From Pellegra To NET

Day 24 of a hospitalization in New Mexico — one of the worst medical states in the country. Not enough providers. Not enough care. And me, stuck in the middle of it, running on depleted stats, trying to get the bare minimum while they try to street me.
This is not a linear story. This is a playthrough where you don't find out what game you're actually in until you're already deep in the dungeon.

I am home on TPN, IV steroids, a PICC line. Homebound. Lupus. Gastroparesis. Healing ischemic colitis believed to be "Lupus Vasculitis." Four cats. Four ducks. A husband. Living my best life between respawn points, truly.
And then my tricuspid valve — mild regurgitation, background noise, barely a stat — deteriorated to severe in ten weeks.
Wait. Still rewinding.

There was a rash on my back. January. It was biopsied. Positive for Amyloid.
A hidden lore item. Sitting right there in the inventory. Nobody picked it up.
Dermatology said the muscle needed a biopsy too. That was supposed to happen in late February. But in late February I was being scoped and piped for ischemic colitis — a forced encounter I did not choose and could not skip. The muscle biopsy quest got abandoned mid-dungeon.
Filed under: later.
Later, it turns out, was already happening. We just didn't have the right lens equipped yet.

April. Heart symptoms getting worse. I go to my scheduled primary appointment and she sends me directly to the ER.
"Pericarditis. Admit — wait, we don't have a bed — okay we're going to send you home, and you need to see a cardiologist THIS WEEK."
We can all laugh at that.
My rheumatologist gets nervous enough to call a STAT cardiology appointment. Four business days. That's STAT in New Mexico. My rheumatologist, bless her, is the only healer in this party who has been paying attention to the actual health bar.
The appointment is set for May 21st.
I start throwing up with a fever on Sunday night, May 18th.

I go to the hospital where the cardiology appointment is scheduled. Mistake. Wrong server. They don't have half my records. And because I have an Enterra II device I can't have an MRI of most of me — head and extremities only, and only if they turn it off first.
New zone. Worse gear. Same damage incoming.

Day 24. New symptom roster since admission: tremors, possible seizures, cognitive decline that I can only describe as dementia-flavored, new rashes, neuropathy, difficulty walking, anemia, low calcium, low protein. Labs that look nothing like my stable weekly TPN labs from two weeks before I got here.
My stats have never looked this bad. Not even close.
What does the team say?
"Your labs are off because you're in the hospital."
The labs drawn the night I arrived. Before I had been in the hospital long enough for it to matter. Labs that were normal four days prior, at home, on TPN, stable.
"Your labs are off because you're in the hospital."
I need you to sit with that logic for a moment. I had to. Extensively.
Here is what I know, what they know, and what keeps getting denied anyway: my labs are a debuff. A stack of debuffs, actually. Actively tanking my stats. Visible on the screen. Flashing. The little skull icon is right there in the corner and has been since the night I walked in.
They keep telling me I have no debuff.
I have been watching my own health bar. I know what my baseline looks like. I have weekly TPN labs going back months — normal, stable, consistent. And then I got sick, and the numbers changed, and I walked in with the changed numbers, and the answer has been, every single time: that's just what happens when you're in the hospital.
That is not a medical explanation. That is a loading screen they put up so they don't have to run the diagnostic.

Now. Here is where the map starts to make sense. Here is where the hidden lore items start connecting.
Test results: elevated CGA. Blood 5-HIAA flagged positive. Nicotinic acid — none detected.
Nicotinic acid. None. Detected.
That is Pellagra. The niacin deficiency disease. The one we eradicated from the developed world when we fortified bread. The one that causes diarrhea, dermatitis, and dementia — which, funny enough, I have all three. The one that shows up when a Carcinoid tumor is eating all your tryptophan before your body can convert it to niacin.
A debuff. Running since January, at minimum. Nobody read the status effect.

The cardiac workup: right heart cath, left heart cath, TEE. Tricuspid regurgitation — severe, no valve damage, no dilation, no carditis. The cardiologist worked very hard — very, impressively, almost heroically hard — to disprove two previous echos from two other hospitals. One from March noting vegetation. One from April noting mitral involvement and LV dilation.
When all the disproving was done and the data still pointed toward Carcinoid heart disease, the answer was: "You're compensating well. We don't need to worry about Carcinoid right now."
They assigned me Functional TR — even though every listed cause of functional TR had been ruled out in their own notes. The notes literally say "patient does not have..." for each one. The things that cause it are not present. And yet here we are, sitting with the diagnosis, because the alternative required someone to say a word out loud.
Then one doctor walked in. Read the whole chart. Looked at the whole picture.
Said: you have Carcinoid.
The NPC who breaks from the script. The one who wasn't supposed to tell you. He said it anyway.
They got mad at him. (continued)