[House, M.D.] Dissociation (3/3)
Title: Dissociation (3/3)
Author: Jason McLaughlin, a.k.a. A Guy Named Goo
Beta: trollopfop
Rating: PG-13 (Some violence, mild swearing, House's presence...)
Fandom: House, M.D.
Pairing: None, although plenty on House/Wilson subtext.
Disclaimer: A Guy Named Goo (Jason McLaughlin) does not own House, M.D. or any of the characters or other details regarding the series. They belong to FOX Television, David Shore, and other parties. Dr. Eli Abramson and any patients, unless otherwise stated, are the creation of Goo. Use of these characters is permitted upon request.
Notes: Please see here. (Not long, just rife with spoilers, so I didn't want to post them right in the story header. But they are important.) Spoilers through to the end of the second season.
Summary: House returns to work and treats a teenage girl whose blackouts lead her to violent and self-destructive behavior. Also, House ignores repeated orders to see a psychiatrist, and in the clinic, a little boy has a bloody nose.
House read the door in front of him. Written on the frosted window were the words "DR. ELI ABRAMSON, M.D., HEAD OF PSYCHIATRY". He finally opened the door without bothering to knock and limped in quickly, throwing the door closed behind him.
The office wasn't very large. It contained a desk with two chairs in front of it, another chair near a long, black leather couch, and several bookshelves full of psychology and psychiatry books. A couple of degrees hung in frames above the desk, and the desk itself was a mess, covered with patient files, empty coffee cups, pens, pencils, and a well-worn copy of the DSM-IV beside the desk lamp. A computer monitor was in the other corner, the tower under the desk and the keyboard on a pull-out shelf under the desk. A desk plaque had the name of the head of psychiatry written on it.
Seated at the desk was a middle-aged man. He looked thin, especially with the sleeves of his dress shirt rolled up, revealing his wiry arms, and he was very pale. His hair was strawberry-blonde, short and messy, and his eyes were deep blue, shielded by a pair of oval-shaped wireframe glasses. He looked up from the file he was quickly scribbling notes in to stare at House.
"Can I help you?" the man, apparently Dr. Eli Abramson, asked, sounding oddly patient for just having had someone barge into his office.
"I'll assume you're Abramson, from the way you have your name thrown around everywhere in here. Do your patients have a hard time remembering who you are?" House asked, seating himself in one of the chairs in front of his desk without being asked to.
Abramson raised an eyebrow. "Yes, I'm Dr. Abramson. Again, can I help you?"
"You know, you're surprisingly hard to find for someone who was apparently just sitting here the entire time. I need a psych consult," House said firmly. "No, scratch that, I needed a psych consult about six hours ago, and you didn't answer a single one of my team's pages for one."
"You're Dr. House," Abramson said, realization dawning on him. He began to sift through the clutter on his desk, coming up with three pink slips of paper. "I was about to get to you, actually. I have a copy of your patient's file in here somewhere..." He was once again trying to sift through the mess.
"I called you for a psych consult hours ago, and that's all you have to say?" House asked, getting more aggravated the longer the other man remained calm. "This department isn't exactly a well-oiled machine since you took it over, is it?"
Abramson paused in pulling the file from the stack and looked up, both eyebrows raised. "I'm sorry. We got backed up. My department has to handle the entire hospital, not just your department." He was sounding like he was starting to lose some of that obnoxious patience of his. This pleased House.
"You don't seem to be terribly busy right now," House observed. "Have some important paperwork to get to while my patient keeps getting worse? Maybe you stepped out to have lunch with Dr. Wilson. That's always more important than patients."
"I missed lunch. Because I was busy," Abramson repeated firmly. "Just what are you insinuating? That I am intentionally neglecting your requests for a consult?"
"Well, you said it..." House lead.
Abramson pulled out several more pink slips of paper. "All right, then. Which of these patients should I have made wait so I could see yours? The one who wanted to jump off the roof?" He put down one of the pink slips. "The one who nearly amputated her arm because God told her to?" He put down another slip. "The guy who swallowed a jug of drain cleaner?" Another slip was added to the pile. "Or maybe your patient was more important the girl who was violently raped?" He put down the last slip. "And these are just the cases I had to run a consult on. I have a ward full of patients that need to be checked on, appointments with said patients, a staff that needs to run almost everything by me, many of which had their own consults to attend to, all the administrative... crap I have to handle, and in case you haven't seen the numbers lately, Dr. House, the psychiatric department is severely short-staffed right now. I was busy."
"Wow, I never realized how crazy this hospital really is," House said, raising his eyebrows appreciatively. "I mean, I always had my suspicions..."
"This isn't even about your patient," Abramson accused. "It's about the fact that you don't like that I didn't come right when you called. It's about the fact that you can't take it that there are other patients that were deemed more important than yours."
"Nice, but my patient is the one who needs the psychoanalysis, not me," House pointed out. "Although I appreciated your little triage show. It almost makes you sound like a real doctor. Too bad my patient got violent and put a fork through a girl's hand while we were waiting for you."
Abramson threw the patient's file down on his desk and stood up, pulling down his sleeves and buttoning them at the cuffs. Then he grabbed a lab coat from the back of his chair and put it on. He picked up the file again. "You want your psych consult? Fine. I'll give you your psych consult." He then proceeded to walk briskly out of his office, leaving House to struggle to catch up.
~*~*~*~*~*~*~
"It wasn't a myoclonic seizure?" Foreman asked of his colleagues. They were all sitting in the diagnostics department again, going over the events in the MRI suite and the results of the MRI.
"I'm sure," Chase said firmly. "I can diagnose a tonic-clonic seizure."
"Her movements were definitely jerky, though," Cameron insisted. "They were still a little jerky when she regained consciousness. The myoclonus is a new symptom."
House entered the diagnostics department then, heading to the whiteboard. "So, if we're regrouping, I guess you found something new."
"Where were you?" Cameron asked, raising an eyebrow.
"I told you: I went to get a psych consult. Wasn't easy, either," House answered. "Anyway, what did you find?"
"No pheochromocytoma," Foreman stated. He got up and walked over to the lightbox, throwing up the images from her MRI and turning it on. House came over to stand next to him, and Cameron and Chase quickly got up to join them. "There's some high signal intensity in the caudate nucleus and putamen bilaterally," he explained, pointing on the MRI. "And there's also some definite signs of neurodegeneration in the frontal lobe, which would explain the behavioral changes, lack of impulse control, and memory problems. It's barely noticeable now, and the films of her last MRI don't show it at all."
"She had a seizure the first time we tried to do the MRI," Chase said. "Tonic-clonic," he added, before anyone could argue with him.
"But there were signs of myoclonus, during and after the seizure," Cameron added. "We're sure it wasn't a myoclonic seizure."
"Huh. So something's eating her brain, and fast," House said, going to add the new symptoms to the whiteboard. "Guess I didn't need to get Abramson all worked up after all." He put the cap back on the marker. "Well, now we just have to figure out what it is, and how we can fix it. Let's get our old friend, the lumbar puncture."
The door to the diagnostics department opened, and Abramson stepped in, looking rather unhappy. He thrust his copy of Karen's file at House. "Here. The results of your psych evaluation. I said more or less the same thing the other psychiatrists said: that she's not suicidal, although she's definitely feeling guilt over hurting her friend right now, and the behavioral changes are not the sign of an underlying psychological condition. I hope that's what you wanted."
House looked down at the folder, then back up at Abramson. "Actually, we already know that now. But hey, thanks for being such a good sport about it."
Abramson growled in frustration, yanking off his glasses and rubbing his eyes. After a few moments, he put them back on and glared at House. "The next time you need a psych consult, make damn sure you actually need one, or I will start ignoring pages from your department." And with that, he turned around and stormed out of the meeting room.
The fellows looked at the door for a moment in surprise. Finally, Chase turned to House. "What the hell did you do to him?" he asked.
House shrugged. "You guys were right: he's nice."
~*~*~*~*~*~*~
Karen was curled up on herself on the examination table. At least, as best as she could be, considering her leg was still in a cast. Chase was preparing the needle for the lumbar puncture, Foreman in the room to assist in case anything else happened with her. She occaisionally sniffled, and there were tears in her eyes.
