The night before I was due to be taken down, and uncasted, these dreams rose to a frightful climax: I dreamed, woke briefly, fell into the same dreams—hundreds of times I must have dreamed of the cast as empty, or solid all through, or filled with a disgusting verminous mass of rotting bones, bugs and pus. The Mendelssohnian joy, and mirth, and gaiety, had all gone. When the dim gray dawn of Monday finally came, I felt shuddery and weak, too sick to have breakfast, to say anything, or think. I lay like a corpse in my bed, waiting to be carried out.
The very term “casting room” had a grim and frightful resonance. Even the word “cast” took on disquieting other meanings. I found unbidden images rising in my mind—of the Casting Room as a place where they cast and cast away; where new limbs and bodies were cast by the Caster, and old and useless ones were cast away. Such fancies kept bursting into my mind, and I could not dismiss them, absurd though they were.
It was a relief, but also a terror, when the orderlies finally came for me and heaved me on a stretcher and out of the room. Out of my room! For the first time in fifteen days. I caught a brief glimpse of the sky as we waited to go down. The sky! I had forgotten it, forgotten the outside world, as I lay in my small windowless cell, in solitary confinement, excited, obsessed, my mind a pressure-cooker of thoughts. The rumbling of the stretcher-trolley seemed monstrously loud, and kept suggesting to me the roll of tumbrils, the sense of being taken to my death—or something worse than death: to the realization of an abominable nightmare, where all my fantasies of the uncanny, the unalive, the unreal, would turn out true.
The Casting Room was small, white, featureless, somewhere between a surgery and a workshop, with shears and other implements hanging on the wall—the strange, frightening tools of the Caster’s Art. The orderlies shifted me on to a raised block in the center—something between a catafalque and a butcher’s block, I felt—and went out, shutting the door behind them. I was suddenly alone in this uncanny silent room.
And then I realized that I was not alone. The Caster, in a white gown, was standing in a corner. I had somehow failed to notice him when I was wheeled in. Or, perhaps, he had come in without my noticing. For, in a curious way, he did not seem to move, but to materialize suddenly in different parts of the room. He was here, he was there, but I never caught him in transit. He had a strangely immobile, carven face, with features of a medieval drawing. It might have been the face of Dürer, or of a mask or gargoyle imagined by Dürer.
I summoned up a social manner and said, “Hello, Mr. Enoch. Funny weather we’re having.”
He made no response—not a movement, not a flicker.
I made some further desultory comments, and then tailed off as he made no reply but continued to stand motionless in the corner with his arms folded and his eyes fixed on mine. I found myself increasingly unnerved—it crossed my mind that he might be mad.
And then, suddenly, without any intermediate movement, he was no longer in his corner, but by the wall where the shears and other tools hung. And now, in a flash, he had the shears in his hands. They looked monstrously large to me—and he looked vast too. I felt that with a single cut he could shear off my leg, or slice me in two.
A single bound and he was on me, shears wide open, for the first cut. I wanted to yell “Help! someone, anyone, come in! I am being attacked by a madman with a pair of shears.” My reason told me that this was all fancy, that Mr. Enoch might be a little odd and taciturn, but was assuredly a skilled and responsible craftsman. So I controlled myself, and smiled, and said not a word.
And then I heard a reassuring sound—a gentle crunching, as the cast was snipped open. There had not been any terrible attack! Mr. Enoch was quietly doing his business. He slit open the cast from top to bottom, and then gently pulled it open, exposing the leg. The cast itself he tossed lightly in a corner. This astounded me, for I had imagined it was enormously heavy, forty or fifty pounds at the least. Friends, at my request, had lifted the two legs, and said, “Blimey! That one in plaster weighs a ton—at least forty pounds heavier than the other one.” From the way Mr. Enoch held it up and flicked it in a corner, it evidently weighed almost nothing at all, and the dead weight of the leg, that extra forty pounds, must have been due entirely to its total lack of muscular tone—that normal postural tone which one finds even in the deepest relaxation or sleep.
Mr. Enoch stepped back, or, rather, suddenly disappeared, and reappeared as suddenly in his original corner, with a faint enigmatic smile on his lips.
And now Sister and the Surgical Registrar came bustling in, smiling and chatting as if nothing had happened—nothing had happened.
