OLIVER SACKS
Medicine, the saying goes, is as much an art as it is a science. Certainly doctors, at their best, treat their patients, not just as bodies, but as whole persons, whose emotions and experiences are no less important than their illnesses or injuries. So it is unsurprising that some doctors, given their regular exposure to human nature in all its strengths and weaknesses, should also be writers — not merely technical writers about physiology, but literary artists addressing life at large.
This would perhaps happen more often if doctoring was not such a stressful and time-consuming job. Those, though, who do find the time to write as well as to practise, have produced some remarkable work. Notable among them, in the past, were Rabelais, the sixteenth-century humourist in France, Henry Vaughan, the mystical Welsh poet in the seventeenth century, and in the nineteenth century Anton Chekhov, the Russian playwright and writer of short stories. In the mid-twentieth century there were the English novelist, A.J. Cronin, and the American poet, William Carlos Williams. And more recently there have been Jonathan Miller, the television documentarist, in England, and in the United States Oliver Sacks, the author of striking books about some of the patients he has treated, based on their case-histories.
In all these diverse cases, what comes through is a stunning relationship between patient and physician, between the deeply afflicted and the respectful, kind-hearted would-be healer. Some of the neurological conditions are rare and strange, can only be ameliorated, not cured. But Dr Sacks, as a specialist, does not just regard those in his care as specimens useful for clinical research: rather, he finds common ground with them in a shared humanity; and behind the mask of disability he finds the face of recognition. Unanimously his patients give him profound thanks. But he is the first to say that he receives, from them, at least as much as he is ever able to give: their wisdom and grace; in many cases, their indomitability of spirit.
Some of their afflictions have been quite bizarre: for example, one patient had difficulty connecting persons or objects to the apposite nouns that represented their identities; his case was described in “The man who mistook his wife for a hat”. In other writings, he exploded such diverse cases as that of a surgeon who had Tourette’s syndrome, a novelist who lost his ability to read because of a stroke, and two brothers who were gifted in a particular area of mathematics but were idiot savants. The book that made him famous, however, was “Awakenings”, his extraordinary study of patients he treated in New York, who were stricken with encephalitis lethargica.
For reasons that have not been discovered, there was an epidemic of such cases in the nineteen-twenties, forty years before Dr Sacks became involved with them. The symptoms are akin to those of advanced Parkinson’s disease. Patients are left virtually speechless and severely handicapped in their movements — plagued by tics, frozen sometimes in mid-gesture, and barely able to walk, if at all. In the worst cases, they were entirely mute and almost entirely paralysed. This was bad enough physically. But the full horror of their situation only became apparent when it was discovered that L-dopa, the drug used for treating Parkinson’s was also effective in treating their condition. Treated with it, by Dr Sacks, they regained considerable powers of movement and of speech. Able to communicate again, they revealed that through all their long years of enforced silence and immobility, they had never lost awareness of their predicament, had never ceased to feel the agonizing frustration of being imprisoned in a useless body, and somehow had had to come to terms with all this without any realistic hope of recovery. That they did so without bitterness or despair is quite extraordinary. But what Dr Sacks discovered in them, when they “awoke”, was an amazing gentleness of heart. They shine through his pages with simple dignity and an undiminished appetite for life. It was Dr Sacks’ great gift to them to help them reconstruct their lives; and in helping them, he repeatedly emphasizes, he came to grasp, with wonderment, the depth of their patience, their gratitude, and their lack of bitterness. All these traits were a lesson to him in nobility; and he counted it a privilege to be among them, to share in their resumption of a normal existence.
“Awakenings”, in due course, was successfully made into a movie, presented as a docudrama. But earlier there had been a radio version of the text, produced in CBC Toronto, with Dr Sacks’s approval and with his participation as narrator. This was no ordinary piece of broadcast drama, with fictional characters; this was an attempt to enter the lives of real people who had survived a living death with grace, to convey for the listeners something of their sweetness and decent strength, and to honour them. And the actors representing the patients approached their roles not only with consummate skill, but also with deep sincerity, with an empathy parallel to the author’s. After the taping, Dr Sacks said that it had been a very moving experience for him to sit in the studio with the cast and hear them recreate around him, truthfully and tellingly, the personalities of his former patients (he had, by this time, moved on to other work, other patients); it was, he said, like meeting old friends again with whom he had lost touch. This, concerning what was done in the studio. But what was done in actuality, by Dr Sacks in person and in his book, was and is an admirable fulfilment of the Biblical injunction, “to defend the poor and fatherless, do justice to the afflicted and needy”.
This is the art of medicine at its heartfelt best.
