Chapter Two:
Susan had no sooner sat down at her desk, when she received a text; a case had come in. Susan headed to the conference room. The patient was an elderly woman who resided in a senior assisted living center. She had been feeling well, when she quite suddenly started feeling nauseous. The health staff attributed it to a simple case of the flu since it had been going around the living center until she started vomiting blood. Masters started the differential by suggesting a bleeding ulcer which Foreman discounted immediately saying that the ER had already scoped her stomach and had found no evidence of an ulcer. "What's her history?" House asked.
"Unremarkable," said Chase. "She's hypertensive, but she's on a beta blocker to control that. She doesn't smoke and only occasionally drinks."
"OK, what about her family history?" House asked.
"There's nothing written here," offered Taub.
"Master's go get a better history; Foreman and Taub go check out her apartment at the living center. Chase, repeat her physical exam and Susan, I want fresh blood pulled for basic chemistries," House ordered.
Everybody got up from the table to perform their assigned tasks. Susan went down to the lab for her phlebotomy tray and then went to the patient's room where she found Chase already performing the physical exam and Masters asking the patient questions. She went over to the left side the patient and waited until she had finished answering her question to Masters, "Well, I don't really remember how my parents died. They just got old," she said as Masters made notes on the form. Susan interrupted, "I'm sorry ma'am, I know you're being poked and prodded a lot right now, but I need to take some blood from you."
With a look of trepidation, but not saying anything, the woman extended her arm out for Susan who put a tourniquet around her arm. Susan put on her gloves noting the numerous bruises on her arm where the ER nurses had tried unsuccessfully to start an IV. She started palpating her arm to find a vein. Not finding one right away, she took off her glove on her left hand, swiped the inside of the patient's elbow with more alcohol, closed her eyes and concentrated on what she was feeling. She felt the tendons, but no veins. After another moment of searching, she removed the tourniquet from the patients arm to allow the circulation to flow. "Dr. Chase, I need to check her other arm, do you think we can trade places?" Susan asked.
"Sure," he replied.
Susan moved around to the right side of the patient and repeated the process; nothing. "Mrs. Jones, has anybody ever tried to take blood from your hands?"
"They've tried, but they are never successful," she answered. "It's really hard for people to take blood from me." Susan nodded as she examined both hands; they each had very small surface veins, but nothing strong enough to handle the vacuum pull from a vacutainer tube. She wasn't even sure she would be able to pull it with a syringe without blowing the veins.
At this point Martha started checking out the patient's arms as well, "Here's a vein over here," she said.
Susan was surprised that she had missed it, but went over to where Martha was standing and felt the vein that she was pointing to. Susan shook her head, "That's not a vein; it's a tendon."
"No, I'm certain it's a vein," Martha said.
"And you're certain to be wrong, it's not a vein," Susan insisted.
Dr. Chase had already left the room to go confer with Dr. House concerning the physical exam, so Susan pulled out her phone, "Dr. House, I'm not finding a vein in either of the patient's arms or hands that I can use for the blood draw, I need permission to examine her feet and pull from there," she said. Susan hung up the phone and made a notation in the patient's chart indicating verbal permission to perform the phlebotomy on the patient's foot. Susan went to the foot of the table and put a tourniquet just above her ankle. She smiled when as she started feeling a couple of good candidates for the blood draw. Just as she was getting the needle ready to go, the patient screamed and kicked her foot upward nailing Susan squarely in her left eye, causing her glasses to fly off her face where upon the nurse running in the room to see what had caused the patient's outburst smashed them under her feet. Susan's hand flew to her left eye as she looked up, "What on earth…?" she started as she saw a very blurry Martha with a needle in her hand with a shocked look on her face. The patient was holding her arm with tears running down her face. Susan quickly removed the tourniquet off of the patient's ankle and went over to Martha. She took the needle from her hand and disposed of it, "I told you, that was not a vein," Susan said as she gently guided Martha out of the way.
The nurse came around to examine the wound and to remove the tourniquet that Martha had put on the patient's arm, "It's OK Mrs. Jones, I know it hurts, but it'll be fine." The nurse turned to glare at Martha, "Maybe next time you'll listen before you just barge in and do whatever you think!"
Susan watched the nurse as she stormed out off the office, "I wonder what's up her craw today," then asked Martha, "Are you OK?"
Martha was shaking from the whole ordeal, but nodded her head, "I guess I missed the vein."
"Oh, you didn't miss, Martha. You hit it dead on, but it wasn't a vein. It was a tendon," Susan explained. Turning to the patient Susan said, "Mrs. Jones, I still need to get the blood from you and there is a really good vein in your foot."
