Letters, p.33
Letters, page 33
To F. Robert Rodman
August 30, 1974
Meyerstein Ward, Middlesex Hospital, London
Dear Bob,
Thank you for your brave and sensitive letters of July 30 (from Sweden) and August 15 (from Hannover). I am going to have to make this a very brief, and inadequate, and rather “inappropriate” reply, as you will see.
I’m sorry I didn’t reply to your first letter, which arrived about three weeks ago—I was rather depressed and distracted myself then, as my father was ill (he is better now), also I was not sure how to reply, altho I strongly shared your feeling that Sweden was the right place now for [Maria]—for both of you—and that whatever you were doing to strengthen links (emotional, cultural, etc.) with Sweden could only be wholly advantageous to you—to you all.
It may have been the strength of this feeling, plus some confused quasi-identification, which made me feel—quite suddenly—around Aug 10, that I wanted to go, that I had to go, to Norway, which I did. Once there I many times lifted the phone, and wondered about “dropping over,” so to speak; but each time some inhibition made itself, along with the sense that I should do best to keep myself in “the middle distance.” On my last day in Norway, I had an idiotic accident (if “accidents” exist as distinct from “incidents”), and took a baddish fall on a mountainside, breaking my left leg, completely rupturing the quadriceps tendon, etc. Mercifully, because it was high and remote, I was found and rescued before nightfall, and returned to England, invidiously and self-consciously, feeling like a fool but also very glad to be alive, last Sunday. I was operated on at once, and today has been my first day sufficiently clear of pain and the obfuscating effects of medications to be able to write any letters.
I will be immobilized here in plaster for 6 weeks or so, and only then can I start progressive weight bearing, exercise, ambulation, etc. It looks, therefore, as if I am likely to be in England until November, possibly December.
Let us keep in touch; take the Middlesex Hospital as my address or forwarding orders until I know where I stand.
And no! You never sound “maudlin”; you have shown extraordinary resource of every sort since you first wrote to me in the beginning.
I will write again soon.
My love to you both,
Oliver
* * *
—
Apart from his impatience to recover the use of his leg and his general fear of passivity and lack of control, OS needed to understand, intellectually, what had happened. How could the injured leg completely disappear so rapidly from his awareness of his own body, and why did his surgeons seem so unconcerned by this? What neurological theory could explain the brain’s ability to “forget” a whole appendage almost immediately? He needed to know why this experience, this rupture in his own body image, had been so terrifying, so annihilating. And why his doctors, by and large, had rebuffed any attempts to discuss this existential problem.
OS’s main interlocutor at this time was A. R. Luria. Following the accident, OS dispatched a number of huge letters to him—some running to forty-five pages—ruminating on these questions. Some of the following letters to Luria have been greatly condensed.
To A. R. Luria
September 13, 1974
Meyerstein Ward, Middlesex Hospital, London
Dear Professor Luria,
It is a while since we have been in touch. I have been meaning to write to you for some time, but am especially prompted to do so now following some strange neurological experiences of my own!
Three weeks ago, while climbing in Norway, I fell, and tore the tendon of my left quadriceps completely off the patella. I was alone, in a scantily-populated part of the country; it was a great good fortune that I was found before the Arctic nightfall, because otherwise I would not have survived to tell the story.
I was operated on August 26th—seemingly a straight-forward injury operation, with no significant peripheral nerve damage (although, I suppose, all sorts of nerve endings would be destroyed or stimulated in the torn tendon muscle).
Thus it is now my 18th post-operative day. What seems to me of great interest—but perhaps it is a commonplace finding (I confess that I am ignorant of the matter)—and what I found terrifying at times was the central disorder associated with injury. Thus, for the prior 13 days after the operation (or 15 days after injury) I found it not only impossible to elicit the least contraction of the quadriceps, but unthinkable. When asked to “tighten the muscle” I would go red with effort—but nothing would happen. I felt my effort diffuse uselessly—that it had no point of reference or application; and that, indeed, it was not a real exertion of “will” because there was no proper intention or idea (image) involved. I found this profoundly disquieting, the more so as I did not expect it. My surgeon spoke of “reflex inhibition” (at spinal or peripheral level), but this was obviously inadequate as description. I wondered fearfully whether I was harbouring an obsessive or hysterical inhibition (or amnesia); and whether the use of the leg would ever return. I found reassurance useless in face of the intensity and strangeness of my own experience.
When I was told to “try to raise the leg,” I could not think what was required; I found it impossible to imagine any procedure by which I could raise it. I felt I was deprived of the idea of the action, the idea of “how.” I felt like a man with a stroke—or so I imagine—who is faced with some bizarre apraxia or amnesia of action. On the 13th post-op. day I discovered, by accident, how to twitch my quadriceps and pull the patella, but I could not at this time make any flexion motion at the hip, or imagine doing so. On the 15th post-op day this became thinkable and doable, for the first time; this was a great relief to me, and felt like a miracle. The power to do this (and the simultaneous idea and intention of doing so) were possible on this day, and came and went in an unpredictable way. Thought I might make the flexion-motion, but find that I had then “forgotten” the movement and could not make it a fourth time; a minute later, perhaps, I would “remember” the movement, and be able to do it—or perhaps not. I was reminded of aphasiac patients who can sometimes get a word, sometimes not—who find the word/idea continually slipping through their grasp.
