"I've biopsied the stripper. I'm waiting on Pathology. His symptoms are compromised by the concussion so he's not following the same pattern as the others. Fever started later," Chase said, consulting his notes. "Rob's maxed out. You give him anymore phenobarbital and you're going to put him in a coma or fry his brain. We need to avoid that. The minute he's comatose, we have seven days. He's coughing up fresh blood. It's hard to confirm if it's coming from his stomach or his chest. It's not going to hurt to do an endoscopy like Wilson suggested. The Meningitis test was negative. We should repeat it just in case."
"There's a young newlywed couple in the ER as we speak. They came into the clinic with the same symptoms. She thought she might be pregnant, which is why they didn't present sooner. The husband has a rash on his torso similar to Rob's," Cuddy revealed. She looked at House calmly. "I'm surprised you even have plans to respect his wishes on the artificial prolonging of life."
Wilson placed his pen down on the legal pad before him. "It's not mesothelioma. The cytology from the biopsy was negative. There was no abnormal cancer cells. You could do a laparoscopy to double check cells in the abdomen, but I wouldn't recommend it. His condition is getting worse. It's just going to weaken him more to do unnecessary tests."
Amber was really trying not to take it personally how much Wilson was making a concerted effort to ignore her. He had chosen the seat furthest away from him, and she was sure if he could, he would have sat in Foreman's lap to just get that bit further away. It wasn't her fault she was dead. She wasn't dead when she got here, in fact, they were having some really hot sex. She knew there wasn't going to be anything romantic between them, but it would have been nice if they could be friends and would be nice if he wasn't treating her like she was, well, a corpse. "He requested it. If I didn't give it to him, for all we know, he would have pulled the plug on letting us touch him at all," she threw back with a glare in House's direction. "I tried to talk him out of it, but he wasn't having a bar of it. I think he's worried we're going to tell him at any minute he's got something that means he can't go back to the Army. He doesn't know anything but being a soldier. No one can blame him for not thinking completely rationally right now. But
( ... )
"He's reporting more and more joint pain. He said it's easier not to move," Cameron offered. "If Lassa Fever was on the table, why not Malaria? Anemia is a distinct symptom of that and Draco has come in moderately anemic. If we look at symptom patterns and still assume Rob is more advanced in whatever it is than anything else, the other cases have classic early Malaria symptoms, while Rob's convulsions, cough and intracranial pressure could be signs of the advancement. He's been sick longest of them all. It makes sense. We should check for splenomegaly."
Foreman was leaning back in his chair. "If we're going to go tropical and environmental, why not Dengue Fever or Ross River Fever?" he suggested. "He's been in Iraq for God knows how long, probably fighting alongside Aussies." Everyone - inevitably - glanced at Chase when this was said. "Ross River is primarily transmitted through Australian mammals, but if he was fighting with Aussies shipped to Iraq too, mosquitoes bite the Aussie, then bite Americans. Then he comes to the island with the disease, island mosquitoes bite him, then everyone else. Symptoms fit."
House rolled his eyes, leaning over to "whisper" to Cuddy. "Are you kidding? Of course I don't plan on it. Don't tell Cameron though. She'll do that thing where her eyes roll so far in the back of her head she can see her brain and start spewing the moral and ethical code out to me in tongues." He exaggerated a shiver
( ... )
Chase frowned. "What, you think he's developed it since being in hospital? Since the test?" he asked, seeking clarification as he tried to wrap his head around it. "The other patients have tested negative for it too. And don't be so quick to fob off something like Ross River. Foreman's right. It can manifest in epidemic-like waves back home and we're sending tri-force troops to Iraq all the time."
Cuddy cleared her throat. "You have to get past Chase, first, and his new guard dog, Amber," she returned to House under her breath with a smug smirk.
"I thought we clarified the rash wasn't Meningitis and that was ruled out?" she asked, speaking louder. "Is the tap going to just be for testing purposes or are you going to put him on an intercostal drain to bleed the fluid out? The way it's progressing, he's going to start drowning before you have a chance to get to get to the tests."
Wilson shot both Cuddy and House a long-suffering look, catching Cuddy's comment and parts of House's previous one. "Anyone thought to enquire as to his state of mind? He's signed a form against artificial prolonging of life. Are we sure he isn't going to try and take himself out with the IV cord behind our backs? A 'how are you feeling' could go a long way when he has a team of doctors sucking bodily fluids out of him at every turn," he reasoned.
Amber looked at Wilson with a small frown. "I always enquire about his state of mind. It's getting worse in that he's losing hope. Can you blame him? All these doctors running around and he's getting sicker. I'd be losing hope to." She shook her head. "I think we should swab the rash, make sure it's not an allergy. All the drugs we're pumping into him and someone who has very little medical treatment in his history, you never know."