The patient glared at Martha, but agreed for Susan to continue. Susan put the tourniquet back on the patient's ankle and swabbed the area with alcohol, "I don't see any veins there," Martha said.
"You don't have to see them to know they are there. A good phlebotomist works by touch, not by sight. There's a good vein right here," she said as she pointed. She grabbed Martha's finger and rubbed it across the vein, "feel that?"
Martha nodded her agreement but then asked, "What about your glasses?"
"I'm nearsighted, I can see her foot just fine," Susan said as she prepared for the draw even with the watering and flashing lights in her left eye from the pain of being kicked. Two minutes later and Susan had drawn three tubes of blood and had bandaged the needle site.
"I'm sorry," Martha said as she walked along beside Susan handing her destroyed glasses to her.
"Actually, it's not me you need to apologize to," Susan said looking at her glasses thinking there was no way she would be able to repair them.
"I should have trusted you," Martha said.
"Yes, but you're only going to learn by trial and error. I'll teach you how to tell the difference later this afternoon if we get a chance. In the meantime, why don't you go talk to Mrs. Jones," Susan said.
Martha turned around to go back to the patient's room and Susan continued to the lab. When she got there, she put her glasses on her desk and headed over to the centrifuge to spin down the blood. While the blood was spinning she went over to the computer to prepare the barcode labels for the tubes. She leaned in and squinted at the screen and entered the appropriate information. When the centrifuge finished, she put the barcodes on the tubes and started the chemical analysis as Dr. House had ordered. Susan went over to her phone on her desk and called Dr. Cuddy who she knew to wear contacts, "Hey, it's me," she said.
"I'm a little busy right now Susan, what can I do for you?" Cuddy asked.
"I need to get my eyes checked; can you recommend an ophthalmologist for me please?" Susan asked. Cuddy gave her the information and she called the office to make an appointment and explained that her glasses had broken and she didn't have a backup pair, and that she was very nearsighted. They wouldn't be able to take her today, but she could come in late tomorrow afternoon. Susan agreed and then realized she would have to hitch a ride home today and then a ride to and from work until she could get a new pair of glasses made since it was illegal for her to drive without corrective lenses. About an hour later the analyzer beeped indicating it was finished analyzing the blood. Susan verified the results in the computer and headed to the conference room. As she walked down the hall, tall and short colorful blurry creatures traveled the hallway with her. Her left eye really hurt and she was still seeing flashes of light from the kick, but assumed it would go away shortly. She was lost in thought and not paying close attention to where she was as she made her way to the 4th floor and turned into the first room she saw with 5 blurry creatures sitting around a table. She walked inside and sat down before she realized that the height and shapes weren't right for her team. She apologized for going into the wrong room and left. She walked out the door and continued down the hall. Before long she realized she must have gone too far, so she turned around and started back the other direction. She made it all the way back to the elevator and turned around to start over wishing she had paid more attention to how many offices there were before Dr. House's office. She started down the hall again looking at each door as she went by, "Why do they make every door look alike?" Susan said to herself. She had just resigned herself to walking much closer to the doors so she could read the names, even though she would look like an idiot if anybody happened to be sitting at their desk, when House, who had watched Susan pass his office for the third time, got up from his desk and stepped into the hall. "Are you planning on pacing the hall all day or are you going to come in?" he asked. Susan turned toward the familiar voice and walked over his direction. As she got closer, she could see his features begin to come into focus; he was frowning.
"What's wrong?" she asked.
House didn't answer as he grabbed her shoulder and pulled her closer. He felt around her eye and she winced at his touch, "It's just bruised. What happened?" he asked.
"It's my fault," Martha said coming up behind Susan and taking the lab reports from Susan's grasp. "I mistakenly stuck the patient's tendon instead of the vein in her arm and she kicked out as Martha was looking at her feet."
"And then the nurse accidently stepped on my glasses that had fallen on the floor. I've already made an appointment with Dr. Cuddy's ophthalmologist for tomorrow afternoon," Susan informed House.
He nodded and they went inside the conference room to begin the DDX. Dr. Chase held out Susan's folder toward her and Susan reached for it missing it altogether. After the second try, Dr. House impatiently grabbed the folder and her hand and put it in her hand, "Sorry, my right eye is significantly worse than my left eye, so I don't have much depth perception when I'm not wearing my glasses," she explained.
"We didn't find anything of interest at the patient's apartment," Taub offered. "There are several seniors sick right now, but according to the staff; they all have contracted the flu. I guess some kids came in last week for a program and several of them were sick and passed it on to the residents."
