Ghosts of the Past
Chapter Five – "Howling in the Night"
By: purpleu
The woman before them on the stretcher bore no resemblance to the woman they knew as Dr. Lisa Cuddy. House's team had seen her when she left the hospital; House hadn't seen her since the night of the crane collapse. All were shocked. Cuddy's curly, long hair that she usually wore loose around her shoulders was cut short to her jawline and held off her face by hairclips. Her skin was even less that what could be described as pasty white; it looked like there was no blood flowing under the surface which was dry and noticeably flaky. Her hands, resting on the blanket, were extremely bloated and shiny, as was her face; her skin was stretched out taught. Wilson description of 'half-dead' was wrong; House's of 'ghost' was much closer to reality. Lydia had seen pictures of Cuddy and was just as shocked as everyone else. Fortunately, she kept her wits about her, and saw that Arlene was coming closer with Dr. Stein…and the children. While Rachel was used to seeing her mother in this state, she didn't want Ben and Elise to become upset. She hurried over to the group as they approached.
"Arlene, why don't you take the children straight up to the lounge? I know mine must be getting hungry, so I'll come up with the food in a few minutes," Lydia said.
"Good idea," Arlene said glancing over at her daughter as she was unloaded from the ambulance.
"Go through this door, take the second elevator on your right to the second floor. When you leave the elevator, make a left, and the lounge is straight in front of you." She looked at her children. "Go upstairs with Mrs. Cuddy and Rachel and I'll be right up with breakfast, OK?"
"OK, Mom," Ben said. Elise reached over and took Rachel's hand.
"So, what's your favorite color? Mine is pink," Elise said as they started to walk away.
"Mine, too!" Rachel said. Arlene and Lydia exchanged smiles as she and Dr. Stein led the children into the building. She turned her attention back to the ambulance and what was happening there.
"Get her straight up to ICU; if they question the admission, tell them who she is. If they have a problem they can…" House began to say.
"Tell them to speak to me," Lydia piped up. "I'll speak to admitting and let them know to set it up as a workman's comp case so there's no question in the billing," she said.
"Thanks; at least this won't add to whatever problems Mrs. Cuddy's already having with the hospital," Foreman said. "I'm…I'm just in complete shock. She didn't look good when we sent her out of here, but…not like this," he said as the ambulance attendants wheeled Cuddy into the building.
"What were her vitals on the trip up?" Chase asked as he and Thirteen walked on either side of the stretcher.
"Steady, but low," the smaller of the two attendants said. He looked at his notes. "BP varied between 90/64 and 78/49. Most recent was 81/56," he looked at his watch. "Twenty-one minutes ago."
"Consistent with what Stein told us last night," House said.
"Where is Stein?" Taub asked as he pushed the button for the elevator.
"I think he may have gone upstairs with Arlene and the children," Lydia said.
"Figures he'd run and hide," said Chase.
"I was going to go back to the car to bring in the food to the lounge." explained Lydia as she pulled out her car keys. "Do you want me to send Dr. Stein into you, or keep him out of the way?"
"Keep him out of the way," Chase, Taub, and Thirteen said in almost perfect unison.
"I don't want to see him right now," Foreman added. "What's been done to Cuddy borders on neglect…severe neglect."
"Then I'll keep everyone busy; hopefully when Thomas gets here, he can occupy Stein's attention and I can look at Arlene's paperwork without any distractions," Lydia said.
"Need any help with the food?" Wilson asked.
"No, I'm fine thanks."
"We'll be in the room next to the lounge," House said as he looked up at the descending numbers on the indicator lights. "That room is reserved for my patients. Mainly because it's the closest to the elevator."
"Alright," Lydia said half-laughing. "I'll poke my head in there at some point to see how things are going." She turned, and hurried away to pick up the food from the van as the elevator arrived at the ground floor. It was a tight fit with the two ambulance attendants, House, Wilson, Foreman and the stretcher, but they managed to squeeze in. Chase, Thirteen and Taub took the other elevator.
"I…I just can't get over the way she looks," Wilson said in disbelief. "We all knew when we discharged her that…there was no good, long-term prognosis for her; but in a matter of five or six months…this?"
"I'm surprised at Dr. Stein," Foreman said. "He had a clear responsibility as her attending doctor there to act a helluva lot sooner than this."
"I have the feeling that Stein spends most of his time chasing errant balls in sand traps," House noted.
"You think he's retired?" asked Foreman.
"From day to day work. He probably pops in at the rest home to wave at the old ladies and flirt with the young nurses," said House as the elevator doors opened at the second floor. "Picks up enough pocket change to keep his Jaguar running and goes on his merry way."
"You're making an unfair assumption with that statement," Foreman warned.
"You didn't see the car he pulled up in," House said as he exited the elevator. The two attendants got Cuddy out of the elevator and followed House, Foreman and Wilson into the ICU room; Chase, Thirteen and Taub were right behind them. The bigger of the two attendants handed Cuddy's chart from the assisted living facility to Wilson; he in turn offered it to House who nodded his head toward a countertop opposite the bed. He doubted there would be much in there to help with the initial assessment; in reality he just didn't want to deal with it at the moment. House watched as Chase and Taub pulled the sheets down to get the bed ready for the transfer. Since Cuddy wasn't going to be able to assist with moving from the stretcher the way many patients could, the team knew it was going to take a concerted effort to get Cuddy over. Thirteen took the pillow off of the bed and used the controller to lay it out flat. The smaller EMT did the same over on the stretcher.
"Dr. Stein told us we've got to be careful with the transfer," the EMT noted. "There was already one incident that resulted in her getting a broken rib," he said nodding toward Cuddy. However tense the mood in the room was, it only became worse with that revelation.
