Disclaimer: House and all respective characters do not belong to me. I am only borrowing them for personal enjoyment.
Also I am not a doctor so I have decided to borrow cases used earlier in the show for medical accuracy. My creativity comes in with building and developing character relationships as well as introducing original characters. Criticism and reviews are most welcome. Hope you enjoy.
A few minutes later Thirteen, Chase, and Taub arrive in Julie's room.
"We think your surgery might've caused an infection called SIBO," Thirteen says as they walk into the room.
Taub grabs a bedpan from one of the cupboards. "Stool test will help us to confirm. Put some of what you're full of in here," he says setting the bedpan on the bed next to Julie's leg.
"If surgery could somehow make you taller, wouldn't you do it," Julie asks.
"Sure. But I wouldn't call a meeting of the Lollipop Guild and tell them they can grow if they work real hard at it," Taub snarks.
"I don't tell anyone not to get gastric bypass," Julie defiantly states. "I tell them how to get healthy. How to improve their lives."
"Yeah, by telling them to do what you were unwilling to," Taub says.
"I was willing to do anything," Julie says. "Thyroid, hormones, crash diets…none of it worked. My body was like a prison. When I got the surgery, I got healthy. And when I got healthy, I got happy."
"I'm not sure you're happy," Taub says. "But if you are, being healthy didn't do it. Being pretty did. Poop in the bedpan," he says tapping it with his pen. Taub turns and exits the room leaving Julie looking frustrated. Thirteen and Chase depart right behind Taub.
"I take it you don't like fatties," Chase says as they're walking down the hallway.
"I don't like hypocrites," Taub snarks.
Thirteen scoffs, "Right, 'cause you've always taken your own advice."
"This isn't about me," Taub states.
"How are your two baby mommas anyway," Thirteen asks. Taub scowls and walks faster around a corner. Chase smirks and looks at Thirteen who grins back as they continue walking.
Meanwhile Wilson is sitting at his desk writing out a prescription when he hears a knock on his open door. He looks up and sees Cuddy standing in the doorway. "What's up," he asks.
"You heard from Adam yet today," she asks directly.
"Can't say I have. Why," Wilson asks.
"He's not answering his phone and Foreman says he hasn't shown up yet," Cuddy answers.
"Great," Wilson says sighing. "You think he's in trouble?"
"Something's obviously going on," Cuddy says walking into the room and sitting down in one of the chairs in front of Wilson's desk.
"Yeah," Wilson agrees.
"That's it," Cuddy asks.
"What," Wilson defends.
"I thought you were gonna help me keep an eye on him..." Cuddy starts but is interrupted by another knock on Wilson's door. Cuddy turns around to see Foreman standing in Wilson's doorway.
"You needed a consult," Foreman asks looking at Wilson.
"Yeah, clinic patient," Wilson says grabbing a file sitting near him. "Trzaska hasn't come in yet?"
"He's getting a stool sample," Foreman responds as he crosses the room and takes the file from Wilson.
"I thought you said…" Cuddy starts but Foreman interrupts her.
"He got in a little over an hour ago," Foreman says looking at the CT scan. "He stopped to help with a car accident and then his bike broke down."
"Why didn't he answer…" Cuddy starts to ask.
"Phone was dead," Foreman says before turning his attention to Wilson. "Your patient has some scarring in the hippocampal region. Looks like meningitis," he says handing the file back to Wilson.
"Did he seem fine," Cuddy asks Foreman. "Was his phone really dead?"
Foreman shrugs his shoulders, "Seemed okay to me. And yes, I watched him plug it in as soon as he walked in the door."
"Thanks," Wilson says and gets up from his desk leaving Cuddy speechless. Foreman follows Wilson out. Cuddy gets up from her seat and walks over to the window looking over at the DDX Office while biting her cheek.
A half hour later, Foreman walks into a lab where he finds Taub and Chase.
"Where's Thirteen and Trzaska," Foreman asks.
"Clinic," Chase answers.
Foreman nods and looks at the fecal sample sitting on the counter. "What'd you find out?"
"It's gonna take about an hour to spin down the sample," Taub says.
"High fat content indicates SIBO," Foreman says as he grabs a bucket and crosses the room to the sink. He turns the water on and starts filling the bucket. "And what does fat do in water?" Chase chuckles quietly and looks at his phone.
"It floats," Taub answers condescendingly.
Foreman turns off the water and comes back, plopping the bucket of water on the counter next to Taub. "What else floats in water?" He puts a glove on, picks up the stool sample and drops it in the bucket. All three of them watch as the feces sinks to the bottom.
