Disclaimer in part one.
Time for a Foreman POV!
We Tried to Hide From Failure
The Weather
We Said We'd Never Fight
Moon And Sun
What's Done Is Done
--Gomez "Mooon and Sun"
Like Cameron, Foreman didn't need an alarm to wake him at 5:30. The unfamiliar bed and surroundings, coupled with his internal clock, did that for him.
The room PPTH had sprung on for him was very large, in a hotel where parents of the wealthiest Princeton students—the sort that had buildings named after great-grandfathers—stayed. Foreman knew the room, as well as his consultation and generous meal allowance, had been because Daniel Hartmann, who had replaced Cuddy as dean of medicine, was scared of both Chase and Cameron. Both of them had been offered the position, and they had both turned it down, preferring to remain practicing specialists and more available for their children (they also, Foreman knew, didn't want to be put in the position where one of them was the other's superior, figuring it wouldn't work as well as it had with Cuddy and House—and that hadn't worked very well). Together, though, the two of them had cases and friends in nearly every department—Cameron worked closely with anyone doing any type of research, and spent heavy time with peds, oncology, pathology, any department that saw an infection, ever, and as head of the clinical departments had could access any patient who had regular and long-term contact with PPTH; Chase could scrub in on any surgery he wanted for the hell of it, solved the high-profile diagnostic cases, and had a vested interest in every short-term patient in the hospital. Everyone at PPTH was a little in awe of them, even liked them; Foreman had literally heard whispers about them in the cafeteria. It was why both of them had nearly unlimited budgets and salaries that even impressed Foreman, himself the head of the Neurology department at Hartford -St. Mary's (the third-largest neurology department in New England).
He checked his cell phone to see if Aisworth, the doctor he had covering his patients, had called, which he had not. There was a text message from Wilson, however, that simply read House asleep. Cuddy and I going home to get Zs. It had been sent barely an hour ago.
He went down to the hotel gym and lifted weights before returning, showering, and calling Aisworth before Aisworth headed into the office. Aisworth's wife was not pleased, because they had a sleeping baby and because he called her Jess instead of Jen. Still, they had a good conversation before he decided it was late enough to go wake House and do his neurological exam. With any luck, he could take the train home tonight, then. He didn't like staying around PPTH for too long; it made him nervous.
He scanned House's file on his cab ride in, still feeling a thrill of nerves and fear at being privy to House's medical history. It was a thick file; House's insane not-suicidal suicide attempts assured that. He inspected each heart attack, each stroke, each surgery, the infarction. He looked at the familiar signatures scrawled on the forms: House's, Cuddy's, and Stacy Warner's on consent forms; Cuddy's, Wilson's, Chase's, Cameron's, even his on procedure forms. He looked at the battery of tests Chase had ordered when he'd initially collapsed: CT of the head and then the blood vessels, ultrasound, MRI, angiograms, ECGs, EEGs, blood tests, IVUS, liver-function tests, kidney-function tests. He traced the path of Chase's diagnosis, saw Cameron's fingerprints all over some of the diseases checked for in the blood. He had arrived late Tuesday night, had therefore only had these tests to go on since then. Running his tests would be good. Chase was good but he was no neurologist.
He sent a mass text to Chase, Cameron, Wilson, and Cuddy, saying that he was about to examine House. Chase texted back immediately, saying that one of his diagnostic fellows was an interventional radiologist and always pulled early-morning hours in the Clinic on Friday because he always forgot to fill his weekly quota. Name was Haxby and would be helpful and grateful to get pulled from the Clinic.
He tipped the cabbie generously, mentally making a note to include it in his reimbursements. He strolled into PPTH feeling absolutely confident and knowing that his grey suit looked great. He wandered over to the empty clinic, mostly filled at this hour with patients who were avoiding going into work.
"I'm looking for Dr. Haxby," he smiled to the receptionist. "I need him for a consult."
Haxby was tall and dark-haired, the sort of television-drama doctor who, if he had even just an ounce of charm, could get any patient to sign a consent form and any administrator to okay a test. "Hi, can I help you?"
"My name's Dr. Foreman, I was called down on a consult by Drs. Chase and Cameron for Dr. House. We were all diagnostic fellows together, back in the day."
"Oh, yeah, I've heard stories. 'S nice to meet you," he smiled broadly. Good teeth. He seemed like the type of doctor Chase would pick.
"Yeah, it's great. Anyways, I'm going to run a few tests on him this morning and I'd appreciate some assistance. Mind giving me a hand? I know that House is kind of cantankerous, especially when he's in a subordinate position like the patient, so it's totally fine if you don't want to."
"Nah, it's House. He's tough but he's not impossible. I'm up for it."
They started walking toward the elevators. "So you hate Clinic that much, huh?" Foreman asked.
He laughed. "It's not the best, but if you come this early in the morning there's hardly anyone, and you have the all-clear to not work."
