A Leg to Stand On

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by Oliver Sacks, M. D.


  But, instead, he did the reverse. By saying nothing, saying “Nothing,” he took away a foothold, the human foothold, I so desperately needed. Now, doubly, I had no leg to stand on; unsupported, doubly, I entered nothingness and limbo.

  The word “hell” supposedly is cognate with “hole”—and the hole of a scotoma is indeed a sort of hell: an existential, or metaphysical, state, indeed, but one with the clearest organic basis and determinant. The organic foundation of “reality” is removed, and to this extent one falls into a hole—or a hell-hole, if one permits oneself consciousness of this (which many patients, understandably, and defensively, do not do). A scotoma is a hole in reality itself, a hole in time no less than in space, and therefore cannot be conceived of as having a term or ending. As it carries a quality of “memory-hole,” of amnesia, so it carries a sense of timelessness, endlessness. The quality of timelessness, limbo, is inherent in scotoma.

  This would be tolerable, or more tolerable, if it could be communicated to others, and become a subject of understanding and sympathy—like grief. This was denied me when the surgeon said “Nothing,” so that I was thrown into the further hell—the hell of communication denied.

  This is the secret delight, the security of Hell [the Devil says, in Goethe’s Faust] that it is not to be informed on, that it is protected from speech, that it cannot be made public….Soundlessness, forgottenness, hopelessness, are poor weak symbols. Here everything leaves off….No man can hear his own tune.

  I felt myself sinking. The abyss engulfed me. Although scotoma means “shadow” or “darkness”—and this is the usual symbolism of horror and death—I was sensorially and spiritually more affected by silence. I kept reading Faust at this time, especially its passage on Hell—and music. “No man can hear his own tune,” on the one hand; on the other the noise, the infernal din of hell. And this was literalized in the roomless room, the cell, where I lay, in the privation of music, and the pressure of noise. I yearned—hungrily, thirstily, desperately—for music, but my rotten little radio could pick up almost nothing, the buildings, the scaffolding, almost barring reception. And, on the other hand, there were pneumatic drills the whole day, as work was done on the scaffolding a few feet from my ears. Outwardly, then, there was soundlessness and noise, and inwardly, simultaneously, a deadly inner silence—the silence of timelessness, motionlessness, scotoma, combined with the silence of non-communication and taboo. Incommunicable, incommunicado, the sense of excommunication was extreme. I maintained an affable and amenable surface, while nourishing an inward and secret despair.

  “If you stare into the abyss,” wrote Nietzsche, “it will stare back at you.”

  The abyss is a chasm, an infinite rift, in reality. If you but notice it, it may open beneath you. You must either turn away from it, or face it, fair and square. I am very tenacious, for better or worse. If my attention is engaged, I cannot disengage it. This may be a great strength, or weakness. It makes me an investigator. It makes me an obsessional. It made me, in this case, an explorer of the abyss.

  I had always liked to see myself as a naturalist or explorer. I had explored many strange, neuropsychological lands—the furthest Arctics and Tropics of neurological disorder. But now I decided—or was I forced?—to explore a chartless land. The land which faced me was No-land, Nowhere.

  All the cognitive and intellectual and imaginative powers which had previously aided me in exploring different neuropsychological lands were wholly useless, meaningless, in the limbo of Nowhere. I had fallen off the map, the world, of the knowable. I had fallen out of space, and out of time too. Nothing could happen, ever, any more. Intelligence, reason, sense, meant nothing. Memory, imagination, hope, meant nothing. I had lost everything which afforded a foothold before. I had entered, willy-nilly, a dark night of the soul.

  This involved, first, a very great fear. For I had to relinquish all the powers I normally command. I had to relinquish, above all, the sense and affect of activity. I had to allow—and this seemed horrible—the sense and feeling of passivity. I found this humiliating, at first, a mortification of my self—the active, masculine, ordering self, which I had equated with my science, my self-respect, my mind. And then, mysteriously, I began to change—to allow, to welcome this abdication of activity. I began to perceive this change on the third day of limbo.

