[PDF] ↠ Reaching Down the Rabbit Hole: Extraordinary Journeys into the Human Brain Author Allan Ropper – Tactical-player.co.uk
The doctor refers to himself as un PC in the chapter about those he believes to be wasting his time, including several examples of young girls who may have been abused and whose problems may be psychosomatic This attitude is beyond any questions of political correctness it is a dinosaur approach to mental illness that exemplifies the dangerous split in the medical profession between physical and mental ill health Psychomatic illnesses are still real and greatly debilitating to the sufferer and those who work in the field of neurology are discovering and about the physical changes in the brain brought about by bad experiences For a balanced, modern view you would be far better off reading Suzanne O Sullivan s All In Your Head. What Is It Like To Try To Heal The Body When The Mind Is Under Attack In This Gripping And Illuminating Book, Dr Allan Ropper Reveals The Extraordinary Stories Behind Some Of The Life Altering Afflictions That He And His Staff Are Confronted With At The Neurology Unit Of Harvard S Brigham And Women S Hospital Like Alice In Wonderland, Dr Ropper Inhabits A Place Where Absurdities Abound A Sportsman Who Starts Spouting Gibberish An Undergraduate Who Suddenly Becomes Psychotic A Mother 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 Dr Ropper Answers These Questions By Taking The Reader Into A World Where Lives And Minds Hang In The Balance This was the BBC Radio4 Book of the Week.It is a series of clinical accounts by Boston neurologist Dr Allan Ropper over his many years working at Brigham and Women s Hospital.Each chapter deals with a separate series of cases with a common theme He also talks about his motivations in medicine and his relationship with colleagues.He is clearly a very reflective practitioner who has learnt from his patients over the years He is inquisitive and wants to look below the surface down the rabbit hole , wants to constantly develop his learning and comes over as very compassionate He also talks quite frankly about cases he did not get right and analysed why that was, making assumptions, being fixed on a diagnosis and also about errors he has found in others such as radiology.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.An interesting discussion about brain death and the philosophy behind that and the difficult position it puts neurologists in The case discussed in detail was a known local paedophile and how this may affect your decision about preserving life or not Carrying a donor card and does this ultimately make you a good guy in death You get the feeling he rather thinks it does or at least not all bad perhaps no one is all bad If you have forgotten your basic neurology this will remind you about what functions come from the different areas of the brain.A slightly unusual slant is the regular references to members of his team and the work colleagues The young residents, developing their skills and trying to nurture them and develop their critical thinking He also talks about work colleagues and their personalities, how they interact with him and patients Although he has great respect for them, you certainly get the feeling there are some aspects he would like to change.Although based in an American hospital and their peculiar admitting rights, residents etc, the basic messages apply to the UK just as much This is a thoughtful doctor who genuinely wants to understand his patient s disease and problems as people He also wants to understand his colleagues and himself. Extracts from this book were broadcast on BBC R4 in January 2015 So fascinating were the readings that I bought the Kindle e book It is written by an American neurologist about his clinical experiences He is a great advocate of diagnosis by watching and listening exactly how a patient behaves, his limitations, her conduct, their memory, enables the clinician to build up a remarkable picture of what is going wrong in the patient s brain Ropper talks sometimes of the accumulated wealth of decades of his clinical experience that he is able, on occasions, to take his junior colleagues completely by surprise by deducing, with remarkable accuracy, what the problem is As I write this review 30 January there is a controversy about a proposal to shorten the time taken by a hospital doctor to reach the level of Consultant Before making up your mind, read this book.Ropper is honest about outcomes, which are sometimes unwelcome But as a physician his priority is the well being of his patients, which involves him in accompanying them through the dark closing years, months and days of their life Brilliantly he tells a wonderful tale of professional expertise and compassion in the treatment of people whose brains have in some way gone wrong I have not been disappointed. The neurologist writing here seems to be on an ego trip, bragging It s a huge concern that he misdiagnoses many patients due to arrogance and a huge over estimation of his abilities Example, he says a young woman with a pink rabbit under her pillow almost always has conversion disorder, he says the s with huge confidence He also writes that one of his colleagues gave a pain killer addict the drugs he wanted, just so he d leave, even though they thought he was faking his symptoms for drugs Instead of getting good reviews this guy should be getting a visit from investigators for clinical negligence.