I could perhaps have stayed on at UCLA, living in my little house in Topanga Canyon, but I felt I needed to move on and specifically to go to New York. I felt that I was enjoying California too much, was getting addicted to an easy, sleazy life, to say nothing of a deepening drug addiction. I felt I needed to go to a hard, real place, a place where I could devote myself to work and perhaps discover or create a real identity, a voice of my own. Despite my interest in axonal dystrophy—Cowen and Olmstead’s special field—I wanted to do something else, to combine neuropathology and neurochemistry in some intimate way. Einstein was a very new college which offered special interdisciplinary fellowships in neuropathology and neurochemistry—disciplines brought together by the genius of Saul Korey—and so I accepted the offer from Einstein.9
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In my three years at UCLA, I worked hard, played hard, and took no holidays. Every so often, I would go to my chief, the formidable (but kindly) Augustus Rose, to say I wanted a few days off, but he would always reply, “Every day is a holiday for you, Sacks,” and, cowed, I would drop the idea.
But I continued my weekend bike rides, and I often rode to Death Valley, sometimes to Anza-Borrego; I loved the desert. Occasionally, I rode down to Baja California, getting the feel of a completely different culture, though the road was very rough beyond Ensenada. I put more than 100,000 miles on my bike by the time I left UCLA and moved to New York. Roads were starting to get crowded by 1965, especially in the East, and I was never again to enjoy biking, life on the road, with the sort of freedom and joy I had had in California.
I sometimes wonder why I have spent more than fifty years in New York, when it was the West, and especially the Southwest, which so enthralled me. I now have many ties in New York—to my patients, my students, my friends, and my analyst—but I have never felt it move me the way California did. I suspect my nostalgia may be not only for the place itself but for youth, and a very different time, and being in love, and being able to say, “The future is before me.”
1. My father would eat continually in the presence of food but go all day without food if it was not available; it is similar with me. In the absence of internal controls, I have to have external ones. I have fixed routines for eating and dislike deviations from them.
2. Helfgott’s achievement was all the more extraordinary because he had survived the camps at Buchenwald and Theresienstadt.
3. Unfortunately, her hip had broken in a bad place, compromising the blood supply in the head of the femur. This caused it to undergo so-called avascular necrosis and finally collapse, causing intense, unremitting pain. Though my mother was stoical and continued seeing patients, leading a full life despite the pain, it aged her, and when I returned to London again in 1965, she looked ten years older than she had three years earlier.
4. It was, of course, more than a chance coincidence. A paper published in 1963 had described axonal changes associated with vitamin E deficiency in rats, and another paper in 1964 had described similar axonal changes in mice given IDPN (iminodipropionitrile). New findings have to be duplicated by other laboratories, and this is what my colleagues at UCLA were doing.
5. IDPN and related compounds produce excessive arousal and hyperactivity not only in mammals but in fish, grasshoppers, and even protozoa.
6. I had hoped that it might be possible to publish some of Jim’s mathematical work posthumously; I envisaged something like F. P. Ramsey’s posthumous book The Foundations of Mathematics (Ramsey died at twenty-six). But Jim was essentially an on-the-spot problem solver: he would scribble an equation or a formula or a logical diagram on the back of an envelope, then crumple it up or lose it.
7. I should have learned that high seas are not for me, that a particular danger attended especially high “freak” waves, and that these can come out of the blue, even in seemingly calm seas. I later had two somewhat similar incidents. One was on Westhampton Beach on Long Island; this tore off the greater part of my hamstring muscles on the left side, and here again a friend, my old friend Bob Wasserman, pulled me to safety. Another one, which I was lucky to survive, happened when I was backstroking, foolishly, in high seas off the Pacific coast of Costa Rica.
I now have a dread of surf and have turned to lakes and slow-moving rivers as my favorite places to swim, though I still love snorkeling and scuba diving, which I learned in the calm waters of the Red Sea in 1956.
