The Game is Afoot

by tpel

We all know the character of Dr. House was inspired by Sherlock Holmes. But what if House actually got to meet Holmes . . . ? Not as silly as it sounds!

3. Eliminating the Impossible

Finally – another chapter!

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"I assure you, I am not the least bit claustrophobic," Holmes remarked, once again giving Foreman the impression that the old man could read his mind.

The two of them were waiting outside the MRI, and had been doing so for 45 minutes past their scheduled appointment time. The results of the morning's cognitive tests hadn't impressed Dr. House. But the fact that Holmes reported feeling off-balance even when sitting or lying down, yet was not nauseous or light headed, was weird enough to pique the diagnostician's interest. Hence, the MRI. Since Holmes didn't exhibit symptoms that would indicate a large tumor or structural defect, Foreman guessed he would be looking for something subtle, something that might require a long time to find. Being stuck inside an MRI tube is no fun, and he didn't want to stress the elderly detective's weak heart any more than necessary, so he'd given him a light dose of Valium as a precaution. With the machine backed up, Foreman was concerned the drug would wear off before they were finished. Holmes apparently did not share this concern. Of course, that might be the Valium talking . . .

Foreman replied, "I'm not suggesting that you are. It's just that many people find MRIs unpleasant. Kind of like being locked inside a big, noisy coffin."

Holmes chuckled, "I once spent several hours inside a coffin."

He didn't elaborate, but he looked like he wouldn't mind doing so. Foreman raised his eyebrows quizzically, and prompted, "Yeah?"

Holmes began, "I was contacted by a gentleman who'd had the misfortune of losing both his sister and his maiden aunt within the span of a week. He described a disturbing turn of events: a pair of pearl earrings that his sister had worn at her funeral, and that he'd believed had gone with her to her grave, turned up in the ears of their late aunt's corpse a few days later, at her wake. Being not quite certain that they were the very same earrings, and being suspicious of the whole matter, he had the jewelry appraised. The earrings were found to be not genuine pearls, but cheap facsimiles. The puzzling part of the situation, of course, was the fact that arrangements for the two women were handled by different establishments . . ."

Fifteen minutes later, Foreman was positioning Holmes in the finally-available MRI, as the detective finished up his tale, " . . . Although within an hour I had overheard enough of the funeral home workers' conversation to discern the nature and extent of their operation, I couldn't very well pop up out of the coffin in their midst. So, I waited through the night for the shift change at dawn, then made my escape."

Foreman grinned, "Weren't you worried that they might, uh, bury you?"

"The thought did cross my mind. Which is why I'd arranged for Watson to come to the chief undertaker's office, if he had not heard from me by a particular time. He was to bluster about a terrible mistake in the hospital, and then pretend to revive me. It's something of a pity that this wasn't necessary, as I think he was rather looking forward to declaring someone 'alive' instead of the opposite."

Holmes' expression had become slightly wistful, then it changed to apprehensive as Foreman strapped him in and immobilized his head. He didn't complain, but Foreman gathered that he wasn't too keen on being handled and restrained. To diffuse the tension, Foreman joked, "It's alright. No premature burials happening on my watch. You've got nothing to worry about . . ."

XXXXXXXXXX

"Clear."

Thump. Electricity hitting the heart, pushing it to wake up and perform its job. One strong artificially-fueled contraction and then . . .

"Nothing."

The failing muscle refused to be roused. Instead of jolting it to life, the burst of energy exacted its toll: a holocaust of a few hundred cells.

"One mig of atropine. Charging to 350."

"Clear."

Thump. The brutal bolt sparked a memory of motion. Or a desire to avoid further punishment . . .

"Got a rhythm! It's tachy, but it's there."

Chase lowered the paddles just as Dr. House entered the room. House commented dryly, "You were supposed to keep her from tanking."

Chase muttered, "Kind of what I just did," then went on to report, "Mrs. Stoneham's respiration deteriorated through the morning, but I had her stabilized on 50 oxygen. She was awake, complaining of back pain. Then she crashed: pulmonary edema got worse, resulting in cardiac arrest."

"Labs?" House inquired.

"The cultures came back negative, and the antibiotics aren't helping, so it's not bacterial. Negative for every virus we've tried."

