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: Thanks for keeping the faith! (And I know this isn't technically a 'turn of the screw,' but I'm not good with chapter titles.)
Chapter 13: The Turn of the Screw
"He is more than entitled to sue," Cuddy said. "But I don't have to tell you that." She leaned forward, hands clasped together in sincerity, "I'm sorry this happened. It's…it should never have happened." She shook her head in sympathy.
"I…okay," Stacy said with a conceding nod. She'd yelled enough already and Cuddy had done everything appropriately. "What happens now?"
"Right now we wait for the MRI," Cuddy explained. "Depending on what it shows, we will either conduct further tests or begin treatment." She paused. "But based on the lab results, we will have to choose a course of action quickly—"
The door opened and Cuddy cut herself off, glancing expectantly at the tech who had stuck her head in.
"Dr. Cuddy," she said holding up a folder. "The scan you requested…"
Cuddy and Stacy both got to their feet and crossed the room quickly—Cuddy moving with a professional stride and Stacy with a worried half-lunge, half-scramble.
"Thanks," Cuddy said taking the folder. She glanced at the radiologist's note and stuck the scan on a lightboard, flipping the switch.
She did a double-take—something that didn't go unnoticed by Stacy.
"What is it?" Stacy asked immediately.
"That's…" Cuddy stared harder at the scan, "…extremely rare," she finished, talking to herself more than Stacy. She stared for another beat before she remembered Stacy was waiting for an explanation. "It's a clot," she said.
"Clots are rare?" Stacy asked.
"This one is," Cuddy responded, again as if she were speaking to herself. "But despite its origin, the treatment is the same." She sighed a little and put the scan away, indicating that Stacy should sit down.
Stacy stood her ground, her gaze level with Cuddy's.
"Greg said that you might have to amputate," Stacy said evenly. She reminded herself that this was easier for her than it was for him.
"He did?" Cuddy said, though she didn't seem too surprised. She nodded, her mouth forming a small line. "Amputation is the best option in this case."
"He was strongly opposed to it," Stacy said. If that was the worst, she could handle the rest. "What are his other options?"
"I should really discuss this with both of you," Cuddy said, gesturing toward the door with the scan.
"If amputation was the shock option I had to sit down to hear, I'm sure you can tell me the others between here and there," Stacy said impatiently. "He'll know them already, but I don't."
"Amputation is the best option by far," Cuddy said. "It's very safe and his recovery time would be negligible compared to other options. If we don't amputate, the next best option is debridement. A surgeon would cut out the dead muscle and remove the clot, restoring blood flow."
"Let's walk and talk," Stacy interrupted.
Cuddy nodded and they left her office for the elevators walking shoulder to shoulder.
"The problem with debridement and by-pass is that even though the dead muscle has been removed, all of the toxins are still in his body, which will make both the surgery and the post-operative period more dangerous," Cuddy continued. "The toxins released by muscle cell death made him sick in the first place, shutting his kidneys down this morning and affecting his circulatory system. We've been able to counteract that so far but if the leg isn't removed, his body will have to process those toxins."
"Even if you remove some of the dead muscle?" Stacy asked.
"Yes," Cuddy answered.
They reached the elevators and Cuddy pressed the 'up' button. She turned to stand squarely in front of Stacy and lowered her voice a little to discourage eavesdroppers.
"In addition to debridement being more risky surgically, dead muscle can't be replaced once it's removed. Depending on how much muscle is affected, he may not be able to bear weight on his leg or move it at all."
She paused. Stacy's frown deepened.
"If we only do a debridement, he may not be able to stand or walk without assistance. It's also possible that he may not be able to walk at all," Cuddy said.
Stacy's face fell.
"But if we amputate," Cuddy continued, "he would be fitted with a prosthetic leg and while he might not be able to run, he would almost certainly be able to walk and move on his own after a period of adjustment. Amputation spares him the post-op complications of filtering toxins and provides him with the best outlook by far."
Stacy paused, waiting for her to continue. She didn't and the elevator arrived.
"That's it?" Stacy said as she boarded the empty car. "Those are his only options?"
"Those are the two best options," Cuddy said following her.
