COLUMN ONE : No Past, but Hope for a Future : A brain injury took away Karine Pire’s ability to remember things for more than 10 minutes. But her mother’s devotion, and researchers’ quest for the secrets of memory, are opening new doors.

Karine Pire cooks lunch in the apartment she shares with her mother, following elaborate lists tacked up all over the kitchen: open oven . . . put breaded filets in . . . close oven.

She has rolled the linens into shiny sunflower napkin rings, smoothed down the place mat corners and, after squinting at a diagram of the cabinet contents, found the dishes.

Over lunch, Pire talks about why she does not often dream, why she cannot smell the strong Belgian coffee brewing four feet away. “I feel love, I think, yes,” she says, but a flicker of doubt passes like a cloud over her face.

After dessert, she positions me for a Polaroid picture, under which she writes “Nancy” so she won’t forget me. Then, she hugs me goodby.

The next day, she has no idea who I am.

Pire has no memory, as we understand it. She lives her life in present tense. The past for her is usually about 10 minutes long, and she is only now, at 28, able to start planning for a future.

An accident eight years ago robbed her brain of oxygen for several minutes, leaving Pire in a fragmented existence of moments strung together without any perceived relation to one another.

Fluent in three languages, she cannot remember to get out of the bathtub after an hour. She has learned to remember her route to school, but after writing an effusive thank-you note to her teacher, she asks the teacher to deliver it to herself.

Hoping to help herself and others, she has worked for seven years with UC Irvine researchers whose interest in new ways to recall previously lost information--and their obvious fondness for her--have remarkably improved Pire’s ability to live more productively.

“It’s very courageous,” said Bonnie Olsen, a Ph.D. in clinical psychology working at UC Irvine’s Memory and Cognitive Disorders Clinic. Along with her husband, clinic Director Arnold Starr, Olsen has worked with Pire since her mother pleaded for their help in 1987.

“Karine is a remarkable human being. Most people with the same injuries and situation would not be able to accomplish what she’s accomplished. She’s moved mountains,” Olsen said.

Given that Pire’s primary memory engine has blown out, there are many things she still cannot feel or do. How memory and emotion are linked is a murky subject still being explored by researchers. Pire’s condition provokes all the big questions: To what depth can someone feel emotions without the memory that contributes to trusting another person? Without any memory of mistakes, how does one learn? Without pain, what happens to the soul?

“I think she has feelings for me and the others she has known for awhile,” Olsen said, “but it takes a loooong time, and . . . how that happens is speculation that I sort of extrapolate based on what I know of human relationships and memory and what I see of Karine. It’s of interest and poignancy because we’ve come to care a great deal for her as a person. But who knows? Who knows? “

A Mother’s Hope

In her sunny, one-bedroom apartment, Pire’s weeks are guided by a large calendar on the wall, her hours by an electronic voice reminder. She uses the device, which can be programmed to announce reminders such as “take medicine,” because she lacks an internal voice to prompt herself.

A student at Coastline Community College’s Traumatic Head Injury program not far from her home, Pire is learning the basics of self-sufficiency--from how to concentrate to writing a resume.

Colette Pire-Vermeulen, 60, has fashioned this ordered world knowing that she will not live forever to mother Karine. Through trial and error she has created an elaborately detailed system of cue cards to help her daughter navigate the everyday drills of laundry, cooking, getting to the bus and playing the VCR.

She is essentially re-raising her daughter, teaching her for the second time to take care of herself.

With her cherubic face and dark wavy bob usually pulled behind a headband, Karine is girlish-looking in jeans, coordinating cardigans and loafers. Her gestures sometimes seem exaggerated because they are slow.

On a recent day, her silver-haired mother sat across from her, eager to share their secrets with a visitor.

Although French is their native language, good manners have them speaking mostly English, despite Colette’s having learned it only after arriving here. Karine plays teacher, correcting her mother’s English and translating.

Cooking for guests is Karine’s link to people, or rather, the link Colette has created for Karine with people.

“Karine does not always tell people, ‘You are important to me,’ but if she cooks, that’s how she says that,” Colette explains. “This is important for her. . . . You cannot just be without people. That is not living.”

