When Canada’s Most Famous Brain Surgeon Almost Killed His Own Sister

O pening the skull had never seemed more difficult to Wilder Penfield than it did on that cold December morning in Montreal. Staring at his sister’s shining white scalp, shaved for surgery on the heavy German-made operating table, he felt weak. It was 1928, and Penfield was one of maybe two dozen neurosurgeons anywhere in the world. The profession was new, thrilling, and shaky—as likely to kill as cure. Although Penfield and his protégé, William Cone, were starting to see improvements in their results, the field was still a Wild West with few rules, not even against operating on your own family members. It would be decades before Penfield achieved global fame for mapping the human brain and devising a surgical cure for epilepsy as the director of the Montreal Neurological Institute. Right now, it was just him, Cone, and Ruth in the antiseptic chill of the Royal Victoria Hospital operating room. Penfield’s older sister had suffered from seizures since she was a teenager, and they had recently become debilitating. He suspected the attacks were brought on by a tumour in the front of her brain, just behind the forehead, and soon after he picked her up at the train station in Montreal, her face grew as red and swollen as a harvest moon. In the OR, Penfield used a wax crayon to draw a horseshoe over her right eyebrow—the line of incision. Ruth, for better or worse, would be awake through most of the procedure. Her scalp had been injected with an anaesthetic, but the brain itself feels no pain—it would need another brain to register the sensation—so she would be able to guide her brother’s knife with eerie poise. Cone was also scrubbed up in the nineteenth-century relic of the Royal Vic OR, with its white marble floors and a steeply raked viewing gallery. Penfield had taught Cone everything he knew and rarely did anything without his help. Cone was a preternaturally gifted surgeon, with long, elegant fingers, big, compassionate eyes, and a hard-won feel for the razor’s edge between life and death. He was as cautious with the knife as Penfield was bold. Cone may have been cautious with a patient’s life in his hands, but he wasn’t for a second timid. He had boxed and wrestled to pay his way through college; the blood and the danger of neurosurgery didn’t scare him. If anything, he seemed to relish the high stakes of his craft, the way it brought him right up to the mortal “precipice,” as the partners called it. He had an abiding confidence in his ability to bring patients back from the brink—but even more so, he had a marrow-deep faith in Penfield. It was Cone who had convinced his partner to operate on Ruth at the crucial moment of decision the day before. “You can do it, Wide,” he had said, using his nickname for Penfield. “I will help you.” Now there was nothing to do but cut.

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L ike every Canadian kid of the 1990s, I grew up knowing about Wilder Penfield. He was, simply, the burnt toast guy. I didn’t know the names of any other surgeons, living or dead, that I can remember. But Penfield had entered the realm of historical celebrity. He was on TV. In fact, he had his own Heritage Minute. Heritage Minutes were these hokey vignettes that appeared on the CBC about important moments in the country’s past, like when Maurice “Rocket” Richard scored five goals for the Montreal Canadiens after moving furniture all day. Penfield’s Heritage Minute was strange and compelling by the standards of the genre. It depicts Penfield performing surgery on a woman whose seizures are heralded by the smell of burnt toast, zeroing in on the source of her epilepsy by triggering the telltale odour in the OR. It was part of Penfield’s long canonization, one that saw him named the “Greatest Living Canadian” by Maclean’s magazine, placed on a stamp, cast in bronze, and honoured with an eponymous street near the institute he founded in 1934. He was the master mapper of our grey matter, the oracle of Montreal. When I read about him again fifteen years later, while working as a journalist for the Globe and Mail in Toronto, I realized just how canonical he had become. I was reporting a story about addiction, and an American psychologist was describing an experiment that was the basis for our whole scientific understanding of the concept. Two researchers in 1950s Montreal put rats in a box with an electrode implanted in their brains that could be triggered by tapping a lever. The rats promptly fell in love with the lever, tapping it thousands of times until collapsing from exhaustion, preferring it to food or sex. The researchers had discovered a candidate for the brain’s pleasure centre. Their findings quickly travelled around the world and built a whole field of study—and they were all part of Wilder Penfield’s research program. I filed him and his hospital away among the long list of subjects I wanted to write about one day. My excuse came just a few years later, when I moved to Montreal to be the Globe’s Quebec correspondent. Someone at the Neuro, as it’s known, gave me an internal history of the institute that wasn’t really designed to be read by laypeople, and there in its densely written pages was the skeleton key to the story I knew I had to write. It was a capsule biography of William Cone, someone I had certainly not heard of as a Canadian kid in the 1990s. The details were sparse, but he seemed to be everything Penfield was not: awkward rather than charismatic, a technician and not a visionary, humble instead of proud, forgotten where his friend was lionized. There were hints, in this obscure book, that Cone suffered from mental illness, and that his relationship with Penfield was far more intense than your average professional partnership. In 1959, I read, Cone died suddenly at the age of sixty-two. I had to know more. I n the