"How long you been a fellow?"
"Only a couple of months. Just completed my residency, Johns Hopkins."
"Oh, really? I went to med school there." They chatted for a few minutes about Baltimore and the quality of the education, and then reached House's room.
House was sleeping, somewhat peacefully, and Foreman wished he had a cane he could rap on the table, like House did, for a dramatic entrance. He settled for turning the lights on high and shaking his shoulder.
"What?" he said irritably. "Oh, look, you came back to your old massah."
"Nice to see you, too," Foreman said. "I'm assuming you know Dr. Haxby. Count back from 100 by 7's."
"Ein hundert, dreiundneunzig, sechsundachtzig, neunund—"
"Got it, you can count and still speak German," Foreman said.
"Oh, that was German? No idea."
"Follow the light with your eyes."
"I thought I wasn't supposed to follow the light right now?" House retorted, flicking his pupils back and forth.
"Where were you born?"
"Stable in Bethlehem."
"Why'd you hire me?"
"Your homies in the hood."
"Chase? Cameron?"
"Hair. Both of them."
"Try to smile."
House frowned. "Going to tell me to turn that frown upside down?"
"Yes." House grinned, baring all his teeth. Foreman noticed a slight lag on his left side.
He quizzed him more on years and dates, getting sarcastic non-answers that told Foreman mental capacity probably hadn't been diminished in any significant way. Foreman tested House's muscles by making him push Foreman's hands up, down, and forward. He made House close his eyes to check for arm drift. He popped his cheeks, checked his eyelids, had House hold one leg three inches off the bed for a few seconds to see if any tremors developed. Foreman tried to make his own face absolutely inscrutable. He had House tap his palms with his index fingers, write his name (he wrote "Belligerent Asshole," though his handwriting was much worse than normal and he had lots of problems grasping the pen), had him clench and unclench his fist, tested two-point discrimination, then quizzed House some more. Finally, he had to do the inevitable.
"Alright, House, let's check your gait and do the Romberg tests," he said, knowing it wouldn't go over well at all.
House shook his head. "CT first. I want to make sure everything's clear." His voice left no room for argument.
"Fine. Let me check your feet for function first, though."
There was some loss of sensation in both hands and feet, especially feet, and then they wheeled him in for a CT. The images came back mostly normal, though there was still some swelling and the area near where the stroke had occurred looked like it would be permanently damaged. Haxby flicked through the shots several times, checking and double-checking carefully. "No residual clotting … blood flow looks good."
"Any damage from the fall? The ischemia? The swelling's still there," Foreman said.
"The bleed area is totally normal, but there seems to be a little damage from the ischemia, and the ischemia could explain the swelling that's still there."
"Still presents abnormally."
Haxby flicked through the images again, knowing what Foreman was looking for. "There's no bleed. There's no evidence there was a bleed."
"Looks good, House," Foreman said via the microphone. "I want to check your gait and the Romberg tests when we get back." He sighed as he released the mic. "This isn't going to be pretty."
It wasn't. House completely failed the Romberg test, which test for balance, and the lack of nerve connectedness Foreman had already found in his foot went halfway up his legs. Even when sitting upright House's legs shook; walking, his bad leg was completely useless, and his good one wasn't much better. House scowled and didn't say anything. As Foreman and Haxby were sliding him back into bed Foreman noticed a piece of paper torn from a day-planner that read Update! AC-C in Cameron's girly scrawl. He dismissed Haxby and was paging Cameron when Chase and the couple's oldest daughter, Elizabeth, came in.
He still did a double-take whenever he saw one of Chase and Cameron's kids; he couldn't help it. Working with the two of them had a very definite rhythm, one that had been preserved through the courtship, marriage, and four children. The children were anachronisms, reminded him that he wasn't House's fellow; now, he didn't even work (nor did he want to work) at PPTH. He never wanted children, never had the urge to see his eyes on someone else or to teach a son how to throw a football, but it was still sometimes shocking to see the ways in which their children echoed themselves. Often, when speaking to one of the kids, their images slip in his mind's eye, blending with ingrained images of their parents. It stymied him how facial features, body languages, sentence phrasing, and even Chase and Cameron's laughs blended and overlapped and reemerged in strange ways. It had been especially unsettling, for instance, when a four-year-old Sophie would give him Chase's dumb-puppy look, or Claire shot him Cameron's crossest, crankiest glare. And now, as almost-adults, they were even more like their parents, were even more jarring to see and to speak to.
"Hey House, how's it going?" Chase said, stepping to read the vitals. "Hey, Foreman. Where are Cuddy and Wilson?"
"They went back to Wilson's place to sleep. I got a text at about four in the morning saying they were taking off."
"They're old now. They can't hack the chairs," House mumbled.
"How's it going, House?" Elizabeth asked, standing by his bed. She looked at his monitors, trying to glean information. Foreman had never understood House's relationship with the Cameron-Chase children, and he especially didn't understand why Elizabeth, who had never showed any aptitude or interest in medicine, was trying to read charts.
