Sunday, January 30

Challenge: Awakening Essay 1

A few weeks ago, I issued a challenge to "unbelievers". I challenged my readers to read N.T. Wright's The Challenge of Jesus and I would read any book of their choosing. After we read these books, we would pen essays concerning what we read and our impressions and comments. What follows is my first essay on the first book in fulfilling my part of the Challenge.

I've read a bit more than half of Awakenings by Oliver Sacks. This book relates the authors contact, case histories, and insights he derived from dealing with number of patients suffering from post-encephalitic Parkinsons. In the 1920's concurrent with the flu epidemic was a sleeping sickness epidemic. Patients who recovered from sleeping system almost invariably later developed differing degrees of Parkinsons. For many of the affected the results were profound. In 1967 a new miracle drug (for these patients) was discovered, L-DOPA (dopamine). This drug had surprising affects on these patients so affected. Most of the patients then went through three stages, awakening, tribulation, and accommodation. This book recounts the experiences (case histories) of several dozen patients, then discusses the disease and its implications in broader terms.
Dopamine is one of the neuro-transmitters in the brain. It seems clear that the virus that cause sleeping sickness damaged the regulatory mechanisms of the brain which control dopamine levels. For most, this meant dopamine levels went to a dramatically lower level. This had profound effects. When in the late 1960's L-DOPA was discovered as a drug used to affect those on Parkinsons this enabled doctors to restore dopamine levels, but in the absence of feedback mechanisms, levels of dopamine relative to other neurotransmitters was only crudely possible by carefully titrating and regulating dosages. Discovering the correct dosage was often problematic. Additionally, even after arriving at an optimal dosage, in almost no cases did the patient recover "normal" life, but usually arrived a less pessimistic outcome, for example varying levels of catatonia might be replaced with frenetic reaction and occasional outbursts which became more predictable.

In sterile medical terms discussing neural network activity, chaotic systems, dopamine levels, et al., misses the other half (often forgotten) of the medical picture, that is the human side of the patient. It is all well and good to say that the neural networks are quiescent or chaotic. It is quite another to be the conscious person living through the lull or the storm. The human side of disease is very often left out of reports of disease and its effects.

Akathisia and akinesia or conflicting urges to move (push) and cessation of absence of the motivation to move war in the Parkinsonian patient. In one of the profound cases of akinesia reported by Mr Sacks, one patient seemed to be frozen motionless all day. Later, when he was "unstuck" he denied it. He said he was merely brushing his nose. By examining a series of photographs over the course of the afternoon, it was verified, that the patient was indeed extremely slowly brushing his nose, except that it took him four or five hours. One the other side of the coin, one of his patients after being "awakened" by L-DOPA had an preternaturally fast reaction time. He estimated her reaction time at 1/30th of a second (instead of 1/8 to 1/4 for a normal person). Playing catch (with a ball) was almost impossible for she would catch the ball and return the ball faster than the eye could follow.

At least two more essays will follow. One on the Sacks ruminations about the medical practice (following Enlightenment thought) of mechanizing and abstracting the state of a patients health. This practice has allowed for great advances, but has left the human side of our patients (often) at the road side. Neglecting this side of the question I think also has led to the current state of ethical considerations and sophistication of the ethical debate surrounding medicine. Because we so rarely consider the human side of medicine (and science) we are blindsided when those issues arise. A second essay will consider some of the implications of these occurrences on the philosophical and theological considerations of what being human entails.