Just One More Question: Stories from a Life in Neurology

by Niall Tubridy

Just One More Question is the story of Niall Tubridy's career in neurology. He shares the stories of encounters that are, by turn, poignant, dramatic and funny.

Using simple and illuminating language Tubridy also explains well-known conditions like multiple sclerosis, motor neuron disease and Parkinson's and and brings us into the examining room as he accompanies patients with these diagnoses on their challenging path.

In addition, he reflects candidly on the reasons he, a doctor's son, went into medicine, how he has been tested, and what he has learned about people - and about himself - along the way.

Genres: Nonfiction, Medical, Memoir, Science, Medicine, Psychology, Neuroscience

304 pages, Paperback

Published April 4, 2019

Reviews

[Petra X]

This is good, interesting because it includes the details and mechanisms of neurological diseases such as multiple sclerosis and motor neurone disease. But it doesn't compare with the sublime Everything that Makes Us Human: Case Notes of a Children's Brain Surgeon. I'm not sure why. Maybe it is because neurosurgery is more dramatic than the medical practice, neurology. Maybe it's the writing. Both books are well-written, but this is more practical, more workaday, whereas Jay Jayamohan's own emotions and personality are more on show in Everything that makes us Human. I haven't finished either book (nearly, both). Maybe when I have I'll know.

[Sandra Deaconu · Rating 5 out of 5]

Cât de mult mi-a plăcut cartea asta! Ca structură și idee generală m-a dus cu gândul la O să vă cam usture, cu mențiunea că Tubridy nu are nici urmă din sarcasmul și cinismul lui Adam Kay. Ambele au fost lecturi savuroase și cred că sunt valoroase pentru oricine, dar cu precădere pentru cei care au legătură cu medicina, însă la Tubridy am simțit căldură în tonul cu care a vorbit despre pacienții și meseria lui. Dacă și în viața reală are aceeași fire răbdătoare, perspicace, analitică, prevăzătoare și calmă, trebuie să fie un medic excelent.

Pentru cineva care vrea să învețe mai multe despre boli, cartea aceasta ar putea părea superficială, întrucât înclină spre latura umană și personală a cazurilor, nu spre cea tehnică și medicală, însă Tubridy nu își propune să ne predea neurologie. El doar ne relatează prin intermediul unor povești ce înseamnă să fii medic, de-o parte și de alta a ușilor spitalului, precum și diverse cazuri foarte interesante, unde ne prezintă câteva afecțiuni, în special pe cele mai des întâlnite în Irlanda, se pare (Boala neuronului motor, scleroza multiplă).

O lectură fascinantă, din punctul meu de vedere, și accesibilă, deși mi-aș fi dorit să fie mai densă și să descopăr mai multe anecdote.

,,Mă întreb dacă nu cumva există o temniță cu amintiri vizuale ascunsă undeva adânc în noi înșine, care se deschide atunci când creierele noastre se destramă."

,,Mințile noastre sunt atât de aglomerate în această eră a informației și suntem întrerupți în mod constant și activ de sarcini care mai de care mai urgente, încât este dificil de trasat o linie unde se termină uitarea de rutină și unde începe adevărata deficiență cognitivă."

[CanadianReader · Rating 4 out of 5]

“getting the patient’s story is central. . . approaching it like a detective, adopting a Sherlock Holmesian strategy to finding out the background history and making the connections. . . tracing the patient’s movements and habits in the lead-up to the moment they discerned something was wrong. It is like a jigsaw, and even pieces that appear dull at the outset can be as important as any other piece when we come to see the whole picture . . . [Neurologists] keep probing, Columbo-style, until they are satisfied that they have found out as much as possible – there is always ‘Just one more question …’”

