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A gutter full of rain
an empty picture frame
a house out at the edges of the city
never noticing the war
til it's right there at your door
and suddenly your hands are bloody
David Gray
Gutters Full of Rain
Chapter 2 Hands: Bloody
The doors opened and the world opened to sound again. Alarms and telephones, a baby crying, running shoes. They burst through the doors and instinct took over for the three doctors. Foreman: "He was shot!" as nurses swooped in on them. "Twice," Cameron added. Chase piped in: "Once in the abdomen, once in the neck." House's eyes opened fully, the first time since it happened. "Hello?" He said it like he was picking up the phone, greeting his mother, like nothing was wrong.
Cameron, still moving with the gurney, fingers still pressed into her boss's neck, looked at him, making eye contact. She verbalized the only non-medical thought repeating in her head: "It's going to be okay, you're going to be okay." Was she reassuring herself or him? She'd said the same thing to the first patient she'd ever seen come into the ER while she was working and her resident had given her hell. It was a basis for lawsuits and false hopes, but she said it anyway and was glad when House responded with a hoarse: "You don't know that." He was thinking again, coherent.
Ketamine was the only coherent thought for House. He could say it. He could get the point across. It could work. Passively, he realized that he'd been shot, but the main focus was that he knew he'd need some type of surgery judging by the way he felt. Dizzy, blurry, his head was ten feet below the surface. He'd need anesthesia. He wasn't sure exactly where the bullet (bullets?) had hit. He remembered falling against the white board, hitting the carpet and lying on his back. He hadn't felt any pain, just impact and fleeting images. He remembered seeing the man's face, getting fuzzier in each passing second. And then the hallucination. Days in the course of minutes where his mind had taken the bits of information coming into his senses and transformed them into a web, mixing reality with fear and desire. It was gone now and the only thing House saw was the too bright fluorescent lights beating down on him and the panicked blurs of faces above.
It could bring him back. He could have meaning again- something beyond putting pieces of the puzzle together. Something beyond his screwed up relationships and his leg. He'd read about the Ketamine, researched it, watched it, decided it wouldn't work. Nothing would work. But wasn't it worth the try? He'd become so tied into the puzzles and the medicine, substituting real life emotion with his soaps and a video game. It was easier that way. It was easier to see everyone react to each other, to be separate from it, detached. Avoiding the interpersonal meant avoiding explanations, feelings, pain. But even attempts at escaping were beginning to be hard to come by. His pain had escalated to unbearable levels, taking with it most of his rationality and all of his attempts at pleasure. He hadn't been on his bike in six weeks. He couldn't sit still enough to watch his soaps or play the video games. Cases were distractions, but more often he found his team providing the answers. He wasn't needed.
So he'd resorted to the morphine, but it was still no way to live. If anything, the morphine was a bore. He'd take it at night if he couldn't sleep and on the weekends to get through. The morphine made him queasy, but he'd only thrown up once, as he'd gotten up in the middle of the night to relieve his bladder and the dizziness had put his head in the toilet instead. He'd plan his mealtimes to avoid the situation in the future- eating breakfast and lunch, but foregoing dinner in anticipation of the drug's effects. He might've tried anti-emetics, but by the time he got home to the morphine, he was too tired and in too much pain to care if he lost his lunch. Ketamine had the potential to alleviate the pain. Alleviating the pain meant he could think again, function again, play again- even if it couldn't take back the gaping chasm in his leg.
Time was running short. House felt his breath hitch and a lancet of pain shot down his side. The world swam for a moment. . Voices muffled as if his head was underwater. His eyes shifted, looking for someone he knew. The spin stopped for a moment and his eyes rested on the dark hair that he thought may be Cameron. She would pass the message: "Tell Cuddy… I want Ketamine." Done. Said. No more time for an explanation. His head swam again, and he knew it was his blood pressure dropping further. But the task was complete and he didn't fight the curling fingers of unconsciousness.
Cameron, stunned and confused, was pushed back, away from House, by a nurse taking her by the shoulders. Cameron's gloves were bloody and she held them up, away from her white lab coat, nervous and afraid as she settled by Foreman's side. She looked to him, silently, breathing hard. Ketamine?
