A/N: Hey folks... With all those nice reviews I thought I'd update early for once... :) I'd like to apologize beforehand for all the medical stuff discussed in the following chapter. I hope it's not too much... And one other thing that's been on my mind: I'd like to thank Dr.Fantabulous for all the nice comments and for reviewing practically each new chapter! It's a pity I can never reply to you personally, because you don't leave an email-address... :)

So... Enough said - here's chapter 7:

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When Wilson and Dr Shaminsky arrived at the ER, Cuddy and House's team were already waiting. The oncologist seemed pale and somewhat shaky, his gaze shifting nervously from Chase to Cuddy and back again. "What the hell happened?!"

The intensivist met his gaze, also visibly shaken, but clearly trying to cover it up.

"He didn't open the door, so I used the key you gave me. I found him on his bed, unconscious. I couldn't rouse him. He was basically unresponsive to pain stimuli... – So, I called you and the ambulance, and brought him in…"

Cuddy nodded at him, indicating she would continue updating the oncologist. Her tone was soothing. "He has a good chance to make it. – His heartbeat was irregular, and his O2 sats were in the lower eighties when he came in, but I think we caught it early enough. I already ordered the emergency team to put him on naloxone to counteract the opiates and on N-acetylcysteine for the acteminophen poisening."

Wilson's expression instantly reflected his shock at her statement. "What… - This is not a vicodin overdose…!", he stated emphatically, staring at her as if she had lost her mind.

Cuddy patiently returned his almost panicked gaze. "Dr Wilson. – He's in a coma; he's in respiratory distress. And he is on long-term narcotic treatment! This is an overdose, if I ever saw one…"

The oncologist seemed to get even more agitated, shaking his head and eyeing her imploringly. "He didn't OD on the vicodin! This… is a mistake! We have to run some tests first. Find out what's really going on…!"

She placed a gentle hand on his arm, sighing. "James. I'm sorry. I know this must be very disappointing for you. - But we all know the risks of dealing with narcotics on a daily basis. - House is deeply unconscious and he presents with acute signs of respiratory depression! This – " She was talking very slowly now, as if explaining something to a small child. " – is an opiate overdose."

Wilson nervously went with a hand through his hair, still shaking his head slightly. "You… don't know that! – Just because he's been on a class III narcotic and lost consciousness, doesn't mean that this is an OD! – He's been sick for days! It might just as well be something else. You might be causing more harm with the medication you've put him on…!"

Cuddy's gaze hardened at that. "If he ODed, and we don't do anything to counteract the poisening, he might die. And his liver is definitely done for, without the NAC to protect it from the I-don't-even-wanna-know-how-many grams of paracetamol coursing through his blood stream right now! – The risk we are taking with the medication, in case this was not a vicodin overdose, is slim in comparison to the risk we'd be taking if we didn't do anything! – I'm fairly sure this was a garden-variety opiate overdose. It's simply the most probable explanation! And we cannot risk not giving him the meds on the off-chance that it was something else…"

Wilson was still staring at her. "This is not a vicodin overdose, Cuddy. – He, he… wouldn't have done that!" He gestured in the direction of the ER to emphasize his point. "He wasn't doing well the last couple of days. I'm sure his… illness… is also connected with the coma. – You have to stop the medicine you ordered. He didn't OD."

She returned his gaze steadily. "Are you willing to bet his life on that…?" Then, in a low hiss: "This wouldn't have been the first time! You know that!" She eyed him pensively for a moment, then stated grimacing slightly: "You don't want this to be an OD, because you want to believe that your trust in him wasn't misplaced!"

Wilson's eyes narrowed at that. "No… You want it to be an OD, because then you could tell yourself that your insane actions a couple of months ago were actually justified!"

For just a moment, the entire waiting area was dominated by stunned silence.

Then Chase turned towards Cuddy as well, obviously intent on getting back on the subject. "While you're right that it could be a narcotic overdose, I also think that it might be something else." He looked somewhat nervous contradicting the dean of medicine. "I mean… He is comatose and he isn't breathing well. – But his BP isn't particularly low, and if anything he's tachycardic, not bradycardic. And his pupils are dilated, which you wouldn't really expect after an opiate OD. – And if it is something else, Dr Wilson's right; we don't know what the NAC might be doing to him."

