Chapter 7
A/N – get ready for what I hope will be a wild rollercoaster ride! New character here. House's night shift nurse is named Anne. I named her after Anne Dudek, the actress who played Amber. I maligned Amber in this story. I am sure that the actress herself is at least a little nicer and more selfless than her character was. I wanted to do something nice to make up for maligning Amber
House's parents couldn't get a flight out until the next day.
11:00 PM
Brenda was in House's cubicle cleaning up a few little things and making things ready for the night shift. Brenda was waiting for the night shift nurse to come in so she could give her report on her patient.
As she was recording House's last set of vital signs before the night shift took over, she looked over and thought she must be imagining things. Were his right toes twitching? No. But then she looked again and sure enough, the toes on his right foot were twitching a little bit. His eyes were not open. He was not breathing on his own, and he would not respond when she asked him to grip her hands or move his arms or hands. But the toes on his right foot were twitching… no, wait, they were moving purposefully. House was moving his toes deliberately.
Brenda went to his side.
"House, open your eyes if you hear me." No response.
"House." No response. Eyes still closed.
Brenda moved away from the bed, but House kept moving his toes.
When Anne, the night shift nurse, arrived in the ICU for report, Brenda relayed all of the pertinent information to her. Brenda noticed that House's right toes were moving incessantly. Brenda's heart leapt. She was talking to Anne, but staring at House's moving toes. It was almost like he was beckoning someone to come to him, but with no other response from him, it was difficult to determine if this was purposeful movement or if this was just some kind of reflex.
12 Midnight
A building must have fallen on me. Oops, a "structure". Can't breathe. Feels like a ton of bricks on me. Three GOOD limbs, and the only things I can move without agony are the toes on my BAD leg. Earthquake? Bomb? Plane crash into the building? Where am I? What fell on me?
Oh God, what… Eyes? Are they working?
House's eyelids fluttered open for a second before he clamped them tightly shut again.
He could see, but he had no idea where he was.
His nurse, Anne, was in the restroom.
Nobody saw him open his eyes.
Oh God, the light's too bright and everything HURTS SO MUCH…Can't hear anything… Am I dead? Shit…
2 AM Day 2
House hadn't opened his eyes again since midnight.
A slightly faster "Beep, beep, beep, beep" from House's monitor could be heard.
Anne did another neuro check.
"Dr. House?" No response.
With no response to verbal stimuli, the next test was to apply painful stimuli. There were several ways to do this. One was to rub the sternum. This was out of the question in the face of his obvious rib fractures and cardiac problems. The other was to apply pressure to the nail beds. Normally she'd do the nail bed pressure test with one of House's fingers, but his hands were burned too badly.
She knew from his history that he had chronic pain in his right leg, and didn't want to cause him pain unnecessarily. It was necessary to try to get him to respond, and his left leg and foot were also burned. She had no choice but to use a toe on his right foot. As she firmly pinched his right big toe, House's eyes shot open, but then clamped shut again. Oh God, she isn't going to stop until I do something but I don't know what she wants me to do – I can't hear her
It hurts too much to move anything else; can't she see that?
He responded appropriately to the painful stimulus by opening his eyes briefly and pulling his foot out of her hand. Anne knew House was aware to some extent, but a method of communication had to be worked out in order to determine how aware he was.
House had been moving the toes on his right foot off and on for several hours.
2:30 AM Day 2
Anne had a brief conference with the other night shift nurses and all of them walked in to House's cubicle. They had to work out some type of communication method.
"Dr. House? Move your right toes." No response.
"Dr. House, open your eyes." No response.
"Dr. House?" Anne said louder. No response.
Anne touched his right big toe gently. He stiffened in response but did not open his eyes.
"Maybe the light hurts his eyes. Turn the big overhead light off, but leave the nightlight on." The overhead light was turned off.
"Dr. House? Open your eyes." No response.
Anne touched his right big toe gently again. He stiffened in response and slowly opened his eyes.
