"Neuro-what? Cardio-who? Vaso-what?" asked Lorelai.
"You used that last one already," Rory pointed out to her.
"Well, what would you have suggested in it's place?"
"Why," Rory replied.
"Vaso-why? does not make sense," Lorelai shook her head.
"And Cardio-who? does?"
"All right, good point there," acknowledged Lorelai in defeat.
"Lorelai! Rory! For heaven's sake, would you let the woman explain herself before I have to be admitted myself?" barked Emily.
"Oh but Mom, the mental institution is on the other side of town," quipped Lorelai.
"Your mother's right, Lorelai. Dr. Steiner does not need you wasting her time like this," Richard interceded.
"Sorry," said Lorelai.
Dr. Steiner smiled, "Okay, let me lay this out for you..."
"Hold on!" said Rory as she reached for her bag and pulled out a notebook and pen.
"You're going to take notes at my diagnosis?" smiled Lorelai.
"Of course, that way I can do follow-up research on treatments and research studies... Oh! no offense, Dr. Steiner."
"None taken," laughed the doctor, "Good to know you've got my back. Anyway, you may have heard of Vasovagal Syncope before?"
They all shook their heads 'no'.
"It's not terribly common. It's a condition whereby the heart slows down for some unknown reason, usually caused by postural change or exertion, sometimes stress, and causes a person to faint."
"Okay," nodded Rory scribbling furiously.
"That is part of your problem, Lorelai." "Stick-out ears being the other," she mumbled.
"What causes it?"asked Rory.
"We don't know, but it is a congenital thing. Sometimes it shows up and sometimes it doesn't. Have you ever had trouble with physical exercise at any point in your life?" asked Dr. Steiner.
Lorelai mulled a moment.
"She got terrible grades in PE," chimed in Emily. "She was always the last one in when they ran the mile in class. We were very concerned about its' affect on her GPA at the time. I thought she was just lazy."
"Painful flashback now," frowned Lorelai.
"There is also a second part to your condition, Lorelai. It can be called a couple of different things: 'Cardio-inhibitory reflex' is one; and 'Neurally Mediated Hypotension' is another."
"Won't it just answer to Fred?"
"No, I'm afraid not," smiled the doctor. "In this condition, you get a sudden unexplained drop in blood pressure, which can also cause fainting, among other things; like fatigue, muscle pain, feeling cold, mental confusion, and clumsiness. Stress can also affect this condition. You can go years and not really be aware of feeling badly at all or, in some sad cases I've seen, you could be bed-ridden and weak for long periods of time."
"Yikes!"
"The combination of both these conditions is pretty unusual, and very exciting for Dr. Sherman, I might add," laughed Dr. Steiner, "He wants to get your permission to write a journal article about it, I think."
"Ooo! Will he put my picture in it?"
"You'll have to talk to him about that. One of the things that we know helps these conditions is very mild exercise. The fact that you are an energetic and busy woman has probably been helping you ward it off until this point in your life."
"Why wasn't I informed of this when she was born?" asked Emily, "I had the finest doctors in Hartford!"
"It's extremely difficult to diagnose. Low blood pressure is an indicator, but not conclusive. We could only really know for sure by administering the Tilt Table test Lorelai had yesterday. And it's a fairly recent, though sort of barbaric, way of finding out."
"What is the worst scenario?" asked Richard, "Is this life threatening?"
"Probably not," acknowledged the doctor, "We have medications that we feel will prevent the heart from stopping completely, and medications to raise blood pressure. There are a few simple lifestyle changes to make: Rest, adding salt to the diet, not exerting the heart excessively, trying not to bend over too much to prevent dizziness, plenty of fluids. We have pretty good success treating the cause of the problem, but not such great success with the symptoms unfortunately. You may very well have to combat those for your lifetime."
"Wow... Okay," said Lorelai in some dismay.
"I usually recommend that my patients seek some kind of therapy as well. It can be difficult to adjust to becoming a chronically ill person."
They all looked at Lorelai sadly then.
"Stop it! You're freaking me out."
