House Keepers
Cuddy shuts the office doors behind her and takes a moment to gather her toughts. She seeks out a phone number from her stationary and dials Arizona.
Halfway across the country a cell phone rattles around, screen casting faint light in a couple's bedroom. A blonde man rolls from a brunette woman to prop up on one elbow, and shuts the thing up by answering the call with a quiet, groggy "Hello?"
"Chase…" Cuddy sounds apologetic for waking him.
"Doctor Cuddy?" He is genuinely surprised, Cameron sitting up behind him.
"I need help."
"What kind?"
She hesitates. "It's House… He's dying."
Robert's face goes blank momentarily, Cameron covering her mouth.
"He's in coma due to brain swelling. We've eliminated bacteria, viruses, drugs and poisoning."
"Fax me the file." Chase is back to his senses. "Cameron and I will take the first flight to Princeton. We'll call you if we get any ideas." The link is abruptly severed.
"Cameron?" Cuddy is left staring at the dead phone. Pushing that little gossip bait aside for the moment, she makes another call and switches to speakerphone.
"Foreman here." He sounds wide awake, a true early bird.
"I need a consult." Cuddy goes for vague, pacing round the desk.
"Why not ask House?" He is surprised.
She pauses by the windows, dawn a warm hue over Princeton. "I can't reach him." Her tone gives away more than intended.
A momentary silence falls between them. "He's the patient." Foreman states factually. "If he can't contribute to self-diagnosis than it's affecting his mind. That's why you called me."
"No. I called you because he taught you to deduce things out of thin air, and be right." She compliments him. "Like you did just now."
"Chase has more success with it." Foreman's tone is laden with refusal.
"Chase is not a neurologist." She counters.
Forman sighs. "I don't want to be near that man." He admits.
Tired and stressed, Cuddy feels her control slip. "You are one hypocritical jerk, you know that. House at least would never refuse a patient."
"No, he'd never blow a case off because its too boring." He bites back, just as pissed.
"He'd never blow it off without giving a diagnosis first, whether it took him a second or a week." She rises to his volume and heaves back to composed. "Want to prove you're a bigger man? Get back here and cure him in spite of your fallout."
Foreman thinks it over for a moment. "I'm coming." He hangs up.
…
Wilson sits in his office, tapping the expensive cell phone against the hardwood desk, eyes telling of an inner battle. The tapping pauses, followed by a deep breath of preparation. Scrolling to the bottom of his phonebook, he starts a call.
"Missis House? Wilson here. … It is him. … We're not sure. … Very serious. ... I think you should come to Jersey." He pauses. "Could I talk to John for a moment?" Knucles rapp on bloater as he waits. "Sir. We're having trouble completing Greg's medical history. It seams most of it is scattered throughout various army bases. Could you make some calls, have the files sent to us? We need every bit of info we can get. … Thank you."
Phone secure in his pocket, Wilson leaves his desk and heads out, hands rubbing over his sleepy face as he boards the elevator. In ICU he spots Cuddy setting up an EEG skullcap on House, a zillion pin-like sensors dotting the man's head through the elastic lattice.
Lines on a nearby LCD screen come alive, mostly sinuses of steady rhythm and fluctuating amplitudes.
"Diffused alpha waves." Wilson notes.
"Coma." Cuddy is not surprised.
A sudden, short phase of slower waves appears at some of the output points.
"Theta on the prefrontal." Wilson points excitedly. "He can hear us."
The smile fades form Cuddy's face as the brain output returns to the dull drone of inactivity. "But he can't do anything with it."
…
The sound of key turning in the lock resounds through House's empty apartment, door opening for Wilson and Cuddy. Looking around, Cuddy takes in the general mess of the place, beer cans and takeaway cartons surrounding the sofa and armchair, dirty clothing stwen about and dust covering almost every surface.
"Fungus." She declares from the small lobby. "This place reeks of it."
"It would explain why the antibiotics and antivirals didn't work." Wilson takes notice of an empty cage atop a corner bookshelf. "Or he could have whatever got to Steve." He takes a clear bag to sample sand and sawdust.
Noise of cabinets opened and closed comes from the kitchen as Cuddy rummages through them. "Organic compound poisoning?" She appears at the doorframe with a can of insecticide spray.
"His maid uses the cleaning agents." Wilson heads for the hall. "He doesn't come near the stuff." Once in the room his sights fall upon a nondescript tin box atop the nightstand. Inside he finds an injection gun and several chargers. A manual underneath all that is entitled 'Capsaicin based analgesic'.
"Did House mention any experimental treatment?" He calls out.
"No, but it would explain the glaring lack of Vicodin bottles in the living room." She walks past him and into the bathroom. The place looks tidy enough, and one peek in his medical cabinet reveals even more surprises.
"Nettle extract?" Wilson's surprised face appears in the mirror as he looks form behind her.
