Oh.
Yes. Yes, please.
“Go ahead.”
The doctor exhales. She pulls a small chart out from under her arm. She does not look at it. She has, I suspect, looked at it enough.
“Miss O’Shea has been on continuous suppressant blockers,” she says, “from puberty. Which I am putting at age sixteen. Based on the dosing history that her former GP’s office faxed us this afternoon.”
“Mm.”
“It is a common timeline. Frequently, the parents put the daughter on them. Sometimes out of protection, because they do not know how the daughter will react when her Omega scent comes online and they are scared of triggering an early Heat. Sometimes out of the convenience of avoiding the conversation. Sometimes because the daughter is, by family standing, in a household that does not really want her to be an Omega in the first place, and the blocker becomes the easiest way to perform the small daily denial.”
My stomach does the small flip it does when a stranger has, very neutrally, just held up a mirror to a piece of Iris’s biography I had already assembled in pieces and not yet had the courage to look at as a whole.
“Okay.” Level. “Keep going.”
“Regardless of the reason,” she continues, “remaining on blockers for the better part of a decade is detrimental to thebody. The medical literature is unambiguous, and the medical profession is, in my honest opinion, not loud enough about it. Long-term suppression alters the endocrine baseline. It elevates cancer risk in the tissue groups it suppresses. It thins bone density. It frequently produces sleep architecture disruption. It makes Heats, when they do break through, more violent. None of which is, I should clarify,her fault.This is the system she was handed.”
“Mm.”
Keep your face still. Keep your voice level. You can think about the rest of it later.
“The complication,” the doctor says, “is that her body has, at this point, adapted to the blocker the way a body adapts to any long-running medication. Which means we cannot, professionally, take her off it cold turkey. If we did, she would go through a withdrawal cascade similar in clinical presentation to the withdrawal cascade of a substance dependency. Chills. Panic attacks. Disorientation. Vomiting in the first seventy-two hours. Possibly worse, depending on her chemistry. We will not be doing that.”
“Good.”
“What we are going to do is taper her off the current formulation while titrating in a softer replacement, designed to do the same job at a meaningfully lower physical cost. The taper is going to take three to four weeks. During the taper window, she is going to feel some of the adverse effects, in compressed form, as her endocrine system rebalances. The fevers are likely to continue and probably to intensify. The insomnia is going to get worse before it gets better. There may be hot flashes. There may be some emotional volatility, the kind that surprises her.”
“How much worse.”
“Manageable. She will be functional. She is not going to be hospitalized. She is going to be uncomfortable for two to fourweeks, and then, on the other side of it, she is going to feel better than she has felt in eight years. The current fever, for the record, is, in my reading, mostly attributable to a different problem. She has been suddenly placed in extremely close quarters with three Alphas and her body is, very simply, overheating in the small constant low-grade way Omegas overheat in that situation. The fever is functionally a thermoregulatory drift, not a Heat onset. We can treat it with aggressive hydration and a serious nap schedule.”
Three Alphas. A nap schedule. A nest. A nest she does not, structurally, know what is.
“Okay.” I take a moment. I file. I open the next folder. “On the medication itself. The new one. There is no overdose risk if she, for example, accidentally double-doses.”
The doctor’s eyes register the question with the specific small reading of a professional clocking that the question came from a slightly different direction than expected. She does not press.
“Dosages are calibrated to the individual Omega,” she says, evenly. “I personally triple-check every prescription that leaves this office. The therapeutic window is wide. An accidental double would not, in the medication class we are using, produce a fatal outcome. It would produce a bad night and a phone call to me at three in the morning, and I have, as I told her in the room, made my personal line available for exactly that scenario. Twenty-four-seven.”
“Thank you.”
She tilts her head. The very small read of a woman who would, in fact, like to know why I asked.
I look at the door of the exam room. The corner of my mouth flattens.
“Our pack leader,” I say, quiet, “lost his best friend to a drug overdose, four winters ago. Connor. The man was the fourth of our four. If I keep our captain informed about MissO’Shea’s prescription history in the way that I am going to need to keep him informed about it, he is going to react. Possibly disproportionately. I want to be in a position to tell him the math is safe.”
The doctor’s eyes soften.
“Mr. Bellerose. The math is safe. And I am happy to set you up with weekly in-person check-ins for Miss O’Shea, with copies of the notes routed to you and any other member of the pack she designates. I am here to make this season easier for her and the people who love her. Not harder.”
“Thank you.”
“Of course.”
She turns to push back into the exam room, to walk Iris through the next four weeks at the level of detail Iris is, in fact, going to actually need.
