Reaching Down the Rabbit Hole: A Renowned Neurologist Explains the Mystery and Drama of Brain Disease

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Apropos of nothing really, but this reminds me of British game shows. It is very alien to the British to applaud oneself or one's accomplishments, whereas Americans jump up and down and shout out how proud they are of themselves, this makes British people cringe. However, it makes much more exciting television, so the producers now have got the British to run around arms in the air shouting out and generally looking awkard and embarrassed. Everyone feels the same inside, it's just a difference in expression and probably the one people prefer is the one of the culture they were brought up in. She called their primary care physician, who told her to get him to the emergency room immediately. In stark educational contrast is the decision to visit George, a patient not seen since being diagnosed with Motor Neurone Disease more than five years before. George is at home, tetraplegic and ventilated. Ropper describes a conversation wherein he explains to George, and George’s wife, his recent role in allowing a patient with motor neurone disease to die. Ropper asks “Are you a little bummed out that I would be part of this?”. Thankfully, they assure him that they are in support of people making their own decisions under such circumstances. While Lewis Carroll's Alice's Adventures in Wonderland is the source of the title, the theme of implausible reality in neurologic practice comes from the White Queen of Through the Looking-Glass. Neurology is queen of the medical specialties, says Ropper. Like Wells, a queen among Gothic cathedrals, she is neither the biggest nor necessarily the best but few exceed her for finesse and elegance. He talks about very unusual presentations of neurological problems and odd presentations. The title comes from wanting to go down the diagnostic rabbit hole to try to get the patient out. There are cases discussed about confusion, malingering and functional problems, and motor neurone disease. In fact two patients are highlighted, one who decides that this is no life to carry on with and the description of her demise is quite uncomfortable. The other takes life by the horns and carries on in spite of considerable adversity, although admittedly helped by their very supportive wife and insurance company (great if you have the cover). Parkinson’s Disease is also studied and in particular the relationship with celebrity Michael J. Fox, who was one of his patients.

Here also is a compelling debate about the religious, medical and philosophical basis of life and death and the conflict of interest between definitions of death and the field of organ transplantation. I’m not sure that those statistics are entirely up to date, but in any case this is not a book for hypochondriacs or anyone who worries that their difficulty in remembering film stars’ names might stem from something more troubling than unmemorable film stars. Because the fear it plays on, consciously or not, is the sudden and cruel inversion of normality. He had a bad headache from the beginning," she told me, "and a fever." The residents had neglected to mention this, but it was important. There is an old joke among stand-up comics that goes: "Dying is easy, comedy is hard." If we were as inner-directed as comedians, we neurologists might say, "Trauma is easy, neurology is hard." Every one of our patients has, in effect, fallen into a hole, and it's our job is to get them out again. Reaching Down the Rabbit Hole A Renowned Neurologist Explains the Mystery and Drama of Brain DiseaseI've rounded up the book from a very precise 2.75 to a 3 because it wasn't a bad read, just not a very good one. An in-the-trenches exploration of the challenging world of the clinical neurologist. From the quotidian to the exotic, from the heart-breaking to the humorous, the authors present an honest and compelling look at one of medicine's most fascinating specialties. * Dr Michael Collins, author of Hot Lights, Cold Steel * CT imaging scans are everywhere, as illegible to the general viewer as a Rorschach test, but deemed the (often bogus) sine qua non of scientific credibility for all matters psychological.

Yet this unreliability is itself a window into another reality, the distorted Alice in Wonderland world to which the title refers and in which neurological patients are wont to find themselves tormentingly trapped. That's because you're missing the right side of the world. You might not be aware of it, but your vision on the right is diminished because of one of the very early strokes. Are you a different person now?"

Two hours later, when she was wheeled into the ICU, Cindy looked toxically ill, with a heart rate of 135 beats per minute and blood pressure of 160/90. She was sweating, salivating, and shivering wildly. Her eyes were wide open but she was by now entirely unresponsive. Her jittery limbs seemed as if they wanted to convulse. Joelle, the senior ICU resident, Hannah's counterpart down on the ninth floor, immediately intubated her.

Holy cow!" I said. "It's an ovarian teratoma. You'd better send her over." It was a snap diagnosis, possibly wrong, but there was no harm in raising on a pair of aces. I had a pretty good idea what the other cards would be: memory deficits, gooseflesh, a high heart rate, and no family history of psychosis. The drooling alone was a tip-off. Neurologists aren't very nice to each other and to other doctors consulting on a case. There is a lot of ego jousting. The author of this book tries hard to be humble, but it's evident that he has high regard for himself and his abilities and unique diagnoses. Reaching Down the Rabbit Hole does not particularly try to be funny, yet its commentary on how events happen to arrange themselves has a comic sensibility. Ropper's mirthless exchange of one-liner jokes with a hospital visitor who turns out to be a former comedy writer establishes a fellowship between the men and helps us understand the origins of this show business take on clinical neurology. This isn’t a beginners guide to neurology and psychiatry, but it is well explained and rationale is given for decisions made by the author and his team for the care of his patients.I wish I was smart enough to become a doctor because I think their work is so interesting particularly neurology. Dr. Ropper, Reaching Down The Rabbit Hole makes this point with his tales of the variety of illnesses, accidents, and medical conditions neurologists treat. He calls neurology the Queen of medicine because of its diversity. Reading this is like being a fly on the wall in a neurology ward. There are some real characters, and some real highs and lows. It’s in part an eye opening education and part like watching a car crash. Allan Ropper's new memoir, Reaching Down the Rabbit Hole, has the hard-boiled style of a Raymond Chandler novel. Like a real-life Dr House, Ropper follows hunches and has sudden startling insights. * The Times *