30 Days and Nights of House/Chase: Day 15

Aug 15, 2008 11:23

It's kinda funny that my Day 15 entry comes after Day 17. 8-D

In any case, this is approximately hump day for our ficathon. Believe it or not, readers, but not only do I have another installment of this story, but two more coming soon! I don't want anyone to feel deprived on Day 17, so I will post the next chapter then.

TITLE:  Not Entirely Human Error - Part 14
AUTHOR:  parkermonster
PAIRING:  House/Chase
RATING:  PG-13, for language
WARNINGS: OK, I admit it. I went totally nerd-shit on the diagnostic stuff. Sadly, it’s more accurate than some of the cases they have on the show. I’d be their medical advisor for free if I got to meet HL and JS. Just sayin’.
NOTES:  Spoilers for Human Error, and everything that leads up to that. Someday I might even incorporate something from Season 4, but not today.
SUMMARY:  Chase is doing fine on his own, and House is making life more complicated, whether Chase likes it or not.


DISCLAIMER: The writers won’t give me any Chase, so I gotta do it myself. At least David Shore now has the decency to admit JS got screwed over last season.

Oh, and there really isn’t a space in “NewYork-Presbyterian”. Beats me why not.

Here are the links to Chapter 1 and the previous chapter.

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Part 14

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After going over the file twice to make sure he wasn’t missing anything, Chase headed down to the Diagnostics department. Even though it was one in the morning, he expected to find House waiting. From reading the case notes, he knew that the patient had been flown in that afternoon from New Mexico, which was a bit far afield from their usual referrals. Much more intriguing was the fact that House had apparently sought out the case and arranged the referral himself. Since when has House been that eager for new patients? I can’t believe he would have done this just for my benefit.

Sure enough, House was sitting at the conference table, drumming his fingers in impatience. As soon as Chase entered, House wordlessly tossed him a marker. Chase smiled and turned to the whiteboard to list symptoms.

Headache

Nausea, vomiting

Intermittent fever

Periorbital pain

Loss of vision

Generalized seizures

Weil-Felix +

After a moment he added the notes:

Two months duration

Central America

“So,” Chase said as he capped the marker and surveyed the board thoughtfully, “He presented as meningitis, but the diagnostic tests are negative and the symptoms haven’t resolved. He arrived in the U.S. from Guatemala a month before the symptoms began. They ran tests for the usual tropical diseases, all negative. He had a positive Weil-Felix test but the serology was negative for rickettsia. Probably worth running a PCR just to be sure, although the symptoms aren’t right. They did what looks like a piss-poor head x-ray six weeks ago and didn’t note any pathology, although on these films it’s hard to tell anything except that he doesn’t have any large masses. We need to run a head CT and make sure he doesn’t have Swiss cheese in there.”

He turned back to House, tapping the marker on his palm. “Anything to add?”

House tipped his chair back with a rather self-satisfied expression. “Actually, no. You hit the main symptoms and I agree about the CT. Any other tests you recommend?”

Chase scowled in response. “Are we working together here, or am I playing the role of a trained diagnostic chimp? Since when do you have nothing to contribute to a diagnosis?”

“Fair enough,” House nodded. “They ran the obvious tests, but then we’re talking about an illegal immigrant with no insurance, so he didn’t exactly get the A team. At least now he has an A-plus-plus team. We should rerun all of the tests properly.”

“I concur. The sporadic fever and recurrence of the symptoms point away from the obvious diagnosis of meningitis, but it makes me suspicious that there’s some sort of infectious process involved.”

“Possibly. His blood and spinal fluid were clean that last time they were checked, but that could have changed. Could it be…” House paused for melodramatic effect, “autoimmune?”

Chase raised his eyebrows. “Feeling nostalgic, are we? Because if you are, allow me to suggest that the problem is neurological.”

House chuckled. “Even Foreman has to be right sometimes.”

“Well,” Chase tossed the marker onto the table, “I don’t think we can take this any further without test results, so give me a page when they’re available.”

“Aren’t you going to…”

“No, I’m not, House. I’m going home. Call me when you have some new information.”

“Hmmph,” House replied. “So much for dedication to patient care.”

“Good night, House,” Chase smiled to himself as he walked out.

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Chase was pleasantly surprised when House didn’t bother him again for two days. He’s actually waiting for the test results. Guess he’s on good behavior for the moment. When the page came, he handed off his patients as soon as decently possible and headed for Diagnostics. When he arrived, House was once again sitting at the conference table.

House slid a new folder across the table to Chase. “You were wrong about the Swiss cheese.”

“Oh?” Chase replied as he looked through the lab data.

