The Leg

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

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.

Operation

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.

Coming to

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?’

Fear

I had known fear when I lay with my leg crumpled on the mountain, and knew there was not much chance of being found alive. I had feared the reality of death – and it was not all that bad. Now I was safe in a hospital bed, and knew a fear quite different from what I had known on the mountain. For that was fear of the known and real, where this was fear of the uncanny and unreal. The idea of a stroke, though it terrified me, brought me some comfort: at least it could provide some explanation, some sense. For what was more frightening than anything in the world was to be confronted with something which was a violation, in effect, of both reason and nature: which constituted, so to speak, a hole in the world. I have found, speaking to hundreds of patients since my own experience in 1974, patients who have lost the sense of part of their body, that every single one of them has known this elemental fear – has known it, and been unable to share it.

Quite apart from this metaphysical fear, there was also a raw and terrifying animal fear. I had already suffered, in effect, an internal amputation: would they now proceed to actual amputation, and remove this functionless thing which hung uselessly from my hip? As each day passed, and the leg remained useless, the fear of amputation grew stronger. I neither divulged nor discussed it – and because it was hidden and secret, the fear increased.

I had a third fear which, in a sense, combined the other two, the sense of amputation and the sense of a yawning hole. I did not just feel ‘a leg’ was missing, as a button may be missing off one’s coat: I felt that part of me, of my person, was missing; and, in consequence, I felt radically diminished. It was only several years later that I came to read The Case of George Dedlow, an imaginary case-history of a physician who had suffered amputations of all his limbs, written by Weir Mitchell, that superb neurologist (and novelist), who had been the first to describe not only ‘phantom limbs’ but also the ‘negative phantom’, the ‘missingness’, which I was experiencing. His fictitious physician-patient George Dedlow writes:

I found to my horror that at times I was less conscious of myself, of my own existence, than used to be the case. This sensation was so novel that at first it quite bewildered me. I felt like asking someone constantly if I were really George Dedlow or not; but, well aware of how absurd I should seem after such a question, I refrained from speaking of my case, and strove more keenly to analyse my feelings. At times the conviction of my want of being myself was overwhelming and most painful. It was, as well as I can describe it, a deficiency in the egoistic sentiment of individuality.

Carpentry

I had to get a grip on myself, I had to understand. The hypothesis of a cerebral lesion I speedily found quite untenable – no such lesion would have spared my foot, for example. Further, it was a violation of Occam’s razor: I must not multiply hypotheses if one would do. The only known damage was to my leg: but the experience was clearly ‘cerebral’ in nature, for it presented itself as a sort of agnosia and amnesia, a not-knowing and not-remembering my leg. This must be some sort of consequence or ‘resonance’ of the cessation of neural traffic: the leg was injured, partly denervated, immobilised in a cast; impulses, it seemed, could neither enter nor leave it; there was thus no information about the leg available to my brain, it was deprived of the wherewithal to make its usual image or representation. My surgeon, doubtless, would know all about it. The following day, when he came, I brought the subject up.

‘How’s the leg, Sacks?’ he asked, tapping the cast.

‘You’ve done a nice job,’ I replied, ‘but it doesn’t seem quite right.’

‘Why, what’s the matter? Is it painful?’

‘Well, not exactly. I am afraid it sounds silly, but ... but it seems to have no tone, and I can’t really feel it or move it.’ I saw an expression of absolute consternation, or so I thought: but it lasted, if it was there, for the merest fraction of a second, and the face he then turned to me was composed, even bland.

‘Nonsense, Sacks!’ he said. ‘You’re mistaken, there’s nothing the matter.’ He turned and left the room, followed, as consultants are, by a great multitude, a retinue, who were all writing in their notebooks, so I imagined: ‘There is nothing the matter.’

Nothing the matter! What did he mean? Why didn’t he listen to what I had been trying to say? I was resentful of his dismissal, and thought him extraordinarily unfeeling. And yet, there was that flash of consternation in his eyes – as if, far from being unfeeling, he had been engulfed by feeling, a feeling he was immediately at pains to deny: ‘I see he fears, and I fear with him. I fear the more because he disguises his fear, and I see it the more sharply because he would not have me see it.’ How much feeling may one expect from a surgeon? This, indeed, was his question on a later occasion: ‘We orthopaedists are only carpenters, Sacks. We are called in to do a job, we do it, that’s that.’

‘But the leg isn’t working,’ I muttered, amazed.

