Free Reaching Down the Rabbit Hole by Allan H. Ropper Page A

have been suffering from Creutzfeldt-Jakob disease, known to us as CJD, and more popularly as the human form of mad cow disease. Because of the rapid decline of his mental state, nothing else seemed to fit. Despite his inaccessibility, his sheer irascibility, I instinctively liked him, and looked forward to our visits. Even on his worst days, I would drop by simply to take a mental break, and I would usually drag a few members of my team with me.
    “HELLO!” I yelled in order to be heard over the air handler. “How are you, Gord? It’s great to see you! How ya doin’?”
    Hannah and young Gilbert, the medical student, lingered noncommittally just inside the threshold, as if at the edge of a precipice.
    “Good,” Gordon muttered almost inaudibly.
    “Are you confused?”
    “Kinda. Everybody’s always confused.”
    “Am I confused?”
    He paused. “Nope.”
    “Mr. Steever, do you know where you are?”
    “Somewhere in this world.”
    Gordon spoke with a flat affect, a tone of resigned indifference rather than one of confusion. He sat in the easy chair between the bed and the window, wearing hospital-issue blue drawstring pants and no shirt, perpetually bent forward like a ballplayer in the losing team’s dugout, alternately anxious and agitated. His nurse, Carmen, stood by the bed, poised to intervene if necessary.
    “And what kind of place is this, Gordon?” I asked. “Is it a supermarket?”
    “I always get mixed up,” he said quietly. “I’m in a box, and it’s the wrong box, and I’m just in another box.”
    He was right. Gordon was one of the few patients on the ward with his own private box—a single room with a view. Through its windows he could look down onto Francis Street and see the gleaming metal-and-glass facade of the new Shapiro Cardiovascular Center, and beyond that the Riverway and Brookline Village. It was a beautiful afternoon, with the sun dipping just low enough to produce some contrast in the tree canopy that welled up beyond the nearby rooftops. But Gordon didn’t look out the window. Most patients don’t. No matter how spectacular the weather, no matter how striking the view, no one seems to notice, including the nurses, and especially the residents. As far as they’re concerned, we could be anywhere.
    “Do you know what city we’re in, Gordon?” I asked.
    “City where people work and live.”
    This was the common theme. Gordon responded tangentially. If he were merely demented, he would have said something like “New Jersey.” His was a unique type of confusion, with speech that approached what my professor, C. Miller Fisher, used to call amphigory , or nonsense speech.
    “He looks a little drugged to me,” I said to the nurse.
    “He actually hasn’t had his Haldol for eight, ten hours, because his IV came out.”
    “The key,” Gordon interjected, staring blankly at the floor, “is when you ever feel good bowling, you can stand back at the line, and you can say, ‘Look now, count one-two-three.’”
    “That’s the key?”
    “That’s the key.”
    “Are you hallucinating, Gordon? Are you seeing things right now?”
    “No.”
    “Good. What’s your address?”
    “My address? Let’s see. There’s a dog in here talking, so he can just say, ‘Hey, do you want to know the best days? Look here!’”
    “How the hell does the brain assemble that ?” I asked Hannah, somewhat rhetorically. “It’s certainly not just aphasia. His diction and tone are perfect and his comprehension near perfect. It’s his internal conversation that’s muddled.” She responded by puffing one cheek.
    Apparently fine just a month ago, Gordon had rapidly degenerated into this state. After two weeks of tests and bedside exams, none of my colleagues could say what was wrong with him or what had caused this. My initial thought was that these strange responses were rattling around in his temporal lobe, but could not connect with each other.
    “He’s talking nonsense,” I said,