Reaching Down the Rabbit Hole (29 page)

“Disengagement.”

“Exactly. They’re gone, yet it’s discomfiting. I started hanging around after codes because I’ve been interested in the size of people’s pupils when they’ve just died, and I get to see this little ballet.”

“You shouldn’t mess with death,” Elliott said.

“That’s what Trey tells me. I tried to lure him into a discussion about brain death, but he doesn’t see the point.”

“What
is
the point? Brain death is death. End of story.”

“But people don’t get it.”

“Well,” said Elliott, “knock yourself out. The rest of us have work to do. I’ll wait for it to come out on DVD.”

Elliott is a brilliant diagnostician and a keen judge of character, but a detached observer. He doesn’t try too hard to connect with patients, with his own colleagues, or even with me. He is an expert at “speed rounds,” for which the residents love him because he can get them in and out of a ward with twenty patients in about forty minutes. He is adored by the nurses merely for gracing the place with his presence, as though he has taken time out from a busy schedule just to say hello, pay a compliment, ask about the new baby, notice a pair of shoes, enter a betting pool, or criticize the Red Sox management. This is how he handles the pressure. He dresses well, he cultivates fine habits, and he lives far away from this madness. He is Jay Gatsby, without the insecurity complex. Beyond that, I can’t say that I really know who he is.

Elliott is my friend in the way that several of my colleagues are friends, even if he has a bad habit of showing up at the wrong time in order to tell me something I could live without knowing: that my patient is a child molester, for example. He is nothing like me, but I would rather have him around than not. I don’t need to be his closest friend, but I do trust him entirely. He is a very good doctor. Almost nothing gets by him. Judged by any of the currently fashionable measures of outcome, he would score extremely high. He has a tremendous
command of therapeutics. But there are patients who do not want to go back to him.

“He didn’t listen,” some of them say. “I told him I was having this trouble with my arm, he told me to get up on the table, he said this is what you have, this is what you need to do, and that was it.”

What they mean is, he doesn’t hear them out, he doesn’t savor their stories. That’s his style. Mine is to pull up a chair, put my hands behind my head, lean back, and just listen, as if to a book on tape. Almost never are two stories the same: patient X and patient Y may have the same medical problem, but very different personal experiences.

What Elliott cannot abide about neurology and about the hospital is the transactional nature of the job, the lack of closure. He moves from one case to the next without getting emotionally caught up in any one of them. Ironically, Elliott never tires of hearing
my
patients’ stories from me. He always has to know the rest of the story, and when he can’t find out what happened from my end-of-the-week recaps, he tries to imagine how the story ends. It is part of his cinematic sensibility. He should have been a screenwriter.

“What happened to Gordon Steever?” he asks me.

“He’s dead,” I say, hoping to head him off, but he won’t have it.

“I know, but how?”

“No idea.”

“Did we ever find out what he had?”

“No,” I say. “No one claimed the body, no one asked for permission for an autopsy.”

“We know what bowling alley he used to manage, though, right?”

“Yes, we do.”

“What about going down there and asking around about him.”

“That would be against the privacy rules,” I tell him, but I know what he’s building up to.

“I don’t see how bowling could be a violation of anybody’s privacy. Let’s go. How about tomorrow? Two strings. You roll on Shabbos, don’t you?”

Elliott has no intention of going bowling. He will probably spend the day reading, cooking, drinking Scotch, and periodically looking out over the Atlantic Ocean from his arts-and-crafts home in Manchester-by-the-Sea. But I know that he’s been waiting all week to ask me that question, maybe all month. And as he knows very well, I roll on any day of the week.

ACKNOWLEDGMENTS

The extraordinary way in which the disordered human brain spins its tale of woe reveals how the organ works, how it creates the primal human experience of illness. Over the years I have been privileged to listen to countless such narratives, to translate them not just into syndromes (cerebral hemorrhage, multiple sclerosis, motor neuron disease), but into truer categorizations of a patient’s plight (confused mind, difficult family, impossible case, threatening crisis, irreconcilable opinion, slow death, tale of heroism). My patients are compelled to get their stories out to assure themselves that there is a steady hand attending to their deepest concerns, and this book is my way of thanking them for being so open. I appreciate the generosity of my colorful mentor, Dr. J. P. Mohr, and of my joyful colleague, Dr. Dan Longo, who allowed me to incorporate snippets of their own patient stories into those of my own.

My residents-in-training are the main reason I get up early to come to the hospital. Several of them allowed me to take liberties with our time on the ward together in order to accumulate the material for this
book. These residents are precious commodities. Foremost among them are several who participated during the writing of the book, but who I will not identify in order to preserve their privacy, but I want them to know how much I appreciate their generosity.

Having taken notes during many patient encounters, and encouraged by my coauthor to record many others, I saw this book as a chance to retell compelling patient narratives through the knowledge of neurological diseases. Readers of the manuscript wanted to hear more about how I cope with difficult cases, what was I thinking at various junctures, and what the practice of neurology means to me. I respond by declaring that my motivation and satisfaction lie in savoring each patient’s story, in listening to the brain itself. Those readers were friends, family, and colleagues who were kind enough to read the book at various stages. We found a considerable amount out about each other in our conversations about the manuscript, and I offer my sincere thanks to them: Jennifer Lyons, MD, Eileen Bockoff, uncle Harry Schachter, David Fine, Alan Schlesinger, Roger Cassin, Joseph B. Martin, MD, Chuck and Rivka Raffel, Kathryn Giblin, MD, Martha Neagu, MD, Thomas Moorecroft Walsh III, MD, Martin A. Samuels, MD, Dr. Geoff Greif, Dolores Araujo, my most capable assistant, and Barbara and Michael Lissner. But the person I drove crazy when writing the book was my wife, so hail to Sandy.

I met Brian Burrell as a result of reading his wonderful book,
Postcards from the Brain Museum
. I invited him to discuss the book at one of the book clubs that our department organizes for the neurology and psychiatry residents. Brian and I have similar outlooks, and he has a lyrical talent for making true stories sing. Whenever I drifted toward standing on a soapbox, and ranted about the everyday frustrations of medicine, he brought me nicely back to the patient’s words in a way that enlivened and enriched my practice, for which I owe him a debt.

We are both grateful to our respective institutions, the University of Massachusetts at Amherst and Brigham and Women’s Hospital,
which afforded us the freedom to step outside our usual roles. We also wish to thank Michael J. Fox and Dwight Evans for permitting us to use their stories. Finally, we should acknowledge the role of serendipity, which allowed us to relate these stories more or less as they occurred.

A NOTE ABOUT THE AUTHORS

Dr. Allan H. Ropper is a Professor at Harvard Medical School and the Raymond D. Adams Master Clinician at Brigham and Women’s Hospital in Boston. He is credited with founding the field of neurological intensive care and counts Michael J. Fox among his patients.

B. D. Burrell is the author of
Postcards from the Brain Museum
. He has appeared on the
Today Show, Booknotes
, and NPR’s
Morning Edition
. He divides his time between writing and statistical research with neuroscientific applications.