8. A few years later, Topanga Canyon was to become a mecca for musicians, artists, and hippies of all kinds, but in the early 1960s, when I was there, it was relatively unpopulated and very quiet. Houses on unpaved trails, like mine, had no close neighbors, and I had to get water trucked up in fifteen-hundred-gallon deliveries, to be stored in a cistern.
9. Korey, a man of immense farsightedness, imagined the rise of a unified neuroscience years before the term was invented. I never met him, for he died, tragically young, in 1963, but he left as his legacy the close interaction of all the “neuro” labs (as well as the clinical neurology departments) at Einstein—an interaction that continues today.
Out of Reach
In September of 1965, I moved to New York to do my fellowship in neurochemistry and neuropathology at the Albert Einstein College of Medicine. I still had hopes of being a real scientist, a bench scientist, even though my research at Oxford had ended disastrously and should have warned against any repetitions. But with the jauntiness of denial, I thought I should have another try.
The fiery Robert Terry, whose beautiful electron microscope studies of Alzheimer’s disease had so enthralled me when he spoke at UCLA, was away on a sabbatical when I arrived in New York, and in his absence the department of neuropathology was run by Ivan Herzog, a mild, sweet-tempered Hungarian émigré who was amazingly tolerant of and patient with his erratic fellow.
By 1966, I was taking very heavy doses of amphetamines, and I became—psychotic? manic? disinhibited? enhanced? I hardly know what term to use, but it went with an extraordinary heightening of the sense of smell and of my normally unremarkable powers of imagery and memory.
We would have a teaching quiz every Tuesday, when Ivan asked us to identify photomicrographs of unusual neuropathological conditions. I was normally very bad at this, but one Tuesday Ivan presented some photographs, saying, “This is an extremely rare condition—I don’t expect you to recognize it.”
I cried out, “Microglioma!” Everyone looked at me, startled. I was normally the mute one.
“Yes,” I continued, “only six cases have been described in the world literature.” And I cited all these in detail. Ivan stared at me, goggling.
“How do you know this?” he asked.
“Oh, just casual reading,” I answered, but I was as startled as he was. I had no idea of how, or indeed when, I could have absorbed this knowledge so swiftly and unconsciously. It was all part of that strange amphetamine enhancement.
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As a resident, I had been especially interested in rare, often familial diseases called lipidoses, in which abnormal fats accumulate in brain cells. I was excited when it was discovered that these lipids could also accumulate in the nerve cells residing in the wall of the gut. This might make it possible to diagnose such diseases even before any symptoms appeared, by doing a biopsy not of the brain but of the rectum—a far less traumatic procedure. (I had seen the original report of this in the British Journal of Surgery.) One needed to find only a single lipid-distended neuron to make a diagnosis. I wondered whether other diseases—Alzheimer’s, for example—could also cause changes in the neurons of the gut and be diagnosed very early this way. I developed, or adapted, a technique for “clearing” the rectal wall so that it was almost transparent and staining the nerve cells with methylene blue; this way one could see dozens of nerve cells in a low-power microscope field, increasing the chances of finding any abnormalities. Looking at our slides, I persuaded myself and my chief, Ivan, that we could see changes in rectal nerve cells—the neurofibrillary tangles and Lewy bodies that seemed charact
eristic of Alzheimer’s and of Parkinson’s disease. I had high thoughts of the importance of our findings; it would be a breakthrough, an invaluable diagnostic technique. In 1967, we submitted an abstract of the paper we hoped to present at the upcoming meeting of the American Academy of Neurology.
Unfortunately, things went wrong at this point. We needed much more material besides the few rectal biopsies we had, but we were unable to obtain these.
We could not proceed with our research, and Ivan and I pondered the matter—should we retract our preliminary abstract? In the end, we did not, feeling that others would examine the matter; the future would decide. And so it did: the “discovery” which I had hoped would make my name as a neuropathologist turned out to be an artifact.
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I had an apartment in Greenwich Village, and unless there was deep snow, I would ride my motorbike to work in the Bronx. I had no saddlebags, but the bike had a sturdy rack on the back to which I could secure what I needed with strong elastic bands.
