A/N: All medical procedures discussed in this chapter are fact-based.
CHAPTER FIFTEEN: The Plan
Wilson and Cuddy walk to House's desk and take seats. Wilson looks more intense, more focused than Cuddy's ever seen him, and even before he begins to speak she senses that he's staked a lot on this conversation.
"I need for you to hear me out before you say anything, Lisa. Are you willing to do that? Because if you can't hear everything I have to say before making a decision, I'm not going to waste my time or yours. More importantly, I won't waste his time."
Cuddy sighs. "You two are aging me more than you know. From him, I expect it. Sometimes, I even enjoy it. It… amuses me. But from you? Why does the world suddenly seem off-kilter?" Wilson just looks at her, waiting. He's serious, and won't engage in banter. "Okay, hit me," she says. She rests her forehead in her hand and closes her eyes: It's only 8:00 in the morning; can this day get any longer?
"What would you say if I told you I can get him back to where he was a year ago?" Wilson asks.
"You know I'd say go for it. But you can't do that… can you?"
"It's pretty well acknowledged that chronic pain alters the neurons in the brain. The brain adapts to these alterations by memorizing the pain cycle, and firing off all the right amounts of agony when certain nerves are stimulated. It's like a computer program—push A, and B always happens. But when you start throwing breakthrough pain into the equation, the brain doesn't like the disruption. So it begins to assimilate the breakthroughs into the cycle. After while, you push A, and B and C start happening."
Cuddy is fascinated. "And that's what's been going on with House?"
Wilson nods. "It's been going on for several months now. It's getting worse; we've all seen it. The only way to stop it is to break the cycle, keep it broken long enough for his brain to 'forget' the pattern, at which point it'll just go back to having A trigger B. We do that for House, and his daily pain levels roll back to what they were about a year ago."
Wilson sees that he still has her full attention, and she doesn't look doubtful, so he continues. "It should take 24 hours. We put him on a continuous morphine drip, and keep him close to '3' on the sedation score chart—sedated and difficult to rouse."
"A chemically-induced coma?" Now she's looking doubtful, and Wilson knows that she's remembering the events of almost seven years ago.
"No, that would be level '4'. I said he'll be difficult to rouse, not impossible. And, after the first sixteen hours, I'll start moving him to level '2'—still sedated, but easy to rouse. I'll keep him there the rest of the time. Then, once he's awake, we immediately start him on a therapeutic dose of Vicodin, and, after a few hours, well, he's good to go."
"So what's the catch? It sounds good. We'll put him in the unit right now and get started."
"That's the catch—no unit." As Cuddy's eyes widen and she opens her mouth to speak, he reminds her tersely, "You agreed to hear me out. I'm not finished. The procedure isn't medically complicated; it simply requires intensive monitoring."
"Hence the term Intensive Care Unit," Cuddy interrupts impatiently.
"Not necessary. And not a good idea. The whole hospital'd know inside of an hour—including his team. And all the psychological contraindications still stand. Cuddy, this is what I do, and I'm good at it. When we did the study in January with twenty bone cancer patients, there wasn't a single untoward incident. And while right now it could be argued that House is medically fragile, not one of the study patients was as generally healthy as he is."
"If I agree to this—and that's a very big if—what would you need?"
"Not much. A cardiac monitor with a pulse oximeter would be the biggest thing. I've got a friend at the Hospice pharmacy—we can get the scrip for the morphine through him, he doesn't know House. He'll recognize the name, and I might have to answer a question or two later, but he won't breach patient confidentiality. A few other supplies and some more O2, fluids, and Compazine should cover it." Wilson sees that she's still on board. "There's just one more problem," he says.
Cuddy closes her eyes and massages her temples. "And I'm sure you're going to share it with me."
"This is one you can't share—I wish you could. I can't do this without House's informed consent. He doesn't trust anyone, and why should he? And I'm going to be asking him to trust me with his life. He'll be totally reliant on me for 24 hours, completely vulnerable--without control. And that's not an easy thing to ask of anyone. But House—well, he's not exactly your average, uninformed patient, blindly placing his trust in the all-knowing physician."
"You've got a remarkable gift for understatement," Cuddy observes dryly.
"So if you're agreeing to this, I'll need to wake him and talk with him—alone."
Cuddy throws both hands in the air; "Sure, why not? I was getting tired of this job anyway. And who knows? Maybe opening a private ICU in an office wing will someday generate revenue. Silly me, I don't know why I didn't think of it before… no, scratch that, I do know why--this is insane!"
Wilson's grin reaches his eyes; "This is House. It fits."
Cuddy chokes back a laugh. "All right. You've got your 24 hours. But I'm warning you--one blip and he's in the unit."
Wilson looks at her, all traces of humor gone. "No. You know there'll be blips. You've gotta trust me. He's gotta trust me."
Cuddy sighs, nods. "I'll set it up. I don't know how, but I'm certain I'll think of something. God knows, these last seventeen hours have taught me how to break the rules with the best of 'em. 'Course, the best of 'em is House, and even he's never suggested creating a hospital inside a perfectly good... hospital."
She fixes Wilson with an exasperated eye. "You may have just outclassed your partner in crime with this one, Dr. Wilson." Cuddy rolls her eyes. "Safety? Honesty? Merely abstract, overrated concepts in my book." She walks out, muttering about unnecessary risks and liabilities, and Wilson knows she'll take care of everything. Everything except convincing House.