SFA

I offer my thanks to my beta reading team for their very valuable input and to Randi for her editorial prowess and skills.

If anyone is wondering, SFA is a genuine medical condition and all cases of SFA referenced within this story can be found in the medical literature. However, this is a work of fiction.

David Brookman ground out the cigarette butt with the heel of his shoe. Strange, here he was, 32 at his last birthday and until six months previously, he had never smoked more than three cigarettes in his entire life. Now he was virtually a chain-smoker. His colleagues in the IT department that he was the director of hated that he'd taken up smoking, but said nothing under the dreadful circumstances.

His doctor had said, "They'll kill you."

His reply had been a softly spoken: "Yes, I expect they will." His doctor hadn't mentioned it again, just placed his antidepressant medication on his automatic repeat prescription list.

David looked up at the door of the building he was about to enter. Fixed to it was an old brass plate, polished down through the wearying years and decades by a multiplicity of hands, bearing dusters, cloths and bottle after bottle of brass polish. The plate bore the words "Coroner's Court." Was it his imagination, or could he smell the tangy scent of Brasso?

He walked through the door and several minutes later, he sat himself down in the moderately-sized room that was used by the coroner for the district.

He had never been in a coroner's court, and previously he might have been interested to look round the late Victorian building, the bench where the coroner presided from, the seating area where witnesses would wait to be called, the small area where six coroner's jurors would sit, if a jury was required, and the small area were nosy members of the public could spectate. But now? David could hardly get up enough interest to live, let alone notice what his surroundings were.

He had arrived early, before everyone else would enter the court. His life had been irrevocably changed six months previously when he had answered the door of the flat he shared, or rather had shared, with his wife of seven years, Diana.

Two police officers had faced him. They told him that his wife had met with an accident and had been taken to the A&E department of St Vincent's Hospital. When he asked them what had happened, they both shook their heads, denying that they had any details. They looked shifty, guilty almost.

When he had arrived at the hospital, she was already dead, but the condition of her body was a testimony to the fact that the medical staff had worked hard, damned hard, to save her life. There had been no medical miracle. Diana was dead.

If someone, anyone, had told David that there could be anything worse than discovering that his wife, the love of his life, had died, he would not have believed them, but he came to realise that the situation he faced was much worse.

He had been taken to identify her body, which he did. The body was covered in a white sheet, though he wondered why they thought to protect the modesty of a dead person?

Everyone was very sympathetic. He thought he saw someone he vaguely recognised, hanging about, looking distraught. David thought, kindly, "Poor man. I'm not the only person here who has lost a loved one." That thought had given him comfort, but eventually it was to come back to haunt him.

That was then, this was now. The funeral was delayed until the coroner's inquest was opened, and the case immediately adjourned for the results of the autopsy to be reported.

Because "life extinct" had been declared with no obvious cause of death, an autopsy was mandatory under the circumstances.

David had operated on autopilot, he had placed the death notice in the local paper, dealt with the letters, sympathy cards and social media posts and the phone calls, and he found the assistance of the local vicar and the funeral director invaluable when it came to the funeral arrangements. He comforted her parents and her younger sister.

The funeral had been well attended with their friends and relatives (David had no living parents or grandparents) and colleagues from both their workplaces. The wake had gone as well as one could expect, people telling stories about Diana, they ate the food and consumed the drinks and David was left alone wondering what to do now that part of his soul had been ripped away.

He felt a weird unspoken undercurrent at the funeral service and the wake, but he didn't understand why. Some people seemed wary of him, almost.

When the autopsy report came out, he wasn't sure what the terms meant so he turned to his good friend Google and learned. He found that although Google was helpful, under these circumstances, Google hadn't been "friendly" to him at all. He took up smoking, drank more than before and generally stopped giving a shit about himself.

Now, a little more than six months later, just after 10AM, the coroner's court began to fill up with people. Retirees, some students from the local college and a few other random people sat on the public benches. In England and Wales, coroner's courts are, generally speaking, open to all members of the public.

