Chapter 27

"Lessons in Breathing"

I walked into the kitchen and stood planted like an automaton: worried, indecisive, my mind a blank, not even certain what I'd gone out there for.

I recall standing weakly, turned around and backed against the counter across from the butcher-block table, my right hand clenched across the taut nerves and tendons at the base of my neck. The left hand held my cell phone in front of my face and I wondered what the hell I'd intended to do with it …

Greg was in on the couch, hunched on his side and burning with fever, and my head was filled with painful scenarios of the struggles he'd been subjected to over the past weeks. I was feeling needy myself right then, overwhelmed and inadequate to handle his continued treatment in the determined manner his condition warranted.

I had to admit it; I was unexpectedly and unreasonably afraid. Afraid for Greg and for myself. Afraid of making a wrong move, afraid of doing him more harm than good, and afraid of what would ever become of me if he were suddenly gone from my life.

And there it was. It all came down to me! The waterworks were there; no surprise.

Our first tears are always for ourselves …

"Get a grip, Wilson!" I wasn't sure if I'd thought those words, or actually said them out loud. But I had to admit there was a voice inside me, angry, unsympathetic and fed up!

This is not yours! Not this time. This is his. It always was. If you were not here, he would handle it himself. He would handle it because his inner strength is prodigious!

He allows you entrance to his world because he chooses to do so. That's the only reason you're around. If you didn't exist, he would find another way … because his sense of determination is that solid, his resolve that strict, and his courage that real. Do whatever you can do to help him recover from this, Wilson! But keep out of his way! He has no time and no patience for your insignificant imagined weaknesses …

I stood in the middle of Greg's kitchen feeling like the Devil had just touched my soul.

I felt as though I had been admonished by a warning voice that lurked deep inside my conscience, and its words had been etched in stone and left to grow wherever they could take root. Something had just reminded me that I was supercargo, and it had given no quarter.

I had always suspected I was not the choreographer of this dance …

I shook myself and looked around. The kitchen was the same as it always had been, but more than ten minutes had elapsed since I'd fallen head first into some kind of blue funk.

I shored myself up and focused on the responsibilities before me. I had a call to make, medication to gather, an obligation to touch base with Cuddy … and a can of soup to heat in the microwave. I must somehow get Greg to eat.

I dialed the phone number of the pharmacy and then ordered the ceftriaxone with a STAT delivery. The sooner they got it started, the better. I ordered three days' worth of albuterol aerosols and a nebulizer. Greg's general lack of mobility and the effects of the hydrocodone on his cough reflex had to be countered somehow.

When I hung up, I called Cuddy and told her of my certainty that House had pneumonia. I discussed my plan of treatment with her, and was not entirely surprised when she insisted on a chest X Ray for confirmation. She told me to go back to him and keep a close eye on him, and she would take care of setting up a visit by mobile radiology in the morning.

I dumped a can of cream-of-chicken soup into a bowl and slid it into the microwave. Sixty seconds. He must eat before he took the hydrocodone!

When I walked into the living room, my arms and hands were full to overflowing. He turned, and his eyes did a quick survey of everything, and then lifted snarkishly to my face in another nonverbal communication that ended in an eye-lock of major proportions. I unloaded all the paraphernalia onto the coffee table and pointed to the bowl and spoon. He ate the soup. Not happily, but he ate it … some of it anyhow.

After that I let him sit back against the pillows again. I handed him the oximeter and watched as he attached it to his finger and hold up his hand for me to read the number. I complained to him that he didn't have it positioned right, so I reached out and set the thing myself, and got the same reading: 90 per cent. I had him lean forward so I could get some breath sounds. There was no real change though, but I was sure I'd heard a diminished air exchange in the right lower lobes … and even the deep breaths didn't change the pulse-ox reading.

I straightened, put the stethoscope down and placed both hands on my hips. He looked at me with one of his "what now?" expressions, but I didn't answer. I walked around to the back of the couch and pulled the Everest & Jennings over to a point where he could slide himself into it with a minimum of effort. "Let's get you into the bedroom."

He didn't protest, just a muttered something-or-other that might have been: "okay" … His clumsy transition from couch to wheelchair was painful for us both, but I allowed him the dignity of doing it himself:

If you didn't exist, he would find another way.

He sat huddled in the chair, eyes glazed and unfocused, and at that moment I wanted to squelch that nasty voice in my conscience:

No! He does need me! He has no one else … except Lisa … and she has an entire hospital to run!

I fought down the need to continue the "non-argument" and decided to let it go, at least for a time. I disconnected his IV, and I heard him say distinctly: "Feel like crap! It's cold in here."

