Seeing is Believing (Part 2)
House, M.D.
by Cheers
The morning had progressed. Of course, that didn't mean it had improved at all, simply that time had gone by. By 11:45 am House had seen four cases of rhinovirus, the common cold, two additional cases of STDs – one gonorrhea the other herpes – and was preparing to see an ear infection in Exam Room 3. With limited resolve and even less enthusiasm, House took the chart from the nurse's hand and moved toward the exam room when he heard those footsteps again. Cuddy.
"House," Lisa called after him. Sheryl, the dayshift nursing supervisor, had kept a close eye on their clinic doctor and reported that House was behaving himself … for the most part. The complaints about his insults to parents were about par for a morning at the clinic, but the case load was steadily decreasing and he hadn't alienated the entire clinic staff, so all in all it was shaping up into a good day. Now if she could just get him to listen to reason.
For no reason, other than his deep suspicion that another ridiculous demand was about to be dropped in his lap, House found himself wishing to be in the exam room with a patient rather than verbally spar with his boss again that morning – at least she could have waited until after he had had lunch. He stopped his forward progress and waited for her to stride up to him. With the ache in his leg it was the easiest course of action since sprinting away was obviously out of the question. As Cuddy approached, he noted the file folder she held half behind her lab coat. He immediately guessed what the folder held.
"No," he said perfunctorily.
"You don't even know what I want," Lisa said as she reached him.
"I'm not going to interview," House informed her.
Lisa took a breath deeper than she would have liked and let it out in preparation for the battle she now knew she would have to fight. House was nothing if not stubborn.
"You could at least look at some of the candidates befo…."
"Why don't you and Wilson interview?" He cut her off. "The Department of Diagnostic Medicine will throw those you choose a welcome bash. Just make sure one of them has Carmen Electra's eyes and we'll all be happy."
"There is no Department of Diagnostic Medicine without doctors," Lisa replied a bit more curtly than she had intended. She had wanted House to rehire Dr. Chase. If he had done that there was a good chance Dr. Cameron would return as well. Dr. Foreman was probably a lost cause but at least House would have two more doctors on his service. The extra clinic hours House was doing would keep him, for the most part, out of trouble but it wouldn't justify his department. For that House needed cases, and to take care of cases House needed staff. Good staff. And, Lisa knew, the qualifier there was the problem. It took a special kind of person to successfully work for House, but when those kinds of people are found there didn't seem to be an illness that could stand up to his team.
"So the degree from Hopkins on my office wall is a forgery," House challenged sarcastically. "You should probably let all the people in this clinic know that. They think they're being examined by a genuine doctor so I guess the jokes on them."
"It's been a week," Lisa tried again.
"Technically, six days," House corrected. "Chase's last fart vapor hasn't even had a chance to dissipate."
"What?" Cuddy's face showed just how easily his last remark had taken her off guard. House was certain that she would have been better acclimated to him by now.
"And you haven't even bothered to consider that I might need time to properly grieve," he continued.
"They're not dead," Lisa interjected quickly. "You drove them away."
"Now you're trying to tell me how I should feel about losing my entire team?" House replied, allowing his verbal volume to rise a bit and draw the attention of everyone at the nurse's station and in the clinic waiting room. "What kind of therapeutic process is that supposed to be? Is that how you assist those who mourn?"
Gritting her teeth to keep her own voice down Lisa practically hissed, "Mourn all you like, House. You have got to hire more staff or the Department of Diagnostic Medicine won't be renewed in the new fiscal budget."
For a moment, House paused to consider how serious Cuddy might be about that. He looked her directly in the eyes. He reasoned that if she were bluffing she would feel guilty enough to quail, if ever so slightly, at his continued gaze. She didn't flinch at all. Cuddy meant it. His department was in jeopardy. What surprised him more than anything was how little he cared about that fact.
"Don't forget what I said about Carmen's eyes," House said as he turned from his boss.
Lisa knew that House understood she was telling him the truth. The Board was quite clear in the directive to her. House was the kind of maverick that simply couldn't be left to his own devices. Teaching other doctors to be good diagnosticians was the only thing other than actually diagnosing illness for which House was valued at the hospital. His brilliance as a physician was never questioned. His ethics and methods continually were. His team had helped, along with James Wilson and her, to keep House in some kind of check. Lisa had thought that House would say something trite and then try to leverage the interview process for less clinic duty. She was prepared to cave … a little. She wasn't prepared for him to simply dismiss her altogether. Not even Gregory House would be willing to risk an entire medical department to get out of something as simple as interviews.
"Not Angelina Jolie's or Beyonce's eyes," House continued as he moved to the door of Exam Room 3 and opened it. "I'm partial," he finished as he stepped inside and closed the door behind him.
As Lisa Cuddy shook her head, sighed in exasperation and marched back to her office, House moved to the counter in the exam room and opened the patient's chart. Five year old male, deaf from birth, possible ear infection, no fever just pain in the left ear was what the nurse's note told him.
