by Oliver Sacks
—
One takes one’s finals at Oxford after three years. I stayed on to do research, and for the first time at Oxford I found myself rather isolated, for almost all my contemporaries had left.
I had been offered a research position in the anatomy department after being awarded the Theodore Williams Scholarship but declined the offer, despite my admiration for the professor of anatomy, the very eminent and eminently approachable Wilfrid Le Gros Clark.
Le Gros Clark was a wonderful teacher who portrayed all of human anatomy from an evolutionary perspective and was known, at the time, for his role in exposing the Piltdown hoax. But I declined his offer because I had been seduced by a series of vivid lectures on the history of medicine given by the university reader in human nutrition, H. M. Sinclair.
I had always loved history and even in my boyhood chemical days wanted to know about the lives and personalities of chemists, the controversies and conflicts that sometimes accompanied new discoveries or theories. I wanted to see how chemistry unfolded as a human enterprise. And now, in Sinclair’s lectures, it was the history of physiology, the ideas and personalities of physiologists, which came to life.
Friends, and even my own tutor at Queen’s, tried to warn me, to dissuade me from what they felt would be a mistake. But though I had heard rumors about Sinclair—nothing too specific, merely comments on his being a “peculiar” and somewhat isolated figure in the university; rumors, too, that the university was going to close down his lab—I was not to be dissuaded.
I realized my mistake as soon as I started at the LHN, the Laboratory of Human Nutrition.
Sinclair’s knowledge, at least his historical knowledge, was encyclopedic, and he guided me to work on something I had only vaguely heard about. The jake paralysis, so-called, had caused crippling neurological damage during Prohibition, when drinkers, denied legal forms of alcohol, turned to a very strong alcoholic extract of Jamaica ginger, or “jake,” which was freely available then as a “nerve tonic.” When its potential for abuse became apparent, the government had it doctored with a very unpleasant-tasting compound, triorthocresyl phosphate, or TOCP. But this hardly deterred drinkers, and it soon became apparent that TOCP was in fact a grave, albeit slow-acting, nerve poison. By the time this was realized, more than fifty thousand Americans had suffered extensive and often irreversible nerve damage. Those affected showed a distinctive paralysis of the arms and legs and developed a peculiar, easily recognized gait, the “jake walk.”
Exactly how TOCP caused nerve damage was still unknown, though there had been some suggestion that it especially affected the myelin sheaths of the nerves, and, Sinclair said, there were no known antidotes. He challenged me to develop an animal model of the disease. Here, with my love of invertebrates, I thought immediately of earthworms: they had giant myelinated nerve fibers, which mediated the worms’ ability to curl up suddenly when they were hurt or threatened. These nerve fibers were relatively easy to study, and there would never be any problem getting as many worms as I wanted. I could supplement the earthworms, I thought, with chickens and frogs.
Once we had discussed my project, Sinclair secreted himself in his book-lined office and became virtually inaccessible—not only to me, but to everyone in the Laboratory of Human Nutrition. The other researchers were senior men, happy to be left alone, free to do their own work. I, in contrast, was a novice, badly in need of advice and guidance; I tried to see Sinclair but after half a dozen attempts realized it was a hopeless business.
The work went badly from the start. I did not know what strength the TOCP should be, in what medium it should be given, or whether it should be sweetened to disguise its bitter taste. The worms and frogs at first refused the TOCP delicacies I concocted. The chickens, it seemed, would gobble anything—an unlovely sight. Despite their gobbling and pecking and squawking, I started to grow fond of my chickens, to take a certain pride in their noisiness and vigor, and to appreciate their distinctive behaviors and characteristics. In a few weeks, the TOCP took effect, and the chickens’ legs started to weaken. At this point, thinking that TOCP might have some similarity to nerve gases (which disrupt the neurotransmitter acetylcholine), I gave anticholinergic drugs as an antidote to half of the semi-paralyzed birds. Misjudging the dose, I managed to kill them all. Meanwhile, the hens which had been spared the antidote grew weaker and weaker, a sight I could hardly bear to watch. The end, for me and for my research, was seeing my favorite hen—she had no name, but number 4304 was an animal of unusually docile and sweet disposition—sink to the ground on her paralyzed legs, chirping piteously. When I sacrificed her (using chloroform), I found she had damage to the myelin sheaths of peripheral nerves and nerve axons in the spinal cord, like the human victims who had come to autopsy.
