[RADIOLAB INTRO]

ROBERT KRULWICH: Hi, I'm Robert Krulwich. This is Radiolab, the podcast. Jad is with his family this week, so it's just gonna be me—although not me all by myself, because we're gonna have a little birthday celebration for a guy who has been a contributor to this program pretty much since it began. Dr. Oliver Sacks will be 80 years old this week. His essays about his patients, Awakenings, Man Who Mistook His Wife for a Hat, they are a model for what we like to do around here: that mix of science and heart and curiosity. So I asked him, would you mind sitting down and talking to me about how you got started? And he said, "Well, all right. The truth is, though, my start wasn't all that easy. In fact, it was kind of rough."

OLIVER SACKS: I came to New York in '65.

ROBERT: He wasn't planning to write essays about science. Not at all.

OLIVER SACKS: I wanted to be a real scientist.

ROBERT: The kind that does experiments in a lab. And he had a research position at Einstein Medical Center in the Bronx, working with ...

OLIVER SACKS: Worms.

ROBERT: Earthworms?

OLIVER SACKS: Right, earthworms.

ROBERT: Oh!

OLIVER SACKS: I'm afraid I committed a sort of genocide of worms from the front garden at Einstein. I collected them by the hundred and by the thousand.

ROBERT: How many altogether?

OLIVER SACKS: Tens of thousands.

ROBERT: The thing about worms is when you give them a little poke, you give them a little—ergh, they have ...

OLIVER SACKS: Very quick reactions, startle reactions when they curl up.

ROBERT: They react faster than people do. And he wondered well, why? So he decided to focus on the wrappers that surround their nerve cells, which are made from a very thin substance called ...

OLIVER SACKS: Myelin.

ROBERT: So thin you have to peel it off really delicately.

OLIVER SACKS: One is looking for a little amount of myelin in their giant nerve fibers, maybe a thousandth of the weight of each worm.

ROBERT: So you're digging up—digging up lots of earthworms. But how did they die?

OLIVER SACKS: Well, I don't want to be pressed on that point.

ROBERT: [laughs] Oh, come on! Give me a little ...

OLIVER SACKS: We sort of anesthetized them, and put them out.

ROBERT: Until very gradually, he accumulated a precious ball of myelin that he could then take to a laboratory to experiment with. Of course, like any good scientist, he also took notes.

OLIVER SACKS: I kept fairly detailed notes in a huge green notebook, my lab notebook. At that time, I lived here in the West Village. I had a motorbike, and I went in daily to Einstein in the Bronx. I sometimes took the book home at night to ponder over. But one morning, when I was in a bit of a hurry, I failed to secure it properly to the motorbike. And when I was on the Cross Bronx Thruway, the notebook broke loose and fell off the bike.

ROBERT: Oy!

OLIVER SACKS: I got to the edge of the road and put my bike on the stand. I could see the book in the middle of the crowded Cross Bronx, being really ...

ROBERT: The Cross Bronx Expressway can get very, very busy.

OLIVER SACKS: Very busy, very crowded, very fast. Very callous drivers who, instead of respecting this notebook, this holy notebook of mine, were tearing it sheet from sheet. On two occasions, I made little sallies to try and get into the traffic, but this would have been fatal. And so I lost my notebook.

ROBERT: And therefore, all the data that you had.

OLIVER SACKS: Collected nine months data in it. But I consoled myself that at least I had the sample, and I could continue the work.

ROBERT: With his little ball of precious myelin.

OLIVER SACKS: And sort of make further results. Although then there was another and even worse accident.

ROBERT: [laughs]

OLIVER SACKS: Which is I lost the specimen of myelin, which I spent nine months getting. And ...

ROBERT: You mean, the thing that you pulled out of all these many animals?

OLIVER SACKS: Yes. It's like ...

ROBERT: How did you lose it?

OLIVER SACKS: I don't know what happened to it. I'm afraid I am a loser. And then the powers that be got together, and basically in a very kind but firm way, they said, "Sacks, you're a menace. Go see patients. You'll do less harm."

ROBERT: So no more lab work for you.

OLIVER SACKS: No more lab work for me. And ...

ROBERT: The rest is history

OLIVER SACKS: And the rest is history.

ROBERT: So now instead of a scientist in a lab, Oliver is assigned to what's basically a nursing home.

OLIVER SACKS: The original name had been the Beth Abraham Home for Incurables.

ROBERT: Now it was just Beth Abraham Hospital up in the Bronx.

OLIVER SACKS: Some of my contemporaries said, "You know, this is the sticks. No ambitious doctor would—you know, would work in a place like this." But I found it perfectly to my liking because I could spend a great deal of time with patients.

