Relay
When she returns from breakfast, Cuddy's disappointed to hear that House had to be sedated. She isn't surprised—just disappointed. He'd had such a good night. His morning CT had confirmed that the bleeding had stopped. Now he's regressing: an eleven on the GCS ten minutes ago.
"House?" she says tentatively as she approaches him. She lays a hand on his.
He stirs, shifting arms and legs uncomfortably, tossing his head a few times, and mumbles, "Sorry…shouldn't be…don't…" His eyes flutter but don't open. Slow, shallow, medicated breathing replaces the restlessness movement almost as soon as it starts.
She smiles sadly. Why does he do these things to himself?
"House, I'm back," she tells him. It's important to let semi-conscious patients know who's with them and what's happening around them. "I'll be here if you need me."
He stirs again, moves his arms and legs again, and opens his mouth like he wants to speak. She can see his eyes shuttling back and forth beneath their lids. He won't stay under long.
Cuddy squeezes his hand and settles in the chair next to him. The ICU's quiet: the beds flanking House's still unoccupied, day shift dug in for the next eleven hours. She's full and sleepy.
A nurse enters to record House's vitals, waking her accidently, then she's out.
--
An hour later, Chase's gentle hand on her shoulder wakes her.
Cuddy blinks at him tiredly for a moment before she understands. He's the surgeon. This is his follow-up on the patient. And maybe he's something else to House. Close to a friend. She remembers hearing he went bowling with House not too long ago.
Chase had woken her only as a courtesy, and he's already busy with House.
"House, it's Chase," he says professionally. "I'm here to check your incision."
House mumbles and shifts, more loudly and violently this time. Cuddy stands, dons shoes, and puts her hand out for the chart Chase has.
"Still not responding," Chase says to himself. "Temp's elevated."
Cuddy nods, examining the nurse's notes. Two degree temperature increase over the last hour. Administered 500 mg acetaminophen ten minutes ago. Cuddy frowns. He's on amipcillin to prevent a urinary tract infection. It's only a moderate spectrum antibiotic, but that doesn't make the fever any less strange. He's trending toward tachycardia and hypertension, she's noticed. Probably an autonomic reaction.
Chase bends closer. "House, if you can hear me, I need you to wake up."
Cuddy's eyes meet Chase's. Worried.
House mumbles, his eyes fluttering, but he doesn't wake more than that.
"That's good," Chase encourages. "Just a little more. I need you to open your eyes for me."
House opens his eyes, blinks blankly. Cuddy doesn't see much awareness in them.
"Hi, House," Chase says smiling. "Can you blink if you understand what I'm saying?"
House stares dully at Chase and blinks.
"I know you're not feeling great right now," Chase tells him. "You're running a low-grade fever. It's probably an autonomic reaction to the head injury, but we're going to check everything out. I'm going to start by checking the incision."
House continues to stare dully, as though Chase is the least interesting person he's ever encountered.
"If you have any questions, blink," Chase instructs.
House stares. Nothing.
"Go back to sleep," Cuddy says.
House's eyes track slowly to her. She sees a glimmer of comprehension before he closes his eyes and relaxes.
She and Chase exchange another glance. Better, but not out of the woods.
Chase begins peeling away the dressing on House's head, speaking softly to him, and Cuddy writes an order for a full work-up to rule out infection and other autonomic syndromes. She and Chase came to the same diagnosis without discussing it, though, and that consensus probably bodes well. Not in House's world, of course, but House can be a normal patient and still be an abnormal person. Consensus has a strong statistical advantage in the normal world. It's probably autonomic dysfunction syndrome. Not uncommon, and if they can control his vitals, not very dangerous.
"Incision site's clean," Chase reports. Cuddy nods. One possibility down. Several others to go.
Chase motions her toward the foot of the bed.
"I can stay with him for a while if you'd like to get some rest somewhere quieter," Chase offers.
Cuddy's eyebrow leaps. "Surgery gives you that much free time?"
Chase smiles slightly. "I requested the morning off," he answers.
