Encephal-in-Silence: Dr. Oliver Sacks

0:15 Oh, hey there. Oh, hey there. How's it going today? Good. How are you? I'm good. We're the History Buffoons. And I'm Kate. And I am Bradley. Welcome. To another History of Buffoons. I don't know why I said that. We just went over that. My bad. How are you today? Pretty good. It's been a really, really, really busy week. You had said that, yeah. You had a lot going on with work and everything. So I picked up an additional class to teach and I'm starting a new class next week. Which will be good. Yeah, I'm excited. Um, I get to work with a lot of cool people. Excuse me, which is great. Yeah. Makes it a lot better.

0:56 Yeah. How was your week? It was it was okay. Um, nothing super ridiculous, I guess. I there's this meat store I told you about. Uh, so we went there last week and then Xavier and I went there again yesterday. So he was excited. Good. He's been super uh about dad lately, which I love. So that's been great. Uh Vespers hit or miss. Because you know, she's Vesper. Yeah. But overall, no, it was it was an alright week, I guess. Okay. So it was snowy this morning, and that made work really difficult. Yeah. Yeah. Well, I have a disclaimer um to start our story off before we get into what we're drinking.

1:40 I love disclaimers. Um, it's an important disclaimer, so as not to get confused with real life. Okay. This is um a story that centers on a guy named Leonard. Leonard. And he is a patient featured in Dr. Oliver Sachs's book, Awakenings. Okay. Leonard is not a single historical figure person. He is a composite character. Gotcha. Um, and he is a narrative combination of many real life people that um Dr.

2:22 Sachs treated um during um a certain period of time in the late 1960s. Okay. So when I'm going to talk about every medical event, every psychological reaction and uh dilemma described in Leonard's story is based on documented real life cases. Okay. Um, Dr. Sachs used composites like Leonard to protect um patient confidentiality. Which makes sense. Yes, exactly. So some of the names and narrative details might be reconstructed, um, but Leonard's um story reflects like the scientific and human aspect of Dr. Sachs's story. Awakenings, wasn't that a movie?

3:02 It was with Robin Williams and uh Robert Downey Jr. Oh yeah. I don't know if I've ever actually seen it. I have not. I did not watch it um while I researched this because I want I actually wanted to know if you would want to watch it at some point. Yeah, I'd definitely check that out because I remember I remember it, I know of it, but I'm almost a hundred percent sure I've never seen it. So Dr. Sex wrote the book and then he is portrayed as a different type of a different doctor in the movie. Like the names aren't the same. Well, and that's fine. So that was my disclaimer. It's based off the book. Yes. I always think it's funny, real quick. Sorry, that people like, oh, the book was better.

3:43 Well, yeah. I know there's more information. Yeah, you can make your own thing, and it's always based off the book, yeah. Or just like even off of that, this was based off of true events. Well, that didn't really happen. Yeah, because it's based off of it, and then they added shit for fucking Hollywood Flair, right? Idiots. Anyways, what are we drinking today? So I may have I bought a six-pack of this for the podcast. I may have drank five of them prior to recording. So I have a conglomerate. Not tonight, by the way. Not tonight, no. This is my uh first beer today. I lie, but anyways, um, so I have a new Sierra Nevada, it's Springfest IPA, and I will already tell you, I know it's delicious.

4:30 Yeah, but I do have backups. I got you uh I know of I've known of this beer for a long time. You've never had it. Um, I also have some myself, but I'll let you show it because it's for you. Yeah, so this is um from Britain. It is Bodington's Boddington's Boddingtons, thank you. Pub Ale. It is a pint and it has bees on it. I just noticed it's got bees on it. Yeah, I love bees on you. You like bees. It also has the like the widget thing in there or whatever. A widget thing? Do you hear that? Oh, yeah. So because of how it's it's like, yeah, it's it's it's a little bit different. I'll just say that. Oh, it says for best reserve results, serve cool but not ice cold.

5:14 I carefully open can, pour contents into a glass, wait and watch the head settle on a perfect glass of Boddington's pub ale. Oh no, should we get some pints? We should get some pints. Okay. Hold please, we'll be right back. And we're back. Hello, we got our pint glasses, so the beer can be properly poured. I think I'm just gonna pour mine with you so I can uh get it to settle properly. So tell me what the widget thingy So it helps with the pouring. So there's actually like something in the can that helps with the aeration and all that stuff, whatever. I'm making shit up as I go.

5:55 Oh, so that sounds legit. I know. It's it might be somewhat right, but I don't know if that's totally right. But this is difficult work over a computer. Well, don't spill it. Thank you. I'm here for moral support. That is a nice pour. So do you hear that there's actually something in the can? Yeah. Um, so Guinness. Yeah, Guinness has that too. Yeah, I did I yeah, I knew that one. Yeah, so it's just it's the same concept, really. So helps with the pour and the whatnot. Let's cut a can open later. It doesn't come out with the pour, it's too big for the hole. That makes sense.

6:36 Yeah. Let's cut a can open later. I'm down. Because I've never actually seen one in person. I thought they were mythical creatures. For science. For science. Beer drinking for science. Okay, so I'm gonna crack my Sierra Nevada and then I'll go to the bottom tens. Cheers! Cheers! I'm curious to what you think about this. So yeah, what kind of beer is it? I didn't even It's a pub ale. A pub ale. Okay, that's an actual kind. Okay. It's good. With a side of Honestly, I feel like it needs to be colder. See, so is that weird?

7:17 No. I like my beer ice cold. Yeah. And I mean, this has been in your fridge. I gave it to you last week for this episode. Yeah. And um it's funny, so when I went to Germany for Oktoberfest, and everyone's like I already know what's coming out of your mouth, and I'm shivering. What? They don't serve it cold, do they? No, no, everyone told me it's not as cold, it's not as cold. I had plenty of cold beer there. Oh, did you? I did. Oh, okay. It might not be like fucking ice cold like we drink it here mostly, at least in Wisconsin. Yeah, but it was cold. That's good. So I had uh Franziskoner on tap at the Zuntigite.

