Author's notes: Thinking on the episode 'Autopsy' got me thinking about what House would have to do to get Wilson to take a swing at him. I'll say no more because of further story exposition.
Also, Nica's glib nature about the clot has to do with her being through a lot in the past. Backstory can be found at --fiction press dot com—title: Changes. Author name is same as here.
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Ch. 2 DVT
"Doing alright?" Chase asked as he got ready to insert the bone marrow biopsy needle into Nica's hip. "If you're in pain—"
"You always this chatty when you're shoving a big ass needle into a girl's hip… or am I special?" Nica asked, smirking.
"If you want, I can ask Dr. Cameron to do the biopsy," Chase said, holding up the needle.
"You do it," Nica said, shrugging a little. "Probably the closest I'll ever get to sex."
Chase hesitated then began pushing the needle in. He expected a groan or something from Nica as he extracted the sample but she was silent, though she was gripping the edge of the bed so tightly that her knuckles were white.
Once it was over, Nica remained curled up, though her grip had relaxed. A quick check revealed that she was unconscious and while Chase thought about waking her, he decided to leave her be for the moment. She'd been through enough just now.
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The next morning, the diagnostics team plus Wilson gathered in the office and passed around Nica's test results.
"No autoimmune or abnormal cells in the marrow," Cameron said, looking at the results.
House limped over to the white board and crossed cancer and autoimmune off of the list. "So no cancer, no lupus or RA… and no fractures on the x-rays means no trauma. What else could cause leg pain in an 18-year-old cancer survivor?"
"What if it's a tumor inside the bone?" Foreman asked, looking at Wilson. "Might not show up on the blood tests."
"But it would show up in the bone marrow biopsy. Marrow and lymph were both clean," Wilson argued, shaking his head. "Doesn't fit."
"So what does fit?" House asked, cleaning the board and picking up a marker.
"Well, the fact that she could walk rules out trauma. Even a hairline fracture would have inhibited her," Foreman said. "Could be a pinched nerve either in the ankle or spine."
"MRI her leg and back," House said, thinking. "Let's hope that's all this is and we don't find something worse in this kid."
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"So it could just be a pinched nerve?" Nica asked as she lay down on the MRI table.
"It's possible," Foreman said, attaching a sat monitor to her finger. "It that's what it is, we'll schedule you for surgery. Relax. This won't take long."
Back in the control room, Foreman first took pictures of Nica's spine while Chase sat next to him. "Doesn't seem scared at all, does she?" Chase asked, watching Nica inside the machine.
"The girl's barely legal, Chase."
"I kiss a patient once and you hold it over my head forever," Chase muttered as Foreman started to move onto Nica's leg. "What's that?" Chase asked, pointing to a spot. "Is that…? Is that what I think it is?"
Foreman looked closer and nodded. "Yep. It's…"
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"…a DVT," Chase said, handing the scan over to House. "Been there for a couple of days by the look of it. Too late for blood thinners."
"Did you call her parents?" Wilson asked House who hadn't said anything since Foreman and Chase had entered the room.
"I'll do it," Cameron said and hurried off to find Nica's parents.
"I'll schedule her for surgery," Wilson said as House got up from his desk, grabbed his cane and left the room.
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Nica gritted her teeth against the newest wave of pain. This was a nightmare for a moment, there was only pain but as her endorphins and the morphine increased, the pain started to ease up enough that she noticed the man in the doorway. He was tall and rugged-looking and his face was worn and unshaven. He leaned on a cane but Nica could tell that he had once possessed an athletic prowess.
"I'm Dr. House," he said, and Nica had a fleeting memory of the 4th 'Star Wars' movie. '"Hi, I'm Luke Skywalker. I'm here to rescue you."' "I'm the doctor in charge of your case." House pulled a chair over and sat down, stretching out his leg. "You have a DVT in your right calf. It's a—"
"A deep vein thrombosis," Nica said, sighing. "Means the leg pain is muscle death. Came to New Jersey for a little vacation with my friends, then this happens. So what do we do now? Cause… dying of cancer I can be down with, but, uh… I don't want to die this way."
"Basically, we'll go in and pull out the clot," House replied, watching Nica's reaction.
"What if I don't want just the basic package? What are my options?" Nica asked, her voice strangely even.
"One, we remove the clot then wait to see what happens," House said, fingering his cane. "Two, we remove the clot, then take out the dead muscle. Three… we amputate the leg above the necrotic tissue."
"What happened to your leg?"
"An infarction in my thigh," House said, evenly.
"Which choice did you go with?"
"Excisement," House said, not meeting her eyes.
"Pain?" Nica asked, simply.
"Yeah."
"And I'd probably end up with a limp like you?" House nodded and Nica asked, "But if I opt just to get the clot removed…?"
"The dead muscle releases cytokines and potassium," House said, carefully. "You could have organ failure or go into cardiac arrest… Even if nothing happens you could still be in pain for the rest of your life. Or… you could be fine. It's your choice."
