Brain On Fire

Cahalan says that, “[o]n April 2, the nurses started [her] first round of five intravenous immunoglobulin (IVIG) infusions” (116). It is too early to tell whether the treatment is working or not. Cahalan’s health is slightly worse than before, but not dangerously so. Everyone is concerned about the presentation of a new symptom, catatonia, which is characterized by rigidity, disinterest in eating, staring, quietness, and mimicking other people’s words automatically.

Cahalan’s father and Stephen bond over their commitment to fight for her, whereas before, they were not on good terms. This chapter includes further presentation of immunology-related science.

Cahalan’s test results continue to return as normal. The experimental therapy is not working. Her team of doctors is giving up, and, in some instances, do not show up for appointments. Cahalan is again showing signs of psychosis, which everyone fears.

Cahalan’s family is exhausted from a lack of answers or insight into Cahalan’s illness. The results from the Cahalan’s spinal tap reveals inflammation in her brain.

Dr. Najjar proves to be the hero of the Cahalan family. He shows up to speak with all of them. He performs the longest intake process of all the doctors. The scope of his intake is the broadest, encompasses the most people, and goes the farthest back in time. He treats Cahalan and her family as if they were people and friends. His tests yield a drawing produced by Cahalan that is the missing piece to her illness. He asks her to draw a clock, and Cahalan puts all the numbers on the right-hand side. From this drawing, Dr. Najjar is able to diagnose her. He coins the expression “brain on fire,” the book’s title. She has anti-NMDA-receptor autoimmune encephalitis, an autoimmune disorder in which her own body attacks itself, causing brain inflammation.

Cahalan’s parents describe Dr. Najjar as being like the protagonist, House, from the show, House M.D. Najjar orders a brain biopsy, which frightens Cahalan’s family. Cahalan, in an altered state, begins to tell visitors and well-wishers with strange ease that she is having a brain biopsy. She does not understand the severity of the procedure until she experiences her friends’ reactions to the news. The surgery goes well, although Cahalan awakes and believes she has lost feeling in her legs (she has not). Her post-op MRI shows that everything is ok.

The dangerous surgical procedure of the brain biopsy proves to be worthwhile for Cahalan: “The results of the brain biopsy confirmed what the team had expected: my brain was inflamed” (143). Cahalan begins a steroid treatment, as prescribed by Dr. Najjar. Some of her symptoms are exacerbated. Her cousin, Hannah, visits and is deeply moved by the changes Cahalan has undergone. Cahalan is moved back to the epilepsy floor, where her roommate is an alcoholic suffering from seizures brought on by substance abuse.

Dr. Najjar contacts Dr. Dalmau, the senior author on a study about patients like Cahalan, Dr. Dalmau’s research and now-streamlined procedure for treatment are what truly saves Cahalan’s life, giving her a chance at recovery.

This point in the book marks the beginning of Cahalan’s recovery. She begins a long series of post-op assessments. She has to see many doctors. She is weak, unable to speak, and unable to write. She is, though, mentally alert, and showing signs of frustration in regard to how much she cannot do. She is trying her hardest to consciously improve, yet at this point, doctors believe her condition to remain precarious.

Cahalan now has an accurate diagnosis. Her prognosis is hopeful, but she still has a long way to go before she has fully recovered. She has to receive chemotherapy at this stage of treatment. Doctors are still testing to see if she has teratomas—cysts that can grow hair, eyes, and teeth. While present for tests at NYU, she is treated as if she is an exhibit at a zoo or carnival:

Now that we had a diagnosis that had never before been seen at NYU, young MDs, hardly a day older than me, stared at me as if I were a caged animal in a zoo[.] […]The young man leading the group of nascent MDs introduced my case as if I weren’t in the room (159).

Cahalan’s father, appalled at this kind of disregard for Cahalan’s humanity, shouts until all medical staff have left her room.

Dr. Najjar proposes the next stage in her treatment, which is an aggressive, three-pronged attack. Cahalan is receiving outpatient treatment and living with her family after spending a month in the hospital. Her family has shaky hopes regarding the long-term treatment plan that is now in place. Whether or not Cahalan will fully recover remains unknown.