As he spoke, Chase drained fluid from his patient's lungs. House furrowed his brow and looked thoughtful for a moment, like he had something to say that might be immediately essential. But instead of sharing such wisdom, he said cryptically, "Eliminate the impossible . . ." then turned and left the room.

That's my cue to tag along, like a puppy who knows he might get kicked but follows anyway. Chase gave orders for Mrs. Stoneham's care, then caught up with House as the older man limped down the hall. With his audience present again, House finished, ". . . and what's left, however improbable, is the truth. Start testing for toxins."

"But we eliminated environmental causes. No one else in her home, or in the other places she frequents, is sick. And she's not getting better in the hospital, she's getting worse."

"Time to un-eliminate them."

As Chase threw out some diagnostic suggestions, which House promptly shot down, he realized that they weren't heading toward their department. Having become accustomed to his boss' habits, he wasn't surprised to find that their path led to the MRI, and Foreman. When they arrived, the neurologist had apparently just finished with the machine and was beginning to wheel Mr. Holmes back to his room.

House began bluntly, "Mrs. Hand needs a house call. I'd go during visiting hours, if I were you. The family is extra-clingy."

"Mind telling me what I'm looking for? I thought we'd ruled out environmental."

"Oh, you know, the usual: methamphetamine, PCP, the fun mushrooms . . ."

Foreman argued tiredly, "She's not hallucinating . . ."

". . . which would make finding those things really cool," said House, who promptly lost interest in the conversation and stalked off down the hall.

Chase noted that during the entire transaction House barely glanced at Holmes, though Holmes, in contrast, scrutinized House and even jotted down a few words in a small notebook. When House had left, Holmes commented, "That would be your supervisor, I presume?"

Foreman responded, "Yeah. Sorry. I would have introduced you, but Dr. House is very . . ."

"Rude?" Chase interjected.

The old man did not appear bothered by House's lack of regard. He smiled enigmatically as he said, "One wants to be the top priority of one's waiter and of the man who drive's one's cab. But being of lesser priority to my doctor could be interpreted as meaning that some other poor soul is closer to death than I am, which, at my age, I find somewhat reassuring."

"Or it could mean that General Hospital is on," Chase snarked under his breath, earning a glare from Foreman. As a peace offering, he volunteered, "Want me to take Mr. Holmes back to his room while you go break into a 62-year-old grandmother's sewing-room-slash-meth-lab?"

This did not appease Foreman; in fact, it annoyed him further: "Yes, let's discuss my upcoming felony in front of a patient, especially one whose profession was solving crimes."

Chase had observed that Foreman's reactions to House's breaking-and-entering demands varied considerably. Sometimes he didn't seem to care, other times it rankled him: indignation tinged with guilt. The Australian doctor hadn't really bothered to study the pattern of such reactions, but he gathered from his colleague's irritability that this particular case fell into the latter category.

Holmes, on the other hand, responded amiably, "I am not, nor have I ever been, in the employ of any law enforcement agency." Then he went on, his eyes bright with amused curiosity, "Might I ask for what purpose you illicitly search your patients' homes? And whether I should, perhaps, get Matthew to leave you a key?"

Chase grinned. Foreman smiled briefly, then looked down as he explained, "Sometimes there's evidence in the home that points to the cause of the symptoms: medications, mold, toxins, that sort of thing"

Chase added, "Dr. House prefers to have us look without informing the patients so nobody has a chance to clean up or hide contraband. Plus, he just likes making Foreman break into houses – the man's got talent."

Once again, Foreman glared, which amused Chase. But there was something about the way Foreman quickly looked away that told Chase that he might be bothering the neurologist more than he'd intended. Was Foreman actually embarrassed? Chase tried to remember if he'd ever seen Foreman embarrassed.

Before Chase could push it further, Holmes addressed Foreman quietly, "From my extensive experience with illegal endeavors and those who commit them, I have concluded that it is possible for one to engage in criminal activities without thereby becoming a criminal. The intention is at least as significant as the action."

Foreman's eyes widened in surprise at this statement. Homes' sincere expression morphed into a wry smile as he continued, "Naturally, I may be biased in this perception. You don't think I knocked on the door of the funeral home and explained to the proprietors that I wished to spy on their employees, do you?"

Chase had no idea what the old man was talking about, but Foreman broke into a big grin.

