“Awakenings” by Oliver Sacks

The movie “Awakenings” is based on a factual memoir also titled “Awakenings” written by Oliver Sacks, MD. The movie tells the story of a neurologist, Dr. Sayer hired by a hospital for the chronically ill, whom is caring for a group of survivors of an endemic of encephalitis lethargica that broke out in the twenties. These patients have all progressively reduced to a catatonic or vegetative-Parkinsonian state and have been in this semi-conscious state for decades. Dr. Sayer uses a patient named Leonard Lowe to test a new experimental Parkinson’s drug called Levo-dopa, to “awaken” him and eventually all the other patients on this ward.

The medical ethical issue of this story is related directly to the administration of an experimental drug in which little is know about it’s effects and the hasty manner in which the dosages were chosen. The story takes place in New York, 1969 where Dr. Sayer is a newly hired doctor at the Bainbridge Hospital for the chronically ill. He was previously a research doctor since his graduation from college. It was made clear at the beginning of the story that Dr. Sayer struggles with human interaction and is reluctant to take the position at the hospital once he realizes he will be interacting directly with patients.

As Dr. Sayer begins to settle into his new environment, he begins to discover a small group of patients in a semi-conscious statue-like state that have a common aspect of their medical history; that being, they all survived encephalitis lethargica years before their deterioration. As Dr. Sayer continues to research the symptoms associated with this state his patients have been living in, he concludes that the experimental drug L-Dopa for Parkinson’s patients could prove to be effective with his patients. The vegetative state in which all these patients are in, greatly hinders the possibility of developing a physician-patient relationship and prevents further attainment of a patient history, as well as obtaining signed  consent. The only one of Dr. Sayer’s patients with a living and involved family member is Leonard Lowe who receives daily visits from his mother. Dr. Sayer visits Leonard’s mother to discuss his plan and obtain the consent needed before he can implement Leonard’s treatment.

Once Sayer has the signed consent to start Leonard on the L-dopa drug he is eager to begin the therapy. To start with, Dr. Sayer administers 200 mg that the pharmacist provides him with. Without any signs of improvement, Sayer obtains a slightly increased does of 250 mg of Levodopa and administers it to Leonard, and again awaits any positive results. Sayer begins to grow more impatient with the lack of improvement and begins to obsess about the idea that the experimental treatment must be successful. One night, when no other hospital personal are present, Sayer obtains a dose of 1000 mg of L-dopa and gives it to Leonard, without taking into account the side effects. This action demonstrates an alteration of Sayers stance of seeking to cure the patient and the personal satisfaction derived from achieving this.

As Leonard begins to improve as a result of his greatly increased dose of medication, Sayer begins to consider the person awakening rather than the professional prestige it may bring him. Once Leonard has awakened, all of his emotions are also awakened, as well as the emotions of the viewer. Dr. Sayer takes Leonard out of the hospital and into the city and invests time in integrating Leonard into society as it is in the present. An emotional scene in which Leonard wades out into the ocean water with rock and roll music playing illustrates his wellness and awakening. The success of the Levodopa therapy that is observed in Leonard leads to the implementation of this drug therapy with the other semi-conscious patients from Leonard’s ward. Many awakenings occur for the other patients receiving L-dopa and the viewers get a glimpse of all the individual awakenings of the patients that were once a room full of statues.

Following these scenes of happiness and life are followed by a change in Leonard. Sayer receives a phone call in the middle of the night from Leonard who is exclaiming that he needs to tell everyone about “things that matter” in life. Leonard’s new perception of the miracles of life leads to him going in front of the hospital authorities to request permission to come and go as he pleases. Once, his request is denied he lashes out psychologically while simultaneously he begins to deteriorate physically. Sayer soon discovers that the adverse effects of the L-dopa therapy are even more devastating than the previous catatonic state.

Although Leonard’s doses of medication are changed daily in order to find a solution to these side effects, Sayer is unsuccessful in preventing these devastating effects and Leonard’s mother demands that the drug treatment be discontinued. The movie ends by showing a room of the same semi-conscious patients from the beginning of the movie, however, the care being given to the patients is much more kind and gentle and alternative therapies are being put to use.

This story of Dr. Sayer and Leonard presents a medical ethical issue that may be considered difficult to recognize due to the initial positive result of the actions. Dr. Sayer does seek to improve the condition of his patients, therefore he is practicing beneficence. When Dr. Sayer increases the dosage so hastily and without permission he is guilty of disregarding the possible adverse effects of the medication. Sayer was also premature in applying the experimental treatments to his other patients without fully understanding the effects of the treatment.