2015年8月4日 星期二

Oliver Sacks: the art of dying...ON THE MOVE: A LIFE; Uncle Tungsten




In this 2007 photo provided by the BBC, Neurologist Oliver Sacks poses at a piano while holding a model of a brain at the Chemistry Auditorium, University College London in London.
 ‘Every doctor aspires to be a little like Sacks whether for his sharp intellect, his obvious humanity or his exquisite writings that go to the core of what it means to be human and frail.’ Photograph: Adam Scourfield/BBC/AP Photo/AP

Like millions of readers I had a lump in my throat as I read Oliver Sacks reveal his diagnosis of terminal cancer earlier this year. Every doctor aspires to be a little like Sacks whether for his sharp intellect, his obvious humanity or his exquisite writings that go to the core of what it means to be human and frail.
In February he calmly declared that metastatic melanoma affecting his liver meant that his luck had run out. I found it hard to share his calm but then like the genial, grandfather-figure he is, he reassured us, oncologists and all, that he still felt intensely alive, wanting to “deepen my friendships, to write more, to achieve new levels of understanding and insight.”
His mention of finding a new focus and perspective resonated with me – it is as close to a universal finding as there is in clinic, where ordinary individuals and famous people all say that cancer forced them to contemplate their life and legacy.


It’s not always pretty, I concede. Cancer triggers joyful marriage but also bitter divorce. It unites bickering siblings but also tears apart those previously contented. It fosters a peaceful reckoning and loving coexistence but equally tempestuous anger and unrelenting sorrow. All I can say is letting go is hard. Actually, it sucks. Watching the march of thousands of such patients, I keep thinking it must be indescribably difficult to bear if it is so difficult just to watch from the vantage point of an unrelated oncologist, who at best catches only glimpses of the struggle patients face every day.
The lump in my throat grew larger this weekend when Oliver Sacks declared that his disease had inevitably returned despite liver embolization and immunotherapy, the holy grail of melanoma treatment. Oh no, I thought glumly, not you too, as if the greatness of being Oliver Sacks were enough to outsmart rapidly dividing melanocytes. Sadly no. The venerable figure that he is, I can just about picture him telling a group of despondent young residents that it would be naive to think that a terminally ill doctor might avoid the fate of many of his patients.
Oliver Sacks dying of metastatic melanoma may have been just another story of misfortune in a world spilling over with bad news were it not for something that caught my eye towards the middle of his column. He lists symptoms of nausea, loss of appetite, chills and sweats and a pervasive tiredness, all cardinal signs of worsening cancer. He tells us he is still managing to swim although the pace is slower as he pauses to breathe. And then, he says something utterly obvious and yet, thoroughly remarkable: “I could deny it before but I know I am ill now.”


In a piece of achingly beautiful writing, this observation may bypass the typical outsider but as an oncologist, it struck me as the essence of what it takes to die well – the concession that all the well-intentioned therapy in the world can no longer prevent one from going down the irreversible trajectory of death.
This recognition allows patients to halt toxic treatment, opt for effective palliation and articulate their goals for the end of life. It permits their oncologist to open up new conversations that don’t include the latest million-dollar blockbuster therapy with a bleak survival curve but do mention the therapeutic benefit of teaming up with hospice workers to write letters, preserve photos and record memories. I would say that this candid admission from a patient is the difference between bemoaning death as a medical failure and viewing life as a welcome gift.

He had determined that there was to be no conversation about her progressive cancer or the fact that she lay dying. Her experience was unacceptable yet the impasse dreadful and ethically troubling.I found myself thinking of a former patient who came into hospital dying of liver failure from metastatic bowel cancer. Her jaundiced skin was practically glowing and she had a resulting insatiable itch. There was not a single comfortable position she could find and it soon became clear that that she needed continuous sedation for comfort. But before I sedated her I needed to be sure that she understood her terminal condition, difficult given that the liver failure was causing agitation. The problem was that her husband was permanently stationed at her bedside and would not hear of me mentioning any bad news to the patient.
One morning her husband was delayed but she needed urgent attention so I walked in alone to find a clearly distressed patient. Looking surreptitiously around the room, and temporarily alert, she whispered, “What is happening to me?”
I sat down and held her hand, noting a trail of bleeding scratch marks.
“Do you want me to tell you?”
Before she could answer, her husband roared from behind me, “How dare you plot to scare my wife like that in my absence? Get out!”
As I covered my ears against the litany of abuse, the patient’s terrorised eyes briefly rested on mine. Sorry, they seemed to say, I am really sorry. Refusing to be mollified by the palliative care staff the man virtually dragged his dying wife home. He made a mockery of her end of life care and left me with a searing memory of my failure to help a dying patient. But I also try to remember that he loved her and just couldn’t bear the thought of letting her go. Letting go is hard.
Doctors fail patients in various ways but in some ways it is easier to fail patients when they or their family deny impending death. They are the ones who deserve our greatest consideration and patience but the truth is that it’s taxing enough to treat intractable pain, omnipresent nausea or pervasive melancholy without having to take on the onerous task of saying, “Believe me, you really are dying.”


