Reaching Down the Rabbit Hole Read Online Free PDF

with her situation,” according to the social worker, and on and on for thirty pages of cut-and-pasted notes from more than two dozen doctors who had examined her over the past two months: too many specialists weighing in with too many disconnected analyses, not adding up to a complete picture. Most of her file consisted of blind alleys and misinterpretations.
    She was in rough shape, virtually blind in her right field of vision, and now aphasic. What worried me was that she didn’t have any reserve left, and any little chip-shot stroke was going to be a disaster. The next one, I was convinced, could wipe her out.
    “I don’t see any vasculitis here,” I told Hannah. The low platelet count, which if anything would tend to protect against clotting and stroke, was another red herring. “I think the thing to do is just start from scratch. Something is missing. We’ve got a new team, so just make like she’s being seen for the first time, make believe she hasn’t been worked up, fill in all the holes. I think there’s a single origin of these multiple emboli. That’s what it sounds like, that’s what it looks like. There’s something upstream that’s flicking off debris into the blood vessels of the brain, and we just haven’t found it yet. If you told me she had a myxoma, I wouldn’t be surprised.”
    Something had to be giving off small flecks that lodged on the walls of blood vessels, effectively narrowing them. That was what had caused the strokes, and that was what had been misinterpreted as vasculitis. It was happening now, and would continue to happen, and the most logical source for the flecks had to be a thrombus (a clot of some kind), a tumor (a myxoma or fibroelastoma), or a bacterial growth due to an infection, probably in or near one of the valves of her heart. Yet my residents insisted that there was nothing wrong on the echocardiogram. After sifting through the case file, we finally got around to visiting her.
    “Hello. This is the neurology team. How are you?”
    “Not so hot.”
    Unlike most of our patients, Arwen Cleary did not look sick. Not only did she look physically fit, but physically vibrant. Rather than sagging into the hospital bed, she balanced on it like a coiled spring, ready to jump out of it if necessary. At the same time she was shy, somewhat abashed at being here. She had had no visitors for over a day, possibly because she did not want her children to see her like this, or, more accurately, to hear her like this, for although she could talk, she could only do so with halting fluency, mostly in monosyllables. She struggled and usually failed to come up with the longer words that best expressed her thoughts.
    “I know, it’s tough, not being able to express yourself easily.”
    “Oh, yeah. I’m off . . . Oh, my gosh!”
    “The dissections . . . I read in the chart that that happened after you got chiropractic treatment. Is that true?
    “Right. Yes.”
    “How much time elapsed, between the two.”
    “It was . . . just a few days.”
    “You know your spirits have been marvelous despite all this. How are you doing it?”
    “I . . . I . . .”
    “You stay optimistic.”
    “You have to.” She spoke with an unnatural monotone, somewhat like a deaf person, without accenting any of her words. That was the aphasia. She struggled with all but the simplest responses, and settled for tropes.
    “Do you find yourself getting down sometimes?” I asked.
    “Some . . . times.”
    “Are you depressed?”
    “No, not depressed . . . just sick of all this.”
    “Discouraged?”
    “Yeah.”
    “Well, thanks for letting us spend some time with you. We’re racking our brains to figure out what’s going on.”
    Stroke offers the most precise and restricted indicator of damage to the brain that nature produces, and therefore allows an understanding of brain function like no other disease. It is highly “readable,” and reading strokes reveals a tremendous amount about