Nocturnal Weight-loss Journey

Look, I know what you’re thinking: vampires don’t get fat.

Yeah? Tell that to my XXXL belt stretched to its last improvised hole.

I wasn’t always like this. Eighty years ago, I was a poster child for Gothic chic — gaunt, brooding, cheekbones sharp enough to julienne fries.

Somewhere between the invention of high fructose corn syrup, and the rise of “holiday blood samplers for the undead”, things got… soft.

Do you have any idea how many calories are in a “double–smoked, truffle–fed, ethically sourced AB negative tasting board”?

Neither do I. My thighs and my belly, however, are fully informed.

My coven has been no help.

“You’re dead, Max, “my Sire Viktor likes to say. “you are beyond such mortal concerns.”

This from a man who still owns corduroy pants he hasn’t hasn’t fit into since the Cold War.

“Maybe I’m emotionally alive,” I told him once. “And emotionally I don’t love this muffin top.”

“Then feed more,” he said. ”More power, more glamour.”

“More gut,” I pointed out.

He shrugged, swept off to brood on his gargoyle, and that was that.

The truth is, I don’t even want to feed on humans the old-fashioned way anymore. It’s messy, morally complicated, and everyone’s on a weird medication cocktail. One sip and I’m tasting SSRIs, hormones, erectile dysfunction medications. It’s like chugging a pharmaceutical smoothie. I feed at breakfast and I get an erection. I feed at dinner and my balls shrink. You get the point.

I want to be in control. Less hunger. Less obsession. Less feeling like a mobile addiction in a black hoodie.

So there I was one graveyard shift – 3:17 AM – doom scrolling in my coffin, when I saw it:

TIRED OF CRAVINGS?

GAP-1: THE NEXT GENERATION IN APPETITE SUPPRESSION. Covered by most insurance plans. Clinically proven. Minimal side effects. *

The Asterix said, “side effects may include existential dread”

Finally, some honesty. They have my number.

“Cravings you can’t control?” Check.

“Haunted by old habits?” Double-check.

Clamoring for a body – and life – you never had?” OK, rude. But accurate.

I clicked “Apply Now”.

Their online form was longer than my unlife.

“do you smoke?”

“No, my lungs retired in 1943.”

“Any history of heart disease?”

“I haven’t had a heartbeat since FDR.”

“Race – ethnicity,”

Nosferatu-American.”

Obviously I couldn’t write any of that, so I lied – like any respectable undead citizen.

Finally, ” THANK YOU, MAXIMILIAN!” scrolled into view…. followed by “To qualify for GAP-1 coverage, please complete fasting labs at a partnered facility within seven days.

There was a list of 24 hour labs. At last something designed for people like me who spontaneously combust at noon.

I picked Nightline Diagnostics because their logo had a MOON. It felt like a sign. “Needle versus vampire: vampire wins.”

Once it was sufficiently dark I stepped into Nightline Diagnostics. . The receptionist barely glanced up. “Name?”

“Maximilian Drakov. "

“Insurance?” I slid my card over. She sighed. ”GAP-1 program. Got it. Take a seat.”

I sat next to a plant that had given up on living and a rack of magazines promising “top Ten Summer Abs Moves.”

I considered eating the plant out of spite.

“Maximilian?” a phlebotomist called.

I followed her into a blood draw room, decorated with a motivational poster of a mountain and the words “the first step is the hardest.”

“Roll up your sleeve, ” she said.

“Just a heads-up, “I said. “I’m… a little tricky.”

“Everyone says that, “she replied absently.

She tied tourniquet, tapped my arm, frowned. Tried my forearm. Frowned harder. She grabbed a needle. “Try to relax. "

She slid the needle in. The needle bent into a 90° angle. We both stared.

“OK, “she said slowly. “That’s…. Not…ideal.”

“maybe the second step is harder, “I quipped. She glared.

Three needles later - still no blood.

“Do you drink a lot of milk? " she asked weakly. “Like, a lot of calcium? "

“My bones are fine, but the rest of me to jiggles.“

She glared.

I grinned, careful to keep my fangs covered.

She fetched reinforcements. After a small conference of increasingly nervous staff and a supervisor who entered “metallic skin disorders” into his tablet, they surrendered.

“Sir, we are unable to perform a blood draw , “the supervisor confessed. “You’ll need to follow up with your provider. "

“If I follow up without the labs, she’ll send me back here, “I groused. We’ll play phlebotomy ping-pong until the sun explodes.”

“We cannot help you, Sir.”

“I’m not leaving until you draw the blood.”

“Then we will have no choice but to call the police.”

“What if I draw my own blood for you” I offered.

Which is how, 10 minutes later, I ended up in a supply closet with three empty vials and three fresh needles that did not look like origami.

