Diagnosis & Treatment

House's sedated body lay in ICU while the team of doctors reviewed the test results and formulated a treatment plan. There were many problems that needed to be tended to surgically. Dr. Hadley was brought in on the differential diagnosis as House's health care proxy in case he couldn't make the necessary decisions to proceed with his care. It was a surprise to all, as no one, not even Thirteen, had known he had changed his proxy.

"The clots aren't coming from an infection. The spinal tap was clear," Foreman laid the results on the table.

"We think a non-union at one of the fracture sites is leaking marrow. While resting, the bones are aligned. It would seem when he's standing, gravity is exerting pressure and pulling the ends slightly apart. I'm going to recommend an IM rod and screws." Dr. Woolf was very straightforward.

Remy nodded, understanding why it needed to be done.

"We'll suck out the occlusion and stent the weakened vessel to keep blood flowing to the surrounding tissues," Dr. Brand added.

"What choice does he have?" Remy agreed that his was all in the patient's best interest. Now they just had to hope House would agree.

When sedation was withheld, Greg felt himself waking up. It wasn't a pleasant experience as pain coursed through his leg like someone was trying to hack it off with a butter knife. A really dull butter knife.

"Mmm," he mumbled, wanting to reach out and massage his leg before he even opened his eyes. Once he was aware of his surroundings, he gave up. "Why am I here?"

"Cindy found you incoherent and writhing in pain," Thirteen informed him.

"Hmm. Still in pain," he grimaced as he wondered why there was no relief.

"House," Cuddy commanded him to focus.

"This is killing me. I need something stronger for the pain." His eyes were watering as he tried to squeeze them shut against the agony.

"You have another infarct. You'll be in surgery within the hour."

"Do whatever you need to: WITHOUT REMOVING THE LEG!"

"House." It was Thirteen's voice. "It's a little more complicated than that."

He looked at her curiously, wondering why she was there and not Wilson. Then he remembered. "You're not allowed to remove anything but the damn clot," he forced out through clenched teeth.

"You heard him. We're good as long as we don't take anything he wants to keep," Remy confirmed as she stared down Cuddy. "He obviously wants circulation restored."

"Prep him for surgery," Cuddy ordered.

Thirteen didn't feel as relieved as she should have. Even though House was deemed aware and able to make his own decision about the procedures, he hadn't had informed consent. So, in effect, she okayed his decisions - even though she knew he'd complain about the potential complications the internal fixation could cause. Had this been any other person, she wouldn't care. Because it was House, and he chose her as his health care proxy, she was responsible to him.

Cindy was waiting outside the OR, just sitting there staring at a space on the floor when Remy walked in. She sat next to House's new friend. "Hey, how are you holding up?"

"I keep wondering if we could have done something different. If we missed something. If I did something wrong."

"Don't be so hard on yourself. He did everything he was supposed to."

"That's what's so crazy." Cindy looked up at her with imploring eyes. "Don't you see? That's why it has to be our fault."

"You can't be at fault for something like this. It's not humanly possible."

"We let him decide against internal fixation. He didn't want surgery and he was against putting metal in his leg."

Remy sat up as if someone had poked her. "Is that why he opted for closed reduction?"

"Yeah. He declined a stainless steel nail and screws. Something about not being able to have an MRI."

"Shit!"

"What?" Cindy stood, partly to stretch, mostly because Remy stood.

"He's having an IM rod put in. A stainless steel intramedullar nail and four screws." She looked to see Cindy's reaction before placing her head in her hands. "He's going to hate me."

Cindy sat back down and put an arm around her shoulder. "You had to decide what was best for him."

"He won't see it that way."

"Could have been worse. They could have chosen titanium."

"Why's that worse and not better?"

"Titanium screw heads tend to break off during insertion. And there's a slight chance the lower tip of the nail can break once he starts bearing some weight."

"That'd really piss him off," Remy seemed to brighten a bit with the news that it could be worse.

Wilson showed up a few minutes later. "The clot's out. The stent is holding. Angio shows good profusion of the affected areas."

Both ladies breathed a sigh of relief.

"When I left they were positioning him for the fixation."

"You're not going to watch?" Cindy was curious that he thought it was no big deal.

"What could go wrong?" Was she just trying to make him worry?

"You keep telling yourself that," she snorted as she left the waiting room.

"What crawled up her ass and died?" Remy hadn't seen much interaction between Cindy and Wilson before.

"She despises me," Wilson admitted.

"What did you ever do to her?"

"She's got 'pissed offedness by proxy'."

Remy arched an eyebrow, questioningly.

"It's way too convoluted to explain, and I'm not sure I even understand."