CHAPTER SIX

Susan startled awake and realized Greg's orthopedic neighbors were arriving to work. She got up and looked through the door at them. They were pretty noisy and she could see where he would find them annoying while he was trying to think. Hopefully in the not distant future, they would find a new home elsewhere. Susan turned away from the door to orthopedics and left out the hallway door.

She poked her head in Phillip's room. Phillip was awake, "May I come in?" Phillip nodded his head and Susan came inside. "Where is your dad?" Phillip shrugged and looked away from Susan. Susan sat down in the recliner and waited in awkward silence for David to return. Fortunately she didn't have to wait long as David arrived within a couple of minutes looking clean and refreshed.

"Somebody's awake," he said. "How are you feeling?"

"I don't feel like I'm about to throw up, but I'm really tired," Phillip said.

"Well, that's something," David said. He looked over at Susan, "I'm glad you came in. I missed you last night. You look pretty beat up though."

"I was up most of the night," she said.

"Did you learn anything?" David asked.

"Only that Phillip has entered puberty," Susan said.

Phillip snapped his head around to Susan, "How do you know? Have you been spying on me?"

"Phillip, that's enough. Sick or not, you are not allowed to talk to her like that. Do you understand? You need to apologize to Susan," David demanded.

"Sorry," Phillip said although it was clear from his tone that he didn't mean it.

"Phillip," Susan said. "I have not been spying on you. I know you've entered puberty because of your blood work, not because I've been looking at you. Even when I helped you clean yourself up at home yesterday, I wasn't looking at you. I respect your privacy."

"You didn't help me yesterday," Phillip said. "Dad was with me."

"No son, I didn't get there until later. Remember, Susan picked you up from school and brought you home," David said. Phillip looked confused. "You don't remember that?" Phillip shook his head. David and Susan looked at each other. Susan got up and walked out.

"Where's she going?" Phillip asked.

"To find and talk to Dr. House."

Ten minutes later Susan was back with Dr. Park. Phillip had fallen back asleep and David was standing next to his bed. "He's asleep?" Susan asked, "I wasn't gone that long."

Dr. Park moved to the side of the bed and started to examine him, "He's not asleep; he's unconscious. We need an EEG; I'll go talk to House." Dr. Park left the room.

Susan turned and looked at David, all the color had left his face and he looked like he was about to pass out. Susan went over to him and guided him to the chair. "Sit down David," she said.

"Susan," he said and wrapped his arms around her. "Please tell me he's going to be OK," he whispered. Susan didn't say anything, but held him close.

Park and Adams came back into the room with the EEG machine and started hooking it up to Phillip. House walked in the room and over to the EEG just as it started printing. He read the tape over Parks shoulder and then stepped back. Park continued looking at the pattern, "This wave pattern suggests a metabolic disorder," she said. "Except that we've already ran all the metabolic blood work and everything is normal."

"We've missed something," he said.

"Alk phos was high," Park said. "Maybe it's his liver."

"Seriously?" House said looking at her, "He's twelve; it's supposed to be high." Susan was staring out in space, "What are you thinking Susan?" House asked.

"Metabolic," Susan said. "I'm trying to think of everything we've eaten over the last week or so." She looked over at David, "No food allergies?"

"No," David said.

"What about things he doesn't like?" Susan asked.

"Well, these days he's eating nearly everything, but until recently I had to struggle to get him to eat his meat," David said. "If it was up to him, he'd eat bread and pasta all day and never touch a piece of meat."

"Ammonia," House and Susan said together. Susan jumped up and left the room and went to the lab.

"Start him on sodium phenylbuterate, citrulline and arginine," House said. Park and Adams left the room to get the medication and return the EEG machine.

"So that's it, you've solved it?" David asked.

"No, we're treating the symptoms. We still don't know the cause," House said.

MDMDMDMD

Back in the lab, Susan was rummaging through the refrigerator for the left over serum sample from Phillip's blood work, "Can I help you find something Susan?" Abby asked.

