CHAPTER TWENTY-TWO: Breathe
The first thing Wilson does when he gets to the kitchen is to place a call to the pharmacy to order the ceftriaxone; he requests a stat delivery. The sooner they get it started, the better. He also orders three days' worth of albuterol aerosols and a nebulizer; House's lack of mobility and the effects of the hydrocodone on his cough reflex have to be countered somehow.
Then Wilson calls Cuddy. He tells her he's virtually certain that House has pneumonia, and he gives her his plan of treatment. She insists on a chest x-ray for confirmation, and Wilson concedes it's not a bad idea. Cuddy promises to set up a visit by mobile radiology in the morning.
When Wilson returns to the living room, House has propped himself up on the pillows. He's awake, but he looks miserable. Wilson hands him the ibuprofen, then picks up the pulse oximeter. After House has swallowed the pills, Wilson hands him the oximeter. House attaches it to his finger and holds his hand up for Wilson to read the number.
"You must not have it positioned right," Wilson tells him as he takes House's hand and positions the monitor himself. He gets the same reading, 90 percent. Wilson picks up his stethoscope. "Sit forward and take some deep breaths."
There's no real change in House's breath sounds; his lungs are still clear, but now Wilson is certain that the air exchange is diminished in the right lower lobes—and even the deep breaths haven't changed the pulse ox reading. "Let's get you into the bedroom," Wilson says calmly as he positions the wheelchair by the couch.
House is able to transfer himself to the chair, but it's clear that this minimal physical effort is difficult for him. He sits huddled in the chair, eyes glazed and unfocused, as Wilson disconnects the IV. "Feel like crap," he says as Wilson pushes the chair to the bedroom. "It's cold in here." That's when Wilson sees that House is shivering.
Once Wilson has him settled in bed, he takes another temperature. "Your fever's spiking; almost 103 now, that explains the chills. Don't need a chest x-ray to tell me it's pneumonia. No wonder you feel like crap." While Wilson's speaking, he's rolling the portable O2 setup to the bedside.
"What's that for?" House grumbles.
"Oh, it's just a little something I like to do when a patient's O2 sat falls below life-sustaining levels," Wilson answers lightly. "Humor me."
"Ninety isn't that bad," House counters, shooting a dirty look in the direction of the oxygen setup.
"No, not bad at all—if you're a lifelong asthmatic who chain-smokes," Wilson retorts as he connects fresh tubing to the machine and sets the gauge for three liters. "We caught this early, and the antibiotics will be here soon; odds are you won't need the O2 for long."
Wilson tries to hand the nasal cannula to House, who patently ignores it. "A touch of pneumonia—not a big deal," he tells Wilson.
"You're absolutely right," Wilson says agreeably. "And we're gonna make certain it doesn't become a big deal," he continues pleasantly as he positions the nasal cannula in House's nose. "To that end, I'll start the antibiotics as soon as they arrive, and we'll start aerosol treatments every six hours. Oh, and your boss has decreed that you're getting a chest x-ray in the morning. We're attacking this thing from all sides; it doesn't stand a chance."
Wilson is smiling and casual—and laughing inwardly. House is obviously frustrated that Wilson is refusing to engage in debate, and finally, he simply rolls his eyes and leans back against the pillows in an exaggerated gesture of defeat. "Could've won that if I felt a little better," he says, in an undertone.
"I'm certain you would've," Wilson says soothingly, trying not to smirk. "So I won't hold the loss against you."
"Big of you," House mumbles. He's started to shiver again. "Can I have another blanket? Or is freezing to death part of your overly-aggressive plan of attack? 'Cuz I hear death cures a lot of things."
"If you'll stop whining, I'll be happy to let ya know." Wilson places the tympanic thermometer in House's ear canal. "Sorry," he says. "Still one-oh-two point eight. Let's wait on the blanket until it's below 102. In the meantime," he continues, grabbing several pillows and placing them on House's lap, "lean forward for me, gonna do a little CPT while we're waiting on the aerosols."
"Chest physiotherapy?" House asks with disgust. "Works great with pediatric patients and comatose adults. I don't fit in either of those categories."
