🎭 ACT III: The Rewrite

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What do you do when the story doesn’t match the facts?

You write a new one.

That’s what the institutions did.

While Nicole’s liver screamed, her heart strained, and her adrenal system tried to kill her slowly — they handed her a script. Psychiatry. Fibromyalgia. Depression. Stress.

This wasn’t just gaslighting.

It was a clinical cover-up.

Weeks after prescribing valproic acid — which triggered Nicole’s hepatic coma — Dr. Sahar Safavi filled out a government form affirming Nicole’s **severe neurological disability.** On January 15, 2020, Safavi certified that Nicole **could not ambulate 50 feet without stopping due to disabling neurological or other physical conditions**, qualifying her for a temporary disabled parking placard.

She checked this box under penalty of law.

And yet, within KU Health’s records, Nicole’s condition was minimized, deflected into psychiatry, and never acknowledged again by Safavi.

A handicap certification is not a casual clinical note. It’s a legal admission that Safavi knew Nicole’s symptoms were real and severe. She just wasn’t going to treat them.

Nicole spent most of 2020 unwell, unacknowledged, and trying to find someone to believe her. Her symptoms persisted — bile vomiting, cognitive dulling, fatigue, pain, neurological symptoms — but no one looked back at her liver, her adrenal system, or her heart.

She was medically frozen.

Dr. Avery Abernathy became Nicole’s new PCP through Meritas. He had **full access** to her history. Nicole brought up the positive ASMA, her hospitalizations, and the unresolved bile vomiting. Yet Abernathy showed no urgency. He didn’t mention autoimmune hepatitis. He didn’t review the prior damage. Instead, both visits were closed out and signed off on **the same day** — without any new direction.

Nicole later discovered that neither her prior KU visits nor the autoimmune labs had been incorporated into the active problem list. Abernathy had the records. He just didn’t use them.

🧠 December 11, 2020 — Nicole Finds the Tumor

Nicole herself located the adrenal mass by reviewing her own imaging from September 10, 2019. She told Abernathy directly.

He ignored it.

Nicole was referred to endocrinologist Dr. Michelle Orr (Meritas) to investigate the adrenal mass. Orr received labs showing:

- **Elevated aldosterone (34 ng/dL)**

- **Low A.M. cortisol (1.1 µg/dL)**

- Symptoms of polyuria and adrenal dysfunction

Instead of investigating further, Orr claimed the aldosterone was fine because the ARR was normal at 13.9 and did not mention the cortisol at all. She failed to order proper follow-up labs or imaging.  Instead choosing to test for a pheochromocytoma which originate in the medulla and this growth is stated to have appeared on the medial limb of the left adrenal gland which would mean a cortical origin therefore ruling out a pheo.

She did not order the right test. She did not escalate the case. Instead, she referred Nicole to another endocrinologist.  At Nicole's request.

Dr. Madhavi Yarlagadda at Research Hospital (HCA) received the referral from Orr. She ordered both aldosterone and renin labs:

- **Aldosterone: 7 ng/dL**

- **Renin: 0.17 ng/mL/hr**

- **ARR: ~41.18** (strongly suggestive of autonomous aldosterone production)

But Yarlagadda never calculated or documented the ARR. She signed off on the labs **as normal.**

Later, in December 2021, Nicole returned to Yarlagadda with MRI imaging. Instead of sizing or marking the adrenal adenoma, Yarlagadda simply described it as showing "slight thickening" and asked Nicole:

> “Well, what do you want me to do? Take it out?”

She signed off. No follow-up was scheduled.

Nicole later received a letter from Midwest Endocrine stating Yarlagadda would be leaving her post. She later discovered Yarlagadda had taken a position at KU Health — rejoining the very system that had started the cover-up in 2019.

By the end of Act III:

- **Safavi** Left KU Health on June 10th, 2021 

- **Orr** remained with Meritas and is now the most senior endocrinologist within their system.

- **Yarlagadda** has since joined KU.

Not a single white coat paid a price.

But Nicole does — every day.

Act III was not about healing. It was about **reframing**:

- Reframing a liver collapse into mood disorder.

- Reframing adrenal dysfunction into anxiety.

- Reframing diagnostic failure into patient noncompliance.

They didn’t treat the illness.

They treated the narrative.

Act IV begins when Nicole leaves Missouri.

And with it, their story starts to crumble.

They controlled the charts.
They controlled the language.
But they couldn’t control what came next.

A machine in Las Vegas would see what they refused to.
And suddenly, they weren’t writing the story anymore.

👉 [Continue to Act IV]