Chapter 84: A Very Good Place to Begin the Story

December 18, 2000, Mayo Clinic, Rochester, Minnesota

“Did you eat?” Mary asked when I arrived at Mayo on Monday evening.

“I had lunch while Samantha and I were flying back from Pontiac, but not dinner.”

“How did that go?”

“About as well as expected. Samantha is torn about her dad and it doesn’t help that Brian regards Noel Spurgeon as a complete scumbag.”

“But you don’t.”

“Not the way Brian does. My problem with Noel is how he treated Samantha growing up, and then how he tried to manipulate me. He was stupid to make the recordings, which amounted to trophies, and even more stupid to try to escape. That’s a good part of Samantha’s problems with him as well. Brian feels that it’s karma that Noel has cancer; neither Samantha nor I do. My philosophy, and my experience tells me disease, of any kind, is not punishment.”

“That sounds exactly like what I’d expect. You’re checked-in, so why don’t we go to dinner and then come back and get your initial blood draws and then get you settled in the Sleep Lab?”

“Sounds good. I do have to point out that several people have suggested your tests aren’t going to be accurate.”

“Why?”

“The baseline isn’t going to include sex!”

Mary laughed, “And you think Mayo is going to provide the appropriate sexual partners to carry out proper tests?”

I grinned, “I wasn’t the one who suggested it! I’m simply relaying the concerns of people close to me!”

“The Sleep Lab would NOT be the place for that! And I don’t think Clara has permission for that kind of forensic testing!”

“Bummer!”

“Let me see if Naomi can take her dinner break. Hematology Residents aren’t like trauma, surgical, or even medicine Residents. Long shifts, but they usually get meal breaks and quite a bit of sleep.”

“You did, if I recall correctly.”

“Yes. It really is more like being on-call and having to sleep at the hospital than what Jessica went through. Hang on a sec.”

Mary pulled her phone from her pocket, flipped it open, and scrolled through her contact list to find and dial Naomi’s number. Naomi was available and could take her break, and four minutes later we were in Mary’s car heading for a Chinese restaurant, with my bags in the trunk.

“I want you to just eat a normal dinner,” Mary said. “Starting with breakfast, they’ll have you on a very specific diet which will allow us to monitor the changes in your blood sugar as precisely as possible. We’ll check insulin levels as well. I’m sorry, but you’re going to feel like a pincushion by the end of the week.”

“I kind of figured.”

“Naomi is assigned as our hematology expert for the week,” Mary said. “Her long shift ends tomorrow evening, and she’s going to work day shift the rest of the week. Doctor Alston and Doctor Ross approved the schedule change, and Doctor Alston is the Attending on your case. Clara is assigned to the team, as are Residents from cardiology, respiratory medicine, neurology, and psychology, along with a nutrition specialist.”

“I have to ask, why isn’t it called pneumology? I know sometimes it’s called pulmonology, but that’s bastardized Latin and Greek. Pneumology would match cardiology, hematology, neurology, psychology, and even psychiatry. That last one is an odd man out because instead of ‘logos’, which means ‘knowledge’ it uses ‘iātrikos’ which means medical, and derives from the root word ‘to heal’.”

“I must have missed the day they explained that in medical school!” Naomi laughed. “I have no idea!”

“Me, either,” Mary added. “And besides you, I don’t think I know anyone who would even have a CLUE that pulmonology was a mix of Latin and Greek. I sure didn’t!.”

“Have you talked to Jess in the last two weeks? I mean besides the conference call?”

“No,” Mary replied. “Why?”

“She had a medical student who said, last week, that ‘NPO’ was ‘Nothing per os’ and they had no idea why ‘os’ was used.”

“Seriously?” Mary said. “That was in my first class where I learned to read and complete charts! It’s «nihil per os»! That said, AMA style, which is used in publications, always spells out ‘nothing by mouth’ in English.”

“But you write ‘NPO’ on charts, right?”

“Yes, always. What did Jessica do?”

“Assigned 200 Latin and Greek terms to be memorized for an exam on Friday.”

