CHAPTER SIXTEEN: Dissembling
"I'd like you to get down as much of this as you can, but slowly," Wilson tells House as he hands him the orange juice. House takes the glass and swallows a tentative sip.
"So what did you and Cuddy decide?" he asks.
"Not much. Gonna switch the anti-emetic to Zofran. Anything else'll be dependent on the results of the bloodwork. You have any kind of an appetite this morning?"
"What'll happen if I say no?" House isn't hungry at all, but he's starting to worry that, at some point soon, Wilson's going to want to get drastic about the whole nutrition thing.
"Nothing. Actually, if you're still nauseated, I'd just as soon prefer you don't try to eat, not right now. Once we get the Zofran on board, you'll get your appetite back." Wilson's trying to sound optimistic.
House, relieved that they're not going to have a replay of all the other food discussions, responds, "Yeah, you're right." He drinks some more juice, and grimaces slightly; his stomach's already complaining. He sets the glass on the bedside table, shakes his head very slightly.
Wilson looks at the full glass, then at House. He decides not to push the issue; it won't be too much longer until they hear from Cuddy. "Let's go ahead and get that IV restarted. You still doing okay?"
"Yeah; not planning on pulling it out again, if that's what you're asking."
That's exactly what Wilson is asking. He wishes that House had been able to get some of the juice down, but the IV can't stay out any longer. He gathers the necessary supplies and sits on the edge of the bed. "You got anything left?" he asks, surveying the bruised and needle-marked arms. "This looks like a train wreck."
"I think the antecubitals are gone; got some left here," House says, indicating his inner forearms.
Wilson locates a likely candidate. As he ties the tourniquet and swabs the vein, House asks him, "How long you thinking this'll take?"
Wilson knows House isn't asking about the restart. "I don't know. Where we are now is the result of months of neglect." He sees House go into defensive mode. "Not your fault," he interjects quickly. "Miscommunication all around, and denial here," he says, taking his part of the blame. "It's gonna take a while to undo; you know that. I know it's hard. But I'm glad you decided to go through with the procedure. If you hadn't, we still wouldn't know, and it would've been a lot worse by the time we caught it." If we caught it.
"Here we go," Wilson says as he slides the cannula in. He sees the flashback of blood in the chamber, and slowly withdraws the needle. And the vein collapses. He looks up at House.
"Everyone misses once in a while. Try again," House tells him.
Wilson ties the tourniquet more tightly, moves up an inch, and manages to get the cannula successfully inserted. As he's attaching the fluids to the heplock, he says, "Ya know, I didn't miss. Veins are getting fragile. You're not staying hydrated." When House doesn't answer, he's not surprised. He takes a roll of gauze and begins to wrap the site.
"What're you doing?" House asks. "Told you, I'm fine now; I'll leave it alone. Said yourself, I just woke up, potassium was low."
"Potassium is still low," Wilson says, looking pointedly at the full glass of juice. "And we're running outta veins. Humor me." He continues to wrap and tape the IV site securely while House glares at him.
Next, Wilson begins a thorough assessment. House's blood pressure is creeping down again, and his bowel sounds remain hyperactive. The main concern this morning, though, is his cardiac status. If his potassium's as low as Wilson suspects, then there could be arrhythmias. Wilson listens carefully, but hears none of the irregular heartbeats which would signify trouble. For right now, House appears to be holding his own.
"How's the pain? Any more problems with the left leg?"
"Pain's under control." That's all House says, and Wilson's so concerned with cardiac status, hydration status, and mentation that he doesn't notice that the question about the leg goes unanswered.
"You ready to move this party to the couch? Should be hearing from Cuddy soon about the bloodwork, then we'll know more. Don't worry about it; one step at a time. Got it under control." Wilson thinks a slight change of subject is in order. "Hey," he grins, as they make their way towards the living room. "I think Cuddy's gonna give us the plague! Cool, huh?"
House won't play. Once he's settled on the couch, he says, "We both know most of this could've been avoided. And I should've been the one to avoid it. Expected more of a lecture. That's it? You're not angry?"
Wilson gives the question some thought. "Yeah, I'm angry. But not at you. I'm angry that we're in this situation. I'm angry at the part I played that got us here. I'm even angry that the general mindset is that narcotics are bad things. Hell, even doctors believe that. I did." He sighs. "But House, my anger, my guilt, it's not gonna help get you better. So I'm gonna get past it, I need to get past it, okay?"
House narrows his eyes. "Shrink tell you that?"
"Yeah… yes, he did. You wanna know anything else he said?" Wilson speaks slowly. "Because if you do, I'll tell you. They're sending the voice file. If you want to hear it, you can." House looks surprised.
"House, no tricks to this. I'm not trying to psych you out. I went because I want to be the best friend I can be, and the best doctor, because you deserve that. I didn't say anything to him that you can't hear, no secrets I don't want you to know. I'm not ashamed that I did it, not ashamed of anything I said."
