"Damn," Cameron said as she looked at the latest results through the microscope. "The more I add, the more unstable the reaction. No wonder she was in so much pain. All these prescriptions were working against each other."
"There has to be something that will work. We have to keep trying." replied Foreman.
"How much time do we have? This could take weeks. By that time all the drugs will be out of her system or she will be dead."
Cameron decided to take a small break from the microscope. She and Foreman had been running tests for a few hours and she was getting a bit loopy. She leaned back in her chair and had a long stretch while yawning from mild exhaustion. Foreman noticed her break and decided it was time to stop looking at samples as well.
"Foreman, do you think Chase is doing a good job with his first case?" asked Cameron, ready for a diversion from the tedious lab work.
"Better than I thought he would," replied Foreman.
"How did you think he would do?"
"He has always seemed lazy to me. He has really jumped in and worked hard to get things done. I never knew he had it in him."
"You never know how people will react when they are thrown outside their comfort zone," answered Cameron. "Personally, I'm having trouble taking instructions from him. No, I'm just having trouble with him in that role in general. It doesn't seem natural."
"That's because you aren't in awe of him like you are House," replied Foreman with a slight laugh. "That and you know him in a different way. I'm sure it is strange."
Cameron was silent in her response because she couldn't argue with his observation.
"Chase is doing his job," continued Foreman. "You have give him that. I still don't trust him, but I don't trust House either. It is my job to keep both of them honest."
"I'm just not sure if I want to be put in that position either," said Cameron. "It gives me a lot to think about over the next few months."
Cameron tried to continue but realized she couldn't. She sighed then got up to leave. "Where are you going?" asked Foreman.
"To get more blood from the patient. With this many tests we will end up bleeding her dry."
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Cameron arrived at the ICU to see Estelle alone. The absence of Wilson and Chase indicated to her they were done with their procedures. She looks like an oversized pincushion, Cameron thought as she noticed all the areas that were poked and prodded.
Cameron stood next to the patient and started to open the sealed tube for the blood sample. As she fumbled with the package it ripped open and fell from her fingers onto the floor. She bent over with anger at her clumsiness to pick it up and then abruptly stopped as she noticed something behind Estelle's left ear. She examined the mark intensely, then whipped out her pager.
"What's up?" Chase asked Cameron a few minutes later as he arrived. He was still in scrubs from his work with Wilson.
"Look at this," said Cameron. She pointed behind the left ear.
Chase reacted with deep surprise uncertain as to how they missed that previously. It was well hidden behind the ear though. He took his turn to intensely study the mark. "Insect bite?"
"It looks like it, very likely a bee sting." Cameron replied.
Chase walked to the end of the bed and opened the chart. "Her previous allergy test showed her negative for bee stings."
"She had been taking bee pollen though," said Cameron. "One insect bite wouldn't push her over the edge, but couple that with the supplement and you have a harsh reaction."
"Anaphylactic shock doesn't fit here." Chase said quickly jumping in. "Her blood pressure is very high, not very low. It explains the unconsciousness though. Page Foreman and we'll discuss this in the office now.
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Chase arrived at the conference room and grabbed the eraser intending to wipe the white board clean. He stopped before doing so though to examine the new artwork decorating it. There was game of hangman that spelled out "Aussie". At the end of the noose was a picture of a kangaroo in a lab coat.
"Hangman is supposed to have seven letters," Chase shouted to House in the other room.
"Aw, come on Chase," said Cameron smiling, "he's cute."
Chase flashed her a "get real" look and proceeded to erase the picture.
"We are starting from scratch," replied Chase. "We have been looking at the problem all wrong. We shouldn't analyze her symptoms. We need to analyze the starting point and then the chain reaction afterward. Let's start with what is likely the trigger."
Chase wrote bee sting on the board.
"I'm assuming you ruled out anaphylaxis since it hadn't been mentioned yet," said Foreman.
"It can't be. Yes, she has respiratory distress and loss of consciousness, but no hypotension and since she wasn't treated for a severe allergic reaction she didn't experience the usual death either.
Chase then wrote loss of consciousness, malignant hypertension, low heart rate and respiratory distress on the board.
"Respiratory distress was caused in part by the mycotoxosis." said Cameron.
"I think we can assume before the bee sting she had many things wrong with her. We need to look at the reaction. What are causes for malignant hypertension and low heart rate."