"I doubt he'll change his mind about amputation," Stacy said. She pressed the button for the ICU floor. "Is there any way to tell how much muscle you would have to remove?" she asked.
"It's difficult to tell," Cuddy said, "but based on the placement and size of the clot, and the delay in treatment, it would probably be more than half of the major muscles in the quadriceps group."
"Oh my God," Stacy said. "All this in just a few days? If we had come back in Saturday or even yesterday—"
"—there's no way to tell how much difference time made in terms of muscle death," Cuddy interrupted as the elevator reached their floor and they got out. She put a hand on Stacy's shoulder. "It's hospital's fault, not yours."
Stacy had a reply ready when she glanced down the hall and saw Wilson standing outside House's room with a chart in his left hand. But instead of looking at the chart, his head was bent and his eyes were on the floor, his posture suggesting loss and defeat.
She exchanged a worried glance with Cuddy and the two of them hurried toward him.
"What happened?" Cuddy asked as she swept up to Wilson.
Wilson jumped: he hadn't heard them coming. Their faces reflected the same worried look his held.
"His lytes nose dived," Wilson said, passing House's chart to Cuddy. "He's okay," Wilson said, turning to Stacy, who'd already noticed that House's room was dark and quiet, and trying to smile, "he's just sleeping. He'll feel better when he wakes up."
Wilson turned backed to Cuddy and set his face. "What did you find?"
Cuddy handed him the MRI folder and the two of them fell to discussing the specifics of House's case.
As they talked, Stacy found herself staring hard into the dim room, trying to discern whether he was awake or not…and how pale he was…and, her stomach tightened, whether he was that horrible shade of ashen grey again…whether he'd lost all of the day's hard-won progress and was back in the same condition as this morning. She took a few blind steps, not hearing the discussion behind her until it stopped.
She waved a hand at them, not looking back, and went to quietly open the door.
Cuddy and Wilson watched her go, exchanged a nervous glance, and fell back to the part of this they were most comfortable with: the medicine.
Stacy slid silently into the room and stole over to the bed. She'd spent enough time in this position to know instinctively whether he was okay in just a few seconds. The heart monitor was beeping steadily and his face told her he was asleep, not unconscious: he was okay. Her stomach unclenched and she breathed easier.
She was just about to step quietly to away when House stirred.
"That's kind of creepy," he murmured. He slowly opened his eyes and blinked up at her, smiling tiredly. "Standing there like that. Could really scare a guy."
"Sorry," she said, beaming back at him. He looked tired and drained, but he was awake. He was joking even.
House motioned for her to turn the light on. "What did they find?" he asked as he pushed himself up.
Stacy hesitated. "I shouldn't be the one to tell you," she said. "You'll have questions." She indicated to the hall. "They're outside." She paused, reluctant to leave, even if it was just to step into the hall.
House impatiently waved her out of the room and watched her talk briefly to Wilson and Cuddy. Both doctors looked at him at the same time and he saw poorly-concealed pity and trepidation on their faces. He waved at them. Pity was no good to him; he wanted answers and action.
Finally they started toward the door, but not quickly enough for House. Wilson's pager went off as they crowded into the room.
He read the small screen. "911," he said. "I have to take this." He looked pointedly at House. "I'll stop by later." He nodded quickly at Stacy and Cuddy, hesitated, then left at a fast trot.
House ignored the event, staring at Cuddy instead. She looked nervous and she wasn't approaching him like she should be: she was hanging back with Stacy. How did someone who seemed to fear giving a diagnosis get to be the associate dean?
"What did you find?" House barked.
Cuddy stepped closer. "The MRI revealed the problem," she said carefully.
House gestured impatiently. "C'mon," he said, "don't spare me. What is it?"
Cuddy took a deep breath. "It's an aneurysm…in your right femoral artery. Saccular."
"And?" House said, again impatiently. If he could have tapped his right foot on the floor, he would have. "Obviously it hasn't ruptured."
"No," Cuddy said, "it hasn't."
"Thrombus," House said immediately. The years of having his natural inclination toward total objectivity cultivated by the theory and practice of medicine had never been more of a blessing than they were now. Too busy making a diagnosis, he didn't feel a thing. But it couldn't last.
