How many ways can a person die? Categories matter. Quickly. Slowly. Old age and natural causes. An accident. A disease. Or, various combinations.

In some ways, ALS is death in slow motion.

Step by step, day by day, muscle group by muscle group, the body slowly dies. Sometimes in a few years. That seems fast. Sometimes in a few decades. Not so fast.

In short, nerves die and the brain cannot communicate with a growing list of muscles. When certain muscles die, we die. Breathing muscles, for example.

My first year with ALS was little more than some odd, seemingly unidentifiable neuromuscular symptoms. My second year with ALS displayed more symptoms and growing muscle weakness; particularly in my back and in breathing muscles.

My third year with ALS displayed more pronounced and expected symptoms of respiratory onset ALS. That resulted in the need for a mechanical ventilator to breathe. For much of that year I was able to move about; even drive.

Those days are gone.

Death in slow motion is a journey nearing an end. The final year.

Death has come quickly and slowly at the same time; not unlike a slow motion train wreck. If my entire adult life has gone by in the blink of an eye— it seems that way— then the past few years have become an odd mixture of slow motion and whatever is faster than the blink of an eye.

ALS is death in slow motion.