"I'm looking for the left over serum from Phillip James," Susan said. "It was just run last night, so it should be in here."

Abby looked in the computer and found the specimen number, "It should be in the white box on the top shelf."

Susan shifted up a shelf and starting going through the samples on that shelf. It wasn't long before she found the sample and handed it to Abby, "Run an ammonia test on this."

"Susan, you're not thinking clearly," Abby said. "This is serum and on top of that it's 12 hours old."

"Right, that was stupid," Susan agreed. She went into phlebotomy and asked Heather to run up to Phillip's room and pull a plasma tube for ammonia analysis. Heather took off with her phlebotomy tray and was back in the lab in fifteen minutes with the tube full of blood, "Ok, now run this for ammonia," she said to Abby handing it over.

"I need it added in the system, Susan. The LIS system won't allow me to test without the test added," Abby said.

"Right," Susan said. "I'm so tired my brain has turned to mush." Susan went to her computer in her office and pulled up the LIS system and added the test with House as the ordering physician. "Okay!" she hollered out to Abby, "it's there."

Abby had already moved to the analyzer and had started prepping the sample. She put the sample on, assigned it as a STAT so the instrument would move to it next before starting the next sample in the queue. It wasn't long before the instrument probe was pulling a sample from the specimen and beginning its analysis. Susan watched the results screen and as soon as the number showed up, she picked up her phone and called House. "Ammonia is 267"

MDMDMDMD

"Who was that?" asked David.

"Your wife," House said as he closed his phone, "confirming the high ammonia level."

"How long will this take?" David asked.

"He should come around in a couple of hours as his ammonia levels drop. They should be nearly normal by the end of the day. They won't stay down though, if we don't find the cause," House said. "Call me when he wakes up."

House walked out the door as Susan was coming in. He reached out to touch her arm and said something to her. Susan nodded with her reply and came into the room. David reached his arm out toward Susan and she came toward him. He pulled her to him and scooted as far to one side of the recliner as he could and pulled her down next to him then leaned the chair back. Susan rested her head on his shoulder and her arm over his chest. "House says he'll come around in a couple of hours as his ammonia levels drop," he said.

"Good," Susan replied.

"What did he say to you?"

"He said I looked like crap and needed to sleep," Susan said with a chuckle.

"Well, I think you look beautiful, but you are obviously very tired," David confirmed.

"I didn't sleep much last night while I was waiting on results. Once they were finished, I did finally crash for a couple of hours in Greg's office before Orthopedics arrived in his old outer office. They're really loud; I'm surprised Greg hasn't sabotaged their equipment yet. It'd be next to impossible to think with all that noise."

David kissed her forehead and wrapped his arm around her, "Close your eyes and rest for a while. I'll watch Phillip." Susan did as she was told and within just a few minutes was sound asleep.

An hour later Phillip regained consciousness; he opened his eyes and looked around at all the equipment hooked up to him then glanced over at this dad and Susan. Susan was asleep curled up on her side with her head on his dad's shoulder. His dad's eyes were closed, but he didn't think he was asleep because his thumb was gently rubbing Susan's hand that was resting on his chest. Phillip didn't say anything, but continued to watch them. David opened his eyes and looked over at Phillip, "Good to see you awake. How are you feeling?"

"Better, I think. I guess she's really tired," Phillip said quietly as he watched Susan breathe.

"She was up all night waiting for your lab results," David answered.

Phillip was silent for a moment while he thought about what his dad said, "Why would she do that?"

"Because she cares about you son,"

"But I'm not really her kid," Phillip said. "I'm just her stepson."

"Not to her you're not; as far as she is concerned you are as much her son as Laura is her daughter," David explained. Phillip shook his head not understanding. Jerrod had told him that his stepmom wished he wasn't born and only treated him nice when his dad was around. So far Susan hadn't been like that, but Phillip knew it wouldn't be long before the same thing happened to him. Phillip turned his head toward the door as a nurse walked in the room to check his vitals. Addressing the nurse David said, "Dr. House said he wanted to be called when Phillip regained consciousness."