There was the special area of seats that were reserved for witnesses who would be available for the coroner to call upon to give evidence and answer any questions that the coroner might have.

There was a table labelled "press" and there was a young girl sat behind it who was probably fresh out of her journalism degree, an old-fashioned reporter's notebook and a Biro in her hands, ready to start taking notes. She hoped her shorthand would be up to the task.

When the coroner entered the room, an elderly official said, loudly, but with a voice touched by age, "All rise!" Everyone stood up, the coroner bowed to them and enjoined them all to "please sit down."

The inquest was reopened.

The coroner was a middle-aged man. He looked like a small-town solicitor, which was exactly what he was. George Cardew was a senior partner at the Bridgeacre firm of solicitors, Cardew, Royston and Hatcher. He'd been the coroner for the town and the surrounding district for 15 years.

Unlike many countries such as the USA, coroners in England and Wales rarely, if ever, had medical qualifications, but always had a legal qualification. If they needed medical expertise, they would be able to call on Doctors, pathologists and the like to assist them.

"Good morning, everyone. Welcome to the Bridgeacre and District Coroner's Court. My name is George Cardew, and I am the coroner. As is the normal practice, I will not be convening a coroner's jury for this inquest.

"The inquest is into the death of Diana Brookman. Mrs. Brookman was married to Mr. David Brookman, and I would like to offer my sincere condolences to Mr. Brookman in regards to the death of his wife."

The first witness he called was the Coroner's Officer who was an investigating officer for the Coroner. Usually, although by no means always, they were former police officers. As with all the other witnesses, he was sworn in to offer his evidence.

"Good morning. My name is Peter Phillips. I am the Coroner's Officer. On March 5th this year, we received a report of a death of a woman. She had been taken by ambulance to Bridgeacre General Hospital."

The next witness who was called was a paramedic. "My name is Paul Harris. I am a paramedic in the employment of the Eastern Counties Ambulance Service. On March fifth, we were directed to an address in Cadman Apartments in Cadman Street, Bridgeacre. We had received a report of a woman undergoing a medical emergency.

"When we arrived, we found that the patient was very unwell and barely responsive. Based on my 20 years' experience, it was pretty clear that the patient was suffering from severe anaphylactic shock. According to her male companion, she was not known to be suffering from any allergies. We administered an intramuscular injection of epinephrine whilst we were in the flat. When we moved her to the ambulance, we placed her on a saline drip and we took her to Bridgeacre General Hospital on blues and twos."

The coroner thanked him for his evidence and then called Dr. Anthony Travers to the witness stand. "My name is Dr. Anthony Travers. I am the Senior Registrar in the A&E Department at Bridgeacre General Hospital. I was the senior Doctor on duty when Mrs. Brookman was brought in by the paramedics.

"We continued with the drip they had placed her on. We took blood samples and administered intravenous antihistamines and steroids. We placed her on oxygen.

"She was severely ill and her condition was deteriorating rapidly. From monitoring her blood pressure and heart rate, it was clear that her organs were already going into failure.

"She had a heart attack and the crash team were summoned. They used defibrillation, which re-started her heart. However, the situation was still very desperate and I took the decision to administer an adrenaline injection into her heart.

"Her heart failed again, and I took the decision to use open heart massage. However, this also failed and I recorded the time of death at 3.15PM. We did what we could, but in this case it wasn't enough."

The coroner thanked him for his efforts to save Mrs. Brookman and called the next witness, the Home Office Pathologist, Peter Brown.

"My name is Professor Peter J. Brown. I am a Home Office Registered Pathologist and a member of the Royal College of Pathologists.

"I was asked to perform an autopsy on Mrs. Diana Brookman. Mrs. Brookman was a woman in her early 30s and, according to her medical records, she was in otherwise good health until she fell ill on March 5th.

"The diagnosis of the cause of death was given by the hospital registrar as cardiac arrest, which was caused by a severe case of anaphylactic shock. In fact, I have to say it was one of the worst cases of anaphylactic shock that I have seen in my 20 years as a practicing pathologist.

