Chapter 29 — A Medical Miracle

_February 10, 2003, Chicago, Illinois_

🎤 Jesse {br}

{psc} "Hi, Jesse, I'm Doctor McCoy."

I laughed, "No way!"

"I am, indeed, a doctor, not a bricklayer! What brings you to see me today?"

"A three-way pileup on a hockey rink in Aurora. One of my defensemen hip-checked a forward on the other team, and they crashed into me. I ended up on top of the forward, and my defenseman landed on me. I'm pretty sure my knee was twisted in the process, but I hit my head, so I don't remember anything from when right before it happened until I woke up about thirty seconds later. I have a neuro check tomorrow for a mild concussion, and I'm here to see you because I have a Grade 1 knee sprain, according to the MRI that the ER docs ran at Rush-Copley. My knee hurts, but my headache is gone, and no double-vision or anything like that."

"Good report! Are you planning a medical career?"

"No chance! I'll leave that to Aunt Jess and Grandpa Al!"

"The nurse took your vitals, so I'll just check your knee. I did see the MRI and agree that it's a Grade 1 sprain. Can you slip off your sweats?"

I did that, and he removed the brace I was wearing, then unwrapped the Ace bandage. He performed a number of flexion tests and also felt for swelling, comparing my 'good' leg to the injured one.

"Besides hockey practice, what do you do for exercise?"

"I have free weights that I use five times a week, plus I walk to and from school every day. I have a bike, but I don't ride it very often now that I have a driver's license."

"Have you decided on a college yet?"

'UW-Madison is the most likely school."

"Do you intend to play competitive hockey in college?"

"I don't plan to try out for the NCAA team; I'll probably play for the club team."

"No desire to play in the NHL?"

"No. Does that make a difference in treatment?"

"For a Grade 1 sprain, generally not, but if you had that desire, I'd probably refer you to a guy at Northwestern who specializes in ACL injuries for college and pro athletes, just to be on the safe side. Given what you said, I think you should follow the RICE protocol for the next ten days. Did they explain that in the Emergency Department?"

"The discharge notes instructed Rest, Ice, Compression, and Elevation. That's what I've been doing."

"Good. Continue to do that. I'm going to suggest you get a ride to school for the next ten days and use crutches when you walk, but keep walking to a minimum. No driving at least until I see you a week from Friday. We'll evaluate your knee and agree on a rehab plan."

"I'm supposed to attend hockey camp in June and be an instructor in July."

"Coaching will certainly be possible, but we won't know about playing for about eight weeks. Your prognosis is good, but there are no guarantees."

"What's the rehab time for a surgical repair?"

"It depends on the sport and type of injury, but up to a year before the athlete could return to full participation. You don't need surgery."

"No, but my friend Nicole does, the girl on whom I landed."

"A young woman is playing in a men's hockey league?"

"It's High School, and yes, she is. She's one of the fastest forwards and best shots in the league. Any checks other than hip checks are against the rules, so this kind of thing doesn't happen very often."

"How bad was her injury?"

"The ER doc said Grade 2. She's having a surgical evaluation today at Loyola."

"OK. Do you have any other questions?"

"No."

"Then I'll send the nurse in to wrap your knee and I'll see you a week from Friday."

"Thanks, Doc."

He left, and about two minutes later, a cute nurse came into the treatment room.

"Hi, Jesse!" she exclaimed. "I'm Gabriela. Doctor McCoy wants me to wrap your knee for you."

"Hi!" I replied. "What do you need me to do?"

"Sit on the exam table and slightly flex your knee," she said. "I'll explain what I'm doing so you or your mom or dad can replace it after a shower."

I moved, and she helped me position my knee, then began wrapping from the bottom in a criss-cross fashion, explaining as she went, and securing it with the Velcro sewn into the ends.

"You'll want to loosen this three times a day for about fifteen minutes," she said. "If your lower leg swells, you have the bandage wrapped too tightly. Got it?"

