Alice slept with her head on Chase's shoulder until she was shaken awake. "Honey, they've got a sick man up front. They need a doctor."
"Send someone else. Wake Taub and Park up. Make them do it. I'm on vacation."
"They don't know what's wrong with him." Park leaned over their seats to speak. "He's got a fever and chills, and a headache. It could be nothing, or," she lowered her voice so she couldn't be overheard, "the whole plane could be in danger."
They stood, heading for where House, Taub, and Foreman were taking up seats by a man wrapped in blankets. One of them had taped a piece of paper with his symptoms written on it to the wall. "His eyes are turning red. Could be a hemorrhage," Foreman offered.
"In both eyes? Seems like a big assumption," Taub rejected. "How long were you in Hawaii?"
"A week, for my sister's wedding and then to go snorkeling and diving," the man said, shivering. He turned to the new arrivals, introducing himself. "I'm Steve, by the- oh God, my stomach."
"Are you going to vomit?" Park asked, grabbing a trash can as a stewardess passed by, giving them a concerning look.
"No, no, it feels like I was punched in the gut by an entire pro football team."
House added, 'abdominal pain' to the list. "Well? What's up next? Hopefully something we can test for on the plane."
"Abdominal aneurysm," Park offered.
"No blood in stool samples," Taub countered. "What about diverticulitis?"
"That's uncommon in people under 40. How old are you?" Alice asked.
"27."
"That's also something that usually involves blood in stool samples," Chase added. "Gastroenteritis can present without it, though."
"He's not vomiting though," Foreman shook his head.
"Do you guys not have a clue?" Steve worried, rubbing his shoulder.
"They're DDXing," House told him.
Alice explained further, taking a seat across the aisle from him. "We're all in differential diagnostics. We bat around theories until we find one that fits and test for it. If the test is negative, we revise our theory and keep testing until we hit one that's right. Right now we aren't sure, but as you can see, we're narrowing it down fast."
"Excuse me, do you think he could be contagious?" A stewardess had walked over, looking concerned. She was the one who passed by as Steve's abdominal pain was developing, House noted.
"We're not sure," Park replied. "We're still narrowing it down." She turned back to the group, proposing, "Thalassemia. Are you tired a lot? Little appetite?"
"Look how round he is, that can't be it," House objected. "Surfer boy, you're up."
"It could be a stomach or intestinal abscess," Chase offered.
"Again, weight loss is usually a symptom of a digestive system abscess."
"Usually. Mono," Taub said, shaking his head.
Foreman put on a pair of gloves, having the man lie down before checking his stomach. "Spleen isn't enlarged. For a case to be this bad, it would have to be."
"Cryptococcus." Alice sat cross-legged on the seat across from where Steve was stretched out. "Were you hiking while you were in Hawaii?"
"Yeah. I went on a couple of trails up and down the volcanoes."
"Is your vision blurrier than normal?"
"No."
"You keep rubbing your shoulder. Does it itch?" Alice asked.
"No, the muscle aches."
Park added it to the growing symptom list. House, meanwhile, leaned against the wall. "Red and black, find his bag." Alice and Foreman shared a look, rolling their eyes before going to find Steve's carry-on luggage. They deconstructed it down to the bag itself, finding nothing suspicious.
"He's got no drugs in here," Foreman finally reported.
"Why would you think I'm a druggie?" Steve asked from his seat. "I haven't touched anything worse than a beer since my freshman year of college."
"Because you look like you're coming down from a bad trip," House explained. "But you're not paranoid or anything."
Taub had a different explanation. "We normally search through our patient's' stuff to see what they're hiding."
"That's comforting," Steve quipped, shivering.
"Did you eat anything outside of your normal diet?" Park asked.
"What did you say?"
"Did you eat anything out of the ordinary while you were on vacation?"
"I can't hear you. I... I can't hear anything. I can't hear anything!" Other passengers, who had been a bit curious before, we're now trying to look around the privacy curtain that a stewardess had set up.
Alice put a finger to her lips, showing that he was being too loud. She took a dry erase board down from the wall, erasing where the stewardesses had written who was on snack cart duty every hour. 'Hearing loss is a new symptom,' she wrote, showing it to him as House wrote the new symptom on the list with the others. 'We're going to keep discussing ideas,' Alice added.
"Whatever it is, it's attacking two systems now," Taub said. "We've got to get it before it moves to the brain, if it hasn't already. Hearing loss could be a brain thing or an ear thing."
"He said he was in the forest hiking, right?" Foreman asked.
'Forest hiking?' Alice wrote.
Steve nodded, not wanting to talk for fear of unintentionally being too loud.
"Did he pick anything up or touch the ground?"
'Picked anything up? Touched the ground?' Alice wrote, handing him the board when he indicated that he had an answer that required more than a nod.
'Tripped on tree root & fell into puddle' was his answer.
"Were there a lot of animals around?"
'Lots of animals around?' Alice scrawled. He nodded.
"Leptospirosis," Foreman told them. "It's in contaminated soil or water when animals are around. He came into contact with both. In addition, most U.S. cases come from Hawaii. If he cut himself in the fall, he could have gotten the bacteria into the wound. We treat with anything penicillin-based."
'Right back w/treatment' Alice wrote before standing up. She went to address the entire plane. "Excuse me, ladies and gentlemen." She paused, waiting for people to look up from their books and take off their headphones. "As I'm sure you've found out, there's someone on this plane who is pretty sick. I'm a doctor, and I have a qualified team that's just made a diagnosis. It's very possible that this man will not survive the flight back to Trenton if you don't help me. I need anyone with a penicillin-based drug to give me one or two pills. That's it. Penicillin, amoxicillin, anything like that. If you could please hold them up. Don't be shy, you're saving a man's life."
She walked around the plane, collecting pills that people held up. On her way back to the curtained-off area, Alice stopped to grab a paper cup from a snack cart. She took a seat and began twisting the pills open, dumping the insides into the cup. "I'd say we have about twenty-five, maybe thirty grams of this."
"We can make it last until we hit the ground, then get him to the hospital right away," House said, watching Alice write, 'This will help. You'll be OK but need to go to hosp. Hearing should return, tho."
Sure enough, the man's hearing returned soon after the first dose of penicillin. "Lucky for you, you have the mild strain of leptospirosis. The other one is a lot worse," Foreman told him, handing him the next dose. "You'll need to be hospitalized for a day or two, but you should be fine."