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

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"Tell the doctor where it hurts." It sounds simple enough, unless the problem affects the very organ that produces awareness and generates speech. What is it like to try to heal the body when the mind is under attack? In this book, Dr. Allan Ropper and Brian Burrell take the reader behind the scenes at Harvard Medical School's neurology unit to show how a seasoned diagnost "Tell the doctor where it hurts." It sounds simple enough, unless the problem affects the very organ that produces awareness and generates speech. What is it like to try to heal the body when the mind is under attack? In this book, Dr. Allan Ropper and Brian Burrell take the reader behind the scenes at Harvard Medical School's neurology unit to show how a seasoned diagnostician faces down bizarre, life-altering afflictions. Like Alice in Wonderland, Dr. Ropper inhabits a world where absurdities abound: • A figure skater whose body has become a ticking time-bomb • A salesman who drives around and around a traffic rotary, unable to get off • A college quarterback who can't stop calling the same play • A child molester who, after falling on the ice, is left with a brain that is very much dead inside a body that is very much alive • A mother of two young girls, diagnosed with ALS, who has to decide whether a life locked inside her own head is worth living How does one begin to treat such cases, to counsel people whose lives may be changed forever? How does one train the next generation of clinicians to deal with the moral and medical aspects of brain disease? Dr. Ropper and his colleague answer these questions by taking the reader into a rarified world where lives and minds hang in the balance.

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"Tell the doctor where it hurts." It sounds simple enough, unless the problem affects the very organ that produces awareness and generates speech. What is it like to try to heal the body when the mind is under attack? In this book, Dr. Allan Ropper and Brian Burrell take the reader behind the scenes at Harvard Medical School's neurology unit to show how a seasoned diagnost "Tell the doctor where it hurts." It sounds simple enough, unless the problem affects the very organ that produces awareness and generates speech. What is it like to try to heal the body when the mind is under attack? In this book, Dr. Allan Ropper and Brian Burrell take the reader behind the scenes at Harvard Medical School's neurology unit to show how a seasoned diagnostician faces down bizarre, life-altering afflictions. Like Alice in Wonderland, Dr. Ropper inhabits a world where absurdities abound: • A figure skater whose body has become a ticking time-bomb • A salesman who drives around and around a traffic rotary, unable to get off • A college quarterback who can't stop calling the same play • A child molester who, after falling on the ice, is left with a brain that is very much dead inside a body that is very much alive • A mother of two young girls, diagnosed with ALS, who has to decide whether a life locked inside her own head is worth living How does one begin to treat such cases, to counsel people whose lives may be changed forever? How does one train the next generation of clinicians to deal with the moral and medical aspects of brain disease? Dr. Ropper and his colleague answer these questions by taking the reader into a rarified world where lives and minds hang in the balance.

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

  1. 5 out of 5

    Petal Eggs

    I have a great interest in neurology, psychoneurology especially. I really like Oliver Sacks, except when he concentrates on himself, i don't find him as interesting as a neurological example as he does himself. Better is Harold Klawans who tells neurological stories with lots of 'ah-ha' moments. It is my perception that Allan Ropper is just too delighted with himself. The book is patronising in tone and very self-congratulatory. I mean, he's just such a genius and has to let us know it. I know I have a great interest in neurology, psychoneurology especially. I really like Oliver Sacks, except when he concentrates on himself, i don't find him as interesting as a neurological example as he does himself. Better is Harold Klawans who tells neurological stories with lots of 'ah-ha' moments. It is my perception that Allan Ropper is just too delighted with himself. The book is patronising in tone and very self-congratulatory. I mean, he's just such a genius and has to let us know it. I know it is an American thing to blow one's own trumpet loudly and a European, particularly British thing, to be self-deprecating at all times even though it's quite fake, but nonetheless I didn't enjoy the tone of the book. (view spoiler)[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. (hide spoiler)] Some of the stories are quite good. Especially of the girl who was displaying all the symptoms of psychosis and needed locking up but was cured within a few hours of having a teratoma (tumour with bits of hair, brain, bone all kind of inappropriate things) removed along with the ovary it was growing on. The symptom that clinched the diagnosis? She was frothing at the mouth, like a rabid dog. Something I learned from the book. That what a patient reports are symptoms and they are all subjective, things we feel, and have to be taken at face value. But what a doctor sees are signs, and they are objective. I'd never thought of it that way. Put the two together and you are on your way to a diagnosis. I'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.

