Triggers for cancer, abuse, and drug overdoses


It was a cold September afternoon and Ashtyn Miller made her way across campus. Fall was one of her favorite time of year there was just something so great about sweaters and boots to her. She had been having chest pain on and off for the past few days so she figured since that was her last class of the day she would go down to Princeton-Plainsboro hospital and at least have it checked out. She burrowed into her leather jacket and walked into the clinic her riding boots echoing off the linoleum.

"Can I help you dear?" The older receptionist asked looking at the young woman who had just walked into the clinic.

"Yes how full are you guys today?" She asked the receptionist figuring if the clinic was super busy she could just go to the emergency department.

"It all depends on your chief complaint how soon you get seen. I'm going to need to know what is wrong and I'm going to need to fill out some paperwork and I'm going to need your insurance card. This is a free clinic but if you have to be admitted we would need the insurance."

"I've been having mild chest pain the past couple of days I've finally figured I should get it checked out. I don't think it's super serious I just feel like getting it checked out would be the best." She said handing over her insurance card and her driver's license figuring they would also need to verify who she was.

"Thank you dear if you could fill these out of me to the best of your ability. I don't blame you if I were having chest pain I'd be here to." She might have an only been a receptionist but she knew chest pain was a rather serious complaint.

Ashtyn looked down at the stack of forms and filled most of them out she had general knowledge of her family history but she felt it could have been slightly more detailed. She got up and made her way to the reception desk. "Alright dear I'll take those here is your insurance and driver's license back. Have a seat and a doctor will be with you shortly."

Ashtyn grabbed her phone to pass the time after all she could be waiting the rest of the afternoon to see a doctor which was fine because she didn't have any more classes for the day, just cheerleading practice and she was actually due to her coaches insistence.

"Ashtyn come with me please." A nurse said standing in the doorway after about ten minutes of waiting.

"She just got here." A patient snarled looking at nurse he had been waiting since ten am and it was now one on the afternoon.

"She did but her complaint is greater than your complaint." The nurse pointed out taking the girl back to the exam rooms. "Step on the scale for me please."

"Sure." Ashtyn kicked off her shoes knowing they added more weight. She stepped onto the scale she normally weighted around 100-110 pounds usually cheerleading was really good about keeping her healthy.

"112 pounds now can you stand straight?" The nurse questioned getting her height. "5'4." The nurse wrote in down in the chart. "Chest pain aren't you a bit young for chest pain."

"That's what I was thinking, but I'd rather not ignore it and have it be something serious." Ashtyn said sitting down on the exam table and crossing her ankles since her feet didn't touch the floor.

"Lift up your tongue." Molly said getting her temperature. "98.2 which is normal." She grabbed the blood pressure cuff from the wall and secured it around her bicep. "115/50 which is really good. I'm going to find a doctor."

Dr. Cuddy was looking for Dr. Chase when she noticed pristine blonde surfer hair ahead of her. "Chase do you have a second?" She asked running to catch up to him.

"Sure what do you need?" He asked looking at the Dean of Medicine.

"You haven't completed your five clinic hours this week." She explained she really hope he wasn't going to play a House and avoid his clinic hours too.

"I'm sorry about that I was actually heading down there when you stopped me." He said hurrying off in the direction of the clinic sure it was rather boring but it did help out the community and he wasn't House who tried to get out of them he had just simply been busy this week.

"Dr. Chase have I got just the case for you." Molly said handing him the red chart. "22 year old college student complaining of mild chest pain. I'm willing to bet she is trying to avoid some kind of exam.

"I'm not so sure about that who would fake chest pain to get out of a test? Food poisoning and period pain maybe, heart related I doubt it." He walked off to the exam room two. "Ashtyn?" He asked making sure he had the correct room. The girl nodded her head and he sat the chart down on the counter. The girl was really pretty she had wavy blonde hair with pink ends. "So how long has the chest pain been going on for?

"A couple of days it's not really painful just sort of annoying. So Australian or British?" She asked trying to figure out his accent not to mention when he walked into the room her heart almost stopped he didn't look like a doctor what with his blonde hair which was surfer like, and his baby blue eyes made her want to melt.

"Hold out your hand for me. I'm Australian most people assume I'm British. So are you an active person?" He questioned he figured judging from her skinny figure and her toned arms she was an athlete of some kind.

