FOREWORD
DHAVAL PATEL MAKES AN APPEARANCE in our home at least once a week. Not his actual self. The last time he was physically at our house was the week after Father’s Day in 2020. Rather, it is his digital facsimile: a picture snapped by my husband, Jeff, a few months before his ALS diagnosis. Standing in the middle of a pool hall, he wears a gray knit sweater with a crossover neck and jeans, both hands in his pockets as he leans casually on one leg. He is smiling at the camera, but his expression is elsewhere.
This picture is one of thousands that gets pulled by “Alexa” and displayed on our Echo Show, the touchscreen smart speaker that doubles as a digital photo frame on our kitchen counter. Most of the images are of our kids, though the banal grocery list or screenshot of a coupon code sometimes makes an appearance. And although the display is seemingly randomized, a small handful of images emerge with such frequency that we can only assume Alexa’s artificial intelligence registers the attention they grab from the viewer. Each time this picture of Dhaval comes into view, we tend to pause and step a foot closer to the screen. We look at his expression, deciphering it. Did he know then? Was there an inkling in his medical brain telling him that the discomfort in his legs was something more pernicious than muscle fatigue or arthritis?
For the ten seconds or so that this picture is on display, we mentally fast-forward through the timeline of his disease. It is a strange inversion of life’s “firsts”: The first time we saw Dhaval struggle to stand up. The first time we saw him using a walker. The first time we saw him in a wheelchair. The first time we saw him need someone to wipe ketchup from his mouth. The first time we saw him after his voice changed. In these moments, the speed and extent of his affliction over the past three years feels staggering. Amyotrophic lateral sclerosis is a disease that spares nothing. Its descent is cruel, and its march is unrelenting. But what we have also witnessed is Dhaval’s uncompromising desire to live fully. His exuberance matches, punch for punch, the unyielding progression of his condition.
At the time of this writing, Jeff and I have known Dhaval for four years—three of which fall under the timeline of his ALS. When we first met him, we were recent Virginia transplants, having moved (or, in my case, moved back) from New York shortly before our second child was born. Our daughter, Kasper, was a toddler and was enrolled in a nearby Montessori school where she quickly befriended Dhaval and Kathryn’s son, Cayson. Soon after, they invited us into a small circle of friends that sprung from our children’s classroom, as adult friendships at this life stage often do.
Our first time at the Patels’ house was for a small backyard barbecue. We drove down a long and rolling road lined with tall trees and stately homes before turning onto their street and into their elegant semi-circular driveway. Their home was spacious and airy. As we walked through their kitchen and out onto their open-air terrace, I commented on a large-scale wooden model train painted in primary colors that was happily situated in their backyard. The kids raced through their sprawling property to climb the train. Watching them, Dhaval remarked, “You could say that we’re reliving our childhood through our kids—or at least the childhood we wanted, because I certainly didn’t have that as a boy!” Later, when I complimented Kathryn on how chic but also family-friendly she had made her home, she responded in a similar way. “Oh, you know,” Kathryn said, “we’re pretty much living the childhoods we wanted through our kids.”
The friendship that formed between our families seemed effortless, if not urged along by providence. In addition to dinners, cocktail hours, and weekend trips, it seemed like not a week went by that we did not run into Dhaval or hear him honking at us from his car as he passed us on our evening stroll. The frequency with which we saw him driving became something of an inside joke. On one such occasion, he pulled right up next to our car at an intersection as Jeff was singing a rousing rendition of Frozen’s “Let It Go” with our daughter. When Jeff looked to his right and saw Dhaval’s grinning face, he leaned across me and shouted through the open window, “If there’s anyone I’m comfortable with seeing me sing like that, it’s you, man!”