ROBERT: Though on the day that he arrived, as he stepped into the lobby, he looked around for the first time, and he thought to himself, like, what is going on here? Because everywhere he looked, he saw people ...

OLIVER SACKS: Some in chairs, some standing.

ROBERT: ... totally still, like, frozen. And though he didn't know this yet, these folks would become yet another accident—or maybe I should call it a collision between Oliver and the science community, one that would be much more painful than getting exiled from the lab. But this time, he would stand his ground and he'd fight.

OLIVER SACKS: Yes, right.

ROBERT: Oliver's frozen patients had gotten sick back in the 1930s from a fever called encephalitis lethargica. They'd survived the disease, but it left them, as one doctor put it ...

OLIVER SACKS: As extinct volcanoes, in whom there was very little behavior and very little sign of mind of an interior.

ROBERT: They'd been stuck at Beth Abraham ever since.

OLIVER SACKS: And it seemed in 1966, when I went there, that there was no hope or no future for them.

ROBERT: But then, one year into his new job, a paper came out that said large doses of a chemical called L-DOPA ...

OLIVER SACKS: L-DOPA, levodihydroxyphenylaniline.

ROBERT: ... seemed to help Parkinsonians unfreeze a little bit. And Sacks thought, "Well, who knows? Maybe they could help my patients."

OLIVER SACKS: It was a hunch.

ROBERT: So he wrote the Drug Enforcement Agency in Washington asking for a supply of L-DOPA so he could run a study. If you've seen the movie, you know what happens next.

[ARCHIVE CLIP, Awakenings: Dr. Sayer?]

[ARCHIVE CLIP, Awakenings: What is it?]

[ARCHIVE CLIP, Awakenings: It's a [bleep] miracle!]

ROBERT: For the patients with L-DOPA, the changes were, to put it mildly, dramatic.

[ARCHIVE CLIP, Awakenings: Where are my glasses?]

[ARCHIVE CLIP, Awakenings: They're on your face.]

[ARCHIVE CLIP, Awakenings: Oh, thank you.]

ROBERT: Can you describe just a little bit what you were seeing?

OLIVER SACKS: Well, I was seeing people become alert, attentive to their surroundings, able to move and able to feel in a way they hadn't been able to for sometimes decades.

[ARCHIVE CLIP, Awakenings: Anthony, how are you?]

[ARCHIVE CLIP, Awakenings: Great, Vince. How are you?]

[ARCHIVE CLIP, Awakenings: Great, too.]

[ARCHIVE CLIP, Awakenings: [laughs] All right, Vince!]

ROBERT: Some of these changes Oliver could see and measure, but to get a fuller sense of what was happening, he wondered what was it like on the inside to suddenly walk and talk and feel after so long?

OLIVER SACKS: "Wonderful. Wonderful."

ROBERT: Said a patient he called Hester, who in one weekend burst out of a 30-year silence.

OLIVER SACKS: "I'm a new person. I feel it. I feel it inside. I'm a brand new person. I feel so much. I can't tell you what I feel."

ROBERT: He gave his patients diaries, and he told them, "Well, tell me what you're feeling and experiencing." Again, here's Hester.

OLIVER SACKS: "I feel very good. My speech is getting louder and clearer. My hands and fingers move more freely. I can even take the paper off a piece of candy, which I haven't done for years. The following day, she wrote, "Anyone who reads this diary will have to excuse my spelling and my writing. They must remember that I haven't done any writing for years and years." And to this she added very poignantly, "I would like to express my feelings fully. It is so long since I had any feelings. I can't find the words for my feelings. I would like to have a dictionary to find words for my feelings."

ROBERT: The government, of course, wanted to know what had happened as well. And they asked Oliver to report what he'd observed on what were called ...

OLIVER SACKS: Rating forms.

ROBERT: Basically, they were charts. So if a patient shook less, Oliver was to mark that change, checking a box.

OLIVER SACKS: On a seven-point scale.

ROBERT: So if his shakes went from a six to a four then, you know, just check the box. Numbers were key.

OLIVER SACKS: That was what they expected, what they demanded.

ROBERT: And that was enough for them?

OLIVER SACKS: That would have been enough for them.

ROBERT: But not for Oliver. He had seen so much that wouldn't even begin to fit on a seven-point inventory. He said, "I'm not doing this."

OLIVER SACKS: And I then stopped keeping these rubbishy inventories.

ROBERT: [laughs]

ROBERT: Because they didn't say enough. But as a researcher, as a scientist, he still had to report what had happened. Which was a problem, because in the 1960s, medical journals had an attitude about clinical studies. They also wanted numbers and patterns and data. They wanted things that you could measure. They didn't want stories.

