- 6 - (W)hole In the Head Nathan Maquam “Daddy, do you think that people have souls?” I asked. We were folding clothes on his bed. The bed was so tall that I had to scramble up onto it to grab more clothes to fold. My father shrugged. “That depends on how you define the word ‘soul.’” he said. “Whatever the soul is, it’s made up of cells. Brain cells. Neurons and synapses.” “But you can’t prove that,” I said. “I can,” he said. “There was once a man who had a metal spike go all the way through his head. He survived, but his personality changed.” “How did it change?” “He was a good man before the accident, and a bad one after,” my father said. “After the accident, he made inappropriate comments to women and swore all the time. Before, he wasn’t like that at all.” “Did you know this man?” “No, he lived a long time ago.” “Did he ever recover?” “No,” my father said, folding the last shirt in the basket. “He was bad until the day he died.” * Phineas Gage was a twenty-five year old railroad foreman. He was well-liked by his peers until the accident happened. Lots of details about the accident are under scrutiny, but here is what we know: in 1848, Phineas was packing blasting powder into holes to prepare the roadbed. Distracted by his men, something caused an explosion with his head right in the line of fire. His tamping iron was shot upward through the left front of his skull and out the back - 7 - of his head. The tamping iron was greasy with blood and fatty brain matter. Here is where the details get fuzzy: some accounts say that Phineas passed out briefly and was carried to the wagon so he could be taken into town. Other accounts assert that he never lost consciousness and climbed up into the wagon of his own accord. He was definitely conscious when the men got him into town. While they waited for the doctor, he sat outside and chatted with passersby. When the first doctor arrived, Phineas greeted him by saying “Here’s enough business for you.” The doctor who would save his life, Dr. John Harlow, would not arrive until 6pm that day—an hour and a half after the accident. Dr. Harlow reached into his skull and pulled out fragments of bone, managing to slow the bleeding. Phineas remained composed and rational throughout this whole process. The next day, Phineas was socializing with visitors under Dr. Harlow’s watchful eye, convinced that he would be back to work in no time. His health began to plummet within the next few days, however, as his brain developed a fungal infection and he lapsed into a coma. A coffin was commissioned for him, but Phineas made a surprising physical recovery except for his left eye, which would stay sewn shut for the rest of his life. He returned home with his family. Here is where things get really fuzzy, and the mass speculation begins to cloud the few eyewitness details that we have. We know that Phineas’s personality underwent serious changes after the accident. Dr. Harlow wrote that he was “fitful, irreverent, indulging at times in the grossest profanity, which was not previously his custom.” He seemed incapable of long-term planning, or of handling and understanding money. Previous evaluations of him making a ‘full recovery’ only took into consideration his ability to walk and talk—family and friends insisted that he was “no longer Nathan Marquam - 8 - (W)hole In the Head Gage” to them. There are wild and contradictory tales of his demeanor. Some accounts feature him as lewd and inappropriate, propositioning any woman he laid eyes on. Other accounts paint him as being altogether disinterested in sex. Some people even speculated that when his left frontal lobe was destroyed, his soul was as well. People understood him to be a godless creature, a monster with “animalistic tendencies.” Save his closest family, people generally stayed away. * It’s evening, and my stepfather is putting his son to bed. My mother and I are in the living room. She’s working on her third glass of wine. “You remind me of your father sometimes,” she says. “That’s not a bad thing.” I shrug, noncommittal. “I loved your father,” she says. “I really did.” “I loved him too,” I say. “That wasn’t him in the end, you know,” she says. “Your father never would have said those things to you. So if you are like him, it’s not the end of the world.” “Ok,” I say. “He was a brilliant man,” she says. “And all he wanted was to be a father. He was always home by four-thirty to be with you, even if he had to be at work at five a.m. to pull it off.” “I remember,” I say. “I was there.” She drains her wine glass and pads sloppily across the kitchen for more. “I should go,” I say. I hug her goodbye, but my body does not feel it. On the drive home, I think that something is following me, is in the car with me. My dog sleeps peacefully in the backseat. I tell myself that if the dog feels nothing, then - 9 - Nathan Marquam there really is nothing. Everything is fine. What’s dead is dead. * The story of Phineas Gage is one that almost everyone knows, but many people don’t remember his name. They just know him as the man whose personality was changed by a railroad spike (even though it was a tamping iron). Though so many of the details of his case are unclear, people keep coming back to him. Why? Phineas’s case was the first one that showed a definitive connection between personality and the brain, proving what scientists had suspected all along. His case became the measuring stick against which all head injury cases are compared. Most people only know the basics of his story: much as my father told it, people believe that Phineas was a good person before the accident and a bad one after. However, this is a gross caricature of what he actually went through. Most likely, Phineas’s major shifts in personality—the profanity, the rudeness, etc—lasted only two to three years. Viewed in this light, Phineas’s story becomes one of a man damaged and recovered, not a man made into a monster by a freak accident. But people want to believe that morality works that simply—maybe because if a good man could be made bad by nothing more than a blow through his frontal lobe, then maybe a bad man could also be made good. In an effort to make sense of Phineas’s story, the sensationalist media of the time blurred