Chapter 24

It was nearly one o'clock in the morning when House rolled over in his bed. He stared off into the darkness wondering why he was experiencing such difficulty sleeping again. He dreaded a relapse in his mental illness, yet he knew that it was unlikely. As often as he enjoyed sleep, insomnia was something that had troubled him for years, maybe even his whole life. He was never completely sure why he had such difficulty sleeping well, but he had a feeling that maybe his restlessness was a result of some underlying emotional conflict. Still, he couldn't figure out why he would have such trouble sleeping on this night of all nights. He'd had a few drinks. He wasn't particularly stressed with his work. In fact, he was very close to a diagnosis now that his team was biopsying a piece of their patient's brain. So then what was it that was keeping him awake?

Surely he wasn't tackling any personal issues at the moment. He and Wilson were on as good of terms as ever, and things with Cuddy were finally returning to the way they used to be. He briefly contemplated whether or not Cuddy could be at the heart of his issues, but he dismissed the thought. He'd come to realize that he didn't really want her in particular; he just didn't want to be alone, and at the time, she had been the woman most accessible to him. Was that what was bothering him? Was he still tired of being alone after all that he had been through? House heaved an annoyed sigh at the thought. He was happy—or rather, he was no longer as miserable as he had been before. He didn't want his life to change. He wasn't even sure if he'd ever be ready for it to change. He'd fallen into a comfortable routine with people whose company he actually enjoyed from time to time (although he would never let them know this). Wilson and Cuddy had become closer friends to him than ever before it seemed, and he was even finding himself becoming closer to Cameron and Chase in recent times. He'd never admit it, but he missed having them on his team. He had always thought that the two of them in addition to Foreman made up the best team that he'd ever led. Perhaps that was why it had been so hard for him to let them go at first. But then why was he still sulking? He had a good—or rather, adequate—team, and he still found time to consult with Chase and Cameron from time to time.

Before he could figure out the reason behind his sleeplessness, though, his cell phone rang on the nightstand next to him, and a digital light shone in the darkness of his bedroom. He briefly considered ignoring the call, but he had a feeling that it might be Foreman calling with the biopsy results. He grabbed the phone just before it went to voicemail and answered it. "Get the biopsy results yet?"

"Yeah," said Foreman. "The plaques are comprised of amyloid proteins."

"So she has amyloidosis?"

Foreman hesitated. "Yeah, but I think she has secondary amyloidosis. The build-up of amyloid proteins alone wouldn't have caused all of her symptoms. She has some underlying condition."

House rolled his eyes. The biopsy hadn't been very helpful then; all of their diagnoses were back on the table. "You'd see amyloid protein build-up with pretty much all of the degenerative diseases we listed."

Foreman knew that House was right. "So how do we know which one she has?"

"Run a genetic test for Huntington's," decided House.

"Don't you think Parkinson's is a little bit more likely?"

"Well the only tests for Parkinson's, we've already done, and we still aren't sure."

Foreman nodded. "If it's not Huntington's, then it's probably Parkinson's. I'll run the test and call you back when I get the results." Foreman hung up the phone and left to draw blood from the patient for a genetic test.

House flipped his phone shut and placed it back in its spot on the nightstand. He didn't even close his eyes, though, because he was already prepared for a dreamless night. In fact, he had lost all hope of sleep about an hour ago, and Foreman's phone call was sure to keep him awake now. He tossed and turned, all the while contemplating possible diagnoses for his patient. What single disease could cause all of the symptoms on his whiteboard? House shook his head violently, both angry and frustrated that he hadn't been able to sleep. He needed the rest to help him think right now, but he knew he would never get any. Damn that maddening insomnia!

Then it hit him: insomnia. Wasn't that the patient's first symptom?

He wondered why one of the least significant symptoms had popped into his head, but then he realized that the plaques' position in the thalamus rather than the hypothalamus wasn't strange at all. The thalamus was responsible for sleep, and growing plaques in the thalamus would make sleeping increasingly difficult. Then he also realized that the plaques were localized to the thalamus, which wasn't consistent with the degenerative diseases that he and Foreman had discussed. If one of those diseases had progressed enough to cause all of the patient's symptoms, then the plaques would probably be found in multiple parts of the brain. There must be something wrong with the thalamus, but what?

What were the other symptoms? House tried his hardest to remember the long list and managed to recall the insomnia, phobias, fever, panic attacks, paranoia, difficulty speaking, involuntary muscle contractions, hallucinations, and sphincter disturbances. What thalamic disorder could cause all of those symptoms?

