Medicosnext
Adarsh Mahato is a medical student at Kathmandu Medical College and the class representative of his batch. An alumnus of United Academy, he has been actively involved in multiple research projects since the beginning of his medical journey. With a keen interest in academic excellence, he has participated in various nationwide medical quizzes and was the runner-up in a prestigious nationwide pharmacology quiz. His inquisitive and studious nature reflects a deep commitment to learning and contributing to the medical field.
There was nothing special about that Tuesday morning when Shanti’s life divided into before and after. There were no warning signs, no premonitions. Just an ordinary woman of thirty-four, standing in front of her bathroom mirror, brushing her teeth with Spotify playing in the background.
The first attack hit her like a thunderclap inside her face.
She lurched forward, toothbrush clattering into the sink as her hands instinctively flew to the right side of her face, hovering just above her skin, afraid to make contact. A series of sounds escaped her throat—not quite screams, but something more primal. Her knees buckled, and she slid to the cold tile floor, tears streaming from her right eye while her left remained dry. Ten seconds. That was all it lasted. Ten seconds that would redefine everything that followed.
When it passed, she remained on the floor, breathing in shallow bursts, waiting for it to return. The mint foam from her toothpaste dribbled down her chin. She wiped it away with trembling fingers, her touch feather-light against her skin.
“What was that?” she whispered to her empty apartment. No answer came.
Three days later, it happened again while she was giving a presentation at work. One moment she was pointing to projections on a screen, the next she was clutching the edge of the conference table, unable to speak, her face contorted.
“Shanti? Are you okay?” Her boss’s voice seemed to come from miles away.
She couldn’t answer. The lightning was back, shooting through the right side of her face, from jaw to temple, behind her eye, across her cheek.Precise, unbearable.Her colleagues stared in confusion and alarm. Someone called for help. Someone else brought water she couldn’t drink.”I think it’s a migraine,” she managed to say when it finally receded, though she knew it wasn’t. No migraine had ever felt like this—like someone had inserted live wires under her skin.They sent her home in a taxi. That night, she searched her symptoms online and found a name for her new tormentor: trigeminal neuralgia.
The Suicide Disease, some websites called it. The most painful condition known to medicine, said others.
Shanti closed her laptop, drew her knees to her chest, and wondered if this was how her life would end—not with old age or accident or illness, but with pain so severe it would eventually make living impossible.
“It’s a complicated condition,” the neurologist explained during her first appointment. Dr. Manandhar showed her diagrams of the trigeminal nerve’s three branches spreading across the face like a tree’s roots. “In most cases, it’s caused by a blood vessel pressing against the nerve, wearing away the protective myelin sheath. Without that protection, the nerve misfires.”
“Can you fix it?” Shanti asked, hope and fear tangled in her voice.
“We start with medication,” he said carefully. “Surgery is an option if that doesn’t work, but it carries risks.”
She left with a prescription for carbamazepine and a follow-up appointment for the following month. She also left with a list of potential triggers to avoid: cold air, strong winds, chewing, brushing teeth, washing her face, speaking for long periods.
“Basically, existing,” she murmured to herself as she read the list in the parking lot. The medications helped at first, dulling the lightning to a strong tingling sensation. But they also dulled everything else. Shanti moved through her days in a fog, her thoughts sluggish, her reactions delayed. She began making mistakes at work—small ones at first, then larger ones that couldn’t be overlooked.”We’re concerned,” her supervisor said during a closed-door meeting three months after her diagnosis. “Your performance has changed dramatically.”
“The medications,” Shanti tried to explain. “They help with the pain, but they make it hard to think clearly.””And without them?””Without them, I can’t function at all.”They offered medical leave. She took it, knowing she might never return.The attacks had rhythms and patterns that Shanti learned to track with obsessive attention. They came more frequently in cold weather, when barometric pressure changed, when she was overtired or stressed. They could be triggered by the lightest touch—a breeze, a strand of hair, the brush of a scarf. Or they could come without any trigger at all, lightning from a clear sky.
She began to organize her life around her condition. She covered the right side of her face when outdoors, shielding it from wind and cold. She cut her hair short to keep it from touching her face. She ate soft foods that required minimal chewing. She spoke as little as possible.
Her friends noticed the changes but struggled to understand.”But you look fine,” they would say, confusion evident in their voices. “Maybe you should try meditation. Or acupuncture. My cousin had migraines and this herbal tea completely cured her.”
Shanti nodded and thanked them for their suggestions, too exhausted to explain that trigeminal neuralgia wasn’t a migraine, wasn’t stress, wasn’t something that could be cured with tea or positive thinking. The lightning lived inside her now, dormant sometimes but always waiting to strike.One by one, friends stopped calling when she canceled plans too many times, when conversations became too one-sided because talking for more than a few minutes might trigger an attack.
On a rare good day, when the medication seemed to be working and no attacks had come since morning, Shanti ventured to the grocery store. She moved carefully through the aisles, selecting items that required little preparation. She avoided the freezer section—cold was one of her most reliable triggers
The microvascular decompression surgery was scheduled for a Tuesday, exactly one year after her first attack. Dr. Manandhar had explained the procedure in detail—how they would make an opening in her skull behind her ear, how they would locate the blood vessel pressing against her trigeminal nerve, how they would place a small sponge to keep the vessel from touching the nerve again.
“The success rate is good,” he said. “About 80% of patients experience significant relief.” “And the risks?” Shanti asked.
“Infection. Bleeding. Hearing loss on the affected side. Facial numbness or weakness. In rare cases, stroke.”
She signed the consent forms. What choice did she have? The medications were becoming less effective. The attacks were coming more frequently, lasting longer. Living had become a series of moments between pain.
The night before surgery, Shanti stood before her bathroom mirror, looking at her face—the face that had betrayed her, that housed the lightning. She touched her right cheek gently, prepared to snatch her hand away at the first sign of pain. None came.”Please,” she whispered, though she wasn’t sure who she was talking to. “Please let this work.”
She woke in the recovery room with a bandage wrapped around her head and a raw, throbbing ache at the surgical site. Different from the lightning. Duller. More ordinary.
“How’s the neuralgia pain?” the nurse asked during rounds.Shanti took inventory of her sensations. The surgical pain was there. A headache was building. But the familiar fearful tingling in her trigeminal nerve was absent.
“I don’t feel it,” she said cautiously, afraid to hope.
For three blessed days, the lightning stayed away. On the fourth day, as she was being discharged, a familiar sensation began building on the right side of her face—a gathering storm. By the time she reached the hospital entrance, she was in the grip of the worst attack she’d ever experienced.When she could speak again, she said, “It didn’t work.”She was one of the 20%.Months passed. Winter gave way to spring, then summer. Shanti tried more medications, different combinations, and alternative therapies. Some helped temporarily. Nothing lasted.
There were better days and worse days. On the better ones, she could almost forget for an hour or two. On the worst days, she understood why they called it the suicide disease.
She kept going to the support group. She learned from others who had lived with this condition for years, decades even. She learned strategies for getting through the worst attacks. She learned that courage sometimes looked like simply making it through another day.Later that night, as Shanti prepared for bed with the careful routine she had developed, she caught her reflection in the mirror. The face looking back was not the same one from before that Tuesday morning a year ago. This face was more guarded, more weary. But it was still here. Still fighting. Still finding ways to live between the lightning strikes.
