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Ernest Hemingway had spent the majority of his last seven months being treated for depression at the Mayo Clinic, during two separate stays in the winter and spring of 1960 and 1961. He had been delusional, depressed, paranoid, and suicidal.

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Upon hearing the news, President John F. Kennedy remarked, “Few Americans had a greater impact on the emotions and attitude of the American people than Ernest Hemingway. . . . He almost single-handedly transformed the literature and ways of thought of men and women in every country in the world.”

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Nonetheless, those months in Rochester failed to heal the writer. A detailed examination of Hemingway’s case—based on letters, records in the Mayo archive, and interviews with locals who met him—reveals a complicated story about his unorthodox treatment.

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The heartbreaking ending—Hemingway’s suicide—has been chronicled in countless biographies. But the Minnesota interlude at Mayo that preceded it—when two midcentury icons crossed paths—deserves its own chapter.

***

Soon after summer vacation started, Lynne Bartholomew had been climbing trees and playing baseball in the park with her friend Franny Butt. Afterward, the pair of 12-year-old tomboys stopped at Franny’s house, where they found her father, Dr. Hugh Butt, standing in the doorway alongside a tall, bearded man.

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An aura hung about him, but she did not know who he was.

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“Yup,” Lynne said. “He didn’t mind.”

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But his hard living—including nearly a dozen concussions—had ground down his body and mind. During the summer of 1960 and into the fall, the 61-year-old writer became increasingly paranoid, deluded, and depressed. The worries caused him to lose weight, interrupted his sleep, and spiked his blood pressure. Once robust and athletic, he had become frail and thin. He talked more insistently of suicide, an obsession which dated back to 1928, when his father shot himself. It all nearly drove Mary, his fourth wife, mad.

They had met in 1944, when both landed in London, covering the war as journalists. Mary Welsh was born in Walker, Minnesota, and raised in Bemidji. Small and slim, and nine years younger, she could hold her own against him fishing and hunting, drinking and screwing. A week after they met, he proposed marriage, despite the fact both were married to other people. “He was such an impulsive man,” she told a journalist years later.

With her husband’s mental condition crumbling in the fall of 1960, Mary sought the advice of George Saviers, the local doctor where they lived in Ketchum, Idaho, and one of Hemingway’s good friends. Hemingway refused the suggestion to check into the Menninger Clinic in Topeka, Kansas. “They’ll say I’m losing my marbles,” he complained.

He eventually agreed to Mayo. Then as now, the Mayo Clinic enjoyed a reputation as the world’s finest and most famous medical center. He could go there under the cover of treatment for his high blood pressure and, tucked away in the boondocks, avoid scrutiny from the press.

On November 30, 1960, Saviers flew with him from nearby Hailey to Rochester in a four-seat Piper Cub piloted by Larry Johnson of Johnson’s Flying Service. The hospital admitted Hemingway secretly, under Saviers’s name, and placed him in a private corner room on the first floor of Saint Marys Hospital, concealed among rheumatism and arthritis patients. Mary followed by train, plane, and bus, checking into Room 1060 at the Kahler Hotel as Mrs. George Saviers.

Nonetheless, as Charles Mayo observed in his autobiography, all that secrecy didn’t stop curious hospital staff from streaming by to glimpse the famous patient.

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Mayo Clinic assigned two of its top doctors to treat Hemingway, the internist Hugh Butt and the psychiatrist Howard Rome, both 40 years old. Butt had distinguished himself with the discovery that vitamin K could save jaundice patients from fatal internal bleeding. Rome, chief of psychiatry, loved literature and advocated reading Dostoyevsky to understand psychiatric conditions.

In his initial examination (which he later summarized in a letter), Butt diagnosed Hemingway with a mild case of diabetes and an enlarged liver. The latter suggested hemochromatosis, a rare hereditary condition that prevents people from absorbing iron. The condition is sometimes associated with diabetes, memory loss, and depression—all symptoms Hemingway presented. The only way to confirm the diagnosis involved a liver biopsy, but that required surgery. Butt opted not to take the risk, most likely attributing Hemingway’s swollen liver to decades of daily drinking.

Both Butt and Rome believed Serpasil, one of Hemingway’s blood-pressure medications, may have caused what Rome described as “depression, agitation and tension”—perceived side effects of the drug. They took him off Serpasil and off the Ritalin he had been prescribed to counteract it. Rome instead prescribed Librium, a then-new sedative that had yielded positive results in reducing anxiety and tension in alcoholics.

Rome also administered electroconvulsive therapy. At a time when the mentally ill were warehoused in asylums, Mayo stood out for its attempts to cure these patients in a hospital setting. Rome would describe himself as “an unregenerate optimist” in an interview with the Mayo alumni magazine.

