Chapter 37
Cuddy strode into the conference room, divorcing her emotionally charged self from who she needed to be, the Dean of Medicine bringing a case to her head of Diagnostics. The years of routine helped with this as long as she did not meet his eyes she would be okay.
"House, you have a patient. 13 year old girl, presents with rapid heart rate, muscle aches, dizziness, headache, anemia, shortness of breath, confusion, fainting, dark urine, bruising and pain and swelling in her left leg." Had she but known it her eyes were the frozen blue grey of a iced over pond, with signs warning skaters to venture out at their own risk. The previous night was hard on both Cuddy and Rachel. She had kept Rachel in bed with her for most of the night trying to distract herself from the large cold empty space on the other side of the bed.
"It's either cancer or abuse. Are the parents here?" House asked, his eyes sliding away from the chill of hers to covertly devour her face.
"The girl is definitely not being abused. The mother is here and she is very concerned, extremely devoted." Cuddy said, her uneasy stance had the skittishness of a Springbok, ready to flee a predator.
"Oh God, I can see you are already identifying." House said in exaggerated exasperation. "If you are determined to be involved with the case. Why don't you just take it? Or better yet call Wilson in for a consult. He has a sub-specialty in Hematology. Then you two can cry over it together." He said rolling his eyes as he handed her back the file.
"The girl had a CVA while riding a roller coaster at Six Flags and I have six doctors on my payroll just for situations like this. It would be inefficient not to use them." she retorted, not reaching her hadn out to receive the file.
"You could have had me at 13 year old with a stroke, if you had led with that." he retorted taking back the file. "I''ll have to agree, things work best when all the people on the bus are doing what they are paid to do. So you you get paid the big bucks to push papers and assign parking spaces and it's a waste to have you down here trying to play doctor. " he said looking at the file.
"People on the bus? Freudian?" she asked with an arched eyebrow, deciding to give as good as she got. If you even glanced at the file you would have known about the stroke." He was at his defensive best, but a little over the top which told her he was deliberately trying to piss her off and keep her at a distance. "She was given given TPA to dissolve the clot and it seems to have worked well. I doubt if she'll have a significant lasting effect but we need to find out what caused it and prevent any future clots.".
" If the roller coaster snatched her head or neck, she could have had the stroke from a temporary positional kink in her carotid," House ruminated. "We'll need a scan. So where's the father?" House asked looking up.
"He's dead."Cuddy said in a cutting way that indicated she thought it was good fate for most of the male species, especially one cranky doc who walked the tightrope of addiction and rebuffed when he needed help the most. After that exit line her hip sway was in full effect as she went toward the conference room door. House turned to begin writing the symptoms the whiteboard.
"Wow, we haven't had a mommy/daddy snipe fest in a while, honeymoon over? " Taub opined flatly.
"Lay off said turning to give him a thunder cloud look. Having the ducklings know about his relationship was awkward enough, but now that it was over it was downright painful. Atleast the looming custody case had tamped them down. "Thanks to you I know that there's always hope for the most doomed relationship. If one gesture won't work another one will, right?"
"Gestures are the mother of intention." Taub replied with a tight smile.
"Or the cover of deception." House retorted.
"Could she have been huffing. That is the the age." 13 offered looking at the symptoms.
"Don't judge everyone by yourself. Her Tox screen was clean" House shot back.
"She did present with shortness of breath, but her O2 Sat levels are high 90s. Anemia could easily be causing it, but we know from the stroke she seems to be in a hypercoagulated state. If there was rapid onset with the shortness of breath I would suspect a pulmonary embolis rather than drugs." said Foreman.
"Let's get a new set of blood test back and a more detailed history before we make any more guesses."
"13 could you go take a history. I have plenty from the mother but no information about the father, just cause he's dead doesn't mean he's erased. Find out how he died. It might be a clue."
"You think this is hereditary?"
"You don't own the monopoly on bad genes, 13. Everybody's got some, it just depends on if your parents are kissing cousins whether you get two mishappen sets or end up with a disease that only requires one bad apple to make you sick, sicker, or sick enough to wish for your appointment with the grim reaper."
