Review by Sarah Keenihan

Reaching Down the Rabbit Hole: Extraordinary Journeys into the Human Brain
by Allan Ropper & BD Burrell

If I had to recommend a single book that captures the essence of an experienced, top-notch doctor making an impact in a public health system, this is it.

Allan Ropper is a clinical neurologist and professor of neurology:

“an authority on what the brain does right and does wrong: language, sensation, and emotion; walking, falling weakness, tremors, and coordination; memory, mental incapacity, delays in development; anxiety, pain, stress, and even death.”

To create Reaching Down a Rabbit Hole, Ropper worked with scientist and writer Brian Burrell to capture moments, cases, personalities and the realities of life in the neurology inpatient ward at Brigham and Women’s Hospital, Boston USA.

What a place to work. A place where – Alice in Wonderland-style – nothing is as it seems, and it helps to believe six impossible things before breakfast. Professor Ropper must reach down the rabbit hole and pull his patients out. Fittingly, he is a highly trained and experienced clinical problem solver. However, unlike the luxury of time afforded to detectives solving murders – the death has already happened in these cases, after all – neurologists are faced with several, even tens of cases every single day that require rapid decisions on investigations and treatments. The wrong decision, even a slight delay, can mean catastrophic damage to the brain or spinal column, and sometimes death. Not only that, high levels of distress in patients and family members add a layer of complexity that most people would run a mile from if they had the chance.

The book presents clinical cases woven amongst a history of neurology, theories of psychiatry and psychology, anecdotes about Ropper’s own training, details of his love for baseball and model trains and other snippets of a life dedicated to medicine.

We meet patient Harry, who had been playing tennis four days earlier, but then ‘was understandably baffled when a progressive numbness took hold in his legs, and then spread to his arms and hands over the course of a couple of days.’ Also needing assessment is Susanna, a 19-year old woman from a devout Pentacostal family. Surrounded by her five family members, ‘Susanna’s arms are shaking, her whole body is shaking. She is fluttering her eyelids at about twice per second, her eyeballs are rolled upward, and her neck is arched backwards.’ Later we read of Mike, who is ‘thin, elfin-looking, with pallid skin’; ‘a huge gash decorated his scalp, with dry-crusted blood cascading onto the bedsheets like a frozen brackish waterfall’. After falling on an icy road, Mike is still alive thanks only to the support of a ventilator machine. He is an organ donor. Ropper and his junior doctor must go through a detailed assessment before declaring him brain dead. That Mike is a convicted pedophile layers the process with extra emotion.

The presented cases studies – most solved successfully, some not – leave the reader in no doubt that Professor Ropper’s clinical and diagnostic skills are exemplary. But what really makes him stand out is his humanity. Famous for providing advice to Michael J. Fox as he faced the debilitating physical manifestations of Parkinson’s Disease, Professor Ropper evidently has the approach we most desire in our medical professionals: treat the patient, not the illness. Looking after a woman with Lou Gehrig’s disease, Ropper helps her with honesty and care to manage each stage of the progressive, muscle-wasting condition. When the moment comes for her to direct the immediate withdrawal of her assisted breathing, she is prepared. In her last breath, she tells her husband, “I…I….love you. Goodbye.” If only we all had such a chance.

As someone who studied three years of medicine before transferring to the sciences, this book was almost enough to make me want to go back. Not because I want to expose myself to such a stressful career – oh my word, it would be incredibly so. But because Ropper’s stories makes you see the sort of a difference a wonderful doctor can make.

All medical students should read Reaching Down a Rabbit Hole; many currently practicing doctors could take a leaf or two from it as well. And for those not sure about which direction to follow in a clinical career once commenced, here is some that Ropper himself received early in his training:

“You want to be a nephrologist or urologist? C’mon! The kidney? It makes urine! Who gives a shit? Now the brain – the brain makes poetry!”

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Sarah Keenihan

Sarah is a freelance science writer based in Adelaide, South Australia. She established her writing business in early 2012 after 15 years working in immunology research and science communication in Australia and Indonesia. She currently works with a range of clients in science, medicine, research, education, outreach and communications. She has a Bachelor of Medical Science with honours, a PhD and a Graduate Diploma in Sciences Communication. When not reading and writing, Sarah indulges in cooking, eating and exercise.

Sarah’s Blog Homepage: http://sciencesarah.wordpress.com
Sarah’s Science for Life 365: http://scienceforlife365.wordpress.com
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