I locked the door, rolled up my sleeve, and stared at my wrist.

And then I bit.

Biting yourself as an art: too shallow, you bruise: too deep, you face plant in a mop bucket. I hit the sweet spot, grimacing as my own blood weld up, I filled the vials, lick the wound closed, and I labeled everything like a responsible patient.

When I handed the vials over, the phlebotomist blinked. “How did - ?”

“Big vein… down below " I pointed to my groin.

Kids, don’t try that at home. Or do. I’m not your dad.

A week later, I had a video appointment with Dr. Patel.

“Nice to meet you, Max, “she said from a neat home office. “Your labs look OK. Your body mass index, or BMI - "

“Let’s not, “I cut in.

She smiled. “You qualify for the GAP-1 program. You mentioned intense cravings?”

“On a good night, I can distinguish the scent of everyone’s blood type on a subway car. It’s…distracting.”

She chuckled, thinking I was joking. I chuckled, knowing I was not.

“I usually start patients on semaglutide, " she continued. “Weekly in injection. Helps the appetite, cravings, weight loss.

“I was hoping for tirzepatide.” I countered.

She winced. “Your plan only covers tirzepatide for diabetes. We can appeal, but they almost always deny. Generally, semaglutide is still effective, Usually… Sometimes…”

So I was getting the off-brand version of my dreams.

“We’ll pair it with the GAP-1 app you can download to your phone.. " she added. “Documenting engagement criteria is important for continued insurance coverage.”

“Sure, I can engage, I’m very engaging.”

She laughed, wrote the prescription, and warned me about nausea, vomiting, constipation, and everything short of spontaneous combustion.

“We just need to get a PA” the doctor mumbled. “Before the pharmacy will fill the script.”

“PA Say what?” I should have seen this coming.

“Prior Authorization”. She answered. I just need to fax a form. Takes maybe 2 or 3 days tops to get the approval. Not to worry.”

Apparently, Prior Authorization occurs when my pharmacy says my insurance company says my doctor needs to fax a form. No, not the form you’re holding. The other form. The form nobody can find.

Not to worry? Spoiler Alert: You figure it out. Three days, my ass! Three MONTHS later, my PA was approved and I FINALLY received my first month of semaglutide - Four auto injector pre-filled syringes. I named them “My Precious”.

Then there was the bill.

At the pharmacy, the tech rang me up and said, very casually, “That’ll be twelve hundred dollars.”

“For how many months?” I asked

“One,” she said. “After insurance.”

I looked a her, then at the price. “So essentially one mortgage payment, half a soul, and possibly a spare organ.” She frowned She didn’t get my sarcasm. I moved her to the top of my snack list.

And of course, I paid. I am, apparently, both immortal and an idiot.

At first, it was glorious. By week two of my first month of treatment, I woke [well rose] without the overwhelming urge to inhale the blood volume of the entire Crossfit class next door.

The constant gnawing loosened. I even ate human food - three fries and half a pickle. My stomach waved a little flag and said. I’m done, thanks, but no thanks.

I stepped on GAP-1’s smart scale. First week: Down four pounds; second week: down seven pounds.

I whooped. In my coffin. Alone. Then, I high-fived the gargoyle Viktor sits on to brood. Dignity is for humans.

The app pinged: “Great job, Max! Don’t forget to log your meals. and your steps.”

I logged my “meals” including one unit O-Negative. There was no macro for “blood”, so I picked “other protein” and moved on.

Engagement Criteria:

Weekly weigh-ins via smart scale

Daily food logs.

5,000 steps per day logged on my smart phone.

The weigh-in and logging were fine, Steps…not so much.

When I turn into mist or a bat, my i-phone didn’t count that as “movement”.

I tried jogging in mid-air. My phone still ignored me. All I did was scare the rats.

Discrimination, honestly.

Two weeks in, I get a notification: Heads up Max! Your movement data is incomplete. To stay in GAP-1, be sure your app is syncing properly. I checked. The app claimed my scale was “offline.” The scale insisted the app was “not authorized.” My phone said everything was “up to date”and suggested I buy a new charger.

I called GAP-1 support.

“Thank you for calling GAP-1 support. Your call is very important to us. Please remain on the line where you be helped by the next available representative.”

49 minutes later I was still on hold, listening to the background music of ABBA and the sun was rising.

I called GAP-1 support again the next night at precisely midnight. The message was different. This time I was instructed to remain on the line, and informed that I was 2nd in the queue for a representative. 53 minutes later, Carla answered. “Thanks for calling GAP-1” a tired voice said. “Are you currently having thoughts of self-harm related to your wellness journey?”

“Not yet,” I answered. But we’re early in the call”

We did the ritual:

Reboot Scale

Delete App

Reinstall App

Re-Pair devices

Swear creatively.

