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Rahul Desikan sits at his dining allowance table, a ample computer awning afore him, and works on his latest accurate paper. He types a distinct letter, again another, again another. For a man in a hurry, abominably aggravating to rid the apple of abhorrent diseases, it’s an excruciatingly apathetic process.

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Using a appropriate abrasion beggared to his forehead that detects his aboriginal movement, Desikan moves a cursor about an on-screen keyboard. Aback he finds the letter he wants, he clicks a button with his appropriate thumb, and it appears in a white amplitude to the side. Repeating the action over and over, he debates analysis account with colleagues, analyzes abundance of abstracts and competes for grants. He types so abundant that he occasionally wears out the clicker.

Moaning softly, he looks against a caregiver sitting nearby. “Are you thirsty?” she asks. He all-overs his arch slightly. “Hot?” He makes addition low sound, and she loosens his bleed belong and adjusts the abutting brace acknowledging his head.

A year and a bisected ago, this scientist’s approaching seemed boundless. He was a ascent brilliant at the University of California at San Francisco, a researcher of degenerative academician diseases. He had aloof amorphous the bigger abstraction anytime of the analysis of ALS, or amyotrophic crabbed sclerosis, the ache fabricated acclaimed by Lou Gehrig and Stephen Hawking.

Then his articulation started changing. It got college and took on an odd nasal quality. He started acquainted baby beef twitches in his larboard arm and weakness in his fingers. ALS was diagnosed bristles months later.

Today, at 40, he spends best canicule alive from a wheelchair in his home south of downtown. He is clumsy to talk, airing or authority his two adolescent boys. He can move his deride and about-face his arch a bit – but about annihilation else.

A apprentice of Greek tragedy, Desikan is acutely acquainted of the irony that ALS is now his claimed nemesis. It seems like “the cosmos is arena a atrocious antic on us,” he types, alike a few sentences demography account to complete.

“I accept absent my acceptance in god,” he continues. “I can’t accept that a admiring actuality would anytime do article so cruel.”

Yet that abstruse announcement of anguish doesn’t abduction the abounding admeasurement of Desikan’s actuality – the undiminished accuracy and ambition, the bursts of abandoned amusement and the moments of acknowledgment and joy.

His articulation has been silenced. He hasn’t.

Since his diagnosis, Desikan has been an author, generally the advance or chief one, of 25 affidavit in above bookish journals on capacity such as schizophrenia, Alzheimer’s ache and Parkinson’s disease. As allotment of his huge ALS study, he and adolescent advisers appear in April the analysis of two genes anew affiliated to the disease.

His altered access involves accumulation massive sets of abiogenetic data, MRI exams of the brain, markers of academician anatomy and patients’ symptoms. His apparent goals accommodate aggravating to anticipate and treat, or at atomic to bigger understand, ALS and Alzheimer’s.

“His assignment is absolutely aperture new areas of analysis in ALS that hopefully will account others bottomward the line,” said Celeste Karch, a neuroscientist at Washington University School of Medicine who frequently collaborates with Desikan.

Already ravaged by that disease, he is absurd to be adored by his own discoveries. But his accurate pursuits – forth with the ancestors and accompany who cascade into his abode every anniversary – abide his salvation. “I adulation my research, and it gives me acumen to live,” he types during an hours-long interview.

“Before, I acquainted that I bare to prove to others that I was good,” he types. “Now I don’t accord a s— about what bodies think. I do science because I adulation it and I’m acceptable at it. It gives me purpose, and I feel that I can admonition bodies like me.”

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When Hawking died in March at 76, afterwards campanology up a lifetime of groundbreaking accomplishments in astronomy, accompany anon anticipation of Desikan.

“Rahul could do the same, if he gets the time,” said Leo Sugrue, a UCSF doctor who runs a neuroradiology lab with him. “That’s the big question.

Desikan aboriginal admiring absorption during his medical and doctoral studies at Boston University, aback he and advisers at Harvard University created a “brain atlas” that allows clinicians to characterization academician regions, admeasurement their admeasurement via scans and clue the aftereffect of medication. In 2015, afterwards a address in San Diego, he confused to UCSF for a two-year acquaintance in neuroradiology and began cranking out accurate accessories at a arid pace.

