Bookpleasures.com is excited to have as our guest, Dr. Sean Pauzauskie, author of his debut novel Stage of Fools.

As Medical Director of the Neurorights Foundation and a clinician who works daily with comatose patients, Sean brings scientific authenticity to his literary exploration of cognitive-motor dissociation—a condition where patients remain mentally aware while physically unresponsive. 

His novel, described as "an innovative, compelling appropriation of Shakespeare's King Lear" by scholar David Bergeron, follows a San Francisco billionaire trapped in a coma as his family schemes around him, forcing him to confront his life choices from the stillness of his hospital bed. 

Norm: Good day Sean and thanks for taking part in our interview. Your literary scholarship has been presented at Nabokov Society conferences—how did your studies under Vladimir Nabokov's intellectual descendants influence your approach to constructing the intricate memory sequences in Steven's comatose state? 

Could you share a specific memory sequence from Stage of Fools that directly reflects Nabokovian techniques, and explain how you adapted those literary devices to convey neurological reality rather than just poetic fiction? 

Sean: Studying with Stephen Jan Parker as my undergraduate-and-after mentor greatly influenced both my dualistic intellectual worldview, which seeks to seamlessly blend art and science, as well as the approach to certain memory sequences in this novel. As Nabokov told Steve informally and Steve shared with me during my undergraduate years: "Life is consciousness. 

And the more conscious you are, the better your life is." And so this novel is in part an attempt to further explore that wisdom. 

As it pertains to memory sequences and in the novel in particular, Nabokov was fond of representing sensory triggers for his characters that serve as portals into the past. 

One example in Pale Fire is when Charles Kinbote hears the phrase "dead petals" in conversation and then is immediately transported to the kingdom of Zembla, to his mother's funeral and the crushed flowers distributed by mourners.

 In one particular sequence in Stage of Fools, while hiking in Marin County with the woman he's in love with but hasn't told yet, a particular thing she says transports Steve Levinson back to a critical moment in his past, sending him into a tailspin of memory and emotion that adds dramatic tension to the moment he feels compelled to possibly reveal his feelings for her to her. There are others, but this would be one good example.

Norm: In researching cognitive-motor dissociation, what was the most surprising patient case that stayed with you and subtly informed the creation of Steven's internal narrative? 

How did learning about that particular case change your clinical practice, and do you find yourself approaching patient care differently now compared to when you began writing this novel? 

Sean: The current state of CMD research focuses more on detection of the condition itself than on the phenomenological experience of the disorder, which is one reason I thought writing a novel about it might make sense. 

There are plenty of anecdotal reports and I have seen a few surprising instances myself of patients who seem to respond to the presence of loved ones in the room, as seen in things like changes in their heart rate and other vital signs, which did inform the novel — strictly in the physical sense of patient experience, and which does then mirror in Levinson's internal narrative. 

These types of cases have changed how I talk to families about what's possibly or even likely going on with their loved one, in that I now tell everyone to treat it as if their loved one can hear them, despite the current lack of ability to diagnose CMD in all coma patients due to how new our understanding of the condition is. 

Norm: How did you balance the neurological accuracy of Steven's condition with the literary need for dramatic tension, particularly when depicting consciousness during periods when brain imaging might suggest otherwise? Was there a moment during your writing process where you had to choose between medical precision and narrative impact, and how did you ultimately make that decision? 

Sean: Again, the current limited information on the actual experience of cognitive-motor dissociation underscored the notion and need for this novel, as an act of empathy for patients who can't speak for themselves. And so the majority of the balance in depicting Levinson's consciousness as it pertains to medical precision and narrative impact is completely imagined. There is one sequence in particular which seeks to depict uncontrolled brain activity, which does venture into uncharted territory when it comes to dramatic tension when brain imaging might suggest a lack of conscious experience. 

Norm: Given your work with the Neurorights Foundation, what specific privacy concerns around neurotechnology did you deliberately omit from the novel that you believe the public should be discussing more openly? If you were to write a sequel addressing these omitted concerns, what technological development do   you anticipate emerging in the next five years that would create the most significant ethical challenges for patient privacy? 

Sean: Privacy concerns around neurotechnology are actually gathering momentum across the country, after we passed the first law in the world for neural data protection in Colorado last year — with California, Montana, and Connecticut having followed.

This is also a great question pertaining to the trilogy, as the next installment, a prequel, is actually already written and in the editing process, and deals specifically with mental privacy as its core issue pertaining to neurotechnology. 

