Chapter 21

House was back in his office palming the gray red ball. The girl had pneumonia from the resistant staph and she was not doing well. They has started her on Vancomycin and so far the reduced fever had been the only positive sign of recovery and that had been from the antiviral. He was actually surprised that the antiviral had begun to work at all, because he had begun to think she had been fighting this for more than 48 hours and the antivirals were not going to do any good, but perhaps the original runny nose had been caused by the MRSA (Methlin Resistant Staff Aureus). He looked into the conference room where and unprecedented five of his former fellows were gathered. He rose wearily and went to join then throwing the file on table. If the girl continues like this she is going to die within the next 48 hours.

"We've done all we can for her. We've diagnosed her what else are we supposed to do?" said Forman.

"Oh I don't know? Perhaps not send her back to her parents in a body bag?" House retorted looking at Forman.

"What did they teach you at the facility, House? One thing I always admired about you is your refusal to kiss ss even when it was about saving yours. We know you've always been about the puzzle and not necessarily the cure. The last time I looked at that door it read Diagnostics, not Miracle Cures."

"If this your attempt to be like me. I'm sorry to report, you have failed miserably. It's always been about winning against the disease not just knowing it's name. I guess they had to take the miracle cures sign down when I left. Never fear it'll soon be up again. Just think about when you were in that isolation room. Perhaps that will motivate you since she doesn't have enough energy to jab you with a needle."

As well as the ventilator they had put in a chest tube. Her white cell count was still elevated her blood pressure was low and 13 and Taub had returned with new information from Appleton academy which had since closed it's doors and were having all the students tested. The silly room roommate had had a Flu party in her room after roommate had been hospitalized.

"What the heck, don't tell me they want to get the flu so they can go home, or shut down the school. Have all the idiots tested for MRSA as well. By trying so hard to miss a week of school they just may have lucked up on a recipe to miss the rest of their lives."

Cameron had talked to the parents an roommate and confirmed she was a champion tennis player who was competing at the national level despite her history of asthma. So since she was an athlete she could have picked up the infection in a gym or any of the various places she had competed. In the end up it turned out to be the school. CA-MRSA may be treated with Vancomycin or other antibiotics that have proved effective against particular strains. Although Vancomycin saves lives, it becomes less effective over time.

Alana had contracted a secondary bacterial infection, which had led to pneumonia. Hoffman wanted to immediately jump to the conclusion that the hospital was to blame, that the MRSA came from the infection in the PEDS ward. He was controlled, but he turned an icy look toward Cuddy and asked what was she doing to eliminate the staph in fection in the hospital. Remembering how guilt ridden and obsessive Cuddy could be about this kind of thing, House quickly disabused him, jumping in to say, that his daughters infection was a different strain from what was in the Hospital .The strain in the Pediatric unit is VRSA, Vancomycin Resistant Staph Aurious. Your daughter's infection was picked up in the community, perhaps at that expensive prep school you send her to that can pay for a hack that should have retired years ago to come in and run tests instead of sending them straight to a hospital in the first place. She probably picked it up at the school or at a gym. I understand she's champion tennis player. If she had the variety that we have here, the Vancomycin wouldn't do anything to it.

"As far as I'm concerned It's not doing much. You need to fix this," he insisted eyeing both of them and suddenly making a desperately abrupt turn for the windows with his fist clinched but hiding wet eyes as he looked toward his wife who was staring into space wringing her hands. Just as House and Cuddy turned away in relief, he added, "We almost lost her when she was born, she was a preemie, born two months early. I know she is a fighter, if you just beat this thing back she can win." And then almost as an afterthought he asked. "Have you closed down the PEDS ward. Sending children there with H1N1 when there's an staph infection out break is a recipe for disaster."

"Already done.", Cuddy answered back vigorously. "We have an environmental bio hazards team disinfecting and everyone who works in PEDS is being tested.

"I didn't want to tell her parents but this kind of complication has been found in nearly 30 percent of people who died between May H1N1." House commented to Cuddy as they walked out of the private waiting room the Hoffman's had occupied since the girls admission. The girl was on a ventilator, and she was heavily sedated to keep her from thrashing around and pulling out the equipment. The strong antibiotics began to work on the infection, at first, but then she took a turn for the worse .

