"Cut- throat bitch, do you mind holding my metaphor for a second?"
"Sure, Greg." Amber replied, a smile traversing her face briefly as she took the walking stick from House.
House's eyebrows knitted together at her pretentious amicability.
"That just cost you twenty-six points, floozy." House said curtly.
Amber's mouth was agape in ostensible shock.
"It's because you called me Greg and smiled. That's another ten points for asking the obvious." House anticipated.
"Now moving on, we've a new case- a 38-year-old man with acute respiratory failure and long lasting fever."
"And you are late because?" Kutner asked.
"Maybe it didn't occur to you, but I don't exactly walk very well. Ring a bell?" House answered sarcastically.
House hands trembled slightly but noticeably and he dropped the manila folders on the ground. He crouched over to pick them up.
Thoughts whirled through his head.
No it cannot be back, I've been on med ever since.
As he got into the most uncomfortable of chairs and propped both of his legs up onto the table, the door of the lecture hall squeaked open.
House's attention shifted to the door.
"Ah, Dr. Lisa Cuddy, what's the occasion for visiting?" House quickly reverted back to his usual caustic mien.
"I need to see you House," Cuddy said cryptically.
"Now," she added, anticipating his disregard over her presence.
"Split yourselves up into teams, the first team to come up with the correct diagnosis gets to keep their jobs," instructed House in his stentorian tone.
The four doctors however were more concerned about the impending demise of the patient, and ignored House's ludicrous game tactics.
Limping up the flight of steps, he caught the gaze of Cuddy and rolled his eyes.
"We'll talk outside."
"If you still don't fire them, their pay is going to get docked from yours. You are not running some game show, House. We don't have money for you to play this." Cuddy said tersely as she closed the door of the lecture hall behind her.
"What? Fine you got me" said House.
"The patient has history of chronic obstructive pulmonary disease (COPD). This is not a diagnostic mystery. It's just another respiratory infection." The Mormon suggested.
"Cuddy's begging me to fire you guys, so why not you get the ball rolling." House told the Mormon, with undisguised annoyance.
"You're fired," House said with uncamouflaged bluntness.
"You damn well bet I am. I'm sick of this" the Mormon said mordantly in his Southern accent.
He had this indescribable air of confidence and even a modicum of superiority exuding from him, as he sashayed out the door.
"Has to be intravascular lymphoma of the lungs- Get him a surgical biopsy to confirm" Thirteen said, diverting the attention back to the case.
"I hired you guys to help me not to make me feel smarter. Get him on heparin in the IV for pulmonary embolism."
"It could be atypical intravascular lymphoma." Thirteen shot back at House.
"Do you have the faintest idea how rare intravascular lymphoma is? And you could be the next one out of here, so shut up and start him on the IV."
House stood up slowly from his seat and headed for the door.
Taub, Kutner, Amber and Thirteen strode out, knowing they had no say-yet again.
Keep playing, we'll see who wins. House is one racist bastard isn't he. Now he'll get a taste of his own arrogance.
The thought swum in his mind as entered the ICU ward 6.
"Mr. Montgomery?" he asked with his distinctive accent.
"Yes?" the answer came in a feeble voice.
Linus grasped the patient's clipboard in his hands.
"They have you on heparin on IV? That's ridiculous; they're trying to bleed the hell out of you. You don't have pulmonary embolism."
We'll see who's right now, House.
"Breathing's shallow and heart rates markedly lower- respiratory failure. I'll get you started on endotracheal intubation."
The Mormon lied.
Now let's see how you deal with that House, good luck.
"No progress on the heparin and the patient almost had oxygen-poisoning." Taub voiced out, as if trying to prove House wrong.
"When we were there, he was already on intubation- no records on the board. Almost killed him, his oxygen level was in the roof" Thirteen added on, as though in an attempt to tell House he was wrong.
"Get him off the heparin and up it on the warfarin-10mg. Beep me if anything else happens."
The aloof and devil-may-care House limped out of the room with a worry draining on him.
House sat in his vinyl chair in his office, gazing deeply at the whiteboard in front of him.
Onset of fever, respiratory failure?
A burgeoning worry gnawed at him.
What is it?
Meanwhile…
"We've ruled out any infections or embolism, it has to be IVL." Thirteen insisted.
Amber, Taub and Kautner said around the glass table in the cafeteria, perplexed over the case on their hands.
"But IVL is a rare disease with an estimated incidence of less than one person per million."
"We'll do a brain and renal biopsy on him to determine whether he has IVL."
A resounding beep echoed menacingly in the lab.
The four of them looked at each other and made a run for the ICU.
"The patients having a cardiac arrest, pulse climbing to 200! Get the defibrillator now!"
"Clear!" yelled Kutner, as he glanced at the heart rate monitor.
With a strong thrust, Taub delivered the electrical current.
"Up the current, he's going off the charts!"
With another hopeful thrust, Taub held firmly the defibrillator onto the ailing patient's chest.
"Alright, patient's heart rate is restored." Kutner proclaimed.
"House, it's enough. That patient had a heart attack, and he's starting to bleed. It's the warfarin." Cuddy's voice hovered a pitch.
"You're going to kill him, House!"
House limped away, a chord inside him wrenched.
This is impossible. How could I be wrong?
House's headache was coming back again.
This time it was throbbing worse than ever. He reached into his pocket for paracetamol and popped two into his mouth along with water.
But the pain did not ease, and he knew it would not.
"House did not turn up for work today." Foreman announced.
"I'm taking over temporarily." Foreman said in a supercilious tone.
The doctors exchanged suspicious glances and Amber asked:
"Why? Grouchy has never missed work."
"No idea. Can we please get to the med? How is the patient coming along?" Foreman answered, skillfully avoiding the question. A frown was now etched on his face.
"Histology confirmed IVL in both the renal and brain. We've started on aggressive chemotherapy and adequate supportive care. He should be okay." Thirteen responded primly.
"What then explains the respiratory failure?" Foreman probed.
"Lung involvement seems to be common, but predominant lung presentation of this disease is rare. It so happens this case is under rare. Respiratory failure caused the heart attack too." Kutner said as a smile of satisfaction spread across his face.
"Looks like House was wrong- finally." Foreman concluded.
"911, I've got some limp guy who passed out on Boulevard Street!"