"I'm a cheerleader for Princeton so I'm most certainly an active person." She said holding out her arm. "I was about ready to guess Australian I just didn't want to offend you if you weren't. So why did you move to the States?"

"Cheerleading any recent falls from the pyramid or hit the field hard after tumbling?" He questioned sometimes falls could cause slight chest pain. He placed two fingers on her wrist and looked down at his watch taking her pulse. "Your heart rate is in the 160's." He pointed out knowing right away that something was wrong because the normal resting heart rate for someone Ashtyn's age was 60-100 she was easily sixty points away from normal. "Does your heart feel like it's about ready to pound out of your chest?" He questioned noticing her nail bed was slightly a slight bluish tone.

"Yes my heart does feel like it's about ready to jump out of my chest. No I haven't fallen or taken a rough tumble in at least a solid week. In fact the bruise on my hip is finally clearing up from the last time I over rotated and hit the mat."

Chase reached for the stethoscope in his lab coat pocket. "I'm going to need you to remove your jacket so I can listen to your heart."

Ashtyn shrugged out of the pink leather jacket and tossed it onto the nearby chair. She was still in a white sweater dress and a pair of brown riding boots.

"Breathe in and out." He instructed listening for any murmurs, crackles or other sounds that shouldn't be in the heart and he heart a small murmur. "I'll be right back." He said leaving the room to find Cuddy or House and Cuddy's office was closer. "Want to take me off of House's service so I can deal with this case?" He asked handing her Ashtyn's chart.

"22 year old with chest pain?" Cuddy questioned looking at the chart. "Is she overweight?"

"Nope she is 110 pounds and is a cheerleader for Princeton University. So it couldn't be a heart attack and her heart rate is in the 160's. No family history of heart disease." Chase rattled off as his boss watched him.

"If I were you I'd admit her start her on beta blockers do an EKG, ECHO, CBC, ABG, TEE, lumbar puncture to check for STI's, and a heart biopsy, oh and do pregnancy test. That's what I would do but your specialty lies in cardiology so you probably know more than an endocrinologist." She pointed out. "I'll talk to House about the case who knows it might just peak his interest if not take as much time as you need." Chase was a really good doctor probably the best on House's team she hardly had any problems out of Chase. Cameron was alright she just needed to learn to speak up and think for herself, and not be so quickly to jump to House's defense. Foreman reminded her of a younger House with the same disregard for the rules, which scared her a bit she didn't really want to deal with two House's lord knows one was plenty.

"Thank you for the help I'll admit her and get her started on beta blockers for the tachycardia." Chase went back to the clinic. "Sorry for making you wait. I'm going to admit you and run several different tests. Your heart rate has me worried so it's better to run a couple of tests and have them come back negative than sending you back to the dorm and having you come back only in worse shape. If you would grab your stuff and come with me."

"What kind of tests?" She questioned the young doctor following him out of the clinic.

"Blood tests, a couple of heart ultrasounds nothing to completely painful, unless they all come back clean then we might have to do a heart biopsy." He said leaving out the lumbar puncture Cuddy suggested since she didn't seem to be showing any signs of an advanced stage STI.

"I really hate needles and I don't handle pain well at all." Ashtyn pointed out wrapping herself up in her leather jacket since the hospital was freezing and the fact that she was suddenly terrified something was majorly wrong with her.

"Only thing that should involve needles are the aerial blood gas, an IV, and a complete blood count." He pointed out leading her into the private room. "I'm going to need you to change into this." He said handing her a gown. "Bra has to come off too."

Ashtyn ducked into the bathroom to change out of her sweater dress and leather jacket and into the hospital gown. She came out of the bathroom feeling terrible. "I'm already sick do the hospital gowns really have to be this terrible?" She complained sitting down on the bed as he wrapped an identification bracelet around her wrist.

"I'm sorry most people do hate hospital gowns. So are you allergic to anything?" He asked siting down on the rolling stool.

"Bees, wasps, Depo, and Keflex all of them are severe enough to make me carry an Epi-pen."

"When was your last period?" Chase asked watching her cheeks flush slightly at the question. "I'm sorry I have to ask some really personal questions."

