Chapter Text
The file marked “Confidential - Rozanov, Ilya G.” dropped on Dr. Adrienne Lee’s desk at 9:43 AM.
“New case.” Lisa, Boston General’s Chief Hospital Administrator didn’t do small talk. “VIP. Ilya Rozanov, NHL Superstar. This is your top priority, starting now.”
NHL? Was that hockey? Adrienne knew almost nothing about sports. She raised her eyebrows as she opened the file. She blinked. “Hanahaki?”
“They want him fixed and they want him fixed fast.”
Adrienne looked back at the file. Stage Two. “Excellent physical condition – except for the flowers growing in his lungs. Occasional smoker – that has to stop.” Adrienne stopped. Oh. Family history of Hanahaki. Father. She shut the file and gave handed it back to Lisa. “This is pulmonology. Send him to surgery.”
Lisa didn’t take the file. “Team doctor said he doesn’t want the surgery,” Lisa shrugged. “That’s why he’s yours.”
Adrienne sighed and dropped the file. “Why not?”
“That’s for you to find out.”
“Fine.” Adrienne leaned back in her chair. “Why does it matter this much? Why’s he a priority?”
“The Bears’ owner is tight with some of the hospital board. They make a lot of donations. The team does a lot of work with the children’s ward, that sort of thing.”
“The Bears?”
“The Boston Bears. Our hockey team?”
Adrienne grimaced. “All I know about hockey is that it’s played on ice.”
Lisa seemed to hold back a smile. She probably didn’t know anything else about hockey either. “He’s coming in today. 2pm. Be ready to roll out the red carpet.”
“Yes, your majesty.”
Adrienne studied Ilya Rozanov’s file. Most of it was fine. Age, height, weight. The vitals were exceptional‚ the baseline numbers of a professional athlete at the top of his sport, the kind of figures that made the current situation surprising. She read the lung capacity assessments and did the subtraction in her head. Without any treatment, he probably had two to three years.
The family history section was not surprising – there was no clear evidence of what caused Hanahaki, but the existing literature acknowledged a strong genetic component. She would have to ask her patient for more information on his father’s Hanahaki.
Adrienne debated whether it was ethical to google her patient. It was probably fine. Ilya Rozanov was a public figure. He probably had a Wikipedia page.
A quick search confirmed she was right. Originally from Russia, moved to the US to play for the Bears. Mother passed away, but father was still alive. Very interesting. Rozanov Senior probably had the surgery, decades back, when surgery had been the only real option on the table. Treatment had come a long way since.
Today there were alternatives, and Adrienne had built the better part of a decade around them – a multidisciplinary model combining medical management with structured psychological work, still common enough that patients tended to land on her desk specifically once surgery had been ruled out.
She scrolled down to Rozanov’s career highlights. Lisa hadn’t been exaggerating – he was a superstar. Award after award, record after record. Adrienne understood perhaps one term in four, but the density of the list spoke for itself regardless.
She reached the section she was most interested in – Personal Life. Nothing. Just some details about a race car he’d driven for charity.
This didn't surprise her. By her estimate, something like seventy percent of her Hanahaki patients were withholding because the obstacle was a pre-existing marriage. The rest split across a handful of other categories — religion, family, status, age. People rarely volunteered which on their own.
She went off Wikipedia and back to the main search page, looking briefly at images and news. There were game highlights, articles about the Boston Bears, and coverage you would expect from an athlete of Rozanov’s caliber. The only person Adrienne recognized from her dip into hockey media was Shane Hollander, Rozanov’s apparent archrival, who Adrienne only knew as Rose Landry’s boyfriend.
By the time her assistant knocked to say Mr. Rozanov had completed his tests and was ready for the consultation, she had a complete picture and a great deal of information she intended to use carefully.
He was larger in person than the photographs suggested, which was not what she expected to think about a professional hockey player. They tended to look exactly as large as advertised.
He sat down without being invited. She noted this.
"I'm Dr. Lee," she said. “How are you?”