"I'll take care of that," the nurse said as she wrote down his vitals.

The nurse left the room and Phillip turned his head back toward his dad and looked again at Susan wondering if what his dad said was true. After a few moments he asked, "Were you as happy with mom as you are with Susan?"

"Phillip, I loved your mother very much and yes we were happy. I waited nine years before I allowed myself to move on and now that I have, I'm happier than I have been in a long time. What I had with your mother was special and I will always have a place in my heart for her, after all she gave me you. I will never forget her and what we shared, but she's gone now," David paused for a moment before he continued, "Phillip, you need to understand that there is nothing wrong with me sharing the rest of my life with somebody other than your mother. Just because I've chosen Susan to be my wife, doesn't mean I'm going to forget your mother. At the same time, what I have with Susan is unique and I love her more than I can even begin to explain to you."

"Do you love her more than mom?" Phillip asked.

"Love isn't quantifiable Phillip. I loved your mother very much and I love Susan very much, but the love that I felt for your mother is different than the love I feel for Susan," He kissed her forehead again, "I wouldn't want them to be the same."

"As touching as this all is, I need to talk to your son," House said as he breezed in from the hallway not at all concerned with being quiet. Susan opened her eyes and looked up at David, whispered in his ear and then together they worked themselves into a sitting position. House checked Phillip's pupil response as well as his proprioception on his left side, all of which had returned to normal. "Why don't you like meat?" House asked when he was finished.

"It's OK," Phillip said.

"Your dad said that you'd rather not eat it if you had a choice, and you only recently started eating it."

"Susan's a better cook than dad," Phillip said, then looked over at David. "Sorry dad."

"No problem," David said grinning. "I agree."

"You ever feel sick after you eat?" House asked.

"Well, just after that sandwich the other day," Phillip said. "I don't think I want chicken salad anymore."

"Understandable," Susan said, "but that isn't what made you sick."

"There are only a few conditions that build up ammonia in your system. It shouldn't take long to narrow them down. In the meantime, we're going to keep you on the medication and watch your ammonia levels. Until we know the cause, I'm going to order that the cafeteria only give you vegetarian meals," House said.

"I don't like vegetables," Phillip said.

"It's that or starve," House said, "your choice." He looked over at Susan, "follow me."

Susan got up. "I'll be back," she told David and followed House out the door.

"I need more information about Phillip's mother and her family," House said.

"Like what?" Susan asked.

"Medical history, lifestyle, gossip, whatever you can get," he answered. In the meantime, I need to order some genetic tests," he said. House explained which genetic tests he needed and Susan went to the lab to get the supplies she needed for the tests he requested.

Susan walked in the lab and over to phlebotomy to get what she needed for the tests that House wanted to run, "Heather would you pack me a phlebotomy kit and supply it with yellow top tubes and also buckle cell swabs for DNA analysis?"

"Sure Susan," Heather said and started putting what Susan needed together.

Susan went over to the supply closet to get a box of gloves in her size and when she got there she found that all the medium size latex gloves were missing. Really? She said to herself. Susan looked down at the bottom shelf to where the nitrile gloves were stored and grabbed a box of mediums. She went back into phlebotomy to get her tray from Heather.

"I thought we weren't supposed to use the nitrile gloves unless we had a latex allergy," Heather said.

"I'd rather you didn't, they are quite expensive, but it seems we're out of medium gloves," Susan said.

"There was an entire case in there this morning," Heather replied.

"There isn't now, I want you and the others to keep an eye on the supply room. I need to know who is taking off with our supplies. Our budget is too tight to be supplying the entire hospital," Susan said. "I'm going to go collect these samples."

Several minutes later Susan walked into Phillip's room bearing the phlebotomy tray and headed over to the bed. David was sitting in the chair next to Phillip's bed reading a journal and Phillip was flipping through the channels on the television. David looked up when Susan walked in and smiled, "You're back."

