—
After I moved to New York in 1965, I took to exploring country roads on my motorbike, looking for a suitable place to get away for occasional weekends. One Sunday, driving through the Catskills, I found a picturesque old wooden hotel perched by a lake—the Lake Jefferson Hotel. It was owned by a genial German American couple, Lou and Bertha Grupp, and we soon got to know each other. I was especially taken by their solicitude for my motorbike, which they allowed me to leave in the lobby. It soon became a familiar weekend sight to the locals. “Doc’s up here again,” they would say on seeing the bike.
I especially loved Saturday nights at the old bar, which was full of colorful figures, yarning and drinking, and old photographs which showed the hotel during its heyday in the 1920s and 1930s. I did much of my writing in a little alcove by the bar, where I could be alone, private, invisible, yet warmed and stimulated by the vivid life at the bar.
After a dozen or so weekends, I came to an agreement with the Grupps: I would rent a room in the basement of the hotel, come and go when I wanted, and keep my things—basically a typewriter and swimming gear—there. I could have this room and enjoy the kitchen and bar, all the amenities of the hotel, for just $200 a month.
Life at Lake Jeff was healthy and monastic. I gave up my motorcycle in the early 1970s—I had started to find the traffic in New York City too dangerous, and motorcycling was no longer a pleasure—but I always had a bicycle rack on my car, and in the long summer days I would cycle for hours. I would often stop at the old cider mill near the hotel and get two half-gallon jugs of hard cider, which I would hang on the handlebars. I love cider, and the half gallons, sipped gradually and symmetrically—a mouthful from this jug, a mouthful from that—would keep me hydrated and slightly tipsy through a long day of cycling.
There was a horse stable not far from the hotel, and sometimes I would go there on Saturday mornings and spend a couple of hours riding a giant Percheron, with a back so wide it was like bestriding an elephant. I was heavy then, over 250 pounds, but the huge animal scarcely seemed to notice my weight; it was such horses, I reflected, that carried knights and kings in full armor; Henry VIII in full armor, it was said, weighed 500 pounds.
But the greatest joy of all was swimming in the placid lake, where there might be an occasional fisherman lounging in a rowboat but no motorboats or jet skis to threaten the unwary swimmer. The Lake Jeff Hotel was past its prime, and its elaborate swimming platform and rafts and pavilions were completely deserted and quietly rotting. Swimming timelessly, without fear or fret, relaxed me and got my brain going. Thoughts and images, sometimes whole paragraphs, would start to swim through my mind, and I had to land every so often to pour them onto a yellow pad I kept on a picnic table by the side of the lake. I had such a sense of urgency sometimes that I did not have time to dry myself but rushed wet and dripping to the pad.
—
Eric Korn and I met in our prams, so we were told, and we have remained the closest of friends for almost eighty years. We often traveled together, and in 1979 we took a boat to Holland and rented bicycles to cycle around the country, circling back to our favorite city, Amsterdam. I had not been to Holland for some years—though Eric, living in England, had gone frequently—so I was very surprised when, completely openly, we were offered cannabis in a café. We were sitting at a table when a young man came to us and with a practiced gesture flicked open a sort of folding wallet containing a dozen or more sorts of marijuana and hash; its possession and use in modest quantities were perfectly legal in Holland by the 1970s.
Eric and I bought a packet but then forgot to smoke it. Indeed, we forgot we had it, until we got to The Hague for our ship back to England and presented ourselves at customs. We were asked the usual questions.
Had we bought anything in Holland? they asked. Liquor, perhaps?
“Yes, Genever,” we replied.
Cigarettes? No, we didn’t smoke.
Marijuana? Oh, yes, we had forgotten all about it. “Well, throw it away before you reach England,” said the customs officer. “It’s not legal there.” We took it with us, thinking we might enjoy a little smoke on board.
We did have a little smoke and then threw the rest of the packet overboard. Perhaps it was more than a little smoke; neither of us had smoked for years, and the marijuana was much stronger than we expected.