Ashtyn grabbed her smartphone from her pocket and pulled up the app on her phone. "My last period was September 2nd of this month." Although she found the question slightly personal she also knew that it was probably necessary.

Chase wrote the date down in the chart. "Is there a chance you could be pregnant?"

Ashtyn giggled softly at that question. "No chance whatsoever last time I had intercourse was a little more than a year ago. I've also since had a yearly exam and I don't have any STI's either."

"Are you currently on any medication?" Chase questioned knowing that the questions were really personal but things like pregnancy were important in ruling out other diagnoses.

"TriNessa, which is a birth control pill." She answered picking at her nails adverting the gaze of the young physician. "I have really bad cramps which makes cheerleading nearly impossible and it helps." She explained.

"Alright go ahead lie on back for me." He instructed setting down the chart and grabbing the blood pressure cuff from the wall.

"Why America over Australia?" She questioned as he attached the cuff to her arm.

"I grew up there and went to school there I just wanted to be in America and this is one of the best hospitals in the country so a better opportunity. Besides my father is a world renowned doctor who practically wrote the book on Rheumatology. I needed to make a name for myself and get away from his shadow. So where are you from?"

"Talk about family pressure and I grew in Nashville."

"Not really I've made my name and he and I are still close despite the fact there is an ocean between us. Nashville, Tennessee?" He questioned she was being vague and vague tended to mean she was hiding something about her past. "Don't be afraid to talk I've heard it all before, nothing and I mean nothing surprises me anymore."

"Trust me you don't want to know about my past life." She sighed picking at her nail noticing the bluish color under it. "Why are my nails blue?"

"Cyanosis it's shows that your blood isn't getting enough oxygen. Which is strange because your oxygen stats are in the upper nineties." He said after attaching a pulse ox machine to her finger. Really what you could be hiding?" He asked curiously finding the blonde college student interesting and really beautiful which he shouldn't have been thinking about.

"I'm from Nashville, Indiana my parents divorced when I was three. Trust me I don't think you want to hear the rest of it." She said crossing her arms over her chest. She hated talking about her screwed up family.

"My family got divorced when I was younger too, it's common nowadays most people want to run the moment the relationship gets hard. Why do I get the feeling you are still hiding something?" He questioned besides House had drilled the phrase 'everybody lies' into his brain so something that she was hiding could hold the answer as to why the chest pain.

"My mother had lung and brain cancer when I was in junior high. Now it seems like every little thing that hurts her is the end of the world. I'm not even going to call them because I'd rather not deal with her shoving religion down my throat and making my heart all about her. I had to get away and find myself it felt like I was trapped growing up." Ashtyn said almost on the verge of tears. "Everyone assumes cancer only affects the patient they couldn't be more wrong I almost didn't graduate eight grade because of her cancer. I feel terrible for only calling on major holidays but that's the only way I can deal with them." She said on the verge she used to have a great childhood with two wonderful parents, but then her mother met Peter and got cancer and her happy world turned dark.

Chase as a doctor knew how hard cancer was for every party but it was an especially trying time for any child watching their parent go through that. "I hate to tell you this but you might want to call your parents you might think you can handle being alone in a hospital but honestly you can't. I can however limit how often the visit and talk about God. He questioned attaching the heart leads to her chest. He felt sad for the poor girl no one young should ever have to watch their parents almost die of cancer.

"How about we see what the tests see and then I might call my parents, it's not like I'm a minor and you need their permission for medical decisions besides I'm kind of used to being without them.

"That fine that you wait but if any tests shows anything out of the ordinary call your parents. I don't want you going through this all alone. What are you majoring in?" He asked curiously.

"I have my cheer squad, and my sorority sisters so technically not alone. I'm studying psychology." She said still hiding the fact that her father died of a drug overdose and before she graduated high school her parents tried forcing her into an arranged marriage.

He walked over to the cabinets and grabbed the equipment necessary for an ABG, CBC, and IV. He washed his hands and put on gloves. "What sorority are you in?"

"That's a lot of needles." She remarked. "So what do your parents and siblings do?" She questioned mainly she just wanted to hear him talk some more. "I'm a Delta Gamma."

"You are nosey." He teased feeling for her radial artery. "My mother was a nurse, my step-mother is a doctor. My older brother is a doctor, my youngest brother is in medical school, and my sister is still in high school, but plans on medical school.

