The tenth nerve

Maya, all of 18, had been battling refractory epilepsy for the better part of her adolescence. The word ‘refractory’ always leaves a bitter taste in my mouth as it signifies a resistance to the arsenal of medications we typically rely upon. Maya’s face, although etched with the fatigue of countless seizures, still held the spark of youthful curiosity. Her parents’ faces were a blend of apprehension and desperate hope as they held hands in front of me.

The MRI suggested she wasn’t a candidate for brain surgery. “The only option we have is called vagus nerve stimulation,” I told them. “Think of it this way,” I continued, leaning forward. “The brain is like a city, and seizures are like electrical storms – sudden, uncontrolled bursts of activity. Medications try to dampen these storms, but sometimes, they just aren’t enough.”

“So, what does the vagus nerve do?” Maya asked. “The vagus nerve is fascinating. It’s one of the longest and most important nerves in your body. It’s like a superhighway connecting your brain to almost every major organ below your neck – your heart, lungs, stomach, intestines. It’s a key player in what we call your ‘rest and digest’ system, the opposite of ‘fight or flight. In epilepsy, by gently stimulating this nerve, we’re essentially sending calming signals to your brain, trying to quieten down those electrical storms.”

Her dad looked thoughtful. “So, it’s not directly in the brain?” he asked. “Exactly,” I confirmed. “The device, which is quite small – about the size of a coin – is implanted under the skin in your chest, and a thin wire connects it to the vagus nerve in your neck. It’s like a tiny pacemaker for your brain, delivering regular, mild electrical pulses. By sending these signals, we believe it helps to modulate brain activity, making it less excitable and reducing the likelihood of seizures. It’s not a cure, but for many, it significantly reduces seizure frequency and severity.”

Maya’s eyes lit up with a mischievous glint. “So, if it’s connected to my heart, does that mean it’ll mess with my love life?” I chuckled. “Of course, but for the good,” I confirmed. “It’s the primary brake pedal for your heart, slowing it down when you’re gazing into the eyes of someone special. When you feel those butterflies in your stomach, part of that is your sympathetic nervous system – the ‘fight or flight’ – kicking in. But when you’re feeling calm, content, and perhaps even a little smitten, the vagus nerve is working overtime, keeping that heart rate steady, bringing a sense of warmth and peace.”

“So, no sudden palpitations during a first date, then?” she quipped, still giggling.

“Hopefully not for any medical reason!” I replied, playing along. “But on a serious note, while there can be some mild side effects like a hoarse voice or a cough during stimulation, they are generally well-tolerated and often improve over time.”

After much discussion, Maya and her family decided to go ahead with surgery. The procedure itself involved a few relatively straightforward surgical steps: a small incision in the chest to place the generator and another small incision in the neck to connect the lead to the vagus nerve. Appearing as a pearly white cord, often surrounded by delicate fatty tissue, the vagus nerve is surprisingly slender for such a powerful highway of information. It doesn’t pulsate nor is it vibrant; it lies quietly, almost serenely, a lifeline waiting to be awakened. Seeing it there, so vital yet so unassuming, always reminds me of the hidden depths of connection within us.

The surgery was successful and Maya recovered remarkably quickly. We spent the next few months carefully programming the device, slowly adjusting the stimulation settings. There were small adjustments, minor hiccups, but gradually and remarkably, we started to see a change: her seizures eventually vanished into oblivion.

As they left after her most recent check-up, I felt a familiar sense of purpose, amplified by the joy of a truly happy outcome. It wasn’t just about managing seizures; it was also about making sure her heart was calm enough to feel every beat of joy, and perhaps, even the flutter of a new crush.