Denial Isn't a River in Egypt - Part 13/?
Title: Denial Isn't a River in Egypt (13/?)
Rating: R (for the occasional use of profanity)
Spoilers: Through Who's Your Daddy; all subsequent episodes are just figments of your imagination. :)
Disclaimer/other: See Part 1
Author's notes: Thanks to ggo85, who practically begged for a scene in which House performs a medical procedure on Wilson, and to the awesome silja_b, for helping me to portray it as accurately as possible. Muchas gracias, y'all.
Previous entries:
Part 1 Part 2 Part 3 Part 4 Part 5 Part 6 Part 7 Part 8 Part 9 Part 10 Part 11 Part 12
Wilson struggled to keep his eyes open as a couple of orderlies steered his gurney toward the treatment room at the end of the hall. The double dose of diazepam he'd been given a few minutes ago made him feel so sleepy, but he didn't dare close his eyes. That would only exaggerate the sensation of movement, and make him more susceptible to yet another vertigo attack. Through a process of trial and error, he had learned that lying on his right side and focusing on the side rail seemed to keep the debilitating symptoms at bay. But it was becoming harder and harder to fight off the powerful effects of the sedative, and he soon drifted into a pleasant, twilight state of consciousness.
He was vaguely aware of being the center of activity once the gurney stopped moving. At some point he must have dozed off for a minute or so, because the next thing he knew, he was lying on an exam table-on his side, with his knees flexed. A right lateral decubitus position, the medical part of his brain supplied. The soft murmuring of baritone voices had stopped, so House had probably chased the orderlies out of the room once they got him settled. Something cold brushing against an exposed area on his hip startled him, and he reflexively opened his eyes. Several seconds passed before Wilson could identify the strange sensation. It was an alcohol swab, used to wipe the Betadine from his skin in preparation for the bone marrow aspiration and biopsy. Crap. Why couldn't he have slept through this, too? He wasn't really afraid of the pain itself, but he was afraid of losing control if it was worse than he expected. That's why he had asked House to do the test, so he wouldn't have worry about keeping up appearances. The colonoscopy had been embarrassing enough, but at least he had slept through the entire thing. He couldn't bear the thought of being awake and looking like a wimp in front of an oncology colleague or one of House's fellows while undergoing a procedure that he routinely inflicted upon his own patients.
Unfortunately, there wasn't any way of getting around one witness to the proceedings. A lab tech needed to be on hand to prepare the specimen slides for analysis. Wilson tried to find some solace in knowing that he didn't have to work with this particular tech that often. He wondered if that was purely a stroke of good luck on his part, or if House had done his homework and handpicked her for that very reason. Whatever the case, Wilson was grateful for the illusion of some small measure of anonymity.
As he started to drift back to sleep, he thought he heard House's voice, and turned his head to peer over his shoulder. "Did you say something?"
"Yeah," House replied, brandishing a small syringe. "I said I was about to inject the lidocaine. Thought it might be nice to warn you before I turned you into a pincushion."
Wilson involuntarily flinched as the needle pierced his skin. "Great. I'll be sure to send you a 'thank you' card."
"Is that all? I was kind of hoping for a fruit basket."
"Would you settle for a blueberry Nutri-Grain bar?"
House finished injecting the local anesthetic and withdrew the needle, recapping it before discarding the empty syringe. "I would if you had any left."
"What do you mean? There's a whole box of them in my desk."
"Not anymore."
Wilson stared at House in disbelief. "You ate my entire supply of breakfast bars?"
"I was hungry," House answered defensively. "I've been working around the clock-trying to figure out what's wrong with you, and I didn't have any change for the vending machine. Besides, with that garden hose shoved up your nose, it's not like you're going to be eating them anytime soon. I didn't want them to spoil."
"They put preservatives in those things, you know."
"Oops. My bad."
House retrieved another pre-filled syringe from the drape-covered tray. "So, do you want a running commentary while I do this?"
Wilson shook his head. "Just give me the CliffsNotes version. Let me know before you stab me or collect the samples."
"Fine with me," House said as he uncapped the needle. "I'm going to stick you again to numb you up some more."
