"Alright. Back to the basics of anatomy: all organs are simultaneously autonomous and dependent on one another. Problems in one cause problems in others, but it's a cascade effect." House made a looping motion with his hand, gesturing to them all collectively. "We have the benefit of hundreds of years of study of human anatomy, and can run off a comprehensive spiel about every organ and interconnecting system. With these guys, though-"
"We get it: they're aliens," Taub groaned, his expression one of pained frustration speckled with sweat. "Can we please move on from how much we don't know, to what you do know?"
"I've warned you about interrupting me before, Taub." His tone would have, doubtless, been curter, but House found himself tempered by the sight of the bandage. Mildly, he added: "I'm keeping a list."
There was silence for a few moments before Foreman felt compelled to prompt House to go on. "Anyway..."
House leaned towards the whiteboard to pick up the pen, using it as a percussive pointer against the frame. "Look, you've got the brain, the lungs, the stomach – drawing direct parallels because they happen to be bipedal with the same number of eyes, arms and legs as us. But really we should be looking at them like an electronics store window at Christmas. Look past the humanoid, the human-robot comparisons to the individual, mechanical systems."
The doctors stared at him, waiting, and House experienced a rare moment of uncertainty. Whilst the revelation had coalesced in his mind from a series of smaller, significant insights and conclusions, his team hadn't made those same leaps. Usually he could drag them right across the finish line of a diagnosis in under a minute, but that was dependent on their understanding of the biology and chemistry involved. His understanding had roots in disassembling an air conditioner once because it was an unlikely place to hide a stash. They all came with slightly different life experiences.
House sat back in the chair in a lazy sprawl, knees spread. His leg hurt the least when he was simultaneously high and revealing he was right. "The assorted components of the Cybertronian respiratory system are like the small electricals section of Home Depot, but when it comes to respiration and cooling, they have more in common with birds than humans."
House's monologue was interrupted by a rattling slide of metal as Ratchet slid open the hanger door with a massive heave. His expression was sour, optics narrowing as he located the humans.
"More fumbling analogies, Doctor?" he snapped, pausing long enough to yank the door back shut before resuming his pace across the hanger. Condensation was rising off of him like steam, and there were streaks and scorch marks across his front. "Are you any closer to even understanding this affliction, let alone being able to fix it before our Prime dies? Because that is becoming perilously likely."
Once he'd realised that Ratchet was offering neither information nor agreement, House had automatically tuned him out. It was professional courtesy that he hadn't cut the Autobot off to get back to the point he was making. In terms of experience, Ratchet had a bit of an edge on him.
"If you want my diagnosis, you can wait and listen," he snapped back, as if he weren't talking to a giant alien robot. "And if you can't wait that long, then you can start requisitioning barrels of doxycycline."
Everyone with the exception of Taub straightened at the revelation, openly surprised.
"Antibiotics?" Thirteen asked.
Ratchet's optics brightened a little, and House could almost hear his processor whirring and his emails pinging. He looked back to his team to continue walking them to the conclusion.
"Birds have air sacs, which pull in air like bellows to circulate it in a one-way flow through the lungs, and to act as coolers since birds don't sweat. Cybertronian vents do the same thing: one way air flow and coolers. They have an internal structure like cold coils that condense out the moisture from the air, routing it to external plates to evaporate naturally, and passing the dry air over warm coils and back into the room. Keeps moisture out, and takes internal heat with it."
"Like a dehumidifier," Kutner supplied, frowning thoughtfully.
"Literally not helpful when I've described how they work so exactly."
House turned back to Ratchet, gripping the top of his cane with the taut energy of a spring. "Check my engineer's analysis: vents are both heat-dump sites and highly efficient particulate absorption systems, which use hundreds of thousands of tiny pleats to capture contaminants. Electrically charged plates further inside Cybertronian systems function as ionizers, producing electrically charged ions that bond to airborne particles that causes them to cling to the active equivalent of the lympathic system. Clinging to leukactye analogues as these 'scrubbers', the particles that missed the filtration pleats are carried to the vents and disengage when the charge runs out and are finally expelled."
Ratchet cocked his helm fractionally. "Correct."
House smiled, eyes fixed on some unseen point with the manic intensity of a diagnosis affirmed. "I should have brought the dissected pigeon with me."
"What?" Foreman asked, easing forward slightly.
"Oh, there's a dissected pigeon in your bunk, Taub, for the shame your injury has brought to our team." House shrugged, seemingly helpless. "I couldn't find a horse."
Taub's head rolled to one side, and he stared blankly up at the roof of the hanger. "I wish the morphine was helping, but it's really not."
"I assume you have a point you're going to make, Doctor?" Ratchet said tersely.
Foreman rolled his eyes, though he still focussed with the same degree of curiosity as Kutner and Thirteen.
House hobbled to stand next to the whiteboard, already going on before he'd turned to face the small assembly. He circled a single, crossed-out word.
