Chapter 38

Morning, Day 9

Dr. Miller walked into House's cubicle after finding an eerily empty ICU waiting room. Blythe was eating breakfast with her son.

Back in the waiting room, All evidence of House hood was gone. House's white board, toys and furniture had been moved back to his office, and all of the artwork that belonged in the waiting room had been put back in its rightful place. The food was gone and so were all of the extra linens. The only reminders of House hood that were left behind were the new futons and sofas. The volunteer was dutifully stationed back at his desk in the waiting room, although the other visitors still looked like they were reluctant to come back in to the room they had been banished from for the previous eight days.

House was looking decidedly better. The hospital food was actually pretty good, he had to admit. All the physical and occupational therapy meant that he had a pretty decent appetite, so the feeding tube stayed out.

"Let's have a look at those hands. How's your pain today?" Dr. Miller asked.

Just as House was about to say something, Blythe interjected "He's still on the morphine, but he's been pretty comfortable."

"Actually, I wanted to hear from him," Dr. Miller smiled.

House looked back and forth between Dr. Miller and his mother. He was still having trouble differentiating between two different voices, so he heard what Dr. Miller said but only part of what his mother said. He was also angry that his mother would take it upon herself to answer for him.

"Mom, I can answer for myself. I never thought I'd say this, but can you wean me off the morphine and put me on something else, maybe something oral? The morphine is messing with me. My muscles feel like jello and all I want to do is sleep all the time. I think it's from the morphine. With all this physical and occupational therapy, I should be able to move better than I can."

"Sure. We can put you back on the Vicodin. How much were you taking before?" Dr. Miller asked, fully aware that he was probably not going to get an honest answer.

Blythe looked at her son, wondering what his answer would be.

"I guess you can't tell from the reams of my old medical history files out there."

"House, I was hoping for an honest answer. Those old records are pretty old. I need to know what you were taking recently, not what you were prescribed to take five years ago. Do you know how much morphine you're on now?"

"Of course. I'm on 5 mg an hour" was the answer.

"And how much Vicodin were you taking before this?"

House looked at his mother, as if afraid to say anything.

"Honey, just answer them. I have no idea how much you were taking or even how much you were prescribed. I'm not qualified to judge you so please just answer him."

"I was doing about 80 mg a day."

Surprisingly, Dr. Miller responded without hesitation; "Ok, we'll start weaning you off the morphine and back onto Vicodin. I know you were originally prescribed a max of 40 mg a day. I assume that your prescription was for 10/750 (10 mg Vicodin and 750 mg acetaminophen per tablet)."

"Yes" was the answer.

"Originally, then you were taking four tablets a day. I assume the pain wasn't manageable on four tablets a day, right?"

"Yes"

"So you were taking about eight tablets a day most recently, right? You're probably taking two tabs at a time. I'm not judging. I'm trying to plan a proper weaning protocol so you don't wind up getting over- or underdosed while you're on both morphine and Vicodin. I also don't want you suffering needlessly."

House lost him after the "weaning protocol" sentence.

"House, did you hear me?" Miller said and typed.

"Not all of it."

Dr. Miller repeated and typed everything.

"Ok, so can we start weaning now?" House replied after he'd read what Miller typed.

"Yes, and we need to talk about side effects of the Vicodin too. If Vicodin is what you need, you can have it. But after taking Vicodin for so long, there are bound to be side effects. Have you been having any?"

House looked at his mother and said nothing.

"Mrs. House, would you mind stepping out? Maybe you can grab some coffee in the cafeteria or something. It's on me." Dr. Miller handed her a gift card for the cafeteria. "We can talk when you get back. Please, it's Ok." Dr. Miller said.

Reluctantly, Blythe went to the cafeteria.

As soon as she exited the room, House let out a sigh of relief.

"I feel like a slave to those damn things." House muttered, more to himself than to anyone else.

"I either have to be in pain 24/7 or I have to take pain pills that make me feel like a depressed, constipated eunuch. What a choice."