"Liver booster." She reads the description. "To offset paracetamol."
"He despises alternative medicine!"
"Aspirin is willow extract in a non-hippy packaging." Cuddy reminds as she pushes a box of that particular household drug aside. "Alternative meds leave no trace in pharmacy logs."
"And he'd do anything to avoid talking about medication." Wilson nods at the bottle of prescription antidepresives, picked up at Princeton General.
Cuddy looks at the bottle sadly.
"It's good that he's finally doing something about it." Wilson turns the situation around. "And that he's cutting down on morphine." He holds up a Vicodin bottle for her to inspect the label - same dosage, longer time frame.
Bagging everything, the two head out.
On the building's stairs Cuddy flips her cell phone open. "This is Dr Cuddy. ICU patient 101 is suspect of exposure to organophosphates, detergents, torpane and food poisoning. Order a through scrubbing and do a scratch test for allergens."
…
Through the blurry glass barrier between D-con shower and changing room, the weary pair of doctors watches on as their old friend is being scrubbed down by a pair of orderlies in suits befitting Chernobyl. His nude form is limp like a string doll in the cradling arms of the stronger man, skin sickly pale. Dried up, House is wrapped in a hospital gown and carried out by armpits and knees like a sack of dead weight, his head hanging out limp and mouth agape. A worried Wilson wraps his arm around a distressed Cuddy as they watch House wheeled away. Moments after, they separate and follow the gurney to ICU in a different elevator. Havings set up a mass of tubes and wires all over House, the nurses leave Wilson and Cuddy with their oblivious friend.
"Get some sleep." He advises. "I'll wake you if anything happens."
With a nod she heads out, leaving Wilson alone, uselessness washing over him.
…
Chase slips his credit card through a slit, prying the pay-phone from its cradle in the seat in front of him. Dialing a number, he sets up a laptop on his knees, text processor active.
In Princeton, ringing startles Wilson awake, head jerking up from the glass table.
"Diagnostics." He yawns.
"Cameron suggests allergy." Chase relies over the speaker phone.
"Scratch test came back negative."
Chase types it down.
"Maybe its an unusual allergen." Her voice is faint but clear, as if she is near the speaker.
Wilson shakes his head. "Received one cc of adrenalin as part of treatment for sedative overdose - didn't help."
"His temperature, sugar and ammonia are all elevated." Chase notes. "Looks like something is messing with the metabolism in general."
"That would be his swollen cerebrum pressing on the brain stem." Wilson is just short of derisive. "Sorry, didn't get much sleep tonight."
The phone rings again.
"Foreman is calling." Wilson declares. "I'll put us in conference mode. Hello?"
"I'm half hour from Princeton, what do you have so far?"
"We've excluded fungus, allergies and metabolism." Chase interjects to make their communication arrangement clear. "Fever with antipyretics is odd, are you sure its not infection?"
"Low white cell count." Foreman reminds.
"He may not be fighting back." Cameron suggests.
"AIDS?" Chase wonders "Given his love life..."
"It wouldn't progress this fast."
"Plus he didn't have so much as a cold since I know him." Wilson states.
"I was thinking something acute."
"Whatever it is, if he can't fight, no amount of anti-anything is going to save him." Foreman warns.
"I'll do an LP to settle the infection debate once and for all." Wilson sounds final. "Foreman - Any thoughts as neurologist?"
"Hereditary metabolic disorder."
Wilson squints. "Which one?" He shakes his head. "Doesn't matter, most would present in infancy. Kill him by first birthday."
"Considering his age and symptom onset, I'd say fatal familial insomnia."
"Fatal being the key word." Chase notes. "Could we try something curable first? Treatable at least? Not to mention that at this stage, any kind of genetic flaw would sooner be diagnosed with an autopsy than a DNA test."
"Only neurological thing left are prions."
"I think we would have noticed the swis-cheese appearance of his gray matter." Wilson reminds.
"Not if they're still microscopic."
"Too small to see on the scan – too small to see in behavior." Cameron states. "And coma is huge."
"What if the swelling isn't a symptom of inflammation." Chase risks. "Maybe its osmotic."
Wilson looks surprised and oddly satisfied. "Venogram, arteriogram and LP it is."
…
Foreman enters the darkened room, only a large swing-arm light illuminating Greg's form on the table, coiled in a fetal pose. A couple of monitors are lined up by Wilson's side, showing all kinds of stats, a discouragingly monotone EEG among them.
"LP clear." Informs the oncologist while preparing the catheter. "No infection or mineral imbalance."
"No response to sound either." Foreman nods at the EEG.
Wilson sighs. "Swelling must have reached the temporal lobe."
"How fast is it spreading?"
"A day to get from drowsy to coma in the frontal lobe, another half to get this far."
"Would you mind if I do the test?" Foreman nods at the older man's hands, shaking form exhaustion.
