A Leg to Stand On

by Oliver Sacks, M. D.

  Consciously, of course, I desired to leave, to graduate from the hospital, and start growing up; and yet, on my last night, my unconscious self contrived a near-accident which, had it been successful, would have kept me in hospital. I had gained, in eight days, a good deal of confidence and strength, was able to walk with my crutches a quarter of a mile at a stretch, to transfer, to balance myself, with verve and panache. It seemed to me no more than exuberance and high spirits that I had an impulse, on my last night, to climb to the roof, even though climbing stairs was a skill I had only just achieved, and this involved not just stairs, but a trapdoor and a ladder. What a thrilling adventure, to climb to the roof, and see the lights of London emblazoning the night sky! Thrilling and—with crutches, and a cast, and a half-denervated leg—absolutely crazy, and potentially lethal. Fortunately, I was spotted before going too far, brought down and lectured sharply on my provocativeness and folly. It was only at this point that it broke through to consciousness, and I realized—I had in fact tried to have an accident, because I was dead scared of leaving. I would not mention a purely private bit of neurotic “acting-out,” had I not discovered that such acts were rather common among the patients. All of us, to a man, were “eager to leave,” eager to get out, and get on to the next step. And yet this involved a relinquishing of care, of the cherished-infant status we were now used to. We wanted, consciously, to be weaned, but unconsciously we feared, and tried to stop it, to prolong our special, pampered status.

  Escapade or no, I was shipped out the next morning, along with half a dozen others—all of whom, I found, had had last-minute escapades. And I, by God, was the only able-bodied one there; the others had catheters, were pale or short of breath, or just looked ill, a sorry crew struggling, or being lifted, into the bus. And our bus—like a lazar-ship, ghost-ship, death-ship—seemed to weave a damned route, alien and isolated, to Hampstead.

  I found myself frightened—we all were, I think—by the blaze and bustle of the world outside, the speed and violence of the traffic, the huge crowds, the noise. The sheer complexity and bustle of the world was terrifying. We all turned away from the windows, aghast, thankful we were not to be thrown into this, yet. Some of us had scoffed at “a Convalescent Home” (“A silly idea, a silly place, I want to get out”), but none of us wanted this after one look at—the Outside. It was a tremendous relief, a liberation, to be no longer “in,” but none of us, we realized, were ready to go “out.” The sense, the necessity, of an in-between, became clear, and the “silly” place became, to us, dear, necessary, and desired. It was an immense relief as we got out of the bustling central city and up towards the quieter heights of Hampstead. There was a moment of fear, and then an enchantment, when we came to that manorial gate, which was creakily opened and then closed behind us, and as we drove up to, and were deposited at, the old manor house itself—a huge, old, rambling, ivy-twined building, set in grounds so green and vast that all sight and sense of the city was gone and banished. Gratefully, shakily, we tumbled out of the bus. We were greeted by a kind-faced, motherly matron and, our exhaustion appreciated, taken to our rooms. All of us fell immediately into exhausted, relieved sleep.

  I awoke—to a scene of pure magic, a low full moon, a harvest moon, flooding the landscape with light, shining on the low wooded hills all around me. It was, I suddenly realized, just one lunar month since the evening I had rowed across Hardanger fjørd, under just such a full moon, the very night before my fall. That enchanted, mysterious, yet sinister evening, when I had heard music on the still water of the fjørd—a dream, an illusion?—no, a reality, but a magical reality, coming from a lakeside church. How enchanted, scarcely breathing, afraid to break the spell, I had moored the boat, and walked softly through the churchyard, past moonlit graves, to the illuminated house of God, filled and swelling with Mozart’s great Mass.

  Had a month, a whole month, actually passed? While I lay frothing and fretting in hospital, the heavenly motions had continued, majestically indifferent, sublimely above my ego-charged frenzies. An immense calm, a sublime peace, enfolded the scene. The sense of fret and impatience drained out of me, like a poison. I felt I was one with the vast calm all round me. Waking, that evening, I felt peace like a blessing—a Sabbath-grace, descended from the sky.