I wandered off after a few minutes and found myself near the captain’s wheelhouse. Illuminated in the gathering dusk, it looked enchanting, like something out of a fairy tale. The captain was navigating, his hands on the wheel, and a little boy of about ten was standing at his side, fascinated by the captain’s uniform, the brass and glass dials, and the sea parting before the ship’s prow. Finding the door unlocked, I entered the cabin too. Neither the captain nor the little boy by his side was disturbed by my entry, and I stationed myself quietly on the captain’s other side. The captain showed us how he steered the ship, showed us all the dials; the little boy and I asked him lots of questions. We were so absorbed that we had no sense of time and were startled when the captain said that Harwich, on the English coast, was approaching. The two of us left, the little boy to find his parents, and I to find Eric.
When I found Eric, he looked haggard with anxiety, and he almost sobbed with relief as soon as he saw me. “Where were you?” he said. “I looked everywhere for you; I thought you’d jumped overboard. Thank God you’re alive!” I told Eric that I had been in the captain’s forecastle and enjoying myself. Then, taken aback by the intensity of his words and his expression, I said, “You care, you really care for me!”
“Of course,” Eric said. “How could you doubt it?”
But it was not easy to believe that anyone cared for me; I sometimes failed to realize, I think, how much my parents cared for me. It is only now, reading the letters they wrote to me when I came to America fifty years ago, that I see how deeply they did care.
And perhaps how deeply many others have cared for me—was the imagined lack of caring by others a projection of something deficient or inhibited in myself? I once heard a radio program devoted to the memories and thoughts of those who, like me, had been evacuated during the Second World War, separated from their families during their earliest years. The interviewer commented on how well these people had adjusted to the painful, traumatic years of their childhood. “Yes,” said one man. “But I still have trouble with the three Bs: bonding, belonging, and believing.” I think this is also true, to some extent, for me.
In September of 1978, I sent more of my Leg manuscript to Lennie—she wrote back, saying that she now felt that this might be “a happy, dancing book”—she was relieved that at last I seemed to be moving on to other interests. Towards the end of her letter, she touched on a darker matter:
“I’m waiting to go into hospital as my very nice and good surgeon feels that the time has come for a major operation on my stupid hiatus hernia and esophagus. Pop and David don’t seem very keen, but I’ve every confidence in him.”
This was Len’s last letter to me. She went into hospital, and things went wrong. What was supposed to be a straightforward operation turned into a disastrous near evisceration. When Lennie learned of this, she felt that life with intravenous nourishment and a spreading cancer was not worthwhile. She resolved to stop eating, though she would take water. My father insisted she be seen by a psychiatrist, but the psychiatrist said, “She is the sanest person I have ever seen. You must respect her decision.”
I flew to England as soon as I heard about this and spent many happy but infinitely sad days at Lennie’s bedside as she was growing weaker. She was always and totally herself despite physical weakness. When I had to return to the States, I spent a morning gathering all the different tree leaves I could find on Hampstead Heath and took them to her. She loved these, identified them all, and said they took her back to her years in Delamere Forest.
I sent her a final letter at the end of 1978; I do not know if she read it:
Dearest Len,
We have all of us been hoping so intensely that this month would see your return to health; but, alas! this was not to be.
My heart is torn when I hear of your weakness, your misery—and, now, your longing to die. You, who have always loved life, and been such a source of strength and life to so many, can face death, even choose it, with serenity and courage, mixed, of course, with the grief of all passing. We, I, can much less bear the thought of losing you. You have been as dear to me as anyone in this world.
I shall hope against hope that you may weather this misery, and be restored again to the joy of full living. But if this is not to be, I must thank you—thank you, once again, and for the last time, for living—for being you.
Love,
Oliver
—
I am shy in ordinary social contexts; I am not able to “chat” with any ease; I have difficulty recognizing people (this is lifelong, though worse now my eyesight is impaired); I have little knowledge of and little interest in current affairs, whether political, social, or sexual. Now, additionally, I am hard of hearing, a polite term for deepening deafness. Given all this, I tend to retreat into a corner, to look invisible, to hope I am passed over. This was incapacitating in the 1960s, when I went to gay bars to meet people; I would agonize, wedged into a corner, and leave after an hour, alone, sad, but somehow relieved. But if I find someone, at a party or elsewhere, who shares some of my own (usually scientific) interests—volcanoes, jellyfish, gravitational waves, whatever—then I am immediately drawn into animated conversation (though I may still fail to recognize the person I am talking to a moment later).
