Of Cabbages and Kings
Chapter 4
Of Shoes and Ships…
As they crossed the main resident lounge at Mayfield, House noted the vacant stares; the solitary islands of men and women in animated conversation with voices in their heads. He sucked in a breath, seeing himself. As he will be; as he may already be. He tried to focus on the people. Observe, diagnose…but he had lost his taste for it. Or couldn't concentrate well enough on it to care very much. And that frightened him more than the ever-present Amber, always in the periphery of his vision.
Finally they arrived at Croft's office. Dr. David Croft, Assistant Director, resident services. "Here's where you get off, Dr. House. I'll see you a little later." Max extended his hand. House nodded, making no move to take it. A knock on the door.
"David Croft. Please take a seat." House noted the large familiar PPTH file folder as he sat wearily in the comfortable chair. "I'm going to need to ask you some questions. I'm sure you know that some won't be easy to answer, and some you'll not want to answer; others you may not know the answers to. Do the best you can to respond truthfully. The more information we have, the easier time we'll have diagnosing your problem, and…" House couldn't help rolling his eyes.
"Boring. This guy is boooring…" Amber's voice sang into his ear, giving him a chill. House concentrated on ignoring her and trying to pay attention to Croft—who was, admittedly, boring.
House nodded, taking in a shaky breath. He felt exposed and trapped. He wanted to be anywhere but there. He wanted to be dead.
"You admitted yourself. What brought you here?"
"It's on the intake form I filled out. In detail," House responded, not really up to talking.
"Yes. Right here. Precise and detailed. But I'd like to hear it a bit less clinically."
"Started having visual and auditory hallucinations four weeks ago. Initially thought they were brought on by lack of REM sleep. Prescribed sleeping pills, which helped with the sleep, not the hallucinations. Last week began to experience delusions. Possible triggers are the sudden suicide of an employee or cumulative effects of long-term opiod use." House tried to keep his voice even. Objective.
"Yes, Dr. House, I can read. It's exactly, word for word, actually, what you wrote on the intake form. Nice and clinical. Tell me about the hallucination. Are you hallucinating now?"
"Yes."
"Tell me about it."
"I see dead people, it seems."
"Care to elaborate?"
"Do I have a choice?"
Croft sighed. He knew House only from the file and the carefully-written notes sent over from Princeton. House's dean had noted that House was a guarded person, in the extreme. He would rather do almost anything than let those guards down. But beneath the veneer lived a powerful emotions, empathy and great compassion. Even if he could be, on the surface at least, an ass and a mind-game player supreme. He also knew how difficult it was for House to trust. And he knew about the pain. Dr. Lisa Cuddy seemed to know this particular physician quite well.
"Not really," he said finally. "But let's change the subject. Tell me about the pain. When it's worst; what you do for it. That sort of thing."
It had been a long time since anyone had asked House about his leg. The question disarmed him. "It's usually worst in the morning. Sometimes…" House stopped, suddenly finding it difficult to talk about it. He swallowed hard. "Sometimes I wonder if I can even make it to the… Most of the time I take a couple of pills and just wait it out." House closed his eyes, not wanting to watch Croft's pity bore through what was left of his dignity.
Croft observed the difficulty with which House spoke even of this. "What do you take for it."
"Vicodin. But you already knew that."
"How much. When you wake up, I mean."
"Forty, sometimes sixty mg. Depending on the pain." Croft looked up from his notes, quirking an eyebrow.
"You are aware that's too much. I can imagine your prescription allows…"
"Sometimes that's not even enough."
"Is there a pattern?"
"Weather, sleep, random chance. No, I haven't really picked up a pain-pattern. Except for the weather thing."
"Have you ever been pain free? Even for a couple of hours… Since the infarction, I mean."
"You mean when I'm conscious? Twice. Four years ago. I tried an experimental pain treatment. Which worked for all of…three months. Just enough to…" House didn't want to go there. "And a couple months ago. I tried methadone. Princeton Pain Clinic. Dr. Ellard."
"I've heard some good things about his work with chronic pain."
"Yeah, well…"
"Go on…"
"I couldn't think. I missed a simple diagnosis. I don't know if it was finally being pain free that distracted me, or whether the methadone made me too hazy to think critically. But I stopped it."
"Why, if you weren't sure?"
"I don't know. Scared, I guess. I thought I was giving away too much. I was afraid of losing my mojo. Something. Without…" House stopped.
"Go on…" House shook his head slightly, sighing. "You have a particular gift. You were afraid of losing that." A statement. "Without it, what? You think you can't practice medicine…"
"It's all I am." He said it quickly, barely audible. "It's all I have...had…" Croft put his notepad down and removed his reading glasses.
