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Fever of unknown origin (FUO) refers to the presence of a documented elevation in body temperature for a specified time, for which a cause has not been found after basic medical evaluation. FUO is categorized as classic, hospital acquired FUO; FUO associated with low white blood cell counts (immunosuppression); and HIV-associated (AIDS-related) FUO.
Description
Fever, an elevation of normal body temperature, is a natural response of the body that helps fight off foreign substances, such as microorganisms (bacteria and viruses), parasites, fungi, and toxins. Body temperature is set by the thermoregulatory center, located in an area in the brain called the hypothalamus. Body temperature is not constant all day, but actually is lowest at 6 a.m. and highest around 4 to 6 p.m. Temperature also varies in different regions of the body; for example, rectal and urine temperatures are about one degree Fahrenheit higher than oral temperature, and rectal temperature is higher than urine. Certain normal conditions can also effect body temperature, such as food ingestion, age, pregnancy, and certain hormonal changes.
Substances that cause fever are known as pyrogens, which can be either exogenous (originate outside the body, such as bacterial toxins) or endogenous (formed by the body's own cells in response to an outside stimulus, such as a bacterial toxin). Researchers have discovered that there are several endogenous pyrogens, each made up of small groups of amino acids, the building blocks of proteins. When these natural pyrogens, called cytokines, are injected into humans, fever and chills develop within an hour. Interferon, tumor necrosis factor, and various interleukins are the major fever-producing cytokines.
In the complex process that produces fever, cytokines cause the thermoregulatory center in the hypothalamus to reset the normal temperature level. The body's initial response is to conserve heat by vasoconstriction, a process in which blood vessels narrow and prevent heat loss from the skin and elsewhere. This process alone raises temperature by two to three degrees. Certain behavioral activities also occur, such as adding more clothes and seeking a warmer environment. If the hypothalamus requires more heat, shivering occurs.
In children, the definition of FUO is applied when fever has been present for 14 days with no apparent cause, even though physical examinations have been made and laboratory tests performed. Doctors pay special attention to the ears, nose, throat, sinuses, and chest as sites of infection, since most childhood infections are respiratory in nature. The majority of children with FUO are eventually found to have one of several infectious diseases or an autoimmune disease. In many cases the disease is common, and in some cases an allergic response is causing the fever. Fever increases the body's metabolic rate and oxygen consumption, which can have a devastating effect on individuals with poor circulation. In addition, fever can lead to seizures in the very young. Some possible infectious causes shown in studies of children with FUO are as follows:
- acute otitis media (middle ear infection)
- bacterial meningitis
- blastomycosis
- brucellosis
- cystic fibrosis
- ehrlichiosis
- endocarditis
- enteric infection
- herpes infection
- HIV infection
- infectious mononucleosis
- lower respiratory tract infection
- malaria
- osteomyelitis
- Rocky Mountain spotted fever
- strep infection (streptococcus infection)
- systemic viral syndrome
- tonsillophyaryngitis or tonsillitis
- tularemia
- urinary tract infection
- viral meningoencephalitis
Transmission
It is possible for a child with FUO to spread infection or illness to other individuals, particularly if an infectious organism is the underlying cause. If a child has FUO, it is best to reduce contact with other young children or immune compromised family members until the cause of the fever has been identified.
Demographics
Fever of unknown origin can occur in anyone, male or female, of any age at any time depending upon exposure to infectious organisms such as bacteria or viruses or to other causes of illness such as fungi, parasites, or toxins or to underlying autoimmune or allergic conditions. Because the underlying cause of the fever is usually recorded as the diagnosis, accurate statistics for those presenting with FUO are not available.
Causes and symptoms
There are many possible causes of FUO; generally though, a diagnosis can be found. The most frequent cause of FUO is still infection, though the percentage has decreased in the early 2000s. Tuberculosis remains an important cause, especially when it occurs outside the lungs. The decrease in infections as a cause of FUO is due in part to improved culture techniques that allow more precise identification of organisms and, therefore, more appropriate treatment. In addition, advances in diagnostic technologies have made it easier to identify non-infectious causes. For example, tumors and autoimmune diseases were as of 2004 easier to diagnose. An autoimmune disease is one that arises when the body's immune system attacks its own tissue as if it were foreign. This happens when the immune system does not recognize protein markers (antigens) on its own cells. In some cases, reactions to medications can also cause prolonged fever.