"Yes," I replied.

"How did you injure it?"

"Playing hockey," I replied. "My teammate and a player from the other team crashed into me, and all three of us went down."

"What position?"

"Goalie for Kenwood Academy. We were citywide champs this year."

"That's awesome! I didn't look at the chart and thought you were in college because you're so tall and muscular!"

"I turn seventeen on the 22nd," I said. "How long have you been a nurse?"

"It'll be a year in June," she replied.

"So you're only about five years older than the tall, muscular hockey player," I replied with a smile.

Gabriela laughed, "Are you hitting on me?"

"Do you want me to hit on you?" I asked with a goofy smile.

"You're a bit young for me, even if it's only five years."

"Age is a very poor way to judge maturity," I countered.

Gabriela laughed, "And you think you're mature?"

"I don't see a parent in the room! Do you? And I manage every aspect of my life by myself!"

"You're emancipated?"

"No, I have parents who believe teenagers are adults! Have coffee with me and judge for yourself!"

Gabriela laughed, "Seriously?"

"Seriously! I can't really go to Starbucks, but I can make you coffee or cocoa."

"And what will your parents say if an adult woman comes to visit you?"

I rolled my eyes, "I am an adult! My parents think so and treat me like one. What can having a cup of coffee or cocoa hurt?"

I picked up a pen and paper from the table next to the treatment bed, wrote my name and cell number on it, and handed it to her.

"It's up to you," I said, though I doubted she'd call because I was still underage.

"I'll, uhm, think about it," she replied. "You can put on your brace and your pants, and then go to reception."

"Thanks, Gabriela!" I said with a smile.

She laughed again, shook her head, and left the room. I put on the brace and my pants, then got off the table. I used the crutches to go to reception, where Mom One was waiting.

"All set?" she asked.

"Yes," I replied. "I need an appointment a week from Friday for a checkup, and I'll need a ride to school at least until then."

Mom One acknowledged what I said and went to the receptionist to make the appointment because the rules required that, even though I could have done it myself. Once that was done, we made our way out to her car. Once she helped me in, I buckled up, then dialed Dad's mobile number.

"Steve Adams' phone," a female voice said.

"Doctor Mary, right?"

"Yes. Is this Jesse?"

"Yes. I assume my dad is being poked, prodded, or magnetized at the moment?"

"He's in the MRI and will attract all metal near him!"

"Especially if it's being worn by a nurse!" I declared.

"You might have a point! How is your knee?"

"It's a Grade 1 sprain, and I don't need surgery, just rest and rehab."

"Good. Any other message for your dad?"

"No. He can call later, but nothing has changed since Saturday. I'll see him tomorrow night when he comes home and let him know about the neuro check."

"Every Adams male needs their head examined!" Doctor Mary declared.

I laughed, "I can't argue with that."

We said 'goodbye', and I closed my phone and slipped it back into my pocket.

"Is there anything you need at the store?" Mom One asked.

"No. I think we have everything I need at home. Are you going to work?"

"Yes."

"Then I'll just hang out in the main house because I can use the elevator to get to Albert's room to use his computer or game consoles."

"Sounds good."

————— {br}
[Rochester, Minnesota]
🎤 Steve {br}

"As I understand it, the latest working theory is dopamine?" Doctor Clara Brown asked when I met with her late on Monday afternoon following my medical tests.

"Yes, though it's highly speculative, and it's not entirely clear that my behavior is reward-motivated the way it's usually represented in the media."

Doctor Brown laughed, "It's all about the orgasms?"

"Or Shakespeare's _Much Ado About Nothing_. I assume you know that particular euphemism?"

"Obviously! Do you know about motivational salience?"

"I did some research with help from Jess. The basis for thinking it might be dopamine is that it reduces insulin production, which could explain my sensitivity to complex carbohydrates. The counter-argument is that it inhibits norepinephrine, but mostly I don't show the symptoms of either excess or deficiency. Nobody would say I'm hyperactive, especially when I'm coding or reading."

