Chapter 79 — The Needs of the Few

A/N: Thank you to Iland Girl, TheReaderOfWorlds, MiaEther, GahMarques, Robin, Lordban, DawnneAndSkipper, Hollow Lives, Musikrulesok, and HeatherSS1 for their reviews on the last chapter!

I was getting desensitized to puke very quickly.

Pathways was a completely different game from working in IPMH. IPMH had a heavy emotional toll to it, as one would expect, but Pathways was harder. Maybe because I had an addict in my life that I cared about very much. Maybe it was because he wasn't the first addict I'd had in my life that I cared about very much. The desperation, the pain, the fear, humanity stripped bare in front of me. I saw reflections of House and my brother everywhere I turned.

I didn't like working there. I'd only been on the rotation for a week, but I knew it wouldn't be for me. Not now, not ever.

"Just get it out, Brad. Better out than in, right...? You ever seen Shrek?"

Brad wretched into the trashcan I'd offered, pure stomach acid. He hadn't been able to keep anything down in days. He was the worst case on the detox unit, for sure. Opiates and alcohol. Percocet and Seagram's Seven, specifically. Hell of a combo. Hell of a combo to live without very suddenly, as well. Eventually, Brad rolled back into bed, wiping his mouth.

I made a mental note to call housekeeping and walked to the sink to get him a glass of water. "You're coming out the other end," I told Brad gently. "In a few days, it'll be over."

"A few days isn't now," Brad replied through gritted teeth. He wasn't a bad guy. Mid-forties, electrician. He'd been downright sweet for the most part, but even he was reaching his breaking point. "I don't—I'm gonna be honest with you, I don't know what the other end of this looks like. I don't know if I want to."

"It'll be better," I promised him, and maybe I shouldn't have done that. We weren't supposed to talk in absolutes to patients. "Anything's gotta be better than this, don't you think?" I offered him the glass, and he took it with a trembling hand.

"Get out of here, go back to a life I can't stand," he said, before chugging about half the glass's contents. He slammed it on his night-stand, and it sloshed out and over, spilling onto the crossword the two of us had been working through earlier. "I wanna...I wanna get fixed. But I don't know how to...to deal with what's out there, without...help."

"That's why outpatient treatment is so important. You'll have groups, counselors. We'll get you set up with a therapist that's in network for you. We're gonna get you the help that you need."

Brad didn't seem emboldened by that. "Yeah. I need a lot."

I'd read through Brad's chart. Marital status? Widower. And I had a feeling that played no small part in how he ended up like this.

"I'm gonna go talk to Paula about getting you on IV fluids. I'm really worried about you getting dehydrated, that's just gonna make you feel worse. IV Zofran too, maybe. Taking it orally doesn't seem to be helping you much."

"You wanna sprinkle in some morphine?" he asked, strained.

"Would if I could, pal."

I headed out to the nurse's station. Paula sat behind her desk, on the phone with a patient seeking admission. I waited patiently for her to finish. When she was done, she looked up at me. "What's up..." She took a long moment to read my nametag. "...Anya?"

Yeah, Paula wasn't going out of her way to acquaint herself with any of the nursing students. She'd called Tali 'Tammy' multiple times since we'd started this leg of our clinicals. I was sure the next time she spoke to me I would suddenly become an Anna or a Tanya. Regardless, I quickly ran her through Brad's status, and asked if it was okay if I started him on the IVs I was considering. She was a CRNP, so she had certain ordering privileges.

"We don't need to turn him into a pin cushion. Have him keep taking the Zofran orally for now, but you can start him on fluids."

"Okay." I waited.

She blinked at me. "Is that all?"

"I have to be supervised anytime I do a procedure," I reminded her. "I've never set an IV on anything but a mannequin before."

"This is your first one?"

I nodded.

Paula didn't seem thrilled by that. "Great. Alright." She pushed her self out her chair and gestured. "Go on then, I'll follow you. It's just like in your practicals."

Except mannequins couldn't twitch when you had a needle in their vein. I made the executive decision not to voice that. Focus, Carhart. I could grab everything. That was the easy part. Then I just had to...do the thing. I'd wanted to be a doctor, for God's sake. Why was I so nervous about just setting an IV? It's not like I'd kill the guy if I missed a vein.

