As a neurosurgeon, I’ve often found that the human body, in all its intricate glory, sometimes presents us with puzzles that even Sherlock Homes would struggle to solve. And then there are those cases that aren’t so much puzzles as they are… cruel cosmic jokes.
Sorab, a Parsi man in his late 60s, whose wit was as sharp as his perfectly pressed suits, was a retired English literature professor with a booming laugh and an uncanny ability to quote Shakespeare. “Doctor,” he declared, his voice a little like Sean Connery, “my tongue seems to be a little muffled.” His wife, Rati, a woman whose patience was clearly forged in the crucible of living with a literary genius, chimed in. “He can’t properly enunciate his sonnets anymore, Doctor. And his attempts at whistling now sound more like sounds made by a dying pigeon,” she said in jest.
I asked him to pull out his tongue. “It feels like a lazy slug, rather than the agile instrument of eloquence it once was,” Sorab quipped, attempting to stick it out, only for it to deviate slightly to one side. I could clearly see fasciculations – tiny, involuntary muscle twitches, like a bag of worms wriggling under the skin. “This is a problem with your hypoglossal nerve, the twelfth cranial nerve,” I told him. “Its job is to be the maestro of your tongue. It dictates every nuanced movement, from articulating the most complex polysyllabic words to helping you savour a perfect meal. It’s the last of your 12 cranial nerves.”
“I once read a book called Doctors by Eric Segal, which contained a mnemonic to remember the 12 cranial nerves used by medical students at Harvard – Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Auditory, Glossopharyngeal, Vagas, Accessory, Hypoglossal,” he belted out without hesitation. “Wow – and do you remember the mnemonic?” I prodded, knowing it would be naughty. “O O O To Touch And Feel A Girl’s Vagina – Ah Heaven!” he said with a cocky smile. His wife’s jaw dropped.
My mind immediately considered the usual suspects for an isolated hypoglossal nerve palsy. Perhaps a small tumour near the brainstem, pressing on the nerve as it exited. Or it could be a vascular lesion, a tiny stroke, infections, even inflammatory conditions… the list was exhaustive. But then, I asked him to remove his shirt and saw muscles twitch over his arm as well. The MRI, as expected, was unremarkable, but the EMG test confirmed my suspicion.
“ALS or amyotrophic lateral sclerosis,” I explained to Sorab and Rati, choosing my words with the care of a poet selecting the perfect metaphor, “is a rather cruel trick of nature. It is a progressive neurodegenerative disease that attacks the nerve cells in your brain and spinal cord – the very cells that control voluntary muscle movement.” I watched their faces trying to comprehend this, the flicker of fear in her eyes, the brave, slightly forced smile on his.
“Unfortunately,” I continued, “it is often diagnosed by exclusion, by ruling out everything else. And the initial symptoms can be incredibly varied – it might start with weakness in a limb, difficulty speaking, or, as in your case, a problem with the tongue.”
Over the next few months, the picture, sadly, became clearer. The weakness in his tongue slowly, inexorably, began to spread. His speech became more slurred. Swallowing became challenging. His once booming laugh was now a mere whisper. “It’s like my body is gradually forgetting how to perform the most basic of human functions,” he confided in me one day, his voice thick with a mixture of frustration and weariness. “Soon, I fear, I’ll be more of a statue than a scholar.”
ALS is a brutal disease. Despite the tremendous scientific advancements made over the last century, there is no real cure. We have medications that can modestly slow its progression, supportive therapies like speech and physical therapy, and assistive devices to maintain quality of life for as long as possible. But the trajectory, for now, remains heartbreakingly clear. “It’s a marathon against time,” I told him, “and we’ll run it with you, every step of the way.”
He faced his diagnosis with a blend of dark humour and profound resignation. “Well,” he mused, “at least I’m in good company. I hear Stephen Hawking knew a thing or two about this. And Lou Gehrig, the baseball legend! Though, I must admit, I prefer intellectual challenges to hitting a fastball.” He even joked about a new “ALS diet” consisting solely of pureed Shakespeare.
Over the next few years, I watched Sorab, a man of such vibrant intellect and spirit, gradually succumb to the relentless grip of ALS. His initial struggles with his tongue progressed to weakness in his limbs, then in his respiratory muscles. The man who once filled a room with his booming voice now communicated through an eye-gaze device, meticulously spelling out words one agonizing blink at a time. The physical struggle was immense, a daily battle for breath, for movement, for communication.