I almost never speak to people in the street. But some years ago, there was a lunar eclipse, and I went outside to view it with my little 20x telescope. Everyone else on the busy sidewalk seemed oblivious to the extraordinary celestial happening above them, so I stopped people, saying, “Look! Look what’s happening to the moon!” and pressing my telescope into their hands. People were taken aback at being approached in this way, but, intrigued by my manifestly innocent enthusiasm, they raised the telescope to their eyes, “wowed,” and handed it back. “Hey, man, thanks for letting me look at that,” or “Gee, thanks for showing me.”
As I passed the parking lot opposite my building, I saw a woman arguing fiercely with the parking attendant. I went up to them and said, “Stop quarreling for a moment—look at the moon!” Startled, they stopped and looked up at the eclipse, handing the telescope to each other. Then they gave it back to me, thanked me, and instantly resumed their furious quarreling.
A similar incident happened a few years later, when I was working on Uncle Tungsten and writing a chapter about spectroscopy. I had taken to wandering the streets with a tiny pocket spectroscope, peering through this at different lights and marveling at their varied spectral lines—the brilliant golden line of sodium lights, the red lines of neon, the complex lines of halogen-mercury lamps and their rare-earth phosphors. Passing by a bar in my neighborhood, I was struck by the range of colored lights within, and pressed my spectroscope against the window to examine them. It became obvious, however, that the patrons inside were disquieted by this odd behavior, my gazing at them (as they thought) with a peculiar little instrument, so I strode in boldly—it was a gay bar—and said, “Stop talking about sex, everyone! Have a look at something really interesting.” There was a dumbfounded silence, but again my childish, ingenuous enthusiasm won the day, and everyone started passing the spectroscope from hand to hand, making comments like, “Wow—cool!” After everyone had had a turn with the spectroscope, it was handed back, with thanks. Then they all resumed talking about sex again.
—
I struggled with the Leg book for several more years and finally sent the completed manuscript off to Colin in January of 1983, nearly nine years after beginning it. Each section of the book, neatly typed, was on paper of a different color, though the whole manuscript was now over 300,000 words. Colin was infuriated by the sheer size of the manuscript, and its editing took virtually the whole of 1983. The final version was reduced to less than a fifth of the original size, a mere 58,000 words.
Nonetheless, it was with a sense of great relief that I relinquished the whole book to Colin. I had never been able to rid myself of a superstitious feeling that my 1974 accident was waiting to reoccur and that it would do so if I did not exorcise it by airing the entire thing in a book. Now it was done, and I was in no more danger of recapitulating the whole thing. But the unconscious is wilier than we realize, and ten days later—it was an icy day in the Bronx—I managed to fall in a particularly clumsy way and to bring about the re-accident I so feared.
I had pulled in to a gas station on City Island. I handed my credit card to the attendant, and I thought I would just open the door and stand up to stretch. The moment I got out of the car, I slipped on a patch of black ice, and when the attendant came back with the receipt, he found me on the ground, half under the car.
He said, “What are you doing?”
“Sunbathing,” I replied.
And he said, “No—what happened?”
I said, “I’ve broken an arm and a leg,” to which he replied, “You’re joking again.”
“No,” I said, “this time I’m not joking; you’d better get an ambulance.”
When I arrived at the hospital, the surgical resident asked me, “What’s that written on the back of your hand?” (I had written the letters C B S there.)
I said, “Oh, that’s a patient who has hallucinations; she’s got Charles Bonnet syndrome, and I was on my way to see her.”6
And he said, “Dr. Sacks, you’re the patient now.”
—
When Colin heard that I was in hospital—I was still there when the proofs of the Leg book arrived—he said, “Oliver! You’d do anything for a footnote.”
