Perhaps one needs to distinguish different sorts of will—a passive-compulsive and an active-deliberative—but one may take over the passive-compulsive. Thus, in the course of that day, what started as puppet-like jerkings, and coercions, of the will, were transformed into active, controlled acts of will. The irritable innervation, returning to life, provided its own electric shocks; these, in turn, led to convulsive-compulsive, or tic-like, movements of the limb; and these, in their turn, to genuine voluntary acts.
All this was, in a sense, the reverse of the scotoma. There, it seemed to me, I willed—and nothing happened: so that I was forced into a singular doubt, and kept asking myself, “Did I will? Have I will? What has happened to my will?” Now, suddenly, unbidden, out of the blue, I had sudden compulsions, or convulsions, of will.
And yet, ironically, this inversion, or perversion, or subversion, of will was precisely the means by which a recovery was effected. An accident of physiology, an injury, had deprived me of will—specifically and solely in relation to the injured limb; and now another accident of physiology, the sparks of returning innervation, were to rekindle will in this limb. First I was will-less, unable to command; then I was willed, or commanded, like a puppet; and now, finally, I could take over the reins of command, and say “I will” (or “I won’t”) with full truth and conviction, albeit in the single matter of moving my leg.
* * *
—
Wednesday the 11th had been set as The Day—the appointed day for me to arise, and stand, and walk. For the first time since my accident I would assume, it was to be hoped, the erect position—and erectness is moral, existential, no less than physical. For two weeks, for eighteen days, I had been prostrate, recumbent: doubly so—physically, through weakness and inability to stand; morally, through passivity, the posture of a patient—a man reduced, and dependent on his doctor.
The posture, the passivity of the patient lasts as long as the doctor orders, and its end cannot be envisaged until the very moment of rising. And this moment cannot be anticipated, or even thought of, even hoped for. One cannot see, one cannot conceive, beyond the limits of one’s bed. One’s mentality becomes wholly that of the bed, or the grave.
Until the actual moment of rising, it is as if one were never to arise: one is condemned (so one feels) to eternal prostration. As Donne wrote,
I cannot rise out of my bed till the physician enable me, nay, I cannot tell that I am able to rise till he tells me so. I do nothing, I know nothing of myself….
And if this was so for Donne, if this is so for every patient who is condemned to lie in bed (“miserable, and though common to all, inhuman posture…”), how much more so was it for me, given the peculiar and specific character of my own disorder, the sense of amputation, leglessness, of nothing to stand on.
Rising, standing, walking pose for every bedridden patient a fundamental challenge, for he has forgotten, or been disallowed, the adult, human posture and motions of uprightness, that physical and moral posture which means standing up, standing up for oneself, walking, and walking away—walking away from one’s physicians and parents, walking away from those upon whom one depended, walking freely, and boldly, and adventurously, wherever one wishes.
To this universal was added the specific—that I had come to question the integrity, the very existence, of my leg, and that there was ground for this strange questioning in the actual injury of the leg. Especial and extraordinary difficulties exist for those not merely recumbent but also leg-injured; and these were precisely and pungently expressed by Hippocrates, two and a half thousand years ago. Speaking of patients who had suffered a broken hip, and had had to be immobilized in bed for a period of fifty days, this combination, he observed, “subdues the imagination, so that such patients cannot imagine how to move the leg, much less how to stand; and if they are not made to do so, will remain in bed for the rest of their lives.” I had indeed to be made to rise, and stand, and walk—but how could I do so, and what might happen, in a case such as mine, where to all the usual fears, inhibitions, hesitations, was superadded a fundamental disruption and dissolution of the leg, a disruption and dissolution at once physiological and existential?
Had ever I faced a more paradoxical situation? How could I stand, without a leg to stand on? How could I walk, when I lacked legs to walk with? How could I act, when the instrument of action had been reduced to an inert, immobile, lifeless, white thing?
What I kept thinking of, in particular, was a remarkable chapter in A. R. Luria’s The Man with a Shattered World—a chapter entitled “The Turning Point.” This was, in essence, for the patient, the recovery of “music”:
At first writing was as difficult as reading, and perhaps more so. The patient had forgotten how to hold a pen or to form letters. He was completely helpless….But a discovery he made one day proved to be the turning point: writing could be very simple. At first he had proceeded just as little children do when they first learn to write—he had tried to visualize each letter in order to form it. Yet he had been writing for almost twenty years and as such did not need to employ the same methods as a child, to think about each letter and consider what strokes to use. For adults, writing is an automatic skill, a series of built-in movements which I call “kinetic melodies.” Hence, why shouldn’t he try to use what skills he still had?…In this way he started to write. He no longer had to agonize over each letter, trying to remember how it was formed. He could write spontaneously, without thinking.
Spontaneously! Spontaneously, yes that was the answer. Something spontaneous must happen—or nothing would happen at all.