Electroconvulsive therapy (ECT) sends electric currents through the brain to trigger a brief seizure, which causes the body to jerk uncontrollably for about 40 seconds. With antidepressants and antipsychotics in their infancy, it was the most effective treatment for severe depression, generating a reported 90 percent cure rate. (Indeed, Mayo and other medical facilities still administer ECT, though no one yet knows exactly how it works on the brain’s circuitry.) A typical course of treatment ran 10 to 12 sessions, administered twice a week.

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Days he didn’t get shocked, Hemingway roamed the hospital, run by the Sisters of Saint Francis, often stopping in at the first-floor office of Sister Lauren Weinandt, assistant to the administrative director, to sit and chat. One day he gave her a six-inch decorative Christmas tree for her desk.

She knew he was there to be treated for depression. “But he was always up when he talked to me,” the 97-year-old nun told me.

Sometimes he walked up the hill behind Saint Marys—nicknamed “Pill Hill” because many doctors lived there—to the Butts’ stucco house on Southwest Seventh Street. Butt had invited him to stop in whenever he wished to sit in the bright sunroom, browse his library, or simply rest.

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Franny complied. “His stomach was like iron,” she said.

Dr. Butt invited the Hemingways to Christmas dinner. Nervous about hosting the famous author, Mary Butt prepared a bûche de Noël, needing three tries to get it right. Dr. Butt served one of the best wines from his cellar. The Hemingways entertained the Butts and their four children with songs in French and Italian.

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***

By early January, however, Rome believed Hemingway had shown enough progress to discontinue the shock treatments. Sunday, January 8, the doctors hosted a luncheon with Hemingway as the guest of honor. Afterward, Butt took him trapshooting at an abandoned quarry near Mayowood. Hemingway, an excellent shot, picked off 27 consecutive clay pigeons.

On January 10, while Mary visited relatives in Bemidji, Hemingway’s medical care at Mayo became national and international news. The following morning, the clinic uncharacteristically released a statement acknowledging that doctors at Saint Marys were treating him for hypertension, with no mention of depression or ECT. The statement added, “It is necessary that his right to privacy be respected and that he have the benefit of rest and quiet.”

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When the story went national, strangers sent Hemingway letters and gifts—a scapular, a rosary, a poem. Acquaintances dating back to the Great War called to wish a speedy recovery. Journalists circled like predators.

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A day later, Gary Sukow reported in therae dunn wizard of Oz mugs,that Hemingway was receiving electroshock treatment, without confirmation from Mayo. Hemingway fretted that the story would go out over the wire services, but Eckman prevented it.

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He found energy to answer mail that had accumulated. Seeing the exercise as therapeutic, Rome offered the services of his longtime secretary, Marie McQuarrie. She typed for hours while Hemingway dictated a flurry of letters from his bed that frequently mentioned his eagerness to resume work on a memoir about Paris (published posthumously as A Moveable FeastDisney Loungefly Mickey Mouse Denim Mini Backpack,

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Rome wrote, “It is my judgment that you have fully recovered from this experience and I see no reason to anticipate any further difficulty on this score.”

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By late March and into April, he became listless and withdrawn. On April 18, he wrote to his publisher that he had only messed up the Paris memoir and conceded failure. Once again despair consumed him. His moods, which could descend into vicious tirades, tormented Mary. She suggested he return to Mayo.

He confided in Tillie that he had an incurable disease, hinting at suicide. “There’s no other way out for me,” he said. “I am not going back to Rochester where they will lock me up.”

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When Saviers finally arrived for their noontime trapshoot, he managed to convince Hemingway to come to the hospital, and sedated him there. That weekend Saviers arranged for Hemingway’s return to Mayo. Monday morning, Hemingway asked to pick up some fresh clothes at the house. Don Anderson, a husky friend, drove him.

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On the flight to Rochester, Hemingway struggled to open the door and jump out of the plane. During a fuel stop in South Dakota, he rummaged through parked cars, searching for a gun.

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Rome assigned Hemingway, admitted under his own name, to 6D East, the locked psychiatric ward. The doctor observed “classical diagnostic features of an agitated depression: loss of self-esteem, ideas of worthlessness, a searing sense of guilt.” And Rome immediately began an aggressive round of shock treatments, four in the first five days.

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A week later he wrote to Mary that their whole financial situation seemed hopeless to him, that he could not remember account details, and that the day after a treatment, “my head is buzzing so that I can barely write this.”

On May 8, after two more treatments, he wrote her in a letter he didn’t finish, “The electric business knocks all of the addresses out of your head.”

