Tuesday, November 15, 1949
Dr. Clarence Fuller, a forty-four-year-old psychiatrist, emerged from his Gramercy Park brownstone at exactly eight o’clock and eyed the shiny new Checker taxicab waiting for him at the curb. It was a weekday-morning ritual he’d arranged with a local cab company to convey him to work at the Bellevue Psychopathic Hospital. Although the trip was only two and a half blocks east and ten blocks north, he preferred to ride rather than walk, especially now that it was mid-November and decidedly chilly. Clarence, an avowed automobile enthusiast who prided himself on his 1947 Cadillac Series 62 convertible, knew he was looking at a brand-new 1949 Checker A2. As he opened the rear-hinged back door and climbed into the spacious interior, he greeted the uniformed driver and complimented him on the car.
“Yup,” the driver responded as he put the cab in gear and pulled away from the curb, heading east on 20th Street. “Just got this beauty yesterday, and it drives like a dream.”
Eyeing the two collapsed jump seats on the floor in front of him, Clarence extolled the roominess and cleanliness of the car, which the driver also acknowledged. Clarence then sat back and relaxed. Although he wasn’t a particularly superstitious individual, he couldn’t help but take the brand-new taxi as a positive sign for the outcome of the day. Although the mere fact of having landed a position as a psychiatric attending at the famed Bellevue Hospital was a definite feather in his professional cap, he was one of many jockeying to be the heir to Dr. Menas S. Gregory, who had run the Psychiatric Division as a fiefdom for almost thirty years. Of course, Clarence knew he had a significant leg up on the competition, since he was a fourth-generation Bellevue physician. His father, Dr. Benjamin Fuller; his grandfather Dr. Otto Fuller; and his great-grandfather Dr. Homer Fuller had all been celebrated Bellevue surgeons extending back over two centuries. Although Clarence had briefly contemplated becoming a surgeon to follow in his forebearers’ footsteps, he’d decided that the mysteries of the human brain and the exciting progress being made in the field of psychiatry were much more intellectually stimulating and too much of a temptation to pass up.
In his quest to be named chief of Bellevue’s Psychiatric Division, Clarence currently saw his main in-house competitor to be Dr. Lauretta Bender, who had built up the division of child psychiatry to unforeseen heights and who was now polishing her credentials with the groundbreaking use of extensive electroconvulsive therapy, even employing it on children as young as four.
At first Clarence had lamented that he couldn’t see a clear way to challenge Dr. Bender, but then he’d gotten wind of something that was even more promising. The procedure was called lobotomy and had been developed by Portuguese neurologist Dr. António Moniz, now tipped to win the Nobel Prize for Physiology or Medicine. Clarence, like Dr. Moniz and an American named Dr. Walter Freeman—who’d significantly simplified lobotomy by changing it from a process that required a full operating room with anesthesia into a bedside procedure—saw lobotomy as an efficacious way of emptying the packed “disturbed wards” of the country’s insane asylums, including Bellevue’s. At last, a rapid twenty-to-thirty-minute procedure could change most, if not all, of the institutionalized patients from shrieking and screaming lunatics who often required straitjackets into docile, childlike individuals who could be discharged home instead of being kept like caged animals.
Immediately appreciating the lobotomy’s promise, Clarence had jumped on it, actively bringing the procedure to Bellevue and championing its use in an expanding variety of patients. As the numbers mounted, so did his belief that the procedure would provide a tremendous boost to his professional prestige, especially after today. At 9:00 a.m. sharp, he’d scheduled a bedside lobotomy on an eight-year-old named Charlene Wagner, a girl whose prominent parents had given up on her after years of effort and struggle with her ongoing and significant behavioral problems.
Although Dr. Bender had considered using electroconvulsive therapy on Charlene, her schedule was currently so backed up that Clarence was able to intervene by talking directly to the parents. He had immediately appreciated the girl’s potential to benefit his career aspirations, since she was an otherwise healthy and photogenic child despite her outrageous conduct. Accordingly, he’d invited the press, alerted both the medical and surgical chief residents so that interns and residents could be encouraged to come and observe, and called the head of the nursing school, who promised to send a large contingent of first-year nursing students. As far as Clarence was concerned, Charlene’s lobotomy was to be a newsworthy command performance that might very well tip the scales to put him solidly out front as the next Bellevue Psychiatric Division director.
