The eager young med student whom Cuddy, obviously in a sadistic mood, had assigned to tag behind him today like a clumsy puppy rushed over to him bearing a chart. "Exam room two," she breathed, pushing up her faulty pince nez. "Fifty-year-old woman with a lesion on her left calf, no known injury..."
House snatched the chart initiated by the nurses from her moist grasp. "Let's make an educated guess. What happens when a middle-aged woman self-medicates her path through a life of quiet desperation with Wing Dings and Ho Ho's and chocolate Yoo Hoos? Yes, it's as silly as it sounds, a totally self-inflicted disease."
"But doctor..."
"Correct, a big butt is a causative agent. Diabetes mellitus, the type formerly known as adult-onset, but with so many pudgy kids waddling around with insulin resistance they now prefer to refer to it as Type II.. And what happens to the extremities when you have achieved this exalted state of insulin resistance and get just the tiniest wound you might normally not even notice? If you weren't in the habit of wolfing down a half gallon of butterscotch swirl ice cream in one sitting, that is?"
"Peripheral vascular disease. Increased chance of infections," she parroted dutifully. "But doctor..."
"Yes, yes, we've already established that big butts are a part of the diagnostic picture. I'll bet you five bucks it's Type II diabetes."
Her round deer-in-the-headlights stare narrowed. "You're on."
House gazed back suspiciously. "What, no arguments about the ethics of betting on patients?"
She sniffed. "I just don't think a doctor should attempt to diagnosis a patient without first reading everything on the chart, and then actually seeing the patient."
He his antennae no longer quivered at full attention. "Have you 'actually' seen the patient?"
"No, but..."
"Please stop repeating diagnostic criteria that have already been established. Now watch how the big boys do it."
He hoped she stumbled enough feet behind him in her puppyish eagerness to avoid becoming entangled in his cane. Chart tucked under his arm, he opened the door to exam room two. He stared into the room for several seconds before turning back to the med student. "Wait here," he ordered, just stopping himself from commanding, "sit," before firmly closing the door in her face.
He whipped out the chart and peered at it. "Ms...ah, Freneau?"
"Yes," she replied.
He lurched into the room, overly conscious of his limp. He wheeled the stool close to the exam bed and sat, perusing the chart in its entirety. "BP one forty over one hundred. Is this typical for you?"
"No, the last time I had my blood pressure taken, admittedly a few years ago, it was only one twenty five over seventy. But this is the first time I've needed to see a doctor since then."
He manuvered to get a glimpse of the back of her leg dangling prettily from the faded cotton hospital-issuance gown. "Whoa," he said, scooting the stool over to the sink area, where he snapped on a pair of gloves and rummaged around for a specimen swab.
"It is nasty-looking, isn't it? I can't believe how quickly it's changed from a small red welt into...this."
He gingerly brushed at the pus and fluid oozing from the roughly spherical wound that had blackened around the edges. "You're wheezing. Did you bring your inhaler?"
"What inhaler? I don't have asthma. Never have had it. This difficulty breathing just started a few hours ago."
"Do you work in a health care setting?"
She looked down at him and frowned. "No. Why?"
"How often do you go to the community gym?"
"I don't."
"Ha. I'll bet those nicely- toned biceps don't come from unloading ships at the docks."
"I work out at home. I've got the weight bench, dumbbells, barbell, the works. Everyone needs a hobby, or so they say. Once again, why?"
Possible staph infection, he could answer. Or that MRSA was screaming at him with huge red neon letters, the anacronym for methicillin resistant staphylococcus aureus. Perhaps even necrotizing fasciitis eating away at her well-developed calf which probably looked excellent in suntan colored pantyhose with strapless heels. Before the two- centimeter- in- diameter rotting weeping hole in her leg, that is.
He took the chart up again, glanced at it. Then he stood up and stuck the thermometer in her ear. "The nurse already did that," she pointed out.
"Sorry, I'm a sucker for useless gestures." Within seconds he had a repeat of the nurse's reading. Very slight fever, barely ninety-nine degrees. Most atypical for MRSA, or its more dire complication.
"Have you been out of the country recently, or have you been palling around with any globe trotters?"
"Are you kidding? On a...social worker's salary? And my...social life...consists mostly reading and watching TV with... Boris' head in my lap." She was having to pause more often in her speech to get enough air in.
"Boris?"
"My cat. He likes...Law and Order...Criminal Intent. But only...Vincent D'Onofrio. A...discerning feline."
"That's highly unusual. Most males are Chris Noth fans." He careened his stool over to the exam room door and opened it a few inches. As he expected, the med student was still standing there. "Go get an Albuterol inhaler, and someone to draw the patient's blood."
He blinked as she held her hand out. "Five bucks? Her weight was on the chart, doctor."
"We don't have to pay for the medicine we dispense to patients. You'll learn all these things eventually." He shut the door in her face again.
"Ah, a social worker. You must encounter your fair share of the poor, the tired, the huddled masses. Those who get out of the habit of washing their hands because they can't afford the ridiculous water bills. Or Kleenex. Those things seems to go up in price every week."
"I do." The face surrounded by long, soft dark brown hair had waxed even paler He rushed the stool back in her direction as though it were a bumper car, then stood and placed his stethoscope on her chest. "Heart rate 150. Is that usual?"
"Not...even when I'm running. Doctor, I..."
"Dr. House."
"I need...to lie down."
He placed his hand in the small of her back to help ease her down onto the exam room bed. His cane clattered to the floor as he grasped her in both arms when her body began jerking and her eyes rolled up into her head.