The strangest aspect of being paralyzed is that nobody ever, ever asks you what it’s like. This may be from concern over not hurting your feelings. Or not wanting to bring up the issue. Or superstition that your paralysis might be contagious if discussed. It’s still odd that nobody inquires. It’s the elephant—the screaming banshee—in the room, and it’s mighty big.

For about 10 years I’ve suffered from primary progressive multiple sclerosis. This is not the form of MS that you read about in optimistic articles. It is relentless, and it doesn’t go into remission or on vacation. It concentrates on the limbs and rarely affects the brain. There’s no treatment. However, I’m not in pain and I’m not in Syria. I can read; I breathe without assistance. I can talk and think. This is a picnic. It may not always be thus.

And I’m able to live at home—thanks to a devoted wife, the largess of old friends who set up a website on my behalf, the kindness of strangers and the expertise of several professional caregivers.

When I was a smart-aleck teenager in the 1970s, I made the usual jokes about people “paralyzed from the neck down.” You never suspect that it will be you, half a lifetime on.

I’ve been immobilized for five years. In addition to losing incalculable personal pleasures, like daily walks with my wife, I also lost a musical career as a jazz and classical guitarist, though I still teach a few advanced students. I published several books of fiction and nonfiction before the disease hit, but my days of roaming the world as a journalist are over. Now I write by dictation.

The process isn’t as awkward as it sounds: After he was overtaken by blindness, John Milton used dictation. At times, so did Henry James and Mark Twain. I have no excuse for second-rate work.

The first thing you have to get used to is total helplessness. You’re dependent on somebody else for everything. If you want your ear scratched, you have to ask. You soon learn that you can’t ask every time the problem arises, or you’d be asking the whole day. And you remember all too vividly the itch that assailed you in the middle of the night before last, the one that wasn’t worth waking somebody up to relieve.

Say goodbye to any sense of personal space, too. People can pat or adjust you however and whenever they like. You’re everybody’s puppy, and if you’re lucky, people find you amusing. If you’re very lucky, they recognize you as intrinsically yourself.

Sometimes, of course, you make them profoundly uncomfortable. Like the old friend who visited one afternoon a year ago and who I never heard from again.

And if you’re not thoughtful by nature, you certainly become thoughtful. There isn’t much else to do. You find yourself reflecting on what it means to be human. The abilities to stand up and walk are pretty fundamental, and when you no longer have them, you no longer feel fully human. This seems unavoidable, alas.

The natural question of Why me? becomes, with time, the larger question of Why? Helpful friends have cited the poem “Do Not Go Gentle Into That Good Night.” I have nothing against Dylan Thomas, but that is a young man’s poem. Determination must carry far beyond rage—into the paradox of an acceptance without surrender.

When I was younger, I imagined (incorrectly) that being paralyzed feels like being encased in stone. Want to know the sensation? Try telling a cat to leave the room. The cat will ignore you. When I tell my right hand to move, it ignores me. That’s what it’s like to be paralyzed—your limbs have turned into uncooperative, alien pets. They don’t understand your language, and they’re not interested in what you want.

You swiftly become pragmatic. Complaining changes nothing, and doesn’t make you feel better—so you learn not to complain. You probably stop being romantic in the sense of optimistic. This is particularly difficult for Americans, since romance is written into our Bill of Rights; any American can grow up to be rich, to be president.

Another personal loss, for me, is books. The act of writing has been distorted, yes, but not as much as the act of reading, which was always a solitary pleasure. Since somebody else has to turn the pages, the solitude is over. Few works that I want to read are available as audiobooks. The alternative, of my not being able to read at all if there’s mental degeneration, is horrific.

You find yourself, unavoidably, living in the past. Happiness isn’t is, but was. You try not to contemplate the future too much. Nor the future of the person you love.