Oliver Sacks, a dear colleague of mine at The New Yorker and in the world of medicine, was an inspiration to me and to countless physicians. A great deal will be said in the coming days about Oliver’s unique literary output—masterful books including “An Anthropologist on Mars,” “Awakenings,” and “The Man Who Mistook His Wife for a Hat.” But we should remember that he also embodied in his medical practice a kind of ideal approach—creative, sensitive, and large-hearted—to his many patients. He was an extraordinary and exemplary doctor.
Neurology is often depicted as a discipline of great detachment. Sacks, who was eighty-two when he died, trained in the field before the advent of the CT scan and the MRI. He learned to observe his patients in extreme detail, calling on his professional training and uncanny perception to make meticulous analyses of motor strength, reflexes, sensation, and mental status; in doing so, he arrived at a diagnosis that might locate a lesion within the anatomy of the brain or spinal cord. And yet, because medical technology had only gone so far in those days, once this intellectual exercise was completed, there was often very little that could be done to ameliorate most neurological maladies.
Sacks showed that it was possible to overcome this limited perspective. He questioned absolutist categories of normal and abnormal, healthy and debilitated. He did not ignore or romanticize the suffering of the individual. He sought to locate not just the affliction but a core of creative possibility and a reservoir of potential that was untapped in the patient. There was the case history, for instance, of a color-blind painter who lost all perception of color but discovered that he could capture the nuances of forms and shapes in hues of black and gray with great mastery.
Both as a physician and as a writer, he had two great themes: identity and adaptation. Illness, he made plain, need not rob us of our essential selves—and this was something he exemplified in his final months, as a he continued to write remarkable essays even as cancer began to sap his strength and overwhelm him. Sacks understood our frequent ability to adapt, and emphasized that the capacity for someone to adapt to a particular condition—amnesia, blindness, deafness, migraines, phantom-limb syndrome, Asperger’s syndrome, and countless other conditions—cannot be known from the outset. These concepts grew from his study of zoology and evolution at Oxford. He similarly saw in medicine a great diversity among individual patients, and the inherent uncertainty of the outcome of a particular disorder. These unknowns gave hope to patients guided by the right doctor—a hope he captured in his description, in “Awakenings,” of catatonic-seeming encephalitis patients at Beth Abraham Hospital, in the Bronx, who had been written off as “locked in” and then revived, at least provisionally, by drugs like L-Dopa.
Sacks was a contrarian who refused to compromise this approach to the sick and the suffering. He resisted the powerful current of modern practice that seeks the generic. He rejected a monolithic mindset, and retrieved the individual from the obscuring blanket of statistics. This put him outside of the academy, exiled to chronic-care institutions. Through his writing, Sacks ultimately received recognition for advancing a unique form of clinical scholarship that was largely abandoned: the study of the single person within the context of his own life. Ever the acute observer, his case histories confirmed that under a single diagnostic term was a spectrum of human biology. No two patients are ever the same, he emphasized. When examining patients on the autistic spectrum, for example, he highlighted, and informed the public about, individuals with the capacity to draw precisely from memory, the capacity to make calculations nearly at the speed of a computer, or the ability to listen to a piece of music and reproduce it on the piano.
Sacks made house calls, not only in California and New York where he practiced, but globally, visiting Dr. “Bennet,” a surgeon with Tourette’s syndrome in rural Canada or the autistic artist Stephen Wiltshire on a tour of Europe. In these visits, he practiced what might be called the medicine of friendship, showing genuine interest and respect to people who are often shunned. This was the therapeutic intervention when neurology lacked effective pills or procedures.
This did not mean Sacks was a Luddite. He was an avid reader of scientific journals, fascinated by scientific advancements in imaging the nervous system at work. He engaged in dialogue with Nobel laureates and lab scientists about the nature of consciousness, providing what they lacked—the insights of a naturalist, a field worker.
Sacks also embodied an attribute that can be lost after people become famous: a boundless generosity of spirit. He encouraged young doctors and scientists to record their experiences and communicate them in prose, celebrating their endeavors rather than seeing them as a form of competition or threat. I believe his intense curiosity and boundless energy moved him to want to learn from the succeeding generation, as great teachers do.
Over the past years, Oliver revealed a part of his life that was once considered a debility and disorder—his sexual orientation. The demeaning of this part of his person, he believed, was the cause for his descent into amphetamine abuse. Drugs may well have killed him decades ago, before his contributions to medicine and writing. It was clinical work, caring for others with competence and compassion, that proved therapeutic for the doctor, giving him the strength to break the powerful grip of drug use. After decades of celibacy, Oliver shared the last eight years of his life with the writer Billy Hayes.
In May, after I had reviewed “On the Move: A Life,” his autobiography, he sent me a letter about what he wanted to accomplish in the time left to him. “In whatever time remains,” he aimed to “pull together another book of case histories–some large … some small, even miniature.” Every dimension of the patient was meaningful in his thinking.