Topical alcohol cleanser. Alcohol wipe. Tourniquet. IV cannula. Plaster. Syringe. Fluid bag. I pulled on my gloves carefully and carried everything to Brad's room. He wasn't in much better shape than earlier, curled into himself on the bed and looking the picture of suffering.

"Got the okay for fluids, but we're gonna wait on the IV nausea meds for now," I told him. "Which arm do you want it in?"

He stuck out his left arm.

"Can you lay flat on your back for me?" I asked, trying to keep my voice steady. "You're uh, popping my IV cherry. You're the first real live person I've ever done this on."

Brad let out a weak little laugh, and did as requested. "Well, at least your honest."

"I try," I said, giving him a smile that probably looked more like a grimace. I bent down next to him, searching his arm for a decent vein. Found a prominent one pretty fast, so I doubted he'd be a hard stick. I applied the tourniquet and rechecked the vein. Still good. I wiped down the crook of Brad's arm with the alcohol wipe, then gave it a moment to dry.

I could literally hear my heart beating in my ears.

You have to stop freaking out. This is not a big deal. This is something nurses do dozens of times a day. It's just—find and stab. You can do this.

I wrangled the cannula out of its packaging and prayed that my hands would stop shaking. I removed the needle covering, taking care not to touch the needle proper. Seeing the actual needle in my hand did nothing to alleviate my sudden terror. I stood there, trying to swallow down my fear. I had to be able to do this. God, imagine if House found out I was about to have a panic attack over setting an IV. I'd never hear the end of it.

"You're—you're gonna feel a pinch," I warned Brad.

"Are you gonna need that trashcan?" Brad asked, touchingly concerned about me, given his current situation.

"Anya," Paula called from where she watched against the wall. Trying to work through the shock of her getting my name right, I looked at her over my shoulder. "The first one's always scary. But it won't get less scary unless you do it."

Was that supposed to be comforting? It wasn't. But it didn't matter. I had to do this. I turned back around. I clenched my hands in a failed attempt to get my shaking under control. I took Brad's arm and stretched the skin distally, just as I'd been taught. Okay. There was the vein. I had the needle at the ready.

"Little pinch," I said again, voice ratcheted up one too many octaves to sound anything resembling confident.

What's the worst that can happen? You miss. Then you try again.

Except when you miss a vein, you hit that warm, moist, airless place under the skin that just absolutely loves to be a petri dish for bacteria, which can collapse veins, cause abscesses—

"Hey, I forgive you in advance if you miss," Brad said, but I barely heard him. It was getting harder to breathe.

And that's just if you miss. If you pierce the vein through-and-through, it'll collapse for sure. Or if he has rolling veins and the needle bounces off—

"Anya—"

And collapsed veins can be permanent, and he's older so that's more likely, actually the possibility of his veins in general being less stable is significantly more likely—

I snapped back to reality when Paula plucked the needle out of my hand.

"N-no, I can do it, I—"

"Look at your hands," Paula interrupted me. "I wouldn't trust you to play Pin the Tail on the Donkey right now, let alone this."

I looked down at my hands. Acute tremor. Looked like I was vibrating, practically. Before I knew it, Brad's IV was set, and Paula was ushering me out of the room.

"Whatever that was," she said, not necessarily unkindly, but not kindly either, "you need to get that under control. Has that happened to you before?"

"Not...not when it comes to this," I said. When House had been detoxing last year and he'd smashed his hand with his pestle, that had definitely been a panic attack on my part. Crying, shaking, couldn't think, could barely talk. I realized with a jolt that there were unshed tears in my eyes. Okay. Yeah. Pretty similar situation.

"Then what's going on?"

"I just. Need a minute." I wasn't about to pour my heart out to some random nurse.

"It's time for your break anyway. Be back in thirty."

I mumbled something that sounded like 'okay' and practically bolted for the stairwell. As soon as the door clanged shut behind me, I leaned against the wall, putting a hand to my forehead and trying to breathe, trying to calm down. A tear escaped my eye, but I honestly didn't know if they were panic tears or embarrassment tears. Something as simple as an IV, and I fucking choked. It was pathetic. Once again, I couldn't imagine what House would say.

I always assumed I would just be naturally good at all of this.