‘That’s not our business,’ he snapped.

‘Then whose business is it?’

A Thing with a Thing

In the midst of my outrage I had a sense of the comically close parallel between the way I regarded the leg, and the way the surgeon regarded me. I regarded the leg as ‘a thing’, and he, apparently, regarded me as ‘a thing’. Thus I was doubly ‘thinged’, reduced to a thing with a thing. And perhaps there was a certain justice in this double indifference that had to do with the indifferent nature of phantoms – which was precisely what my leg had become, or been replaced by. Side by side with feelings of grief and solicitude, of all that would naturally be felt towards a hurt member, there was, in me, a distinct feeling of indifference: what, genuinely, could one feel for a phantom? If a man is hurt, is manifestly suffering, his suffering calls forth an immediate resonance of sympathy: but no such feelings are called forth by a phantom – either in its possessor or in anyone else.

Yet I was cowed by the surgeon’s admonition, which smacked of the schoolroom, courtroom or nursery, and which seemed to reduce me to the status of a criminal or a child. In more general terms, I felt that he had spoken politically: that he had, in effect, said, ‘We do not accept your claim. We do not find there is anything to discuss,’ and had therewith vetoed any further discussion. It would have been impolitic to protest: I withdrew into a less vulnerable realm.

Telling

My journal became, not only the repository of my secret confidences, but the ideal friend who would hear and understand me, who would listen – and answer: I found myself using pens of two colours, one for myself, one for the ideal ‘other self’, with whom I was in intimate correspondence. This ‘correspondence’ was the only thing which broke through what would otherwise have been a sense of the most absolute isolation. It was only when I found myself better – though still profoundly perplexed by what had happened – that I was able to unbosom myself to a true ‘other self’, and then it was to Luria, in Moscow, that I wrote. I had tried, frantically, absurdly, for several days, to phone him in Moscow, putting hundreds of twopenny bits in the portable phonebox, and arguing desperately with the operator when she said that one could not phone Moscow. Finally I sent off a letter to him, a miracle of detached and minute observation, carefully masking my agony of spirit. And when, at last, I got a letter back from him, I found he had most wonderfully heard and understood: ‘I find your observations most important,’ he wrote. ‘It is really astonishing how little has been done to describe the central effects of a peripheral injury. It is a new field you are discovering.’ But his letter was only to arrive nine weeks later. Until then the silence was unbroken.

Conspiracy of Silence

A strange silence, indeed, seems to surround the whole subject. It is a rare patient who can heed the muteness within him and voice it to his physician; and a rare physician who will truly hear, and not turn deaf ears to his patients. I did not become aware of any accounts of experiences similar to mine until more than three years after my accident. Then, in rapid succession, I found three such accounts. Weir Mitchell’s, based on his experiences in the Civil War; Babinski’s – an entire book – written during the First World War; and Leontev and Zaporets’s book, based on their experience with 200 soldiers in the Second World War. Only the special conditions of war, when there is a multitude of such injuries, is able to break the barrier of silence – and when the war is over, everything is forgotten. Although all these authors were of the utmost eminence, and their publications of the utmost importance, I have never met anyone who has heard of these works, let alone read them – and this strange forgetting extends to the authors themselves. Weir Mitchell ‘forgot’ his ‘negative phantom’; Babinski ‘forgot’ his ‘syndrôme physiopathique’; and Luria ‘forgot’ the work of Leontev – even though it was inspired by, and actually dedicated to, him.

Although I had been driven into a sort of philosophical isolation, I was not immune to the ordinary pleasures of social intercourse. ‘Most fortunately it happens, that since reason is incapable of dispelling these clouds, Nature herself suffices to that purpose, and cures me of this philosophical melancholy and delirium, either by relaxing this bent of mind, or by some avocation, and lively impression of the senses, which obliterate all these chimaeras. I dine ... converse, am merry with my friends.’ Like Hume, I found my friends important; we ate, we conversed, we were merry together. They were delighted to find me jolly and intact – that is, apart from my strange preoccupation with the leg which, by and large, they were happy to ignore. When they left, the ‘chimaera’ was still there.

How long?

How long could I expect to have this bizarre disability? When, and how, could I expect to get my leg back? These were not merely difficult questions, but impossible ones. For on what is expectation based? On experience, the present situation. But I was, in the most literal and radical sense, without experience. I did, on one later occasion, speak of ‘amnesia’ to the surgeon, for not only was I unable to perceive the leg, I was in some sense unable to remember it either: I could not remember what it was like to have a whole leg, or to walk naturally. As in a depression, or a migraine, or a Parkinsonian crisis, the patient may feel it has gone on for ever, and, by the same token, will go on for ever, so changelessness and timelessness were built into my leglessness.