"Can't wait." Wilson turned his head back around so that he was facing straight ahead-partly because he was getting a terrible crick in his neck, and partly because he needed some semblance of privacy. He felt so sleepy and relaxed that he almost fell asleep-until House reached the nerve-rich connective tissue covering his hipbone and injected the anesthetic. Wilson barely managed to muffle a slight gasp. Shit, that hurt! Then, a few seconds later, the burning began to subside, and he slowly let out a breath that he didn't realize he'd been holding.
While he waited for the local anesthetic to take effect, Wilson cursed himself for getting into this predicament. What in the hell had he been thinking when he agreed to let House run all of these tests in exchange for one measly consult with a pain specialist? Now that he was about to have a wickedly large needle jabbed into the back of his hipbone, their lopsided agreement didn't make quite as much sense-or seem quite as noble. He was sick and tired of being poked and prodded, and feeling so damned helpless and dependent on a bunch of strangers for nearly everything. A week ago, he'd been running the entire oncology department. Now he couldn't even get out of bed to take a piss. It was so frustrating and humiliating! And the worst part was that there appeared to be no end in sight. He was scheduled for an allergy scratch test around 'dinnertime'-a term that held no real significance since he couldn't have anything to eat until the NG tube was removed. Then there was the EGD scheduled sometime tomorrow morning, and God knows what else House and his team might have in mind. Maybe he should ask for a psych consult. He must be crazy for going along with this.
A familiar voice intruded upon his self-pitying reverie, and he looked back over his shoulder. "What?"
"You feel this?"
"Feel what?"
House snorted. "Guess that answers my question."
"Oh." Wilson felt incredibly foolish. Of course. House wanted to make sure his hip was adequately anesthetized before he made a small incision for the large-bore aspiration and biopsy needles to pass through. It was so easy to lose track of the details from his perspective as a patient, and a loopy one at that. "Yeah, it's numb."
Wilson dropped his head back onto his pillow and turned his face toward the closed vertical blinds, away from House. He had performed this procedure hundreds-if not thousands of times-but he wasn't sure if his years of training and experience would help to allay his anxiety or not. He could imagine every single step...as well as every possible thing that could go wrong. What if he had a weird, delayed allergic reaction to the lidocaine? Or what if House got a dry tap and had to stab him again? Or what if the needle got stuck in the bone, or House lost the core specimen when he did the biopsy and had to go digging around for it? Or what if...
He immediately berated himself for even entertaining such thoughts. This was a simple, routine test, and he had every confidence that House could do it without any problems-even if he was a little out of practice.
There really wasn't any pain to speak of as House began to advance the aspiration needle into his hip-only some pressure as he felt the needle being twisted back and forth until it passed through the bone and into the marrow cavity. He wasn't sure if that was because House had an amazingly good technique, if the local anesthetic was more effective than he had expected, if the larger dose of diazepam made him feel fuzzier than he realized, or if he was simply too physically and emotionally exhausted to care. It didn't matter as long as he could get through this with some degree of his dignity intact.
Wilson lazily repositioned his head, wrapping his arms around the edge of the pillow almost as if in an embrace. An insistent voice in the periphery of his consciousness caught his attention, and there was a fleeting moment of embarrassment as he realized that he must have zoned out again. "What?"
"You doing okay?" House asked as he removed the stylet from the aspiration needle and attached a 10 ml syringe.
Wilson's eyelids slowly fluttered back open. "Umm...tired," he slurred.
House softly cleared his throat. "I'm going to aspirate the marrow now. This is probably going to sting a little. You ready?"
"Yeah." For some bizarre reason, Wilson thought the trite words of reassurance sounded oddly humorous. It was one of those things medical people tended to say before inflicting some kind of pain. Like telling patients they might feel a little bit of pressure, when it probably felt more like a truckload of frozen pizza falling on top of them.
"Okay, here goes," House said, sounding almost apologetic.
Wilson took a deep breath to prepare himself, not exactly sure what to expect next. Some of his patients claimed that this part of the bone marrow aspiration was only slightly uncomfortable, while others swore that it was the most excruciating pain they had ever experienced. Now he was about to find out for himself. Wilson didn't have to wait long for his answer. At first, there was just a mild twinge in his hip near the extraction site-nothing he couldn't handle. Then he felt a weird, pulling sensation, which was promptly followed by a sharp, shooting pain across his left buttock and down his leg. As the pain suddenly intensified, he clenched his teeth and hissed, reflexively tightening his grip on his pillow.