  To the soul—lost, confounded in the darkness, the long night—neither charts, nor the chart-making mind, were of service. Nor, indeed, was the temper of the charter—“strong masculine sense…enterprise…vigilance and activity” (as a contemporary wrote of Captain Cook). These active qualities might be valuable later, but at this point they had nothing to work on. For my state in the dark night was one of passivity, an intense and absolute and essential passivity, in which action—any action—would be useless and distraction. The watchword at this time was “Be patient—endure….Wait, be still….Do nothing, don’t think!” How difficult, how paradoxical, a lesson to learn!

  Be still, and wait without hope

  For hope would be hope of the wrong thing; wait without love

  For love would be love of the wrong thing…

  Wait without thought, for you are not ready for thought…

  —T. S. ELIOT

  I had to be still, and wait in the darkness, to feel it as holy, the darkness of God, and not simply as blindness and bereftness (though it entailed, indeed, total blindness and bereftness). I had to acquiesce, even be glad, that my reason was confounded, and that my powers and faculties had no locus of action and could not be exerted to alter my state. I had not sought this, but it had happened, and so I should accept it—accept this strange passivity and night, this strange scotoma of the senses and reason, not with anger, not with terror, but with gratitude and gladness.

  This, then, was the change, starting on the third day of my limbo, which moved me from a sense of abomination and despair, a sense of a hideous and unspeakable hell, to a sense of something utterly, mysteriously, different—a night no longer abominable and dark, but radiant, secretly, with a light above sense—and, with this, a curious, paradoxical joy:

  In darkness and secure, By the secret ladder, disguised—ah, happy chance!

  In Darkness and concealment, my House being now at rest.

  In the happy night, in secret, where none saw me,

  Nor I beheld aught. Without light or guide, save that which burned in my heart.

  This light guided me. More surely than the light of noonday to the place where He was awaiting me…

  —ST. JOHN OF THE CROSS

  I had thought, in the pride of reason, in the noonday light of reason, that whatever was worth accomplishing in life could be accomplished by reason and will, by that “strong masculine sense…enterprise…vigilance and activity” which had previously characterized my endeavors. Now, for the first time in my life perhaps, I had tasted, been forced to taste, something quite different—to experience, in patienthood, the profoundest passivity; and to realize that this was the only proper attitude at the time.

  Socially I had to try to be active and adult, and avoid more than the minimum necessary dependence on others; but spiritually—which was not socially, but inwardly—I had to relinquish all my powers and pretensions, all my adult, masculine enterprise and activity, and be childlike, patient, and passive, in the long night, this being the only proper posture of the soul at this time.

  The captain of the plane, a bluff hearty man, full of enterprise and decision and strong masculine sense, even he had said, had he not: “The first thing about being a patient is—to be patient”; and, earlier in my hospital stay, one of the surgical registrars (alas, not my own), seeing me vexed, irritable, impatient, and fretting, had said gently: “Take it easy! The whole thing, going through it, is really a pilgrimage.”

  Thus my limbo—which lasted for a timeless twelve days—started as tormen
t, but turned into patience; started as hell, but became a purgatorial dark night; humbled me, horribly, took away hope, but, then, sweetly-gently, returned it to me a thousandfold, transformed.

  In this limbo, when I journeyed to despair and back—a journey of the soul, for my medical circumstances were unchanged, arrested in the motionless fixity of scotoma, and in an agreement, not uncordial, between my physicians and myself not to make any reference to “deeper things”—in this limbo, this dark night, I could not turn to science. Faced with a reality, which reason could not solve, I turned to art and religion for comfort. It was these, and these only, that could call through the night, could communicate, could make sense, make more intelligible—and tolerable: “We have art, in order that we may not perish from the truth” (Nietzsche).