  2. 5 out of 5

    Dan

    As a retired neurologist, I really wanted to like this book, but I found it very disappointing. I have tremendous respect for Dr. Ropper. Principles of Neurology, the textbook of neurology that he currently edits, is still my favorite introduction to general neurology. I have heard him speak several times and always found him to be an eloquent and thoughtful speaker. This book seemed to have been written by someone else and perhaps it was. Most disturbing was the dismissive and patronizing attit As a retired neurologist, I really wanted to like this book, but I found it very disappointing. I have tremendous respect for Dr. Ropper. Principles of Neurology, the textbook of neurology that he currently edits, is still my favorite introduction to general neurology. I have heard him speak several times and always found him to be an eloquent and thoughtful speaker. This book seemed to have been written by someone else and perhaps it was. Most disturbing was the dismissive and patronizing attitude towards patients with conversion disorder and other psychogenic causes of neurologic-like syndromes. I have always tried to teach my residents and students that these patients are perhaps the most challenging patients we see because they not infrequently also have a real neurological problem hidden amongst the psychiatric noise, and missing this can be catastrophic and even fatal. I will never forget a patient who died of "pseudoseizures." She had been sent to the hospital for an EEG but started having continuous seizures before reaching the EEG lab. Her attending neurologist insisted these were pseudoseizures and did not need to be treated. By the time it was recognized that she was truly in status epilepticus (continued or repetitive seizures) her brain had been permanently injured and she died. It turned out that she had unrecognized porphyria, a metabolic disorder that can cause psychiatric problems as well as neurological problems including seizures. At the very least, most patients with psychogenic neurologic-like disorders have symptoms that are real to them, and they deserve to be treated with compassion, respect, thoroughness, and honesty.

  3. 4 out of 5

    K.J. Charles

    A moderately interesting story of the life of a neurologist, marred by the gigantic ego of the author. I'm sure you need a gigantic ego to do the job and there are plenty of stories where he gets stuff wrong (at first, before getting it right obv) but the overall impression is of being sat next to someone at a dinner party who starts off seeming an absolutely fascinating and enthralling raconteur and by the third course you're wondering who you ought to stab in the eye with a dessert fork: yours A moderately interesting story of the life of a neurologist, marred by the gigantic ego of the author. I'm sure you need a gigantic ego to do the job and there are plenty of stories where he gets stuff wrong (at first, before getting it right obv) but the overall impression is of being sat next to someone at a dinner party who starts off seeming an absolutely fascinating and enthralling raconteur and by the third course you're wondering who you ought to stab in the eye with a dessert fork: yourself or him. This is not helped by the "I don't care, sod off" attitude he (his persona) takes to people with psychosomatic conditions, many of whom seem to have been sexually abused. He sees someone who is literally so traumatised by family abuse their entire body stops functioning, and his attitude is "stop wasting my time, I have real patients to help" rather than, I dunno, "let me refer you to another department and ideally the police". And yet the narrator repeatedly applauds himself for his own humanity, humility, kindness, and willingness to listen compared to other neurologists. It makes you wonder what the rest of them are like.

  4. 4 out of 5

    Nikki

    Reaching Down the Rabbit Hole is a really fascinating book. It's a little fictionalised, so we get dialogues and little portraits of character, enough that we can care about the cases discussed. Dr Ropper is pretty much everything an ideal doctor should be: knowledgeable, capable of acting fast, capable of explaining complex processes clearly, intuitive, willing to listen, willing to admit he's wrong... At every stage, he emphasises to the reader and to the residents he's teaching that each case Reaching Down the Rabbit Hole is a really fascinating book. It's a little fictionalised, so we get dialogues and little portraits of character, enough that we can care about the cases discussed. Dr Ropper is pretty much everything an ideal doctor should be: knowledgeable, capable of acting fast, capable of explaining complex processes clearly, intuitive, willing to listen, willing to admit he's wrong... At every stage, he emphasises to the reader and to the residents he's teaching that each case is individual, that the right answer for one person isn't the right one for the next, and so on. There are a couple of very good chapters on Parkinson's and ALS, some fascinating things like the fact that an ovarian teratoma can cause seizures and all sorts of neurological symptoms, etc. At every turn, it demonstrates the complexity of the brain, the limits of our understanding. What nearly spoiled it all for me was the fact that Ropper really does revert to talking about hysteria. When I quoted a section to my mother, a psychiatrist, she texted back to ask if the book was written in 1899 -- that's how out of date that section seems. For the most part, he even seems sympathetic to these patients, which is more than I can say for a lot of people who dismiss hysteria/psychosomatic illnesses/conversion disorder, etc. But in this case there seems to be a barrier in his thinking: he sees a young woman with a teddy bear, and he immediately chalks it up to hysteria. Whatever her symptoms: hysteria is the answer. Sure, he dresses it up as "conversion disorder", but what he means is still pretty much the Victorian hysteria. He uses that term as a direct synonym for conversion disorder, psychosomatic problems, etc. And it's exactly that attitude that makes life difficult for people who have mental illnesses, insight and even a glimpse of the way that people are going to look at them. If I'm going into a doctor's office with some problem, I prepare myself for the inevitable questions about my levels of anxiety, my depression during the last few weeks, is there anything at home I'm struggling with... Because there's a diagnosis of GAD and depression right there in my file, I know that nine out of ten doctors will listen to my symptoms and hear only psychosomatic. And some of those will even blame me for that -- me, the thinking rational person -- even though I could no more help it than I could pick the stars out of the sky. I started having horrible stomach pains in 2010, my second year of university, at the same time as I started a pretty steep descent into anxiety. Doctors were reasonably sympathetic, but continually told me that what was happening to me, whatever it was, just happened because of my anxiety. Here's a pill, take it and everything will go away. And I believed them: the pain had to be in my head, because I have an anxiety disorder. I knew they wouldn't believe in the pain and so I didn't either. Even at the point where my physical symptoms were completely blatant, when you could do a physical exam and precisely locate the source of the pain, my GP was reluctant to send me for an ultrasound because, in his opinion, I was probably just stressed about my master's degree. He repeatedly asked if I was happy, if I was sure I was doing the right thing in my career, while I was trying to ask for pain relief. When eventually I pushed hard enough, he sent me for an ultrasound, warning me that I was wasting everyone's time. My gallbladder was packed with stones, and the only option was to remove it. At one point in this book, Ropper discusses signs and symptoms. Symptoms are what the patient reports; signs are what the physician observes. Don't stop listening to the symptoms just because you think you can see the signs. Don't get blinded to one thing because another has already been diagnosed.