I lay for two weeks without hope, without anything tangible, anything concrete, anything real happening. I did not divulge my hopelessness, nor did it spread; it was, as it were, an intellectual despair, and existed only in relation to the leg. Outside this sphere I felt full of life, and enjoyed reading and writing, my friends and my leisure. My days were full of varied activities, but my nights were full of images of leglessness, dreams in which nothing actually happened, dreams which consisted of one motionless scene with one figure in it, myself minus leg. I had never had such dreams before, and it came to me, after a while, that they were ‘neurological’ dreams – dreams determined chiefly by a neurological or physiological situation, and therefore more akin to phantoms than to dreams.

Intimations

On the 12th day after surgery, I noticed occasional twitching of the otherwise flaccid muscle, sometimes a fascicular twitch of a single muscle bundle, which conveyed no sensation whatever, and would go unnoticed unless I chanced to see it; sometimes a more massive spasm or jerk, involving a good part of the muscle. With these larger twitches there were sometimes lightning flashes of pain – and, sometimes, flashes of pain without twitches. These sensory and motor phenomena confirmed my notion of a massive denervation – but were also intimations of some returning innervation. I was definitely pleased to see them, but did not know how much they might portend: the flashes might intimate a 1 per cent return of function, but 1 per cent in itself was worse than useless (0 per cent is better than 1 per cent in such lesions).

That same day I had a singular and (I felt) significant experience: a friend brought in a tape-recorder, and with it a single tape – the Mendelssohn Violin Concerto. I had felt myself seriously starved of music while in hospital and when the music flowed out, I felt an indescribable joy, as if a world had been created where before there was nothingness and void. That night, for the first time in many nights, my dreams were not exclusively like still photographs and phantoms. I dreamed the Mendelssohn again and again, and waking up, I thought: ‘That’s strange, did someone put the tape-recorder on?’ I reached out a hand, and found it was not on: but still the music went on, playing itself in my mind, on and off, the whole day. I remembered that Kant had called music ‘the quickening art’, and in that beautiful, Mendelssohnian weekend, I got a new sense of some sweet silvery motion, in opposition to the hideous visual stillness, the frozenness, of the preceding two weeks. The leg felt the same, or failed to feel at all: but, inexplicably, a new hope stirred in me.

Beneath the Cast

Just two weeks after surgery, I was taken down to the Casting-Room, to have my leg uncasted and the stitches removed. One of my recurring dreams – a particularly nasty one – was that the cast contained nothing at all, being either an empty cylinder or solid chalk. Occasionally these images, of petrifaction and inorganic death, thrust themselves into my waking-state, so I went to the Casting-Room full of eagerness and fear.

I had imagined that the cast was enormously heavy, forty or fifty pounds at the least, because friends, at my request, had lifted the two legs and said: ‘Blimey! That one in plaster weighs a ton ... at least forty pounds heavier than the other one.’ I was astounded, therefore, when the cast was cut off, to see it held without effort and thrown lightly in a corner. I asked what it weighed, and was told: ‘Maybe three pounds.’ The dead weight of the leg, that extra forty pounds, was entirely due to its lack of the normal postural tone one has in even the most passive normal limb. ‘Have a look!’ said the caster. ‘They’ve done a beautiful job there.’ I raised myself on my elbow, and had a long, long look. I was profoundly reassured and disquieted: for it looked perfectly all right, and quite dreadfully all wrong. It was there, visually there, but not livingly, substantially or ‘really’ there. I was struck by the wasting, how much it had shrunk; I was struck too by the size of the scar – I thought it would be a little one, and it was about a foot long; I was struck by the beautiful, almost translucent, delicacy of the limb; and I was struck by its absolute, almost appalling, unreality. It lay before me, exquisite, lifeless, like a fine wax model from an anatomy museum. I put my hand out to touch it – and touch was as uncanny and equivocal as sight. It looked like wax, and it felt like wax – finely-moulded, inorganic and ghostly. I could not feel the feeling fingers with my leg, so I pinched it and tugged out a hair – I could have stuck a knife into it for all the feeling it had. The Registrar came in, looked and said, ‘Mm, very nice!’ – he seemed unaware that it was only made of wax. Sister said she would take out the stitches, that I might feel some pulling and tweaking, and if it really hurt I could be given some local. I watched her fiddling for an unconscionable time, making peculiar, senseless motions with tweezers and scissors, and finally asked: ‘When will you begin?’ She gave me an odd look, and said: ‘I’ve just finished.’ I had not only felt nothing of her removing the stitches, but had completely failed to realise that that was what she was doing: her motions appeared unintelligible, and unrelated to me, because the leg was still senseless and unrelated to me.