House mentally ran through a list of diseases before deciding that none of them fit when suddenly, his first hunch reappeared in the back of his mind: insomnia. He knew the answer, it was in there somewhere, but he couldn't quite grasp it.

Of course! Insomnia!

The phone rang again, and this time, House immediately grabbed it. "The test was negative," predicted House.

"Yeah," said Foreman, not really surprised. "It must be Parkinson's Disease."

"It's not Parkinson's Disease," replied House.

"Okay… what is it?"

"What did her parents die of?"

"They died in a car crash. Why?"

"Damn," muttered House. "How much blood do you have left?"

"What? Why?"

"Do you have enough left to run another genetic test?"

"What are you looking for?"

"Check for a PrP gene mutation," replied House. He rose from his bed and started getting dressed.

"You're thinking a prion disease?"

"I'm coming in," said House without giving Foreman an answer. "I'll be there in ten minutes." He hung up the phone, grabbed his cane and keys, and dashed out the door as quickly as a cripple could.

When House arrived at the hospital, he immediately walked to the patient's room and wasn't surprised to find her awake. After all, like him, she suffered from insomnia; she would come to learn, though, just how serious hers was. House was surprised, however, to find Cameron also inside the room, attending to Mirai. "What are you doing here?"

"Checking on your patient," she replied.

"Obviously," he responded, "your being the key word in that phrase."

Cameron left the side of Mirai's bed and approached House. "She used to be my patient."

"Used to being the key words in that phrase," retorted House.

"I was just running a follow-up."

"At two o'clock in the morning?"

"I got stuck with the night shift in the ER, and I thought I would stop by here on my way out."

House stared at her with skeptical eyes. He knew that she was lying; he just didn't know why. "You were at work all day today; you didn't get the night shift. You chose to be here."

"Why would I actually want to be here in the middle of the night, especially with your patient?" She ignored the fact that House knew that she'd been working all day.

"Exactly."

Cameron was saved from having to reveal her true reason for being at the hospital in the middle of the night when Mirai spoke up. "What are you doing here?"

"That's what I'm trying to figure out," snapped House.

Cameron rolled her eyes. "I think she was talking about you."

"Why would she be talking about me? I'm her doctor. Unlike you, I have a reason to be here."

Cameron turned to look at Mirai before returning her focused stare to House. "Care to share that reason?"

House continued to glare at Cameron, but he finally looked at Mirai. "I know what's wrong with you."

Much to everyone's surprise, though, Mirai did not seem hopeful or happy or even the slightest bit relieved. She simply seemed more fearful than ever. She shook her head.

House was confused. If she didn't want a diagnosis, why had she come to see him? Then again, Cameron had nearly forced her to see House. What was she afraid of? "You're afraid of a diagnosis?"

Mirai nodded slightly.

"Monopathophobia," mumbled House.

This statement earned a glare from Cameron. "I thought you didn't have the names of all the phobias memorized," she stated sarcastically.

"Just the interesting ones," replied House casually before looking at his patient. "You're afraid of a definite illness."

Feeling suddenly uncomfortable, Mirai sought refuge in her one distraction: fortune-telling (or in her case, observation). "Y-You are chaotic and unc-conventional."

"You read that on my palms?" snarked House who was already annoyed with the situation.

Mirai shook her weak head. "Your eyebrows." Well, according to ancient fortune-telling practices, she would have gotten that from his eyebrows. Honestly, it hadn't been hard for her to discern that her doctor was chaotic and unconventional from his behavior. It was for that reason that House wasn't very impressed. Nevertheless, Mirai continued her observations. "You are c-chaotic and unconventional," she repeated, "b-but you are also very n-narrow in your own views."

Cameron stared at Mirai, wondering where she was going. She looked at House and noticed that he was still unfazed.

Mirai continued on her same point. "Y-You are c-calculating and intolerable of others—"

"Wow, she's good," House joked to Cameron in an attempt to validate Mirai's statement of the obvious.

"—but you are g-good at assessing the rest of the world."

"Like how I know you're a big, fat phony who's just avoiding the fact that she's sick," House joked caustically.

Mirai nearly frowned but continued her observations. She knew that her doctor was only deflecting his own issues onto her, and that notion led her to her next conclusion. "You're cautious and r-reserved because you are af-fraid of the t-truth."

"Looks to me like I'm not the one hiding from the truth," replied House, and he was about to give her a diagnosis, but she continued speaking.

"Your eyes," she continued, "they're like hers."

