Ava is twenty. Officially out of her teen years she's excited for the future. She had a vision board taped above her desk. Twenty-one was circled in gold marker because she couldn't wait to order her first legal drink, even though she'd probably hate the taste. She looked into apartments she couldn't afford yet, wedding dresses she pretended weren't serious, trips she promised herself she'd take, and careers she'd spend the next decade chasing. She believed life rewarded preparation. Making a doctor's appointment had taken three months because adulthood was busier than anyone warned her it would be. Between work, classes, friends, and trying to remember whether she'd paid her car note, she almost canceled her annual physical. Instead, she went. The appointment was ordinary until it wasn't. The doctor paused. He looked at the computer screen longer than he looked at her. Then he asked a question. Then another. And another. His expression changed in a way she couldn't quite name. Finally, he folded his hands together. "I'd like to refer you to a specialist, it's just routine."