“Okay.” He had a Russian accent, Adrienne noted. His face was impassive. He was hard to read.
“How are your symptoms?”
“Some coughing.”
She typed this in. “Any fatigue?”
“No.” He was a man of a few words. This was a different man than the swaggering shirtless hockey player she’d watched in interviews. She supposed that made sense. In the rink, he was a victorious king. In here, he was a dying patient.
“Any pain?”
“No.”
“Anything else that’s different?”
He gestured to his chest. “Some heaviness here. Like something’s on my chest. Hard to breathe sometimes.”
She typed that in too. “We can give you something to combat that. Steroids, bronchodilators.”
He made a face. “Team doctor has to clear.”
“They referred you to me for treatment.”
“NHL has list of banned medication.”
Adrienne looked at him, surprised. “You’re still planning to play?”
He answered instantly, like the answer was obvious. “Of course.”
Adrienne tried to keep her tone measured. “You have a life-threatening condition. Professional hockey is a violent, dangerous, sport. It is not a bad idea to pause while pursuing treatment.” She swallowed down what she really wanted to tell him - he should absolutely stop regularly throwing himself at 250-pound men at top speed when his lungs were compromised.
“Is it required? To stop?”
“Not medically required, but it is recommended.”
“Then I play.”
Bad idea, Adrienne thought, and let it go. It figured he would not be willing to let go of the sport that made him great. She wasn’t here to judge. She was here to cure him.
“I saw your family history. Your father had Hanahaki. Can you tell me more?”
Rozanov shrugged. “He never really talked about it. He had it young, before he married my mother. In his twenties? Fixed with surgery.”
Adrienne nodded, finishing up the initial intake. “I have your test results, both the ones from the team doctor and the ones you did today.”
“And?”
“They confirmed what we already knew. You have Hanahaki disease, Stage Two.” Adrienne
“Okay.”
She pulled up his imaging on the screen and turned it toward him.
"Stage Two," she said. "Which means bilateral involvement, both lungs‚ with the left lobe as primary. The growth is established but not yet obstructive. Your lung capacity is currently at 85% of your assessed baseline, which is still well above functional range, but the trajectory matters more than the number." She let him look at the imaging for a moment. He looked at it the way she imagined he watched game film, assessing, filing, not flinching. "The fact that you're here at Stage Two is unusual. Most patients present at Stage Three or later."
"Team doctors," he said. "They watch everything."
"Lucky." She said it without inflection. "Stage Two gives you options that Stage Three patients don't have. I want to go through all three clearly before we discuss anything else. Do you have questions before I start?"
He shook his head once. She proceeded.
"Option one: reciprocation. If the person you have feelings for returns them genuinely, the disease resolves‚ completely, in most cases, within four to six weeks. Lung tissue recovers. No intervention required." She kept her voice even. "I include this for completeness, but most of my patients come to me because precisely because they've determined it's not available to them."
He nodded slowly. “No. Not available. What is next.”
"Option two: surgery. Full removal of the flowers and the root growth. At Stage Two, the success rate is 95%. Recovery is six to eight weeks, during which you cannot play. Following recovery, your lung capacity returns to baseline within three months." She paused. "The psychological consequence is the removal of the feelings that caused the disease and possibly removal of the feeling of affection. It's typically described as a gradual fading. Most patients report that at six months post-surgery, the feelings are inaccessible - but many also report the inability to feel anything at all."
“No surgery,” he said simply. “Next option.”
"Option three: therapeutic distancing, supported by symptom management. This involves working to process and gradually dissolve the attachment, alongside medication to manage progression. The success rate at Stage Two is approximately 20%." She held his gaze. "That's not a misprint. One in five patients who attempt this option achieves full resolution. The medication – anti-inflammatories and antibiotics, extend your functional window. The therapy addresses the root cause. Together they give you a genuine chance, but I want you to understand what that chance actually is."
"I want to do option three," he confirmed. This was why most people came to her. She was not surprised at all.
“I want to be clear before you make your choice – surgery has a 95% success rate. Therapy has a 20% success rate.”
