The Amnesiac: The Strange Case of Doctor Oliver Kean

By Thomas H. Milhorat

A GRIPPING TALE OF SELF-DISCOVERY, THE AMNESIAC TAKES THE READER INTO A WORLD OF HARDSHIP AND PAIN AS WELL AS HOPE AND HUMANITY.

 

Dr. Oliver Kean is a world renowned medical scientist who had focused his life on the welfare of his fellow man. After a savage mugging in the parking lot of Bellvue Hospital, Oliver Kean is left wit

• Language: English
• Publisher: Book Vine Press
• Release date: Nov 30, 2022
• ISBN: 9781959450689

Thomas H. Milhorat

Thomas H. Milhorat M.D. is a world renowned neurosurgeon who lives with his family in Bedford, NY. He has written two other well received novels: "Melia in Foreverland" & "The Devil's Dance".

Book preview

From the Author

The mind of man is a riddle and it needs to be deciphered in order to understand him. Of the many elements that account for his towering intellect, none is more central to knowing and reasoning than good memory. And if you stop to consider it, you are likely to agree that good memory is indispensible, irreplaceable, and mostly unfathomable on a personal level. Familiar examples of this God given faculty include memories of life’s experiences, memories of people and places, memories of things lost and found, memories of words, memories of ideas and concepts, and there are, furthermore, skills that some might call memories such as a particular style speaking, handwriting, dancing, singing a song, playing a musical instrument, and so on. Without memories, man is helpless and adrift. Surely there is nothing more enriching and treasured than happy memories, especially memories of those we love, of our youth.

The formation and retrieval of memories involve a multitude of complex mechanisms that are dependent on highly specialized cellular and chemical interactions in the brain, but beyond these generalizations very little is actually known. I have studied this mystery through a long career as a neurosurgeon. And while patients with profound memory impairment are nothing new in my profession, I have come across one case that is so exceptional that I hasten to document it before the lengthening shadows of forgetfulness catch up with me; for this is the story of a beautiful and clairvoyant mind that has seen into the future.

In recent years, the brain-mind relationship has been the subject of considerable scientific disagreement. This controversy speaks to two interactive elements: the brain, which is necessary for life and conscious thought, and the mind which is mysterious, unpredictable, and unique in every human being. Among the unparalleled functions of the human mind are its ability to enable the faculties of awareness, perception and intellect, which allow us to define distinctions such as right from wrong, the consequences of good and bad behavior, the ever sly natures of love and hate, charity and greed, honesty and deceit, happiness and despair, indeed, every aspect of the human condition. All too often, however, the mind enables alternant faculties that include wickedness, malevolence, and the destruction of things we hold sacred. It is here that the working boundary of science ends and no present day methods can take us beyond it. There is the belief even in the most uncompromising scientists that something additional to the brain and mind exists in every human being. That something is a ‘conscious spirit’ which is present from birth to death and is an accompaniment of the body and soul. Some people, including many theologians, are convinced that the ‘conscious spirit’ continues its existence after death and is one with God. The scientist may also believe this but it is an act of faith beyond his ability to prove it.

The delicate balance of the brain-mind relationship is something that should interest us. In some men, the scale appears to be tipped in one direction or another and this might account for differences in their qualities as, for example, the exceedingly educated man who does not need God, and the exceedingly soulful man who does not need education. It is also possible that when one part of the relationship is weak the other part becomes strong. In my many years of neurosurgical practice, I have seen this sort of compensation in occasional patients with catastrophic brain injuries. Dr. Oliver Kean is by far the best example. Science cannot impose a solution, anymore than theology can tell us where to find it. We cannot choose between body and soul. We must have both. Someday, should the mystery of the brain-mind relationship be solved, those who have sought the truth will rejoice alike: the scientist and the philosopher; the theologian and the agnostic; those who are as young as spring and those who are lying on their death beds. None need fear the truth. And surely that applies to all of us.

