Entering treatment room #2 around 10 a.m. the next morning, Dr. Morgan wasn't entirely surprised to find Dr. House sitting on one of the exam tables. He saw the older man roll his eyes in a clear gesture of annoyance as soon as he spotted the orthopedist. Apparently, he hadn't expected him of all doctors to perform his clinic duty this morning…
"Dr. House!" He forced himself to remain completely professional, deciding at once that this was not the moment to continue their territorial mini-war. "Good to see you up again." Then, trying not to make this any harder on the other man than it already had to be: "Leg still giving you trouble…?"
It wasn't exactly a long shot.
House hesitated briefly – clearly fighting with himself over something – before finally just nodding his head. He had already changed into an examination gown, so at least the awkwardness of undressing would not be an issue this morning.
Morgan nodded, moving towards the footpart of the table. "Okay. Lie back for me, please."
House did so with obvious difficulties.
Eyeing the right foot and lower leg, one problem became immediately apparent.
"Okay, House. There's quite a bit of swelling. – The bracelet needs to come off."
House immediately shook his head, one hand going to rub his once again sweaty forhead. "Not… possible!" Even though his tone was trying for nonchalant, he was clearly still in huge amounts of pain.
Carefully touching the bracelet and finding it to be practically immovable due to the very tight fit it made, Morgan nodded determinedly. "Yes, possible. It's impairing the circulation. – It needs to come off."
When House still hesitated, he once again took charge of the situation. "Do you have a number I could call? Someone I could talk to to explain the situation?"
House looked almost a little lost all of a sudden. "I don't know, I… There's probably a parole officer, but I've never met him. – Foreman has been arranging the whole thing."
Without another word, Morgan went to one of the stationary phones near the door quickly punching in a few numbers. "This is Dr. Morgan. I need to talk to Dr. Foreman, please." A brief pause; then: "It's quite urgent. Please ask him to come to the phone for a moment." Another pause, then: "Thank you." He briefly glanced at his patient while waiting for their current dean of medicine to answer the phone, noting his very tense posture and tightly clenched left fist.
"Dr. Foreman, this is Dr. Morgan. – I'm sorry to interrupt you, but this couldn't wait unfortunately… I'm calling about Dr. House, he – " A brief pause, while Foreman was apparently talking. Morgan rolled his eyes. "No, it's not about – Wait a minute! I'm calling because Dr. House is down here with me at the clinic. He injured his leg – I need to remove the ankle bracelet."
House had stilled completely by now, obviously following the one end of the conversation he could hear.
Another eye-roll. "No, he didn't bribe me… Come on, Foreman, you know me better than that." He sounded almost a little angry by now. "I'm not kidding you. There's some swelling and the bracelet is making things worse. It needs to come off, now. There's no question about that. I'm just calling so you can let whomever it is that is monitoring this stuff know that we cut if off for legit reasons; so there are no misunderstandings…"
Then, icily: "Do what you have to do, but I'm cutting that thing off now." With that, he simply hung up the phone.
Returning with a pair of scissors, he simply started cutting the plastic part of the bracelet, careful not to hurt the skin of the ankle in the process. He felt House tense some more.
"Relax, House. I'm being real careful…"
The moment the bracelet came off, House exhaled audibly in a mixture of relief and pain. He once again seemed awfully pale…
"House?" Dr. Morgan briefly touched the other man's arm, trying to get his attention. "Give me a number for pain, okay? One to ten…"
In a gesture that was quickly becoming familiar, House averted his gaze, still breathing heavily. "An eight; maybe…" He sounded reluctant at the admission, although why, Morgan had no idea.
"Okay. What have you taken so far…"
"Hydrocodone. 30 or 40 mg. – Lost some of it again though…"
Morgan winced at that. Hard to imagine the kind of pain it would take for a man like House to actually throw up…
He started to prepare a syringe.
"Okay, listen, House. I would like to make a very brief assessment of the leg before I give you anything. – But I've prepared a syringe now, which I'm going to give to you, as soon as I've taken a quick look, alright?"