“I don’t want surgery,” he said in a tone that booked no room for argument.
“Surgery is more likely to cure you. You can live your life, keep playing hockey.”
Rozanov shook his head. “You know my father had the surgery. I know what the surgery does to a person. I do not want it.”
Adrienne nodded. "Option 3 it is.”
“Tell me more about Option 3. What made the 20% effective? What did they do?”
“They committed to the treatment plan. They successfully stopped loving their UL.”
“UL?”
“Unrequited Love,” Adrienne explained. “In about a year, the flowers disappeared.”
Rozanov was looking determined. Like she’d just given him an opponent and he was going to take it down. “What is treatment plan?”
“We are going to create yours today. It involves understanding your current relationship with your UL and establishing the boundaries that will allow you to stop your affection.”
One side of Rozanov’s lips quirked up, but there was no humor in it. “So get over it or die trying?”
“Crude, but accurate.”
“Okay. How.”
“Today, we set up your treatment plan. After, I want to see you once every two weeks to track your progress. In parallel, I'll work with your team doctors on medication that will pass NHL requirements.”
“Okay.”
“Normally I’d come in wit a draft protocol already built, but…” she pulled out the information sheet and handed it to him. “You left all the questions on your UL blank.”
“Yes.”
“I’ll need some information to put together a protocol. Can you fill it out? You can anonymize the form, John/Jane Doe, that sort of thing.”
Rozanov snorted, but didn’t make a move.
“Will you fill this up?”
He grimaced. “I can’t. It’s – It’s complicated.”
“I’ll need your cooperation to put together a treatment plan,” Adrienne said matter-of-factly.
She understood that. Most Hanahaki patients started out afraid of revealing their loved one. She had a theory Hanahaki patients often reacted as strongly as they did because of the secrecy in loving someone that didn’t return their love. The pain, the stress, the anxiety, had no outlet, so it all turned inwards until it destroyed them.
“I give you my word this will stay confidential. There are very strict laws governing patient privacy. I will lose my license if I go to the press. I’m here to help you, but I need you to be honest with me.”
He said nothing, Adrienne figured that meant he agreed. “I need to understand your history with your UL. What can you share with me?”
“I know you want me to talk but this is a big fucking deal, okay?” he snapped. “I’ve held this in for eight fucking years.”
In that moment, Adrienne saw the big emotions bubbling under the stoic Russian exterior.
“Medical records carry the highest tier of protection. I can avoid specifics as an extra layer of confidentiality.”
There was a long stretch of silence.
“I don’t wany anything in writing,” he said finally.
“I will use only ‘UL’ as we document the treatment plan. In our sessions, we can use a code name. John or Jane Doe, like I said earlier.”
Rozanov huffed out something that sounded like a laugh. “Okay. Jane.”
“Okay,” Adrienne agreed. This was encouraging. “What can you tell me about Jane?”
Rozanov leaned forward to rest his hands on his knees. “I suppose the most important thing you have to know is that Jane is a man.”
He looked at her like he was daring her to react. She said nothing and tried to keep her face as impassive as possible. She wanted him to keep talking. But she was definitely surprised. His media presence indicated he was a number of female romantic partners. There was never a hint of anything else. Rozanov had this well under wraps.
“Jane is also a hockey player,” he continued. “This is why it is secret. There has never been any queer NHL player. And I am Russian – Russia has laws against it. I am here on visa. They can deport me. If I have to go back to Russia, I don’t know what will happen to me. Maybe jail. Maybe worse.”
He sat back. “So I’m dead either way. But Jane - Jane still gets to play. This does not have to ruin him.”
Adrienne noted ‘catastrophizing’ in her head. This was not uncommon in Hanahaki patients. They to tended to feel very strongly and worry very much. They would have to work on that in their next sessions.
“Thank you for sharing that with me. I know it wasn’t easy.”
He nodded. “What do you need. For the plan.”
“For one, I’d like to understand your interactions, and whether it’s possible to minimize them or avoid them altogether.”
