House woke suddenly, startled out of his sleep by a noise that his mind – was it a clank or a thud? Eyes snapped open and ears listened intently but nothing followed but silence. The room was dark, and a quick check of his illuminated watch showed the time to be just after three in the morning. It was the second time he'd been awakened; the power had come back on just after midnight and the noises of returning electricity had been his first unexpected wakeup call.
He listened intently, trying to decide if whatever had awakened him was worth getting up for, even as his body begged him to stay in bed. Well, if nothing else, he should check on Wilson. House had offered him the bedroom, but Wilson said it was easier on his ribs to lie propped up on the sofa. And, as he correctly pointed out, he had experience sleeping on the couch.
The first thing House noticed on opening the bedroom door was the light across the hall. Had he left it on or had Wilson gone to the bathroom on his own? House was talking even before he'd reached the bathroom door. "What the hell are you doing walking alone? Thought I told you—" Shit! Fuck! Merde! Depp! Swear words in multiple languages flooded his brain the instant he saw Wilson was lying on the floor, half twisted around the commode. All pretense of sounding casual vanished the instant his eyes fixed on Wilson's still form. Not again! His friend's breathing was shallow and far too rapid.
"Wilson! What the fuck did you do?"
Wilson held his chest, eyes wide with fear. "Can't breathe," he gasped.
No shit.
"Got that." Even years of medical training couldn't quite keep the panic out of his voice. "Need doctor stuff. Hang tight." Right, easy for him to say. The swear words kept coming as House hurried back to the main room and grabbed the medical bag. What Wilson needed was a hospital, trauma team, x-rays and probably a chest tube. There was only so much he could do here. Shit!
There was no room to work in the small bathroom. Moving Wilson was dangerous. But Wilson not being able to breathe was worse; he'd have to risk it. Leg screaming in protest, he reached under Wilson's arms and pulled him into the hallway.
He gently tapped Wilson on the cheek. "Still with me?" Wilson's eyes fluttered in response.
Lowering himself to the ground, House upended the medical bag and rifled through the contents nearly shouting with relief when his eyes focused on the thoracostomy kit. Thank God, the devil, or all the tea in China. He had absolutely no idea why Wilson brought the kit one other than out of some weird sense of overpreparedness, but doing so might very well save his life. House braced Wilson's torso against his knee, pressing a stethoscope against his back. Left side breath sounds were good. He moved the instrument and listened carefully to the right lung. Nothing. Could be a tension pneumo. Shit. Either a broken rib, trauma from this latest fall, or some combination had probably caused air to become trapped in his chest. Wilson could barely breathe.
House flipped open his cell phone, cradling it in the crook of his shoulder, freeing up his hands. He had no idea if the roads had improved enough for an ambulance to reach the cabin, but staying here was a death sentence for Wilson.
"9-1-1," the voice answered almost immediately, "what's your emergency?"
"I have a 40-year-old male who fell in a bathroom. Tachycardic and tachypnoeaic—" House stopped himself. Use plain English; the idiot answering these calls wasn't a doctor. "My friend fell in the bathroom," he continued more slowly. "He's having chest pain and trouble breathing. Absent breath sounds on the right. I'm going to do a needle decompression."
"Uh, sir, I can't recommend—"
"I'm a doctor, dammit, I know what I'm doing." All semblence of patience was abandoned. "Just get the EMTs here. He's going to need a chest tube." Using the surgical scissors, he sliced through Wilson's sweatshirt, exposing his chest.
The voice on the phone was still talking. "Sir, what's your name?"
"House. Dr. Gregory House."
"And your address?"
Shit. How was he supposed to know? "Wilson! What's the address of this place?"
Wilson struggled to answer, but either pain and fright or both kept the words from coming out.
"Fuck."
"Sir?" the 911 operator asked hesitantly.
"I don't know."
"It's alright, sir. We'll get the location from your cell phone. We're dispatching someone now. I need you to stay on the line with me."
"No can do. Lives to save." House tossed the phone aside, leaving it on in case they still needed it for location and turned his attention back to Wilson.
"I think you have a tension pneumo. Help's coming but, in the meantime, I've got to relieve the pressure. Got it?"
Wilson nodded but House saw fear in his eyes. Whether it was fear of what was to come or the fear of being unable to breathe, House didn't know. In the background, the 911 operator was trying to get his attention. He ignored her and instead dumped betadine over the right side of Wilson's chest, unable to avoid noticing how quickly it rose and fell. Next, he ripped open the plastic package containing the 14-gauge hypodermic, again thanking Wilson's blasted preparedness for the fact that he at least had the right supplies.
