Chapter 13: Syncope

September 25, 1994, Amsterdam, the Netherlands

“Steve? Steve?” I heard Karla say through the fog that clouded my mind.

Fortunately, when my knees had gone weak and my head had spun, there had been a low wall just to my side. I’d sagged onto it just as my knees would have given out. I fought the effects by doing my best to regulate my breathing and allow the adrenaline surge to run its course.

“Steve?” Karla said, now sounding very worried.

“I’m fine,” I said slowly.

“You almost passed out. I think we should call for an ambulance.”

I shook my head, as much as to clear the cobwebs as to say no.

“I know what’s wrong,” I said. “Just give me a few minutes.”

“Are you sure? I think you need a doctor!”

I laughed softly despite the fog in my head, “I have plenty of doctors back home, I’m not sure I need another one.”

“You have a serious illness?” she asked.

“I have something wrong, but the only way they’ll know for sure what it is will be when I die.”

“You’re dying?!” she gasped, then wailed, “Oh no!”

“Everyone is dying,” I said lightly. “From the time you’re born, every day brings you one day closer to your death. Will you sit down, and let me explain? Please?”

She sat down on the low wall next to me, and took my hand.

“What is it that’s wrong with you?” she asked.

“I have some kind of problem with how my body processes adrenaline. In certain circumstances, the adrenaline rush causes a momentary short-circuit and my heart skips a couple of beats and my breathing stops. But it always kicks right back in. Always. Sometimes I pass out, other times I just get weak in the knees and my head spins. This morning, it was minor, this time, it was moderate.”

“Because I asked you that question?”

I nodded, “Yes. I can’t totally explain it, and neither can half-a-dozen doctors at the University of Chicago and a few more at the Mayo Clinic. They THINK it has to do with my hypothalamus; some kind of congenital defect. You know, something you’re born with. I need to call my doctor and talk to him.”

“Are you sure you shouldn’t go to the hospital?”

“Yes. They won’t find anything and I’ll end up being there a couple of days while they try to figure it out and get my medical records from Chicago to ensure I’m actually OK. And they’ll shrug their shoulders and let me go because they won’t find anything. I just need to get back to my hotel room.”

“I’ll walk with you,” she said. “I’m worried you might hurt yourself.”

“That has happened before,” I said.

“Then come on, I’ll walk with you.”

“Thanks; I’ll pay for a taxi to take you home,” I said.

“Can you walk?” she asked.

“Give me a couple of minutes, please.”

We sat for about ten minutes while my head cleared and my legs steadied. When I stood, Karla put her arm around my waist and I reflexively put my arm around her shoulder. I realized what I’d done, but felt she was doing the right thing to be safe. It took about twenty minutes to get back to the hotel. In the lobby, I dropped my arm from her shoulder and she removed hers from my waist.

“I’m going to go call my doctor,” I said.

“Maybe I should wait until you’re sure everything is OK.”

“Karla...” I said gently.

“I’ll wait here, in the lobby. You can come down and tell me you’re fine. OK?”

She was making sense, and if I DID have to go to the hospital, having the person who saw the near-syncopal events with me made sense.

I nodded, “OK. It may be twenty minutes.”

“It’s OK.”

She sat down in a chair in the lobby and I went to the elevator and rode it up the eighth floor and walked to my room. I was feeling OK, but I knew I needed to call Al and talk to him. I probably needed to call Jessica, too. I checked my watch and saw that it was about 2:00am, which meant it was 7:00pm the previous day in Chicago. I took out my AT&T calling card and dialed Al’s cell phone.

“Al Barton,” he said.

“Hi Al, it’s Steve.”

“Steve? Where are you?”

“Amsterdam,” I said. “I had two near-syncopal events in just over twelve hours.”

“Damn it! Hang on, let me get back into my study. I was just leaving the house.”

It was about thirty seconds later when he asked me to tell him what happened, which I did.

“So,” he said when I finished explaining, “two events, the second worse than the first, because you were completely surprised by something someone said?”

“In a nutshell, yes.”

“But not shocking or horrible news?”

“No.”

“How did you react to the news about Rob and Charlie, well, what you thought was the news?”

“I didn’t have any effects.”

“So the shocking news didn’t affect you and the surprise news did? Something doesn’t add up.”

“You’re telling me!” I chuckled.

“What’s changed?”

“I’m exercising and doing my kata every morning. I ran in Hyde Park in London and in Vondelpark here. And in both places, I’ve done a lot of walking.”

“Diet?”

“Lots of potatoes,” I said.

“Hmm. When was your last near-syncopal event? Japan, right?”

“Yes.”

“And you were eating a lot of rice then.”

“That’s true. Do you think there’s a link?”

“I know of no physiological link, and I know correlation doesn’t imply causation, but I would be remiss if I didn’t suspect some link between your hypothalamus, your blood sugar, and your mood swings. That has to be it. I know I’ve talked to you about your carbohydrate intake, but it was always in relation to the mood swings. Maybe, just maybe, there’s something messed up with your brain chemistry that is related to changes in your blood sugar. You’ve always had low blood sugar, right? Not just as an adult.”