Side effects of ECT include memory loss, though usually temporary. The confusion deeply troubled Hemingway, who had possessed a near-photographic memory. Mary believed Rome thought the shock treatments were more effective than they actually were. It is now understood that alcoholics often don’t respond to ECT, and Hemingway was undoubtedly an alcoholic. If he was also suffering from undiagnosed dementia, as some medical historians now suspect, the shock treatments could have worsened his condition.

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***

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Rome understood the harmful effects prolonged confinement could inflict upon a patient and worried the loss of freedom might be detrimental to Hemingway. So when Hemingway pledged not to harm himself, Rome relaxed the restrictions. He allowed Hemingway to leave the locked unit as he pleased to go trapshooting, picnic near the Mississippi, and hike the outskirts of town, where residents were surprised to see him in their familiar surroundings.

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Other times, Hemingway stopped to talk to Bianco’s son Dick when he was mowing the lawn. “He was like a bear, very hairy,” Dick told me.

Farther along, in a house on Balsam Court, Myra Sullivan looked up from the kitchen window one morning while peeling potatoes and spotted her literary idol walking by briskly. The sight repeated itself maybe 10 times that spring.

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Even by the standards of the time, which were more lenient than today’s, it was unusual for doctors to grant a patient with an enlarged liver and a long history of daily drinking license to consume alcohol. It was stranger to put a gun in the hands of a depressed patient who had intended to shoot himself.

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At the same time, the intimacy of the relationship gave Hemingway’s doctors insights about their patient. Aware of Hemingway’s extroverted nature, Rome charged Bob Rynearson, one of his young residents, to socialize with the writer. Bob was the son of Edward Rynearson, an endocrinologist at Mayo, a friend of Rome and Butt, and a collector of Hemingway first editions. The younger Rynearson invited Hemingway to Sunday brunch at his parents’ Cape Cod–style house in the Sunny Slopes neighborhood, where deer roamed the lawns. Their house featured Rochester’s first in-ground swimming pool, surrounded by a white fence and grape vines.

“They told us to treat him like family, but I thought there is no way he is like one of us,” Bob’s wife Marjie told me. She avoided him at first, busying herself with brunch preparations in the kitchen. “It made me anxious to think we had a famous person down by the pool.”

That spring, Hemingway became a regular at the Rynearsons’ table and pool, making the mile-and-a-half walk from Saint Marys with Bob’s sister Ann, a recreational therapist. He enjoyed splashing in the pool with the children and telling them stories about the war. He shadowboxed poolside with Bob and, according to family lore, cut his knuckle on Bob’s tooth.

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The turtle steaks turned out a bit tough, but Marjie redeemed herself another night with a pheasant dinner that “delighted” Hemingway. He gave Marjie and Bob a copy of New Elemis collagen marine bundle, inscribed, “Here’s hoping we can fish together some time. Your old sparring partner, Ernest Hemingway.” At 9 pm a driver came to return the patient to his locked room at the hospital.

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In early June, Aaron Hotchner visited and drove Hemingway out of town for a walk in the woods. Hotchner later detailed the outing in his book.

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Mid-June, Rome informed Mary that her husband’s sexual drive had returned and suggested a conjugal visit. She arrived around June 21, but the assignation ultimately proved “entirely unsatisfactory to either of us,” she wrote in her memoir. Two days later Rome asked Mary to meet him in his office. She was surprised to see her husband dressed in street clothes and “grinning like a Cheshire cat.” 

The doctor told her Hemingway was ready to go back home. Rome believed his best chance at recovery lay in being free to write. She disagreed but figured it futile to argue. “I realized that he had charmed and deceived Dr. Rome to the conclusion that he was sane,” Mary wrote.

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Perhaps he had finally found peace in his resolve. Or perhaps she created this version later.

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Rome had wanted to spare Hemingway the “corrosive deteriorating effects of” confinement in the hospital. In tight, even script, he expressed his sympathy and his regret that he could not have done more: “My sorrow is at the loss of such an unusual man, a complex of paradoxes which made him the genius he was at capturing the spirit of a whole generation because he personally epitomized its conflicts and contradictions, its anxiety and courage.”

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Three months later, she wrote Rome, lamenting, “What more could I have done?”

He replied with a typed, single-spaced, four-page letter, reminiscing almost fondly about his many conversations with Hemingway. They’d talked about suicide, honor, fears, and the desire for control. Rome hinted at remorse.

Yet after months spent reflecting on the course of events in Rochester and Ketchum, he concluded, “I feel sure that had I to do it over again today with the information I had, I would do again as I did then.”