"What, you think by staring at them it's like what would happen if you went to medical school?" House asked, and Foreman chuckled.
"I think that, as an English major and avid watcher of medical dramas, I can figure out what BP stands for," she shot back.
"How's he doing?" Chase said in a low voice. "I'd like to move him off ICU today."
Foreman nodded. "He should be able to do that. Neurological signs were … okay."
"I know exactly what my neurological signs were, you can talk about it in front of me," House shouted. "I did train you, you know. If that means anything these days."
Foreman sighed. "Some spasms. Trouble with both walking and balance. Nerve trouble in the legs and arms, especially legs, including tremors. Some disgraphia, trouble with fine motor skills like making a balled fist. Small facial problems. No neuropathic pain, though, but that might be because of the massive amounts of Vicodin he still has in his system."
"Hey, got your page. What's up?" Cameron came into the room.
"Good news and so-so news. We're going to move him out of the ICU. But there's some nerve trouble, some fine-motor skills trouble, and trouble walking and balancing. CT was … clean," Chase read the last part from Foreman's notes before handing it to Cameron.
"The thing that still confuses me, though," Chase said, grasping the rails at the foot of the bed. "is why the clot and the stenosis formed in the first place. The statins and the liver failure should have ensured that his blood wasn't clotting. We should have had a bleed. Instead, we have atherosclerosis, when the blood pressure is not off-the-charts, and has been under treatment for a while."
"The liver failure's explained by the years of substance abuse," Cameron threw House a look. "And he's had atherosclerosis for a while, since before the infarction."
"Yes, but look at the pattern, it's nearly all abdominal. There's not a lot of buildup in his brain, or even his heart. I mean, his dad had it, but still … this seems worse. Your blood pressure has shot up over the past few months, and the statins and ACE inhibitors should have been controlling the clotting, so basically they're disguising the problem. It could be something like fibromuscular dysplasia."
"It would have appeared before his 50th birthday," Foreman objected.
"Unless," Chase said, "the statins that he's been on since he was 37 delayed the onset, because it was already being treated. Now it's simply gotten worse, because the substance abuse and the disease have finally overtaken the treatment."
"And that could be why there's a lot of buildup in the kidneys, liver, and carotid, but not brain or heart. Though the pills and alcohol still degraded function," Cameron said, working it out.
"I'll have Haxby do an angiography; if it's fibromuscular displaysia that explains a lot," Chase said.
"Still doesn't explain why he went into a coma for two minutes of ischemia," Foreman pointed out.
"It's unusual in embolic strokes, not impossible. There's some necrotic tissue around the area, it hit low in his cerebellum, near his brain stem. The right angle on the fall could've caused it as well," Cameron said.
"Aren't differentials fun?" House interjected.
"I think we should put stents in his hepatic artery," Chase said, flicking through the charts, if only for something to do. "Possibly carotid and renal as well. You like it?" He turned to House, who nodded. "Alright," Chase said. "I'm ordering the tests and moving you, and getting a PT and an OT to come visit, and then I'll be reachable by pager for the rest of the day." He turned to the others. "Al, can you get a hold of Wilson and Cuddy to have them meet us after your board meeting? And talk to the PT and the OT once they get done with their assessments?" Foreman noted the use of 'Al,' a term of endearment he'd heard used fewer than a dozen times.
"Yeah, no prob," she said.
Chase looked like he was about to say something else to his wife—it was amazing how clearly they were able to delineate home and hospital most of the time, and how obviously in this moment they were a couple and not a couple of doctors—but just shook his head quickly and returned to doctor-mode. "Foreman, I'd really appreciate it if you stayed around till we have this meeting so you can really go in-depth about the neurological symptoms and how long recovery will take. We need to go over everything as a group, figure out what steps to take next."
"When's the meeting?" He was a little affronted by Chase's diplomatic tone, as if Chase was in charge. Which, technically, he was.
"We're meeting as soon as I'm out of the board meeting," Cameron said. "It should be about six."
Foreman sighed, and Chase interjected, "If you want, we can take you right to the train station afterwards."
"Nah, I'll stay through tomorrow morning," he said. "It's not like I'm paying," he grinned. He could leave tomorrow, kill time today at a movie or reading patient referrals.
"Great. Ready to go, Lizzy? I'm just turning in these forms."
"Yeah," she said, getting up. "All set for our exciting day of grocery shopping."
"You're getting lunch at Mediterra out of that grocery shopping," her mother reminded her.
"I know. Besides, I love Wegman's. We don't have them in the City." She honestly seemed to be telling the truth.
"Let's get going then," Chase said, leading her out. Cameron got a page, muttered, "crap," and dashed out herself.
"See you later Foreman," Elizabeth called as they all walked off in their respective directions.
Let me know what you think!
