Disclaimer: House and all respective characters do not belong to me. I am only borrowing them for personal enjoyment.
Also I am not a doctor so I have decided to borrow cases used earlier in the show for medical accuracy. My creativity comes in with building and developing character relationships as well as introducing original characters. Criticism and reviews are most welcome. Hope you enjoy
A short while later Trzaska enters Jason's room.
"Dr. Trzaska," Jason says and then coughs.
"Still have the cough," Trzaska asks.
Jason nods, "I'm feeling a lot better, though."
"His fever's gone, and his rash is going away," Mrs. Jankowsky says.
"I see," Trzaska replies and pulls some things out of a nearby cart.
"Is everything okay," Vanessa asks.
"Just ordering some tests," Trzaska replies smiling. "Absolutely nothing to worry about." Trzaska draws some blood and leaves Jason's room. He drops the blood off and orders his tests and leaves instructions for someone to find him in the clinic when the results come back.
After turning in the records of the third patient he's seen, a nurse hands Trzaska the lab results. Trzaska smiles and heads upstairs to the diagnostics office. He finds Foreman still working on paperwork but the stack he has been working on is much smaller.
"I ran a TSH, T3 and T4," Trzaska says. "Patient's negative for hypothyroidism
Foreman looks at the results for a minute. "Well the fact that he's getting better would indicate the unreliability of the tests."
"If I'm right and it's a viral infection, one of two things always happens: patient dies or the patient's immune system fights off the invader," Trzaska responds. "He's getting better. That doesn't prove you're right, it just proves he's getting better. "If I'm right, the antibiotics you prescribed could block his kidneys and liver, impeding his ability to fight off the virus. Could kill him."
"Fifty bucks," Foreman asks.
"You wanna bet on the patient's health," Trzaska asks.
"You think that's bad luck," Foreman asks. "Do you think that God will smite him because of our insensitivity? 'Cause if he does you make a quick fifty." Foreman pauses and then leans forward. "Tell you what, go check his white blood count. If he's fighting off a virus like you think it'll be way up."
Trzaska nods and leaves the office. He goes back down to the clinic and picks up the phone at the nurses' station. He orders a CBC with the leftover blood from what he had drawn. Then grabs a file and calls a patient into an exam room.
Meanwhile Thirteen, Chase, and Taub are in the elevator heading back up to the ddx office. "Guess Foreman's right after all," Chase says.
"That's all you have to say," Taub asks irritated. "How about a new idea for what's really wrong with this kid?"
"What are you afraid of," Chase asks.
"Really," Taub asks. "How about the way things went the last time Foreman was in charge? House liked screwing with people but Foreman gets off on the power."
"Since you're not dating him you should be fine," Thirteen says.
"They are living together," Chase says raising an eyebrow."
Meanwhile back in the clinic.
"How much longer," the patient asks. This time it's a young female. She's petite with blonde hair and blue eyes.
Trzaska is playing a game on his phone again. "2:30," Trzaska says looking at the clock on the wall. "I figure she was on the 8th hole when I paged her…" he grimaces as his guy dies, and hands her the phone. "Probably got another half hour. She starts to play as Wilson opens the door.
"Cuddy said you need a consult," Wilson says. "What's up? I'm busy."
"Her leg hurts after running six miles," Trzaska says. "What could it be!"
Wilson just looks irritated at Trzaska.
Several minutes later, Trzaska walks into the ddx office with a printout. Chase is on the computer while Taub and Thirteen are reading medical texts that are scattered on the table.
"Hey," Trzaska says to everyone.
Foreman walks in from his adjoining office, "White cell count isn't up, is it?"
"No, we were both wrong," Trzaska says tossing the paper to Thirteen and Taub. "White cell count is down, way down, and dropping. His immune system is shot. We need to get him into a clean room." Everyone looks at each other nervously.
Soon after, Chase and Jason are prepping to go into the clean room. Jason is sitting in a wheelchair and Chase is next to him.