He was shivering, and I wasted no more time getting him back the hallway and around the corner into his bedroom. I rearranged his pillows … the ones for his shoulders and the two for his legs … and then pulled the wheelchair's footrests out of the way and applied the brakes. He made it to a sitting position on the edge of the mattress, but he was still having trouble hefting his legs into a comfortable position on the bed.

I helped him get settled and pulled the blankets over his legs and up to his chest. He was much too warm. Even the fabric of the gray sweats was warm to the touch. I quickly took another temp reading and said to him in a no-nonsense voice: "Your fever's spiking. It's almost 103. Don't need a chest X Ray to tell me it's pneumonia. No wonder you feel like crap!" While I was talking, I was rolling the portable 02 setup to the bedside.

He looked at it blearily, and I could still see that he had the shivering shakes. "What's that for?"

"Oh … just a little something I like to do when a patient's 02 sat falls below life-sustaining levels," I told him in a teasing manner. "Humor me!"

"Ninety isn't that bad," He countered, and I saw a second's impatience in the fever-glittered eyes when he glared at the oxygen setup.

"No, not bad at all … if you're a lifelong asthmatic who chain-smokes …" I was giving him the hard time he deserved at the moment, and he transferred the glare from the 02 setup to me. I was busy connecting fresh tubing to the machine and setting the gauge for three liters. I ignored the stare and turned to smile at him in the most pleasant manner I could muster. "We caught this early, and the antibiotics will be here soon. Odds are, you won't need the 02 for long."

I tried to hand the nasal cannula to him, but he ignored it and continued to stare at me. "A touch of pneumonia … not a big deal." He said finally, and his voice was becoming so weak that the statement turned to a mockery. I rolled my eyes and bit my tongue.

"You're absolutely right," I told him. "And we're gonna make certain it doesn't become a big deal." I took the cannula myself and inserted it gently into his nostrils, and the glare never melted, never wavered. "To that end, I'll start the antibiotics as soon as they arrive, and we'll begin 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 have a chance!"

I could see he was about half pissy that his attempted debate seemed to be falling on deaf ears. I smiled at him and tilted my head in silent acknowledgment of his frustration. It wasn't that often I got ahead of him, and for a few moments of stolen triumph, I let him know it. God, he was frustrating! But that was at least half of what drew me to him. I wasn't sure whether he was aware of that fact or not, and I didn't debate the issue. Just stood and looked at him kindly and celebrated my tiny victory, knowing he would more than make up for it at a later time.

"I could'a won that one if I'd have felt a little better …" he groused.

"I'm certain you would have," I acknowledged benevolently in return, and watched as the furrow between his brows deepened. I tried not to smirk. It was difficult, but I believe I managed very well. "So … I won't hold the loss against you."

"Big of you," he mumbled. At that moment I saw him begin to shiver again. "Can I have another blanket? Or is freezing to death part of your overly aggressive plan of attack? 'Cause I hear death cures a lot of things …"

"If you'll stop your whining, I'll be happy to let you know," I said. I placed the tympanic thermometer in his ear canal. "Sorry," I said, but it's still 102.8 … let's wait until it's below 102. In the meantime …"

I grabbed two extra pillows from the foot of his bed and placed them in his lap. "Lean forward for me and let's do a little CPT while we wait on the aerosols."

"Chest physiotherapy?" He asked disgustedly. "That works great with pediatric patients and comatose adults … but I don't fit into either of those categories."

That remark was loaded with buckshot and he was trying to ambush me. I ignored him again, and drew another glare. However, he'd done as I asked and leaned his body forward into the stack of pillows. I cupped my hands and began the rhythmic percussions against Greg's back that were designed to loosen secretions in his lungs.

I began rather forcefully, but when I felt him wince beneath me, I knew the treatment was very uncomfortable for him. He was still so rail-thin that I actually felt as though I were striking against bone. At that moment I was very glad he was in no position to glance up and see the look on my face. It would have been a dead giveaway of the pain that still filled my heart. I geared back immediately and began using the same force I might have used on a pediatric patient.

When the procedure was over, I didn't remove my hands, but flattened them out and gently rubbed the skeletal back in order to take the sting out of the percussions … exactly the same thing I would have done for a child.

His muscles gradually relaxed beneath my hands, and I could feel the smile returning to my face when he took a deep, shaky breath, letting go of the tension his frail body had created to defend itself against the blows. I kept up the massage for a few more minutes, to unobtrusively allow him to regain a little stamina before I repeated the procedure on his chest.

At last, I gripped his shoulders gently as I could and leaned him back gradually against his pillows. He didn't open his eyes, didn't try to reposition himself. He had relaxed a bit and was already breathing a little more easily. I decided he did not want to waste the moment of release by talking.