"Looks like I was wrong to dismiss apnea," Foreman says pulling off his glove and throwing it in a biohazard bin. "Get her set up in the sleep lab," he says as he turns and leaves the lab.
Several hours later in the sleep lab, Julie is asleep with a CPAP mask on and an array of electrodes attached to her forehead. Chase, Taub, and Thirteen watch from the observation room. They are all watching an episode of Scrubs.
"How can you two watch this," Thirteen asks.
"What? It's funny," Chase says. "And it's nothing like real life."
A few seconds of silence go by until Taub breaks it. "Am I the only one who is annoyed because Trzaska isn't stuck here?"
"Yes," Thirteen and Chase say at the same time. Taub scowls while Thirteen and Chase glance at each other and smile.
"You want to leave go ahead," Thirteen says slightly annoyed.
Taub looks over at the sleep monitor. Julie's EEG is flat lining. He then looks into the room and finds that Julie's bed is empty. "Uh, guys."
Thirteen and Chase look into the room and see exactly what Taub sees. "Where would she have gone," Chase asks no one in particular.
After a few minutes of looking, the trio finds Julie in a rehab room. She's running on a treadmill even though her leg is still in a cast.
"Hey, I looked for you guys in the control room, but you seemed busy," Julie pants while she's running.
Chase turns off the treadmill. "Get off there. Last time you exercised, you had a cardiac incident."
"I feel fine," Julie says.
"You felt fine last time," Taub says.
"I only slept a couple hours, but I feel great," Julie says stopping moving. "Can I get one of those machines?"
"You're running on a broken ankle," Thirteen says puzzled.
"It doesn't hurt," Julie says.
"And your leg is bleeding," Taub says. He gets a syringe and sticks her in the calf, just above the bloody cast. "You feel that?"
Julie shakes her head. "What does that mean?"
Taub gives her a concerned look. "We need to get you back to your room." They get Julie back to her room and get her settled in for the night. The three doctors stand outside her room looking in on her.
"I've had enough of this, I'm going home," Thirteen says.
"We can't just call it a night," Taub says. "We need to come up with a new differential."
"Yes, in the morning," Thirteen says. She starts walking down the hall away from Taub. "Goodnight."
Taub stares after Thirteen and then turns to Chase who shrugs his shoulders and pats Taub on the arm before turning and walking away himself. Taub sighs and looks back at Julie before turning and walking away.
It was late into the night. Well past 1 a.m. when Thirteen quietly walked into Amelia's room. She stood with her hands in the pockets of her lab coat as she watched Trzaska. Trzaska is looking into Amelia's eyes. She seems tired, barely able to stay awake. Trzaska is standing with his back to the door. He is so focused on Amelia he never heard Thirteen come in. Amelia couldn't talk since she had been intubated earlier in the day. Her paralysis was getting worse and she could no longer breathe on her own. Trzaska was holding her hand, looking into her face and smiling.
"You get some rest now," Trzaska says softly. "We'll talk again tomorrow." Amelia blinked once in response, communicating as best she could without the use of her voice. He opened the door to the i.v. pump and put in the code to increase the morphine level. "Good night," Trzaska whispers. He leans down and kisses her on her forehead.
"Who is she," Thirteen asks after she watches Amelia fall asleep. Trzaska jumps a little. "I'm sorry, I didn't mean to startle you," Thirteen says. "I know you've been here for the last few days. Moreover, you have been acting different. I assume this is what has been bothering you." Thirteen tries to look sympathetic. She had watched a loved one suffer before, and she was more than willing to listen if Trzaska wanted to talk. "Thought you might want to know Julie has numbness in her foot."
"I couldn't give a crap," Trzaska says looking down at Amelia. "You want to know who she is, let's see if you can figure it out." He limps over to the end of the bed and picks up the chart there. Trzaska crosses the room and hands it to Thirteen.
Thirteen holds the chart in her hand and looks at Trzaska with a puzzled look on her face. "Why don't you just tell me about it," Thirteen asks. "I don't want to figure it out. I just want you to know I'm here to listen."
Trzaska forces a smile but it isn't very convincing. "I appreciate it Remy, but please just look at the chart. I wouldn't know where to start."
Thirteen briefs through the chart looking at the patient's diagnosis. "She has, Krabbe's disease," Thirteen reads aloud. "Krabbe's disease, I've never even heard of this."