Since the taxi driver had driven Clarence to work on multiple previous occasions, he knew exactly where the doctor wanted to be dropped off. The man pulled to a stop directly in front of the massive wrought iron gate on the corner of First Avenue and 30th Street. After Clarence thanked the driver and alighted from the cab, he paused as he always did when the weather permitted to gaze up at the massive, eight-story Bellevue Psychopathic Hospital. It was, in his estimation, the most impressive and physically imposing psychiatric institute in the world, as well as being probably the most famous.
Although its construction had started in the Roaring Twenties, the building wasn’t completed until 1933, sixteen years previously, at the height of the Depression. Regardless of the difficult economic times, it had been constructed of expensive red brick and gray granite in a grand Italian Renaissance style with no dearth of architectural embellishments, including porticoes, niches with terra-cotta and concrete vases, pediments, and decorative cornices. Overall, despite its elaborate details, it fit very well with the main Bellevue Hospital building that had opened at the turn of the twentieth century, designed by the renowned architectural firm McKim, Mead & White. The main hospital, too, had been built of red brick and gray granite but with substantially fewer architectural flourishes.
From where Clarence was standing, he could not see his office window, as it was in the central, ten-story portion of the structure and faced south, looking out over the rest of the Bellevue Hospital buildings. Once he’d given the building the respect it deserved, Clarence pushed open the wrought iron gate and hurriedly headed for the First Avenue entranceway. Most people used either the grander 30th Street entrance or the more convenient 29th Street one, which faced the Bellevue Hospital complex. Both led to a common reception desk. Clarence preferred the lesser-used First Avenue entrance as a sign of respect, as if the building was somehow sentient, a thought that always made him smile.
As excited as he was, he didn’t waste time waiting for an elevator to get up to his third-floor office but rather used the ornate Leonardo da Vinci–inspired central stairway. After a cursory hello to his scheduling secretary, Grace Carter, who handed him his day’s itinerary and told him all was ready for Charlene’s procedure, he disappeared into his inner sanctum. Clarence changed his suit jacket for a long white doctor’s coat, better for the pictures he assumed and hoped the press would be taking, and went to his desk. Although few of the other psychiatrists on staff ever wore white coats, Clarence often did. In his opinion, the coat was more professorial and in keeping with his position as a medical academic.
From the desk’s central drawer, he carefully lifted out a fancy wooden box and opened the lid. Nestled in cloth-lined depressions were two custom-made orbitoclasts, which he was going to use for the upcoming lobotomy, one for each eye. The instruments had been designed for Clarence according to the specifications dictated by Dr. Walter Freeman, who had devised the transorbital lobotomy bedside technique that Clarence now exclusively used. The stainless-steel instruments looked surprisingly like traditional ice picks, each with a ten-inch-long pointed stiletto blade. The difference was that they had rounded stainless-steel expanses on the bases of their handles, which enabled them to be struck with a mallet to drive them through the thin, bony roof of a human eye socket. Also nestled in the box in its own cloth-lined depression was a machine-tooled, stainless-steel mallet.
Satisfied that all was in order, Clarence stood up and slipped the box into one of his white coat’s deep side pockets. After a quick check in the mirror behind his coat closet door to make sure his hair was in place, he headed out of his office. Again using the stairs, he ascended to the fifth floor, where he’d had Charlene Wagner moved from the locked ward for disturbed children into a private and particularly photogenic room. As he walked along the two-toned yellow-tan central corridor, passing beneath the squares of purely decorative faux ribbed vaulting that lined most of the building’s hallways, he felt his excitement ratchet upward.
Entering the room, Clarence could not have been more pleased. It was crowded with nursing students in their starched, white-smocked outfits, a handful of interns and residents, and, more important, a number of reporters, some even holding large press cameras. A few flashbulbs went off, causing him to blush and wave.
Just as he expected, Charlene Wagner looked angelic in an off-white dress. Following his orders, she’d been tranquilized with Luminal that morning and was currently asleep in her bed with her blond hair splayed out to frame her cherubic features. She was tall for her age, appearing nearly prepubescent. Three impressively sized psychiatric attendants were grouped around the head of the bed, which had been pulled away from the wall. Behind them were two windows that offered a narrow view of the East River.