"That said," the doctor smiled and went on, "We are fortunate to have ways to cope with this. You're lucky you weren't born a Victorian, Loralai."
"Oh, I know," nodded Lorelai, "'Cause my ass is really my best feature and... well... with the bustles and all...Um... okay, never mind," she finished lamely at their raised eyebrows.
"Lorelai, be serious!" said Emily, then turned back to the doctor, "No one in my family had anything like this!"
"Perhaps not, but Lorelai has it now," said the doctor simply. "Okay, we'll start you on the drugs, and send you home in the morning. I want two weeks of serious rest from you, and then we'll see you back here for another Tilt Table test."
Lorelai groaned at that.
"It's the only way to know if the medication is working or not. We want to keep your heart beating all the way through the test. That is our goal."
"And if it doesn't?" asked Richard grimly.
"Well, I'm sure it will. But if not there are other more severe options."
"Like what?" Rory paused in her scribbling.
"Well, a pacemaker for one. But I'm sure it won't come to that," added the doctor hastily.
"Okay, I'm stopping with the defensive humor now: I have a few questions," declared Lorelai. "Fire away."
"Will I be able to run my Inn?"
"Yes, you should be able to, provided you allow yourself rest and take your medication. I suggest you have a good right-hand person though, because there may be days, or weeks even, when you won't feel up to it."
Lorelai nodded then looked to her family, "Um... Hey guys? Could you give me a few minutes alone with the doctor now, please?"
"I don't think that's such a good..."started Emily.
"Of course, Lorelai. Many patients like to ask questions privately," answered the doctor pointedly.
Emily, Richard and Rory shuffled out reluctantly then and shut the door behind them.
"Okay, Barbara," Lorelai leaned in. "Am I going to need some kind of... help... further down the road?... I mean like a nurse or something, because I need to make provisions for that now. I don't want my daughter feeling like she has to stick around..."
"Lorelai, I don't foresee that as a permanent long-term need. There may very well be short periods of time when you might need some help, though. This thing tends to go up and down unexpectedly. It's really not possible to know right now for sure. I'm sorry."
"Okay." Lorelai digested that, then lifted her head to meet the doctor's gaze, "Will I be able to have another baby if I want one?"
The doctor shifted her eyes and paused, "I'll be honest with you, I wouldn't suggest it. You would have to go off the medication during pregnancy and nursing. It would be considered a high-risk situation for you, and you would require close monitoring, especially at your age." Lorelai winced at that. "That said though, the risk is quite low for the baby, and I did have one patient who delivered without out much incident. But your blood pressure does tend to go down during pregnancy, which is not good for you. It would be your decision though, of course."
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::
She awoke with a start. She'd been dreaming about Luke. She caught her breath, the missing of him so strong within her in that moment. She put her hand over her eyes...
"Lorelai?" she heard.
"Mom?" she turned to look at Emily who was seated quietly next to the bed. "You should go home, I'm sure you have jet lag." "We will later." Emily looked at her daughter a long while. "You look pale. How are you feeling?"
"Like I want to get out of here and have a cheeseburger."
"I don't know how you escaped conventional heart disease with your diet. Leave it to you to have something strange and unexplainable."
"Guess I'm lucky," smiled Lorelai in irony. "I guess if I'm going to have to feel crappy off and on for the rest of my life, God thought she'd a least give me the comfort of cheeseburgers."
Emily smiled thinly at that, "Can I get you something?"
"Did the doctor say I couldn't have coffee?"
"No, she just said more fluids and salt."
"Salt wouldn't be very good in coffee."
"I'll go see if I can find you some coffee," said Emily, "without salt."
As she stood to leave, Lorelai stopped her at the door, "Mom?"
"Yes, Lorelai?"
"Thank you for coming home."
"You're welcome, Lorelai." smiled Emily.
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::
A moment later Rory tiptoed into the room quietly.
"Hey, kid!"
"Oh, I thought you were still asleep," smiled Rory.
"That got too boring," said Lorelai, and sat up, "Come here!"
Rory climbed up on the bed with her mother and they wrapped their arms around each other and lay back.
"Did you get some dinner?"