"I'm never far," Susan said. "Hey kiddo, we need to get some samples from you to do more testing."

Phillip was staring at the tray of syringes, needles and tubes. His eyes opened wide, "Those are really big syringes," he said.

"Oh these?" Susan held up the largest syringe in the tray and tossed him the package. Phillip picked it up and looked at it his eyes growing even larger when he saw the two inch needle. Susan grinned at him and then let him off the hook, "We're not using that syringe on you – it's just part of the normal supplies in the tray." Phillip's face quickly shifted from apprehension to relief and David laughed.

"You're mean," David said.

"It's all part of being the 'evil step-mother'," Susan teased. "Seriously though, Phillip, we need a couple of samples." She pulled out the buckle cell kit and showed him how the swab would rub on the inside of his cheek. She put on a pair of gloves and opened the kit, "Here, you can even do it yourself."

Phillip rubbed the swab on the inside of his cheek just as Susan told him to and then handed it back. Susan slipped the swab inside the container and labeled it. Then she pulled out a tourniquet, three yellow top tubes and a needle, "I'm afraid you can't do this one yourself," she said. "However, if you want someone else to take your blood, I understand."

"You can do it," Phillip said trying to be brave.

"Ok. Now I'm going to give you the tubes for you to hold in your other hand after I put your blood in them. I want you to mix them up real good, but don't shake them. Just turn them upside down and right side up seven times, like this." Susan explained showing him how to invert the tubes. She cleaned the inside of his arm with alcohol and then put the tourniquet over his bicep. "You know when you get well, I think we should go shopping. You're outgrowing your clothes and you've got holes in the knees in some of your jeans," Susan said to distract him as she plunged the needle in his arm and starting pulling the first tube. "And, I think you need some new sneakers too, don't you?" Phillip nodded but was looking away from his arm. Soon Susan had all three tubes pulled and she handed them to Phillip, "Start mixing those just like I showed you," she said.

"You're already finished?" Phillip asked. "I didn't even feel it."

"Good," Susan said with a smile. She finished putting the co-band around his arm to lessen any chance of a bruise and then took the tubes from him. "Nice and mixed up, good job," she said.

"Jerrod said you wouldn't like the way I dress," Phillip said referring back to what she said earlier. "He said you would start telling me what to wear." David looked up from his journal.

"Why would he tell you that?" David asked.

"He said his step mother hates him and is always telling him what to do and what to wear."

Susan decided to step back from the conversation and let David take lead, "Son, Jerrod has been through a lot with his mother. She didn't take care of him and didn't give him any direction at all. His step mother has had to take over the role his real mother didn't provide."

"He said that he is going back to live with his real mom this summer," Phillip said. "He said that she was really cool and let him do whatever he wanted. He said since he was thirteen the judge will let him do what he wants."

"No Phillip; the judge isn't going to let Jerrod go live with his mom," David said.

"But Jerrod said…," Phillip started.

"Jerrod doesn't know the whole story," David explained. "I can guarantee you that he won't be living with his mom. His stepmom is a wonderful lady and she's already worked wonders with Jerrod. He's much better off with her and his dad than he is with his mother."

Susan remembered Jerrod from when he spent the night with Phillip several weeks ago when his parents had to go out of town overnight, but was unaware of the story behind his situation. She looked over at David as she followed the conversation. Finally, she decided to speak up, "Phillip, I don't know what Jerrod has told you, but just because he thinks his relationship with his stepmom is bad, doesn't mean that our relationship will be the same way. In fact, I wouldn't be surprised if his relationship with his stepmom is a lot better than he is letting on. Maybe listening to Jerrod isn't the best way to learn about what a step mother will do or not do."

"So you're saying I shouldn't be friends with Jerrod. He said you'd say that too," Phillip said.

"No, you're putting words in my mouth. I'm not saying that at all," Susan said.

"What she's saying, Phillip, is you need to make your own judgment based on your own experience. Don't rely on other people to tell you how things are or will be," David said. "You can and should listen to other people and learn from their experience, but you always need to think for yourself."