“Did you pass?”

“Ninety-seven percent,” I chuckled. “I helped Jess study when she was in medical school. There were a few I didn’t remember.”

“How would you do on polymers?” she asked with an arched eyebrow.

“F minus!” I chuckled. “I never advanced beyond basic chemistry because it wasn’t necessary, and the Polymer Princess and I don’t discuss chemistry very often!”

“‘Polymer Princess’?” Naomi asked.

“Kara. That’s her area of specialty. And it’s also her nickname on AOL messenger.”

“What’s Jessica’s?” Mary asked.

“DrJessicaRabbit,” I chuckled.

“And she likes to play pat-a-cake, of course!” Mary teased.

“Of course!”

“I reviewed your blood chemistry panels today and I was surprised by something,” Naomi said.

“What?” I asked.

“Your testosterone levels are right in the center of the range. I’d have expected them to be higher, given what I know about your history, which I admit is limited. I say that because a study done in ‘93 showed that men who produce more testosterone are more likely to engage in extramarital sex.”

“I can’t believe that’s the only indicator,” I replied.

“No, of course not, but with your hormone regulation problems, it wouldn’t have been surprising to see you have high levels of testosterone because higher levels are associated with periods of sexual activity, and there’s a correlation between men with lower levels and marriage.”

“Is there a cycle?” I asked. “Nearly all my blood tests have been in the morning.”

“Testosterone levels follow a daily rhythm which peaks early in the day. We’ll be doing morning and evening blood panels, though obviously we have to be careful about the total amount of blood we take.”

“Just send me a cute phlebotomist!”

“He’s incorrigible!” Mary laughed.

“You know, I wonder about something,” Naomi said. “In Steve’s medical records, he showed a sensitivity to adrenaline. What if he has the same kind of atypical sensitivity to other hormones, such that levels which appear in the center of the reference ranges have an outsized or undersized effect?”

“Hold that thought!” Mary said as she pulled into the parking lot of the Chinese restaurant. We went in, were seated, and placed our orders. When our green tea arrived, the conversation continued.

“Now that I’ve had a few minutes to think about it,” Mary said. “That does make sense. Obviously you’re referring to testosterone, but it could be insulin and a host of other hormones as well, which would begin to make more sense of his carbohydrate metabolism and his atypically low blood sugar levels. Unfortunately, there isn’t a lot of literature available about that. I know of at least a dozen clinical tests that are underway about hormone regulation, metabolism, and effects, but nothing is ready to be published.”

“And,” Naomi said with a smirk, “testing the testosterone theory by giving Steve supplemental testosterone might create havoc!”

“And a lot of fun!” I replied, doing my best not to attract attention by laughing too loud. “You know, put up a sign-up sheet - ‘Test subjects wanted! Must be female, 18-20, in good shape; prefer athletic build and small breasts; virginity strongly preferred, but not required; must be willing to engage in all forms of copulation. Payment in endless strings of orgasms!’.”

Both Mary and Naomi were laughing softly, struggling mightily, as I had just before, to not burst out laughing and attract attention.

“I think we’d lose our medical licenses!” Mary said when she finally got control of her laughter. “I don’t think Clara could get away with anything remotely resembling that, and she’s researching the complete gamut of sexual function and dysfunction!”

“Hmmm...” I smirked. “Candy stripers, nurses, Residents, med students...”

Both women laughed and the conversation stopped for a moment when a waiter brought our hot and sour soup. Despite being thickened with corn starch and being high in sodium, Mary had agreed it was OK for me to have as I’d had no carbs at all at breakfast and lunch.

“All goofiness aside,” I said. “What are the rules I need to follow?”

“Literally no food or drink, including water, which isn’t provided. The nurses will keep track of how much you drink - just do it as you normally would. There will be a bottle you’ll be able to carry with you when you’re not in your room. Beyond that, you’re free to roam the hospital and grounds, so long as you’re in your room when we need to do your hourly glucose checks. I know that’s fairly restrictive, but I’m not going to require you to stay in your room or in bed. Did you bring sweats?”

