Chapter 84: Michigan Avenue
The records came on the thirtieth of December, by secure fax, which is a sentence from another century and is nevertheless how it happened.
Fourteen pages. Faxed pages have a gray band down the left where the roller is worn, and I still have them. Moreno called me at ten past eight in the morning and said the word fourteen and then said, “Come in at one.”
I got there at ten to one, with Ethan at home and Roz watching him, and I kept my coat on for the first twenty minutes.
He had them laid out on the desk in two rows, and beside them, in a second stack, Ethan’s own file.
“Before you sit down,” he said. “You are going to want this to be one thing. It is not going to be one thing.”
“All right.”
“Sit down.”
The practice is on Michigan Avenue, on the eleventh floor, internal medicine, four physicians. Ana Reyes-Blackwood was seen twice.
She had no primary care physician of her own in Illinois. She used a walk-in list. That is its own small fact and I have thought about it a great deal.
Nineteenth of November 2025. Second of December 2025.
The first note is nine lines long.
Twenty-nine-year-old female. Six-week history of nocturnal cough. Wakes at approximately 03:00 with cough and shortness of breath. Denies daytime symptoms. Works from home.
Chest clear on auscultation. Oxygen saturation 98 percent on room air. Temperature 36.8.
No history of asthma. No allergies. Non-smoker.
Assessment: likely post-viral cough, dry winter air. Advised humidification of the sleeping environment.
I read that line four times, and then once more with my finger under it.
Advised humidification of the sleeping environment.
I looked up. Moreno was watching me and he had known I would stop there and he had let me get there myself.
“That advice is correct,” he said. “I would have given it. Ten thousand physicians gave it that week. Write that down too.”
I wrote it down. He made me read it back. He does that.
The second note, thirteen days later, is longer.
Returns. Symptoms not improved. Reports waking most nights, cough, chest tightness, described as being unable to get a full breath.
Chest clear. Saturation 97 percent. Peak flow within predicted range.
Reports significant fatigue. Reports low mood.
Then five words in the middle of the paragraph that I have never been able to read calmly.
Symptoms absent while travelling; better at mother’s.
She had gone to San Antonio for Thanksgiving. She was away from that house from the twenty-second to the twenty-sixth of November 2025.
Four nights. And she told a doctor on Michigan Avenue that she had not woken up once.
The assessment on the second visit reads: symptoms out of proportion to examination. Query anxiety, query sleep disorder. Reassurance given. Sleep hygiene advice. Follow up six weeks.
Follow up six weeks. She had seven days.
There is no third visit because there was no third week.
There is no imaging. There were no prescriptions except a course of something for reflux that she filled on the third of December and, according to the pharmacy record, did not refill.
The pharmacy is four blocks from the house. She walked there. Roz says she always walked there.
Moreno let me sit with it. Then he put his hand flat on the second stack.
“Now the other one,” he said.
Ethan’s file. Nineteen logged episodes between March and September 2026, in my handwriting, transcribed into his notes in Bernice’s.
Onset times. Durations. Colour. Recovery. What I did.
Chest clear. Saturations normal between episodes. No wheeze. No fever. Growth on the fiftieth centile and steady.
Assessment, mine, from March: episodic. Assessment, his, from June: not asthma.
“Look at them side by side,” Moreno said, “and tell me what you see. Don’t tell me what you think.”
I looked at them side by side for a long time.
“Both of them are worse at night,” I said.
“Both of them examine normally.”
“Neither of them fits.”
“Yes.”
“And both of them get better somewhere else.”
He did not answer. He turned Ethan’s file around and showed me a line I had given him myself in July and forgotten.
Six nights at his grandmother’s house in Kenilworth, 8 to 14 May 2026. No episodes.
I had written that line myself in a text message in May and thought nothing of it, because a well child is not a data point until he is.
“Say the rest of it,” Moreno said.
“It isn’t a diagnosis.”
“No.”
“It’s a place.”
“It is a pattern,” he said, “which is a thing I am allowed to say, and it is not a place, which is a thing I am not.”
Then he closed both files and squared them, and said the sentence that started the next four months of my life.
“Get me the death certificate,” he said, “and get me the name of whoever signed it.”