“So, it’s not just us,” said Nicole, glancing at Sue.
“To think that he exaggerated?”
“Right. Sue and I talked about the paper before you got here. We were stumped but thought maybe you could explain.”
I extended two empty hands out in front of me. “Nope. You can only hold so much in your head at a time, as far as I know. And the improvement he claimed? Anyone would get better after 153 hours spent developing a strategy.” I turned to Sue. “You said there were two documents on background. What’s the other?”
Sue let out a long breath. “It’s a research review from his original proposal to the VA, the one from 19 months ago. I’d guess you’d call it ‘deep background’ for our project, since it has nothing to do with memory span…or any type of learning or training for that matter.” She shrugged, as if saying ‘that’s all there is.’
“If it’s not about memory or learning, what’s it about?” I asked, frowning.
“Phantom limb pain.”
What the hell?
Thursday, August 6, 9:46 AM
The Experimenter opened the door to ‘the residence,’ flipping on a switch as he did. Two transparent cages appeared in a pool of light in the center of an otherwise dark room.
The enclosures were constructed of sheets of laminated glass and Lexan, a combination commonly known as bulletproof glass. The first cage was small at three feet on a side, eight feet tall, and enclosed at the top. It was bolted to a tiled floor that sloped to a drain in the center. A large shower head was installed in the ceiling.
An attached, second cage was larger, at 10 by 10 by 8 feet. A heavy-duty, stainless steel toilet was installed in one corner. The only other adornment was the commercial tumbling mats bolted to the floor. Two sliding doors provided access to the cages from outside, while a third permitted movement between them. All three doors were closed and secured by a one-inch steel pin that could only be reached from outside the enclosures.
Movement caught the Experimenter’s eye. Subject Number 2 was stirring. He sat up on the floor of the larger pen, rubbing the sleep from his eyes. “No,” he moaned, when his gaze fell on the Experimenter. “You gotta let me outta here.”
“I think not. We have much left to explore.”
It wasn’t that the Experimenter believed he could convince the man they were sharing some great, scientific adventure; he had abandoned any hope of that with his first subject. But the soft, calming words came naturally, much like the master might say to his dog before putting him to sleep. Death would come to Subject 2, but hopefully, it was still weeks away.
“Please. I won’t tell nobody,” the man pleaded, his voice cracking, his chin quivering. “I’ll get outta town. Never be back.”
“Sorry, I haven’t been around more,” the Experimenter said, ignoring the man’s hollow promise. “I’ve been busy. But the good news is, I have most of the morning open. Shall we make the most of it?”
Subject 2 began scooting backwards, forcing himself into the corner farthest from the Experimenter. “I got money. You can have it, if you let me out.”
The Experimenter had been walking toward a small storage cabinet in the corner of the residence but drew up short. “Really. You have money?” He chuckled at the preposterous claim.
The man blinked several times, his lips trembling. “Not me. My cousin. Please, you gotta call him.”
“I see.” The Experimenter continued to the cabinet where he removed a Taser from one of the top drawers.
“No,” the man moaned. “You’re gonna kill me with that thing.” He began sobbing.
For once, the Experimenter agreed. The Taser wasn’t optimal. He risked stopping the man’s heart or injuring him in a fall. The tumbling mats helped with the latter problem, and he knew where to shoot someone to minimize the former. But there was still the possibility of losing his Guinea pig, and he loathed that thought.
So, he had started to research drugs. He needed something that incapacitated quickly and dissipated just as fast. As distasteful as he found it, date rape appeared to be the demand that was driving the generous supply he had found. But until he discovered just the right concoction, the Taser would do.
He moved the reinforced wheelchair near the closed door of the larger cage. On its seat were restraints for the hands and feet. Then, he positioned himself at a slot cut into the walls near the corner with the toilet. Knowing the subject would flee to the opposite side, the Experimenter would have a clear shot. It was close to the maximum range for his weapon but missing once or twice would only try his patience. It wouldn’t change the outcome.
“Wait,” the man pleaded between sobs.
In the dim light, the Experimenter could see the sheen of sweat on the man’s face as he hugged himself and rocked slowly in the corner. He squeezed the trigger, the barbs of his shot finding their mark on the upper thigh. Perfect.
He pushed the gun through the slot in the glass wall. It fell to the floor, as it completed the 5-second burst of electricity that would temporarily paralyze Subject 2. The Experimenter opened the door to the cage and pushed the wheelchair inside. Retrieving the Taser in case the man required another volley, he moved to the subject and quickly attached the restraints. He rolled the man to his side, then laid the chair behind him and attached the arm and leg straps to its structure. Finally, he pulled the man’s head against the high back of the wheelchair, securing it with bands around the throat and forehead.
The Experimenter had found that the limp, ‘dead’ weight of a tased man was difficult to lift. But with the man lashed to a rigid frame, the chair was soon righted. He pushed his prize into the adjoining experimental chamber.
A long, adjustable arm, much like those used for examination lights in doctors’ and dentists’ offices, extended into the room from the far wall. A thick wire cable exited the end of the arm and was attached to a cloth cap covered with an array of metal disks. The Experimenter placed the wheelchair directly below the cap.