7:58 Thank you. That was German. I know. You know, talking about Germany. Yeah, but it's funny. I had it in Germany at an Italian restaurant that was attached to our hotel. And they had this the best, and I'm you know, I I've told you I'm not a huge spaghetti noodle fan. They had the best spaghetti bul Bologniers, how is that how you say it? Bolognese, yeah. Um, and the chick who worked there, her name was Melisa, was very nice to look at. So I'm so happy for you. Yeah, I was too. I say that with me, my buddy who we went with, he was all about her. Because I think he was he was single at the time, so it was pretty funny.

8:40 But anyways, I'm very happy for you. Okay, fair enough. Okay, so let's get into Leonard and Dr. Oliver Sachs. Okay. Okay, so Leonard was um a bright man growing up in the 1920s until an epidemic changed his life. 1920s, okay. In his late teens, Leonard contracted encephalitis lethargica, okay, which is the sleeping sickness. Oh no. Yes, just makes you want to sleep. Oh, I will get into it. And this was actually kind of a worldwide outbreak during uh the first world war. Oh, okay.

9:20 So encephalitis lethargica swept across Europe and North America between 1916 and the late 1920s. Wow. It wasn't dramatic, it wasn't quick, it was slow and really creepy. Okay. Patients slipped into extreme lethargy, sometimes sleeping 20 hours a day, drifting in and out of consciousness. Oh Lord. Others developed delirium, um, eye paralysis, personality changes, and sudden violent movements. Oh, Jesus. The cause was never definitively identified. Okay. What made encephalitis lethargica horrifying was what came after.

10:05 After you had it? Yes. So many survivors appeared to recover. Okay. Only to develop severe neurological problems years later, sometimes even decades later. Oh wow. So it was like a slow roll. Yeah. So they would have the initial onset get better, and then years and years later, they would have post-encephalit encephalitis syndrome. Oh shit. So what did that entail? So um what they would include, what they would get would be like Parkinson's like rigidity, tremors, frozen facial expressions, and a really creepy in inability to move.

10:47 Oh, that would suck. These patients were mentally present, but physically they looked locked in place. Okay. Sometimes for decades. Oh, so they were just like a statue. That's fucking weird. People were stuck between sleeping and awake, motion and motion and paralysis, time and oblivion. Um, they're like I said, it was just it as soon as encephalitis lethargica showed up, it was gone. There was no explanation, no weird ending, no Right. So, do you remember when you were a kid when when k other kids would tell you stories or like made up shit?

11:27 But they say, No, I swear to God, that's real. What you just said reminded me of one that I uh remember hearing a long time ago. There was a supposedly this guy who took acid and tripped so hard that he like had a some type of mental break or whatever, and he thought he was a glass of orange juice and couldn't move because otherwise he would spill. Wow. So that just reminded me of that for some reason. Interesting. Yeah, I don't know if it's true, but I'd like to believe it is. Yeah. Because that would be fucking weird. So, like many survivors, Leonard went through this encephalitis lethargica.

12:07 Okay. And then recovered only to develop post-encephalitic syndrome years later. How many years later did he so now we're talking into his 30s? Um, Leonard he was 16 at the time, you said, right? Is that right? Um, he was he was he grew up in the 1920s when the outbreak was was full force. Oh, okay. It happened in the 19 in 1916. Oh, maybe that's where I was in 2020. Yeah, that's right. Sorry. Um, so by his 30s, Leonard was locked inside a near motionless body. He was conscious and aware, but not fully awake.

12:49 So could they talk or no? They were just they were speechless, motionless, they lacked energy or even motivation to do anything. Well, because they couldn't. Doctors described him and others like him as transfixed, motionless in a sort of trance for decades, giving up as like hopeless cases. And they were just in the hospital for decades. Like on a bed? Yeah. So how did they get food? I'm assuming they had like you should never assume. Probably like tubes, feeding tubes, you know. Think so? Probably like IVs and all that for liquids and stuff. Because like your body would just deteriorate.

13:30 Wouldn't his muscles just fucking completely break down? Yeah. Oh, that would suck. Yeah. So during these decades, Leonard could register events around him with his eyes. Um, he had Parkinson like uh symptoms, the tremors, muscle rigidity, and the inability to initiate movement. Um, the the epidemic's after effects resembled Parkinson's disease so much that neurologists suspected a link in the brain's dopamine system. Okay. By the 1950s, Leonard had deteriorated to a state of uh extreme echinesia. He could not voluntarily speak or move and was as passive as a zombie.

14:15 Wow. Have they met a zombie to be able to compare that to? They've heard they've read stories. I believe those are science fiction. The one tiny outlet um of will that he retained was the ability to write in micro script on a small slate board, spelling out one letter at a time. But what is micro script? Like he very little movements. Okay. So literally that's what it sounds like. Yeah. How did they read it if it was so small? So Benny didn't take the time. Okay. So over 15 years before 1969, Leonard was essentially mute and immobile, communicated only by slowly tracing out words on that slate.

15:03 Each letter would take nearly a minute. Wow. So most hospital staff would lose patience and limit their questions to simple yes or no. Isn't it funny how they would lose patients? I mean, they're supposed to take care of their patients, not lose them. Just saying, uh cat here. Well, it we are in your house, it's everywhere. Yeah, it really is. There it is. There it is. Dr. Oliver Sacks, however, intersex treated Leonard as fully present. Well, good for him. Way to be like progressive in this shitty world where everyone's just like, fuck you, dude, just I'm moving on.

15:45 So my initial um research was all about Dr. Oliver Sacks. And it was so there's so much information, I was overloaded for a good several days. Yeah. And rewrote the story and rewrote the story and rewrote the story until I found Leonard. Leonard. Yeah. So okay, so um Sacks would sit for hours if necessary, gently asking open-ended questions. Okay. Like, how are you? Or what is it like being the way you are, waiting patiently for Leonard to answer. And would he? Yes, he would. So how so he just he had little movement in his hand then?