"Can you walk Jason," Chase asks.
"Yeah, a little," Jason responds.
"All right, okay," Chase says. "'Cause we'll need to leave the chair outside." He turns to the nurse helping him. "Thank you…where's April? April!" April comes in. "Can you take the chair, please?" April leaves with the wheelchair and Chase turns to Jason. "I'll need to take your mask and your robe, too." Jason undresses and is now just wearing his boxers. "You might want to block your ears for this, it's quite loud." They're blasted with air. When that's done Chase starts getting Jason settled into the bed in the clean room.
Thirteen, Taub, the Jankowskys, and Vanessa are watching.
"Something's made his immune system compromised," Taub says.
"His white blood cell count is down, which means his body can't fight off infections," Thirteen states. "If he gets sick, he'll die."
"Sick. How sick," Mrs. Jankowsky asks.
"If he gets a cold, he'll die," Taub says.
Later, Chase is prepping Jason for a marrow sample. Jason is coughing.
"Okay, I'm going to push the needle into your hipbone, and take some of the marrow," Chase says and inserts a needle.
"That's not so bad," Jason says.
"Hah, that was just the anesthetic," Chase says. "The core biopsy needle, it's a little bit bigger. Okay man, take a deep breath, this is…this is gonna hurt. A lot." Jason grabs the bed and grimaces in pain. "Marrow makes the blood cells. You take a peek of it under a microscope, and maybe we find a viral infection. Maybe we find some fibrosis. Something to explain why your blood count is so low." He fills the syringe with marrow. "There we go. One step closer to an answer."
"What if you don't find one," Jason asks. "I can't stay here forever."
Meanwhile Trzaska is with Cuddy in her office.
"The patient could have died," Trzaska argues.
"The one with the pulled muscle," Cuddy questions.
"Well, those symptoms are consistent with a dozen other conditions," Trzaska reasons. "I, you know, I, I'm entitled to a consult!"
"You are not getting out of clinic duty," Cuddy says.
"Oh, come on," Trzaska whines. "You've got a hundred other idiot doctors in this building who go warm and fuzzy every time they pull a toy car out of a nose, you don't need me here."
"No, I don't, but believe it or not, working with people actually makes you a better doctor," Cuddy replies.
"When did I sign up for that course," Trzaska asks.
"When did I give you the impression that I care," Cuddy asks. She pauses waiting for his answer.
"Working in this clinic obviously instills a deep sense of compassion," Trzaska says sarcastically and starts to limp out. "I've got your home number, right? In case anything comes up at 3 o'clock in the morning."
It's not going to work," Cuddy says getting up from her desk and walking towards Trzaska. "You wanna know why? Because this is fun. You think of something to make me miserable, I think of something to make you miserable: it's a game! And I'm going to win, because I got a head start. You are already miserable. And by the way, now is really not the best time to be acting just like House. I think you know my current attitude towards House behavior." Cuddy leaves her office, and runs into Chase.
"Sorry," Chase says. Cuddy walks past him and Chase turns to Trzaska who is now also leaving Cuddy's office. Chase walks with him. "What's with her," Chase asks.
"She doesn't approve of my attempts to get out of clinic duty," Trzaska answers honestly while approaching the pharmacist. "Thirty-six vicodin," he says to the pharmacist.
"Who's the patient," the pharmacist asks.
"I am," Trzaska answers.
"You can't…" the pharmacist starts to protest.
"Dr. Chase is the prescribing physician," Trzaska says.
"Yeah," Chase says while nodding to the pharmacist. He looks back at Trzaska, "You try kissing a little ass?"
"I can't kiss Lisa's ass," Trzaska answers. "It's like kissing up to your mother or your sister. It just leaves a bad taste in your mouth." He grabs a bottle from the counter and turns to leave.
Chase's eyes go big. "Adam! Wrong bottle." He gives Trzaska the right bottle.