What if I can't? What if I'm not made of the right stuff? What if it doesn't get easier? What if I'm always afraid?

Oh. Yep. I was full-force crying now.

Gave up being a doctor. Can't even cut it as a nurse.

"Anya?"

I looked up. Tali had the door open a crack, her head poking through. "Hi," I managed, voice watery. "I'm—I'm good."

"Uh...you don't look good."

"I just need a second, Tali." I didn't even know what my problem was. How could I begin to explain it to her?

"Okay. That's fine. Just...I'm here. If you need me."

I couldn't help but smile at Tali. "You're a good friend. But I'll be okay." One truth, one lie.

Tali let me be, as requested. I spent my break trying to get myself under control. A quick trip to the bathroom to wash my face and check how red my eyes were. The answer was very.

But it didn't matter.

I took one last deep breath, wishing the shaking would stop, and I went back to finish out my shift.

"So, Elevator C is down, but honestly, respiratory and the phlebs mainly just use that to get to the ER faster, so it's not the end of the world. I've got you on hold with the company that Facility Engineering says makes the part we need, but fair warning, it's based in Beijing, so language barrier is probably gonna be a thing—also, Two North called, and they want to know if you can ship one of the travel RNs from ICU over there for the night, they had two call-offs, and the patient census is pretty high, but ICU's only got ten patients, so they can probably spare one, but I wanted to check with you first."

Cuddy practically beamed at me. "You're learning fast."

At least I'm good at something. "I told you I'd try my best."

The past week certainly hadn't lacked in chaos for me to corral and subsequently delegate. If I'd learned anything in my extremely brief time as Cuddy's oh-so-esteemed executive assistant, it was that the hospital was one, maybe two Jenga blocks away from collapsing completely at all times. Five to nine indeed. Cuddy was letting me off easy, only having me work eight to five, with an hour lunch break thrown in. A lunch break I usually spent taking a cat nap, because between my newfound employment and clinicals, sleep was becoming something that was more and more difficult to obtain. I hadn't had more than four hours in days.

I'd probably feel better about the whole situation once I got my first paycheck.

Cuddy checked the time. Almost four. "You look like you're going to fall over. Do you have clinicals tonight?"

"Midnight to eight in the morning."

"Go home, get some sleep," Cuddy ordered.

I could've kissed her. "Are you sure?"

"Positive. I'll see you Monday."

I body felt ready to collapse in relief. "Thank you so much."

"Stop thanking me and go to bed," Cuddy said, but there was a hint of amusement in her eyes. Maybe she was trying to mother me in her own way. Or just trying to win me over, as House kept insisting in the rare moments I'd actually seen him this week. Either way, I was grateful. I made to leave, but just before I crossed the threshold from her office into mine, I stilled, hand on the doorframe.

"Dr. Cuddy?" I asked tentatively.

"Yes?"

I half-turned around. "When you first started actually working with physical patients...did you..."

"Freak out?" Cuddy guessed.

Hesitantly, I nodded.

Cuddy seemed to mull on the question for a moment. Maybe debating whether to give me a truthful answer or not. "The first time I was told to intubate somebody, I froze. It was maybe a week into my residency," she began. "The reality of it all came crashing down on me. That we're responsible for real, living, breathing—or in this case, not-breathing—humans. Unfortunately, it was a very bad time to have that realization."

It was difficult to imagine Cuddy freezing. With the amount of Cuddy time I'd been getting lately, it had become even more evident that she was enormously composed and enormously capable. She dealt with everything with a precise grace I was only just starting to understand.

"What happened? Did you, uh...did you snap out of it?" I asked carefully, wondering if I was pushing too far.

"One of the other residents ripped the tube out of my hands. He did it, and I just stood there. I'd never been so embarrassed in my life."

"And...how did you get past that?"

Cuddy pursed her lips. I was having a hard time gauging her expression. Concern? Compassion? Or maybe a wound that still hadn't healed all the way? "I remembered what it felt like to fail. If you can't do something just because it needs to be done, doing it to avoid feeling like crap about not doing it is an acceptable second best."

That was more realistic advice than I'd been expecting. I swallowed with some amount of difficulty. "House says I have a pathological fear of failure."

