Boston, MA - A renowned cardiologist with prestigious academic and clinical credentials has written a new book regarded by some as required medical reading. The book, however, is not standard educational fare, but rather an unflinching look at Dr Thomas Graboys's personal transition from doctor to patient as he struggles with a particularly aggressive form of Parkinson's disease and an Alzheimer's-like dementia.

Graboys ran a successful practice at the Lown Cardiovascular Research Foundation, part of the Brigham and Women's Hospital, and is still a clinical professor of medicine at Harvard Medical School. He remains at the Lown Cardiovascular Research Center as president emeritus. Diagnosed with Parkinson's disease at age 49, his memoir, Life in the Balance: A Physician's Memoir of Life, Love, and Loss with Parkinson's Disease and Dementia, is now published by Union Square Press.

In a recent interview with Tom Ashbrook of National Public Radio (NPR) [1], Graboys said some days are better than others. His wife, Vicki Baker-Graboys, described the day-to-day fluctuation in function like a switch being flipped. Some days are good, some days are not so good, she said. At times, cognitive function can vary from hour to hour, although mornings tend to be best. Graboys published a first-hand account of his life with Parkinson' disease, an excerpt from Life in the Balance, in the Boston Globe Sunday Magazine in March 2008 [2]. In it, he writes:

"The daily struggle with Parkinson's disease is relentless. There is no reprieve, and the future is uncertain. Even on the good days, Parkinson's lurks like an unwanted shadow. In my case, Parkinson's is a 24-hour-a-day affair, because the associated Lewy-body disease brings forth vivid nightmares and violent sleep on a weekly basis, nightmares so realistic that I am likely to act them out. I have dreamed of being attacked and, in an effort to fight back, have inadvertently struck my wife, Vicki."

In addition to the physical symptoms, which include a paralysis of mind and body upon waking, double vision, minor hallucinations, disorientation, drops in blood pressure that bring him close to fainting, and changes in body temperature, even basic tasks "like putting my arm through a sleeve can be exasperating," writes Graboys. Physical deficits, however, are just part of his daily battle.

"My interactions with people are marked by a slowness of thought (called bradykinesia) that is as embarrassing as it is frustrating," he writes. "It's more than losing my train of thought, though that happens a hundred times a day or more. It's having the words in my head, but being unable to move them from the part of the brain where thoughts are formed to the part that controls speech. The neural pathways are disorganized, like some fantastically complex highway system with overpasses and intersections, exit ramps and onramps, all leading nowhere."

Graboys told NPR that his parents both developed Alzheimer's disease, and with the first onset of his symptoms in his late 40s, he was worried that he too would succumb to the disease. Dr John Growden, director of memory and movement disorders at Massachusetts General Hospital and professor of neurology at Harvard Medical School, made the initial diagnosis of Parkinson's disease, and said early stages of Graboys's disease were characterized by depression, as well as emotional and physical lethargy, a common early manifestation.

Graboys told NPR that anger and frustration were inevitable after the diagnosis, but there were days when he still felt that Parkinson's had not affected his intellect.

"In the past, I was narcissistic and vain in this regard, and it was very difficult for me to accept that something was going on in my body that I couldn't control," said Graboys. "The name of the game is losing control, and we're all desperately trying to hold on to what we've got and to maintain a level of individualism in a process that's chipping away at my ability to do activities of daily living."

In his practice, Graboys developed a reputation as a patient's physician. Since his diagnosis, which forced him to retire in 2005, many patients have written to provide comfort and to thank him for his care. As the Boston Globe reports, one of those patients, Philip Heymann, a professor at Harvard Law School, wrote that he has "never dealt with a doctor whose skills, honesty, and considerateness I have admired more than yours" [3].

In addition to his prestigious academic and clinical positions, Graboys became well-known in Boston athletic circles when he was part of the "dream team" of cardiologists who correctly diagnosed Boston Celtic forward Reggie Lewis with a structural heart defect that ultimately led to his death. He has done early research in the area of cardiac arrhythmia and sudden death, but some of his later work focused on second opinions for interventions in cardiology, including catheterization, angioplasty, stents, and coronary bypass surgery.

Graboys went to college at Cornell University and then on to New York Medical College. He completed his internal medicine training at the Boston City Hospital and did a cardiovascular fellowship at the Peter Bent Brigham Hospital. He is the author or coauthor of approximately 170 papers and abstracts and coauthor of Angina Pectoris: Management Strategies and Guide to Interventions.

Graboys was also actively involved in the antinuclear movement, serving as chair of the Greater Boston Physicians for Social Responsibility from 1980 to 1987. He was the host and associate producer of a television program called "Critical Condition: The Nuclear Arms Race." He was also a board member of the national Physicians for Social Responsibility and served on the advisory board of International Physicians for the Prevention of Nuclear War, a group who won the Nobel Prize in 1985 for their work.