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A READER'S JOURNAL
A Leg to Stand On
A Neurography
by
Oliver Sacks
ARJ2 Chapter: Evolution of Consciousness
Published by HarperPerennial/NY in 1990
A Book Review by Bobby Matherne ©2015
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Thom Gunn was a friend and poet of Oliver Sacks and was mentioned often in his recent biography, On the Move, whose title was inspired by one of Gunn's poems. The heart of this book is aptly described in the Preface:
[page 9] Thorn Gunn has written powerfully of the "occasions" of poetry. Science has its occasions no less than art: sometimes a dream-metaphor, like Kekule's snakes; sometimes an analogy, like Newton's apple; sometimes a literal event, the thing-in-itself, which suddenly explodes into unimagined significance, like Archimedes's "Eureka!" in his bath. Every such occasion is a eureka or epiphany.
Sacks loved the way that A. R. Luria wrote stories based on his personal experience and neurological condition, particularly in his The Man with a Shattered World, and called this way of writing a neurography, coining a word for a genre that Sacks himself was to begin specializing in. (Page 11) Methinks Oliver would like the word used as a subtitle to this book. Basically, if you are to write a biography of someone, you need to get into their life, but if you are to write a neurography, you must get into some neurological disorder, and in this case Sacks had some neurological disorder get into himself. As the accident and its recovery ensued, we find Sacks as both a doctor and a patient, a much more patient doctor than patient.
If someone told us, "I feel ill", we would never respond "You're having a eureka moment", up until now. But, rightly understood, in the science of medicine, its "occasions" or "eureka moments" are illnesses and injuries, and we can learn from them as much about human beings as Kekule learned about organic chemistry, Newton about gravity, and Archimedes about physical density.
Sacks explains.
[page 9, 10] The occasions of medicine are provided by sickness, injury, patients. The occasion of this book was a peculiar injury, or at least an injury with peculiar effects, resulting from an accident on a mountain in Norway. A physician by profession, I had never found myself a patient before, and now I was at once physician and patient. I had imagined my injury (a severe but uncomplicated wound to the muscles and nerves of one leg) to be straightforward and routine, and I was astonished at the profundity of the effects it had: a sort of paralysis and alienation of the leg, reducing it to an "object" which seemed unrelated to me; an abyss of bizarre, and even terrifying, effects. I had no idea what to make of these effects and entertained fears that I might never recover. I found the abyss a horror, and recovery a wonder; and I have since had a deeper sense of the horror and wonder which lurk behind life and which are concealed, as it were, behind the usual surface of health.
Lacking any insight or reassurance into his leg problems from his doctor, Sacks wrote to Luria, who replied that "Such syndromes may not be rare, but they are rarely described." (My paraphrase) Sacks set out to investigate Luria's claim, found it to be true, and began to describe such syndromes, beginning with his own alienation from his leg during recovery from the operation which re-attached his quadriceps, an operation which restored the muscles and nerves of one leg, but left Sacks curiously disabled. Sacks interviewed hundreds of patients with similar disabilities after operations who were met with similar nonchalance and lack of understanding from their doctors. This book was written as much for the doctors as the patients — neither of whom, rightly understood, had a leg to stand on — the doctors lacking the ability to understand the patients' dilemmas and the patients lacking the ability to communicate with their doctors. Sacks, a qualified doctor, found that even he could not communicate his own recovery dilemma with his surgeon until after he had completely recovered the function of his leg.
Sacks was climbing up a 6,000 foot mountain overlooking a fjord in Norway when he encountered a sign, "Beware of Bull", at about 3,000 feet and decided this must be a prank, that no bull could be pasturing this high, so he went through the gate and continued climbing until he turned a corner on the narrow path and there was a huge white bull sitting down blocking the path completely. When it turned its face to Sacks, it seemed to turn into a monster and evil devil. Sacks turned around headed down the path, but suddenly he lost his nerve and began running lickety-split down the steep slippery path and suddenly found himself lying at the bottom of a rocky cliff. The doctor part of him took over.
[page 21] My first thought was this: that there had been an accident, and that someone I knew had been seriously injured. Later, it dawned on me that the victim was myself; but with this came the feeling that it was not really serious. To show that it was not serious, I got to my feet, or rather I tried to, but I collapsed in the process, because the left leg was totally limp and flail, and gave way beneath me like a piece of spaghetti. It could not support any weight at all, but just buckled beneath me, buckled backwards at the knee, making me yell with pain. But it was much less the pain that so horribly frightened me than the flimsy, toneless giving-way of the knee and my absolute impotence to prevent or control it — and the apparent paralysis of the leg.