Contents

Part One: In the Still of the Night

Chapter 1: The Mugging

Chapter 2: Against All Odds

Chapter 3: Remembrances Lost

Chapter 4: Moving Forward

Part Two: A Strange New World

Chapter 5: False Memories

Chapter 6: In the Spotlight

Chapter 7: The Sublimity of a Noble Man

Chapter 8: Other Dreams Other Voices

Chapter 9: When the Truth Becomes a Lie

Part Three: Dead Reckoning

Chapter 10: In Pursuit of an Honest and Useful Life

Chapter 11: Clear and Present Dangers

Chapter 12: Absolute Self or God

Part One: In the Still of the Night

Chapter 1

The Mugging

Suddenly there came the bad weather. It arrived one night in 1996, the last day of October, when a monstrous storm swept down from the Canadian high lands and battered the northeast coast with raging torrents of freezing rain that ended the trick-or-treat rounds of Halloween-costumed children as far south as Delaware. Most New Yorkers had gone to bed early unless they worked the late shift or were among the habitual cast of night-stalkers out on the hunt and looking for a score. The temperature had dropped and soon the streets were bare of pedestrians and traffic.

In the outdoor doctor’s parking lot of Bellevue Hospital at the corner of First Avenue and 25th Street all was quiet except for the sound of the wind and hardened rain. Flickering lights from glazed overhead lamps illuminated a half dozen deserted cars with iced up windows, an open gate that swayed eerily back and forth in rhythm with the wind, and from the eaves of the adjacent Emergency Room foot-long icicles hung like crystal fangs of some lurking pre-historic vampire. Next to one of the cars there was something on the ground.

Hours passed before the desultory rounds of a young security guard brought him to the lot. Flashlight in hand, his eyes bleary and unfocused, with a Lucky Strike clenched firmly between his lips, he went about his uninspired duties, shining his light around, checking on the cars one by one, and smiling to himself that the big-shot doctors had problems just like his own. Except now, of course, since they were inside cozy and warm and he was outside in a driving hailstorm. The damn S.O.B’s! Then he saw it: a body on the ground in a puddle of blood! He pulled up short, recoiling in terror, his eyes fixed with burning intensity on the motionless figure, and with wanton dereliction of his sworn duty to investigate the scene of every odd occurrence that came his way, he ran straight into the Emergency Room to notify the big-shot doctors.

With almost unimaginable swiftness, a trauma surgeon, a nurse, and two attendants appeared with a stretcher on wheels that was dispatched to the lot. The surgeon knelt down beside the body, straightened out the head which lay to one side on the pavement, and began a search for the basic signs of life: an arterial pulse, respirations, and reactive pupils.

Is he alive? the pretty young nurse asked, with hopeful curiosity, as she took the victim’s head between her hands and supported it for the surgeon.

Hold him still, honey, he’s still alive….but just barely. Okay boys, no time to spare. Let’s put him on the stretcher and get him inside. Clean him up so we can have a look at his injuries and find out who the hell he is. Hurry, hurry, hurry. Nurse, I want you to start an IV and arrange for X-rays of the skull and cervical spine, and then an MRI of the brain, stat! After that I want you to give the OR a head’s up. I’m going to get in touch with the neurosurgeon-on-call and let him know we’ve got an elderly gent with a very bad head injury.

The patient was wheeled into an empty cubicle of the Emergency Room where he was undressed behind drawn curtains by the two attendants. A search of his bloody clothing provided no useful information concerning the victim’s identity, as the pockets of his trousers had been pulled inside out and his wallet was missing. He was cleaned up, beginning with the head, the hair of which had to be cut away with surgical scissors and razors because of all the matted blood. Inspection revealed irregular lacerations on both sides of the scalp in front of the ears, a three inch deep gash behind the left ear, abrasions of the face and neck, the eyes were swollen shut, the nose was fractured to one side, three front teeth were missing, and there was prominent bruising of the chest and abdomen.

A mugging, said one of the attendants, in an undertone. He must put up a hell of a fight. Look at the defensive wounds on his hands.

Well, we’ve done our job, said the other, frowning with displeasure, and shaking his head slowly from side to side. Nothing more we can do. Maybe the docs can save him.