"Have you noticed ebbs and flows in your sexual activity? Or any cyclical behavior?"

"Nothing cyclical, and the ebbs and flows are really only about new partners, and more often than not, that's intentional."

"You still have five regular partners, right?"

"Yes. My wives and my girlfriends."

"And new partners?"

"Fairly consistent, though I intend to have an ebb cycle, which might stay that way for some time, or even long-term."

"Did something happen?"

"I'm getting older," I chuckled. "No dysfunction, but I'm at a point where my preferred partners are less available and are likely to continue to be."

"Have your preferences changed at all?"

"Not really."

"Sixteen to nineteen?"

"Roughly. It's also the case that social views on teenagers are changing for the worse, as we've described."

"How do you feel about aging?"

"It doesn't bother me, and the only reason I mentioned it is because the age gap is now sufficiently large that I'm 'too old' for girls I'd like to be with, given the opportunity."

"When you say no dysfunction, what does that mean?"

"Just what I've said. My initial refractory period is largely unchanged from when I was a teenager and is roughly ten to fifteen minutes, though, on occasion, I've had much shorter times. I can usually have six or seven orgasms before the refractory period becomes long enough that I need an extended rest period. Again, there have been times when it's been as many as eight with no long rest periods."

"Nice marketing job!" Doctor Brown declared.

"And a wasted one, given I'm a patient!"

"Any changes in preferred activities?" Doctor Brown asked.

"No. I still strongly prefer either missionary or lotus position sex, as well as giving and receiving oral sex. Nothing has changed since the last time we spoke in that regard. The extremes are still anal and light bondage, but light bondage bothers me."

"Because you've had friends who were raped."

"Yes."

"Do you have any unfulfilled fantasies?" Doctor Brown asked.

"Jennifer Jason Leigh from _Fast Times at Ridgemont High_!"

Doctor Brown laughed, "Any that you _could_ fulfill if the circumstances presented themselves? I mean, without Doc Brown's DeLorean time machine?"

"No. There's the ongoing teasing with my friend Kathy, but she and I were together in High School and during our first year in college. Believe it or not, actresses don't really do anything for me, and most girls I want to sleep with are available."

"I take it from that that you avail yourself of those opportunities?"

"Within the rules agreed with my wives, yes. And those rules aren't really restrictive, and certain exceptions are permitted."

"What rules are in force now?"

"Nobody who works for me, which is inviolable. Nobody who works at the hospital or the university, though there can be rare exceptions. Those need approval in advance, as do overnights when it would take me away from my wives or girlfriends. For those overnights where I do need an exception, the girl needs to ask my wives."

Doctor Brown laughed, "And, of course, they do, right?"

"Yes. The same is true for more than two encounters. I have a few long-term relationships besides the official girlfriends, but those were discussed and approved beforehand."

"How many active lovers do you have?"

"If you count the occasional 'when we see each other' encounters, around fifteen."

"You're still rigorous about STI testing, right?"

"Yes. It's the most important rule of all."

"Have you had any manic or depressive incidents since I last saw you?"

"No. Diet, exercise, sufficient sleep, and copious amounts of sex keep everything on an even keel."

"And if you miss any of those?"

"One night of poor sleep isn't a concern, nor are short periods of abstinence or missing a day or two of exercise. Violating my diet is a serious concern, so I'm fastidious about it. On those very, very rare occasions I don't eat right, I take fast-acting propranolol. That protects against any manic episodes that might occur from eating too many carbs."

"When was the last time that happened?"

"Right before Christmas," I replied. "My flight was extensively delayed, and the only food available had more carbs than I'm allowed. I took the propranolol prophylactically before I ate. I had no negative effects."

"Your other symptoms included poor judgment. Any incidents?"

"That depends on who you ask, but my wives do not believe so."

"May I ask?"