* But nothing, perhaps, is ever fully “out of the blue”—every emergence has its prerequisites. Earlier in the day, before I had gone down to the Casting Room, Nurse Sulu had remarked on the wasting of my left buttock: “It’s terribly atrophied,” she said. “You just lie on it. Exercise it!” For some reason, with my leg paralyzed, I had tended to lie or sit inertly, without attempting any movement, any contraction, of the buttock muscles, the gluteus maximus, on the left. Now, stung, I tried to contract it—and it contracted at once, strongly, without difficulty. Further, I observed that, when I contracted it, something tensed, tightened, in the outer side of my thigh. How can this be, I thought, the quadriceps is paralyzed, I cannot contract it, voluntarily, at all. And then I realized that it was not the quadriceps contracting, but a slender muscle outside it, the tensor fasciae lata, a muscle which shares its nerve supply with the gluteals, and not with the anatomically adjacent (and functionally similar) quads. So, it was spared, and not paralyzed, from my femoral nerve injury, like the quad. And yet its contraction—the first active contraction in my previously inert leg—allowed, as it were, a focussing of motor attention on my thigh, a slight return of feeling, and power, and will, to an area which I had regarded as “dead,” as “not me,” for fourteen days.
Or did it, perhaps, by activating motor cells in the spinal cord, serve to reduce the spinal inhibition, the reflex “shock,” which (as Swan later suggested) had been added to the nerve damage? Was it, in either case, a prerequisite for the “spontaneous” flexion of the hip flexors which came later that day?
CHAPTER FIVE
Solvitur Ambulando
Every disease is a musical problem, every cure a musical solution.
—NOVALIS
I stood up—or, rather, I was stood up, hoisted to my feet, by two stout physiotherapists—helping as best as I could with the two stout crutches I had been given. I found this bizarre and terrifying. When I looked straight ahead, I had no idea where my left leg was, nor indeed any definite feeling of its existence. I had to look down, for vision was crucial. And when I did look down I had momentary difficulty in recognizing the object next to my right foot as my left foot. It did not seem to belong to me in any way. I never thought of putting any weight on it, of using it at all. So I stood, or was stood, supported not b
y my legs, but by crutches and physiotherapists, in a strange, and rather terrifying, stillness—that intense stillness which occurs when something momentous is about to happen.
Into this stillness, this transfixion, brisk voices broke in.
“Come on, Dr. Sacks! You can’t stand there like that—like a stork on one leg. You’ve got to use the other one, put weight on it too!”
“What ‘other one,’ ” I was tempted to ask, thinking, How could I walk, how could I stand on, let alone move, a ghostly lump of jelly, a nothing, which hung loosely from my hip? And even if, supported by its carapace of chalk, this preposterous appendage could support me, how then would I walk when I had forgotten how to walk?
“Come on, Dr. Sacks!” the physiotherapists urged. “You’ve got to begin.”
To begin! How could I? And yet I must. This was the moment, the singularity, from which beginning must begin.
I could not bring myself to put weight directly on the left leg—because this was strictly an unthinkable, as well as a fearful, thing to do. What I could do, and did do, was to lift the right leg, so that the left leg (so-called) would have to bear weight, or collapse.
Suddenly, with no warning, no anticipation whatever, I found myself precipitated into a vertigo of apparitions. The floor seemed miles away, and then a few inches; the room suddenly tilted and turned on its axis. An acute shock of bewilderment and terror seized me. I felt myself falling, and exclaimed to the therapists:
“Hold me, you must hold me—I’m utterly helpless.”
They said, “Now steady yourself—keep your eyes up.”
But I was infinitely unsteady, and had to gaze down. There and then I perceived the source of commotion. The source was my leg—or, rather, that thing, that featureless cylinder of chalk which served as my leg—that chalky-white abstraction of a leg. Now the cylinder was a thousand feet long, now a matter of two millimeters; now it was fat, now it was thin; now it was tilted this way, now tilted that. It was constantly changing in size and shape, in position and angle, the changes occurring four or five times a second. The extent of transformation and change was immense—there could be a thousandfold switch between successive “frames.”
While the changes were so monstrous in extent and surprise, it was out of the question for me to do anything without being held. It was impossible to proceed with such an instability of image, every parameter unpredictably varying by many orders of magnitude. Within a minute or two (that is to say, after several hundred transformations) the changes became less wild and erratic, although continuing at the same rate as before: the conformations and transformations of the chalk cylinder, though still outrageous, were being modulated and damped, beginning to approach acceptable limits.
At this juncture, then, I decided to move. Besides, I was being urged, even physically levered and pushed, by the two physiotherapists, who perceived my consternation and showed some sympathy, but who nevertheless (I surmised, and later ascertained) had not the faintest idea of the sort of experience I was going through, or contending with, at this time. It was just conceivable (I now thought) that one might learn to operate such a leg—although it would be like operating an extraordinarily unstable robotic contraption, constantly varying in an inherently improbable and unpredictable way. Could one, indeed, make a single successful step, in a world, a perceptual world, constantly altering in shape and size?
