Chapter 14
On Your Mark
House was unusually prompt the next morning. He would never apologize to MacBeth but the early arrival was one way of demonstrating his new respect for her tactics. Jessica was sitting stoically in the audience to hear the opening statements. Just as Boz predicted, Plaintiff's counsel vilified House because of his bedside manners and his Vicodin addiction. They also brought up the fact that he was at the offsite betting room while his patient was fighting for his life.
House wondered how they found that information out? Someone at PPTH had to have said something. MacBeth didn't react at all to the information. It was her turn for opening statement.
"Ladies and Gentlemen,
You already know my client is the defendant, Gregory House. Dr. House has been kicked once out of Johns Hopkins for cheating, fired from three different hospitals for not getting along with his peers and supervisors and he has been suspended at PPTH while he attended drug rehabilitation, twice. My client is a man you wouldn't want at the dinner table and you wouldn't want your daughter to bring home to meet you. Despite this, you'll hear from just about everyone, including the Plaintiff's own expert, that if you were sick and the doctors couldn't diagnose you, you'd want Greg House as your doctor. He is considered unorthodox but brilliant, the very best in his field. He won't wear a lab coat or iron his shirt, but he will find out what's ailing you when you're dying and no one else knows what to do.
You're also going to hear that Dr. House is an addict. Eight years ago he experienced an infarction in his leg and he wasn't diagnosed quickly enough. They wanted to amputate the leg but Dr. House said no, he'd take his chances that the leg and he could survive. Unfortunately, while he was unconscious, the decision was taken out of his hands and the surgeons tried to remove just the dead muscle and leave him the rest of his leg. Sadly, the nerves around the muscle were damaged and this means that Dr. House is in excruciating pain every minute of every day. For a long time, the only way for him to tolerate the pain was by using Vicodin. You'll hear a lot about Vicodin addiction but you'll learn that, if you're in pain, the Vicodin goes first to calming those receptors before it attaches to the receptors that make you high. So, the more pain you have, the less likely you'll get a high from Vicodin. You'll just experience less pain. That's why Dr. House can still practice on painkillers; the Vicodin dulls the pain to a level where he can treat patients. Is he high at the same time? No.
My client treated Mr. Lawrence after Plaintiff's own physician and five physicians at Princeton General failed to properly diagnose him. He was sent to Dr. House late in the game. The first hour was crucial to his diagnosis because that's all the time Dr. House and his team really had left If they couldn't diagnose the condition within an hour, he wasn't going to survive because he would then develop sepsis and multiple organ failure no matter what they would have done. So now the 24 million dollar question is, why did Dr. House, the brilliant Dr. House, not diagnose Mr. Lawrence within the hour?"
"You'll learn a sad truth in this trial--everyone lies-- including Mr. Lawrence and his wife. Their lies may have cost Mr. Lawrence his life. My experts will tell you that they left out a crucial piece of evidence when they were giving Mr. Lawrence's medical history to Dr. House and his team. To complicate things, the normal tools to diagnose this condition failed to reveal an important aspect of the illness. Dr. House and his team needed the information that didn't show up on the x-rays. As a result of the lies and the failure of the tests to reveal an important aspect of the disease, Dr. House didn't diagnose Mr. Lawrence for an hour-and-half. Considering the doctors at Princeton General had six hours and didn't diagnose him, I think you'll find that Dr. House was brilliant once again, but just didn't get his chance soon enough to save his patient. I ask that you remember that Dr. House, although not the kind of guy you want your daughter to marry, is the very guy you want as your doctor. Thank you ladies and gentlemen, I'll talk to you again during closing statements."
She always made her openings short. People were typically bleary eyed after lunch, unable to concentrate and already bored. She sat down and felt House kick her under the table. She laughed to herself; he was pissed again. After the day was over, House asked her, "Did you have to tell them that you wouldn't want to have dinner with me?"
"I'm just stating the obvious. It's just a game Greg. Go home, but I need you at the table tomorrow. So be here. Wilson is coming to show his support, so that's good. One of the juror's wives was treated successfully by Wilson so he's going to be a real asset to you, as usual."
The next day Mrs. Lawrence took the stand as the first witness. She was on the stand with Plaintiff's counsel for two hours and had been a very sympathetic person. Finally, it was MacBeth's turn.
"Mrs. Lawrence, I'm going to show you a two page document entitled, "Patient's Medical History" marked as Exhibit 23. Mrs. Lawrence, you filled this out when your husband was admitted to Princeton Plainsboro Hospital, right?"
"Yes."
"In fact, that's your signature where you signed that everything you wrote or marked above is true and correct, right?"
"Yes."
"I noticed that you went into great detail about your husband's car accident and his bout with meningitis two years ago, correct?"
"Yes."
"That night at Princeton Plainsboro your husband's life was on the line and so you wanted to be careful and accurate with what you told the doctors, right?"
"Yes."