"Yeah, Grandpa took me to the cafeteria." "Good. What else did you do?"
"Well, I found Luke in the waiting room," said Rory and turned to look at her mother.
"Oh," said Lorelai noncommitally.
"How long has he been down there, Mom?"
Lorelai sighed, "Apparently since the beginning of this melodrama. I'd hoped he'd gone home by now," she paused a moment, then "Did he talk to you?"
"Mostly I talked to him," stated Rory.
"Oh?"
"He looked liked hell."
Lorelai nodded, "What did you talk about?"
"I took my notes out and updated him on your diagnosis."
"That's good. What did he say?"
"He wiped his eyes and went to get some tea."
"Oh."
"Mom?"
"Yeah?"
"Has he been up here to see you at all?" asked Rory.
"No."
"I see."
They paused here.
"I guess...he just can't," Lorelai tried to explain.
"Because of his mother?"
"I don't know, Freud."
"You still love him, though, right?"
"All right, Rory," declared Emily as she and Richard re-entered the room, "We need to let your mother rest now. We'll stay in Hartford tonight and come get your mother first thing. Here's your coffee, Lorelai, and a bag of pretzels—it was the best I could do, I'm afraid."
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::
She was already awake when Tanika came on her four a.m. rounds this time.
"Hey Lorelai, do you want to do another walk-about after I take some blood?"
"Yes, please."
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::::
It was hard to press down the trepidation she was feeling as she approached the waiting room this time. She really didn't really know what she wanted to see, but she knew she had to check.
He was there, standing at the window this time looking out on a courtyard which featured a lit fountain. She went to stand at his side.
"Do they really think a fountain in a courtyard is going to make people feel better about being in this place?" he asked, his eyes still focused on the spraying water.
"I don't know," replied Lorelai, gazing at the frolicking water nymphs made of stone.
They stood and stared in silence then.
"I..." he began, unable to look at her.
"Don't..." she said trying to hold it together, "Let's just watch the water now. It's four a.m. I just want to stand here right now. And then I'm going to go back to my room and you are going to go home."
"All right," he said.
"You used that last one already," Rory pointed out to her.
"Well, what would you have suggested in it's place?"
"Why," Rory replied.
"Vaso-why? does not make sense," Lorelai shook her head.
"And Cardio-who? does?"
"All right, good point there," acknowledged Lorelai in defeat.
"Lorelai! Rory! For heaven's sake, would you let the woman explain herself before I have to be admitted myself?" barked Emily.
"Oh but Mom, the mental institution is on the other side of town," quipped Lorelai.
"Your mother's right, Lorelai. Dr. Steiner does not need you wasting her time like this," Richard interceded.
"Sorry," said Lorelai.
Dr. Steiner smiled, "Okay, let me lay this out for you..."
"Hold on!" said Rory as she reached for her bag and pulled out a notebook and pen.
"You're going to take notes at my diagnosis?" smiled Lorelai.
"Of course, that way I can do follow-up research on treatments and research studies... Oh! no offense, Dr. Steiner."
"None taken," laughed the doctor, "Good to know you've got my back. Anyway, you may have heard of Vasovagal Syncope before?"
They all shook their heads 'no'.
"It's not terribly common. It's a condition whereby the heart slows down for some unknown reason, usually caused by postural change or exertion, sometimes stress, and causes a person to faint."
"Okay," nodded Rory scribbling furiously.
"That is part of your problem, Lorelai." "Stick-out ears being the other," she mumbled.
"What causes it?"asked Rory.
"We don't know, but it is a congenital thing. Sometimes it shows up and sometimes it doesn't. Have you ever had trouble with physical exercise at any point in your life?" asked Dr. Steiner.
Lorelai mulled a moment.
"She got terrible grades in PE," chimed in Emily. "She was always the last one in when they ran the mile in class. We were very concerned about its' affect on her GPA at the time. I thought she was just lazy."
"Painful flashback now," frowned Lorelai.
"There is also a second part to your condition, Lorelai. It can be called a couple of different things: 'Cardio-inhibitory reflex' is one; and 'Neurally Mediated Hypotension' is another."