OLIVER SACKS: Phenomena, phenomenological description, if you want to put it this way, had been largely displaced by laboratory tests of one sort and another. And that these ...

ROBERT: Meaning adjectives and adjectives, and what it was by numbers?

OLIVER SACKS: Well, that the urea was so and so, the chest X-ray so and so. And the more human sorts of description had become rarer.

ROBERT: A hundred years earlier in the 1870s, doctors did quote patients and did describe scenes in their clinical studies.

OLIVER SACKS: Many of the 19th-century accounts are vivid and descriptive.

ROBERT: But as medical machines got better, numbers became more reliable, gradually pushing out description—with one very singular exception. His name was ...

OLIVER SACKS: A.R. Luria.

ROBERT: Doctor A.R. Luria was a neurologist living in Moscow in the 1960s. He still did case studies the old-fashioned way. One of his accounts of a man with a remarkable memory was startlingly vivid.

OLIVER SACKS: Yes. So much so that I read the first 20 pages of this thinking it was a novel.

ROBERT: Huh!

OLIVER SACKS: And I then realized that it was a case history, but the most extraordinary and detailed I had ever read. But a case history which did not shy away from the human aspects and the pathos and drama. And then in 1967, I read a book ...

ROBERT: Also by Doctor Luria.

OLIVER SACKS: ... called Human Brain and Psychological Processes. And ...

ROBERT: And this is the book you are holding in your hand.

OLIVER SACKS: The book I'm holding at the moment, or I should say another copy of the book. When I read the book, I got appalled or frightened and awed by its power and its depth and its narrative sweetness.

ROBERT: "Wait a second," Oliver thought, "This man is doing exactly what I want to do." And suddenly, he was jealous and maybe more than a little competitive, because this guy was doing it so well.

OLIVER SACKS: And I thought, "This man has seen it all, he's writing, has thought it all out in detail. Sooner or later, he will see and think and write everything I can. Therefore, there will be no place for me in the world. Luria will have done it all." And I tore this copy in two.

ROBERT: I hope you owned this book, it wasn't a library book.

OLIVER SACKS: Well, it was indeed a library book. And I explained to the librarian at Einstein, I didn't say that I destroyed the book. I said, "Most unfortunately, I lost the book. But here is a new copy." And I got another new copy for myself, which I'm holding at the moment.

ROBERT: Ah.

ROBERT: And so, both frightened and boosted by Luria's example, Oliver Sacks sits down and he writes his manuscript for Awakenings. And following Luria's example, he wrote it as vividly as he possibly could, with quotes, with scenes, with emotions. The book came out in 1974. And what happened?

OLIVER SACKS: Well, when Awakenings was published, many essayists and poets and others liked it very much. Auden said he thought it a masterpiece.

ROBERT: That's W.H. Auden, the great poet.

OLIVER SACKS: And it was selected as book of the year by five writers. On the other hand, there were no medical reviews, whatever.

ROBERT: None?

OLIVER SACKS: None.

ROBERT: Well, to be fair, one small journal ran an editorial ...

OLIVER SACKS: Saying that among the most surprising things the previous year were the appearance of this extraordinary book and, quote, "the strange mutism," unquote, of the profession.

ROBERT: The strange M-U-T-I-S-M.

OLIVER SACKS: Yes, the strange mutism.

ROBERT: As in silence?

OLIVER SACKS: Yes, as in silence.

ROBERT: This isn't science, some neurologists said, this is anecdote. Awakenings is not useful, it's overwritten. Where's the data, and what is Sacks doing? The attacks got personal.

OLIVER SACKS: One of the most painful was from a man who said, "Sacks is the doctor who mistook his patients for a literary career."

ROBERT: Ooh!

ROBERT: The science community almost unanimously ignored Awakenings. But in the middle of this quiet, out of the blue, a letter arrived at Oliver's house.

OLIVER SACKS: From Moscow. It excited me. It had beautiful handwriting, done obviously, with a fountain pen.

ROBERT: He opened it and it was from the man himself, A.R. Luria. And it turns out Luria not only liked Awakenings, he liked exactly what the other neurologists didn't like.

OLIVER SACKS: He said, "The art of description common to the great neurologists and psychiatrists of the 19th century is almost gone now." And he went on to say that Awakenings should be revived and with a great success.

ROBERT: That letter, Luria's letter, plus the response from poets and playwrights and movie makers gave Oliver the boost he needed to double down and begin writing book after book after book in his new but old style. He wrote stories about husbands who mistook their wives for hats, colorblind painters, deaf people, Touretters, autistic people, blind people. His descriptions in all these books are so full of feeling, he makes these people come alive. This is his legacy. Oliver Sacks is a great includer. And when I asked him isn't it possible that your critics were maybe a little right, that maybe you overdid it a bit in Awakenings, put in too much description? He says, no.

