lost in the people sauce

Why would you do this to me, Dr. Lecter immune system?? I thought your job was to protect me.

The writing here isn’t super-consistent - if I recall correctly,  someone refers to Will being treated with antivirals, which would be ineffective against that type encephalitis - but it being autoimmune also has really interesting implications with regards to Hannibal’s bougie chicken soup.

[Soup Discourse]

Many of the soup ingredients Hannibal lists off - ginseng and star anise, for example - are reputed immune boosters, which, if your immune system is the root of the problem, is perhaps not ideal.

Now, realistically, those ingredients are not going to be any match for what corticosteroids (an anti-inflammatory that is the first-line treatment for brain inflammation in encephalitis, and which also has strong immunosuppressant properties) would do.

But Hannibal has already mentioned (to the late Dr. Sutcliffe) that he has identified the exact type of encephalitis Will has as being autoimmune; so the soup being an immune-booster feels like a mean little private joke that Hannibal is making to himself, at Will’s expense. Which seems like the kind of thing he would do, because he does find himself funny:

Ha ha, Cannibal Man.

…but it also gives interesting context to Hannibal’s reaction in this exchange:

It’s like Hannibal didn’t quite realize how touched Will would be to be brought soup, and also didn’t expect Will’s gratitude at being taken care of to feel so meaningful. It feels like the first time he second-guesses his general plan to effectively ruin Will’s life, and for a moment, Hannibal seems almost human.

(You know, until he course-corrects and merrily resumes murdering people.)

I can’t take credit for the chicken soup observation (it’s something I read a while ago either on here or on reddit), but the ‘autoimmune disease as betrayal by a theoretically protective entity’ angle is something I’d thought a lot about before ever watching Hannibal. Which is probably why it hit so hard for me.

[Back to Hannibal-as-the-personification of the self-attacking Immune System]

(cw for medical system-related horror)

I have an autoimmune disease that attacks the spine and brain, and whose diagnosis and treatment modus are similar to what a patient with autoimmune encephalitis would get - MRI for primary diagnosis, followed by immediate IV corticosteroids to reduce inflammation; and then a selective immunosuppressant - the standard is rituximab for encephalitis, and I take that drug’s biosimilar cousin, ocrelizumab, for multiple sclerosis.

There are differences - multiple sclerosis is chronic, whereas autoimmune encephalitis tends to be something where if you give the immune system a dose or two of anti-cd20 drugs, it gets the hint, and the next crop of B-cells to exit the bone marrow are programmed to leave the brain the hell alone (not sure how that works, but— awesome); also, multiple sclerosis is orders of magnitude less immediately dangerous than encephalitis, and generally doesn’t cause psychosis unless you’re really far along and really unlucky.

But during the weeks and months after I was diagnosed with MS, I felt profoundly shaken, and the thought that I kept coming back to was that my brain and my spine were being attacked by the very system that was supposed to protect me. It just felt so absurd.

I also really related to Will’s simmering panic about his worsening condition in s1. Hugh Dancy did an excellent job of evoking that - especially in the scenes where Will insists to Hannibal that something is wrong, only to be assured it’s all in his imagination and that nothing is physically wrong with him. In my case, no one intended to harm me, but I had that exact conversation dozens of times, with friends, family, and doctors.

I can also relate to the shock and betrayal Will felt, because - while no one intended to harm me - the first neurologist I saw did really fuck up. (He failed to send along any MRI results, so everyone just assumed they were negative for signs of MS; I had to change family doctors around that time, and records were still paper, so I think the new doctor thought the sheet with the results just got lost.)

Finding out that I should have been diagnosed much earlier, and would have if not for someone else’s negligence, was really painful; I was having a lot of problems physically, and it was hard to assess how much of it would be permanent. Again, I don’t think it was on purpose, but this was a serious medical fuck-up (my new neurologists all encouraged me to file a complaint with the licensing board), and I felt extremely let down by and somewhat angry about that first neurologist’s failure to even fax the results of a test that was so important.

(Licensing Board found in my favour, and made him take a course in records management. I presume he’ll never screw up in that way again.)