Work is the best antidote to sorrow
Sherlock Holmes, The Adventure of the Empty House
It had been a while since House had spent the night at the office. He'd spent a fair few working there, but he couldn't remember the last time he'd deliberately slept on the comfy chair. Not that there had been much of a night nor much comfort. Even he had more sense than to tackle the motorcycle ride home on a cocktail of Vicodin, scotch and exhaustion, and the chair had seemed like the best option. Now he was wishing he'd broken into Wilson's office and slept on the couch. His leg didn't like either, but his back would probably have preferred to be horizontal.
Despite the drug/alcohol mix, he'd woken with a start at six, and stayed in denial until seven when an almighty cramp and growing headache had forced him awake. After a few minutes of massage, deep breathing and swearing, he persuaded his leg to uncramp enough to get him down to the locker room for a shower. He was going to look like hell today; he didn't have to smell like it as well.
In the elevator on the way back to his office, he fished out his current bottle of Vicodin, remembering only when he heard the lack of a rattle that he'd meant to get a refill the previous day. He knew he'd taken one too many the night before, also knowing that without it he wouldn't have made it through the night on the chair. There would be time to get more later on, his clinic duty due to start in a couple of hours. If Cuddy caught him anywhere near the clinic, she might start remembering all the duties he'd missed last week, and since he intended to miss more this week, he didn't want to jog her memory. He'd take the pain over that at the moment.
Someone – probably Cameron – had put the lights on in the diagnostics lounge. Only she would think 8 am was a good time to start work. Pointedly not looking through the glass, House pushed open the door to his office, stowing his bag under the desk and trying to ignore the smell of fresh coffee. One look at his desk had confirmed his guess at the identity of the earlybird. A pile of patient files sat in the middle of the mess, clearly inviting him to take a look.
It was an invitation that he had no trouble in refusing. Still moving carefully, only too aware that the last Vicodin had been too long ago, he began clearing up the debris from the previous week's work. Reference books went back on the shelf, CDs and records stacked up again, empty glasses and mugs were gathered together for someone else to wash up. He managed to drag out the tidying for half an hour, arranging and rearranging the CDs and shuffling unread papers around the looming pile of files.
Chase and Foreman arrived together, just as House reached breaking point; the pain and the smell of fresh coffee were driving him crazy. He scooped up the pile of files and went through into the lounge.
"No." He dropped the files onto Cameron's desk and headed to the coffee machine.
"You haven't even opened them," she protested.
"Doesn't matter. The answer's still no."
"The amazing Doctor House." Foreman lifted his hands towards his boss. "Diagnosing lack of illness from the outside of patient files."
"Still no." House added sugar to his coffee and began to make his way back across the room. Cameron intercepted him, standing between him and door of his office. Sighing, House stopped, leaning on his cane. "If you're bored, I'm sure Cuddy could use more help in the clinic. Or you could write something fascinating and get it published." He noticed the flicker in her expression and the corners of his mouth twitched. "Or maybe you've already thought of that."
"I just think we should treat some of these people." She gestured to the pile of folders. "I went through and weeded out the ones I thought you'd find interesting."
"Well that was your first mistake. I mean, just look at them." Cameron did so, then looked back at him, expression blank. House tutted. "They're all blue," he said. "I hate blue folders. Now move." He gestured with his coffee cup.
"That's the best you can come up with?" Cameron asked, holding her ground. "You hate blue?"
"No, I said I hate blue folders. And since when have you been so in love with them? Don't you think the red ones will be hurt by your rejection?"
Not rising to the sarcastic tone, Cameron folded her arms and took half a step backwards, putting her back to his office door, making it clear that she had no intention of moving, even as he took a step forwards, looming over her.
"Just read them," she said, lifting her chin to look him in the eye.
"You may do crazy things when you're on the rebound from a patient's death. I don't."
Chase made a sound that was probably a muffled laugh. "You don't need the excuse."
"Thank you for that." House narrowed his eyes, considering the options and noticing Cameron mirroring his expression. He wondered if she'd copy him if he stuck out his tongue, and was just about to try when an idea occured to him.
"What's it worth to you?" he asked. "My consultation?"
"Worth?" Cameron repeated, momentarily confused.
"If I do this for you, what will you do for me?"
That got him an actual laugh from Chase – always an appreciative audience – and a frown from Cameron. Enjoying her growing annoyance, House put down his coffee and plucked the top file from her desk.
"One of these," he waved the file, "for one of these." Leaning his cane against the desk, he dug into his jacket pocket and produced the empty Vicodin bottle, shaking it under Cameron's nose.
She held his eyes for a moment, weighing up the options.
"Deal," she said at last, taking the bottle. "But you first."
"What? Don't you trust me? You trot on down to the pharmacy and I'll just take this back to my office."
"No way." Cameron didn't move. "Read it first. Then you can have your fix."
Muttering about women scorned, House perched on the edge of the desk to skim read the file. After a few lines, he glanced up again.
"I'm reading, already. Go charm the dragon at the gate of the drug palace."
"We'll keep an eye on him." Foreman told her, bringing his own mug of coffee to the central table and pulling a chair round to face House.