Between 1977 and 1982, A Leg to Stand On was finally completed, some while swimming at Lake Jeff. Jim Silberman, my editor and publisher in America, was disconcerted when I sent him the Lake Jeff section of the book. He had not received a handwritten manuscript for thirty years, he said, and this one looked as if it had been dropped in the bath. He said it would have to be not just typed but deciphered, and he sent it to one of his former editors, Kate Edgar, now freelancing in San Francisco. My illegible, water-stained manuscript with its ragged, incomplete sentences, arrows, and indecisive crossings out came back beautifully typed and annotated with wise editorial comments. I wrote to Ms. Edgar saying that I thought she had done a remarkable job with a very difficult manuscript and that she should look me up if she returned to the East Coast.
Kate returned the following year, in 1983, and she has worked with me, as editor and collaborator, ever since. I might have driven Mary-Kay and Colin mad with my many drafts, but for the past thirty years I have been lucky to have Kate working, as they did, to unmuddle, distill, and dovetail my endless drafts into a cohesive whole. (She has, moreover, been a researcher and companion on all of my subsequent books, meeting patients, listening to my stories, and sharing adventures from learning sign language to visiting chemical laboratories.)
1. In the late 1970s and early 1980s, I also spent some time in an Alzheimer’s clinic at Einstein, and I prepared five long case histories based on some of these patients. I sent the manuscript of those to my former chief at Einstein, Bob Katzman (he had gone on to chair the neurology department at UCSD). But somehow, in the midst of moving, it got lost—another book, like “Myoclonus,” which would never see the light of day.
2. Not infrequently dilemmas of an unusual sort arise, and here the Little Sisters show a moral breadth and clarity of mind. One of their residents, Flora D., a parkinsonian woman, was greatly helped by L-dopa but concerned by the extremely vivid dreams she started to get. It is not uncommon to have erotic dreams or nightmares on L-dopa, but Flora had incestuous dreams, of intercourse with her father. She felt guilty and extremely anxious about this until she described the dreams to one of the nuns, who said,
“You are not responsible for the dreams you have at night. It would be quite different if these were daydreams.” This was a clear moral distinction consonant with a clear physiological distinction.
3. Some years later, under the title “The Disembodied Lady,” I related her story in The Man Who Mistook His Wife for a Hat.
4. I described Mr. Thompson in “A Matter of Identity” in The Man Who Mistook His Wife for a Hat.
5. In the early 1990s, I introduced Jonathan to my friend Marsha Ivins, an astronaut who has flown on five space shuttle missions. (She read “The Disembodied Lady,” she told me, while in orbit.)
How, we wondered, might Ian do in space? The nearest thing, gravity-wise, Marsha said, was to take a ride in the astronaut training plane familiarly known as the Vomit Comet, which, by steeply climbing and then diving, briefly takes its passengers from almost 2 g to 0 g. Most people feel an all-encompassing weightlessness in 0 g and a corresponding heaviness in 2 g, but Ian felt neither.
6. I had intended to write her story and include it in The Man Who Mistook His Wife for a Hat, but in the event it took more than twenty-five years to return to writing about Charles Bonnet syndrome, for Hallucinations.
A Matter of Identity
Although it took me almost a decade to write A Leg to Stand On, I was pursuing other subjects during that time as well. Chief among them was Tourette’s syndrome.
In 1971, I had been re-approached by Israel Shenker, the journalist at The New York Times who had come to Beth Abraham in the summer of 1969 and published a long article about the initial effects of L-dopa. Now he called again to ask how the patients were doing.
Many were enjoying a sustained “awakening” with L-dopa, I replied, but some were having odd, complicated reactions to L-dopa. Above all, I said, they were ticcing. Many of them had started making sudden, convulsive movements or noises, sometimes expletives, which would burst out of them; I thought these were probably from an explosive activation of subcortical mechanisms which had been damaged by their original disease and were now being stirred up by the continual stimulation of L-dopa. I indicated to Shenker that with all of these multiple tics and expletives, some of the postencephalitics were showing something which looked like a rare condition called Gilles de la Tourette syndrome. I had never actually seen anyone with this, but I had read about it.