Chapter 10:

Susan went straight to a copy machine when she got into work and made a copy of both her birth certificate and her marriage license. She dropped by her lab and put her stuff away and set the original documents on her desk. She took the copies she had just made to the main lab where she found the inspector speaking with her team before they started inspecting the various areas of the main laboratory. When she finished Susan got her attention and handed her the documents. "I went ahead and made a copy of my marriage license as well so you could see the name change," she said as she handed over the documents. She just heading out the door when she was stopped by the lab manager, "Why are you down here?" he asked.

"I needed to provide more documentation for the inspector," she said.

"I told you not to step foot in my lab again," he said. Susan just shook her head and left. This was stupid she thought to herself. If House was nicer, she wouldn't be going through this with this guy – but then again, if House was nicer, the board wouldn't have seen fit to create the specialty lab and she wouldn't be here working for him either. It was a vicious circle. She really thought after the whole Jeffrey fiasco that she would have proven herself to the rest of the hospital staff. Why did she always have to prove herself? What was wrong with her? She thought about her conversation with Laura the night before and thought to herself again that she was tired of being someone else's disappointment. She was better off alone.

When she walked in the lab, House was sitting at her desk reading her marriage license, "Why did you bring this in?" he asked.

"To show the name change to prove I was who I said I was to the inspector," Susan said. "I just dropped off copies to her down in the main lab. Ran into Chris while I was there, he was none to happy about my presence in his lab."

"He needs to get over it, sometimes you have to go to the main lab," House said. "Do you want me to talk to him?"

"Hardly, you're the reason he's so hateful to begin with. You'll just make it worse. I can handle it," Susan said. "Why are you here? Are you hiding out again?"

"No. You and I have a meeting in Cuddy's office in about 15 minutes," House said.

"Concerning?" Susan asked.

"I don't know, but she was not happy when she called me," House said.

"Great. – That's all I need, more confrontation. I suppose we should go then," Susan said with a sigh. House and Susan left the lab and made their way to Dr. Cuddy's office. When they arrived, Dr. Cuddy directed Susan to sit in the chair opposite her and House went over to the couch and sat down.

"Susan, there has been an accusation made that you are diagnosing and treating patients," she said.

Susan's mouth dropped open in shock. She turned to look at Dr. House, "You don't believe this do you?" she asked. House looked as surprised at the revelation as Susan.

"Susan, you need to direct your attention to me," said Cuddy.

"Sorry, I'm just stunned by the accusation. Of course, I don't diagnose or treat patients. I'm a lab rat, not a physician. I'm not qualified," Susan explained.

"You do have a lot of experience and I know that you recognize certain disease states," Cuddy explained.

"True, but I don't diagnose anybody. Sometimes when Dr. House or the fellows order certain tests and I see the results, I have a fairly good idea what test they are going to order next to confirm. So, I've ran tests pro-actively without an actual order before. I know I'm not supposed to do that, but so far I've managed to run the tests they planned on ordering," she explained. "If I'm not sure, I ask."

"Give me an example," Cuddy ordered.

"If they've ordered a hepatic function test and I see high values of AST and ALT, I'll often go ahead and run a hepatitis panel to they can rule that out as a potential diagnosis. I also automatically reflex to an a1c if someone has a high fasting glucose," Susan said. "There are a few others like that that I've done. The other day I had to prepare a bone marrow aspirate and while I created that slide, I decided to create a smear of the blood sample as well just in case they needed to see it."

"Dr. House, have you been aware that she has been running tests without orders?" Cuddy asked.

"I see the results," he said. "I don't disagree with any of the tests she's ran."

"So what do you do if the doctors don't eventually order the tests?" Cuddy asked.

"I don't send it to billing," Susan answered.

"But the results are still recorded?" Cuddy asked.

"Well, yes – I ran the tests; I don't think I should remove the results from the database. I'm not sure that I can anyway."

"Susan, you can't run tests without doctor's orders. That's a violation of hospital policy and state regulations," Cuddy said.

"But if I know what they are going to run next, isn't it in the patient's best interest to get the results faster than I would by waiting on an order?" she asked.

"Just don't do it anymore," Cuddy said. "Now, about making a diagnosis…"

"I don't diagnose anything," Susan interrupted.

"What about Georgia? You told Martha that she had cancer several months ago," Cuddy asked.

"I was showing her how to process the tissue specimens and when we finished staining, I said she had cancer to Martha because I recognized it, but I took images of the slides and sent them to Dr. House. I didn't document my findings or even tell Dr. House what I saw. Dr. House made the diagnosis," Susan explained.