Cuddy looks to House for a moment. He's sleeping. His heart rate and blood pressure are elevated given the medication he's on. He's restless, grimacing. But she can't do anything more for him until she's had some sleep. Chase looks much more rested.
She looks back to Chase. "Thanks," she says. "But page me when the lab results arrive."
"Of course," Chase replies.
Cuddy walks House's chart to the nurse's station, ensures the labs are ordered correctly, and trudges toward her office to the couch that waits there.
--
Chase busies himself looking for infection before he draws the labs. He checks the stitches in House's scalp. Clean. The IV site. Clean. Runs a quick physical for other sites of inflammation. Nothing. He gathers the supplies he'll need to draw blood and collect a urine sample. All the while his mind is elsewhere.
He remembers the shock of seeing House get shot two years ago. The confusion. He and Cameron had stabilized House while Foreman called security. He remembers she'd pressed both hands against the neck wound while he'd examined the abdomen. Quick transfer to a gurney, rush to the ER. Cameron told him later, half-jokingly, that he'd been so bossy the whole time. Well. He was the intensivist.
He'd been so stunned after the shooting: watching the surgery, checking on House in the ICU. That bloodstained carpet. But after a year of watching House continue to self-destruct—the blow of regaining and lose again full use of his leg, Chase realized, was hard to absorb, but House had no cause to punch him over a diagnosis; then the debacle with the detective House wouldn't leave alone, nearly going to jail and taking everyone else with him, detox and rehab in the middle of all that; and then the last straw, followed by Chase's move to the relative quiet of working in surgery—Chase is inured to the things House does to himself and others. He's learned to stay out of the way.
House looks sick right now, yes, and drilling a hole into his skull less than twenty-four hours after he sustained a skull fracture was pure insanity, but Chase has successfully compartmentalized House. He'd performed hypnosis professionally and watched with detachment as House had relived the bus crash during surgery. He'd done his job when House had seized. He'd noted that Wilson was having serious problems compartmentalizing. Whatever's going on between the two of them, he's wise enough to stay out of it. He'll do his job and get out of the way. That's the only workable approach to House he knows.
"Okay, House," Chase says. "I'm going to draw some blood. You'll feel pressure on your upper arm and then a slight pinch. Try to stay still. I'm going to start now."
He ties the tourniquet and finds a vein. House has never given him trouble in the past with a blood draw.
House really isn't the bad guy he wants people to think he is. Chase respects him for always putting his patient first. If Chase didn't believe House did good things, he wouldn't be caring for him right now. Deep brain stimulation, though an utterly mad idea, had been a good thing for Wilson and Amber.
Not such a good thing for House, he thinks as he watches a vial fill with House's blood. But House is oddly selfless at times.
Chase pushes those thoughts away. He's already made his peace with House. Mentally, he shoves House back in his compartment.
Compartmentalizing. It's the only way to stay sane as a trauma surgeon. Chase has already compartmentalized Amber's death. That one wasn't hard. He didn't know her.
The whole thing has really affected Foreman, though. It had been Cameron's idea to meet at the pub last night to decompress. Foreman needed it. He'd hidden it well, but they could both tell he was worried about the team and worried about House. Great idea Cameron had had. She was brilliant. He feels warm and bright when he thinks about her. They'd sat on the couch last night and talked for half an hour about everything that had happened. Gotten everything out in the open. He'd slept well last night.
She'd been the one who suggested he ask for the morning off, knowing in that way she does that Cuddy would stay and Foreman would go back after leaving the pub, and that they'd both need someone to relieve them. When the ER needed her, she had to be there, she'd argued, whereas he could get a replacement for half a day. He hadn't needed much convincing. He still wasn't entirely comfortable with her being alone with House. Didn't trust House, that was it. Easier not to trust House than her.
He snaps off the tourniquet, tapes cotton into the crook of House's arm, and bends it to staunch the wound. Not that there'll be any trouble with that, he knows, because House still has a clotting agent in his system, but he does it anyway.
"All done, House," he says.
