. Unless otherwise noted, we are happy to take requests for the author to sign your book to a specific person, but we can't guarantee it. Is that true?"Right. It was incomplete. She was sweating, salivating, and shivering wildly. Most of her file consisted of blind alleys and misinterpretations.She was in rough shape, virtually blind in her right field of vision, and now aphasic. And I hear you, that the dizziness is what's driving you crazy. It sounds simple enough, unless the problem affects the very organ that produces awareness and generates speech. "That's the pitch. Within a few days, she showed signs of improvement, and was again discharged on a blood thinner.Ten weeks later, to her infinite frustration, it happened yet again, and she arrived at the same hospital in the middle of the night with another language problem, this time even more pronounced, as well as right arm weakness. "He had a bad headache from the beginning," she told me, "and a fever." . "Copyright 2014 by Dr. Allan H. Ropper and Brian David Burrell. That's what it sounds like, that's what it looks like. In this book, Reaching Down the Rabiit Hole, Dr. Allan H. Ropper and Brian David 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. Brian Burrellis a senior lecturer in mathematics at the University of Massachusetts Amherst, where he has taught for the last 25 years. Toll Free (800) 542-READ The next call could not be taken so lightly.By morning, Cindy wouldn't leave her room, and would not or could not tell her roommate why. Harvard Book Store is located at the corner of Mass. This is medical writing at its best; in the tradition of Rouche, Lewis Thomas, and Oliver Sacks. VS Ramachandran, New York Times bestselling author of The Tell-Tale Brain and Phantoms in the Brain (with Oliver Sacks), and Director of the Center for Brain and Cognition, UCSDDr. Then, it sucks. "Yes, like a dog," was the reply. Cross Dunster St. and proceed along Mass. Her arms had to be restrained with straps, and she was soaking up tranquilizers like a sponge. What worried me was that she didn't have any reserve left, and any little chip-shot stroke was going to be a disaster. 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. After sifting through the case file, we finally got around to visiting her."Hello. You can view our video archive of past events as well below: 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 cant 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, Add the book to your shopping cart and then click. "It's the recurrence of many, many small strokes over time. This would be the third one. "Apparently, that's his baseline. She had turned out to be one of our strongest clinicians.Although she hails from the Midwest, Hannah Ross has a northern European flair, somewhat Dutch, in that she is tall, lithe, wears fashionably businesslike glasses, and seems indifferent to the possibility that anyone might appreciate the effort she has made in choosing her look, probably because the effort is now merely a habit. Do the echo over. You can't just sit there, so you go down the hole after the patient. We will require credit card information when you place the order. When you see it, the syndrome is unmistakable: an ovarian teratoma stimulates an antibody that will produce the very ensemble of symptoms that were described to me over the phone.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. The next one, I was convinced, could wipe her out. * * *A week earlier, Cindy Song, a sophomore at Boston College, had started acting a bit withdrawn. Eventually she went to rehab, and from there she went home. Like, I just" She trailed off. Some people add a fourth: oriented to situation. His room on the tenth floor of the hospital tower commanded an outstanding view of Fort Hill Park in Boston's Roxbury section, but Vincent took no notice. I said. 1256 Massachusetts Avenue Fox, Ozzy Osbourne and other personalities. According to the notes in her chart, she had by now had three separate strokes, clearly visible on MRI scans, in addition to the vertebral dissection from her neck manipulation. ""Once I'm home, I'm good. Five days later, Vince was discharged, talking normally again, and, for better or worse, just like his old self. "Ignore the scan for now," I told Hannah. Along with twenty-nine of our other patients, he had been waiting for a visit from the neurology team on their morning speed rounds.Hannah was in charge. She had had no visitors for over a day, possibly because she did not want her children to see her like this, or, more accurately, to hear her like this, for although she could talk, she could only do so with halting fluency, mostly in monosyllables. Walking from the Harvard Square T station: 2 minutes. It is a gem. Joseph B. Martin, M.D., Dean Emeritus, Harvard Medical SchoolA fantastic contribution to helping us understand the ways in which our brains can go wrong. I later asked him. Unable to attend a Harvard Book Store author event? If the problem is properly framed, there are very few other things it could be. In other words, she has too much water in the cavities of her brain, a serious problem. She had a low platelet count, according to the hematologist. Her jittery limbs seemed as if they wanted to convulse. No more smiles, no more jokes. What is it like to try to heal the body when the mind is under attack? You might not be aware of it, but your