Wilson decides to let that one slide—especially since House has already leaned obediently into the stack of pillows in front of him. Wilson cups his hands and starts the rhythmic percussion against House's back that's designed to loosen secretions in the lungs. He begins forcefully, but when he sees House wince he realizes quickly that the procedure's uncomfortable for him; House is still so thin that Wilson feels as if he's striking directly on bone. He's glad that House can't see the sadness on his face as he gentles his hands, and uses precisely the force he'd use with a pediatric patient. And when he finishes, Wilson doesn't remove his hands; he flattens them out and carefully rubs the skeletal back, to take the sting out of the percussion—just as he'd do for a child.
Wilson feels the muscles relax under his hands, and smiles a bit when House takes a deep, shaky breath, letting go of the tension his frail body had created to defend itself against the blows.
Wilson continues the massage for a few extra minutes, to unobtrusively allow House to regain a bit of stamina before they have to repeat the procedure on his chest. Finally, he grasps House's shoulders gently, and leans him back against the pillows at his head. House doesn't open his eyes, and doesn't attempt to reposition himself; he's relaxed, and already breathing more easily, and appears content now to submit to the gentle ministrations.
Midway through the chest percussions, House begins to cough. Wilson gives him a handful of tissues, and keeps his hands on House's shoulders as the coughing wracks his body. But Wilson isn't surprised when House is unable to bring anything up; the cough effort he's able to sustain is too weak to be effective.
"Sorry," House whispers. "I know you need a sputum specimen. Was gonna try. Hurts." He leans forward and begins to cough again, and this time Wilson wraps an arm around his back, and holds a pillow firmly against his chest, to lessen the discomfort.
Wilson had been prepared to remind him that it's supposed to hurt, that even 'a touch' of pneumonia can mean a day or two of feeling awful. Instead, he waits for the coughing to end, and then he just says quietly, "We don't need a specimen unless the antibiotics aren't effective; don't try so hard. It's okay; I know. I know it hurts. I'm sorry. We've got the secretions moving, though; that's what's important." And he decides to forego the remainder of the CPT.
When the medications arrive a little while later, Wilson draws blood for the labs first; he wants a complete blood count before starting the ceftriaxone, and he's arranged for the courier to make an early pickup. Then he gives a loading dose of the antibiotic, but elects to wait a couple of hours on the aerosols. House's fever is finally coming down, his O2 sats are approaching normal, and he's fallen into an almost-comfortable sleep.
Wilson sits by the bedside for the next two hours, watching as House occasionally struggles for breath. Wilson adjusts the pillows to keep his head elevated, and twice removes House's fingers from the nasal cannula when he attempts to take it off in his sleep. When the fever finally breaks, Wilson wipes the sweat from House's face and slides a clean pillow under his head. Then he gently arranges the promised extra blanket over his legs and chest. House continues to sleep.
At 10:30pm, as Wilson's preparing the aerosol treatment, House awakens on his own. He's already feeling better, and he takes the nebulized aerosol without argument. When Wilson hands him his medications, he looks at the pills, and then at Wilson. "You already take yours?"
Wilson looks away from him. "Well… no. Figured I'd skip it tonight, uh… just in case."
House nods. "I see." Then, he sets his own medication down on the bedside table, deliberately reaches up and begins to remove his nasal cannula.
"Hey! What are you doing? It's already past time for your meds. And we just got your sats back to normal range!"
"Past time for your med, too. And I figured I'd skip the O2 tonight, so you'd have something real to worry about while you stay awake. Just in case."
The two men look at each other wordlessly. Wilson's glaring at House, while House watches Wilson with something approaching amusement. Wilson's the one to break eye contact. He shakes his head, rubs the back of his neck, sighs. "Fine. I'll take it. Get the oxygen back on. Take the pills. I'll be right back."
When Wilson's awakened by his alarm at 4:00am, he prepares the neb and enters House's room quietly. House is sleeping peacefully. His temp's under 100, his O2 sat is 95 percent—and he's wearing the O2, as promised. Wilson decides to give the aerosol blow-by; he doesn't want to wake House, so he holds the treatment by his mouth and nose until it's gone. Then he carefully does a respiratory assessment, and he's pleased that House's respiratory status has remained stable. Okay, House, so I didn't need to sit up and worry all night. Guess what? Happy to have been wrong.
Wilson gently adjusts a pillow that's slipped down, and straightens the blankets that House had kicked away. Then he returns to the living room to lie on the couch, and falls easily back into a peaceful sleep himself.