  Science and reason could not talk of nothingness, of hell, of limbo; or of spiritual night. They had no place for absence, darkness, death. Yet these were the overwhelming realities of this time. I turned to the Bible—especially the Psalms—because these continually spoke of such things, and of a return, mysteriously, to light and life once again. I turned to them as descriptions, as case-histories, in a way, but also with hope, as a sort of prayer or invocation. And I turned to the mystics, and the Metaphysical poets too, for they also offered both formulation and hope—poetic, esthetic, metaphoric, symbolic, without the blunt plain commitment that “religion” involved.

  Study me then, you who shall lovers be

  At the next world, that is, at the next spring

  For I am every dead thing,

  In whom love wrought new alchemie.

  For his art did expresse

  A quintessence even from nothingnesse,

  From dull privations, and lean emptinesse,

  He ruin’d me, and I am rebegot,

  Of Absence, Darknesse, Death; things which are not.

  —JOHN DONNE

  Donne’s midwinter ode, from a midwinter of life, communicated to me the plight, and hope, of the dead soul. I often murmured it to myself, especially the last words: “I am rebegot / of Absence, Darknesse, Death; things which are not.” Or, sometimes, just “I am, I will be, rebegot.” I repeated them in a sort of litany or soliloquy. I hugged them, and held them, closer and closer to me, for they seemed to hint at some secret, impossible hope, where I could see no reason to hope.

  But finally, the Metaphysicals and mystics were laid aside, and there remained only the Scriptures, the impossible faith:

  Thou, which hast shewed me great and sore troubles, shalt quicken me again, and shalt bring me up from the depths of the earth.

  —PSALMS 71:20

  Secretly, half-skeptically, hesitantly, yearningly, I addressed myself to this unimaginable “Thou.”

  CHAPTER FOUR

  Quickening

  But by what means may the animal be moved by inward principles…? By means of what instruments?…let us compare automata…Is the first instrument of movement spirit? Or natural causes—like the movement of the heart?

  —WILLIAM HARVEY, De Motu Locali Animalium

  Throughout these twelve endless yet empty days the leg itself had not changed a jot; it remained entirely motionless, toneless, senseless, beneath its white sepulchre of chalk. Its absolute fixity and unchangeability, its replacement, so to speak, by an inorganic white cylinder, its lifeless, petrified and calcarious quality, were re-presented to me every night, countless times a night. And my dreams—these too changed not a jot, but retained the same eidetic and diagrammatic vividness, the same absence of any motion, or happening, or event, the same deadness, as they had exhibited on their first appearance.

  The idea of any progress, any change, or any hint or hope of this, was continually nulled and annulled until the following Saturday morning. I quote the following entry from my diary:

  New phenomena from leg. Sudden, incredibly severe, extremely brief flashes of pain from somewhere in the leg, strobe-like in their blinding intensity and brevity. “Lightning pains” are similar….Such a pain absolutely convulses one while it lasts, but its duration is only a few thousandths of a second. I wonder about the physiology of these extraordinary pain flashes. What on earth goes on?

  I have also started to have involuntary flash-like twitches in the previously inert and silent muscle. Both the twitches and the flashes are almost spinal in quality, as if isolated sensory or motor cells are involved….

  They give a double feeling—part fear, part hope. They are obviously pathological. Their character indicates that a genuine denervation is involved. But their very appearance is perhaps a sign of returning innervation.

  No voluntary movement is yet possible or thinkable, but these involuntary flashes—figurations and fasciculations—are perhaps the first sparks of life—and may indicate that the muscle is getting ready to respond.

  These fasciculations of the muscle, not at all “private,” but perfectly visible to all, represented the first positive reality since I had entered the hospital. These crackles and flashes were a token and earnest of neurological recovery, a sign that some irritability, some “life,” was coming back to the nerve-muscle, since its injury two weeks before. They gave me a strong sense of electrical activity—a sort of spontaneous “faradization” or fulguration of nerve-muscle—an electrical kindling of the tardy spark of life.

  I had very much the feeling of an electrical storm—of lightning flashes jumping from one fiber to another, and an electrical muttering and crackling in the nerve-muscle. I could not help being reminded of Frankenstein’s monster, connected up to a lightning rod, and crackling to life with the flashes.