House's voice penetrated through the haze of pain and drugs. "You okay?"
Not trusting himself to speak, Wilson merely scrunched his eyes closed and nodded. He knew that it only took about five seconds to withdraw a small amount of marrow for analysis, but it seemed that time had crawled to a standstill. Moisture began to seep through the corners of his eyes as he buried his face into his pillow. Then, almost as quickly as it had begun, the pain mercifully abated.
House leaned forward, trying to catch a glimpse of Wilson's face. "Sure you're okay?"
"Yeah," Wilson panted. "Just...yeah."
"Sorry." House detached the marrow-filled syringe and handed it to the lab tech. "Maybe you should have had one of your buddies from oncology do this."
Wilson inwardly shuddered at the thought. "No, you're doing fine. Did you get a good sample?"
House carefully inserted the stylet back into the large-bore needle while he waited for the tech to prepare a quick smear. "We'll know in a minute. Hang on while we check for spicules."
The lab tech examined the slide, and then held the specimen in front of House for his inspection. "Looks good," he reported.
Wilson blew out a breath in relief. That meant that House had definitely gotten the sample from the marrow cavity, and wouldn't have to stab him again for this part of the procedure. However, knowing House, he'd probably want to collect another aspirate in case he needed to run more tests, and sure enough, he didn't disappoint. At least he didn't have to start the painful process completely from scratch. He attached a heparin-filled syringe to the needle already embedded in Wilson's hip and withdrew another sample. Fortunately, the second extraction didn't hurt nearly anywhere as much as the first. Wilson rationalized that maybe knowing what to expect had helped to alleviate his anxiety, which in turn had helped to alleviate the pain. Nevertheless, House owed him big time for consenting to so many-and probably-unnecessary tests.
House set the syringe containing the second sample aside and grabbed a couple of squares of sterile gauze from the prepackaged kit. "Okay, you know how this works. The biopsy shouldn't be nearly as bad."
"Oh, yeah?" Wilson snapped. "And how many times have you had this done?"
"Before now, how many times have you?" House shot back.
That was true, but Wilson refused to let a valid point ruin a perfectly good sulk. "I can't believe I let you talk me into this," he grumbled. "All it's going to do is tell you whether or not the anemia is due to an iron deficiency. You could have waited to see if it improved before rushing into an invasive test. You're just torturing me for the hell of it."
The muscles in House's jaw visibly tightened, as if he was forcing himself to bite back a snarky remark in response. "Look, you know as well as I do that we need to make sure that the anemia is just due to an iron deficiency, and not a more serious underlying condition."
"You already have my lab results," Wilson argued. "The TIBC, serum ferritin...serum iron...and all that other stuff. That's pretty damned conclusive."
"Not necessarily. You've developed an alarming susceptibility to infections, and you have some slightly screwy lab values and a laundry list of systemic symptoms that don't fit any particular disease profile. We need to-"
"You're overreacting," Wilson interrupted. "You're trying to find some exotic explanation for a simple problem. I'm a little anemic! That's all."
"Maybe," House conceded. "But under the circumstances, we need to make absolutely sure what's causing the anemia. Right now, we don't know if you're not absorbing enough iron, or if you're losing it from a bleed-most likely in your GI tract. It could be either...maybe both."
Wilson felt too sleepy and miserable to come up with a sarcastic retort. His eyelids slipped half closed as he stared ahead at nothing in particular. "I'm so tired of all of this," he complained in an increasingly slurred voice. "I'm tired of setting off a vertigo attack just about every time I turn my head, and I'm tired of feeling like I'm going to puke-even with this tube up my nose. And I'm tired of this stupid tube. It's driving me crazy! It feels weird and makes me feel like I'm going to gag, and the tape makes my nose itch. I'm sore from lying in bed all day, I'm bored, and I'm tired of people pestering me, especially when I'm trying to sleep. I want to use a real bathroom again instead of having to pee in a bottle, and I want to take a shower, and shampoo my hair, and shave, and wear real clothes so my ass doesn't hang out, and...well, I just want to feel normal."