In the next five years patients and consumers may be faced with "thought-to-text translation" technology as an option in daily life, meaning that one might be able to put on a neurotechnology device and simply think in order to generate written words. 

Ethically, however, as you can imagine, this could pose ethical challenges regarding a patient or consumer's right not to have their innermost thoughts uploaded to a company's databank, or their mind to be read by such devices in the first place. 

Norm: Stage of Fools features San Francisco prominently as both setting and character—how does the city's particular energy and technological culture complement your exploration of consciousness and identity?

 In what ways does San Francisco's juxtaposition of technological innovation against human vulnerability mirror the central tension in Steven's experience between advanced neurotechnology and his fundamental human helplessness? 

Sean: San Francisco's unique energy and tech culture I felt served as the ideal backdrop for an exploration of consciousness and identity. 

Primarily in the sense that we're often forced to push boundaries and rely on creative energy in order to gain new insights into what's possible, both internally and externally. 

Internally, Levinson's lifetime spent in The City prepares him to go inward and ask questions that push his own internal boundaries, notions of who he is and why he acted the way he did throughout his life, to both good and bad ends. 

Externally, San Francisco's business culture makes something like the ultrasonic thalamic stimulator, the device which might wake him from his coma, a viable and believable new way of exploring what's possible for patients by the use of neurotechnology. 

As far as Steve's helplessness, it is also worth noting that the great heights of what's possible in San Francisco also come with the depths of a social underbelly, of those dispossessed and unable to help themselves in the face of economic instability. 

And so Steve's character also reminds us, mirroring San Francisco's economic polarization and at times unstable business climate, that those who enjoy those great heights are also not immune from experiencing certain depths, by the city's great churning social and financial dynamics, which continuously challenge one's notion of who they are as they ride the City's great and exciting waves. 

Norm: Your committee work on the House Energy and Commerce Committee involved policy discussions about medical innovation—how did that experience shape your portrayal of the medical ethics committee deliberations in the novel? Could you describe a real-world policy debate you witnessed during your committee work that directly inspired one of the ethical dilemmas presented in the novel's hospital setting?

Sean: Sure. As a House Energy and Commerce Committee staffer I was involved in multiple discussions involving the ethics of scientific and health innovation. 

At the time the National Institutes of Health was in a sort of review process, and not only were the ethics and politics of the commercialization of scientific advancements coming out of the Institutes discussed, but the very ethics of the scientific process itself as it pertained the three-part relationship of government, academia, and industry. 

This certainly shaped my portrayal of Steve Levinson as someone who sits at the cusp of advanced innovation in health technology with the ultrasonic thalamic stimulator, but also within the wider purview of neurotechnological advancement which in the coming years will change our understanding of and abilities to influence the brain, and therefore what it means to be human. 

Which is spurring the need for consideration of the ethical implications of this coming change. One related example of a policy debate from my time in the Energy and Commerce Committee involved the creation of the National Stemcell Bank. 

At the time stem cells were a controversial topic in biomedical research for their implications in understanding human development, and another example of the intersection of scientific revolution and ethics — the analogy to the neurotechnological revolution being the genetic revolution that the promise of stem cells were created by.

 I participated in high level discussions between the NIH director and the chair of the Energy and Commerce Committee that directly led to the NSCB's creation, which led to discoveries from everything from how the brain develops in certain diseases to gut, kidney, liver discoveries, and even the understanding of certain cancers. 

The debate in the novel of whether or not to use the ultrasonic thalamic stimulator to awaken Levinson was inspired by the debates I participated in regarding whether stem cells should be allowed to enable this research, despite its implications regarding the sanctity of stem cells as the origins of human life. The analogy being the sanctity of the human brain and mind as it pertains to neurotechnology. 

Norm: As someone who bridges medicine and literature, what unique narrative possibilities does the comatose perspective offer that traditional first- or third-person perspectives cannot achieve? 

How does this narrative technique change our understanding of time and memory, and what literary tools did you employ to make Steven's fragmented consciousness feel coherent to readers? 

Sean: The narrative possibilities of a comatose patient serves two important reasons. 

The stillness of a coma, first, I felt might help portray Steven's development. He'd be able to narrate with more candor — and in a less inhibited way. With no one there to argue the facts with him, he'd be able to remember everything from deep within his mind. 

From this honest, isolated depth of reflection, I felt this would allow him to change in ways he wouldn't have if, for example, he had to argue with his family regarding what was real and imagined from his life, whose version of the story was accurate. 

Second, I also felt this narrative device might allow Steven's imagination to flourish and allow the reader to make judgments about what it says about him. 

