Awakenings

 

The movie Awakenings was a wonderful movie about how a physician researcher throws himself into his work.  Dr. Malcom Sayer showed up at Bainbridge Hospital seeking a position as a medical staff researcher in a neurology laboratory.  His background in research had most recently dealt with earthworms, not humans.  After going through an awkward interview with Dr Kaufman and his colleague, both of whom didn’t even seem to care Dr. Sayer had had no research experience with human subjects, Dr. Sayer took the job.  Most of the patients at Bainbridge had diagnoses of Parkinson’s, Multiple Sclerosis and Turret’s Syndrome, but there were some who had various “atypical” neurological disorders.  Several of these had not had thorough examinations in years.

 

Dr. Sayer’s primary studies centered on Leonard Lowe who had been institutionalized in 1929 as a child due to progressively worsening symptoms which eventually rendered him into a catatonic state.  Leonard’s symptoms began as a child with a hand tremor and expanded to symptoms such as being in a trance, ataxia, etc.  Dr. Sayer takes an interest in Leonard immediately and Leonard quickly becomes the center of Dr. Sayer’s care.

 

Through simple observation, Dr. Sayer begins to note that some of these patients with “atypical” neurological diagnoses who are essentially unresponsive have some interesting reactions.   He notes that Lucy will only walk as far as the ordered pattern went and then stopped, but when the pattern was continued, she continued.  He also notes that the gentleman in the hall had an automatic response when Dr. Sayer dropped his pen, the man caught it.  Dr. Sayer continued to observe the patients and additionally noted that things like the right kind of music and human contact caused the patients to respond.  As Dr. Sayer randomly observes these and other phenomenon, he begins to hypothesis that these patients were taking on the will of the objects they caught and threw, or the will of the human that was helping them move, etc.

 

With the help of Ms. Eleanor Castello, RN, essentially a co-investigator, Dr. Sayer discovers that all of the patients with “atypical” neurological diagnosis all had encephalitis in the 1920’s and most were asymptomatic until about fifteen to twenty years later.  They each experienced a down hill spiral of debilitating symptoms leading to essentially a catatonic state.

 

With Leonard Lowe fitting into these parameters, Sayer began to do some testing.  He administered an EEG with a flashing strobe light.  The results showed that Leonard had increased brain activity when Dr. Sayer said his name.  Along with this, Dr. Sayer noted that an up and coming drug, L-dopa, was being used to treat Parkinson patients.  With his patients having similar symptoms, he decided to experiment by placing his patients on L-dopa.

 

Dr. Sayer took his findings to the not so caring Dr. Kaufman to pursue permission to proceed with the drug therapy.  I guess Kaufman is the closest thing in the movie that would represent an IRB.  Sayer argued that these patients were “alive inside.”  Kaufman finally approved the trial on one patient.  Dr. Sayer immediately went to Leonard’s mother for informed consent.  She granted him permission to proceed after he stated his desired goal was for Leonard to be able to interact with her and his environment.

 

Dr. Sayer did disclose to Leonard’s mother that the drug therapy had not been approved for anything other than Parkinsonism.  He also stated that this trial would be limited and that he really did not know if the benefits outweighed the risks.  Sayer does observe Leonard fairly closely as he administers the L-dopa at a starting dose of 200 mg as recommended by the pharmacist.  He initially sees no change, but once Leonard’s dosage increases to 1000 mg, which was never approved by the pharmacist, he begins to go from essentially unresponsive to fully capacitated. 

 

The movie never goes back to address this actual dose and how Sayer did not properly consult with the pharmacist.  Not only that, Sayer actually allows Leonard’s mother to administer the initial doses.

 

Sayer awakens at Leonard’s bedside to discover he was not there.  Leonard was found in the community room on his own “awake.”  He began to take in sensory input as he had not done since he was a boy.  He noted the breeze from a fan, the sound of a passing car’s horn, he answered to his name.  He becomes able to feed and dress himself which he had not done as an adult.  Ms. Lowe was thrilled when she saw her son, who had basically been in a vegetative state, call her name, walk to her and hug her.  These were the desired results of the research.

 

As Leonard remained “awake” day in and day out, Dr. Sayer requested that the other patients be placed on the same regimen.  At that time, no side affects had occurred.  After the staff who had worked closest with Sayer donated their paychecks to foot the bill of the medication for the other patients, and these patients were started on L-dopa.  Therefore they could be considered investors. Soon thereafter Leonard began experiencing mild side effects of the drug.  The single patient trial had not lasted long enough to see what the delayed side effects were and when the side effects started, it was too late.  All of the other patients had started the L-dopa.

 

With each patients initial “awakening” they were thrilled to be out of their locked in state and able to interact with their environment.  However, as they all began to realize what had been lost during their catatonic period, they experienced the negative impact that being “awakened” caused.  Most of them awoke to find their parents and/ or their spouses were dead, that the culture they were a part of prior to catatonia was long gone, and that they had in general lost out on decades of their lives.  Some of them became angry.

 

As Leonard regained his independence back physically and mentally, he began wanting to be free to do as he pleased.  Dr. Kaufman felt that letting him out of the institution could be detrimental.  Leonard became angry and basically attempted to escape from being “caged up”.

 

Soon thereafter, the other patients realized Leonard was regressing back to his initial symptoms and they most likely would follow suit.  They became disheartened that they were “awakened” only to eventually go back to their previous catatonic state.

 

At this point, Leonard began experiencing paranoia.  He took his anger out on Dr. Sayer, the very one who had tried to help him regain his life.  Ironically, Leonard tells Dr. Sayer that he is the one who is asleep based on his mundane, eventless lifestyle.

 

Sayer begins to back down on the dosage as the side effects surface.  He does not appear to have any scientific reasoning for the dosages he chooses.  It is almost as if he were guessing.  At this point, Dr. Sayer had become very emotionally involved with all of these patients, particularly Leonard.  This clouded his judgment and rendered him no longer objective.

This is when Ms. Lowe requests that Leonard’s participation in the research be terminated.  She had suffered great emotional stress as did Leonard and Dr. Sayer himself.  With Leonard regressing, it seemed clear to me that his mother remained in charge of decision making just as she had been before the research began.  Dr. Sayer abided by her wishes and soon Leonard was back to his catatonic, dependent state.

 

Dr. Sayer’s conclusion was that “the human spirit is more powerful than any drug and that that was what needs to be nourished.”  In a subtle secondary story line, the movie ends with Dr. Sayer ironically “awakening” to his sprouting relationship with Eleanor that even Leonard could see.  So as opposed to Sayer “awakening” Leonard, Leonard indirectly “awakens” Sayer.

 

Hardly any of the “research” Dr. Sayer does is actually by a rigid research guideline.  He alters variables such as dosage often.  He adds other variables like taking the patients on outings, the actual event of awakening them simultaneously, etc.  I am sure the real life story was more rigid than the movie portrays.