“Yes.”

“You can wear those, rather than a hospital gown, and pajamas and a robe are fine if you brought those as I suggested for the sleep study.”

“I did.”

“I saw you brought your laptop with you.”

“Yes. Any chance I can get a modem line in my room?”

“That’s pretty easily accomplished. I’ll put in the request with IT when we get back. You have a private room, of course, though you’ll be in the Sleep Lab for the first two nights.”

“I’m not sure I’m going to sleep too well with EKG and EEG leads attached.”

“Don’t forget the EMG, EOG, and nasal airflow monitors.”

“I know what an electromyogram is; what’s an EOG?”

“An electro-oculogram, which measures eye movements. It, along with the EMG and EEG help determine your sleep state.”

“What all is measured?” I asked.

“I ordered a full polysomnography, so that means brain activity, eye movement, oxygen and carbon dioxide blood levels, heart rate and rhythm, breathing rate and rhythm, the flow of air through the mouth and nose, snoring, body muscle movements, and chest and belly movement.”

“OK, now I’m sure I’m not going to be be able to sleep!”

“Strangely, most patients don’t have too much difficulty. You’ve meditated before, right?”

“Yes.”

“Then just use some of your meditative techniques and I think you’ll fall asleep.”

“I’m also not used to sleeping alone,” I chuckled.

“I believe the Sleep Lab has access to a supply of teddy bears and other stuffed animals,” Naomi offered.

“Kara calls me ‘Snuggle Bear’ and I daresay she wouldn’t accept one of those as a substitute!”

She had, but as a symbol, during our Year in the Wilderness, but that was a VERY different thing.

“Well,” Naomi said, “I’m on shift tonight and the Sleep Lab is like Fort Knox! Off limits except to staff who are assigned there, behind locked doors, and the rooms are sound-isolated from the rest of the hospital, so I can’t help!”

“I don’t think anyone can,” I chuckled.

“You’re going home on Saturday morning, right?”

“Yes. My kids would not understand if Dad wasn’t home for Christmas. I’ll be back in February, and will do as you asked.”

“What was THAT?” Mary asked.

Naomi laughed softly, “Not bother with a hotel.”

“Don and I are going down to Chicago for a few days between Christmas and New Year’s. What does your schedule look like?”

“Like I’m a first-year Resident!” Naomi said, shaking her head.

“Sorry,” Mary replied. “I wasn’t thinking.”

A waiter brought our main courses, which were three dishes to share, though I didn’t take any of the rice which was served in a community bowl.

“I’m almost halfway done with my first year,” Naomi said. “Things will be better after July.”

“Something has to give, eventually,” I said. “I had thought maybe something would come of the lawsuit in New York, but all that did was slightly reduce hours for Residents in New York and scuttlebutt says it’s dealt with by a wink and a nod.”

“It pretty much has to be,” Mary replied. “Medicare funding and state licensing pretty much create a set of conditions that can’t be changed formally without Congressional action, and they won’t do anything because of what it would cost.”

“I’m curious about what you do overnight, Naomi,” I said.

“Most of the calls are either from oncology or the ER. Leukemia and lymphoma patients make up a good percentage of patients I see, along with blood disorders such as hemophilia. There are also marrow transplant patients as well as the gamut of blood diseases. Being a research hospital, we have more than a typical share of all of those. There are also surgical calls - before, during, and after. And not everyone gets sick or has a medical emergency or incident during office hours!”

“I didn’t mean it that way,” I replied. “I just wondered what would get you out of bed. Now I know!”

We finished our meal, I paid the bill, and we headed back to the hospital. Mary got me to my room where I unpacked my things. While I changed into my sweatsuit, she called the Sleep Lab to let them know I was checked-in.

“What time am I supposed to be there?” I asked.

“9:00pm so they can go over everything with you and get you hooked up and in bed by 10:00pm. I’m going to do a quick medical history review right now to update your chart.”

I nodded and sat down while Mary went over the usual questions, noting on the chart that there were no discrepancies or changes, and listing what I’d had for dinner.