16:30 That's all it was. Yeah. Why do you this is I didn't say this is in your research or anything, you personally. Why was the hand so mobile but everything else was not? I don't know. Doesn't that seem weird? I don't know. Okay. We should watch the movie. Great insight. Yeah, you're welcome. All right. But this patience between doctor and patient formed a really deep bond between the two. Um, but through these slow, effortful conversations, Leonard revealed the rich inner life trapped within his frozen body. Okay.

17:10 When Dr. Sachs first asked him what it felt like to be in this state, Leonard spelled out a single word. Caged. Sure. I mean, yeah, you're you're trapped in a meat cage. He then added deprived and then eluded a cat pacing in endless mute circles inside of a cage, like what you see at the zoo, which I hate. Just back and forth and back and forth. That's just what they do though. I know, but there's no stimulation. Yeah, there is. Sometimes they have a ball. You make it seem like they're in like a 1930s fucking zoo. I think of like the beginning of the Peter Jackson King Kong where they show a zoo where they're all it's terrible.

17:56 Yeah. That's not how they are these days. They're they're actually don't get me wrong, there's shit that happens, but they're well taken care of. So Leonard said um, the absence is a terrible isolation and coldness and shrinking more than you can imagine. A bottomless darkness and unreality. So despite his blankness, Leonard was fully aware of his condition and its despair. Um, he said, I am still alive inside, um, alive, but like entombed in a body that can't obey. Yeah. Now, again, Leonard is a conglomeration of multiple people.

18:36 Yes. So um written in a story type format. Right, just to kind of get it out, whatever. So we'll just talk about Leonard because that's what we're talking about. But so like he could see, though. Is that one thing you said? I think so. Could see. I think there is some people with eye paralysis. Okay, you did mention that. That's right. Okay. Cause could you oh my god, excuse me. Could you imagine not being able to see? Even if you're just laying there, I'd rather stare at a ceiling than nothing than black. Yeah. Because like if I ever had to lose a sense, the one I never want to lose is my sight. Yeah. I wear glasses, but you know, I could never lose my sight because it'd be like that would be awful.

19:20 So I feel I I feel I'm sure I know they make it work and everything. Anyone who's blind, good for them. But man, I could not do that. That would that would break me in half. So I couldn't imagine. Anyways. Yeah. Yeah. So Dr. Sachs confirmed a long suspicion that he had through Leonard and dozens of other patients at the Bronx Hospital, which is where they were. They appeared hopeless, but their minds were very much intact and yearning to reconnect with the world. Okay. So Sachs later wrote that other physicians had dismissed such post encephaletic. Patients as living statues beyond help, but he sensed that they still had life in them.

20:06 Well, I mean, yeah, they were still alive. Yes. So. Leonard's own words demonstrated the real and full presence of the patient is still there behind the mask, and this understanding set the stage for an experiment that would test whether that caged life could be freed. Okay. By the late 1960s, researchers had discovered that Parkinsonian disorders involve a deficit of dopamine in the brain, and a new drug, Levo Levodopa, which we call L-Dopa. L Dopa. Mm-hmm. Could restore this neurotransmitter. Sounds like a drug from Mexico.

20:47 La DOPA. Hey, you got any of that? L'OPA, man? I'm looking for some. Earlier trialers in typical Parkinson's disease showed promising reversals of rigidity and tremors when high doses were given gradually. Okay. Okay. So Dr. Sachs wondered could L DOPA awaken these post-encephalytic patients who had been frozen for decades. Okay. Okay. He hesitated and thought about it for about two years before he did anything. It took him a while. Which I mean, I guess. Yeah, you don't jump into something like that lately. Well, okay.

21:27 What? A lot of people do. Mm-hmm. You know. I'll just stop there though. Lower doses were useless, but higher doses might have unpredictable effects. So how did they know lower doses were useless? And did they try it? Because with the Parkinson's, they needed high doses. And they linked the two with the dopamine in the brain. Okay. Okay. In the summer of 1969, Sachs obtained permission to administer Lodopa to a small group of these patients at the Beth Abraham Hospital in the Bronx. Oh. Leonard, then in his late 40s, was chosen as one of the first candidates.

22:08 Nice. The drug was introduced slowly and carefully with Sachs monitoring any sign of change. How did they administer it? Was it like in an IV or do you not know? I do that. For the first time in decades, something other than the illness was acting on Leonard's brain. Within days, like within a week, like less than a week, of reaching a therapeutic Ladopa dose, Leonard's transformation became dramatic. Oh, okay. Sachs saw this man who had been speechless and incapable of voluntary motion suddenly opened his eyes to the world and came fully alive.

22:55 How so? It was as if a sleeping soul had re-entered his body. Leonard woke up with his old personality intact, astonishing everyone around him. That would kind of be freaky. A little bit. Nurses who had ever known him as a silent statue now heard him speak in a clear voice. Oh, so he could speak right away? He could stand up and walk fairly steadily down the halls, at first tentatively, and then with more growing confidence. Okay, so how how could he do that when he was laying in bed for eight 18 plus years or whatever? I mean, maybe they had some kind of program to like help move his body, because I mean loved ones do that with people in comas, and I mean I get that, but like they didn't even want to wait a minute for him to write a letter, let alone move his legs and whatever.

23:45 But even with that movement, that much time, I can't imagine you're building muscle mass. I mean, your muscles are gonna atrophy. Yeah. And how the fuck, like, I'm a new man. Yeah. It's like I'm a real boy. I'm a real girl. Shout out. So decades old skills and habits returned almost overnight. Okay. One morning, Leonard strolled over to the piano that was in the ward and began to began to play familiar tunes. Other patients in the La Dopa trial experienced similar awakenings. Immobile bodies became animated. Faces that had been masked like broke into smiles, and the ward was excited conversation and laughter for the first time.

