Brimmings: up from the well

I find every patient I see, everywhere, vividly alive,
interesting and rewarding; I have never seen a patient
who didn’t teach me something new.  Or stir in me new
feelings and new trains of thought.
–Oliver Sacks

I’ve just finished Oliver Sack’s recently published autobiography, On the Move: a Life. Better, I devoured it.

Medicine has always interested me, and I read a lot of its literature on an almost daily basis. Still, while I know some things about how the body works, I’m largely ignorant when it comes to how the brain functions, its capacity for life enhancement and, conversely, its potential for horrendous suffering, physical and mental, when failing to function properly, either through genetics, injury, disease, or simply aging.

In reading Sack’s book, I’ve made a dent into the immensity of what I’ve missed. After all, Sacks is a neurologist, and a gifted one at that–a doctor fond of research with an extraordinary compulsion for not only writing down his observations of more than fifty years, but in an idiom we laymen can understand.

He’s written eleven books, published in hundreds of medical journals, and with a rare propensity for uniting science and art, has regularly contributed to the likes of The New York Review of Books and my favorite, The New Yorker. The New York Times has appropriately dubbed him “the poet laureate of medicine.”

Do you remember the riveting movie, Awakenings, starring a young Robin Williams and Robert De Niro, with its moving depiction of postencephalitic patients hospitalized for some forty years, initially responding to a bold and controversial therapeutic approach that gave them a brief window of normality, only to relapse? It came from Dr. Sacks’ book of the same title.

You may also know of his popular collection of brain vagary anecdotes published as The Man Who Mistook His Wife For a Hat.

What I find most compelling in Sacks is his innate compassion for his patients, a doctor who sees them as individuals possessing a context integral to their healing and thus worth knowing, a practitioner who conveys to his patients that they matter deeply.

Up there too is his refreshing approach of reaching past the compensational paradigm of contemporary medicine to root out the origins of our morbidities and facilitate their cure.

And no corner thing, there’s his open honesty about his earlier drug addiction.

Likewise, he writes movingly of being gay and about his several loves.

At the personal level, Sacks is a natural draw for me in his love for both science and literature, lifelong zeal for motorbikes and  weight lifting, his introversion, a brother with schizophrenia (which is true of my son), his outspokenness about entrenched medical prejudice with its jealousies and frequent resistance to innovation.  All of these, and more, find their way into On the Move.

I was surprised to learn that Aubrey “Abba” Eden, Israeli diplomat, who always impressed me with his Cambridge accent and articulate English, was a first cousin; likewise, Al Capp, formerly loved for his Little Abner cartoons until his sexual downfall.

Sacks, towards the end of his autobiography, writes of his declining health, without mentioning his now, terminal metastatic melanoma (he’s now 82). I take this omission as his not wanting reader pity to enter into play in judging his autobiography.

The reality, of course, is that Sacks is a very brave man who has lived in death’s neighborhood for many years, both as a physician and in his personal life.  Thus I wasn’t surprised  in the least in his openness and acceptance of his terminal illness elsewhere.  See http://www.nytimes.com/2015/02/19/opinion/oliver-sacks-on-learning-he-has-terminal-cancer.html?_r=0

Below I’ve given you my chosen book highlights, hoping they’ll entice you to read this supremely humane work.  As I write, On the Move has made the Best Seller List of the New York Times:

On being gay:

“You are an abomination,” she said. “I wish you had never been born.”

My mother, so open and supportive in many ways, was harsh and inflexible in this area.

Her words haunted me for much of my life and played a major part in inhibiting and injecting with guilt what should have been a free and joyous expression of sexuality.

On taking tests:

I am very bad at factual exams, yes-or-no questions, but I can spread my wings with essays.

On his brother’s schizophrenia:

…what sort of world Michael lived in, none of us knew. And yet he was very intelligent; he read continually: had a prodigious memory, and seemed to turn to books rather than “reality” to get his knowledge of the world.

On the poet Thom Gunn:

I’m not sure what Thom saw in me at this point, but I found in him great personal warmth and geniality and warmth mixed with fierce intellectual activity. He was incapable of indirection or deceit, but his directness was always accompanied, I thought, by a sort of tenderness, too.

On Robin Williams (who, portrayed Sacks in the film version of Awakenings):

Over the next twenty-five years, Robin and I became good friends, and I grew to appreciate–no less than the brilliance of his wit and his sudden, explosive improvisations–his wide reading, the depth of his intelligence, and his humane concerns.

On medicine:

This gave me a feeling of what was wrong with American medicine, that it consisted more and more of specialists.

…unconscious motives may sometimes ally themselves to physiological propensities. One cannot abstract an illness from the whole pattern, the context, the economy of someone’s life.

On Awakenings:

The postencephalectics had been in a state of suspension for decades–suspension of memory, perception, and consciousness. They were coming back to life, to full consciousness, and mobility. Would they find themselves like Rip Van Winkle, anachronisms in a world that had moved on?

When I gave L-dopa to these patients, their “awakenings” were not only physical, but intellectual.

American Medical Association response to “Awakenings” experiment:

In the summer of 1970 then, in a letter to JAMA, I reported my findings, detailing the total findings of L-dopa in sixty patients whom I had maintained on it for a year. JAMA published my letter, but while I had got plenty of positive responses to my letter in The Lancet, my letter in JMLA was greeted by a strange, rather frightening silence.

The silence was broken a few months later, when the entire letters section in one JMLA was devoted to highly critical and sometimes angry responses from various colleagues.

I thought it was improper of JMLA to publish these attacks without giving me an opportunity to respond to them in the same issue.

I knew that I had something important to say, but I had no way of saying it, of being faithful to my experiences without forfeiting medical “publishibility” or acceptance among my colleagues.

On the death of his mother:

My mother’s death was the most devastating loss of my life–the loss of the deepest and perhaps, in some sense, the realest relation of my life.

On W. H. Auden:

He was …critically important to me during the writing of Awakenings, especially when he said to me, “you’re going to have to go beyond the critical…Be metaphorical, be mystical, be whatever you need.”

I wept after I received Auden’s letter [following publication of Awakenings]. Here was a great writer, not given to facile or flattering words, judging my book a “masterpiece.”

On nursing homes:

In some of these places …I saw the complete subjugation of the human to medical arrogance and technology. In some cases the neglect was willful and criminal–patients left unattended for hours or even abused physically or mentally….I worked in other nursing homes where there was no negligence but nothing beyond basic medical care. That those who entered such nursing homes needed meaning–a life, an identity, dignity, self-respect, a degree of autonomy–was ignored or bypassed; “care” was purely mechanical and physical.

On himself:

I am shy in ordinary social contexts; I am not able to “chat” with any ease. I have difficulty recognizing people (this is lifelong, though worse now my eyesight is impaired). I have little knowledge of and little interest in current affairs, whether political, social, or sexual. Now, additionally, I am hard of hearing, a polite term for deepening deafness. Given all this, I tend to retreat into a corner, to look invisible, to hope I am passed over.

On writing:

The act of writing, when it goes well, gives me a pleasure, a joy unlike any other. It takes me to a place–irrespective of my subject–where I am totally absorbed and oblivious to distracting thoughts, worries, preoccupations, or indeed the passage of time.

__rj