In the April 23rd issue of the New York Review of Books, Oliver Sacks – who, in January of this year, learned that his liver was overrun by metastatic cancer – writes with characteristic skill on the shifts in constitution that frequently accompany illness, treatment, and convalescence.

Photo Credit: Luigi Novi | CC BY 3.0.

Sacks opted on February 16th to undergo an embolization procedure that his doctors hoped would deprive the metastatic cells in his liver of the blood and nutrients required for their survival and continued spread. He was warned that the procedure would trigger a massive die-off of cells, and that their extermination would be accompanied by significant pain and lethargy. Sacks describes his post-operative experience:

I am glad I was forewarned, for the following day (Tuesday, the seventeenth), soon after waking from the embolization—it was performed under general anesthesia—I was to be assailed by feelings of excruciating tiredness and paroxysms of sleep so abrupt they could poleaxe me in the middle of a sentence or a mouthful, or when visiting friends were talking or laughing loudly a yard away from me. Sometimes, too, delirium would seize me within seconds, even in the middle of handwriting. I felt extremely weak and inert—I would sometimes sit motionless until hoisted to my feet and walked by two helpers. While pain seemed tolerable at rest, an involuntary movement such as a sneeze or hiccup would produce an explosion, a sort of negative orgasm of pain, despite my being maintained, like all post-embolization patients, on a continuous intravenous infusion of narcotics. This massive infusion of narcotics halted all bowel activity for nearly a week, so that everything I ate—I had no appetite, but had to “take nourishment,” as the nursing staff put it—was retained inside me.

Another problem—not uncommon after the embolization of a large part of the liver—was a release of ADH, anti-diuretic hormone, which caused an enormous accumulation of fluid in my body. My feet became so swollen they were almost unrecognizable as feet, and I developed a thick tire of edema around my trunk. This “hyperhydration” led to lowered levels of sodium in my blood, which probably contributed to my deliria. With all this, and a variety of other symptoms—temperature regulation was unstable, I would be hot one minute, cold the next—I felt awful. I had “a general feeling of disorder” raised to an almost infinite degree. If I had to feel like this from now on, I kept thinking, I would sooner be dead.

This time of pain and suffering would constitute the first in two major waves in the aftermath of Sacks' surgery. The second would come 10 days post-procedure, when Sacks writes that he turned a corner in a manner "delightful, and wholly unexpected: there was no intimation, beforehand, that such a transformation was about to happen."

His ruminations on the cause of his "transformed state" are well worth reading, and are largely informed by the first half of his essay, which explains in some detail various physiological bases for general feelings of disorder. Do read the piece in its entirety, at NYREV.

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