Cuddy nodded slightly, a pained look on her face. "Over eight-five percent occluded."
"Infarction," House said, swinging his fist at nothing, as though he'd known it all along.
"Yes," Cuddy confirmed.
House hit the bed hard with his right fist and looked away from Cuddy and Stacy to the opposite wall, jaw clenched tight.
Stacy approached him tentatively. "Greg?" she said cautiously.
He didn't answer, his chest rising and falling quickly. The room was silent for a moment.
"Four days," House ground out, still not looking at anything but the wall. "It took you morons four days to figure that out."
"Yes, it did," Cuddy said. "I apologize. I'm going to oversee your treatment myself now." She took a deep breath. "The best option at this point is amputation."
"No," House said firmly, turning his head quickly to glare at Cuddy.
"Then we'll do a debridement," Cuddy said.
"Wrong again," House said. "Here's what you're going to do: you're going to remove the clot and restore circulation now—I've had nothing to eat and almost nothing to drink in over eight hours, I'm ready, all you need to do is find me a surgeon—and once the cellular waste has been eliminated, then we'll talk debridement, but I am not going to let you chop my leg off because a bunch of idiots didn't order the right tests."
"That's not possible," Cuddy said. "We don't know how long the artery has been occluded, but based on your symptoms, the muscle has been deteriorating since Friday. Your system can't process that much waste. We'll remove the clot, but we have to begin debriding now."
"No," House said firmly. "Not while the tissue might be viable."
"You were admitted this morning in acute renal failure caused by the leakage of cellular waste," Cuddy said matter-of-factly. "Your kidneys are still unable to process the amount of waste they're receiving now—they won't be able to handle all the toxins they'll be bombarded with if we restore circulation without debriding. We have to do the surgery. The necrotic tissue has to be removed. If there's too much—"
"I don't care what you find," House said stiffly.
"It may become necessary in order to save your life," Cuddy said in a caring yet firm voice.
"I like my leg," House said with stoic understatement. "I've had it for as long as I can remember."
"Honey," Stacy said in her best soothing, convincing tone, "I love your leg as much as you do."
House wasn't listening. "They're not cutting it off," he declared.
"Amazing advances have been made," Cuddy said, trying a new tactic. "Kids with prosthetic legs are running the 100-meter dash in twelve seconds."
"Yeah, they're just not as pretty," House snipped in a half-growl, unwilling to let this go on any longer. He knew what the problem was, he knew what to do about it, and he wanted it done immediately. "Do a bypass," he said, "restore the circulation."
"Amputation is safer," Cuddy pointed out.
"For you or me?" House said, his voice betraying some of the bitterness he felt.
"The blockage of blood flow—"
"Four-day blockage," House interrupted nastily.
"Yes," Cuddy said. "It caused muscle cell death. When those cells die, they release cytokines and potassium—"
"If you restore the blood flow instead of just lopping it all off," House said derisively, "then all that crap gets washed back into my system. The cytokines could cause organ failure, the potassium could cause cardiac arrest. On the other hand, I may just get the use of my leg back."
"The post-operative pain alone—"
"I'll get through it," House said dismissively. "I understand the risks, you're in the clear. Go schedule an O.R."
Cuddy nodded swiftly and left.
Stacy watched Cuddy go and turned immediately to House. "God, you're an idiot," she said, angry with him for being so stupidly stubborn and angry with circumstance for letting this happen in the first place.
"I think I'm more of a jerk," House said jokingly, attempting to shrug the situation off. He was angry and scared and he didn't want to go three rounds with his girlfriend right now.
But Stacy wasn't having any of his attempted deflection. "I'm not being glib," she said, anger beginning to mix with fear and despair. "And I'm not being cute. I don't want you to kill yourself."
"I'm not gonna die," House said seriously, but with a hint of an eye roll.
"Oh, I feel completely reassured," Stacy said in a bitter, biting voice.
"Stace, I'll be fine," House said sincerely, doing his best to calm her down.
"Cardiac arrest! Organ failure!" Stacy incredulously. "Greg, your kidneys were failing a few hours ago. You're already sick and this is going to make you worse. Why would you do this to yourself? Because you don't want to look different?"