If memory is imagination or a form of fiction itself, as some suggest, I felt this vantage point would help this issue resonate on the page. The narrative tool of a braided narrative — alternating between present and past — I felt might make his fragmented conscious present more coherent, pulled together by what we are supposed to perceive as the solidity of the past. 

Norm: In what ways does your experience treating epilepsy patients inform the novel's exploration of memory, consciousness, and the fragile boundary between neural activity and subjective experience? 

Are there specific symptoms or experiences from your epilepsy patients that directly shaped how you depicted Steven's moments of clarity versus confusion within his coma state? 

Sean: Epilepsy is perhaps one of the most interesting neurological phenomena pertaining to consciousness, in that most of the time patients lose consciousness during a seizure. 

While this is usually what serves as public perception of what epilepsy is, I spend a decent amount of time as a hospital neurologist explaining to people that there is a gray area of conscious awareness in epilepsy, with some types even involving preserved consciousness, in what we call "partial epilepsy." 

The terminology isn't as important in the novel as the notion that Levinson's character, due to his injury, experiences symptoms of epilepsy that falls into that gray area, with partially preserved consciousness. 

This allows Levinson to experience both moments of lucidity and confusion as his brain reacts to his brain's new state, as he drifts across these fragile boundaries that you mention. It seems we would all do well at times to question the validity of our perceptions, with Steven simply faced with a more direct and clear reason to do so. 

Norm: Walker Percy, another physician-author you've been compared to, explored the intersection of medicine and spirituality—how does Stage of Fools engage with spiritual dimensions of consciousness that medical technology cannot measure? 

Given your dual perspective as both neurologist and writer, where do you personally draw the line between what can be measured neurologically and what might represent something beyond current scientific understanding? 

Sean: This is an important question, as today more than ever we've become obsessed — and for mostly good reason — with measuring things in medicine. So much that we're at the point where testing in the hospital has taken precedent over the human elements of healing. 

And you're right that a distinction must be made between what can and cannot be measured. Things like trust, empathy, compassion, and hope are all essential elements to the healing process, while there is no metric that can capture them in the clinic. 

I would draw the line when it comes to physical correlates of consciousness and these spiritual dimensions which go beyond scientific understanding.

 I am married to a hospital chaplain who I often joke takes over when attempts to treat the physical fail, however hard pressed to admit our limitations to do so. 

Norm: In developing Steven's character arc, which historical accounts of near-death experiences or consciousness during unconscious states most profoundly shaped your understanding of what such an experience might feel like? 

Were there any accounts you ultimately decided not to incorporate because they felt too improbable for your narrative, and how did you determine where to draw that line between medical possibility and literary credibility? 

Sean: Historical accounts of near-death experiences tend to focus on things like people being outside of their bodies, looking down on themselves, being visited by deceased relatives or loved ones, and tunnels of light that appear for people to follow. 

And as I said before, reports on people's state of mind during cognitive-motor dissociation are still emerging as part of the qualitative research. 

Ultimately, I chose not to include too many of these throughout the narrative, as I wanted to keep it focused on Steve's memory and assessment of his life, as well as what was happening in the present moment. 

And as far as I'm concerned, nothing is improbable when it comes to conscious experience when on the edge between life and death. But for this novel I wanted to imagine something possible and new rather than merely draw on what's been reported in the past, while I do incorporate certain elements of previous reports in a few places. 

Norm: Where can our readers find out more about you and Stage of Fools? 

Sean: To learn more about me and the Neurorights work, I'd encourage potential readers to Google "Sean Pauzauskie Neurorights", which will produce a list of articles and other informational materials. 

To learn more about Stage of Fools, please visit: MY WEBSITE

Norm: As our interview comes to an end, the novel's October 2025 release coincides with rapidly advancing neurotechnology—what conversation do you hope Stage of Fools sparks between neurologists, ethicists, patients, and policymakers about where we're headed as consciousness becomes increasingly measurable and potentially modifiable? 

If you could gather three specific stakeholders in one room to discuss the implications of your novel, who would they be, and what single question would you pose to them to advance the conversation most productively? 

Sean: I would gather the FDA Director from government, from industry Tan Le of the company Emotiv, and from academia, Dr. Rafael Yuste, and I would ask them: what kind of future do you want for the human brain and mind, both in terms of possibility and addressing potential perils? 

How do we ensure that only the good comes of neurotechnology for patients and healthy people? And how do we build that future of amazing benefits while avoiding risk together?

Norm: Thanks once again and good luck with all of your endeavors