My project in neurochemistry was to extract myelin, the fatty material which sheathes larger nerve fibers, enabling them to conduct nerve impulses more speedily. There were many open questions at the time: Was invertebrate myelin, if it could be extracted, different in structure or composition from vertebrate myelin? I chose earthworms as my experimental animal; I had always been fond of them, and they have giant, myelin-sheathed, rapidly conducting nerve fibers that permit sudden, massive movements when they are threatened. (It was for this reason that I had chosen earthworms to work with ten years before, to study the demyelinating effects of TOCP.)
I committed a veritable genocide of earthworms in the college garden: thousands of earthworms would be needed to extract a respectable sample of myelin; I felt like Marie Curie processing her tons of pitchblende to obtain a decigram of pure radium. I became adept at dissecting out the nerve cord and cerebral ganglia in a single, swift excision, and I would mash these up to make a thick, myelin-rich soup ready for fractionation and centrifugation.
I kept careful notes in my lab notebook, a large green volume which I sometimes took home with me to ponder over at night. This was to prove my undoing, for, rushing to get to work one morning after oversleeping, I failed to secure the elastic bands on the bike rack and my precious notebook, containing nine months of detailed experimental data, escaped from the loose strands and flew off the bike while I was on the Cross Bronx Expressway. Pulling over to the side, I saw the notebook dismembered page by page by the thunderous traffic. I tried darting into the road two or three times to retrieve it, but this was madness, for the traffic was too dense and too fast. I could only watch helplessly until the whole book was torn apart.
I consoled myself, when I got to the lab, by saying at least I have the myelin itself; I can analyze it, look at it under the electron microscope, and regenerate some of the lost data. Over the ensuing weeks, I managed to do some good work and had started to feel some optimism again, despite some other mishaps, as when, in the neuropathology lab, I screwed the oil-immersion objective of my microscope through several irreplaceable slides.
Even worse, from my bosses’ point of view, I managed to get crumbs of hamburger not only on my bench but in one of the centrifuges, an instrument I was using to refine the myelin samples.
Then a final and irreversible blow hit me: I lost the myelin. It disappeared somehow—perhaps I swept it into the garbage by mistake—but this tiny sample which had taken ten months to extract was irretrievably gone.
A meeting was convened: no one denied my talents, but no one could gainsay my defects. In a kindly but firm way, my bosses said to me, “Sacks, you are a menace in the lab. Why don’t you go and see patients—you’ll do less harm.” Such was the ignoble beginning of a clinical career.1
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Angel dust—what a sweet, alluring name! Deceptive, too, for its effects can be very far from sweet. A rash drug taker in the 1960s, I was prepared to try almost anything, and knowing my insatiable, dangerous curiosity, a friend invited me to join an angel dust “party” in an East Village loft.
I arrived a bit late—the party had begun—and when I opened the door, I was faced by a scene so surreal, so insane, that it made the Mad Hatter’s tea party seem, by comparison, the essence of sanity and propriety. There were almost a dozen people there, all of them flushed, some with bloodshot eyes, several staggering. One man was uttering shrill cries and leaping about the furniture; perhaps he fancied himself a chimp. Another was “grooming” his neighbor, picking imaginary insects off his arms. One had defecated on the floor and was playing with the feces, making patterns in it with an index finger. Two of the guests were motionless, catatonic, and another was making faces and blathering, a farrago which sounded like schizophrenic “word salad.” I phoned emergency services, and all of the partiers were taken to Bellevue; some of them had to be hospitalized for weeks. I was exceedingly glad I had arrived late and had not taken any angel dust myself.
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Later, working as a neurologist at Bronx State, I saw a number of people who had been precipitated by angel dust (phencyclidine, or PCP) into schizophrenia-like states sometimes lasting months on end. Some had seizures, too, and many of them, I found, had highly abnormal EEGs for as much as a year after taking the angel dust. One of my patients murdered his girlfriend when they were on PCP, though he retained no memory of the deed. (Years later I published an account of this very complex and tragic business, and its equally complex and tragic sequelae, in The Man Who Mistook His Wife for a Hat.)
