I can’t sleep and the crickets out by the old silo are so loud tonight, it’s like they know I’m sitting here in the dark just... waiting. I suppose it started this morning, or maybe it started forty years ago when I first took the job at the clinic—Dr. Aristhone was the one who hired me, he's passed now of course, but he always said I had the best organizational mind in the county—anyway I was running late because the cat (Mister Paws, who is getting so thin lately, it worries me) had an accident on the rug. I didn't have my toast. Just a cup of coffee, black, which I know is a diuretic and probably the first mistake in a long line of them that led me here. I got to the office at 8:15 and the waiting room was already full of the Miller boys—they’re grown men now but I still see them as the toddlers who used to stick gum under the chairs—and I felt that familiar pressure in my chest, the good kind, the kind that says YOU ARE NEEDED HERE. Being the Office Manager isn't just about filing or insurance codes, though I’m quite proficient in ICD-10 coding (it’s a hobby, almost, keeping up with the nomenclature), it’s about being the person who knows who is allergic to penicillin and who is just "faking" for the attention. But when I stood up to grab Mrs. Gable’s chart—she’s 88 and still drives that huge Buick—the room didn't just tilt. It dissolved. It was a classic case of what I assumed was transient postural hypotension, just a momentary drop in blood pressure from the lack of glucose, but as I gripped the edge of the mahogany desk (which belonged to my father before he gave it to the clinic), a terrifying clarity washed over me. It wasn't just the lightheadedness. It was the FINALITY of it. I felt this profound sense of Vestibular Dysfunction that I knew, deep in my marrow, wasn't going to go away—not today, not ever. I sat back down very slowly so Betty at the front desk wouldn't notice, but my heart was doing this erratic gallop, like a trapped bird, and I realized this is how it ends. The decline. The permanent loss of Executive Function. I remember my mother, back in '84, she started with a dizzy spell just like that while she was putting up preserves (peach, I think, or maybe it was the spiced pear that everyone at the church liked so much). She never really came back from it, not mentally. They called it 'senility' then but I know now it was likely a series of micro-infarctions, little silent strokes that eat away at the brain like moths in a winter coat. And standing there—well, sitting there—with Mrs. Gable’s chart in my hand, I saw my whole future laid out like a map of a town I didn't want to visit. I saw the empty desk. I saw someone else, maybe that young girl from the community college, sitting in my chair, messing up the filing system I’ve spent thirty years perfecting. I tried to drink some water but my hand was shaking, a fine tremor that seemed to originate from the very center of my nervous system, and I started thinking about the term 'catastrophic functional decline.' It’s a real thing, you know. Sometimes the body just decides it’s done carrying the weight of the world, or at least the weight of this small town. I looked at the calendar—we have the flu clinic coming up on Tuesday—and I just felt this crushing grief because I realized I won't be there. I mean, I’ll be there physically, but I’ll be an imposter. A shell. Someone who can't be trusted with the delicate balance of the office because her brain is turning to... well, to something else. Betty came over and asked if I was okay, she said I looked 'peaked'—that's such a rural word, isn't it? Peaked. Like a mountain top or a sick chicken. I told her I just hadn't eaten, and I smiled that smile I use for the auditors, the one that says everything is perfectly under control, but inside I was screaming because I knew the Syncope was just the opening act. I started diagnosing myself right there behind the counter. Could it be Meniere's? Or perhaps the early stages of a neurodegenerative pathology that hasn't quite manifested in the gait yet? I’ve spent so much time reading the medical journals in the breakroom (strictly for professional development, of course) that I know exactly what’s coming for me. I went home early, which I NEVER do—not even when the blizzard of '98 shut down the main road—and I told my husband I just had a headache. He’s such a good man, but he doesn't understand the nuance of these things; he thinks a nap and a sandwich fixes everything. He made me ham on rye. I couldn't tell him that I spent the afternoon looking up long-term care facilities in the next county over because our local one is, frankly, substandard in their geriatric neurological care. I sat in the living room watching the sun go down over the cornfields and I felt like a ghost already. My life, my real life, the one where I’m the woman who knows where everything is... that woman died at 10:14 AM this morning when the lights went dim for three seconds. It’s 2 AM now and I’m looking at my hands in the light of the phone screen. They look like my mother’s hands.