In exactly that moment, Forman entered the room without knocking.
"What the hell is going on here." He sounded angry more than anything else.
Morgan turned towards him, immediately straightening up. "Excuse me?!"
"I wanna see the injury, or I'm not calling anybody."
Morgan calmly met his gaze. "That's not for me to decide." He turned towards his patient. "Dr. House…?"
House's expression was unreadable, but he briefly shrugged one shoulder. "Whatever. – But no touching…"
Turning towards the footpart of the exam table, Foreman briely eyed the syringe Morgan was still holding. "I hope he didn't con you into anything. – He's got Vicodin as a standard prescription, you know…?"
Dr. Morgan just smiled at him at the 'advice'. "I can handle the medical side of this, Dr. Foreman; but thank you…"
Foreman's attention was by now fixed on House's leg, the lower part of which was visible beneath the hospital gown. "Yeah, okay; there's some swelling. Not sure it would have been absolutely necessary to cut it off, but what's done is done I guess. – I'm gonna call his parole officer and explain the situation. He will probably ask us to keep an eye on him, until a new one has been attached..."
House's face closed off completely at that, while Morgan felt anger creeping up himself. "I doubt that he'll be running anywhere anytime soon," was all he finally gave back, unable to suppress the sarcasm in his tone.
Foreman sighed at that. "Listen, Dr. Morgan. I'm not the bad guy here. I'm just trying to make sure he doesn't pull a typical 'House' on you."
Morgan was slowly but surely losing his patience. "Yeah, well. I'm more concerned with finally assessing my patient now and getting him some treatment, if you don't mind…"
Once Foreman had left the room without another comment, House exhaled audibly, some of the pain finally showing on his face again. Morgan didn't hesitate anymore now and turned towards the leg.
"Okay, House. I need you tell me what hurts more than it should right now." Given the man's chronic pain situation, this seemed to be the logical question to ask.
"Knee." Was the immediate response, once again pressed through gritted teeth.
Morgan nodded at that. "Alright. What about the old injury… I don't know your history on that." He was already reaching for the gown to push it up slightly, when his hand was suddenly caught in an iron grip. Despite his surprise he didn't fight the other man's hold on him, instead simply letting his hand relax.
"Come on, House, I'm a doctor. I just wanna take a quick look; I'm not putting it up on YouTube…"
House didn't let go off his hand, but he slowly loosened his hold. "There's nothing to look at. Just some… scar tissue. – I had an infarction, about thirteen years ago, which led to first muscle death, then debridement surgery of the quadricepts. That's it. End of story…"
Gently extracting his hand from the other man's grip, Morgan simply nodded. "Okay. For a complete assessment of the leg, I still need to see it; feel for heat, look for swelling… You know that. It'll just take me a minute."
Silence for several long moments. Then House finally swallowed once, before shakily lifting his hand off the thigh, reluctantly giving up the protection.
Quickly sliding up the gown, Morgan immediately started to inspect the thigh, then carefully probe the knotted tissue, trying not to outwardly react to the sight of the massive scar and tissue indentation.
"Nerve damage…?" He finally asked quietly.
Just a nod.
He lightened his touch some more…
Once he had checked the thigh area for any acute heat or swelling, he quickly pulled the gown down again to once more cover the scar. Moving his hands to the knee itself, he then started off by checking the pulse at the back of the joint, aware now of the man's previous history regarding circulation issues.
"Good pulse," he calmly reported without interrupting his examination. "I'm gonna check for tenderness around the knee joint now, then give you something for the pain before we do the functional exam, okay?"
He thought he saw House nod slightly again, but didn't receive any verbal reply.
"Is any of this painful?" He gently palpated the different parts of the knee, watching the other man for reactions.
He felt him wince slightly once or twice.
"A little."
He nodded. "Okay. I'll give you some Demerol now, then check the mobility and stability of the joint. – The bones feel fine so far, but there might be some ligament damage…"
Not getting any protest from his patient, he quickly injected the analgesic.