vision on the right is diminished because of one of the very early strokes. "I'm at your service. "You'd better send her over. Now I can't see clear. Among the staff, the consensus was: "We're going to need a bigger boat." This book should be read by those with an interest in the brain, patients and families who struggle with life-threatening illness, and by all of us as potential sufferers who will appreciate the efforts made for them. Eventually, both the resident and the attending gynecologist were convinced, and they were comfortable knowing that Cindy could still have children with her remaining ovary.This was a rare, rare thing. Your patient disappears down a rabbit hole. His stories are sometimes painful, sometimes heartwarming, but invariably tremendously illuminating. Elizabeth Loftus, author of The Myth of Repressed Memory, Macmillan Code of Ethics for Business Partners. His other books includePostcards from the Brain Museum, The Words We Live By,andMerriam-Websters Guide to Everyday Math. Join our Signed First Edition Club (or give a gift subscription) for a signed book of great literary merit, delivered to you monthly. My guess is that it was just a coincidence. "When I gave him a shout-out," he said, "you'd think I'd asked him to put up bail for the Unabomber. "Mom, they've been after me for weeks, creeping in through the cinderblocks, taking my clothes off. A short, intense man with thick gray hair and a perpetual scowl, he did not look as though he was having fun, or even capable of having any fun. Still smiling.At East Shore Hospital an MRI showed an ambiguous blotch on the left frontal lobe of Vincent's brain, and at the suggestion of one of his sons, a pediatrician, the family requested a transfer to us. After a short interlude of relative calm, the psych nurses became alarmed when Cindy's jitteriness escalated into full-blown myoclonusarms and legs flinging up off the bed, her head jerking back violently. How are you doing it? "Vincent, we need to go," she said."Fine. . ""No, you haven't. She moves swiftly from room to room, from pod to pod, from the nurses' station to the rolling laptop cart, where she displays an instantaneous command of electronic medical records, and can bring up an MRI scan and zoom in on a tumor or a cerebral hemorrhage with no wasted effort. "Is she salivating like she has rabies?" ""No, not depressed just sick of all this.""Discouraged?""Yeah. The guy comes in here a pussycat, and when you finish with him he's Mr. What's-It-To-You-Pal. We've got a new team, so just make like she's being seen for the first time, make believe she hasn't been worked up, fill in all the holes. After the bedside visit, the thrombosis suddenly has a name, the glioma has a wife and children, the hydrocephalus writes a column for a well-known business journal. Dr. Ropper and his colleague answer these questions by taking the reader into a rarified world where lives and minds hang in the balance. The residents had neglected to mention this, but it was important. Her speech was now noticeably impaired. It's not for everyone. We ship anywhere in the U.S. and orders of $75+ ship free via media mail! ""Vincent uh, yeah Vince. It's a real thing." ""What day is it? Although it went unmentioned at morning rounds, her case would offer a sobering reminder that there are significant limits to our knowledge of diseases of the human nervous system. Harvard Book Store welcomes renowned neurologist DR. ALLAN H. ROPPER and author BRIAN DAVID BURRELL for a discussion of their bookReaching Down the Rabbit Hole: A Renowned Neurologist Explains the Mystery and Drama of Brain Disease. "Something had to be giving off small flecks that lodged on the walls of blood vessels, effectively narrowing them. That was my first question, and would turn out to be my only one. "Medical textbooks teach you what tests to do to make a diagnosis, but they do not dwell on the simple reality that humans are interpreting the tests. I wasn't entirely right. I am waiting at the nurses' station with the rest of the team. ""What are you talking about, honey? He was sitting up in bed, watching television with a smile of bemused innocence. And their treatments are entirely different.My experience told me that Arwen Cleary's echocardiogram had missed something, not just once, but twice. Her vision had not fully returned. Such beds are hard to come by, and it took a hard sell by the emergency room doctor to secure the promise of one by the next afternoon, "if you could just hang onto her and give her Haldol in the meantime. "The more she persisted, the more Vincent perseverated. Do you see that cyst on the ultrasound? You'd better send her over." Her psychosis resolved within days. ""Fine, yes. "Did anything happen at the game? Others will become epilepsy or stroke specialists, some will go into psychiatry. What he models for us is the essence of good doctoringattention, carefulness, and Oslerian dedication; he throws in, for good measure, his own irony and humor. It sounds simple enough, unless the problem affects the very organ that produces awareness and generates speech. That was what had caused the strokes, and that was what had been misinterpreted as vasculitis. I had seen the scans and knew they did not hold the answer. "What are you watching?" She was shivering mildly and sweating all over. Online Returns "How about a virus?" Can I request a personalized