I have two questions concerning the discard pile:
1. What happens if the first card turned face up is the excuse?
The Excuse starts the discard pile, and the first player has the option of picking it up.
2. What if the first player takes his first card from the discard and discards an Ace?
The discard pile is empty, so the second player must draw from the deck. If they also discard an Ace, then the first player must draw from the deck on their second turn. This continues until a player discards something that's not an Ace.