Reaching Down the Rabbit Hole

June 30, 2014
Ropper, a professor at Harvard Medical School and founder of neurological intensive care, and Burrell (Postcards from the Brain Museum) present an intriguing, if meandering, account of neurology’s real-world applicability. The authors repeatedly emphasize, that proper diagnoses of neurological issues require both intensive study and exquisite intuition because the brain is so mysterious. Among the many patients featured is a chronic-pain faker who tries to score drugs and gets caught red-handed as well as a psychotic whose confusion, unlike other patients with severe cognitive problems, has its “own internal logic,” leading him to believe Ropper was two different people despite exhibiting full awareness of his surroundings. Perhaps the biggest takeaway from Ropper’s work is that every individual’s mind, both in sickness and in health, is as unique as the proverbial snowflake. “Up on the ward,” he says, “every grand theory of mind and every sweeping generalization about consciousness falls apart when exposed to the cold, hard truth of a single case.” The book struggles to coalesce around a central claim or message of particular intrigue, though Ropper and Burrell still lead the reader a captivating stroll through the concepts and realities of neurological science.

Starred review from September 15, 2014
A renowned neurologist examines some important questions: "[W]hat does it mean to be the patient faced with these seismic problems, and how is a connection made with the physician who embodies the knowledge that can make it better?" Harvard Medical School professor and Brigham and Women's Hospital master clinician Ropper and writer Burrell make an intellectual, sympathetic team: One brings the meat and potatoes to the table, the other, a measure of distance. They exhibit both a hungry curiosity and an elegant writing style married to the humbleness that comes from standing at the edge of the rabbit hole. The meat and potatoes are the individual cases that have crossed Ropper's path and that the authors have framed into stories. These neurological tales shimmer and flash, a wily combination of Oliver Sacks and Berton Roueche, "through the painstaking examination of the patient. Every gesture, every movement, every inflection of speech, every reflex, all these point to the precise location of the problem in the nervous system." Though a neurologist has to be well-acquainted with the design and function of the nervous system and use the latest technology, it's also vitally important to "[s]tick with the patient's story and the bedside exam." Ropper's patients range all over the place, from heroic to discomfiting to scary, and his predilection to neurological arcana makes for gripping material-as one patient recalled, "When they started...the hallucinations, what I saw first was Queen Elizabeth and her corgis in my fireplace...I also had Dick Tracy come by. He had a yellow overcoat. It was Warren Beatty." The author explores a wide variety of conditions, including the exterior degeneration of ALS and the often befuddling symptoms of advanced brain trauma, but he rarely falls into jargon and always keeps the narrative lively and engaging. Compassionate, useful reading related by an expert in his field.

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October 1, 2014
The brain is mysterious and complicated, but longtime Harvard Medical School professor and neurologist Ropper (who counts Michael J. Fox among his former patients) and coauthor Burrell clearly explain what can go wrong, from Parkinson's disease to brain tumors, concussions, and strokes. They also throw in many fascinating tidbits. For example, Scandinavians have the fewest strokes, and the Japanese have the most, and few autopsies are performed today because everyone believes scans have already given the answer and because Medicare and Medicaid do not pay for them. As the title suggests, Ropper's patients have fallen into an Alice in Wonderlandlike hole and find themselves in a bizarre realm in which nothing is what it seems. The authors disguise the identities of almost everyone (except Michael J. Fox) and say that 70 percent of the dialogue in the book is verbatim, 20 percent recollected, and 10 percent extrapolated, which seems like a stretch for the scenes from three decades ago. Still, they successfully convey what makes neurology the queen of medical specialties and the brain the most complex, fascinating organ in the body.(Reprinted with permission of Booklist, copyright 2014, American Library Association.)