XXXXXXXXXX

House got up from his chair as the credits were rolling to an end. He hop-stepped over to turn off the television, pleased that he'd passed the hour blissfully undisturbed. It had taken many a moon, but he'd finally impressed upon his fellows that they were not to interrupt the soap opera unless there was an emergency – and that he adhered to a very strict definition of the word 'emergency'.

With the TV off, he heard the door to the outer office open. Unfamiliar voices sounded in the doorway. Grabbing his cane, House went out to investigate. Just inside the glass doors he found Mr. Holmes, seated in a wheelchair, accompanied by a young man, presumably the grandson. They seemed to be having a disagreement over how to proceed.

When House approached, Holmes looked up at him, then directed his companion, "You may tell your mother that I am with my doctor."

The young man accepted his dismissal with equanimity, shooting House a glance of bemused apology before withdrawing. Once alone with House, Holmes turned his attention to the two whiteboards. He cocked his head toward the one with his own symptoms. As his eyes scanned the title, his lips quirked into a half-smile and he remarked dryly, "Dying? Not very optimistic, are we?"

House shrugged, "I like to set the bar low."

Before House could resolve his conflicting desires to tell the guy to get the hell out of here and to ask for his autograph, Holmes began propelling his wheelchair . . . directly toward House's office. The words 'where do you think you're going?' seemed trite. As for 'why?', House was curious enough to follow along and see.

Holmes entered the office first. House closed the door behind them, then walked over to perch against the edge of the desk. The fact that Holmes had sent the grandson away and proceeded into the relatively secluded inner office would seem to indicate that he wanted to speak to House in private, perhaps to reveal some information that he didn't want the family to know. House began to doubt this hypothesis when Holmes showed more interest in the furniture and other items on the floor than he did in the doctor he'd supposedly come to consult.

After a minute of intensely studying the surroundings, Holmes locked his wheelchair and winced as he reached around behind him to retrieve the canes that were attached there. Without so much as a glance at House, he levered himself to his feet and began walking across the room, veering around a chair and a pile of journals that were in his path. The thick, long, navy blue robe he wore over his hospital pajamas gave him a measure of visual substance, but he was so thin and angular that he looked like a strong gust of wind could blow him away. This impression was reinforced by the fact that he leaned – not stooped – forward slightly as he walked, as if walking into a storm or hiking up an incline. Otherwise, he placed his canes confidently and his gait was surprisingly steady.

Holmes reached the glass door that led out to the balcony. After a little fiddling, he managed to get the door open. He carefully stepped over the raised doorstep and went out onto the balcony.

"If throwing yourself off my balcony is your idea of a suicide attempt, I'm going to be very disappointed," House said, more to himself than to the detective. Although the height would be insufficient to kill most people, he had to admit that it might be enough to finish off a centenarian. Still, he would expect more originality from Sherlock Holmes.

House followed the old man outside and saw that he was making no move to hurl himself onto the pavement below. Instead, he leaned against the front wall of the balcony and fished a pipe out of the pocket of his robe.

House felt amusement bubbling up inside him, but tried to smother it with a dollop of offence. The detective wasn't seeking medical counsel; he was just looking for a place to light up! What does my balcony look like, the smoking section? Aloud, he challenged, "And you're sure I'm OK with this because . . ."

"You have not smoked cigarettes for many years, but you are not averse to other forms of tobacco. Additionally, you enjoy disregarding rules and flouting authority. Permitting me to smoke on hospital grounds would be an opportunity to do so," Holmes supplied matter-of-factly.

Instead of replying directly, House inspected his own hands, noting the slight flattening between two fingers and the subtle remnant of a yellow tint. He looked over his clothing for several seconds before finding a spot on the hem of his jacket that bore the half-moon pattern of a cigar burn.

Holmes followed his progress with his eyes and nodded his approval, which pleased House more than he thought it should. So he countered with, "I'm no rebel. I'm as meek as a lamb, as tractable as a lemming . . ."

"Your attire says otherwise."

"That just proves I'm a slob. I get away with it because I'm brilliant and charming."

"And your choice of footwear?" Holmes said, becoming more animated as he warmed up to the debate.

"Purely practical," House shot back, holding up his cane and giving it a twirl.

Smirking, Homes argued, "Your disability might explain the fact that you wear trainers to work, but it doesn't explain the fact that you wear those trainers."

