Last year, I was struck by the news that Dr. Oliver Sacks had died — I am not sure when I first heard about him and his writings, but I was familiar enough to feel a tinge of sadness at his passing. I’d read a short story or essay here and there, but I hadn’t read any of his full-length books, and The Man Who Mistook His Wife for a Hat had been sitting on my bookshelf for quite some time. The timing to begin reading it, it turns out, could not have been better: I started it during the last week of my Medical Neuroscience course, and finished it during my next course, “The Mind.” The reason these courses paired well with this book will be obvious to anyone who has read it, and I hope will be obvious to all at the end of this review.
It was clear to me at the outset of this book why he is heralded as one of the great medical writers of the 20th century: Dr. Sacks’ stories serve as the benchmark for fascinating and beautiful clinical writing. There seems, to me, to be two main reasons for this. The first is that Dr. Sacks practiced a type of medicine that leaves the reader nostalgic for a better way. He frequently speaks of seeing patients — not just for short, hurried appointments but really seeing them — and spending as long as necessary with them to solve, or at least thoroughly understand, the problems they were facing. He also references several times in which he sought out patients to follow up on them. It is clear from his stories that he was an excellent clinician, dedicated to the care of patients above all else. Whether he was doing house visits to better accommodate a patient, or conducting his own outside research on a problem to better counsel someone who came to see him, Sacks’ love for his patients is obvious throughout each story.
The second reason that Sacks writes such interesting vignettes is that the cases he sees are themselves fascinating and often fantastical. He describes a patient with hemi-neglect, who cannot willingly look to the left, even though she cognitively understands her disability. She compensates by spinning around to the right until things in her left visual field come into view. There is a man with advanced Korsakoff syndrome (alcoholic degeneration of the memory centers of the brain) presenting with an extreme case of anterograde amnesia — though the man is 60-something, he genuinely believes he is in his 20s and has no new and lasting memories from the last 40 years of his life. One story is about a set of twins with profound developmental deficits and autism spectrum disorder; although they cannot perform math in the typical sense, they have an uncanny ability to spout off 12+ digit prime numbers, or to know what day of the week a certain date will fall on twenty thousand years in the future.
Although these stories and the others would probably be interesting if told by anyone, something about Sacks’ style makes the vignettes even more compelling. He displays his own emotions about each case without hesitation; he mirrors the awe, puzzlement and excitement of the reader, and is often candid with his patients if he does not understand something he is seeing. The reader gets the feeling that despite years of patient encounters, Dr. Sacks has not lost his wonder and love for an interesting case. As one example, he writes of “street neurology”, his term for the act of watching individuals on the street, going about their daily lives, as a way to gather more information about them and their diseases.
This small collection of stories tackles a wide variety of social, philosophical and ethical issues, as well. In neurology, as Dr. Sacks describes it, there are blurred lines between normally separate parts of the world, even of medicine: the conscious and unconscious, memory and imagination, medication and perception. The curious interplay of these components are usually subconscious in us, but the complex neurology cases in The Man Who Mistook His Wife for a Hat force us to stop and reconsider how the different parts of our brains work together, and what happens when they stop cooperating. Sacks writes easily but seriously about these issues, and again, the care of patients take precedence over any abstract fascination in a curious case.
Several stories address the paradox of treatment — what happens when the treatment of a disease is not unilaterally good? One story in particular, Witty Ticcy Ray, is about a man with Tourette syndrome — a rather advanced case in which the disease affects nearly every part of his life. After treatment, the man who was known for being quirky, energetic and excitable becomes dull, both to others and to himself. Ray and Dr. Sacks are both forced to reconsider what has often been taken for granted in medicine: the patient is better off once we have treated them. Though this may be true a majority of the time, Ray’s decision — to take limited doses of the medication, only at certain times, thus retaining his unique personality — proves that it may not always be the case. Dr. Sack’s’ own wrestling with this issue is evident throughout the story, making it an even more compelling read.
Oliver Sacks was widely regarded as both an excellent writer and an excellent physician; the fact that he was both makes his writings especially pleasant for medical students to read, and might make us lament his passing even more. I found many noteworthy parts of The Man Who Mistook His Wife For a Hat, but the overall tone of the book was the most enjoyable aspect for me. Dr. Sacks presents his patients with a kind of reverence not often seen in clinical writing, and it was refreshing to read medically interesting stories written by someone who was enamored by the wonder and mystery of it all. Sacks’ many charming characteristics are evident in his writing — thoughtfulness, curiosity and intelligence — yet he writes with an air of humility. Every medical student should have a copy of this book on his or her shelf. The beauty of his writing, though, is that it’s not just for medical students; anyone with a curious mind will find enjoyment in the whimsical clinical tales in this collection, and may find themselves also lamenting the loss of this great physician.
Prints, Pages and Pagers aims to look closely at the lives of medical students and doctors, real or fiction, whose lives and experiences are told in novels, short stories, poetry or any kind of writing. These book reviews are an opportunity for medical students to learn from the many fascinating stories produced by the field of medicine, and maybe to read something other than a textbook.