  There was a light September mist blurring the light, softening all outlines, wreathing and protecting us. This too I felt as a sweetness and blessing—appropriate for the calm interim ahead: “Thank you, thank you, thank you, Fog.”

  Gently, softly (the violence had gone out of me), I levered myself out of bed, and on to my crutches. It was late, I had slept through supper, the patients were abed. Softly, gently, I descended the great staircase—how right this old manor was for the period I was now in. All was silent, benignly silent, below—the silence of peace, of repose, of a Sabbath. I closed my eyes and murmured a prayer of thanksgiving and praise.

  Who cared if there was really any Being to pray to? What mattered was the sense of giving thanks and praise, the feeling of a humble and grateful heart.

  Between the last full moon and this, in the space of a single lunar month, I had come near to death, and been saved at the last moment; had had my mangled flesh sewn together and united; had “lost” my leg (for an eternity?) in a limbo of non-feeling; had recovered it, as by a miracle, when recovery seemed impossible. I had had the foundations of my inner world shaken—nay, I had had them utterly destroyed. I had experienced “reason’s scandal,” and the humiliation of mind. I had fallen into an abyss, with the breaking apart of my tissues, my perceptions, the natural unities of body-soul, body-mind. And I had been lifted from the abyss, reborn, reaffirmed, by powers beyond my understanding and reason. I had been shaken and foundered—but mysteriously saved. And now I had come to this sweet haven, this old manor house, in Hampstead, where candles glimmered in human lightness and a vast moonlit calm lay on the hills about me. I opened the door—what a freedom was this, for in the hospital there was no liberty to come and go—and stood, for a minute, in the soft air, savoring its fineness and the sweet smell of woods, and seeing in the distance the nightglow of London, city of cities, my mother.

  For some reason, in the hospital, I had found it difficult to weep. I was miserable, frequently, but with a hard, dry-eyed anguish. Now, suddenly, I found the tears coming down. I wept—joy, gratitude?—without knowing why I did so.

  * * *

  —

  It was not till breakfast that I met my fellow patients—all of us patients, convalescents, brought together for a time. A newcomer, low on the totem-pole, I was assigned to a table in the corner, an object of curiosity, concern and perhaps some contempt to the veterans. There was an instant feeling of group—and hierarchy—like a first day in army or school—but beneath this, a warm and comradely feeling.

  Straightaway I ran into a problem: I could not bring my crutches to the table, but if I disposed of them, how could I get to the table?

  “See here,” said my neighbor, seeing me puzzled and awkward. “Sit yourself down, and I’ll put your crutches in the corner. We all have to help each other here.”

  I thanked him. He was a little grizzled man, a diabetic, who had just had an amputation and was much plagued, he confessed, by vivid phantoms. We introduced ourselves quasi-medically, with our symptoms and problems, and only later in a more personal way.

  “What about you? What happened?” he asked, with a glance at the cast.

  I told him.

  “Isn’t that the darnedest thing!” He turned to the others. “Doc here’s got a leg, but no feeling in the leg—and I’ve got the feeling, but no leg to go with it! You know—” (he turned back to me) “we could make one good leg between us. I’ll donate the feeling and you give the leg.”

  We laughed. We all laughed. The ice was broken, and it came to me that this man, with no special knowledge, had gone instantly to the heart of the problem—the heart of t
he problems, both his and mine, the comic and basic opposition of positive and negative phantoms. Indeed, he went further:

  “This damn phantom,” he said. “Stupid bloody thing. Who needs it? Ain’t there no way of stopping it happen? By Jiminy,” he cried, “you are the answer. All they should ’ave done, before they took it off, was to give it an anesthetic, cut the nerves, put it in a cast—so I lost the feeling of it, like you lost yours. And then, when the feeling wasn’t there, then cut it off! Get rid of the feeling, get rid of the idea, then get rid of the thing itself!”

  I marveled at this clarity of mind. The idea struck me as sound, even brilliant. I felt like “medicalizing” it for him, and sending a letter in his name to the Lancet: “Simple prophylaxis against the development of phantoms.”