Beads of perspiration appeared on his forehead as he squinted painfully and tried to get his bearings. Anne looked at his heart monitor and noticed the rhythm did not increase as it would normally do when waking someone with a healthy heart. The other nurses in the room noticed the same thing. They were expecting to see his heart rate increase during the neuro check and when he stiffened and opened his eyes.
It wasn't like House didn't already have enough problems.
Normally a patient with burns as bad as House's would be receiving quite a bit of pain medication, but they needed a better assessment of his pain and his level of orientation in order to determine how much pain medication he should receive.
Until they were able to elicit some type of response from him, it'd be next to impossible to assess his pain or his degree of orientation. An elevated heart rate, even in the absence of other responses, can be a good indicator of pain and agitation, but his heart rate didn't go up.
They're whispering lies about me! Head feels like it's full of cotton. Wait, no, it's my ears… oh God, I can't hear anything!
They're whispering and lying and I think they want me to do something. Can't talk... can't move… hurts too bad…got this thing in my throat…can't breathe…I'm screwed
House looked wildly around in the dimmed light. Although he had to squint, it didn't hurt so much to keep his eyes open now that the light had been dimmed. He saw Anne next to him looking down at him, and the other nurses at the foot of his bed. They all had that same Wilsonesque concerned frown on their faces.
He looked at all the IV meds he was getting, then he looked at his heart monitor.
Dopamine. Norepinephrine. Oh my God. Must be in a hospital. Where's Wilson!! Can't talk, can't breathe, can't hear, oh shit, get me out of here
He was quickly becoming overwhelmed and increasingly confused. His thought processes were becoming more and more scrambled as the moments went by.
He clamped his eyes shut again.
As much as Anne hated to do this while he was obviously starting to get agitated, she needed to finish the necessary task of establishing some kind of communication method with him.
"Dr. House, open your eyes." No response. Brenda had told Anne that House could be a total jerk, and Anne had heard that from some of the other nurses too. Anne had met House before in the course of taking care of his patients, but she was able to look past the jerkiness and see the man as a human being who, right now, needed to be able to communicate. Anne accurately assessed that, in addition to other possible neurologic problems, he was probably deaf.
Anne touched him gently and he slowly, painfully, opened his eyes. House squinted and looked at her expectantly, trying and failing to figure out what she wanted.
Anne simply pointed to his right foot. Something wrong with my foot?
House looked at her, completely and utterly confused.
Anne pointed to his right foot again and wiggled her hand, to try to show him she wanted him to move his right toes. I don't know what she wants me to do but she must want me to do something with my right foot. House stared at his right foot, wiggled his right toes and looked back up, questioningly, at Anne. I hope that's what she wants.
Anne smiled broadly and gave him two thumbs up. House looked at Anne with something akin to a blank stare. Ok, I have no clue who these people are. What… where…? Can't think straight
Anne said "Dr. House, we…" and House stared expectantly at her face. Can't hear you. Suddenly remembering that he probably couldn't hear, she changed her tactic.
She grabbed a small write on, wipe off board. Beads of sweat started up again on House's forehead. He was so confused! He had no idea what time, or even what day it was. He didn't even know where he was; let alone what this strange woman was going to want him to do next. She wrote "Nod your head if you can read this" on the board and waited for him to nod his head. He wouldn't move his head or neck. He had no memory of the electrocution or of all the times he had been defibrillated, but Anne knew that after everything that had happened to him, he had to be in pain. Anne could see that he was becoming more and more agitated, but she also needed to briefly assess how alert and oriented he was before the agitation got out of hand. One way to assess orientation is by asking the patient his name and where he is.
Anne wrote "Write your name."
She put the board under his right hand, and gently pressed a marker into his right hand.
No reply.
Anne took the board back and wrote "Write where you are."
She returned the board and the marker to him.
No reply.
Anne took the board and the marker back, and wrote "You're in ICU at PPTH.
You coded in your office."
If you say so, thought House.
He scrunched his eyes shut. He was becoming increasingly more confused, disoriented and upset as the minutes passed. He couldn't process any more information.