"I developed an online relationship with a young woman who was seeking some very specific fantasies, and shortly after I refused, she was murdered."

"What fantasies?"

"The role play was the virginal teenage babysitter seducing the dad when he drove her home. The non-role play was losing her virginity tied spread-eagled to a bed."

"She was a virgin?"

"She claimed to be. She wanted the bondage fantasy first, then the role-play. I declined because it was too close to rape, and you know my history there with my friends."

"What happened?"

"She came to my house, revealed the fantasy, and I declined. She chose to leave, so I put her in a cab for Union Station. I paid the cabbie, then went back inside. She was found dead, having been murdered that night after she left my house. I don't know more details because the police are playing it close to the vest. They checked my alibi, and it was ironclad and airtight."

"Have you met other people online?"

"Yes. This is the first time it's gone wrong."

"You don't find it risky?"

"No. Of course, I've been using online services since the mid-80s, before the internet existed."

"Do you engage in any other risky behavior?"

"Skydiving in the past, but I stopped after my concussions. Doctor Kirilenko cleared me to do that if I wanted, but I think I got it out of my system, because I don't really have any desire to do it again."

"Do you have a desire to engage in risky behavior?"

"I don't think so. I'm very happy with my family, my company is very successful, my sex life is great, my friends are great, the dōjō is great, and I'm able to travel. That's pretty much the sweet spot for me. All that's missing is grandkids, but I have a few years to wait for those."

"Where do you struggle?"

"I honestly don't at this point. Life is good, I'm content, and the challenges are ones I enjoy facing."

"What challenges?"

"Work, raising children, and keeping my marriage on an even keel. But I'm able to meet all of those."

"You do seem to have everything together. I don't think we need to meet when you're here in the Fall unless there's some specific difficulty with your sex life."

"Thanks, Doctor," I said.

"I'll call for the med student to come get you."

"I think I can find my way back to Mary's office."

"OK."

We shook hands, and I left her office and made my way back to Mary's office, where I found her with Doctor Ross and her medical student, Jing.

"Come in," Mary said. "We're just going over your lab results."

"Does anything differ from the baseline?"

"It probably won't surprise you that your TSH is high."

"No, it doesn't. I expected thyroid problems at some point. How high?"

"High enough that we're recommending 25mg of levothyroxine daily. Have you noticed your hands and feet being cold?"

"No more than normal, that is to say, occasionally during the winter. I think it sounds reasonable. What are the side effects of levothyroxine?"

"You owe me $20!" Mary declared, looking at Doctor Ross.

"Not yet!" Doctor Ross said. "The side effects are potential weight loss, trouble tolerating heat, sweating, anxiety, trouble sleeping, tremors, and fast heart rate. That's why we're starting with a low dose. It takes about six weeks for your TSH to level out, so you'll have blood drawn at the end of April so we can see if the dosage is correct."

"From that list, trouble sleeping and tremors concern me. Trouble sleeping is a concern for the obvious reason that would create a terrible choice for me — risk an imbalance in my personality versus any negative effects of hypothyroidism. The tremors for the reason they could interfere with typing and with karate. I need to know how much of a risk those are."

"Typically only for too high a dose. 25mg is fairly low, but if you're overly concerned, we can go with 25mg every other day and see what happens. You aren't showing any symptoms yet, so that's a reasonable approach. It's also the case that stopping levothyroxine or lowering the dose resolves the symptoms."

"I'd like to discuss it with Jessica and Al," I replied. "Barring contrary advice, I'll start with 25mg every other day, and if that doesn't bring my TSH levels down in six weeks, then I'll begin taking it daily."

"Draw," Doctor Ross said to Mary.

"You two are hilarious," I said with a smile. "Was it an actual bet?"

"After a fashion," Doctor Ross replied. "I'm sure you know from Jessica and Al that we discuss cases in detail, and nearly always, in cases where we suspect a patient might have a concern about treatment, we discuss options and how we'll handle it.

