"Tell me about that," Helen said.
"I don't know where to start."
"Start anywhere. There's no wrong place."
Sienna looked at the tissue box on the side table and then at the narrow lane outside the window and then at her own hands in her lap, the fingers woven together, the scar on her left thumb from the scalpel slip during her residency. She took a breath.
"It started with the injury. Her shoulder. I'm her physician. I've been treating her for four weeks, hands-on rehabilitation every day, and at some point the line between doctor and patient started to blur. And then it didn't blur anymore. It just disappeared."
Helen tilted her head. "When did it disappear?"
"Saturday night. Two nights ago." Was it only two nights? The timeline felt compressed and impossibly stretched at the same time. "She kissed me. Or I kissed her. Both. On a bench by the ocean. And then we went back to her apartment and..." She trailed off. Heat climbed her neck and flooded her cheeks,and she was forty-one years old and turning pink in a therapist's office.
"You had sex," Helen said, as if it were the most unremarkable sentence in the world.
"Yes." Sienna pressed her palms flat against her thighs.
Helen crossed her legs and waited. "And how was that?"
Sienna let out a breath that was half-laugh, half-exhale. "Life-changing. That's not hyperbole. Something happened to me that I didn't know could happen. Physically and emotionally. I cried. During. After. I haven't cried in front of another person since I was..." She stopped. When had she last cried in front of someone? She couldn't remember. Her parents' house hadn't been a place for tears.
"You cried," Helen said.
"Like a wall came down."
Helen was quiet. She let the silence sit between them, unhurried. Outside, a bird landed in the lane. Sienna's knee was bouncing again and she pressed her hand against it.
"Can we talk about what you think broke open?" Helen asked.
Sienna nodded. She knew what it was. She'd been turning it over since yesterday, examining it from every angle with the same analytical rigour she applied to diagnoses, and she'd arrived at a conclusion she didn't like.
"I've been shut down," she said. "For a long time. Nothing dramatic, no single event, no specific wound. My parents loved me in the way they knew how, which was quiet and structured and focused on achievement. There wasn't a vocabulary in our house for the rest of it. For wanting, or being seen, or saying out loud what you actually felt. I learned to put all of that in a box and I got very good at keeping the lid on."
She looked at the tissue box. "I thought I was fine. I'm forty-one. I've built a career. I have a flat with an ocean view. I wake up and I do it again. I was fine."
"And then Elise."
Sienna's throat tightened. She pressed her thumbnail into the side of her index finger. "And then Elise."
Helen waited.
"She looked at me like I was worth looking at. That sounds pathetic."
"It sounds honest." Helen's voice was quiet, without pity, the same tone she used when she wanted Sienna to keep going.
"She told me I was beautiful and I literally couldn't accept it. My brain rejected the information. And then she..." Sienna pressed her fingers against her eyes. The tears were close to the surface, treacherous, ready to break through. "She touched me and I came apart. Years of keeping everything locked down and one woman with calloused hands from holding a hockey stick broke all of it open in one night."
"What did it feel like?"
Sienna's breath shook. "Terrifying. And the most alive I've ever felt."
The clock on Helen's desk ticked in the quiet. Helen leaned forward slightly. "Sienna, can I be direct with you?"
"Yes."
"The professional boundary you mentioned. Between you and Elise. How much of your distress about that is genuine ethical concern, and how much is a shield?"
Sienna stared at her. The question was surgical.