“Why are you doing this?” the man moaned when he had recovered his senses. “I haven’t done nuthin’ to you.”
The Experimenter ignored him, pulling the arm down and extending the cable until the cap rested on the man’s head. After checking the cap’s alignment, he secured it with a chinstrap. In moments, the electrodes were attached to the man’s leg, the pan filled with water, and the panel with the lights and buttons positioned within easy reach of the man’s right hand. The Experimenter stood to his full height and stretched, pleased that the preparations for the session were complete.
Perhaps realizing the futility, Subject 2 had stopped pleading and sat trembling in the chair, a breath occasionally catching in his throat and coming out as a sob.
The Experimenter started for the sound-proof door when a tone from his phone stopped him short. He had a text. He scowled as he read the words. Although he knew this flurry of demands was typical, it was trying. He turned to Subject 2. “Sorry. I’ll set the computer for a couple of hours of practice, but that’s all for today. I’ll be back late, after I’ve dealt with other matters.”
The thought of two hours of shocks delivered mechanically with no hope of reprieve, no possibility of sympathy was too cruel, and Subject 2 broke down and began to sob uncontrollably.
But then, the Experimenter knew, it would have been worse for his subject if he could have stayed.
Thursday, August 6, 10:17 AM
After recovering from my surprise at the words ‘phantom limb pain,’ I suggested we take a short break. Earlier, I had thought this point in the meeting might be a good time to talk to Nicole, maybe see if she had plans for the weekend. But under the circumstances, any ideas about socializing were swept aside by confusion.
As a company, we studied the effect of technology on learning. My coursework in school had been broader, but I’d never studied phantom limb pain. Sure, I knew what it was. Pain that seemed to come from a limb that had been lost from surgery or an accident. But what did that have to
do with my field?
While pondering that question – and finding no answer – I had gotten a cup of coffee. I returned to the conference room, cup in hand, to find Sue and Nicole already there.
“Yeah, this isn’t going the way I thought it would either,” said Sue. “But I didn’t think you’d be drinking already.”
“Nine-thirty’s too early?” I asked, trying to sound surprised. “So, are you ready to talk about phantom limb pain?”
“Unless the company’s going to send me back to school, as ready as I’ll ever be. I spent two and a half of the three days trying to crack the code on this part, and I can tell you what I have. Nicole, this may be more down your alley than ours, so please jump in whenever you want.”
“Sure,” she replied. She turned to me. “I have to admit, I don’t know a lot about this specific topic. I can ask around at work, if you want?”
I nodded, appreciating her candor and her offer. “Thanks. We’ll see if it comes to that, but like Sue said, this is deep background and may not be that important.” We turned back to Sue.
For the first ten minutes or so, the background charts held what you’d expect – a definition, a few examples, some statistics. Admittedly, the problem was more common than I realized, with up to 80% of all patients experiencing sensations from the missing limb and nearly all of these involving some degree of pain. And while a wide range of treatments had been attempted, from pain-killers to acupuncture to surgically removing the damaged tissue, nothing seemed to work. At least, not for long, which brought us to Worthington’s approach.
“Some researchers, Dr. Worthington included, believe that current treatments don’t work because they don’t consider the underlying problem,” Sue said. “And that problem comes from changes in the nervous system, particularly in the brain, after a limb is lost. Those changes are called brain plasticity or neuroplasticity.”
Sue paused a moment, looking first at me, then Nicole. “I supposed defining plasticity wouldn’t be necessary in a proposal that’s going to experts at the VA.” She released a single laugh. “It’s probably not even necessary for you two either, but me? I had to do a little digging to get comfortable with the concept. Want to hear what I found?”
“I would,” I said. “I have some background from school, but maybe not enough. And it’s always good if we start on the same page.”
Sue nodded. “Quite a bit of the research I read dealt with recovering functions, like speech, after some sort of trauma to the brain. And the analogy that really helped me was to think about the circuits in the brain like roads. You have a way you drive to work each day. But one day, a bridge along your route is destroyed.”
“So, in the analogy, the destroyed bridge is the part of the brain that’s injured?” I asked.
“Exactly,” Sue replied. “So, at first, you can’t get to work. The bridge is gone and your path is blocked. But you start wandering other roads – maybe ones you use to get to a restaurant or the movies. Pretty soon you find a way to get to your job. It’s slow and inefficient, but it gets you there. You keep using it and it gets faster. You find new shortcuts. After a while, your new route is nearly as good as the old one. Brain plasticity is the equivalent of finding and claiming these other roads for a new purpose.”
“I can see why you like it,” I said, leaning back in my chair and thinking that Sue’s talk wasn’t as bad as she had implied. We were making progress on understanding Worthington’s field. But this moment of satisfaction took longer to form in my head than it lasted.
“Ah, hold on a second,” I said slowly. “So, plasticity works. I get to the office on time with my new route. Where’s the problem? Where’s the phantom limb pain in all this?”