  5. 5 out of 5

    Kristy K

    3.5 Stars A neurologist takes us through multiple cases he’s dealt with over a short course of time. Some very interesting cases with many diseases I’d never even heard of. A great read, especially if you enjoy books like The Tale of the Dueling Neurosurgeons.

  6. 5 out of 5

    Donna

    I wanted to like this science based nonfiction book because I always like books like this. But the title seemed somewhat inaccurate for this book. It wasn't about the mystery and drama of brain disease.....it was really all about one particular neurologist. I, I, MY, MY, ME, ME was incredibly repetitive....just sayin'. I was also shocked by some of his statements....it sounded more like disregard for others. I wish I had liked this.

  7. 5 out of 5

    Bettie☯

    This review has been hidden because it contains spoilers. To view it, click here. (view spoiler)[ Bettie's Books (hide spoiler)]

  8. 4 out of 5

    Jeremy

    I read it wondering if the author, a neurologist, would ever turn professional insight on himself. If he did, he would realize he spends an entire book blowing eighteen over-inflated tires of sexist, egotistical, out of touch diesel right up his own glowing red exhaust stack. I was hoping for someone to talk about being a neurologist and the rigors of having such an interesting title, an adjunct to the great "Do No Harm". Instead, I got the self-important musings of a tactless, namedropping, arr I read it wondering if the author, a neurologist, would ever turn professional insight on himself. If he did, he would realize he spends an entire book blowing eighteen over-inflated tires of sexist, egotistical, out of touch diesel right up his own glowing red exhaust stack. I was hoping for someone to talk about being a neurologist and the rigors of having such an interesting title, an adjunct to the great "Do No Harm". Instead, I got the self-important musings of a tactless, namedropping, arrogant misogynist. I kept reading hoping he would stop talking about himself and talk about something interesting, but alas, his reference to women neurologists using a reflex hammer to test brain reaction in unconscious patients by saying they, "tend to press harder than men, as if to insure that no one is getting out alive" was my final straw. This neurologist should've seen a neurologist before writing this book.

  9. 5 out of 5

    Lori

    Wish I could review this book. I won it on September 28 as a giveaway on goodread. Never received the book. Looks like other people liked the book. I always read the books I win and do a review on them. Too bad I did not get my copy. I sent a message asking why I did not receive my copy but never heard back. UPDATE;I received my copy of this book last week. I can now do a review of the book i won in first reads giveaways. Dr. Allan Ropper is a Neurologist in Boston. In his book he writes many ca Wish I could review this book. I won it on September 28 as a giveaway on goodread. Never received the book. Looks like other people liked the book. I always read the books I win and do a review on them. Too bad I did not get my copy. I sent a message asking why I did not receive my copy but never heard back. UPDATE;I received my copy of this book last week. I can now do a review of the book i won in first reads giveaways. Dr. Allan Ropper is a Neurologist in Boston. In his book he writes many cases he has worked on over the years. Most of the persons are fictionalized persons to give samples of different "diseases" of the brain. the figures skater whose body has become a ticking bomb. the man found in traffic circling around because he could not find his way home.there are several cases of people who are suffering from ALS or Lou Gehrig's disease. This is a pretty interesting read It can be fascinating, terrifying, heartbreaking. There are so many Neurological illnesses a person can get. Dr. Ropper discusses many of them in his factual book. there is even a chapter using Michael j. Fox when he discusses Parkinson's disease. There is a chapter on seizures and Epilepsy. interesting but a tough one to read since i have a son who has epilepsy. I liked that Dr. Ropper gave stories and examples to describe his cases. Glad i finally got my copy. If you find reading about medical cases, you may find this a good read.

