House was already writing down symptoms on the whiteboard when the team arrived.
"What's up?" Kutner asked, impossibly bright even this early. Thirteen simply headed for the coffee pot to start some.
"New patient," House replied. "History is still a bit sketchy, but we'll get a better one soon as she gets here. She's being transferred from Middletown. 7-year-old girl who has been having headaches the last day or two, some dizziness, slight visual changes, now developing nausea and abdominal pain. Her mother also thinks she's seemed tired lately."
Taub hid a yawn behind one hand. "The flu?"
"Good guess, if we ignored the neurological symptoms." House's tone was dripping with sarcasm. "Nope, this definitely has a neurological component."
Foreman studied the board. "Meningitis?"
"We'll do an LP when she gets here, although I don't think she was febrile. Still, ought to rule it out."
"What treatment has she had?"
"Supportive care and Imitrex."
"And she's developing nausea even with Imitrex?" Taub was getting interested now.
"Yes." House studied the board. "Okay, rule out infection, standard tox screen. What else, people?"
"Any of her friends sick?" Thirteen asked.
House rewarded her with a nod. "Good. You and Taub can drive to Middletown soon as we get the names of her friends from her parents. Check her friends, the school, home, her usual places."
"That's a two-hour drive," Thirteen protested.
"Only if you obey the speed limit," House pointed out. "But if you don't, I'm not responsible for any speeding tickets."
"Could get an MRI, just to rule out intracranial bleed, although it would sure be odd in a 7-year-old," Foreman suggested.
"Good. Soon as she gets here, Thirteen and Taub get names and school from the mother, then hit the road. Foreman and Kutner, MRI, LP, full lab workup. I'll get a more thorough history from the father."
The team had been starting to move, but that froze all of them in their tracks. "You're going to do the patient history?" Foreman asked, making sure he'd heard right. "You never talk to the family."
"Actually, I do talk to the family, but only before daylight on the last Saturday of the month. You just must not have noticed yet." House limped toward his office, and the team looked at each other before heading in a line for the now-full coffee pot. It was looking like it would be a long day.
(H/C)
Cuddy had Rachel up and getting fed before Lyla exited her room. "Such a luxury to sleep late," her sister said. "Although your mattress in the guest room really could be better." She looked around suddenly. "Where's Gary?"
"It's Greg, and he had to go to the hospital for an emergency in the middle of the night."
Lyla shook her head. "I'm glad Bill has his priorities straight. No running out on me in the middle of the night."
"Except when he's traveling for business?" Cuddy pointed out, giving the last word an emphasis that added a whole different meaning.
Lyla immediately gave a huff and turned toward the bathroom. "I'm going to take a shower. Hope you've got enough hot water."
Cuddy waited until the door to the bathroom shut, then studied Rachel. "Rachel, maybe having you be an only child isn't such a bad thing, after all." Even as she said it, though, tears welled up slightly as she thought of her major failure in life. She could subdue her peers, her job, and her hospital, but not her own body, it seemed.
She let her thoughts wander across the past as she finished feeding Rachel. If House's models of relationships had been illusion and pain, Cuddy's had been competition. Her father was one of the most driven people she'd ever known, absolutely consumed with the need to be successful, defined in financial and employment terms. He had married the best choice in his town for wife, had a successful career, moved to a successful neighborhood, and drove a successful car, but he had never seemed satisfied, and though he had never said it, she had no doubt he was disappointed that neither of his daughters had been his son. They thus found themselves in a competition from childhood on to outdo each other, to succeed, to earn his esteem. Cuddy had been the more successful careerwise, and Lyla's barbs had been especially sharp in the years since Cuddy's promotion at PPTH. Her parents were proud of her now, she knew. They said so. But part of her still wished that they had been able to be proud of her all along.
She leaned over, kissing Rachel on the forehead. "I'm proud of you," she said fiercely, "and you will never, ever have to earn love from me. Or from House." She smiled suddenly, realizing how natural it was to link his future to hers. She still felt her lack of pregnancy, but she had at last found a good relationship, and unbelievably, it was the one that had been dangling under her nose all along. For maybe the first time, she truly did not care what Lyla thought about her choice - or what her father thought, or how it compared to other people's. She was happier than she had ever been. That was enough, regardless of what they thought.
Thinking of House made her wonder how he was getting along. She took a minute out of admiration of her own daughter to send some good thoughts for Jensen's.