"It's a bacteria, replicating in the ventilation system and hiding inside the Circulating Leukocyte Analogues to get around, hence the doxycycline." He drew a second line under stress aggravates. "The CLAs go to where stress is, and as there's always stress from combat, they're frequently dispatched to drop their contaminated loads. That's why all four patients have reported suffering minor system troubles over the last year. Every time there's a bit of repair work, the bacterium get deposited at the same time and start to multiply."
Which meant that there had been a benefit to taking 'useless' histories, after all. Even if all of which having been less imaginative and Douglas Adam's-esque than House had been hoping for.
"Doxycycline's a good catch-all to start with if we don't have an identification of the bacteria," Kutner affirmed. He looked up towards Ratchet, who was slowly approaching them from the door to the hanger. "NEST have given us access to a pathology lab a few miles away. If we can isolate a sample from the energon for cultures, we can probably confirm by tomorrow night."
"No need." House dropped the pen back into the rest at the bottom of the whiteboard, using the clatter and his light tone to marshal their attention. "It's Chlamydophila psittaci."
Thirteen and Kutner exchanged a look. Foreman looked dumbfounded. Taub inhaled as if to speak, then shut his mouth with a scowl.
Ratchet finally spoke for them all, though less incredulously than they perhaps would have. "You think they have Psittacosis?"
Taub made a vague flapping gesture with his hands. "Bird flu?"
"That's a misnomer," Thirteen said distractedly, the correction a tangential thought as she drew the pieces together. She shifted focus from House to the board. "It would survive in mechanical systems because it's so resistant to environmental stresses like extremes of temperature and humidity."
Ratchet drew a hand up to his jaw in a very human gesture of thinking, turning on his heel so that he stood in profile to them. The type of bacteria made a kind of sense, but the devastating impact it had had on Optimus and the others didn't. "The CLAs are programmed to protect against pathogens. With the exception of myself, every bot has the same CLA programming. If four are susceptible to a bacterial infection, then we should all be."
House nodded, accepting the point but satisfied that it served rather than refuted his diagnosis. "Your CLAs have adapted to this bacteria as a part of the atmosphere by absorbing it, and it's safe to say that you're all immune to the elemental form of the bacteria – where it can't replicate. But it's not the same bacteria once it's inside. Chlamydophila psittaci goes through transformations like hipsters go through filters. It's why it's deadly in birds: when taken up into the lungs and then the blood stream, it isn't destroyed by the lysosomes like it should be. Instead it transforms – into a reticulate body."
Thirteen nodded, glancing up to Ratchet. "That's when, in an organic species, it would replicate and lead to pneumonia, encephalitis, endocarditis, or thrombophlebitis, potentially killing the host."
"And when the host is dead," Taub said a fraction too loudly, "it reverts back and gets released into the lungs, ready to infect again."
"So they four of them have managed to breathe in a reticulate sample from an infected bird, not an elemental one," Foreman concluded, bring his hands together in fists and resting his chin on them.
House flexed his fingers about the top of the cane, eyes still fixed on some unseen point – as if visualising the anatomic elements at play. "And then given it a nice warm home to replicate in inside the vent pleats, filling the air cooling system with soup and getting sopped up by the CLUs. With each attack or political contortion that strained their systems, the CLUs circulated until their whole fuel system was infected."
Ratchet made a low buzzing sound, interjected with angry clicks. When he looked back to the doctors, the plates about his optics had contacted and narrowed. "Why wouldn't my scanners detect it?"
It was a complaint borne of frustration rather than guilt or shame – a significant improvement over the wallowing and wining House had found himself suffering from colleagues over the years. Frustration was something he recognised and could tolerate in others. Frustration, properly channelled, led to anger and spite – two of the best motivators to do better.
To Ratchet, House aimed to offer some variant of comfort. "You and everything else here are covered in millions of bacteria, none of which have ever been harmful before. You can't expect to know what they all are in real-time. And I imagine you've all screened the innocuous bacteria and programmed your scanners to overlook it, so you don't get into sensory hysterics every other second."
The Autobot nodded fractionally. "Doxycycline washout, and I can reprogram the CLAs," he murmured, already turning away from them to begin. His footsteps echoed throughout the hanger as he left without a backwards glance or parting remark.
Taub flopped a hand towards his departing back in a kind of wave. "You're welcome."
"So I was right about the bacteria." Kutner sprung to his feet to stand in front of the board, looking over the diagnosis buried within the notes and scrawls. His smile, broad and easy, made him appear even younger. "Awesome."
House shook his head, slipping a hand into his pocket and thumbing open the pill pot inside. He withdrew two Vicodin and shut the lid without showing his hand, though took the tablets with his usual unapologetic flair. "You weren't right about it being bird bacteria, though." He scoffed a laugh. "Told you this Bird Flu thing wasn't being hyped by the media. Like Fox [i]ever[/i] exaggerates about [i]anything[/i]."
Thirteen brushed her mouth to hide a smile. Her expression turned pensive, and she looked towards the door that Ratchet had left through. Where, not long ago, they'd ran through to get away from massive fighting alien robots. "Do you think they'll tell the Decepticons, since they're infected as well?"