Sister said she was going to remove the stitches, but the Registrar interposed: “Don’t you want to look at your leg? After all, you haven’t seen it for more than two weeks!”
Did I? Most assuredly, and passionately and eagerly; and yet I feared, shrinking, not knowing what I would see; and admixed with both feelings was a curious lack of feeling—a sort of indifference, real or defensive—so that I hardly cared what I would see.
With the Registrar’s help, I raised myself on one arm, and took a long, long look at the leg.
Yes, it was there! Indisputably there! The cast was neither empty nor solid, as I had feared, nor did it contain a mass of earth, or dung, or rotting chicken bones. It contained—a leg, of approximately normal dimensions, though greatly wasted in comparison with its fellow, and with a long, clean scar about a foot long. A leg—and yet, not a leg: there was something all wrong. I was profoundly reassured, and at the same time disquieted, shocked, to the depths. For though it was “there”—it was not really there.
It was indeed “there” in a sort of formal, factual sense: visually there, but not livingly, substantially, or “really” there. It wasn’t a real leg, not a real thing at all, but a mere semblance which lay there before me. I was struck by the beautiful, almost translucent, delicacy of the limb; and I was struck by its absolute, almost appalling, unreality. It was exquisite, lifeless, like a fine wax model from an anatomy museum.
Gingerly I put out my hand to touch it—and touch was as uncanny and equivocal as sight. It not only looked like wax, but it felt like wax—finely molded, inorganic and ghostly. I could not feel the feeling fingers with the leg, so I squeezed the leg, pinched it, pulled out a hair. I could have stuck a knife into it for all the feeling it had. There was absolutely no sensation whatever—I might have been squeezing and kneading lifeless dough. It was clear that I had a leg which looked anatomically perfect, and which had been expertly repaired, and healed without complication, but it looked and felt uncannily alien—a lifeless replica attached to my body. I thought again of the young man on that long-past New Year’s Eve, his pale, scared face, and the consternation as he whispered: “It’s just a counterfeit. It’s not real. It’s not mine.”
“Well,” said the Registrar. “You’re looking hard enough. What do you think of it? We did a nice job, eh?”
“Yes, yes,” I replied, bemusedly trying to gather my thoughts. “You did a very nice job, beautiful, really beautiful. I do thank and congratulate you. But—”
“Well, what’s the ‘but’?” he asked with a smile.
“It looks fine—it is fine, surgically speaking.”
“What do you mean—‘surgically speaking’?”
“Well, it doesn’t feel right. It feels—sort of funny, not right, not mine. Difficult to put into words.”
“Don’t worry, old chap,” the Registrar said. “It’s done beautifully, old fellow. You’ll be right as rain. Sister will take the stitches out now.”
Sister advanced, with her gleaming instrument tray, saying, “It shouldn’t hurt too much, Dr. Sacks. You’ll probably just feel a tweaking sensation. If it does hurt we can put in some local.”
“You go ahead,” I answered. “I’ll let you know if it hurts.”
But, to my surprise, she
didn’t seem to be going ahead, but fiddling around, with her scissors and forceps—fiddling in the strangest, most unintelligible way. I watched her, perplexed, for a time and then closed my eyes. When I opened them, she had stopped her unconscionable fiddling, which, I suppose, must have been some sort of warm-up or preparatory activity: I presumed she was now ready to take out the stitches.
“You going to start now?” I enquired.
She looked at me in astonishment. “Start!” she exclaimed. “Why, I just finished! I took out all the stitches. I must say, you were very good. You lay quiet as a lamb. You must be very stoical. Did it hurt much?”
“No,” I answered. “It didn’t hurt at all. And I wasn’t being brave. I didn’t feel you at all. I had no sensation whatever when you pulled the stitches out.” I omitted to say, because I thought it would sound too strange, that I had entirely failed to realize that she was taking them out, indeed that I had failed to make any sense of her activity whatever, or to see it as having any sense or relation to me, so that I had mistaken all her motions as meaningless fiddling. But I was taken aback, confounded, by the business. It brought home to me once more how estranged the leg was, how alien, how exiled from myself. To think that I could have seen Sister making all the characteristic motions of snipping and pulling out stitches, but was only able to imagine she was warming up in readiness for the real thing! Her activity had seemed meaningless and unreal, presumably, because the leg felt meaningless and unreal. And because the leg felt senseless, in all senses of senseless, absolutely senseless and unrelated to me, so had her motions which had been related to it. As the leg was merely a semblance, so her motions, her taking-out stitches, seemed merely a semblance. Both had been reduced to meaningless semblance.