"Won't it just answer to Fred?"
"No, I'm afraid not," smiled the doctor. "In this condition, you get a sudden unexplained drop in blood pressure, which can also cause fainting, among other things; like fatigue, muscle pain, feeling cold, mental confusion, and clumsiness. Stress can also affect this condition. You can go years and not really be aware of feeling badly at all or, in some sad cases I've seen, you could be bed-ridden and weak for long periods of time."
"Yikes!"
"The combination of both these conditions is pretty unusual, and very exciting for Dr. Sherman, I might add," laughed Dr. Steiner, "He wants to get your permission to write a journal article about it, I think."
"Ooo! Will he put my picture in it?"
"You'll have to talk to him about that. One of the things that we know helps these conditions is very mild exercise. The fact that you are an energetic and busy woman has probably been helping you ward it off until this point in your life."
"Why wasn't I informed of this when she was born?" asked Emily, "I had the finest doctors in Hartford!"
"It's extremely difficult to diagnose. Low blood pressure is an indicator, but not conclusive. We could only really know for sure by administering the Tilt Table test Lorelai had yesterday. And it's a fairly recent, though sort of barbaric, way of finding out."
"What is the worst scenario?" asked Richard, "Is this life threatening?"
"Probably not," acknowledged the doctor, "We have medications that we feel will prevent the heart from stopping completely, and medications to raise blood pressure. There are a few simple lifestyle changes to make: Rest, adding salt to the diet, not exerting the heart excessively, trying not to bend over too much to prevent dizziness, plenty of fluids. We have pretty good success treating the cause of the problem, but not such great success with the symptoms unfortunately. You may very well have to combat those for your lifetime."
"Wow... Okay," said Lorelai in some dismay.
"I usually recommend that my patients seek some kind of therapy as well. It can be difficult to adjust to becoming a chronically ill person."
They all looked at Lorelai sadly then.
"Stop it! You're freaking me out."
"That said," the doctor smiled and went on, "We are fortunate to have ways to cope with this. You're lucky you weren't born a Victorian, Loralai."
"Oh, I know," nodded Lorelai, "'Cause my ass is really my best feature and... well... with the bustles and all...Um... okay, never mind," she finished lamely at their raised eyebrows.
"Lorelai, be serious!" said Emily, then turned back to the doctor, "No one in my family had anything like this!"
"Perhaps not, but Lorelai has it now," said the doctor simply. "Okay, we'll start you on the drugs, and send you home in the morning. I want two weeks of serious rest from you, and then we'll see you back here for another Tilt Table test."
Lorelai groaned at that.
"It's the only way to know if the medication is working or not. We want to keep your heart beating all the way through the test. That is our goal."
"And if it doesn't?" asked Richard grimly.
"Well, I'm sure it will. But if not there are other more severe options."
"Like what?" Rory paused in her scribbling.
"Well, a pacemaker for one. But I'm sure it won't come to that," added the doctor hastily.
"Okay, I'm stopping with the defensive humor now: I have a few questions," declared Lorelai. "Fire away."
"Will I be able to run my Inn?"
"Yes, you should be able to, provided you allow yourself rest and take your medication. I suggest you have a good right-hand person though, because there may be days, or weeks even, when you won't feel up to it."
Lorelai nodded then looked to her family, "Um... Hey guys? Could you give me a few minutes alone with the doctor now, please?"
"I don't think that's such a good..."started Emily.
"Of course, Lorelai. Many patients like to ask questions privately," answered the doctor pointedly.
Emily, Richard and Rory shuffled out reluctantly then and shut the door behind them.
"Okay, Barbara," Lorelai leaned in. "Am I going to need some kind of... help... further down the road?... I mean like a nurse or something, because I need to make provisions for that now. I don't want my daughter feeling like she has to stick around..."
"Lorelai, I don't foresee that as a permanent long-term need. There may very well be short periods of time when you might need some help, though. This thing tends to go up and down unexpectedly. It's really not possible to know right now for sure. I'm sorry."