  10. 5 out of 5

    Socraticgadfly

    We may have a new Oliver Sacks! I hope this is just the first of several books from Ropper. Ropper offers the somewhat different vantage point of being focused on neurology, which means more of his stories are about the physical debilitations of neurological problems with no psychological effects. His description of dealing with multiple patients with Lou Gehrig's is worth a read in itself.

  11. 4 out of 5

    Laura

    Reaching Down The Rabbit Hole is a strange semi fictionalised account of a neurologists journey through exploring rare and complex brain diseases and disorders. I enjoyed much of the book, particularly a couple of the patient stories. The writing style was rather heavy and overly “wordy” which some readers may find challenging. However, for the most part, I was able to keep a good understanding of the point the author was trying to convey. The difference in American healthcare (as opposed to the Reaching Down The Rabbit Hole is a strange semi fictionalised account of a neurologists journey through exploring rare and complex brain diseases and disorders. I enjoyed much of the book, particularly a couple of the patient stories. The writing style was rather heavy and overly “wordy” which some readers may find challenging. However, for the most part, I was able to keep a good understanding of the point the author was trying to convey. The difference in American healthcare (as opposed to the British) was very obvious here. It still astounds me that healthcare is considered a privilege in the states. The discussion about medical ethics and neuropsychiatry are two of my favourite aspects of the book. As with all books of this genre, there are some tongue in cheek moments and some which some readers may raise an eyebrow at. 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. A worthwhile read for medical professionals and those read in neurology.

  12. 4 out of 5

    Rabbit {Paint me like one of your 19th century gothic heroines!}

    Disclaimer: This ARC was given to me for free in exchange for an honest review from Netgalley. This was a really interesting look into the ward of not only a teaching hospital, but a look into some puzzling neurological diseases and how they vary individually, sometimes nothing like the textbook case. I did find the author's tone a little dry and condescending, but I am taking account that he is an older man. This was a pretty good book all-in-all.

  13. 4 out of 5

    Cami Connell

    Some parts of this were interesting. However, I thought the doctor had a tendency to pat himself on the back while turning a blind eye to cases that he called hysterics. He seemed particularly insensitive to these cases, even though he suspected sexual abuse and other issues. Overall, I like his old school approach.

  14. 4 out of 5

    David

    The cases are generally interesting, but the narrator is a hard voice to like. A subtitle that would better catch the tone is "The Many Times I Have Been Right (And Others Wrong)"

  15. 4 out of 5

    Nick Davies

    This was an interesting book written by a clinical neurologist, which provided a lot of insight into the field, was intelligently written, and also was pitched at a good level for the non-specialist. Plenty of case studies are discussed, as are aspects of the author's role in a Boston hospital department, and it comes across well. There are some parallels with the better of Oliver Sacks' books. However, due perhaps to the nature of neuroscience as opposed to psychology, the described conditions w This was an interesting book written by a clinical neurologist, which provided a lot of insight into the field, was intelligently written, and also was pitched at a good level for the non-specialist. Plenty of case studies are discussed, as are aspects of the author's role in a Boston hospital department, and it comes across well. There are some parallels with the better of Oliver Sacks' books. However, due perhaps to the nature of neuroscience as opposed to psychology, the described conditions were a little less interesting to me than, for instance, the abnormal psychological illnesses described by Sacks in 'The Man Who Mistook His Wife For A Hat'. The likes of motor neurone disease, traumatic brain injury, Parkinsons Syndrome, stroke etc. are all of course more common in a medical context but are hence less 'academically' or 'scientifically' interesting to me as a reader interested in medicine and psychology than the rarer disorders. Reading the book as someone more turned on by factual content than human interest stories, there was only so much I could get from it.