"In your case, you're much more informed than the typical patient, which changes the dynamic a bit. It's not that we hide things, but most patients accept medical judgment and agree to do what the doctor recommends, even if they don't actually follow through.

"Mary felt that given the family history, you'd accept the prescription. I felt you'd be more concerned about side effects and might reject it out of hand. You neatly split the difference by asking questions and expressing your concerns. Neither of us felt you'd agree then not follow through."

"All you have to do is let Birgit know, and you can be sure I'll do it!" I chuckled. "For some unknown reason, and strangely for a teenage daughter, she wants to keep me around!"

Both Mary and Jing laughed, and Doctor Ross shook his head.

"My two daughters had zero use for me from about twelve to seventeen. My son was never like that."

"Sounds like me and my dad," Mary replied. "He was FAR too concerned about my social life."

"You should have Chinese parents, Doctor Whittaker!" Jing lamented. "I'm in my last year of medical school, and my dad STILL wants to control who I socialize with!"

"That's OK, Jing," I replied. "My mom felt she could control my life for my entire life and still feels that way, which is why we're mostly estranged. I get along with my dad just fine, but my mom? Nope."

"He's not kidding," Mary interjected. "Anyway, back to medicine. We don't want to make too many changes at once, so no modifications to anything except the levothyroxine every other day. The kids should all have TSH levels taken for a baseline."

"I'll let the moms know," I replied. "Anything else to watch out for?"

"No. You can have the labs done at the hospital and have them send them to me."

"Don's Livery Service!" Mary's husband said, coming into the office.

"He's ready to go," Mary said. "Steve, we'll see you back here in August."

"Thanks, Mary," I replied. "Thanks, Doctor Ross. Nice to have met you, Jing. Good luck with the Match."

"Thanks!"

I shook hands with all of them, then Don and I left the office and headed to his car. Ten minutes later, he dropped me at the Mariott. I thanked him for the ride, we shook hands, and I headed into the hotel. I went up to my room, took a quick shower, and put on clean clothes. I had just finished when my mobile phone rang.

"Steve Adams."

"Hi! It's Anna. We're all checked in."

"Great! I just finished my shower after a full day of medical tests. What did you want to do?"

"Dinner? If you know a place, feel free to suggest one."

"There's a midscale place just north of the hotel at 1st Avenue and Center that my doctor recommended. My treat."

"Thanks! Meet in the lobby in ten minutes?"

"Great!"

We ended the call, and I called Jessica's mobile so I could speak to her without being intercepted by a certain daughter who would demand a full report before I spoke to the doctor in the family.

"Hi, Tiger! What did Mary have to say?'

"My TSH levels are high, which should come as no surprise. She and Doug Ross prescribed 25mg of levothyroxine every other day. They want my TSH levels in six weeks to see if they need to adjust the dosage."

"That's a very low dose."

"We negotiated from daily to every other day. I'm concerned about the possible side effects of tremors or sleep difficulty. We'll slowly ramp up the dosage if necessary. I'm not having any symptoms, so they were amenable to starting slow. Mary and Doug suggested the kids all have a baseline TSH level recorded."

"That makes sense. What about the dopamine theory?"

"Doug and Mary want to do one thing at a time, which makes sense, given nobody knows for sure what's causing my hormone imbalances."

"That makes sense in your case. Have you spoken to my dad?"

"No. I figured if you agreed, there was no point in consulting him. He'll receive the full report from Mayo, as will Mike. Did you speak with Jesse?"

"Yes. He said he called and spoke to Mary. Did he tell you the name of the doctor?"

"No."

"McCoy."

I laughed, "Damn it, Jesse, I'm a doctor, not a bricklayer!"

"I believe that's what he said when Jesse first heard his name. He has his neuro check tomorrow, but Dad and I both think he's clear."

"Good. I'm about to head to dinner with Anna Wilson and her friend Angie. See you tomorrow!"

"See you tomorrow. Are you going to speak to the kids?"