24:30 So did they have them like in a separate wing type thing or their own little ward? I I didn't look into where in the hospital they were. Were they peppered in with the other patients? I'm sure they're all together. United. United in silence together. United in silence. In encephalitis, right? That's the right word. Encephalosilus. Encephalitis. Encephalence? That's the one. That's the title. As one observer put it, it was much like witnessing magic. Even sex, a neurologist trained in objective science, described the drug's effect as the uncanny lifting of blockage and the return of ease of grace, of joy, and delight and resolve.

25:18 And that's from the El Dopa. Yes. Okay. So with that being so this happened, you said around World War One. Right? The original epidemic. Someone didn't turn their phone off. Who calls me this late? Potential spam. Fuck you, Spam. And your potentialness. It's almost eight o'clock. Like they don't stop calling me. Potential spam does not have a fucking clock. So they're working hard around it. Anyways, thanks, Potential Spam, for fucking cutting me off and losing what I was gonna say.

26:02 Um, what was I gonna say? I don't know. Words. Fuck, what the hell was I just talking about? Fuck you, spam. But I don't even like spam. Okay. So for Leonard, the emotional impact of awakening was as profound as the medical change. Sachs later wrote that Leonard felt like you know, yes, Bradley. I remember what I did. That's okay. Go ahead. So I'm gonna drink. This the original thing happened around World War One. This is something like could this still happen today? I guess. I don't think encephalitis is around. No, so they killed it? No, it just disappeared. It went to the moon? Something.

26:42 Mars. Aliens came and took it. I don't know. It's like, oh, we've been looking for it. It just showed up and then it disappeared. There was no, there was no like where it came from, no idea. No idea where it went. I bet it was aliens. Extraterrestrial, hands down. Yeah. I mean, that's my favorite conspiracy theory, so I mean, okay, so it just disappeared. Yes. Could you imagine if it just came back? So I guess not. I just looked it up because you know, I was guessing. Yeah, like that's what you do. So encephalitis is inflammation of the brain.

27:22 Yeah. Usually caused by viral infections. Okay. Okay, it's not like back in World War I, they didn't know what it was. Right. Um so they could treat it now if if it happened, basically. Okay. So let me talk about okay. So that was encephalitis. Encephalitis encephalitis lethargica. Yeah. Um was something different. It has not returned. Okay. Yeah. That's so crazy. There was no clear cause. And no reason why it left. Um, some research researchers think it may have been triggered by an immune response late related to the 1918 flu, but that's all speculative.

28:02 Is that the Spanish flu? Is that what they call that one? Maybe. Is that that? Yeah. That's I mean, I know it was around then. Yeah. So yeah. So encephalitis is around encephalitis lethargica is not. Gotcha. So there is a significant difference between the two. Okay, I see. Gotcha. Okay. So Saks later wrote that Leonard felt like a man released from entombment. Yeah. Reborn into the world. Um, he sax asked, What are your feelings? And Leonard's reply verbally, I have been hungry and yearning all my life, and now I am full.

28:44 I feel saved. I feel like a man in love. I have broken through the barriers which cut me off from love. How much back taxes do you think he has to pay at this point? Good question. Because he has not been paying his taxes. So, and and again, I know this is a conglomerate of pers of people. Yeah. So I don't know if you came across this when you're looking up any of this stuff, but like any of these people that they have loved ones that just abandoned them basically and said, Well, he's in the hospital, or she's in the hospital, whatever. Like, how do you think that went? Yeah. Because, like, I mean, there's some really good people in this world, and they'd be like, I'm with you, and they would go and help move their muscles and stuff, whatever, or read them a book, or whatever the fuck it would be, like people doing comas and stuff, whatever.

29:37 But like that would be really tough. That would be really tough. Because it's like, I can't interact with you. I mean, I'm a big interaction person, I interact with people all every day with my job and everything. So um I don't know. I just I can imagine if there were people with significant others, children, whatever it was, family members, that they just kind of faded away. Like, well, it's a lost cause, let's move on with our life, which would be really shitty to wake up to if you awoke, obviously. Because I can't imagine every single one worked, right? Um, from what I understand, most of them did.

30:19 Oh, wow. But there is a caveat. Oh. Okay, which I will get into. So Leonard spoke with vitality. Decades of pent-up thoughts and emotions came rushing out. He wanted to read every newspaper, every book he had missed. He wanted to listen to music and talk to everyone. Um, Sack said he his predominant feelings at this time were feelings of freedom, openness, and exchange with the world. Okay. So Leonard's entire demeanor was full of happiness. Um, he said happiness that he had not felt for 30 years. 30 years. That's insane. Yeah.

30:59 And his life was given back to him within a week of this trial. Wow. Family members who visited Leonard were astonished, were overjoyed. I don't know if they were visiting him up until the awakening or after the awakening. Or if there's like, hey, uh he's up awake now. Yes. He's up. He's using the the loo right now, but you know. Right. I had to speak in British because we got so this man they remembered that they remember this man from before the the um ill illness. Yeah. Witty, articulate, and loving. Yeah. And it seemed like he came right back as such.

31:39 Huh. Yes. Well, I mean, you would think he wouldn't lose the person he was, right? Because he he really didn't have a lot of influences to change him. Right. You had the doctors and the the nurses and everything that interacted with you, but at that point you have nothing really to alter your personality because you're just stuck inside. Yeah. So I mean, you would think he would be the same person. At least I would think he'd be the same person, but okay. So after the initial euphoria settled, he had to face more of a psychological shock of the lost time. Well, yeah. I mean, he lost how so how long again? He was in there for 30 years.