“Yes, that’s right. It’s always been near the bottom of the scale, almost to where it would become hypoglycemia.”

“Which, I think, may be why you always drank soda. You didn’t realize it, but it was a form of self-medication. If your blood sugar dropped too low, you felt lethargic and drank sugar water with caffeine to pick yourself up again.”

“Now that you mention it, that sounds right.”

“How do you feel right now?”

“OK, I guess.”

“I’m a bit worried about the two events so close together. I’ll give you two options. Check yourself into the Academic Medical Center at the University of Amsterdam, or have someone stay with you for the next day or so. When do you fly to Munich?”

“Tomorrow afternoon,” I said.

“Is there any chance of delaying that until early on Monday?”

“I suppose.”

“Do that, please. And don’t be alone until Monday morning. Or check yourself in. I can call the hospital and talk to someone. There’s a doctor I know in trauma there who can grease the skids.”

“I do NOT want to check into a hospital, Al!” I protested.

“Do you have a friend, co-worker, or someone like that you can call?”

Oh, I did, and there was an obvious answer seven floors below. But the very suggestion Al was making risked bringing on a third near-syncopal event! I wondered how Hans would react to a call in the middle of the night, and decided he’d probably be OK. I’d need Karla to stay until he arrived, but we could easily sit in the lobby and wait, assuming she was willing.

“Yes; a Dutch guy named Hans who I made friends with in London. He works for one of the two companies I’m working with.”

“OK. Call him. But wait for him someplace public, preferably where you can tell someone what to watch out for. Speaking of which, what did the person you were with say happened?”

“I didn’t ask, actually.”

“Are they around? Can I talk to him? Or her?”

“Is that necessary?” I asked.

“Who’s the doctor here?” Al said sternly.

“OK. Let me call you back in five minutes. I promise.”

“Do that,” he said.

I was fairly sure there was a payphone in the lobby, and that would prevent any misunderstandings, so I left the room, and went down to the lobby where Karla was waiting.

“My doctor wants to talk to you. He’s going to ask some questions about what you observed. OK?”

“Yes, of course.”

We walked over to the pay phone and I placed the call.

“Al, you’ll be speaking to my friend, Ms. Karla Timmer. She was with me all evening. I was walking her from the bar to her tram to send her home when I had my event.”

“OK. Did she also witness the first one?”

“Yes, yesterday when she came by to go to lunch.”

“OK. Let me speak to her.”

I handed Karla the phone.

“This is Doctor Al Barton,” I said to her, “Head of Emergency Medicine at the University of Chicago Hospital.”

She said ‘hello’ and I listened to half the conversation, and was able to deduce most of Al’s questions from Karla’s answers. I was VERY thankful for her discretion.

“No; I just said something that surprised him ... no, it’s really not important ... I’d rather not.”

Knowing how well Al knew me, I was sure he could guess the topic, but I doubted he could discern exactly what was said, and I had said that I was walking her from the bar to her tram. The conversation continued, and it was interesting to hear her describe the look on my face, my eyes, and my other physical reactions. They more or less matched what had been said about them in the past.

“Yes, Doctor. I will. No, it’s OK. Yes. One moment.”

She handed me the phone.

“Hi, Al.”

“OK. It sounds like you were lucky that second time. You could easily have fallen.”

“I know. But I didn’t.”

“All the same, I’m still worried. I’d prefer you went to the hospital, but I know you well enough that you won’t. Call your friend, please.”

“Thanks, Al. I need to call Jess and let her know.”

“Yes, you do. Tell her I OK’d you staying with someone. Otherwise you’ll get no end of grief.”

“You’re a pal, Al!” I chuckled. “Thanks.”

“One more thing,” he said. “Please don’t run tomorrow or Monday. Take it very easy, and call me from Munich. We’ll decide what to do then.”

“OK.”

“And I want you to go as close to zero carbohydrates as possible until you get home.”

“Got it,” I agreed.

We said ‘goodbye’ and I hung up.

“I need to call my friend Hans to see if he can come stay with me.”

“Don’t bother him; I can stay. Doctor Barton said I needed to stay with you until someone came, but I’m here and your friend would have to come from wherever he lives and that might be a few hours. We planned to spend tomorrow together, too.”

“But...” I protested.

“Forget that, OK? We can worry about it after you get some sleep. I’m concerned about you.”

“OK,” I said, acquiescing. “I need to make two more phone calls,” I said. “But I’ll do them from upstairs. I guess you can come up.”

We walked to the elevators and went up to the eighth floor and into my room. I went to the desk and made a call to the house. Elyse answered and I asked for Jessica.

“Hi, Babe,” I said.

“Tiger? This is a surprise. Isn’t it really late?”

