Placebo Effect

Dr. Darryl Nolan was called in again to consult on House's case. It was House, himself, who diagnosed his kidney failure. And when it was brought up to his team and surgeons, they had to agree. How ironic was it that it took ten years of Vicodin abuse to produce liver toxicity and hallucinations, but only two years of chronic use of anti-inflammatory drugs to disrupt kidney function?

"It's the addictive behavior," Nolan said matter-of-factly. "When the pain got worse, you took more and more."

Greg nodded, ashamed that he had substituted one addiction for another, seemingly less harmful substance.

"Did you not know this would happen?"

"I just didn't think it could happen so fast."

"Two years is fast?"

"Time flies when you're trying to have fun."

"I don't see much of a choice but to go back on some form of opiates to help you get through the next few weeks." Nolan knew they had no other options.

"I'm afraid. I don't want to get hooked. And I don't want to hallucinate," House confessed.

"You won't be on large doses. Just enough to help you cope with the pain. You'll be monitored closely, and on a strict schedule."

"Sounds scary."

"There will be heavy pain at times that might make you want more than you can have."

Greg winced. "I'll just have to suffer through."

"You'll make it. Remember, it's better than needing a kidney transplant."

House snorted, "As if I'd find one."

"I'm going to meet with Dr. Cuddy and Dr. Woolf to discuss the new pain management regimen. You hang in there." Nolan patted Greg on the shoulder.

Dr. Nolan requested a private conference room with locking doors at the location to discuss the patient's new drug therapy. He invited Drs. Cuddy, Woolf and Brand, as well as House's team, Dr. Wilson, Cindy and even Dr. Radcliffe. Once everyone was seated, he locked the door and drew the blinds.

"I wanted you all to be here to hear this from me," Nolan began. Dr. House is going to go back on opiates as part of his pain management regimen while he's healing." He saw the objections as they crossed each participant's face. Putting up his hands in a gesture of placation, he continued. "I know you all think it's a bad idea. Greg thinks so too, but opposed to kidney failure, he's agreed that he needs to manage the pain more aggressively for the time being.

"Drs. Cuddy, Brand, Radcliffe and Woolf and myself have come up with a schedule that we think will help Greg deal with the pain - without getting him addicted to the opiates again. We're going to trick his brain into thinking he's taking more than he actually is."

"The placebo effect. That's you're bright idea?" Wilson scoffed. "We've tried that before."

"And it worked," Cuddy interjected. "He thought he was getting morphine in the spine when I was only injecting saline."

"Okay, so it worked once." Wilson snorted. "From the sounds of it, you plan on trying it more than once."

"Won't House figure it out? One day he'll be feeling relief, the next he won't." Chase was with Wilson. House was no dummy.

"For this to work, we all have to be convincing." Nolan looked sternly at Wilson, then at Chase. "All of us."

"I don't know if I can do it," Wilson conceded.

"I don't think it's ethical," Thirteen piped up.

"There you have it," Wilson pointed to Remy. "She's his health care proxy, and she says no."

"I said it was unethical, not that we shouldn't do it," Remy sniped.

"Besides, he's making the decisions."

"And if he's too out of his mind with pain because he's on a placebo, you get to make the decisions," Wilson rubbed it in. "Then what?"

"Listen, it's not going to happen like you think." Nolan stood at the head of the conference table. "Greg knows he's going to get metered doses. He'll know when he's maxed out and unable to get more. He knows he's going to have pain, and that there will be times when the medication will barely take off the edge. We've set him up for it emotionally.

"What he won't know is exactly how much he's getting and when. He'll get real doses of real medication. He'll also get lower doses than he's told he's getting. All dosages will be administered by Drs. Cuddy or Woolf, or one of the Fellows. Drs. Brand and Radcliffe are involved so that when House believes there is something fishy going on, they will be able to verify that he is getting what he needs."

"And we know he will think he's figured out what we're doing. That's why we all have to be on the same page," Cuddy interjected.

Cindy rolled her eyes.

"You seem skeptical," Nolan had noticed. "You have something to add?"

"We all know his pain is real. I understand what you're doing and why you're doing it. I get it. But you're going to need to have some other forms of relief available for him when the pain medication he thinks he's getting isn't enough or doesn't work."

Wilson could only nod in concurrence. House was going to be a bear when the pain came without relief.

"We'll have a physiotherapist and massage therapist at his disposal." Cuddy made some notes as a reminder to herself to set that up.

"Since a lot of his pain may be due to inflammation, I recommend that you keep his leg elevated as much as possible. As the muscles in his thigh tend to give him the most problem, range of motion and isometric exercises might help with the spasms-"

"If we use a bi-valve technique at the thigh portion of the cast, say two and a half to three inches above the knee, and make a removable panel, we could curtail the muscle cramps and apply moist heat and/or electrical stimulation as needed." Cindy had interrupted her boss to deliver another method.

Radcliffe nodded.

Dr. Woolf was astonished. Why didn't he think of it himself?

"Now I know why House has a team," Nolan muttered.

Wilson smiled at Cindy. She was a lot like House in her unusual way of thinking out treatments that required out of the box solutions. No wonder he liked her.

She didn't reciprocate the feeling. If anyone was going to screw things up for Greg, it would probably be his best friend.

On their way out the door, Wilson caught up with Cindy. "Why are you so obstinate?"

"Excuse me?"

"You have this attitude like I'm the enemy; that the staff at Princeton- Plainsboro Teaching Hospital are idiots."

"If the shoe fits," she pulled away from him.

James caught her by the elbow.

Cindy looked at his hand on her arm, then at him. "Unhand me!"

"If you want to stay on House's good side, you should try to get along with his friends."

She couldn't help but snort. "Don't lecture me on what Greg needs."