Anne needed him to pay attention just for the next few moments. She thought he might be able to write. She gently tapped him again. His eyes shot open with anger and marked agitation.
Stop it, gotta get out of here… don't touch me… can't move, hurts too bad… gotta get out… suffocating… can't breathe…
House started thrashing his arms wildly. The more he moved, the more everything hurt, which only escalated his agitation. He had no idea why everything hurt so badly.
He just knew he had to get out of there. He bit down on the breathing tube in his mouth. His teeth were clenched on the breathing tube and he wasn't getting any air.
His heart rate and blood pressure hadn't gone up even with all this agitation.
His oxygen saturation had crashed, though, because he wasn't getting any air.
Its alarm was blaring out loud. House was oblivious to the noise.
He wanted to scream "Help me! I'm suffocating! Get me out of here!". All he could do was violently but aimlessly flail his arms in the bed.
Anne realized she'd better forget the neuro exam for now. She immediately pulled out the syringe of morphine that she'd prepared.
Five seconds after she gave him the morphine bolus dose, he relaxed enough to open his mouth. Air rushed back in through the now-open breathing tube. Quiet began to descend upon the room again and House's entire body relaxed.
However, one more question still needed an answer while he was still awake enough to be able to write. She wrote "I just gave you pain medicine. Are you in pain?" on the board. She made sure his eyes were open and that he saw what she wrote. She put the board in his lap, put a marker in his right hand, and gently held his still weakly fidgeting right arm to the board so that he could write. Although he was feeling a little better, he still wanted to scream YES!!!!!!!
She wasn't surprised at the answer.
"YES" he weakly scribbled in big, wavering letters.
Anne started the continuous morphine IV drip.
"Ok, Dr. House. You're on a morphine drip now. From here on out, if your eyes are closed, we'll gently touch your right big toe if we need to get your attention. We'll keep the marker and the board on the bed where you can reach them." she wrote on his board. He looked at her with understanding.
A few minutes later, he was mercifully sound asleep.
4 AM Day 2
Cuddy and Kutner were sound asleep in the waiting room-turned-mobile diagnostics lab.
Anne came out to update Cuddy, but upon seeing that she was asleep, Anne decided not to wake her up.
House's external pacemaker was still attached to him, but his heart rhythm remained stable enough throughout the night that the pacemaker could remain turned off. With the morphine on board, House actually slept. For the benefit of anyone else entering his cubicle from now on, Anne made three identical signs to give anyone entering his room a necessary "heads up".
She taped one of the signs on the outside of the sliding glass door to his cubicle, one to the wall above his bed, and the last to the foot of his bed.
"Patient can't hear. If his eyes are closed, please try to let him sleep. If you still need to come in, touch his right big toe gently to wake him and give him a minute to open his eyes. Leave the overhead lights off when you don't absolutely need them. Use the little white board on his bedside table to communicate with him. He can write. If you transport him anywhere else in the hospital, take that white board too."
Dr. Miller had spent parts of the last 11 hours sucking down coffee and diving into House's old medical records. Although he'd made good headway, he still wasn't finished. He knew they had a myriad of problems to address. The fact that House was responsive was a very good sign. The apparent hearing loss was a little worrisome, but not life threatening. It could be explained by the fact that he'd had his IPod in his hand and its ear buds were in his ears when he electrocuted himself. Miller wasn't sure, but he guessed that House's deafness was due to the loud noise the IPod probably made when it got zapped. If that was the case, his hearing loss would probably resolve on its own to at least some extent. The extreme agitation, confusion and disorientation weren't surprising either, but House would be kept as comfortable as possible with the morphine. They could also add some other meds to relieve agitation if the morphine alone didn't. Miller would deal with those issues down the road if they didn't resolve on their own. The most urgent problems at this moment were his heart rate and blood pressure. House's cardiovascular symptoms were not really adding up. One plus one doesn't equal eleven. Why the hell is he maxed out on TWO vasopressors but his heart rate and blood pressures are not reacting well to either of them? We subtracted the pacemaker, but had to increase the dose of another pressor. We should be subtracting, not adding…
