We were away from the door to outside, Sana sitting in a wheelchair. I was beside him, his head resting on my side. He was asleep. He was asleep most of the time now, but that was okay. As long as he was safe, he could be Sleeping Beauty. The snow was ghostly outside in the moonlight, everything covered in a pure white light, it seemed. The roads had been just cleared. My papa had been watching for that with an eagle eye. With the all clear from both the attending doctor in the ward we'd been in and Sana's regular doctor, we were finally going home. 

It turned out, Sana had been vomiting due to his testosterone hormone levels violently changing, which showed up on a series of blood tests. Just going up and down and all around. This caused his stomach to be very upset, and he couldn't control what happened next. His regular doctor told us she recalled it wasn't something that happened often, and kindly explained to me while we were on a speaker call that this phenomenon was one of the reasons why Sana wasn't on testosterone for his transition. It was safer that way, knowing his true "free T" level. That's the term used for testosterone you produce naturally. The same thing could happen with his estrogen level, and that's why he had a hormone-free IUD. 

Still, Sana's testosterone level was pretty high normally. It gave his body a male shape, and due to this having always been the case, he has slender hips as a man does, too, and broader shoulders. I think his body is beautiful. 

The attending doctor on the ward told us he suspected Sana was having so many asthma attacks due to simply dry winter air, because of the timeline of the onset. He suggested we buy a humidifier, and see if that helped. If not, he could refer us to a specialist. He asked if we had a nebulizer at home, and we said we did. He was content with that, and off we went.

Staring at the glowing snow under the streetlights, I put my hand on top of Sana's head. The heat of it, his soft hair in my fingers. A small smile slipped onto my face. 

I was so glad he was safe now. So relieved. But I knew that the next one was just around the corner. And for this, I had to prepare myself. I didn't know how bad it could get. All I knew was that I loved him, I would be here for it, and I could not falter. He needed me, and I needed him. That's all that mattered. 

I breathed in slowly, that sad feeling descending over my body, starting with my eyes. My hand cupped his cheek, feeling his soft skin against my palm. 

I remembered when I'd done the same thing, and his cheek had been cold. I shut my eyes tight, trying not to remember. But it was sealed into my brain, unmoving. 

It had been a November night. Getting colder. His birthday was just around the corner, November 29th. I wanted to celebrate it with him. We were staying at my parents' house, because Sana was American and liked to celebrate an American holiday called Thanksgiving. He wanted to bring Thanksgiving to us. I secretly qualified it as him becoming an official member of my family. But that was my little secret. 

My family was so excited for his Thanksgiving. He was worried that he might not be able to find all the ingredients, and worried that he'd have to substitute the turkey with a chicken, or several chickens since my family is so large. My nephews wanted to know why we were having a big feast a month before Christmas. They were so excited. They'd spent the weekend trying to kick Sana's ass in Mario Kart, but Sana was just too good. I'd catch them having little meetings, discussing strategies to beat him in Super Smash Bros. I'd always laugh right after I passed them, and they'd yell at me to "get out of here", because they thought I'd tell Sana what they were planning. And they were right.

My sisters' husbands would be in the living room, patiently listening in to Sana talk about the feast, just quietly drinking beers and probably getting just as excited as the little boys about the food. Sana is an expert at describing food. Just making your mouth gush with water as he described the perfect amount of maple syrup and brown sugar which would be brushed on and melted into the turkey as it cooked for hours, creating a crackly glaze. He'd described the stuffing, a turkey flavored finely diced bread dish that was spiced with all kinds of herbs and things and so soft and buttery. He'd described the sweet potatoes, wondering how many he'd need, saying that he'd "candy" them and serve them with something called marshmallow fluff. 

Sana's guitarist, Nobu, had called earlier that week and lamented the meal. "Sana-chan cooks that for us Lyra members every year. You're stealing my Thanksgiving. Ughhh. I can't forgive you. I wanted my corn bread." We'd laughed so hard at that. Sana apologized and said he'd make the corn bread again and specially deliver it to Nobu. Nobu had perked up at that. Sana always had to make people happy. He couldn't leave it when someone was upset, even if they weren't that mad.

We went to a theme park the evening of the 24th, because my nephews had wanted to go. Sana said he wasn't feeling his best, kind of weak, but he said he'd be okay. Even so, I was on alert. I was monitoring him. Lately, sometimes when we were out, he'd suddenly drop to his knees and he'd be supporting himself with his hands. It filled me with so much fear. It was his blood sugar. He'd recently been suffering from low blood sugar, a problem he didn't used to have. We were still trying to figure out how to adjust his diet, and recognize the signs. But the signs were so like when he had high blood sugar. It seemed the only difference was a willingness to eat, and when he had low blood sugar he had no appetite, which he tended not to notice. But that wasn't his fault. We were working on it. 

As we walked around the theme park, I held his hand. He loved all the colorful lights against the night sky. We'd stop to look at the sparkling, changing lights of things like a rollercoaster or lights strung between shops. Christmas season starts early in Japan, and Sana said that even though he'd lived in Japan since the start of high school, he still wasn't used to that. Christmas is Sana's favorite time of the year. I love that Sana makes me stop and analyze things. He makes me notice the small things that I miss all the time by moving too fast. 