"I'm going to run these down to the lab. We have to send them out and I want to get them in today's shipment," Susan said.

Phillip didn't say anymore after Susan left. He picked up the remote and started flipping through the channels. David could see that he wasn't really paying attention to the channels, just flipping through them, "What are you thinking son?"

"Nothing."

Obviously Phillip wasn't thinking about nothing, but David decided not to press him. He knew that Phillip was thinking over everything that he'd been told and that he'd come to his own conclusions soon. The television finally landed on a channel and stayed there for more than just a few seconds. David glanced up; it was some show about catching alligators in the swamp. He watched for a moment and then took up his journal to finish the article he's been reading.

"Dad?"

David looked up in question, "Do you think Jerrod will ever like his stepmom?"

"I'm sure one of these days he'll realize how blessed he is to have her," David said letting that sink in and hoping Phillip would apply it to himself.

MDMDMDMDMD

Susan sent the samples off to the reference lab and indicated the results to be rushed. They'd have to pay extra for that, but it was worth it to Susan to get the results back quicker. She went in her office and sat down to rest for a minute. She was so tired.

"You know an hour here and an hour there isn't going to get you what you need," House said as he came in the door.

"I know," she said. "When this is over, I'm going to crash."

"You need to take better care of yourself," he said.

"Interesting," Susan said. "Why would you say that?"

"I can't care about the well-being of my sister?" he asked.

Susan laughed, "Right."

"You laugh. I'm hurt," House said and then came in and sat down. "Did you get those samples sent off?"

"Yep," Susan said. "Put a rush on them, so hopefully we'll have the results in a couple of days. In the meantime, what do we do?"

"We treat the symptoms. His ammonia levels are dropping precipitously. There are least three different metabolic causes for high ammonia levels, but they're all treated similarly," House said.

"He's going to have to go on a vegetarian diet," Susan said.

"Yes, which means you'll be making major changes in the way you cook," House said.

"Yeah, I tend to center our meals on what variety of meat I'm cooking for that meal. Jeff was a real carnivore and I got used to cooking meat-centric," she said. "It's definitely going to be a change of pace." She paused for a moment thinking, "Well, I'm always up for a challenge. I'm sure I'll enjoy experimenting. In fact, there are a lot of vegetarian cook books in one of the cabinets in the kitchen," Susan said.

"David's wife was a vegetarian?" House asked.

"Apparently," Susan said. House's eyes took on a faraway look, "I know that look," Susan said. House didn't reply and turned to walk out the door.

"Why didn't you tell me your wife was a vegetarian?" House asked David when he walked in the room.

"I..uh..," David said.

"Forget it, why was she a vegetarian?" he asked. "Was it a religious thing or some great calling to save all the animals in the world…?"

"No, not really; she didn't have any issues cooking meat for me, she just said it gave her a headache every time she ate it, so she just didn't eat it to avoid the headache," David said.

"Now see, everybody lies. That's the kind of information I needed. You're right kid, your mom did make you sick," House said. Susan finally walked in just as House made that comment.

"I did not make him sick," Susan said.

"I'm not talking about you; I'm talking about his real mom. Although you didn't help matters any," House said. "You have partial OTC syndrome and you inherited it from your mother."

"I thought OTC syndrome showed itself during infancy," Susan said.

"Not always, this is the later variety and not anywhere near as severe. If it had been the full version, he would have died before he even reached one year old. It's a lot worse in males than in females. We treat for the ammonia levels and you'll have to be counseled by a dietician. Great! Case closed, Later." House walked out the door leaving the rest of the family behind rather stunned by the outcome.

"So I'm going to be OK?" Phillip asked.

"You're going to be fine," Susan said. "You're going to have to deal with getting your blood taken a lot so we can monitor your ammonia levels and we'll adjust your eating habits, but yes, you're going to be fine."

David smiled, "Thank God."

Susan smirked, "Yes, but don't let Greg hear you. He likes to take full credit."