13 stared at him with big eyes, blinking in a startled way, because she thought they were past him deliberately being obnoxouis about her disease and life expectancy.
"What was that last bit of advice you gave Foreman and I? You know, fight, have sex or quit" she said pausing at the door to serve that salvo with a knowing look before turning to leave the conference room.
"Taub and Chase, I need you to check out the patient's home." House continued.
"Cam, make she's clear of the anticogulants, we'll have to monitor her closely for clots, but we need new coagulation studies PT, PTT, INR. The other blood tests you can do right away. CBC, blood smear to see if cells are torn or broken, platelet count, Coombs test, Lactate Dehydrogenase test. Foreman, we need a base line neuro-evaluation of her post stroke, so we can be aware of any new symptoms. She came with a contrast Cat scan, check that out, but I think we still need an MRI of the brain and carotid scan, and an Adams13Assay."
"The rollercoaster was fun! I've always loved roller coasters," said Emily in response to Cuddy's question, while 13 stood by taking down notes and looking frustrated on being pre-empted in taking the history.
"When you were on the rollercoaster did you feel your head snatch or rock in a particular way?
"No, but I did get a headache. A really bad one. It's the last thing I remember. I hope the rollercoaster didn't cause it. Then I won't get to ride them anymore."
"Luckily your mom realized something was wrong and got you in to the hospital right away."
"Yes, but she was scared to death. She thinks I am going to die." Emily said looking a Cuddy with big eyes before doing an exagerated face palm. "What am I talking about, my Mom is never going to let me ride a coaster again, no matter what you find out."
"It's going to be okay. You are not going to die. You have the best chance in the world here and we can control your condtion with blood thinners until we figure out what is causing it." Cuddy said reassuringly patting the girl's shoulder. Your Mom's just worried. That's what mother's do."
"You must be a Mom." the girl said smiling at Cuddy.
"Yes, I am Cuddy said I have a one year old. How did you know?"
"You know just what to say. Your daughter is very lucky."
"I think your Mom is pretty lucky too. " Cuddy said with a smile and the first warm feelings she had had since leaving Rachel. These were soon doused as Emily's mother came back into the room.
"Why do you think I'm lucky? My daughter could be dying."
Cuddy looked at her in shock..
" I don't coddle my daughter, I'm always honest with her about what I'm thinking and feeling."
"Not to second guess your methods, but there are times when keeping your own counsel might be best. Many diseases are stress related so you should probably try to reassure your daughter not scare her."
"Dr. Cuddy, just because you adopted a child a year ago. Don't presume to tell me how to raise my child. Yes, the walls around here have ears and mouths too. Actually, I'm sorry you are having custody issues, I have been through the courts and I wouldn't wish it on anyone."
"I guess I would say thank you, privacy invasion is not a motivator. Just because people gossip that does not make it okay to listen"
"Lady, I live by my wits, to do that you have to have an ear to the wind. Nothing personal. Hey, like I said I been through it. You could even benefit from my advice if things don't go well for you in court." The woman said ambiguously.
Cuddy looked up in relief when Foreman came in to take her down for a scan gladly leaving 13 to deal with this harpy of a mom. Giving a last look and nod at the 13 year old girl, she was gone. As Cuddy closed the glass door behind her she wondered how they woman had been in a custody battle if the husband was dead?
"The father died in a car accident seven years ago said 13 as the the fellows reagtered in the conference room. They seemd like they have moved a lot in the last five years, mostly east coast. New Hampshire, North Carolina, and now New Jersey, always coastal."
Taub reported he had found nothing unusual at the home. Then all six began discussing the results of the test.
"She definitely has clotting issues, looks like Thrombotic Thrombocytopenic Purpura. She has bruising" said 13.
"Could be Upshaw-Schulman syndrome (USS) "said Forman almost simultaneously. We could do Plasmapheresis to remove antibodies."