"Take a look at the box marked 12. It reads, have you ever had or currently have a problem with alcohol, i.e. alcoholic, allergy, more than two drinks five times a week?"
Mrs. Lawrence looked at the document and her face flushed.
"What did you mark?"
She was silent. The whole audience, including House, waited for the response ...wondering why she hesitated. "I marked it, 'no.'"
"Your husband was a recovering alcoholic, wasn't he?" MacBeth deliberately said it with kindness and concern. She didn't want the jury to think she was unsympathetic to alcoholism.
Mrs. Lawrence looked at her attorney as if he would give her the answer. The act of looking to your counsel for a response was never something you wanted the jury to see, but her counsel didn't . She hesitated, not knowing what information MacBeth had, but realizing she must have something if she was bringing it up, "Yes."
"Thank you. I have no further questions."
The judge looked at Plaintiff's counsel, Todd Edmunds, "Redirect?"
"Mrs. Lawrence, "Why did you mark this no?"
"I misread the question and thought it was asking if he currently had a drinking problem. He'd been sober two years."
"No further questions."
The expert that was hired for the Plaintiff claimed that the staff should have suspected that the patient had Boerhaave syndrome. House was visibly disgusted with the expert who was a doctor from Johns Hopkins. When it became time to cross exam the expert, MacBeth stood up.
"Dr. Singh, over one-third of the patients with Boerhaave present with no classic symptoms and are atypical, is that correct?"
"Approximately one third."
"And over one out of three die because they cannot be diagnosed in time, right?"
"Yes."
"Would it be important for a doctor to be told that the patient was an alcoholic to assist in the diagnosis of this condition?"
"Not in this case, the patient hadn't been drinking in the last two years."
"But you don't know that do you? Alcoholics don't always advertise their drinking, especially to spouses, correct?"
"That may be, but his wife claims he had been sober."
"Well, let's assume that might have been true, but wouldn't the fact that he had been a recovering alcoholic at least be one more reason for Dr. House to suspect Boerhaave?"
"Yes."
"Dr. Singh, are you familiar with Dr. House's reputation?"
"Yes."
"Can you tell the jury what his reputation is as a diagnotician."
"The best. He is the best at what he does."
"Is it true that doctors may do everything well and still lose a patient?"
"Yes."
"No further questions."
The next day House stayed at the hospital and worked. Additional witnesses were called, including an economist to tell the jury how much in dollars Mr. Lawrence's life would be worth. The economist indicated that Mr. Lawrence would have made $3.8 million dollars over the remainder of his lifetime. That loss of income for his wife coupled with the costs of the medical treatment and other expenses meant that the total liability to House and the hospital would be $4.4 million. That afternoon the Plaintiffs rested.
MacBeth called Thirteen first, Taub second, Chase third and Foreman last to tell everyone what their part was in the diagnosis and why each of them failed to diagnose Boerhaave. Each attributed the problem mostly to the failure of the X-Ray to reveal a tear in the esophagus , something that typically shows up at this stage of the condition. Chase, an intensivist, went further.
"The only other case of Boerhaave I have seen was in a former alcoholic. Had I been informed that Mr. Lawrence was an alcoholic, recovering or not, I would have insisted on an endoscopy to verify the X-ray findings. But without that information, there was no reason to suspect that the x-ray findings might be wrong."
Until they had testified, the team could not sit in on the trial because the court had ruled that all potential witnesses be excluded from the courtroom until after they testified. Now the team lined the front row behind House. So Jessica, Cuddy, Wilson and the team were now all in the audience.
The next day MacBeth called House to the stand. She took fifteen minutes just to run him through his credentials, a quarter which not even Cuddy or Wilson knew. She asked him to go through the diagnosis which he did in typical House fashion, bored. She ran him through the night of Mr. Lawrence's death and his part in the diagnosis.
"Why was it so important to know that Mr. Lawrence was an alcoholic?"
"Boerhaave is more common in alcoholics. If I had been informed that he was an alcoholic, recovering or not, I would assume that he was lying and that he was still drinking and I would have insisted that an endoscopy be performed as a back-up test. Since I didn't have that information, I had no reason to think that the X-ray could be hiding something."
"Dr. House, tell us about the pain in your leg. Before your rehab last year, what happened if you didn't take Vicodin?"
"I didn't function at all. Prior to last year, I didn't have the time or the willpower to go through a very painful detoxification. The pain was so great in my leg that it followed me wherever I went. I wasn't able to do my job without painkillers."
"Did Vicodin allow you to do your job?"
"Back then I couldn't work without it."
"Are you addicted to it?"
"Yes, but I don't use anymore, not since my rehabilitation."
"Did the Vicodin make you high?"
He laughed to himself. "I wish."
"No further questions."
Plaintiff's counsel got up. "Dr. House, what happens when you withdraw from Vicodin?"