Yes, still ‘the leg’, and not at all ‘my leg’. Seeing it, touching it, provided some sort of reassurance and reality (I could no longer, even in dreams, see the cast as completely empty or solid), but no existential reality. The leg still seemed profoundly unalive. And yet, there was an important change: until this time I had seen it as post-mortem, cadaveric: now I saw it as awaiting life, as foetal. Before, it was as hideous as a corpse: now it had the delicate translucent beauty of the unborn.

Standing, Walking

On the 16th day after surgery I was judged ‘ready to walk’. What would I walk with? How could I walk? How could I stand on, let alone move, a ghostly lump of jelly, a nothing, hanging loosely from my hip? And even if, stiffened by its carapace of chalk, this preposterous appendage could support me, how could I walk when I had forgotten how to walk? I was hoisted to my feet by two stout physiotherapists, and, supported by them, and my crutches, I stood – on my good leg. ‘It won’t do,’ they said. ‘You’ve got to use the other one too.’ ‘What “other leg”?’ I was tempted to say. It didn’t make sense, it was unthinkable, but I commanded myself to do it, partly lifting my good leg, so that something would have to bear weight, or collapse.

Gregorian Delirium

All of a sudden, without warning, everything became chaotic. One instant, the ground seemed immensely far away and the leg a chalk cylinder of infinite length; the next moment, the leg was minuscule, and the ground under my nose. The ground rose, retreated, tilted, torqued. Perceptual illusions succeeded one another at the rate of five or six a second. I thought of Hume – ‘we are nothing but a bundle or collection of different perceptions, which succeed one another with an inconceivable rapidity, and are in a perpetual flux and movement’ – and also of Richard Gregory, and his ‘perceptual hypotheses’. The illusions, the apparitions, whatever I should call them, were clearly conjectures, guesses ... perceptual hypotheses. While utterly helpless amid pandemonic illusions, I said fiercely and desperately to the physiotherapists, ‘Hold me!’ and would instantly have fallen had they not done so. The first dozen, or fifty, illusions were random excursions over an enormous, perhaps infinite range; and then the excursions grew less, some sort of matching or testing or targeting was in process, a guessing and testing which had nothing to do with me.

Out of nothingness, out of chaos, measure was being made, the jumping, fluttering metrics were converging towards some standard, or a scale. As this became more apparent with each second, I had the sense that a world was being created; or, if not a world (for everything was still flashing, visual, unreal), the possibility of a world. I suddenly thought of Job: ‘Where wast thou when I laid the foundations of the earth ... who determined the measures thereof?’ And I felt, with delight, that I was there, I saw it. There is a book about the cosmos called The First Three Minutes. In my first three minutes, I felt, I was myself present: an observer, a witness at the beginning of what was going to be my world, though as yet it had neither contents nor sense.

For three minutes, for a thousand ‘frames’, I stood still, supported by the good therapists, unable to step – for how could I step into a world constantly altering in size and shape? But at least a space, a sort of ghost space, was being framed, where, for two weeks, there had been a complete void, neither substance nor space.

As soon as this half-space was sufficiently stable, I started to step. The unreality was still extreme: it was not ‘my leg’ I was stepping with, but a huge, clumsy prosthesis, or hypothesis, a bizarre appendage, a leg-shaped cylinder of chalk. I had hardly started before the leg got jammed, and so ludicrously that I almost fell on my face. I found an unaccountable difficulty moving it, until I looked down, and saw it had got stuck behind my right foot. I found myself wholly unable to judge any step, either in size or direction, by simply feeling: I had to look down and see what I was doing. In the complete absence of any useful inner sensation – call it muscle-sense, movement-sense, position-sense, proprioception – I was constrained to monitor every step and to adjust it in accordance with external things – the position of objects – and external scales. I found this walking, or pseudo-walking, a matter of the most elaborate and exhausting and tedious computation. It was locomotion of a sort, but it was utterly mad – ingeniously Humean but not really human. ‘This is walking?’ I said to myself.