32:21 And how old is he at this point, roughly? I know I think he was in his 40s. Okay. So he so um the technology, the culture, the city around him were all unfamiliar because he went in in the like 20s or 30s. It's kind of like when Captain America woke up at the end of the first Avenger, Captain America, first Avenger movie. He's like, what the fuck? He realized he was no longer the young man who fell ill, but a middle-aged patient who has spent the better of his life in a hospital. So did they have to shave him all the time? Yes. How how did they how did they know he didn't want a beard?

33:01 Oh my god, Bradley, the questions. Wouldn't it be great though? It's like, let's see how long I can get. Oh, Jesus. Right? Wouldn't that be awesome? It's like fucking Gandalf over here. Okay, so Dr. Sex and the staff gently helped Leonard begin orient um orienting to modern life in 1969. Yeah, showing him contemporary newspapers, television, and explaining events that had transpired. That's yeah, is that the year we went to the moon? 69, right? Was it 68? I think it was 69. Okay. Um, could you imagine waking up after like 30 years and like, holy fuck, we're going to the moon. Yeah.

33:41 When did that happen? It's like, how do we get there? So Leonard met younger patients and nurses and was amazed and sometimes dismayed by how much he had missed. Um the adjustment raised a question: how do you pick up the threads of a life delayed for decades? So Leonard himself felt as if he was still a 20-year-old that he had been when the illness first struck. So, besides obviously his physical form being aged, I mean you're gonna have some limitations because of that. But your mind is set back then for more or less, even though he was conscious, I guess, but like stuck in his head.

34:25 Yeah. That's a good thing though. I mean, your body might not move as nimble as it used to. I know fuck mine doesn't. I'm 46, so but uh I would imagine that's gotta help a little bit with that young youth mindset, I guess I guess is what I'm trying to say. Yeah. So so one of his fellow awakened patients, Rose, um, could not bridge the gap at all. Having fallen ill in 1926 at age 21, she awoke in 1969 to find her world of 2019 had vanished and remained permanently in the past.

35:06 The shock was so great that Rose stopped responding to L Dopa almost as if she chose to retreat rather than face an incomprehensible new reality. That's so wild that you would choose that over trying to overcome that. I mean, I understand what you're saying, but fuck that, man. So Leonard coped better than Rose, but the awakening brought as much sorrow as joy. France's own age had grown old or died, and the world had moved on without him. Yeah, the emotional term oil underscored an ethical dilemma for sex, as it was entirely merciful to reverse time for such patients, or were they being burdened with grief and confusion along this renewed life?

35:51 Yeah. I literally put it on silent. I swear to God, I put it on silent. It's literally on silent. Alarms transcend silence. It sure did. Yeah. No, I know they do. It's time to take pills. Because if you if you had your phone on silent and set an alarm, you would be fucked in the morning. So yeah. Yeah. Yeah. Anywho. So, my apologies. It's all right. So, Sachs approached this personal implication of the experiment with a lot of sensitivity. He understood that treating these patients required far more than giving them just a new drug. Okay. It required psychological support, patients, and reorienting them gently into a changed world.

36:37 So at the same time, Leonard embraced his second chance with determination. In the weeks following his awakening, he kept a notebook, effectively an autobiography, to record memories of his childhood and the feet feelings coursing through him. He spent time outdoors in the hospital garden, marveling at simple pleasures like sunshine and fresh air on his skin. Grass. I mean, shit. That would be amazing. Um, Leonard also struggled with regaining autonomy after so long as a dependent patient. Sure. As he grew uh stronger, he chafed against the hospital's rules and the realization that he was still viewed as an invalid. Um, in Sach's account, Leonard began to desire the freedom to come and go as he pleases, even agitating to be discharged despite still needing medical supervision.

37:27 Right. So this created friction with the hospital administration, further questioning more ethical questions. Um, how much freedom should someone in Leonard's situation have, and what kind of life could he leave outside the ward given his unique condition? So who who paid for them to stay there this whole time? I'm sure they didn't have insurance. Isn't that wild to think about? Yeah. I am not a fan of the medical world. The government? That too. Oh, wait, yeah. Maybe they did. Sachs had to balance Leonard's newfound willpower and desires with practical concerns for his safety and his health.

38:08 Okay. The personal implications of Leonard's awakening were complex. It was not just a medical triumph, but the revival of a full human being with hopes, rights, and emotions. Right. About a month and a half after his awakening, Leonard's rebirth continued to be celebratory, but then roughly six weeks into treatment, the La Dopa effects started fleeting. Oh no. So it had like a shelf life kind of, if you will. So did he start like it's like, oh doc, I can't move my left arm. Doc, I can't move both my arms. Almost. So Leonard, who had been taking steadily increasing doses, suddenly began to develop a drastic sensitivity to the drug.

38:56 And early August of 1969, he started showing some new symptoms. Slight facial ticks at first, which progressed to jerky movements of his arms and legs that he could not control. Like the Parkinson's thing you were talking about. Okay. Each day Leonard oscillated between periods of normal movement and bouts of irresistible restlessness. He would pace the corridors for hours, unable to sit still, then swing to the extreme opposite where he would freeze up rigid and blocked again. Sex was alarmed to see that Leonard once his once smooth recovery had become such a roller coaster of involuntary behaviors. Right, yeah.

39:36 Even when they tried lowering the dose, Leonard's system seemed to overreact to any LA dopa now. So as one account describes, six weeks later he developed exaggerated sensitivity to the drug, and even with tiny doses, doses had uncontrollable side effects. So basically, he was becoming almost immune to the L DOPA. He was now being Overstimulated in his brain. Oh, I see. Okay. With the dopamine um reactions. Gotcha. So Sachs and his team documented a range of side effects emerging, not just in Leonard, but across the all the awakened patients.

40:17 Right. Some of the adverse effects were physical. Patients developed jerking jerking ticks and even violent flinging motions of the limbs. Oh, Jesus. Episodes of eyes rolling upward into their head or fixed in places and other neurological disturbances. Oh boy. Other side effects were behavioral and psychological. Patients experienced surges of intense, intense emotion and impulse that they struggled to control. Sure. Some manifested as manic euphoria. Manic euphoria, okay. One deliriously happy patient exclaimed to Dr. Sachs, My blood is champagne.