"After dinner. I just wanted to make sure you heard what Mary and Doug said right away."

"I appreciate it. I'll let Kara and Suzanne know."

"Thanks."

We said 'goodbye', and after I closed the phone, I headed down to the lobby to meet Anna and Angie. I only had to wait about two minutes before they came up to me, and immediately, I noticed something different about Angie. She seemed animated, and her gait was normal, unlike how she'd been when I'd met her in Milford. I wondered if they'd found a new dose or even a new medication that didn't have the same side effects.

"Hi!" Anna said and gave me a quick hug.

"Hi!" I replied. "Hi, Angie."

"Hi, Steve!" she said brightly.

That was VERY different from her slow speech in Milford when I'd compared her to a computer where the CPU clock rate was slowed down.

"We can walk," I said. "It's only about two blocks, and it's not ridiculously cold outside."

"Sure," Anna agreed. "Have they discovered anything?"

"Just my Thyroid Stimulating Hormone being a bit high," I said as we began walking. "That was basically expected at some point because my mom had thyroid problems. Otherwise, no changes, though the full EEG-MRI results won't be ready for a day or two."

"That's the test I'm having," Angie said. "Well, along with some others, but that's the main one."

I wanted to ask more but wasn't sure I should, as I barely knew Angie.

"How's work?" I asked Anna.

"Good. I was promoted again, so now I manage my group."

"That's great. How are the boys?"

"OK. They're with Gina and her family while I'm here. How are things with you?"

"Work and karate keep me busy, and the family is as crazy as it's always been!"

"Your life was always a bit crazy and very complicated."

"Anna explained about your family," Angie said. "It's, uhm, different."

"That's one way to put it," I chuckled.

"My friend Mike has a baby with his friend similar to your oldest son."

"I know Mike," I said. "He and my wife Jessica are friends. They first met when he visited Indiana University when he was considering medical schools."

"So you've met Clarissa?"

"Yes. The first time was in Hawai´i when we were at a wedding."

"So you know Brandon and Kimiko, then, right?"

"Yes. Kimiko is the sister of my «Shihan». I'm a 6th Dan in that school, but in Chicago."

We reached the restaurant, and the hostess seated us immediately. A waiter came over and took our drink orders, which for me was sparkling water with lime.

"I need to use the ladies'," Angie said. "I'll be right back."

She got up and walked towards the restrooms.

"She's different," I said. "New medication?"

"No medication. She's at Mayo because of what the doctors are all calling a medical miracle."

"Is it OK to ask?"

"She was diagnosed with schizophrenia in college and has been on medication pretty much consistently since around 1983. You saw how she was in Milford, and that's how she had mostly been since around 1990, when there was a problem with her treatment that really messed her up. For the last thirteen years or so, they managed her condition, but it made her feel like she was in a fog.

"Anyway, back in October, her appendix burst, and she developed peritonitis. She was in the hospital for two weeks on a high-dose antibiotic cocktail. About halfway through, suddenly, her cognitive abilities all came back, and there was no sign of her schizophrenia. They weaned her from all the drugs, and she didn't relapse.

"She's here because they want to see if there's any difference from an EEG-MRI that was performed ten years ago. She'll also meet with a team of psychiatrists because she wants the State of Ohio to grant emancipation, which is almost impossible to achieve for someone diagnosed with schizophrenia. She managed to get her driver's license last month, which was the first big step."

"Wow! I'm no expert, obviously, but you don't just suddenly get better from schizophrenia. Was it a missed diagnosis?"

"They don't think so. Something about the illness, the surgery, the anesthesia, or the antibiotic cocktail seems to have cured her, though they want five years before they will say she's cured. She has an attorney fighting with the State of Ohio and, of course, several doctors on her side, including Doctor Mercer and Mike Loucks."

"Is she seeing Doug Ross?"

"Yes. Is that your doctor?"

"Yes, along with Mary Whittaker. Changing subjects, are you dating?"