"So a family of doctor's that's impressive. Why the wrist I've never had a nurse get blood there?" She asked watching him grab the needle.

"Little pinch." He warned collecting a small amount of atrial blood. "That's because it's not the blood we use for a blood test its atrial blood which is a different test all together." He placed pressure over the puncture site to help stop the bleeding.

Ashtyn whined feeling the pinch in her wrist. "So what do you think could be wrong with me?"

"Well it could be a lot of things, you could have a tumor in the heart muscle, you could have an undiagnosed heart defect, could be a virus attacking the heart, or it could just be that you have a heart arrhythmia. Once I get an IV into your arm I'm going to start you on Metoprolol Succinate which will help with your high heart rate."

"Isn't that a beta blocker?" She questioned remembering the name from somewhere.

He placed a bandage over the puncture mark and grabbed the IV needle. "Another stick, I'm sorry you probably feel like a pin cushion and yes it's a beta blocker it'll help lower your heart rate."

"I do feel like a pin cushion but I also know that you wouldn't be doing the tests without having a valid reason." She winced feeling the needle above her wrist. She watched as he placed tape over the IV and pushed clear liquid into one of the open ports.

"Trying to avoid me?" House asked leaning against the sliding door wondering where the kangaroo had hopped off to. "I need the kangaroo dealing with my cases not his own cases besides hearts are boring wouldn't you rather be dealing with a police officer who can't stand?"

"I'm not trying to avoid you. I forgot to do my clinic hours for the week you'll do just fine without me; you seem to be forgetting you have Cameron and Foreman also."

"Have you checked her for syphilis?"

"No and because nothing seems to point to it. She isn't having psychosis it's only high heart rate and a heart murmur." He remarked changing his gloves and collecting her blood. "Alright no more needle pokes for a while." He said tossing the gloves and having a nurse drop the blood and blood gases by the lab.

"I don't have syphilis the doctor I see always does an STI screening. I'm not pregnant nor do I have STI's just because I'm a cheerleader doesn't make me a slut whose screwed the entire football team. Football players are all the same anyway wanting a quick lay and nothing else and I have morals. Shocking isn't it." She already disliked the older doctor leaning against the doorframe she was used to people seeing blonde and pretty and thinking she was easy.

Chase bit back a laugh she was snarking at House like a pro. "If you need help with the police officer you know where to find me. If you will excuse me I have an ECHO to perform."

"Okay but just remember I'm always right." House left the room amused at the snarky girl he couldn't help but think her and Chase would make an excellent couple. She certainly was his type or at least the type he had seen from his previous relationships.

"He was pleasant please tell me he isn't taking over my case." Ashtyn teased he seemed like a dictator.

"That would be what I put up with on a daily bases." Chase joked grabbing the EKG stickers. "Let's see why your heart rate is so high."

"I feel sorry for you I had a swim coach like him once, she's the reason I stopped swimming. I like how his first guess was an STI. I might be in college but is so wrong of me to have morals and want a connection before stumbling into bed naked? I feel like being a cheerleader and a blonde discredit me as a person and make people have assumptions about me that aren't true."

"Advanced stage syphilis can cause heart related problems which is what he is thinking could be wrong. Seeing as how you don't seem to have any of the problems associated with syphilis it's safe to assume it's not an STI. Trust me I get judged harshly too. Most people don't look past the fact that I'm young, blonde, and easy on the eyes. It gets annoying having patients question if you actually are a doctor. So how is school going so far?" He asked attaching the EKG stickers to her chest.

"Trust me I'm up to my eyeballs in research for a research paper and cheer practice most nights and having a job. Wait could stress cause heart problems I've been a little stressed more than usual. What with being cheer captain and having two huge papers due, and being president of public relations."

"It's possible but unlikely unless you have broken heart syndrome which could be caused by stress, but it normally presents itself as a heart attack." He said watching the waves show up on the computer screen which showed high tachycardia but it showed nothing that suggested an arrhythmia.

"My heart hasn't been broken. So is there anything wrong?" She asked trying to get a look at the monitor.

"Nothing that I didn't already know which means it's probably not an arrhythmia." Chase said removing the black sticky pads. "Still having pain in your chest?" He asked wanting to know what her pain level was.

