A Last Meander

Perhaps no other person in modern medicine has done more to transform patient into protagonist than Oliver Sacks. Since his book Awakenings in 1973, Sacks has set himself apart from other medical writers with his ability to command the space that separates science from subjectivity. Therefore it is a welcome but sad pleasure to read one final book from Sacks, who died in 2015.

The River of Consciousness, a posthumous collection of essays, meanders through Sacks’ scientific and non-scientific landscapes. He reflects on consciousness, sentience in worms and flowers, the unreliability of memory, and the importance of creativity, among personal anecdotes relating to his work and his struggle with illness. If you are looking for a trajectory or a compass to direct you through these narratives, you will be hard-pressed to find one; Sacks distills his influences into a sentimental, albeit patchwork, collection of stories. But if you relinquish yourself to the journey, Sacks’ unique perspective on the human experience makes for an enjoyable ride.

It is hard to conceive of a more human endeavor than medicine. Being a doctor is at once messy, visceral, and personal, yet society at large labels doctors with sterile attributes – lab coat, MCAT score, patient turnover. Challenging these stereotypes, Sacks opened a window into the dry world of medicine for voyeurs interested in a glimpse into the consciousness of neurological patients (The Man who Mistook his Wife for a Hat, Hallucinations). He turned the lens on himself in his memoir (On the Move) before succumbing to liver cancer the same year it was published.

Two years after his death, it is perhaps fitting that Sacks offers us a posthumous peek into the immense breadth of interests that informed his chosen vocation as neurologist and avocation as writer. In these essays, he takes us on an expedition to get at the biggest question asked by philosophers and scientists alike – what is the meaning of life?

In search of an answer, he flits between anecdotes from his own life to observations made by other intellectual giants, including Charles Darwin, Sigmund Freud, and Susan Sontag. In fact, so blurred are the lines between Sacks’ experience and these complementary narratives that one almost envisions Sacks writing these essays while imagining himself in conversation with his heroes. In his essay “The Creative Self,” Sacks tells us that the drive to be creative is elemental. He uses the example of children at play to surmise that imitation and assimilation, followed by a period of forgetting, allows borrowed ideas to be reinvented as new stories. For Sacks’s generation, reading was one of the few ways to immerse oneself in another world. He describes a lecture given by Sontag where she describes her voracious childhood reading as a form of “mental gluttony [sic]” that allowed her to later write herself. Sacks calls the period of imitation an apprenticeship, a training period from which true creativity may emerge.

In the essay “Darwin and the Meaning of Flowers,” Sacks explores the little advertised fact that Darwin was an avid botanist, and paints a picture of the erstwhile naturalist tinkering in his garden while postulating the coevolution of flower anatomy and insect mouthparts. What Sacks wants us to see (through his eyes, but from Darwin’s point of view) is that even though the theory of natural selection outraged scientists and religionists at the time – he describes “the Origin [as] a frontal assault…on creationism” – it is “not militancy or polemic that shines” out of Darwin’s theories on plant evolution, but “sheer joy [and] delight in what he was seeing.”

For us scientists not fortunate enough to spend endless hours frolicking in manicured gardens observing the nature of birds and bees, the description of Darwin’s joyous route to discovery conveniently omits the hard-earned currency of academic success. But this omission appears to be Sacks’ intent. He wants to stir in us nostalgia for exploration and a reverence for idyll in science. Once early stage scientists get over the fact that they might never find time to tend to a garden, they may appreciate Sacks’ message that the uphill battle of being a revolutionary scientist can be eased by a pure delight in experimenting.

Not all of the essays have a lesson to share. “Speed” walks us through the subjective nature of time, exemplified by different manifestations of Parkinson’s disease in two patients. One patient moves slowly (Sacks uses a flipbook of photos to discover that a series of poses where the patient appears to be sitting still is actually a long endeavor to wipe their nose). The other moves like a “speeded-up film.” As he contemplates consciousness and time, Sacks expounds on his love of HG Wells’ “vividly imagined, almost cinematic descriptions of altered time” alongside his own observations on consciousness, and somehow manages to weave in the two fascinating but diametrically opposed stories of his own patients. At the end of the essay we have arrived nowhere – except, perhaps, to the start of the next story – but by now I am buckled in and traveling through the museum of Sacks’ mind. So far, I like the trip.

And so the stories go. Sacks pontificates on consciousness in the invertebrate brain in “Sentience: The Mental Lives of Plants and Worms.” Any brain buff worth their neurons is usually astonished by the genius of cephalopods (octopuses and cuttlefish), and Sacks appears to be no exception. A chapter on “The Creative Self” is not a new-age text but an examination of mimicry and imitation in developing creativity.

The final essay – “Scotoma: Forgetting and Neglect in Science”– is poignant and cautionary. Here Sacks bemoans the neglect of history in science, telling us that he often found answers to modern neurological prognoses in old “nineteenth century accounts, which tend to be much fuller, much more vivid, much richer in description, than modern ones.” He recounts the lessons of scientists who made discoveries before the world was ready for them (Gregor Mendel, Oswald Avery, Barbara McClintock). He laments their prematurity and blames our scientific scotoma (or diminished vision) for a “loss of knowledge, or forgetting of insights…and sometimes a regression to less perceptive explanations.” It is one part foreshadowing – we are, after all, treading water in dangerous scientific times – and one part contemplation. In the twilight of his life, Sacks appears apprehensive that his radical ideas about consciousness and the brain were conceived several generations too early.

Sacks published fifteen books (including this one) and countless articles in his lifetime. The River of Consciousness alludes to the literary abundance of his role models (Darwin wrote “six books and seventy-odd papers” on plants alone). We do not need this book to remind us that Sacks has joined their ranks, but it is a bittersweet reminder of what a literary and scientific giant he was.

Rhea Datta, PhD. is a postdoctoral research fellow at New York University where she studies early embryonic development. She will be joining the faculty at Hamilton College in the fall of 2018.