"Single mom, age forty? Not exactly a prime candidate."

"You're still a beautiful woman," I said.

"At least you didn't use that stupid 'as the day I met you' line!"

"The opinions of my daughters and some female friends to the contrary notwithstanding, I'm not a _complete_ idiot!"

"I have been on a few dates, but nothing to write home about, so to speak."

Angie came back, which meant including her in the conversation.

"You're 6th Dan?" she asked. "Shōtōkan, right?"

"Yes."

I practice Aikidō, and I'm 1st Dan."

"One of my students began in Aikidō," I replied.

"You're an instructor?"

"I was awarded the title 錬士 (_Renshi_), or Polished Instructor."

"That's quite an achievement."

"Thanks."

The waiter came to take our orders and went to put them in with the kitchen.

"Anna says you run a computer company of some kind," Angie said.

That kicked off a long conversation about my past, with Anna and Angie relating some of theirs, though I knew quite a bit of Anna's from when we had dated. The conversation lasted all the way through dinner and coffee afterwards, as I opted to skip dessert as there was nothing even remotely reasonable for me to have on the menu.

When we finished our coffee, I paid the check, leaving a generous tip on the table. We made our way back to the hotel, I said 'good night' to both women and promised to keep in touch with Anna. Once I was back in my room, I called home to talk to the kids and my wives. I spoke to Jesse last, and asked him about his medical visit.

"Not much more than what I told Doctor Mary," he said. "Well, except for flirting with the cute nurse."

I laughed, "Like father, like son! You have your neuro check tomorrow, right?"

"Yes. Grandpa Al said Doctor Carver would check me. I think he checked you, right?"

"Yes, when they were trying to find the source of my syncope."

"Penguin heads are full of blubber!"

"Watch it, lame Little Duck!" I growled.

Jesse and I both laughed.

"I'll see you late tomorrow afternoon. No need to try to call me with an update."

"OK, Pops! Do you need to speak to anyone else?"

"Nope."

We said 'goodbye', I hung up, then pulled out my laptop to answer emails. I spent about twenty minutes doing that, then checked the bug tracking system to see what would be waiting for me on Wednesday morning. There was only one new bug, and it wasn't rated 'blocking', so I didn't look further into it. I shut down my computer and pulled out _Natasha's Dance: A Cultural History of Russia_ by Orlando Figes, a book Natalie had strongly recommended.

I read for about an hour until I was interrupted by a knock at the door. I put the book down, got up, and went to answer it.

"Hi," Anna said.

I was slightly surprised to see her, though as I thought about it, I was probably reading more into it than I should, given her historical insistence on monogamy and fidelity.

"Hi," I replied.

"May I come in?"

"Sure. Can I get you something to drink?"

"I wouldn't mind a glass of wine, but I suspect you don't drink, given your restrictions."

"I do, occasionally, but mostly bourbon. Distilled liquor is metabolized differently from fermented liquor. There might be some individual bottles in the minibar, and you're welcome to one if you want."

"Sure," she said.

I checked and let her know what was available. She chose a merlot, and I decided to have some Maker's Mark. I opened the bottles, poured them into lowball glasses, and took them to the table. We both sat down and sipped our drinks.

"Where's Angie?"

"She has her own room. A year ago, that could never have happened. Now, she's like she was when I first met her when we were fourteen. She was kind of quirky during our Senior year, which was probably the first sign of her illness, but even those quirks are gone. She's always been frustrated with her situation, but as you can imagine, it's worse now."

"I believe it. How much freedom does she have?"

"Some. Her parents make her medical decisions, but they always defer to Mike, who listens to Angie. Her license allows her to drive in the daytime only, which took quite a fight to make happen. Mike and his stepdad, who's an attorney, fought the State of Ohio and won that concession. The biggest restriction is she can't even go on a date because she was declared _non compos mentis_. Even a single romantic kiss would be considered sexual assault."

