Bookpleasures.com isexcited to have as our guest, Dr. Sean Pauzauskie, author of hisdebut novel Stage of Fools.

As Medical Director of theNeurorights Foundation and a clinician who works daily with comatosepatients, Sean brings scientific authenticity to his literaryexploration of cognitive-motor dissociation—a condition wherepatients remain mentally aware while physically unresponsive. 

His novel, described as“an innovative, compelling appropriation of Shakespeare’s KingLear” by scholar David Bergeron, follows a San Franciscobillionaire trapped in a coma as his family schemes around him,forcing him to confront his life choices from the stillness of hishospital bed. 

Norm: Good day Sean andthanks for taking part in our interview. Your literary scholarshiphas been presented at Nabokov Society conferences—how did yourstudies under Vladimir Nabokov’s intellectual descendants influenceyour approach to constructing the intricate memory sequences inSteven’s comatose state? 

Could you share a specific memory sequencefrom Stage of Fools that directly reflects Nabokovian techniques, andexplain how you adapted those literary devices to convey neurologicalreality rather than just poetic fiction? 

Sean: Studying withStephen Jan Parker as my undergraduate-and-after mentor greatlyinfluenced both my dualistic intellectual worldview, which seeks toseamlessly blend art and science, as well as the approach to certainmemory sequences in this novel. As Nabokov told Steve informally andSteve shared with me during my undergraduate years: “Life isconsciousness. 

And the more conscious you are, the better your lifeis.” And so this novel is in part an attempt to further explorethat wisdom. 

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

One example in PaleFire is when Charles Kinbote hears the phrase “dead petals” inconversation and then is immediately transported to the kingdom ofZembla, to his mother’s funeral and the crushed flowers distributedby mourners.

 In one particular sequence in Stage of Fools, whilehiking in Marin County with the woman he’s in love with but hasn’ttold yet, a particular thing she says transports Steve Levinson backto a critical moment in his past, sending him into a tailspin ofmemory and emotion that adds dramatic tension to the moment he feelscompelled to possibly reveal his feelings for her to her. There areothers, but this would be one good example.

Norm: In researchingcognitive-motor dissociation, what was the most surprising patientcase that stayed with you and subtly informed the creation ofSteven’s internal narrative? 

How did learning about that particularcase change your clinical practice, and do you find yourselfapproaching patient care differently now compared to when you beganwriting this novel? 

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

There areplenty of anecdotal reports and I have seen a few surprisinginstances myself of patients who seem to respond to the presence ofloved ones in the room, as seen in things like changes in their heartrate and other vital signs, which did inform the novel — strictlyin the physical sense of patient experience, and which does thenmirror in Levinson’s internal narrative. 

These types of cases havechanged how I talk to families about what’s possibly or even likelygoing on with their loved one, in that I now tell everyone to treatit as if their loved one can hear them, despite the current lack ofability to diagnose CMD in all coma patients due to how new ourunderstanding of the condition is. 

Norm: How did youbalance the neurological accuracy of Steven’s condition with theliterary need for dramatic tension, particularly when depictingconsciousness during periods when brain imaging might suggestotherwise? Was there a moment during your writing process where youhad to choose between medical precision and narrative impact, and howdid you ultimately make that decision? 

Sean: Again, the currentlimited information on the actual experience of cognitive-motordissociation underscored the notion and need for this novel, as anact of empathy for patients who can’t speak for themselves. And sothe majority of the balance in depicting Levinson’s consciousnessas it pertains to medical precision and narrative impact iscompletely imagined. There is one sequence in particular which seeksto depict uncontrolled brain activity, which does venture intouncharted territory when it comes to dramatic tension when brainimaging might suggest a lack of conscious experience. 

Norm: Given your workwith the Neurorights Foundation, what specific privacy concernsaround neurotechnology did you deliberately omit from the novel thatyou believe the public should be discussing more openly? If you wereto write a sequel addressing these omitted concerns, whattechnological development do   you anticipate emergingin the next five years that would create the most significant ethicalchallenges for patient privacy? 

Sean: Privacy concernsaround neurotechnology are actually gathering momentum across thecountry, after we passed the first law in the world for neural dataprotection in Colorado last year — with California, Montana, andConnecticut having followed.