“I had two near-syncopal events today, just over twelve hours apart. I just got off the phone with Al Barton. He’s concerned, but said I should be OK. He advised I have a friend stay with me.”

“Two? That close together? What happened?”

“The details aren’t important right now,” I said out of deference to Karla. “But Al strongly suspects a relationship between the problem with my hypothalamus, my blood sugar, and my mild bipolar disorder. I ate a lot of potatoes in the last week. Just like that one event in Japan when I’d been eating a lot of rice.”

“But there’s no physiological link!” she protested.

“Al said the same thing, but guess what? The evidence points to it. I’m a freak of nature, you know that!”

My silly comment had the desired effect, and Jessica laughed.

“Yes, you are! And this friend who is going to stay with you is female, right?”

I chuckled, “Good call, but it’s not like that. I’ll explain later.”

“She’s there?”

“Yes.”

“Have fun, Tiger!”

“As I said, it’s not like that.”

“It’s always like that,” Jessica laughed. “I’m going to call Doctor Barton and confirm. OK?”

“Yes, of course. I’ll write it in my health file, too. Also, Al asked me to change my flight, so I’m going to do that now.”

“To Monday?”

“Exactly.”

“Call me if anything happens.”

“I will.”

We said our ‘goodbyes’ and I hung up. I immediately dialed the emergency number for the travel agency and had the person who answered rebook my flights. Because I had purchased business class tickets, it was a simple matter of ensuring there was an available seat on the 7:00am flight on Monday, which, fortunately, there was. I had them rebook the flight, then hung up and dialed the reception desk and asked to extend my stay until Monday morning. That wasn’t a problem either, and with everything set, I replaced the receiver.

“Your wife is a doctor as well?”

“Yes.”

“You should get to bed,” Karla said.

“What about you?” I asked.

“Your friend the doctor said I need to make sure you fall asleep. Then I can get some pillows and sleep on the couch. It’s OK.”

Normally, I would have argued with her, but until we had a chance to talk, I wasn’t going to do or say anything that might cause trouble.

“OK,” I said.

I went to the bathroom, brushed my teeth, then came out and got a pair of shorts and a t-shirt. I went back into the bathroom and changed, then got into bed. Karla turned off all the lights except a dim desk lamp, I closed my eyes, and I fell asleep fairly quickly.

When I awoke, I saw it was 8:00am, and the only light in the room was a single, dim shaft that leaked through the ‘blackout’ curtains. I saw Karla’s shadowy form on the couch, and as she was sleeping, I took stock of how I was feeling. My head was clear, and despite having less than five hours of sleep, I wasn’t feeling tired. My breathing and heart rate were good. One thing I did need was the bathroom, so I quietly slipped from the bed and went into the bathroom. I emptied my bladder and washed my hands, and when I came out, Karla was sitting up.

“How are you feeling?” she asked.

“Fine. Thanks for staying.”

“You’re welcome. What do you want to do?”

“Well, we need to eat something, and you’re going to need fresh clothes. How about I order room service for us, and then we can go get you some clean clothes and you can freshen up.”

“OK.”

I checked on what she wanted to eat, then called room service and placed an order. I was very specific that there was to be absolutely nothing except what I ordered with my meal. I knew I could just not eat it, but I hated wasting food, and I was going to follow Al’s instructions to the letter. The last thing I needed was to end up in a hospital in Europe and be unable to finish my business trip or have trouble flying home because of medical clearance. I knew I had an out, in that a call to Jeri or Samantha would have a private plane here in eight hours to whisk me home, but that would be only an absolute last resort.

“What do you want to do today?” Karla asked when I hung up.

“Well, I’m not allowed to run or exercise for two days, so I won’t be doing what I normally do in the morning. And I have another full day, instead of just a few hours. I honestly think I should take it easy, based on what my doctor said.”

“Why don’t we just stay here, at least until lunch, to make sure you’re OK?”

“Don’t you want to shower and change?” I asked.

She laughed, “I probably should. I smell like smoke and who knows what! If you had training clothes I could borrow, I could shower and then wear those until we went to my flat. I saw a spare toothbrush in the bathroom, too.”

I did have a clean pair of sweat pants that would fit, although they’d be a bit loose. And I had plenty of t-shirts. Was there a risk in doing that? I didn’t think so, but then again, I honestly didn’t feel like going all the way across town for her to change, at least until later in the morning. And even then, we’d certainly have to take a taxi, as I wanted to follow Al’s instructions to be careful and take it easy.

“I do have sweat pants and a t-shirt you could borrow, if you’re comfortable doing that.”

“It’s OK, yes.”

“Then why don’t you shower before breakfast arrives,” I said.

I turned on a light, got the clothes from the wardrobe, and handed them to her. She went into the bathroom and I heard the shower start. I pulled out my PowerBook and updated the medical file with all the details I could remember, as well as what Al had told me. I had just finished when Karla came out of the bathroom wearing my black sweatpants and a black t-shirt, her clothes in a plastic bag she’d found in the bathroom.