Chase looked at Foreman tiredly. "Well done, Foreman. Next time just test for the shit, okay? Especially if it's just bloods. Still, we all got thrown on the wrong path thinking it was one illness."
He took a crumpled piece of paper from his pocket and unfolded it. "Keep thinking outside the box, but I don't think it's going to hurt to focus the environmental factor of the desert environment he was in for months before he went AWOL from service. He died seven or so weeks after the date he ended up on the island, and he started getting sick just over two weeks ago... now. I think it's linked, but I think whatever we have been dosing him with has prolonged the death. Something he wouldn't have probably presented to an infirmary in Iraq to be given. I also think that if he was symptomatic of this during fighting, he wouldn't haven taken any notice like he did here. Dust, dirt, fumes, chemicals. He could have been coughing his guts up and had any number of excuses to cover it. Nausea could have been written off to dehydration. Fever, to
( ... )
Cameron realised Amber had become Rob's friend, on some level. She was shocked to hear what Chase had to say, too, so she could only imagine what it was like for Amber to try and absorb. "If he died seven weeks after the date he got here on the island, he wouldn't have known he died. How would he know?" She turned to Chase with a frown. "How do you know? This could just send us on another wild goose chase, which we don't have time for. How certain are you that he died there, or are you just clutching at straws and speculating?"
Foreman pressed his lips together and sighed as he rolled his eyes a little. "The dude's a frontline soldier. It's not such a freak thing to speculate," he pointed out. "And even if it is, what other leads to we have? None. A dirty great abscess in his brain that could be caused by anything. To even shove the speculated death into the background, the environmental factor of the war still remains prominent like Chase said. We haven't explored that yet because we got sidetracked by the other patients who aren't soldiers who have been stuck in the desert for months on end. I think the abscess should be the launch pad. What about Glioblastoma multiforme? Seizure, nausea, vomiting, and abscess. It's also one of those diseases that can be asymptomatic until the abscess reaches any prominent size. Explains the time lapse. Also doesn't offer a very positive prognosis, but the guy could still be mincemeat in three days no matter what we do."
The squeak of the marker against the white board added to the noise of the room. Aspergillosis, Nocardiosis, Sporotrichosis, and GBM were written down one below the next in the empty space. For right now, House would take anything he could get. They could start narrowing down once they were out of ideas. There was no time to waste arguing.
"I saw the funeral notice, and the email from Cuddy. He's dead. Amber didn't know she died either until she got here," he explained pointedly. "Keep going," he instructed.
Chase pulled a photocopy of said documents out of the front of Rob's medical record and pushed it across the conference table to Amber. "I'll talk to you more about it later, okay? Long story. You're just going to have to trust me on this. It's not vital knowledge, but it's something we should just be aware of, otherwise I wouldn't have raised it."
Amber had to take a few moments to read over the documents. It hurt to read. Rob shouldn't have been one of the people like she was. But then, if he was, he could be stuck here with Fox and Amber just knew how important the tattooist was to him. She touched her fingers to her lips briefly and then pushed the photocopies away into the middle of the table, clearing her throat as her eyes locked back on the whiteboard. "Legionellosis."
"Wait, what about the rash on his torso? We can't just ignore that. It doesn't look like a rash from an drug allergies. What about something like Pneumocystis Pneumonia, but linked to another bacterial infection. Like Chase said, he's been in extreme environments. If he's been immunocompromised by one illness, he could be like a buffet for other infections," Cameron reasoned. "Or what about WHIM Syndrome?"
"If he's a bacterial buffet, he's dead," Foreman said bluntly, but honestly. "We can either diagnose him or we can't. With his symptoms, if the girlfriend doesn't pull the plug, his liver is going to fail in less than a week anyway if we don't find this thing and target it. Pneumocystis wouldn't cause a brain abscess or seizures or any of his neurological symptoms. The rash isn't going to kill him, failing respiratory system and failing liver will. WHIM makes more sense if you're going to go with anything, but I doubt it's that. He has no warts. Anywhere. It could be Empyema. Covers everything but the rash. The cellulitis could just be caused by an Eczema from the tropical environment or the stress his body is under."
Legionellosis, WHIM, and Pneumocystis were abruptly added to the list. "No sense in ignoring the rash," House warned, eyes transfixed to the board. "It's been there for a week. You think he got an Eczema flare up eight weeks after he got here without it flaring up before? Rash could be explained by something like... oh, I don't know, Bacterial Meningitis if Meningitis was a symptom like I said five days ago. Just because you got the last diagnosis right doesn't me you get a free pass on this one. You can forget the cookies now," he scolded.