  What I found with him I found with them all. They were all much wiser than the doctors who treated them. There is among doctors, in acute hospitals at least, a presumption of stupidity, in their patients. And no one was “stupid,” no one is stupid, except the fools who take them as stupid. Working in a chronic hospital, with the same patients, one gains a greater respect for them—for their elemental human wisdom, and the special “wisdom of the heart.” But at that first breakfast with my “brothers”—not my colleagues in expertise, but my fellow-patients, fellow-creatures—and throughout my stay in the Convalescent Home, I saw that one must oneself be a patient, and a patient among patients, that one must enter both the solitude and the community of patienthood, to have any real idea of what being a patient means, to understand the immense complexity and depth of feelings, the resonances of the soul in every key—anguish, rage, courage, whatever—and the thoughts evoked, even in the simplest practical minds, because as a patient one’s experience forces one to think.

  Communication in the Home was instant and profound. There was a transparency, a dissolution of the usual barriers, between us. We not only knew the facts about each other (Doc’s leg, Mrs. P.’s ovary, etc.), we knew, we sensed, we divined each other’s feelings. This sharing of normally hidden and private feelings—feelings, indeed, often hidden from oneself—and the depths of concern and companionship evoked, the giving and sharing of priceless humor and courage—this seemed to be remarkable in the extreme, unlike anything I had ever known and beyond anything I had ever imagined. We had all been through it—sickness and fear—and some of us had walked in the Valley of the Shadow of Death. We had all known the ultimate solitude of being sick and put away, that solitude “which is not threatened in Hell itself.” We had all descended to great darknesses and depths—and now we had surfaced, like pilgrims who had taken the same road, but a road, thus far, which had to be travelled alone. The way ahead promised a quite different passage, in which we could be fellow-travelers together.

  We had met by chance. We would probably never see each other again. But the meeting, while it lasted, was elemental and profound—an unspoken, shared understanding and sympathy. The certainty, the intuition, of what we shared, the certainty in the depths and foundations of our relations, was like a shared secret which need not be spoken. Indeed, for the most part, our speech was light. We joked, we bantered, we played billiards and banjos, we talked about the news and the latest football scores, and about the flirtations and favoritism we observed in the staff. Everything, on the surface, was merry and light. An outsider would have thought us a frivolous lot, overhearing our conversation. But its lightness, our lightness, covered profound depths. Depth was implied, was secretly present in our words, in the lightest, easiest antics and frolics. If we were frivolous, it was the high spirits of the newborn—and, equally, of those who have known the deepest darkness. But none of this would have been seen by an outsider. He would have observed the surface, not the depths. He would not even have guessed that there were any depths concealed and revealed in our frivolities.

  * * *

  —

  After breakfast I wandered out—it was a particularly glorious September morning—settled myself on a stone seat with a large view in all directions, and filled and lit my pipe. This was a new, or at least an almost-forgotten, experience. I had never had the leisure to light a pipe before, or not, it seemed to me, for fourteen years at least. Now, suddenly, I had an immense sense of leisure, an unhurriedness, a freedom I had almost forgotten—but which, now it had returned, seemed the most precious thing in life. There was an intense sense of stillness, peacefulness, joy, a pure delight in the “now,” freed from drive or desire. I was intensely conscious of each leaf, autumn-tinted, on the ground; intensely conscious of the Eden around me, and, beyond this, the wide sweep of Hampstead Heath, and the steepled churches of Hampstead and Highgate, high on the skyline. The world was motionless, frozen—everything concentrated in an intensity of sheer being. A perfect peace and communion lay upon the land. This peacefulness had a quality of thanksgiving and praise, a kind of silent, holy intensity; but a silence which was also thanksgiving and song. I felt the grass, the trees, the Heath all round me, the whole earth, all creatures, issuing forth in praise. I felt that all the world itself was one vast hymn—and that my own soul, peaceful, joyful, was part of this hymn.

