I have to assume, as my grandparents surely did, that Kidner had only the best of intentions in offering to remove Annie’s leg. But I don’t want to assume. I want to know.
“Go back to 1936,” I say to Frassica. “Put yourself in Dr. Kidner’s place, if you can. Why does he want to amputate, and what does he tell my aunt and her family?”
To begin to answer my question, Frassica takes me into conference room 5152, the department’s gathering place for major discussions. For the moment, I’ve become one of Frassica’s students, although without any of the prerequisite courses I would need to qualify for medical school. He grasps the left leg of a skeletal model that dangles, front and center, in the conference room and he manipulates it to give me a visual understanding of Annie’s struggles with her right leg.
“As you know, something went wrong, possibly during pregnancy or birth, possibly inherited, that caused the deformity,” Frassica says. The available facts don’t lead to a definite conclusion, but Annie’s low birth weight—and Mona Evans’s statement that the delivery was normal—suggest some sort of genetic condition or some sort of trauma during pregnancy that resulted in damage to the central nervous system and a malformation of her leg and hip (Kidner did a “minor” operation to straighten Annie’s hip at the same time as the amputation, according to the Routine History).
“If the problem is neurological, like cerebral palsy, and there’s spasticity, then it won’t matter how much you attempt to straighten the leg,” Frassica says. Annie’s doctors did try to straighten it, and kept trying, which probably means they weren’t sure of the cause or didn’t think it was cerebral palsy. Nothing worked, though, as the Routine History made clear: She was in casts and braces all the time, but the leg didn’t improve much, and failed to develop.
“If the leg can’t function, the muscles don’t develop, and that leads to contracture. The leg can’t extend and can’t bear any weight,” Frassica says, pushing up the skeleton’s leg so that the model is now balancing—teetering—solely on the other one. Like car engines, legs and knee joints have fewer problems when they’re put to work; an unused leg not only contracts, it’s far more vulnerable to skin problems and sores. Annie’s condition also wasn’t static—as she grew to adult size, her limb became heavier to lug around and a greater drag on her ability to walk, as well as requiring a larger brace.
Kidner had started his career at Detroit’s Children’s Hospital, where he continued to hold a position while working at Harper, so he might well have known of Annie, or known of her case, earlier than 1936. Tillie first brought Annie to Children’s in 1921, when Kidner was on staff, and Children’s was the place where Annie acquired the cast and brace that, ultimately, failed to work. Kidner would offer amputation only as a last resort, Frassica says, but in Kidner’s mind, hadn’t Annie more or less reached that point? The Routine History: Until she was 17 years of age, patient walked with crutches, and at that time she was able to walk a little with a brace.
For a seventeen-year-old, walking a little wouldn’t get her very far; it certainly wouldn’t get her to that sense of independence that she craved. To use an expression Kidner had never heard, the surgeon probably saw the amputation as a win-win: Replace Annie’s useless limb with a prosthetic one, removing the dead weight that made walking impossible and giving her a chance at a stable gait that, if not entirely normal, at least did not require crutches or braces or handrails.
Even the most resourceful patients, with supportive and wealthy families that can afford the best care and the highest-quality artificial limbs, have difficulty making the transition to a prosthetic leg, which must be maintained daily to perform properly. Annie was hardly the ideal candidate for the task ahead, a factor that Kidner would have taken into account, Frassica tells me. Of course, the ideal candidates—physically fit, mentally acute, psychologically prepared—rarely have to face an amputation. “You would never cut off a limb without a lot of thought,” Frassica says on the walk back to his office, “especially since Annie’s problems extended to her hip, requiring an amputation above the knee. That sort of prosthetic requires more energy to walk than a person with two whole legs, because of the difficulty of movement without a fully functioning knee joint. Of course, in those days, prosthetics weren’t as lightweight as they are now, so it would be even harder.”
Even a win-win has its downsides. Annie’s life was about to change, and there was no way to prepare her for the unrelenting challenge and exhaustion of life lived with an artificial limb.