  16. 5 out of 5

    Catherine

    Stories about a neurologist in an acute hospital. Tales of people with complex and often mind-boggling presentations, like the man who drove for half a day in circles in his car. Reviewers likened Dr. Allan Ropper's work to those of Oliver Sack's. I would say that it is far from fair or accurate to compare the account in this book with Sack's compassionate, insightful and warm writings of his patient's plights or his ability to shed light on the mysteries of the human mind and to encourage empath Stories about a neurologist in an acute hospital. Tales of people with complex and often mind-boggling presentations, like the man who drove for half a day in circles in his car. Reviewers likened Dr. Allan Ropper's work to those of Oliver Sack's. I would say that it is far from fair or accurate to compare the account in this book with Sack's compassionate, insightful and warm writings of his patient's plights or his ability to shed light on the mysteries of the human mind and to encourage empathy. Why? As noted by previous reviewers, the Dr. Ropper featured in this book is his own biggest fan. No, literally. In the first few chapters, you will realise that he (says that he) is the only one getting things right on his team. He is the most brilliant, most astute, most knowledgeable, most experienced. While I have no doubt about his expertise and his positive reputation in his field, I also can't help but note that he has little regard for his colleagues and the junior doctors. They should have just listened to him. Being Chinese, I also noticed that all the Asian colleagues in his writing are either nameless (the Chinese American female neurosurgeon - even the janitor has a name!) or got the wrong end of the stick (i.e. Chin, the poor senior registrar who treats everyone to lunch and got thieved by his junior as a "lesson"). And his patients - oh god! If the Dr. Ropper in the book were to be my consultant, I would walk out of the consultation room - fuming because of his tone and attitude. For example, calling a patient with psychogenic epilepsy as hvaing "sham epilepsy" - it might be important not to be repetitive in this narrative, but semantics do evoke strong emotions and thoughts, and must be chosen carefully so as not to give the wrong impression. However, the narrator did a good job of pointing out the social inequalities in the local area, and was empathetic with Black American patients, whom he felt are on the fringe of the Bostonian society, which sometimes prevent them from accessing help. Nevertheless, there are some wonderful accounts of rare cases, such as the young Asian Korean woman who was fuming like she has rabies. That definitely requires an experienced eye to make an accurate and prompt diagnosis, and to prevent further damage to the patient's physical functioning and quality of life. I have noted from a previous reviewer that the writing in this book doesn't seem to match Dr. Ropper's real life demeanor - his talks, conferences, lectures - where he presents himself as a thoughtful and considerate character. If this narrative in this book is the doing of a money-minded publisher who just wants to create a "hit" by creating unnecessary drama at the patient's and staff's expense, then Dr. Ropper would strongly benefit from getting another literary agent. Ovverall, I would recommend reading this book with a pinch a salt. Focus on the neurological experiences, laugh at the silly drama.

  17. 5 out of 5

    Bruce Gargoyle

    Full review at http://thebookshelfgargoyle.wordpress... (Oct 8) I received a digital copy of this title from the publisher via Netgalley. Ten Second Synopsis: Dr. Allan H. Ropper and Brian David Burrell comprehensively explain, through the lived experiences of a number of patients, the complex and sometimes utterly bizarre nature of the brain and the things that can go wrong with it. I;m going to take a punt and proclaim that this is the most accessible and gripping book about neurology that you wi Full review at http://thebookshelfgargoyle.wordpress... (Oct 8) I received a digital copy of this title from the publisher via Netgalley. Ten Second Synopsis: Dr. Allan H. Ropper and Brian David Burrell comprehensively explain, through the lived experiences of a number of patients, the complex and sometimes utterly bizarre nature of the brain and the things that can go wrong with it. I;m going to take a punt and proclaim that this is the most accessible and gripping book about neurology that you will ever read. Together, Ropper and Burrell have hit on a fantastic and engaging narrative style that is matter-of-fact, personal and touches on all the existential fears floating around in the human psyche relating to the potential for death or permanent disability and how one might reasonably (or unreasonably) face these fears. Another interesting point in the book is Ropper’s up-front acknowledgement that doctors and medical professionals are not infallible and are subject to the same pressures, doubts and muck-ups that plague the rest of us. was really surprised at how deeply I got into this book, and how much of its content has popped up in my thoughts since I finished reading it. Coincidentally, the ALS/Motor Neurone Ice Bucket Challenge started hitting the internet while I was making my way through this book and while I already knew a small amount about the disease, it was nicely topical to be able to read into the topic more deeply just at that time. If you’re a fan of Michael J. Fox (and who isn’t, really?), it turns out that Ropper has been involved in treating and advising Mr Fox through his diagnosis of Parkinson’s disease, so there’s a bit of bonus celebrity-related material in here too. While I was engaged and challenged by the more emotional and worrying patient stories, I also very much enjoyed the initial chapters of the book which aptly described the range of bizarre cases that can pop up in the neurology department and the interesting and unexpected ways in which medical staff go about trying to figure out what’s wrong. All up, if you’re interested in the brain in all its mysterious glory you should probably keep this book on your radar. Recommended.

  18. 5 out of 5

    Paul

    This review has been hidden because it contains spoilers. To view it, click here. This book never engaged me entirely. It was supposed to be anecdotal--stories about neurology. I found the stories too brief, but that was largely because the author never had a chance to follow up on long-term outcomes. Once he had solved the problem, the patient either died or went home. My takeaways from the book. 1) Neurological illness is highly specific to the person who has it, and requires long inquiry into the patient's self-reported symptoms. It is easy to miss the correct diagnosis, be This book never engaged me entirely. It was supposed to be anecdotal--stories about neurology. I found the stories too brief, but that was largely because the author never had a chance to follow up on long-term outcomes. Once he had solved the problem, the patient either died or went home. My takeaways from the book. 1) Neurological illness is highly specific to the person who has it, and requires long inquiry into the patient's self-reported symptoms. It is easy to miss the correct diagnosis, because presenting symptoms vary from purely physical to psychiatric. It takes years of careful listening to effectively diagnose each case. 2) In instances of conversion hysteria, the family of the patient is frequently overbearing and probably causal to the symptoms. Some families demand that the neurologist solve this problem right now and provide a solution that will indicate easy treatment with drugs or reassurance that the illness is nothing to worry about at this point in the patient's life. Either solution is rarely the case. The neurologist is often blamed by these families because he or she is regarded as a shaman who can cure all ills and provide happy endings. Somehow the illness becomes the doctor's fault. 3) Neurological illness manifests in frequently bizarre symptoms. Some of them are similar enough to previous cases in the doctor's experience that he or she can by inductive reasoning come up with a dead-on diagnosis. 4) Initial examinations and cuts into flesh of patients are performed by the doctor of lowest stature among the group of residents and interns. It's surprising that the first cuts aren't done by candy stripers, followed by maintenance staff and kitchen workers. The resident or intern making the first cut is often terrified at the experience, and this is the school of hard knocks that newly minted doctors all have to go through. It seems brutal, but it's standard practice. 5) 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. Ultimately for me, the book was interesting but not absorbing. This is probably my own shortcoming.