Midway through the chest percussions, he began to cough. I handed him a knot of tissues and kept my hands on his shoulders as the coughing wracked his body. I wasn't really surprised that he was unable to bring anything up; the cough effort he was able to sustain was just too weak yet to be effective.

"Sorry …" he finally whispered. "I know you'd like a sputum specimen and I was gonna try … but it hurts." He leaned forward and began to cough again. And cough. And cough. This time I realized something else was in order. I wrapped an arm around his back and held a pillow firmly against his chest in an effort to lessen the strain.

I thought about reminding him that it was supposed to hurt … that even a touch of pneumonia could mean days of feeling awful. But he didn't need to be reminded of that. He knew.

I waited with him for the coughing to finally end, and he leaned weakly into my sheltering arm and the pillow while I spoke to him quietly. "We don't need a specimen unless the antibiotics aren't effective. Don't try so hard. It's okay … I know it hurts. I'm sorry." At that point I decided to forego the rest of the CPT.

When the medications arrived awhile later, I drew blood for the labs, wanting a complete blood count before starting the ceftriaxone, and I arranged for the courier to make an early pickup. I then gave a loading dose of the antibiotic, but decided to wait a couple of hours on the aerosols. His fever is finally coming down, his 02 sats are approaching normal, and I saw that he was beginning to fall into an almost comfortable sleep.

Very gently, I steadied his head and slid him out of my arms, allowing him to fall backward against the pillows again.

For the next two hours or so, I sat beside the bed, wide awake, and watched as he occasionally struggled for breath. I readjusted the pillows to keep his head elevated, and twice found myself removing his fingers from the nasal cannula when he attempted to swipe it off in his sleep. When his fever finally broke, I wiped the sweat from his forehead and upper lip and placed a clean pillow beneath his head. I found an extra blanket and, as promised earlier, covered him with it and drew it up across his body. He did not awaken.

I prepared the aerosol treatment about 10:30 p.m. and Greg awoke on his own. He was feeling better, he said, and took the nebulized aerosol with no argument. When I handed him his meds, however, the snark returned for a moment. He eyed his pills and then looked up at me. "You already take yours?" He asked without preamble.

I looked away for a moment before making any admission. "Well … uh … no. Figured I'd skip it tonight … just in case."

He nodded. He did not speak. He knew he did not need to. My winning game, such as it was, was over. Pass thrown and intercepted. Then: "I see." He opened his hand and his own meds dropped from his palm onto the blanket. He then reached up to pull out the cannula.

I knew when I was being stonewalled. "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 meds too!" He countered. "I figured I'd skip the 02 tonight … so you'd have something real to worry about while you stay awake tonight. Just in case!"

Here we go again!

We were having another of those wordless conversations. He glared, I stared. I glared, he stared. Impasse. Status quo. Mexican standoff.

I lost. My amusement made me look away first, just as he had known it would. He shook his head and rubbed the back of his neck. Was he mocking me? He sighed.

"Fine … I'll take it." I almost snarled at him, but there was no anger in it, which he already knew. "Put the oxygen back on! Take the pills! I'll be right back."

When my alarm woke me at 4:00 a.m., I prepared the neb and entered his room quietly. He was asleep. His temp was under 100, his 02 sat was 95 per cent … and he was wearing the 02, as promised.

I decided to give the aerosol blow-by; I didn't want to wake him. So I held the treatment by his mouth and nose until it was gone. After that I did a careful respiratory assessment, and was quite pleased that his respiratory status had remained stable.

Okay, House … so I didn't need to sit up and worry all night. Guess what? Sure am happy to have been wrong.

One of his pillows had slipped away and down to his right shoulder. I straightened it carefully. He had kicked away the extra blanket I'd given him, and I guessed he didn't need it anymore since the fever broke. I folded it and placed it with a heap of other stuff at the foot of the bed.

The room was dim. The way it always is at night. His face was in shadow, the smudges of light deepening out the hollow places around his eyes, his cheeks, his neck and chin.

His arms lay at his sides, fingers curled loosely toward his palms … but not fisted. They were relaxed. I looked from his hands and retraced the line of his body upward again, checking for tightness across the brow, a tension near his mouth. There was none. He was not in pain, not in discomfort. His sleep was simply that: sleep.

I returned to the living room and feathered my own nest. Kicked off my shoes and lay down on the cocoon I had created. Took a deep breath and expelled it gratefully. I pulled up the blanket and closed my eyes.

It was the last thing I remembered …

Oooo0oooO

e knewrtight away somethin

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