As doctors, both Cameron and Foreman were familiar with Ketamine- the hallucinogenic drug sometimes used on animals and on humans when an anesthesiologist wasn't available for an emergency surgery. It was easy and safe to administer compared to many drugs, but its use was often controversial and dissuaded in major surgeries for adults Foreman, in particular, was aware that Ketamine wouldn't relax the muscles that the surgeons needed in order to do an abdominal surgery. The doses that House would need would far exceed safety, and potentially lead to tachycardia and respiratory suppression. Foreman shook his head, as if to re-evaluate what he had heard. But nothing more was forthcoming. House had said he wanted Ketamine.
Chase, too, had been pushed back out of the way and now stood next to Foreman. He hadn't caught what House had said, but he saw that the reactions on his colleague's faces were confused by it. Chase was confused by the whole situation. He'd reacted with the practiced ease of the intensivist he'd been trained to become, but once he was moved out of the way, the situation hit his conscience as if he'd been shot himself. His stomach was suddenly flipping and he swallowed the lump in his throat as he watched the emergency doctors and nurses take over their boss's care.
They lifted House's limp arms and legs and transferred him, now unconscious, to the emergency room bed. A nurse ran scissors up both legs of his pants, exposing him to the air. His shirt was cut off completely and he was naked. . The doctors were already accessing the wounds, one probing at the abdomen, while another alternating between peering at and holding the wound at his neck. Nurses reached for a multitude of tubes. Airway: A doctor was practically shoving the ET tube down House's throat, leaving it protruding for a moment before a bag was placed over the end and air was being forced down House's lungs, past the expanding hematoma in his neck.
Another nurse was starting a line in the crook of House's elbow. Blood would temporarily be replaced with fluids until the type and crossmatch could be completed or records could be pulled. The nurse paused for a moment when she turned his elbow over. It was marked by punctures, a few of them bruised. Her look spanned up to the attending, who nodded and grimaced while holding the portable ultrasound to House's abdomen. House was known to be radical; suspected of being a drug abuser. This was confirmation.
At the doctor's instruction, another nurse prepared a Foley and started it, watching, expectant, as it first filled with yellow, and then red. The nurse moved to House's head and pulled another tube, an NG, running it up through House's nose and into his stomach. It, too, filled with blood. For a moment, things seemed out of control as blood leaked onto the sheets. White sheets, red blood, nurses in purple scrubs.
Cuddy suddenly appeared by Foreman's side, hands on her hips. "What the hell happened?" Exasperated. Chase, Foreman, and Cameron remained silent, still watching as the ER worked in a flurry of activity. They could barely see House now, but still they stood- transfixed. Cuddy stalked over to the ER team, peering in between the movement and staying out of the way, seeing her best diagnostician bleeding, unconscious, blood pressure dangerously low.
She'd gotten the news from a security officer that she knew only as Rich, who had run into her office with the simple statement of "It's under control. We've got him." She'd stood immediately, the paperwork beneath her forgotten.
"What? What are you talking about?"
"It was Dr. House," he'd said. "The guy shot him- in his office. It's under control. We've called the police."
"Where's Dr. House?"
"Triage."
"Was anyone else hurt?"
Rich shook his head as Cuddy rushed past him and walked with a professional, but concerned urgency to the ER. Once there, she'd taken in the sight, pushing back her emotion and focusing on the activities before her. Doctors and nurses had swarmed in on the newest patient, monitors beeped, doctors yelled. She didn't hear House complaining, which meant that he was unconscious. She made out House's shoes lying on top of his clothes next to the bed. His bare feet and a glimpse of his torso were the only skin she could make out- the rest was red and white. Despite all her arguments with him, despite all of his stares and comments, they shared a common history and a screwed up respect for each other. She may have hired him out of guilt over his leg, but never wanted or expected to see him this way again.
Knowing the ER had control, and needing to be in control herself, she went back to the three fellows, who were still staring. "You three, in my office, right now." The commander in chief, dean of medicine, used her tone and the three doctors were shaken out of their shock and followed Cuddy to her office.
Cameron and Chase peeled the bloody gloves off their hands, throwing them in the biohazard bag at the exit of the ER. Three glass doors later, Cuddy strutted behind her desk, still standing, sighing as she watched the three doctors following her enter, faces drawn to the floor. Cameron's arms were crossed and her fingers tapped on her biceps. "Sit," Cuddy commanded. Cameron and Chase moved to the couch, while Foreman went to the chair in front of Cuddy's desk. "Speak." Cuddy commanded. "What happened?"
