Phantoms in the Brain: Probing the Mysteries of the Human Mind Read Online Free PDF Page A

detail? Are they like alien abduction and spoon bending, or are they genuine anomalies—like X rays or bacterial transformation4—that may someday drive paradigm shifts and scientific revolutions?
    I was personally drawn into medicine, a discipline full of ambiguities, because its Sherlock Holmes style of inquiry greatly appealed to me. Diagnosing a patient's problem remains as much an art as a science, calling into play powers of observation, reason and all the human senses. I recall one professor, Dr. K.V.
    Thiruvengadam, instructing us how to identify disease by just smelling the patient—the unmistakable, sweetish nail polish breath of diabetic ketosis; the freshly baked bread odor of typhoid fever; the stale−beer stench of scrofula; the newly plucked chicken feathers aroma of rubella; the foul smell of a lung abscess; and 11

    the ammonialike Windex odor of a patient in liver failure. (And today a pediatrician might add the grape juice smell of Pseudomonas infection in children and the sweaty−feet smell of isovaleric acidemia.) Inspect the fingers carefully, Dr. Thiruvengadam told us, because a small change in the angle between the nail bed and the finger can herald the onset of a malignant lung cancer long before more ominous clinical signs emerge. Remarkably, this telltale sign—clubbing—disappears instantly on the operating table as the surgeon removes the cancer, but, even to this day, we have no idea why it occurs.
    Another teacher of mine, a professor of neurology, would insist on our diagnosing Parkinson's disease with our eyes closed—by simply listening to the patients' footsteps (patients with this disorder have a characteristic shuffling gait). This detectivelike aspect of clinical medicine is a dying art in this age of high−tech medicine, but it planted a seed in my mind. By carefully observing, listening, touching and, yes, even smelling the patient, one can arrive at a reasonable diagnosis and merely use laboratory tests to confirm what is already known. Finally, when studying and treating a patient, it is the physician's duty always to ask himself, "What does it feel like to be in the patient's shoes?" "What if I were?" In doing this, I have never ceased to be amazed at the courage and fortitude of many of my patients or by the fact that, ironically, tragedy itself can sometimes enrich a patient's life and give it new meaning. For this reason, even though many of the clinical tales you will hear are tinged with sadness, equally often they are stories of the triumph of the human spirit over adversity, and there is a strong undercurrent of optimism. For example, one patient I saw—a neurologist from New York—suddenly at the age of sixty started experiencing epileptic seizures arising from his right temporal lobe.
    The seizures were alarming, of course, but to his amazement and delight he found himself becoming fascinated by poetry, for the first time in his life. In fact, he began thinking in verse, producing a voluminous outflow of rhyme. He said that such a poetic view gave him a new lease on life, a fresh start just when he was starting to feel a bit jaded. Does it follow from this example that all of us are unfulfilled poets, as many new age gurus and mystics assert? Do we each have an untapped potential for beautiful verse and rhyme hidden in the recesses of our right hemisphere? If so, is there any way we can unleash this latent ability, short of having seizures?
    Before we meet the patients, crack mysteries and speculate about brain organization, I'd like to take you on a short guided tour of the human brain. These anatomical signposts, which I promise to keep simple, will help you understand the many new explanations for why neurological patients act the way they do.
    It's almost a cliché these days to say that the human brain is the most Figure 1.1
    complexly organized form of matter in the universe, and there is actually some truth to this. If you snip away a section of brain, say,