Walk a mile in Annie’s shoes? No thanks.
Kevin Carroll at Hanger Prosthetics, one of the country’s leading makers of artificial limbs, helps me create a picture of Annie and her new leg, the one that the city’s welfare department paid for, the one that the Routine History says “never fitted her very well, although it was repaired and changed several times, with the result that patient did not walk well.”
Let’s start at the beginning: Annie would wake up from the operation, Carroll says, with something approaching grief for her missing limb. There’s no good time to lose a leg, but at seventeen, Annie was already too old. “She would have bonded with her leg,” Carroll tells me. “If she’s like others I’ve met, she would have seen it as part of her, and losing it would have been a terrible psychological blow.” Young children, in Carroll’s experience, have the best shot at adjusting to an amputation.
Her artificial leg, standing alone, would have been a work of art, or at least of craftsmanship. Made of wood, covered with rawhide, coated with a lacquer, and finished with flesh-toned enamel to approximate the look and color of skin, Annie’s leg represented decades of hard-earned expertise, first acquired in this country during the aftermath of the Civil War, when advances in warfare left more veterans without a hand or arm or foot or leg, and advances in medicine kept them from dying on the battlefield, creating a greater need for a variety of well-made prosthetic limbs than ever before. Union surgeons performed more than thirty thousand amputations of all sorts, with an estimated 75 percent surviving the deadly risks of infection and gangrene; historians put the Confederate numbers, which are harder to document, in the same range.
Titanium alloys and tiny computers are now revolutionizing the industry, offering above-knee amputees such as Annie the chance to walk with a normal gait. (Double amputee Oscar Pistorius of South Africa runs fast enough on his high-tech prosthetic legs to put him in the company of Olympic-class athletes, presenting the overseers of sports competitions with an unprecedented question: Do artificially-powered limbs give athletes with disabilities an unfair advantage over those with two human ones?) But these technological advances are still filtering their way down to the typical amputee; before computers came along to serve as a liaison between mind and body, an artificial limb couldn’t simulate the function of knee and ankle joints, and it couldn’t absorb the impact of a foot striking the ground, making every step an awkward proposition. For Annie, who never learned to walk properly in the first place, the motion of putting one artificial foot in front of the other would have required weeks if not months to master, as well as large amounts of patience, endurance, and strength.
Learning how to attach the leg wasn’t hard, but it had to be done right. Annie would place her stump—or “residual limb,” as today’s orthopedists prefer to call it—into the prosthetic socket, making sure that it fit snugly, and then tie or strap a leather-covered metal band around her pelvis to prevent the eighteen-pound apparatus from turning on itself. It’s likely she had a stabilizing leather shoulder strap as well, which was a common way for above-the-knee amputees of short stature and slight build to better support the heavy leg. Still, there’s no way to distribute the extra weight as smoothly and as evenly as a normal leg does. “She would feel the pull on the shoulder with every step,” Carroll says.
She would also sweat. The additional energy required to walk with an artificial leg would produce an abundance of perspiration, and the moisture would soak the soc
ket, causing the rawhide there to become wet. If Annie didn’t remove her leg once or twice a day to clean it and let it dry, the socket could swell and shrink, losing its precise shape. Then, as Annie walked, the torque would cause her stump to move in the socket, rubbing her skin raw and increasing her chances of getting rashes and infections.
Even if Annie did a perfect job of caring for the socket, the odds were against her. At seventeen, her body was still a work in progress, which meant her stump was likely to change shape. It didn’t matter whether it was tight or loose—either outcome would throw off the alignment, making the artificial leg slightly longer or shorter than her other one. “That’s when you see prosthetic-wearers swinging their legs around to clear the floor or find a point of contact,” Carroll says.
The leg itself could last a decade or even more, but the socket might need adjustment or replacement every year, or every few months, depending on the patient. No wonder Annie had such problems: This never fitted very well, although it was repaired and changed several times, with the result that patient did not walk well.