"Is it going to hurt?" Karen asked pitifully, starting to shake a little.
"Yes. But just for a little bit," Chase assured her. "It'll be over before you know it."
Karen nodded and glanced over at Foreman. "And this will tell you guys what's wrong with me?"
"Hopefully," Foreman confirmed. "You have to stay still for it, though. Just relax."
Out in the hall, Cameron was standing with Karen's parents, watching the procedure. Karen's mother was leaning against her father, her hand over her mouth to catch a sob. "This will hurt her..."
"It's a necessary test," Cameron reassured her. "Dr. Chase has performed a lot of these. She's in good hands."
"That girl she hurt... Tanya... her parents are talking about pressing charges against her, or suing us," Karen's father noted. "They can't do that, right? I mean, if she's sick..."
Cameron shook her head. "I'm not a lawyer. I'm pretty sure they don't have a standing in criminal court, though. She was clearly not of her right mind at the time. I... don't know how it works in civil court." Cameron heard another sob, and turned to look at Karen's parents. "Mrs. Logan, if you have any concerns about that, I could take you both down to Legal and see what they have to say about it..."
Mrs. Logan shook her head. "I just want Karen to get better. I... I would rather it have just been her acting out. At least we could have done something. I don't want her to be sick..." Mr. Logan pulled her closer and rubbed her back.
Inside the exam room, Chase finished cleaning the area with the antiseptic pad. "I'll have to ask you to try to relax and stop shaking. I know it's scary, but..."
"I... I'm not shaking..." Karen whimpered.
Chase looked over at Foreman, who stepped forward and held out his hand. "Karen, I want you to take my hand." Karen's hand shot out, her movements sudden and jerking, and it took her a few times to finally grasp Foreman's hand. It was still trembling perceptibly.
"Karen, can you sit up?" Chase asked her.
Foreman released her hand, and they both watched her slowly attempt to force herself up, her arms giving out several times as they suddenly jerked forward. She finally managed to sit up, her back perfectly straight. Foreman pressed her back, between her shoulders, very gently. "Karen, can you lean forward a bit? Not at the waist. Like you're slouching, to lean over a desk or something." Karen just shook her head.
Chase capped the needle and dropped it in the sharps container. "I can't do an LP when she's like this."
"I'm sorry!" Karen cried out, clearly terrified.
Chase shook his head and stepped over to her. "It's not your fault. Really. We'll just have to use a different test." He helped her off the examination table and into a wheelchair.
Outside the room, Mrs. Logan turned to Cameron. "What's happening? Aren't they doing the test?"
Cameron was observing the action inside the room with rapt attention. Realizing that Mrs. Logan had spoken to her, she turned and shook her head. "They can't. She's... she's getting worse."
~*~*~*~*~*~*~
Although House had mastered keeping his controller fixed in front of him as he played Halo on his X-Box, Wilson was significantly less skilled, turning the entire controller in the direction where he wanted to go. His lack of skill was also evident in the fact that House had beaten him in three of the four games they had played so far, and the one time Wilson had won had been because he exploited a moment where House was fumbling for his Vicodin.
"I heard you met Eli," Wilson noted conversationally, lifting his controller as he tried to steer his vehicle in the game. "What'd you do to him?"
"Got my patient a psych consult," House said easily, expertly manipulating his vehicle despite the distraction of the conversation. "I guess he didn't like my dynamic personality. I thought shrinks ate that kind of thing up..."
Wilson was now moving his whole body in an effort to control his vehicle, occasionally leaning into House. If House minded, he didn't object. "Tell me, do you only derive pleasure from making decent people miserable, or do you get some sort of nourishment from it?"
"It's what keeps me healthy and youthful," House answered easily, beating Wilson once again. Wilson, for his part, got up and turned the game off, returning to the couch to sulk.
"I don't get why everyone keeps saying he's 'nice'," House continued, picking up the remote control and turning the cable box back on. He then began to flip through the channels. "It seems to me he's more 'condescending'."
Wilson shrugged. "He's... really committed to his work. Something you can identify with."
"Are you going to try to make us the bestest of friends so that we can all hang out together at lunch and giggle and have all sorts of fun?" was the somewhat annoyed response. Wilson could tell that House was uncomfortable with the thought of him being friends with someone else.
"I just want you to get along. I don't want to have to choose between you two, because you know I'll have to pick you and I kind of want to have more friends," Wilson explained.
House raised an eyebrow. "You'd be friends with me, even if it meant never having another friend for as long as you live?"
Wilson nodded. "You were there first. And, in your own bizarre, subtly-supportive way, you've always been there. If just to point and laugh at me while I'm down."
House laughed a little at that. "I'm not being 'subtly-supportive', so much as you force yourself on me while you're down and it'd be like leaving a puppy out in the rain." He finally seemed to settle on a channel, which was showing women's volleyball. "So is this the part where you go 'Eli has an X-Box 360, a Playstation2, and a GameCube' and I have to keep up with the Joneses?"
Wilson laughed. "No, he doesn't have video games. You'd probably find him really boring. His house is full of books and medical and psychiatric journals and he mostly listens to jazz and classical music."
"Probably the kind of guy who TiVo's Masterpiece Theatre and Nova," House muttered.
"No, actually, he doesn't own a TV at all."
"That's just inhuman."
"Tell me about it," Wilson said, rolling his eyes. "He's a great conversationalist, though. Really listens to people, and seems genuinely interested."
"Well, he's a psychiatrist. He'll probably hand you a report and a bill at the end of the month," House scoffed. "And he's just trying to impress you. People who think they have to prove they're smart go to great lengths to look smarter than they are. He's probably got a TV hidden somewhere and secretly loves The Three Stooges."
"As opposed to you, who doesn't have to prove his intelligence to anyone and therefore doesn't hide that he likes video games and watches SpongeBob?"
"Right. I'm secure in my intellect. I don't have to wrap myself up in pseudo-intellectual crap to prove it."
Wilson got up to get them both a beer. "Well, then I guess I don't need a psychiatrist for a friend. I already have you, with your expert ability to read people."
"Damn straight," House said, raising his fist triumphantly.
~*~*~*~*~*~*~
"So. We couldn't get a lumbar puncture, we could barely get an MRI... this girl just doesn't want us running tests on her, does she?" House asked, sipping his coffee. He was starting to adjust to the new supplier, although he'd never admit that to anyone.
"It could be a parasite. It's spreading fast enough," Cameron suggested.
"Or neurotoxicity," Chase suggested. "Mercury, inhalants..."
"If it were neurotoxicity, other organs would be affected: heart, liver, kidneys, lungs..." Foreman pointed out.
"Get a blood test. Hell, poke her every which way," House suggested. "If it's moving this fast, she'll probably forgive us when she doesn't die. Oh, and grab a piece of her brain while you're poking around." He took out his bottle of Vicodin, shaking out the last pill and dry-swallowing it.
"You want us to do a brain biopsy?" Cameron repeated, looking up from her copy of the file.
"Yes. A brain biopsy for a rapidly progressing neurological condition. Shocking concept, I know," House replied. "Now, I believe I just gave you a lot of work to do. Go do it."
House watched the fellows get up and leave the department to attend to their appointed tasks. Once they were out of sight, he left the room himself, heading over to Wilson's office. He opened the door without bothering to knock.
"What do you want, House?" Wilson asked, not looking up from the folder he was reading.
House closed the door behind him and limped over to the desk, sitting in front of it. He took out the bottle and put it on top of the folder. "Vicodin. I need more."
Wilson eyed the bottle quietly for a long moment, not touching it. When he looked up at House, his eyes were wide. He worked his mouth nervously for a few moments, not saying anything, then sighed and pushed the bottle back toward him. "I can't."
"Sure you can. Just take that pad of paper with the RX on it out of your desk, put the pen on it, and the rest will come naturally," House urged, starting to worry about what Wilson's behavior meant.
"No, I mean I can't prescribe it to you," Wilson stated.
House glared at him. "You decided now is a good time to start feeling like a guilty enabler? I was shot not long ago, if you remember."
Wilson shook his head. "That's not it. Cuddy told me not to. If I get caught, I could face disciplinary action."