In about 10 percent of cases, no definite cause is found. In another 10 percent, 'factitious fevers' (either self induced or no fever at all) are identified.
General constitutional symptoms tend to occur along with fever, including muscle aches and pains (myalgias), chills, and headache . Sometimes symptoms such as a rash suggest an allergic reaction.
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When to call the doctor
An infant under three months should be seen as soon by a pediatrician as possible if a fever develops. If a toddler or older child has a fever for more than a day or two (48 to 72 hours), with or without other symptoms, the pediatrician should be consulted so that an early diagnosis can be made and treatment begun. It is especially important to watch for signs of dehydration , particularly if the child is not drinking liquids or seems too sick to drink. A crying child with fever may have pain associated with a specific condition and should be seen by the pediatrician as soon as possible.
Diagnosis
Few symptoms in medicine present such a diagnostic challenge as fever. Nonetheless, if a careful, logical, and thorough evaluation is performed, the underlying cause generally can be diagnosed. The child's medical history is first reviewed along with travel, social, and family history, which can reveal important clues.
The first step medically is to search for an infectious cause. Skin and other screening tests for diseases such as tuberculosis and examination of blood, urine, and stool are generally indicated. Antibodies to a number of infectious agents can be measured; if antibody levels are rising, they may point to an active infection. In some cases, a febrile agglutination test can be performed to detect the presence in blood of certain infectious organisms that may stimulate the immune system to produce antibodies known as febrile agglutinins. The test helps diagnose or confirm certain febrile diseases that are known to be associated with febrile agglutinins. These may include:
- brucellosis, a type of infection caused by bacteria belonging to the genus Brucella and characterized by intermittent fever, sweating, chills, aches, and mental depression
- rickettsial infections, a group of diseases caused by the bacteria Rickettsia
- salmonellosis, caused by Salmonella bacteria and marked by nausea and severe diarrhea
- tularemia, also called rabbit fever, a bacterial infection characterized by a high fever and swollen lymph nodes
Various x-ray studies are of value and may be performed, particularly if organisms are identified that may indicate involvement of abdominal organs. Imaging techniques such as ultrasound, computed tomography (CT scan), and magnetic resonance imaging (MRI) may be performed. These enable physicians to examine areas that were once accessible only through surgery. Furthermore, new studies using radioactive materials (nuclear medicine) can detect areas of infection and inflammation previously almost impossible to find, even with surgery.
The removal and microscopic examination of tiny bits of tissue (biopsy) from any suspicious areas found on an x-ray exam can be performed by either traditional or newer surgical techniques. Material obtained by biopsy is then examined by a pathologist in order to look for clues as to the cause of the fever. Evidence of infection, tumor, or other diseases can be found in this way. Portions of the biopsy are also sent to the laboratory for culture in an attempt to grow and identify an infectious organism.
Fever in an individual with HIV, primary immune deficiency, recent transplant, on chemotherapy , or anyone else who is immunocompromised constitutes an especially difficult problem, as these patients often suffer from many unusual infections. HIV itself is a potential cause of fever.
Treatment
Most children who undergo evaluation for FUO do not receive treatment until a clear-cut cause is found. Antibiotics or medications designed to suppress a fever such as antipyretics ( acetaminophen ) or non-steroidal anti-inflammatory drugs (NSAIDs) will only hide the true cause. Once physicians are satisfied that there is no infectious cause, they may recommend medications such as acetaminophen, NSAIDs, or corticosteroids to decrease inflammation and reduce constitutional symptoms. Parents are advised not to give children aspirin for fever because of a side effect called Reye syndrome, which may cause liver failure. Fluids are replenished by having the child consume clear liquids. A child too sick to drink may be hospitalized and given intravenous fluids.
The development of FUO in certain settings, such as when it is acquired by patients in the hospital or in immunosuppressed individuals with a low white blood count, often needs rapid treatment to avoid serious complications. Therefore, in these instances antibiotics may be given after a minimal number of diagnostic studies. Once test results are known and causative organisms identified, treatment can be adjusted appropriately.
Alternative treatment
Practitioners of complementary medicine recommend herbs to treat fever. A tea made with catnip, lobelia, and dandelion will reduce fever or catnip tea enemas administered daily. Rest is recommended and large quantities of clear liquids to flush out toxins and help prevent dehydration. Some practitioners recommend letting a fever run its course or cooling the body with cool sponge baths.