"Thanks," Trzaska says, putting the pills in his pocket and starting to walk away when suddenly he stops on the spot. "What was the kid's first symptom? Of his 800 symptoms, which one hit him first?"
"Ah, the cough," Chase says.
Trzaska leaves Chase confused, limps to the elevator and goes into the ddx office upstairs. Taub and Thirteen don't pay him any attention. Trzaska grabs two medical books from the bookshelf and carries them over to the computer. He stares at the white board and flips through the books as well as searching online.
A few hours later everyone is getting ready to go home when Trzaska gets up from the computer.
"Gout," Trzaska says as Foreman walks in with his briefcase. Chase, Taub, Thirteen, and Foreman look back and forth at each other.
"Um, are we talking about Jason," Chase asks.
"Gout? Uric acid crystals in the joints," Foreman asks. "The symptoms are pain, swelling, redness, stiffness…not one of which do I see on that board."
"Because he doesn't have gout," Trzaska says smiling. "Every day, cells die. We survive because the remaining cells divide and replace the losses. The colchicine, a gout medicine, blocks mitosis and stops cell division, which will result in abdominal pain, rash, nausea, fever, kidney failure, low blood pressure, and will also mess with the bone marrow." Trzaska crosses each of the symptoms off the white board as he lists them.
"But he doesn't have gout," Taub says. "Why would he have gout medication?"
"Because y'all were right," Trzaska says. "He didn't have two conditions at the exact same time. First, he got a cough. Now, because he's an idiot, he went to a doctor. In order to feel justified charging two hundred dollars, the doctor felt he should actually do something. He wrote a prescription. Seven thousand people die each year from pharmacy screw-ups. Not nearly as many as die from doctor screw-ups, but still, not something they use in their promotional material. The pharmacist gave him gout medicine instead of cough medicine. And the only thing it wouldn't do: it would do absolutely nothing to relieve his cough. Occam's Razor. The simplest explanation is almost always somebody screwed up."
"But once he checked into this hospital he was completely in our control," Thirteen interjects. "Our food, our pills, our everything. So even if you're right, no gout medication. He'd either continue to deteriorate or he would have gotten better. But he got better, and then he got worse. It doesn't fit. It doesn't make sense."
"Okay then, two people screwed up," Trzaska says. "Not as simple as one, but…come on." Trzaska walks out of the office and the others follow.
A few minutes later Trzaska and the rest of the team approach the Jankowskys and Vanessa sitting in a waiting room.
"He's resting; he…" Vanessa's voice trails off as she notices everyone walking toward them.
"I'm Dr. Trzaska," he says introducing himself to the Jankowskys. "Who gave Jason his cough medicine?
"Huh," Mrs. Jankowsky asks.
"There's a reason there's a nice, simple division of responsibilities in a hospital. You hold his hand, we get him better. If we start tucking him in at night, well, that's not fair to y'all, and if you start prescribing medicine, that's not fair to us. So what I want to know is: who stepped on our side of the line? Who cared enough to get stupid enough to give him his cough medicine?"
"When we checked in Dr. Foreman said…" Vanessa starts.
"Tuesday, he's getting better," Trzaska interrupts. "Wednesday, he's getting sick again. Somebody gave him his cough medicine Wednesday." He pauses waiting for someone to answer him. "Come on, nobody's gonna be mad. I just want to know who tried to kill the kid."
"Dr. Trzaska," Foreman's tone is reprimanding.
"His throat was sore," Mrs. Jankowsky bursts out.
The doctors' jaws drop except for Trzaska who smiles and looks back at Foreman. "Page Dr. Occam. He's gonna want to hear about this."
"I'm sorry," Mrs. Jankowsky shouts. "He was coughing, and I just wanted to help him…"
"Where are the pills," Trzaska interrupts.
"He took the last of them before he was switched into that room," Mrs. Jankowsky says.
"They're all gone," Thirteen asks.
"It was just cough medicine," Mrs. Jankowsky says.
"No, it wasn't," Trzaska states. "Where's the bottle?"