He knows—a better word is believes—that his amnesia is a medical matter beyond his control, but he senses that it’s also somehow a choice he has made.
This line furthers the question of how much of his current situation is Fate at work——a “medical matter” over which he had no control——and how much is free will, a “choice he had made.” Why would anyone choose amnesia? Would you? What event in the past would have been so traumatic as to make him want to have his entire past scrubbed from his mind? Both as a writer and reader, I want to find out.
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