He glided into my office in patent leather shoes—shiny, brown, and freshly polished. His socks, a bright mustard, perfectly matched his tie as well as his handkerchief, neatly folded in his left breast pocket. Light blue pinstripes ran vertically up his gray blazer, drawing my gaze upward towards his healthy, tanned face.

No surprise, his teeth were ivory and straight, almost as white as his pants. Not a hair was out of place. He was charming.

He was Italian. He lived a part of the year in New York but most of the time in Florence. His heavily accented baritone was rich and smooth but also cheerful and full of life.

He sat down across from me, his wife by his side. They did not look their age—early seventies if I had to guess. But I didn’t have to guess, since his chart was open on the screen in front of me.

As I sat there typing notes, my head bobbed up and down, alternating between making eye contact and doing my best to avoid hitting the wrong keys. I tried to gently nudge the flow of the conversation toward the reason he was there: his symptoms. “When did the weakness start? Is it only in the foot or also the leg?” The man had other plans in mind.

He didn’t have time for illness. He first needed to let me know that he had come from nothing. His success had been earned through hard work.

His wardrobe was emblematic of that. The beautiful fit and fabric of his shirt hugged his chest like Olympic gold medals, arranged for all to see. He boasted.

He wanted me to k.