"Sleep apnea, obesity, sedentary lifestyle, combine all that with an allergic reaction and who knows?" said Cameron. "She was on an ACE Inhibitor for the blood pressure by one doctor, and then taking NSAIDS for arthritis and she was taking ibuprofen on her own. That rendered any benefits of a drug controlling her blood pressure useless."
"Wait a second." Chase said as bells started ringing in his head, "Arthritis. If the ACE Inhibitor wasn't working, the NSAID wasn't either." Chase said. He then wrote on the board pain.
"Care to be more specific?" asked Cameron.
"No, he's onto something here," said Foreman."The autonomic nervous system's response to pain receptors plays a role in physical reactions."
"It's not just that. She was supposed to see a Rheumatologist next week about possible Fibromyalgia." said Chase.
Foreman saw where he was going with this and started working out the analysis. "Okay, let's assume she has Fibromyalgia. The causes are not clear, but one possible cause is chemical changes in the brain which affects the regulation of neurotransmitters. That would cause her migraines and depression, but it would also increase her amount of pain."
"Isn't one of the possible causes also a viral infection?" asked Cameron?
"That isn't well proven and not a common cause," replied Chase. "None of her problems hint of anything viral. There is however one possible cause that fits the best here." Chase wrote on the board. Abnormal reactions of the SNS
"Fight or flight," said Foreman.
"Exactly," replied Chase. "A normal sympathetic nervous system reacts to stress properly by releasing epinephrine and norepinephrine to the adrenal glands."
"So the adrenal glands didn't properly regulate the heart rate and constrict blood vessels during a bee sting and that threw her entire body into complete distress," said Foreman
"It allowed too much epinephrine to enter her system. That caused an adverse reaction to her already the high blood pressure, thus sending it through the roof." Chase added.
"What about the low heart rate?" asked Foreman. "If she had too much epinephrine in her system, that would have gone up too."
"That has since stabilized. A common cause of low heart rate is improper medication. She was on blood thinners."
They all took a moment to process this new line of thinking. To Cameron, it was a bit far-fetched. "Many of the same symptoms could be caused by her hypothyroid medication not working. There could be nothing wrong with her sympathetic nervous system. If that is the case, she needs more epinephrine."
"Her heart is too weak," said Chase. "The cardiac irritation caused by the epi would be too much for her. What she had in her system already caused damage."
Cameron and Foreman took a moment to objectively process this theory and analyze other options.
"How about ibogaine?" asked Foreman. "It's experimental, but it is proving to be effective for rapid detox. We need to get the drugs out of her system faster so we can do the proper treatment."
"Ibogaine causes fatal cardiac arrhythmia," replied Chase.
"In isolated cases," said Foreman.
"Yes, those cases being someone with a bad heart and bad health in general."
"It might be worth the risk," said Foreman.
"She likely die if we try anything drastic," said Chase. "All she needs right now is more time for the IV fluids to run through her system."
"So the strategy right now is to do nothing?" exclaimed Cameron. "You'll end up killing her."
"I'll entertain more ideas. Until then, yes, we do nothing. Even House will tell you no matter what, sometimes patients die. We shouldn't be the ones that end up killing her because we want to be heroes."
"Okay then," said Cameron not ready to give up the fight. "Back to the lab. I'll see if I can't find that better idea."
Foreman looked at Chase. "I'll start looking into other rapid detox procedures."
Chase watched as they left and then he took a deep breath of relief. Now was not the time to be uncertain, so he had to hold his ground. He was being judged. Then he went to the white board and started drawing his own hangman picture.
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Cameron waited around until Chase went up to the ICU. When he did she pounced on the opportunity.
"House, you've had your fun. Now get in there and stop this madness." Cameron said as she flung her way into House's office.
"My tickets are non-refundable and non-changeable. Coming back early won't be possible."
"Chase is in over his head. He isn't making good choices. Come on, you have heard everything. His plan is wrong. His patient will be dead soon if we don't do anything."
"You act if though you have a test that proves you are right. I believe there was a suggestion of coming up with something better?"
"Come on, his theory is even crazy for you. We need you to step in and use your legendary brilliant mind. A patient is dying here."
"Flattery is so beneath you. I'm disappointed," replied House. "Patients are always dying. They can die while I'm enjoying my vacation in a tropical paradise. I'll still sleep at night. Now go away. I'm having a drink soon at the cabana with Swedish twins."
Cameron turned to leave in disgust. She knew she didn't have much time to do this and House wasn't changing his mind.
"Read some of the articles by Rowan Chase. He was one of the first Rheumatology experts to acknowledge Fibromyalgia as a disease. He knew what he was talking about." House said as she was leaving.
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