On the 16th post-operative day I was got up on crutches for the first time. I found this bizarre and terrifying. When I looked straight ahead, I had no idea where my left leg was, nor indeed any definite feeling of its existence. […] Whenever I looked down I found my visual perception strangely unstable: I had momentary difficulty in recognizing an “object” next to my right foot as my left foot: It did not seem to “belong” to me in any way. When I accepted it as my foot, it seemed too heavy, too far away, tilted to one side, in the wrong place, etc.—really a sort of central visual-kinaesthetic dis-orientation, analogous, I felt, to the loss of “motor images.” […]
One speaks of having to “relearn” actions and motor patterns after they have fallen into disuse for a while—but I confess that I had no real anticipation whatever of the sort of difficulties I would encounter, and the mode of their recovery.
I have been intensely put in mind of patients with stroke, and of the loss and processes of learning, recover and discover, adaptation, innovation, etc. you relate in The Man with a Shattered World. I can now appreciate the beauty and accuracy of the descriptions in there, as never before.
Strange business! I would be most interested in your comments. I have to wear the plaster another 3½ weeks, then will have to spend a period strengthening the leg (it is so wasted and weak already, after 2½ weeks in plaster), and learning to walk alone (the final difficulty, I fear). I do not see at the moment how I could extend my knee or hold it extended. I cannot imagine walking without the plaster. So I will stay in London another 6 weeks or so before I can return to my work in New York.
The experience of being a patient (the first time for me) is quite extraordinary; and I am tempted to write up this whole experience as a little journal or book. […]
I hope that you are in good health, and have been having an enjoyable summer.
I spent a delightful day with our friend Richard Gregory about 3 weeks ago. Have you seen his latest book, an anthology of papers which Colin Haycraft has just brought out?[*17] Beautiful work.
I should very much enjoy a letter from you. I feel so isolated in my hospital room, and visitors and letters are the breath of life.
Yours cordially,
Oliver Sacks
To Richard Gregory
Experimental Psychologist[*18]
September 14, 1974
Bond St. Ward, Middlesex Hospital, London
Dear Richard,
Thank you so much for your book and your letter. Your book “hit the spot” perfectly—I was reading too much, but I was utterly starved of visual nourishment and stimulation, and found myself drinking in the delights of these eagerly from the book.
This experience (which is not finished yet!) has been an astonishing one in so many ways—so much so that it is now clear to me that this is the “material” for my next book. I have no doubt that my experience has been basically similar to that of all patients who are suddenly and unexpectedly injured, rendered helpless and dependent, immobilized and isolated; in my own “case” (I suspect) all sorts of symptoms and phenomena have been magnified by the magnifying glass of my intelligence and imagination, coupled with obsessiveness and fears. As an astronomer peering at a new planet gradually “sees” or “makes out” more and more features, which become clearer and clearer as he “concentrates” upon them; so I have felt like an “internal astronomer,” peering and gazing at landscapes of symptoms, and by the act of continual exploration increasing the symptoms and becoming enveloped (“wrapped up”) in them.[*19] (There are dangers in this sort of introspective astronomy, especially when it concerns itself with morbid phenomena.) However, whatever intensification or prolongation of various strange disorders I may have caused, I am now getting better—visibly, palpably, with each passing day, almost each hour—and have as a “trophy” an exceptional penetration into the “central” aspects of all this (injury, operation, enclosing and immobilizing part of the body, suffering a hiatus in normal experience) and this, I think, is very important to write up. […]
The first walk was grotesque: I would find myself mysteriously unable to proceed, and discover that one foot was stuck behind the other, or in some wild unusable position. […] The 2nd and 3rd walks were each better by many orders of (imaginative and practical) magnitude. The 6th walk (yesterday) I experienced/enacted a true “kinetic melody” for the first time: i.e. I did not have to think “First I do this; now this; now this, etc.” but “it went by itself” melodically and naturally; then suddenly […] I “lost the hang of it,” and had to go back to my graceless, conscious, cautious, unmusical and unnatural pseudo-gait.