"Upon examining the organs of the deceased, I saw that they all shown signs of degradation as a result of a severe allergic reaction. It was not easy to identify the point of entry for the allergic reaction. There were no insect bites, for example, no markings on the lips and in the mouth and throat indicating that Mrs. Brookman had ingested a food or drink to which she was allergic."

He paused and glanced down at his notes before he continued. "However, upon further examination, it became clear that Mrs Brookman had engaged in sexual intercourse not long before her death. The lips of her vagina and the inner surface of her vagina, the vulval vestibule, showed signs of a severe allergic reaction.

"I had then developed a hypothesis as to what had occurred, but I had to undertake tests to establish if it was what had happened. I removed some of the seminal fluid and placed it in a test tube with some cells taken from Mrs. Brookman. After a suitable period of time I examined them under a microscope and I noticed that there had been a severe reaction between the cells and the sperm.

"It is my conclusion that Mrs. Brookman's anaphylactic shock was caused by her exposure to the sperm of her last sexual partner. Mrs. Brookman suffered from a rare condition called Human Seminal Plasma Hypersensitivity, which is otherwise known as Seminal Fluid Anaphylaxis."

The coroner interrupted him. "Professor Brown, I have not heard of this condition before. Is it rare or is it common?"

Professor Brown replied, "As I said it is a rare condition. Only some 80 cases have been reported in the medical literature since it was first mentioned in 1967. However, what is even rarer is the extreme reaction of Mrs. Brookman's body."

"It's not always fatal?"

"Good gracious me, no! Hardly ever, in fact. After I reached my conclusion of the diagnosis, I undertook some research and the only cases of severe or even fatal reactions was a young man with a severe peanut allergy who died of Seminal Fluid Anaphylaxis, or SFA as it is also known, when he performed oral sex on a boyfriend who had eaten a peanut butter sandwich some time previously. He died, sadly.

"There was another severe case, although not fatal, of a woman who developed SFA because she was allergic to Penicillin, her husband was on Penicillin and it became concentrated in his sperm. However, the transmission there was also as a result of oral sex."

He paused, looked embarrassed, and said, "Although not strictly relevant the only case of a fatal case of SFA that I discovered, occurred in the Irish Republic in 2008 when a woman had consensual sexual intercourse with an Alsatian dog and died of anaphylactic shock as a result of a severe allergic reaction to the dog's semen."

There was a gasp of horror in the courtroom, and the coroner visibly flinched. "Thank you for your evidence, Professor Brown. Please remain in the room in case I need your expert guidance."

Professor Brown nodded and left the witness stand.

The coroner then looked up from his notes and said "I would next like to call Sean Pierce to the stand."

A young harassed looking man took the stand. He looked reasonably handsome, but his eyes had a haunted look about them.

The coroner began questioning him. "Mr. Pierce, what was your relationship with Mrs. Brookman?

"We worked together at the same company. I liked her, she liked me. It started out as lunches in cafes and restaurants, then drinks after work a couple of times. At some point, it turned to flirting and then we commenced having a sexual affair." He swallowed, painfully aware that the husband of his dead lover was in the courtroom. Pierce glanced toward him, and David was both shocked and horrified at the shell of a man he saw. He'd met Pierce several times at company sponsored events, and ironically, he had actually liked the man.

The coroner continued with his questioning. "How long did your sexual affair continue?"

"Six months, Sir."

The coroner frowned. "But if your affair was a sexual one, how was it that Mrs. Brookman died under the circumstances that have been outlined by other witnesses today?"

He paused, almost on the verge of tears. "Because that was going to be our last time together as lovers.

"She told me that she was starting to develop loving feelings toward me, and because she loved her husband to bits, she couldn't allow our affair to continue. Funnily enough, I had also started to have feelings for Diana, and as it wasn't ever my intention to break her marriage up, I agreed to us ending our affair.

"She said that she and David, her husband, had started to talk about having a family, so she was going to go off the pill and she couldn't risk having me father her child rather than her husband.

"I said that I agreed and that as I liked her husband, I'd not be happy with the idea of doing that to him."