Niall Tubridy’s Just One More Question provides the lay reader with an introduction to neurology, the medical speciality concerned with diseases of the brain and nerves. Dr. Tubridy, who practises and teaches in Dublin, is a frank and amiable guide, and his book is more accessible, lighter on medical jargon and anatomical terminology, than many other recent medically themed nonfiction books—say, Fragile Lives, Stephen Westaby’s memoir of his work as an innovative and risk-taking heart surgeon, or Gavin Francis’s Shapeshifters: On Medicine and Human Change. Tubridy’s book focuses mostly on the stories of patients: some with more commonly known neurodegenerative diseases, such as dementia, multiple sclerosis, Parkinson’s Disease, and motor neuron(e) disease (ALS); others with lesser-known neurological conditions, including Guillain–Barré syndrome (in which the immune system rapidly attacks the peripheral nerves, sometimes leading to life-threatening weakening of the muscles of respiration), transient global amnesia (for which the exact cause remains unknown), paroxysmal kinesigenic choreoathetosis (“spasmodic flailing . . . brought on by the initiation of voluntary movement”), and cerebral spinal fluid leaks (which occur when the fluid that bathes and cushions the spinal cord and brain issues from a tear in the meninges, the membranes that line the skull and the vertebral canal).

As well as presenting many stories of his patients over the years, Tubridy includes elements of the memoir. The reader learns a little about the doctor’s childhood, family (particularly about his dad, a psychiatrist who specialized in treating those with addictions, and his brother, Ryan, a high-profile Irish TV presenter), his medical training (in Dublin, London, Paris, and Melbourne), and Irish culture in general. The author describes a typical day at the hospital, aspects of his work as a professor of neurology, and some of the issues and challenges he faces in his interactions with patients, not the least of which is their tendency to consult Dr. Google and settle on the most dire of diagnoses before even setting foot in his consultation room. He addresses many medical professionals’ fear, wariness, and even dismissal of neurology as a specialty that might offer patients diagnoses but little in the way of treatments. He also discusses a challenge common to all physicians these days: the drive for efficiency, which in Ireland goes by the name of “key performance indicators”. These determine how many patients doctors see a day, how much time is spent with each, and when patients can be safely discharged from hospitals so beds can be freed up. Being efficient, however, has costs: doctors feel emotionally exhausted; patients feel robbed of care.

To counter the skepticism with which neurology is viewed, Dr. Tubridy seeks to provide a somewhat more optimistic view of the specialty that clearly fascinates him. He balances stories of patients with poor outcomes with those whose conditions can be treated, ameliorated, and sometimes cured. I enjoyed his engaging and informative book.

Rating: 3.5 (rounded up)

[Ioana · Rating 4 out of 5]

„Câteodată, simpla natură umană care se ascunde în spatele simptomelor neurologice este suficientă ca să-ți frângă inima.”

Prin intermediul cărții de față, dr. Niall Tubridy, neurolog irlandez, creionează momente impresionante ale vieții sale personale și profesionale, explicând, printr-un limbaj accesibil, mecanica creierului și dedeusbturile vieții de medic, accentuând în același timp stările și sentimentele trăite de pacienții nevoiți să se confrunte cu schimbările radicale, uneori chiar devastatoare, apărute în urma primirii unor diagnostice precum bola Parkinson, sindromul Guillan-Barre, boala neuronului motor.

Iată câteva dintre cele mai interesante informații aflate pe parcursul lecturii:

- emisfera stângă a creierului controlează partea dreaptă a corpului, la dreptaci creierul stâng determină abilitatea de a vorbi; așadar, este foarte important de stabilit dacă o persoană este dreptace sau stângace încă de la începutul istoricului medical

- puncția lombară se realizază pentru a confirma ori infirma cazurile de meningită, encefalită, scleroza multiplă, hemoragiile craniene. Aceasta consta în plasarea unui ac lung în partea inferioară a spatelui, scopul fiind colectarea unei mostre din lichidul care înconjoară măduva spinării (lichidul cefalorahidian).

- boala autoimună apare atunci când anticorpii încep să atace organismul, iar pentru a riposta, în sistem sunt trimiși anticorpi sintetici numiți imunoglobulină

- sindromul Guillan-Barre (polineuropatie acută inflamatorie demielinizantă) este asociat cu un anticorp rebel produs de propriile noastre mecanisme de apărare împotriva infecțiilor, producând un asalt asupra nervilor, în special a nervilor care pleacă de la creier, dar se află în afara creierului și a măduvei spinării, golindu-i de mielină, care permite transmiterea semnalelor spre și dinspre creier

- urechile ne ajută să ne păstrăm echilibrul, partea lor internă având trei canale mici numite canale semicirculare, care comunică cu ochii și ne ajută să ne menținem echilibrul

- boala Parkinson apare din cauza pierderii rezervelor de dopamina, un neurotransmițător care transportă informația de la creier spre celulele nervoase. Boala nu poate fi combătută, doar ținută sub control prin medicamente care împiedică enzimele să distrugă dopamina pe care o avem în organism încă de la naștere

[Alynus · Rating 5 out of 5]

Ar fi grozav dacă cei mai mulți medici de la noi ar gândi și proceda așa cum ne povestește dr. Tubridy.