“You don’t get up in the night to urinate, do you?”

“I’m not THAT old,” I chuckled.

“That can happen even in younger men.”

“I’m likely going to wake up around 5:00am, which is my usual time.”

“I noted that from our previous conversations. When you wake, they’ll disconnect you and you can come back here. An exercise physiologist will come get you so you can do your 5K on the treadmill with the cardiac and respiratory monitors. Just run at your normal pace. When you’re done, come back here and we’ll get your blood draws done and you can have breakfast. We’ll do glucose tests hourly for the rest of the week, when you’re awake. On Thursday night we’ll do them overnight, too.”

“Oh THAT will be fun,” I sighed.

“We want to see the results for a full twenty-four hours, and by then you’ll have been on the special, monitored diet for more than forty-eight hours. And I’d say it’s a small price to pay if we find a way to limit your mood swings, wouldn’t you?”

“Yes.”

“One area we’re going to investigate is your gluconeogenesis. With a totally controlled diet, we’ll have a very good picture of exactly how your body creates glucose and manages it with as close to zero carbohydrates as possible.”

“This is going to be the epitome of a bland diet, isn’t it?”

“Actually, there is nothing that prevents you from using spices, so long as you don’t go heavy on the salt. We don’t want to elevate your sodium levels so you retain water.”

“And the Chinese tonight? With the hot and sour soup and the MSG?”

“That’s part of your normal diet, right?”

“Yes.”

“Then that won’t be an issue because we want your normal diet as the baseline for tomorrow morning.”

“Then there should be no concerns in that regard,” I replied. “The only thing I ever put salt on were French fries and I haven’t had those since I was in Amsterdam years ago. I prefer other spices when cooking, though an occasional dash of salt goes into some things. I think my biggest intake of sodium comes from the four strips of bacon or three sausage patties I have at breakfast.”

Mary nodded, “You’ll get eggs and some kind of beef or chicken in the mornings. That’s not because I’m telling you to stop eating bacon or sausage, but because we want to carefully control sodium and a couple of slices of bacon would put you over the limit.”

“Life without bacon is NOT worth living!” I declared with a silly grin.

“I think I’ll agree with you on that one!” Mary replied. “Salted, cured, and smoked dead pig is about the best there is!”

I laughed, “Have you been talking to Jesse? He uses the ‘dead pig’ line on his sisters!”

“So did my big brother!” Mary laughed.

“Is Don expecting you?”

“Not until after you go to the Sleep Lab. He’s playing poker with some friends, so I’ll probably beat him home.”

“He’s welcome to play with us in Chicago!” I said slyly.

“Who wins more? You or Jesse?”

“It’s about even at this point. The problem is, Matthew is learning quickly, and he plays with us once a month. And, of course, my friend and employee Terry is almost as good as Jesse and I are.”

“You win that often?”

“Before the kids got really good, mostly by playing with me, I won a good chunk of the time. Hold ‘Em is more about playing your opponent than the cards you have. You watched TNG, right?”

Mary laughed, “Yes, and I remember Data being confused by Riker’s bluffing. Before I forget, Don asked if you’d be able to put him in touch with someone at Spurgeon to manage our investments.”

“Indeed I would. Just have him ask me when you guys are in Chicago and I’ll introduce him to Bo DeWitt.”

“Thanks. You’ll need to shower before we go to the Sleep Lab. Why don’t you do that now. Make sure you wash your chest and face with the soap we’ve provided.”

I nodded, “For the electrodes.”

“Yes. Don’t put on any deodorant or anything like that, either. I’m assuming you don’t need help?”

“This is where normally I’d make some sort of completely inappropriate remark, right?”

Mary laughed softly, “Just get your shower!”

I got my summer pajamas and slippers, went into the bathroom, closed the door, and showered, making sure I washed my chest, arms and face thoroughly. When I finished, I dried myself, put on my pajamas and slippers, and went back to join Mary. About ten minutes to nine, I put on my robe and just as we were about to leave the room, an orderly arrived with a wheelchair.