Into the Abyss

Born in Vietnam and orphaned in the war, Karine was brought to Belgium in 1968 by Colette and her late husband, Milou, who worked as a liaison between researchers and an American drug company. They had watched the war play out on TV in their comfortable Brussels apartment and decided to provide a home for an abandoned child.

It took two years of paperwork, but the Pires finally adopted Karine. A year later they adopted Nathalie, now 26, who also had been orphaned in Vietnam.

Karine was a bookish girl, serene and playful, her mother says. She was earning good grades at the university in Brussels, studying to be a translator. She had a serious boyfriend and dreams of a future with him.

At 21, Karine developed mononucleosis, low blood pressure and toxemia. After a few weeks, she became groggy and her parents rushed her to the hospital emergency room. By the time they arrived, Karine had lapsed into a coma, and her brain was without oxygen for as much as five minutes, Starr said.

“She was in a coma for several weeks. She probably had an overdose of barbiturates,” he said. “But nothing points to this being a suicide attempt.”

Her father had been prescribed barbiturates, which were kept in the bathroom medicine cabinet. Some of the researchers who work with Karine speculate that she had been accidentally taking these drugs instead of her own medicine.

For three months, Karine was in the hospital. Her motor skills were crippled by brain damage. She spent long hours in physical therapy, swimming and exercising to regain some of her agility. Three months later she began outpatient therapy. After a year, doctors sat down with the family. It was, they said, as good as it would get.

Colette was furious, her husband devastated but resigned.

“In the end, we have no . . . “ Colette searches for the right words in English, until Karine steps in and translates.

“In Belgium, my recuperation was at the maximum,” she says confidently.

“She was living from moment to moment,” Colette says. “I’d say, ‘Karine, drink your tea.’ She’d drink the tea. And then she would forget to keep drinking the tea. She had no expression. Sometime, she could laugh, see someone do something, but not very much.”

The Sunrise

In early 1987, about the time her mother felt end-of-her-rope frustration over what to do with her, a family friend living in Orange County mentioned Karine’s predicament to Starr. He was treating the friend’s mother for Alzheimer’s disease.

“Eclectic in my interests,” Starr now says with a grin, he offered to help.

And the sun came up for the first time in a year for Colette.

“I remember the most striking thing was when she wrote to tell me she’d taught her daughter how to use the computer,” Starr said, shaking his head slightly at the incongruity of someone who had “profound amnesia” learning Word Perfect.

In September, 1987, mother and daughter flew from Belgium to meet with the researcher. Seeing that Karine had twitches and spasms, Starr prescribed medication used for Parkinson’s disease, a central nervous system disorder that causes similar symptoms. The drugs worked.

Starr asked for a volunteer to work with Karine during her visits to the United States. Olsen, who had spent a decade as an occupational therapist with the memory disorders team and was studying for her Ph.D., jumped at the chance.

“When I met Karine in 1988, she was inert,” Olsen recalled. “She would answer direct questioning with, ‘I don’t know.’ That was about it.”

Starr also signed up Elizabeth Parker, a neuropsychologist and adjunct professor of neurology and neurosurgery at UC Irvine. Parker, also a clinical professor at USC, had specialized in research into alcoholism-induced memory loss for the National Institutes of Health.

Parker, who like the others waived any fees, tested Pire to gauge her thinking and perception.

“After the coma, she remembered Spanish, but she couldn’t remember her life, or anything after the age of 12,” Parker said. “She was pretty much a black hole.”

One drill to measure her memory for learning was revealing: A record player turntable has a dime on it. The task is to place a detachable turntable arm on the dime and keep it there as the turntable circles; a machine measures the speed and success rate.

A day after she first tried the test, Karine was asked if she had ever used the turntable. No. Had she ever seen it before? No. But without instructions, she picked up the arm, poised for the test.

Even though she did not remember learning the information, she had. There were other hints that information was seeping in.

The Key

The researchers were most intrigued by Karine’s inability to smell because for years it has been suspected--not proved--that memory and smell are linked. The areas of the brain that support their functions are adjacent.

In the summer of 1988, Olsen was studying in England and Starr suggested that they visit Karine at her home in Brussels.

