Oliver Sacks: The Captivating Medical Storyteller
by Maggie Brown
While you are studying for that human physiology exam or writing that biology lab report, do you ever wonder if you are neglecting your hobbies and extracurricular activities?
Well, one neurologist somehow found a way to do it all! An author of several books, a weightlifting guru, friends with poet Thom Gunn, a cross-country motorcycle rider…and did I forget to mention that he has contributed invaluable knowledge and insight to the medical world?
This describes none other than the famed British author and neurologist Dr. Oliver Wolf Sacks, who passed away at the age of 82 in his Manhattan home on August 30, 2015 after a long battle with metastatic cancer. Sacks' wide range of experiences played an instrumental role in his ability to sympathize with his patients and record his findings in an anecdotal prose. So lyrical was his writing that he was dubbed the “poet laureate of contemporary medicine.” From the vast chronicles of all of Sacks' works, let’s take a look at a few of his most famous case studies.
The Man Who Mistook His Wife For A Hat
A music teacher, referred to as “Dr. P” in Sacks' book titled “The Man Who Mistook His Wife For A Hat,” believed he was having trouble with his vision when his ophthalmologist referred him to a neurologist – Dr. Oliver Sacks. P’s wife described his unusual behavior to Sacks, noting that “when in the street he might pat the heads of water hydrants and parking meters, taking these to be the heads of children; he would amiably address carved knobs on the furniture and be astounded when they did not reply.”
In one of Sacks' first meetings with P, the clever neurologist immediately noticed there was something odd about his patient. While talking with Sacks, P would become fixated on individual features of Sacks’ face, instead of seeing it as a “whole.” When the examination was complete during one appointment, P began to look for his hat. As Sacks recalls, P “reached out his hand and took hold of his wife’s head, tried to lift it off, to put it on. He had apparently mistaken his wife for a hat!”
After further examination, Sacks concluded that P was suffering from visual agnosia, which is a condition characterized by the National Organization for Rare Disorders as “the total or partial loss of the ability to recognize and identify familiar objects and/or people by sight.” The condition is caused by lesions in the brain as a result of a stroke, Alzheimer’s disease, exposure to toxins, traumatic brain injury or, in P’s case, a tumor. Affected individuals can go through rehabilitation to work on restoring lost memories and familiarity with common objects. While P’s visual agnosia did progress, he “lived and taught music to the last days of his life.”
The Musician Whose Consciousness Lasted Thirty Minutes
In his book “Musicophilia: Tales of Music and the Brain” (2007), Sacks writes about classical musician and conductor Clive Wearing who came down with what his doctors initially thought was a prolonged flu virus. When Wearing’s symptoms persisted, they concluded he may have meningitis. However, he became increasingly lethargic, short-tempered and eventually suffered bouts of amnesia. Although Sacks was not involved in diagnosing Wearing’s disease, he followed his case through to the successful diagnosis.
Wearing was slipping in and out of consciousness when his doctors successfully diagnosed him with the herpes virus, known to attack the central nervous system. When he fully regained consciousness, he had lost all personal memory and many semantic memories, which refer to our general knowledge about the world. For example, Wearing wasn’t able to define common things like “eyelids” or “trees.” At one point he even ate an entire lemon—including the rind—because he did not know what it was! Most dramatically, Wearing continually lost his short-term memory and could not distinguish one day from the next. He interpreted this discontinuity as an indication that he had just “woken up.” This confusion prompted him to write diary entries as proof of the past. His entries never strayed too far from the one below:
8:31 AM: Now I am really completely awake.
9:06 AM: Now I am perfectly, overwhelmingly awake.
9:34 AM Now I am superlatively, actually awake.
Psychiatric Patients Awakened After Being Catatonic For Decades
Sacks' most famous studies were chronicled in his book “Awakenings” (1973), which detailed his use of the drug levodopa to treat patients suffering from encephalitis lethargica, or the “sleepy sickness.” According to the National Institute of Neurological Disorders and Stroke, this disease attacks the brain and causes “high fever, headache, double vision, delayed physical and mental response, and lethargy.” Since the sixteenth century, doctors across Europe have reported outbreaks of the disease.
Another epidemic occurred during the First World War, prompting Sacks to examine the affected patients. He studied the cases of numerous individuals, finding that they were barely conscious and had been suspended in catatonic states for forty years. In 1969, Sacks began treating them with high doses of L-DOPA, a dopamine-enhancing drug used to treat patients with Parkinson’s disease even today. It is normally produced in our bodies as a precursor to neurotransmitters like dopamine, but those who have suffered specific brain damage—like Parkinson’s disease and encephalitis lethargica patients—struggle to produce it naturally.
This wonder drug allowed “sleepy sickness” patients to temporarily “wake” from their frozen states, many realizing that they had lost decades of their life. One woman was relieved from the tormenting repetition of “two equals two equals two equals two” that kept her in a catatonic state. Another patient no longer had to “walk around a mental square to seven notes of a Verdi theme” that normally would persist for “hours and days.” While Sacks was able to release them from this mindless purgatory, it did not last long. The side-effects of L-DOPA included uncontrollable muscle spasms. This diminished the benefits of the treatment, and many patients actually requested to be taken off the drug only to return to their catatonic states.
Oliver Sacks has been incredibly influential in developing a deeper level of understanding in the field of neurology. His “clinical anecdotes,” or case studies reported in the form of stories, were much more accessible to the general public—a quality that is not easily achieved in the world of science. Within these narratives, he spent an equal amount of time explaining and analyzing his patients’ spirits as he did their conditions, almost humanizing them.
In an op-ed piece for the New York Times earlier this year Sacks announced that he was suffering from terminal cancer. He still, however, intended “to write more, to travel if I have the strength, to achieve new levels of understanding and insight.” For any aspiring physician, Sacks’ holistic approach to medicine and to his patients is an invaluable quality to emulate. The passion he felt for medicine and which he spread through his research and written work will be felt throughout many academic disciplines for several decades to come.