Nevergreen

Thank you for that kind introduction, Dr. Baddeley; I’ll certainly remember it when the NSF meets this spring to review proposals. (Laughs)

My fellow physicians, I would like to speak today about a case that has perplexed my team for more than a decade, humbling us with its complications as it reminds us that medicine is a practice and not a discipline -- the case of Lee Kroeber. As the case is so well-known, I am disposing with the usual medical figleaf of referring to the patient by their initials; there is not a one among you who would not recognize her once the particulars were related.

This case is rich in data, offering us much to learn from, but it is richer in unknowns that pose some fundamental questions. Questions that neither I nor my team are capable of answering. It is my hope that by presenting the case to you, my distinguished colleagues, we might gain some clarity on this case.

If you think that I am using this keynote address as a glorified patient presentation in the hopes of picking your brains, you’d be right. Because we believe this case has certain implications that go well beyond the corridors of my hospital, as you will see.

First, the particulars of the case. On April 14, 2026, Kroeber was driving to a publisher’s party in Baltimore when a drunk driver swerved across three lanes of traffic and hit her car head-on. The drunk driver died at the scene but Kroeber was stabilized and brought to Jack Robertson Hospital. I was fortunate enough to be the on-call that night. I say fortunate because though none of us ever want to see a case that demands so much of us, none of us ever wants to miss the opportunity to learn new things. And Kroeber’s case has taught my team and taught me much that I hope to share with you today.

Due to a malfunction of the air bag, Kroeber’s head had hit the dashboard at an angle, crushing the left side of her skull and causing intracranial bleeding. MRI images indicated a pressure build-up in the hippocampus and dendate gyrus as well as damage to the medial temporal lobe. We therefore performed a craniotomy to remove bone shards and relieve the hematoma. After a six hour surgery, it appeared to be a complete success with no obvious complications.

But, as you all well know, just as the proof of the pudding is in the eating, the proof of brain surgery is in the waking. And it was when Kroeber awoke, not on the first day but the second, that we saw signs of a serious complication. For Kroeber not only didn’t remember the accident, she didn’t remember the previous day.

At first, we assumed that this was merely a side-effect of the accident or the pain medication. Kroeber had displayed a mild endogenous reaction to morphine and was therefore on fentanyl as a prophylactic measure. However, even after the pain medication was withdrawn, the inability to remember anything that happened after the accident remained. After several days of testing were completed, we realized the truth: Kroeber had developed episodic anterograde amnesia.

Episodic anterograde amnesia is well-known in the literature and several classic examples have been documented ranging from Henry Molaison to Eugene Pauley to Leonard Shelby. In each case, confounding factors created a variable outcome. For example, Molaison was incapable of developing any new memories following his surgery for epilepsy but had complete recall of his childhood. Pauley was able to learn new short sentences and simple skills but these were quickly forgotten if he did not continually practice them. And Leonard Shelby had the ability to plan complex on-going tasks provided he looked at something reminding him of the ultimate goal every few minutes. But for Kroeber, the confounding factors led to a result that no-one could have foreseen.

Already a well-known author before the accident, Kroeber had made notes for her next story, to be called “Nevergreen”. Kroeber’s usual method of writing was to look at her notes as soon as she woke up and then to go to her computer and write for at least two hours before doing anything else. Since we felt that returning to her customary habits might help with her recovery, we encouraged her to follow that routine. And the world is grateful that we did.

Over the next six months, she wrote a series of stories, ranging from 100-word “drabbles” to a fifty-thousand word short novel, all based on that same set of notes. These were collected and published with a brief medical introduction written by my team; the anthology was greeted with terrifying acclaim. That year she became the first author to win the International Booker Prize, the Pulitzer Prize, and the Nobel Prize for Literature, all in the same year. In addition, her stories were converted into a television series and a set of movies that made her name a household word.

Meanwhile, back at the lab my team was working hard to understand the roots of her amnesia. First using computer models and then moving to animal analogues, we worked to replicate her condition. Ten years of steady, frustrating, brilliant, tiresome, inspiring, maddening work finally bore fruit this past year. Not only were we able to discover how to cause her condition in mice and then in rhesus monkeys, an inadvertent slip of the scalpel showed us the path to reversing it via induced plasticity.

The process currently has an 80% success rate, with the most notable side-effects being a loss in general problem-solving. To put it in plain terms, the monkeys either showed no change in their condition or became able to form new memories but were unable to develop new ways of solving problems. They were no longer subject to that sudden spark of inspiration that changes a competent artist into a maestro.

Though the process we have developed currently works only on episodic anterograde amnesia, there is evidence that it may be useful for other types of brain injury. Obviously, my team is currently hard at work attempting to broaden the usefulness of this technique.

However, we were not circumspect enough in our work. Somehow, news of what we had accomplished leaked out to the general public which, as might be expected, both condemned and embraced it in equal measures. On the one hand, we have groups representing different neurodiverse people, trying to shut our lab down as a genocidal threat to their very existence. On the other hand, we have parents and children and pastors and politicians of patients with severe brain trauma, desperate to see if this technique can restore their loved ones. Honestly, having to watch as the hope drains from their faces when we explain the limits of what we can do is even worse than the vituperation we received on a daily basis from those who see us as “worse than Hitler”. And then there is the third extreme of desperate writers and painters and other artists, who beg us to cause them to suffer as Kroeber suffers, in the hopes of making art as immortal as hers.

But such extremes are nothing new to those of you who work in research. What makes our case compelling and worth bringing before you, my fellow physicians, is the very real person at the heart of the case - Lee Kroeber herself.

Many would consider Kroeber a mentally competent individual. Though she has episodic anterograde amnesia, it has not prevented her from managing her assets so well that they have not only grown but become substantial enough to fund the very research which developed the process to cure her condition. A process that we could begin tomorrow, if her informed consent were given.

And there’s the rub. We have asked her, several times, if she would be willing to undergo the procedure. Roughly half the time she consents but she refuses the other half, stating that curing her risks removing that indefinable spark that has made her work so prolific and so well-loved. And, having seen the results in our test animals, I cannot say that she is wrong; if the process works, she will be able to live a normal life - but not an extraordinary one. She will no longer be the writer who moved us all to tears with her stories.

No longer will we cry when Horatio burns the bridge, no longer will we cheer when Lars throws down his weapons and declares his love. We will have read our last new Lee Kroeber story.

And that, my fellow physicians, brings me to the question I wish to ask of you. When we became physicians, we swore to “first do no harm”. Where is the harm in this case? Should we cure her condition by stealing her abilities? Or should we continue to glory in her prose but at the cost of a normal life for her? Which path holds the most harm?

I ask you - which path should we choose?

THE END

Bio: "I've previously published in Youth Imagination Magazine, Aphelion Webmagazine, and Pilcrow and Dagger. I also have stories in the Strange Wars and Strange Economics anthologies."

E-mail: John DeLaughter

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