Supporting the immune system is one way to help avoid infection by exposure to bacteria, viruses, and toxins as a potential source of fever. Green drinks made with young barley are believed to cleanse the blood and supply chlorophyll and nutrients for maintaining healthy tissue. Because stress is known to produce biochemicals that reduce white blood cell functioning, it is important to get sufficient sleep and reduce stress to help keep the immune system functioning well. Therapeutic massage, yoga , and other types of stress reduction programs are available in most communities.
Prognosis
The outlook for children with FUO depends on the cause of the fever. If the basic illness is easily treatable and can be found rather quickly, the potential for a cure is quite good. Some children may continue to have an elevated temperature steadily or intermittently for six months or more. If no serious disease is found, medications such as NSAIDs are used to decrease the effects of the fever. Careful follow-up and reevaluation is recommended in these cases.
Prevention
Although FUO cannot actually be prevented because the sources are unknown, the immune system can be strengthened to help avoid infection from bacteria, viruses, and toxins. Several nutritional supplements are reported to help build the immune system. These include garlic (contains the essential trace element germanium), essential fatty acids (found in flax seed oil, evening primrose oil, and fish oils), sea vegetables such as kelp, acidophilus to supply natural bacteria in the digestive tract, and vitamins A and C, both powerful antioxidants that improve immune function and increase resistance to infection. Zinc is another nutrient essential to immune system functioning.
Nutritional concerns
Immune system function requires ingesting certain essential nutrients and avoiding others that depress immunity. A diet that improves immune system functioning includes fresh fruits and vegetables, as many eaten raw as possible to provide necessary enzymes; whole grain cereals, brown rice, and whole grain pasta for essential vitamins, minerals , and fiber; and non-meat sources of protein such as nuts, seeds, tofu, legumes (beans), and eggs. Fish, fowl, and lean meats can be consumed in small amounts. Sweets, especially if sweetened with refined sugars, should be reduced or avoided altogether. A diet high in fats and processed foods made with refined flours and sugars can actually suppress the immune system. Alcohol and caffeine should be avoided.
Parental concerns
When FUO is present, parents may be concerned that effective treatment will be delayed by waiting for a diagnosis, which may depend on waiting for the results of diagnostic tests. Depending on the extent of the fever, keeping the child quiet and in bed is probably recommended until all results are available and a definitive diagnosis is made. The doctor will undoubtedly recommend giving clear liquids as often as possible to avoid dehydration from the high body temperature. After the tests have been performed, the physician may recommend fever-reducing medications such as acetaminophen or ibuprofen. If the fever is high enough for concern, physicians may prescribe a broad spectrum antibiotic as initial treatment rather than waiting for the results of all diagnostic tests. When results are available, the physician will likely prescribe a new medication most appropriate for the diagnosis.
KEY TERMS
Acquired immune deficiency syndrome (AIDS) —A disease associated with infection by the human immunodeficiency virus (HIV) that attacks the immune system.
Antibiotics —Drugs that are designed to kill or inhibit the growth of the bacteria that cause infections.
Antibody —A special protein made by the body's immune system as a defense against foreign material (bacteria, viruses, etc.) that enters the body. It is uniquely designed to attack and neutralize the specific antigen that triggered the immune response.
Antigen —A substance (usually a protein) identified as foreign by the body's immune system, triggering the release of antibodies as part of the body's immune response.
Computed tomography (CT) —An imaging technique in which cross-sectional x rays of the body are compiled to create a three-dimensional image of the body's internal structures; also called computed axial tomography.
Culture —A test in which a sample of body fluid is placed on materials specially formulated to grow microorganisms. A culture is used to learn what type of bacterium is causing infection.
Immunosuppression —Techniques used to prevent transplant graft rejection by the recipient's immune system.
Magnetic resonance imaging (MRI) —An imaging technique that uses a large circular magnet and radio waves to generate signals from atoms in the body. These signals are used to construct detailed images of internal body structures and organs, including the brain.
Nonsteroidal anti-inflammatory drugs (NSAIDs) —A group of drugs, including aspirin, ibuprofen, and naproxen, that are taken to reduce fever and inflammation and to relieve pain. They work primarily by interfering with the formation of prostaglandins, enzymes implicated in pain and inflammation.