"Okay." Lorelai digested that, then lifted her head to meet the doctor's gaze, "Will I be able to have another baby if I want one?"
The doctor shifted her eyes and paused, "I'll be honest with you, I wouldn't suggest it. You would have to go off the medication during pregnancy and nursing. It would be considered a high-risk situation for you, and you would require close monitoring, especially at your age." Lorelai winced at that. "That said though, the risk is quite low for the baby, and I did have one patient who delivered without out much incident. But your blood pressure does tend to go down during pregnancy, which is not good for you. It would be your decision though, of course."
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::
She awoke with a start. She'd been dreaming about Luke. She caught her breath, the missing of him so strong within her in that moment. She put her hand over her eyes...
"Lorelai?" she heard.
"Mom?" she turned to look at Emily who was seated quietly next to the bed. "You should go home, I'm sure you have jet lag." "We will later." Emily looked at her daughter a long while. "You look pale. How are you feeling?"
"Like I want to get out of here and have a cheeseburger."
"I don't know how you escaped conventional heart disease with your diet. Leave it to you to have something strange and unexplainable."
"Guess I'm lucky," smiled Lorelai in irony. "I guess if I'm going to have to feel crappy off and on for the rest of my life, God thought she'd a least give me the comfort of cheeseburgers."
Emily smiled thinly at that, "Can I get you something?"
"Did the doctor say I couldn't have coffee?"
"No, she just said more fluids and salt."
"Salt wouldn't be very good in coffee."
"I'll go see if I can find you some coffee," said Emily, "without salt."
As she stood to leave, Lorelai stopped her at the door, "Mom?"
"Yes, Lorelai?"
"Thank you for coming home."
"You're welcome, Lorelai." smiled Emily.
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::
A moment later Rory tiptoed into the room quietly.
"Hey, kid!"
"Oh, I thought you were still asleep," smiled Rory.
"That got too boring," said Lorelai, and sat up, "Come here!"
Rory climbed up on the bed with her mother and they wrapped their arms around each other and lay back.
"Did you get some dinner?"
"Yeah, Grandpa took me to the cafeteria." "Good. What else did you do?"
"Well, I found Luke in the waiting room," said Rory and turned to look at her mother.
"Oh," said Lorelai noncommitally.
"How long has he been down there, Mom?"
Lorelai sighed, "Apparently since the beginning of this melodrama. I'd hoped he'd gone home by now," she paused a moment, then "Did he talk to you?"
"Mostly I talked to him," stated Rory.
"Oh?"
"He looked liked hell."
Lorelai nodded, "What did you talk about?"
"I took my notes out and updated him on your diagnosis."
"That's good. What did he say?"
"He wiped his eyes and went to get some tea."
"Oh."
"Mom?"
"Yeah?"
"Has he been up here to see you at all?" asked Rory.
"No."
"I see."
They paused here.
"I guess...he just can't," Lorelai tried to explain.
"Because of his mother?"
"I don't know, Freud."
"You still love him, though, right?"
"All right, Rory," declared Emily as she and Richard re-entered the room, "We need to let your mother rest now. We'll stay in Hartford tonight and come get your mother first thing. Here's your coffee, Lorelai, and a bag of pretzels—it was the best I could do, I'm afraid."
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::
She was already awake when Tanika came on her four a.m. rounds this time.
"Hey Lorelai, do you want to do another walk-about after I take some blood?"
"Yes, please."
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::::
It was hard to press down the trepidation she was feeling as she approached the waiting room this time. She really didn't really know what she wanted to see, but she knew she had to check.
He was there, standing at the window this time looking out on a courtyard which featured a lit fountain. She went to stand at his side.
"Do they really think a fountain in a courtyard is going to make people feel better about being in this place?" he asked, his eyes still focused on the spraying water.
"I don't know," replied Lorelai, gazing at the frolicking water nymphs made of stone.
They stood and stared in silence then.
"I..." he began, unable to look at her.
"Don't..." she said trying to hold it together, "Let's just watch the water now. It's four a.m. I just want to stand here right now. And then I'm going to go back to my room and you are going to go home."
"All right," he said.