"We'll pull the tube later today," House promised as he lifted the cotton gauze to see if the tiny incision had stopped bleeding. "If you don't start puking again, we'll start you on some ice chips and clear liquids and see how you do. And I'll stop by your office and pick up the electric razor you keep on hand for quick touch ups when you want to look pretty."
Wilson's lower lip turned outward in a slight pout. "Professional," he corrected. "Sometimes I have to meet with a patient's family or potential donors late in the day."
"Whatever. Unfortunately, there's not much else we can do as long as the vertigo keeps you knocked flat on your back. Tomorrow we'll try to get you up on your feet. If you can walk around for a few minutes without keeling over, maybe we can let you take a shower in another day or two. In the meantime, I suppose I could see about having one of the nurses scrounge up one of those inflatable plastic basins so you can get your hair shampooed."
A small smile slowly crept across Wilson's face. "That would be great. Thanks."
"No problem."
Satisfied that the bleeding had stopped, House retrieved another ridiculously long needle from the prepackaged kit. "I'm about to start the biopsy. All right?"
"Knock yourself out," Wilson mumbled as he tightened his grip on his pillow in anticipation. The tissue around the small incision was numb, so he didn't feel much of anything until House began to twist the needle into the bone. There was more pressure than there had been during the aspiration, but that was perfectly understandable. This time House would be breaking off a tiny sliver of bone as well as obtaining a sample of marrow, so he had to use a larger needle.
Soon the pressure progressed to steady, dull ache, and Wilson started to feel a little anxious. In theory, the pain shouldn't get any worse than it was right now, but that didn't stop him from worrying about making an ass of himself. However, to his relief, the pressure in his hip began to let up, and the ache quickly dissipated.
House sighed loudly as he withdrew the needle. "Got it," he announced triumphantly. Holding the biopsy needle with the sharp end pointing upward, House used the stylet to push the sample onto the slide that the lab tech held out for him.
"How does it look?" Wilson asked, unable to contain his curiosity.
With a slight shrug of his shoulders, House answered, "The core specimen appears normal-dark red marrow with white lattice, and the bone was firm. Not too soft, and not too hard. Like Goldilocks and the Three Bears, it's juuuuust right."
Wilson grunted in acknowledgement. Now that the much-dreaded procedure was over and he could relax, the sedating effects of the diazepam finally caught up with him. His eyelids slid shut and he was about to doze off again when he suddenly remembered something. Wilson's eyes snapped back open, and he turned his head toward House. "Hey, how did my last round of lab work look, and this morning's tests? I've been too tired today to read my chart."
"Why don't you sleep off the drugs first, and then we'll talk?" House suggested as he pressed a fresh wad of gauze against the small wound.
Wilson was immediately suspicious. "Why? What's wrong? What did you find?"
"What makes you think we found something?"
"Because you wouldn't be so evasive if everything was perfectly normal."
House tilted his head in the lab tech's direction. "In a minute. I want to sit down first if we're going chat. I'm not used to having to do my own grunt work, you know."
Wilson inwardly cringed. The tech had been so quiet, that he'd completely forgotten she was there-especially when he vented his frustrations about all the little indignities he had recently endured. Shit. The medication flowing through his veins made it way too easy to slip up and say embarrassing stuff. It was worse than wine. In Valium veritas, or something like that. He made a mental note to talk to House about changing his meds after the EGD tomorrow morning.
While they waited for the lab tech to leave, Wilson nodded off into an almost trance-like state. He felt strangely detached as House finished up-keeping pressure on the incision until it stopped oozing blood, removing the sterile drapes, cleansing the Betadine from his skin, applying a dressing to the wound, and pulling the flimsy hospital gown back down over his bandaged hip. As he was on the threshold of making the transition from drowsiness to a light sleep, Wilson felt a not-so-gentle shove to his shoulder, and he blindly reached back with his hand and swatted at the unwelcome intrusion. "Go 'way."
"C'mon," House persisted. "You need to lie on your back to keep pressure on the biopsy site."
Wilson muttered several profanities under this breath as he straightened his legs and slowly rolled over onto his back. When it was clear that the change in position hadn't triggered a vertigo attack, he cautiously opened his eyes. "Is the tech gone?" he asked in a gravelly voice.