He began to look even more distressed. "She said that because I'd been so good about it that she would make our last time together special, that we would have unprotected sex this last time. All the other times we'd used condoms, but not this time. She said it was my treat for being a good sport about it."

Tears began to trickle from his eyes. "So, we made love without a condom and we both climaxed. Then as we lay in bed cuddling together, chatting, she suddenly started to feel ill, wheezy and clammy and looking sickly.

"I dialled 999 and they arrived very quickly and they started treating her. I went to the hospital with her, as I thought it would be wrong of me to abandon her when she was ill."

The coroner nodded, and said, "Thank you Mr. Pierce. Please return to your seat."

The coroner took his glasses off, rubbed his eyes and placed his glasses on his desk. "This has been a very distressing case. Doubtless some will revel in the salacious nature of this case," he cast a glare toward the reporter, "but I'd like to remind everyone that her husband and members of her family are still grieving at her loss. For what this is worth, I would like to take the opportunity to offer my sincere condolences to Mr. Brookman.

"Sometimes decisions by a coroner take several days or even weeks to be formulated. However, in this instance I have no hesitation in ruling that Mrs. Brookman died as a result of misadventure. Meaning that her death was caused accidentally whilst she and Mr. Pierce were performing a legal act without negligence or intent to harm."

He declared the court's business over and everyone left the room. Wisely, Pierce didn't approach David.

Although David's employer didn't have a staff private medical insurance scheme, the company decided to book David in for counselling sessions with a psychiatrist, which the employer paid for.

He had two sessions a week and his psychiatrist, Carli Foster, a transplanted New Yorker who cheerfully admitted looking like a cross between Cyndi Lauper and Joan Jett, was a breath of fresh air for David. She got him, she knew where he had been and where he was coming from. Almost verbatim, those were her first words to him.

She asked him about his smoking, and when he told her he had smoked barely more than three cigarettes in his entire life before his wife died, she nodded.

Rather than dealing directly with his feelings of loss and betrayal, she took several sessions to help wean him off cigarettes and on to E-cigarettes. "Yeah, they might have other dangers inherent to them, but at the moment, who gives a fuck, right?" She laughed at her own joke and to his surprise, David joined her in the laughter. Perhaps the sessions aimed at him smoking were also designed to help him get over his betrayal? She was even more intelligent than he'd given her credit for.

He switched to E-cigarettes and was able to taper off using nicotine by using lower and lower strengths.

Eventually she spoke of the betrayal by Diana. "David, we have to talk about your wife. From what you told me, and this is the height of irony, from the evidence given by your wife's lover, she loved you very deeply. Quite naturally, you'll be wondering why she cheated on you?

"Without being able to speak with her it's not possible for me to say, but there are many reasons why people cheat on their spouse or their partner. Not any that a 'normal' person would find valid, but if they didn't work for the cheater, then they'd never cheat, now would they?"

"What reasons are there?" David asked.

"Oh, the much mythologised seven-year itch, feelings of inadequacy, not feeling loved by their spouse, dozens of similar excuses. You'll notice I say excuses, and not reasons?

"However, there are some people, both men and women, who really should not be married, to be honest. There is a condition that many in the mental health field deny exists: Nymphomania or satyriasis, the former a description for women the latter for men. A broader, catch-all term, is hypersexuality.

"This can be caused by a number of reasons, being a survivor of childhood sexual abuse or rape for both males and females, Klüver--Bucy syndrome or mental health issues such as bipolar. Although living with someone for so long I expect you'd probably have noticed if she had been bipolar?

"Hormone imbalances can also cause the problem. However, this isn't to excuse your wife. After all, from what you've told me, she and you were enjoying a satisfying sex life, so rather than cheating on you she could have asked for increased sex from you rather than taking a lover.

Although what happened to her is totally out of left field, as I've never heard of anything like it when I was training as an MD, and later as a psychiatrist. In fact I had to look up the syndrome, as I'd never even heard of it."

Throughout the sessions she employed a variety of techniques to help him recover some semblance of a normal psyche after the battering Diana's cheating and death had caused him.