Happy Birthday, Good Dr. Sacks

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Thank you. On of the show's all-time favorite human beings.
The late neurologist and science writer, Dr. Oliver Sacks.
We had spoken to Oliver Sacks many, many times on this show, and his essays about his patients, most famously Awakenings and the man who mistook his wife for a hat, they are a model for what we like to do around here, the mix of science and heart and curiosity. So today what we're going to do for you is to play you a conversation that one of our other all-time beloved humans, Robert Kralwich, had with Dr.
Sachs about a decade ago. Dr.
Sachs was just turning 80 years old at the time. So to celebrate, Kralwich sat down with him and had him explain how thousands of worms and a motorbike accident led to his brilliant career as a writer.
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. I came to New York in 65.
He wasn't planning to write essays about science, not at all. I wanted to be a real scientist.
The kind that does experiments in a lab. And he had a research position at Einstein Medical Center in the Bronx working with worms.
Earthworms? Right. Earthworms.
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.
How many altogether? Tens of thousands. The thing about worms is when you give them a little poke, you give them a little...
They have very quick reactions, startle reactions when they curl up. 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 myelin.
So thin, you have to peel it off really delicately. One is looking for a little amount of myelin in their giant nerve fibers, maybe a thousandth of the weight of each worm.
So you're digging up lots of earthworms, but how do they die? Well, I don't want to be pressed on that point. Oh, come on.
Give me a little. We sort of anesthetized them and put them out.
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.
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 throughway, the notebook broke loose and fell off the bike.
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...
The cross Bronx expressway can get very, very busy. 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.
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.
And therefore all the data that you had collected from all of these? Nine months data in it. But I concerned myself that at least I had the sample and I could continue the work.
With this little ball of precious myelin. And sort of make further results.
Although then there was another and even worse accident, which is I lost the specimen of myelin, which I spent nine months getting. I mean, the thing that you pulled out of all these many animals? Yes.
How did you lose it? 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, Sax, you're a menace. Go see patients.
You'll do less harm. So no more lab work for you.
No more lab work for me. And the rest is history.
And the rest is history. So now instead of a scientist in a lab, Oliver is assigned to what's basically a nursing home.
The original name had been the Beth Abraham Home for Incurables. Now it was just Beth Abraham Hospital up in the Bronx.
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. 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.
Some in chairs, some standing, 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.
Yes, right. 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, as extinct volcanoes in whom there was very little behavior and very little sign of mind of an interior. They'd been stuck at Beth Abraham ever since.
And it seemed in 1966 when I went there that there was no hope or no future for them. But then one year into his new job, a paper came out that said large doses of a chemical called L-Dopa L-Dopa, levodihydroxyphylalanline, seemed to help Parkinsonians unfreeze a little bit.
And Sacks thought, well, who knows? Maybe they could help my patients.

It was a hunch. 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.

Dr. Sayre?

What is it?

It's a f***ing miracle.

For the patients with L-Dopa, the changes were, to put it mildly, dramatic.

Where are my glasses?

They're on your face.

Thank you.

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

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. Anthony, how are you? Great, man.
How are you? Great, too. All right, man.
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. Wonderful, wonderful, said a patient he called Hester, who in one weekend burst out of a 30-year silence.
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.
He gave his patients diaries, and he told them, tell me what you're feeling and experiencing. Again, here's Hester.
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.
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... Rating forms.
Basically, they were charts. So if a patient shook less, Oliver was to mark that change checking a box...
On a seven-point scale. So his shakes went from a six to a four.
Then, you know,

just check the box. Numbers were key.
That was what they expected, what they demanded.

And that was enough for them? That would have been enough for them. 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. And I then stopped keeping these rubbishy inventories.
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. 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... Meaning adjectives and adjectives and adverbs had been placed by numbers? That the urea was so-and-so, the chest x-ray, so-and-so,

and the more human sorts of description had become rarer.

A hundred years earlier, in the 1870s,

doctors did quote patients and did describe scenes in their clinical studies.

Many of the 19th century accounts are vivid and descriptive.