During one particularly poignant visit, I found him lying in bed, frail but still with that spark in his eyes. He had painstakingly spelled out a message for me: “Doctor… my body may be… a silent… fortress… but my mind… still quotes… Hamlet.” He then managed a weak, lopsided smile. Sorab passed away peacefully in his sleep, surrounded by his beloved Rati and his treasured books. His passing, like all patients lost to this relentless disease, was a stark reminder of the frontiers we still need to conquer in neuroscience.
But even in death, Sorab left an indelible mark. He showed me that when the body betrays you, the mind, if nurtured, can remain a vibrant, unyielding beacon. And sometimes, the most profound lessons are learned not from what we can fix, but from what we are yet to understand. His legacy, I believe, is not just in the sonnets he taught but in the quiet, powerful poetry of his fight.
“Don’t forget to teach the mnemonic to your students,” were his last words to me.
21 thoughts on “The twelfth nerve”
Touching
Every Sunday look forward to your article. Gain some medical insight, the challenges to conquer the unknown, your vastness of experience (wonder AI challenge)… Keep writing and educating your readers! Thank you!
Hie Dr. Mazda, Each Sunday, I hunt for yr article in mid.day n now in jame weekly.. I hv become very greedy, it’s the first thing I read and if not in news papers, then my very good friend, hutoo dudhwala sends me on watts app
Your writing skill is a God’s gift I must say, u explain the most difficult thing in simpler n witty way..thank you for sharing your experiences and incredible knowledge. Respects,
Hi Doc,
It surely saddened me to read Sohrab is no more – but, he too knew he was in good hands of an honest person who would not suggest any unnecessary operations.
Rest in peace Sohrab – you were one of the few lucky ones to have known Dr. Mazda, and a doctor’s honesty.
I enjoy your articles every sunday in Jame jamshed.I like the way you mix humour with medical science.
Keep writing doctor.
Wistful and touching!
It is touching to see the faith people put in you. Not only in your abilities but more so in your integrity. You are a rare commodity….a clean, honest, dedicated, caring doctor. The fact that you are also brilliant is purely circumstantial. Keep up the good work. Very proud of you.
Like most of your readers, I spent the last few minutes holding Sorab’s hand and praying for his recovery against all odds. Your compassion has engulfed all of us, Maz! Bless your caring heart!!
Excellent as usual. Keep it up
Felt sad that the cranial nerve series has come to an end and that too on a sombre note. But then thinking of the acronym put a smile back on my face. In every article, you beautifully remind us that both joy and sorrow are transient, inevitable, and an inseparable part of life. Thank you for grounding us in the present.
What a beautiful , simple but profound revision of all the cranial nerves .Unimaginable and the short form of all of them is hilarious .Never can miss any of them .Superb
Enjoyed the piece and the mnemonic😀
You know Doc it’s a profound dilemma in life whether it is better to lose a loved one to the inevitable after a long journey of pain and suffering to the incurable or suddenly to something which could be cured.
We are so attached to the visible body…it’s a tough call.
Lovely tribute to the indomitable spirit of Sorab.
Only you could juxtapose a devastating diagnosis of ALS with an irreverent memory device for the cranial nerves and Sorab’s love of Shakespeare.
Surely this is life with its ups and downs and the divine mixed up with earthiness.
Only you could take the twelfth nerve and turn it into a tale where Shakespeare, Sean Connery, and neuroscience walk hand in hand
Alovely peace of writing.Here even if sorab does not get cured knowing ur ability to b with this incurable problem along side of ur patient speaks volumes about u as neoro doctor. God bless you.
Dearest Dr Mazda sir …..
I am really really sorry for Sorab ji for his sad & unfortunate loss of Life
May be first time ever you have mentioned about death of your patient bcos your normal articles have happy ending with successful surgery & in depth procedure followed in OT…..
You have explained all the 12 cranial nerves so nicely in simple words for your esteemed readers…..
Looking forward for your next chapters sir 🌹
As always waiting eagerly for your coffee book of your compilation of your mind blowing pieces for your FANS ❤️
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V sad blog. But the upbeatness of Sohrab is inspiring. And a reminder how much more medical science has to go further to cure what he was suffering from
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