"God, you guys are thinking in sync again."he said looking giving 13 and Foreman and exasperated look. "Two names for the same disease and you are both wrong." House sniped.
"Microangiopathic hemolytic anemia." Chase tossed in."
"Do you have a medical thesaurus under the table and decied to try to impress me by how many names you can use for the same wrong diagnosis."
Everyone at the table turned and looked at each other. This was the opposite of singing House, this was House with a foot up his ss. They had no doubt the shoe on that foot was high and pointy and belonged to the their common boss Dr. Lisa Cuddy. House had apparently screwed up, but how?"
"On the coagulation study, she has an Antithrombin III defiency, now whether it was aquired or inherited we have yet to determine. Did we test the Mom?" house announced after having stolen the collective tongues of his juniors.
"Yes, her clotting study was in the normal range, so if it is inherited it must have come from the Dad. Did you ask if the Dad or anyone in his family had clotting issues, strokes heart attack, DVT, pulmonary embolism?"
"Not according to the Mother, she will barely talk about the Dad. Something fishy there." said 13.
" No matter how she has it, treatment is the same. Anti clotting drugs. She's on Warfarin while she is in the hospital. We'll probably send her home with Plavix."
"You're talking about sending her home?"
"Why not? We know what her problem is and there is a standard protocal for treating this deficiency. She can live a normal life. The case is solved. No reason to keep her here."
Just then the air was rent with the sound of multiple beepers.
"Patient's alarms just went of Sat levels are plunging. She heading for a crash." yelled Froeman as they all sped out of the conference room. It turned out Emily did have a Pulmonary embolism which they wer able to locate and remove fairly quickly.
Back in the confernce room 13 announced to the goup.
"I was right there is something fishy, registration, said this woman and girl have no history not only did the insurance info not pan out. There names are phony, no social security numbers."
House turned to look at 13. "It's a mystery, but doesn't put her health in danger."
"How is not having insurance, not going to put her life at risk when she needs meds now. Blood thinners everyday, for life."
"So what are you thinking, why is this woman lying about who she and her daughter are?" Can't be witness protection they give social security numbers and real identies. You tested the mother and child, did we do an actual DNA?"
"No, but we have enough sample left, we could?"
"So do you have to ask. Go! We certainly can't release the kid into custody of a woman if we don't even know their identities." She could be the wife a pedophile, that's had the kid locked in the basement for 10 years."
After the ducklings disperse from the conference room, House shows up in Cuddy's office.
"You and this family are getting along like a house on fire, What I can't understand is why you care so much. Does it remind you of you and Rachel?" he asked his voice gentling.
"And what if it does?" Cuddy shot back. She went through a custody fight with her daughter, she understands what I'm going through." The implication being that he didn't.
You are saying she's a self-sacrificing mother. I'm saying I suspect she doesn't have legal custody. She gave upon the court. She's been running and hiding for almost 10 years. I bet you the father is not even dead unless he had a major stroke. Her condition is hereditary and usually manifest sometime from teens to twenties. If the mother had been in touch with the father or his family, she would have known her kid needed to be checked for clotting issues. If she had been on blood thinners even asprin, she would never have had a stroke or a pulmonary embolism. Now that's abuse. I was right in the first place." He picked up the phone and handed it to her. "I think it's time to make that call to social services."
"House,you have no proof. I'll talk to the mother after you give me some evidence. Don't tell me you haven't taken a DNA test. Lack of permission has never stopped you before." she said.
"I'll let you know when we get the results back, but it's your job to find out if she's on the lamb. You've obviously bonded."
"I'll find out what I can House. Obviously if there's a problem with the insurance then the hospital will need clarification."
"I knew that bottom line would motivate you, but I know you care about this kid too." he finished in softer tone.
There it was, the collision of eyes, she had been avoiding all day went through her like an electric shock. There gazes held traped and then gentled. She always thought it was the one way they communicated with out words, soul to soul. Then why couldn't he understand she cared about him?Maybe he did understand she thought after a minute of being locked in his gaze, but the trust issues that stood between might as well be the great wall of china.