This is also a greatquestion pertaining to the trilogy, as the next installment, aprequel, is actually already written and in the editing process, anddeals specifically with mental privacy as its core issue pertainingto neurotechnology. 

In the next five years patients and consumers maybe faced with “thought-to-text translation” technology as anoption in daily life, meaning that one might be able to put on aneurotechnology device and simply think in order to generate writtenwords. 

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

Norm: Stage of Foolsfeatures San Francisco prominently as both setting and character—howdoes the city’s particular energy and technological culturecomplement your exploration of consciousness and identity?

 In whatways does San Francisco’s juxtaposition of technological innovationagainst human vulnerability mirror the central tension in Steven’sexperience between advanced neurotechnology and his fundamental humanhelplessness? 

Sean: San Francisco’sunique energy and tech culture I felt served as the ideal backdropfor an exploration of consciousness and identity. 

Primarily in thesense that we’re often forced to push boundaries and rely oncreative energy in order to gain new insights into what’s possible,both internally and externally. 

Internally, Levinson’s lifetimespent in The City prepares him to go inward and ask questions thatpush his own internal boundaries, notions of who he is and why heacted the way he did throughout his life, to both good and bad ends. 

Externally, San Francisco’s business culture makes something likethe ultrasonic thalamic stimulator, the device which might wake himfrom his coma, a viable and believable new way of exploring what’spossible for patients by the use of neurotechnology. 

As far asSteve’s helplessness, it is also worth noting that the greatheights of what’s possible in San Francisco also come with thedepths of a social underbelly, of those dispossessed and unable tohelp themselves in the face of economic instability. 

And so Steve’scharacter also reminds us, mirroring San Francisco’s economicpolarization and at times unstable business climate, that those whoenjoy those great heights are also not immune from experiencingcertain depths, by the city’s great churning social and financialdynamics, which continuously challenge one’s notion of who they areas they ride the City’s great and exciting waves. 

Norm: Your committeework on the House Energy and Commerce Committee involved policydiscussions about medical innovation—how did that experience shapeyour portrayal of the medical ethics committee deliberations in thenovel? Could you describe a real-world policy debate you witnessedduring your committee work that directly inspired one of the ethicaldilemmas presented in the novel’s hospital setting?

Sean: Sure. As a HouseEnergy and Commerce Committee staffer I was involved in multiplediscussions involving the ethics of scientific and health innovation. 

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

This certainly shaped my portrayal of SteveLevinson as someone who sits at the cusp of advanced innovation inhealth technology with the ultrasonic thalamic stimulator, but alsowithin the wider purview of neurotechnological advancement which inthe coming years will change our understanding of and abilities toinfluence the brain, and therefore what it means to be human. 

Whichis spurring the need for consideration of the ethical implications ofthis coming change. One related example of a policy debate from mytime in the Energy and Commerce Committee involved the creation ofthe National Stemcell Bank. 

At the time stem cells were acontroversial topic in biomedical research for their implications inunderstanding human development, and another example of theintersection of scientific revolution and ethics — the analogy tothe neurotechnological revolution being the genetic revolution thatthe promise of stem cells were created by.

 I participated in highlevel discussions between the NIH director and the chair of theEnergy and Commerce Committee that directly led to the NSCB’screation, which led to discoveries from everything from how the braindevelops in certain diseases to gut, kidney, liver discoveries, andeven the understanding of certain cancers. 

The debate in the novel ofwhether or not to use the ultrasonic thalamic stimulator to awakenLevinson was inspired by the debates I participated in regardingwhether stem cells should be allowed to enable this research, despiteits implications regarding the sanctity of stem cells as the originsof human life. The analogy being the sanctity of the human brain andmind as it pertains to neurotechnology. 

Norm: As someone whobridges medicine and literature, what unique narrative possibilitiesdoes the comatose perspective offer that traditional first- orthird-person perspectives cannot achieve? 

How does this narrativetechnique change our understanding of time and memory, and whatliterary tools did you employ to make Steven’s fragmentedconsciousness feel coherent to readers? 

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

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

Fromthis honest, isolated depth of reflection, I felt this would allowhim to change in ways he wouldn’t have if, for example, he had toargue with his family regarding what was real and imagined from hislife, whose version of the story was accurate. 

Second, I also feltthis narrative device might allow Steven’s imagination to flourishand allow the reader to make judgmentsabout what it says about him. 