Sacks asked himself, "OK, Doctor, would you kindly examine this leg?" So Dr. Sacks examined and proclaimed that the entire quadriceps had been torn away from the knee. In the process, he flexed the heel to the buttocks, causing Sacks the patient to scream in intense pain. Only after this detailed analysis did it dawn on Sacks that he might die, not so much from the injuries but from hypothermia, if he could not get down the mountain before nightfall to some shelter. He created a splint out of his umbrella, tearing strips from his jacket to attach the splint to immobilize his leg and prevent further injury as he moved himself down the mountain to safety. He took inventory as he started to move, "Three good limbs and the energy and strength to put up a good fight, including a leg to stand on." (Page 25) That included one leg to stand on, but for now that good leg could only act as a brake as he slid feet first down the muddy, slippery path. When his bad leg hit an obstruction, he screamed in pain, but quickly remembered the white bull and silenced himself. After two hours, he encountered a mountain stream with stepping stones that he had feared crossing on two good legs on the way up. He decided he could only cross by walking on his hands to keep his head above the frigid flowing water. He yelled at himself, "I'll kill you if you let go — and don't you forget it!" (Page 29) After crossing the stream, he struggled on down the path, using swimming motions, pulling his body over the muddy and rocky path while singing aloud the refrain of the Volga Boatman's song of Goethe, "Ohne Haste, Ohne Raste!" (Translated maintaining the Germanic rhythm: Without Hurry, Without Stopping!), heaving his body downward with each beat of the song. Soon he felt a coordination set in with the rhythm of the song as he moved almost effortlessly. He could even notice and enjoy the sky above him triggering happy memories as he maneuvered down the slippery path.
[page 33] An hour passed, and another, and another, under a glorious cloudless sky, the sun blazing pale-golden with a pure Arctic light. It was an afternoon of peculiar splendor, earth and air conspiring in beauty, radiant, tranquil, suffused in serenity. As the blue and golden hours passed, I continued steadily on my downward trek, which had become so smooth, so void of difficulties, that my mind could move free of the ties of the present. My mood changed again, although I was to realize this only later. Long-forgotten memories, all happy, came unbidden to my mind: memories, first, of summer afternoons, tinged with a sunniness which was also happiness and blessedness — sun-warmed afternoons with my family and friends, summer afternoons going back into earliest childhood. Hundreds of memories would pass through my mind, in the space between one boulder and the next, and yet each was rich, simple, ample, complete, and conveyed no sense of being hurried through.
Later he realized his mood had been one of preparing for death, recalling what his friend W. H. Auden had said, "Let your last thinks all be thanks." It was getting dark and he as running out of hope when two reindeer hunters heard him moving, took him for a reindeer, and stalked him, only to discover a horizontal man crawling injured down the path. They asked him what happened and when his meager knowledge of Norwegian failed to reach them, Sacks drew a picture in the dirt of a bull, at which point the two hunters began to laugh, and Sacks along with them. He was alive, he had been rescued, and all was right in the world again. The hunters brought him to their small cabin and one of them went down to fetch help from the nearby village. A group of villagers arrived and carried him down in a stretcher to the small hospital in Odda, from which he was to be moved to a larger hospital in Bergen, where he contacted his brother who arranged for him a later flight home to London for the quadriceps surgery.
In the Bergen hospital a new cast was placed on the leg prior to his flight to London. Sacks awoke in bed with his leg swollen inside the cast with his mood was a black as ever, fearing he would never regain full use of his leg. Only an angel could help him recover a shred of hope, and miraculously one appeared in his room. Sacks rubbed his eyes thinking he was dreaming, but he wasn't, a vision in white had floated into his room.
[page 43] A young man — dressed, preposterously, in a white coat, for some reason — came in dancing, very lightly and nimbly, and then pranced round the room and stopped before me, flexing and extending each leg to its maximum like a ballet dancer. Suddenly, startlingly, he leapt on top of my bedside table, and gave me a teasing elfin smile. Then he jumped down again, took my hands and wordlessly pressed them against the front of his thighs. There, on either side, I felt a neat scar.
"Feel, yes?" he asked. "Me too. Both sides. Skiing . . . See!" And he made another Nijinski-like leap.The young man in white was a Norwegian surgeon who had a similar accident and was demonstrating the possibility of a complete recovery for Sacks. Doctors who do not think outside of their deeply ingrained medical procedures would never consider such behavior proper or useful — unless they read this.
[page 44] Of all the doctors I had even seen, or was later to see, the image of this young Norwegian surgeon remains most vividly and affectionately in my mind, because in his own person he stood for health, valor, humor — and a most wonderful, active empathy for patients. He didn't talk like a textbook. He scarcely talked at all — he acted. He leapt and danced and showed me his wounds, showing me at the same time his perfect recovery. His visit made me feel immeasurably better.
After the surgery, which went just fine, the challenges began for Sacks. His surgeon, Dr. Swan, told him desultorily before surgery, "We reconnect it. Restore continuity. That's all there is to it." Ah, were it only so easy for the patient as it is for the surgeon. Miss Preston was Sacks physiotherapist, and when she went ballistic over the orthopedic surgeons knowing so little about the recovery portion of the operation for the patient, Sacks warmed up to her. Sacks' inability to budge his repaired leg worried him intensely until he realized that his foot and toes worked fine which meant he had nerve connections down the length of his leg. Now the big problem arose: Sacks didn't believe he had a leg! When Nurse Sulu came in and found Sacks' left leg hanging out of the bed, she scolded him. Sacks replied, "Nonsense! My leg is right here, in front of me, right where it should be." Well, it wasn't, so he asked the nurse to return his leg to the bed and then a remarkable thing happened.
[page 69] I waited for her to move it, but to my surprise she did nothing. Instead she bent over the bed, straightened up and started for the door.
"Nurse Sulu!" I yelled — and it was her turn to be startled. "What's going on? I'm still waiting, please, for you to move my leg back!"
She turned around, her almond-eyes wide with amazement.
"Now you're joking, Dr. Sacks! I did move your leg back."