surgical theatre on that chilly December day in 1928, Penfield steeled himself and opened a bone flap in his sister’s skull with the rasping back and forth of the Gigli saw. Operating on the brain was like breaking into a bank vault: any false move could trigger a deadly alarm. Once you were inside, there was a time bomb you had to defuse with a pair of tweezers. The complexity of the brain is almost impossible to fathom. The poet Emily Dickinson was right when she wrote that the organ is “wider than the Sky”—each one contains no fewer than a hundred billion neurons connected to other cells thousands of times, meaning the number of possible mental states is greater than the number of subatomic particles in the universe. In our brains, the cosmos is shrunk down to a three-pound lump of pink tissue. Neurosurgeons of the 1920s deigned to enter this microcosm with a tool kit basically unchanged since the Crimean War. The possibilities for havoc—loss of speech, paralyzed arms or feet, blindness, chronic pain—were as endless as the human faculties contained in a person’s head. Penfield navigated the tripwires lacing Ruth’s brain to remove a tangerine-sized piece of tumour before realizing there was plenty left. Facing the decision whether to remove more of the hard grey tissue clinging to his sister’s skull, he sought the guidance of his partner. Cone had been there at every step, using the automatic sucker to clear blood from the surgical field and an atomizer that kept the brain shiny and moist with squirts of saline. All along, he provided moral as well as technical support, steadying him with his deep, gentle voice. Now Wilder stopped and looked over at Bill, who shook his head: no. “Don’t chance it, Wide,” he said. The risk of massive bleeding was too great. Cone knew that Ruth might not survive if something went wrong, and Penfield would never recover. Most brain surgeons at that point in history would have stopped. The most skilled preferred to chisel away at tumours, even if it meant performing a dozen more operations as the malignancy grew back. Neurosurgery was basically palliative care, a way to slow the death march. Penfield had more aggressive instincts. Standing over his sister’s open head, he wasn’t ready to leave behind more killer tissue. He knew how much she had to live for; her husband and three children back in California needed her. The living brain is soft and gelatinous, with the texture of Jell-O, and surgeons rarely use a knife to cut it. Penfield preferred a loop of silk thread, tightened like a lasso until the offending tissue was removed. Now he prepared for another incision. In a way, it was madness, and he went ahead “with a sort of frenzy,” he later admitted, tightening the knot bit by bit. Just when he thought he had succeeded, a whirlpool of blood rose up from the base of Ruth’s skull, obscuring everything in its way. Penfield stepped back, overcome with horror at what he had done. As he tried to regain his composure, Cone took over and tried to stop the bleeding. After a quarter of an hour, Penfield was finally able to return to the table, but he was forced to abandon the tumour. The rest of the grey mass would have to stay. The partners gave three successive blood transfusions, closed the trap door in her skull, and secured it with silver wire. Ruth, who had passed in and out of consciousness during the worst of the crisis, woke up. “Well, little brother, have you finished?” she said through a tired smile. Penfield knew he hadn’t finished, not really. For now, to save her life, he had left behind a probably fatal quantity of malignant tissue, a smaller time bomb that would only grow bigger and more combustible. At the same time, in his quest to excise the tumour, he had removed an alarming amount of healthy tissue—about an eighth of Ruth’s brain in all. Behind her forehead was now essentially a void. The truth was, he didn’t really know what would happen to Ruth without her right frontal lobe, the area he had carved out. In his dressing room afterward, he stared into the distance, half undressed and close to tears, holding one sock limply in his hand. Ruth had survived, but Cone had been right: he shouldn’t have risked it. He had gone too far, and he had been flying blind. When another surgeon entered the room, Penfield erupted in a rare cry of helplessness. “Why should anyone want to operate on brain tumours? I’ve worked all day long . . . and still I have failed.” The other surgeon only grunted, as if to say: This is the job. For now, he was right. This was neurosurgery in 1928: brutal, dangerous, and bleak. It was a science that matched eye-popping ambition—healing damage to the universe within our skulls, the galaxy of cells that makes us us—with tools and techniques that were stuck in the Victorian era. It was a branch of medicine that required exquisitely precise knowledge of the various functions of our most delicate piece of anatomy—where speech, vision, memory, and dreaming come from—but to a large extent lacked this knowledge altogether. It was a journey into a treacherous country without a map. Eventually, Cone and Penfield would provide that map, not just for themselves but for the entire field of neuroscience and, in a way, for all of humanity. Their thirty-year cartographical journey would also put a strain on their relationship that it would not survive. For now, however, Cone and Penfield liked to say that they were working together in “double harness.” All they had to navigate by was each other. Excerpted from The Mind Mappers: Friendship, Betrayal and the Obsessive Quest to Chart the Brain. Copyright © 2025 Eric Andrew-Gee. Published by Random House Canada, a division of Penguin Random House Canada Limited. Reproduced by arrangement with the publisher. All rights reserved. The post When Canada’s Most Famous Brain Surgeon Almost Killed His Own Sister first appeared on The Walrus.