Observer

I had proceeded from Nowhere to Somewhere. I had achieved a sort of position. As an observer, I could say, ‘There is a leg there,’ but I could not say: ‘This is my leg here.’ For to say this is the prerogative of the actor, and, as yet, I was no more than an observer.

Music

There is a beautiful aria in the Messiah which opens with the words ‘And suddenly’. Suddenly, two weeks ago, there was no Leg, nothingness, void; suddenly, five minutes ago, pandemonium had burst forth; and now, and suddenly, music came to me. Mendelssohn stirred and started in my soul, quickened my soul and, with it, my body: and suddenly, spontaneously, not knowing (or caring) how, I found myself walking with the music, to the music, in it:

You are the music
While the music lasts.

And suddenly, thus, I found myself walking, walking with ease, with grace, with my own self and style, walking, as Luria would say, with ‘kinetic melody’ (or, as Harvey once said, with ‘the silent music of the body’): with my own kinetic and perceptual melody, my own feeling, my own reality, quickened into life by the music. What I had dreamed, perhaps fancifully, over the weekend – of music as a divine messenger and message of life – became real, incarnate, in my person at that moment. And suddenly, in that wonder, my leg became real, was quickened into living flesh and substance and reality, quickened into an existence beyond thought and hypothesis, existence which exists because it is action. (‘Existence is Action,’ Leibniz said. ‘What does not act does not exist.’) It did not occur to me to examine my leg: I could feel that tone had come back to it, that that dreadful dead softness had become quick and firm.

The physiotherapists wanted to stop me – ‘It’s your first walk, don’t overdo it!’ – but the exuberance of joyous motion carried me along. (Even Pavlov speaks of ‘muscular gladness’.) I forgot, or denied, obvious weakness, the weakness of muscles not used and atrophied since the fall, the weakness of muscles with as yet barely adequate nerve supply. And what I forgot, or denied, suddenly felled me: suddenly, in mid-stride, the inner music stopped, stopped as suddenly as if a needle had been lifted from a record; and, as suddenly, in that moment when the music stopped, my kinetic melody, my walking, stopped dead too; and suddenly I was back in cinematic delirium, in that awful wild jumping of sizes and frames. The two physiotherapists guided me to a rail, which I grabbed with all my strength. The left leg flopped nervelessly: I touched it, and it was toneless, unreal. ‘Don’t worry,’ said the physiotherapists, ‘it’s local fatigue. Give the nerve-terminals a little rest, and it’ll be right again.’ Half-propped against the rail, half-standing on my good leg, I rested the left leg, and the delirium grew less. After two minutes or so, there was sufficient stability, and, with my supporters, I ventured forth again. And suddenly the music came back, and with it natural walking, and a restoration of tone and actuality to the leg. Luckily it was only a few yards to my room and I was able to retain the music, and musicality of motion, until I had gained the chair in my room, and, from this, my bed, exhausted but triumphant.

Relapses

My new-found actuality, musicality, was at first unstable, and apt to break down, quite suddenly, with fatigue. Such episodes were reversals of my musical recovery, or relapses into cinematic delirium, and again showed the absolute contrast between the two conditions. It happened, for the last time, about a month after I had left the hospital, when I had walked for several miles in the grounds of the convalescent home, forgetting that I was still, indeed, convalescent. My error was to tackle a flight of stairs in this state, for hardly had I started, when the whole damn thing happened again! The step in front of me suddenly looked as huge as a cliff, then small, then tilted; it twitched and it changed. I sat down on a stair till the delirium had passed. This is seven and a half years ago – I have not known it since.

Solvitur ambulando

There is an old tag – Solvitur ambulando. Through losing, then regaining, the ability to walk, one may explore – not as observer, but as actor – the essential nature of animal motion. In 1627, the same year as he published his book on the circulation of the blood, Harvey wrote a book on animal motion: he was the first to make a mechanical, Galilean analysis of this, and he pressed such an analysis as far as it would go. But when he had done this, he spoke of animal motion as beyond all analysis, as being ‘inspired’, and essentially musical – posture and motion he called ‘the silent music of the body’. In 1627, then, Harvey boldly conjoined science and art – but then grew fearful of his boldness, and never published his book (it was published only at the tercentenary of his death). Until we achieve such a conjunction, we can never hope to fathom the mysteries of perception and action but will remain lost in the empty labyrinths of empiricism.