He wasn’t the kind of man you would expect to hesitate. At 58, he had built a reputation on decisiveness. Deals were closed quickly. Emails were answered faster. Conversations, efficient to the point of intimidation. His colleagues described him as ‘sharp’. His wife, more accurately, called him ‘impatient’.
Which is why the first symptom felt almost… insulting. “I stand up,” he told me, “and nothing happens.” He demonstrated it at the clinic. He leaned forward, hands on his knees, gathered momentum—and then paused. Not by choice. Not by doubt. Just paused… as if someone had pressed a silent, invisible brake. Then, after a few seconds, his body lurched forward and he began to walk. Small steps at first. Then faster. Then almost too fast, like a car that has suddenly remembered it can accelerate but forgotten how to ease into it. “Once I start,” he said, slightly breathless, “I can’t seem to stop properly.”
The brain is often thought of as a machine that helps us move. But that’s only half the story. Because movement is not just about doing. It’s about deciding when not to do.
Hidden deep within the brain lies a set of structures called the basal ganglia. They don’t generate movement. They don’t control strength or sensation. They control permission.
They are the quiet gatekeepers that ask at every fraction of a second, should we move, how much do we move, is now the right time to stop? When they work, life flows. When they don’t, life hesitates.
On examination, the clues were subtle but unmistakable. “Tap your fingers,” I said. He did. Slowly. Then slower still, as if the energy were draining out of the movement itself. “Now swing your arms as you walk.” He tried. One arm moved. The other seemed to have forgotten its role entirely. “Do you feel stiff?” A nod. “Like my body is… reluctant,” he said. That was the word. Not weak or numb: reluctant.
The diagnosis was early-onset Parkinson’s disease, a condition where the basal ganglia lose a crucial chemical messenger—dopamine—and with it, the delicate balance between initiation and inhibition begins to crumble. Too little movement, too much hesitation, and hence a tremor. And occasionally, once movement begins, there is also an inability to stop gracefully.
We spoke about treatment. Medication that would restore some of that lost chemical conversation in the brain. Exercises to retrain rhythm. Patience—a lot of it. “And when meds begin to stop being effective, we have a surgical procedure called deep brain stimulation—but we’ll cross that bridge when we get there,” I forewarned, before I saw the panic rise in his eyes.
“Will I go back to being myself?” he asked. It’s a question that never has a simple answer.
“You will still be you,” I said. “But you may have to learn a new way of being you.”
He smiled faintly. For a man used to control, this was unfamiliar territory.
A few weeks later, he returned. Something had changed. He stood up from the chair—paused, yes—but this time, the pause was shorter. Less intrusive. As if the brain had found a workaround. A detour around a damaged road. “I’ve started counting,” he said.
“Counting?” I questioned him, then remembered having taught him that on the previous visit. “In my head. One… two… go,” he gestured to jolt my memory a little.
It is such a simple thing, and yet, profoundly clever. He was made to bypass his basal ganglia using conscious rhythm to replace an automatic one. One can recommend it to someone who has the condition. The brain, when challenged, doesn’t just fail. It adapts. Quietly. Creatively. Persistently.
As he walked out of the clinic, his steps were still measured, still deliberate—but no longer reluctant. At the door, he turned. “You know what the strangest part is?” he said. “I’ve spent my whole life rushing. Finishing other people’s sentences. Walking ahead of everyone else.” A pause. “Now my brain is forcing me to wait… for myself.” He smiled. “And for the first time,” he added, “I think I’m finally keeping up.”
Because sometimes, the brain doesn’t slow you down to stop you. It slows you down… so you can begin again properly.
The author is consultant neurosurgeon at Wockhardt Hospital, Mumbai.
mazdaturel@gmail.com @mazdaturel