House stirs, mumbles, winces, shifts his limbs. Chase doesn't attempt to wake him. He needs to rest. Chase watches his heart rate and BP climb, then fall as he settles. His temp's dropped two tenths of a degree. Acetaminophen's working. Chase nods to himself.
He sets the blood aside and preps for the urine sample.
This morning's CT had looked much better. No more bleeding. Intracranial pressure within normal ranges. Still a nasty fracture, though. Deep brain stimulation was insane.
But effective. And that's what matters to House. Chase stops his thoughts, pushes House back to the compartment. He's here to help with the medicine. Nothing else.
A nurse enters to record House's vitals. Chase stays out of the way, collecting urine from the cath bag.
No one speaks to House, but their presence must annoy him because he becomes agitated. Vitals spiking. Talking, moving. Chase and the nurse exchange a glance. What set this off?
"It's okay, House," Chase says in a calm, authoritative tone. "We're looking after you. Calm down and rest."
House complies, quieting, his tightened face smoothing. His vitals drop to more acceptable levels.
"That's better," Chase encourages. "You're all right."
He hands the fluids for the lab to the nurse and goes to the side of the bay to wash his hands. Cuddy wants an LP to rule out viral meningitis, but he's not comfortable conducting that procedure on such a restless patient. It can wait a little while.
House's heart rate and BP are up again when he comes back. House moves restlessly in the bed. Chase nods to himself. Waiting on the LP is the right decision.
Chase places a hand on House's. "It's all right, I'm here," he says. "We're taking care of you. It's okay."
House calms. His vitals drop.
Chase senses the pattern. He pulls the oversized chair closer to the bed so he can keep a hand on House's and monitor his vitals. He hopes the contact, hand on hand, will keep House calm, but he's prepared to reassure House again and again.
Even House can become confused and upset. For all he tries to deny it, he's human.
That's no surprise to Chase.
--
Foreman sees Chase talking to House through the glass wall. House appears to be asleep. But Foreman's seen House's chart. He'd been there earlier in the morning when House had been heading toward a hypertensive crisis; he'd ordered the morphine-diazepam cocktail that had stabilized House. He's here now because that cocktail should be wearing off and he wants to assess House's mental status again. House isn't asleep. Not fully.
Foreman presses a hand to his eyes. Between caring for House, acting as attending for Amber, and dealing with the team, he hasn't had much time to sleep. When he has slept, he hasn't slept well. Too much to process. He's happy to see Chase in with House. Cuddy must be off resting. He'd told Taub, Kutner, and Hadley he didn't want them to come in—at all, really—before ten. He hasn't seen them yet. As it should be.
House starts thrashing inside the room. Foreman's heart jumps before his trained eye recognizes the erratic movement as restlessness. Not a seizure.
Time to go in. House may need light sedation again; if he does, Foreman wants to get it to him as quickly as possible. His CT may have looked good, but he can undo any progress he's made with one hypertensive crisis.
"Calm down, you're okay, House, you're in the hospital," Chase says, gently restraining House's hands.
Chase looks up at Foreman. "Keeps trying to remove the leads," he says with a nod at House's chest.
"He did that earlier," Foreman replies. Then to House, "House, this is Foreman. You've got to settle down. We're taking care of you."
House's face is contorted. He tosses his head, "No, no, no, don't, stop—"
"House, you're okay, you're in the hospital," Chase says clearly and calmly.
Foreman watches his heart rate climb. 150. 160. His blood pressure's nearing the danger zone for a brain injury.
"House, we're going to have to sedate you if you don't calm down," Foreman says.
He grabs House's arm when House reaches for the EKG wires. House is stronger than he should be. He's not waking up.
Foreman orders the same sedative cocktail, indicating that Chase get it.
"House, you're going to herniate if you don't relax," Foreman says. "You're okay. We're not going to hurt you. You have to calm down, though. Your blood pressure's too high." Foreman recites the numbers. "You know that's too high. Calm down, okay?"