"That son-of-a-bitch!" Wilson exclaimed. "Stein didn't mention anything about that last night!"
"I'm sure there are a lot of things we didn't hear about last night," House said grimly. "Get her on the bed so we can find out what other surprises have been untold." Thirteen grabbed the sheets from the stretcher near Cuddy's head and shoulders; Chase was to her right down by Cuddy's hips and legs. On the count of three they moved her over smoothly thanks to the two EMTs who took the same positions on the opposite side of the stretcher.
"You want to get these out from under her?" Thirteen asked indicating the sheets that they used to move Cuddy.
"We don't need the extras; they'll only get in the way," House said. "We've got enough hampering her proper care already." The EMTs exchanged looks with Chase and Thirteen, and the four of them maneuvered Cuddy and got the sheets out.
"Thanks; don't need to catch any grief from our boss," the big guy said. "He does nothing but bitch and threaten to dock us pay when we leave linens behind." He stepped forward to pull up the sheets and blankets on Cuddy, but House stopped him.
"She's going to get stripped down so we can find out where all her ouchies are; those will only get in our way." The two ambulance attendants looked at each other and shrugged.
"Thanks, guys. We…appreciate your help in getting Dr. Cuddy up here," Wilson said extending his hand to each of the EMTs. "I suppose there's paperwork to be signed?" The smaller of the two stepped forward and offered Wilson a pen; he held out a clipboard and indicated where to sign. While the taller of the two attendants headed to the door with the now empty stretcher, the smaller one, the one with the clipboard, hung back.
"Um…I've been doing this long enough…I'm a not doctor by any means; but I know someone in bad shape when I see it. I also got it from what Mrs. Cuddy said that you all used to work with the doctor," he said nodding at the bed. "We're used to doing round trips, not ones that are one way. It still gets to me when I see it. I'm sorry." Foreman had overheard the conversation and approached Wilson and the EMT.
"Dr. Cuddy is in bad shape, but we're going to do everything we can to improve her status and get her into a facility better able to serve her needs. The long term prognosis isn't good…but I hope we can call on your company to at least bring her somewhere more appropriate," he said. The EMT smiled as he reached into his pocket.
"Our boss is always nagging us to hand these out," he said handing a business card to Wilson. "I just don't feel right doing it, so I wind up throwing a bunch away at the end of each week to make it look good. But in this case…I'd be really happy if we can take Dr. Cuddy back out of here after you guys fix her up."
"Thanks," Wilson said extending his hand. "Your name is…"
"Joe…Joe Miller. His name's Morris," he said pointing to his partner. "So just ask for Joe and Mo."
"Sounds good," Foreman said with a smile. Joe turned, met up with Mo at the door, and the two EMTs were off to take care of their next patient. House, his team, and Wilson remained standing in place, none of them moving or speaking. They were still stunned by Cuddy's appearance and were trying to absorb the gravity of her condition.
"I hate to say this," Thirteen said. "But this reminds me of when they brought you in after extracting you from the building wreckage," she said to House. "We were told you were hurt, bleeding, unconscious…but I don't think it really hit any of us till we saw you laying there…and you looked dead." Thirteen looked at House, then at the rest in the room. "It took us a minute to…forget who you were and treat you like any other patient." House had looked down at the floor; he felt his team's and Wilson's eyes on him as the memory of that awful night came back to them.
"In other words, I'm lucky I'm alive because you all stood around sucking your thumbs for comfort. Good thing I didn't need any really competent doctors at that point," House said, using his usual sarcasm to diffuse any emotions in the room. To help him deal with his own feelings, he refocused attention back onto Cuddy. "How much effect has the slop they've been forcing into her feeding tube had on her?" He stepped over to the chart that accompanied her to PPTH and flipped it open to the beginning when she would have been first admitted to the improperly named nursing home. Taub realized House was asking how much Cuddy weighed; he looked at the numbers on the digital scale contained within the bedframe. His eyes widened.
"This is taking into account the fluid she's retaining…40.37 kilograms…" Taub looked over at House. "That's about 89 pounds; that can't be right."
"It's not outside the realm of possibilities," House said. "According to this fairy tale that was sent over with her, Cuddy weighed 54.43 kilograms or about 120 pounds on admission to the hundred acre wood."
"A weight loss of 31 pounds or so in a five month span isn't extreme," Foreman noted. "But as Taub said, her weight now includes the ten or fifteen pounds of fluid she's retaining." He watched as Chase set up the cuff on Cuddy's arm to give them periodic BP readings, pulse and blood oxygenation. The initial numbers did not look good.
"And it's the way the weight's been lost," said Chase as he listened to Cuddy's heart. He took the stethoscope earpieces out and looked at Wilson. "Help me lean her forward so I can try to hear her lungs," he said. Wilson grabbed a pair of gloves from the rack on the wall, put them on, and helped Chase sit Cuddy up so he could listen from the back of her torso. Wilson made a face as the rear of Cuddy's gown opened, and he saw the condition of her skin.
"Her entire back is red and dry; a number of areas look to be potentially compromised and thinned," he reported.
"And I hear rails in the lower right lobe," Chase said. "Not strong enough to be pneumonia…"
"She's getting the deluxe package," House said. "EKG, chest x-ray, full blood and urine panels…we've got to find out what's still working on her and how badly it's working." He walked over to the bed and looked at the IV. "She only has saline with ringers running, and that's at a pathetically slow rate."
"Look at her veins" Thirteen said holding up Cuddy's right arm. "As dehydrated as she is, we may not be able to run anything any faster…or find a new site."
