Chapter 1: A Potential Solution to an Intractable Problem

Boxing Day, 2000, Chicago, Illinois

🎤 Steve

I sagged back in my chair, feeling a bit lightheaded, though it didn’t feel like a full syncopal episode.

“Shit,” Suzanne swore, jumping up from her chair.

“I’m OK,” I said, then took a deep breath and let it out.

“Jessica will kill me if I don’t tell her,” Suzanne said.

I knew it was useless to protest, and two minutes later a coterie of doctors swarmed into the room - Jessica, Mary, Al, Sofia, and Alejandra. Kara was with them as well.

“I felt lightheaded,” I said. “I hardly think I need FIVE doctors.”

“What happened?” Al asked.

Suzanne spoke up quickly, “I surprised him with something. I should have known better.”

“Al, I’ll take care of this,” Mary said. “Go back to your grandkids. You other doctors can go as well.”

“I’m staying,” Jessica said. “As the wife. Kara, stay, please.”

“I’m fine,” I protested.

“That’s for ME to determine,” Mary said firmly.

My father-in-law, Sofia, and Alejandra left, then Mary did a quick physical, including taking my blood pressure and checking my blood sugar.

“Everything is pretty much in line with your norms,” she said, putting her blood pressure cuff and stethoscope back into her black bag. “Your blood sugar is about what I’d expect given the carb budget I gave you. How long did you feel dizzy?”

“Maybe fifteen or twenty seconds,” I replied.

“And your last syncopal event was when you were on a 50 gram carb budget, right?”

“Yes.”

“Unfortunately, we don’t really have enough data points to plot a reasonable graph. You didn’t have any lightheadedness in South America, right?”

“As I told you in Rochester, and before that, on the phone.”

“You know the drill, Steve,” Mary said firmly. “And you know why we ask the same questions.”

“I do. But I also know I’m a reasonably good patient and that I’m completely honest with you, and that you know both of those things.”

“Gotta run the playbook!” Mary said with a soft laugh. “Is it OK to ask what Suzanne said?”

“I told him I had more than enough credits to graduate,” Suzanne responded before I could say anything.

“And THAT did it?”

“You know Steve - his brain instantly worked out what I was implying and that appears to have caused the reaction.”

“Adrenaline,” I replied. “I could feel it. Don’t ask me why THAT caused an adrenaline response, but it did.”

“You know,” she said. “we may have missed something obvious because everything seemed correct.”

“What’s that?” I asked.

“Adrenaline, because it binds to α-adrenergic receptors, inhibits insulin secretion by the pancreas, stimulates glycogenolysis in the liver and muscle, and stimulates glycolysis while inhibiting insulin-mediated glycogenesis in muscle.”

I chuckled, “In English, please?”

“Excess adrenaline plays havoc with carbohydrate metabolism. But you don’t have excess adrenaline, at least when we look at norms for men your age. But if your response to adrenaline is triggered by lower levels than the norms, that might explain a whole host of things. That said, the flip side is that if adrenaline binds to β-adrenergic receptors, it triggers glucagon secretion in the pancreas, causes adrenocorticotropin secretion by the pituitary gland, and increased lipolysis by fatty tissue.”

“That sounds like it would raise my blood sugar,” I said.

“Yes. Fundamentally, we can say that the combined effect would be increased blood glucose and higher levels of fatty acids, both of which provide the building blocks for energy production within your cells.”

“But you’re not seeing that.”

“Maybe we are,” she said thoughtfully. “If your condition is such that for some reason adrenaline, which is supposed to be a nonselective agonist, prefers α-adrenergic receptors to β-adrenergic receptors, that would explain everything. Well, except for WHY that’s the case. How far does your aversion to pharmaceuticals go?”

“Antibiotics, vaccines, and aspirin are all OK without question, and ibuprofen when aspirin isn’t a good idea; psychoactive drugs are off limits. Anything else is negotiable.”

“I’m thinking a very low dose beta blockers might help. The concern I have is that oral propranolol, which is what I’d suggest, is only effective for about ninety minutes. There are extended release versions, but I’d have to check to see if the dosages from those are appropriate. My concern is that it’s contraindicated for anyone with bradycardia, and your normal resting heart rate is right on the edge at 62 to 65 beats a minute. If you do take it, you’ll need to monitor your heart rate.”

“What’s it usually used to treat?” I asked.

“Hypertension and tachycardia, as well as PTSD and other anxiety disorders. It’s not psychoactive or mood-altering in the way you mean when you use that term. One of its main properties is that it’s an adrenaline inhibitor.”

“Side effects?”