House stops resisting so violently, but his vitals don't drop to normal levels. He's still talking, fidgeting, shaking his head. He's crying, too, Foreman realizes.
Foreman speaks to him, trying to calm him, mentally urging Chase to hurry up. House has been hypertensive for three minutes by his estimation. That's too long. He's flushed and sweating.
Chase returns and they watch House's vitals descend over a long two minutes to the low end of normal range.
Foreman breathes for the first time since he's been in the room. Chase shares the same weary expression.
Foreman motions Chase to the end of the bed. "How long have you been here?" he asks, noticing the sweat stains on Chase's scrub top.
Chase consults the monitor for the time. "About an hour."
Foreman shakes his head. "Was he ever that bad?"
"No," Chase says with a tired sigh. "He's been getting close to it for about fifteen minutes, but I was always able to talk him down."
"He say anything that made sense?" Foreman questions.
"Not much," Chase answers. "Mentioned Amber a few times, and Stacy and Wilson, but most of it was the same as what you heard."
Foreman nods. Disorientation, reliving negative moments—neither is abnormal with a severe brain injury. House is having a bad morning like any other patient.
"I can take over," Foreman offers, glancing again at Chase's somewhat disheveled appearance.
"You sure?" Chase asks. "Because I can stay. Hard part's over."
Foreman shakes his head. "I want to check his reflexes. But if you could come back in half an hour…?"
"Sure," Chase says easily.
"Thanks."
It's like old times again, negotiating patient-sitting duty. Except he likes Chase now.
"I'll check on the labs, too," Chase volunteers. "Should be done by now."
Foreman nods his thanks and looks back to House as Chase leaves. Vitals steady. Normal range. His skin's turning pale again. His slack face confirms the sedative effect.
Foreman moves the blanket and takes House's foot to begin checking his reflexes.
He keeps his mind on the medicine. When he confirms that the House he knows is still alive, he'll let himself think about everything that's happened. But not now. Now he does his job—just that, nothing else.
--
Cuddy's page wakes her from a light, troubled sleep. She reaches the unit a few minutes after the labs.
Foreman's in with him puzzling over the report.
"Looks like paroxysmal autonomic instability with dystonia," he says, passing her the report. "Autonomic dysfunction syndrome."
Cuddy nods quickly and scans the report herself. White count's barely elevated—a response to the scalp laceration—rules out infection. Thyroid panel clean. Creatine kinase and troponin levels consistent with yesterday's cardiac arrest, not indicative of any other syndrome. Still waiting on cultures, but his white count doesn't indicate infection.
"No lumbar puncture?" Cuddy asks.
"He was too restless," Foreman answers. "Chase didn't want to risk it."
Cuddy glances from House, who's still and quiet, to Foreman. Foreman explains Chase's hour with House, having to sedate him again.
She nods. "We should do it now while he's out."
Foreman doesn't need to be told. He's already moving to set up for it.
Cuddy uses the time to catch up on House's chart. He's not having the best day. Her lip curls a little, wryly, at the irony of a lumbar puncture to rule out viral meningitis when House had caused a minor meningitis scare in the ER some thirty-six hours ago. He would appreciate it, she thinks. Hopes. She's still not sure that he's in there.
A nurse helps the two of them turn him and hold him while Foreman conducts the procedure. House doesn't move when Foreman inserts the needle. She watches as clear spinal fluid drips into the container. Appears to be negative. Good.
She holds his shoulder while Foreman cleans up. He feels too warm to her and she consults the monitor. His temperature's up again around 100 degrees, though the acetaminophen's still working. She orders another 500 milligrams when Foreman's done. They leave House on his side. The nurse returns with the medication and pillows to keep him in place.
Cuddy's satisfied that House is physically stable, but she wants him to wake up and speak again. She's worried he won't rebound for this one. She also knows he needs time to sort things out.
Okay. She doesn't want to wait, but she can give him time. She needs time, too, she realizes.
She leaves him in Foreman's capable hands with an order to page her if his condition changes. She drifts down to the parking garage. She has another visit to pay.