"I suppose it depends on their own laws regarding biochemical warfare," Kutner replied, becoming equally serous. "They've been at war with each other a long time. Longer than humanity's been here as a species. Who knows what that does to morals and ethics – when any edge can be what ends it, even if it is an abhorrent one."
"Oh who cares." The tone did not invite a response. House eased to standing and began to slowly make his way towards his sleeping area – the couch in the hanger back office, which had no neighbouring pigeon carcasses or doctors. "We're finished here. Pack up and be ready to go in the morning. Let Kang and Kodos figure out the rest."
Foreman turned in the chair just enough to keep House in view. "You don't want to see the treatment through?"
House stopped with a very put-upon sigh, tilting his head back before turning back to face them. "They're gonna be pretty busy with clean-up on this [i]military base[/i] that we no longer have any business being on. We got the diagnosis, the treatment could take days for them to apply, and I for one am starting to worry about getting neuralyzed." He gave them all a significant look, then turned and began walking away again.
Foreman shook his head, eyebrows raised. "He can't really want to miss out spending more time with legitimate aliens from space."
Kutner stood and pushed a few pieces of paper around the table with his fingertips. "Obviously." Finding a glossy photograph of a Cybertronian internal organ, he began to carefully fold it into a small square. "But he's running low on Vicodin."
Taub exhaled noisily and rubbed his knuckles into his left eye socket. Foreman glanced between Thirteen's and Kutner's matter-of-fact expressions, then made a disgusted sound and stalked off.
It was the same private jet that took them back home – House recognised the grease stain on the inner arm rest when he sat down. The call from the Diego Garcia base came an hour after take-off, and he was disappointed that it was audio only. He suspected it was because oversized children like Kutner might try to get a picture now that they were physically removed from armed soldiers and more-armed-and-stompy aliens.
House was sitting closest to the speaker phone out of seniority, leg elevated on a foot stool and cane balanced on his knee. He thought that the walking Peterbuilt sounded significantly better than the last time they'd spoken.
"Thanks to your insight into the native biosphere and the speed of your diagnosis, Ratchet expects that the four of us who were afflicted by the bacteria will have recovered fully within the next few solar cycles."
"How did Ratchet treat you, exactly?" Kutner asked, leaning as far forward in his chair as he could without falling out of it.
"He saturated our protoforms with charged energon, and then temporarily drained all the fuel from our frames," Optimus replied, smooth and easy. Clearly total exsanguination was less of a big deal to Cybertronians than organics. "We were refuelled to capacity with doxycycline until our nanites were saturated, drained once more, and replenished with clean energon."
Thirteen grimaced a little. "That sounds… uncomfortable."
There was a muffled rumble of sound. "A temporary discomfort is a small price for survival."
"Truer words were seldom spoken," House remarked, flicking one end of the cane to unbalance it and then catching the handle before it struck the carpet. He lay it against the wall of the plane, waiting for Optimus to go on.
Taub was quick to fill the silence, lacing his fingers together between his knees. "What about the Decepticons? One of them, at least, was definitely infected during the fight."
"We will communicate the instructions on a general frequency until such time as Megatron makes contact with us. It is likely that they will need human assistance to procure such a quantity of doxycycline." A pause, then a rough sounding sigh as if Optimus were remembering an unpleasant argument in vivid detail. "We have worked hard to prevent chemical and biochemical weaponry from becoming a factor in our war. Furthermore, it is unconscionable to me to allow them to perish because of an affliction we infected them with."
House arched a brow at the speaker. "So you'll just stick to shooting them, right?"
Optimus sighed, sounding a little wearier, then went on: "We may also be able to use the cure as leverage, and broker a temporary cease fire."
The doctors exchanged a look at that, acknowledging the murkier implications of the simple statement. To break the awkward silence, Kutner offered: "Glad we could help."
"Indeed. We extend our gratitude to you and your team, Doctor House."
"Live long and prosper," House replied, then became the first human in history to hang up on Optimus Prime. Kutner looked close to agony and sank back in the plush chair.
The click that had signalled the end of talking to an alien seemed to resonate through the plane, stunning the team into silence. Within a few minutes, the quiet was broken by the cheery beeps and whirrs from a game on House's phone.
Taub patted an idle rhythm on his knee, marvelling at how mundane the transition back into 'real life' was looking to be. He nodded towards the immaculate whiteboard near the doorway, which still smelt vaguely of chemicals. "Can you believe they watched us clean that before we took it away?"
Kutner gave a rueful smile. "Don't worry. I made sure I memorised the whole thing. I can write it out if anyone wants a copy."
Foreman held up a hand to decline. Taub and Thirteen didn't say anything in front of House, but their non-response was answer enough.
Pleased, Kutner fidget to look out of the window. On the other side of the clouds below them were people who had no idea they were sharing their world with giant alien robots. Fighting biomechanical giant alien robots, no less. And they'd been the first human doctors to treat them.
He fidgeted his toes in his shoes, feeling the sharp corners of folded paper he'd stashed in between two layers of socks. Even if they never talked about it again, this was going down as the greatest week of his life.