Both men's gaze drifted down to House's silver-and-red trimmed sneakers. House couldn't help but chuckle, "Maybe I'm color-blind?"

"No, you are not. But that is not germane to the issue of whether you will obstruct me from enjoying my vice." Holmes gestured with his pipe.

House answered by stepping back inside his office, picking up a folding chair with his left hand, and maneuvering it out onto the balcony. He set it up next to the wall against which Holmes leaned, so that the old man could use the solid structure to help himself sit down and stand up. Holmes nodded his thanks, sat down, and set his arthritic hands to carefully packing a pinch of tobacco. House left him to it.

XXXXXXXXXX

Wilson rummaged about the cupboards in the kitchenette of the Diagnostics department, looking for packets of sugar he could steal. Or rather, steal back.

He didn't care if House caught him doing this – that was sort of the point of their little game. But he would prefer it if House's team didn't walk in right at this moment. He could picture their reactions: Cameron would offer to help him find the sugar, and then present a variety of other sweetening options, which would make him feel like an idiot. Foreman would roll his eyes and make some polite yet vaguely condescending comment, which would also make him feel like an idiot. Chase would smirk and go about his business, which actually would be just fine.

But Wilson would bet against the laconic Aussie arriving first. The three of them normally trooped in about ten minutes past the hour, when they figured House's post-soap Vicodin had time to kick in. According to House, Foreman, and especially Cameron, sometimes skimped on that buffer zone, but Chase almost never did. Speaking of House, Wilson thought he heard signs of life coming from behind the closed office door. He could go investigate, but decided to sit and enjoy his coffee, complete with repatriated sugar, instead. House would emerge soon enough.

Wilson had just seated himself at the table when House came out of his office, dry swallowing a pill as he walked. The oncologist began, "I helped myself to a white powdery substance from your cupboard. I hope to God it's sugar."

House looked startled, then guarded. Then, slowly, a conspiratorial smile spread across his face.

"What?" said Wilson.

"Sherlock Holmes is smoking his pipe on my balcony."

Wilson laughed out loud, "You're kidding."

House shook his head, grinning like a twelve-year-old who just met Batman on the bus.

"You're not kidding?" Wilson grinned back, pleased that House's pensive mood of a few hours ago had subsided into goofiness.

House gestured with his head toward his office. Wilson took this as an invitation. He walked over to House's office and, with exaggerated care, leaned into the doorway to take a peek. He saw that there was, indeed, someone on the balcony, and he smelled pipe tobacco burning. He laughed again, "You're not kidding," then sobered as he came back to the table, "Wait a minute – you're letting him smoke? When we discussed the fact that he doesn't have cancer, I didn't mean I wanted you to give it to him."

House snorted, "He's been smoking longer than most people have been breathing. You want him to quit now? Anyway, my money's on his heart, and probably his kidneys, kicking out before his lungs do."

"Hey, you know what else smoking is bad for? Your heart."

"Ehh," House shrugged, "for all we know the nicotine is the only thing keeping it going."

Wilson wasn't seriously advocating for trying to stop Holmes from smoking. What he really wanted to do was pump House for information about how the detective came to be on his balcony. Unfortunately, right on schedule, House's team started filtering in.

Without preamble, Foreman slapped some MRI films up on the light box, while Chase and Cameron continued the conversation they'd apparently been engaged in on the way:

"Her primary symptoms are respiratory," Cameron said, "What about allergens?"

"If it's something airborne, she should be getting better here. And the respiratory distress is the most serious symptom, but the rash preceded it."

"Maybe the allergic reaction triggered an underlying condition . . ."

House made his way over to the MRI slides; Wilson followed, then Chase and Cameron. To Foreman, House inquired, "What've you got?"

"As expected, there's no global atrophy that would point to Alzheimer's. There's evidence of several micro-infarcts . . ."

House dismissed, "Standard wear and tear."

"We don't see many hundred-year-old brains for comparison, but, yeah, it's probably typical," Foreman agreed.

Pointing at one of the images House said, "Look at the hippocampus."

"Uh huh. There's more lesions than I would've expected, given his minimal memory impairment," Foreman commented, "Actually, the scan doesn't do much to clarify the clinical picture: it over-explains the mild slowing of short-term memory retrieval, yet there's nothing here to explain the more significant attention and balance issues."