House's beeper went off.

Alana Hoffman had developed a pleural effusion, a collection of fluid between the layers of tissue that line the lungs and chest cavity, and a film of scar tissue on the surface of her lungs, a chest tube was inserted but her outlook was grim. This situation was a rare complication of the flu but so far it seemed like this girl was batting 0 for 4.

"The only treatment left is to go in and scrape and peel the scar tissue off the lungs", House said looking at Chase. "Otherwise, the scarring could harden and prevent the lungs from fully expanding.

"If this girl dies is it going to kill your chances with the board? Surely Hoffman can't get away with dumping you. His daughter came in with a lethal combination of disease," insisted Chase.

"I'm not worried about Hoffman, right now I'm worried about getting Cuddy to approve this procedure."

House entered Cuddy's office and he realized that despite their personal relationship, he still felt that grip of challenge when he faced her desk. It wasn't fear but a feeling of sharpness, an exhilaration that was a combination of sex, risk, battle, and a macho need to show he could get the upper hand whether by manipulation, domination, or intimidation. Even though they were more frequently on the same page now, as if the mixing of their pheromones had some how aligned there minds. This was much more like a play now acted out in the positions and the attitudes they knew by rote from years of enactment. In some ways Cuddy refused him more now, he wasn't sure if it was because she wanted to prove to him that just because he was in her pants, it didn't mean he could control her mind. The other alternative was she still doubted his sanity and was determined to keep a tighter reign over him. He felt it was more important for him to win the actual battle these days, because he was less inclined to go behind her back, the cost for that kind of behavior was way too high on a personal and professional level. Even though it was a form of foreplay, and they enjoyed it, at some point during the play acting the real battle would begin with a clash of steel swords. Their respiration would increase and they would stare at each other in breathless impasse.

"I think we need to go in and scrape the Hoffman girl's lungs, they are scarred, tight and not expanding as they should. She just had a pleural effusion and we've inserted a chest tube."

"That's invasive surgery House. How bad are her lungs? What about the ECMO? Won't that be a less invasive way to help her? The research out of Australia and new Zealand sound good."

House had mentioned ECMO (Extracorporeal Membrane Oxygenation) to her earlier that day and he could tell she had read the article in the last issue of JAMA. It was a machine that would basically put more oxygen in her blood and boost her immune response.

"Yes, read that. It can't hurt, but I don't think it's going to be quick enough. She needs more lung capacity or she won't last long enough to benefit from ECMO."

"House, other patients are being saved without such invasive techniques. What about that new IV antiviral Peramavir?

"FDA has not approved Peramavir. It's experimental. Only a couple of doctors have gotten special permission to use it on compassionate grounds. Paper work could take days. I think a EUA (Emergency use authorization) is on the table that would allow the government to stockpile the drug and reduce the paperwork but hasn't happened yet. Again too long." He saw her bite her lip in hesitation, he never saw Cuddy hesitate. She looked tired and he was worried about her. She had so much on her shoulders and he knew a lot of it was surrounding him. His voice became suddenly gentle even though it might be a tactically imprudent. "Cuddy you need to forget that this is the daughter of the Board chairman. She's just like any other patient. Your fear not to kill her will be in the end, what ends up killing her."

"Why didn't you just call me a wimp and be done with it," she sighed looking up at him with a weary smile. Okay, House, but Edmonds does the surgery, Chase can assist. I'll go get permission from the Hoffmans."

Chase, assisted on the surgery which was performed by his former boss head of general surgery. David Edmonds. Alana, improved steadily after the invasive surgery.

"She's climbed the hill up out of a debiliting illness before and I'm sure she will do it again.," said Hoffman. He was on the point of shaking House's hand when House's beeper went off. In spite of everything the girl was again in respitory failure and had to be reintubated. Her organs had begun to shut down and there was fear her left foot would have to be amputated.

