  She wore a short-sleeved summer dress, despite the fresh bandages on her arms.  I was so shocked I couldn’t speak, but it was not the bandages.  It was the black eye and the vague pleasant smile with which she greeted me.

I didn’t need to look at the chart, but for the record, this is what it said.  “Recurrence of symptoms, judged to be life-threatening.  Prefrontal lobotomy approved by husband and carried out.  Normal post-op care.  S. J. DeWitt.”

Art: SMC.

“Oh Doctor–” she said dreamily.  She looked at my name badge.  “Dr. Hoskins.  I had such a lovely weekend.  I’m so blessed.  You know what I found when I got home?  In the fridge, a gorgeous red box, shaped like a heart, just like Valentine’s Day, from Adèle, my best friend, the most wonderful Belgian chocolates.”

THE END.

David Pratt’s poetry and short fiction have been published in over 100 journals in the United States, Canada, Britain, and Australia,  His op-eds have appeared in national newspapers in Canada and the United States.  He is the author of Apprehensions of van Gogh (Hidden Brook Press, 2015), and Nobel Laureates: The Secret of Their Success (Branden Books, 2016).  He lives in Kingston, Ontario, Canada. He can be found online at: http://davidpratt.ca/.

 

References and citations:

¹”The Worst Nobel Prize Ever Awarded [To Antonio Egas Moniz].” February 07, 2015. Accessed November 19, 2018. https://www.youtube.com/watch?v=StrsvKSAbT8. Uploaded by user, SciShow (Hank Green).

²”I’M SO LONESOME I COULD CRY (1949).” Performed by Hank Williams. November 03, 2009. Accessed November 19, 2018. https://www.youtube.com/watch?v=4WXYjm74WFI. Uploaded by user, wilson mcphert.
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