"From that answer, I'm guessing you know all the side effects. Down the road, there might be a better alternative for you than anything containing Vicodin since obviously you're experiencing Vicodin-related depression. First off, I'm switching you to Vicoprofen because of your liver. Vicoprofen has ibuprofen instead of acetaminophen so it should be easier on your liver. You don't have to feel like a slave to pain meds. There are pain meds that don't cause sexual side effects or depression. It's a matter of finding the right combination; but that can be taken care of down the road."

House looked at Dr. Miller expecting more of a lecture than he got.

"I'm not here to lecture you. I don't have chronic pain, so I don't know what it's like. I just know we have to treat the 'here and now'; we have to treat the chronic pain you already have and the pain from your burns, and we have to get you off the morphine. So we'll start the weaning protocol as soon as Lynne gets the Vicoprofen from the pharmacy. We'll start you on the Vicoprofen and then cut your morphine to 4 mg an hour. We'll wean the morphine down, and the Vicoprofen up, over a period of a few days. You can have extra Vicoprofen before or after dressing changes and therapy if you need it." Dr. Miller said and typed.

"Ok" House responded.

"We also need to talk about your hands. The cadaver skin has all fallen off, as we expected it would. But your skin hasn't grown back in like we were hoping. You need autologous skin transplants on both hands. We'll need to take donor skin from another part of your body to cover the unhealed parts of your hands." Miller said and typed.

"Shit." was the one word reply.

"Yeah, I know. We have no choice. We're kind of limited as to where we can get the donor skin from since it has to be from an area that hasn't been burned. Fortunately we don't need much. We'll need to use a tissue expander to help grow some more normal skin. I was thinking we'd put the tissue expander in your abdomen, and take the donor skin from there." Miller said and typed.

Great. Another scar to have to hide thought House.

"If you have no choice, you have no choice." House replied.

"The good news is, we can take the dressings off of everything else except your hands. We'll put the tissue expander in as soon as I can schedule an OR – probably tomorrow. I'll talk to your mom if you want."

No answer from House.

Miller took the rest of House's dressings off and examined the extremities.

"Ok, I'm done for now. Do you have any questions?" Miller said and typed.

"Yeah. Am I being committed to the psych ward after I leave here?" House asked angrily. "Golan won't answer that. I don't trust him. In fact, I don't want him anymore. I don't want to be locked up somewhere."

"House, you tried to kill yourself. You need help for that that I can't give you. If you won't agree to get help from Dr. Golan, then we need to find someone else. I know the Vicodin probably had a lot to do with it. Vicodin can cause depression or aggravate pre-existing depression. That's why I said that I thought we needed to find an alternative for you down the road." Miller said and typed.

"If I agreed to an out patient support group, would you agree not to lock me up somewhere?"

"I'll agree to help you find another psychiatrist, I'll agree to work with you and a pain management specialist, and I'll agree to help you find a support group. How's that? If you need inpatient psychiatric care, then the decision of whether to 'lock you up' or not wouldn't rest with me anyway. It would be up to a psychiatrist. I think it shouldn't be necessary to keep you in a psych ward against your will if you agree to the three things I said."

"Deal!" House replied.

Mrs. House returned to her son's room and Dr. Miller updated her on everything they'd discussed, minus the Vicodin side effects that House obviously wanted kept private.

House's physical therapist, Allen, arrived for the morning physical therapy session with some surprises.

"Dr. House, it's time to get you back up on your feet, now that the rest of your dressings are off. I noticed from my initial exam that you have signs and symptoms of carpal tunnel syndrome in your right wrist. I bet you never told anyone that."

House stared at him and said "What choice do I have? If I had surgery on it to correct it, I'd be in a wheel chair while the thing heals. I don't want to use a wheel chair because the remaining leg muscles in both of my legs would atrophy from lack of use. Then I'd have an even harder time walking again. I'm already facing a wheel chair if I develop arthritis. I'd like to delay that as long as I can."