"So don't get caught. I'll get it filled out of town," House said, sounding a little desperate. "Why is she choosing now to cut me off, anyway?"
"She'll find out, and you know that," Wilson argued. "And she found out you never saw a psychiatrist yesterday."
House snorted. "But I did. Abramson even told you as much."
"Your patient saw him. As in for evaluation or treatment saw him," Wilson snapped back. "Either way, Cuddy's issued a hospital-wide directive: no one is allowed to prescribe you Vicodin or any other narcotics until you've had a psychiatric evaluation. Which means the only doctor in this hospital you can get a prescription from right now is Eli."
House got up, looking away from Wilson. "That's just great. I'm fine. I went to clinic duty, I'm treating my patient--"
"But do you care?" Wilson asked.
House turned and looked at him. "What do you mean? I never actually see my patients. You know that."
"Your patient is decompensating fast. You usually fight tooth and nail to keep your cases from getting any worse, damn the consequences. You're... oddly resigned with this one. You've been treating her strictly by the book," Wilson explained. "The most you've done for her is fight with Eli to get a psych consult, and you admit that was for your own purposes, not for her."
"You've been talking to Cameron again, I see," House observed, rolling his eyes slightly. "Cuddy thinks something is wrong with me because I'm actually behaving myself? There is just no pleasing that woman..."
"It's not just Cuddy," Wilson argued. "You're... not focused. This case got interesting for you fast, and you don't even seem to think that's worth more of your attention. You're more hung up on Eli than you are on treating her. Even if Cuddy hadn't told me not to give you the Vicodin, I still would have pushed you to see someone."
House grabbed the doorknob. "I am doing a more than competent job with her. I would think that would be enough for you people. I shouldn't have to do tricks to please you." He then left, slamming the door behind him.
~*~*~*~*~*~*~
"You're going to have to shave my head?" Karen asked, tugging on a lock of her increasingly less blonde hair. Before anyone could respond, the whir of a small saw sounded. After a few minutes, the sound stopped, and Chase removed her cast in two halves.
"That should make you feel a bit better, anyway," he told her, taking off his mask and putting the small saw on a tray of instruments.
Cameron watched as Karen leaned over to scratch her leg before answering her, noting that she only bent at the waist. "Just a small patch of it so we can get into your skull. Your head will be bandaged until it heals, but by the time the bandages come off, no one will be able to notice."
"You keep talking about all of these tests, and you still haven't found anything wrong," Karen sighed, laying back down, her arm twitching as she did. "How many more do I need?"
"We're doing as many as we can today, so that you should know what you have very soon," Chase reassured her.
Karen continued to stare at the ceiling. "Who is Dr. House?" she suddenly asked.
Cameron raised her eyebrows. "Why?"
"My bracelet says I'm being treated by Dr. House, but I haven't met him. Is that just a name you put on your bracelets when a lot of different people are seeing someone?"
Chase laughed a little. "No, Dr. House is a real person. He's our boss. He's overseeing the case."
"Then how come I haven't met him?" Karen pressed.
Cameron cleared her throat. "Dr. House doesn't usually see patients himself. It's just standard procedure for him. But he's one of the best diagnosticians in the country, and he's being consulted for everything, so don't worry about him. Trust me: you don't want to meet him. He's a real jerk."
Chase started to laugh at that. Karen looked over at him for a moment, then at her bracelet again. "My parents had me moved here so I could be seen by a really good doctor. I guess they meant him. I hope they get their money back."
Chase began to help her up. "You should try to walk around a bit to strengthen your leg a bit. After we're done with you, you'll need some physical therapy."
Karen shakily got out of the bed, using the back to keep her standing. Chase slowly released her, and she took a few shaky steps forward, then started to fall again. Chase caught her and helped her back into bed. "Well, I guess I'm lucky I've got the hot doctor holding me..."
"Keep talking like that, and I'll start to think you're faking it just to get me to grab you," Chase teased.
Cameron rolled her eyes and closed her copy of the file. "Someone will be in shortly to get you ready for surgery. if you need anything before that, you know where your call button is."
~*~*~*~*~*~*~
House stepped into the clinic exam room, reading the chart as he did so. He wasn't interested in the patient's history, but rather the test results that had been placed in the folder. He looked up to see Tanner sitting on the table, his nose blissfully not bleeding. His mother, as always, was hovering close.
"So, do you want the good news, or the bad news?" House asked, grabbing the stool and pulling it over. He rubbed his leg and reached for his Vicodin, but remembering he was out he moved his hand back to the folder.
"There's bad news?" Tanner's mother asked, alarm crossing her features.
"No one ever wants the good news first," House mused. "Well, suit yourself. The bad news is your son has a condition called von Willebrand Disease, and there's no treatment for it."
"What?!" Tanner's mother gasped, pulling her son closer to herself. "What... what can I do?"
House sighed. "That's why people should ask for the good news first. Right now, you're probably hurting him more." Tanner's mother immediately released him. "The good news is, as far as diseases go, it's pretty harmless. Your son has what is called Type 1 von Willebrand Disease, a mild blood clotting disorder characterized by spontaneous bruising and occasional nosebleeds. As long as your sons stop smacking him around and you quit crushing him, he should live a long, normal life."
Tanner looked up at his mother. "Mama, am I sick?" he asked.
His mother looked unsure. "I... don't think so. He has a disease, but he's fine?"
"You were hoping for the flesh-eating bacteria, maybe?" House asked. "It's a mild disease. I told you what you had to do. Take my advice and we shouldn't have to see young Taylor in our clinic for a while."
"It's Tanner," Tanner's mother corrected him.
"Whatever," House said dismissively. "I have sick patients to see. Sicker than your son. Don't let the door hit him on the way out. And I mean that." He got up and limped out of the room.
~*~*~*~*~*~*~
House made his way over to Cuddy's office, still holding Tanner's folder. He entered without knocking, catching her on the phone. She looked up at him, muttered "I'll call you back", and hung up, looking up at him. "Dr. House. I suppose by now you've heard about the directive."
House threw the file onto her desk. "Tell me that's the work of someone who isn't focused."
Cuddy opened the file and scanned it quickly. "You diagnosed von Willebrand disease in a kid who presented with nothing but a nosebleed. Good pick up." She closed the folder. "Go see a shrink."
"Cutting a chronic pain patient off of his painkillers is cruel, even for you," House all but snarled at her. "Is that how it's going to be now? If I don't listen to you, you'll make it so I'm in so much pain that my choices are to do what you say or shoot myself? Or maybe you could just let another madman waltz into this hospital and do that for me!"
Cuddy sighed and looked down at her desk. "I don't want to have to do it, House. But I don't feel comfortable with you working here unless you get evaluated. You ignore my threats of suspension, you laugh at me when I threaten to fire you... you don't leave me with many options. It won't kill you. An hour, maybe less, with Dr. Abramson and you can have all the Vicodin you want. Hell, if he hands me an evaluation, I'll write the prescription myself."
"What is this really about? Were you hoping that life would get exciting with me back, and now that it's not you can't take it?" House accused. "Were you hoping taking away my pain pills would have me in my patient's room, pumping her full of drugs that I know won't work and insulting her the entire time? Does me misbehaving get you off?"
Cuddy opened a drawer on her desk, pulling out a file and slamming it closed. "Ketamine, House. You asked for Ketamine after you were shot, and you won't tell anyone why. If it's simple, if it doesn't bother you, then why won't you just tell us what that was about and shut us all up?"
"You want me to see a shrink so you can solve the great Ketamine mystery?" House asked incredulously. He sat down in the chair in front of her desk. "I'd just gotten shot. I was muttering things. That's it. Nothing else."
"It's something else, and it's bothering you," Cuddy shot back. "It's affecting how you work. Why are you fighting this? Does the thought of talking to a psychiatrist for an hour really offend you on so many levels that it's worth taking a stand against?"
House rubbed his thigh and glared at her for a long time. She was still staring down at her desk, and the closed file she'd placed on it, on top of the one he'd brought her. He finally, shakily got to his feet and turned around. "As much as I'd love to keep arguing in circles with you, my patient is having brain surgery right now. I should really check in on that. Unless you think me talking about my feelings is more important than that, too." He didn't wait for her answer as he limped out of the room.