“In typical dosages in patients with no previous history of heart attacks, the usual - nausea and constipation. But with the low dosage I’m suggesting, I doubt you’d see any side effects. If I’m right, then it’ll have a similar effect of being in a meditative state, but without shutting out the world.”

“I’m guessing there are restrictions that come with this drug,” I said.

“No alcohol, because it reduces the efficacy of beta blockers. No nicotine, in any form. And you should limit caffeine, but your current limits should be OK.”

“No bourbon is a pretty tough thing to accept,” I said. “As for nicotine, why do I have the feeling that you’d say that no matter WHAT drug you gave me!”

“Setting aside the cancer risk from smoking, nicotine is a stimulant, which is about the last thing you need. It’s a known vasoconstrictor, and can cause tachycardia and hypertension. So, we can dispense with the ‘smoking a few times a year is a reasonable risk’ argument because it’s not about that.”

“Swell. How will you know it’s working?” I asked.

“If you don’t have any syncopal events with the carbohydrate limits I gave you. But you haven’t had them even when you’ve exceeded the limits.”

“What about the mania?”

“If it’s operating similar to anxiety disorders, the drug might help in conjunction with Doctor Mercer’s suggestions.”

“What do you think, Jess?” I asked. “I promise not to turn stool pigeon and tell your dad, and nobody else here will!”

“I think it’s worth trying,” she said. “It’s unconventional, but then again, everything about you is unconventional!”

“Isn’t THAT the truth!” Mary said, causing everyone to laugh.

“Let me think about it overnight,” I said. “I’m leaning towards giving it a try.”

“OK. We’ll check the dosage available via time release, but I can’t write you a prescription in Illinois, so one of the doctors here will have to do it. It can’t be Jess or her dad for ethical reasons.”

“Alejandra practices internal medicine,” I said. “You can ask her.”

“She’ll need to examine you,” Jessica said.

“Been there, done that,” I said smugly.

“You dog!” Mary said with a laugh.

I shrugged, “All you need to do is get a license in psychology or psychiatry and you can read my journals!”

“I’d need my head examined!” she replied, causing everyone to laugh.

“Suzanne,” Kara asked. “Were you actually implying that you DID graduate?”

“Yes, and I realized about twenty minutes ago I should have said something to Steve when I first thought about graduating early, which was at the end of September. I meant it to be a surprise, which I guess it was, but not in a good way.”

“What’s your plan?” I asked.

“Unless I’ve totally messed up, I just planned to stay. I told my mom I was going to move to Chicago early. She thinks I’m staying with my dad, which I will, if it’s a problem.”

“You haven’t totally messed up,” I said. “But something this momentous should have been discussed. But we can do that later, without the audience.”

“Steve,” Mary said, “I want you to make an appointment with Alejandra. It needs to be at her office, not here, so that there are no questions about the script.”

“I’m sure she’ll accommodate,” I replied. “I’m not sure how Northwestern would handle something like that.”

“I’ll write a referral,” Mary said. “That’ll keep everything on the up-and-up. And I think I’ll leave you four and return to the circus!”

“Did anyone say anything to my dad?” I asked.

“No,” Suzanne said. “The doctors were all together except Jessica’s dad. He saw us and followed us in.”

“He would,” I chuckled. “Thanks, Mary.”

I stood, we hugged, and she left, closing the door behind her.

“You’re welcome to move in whenever you want,” I said. “I take it your mom is sending stuff from Colorado?”

“Yes. I brought clothes, my diary, my laptop, and a few other things, but she’s sending everything else. I’ll just let it go to my dad’s place in Lincoln Park rather than create any drama. I’m sorry for the drama I created here.”

“It was bound to happen sooner or later, with someone. At least in this case it actually might turn out to do some good. What do you plan to do for the next eight months?”

“I’m going to take two classes - Introduction to Computer Science and World Religions. They’ll count towards my electives, and I figured they’re critical to fulfilling my role.”

I nodded, “Wise. Shall we rejoin the circus?”

The four of us left the office and Alejandra came to me and we agreed that I’d see her in her office at Northwestern on Thursday. Unsurprisingly, the doctor activity hadn’t gone unnoticed by the two most observant individuals in the great room - my dad and my eldest daughter. I decided to tackle the more difficult conversation first. I went over to Birgit, took her hand, and led her back to my study.

“What happened?” she demanded to know, dropping my hand and putting her hands on her hips.

“I got dizzy,” I replied, knowing EXACTLY what she would say.

“How could they tell?” she asked with a smirk.

“Predictable as ever, Pumpkin,” I chuckled. “Doctor Mary thinks she has some medicine which might help. I’m going to see Aunt Alejandra on Thursday so she can write a prescription.”

