At the Gateway to the Brain

* * *

Matt, June 22, 2004

A drift on anesthesia, Matthew Nagle lay still in the neurosurgical intensive care unit of Rhode Island Hospital, his shaven scalp discolored by a brown antiseptic and covered by a white turban of gauze dressing. Plastic hoses connected the tube in his throat to the ventilator that hissed and puffed and hissed and puffed into his lungs.

While a high school senior in 1998, Matt had galloped across football fields, two hundred pounds of muscled energy charging at opponents; he set a record for unassisted tackles that was featured in the Boston Herald. Now twenty-three, he had a severed spinal cord, and his limbs were completely paralyzed. Swaddled in white hospital sheets and floating on a special bed to prevent bedsores, Matt had just had brain surgery as the first human volunteer for the BrainGate Neural Interface System. Sinuous green waves raced across the monitor as his heart, strong as ever, pumped out twenty liters of blood every minute. There had never been a question about Matt's heart while the BrainGate research team planned his surgery.

I touched Matt's upper shoulder, the only place other than his head and neck where he could still feel human contact. My hand appeared dark brown against his pale skin, which seemed bleached by the fluorescent lights of the hospital.

"Matt, how're you feeling?"

Slowly his eyelids opened, a trace of a smile on his face. Then his eyes closed again, the right faster than the left. I felt an infusion of relief; Matt had just winked at me. My grip loosened on the cold rails of his KinAir bed, and I smiled back at my young patient, who drifted away, back into postoperative sleep.

The pill-sized BrainGate implant was now on the surface of Matt's right brain (see figure 1.1 in the gallery). A hundred microelectrodes — each thinner than a hair and a millimeter long — sent fine wires to a titanium pedestal, about the diameter of a nickel, that protruded from Matt's head. When the skin healed, a fiber-optic cable would connect Matt to a computer that analyzed and stored his brain's electrical nerve signals.

If — and this was my clinical career's biggest if — the experiment succeeded, Matt would control a computer's cursor by only thinking about it, just as though he were moving a computer mouse with his paralyzed hand. That would remove a few links in the chains of his paralysis.

* * *

As a clinical investigator for the BrainGate study, I had discussed with Matt and his parents the many risks and potential benefits of the implant. Doctors, nurses, neuroscientists, and clinical engineers had planned every step and coordinated all the details, along with Cyberkinetics Neurotechnology Systems, Inc., the company formed by researchers at Brown University to develop the BrainGate. I remembered the research team's excitement as we worked on this revolutionary technology — but I also recalled moments of fear that our dreams for the BrainGate would end in disaster.

I told myself to calm down. Almost a decade of studies with monkeys had convinced the Food and Drug Administration (FDA) and three institutional review boards (IRBs) to approve a study of the first human BrainGate implant. Feeling less nervous, I reflected upon Matt's journey into disability and upon his yearning to overcome paralysis through the BrainGate, stem cell therapy, or any other technology.

A nurse dabbed Matt's face with a damp cloth. He was sweating in response to the stress of surgery.

"Please be careful near his nostrils," I said. "He's got MRSA; it's not that far from his nose to the incision."

The nurse looked taken aback, but it was clear she understood my fear that methicillin-resistant staphylococcus aureus — a variant of the benign bacterium we all harbor — might infect Matt's surgical wound. She moved the washcloth away and promised to pass on my concerns to the other nurses.

I left to find Matt's parents, Ellen and Pat Nagle, who were waiting downstairs. Standing near the elevator on the hospital's sixth floor, I stared out a large tinted window while familiar questions streamed into my brain with the sunlight. What did the BrainGate study mean for people with severe paralysis? Why had Matt subjected himself to this experiment, the first on a human being? Why had he, after having been paralyzed, undergone yet another metamorphosis — this one almost turning him into a cyborg? Why had his parents allowed him to do this? I also thought about my role in recruiting Matt for the study, which had many risks and only nebulous chances for success.

Led by John Donoghue, the chairman of Brown University's neurosciences department and a cofounder of Cyberkinetics, our research team had designed the study to answer the following questions:

1. Would the device be safe in human beings and not cause complications such as brain infections, bleeding, seizures, or any of the twenty-eight other adverse events listed on the informed consent form?

2. Would the implant record signals from single neurons, and do so reliably?

3. Could the BrainGate use these recordings to function as a neural prosthesis, like a bionic brain?

4. With the BrainGate, would a paralyzed patient be able to control a computer cursor through thoughts alone?

5. Finally, would the device allow advanced uses, such as controlling a television or opening e-mail? (The possibility of playing video games had also excited Matt, but this wasn't mentioned in the thick protocol submitted to the FDA.)

While training in rehabilitation medicine — also known as physical medicine and rehabilitation or physiatry — I had developed an interest in spinal cord rehabilitation. During and after my residency at Boston University, I treated many patients with spinal cord injuries due to car accidents, falls from buildings, dives into shallow pools, gunshots, ruptured aortic aneurysms, bicycle accidents, and stabbings. Each of these patients...