Title: Of a Thursday
Author: Sy Dedalus
Rating: T, TV-14, PG-13
Pairing: House/Stacy (only cause it's canon), House/Wilson strong friendship
Spoilers: Season One.
Warnings: WIP
Summary: House meets blood clot, or a fill-in for the infarction.
Disclaimer: Not mine. The bits of dialogue that you recognize from the episode are not mine either, i.e. please don't sue my dirt poor ass.
A/N: Been waiting to get to this chapter for a long time. Hope you like it!
Chapter Nine: Rhabdomyolysis
He'd been dreaming again, his mind replaying the death of a patient ten years ago that had hit him hard and still bothered him when his defenses were down at night and it could creep back in, when he snapped awake suddenly.
He had it. He knew what it was. All of his symptoms were related. They had to be.
It started with leg pain. The pain got better but his muscle got weaker. Ischemia—something was cutting off the blood flow to his right thigh muscles. Untreated ischemia led to necrosis and necrotic cells dumped all kinds of crap into his system and his kidneys couldn't take it. Myoglobin. Nephritic toxicity. Poisoning his kidneys, couldn't get the stuff out of him, and that's what was making him tired and fuzzy. Couldn't think, sleeping all the time, bloody urine without the accompanying edema or abdominal pain, weak muscle in his thigh, it all fit. Everything but the fever and the fever had been gone for two days. Myoglobinuria—myoglobin in his urine. Tea-colored, yes, it was tea-colored, not rust-colored. He should've noticed it before. That was it. And rhabdomyolysis—skeletal muscle being destroyed and leaking all kinds of crap into his system leading to ARF, acute renal failure. That was it. That was it. The elevated CK level should've tipped him off immediately—that idiot quack from the E.R. too—but he'd missed it. And now it had been going on for four days and if he was this sick and his CK had been elevated three days ago—oh shit, he was fucked.
He needed to—had to call—someone—had to—but he was so tired. He couldn't move, he was so tired, so weak. Acute renal failure, probably affecting his blood pressure now. Just so tired. He had no idea where the phone was.
Myoglobinuria. Rhabdomyolysis. ARF. He tried to fix those words in his mind so he wouldn't lose them.
Where was the phone?
It was dark—he couldn't see—not blindness? surely not? No, no, just nighttime. Dark outside, dark inside. Bed. He'd been asleep. He heard breathing. Who?
Myoglobinuria. Rhabdomyolysis. ARF. Don't forget don't forget don't forget.
Where was the phone?
Dark. Why dark?
What did he want with the phone? Where was it? Why was it important?
He couldn't see anything. Why? Couldn't seem to breathe fast enough. Couldn't get enough air.
Someone was there next to him. Who? Ryan? No, he didn't let Ryan sleep in his bed. They slept outside in the tree house. He didn't like Ryan and wished he would go home. Ryan pushed him and told him his mother made him come over, that he hadn't wanted to, and he didn't like this smelly old tree house and he didn't want to play with baseball cards and it was weird knowing everyone's batting average and RBIs and on-base percentages, normal kids didn't know that stuff, normal kids played baseball not talked about it all the time, and he didn't throw the ball right and he couldn't run like The Mick with that special limp from when he hurt his knee or hit lefty any good and this tree house was crummy. He'd never let Ryan sleep in his bed, not if he had a thousand million nightmares and monsters were chasing him across the desert and his feet were burning off.
He couldn't breathe enough. Something about the phone?
Myo something. Myalgia? No. His muscles didn't hurt. Not really. But they had. That meant something, right? What did it mean?
Why couldn't he breathe enough?
ARF. Arf? Alf? No. RAF? Royal Air Force? No. Arf arf arf, the sound a dog makes? No. AperiodRperiodFperiod. A.R.F. Maybe it didn't mean anything.
Someone was next to him. Who? Someone.
He felt himself falling asleep again. There was something…some reason he wasn't supposed to…something he was supposed to remember…but he couldn't think of it and he was so tired…
He wasn't sure if he was awake or not, but it had come back to him. Acute renal failure because of Myoglobinuria because of Rhabdomyolysis. He repeated the words over and over to himself, trying to discern if he was awake.
After a while, he recalled who he was in bed with and figured out how to use his arms again. He nudged her and started muttering her name over and over again, trying to increase the volume, but he wasn't sure if she was even there or if he was actually speaking.
"Stacy, Stacy, Stacy, wake up, wake up, wake up."
He registered her moving and saying something, then her hands on him. He repeated the words over and over again: Rhabdomyolysis. ARF. Myoglobinuria.
