This is the second major opera based on the writings of British neurologist Oliver Sacks, whose case study “The Man Who Mistook His Wife for a Hat” was adapted by Michael Nyman in 1986.

“Awakenings,” by American composer Tobias Picker, is inspired by Sacks’ 1973 account of treating victims of encephalitis lethargica. Nicknamed the “sleeping sickness,” this coma-like condition is marked by catatonia and hypersomnia. In the late 1960s, while serving on staff at a Beth Abraham Hospital in the Bronx, Sacks encountered a group of individuals suffering from the illness. His experiments with the anti-Parkinson’s medication L-DOPA “awakened” these patients, but their revivification was tragically short-lived. Uncontrollable tics and psychotic side effects soon took over, and the drug was stopped, causing many of the patients to slip back into their somnolent states.

Recorded in 2023 on Boston Modern Orchestra Project’s (BMOP) in-house label, “Awakenings” premiered a year earlier at Opera Theatre of Saint Louis. Picker first adapted the story as a 20-minute ballet in 2010, though from what’s available of that piece online, it doesn’t sound like he recycled any significant stretches of the score in his operatic version. The subject matter may seem rather unusual for Picker, given the verismo tales of murder and forbidden desire he typically favors for his operas. But in fact, he was close friends with the late Sacks, who helped the composer work through his Tourette’s. Moreover, Picker’s husband Aryeh Lev Stollman—who penned the libretto for “Awakenings”—is himself a physician/author like Sacks.

Highly fictionalized doctor dramas certainly make for engaging soap operas. But the real-life minutiae of the medical field—all the diagnosing, prescribing, monitoring, and rehabilitating—wouldn’t seem to lend themselves to the stage, no matter how theatrically miraculous the cure is. Nevertheless, Picker and Stollman make a case, at least in the opera’s initial scenes. The expertly crafted opening sequence features a choral retelling of the Sleeping Beauty myth. Subgroups of the Odyssey Opera choir trade off phrases of a folksong-like melody that melancholically conveys a sense of powerlessness. All the while, the BMOP, conducted by Gil Rose, plods steadily through monotone repetitions of the pitch A, standing in for the patients’ statuesque immobility.

As the act unfolds, Picker traces the sleepers’ return to life through simple yet effective musical means. Scene three introduces a lethargic ostinato on piano, cycling endlessly on D—F—E. When the L-DOPA doses finally kick in for patient Leonard, this three-note figure gradually picks up in tempo, and a soaring solo-violin line manages to break free from the static pattern. In the episode that follows, a buoyant waltz theme reminiscent of Janáček’s “Jenůfa” prelude takes over as more patients regain their movement. However, it’s soon supplanted by a new motive that instills a tinge of unease—a rocking perfect fifth that suddenly sinks a half-step downward to a minor sixth. It perfectly captures Dr. Sacks’ ominous remark about the “glorious yet foreboding” summer days his patients are enjoying for the first time in years.

While Penny Marshall’s 1990 film adaptation of “Awakenings” focuses almost exclusively on Robert De Niro’s Leonard, Stollman divides the narrative among Leonard and two other patients, Miriam and Rose—a charming pair of gal pals played with equal parts pathos and humor by soprano Joyce El-Khoury and mezzo Adrienne Danrich, respectively. We see brief glimpses into their pre-disease lives, we witness them reconnecting with family, and we hear their mixed feelings of delight and disorientation at having been pulled into a present they don’t recognize. Yet the opera starts to lose momentum here, with each scene falling into a predictable structure—a long, meandering stretch of arioso dialogue culminating in a sweeping ensemble number. We’re supposed to be touched by these more lyrical moments, and Picker’s Sondheimian vocal writing is certainly lovely. But Stollman’s text often lacks the poetry needed to communicate the characters’ emotional extremes in any depth.

By the time the curtain closes, it’s not clear what we’re meant to take away. Some cheap carpe diem platitude would surely ring hollow. But otherwise, all we’re left with is overwhelming frustration. Before our eyes, a group of innocent invalids has been resurrected, teased with the illusion of recovery, and then dispatched back into oblivion. Even the small taste of normalcy they regain is fraught with disappointment. Stollman establishes a love triangle among Leonard, the fictional Nurse Rodriguez, and Dr. Sacks, who only came out publicly in the last year of his life. Tenors César Delgado as Rodriguez and Andrew Morstein as Leonard express their private longings in bittersweet torch songs, crowned by aching, Italianate top notes. Morstein’s sweetly naïve head voice and tone of youthful infatuation is particularly affecting, given that he’s playing a middle-aged patient who was robbed of his adolescence. Yet all this pining remains closeted and unrequited—the sad reality for many gay men of the era, but one that only exacerbates the numbing dissatisfaction of this opera.

In their liner notes, the creators claim they tried to maintain an objective stance to the story. Yet there are subtle manipulations, both in the score and in the performances, that musically divide the characters into good and bad guys. Sacks is undeniably framed as the former: baritone Jarrett Porter delivers the doctor’s reassurances with fatherly compassion, his tone giving way to defeated exhaustion when he realizes the repercussions of his actions. In a heartfelt monologue redolent of Britten’s “Peter Grimes,” he admits his hubris over the plodding “statue” ostinato of the opening chorus. Yet Sacks never seems to fully take responsibility, pinning his flaws on the homophobic rejection of his mother, which we see in an awkwardly shoehorned flashback.

Once it sets in that a terrible medical injustice has taken place, our frustration inevitably hardens into anger. Indeed, one’s views on the doctors in charge totally transform—perhaps in spite of Picker and Stollman’s intentions. Ultimately, it’s the would-be antagonist who honestly articulates the ethical dilemma raised here. The hospital’s medical chief—whose ridiculous name “Podsnap” is taken from the bigoted buffoon of Dickens’ “Our Mutual Friend”—is portrayed with Verdian villainy by bass Keith Klein. It’s Sacks, we’re told again and again, who treats his patients with selfless love while Podsnap is the rigid authoritarian, initially rejecting the request to administer L-DOPA. By the end of the opera, however, Podsnap’s seemingly small-minded admonition, “We don’t experiment here,” comes off retrospectively like the kind of prudent wisdom needed to make a morally complex decision. Although Klein never sheds his air of stubborn arrogance in the character’s final aria, Podsnap’s closing words impart the hard truth we need to hear: “Can it be wrong to have tried? I don’t know. Though in the end I did not protect them.”

While it’s possible to write a successful opera steeped in ambiguity that doesn’t furnish us with firm answers, “Awakenings” hits a strange nerve. Audiences will make of it what they will. After wrestling with the recording several times, this listener was forced to relinquish with a shoulder-shrugging, “There but for the grace of God go I.” Picker and Stollman themselves seem to leave us with a comparable shrug-like gesture of resignation, reprising the Sleeping Beauty chorus in the final bars with new text: “No prince, no love, nor God Himself, / Did change what Fate ordained.”