"It's a rare neurologic disorder, ask Foreman about it," Trzaska states. "I don't understand it very well myself. All I know is she is dying, painfully." Trzaska walks back over to the foot of Amelia's bed and looks at the monitors. "You're right; this is why I have been distracted. She's, she's a very old friend of mine. She was there for me when I was younger, when I needed her. She's always been there when I needed her. So now I'm here for her. I'm sorry for my lack of interest in our latest case but to be honest I don't really care." Trzaska limps with his cane over to the door and stops next to Thirteen. The two stood nose to nose looking into each other's eyes. "I'm going to get some food," Trzaska coldly states. "Thank you for stopping by Remy, I'll see you tomorrow." Trzaska turns to open the door, his shoulder slightly brushing against Thirteen's on the way out.
Thirteen thought Trzaska would give her some answers, but instead she had more questions. She went home that night and had a hard time sleeping. She could tell Trzaska wanted to talk about what was going on, but it was a painful subject. Thirteen knew firsthand how difficult it was after watching her brother succumb to his Huntington's.
The next morning she got to work a little early. She knew Foreman would be the first one in and she wanted to ask him about Krabbe's disease. A few minutes before nine, Foreman arrived right on schedule. "Good morning," Foreman says. "What's up? You're never the first one here."
"Yeah, everything's fine," Thirteen lies unconvincingly. "I wanted to ask you if you've heard of Krabbe's disease."
"Krabbe's disease," Foreman asks. "Yeah, it's a genetic disease caused by a mutation on chromosome 14. The buildup of unmetabolized lipids affects the growth of the nerve's protective myelin sheath and causes severe degeneration of motor skills."
"Is it painful," Thirteen asks.
"Well it can be," Foreman said as he thought. Most experience muscle weakness and atrophy, deafness, optic atrophy, fevers and paralysis amongst other symptoms. It's very rare in this country, why do you ask?"
"You said it's a genetic mutation," Thirteen questions.
"Yes, it's most common in infants and young children but it can come on later in life," Foreman answers.
"Is there a treatment for it," Thirteen asks.
"Well bone marrow transplants have been shown to help if caught early," Foreman replies. "But it's mostly just supportive treatment."
"Thanks," Thirteen says. She gets up from her seat, grabs her coffee and leaves the office. Foreman wears a puzzled look on his face and sips his coffee while watching Thirteen leave.
An hour later Chase and Taub arrived in the ddx office. Thirteen had already returned and was reading a textbook when they walked in. They brought reports with them and threw them on the table for Foreman to read. Foreman picks up the file and glances over it.
"Numbness in her left foot is ascending into her leg," Taub says.
"How did she manage to sneak out for a run," Foreman asks.
"She said she needed to use the bathroom," Chase replies looking at Taub.
"Results of the apnea test," Foreman asks.
"Alpha waves on the EEG ruled it out," Chase answers.
"Ascending numbness means her nerves are breaking down," Thirteen says.
"Or her brain," Taub says.
"Or both," Foreman responds.
"If the problem's in her brain, it could be MS," Thirteen suggests.
"Or early onset Parkinson's," Chase states.
"But if it's her nerves, it could be transverse myelitis," Taub says.
"Or a million other things," Foreman states. "We're gonna stay in the dark until we can figure out if her electrical problem is in her brain or her nerves. Go run an NCV test. And find out where Trzaska is."
"Clinic," Thirteen says. "Ran into him an hour ago."
"Well after you get through with the NCV test tell him to get his butt back on this case," Foreman says. "There's a hundred doctors Cuddy can use to wipe runny noses. Only you four can figure out why this woman's dying!"
The team leaves the office and Foreman stares at House's ball that is still sitting on his desk. He frowns and knocks it off with the back of his hand.
"I'm gonna run down to the clinic, meet you back up here soon," Thirteen says and takes off down the hall with coffee in one hand and a file in the other.
Later in the treatment room, Taub is attaching electrodes to Julie's legs.
"The test will measure the amount of time it'll take this electrical impulse to travel along your nerves," Taub says.
"Will it hurt?," Julie asks.
"No. Give me your arm," Taub says.
"You can ask nicely," Julie says.
"I learned at med school you don't actually cure with kindness," Taub snaps.
"You're right. I'm a hypocrite," Julie says. "But I don't have a choice."
"Not really interested in your rationalizations," Taub states.
"If I'm open about the gastric bypass, no one would listen to me anymore," Julie says.
"You mean no one would buy your DVDs," Taub says.
"It's not about the DVD sales," Julie snaps. "I'm helping people. My clients are making themselves healthy. They're living better lives. Can you honestly tell me you've never done anything hypocritical?" Taub doesn't say anything. "I'm sure you had good reasons."
"Give me your arm… please," Taub asks. Her arm is shaking as she raises it about six inches off the bed. "Keep your arm raised," Taub says. She has trouble keeping her arm up.