"I told you," a voice from the door said. "We didn't have the means to give her the kind of treatment she needed; we did the best we could." Dr. Stein stood in the doorway; Lydia and Thomas were right behind him.
"The best you could have done was realize you were killing her, even more slowly and painfully than the damage from the damn building dropping on her was," House said, his voice harsh and raising in volume. He turned and walked toward the door. "But instead you listened to the twisted fantasy laid in front of you by Mama Cuddy and tried to raise the barely living from the nearly dead. From the condition she's in, I'd say you confused your copy of Merck's Manual with the latest issue of Mad Magazine."
"I told you…I did what I could…" Stein said, his voice choking up as it trailed off. As Wilson came over next to House, he had every intention of blasting Stein's medical skills and judgment as well; but he hesitated as he finally had a good look at the doctor. Stein was far from a young man…in fact he looked to be about Thomas' age, almost eighty. The man looked frail, like he needed nursing care himself. Wilson could see there was a tear running down Stein's cheek.
"We were just taking a walk to the men's room and then stepping outside for a bit," Thomas said. "I believe the facility is at the end of the hall, on the other side?" He caught House's eye and gave a slight shake to his head as he looked back at Stein.
"Yes, it's down the hall on your left," Wilson answered. Thomas nodded and started to ease Stein away from the door.
""Let's take a whizz and then get out for some deep breaths," Bell said taking Stein by the arm. Lydia watched as the two men made their way down the hall; she put her head down as she stepped into Cuddy's room.
"That poor man shouldn't be in charge of anything," Lydia said shaking her head.
"You got annoyed with him last night as much as the rest of us did," said Chase. He was looking over Cuddy's veins with Thirteen to see what was available to use without collapsing.
"That was before I found out the man has had three heart attacks, two CHFs, a stroke…he's got a pacemaker/defibrillator. He should be taking it easy, not taking on the responsibility of the health of a bunch of senior citizens, much less taking on a case with as many intricacies as Cuddy's." Thirteen and Chase walked by House, Wilson and Lydia on their way out of the room.
"We're grabbing an IV kit and seeing what we can get," Thirteen said rolling her eyes as they passed by.
"It doesn't matter how many health problems he has," House said. "He never should have taken on the responsibility if he can't handle it."
"I hate to say this…and I know you're not going to want to hear this," Foreman began. "But we're going to have to report this abuse."
"Leave my name off whatever you file," House said turning away to watch Taub take measurements of Cuddy's swollen arms and legs.
"After finding out the circumstances behind what happened with your leg, it's understandable that you don't want to open yourself up to anyone's anger or retribution," said Foreman. "But it's your team…all of us who are treating Cuddy and notating the abuse."
"If you remember last night's conversation, I didn't even want to take this case on," House said angrily as he walked back and got in Foreman's face. "But it seems somehow I got outvoted by my own team…and few outsiders besides," he said with a quick glance at Lydia.
"House, you could have begged off getting involved in Cuddy's case," Thirteen said returning to Cuddy's bedside as she opened up the IV kit and started to hunt for a vein. "But you know damn well you'd stick your cane in anyway." Furrowing her brow in frustration, she muttered, "Not like you hadn't with her already." She picked her head up and saw the look Chase was giving her; it was then that Thirteen remembered Lydia was in the room. "Sorry," she said glancing at House's girlfriend.
"Don't worry about it. I'm well aware of ancient history," Lydia said, walking over to get a look at the numbers Taub was writing down. "And the bottom line, is that Dr. Cuddy only got one shot at him; I get him over and over and over…" By the fourth or fifth "over" everyone in the room was either smiling or laughing…even House. He did like it when Lydia semi-joked about their love life…it kept them all guessing. House was about to make an off-colored comment, when he saw the look on Lydia's face; she went over to box of gloves and removed a pair for herself.
"What do you see?" he asked. Lydia went to Cuddy's bedside; the sheets and blanket were still pulled down, but the hospital gown was large and long enough that it covered her fairly well. Taub had only moved it a little to take the measurements on Cuddy's legs.
"Look at her abdomen," Lydia replied is a solemn voice. It clearly was distended. Lydia reached out a gloved hand and gently pushed; she met resistance.
"Well, she either got knocked up, or…."
"House!" The universal exclamation of disapproval echoed through the room. Lydia quickly pulled up the sheet to just above the groin area so as to give Cuddy some measure of dignity. She then worked the exam gown up to expose the stomach; the skin was stretched, shiny in spots and flaky in others. Lydia pushed on the abdomen but harder this time; a sloshing sound could be heard.
"Ascites," she said with only the barest sound of relief in her voice. She knew that retention of fluid in the body to the extent Cuddy was displaying it was bad. That it was also effecting the peritoneal cavity, too, was even worse.
"What's causing it?" House said sounding like the teacher he was intending to be. Lydia picked up right away on what he was doing; it kept her mind sharp for all sorts of cases that she would handle in the future if he played inquisitor now.
"The family doesn't report a history of drinking, so cirrhosis can be reasonably ruled out. Since that's the cause of ascites in most cases, kidney function, congestive heart failure and tumor would be the next most likely causes. Based on the labs that were sent over with her…"
"Knowing the unreliability of the source, you're going to use them in a DDX? Not with my team you won't…"
"Rerun the labs here with heart enzymes, and do a nine-lead EKG," Lydia said hurrying to correct herself. House nodded.
"You remember how to do an EKG set-up?" he asked. She gave him a look as she went to leave Cuddy's bedside.
"Yes, that was that funny little test I ran on your patient the other day in the clinic…remember?" She removed her gloves and looked at Wilson. "I'll find the machine at the nurses' station?"
"Or floating in the hallway, depending if someone's been using it. ICU, Surgical ICU and Pediatric ICU are the only areas that have their own machines," he said moving with her to the doorway.