"Greg?" she said, awake immediately, reaching to turn a lamp on. "What is it? What's—"
"I need you to write something down," he said tiredly, eyes closing reflexively against the light.
She wasn't sure he was even awake, the way he was talking in a half-mutter. He might've been dreaming.
"Now," he added and unglued his eyes, fixing an wild, frantic look on her.
"Tell me, I'll remember it," she said. This wasn't good. She was calling 911 the second he let her go. "What's wrong?"
"No, write it," he insisted, trying hard to focus on her.
"Greg, what is it—"
"Don't talk!" he half-yelled, too tired to get a real yell out. "Please—" he added imploringly, "just write it down. Hurry."
"I'm calling 911," she said and had her feet on the floor before he could stop her.
"No!" he said as forcefully as he could. "Please—just do this," he turned his head toward her, blinking and trying to get her visage to stop swirling in front of him. "Now, before I forget. Hurry!"
She fumbled around in a drawer and came up with a pen and the back of a law journal.
"Okay, I'm ready," she said, wondering if he had it together or this was some sort of waking nightmare.
"Write it down," he insisted.
"I'm ready, I'm ready," she said, poised to write. She showed him the journal and pen. "What is it?"
"Okay," he said and concentrated, visualizing the words and what the meant, the physical processes each involved, the root words, making sure he got them right because if he didn't... "Myoglobinuria. ARF. Rhabdomyolysis. Alkaline diuresis." He stopped and pressed two fingers against his neck. Thump…thump…thump…thump… "Bradycardia. Don't write that one. Hyperkalemia—write that—hyperkalemia."
"I can't spell most of those," she said helplessly, wanting to help him but not knowing if this was the right thing or if she should ignore him and run to the phone.
"Don't worry—just get close enough," he said. "Myoglobinuria, ARF, rhabdomyolysis, alkaline diuresis, hyperkalemia. Got 'em?"
"Close enough," she said shakily, trying to smile and checking what she'd written down.
"Now call Wilson," he demanded.
"I'm calling 911," she said, smile gone and half-way to the door in a flash.
"No!" he said, unable to focus on her at all now, feeling himself fade. This wasn't good. She had to call Wilson, not anyone else, just Wilson. "No, they don't know what they're doing. Call Wilson. Read him the list—he'll know what it means."
"You can't tell me what it means?" she asked, reaching toward him, hoping to reach him. He was so pale. His eyes—he wasn't looking out of his eyes. He wasn't there. "Greg?"
"Just call him!" he snapped, not sure if he was talking or not, starting to lose consciousness. If she didn't call Wilson, if he couldn't get the message across… No, no, she would, she would. "Do it now! Before I pass out! Go!"
She scrambled out of bed and ran to get the phone. She cursed as she punched the wrong number in, running back to the bedroom, and cursed again when she hit the wrong number again.
House was barely breathing on the bed, face chalky and pale, eyes fixed on the ceiling.
"Pick up, pick up, pick up," she muttered as the phone rang. "He's not answering. What's his pager number?"
She saw him swallow and try to say something when the phone clicked and a sleepy voice on the other end said, "Hello?"
"James, thank God," she said. "Something's really wrong with Greg—"
"What—" he stated to say.
"I don't know!" she exclaimed. "He gave me a list to read to you. I don't know if I have these right, but they're—" she read the list to him.
"Oh my God," Wilson said when she'd finished.
"What does it mean?" she asked frantically.
"Are you with him right now?" Wilson asked.
"Yes," she said.
"Okay, go put your fingers on his neck," he said. "I need you to tell me how fast his heart's beating. You there?"
"Yeah," she said, placing her fingers on his neck. "It's slow."
"Is his breathing slow too?" Wilson asked.
Stacy checked. "I think so," she said. "What's wrong with him? He looks horrible. Tell me what those words mean. Is he dying? He looks like he's dying. Oh my God."
"It's okay," he said calmly. "Don't panic." He wanted to say, 'he's not dying,' but he honestly didn't know if that was true. "Is he awake?"
"Greg," she said shaking him, "Greg, wake up." She shook him harder. He was ashen and unmoving. "Wake up! Greg!" she shouted. "No, he's not," she said to Wilson. "Oh my God. What's wrong with him?"
"He'll be all right," Wilson said calmly. "Listen, I need you to call an ambulance and make sure they take him to our hospital. Read them the list you read me. Don't panic—he needs you to stay calm. Stay calm and dial 911. I'm going to hang up now so you can do that, okay?"