"Yes I still have pain in my chest I'd say it's about a five, but I've had sprained ankles that have hurt more." She said being honest it wasn't painful it was more of annoyance than anything.

"You don't have to be strong if you are in pain don't be afraid to ask for pain medication if you need it." Chase remarked grabbing the ultrasound gel. "Sorry this is going to be cold." He warned squirting the gel onto her chest.

"It doesn't really hurt its more of annoyance. I'd let you know if I was in a lot of pain and that is really cold." She said praying it was nothing and that she could go back to school and endure cheer practice later tonight.

Chase noticed a mass in her left atrium. "You have a tumor which explains the chest pain and fast heart rate." He said pointing it out on the ultrasound.

"So I have cancer in my heart?" Ashtyn asked starting to cry.

"Most heart tumors aren't cancerous I've never seen an atrial myxoma be cancerous granted we'd need to do a heart biopsy to verify that it's not cancerous before you go into surgery to have it removed; but it's safe to assume it's not cancer. Heart cancer is very very rare I've never seen a case of heart cancer." He said cleaning the gel off her chest. "Now are you going to call your parents or should I call them?" He questioned not wanting her to be alone.

"Dr. Chase I'm fine it's a tumor can't you just cut it out and send me on my way? Please I don't want my parents here, I'm fine being alone." She admitted she'd rather do it all on her own then be reminded of her father who died of a drug overdose and her over religious mother or her siblings who blamed her for getting away from their rapidly deteriorating mother.

"Ashtyn all surgeries have risks this isn't a tumor in your appendix it's in your heart. Just because it isn't cancerous doesn't mean it doesn't pose risks to your health. The surgery also has risks and I don't want to be the person who has to make a call to your mother that you died during surgery. I know you don't like your family, honestly there are days that I don't like my family but they are your family. I've seen it before a family member gets sick and the relatives come to visit it can help build back the bridge. At least call them and I'll stop lecturing you. I really don't want you going through this alone." He cooed softly wishing he could tell her that the heart pain was nothing but now she was facing heart surgery which meant he needed to distance himself and shake the feelings of wanting a relationship with the blonde. If he had met her anywhere else he would have already asked her out for dinner.

"I don't care about the risks. I don't want to deal with my family. I haven't seen them since Christmas break freshman year. My family aren't people I want to be around but since you insist I call them I will gladly call them I just need you to hand me my phone from my jacket pocket."

Chase dug the phone out of her jacket. "If at any time the stress you out I will kick them out. I'm going to give you some privacy and go check on your lab work and schedule you for a heart biopsy. I know it seems really scary having a tumor in your heart but statistically the odds of it being cancerous is minuscule." He tucked her chart under his arm and went to schedule the biopsy and grabbed her lab work from the lab. He went to his sort of office and flopped onto the chair he often took naps on.

"So what's wrong with the car?" House asked looking down at Chase.

"Do you mean Ashtyn?" He questioned looking at his boss. "She has an atrial myxoma. I need to do a heart biopsy and make sure it's not cancer. I don't think it is cancer if she did have cancerous cells in her heart she would probably be in heart failure due to the size. Besides heart cancer is rare." He admitted finding an elevated white blood count in her lab results but everything else was in the normal range.

"She's named after a car and you like her don't you?" House questioned looking at him.

"Don't you have to like patients?" Chase questioned avoiding the question. "She's my patient anyway so even if I did like her I couldn't peruse her at least not right now."

"Who cares about ethics you two are around the same age. She's pretty, athletic, and smart your type. What's holding you back once she has surgery she'll be fine and you two can have hot rabbit sex late into the night. She's a cheerleader right just imagine how flexible she is." House joked watching Chase squirm.

"I'm 27, she is only 22 that's a five year age difference not to mention she's my patient."

House grabbed the chart she'll be turning 23 in a couple of months and you just turned 27 a couple months ago so it's more like four years and a couple months."

"I should get back to my patient." Chase said heading to his locker to change into a pair of scrubs. Ashtyn was really pretty with her mossy green eyes and that smile that could easily power a small town.