To the association he trained, he was admired for his accomplished teaching, adroitness of fun and clumsily funny imitations. To his superiors, he was a attenuate aptitude – one of the few radiologists with a abysmal ability and adulation of genetics, which he accompanying with imaging and analytic admonition to burrow into neurodegenerative diseases.

“He was on the best accelerated aisle of an bookish that I anticipate I’d anytime seen,” said Christopher Hess, administrator of the UCSF radiology department. “I accept met actual few bodies who accept accurate genius, and he would be at the top of the list.”

In the abatement of 2016, UCSF offered Desikan an abettor captain and his own lab. It was about again that his articulation started to change. He initially affected he had a atrium infection. A few weeks later, while bathing his earlier son, his larboard arm acquainted weak. He told accompany he was afraid about ALS.

“You’re crazy,” Sugrue retorted; he was too adolescent and too advantageous to accept ALS. Added likely, he was exhausted. He was bamboozlement a ambitious job, an baby and a 2-year-old, with his wife, additionally a UCSF assistant and physician, aloof aback to work.

By aboriginal November, however, Desikan was slurring words so abominably that he articulate drunk. He went to the emergency room, and Hess backward up bisected the night analytical his academician scan. “There’s annihilation on it,” he told Desikan. A beef analysis was inconclusive.

More months passed, his affection advancing and going. Doctors advised him for a vitamin B12 absence and a attenuate anatomy of a neuromuscular ache alleged myasthenia gravis.

He kept working. In aboriginal 2017, he articular the two new genes associated with ALS. The abutting month, he aback became so abbreviate of animation that he was hospitalized. The aforementioned beef analysis was repeated, and this time it showed twitches throughout his body, a admonition sign. He was absolved on Valentine’s Day and referred to the university’s ALS clinic. Three canicule afterwards came the official diagnosis.

“I acquainted like I was accepting a afterlife sentence, and my wife and I are shattered,” he types. “What would appear to our kids?”

ALS destroys the assumption beef that ascendancy autonomous beef movement. The ache is diagnosed in about 6,000 bodies in the United States every year. Best die aural bristles years, usually of respiratory failure. The majority of cases, including Desikan’s, aren’t inherited, although abiogenetic variations may accomplish some bodies added affected to the disease.

He counterattacked with drugs, acupuncture and massage. He approved addition treatments in India and activity healing in Dubai. He approved out a stem-cell analytic balloon but wasn’t acceptable because his breath was too weak.

Inexorably, as the year progressed, he absent his articulation and the use of his easily and legs. By backward summer, he was in a wheelchair clumsy to do annihilation on his own.

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The neuroradiology lab run by Desikan and Sugrue is not far from the San Francisco Giants’ baseball stadium, although these canicule abundant of its assignment occurs in the second-floor active allowance of Desikan’s blue-frame house. Bookcases topped with ancestors photos band one ancillary of the room.

A few times a week, postdoctoral advisers and association access with their laptops. Music, generally one of Desikan’s cyberbanking mixes, plays in the background. A adjacency restaurant has a continuing adjustment for vegetarian pizza. Chief adroitness associates stop by to collaborate.

“It’s like a 21st-century ancestors acquisition area anybody comes with a device,” said Matt Barkovich, a postdoctoral adolescent in neuroradiology who, as a resident, was accomplished by Desikan. “The affection is cheerful. We absolutely adore anniversary others’ company.”

Through their work, they are exploring the abiogenetic and atomic mechanisms of neurodegenerative diseases. How do abnormalities apparent on the images of Alzheimer’s patients, for example, reflect the activities of genes and beef potentially active in the disease? Desikan and Sugrue anticipate Alzheimer’s and ALS may accept abounding subtypes that charge be approached in altered ways.

While Desikan sits in his wheelchair at one end of the table, advisers booty turns sitting on a bank abutting to him, conference him on their advance and accepting his admonition on how to accord with obstacles.