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Nica's parents, Mike and Jenna, arrived at the hospital the next day, along with Kara Harmon, Nica's best friend, just as Chase and Wilson where taking Nica into the operating room, Cameron coming towards the small group so as to update Nica's parents. Kara asked, "So what's wrong with Nica? What happened to her leg?"
"Nica has what's known as a DVT," Cameron said, trying to keep her voice even. "The clot is in the muscle of her right calf and because it went undetected, it started causing the muscles to die."
"Is Nica going to be okay?" Mike asked, taking his wife's hand.
"We have every reason to believe she'll be just fine," Cameron said, giving a small smile. "Someone will come find you to let you know how the surgery went," she added, turning to leave.
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Up in the observation deck of the O.R., House looked down at the surgery taking place. Nica Brennan lay on the table as Wilson threaded a wire into her calf and pulled out the clot before another surgeon opened up the leg. Chase left the room and a few moments later joined House. "There's significant muscle death in her calf and a small pert of her thigh muscle looks suspect."
House looked down at Wilson who was looking up expectantly. With the clot removed, the thigh muscle would recover on its own. The muscle in Nica's calf on the other hand… "Close her up," House said after a moment. Chase looked dubious, but nodded and went to tell Wilson while House went to update Nica's parents who were waiting in the lounge.
Jenna Brennan stood and nudged her husband who stood as well. Kara wheeled closer as the doctor with the cane spoke. "We removed the clot. There's still some muscle death… but now that the circulation has been restored, we believe she'll recover."
"Thank God," Jenna said, hugging her husband and Kara.
"She's not out of the woods yet," House added. "Right now she's doing okay, but the cytokines and potassium in her bloodstream can still cause organ—"
"Organ failure and cardiac arrest," Mike finished. "Yeah, we, uh… we've been through this once or twice." He sat down and looked up at House. "Is Nica going to be in pain when she wakes up?"
House couldn't formulate a good response so he just nodded.
"Can we see her?" Jenna asked.
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House had expected to see Wilson come into his office to update him on Nica's condition, but when the older doctor heard his friend come in, there were two things House did not expect. One was the livid expression on Wilson's face and the second was the solid punch that threw House out of his chair and onto the floor, his bad leg hitting first.
House looked up to see Foreman, Chase, and Cameron hurrying into the office. Foreman pulled Wilson away and Cameron knelt down, putting a gentle hand on her boss's shoulder. "House, are you okay?" House nodded as he didn't know how to reply to the question, but once Cameron was sure that House was fine, she rounded on Wilson as she helped House up and into his office chair again. "What the Hell was that for, Wilson?"
"Nica's been through Hell 50 times over," Wilson said to House as he struggled to stay calm. "You had a chance to save her from a world of pain, House, and you didn't! What, you want her to turn into you? Is that it?"
"I did what she asked me to do," House replied, roughly rubbing his leg.
"And her wish was to die!" Wilson shouted, unaware that passing hospital staff and patients were stopping to stare.
"She didn't want to lose her leg," House said, kneading his knuckles and fingers deeply into his thigh. He'd decided to give Ingrid a call again once Wilson and his team had left the room. Somehow, Ingrid had always been able to ease the lingering pain in his leg and soothe the remaining thigh muscle. "I'm going to check on her, make sure there are no complications… I have it covered, Wilson."
Wilson wrenched himself out of Foreman's grip and stormed out of the room, shoving past the crowd outside the diagnostic office, followed by Foreman who seemed determined to prevent a brawl.
Cameron sat on the corner of House's desk and studied him. "You sure you're okay?"
House wanted to just nod 'yes' but his leg started throbbing again. "Could you grab my bag and tell Cuddy I'm off for the day?" Cameron nodded and after handing House his duffle bag, she and Chase left the room. Once alone, House pulled out his cell phone and speed dialed Ingrid to tell her he needed an emergency visit. She said she'd be in his office in 30 minutes and hung up. Popping two Vicodin, House eased his leg up onto the desk and pulled out his GameBoy to play for a while as he waited for Ingrid to show up.
Once he'd heard her knocking, House stood up to let her in and pulled the blinds shut before sitting down in his other lounge-style chair.
"You sound urgent," Ingrid said, sweetly, her Spanish accent adding a beautiful note to her voice. House stood to take off his pants so that he was only wearing his boxer shorts and leaned against the back of the chair as Ingrid pulled out a small bottle of lotion. A few minutes later, her deft hands were massaging the remaining leg muscle and the pain was starting to recede.
In the past 3 years when the leg pain was starting to slowly increase, House had become something of an expert on leg massage. Ingrid was the best by far. She knew exactly how much pressure to use and was very careful not to cause him any additional pain. The student house had called after that migraine mess had been too rough and he'd had to take double the usual amount of Vicodin.
Since then, he'd put Ingrid's number on his speed-dial. Meeting her had been the only good thing to come out of the detox/Hell week Cuddy had put him through.
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45 minutes later, House wrote Ingrid a check for her standard fee and handed over a 40 dollar tip. "Thank you."
"You are welcome, Dr. House," she said, smiling. "Next week also? Usual time?" House nodded as she turned and left the office. Once the door had closed, House grabbed his cane and decided to check on Nica before heading home.
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