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Neurologist, writer, healer

Oliver Sacks and Ramachandran. Photo: Special Arrangement  

‘Healing’,

Papa would tell me,

‘is not a science,

but the intuitive art

of wooing Nature.’

W.H. Auden (1969), The Art of Healing

The list of men and women who have brought a spirit of innovation and experimentation to the challenging field of medicine is long. Illustrious names include Hippocrates, Thomas Percival and Florence Nightingale. Professor Oliver Wolf Sacks, the eminent neurologist of New York, who passed away recently, undoubtedly belonged to this pantheon. Sacks’ appeal went beyond the frontiers of medicine. He was both humane and charitable, and the quality of time that he gave to everyone who came to him for relief from pain will stand as a model for current and future practitioners of medicine. More than this, his fascination for creating enduring literature woven around his calling as a healer is almost unparalleled.

Greatest contributions

I spoke at length on Sacks to Professor V.S. Ramachandran (‘Ramu’ to friends like me), a distinguished alumnus of the Stanley Medical College, Madras and current Director of the Centre for Brain and Cognition at the University of California, San Diego, to get a contemporary assessment of Sacks’ contributions to neurology. Incidentally, Sacks, while writing the foreword for Ramu’s most famous book, Phantoms in the Brain, had said: “Ramachandran tells us he enjoyed the books of George Gamow and Stephen Jay Gould…(with this book) he himself has joined these grand science writers.” And talking of one of Ramu’s other books, The Emerging Mind, Sacks said, Ramu “illuminates everything he touches on — whether it is phantom limbs or how the brain can generate illusions and delusions…” Ramu believes that Sacks’ greatest contributions were his abilities to bridge seemingly unrelated disciplines, and to inspire students to pursue careers in medicine and neurology. Ramu adds: “Even if simply conceived of as literature, rather than medicine, Sacks’ writings were unparalleled — reminding one of Lewis Thomas and Peter Medawar.”

He explains how most of Sacks’ original work began as careful observations of single cases, but soon formed the basis of large-scale formal experiments by others. For instance, Sacks noted that patients with left hemisphere strokes were, paradoxically, better at detecting lies than normal individuals. According to Ramu, Sacks suggested that detecting lies was a primordial pre-linguistic perceptual function performed by the right hemisphere in primates (including humans) that was normally inhibited by the more “conceptual” left hemisphere; so the stroke disinhibited and enhanced the ability to detect lies. This was one of the first examples of a mental capacity being enhanced following brain damage. This astounding idea inspired a great deal of work highlighting Sacks’ unique place in the history of neurology.

The central point of all the outpourings of grief over his death at the age of 82 was his splendid case-based innovation in the treating and teaching of the complexities of numerous neurological disorders: migraine, encéphalitis, Parkinson’s, and so on. He firmly believed in a holistic approach to treating every disorder. To him a patient was not a mere object needing care, but one who had a history and a context that had to be probed by every medical practitioner. Generous praise of Sacks dealt equally with his ability to communicate with a wide range of patients and chronicle articulately their responses in great detail. He, no doubt, kept notes assiduously. But then, it is an entirely different proposition to connect them and invest meaning into every word that could clarify the problem on hand. His 13 books stand out for their soulful approach to human suffering, and their extraordinary narrative laced with Sacks’ inimitable humour.

Raised in the U.K in the mid-1930s, Sacks went to St. Paul’s School in London. An avid motorcyclist and an adventure seeker, he quickly came to the attention of his teachers, one of whom commented, “Oliver will go far, if he does not go too far!”

After graduating in medicine from Queen’s College, Oxford in 1958, Sacks took a surprising decision to move to the U.S., where he remained until his death. Looking back, he himself was perplexed why he made that move. This tectonic shift was possibly influenced by his own assessment that he needed to give himself more space: both his parents and two brothers in England were doctors, and his brother was schizophrenic.

There is nothing to infer that Sacks ever regretted this change of locale. He actually benefited — first from his residency at Mount Zion Hospital in San Francisco, and later the unique teaching opportunity at New York University as well as Columbia. He gave his best to all the three institutions. In fact, he spent four decades at Columbia, an index of his dedication and loyalty.

Sacks will perhaps be remembered most for his prolific writing. His first book (published in 1967, revised in 1985 and then in 1992) was on migraine. Sacks referred to it as “my first born, written in a burst (nine days).” The book was addressed to three categories of readers: patients, medical practitioners and researchers. In his introduction to the first edition, Sacks portrayed migraine as both a physical and symbolic event. In his view, migraine attacks were “drenched in emotional significance, and could not be usefully considered, let alone treated, unless their emotional antecedents and effects were exposed in detail.” Writing mainly for the layman, and avoiding technical language as far as possible, Sacks brought a new perspective to the task of alleviating pain.

The next book that drew considerable attention was Awakenings (1973), which W.H. Auden described as a “masterpiece”. This dealt with Sacks’ experiment with a new drug L-Dopa on post-encephalitic patients at Beth Abraham Hospital in Bronx, New York. These were a group of people who had contracted a sleeping sickness during a post-World War I epidemic. The new drug gave them an “awakening” effect that won Sacks a great reputation for innovation. Talking about this, he said: “Awakenings came from (a) most intense medical and human involvement… as I encountered, lived with patients… some of whom had been transfixed, motionless, in a sort of trance, for decades. Migraine was still in the medical canon, but here I took off in all directions — with allegory, philosophy, poetry, you name it.” The book was made into an Oscar-nominated film of the same name.

Another book that deserves a mention is The Man Who Mistook His Wife for a Hat (1985), which, according to Sacks himself, was a surprise hit. The book carried case histories of patients who had forgotten most of their past and therefore could not recognise even familiar faces or objects. The patients were wrongly dismissed as retarded, although they had amazing artistic or mathematical talents.

Terminal illness

Tragedy struck Sacks in 2005 when a rare tumour was detected in his right eye. While receiving radiation treatment, he suffered a partial loss of vision with which he managed admirably for nearly a decade, until March 2015, when it was found out that his ocular melanoma had spread to the liver and he had less than six months to live. Ramu went to see Sacks in his apartment in New York as recently as last month, and found him to be in surprisingly good spirits. As Ramu was taking leave, Sacks gave him a hug and said, “I’ll probably never see you again; have a good life, Rama.” Ramu replied, “Well you never know”, leaving it ambiguous as to whether he meant in this life (if there was an unexpected tumor regression, for instance) or something more mystical. “Well, I’m an old Jewish atheist, Rama, but you are right, who knows,” Sacks answered.

Five weeks later he passed away.

Sacks’ Op-ed piece, ‘My own life’ in New York Times (February 19, 2015) poignantly announced to the world that he had a terminal illness. It revealed his grit and composure that could handle the prospect of an end to all his joyful activities with dignity.

I cannot resist quoting a graduate student at the University of Toronto. “Even when looking death in the eye, he [Sacks] finds reasons to live life more animated than ever. I would hate for this to sound like a eulogy; it is more like a celebration of a hero,” the student said.

Is there not a message here for the rest of us fretting and fuming all the time about how unfair life has been?

(R.K. Raghavan, a former Director of the Central Bureau of Investigation, New Delhi, is a freelance writer.)

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Printable version | Oct 21, 2020 10:14:26 AM | https://www.thehindu.com/opinion/op-ed/neurologist-writer-healer/article7629878.ece

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