The nurse took over and recorded the patient’s vital signs in long hand on the hospital chart: 11:59 PM, 10/31/96: pulse faint and rapid (185); blood pressure so low it can’t be read on the monitor with confidence (probably less than 40 systolic); respirations shallow with rhythmic waxing and waning and recurring episodes of apnea. She started an IV and hung a bottle of 5% normal saline, which was run in rapidly, drew 20 cc’s of blood for type and cross match, and elevated the patient’s legs above the level of the heart by means of raising the foot of the stretcher. Then she called for the surgeon and went hastily about her other duties. As they changed places, he looked down at the patient and then at the nurse and let out a long mournful wail. Oh God! Oh No! Not That! Not Dr. Kean!

Now it is a canon of modern medicine that the first piece of business in the management of patients with severe head injuries is to secure an open airway. In many cases, depending on the circumstances, this is done in the emergency room and consists of passing a long tube between the mouth and the trachea, a process known as intubation, for the purposes of aspirating blood and secretions, ventilating the lungs, and providing a route for the administration of anesthesia during surgical procedures. It has been said that no one is more proficient in such matters than an experienced trauma surgeon at Bellevue Hospital. But on this particular night, for reasons yet to be fully explained, the surgeon on duty, Dr. Charles Rodderman, was trembling like a frightened child awakened by an all-too-real grisly nightmare. Though he knew precisely what needed to be done and how to do it, his nervous state prohibited him from actually doing it, so he paged the general surgery resident-on-call and assisted the eager young trainee who passed the tube correctly, albeit after several attempts, and suctioned out the trachea and upper airway before hyperventilating the lungs manually and forcefully and repeatedly. Two units of whole blood were hung and compressed manually to speed the delivery.

Next, the patient was taken directly to the Radiology Department where a sleepy-eyed anesthesiologist was waiting. He administered oxygen through the endotracheal tube and injected the IV port with a muscle relaxant in order to minimize coughing and bucking during the imaging studies. Dr. Rodderman excused himself and went to the phone to take a call. When he was done, the anesthesiologist pulled him aside.

"What’s going on, Charlie? Something wrong? You’re pale as a ghost. Who the hell were you talking to?

The patient’s wife. She expects to be here in about 45 minutes to an hour. It’s takes that long to drive down from Bronxville at this time of night.

The patient’s wife? The ER chart says he’s a John Doe.

Not any longer, Julie. The patient’s been identified. His name is Dr. Oliver Kean and he’s a very important guy: a Professor of Biochemistry at the New York Hospital/Cornell Medical School. When I was a student there, he was a one of my favorite teachers. Isn’t that ironic? And guess what? I’m the one who identified him. Who could have imagined?

"Aw, Charlie, I’m so sorry. I’m really sorry. What a shock!

"You said it! He’s almost like a member of my family. Funny isn’t it, and now I’m worried about his family. He’s got two daughters and a son. The only thing I told Mrs. Kean was that her husband had an accident and was pretty banged up. That’s all I was comfortable saying over the phone. She doesn’t know yet that he’s probably a goner. Gessus, Julie, life sure is a kick in the head, isn’t it?"

No pun intended, right Charlie? By the way, what was he doing down here at Bellevue?

Mrs. Kean told me he went there after work, probably around 8 PM, to visit one of their Bronxville neighbors up on the fifth floor. The guy was scheduled for a kidney transplant in the morning and was so nervous he was thinking about checking out. That would have been a big mistake because he has terminal renal failure and was sure to die if he took himself off the list and had to wait around a year and a half for another matched kidney. Dr. Kean’s purpose in coming to the hospital was to reassure him that he’s in the best of hands and everything would turn out fine. It looks like the mugging took place about an hour later when Dr. Kean was getting into his car to go home.

Proves what I’ve been saying for years, Charlie: no good deed goes unpunished.

The doors of the radiology suite suddenly swung open again and an individual wearing a starched white doctor’s coat over light-green surgical scrubs strode calmly into the room. He was the neurosurgeon-on-call, Dr. Maury Hansom, and his timing couldn’t have been better.