"James, what's wrong with him?" she demanded.
"His kidneys aren't working—but he'll be okay," he said. "Call 911 now. I'm going to hang up, okay?"
"Okay," she said.
There was a click and the line went dead. For a moment, all she could do was shake. Then she snapped out of it and dialed 911.
Wilson pulled on the first shirt and pants he could find, skipped socks and underwear entirely, stepped in to a pair of loafers, grabbed his keys and wallet, and sprinted out of the apartment and down the stairs to his car, all the while thanking everyone and everything he could think of that he'd slept at his place and not Julie's tonight.
He cranked the engine, stabbed the flashers on, and sped into the street, also thankful that it was 5 a.m. and the traffic lights were still blinking yellow and red so he had a clear path as he raced toward House's apartment.
He punched the number for the hospital switchboard on his cell and got them to connect him to nephrology, then left an urgent message to page the on-call doc and have whoever it was call him on his cell, thankful again that the person who answered knew him and didn't ask questions. He parked sideways in the fire lane, cut the engine and left the flashers on, not even bothering to lock the doors of his very nice and very new BMW. He dashed up three flights of stairs, too keyed up to wait for the elevator, and knocked quickly on the door.
He heard her walking quickly toward the door and turning the locks. He was mildly surprised to see that she'd managed to get dressed since he knew the 911 operator had kept her on the phone, but she'd always been capable. Right now as she stood before him, phone in hand, she looked like she was falling apart.
"James, thank God," she said to him. "No, it's my friend," she said into the phone. "He's a doctor."
"Where is he?" Wilson asked quickly stepping inside.
"Bedroom," Stacy said.
"What's the ETA on the ambulance," Wilson asked over his shoulder as he hurried back to the bedroom.
Stacy asked the operator. "Five minutes she says," Stacy said.
Wilson nodded quickly as he entered the bedroom. House looked like half-dead, pale and unmoving. He quietly took House's pulse, noting everything he saw. Resps slow and shallow, skin dry, elevated turgor, and the big one, hard to miss, totally unconscious. Pulse—Jesus—45.
"Has he been eating and drinking?" Wilson asked.
"Not very much," she said, ignoring the 911 operator. "He said the medicine he was taking for his leg made him nauseous, so he wasn't hungry. I tried to get him to drink, but he slept so much…"
"It's okay," Wilson said. "Don't worry about it. He's just a little dehydrated—that's all."
"Is this related to the UTI?" she asked anxiously. "Or—he thought he might have the flu or mono."
Wilson looked at her strangely. "I don't think it's related to any of those things," he said.
"But—" she started, "—the E.R. doctor said that if his urine got darker…"
"Has it?" Wilson asked quickly.
"I don't know," she said. "He's had blood in his urine since Friday, but he said it looked okay. A little darker than normal, but he said it was okay."
"Did he ever say it looked like tea?" Wilson asked.
"No," she said, "but he slept almost all day and all of yesterday."
"Did he complain of being tired?" Wilson asked.
"Yes, all the time," she said. "He said it was because of the codeine he was taking and then today because he thought he had the flu or mono."
"He was taking codeine?" Wilson said with surprise.
"For his leg," she said. "With antibiotics. The E.R. doctor—Young—gave it to him. Greg said it made him tired."
"Did he say anything else about his leg?" Wilson asked. "Did he mention weakness or soreness, or just pain?"
"He said it felt heavy," she answered, "but he said it wasn't bothering him anymore last night."
"Okay," he said, processing the answer.
"What did he tell you?" she asked. "The list I read. What does that mean?"
"The words he gave you," Wilson said, "mean that his kidneys are shutting down because of too much myoglobin in his bloodstream. Myoglobin's a protein that's secreted when cells die, especially muscle cells, and too much of it messes the kidneys up. He thinks it's caused by muscle necrosis—muscle death—and he told me what to do to counteract the excess of myoglobin—to get his kidneys working again. I asked you to see how fast his pulse was because of the last word he said—hyperkalemia—which means there's too much potassium in his body right now. It's keeping his heart from beating fast enough. That's the main problem—that's why he looks so bad and slept so much. As soon as we can get the imbalance in his system corrected, he'll be okay. The EMTs will start him on IV fluids and that'll help. This is highly treatable—he'll be fine."
The fearful expression that had been growing on her face throughout his explanation got worse. She looked like she was near tears.
"It's okay," he said soothingly. "These things are easy to fix. He told us how to fix them. He'll be much better in a few hours."