(H/C)
House sat in his office, tossing his ball, thinking. LP results were pending, and MRI was negative. Taub and Thirteen were doing research in Middletown; Kutner and Foreman running tests here. Tox screen so far was negative. Blood pressure was low, heart rate up. House had spent quite a while talking to Jensen, getting the most thorough history he could, but nothing jumped out, even when later supplemented by talking to Melissa. Cathy had been a perfectly healthy child all her life, had started having headaches and fatigue a day or two ago - and was steadily developing additional problems now. White count was not elevated. Still no fever.
This had to be environmental, most likely, although she hadn't been anywhere new, hadn't changed her routine lately. Thirteen and Taub were probably on the front lines in Middletown. Meanwhile, Kutner and Foreman were expanding what they were testing for on the toxicology. House found himself hoping they could find it in time. The girl reminded him of his own building family.
Hope. What a foundation for a differential. Focus, House, he chided himself.
He shifted in his office chair and winced as a jolt of pain stabbed his right leg. What on earth was wrong with it? The weather was no excuse today, bright and sunny. He carefully lifted the leg down from his desk and leaned over to check the pulses at the ankle again. Strong and steady. There was no problem with circulation, no new clot. His cell phone rang just then, and he fished it out. Cuddy. Immediately putting on a stiff upper lip and pulling his hand away from the leg, even though she couldn't see him, he answered. "Hi."
"Hi. How's it going?"
"She's slowly getting worse. We're chasing leads. Sooner or later, we'll catch up with one. How's it going with your sister?"
"She went out shopping. Thank God. I just wanted to remind you to eat lunch."
"Is it lunch time?" Surprised, he looked at his watch.
"Yeah, that's what I thought. Eat and take your pain meds, in that order."
"Okay, I'll be good," he said, and she immediately was suspicious.
"You're not going to object? List all the things you should be doing instead and how you haven't got time to take out to eat?"
House tossed the ball. Was it more stressful on her for him to try to avoid stressing her? "I'm sure I could come up with a few other things to do, if you really want me to. I'm almost to level 5 on my game. That's much more fun than lunch."
She laughed, sounding a bit more relaxed. "Eat, House."
"Yes, mistress. On my way right now."
"And keep me informed on Jensen's daughter."
He sighed. "I will."
(H/C)
A little later, House was just finishing up his Reuben in the cafeteria with a chaser of Vicodin and anti-inflammatories when his pager went off. He grabbed for it, hoping for a message from Taub and Thirteen, but nope, it was from Foreman. He stared at it for a second, then stood and headed for Cathy's room. Foreman stepped away from the bed, and Jensen looked up as House arrived. "Her visual changes are getting worse, and she's starting to show intermittent arrhythmia," Foreman said, sotto voce. Jensen stood, resting his hand on Cathy's shoulder for a minute, then came over to join the conference in the doorway.
"Do you have any idea what's causing this yet?"
"I'm pretty sure it's environmental, but we're still narrowing down possibilities." Foreman looked startled at House giving a direct and non sarcastic answer to that question. "Foreman, go call Taub and Thirteen. Find out what they've discovered, and if they haven't found anything yet, tell them to look again." Foreman nodded after a moment and headed off, and House stepped outside, out of earshot of Cathy and Melissa. Jensen followed him.
"How bad is she?"
"Whatever this is is attacking the central nervous system. Still no fever, though, so probably not infectious. I wish there were some way to speed up the diagnosis, but we have to wait for the data we need to come in." As usual, House felt helpless on this conversation and reminded himself exactly why he usually avoided contact with the families and patients. They wanted reassurance. All he could offer was a mental flow chart, and they didn't understand that that was how it worked for him, that reassurance simply wasn't relevant.
Jensen sighed. "I understand. Thank you." Actually, watching House, seeing the outright reverence (often with exasperation, but still reverence) the hospital showed at his name, watching his team work at narrowing things down, was reassuring. Brilliance doesn't have to be understood to be recognized. "I'd better get back in there before Cathy starts worrying what we're keeping from her." He turned and went back into the room.
House lingered outside, watching the family through the glass wall. The mother on the far side of the bed, leaning over with a world of concern and compassion in her eyes, one hand resting on her daughter's hair. Jensen on the near side, hand on her shoulder, eyes intent, probably feeling helpless himself but just being there. Cathy between them, eyes closed, fear on her face. She was old enough and was also sick enough now to realize that something truly was wrong.
They were together. In a crisis, they were still all together.
Is that what family was? Is that what he'd always missed? Is that what he could have, with Cuddy and Rachel and the baby to be?
"House!" Kutner's voice sounded behind him, and House, not wanting to be caught standing here staring at the family and clearly not thinking about the case, spun around away from the window. The flare of pain up his right leg took his breath away, and he was unable to suppress a grimace. In the next second, his leg totally gave out, folding up like the leg on a card table, and he went crashing all the way down.