  I felt, then, on Saturday, that I was “electrified” or rather, that a small and peripheral part of the nervous system was being electrified into life: not me, it—I played no part in these local, involuntary flashes and spasms. They were nothing to do with me, my will. They did not go with any feeling of intention or volition, nor with any idea of movement. They neither stimulated, nor were stimulated by, idea or intention; thus they conveyed no personal quality; they were not voluntary, not actions—just sporadic flashes at the periphery—nonetheless a clear and crucial and most welcome sign that whatever had happened, or had been happening, peripherally, was now starting to show some return of function—abnormal, flash-like, paroxysmal function, but any function was better than no function at all.

  Throughout limbo I yearned for music, but was frustrated in my efforts to obtain it. By mid-week I was sick of my impossible radio, and asked a friend, Jonathan Miller, if if he would bring in a tape recorder and music. On Saturday morning—that same Saturday, the 7th—he brought along his recorder with a single cassette, saying he was sorry, this was the only one he could find. It was Mendelssohn’s Violin Concerto.

  I had never been a special Mendelssohn lover, although I had always enjoyed the liveliness and exquisite lightness of his music. It was (and remains) a matter of amazement to me that this charming, trifling piece of music should have had such a profound and, as it turned out, decisive effect on me. From the moment the tape started, from the first bars of the Concerto, something happened, something of the sort I had been panting and thirsting for, something that I had been seeking more and more frenziedly with each passing day, but which had eluded me. Suddenly, wonderfully, I was moved by the music. The music seemed passionately, wonderfully, quiveringly alive—and conveyed to me a sweet feeling of life. I felt, with the first bars of the music, a hope and an intimation that life would return to my leg—that it would be stirred, and stir, with original movement, and recollect or re-create its forgotten motor melody. I felt, in those first heavenly bars of music, as if the animating and creative principle of the whole world was revealed, that life itself was music, or consubstantial with music; that our living moving flesh, itself, was “solid” music—music made fleshy, substantial, corporeal. In some intense, passionate, alm
ost mystical sense, I felt that music, indeed, might be the cure to my problems—or, at least, a key of an indispensable sort.

  I played the Concerto again and again. I didn’t tire of it: I desired nothing else. Every playing was a refreshment and a renewal of my spirit. Every playing seemed to open new vistas. Was music, I wondered, the very score of life—the key, the promise, of renewed action and life?

  On Saturday and Sunday the sense of hopelessness, of interminable darkness, lifted. I had a sense—not of dawn, but the first intimations of dawn: it was still mid-winter, but a spring might perhaps come. How, I did not know—it could not be conceived, it was not a matter which could be solved (even touched) by conjecture or thought. It was not a problem but a mystery which I faced—the mystery of a new beginning and quickening. Perhaps there had to be, before this, an infinite darkness and silence. Perhaps this was the womb, the night-womb, in which new life was created.

  Not only was there some lifting of the hopelessness that weekend, but a curious sort of lightness and gaiety of spirit. There was the sense of a possible convalescence. A sense of renewal grew upon me.

  Each time I played the Mendelssohn, on the recorder, or in my mind, and each time I had a sudden electric spasm of the muscle, this spirit of hope took hold of me again. Yet, my hope was, in some sense, theoretical—it was not clear that I had anything to be hopeful about. I still thought of the leg, of the flesh, as “finished.” What was music, what were these fine feelings, if I lacked the mechanism, the apparatus, the flesh? I desperately needed to see the leg—to see that its substance, its flesh, its reality, was intact. And by good fortune and timing, this was to occur the next day.

  * * *

  —

  On Monday morning, the fourteenth day after surgery, I was due to go down to the Casting Room, to have the wound inspected and the stitches removed. In these two weeks, indeed since the night of the accident, I had not actually been able to see the leg—it had always been covered and encased in a cast. There was something about the cast—its smooth featurelessness, its sepulchral whiteness, and its shape, which was like a vague and obscene parody of a leg—which invested it with horror: and indeed, as such, it played a great role in my dreams.

 

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