“Yeah, it’s more like cottage cheese.”

Chase frowned as he walked to the viewer. House was right; the patient’s brains were riddled with small masses. Shit, he thought. This guy’s in big trouble. He turned back to House. “Have you seen something like this before?”

House shrugged. “Might just be metastases from a tumor we haven’t looked for yet.”

Chase turned back to the films. “I don’t think so. These masses scan more like cysts than solid tumors, but the margins are diffuse, which doesn’t fit. We should do a full-body scan to rule out cancer, but I’m still thinking infection.”

“Odd infection, with no antibodies to anything the lab could think of in the blood or spinal fluid. If his immune system is that weak, he’s got bigger problems than brain masses.”

Chase flopped into a chair. “True, but I still think infection. The pattern of masses and lack of antibodies seem to rule out any common Central American parasites I can think of. It could be a virus, but all the tests for meningitis and encephalitis are negative. Maybe he’s got a type that no one has seen before, but if so, we probably won’t be able to treat it at this advanced stage. Maybe a disseminated fungal infection, although they already tested for histoplasmosis and the other likely suspects. I’m going to vote for that or a bacterial infection.”

“Interesting,” House replied. “Totally unsupported by the tests, but interesting.”

Chase frowned. “In any case, we need to crack his skull and see the masses up close. That’ll give us some tissue to work with. Maybe we can excise the ones encroaching on his optic nerves and salvage some of his vision, at least.”

House nodded. “Agreed. I’m still leaning toward some sort of neoplastic process, so I’ll run this afternoon’s MRI results by Wilson and see if he can find anything. We’ll schedule surgery for tomorrow morning.”

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House stood in the gallery and observed the surgical procedure with a smile. Chase had decided to scrub in and check out the lesions himself. I’ve got Chase’s attention. Good case, he thought. Not for the patient, of course. The way everyone at the head of the table was leaning in suggested that they had found something significant.

“The masses are firm but there’s no vascular infiltration,” Chase’s voice came over the loudspeaker. “It could be a disseminated lymphoma, which doesn’t seem likely, or maybe even astrogliosis. We’ll have to wait for the histology.”

That was just fine with House. He’d never admit to it, but it felt good to have a team again. Especially this team of one.

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Chase was back in the ICU when he got House’s page.

Granuloma.

He couldn’t leave immediately, so he paged back:

Organisms?

Nope.

Gliosis?

Multinucleated giant cells.

Infection!!!

With what???

???

Also, new symptom. Go examine. Order morphine.

That was sneaky, Chase thought. He knows I’ll actually go if the patient needs painkillers.

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“Well,” Chase said as entered House’s office, “Thanks for sharing, House. That certainly made my day.”

House gave him that snarky smile that sometimes made Chase want to smack him with his own cane. “Thought you’d like it.”

“Right. What guy wouldn’t enjoy examining someone in excruciating pain from swollen, inflamed testicles? It hurt just looking at him.”

“No kidding. So, differential for multiple brain granulomas and giant purple balls?”

Chase sat down and frowned. “Wegener’s and Churg-Strauss don’t fit. I was thinking maybe granulomatous amebic encephalitis before the new symptom arrived. Then I remembered the positive Weil-Felix test…”

House broke in. “You think rickettsial infection fits?”

“No, I don’t,” Chase replied, “So I asked the patient about his diet when I was in there. Queso fresco was a major component back in Guatemala. I’m thinking neurobrucellosis.”

House leaned forward with a thoughtful expression. “Central America and raw dairy products fit. There were no serum or spinal fluid antibodies to Brucella, though. The tissue samples showed no signs of gram-negative bacteria either.”

“True,” Chase nodded. “But the infection could be attenuated at the moment, and it’s unusual but not impossible that there are no measurable antibody titers.”

“I like it,” House said. “They’re already running cultures on the tissue, so that could confirm the diagnosis.”

“Too slow. I suggest we run a sample through PCR to confirm as soon as possible. His brain could wait a few days, but not his testicles. Maybe we could start him on antibiotics now? I checked the regimen; a combination of rifampin, doxycycline, and IV gentamicin. There shouldn’t be any permanent harm if they turn out to be unnecessary.”

House nodded. “If it was me, I’d definitely welcome the side effects if they came with a human-sized set of balls. I say go ahead.”

“Your patient, your orders,” Chase said as he rose with a smile. “For my part, I’ve already located PCR primers at NewYork-Presbyterian. They’ll be here by morning.”

“Good thinking,” House smiled. “I taught you well.”

“That must be it,” Chase said as he headed off to the ICU. “Hold that thought until we have a confirmed diagnosis.”

