In August I shared the clinical syndrome called Alice in Wonderland, and Alice themes seem very popular in neurology these days for entities that reveal the mystery and drama of brain disease. This in fact is the subtitle of a marvelous new book coauthored by Dr Allan H. Ropper and Brian David Burrell, Reaching Down the Rabbit Hole. In our practices we are increasingly involved in the neuro aspect of rehabilitative care. While teasing out masquerading signs and symptoms of disease has always been part of the assessment in binocular vision disorders, “neuro” is part and parcel of caring for the patient with a history of confirmed or suspected brain injury.
In what sense are we reaching down the rabbit hole? As Dr. Ropper explains, the brain is the only organ system in which the clinician interrogates the very organ that has gone awry. How the patient looks, what the patient hears, and how the patient expresses herself is intimately related to the doctors eyes, ears, and mind. To the extent that we can follow the patient down the rabbit hole, and help pull them back to the surface, half the battle is won.
Toward this end, Dr Ropper says something very powerful in his introduction regarding the patient-doctor interaction:
“What they hope, what they expect, what they deserve, is that we take the time to listen, because the act of listening is therapeutic in itself. When we do it right, we learn details that make us better doctors for the next patient. The residents may not get this yet They are focused on diagnosis and treatment, on technology, on scales, titers, doses, ratios, elevations, and deficiencies. All well and good, I tell them, but don’t forget to listen.”
You can get a taste of Dr. Ropper’s substance and style in this 8 minute NPR piece. But nothing will substitute for curling up with the book, which reads like a neuro-novella. I highly commend it to you.