OLIVER SACKS: I would now say that the description was inadequate. And I think, for example, that even with ordinary Parkinson's disease, to give an adequate description of how someone with Parkinson's rises from a chair and makes his difficult way across a room may need 50 pages of very clear prose. I think that to describe a sneeze and all the feelings which may proceed and attend and succeed it would require many, many pages of lucid prose.

ROBERT: Come on. What is a regular neurologist gonna do with 50 pages about a sneeze? How's he gonna use that?

OLIVER SACKS: Well, you might indeed be able to use it. Let me give an example.

ROBERT: No, no. 50 pages on a sneeze? You've just gone from useful to Proust. There's a line here, and you just crossed it. This is literary. This is no longer medical writing for doctors.

OLIVER SACKS: Well, I try to be, and I believe I am a good doctor. And a doctor does not just diagnose a disease. That is the least. He has to do that, but it's the least of what he does. He is also concerned with the impact of the disease on the person, their experience of it, and how they may adapt or otherwise how they may respond to treatment. So there is quite a strong individual story to be said of everyone with a disease or an injury. Or rather, you must expand the notion of medicine.

ROBERT: No, but how far do you expand it? Because you already have—you have millions of readers. Your stories have enormous influence. You're loved. The only question that dangles here is: what have you done for doctors? They're your holdouts.

OLIVER SACKS: Well, I think things have changed. At first there was this strange mutism, especially among senior doctors, though I think junior doctors might sometimes have a copy of Awakenings with a brown paper cover.

ROBERT: [laughs]

OLIVER SACKS: But now I think narrative has come back into medicine partly as a thing which is taught in medical school. I never thought of it as anything distinct from medicine, and it makes you realize that science is fun and science is play, but ...

ROBERT: Okay, so let me just do this. I have one last question. I'm still gonna be channeling your doctor critics when, this being your birthday, I feel it's something I should do. So if you were to get sick this afternoon and have to call a doctor—and we'll just say the name of this doctor happens to be Dr. Oliver Sacks. Would you trust him to fix you, or just talk about you so very beautifully, so people all over the world will know your story? Which is that Dr. Sacks best at?

OLIVER SACKS: Well, it would depend what I had.

ROBERT: [laughs]

OLIVER SACKS: I'm going to give you an example.

ROBERT: Okay. [laughs]

OLIVER SACKS: Some years ago when I was flying to California, the air hostess—the term was used then—came around at one point to get orders for breakfast. And she said, "Dr. Sacks?" And the man next to me said, "Yes."

ROBERT: [laughs]

OLIVER SACKS: And I looked around furiously. And anyhow, it turned out that he was another Dr. Sacks, in fact, a Dr. David Sacks, and he was a pulmonologist from Stanford. We got chatting a little bit until there was a call over the loudspeaker. "Is there a doctor on the plane?" And with Sacksian alacrity, the two of us got up, converged to the patient, who was a woman, obviously just coming to from an epileptic fit. And as she became clearer, we asked if she'd ever had a seizure before, and she said, "No." She was a medical technician. She knew about such things. I thought that one of her pupils was a little larger than the other. My fellow Dr. Sacks said he also thought that one of the pupils was a bit enlarged, but we weren't quite sure. We—I said, "Well, let's observe." And as we observed, the enlarged pupil enlarged more. And I looked at Dr. Sacks and Dr. Sacks looked at me and we said, "Let's go to the captain." I'm not timid when it comes to doing something for the patient.

ROBERT: What did you want to tell the captain?

OLIVER SACKS: We said to the captain, "We think this woman is bleeding in her brain, that this caused the seizure and this is also causing pressure in the head and the pupil, and she must be in neurosurgical hands as quickly as possible." The captain said, "Okay," and he emergently landed at Denver. The woman was taken off the plane, she was successfully operated on and she thanked us both. So I can be ...

ROBERT: Now which Dr. Sacks? Which of the two should get the lion's share of the credit?

OLIVER SACKS: Well, we did it together.

ROBERT: But notice that he told it fantastically. Which is why we envy Oliver Sacks. We admire him and we honor him on his 80th birthday. So happy birthday, Oliver. You have paved the way. And that's it for this short on Radiolab. I'm Robert Krulwich. Jad and I will be back next time, and we'll see you then.

[LISTENERS: Hi. My name is Britt Vann and I live in Manhattan. My name is Erica Stisser and I live in Brooklyn. And we've been best friends since fifth grade. Radiolab is supported in part by the National Science Foundation and by the Alfred P. Sloan Foundation, enhancing public understanding of science and technology in the modern world. More information about sloan@www.sloan.org.]

 

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