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The next afternoon, Chase was checking patient charts when House appeared at the office door with an ominous expression. He sat across the desk from Chase and folded his arms.

“Well?” Chase responded. “Are we back to the beginning?”

“No, it’s neurobrucellosis. We’re sending a sample out for species identification, but they all respond the same treatment, so this case is pretty much closed.”

Chase leaned back with an expression of relief. “Good. So why the glare?”

“You’re an idiot.”

“Because I got the diagnosis right? Fascinating logic.”

“No, you’re an idiot because you were capable of getting it right and yet you persist in throwing your skills away in the ICU.”

“Uh huh,” Chase nodded. “And dare I ask what your recommendation is for my career pathway?”

“Come back to Diagnostics. It’s where you belong.”

“You fired me from Diagnostics, remember? Told me I had nothing more to learn there, if I recall.”

“I was talking about the fellowship then. Now I’m talking colleague, team supervisor, another opportunity to work side-by-side with the master.”

“I see,” Chase smiled. “You know, I rather like it here in Intensive Care. Nobody argues or tosses insults when a patient flatlines. You just do your job and save a life, right on the spot.”

“Boring. They don’t need you to save lives. They’d manage quite nicely without you.”

“Probably, but I can’t say that I’m all that excited about the notion of coming back to Diagnostics full-time.” Chase found himself relaxing in House’s presence for the first time since he’d lost his Fellowship.

“C’mon, admit it, you miss the mystery, the drama…” House threw his arms wide. “The spectacle, the romance, all in Technicolor and Dolby Digital.”

Chase grinned. “I see. We’re doing a movie metaphor now.”

“Yes! And the part of the brilliant yet beautiful Doctor Robert Chase will be played by…drum roll, please…Zac Efron!”

Chase shook his head in mock disgust. “Alright, then I get to cast the part of Doctor Gregory House. Let’s see. Brilliant, drug-addled sociopath. Obnoxious yet vaguely amusing at times. I have to go with…Dennis Hopper.”

House positively beamed. “Excellent. I like it. Gotta get me a real hog to ride, though. So, who do you think for Cuddy? Someone with ginormous twins, of course. Pamela Anderson is no longer nubile enough to do our fearless leader justice. Maybe Carmen Electra in a push-up bra?”

“I’m not going there,” Chase replied with a small smile. “And I can’t believe you passed up the chance to cast Neil Patrick Harris as me, after all the Doogie jokes.”

“Not young or pretty enough,” House scowled, then broke out into a grin. “He’d make a killer Wilson, though. Doogie, all growed up.”

“You know, that really works. One more and I need to get back to work. We’ll want a younger Louise Fletcher for your archnemesis Nurse Brenda.”

“Perfect! So how about dinner?”

Chase snapped his head back as far as it would go. “Excuse me? I think I just got conversational whiplash.”

“I asked you out. Big surprise,” House said with a barely disguised look of reproach.

“Why are you doing this, House? You’re not even gay.”

“Labels, labels. What makes you think I’m not of the homosexual persuasion?”

“Well, that thoroughly disgusting screensaver on your office computer, for one thing. I don’t even know what those two naked women are doing, but it’s not sanitary. Also, the hookers you rave about constantly. Oh, and then there’s Stacy? Love of your life, object of romantic pursuit, et cetera, et cetera?

“Yeah, there is Stacy. However, this all goes to show that I am neither gay nor straight. I’m polymorphously perverse.”

“Well, you’re perverse, that’s always been obvious.” Chase paused. “Although, I guess that diagnosis would fit in with your arrested emotional development.”

“Bucking for a psychiatry fellowship next?”

“No, working for you for three years taught me everything I need to know about aberrant behavior.”

“When have I ever…? Oh, that’s right, we’re talking about me. Anyway, I’m not being perverse right now. I want us to have, for lack of a better word, a relationship. Close up and personal.”

Chase laughed without sounding very amused. “That’s probably the very definition of ‘perverse’. We’ve just started back on speaking terms, and we’re not really friends yet. I don’t see anything...social happening before I even like you again.”

He said ‘yet’, House thought. We’re making progress here.

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TBC, very soon

A/N: In Freudian theory, the term “polymorphously perverse” refers to a normal developmental phase where very young children find sexual gratification in virtually everything, including body parts and objects of ‘affection’ that society may not consider appropriate. Most, but not all, people grow out of these multi-directional urges. It’s more complicated than this, of course, but you get the idea. And despite what a previous version of Wikipedia said, this expression was not invented by Woody Allen. He just uses it a lot.

The next chapter is posted here.

house/chase fanfic, 30 days and nights of house/chase

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