Wilson's statement decides it for House. "No. Don't need to hear it. You did what you had to do. Good enough."
Not the reaction I was expecting, Wilson thinks. But he's not himself; maybe the fireworks'll come later. Just hope he remembers that 'did what you had to do' attitude if he winds up needing the PICC line.
The phone rings. "I'm sure that's Cuddy with our results," Wilson says as he goes to answer it.
Cuddy sounds tense. "Just ran the 'lytes. Twice. Potassium's heading into the basement. 2.3 mEq. That's low enough to cause heart arrhythmias. How was the last cardiac assessment?"
Wilson glances at House, who is, thankfully, flipping idly through the TV channels. He keeps his voice calm, says casually, "No problems there."
"Not yet," Cuddy responds grimly. "He's right there, isn't he?"
"Yeah, okay."
"I'm on my way to Hospice to pick up the potassium and the Zofran. I'm also gonna get an EKG machine, and I'm bringing a cardiorespiratory monitor from here. He's gonna need to stay on it while we're replenishing the potassium; he'll be at risk for ventricular tachycardia. We'll have to monitor him closely. I'll get there as quickly as I can. Hospice is expecting me, and they have everything ready; I shouldn't be more than fifteen minutes or so."
"That should be just fine," Wilson says evenly, aware that now House has the TV muted, and is listening. "Anything else?"
"Indicative of moderate to severe dehydration; increased sed rate, high hematocrit. Liver profile looks surprisingly good, under the circumstances. Are you certain he's had only the one episode of vomiting? Because that wouldn't explain this potassium deficit…."
"I'll check into that. My guess would be probably not. Let you know."
Wilson hangs up the phone and turns back to House, trying to think how to phrase the question. Just assume there were other episodes, and that naturally, they weren't worth mentioning. "How many times would you guess you've vomited since we've been home?"
House turns back to the muted television. "Two, three maybe."
Need to at least double that. "So you haven't kept anything down at all?" He keeps his voice neutral, just mildly curious, no accusations.
"Don't think so. Problem?" House still won't look at him.
No, but there could be at any time. "Potassium's low. Good news is, could explain some of the symptoms; muscle cramps, anorexia—"
"Don't waste the good news/bad news routine, Jimmy. Save it for some moron who might buy it. Number?"
"It's low, House. Cuddy—"
"Number?"
Wilson sighs. "2.3. When was your last episode?"
"Bathroom. Few minutes after you and Cuddy left me this morning."
Great. He doesn't need to be actively suicidal; passive's working out just fine. Wilson picks up his stethoscope, and keeps his demeanor calm. "Lie back for me."
House complies while he searches Wilson's face for a reaction to his admission. "I'm in trouble, aren't—"
"Quiet, please." Wilson listens intently for several minutes. He's beginning to think they might've been lucky when he hears a definitive change in rhythm. Gotta get that EKG. Where's Cuddy?
Wilson straightens and looks down at House. He chooses to deliberately misinterpret the question House had been trying to ask. "No, no trouble yet. A few PVCs, that's all; could be perfectly harmless. Cuddy should be here any minute. We're gonna need to run an EKG, just to be safe; she's bringing the machine." He tries to convey a reassurance he doesn't feel, but his biggest concern right now is keeping House absolutely calm. Let's steer the discussion away from his cardiac status; don't wanna answer any questions. "From now on, we're gonna put you back on intakes/outputs, at least 'til the vomiting's under control. I'll need you to help me out with that; lemme know about any more vomiting, okay?"
"Yeah… sure." House is puzzled; where's the lecture? I'd feel better if he'd just yell or something; then I could yell back. He regards Wilson appraisingly, but Wilson simply looks back at him with kind concern. This is too confusing; finally he just leans his head back into the pillow and closes his eyes. Brain's just not working right. Should've said something. Stupid…. He hears the doorbell, hears Wilson let Cuddy in. They're talking, but he can't make out the words. After a minute he quits trying, and just lets himself drift. It's getting so easy to drift.
"How's he doing?" Cuddy asks quietly.
"He's got some definite arrhythmias. Took awhile to hear 'em, but they're there. And he admitted that he's been bringing everything up since we got home." Wilson makes a frustrated sound, and Cuddy puts a hand on his arm and speaks softly.
"Let me get him set up for the EKG. Go get some coffee, or something. Give yourself a few minutes. I'll get the fluids hung, get him ready."
"All right, I'll do that. But Cuddy…. Don't yell at him. I know, it's the natural reaction, but… well… he's so sick—"
Cuddy smiles. "Don't worry about it. I'll give him a hard enough time so he doesn't think I might actually be worried, but not hard enough to upset him. I know how to play the game. Okay?"
Wilson nods; it's true, Cuddy knows how to handle House, sometimes better than Wilson does. "I'll be in the kitchen. Call me when we're ready to run the EKG." As he walks to the kitchen, he's thinking that Dick's suggestion of getting a punching bag might actually have some merit.