Dutch Tilt
creative nonfiction by Dianne Aprile

 Dutch Tilt
A shot in a movie that creates in viewers an uneasy or unsteady feeling.

#1. The Cold Open 
The cinematic technique of jumping directly into a story before titles or credits are shown.

In 1955, when she was 41 years old, they decided she needed a lobotomy. She, being my aunt Aileen, my mother’s sister. They, being a team of physicians led by Dr. Everett Grantham, a well-respected University of Louisville neurosurgeon who had published widely on his successes using brain surgery to help patients with both intractable pain and debilitating psychoses. 

Forty years later, with a memory sharper than my own, she described—to me and my tape recorder—how she felt the night before her lobotomy:

#2. The Flashback
A scene that shifts away from narrative to memory, providing important backstory.

“I remember . . . I was so scared I thought I would die. This nurse, she was real nice. I smoked cigarettes then, and she said, `You know, I get off at 11 o’clock but I’m gonna stay because you are so afraid. I’m gonna sit with you all night.’ And I said, `Do you think I could have a cigarette?’  And she said, `I’ll have to go and ask.’ So she came back, and she said, `You can have one,’ and she lit it for me. She must have given me something, because I don’t remember any more. I just remember that she held a match and lit that cigarette.” 

#3. The Matte Shot 
A film technique used to combine two or more images into a single image. A split screen.

I grew up knowing these facts about my aunt Aileen, whom I always called Eenie. There was never any attempt to hide the truth—that Dr. Grantham had slipped a needle deep beneath her skin, threading it past the flesh of her forehead, guiding it behind her eye sockets to the place that modern science, circa 1955, had deemed the troublemaker, the devil who made her do it, the gremlin at fault for her compulsive handwashing, her sexually obsessive thoughts, her fears (of dirt, of germs, of dogs, of thunderstorms) – fears that overwhelmed her at times, forcing her into an icy solitude, a fiery misery of the mind. Her brain—specifically, the medial ventral frontal lobe—needed attention, it was decided. 

She, however, rebelled against the suggestion. She had no fight with her brain. It had served her well, she who loved to read novels, to work crossword puzzles, to argue about politics, to embroider stories around the kitchen table. She who had worked at responsible jobs, at the Indiana Quartermaster Office during World War II, and now as the secretary to the president of a well-connected Kentucky construction company, where she would continue to work until she retired at age 71. She would keep her brain just as it was, thank you. 

#4. The Backstory
A story within a story.

“I was at Norton I guess a month and a half, and one day the doctor called me to his office and said, `Did you ever hear of a lobotomy?’ Well, I didn’t know what they called it; I said no. He told me, he said, `You know Ms. So-and-So, right? She was afraid of needles, afraid to thread a needle. She had the operation.’ And he said, `Now she does fancy work and crocheting.’
“And, of course, I thought, You’re not going to get me to do that. I didn’t ask him too much about it because I just thought, you’re not talking me into this. I don’t know what it’s supposed to do – sever a nerve, maybe? I don’t know. I just said, `Oh no, I couldn’t do that.’ 

“But . . . finally I said yes.”

. . .the first psychiatrist she saw told her he admired her sense of humor. He believed it was what kept her from going over the brink. For decades after he made that observation, she liked to quote it. 

#5. Time Lapse
A technique that creates an illusion of time passing.

Grantham died in 1997 at the age of 84; he was by then living in a retirement home in Louisville. An internist who knew him socially as well as professionally called him a “Sphinx” for his taciturn ways and “Bull Moose of the North” for his passion for the outdoors. The two men had shared fishing trips in Labrador, Iceland and Canada. He was a large man, something over six feet, with big hands, beefy fingers. Yet his touch was delicate in the surgical suite. He wore horn-rimmed glasses and was a handsome man, square-jawed with a prominent nose. He spoke in monosyllables, grunted really, but he was a careful listener when it came to his patients’ stories.