Unlike suturing or locating a pulse, dealing with death does not become easier with time. If you care about your patient, it always hurts. It hurts when you fail to cure them and it hurts when you fail to help them die. Patients who can get even part of the way to acknowledging their mortality ultimately do themselves, their relatives and even their oncologists an untold favour.
But of course, it’s one thing to understand your mortality and quite another to articulate your feelings for the world to scrutinise. At his diagnosis Oliver Sacks wrote, “I cannot pretend I am without fear. But my predominant feeling is one of gratitude.” Those insightful words brought inspiration to untold patients.
But the doctor who brought to us the man who mistook his wife for a hat isn’t about to mistake death for what it is. Now he reminds us with all the poise and dignity we have come to expect of him that there is value in embracing our mortality, that there is an art to dying, and before he goes, he might just show us how. For this and so much more, we owe him.








In a poignant essay, renowned neurologist Oliver Sacks reveals he has an incurable cancer: http://cnn.it/1Acnfdb

On The Move


smaller jpg OTM front jacket
ON THE MOVE: A LIFE 預計2015年5月出版
by Oliver Sacks
An impassioned, tender, and joyous memoir by the author of Musicophilia and The Man Who Mistook His Wife for a Hat.
Coming May 2015
Also available from Random House Audio
Jacket image: TK
Jacket design by Chip Kidd
Alfred A. Knopf, Publisher, New York
(Pre-order) Purchase from: Amazon | Barnes and Noble

On The Move: A Life

When Oliver Sacks was twelve years old, a perceptive schoolmaster wrote in his report: “Sacks will go far, if he does not go too far.” It is now abundantly clear that Sacks has never stopped going. From its opening pages on his youthful obsession with motorcycles and speed, On the Move is infused with his restless energy. As he recounts his experiences as a young neurologist in the early 1960s, first in California, where he struggled with drug addiction and then in New York, where he discovered a long forgotten illness in the back wards of a chronic hospital, we see how his engagement with patients comes to define his life.
With unbridled honesty and humor, Sacks shows us that the same energy that drives his physical passions—weightlifting and swimming—also drives his cerebral passions. He writes about his love affairs, both romantic and intellectual; his guilt over leaving his family to come to America; his bond with his schizophrenic brother; and the writers and scientists—Thom Gunn, A.R. Luria, W.H. Auden, Gerald M. Edelman, Francis Crick—who influenced him. On the Move is the story of a brilliantly unconventional physician and writer—and of the man who has illuminated the many ways that the brain makes us human.
Oliver Sacks is a practicing physician and the author of twelve books, including The Mind’s Eye, Musicophilia, The Man Who Mistook His Wife for a Hat, and Awakenings (which inspired the Oscar-nominated film). He lives in New York City, where he is a professor of neurology at the NYU School of Medicine.
Oliver Sack’s An Anthropologist on Mars, Awakenings, Hallucinations, The Island of the Colorblind, The Mind’s Eye, Musicophilia, Seeing Voices, and Uncle Tungsten are available in Vintage paperback, as is Vintage Sacks, a collection of his finest work.


【書評:薩克斯不會停下來】文/周達智 (tc)

全文看:https://goo.gl/8KigoY

//薩克斯自傳以 "On The Move” 為題明志,取自友人 Thom Dunn 同名詩作,首次披露私人生活。絕少讀者猜得出,封面像香煙廣告模特兒的美男子,就是大鬍子醫生。筆者問過幾位朋友,全未聽說過薩克斯是同性戀者;更難想像,一生投身腦科學的紐約大學教授,當年曾沉迷健身,創下深蹲舉重 600 磅的加州紀錄。身在嬉皮士年代的加州,腦科學家不諱言經常進行精神科藥物實驗,曾有四年廢寢忘食,「被腦部的快感中心操縱」。薩克斯自言「大情大性,為一切愛好投入激烈的熱情,絕不保留」,青春的狂燄曾經燃燒過甚麼,相信自傳難以盡錄。//


