January 2024

Six months later, the silence didn’t feel the same. It had held—mostly. The mornings were still quieter. The pattern still there if he paid attention. The sound would ease when he woke, then return slowly as the day moved forward. He had adjusted to it.

At least, that’s what he had been telling himself.

“Doctor, can you please review this case? We think the submitting laboratory made a mistake and mislabeled the slides?”

James looked up. The folder was already in his assistant’s hands. He took it. Opened it. Looked down. Familiar. But something wasn’t right.

“I’m sorry, what?” he said.

“We think the slides are mislabeled,” she said. “The numbers don’t match the requisition.”

He had seen this before. Dozens of times. More. It was routine. He looked again. Numbers. Requisition. Slides. They didn’t connect. Not in the way they should have. He frowned. Looked closer.

“What is this?” he said.

“Doctor, should I leave the case with you?”

He looked at her. He knew her. He knew this room. He knew this problem. So why couldn’t he follow it? A tightening sensation started in his chest. Subtle at first. Then sharper. His hands began to tremble. No. That wasn’t right. He set the slides down. Carefully. Too carefully. The room shifted. Not dramatically. Just enough that something felt off. He took a breath. It didn’t settle anything. Another. Still nothing. His heart was racing now. He could feel it. Not just fast—uneven.

This is an anxiety attack.

The thought came suddenly. Clear. Clinical. He had seen this before. Patients describing it. The same sequence. The same loss of control. But not like this. Not in him. A wave of nausea rose. His vision tightened slightly at the edges.

“I’m sorry,” he said, standing too quickly. “I need to leave. I don’t feel well.”

His assistant stared at him. Startled.

“Of course,” she said. “Yes—of course.”

He walked out. Not running. But not steady either. In over thirty years, he had only called in sick twice. He had never left like this. The hallway felt longer than usual. The air different. He got to his car. Sat. Hands on the wheel. Still shaking.

“Okay,” he said out loud.

His voice didn’t sound like his own.

“Okay… okay…”

He took a breath. Held it. Let it out slowly. It didn’t help. The diagnosis was still there. Clear. Unmistakable. Anxiety attack. But knowing it didn’t change it. He drove home. Carefully. More focused on staying in control than on the road itself.

By the time he pulled into the driveway, the shaking had eased slightly. Not gone. Just less visible. The house was empty. Of course it was. Deanna was still downtown. He walked inside. Closed the door. And then stopped. For a moment, there was nothing to do. Nowhere to direct it. The silence in the house felt different. Not peaceful. He sat down. Then stood up again. Then walked into the kitchen. Then back. His hands were still trembling. He pressed them against the counter. Held them there.

“This is not happening,” he said quietly.

But it was. He tried to reconstruct it. Step by step. The case. The numbers. The disconnect.

Why couldn’t I follow it?

That was the part that didn’t make sense. Not the anxiety. Not the physical symptoms. The cognition.

What am I doing?

The thought came back. Sharper this time. If that had been a melanoma—He stopped. Didn’t finish the thought. He knew where it went. He sat down again. This time he stayed there.

When Deanna walked in, she knew immediately. She didn’t ask anything at first.

She just looked at him. “James?”

He looked up. “I had an anxiety attack,” he said.

No hesitation. No softening. Her expression changed. Not shock. Recognition. Concern.

“What happened?”

He let out a breath. Then another. And then it came out.

“I couldn’t think,” he said. “Something simple. A mislabeled case. I’ve seen it a hundred times.”

She moved closer. Didn’t interrupt.

“I couldn’t follow it,” he said. “The numbers didn’t make sense. I couldn’t connect them.”

His voice was tightening now.

“And then my hands started shaking. My heart was racing. The room—” he stopped, searching—“it wasn’t spinning exactly. But it wasn’t right.”

Deanna sat down across from him.

“And I knew what it was,” he said.

He looked at her. “I knew it was an anxiety attack.”

“Have you ever had one before?” she asked.

“No.”

The answer came immediately. “And you were at work.”

“Yes.”

He let out a short breath. Almost a laugh. But there was nothing behind it.

“I left,” he said. “I just walked out.”

Deanna nodded slowly. “That was the right thing to do,” she said.

“I’ve never done that,” he said.

“I know.”

That wasn’t reassuring.

“That’s not me,” he said.

There it was. Not the fear of the attack. The fear of what it meant.

“I couldn’t process it,” he said again, quieter now. “I couldn’t think.”

Deanna leaned forward slightly.

“You got out,” she said. “You recognized it and you left.”

He shook his head. “That’s not the point,” he said. His voice was sharper now. “What if I didn’t?” he said. “What if I stayed? What if it was something else?”

Deanna didn’t answer right away.

“What if that was a melanoma?” he said.

There it was. The thought he had stopped earlier.

“I’m signing out cases,” he said. “People are making decisions based on what I say.”

His hands were trembling again. “I can’t do that if I’m not—” he stopped.

Didn’t finish it.

If I’m not what?

In control. The word didn’t need to be said. From the hallway, Tess had stopped. She hadn’t meant to listen. But she heard enough. She stepped into the room slowly.

“Sir?” she said.

James turned.

She had never seen him like this. “Are you okay?” she asked.

He didn’t answer right away. “I don’t know,” he said.

That was the truth. Tess looked at Deanna. There was something in her expression—uncertainty, concern, something close to fear.

“I’ll make tea,” she said quickly, almost reflexively, and stepped back toward the kitchen.

The room felt different now. Not private anymore. Not contained. Deanna looked back at James.

“We’re going to figure this out,” she said.

He nodded. But it didn’t land. Because for the first time—he wasn’t sure that was true.

And that was what scared him the most.

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