Nothing.

Carla pounded furiously on her keyboard for several minutes. “I’ve escalated your ticket. In the meantime, you can manually enter your weight.”

“What about the engagement criteria?” I asked.

“That’s a different tech team.” I could hear the yawn. “But they totally understand when it’s a technical issue.”

Spoiler Alert: they did NOT understand.

To be fair, communicating with GAP-1 technicians in my home trouble-shooting my GAP-1 equipment, while I remained hidden in my coffin trying to avoid detection was …dicey at best.

I had not yet solved my tech crisis when my first month of medication ended, and I received the GAP-1 portal message: “Dear Member, semaglutide for weight management has been removed from your formulary. You may continue this medication by paying the full cash price of $1,800 per month.

I swear I heard my wallet scream.

The note continued: “Alternatively, Tirzepatide is now approved for weight management, pending prior authorization.”

“So,” I told my reflectionless bathroom mirror, “after one month of the budget version, they’re offering what I originally asked for…and we get to do the prior authorization circus again.”

The mirror did not respond, which was probably wise. Next on my checklist was my appointment with Dr. Patel.

“Good news,” she said brightly. “We can now request Tirzepatide for you!… After PA….” The doc was mumbling again.

“Ah,” I sighed. “Prior Authorization. My favorite horror genre.”

“She looked up at me, nodding in agreement. “You need to document your failed lifestyle interventions again.”

I sighed. “I’ve tried keto, cardio, and not murdering people. None sustainable.”

Doc Patel smiled.

I mentally cooed. “How adorable, she still thinks I am kidding.”

The doctor continued: “I am putting down for proof of failure of cheaper options: Inadequate response to Semaglutide.”

“I drink plain black coffee. I’ve failed all joy. Do those count?”

Then came the wait. You would think being immortal would make waiting easier. It does not. I endured the Spanish Flu, the Cold War, and Dial-up Internet. But waiting for Prior Authorization? Somehow, this is what makes me question my immortality.

But wait, I did, and in a mere three weeks, I was approved for Tirzepatide.

Silly me, I thought that would be the end of my wait.

Clutching my prescription, I entered the first pharmacy: “Oh, we don’t stock that.”

Second pharmacy: “We had one box. It expired in 2023.”

Third pharmacy: “We have the drug, but we are out of compatible needles.”

“What does that mean?” I asked.

“it takes a specific gauge and length, “the pharmacist said. “We only have ones for, uh, horses.”

“I am not injecting myself with a javelin.”

Fourth Pharmacy: “we can order it. It’ll be 10 to 14 days. "

“Sure, “I said. “What’s two more weeks between me and a murder charge.”

After enough delays to fill a miniseries, I finally had the box. I took the first dose. It was amazing!

For the first time in forever, the constant annoying quieted. My cravings for blood dim to background noise. I could walk past a crowded bar and think ‘those people are annoying’, instead of, ‘those people are snacks’.

I lost more weight. I felt - relatively speaking- almost sane.

Which is when the insurance company did what insurance company do.

“we’ve updated our coverage” the message began. “Tirzepatide for weight management will no longer be covered under your plan. You may remain on Tirzepatide for diabetes indications. If you do not have diabetes, please consult your provider regarding alternative options.”

I’m back in Dr. Patel’s office.

“They dropped tirzepatide.” I said.

She sighed. “I know. I’m getting a lot of unhappy patients like you. " She hesitated. “there….is another option. "

“If you say, ‘mindful breathing’ I’m going to chew through this desk. "

“Cash-Pay Program.” she said quickly. “Manufacturer sponsored; No insurance; Flat rate of $299 per month; No prior authorization; No engagement criteria; Just a credit card and some basic labs. "

I stared at her evenly. Her cheeks pinked. “Well, we like to exhaust insurance options first. "

I am now 6 months into my weight-loss journey with tirzepatide, and everything is fabulous.

Viktor and my coven have taken note of the new me, and they are starting to come around. Now that he is losing weight, Viktor no longer sits on the gargoyle brooding. He’s out most every night riding his Harley.

I inherited Viktor’s corduroy pants. Now, when I jog mid-air, I make a swishing noise that my iPhone recognizes as movement. I don’t need to keep a daily step count with the cash program, but who knows what the future holds?

Business for Doc is booming - mostly undead seeking the Holy Grail of weight loss. She is beginning to realize that I was not …joking with her. And NO, I have not bitten her. Why would I?” She is the Keeper of the Sacred Prescription Pad

Oh, and in case you haven’t figured it out already, tirzepatide is now “My Precious”. I demoted semaglutide to “My Semi-Precious”. Get it? …Pretty good, right? … Hey! Quit with the attitude…my story, my rules.