40:58 What? So they just wanted to drink it, or? I have no idea. I mean that's he was just intoxicated on life. It was bubbly. In Leonard's case, the pendulum swung between elation and torment. Right. He began to feel overwhelmingly driven by desires that he had that he had been long suppressed. Like what? Um so his he it was basically his sexual appetite. Oh it spiked uncontrollably. He just wanted to go bang, bang, bang. According to Saks, Leonard became so sexually fixated and disinhibited that he injured his own genitals in frantic frustration.

41:38 So he was going to pound town with his right hand and oh my god, I yanked too hard. Yeah. That sounds terrible. Yeah. Um, his emotions swung wildly, if not euphoric, he was irritable or even despairing. On one occasion, overcome by the sense that he was losing control of himself. Leonard attempted to smother himself with a pillow. Oh Jesus. So he thought he was going back and he's like, I don't want to go back there. Yeah. So he's like, things are getting out of control. I can't control them, obviously. So the better alternative is to end it for myself because I can't go back there. Yeah. Wow. Oh wow. That's crazy. So Sacks found himself um with a heartbreaking reversal of what was happening.

42:22 The very freedom that Leonard had had been celebrating was becoming unbearable for him. Right. It was as though the floodgates of 30 years of pent-up energy had opened too wide. Sure. Sachs tried adjusting Leonard's dosage up and down, searching for a stable middle ground. The ward that had been full of joyful activity became a place of anxious vigilance as nurses watched for sudden outbursts or collapse. Yeah. Even more ethical questions loomed. How much aliveness was too much? Where is the line between treating disease and fundamentally alter fundamentally altering someone's personality?

43:05 Sachs wrote that awakenings became a kind of drama about dosage. Right. An examination of how much aliveness is tolerable and at what cost. Jesus Christ. His patients had to endure being human guinea pigs in uncharted territory. And Leonard's case, despite everyone's best effort, it became clear that his his high hopes could not be sustained. No. Over the late summer of 1969, Leonard's condition oscillated unpredictably. Some days he appeared nearly normal. On others, he was wrecked by tremors or lost in manic ramblings. His handwriting, once neat on the slate, though small, uh, deteriorated into scrolls during agitated phases.

43:50 Um, the precious gains like the fluid speech and the easy movement movements were starting to slip away bit by bit. The decline was devastating for Leonard and those who cared for him. And of course, Leonard was aware of what was happening. Well, yeah, I mean, kind of had to be, I'm sure, but fucking hell. In rare moments of lucidity, he expressed fear and grief that the darkness was closing in again. He remained intensely grateful for the time that he had been awake. Well, sure. He said, I've had a taste for life and it was beautiful. Yeah. Even as his hands began to shake and his voice grew halting, Leonard tried to reassure Sax that he did not regret the awakening, however brief.

44:34 Wow. So by the end of 1969, despite every adjustment and care, Leonard's doctors were forced to make a painful decision. They put him down. Not quite. Ladopa had to be discontinued. Oh boy. You say discontinued, but does they stopped administering it to him? Okay. The side effects and psychological turmoil turmoil were simply too injurious. As the drug tapered off, Leonard's wild swings and involuntary movements gradually subsided. Sure. But along with along with them went the vigor that El Doba had given him. Leonard regressed towards his former catatonic stage each day a little more.

45:15 Oh boy. And a little less responsive. Yeah. One morning, Leonard could no longer rise from his wheelchair. Another day he could no longer hold a pen. Oh, geez. Finally, one day he fell quietly silent once more. The living statue returned with Leonard trapped internally, just as before. Dr. Sachs reported these developments with profound sadness. All the awakened patients who had leapt back to life eventually returned to a catatonic state despite increasing doses of Lidopa. So it was just basically it was a uh what's the word I'm looking for? Temporary thing. It was temporary.

45:56 And it it was enough to get him to wake up, but it was a short-lived solution, I guess we'll call it. That's too bad. Leonard was the first to be awakened, and he was also the first to decline. Well, I mean, it makes sense because it sounded like there was a shelf life of the awakening, basically, is what that is. For Leonard's family and hospital staff, staff, the outcome was disheartening. Right. They had witnessed a beloved man essentially resurrect only to lose him again. Yeah. In the wake of Leonard's re-catonia, ketatonia. Ketatonia. Dr. Sachs and the team made every effort to keep him comfortable and to maintain human contact.

46:39 They discovered that although Leonard could no longer initiate speech or movement, he still remained reachable. How so? His mind was still there. Well, yeah, but how is he reachable? They could still talk to him. And he could still I'm sure he could still write. I didn't actually look into the writing part. But he was still there, he just couldn't move. So Leonard did manage a few written words um suggesting that some small part of El Dopa effect lingered. Yeah. Um, but more often though, he remained still. Um, and Leonard lived out the remainder of his years in the Bronx hospital, cared for by staff who knew the soul hidden within him.

47:26 He passed away in 1981, never having sustained another full awakening. So did they try again? I'm pretty sure they didn't. I mean, wouldn't you think like, and again, I am not a doctor of any stretch, nor do I want to be. So, late 60s, they do this. He goes back. Let him I don't I mean, I don't know how much time you let it pass, let that go through. You could have tried to awaken him again, right? If that was me, if Leonard was a single person, not a conglomerate, and that was me.

48:06 Go. Yeah. Try it again, dude. Even if it was for another month and a half. Yeah. You know, just put a cage on my hand so I don't go all whatever. So the immediate immediate medical verdict on L Dopa experiment was mixed. I'm sure. It was not the enduring cure that Sax was hoping to give his patients, but there was still gifts left in its wake. Yeah. Leonard's brief moments of freedom had allowed him to reconnect with his family. His mother and his niece visited often during his lucid period. Nice. And to say the things that had long been unsaid. Well, see, that could you imagine, like for a person being trapped in their body, how even if how brief that was that he was awake, being able to do that, love your mom, you know, yeah, whatever it might have been.