"That either means you'll be an incredible nurse, or an awful one," Cuddy told me honestly. "I'd put my bets on the latter." She narrowed her eyes at me, seeming to know exactly why I was asking. "You're feeling overwhelmed. It's all become real to you. But that will fade. You just have to be adaptable. It's the most important thing in the medical field. It's the reason I keep your father on the payroll in spite of the near decade long migraine he's given me. Accept that this job will change you. Lean into it. The only way out is through."

The only way out is through. Maybe it was that simple. I could only hope.

I nodded my head, chewing on my bottom lip. "Thanks, Dr. Cuddy."

"You're welcome. Now come on, I'll walk you out—I need to go check in with Brenda, anyway."

We walked out side by side, and I may have felt just the tiny bit better. Maybe Cuddy was the right person to talk to. House would have berated me and called me a coward or some variation thereof. Zach would have comforted me but probably not have had any idea what to say. Wilson and Cameron would've been too sympathetic, and I didn't want their pity. Foreman and Chase...probably wouldn't have understood at all, if I had to guess.

Was Cuddy winning me over? I didn't know if it was part of her 'evil plan' as House kept repeating, but it might've been working, either way.

Before we could even reach the clinic proper, we were intercepted by a severe looking woman who looked like the words 'lawsuit' may have been poised on her tongue.

"I am not having an affair with my daughter's karate instructor, and I did not give my husband herpes!"

Oh. I remembered this. Apparently Clueless had started. I covered my mouth with my hand, trying not to laugh.

Cuddy let out a long exhale through her nose, closing her eyes for a brief moment.

"Anya?"

"Yes?"

"Go find your father."

I didn't have to look far to find House.

"—pain in the lower extremities. Not a sign of a food allergy," Chase was saying as I pushed through the differential room doors.

"Means there's a neurological problem," Foreman deduced.

"More significantly, it's yet another sign of heavy metals. It's practically screaming Number of the Beast, at this point," House said, hovering near the white board and tapping one of the whiteboard markers against his chin.

"House," I said, trying to catch his attention. "Mother Superior requests your presence in her office."

"Tell her to...just come up with a decent insult and fill in the blanks yourself," House said, barely sparing me a glance. He hadn't exactly been cold with me this past week, but he had been different. There was some kind of distance there that I couldn't name, and I didn't like it, but I didn't know how to bridge it, either. "Cameron, the hair, the blood, what does it tell us?"

"All negative," Cameron reported. "It's got to be something else."

"Lupus could cause—" Foreman began.

But I cut him off. Because Fangirl Anya was dead, but her ghost still haunted me. "It's never lupus."

Foreman shot me a look that said he didn't appreciate the comment from the peanut gallery. "Do you have a better idea?"

"Nope," I said. "But it's not lupus. The progression is way too fast."

"My spawn is correct. Also, no joint pain from Husband of the Year."

"So it's an atypical presentation! We should still get an ANA—"

"It's not lupus! The symptoms don't match," House overruled him immediately.

"Yeah, and the tests don't match heavy metal toxicity," Cameron pointed out. She seemed ready to say more, but her pager, along with Chase's and Foreman's, all went off simultaneously.

Chase got to his first. "Rapid response. Our patient's having trouble breathing."

House nodded towards the door, looking grave. "Go."

They did.

I crossed my arms, grazing my eyes over the whiteboard. "You're right, you know."

House glanced at me. "About the heavy metals? I'm aware. Right answer..." He reached into his pocket and drew out his vicodin. "But we have to show our work to get an A."

"Do you want me to tell you?"

House emptied out a palmful of vicodin. "Does he die?"

"No."

House knocked the vicodin back, swallowing them dry. I could never understand how he managed that without choking. After a moment's consideration, he said, "Then no. Not yet."

Something gnawed at me about the ethical responsibility of letting a man suffer for the sake of House getting his fix. But that something had been gnawing at me the whole time I'd been in this universe, and I didn't expect it to ever go away. I could rationalize it as House needing his puzzles to stay sane, and a sane House meant saved lives. But that didn't mean the guilt wouldn't still rear its head each time I chose not to give House a diagnosis that I very clearly remembered.

I mean, she poisoned her husband with gold. Kinda hard to forget. Poetic, as House said. Or would say. Whatever.

"Cuddy's waiting on you," I reminded him, needing to fill the quiet.