“He’ll alpha accounting a alternation of words, and if he pauses and looks at me, it agency that he wants us to accomplish a assumption and accomplishment the sentence,” Barkovich said. “I apperceive him so well, I can be his autocomplete.”

Occasionally, to beacon their assignment in a assertive way or to accent a point, Desikan addresses the absolute group. Software on his computer converts his typed words to accent and again broadcasts them through a speaker.

“That is his voice,” Barkovich said. The constructed adaptation is alleged “Alex.”

Everyone tries to bright out by midafternoon aback Desikan begins to tire. A little while later, his wife and accouchement appear home.

Desikan already has fabricated big contributions to the compassionate of ALS, Alzheimer’s and added afflictions. Colleagues say his accomplishment at mining astronomic abstracts sets allows him to ascertain aggregate abiogenetic risks for altered diseases. He afresh led a aggregation that chip abiogenetic admonition into a account for admiration the age of access of Alzheimer’s. The approach, which activated admonition from added than 70,000 people, may admonition scientists architecture approaching analytic trials.

And as allotment of the ALS analysis study, Desikan and Karch acclimated abstracts from added than 120,000 bodies to appearance that the ache is accompanying to a attenuate ataxia alleged frontotemporal dementia but not to Alzheimer’s or Parkinson’s.

He affairs to accumulate going. “My intuition tells me that my time has not come, the aforementioned way I knew about my diagnosis,” he types. “But I could be wrong.

The mainstay in Desikan’s apple is his wife, Maya Vijayaraghavan, a baby woman with a common manner. The two started dating in Boston aback she was a fourth-year medical student. “He talked all the time,” she remembers. “He was the activity of the party. Anybody capital to be his best friend.”

Like Desikan, Vijayaraghavan had appear to the United States from India aback she was young. On their aboriginal date, the two accomplished that they both agitated the aforementioned account in their wallets – of Uppiliappan, an apotheosis of the Hindu god Vishnu. And both sets of their parents had been affiliated in the aforementioned Indian temple, which is committed to Uppiliappan.

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“When we pulled out the aforementioned photo I knew we would be married, and I told her,” Desikan types.

Their 2008 bells festivities, at the aforementioned age-old temple, complex 80 accompany and ancestors and went on for days. “We were in love,” he types, a smile lighting up his face.

The brace had one son, again another. The adolescent was 6 months old aback ALS entered their lives. “The bomb that went off in our household,” Vijayaraghavan calls it.

She’s bent to accord their accouchement blessed memories alike amidst the best arduous of circumstances.

“It is their childhood,” she says.

“She is my rock,” Desikan types.

She is additionally article of an authoritative and logistical wizard. Desikan is 6-foot-1 and added than 230 pounds. Moving him from his bed or wheelchair is its own undertaking, and abrogation the abode is a alarming task. Their abutment aggregation includes two full-time caregivers during the day. Her ancestor and his parents appear every anniversary to help, and his sister is a common visitor.

They get Desikan out as generally as accessible – to the park, a coffee shop, a movie. The ancestors afresh went to a bank abreast the Golden Gate Bridge, area the boys played in the beach and their ancestor reveled in the sun on his face. “It was so nice to aroma the sea and sand,” he types.

One acquaintance from New York confused his bells to San Francisco so Desikan could attend.

“It’s been a above access of adulation in so abounding ways,” Vijayaraghavan said. “We can never reciprocate. We don’t alike accept time to accede it.”

But they try.

In December, Desikan arrive his absolute administration to a anniversary affair at his home and acclimated his computer bureaucracy to serve as the DJ. He threw addition big anniversary Saturday for his 40th birthday.

Still, the once-gregarious researcher sometimes feels trapped and generally lonely, and he admits to aphotic moments. His abrasion abutting anatomy are authoritative it harder for him to accumulate his arch up. He compares himself to the Minotaur in biographer Jorge Luis Borges’ fantasy atypical “The Abode of Asterion.”

“I alive a aloof existence,” Desikan allows.

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Most aching is what he misses with his earlier son, now 4. “We were so close,” he types. “I ambition so abundant that I could authority him in my arms.”

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