"Back off," House said joining the two. "I'm the one playing Professor Higgins here." Lydia stepped into the hall and found an EKG machine by the room next door. She started to wheel it in, when…
"House…We can't get another vein on her and we lost the one she came in with," Chase said. House clenched his jaw; he was used to meeting obstacles with cases…but considering who the patient was… Cuddy, leave it to you to bust my kahunas without saying or doing a damn thing, House thought. "I can do a midline here in the room; but she's going to have to go to radiology to get a central line put in."
"Get the midline in place in her neck," House said to Chase. "Then take a look at the boo-boo on her ass," he directed Taub. "And let me know when you do; I want to relive old memories." House glanced over at Lydia as he issued that last set of instructions; she knew it was payback for her comment about doing his clinic work earlier. I hope Greg really is taking things in stride; because with the way things look in Cuddy's case, he's going to need all the medical brilliance he's got to keep her alive, Lydia said to herself.
"You want to wait on the EKG for now?" she asked as she rolled the machine into the room. House nodded.
"Midline and the inspection of her tuches take priority," explained House. "Once the line's going, start her on 1000mg. Vancomycin and 500mg. Levofloxacin, BID." He turned to Lydia. "Why are those two appropriate?"
"Because…she's most likely coming in with staph and/or strep…possibly MRSA, too. But we'll need the results of the cultures to confirm and to check for the susceptibility of the bacteria to the particular antibiotics prescribed. In the meantime, they're broad spectrum enough to cover her." Lydia knew she was right and looked at House for his confirmation. None was coming.
"Why didn't I say sulfadoxine?"
"It's a sulpha drug and allergies to them are common," Lydia replied. House nodded and started to walk away from the bed. "Plus sulphanomides displace bilirubin from albumin, the excess of which would cause brain damage…kernicterus…and I think Dr. Cuddy's got enough of that already." There was no smile on House's face, but by the gleam in his eyes when he turned to her, Lydia could see he was pleased with the fact that she carried her explanation through.
"I was going to go get a cup of coffee, but I need someone to keep Mama Cuddy and Doctor Doolittle out of my face. Having no sympathy for either one right now is going to ruin my reputation." House said.
"What reputation?" House's team and Wilson said at once. He answered them with a scowl as he made his way to the door.
"Maybe strength in numbers will help," Wilson said. "I was going to grab another cup and something to eat."
"I could use something, too," said Foreman joining House and Wilson.
"I want to stay here and get this midline in," Chase said. "I have to pick up the supplies; I'll give the pharmacy a heads up and bring the Vanco and Levaquin back with me."
"I'm just going to grab something from the other room, then come back in here and keep an eye on Cuddy," Thirteen said.
"Good, because I was going to check her heels for any skin break down," Taub said. "Then I'll want to take a look at what Wilson saw on her back. Then comes the sacral area and we'll know what we're dealing with. By that time, Chase should be ready to put the line in and I can grab something to eat."
"Would you mind if I watched you as you looked over Cuddy's skin?" Lydia asked Taub. "I was curious as to how you assess the level of a wound."
"Well, I'm not expecting anything on her feet or back to even be at a stage one; but the tush is another story. You're more than welcomed to stay and ask questions."
"Thanks." Lydia turned to the group headed to the lounge. "I'll come in and help run interference in a few minutes. Oh…I had the chance to take a quick look at Arlene's paperwork, and I can see right away what went wrong. The 'nursing' facility she's in got the insurance and billing correct. PPTH got it wrong. All the treatments Cuddy received immediately after the collapse were put through as her having no insurance."
"What? That's ridiculous," Foreman said. "She has the same health insurance we all do. Plus, this was a workman's compensation case…she was on hospital business when she got hurt."
"Somehow, someone failed to notice or make note of that," Lydia said. "It's easily correctable; but from the notes Arlene has made, someone from my staff has been giving her grief…and I intend on finding out who it is."
"The initial billing took place before you started working for the hospital, right?" Wilson asked.
"Yes, but the communication between my department and Arlene has happened on my watch. And while there's two sides to every story, one of Arlene's notes say that the person on the phone offered Arlene the opportunity to pay only a certain percentage of the bill, and the rest would be written off. Those kind of arrangements can't go through without my written approval; and I think I would remember the name Lisa Cuddy," she said glancing at her boyfriend.
"I'm sure you would," said Foreman picking up on the look. "So you can go into the billing system and straighten things out?"
"The workmen's comp carrier may question why we've waited so long to bill them, but I'm sure I can talk my way through any bull they throw at me." House was leaning against the wall, listening to Lydia handle the other side of medicine; the dollars and cents and bureaucracy that too often the patient pays the price for. She dealt with it with same aplomb that she did the medical aspects of things. There was no doubt in his mind that she could run the hospital after a little more experience under her belt. Of course, that would have to be after she went to medical school…
"House…hello, anyone in there?" Wilson asked. House looked around; Lydia had joined Taub to examine Cuddy, the rest of them were about to get their coffee and something to eat. He saw that Chase was with them also.
"Grabbing a java jolt before you pick up a scalpel may not be a good idea," House commented as he ignored Wilson.
"Being it's a weekend, the pharmacy needs a little extra time to pull the antibiotics," Chase said. "And after last night, the caffeine won't do me or Cuddy any harm."
"House, what is the deal with you and Lydia?" Foreman asked as they entered the lounge, and went straight to the table Lydia had set up with coffee and food. It was at the opposite end of the room from where Arlene Cuddy sat with her granddaughter and Lydia's kids; Stein and Reverend Bell had thankfully not returned yet.