"I thought you wouldn't want to be anywhere near him?" Wilson's jab is all the more cutting for its off-handed delivery, but he hands the cannula none the less.
Foreman rolls his eyes and enters a jugular.
Wilson's eyes are locked on the screen. "Theta waves again."
"He can sense pain…" Foreman doesn't know if he should be glad for the man or not, but quickly focuses on seting up the central line, watching it appear on an x-ray. "I may not like House as a person but that doesn't mean I'd want to see him brain damaged." The voice softens.
Wilson squints. "You know what its like."
"First hand experience." Foreman replies calmly, eyes on the screen. "I'm in the aorta, injecting the dye."
"Blood coming in…" Wilson watches it branch through House's head, than retreat a similar path back. "…blood coming out. Lymph drainage steady. No residue." He sighs. "Plumbing clear."
Foreman retrieves the line. "Ten down."
…
Chase and Cameron enter diagnostics, where Cuddy, Wilson and Foreman are digging through a mountain of documents.
Chase is dumbstruck by the sheer amount of it. "What is all that?"
"House's medical history." Foreman replies. "He must have been the sickest sickly kid in history. Every year a pneumonia, every couple of months the flu, almost perpetual cold..."
"Until puberty." Cuddy corrects. "After that its blank until the infarction."
"If you ignore all the physicals he did with each new job." Wilson adds.
"That's an impressive immune system." Chase picks up a file as he and Cameron sit down among colleagues.
Cameron frowns at one of the reports. "Maybe it's too impressive."
"Autoimune?" Wilson follows her reasoning. "Again, low leucocytes."
"There doesn't need to be a lot of them – his brain isn't reproducing or moving."
"But there are dozens of kinds of autoimmune." Cuddy sounds frustrated. "We'd never diagnose in time."
"Doesn't matter - the treatment is the same."
"If this is anything other than autoimmune we're going to kill him." Foreman warns.
"So we use steroids instead of radiation. He's on anti-inflamatory medicine anyway. If it works, great, if not we get him off steroids and the immune system recovers."
"Except House is short on time." The dean presses on. "We don't have maneuvering space to risk an error. If you're wrong he's gone."
"If we do nothing he's dead anyway." The younger woman is on the defensive.
Wilson and Cuddy share a knowing look but before either can speak their minds their pagers go off.
"His parents are here." She reads. "Foreman, you check his status."
…
"Mister and Missis House." Cuddy walks up to the old couple anxiously standing in the hospital atrium.
"Dr Cuddy." Blythe steps up to meet the dean. "How is Greg?"
Cuddy licks her lips subtly, swallows. "He's in deep coma."
Blythe gasps, John shuts his eyes.
"The good news is he is in it for only sixteen hours and hasn't dropped in fast, but descended gradually over a period of one day."
The parents calm again, attentive.
"That means he will probably wake up when we find out what is causing this."
"You don't know what's wrong with him?" John is unnerved.
"We believe it's autoimmune."
John senses her uncertainty. "But…?"
"We're not sure and we don't have enough time for definitive tests."
"Well wouldn't the treatment tell you that. If it works – you're right, if not – it's something else." John's words explain the source of Greg's genius.
"The treatment is just as dangerous." She informs. "If House has even a minor infection in his system, it will get out of control. And hospital acquired ones are most dangerous."
"You are saying the treatment could kill him?" Blythe is terrified.
Cuddy takes a deep breath. "Yes."
"And if you don't treat him?" Inquires John.
"His condition will get worse until it affects the autonomous functions: breathing, heartbeat…"
"You can put him on a respirator, a pacemaker." Blythe is grabbing for straws.
Cuddy gathers her sympathy. "Yes. And that will buy us a little time. But the longer he is this way the more likely there's going to be brain damage." She takes a moment to rephrase. "Swelling constricts the blood vessels, reducing the supply of blood to his brain, that's why it's not functioning now, merely surviving. And only becouse of the drugs he's on. It's slowly starving it out, and if we don't find a way to reverse it it's going to get worse. If it does get to the point of cardiac arrest, we would be supporting a brain-dead body."
Just then, Foreman strides over. "He's not sensing light and the knee-jerk reflex is abnormally strong. I just thought you should know."
Blythe can sense the bad feel of his news despite not understanding a thing. "What does that mean?"
"The swelling has spread to his occipital lobe." He elaborates. "Next stage is brain stem - respiratory failure."
John rubs his brow. "If you do it you will either save him or kill him. If you don't do it, you'll get time to do more tests, but there might be no one left to save once you know the answer?"
"I'm afraid so."
He huffs, arms crossed with one hand stroking the brow thoughtfully. "If this were Greg's patient… What would he do?"
Cuddy steels herself to face the truth of the matter. "He'd risk it."
TO BE CONTINUED