~*~*~*~*~*~*~
The surgery had been a success, amazingly enough. The fellows had been worried, considering the problems that had arisen when they had tried to test Karen previously, but they now had their sample. Foreman was sitting in front of the microscope, loading the sample slides under it to examine it. It didn't take it long to see the problem.
"Oh, damn..." Foreman muttered. "I should have figured this out sooner..."
"What is it?" Cameron asked. Foreman pushed the microscope aside and looked in. "Oh, damn. Creutzfeldt-Jakob?"
"She didn't have a typical presentation of it," Chase brought up. "Are you sure?"
"It's probably a variant Creutzfeldt-Jakob," Foreman explained. "It probably originated in the temporal lobe and spread into her hippocampus, which would explain the blackouts and lack of impulse control. And I'd say it's spreading to her frontal lobe. She's got a few weeks left, if that. And they won't be good ones."
"Isn't variant Creutzfeldt-Jakob caused by Mad Cow?" Cameron asked, looking into the microscope again.
Foreman leaned back in his chair. "That's what some neurologists believe. There was a rash of it in Britain during the Mad Cow outbreak. No one's proven a definitive link, though, so we can't really say what caused it."
"Damn. Well, I guess now there's nothing left to do but tell House we solved the case and break it to her," Chase said miserably.
"Actually, I think I got the gist of it," House said, limping into the room. The fellows all jumped.
"How do you keep doing that?" Foreman cried, backing away from the table as House approached. He leaned in to look into the microscope.
"That's for me to know and you to never find out. It's way too much fun," House told them, looking at the sample. "Yup, her brain's a sponge. And not in the good way. Who gets to be the bearer of bad news?"
When no one volunteered, House looked up and examined all three. "Hmm...eenie, meenie, miney...Foreman. You're a neurologist. I'm sure her parents are going to have a lot of questions. You can get it across just how toast their daughter is."
Cameron looked at House for a long time. "You honestly don't care that your patient is going to die? That you can't fix her?"
"Of course I care. No use crying about it, though. VCJD has no cure and only a couple of treatments that no one thinks work. Even if I figured this out on day one, there's not a damn thing I could have done," House said, still sounding oddly unphased by the events. He got up and went to leave the room. "What is it with you three lately? Do I have to repeat every order before you do something? Foreman, I told you to ruin a girl's life. That means now."
Foreman glared at House, then grabbed the file and left the lab. House limped out not long afterwards.
Cameron turned to Chase and pointed at the door. "That's what I'm talking about when I say he's not normal."
"I heard that!" House called out from the hall.
~*~*~*~*~*~*~
"There's...nothing you can do?" Mrs. Logan sobbed, clutching her husband. Karen was in her hospital bed, staring off at a point at the wall. If she heard what was being said, she gave no indication of it.
Foreman shook his head. "In Britain, there's been some success with a drug called pentosan polysulphite. It's believed to slow or halt the progress of the disease. But even if we got it and it worked, we can't undo the damage that has been done. We can only manage it."
"And without this drug?" Mr. Logan asked.
Foreman looked down at the floor for a moment, then met Mr. Logan's eyes. "VCJD tends to spread faster than the regular form of the disease. Based on the timeline of events, which indicate she was infected about six months ago, and on her current progression, there will be more dementia and memory loss, and she'll continue to lose function in her limbs and throughout her body. From there, she'll enter a coma and die shortly thereafter as the parts of the brain that control important systems in her body are eaten away. This will take another two, possibly three weeks at this rate."
Mrs. Logan turned to look at Karen, then back to Foreman. "Please, try the drug. Try anything. We can't lose her. Not like this."
Foreman nodded. "I'll do my best. It's a very experimental treatment, so we'd have to get her into a research study."
"Of course. We'll do anything," Mr. Logan said firmly.
Karen just continued to stare at the wall, not responding to the conversation at all.
~*~*~*~*~*~*~
House wasn't sure why he wandered into the physio department. He had originally intended to retreat to his office to nurse his aching leg, but somehow his course took him on a detour. It alarmed him slightly that he couldn't trace the thought process that had taken him here, or why his body still insisted that he keep going, despite the fire in his leg.
He continued walking slowly, people in the halls giving him confused or surprised looks as he did. No one had expected to see him here after his violent refusal to get physical therapy after his infarction, and some of the newer staff didn't even know who he was.
He stepped up to the room with the physical therapy pool. It seemed to be closed: the lights were off and it was empty. Perhaps no patients needed it at three in the afternoon...at any rate, the door was unlocked, and he felt himself compelled to push it open and step inside, up to the edge of the pool.
He closed his eyes for a moment, breathing in the smell of chlorine, which seemed to be fading from the air. Perhaps he was adjusting to it already. He leaned heavily on his cane, and thought he could smell the salty tang of the ocean. Thought he could feel himself sinking into the depths of the water, the weightlessness making his battered body less of a burden to carry, the cool water easing the throbbing pain in his thigh.
He opened his eyes and realized he was face-down in the pool, with no recollection of jumping in, still clutching his cane. He panicked for a moment, rolling over onto his back and breathing deeply. Then he remained there for a moment, savoring the temporary relief the water offered him. He could forget his pain, forget the withdrawal symptoms that were finally starting to creep into his body. He didn't know how he got here, and for the moment, he really didn't care.
He finally pulled himself slowly up onto the edge of the pool, sitting with his feet dangling in it for a moment, before finally hauling himself to his feet and making his slow way out of the physio department.
More people were staring at him now, whispering amongst themselves as they watched his soaked form limping painfully away. When he was almost out of the physio department, he turned around, shouted, "What? Never seen a guy take a relaxing dip in the pool before?" He then pushed open the door and headed toward the elevator.
~*~*~*~*~*~*~
No one seemed to find a patient wandering slowly, awkwardly through the halls. Maybe it was the fact that Dr. Chase had ordered Karen to work her leg, so they expected it. At any rate, no one seemed to notice her slip into the dark, empty diagnostics department, grasping furniture on the way to make sure she could still stand, her limbs threatening to give out.
Her thoughts were racing. Words like "dementia", "loss of limb function", "coma", and "death" kept popping up. She couldn't imagine herself going like that. She didn't give a damn about the medicine that her parents kept promising to get her, and how it would work. She couldn't live like this.
She wasn't sure what she expected to find in this room. She knew this was where all the doctors that kept testing her were from. She'd read their badges, and they had all that equipment. She'd find something. She looked over toward the office at the other end of the meeting room. There was a balcony just beyond it. If she could get there...
She shuffled slowly to the office, trying to open it. It wouldn't open. She could feel her rage surge inside of her as she pulled the door, trying to get the lock to give. She finally grabbed one of those black chairs, with the curved backs that were supposedly better for your spine, and shoved it as hard as she could manage into the door. It crashed with the loud clatter of breaking glass. She looked outside of the room, waiting to see if people were coming. They were. She didn't have much time.
Threatening to stumble over with each step, glass cutting into her feet, she charged through the office and yanked open the door. One of the doctors who had worked on her was with them. The pretty woman that thought she was being mean to her friends. The one she probably liked the least right now. Giving them a quick look, she continued to plow forward.
The momentum was enough to carry her straight over the balcony, and she tumbled over, head first.
~*~*~*~*~*~*~
House was still very wet, although not dripping wet as he had been, when he stepped into Abramson's office without knocking. He'd already been to his own department, where he'd howled about his broken door and the fact that his patient could commit suicide in his own office while his team was supposed to be taking care of her. Then he'd quietly dismissed himself and headed toward the elevator, where he found himself here.
Abramson looked up from the folder he was writing in. "Dr. House. You're...wet."
"I went for a swim," House said, as if that explained everything. He limped slowly over to the desk. "I need my Vicodin."
Abramson examined House for a moment longer. "I heard your patient committed suicide."
"Yeah, she did. Not my fault. I need my Vicodin," House repeated, still looming over the desk.
Abramson sighed, opening his desk and removing a prescription pad. He hastily scribbled the prescription on the top sheet, signed it, and tore it off the pad, holding it out to House.
House looked at it suspiciously, then reached out to take it. Sure enough, it was yanked out of his grasp. Abramson stood up and gestured to one of the chairs in front of his desk. "Have a seat, Dr. House."