I don’t know what he thought of Eenie when they met the first time. I do know that another of the community’s esteemed physicians, the first psychiatrist she saw, told her he admired her sense of humor. He believed it was what kept her from going over the brink. For decades after he made that observation, she liked to quote it. 
Four years before her surgery, in 1951, at the annual meeting of the American Philosophical Society held in Philadelphia, Dr. John Fulton, of Yale, read a paper titled “The Physiological Basis of Psycho-surgery.” In it, he referred to Dr. Grantham in Louisville and his success with what was called a “restrictive” lobotomy, a surgical intervention on the medial quadrants of the frontal lobe (what Fulton referred to as “the visceral brain” as opposed to the neo-cortex, or the intellectual brain). Grantham, Fulton said, had found “empirically” that those who underwent operations limited to the visceral brain “do not tend to suffer intellectual deficits” but, he noted, they do exhibit “marked therapeutic benefits.” Fulton concluded that Grantham’s surgical technique was “all that was needed to break the vicious cycle that underlies certain psychoses.” 

#6. Fade-out  
A cinematic technique in which a shot darkens and disappears.

Her “restricted” lobotomy at the hefty but nimble hands of Everett Grantham was hardly Eenie’s first hospitalization. As a child of 11, she had suffered a skull fracture after being struck by a car as she walked home from the movies along Barrett Avenue. She spent days in a coma. A few years later, at 13, she suffered a protracted high fever when she contracted diphtheria. The health department quarantined the household – which included three other school-age children at the time, one of them my mother. 

As a young woman, after the handwashing began to take over her life, she spent months at a time in psychiatric wards at the old city hospital, Norton Hospital and Our Lady of Peace. Twice, before the lobotomy, she was subjected to rounds of ECT. The first time she was committed by her family, and the shocks were delivered without anesthesia. The second time, she checked herself in for treatment, and after the first shock, which was by this time mediated with drugs, she checked herself right back out. By the time she entered Norton for her lobotomy, she had perfected, in the way that seemingly powerless people do, her own methods of securing assistance from those she needed by flattering them, by smiling graciously, by teasing, by asking about their lives and remembering the details to slip into the next conversation, to impress upon the listener her decency, her worthiness of help. She knew how to hide a ten-dollar bill in her fist and slip it unnoticed into the hand or pocket of an aide. It was a habit she retained her entire life, using it right up to the end, at age 93, when she was forced to give up the house where she had lived, alone, on her own, for 20 years, and move into assisted living. Whatever tragedy came her way, and so much did, over the course of the years following the lobotomy, she managed in every case to find a friend or relative to care for her. 

#7. Mise en Abyme 
A French term for a dream within a dream.

“I don’t remember anything (about the surgery) until . . . the next night. They said the operation was at 7 o’clock in the morning, and I didn’t wake up till 4 in the afternoon. And what did I do as soon as I woke up? I said, `I have to wash my hands.’  I remember saying it: `I gotta wash my hands.’”

#8. The Cutaway 
A shot, usually a close-up of some detail or landscape, which veers away from the action at hand, used to prevent a break in continuity.

When I was a child, I spent the night often with Eenie in the quarry-stone house in Louisville’s Highlands that she shared with her mother and brother. On Saturdays, my grandmother, Eenie and I would take a taxi downtown to have lunch and catch a movie. There were many movie houses on Fourth Street in those days, and we would casually stop to read each marquee until we found a feature that suited us.  And then, regardless of when the movie had started, we bought tickets and took our seats. Movies ran consecutively in those days, and no one cleared the theater between showings. So we watched to the end, then remained seated for the next showing to see what we had missed by arriving late. 

It seems odd now, but part of the game was to try to figure out from the context what the movie was about. We looked for clues, listened for hints. Always, at some point, Eenie would lean across my box of popcorn to whisper to my grandmother, “This is where we came in.” And we would gather our belongings and leave. 

I saw many movies in this oddly disjointed, nonlinear, post-modernist manner. I think I learned to love movies, watching them this way. Truffaut had his day for night. I had my ending for opening. Flashback. Flash-forward. Cutaway. Cold open. Mise en abyme. That was what my life with Eenie became over the 60 years I knew her. 

Always another story within a story. 

Dianne Aprile
is an author and editor of books, a poet and essayist whose work has appeared in magazines, journals, anthologies, and newspapers. She serves on the faculty of the Naslund-Mann School of Writing, Spalding University, where she has taught creative nonfiction since the program’s inception in 2000. A native of Louisville, she was an award-winning journalist for 30 years and, with her husband, owned and operated a jazz club for five years before moving to Washington state. The couple returned to their hometown in 2022.