Toxin —A poisonous substance usually produced by a microorganism or plant.
Ultrasonography —A medical test in which sound waves are directed against internal structures in the body. As sound waves bounce off the internal structure, they create an image on a video screen. Ultrasonography is often used to diagnose fetal abnormalities, gallstones, heart defects, and tumors. Also called ultrasound imaging.
See also HIV infection and AIDS ; Rheumatic fever .
BOOKS
Hay, William. Current Pediatric Diagnosis & Treatment. New York: McGraw Hill, 2002.
Matten, Grace. Fever of Unknown Origin. Durham, NC: Oyster River Press, 2001.
ORGANIZATIONS
American Medical Association. 515 N. State St., Chicago, IL 60612. Web site: http://www.ama-assn.org.
Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. Web site: http://www.cdc.gov.
WEB SITES
Chan-Tack, Kirk M., and John Bartlett. 'Fever of Unknown Origin.' emedicine , November 17, 2004. Available online at http://www.emedicine.com/med/topic785.htm (accessed November 18, 2004).
Dedication
To my family, for being there for me always. And the readers who make it possible for me to keep doing what I love. Last, but never least, to Sasha, for being the best editor in the world.
Chapter One
Surely fate couldn’t be so big a bitch to throw her into the middle of a heat cycle when she was minutes away from facing off against the biggest jerk-off known to werekind? Hell, probably humankind too.
The unfortunate answer to that question sucker-punched Lilly Prescott as a giant wave of prickly warmth undulated through her. Damn it, perfect timing had never been her strong suit, but this was just plain pathetic. Knuckles cramping, she gripped the leather-wrapped steering wheel of her hybrid Ford Escape and tried to focus on anything besides the lusty ripples of pleasure spiraling through every cell in her body. She squirmed in her seat. The crotch of her silk thong pulled snug, intensifying the sensations. “Oh crap.”
The road leading to Morgan’s Ridge appeared. Gritting her teeth in fierce determination, she veered left onto the private road and bumped over the snow moguls not yet cleared by the plows. Thanks to the winter storm that’d blanketed most of Michigan’s Upper Peninsula earlier in the week, several inches of fresh powder filled the tire ruts indenting the thick crust of old snow.
The cabin wasn’t far—less than a mile. Damn it, she’d ridden out longer stretches than this before. The SUV bumped over another mogul, and the thong rubbed in a taunting glide across her clit.
“Shit, shit,
shit
.” No way would she last. She stomped on the brake, and the vehicle fishtailed toward the side of the road. The second the SUV slid to a stop, she rammed the gears into park and unhooked her seat belt. She fumbled with the buttons on her wool trousers, her decision to forgo a skirt in favor of appearing less feminine for her upcoming showdown suddenly a huge bonehead idea. Almost as moronic as forgetting to pack the herbal supplements that helped counterbalance her chaotic hormonal shifts.
A part of her couldn’t believe she was about to get busy with herself on a deserted road in the middle of the freakin’ Michigan wilderness. Talk about one of the lowest moments of her life. Yeesh. Buttons freed, she shimmied the trousers down slightly and slipped her thong to the side. Closing her eyes against the pathetic shamefulness she’d been reduced to, she slicked her fingers over her throbbing flesh. An instantaneous orgasm crashed over her. She bit her bottom lip, smothering her relieved groan. Before the quakes even faded to a pleasant glow, the hot, sexual flush roared back with a vengeance.
Oh bloody hell.
“Lamebrain mutt is walking in circles.” Ducking his head to avoid getting jabbed in the eye by a low-hanging pine bough, Dante Morgan continued tracking the paw prints stamped in the deep snow. If Chevy—his two-hundred-pound Great Dane—kept getting lost like this, he was strapping a GPS unit on the directionally challenged dog.
The paw prints led to a fallen fir tree. On the far side of the hollowed trunk, Chevy’s tracks continued, followed by several sets of smaller tracks. Red fox cubs. Visualizing Chevy fleeing a mob of the much smaller creatures, Dante grunted. “That’s my boy, the gutless wonder.”
Flipping up the collar of his Sherpa-lined jacket, he stepped over the tree, snapping the branches beneath the heels of his insulated boots. His breath puffed in front of his face, visible proof of the lowering temps. Why the hell couldn’t Chevy decide to get lost in July or August? Or any other month that didn’t come with subzero windchill.