"What deal?" House asked. "We're dating, we share living space, we have sex as often as we can…"
"No, I mean with all those medical questions you were asking her. She's not in medical school."
"Yet," House said as he took a handful of Dunkin' Munchkins. "By the time she gets there, I want her to be several steps ahead of her teachers. It'll boost her confidence and drive them crazy."
"So…Lydia's going to go for it after graduation?" Wilson asked. House read his mind; he knew his friend was wondering where his leg surgery would fit in.
"Nothing's been chiseled on a rock but…" House said looking at Wilson and his team. "Like I said last night, on Friday, May 9th of the coming year, Fraulein graduates from college. On Monday, May 11th, I've agreed to start the reconstruction of my leg. One year after that, we'll know the outcome…good, bad or what made you think this was going to work?" House popped one of the donut holes into his mouth. "The next semester after that, no excuses…Lydia has agreed to start medical school…go get what she was robbed of years ago." House looked downward. "It's the closest thing the two of us will ever come to making promises to each other without involving all that, 'Forever and ever, I do' crap." He felt Wilson's eyes burning into him as he took a sip of his coffee.
"Is Lydia's going to go the College of Medical Sciences' Adult Studies Program?" Thirteen asked.
"She hasn't applied anywhere yet. I don't think a 4.0, plus all her other work, places any kind of question on her acceptance. She's anxious about the adult leader scholarship; they only hand out one, and she doesn't know if she's going to get it."
"And with two kids, she can't afford med school without it," Chase said.
"She'll afford it…one way or another," House said with a frown.
"Why…do you not look very happy about this? Not sure you want two doctors in the family?" Wilson asked with a smile. House shot him a look over his choice of words.
"Three," House corrected. "You forgot about Doogie." Thirteen glanced over her shoulder to the other end of the room.
"He's as bright as his mother, that's for sure," she said. "So is Elise." As if on cue, Lydia's daughter came skipping over to the group with Rachel in tow.
"This is my new friend, Rachel; these are the doctors helping your mommy." Elise said handling the introductions. There was an awkward silence as Rachel looked up at each of them in turn.
"Thank you," she said quietly.
"We're…we're doing our best, sweetie," Wilson said.
"Come on," Elise said tugging at Rachel's arm. "Let's go draw more teacups and food so we can pretend to have a tea party." The two little girls skipped their way back to the table; they passed Ben on the way who had started to walk toward House.
"Surviving the female onslaught?" he asked the boy. Ben rolled his eyes.
"Yeah; at least she plays soccer," he said with a sigh.
"You know, girls aren't so bad," Thirteen said. "You may have to learn very soon to put up with them."
"Yeah…what will you do if your new cousin turns out to be as girl?" Wilson asked. Ben thought for a moment, then shrugged.
"Teach her soccer, I guess." The adults laughed as Wilson put his arm around the boy's shoulder.
"Good answer, pal," his future uncle said. The boy seemed embarrassed by the attention, but that disappeared when he turned to speak to House.
"Mom let me use her iPad so I could look up some medical stuff," the child said. "I don't understand something…could you explain it to me?"
"Since they gave me that fancy piece of paper that says 'Doctor of Medicine,' in theory I should be able to make sense of it. What've you got?" House asked. Ben held up the iPad and ran his finger down the page.
"Osteomyelitis" the boy said. "I don't get it." House squinted his eyes.
"What does 'osteo' refer to?" he asked.
"Bone," Ben replied.
"And anything that ends in 'itis' means…"
"Inflammation or infection."
"And myelo?" Ben shook his head. "Like the other two, it's Greek in origin and means marrow," House said. The boy's face brightened.
"Bone marrow. So that's how the infection gets into the bone," he said.
"Mmm…yes and no. It can come through the bloodstream which involves the marrow, but it can also come from nearby tissue, like cellulitis." Wilson and the team watched in amazement as the child pulled an old-fashioned notebook out from behind the iPad and wrote down all the things House was saying. As he was doing this, Wilson saw Lydia standing in the hall, looking into the room with a concerned expression. She gestured for someone to follow her back to Cuddy's room. Wilson caught House's attention and nodded toward Lydia. Without another word to Ben, House turned and walked to his girlfriend.
"Where's House going?" the child asked.
"He's got to see the patient," Thirteen said, realizing what was going on. "He'll talk to you later, I'm sure."
"OK," Ben said without batting an eye. "Patients come first." He closed the notebook and headed back to where his sister and Rachel were.
"Are you sure that kid isn't 38 rather than 8?" Foreman asked as the remaining group hurried back to the room.
"Or House's kid?" Chase added in. As Wilson, Thirteen, Foreman and Chase walked in, they were greeted by the unhappy faces of Taub, House and Lydia.
"This sacral wound is much bigger than what Stein indicated," Taub said as he and Lydia rolled Cuddy over onto her side. "In fact, it's double in size…and deeper."
"There's necrotic tissue covering the upper right quadrant of the wound," Lydia pointed out with a gloved finger. "And look at the drainage on the bandage."
"Suppuration," Foreman said.
"And when you have pus, you have infection," House said. "She's got to get into surgery now. If the pus is from the wound, that's one thing. If it's due to osteomyelitis…"
"It's down to the spinal column," Chase said pulling out his phone. "And then to the brain…" He rapidly dialed the pharmacy. "This is Dr. Chase. Do you have that antibiotic ready for me? I'm aware of the fact it's Saturday…I don't give a crap about your lack of staff. I'll be there in two minutes and it better be ready or I'll pull the order myself!" He slammed the phone closed. "I'll get the midline in; call radiology." Chase ran out of the room; his footsteps could be heard descending down the staircase to the first floor.
