A/N: Short update. It's SPRING! (officially).
By the way, a line in one of the reviews gave me an idea for a one shot following this story but before the next big one, Pain. I've said it before, but remember that reviews can feed the muse. I have no control over what "takes" or what doesn't, but there are definite plot lines in this series and even whole stories that sprang out of a comment somebody made in a review. Such as "Belle," a favorite with a lot of people. You have no idea the power your review can carry, even if it just says, "I like the cat." :)
Enjoy this update.
(H/C)
House limped toward Diagnostics, his mind flowing in full, uncrippled stride. Data, treatment, and statistics all fell into line as summoned. If he was correct, the best treatment was the antimalarials in combination with doxycycline, but at least he had had Kutner on doxy since yesterday morning. He had tried to pick their three initial antibiotics to cover just about any infection between them, though bizarre things could still fall through the gaps. Hopefully the doxy alone had been doing them a little good so far even if it needed other meds added. The fever was no higher today.
Time table. Kutner had still been responsive to pain yesterday at the lumbar puncture. Even last night, he had twitched and retreated to pressure on his nails. He was deeper this morning, but that was new, and hopefully, they still had time to turn it around. Seizures often occurred in the earlier stages of the illness before you got to unconsciousness, and nobody had seen Kutner have one, but on the other hand, for all they knew, he might have had one five minutes before they entered his apartment yesterday. Hypoglycemia had definitely been present yesterday. Given his dehydration, they had put it down to the fact that he hadn't been eating or drinking, but it also went along with malaria. That, too, had been being treated since yesterday, and glucose was better this morning.
Statistics. They were grim, with death not uncommon and the possibility of lasting brain damage with either lifelong cognitive or physical effects or both in 20% of the survivors. The only positive thing about those statistics was that they were based almost entirely on cases from third-world countries, many of those children. Patients like Kutner who were adults in full strength and health and nutrition beforehand were rare.
Where the hell had he gone? Subsaharan Africa was the most endemic geographical area, though India would also serve; they had malaria there year round. India was even more likely, given Kutner's background. But fitting it into last week still pushed the incubation period. The average was 9-30 days. If he'd gone to India to do something for the anniversary of his parents' death on Thursday, there was no way he was starting to feel bad by the next day. Communication had stopped Friday night, and it probably would have continued for a while when he just thought he had a virus. House put the most likely onset of symptoms as Thurday to Friday, dismissed at first as emotional stress due to the anniversary, later as just a bug.
And what about Saturday? What about Sunday? Why hadn't he contacted somebody as he got worse? Delirium had been well set in by Monday. House imagined Kutner spending the whole weekend fading in and out of reality, probably most of his fevered thoughts focused on his parents' death, and he shivered, then forced himself to push the sympathy down. Sympathy wouldn't help this situation. Clear thought was what would make the difference.
The elevator door opened on four, and he exited, making a beeline for the conference room. The three egglings were there with Foreman at the whiteboard, attempting to moderate. House stalked in and picked up his note. Ramirez had signed in first, but there were a few jolts in the signature, and Templeton had signed immediately next to her, not on the line beneath. Obviously a tie, but Ramirez had won the tug-of-war for the pen left beside the note. House mentally gave her a few points. She had some fight in her, that one. Hollingwood had signed on the line below. Foreman, though present, hadn't signed in at all.
"So Ramirez arrived first," House stated, just to stir the pot.
"We got here together," Templeton fired back immediately.
"So Ramirez is the faster reader. Ten points to her." House went to the whiteboard and reached out for the marker. Foreman yielded it and went over to get a cup of coffee.
"She didn't . . ." Templeton started, and House cut him off.
"Irrelevant. Better luck next time in the battle of the pen, but you lost." He looked over at Hollingwood. "Looks like you were definitely last."
She met his piercing glare evenly, not defiant but filling in her case. "I called the nursing station for an update from the elevator, and I was still on the phone with them when I came in and was focused on that, so they reached the note first. I figured whatever it said, they would share the information."