“They’re marvelous devices,” Carroll tells me. “But they do have their pitfalls.”
Mary Greco’s reply to my e-mail makes no reference to the need for a court order. It merely says, without preface, that I should fill out the attached form, authorizing the department to release “protected health information” and providing as much detail as possible about the patient in question. Once Greco receives my signed authorization, she writes, she will “access our record database to see if the information you are seeking is still available.”
Greco’s e-mail doesn’t specifically state that the department now regards me as having the legal standing to seek Annie’s records, but logically, there’s no other explanation for the turnabout. It’s hardly a big victory—after all, I don’t yet have a single new piece of information—but I feel like celebrating nonetheless.
Where the form asks for the “identity and type of information,” I write a description both broad and precise, attempting to cover every base: “Any and all records, medical or psychiatric, relating to the institutionalization of Annie Cohen, deceased. Records may include Northville State Hospital Case No. 16317 and previous Wayne County General/Eloise Hospital and Infirmary Case No. 17205. See attached supplemental page for specific dates between 1940 and 1972.”
I don’t have to wait long. A week later, I get a call.
“Mr. Luxenberg? This is Sara West from the Department of Community Health in Lansing.” I feel myself gripping the phone a bit harder. “We sent you a letter yesterday saying that we could find no records, that they have been destroyed.” If this were a sports event, I would say the crowd just got very quiet. “But we learned today that a record was found, so I wanted to call you before you got the letter.”
A record? One record? Could she be more specific?
“It’s just two pages from 1972,” she says. “That’s all we have.” I pepper her with questions. Why just two pages? How come those weren’t destroyed, too? She says she doesn’t know, she’s only working there for a few months and is calling on Greco’s behalf. I apologize for my persistence, explaining that this is my best chance for finding out more about my aunt, that we had only recently learned of her existence. “It’s hard to be in this position,” I say. “I can’t look for the records myself, so I have to rely on the state for a thorough search.”
“Your aunt was a secret?” West says. “Wow.”
With that one word, I’ve transformed myself from something other than one of the unseen thousands who write to the government daily, weekly, yearly, seeking information. “I’ll see if I can find out anything else about the search process,” she says.
On hold, I curse myself for not pursuing the entire file back in 2000. West returns to the line. “It appears that all Northville files older than twenty-five years were destroyed about a year ago, in keeping with the state’s records retention policy.” She stops. “I’m sorry.”
If I were a tire, I’d be flat by now. I persist, though, looking for some sliver of hope. “Then why did these two pages from 1972 survive? They’re older than twenty-five years.”
I’m asking her questions she can’t answer. She suggests that I wait until I see the pages. She’s putting them in the mail today.
The surviving record arrives from Lansing, and now I understand why it wasn’t destroyed—it’s from the state’s master index of patients in mental hospitals, a set of cards created to track Annie Cohen’s journey through the system after her transfer to Northville. Mostly, it confirms facts that I already know, but two entries stand out, two bits of information that mitigate my disappointment in acting too late to rescue thirty-two years of records from the shredder or incinerator or landfill or whatever the state of Michigan uses to dispose of its history and, in this case, my aunt’s.
Fact #1: Commitment date, 6–12–1940. Type of Order: Permanent.
I bring out Annie’s court file. My recollection is correct: There’s no document describing Annie’s commitment to Eloise as permanent, no final order, not even a docket of actions taken so that someone coming along a year or a decade or sixty-five years later might know definitively what had happened to this young woman after three doctors examined her and two had declared her “actually insane.” The only hint in the court file is the stamped date, June 12, 1940, and that scrawled notation, “Eloise or Ypsi Public.”