48:58 Yeah. Just to get that out, be like, sorry I wasn't there. It's like it's not his fault, obviously. But you know what I mean? I could I can only imagine what that would have meant to somebody like that. Yeah. So um, Leonard's brief um, oh, excuse me. Um, he had experienced love and laughter once again. And many of the other patients too retained some faint glimmer of responsiveness or simply the knowledge in whatever corner of their mind it recited that they truly lived again, however, brief. Dr. Sachs noted, although the physical awakenings were temporary, a deeper awakening occurred in the hospital community. Oh the doctors and nurses, having seen the people behind those long, unchanging faces, could never go back to regarding them as hopeless cases.

49:44 Well, see, that's good at least. They continued to treat the post-encephalatic um patients with greater empathy and dignity, knowing now that inside every frozen body was a human being longing for connection. Okay. In a sense, Leonard's personhood had been vindicated. He was and had has always been fully human, not a zombie. And he proved it, prove it, he proved it when given the chance. Yeah. So Leonard's story, as chronicled by Dr. Oliver Sachs in his book Awakenings, is inspiring but yet sobering. Ethically, it raised difficult questions that reverberate even today. Yeah. Sachs himself was initially astonished and shocked by how some of his medical colleagues reacted to these cases.

50:28 When he published a preliminary port report in 1970 detailing their miraculous but short-lived recoveries in 60 patients, many doctors refused to believe it or argued such a disillusioning story should never have been told. Okay. Perhaps it was more comforting to cling to the idea that a miracle drug cure of a miracle drug cure than to face a messy reality that Leonard's awakening presented, that neurological and personhood are complex and simple fixes can fail. Right. Sachs, however, felt that not telling the full story would be a greater ethical lapse. Okay. He championed a different, excuse me, a deeper understanding of these patients, one that went beyond viewing the later complications as mere side effects.

51:18 Right. He said, quote, these could not be seen as side effects, but it had to be seen as integral parts of an evolving whole, urging fellow physicians to reckon with the whole human situation, not the clinical data. Okay. One ethical implication Leonard's case highlights is the question of consent and hope. Sure. Leonard and the others could not have fully understood what this experimental treatment held in store, even Sachs didn't. Well, no, it was experimental. It was experimental. And when Leonard was entombed in his illness, he could only consent in the most limited way. Okay, so I know we're in a we're in a world of everything's gotta be consent.

52:02 Like, may I shake your head? Right. And I okay, and I respect people's personal things, whatever. You can't communicate with these people. Yes, he could write a little bit, whatever. If I was in that position, I don't give a fuck. Try it. Yeah. What else do I have to lose? Oh, I gotta be a statue longer? Fucking do it. Yeah. So I mean, I get the consent thing, but I I feel like that's misplaced in this because I don't know. Anyways. So Saks had to make a decision. Was it right to disrupt the status quo of these long-suffering patients, potentially exposing them to emotional turmoil for a chance at revival?

52:48 How would you have known that though? Sax decided it was right. Yeah. And Leonard's own words, quote, I feel saved. I have broken through the barriers, suggests that from the patient's perspective, those awakened days were worth it. 100%. I I would agree with that. So in his long-standing relationship with Leonard and others, he felt a responsibility to stand by them before, during, and after the L DOPA trials. Good for him. He did not simply administer a pill. He shared in their hopes, their disappointments, and their care over the years. In Awakenings, Sachs writes with humanity and a deep sense of concern, making it clear that true healing was a complex art.

53:33 It demanded caring for the patient's soul, not just treating their disease. Okay. So this humanistic approach is an is an ethical lesson from Leonard's story. Patients like him were not objects of experimentation, but partners in a journey, each with a personal story that mattered. Which I agree with. 100%. I'm going to end on a fun fact. I like fun facts. The minor planet 84928 Oliver Sacks, discovered in 2003, was named in Oliver Sachs' honor. He discovered a planet? No, they named a planet after him. Oh.

54:14 When did Saks die? 80s? In the 1980s? 80s. Or maybe the 2000s? I read it at one point. I did. I did, sure did. I don't I'm sorry. Oh Lord have mercy. He died August 30th, 2015, at the age of 82. That's where I got the 80s. He was 82. So is there anyone left with this in in life? I did not research that. I feel like you should have. Because if it just disappeared.

54:57 Do you think it went to his planet? Yes. Yes. But you know what I mean? Like there are no confirmed patients still suffering with encephalitis. Lethargia Lethargica. Yeah, lethargica. I mean, good on us for that, I guess. Isn't that a wild story? It it's fucking weird because could you imagine being trapped? Like, coma is one thing. You're a quote unquote not lucid it anyway. Like you're not even you're not awake, you're not conscious.

55:39 And I know like they always say, well, talk to them, read books to them and such when they're in a coma. Just in case. Because you know, they can hear you, they can hear your voice, they hear your energy and all that stuff. Whatever, blah blah blah. These people were alive and they could hear shit. Whatever. They weren't they weren't in a coma. They were paralyzed. Their whole body just including their mouth. Except for apparently their fucking hand. Well, his. So could other patients of that not write? We'll have to watch the movie to find out, folks. That's fucking s so I read that um the book is pretty good, but they go into a lot of like scientific background that some people couldn't quite grasp, but the actual story was pretty amazing to read about.

56:34 So you said Sachs wrote the book? Yes. Correct? Yes, he wrote many books. Oh, he did. He did. What year did the awakenings come out? I don't think some of my questions are so unrealistic. No, but you know. You just can't accommodate all of them? Wow. And this happened in 69. Right. So it was pretty quick. I think I think it was a good time frame. Like it wasn't so close, and it wasn't like decades later. Okay. And then the film Awakenings was 1990. That was 90?