"Does this mean something is wrong with my nerves," Julie asks.
"No. It's your muscles," Taub says. "We don't need to run this test. It's not what we thought."
Thirteen is smiling as she walks out of Victoria's room. She had arrived just in time to see her off and had also finished her coffee. Thirteen heads down the hall for Amelia's room. As she turns a corner, she begins to hear shouting. Thirteen picks up her pace and starts running down the hall. She discovers the shouting is coming from Amelia's room. Trzaska is furious. Thirteen sees him throw a bedpan across the room at a few of the nurses and swing his cane at a male nurse trying to get close to him. "I SAID GET OUT," Trzaska exclaims. Thirteen enters the room and gets between him and the nurses. Holding her arms out, Thirteen tries to put some distance between everyone. "GET OUT," Trzaska yells again.
"Just go," Thirteen tells the nurses. "It's ok just go." The nurses hesitantly leave, the male nurse glares at Trzaska on the way out.
"You son of a…" Trzaska says as he moves to strike him.
"Just hold it," Thirteen shouts placing her body between Trzaska and the nurse. He bumps into her and almost falls causing Thirteen to have to catch him. "Will you just sit down," Thirteen orders. Trzaska misplaced his cane and collapses on the floor when he tried to lean on it. Rather than get angry about it, he decides to just stay where he landed. Thirteen could see the anger fading as a sleep-deprived look overtook his features. Trzaska massaged his right knee as he sat there. Thirteen squats down and looks at Trzaska's face. "What the hell has gotten into you," she asks.
"They were trying to lower her morphine," Trzaska says, barely audible. "They would have woken her up. I couldn't take that look in her eyes again. That pained look." Trzaska put his head down and wipes the sweat from his face.
Thirteen looks at him and sits down across from him. "I asked Foreman about her disease," Thirteen states while setting the file down on the floor. "I'm sorry, it must be difficult."
"It is," Trzaska says blankly. "It's the most terrible thing I have ever gone through. Even worse than our parents."
"Your parents," Thirteen questions. "What did they go through?"
"They died," Trzaska says calmly. "A long time ago." Trzaska grabs the bed and pulls himself up. "Please leave Remy," Trzaska requests. "And please tell them not to touch her morphine drip." Thirteen stands up, picking up the file as she does so, and stares at Trzaska unsure of what to do. "Please Remy, I want to be alone," Trzaska says.
Thirteen nods and reluctantly walks away from him. She stops as she reaches the door and turns back around. "I know this is hard, but Foreman is getting upset that you've been absent from the differentials. I brought you a copy of the updated file," Thirteen says walking back and setting the file down on Amelia's bed. She smiles awkwardly and then turns around, exiting the room.
Meanwhile Chase and Taub are in one of the elevators heading down to the ddx room.
"She has muscle weakness. Could indicate myasthenia gravis," Taub says.
"Yep," Chase replies.
"Also could be some kind of toxin," Taub suggests.
The elevator doors open revealing Foreman waiting to get on. "Perfect I get to kill two birds with one stone," Foreman says getting on the elevator and pressing the button for the ground floor. "What'd the NCV show?"
"She has muscle weakness. Could indicate myasthenia gravis," Taub says again.
"It's not myasthenia gravis," Foreman replies. "Her breathing's improving and the weakness is in her extremities." The elevator doors open and the three step off and into the lobby. Foreman sets a pace for Cuddy's office.
"Could be a botulinum reaction," Chase suggests. "She probably used a lot of botox to tighten up her skin."
"True, could also be any kind of heavy metal toxicity," Foreman responds. "PSP or arsenic from eating too much seafood. Cadmium from bad bottled water. Or lead or nickel from canned fruits or natural grains. Lucky for us, we can treat all those toxins with the same thing: chelation." Foreman leaves Chase and Taub in the clinic as he enters Cuddy's office.
Cuddy is on the phone when she notices Foreman. "Listen, can I call you back," she asks. "Great. Thanks."
"Can you tell Trzaska to back off his clinic duties for a while," Foreman asks.
"What are you talking about," Cuddy responds.
"Ever since you threatened him with excess clinic hours he's been putting extra time in the clinic to try and stay ahead," Foreman states.
"And that's a bad thing," Cuddy asks. "The clinic has been doing well. It hasn't been this efficient in years."
"It can stand to be a little less efficient when I have a patient dying," Foreman barks angrily.
"What do you mean," Cuddy asks again. "Are you saying he hasn't been involved in your case?"
"That's exactly what I'm saying," Foreman replies.
Cuddy nods solemnly, "I'll talk to him." Foreman nods and leaves her office.