PCP was originally introduced as an anesthetic in the 1950s but by 1965 was no longer in medical use because of its horrific side effects. Most hallucinogens have their primary effects on serotonin, one of the brain’s many neurotransmitters, but PCP, like ketamine, impairs the transmitter glutamine and is far more dangerous and long lasting in effect than other hallucinogens. It is known to cause structural lesions, as well as chemical changes, in the brains of rats.2
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The summer of 1965 was a particularly difficult, dangerous time for me, because I had three structureless months on my hands between finishing at UCLA and starting at Einstein.
I sold my trusty BMW R60 and went to Europe for a few weeks, where I bought a new, more modest model, an R50, at the BMW works in Munich. I went first to the little village of Gunzenhausen near Munich to see the graves of some of my ancestors; some of them were rabbis and had taken the name Gunzenhausen for themselves.
Then I went to Amsterdam, which had long been my favorite city in Europe and where I had had my sexual baptism, my introduction to gay life, ten years before. I had met a number of people on previous visits, and now, at a dinner party, I met a young German theater director called Karl. He was elegantly dressed and articulate; he spoke with wit and knowledge about Bertolt Brecht, many of whose plays he had directed. I thought him charming and civilized but did not think of him as especially attractive in sexual terms and gave no thought to him when I returned to London.
I was surprised, therefore, to get a postcard from him a couple of weeks later, suggesting that we meet in Paris. (My mother saw the postcard, asked whom it came from, and might have been mildly suspicious; I said, “An old friend,” and we left it at that.)
The invitation intrigued me, so I went to Paris by road and ferry, taking my new motorbike with me. Karl had found a comfortable hotel room with a commodious double bed. We divided our long weekend in Paris between sightseeing and lovemaking. I had brought a cache of amphetamines with me and downed twenty tablets or so before we went to bed. Hot with excitement and desire, which I had not felt before taking the tablets, I made love ardently. Karl, surprised by my ardor and insatiability, asked what had got into me. Amphetamines, I said, and showed him the bottle. Curious, he took one, liked the effect, took another, and another, and another, and soon, like me, he was fizzing with the stuff, as excited as if he had been in Woody Allen’s “orgasmatron.” After I know not how many hours, we separated, exhaus
ted, had a little break, and started back again.
That we might thrash about like two animals in rut was perhaps not wholly surprising, given the circumstances plus the amphetamine. But what I did not expect was that this experience would cause us to fall in love with each other.
When I got back to New York in October, I wrote fevered love letters to Karl and received equally fervent ones in return. We idealized each other; we saw ourselves spending long, loving, creative lives together—Karl fulfilling himself as an artist, I as a scientist.
But then the feeling started to fade. We asked ourselves whether the experience we had shared was real, authentic, given the huge aphrodisiac thrust of the amphetamines. I found this question particularly humiliating—could so lofty a transport as falling in love be reduced to something purely physiological?
In November, we oscillated between doubt and affirmation, thrown from one pole to the other. By December, we were out of love and (without regretting or denying the strange fever which had gripped us) had no desire to continue our correspondence. In my last letter to him, I wrote, “I have memories of a fevered joy, intense, irrational…totally gone.”
Three years later, I received a letter from Karl, telling me he would be coming to live in New York. I was curious to see him, to reencounter him, now that I had ceased to take drugs.
He had got a small apartment on Christopher Street near the river, and when I entered, I found the air ill-smelling and thick with smoke. Karl himself, so elegant before, was unshaven, unkempt, unclean. There was a dirty mattress on the floor and pillboxes in a shelf above it. I saw no books, no residue of his past life as a reader and director. He seemed to have no interest in anything intellectual or cultural. He had become a drug dealer and would talk about nothing except drugs and how the world could be saved by LSD. His eyes had an opaque, fanatical look. I found all this bewildering and shocking. What had happened to the fine, gifted, civilized man I had met just three years earlier?