Ashtyn huffed and hit the end button on her cell phone her mother, step-father, and siblings were coming to see her. She rolled over looking at the windows with the view of Princeton. She really hated that she had to deal with her mother after three and a half years living in New Jersey refusing to come home for breaks and summer stating that she had a job, school, and cheerleading. She watched Chase enter the hospital room dressed in a pair of green scrubs which made his blue eyes pop.

"How'd the phone call go?" He asked rechecking her vitals making sure she was stable for the procedure.

"They are taking the earliest flight out of Indiana. So how about we get the heart biopsy and get surgery scheduled before mother get here before she tries to ship me to the quacks back in Indiana."

"Alright so the point of the heart biopsy is to get collect a sample of tumor tissue and a small amount of actual heart tissue. You will be given a light sedative to help with pain and I'll make a small nick and thread the biopsy needle into your chest and remove the smallest amount of tissue. In total it will take about thirty minutes. Do you have any questions if not can I get you to sign this?" He said handing over the consent form.

"You'll be doing the procedure?" She asked making sure that he'd be the one doing to procedure. She signed the consent form and handed it back over to him.

"Of course I'll be doing the procedure any other questions?" He asked as a nurse entered the room and placed a hair net over her hair.

"No more questions." She said looking at a nurse once he left the room. "So is Dr. Chase any good?" She asked suddenly terrified that he would mess up.

"Dr. Chase is probably one of the best in this hospital. He is a triple board certified as an intensivist, cardiologist, and a surgeon and has a medical license in both Australia and America and he isn't even thirty yet. So I'd say you are in excellent hands." The nurse said rolling her out of the room.

"Wow that's really impressive." She remarked being pushed through the hallway.

"You'll be just fine." The nurse said pushing her into the surgery room.

"Ready Ashtyn?" Chase asked as the nursing team transferred her over to the surgical table. "You're not going to be fully asleep you'll be under a light sedative but you'll be aware of what's going but won't feel a thing."

"I'm as ready as I'll ever be." She remarked as nurse administered the sedative it was odd seeing the young doctor in a mask and safety glasses it was almost a shame for his baby blue eyes to be concealed behind plastic.

Chase made a small nick and threaded the biopsy needle into the hole. "You doing alright?" He asked looking at the heart monitor noticing it had raised a couple of points but she showed no signs of distress.

"I'm doing fine no pain whatsoever." She said looking at the ceiling of the surgical room thinking happy thoughts which were cheerleading memories.

"It's almost over." He said removing the tissue from the tumor along with the heart tissue and sticking the sample into a clear container.

"Is it supposed to hurt?" She questioned tears threatening to pool in her eyes.

"It shouldn't hurt. Why are you in pain?" He questioned removing the needle.

Ashtyn let out a piercing scream and the heart monitor jumped up thirty points. "It hurts." She shrieked holding onto her chest.

"Move your hand for me, and someone hand me an ultrasound probe." Chase ordered squirted gel onto her chest. "Breath I know you're in pain but the more you corporate the sooner I find out what hurts. Nurse push 1 of Morphine." He moved the probe over her chest and what he saw made his own heart want to stop.

"Ashtyn you are experiencing something called an aortic dissection."

She reached for Chase's gloved hand. "That sounds serious is it serious?" She asked fear seeping into her green eyes as tears ran down her face. "Am I going to die?"

Chase pulled off his gloves and held her hand hating to see her cry. "I'm not going to lie an aortic dissection in extraordinarily painful and very serious. In the past an aortic dissection was a death sentence however nowadays you have about a 70-30 shot of making it off the table depending on the severity of the dissection and how quickly you get into surgery after a dissection. I am going to do my best to make sure nothing bad happens to you. Just relax sweetheart and think happy thoughts." He cooed as an anesthesiologist covered her face with a mask.

Ashtyn slowly felt very sleepy but she did as Chase told her to do. She thought of cheerleading and her team winning the NCA College Championships. "I'm scared, Dr. Chase." She said tightening the grip on his hand scared she was going to die.

"I know you are, I'd be scared too." He soothed watching her eyes flutter. "Just go to sleep and when you wake up everything should be just fine the dissection should be fixed along with the tumor." He winked as she released his hand falling into a drug induced sleep.


AN: I am a busy college student so updates might be a little slow I plan for an update at least once if not twice a week depending on my time anyway I hope you like it. :)