His brain struggled to pull up the pages of long-forgotten trauma textbooks as his fingers palpated Wilson's skin, searching for the anatomical landmarks. "This is gonna hurt like hell. Hold still so I don't stick the damn needlecath through your heart." The words were harsh, but House kept his tone gentle. And they both knew the threat of a heart puncture wasn't real. "You with me?" he added softly.
Wilson squinted and gave the briefest nod.
House protectively squeezed Wilson's shoulder then returned full focus to the task at hand. "Here goes." Second intercostal space, House reminded himself, as he slid the needlecath into Wilson's chest, superior to the third rib at the midclavicular line. Wilson gasped, then emitted a slight wail, but somehow managed not to move. House continued to advance the needle until he felt the pressure equalizing and the hiss of escaping air confirmed his diagnosis. Definitely a tension pneumo. House removed the stylet, and installed a flutter valve, leaving the plastic catheter in place and securing it to the chest with tape.
Almost immediately, Wilson's breathing began to ease a bit and the panic disappeared from his features.
House let out a long, slow breath. "Better?" he asked after a moment.
Wilson grunted something between "yeah" and "thanks." However, the gratitude in his now-opened eyes that told House he'd done the right thing. House again listened to Wilson's chest. "You know, you're making me do real doctor work here, Wilson." He kept up a steady commentary as he worked. Breath sounds. Not great, but there, which was a definite improvement. "You owe me big time. This is ten times worse than Clinic duty."
House took advantage of the momentary lull to reassess Wilson's vitals and check for new injuries. "What were you thinking?" he asked as hands gently probed Wilson's head, then worked their way down. "Trying to break that thick skull of yours? First rule of Cripples 101 – call for help when you need it."
He left the injured wrist and knee alone – manipulating them would only hurt and it didn't much matter at this point whether Wilson had done more damage. A light press on Wilson's abdomen produced a thick grunt. It was hard to tell whether the pain was just muscle soreness from the impact or whether Wilson had sustained internal injuries. They'd just have to wait until they reached the ER and could do an ultrasound.
"Well, the rest of you seems intact," he confirmed, hoping to reassure Wilson, whose eyes had followed his every move. Breathing was better but still not great. He still needed a chest tube. Where were those blasted EMTs?
After a moment, House lightly placed a hand on Wilson's chest, ostensibly to check the placement of the catheter. The warmth of his skin and the steady intake of breath reassured him and, at the same time, seemed to relax Wilson, who gave the slightest hint of a smile before again closing his eyes.
House wasn't sure how long they stayed that way when a loud commotion signaled the arrival of the EMTs. "Back here," he called, somewhat unnecessarily, given that they could see him from the doorway.
The next few minutes were a blur as House turned over responsibility for Wilson's care to a man and a woman who probably had barely graduated high school. Trained eyes followed their every move as they assessed Wilson's vitals and checked the catheter he'd placed.
"What's his name?" the female EMT asked.
"Wilson. Dr. James Wilson."
"MD?"
"Yeah."
"What happened?" she asked.
House briefly related the day's events, watching as the male EMT put Wilson on oxygen then started an IV with normal saline. Had it really been less than a day since Wilson's initial tumble on the stairs?
They put on a neck brace. House almost told them not to bother but figured that it couldn't hurt and they'd find out soon enough that there weren't any spinal cord injuries.
"Dr. Wilson?" the EMT touched Wilson's shoulder and spoke loudly into his ear. "Do you know where you are?"
"Cabin," Wilson managed to get out.
"Do you know what day it is?"
"Sunday?"
"Are you in pain?"
"Not bad."
As Wilson was bundled up for transport, House had to admit that they'd done a decent job – better than he'd expected in the middle of nowhere.
"Doc," the male EMT said, plunging supplies into his bags, "good thing you were here. That needle aspiration probably saved his life."
House gazed down at Wilson, unsure how to respond. He saved lives every day, but not like this. Not like this for a long, long time.
The EMTs were ready to go which meant he needed to stand up. Propped uncomfortably on the ground so long and supporting Wilson's weight for much of that time had cramped his already aching muscles.
"Want to ride with us?" the male EMT asked, mistaking his discomfort for indecision, "or follow in your car?"
I'd like to stand up, House thought to himself. "Go with." As if he'd leave them alone with Wilson. He pointed from his leg to his cane, which had been pushed out of his reach in the frenzy. "Bum leg. Need a hand." The EMT was stronger than he looked because, in an instant, he'd hauled House to his feet, handed him the cane, and turned his attention back to Wilson.
"On three," he said, and Wilson was lifted from the floor. House followed them out, ignoring the mess, the smoldering fire, the lights, or locking up. He was thinking only of two things – keeping up with the EMTs and not falling flat on his ass while doing so.