"I recall you saying she wanted to be a mom and a wife," I replied. "I'd guess physiology would stop the biological mom part, but she could marry and adopt."

"Marry? Probably, if Mike and his stepdad win the battle. Adoption is unlikely because of her history. They won't risk it."

"You're probably right. Do they have any idea at all what happened?"

"None. The main suspicion is the general anesthesia somehow rewired her brain; Mike thinks it might have something to do with the antibiotic cocktail they gave her because she nearly died of sepsis. Clarissa suspects Angie's immune response did something. In other words, no idea at all except pure speculation."

"So, in a sense, she's in the same boat I'm in — nobody knows what caused her condition to resolve, while nobody knows what caused mine to begin. The speculation for me is some kind of congenital defect in my hypothalamus, but they can't say for sure. How is Kyle doing?"

"Graduated, married, and a baby on the way in about five months!"

"That's awesome. Where's he working?"

"For a sports agent in Cincinnati as assistant office manager. Veronica teaches kindergarten."

"I strongly suspect he didn't convince her to allow him two wives," I chuckled.

"You know her?"

"Only by name. He mentioned her when I ran into him at the diner in Newtown and joked about it. I advised him that it was a tough path."

"You seem to have managed it."

"Not without quite a bit of hard work and more than a little heartache. Things have finally stabilized."

"But have you changed?"

"If you mean my view on relationships? No. That was always your sticking point. And that was true for quite a few girls over the years."

"You're implying you still behave that way."

"I do have the freedom to manage my sex life as I see fit. There are some basic rules, but it's always up to me."

"I still find it difficult to understand, but it seems to be working well for you."

"It is. And, as I said, that was the thing that prevented us from being together."

"When I showed up at your door, did you expect me to sleep with you?"

"Actually, my immediate thought was the opposite — that given our history and your views on monogamy, that wasn't the reason for your visit. I assumed you simply wanted to continue our private conversation. Nothing you've said or done has caused me to change my thinking."

"Hypothetically speaking, if that's what I had wanted, what would happen?"

"Twenty-five years later, I still don't do hypotheticals. I maintain that until it's real, any answer that's given is provisional at best. And I absolutely refuse to answer 'What if?' questions about the past, except in the rarest of circumstances."

"What do you mean?"

"Something like you asking what might have happened if you were OK with my lifestyle choices or if you hadn't become angry with me or any other question that requires something in the past to change. The problem with those questions is not just that they are speculative but that there is simply no way to know what might have happened if that thing changed because of what I'd call a ripple effect. You simply can't know what else would have changed, and it's illogical to assume you could change just that one thing."

Anna considered for a moment, then nodded.

"That does make sense," she replied. "Obviously, if you married a different person, your entire life would change."

"Precisely."

"But what's the difference in saying you want to do something versus asking the other person how they'd respond to you wanting to do something. Don't you do that in business planning?"

"Absolutely. But I also try to gather as much information as possible to avoid as much speculation as possible. If I can obtain actual information to act on, that's always better. By saying that I don't like hypotheticals, I'm actually asking for information. My other problem with them is that they can be insincere and imply things that aren't true.

"You asked me, hypothetically, what would happen if you wanted to go to bed with me. For most people, that would imply you _did_ want to go to bed, and could lead to the guy being upset that the offer wasn't real. And that might lead the girl to do something she hadn't intended because she didn't want the guy to be upset.

"It's FAR better to just say what you want or simply ask a direct question. Think about the difference between 'If, hypothetically, I wanted to go to bed with you, what would happen?' and 'Do you want to go to bed with me?'. It might seem subtle, but the first implies you want to; the second one does not. Do you see that?"

"Weirdly, I do. Out of curiosity, what are the rules?"

"The one that would apply here is a mandatory one — a recent clean STI test."

"I have one."

"Then you're free to ask, and I'll answer."

Anna smiled, "Do you want to love me, screw me, and fuck me?"