Correspondence

Motor Neuron Disease

N Engl J Med 1996; 334:1203May 2, 1996

Article

Wheels and gears whirred.

The metal chair rolled to face right

at the flick of the switch

by a scalloped finger

sculpted from its melting muscles.

His legs scissored

on the chair supports

to dangle from his bulging torso.

His face was large in comparison,

the mouth frozen

in a mirthless grin

his languid tongue squirmed,

puddled in saliva.

In his agile mind

he played with cosmic questions:

a finite universe,

expansion and contraction,

details of the Big Bang.

Concepts pinballed through brain circuitry,

bridged the frontal neocortex,

crossed the callosal bridge,

tagged temporal meshes,

leapt to the limbic lobe,

and bounced off occipital circuits.

Universes were set to spin,

to explode outward at light's speed.

Giant novas flashed

and black holes snuffed out worlds

at the mere spark of imagination.

Until —

on a whim —

he decided to form a word.

And then

feeble cortical motor cells

strained their dying cytoplasmic masses,

struggled to send messages

down the wires of the spine

to trigger spinal motor cells

in their final death throes,

but only a few pulses reached

their vanishing muscles.

He waited with infinite patience

for the downstroke of the respirator bellows

to reflood his lungs

so he could send a few syllables

hissing.

Jay Liveson, M.D.
159 E. 74th St., New York, NY 10021