"Yeah." House retrieved his bottle of Vicodin from the right front pocket of his jeans before he sat down on the pneumatic stool beside the examination table. "I know you know the routine, but you need to tell us if you need something stronger than Tylenol for the pain. You're going to be sore for a couple of days."
"You think?!"
House shrugged, appearing completely unrepentant as he pried the lid off the amber vial and shook a pill into his hand.
"So what did my test results show?" Wilson asked, rubbing his eyes. "Make it fast, I'm fading here."
"Then maybe we should have this conversation when you've slept off the meds," House replied. "It's a waste of time if I have to go over this again in a few hours after you've had your beauty sleep."
"No, I want to do this now."
House rolled his eyes, making no effort to conceal his annoyance. He downed the Vicodin with a flourish, and then shoved the plastic prescription bottle back into his pocket.
"Well, the nailfold capillaroscopy was unremarkable," House reluctantly began. "There weren't any degenerative changes, and your lab work didn't turn up anything that would indicate a connective tissue disorder. Your creatine kinase and aldolase were both within normal limits, and your RF was negative. The lymphocyte subset panel and C-reactive protein were a little elevated, but consistent with a resolving viral upper-respiratory infection. Tox screen was clear-no evidence of any heavy metal poisoning, and your electrolyte levels are all back within a normal range. Some target cells showed up in the peripheral blood smears, which would seem to suggest an iron-deficiency anemia-"
"You...you..." Wilson sputtered. "You knew about the target cells, and you did the bone marrow aspiration and biopsy anyway?"
"I've already told you why it needed to be done. If you're so out of it that you can't remember, then there's no point in continuing this conversation."
"No, I want..." Wilson sighed. He was simply too tired to argue with House, and wanted to find out the rest of his test results before he succumbed to the drugs. "Sorry. Go ahead."
"You sure?"
"Yeah."
House grimaced as he wrapped both hands around his right thigh to massage the recently traumatized muscles. "Okay, let's see. What's left? Uh, the electrophoresis results should be available any minute now, and we should have the results of your PCR back sometime tomorrow. Oh, and your colonoscopy was normal."
Wilson felt a peculiar sense of relief. He had never seriously considered colorectal cancer as a possibility, and had only agreed to the colonoscopy to humor House. But having tangible proof that he didn't have any malignancies in his lower GI tract brought a certain peace of mind that he hadn't expected. He was about to allow himself to fall into a contented slumber when he realized that House still hadn't told him the whole story.
"Uh, House?"
"Yeah?"
"What about my CT scans?"
House abruptly stopped massaging his thigh. "We found a 3.5 cm. simple hepatic cyst in the anterior segment of the right lobe-just a random doodad. If you want to play it safe, you might want to get another scan done in six months to see if there's been any change. But as long as the cyst doesn't become symptomatic or rupture, chances are pretty good that you won't need to have anything done about it."
Wilson mulled over the information. The benign lesion was an incidental finding-nothing more. So why did it feel like the hairs on the back of his neck were beginning to stand on end? He pinched the bridge of his nose, not sure he wanted to know the answer to his question. "House, what else did you find?"
There was an awkward pause that seemed to drag on forever. "You have a couple of slightly enlarged hilar lymph nodes on the left side," House admitted. "Using a portable x-ray machine instead of shipping you off to Radiology may have kept your vertigo from getting worse, but it exaggerated the heart's shadow and made the mediastinum appear wider-allowing the adenopathy to play hide-and-seek with us."
"What do you mean by 'slightly enlarged'?"
House hesitated. "Both lymph nodes are about 1.4 cm., and there's no evidence of parenchymal involvement or calcification. But-"
"But what?" Wilson asked, suddenly wary of where House was heading with this.
House drew in a deep breath and slowly let it out. "But...we still need to do a biopsy."
That got Wilson's adrenaline going, and his hands shot up in protest. "No. Absolutely not. I'm not going to let anyone put me under general anesthesia and cut into my chest as part of an elaborate fishing expedition. If you're having to look this hard to find something wrong, then there's probably nothing wrong for you to find."