"They screwed up, Stacy," House said passionately. "They missed it. I'm not going to let them have my leg just because it's safer for them. I'm young, I'm healthy, I'm in good shape. I can do this."
"You were healthy," Stacy shot back. "You're not any more. Greg. You could have died this morning."
"I was fine," House said dismissively.
"You were not fine!" Stacy half-shouted.
"Can we not fight about this?" House said peevishly.
"Okay," Stacy said, sitting down. "God knows you're right about everything," she muttered angrily, her hands nervously fluttering around of their own volition, "especially the things you're wrong about."
House tried to glare at her, but he couldn't pull it off. He didn't feel like fighting. …well, he felt like he could throw a few punches, but not at Stacy.
She saw his countenance change and her expression softened too. "If you do this…" she began unsteadily, "what happens?"
House took a deep breath. "The procedure is very simple," he said. "It won't take long. After that…I'll feel bad for a few days, and once all of the crap is out of my system, I'll be fine."
"That's it?" Stacy said unbelievingly, "you'll be fine? Just like that?" She snapped her fingers. "No cardiac arrest? No organ failure?"
"Those are potential complications," House said evenly. "Informed consent, that's all."
"No, Greg, that was a lot more than her making you aware of potential complications," Stacy said. "This sounds extremely risky."
"Every medical procedure entails risk," House countered.
Stacy stared at him, unconvinced.
"It's not as safe and clean and nice as amputation," House said contemptuously, "but it raises the odds of me getting my leg back considerably."
"And the odds of you dying?" Stacy asked.
"I already told you," House said, becoming even more frustrated than he already was, "I'll be fine." Why was this so hard for her to accept?
Stacy sighed. He wasn't going to listen. "I just want you to be okay," she said. "You're choosing the most risky option. I can't help worrying."
House met her gaze. "I have to do what I think is right," he said. "I won't be able to live with myself if I don't."
"You might not live at all if you do," Stacy said with earnest sincerity.
"I'm not going to go through this again," House said. "It's my decision and I've made it. I understand that you're worried, but I have to do this."
"I know," Stacy said bowing her head. "I just wish you had better options."
"So do I," House said with a small smile.
Stacy let out a long sigh and took his hand in hers, kissing it quickly. "I just want you to be okay," she said softly.
He smiled and rubbed her hands.
"So," she said. "What do we do now?"
"We wait for the doctor to come back," House said. "They can do this today. In a few hours."
"And then?" she asked.
"We see how it goes," he said.
Stacy sighed again. "Okay," she said. She would have to accept that this was his choice. What else could she do? "Do you want me to get you anything from the apartment?" she asked.
"Oh, I dunno," House said. He smiled wryly. "I could use a drink."
"So could I," Stacy commiserated. "Are you sure you don't want me to call your parents?"
"I don't think I can handle my father right now," House mumbled.
"You never can," Stacy said.
"Call them when I'm dead," House muttered, "not before then."
Stacy gave him a hard look. She knew his gallows humor kept him sane, but it was difficult to hear at a time like this.
"It's not like they can do anything," House explained with a shrug. "They'll just be needlessly worried and an imposition on you."
Stacy conceded that point. "Do you have a phone number in case something happens?" she asked.
"Ask Wilson," House said sarcastically. "My mom loves him."
"Don't pout," Stacy admonished, "it makes you look wimpy."
"Am not," House muttered. He couldn't do witty banter right now.
The conversation lulled and House glanced out the window at the nurse's station where Cuddy was on the phone, then to his leg. He tried to lift it again, straining but getting nowhere.
"How is it?" Stacy asked, watching him closely.
House glanced quickly up at Stacy, then back to his leg. "Can't feel it," he murmured. He lay back and rubbed his face tiredly, pausing on his chin. "Still need to shave," he said.
"You do," Stacy said scratching his chin. "I've got your razor—"
"Here she comes," House interrupted, his eyes tracking Cuddy as she approached the room. He sat forward again and Stacy's hold on his hand tightened.
"You're in first thing in the morning," Cuddy said.
