SIX PARTS LOVE

David Rabin was 45, the director of endocrinology at Vanderbilt Medical Center, when he suddenly began to experience severe difficulties in walking and coordination--a devastating diagnosis of amyotrophic lateral sclerosis followed. This journal, a joint effort by Rabin and his daughter with input from his wife (a psychiatrist) and three other children, chronicles the inexorable progress of the disease over the next five years: Rabin is now wheelchair-bound, eats and breathes with the assistance of tubes, and communicates via a computer: mentally, he retains every function at his pre-illness level. This, of course, is the frightening hallmark of A.L.S. (commonly, Lou Gehrig's Disease): that as physical ability and function dwindle (death comes gradually as a result of respiratory failure), mental ability and function remain unchanged. The Rabins have major messages for three groups here. First, Rabin wants others with A.L.S. to know what they can expect as the disease progresses, and he offers detailed advice on practical matters (for stiffness and weakness of the lower limbs in the early stages, ""I found the Wallaby half-boot ideal; it is not heavy, yet splints the ankle and lessens the danger of falling""). Second, for physicians: Rabin was appalled by the unfeeling indifference he encountered from the majority of physicians treating him. The message is certainly not new--but still needs repeating: there is no place for the authoritarian, uncaring doctor today. Finally, the Rabins' story speaks to friends, colleagues, and neighbors who ignored, shunned, or were simply uncomfortable in the presence of one with a chronic, disabling disease: the best thing is always simply to be there--offer support, listen, run errands--but don't disappear. An eloquent, distressing account, with important messages for those similarly affected.