  19. 4 out of 5

    Mary

    This review has been hidden because it contains spoilers. To view it, click here. 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. Fans of House will enjoy reading this book. The chapter that deals with ALS (Lou Gehrig's Disease) is very difficult to read. He presents the lives of two differe 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. Fans of House will enjoy reading this book. The chapter that deals with ALS (Lou Gehrig's Disease) is very difficult to read. He presents the lives of two different patients and describes the cruel progress of their disease and the difficult decisions they face and the extreme changes and challenges ALS brings to their lives. Dr. Ropper enjoying teaching, training, and working with the interns, residents, and medical students he trains. He describes one case where a patient of his dies from an abscess that turns his spinal cord to jelly. The patient was paralyzed from the neck down with no hope of any function being restored. Initially, Dr. Ropper and his team thought the man was suffering from the more common Gillian Barre Syndrome but they were wrong. Ropper discusses the mistakes and oversights that occurred that caused this misdiagnosis. Mostly cause by a radiologist missing evidence of this rare condition on the MRI. He focuses on what a valuable lesson this was for him and his students. Also a very interesting discussion of death. He also discusses treating the actor Michael J. Fox for his Parkinson's Disease.

  20. 5 out of 5

    Mariavv

    This book was interesting enough for me to finish it in three days, but it's not a book I would tell anyone to go buy right now. Pick it up if you find it at a book exchange or in a bargain bin, though. It is well-written and generally entertaining, but it spends more time on the drama of brain disease than on the mystery of it. A sick person comes into the hospital, no one can figure out what's wrong with him or her until our hero neurologist walks into the room and proves he's smarter than eve This book was interesting enough for me to finish it in three days, but it's not a book I would tell anyone to go buy right now. Pick it up if you find it at a book exchange or in a bargain bin, though. It is well-written and generally entertaining, but it spends more time on the drama of brain disease than on the mystery of it. A sick person comes into the hospital, no one can figure out what's wrong with him or her until our hero neurologist walks into the room and proves he's smarter than everyone else, and then their long and painful process of recovery (or not) is extensively described, including how it made the doctor feel. It is not like the books by Oliver Sacks, because it describes common brain diseases more than rare ones, which makes it less exciting than it could have been, no matter how touching the stories about Parkinson's and ALS sufferers are. There is also a lot of reflection on what it means to be a doctor in general and a neurologist in particular, which is at times interesting but often strays towards the overly self-congratulatory. Allan Ropper is clearly very impressed by his own genius. I also thought it was funny that at one point in the book he makes fun of other doctors for boasting about their celebrity patients and then continues to mention on every other page that he treated Michael J. Fox for Parkinson's.

  21. 5 out of 5

    Gaynor Thomas

    I found this book interesting but I didn't find the writing style engaging. The subject matter is fascinating but it is written in a somewhat disjointed manner which does not do justice to the stories being told. I received my copy from netgalley in return for an honest review so there were a few formatting issues due to it being a galley proof, but this was not a factor in my opinion of the writing style. Overall I gave it three stars because it is not a bad book, but it is nothing special eith I found this book interesting but I didn't find the writing style engaging. The subject matter is fascinating but it is written in a somewhat disjointed manner which does not do justice to the stories being told. I received my copy from netgalley in return for an honest review so there were a few formatting issues due to it being a galley proof, but this was not a factor in my opinion of the writing style. Overall I gave it three stars because it is not a bad book, but it is nothing special either.

  22. 5 out of 5

    Clare

    I enjoy medical books or books about certain conditions. Reaching Down the Rabbit Hole was a fascinating look into brain injuries or diseases of the brain. This was a nice audio book with bite sized chapters so you could dip in and out of the book if you wished. There was a story about a young man with Motor Neurone Disease, diagnosed when he was 35 years old. He was wheelchair bound and could not speak by himself anymore. Yet with the help from his lovely wife he had a job, and a daughter who ad I enjoy medical books or books about certain conditions. Reaching Down the Rabbit Hole was a fascinating look into brain injuries or diseases of the brain. This was a nice audio book with bite sized chapters so you could dip in and out of the book if you wished. There was a story about a young man with Motor Neurone Disease, diagnosed when he was 35 years old. He was wheelchair bound and could not speak by himself anymore. Yet with the help from his lovely wife he had a job, and a daughter who adored him. I was Really awe inspired.