If memory is imagination or a form offiction itself, as some suggest, I felt this vantage point would helpthis issue resonate on the page. The narrative tool of a braidednarrative — alternating between present and past — I felt mightmake his fragmented conscious present more coherent, pulled togetherby what we are supposed to perceive as the solidity of the past. 

Norm: In what ways doesyour experience treating epilepsy patients inform the novel’sexploration of memory, consciousness, and the fragile boundarybetween neural activity and subjective experience? 

Are there specificsymptoms or experiences from your epilepsy patients that directlyshaped how you depicted Steven’s moments of clarity versusconfusion within his coma state? 

Sean: Epilepsy is perhapsone of the most interesting neurological phenomena pertaining toconsciousness, in that most of the time patients lose consciousnessduring a seizure. 

While this is usually what serves as publicperception of what epilepsy is, I spend a decent amount of time as ahospital neurologist explaining to people that there is a gray areaof conscious awareness in epilepsy, with some types even involvingpreserved consciousness, in what we call “partial epilepsy.” 

Theterminology isn’t as important in the novel as the notion thatLevinson’s character, due to his injury, experiences symptoms ofepilepsy that falls into that gray area, with partially preservedconsciousness. 

This allows Levinson to experience both moments oflucidity and confusion as his brain reacts to his brain’s newstate, as he drifts across these fragile boundaries that you mention.It seems we would all do well at times to question the validity ofour perceptions, with Steven simply faced with a more direct andclear reason to do so. 

Norm: Walker Percy,another physician-author you’ve been compared to, explored theintersection of medicine and spirituality—how does Stage of Foolsengage with spiritual dimensions of consciousness that medicaltechnology cannot measure? 

Given your dual perspective as bothneurologist and writer, where do you personally draw the line betweenwhat can be measured neurologically and what might representsomething beyond current scientific understanding? 

Sean: This is an importantquestion, as today more than ever we’ve become obsessed — and formostly good reason — with measuring things in medicine. So muchthat we’re at the point where testing in the hospital has takenprecedent over the human elements of healing. 

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

I would draw the line when it comes tophysical correlates of consciousness and these spiritual dimensionswhich go beyond scientific understanding.

 I ammarried to a hospital chaplain who I often joke takes over whenattempts to treat the physical fail, however hard pressed to admitour limitations to do so. 

Norm: In developingSteven’s character arc, which historical accounts of near-deathexperiences or consciousness during unconscious states mostprofoundly shaped your understanding of what such an experience mightfeel like? 

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

Sean: Historical accountsof near-death experiences tend to focus on things like people beingoutside of their bodies, looking down on themselves, being visited bydeceased relatives or loved ones, and tunnels of light that appearfor people to follow. 

And as I said before, reports on people’sstate of mind during cognitive-motor dissociation are still emergingas part of the qualitative research. 

Ultimately, I chose not toinclude too many of these throughout the narrative, as I wanted tokeep it focused on Steve’s memory and assessment of his life, aswell as what was happening in the present moment. 

And as far as I’mconcerned, nothing is improbable when it comes to consciousexperience when on the edge between life and death. But for thisnovel I wanted to imagine something possible and new rather thanmerely draw on what’s been reported in the past, while I doincorporate certain elements of previous reports in a few places. 

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

Sean: To learn more aboutme and the Neurorights work, I’d encourage potential readers toGoogle “Sean Pauzauskie Neurorights”, which will produce a listof articles and other informational materials. 

To learn more aboutStage of Fools, please visit: MY WEBSITE

Norm: As our interviewcomes to an end, the novel’s October 2025 release coincides withrapidly advancing neurotechnology—what conversation do you hopeStage of Fools sparks between neurologists, ethicists, patients, andpolicymakers about where we’re headed as consciousness becomesincreasingly measurable and potentially modifiable? 

If you couldgather three specific stakeholders in one room to discuss theimplications of your novel, who would they be, and what singlequestion would you pose to them to advance the conversation mostproductively? 

Sean: I would gather theFDA Director from government, from industry Tan Le of the companyEmotiv, and from academia, Dr. Rafael Yuste, and I would ask them:what kind of future do you wantfor the human brain and mind, both in terms of possibility andaddressing potential perils? 

How do we ensure that only the goodcomes of neurotechnology for patients and healthy people? And how dowe build that future of amazing benefits while avoiding risktogether?

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