"Alright, you can go now. Dr. House, I need you to stay behind," Cuddy said.

Susan left Cuddy's office rather shaken by the whole ordeal. "What's going on?" House asked Cuddy. "Susan hasn't done anything wrong."

"She can't run tests without orders," Cuddy said, "You know that."

"She hasn't run anything that I wouldn't have ordered. Her being pro-active like that has saved precious time on several patients at this point," House argued.

"Regardless, the regulations are clear. She can't test without an order," Cuddy countered. House was about to comment back when Cuddy interrupted him, "Look, if you want to set up 'standing orders' for reflex tests when there are specific results, then go ahead. That will solve most of the problem…"

"Do you have any idea how many combinations of results there are that I have follow-up testing for? It'll take forever," He said.

"Then you better get started," Cuddy said dismissing him.

Before House left he said, "You never answered my question."

Cuddy sighed, "The inspector came by my office early this morning. She started out by telling me that the Diagnostic Lab was the best lab she had ever seen and that the record keeping was impeccable, but despite that she implied impropriety and I have to investigate. She didn't say anything about testing without orders, so she must not have seen anything that indicated that, but did mention diagnosis and treatment."

"The lab records for inspection wouldn't show either of those kinds of occurrences anyway, it's all about making sure calibrations and quality control records are well kept, corrections for when things fail, reporting documentation and employee qualifications, stuff like that. How would an inspector even have evidence for diagnosis and treatment in lab records? Medical records sure, not lab records. Someone had to bring it to her attention. Susan was with her all day yester…" House broke off suddenly as his eyes widened with realization and walked out the door without another word.

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Susan sat at her desk drumming her fingers with one hand and holding a business card in the other. She picked up the phone and looked at the business card in her hands. She dialed the extension, "Yes, this is Susan Watkins. May I speak with Dr. James please?" Susan listened as the admin explained that Dr. James has been out of the office all week, but should return Friday. Susan left a message with her to have him call when he got back in the office.

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House walked in the main lab, passed the processing techs and walked straight into the lab manager's office. He slammed his cane down hard on the desk causing Chris to jump several inches out of his chair, "What are you trying to pull?"

"What are you talking about?" Chris said; his heart racing.

"You know what I'm talking about," House said, "and I'm here to tell you to lay off Susan. Your beef is with me, not her. You have issues with me, be a man and come to me – oh wait I forgot, you're not a man you're a puppet for your buddy Jeffrey." Seeing the look on his face House continued, "Oh yeah, I know all about your lunchtime liaisons in the janitor closets. Jeffrey lost his job and unless you want to lose yours, you'll back off." House started out the office but turned at the door, "By the way, I hope you brought a change of clothes," noting the puddle on the floor.

Chris looked down, "Oh god," he said putting his face in his hands.

Having heard the entire exchange, the lab techs watched House leave and as soon as he was out of the lab, the whispering began. It wouldn't be long before this piece of gossip was all over the hospital.

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"Susan?" the voice said, "This is David, my admin said you called."

"I thought you were out of the office until Friday," Susan responded.

"I am, but I check in from time to time and she said you'd left a message. I was going to call you the other night, but I had to suddenly leave town for a family emergency," he said.

"Is everything OK?" Susan asked.

"It is now. My mother had a dizzy and fainting spell and dad took her to the hospital, but she's fine now and they are releasing her to go home tomorrow. Turns out it was just a case of the flu. After we get her settled at home, I'll be back in the office." he explained. "So was there a reason you called?"

Susan hesitated but then said, "I was wondering about your offer to bring me on teaching full time."

"I thought you like working for Dr. House?"

"I do, but there have been several situations occur that make me think that I'm not the right person for the job," Susan said.

"Like?" he asked.

"I'd rather not get into the details, but if that offer is still open I'd like to consider it," Susan said. David was silent for a few moments, "It's OK if you've changed your mind," she said. "I'm sure I can find something somewhere else."

"No, no don't do that. You don't need to leave. I was just thinking that I needed to talk to Dr. Cuddy. We probably wouldn't be able to make it official until the start of the next academic year, but I bet we can work something out before then in an unofficial capacity," he said. "I tell you what; I'll be back in the office Friday. Let's get together for lunch and talk about our options."

"Sounds great, thanks," Susan said. Susan hung up the phone. She didn't want to leave the diagnostics lab, but it was obvious at this point that she just didn't belong.