the vision of those in the future trying to look back. Since Phineas’s death, scientists have recreated models of his skull and brain in a number of ways, trying to figure out definitively what part of him was destroyed. But I want to know who he was before the accident, and if any of that old spark came back. I want to know if Phineas knew when he was being mean, or if he was merely frustrated and could - 10 - (W)hole In the Head no longer control his emotions. I want to know if he cried at night—and if he did, who was there to hold him. If he truly got better, I want to know if he got back the parts of who he was, or if he became someone else entirely. What was it about Phineas that made him survive the unsurvivable? Did he want to keep on living, or was life merely a thing that he was cursed with? * My father wasn’t admitted into the hospital until 2013, but I knew that something was wrong starting about two years before that, when I was twelve. He got mad when I talked to my friends on the phone instead of talking to him. He made fun of my hobbies, told me that my poetry was nothing more than “words puked across the page.” Years before, when I had taken up balloon-twisting, my father had filled his car with all of my creations to show his coworkers. Before he left for work in the morning, at his request, I’d get up early to fill his car with deformed giraffes, monkeys on lopsided palm trees, and balloon dogs with disproportionately long bodies. But when I printed my first Plath-inspired piece for him to put in his cubicle, he didn’t even wait until I left the room to throw it away. When I try to draw a line between Dad and Not-Dad, it gets fuzzy. A week after he threw my poem away, he read the Bukowski book I left on the kitchen table so that we could talk about it. He left CD’s on my desk for me to try, always made sure that my computer stayed updated, and took me to Halloween stores. These are the things that I tell myself were definitely my father. But what to make of that Thanksgiving in 2012 when he, in front of everyone, declared that I was an unreasonable, impossible, and shallow child? His mother apologized to me and said, “That’s not who I raised him to be. That’s not him.” Who was it, then? * - 11 - Nathan Marquam I still don’t know if I believe in souls. Whenever I think of the dead, I can feel them watching me. My father always told me that it was in my head. The night my drama teacher died, I curled up next to my father in bed just as I’d done as a much younger child. Pressed tight against his arm, I laid there and listened to his steady breathing, trying to escape the growing chill I felt from the side of the room that faced my back. I fell asleep right before my father left for work. I remember him pulling the blanket across my legs and placing my stuffed animal back under my arm. I am twenty-one years old now. Still, as I pick through the various eyewitness accounts of Phineas before and after his accident, I feel that same, dull chill. Every article about Phineas uses one of two pictures—there are only two known photographs of him, and even those weren’t confirmed until around 2009. With most old pictures, I look at them and see nothing. These photos are different. There’s something of Phineas captured there, something proud and unkillable. He looks smart and ruggedly handsome even in his disfigurement. He holds his tamping iron like a knight holds his sword, staring slightly off- camera with his single, fixed eye. I look directly into his gaze, then shiver. It’s all in your head, I remember my father telling me. I shiver again, remembering my father. I try not to think about my father or Phineas Gage or anything else until my roommates are home, but I can’t stop. I’ll feel better when there are voices and light and real, live people there to remind me what’s real and what’s in the past. * In April of 2013, my father was admitted to the hospital for the first time. We thought he was having heart trouble because he was having a hard time climbing the stairs. It turned out that in addition to his diabetes, - 12 - (W)hole In the Head he had developed lupus. The doctors prescribed him new medications and better nutrition to rescue what little kidney function he had left. “You need micronutrients,” the doctors said. My mother bought him a juicer, which he only used twice. My mother and I kept finding pizza in the fridge, ice cream in the freezer. My father only got sicker. I’d come home from school and hear him in the bathroom vomiting, then see him eating a poptart just a few minutes later. At first, it was weird when he was away at the hospital. After a while, it was weird when he was home. I’d automatically reach for three plates instead of four when I set the table. The health complications seemed to stack on top of each other, the words overlapping: dialysis, kidney failure, labile. One minute, he’d say I was the best kid a father could ask for. The next, I was a coldhearted bitch just like my mother. He caught a staph infection from the dialysis, which went to his heart. The doctors opened him up and put in a graft that would last ten years at most. The day after the surgery, my father was covered in wires, twitching in the hospital bed as my mother pulled the blanket over his thin legs. Though he survived, the chill still followed me home that night. I begged the universe to let him stay, then cried uncontrollably when he came back from the hospital. The chill was gone when he left for assisted living for six weeks. He never came home again. I walked into the house one night and my mother’s face was so quiet and tired that she almost didn’t have to tell me. She pulled me into her arms, and I stared at his teacup still hanging on the wall. I wanted to throw it into the void at my back, the thing waiting for me to be alone. It’s all in your head, I told myself. I’m still in your head, it became, with his dry, labile laugh to accompany. Which voice actually belonged to my father? When I tell - 13 - Nathan Marquam people about him, what parts do I include? What parts do I leave out to make a better story? * There’s only one film adaptation of Phineas’s story that I can find: a fifteen-minute short film titled Gage, released in 2014. Overall, the