Tall and slim, of Norwegian lineage, with fair complexion and pale blue eyes, his grey-blond hair thinning over the crown, his features refined, almost pretty, and his step lithe and lively, he could easily pass for a man of 45, though he was in his middle 60’s or thereabouts. Thirty years earlier, Dr. Hansom had been Chief of Bellevue Hospital’s Second Division of Neurosurgery (Cornell Service) and during his tenure he had been a mentor to hundreds of medical students and neurosurgical trainees who came to know him as a superb technician, eminently skillful, a prissy no-nonsense perfectionist who in his spare time occupied himself with the study of philosophy and the arts, but most of all, he was a surgeon with unsurpassed compassion and devotion to his patients.

Dr. Hansom to the rescue! cried Dr. Rodderman as he rushed over to greet him. You’re never a minute too soon or a minute too late. By the way, Maury, the X-ray and MRI images just came up on the screen. Let’s go over and see what we’ve got!

The radiologist-on-call joined the men as they entered a small, darkened room suitable for viewing radiographic and computer images, and he was immediately taken by the aura of the venerable brain surgeon about whom he had heard so much but never met.

Hello sir, he stuttered, I’m Ian Goldsmith, it’s an honor to meet you. I’m glad you’re here because there’s a lot going on. I’ve had a quick look at the studies but since I’m a general radiologist with no formal training in neuroradiology, I’d like to defer to your interpretations. Where do you want to start?

"Let’s begin with the X-rays of the cervical spine.

Anything there?"

Normal, sir.

Ah ha, aha, aha,….. Dr. Hansom repeated as he studied the images in sequence one by one. No fractures. No dislocations or deformities of the cervical spine. The only abnormalities I see are some degenerative changes of the 4-5 and 5-6 cervical discs which are consistent with the patient’s age. That’s good because it means we can move him safely without worrying about injuring the spinal cord. He won’t need a collar. How about the skull X-rays?

There’s a big fracture behind the left ear, sir.

Ah yes, hard to miss it. Hmm…. it’s a comminuted and depressed fracture of the left occipital bone which extends into the petrous bone and foramen magnum. It looks to be about eight centimeters in diameter and is compressing the left transverse sinus. Not good!

What do you think caused it?

Blunt force injury of some kind, but not the sort that comes from the head striking against a flat surface, say the asphalt surface of a parking lot. A baseball bat, a steel pipe, or the butt of a gun could do it. The rest of the skull appears relatively intact. Let’s have a look at the MRI.

There’s a lot going on, sir. The only thing I could be sure about was the huge blood clot in the left cerebellum. Right here on image 24, where I’m pointing.

"That’s not a clot in the cerebellum, Dr. Goldsmith, it’s a subdural hematoma. Let’s back up and review the images 18 through 23. All right, keep going, keep going…. good. Do you see what I’m getting at? The collection of blood is not in the cerebellum but in the space between the surface of the cerebellum and the overlying skull due to laceration of veins that drain the left tranverse sinus. The cerebellum seems to be relatively intact, but it’s been displaced from left to right by the mass effect of the hematoma. Can you see that?"

Yes.

Okay. Now let’s review the horizontal images starting with number one through ten…..Oh boy!

What is it, sir?

The brain is massively swollen! Look at the first seven images, Dr. Goldsmith. There’s complete obliteration of the cerebrospinal fluid spaces between the surface of the brain and the inner table of the skull. Hold on a minute…..Julie! Time to get moving! Hang a bottle of Mannitol and run in a 90 gram bolus over the next 45 minutes. I want the patient in reverse Trendelenburg position with the head elevated to 60 degrees. And let’s hyperventilate him. He’s obviously got raised intracranial pressure. We’ve got to bring it down or the brain is going to squeeze out of his head like toothpaste when I open the skull.

At least there’s no structural damage to the brain, Dr. Goldsmith observed, casually, as he pulled up images one through 17 in sequence. Just some swelling.

No, no, no. There’s more to it than that, Dr. Hansom, replied, losing patience now, and regretting his decision to educate the neophyte in the nuances of reading MRI images at a time like this.

"The frontal tips of the brain are severely contused. Go back and look at images 7 through 13. See what I mean? They show evidence of pinpoint hemorrhages in the left temporal lobe and the hippocampus - the area where memories are formed and stored. Perhaps most importantly, there is massive swelling of the brain caused by blunt force trauma at the back of the head which has driven the brain forward against the bony ridges at the base of the skull. This is a textbook example of a contrecoup injury."