We met back up with my family for dinner. It was my mom and papa, my younger twin sisters, their husbands, and my two nephews. My nephews were excited to eat, as usual. We decided what we all wanted, and the boys loved that we were eating "American style" food. They eagerly questioned Sana throughout the whole meal about food in America, and Sana was only too happy to answer. He's so good with them, and they adore him. 

Towards the end of the meal, I noticed Sana stopped eating. He was staring straight down at his food. A blank stare. I'd never seen that look on his face. As he stared, I noticed his eyes go distant. He just said quietly, only for me to hear, "I have to go to the bathroom." I barely heard him. I said I'd go with him, and excused us. My family told us to take our time, and they'd order dessert. 

I got up from the picnic style table, and helped Sana swing his legs over, holding his hands. And as I was holding his hands, he went to stand up. 

He didn't make it that far. 

As I watched in horror, he fell face forward into the dirt. Right in front of me. And he didn't move afterward. Just crumpled on the ground, still as a statue. 

My family and I froze in shock for a moment. In a flash, my sisters' husbands were up out of their seats on the ends of the table. Naoko's husband, Daichi, rolled Sana over as I stepped back, still in shock and unable to move. My mouth was still open, my hands over my face. That's when Natsuko cried Sana's name, and I came back. I just started screaming. My mom ran over and took me in her arms. My dad joined Daichi and Natsuko's husband, Haru. Haru is a doctor, and his ear was pressed to Sana's chest. In a heartbeat, he started CPR. I just sputtered. "What- what-" I couldn't say anything else. I couldn't see anything for a few seconds, my vision blurry, and my vision cleared. I realized I was crying. 

My papa got on his cellphone and from his words, I knew he was calling emergency services. The girls from the food stand we'd gotten our dinner from were running over. I saw other staff members running in a different direction. Natsuko was with our nephews, and I saw her running with them towards a bathroom. Naoko was just standing there, her mouth open, just frozen, staring at Haru and Sana. Daichi took over CPR. 

In just a few minutes, the paramedics arrived. They had an AED, a device which shocks the heart back into a regular rhythm. They yelled at all of us to step back. So many people were looking at us. They opened Sana's shirt and took off his white tank top underneath, revealing all of his tattoos in the process. This brought me back for a moment, this familiarity. I knew every detail of those tattoos. They stood a chance of making this all seem real. They shocked Sana twice. The monitor said he was back to a regular rhythm. But, if he was back to a regular rhythm, why wasn't he waking up? The paramedics wanted to know who'd be riding with them to the hospital, and my mom pushed me forward. I'd been in too much shock to even raise my hand. 

In the ambulance, I kept trying to will Sana to wake up. Almost praying. Bargaining. Just wake up now. If you wake up now, I'll buy you chocolate, your favorite. If you wake up now, I'll buy you that trumpet you wanted. If you wake up now, I'll give you the world.

My brain was trying to convince me that he was only sleeping. Maybe this was a dream, and I only had to wake up. My hand wandered toward his cheek, and as it cupped his face as it had a thousand times, it found it clammy and cold. I gasped a little bit, and my hand fell from his face. 

That's when the paramedic in the back of the ambulance with us started asking me questions. What was Sana's name? How old was he? What was his address? I realized I knew the answer to every question. Under his breath, I heard the paramedic say, "gender, male" and tick a box on his clipboard. My face turned to him, my eyes wide. 

I'd had this conversation with Sana before. He said in a medical emergency, his biological sex had to be revealed to be female. He had no shame in it. He said his biological sex was closest to a female's. I had protested, my hands up in front of me when he'd told me this. I didn't understand. He explained it to me so gently. He said that I had to tell them, because he had female sex organs inside. He had an IUD. It was a medical, biological fact, and would help the doctors treat him. He'd said, what if the problem was he had a burst cyst on an ovary? If the doctor thought he was biologically male, then they'd never check for that. What if he had a UTI? Or even, what if he had something like cervical or uterine cancer? Or his IUD was digging into his uterine wall? The doctors had to know where to look to diagnose a problem. When he explained it that way, I finally understood it. But it made me no less uncomfortable with it. 

Then I remembered a very specific part of that conversation, and it made me want to drop my face below my knees in shame. 

He'd described the common symptoms of a heart attack in a female versus a male, as an example of why it was important to tell a doctor his biological sex. And I'd realized, that he'd had some of those symptoms earlier in the day. I wanted to burst into tears. But I had a job to do. 

"No, no, gender is female," I told the paramedic. 

"Oh, okay." So simple. He scratched out the box he'd ticked and ticked another one. I began explaining the symptoms I'd remembered. He wrote them down. I explained about Sana's endocrine disease, and he wrote this, too. He told me that was very helpful. I felt proud. Because of that information, he took Sana's blood glucose level and found it to be a little high.