"Had?" House looked everywhere but into Croft's serious eyes. He stood suddenly, needing to move, needing his Vicodin. Needing not to be in pain. He paced the room, leaning heavily on his cane, eventually resting his forehead on the closed office door.
"I can't…" It was suddenly too much. Too many reveals; too much said. Too many voices in his head, too many people, each wanting a part of him. Croft, Amber…even Kutner's sad eyes, accusing, taunting, mocking. It was too much.
"I need something for my leg. It's been hours and…"
"I know. We need to get you off the Vicodin, if only to rule it out as a cause of your hallucinations and delusions. But we need to get you as pain-free as possible. Let's get some blood work and we'll get you something." Croft spoke into his phone, asking a tech to come down to the office. "But it's probably the last two you get to take. At least for awhile, if not permanently."
House nodded. "We need baseline studies. Opiate levels, liver studies. Complete workup in the morning, including a CAT scan. You were in a motorcycle accident in April?"
"Yes."
"What happened?"
"I wrapped my bike around a tree."
"How did that happen? You an experienced biker?"
"Yes. Been riding since I was 16. First accident. I don't remember exactly…"
"Think they're connected? This and the accident?"
"I don't know…I know I'd had some intermittent blurring in my vision."
"Can you describe it?"
"The peripheries…halos, maybe. Hard to describe. Maybe just blurred."
"Was that before or after the accident?"
"First time was four days after the accident."
"And then?"
"Like I said transient. There and gone. Maybe once, twice more."
"How were you feeling then? Aside from the leg pain?"
"I was seeing someone. A shrink. Went a couple times."
"Why?"
"I was just tired of it. All of it. I wanted…I knew I needed to do something. I don't know. I hate shrinks. Most are idiots, and all they have are platitudes to sell. I…"
"Who were you seeing?"
"Andrea Sanderson, in New York."
"Why not someone at Princeton?"
"It was no one's business. Still isn't."
"Those visual disturbances. They could have been the start. Did you consider that they might have been visual hallucinations?"
"I considered it."
The tech interrupted them. Blood taken. Pills administered. "You're so pathetic. I saw you practically drooling over those two tiny pills. And it's not even Vicodin. Really pathetic. You think the shrink missed that? They might as well put a big fat 'A' on your forehead for Addict." House practically jumped at Amber's words. She had faded to shadow as he and Croft had talked. Her laughter made him nauseous.
"Dr. House? You OK?" House gasped, in a cold sweat.
"I…um…I swallowed the pills too fast. Sorry."
"What are you experiencing?"
"My friendly, neighborhood subconscious, being a pain in the ass, so what else is new?"
"Same hallucination, your friend's dead girlfriend?"
"Yes. Amber."
"Not your fellow, the one who committed suicide?"
"He's there, but at least he doesn't talk. Not much. Just glares."
Croft paused, considering if he should continue the interview or if House had had enough for one day. On the other hand, he needed to know. Before House was in full-blown withdrawal. "Have you ever attempted ending your own life when it got to be too much? The pain, the loneliness?"
House knew he couldn't fudge this one. It would be in his records. "Not actively attempted. If you're asking if I've ever wanted it to just be over? Yes. Twice. No. Times."
"Care to share?" Croft tired to keep it matter-of-fact. "Can you describe the conditions?"
"Not really." Croft's expression told House that he really didn't have much of a choice.
"It's important to know before you start to have severe withdrawal symptoms. It will help us know what we can give you for the symptoms and what we can't."
House told him haltingly about Christmas eve 2007 and how Wilson found him. "Sounds pretty actively suicidal to me."
"It wasn't. I just…It just didn't matter anymore. In my mind, my life was over. I was looking at the loss of my medical license, my career and 10 years in prison. I just didn't care anymore. I wasn't counting pills or measuring out the bourbon. I just…"
"And the other times?"
"First time, I was 13. I…" A memory flashed like a lightbulb. Was it real? Or something concocted from his unreliable mind? "It was a long time ago. I'd rather…"
"Fine. What about the other time?"
"It was after the infarction. My girlfriend left. I fell apart. End of story."
"What happened?"
"Morphine. Couldn't bring myself to do it in the end, though. Didn't have the guts. Didn't want to risk Wilson's disappointed admonitions if I'd failed to bring it off somehow, and lived to face him."
"Who's Wilson?"
"My best friend, I suppose."
"Ah. Amber's boyfriend."
Croft considered a moment. There were more questions. And a lot of possibilities. Substance abuse? Probably. Psychotic break due to stress? Likely. He'd read the file. Maybe it all became too much and he just snapped. Depression. Also likely. He didn't think House was actively suicidal. But he wasn't sure. Clearly, Dr. House had co-occurring disorders, and there was more to learn. But Croft thought that House had enough for one session. And he certainly had enough for intake. And more than enough to indicate inpatient evaluation and treatment.
