"Some research suggests that atorvastatin might help in combination with the doxy and antimalarials," Taub reported. "I called the nurses to get that added."
"Anything else we didn't already know?" House demanded, looking from Taub and Foreman to the whiteboard, which now had cerebral malaria written as the last entry beneath the symptoms.
"Not so far." Again, it was Taub who answered. Foreman sat silent, pulled back from the table a few inches with a distance more psychological than physical. House had called everybody back for this conference. The room seemed full with six doctors around the table; yet for three of them, the team member not there left an almost palpable absence, a black hole in a vacant chair, drawing in all energy to itself.
"So you got the diagnosis early this morning?" Templeton clarified.
"Yes. And started treatment." House glared at him, all but daring him to call the whole rest of the morning unfair to the candidates. Templeton had the sense not to.
"How?" Ramirez asked. House turned to her. "How did you get it this morning? You didn't know about the trip to India then. Did you?"
"No. I didn't have the passport until we found it." House rewound mentally, trying to recreate his thoughts. First thing this morning seemed hours ago, and he was getting tired now, with his leg as always increasing in volume as his adrenaline ran down. Explaining an epiphany could be harder than having one in the first place. "Kutner was deeper this morning when I examined him, totally unresponsive. That suggested something moving on into the brain or CNS, not just a fever that went along with some general systemic illness. Thinking about febrile illnesses with progressive delirium advancing eventually toward coma, regardless of incubation time or location, I thought of P. falciparum. I checked his retinas at that point, and they were pale. It fit."
The three egglings nodded slowly, but they were visibly impressed. Making that leap without proof of foreign travel and actually against the assumed timetable was a lot harder beforehand than it had been once they knew about the trip to India.
"He seemed like he might have been stabilizing a little when I examined him," Ramirez offered. "Hard to define, but it was an impression. Maybe the meds are starting to work."
"We still don't know where he went last week," Templeton said. The search of Kutner's car had drawn a blank - no oil change sticker, no ripped-off airline tags.
"Or why he didn't go to India last week," Hollingwood added. "It would have been so much easier while he was on vacation. He'd never been before; why slam it into one day?" They had verified no former trips against the passport a few minutes ago.
"We also don't know why he didn't take antimalaria tablets when he did go to India, even a month ago," Taub said. "Kutner should have thought of that."
House looked to the whiteboard again, to the entry of Uncharacteristic Stupidity. Kutner must have been very distracted, even a month ago. House still thought that trip must have been a last-minute impulse to totally forget about malaria pills. When something else he was trying to work out long distance had failed, requiring personal supervision? But what?
And yet nothing had been visible in the kid's attitude. For a whole month minimum, and almost certainly longer than that, Kutner had been keeping things, significant things, not only from his parents on this subject but also from his boss. House should have noticed.
Ramirez was speaking, he realized. "He had something on his mind enough to forget about the pills. This has to tie into that anniversary last week. He must have been planning something emotionally significant for a good while, and that's why he dropped medical details and also why he didn't realize he was really getting sick."
"I think we're all agreed on that," Templeton replied. "What was in that test tube, House?"
"What test tube?" Ramirez asked. All the others came to attention.
House shrugged. He could feel its shape in his pocket. "He had a test tube in the DVD case along with the passport. It looked like some kind of dirt. It wasn't a mosquito, anyway. We've got the diagnosis now, so that's probably only relevant psychologically. We can test it later if we think we have to for the case." He intended to test it today, himself, medically relevant or not. He wanted to know, not just from curiosity, though that was part, but also as another possible clue on the road of how many things he himself had missed over the last few months. He'd been too busy interacting with his father and getting trapped in an exploded building to pay proper attention to the team. But he didn't intend to share the results of that test - or of the firesafe once he found it - unless they did turn out to be medically relevant. He'd preserve Kutner's privacy that much.
"Now that we have the answer, shouldn't we tell his family what it is?" That was Hollingwood, of course.
House focused, coming back to the present. "Just for that, you can have the pleasure of . . ." He stopped, looking back at the whiteboard. Damn it. On any routine patient, he would have loved to pass the buck. "I'll do it, and you three can tag along to watch. But after lunch." He could reasonably stall that much, at least. It was almost lunchtime now. "This afternoon, everybody will be on research, looking for anything new in treatment." Which would also give him space for private test tube testing and another search for that safe. "We'll meet back here at 1:00 to go talk to the parents. Go eat."