Finding my horrible fears and phantasms unfounded, finding the leg at least formally intact and there, finding finally an infinite reassurance when Mr. Enoch lifted the heel off the block, and the knee locked firmly, precisely, in place, and that the horror of kneelessness, dislocation, disarticulation, was gone—I suddenly felt an infinite relief: a relief so sweet and intense, so permeating my whole being, that I was bathed in bliss. With this sudden sweet and profound reassurance, the sudden and profound change of mood, the leg was utterly transformed, transfigured. It still looked profoundly strange and unreal. It still looked profoundly unalive. But where it had previously brought to mind a corpse, it now made me think of a fetus, not yet born. The flesh seemed somehow translucent and innocent, like flesh not yet given the breath of life.
Theoretical as yet, the flesh was there, healed anatomically, but not yet quickened into action. It lay there patient, radiant, not yet real, but almost ready to be born. The sense of dreadful, irretrievable loss was transformed into a sense of mysterious abeyance. It lay there, in a strange suspension, or limbo, a mysterious landscape between death and birth….
…between two worlds, one dead
The other powerless to be born
—MATTHEW ARNOLD
Flesh which was still as unliving as marble but, like the marble flesh of Galatea, might come to life. And even the new plaster partook of this feeling: I had hated the old one, feeling it putrid, obscene, but I immediately took a liking to the new one which Mr. Enoch was now carefully applying, laying layer upon layer round my new pink leg. This cast I thought elegant, shapely, even smart. More important, I thought of it as a sort of good chrysalis, which would sheathe the leg and let it develop completely, until it was ready to hatch, to be reborn.
* * *
—
As I was wheeled back from the Casting Room, and up in the elevator, we paused by the broad windows, which were open now to the air. The sky had been dark and charged before; but now the storm had broken, and it was heavenly calm and clear. I felt the very elements themselves had had their crisis at precisely the same time as I had had mine. All was resolved now, the heavens clear and blue. A lovely breeze came through the great windows, and I felt intoxicated as the sun and wind played on my skin. It was my first sense of the outside world in more than two weeks, two weeks in which I had moldered, in despair, in my cell. And there was music, a new radio, when I returned to my room—wonderful Purcell, Dido and Aeneas—and this too, like the wind and the sun and the light, came like a heavenly refreshment to my senses. I felt bathed in the music, penetrated by it, healed and quickened through and through: divine music, spirit, message and messenger of life!
Relieved of all my anxieties and tensions, sure and confident that the leg would come back, and that I would recover and walk again—though when, and how, God only knew—I suddenly fell into a deep blissful sleep: the sleep of trust. A deep, deep, and in itself healing, sleep—my first proper rest since the day of the accident—my first sleep uninterrupted by hideous nightmares and phantoms. The sleep of innocence, of forgiveness, of faith and hope renewed.
When I awoke I had an odd impulse to flex my left leg, and in that self-same moment immediately did so! Here was a movement previously impossible, one which involved active contraction of the whole quad—a movement hitherto impossible and unthinkable. And yet, in a trice, I had thought it, and done it. There was no cogitation, no preparation, no deliberation whatever; there was no “trying”; I had the impulse, flash-like—and flash-like I acted. The idea, the impulse, the action, were all one—I could not say which came first, they all came together. I suddenly “recollected” how to move the leg, and in the instant of recollection I actually did it. The knowing-what-to-do had no theoretical quality whatever—it was entirely practical, immediate—and compelling. It came to me suddenly and spontaneously—out of the blue.*
Excited, I rang my bell and called for the nurse.
“Look!” I exclaimed. “I did it, I can do it!”