"Yeah, and we all know how well that usually works." House took a mouthful of coffee and glared at Cameron over the rim of his mug. "It's kind of hard to think when you're in pain. Short-circuits the brain, don't you know."
Giving in, Cameron headed for the door.
"Don't let him out of here til he's done," she said to Foreman as she passed.
When she was out of sight, House grinned at the two men
"So now she's gone, do you want to swap dirty stories or just get right on with the belching contest?"
"You've got a file to read." Foreman picked up the newspaper and pointedly shook it open. Chase was already apparently engrossed in his crossword. Left no choice, House carried on reading the patient file, sipping coffee and holding the handle of his mug so tightly that his knuckles turned white. He resisted the desire to put the mug down and grip his leg. Not only would it not really help, he didn't want the others to know how bad it was. It would have been nice if the file had been something suitably complicated and distracting, but he had already spotted what was missing, so all he could do now was sit and wait for Cameron to return bearing gifts.
She did so after about ten minutes of agonised waiting, and not only for House. Lacking other distractions, he'd begun whistling, firstly under his breath, then with increasing volume and annoyance. Neither of the others had said anything, but he'd chosen a suitably repetitive tune that had to be driving them crazy by now. All three looked up eagerly as Cameron came through the door, to her obvious amusement.
She stood out of arm's reach, holding the small orange bottle between thumb and forefinger and giving House an expectant look. Pride getting the better of pain for a moment, he picked up his cane and limped to the white board, not worrying that his steps were more dragging than usual.
"So, Cameron has thrust upon us a sixty-three year old woman. Not a pleasant mental image but there you are." He began writing up the list of symptoms.
Vomiting
Hyponatremia – plasma sodium 127 mmol/L
Fever 38º
Confusion & Lethargy
"Admitted two weeks ago with a four week history of vomiting and nausea," he said. "Went on too long for food poisoning, no gastoentiritis. Alert and conscious but now showing signs of confusion and disorientation. Some genius noticed that she's dehydrated – wonder why that could be – so they've got her on saline and antiemetics. Probably the same genius decided it might be an idea to do some basic labs."
Down the other side of the board he wrote:
Blood pressure 130/76
Cortisol 799 nmol/L
White count 13
CRP 10 mg/L
"Chest and abdominal exam all normal, full autoimmune profile and normal thyroid function." In the silence, he became aware of the expressions on his subordinates' faces. "What?" he asked.
"You actually read the file." Cameron sounded surprised.
"You can remember all of that, and have no idea what her name is?" Foreman asked.
"Well from her creatinine count I'd guess Dorothy, but don't take my word for it." House turned to Chase. "Don't you have an oar to stick in at this point? Or does your silence indicate that paddles and creeks are more your style at the moment?"
Chase frowned at the board. "You said they'd done basic labs. What about a CT or MRI?"
"Well spotted." House unhooked his cane from the board and began pacing. "When her fever went up they did a CT. Periventricular patchy white matter changes but no features of raised intracranial pressure or space occupying lesion."
"SIADH?" suggested Foreman.
"Sodium level's still too high," Cameron pointed out. "Chronic pancreatitis?"
"No abdominal pain." House told her. His pacing had brought him round behind her and Foreman. "Think about it. What's missing from this picture?"
"Since you can obviously see the invisible, why don't you tell us?" Foreman asked.
"Well, I would, but, you know, my leg really hurts." House gave an exaggerated sigh and turned wide, innocent eyes on Cameron. "It's so distracting when that happens."
Not fooled for a second, but giving in anyway, Cameron handed him the bottle. As he unscrewed the top with one hand, trying not to show how much he was shaking or how relieved he was, he used his cane to point at the white board.
"Nowhere in that impressive list of statistics do I see the letters C, S or even F. Which means they haven't done a lumbar puncture. So you'll have to, won't you?"
"And what are we looking for?" Chase asked. "What are you expecting to find?"
"What's wrong with her, I hope." House dry swallowed a tablet. "And while one of you does that, the others can get her started on antibiotics for meningitis. Broad spectrum until we know exactly which of the coccobacilli we're dealing with."
"Meningitis?" Foreman was sceptical. "No rash, no stiff neck, no light sensitivity. Unless there's something you haven't written down there?"
"Damn posters." When Foreman gave him a blank look, House went on. "They've got everyone thinking you need all the symptoms all the time. Chronic meningitis creeps up on you more slowly, particularly if you're well on in years. And you don't show the holy trinity of fever, neck pain and lethargy, although she's got two of the three now. Just for that, you can go do the LP and you," he turned to Chase, "go get her started on antibiotics."
"And me?" Cameron asked.
"You brought me treats." House shook the Vicodin bottle at her. "So I've got a treat for you. The post hasn't been opened yet."
He left them exchanging annoyed looks and retreated behind the TV in his office. Although he knew it was really too soon, he fancied he could feel the narcotic starting work. Thank God for the placebo effect. Closing his eyes, he let the sounds of General Hospital wash over him.
Cameron brought him in the post at ten. She also brought in the pile of folders that he had not accidentally left on her desk.