"The chemistries were all in the normal range, but the CBC showed an elevated platelet count," Susan said.
"How do we know you ran the right tests on the right patient?" Taub asked.
Susan looked at the Taub shaped blurry figure in the room, "I'm nearsighted, I can see close up. Besides, her specimen was the only one I was running at the time. Trust me. The results are hers."
"She's not running a fever. Her blood pressure and pulse are fine and there was nothing remarkable on the physical examination. I don't think this is any sort of infection," Chase added.
House ordered Susan to run an Iron study on the blood she had just collected and the team to perform an Esophagogastroduodenoscopy for a more thorough look than what the ER had previously performed. Susan let the team head out first before she started to move, "You think you can find your way to the lab with no problem?" House teased.
"I'll be fine. Thank you," Susan said as she got up from the table tripping over the trash can as she made her way to the door. House held back a grin as he helped her off the floor and put the trashcan back in place. "Thanks," Susan mumbled embarrassed and hurriedly left the room. On the way back to the elevator, Susan made sure to count the number of doors between House's office and the elevator. She was so embarrassed and she knew Greg would make full use of her handicap over the next couple of days until she could get a new pair of glasses.
Two hours later Susan had finished the iron study and rather than take the results to the team, she sent the results to them electronically. It was getting late and she decided to shut things down in the lab and just as she was finishing, she heard Dr. House come in the lab behind her, "Hey," he said as she turned around.
Susan smiled at him, "What's up?" she asked.
"It's time to go home," he said picking up her jacket and holding it out for her.
As Susan reached for her jacket, he pulled back slightly so that she just missed grabbing it. She took a step forward and reached for it again as House pulled back again, "Greg!" she said exasperatedly. He chuckled and helped her put it on. Susan grabbed her purse and slung it over her shoulder, "I'm ready." As much as she was annoyed by his teasing, it also pleased her that he had thought to come get her and take her home without her having to ask.
"How are you planning on getting to work tomorrow?" he asked as they walked to his parking space him grabbing her elbow as they stepped down the curb. "If you think I'm coming in that early, you're nuts."
"I have class tomorrow morning, so I can't be late. I thought I might give Dr. James a call and see if he wouldn't mind dropping by to pick me up," Susan replied.
House nodded and smiled, "Good excuse anyway," he said as he opened the passenger door for her.
"That's what I thought too," Susan said returning his grin.
"I'm sorry Susan, I can't. I have a parent-teacher conference at my son's school. Otherwise I'd be happy to pick you up," David said.
"OK, not a problem. I'll talk to you later," she replied and then hung up the phone. Susan thought about her options to herself, there weren't many available to her so she decided to call a cab. She made the phone call and arranged for the cab to pick her up at 7am the next morning. Susan's stomach growled in hunger, so she made her way to the kitchen to see what there was. She hadn't been able to go to the grocery store and the refrigerator was empty of anything edible except condiments and pickles. She opened the freezer which was also barren since she had dumped out all of her left-over's in her fit this morning. She was beginning to regret that decision. She went over to the cabinet where she stored her bread and found a couple slices left. She pulled that out and the jar of peanut butter from the pantry and made herself a peanut butter sandwich for dinner. Not great, but better than nothing. When she finished the sandwich, she was still hungry, but she could live with it. She wasn't going to lose weight by ingesting more food. Susan rubbed her temples. She had a headache which made sense since she'd been straining to see the majority of the day. She started to watch television, but turned it off fairly quickly because it was annoying to try to watch. Instead she turned put a CD in the player and listened to some music while she picked up a book she had been reading. Thank goodness there wasn't anything wrong with her close up vision, but she had read less than a page when she decided, she was just too tired to read and got ready for bed instead.
MDMDMDMDMD
"She can't see," House said.
"What do you mean she can't see," Cuddy asked.
"I mean exactly what I said, she can't see," House reiterated. "The woman's blind as a bat without her glasses."
"Well, we knew her eyes were bad. Her lenses are fairly thick, especially the right one." Cuddy said.
"Yeah, but not thick enough for as hard a time as she is having," House said. "I think when the patient kicked her in the left eye; she must have done some damage. She said that her right eye was significantly worse than her left which is why she doesn't have good depth perception when she doesn't have her glasses. She should be seeing well enough with her left eye to get around, but she's tripping over things as if there is no depth perception. I'm wondering if she is even seeing anything out of her left eye at all."
"Well, you did say she has an appointment tomorrow afternoon with my ophthalmologist. I'm sure he'll figure it out," Cuddy assured. "He's good and very thorough."