No Exit
Chapter 4
"Dr. House. I'm Jun Kwan. Honored to make your acquaintance in person. I've read one or two of your papers. Your clarity of thinking and honesty about our profession is refreshing." It was a way to break the ice. Kwan assumed House would take it as so much bullshit, but he had read several of House's papers on diagnostics and one on renal failure in pain patients. Right now, House didn't look the vision of medical brilliance Kwan admired. He looked like a patient in dire straits.
The battery of tests took hours. Kwan was curious about the Ketamine treatment and its effects; he told House things he already knew. "I'm trying to figure out what went wrong with the Ketamine after three months."
"Simple. It stopped working. Fifty percent of cases. Period." EMGs, MRI, PETScan, blood tests.
Kwan scanned the list of meds and procedures tried over the course of six years. "But even the Vicodin doesn't work completely for you. The pain is still too severe, even on the dosages you're on, to make physio possible." A question or a statement. House wasn't sure. He was just exhausted.
Kwan had mentioned something about a guy at Albert Einstein and hedonic tone studies. House had recalled reading about it in the Journal of Pain Management. "I think your Hedonic tone might be signficantly lowered. It's a guess right now. But if true, would complicate both your pain and pain management issues. But I think it may explain a lot. You probably know that you have CRPS, complicated by the muscle damage and the over-compensation by the remaining good muscle. The Ketamine short-circuited the CRPS for three months. Allowed you to exercise and do physio. If we can attack the both…"
"Been there. Done that."
"In any event, I need to evaluate all these tests in light of your history and Dr. Harrington's thoughts. We need to keep you on the Subutex for now, but titrate it down while we start you on a Tramadol/acetaminophen formulation short-term. Long term, I'm not sure your your liver will handle it. In any event 'eleven' isn't acceptable. You're in too much pain and I don't have any long term answers today."
House returned to his room. He felt sick and humiliated, having to be transported by wheelchair. The Ultram would kick in soon and then…
Cuddy was waiting for him when entered. She was standing, her hip perched on the window, arms folded. He looked away, embarrassed.
"Dr. Harrington said…" Cuddy tried to conceal her shock at his appearance. He'd looked bad Christmas morning, but nothing like this. His clothing hung loosely; she was certain he'd lost at least 10 pounds in the five days he'd been up on four. His beard had grown in more, making him look even more gaunt…and his eyes held more pain than she could stand.
"It's fine. I just wasn't expecting that you…" It was anything but fine, but it was inevitable: her visit.
"I can come back later if…" House glanced back at the orderly, who was waiting to assist House, shooing him from the room with a withering look. "Do you need…?" she stepped towards the wheelchair to offer. The pain seemed marginally better and House stood shakily, but on his own. His leg held as he dragged it slowly, finally sitting heavily in the easy chair.
"How are you doing?" It was a stupid thing to ask, she knew. The answer was obvious, even before she saw him; observed him.
"Peachy-keen. Lots of people at my beck and call, all hours of the day and night. All I have to do is flick a button and they come running. Just like Club Med." He paused. "Thank you. For the other day, Cuddy. So. How's life among the living? The team behaving? Foreman apply for my job yet? Wilson and Tritter elope?"
"House…"
"Yeah. Right. His motives were as pure as the snow outside this window. He's been fucking with my mind since September. And it's all been for my good."
"His intentions…"
"Yeah, well you know about intentions and Hell, don't'cha? Except I'm the one in Hell right now, while he's out on the golf course."
"It's December."
"Indoor golf course."
"Harrington's good." Time to change the subject. She didn't want to agitate him further. She'd leave that discussion to Catherine.
"Is she?"
"She knows what she's doing. She works with a lot of doctors who…"
"Are impaired? That what you think I am? Well I am now. That what you think I was? Impaired?"
"No. I…"
"Not able to do my job?" House laughed bitterly.
"I was out of my mind in pain. Detoxing. I hadn't slept in days and puking my brains out every hour. I still figured out that girl's problem. You couldn't and neither could he. And I'm impaired.
"I never said…"
"Then why am I here?"
"You're here voluntarily. I assume you came here because of what happened…"
"What happened was a direct result of what…"
"You tried to kill yourself." There. She'd said it.
"I did not try to kill myself." House rubbed the bridge of his nose. "Look. I do not want to talk about this now. I…" Even Harrington understood that. His emotional defenses were too worn down. He couldn't do it. And Cuddy always knew how to get past even his best defenses.
Cuddy moved to House's easy chair, sitting on the ottoman. House moved his feet to allow it. Even though her nearness was his biggest threat. "I'm sorry." He looked upward, exasperated. Sorry wasn't enough right now. He knew she meant it.
"I'm sorry for all of it. Not just this. It was wrong to lie to you about that patient. Hell, it was wrong of me to not allow you to try the cortisol in the first place. I was concerned…"
"That what? I was making intuitive leaps with no obvious medical evidence. How's that different than…" What was the use, he thought. How often had they been over this ground. "It's OK for me to connect the dots when I'm on narcotics; but when I'm not…not so much? That makes sense."
"House, I didn't come here to argue."
"Why are you here?" He had been feeling better, the combination of the Ultram and sparring with Cuddy helping. But now he was fading fast. He was feeling suddenly sleepy and wanted nothing more than to make it back to his bed. He rose from the chair, intending to do so with a flourish to signal the end of Cuddy's audience with him. Instead he nearly keeled over as a combination of the sleepiness and a slight dizziness swept over him. Cuddy caught his arm before he fell. He didn't resist her assistance.
"Tuck me in?"
"How long's it been since you've slept?"
"Don't remember. Will that affect whether you tuck me in or not?" Cuddy smiled at the remark. "'Cause if so, I think it's been a week. Maybe longer." She regarded him a moment as he nodded off before tucking the blanket around him and quietly exiting the room.
"How is he?"
"Asleep." Harrington looked surprised and pleased.
"He hasn't slept in days. Not really. Kwan put him on Ultram for the pain." Now it was Cuddy's turn to look surprised. "Stop gap. The pain was bad. I might have titrated down the Subutex too quickly."
"Has he talked about Christmas eve?" Harrington arched an eyebrow.
"Sorry. Instinct to ask. I know you can't say. Is he going to be alright?"
"He may never be pain free. He may still have to be on opoids or opiates for the rest of his life. As for the rest of it…" She shrugged. "It's early. He has a long road ahead and we haven't taken the first step yet. I have two months with him. Just getting him to trust me could take that long. So, who knows?"
"I'm glad he's working with you. Thank you, Catherine." Cuddy moved through the hospital corridors like a ghost. She neither saw nor heard anyone in the busy hallways. She slammed, then locked her inner office doors and wept.