An arctic breeze ruffled through the pines, and Dante halted, sniffing the air. A feline was in the area. Not the standard domesticated kind possessing a collar and fluffy tail either. This was a were-cat—lynx. Or lynchat, to be more precise. He knew with all certainty he’d fingered the exact breed because the damn lynchats were a constant thorn in his side. Little surprise one of them would show up on his land. He had a good inkling which of the pain-in-the-furry-asses it was too. More than any of the others of her ilk, Lilly Prescott had elevated the art of bugging the shit out of him to a staggering level.
Grumbling, Dante stalked through the alley of pines. The scent spiking the air grew more pronounced, more…arousing. His steps faltered and saliva pooled in his mouth, his cock stiffening in interest.
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Shit, maybe it wasn’t Lilly. No way in hell anyone that aggravating could smell this intoxicating. Oblivious to everything but the heady bouquet playing havoc with his supersensitive olfactory system, he edged toward the trees dotting the base of the hill. A tan SUV straddled the side of the road and a snowdrift. Vaporous exhaust billowed from the tailpipe—proof the vehicle hadn’t been abandoned.
Fuck. It
was
Lilly. He’d recognize that vehicle anywhere, since he made a practice of hoofing it in the opposite direction on the rare occasion he crossed its path. So why were his boots still crunching in the snow, drawing him closer to the SUV as if he were entranced?
He blamed it on her damn scent. Faced with that potent, alluring smell, there was no way he could resist. He slipped from the concealing pines and jumped the few feet to the road. Landing with predatory ease, he crouched low and eyed the idling vehicle.
A muffled shriek pierced the stillness, and his muscles tensed.
What the fuck?
It sounded like someone was getting tortured. Keeping low, he crept forward, staying out of range of the rearview and side mirrors. The brake lights flashed, and he froze. When the vehicle remained in place, he released his breath and moved in closer.
Not giving himself time to question the sanity of charging to the rescue of the one female responsible for a shitload of his headaches, he hunkered next to the side of the vehicle. Hoping he’d guesstimated the blind spots correctly, he lifted slightly and peered inside the window. No one in the backseat. He glanced toward the front. From this angle, he couldn’t determine who sat up there or what possible threat they provided. Ducking his head below the window line, he shuffled toward the driver’s side door.
A moan filtered through the window and squeezed like a fist around his still-rigid cock. He clenched his jaw. Christ, what kind of a perv popped a woody at the sound of another’s agony? Only the moan hadn’t seemed so much pained as…desperate. Needy.
His heart thumping wildly, he slowly lifted from his crouch and peeked inside the window. He went dead motionless at the sight greeting him. Lilly Prescott was reclined in the driver’s seat, her eyes clamped shut and one hand busy between her legs. Enthralled, he watched the frantic motion of her fingers.
A narrow strip of dark blonde fuzz arrowed low on her exposed pussy, pointing the way to treasures farther south. The delicious scent of her arousal clung heavy in his nostrils, and he battled the overwhelming urge to yank open the door and bury his face in her lap. He licked his lips when her index finger plunged inside her dripping pussy and she wiggled her ass against the seat.
Yeah, baby, stroke deep. You’re almost there.
Shit,
he
was almost there. Two more seconds and he’d be coming right along with Lilly.
Out of nowhere, a massive weight slammed into Dante, tackling him to the ground. An exuberant
woof
blasted into his ear. Grunting, he wrestled with Chevy’s flailing paws and dodged a rough, wet swipe from the Great Dane’s lolling tongue. Dante’s gaze whipped to the SUV, and he spied Lilly’s wide blue eyes gaping at him in horror.
He struggled to his elbows, but before he reached a sitting position, the vehicle lurched forward, tires spinning. “Lilly, wait—”
The SUV gained traction and plowed on, pelting him with a shower of snow. By the time he managed to clear most of the cold, white powder from his face, the SUV’s taillights were distant red lights. Grimacing, he shot a look at the enormous dog rolling blissfully in the snow. “See, boy, this is why we stay clear of cats. They’re too damn prickly.” Even if they did smell like dessert.
Lilly didn’t slow down until she reached the cabin’s driveway. “I can’t believe that son of a bitch was peeping on me!”