“Why can’t Doctor Mary do it?”

“Because her license is from Minnesota, not Illinois.”

“Dumb!” Birgit declared.

“No, Pumpkin, it isn’t. Nearly all licensing is done at the state level, which is how it was intended from the beginning. The national government, what they call ‘federal’ in your social studies classes, isn’t supposed to have very much power. But we can discuss that later. I just wanted to make sure you knew I was OK.”

“Are you?” she asked, her eyes narrowing.

“Yes, I am. Suzanne just told me something that was a surprise.”

“That she’s moving here right away?” Birgit smirked.

“She told you?”

“I guessed! She was asking lots of questions about living here and it didn’t seem like she was talking about next Summer. Then you said she surprised you, and I guessed.”

“My daughter, the intelligence agent!” I chuckled.

“Well, if we’re talking intelligence, it’s not any of the BOYS in this house!”

“I love you, too,” I replied deadpan.

Birgit held out her arms in the way that indicated she wanted to be picked up, so I lifted her up and gave her the bear hug I was sure she wanted. She kissed my cheek and I kissed her forehead, then put her down.

“I love you, Dad!” she said. “Even if you are a boy!”

“Get out of here, you little turkey!”

She laughed and scampered from my study. I went to the door, signaled my dad, and he came over. I invited him in and shut the door behind us.

“Nothing critical,” I said. “Just a bit of lightheadedness. Mary suggested I start low-dose propranolol, which is a beta blocker. It inhibits adrenaline, so it might help with both the syncope and the mania.”

“Why not just stay on the zero carb diet?”

“First, Mary isn’t sure about the long-term effects of ketogenic diets, but it’s also the case that at some point, even that might not work to control the mania. If THIS works, then I don’t have to worry about the alternative that scares me.”

“The drug isn’t psychoactive?”

“No. The only concern Mary has is my low resting heart rate, so I’ll need to monitor my pulse.”

“What is it usually used to treat?”

“Hypertension, tachycardia, and anxiety disorders.”

“It was your adrenaline response that set off the entire investigation, right?”

“Yes. Maybe they could have tried this back then, but nobody had any idea exactly what was going on. Well, they don’t now, either, but they have a better idea than they had.”

“Do you still plan to take it easy?”

“Yes. Right now I’m thinking of working from home three or four days a week. I don’t want to disappear completely from the office because I think that would be bad for morale. Working from home lets me be more flexible with my hours and go to the dojo during the day. I’ll also figure out what I’m going to do spiritually, but the most likely thing is just personal meditation. I don’t have much use for organized religion.”

“You know my take on that!”

I nodded, “I do, but you know my position on atheism.”

My dad smiled knowingly, “I do.”

“When will you start taking the medication?”

“After I see Alejandra on Thursday. Mary can’t write the prescription, and having Jess or Al do it puts them in a potentially difficult situation if anything were to go wrong.”

“Keep me informed, please.”

“I will. I still need to speak to Beth and Karl, but at least now I have something concrete to tell them. Shall we go back to the madhouse?”

Dad laughed, “With all my concerns about your choices years ago, I have to say I’m pleased with how things have turned out. The grandkids are all wonderful young men and women, and really, that says it all.”

“Thanks.”

We left my study and I spent time with family and friends. By 10:00pm, everyone had left for the evening, and after getting the kids to bed, I said ‘good night’ to Kara and Jessica, and then Suzanne and I went to her room.

“What deep, dark fantasy of yours can I fulfill?” she asked.

I chuckled, “Find twelve virgins to act in Abbie’s movie!”

Suzanne laughed, “So much for calm and relaxing!”

“Probably not a good idea for a host of reasons,” I replied.

“Why? If the girls are all over eighteen you can fuck them on camera and nobody can do a thing about it!”

“You don’t think that’s more than a bit over the top?”

“Abbie wrote the screenplay for you! You tell me!”

I chuckled, “You can ask her about it tomorrow when she and her family arrive.”

“So, any other deep, dark fantasies?”

“I think most guys would say my entire life was a fantasy! How about your fantasies?”

“You fulfilled that when I got to watch you deflower Cheryl! Before I forget, when will Leigh be here?”

“Sunday, for the party. I have rubies for her, too, though I know she might have to wait to wear them until she graduates so there aren’t any problems at home. Before I forget, I think I might have a male candidate.”

“Oh?”

“You remember I told you about Jackson? He’s shaping up very nicely.”

“How did things go with Holly?” Suzanne asked.

“She decided to go for eleven, plus the bonus points that only girls with decent-size breasts can earn!”

Suzanne laughed, “Not happening here, though if cumming on my face turns you on...”