Silence claimed the room for a moment. Chase looked down, touching his bruised knees where they had hit the ground next to House, rubbing the tips of his fingers over them. He could feel the knots forming. He thought of Cuddy's question, frowned, couldn't think of an answer.
Cameron crossed her legs, put a hand to her mouth, removed it when she thought she smelled the lingering metallic blood and remembered where it had been. All of them had washed their hands on the way to Cuddy's office, scrubbing hastily to remove the blood from underneath their fingernails and from the creases in their skin. But Cameron could skill feel it. She bit her bottom lip, sighed, and sat up straighter. Why was her throat so dry?
Foreman spoke. He related the story seamlessly. He had been closest, had seen and attacked the attacker, and was distanced enough from House to have the least amount of blood splatters.
Street smarts, House had said. Foreman was there because of his street smarts.
As he finished, two police officers knocked on Cuddy's door. The perpetrator was being treated, the officers would need interviews and statements. Cuddy nodded and allowed the team to follow the officers. Exiting, Cameron turned, suddenly remembering. "Ketamine," she said, suddenly- the first words she had uttered since the ER. Cuddy looked up.
"What?"
"Ketamine," Cameron said. "He said…" she paused as she saw Foreman shake his head, looking to her, telling her silently- it was just another crazy House idea. "House," she decided. House had told her to pass the message and she'd do it. It was his life. "…he said to tell you he wanted Ketamine."
Cuddy sighed and nodded, watching the team leave. It was left to her now. Ketamine. Cuddy ran the sound of the word over a whispered breath. Ketamine.
He'd never brought it up in front of her, but she knew he'd been interested. Two years before when he'd been going through another episode of breakthrough pain- he'd called into work for a week, claiming he had the flu, before she'd hassled Wilson (the informant) to bring him in for an MRI, which in the end had been a moot point. No further damage, no regeneration, no healing, and no other reason for the pain. House had spent the week clenched on his couch with his laptop and his Vicodin, reading journal after journal on pain management before stumbling across one in German about the Ketamine. It had just been attempted with relatively good results. Two patients, limited samples, unknown long-term effects. Both patients had come out with significantly reduced pain. The medical and scientific community was a hard sale, however. With the extraordinarily drastic methods implied by inducing a five-day coma (practically killing the patient), sample size and control methods were inherently limited. There would be no double blind studies with induced comas and sponsors were hesitant to associate themselves with what they considered to be radical medicine. And insurance coverage- forget it. Each participant had to round up enough money for the procedure and ICU care- which usually amounted to over $30,000.
Wilson had found House crashed out in front of the printed article, having taken one too many Vicodin and exhausted from the pain. Wilson handed the article to Cuddy after he'd managed to get the slightly stoned House into the MRI. Cuddy read it, researched the experiment, but kept her knowledge to herself. Cuddy knew that House would've kept close tabs on follow-up studies. To base his treatment off of one study was ludicrous- especially considering the risky and expensive nature of the treatment. Cudd also kept up with the research, hoping that this could provide an answer to her mistake.
To Stacy's mistake. When results became mixed and patients began having to have more and more treatments- every six months, four, two… until they were in a Ketamine induced dissociative state half their lives just for a respite, suffering random hallucinations, and decreasing cognitive functioning. House didn't talk about them. Cuddy didn't mention that she'd kept up with them or even that she knew.
No less than four witnesses in the ER had heard House direct his wishes to Cuddy. It automtically put the decision into her hands. As his doctor, she would have advised against it. But she'd known him for years. She was more than just his doctor. If he wanted Ketamine, something had changed. She must've missed it. Caught up in her own personal issues and her attempts at a normal life, she'd missed House's symptoms. The pacing, the increasing irritability. He was willing to risk his mind for a respite. It was a big jump for a man who only had his mind. Even with the Ketamine, he would still be limited. Ketamine couldn't regrow a muscle. Wouldn't allow him to beat Wilson in a footrace.
Wilson.
Cuddy picked up the phone, automatically dialing Wilson's pager, inserting 911.
