 Eventually, Tenma reveals her feelings to Karasuma, but before she can get a reply he contracts a rare disease which causes memory loss to both his long-term and short-term memory.In chapter 273, Far and Away, before he completely lost his memory, he saw an illusion of Tenma and confess his love to her, that he had always loved her and promised himself that looking at her is just fine because he doesn't want her to be sad, but he couldn't keep the promise of him not falling in love with her.Tenma wasn't able to hear Karasuma's confession and decided to stay in the U.S. to become a doctor to cure Karasuma and hope he can remember about her and 2-C class.