Chapter 17: Pure, unadulterated bovine excrement!

February 11, 2001, Rochester, Minnesota

🎤 Steve

Naomi Blom was waiting for me when I walked into the arrivals hall at the airport in Rochester. We greeted each other with a hug, then headed for her car.

“Thanks for putting me up for two nights,” I said.

“I thought it was silly for you to pay for a hotel when I have a comfortable apartment.”

“You’re making a bold assumption.”

Naomi laughed, “No, I’m not. You would have rejected the offer I made in December and made a hotel reservation if you didn’t want to sleep with me.”

“It is possible I changed my mind on the way here.”

“If I recall correctly, you have a serious thing for red pubic hair, which I have!”

“Busted,” I chuckled.

“Not to mention your obvious enjoyment of my virtuoso performances on the skin flute!”

“You had me at ‘red pubic hair’!”

We got into Naomi’s Honda and she drove us to her apartment where she had me put my bag in her bedroom and then invited me to have a snack of mixed nuts and lemon-flavored sparkling water.

“How did you manage two nights off in a row?” I asked.

“I traded with a second-year with whom I’m fairly close. We traded last month when she needed a night off. Little did she know she could have extracted WAY more from me for tomorrow night!”

“I’m that good?”

Naomi smirked, “Any port in a storm?”

“I believe it’s my ship which will dock in your port!”

Naomi laughed, “You didn’t even blink at the backhanded insult!”

“Trust me, you are in the minor leagues when it comes to insulting me! My eldest son and eldest daughter are the champs at that, followed closely by my office mate!”

“Female, of course.”

“Of course.”

“Are you fucking her?”

“Against the rules.”

“That’s not what I asked.”

“No, I’m not. She and I had a thing when I was in college and she was in High School, but she decided working for me was a better option because she couldn’t handle my lifestyle.”

“Your harem, or whatever you want to call it?”

“Yes. It’s one thing to be in, say, your position, where it’s a love affair, it’s another thing to be in Kara’s or Jessica’s position where it’s a permanent state of affairs.”

“Cute play on words! I don’t think I could handle that long-term, or even short-term, really.”

“That’s a fairly common reaction. I only know one other set of three people who are in a permanent relationship, though I don’t really know the inner-workings of their relationship, just that two of them are married and there’s a third person permanently part of the family.”

“So not like yours where you try to make it a true three-way marriage?”

“No idea, and they’re private about it and I’m not one to ever ask.”

“You aren’t curious?”

I shook my head, “No, not really. I figure if they want me to know, they’ll tell me. Otherwise, I just accept it and move on with life. It turns out that makes things a LOT easier. The more people who mind their own business, the better off we all are. Period. We actually talked about that this afternoon during what we call our Rap Sessions; I think I told you about them.”

“You did. Basically two hours or so of philosophy on alternate Sundays. Was that the topic?”

“No, it was mainly about the infantilization of teenagers and the use of ‘moral panic’ to pass laws which make it difficult for kids to actually grow up and gain experience, and which, perversely, actually puts them in more danger.”

“How so?”

“On the ‘more danger’ part - the moral panic over ‘stranger danger’ has ensured kids are kept inside or under constant surveillance by adults they’re related to or know. Guess where the vast majority of abuse happens and who the vast majority of abusers are?”

“I don’t have to guess; I know. It’s family and friends.”

“So we’re insisting kids spend MORE time in the places they’re most likely to be abused and with people who are most likely to abuse them. Another argument is that kids might be kidnapped. Care to guess the ratio of custodial dispute kidnappings to stranger kidnappings?”

“It has to be insane.”

“A few dozen stranger kidnappings of kids under 21 each year versus something on the order of a hundred thousand parental kidnappings. So, who’s the REAL danger?”

“The non-custodial parent, obviously; not the stranger.”

“Exactly. So, all the panic is actually for nothing, but because people were whipped into a frenzy by a few outlier cases, kids are being severely harmed by not being able to experience the world or grow up properly. And they’re being taught that being outside, in public, is dangerous and they need to be fearful at all times. It’s BS.”