“It’s really more of a question of what turns YOU on!” I replied.

“Let’s do some experiments to check!” Suzanne offered.

“That’s the best idea I’ve heard all day!” I agreed.

December 27, 2000, Chicago, Illinois

🎤 Birgit

“You are all mine today!” I declared, climbing into the chaise next to my dad.

“That was our agreement,” Dad agreed.

I snuggled close and breathed deeply, loving the smell of Dad’s deodorant and soap. He tightened his arms around me and I purred because of how big and strong he was, and how safe I felt in his arms. Someday, I would ask for what I really wanted, but it wasn’t time. But that didn’t mean I didn’t think about it.

“What are we doing today?” Dad asked after about five minutes.

“Cuddling would be just fine!” I giggled.

“If that’s what you want, we can do that.”

“Maybe we can watch some DVDs? I got Runaway Bride, My Best Friend’s Wedding, Pretty Woman, and Steel Magnolias for Christmas!”

“Ugh. You know what I think of Julia Roberts!”

“And you know what I think of her! You promised we’d do whatever I wanted today!”

“I did,” Dad agreed.

If only! But not yet. Maybe when I was fourteen or fifteen and looked like a woman!

“Will you make breakfast for me?” I asked. “And lunch? And take me out to dinner?”

“If that’s what you want, Pumpkin.”

“It is!”

“Where did you want to have dinner?”

“Well, we have to go someplace that serves food that you can eat.”

“Pretty much any restaurant, even Connie’s, has salads, and you know I like salads. Or Chinese or Japanese.”

“Japanese!” I declared.

“Then we’ll go to Takumi. The waitresses all wear kimono.”

“Cool! Are you really OK, Dad?”

“Yes. What I said yesterday is totally true. I promise. You can ask Aunt Alejandra after my check up tomorrow if you want. And you can ask Doctor Mary.”

“May I ask a nosy daughter question?”

“Have I ever been able to stop you?” Dad asked.

“No!” I giggled. “You and Aunt Alejandra...”

“Yes, before she met Trent.”

“And did you meet the girl in Argentina?”

“I did.”

“And?”

“What do you think, nosy daughter?”

I giggled, “I think you made her very happy! Just like Rachel! Her mom is such a bitch!”

“Pumpkin, please don’t use that word. Rachel’s mom is just having trouble dealing with Rachel growing up. That’s kind of normal.”

“Including you and Mom and Mom? And Aunts Elyse, Jennifer, and Josie? And the cousins’ parents?”

“Let’s just say sometimes we have to convince each other that we’re doing the right thing. That’s especially true where sassy young women are involved!”

“And boys? Hmm?”

Dad chuckled, “Boys are different.”

“No kidding,” I replied dryly. “And brothers are the worst!”

“I thought you and Jesse got along now.”

“We do! But that doesn’t mean he’s not a dumb boy! Besides, he has Libby to help him not be as dumb as boys usually are!”

“Is that what you think Bethany did for me?”

“No. Well, if she tried, it sure didn’t work!”

“Excuse me?!” Dad protested.

“What did Katy say? ‘Your dad got laid a lot despite being a dumb boy, not because he was one’!”

“Katy and I are going to have words!” Dad declared, pretending to be upset.

“It’s not MY fault all your women are smarter than you are!”

“Including you?”

“Obviously!” I giggled. “But you know I love you, Dad!”

“One of these days, Pumpkin...”

“Uh-huh.”

We cuddled for another ten minutes before we went to the kitchen so Dad could make breakfast for us. After we ate, we cleaned up and then went to the great room to cuddle on the couch and watch movies until lunch. After lunch we watched more movies cuddled together, and then we went upstairs to our rooms so we could change for dinner. I decided to take a quick shower, then put on lavender body spray, which I knew Dad really liked, put on my cutest dress, put in my earrings, and then went downstairs to find Dad.

He was waiting in the foyer, and looked super handsome in his black, long-sleeve shirt and black slacks. We put on our heavy coats, our hats, and gloves, then went out the back door. He opened the passenger door of his BMW for me, as if I were his date which made me feel really special. Of course, any time I got to spend with my dad was really special. And this day, he was all mine!

The restaurant was totally cool, with low tables like the one Dad had in his office, and all the waitresses looked really nice in their fancy kimono. The food was really yummy, and when we finished eating, Dad took me to Oberweis so I could get ice cream. I felt bad that he couldn’t have any, but I’d never heard Dad complain about not being able to have sweets. I was sure if he did, it was private with my moms because he wouldn’t want us kids to know it bothered him because he was afraid we might feel bad. After ice cream, we went home and I got more cuddles before bed.