"She can keep waiting." House went to Cameron's desk, to the fresh pile of mail that sat there. The envelope on the top was already torn open. House picked it up. "Cameron ran me through the budget report. I half-listened. But I did pick up the part that good might not be good enough for Vogler."

Anxiety ate at me. I'd been trying very hard not to think of this for the past week. "We have to hope it is."

"Well. It's a good thing Cameron didn't turn in the report to financial yet." House picked up the torn open mail. He limped back to me, handing me the envelope.

Confused, I slipped the contents out. A letter. Official looking. From Business Affairs.

I started to read it aloud;

"This letter is to notify Dr. Gregory House MD, Head of Diagnostics at Princeton Plainsboro Teaching Hospital, that a sum of money has been anonymously donated to Princeton Plainsboro Teaching Hospital, earmarked for specific use by the Diagnostics department. This sum comes to a total of—"

I dropped the letter, eyes going wide. House deftly caught it with his cane before it hit the ground.

"Oh my God." I couldn't believe it. "800,000 dollars. Who the hell gave you 800,000 dollars?"

"You mean this wasn't you?" House asked, and I suddenly realized exactly why he'd given me the letter.

"Me—!? House, I'm good, but I'm not 'conjure nearly a million dollars' out of thin air good." I grabbed the letter again, reading it over. "Are we really this lucky?"

"Doubt it. Who'd you tell about the budget report?"

"The team. Wilson, I think. No one else. And none of them have that kind of money, either."

"Chase is rich."

"Chase's dad is rich, and Chase didn't get jackshit in the will."

"How do you know?"

"Show! Eight years!" I said, still mostly focused on the letter. Eight-hundred-fucking-thousand. Holy shit. That only put us at a 400,000 dollar deficit for the financial year. Which, honestly, was probably far better than a lot of the other clinical departments.

"But how do you know this time? Did he tell you?" House pressed. Of course he'd care less about 'the department is saved!' thing and more about who the mystery money came from. Not that I wasn't curious, but I was just so relieved to know we were living to fight another day that I couldn't bring myself to be too concerned about it.

"No, but even if he did make it into the will this time around—Chase wouldn't do this. I know Chase, and Chase wouldn't do this," I repeated for emphasis. "Chase is a good guy, but he's not Mother Theresa."

House seemed torn between wanting to argue with me and not wanting to suggest Chase was an altruist. "Somebody did something."

"The money doesn't have any strings attached, House! Gift-horse, mouth, you know the old saying?"

"Nothing comes with no strings attached."

"It's anonymous!"

House grabbed the letter from me and tossed it in the waste bin. "For now."

I rolled my eyes, but even House's pessimism couldn't put a damper on how psyched I was. "Look, whatever happens happens, but for now, I'm just happy that we don't have to worry whether these offices will still be here in six weeks." I stretched languidly. "Now, if you don't mind, I'm gonna go nap in your chair until I have to get up for clinicals."

"You're not even going home?"

"If I lay in my bed there's no way I'm going to be able to convince myself to get out of it tonight." I bypassed House to head to his office. "I'll catch you later."

House didn't respond, and I felt that distance again.

I touched the handle for his office door, but something stopped me. "House?" I called over my shoulder.

"Sleeping, my chair, yeah, heard you the first time."

"No. I...how's your leg doing? Please just tell me the truth, or I'm just going to catastrophize it in my head." He'd been taking more vicodin, and that was just in front of me. I knew he usually toned it down around me, not for my benefit, of course, but just so he wouldn't have to deal with my standard fussing and bitching. So if this was him toned down...

His pain got bad during the last stretch of season two. Really bad. He started injecting morphine. I didn't know exactly when that started, towards the end of the season, definitely.

"Shouldn't you know?" he asked, not looking at me.

"I'm not in your head."

Quiet.

"Bad," he eventually said. "More bad than usual."

I was caught off-guard that he hadn't deflected. "Is there anything I can do?"

"No. Which is why it's pointless to ask." There was a tense draw to his shoulders, and I wanted nothing more in that moment than to take his pain away.

I stared at his back for a few long seconds. "House—"

"Go to sleep, Anya."

There was nothing for me to do. Nothing for me to say. Not for the first time that week, I felt useless.

But I did as I was told, leaving House alone with his puzzle, and his pain.