"You've had six infections since August," House reminded him in an uncharacteristically patient, restrained tone. "We need to figure out why. The adenopathy could indicate-"
"It could indicate nothing. It's probably from a resolving pulmonary infection."
House shook his head. "Your chest x-ray didn't show any infiltrates, or your CT scan, for that matter."
"You're overreacting," Wilson argued, now fully awake. "The adenopathy could be from the viral upper-respiratory infection I had a couple of months ago. I had a wet-sounding cough for a few days. Maybe I had a sub-clinical case of bronchitis or pneumonia, and the lymph nodes are still swollen from that."
"Well, since you never bothered to get a chest x-ray done the last time you were sick, we'll never know."
Wilson shot a quick menacing glare in House's direction. "The answer is still no," he managed as a yawn snuck up on him in mid-sentence.
House inched closer to the examination table. "We need-"
"No."
"We need to make sure it's not sarcoidosis or lymphoma."
Wilson struggled to keep his eyes open as the short burst of energy from the adrenaline began to wear off. "My lab work isn't consistent with either of those diagnoses."
"Maybe it's an atypical presentation."
"House..."
House rubbed his face with both hands and exhaled loudly. "Don't be an idiot. Unless we figure out why you keep getting sick, you're going to continue to keep getting sick, and it's going to get harder and harder to shake off infections. The last time you picked up a virus, it took two months for the vertigo and nausea to completely clear up. This time, you wound up in the hospital-so badly dehydrated that you were having cardiac arrhythmias. Maybe you won't be so lucky when the next infection settles in your ears. Maybe your potassium level will bottom out from throwing up everything but your toenails, and you'll drop dead from ventricular fibrillation. Or you'll choke on your vomit, cut off the oxygen supply to your brain, and wind up in a permanent vegetative state and sharing a room with Coma Guy."
Wilson hated it when House resorted to hyperbole to manipulate him, mostly because it was so effective. He knew that there was very little evidence to indicate that he had sarcoidosis or cancer, but he had to admit that it was at least theoretically possible. House had an uncanny knack for finding connections where none seemed to exist. His friend had certainly been right about one thing-the symptoms were becoming increasingly worse with each infection. The last time he had labyrinthitis, it seemed like the vertigo and nausea were never going to end, and he began to wonder if he was going to need a cane for the rest of his life to help him get around. Now he had to be heavily sedated just so he could be rolled down the hall on a gurney. He couldn't afford to risk developing yet another debilitating ear infection-or worse.
Unable to fight off the sedative any longer, Wilson reluctantly gave in. "Fine. But I'm not going to let you con me into any more invasive procedures. This is the last one. Now leave me alone so I can get some sleep." Then he closed his eyes, and waited for oblivion to claim him.
House felt a twinge of jealousy as he watched his sick friend slip into an exhausted, drugged slumber. Wilson would be blissfully unconscious when it was time to wheel him back to his room, whereas he had to hobble back to his office on his own power-with a bum leg, and still suffering from the waning throes of a muscle spasm. However, House grudgingly conceded that the pain wasn't as bad as he expected from having to keep his weight evenly distributed on both legs for nearly half an hour while he performed the bone marrow aspiration and biopsy. Maybe if he stayed seated a little while longer, the spasm would resolve and he wouldn't need to take another Vicodin. Besides, it wasn't like there was any big hurry for him to leave. It would be another fifteen or twenty minutes before Wilson could be moved back to his room, and someone needed to keep an eye on him to make sure he didn't fall off the examination table or do something stupid while he was still three sheets to the wind. House figured that he might as well stick around, at least for now.
A blur of white in his peripheral vision caught his attention as he was kneading his thigh, and he instinctively turned his head toward the narrow gap where the vertical blinds didn't close completely. House couldn't see anything except someone's left shoulder, and leaned sideways to get a better look. A couple of seconds ticked by before he could identify the figure on the other side of the glass as Foreman, waving a piece of paper and apparently engrossed in an animated discussion-presumably with Chase and Cameron. He had left instructions for them to notify him as soon as the results of the electrophoresis were in, so he immediately knew what was in Foreman's hand. The pain in his leg momentarily forgotten, he grabbed his cane and headed for the door, stopping along the way to open the blinds enough so that he could keep tabs on Wilson while he conferred with his team.