Fin
Author: Jason McLaughlin, a.k.a. A Guy Named Goo
Beta: trollopfop
Rating: PG-13 (Some violence, mild swearing, House's presence...)
Fandom: House, M.D.
Pairing: None, although plenty on House/Wilson subtext.
Disclaimer: A Guy Named Goo (Jason McLaughlin) does not own House, M.D. or any of the characters or other details regarding the series. They belong to FOX Television, David Shore, and other parties. Dr. Eli Abramson and any patients, unless otherwise stated, are the creation of Goo. Use of these characters is permitted upon request.
Notes: Please see here. (Not long, just rife with spoilers, so I didn't want to post them right in the story header. But they are important.) Spoilers through to the end of the second season.
Summary: House returns to work and treats a teenage girl whose blackouts lead her to violent and self-destructive behavior. Also, House ignores repeated orders to see a psychiatrist, and in the clinic, a little boy has a bloody nose.
House read the door in front of him. Written on the frosted window were the words "DR. ELI ABRAMSON, M.D., HEAD OF PSYCHIATRY". He finally opened the door without bothering to knock and limped in quickly, throwing the door closed behind him.
The office wasn't very large. It contained a desk with two chairs in front of it, another chair near a long, black leather couch, and several bookshelves full of psychology and psychiatry books. A couple of degrees hung in frames above the desk, and the desk itself was a mess, covered with patient files, empty coffee cups, pens, pencils, and a well-worn copy of the DSM-IV beside the desk lamp. A computer monitor was in the other corner, the tower under the desk and the keyboard on a pull-out shelf under the desk. A desk plaque had the name of the head of psychiatry written on it.
Seated at the desk was a middle-aged man. He looked thin, especially with the sleeves of his dress shirt rolled up, revealing his wiry arms, and he was very pale. His hair was strawberry-blonde, short and messy, and his eyes were deep blue, shielded by a pair of oval-shaped wireframe glasses. He looked up from the file he was quickly scribbling notes in to stare at House.
"Can I help you?" the man, apparently Dr. Eli Abramson, asked, sounding oddly patient for just having had someone barge into his office.
"I'll assume you're Abramson, from the way you have your name thrown around everywhere in here. Do your patients have a hard time remembering who you are?" House asked, seating himself in one of the chairs in front of his desk without being asked to.
Abramson raised an eyebrow. "Yes, I'm Dr. Abramson. Again, can I help you?"
"You know, you're surprisingly hard to find for someone who was apparently just sitting here the entire time. I need a psych consult," House said firmly. "No, scratch that, I needed a psych consult about six hours ago, and you didn't answer a single one of my team's pages for one."
"You're Dr. House," Abramson said, realization dawning on him. He began to sift through the clutter on his desk, coming up with three pink slips of paper. "I was about to get to you, actually. I have a copy of your patient's file in here somewhere..." He was once again trying to sift through the mess.
"I called you for a psych consult hours ago, and that's all you have to say?" House asked, getting more aggravated the longer the other man remained calm. "This department isn't exactly a well-oiled machine since you took it over, is it?"
Abramson paused in pulling the file from the stack and looked up, both eyebrows raised. "I'm sorry. We got backed up. My department has to handle the entire hospital, not just your department." He was sounding like he was starting to lose some of that obnoxious patience of his. This pleased House.
"You don't seem to be terribly busy right now," House observed. "Have some important paperwork to get to while my patient keeps getting worse? Maybe you stepped out to have lunch with Dr. Wilson. That's always more important than patients."
"I missed lunch. Because I was busy," Abramson repeated firmly. "Just what are you insinuating? That I am intentionally neglecting your requests for a consult?"
"Well, you said it..." House lead.
Abramson pulled out several more pink slips of paper. "All right, then. Which of these patients should I have made wait so I could see yours? The one who wanted to jump off the roof?" He put down one of the pink slips. "The one who nearly amputated her arm because God told her to?" He put down another slip. "The guy who swallowed a jug of drain cleaner?" Another slip was added to the pile. "Or maybe your patient was more important the girl who was violently raped?" He put down the last slip. "And these are just the cases I had to run a consult on. I have a ward full of patients that need to be checked on, appointments with said patients, a staff that needs to run almost everything by me, many of which had their own consults to attend to, all the administrative... crap I have to handle, and in case you haven't seen the numbers lately, Dr. House, the psychiatric department is severely short-staffed right now. I was busy."
"Wow, I never realized how crazy this hospital really is," House said, raising his eyebrows appreciatively. "I mean, I always had my suspicions..."
"This isn't even about your patient," Abramson accused. "It's about the fact that you don't like that I didn't come right when you called. It's about the fact that you can't take it that there are other patients that were deemed more important than yours."
"Nice, but my patient is the one who needs the psychoanalysis, not me," House pointed out. "Although I appreciated your little triage show. It almost makes you sound like a real doctor. Too bad my patient got violent and put a fork through a girl's hand while we were waiting for you."
Abramson threw the patient's file down on his desk and stood up, pulling down his sleeves and buttoning them at the cuffs. Then he grabbed a lab coat from the back of his chair and put it on. He picked up the file again. "You want your psych consult? Fine. I'll give you your psych consult." He then proceeded to walk briskly out of his office, leaving House to struggle to catch up.
~*~*~*~*~*~*~
"It wasn't a myoclonic seizure?" Foreman asked of his colleagues. They were all sitting in the diagnostics department again, going over the events in the MRI suite and the results of the MRI.
"I'm sure," Chase said firmly. "I can diagnose a tonic-clonic seizure."
"Her movements were definitely jerky, though," Cameron insisted. "They were still a little jerky when she regained consciousness. The myoclonus is a new symptom."
House entered the diagnostics department then, heading to the whiteboard. "So, if we're regrouping, I guess you found something new."
"Where were you?" Cameron asked, raising an eyebrow.
"I told you: I went to get a psych consult. Wasn't easy, either," House answered. "Anyway, what did you find?"
"No pheochromocytoma," Foreman stated. He got up and walked over to the lightbox, throwing up the images from her MRI and turning it on. House came over to stand next to him, and Cameron and Chase quickly got up to join them. "There's some high signal intensity in the caudate nucleus and putamen bilaterally," he explained, pointing on the MRI. "And there's also some definite signs of neurodegeneration in the frontal lobe, which would explain the behavioral changes, lack of impulse control, and memory problems. It's barely noticeable now, and the films of her last MRI don't show it at all."
"She had a seizure the first time we tried to do the MRI," Chase said. "Tonic-clonic," he added, before anyone could argue with him.
"But there were signs of myoclonus, during and after the seizure," Cameron added. "We're sure it wasn't a myoclonic seizure."
"Huh. So something's eating her brain, and fast," House said, going to add the new symptoms to the whiteboard. "Guess I didn't need to get Abramson all worked up after all." He put the cap back on the marker. "Well, now we just have to figure out what it is, and how we can fix it. Let's get our old friend, the lumbar puncture."
The door to the diagnostics department opened, and Abramson stepped in, looking rather unhappy. He thrust his copy of Karen's file at House. "Here. The results of your psych evaluation. I said more or less the same thing the other psychiatrists said: that she's not suicidal, although she's definitely feeling guilt over hurting her friend right now, and the behavioral changes are not the sign of an underlying psychological condition. I hope that's what you wanted."
House looked down at the folder, then back up at Abramson. "Actually, we already know that now. But hey, thanks for being such a good sport about it."
Abramson growled in frustration, yanking off his glasses and rubbing his eyes. After a few moments, he put them back on and glared at House. "The next time you need a psych consult, make damn sure you actually need one, or I will start ignoring pages from your department." And with that, he turned around and stormed out of the meeting room.
The fellows looked at the door for a moment in surprise. Finally, Chase turned to House. "What the hell did you do to him?" he asked.
House shrugged. "You guys were right: he's nice."
~*~*~*~*~*~*~
Karen was curled up on herself on the examination table. At least, as best as she could be, considering her leg was still in a cast. Chase was preparing the needle for the lumbar puncture, Foreman in the room to assist in case anything else happened with her. She occaisionally sniffled, and there were tears in her eyes.