Olsen was still interested in Karine’s lack of smell perception. So for three days, 10 hours each day, they did test after test--the same ones Parker had done, including one scratch and sniff:

“Was it just citrus she couldn’t smell? Or was she not familiar with the smell because they don’t have citrus in Belgium? Or was it a language problem, where she didn’t remember the word for a certain smell? Or was it that she had lost the memory of that smell? We didn’t know,” Olsen said.

Karine had been using a pencil to scratch and reveal the scents, but was unable to recognize any of them. Olsen decided that the problem might be that she was not removing enough coating to release an aroma.

So Olsen got a room key that Karine could use to scratch harder. Still nothing.

The next day, Olsen asked her, “Have you ever done this scratch and sniff exercise?” Karine shook her head no. But when they started the tests and Olsen picked up the pencil, Karine picked up the key.

In that moment, Olsen felt a spark of hope that Karine’s whole life could change. And Colette started to cry with relief.

“It told us there was something accessible in Karine that would allow her to learn,” Olsen said. “She didn’t remember that she knew something, but she had learned it. That’s when I knew we were on to something.”

The Lemon Squares

During the researchers’ visit to Brussels, Karine made an elaborate dinner for them and her family. During the meal, her father suffered a heart attack, and was rushed to the hospital. She does not remember the dinner, but she does recall her father’s brush with death.

The more traumatic or compelling the circumstance, the more likely a person is to encode and file that memory, the researchers said.

That summer, Olsen said to Colette, “Let’s just try, let’s just see what we can do” with cooking. Recipes were a series of steps, and Karine apparently was able to learn or recall information that she learned in steps.

In 1989, Karine and Colette made two visits to Orange County. Most of the time, Karine was cooking. In Olsen’s Laguna Beach home, she made lemon squares for days on end.

Each morning, the ingredients were listed on cards, the steps to make them spelled out exhaustively: Preheat the oven to 350 degrees. Get out a mixing bowl. Take box of cake mix out of the cupboard, open the top and pour the contents of the bag into the bowl. Throw the box in the trash. Take out a measuring cup and a box of sugar from the cupboard, set it on the counter, open the top of the box . . .

“It can take a loooong time for Karine to make something,” Colette says with a twinkle in her eye.

Each morning, Olsen would ask: Do you remember baking something yesterday? No. Do you remember what you baked with? No. OK, if you were to bake lemon squares, what do you think some of the ingredients would be? Pire would remember half the ingredients. And how do you think you might go about preparing lemon squares? She would list more of the steps each day.

Although Olsen never wanted to look at lemon squares again after that, the exercise told her that even though Karine had very little memory, she could learn things anyway.

“What is so important to remember,” Parker said, is “that she (could have) been relegated to the back wards of an institution and the family was told, ‘Nothing can be done.’ ”

The Mind’s Mysteries

Although there is disagreement and uncertainty over how memory works, the Irvine researchers subscribe to a theory developed by Canadian Endel Tulving:

There are at least three basic memory systems. The first is episodic, which is what most of us consider to be our memory. This is the collection of events, thoughts and feelings we accumulate through life. It requires a conscious effort and becomes part of our self-awareness.

The second system is semantic, that pool of knowledge about the world and ourselves that we acquire through life but don’t necessarily know how, like the spelling of a word. Also called learned information, it is not necessarily related to episodic memory.

The third system is procedural, and it consists of information that is gathered in a more primitive way. A baby throws a toy, it hits the wall and lands, a parent fetches it and returns it. After the infant does this repeatedly, the information is remembered.

This is now the main memory engine Karine uses, the researchers think.

They figured that if step-by-step cooking worked, she might be able to learn other things the same way. Parker and Olsen would come up with a theory, and Colette would apply it, step by step, to an everyday task.

Constant observation and attention to Karine as she performed these tasks was critical. Once she learned an error, it was very difficult to unlearn. So her mother would take the learning-by-steps concept and apply it to everything. It took them two years to get the hang of it. Now, the system is constantly evolving as Karine acquires skills. As this happens, Olsen says, Karine becomes more confident, and she has developed poise and budding self-identity.

Finally, a Future

On a late fall morning, I visited Colette and Karine in their apartment. They were excited that a reporter would write about them, and they wanted parents of the brain-injured to be familiar with the community services that Colette has learned about the hard way--through persistence.