“What about rape? That’s a real threat.”

“And again, usually perpetrated by someone the victim knows - boyfriend, girlfriend, date, or relative. The rates for 1999, which are the latest ones I have, show that the number of rapes each year is about 1 for every 10,000 people. That would mean Rochester would average about eight rapes a year, and of those only two would be by a stranger. Of the remaining six, one would be a non-spouse relative, three would be by a friend or acquaintance, and two would be by a current or former partner. Those are the cold, hard facts which go against the moral panic.”

“What about unreported rapes?”

“They happen, and it wouldn’t surprise me if the number of unreported rapes was much higher than the number of reported rapes, but I suspect the ratio is about the same, if not even more tilted against strangers and towards acquaintances.”

“I never thought of it that way.”

“Because the news media, politicians, political activists, and the control freaks make sure they give a consistent message which drowns out the truth. Of course, it’s also the case that people are very bad at statistics and also are easily swayed by emotional appeals rather than logic. And THAT is what has society so fucked up. And it’s going to be even more fucked up in the future, which is what my little band of subversives is trying to prevent, or at least attenuate. Everyone in the group does their best to counter the bullshit as they go about their lives, both at work and in their relationships and public and private encounters.”

“I think I know you well enough to know the answer to this question, but how do you deal with your kids?”

“I let them do as much as I think I can defend against the insanity which is DCFS, the school system, and the general stupidity of adults. For the youngest kids, an adult walks to school with them but keeps enough distance so the kids can be unsupervised while appearing to be supervised. That keeps the school and busybody parents off our backs. My kids, and most of their friends, are allowed to walk or ride their bikes to their friends’ houses. Mostly we don’t have any trouble, but there are a few parents in the neighborhood who freak out if fourteen-year-olds are allowed out unsupervised.”

“Seriously? Chicago must be WAY crazier than Rochester. Nobody here would call Family Services or the police if a fourteen-year-old was outside alone. Heck, I doubt they’d do it for a twelve-year-old.”

“It’ll spread,” I said. “We’ve already had a case where DCFS claimed neglect because a seven-year-old was hurt, not badly mind you, while being watched by a twelve-year-old, despite the twelve-year-old calling 9-1-1 and doing everything right. They went after the parents and removed the kids from the home. I can’t even COUNT the number of times I was left home alone after age twelve, and with two younger siblings. I had friends who babysat at fourteen, but now DCFS is saying that fourteen is too young to babysit, though they aren’t actually doing anything to stop it. For now.”

“You talked about all this today?”

“Yes. It was most interesting because we have a budding subversive who’s a teacher in the Chicago Public Schools. She just doesn’t realize she’s being turned into a subversive as yet!”

“Those sound like fun!”

“Come down with Don and Mary for a three-day weekend sometime when we have one. You’re more than welcome.”

“Meeting your kids would be awesome, based on everything I’ve heard from Mary.”

“They are a force of nature, that’s for sure! And a lot of fun.”

“Speaking of fun, care to go to bed with me?”

I put down my glass, took her hand, and led her to the bedroom.

February 12, 2001, Mayo Clinic, Rochester, Minnesota

“I need you to take me through everything that happened last Thursday,” Mary said after we greeted each other on Monday morning.

“Starting with what?”

“When you went to bed the night before. I assume your food diary is up to date?”

“Yes,” I replied, handing her a floppy disk. “The Reader’s Digest version is that I followed your diet prescription to a ‘T’ and took my medication at the usual times on Wednesday and Thursday - 6:00am and 6:00pm. Kara, Jessica, and I were in bed at 10:30pm.”

“Sexual relations?”

“No.”

“Is that normal?”

“We don’t have sex every night, Doc! Most, but not every!”

“I could leave this to Clara’s session tomorrow, but I’ll ask - is there a reason?”

“Last night both wives just wanted to cuddle.”

“How did you sleep?”

“Just fine. When I woke up on Thursday morning I felt good. I ran, showered, cuddled Birgit, then had breakfast. After breakfast, I worked until noon, then had lunch. After lunch, I worked for a few hours, then had my Thursday Afterschool Special.”