"Surgeons go home before five now?" House snapped. "I know you can get me in. Stop wasting time."
"Your kidney function is still poor," Cuddy pointed out, "if we restore circulation now you'll need dialysis. Your body needs to recuperate before it's attacked again."
"So you're treating the symptoms instead of the cause," House said snidely, "and meanwhile my leg continues to rot."
"You need your kidneys more than you need your leg," Cuddy pointed out.
"I can get new kidneys," House said, "I can't get a new leg. Bump me up."
"No," Cuddy said. "I can't." Her eyes flicked to Stacy and back to House in a less than a second. "Medically I can't," she added, looking slightly nervous.
House caught the glance at Stacy and read it for what it was. "You're worried about me suing you?" he said in exasperation. "You're not going to do it now because you're worried about your malpractice insurance premiums?"
"No," Cuddy said evenly, "I'm not going to do it because it's wrong. Medically, ethically, and, yes, legally. Morally. Even logically. Logically it's wrong."
"Logic got me where I am now," House grumbled. "It's done me no good."
"I can't do this," Cuddy said. "I won't."
"You can and will!" House shouted.
"Organs are more important than limbs," Cuddy said. "No surgeon will take you in your current condition. Not at this hospital."
"Then find one who will and transfer me," House growled.
"Greg, you're being unreasonable," Stacy said.
"It's not unreasonable to want to save a limb," House said.
"It is if you're risking your life to do it," Stacy replied. She turned quickly to Cuddy before House had a chance to speak again. "What about options?" she asked. Make him understand her eyes said.
"There are no other options," House snapped before Cuddy could answer. He addressed Cuddy in a low, cold, angry tone, "Postponing surgery not only lessens my chances of regaining utility, it also does more harm to the major organs you're trying so hard to protect. It's idiotic to wait."
"Your lab work shows marked improvement in kidney function every time we test," Cuddy said, "but they're still working at less than half normal capacity. The current treatment has been effective; if we continue it, by tomorrow morning your body will be much better prepared to process cellular waste and then we can do it your way."
Cuddy didn't wait for House to protest this time. She removed a piece of paper from his file and offered it to him.
House stopped talking and looked dully up at her. He knew what that was and he had a good idea of what it said.
"What is that?" Stacy asked, sensing that Cuddy had House cornered and that both doctors knew it.
"His blood gas results from half an hour ago," Cuddy said without taking her eyes off of House. "Dr. Wilson said you passed out twice. If your electrolytes become this imbalanced after only hour without support, you will need new kidneys by morning. If on the other hand you wait—"
"I know, I know," House said irritably. "You run as much saline through me as possible, load me up with electrolytes, and then undo all of that. The longer you wait, the more prepared my kidneys will be and the more crap they'll have to wash out." He paused with a deadly stare. "Or maybe this clot will detach from the artery it's hanging out in now and go straight for my lungs—that would be so much faster," he sneered.
"The E.R. team assessed that risk this morning and Dr. Wilson and I considered it again this afternoon," Cuddy said perfunctorily.
"And yet it could happen, just like I could be fine if you do this now," House said.
"Your kidneys won't be able to handle it—"
"You know what?" House said. "I was tired of this conversation before it began. I'm leaving. Bring me a phonebook. No, better yet, get Wilson in here. Someone will do this."
"Greg—"
"No, Stacy," House said. "The longer they sit around doing nothing, the worse off I am in the end. I'm not going to let that happen."
"As your doctor, I strongly advise against a transfer," Cuddy said.
"That's great," House said, "but I'm stable and I'm ready to leave. Now that we're done with the legal chit chat, go page Wilson."
Cuddy eyed him carefully, waiting a moment before she answered. Everything about him screamed 'I'm serious.' She had no legitimate reason to keep him here and one of the hospital's lawyers was in the room. Her hands were tied.
"All right," she said at last and exited the room.
"You know we have 20 fewer malpractice suits than any other hospital in the region," Stacy said.
"The only numbers I care about are the minutes and hours between this moment and removing that clot," House said stubbornly.
"And you think James is going to help you?" Stacy said.
"He'll understand," House said.
"What if he doesn't?" Stacy asked.
"He will," House said firmly.