Affecting everything, affected by everything

 kw: book reviews, nonfiction, neurology, medicine, memoirs

A medical student begins losing her sight, but at first cannot tell; eventually she realizes that her brain is filling in plausible details where her vision has stopped working. An older woman's leg makes running motions when she tries to sleep, sometimes kicking her husband; when it begins happening while she walks it gets very hard to walk reliably. A man wakes up in the morning, feeling fine; he talks with his doctor as usual—from the doctor's perspective—but his speech is mostly nonsensical and he doesn't realize he's beginning yet another day like the prior 7,600 or so because he has been in this hospital for 21 years.

I have heard it said that if there were only one human in the Universe, that more than half of the total complexity of the Universe would be found in that person's brain. When a functional object has not just billions but quadrillions or quintillions of moving parts, it is amazing that it functions at all, let alone with any reliability.

Neurologist Pria Anand, in The Mind Electric: A Neurologist on the Strangeness and Wonder of Our Brains, brings together more than a dozen stories, including a few of her own experiences, connecting them with history and mythology, to illuminate some of the things that do go wrong in the brain. Treating people (usually women) with migraine headaches is one thing. Experiencing them herself, complete with premonitory auras and even hallucinations, is quite another. For the sake of their sanity, doctors must learn to keep a certain distance from their patients. When a doctor is suffering the same symptoms, that distance is hard to maintain.

My mother died with Alzheimer's Dementia, as did her sister and their father before them. During her last year my mother was cared for by a wonderful nurse named Mary. But Mary, who also had relatives with similar dementia, eventually couldn't stand the strain and had a nervous breakdown. After Dad retained a new nurse, Mary would visit frequently, now as a friend rather than a caretaker. Mary recovered.

Many of the syndromes Dr. Anand discusses are found more in women than men, some are hard to diagnose, and in many cases a woman may be dismissed as "hysterical" by doctor after doctor before finding one with sufficient experience, and compassion, to ferret out the cause. Even something like Restless Leg may be dismissed as a hysterical manifestation, and since it has several possible causes, a doctor may be reluctant to order a whole bunch of tests to narrow the search for a cause.

I learned a few things. One that is important: the cerebellum is more than a control center for the body as I had thought. It mediates coordination, bringing together the will or desire, the evidence of the senses, and the knowledge of place and space, to weave the coordinated movements required to carry out the "orders" of the cerebrum. It can also briefly override the autonomic functions of the brain stem. We can briefly "take control" such as holding our breath when swimming underwater. But a disruption or injury to the breathing control circuit between the cerebellum and the brain stem, can produce a syndrome in which a person must breathe by an act of will, making it impossible to sleep. But being forced to stay awake has its own horrific result: in about two weeks without sleep, you just die. Diseases that damage the cerebellum produce any number of motion and coordination disorders.

Blindness is not just an eye problem. Several things can happen to or in the eye to affect our vision, such as damage to the cornea, the lens, or the retina. But between the eyes and the back of the brain where "vision happens", the optic nerves pass their signals through a few structures. A hiccup anywhere along the line can cause partial or total blindness. Damage at some junctures cause a person to be entirely sightless and yet not know it. Treating such a person cannot be aimed at restoring sight, but at setting up the support systems (relatives, spouse, friends, etc.) to keep the person oriented and safe. If such a one can't realize she's blind, she could walk into traffic or off a cliff with total confidence.

You may have heard of fever dreams. This has two meanings, one being the hallucinations that accompany malarial fevers. The other is more prosaic, something I experienced a few times as a child: when my fever due to a flu or cold rose about 102°F I would have what I called the Banging Dream. It would begin with a sound like a grain of sand ticking as it dropped from one side to the other of a small metal container that was being rocked back and forth; the container and the grain would enlarge slowly, and within a minute or two I would feel like my head was a huge steel drum in which a boulder was crashing back and forth. The basis was the sound of my own heartbeat, amplified monstrously as my overheated brain lost control of my senses. Other people experience moving colors, or "visits" from dead relatives…there is a panoply of odd things the brain under stress will do.

The author is such a good storyteller that I am at a loss how to proceed. Read for yourself and let her lead you on a guided tour of the world of a neurological resident and practicing neurologist.