"The infarcts could be the early stages of vascular dementia," Cameron suggested "That would account for the confusion and inattention."

"Very early," House put in, "At this rate he'll have a VaD diagnosis when he's a hundred and twelve."

"Plus, he's not confused," Foreman argued, a touch of impatience in his tone.

Cameron shot back, "He got lost waiting for a cab. That's confusion."

"That's one episode. Otherwise, he's completely oriented. It's not dementia," said Foreman.

Wilson decided to step into the fray with, "If that's really the only instance of confusion, maybe he just got turned around in a strange city and panicked."

From their expressions, Wilson could tell that Foreman and House weren't too keen about this theory, but Cameron admitted, "The symptoms Mrs. Linzer described are consistent with the aftermath of a panic attack."

Chase finally chimed in with, "A TIA. We know he's had some minor infarcts. Maybe he was having one then. That would account for the disorientation. Other symptoms might've been mild and cleared up before he came to the clinic."

Foreman nodded approvingly, "After the fact, there's no way to tell how recent any of the infarcts are, especially when they're this size. But a TIA in progress would explain acute temporary confusion."

"A TIA is a kind of stroke, is it not?" came a voice from behind them, "I don't recall ever having a stroke."

Wilson jumped, then suppressed a grin at the startled looks on Chase, Cameron, and Foreman's faces. Holmes must have come out of House's office and wheeled up quietly to join the group. House answered smoothly, "That's what you can expect to remember when you've had a stroke."

Foreman clarified, "Often people have Transient Ischemic Attacks without being aware they are having them. You might have experienced them as short periods – maybe less than an hour – of disorientation and weakness, and, because of the brain involvement, you might not remember them at all afterwards."

"Could that be the cause of my current difficulties?" Holmes asked.

Foreman shook his head, "Doubtful. Strokes are often accompanied by loss of balance and concentration. But even if you had one recently, it would be unlikely that those symptoms would persist without any other neurological symptoms."

House's expression was hard to read. Wilson knew how his friend felt about having patients present during the differential diagnosis process. Holmes wasn't doing any of the things that typically set House off: he wasn't emotionally overwrought, there was no reason to think he was lying, and his questions weren't stupid. Still, the oncologist wondered how long before House said something rude to get rid of him.

It was Cameron, however, who addressed the issue, asking Holmes, "Can we, uh, help you with something?"

The old man paused reflectively for a moment, then replied, "No. No thank-you. I believe I've achieved what I came here for."

House sniffed, lips quirking into a quick smirk, while his team, who probably believed that Holmes had just entered the department while they were gathered around the MRI slides, looked puzzled at what Holmes thought he'd 'achieved'."

Holmes began slowly wheeling himself in the direction of the exit. He stopped in front of the whiteboards and chuckled softly. He turned his head back toward the doctors, as if ready to make a comment, but then glanced back toward the exit and House's office door and said nothing. As Holmes continued toward the exit, Cameron apparently thought better of letting a frail patient wander around the hospital unaided and offered assistance in getting back to his room.

"That's quite all right," Holmes responded, "Matthew and his mother are a tad overprotective. I expect he will intercept me before I need to travel too far."

Foreman said, "I'll go with you. Even if the TIAs aren't the cause of your symptoms, we should discuss measures to reduce your risk of having a more severe stroke."

Foreman and Holmes left. Wilson became aware that House had been watching the detective intently from behind and continued to stare at the spot where Holmes' wheelchair had stopped. House frowned contemplatively for several seconds, then ordered Cameron and Chase, "Get me a clean room."

"For . . . for Mrs. Stoneham?" Chase asked. Wilson shared his sense of whiplash. They'd all been focused on Holmes, but the request made more sense if it were meant for the other patient.

House replied, "Nope. But he's only going to need it for an hour or two. She can use it when he's finished, if Foreman doesn't find her 'stash'."

'Well, that clarifies . . . nothing.' Wilson mused.

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I'm sorry for the slow updating; I'm afraid it's my nature. Thanks so much for all your encouraging reviews! I appreciate the feedback. Shinriko – the alphabetizing goof is probably a sign of neurological deterioration, but I'm afraid it's mine, not Holmes' :-) GranTorino – nah, I couldn't keep House and Holmes apart forever, that would be cruel! Speaking of cruel, I think this is the closest I've ever come to writing a cliffhanger . . .