57:14 Holy crap. And you said RDJ's in that? I didn't know that. I think he's Leonard. That would make sense. And Robin Williams plays Dr. Sax, but their version of Dr. Saxe. Whatever name and whatever. Yeah. Yeah. I would definitely watch that with you. And now I want to because I've never seen I'm I'm 100% sure I've never seen that movie. Again, I knew of it, never watched it. I love Robin Williams, Tortured Soul. But uh he was great. Yeah. I miss I missed uh his comedy and his general personality. Oh, he was so talented.

57:54 Talent of the wazoo. Oh, he was he was so good. And I I mean it's funny. There's some quote that I'm I'm not gonna remember, so just generalize it. But it's like typically the funniest people are the saddest or whatever. It's there's it's more in depth than that. Obviously, I'm just fucking not making light of it. I'm just I don't remember it. But yeah, he was he was something else. I grew up on him with Mork and Mindy. Did you ever watch that show? You're too young for that, right? Yeah. I watched Mork and Mindy and all of his other shit and whatever, and you know, Hook and all that stuff. I mean fucking you just said Hook is like what 35 years this year. Oh, yeah. I was I was reading off those movies.

58:36 Was that the 35-year one? I think so. It's gotta be close, if not. Shit. Because now I'm drawing a blanket. 1991. So it's 35 years. 1991, yeah. Oh my gosh. Jeez Louise. Hook is great. Gosh, we have so many movies to watch. Well, let's just call in sick. How how did you like the boating type? I haven't had Bodingtons, but I've had Boddingtons. Boddingtons. I I haven't had it in a long time. It it's good. I enjoy it. It's not something I would drink on the regular basis. I didn't happen to finish mine. Yeah, I saw that.

59:16 Very well. Yeah. Very well done. Um Bravo. Pip pip. Pip pip. Pip pip Cheerio and all that sort of thing. Never can't wait. Anyways. Um when you when you drank it, you notice how it's a little more airy. Yeah. That is from the intentional and the widget and all that stuff and so on. Isn't actually called a widget? Yeah, typically. I don't know if it says it on the can, but yeah, it's it's called a widget. Cool. I will uh teach you teach you that after we're done with it. Oh dear. I just yawned. Why? Why would you do that? I don't know. We're we're on camera. Sorry. So uh that is fucking weird.

59:57 Um pretty wild stuff. Yeah. But I couldn't imagine being trapped in my own body and not being able to fully communicate or move or anything. For thirty years. I mean, I plus. Yeah. I have a hard time sleeping, let alone thirty years. I mean, holy shit. Because he was awakened for a month and a half and then and that was 69 and then he died in 81. God damn. So another 12 years-ish. Ish, depending on your time. Yeah, exactly. That he went back to it.

1:00:38 That's so fuck. And it just disappeared. That whole disease just disappeared. So what's the difference between encephalitis and encephalitis lethargia? Okay, so of course you had to ask that. I literally had what the what the difference was between encephalitis lethargica and Parkinson's. Okay. I literally looked that up. Ugh. Rude. So what's the difference on that? I'm looking. Wow. I was just told to shut up on camera on audio. I feel so. I'm gonna drink a beer while she's looking this up because.

1:01:20 Oh, that was a nice crack of can. Encephalitis is a general term for brain inflammation. Okay. The cause is viral, like herpes or West Nile. It's autoimmune and it's uh post-infection. Okay. Encephalitis lethargica um is unknown. So I feel like this is all made up. Um, the onset of encephalitis is sudden, days to weeks. Encephalitis lethargica is graduated, sometimes sometimes sudden. Yeah. The symptoms in the acute phase for encephalitis is fever, seizures, confusion, and coma.

1:02:05 Lethargica is extreme sleepiness, eye movement issues, and ketatonia. Um, in the chronic phase for encephalitis, may recover to sorry, may recover or have resist residual neurological issues. Okay. Lethargica is post-encephalitis. Parkinson's rigidity and acuse kinesia, which is a lack of movement. Okay. Um fatality rate for encephalitis varies from 5% to 30%. Oh, wow. Lethargica is high during epidemic. Many survivors had lifelong effects. Um encephalitis is around today, and it and uh lethargica is not.

1:02:51 Isn't it just wild that it just completely like just poof? Peace out, homies. We're gonna go to a different planet. The treatment for encephalitis is antiviral supportive care and immunotherapy. Um, lethargica was nonspecific. L dopa used decades later in chronic phase. Is L DOPA still a thing? Maybe for Parkinson's. Okay. Yeah. Um, it is all encephalitis is also known as brain inflammation. Lethargica is the sleepy sickness. The sleepy sickness. And encephalitis public awareness is moderate, especially during viral outbreaks.

1:03:35 And for lethargica, it was famous due to Dr. Oliver Sachs's awakenings. That's wild. I mean, uh I again I will end on this. If I was if I was Leonard or one of the people that made up Leonard, I would have been fucking appreciative of Dr. Sachs for waking me up for a month and a half. It is, okay. Um that makes sense. I mean, like you said, there had a lot of commonalities between it, so okay. I I totally get that. So isn't that crazy? It really is. I mean, I couldn't even imagine.

1:04:17 So yeah. Well. I suppose. All right, buffoons. That's it for today's episode. Buckle up because we've got another historical adventure waiting for you next time. Feeling hungry for more buffoonery? Or maybe you have a burning question or a wild historical theory for us to explore? Hit us up on social media. We're History Buffoons Podcast on YouTube, X, Instagram, and Facebook. You can also email us at history buffoonspodcast at gmail.com. We are Bradley and Kate, music by Corey Akers. Follow us wherever you get your podcasts and turn those notifications on to stay in the loop. Until next time, stay curious and don't forget to rate and review us.

1:04:57 Remember, the buffoonery never stops.