[Ita · Rating 4 out of 5]

As a patient of Professor Tubridy I was intrigued to find out what he Doctors in general thought of their patients.

As I have CP and also suffer with atypical migraines I am interested in the workings of the brain.

This is brought an accessible level for anyone to understand and find out a little about the many brain illnesses.

Now maybe the next time I attend the clinic I will have a greater appreciation for the doctors who I attend.

I was a patient of his predecessor Professor Hutchinson as were my grandfather and uncle whom had to give them both their MND diagnosis albeit a number of years apart.

Looking at my MRI scans must have been a nightmare trying to see changes to my brain amongst the old damage at birth.

Great to know we are all human at the end of the day. Now I be watching him watching us after reading this book.

[Sanjana Kini · Rating 4 out of 5]

I read this book for my very first meeting of medical school book club. I’ll have to admit that everyone else didn’t seem to like it that much and found it same-y but I really enjoyed the book. It broke down cases of brain disease in a way that was easy to follow and understand. It was also the first time I’ve understood certain neuro concepts. Lots of wisdom that I will take on in my practice.

[Kristi LaMonaca · Rating 4 out of 5]

Great book about a neurologist from Dublin. A lot of tragic and heartbreaking stories, but Turbidy always turned them around to something positive. Inspiring for people in the healthcare field.

[Kevin Hogan · Rating 3 out of 5]

By no means a bad collection of memoirs at all, but like other reviewers I felt he never really goes too far past the surface level. It's largely a collection of unrelated patient cases / anecdotes. There are some interesting observations at times but would have liked to see a more coherent thread /narrative from the author, would be interesting to hear how his experiences have shaped his general outlook on life or even his views on the medical system and profession. While it contains some interesting descriptions of neurological conditions also the author doesn't go much beyond the surface level on these either, and overall was left somewhat wanting. By no means a bad book though, well written and author shows great commitment to his craft and compassion for his patients.

[Caroline · Rating 5 out of 5]

Fascinating read. I found this book funny at times but so sad at times. Each of the patients stories were told with great compassion. I hope he writes another book. My favourite chapter was the one where he outlines his normal working day. I found it fascinating and also touching that he cares so much about the patients. Our health service gets such a bashing it’s great to hear from doctors like Professor Tubridy.

[Iain Snelling · Rating 3 out of 5]

Feel a bit mean with only 3 stars but the format of short chapters gave it an anecdotal feel rather developed narratives. A few more details and acknowledgement of other team members and organisational issues and frustrations would have been helpful. The writing is engaging and respectful of patients and the often devastating impact of neurological conditions, and the explanations of the science are just right.

[John Maguire · Rating 2 out of 5]

Somewhat interesting but a bit too lightweight in its explanation of the underlying brain functions and failures for my liking. Sounds like exactly the kind of empathic, considerate neurologist I’d love to be referred to if I ever needed one though!

[Joseph Whelan · Rating 5 out of 5]

Brilliant book. The author takes us on a roller coaster ride through the the world of neurology. He explains comlex neurologic diseases in easy to understand langue. His stories of the conditions he has treated are funny, poignant and downright scary. Throughout the book his dedication to his chosen profession and the patients he treats shines through.

[Cris · Rating 5 out of 5]

"Nu că aș fi trăit pe străzi, dar el deja își cumpărase o casă și o mașină și, mult mai important, părea mult mai matur decât mine, care mă întorceam într-un apartament co-închiriat din Lilley Road cu un Big Mac rece sub braț. Mă simțeam confuz că, la zece ani după ce terminasem școala, lucram un număr ridicol de mare de ore, deși într-o slujbă pe care o iubeam, dar cu niciun rezultat tangibil. Cu toate acestea, chiar și ca doctor tânăr am simțit că există oameni care au nevoie de mine. Aveam un scop în viață pe care nu puteai să-l cumperi cu bani".

