The Face That Feared the Wind
Eight years of trigeminal neuralgia. A photograph on a Tuesday morning. And what MVD surgery gives back that no medication can. It is considered one of the most severe pains the human nervous system can produce. There is a reason it was once called the suicide disease. I do not reach for that phrase easily. The photograph arrived on a Tuesday morning, between two clinic appointments. A hill somewhere in the background. A man, a woman, a small child. All three of them laughing — the kind of photograph people take without thinking, because they are too busy being happy to think about the camera. His wife had written two lines beneath it. We got our husband and father back. I set my phone down and sat with that for a moment. In twenty-seven years of operating on the human nervous system, I have learned that the measure of surgery is rarely what happens in the theatre. It is what happens in photographs like this one. Mr. Joshi had come to me eight months earlier wearing a scarf. It was May. Pune in May does not ask for scarves. He is forty years old, a pharmaceutical salesman from Bhopal. His work is the road — two-wheeler, city to city, wind in his face, client to client. Or it had been, once. By the time he sat across from me, he had not done a full day of field work in years. He had stopped wearing a helmet because the chin strap triggered the pain. He had stopped taking the morning routes because the air was cooler then, and cooler meant sharper, and sharper meant the thing that happened to his face. The thing that happened to his face was Trigeminal Neuralgia. It had begun eight years earlier, when he was thirty-two. A pain in the upper jaw — fleeting, electric, gone before he could describe it. He thought it was a tooth. His dentist thought it was a tooth. One extraction later, the pain was still there and there was one less tooth. He moved through four or five doctors over several months before someone finally named it correctly. The Trigeminal nerve is the fifth cranial nerve — the largest of the twelve that arise from the brain. Its three branches carry all sensation from the face: the forehead and eye above, the cheek and upper jaw in the middle, the lower jaw and chin below. In some people, an artery makes contact with the nerve at the precise point where it enters the brainstem — the root entry zone, where the myelin sheath is thinnest and most vulnerable. The artery presses. It pulses sixty, seventy, eighty times a minute, every minute of every day. Over months and years, that pulsatile pressure erodes the myelin. Bare nerve fibres are exposed. And the nerve, stripped of its insulation, begins to misfire — sending volleys of pain in response to the lightest, most innocent stimuli. A sip of cold water. A breeze on the cheek. The touch of a toothbrush. The strap of a helmet. Each of these — innocuous, unremarkable acts of an ordinary day — becomes, in Trigeminal Neuralgia, the trigger for an electric shock of pain that erupts without warning on one side of the face and vanishes before the patient can even cry out. What the patient feels is a bolt of electricity through the face. It lasts seconds. It is, by the consistent testimony of those who have lived with it, among the most severe pains the human nervous system can produce. There is a reason it was once called the suicide disease. I do not reach for that phrase easily. I use it here because Mr. Joshi needs you to understand what eight years of this does to a man — eight years of electric pain that arrives without warning, that leaves you not only with relief but also with dread. Dread of the next attack. Dread of the sip of water, the gust of wind, the careless touch. The pain itself lasts seconds. The terror of the pain lasts every waking hour. That is the true weight of Trigeminal Neuralgia — not just what it does to the face, but what it does to the mind that lives inside the face, always waiting, never knowing when the lightning will strike again. He was put on carbamazepine — the standard first-line medication for Trigeminal Neuralgia. It quieted the nerve, partially. Enough to keep going, for a time. But carbamazepine is an anticonvulsant that works by suppressing electrical activity across the entire nervous system, not only in one small misfiring nerve. The result is a whole-body dimming. Drowsiness. A blunting of thought. The sense — which patient after patient describes to me in almost identical words — of watching life from behind glass. “I was present, but I wasn’t really there.” That is what Mr. Joshi told me, months after his surgery, when he could speak about it clearly. He was still showing up. Still riding shorter routes with a face mask to shield his cheek from the wind. Still coming home. Still doing what needed to be done. But something in him had gone quiet. His income had fallen. His manager had noticed. And around this time, he got married. His wife had married the man she loved. She had certain expectations of their life together — entirely ordinary ones. An evening out, friends over, a family gathering, a trip somewhere. What she found was a husband who flinched when she touched his face, who went silent without explanation on some evenings, who could not wear a helmet, who declined most invitations. Chronic pain, poorly understood by those outside it, is very good at creating distance between people who love each other. Not through cruelty. Through silence and the slow accumulation of things not said. This is what Trigeminal Neuralgia does to a marriage — quietly, without anyone being the villain. There was only a man