//大鬍子薩克斯醫生 Oliver Sacks 著作等身,以敏銳的筆觸和深邃的關懷,重現神經心理學案例中每一個人的生命和思想世界,揭示大腦和思維之間的奧秘,成為家傳戶曉的暢銷書作者及腦科學家。如今滿臉祥和,受千萬讀者愛戴的他,自少嚮往到處闖盪的自由和力拔山河的強壯。那位愛在週未換上黑色皮褸,讓「地獄天使」車黨也視為一伙的年青醫生,18 歲前往牛津就讀前換來第一部鐵騎;試車時老爺車突然鎖起油門,才知道掣動器也失修。他寧願沿途高呼讓路,在敦倫的攝政公園繞圈至燃油秏盡,也不肯將車拉倒停下來。//

wikipedia
奧利佛·薩克斯Oliver Sacks,1933年7月9日),英國倫敦著名生物學家腦神經學家作家業餘化學家。他根據他對病人的觀察,而寫了好幾本暢鍚書。他側重於跟隨19世紀傳統的「臨床軼事」,文學風格式的非正式病歷。他最喜愛的例子為盧力亞著作的記憶大師的心靈
他在牛津大學王后學院學醫,後到美國加州大學洛杉磯分校神經科執業,1965年移居紐約,從醫並教書。他在愛因斯坦醫學院擔任臨床腦神經教授、紐約大學醫學院擔任腦神經科客座教授及為安貧小姊妹會擔任顧問腦神經專家。
薩克斯只在他的病例中記述少量的臨床數據,主要集中在病人的經歷上(其中一個病例為他本人)。其中許多病例均無法治癒或接近無法醫治,但病人會以不同方式改變他們的病情。
他最著名的著作——《睡人》(Awakenings,後來改編為同名電影無語問蒼天)講述了他在多名1920年代的昏睡病嗜眠性腦炎病人身上試用新葯左旋多巴的經歷。這同樣是英國電視連續劇Discovery首集的主題。
他的另一本書描述柏金遜症的各種影響以及杜雷特症的個案。《錯把帽子當太太的人》是描述一位視覺辨識不能症狀的人(此病例是1987年麥可·尼曼創作的歌劇的主題),《火星上的人類學家》是關於天寶·葛蘭汀(一位高功能自閉症的教授)的描述。薩克斯的著作被翻譯成包括中文在內的21種語言。

作品列表[編輯]

  • 《偏頭痛》(Migraine) (1970年)
  • 《睡人》(Awakenings) (1973年);范昱峰譯(1998年)台北:時報文化,ISBN 957-13-2757-3
  • 《單腳站立》(A leg to stand on) (1984年) (薩克斯在一場意外後無法控制自己雙腳的經歷)
  • 錯把太太當帽子的人》(The Man Who Mistook His Wife for a Hat) (1985年);孫秀惠譯 (1996年),台北:天下文化。
  • 《看得見的聲音》 (1989年) (Deaf culture and sign language)
  • 《火星上的人類學家》(Anthropologist on Mars) (1995年); 趙永芬譯,台北:天下文化。
  • 《色盲島》(The Island of the colorblind) (1997年) (一個島嶼社群上的先天性完全色盲);黃秀如譯(1999年),台北:時報文化。
  • 《鎢絲舅舅─少年奧立佛.薩克斯的化學愛戀》(2001年);廖月娟譯(2003年)台北:時報文化。
  • Oaxaca Journal (2002年)
  • 《腦袋裝了2000齣歌劇的人》(Musicophilia: Tales of Music and the Brain)(2008年)廖月娟譯,台北:天下文化
  • 《看得見的盲人》(The Mind's Eye) (2012年) 廖月娟譯,台北:天下文化

外部連結[編輯]


奧利佛·薩克斯的個人網頁 (英語)
奧利佛·薩克斯的支持者的網頁 (英語)
The Fully Immersive Mind of Oliver Sacks於Wired 10.04


這本書的中文本【鎢絲舅舅】似乎受忽視......

“I had intended, towards the end of 1997, to write a book on aging, but then found myself flying in the opposite direction, thinking of youth, and my own partly war-dominated, partly chemistry-dominated youth, in particular, and the enormous scientific family I had grown up in. No book has caused me more pain, or given me more fun, than writing Uncle T.–or, finally, such a sense of coming-to-terms with life, and reconciliation and catharsis.”
-- Oliver Sacks on "Uncle Tungsten"