This latest piece of the puzzle makes the chronology clear. On April 25, Judge O’Brien sent Annie to Eloise on a temporary order. Two days later, the superintendent of Eloise signed a form letter that states, without qualification, that it would be “improper and unsafe” for Annie to attend the hearing that would determine her sanity. That hearing, set first for May 8 and postponed twice, finally took place on June 12, without Annie in attendance. O’Brien accepted Dr. Peter Bolewicki’s tie-breaking conclusion that Annie was actually insane, and made her a permanent patient at Eloise. He stamped the June 12 date on the cover of Tillie’s original petition, but otherwise placed nothing in the public file that reflected the change—this momentous, life-altering change—in Annie’s status.
Fact #2: A diagnosis, with two codes added by hand, 295.90 and 312.00.
The codes come from the DSM-II—that era’s Diagnostic and Statistical Manual, the psychiatric standard now in its fourth edition. Her symptoms fit the criteria for 295.90, a conduct disorder characterized by aggressive behavior, and 312.00, chronic schizophrenia, undifferentiated—both catchall diagnoses.
In other words, Annie left Eloise in 1972 exhibiting much the same symptoms as when she arrived in 1940. Psychiatry and the mental health system had changed dramatically in those three decades, but not much had changed for Annie.
Ed Missavage squints at the 1964 roster of Eloise psychiatrists, photocopied from one of his former colleague’s donated papers at the Wayne State University archives. I’m hoping that perhaps one of the young psychiatrists who joined the staff in 1964 might have had Annie as a patient in her later years at Eloise. Missavage studies the list for a few minutes before concluding that it’s unlikely I’ll ever find any of the doctors who treated Annie. “I don’t think any are alive,” he says. “But more to the point, I don’t think your aunt got much attention from the psychiatric staff after a while.”
“Why’s that?” I ask.
“She was part of the long-term population,” he says. “Her condition didn’t change much, so I suspect that the people she saw most often were the attendants and the nurses on her particular ward. And unless we know which building she lived in, there’s no way to know who those people were, if they’re still alive.”
Anonymous and nearly invisible, even at the place where she spent thirty-one years.
David Oliwek wants me to meet George Barahal, a family friend and professor emeritus of Wayne State University’s psychology department. “I’ve been telling him about your search and about Annie, and he thinks he can help,” David says.
“He’s a great guy, and he knows a lot of people who worked at Eloise. Why don’t I take you over there for dinner?”
On a warm May night, too humid for anything more than shirtsleeves, we spread our deli sandwiches on a table in Barahal’s den while he studies Mona Evans’s Routine History and quizzes me about Annie. Barahal’s a man of many interests, one of which is baseball. He’s been a fan of the Detroit Tigers since he was a kid in the 1920s and probably owns the distinction (as far as anyone knows) of being the team’s longest-running season ticket holder. He celebrated his ninetieth birthday with a bash at the Tigers’ new Comerica Park. I tell him I’m jealous, and I mean it: Barahal got to see a few legends play back in his day, including Hall of Famers Hank Greenberg and Mickey Cochrane—although as a ninety-year-old, he’s also had to suffer through more losing Tiger seasons than either of us cared to count.
“The Detroit Psychological Clinic,” Barahal says, looking up at me with his piercing eyes. “I know the people who used to run that.”
I had seen a reference to that office in Annie’s records—“the Detroit Public Schools, Psychological Clinic.” I had called the school system to find out about it, had gotten nowhere, and hadn’t tried again. “Is the clinic still around?” I ask.
“I’m almost certain it is,” Barahal says.
“What does it do?”
“Testing, mostly, and social work,” he says. “At least that’s what it used to do. Let’s see if I can get you Annie’s records.”
I indulge him. “Sure, give it a try,” I say. But what I’m really thinking is: Right. I’ve been making a nuisance of myself at offices and courthouses all over this state, writing letters and arguing privacy laws and asking gatekeepers to search for records that may not even exist, and now this retired professor thinks he can make a few phone calls and presto!, Annie’s school records—from the 1920s!—will materialize like magic.
Annie's Ghosts Page 23