Cuddy was again there comforting Hoffman and his wife. That's when House pulled her aside and asked about the Peramavir. "Everything we've done has helped with the results of the disease, we are still actively trying to put a halt to thing, right now it's like a runaway train and if we don't stop it this girl is not going to last another 12 hours. We may even have less. I think it's time to call in the big dogs, we need to try the IV antivirals, namely Peramavir. The clinical trials do look good. A couple doctors have gotten approval with excellent results on patients who were minutes away from having limbs amputated and multi organ failure. I think we have a case for compassionate grounds to appeal to the FDA. So far 20 patients approved. Eight survived two died and Pneumonia got better everyday. We only get so many chances at this Cuddy and this girl's luck is running out.

Cuddy nodded. "Get your team started on the paperwork and I'll talk to the Hoffmans. I think he knows someone at the FDA, perhaps he can put some speed on it."

House was with his team at the white board, but instead of listing symptoms he had listed the things they had tried to fight the infection and the options that were left.

"There's only one thing left we can try, for compassionate appeal to the FDA for this drug. It's 4 hours of paperwork and since we barely have that much time, Cameron and 13 could you start it right away. No that's not sexist," he replied seeing thirteen's narrowed eyed resistance. "I know Cam is an ace at that kind of thing and you have been involved since presentation in the ER. Besides in most cases same sex working partners aid in mental focus. That's the whole point of schools like Appleton's, but in this case, it may only be half right." He said turning to give 13 an incredulous look. " Does this mean you can never focus? Just remember Cam is a married woman. We need this paperwork fast accurate and persuasive. Touch bases with Cuddy, she has her hands full with the staph breakout in PEDS, but she may be able to give some shortcuts, or know of some strings that can be pulled at the FDA."

"Have you gotten approval from Cuddy?" 13 asked.

"Stop stalling and get to it. Cuddy has already approved. The only alternative is death. If this girl dies I don't want it to be because we couldn't get FDA approval in time."

"Funny these days, how House seems to obtain approval telepathically, when it's used to take a trip to Cuddy's office. It reminds me of the early days of those two." Taub nodded towards 13 and Foreman. "How they'd arrive here and expect us to buy that they'd done a whole DDX in a two minute meeting in the lobby."

Apparently Hoffman did know someone at the FDA and even tough they had fill out all the paperwork they got the drug in record time. Within 48 hours the girl was out of the woods, breathing on her own and conscious. Triumphantly House went to Cuddy's and crawled in bed beside her giving her the good news about Alana opening her eyes and recognizing her parents.

"That's great Greg," she said sleepily waking up and feeling him freshly showered, but heavy boned and exhausted beside her. She reached around his back rubbing his shoulders in comfort. "We found the staff carrier in Peds, a med student. He's on an antiviral regime and released from rounds until it's gone, so it looks like we've both wrapped up our problems. I envisioned we'd be celebrating now," she said nuzzling her head into the warm space between his head and shoulders.

"Celebrating how?" he said archly, sliding his hand around to her back to pull her closer.

"You know." she said softly as she found his mouth and even through his tiredness a flash of passion seared through him as her delighted hands found him totally bare.

"If you are too tired. I understand. It's been a hard week for both of us. We can celebrate tomorrow," she continued giving an exaggerated yawn and turning her back on him. Suddenly she found herself grabbed and pinned back against the mattress as she felt his body cover hers and all tiredness left her.

"If I am ever that tired. You have my permission to trade me in." he insisted insistently biting her neck and since I'm not adverse to pill popping there will always be help to be had."

"If you need help we will get you some, but I don't think you do." she feeling his sudden tumescent burgeoning against her thigh.

"You're all I need he said softly, slowly moving her lace and cotton nightie up her torso his mouth following it in a rain of kisses.

"Oh, Greg, I've missed you." she said in tight voice that transformed into mindless moaning as he begin to give attention to her breast."

"We've been together every day." He insisted.

"It's the nights I miss." she said softly.

"How many nights?

"Three." she murmured.

"We can make that up if we both play hooky tomorrow. What do you say boss lady?"

"House, stop trying to get favors when I'm under the influence." she groaned.

"Is that a yes? He asked, tickling her so that she dissolved in giggles.

"No," she whisper defiantly

"Okay, if you say yes in the next 15 minutes. I win." He said proceeding to

push her to the edge of her control.