By Chet Yarbrough
Reaching Down the Rabbit Hole
By: Brian David Burrell, Dr. Allan H. Ropper
Narrated by: Paul Boehmer
“Reaching Down the Rabbit Hole” offers insight to those at a crossroad in life.
“Reaching Down the Rabbit Hole” is an apt book-title for diagnosis of brain dysfunction. Like “Alice’s Adventures in Wonderland”, truth of a neurological disorder is like following a rabbit down a “…Rabbit Hole”. Diagnosis of neurological disorder resonates with the obscure analogies of Lewis Carrol’s imagination.
One presumes “Reaching Down the Rabbit Hole” is written and edited by Brian Burrell. It may be that division of a doctor’s and writer’s expertise may not be a fair description of this book’s creation. But, unquestionably, Dr. Ropper’s stories drive the narrative. In any case, from a potential patient’s perspective, this is an insightful examination of what it means to live or die when a serious neurological disease strikes.
Dr. Ropper’s experience at a leading hospital in Boston is a terrifying journey into the art of neurological medicine. The terror lies in what doctor’s do not know about brain function. When one’s neurological system fails, diagnosis and prognosis are keys to a patient’s decision to live or die. What Ropper’s experience suggests is doctors must carefully interview every patient who seeks help for what is abnormal behavior.
What Ropper explains is–careful physical examination and detailed interview notes improve diagnosis and treatment for neurological disorder.
It is somewhat understood that doctors, and the medical profession in general, are extremely busy, particularly in this age of Covid19 and a perennial flu season. What Ropper’s experience shows is accurate diagnosis in a case of brain dysfunction is inhibited by a three headed monster–time, education, and practice. For the medical profession, there will always be some medical crises that overburdens services.
The natural consequence of medical overburden comes from population increase, a 24-7 work week, and burn-out which affects a doctor’s time for diagnosis.
Of particular interest in Ropper’s stories are neurological diseases like Alzheimer’s, Parkinson’s, ALS, and medical emergencies like stroke. Ropper implies many doctors do not spend enough time interviewing patients to clearly understand what is going on with their neurological disorder. Doctors don’t ask enough questions about when symptoms began, how they exhibited, and the effect they have on the patient’s life.
A three headed monster (time, education, and practice) interferes with proper diagnosis by attending physicians.
Doctors only gain experience through education and, more importantly, practice. Mistakes are made in every profession, but none more directly impact the individual than in doctor/patient relations. Ropper notes the best way of reducing mistakes is to learn from them and not make them again.
When a mistake in diagnosis leads to death, Ropper explains it is important for doctors to fully investigate the details of the mistake. Ropper argues autopsy should be used as a tool for understanding mistakes and improving future treatment.
Michael J. Fox, as is generally known, is struck by Parkinson’s disease, a neurological disorder that creates a palsy or tremor in one’s body. Fox went to Ropper in his late thirties when the symptoms first appear. Fox wishes to continue his career but needs help with the tremors. Initially, Fox and his career handlers wish to keep the diagnosis secret. However, Fox grows to understand he can continue to act and do more for research and cure by going public. Fox, according to “Reaching Down the Rabbit Hole” raises millions of dollars for treatment of Parkinson’s disease. As is well known, Fox continues his career successfully as an actor with Parkinson’s disease.
Living with a neurological disorder is closely examined in “Reaching Down the Rabbit Hole”. Living with the disorder is a personal choice.
Some embrace the disorder like Michael J. Fox, the only “real name” patient in the book. Others suffer, many in silence, with what treatments are available to mitigate their symptoms.
Another impactful story takes two different directions. Two patients are diagnosed with ALS (Lou Gehrig’s disease) which is presently incurable and fatal. After careful diagnosis, Ropper explains the progression of ALS to two of his patients. One chooses to be kept comfortable to end her life rather than deal with its progressive debilitation. The second person chooses to deal with the debilitation and live longer with his family despite its consequence.
Stephen Hawking is not mentioned in “…Rabbit Hole” but is known as the Lucasian Professor of Mathematics at the University of Cambridge. He became a noted author of Astrophysics with contributions to the science of black holes, space, and the concept of time.
There is much more to be learned by listening to “Reaching Down the Rabbit Hole”. The fundamental message is that when a neurological disorder interrupts one’s life, the decision about what one should do is based on two things. One accurate medical diagnosis and two, a personal informed decision about what to do with one’s life.
The book’s conclusion is that a decision about living or dying from an incurable neurological disease can only be made by the stricken patient, no one else. This is not to say a doctor and one’s family is not a part of the decision but that the final answer lies with the patient.