Ruth removed the first set of files and opened them to reveal a photograph of an average-looking woman, middle-aged, with a serious expression on her face. Ruth could tell from the background that the photo was taken at Emeraldine but didn’t recognize the woman at all.
January 21, 1947: Patient D. Rice was temporarily detained at the hospital due to sudden and unprecedented hallucinatory episodes. Performed a transorbital lobotomy and she was able to return home several days later with no further hallucinations . . .
Ruth was relieved to see that she was a short-term, temporary patient. That explained why she didn’t recognize her. She read on.
May 8, 1947: Check-in with D. Rice has confirmed success of psychosurgery. She has suffered no further hallucinations and has been able to reengage in her role as a mother and wife . . .
September 16, 1947: D. Rice has returned for further evaluation and treatment. Is presenting with extreme obsessive behavior and bouts of uncontrollable anger. Upon examination, determined that initial cutting had not penetrated deeply enough into her prefrontal white matter （likely out of an abundance of caution due to the relative newness of the procedure）。 Performed a second transorbital lobotomy, this time with much deeper incisions.
A second lobotomy? Ruth knew Robert performed multiple lobotomies in only the most extreme cases. Each additional procedure incurred greater risk—intracranial bleeding, postsurgical epilepsy. Robert had performed the second lobotomy in his private practice, not the hospital. Appalled, she continued reading.
December 12, 1947: D. Rice seems to have responded well to second lobotomy. Reports that majority of obsessive behaviors and urges have diminished and has had no violent outbursts.
Ruth read pages and pages of Robert’s detailed follow-up notes until she finally got to the third set of files. The photo on the first page stunned her. This woman, who had initially appeared perfectly average looking, was now both visibly filthy and obese. At this point she shouldn’t have been surprised. Ruth had seen weight gain in some of the lobotomy patients at Emeraldine, but this—the before and after side by side—well, the stark reality of the deterioration made her reach for the trash can fearing that she might retch. She read on.
March 18, 1950: D. Rice returned demanding a third lobotomy. Patient was almost unrecognizable due to extreme weight gain. This seems to be an unpleasant side effect of psychosurgery for some patients. However, obesity is preferable to other psychological conditions that are threatening to society at large.
Patient is requesting further treatment claiming obsessive impulses have returned. Clothing was noticeably soiled, yet she stepped out on six separate occasions to wash her hands. She also had several poorly concealed bald spots and admitted, when asked, that she had been pulling out her hair. She seems marginally untethered from reality. Considering third lobotomy . . .
April 3, 1950: Several days after third lobotomy D. Rice has suffered postoperative hemorrhage and died. After intermittent success with psychosurgery, she has ultimately succumbed to one of the rarer risks of the procedure.
Ruth gasped. This was worse than she could have imagined and, also, exactly what she had been looking for. Robert had not only performed multiple lobotomies on the same subject outside the hospital, but he had killed someone. She stood for a moment, dizzy from the thought of what she had discovered. This was akin to murder. Suddenly, she heard the sound of tires on gravel. Moving as quickly as she could, and holding tightly to the evidence in her hands, she ran back to the house before Robert found her.
She kept running until she made it up the stairs and into her bedroom, where she locked the door in panic. Peering out the curtain of the bathroom, she saw that she’d been mistaken. Robert’s car was not there. Where was he? Had he gone to the townhouse? If he went to the city, he could see patients at his office there. She looked at the clock on the bookshelf across the room. It was already 8:00 p.m. Robert would be finished seeing patients today, so even if he was there, it didn’t matter now. She had what she needed, and first thing in the morning, she would call the licensing board and have him stopped for good.