After handing off his box of instruments to a nurse who would see to their sterilization, Clarence cleared his throat and gave a short and concise history of the patient and an explanation for why the procedure would be beneficial to everyone, including the troubled girl. He wanted to make the affair as short as possible to emphasize the utility of lobotomy to help empty the disturbed wards of the country’s mental institutions. He asked if there were any questions, but no one raised their hand.
Without more ado, Clarence took the hypodermic syringe filled with lidocaine from one of the attending nurses. While some devotees of the transorbital lobotomy used electric convulsion to render the patient unconscious, Clarence’s opinion was that it wasn’t necessary. He was convinced that local anesthesia was more than adequate since the interior of the human brain was devoid of sensory fibers. After a nod to the male attendants, one grasping Charlene’s head to steady it and the other two holding her arms and torso, Clarence leaned forward and retracted the girl’s right upper eyelid. A hefty psychiatric nurse grasped the girl’s ankles.
Charlene let out a howl and a string of expletives and struggled against the restraining hands, but to no avail. With considerable adeptness, Clarence rapidly infiltrated both medial upper eyelids and then walked the needle point along the roof of both eye sockets to anesthetize those areas. The process took literally seconds. Satisfied, he handed off the syringe, waited a few beats for the lidocaine to take effect, then took up one of the orbitoclasts.
While the psychiatric attendant struggled to keep the screaming child’s head motionless, Clarence raised the lid of her right eye and then pushed the point of the orbitoclast at a forty-five-degree angle into the conjunctival recess until it hit up against the boney vault of the eye socket. He then took the mallet from the assisting nurse and, with a few decisive taps, penetrated the bone, pushing the orbitoclast into the girl’s brain.
Now out of breath, Charlene fell silent as Clarence advanced the orbitoclast to the five-centimeter mark. Once it was at that position, he merely pushed the handle of the instrument several inches medially and then several inches laterally, causing the instrument’s flattened tip to sweep through brain tissue and effectively sever the nerve pathways between the forebrain and the midbrain.
Several flashbulbs went off, but no one said a word. Ignoring the observers, Clarence advanced the orbitoclast to the seven-centimeter mark and repeated the lateral sweeping motion before pulling the instrument out.
“The right eye is already completed,” Clarence said as he handed off the first orbitoclast to the assisting nurse and took the second. “All we need to do is repeat the procedure on the left, and we are done. What should be plainly obvious is that this is a simple, straightforward, and remarkably effective procedure. Are there any questions before we continue?”
Clarence glanced around the room. No one spoke. He could see that the nursing students in particular were agog. Returning his attention to Charlene, Clarence once more began the procedure, again using the mallet and several taps to penetrate the boney roof of the left orbit. After sweeping the orbitoclast medially and laterally at five centimeters, he then advanced the instrument to the seven-centimeter mark, sweeping it medially. But when he swept it laterally, disaster struck. To his horror, a sudden pulsating jet of blood arced up alongside the orbitoclast, forming a miniature geyser and spattering a line of bright crimson dots down the front of his otherwise spotless white coat.
Shocked at this unforeseen event, Clarence reeled back as the throbbing geyser continued spraying blood, causing other people in its path to leap away from the bed. Instantly, he knew what had happened. Given the strength of the pulsating jet of blood, the orbitoclast had undoubtedly severed the anterior cerebral artery, the main blood supply to the forebrain.
Clarence was paralyzed by sheer panic and had no idea what to do as he stood there frozen in place, staring at the offending instrument still sticking out of Charlene’s left eye. As the pulsating jet of blood began to lessen, he briefly considered trying to get the girl over to surgery in the main hospital. Yet his intuition nixed the idea, telling him it would be futile, since she had essentially had a massive hemorrhagic stroke. But in the middle of his confused panic, one thing that seemed clear was that this obstreperous, behaviorally outrageous, and contrary girl had managed to remain in character. Instead of helping his career, she’d probably managed to sabotage it and thereby ruin his chances of using lobotomy to become Bellevue’s psychiatric chief.