I also found that TOCP knocked out the sudden curling reflex in earthworms, though not their other movements, that it damaged their myelinated nerve fibers but not their unmyelinated ones. But I felt that my research as a whole was a failure and that I could never hope to be a research scientist. I wrote up a colorful and rather personal account of the work and, with this, tried to dismiss the whole wretched episode from my mind.
—
Depressed by this and isolated because all my friends had left the university, I felt myself sinking into a state of quiet but in some ways agitated despair. I could find no relief except in physical exercise, and every evening I went for a long run on the towpath along the Isis. After running for an hour or so, I would dive in and swim and then, wet and a little chilled, run back to my mean digs opposite Christ Church. I would gobble some cold dinner (I could no longer bear to eat chicken) and then write far into the night. These writings, titled “Nightcaps,” were frenzied, unsuccessful efforts to forge some sort of philosophy, some recipe for living, some reason to go on.
My tutor at Queen’s, who had tried to warn me against working for Sinclair, perceived my condition (I found this surprising and reassuring; I was not sure that he even knew of my existence at this point) and voiced his concern to my parents. Between them, they decided I needed to be extricated from Oxford and put in a friendly and supportive community with hard physical work from dawn till dusk. My parents thought that a kibbutz would fill the bill, and I too, though devoid of any religious or Zionist feeling, liked the idea. And so I departed for Ein HaShofet, an “Anglo-Saxon” kibbutz near Haifa where English would be spoken until, it was hoped, I became fluent in Hebrew.
I spent the summer of 1955 in the kibbutz. I was given a choice: I could work in the tree nursery or with chickens. I had a horror of chickens now and opted for the tree nursery. We got up before dawn, had a large communal breakfast, and then set off for our work.
I was amazed at the huge bowls of chopped liver at every meal, including breakfast. There were no cattle on the kibbutz, and I did not see how its chickens alone could provide the hundred pounds or so of chopped liver we consumed every day. When I enquired, there was laughter, and I was told that what I had taken for liver was chopped eggplant, something I had never tasted in England.
I was on good, at least conversational, terms with everybody but on close terms with nobody. The kibbutz was full of families or, rather, constituted a single super-family in which all the parents looked after all the children. I stood out as a single person with no intention of making my life in Israel (as so many of my cousins planned to do). I was not good at small talk, and in my first two months, despite intensive immersion in the ulpan, I learned very little Hebrew, though in my tenth week I suddenly started to understand and utter Hebrew phrases. But the hardworking physical life and the presence of friendly, thoughtful people around me served as an anodyne to the lonely, torturing months in Sinclair’s lab, when I was so shut up in my own head.
And there were great physical effects, too; I had gone to the kibbutz as a pallid, unfit 250 pounds, but when I left it three months later, I had lost nearly 60 pounds and, in some deep sense, felt more at home in my own body.
After I
left the kibbutz, I spent a few weeks traveling to other parts of Israel to get a feeling of the young, idealistic, beleaguered state. In the Passover service, recalling the exodus of the Jews from Egypt, we would always say, “Next year in Jerusalem,” and now, finally, I saw the city where Solomon had built his temple a thousand years before Christ. But Jerusalem was divided at this time, and one could not go into the old city.
I explored other parts of Israel: the old port of Haifa, which I loved; Tel Aviv; and the copper mines, reputedly King Solomon’s mines, in the Negev. I had been fascinated by what I had read of kabbalistic Judaism—especially its cosmogony—and so I made my first journey, a pilgrimage in a way, to Safed, where the great Isaac Luria had lived and taught in the sixteenth century.
And then I made for my real destination, the Red Sea. Eilat had a population of a few hundred at this time, with little more than tents and shacks (it is now a glittering seafront of hotels, with a population of fifty thousand). I snorkeled practically all day and had my first experiences of scuba diving, still relatively primitive at this time. (It had become far easier and more streamlined by the time I got my certification as a scuba diver in California a few years later.)