"I don't believe you were just talking to Ben about this very thing," Wilson said.
"You were?" Lydia asked as she and Taub placed Cuddy on her left side by wedging extra blankets under her.
"Yeah, he was playing with your iPad…and just came over and…started asking House questions about the subject of osteomyelitis," Wilson said, clearly taken back. House said nothing as he removed his exam gloves; he just continued to stand at the end of Cuddy's bed and stare down at her.
"Do you want me to take those?" Lydia could sense he was upset, but probably had his mind going at full-tilt to assess Cuddy's situation. He absent-mindedly handed the gloves to her, and finally stepped away from the bed. He noticed that Thirteen was on the phone, he assumed with radiology.
"Radiology said to give them a call after Chase gets the midline in," she said after ending the call. "Being that it's Interventional Radiology instead of the main department, they're only handling the overflow from yesterday." House looked at Taub.
"Get a hold of Wound Care; find out who's covering. If it's not Grimes, then get a call into him, tell him who the patient is, and to get in here. I don't want anyone but him," he said. House hesitated for a moment. "We don't want to lose her."
"Umm...excuse me…House?" He recognized the female voice that came from the doorway.
"I don't have any openings on my team," he said without turning around. "And if I did, you already blew your chance." He finally faced the doorway; there stood Dr. Allison Cameron.
"I got a text from Chase telling me what was going on with Cuddy," she said as she stepped into the room. "I wanted to stop by…"
"So you and the Aussie heartthrob have re-fanned the flames of passion? Good. I've been needing some ammo to re-load my snarky comments cannon with." Cameron shook her head.
"Unlike some people I know, Chase and I have managed to be mature about things; we've worked things out and are just friends. The fact is, I'm engaged…and expecting."
"What is it…a plague?" House asked looking disgusted.
"Ignore him," Wilson said as he went to hug Cameron. "Congratulations! I'm getting married in a few weeks and my fiancée is expecting a baby, too."
"That's great!" She looked at her former boss. "And you're afraid it's catching?" she said to House. "I've got news for you; the first thing you need is a girlfriend," Cameron snapped. House locked eyes with her and let a slow smile creep over his face.
"If you'll turn around, and look to your left, you'll see I've taken care of that detail." Cameron looked over her left shoulder and saw Lydia standing there.
"Oh…I'm so sorry. Foreman and Chase told me about you; they've even showed me a picture of the two of you, but I thought they were…"
"Yanking your chain?" Lydia said laughing. "No, I'm quite real. I'm Lydia Strohman, Greg's…Dr. House's girlfriend." Cameron couldn't even bring herself to look at House; she knew he'd have that triumphant "I told you so" look on his face.
"Nice to meet you," Cameron said shaking Lydia's hand. She quickly looked House's girlfriend up and down. "You're not…"
"Her oven's empty but definitely not cold," House quipped. Cameron looked embarrassed on Lydia's behalf, but it didn't seem to bother her at all.
"I'll confirm one thing Greg said; the factory got shut down a few years ago. But I do have two children, a boy and a girl." It was now Cameron's turn to smile.
"You're…a stepfather?" She started to out and out laugh.
"No, we're not married; just living in sin."
"He does very well with my kids," Lydia noted. "My son wants to be a doctor, and my daughter a music teacher. She plays the piano with him." Cameron stopped laughing and looked at House.
"I'm…impressed," she said becoming serious. She turned away from her former boss as Foreman and Thirteen came over to greet her.
"I'll just say hello," Taub said. "Don't want to come near you while I'm dealing with this wound." Just then, Chase came bounding into the room.
"Hey!" he said giving Cameron a kiss on the cheek. "I didn't expect you to show up here."
"I didn't feel like having breakfast at the hotel, so I came into town and went to Venus café…then I got your text. I wasn't sure what to do…I thought I'd stop by…"
"And see if you can help?" House said in a mocking tone. "There may be staph, strep and MRSA in her wound. If you weren't on the nest, I'd say dive in, but I don't want to get blamed for your offspring coming out with a third eye and a leg out its butt."
"You're being protective of a member of your team?" Cameron asked in surprise.
"You're not a member of my team anymore," he noted.
"I'm not a member of your team officially; you're protective of me," Lydia said.
"No, I'm not. You were up to your elbows in her wound a little while ago," House said as he moved over to where Chase was. "If I am protective of you, it's only because there are certain physical benefits that come with it." Cameron shook her head in amazement.
"Is he like this all the time?" she asked.
"Yep. And Fraulein doesn't mind it one bit." Lydia was beginning to get the feeling that House was enjoying showing their relationship off to Cameron. Let him, she thought. At least it's distracting him.
"I'll be finished redressing the wound in a few minutes," Taub said as he swiped the area with saline. Cameron took a few steps around the end of the bed and looked at the wound from a distance. She came back around to the other side of the bed and looked at Cuddy's face.
"She…I hate to say this, but I wouldn't have even known it was her. Chase told me she was bad when she left here a few months ago, but who the hell let her fall into this kind of condition?" she asked.
"I…I told them, we did what we could. I've known Lisa since she was a little girl; do you think I would let her be like this if I could help it?" Stein and Bell had come back from their walk; unfortunately, he heard Cameron's comment.
"Keep the parade moving," House shouted out. "The answer to your 'who' just passed by the door. The shorter of the two, protesting futilely." Foreman explained who Stein was and what his personal relationship was to the Cuddy family.
"It's a shame that she has to be like this all because the facility was ill-equipped to take care of her," Cameron said.
"I had to pick that place," Arlene said as she walked into the room. "I needed to be able to take Rachel to her. I…I think Lisa knows when I bring Rachel to see her."
