speed revisited

Consider this a kind of follow-up to my post from some weeks ago on moving at the speed of God.

I’ve been reading Lawrence Wechsler’s And How Are You, Dr. Sacks? — which is just fascinating. But for today I want to talk about something specific that comes up near the end of the book: the question of whether Sacks was a reliable narrator, whether his fantastic “clinical tales,” as he calls them, were just that, fantasies. Many of his fellow neurologists simply don’t trust him, and Wechsler gives over an entire chapter to their doubts. But Wechsler also provides the testimony of people who worked closely with Sacks, and among the most interesting of these is Margie Kohl (later Marjorie Kohl Inglis).

Kohl’s view is that many of the neurologists who are skeptical of what Sacks discovered simply aren’t patient enough to investigate as he investigated. “Most neurologists are so stuck in their checklists and their Medicare-mill fifteen-minute drills that they miss everything; Oliver missed nothing.”

Kohl worked with Sacks when he was treating the victims of encephalitis that he later described in his famous book Awakenings — perhaps also his most controversial book, because the changes he describes these people experiencing seem, to many neurologists, too dramatic to be true. So Wechsler asked Kohl whether Sacks had invented his patients’ spectacular response to the drug called L-DOPA, and she replied:

I know the charge is not true, and I was there. Sure, he would occasionally attribute higher vocabulary to some of the patients — Maria, for instance, was uneducated and he made her language flow, but this was as much as anything out of respect for her, an honoring and cherishing of her — and in a wider sense he embellished nothing. And many of the patients did talk fluently and with great subtlety.

But you had to be willing to sit at the bedside and listen. They didn’t just up and tell you these things. You had to establish rapport and a context.

With Leonard, for instance, most people had never gotten to him because (and I am speaking here of the years before L-DOPA) they wouldn’t spend the time with him: He was very slow, each letter might take a minute for him to spell out on his board, and everyone else would limit themselves to yes or no questions. But Oliver sat it out.

Leonard L. is one of the major characters in Awakenings — also one of its saddest stories. As you can tell from Kohl’s comment, for decades Leonard could not speak, but could only write his thoughts out with great labor on a chalkboard — which is why the neurologists who treated him would only ask him Yes/No questions: that way they only had to wait long enough to see that he was making a “Y” or an “N.” But Sacks asked him questions that required much longer answers — and then “sat it out” as Leonard wrote on his board. Can you even imagine what this meant to Leonard? — to have someone give him encouragement to say what he needed to say, no matter how long it took?

Some years after the book’s publication, when he learned that Leonard had died, Sacks wrote a letter to his mother, which concludes with these moving paragraphs:

Only the passage of years can give one perspective — and it comes to me that I have known Leonard — and you — for fifteen years; which is quite a long time in anyone’s life. What I felt in 1966 I felt more strongly every year — what a remarkable man Leonard was, what courage and humour he showed, in the face of an almost life-long heart-breaking disease. I tried to give form to this feeling when I wrote of him in Awakenings … but was conscious of how inadequate and partial this was: perhaps even more so to you, for you were such a life-giver to him … Perhaps this only became clear to me in the years afterwards….

I have never had a patient who taught me so much — not simply about Parkinsonism, etc., but about what it means to be a human being, who survives, and fully, in the face of such affliction and such terrible odds. There is something inspiring about such survival, and I will never forget (nor let others forget) the lesson Leonard taught me; and, equally, there has been something very remarkable about you, and the way in which you dedicated so much of your strength and life to him … he could never have survived — especially these last years — without your giving your own life-blood to him…. You too are one of the most gallant people I know.

Now Leonard has gone, there will be a great void and a great grief — there has to be where there has been a great love. But I hope and pray that there will be good years, and real life, ahead for you yet … you have a great vitality, and you should live to a hundred! I hope that God will be good to you, and bless you, at this time, give you comfort in your bereavement, and a kind and mellow evening in the years that lie ahead.

With my deepest sympathy and heartfelt best wishes,

Oliver Sacks

Sacks loved Leonard, and admired him, and he could love and admire him only because he knew him, and he could only know him by spending a great deal more time with him than anyone else would have — as in more time by a factor of fifty. Checklists are sometimes absolutely necessary; but at other times they and a daily schedule of “rounds” are the worst tools a doctor can have. Sacks was willing to move at the speed of Leonard — at what felt like no speed at all, what felt like stasis — and as a result “Oliver missed nothing.” Having missed nothing, he garnered a testimony that he could pass on to his readers. And in that way, sisters and brothers, he moved at the speed of God.