Brain on Fire Review


I read a review on Love and Skye blog about Brain on Fire: My Month of Madness , and was compelled to read it. I won't give the whole synopsis, as I don't want to ruin the nuances of the story, but I wanted to share my reactions to the story as a health care provider. This book is an account of a young twenty-something successful otherwise healthy New York reporter, Susannah Cahalan who suddenly experiences symptoms of paranoia which progresses to psychosis, seizures, and then catatonia. In my advance health assessment course, we were told "Think horses, not zebras" meaning the symptoms a patient presents with usually points to a common straightforward illness a "horse" and not an exotic disease or a "zebra". In this case the diagnosis was definitely a zebra, and took almost a month and a handful of specialists at NYU hospital to finally pinpoint and treat this mystery diagnosis. This story left an impression on me for several reasons. One, her symptoms were dismissed initially as "stress-related" and even as alcohol withdrawal symptoms. The author was fortunate enough to have a supportive family who demanded answers and follow up from the health professionals. As primary care providers we are trained to look for horses, not zebras, but this is a cautionary tale of when the symptoms and history don't add up, to start looking for zebras. Cahalan was also fortunate enough to have access to a team of the top specialists in neurology, infectious disease, and psychiatry working on her case. Had she been in a position without access to specialists or without family support both emotionally and financially, her outcome may have been very poor. I think of how many patients I have seen who do not have someone advocating for them, and if they were to be in this position what would happen. Sometimes, as primary care providers we are the only advocates for the patient. Cahalan researches the history of the disease, and how so many with this disease, many children, have gone misdiagnosed. She also touches on the future of research in the field of neurology, and the possible links of autoimmune illness to mental illnesses, which is really fascinating groundbreaking research. This memoir also highlighted how terrifying from the patient perspective losing touch with reality and memory can be. In my time as a nurse I have often had a glimpse into the minds of those with psychosis or memory impairment, but rarely would I get insight into the patient's personal perspectives on this experience. This is a fantastic read which I recommend adding to your summer reading list.
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