inscription? She would have to stay on the blood thinners for the rest of her life, and I may never be able to say what caused her problem, or whether it was still a problem, until she suffers the big stroke that wrecks her.Six months later, she came to the outpatient clinic, her speech much better, but still frustratingly limited. Harvard Book Stores award-winning event series continues! Email info@harvard.com, Online Customer Service . What is it like to try to heal the body when the mind is under attack? I told his wife that if he started being nice to her again she should bring him back in immediately. * * *There is an old joke among stand-up comics that goes: "Dying is easy, comedy is hard." That's what's different. It is a place where, as the Red Queen mentions to Alice, it helps to believe six impossible things before breakfast. No one fully understands it, but I know it clinically when I see it, or even hear it over the phone, because I collect arcana. "No," I said. "I think the thing to do is just start from scratch. When he disagreed with a call by the umpire, he would throw up his arms in disbelief, kick the dirt, and swear under his breath, not for show or for the approbation of his teammates, but out of real anger and disgust. By the time he was dropped off at his house, his wife was startled to see a bemused look on his face, an air of innocence in place of his usual gruffness. As you exit the station, reverse your direction and walk east along Mass. ""That's because you're missing the right side of the world. This is the neurology team. Everything came back normal. If you told me she had a myxoma, I wouldn't be surprised. Privacy Policy . Hannah asked Vincent, in an inflection she would later inform me was Kansan rather than Missourian. . Okay." He is credited with being one of the founders of the field of neurological intensive care and is author of the most widely used textbook of neurology in the world, Principles of Neurology, now in its tenth edition, in addition to numerous books and over 150 scholarly articles. But a few special ones, like Hannah, will carry on the clinical tradition, one case at a time.Back on the ward, she comes up to me with the patient list. How does one train the next generation of clinicians to deal with the moral and medical aspects of brain disease? ""I I was always on the go. The first phone call was not too worrisome. Ropper and Burrell write with great verve and panache and each chapter reads like a detective story. "Holy cow!" We brought him out, not quite as good as new, with a slight speech deficit that most people wouldn't even notice, but we got him out. If it doesn't show something abnormal on one of her heart valves or in one of the chambers, I'll eat my hat. Her only hospitalizations to that point had been in maternity wards. "Remove her ovary?" In a profession where sartorial flair is an unexpected and somewhat suspect concept, Hannah's clogs, leggings, and wraps seemed needlessly exotic, and sowed uneasiness among the Dockers, Skechers, and scrubs crowd. She did suffer a cerebral hemorrhage, but it resolved with almost no consequence. ""What kind of person were you before all these strokes, and what kind of person are you now? Rather than sagging into the hospital bed, she balanced on it like a coiled spring, ready to jump out of it if necessary. The hospital would have to eat the cost. "Elliott thought you ought to see this lady first before we make rounds," she tells me. ""She's the lady with the hydrocephalus." He gave one-word answers to her questions, avoided eye contact, and seemed quite unlike himself. Ave. in front of the Cambridge Savings Bank. Her pupils were huge. You will pass Au Bon Pain, JP Licks, and TD Bank. While he knew the answers to many of our questions, most of his responses didn't come out quite right, yet he seemed unaware and unconcerned. It was wrong. . "Her name is Mrs. G, and she's making me nervous.""Why? When she got to Cindy's room and sat down in front of her daughter, all she got back was a blank stare focused on the wall behind her. Although these are all called strokes, they are as different from each other as hepatitis is from gall bladder disease (both of which give you jaundice). Each day they show up in a predictable parade of signs, symptoms, and diseases: an embolus, a glioma, a hydrocephalus; a bleed, a seizure, a hemiplegia. Dr. Ropper and his colleague answer these questions by taking the reader into a rarified world where lives and minds hang in the balance. Dancing Yeah. Moreover, I insisted that they do it transvaginally in order to get a good look at the ovaries. "The Bunkers. No one called him Vinnie, few called him Vince, and when he stood at the plate, none of his teammates dared to cheer him on by name.As the game wound into the late innings, Vincent's behavior began to change, subtly at first, then dramatically. "She gets that way. I know it's frustrating, but your kind of case can't be solved by a book, or it would have been solved by now. ""Gee, you're so dumb. "Are you very weepy? He has advised the US Department of Defense Health Board and the Pontifical Academy of Sciences at the Vatican. "I had to insist that there was now no doubt about it: the ovary-brain connection. 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 livingHow does one begin to treat such cases, to counsel people whose lives may be changed forever?