Dhaval and I forged our own friendship through happenstance run-ins at the local Starbucks, mostly on the Friday mornings he was off work. I would be typing away on my laptop on one of the large communal tables. He would zip in and out to pick up an online mobile order, but we would take ten or fifteen minutes or longer to chat. Without intending to, the conversations frequently found their way to the subject of identity. We were both products of immigrant parents who were raising our own multicultural children. We shared an impassioned curiosity about how our own bifurcated identities informed our roles as stewards and guides for our kids. We exchanged ideas, podcast episodes, and perspectives, and these conversations reinforced a sense that life was full of possibility and potential. The next and, quite possibly, most exhilarating phase of our lives was upon us, and we were cracking the surface of it. To be fair, we also talked about silly and superficial things, like the cost of kitchen appliances and the merits of processed cheese.
Despite the stark physical contrast between the able-bodied man I remember and the immobilized one I meet with today, both versions of my friend live in my mind’s eye when I think about Dhaval. He still has the same alertness and expressiveness, the same generous smile, and the same unflappable confidence in his own abilities—though this confidence has been redirected away from action-based endeavors and channeled with remarkable intensity toward a mental expansiveness—a spiritual and intellectual journey into his interior world.
If ALS is a thief of time and an oppressor of agency, The Impulse of Energy is an act of defiance. This book is an insistence that a life in motion stays in motion, if not in body, then in mind. It is a herculean effort given the extent to which despair and despondency, ALS’s most steadfast companions, loom over the strongest of wills.
“I stare at my outstretched legs all day,” Dhaval wrote in a text in November of 2023, on the psychological pain of seeing his “skeletonized body.” “It’s exhausting. Sometimes I ask for a blanket even though I am hot.” These are rare moments of disclosure, scattered between longer periods of time, in which, Dhaval takes care to demonstrate positivity and fulfillment. We do not speak much of it, but any friend can see the agonizing circumstances and eventualities connected to his disease beyond the loss of physical abilities.
There are the existential aches. Imagining the lives of his boys as they progress from childhood to adolescence and then manhood. Knowing there is an unfillable hole he is leaving behind in his family, his friend groups, and his profession. Fractures and rifts that cannot be righted in this lifetime. And then, there are the mundane injustices. Listening to able-bodied people complain about shuffling their children from soccer practice to piano lessons. Hearing friends promise more frequent visits, and then seeing the months tick by. Watching actors in Korean dramas devour mouthfuls of steaming instant ramen noodles with rapture. (As frivolous as this sounds, it is a subject that comes up quite often between me and Dhaval. For some, especially us immigrant-origin kids, the importance of gastronomic pleasures cannot be underrated.)
The Impulse of Energy is an intimate examination of life and identity, spurred by the diagnosis of a fatal motor neuron disease that eradicates the ability to use one’s body, one muscle at a time. In this book, Dhaval weaves and alternates between two timelines: a personal narrative spanning from the earliest memories of growing up in North Carolina, the path to fatherhood and acclaim as a cardiologist in the Washington, D.C. suburbs, and his most recent journey with ALS from diagnosis to the present day. The most seminal events—standing up to a bully at the bus stop, touring colleges with his stern father, whose approval he both vied for and rebelled against, locking eyes with his wife Kathryn across a lecture hall for the first time, receiving his diagnosis—are painted with exquisite detail. He is, quite simply, answering the age-old question for himself and his sons: “Who am I?”
The deepest desire of our human nature, I believe, is to be understood. Some may argue that it is to love and be loved, and I do not have the confidence to disagree. But there is something unique and singular about the feeling of being completely seen. Tensions unravel, and surrender occurs. The funny thing is that if we are lucky enough to have children, they themselves may dedicate a considerable portion of their lives to trying to unpack the mystery of their mother or father. This book is so much more than a roadmap of Dhaval’s life and the events, decisions, and influences that have shaped him. It is a telling of what it means to endure one of the most painful, significant, and identity-threatening experiences that can happen to a person. It is, undoubtedly, and as most memoirs are, a chronicle of self-discovery and an invitation to...