  23. 4 out of 5

    Catherine Davison

    This was a fascinating read. Could not stop reading it. If you're at all interested in how the brain works or how it can go wrong and how neurologists decipher the signs to formulate treatment plans then you won't be disappointed by this book. Also if, like me, you grew up watching Michael J Fox you'll appreciate his story told in part here by the author, his neurologist.

  24. 5 out of 5

    Pam

    I read this because I'd heard it serialised on radio 4. I thoroughly enjoyed reading it, truly fascinating and enthralling.

  25. 5 out of 5

    Aubrey

    The author was so terribly self absorbed he ruined the fascinating parts of what was supposed to be the content of the story.

  26. 5 out of 5

    Lauren

    Excellent book for the medical drama nerd. Interesting and refreshing novel about the passion of practicing medicine in an era when we are battling with the computer more than caring for patients.

  27. 4 out of 5

    Megan

    This review has been hidden because it contains spoilers. To view it, click here. My favorite passage of the book is when Ropper describes a patient's journal entry: "In one burst of creativity, he wrote a brief memoir of the summer of his twelfth year, when his parents sent him to stay with his uncle, a fisherman in Nova Scotia. He didn't understand how or why an East Boston kid like himself wound up on the open sea, hauling halibut into a dory, but he reveled in every day of it. The sight of baleen whales surfacing every morning beyond the bay, he was told, was the result o My favorite passage of the book is when Ropper describes a patient's journal entry: "In one burst of creativity, he wrote a brief memoir of the summer of his twelfth year, when his parents sent him to stay with his uncle, a fisherman in Nova Scotia. He didn't understand how or why an East Boston kid like himself wound up on the open sea, hauling halibut into a dory, but he reveled in every day of it. The sight of baleen whales surfacing every morning beyond the bay, he was told, was the result of their being driven closer to shore by the German U-boats that infested the waters. It was 1943. The summer culminated in a village tradition, in which the fishermen and their families came together on the water to haul in a large co-op net trap, some hundred meters across, containing a large school of pollock. As the depth of the massive net was drawn to within six feet of the surface, the water came alive with the thrashing of thirty- to forty-inch-long fish, and the fishermen and women scooped them into the dories using pole nets. In the process, fish scales flew like sleet, covering everyone from head to foot, leaving only the whites of their eyes showing. Wally recalled being assigned a spot next to a young girl wearing a yellow slicker that gradually turned silver under a spray of glistening scales. Hannah decided that this was the most serene moment in Wally's long life: standing next to a cute girl, being waist-deep in thrashing fish, living in a safe place among strong, stoic, caring people, covered with fish scales. It was probably the last time that Wally was at peace with the world and with himself."

  28. 5 out of 5

    Vegantrav

    What happens when the brain malfunctions or is injured? How is the individual affected? How are the families of that individual affected? We get utterly intriguing answers to these questions from Dr. Ropper, a neurologist at Boston's Brigham and Women's Hosptial. Dr. Ropper draws on 2 main sources in this book: (1) cases from his past experience and that of other neurologists and (2) cases from just a few short weeks of his regular rounds at Boston's Brigham and Women's Hospital. What we learn is t What happens when the brain malfunctions or is injured? How is the individual affected? How are the families of that individual affected? We get utterly intriguing answers to these questions from Dr. Ropper, a neurologist at Boston's Brigham and Women's Hosptial. Dr. Ropper draws on 2 main sources in this book: (1) cases from his past experience and that of other neurologists and (2) cases from just a few short weeks of his regular rounds at Boston's Brigham and Women's Hospital. What we learn is that the brain is a fickle little organ, and there are many, many ways for things to go awry with it, and when something goes wrong with the brain, it can drastically affect not just our normal bodily functions but even the most fundamental aspects of our very selves (our memories, our behavior, our disposition, our emotions, etc.). This book reads almost like a television medical drama--just without all the soap opera-ish affairs. But the drama for the patients, for their families, and for the medical professionals who treat them is very, very real. And it is endlessly fascinating and frightening. Dr. Ropper tells his tales with great candor and appreciation for his own and his profession's limitations. He is humble and kind and is genuinely interested in his patients and in helping them as well as educating the general public. And in this book, he provides a great education for those of us outside the medical profession. If you are at all interested in the human brain and its functioning, this book is will not disappoint.

