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Awakenings Paperback – October 5, 1999
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It hardly seems fair that so many great doctors are also great writers. Perhaps it's qualities like sensitivity, craft, and dedication that keep physicians like Oliver Sacks in hospitals all day and at writing desks all night; if nothing else, these qualities shine in books like Awakenings. This powerful set of case histories rises above its pathological foundation to find new literary territory, a medical-spiritual synthesis equally stimulating for the mind and the soul. It's no wonder Hollywood producers chose to turn it into a feature film--anyone can see the universal human struggle against bondage and despair in these pages.
The sleeping-sickness epidemic of 1918 caused hundreds of survivors to slip into a bizarre rigid paralysis with similarities to advanced Parkinson's disease. These patients, only occasionally able to communicate or move, were nearly all institutionalized for life, their ranks increasing every now and then with similarly afflicted men and women. Sacks came to work at a long-term care facility shortly before the first exciting results with L-dopa and Parkinson's in the late 1960s; his patients soon embarked on dramatic, difficult recoveries from up to 50 years of torpor. He documents their spiritual and medical obstacles with great care to portray their individual personalities, long suppressed but finally released. Though many great doctors are also great writers, few can compare with Oliver Sacks for expressing the relation of medicine to the human spirit. --Rob Lightner
"[Sacks] opens to the reader doors of perception generally passed through only by those at the far borders of human experience".
-- The Boston Globe
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Dr. Sacks wrote several other books involving neurological conditions including; The Man Who Mistook His Wife For A Hat, An Anthropologist On Mars, Musicophilia, Migraine, and Hallucinations. I would recommended them all.
Encephalitis Lethargica was a sleeping sickness that had similar symptoms to those of Parkinsonism. Striking after WWI, encephalitis lethargica became a worldwide pandemic. In the United States, neurologist Olive Sacks sought to find solutions for symptoms of encephalitis lethargica. He worked with many patients who had encephalitis lethargica and distributed doses of L-DOPA, a drug commonly used to treat symptoms of Parkinson's disease. He believed L-DOPA would help reduces symptoms of encephalitis lethargica because most of the symptoms were similar to those of Parkinson's disease. Throughout the time he was distributing trials of L-DOPA, Oliver Sacks recorded many of his experiences with his patients. He would record comparisons of the patient suffering from encephalitis lethargica before taking L-DOPA and their responses after taking it. His recordings became known as one of his famous novels Awakenings.
In his novel Awakenings, Sacks describes his experiences with post encephalitic patients upon taking L-DOPA. He begins his novel with a prologue describing and making connections between Parkinsonism and encephalitis lethargica and the aftermath of those who suffered from the sleeping sickness. He then continues with how life was for patients at Mount Carmel, an institution for people who were mentally ill followed. The rest of his novel, Awakenings, is similar to a journal entry; an entry for each of the patients he worked with. He described the patients and their behaviors prior to taking L-DOPA and their behaviors after taking it.
Sacks began his Awakenings entries with Frances D, one of the various patients Sacks worked with at Mount Carmel. He begins her story by mentioning how she became a victim of encephalitis lethargic at the age of fourteen. He continued to describe her state of being as deteriorating in which she became less capable of controlling her muscles from becoming stiff for long periods of time. Sacks also mentioned how there was a point at her life when everything seemed to be normal and she was even working, but that period did not last long. Shortly after, her symptoms worsened, and she had to be institutionalized. On June 25, 1969, Frances was given a dosage of L-DOPA. Five days after being started on L-DOPA, Frances still seemed to have symptoms of tremors and excessive muscle movements. On the eleventh day of her trial, her symptoms began to reduce and her speech was a bit clearer than before.
As she continued to receive her doses of L-DOPA, Frances' symptoms began to reduce, but at the same time, she began having negative outcomes from taking the drug. Her breathing and fidgeting were becoming more and more irregular. Because her breathing seemed to worsen, Sacks was forced to discontinue the distribution of the drug, but Frances insisted on the benefits she was receiving because of the drug. Instead, Sacks reduced the dosage.
