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.
62 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 ❤️
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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What meant the most to us was seeing her regain some hope and confidence. ALS is an incredibly difficult journey, but this experience has helped her feel stronger and more like herself again. For anyone caring for a loved one with ALS, or living with the condition themselves, we believe it’s worth exploring alternative, natural approaches like the one offered by NaturePath Herbal Clinic.
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I am here to say all i experienced with Dr Isikolo just like everyone else who is grateful would do. Dr Isikolo saved my marriage and it happened just like a miracle. For a very long time, I have issues with my husband and he became very distant from me and that alone worries me a lot. Family and friends did all they could to help the situation but to no avail. Days became week and weeks became months and months became two years plus. I knew I had to seek help. So I contacted Dr Isikolo and he offered willingly to help me which he did. He resolved the situation and the love and connection I and my husband shared, was restored and it all happened like a miracle. Now we do everything together and the kids are so happy that I never left and Dr Isikolo is all I have to thank for the full support and making my family happy and whole again. Review his webpage and get more info: https://isikolo-temple.com or text him via WhatsApp +234-8133261196
I’m beyond grateful to Dr. Benjamin for changing my life completely! I had been playing the Mega Millions lottery for years without success, until I came across Dr. Benjamin and decided to give his spell casting services a try. After performing a powerful lottery spell for me, everything turned around in the most unbelievable way—I won the Mega Millions jackpot of $670,000,000,00! The experience still feels like a dream come true. Dr. Benjamin was professional, kind, and deeply spiritual throughout the entire process. He guided me with confidence and positive energy, and his work truly produced results beyond my imagination. I highly recommend Dr. Benjamin to anyone who believes in miracles and is ready for a life-changing breakthrough. reach him via drbenjaminlottospell711@gmail.com or WhatsApp: +18588585788.
Wow what a good God I am so excited to tell you all how I become a millionaire I’m a woman of faith I was reading a comment on google where I meet a man sharing how Dr UYI cast a spell for him and he get his wife back after the spell I was interested I have to do research when I was doing the research I got so many testimony about this same man call Dr UYI how he help people to win lottery how he help people to get there ex back how he help people to do so many things I was happy and I contact him to help me win the lottery when I contact him and he told me what to do and after I did what he ask me to do he den gave me a lottery number to play and told me to go and buy ticket after playing the game I was so surprise the game come out good and I won the sum of 90, 000,000 dollars i was amazed and promise to share it to the people around me if anyone is willing to play the mage lottery it should contact Dr UYI so he can give you the right number to play thanks to you Dr UYI I’m so so grateful contact Dr UYI via drzukalottospelltemple@gmail.com OR WhatsApp on +17174154115
A LIFE-CHANGING LOTTERY WIN THROUGH LORD BUBUZA’S GUIDANCE
I can never stop thanking Lord Bubuza for the help I received. I love playing lottery games, but I had never won before. My bills were piling up, and my job was not enough to cover my expenses.
I searched online for ways to improve my life and came across testimonials from people who testified that they had won big after receiving lottery numbers from Lord Bubuza. I contacted him through WhatsApp at +1 (365) 808 5313 and explained that I wanted to win the Powerball lottery. He explained what I needed to do before providing lottery numbers. I followed his instructions carefully, and after the spell was cast, he gave me numbers and explained where and how to play.
I was amazed when I won $310,500,000 after playing the numbers he gave me. This experience changed my life, Lord Bubuza is a God on Earth. Contact him for help too by
email: Lordbubuzamiraclework@hotmail.com
WhatsApp: +1 (365) 808 5313.
A LIFE-CHANGING LOTTERY WIN THROUGH LORD BUBUZA’S GUIDANCE
I can never stop thanking Lord Bubuza for the help I received. I love playing lottery games, but I had never won before. My bills were piling up, and my job was not enough to cover my expenses.
I searched online for ways to improve my life and came across testimonials from people who testified that they had won big after receiving lottery numbers from Lord Bubuza. I contacted him through WhatsApp at +1 (365) 808 5313 and explained that I wanted to win the Powerball lottery. He explained what I needed to do before providing lottery numbers. I followed his instructions carefully, and after the spell was cast, he gave me numbers and explained where and how to play.
I was amazed when I won $310,500,000 after playing the numbers he gave me. This experience changed my life, Lord Bubuza is a God on Earth. Contact him for help too by
email: Lordbubuzamiraclework@hotmail.com
WhatsApp: +1 (365) 808 5313….
A LIFE-CHANGING LOTTERY WIN THROUGH LORD BUBUZA’S GUIDANCE
I can never stop thanking Lord Bubuza for the help I received. I love playing lottery games, but I had never won before. My bills were piling up, and my job was not enough to cover my expenses.
I searched online for ways to improve my life and came across testimonials from people who testified that they had won big after receiving lottery numbers from Lord Bubuza. I contacted him through WhatsApp at +1 (365) 808 5313 and explained that I wanted to win the Powerball lottery. He explained what I needed to do before providing lottery numbers. I followed his instructions carefully, and after the spell was cast, he gave me numbers and explained where and how to play….
I was amazed when I won $310,500,000 after playing the numbers he gave me. This experience changed my life, Lord Bubuza is a God on Earth. Contact him for help too by
email: Lordbubuzamiraclework@hotmail.com
WhatsApp: +1 (365) 808 5313….
I’m beyond grateful to Dr. Benjamin for changing my life completely! I had been playing the Mega Millions lottery for years without success, until I came across Dr. Benjamin and decided to give his spell casting services a try. After performing a powerful lottery spell for me, everything turned around in the most unbelievable way—I won the Mega Millions jackpot of $670,000,000,00! The experience still feels like a dream come true. Dr. Benjamin was professional, kind, and deeply spiritual throughout the entire process. He guided me with confidence and positive energy, and his work truly produced results beyond my imagination. I highly recommend Dr. Benjamin to anyone who believes in miracles and is ready for a life-changing breakthrough. reach him via drbenjaminlottospell711@gmail.com or WhatsApp: +18588585788.
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Hello everyone am Gary Van I want to use this medium to appreciate a great spell caster called Dr Ogaga that transformed my life financially, I used to work as driver in a company and I always play lotto but I have never been lucky, then one day as I was glancing through the Internet I came across a testimony of a woman who won $600million through the help of a strong spell caster called Dr Ogaga after praying for her he gave her a lucky numbers to play and she won 600,000,000$ I also decided to try my luck I contacted the Dr Ogaga and he promise he was going to help me win too I didn’t actually believed 100% but on the second thought I decided to give it a try He instructed me on what I need to do which I did with no stress at all, then after two day he sent me some numbers and asked me to go and play them I went strait to the store and play the numbers then I went back to check when the results were out, behold my numbers came out as the winning numbers it was like a dream to me, even till now I still fined it difficult to believe that I am now a millionaire from being a driver to being a millionaire all thank to Dr Ogaga I will never forget your help, if you are out there and you also want to be a winner I will advice you to also contact Dr Ogaga and I promise you he will not disappoint you at all. Here are his contacts. Email ogagaodia41@gmail.com
Whats>>App +1(365)350-5955.