Something else fascinating. I was confined for 20 days and nights in an almost-featureless oblong room 7ʹ x 9ʹ—(the window was blocked by scaffolding, and I could neither see through it, nor out through the door). When I was moved into a larger room, yesterday, which showed a complete prospect through both door and window, I noticed a sharp and complete stopping of stereo depth perception at a point within my present room; and looking outside, across the corridor, a pipe on the opposite wall appeared to be in the same plane as my own door, despite a gross parallactic difference observable between each eye. […]
This rectified within a few minutes—as I gazed and visually “palpated” the new situation, I felt my visual space becoming larger, until I could clearly see the depth between them.[*20] […]
I also experienced abnormalities, instabilities, uncertainties of scale and perspective. The garden looked minute (and idyllic)—almost as if seen thru the wrong end of a telescope. The right angle of the rectangular lens (which I suppose subtends about 135 degrees on the retina) appeared too long for about a minute, becoming more obtuse or acute. The rather grotesque view above the garden—the hospital building dominated by the ludicrous, meaningless (here ambiguous) spoke of the Post Office tower (looking like an axle of the earth, if anything at all)—all of this looked grossly fore-shortened, as if I were looking through a 300 mm. telephoto lens. Again it has come to look more “normal” by degrees.
So, it is clear how profoundly one can lose one’s depth and distance perception and judgement when “starved” of space for a matter of days; this seems exactly analogous to the loss of sensory and motor images, procedural “know-how,” intentionality etc. which I experienced with the immobilized, invisible, de-afferented leg.
Forgive this rambling letter; but I am bursting at the strangeness of all this, and you are someone who might be interested. I will be in London either here in the hospital, or in the Convalescent Home (Athlone House, on Hampstead Heath) until the end of the month. Do please visit me if you are in town on the 23rd.
My best regards to Freja and yourself,
Oliver
To F. Robert Rodman
September 30, 1974
Athlone House, Hampstead Lane, London
My dear Bob,
I have just received your letter (there is a great mail hold-up in London at present). I was much saddened to hear of Maria’s death, and offer you all my sympathy in your loss. I did not know her well, but I knew her well enough to feel her rare and special quality—and this, of course, is irreplaceable. I hope that her last weeks were peaceful, and not fraught with too much pain or fear.
I know what a frightful, limitlessly-harrowing experience this has been for you (and perhaps, tho’ less, for your children also). I know too that the real loss, as opposed to the anticipation of loss, starts now.
I am heartened to see that your letter is full of clarity and courage; it is the letter of a broken-hearted man, but also of a man who has—beneath or beyond the depths of his grief—still greater depths of strength and faith to carry him through his affliction. You may not be conscious of this, but it shines through your letter, and it is there. It will especially be this ultimate and unconscious strength and resolve which will support you in the agonizing months ahead, and which will gradually—without any denial or obliteration of reality—start to heal the unbearable wounds. And it is good and important that you have your practice to return to—whatever your later decisions or moves. Also, you will understand your patients as never before (I don’t mean that your understanding and sympathy weren’t deep before; but that they will be still deeper now you yourself have plumbed the depths of painful experience and emotion).
* * *
—
I forget exactly what I wrote to you from hospital—it was a difficult time then, with a lot of pain, uncertainty, fear. The last thing I would want to suggest, or seem to suggest, is that there was any significant connection between my accident and your situation. Such things are always, of course, multiply determined and “over-determined,” and this particular accident, I think, especially so. No! I had many excellent “reasons” for contriving (or facilitating, or allowing) such an accident, which had reference to pressing parts of my life (in particular, an ugly situation in New York, which led me to a whole series of destructive acts from the burning of my book on April 19 to my fall in the mountains on August 24); no, many many reasons not bearing on you. And, I will add, not all of them entirely destructive or “bizarre.” I have found the entire business absolutely extraordinary: the shock of sudden crippling; the multiple aspects of “patienthood,” helplessness and dependence; excruciating sensitivity to the behaviour (and especially the motives) of those round one; the certainty that one will never recover (I had a severe “negative phantom” for almost 3 weeks, and could neither move, perceive, nor imagine my leg; I felt acutely amputated, bereft of my leg); and then the unexpected, incredible steps of recovery, which seemed like a miracle (the wisdom of Nature, the grace of God; but certainly the sense of nature as a definitely wise and healing force, nature as provider and Providence for all of her creatures). In my lesser way, I too have plumbed the extremes of this experience and feeling, and feel definitely and indeed radically altered by it. I also shall see my own patients in a more compassionate and comprehending light, having been through patienthood myself.
I will also write (have already roughed out 40,000 words of) a book on the whole experience, with all its implications + ramifications. It is, I suppose, the book on Care (and “anti Care”) which I was planning to write before, but which has now been given a far deeper reality and authenticity through being a patient myself. I see that I needed injury and patienthood of my own to deepen my insight and write a better book. The experience is both the source and the cost of all genuine “material.”
I wonder whether sometime—later, not now—it may help to assuage your grief, clarify your soul, set things in new significances + perspectives, if you were to “transform” some of your recent and present experiences into Art, Communication, Insight—I don’t know what word to use. But I don’t think one can (or should) try to do this while one is still overwhelmed by feeling. One cannot feel to the utmost and examine one’s feelings simultaneously; but certainly one can (and must) first experience and then explore.