Am adorat cartea de la început până la sfârșit. Am citit-o extrem de repede. Nu doream să o las jos, voiam să continui să aflu mai mult. Pentru oricine care face parte din domeniul sănătății mintale (neurolog, psiholog, psihiatru, etc) cartea lui Dr Tubridy e o comoară. Arată atât de elegant și cu enorm de multă compasiune și empatie ceea ce se află în spatele cortinei. Cum anume este să fii de fapt medic.Cum este să te întâlnești cu suferința celorlalți în fiecare zi și de ce unii medici pot să devină irascibili. Problemele sistemului medical, problemele cu care se confruntă medicii. Mi-a plăcut că s-a axat mai ales pe problemele de natura interioară pe care cineva din acest domeniu le trăiește. E extrem de important să ne aducem aminte că până și cei care ne salvează pe noi, uneori, au nevoie la rândul lor, să fie salvați. Că în ciuda faptului că ei sunt îngerii noștri, în spatele aripilor au același trup uman, precum toată lumea. Și chiar dacă acele aripi nu aduc mereu recompensa financiară pe care o merită (una imensă), aduc ceva complet de neprețuit: sănătatea celorlalți.

[David Lewis · Rating 4 out of 5]

Really enjoyed this book 8.6/10

[Hayley · Rating 3 out of 5]

An interesting book which covers various neurological disorders and illnesses, including a part memoir about life as a neurologist scattered throughout.

[Abby · Rating 4 out of 5]

This book was a good read as a medical student currently in my pre-clinical neurology block. I think one of the most interesting points he brought up was the difference between living in the "land of the well" vs. the "land of the unwell," and how doctors are the ones who help people navigate between the two. I like the thought of that. Being any kind of specialist doctor will mean being an expert guide for patients.

I'm curious what it would be like to be a student of Dr. Tubridy. His voice in the book is confident but humble. Yet, he describes a former student telling him that his rotation was dreaded as one of the toughest.

[Marion Roux · Rating 5 out of 5]

How lucky we readers are that Niall Tubridy's family and friends persuaded him to put pen to paper. This is a most interesting book by an empathetic and knowledgeable teacher who explains the subject of Neurology so well.
"Just One More Question", as a title, is clever as this is his approach during his initial interview with, and examination of, a patient, where he is probing for signs and symptoms of their complaint before making a diagnosis.
It is also enlightening to read of the impact the present era of technology and cellphone usage has on human behaviour. "Bedside manners" and face-to-face interactions often now need to be taught as these are essential to establishing good doctor/patient communication and the opportunity to 'detect' problems while observing the patient. By the same token, 'appearance, demeanour and bearing' can contribute to trust and interaction between all parties.

[Rob Hartnett · Rating 5 out of 5]

“One day the sky will fall in on each of us. I urge you to celebrate the fact when today is not that day.”

Niall Tubridy deals with with important stuff. The stuff that changes lives, for his patients and those around them. He does it every day and has given us an insight into some of those days.

He lets us under the mask of the Consultant to reveal his own uncertainties, at times, as well as the confidence he gains from having listened so well down the years.

It that patience to listen, and ability to hear the full picture around symptoms, that make him an exemplar in what he does.

And as for the importance of choosing the right words that will be recalled and clung to for years, how very true.

A brilliant start to my reading year. Thanks Professor.

[Alex SCHELLEMAN · Rating 2 out of 5]

This was an odd one. I so wanted to enjoy it, but there was something so...superior about the tone of the writing. Clearly, the author is an empathetic, considerate and thorough doctor. However, there are several passages where he all but writes ‘back in my day!’ while shaking a metaphorical fist at the younger generations of medical staff. In one chapter, he talks about a patient who he tells ‘it would be far more effective....if she lost some weight’ but then later tells the story of a patient who dieted so severely that she lost feeling in her legs; clearly unable to see the link between the two. I enjoyed his descriptions of neurological exams and case studies, but the hubristic writing rubbed the wrong way. Or maybe I’ve just read ‘This Is Going To Hurt’ too many times.