They all stood, but Foreman didn't join the exodus. "House, can I talk to you for a few minutes?"
House nodded and walked into his office with Foreman trailing. "Glad to know you can still talk," he couldn't resist saying. "You weren't contributing much there."
"Taub told you the one thing we came up with this morning. No point in repeating it." House sat down at his desk, resisting the urge to rub his leg. Foreman remained standing, though he moved to the other side, the barrier between them. "I've made up my mind on the UCLA position. I'm taking it."
House had already known he would once he got over being offended at House's interference, but the next statement caught him by surprise.
"And I'm claiming all of my stockpiled vacation time instead of working out two weeks' notice so I can pack and move. I'm leaving the hospital now."
House's eyes focused more sharply, the blue microscope inspecting the other doctor. "Interesting."
"Saves the hospital money, actually, since you won't have to pay me time for the next two weeks plus the unused vacation on top of that on my last check. You won't be shorthanded, either, not with the three-ring circus around and two of them eventually staying for good. Win-win situation." He threw House's words from yesterday morning back at him.
"Makes sense," House agreed. "And it's a heaping shovel of bullshit. That's not why you're leaving now." Foreman shifted his weight almost imperceptibly, caught himself, and stilled. "You don't want to see this, do you? It's hitting too close to home."
"It's just a matter of convenience," Foreman insisted.
"Nope." House shook his head firmly. "You weren't totally objective on this case yourself; you missed things on that search that you shouldn't have. And that was before the diagnosis. Now that you know the diagnosis, you also know the prognosis, and just in case things go wrong for Kutner, you don't want to be around to see it. You don't want to watch somebody you've gotten to care about having to recover cognitively from a brain illness. You can identify too closely with that. It's too uncomfortable. And it could be physical rehab, too." The possible outcomes lined up neatly on the whiteboard of House's mind. He hated reading the message himself there, but he couldn't turn it off. Neurological deficits. Cognitive effects, even lifelong. Hemiplegia or other significant physical disability. All of it was possible at this stage. They wouldn't know until Kutner woke up and was recovered enough to be tested.
"It's a case, that's all."
"Keep saying that, but deep down, you still won't believe it. You've gotten to know him, worked alongside him, even grown to be friends to some extent."
"He's not a friend," Foreman persisted doggedly. "Just a coworker. This decision has nothing to do with Kutner. We already talked about the job yesterday morning before we even found him."
House studied him. Denial in spades, but suddenly, he himself was too tired to beat down the stone wall. Foreman was finished as far as his mentorship was concerned. He wasn't going to take another lesson from House; from here on, he was on his own. He couldn't learn a lesson he wasn't ready to face, anyway. Jensen had taught House that much.
"Going to insist on the 2-week notice?" Foreman challenged. "You've known about this job offer a lot longer than two weeks."
House pinned him visually long enough to start Foreman's weight shifting subtly again from one foot to the other, and then he looked past him to the shelves against the glass wall. "Go ahead and run, then," he said.
Foreman relaxed, but he couldn't resist collecting his dignity before his exit. "It's just more convenient logistically this way with the move."
"Yeah, right." The skeptical sarcasm could have been cut with a knife.
Foreman turned for the door but paused right at the threshold and looked over to the conference room and then back at House as if it truly struck him that this was the last time. If he thought of words of farewell, he didn't say them, but he took a long moment to soak it all in. Then he was gone.
House picked up his ball and rotated it in his hands, thinking but too tired to throw. He would have to run through that same prognosis with Kutner's parents in a little while. This was the worst form of malaria, a very nasty parasite. Of course, statistics were not 100%. And, as he'd thought earlier, this was not a third-world country, which ought to help their odds some. Both the previous condition of the patient and the current condition of the medical care were far better than the average case that had contributed to those statistics. But still, there were chances for a very bad outcome here, even if the meds worked and the acute phase was survived. Malaria was also notorious for reappearing later, but now that the diagnosis was known, they could hit it immediately with the proper drugs in the future. The waxing-and-waning potential of the fever could be lived with. House hoped that that was all Kutner had to live with and not lifelong disability, mental or physical. House refused to dwell yet on the fact that he might actually have three positions open. No, he would hold Kutner's job through recovery, and the kid would return to the team.
House was still sitting there five minutes later, holding the ball and staring into space, when Cuddy arrived barely in front of Wilson and Sandra to collect him for lunch.