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A Beautiful Mind ...
Andrew Engel has spent nearly 12 years in college, working gradually, steadily for the chance to utter that word. The moment came last week, when the University of Maryland, Baltimore County senior completed his final course requirements for a degree.
Graduation, scheduled for tomorrow afternoon at 1st Mariner Arena, was still
a week away, yet as Engel walked across the campus of emerald grass and boxy
buildings, he allowed the joy of accomplishment to consume him. That way,
the moment would be permanently etched in his long-term memory, instead of
becoming a feeling he knew he had experienced but could not recall.
A malignant brain tumor, discovered shortly after he began his freshman year
at Rutgers University in 1995, robbed Engel of much of his short-term memory.
His drive and intelligence, however, remained undiminished. That is why Engel,
who lives in Ellicott City, is not only a degree candidate but an inspiration
to many who have witnessed his odyssey.
"He was determined, very determined that he was going to do this," said
Joyce L. Riley, associate director of UMBC's Health Administration and Policy
Program and Engel's academic adviser.
A team of doctors at Johns Hopkins Hospital that included Dr. Benjamin Carson
removed the tumor in November 1995, but the damage it caused was so extensive
that the doctors warned that Engel would likely never excel in a college setting.
Engel refused to accept that limitation. He asked his doctors to help him devise
a new way to retrieve information from a brain that had become unable to retain
significant amounts of it for more than a few minutes. They tailored a program
that helped him prod information from his short-term memory reserves into long-term
memory.
Engel enrolled at Howard Community College in 1997. Two years later, he transferred
to UMBC, registering for no more than two classes a semester, taking his tests
untimed, reading his course work aloud twice and hiring a notes-taker to bolster
his extensive notes-recording regimen.
"It's surreal - I still can't believe it," said Engel of his coming
degree in health administration and policy. He's 29 now.
"I go home and I feel like I should be studying. I'm watching TV and I'm
like, 'I can't be watching TV. I have to go and study.' I can't believe it, because
I've been in school for so long. I feel like there should be another class coming
up."
But there isn't. Instead, he is about to enter the working world, more than a
decade behind those with whom he graduated from Columbia's Wilde Lake High School
in 1995. That includes his identical twin brother, Jason, a lawyer who graduated
from Rutgers and the University of Maryland School of Law.
The two had been inseparable throughout much of their childhood. Most people
couldn't tell them apart until their teen years. That's when Andrew Engel suddenly
stopped growing. Now 5 feet 8 inches, he is nearly a foot shorter than his brother.
At the time, Engel did not know that a brain tumor had damaged his pituitary
gland, which secretes a growth hormone. During his freshman year at Rutgers,
the tumor's impact soon became evident. Engel was eager to make a solid start
in college, hoping for a 4.0 grade-point average. But not only was college much
more difficult than high school, no matter how much he studied, he couldn't remember
his course work.
"He would call home and say, 'Everyone is so much smarter than I am,' and
that didn't sit right with us," said Engel's mother, Eileen, a retired elementary-school
teacher. "At the time, his older sister was there, too, and we asked her
to help him. We thought that it was maybe anxiety or being away from home. She
took him to the library to help him with one assignment and called me and said,
'Mom, he can't remember one paragraph to the next.'"
Engel arrived at Rutgers in August 1995. A few weeks later, he began occasionally
forgetting the names of his friends or his dormitory. He left school before the
end of September. Then one day, while at The Mall in Columbia, he could not quench
his thirst, no matter how much he drank.
His mother took him to a pediatrician. An MRI revealed a germinoma, the most
common type of germ-cell tumor in the brain.
"I knew that it was likely a tumor, but I thought it would be benign, something
that could be easily taken care of," Eileen Engel said, "but it turned
out to be malignant."
The family took the ordeals in stride. "I'm a very pragmatic person, not only with Andrew but with myself," Eileen Engel said. "I don't look ahead. I just take it one step at a time. I'm the kind of person where if I have a problem, I research it, find out what decision I need to make, go over the pros and cons and don't look back."
Engel embraced the same philosophy through surgery and treatment. "Dr. Carson said he didn't want to be too aggressive," Engel said, "so they removed part of the tumor and then took care of the rest with radiation." But then Engel began vomiting several times a day, his appetite diminished and his weight fell to fewer than 100 pounds.
Doctors inserted a tube in his nose to feed him a nutrition drink. Although he began to regain strength, doctors told him that the damage to his short-term memory would prevent a successful return to the classroom.
"I was frustrated because I really had a strong desire to go back," Engel said. While friends complained about their heavy college course loads, he found himself wishing he could share that burden.
"When he came to us, he was sad and angry about what he was going through, and wondering why that sort of thing had to happen to him," said Dr. David Schretlen of Johns Hopkins' Department of Psychiatry and Behavioral Sciences.
"Andrew has severe amnestic syndrome," said Schretlen, referring to a particular grade of amnesia. "He was unable to learn and remember new information. If you gave him a list of 15 words, he could remember seven or eight of them, but if you asked him 20 minutes later, he could remember one or two. His immediate memory was normal but after 15 to 30 minutes, what he learned would have gone."
Schretlen helped tailor a learning program especially for Engel. He and then post-doctoral fellow Dustin Gordon would go over Engel's syllabus and assignments in advance of the learning process.
Engel carried a pocket-sized notebook to jot down information throughout the day and occasionally used Post-It notes. He would organize his thoughts for writing essays. He would remember a date or an event in history by visualizing related scenes.
"He sustained damage to the neurological structures that support memory," said Schretlen, who added that such damage cannot be repaired. "That's what makes his accomplishment so impressive, because he has been able to compensate for the damage to his neurological hardware."
After eight months of experimentation, Engel enrolled in Howard Community College, where he put his new memory-retrieval skills to work. He would employ mnemonic memory aids, similar to "i before e except after c." He would review assignments over and over and then read them again just before the start of a class. He typed all his notes from his notebook to help himself remember them.
He did well enough to transfer to UMBC in the spring of 1999, enrolling as a sophomore with 40 credits from HCC. By then, he had grown more familiar with how much work he could handle and took no more than two classes per semester. He often dropped a class if it proved too troublesome.
He even secured his own internships, including one as a guest-relations intern at Sinai Hospital that had him keeping records of patient satisfaction.
"This has taught me about determination and never giving up," he said. "I think I was always determined. I was a good student in high school. I had a 3.8 GPA. But in college, I was a better student because I worked many, many, many times harder. Now, I'll just try to work as hard [in the work force]."
He has begun his job search, seeking work at a retirement community, nursing home or hospital. But first things first. His family has already gathered for tomorrow's graduation, eager to witness a moment nearly 12 years in the making.
"Actually, I hope I won't be too emotional," said Eileen Engel, her voice filled with laughter. "I'm a breast cancer survivor, and four years ago, they gave me two to four years to live. I was praying to make this graduation."
The damaged pituitary gland left Engel with a boyish face, which helps him blend in with many of his classmates, a good number of whom are more than a decade younger.
As he walked across the UMBC campus Monday, Engel pointed to several buildings that weren't there when he began as a sophomore. Many instructors have come and gone. As for the students, two graduating classes have come through the school since his arrival. He's been there long enough to remember things, ironically, that others can't.
"A couple of days ago, I was pointing to a place on campus and I said, 'There used to be a Chick-fil-A there,'" he said. "And someone looked at me like I was crazy."
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