He didn’t go back to work the next day. Not because he couldn’t. Because he wasn’t sure he should. The house was quiet in the morning. Deanna had already left for downtown. Tess moved softly in the kitchen, as if the rhythm of the house had shifted overnight. James sat at the table with a cup of coffee that had long gone cold. He hadn’t taken the second medication. Only the first. He noticed the difference almost immediately. Not dramatic. But enough. The edge was back.

He picked up his phone and read the psychiatrist’s message again. Then he typed.

I need to be seen. Something is not right.

The reply came sooner than expected.

Come in this afternoon.

He didn’t feel relief. He arrived early and sat in the same chair as before. The same room. The same quiet order. The bookshelf. The Bible still there. This time, he didn’t look away. He simply noticed it.

The psychiatrist entered, closed the door, and sat down. “You said something isn’t right.”

James nodded. “I had an episode at work.”

The psychiatrist leaned back in his chair. 

“I couldn’t process a case,” James said. “Something simple. A mislabeled specimen. I’ve handled it hundreds of times.”

“And?”

“I couldn’t follow it. The numbers didn’t connect. I couldn’t think.”

“And then?”

“My heart started racing. My hands were shaking. The room didn’t feel right.”

“A panic attack.”

“Yes. I knew that part.”

“What concerned you more?”

James didn’t hesitate.

“The thinking.”

That hung in the room.

“Not the anxiety. The fact that I couldn’t process something I should have been able to process.”

The psychiatrist nodded.

“Has that happened before?”

“No.”

“Even briefly?”

“No.”

The psychiatrist studied him for a moment. “Have you noticed any other changes? Memory? Losing track of things? Words not coming as easily?”

James leaned back. “Not like that,” he said at first. Then stopped. “I forgot my password a few weeks ago. Something I use every day.”

“And since then?”

“Nothing obvious.”

But even as he said it, he wasn’t completely certain.

“What about when you’re reading?” the psychiatrist asked. “Cases. Reports.”

“Sometimes I have to go back over things,” James said. “More than I used to.”

“How often?”

“I don’t know. Enough that I’ve noticed it.”

The psychiatrist nodded. “Any changes in decision-making?”

James almost said no. “I don’t think so,” he said instead.

The psychiatrist let that sit. “What happened after the episode?”

“I left. I went home.”

“And since then?”

“I tried adjusting the medication,” James said. “The second one.”

“Gabapentin.”

“Yes. I couldn’t tolerate it. Dizziness. Worse at work. I stopped.”

“And now?”

“Just the clonazepam.”

“And how do you feel on it?”

James paused. “It works,” he said.

The psychiatrist waited. “But I don’t feel like myself.”

“How so?”

“Slower. Less sharp.”

The psychiatrist nodded. “That’s not uncommon. And that concerns you.”

“Yes.”

There was no hesitation now. “What if this isn’t just anxiety?” James said.

The psychiatrist didn’t answer immediately. “What are you thinking it might be?”

James held his gaze. “Something degenerative.” He let the word settle. “Early dementia.”

The psychiatrist leaned back slightly. “That’s a serious concern.”

“Yes.”

“Let’s take this step by step,” he said.

“What you experienced in the lab can happen under acute anxiety. Even in high-functioning individuals.” James nodded. “But given your concerns, and your profession, it’s reasonable to look further.”

That was the shift. Not reassurance. Not dismissal. Acknowledgment.

“I’d like to do a brief cognitive screen.”

James agreed. The questions were simple. Recall. Sequence. Attention. He answered all of them correctly.

“That looks normal,” the psychiatrist said.

James nodded. But it didn’t reassure him.

“Given your concerns, I think it would be appropriate to have a neurologic evaluation,” the psychiatrist said.

There it was. “To rule out anything structural or degenerative.”

James sat back. He had expected that. Still, it landed.

“I’ll make the referral.”

“What do I do in the meantime?”

“Stay on the lowest effective dose of clonazepam. Avoid the second medication.”

“And work?”

The psychiatrist paused. “I would be cautious.”

Cautious. That wasn’t a word James had ever used for himself. He stood to leave.

“James.”

He turned.

“This doesn’t define you.”

James didn’t respond. Because that wasn’t the question he was asking. He walked out.

The drive home felt longer this time. Not because something was happening. Because something might be. At a stoplight, he found himself staring at his hands. Steady. He turned them over once. The same hands.

How many slides had passed through them without hesitation?

How many times had he trusted what he saw without question?

He rested them back on the wheel. Nomura came to mind. There had been a time when no one questioned him. Not because they were afraid to. Because there was no reason to. Precise. Consistent. Reliable. Then something changed. Not all at once. A pause where there hadn’t been one before. A second look that seemed unnecessary. A slight hesitation. At the time, James had dismissed it. Everyone slows down a little. But it hadn’t stopped there.

Then Ramelli. Different personality. Same pattern. He should have retired earlier. James had thought that more than once. Not critically. Just clearly. There was a point where experience no longer compensated for something else. A line. Not sharply drawn. But real.

James tightened his grip on the wheel. 

That won’t be me.

The thought came quickly. But it didn’t settle anything. Because for the first time, he didn’t know if it was true.

He pulled into the driveway and sat for a moment before getting out. The house was still. Tess appeared from the hallway.

“Sir?”

“I’m okay,” he said.

She nodded, but didn’t move right away. He walked past her, set his keys down, and sat without turning on the lights.

When Deanna came home, she found him there.

“Hey…” she said softly.

He looked up. She set her bag down and walked over slowly.

“How did it go?”

“He’s referring me to neurology.”

She didn’t react immediately. “Okay,” she said gently.

“To rule out something else.”

She sat across from him. “What kind of something else?”

He hesitated. “Something degenerative.”

The words felt heavier this time. She didn’t look away. “Okay,” she said again, softer.

“I couldn’t follow something simple,” he said. “Something I’ve done my entire career.”

She leaned forward. “You had an anxiety attack.”

“That’s not the part that worries me.” His voice tightened. “It’s the thinking.”

He moved closer to Deanna. “I’ve seen this before.”

She waited. “Not in me.”

She reached across and placed her hand over his. “Then we look at it,” she said. “We don’t ignore it.” He held her gaze. “We don’t wait,” she added.

Her voice was steady. “And whatever it is, we face it together.”

That word settled differently. Together. He nodded. Not fully convinced. But not alone. The tinnitus was there. Faint. He noticed it. Not just as sound. But as something he could no longer dismiss. And now it wasn’t just pointing to anxiety. It was asking a different question. One he hadn’t had to answer before.

And wasn’t sure he was ready to.

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