"Is it going to hurt?" Karen asked pitifully, starting to shake a little.
"Yes. But just for a little bit," Chase assured her. "It'll be over before you know it."
Karen nodded and glanced over at Foreman. "And this will tell you guys what's wrong with me?"
"Hopefully," Foreman confirmed. "You have to stay still for it, though. Just relax."
Out in the hall, Cameron was standing with Karen's parents, watching the procedure. Karen's mother was leaning against her father, her hand over her mouth to catch a sob. "This will hurt her..."
"It's a necessary test," Cameron reassured her. "Dr. Chase has performed a lot of these. She's in good hands."
"That girl she hurt... Tanya... her parents are talking about pressing charges against her, or suing us," Karen's father noted. "They can't do that, right? I mean, if she's sick..."
Cameron shook her head. "I'm not a lawyer. I'm pretty sure they don't have a standing in criminal court, though. She was clearly not of her right mind at the time. I... don't know how it works in civil court." Cameron heard another sob, and turned to look at Karen's parents. "Mrs. Logan, if you have any concerns about that, I could take you both down to Legal and see what they have to say about it..."
Mrs. Logan shook her head. "I just want Karen to get better. I... I would rather it have just been her acting out. At least we could have done something. I don't want her to be sick..." Mr. Logan pulled her closer and rubbed her back.
Inside the exam room, Chase finished cleaning the area with the antiseptic pad. "I'll have to ask you to try to relax and stop shaking. I know it's scary, but..."
"I... I'm not shaking..." Karen whimpered.
Chase looked over at Foreman, who stepped forward and held out his hand. "Karen, I want you to take my hand." Karen's hand shot out, her movements sudden and jerking, and it took her a few times to finally grasp Foreman's hand. It was still trembling perceptibly.
"Karen, can you sit up?" Chase asked her.
Foreman released her hand, and they both watched her slowly attempt to force herself up, her arms giving out several times as they suddenly jerked forward. She finally managed to sit up, her back perfectly straight. Foreman pressed her back, between her shoulders, very gently. "Karen, can you lean forward a bit? Not at the waist. Like you're slouching, to lean over a desk or something." Karen just shook her head.
Chase capped the needle and dropped it in the sharps container. "I can't do an LP when she's like this."
"I'm sorry!" Karen cried out, clearly terrified.
Chase shook his head and stepped over to her. "It's not your fault. Really. We'll just have to use a different test." He helped her off the examination table and into a wheelchair.
Outside the room, Mrs. Logan turned to Cameron. "What's happening? Aren't they doing the test?"
Cameron was observing the action inside the room with rapt attention. Realizing that Mrs. Logan had spoken to her, she turned and shook her head. "They can't. She's... she's getting worse."
~*~*~*~*~*~*~
Although House had mastered keeping his controller fixed in front of him as he played Halo on his X-Box, Wilson was significantly less skilled, turning the entire controller in the direction where he wanted to go. His lack of skill was also evident in the fact that House had beaten him in three of the four games they had played so far, and the one time Wilson had won had been because he exploited a moment where House was fumbling for his Vicodin.
"I heard you met Eli," Wilson noted conversationally, lifting his controller as he tried to steer his vehicle in the game. "What'd you do to him?"
"Got my patient a psych consult," House said easily, expertly manipulating his vehicle despite the distraction of the conversation. "I guess he didn't like my dynamic personality. I thought shrinks ate that kind of thing up..."
Wilson was now moving his whole body in an effort to control his vehicle, occasionally leaning into House. If House minded, he didn't object. "Tell me, do you only derive pleasure from making decent people miserable, or do you get some sort of nourishment from it?"
"It's what keeps me healthy and youthful," House answered easily, beating Wilson once again. Wilson, for his part, got up and turned the game off, returning to the couch to sulk.
"I don't get why everyone keeps saying he's 'nice'," House continued, picking up the remote control and turning the cable box back on. He then began to flip through the channels. "It seems to me he's more 'condescending'."
Wilson shrugged. "He's... really committed to his work. Something you can identify with."
"Are you going to try to make us the bestest of friends so that we can all hang out together at lunch and giggle and have all sorts of fun?" was the somewhat annoyed response. Wilson could tell that House was uncomfortable with the thought of him being friends with someone else.
"I just want you to get along. I don't want to have to choose between you two, because you know I'll have to pick you and I kind of want to have more friends," Wilson explained.
House raised an eyebrow. "You'd be friends with me, even if it meant never having another friend for as long as you live?"
Wilson nodded. "You were there first. And, in your own bizarre, subtly-supportive way, you've always been there. If just to point and laugh at me while I'm down."
House laughed a little at that. "I'm not being 'subtly-supportive', so much as you force yourself on me while you're down and it'd be like leaving a puppy out in the rain." He finally seemed to settle on a channel, which was showing women's volleyball. "So is this the part where you go 'Eli has an X-Box 360, a Playstation2, and a GameCube' and I have to keep up with the Joneses?"
Wilson laughed. "No, he doesn't have video games. You'd probably find him really boring. His house is full of books and medical and psychiatric journals and he mostly listens to jazz and classical music."
"Probably the kind of guy who TiVo's Masterpiece Theatre and Nova," House muttered.
"No, actually, he doesn't own a TV at all."
"That's just inhuman."
"Tell me about it," Wilson said, rolling his eyes. "He's a great conversationalist, though. Really listens to people, and seems genuinely interested."
"Well, he's a psychiatrist. He'll probably hand you a report and a bill at the end of the month," House scoffed. "And he's just trying to impress you. People who think they have to prove they're smart go to great lengths to look smarter than they are. He's probably got a TV hidden somewhere and secretly loves The Three Stooges."
"As opposed to you, who doesn't have to prove his intelligence to anyone and therefore doesn't hide that he likes video games and watches SpongeBob?"
"Right. I'm secure in my intellect. I don't have to wrap myself up in pseudo-intellectual crap to prove it."
Wilson got up to get them both a beer. "Well, then I guess I don't need a psychiatrist for a friend. I already have you, with your expert ability to read people."
"Damn straight," House said, raising his fist triumphantly.
~*~*~*~*~*~*~
"So. We couldn't get a lumbar puncture, we could barely get an MRI... this girl just doesn't want us running tests on her, does she?" House asked, sipping his coffee. He was starting to adjust to the new supplier, although he'd never admit that to anyone.
"It could be a parasite. It's spreading fast enough," Cameron suggested.
"Or neurotoxicity," Chase suggested. "Mercury, inhalants..."
"If it were neurotoxicity, other organs would be affected: heart, liver, kidneys, lungs..." Foreman pointed out.
"Get a blood test. Hell, poke her every which way," House suggested. "If it's moving this fast, she'll probably forgive us when she doesn't die. Oh, and grab a piece of her brain while you're poking around." He took out his bottle of Vicodin, shaking out the last pill and dry-swallowing it.
"You want us to do a brain biopsy?" Cameron repeated, looking up from her copy of the file.
"Yes. A brain biopsy for a rapidly progressing neurological condition. Shocking concept, I know," House replied. "Now, I believe I just gave you a lot of work to do. Go do it."
House watched the fellows get up and leave the department to attend to their appointed tasks. Once they were out of sight, he left the room himself, heading over to Wilson's office. He opened the door without bothering to knock.
"What do you want, House?" Wilson asked, not looking up from the folder he was reading.
House closed the door behind him and limped over to the desk, sitting in front of it. He took out the bottle and put it on top of the folder. "Vicodin. I need more."
Wilson eyed the bottle quietly for a long moment, not touching it. When he looked up at House, his eyes were wide. He worked his mouth nervously for a few moments, not saying anything, then sighed and pushed the bottle back toward him. "I can't."
"Sure you can. Just take that pad of paper with the RX on it out of your desk, put the pen on it, and the rest will come naturally," House urged, starting to worry about what Wilson's behavior meant.
"No, I mean I can't prescribe it to you," Wilson stated.
House glared at him. "You decided now is a good time to start feeling like a guilty enabler? I was shot not long ago, if you remember."
Wilson shook his head. "That's not it. Cuddy told me not to. If I get caught, I could face disciplinary action."
"So don't get caught. I'll get it filled out of town," House said, sounding a little desperate. "Why is she choosing now to cut me off, anyway?"