"Anything interesting turn up?" House asked as he stepped into the hall and closed the sliding glass door behind him.
Foreman nodded. "His Hb A2 level is elevated."
"How elevated?"
"4.5%-high enough for beta thalassemia minor."
House wasn't so easily convinced. The chances that Wilson could have a rare type of mild, hereditary anemia usually found in people of Mediterranean descent was highly unlikely. He held out his hand and wiggled his fingers. "Let me see."
"Maybe we were wrong about an iron deficiency being the cause of the microcytic anemia," Foreman suggested, placing the computer printout in House's outstretched hand.
House shook his head as he quickly scanned the report. "We're not wrong. There's no way Wilson could be absorbing enough iron from a steady diet of chicken noodle soup, saltine crackers, and ginger ale-even when he manages to keep from barfing it right back up. The only question is whether he's losing enough blood in his GI tract to be clinically significant."
"But if he has an iron-deficiency anemia and beta thalassemia minor-"
"Then it looks like somebody screwed up," House said in an exasperated tone. "If Wilson just had beta thalassemia minor, then it would make sense that the Hb A2 level is elevated. The guys on the hemoglobin assembly line that produce beta chains have a defective beta globin gene, so they're genetically predisposed to be lazy slackers. They never meet their quota, so there's always a bunch of extra alpha chains floating around without anything to bind to. But if the condition coexists with an iron-deficiency anemia, then the entire hemoglobin protein synthesis process slows down, hiding the fact that the lazy bums responsible for turning out beta chains aren't doing their jobs. The percentages should appear deceptively normal across the board. That's not the case here."
House sighed as he glanced over at Wilson to make sure he was still sound asleep before shoving the paperwork back at Foreman. "Do another electrophoresis to see if the Hb A2 level really is elevated."
"Nobody screwed up," Cameron protested. "Repeating the test would be a waste of time.
Chase slipped his hands into the pockets of his lab coat as he leaned against the glass wall separating the hallway from the treatment room. "We could do a quantification by HPLC. That would give us a more accurate result. Or if we want to find out for sure whether or not Wilson has beta thalassemia minor, we could do a genetic screen. Either way, we need to know. If a genetic mutation is affecting his ability to produce the right mix of hemoglobin chains, that makes treating the iron-deficiency anemia a bit tricky. If we give him supplements to correct the anemia, it's not going to fix the genetic problem, and we could throw him into iron overload. We'd have to make sure that the benefits outweighed the risks.
House shifted his cane to his left side so he could massage the muscle spasm that was starting to flare up again. "Just do the HPLC for now. We'll worry about the genetic screen later."
"What about the lymph node biopsy?" Cameron asked. "Did Wilson agree to it?"
House nodded, eager to wrap up this discussion so he could go back to his office, sink into his comfortable Eames lounge chair, prop his leg up on the ottoman, listen to some tunes, and possibly knock back another Vicodin. "Yeah. Who's available?"
"MacFadyen said he could do it tomorrow morning at 11:30," she replied. "And Jarrett can work him in around 3:00, after her last case of the day."
"Get MacFadyen to do it. The sooner, the better." Switching his cane back to his right hand, House gestured toward the still sleeping Wilson. "The diazepam finally knocked him out, so one of you needs to stay with him until he can be moved back to his room-which should be in about fifteen minutes. After the allergy testing is out of the way, go ahead and pull the central line and replace it with a peripheral one. We have enough problems to deal with right now. We don't need to roll out the welcome mat and invite any infections to move in and complicate matters even more. Pull the NG tube, too. If the vomiting's under control, let him have some ice chips. If he keeps those down, then you can start him on clear liquids."
House was about to turn to leave when he suddenly remembered something. "Oh, he wants the electric razor that he keeps in his desk. It's on the left side, bottom drawer. And get one of the nurses to wash his hair. Maybe his mood will improve once he gets cleaned up a little."
Satisfied that he had covered all of his bases, he glanced at his friend on the other side of the glass one more time before heading back to his office, tightening his grip on his cane in frustration. It now seemed that Wilson had two problems contributing to his anemia, and possibly three, depending on what they found during the EGD in the morning. Just how many problems did Wilson have, and how did they all tie together to explain why he kept getting sick?
Part 14