But as medical machines got better, numbers became more reliable, gradually pushing out description, with one very singular exception. His name was...
A.R. Luria.
Dr. 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. Yes, so much so that I read the first 20 pages of this, thinking it was a novel.
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.
Also by Dr. Luria.
Called

Human Brain and Psychological Processes. This is the book you are holding in your hand.
The book

I'm holding at the moment, or I should say another copy of the book. Yes.
When I read the book,

I don to do. And suddenly he was jealous and maybe more than a little competitive because this guy was doing it so well.

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. I hope you own this book.
It was not the library book. 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. 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? Well, when Awakenings was published, many essayists and poets and others liked it very much.
Auden said he thought it a masterpiece. That's W.H.
Auden, the great poet. And it was selected as book of the year by five writers.
On the other hand, there were no medical reviews whatever. None.
None. Well, to be fair, one small journal ran an editorial 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.
The strange M-U-T-I-S-M. Yes, the strange mutism.
As in silence. Yes, as in silence.
This isn't science, some neurologists said. This is anecdote.
Awakenings is not useful. It's overwritten.
Where's the data? And what is Sachs doing? The attacks got personal. One of the most painful was from a man who said Sachs is the doctor who mistook his patients for a literary career.
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.
From Moscow. It excited me.
It had beautiful handwriting done, obviously, with a fountain pen. 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.

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 showed it could be going to revive to great success after this short break. Radiolab is supported by Audible, presenting Sunrise on the Reaping, the highly anticipated new audiobook in the Hunger Games series by Suzanne Collins on Audible.
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Welcome back. We are listening to Robert Krolwich interview the late, great Dr.
Oliver Sacks about how he tripped and stumbled into becoming a brilliant science writer.

When we left for break, Dr. Sacks had just described receiving a letter of praise from another doctor writer, one whom he very much looked up to.
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.
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 pose.
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. Come on, what is a regular neurologist going to do with 50 pages about a sneeze? How is he going to use that? Well, you might indeed be able to use it.
Let me give an example. No, no.
50 pages on a sneeze? You've just gone from useful to Proust. There's a line here and you've just crossed it.
This is literary. This is no longer medical writing for doctors.
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. No, but how far do you expand it? Because you already 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. Well, I think things have changed.
And 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. 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 makes you realize that science is fun and science is play.
But... do this.
I have one last question. I'm still going to be channeling your doctor critics, 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 act? Well, it would depend what I had. I'm going to give you an example.
Okay. 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.
Sachs? And the man next to me said, yes. And I looked around furiously, and anyhow, it turned out that he was another Dr.
Sachs, in fact, a Dr. David Sachs, 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 Sachsian 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.
Sachs said he also thought that one of the pupils was a bit enlarged, but we weren't quite sure. I said, well, let's observe.
And as we observed, the enlarged pupil enlarged more. And I looked at Dr.
Sachs, and Dr. Sachs 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. What did you want to tell the captain? We said to the captain, we think this woman is bleeding in her brain.
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 emotionally landed at Denver.

The woman was taking off the The captain said, okay, and he emotionally landed at Denver.

The woman was taking off the plane.

She was successfully operated on, and she thanked us both.

So I can be...

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

Well, we did it together.

But notice that he told it fantastically. That was the late, the great Dr.
Oliver Sacks. If you're interested in reading more of his work, we recommend literally any of his books and countless essays.
Oh, so good. Although I really loved An Anthropologist on Mars, and then I was a sucker for his autobiography on the move.
Yeah. It's also fun to read his book, Awakenings, and then watch the movie with Robin Williams playing him.
And we also, we have tons of episodes with Dr. Sachs talking about his life, his patients.
Just Google Radiolab and Dr. Oliver Sachs, and so many will pop up.
And that's it for today. Live your best life.
And part of that, obviously, is tuning in again next week. Hi, I'm Rianne, and I'm from Donegal in Ireland.
I'm here at the staff credits. Radiolab was created by Jad Abumrad and is edited by Soreen Wheeler.
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Get ready for Netflix's gripping new medical drama, Pulse. Set in a cutting-edge Miami trauma center, third-year resident Dr.
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Xander Phillips gets suspended. Then, when the emotional and physical stakes are at their highest,

a storm will push the hospital and its residents to their limits.

Witness how life can change in a heartbeat when you're operating under pressure.

Watch Pulse, April 3rd, only on Netflix.