“We are in different teams, but same division. We see each other at games, some events like All-Stars and NHL awards.”
“That’s good.”
“Good?”
“You don’t see each other every day. You live in other cities. It means you can control when you interact. Distance is good.”
“I guess.”
“What about communication? How often do you contact each other?”
“We haven’t spoken since October.”
“Did you formally part ways?”
“What?”
“Did you break up?”
“Oh. Not really, we were never together in the first place. But he told me he couldn’t do it anymore. And-” Rozanov swallowed hard. It was obviously emotional. “And he started dating someone else very publicly.”
“That must have hurt.”
“I am dying now. So yes.”
“I’m sorry.”
He gave a bitter laugh. “She is perfect. He is perfect. They make sense.” His voice was dripping with jealousy.
Adrienne added that information to her mental assessment as well. A significant part of the next sessions would be dismantling the idealization, helping the patient understand their UL was not perfect, but mere mortal.
"Okay," she said. "That actually simplifies the distancing protocol. There's no formal ending required, no conversation that needs to happen.”
"Great," he said, in the tone of someone for whome it was not great at all.
“The first step is removing the access points. Cutting off contact." She looked at him directly. "Do you have his contact saved on your phone?"
“Yes.”
"The research on distancing consistently shows that the hardest part is the first move, and that resolve is highest early in treatment and in clinical environments." She kept her voice matter-of-fact. "There's no pressure to do this right now. But if you're willing, this would be a good moment."
“You want me to block him? Erase messages?”
“Only what you’re comfortable with. But yes, we do recommend total avoidance, if possible.”
He pulled his phone out of his pocket. She watched his thumbs fly over the screen. His shoulders had gone rigid.
He put the phone down. “Done.” Adrienne pretended not to notice his hands were shaking.
"Good," she said quietly. "That's the hardest single action in the protocol and you've done it." She meant this. Most patients took weeks to reach that step. "From here, the plan is straightforward: strictly professional interactions only. Games, league obligations. Nothing private. No seeking out, no responding to anything that crosses the professional line." She paused. "How does that feel?"
"Fine," he said. The word was doing a great deal of work.
"One more thing," she said. "Many patients find a symbolic gesture helpful‚ something physical that marks the beginning of the distancing. People used to burn letters, throw away clothes, gifts. Removing them from social media, deleting photographs from their phone."
"I'm not on social media," he said.
“It doesn’t have to be anything like that. The principle is removing something that still connects you.”
He looked like the words were being ripped from him. “I… have pictures. On my phone. In a locked folder. For some stupid NHL awards ceremony bit.”
She said nothing. The room was very quiet.
He picked up his phone. He was much slower this time around. She heard the ‘woosh’ sound that indicated the pictures were being deleted one after another. His breathing was erratic.
“I can’t – I can’t do anymore today.”
"You’ve made fantastic progress today," she said. And she meant it.
Rozanov’s skin looked ashen as he stood up.
"I’ll see you in two weeks."
PATIENT NOTES — A. LEE, MD
Patient: I. Rozanov. Initial consultation completed.
Diagnosis confirmed: Hanahaki disease, Stage Two, bilateral, left lobe primary. Lung capacity 85% of assessed baseline. Family history positive (paternal, surgical resolution).
All three treatment pathways reviewed in full with patient. Patient declined surgical intervention after being informed of comparative success rates. Patient elects Option 3 — therapeutic distancing with pharmacological support. Patient fully informed of associated success rate and consented knowingly.
Initial distancing measures undertaken in-session at patient's own initiative: contact blocked, physical mementos removed. Patient tolerated this well given the circumstances, though not without visible cost.
Patient is intelligent, controlled, and a reliable historian once trust is established. Underlying distress is significant and, in my assessment, substantially greater than the patient is willing to outwardly present. Prognosis for Option 3 will depend heavily on continued engagement and on factors outside strictly clinical control.
Follow-up scheduled in two weeks. Will coordinate separately with team medical staff regarding a league-compliant pharmacological regimen.
— A. Lee, MD