We took an early lunch today and then headed over to the auditorium. I plopped myself in a seat in the front row, twirled my cane and made suggestions; Foreman stood with his arms folded, offering more suggestions; Chase and Cameron twiddled with the PowerPoint projector and ignored Foreman and me.

The white coats started filing in. James came down to the front to say hello and encourage Chase (and heckle me) before he headed up to actually sit with his department.

Pratt, from the Education Committee, came over, rubbing her hands together and babbling about how good it was to see me again, how long it had been since my department had presented at M&M, what an interesting sounding case we had.... She looked around at my staff; I followed her gaze; finally Cameron took the hint and introduced herself. Handshakes all around.

Pratt looked around and commented on the big crowd. Foreman's mouth twitched with amusement. Chase's hair flopped in his face as he shuffled his notes one last time. He looked at Pratt and nodded. Cameron and Foreman sat to my left, Chase followed Pratt up to the stage, they tested the mike, and Pratt leaned over the microphone.

"Good afternoon, and welcome to Morbidity and Mortality. This afternoon we'll be hearing from Dr Robert Chase, a fellow of the Department of Diagnostic Medicine. Dr Chase?"

Chase stepped to the microphone and started his presentation. The first slide went up with the kid's initial symptoms....

He did a good job. Pretty soon he was putting up the initial CT scans and opening the discussion

I listened with only half an ear, just piping up something about AND THE RASH? every now and then. I was surprised Chase chose this case to present. Sure, it was a very weird case, and apparently leprosy's on the rise in the US and may be underdiagnosed. But there was all that stuff going on with his dad... and, well, yes, a lot of that was probably my doing (though not inviting dad to just drop in out of the blue. That was all Rowan.)

I still haven't told Chase about Rowan. It's going to be an ugly day when that news arrives from Australia. And I'm not sure what saddens me more -- Rowan's being so stubborn and proud or Chase's (attempted) cultivated indifference.

The rheumatology folks and my old chums in infectious disease did their best, but Chase had stacks of negative test results shooting down every theory they came up with. We finally did the double reveal of the anthrax and the leprosy, and a murmur went around the auditorium. Chase ended up drawing a little diagram on the whiteboard showing how the treatment for the anthrax ended up also treating the unknown Hansen's, triggering a reaction that sickened the kid further.

There was a lot of discussion afterwards, but no brawling -- just a round of applause and an exodus for the donuts. Chase and the other two hung back to answer a couple more questions and shake some hands, and then we were off to the pastry table as well.

And now it's a quiet afternoon in the office. They have their papers spread out all over the table, with a couple of donuts sitting on napkins in the little empty spot in the middle. Foreman is teasing Chase about the presentation, Cam's passing out the mail, and I'm leaning back in my chair taking it all in.

Maybe things are getting better again.