film consists of hits and misses in equal measure. Phineas doesn’t deliver his iconic line to the first doctor (“Here’s enough business for you!”). He doesn’t remain calm and rational during the surgery, but rather screams in pain and fear. He leers at passing women, often with a beer bottle in his hand. In these moments, I wonder if the film is interested in who Phineas was or in the stories people tell about him. The film is bookended by Phineas making an appearance in a travelling circus. In many ways, it feels as though the film exists to make yet another spectacle of him. But there’s one moment in the film that for me, redeems almost anything. After months of trying to control Phineas’s erratic behavior, Dr. Harlow places a gun to Phineas’s head in a moment of desperation. Phineas grabs the gun and moves it right over the scar left by the tamping iron, daring him to pull the trigger. Dr. Harlow does not pull the trigger. It cuts to Phineas and Dr. Harlow standing outside, and Phineas explaining to Dr. Harlow how to hold the gun, how to shoot straight. When Phineas takes his turn, the gun does not fire. There is a brief, terrible moment of helplessness that he’s left with before he lumbers away, a beer bottle swinging in his hand. There’s no record of this scene actually happening, but it represents Phineas in a way that makes sense. He had all his old memories—he remembered all his friends and family, and even who he used to be. But whenever he tried to interact with them, the necessary parts of his brain just wouldn’t fire. - 14 - (W)hole In the Head * Phineas lived for twelve years after his accident. He is remembered mainly for his erratic behavior in the immediate few years that followed, not for the rest of those twelve years. For a good portion of those years, he was a stagecoach driver in Chile. Driving a stagecoach requires precise movements, patience, dexterity, and even handling money—certainly not a job for an individual who matches the descriptions of Phineas right after the accident. Yet he did this job successfully. Neuroscientists believe that he was able to hold this job due to a mixture of brain plasticity and the strict, regular routine of his stagecoach job. I’m sure this is probably the correct way to look at it, but I prefer to believe that Phineas survived due at least in part to his tenacity and will to live. Maybe, even in the darkest moments when Phineas allegedly swore at children or propositioned married women, there was some tiny bit of him left, buried so deep inside that even the tamping iron could not scrape it out. Maybe it just took time and patience to get it back. Maybe he survived thanks to the loving support of his family, who were there through every leg of his illness. This may have been a burden his family was happy to bear, but memories of my father make me think otherwise. I’m sure Phineas’s family hated him more than the newspapers ever could, that the juxtaposition of having him and not having him was slowly killing them. Maybe he started working again because he wanted to, or maybe it was because his family made him go back to work just to get him out of the house. How did he learn to manage money again? Did someone teach him, or did he teach himself ? Before the open heart surgery, my father liked to wander around grocery stores. He’d come home with strange, overpriced vegetables that we didn’t need, blowing large portions of our already-tight food budget. My mother - 15 - Nathan Marquam finally took his credit cards away, rationing out cash for him instead. He spent all of that money on strange food that he usually threw up anyway. Who taught Phineas to manage his money? Who taught him how to keep on living when all the newspapers said he had no soul, when the only people who wanted him for hire were travelling carnivals? Who taught him how to step forward onto that stage and offer those gawking faces his handsome, fixed stare, daring them to see him as anything less than complete? Who taught him how to survive? * A month after my father first went into the hospital, I knew he was going to die. Most people (including my mother) didn’t know until after the open-heart surgery, but I knew because he told me. It was the day after he had surgery for his diabetes-induced retinopathy. “It’s too late,” he said, turning to look at me with his one- eyed stare. “It’s not!” I said. “Look at that juicer Mom bought you. I’ll help you put it together.” “No,” he said. “It’s too late. I don’t want to be here in this stupid old man body that’s shaped like a pear, slowly shutting down. No one told me anything until it was too late. It’s too late.” Nothing I said could convince him otherwise. My father believed that humans are just clusters of cells that either live or die. There’s no in between, no before or after—just life powered by biological supercomputers in our skulls, and death when those cells die. I can find no mention of what Phineas believed, if he believed in anything other than himself. Maybe he didn’t need to. I want to believe that Phineas was a good person, that he apologized to the people he had wronged after the accident. I want to imagine him accompanying the town’s - 16 - (W)hole In the Head children to church on Sundays and making small talk with the passengers aboard his coach, learning slowly how to rebuild. I want to know who he was, who he loved, why he decided to keep on living. I want to give Phineas all of the grace and understanding I still cannot give my father. Is there such a thing as a soul? Is there something essentially human about us that transcends the fatty supercomputer of our brains? Scientists look at what happened to Phineas as proof that we are our brains, but the real story of Phineas teaches the exact opposite: Phineas was his tenacity and his kindness. His social reintegration teaches us that the brain will heal itself, forge new connections— that it is possible to survive the unsurvivable. Had my father thought of it like that, maybe things would have been different for him, or maybe they wouldn’t have. All I really know is that it’s my choice how the story gets told. It changes a little every time—the details are fuzzy around the edges— but I tell his story just the same.