Karine and her mother moved here three years ago so that Karine could attend Coastline’s Traumatic Head Injury program.

Of her daughter’s transformation, Colette said simply, “To come from this nothing to now, it is truly something. Not many people know about this program, which Bonnie told us about.”

Karine--who always smiles when she talks, her chin thrust upward like a boastful child--said her three years of classes have been “a big change. I graduate in June. That is the best.”

What the Coastline program has given her is spelled out in a February paper she wrote on her computer, its title--”How the college has Interfered in My Life”--translated from French. She wrote: “I have more independence. I have found back my character. I have an opened mind. I can exchange my ideas, my opinions with other persons. All this occurred thanks to the Interact Course.” The computer class, she said, gave her “more memorization (with some games). I write every evening what I have done during the day (with my own computer at home). Manual dexterity.

Acceptation of all my errors (with no argue).”

And her conclusions: “The influence of the school had played a big part in my evolution and today I plan to create a newspaper for head-injur(ed) in my country. With some information from specialist peoples, and a great part written by head injur(ed) themselves (feeling, living, network, easy recipes).”

She has step-by-step lists for almost every key activity in her daily routine. They are laminated so she can mark off completed tasks, then wipe them clean for reuse. Two days a week she does banking and marketing. On one recent trip to the grocery store, she carried a detailed list of provisions and studied it repeatedly as she shepherded her cart through the aisles. She was slow, but she made no mistakes, even recognizing Laughing Cow cheese from Belgium.

A half-hour after we parked, she could not find the car.

Three times a week, she spends afternoons at the Dayle McIntosh Center’s Clubhouse in Orange. It is a nonprofit program where she is acquiring job skills and socializing at dinners and dances.

After graduation and her return to Belgium next summer, Karine will live in her own flat in Brussels, purchased with savings her father left when he died two years ago. Belgian public benefits will help as well, and most of her bill payments will be electronically withdrawn by creditors. All of her drawer knobs will be color-coded: blue for sweaters, yellow for writing utensils. Her mother will live in an apartment down the hall.

Karine plans to work at least part time; cooking, errands and personal preparations take most of a morning. She can get herself to and from the bus stop, pack her own clothes for a vacation and secure her apartment before leaving.

She has already volunteered at a peace organization and a day-care center.

“It is always important for the work, even if it is something volunteer,” her mother said. “Doing something, having a purpose, it is so good for Karine.”

Flying Solo

The medical community generally holds that recovery from a brain injury peaks at one year. Karine is in her eighth.

“To have this girl function in society with a severe memory deficiency” is very special, Starr said. “She needs a lot of support now, but I suspect in 10 years she’ll be fairly independent. But then we all need a bit of help--from bosses, from parents, from spouses,” he said with a wink.

So what is the value to society of having a person perform the functions of life without necessarily feeling the emotions that accompany them?

“You can write people off like this and say they are complete vegetables or get great disability (benefits for them),” Parker said. “But here is someone useful and not locked up like an animal. To say she will ever be completely independent, I think that’s her mother’s fantasy. . . . But to me this is a story of hope, to me it’s the way that memory theory can be useful to others, and how what we learn from Karine can help others if they apply it.”

Half a million Americans each year suffer some form of brain injury--from car wrecks or heart attacks to strokes--and 90,000 suffer permanent brain damage. Memory loss is a common result. What makes Karine’s case remarkable is her comeback, and the uncanny way that fate brought her to the researchers. Had her friend not been Starr’s patient, had her mother not crusaded to get her help and her family not had the means to fly her here, she might still be staring into space.

Will Karine ever feel the way someone with an undamaged memory can?

“Who we are today are all the events we had up to today,” Olsen said. “Without the past you don’t have a future. So you are not only static, you just don’t care. She doesn’t care about 10 minutes from now.”

But there are signs of progress.

Typically, Karine would make a remark such as, “Orange trees are so pretty,” said Olsen, who spends several days a month with her. The other day, she said, “I’d really like to buy an orange tree for the patio.”

“That looking into the future, the reflection, it’s not clear where it is coming from,” Olsen said. “But to have a sense of self one needs to be able to reflect. . . . It was a subtle emerging of a personhood.”

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