"You can experience: restlessness, muscle pain, bone pain, insomnia, diarrhea, vomiting, cold flashes, goose bumps, involuntary leg movements, watery eyes, runny nose, loss of appetite, irritability, panic, nausea, chills, sweating and there can be other symptoms.
"Isn't it true that you were undergoing Vicodin withdrawal while you were treating Mr. Lawrence?"
"No."
He was clearly taken back by the answer. "Dr. House, do I need to remind you of your response in your deposition? Page 34, lines 12-24.
Question: Wasn't Mr. Lawrence admitted the day after you entered rehab, correct?
Answer: Yes.
Question: This rehab was on the fourth floor of Princeton Plainsboro which meant they let you out to examine Mr. Lawrence?
Answer: Yes.
Question: The first step in rehab is to take away all your drugs correct?
Answer: Yes.
Question: When a Vicodin addict has their drugs taken away don't they go they go through withdrawals?"
Answer: Yes, usually.
When you answered my questions at your deposition were you telling the truth?"
"Yes." House said with the slightest hint of a smile.
"And isn't it true that you took off while you were working on Mr. Lawrence's case to place a bet on the Derby at the Off-betting parlor on Winston?"
"Yes."
"No further questions." Plaintiff's counsel sat down.
The court asked MacBeth, "Redirect?"
She stood and turned to face the witness box. "Dr. House, who is Valdemort?"
"A villain in Harry Potter." (There was laughter from the jury.)
"And who was Valedmort to you?"
"An orderly named Paul Anderson that I paid to slip me Vicodin while I was in rehab."
"So you went to rehab but never went through withdrawal?"
"Yes."
"What happened to Valdemort?"
"His extracurricular activities were stopped when he was fired by the Dean of Medicine, Lisa Cuddy.
"And when did you go to the betting house for the horses?"
"I went on my lunch hour while we were waiting for tests to come back."
"So, was there anything you could have done during this interlude?"
"Plenty I could have done, but not for Mr. Lawrence." (Again laughter.)
"No further questions."
The whole morning had been taken up by House's testimony. The afternoon was taken up by the first expert, Dr. Gastone Revelier, a pain relief expert who testified that House would not have been high considering his extensive nerve pain from his leg. He showed a PET scan of House's brain and explained that House's body would have been using the drug to quell the pain and there would be none left over to activate the pleasure receptors. Despite using double the dose of Vicodin, House was not getting high.
The expert, G. Gordon from Vanderbilt University was called next. MacBeth established that not only was Gordon a brilliant pulmonary and critical care physician, but well recognized as the guru of Boerhaave Syndrome. He had written numerous well recognized medical articles on the syndrome. He was incredibly persuasive and told the jury that, in light of the fact that the Xray did not show a perforation and the Lawrences failed to note the history of alcohol abuse, the doctors pursued the right course of action.
"Most important was the fact that the XRay failed to show the tear. Unfortunately, this happens about 15% of the time. I cannot fault Dr. House for his actions; I would have taken the same steps to diagnose the patient."
"Thank you. No further question."
After the day was over, MacBeth, House, Cuddy, Wilson, Jessica and the team went out for drinks. MacBeth had ordered a round of drinks while they waited for Dr. George Gordon to get off the phone. Dr. Gordon came to the table.
"Georgie, what do you want to drink?"
"Ah Mac, you know what I want..."
"Alright, waitress, please bring us a Martini, shaken, not stirred. Oh hell, make it two."
She smiled at the people at the table.
George patted MacBeth on the back, "Mac, you did it again. You were brilliant, perfect timing and no unnecessary questions. But as good as you are as an attorney, I still wish you had stayed at Mass General with all of us. When you left, it was miserable. All the laughter was gone."
Wilson asked, "You were the attorney for Mass General?"
George laughed, "Attorney? We were interns at Mass General but after our internship MacBeth left to go to law school."
MacBeth looked up and saw everyone's jaw drop. She looked back at them as if they were all nuts. "Si no abres tú boca las moscas no pueden entrar."
"Huh?" Chase asked.
MacBeth took a drink. George answered, "If you don't open your mouth the flies can't enter."
Cuddy asked, "You went to med school?"
MacBeth shrugged and smiled sheepishly. "I went to Harvard as my undergrad, then Hopkins for med school, went back to Mass General to do an internship, left after my internship was through and went to Hawaii to go to law school. I thought you knew all that?"
They all shook their heads "no."
They appeared so stunned that George looked at them and said, "You all look like deer in headlights."
MacBeth grabbed her drink and turned to House. "Greg, I'm pretty sure we'll have a verdict tomorrow. I think after closing it won't take long and they'll bring the verdict back." She looked at everyone, "When it comes back in our favor, I don't want any patting on the back or signs of happiness or victory. This woman's husband is dead, remember that."
House snickered and finished his drink. "You're cocky, aren't you?"
"To paraphrase what Holmes told Watson, it's just as much a deviation from the truth to underestimate oneself as to overestimate oneself."