House narrowed his eyes in confusion. Whose eyes? Cameron's eyes? He looked at Cameron and back at his patient. "What are you talking about?" He was clearly incredulous and annoyed.

"They're deep," she responded. "It m-means th-that you are cautious and reserved—"

"Yeah, you already said that."

"—but also r-romantic."

Cameron snorted. "Too bad," she joked. "You were doing so well, too." House romantic? Never.

Mirai shook her head. She could see it in his eyes. She could see the way he looked at Dr. Cameron; she could hear the way he talked to her. She could even see how he avoided any personal comment with a sarcastic deflection. She knew that she was right. She delivered the same observation to House that she had given to Cameron. "B-but it also means that you are too realistic, and you n-never let yourself g-get too close to anyone."

House rolled his eyes. This was like talking to Wilson. "Can't we just get to the part where I tell you what's killing you?"

"I'm dying?" asked Mirai with a frown. She shook the thought from her head. "Y-You should t-take some advice from D-Dr. Cameron."

"Why?" House asked sharply. "Because she's gone gaga for the new hubby?"

Mirai seemed sincerely confused by the question. "No," she said, "because I t-told her the same thing."

House smirked, and he stared at Cameron who was beginning to blush. "That's why you're here, isn't it?"

"What are you talking about?" snapped Cameron.

"You're just here avoiding Chase."

"That's ridiculous," claimed Cameron. "I thought that we agreed she was a phony. How can you trust her observations?"

"I'm not a ph-phony," interrupted Mirai.

House turned his attention back to her. "No," he agreed. "You're a coward."

"I am n-not a—"

"You can't handle a diagnosis because you're afraid of the implications."

"And you're not?" asked Mirai with fear in her voice. "I-If you weren't afraid of the imp-plications, then you wouldn't have t-trouble getting c-close to anyone."

Cameron turned to House and contemplated whether or not Mirai had been correct in observing that House was a romantic at heart.

House ignored Cameron's stare and Mirai's comment, though. "You have Fatal Familial Insomnia."

Mirai didn't like the sound of that, especially the first word.

Cameron stared at House in shock. "That's incredibly rare," she noted. "There are only about 50 families in the world who carry that disease."

"It's genetic?" asked Mirai.

House nodded. "I'm still waiting on the results of the test, but it explains all of your symptoms."

As if on cue, Foreman entered the room and was just as surprised as House had been upon seeing Cameron. "What are you doing here?"

"Don't even bother," said House. "I've already tried."

Cameron just rolled her eyes at the two of them. She said nothing.

Foreman returned his attention to the medicine. "The test was positive. She has a prion disease, but we don't know which one."

House shook his head. "Yes we do."

Cameron was stunned, and she delivered the diagnosis to Foreman. "She has Fatal Familial Insomnia."

Foreman was just as shocked. He didn't argue, though, because it made sense.

"W-What does that m-mean?" asked Mirai, now more afraid than ever.

"A genetic mutation is causing the formation of insoluble proteins in your thalamus," said Cameron.

"Am I g-going to be okay?" she asked. Based on the look in their eyes, though, she knew that their answers would be bleak. She didn't want to hear it, but House told her anyway.

"No," he said. "That's why they call it Fatal Familial Insomnia."

"I'm going to die?" She choked as tears began to fall from her eyes.

Foreman nodded, and Cameron bowed her head, but House felt the need to tell her precisely how she was going to die. "Your symptoms will persist for about three more months. You'll start to develop stupor, and then you'll undergo the stages of dementia. You'll lose the ability to speak. You'll be mute."

"House—" interrupted Cameron in an attempt to protect Mirai from the glum details, but she had no effect on House.

"Your insomnia will continue to get worse until eventually, you won't be able to sleep at all. Nine months from now, you'll die of insomnia."

At this point, Cameron finally grabbed House by the arm and dragged him from the room. She stared angrily into his crystal blue eyes. "How could you say that?"

"What are you talking about?" House pretended to be befuddled. "She needed to know."

"Well maybe you could have just told her that she would die in about nine months."

"Right," shot House, "so she can be surprised when she suddenly can't talk or sleep."

Cameron shook her head at him. Just a second ago, she had been sure that there was something deep inside of him that cared, something—as Mirai had put it—romantic. Maybe she had been wrong. "I'm going to go get some sleep," she stated before turning around.

House watched her walk down the hall, and when she disappeared behind elevator doors, he stared through the glass walls into his patient's room. Inside, Foreman was consoling Mirai. House finally decided to return home, although he knew he would never be able to fall back asleep.