As soon as the tumult of sensations and apparitions burst forth, I had the sense of an explosion, of an absolute wildness and chaos, something utterly random and anarchic at work. But what could produce such an explosion in my mind? Could it be a mere sensory explosion from the leg, as it was forced to bear weight, and stand, and function, for the first time? Surely the perceptions were too complex for this. They had the quality of constructs, and not of raw sensations or sense data. They had the quality of hypotheses, of space itself, of those elemental a priori intuitions without which no perception, or construction of the world, would be possible. The chaos was not of perception itself, but of space, or measure, which precedes perception. I felt that I was bearing witness, even as I was undergoing it, to the very foundations of measure, of mensuration, of a world.
And this perception, or pre-perception or intuition, had nothing whatever to do with me—it was proceeding in its own extraordinary and implacable way; which started, and remained, essentially random, while being modulated by some sort of matching or testing, a targeting or guessing, perhaps a trial-and-error process, a wonderful yet somewhat mechanical sort of computation. I was present, it is true, but only as an observer—a mere spectator at a primordial event, or “Big Bang,” which was the start of inner space, the microcosm, in me. I was not actively, but passively, undergoing these changes, and as such could bear witness to what it was like to be present at the founding of a world. A true miracle was being enacted before me, within me. Out of nothingness, out of chaos, measure was being made. The jumping fluttering metrics were converging towards some average—a proto-scale. I felt terror, but also awe and exhilaration of spirit. Within me there seemed to be the working of a cosmic mathematics, the establishment of an impersonal microcosmic order.
All at once I thought of God’s questions to Job: “Where wast thou when I laid the foundations of the earth? Who hath laid the measures thereof?” And I thought, with awe, I am there, I have seen it. The frames, the fluttering frames, made me think of Planck and Einstein, and how quantality and relativity may stem from one birth. I felt I was experiencing the “pre-Planck time” of myself—that unimaginable time cosmologists speak of—in the first 10-43 seconds after the “Big Bang”—when space is still unstable, fluttering, quantal: that time of preparation which precedes the beginning of real time.
I stood still, arrested, riveted to the spot, partly because the vertigo made movement impossible, partly perhaps because I was arrested by these reflections. My soul was transfixed in a rapture of wonder. “This is the most wonderful thing I have ever known,” I thought. “Never must I forget this marvelous moment. Nor can I possibly keep this to myself.” And following straight on this thought came more words out of Job: “Oh, that my words were now written! Oh, that they were printed in a book!” In that moment I knew I must describe my experiences.
Never have I so known the swiftness of thought: never have I so known the swiftness of perception. All this which takes so long to relate—thinking of sensation being rekindled in the leg, and in higher, unused co-ordinating systems; of these, at first so wild and chaotic, being calibrated and corrected by some trial-and-error method; of my mind as a torrent of different perceptions, and perceptual hypotheses and computations, succeeding one another with inconceivable rapidity—passed through my mind in a flash.
I must have presented a strange sight to the good therapists, who probably saw an obviously unstable, staggering, confounded man, with a look at first of consternation on his face, gradually regaining his equilibrium; at first perplexed and fearful, then fascinated and intent, and finally joyful and at peace.
“You went through some changes there, Dr. Sacks,” said one of them. “How about taking the first step now?”
* * *
—
The first step! In my efforts to stand, to gain control, I had thought only of holding-on, of survival, or standing, and not yet of moving. Now, I thought, I might try to move. And I was being urged, perhaps even gently pushed and levered, by the therapists, who knew one thing for certain: that one must get on with it, one must proceed, one must take the first step. They knew—priceless knowledge, which the mind can forget—that there is no substitute, ever, for doing, that “In the beginning is the deed,” and that there is no path to doing, no way of doing, other than doing.
My first step! Easier said than done.
“Well, Dr. Sacks, what are we waiting for?”
“I can’t move,” I replied. “I can’t think how to. I have no idea wha
tever how to take the first step.”
“Why?” she said. “You were able to make a flexion movement at the hip yesterday. You were so excited about it—and now you can’t take a step!”
“It is one thing to flex the leg in bed,” I replied, “but quite another to take the first step.”
She gave me a long look and then, seeing the uselessness of words, wordlessly moved my left leg with her leg, pushing it to a new position, so that it made, or was made to make, a sort of step. Once this was done, I saw how to do it. I could not be told, but could instantly be shown—and she showed me what such a movement was like, as the at first involuntary, or tic-like, flexion the day before had shown me what hip flexion was like, so that, having been shown, I could bring my will to bear, and do it actively for myself. Once the first step was made, even though it was an artificial, not a spontaneous, “step,” I saw how to do it—how I might flex the hip in such a way that the leg moved forwards a reasonable distance.
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