I wondered again, as I had wondered when I first went to Oxford, whether I really wanted to become a doctor. I had become very interested in neurophysiology, but I also loved marine biology, especially marine invertebrates. Could one combine them, perhaps, by doing invertebrate neurophysiology, especially studying the nervous systems and behaviors of cephalopods, those geniuses among invertebrates?2
A part of me would have liked to stay at Eilat for the rest of my life, swimming, snorkeling, scuba diving, doing marine biology and invertebrate neurophysiology. But my parents were getting impatient; I had idled long enough in Israel; I was “cured” now; it was time to return to medicine, to start clinical work, seeing patients in London. But I had one more thing I needed to do—something which had been unthinkable before. I was twenty-two, I now thought, good-looking, tanned, lean, and still a virgin.
—
I had been to Amsterdam a couple of times with Eric; we loved the museums and the Concertgebouw (it was here that I first heard Benjamin Britten’s Peter Grimes, in Dutch). We loved the canals lined with tall, stepped houses; the old Hortus Botanicus and the beautiful seventeenth-century Portuguese synagogue; the Rembrandtplein with its open-air cafés; the fresh herrings sold in the streets and eaten on the spot; and the general atmosphere of cordiality and openness which seemed peculiar to the city.
But now, fresh from the Red Sea, I decided to go to Amsterdam alone, to lose myself there—specifically, to lose my virginity. But how does one go about doing this? There are no textbooks on the subject. Perhaps I needed a drink, several drinks, to damp down my shyness, my anxieties, my frontal lobes.
There was a very pleasant bar on Warmoesstraat, near the railway station; Eric and I had often been there for a drink together. But now, by myself, I drank hard—Dutch gin for Dutch courage. I drank till the bar went in and out of focus and sounds seemed to swell and retreat. I did not realize until I stood up that I was unsteady on my feet, so unsteady that the barman said, “Genoeg! Enough!” and asked if I needed any help getting back to my hotel. I said no, my hotel was just across the street, and staggered out.
I must have blacked out, for when I came to the next morning, I was in not my own bed but someone else’s. There was the friendly smell of coffee brewing, followed by the appearance of my host, my rescuer, in a dressing gown, with a cup of coffee in each hand.
He had seen me lying dead drunk in the gutter, he said, had taken me home…and buggered me. “Was it nice?” I asked.
“Yes,” he answered. Very nice—he was sorry I was too out of it to enjoy it as well.
We talked more over breakfast—about my sexual fears and inhibitions and the forbidding and dangerous atmosphere in England, where homosexual activity was treated as a crime. It was quite different in Amsterdam, he said. Homosexual activity between consenting adults was accepted, not illegal, not regarded as reprehensible or pathological. There were many bars, cafés, and clubs where one could meet other gay people (I had never heard the word “gay” in this connection before). He would be happy to take me to some of them or just give me their names and whereabouts and let me fend for myself.
“There is no need,” he said, suddenly getting serious, “to get dead drunk, pass out, and lie in the gutter. This is a very sad—even dangerous—thing to do. I hope you will never do it again.”
I cried with relief when we spoke and felt that some huge burden, a burden above all of self-accusation, had been lifted or at least much lightened.
—
In 1956, after my four years in Oxford and my adventures in Israel and Holland, I moved back home and started as a medical student. In those thirty months or so, I rotated through medicine, surgery, orthopedics, pediatrics, neurology, psychiatry, dermatology, infectious diseases, and other specialties denoted only by letters—GI, GU, ENT, OB/GYN.
To my surprise (but my mother’s gratification), I had a special feeling for obstetrics. In those days, babies were delivered at home (I myself had been born at home, as were all my brothers). Deliveries were largely in the hands of midwives, and we, as medical students, would assist the midwives. A phone call would come, often in the middle of the night; the hospital operator would give me a name and an address, and sometimes she would add, “Hurry!”