“Worthington’s proposal covers that,” said Sue. She paged through a couple of slides until she found what she wanted – a chart called Negative Plasticity. Its text was so dense and the font so small that when it appeared on the screen, I could swear the room got darker. “I’ll give you two a minute to look this over.”
The slide started off easily enough with an example of a man who lost his ring finger. The cortical area used to sense and control it was reallocated to the little finger and the middle finger of the same hand. The brain area had function A, controlling the ring finger, but after injury, got function B, controlling two of the remaining fingers. And importantly, he experienced no phantom limb pain.
Unfortunately, that case was only the first line on the chart, and the rest of the dense text was research on negative adaptations. First was the example of an amputated arm, but the brain areas serving the arm weren’t repurposed. They remained allocated to a limb that wasn’t there, producing sensations ranging from minor itches to searing, burning sensations. The next study was similar, except there was evidence that the cortical mass serving the missing limb had become enlarged. The chart didn’t say this, but it was as if the area was searching for a purpose and grew to increase its sensitivity, when all it did was increase the pain.
There were a series of studies about where the pain originated. One researcher placed the blame on the brain itself. Another emphasized the random signals coming from the damaged area that the brain interpreted as pain. A third blamed the conflict between the neural signals and visual data. Or between those signals and memories of the limb.
The chart was like a crowd of people, all pointing their fingers in different directions. Here’s the problem. No, it’s here. It was academic back-and-forth; it was scientific give-and-take. I glanced at Nicole. She was staring sightlessly at the tabletop, her elbow placed there, her head resting in her hand. I suspected she was trying to find order, a conclusion in the tangled story these studies told.
“I give,” I said finally, looking at Sue. “What the heck is this research supposed to tell us?”
There was a smile tugging at the corners of Sue’s mouth. “It’s supposed to tell you what I did for three days getting ready for this meeting,” she said. “Also, it’s supposed to tell you this.” She advanced to the next chart, called ‘Bottom Line,’ which included only three phrases:
Our understanding of the role of plasticity in phantom limb pain is incomplete;
But plasticity produces it; and
Plasticity can fix it.
“How ingenious.” It was Nicole’s voice. Her hands opened in front of her, as a smile captured her eyes. “He suppresses normal brain activity to give the maladapted area something to do…something besides feel pain, that is.”
My eyes went back to the chart, then to Sue’s face. Sue was nodding, telling me that Nicole was right, but I was missing a step in the reasoning. “Why would he want to block normal brain activity? Why not block the maladapted area and stop the pain?”
“That would work for a while,” said Sue. “Sort of like a pain killer, it would deaden the sensation while the device was on. But once it’s turned off, the pain would return, and it might even come back worse.”
The pieces finally fit, my hand slapping my forehead as if I wanted to trap this elusive thought before it escaped. “Right. If the device blocks the area of the brain controlling a healthy limb, that creates a void. There is a limb that can feel and move, but has no area serving it. Plasticity steps in to rewire the circuits that had previously controlled the missing limb to fill that gap. Now, the area that was maladapted has a new, needed function and the pain disappears.”
“Voila,” said Sue. “The pain is gone…at least in theory. That brings me to the end of my charts, leaving this final question – what’s the relationship between this phantom limb pain research and increasing memory span? What we received from Worthington’s proposal is exactly three sentences.” She read them.
“By using the Neural Activity Blocker to arrest normal processing of the stimulus materials, additional areas of the cortex will be recruited for the task. After practice, the subject will be able to draw upon those facilities normally associated with the memory span task, as well as those areas plastically adapte
d to it during brain activity suppression. The effect of the process will be an increase in the cortical capacity that’s applied to encoding, storing, and retrieving the stimuli, resulting in a measured increase in memory span performance.”
I shook my head as Sue finished. Again, Worthington was claiming that he had physically expanded the areas of the brain devoted to the memory span task. That assertion still appeared brash to me, but not quite as implausible as it had seemed an hour ago. That was both an exciting and a disquieting notion.
“Do we know the areas of the brain he’d have to block to affect someone’s memory for numbers?” asked Nicole.
“I don’t. Doc, you have any ideas?”
I grimaced, considering the complexity of the answer to this seemingly simple question. “Not really, although I’m pretty sure those areas might change. If someone tried to remember the list by picturing the numbers, part of the visual cortex would be involved. If the person tried to think about their sound, a different area would become active.” I paused, rubbing my forehead a moment. “It seems almost impossible to determine in advance all of the areas that might be involved and suppress them. And these three sentences are all we have?”
“Unfortunately, yes,” replied Sue. “For anything else, we’ll need to ask. Toward that end, I’ve scheduled a meeting with Worthington for next Monday, and I’ve been told that a colleague, Dr. Sebastian Atwood, will be joining him.” Sue looked at each of us in turn. “That’s it for me. Now you know what I know…although, Doc, you need to go back and study that chart on negative plasticity some more. You finished it awfully fast.”
“Yeah, I’ll be sure and do that tonight,” I said, smirking. “It’ll be something to put me to sleep, if nothing else.”
Of Half a Mind Page 3
