Everything in Its Place by Oliver Sacks;

Author:Oliver Sacks; [Sacks, Oliver]
Language: eng
Format: epub
Publisher: Penguin Random House LLC
Published: 2019-04-23T00:00:00+00:00

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I FIRST MET Mr. K. about six months after this, in March 2002. He was a tall, amiable man, well dressed, affable, and voluble. He presented his story rationally and consecutively, but with numerous asides. (It was not clear how much he was recollecting his own experiences, and how much he had been told his story by others, and now had it well rehearsed and fluent.) He was persuasive and charming, and talked freely about other aspects of his life—his interest in art, his wish to write a book about more than a hundred little-known art museums in Europe and to make a virtual online museum of their treasures. He was exuberant, expansive and loquacious when he spoke of all this, and I wondered whether there was an impulsive, “frontal-lobe” flavor to his thinking, as might happen with an incipient frontotemporal dementia. And yet I could not be sure without knowing the patient for a longer time, in depth; perhaps, as his wife insisted, this high-energy ebullience was normal for him.

Recent neurobehavioral testing had revealed that he still showed a tendency to perseveration, impulsivity, inattentiveness in scanning, and memory retrieval deficits—a pattern suggestive, though not diagnostic, of mild frontal lobe and hippocampal dysfunction.

My neurological examination of Mr. K. was unremarkable, apart from a tremor of his left hand. He had now been off all drugs for several weeks, and his mild parkinsonism had almost entirely disappeared. It was evident, however, that he and his wife were haunted by the uncertainty his physicians had expressed, and which they themselves shared. “Hopefully a steroid psychosis is what it was,” Mr. K. said, “but there may have been other underlying causes. Maybe the beginnings of Alzheimer’s. What concerns me is that there was no definitive diagnosis. Was it just steroids, or something more serious coming around the bend?” If there was indeed a neurological disease, temporarily unmasked or unleashed by the steroids, was it not still hanging over him, waiting to cause a more irrevocable dementia? Both husband and wife used the term “lurking,” and wondered if there was anything more to be done to provide reassurance and a clearer diagnosis.

I could not give the definitive answer they wanted—the whole business was a strange one. There was dispute in the neurological literature as to whether such an entity as “steroid-induced dementia” even existed, and, if so, what its prognosis might be—recovery had been reported in some cases, not in others.

Unable to offer Mr. K. a conclusive diagnosis but reassured by his manifest improvement, I advised him to resume all of his normal activities, hoping that his work, which necessitated much traveling and making complex decisions and negotiations, would give him some reassurance, along with a renewed sense of identity and optimism. When I next saw him, six months later, he told me he had indeed been working very hard: “My illness cost my business dearly. I’m trying to put it back together again.”

I followed up with Mr. K. at

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