He pointed at Cameron. "How many tests can we run with what you took from his brain? Magic number here is seven. Eight if you assume Foreman's still going to stay cocky and mess one up."
"It's not a Meningitis rash. The rash faded with the tumbler test. And it's just on his torso, nowhere else. He would be covered by now if that was a Meningitis rash," Chase had to point out before House got too smug. "You're missing the clues just as much as Foreman is. Just like we all are. You got your Meningitis symptom. You can feed each other cookies while the rest of us actually work, hmm? Leave the pissing contests at the door for this one, please. We don't have time," he said, getting snippy himself. "If Meningitis is a symptom, what is it a symptom of, House? What differentials are you going to offer?"
"It's cellulitis," Amber insisted. "And how do we know he isn't prone to Eczema? He presented with the flu. He isn't going to randomly throw in 'Oh, by the way, I get itchy in the heat or when I'm stressed occasionally'."
Cameron put her hand to her hand. "Oh puh-lease, enough with the testosterone. If you're going to start pissing on each other and pounding your chests, I'm out of here." She shook her head. "You'd be lucky to get seven. With his condition as unstable as it is, we didn't want to keep him open too long. We have to decide which possibilities take priority and work from there."
Foreman threw his hands up. "Hel-lo! Are we just going to ignore the respiratory failure, neurological symptoms and liver scarring? I'm surprised someone hasn't said Lupus," he said sarcastically.
He pointed to the whiteboard. "I say test in the order they're presented on the whiteboard. The top three fit everything if you squint. Except Nocardiosis, seeing as we're stuck on the rash. If it was that, it would be on his arms and legs, just like Meningitis if it was exhibiting a rash at all."
House clenched his teeth in aggravation, raising his voice. "Shut up, all of you. I get the privilege of being the sarcastic one in this room. Bacterial meningitis test was positive." House wrote down Granulomatous Amoebic Encephalitis and Hib. "And 'Lucky to get seven' isn't a damn number. Give me a number. Three? Four? I want the pieces big enough that we can actually get a diagnosis instead of wasting time getting an inconclusive outcome, but we need to stretch this out as far as we can."
He struck a line through 'Nocardiosis,' 'Pneumosystis,' and 'WHIM.' "We all agree to rule these three out?"
"No," Chase said immediately, watching the lines go through the board. "You don't call a differential to narrow down only to rule them out on a whim. Leave them there, just test them some other way. You have three tests. That's all the biopsy will allow."
He paused, shaking his head to him. "Nocardiosis fits, House. Save for the rash on his arms and legs. It's transmitted by soil. It's difficult to diagnose. Do you really just want to strike something like that out because we can't all decide is the rash is even a rash?"
He took a crumpled piece of paper from his pocket and unfolded it. "Keep thinking outside the box, but I don't think it's going to hurt to focus the environmental factor of the desert environment he was in for months before he went AWOL from service. He died seven or so weeks after the date he ended up on the island, and he started getting sick just over two weeks ago... now. I think it's linked, but I think whatever we have been dosing him with has prolonged the death. Something he wouldn't have probably presented to an infirmary in Iraq to be given. I also think that if he was symptomatic of this during fighting, he wouldn't haven taken any notice like he did here. Dust, dirt, fumes, chemicals. He could have been coughing his guts up and had any number of excuses to cover it. Nausea could have been written off to dehydration. Fever, to ( ... )
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"I saw the funeral notice, and the email from Cuddy. He's dead. Amber didn't know she died either until she got here," he explained pointedly. "Keep going," he instructed.
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He pointed at Cameron. "How many tests can we run with what you took from his brain? Magic number here is seven. Eight if you assume Foreman's still going to stay cocky and mess one up."
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He pointed to the whiteboard. "I say test in the order they're presented on the whiteboard. The top three fit everything if you squint. Except Nocardiosis, seeing as we're stuck on the rash. If it was that, it would be on his arms and legs, just like Meningitis if it was exhibiting a rash at all."
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He struck a line through 'Nocardiosis,' 'Pneumosystis,' and 'WHIM.' "We all agree to rule these three out?"
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He paused, shaking his head to him. "Nocardiosis fits, House. Save for the rash on his arms and legs. It's transmitted by soil. It's difficult to diagnose. Do you really just want to strike something like that out because we can't all decide is the rash is even a rash?"
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