Her gaze shifted from him to the bed and she approached it, expression unchanged. "Greg?" she said in a choked voice. "Greg?" She turned back to Wilson. "Why won't he wake up?"
"All of that stuff in his system—not only myoglobin and potassium but other things—has slowed his heart-rate and worn his body out, so he's unconscious," She made a choked noise and he stepped closer to her, putting on a comforting expression. "Don't worry," he said soothingly, "he's not feeling anything, no pain, and he'll be fine once we treat him—no long-term effects."
He kept to himself the thought that the degree of muscle necrosis that would cause such a severe imbalance would almost surely have long-term effects. She didn't need to hear it; it would only upset her further and right now she looked like she was breaking down.
He stepped closer to her, holding his arms out. "Hey," he said softly, "come here."
She let him embrace her and he felt her trying hard not to cry. "It's okay," he said soothingly, "it's okay."
He held her for a while as she shook quietly and let her go when she pushed away.
She wiped her eyes and sniffled, trying to smile. "Thank you for being here," she said.
He smiled back. They both jumped at a harsh knock on the door.
"That's them," Wilson said in action again, going toward the front door. "I'll let them in; you pack a bag for him. He'll need a change of clothes and toiletries," he called. Packing a bag would keep give her something to do and ease the panic she was feeling.
He let the paramedics in and directed them to the bedroom, telling them what was going on and what they should do. His cell phone buzzed in his pocket and he answered it, stepping into the hall as he watched the paramedics get House onto their gurney.
"James Wilson," he answered.
"Dr. Wilson," a male voice said, "this is Dan Sanders from nephro. You paged me."
"Yes," Wilson said. "I've got a patient for you en route, five to ten minutes out. Meet us in the E.R. Thirty-nine year old male, acute renal failure possibly caused by myoglobinuria induced by rhabdomyolysis; exhibiting symptoms of hyperkalemia. Moderately dehydrated. He's been taking codeine PRN for at least two days, probably forty to sixty milligrams. Pulse is—hang on—" he cupped the palm of his hand over the receiver and called, "Guys. Pulse and BP."
"43, 95 over 67," one of them answered.
"Pulse 43, BP 95 over 67," Wilson repeated into the phone.
"Wilson, wait, wait," Sanders said, "how do you know all this?"
"You know Greg House, right?" Wilson said.
"Yeah," Sanders said, "he's there too?"
"It's him," Wilson said. "He's the patient."
"Please tell me you're kidding," Sanders said.
"I wish," Wilson said. "His girlfriend called me fifteen minutes ago in a panic. He gave her a list to read off to me before he lost consciousness. The problems: acute renal failure, myoglobinuria, rhabdomyolysis, hyperkalemia, and the treatment: alkaline diuresis."
"Holy crap," Sanders interjected. Wilson couldn't tell if he was worried or impressed.
"Yeah," Wilson agreed. "He's been sick since last week. He went to the E.R. on…Friday, I think, and was diagnosed with a UTI. Girlfriend says he's been out of it since yesterday."
"Jeez," Sanders said. "You said five minutes out?"
"Yeah," Wilson said and looked up as the paramedics signaled to him. "Hey, we're ready to roll here. Get his E.R. records from last week. I don't know what kind of tests they ran. I gotta go. See ya in a few."
"I'll be there," Sanders said.
Wilson hung up and went over to Stacy, who had a bag in her hands and looked ready to collapse.
"Hey," he said putting his hand on her shoulder and taking the bag from her.
"They couldn't get him to wake up," she said in a shell-shocked voice.
"Don't worry," Wilson said as he steered her out of the bedroom behind the EMTs. "I was just on the phone with one of the nephrology docs and he's going to meet us there. He knows what's up. We'll have House yelling at us again in no time." He called to the EMTs, "Princeton-Plainsboro Teaching Hospital, guys. They're waiting for him."
"We know," one of the EMTs called over his shoulder.
"Do you have your keys?" Wilson asked Stacy, stopping her in the doorway.
She nodded shakily and picked up her purse from the foyer table. Wilson locked the door and motioned for her to step into the hallway.
She started toward the paramedics, who were headed for the elevator.
"Stacy, wait," Wilson said as he shut the door and made sure it was locked. "Ride with me."
"I want to go with him," she protested weakly.
"It's easier if you go with me," he said.
She looked unconvinced and half-turned to follow them.
"You'll just be in their way," Wilson said. "Come on, we'll follow them."
She stopped and let Wilson take her arm and lead her down the stairs to his car.