  29. 4 out of 5

    Sarah

    So interesting, so well written

  30. 5 out of 5

    Sean Goh

    Insights into the world of neurology, where there is no substitute for talking to your patient and figuring out their mental landscape. A good read for doctors young and old, whatever your specialty. Or for anyone interested in how the brain works (and malfunctions). ___ What everyone on the ward needs, more than anything else, is to tell us their stories. What they hope, what they expect, what they deserve, is that we take the time to listen, because the act of listening is therapeutic in itself. Insights into the world of neurology, where there is no substitute for talking to your patient and figuring out their mental landscape. A good read for doctors young and old, whatever your specialty. Or for anyone interested in how the brain works (and malfunctions). ___ What everyone on the ward needs, more than anything else, is to tell us their stories. What they hope, what they expect, what they deserve, is that we take the time to listen, because the act of listening is therapeutic in itself. When we do it right, we learn details that make us better doctors for the next patient. The residents may not get this yet. They are focused on diagnosis and treatment, on technology, scales, titres, doses, ratios, elevations, and deficiencies. All well and good, I tell them, but don't forget to listen. Alice in Wonderland is an absurdistan story. Beyond fantasy, it's ridiculous. That's neurology in a nutshell. Your patient disappears down a rabbit hole. You can't just sit there, so you go down the hole after the patient. Psychosis is a special type of confusion with its own reality, an internal reality that is consistent only with itself. While a psychotic's internal stream may seem bizarre and disconnected, it has its own internal logic. One thing people never forget is who they are. Memory works both ways. You can't be capable of forming new memories (anterograde) when you ostensibly cannot recall old ones (retrograde). TGA (transient global amnesia) describes a fixed period of complete retrograde AND anterograde amnesia. Symptoms are what a patient reports. Signs are what a physician sees in an examination. Symptoms are thus subjective, signs objective. When a patient reports a symptom we have to take it at face value, a headache, dizziness, numbness, lower back pain. We have no tests for such things, and accept them as real until something in the patient's behaviour gives the game away. Psychological non-epileptic seizure - or P-NES - instead of pseudoseizure. That's now a term of the art. It was coined either by someone with a very devious sense of humour, or no sense at all. Predictably, the American strategy of dealing with a P-NES holds no one accountable, involves a brain-centered euphemistic explanation coupled with some touchy-feely stuff, and ends with a recommendation for a therapeutic programme that, very often, the patient will ignore. In its abdication of responsibility, motivated by the fear of a lawsuit, it closely mirrors the beginning of the end of a doomed relationship: "It's not you, its.. no wait it's not me either. It just is what it is." 3 kinds of patients show up on the ward, the risk-neutral, the risk-averse, and the risk-resistant. We rarely see a fourth kind, the risk-takers, who instead show up in the morgue, if they show up at all. Most of the time they go straight to the funeral home. Risk-takers don't come to the hospital of their own volition. They simply refuse to go to a doctor for anything. Risk neutrals go to the doctor because they believe in modern medicine. They listen, question, comprehend and for the most part, cooperate. Risk-averse need reassurance, have to know everything, call everyone. They anguish, they're neurotic but in the end they fall in line. Risk-resistant act as if they have something to hide, often do have something to hide, and hide it even when it would be in their best interest to let us know about it up front. As far as the hospital is concerned the patient is always right because personal autonomy trumps probabilistic outcomes. You have to respect their wishes as human beings, we are told. But the patient is so often dead wrong, especially when it comes to their own brain. The patients are holding out their troubles. They are not really asking you to take them. You should only take them if you want or need to take them. Otherwise, leave it. They'll get along without your suffering. You have another job to do. You have to be able to distance yourself without being unsympathetic. We frequently do not know the cause of a problem, but back into a good treatment. When that happens, stop being a scientist, and keep going. There were no EMTs back then. The ambulance drivers could perform CPR and they could put in an IV. That was about it. And they could drive like mad. Most intelligent doctors do have the capacity to be great diagnosticians. Yet if their training and subsequent work in the field do not continually excite them intellectually, and if they have no inclination to question the experiments of nature unfolding right in front of them, they won't get there. Aptitude isn't enough. To become a good clinical neurologist, you have to be intensely interested by what the brain does, how it works, how it breaks down. Raymond Adams would walk into a patient's room thinking, "What am I going to learn now?" Don't lose the opportunity to appreciate what the signs and symptoms are teaching you about the brain. It's to the patient's benefit if you soak up the details, if you're really into it. All ALS sufferers face a kind of Hobson's choice. They will die. The only question is when and how. How much suffering are they willing to bear? How much incapacity? How much of a burden are they willing to become? "Go home and live, don't go home and die." The idea that I could be in two places at once fell off the table for me decades ago, and I realised that in the end it just means being late for dinner. Michael didn't need the world's leading Parkinson's expert. That guy is only needed for a case no one else can figure out. The interdependency that is built into a modern hospital, our reliance on checklists, hierarchies, consultations, and each other, protects us individually from taking all of the blame when things go wrong. We can and do make mistakes, but in theory someone is there to catch and correct them. In practice, the system of checks and balances can fail at every level, and a low probability event, a succession of unlikely failures, can be set into motion. In Harry Connaway's case, a cascade of errors of omission began to fall like dominoes. The practice of medicine benefits from revisiting the discoveries of the past. For a physician, seeing further means looking over the shoulders of giants.

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