Turning, House faced his patient and one of his patient's parents, the mom. The boy was playing with an action figure of some super hero House didn't care to attempt to identify. The mother was watching the boy.
"When did the ear start hurting?" House inquired. Neither of the people in front of him seemed to notice he spoke. House expected this of the child, not the mom. He narrowed his eyes in concentration, watched and waited. When the mother didn't notice his attention to her for nearly a full minute House clapped his hands. There was no startled response, but the movement must have caught her eye because she looked his way, noticed he was waiting and straightened.
"I'm sorry," she said in a typical nasal delivery common of the deaf who learn to enunciate by tactile practice in oral deaf education. Very Marlee Matlin.
"When did the ear start hurting?" House repeated.
"He's been rubbing it since yesterday afternoon," the woman told him. As if on cue the boy pulled at his left ear pausing from his play to do so.
"Has there been any drainage?" House asked, looking at the mother to make sure she was looking at his face.
"No," she replied. "But he didn't sleep well last night."
Nodding, House turned to pull the otoscope off the wall. Deafness was often inherited but it didn't mean the kid couldn't have otitis media. A simple look see in the kid's ear would tell him what he needed to know. A script for an antibiotic and it would be lunch time and time to leave the wasteland of the clinic behind for the wasteland of the cafeteria. The difference was that in the cafeteria he was very likely to see Wilson, and doing so would make that particular wasteland bearable.
Tapping the child on the shoulder, House got his attention. The boy looked up into his face with what House could have sworn was an intelligent curiosity beyond his years. With a sudden gentleness the boy reached up and brushed House's stubbled beard with his fingertips, smiled and then shrugged. House supposed his might be the first beard the boy had ever seen. House brandished the otoscopic light and waved the light over his own hand to demonstrate the proverbial 'this won't hurt a bit' doctor routine before saying "I'm going to look in your ears." The child seemed to understand because he tilted his head to the side making performing the exam much easier. How many ear exams does it take to condition a small child to accept an otoscopic exam as the natural course of a clinic visit? House wondered. House examined the healthy ear first and noted an open ear canal with slight cerumen build-up but nothing structurally unusual. The hearing loss must be neurogenic, he reasoned. Next House moved to the left ear and noted again the easy acceptance as the boy tilted his head to the other side. What House found was a little confusing. The ear canal on this side was much smaller and shorter than on the other side. There was almost no cerumen and the structures were not inflamed as he anticipated that they would be.
House deposited the otoscope back in the wall bracket. Moving to the exam stool he sat down and deposited his cane on the edge of the instrument tray as was his custom. He looked critically into the boy's face.
The boy's mother stared at the doctor for a moment and said, "Does he have an infection?"
House didn't immediately answer. He was fascinated with the child's facial features. The face was normal except for a slight asymmetry of his mandible. Hadn't he just thought about facial symmetry? Was he seeing what he thought he was seeing? It was subtle. Maybe too subtle. If he was right, there might be more wrong here than just an earache.
"No," House said at last. "I don't think so." House tore his attention away from the boy and faced the mother. "I'd like to admit your son for some tests."
"Why?" the woman asked, now openly alarmed. "What's wrong with Bobby?"
House tilted his head in a fashion similar to what the child had done for the ear exams. "I'm not sure," he admitted, his curiosity piqued. "But I do know that it isn't an infection and ear pain in a child with deafness isn't normal. Don't you agree?"
The mother looked at her child and then back to the doctor. "It's just an earache," she protested. "Do you always admit children with earaches or just the deaf ones?"
The accusatory tone was what House had expected. The deaf community was close knit and structured. The fact that she would bring her child to a free clinic at all was a wonder and testified to the ongoing nature of the problem. The pain may have started last night but House was certain that this wasn't the first night of ear pain the boy had suffered recently. For whatever reason, the boy's usual pediatrician and otologist hadn't been able to find the problem. This was the mother's way of reaching out from the confines of the only community she had probable ever known.
"You knew there was something more wrong than an earache when you brought him here," House replied, not bothering to keep the smugness – a nuance she couldn't hear anyway – out of his voice. "Whatever is causing his pain is more than his regular doctors have been able to diagnose." House looked back to the boy. "Why don't you let me find out what the real cause of his problem is and we can just skip the 'you don't trust normal people part' from the beginning. It will go much better that way."
He glanced back into the mother's face to see her working through his not-so-subtle assessment of her dilemma. After a few moments her features relaxed as she got around to accepting his proposal and she nodded. "Okay," she said.
"Fine," House said standing. "I'll send the nurse in to get started with the admission process."
Grabbing his cane and his new patient's chart House turned to leave the room. It wasn't until he opened the exam room door that he would realize something else besides the pain in a deaf boy's ear was going to change his plans for lunch that day.
