House sat quite still, in his office, his eyes closed. His unmoving body belied the exertions of his mind, yet no trace of his deliberations could be outwardly seen.
"House?" The voice came unexpectedly, and House opened his eyes with a jerk.
"You have the results?" He said, by way of response as Foreman pushed his way into the room, Cameron close behind him.
"All tests were positive for benzene. The whole street was contaminated; they've got hazmat teams in there now trying to clean the place up. Air pollution in Jameson's house were sixty thousand parts per million and the groundwater was seventy parts per million.."
House nodded as he listened, his face impassive.
"Did you hear what we said?" Foreman pressed, irritated at the lack of responsiveness. "Both of those levels exceed toxic thresholds."
"I heard you." House sighed.
"And?
"And…?"
"And what are we going to do? The treatment is – "
"There is no treatment. The best we can do is manage the symptoms."
A hush fell as each person absorbed House's words. Although neither Cameron nor Foreman would admit it, they had both harboured the hope that, despite the public health expert's words, House would have been able to provide some glimmer of hope, some abstract course of treatment that would halt the destructive action of the poison.
The shrill blast of three pagers shattered the stillness, and almost as one each doctor reached for their own device.
Cameron reached hers first.
"It's the ICU. It must be Chase."
……………………….
"What happened?" Foreman called, sprinting down the corridor towards the ICU room that housed Chase, closely followed by Cameron.
"Dr. Chase went into cardiac arrest again. We shocked him back," The ICU doctor added rapidly, noticing the alarm on Foreman's face. "But he'd managed to partially remove the ventilation tube. We had to re-intubate him but his breathing is laboured and he's bradycardic."
"Are you sure you intubated him correctly?" House's voice sounded from behind.
"Of course." The doctor responded, somewhat indignantly.
"Have you x-rayed the chest to make sure?"
"I can assure you there's no need," the doctor answered stiffly, "I have performed the procedure several times, after all."
"You should schedule a chest x-ray." House said, directing the request at Foreman.
"Dr. House, as I said…"
"Do the x-ray. If he's aspirated the lungs we need to know sooner rather than later."
The doctor glared for a moment, then without speaking, turned and strode away down the corridor.
The incessant hiss of the ventilator greeted House, Foreman and Cameron as they entered the ICU room.
A tense silence hung in the air between them as they once again surveyed the insentient form of Chase, his body still but for the mechanically-regulated rise and fall of his chest. His face was paler now, the skin stretched over his cheekbones, grey and taut.
"He's getting worse." Cameron said, her voice hushed. She turned to face House.
"There must be something we can do."
House did not respond immediately, his eyes focused somewhere between Chase's bed and the blank wall behind him.
"Benzene has a triphasic pattern of elimination. The initial half life is one hour, then three, then fifteen plus. Chase is in the third phase. The best we can do is watch and wait. Either his body will eliminated the toxins, or…" He paused. "Get the chest x-ray." He asserted again. "We can't do anything unless we know what's going on."
"The x-rays are in."
Cameron slotted it into the light box, illuminating the image of Chase's lungs, an area of shadow clearly visible on the x-ray film.
"The right lobe has been aspirated." Cameron sighed. She turned to face House, "How bad is this?"
"It depends," House replied. "on the constituents of the aspirates." House surveyed the x-ray more closely.
"Vomiting is more classically associated with benzene ingestion, not inhalation. Hydrocarbons are lipophilic, so if Chase ingested benzene in all likelihood the mucous membranes in his lungs have been partially dissolved. Assuming however that there was only the one route of exposure, we shouldn't have anything to worry about."
Cameron looked on, horror struck.
"Dissolved?"
"Yeah." House nodded, "Neat, huh?"
"Neat?" Cameron responded, in a tone that made it clear she didn't find his words 'neat'. "You think this is neat?"
"You don't?"
"House!"
"Draw off some of the aspirates, test the pH. Anything less than three and we have to worry about chemical pneumonia."
"What about bacterial pneumonia?"
"Always a possibility with digestive aspirates. Culture and gram stain the sample you take. Start a course of ampicillin to cover all the bases."
A/N: Hope you enjoyed this one. As I said a few chapters back, I have taken a slight liberty with the time line – in reality, benzene is eliminated within a few hours. But hey, that's fiction for you!
Sarah