In 1974 I was tossed off a cliff. The circumstances were slightly absurd: I was on a mountain in Northern Norway, and I had a contretemps with a bull. It was a very isolated area, and no one knew where I was. I was alone, with a grossly injured and useless left leg. I thought I would die, but to my surprise I was saved. A reindeer-hunter found me, a posse carried me to the nearest Arctic village, ambulance and plane conveyed me to London. The next morning I was scheduled for emergency surgery.
Becoming a patient
I had asked to be put with the other patients in the ward. ‘You can’t do that,’ I was told. ‘You’re a doctor. You must have a room of your own.’ But when I asked if it might be possible for the operation to be done under spinal anaesthesia, I was told that that too was out of the question. ‘Can’t have patients watching their own surgery.’ Two years before, my mother, who was a surgeon herself, had had to have some major surgery. She had asked if this could be done under spinal anaesthesia, with an oblique mirror set up in such a way as to enable her to watch her own surgery. The surgeon, an old friend of hers, was delighted to comply – and she, in turn, took real delight in watching, and afterwards in describing to me, the ‘beautiful’ anatomy and the skill of the surgeon. Not only had she enjoyed, and, in a sense, ‘participated’ in, the procedure, she had also avoided the terrors of uncontrol and passivity. I was deeply annoyed, though I said nothing, that this was not permitted to me.
The surgeon was brisk and dapper, a man who always gave the impression of being in a great hurry. He came in to see me after I had already been given the premed. ‘Sacks!’ he snapped. ‘You’ve ruptured the quadriceps tendon. We reconnect it. That’s all.’ With this he disappeared. I had neither said, nor been able to say, a single word.
Since I live to observe, to remember, to record, it is a grief to me that I can say nothing, directly, of the surgery. My consciousness was extinguished, while the surgeons did their work. It was a long business, five or six hours, since there were crushed and torn tissues besides the avulsed tendon. I was quite shocked and toxic in the two days that followed, and have only the most patchy recollection of these.
On the third day my fever cleared, and I came to, overjoyed at finding myself alive and in one piece. Alive, anyhow: but was I in one piece? The operated leg was entirely covered in a cast, so I couldn’t really see it – but who needs to see their body, if they feel it and move it? I was startled by the tremendous wasting and softness of the quadriceps: I could put both fists under the cast, and the thing felt like jelly. I tried to contract it – and nothing happened. ‘Quadriceps flaccid. No response. Why?’ I wrote in my journal, and forthwith dismissed the question from my mind.
But it was less easily dismissed in the night that followed. I kept dreaming of the accident, and of the suddenly useless leg, and kept trying, in my dreams, to get it working again: in particular, to contract my odd floppy quad. The strenuousness of my efforts finally woke me, and I discovered that I was actually trying to tense the muscle. But neither dreaming nor waking did I have any success. ‘I’m just being silly,’ I said to myself. ‘I’ve forgotten how to do it ... The physiotherapist will be along soon – she’ll show me how to do it.’
She came along later, full of briskness and brio. ‘We’ve got to get the leg going,’ she said. ‘It’ll be working in no time.’ She told me to tense the muscle. ‘Come on, really hard!’ I went black in the face, but nothing happened. ‘Come on!’ she urged. ‘You’re not really trying.’ Was I really trying? What did ‘trying’ mean? I was certainly making a colossal exertion, but exert as I would, nothing happened in the leg. ‘OK,’ she said. ‘We’ll try other procedures.’ And she went – we went – through a whole arsenal of ‘procedures’. We spent two hours trying, and the leg remained – dead. Not the foot, which was as lively as ever: but the rest of the leg, all blank in its cast, and the injured and operated quadriceps in particular. I found this very queer, and disquieting, and ambiguous. ‘Is the muscle paralysed?’ I said to myself. ‘Has it been denervated? Am I genuinely trying – and failing? Or am I somehow failing to try?’ Normally one calls upon oneself to respond, to move an arm or a leg, and the response is immediate: indeed, the ‘call’ and the ‘response’ seem one. Now I called – and there was no response. Was my call unheeded, unheard by the muscle – or was I, in fact, failing to call? Was the muscle unable to obey my command, or was I failing, somehow, to issue a command? An unexpected complexity and perplexity arose, unlike anything I had known before.
Where has it gone?
Exhausted, I fell into a brief, and apparently restless, sleep, from which I was awoken by a nurse bursting in through the door: ‘Watch it, Dr Sacks!’ she cried. ‘You’ll have the leg off the bed.’
‘What do you mean?’ I replied. ‘It’s right here in front of me.’
‘No, it’s not,’ she insisted. ‘It’s half pushed off the bed.’
‘What on earth are you talking about?’ I asked, wondering whether she was indulging in some sort of joke. ‘Shouldn’t I know where my own leg is?’
‘You should,’ she replied, ‘but apparently you don’t ... Please stop talking and take a look.’
I shrugged and looked down – and was completely confounded. It was not in front of me, as I knew, or presumed, it to be: it was sticking out at an angle, half off the bed. In the moment when I saw it was not where I imagined, I realised I could not feel it at all. I asked the nurse to move it back on the bed. She did so, and I felt nothing, nothing at all. I had no feeling of its being moved, or of its whereabouts, at all. And in this moment of finding I could not perceive where it was, I found I could not perceive that it was ... I watched the nurse move it, and it was like watching someone else’s leg, or a piece of furniture, being moved. My own leg, in this moment, was no longer my own, and no longer part of my body or my self. No longer part of anything – unreal, absurd. (‘That which is not Body is no part of the Universe,’ writes Hobbes, ‘and since the Universe is All, it is Nothing and Nowhere.’) Suddenly, then, my leg (my ex-leg) was Nothing and Nowhere: it was gone, so far as living or felt reality was concerned; it was no longer ‘there’. And indeed there was no ‘there’: it had gone, and left not a trace behind; neither a trace, or a place, or a space (Leibniz’s notion of Nothingness: ‘No Trace, Place or Space’).
I suddenly remembered a patient on the Neurology Wards 15 years before, who had woken from sleep, one Christmas Day, to find ‘a strange leg’ in his bed. There was a Christmas party going on, and the only ‘explanation’ he could imagine was that one of the nurses, as a joke, had filched a leg from the Anatomy Room, and slipped it under the covers as he slept. Amused, and disgusted, he threw ‘the damn thing’ out of the bed, but then found, to his inexpressible amazement and horror, that he came out with it, that ‘the damn thing’ was attached to him. I recalled his ashen face as he said: ‘It’s not mine. What is it ... Am I mad? What has happened?’ It turned out that he had a tumour of the right parietal lobe of his brain, which had haemorrhaged while he was snoozing on Christmas Day, obliterating the ‘leg area’ of the brain, and thus obliterating any sense of his own leg, so that, when he ‘discovered’ it, it was not his, but ‘a damn thing’. In the moment of realising that my own leg was estranged, I had an overwhelming memory of this young man, and thought: ‘Christ! Could I have had some sort of stroke under anaesthesia? An embolus maybe? What’s wrong with my brain? What has happened to the leg area of my brain?’