Sacks' purpose of distributing the drug was to see whether the use of L-DOPA would reduce symptoms of encephalitis lethargica. As described in his novel, patients suffering from the sleeping sickness did show some improvements with the use of the drug. The drug is meant to replace the loss of dopamine levels in the person's brain. In class we have learned that dopamine is a neurotransmitter and it helps send signals from one cell to another. Because a person suffering from encephalitis lethargica has low dopamine levels, they tend to experience tremors. With the help of L-DOPA, dopamine levels increase and the tremors are reduced. This helps explain neurotransmitter replacement therapy.
Sacks' entries of prescribing doses of L-DOPA describe relationships to what we have learned in class about pre-synaptic and post synaptic neurons as well as brain structures. Encephalitis lethargica is known to attack parts in the brain that help produce dopamine. Similar to what we learned in class, when a part in the brain is affected its function will decrease causing severe disorders. We have also learned that dopamine is an important neurotransmitter that has important role in brain function. Some of these functions include roles in a person's behavior as well as voluntary motor movement and memory. We have also learned about the relationship between the pre-synaptic neuron and the post-synaptic neuron. In a normal neuron, you will see a balance and normal production of dopamine. The pre-synaptic neuron will release dopamine to the dopamine receptors in the post-synaptic neuron. When a person suffers from encephalitis lethargica, similar to Parkinson's disease, the brain does not produce enough levels of dopamine resulting in a shortage of dopamine levels released from the pre-synaptic neuron to the post-synaptic neuron.
Overall, I really enjoyed reading this book for various reasons. In regards to Oliver Sacks, he strongly believed that prescribing L-DOPA to treat patients who suffered from encephalitis lethargica could have improved symptoms. In his entries he was able to support his beliefs, although some of the cases when prescribing this medication did not turn out as he had planned. When reading Awakenings I noticed how emotional some of the entries were. In regards to the patients, it was heartbreaking to read about the lapses they went through even after going through medication and rehabilitation. I felt as though the book showed what it really means to have motivation. In Frances' case, she insisted on receiving doses of L-DOPA regardless of the fact that it was affecting her negatively. She wanted to get better and be able to live a normal life as she used to. Unfortunately because her health was at risk, doses of L-DOPA were cut and she relapsed into a "sleep" again. When patients relapsed after taking the medication, it disproved Sacks' beliefs that there would be long term positive outcomes upon using L-DOPA.
This book was also educational in which it taught me so much about how a drug developed to treat a specific disorder has multiple purposes and can help treat another disorder. For example, we learned how L-DOPA is mainly used to treat patients who suffer from Parkinson's disease, yet it is also used to treat Encephalitis lethargica. Because most symptoms of Encephalitis lethargica were similar to those of Parkinson's, L-DOPA turned out to be a useful treatment. It would cross the blood brain barrier and convert itself into dopamine to help replace the dopamine that was lost. It also shows how the material in our class is relevant in terms of those who suffer from a p-psychological disorder as well as the relationship between pre-synaptic neurons and post-synaptic neurons.
Though this book was certainly difficult to begin, thanks to the ubiquitous medical jargon, it was more than just reporting on medical cases - it was a memoir, not simply prose but almost poetry in its flow. Sacks was able to take medical reports - often considered the routine, brunt work of doctors - and turn them into a literary masterpiece. Really, the story itself is explosive, incredible, and the stuff of dreams - the cases heightened to seemingly unreal dimensions. But it is this fantastic nature which gives this book its quality, for the stories are indeed true. Even though the treatments end badly, even fatally, for most of the patients, the story is one that should capture medical-loving minds for generations.
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This is fascinating stuff!
I am not nor was I ever a medical student nor have I ever worked in the medical field.Read more