The midwife and I, on our bicycles, would converge on the house, go to the bedroom or occasionally the kitchen; it was sometimes easier to deliver on a kitchen table. The husband and family would be waiting in the next room, their expectant ears tuned for the baby’s first cry. It was the human drama of all this which excited me; it was real in a way that hospital work was not and our only chance to do something, to play a role, outside the hospital.
As medical students, we were not overloaded with lectures or formal instruction; the essential teaching was done at a patient’s bedside, and the essential lesson was to listen, to get the “history of the present condition” from the patient and ask the right questions to fill in the details. We were taught to use our eyes and ears, to touch, to feel, even to smell. Listening to a heartbeat, percussing the chest, feeling the abdomen, and other forms of physical contact were no less important than listening and talking. They could establish a bond of a deep, physical sort; one’s hands could themselves become therapeutic tools.
—
I qualified on December 13, 1958, and I had a couple of weeks in hand; my house job at the Middlesex was not due to start until the first of January.3 I was excited—and amazed—to find myself a doctor, to have made it finally (I never thought I would, and sometimes even now, in my dreams, I am still stuck in an eternal studenthood). I was excited, but I was terrified too. I felt sure I would do everything wrong, make a fool of myself, be seen as an incurable, even dangerous bungler. I thought a temporary house job in the weeks before I started at the Middlesex might give me needed confidence and competence, and I managed to get such a job a few miles outside London, at a hospital in St. Albans where my mother had worked as an emergency surgeon during the war.
On my first night, I was called at 1:00 a.m.; a baby had been admitted with bronchiolitis. I hurried down to the ward to see my first patient—a four-month-old infant, blue around the lips, with a high fever, rapid breathing, and wheezing. Could we—the nursing sister and I—save him? Was there any hope? Sister, seeing that I was terrified, gave me the support and guidance I needed. The little boy’s name was Dean Hope, and absurdly, superstitiously, we took this as a good omen, as if his very name could sweeten the Fates. We worked hard all night, and when the pale grey winter day dawned, Dean was out of danger.
—
On January 1, I started working at the Middlesex Hospital. The Middlesex had a very high reputation, even though it lacked the antiquity of “Barts”—St. Bartholomew’s, a hospital dating back to the twelfth century. My older brother
David had been a medical student at Barts. The Middlesex, a relative newcomer founded in 1745, was housed, in my day, in a modern building from the late 1920s. My eldest brother, Marcus, had trained at the Middlesex, and now I was following in his footsteps.
I did a six-month house job on the medical unit at the Middlesex and then another six months on the neurological unit, where my chiefs were Michael Kremer and Roger Gilliatt, a brilliant but almost comically incongruous pair.
Kremer was genial, affable, suave. He had an odd, slightly twisted smile, whether from a habitually ironical view of the world or the residue of an old Bell’s palsy, I was never sure. He seemed to have all the time in the world for his housemen and his patients.
Gilliatt was much more forbidding: sharp, impatient, edgy, irritable, with (it sometimes seemed to me) a sort of suppressed fury that might explode at any moment. An undone button, we housemen felt, might provoke him to a rage. He had huge, ferocious, jet-black eyebrows—instruments of terror for us juniors. Gilliatt, recently appointed, was still in his thirties, one of the youngest consultants in England.4 This did not diminish his formidable aspect; it might have heightened it. He had won a Military Cross for outstanding bravery in the war, and he had a rather military bearing. I was terrified of Gilliatt and became almost paralyzed with fear when he asked me a question. Many of his housemen, I would later find, had similar reactions.
Kremer and Gilliatt had very different approaches to examining patients. Gilliatt would have us go through everything methodically: cranial nerves (none to be omitted), motor system, sensory system, etc., in a fixed order, never to be deviated from. He would never leap ahead prematurely, home in on an enlarged pupil, a fasciculation, an absent abdominal reflex, or whatever.5 The diagnostic process, for him, was the systematic following of an algorithm.
Gilliatt was preeminently a scientist, a neurophysiologist by training and temperament. He seemed to regret having to deal with patients (or housemen), though he was, I was later to learn, a completely different person—genial and supportive—when he was with his research students. His real interests, his passions, were all related to the electrical investigation of peripheral nerve disorders and of muscle innervation, where he was on his way to becoming a world authority.