It was doing Cameron's head in watching Amber speaking directly to Wilson like that. A cheesy as it sounded, it was like watching a ghost, and she could only begin to imagine how Wilson was feeling with it. She had died so horrifically after being kept alive to try and save her, now she was just... here. And on the differential. Cameron realised enough though to want to point out to House he made an error firing Amber. She hadn't seen any evidence yet that Amber was less than capable of holding her own in diagnostics.
"More broad spectrum ABs? House, he's not responding to them. If they were going to work, he wouldn't be getting sicker and wouldn't have his lungs filling up with fluid. Amber has a point. The more you give him, the more you risk side effects that could mask whether his symptoms are getting better or worse if you throw everything at him at once. Thiabendazole can cause nausea, vomiting, fever, headache, dizziness and that's just one drug. Then you need to ween him off each one to see what's worked. There's not enough
( ... )
"It's still going to take time to give them to other patients," Foreman reasoned, gesturing with his hand. "He could still have side effects. What works for one patient could kill another. When did you stop realising diagnostics wasn't a little like Russian Roulette? Too much time in the ER," he scoffed.
He turned his attention to House. "It might not be Ross River because you don't like Aussies in general or because that's too easy?"
"Now I know what to get CB for her birthday. Collar and leash. Cheap, and effective." House smirked back, exaggerating a mock growl in Cuddy's direction, bared teeth and all.
The Wilson/Amber dynamic was getting quite amusing to watch. Amber was getting frustrated.
"It's meningitis, but it's not just meningitis. Meningitis as a symptoms for something else. What other diseases do we know that cause meningitis?" He turned back to the team. "And before you start again, it isn't Ross River, because it isn't a virus. How do you know that the broad spectrum antibiotics aren't keeping whatever is killing him from actually killing him? He already has the side effects, so we don't have to worry about that now, do we? Up the broad spectrum dosage." He paused for a moment, grabbing his coffee from the table, taking a sip. "Or don't. On second thought, do the exact opposite, and take him off of them. See if he deteriorates. If he does, we know it's bacterial."
Chase was about to throw something else in when his pager went off. He unclipped it from his belt and brought the message up. "Draco's got bloody diarrhoea," he sighed, scratching his fingers through his hairline. "And a rash.
A second page came through almost simultaneously from another doctor. "Rob woke up hyperventilating after a nightmare." He frowned and shook his head. "No, that doesn't make sense. He'd be crashing if he hyperventilated. His lungs don't have the capacity for it. I need to get over there to check this out." He clipped his pager back to his belt and left without another word.
"I bet you would love to watch her wear it," was Cuddy's hushed response and she just quirked an eyebrow at Wilson as if challenging him to say something about his disapproval.
Her eyes turned back to the whiteboard and she gestured with her pen. "The soldier doesn't have diarrhea. The only gastro symptoms he has his nausea and vomiting, possibly vomiting blood. Haven't the other patients mostly been mirroring his symptoms to this point?"
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"I thought we clarified the rash wasn't Meningitis and that was ruled out?" she asked, speaking louder. "Is the tap going to just be for testing purposes or are you going to put him on an intercostal drain to bleed the fluid out? The way it's progressing, he's going to start drowning before you have a chance to get to get to the tests."
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"More broad spectrum ABs? House, he's not responding to them. If they were going to work, he wouldn't be getting sicker and wouldn't have his lungs filling up with fluid. Amber has a point. The more you give him, the more you risk side effects that could mask whether his symptoms are getting better or worse if you throw everything at him at once. Thiabendazole can cause nausea, vomiting, fever, headache, dizziness and that's just one drug. Then you need to ween him off each one to see what's worked. There's not enough ( ... )
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He turned his attention to House. "It might not be Ross River because you don't like Aussies in general or because that's too easy?"
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The Wilson/Amber dynamic was getting quite amusing to watch. Amber was getting frustrated.
"It's meningitis, but it's not just meningitis. Meningitis as a symptoms for something else. What other diseases do we know that cause meningitis?" He turned back to the team. "And before you start again, it isn't Ross River, because it isn't a virus. How do you know that the broad spectrum antibiotics aren't keeping whatever is killing him from actually killing him? He already has the side effects, so we don't have to worry about that now, do we? Up the broad spectrum dosage." He paused for a moment, grabbing his coffee from the table, taking a sip. "Or don't. On second thought, do the exact opposite, and take him off of them. See if he deteriorates. If he does, we know it's bacterial."
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A second page came through almost simultaneously from another doctor. "Rob woke up hyperventilating after a nightmare." He frowned and shook his head. "No, that doesn't make sense. He'd be crashing if he hyperventilated. His lungs don't have the capacity for it. I need to get over there to check this out." He clipped his pager back to his belt and left without another word.
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Her eyes turned back to the whiteboard and she gestured with her pen. "The soldier doesn't have diarrhea. The only gastro symptoms he has his nausea and vomiting, possibly vomiting blood. Haven't the other patients mostly been mirroring his symptoms to this point?"
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