"No," House said, without looking up.
"You haven't even looked at them."
"Don't need to. No." He was apparently fascinated by the journal article he was reading, although he'd run his eyes over the first paragraph four times without really taking it in. He hadn't been boasting when he said he read Portuguese, but it took more concentration than he had at the moment.
Cameron put the files on his desk anyway.
"I've put a note on the ones I thought were particularly interesting."
"You usually do. And you're usually wrong. Is "esquerdo" the right or the left?"
"I have no idea. This came for you." She put an envelope on top of the pile of folders. "It's marked 'personal' so I thought-"
"Great, thanks, you've been a lot of help. I think it's the left." Without really looking, House put out a hand and pulled the envelope towards him. As he did so, he rested the journal on his knee and brought his cane up with his other hand. It caught the bottom of the pile of files, pushing them off the edge of the desk. "Ooops." House still didn't look up, but he knew Cameron would roll her eyes, possibly fold her arms then leave. He heard the door close behind her.
House's mind was still mostly on the journal article, although he was really going to have to get a Portuguese dictionary- right now, he wasn't sure whether the "coração" was the heart or the liver. Giving up, he had a closer look at the envelope. It was addressed Gregory House – Personal with the hospital's address underneath. Normally patients addressed things to Doctor House; hardly anyone used his first name. As he slit it open, he made a mental note that 'personal' was the only instruction that would keep Cameron out of his post. Interesting but irrelevant – there was never going to be time when he was more concerned about the mail than she was.
The envelope contained a photocopy of a set of medical records, wrapped in a covering letter. Glancing at it, House unfolded the records and began to read. He'd just about reached the bottom of the first page when Wilson stuck his head round the door.
"You want some coffee?"
"No," House said, without looking up, "I want you to come in and have a look at this."
"You're asking for a consult?"
"If you're James Wilson the oncologist, then sure. If you're just his annoying sidekick, I'll have to wait for the real thing."
Rolling his eyes, Wilson came and accepted the offered papers, taking a seat as he began to read.
"I saw Chase. He told me about Rachel. I'm sorry."
"Yes." House began to twirl his cane between his fingers, not looking at Wilson. "If her damn doctor had ever even opened a medical textbook we might have stood some chance. As it was, a band-aid would have been about as much use as we were."
"It wasn't Chase's fault." Wilson looked up from the file. "Don't take it out on them."
"I didn't. No more than usual."
"And if you don't turn up for your clinic shift, Cuddy will just come looking for you."
"Not if I can find somewhere really good to hide." He brought the cane down on the ground with a thud, leaning forwards onto it. "So are you going to give me a consult or are you going to carry on trying to find cunning ways of making me confess my irrational guilt over losing a patient?"
"Are you feeling irrational guilt?"
House dropped his eyes, looking at his hands.
"No more than usual."
Wilson nodded, understanding, then turned his attention back to the file.
"From the looks of this, I'd have to agree with her other doctors' opinions."
"Yeah, and we all know how often they're right."
"Since when do you care?" Wilson closed the file and looked at his friend.
"I care deeply," House said in mock offence. "I'm hurt to think that you'd think otherwise. Her daughter sent me the most charming letter. She even cared enough to handwrite it. I can't ignore something like that."
"You're not going to tell me the real reason, are you?" Wilson asked.
"Have I ever deceived you before?"
"Yes."
"About a patient?"
Wilson thought for a moment.
"Three times in the last five months."
"And that's a reason for you not to even look at this? I'm shocked." House shook his head. "And to think they asked for the best."
Wilson wouldn't walk into that one. "Meaning you."
"In general, yes. But since I'm not the oncologist, in this case, you get to be the best. You go girl."
"And?" Wilson narrowed his eyes, watching House suspiciously.
"And what?" House asked, with his best innocent look.
Wilson leant back in his chair. "Let's have it."
"What?" House was apparently genuinely puzzled.
"Let's have the sarcastic half sentence that completely negates what's gone before. The best if you want an over-earnest schoolboy in a labcoat. The best oncologist in his office."
"Ah, my reputation goes before me." House's half-smile drooped and he shook his head. "There's not much I can do, is there? Except refer it to you. Which I'm doing."
Wilson nodded. "Thanks." The compliment acknowledged, he tapped the papers. "Do you want to be kept up to date on this?"
"Are you kidding? If I wanted to keep working on it, why would I have given it to you?"
"Good point. I'll see what I can do. You," Wilson added, standing up, "don't forget your clinic duty later on."
"And today is going to be different from every other clinic duty and actually see me turn up on time, ready to work, because…?"
"Then you know that some damn doctor isn't going to misdiagnose and land you with another dead body."
"Ouch, a low blow there from the nice doctor." House thrust his cane between his arm and his body, jolting as though he'd been stabbed. "I'm wounded to the core and shall rush to do my duty of removing inanimate objects from inappropriate orifices."
"Go to the clinic. I'll make the call. Unless you've changed your mind and want to do it?" Wilson paused at the door, holding out the file.
"Blackmailer."
"You bring out the best in me." Wilson let the door shut behind him.