"What’s that?

Aw, c’mon, Dr. Goldsmith, you should know the answer to that. Where did you go to medical school?

Guadalajara, Mexico, sir, I had to teach myself Spanish.

Oh….I see. Well then, a contrecoup injury is trauma that occurs opposite to the side impacted. It’s is not uncommon with head injuries because the skull is a rigid structure and the brain is soft and surrounded on all sides by a thin layer of cerebrospinal fluid. When the head is stuck forcefully, the brain keeps moving away from the point of impact whereas the skull comes to a stop either by a fixed object or inertia. In this case, the patient was struck from behind and the brain was driven forward against floor of the skull. The tips of the left temporal lobe and the hippocampus were the hardest hit and took a real beating from the knife-like edges of the bony ridges at the base of the skull.

What are the neurological

Enough, Dr. Goldsmith! No more questions. Right now we’re not thinking about neurological deficits, we’re trying to save a life. I gotta move on now. Nice to meet you.

Maury, Dr. Rodderman interrupted, with impatient excitement. Mrs. Elizabeth Kean has just arrived. They put her in the General Surgery conference room and she’s waiting to talk to a doctor. May I join you?

This small, stark, windowless conference room had been a haven for families of surgical patients since the turn of the century. It sat no more than six – another four standing - and among its vestiges of the past was a long walnut table with matching straight-back chairs, circa 1905, an outworn parquet floor with mismatched scatter rugs, and original flower-patterned wallpaper that had aged a sickly shade of yellow-green, as though saturated by the soulful exhalations of joy and sorrow. For here, good and bad news had been delivered daily for almost ninety years. Sitting at the table was a petite middle-aged woman. She looked up with anxious eyes as the surgeons came into the room.

Hello, Mrs. Kean, I’m Charles Rodderman, the doctor who called you about your husband’s accident. Sorry to have awakened you in the middle of the night. My colleague here, Dr. Maury Hansom, is one of the city’s most renowned neurosurgeons and we’re lucky to have him. He’ll tell you what’s going on.

"Neurosurgeon? Oh good heavens…..is my husband all right? Why does he need a neurosurgeon?"

I’ll answer that, Dr. Hansom replied in a calm and soothing tone of voice. He leaned forward across the table and took her trembling hands in his. I’m very sorry to meet you under these circumstances, Mrs. Kean. Please try to relax. The reason I’m here is because your husband has sustained an injury to his head with a loss of consciousness. That’s always a call-to-arms for a neurosurgeon. There’s nothing unusual about that. Now it’s quite clear he’s had a pretty bad concussion. Just how bad we don’t know. When he was admitted to the hospital a couple of hours ago he was unresponsive. Fortunately, we’ve been able to stabilize his condition….

Oh, thank goodness. Please forgive me for interrupting, doctor, but what was the cause of the accident?

This wasn’t an accident, Mrs. Kean.

"What’s that?….Why I’m certain I heard Dr.

Rodderman say my husband had an accident."

He didn’t want to upset you any more than necessary, ma’am. That’s hospital policy when we are giving bad news over the telephone. Let me try to set things straight. Based on what I’ve been told, your husband was beaten and robbed in the doctor’s parking lot as he was leaving Bellevue Hospital around 9 PM. It appears that at least two individuals were involved, and he put up a good fight.

Oh, the poor dear. May I see him?

No, I’m sorry, Mrs. Kean, that’s not possible. He’s already up in the Operating room.

In the Operating Room? I had no idea…..how bad is it, doctor?

It’s too soon to tell, ma’am. His brain is swollen. He has a depressed skull fracture behind the left ear and a collection of blood in the back of the head that is compressing his brain tissues. There is also some bruising of the frontal areas of the brain.

Ah God! she cried out, turning pale, and looking at him in terror. What kind of surgery are you going to perform?

"Well, the first thing I have to do is to remove the fractured bone behind the left ear and drain the blood clot which is displacing the hind part of the brain from left to right.