"She'll find out, and you know that," Wilson argued. "And she found out you never saw a psychiatrist yesterday."
House snorted. "But I did. Abramson even told you as much."
"Your patient saw him. As in for evaluation or treatment saw him," Wilson snapped back. "Either way, Cuddy's issued a hospital-wide directive: no one is allowed to prescribe you Vicodin or any other narcotics until you've had a psychiatric evaluation. Which means the only doctor in this hospital you can get a prescription from right now is Eli."
House got up, looking away from Wilson. "That's just great. I'm fine. I went to clinic duty, I'm treating my patient--"
"But do you care?" Wilson asked.
House turned and looked at him. "What do you mean? I never actually see my patients. You know that."
"Your patient is decompensating fast. You usually fight tooth and nail to keep your cases from getting any worse, damn the consequences. You're... oddly resigned with this one. You've been treating her strictly by the book," Wilson explained. "The most you've done for her is fight with Eli to get a psych consult, and you admit that was for your own purposes, not for her."
"You've been talking to Cameron again, I see," House observed, rolling his eyes slightly. "Cuddy thinks something is wrong with me because I'm actually behaving myself? There is just no pleasing that woman..."
"It's not just Cuddy," Wilson argued. "You're... not focused. This case got interesting for you fast, and you don't even seem to think that's worth more of your attention. You're more hung up on Eli than you are on treating her. Even if Cuddy hadn't told me not to give you the Vicodin, I still would have pushed you to see someone."
House grabbed the doorknob. "I am doing a more than competent job with her. I would think that would be enough for you people. I shouldn't have to do tricks to please you." He then left, slamming the door behind him.
~*~*~*~*~*~*~
"You're going to have to shave my head?" Karen asked, tugging on a lock of her increasingly less blonde hair. Before anyone could respond, the whir of a small saw sounded. After a few minutes, the sound stopped, and Chase removed her cast in two halves.
"That should make you feel a bit better, anyway," he told her, taking off his mask and putting the small saw on a tray of instruments.
Cameron watched as Karen leaned over to scratch her leg before answering her, noting that she only bent at the waist. "Just a small patch of it so we can get into your skull. Your head will be bandaged until it heals, but by the time the bandages come off, no one will be able to notice."
"You keep talking about all of these tests, and you still haven't found anything wrong," Karen sighed, laying back down, her arm twitching as she did. "How many more do I need?"
"We're doing as many as we can today, so that you should know what you have very soon," Chase reassured her.
Karen continued to stare at the ceiling. "Who is Dr. House?" she suddenly asked.
Cameron raised her eyebrows. "Why?"
"My bracelet says I'm being treated by Dr. House, but I haven't met him. Is that just a name you put on your bracelets when a lot of different people are seeing someone?"
Chase laughed a little. "No, Dr. House is a real person. He's our boss. He's overseeing the case."
"Then how come I haven't met him?" Karen pressed.
Cameron cleared her throat. "Dr. House doesn't usually see patients himself. It's just standard procedure for him. But he's one of the best diagnosticians in the country, and he's being consulted for everything, so don't worry about him. Trust me: you don't want to meet him. He's a real jerk."
Chase started to laugh at that. Karen looked over at him for a moment, then at her bracelet again. "My parents had me moved here so I could be seen by a really good doctor. I guess they meant him. I hope they get their money back."
Chase began to help her up. "You should try to walk around a bit to strengthen your leg a bit. After we're done with you, you'll need some physical therapy."
Karen shakily got out of the bed, using the back to keep her standing. Chase slowly released her, and she took a few shaky steps forward, then started to fall again. Chase caught her and helped her back into bed. "Well, I guess I'm lucky I've got the hot doctor holding me..."
"Keep talking like that, and I'll start to think you're faking it just to get me to grab you," Chase teased.
Cameron rolled her eyes and closed her copy of the file. "Someone will be in shortly to get you ready for surgery. if you need anything before that, you know where your call button is."
~*~*~*~*~*~*~
House stepped into the clinic exam room, reading the chart as he did so. He wasn't interested in the patient's history, but rather the test results that had been placed in the folder. He looked up to see Tanner sitting on the table, his nose blissfully not bleeding. His mother, as always, was hovering close.
"So, do you want the good news, or the bad news?" House asked, grabbing the stool and pulling it over. He rubbed his leg and reached for his Vicodin, but remembering he was out he moved his hand back to the folder.
"There's bad news?" Tanner's mother asked, alarm crossing her features.
"No one ever wants the good news first," House mused. "Well, suit yourself. The bad news is your son has a condition called von Willebrand Disease, and there's no treatment for it."
"What?!" Tanner's mother gasped, pulling her son closer to herself. "What... what can I do?"
House sighed. "That's why people should ask for the good news first. Right now, you're probably hurting him more." Tanner's mother immediately released him. "The good news is, as far as diseases go, it's pretty harmless. Your son has what is called Type 1 von Willebrand Disease, a mild blood clotting disorder characterized by spontaneous bruising and occasional nosebleeds. As long as your sons stop smacking him around and you quit crushing him, he should live a long, normal life."
Tanner looked up at his mother. "Mama, am I sick?" he asked.
His mother looked unsure. "I... don't think so. He has a disease, but he's fine?"
"You were hoping for the flesh-eating bacteria, maybe?" House asked. "It's a mild disease. I told you what you had to do. Take my advice and we shouldn't have to see young Taylor in our clinic for a while."
"It's Tanner," Tanner's mother corrected him.
"Whatever," House said dismissively. "I have sick patients to see. Sicker than your son. Don't let the door hit him on the way out. And I mean that." He got up and limped out of the room.
~*~*~*~*~*~*~
House made his way over to Cuddy's office, still holding Tanner's folder. He entered without knocking, catching her on the phone. She looked up at him, muttered "I'll call you back", and hung up, looking up at him. "Dr. House. I suppose by now you've heard about the directive."
House threw the file onto her desk. "Tell me that's the work of someone who isn't focused."
Cuddy opened the file and scanned it quickly. "You diagnosed von Willebrand disease in a kid who presented with nothing but a nosebleed. Good pick up." She closed the folder. "Go see a shrink."
"Cutting a chronic pain patient off of his painkillers is cruel, even for you," House all but snarled at her. "Is that how it's going to be now? If I don't listen to you, you'll make it so I'm in so much pain that my choices are to do what you say or shoot myself? Or maybe you could just let another madman waltz into this hospital and do that for me!"
Cuddy sighed and looked down at her desk. "I don't want to have to do it, House. But I don't feel comfortable with you working here unless you get evaluated. You ignore my threats of suspension, you laugh at me when I threaten to fire you... you don't leave me with many options. It won't kill you. An hour, maybe less, with Dr. Abramson and you can have all the Vicodin you want. Hell, if he hands me an evaluation, I'll write the prescription myself."
"What is this really about? Were you hoping that life would get exciting with me back, and now that it's not you can't take it?" House accused. "Were you hoping taking away my pain pills would have me in my patient's room, pumping her full of drugs that I know won't work and insulting her the entire time? Does me misbehaving get you off?"
Cuddy opened a drawer on her desk, pulling out a file and slamming it closed. "Ketamine, House. You asked for Ketamine after you were shot, and you won't tell anyone why. If it's simple, if it doesn't bother you, then why won't you just tell us what that was about and shut us all up?"
"You want me to see a shrink so you can solve the great Ketamine mystery?" House asked incredulously. He sat down in the chair in front of her desk. "I'd just gotten shot. I was muttering things. That's it. Nothing else."
"It's something else, and it's bothering you," Cuddy shot back. "It's affecting how you work. Why are you fighting this? Does the thought of talking to a psychiatrist for an hour really offend you on so many levels that it's worth taking a stand against?"
House rubbed his thigh and glared at her for a long time. She was still staring down at her desk, and the closed file she'd placed on it, on top of the one he'd brought her. He finally, shakily got to his feet and turned around. "As much as I'd love to keep arguing in circles with you, my patient is having brain surgery right now. I should really check in on that. Unless you think me talking about my feelings is more important than that, too." He didn't wait for her answer as he limped out of the room.