[Anne-Marie · Rating 5 out of 5]

I loved this! Its so personable, well paced, translates the world of neurology into layman's language and explains complex conditions very clearly. I love the insights aspect into the neurologist point of view and how the analysis begins at the point where he calls a client from the waiting room by observing how they carry themselves and how they follow instructions; all which contribute to the diagnosis process. He describes very compassionately how patients are instantly transported from 'the world of the well' to 'the land of malady' when provided with their neurological diagnosis; how in one split second, a life is changed forever. A fascinating read.

[Ajla · Rating 5 out of 5]

I was amazed by neurology in my Student years. I always wanted to become a Neurologist. Dr. Tubridy has reminded me why. I find the book very approachable for not only Physicians, but also for people who are interested in Neuroscience / I would say Patients too. They can better understand what and why we do what we do, and why Neurology is not only "make Diagnosis and say Goodbye".



"I was amazed by the finely tuned way that neurologist listened to every cadence of a patient's voice; how they watched, all but forensically, every flicker of movement. They were like expert electricians who could find the precise area where the wiring or the bulbs were faulty."

[Eileen Conway · Rating 3 out of 5]

I enjoyed this book immensely, and found the stories of Tubridy's life and practice compelling. I do have a weak spot for neurology though, so I was pre-inclined to the subject matter. That said, I did wish that there was a bit more details throughout, and perhaps more on challenging cases. The episodic nature of the book was fun and made it ideal for reading in quick snippets while traveling, but sometimes it left me wanting for more. And warning, psychosomatic symptoms are unavoidable while reading!

[Ashley NicIllechiar · Rating 5 out of 5]

Excellent first-hand account of the world of neurology

I find this field of medicine extremely interesting and as a nurse can empathise with some of the situations in this book.
Well written and respectfully explains what patients go through to seek a diagnosis. The world of neurology is quite complex and the disorders can be cruel. It is helpful to gain insight into some semblance of what our patients experience as well as their families when receiving a diagnosis. Niall is empathetic and engaging, an excellent read!

[Graham · Rating 4 out of 5]

An engaging little read, although as other readers have noted, if you're looking for depth then you've come to the wrong place. Instead this offers a cursory look at the day-to-day casework of an Irish neurologist, examining the main kinds of disease and illness commonly tackled, with dottings of memoir interspersed amid the cases. The author warns from the outset that characters have been merged and names changed, but this does have the ring of authenticity to it. As somebody formerly on the "other side" of neurologist meetings, it was nice to see things from a different perspective.

[Ramdas · Rating 5 out of 5]

The brain remains a mysterious organ and Neurologists are the true heroes, tirelessly working to help patients, often with hugely debilitating, intractable conditions. This book is a poignant, heartwarming tale of Niall Tubridy’s life as a neurologist and his varied, quirky encounters with neurology patients presenting with a spectrum of symptoms. The book is informative, sparkling with humour, compassion and humanity.

[Maggie · Rating 4 out of 5]

This was a wonderful beautifully written read I was gripped from page 1 and I couldn't get enough of it. Neurology is so fascinating yet equally frightening. The stories bring the subject into ordinary peoples lives and the reader see how they are affected. Professor Tubridy has great emotional intelligence on top of his other obvious attributes I thank him for allowing me into his world. I hope he will consider writing more. Highly recommended.

[David Anguizola · Rating 4 out of 5]

Read by a neurologist, the author inspire to go deep into the stories of patients and how their symptoms consume not only daily activities but also daily thoughts and worries. Furthermore, how these annoying neurological complaints affect the tranquility of the neurologist, how to deal with them. Recommended to everyone whose interested in both faces of the consult, the patient and the neurologist.

[Sambasivan · Rating 5 out of 5]

Amazing real life stories with human touch. Multiple Sclerosis, Motor Neuton Disease, Parkinson’s, Alzheimer’s are really life destroying diseases for which there is no full cure till date. The author humbly talks about his personal experiences as a neurologist with supreme sensitivity. He has also opened up on his father and personal life.
Could be a life changing read.

[Lyndsey Gallagher · Rating 4 out of 5]

I picked this book up because it reminded me of Adam Kay's book This Is Going To hurt. Although I enjoyed it, it wasnt as good for me personally. It was entertaining but not as addictive as Adam Kays.