A/N: Again, Brynaea to the rescue, on several levels! And thanks to all for the absolutely awesome reviews on that last chapter! BTW, poor House has been home for three days, and has had three life-threatening crises, but—for those of you who are worried—I've intentionally arranged them so that they are not crises which require hospitalization. Had he been in the ER, he'd have been observed there for several hours, and then released, especially under his circumstances. Seen it happen when I worked in hospitals. And NO, I'm not gonna kill 'im. Relax:) mjf
CHAPTER TWENTY-SEVEN: Adrenaline
House is still trying to say something, and despite the extreme difficulty breathing, he's insistent. Wilson sees that his eyes keep going down to his hand, beneath the blanket. And he continues to repeat the same two syllables.
"A… P? Not getting it," Wilson says, frustrated, as he rips into the intubation tray. When House somehow finds the energy to try to lift his hand, Wilson realizes that House knows what's going on, and is trying to tell him. Wilson forces himself to stop, take a deep breath, and focus on House.
Same two syllables, same weak motion of the hand. Over and over again, as time ticks away and House's respirations grow even more ineffective. Finally, in a mixture of frustration and panic, House manages to free one hand just a bit from the edge of the blanket. Wilson pulls the blanket back the rest of the way, sees immediately that there are welts beneath the skin of House's palms, and the palms are red and swollen, and as he watches, it's getting worse. "Angioedema…" he whispers, thinking. "A P… epi? Epi! You're having an allergic reaction!"
Time, which had previously seemed to stop, starts moving again, quickly. Wilson slams the TPN pump off and grabs the epinephrine syringe from the code box. Not wasting the time to locate a vein, he injects the drug intramuscularly, into House's left thigh. Then, his own adrenaline surging, and ambu bag in hand, he watches House intently for a very long forty-two seconds, until House is able to pull in his first real breath.
As Wilson takes his first real breath, he's already moving around the bed, hooking up the oxygen, turning it up to 5 liters. Hooking up the cardiorespiratory monitor. Sinus tach; good, normal under the circumstances. Putting the pulse oximeter on House's finger, and smiling when it reads 97 percent. Noting with satisfaction that the blood pressure is only a little elevated, much closer to normal than it has any right to be. Much closer to normal than mine is, I'm sure, he thinks wryly.
As Wilson auscultates House's lungs, he hears them take in air more easily with each breath, and House's ribcage is no longer retracting. With a wide smile, he says, "Okay, I'll say it before you can. Yet again, you are a great diagnostician. You saved your own life. You saved yourself an unsuccessful intubation; I'll wager that by the time I got in here, your airway was pretty much shut tight. And you saved yourself the ambu by no more than five seconds. Incredible," Wilson shakes his head in wonderment as he starts to backflush the PICC line, watching the blood fill it as he removes the offending TPN solution.
"Looks like we won't even have to reinsert the PICC. Lucked out on this one, all around. Now all we have to do is figure out what caused the anaphylaxis." He flushes the blood from the line with normal saline, then hooks the line to a bag of D5W and resets the pump.
"Sodium acetate," House volunteers in a raspy voice.
"What? How do you know that?"
"Only component in there that would cause this, with these symptoms," House says, holding up his hands and indicating his still-edematous palms. "And luck wasn't involved," he continues, with a bit of smugness. "Brain power," he says. "My brain power," he adds—unnecessarily, Wilson thinks. "Just get the pharmacist to remove the sodium acetate; we'll be good to go."
"You got it. This time we'll go with the all-natural, totally organic, one-hundred percent preservative-free, health food version," Wilson says as he picks up the phone.
When Cuddy arrives after work with the new TPN solution, House's cardiac status has returned to normal sinus rhythm. The oxygen is down to 2 liters, and his O2 sat is holding steady at 96 percent. His blood pressure's normal and his lungs are clear. Although his palms and the soles of his feet itch, the swelling's going down. He feels so good, in fact, that he refuses the racemic epi aerosol breathing treatment Cuddy's brought.
"C'mon, House, just do it," Cuddy says. "If you'll take the aerosol, I'll tell you all about what happened today when Chase got a clinic patient, a teenager whose mother was complaining that his hair was mysteriously 'turning blue, but only on the ends.'"
House laughs in anticipation and accepts the nebulizer, then settles back to take the treatment and hear about how his nonconfrontational wombat handled the latest contender for 'medical moron of the month.'
When the breathing treatment's finished, it's House's turn to talk. And talk he does. Wilson's moving in and out of the room, replenishing the code supplies Cuddy's brought, figuring out a timetable for the TPN administration, and just generally taking advantage of having Cuddy here to monitor House for a while. It doesn't take Wilson long to figure out that House is telling the fish story to end all fish stories.
House is relating, in painstaking detail, the story of the anaphylactic reaction. Wilson's pretty sure that, somewhere along the line, House has added a couple of clueless paramedics and maybe even a defibrillation incident to the story. Cuddy, of course, knows what really happened, but she's making all the appropriate impressed noises, widening her eyes at all the proper dramatic spots. And House is eating up the attention.
Wilson's in the kitchen when Cuddy joins him, laughing. "I didn't know that telling whoppers was a side effect of epinephrine," she says.
Wilson laughs too. "Hey, he's earned it," he says. "Remember when you told me yesterday that House is the man who wrote Murphy's Law? Lucky for all of us that he keeps figuring out how to break the law. What could've been a real crisis was averted, only because he ignored me when I told him we didn't need three docs on this case. And to think, I actually got annoyed when he insisted on studying the label before he'd let me hang the TPN."
Cuddy finishes preparing a glass of ice water for House. "I'd better get back in there before he starts adding white lights and long dead relatives to the story," she says.
"Won't happen," Wilson observes with amusement. "House says all that stuff is just 'a chemical reaction that takes place while the brain shuts down,'" he points out, remembering House's lecture about the infarction and his own near-death experience. "Said he finds it more comforting to believe that life isn't simply a test."
Cuddy quickly grows serious. "Every single day of that man's life is a test," she says sadly.
"And so far, he's passing them all," Wilson tries to reassure her. "It's up to us to make sure he keeps getting those good grades," he says as they head back to House's room to let him crow a little more about yet another self-orchestrated victory over imminent death. That's one story neither of them will ever get tired of listening to.