Cuddy was eyeing him patiently, replying in a calm but insistent voice. "Dr Chase. Would you like to be the one to tell House that he needs a new liver, when he wakes up to find that we didn't treat him for acetaminophen poisening? Even though a vicodin overdose was the most probable diagnostic option we had?"

Before the younger medic had the chance to reply anything, the head of the ER team suddenly exited the treatment room, directly approaching the dean of medicine.

"He's getting worse. – He just had a pretty bad seizure, and his temp's suddenly spiking." Cuddy paled slightly at the news.

Dr Shaminsky now spoke for the first time, clearly addressing the ER doc. "How high?"

The young medic met his questioning gaze. "105."

Wilson turned towards the pain specialist at that, frowning slightly. "What are you thinking?"

Shaminsky shook his head slightly. "About a month ago, Dr House informed me that he wanted to try and reduce the dosage of the SSRI. – I told him I wouldn't recommend changing anything in a well-working pain management regimen, unless there were side-effects or other complications. I asked him if he was experiencing any lasting side-effects from the paroxetine. – He said nothing serious, except for some restlessness. He wanted to try and reduce it a bit." All eyes were resting on the pain specialist by now. "He called me again a couple of days after that to tell me he'd re-adjusted the dosage due to significantly increased pain-levels after the reduction. I okayed it."

Chase's face suddenly lit up in understanding, before his expression almost immediately turned incredulous. "You're thinking serotonin syndrome?! You think he might have started to develop one, recognized the symptoms and therefore tried to reduce the SSRI?" He shook his head. "If he'd thought he was developing a serotonin syndrome, he wouldn't have increased the dosage again, even if his pain had started to get worse. That would have been suicidal! He wouldn't have risked it… - And it would be extremely untypical to develop a serotonin syndrome months after starting him on the SSRI…"

Shaminsky returned his gaze, a serious expression on his face. "While serotonin syndrome usually has a very acute onset, it might also have shown a delayed appearance, if something in his metabolism had changed in the meantime. All the more, since the SSRI is not the only component possibly causing it. Opiates have also been shown to be able to evoke a serotonin syndrome, particularly when administered in combination with an SSRI. Maybe he has been processing the paroxetine or the vicodin more slowly lately. Or maybe the serotonin-imbalance in his brain, associated with the depression he has certainly been suffering from, has regulated itself by now, causing the SSRI to lead to an excess of the neurotransmitter. – Could be a lot of things." He shrugged. "Serotonin syndrome would account for all the symptoms Dr Wilson told me about on the way here. The nausea, the sweating, the dizzyness and coordination problems… The tachycardia, the fever… And now the coma. Even the respiratory insufficiency…"

Foreman nodded pensively. "Would also explain why the NAC made him worse. As an NMDA receptor antagonist, it attenuates glutamatergic neurotransmission, which would in turn stimulate serotonin receptor mediated transmission. – With the NAC we indirectly boosted the serotonin concentration in his cerebral cortex enormously. And this on top of a possible serotonin syndrome that has already led to a coma… - He's lucky if he comes out of this with complete neuronal function."

When Cuddy didn't respond anything immediately, Cameron quietly concluded: "So… We should basically stop all the medicine he's been taking lately, including what we gave him here, and start him on methysergid or cyproheptadin to counteract the serotonin syndrome. If we were right, he should come out of the coma in the next 6 to 12 hours."

Cuddy crossed her arms in front of her chest defensively. "But if it was an overdose after all, we lose his liver."

It was Foreman who responded with a half-snort. "And if it's not, and you continue the NAC, we fry his brain."

Chase nodded. "And he's been getting worse with the OD treatment. So… Obviously that's not it. We need to stop the NAC immediately, start him on cyproheptadin, get him on plenty of fluids to secure his kidney function, and try to bring his temperature down."

Cuddy shook her head slightly, clearly unsure about how to proceed. "He'll kill us, if he loses an organ because all of you were too naïve to consider a coma in an opiate addict might be related to an overdose!"

Chase met her gaze steadily, countering immediately: "He'll kill us, if he loses brain function because we concluded it had to be."

The dean of medicine just stared at the younger medic for long moments, before finally facing the ER doc again, her expression conveying her unhappiness with what she was about to say.

"Stop the NAC; start him on cyproheptadin. - And pray that you're all right about this."