When he saw House relax slightly after a few minutes, he gently took hold of the leg again. "I'm gonna quickly check the mobility of the joint. Let me know when it gets too much, okay?"
Carefully starting to bend the leg, he elicited a strangled moan from his patient before meeting strong resistance after about 90 degree. Straightening the leg out was easier, but still seemed to hurt the other man.
"Okay, you know the drill… Functional tests next; just try to relax." Taking more time now to test the stability of the joint and ligaments, Morgan noted that House seemed relatively fine pain-wise as long as he didn't put any strain on the thigh muscle. That he seemed to be feeling even through the opioid boost…
"Okay, House. We're almost done here." He patted the right foot lightly. "Can you pull your leg towards yourself? Try to bend the knee as far as you can…"
Firmly gritting his teeth, House tried to comply and actually managed a small movement, before suddenly just starting to retch. – Startled, Morgan managed to hand him a small basin, just in time…
"Sorry…" House sounded breathless, weakly handing back the basin. Morgan frowned at the very small amount of bile it held.
"You're dehydrated, House. – If you're still feeling nauseous after we've braced the leg, I'm prescribing you an antiemetic…"
Quickly disposing of the basin, he waited for his patient to sit up again before handing him a cup of water and settling on a stool right in front of him to inform him about his preliminary diagnosis.
"So… It looks like an ACL; based on the functional tests, I'd say it's a partial tear. – Lachman test was positive, but with a firm end point; pivot shift test was negative." Reaching for the patient chart, he started writing something down. "I'm ordering an MRI and x-rays to have a closer look at everything."
House gave a bitter half-laugh at that. "Seriously?! You wanna waste a thousand bucks on a leg that's already fucked anyway…?"
Giving the other man a stern look, Morgan otherwise completely ignored the remark. "After that, we can talk surgery if we have to, depending on what the scans show us. – But it'll probably already feel a lot better with a brace on, and some rest and ice."
Rummaging around in one of the cupboards, he returned with a hinged knee brace a minute later. "Let's see if we can support the leg a bit with this... Can you please lie back again?" He carefully started fitting the brace around the by now remarkably swollen knee. Strapping its lower part around the shin quickly enough, he then slowly closed the Velcro around the lower thigh right above the knee joint, just below the old scar.
"This feel okay…?" He carefully tightened the strap.
House frowned slightly down at his leg, but replied with a small nod. "Think so."
When he then suddenly winced sharply, Morgan eyed him critically. "You sure? We can also get you a whole-leg brace that might fit more comfortably…"
House started to shake his head, but then suddenly jerked again, face paling up quickly now. "Maybe," he swallowed thickly, "not a bad idea… I don't know what's wrong." He sounded strangly disconcerted by the notion. – For some reason it made Morgan smile slightly, but he immediately sobered again when he saw sweat once again appearing on the other man's forehead.
"Probably just too much pressure too close to the damaged nerves," he kept his voice calm, carefully opening the upper strap again. "Don't worry about it."
A few minutes later, House's leg was finally supported by a whole-leg soft brace that didn't seem to cause him any more pain around the old injury. Waiting for him to slowly sit up again, Morgan eyed his patient critically once more.
"You feeling any better? – How's the pain now?"
House very briefly met his gaze, replying with another minute nod. "It's… good for now; thanks." His eyes flicked away again.
Morgan suppressed another smile. "No problem. I'll have radiology squeeze you in in an hour, if that's okay for you. If you come see me again after that, we can have a look at the scans together. – You want some more water before you go? Your color still isn't great…"
House seemed startled by the remark, frowning in something that looked like a mixture of confusion and slight annoyance. He was already reaching for his crutches, when he finally replied in a clipped tone.
"I'm fine, it's no big deal. And you can stop that whole 'pretending to care' act, 'cause I'm not falling for it."
Exhaling slowly as soon as House had left the exam room, Morgan shook his head before sarcastically informing himself and the now empty room: "Well… This is gonna be fun!"
Tbc… :)