And then, it all became clear... Well, kind of clear.

There it was. On, no less, the VERY FIRST PAGE of my chart. Written in pen at the VERY TOP of the page. In my doctor's handwriting. In large print.

"Alpha-1 level???"

You may recall that a number of years earlier, he mentioned a level that he assured me not to worry about. Trust me... Just lose some weight, and you'll be fine. This couldn't possibly be the same thing that was causing an issue now, could it?

"Jim... Did you look at this?" I could tell by the tone of his voice -- It was not a question to which he anticipated an appropriate answer. My primary doctor looked at it, and his face grew pale. For the first time in five years, I witnessed this educated, well-spoken man being rendered speechless. It was clear that not only did he not recall writing the note, but he had no real idea what it meant. My heart sank as I waited for some sort of explanation or treatment suggestion that could put my mind at ease. Needless to say, none was forthcoming.

The hepatologist, at this point clearly uncomfortable and not wishing to throw my primary care doctor under the proverbial bus, glossed over the issue with a brief, cursory explanation and quickly left the room. My primary care doctor told me that he would get back with me with details. I anxiously awaited the details from him, hoping for the best but expecting the worst.