I have added an author's note at the bottom of the chapter.
Author's note: Here's another chapter. I didn't want to leave you hanging too long.
Chapter 5: An Impossible Diagnosis
When Barry was finished, he looked up and saw that House and Wilson were finished and were waiting for him. "Sorry. So, who's first?"
"House?" Wilson suggested.
"Ultrasound and MRI show a foreign body in the abdomen, which clearly has a heartbeat. Features are inconsistent with a parasite. Blood, stool and urine samples show no indication of parasitic activity. OK, Wilson, you're up."
"Beta-hCG is very specific as a marker for testicular cancer, yet both ultrasound and MRI show no abnormalities in the testicles. Biopsy is negative. Sperm count is also normal, indicating that nothing is affecting testicular function." From the corner of his eye, he could see the smirk on House's face. "A beta-hCG count of 25,300 IU/L could indicate that the cancer has metastasized, but what is in his abdomen doesn't look like any tumor I have ever seen. Also, other non-specific markers such as AFB and LDH should be elevated, but they are all within normal ranges. The only thing consistent with cancer is the extremely high beta-hCG."
House was looking expressionless as another potential diagnosis was shot down. "Now for our third contestant."
Barry consulted his notes and then began. "Both ultrasound and MRI are consistent with a fetus. Gestation sac measures 48 mm, and the fetus has a crown to rump length of 44 mm. This would be consistent with a fetus of roughly 11 weeks, which would put the date of conception somewhere around August 1st through 4th. Progesterone and estrogens are all at levels consistent with the estimated gestational age. Beta-hCG is low for a normal pregnancy, but is completely consistent for an ectopic pregnancy." He looked up from his notes and saw the horrified looks on the other doctors' faces. He'd been so intent on the bet that he'd forgotten that there was a real person behind the symptoms. "Of course, we know it isn't a baby," he concluded, rather lamely. In the silence that followed his pronouncement, the two other doctors silently reached into their pockets and pulled money out of their wallets, and handed it over to Barry.
Then House was out of his chair, pacing back and forth along the length of the conference room muttering, "August first," under his breath. "Damnit. August first." Realization dawned, and now he was almost shouting. "How could she have… Why would she have done this to me?"
Wilson ached to see the agony in his lover's eyes. "Who are you talking about? How do you know that someone did something to you?"
House didn't appear to have heard him. "Why didn't she do something to you? Why me? She was your patient!"
"Who are you talking about?"
"She died at the end of July. The girl in foster care with the weird name."
"Kayla? You think she has something to do with this?"
"Well, on August first I was talking with a dead chick, and Dr. Coleman say that's within the estimated date of conception. I don't think it's a coincidence."
"Are you sure it was August first?" asked Wilson.
"Yeah, it was the same day we." He trailed off and raised his eyebrows at Wilson, who was looking confused. "The carpet in your office," he prompted. "Jesus Wilson, no wonder you've been divorced three times!" Wilson was blushing now.
"Are you sure you didn't dream this? It sounds pretty far fetched," suggested Barry.
"And being pregnant isn't?" shot back House,
Then Wilson whispered, "I saw her that night, too." He was looking pretty spooked.
"Oh great, now we have to start running embarrassing tests on Wilson," grumbled House.
"No, because I'm not the one who's been puking for the last two months; we just talked a little bit."
"About how to screw up my life?" Greg asked.
"No, nothing like that." Wilson paused, wondering how much to reveal. "Haven't you ever wondered why I kissed you that night? After all these years of knowing each other?" He watched as House nodded, remembering. "I guess you might say I got relationship advice from a dead twelve-year old."
"Glad that worked out well for you because she clearly doesn't know shit about anatomy. Why would she do this to me?"
"I have no idea."
House looked over at Barry who was looking a little uncomfortable at the somewhat personal nature of the recent conversation. Barry was also reeling from how fast the diagnosis had gone from something akin to a joke to being seemingly real. House sighed. "Well, we now know what's wrong with me, and we now have an idea about how it happened. So what do we do about it?"
For the first time tonight, Barry was in familiar territory. "I suggest that we try a non-surgical option first. A single dose of methotrexate." He saw Wilson's eyes widen at the mention of the chemotherapy drug; House was looking expressionless. "I'd suggest having Wilson administer it on Friday, so that if there are any side effects, you can deal with them over the weekend. Cell growth will stop, and then we should see hCG levels begin to drop. The tissue should be adsorbed by the body, but if not, it will be necessary to do a laparoscopy."
"So one weekend of excessive puking, and then I can finally stop feeling continually nauseous?" He waited for Barry's nod. He thought about it for a moment, before capitulating, "As long as it isn't in the oncology clinic. How long do you think it would take for everyone in the hospital to know I have cancer? Of course, that would still be better than having everyone know the real reason. To be a freak, in addition to being," he didn't finish the sentence, but the unspoken phrase "a cripple" seemed to hang in the air.
"We have to do it in the hospital in case you have an adverse reaction," exclaimed Wilson. He looked over at House, who was looking stubborn. "Fine. We'll do it in my office, but Cuddy is going to need to know and sign off on it. People get a little upset if chemo drugs go missing."
House nodded. It was better than he'd been expecting. Hopefully, Cuddy would go along with it and would keep her opinions to herself. They began gathering up the papers that were scattered across the conference table.
Wilson turned to his colleague. "Barry, do you want to join us for dinner? I thought we'd stop at the Wok Shop on the way home."
Barry glanced at his watch. "Nah. If I leave now, I can probably see my kids before they go to bed."
Wilson looked up from the papers he was stuffing into a folder. "Thank you. For everything."
Barry nodded, and turned to look at House who was staring off into space. "House. I'm sorry." At what, he wasn't entirely sure – the diagnosis, the treatment, or maybe just the whole situation. House nodded, but didn't meet Barry's eyes.
Silently, they all walked out to the parking structure.
TBC
New Authors Note: I know that some of you may be horrified that Barry made the suggestion to end the pregnancy. My reasoning for this is that he would consider this an abdominal ectopic pregnancy (ectopic refers to any pregnancy occurring outside the uterus). Standard treatment in this case is ending the pregnancy, as this condition is considered life threatening to the mother and with very little chance of the fetus surviving to term.
Authors Note: I never thought I would write an mpreg story, but then I had the interesting idea to do some research on beta-hCG (I don't even remember why exactly), and what I found was that it is what is tested for in a blood pregnancy test, and that in men, it is marker for testicular cancer. Many of the early symptoms of both pregnancy and testicular cancer are similar, as they are both caused by the body's reaction to high levels of hCG. Which lead to the thought that Wilson would see a set of symptoms, and would have definitely run a test for hCG, and would diagnose testicular cancer. As I continued the research, I found that the blood levels at the end of the 1st trimester would be on the same order of magnitude as a man with advanced testicular cancer. I was amazed at how well the numbers did correlate. So if a man was pregnant, it would initially present as cancer (and Wilson's an oncologist, how convenient). So then, I tried to imagine how it would go from that diagnosis, to a diagnosis of pregnancy, especially in a world where male pregnancy was not allowed, except in the case of where there was a bit of supernatural intervention. And thus, the story was born almost fully formed in my mind, and I have spent the last few years writing it down.
More references:
Deborah Levine (Ed.) Atlas of Fetal MRI, Taylor & Francis, Boca Raton, 2005.
Wikipedia: Tumor_marker
Wikipedia: Human_chorionic_gonadotropin
BabyMed dot com (pregnancy calender)