Mary rolled her eyes, “Please tell me she’s over the age of consent.”

“Eighteen. Anyway, we were just about to leave the sauna when Jesse burst in to tell me that Francesca, who was his girlfriend from the time he was a toddler, had run away from home in Iowa to come to see him. I was stunned for a second, put my hand on the doorframe to steady myself, but recovered quickly. Jesse said I went pale, and I’m sure he was right.”

“What were you thinking at that exact moment?”

“About the swarms of police and federal agents who were going to descend on the compound because Francesca’s mother is completely unhinged.”

“Trying to protect her daughter’s virtue?”

I chuckled, “Said daughter disposed of said virtue willingly and repeatedly before her mother whisked her away to Iowa.”

“Like Father, like son! Speaking of which, I was thinking of inviting Joy for dinner on Wednesday evening just to tease Jesse.”

“The cute candy striper who brought me flowers?”

“Yes. I know her parents very well, so it won’t be any trouble.”

“Go for it,” I chuckled. “Are you going to have him do a fasting blood sugar?”

“Yes, but not a glucose tolerance test. If he has even a mild version of what you have, I don’t want to trigger anything.”

“This would toss out your ‘X’ chromosome theory.”

Mary nodded, “It might. Your dad has no current health problems other than his hip replacement. That doesn’t prove anything one way or the other, but it could be that we’re dealing with some sort of mutation.”

“I know quite a few people who think I’m a mutant!” I chuckled.

“I’ll file that under ‘not news’,” Mary said with a smile. “If I recall correctly, your dad has no living close relatives.”

“None that he’s ever spoken about.”

“Did you do your regular blood sugar testing?”

“The results are on the floppy, but they were normal for me.”

“On a scale of one to ten, compared with your other syncopal episode, how would you rate this one?”

“I suppose I’d call it a two, because I had to steady myself for a few seconds.”

“Weak knees? Queasy stomach?”

“No. Just a dizzy feeling and the pallor Jesse observed.”

Mary was quiet for a moment, “We may be chasing a false positive because what you had is actually a standard fear response, which you said is what you were thinking. Add in the cool air which would have hit you when the door opened, and that could explain it. Go back a bit - had you been active, or just sitting in the sauna?”

“We’d actually been sitting in the whirlpool.”

“You got up, went towards the door, then got hit with cool air and Jesse’s revelation almost simultaneously.”

“Yes.”

“What I really need is full blood work from that instant, but we’re never going to catch a spontaneous moment like that. I think, assuming everything checks out today and tomorrow, we’ll continue with the current plan until the end of March, then evaluate if the proposed plan for after that is a good one. I’ll also have a full set of workups on Jesse as well. I don’t plan a psych eval for him. If we need one, he can see someone in Chicago.”

“You’ll need approval from his moms for that. I’d agree, but they have the final say.”

“Would they object?”

“Most likely not, but they would be very upset if they didn’t have a say in the matter.”

“You didn’t observe Jesse’s incident, did you?”

“No. He told me about it, but I didn’t see it.”

“OK, then I’ll wait to speak to him. My working theory for him is that it’s typical teenage syncope, which fits if he has your low blood pressure. For now, let’s get your exam started.”

“New medical student, right?”

“Yes. The endocrinology clinical rotation is eight weeks.”

“How did Laurent do?”

“I gave him top marks. He just needs to work on being a bit more forceful, though I have to say, our profession could use a bit more politeness.”

“And the new student?”

“About as polar opposite as you can get! A young woman from Kentucky horse farm country who is more blunt and direct than you are, and has zero tact! She’s also very casual - too casual for my taste.”

“This should be fun,” I chuckled.

“Lesbian.”

“So?”

“Sorry. I assumed your response ... never mind. It was a bad assumption. And I shouldn’t have said anything about her orientation.”

“Doc, you know it’s a non-issue for me. I’ve spent the last twenty-five years with a lesbian who was confused about her orientation for the first ten years or so. Jesse is the result of that relationship.”