Pretty much all arrived together, apparently. "Nice theory, at least, but you need to become more cynical. It will help you as a doctor. And did you share your info from the nursing station?"
"Yes. Fever no higher, urine output increased overnight even if it's still low. He does seem to be totally unresponsive this morning, even to pain. Morning labs were already ordered but pending; I said I'd call back."
"No need." He tossed the morning labs onto the table, and three heads converged over them with Foreman hovering in the back row but higher than them all as he was still on his feet.
"Kidney function is still stressed but a little better," Ramirez said, going to that first, but after the showdown yesterday, he couldn't blame her.
"Glucose is normal now," Hollingwood noted.
Foreman nodded and sat down. "We'll have to keep an eye on that as we keep giving him the dextrose in the IV fluids and change the mix if it gets too elevated. It often winds up high with IVs." He shook his head. "Damned normal white count."
"That plus the antibiotics not helping yet makes it more likely viral," Templeton said. "West Nile? That can affect WBC differently in different cases. Awfully early for mosquitoes, though."
"It is here," Ramirez countered. "We don't know where he went last week yet."
"Wherever he went, he drove," Templeton objected. "No airline tags on the suitcase."
"I always take mine off first thing, right at the airport," Hollingwood threw in. "I just don't like the look of them."
"But you're a woman," Foreman said. "He hadn't even unpacked his suitcase. It's possible he tore them off but doubtful."
"Unless it was some kind of emotional final step, tying back to the anniversary of his parents' death," Ramirez suggested. "I could see that. Unpacking the suitcase could be generic, any trip, but that tag with your flight numbers and airports is a lot more specific. He might have wanted to get rid of that first thing, putting it behind him."
"Did you search his car yesterday?" House asked, knowing the answer. Foreman wouldn't have failed to mention that.
Sure enough, Foreman looked guilty briefly then suppressed it at the lapse. Templeton got defensive. "No, but we thought it was important to notify you about the lack of souvenirs as soon as possible. And you needed that laptop. His suitcase was up in the apartment; he'd unloaded the car already, wherever he went to."
"Ah, but if you didn't search the car, you don't know that. Maybe the suitcase was load one, and he started feeling ill and decided to do the rest later. Maybe there are torn-up airline tags in the floorboard. Or even if he did drive, he could have gotten the oil changed before his trip."
"Those mileage stickers," Ramirez said. She looked at Templeton with a clear expression of dropped the ball on that one.
"What about his passport?" Hollingwood asked abruptly. "If he did fly instead of drive, he could have gone anywhere in the world last week."
"Didn't find the passport."
"Who searched his desk?" House asked. Foreman looked at Templeton. "Did you find the laptop there? Did you keep going at all after that or just decide that was automatically the most interesting thing in the desk to us?"
Templeton sighed. "I'll go back and search it again," he offered. "And the car."
"Good idea, but I'm going with you this time." House wanted to search that apartment himself.
At that moment, Taub entered the room. Everybody looked at him, and then all egglings plus Foreman checked either their watches or the clock. "About time you showed up," House snarled.
Taub sat down and looked straight at his boss, giving a slight nod. House's heart sank. "I got here as soon as I could."
"Odd that the traffic wasn't that bad for the rest of us," Ramirez commented.
"Well, now that we're finally all here, don't bother sitting down. Taub and Foreman, you're doing research today. See if you can come up with anything new in the world that we don't know about that might help." Taub nodded again, reading the subtext easily. "Templeton, you and I go back to that apartment to search it again. Plus the car. Ramirez and Hollingwood, you're working together. Talk to the parents some more, see if you can find out anything more about last week or even before last week, any recent trips at all, and you can do another morning exam while you're at it."
They rose en masse and all left except Templeton, who stood but waited for his prospective boss. House looked at him until he started to squirm and mentally timed the process. "You do have to work together with a team on this job, you know. Keep that in mind while you're fighting each other for pens."
"You're the one who set that note up as an arrival competition," Templeton replied.
House had to grant him that much. "It still applies on the cases. Let's go," he said. He limped for the door, and Templeton fell in a step behind him.