Clearly Dante Morgan didn’t get the whole notion of privacy. Growling, she careened to a stop in front of her cabin’s small porch. After securing the parking brake, she jumped out and stomped to the front door. Fingers trembling from a combination of shock and fury, she fumbled the key into the lock. Kicking the majority of snow free of her suede boots, she trooped inside and flipped on the overhead light. She barely registered the cabin’s tidy appearance or the fresh citrus scent lingering from Melanie’s recent cleaning, and instead continued to fume.
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How the hell was she going to face Dante now? Her plans of remaining cool and collected while she brokered for the millionth time for property that should rightfully belong to her had just gone up in smoke. “This is just freaking
great
.” She yanked her scarf off and tossed it on the leather club chair. Her white parka soon joined it.
She made it halfway across the main living area when the opening notes of Beethoven’s Fifth Symphony sounded. Pivoting, she stalked back to the chair and fished her cell phone from the parka’s deep pocket. She scanned the Caller ID before jabbing the talk button. “No need to send search and rescue, Kinsey, I made it up here fine.”
“I had no intention of doing any such thing.”
Lilly snorted at her sister’s innocent tone. “Who are you trying to kid? You have the fire and sheriff’s department on speed dial.”
“Lots of people do. It’s called being prepared.” Kinsey didn’t need to be in the room to deliver a proper chastisement.
“Sure, but most people don’t have the numbers for every single fire station in the damn state programmed into their phone.”
“You’re grouchier than usual. Something happen?”
Lilly bit back a soft sigh. Nothing snuck past Kinsey. Sometimes it really sucked being related to a shrink. “I had a run-in with Dante Morgan.”
A lengthy silence preceded Kinsey’s reply. “I knew I should have been the one to make the trip up there. You have no patience when it comes to Dante.”
“Yeah, well, this time it went way beyond stretching my patience.” Lilly’s grip tightened around the cell phone until it threatened to snap the device in two. “He’s a perverted peeping Tom. I’d report him to the sheriff if he weren’t related to the bastard.” That was the problem. In this neck of the woods, everyone was related to a damn Morgan.
“What happened?”
Keeping the graphic details to a minimum, Lilly filled her sister in on the
incident
.
It took a suspiciously long time for Kinsey to speak up. When she did, her voice sounded strained, as if she were having a hard time keeping her mirth reined in. “That must have been…um…embarrassing.”
“Yah think?” Lilly scowled. “And so help me, if the tiniest chuckle comes out of you, I’m hanging up.”
“Sis, I think you should talk this out. Leaving moments like that to fester will…” A smothered giggle trickled through the speaker.
Glaring, Lilly punched the End button and tossed the phone on top of her parka. Despite the relative coolness of the room, heat shivered across her skin.
Damn it.
The edginess was back full force. Of all the times to forget to pack her supplements. Hoping to track down a stray bottle somewhere in the cabin, she hurried into the small kitchen. Another flash of seductive warmth struck while she was rifling through the cupboards. Squeezing her thighs together, she tried riding it out, but the overwhelming sensation refused to be ignored.
Panting and sweating, she raced into the master bedroom. She struggled with her zipper, but before she even got a decent grip on the metal tab, an image of Dante Morgan’s annoyingly gorgeous face unexpectedly loomed onto her mental big screen. A warning tremble coursed through her clit seconds before an orgasm of magnificent proportions slammed into her. She cried out, her knees wobbling. Pinpricks of dazzling light swam in her vision as the intense waves shimmered throughout her body. She slumped on the end of the bed before her legs completely gave out.
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Gasping for breath, she rolled onto her back and stared at the ceiling. Hard to say which was more disturbing—experiencing the most mind-blowing climax of her life without actually touching herself, or having it happen with Dante Morgan invading her head.
Chapter Two
Hope Falls—the closest thing resembling a town in this Hicksville, USA wilderness—consisted of a post office, a grocery store and a bowling alley with a bar attached. The one and only time Lilly had ventured inside the bar, she’d witnessed a couple of local boys going at each other with bowling pins, proving once and for all that a fifth of Jim Beam, a full moon and redneck werewolves were a recipe for disaster.
She coasted into the grocery store’s parking lot and took the first cleared parking space she came across. Winding her scarf tight, she dashed toward the sliding doors. Inside the store, the PA system still piped Christmas music. Someone needed to tell the manager it was the freakin’ end of January.