Long before Oliver Sacks became a distinguished neurologist and bestselling writer, he was a small English boy fascinated by metals–also by chemical reactions (the louder and smellier the better), photography, squids and cuttlefish, H.G. Wells, and the periodic table. In this endlessly charming and eloquent memoir, the author of The Man Who Mistook His Wife for a Hat and Awakenings chronicles his love affair with science and the magnificently odd and sometimes harrowing childhood in which that love affair unfolded. In Uncle Tungsten we meet Sacks’ extraordinary family, from his surgeon mother (who introduces the fourteen-year-old Oliver to the art of human dissection) and his father, a family doctor who imbues in his son an early enthusiasm for housecalls, to his “Uncle Tungsten,” whose factory produces tungsten-filament lightbulbs. We follow the young Oliver as he is exiled at the age of six to a grim, sadistic boarding school to escape the London Blitz, and later watch as he sets about passionately reliving the exploits of his chemical heroes–in his own home laboratory. Uncle Tungsten is a crystalline view of a brilliant young mind springing to life, a story of growing up which is by turns elegiac, comic, and wistful, full of the electrifying joy of discovery. Read an excerpt here: http://ow.ly/yhxCT

相片:“I had intended, towards the end of 1997, to write a book on aging, but then found myself flying in the opposite direction, thinking of youth, and my own partly war-dominated, partly chemistry-dominated youth, in particular, and the enormous scientific family I had grown up in. No book has caused me more pain, or given me more fun, than writing Uncle T.–or, finally, such a sense of coming-to-terms with life, and reconciliation and catharsis.”
-- Oliver Sacks on "Uncle Tungsten"

Long before Oliver Sacks became a distinguished neurologist and bestselling writer, he was a small English boy fascinated by metals–also by chemical reactions (the louder and smellier the better), photography, squids and cuttlefish, H.G. Wells, and the periodic table. In this endlessly charming and eloquent memoir, the author of The Man Who Mistook His Wife for a Hat and Awakenings chronicles his love affair with science and the magnificently odd and sometimes harrowing childhood in which that love affair unfolded. In Uncle Tungsten we meet Sacks’ extraordinary family, from his surgeon mother (who introduces the fourteen-year-old Oliver to the art of human dissection) and his father, a family doctor who imbues in his son an early enthusiasm for housecalls, to his “Uncle Tungsten,” whose factory produces tungsten-filament lightbulbs. We follow the young Oliver as he is exiled at the age of six to a grim, sadistic boarding school to escape the London Blitz, and later watch as he sets about passionately reliving the exploits of his chemical heroes–in his own home laboratory. Uncle Tungsten is a crystalline view of a brilliant young mind springing to life, a story of growing up which is by turns elegiac, comic, and wistful, full of the electrifying joy of discovery. Read an excerpt here: http://ow.ly/yhxCT


"My own first love was biology. I spent a great part of my adolescence in the Natural History museum in London (and I still go to the Botanic Garden almost every day, and to the Zoo every Monday). The sense of diversity—of the wonder of innumerable forms of life—has always thrilled me beyond anything else."
-- Oliver Sacks

Dubbed “the poet laureate of medicine” by The New York Times, Oliver Sacks is a practicing neurologist and a mesmerizing storyteller. His empathetic accounts of his patients’s lives—and wrily observed narratives of his own—convey both the extreme borderlands of human experience and the miracles of ordinary seeing, speaking, hearing, thinking, and feeling. Vintage Sacks includes the introduction and case study “Rose R.” from Awakenings (the book that inspired the Oscar-nominated movie), as well as “A Deaf World” from Seeing Voices; “The Visions of Hildegard” from Migraine; excerpts from “Island Hopping” and “Pingelap” from The Island of the Colorblind; “A Surgeon’s Life” from An Anthropologist on Mars; and two chapters from Sacks’s acclaimed memoir Uncle Tungsten.

相片:"My own first love was biology. I spent a great part of my adolescence in the Natural History museum in London (and I still go to the Botanic Garden almost every day, and to the Zoo every Monday). The sense of diversity—of the wonder of innumerable forms of life—has always thrilled me beyond anything else." 
-- Oliver Sacks

Dubbed “the poet laureate of medicine” by The New York Times, Oliver Sacks is a practicing neurologist and a mesmerizing storyteller. His empathetic accounts of his patients’s lives—and wrily observed narratives of his own—convey both the extreme borderlands of human experience and the miracles of ordinary seeing, speaking, hearing, thinking, and feeling. Vintage Sacks includes the introduction and case study “Rose R.” from Awakenings (the book that inspired the Oscar-nominated movie), as well as “A Deaf World” from Seeing Voices; “The Visions of Hildegard” from Migraine; excerpts from “Island Hopping” and “Pingelap” from The Island of the Colorblind; “A Surgeon’s Life” from An Anthropologist on Mars; and two chapters from Sacks’s acclaimed memoir Uncle Tungsten.

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