“I know. My mind just went someplace it shouldn’t have.”

“Don’t sweat it. My history indicates that my mind often goes where yours did! What’s the budding doctor’s name?”

“Gloria.”

Mary dialed a pager number, entered a code, and then we left her office to go to an exam room. Gloria came in a moment later and Mary introduced us.

“Mr. Steve Adams, Gloria Macdougal; Gloria, Mr. Steve Adams.”

“Hi,” Gloria said casually.

I knew the protocol was to address patients formally, by the surnames until the patient gave permission otherwise, but even in some instances, the formality was to be retained. Mary had given the formal clue by using ‘Mr.’ in addressing me and Gloria had either missed it or ignored it.

“Good morning, Gloria,” I replied.

“Gloria, Mr. Adams has given consent for you to fully participate today. You’ve observed for the past week, but now you’re going to take your first complete medical history.”

“OK,” Gloria replied.

Suddenly, I missed Laurent’s formality, as Gloria’s responses bordered on disrespect. I was sure she had excellent grades and had done well on her USMLE, because otherwise, the only way she’d have been allowed into Mayo Clinic was as a patient. By rough guess, the rotation at Mayo would be her fourth or fifth, and I wondered what she’d done for her previous rotations. Gloria picked up a clipboard and began asking the usual set of questions. I played it straight, although I didn’t volunteer anything she didn’t ask. She actually did a better job than Laurent in sussing out my condition. Once she finished, she looked over a chart Mary handed her.

“Scale, please,” Gloria said tersely once she’d flipped through the pages.

In another context, with another student, I’d have been tempted to sing, slightly off-key of course, ‘Do ... re ... mi ... fa... ‘, but this was neither the time nor place, nor was Gloria the right medical student. Instead, I removed my shoes and belt and stood on the scale. She adjusted the weights, then used the slidable arm to determine my height.

“I believe a physical exam, complete blood chemistry including electrolytes, a glucose tolerance test, and an EKG are in order,” Gloria said.

“Did you look at the chart?” Mary asked.

“Yes.”

“Look again, please.”

She did.

“This makes no sense,” Gloria said. “If he has what amounts to a sugar metabolism condition that presents as diabetes, a complete glucose panel including a tolerance test is absolutely indicated.”

“What do you think will happen if we do that, based on the history you took and the information on the chart I handed you?”

Gloria spent five minutes looking over it.

“Well, it might mess up his metabolism for a few days, but the results are important to a formal diagnosis of some form of diabetes.”

“Except he doesn’t have diabetes or anything like it. Look at page two, about halfway down the page, and read the notes.”

“I saw that, but the differential diagnosis IS diabetes or pre-diabetes until it’s ruled out. The chart doesn’t rule it out.”

“Actually, it does,” Mary replied. “His glucose and A1C numbers are consistently low, not high. What does that tell you?”

Gloria frowned, “None of this makes sense. Is this a fabricated chart meant to trick me?”

“Everything in that chart is accurate and has been consistent for several years. I purposefully didn’t give you a full medical history, just the results from the previous two rounds of tests.”

“That’s hardly fair!”

I groaned and shook my head.

“Do you honestly believe you’ll always have every bit of information when diagnosing a patient?” Mary asked. “And do you believe that every patient fits the differential diagnosis system?”

“Well, at medical school...”

“Forget medical school,” Mary interrupted, sternly. “You have an actual patient in front of you with an actual condition for which we do not have a diagnosis, only symptoms and theories. When you get to the bottom of the flowchart for possible diagnosis, THAT is where research starts. On the first page of the chart, what’s shown under ‘diagnosis’?”

“All zeros. I figured that was so I had to work it out myself.”

“You assumed. And that is the first step to a failed diagnosis and incorrect treatment. If I wanted to obscure it, it would have been blank or blacked out. All zeroes is the code for a condition which has no code. Look at the chart and your history notes, and tell me what would happen if we ran that test. And think about it, this time.”

Gloria was quiet for a few minutes as she looked through her notes as well as the chart.