DEPARTMENTS  |
NOVEMBER 2008 – NO. 28
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Medicine
by Howard Dully and Charles Fleming
My lobotomy
Doctors Hospital is a small private institution in San Jose. It looks more like a set of doctors' offices than a hospital. It's a long, low building, painted all white, with room for maybe 50 or 60 patients.
I was admitted as one of them on the afternoon of Thursday, December 15, 1960.
My dad drove me down there. My stepmother Lou stayed home. I don't remember saying good-bye to her, or to my step-brother George or brother Brian. I do remember having a sense of adventure, of playing hooky. I got to go to the hospital and they didn't. They had to go to school.
It was a sunny day, and my impressions of the hospital are all sunny ones. After we did the admitting paperwork, they put me in a bright, yellow room. My dad said good-bye without making any big deal out of it, and I was on my own.
I got undressed and put on the gown with the opening in back, which felt kind of ridiculous. Just like I'd expected, there were nurses clucking over me.
It was a private room, so I got to watch whatever I wanted on TV. But after a while I was interrupted by the nurses, who said the doctors had to do some tests. They took some blood. They listened to my heart. Then I went down to another room where they took some X-rays of my chest and then my head. The radiologist noted that my skull was normal, my pineal was not visualized — whatever that means — but that the frontal sinuses were "extremely small and poorly developed." They gave me the stamp of approval, and sent me back to my room.
That's it? Those were the tests? Fine. I wasn't worried about a thing. I knew I wasn't sick. Nothing hurt. Plus, when dinner came, I did get Jell-O. It wasn't all it was cracked up to be, and the meal was a little skimpy, but no one shouted at me. No one made me go eat by myself in the other room. I got to watch TV and eat dinner at the same time. I went to bed that night feeling cheerful.
I don't remember whether the nurses gave me anything to make me sleep. Was there a pill? Was there a shot? It seems like there would have been, but I don't remember it. I don't remember anything that happened next.
Dr. Freeman's admittance orders, written on the stationery bearing his 15 Main Street address in Los Altos, said this: "Please admit to Doctors Hospital Thursday, December 15 at 3:00 p.m. for transorbital lobotomy December 16 at 1:30 p.m." His pre-op orders called for a complete blood count, measuring the "bleeding and clotting times," a urinalysis, an X-ray of my skull, and an electrocardiogram.
So far, so good. Then it says, "May be up and about until time for operation. Regular diet. If restless at night give him sodium amytal at 10:30 p.m." Sodium amytal is a barbiturate; it would certainly sedate me. That makes sense, too.
But Freeman had a warning for the nurses: "Avoid escape. The patient is full of tricks. Nurse not to leave him alone at any time. Is not to know why he is in hospital except for examinations."
Escape? Why would I try to escape? Where would I go? I was a twelve-year-old kid in a hospital gown. My father and stepmother and doctor had all told me I was in the hospital for tests. I had no reason to believe they were lying to me. They were treating me like the Birdman of Alcatraz, but I was just a kid who had been looking forward to Jell-O.
I don't remember waking up the next morning. I don't remember being prepared for surgery. I don't remember seeing Freeman. I don't remember anything of that morning. That whole Friday disappeared.
Then it was over.
I remember waking up the next day, which would have been Saturday. I felt bad. My head hurt. I had a fever. They kept taking blood, and giving me shots. I thought something had gone wrong. What happened with the tests?
Freeman's notes tell the story: "Howard entered Doctors hospital on the fifteenth and yesterday I performed transorbital lobotomy. The only thing that seemed to bother Howard was the needles he'd received on several occasions."
Freeman described the surgery itself in simple language. Even I could understand it. He was assisted in the operating room by Dr. Robert Lichtenstein, and his notes said, "I introduced the orbitoclasts (the name Freeman had given to his personally designed lobotomy knives) under the eyelids three centimeters from the midline, aimed them parallel with the nose and drove them to a depth of five centimeters. I pulled the handles laterally, returned them halfway and drove them two centimeters deeper. Here I touched the handles over the nose, separated them 45 degrees and elevated them 50 degrees, bringing them parallel for photography before removal."
In other words, he poked these knitting needles into my skull, through my eye sockets, and then swirled them around until he felt he had scrambled things up enough. Then he took a picture of me with the needles in, and that was that.
From reading Freeman's other notes I know the procedure didn't last more than ten minutes. There are no medical records available about my stay in Doctors hospital, so there is nothing but Freeman's notes to explain the fever and headaches and nausea.
But I do have a receipt, a "Physician's Service Report," from Blue Cross Hospital Service of California. It says I was admitted on December 15 to be treated for "schizophrenia, mixed" and discharged on December 21. Under the heading of "Medical Treatment Rendered," the paper says, "Transorbital lobotomy. A sharp instrument was thrust through the orbital roof on both sides and moved so as to sever the brain pathways in the frontal lobes."
The charge for the hospital stay was two hundred dollars.
To get me properly sedated, Freeman had administered a few jolts of electroshock. I don't know how much was typical, but I got some extra.
"Howard came around quickly after the first shock," Freeman wrote. "I eventually gave him four, after which he was quite slow in recovering. I think it was one more than necessary."
After the procedure, Freeman wrote that there was "an escape of a small amount of blood-stained fluid" from each eye socket. I did not get much swelling, he said. "However, he did have a considerable amount of vomiting during the night and I prescribed Dramamine 50 milligrams for its control. He'd been incontinent once during the night. He resisted efforts to get his eyes open and complained about the needles that were being given him. His temperature, pulse and respiration were quite normal."
My brain wasn't. Freeman said that I didn't know where I was or what was going on. "When I saw him this morning, he recognized me but thought he was on Orange Street and that the day was Monday instead of Saturday. He did not know that anything particular had happened to him."
Well, I know something had happened, because I felt terrible. I may have picked up some kind of infection. Freeman's next set of notes, written the following Wednesday, read, "Howard had a rough time of it over the weekend. His temperature went up to 102.4 degrees, his neck was stiff; he had severe headache and was quite sluggish. I did a spinal puncture which showed some 4,000 white cells and 90,000 red cells, but the culture was sterile. During the waiting period for the culture I had given him about five or six doses of penicillin, one million units each, and his temperature promptly came down and stayed down."
Freeman was sort of famous, or infamous, for that "spinal puncture." Years before he had developed something he called the "jiffy spinal tap." Though he was accused from the beginning of risking his patients' lives using it, he liked this procedure for the same reason he liked the transorbital lobotomy: It was quick, and cheap, and didn't require an operating room or an assisting physician. With his "jiffy" procedure, Freeman simply had his patient sit in a chair turned around backward, with his head bent forward and his chin resting on his hands. Freeman then punctured the spinal column with a needle and entered the spinal canal at the base of the skull, between the first vertebra and the skull itself. As one medical writer said in his study of lobotomy, "A slight error (in this procedure) can produce a life-threatening injury."
The spinal tap, the infection, and the excess electroshock had left me pretty weak. Freeman's notes on my discharge read, "He was a bit wobbly on his feet when he was discharged from the hospital but was eating well, sleeping well and had no complaint of headache; his neck had loosened up and he seemed quite mild."
Excerpted from the book My Lobotomy: A Memoir, by Howard Dully with Charles Fleming. Copyright 2007 by Howard Dully and Charles Fleming. Excerpted by permission of Crown Publishers, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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AUTHOR BIO:
Howard Dully is a tour bus driver who lives happily with his wife in San Jose, California. This is his first book.
Charles Fleming is a former Newsweek correspondent and Vanity Fair contributor and the coauthor of a number of bestselling nonfiction books. He lives in Los Angeles.
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