  Everything about me was infinitely familiar. Had I not grown up near Hampstead Heath, and run all over it as a child? It had always been a magic realm, a dearly familiar home. But now, on this morning, as though on the first morning of Creation, I felt like Adam beholding a new world with wonder. I had not known, or had forgotten, that there could be such beauty, such completeness, in every moment. I had no sense at all of moments, of the serial, only of the perfection and beauty of a timeless now—a nunc stans.

  A magic realm of timelessness had been inserted into time, an intensity of nowness and presentness, of the sort usually devoured by past and future. Suddenly, wonderfully, I found myself exempted from the nagging pressures of past and future and savoring the infinite gift of a complete and perfect now. Idly, but not idle—for in leisure there is neither idleness nor haste—I watched the slow wreathing of smoke, into the still air, from my pipe. Idly I heard, upon every hour, the tolling of bells from all directions: Hampstead calling, tolling, to Highgate, Highgate to Hampstead, each to each, and all to the world.

  So I sat, and thought, my mind active, but at peace. And I observed, further, that I was not “unique,” and that sitting or strolling in that paradise were other patients, unhurried, unworried, in repose. All of us were enjoying an extraordinary Sabbath of the spirit—so I guessed, so I confirmed in the sweet and timeless month of my own residence there. There was a peculiar calm, as of a cloister or college. It was for all of us, irrespective of the conditions of our lives, a peculiar interlude unlike anything we had ever known. We had emerged from the sheer misery, the storms and terrors, of sickness, the undermining uncertainty about whether we would get well; but we had not yet been reclaimed by the daily round of life, or of what passes for life in the unredeemed world, with its endless obligations, vexations, expectations. We were being granted a magical interlude, between being-sick and returning-to-the-world, between being-a-patient and being-a-paterfamilias-and-breadwinner, between being “in” and being “outside,” between past and future. The mood of Saturday morning lasted; it was as undimmed, as radiant, a week, a month later.

  * * *

  —

  Another September, another year, having found peace after a period of fret, I find myself reading Hannah Arendt, on “The gap between past and future: the nunc stans.” Indeed, this is interleaved in the act of recollection: I recollect and write for a while, and then take a break for Hannah Arendt. She speaks of a “timeless region, an eternal presence in complete quiet, lying beyond human clocks and calendars altogether, the quiet of the Now in the time-pressed, time-tossed existence of man…this small non-time space is the very heart of time,” and how it is the very home, the only home, of Mind, Soul and Art; the only point where past and future are gathered together and the pattern and the meaning of the whole
become clear. Precisely this timelessness was given now—the special gift of Caenwood.

  In my student days, alas, I largely took Oxford for granted, and failed to appreciate or make use of its timelessness, its privilege, but I was vividly aware of my privilege now—the special interlude being granted to me in this time of convalescence. I felt this intensely. Everyone did at the Home. For many—job-ridden, family-ridden, chronically worried and anxious—it was the first real leisure, the first vacation they had ever had—the first time they had ever had time to think—or feel. All of us, in our way, thought deeply at this time and, I suspect, were profoundly changed, sometimes permanently, by the experience.

  In the hospital we lost our sense of the world. It was in the Convalescent Home that we first re-encountered the world—albeit at a distance, attenuated, in miniature. My first morning I had spent basking in the sun, going for short exploratory sallies in the garden; I could stroll, with my crutches, for a few minutes at this point. In the afternoon I made it to the gate of the Home. This involved an incline, and knocked me out completely. Gasping, trembling, I sank down by the gate, overwhelmingly reminded of my incapacity and inadequacy. Across the road, in the playing fields of Highgate, I saw the school team practicing rugger, a sight I normally enjoy. I was surprised and appalled at a spasm of hate in myself. I hated their health, their strong young bodies. I hated their careless exuberance and freedom—their freedom from the limitations which I felt, so overwhelmingly, in myself. I looked at them with virulent envy, with the mean rancor, the poisonous spite, of the invalid; and then turned away: I could bear them no longer. Nor could I bear my own feelings, the revealed ugliness of myself.