But when I tried to show her, nothing happened at all. The knowledge, the impulse, had departed as it came, suddenly, mysteriously. Mortified and puzzled, I returned to my book—and then about half an hour later, and again in mid-word, unbidden, unconsidered, I had the same impulse again. The impulse, the idea, the remembrance, flashed back—and I moved my leg (if “moved” is not too deliberate a word for the utterly undeliberated, spontaneous movement which occurred). But a few seconds later it was impossible again. And so it was throughout the rest of the day. The power of moving, the idea of moving, the impulse to move, would suddenly come to me—and as suddenly go—as a word, or a face, or a name, or a tune, can be at the tip of one’s tongue, or in the immediate gambit of one’s vision or hearing, and then, as suddenly, disappear. Power was returning, but it was still labile, unstable, not yet securely fixed in my nervous system or mind. I was beginning to remember, but the memory came and went. I suddenly knew, and then didn’t know—like an aphasic with words.
The term “ideomotor” came spontaneously to mind. The flashes I had had previously were merely motor, fragmentary spasms and twitches of an irritable nerve-muscle—there being no correspondence with any inner impulse, idea or intention. They had nothing to do with me—whereas these flashes, by contrast, involuntary, spontaneous, unbidden as they were, did most certainly, and essentially, and fundamentally, involve me: they weren’t just “a muscle jumping,” but “me remembering,” and they involved me, my mind, no less than my body. Indeed, they united my mind and my body; they exemplified, in a flash, their quintessential unity—the unity which had been lost, since my disconnecting injury.
The surgeon’s original words recurred to me, “You’ve been disconnected. We reconnect you. That’s all.” What he meant, in a purely local and anatomical sense, had, I now felt, a much vaster (if unintended) sense—the sense in which E. M. Forster says “Only connect.” For what was disconnected was not merely nerve and muscle but, in consequence of this, the natural and innate unity of body and mind. The “will” was unstrung, precisely as the nerve-muscle. The “spirit” was ruptured, precisely as the body. Both were split, and split off from one another. And, since
“body” and “soul” have sense only insofar as they are one, both became senseless when they no longer connected. In these ideomotor flashes, then, a most momentous re-connection, or re-union, occurred, even if it lasted no more than a moment—the convulsive reunion of body and soul.
Yet there was an extreme limitation, a peculiarity, to this will. First, it was good for nothing except a single, rather stereotyped, movement at the hip—and what sort of will has a repertoire of one movement? Second, it was always accompanied by an impulse or impulsion—of an oddly intrusive and irrelevant sort. I would be reading—in mid-sentence, my mind far away, utterly remote from anything to do with my leg—when all of a sudden there would come this peremptory, and specific, impulsion. I welcomed it, enjoyed it, played with it—and finally mastered it. But it was will and action of a most peculiar sort, the resultant being a strange hybrid—half jerk, half act.
Recently I had to have—as the surgeon had originally suggested for the quadriceps—some electrical stimulation, to some injured neck muscles. Every time the current stimulated the trapezius muscles in the neck I had a sudden impulse to shrug my shoulders, to shrug them expressively, in the gesture “So?” It would occur to me to shrug my shoulders, as it might occur to anyone; except that the occurring only occurred when the trapezius was faradized. I found this experience amusing, fascinating—and somewhat shocking; for it showed, very clearly, that one could have a sense or an illusion of free will, even when the impulse was primarily physiological in nature. At such times, in effect, one was no more than a puppet—compelled to react, but imagining that the reaction was free. This, I now believe, was what had been happening with the strange half-convulsive, pseudo-voluntary contractions. I think that there were random sparks, or firings, of the now-recovering neuromuscular apparatus, which had been inactive, perhaps in a state of shock, since the surgery. Over the weekend, these firings were very small, very local, and caused only small fasciculations or flashes in individual muscle bundles. On Tuesday there started convulsive, massive jumps of the whole muscle (including its pelvic attachment) in such a way as to jerk the leg. These massive contractions—like the massive contractions of nocturnal myoclonus, or tics, or the massive contractions of a faradized trapezius or even knee-jerks—constituted a sort of short-circuit in, or stimulus to, the whole voluntary system. And, apparently, one cannot have a substantial portion of voluntary muscle activated, however mechanically or involuntarily, without stimulating (or simulating) a feeling of voluntas, of will. (This queer, quasi-voluntary feeling may occur when a patellar reflex, or knee-jerk, is elicited.)
A Leg to Stand On Page 11