Then I’m going to remove normal bone from both sides of the head above and in front of the ears - a procedure commonly referred to as a subtemporal decompression - in order to give the brain more breathing room. Before proceeding, I’ll need you to sign two operative permits. The first is for the surgical steps I’ve just described. The second is for permission to perform a tracheostomy. This latter step is a relatively minor procedure that consists of a direct opening in the throat for placement of a fixed tube under local anesthesia and is performed routinely in unresponsive patients such as your husband. In most cases the tube can be removed in a few days or weeks, depending on the circumstances, with very few complications. It’s the best of all possible airways."

Ahhhh…..doctor.

Now Mrs. Kean, he continued in rote fashion, because the surgical steps I am going to perform involve a lot of positioning and repositioning, the operation will probably take me about four or five hours, perhaps a little more. In the meantime, I’d like to offer you the conveniences of the Surgery Department office on the second floor which has a nice new bathroom with an overhead shower, a small refrigerator and kitchenette, and a private on-call room with a bed. Dr. Rodderman has volunteered to stay with you and see to your needs. He made an awfully big fuss about that, Mrs. Kean. Your husband was one of his favorite teachers in medical school, you know. As soon as I’m done I’ll come down and find you.

When can I see him?

That depends. If things are stable, I’ll take you up to the ICU where you’ll be able to see him briefly.

Will Oliver make it, Dr. Hansom? she moaned softly, with tears coming to her eyes, and mumbled something else but the words were hesitant and inaudible.

I’ll do my best, ma’am. That’s all I can say.

"Aw God, why him? He’s such a good man, Dr.

Hansom. Please help him."

When one is young and healthy and full of life, you can’t be blamed for feeling immortal. It’s as though other people grow old and die…..not you. But it’s a grand illusion. Elizabeth Kean had always disliked hospitals. She disliked their appearance and the way they smelled of mercurochrome and ether. She disliked the way the wheel chairs and stretchers were always parked in the corridors. She disliked the self-important nurses who rushed around in crisp white uniforms with their noses in the air and never stopped to acknowledge anyone but the doctors and each other. She disliked hospitals the way really sick people disliked them. But now her own husband was really sick, and disliking hospitals was something she didn’t want to do.

As for the conveniences of the surgery office, she did not seek bed, nor was she able to do so. Her senses were stunned, electrified almost, and thoughts radiated through her brain in disordered haste, flashing and disappearing like unruly sparks off a blacksmith’s anvil. Sleeping might fuel the hell-fire. And dreaming could be worse.

In the surgery office there was a feeling of supreme privacy. Yet all around her voices crackled over the intercom, steps passed by the door, toilets flushed, stretchers rattled through the corridors, and somewhere a telephone was ringing. Suddenly she remembered: the children! Of course, in all the excitement she had forgotten about the children! Her cries of anguish roused Dr. Rodderman who was stretched out and half-way asleep on a couch. He opened his eyes long enough to find his cellphone and handed it to her, whereupon she called her sister-in-law, Constance Kean Nickelby, who lived in Tuckahoe, two towns south of Bronxville. It took five rings for the phone to pick up. The conversation was brief, and between fits of uncontrollable sobbing, Elizabeth Kean presented her understanding of the terrible events which required immediate surgery for her helpless and possibly dying husband, in a grave and mournful manner. When it came Connie’s turn, she expressed her shock and sympathy and said she’d go straight up to Bronxville and stay with the children until there was more information. Connie was good like that. But exactly how she’d explain things to the rest of the family she did not know.

In the darkened office of the Surgery Department transom-light fell on a shadowy figure perched precariously on the couch, one leg hanging limply over the edge, a cushion fallen on the floor. Despite his many fine qualities, Dr. Rodderman had one annoying habit: he snored. She settled into a cushioned easy chair, rested her head against one of the arms, and closed her eyes. There was nothing to do but wait. Still, waiting can be the hardest thing to do when you’re waiting for something good or bad to happen. Hope and fear competed for her attention, unaffected by the rhythmic rasps of heavy snoring.

Hours passed. A voice in her head asked what she had wished for when she said her prayers. "Another