"Wishful thinking," House said dismissively. "Which is why your desire to keep her around for a while longer is pure folly. She can't react…"
"House…look at the monitor," Cameron said. Sure enough, Cuddy's pulse and blood pressure had risen slightly from the last time he had looked at it. "It's risen since I've been in the room, and went up even more when she came in," Cameron said indicating Arlene.
"It's probably positional; put her on her back and sit her up," House directed. "No one talk." Taub, who had finished changing the dressing on the wound, removed the blankets he and Lydia had placed behind Cuddy; he and Chase rolled her on to her back, then slid her up gently in the bed. Taub removed his gloves and pushed the bed controller to bring her upright; her vitals dropped.
"Talk." House said to Arlene. "Talk to her." Mrs. Cuddy approached the bed; she reached for her daughter's hand.
"Lisa, I have you back at your hospital. Dr. House and his team are taking care of you. Dr. Stein…he tried. He really tried, but I should have listened to him. I never should have put you in that facility." House and the others in the room watched the monitor carefully. There was no real change in the numbers.
"Told you; positional."
"Mention her daughter," Lydia whispered to Arlene. "Mention Rachel."
"Rachel is here with me, too. She playing with two wonderful children. They're very bright like she is." There was slight increase in the numbers.
"Keep saying the kid's name," House said.
"Rachel was very good on the car ride up and a nice woman, Dr. House's girlfriend, has given her juice and muffins and all sorts of breakfast things. You know how much Rachel likes that."
"Boy her numbers really went up when Arlene said 'Dr. House's girlfriend,'" noted Wilson.
"You're surprising everyone with that," Cameron added. House gave her a look.
"It would seem information is getting through to her, but the only way she can respond is non-verbally," House said.
"Let's bring her up-to-speed on what's going on," Foreman said. "Not that she hasn't probably already heard us. Cuddy, it's Foreman…you've got a lot of problems, a lot of things going on…we're going to try and help you."
"I'm going to be putting a midline in on the right side of you neck; that way your right arm will stay free for blood pressure readings. After that you'll go to Interventional Radiology; we'll get a central line in on you left side," Chase said. House noticed there was only a small change in her vitals; he began to wonder if she really did react to what was being said to her.
"What are you going to be doing to her? What's a central line?" Arlene asked anxiously.
"You're going to have to sign some consent forms for the different things that are going to be happening," Lydia said. "Why don't you go back into the lounge, and we'll come in and explain everything to you." Arlene nodded.
"I have a feeling I'm going to be needing a seat," she said.
"It's not that bad. Besides, these are all things that need to be done to help your daughter," Lydia reassured her.
"Will you and Dr. House be the ones to talk to me?"
"If…you'd like," Lydia said as she saw her boyfriend roll his eyes.
"OK, I'll wait for you in the lounge. Oh…your children are delightful, by the way. I thought by now Rachel would be asking to come in and see her mother, but she's content to just play and talk with your kids," Arlene said with a smile.
"I thought they would be good together," Lydia said. "Arlene, our friend, Tom, who is the kids' soccer coach is stopping by in a little bit with his two children who are around the same age. Could Rachel go outside with them and kick a ball around on the grassy area behind the building?"
"Well, Rachel doesn't have any equipment with her; I don't even have one of her soccer balls in my car."
"I have extra in mine; I'm sure we could find something that would fit her." Arlene bit her bottom lip and took several steps forward to Lydia.
"Thank you…thank you so much," she said placing her hands on Lydia's arms. "You have made this so much easier on both Rachel and me with your kindness."
"It's my pleasure. Arlene…do you and Rachel have a place to stay? I didn't know if you've made arrangements in a hotel or with friends…" Arlene shook her head.
"No, I really didn't think that far ahead. Truthfully, with all these bills now piling up and the small amount the hospital has offered as a settlement…" The poor woman looked overwhelmed.
"Don't worry about any bills from the hospital," Lydia said consolingly. "Information was entered into the computer incorrectly; I'll start work on fixing that on Monday."
"Arlene, what do you mean by a small amount, in reference to the hospital's settlement?" Wilson asked.
"Oh, I suppose I'm being unrealistic about what I expected them to offer," began Arlene. "But, it's supposed to be enough to care for Lisa for the rest of her life, which…I know isn't a long time," she said sadly. "But it's also supposed to take care of Rachel until she's eighteen. Lisa had a college fund set up for her that she contributed to the past three years…but that's going to stop. Then there's the day to day expenses of raising a child. I'm sure I don't have to tell you about that," she said to Lydia.
"No, you don't. What has the hospital offered you, if you don't mind me asking?
"One-hundred eighty-five thousand."
"That's a pretty good dollar amount per year," Foreman said. Arlene shook her head.
"That's in total."
"What?" Wilson exclaimed.
"That's ridiculous!" Cameron chimed in.
"I thought it was low," Arlene said tearing up. "Because I'll have to pay for Lisa's care in whatever facility she goes to if I accept the settlement. The workmen's comp insurance would end."
"How much does Shady Acres Rest Home soak their patients for?" inquired House.
"Fifteen thousand a month. I...I never thought we'd ever be in this position. I was comfortable in retirement, I was doing fine with the payout from my late husband's insurance policy…Lisa had a wonderful job, a home. Now…" Arlene couldn't hold back her tears any longer.
"There you are." Thomas walked into the room and quickly assessed the situation. "Has this lot gotten you upset? I won't stand for that." He rested his hand on Arlene's shoulder.
"It's just so hard to talk about burying your child," she said leaning into Thomas.