~*~*~*~*~*~*~
The surgery had been a success, amazingly enough. The fellows had been worried, considering the problems that had arisen when they had tried to test Karen previously, but they now had their sample. Foreman was sitting in front of the microscope, loading the sample slides under it to examine it. It didn't take it long to see the problem.
"Oh, damn..." Foreman muttered. "I should have figured this out sooner..."
"What is it?" Cameron asked. Foreman pushed the microscope aside and looked in. "Oh, damn. Creutzfeldt-Jakob?"
"She didn't have a typical presentation of it," Chase brought up. "Are you sure?"
"It's probably a variant Creutzfeldt-Jakob," Foreman explained. "It probably originated in the temporal lobe and spread into her hippocampus, which would explain the blackouts and lack of impulse control. And I'd say it's spreading to her frontal lobe. She's got a few weeks left, if that. And they won't be good ones."
"Isn't variant Creutzfeldt-Jakob caused by Mad Cow?" Cameron asked, looking into the microscope again.
Foreman leaned back in his chair. "That's what some neurologists believe. There was a rash of it in Britain during the Mad Cow outbreak. No one's proven a definitive link, though, so we can't really say what caused it."
"Damn. Well, I guess now there's nothing left to do but tell House we solved the case and break it to her," Chase said miserably.
"Actually, I think I got the gist of it," House said, limping into the room. The fellows all jumped.
"How do you keep doing that?" Foreman cried, backing away from the table as House approached. He leaned in to look into the microscope.
"That's for me to know and you to never find out. It's way too much fun," House told them, looking at the sample. "Yup, her brain's a sponge. And not in the good way. Who gets to be the bearer of bad news?"
When no one volunteered, House looked up and examined all three. "Hmm...eenie, meenie, miney...Foreman. You're a neurologist. I'm sure her parents are going to have a lot of questions. You can get it across just how toast their daughter is."
Cameron looked at House for a long time. "You honestly don't care that your patient is going to die? That you can't fix her?"
"Of course I care. No use crying about it, though. VCJD has no cure and only a couple of treatments that no one thinks work. Even if I figured this out on day one, there's not a damn thing I could have done," House said, still sounding oddly unphased by the events. He got up and went to leave the room. "What is it with you three lately? Do I have to repeat every order before you do something? Foreman, I told you to ruin a girl's life. That means now."
Foreman glared at House, then grabbed the file and left the lab. House limped out not long afterwards.
Cameron turned to Chase and pointed at the door. "That's what I'm talking about when I say he's not normal."
"I heard that!" House called out from the hall.
~*~*~*~*~*~*~
"There's...nothing you can do?" Mrs. Logan sobbed, clutching her husband. Karen was in her hospital bed, staring off at a point at the wall. If she heard what was being said, she gave no indication of it.
Foreman shook his head. "In Britain, there's been some success with a drug called pentosan polysulphite. It's believed to slow or halt the progress of the disease. But even if we got it and it worked, we can't undo the damage that has been done. We can only manage it."
"And without this drug?" Mr. Logan asked.
Foreman looked down at the floor for a moment, then met Mr. Logan's eyes. "VCJD tends to spread faster than the regular form of the disease. Based on the timeline of events, which indicate she was infected about six months ago, and on her current progression, there will be more dementia and memory loss, and she'll continue to lose function in her limbs and throughout her body. From there, she'll enter a coma and die shortly thereafter as the parts of the brain that control important systems in her body are eaten away. This will take another two, possibly three weeks at this rate."
Mrs. Logan turned to look at Karen, then back to Foreman. "Please, try the drug. Try anything. We can't lose her. Not like this."
Foreman nodded. "I'll do my best. It's a very experimental treatment, so we'd have to get her into a research study."
"Of course. We'll do anything," Mr. Logan said firmly.
Karen just continued to stare at the wall, not responding to the conversation at all.
~*~*~*~*~*~*~
House wasn't sure why he wandered into the physio department. He had originally intended to retreat to his office to nurse his aching leg, but somehow his course took him on a detour. It alarmed him slightly that he couldn't trace the thought process that had taken him here, or why his body still insisted that he keep going, despite the fire in his leg.
He continued walking slowly, people in the halls giving him confused or surprised looks as he did. No one had expected to see him here after his violent refusal to get physical therapy after his infarction, and some of the newer staff didn't even know who he was.
He stepped up to the room with the physical therapy pool. It seemed to be closed: the lights were off and it was empty. Perhaps no patients needed it at three in the afternoon...at any rate, the door was unlocked, and he felt himself compelled to push it open and step inside, up to the edge of the pool.
He closed his eyes for a moment, breathing in the smell of chlorine, which seemed to be fading from the air. Perhaps he was adjusting to it already. He leaned heavily on his cane, and thought he could smell the salty tang of the ocean. Thought he could feel himself sinking into the depths of the water, the weightlessness making his battered body less of a burden to carry, the cool water easing the throbbing pain in his thigh.
He opened his eyes and realized he was face-down in the pool, with no recollection of jumping in, still clutching his cane. He panicked for a moment, rolling over onto his back and breathing deeply. Then he remained there for a moment, savoring the temporary relief the water offered him. He could forget his pain, forget the withdrawal symptoms that were finally starting to creep into his body. He didn't know how he got here, and for the moment, he really didn't care.
He finally pulled himself slowly up onto the edge of the pool, sitting with his feet dangling in it for a moment, before finally hauling himself to his feet and making his slow way out of the physio department.
More people were staring at him now, whispering amongst themselves as they watched his soaked form limping painfully away. When he was almost out of the physio department, he turned around, shouted, "What? Never seen a guy take a relaxing dip in the pool before?" He then pushed open the door and headed toward the elevator.
~*~*~*~*~*~*~
No one seemed to find a patient wandering slowly, awkwardly through the halls. Maybe it was the fact that Dr. Chase had ordered Karen to work her leg, so they expected it. At any rate, no one seemed to notice her slip into the dark, empty diagnostics department, grasping furniture on the way to make sure she could still stand, her limbs threatening to give out.
Her thoughts were racing. Words like "dementia", "loss of limb function", "coma", and "death" kept popping up. She couldn't imagine herself going like that. She didn't give a damn about the medicine that her parents kept promising to get her, and how it would work. She couldn't live like this.
She wasn't sure what she expected to find in this room. She knew this was where all the doctors that kept testing her were from. She'd read their badges, and they had all that equipment. She'd find something. She looked over toward the office at the other end of the meeting room. There was a balcony just beyond it. If she could get there...
She shuffled slowly to the office, trying to open it. It wouldn't open. She could feel her rage surge inside of her as she pulled the door, trying to get the lock to give. She finally grabbed one of those black chairs, with the curved backs that were supposedly better for your spine, and shoved it as hard as she could manage into the door. It crashed with the loud clatter of breaking glass. She looked outside of the room, waiting to see if people were coming. They were. She didn't have much time.
Threatening to stumble over with each step, glass cutting into her feet, she charged through the office and yanked open the door. One of the doctors who had worked on her was with them. The pretty woman that thought she was being mean to her friends. The one she probably liked the least right now. Giving them a quick look, she continued to plow forward.
The momentum was enough to carry her straight over the balcony, and she tumbled over, head first.
~*~*~*~*~*~*~
House was still very wet, although not dripping wet as he had been, when he stepped into Abramson's office without knocking. He'd already been to his own department, where he'd howled about his broken door and the fact that his patient could commit suicide in his own office while his team was supposed to be taking care of her. Then he'd quietly dismissed himself and headed toward the elevator, where he found himself here.
Abramson looked up from the folder he was writing in. "Dr. House. You're...wet."
"I went for a swim," House said, as if that explained everything. He limped slowly over to the desk. "I need my Vicodin."
Abramson examined House for a moment longer. "I heard your patient committed suicide."
"Yeah, she did. Not my fault. I need my Vicodin," House repeated, still looming over the desk.
Abramson sighed, opening his desk and removing a prescription pad. He hastily scribbled the prescription on the top sheet, signed it, and tore it off the pad, holding it out to House.
House looked at it suspiciously, then reached out to take it. Sure enough, it was yanked out of his grasp. Abramson stood up and gestured to one of the chairs in front of his desk. "Have a seat, Dr. House."
Fin