"And I appreciate that. There are alternatives to a cane or a wheel chair. There are 'Hands Free crutches' and there are platform crutches. A 'hands free' crutch attaches with Velcro straps to the affected leg, but it wouldn't work for you because the straps go around the thigh. The other choice is a pair of platform crutches like what I brought today. They don't go under your armpits and don't require any use of your hands. You bend your arms and rest them, like this, on the platforms. Your forearms bear the weight, instead of your armpits or your hands." Allen demonstrated their use, and typed all of this to make sure House understood.

"Ok, got it. I've never seen anything like that. I had to use underarm crutches after the leg and I hated them. Do they make these in different colors? Since I have to look like a cripple, I guess I oughta look like a cool cripple." House smiled.

"Yeah, we can have them powder coated any way you like." Allen quipped. House laughed. "No, I'm not joking. I'm serious. They're metal so we can have them powder coated if you want. It's not like you're going to be returning them, so you can have them personalized any way you want." Allen said.

"So let's start now. Sit up with your feet over the side of the bed. You tell me how much help you need." Allen said.

Gingerly, House slid his left leg over the side of the bed and then used both arms under his right thigh to move his right leg over the side of the bed as well. Not being able to use his hands, it took him twice as long to accomplish this task, but Allen stood by and watched while House did it independently. "Put the oxygen back on" House panted, although all of his numbers looked normal. Allen put the oxygen face mask back on, although it was more for psychological support than physical support. House was breathing fine. He looked terrified, though.

Blythe said "Should I stay here for this?" Allen replied "You'll need to know how the crutches work, so yes."

"Ok, rest your forearms here." Allen showed him how to do that. "There are hand grips, but I don't want you using them at all. We'll use the Velcro straps around the platforms so the crutches stay in place. We'll do this on the count of three. When I say three, lean forward with your weight on your left leg and your platform crutches to stand up. I know you can do this by yourself so I'm not going to help unless you say you want help. I know you're scared, but you can do this. Ready?" Allen said and typed.

"I guess" House said.

"One, two, three" Allen said and on the count of three, House lurched forward and stood up precariously, shaking on his left leg and the two platform crutches. "Catch me!" House cried, but just as Allen moved to catch him, House looked up with a lopsided grin on his face. "Gotcha!" House laughed nervously. "Seriously, I can do this. Move the recliner a little closer." And with that, House crutched a few steps to the recliner and sat down with a look of pride as if he'd just climbed Mount Kilimanjaro.

"Great! Now when I come back after lunch, you're gonna walk back to bed!" Allen laughed. "Buzzkill," House replied and Blythe laughed as well.

Lunch arrived, Allen left and the two occupants of the room were left in peace and quiet to eat their meals.

5 pm, Day 9

Kutner arrived in House's cubicle with a surprise, carrying a manila envelope. House had had a second session with Allen already, and was able to crutch the few steps back to bed without assistance from Allen. Blythe had returned to her knitting and House was asleep. When Kutner arrived, the sound of his door opening was enough to wake House up, who glared angrily at poor Kutner. "Sorry, I didn't mean to wake you up, but I have a cool surprise for you."

Kutner gave him the envelope and left.

Two items were inside the envelope. One was a picture of a new pair of bright black powder coated platform crutches with the Nike emblem and bright orange flames stenciled on both crutches. The forearm platforms were padded and the padding was covered with bright black leather, the kind found in motorcycle jackets. The Velcro straps on the platforms were even colored black. Even the rubber tips were cool. The whole package just screamed "House."

House always thought the canes he bought from his usual hangouts were cool, but they were the coolest things House had ever seen.

The other item in the envelope was a note.
"House, here's to looking like the coolest cripple in town. I got the idea from watching American Chopper. I think these are the coolest things I've ever seen. I found a motorcycle shop in town that agreed to do the custom paint job and padding. They even found rubber tips for the bottom, made out of leftover rubber from some old Nike Shox. This is courtesy of me and Taub. Don't say we never gave you anything. This is just a mock-up. The real crutches will be ready by the time you get discharged. See ya later."