SPIN

By the time we made the clinic entrance I was bearing most of his weight. Molly Seagram, fortunately, was out of the office; once I closed the outer door we were alone. I helped Jase onto a table in one of the examination rooms, then went back to the reception desk and posted a note for Molly to make sure we wouldn't be disturbed.

When I returned to the consultation room Jason was crying. Not weeping, but tears had streaked his face and lingered on his chin. "This is so fucking awful." He wouldn't meet my eyes. "I couldn't help it," he said. "I'm sorry. I couldn't help it."

He had lost control of his bladder.

* * * * *

I helped him into a medical gown and rinsed his wet clothes in the consulting room sink and put them to dry next to a su

Jason recovered some of his composure, though he looked diminished in the paper gown. "You said this was a curable disease. Tell me what went wrong."

"It is treatable, Jase. For most patients, most of the time. But there are exceptions."

"And what, I'm one of them? I won the bad news lottery?"

"You're having a relapse. That's typical of the untreated disease, periods of disability followed by intervals of remission. You might just be a late responder. In some cases the drug needs to reach a certain level in the body for an extended length of time before it's fully effective."

"It's been six months since you wrote the prescription. And I'm worse, not better."

"We can switch you to one of the other sclerostatins, see if that helps. But they're all chemically very similar."

"So changing the prescription won't help."

"It might. It might not. We'll try it before we rule it out."

"And if that doesn't work?"

"Then we stop talking about eliminating the disease and start to talk about managing it. Even untreated, MS is hardly a death sentence. Lots of people experience full remission between attacks and manage to lead relatively normal lives." Although, I did not add, such cases were seldom as severe or as aggressive as Jason's seemed to be. "The usual fallback treatment is a cocktail of anti-inflammatory drugs, selective protein inhibitors, and targeted CNS stimulants. It can be very effective at suppressing symptoms and slowing the course of the disease."

"Good," Jason said. "Great. Write me a ticket."

"It's not that simple. You could be looking at side effects."

"Such as?"

"Maybe nothing. Maybe some psychological distress— mild depression or manic episodes. Some generalized physical weakness."

"But I'll pass for normal?"

"In all likelihood." For now and probably for another ten or fifteen years, maybe more. "But it's a control measure, not a cure—a brake, not a full stop. The disease will come back if you live long enough."

"You can give me a decade, though, for sure?"

"As sure as anything is in my business."

"A decade," he said thoughtfully. "Or a billion years. Depending on how you look at it. Maybe that's enough. Ought to be enough, don't you think?"

I didn't ask, Enough for what? "But in the meantime—"

"I don't want a 'meantime,' Tyler. I can't afford to be away from my work and I don't want anyone to know about this."

"It's nothing to be ashamed of."

"I'm not ashamed of it." He gestured at the paper gown with his right hand. "Fucking humiliated, but not ashamed. This isn't a psychological issue. It's about what I do here at Perihelion. What I'm allowed to do. E.D. hates illness, Tyler. He hates weakness of any kind. He hated Carol from the day her drinking became a problem."

"You don't think he'd understand?"

"I love my father, but I'm not blind to his faults. No, he would not understand. All the influence I have at Perihelion flows through E.D. And that's a little precarious at the moment. We've had some disagreements. If I became a liability to him he'd have me relegated to some expensive treatment facility in Switzerland or Bali before the week was out, and he'd tell himself he was doing it for my sake. Worse, he would believe it."

"What you choose to make public is your business. But you need to be seeing a neurologist, not a staff GP."

"No," he said.

"I can't in good conscious continue to treat you, Jase, if you won't talk to a specialist. It was dicey enough putting you on Tremex without consulting a brain guy."

"You have the MRI and the blood tests, right? What else do you need?"

"Ideally, a fully equipped hospital lab and degree in neurology."

"Bullshit. You said yourself, MS is no big deal nowadays."

"Unless it fails to respond to treatment."

"I can't—" He wanted to argue. But he was also obviously, brutally tired. Fatigue might be another symptom of his relapse, though; he had been pushing himself hard in the weeks before E.D.'s visit. "I'll make a deal with you. I'll see a specialist if you can arrange it discreetly and keep it off my Perihelion chart. But I need to be functional. I need to be functional tomorrow. Functional as in walking without assistance and not pissing myself. The drug cocktail you talked about, does it work fast?"

"Usually. But without a neurological workup—"

"Tyler, I have to tell you, I appreciate what you've done for me, but I can buy a more cooperative doctor if I need one. Treat me now and I'll see a specialist, I'll do whatever you think is right. But if you imagine I'm going to show up at work in a wheelchair with a catheter up my dick, you're dead wrong."

"Even if I write a script, Jase, you won't be better overnight. It takes a couple of days."

"I might be able to spare a couple of days." He thought about it. "Okay," he said finally. "I want the drugs and I want you to get me out of here inconspicuously. If you can do that, I'm in your hands. No arguments."

"Physicians don't bargain, Jase."

"Take it or leave it, Hippocrates."

* * * * *

I didn't start him on the whole cocktail—our pharmacy didn't stock all the drugs—but I gave him a CNS stimulant that would at least return his bladder control and the ability to walk unassisted for the next few days. The downside was an edgy, icy state of mind, like, or so I'm told, the tail end of a cocaine run. It raised his blood pressure and put dark baggage under his eyes.

We waited until most of the staff had gone home4X109 A.D. and there was only the night shift at the compound. Jase walked stiffly but plausibly past the front desk to the parking lot, waved amicably to a couple of late-departing colleagues, and sank into the passenger seat of my car. I drove him home.

He had visited my little rental house several times, but I hadn't been to his place before. I had expected something that reflected his status at Perihelion. In fact the apartment where he slept—clearly, he did little else there—was a modest condo unit with a sliver of an ocean view. He had furnished it with a sofa, a television, a desk, a couple of bookcases and a broadband media/Internet co

Jase stretched out on the sofa. He looked like a study in paradox, his body in repose, his eyes bright with drug-induced hyperalertness. I went to the small adjoining kitchen and scrambled eggs (neither of us had eaten since breakfast) while Jason talked. And talked some more. And kept on talking. "Of course," he said at one point, "I know I'm being way too verbal, I'm conscious of that, but I can't even think about sleeping—does this wear off?"