It is Friday, my regularly scheduled outpatient clinic day. As what sometimes happens, the last patient of the day and her mother are crying. This is how it unfolded. I look down and see written on the referral sheet: 16-year-old girl with QT prolongation and syncope. Sounds simple — diagnose her with long QT syndrome, take away her alarm clock, swimsuit and running shoes, start a beta blocker, print out a sheet on QT-prolonging medications, and send her on her way. Well, it is never that simple. In fact, it is always complicated. This girl’s corrected QT interval is 469, she has normal appearing T-waves, and now it gets dicey. As she tells the story, it becomes less clear whether she actually fainted. Syncope has been replaced by extreme dizziness that brought her to her knees, but she swears consciousness never left her. There is no family history of sudden cardiac death, but her 19-year-old sister had a single seizure at 8 years of age while waking up to her alarm.