THE IMMOBILE MAN, A NEUROLOGIST'S CASEBOOK. BY LUD GUTMANN, MD. 132 PAGES. McCLAIN PRINTING COMPANY 2008
Every physician's career is filled with memories of remarkable people, occasional triumphs of deduction, and haunting missed diagnoses. In The Immobile Man: A Neurologist's Casebook, Lud Gutmann, MD, follows in the tradition of clinical storytelling stretching back to William Carlos Williams' The Doctor Stories, the medical mysteries of Berton Rouche, and the neurological explorations of Drs. Harold Klawans and Oliver Sacks, to name a few. Several of these 17 vignettes appeared previously in Neurology.
While neurological details are simplified for a general audience, medicine is merely Dr. Gutmann's starting point. He looks for the “person behind the illness,” chronicles resilience in the face of tragedy, and ponders the complex relationship between mind and physical symptoms.
We learn a lot about Dr. Gutmann's life, as well. Born in Germany, he came to the United States at age four, shortly before World War II, and grew up on a farm in New Jersey. His first stories date from medical school at the Columbia University College of Physicians and Surgeons in the mid-1950s. Others spring from his long career at West Virginia University Health Sciences Center, where he helped establish the department of neurology, served as its chairman for 28 years, and continues to teach today.
He is, above all, an astute clinician, in the tradition of his mentor at the University of Wisconsin, Frank Forster, MD, one of the founders of the American Academy of Neurology. Dr. Forster skillfully demonstrated physical findings on rounds while allowing a severely handicapped young woman to feel valued and important.
Dr. Gutmann recalls that watching a group of Parkinson disease patients shuffling to the clinic at Columbia piqued his interest in neurology. Early trials of levodopa, in which he participated, produced almost miraculous improvement, yet some early patients were unsatisfied, expecting a return of lost youth.
Modern technology may be light years away from the skull films and spinal taps available in the 1950s, but careful listening and observation remain key to solving a mystery. Dr. Gutmann chronicles failure as well as success. One “eyeball” diagnosis, obvious in retrospect, is missed by hundreds of medical students. Family secrets produce an ethical dilemma about what to reveal and to whom. Deep psychological problems underlying one woman's obsession with a non-existent illness proves tragic. Dr. Gutmann long ago made the connection between conversion reactions and a history of abuse.
The history and culture of West Virginia permeate his stories. Coal mining and its dangers, probably unfamiliar to most neurologists, are an inescapable fact of life. Ancient feuds are remembered, and punishment of transgressions can be swift and violent. Family loyalties are strong, and stoicism in the face of hardship is ingrained. Dr. Gutmann has had the good fortune to follow patients for 40 years, and some became friends.
One of his finest essays, “Salli and Rosi,” is a meditation on his parents' decline into dementia. Their lives were shaped by the dislocation and hardship of leaving Germany and starting life over in the United States. His father, always steady, quiet, and responsible, became irascible and angry as his dementia progressed, while his mother, always controlling, became placid and happy. Dr. Gutmann explores the inevitable regrets, guilt, ambivalence, and the toll an endless burden of care takes on even a loving family.
Short, engaging, and conversational, the stories in The Immobile Man stick in the mind and may conjure up the reader's long-forgotten memories. Dr. Gutmann has another volume of tales and a memoir in the works. Watch for them, and perhaps his example will inspire more neurologists to record their own memorable and instructive stories.
Call for Nominations for Neurology Today Editor-in-Chief
The AAN is requesting nominations for the position of editor-in-chief of Neurology Today, the Academy's twice-a-month news tabloid for neurology professionals. Current Editor-in-Chief Lewis P. Rowland, MD, FAAN, is stepping down in his tenth year of leading the publication.
Only Fellows of the AAN are eligible for appointment. Any member may submit a nominee; the nominee should approve the submission of his or her name. Fellows may nominate themselves. Nominations should include a brief statement addressing the skills, abilities, and characteristics of the nominee. Nominations will be accepted until October 1, 2009, and the selected candidate will begin January 1, 2010.
According to Robin Brey, MD, FAAN, chair of the Search Committee, nominations are welcomed from diverse backgrounds, including geographic, gender, ethnic origin, professional setting, subspecialty, and time in the profession. The candidate must have significant writing and editorial experience and have familiarity with AAN activities. The editor-in-chief is compensated commensurate with the requirements of the position.
Nominations should be sent to Donna Honeyman at email@example.com or by fax at (651) 361-4813.