Fleischman starts off by stating that Gage has become a staple of textbook examples in psychology and neurology due to the fact that his accident helped describe the function of the frontal lobe. This part of the brain is found behind the forehead and is responsible for planning, decision-making, judgment, and social behaviors. Modern-day neuroscientists Antonio and Hanna Damasio have found that patients with damage in the same areas of the brain (the frontal lobe) have some traits in common with Gage. For instance, patients who were injured in the frontal lobe tend to perform well on logical or mathematical type tasks; however, they struggle to make good decisions in everyday life. Patients may appear to lack emotion (their emotions are “flat”) or have difficulty matching their emotional response to the situation at hand. Additionally, they may have difficulty understanding social cues or responding with empathy.

According to Fleischman, most of the patients studied by the Damasios had suffered damage from surgery to remove tumors in the frontal cortex. Although surgeries such as tumor removals save patients’ lives, they can result in permanent changes to a person’s personality and/or behavior. To study these patients, the Damasios used modern scanning techniques (such as computed tomography [CT] and magnetic resonance imaging [MRI]) that provide detailed visualizations of the living brain. They also developed simple tests to measure each individual’s emotional response. One test measured skin conductance. Since skin temperature typically increases and sweating occurs during times of high emotional arousal, the Damasios used this test to gauge each patient’s ability to respond emotionally. During testing, patients viewed positive images (i.e., happy scenes), negative images (disturbing pictures), etc. Skin responses remained nearly flat among all tested patients. Another test was administered using a computer-based “gambling” task. Players attempted to determine which deck (in a set of four) contained safer cards. After repeated attempts, most players eventually learned to choose safer options, whereas patients with damage to their frontal cortex continued to select the less safe option even though they could logically articulate why the other option would be better.

Hanna Damasio then tried to create a more accurate representation of Gage’s brain injury than Dr. Harlow did. According to Fleischman, Dr. Harlow was unable to accurately determine exactly where the tamping iron entered into Gage’s skull. Therefore, modern-day researchers need a more precise definition. In 1994, Hanna asked a doctor at Harvard University to examine Gage’s skull again. The skull was photographed, measured, and X-rayed, and the data were digitized. Using a three-dimensional computer model of a human skull, she created an overlay of Gage’s skull and plotted the entrance and exit points of the tamping iron. She also electronically inserted the tamping iron into the skull. Using another computer program called Brainvox, the team fit a model brain into the digital skull and calculated probable pathways for the tamping iron to travel through. By comparing these probable pathways to the physical evidence of Gage’s skull, the team eliminated unfeasible paths and narrowed down their possibilities to one possible path.

Gage’s reconstructed injury showed that he sustained a very serious head injury but managed to survive due to the narrowness of the tamping iron. The tamping iron missed several key areas in Gage’s brain that regulate basic functions. The tamping iron avoided areas in the brain known as Broca’s area that control language production, as well as motor and somatosensory strips that control movement, sensation, and spatial awareness. As a result, Gage retained cognitive abilities such as balance, attention, memory, and verbal skills. However, at the same time, the tamping iron damaged significant portions of the frontal lobe, particularly in the left hemisphere of Gage’s brain and the lower-frontal region. Hanna Damasio recognized this damage as consistent with the damage observed in her own patients who experience difficulties with decision making and emotional expression. Thus, what made Gage’s injury so exceptional was both where the tamping iron went and where it didn’t go.

Finally, Fleischman describes Gage’s place in modern-day memory. The Brainvox image appeared on the cover of Science magazine and received widespread coverage in popular media outlets. Today, Gage’s skull and tamping iron are preserved at Harvard Medical School, where they serve as significant medical relics. In 1998, Cavendish Vermont held a festival/medical conference celebrating the 150-year anniversary of Gage’s accident. Researchers and patients came together at this event to discuss and contemplate what Gage’s case has contributed to our knowledge of the brain. A commemorative plaque was erected in Cavendish explaining Gage’s accident and its significance. Finally, Fleischman addresses the concept of luck. He states that while Gage suffered greatly from his accident and was forever changed by it, he was able to lead a productive life for 11 more years after the accident, worked, traveled, and died surrounded by his loved ones.