Book Review: Reaching Down the Rabbit Hole. Extraordinary Journeys into the Human Brain


Reaching Down the Rabbit Hole: Extraordinary Journeys into the Human Brain is the non-fiction collection of clinical tales, co-written by Dr Allan Ropper and Brian Burrell. Written from the perspective  Dr Ropper, the book details his encounters with patients during his 40 year career as a prominent neurologist at  Harvard’s Brigham and Women’s Hospital.

During his career, Dr Ropper has seen a myriad of neurological diseases; from common presentations such a stroke and Parkinson’s disease, to rarer conditions such as herpetic encephalitis and paraneoplastic syndromes. The book makes for some great neuropathology revision for medical students and junior doctors. Each patient’s case is recalled with detailed descriptions of clinical findings alongside explanations of the pathology involved. Yet, the authors’ use of language is relatively free of medical jargon and the stories are compelling enough to engage and fascinate readers who are not medically trained.


Vincent’s form of speech difficulty, known as Wernicke’s aphasia, sounds like gibberish, but not pure nonsense. It can include halting phrases that almost make sense, echolalia (repeating someone else’s just-used words), perseveration (giving the same answer to a succession of different questions), and play association (cracking wise). While he knew the answers to many of our questions, most of his responses didn’t come out quite right, yet he seemed unaware and unconcerned.

“What’s your name?” Hannah said.


“Good. Where are we? What place is this?”

“Vincent … uh, yeah … Vince.”

“What day is it?”

“Avince … Vince.”

“Okay. Look at my hand. Now follow my thumb.”

“Gee, you’re so dumb.”

Gilbert, the medical student who had made the initial exam, recorded this as “orientation times one.”

“To one what?” I later asked him.

“To himself,” he said.

“Have you ever met a patient who wasn’t?”

“I don’t think so.”

“No, you haven’t. It doesn’t exist.”

Copyright © 2014 by Dr. Allan H. Ropper and Brian David Burrell via MacMillan Publishing

With such a vast amount of complicated medical information to be divulged, it would be easy for a book like this to focus solely on each patient’s disease, rather than the patients themselves. Yet,  each case is written with curiosity about the person behind the pathology, acknowledging the the quirks and circumstances that make that person and the case, unique. This, it would appear, is Dr Ropper’s approach to both writing and clinical medicine.


We treat people with seemingly implausible ailments all of the time. Each day they show up in a predictable parade of signs, symptoms, and diseases: an embolus, a glioma, a hydrocephalus; a bleed, a seizure, a hemiplegia. That’s how the residents refer to the cases, as in: “Let’s go see the basilar thrombosis on 10 East.” When viewed in terms of actual patients, however, no day is quite like any other. After the bedside visit, the thrombosis suddenly has a name, the glioma has a wife and children, the hydrocephalus writes a column for a well-known business journal. Our coed suffering from psychosis turned out to be a Rhodes Scholarship candidate, the case of multiple strokes became a charming woman who had competed in the Junior Olympics, and the man for whom a smile was a troubling symptom owned a personal empire of six Verizon wireless stores

Copyright © 2014 by Dr. Allan H. Ropper and Brian David Burrell via MacMillan Publishing

“Reaching Down the Rabbit Hole” is not exactly an exercise in physician humility and the writing does have elements that are reminiscent of the TV show “House”. In many cases, Dr Ropper’s patient’s are suffering from severe and complicated neurological conditions that confound other doctors, until he swoops in and saves the day.  There are elements of the cases that feel slightly fictionalised or embellished in order to sustain this story arc. Nevertheless, it makes for easy and engaging reading.

What I loved most about this book was Dr Ropper’s obvious love and fascination for the human brain, as well as his emphasis on the value of clinical examination. As medical students, it is easy to fall into the trap of viewing the patient as their pathology. We take histories and perform examinations in order to find disease that can be immediately categorised and treated (often in accordance with stringent guidelines). In our attempts to be efficient, we can close ourselves off to exploring the nuances of the neurological examination and the insight it can give us into the remarkable functions of the human mind.

“Reaching Down the Rabbit Hole” serves as a reminder for doctors to remain both attentive and curious about the patients in front of us.





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