"I have news for you; it's hard to talk about burying anyone," he said. "I've officiated at more funerals than I can count and it's never easy whether the person has lived a good long life, or been cut down in their prime." Thomas moved Arlene away from him so he could see her face. "But I will tell you now, what I have always said to the mourners I've comforted; don't feel sad because they're gone, feel happy and smile that you were blessed to have had them." Arlene looked over at the bed; she somehow managed a smile and nodded.
"I am lucky…very lucky." Thomas heard the few sniffles in the room and knew it was time to change the mood again.
"This isn't something you have to worry about right now. You have the best doctors in the world taking care of your girl."
"That's what Lisa always said about them; about you in particular, Greg. She said you had the most brilliant mind of anyone she had ever met." Despite herself, Arlene started to chuckle. "But did also say that you drove her crazy."
"The feeling was mutual," answered House.
"Where are the tissues around here? We can't let this lady go back to her granddaughter like this," he said. "Lydia…Tom has stopped by with his kids and wondered about taking the children outside to get some fresh air and play a little soccer."
"Arlene and I were just talking about that; it's a great idea," Lydia replied. "There's extra equipment in the car for Rachel to use. I left my pocketbook in the lounge, and the keys to the van are in the outer pocket. It's a gray bag."
"Got it. He was also thinking of taking them out for a bite to eat…maybe some pizza or something."
"Oh! Here you're talking about lunch and I haven't even figured out our sleeping arrangements," Arlene said.
"Don't worry about them," Wilson said. "There are…several rooms here at the hospital used to house the parents and families of the children with cancer that we're treating. I happen to know that several are empty at the moment; we can put you up in there."
"Thank you, I appreciate that," Arlene said as she wiped her eyes. "Well…let me introduce myself to your friend and take Rachel to the ladies' room before she goes running around." Arlene Cuddy left the room and more than one person stepped forward to grab tissues from the box on Cuddy's bed tray.
"Those were beautiful words you said," Cameron noted to Thomas.
"Thank you. I'm sorry, I don't believe I've met you."
"Dr. Allison Cameron; I used to work with Dr. House's team."
"Until she decided to leave for what she thought were greener pastures," House said.
"I've just been made head of my own department, I'm engaged to my best friend, and I'm expecting. I'm doing just fine."
"Those pastures do sound pretty green to me," Reverend Bell said. "When are you due?"
"The middle of May."
"That's when Annie, my fiancée is due," Wilson smiled.
"When are you tying the noose around your neck? If it's anywhere near Wilson's nuptials, maybe you can get a two for one deal out of Bell. He does funerals no matter what other name you want to give it," House said looking over at Chase as he worked on putting the midline in.
"Sorry," Wilson said to Cameron. "But the only wedding I'd want to see Reverend Bell perform at the same time as mine would be his son's." He nodded his head toward House.
"Alleged son," House quickly added pointing his cane at Wilson. "That's the adjective we're using for now since no scientific proof has been offered yet."
"And none ever will be if you keep putting off having the test," Wilson replied.
"I've given him my word and his blessed mother's reputation…but even that's not enough proof for him," Thomas said with a smile. Lydia saw that Cameron looked shocked as her head swiveled back and forth between House and Reverend Bell.
"I'm sure that Chase had kept you up-to-date on things happening around here, but considering that you didn't believe him that Greg had a girlfriend, I take it you didn't believe anything else he told you, too," Lydia said coming over to her. "Can you join us for lunch and everything can be explained and clarified for you?"
"Yes…yes, I'd love to. Chase and I were going to have lunch, but he's a little busy," she said watching him work on Cuddy.
"At least it's for a legitimate reason," Chase said.
"This time," Cameron shot back. "And the person I was supposed to meet for dinner canceled on me; she got called out of town on business. So, I'd love to join you."
"I just have to warn you; we'll be spending most of our day here," Lydia said.
"Nothing I'm not used to."
"When is Phil coming in?" Chase asked.
"Tomorrow, after his shift," Cameron answered. "They wanted him to do a double, but he begged off."
"I take Phil is the doomed groom?' House asked. Cameron gave him a look.
"He is my fiancée, yes. And he and Chase get along well." House frowned.
"Too bad; there was the potential for fun and mayhem if they didn't like each other."
"Is he a doctor?" Foreman asked.
"He's a PA in the Pediatric ICU. Our hospital's putting in an ER trauma center for pediatric cases, and Phil's the liaison between the PICU and the ER. He's attending the conference for ER administrators so they can better set-up the new area."
"Nice," said Wilson. "We really…should start taking cues from how other hospitals do things. There are some really great ideas out there."
"First we need more money," Foreman pointed out.
"I'm working on that," Lydia said. Seeing Cameron's puzzled look, she explained her position at the hospital.
"And on top of that, she's going to medical school," House added in.
"Well, not quite yet; the details are still being worked out."
"Got it!" Chase said. "Got backflow."
"It's about time," said House. "Get a hold of radiology," he told Thirteen. "Tell them she's ready for the next step."
"Just heard back from wound care," Taub said "Grimes was out-of-state for the weekend, but when they told him what was going on, he turned around. He'll be here within two hours. Wound Care wants to look at it once she's back from radiology."
"Good." House said looking down at Cuddy. "Get these bags of antibiotics hung and we can…..
"Dr. House?" The sound of a small voice startled everyone. They turned to see Rachel Cuddy standing in the doorway.
"Honey, what are you doing here?" Lydia asked hurrying over. "You're going to scare your grandma if you wander away like that."
"I wanted to ask Dr. House something," the child said. House was clearly uncomfortable, but he didn't want to hear any grief from the others.
"What do you want?"
"Can you fix my mommy so she'll talk again?" House looked around awkwardly.
"Why?"
"I forgot what my mommy sounds like…and I want to remember."