FF: Broken Places
I've been working on this for a while, and kept getting lost in the research. I think I spent more time linking around through medical websites and reading than I did actually writing this. Hopefully the medicine will ring true to those who know much more than I.
Title: Broken Places
Author: Ellie
Rating: PG13
Gen, ~4900 words
Spoilers: Set sometime prior to “No Reason,” but contains references to it and early S3, though no actual spoilers
Summary: Wilson refers a former patient to Diagnostics, but her illness doesn’t interest House as much as her treatment history.
****
“The world breaks everyone and afterward many are strong in the broken places. But those that will not break it kills.” --Ernest Hemingway, “A Farewell to Arms”
****
Marion ignored the disquiet in her stomach and patted Ace’s neck while staring at the rider currently on course, flying, but catching a rail at the last fence. As she took a deep breath and gathered the reins, she felt her neck twinge and wondered if she shouldn’t have taken a Midol or some of her Gatorade before coming back to the ring for the jump-off.
As they cantered into the ring, the announcer’s voice proclaimed, “Last on course in the Princeton Jumping Derby’s Junior-Amateur Classic, number 416, Marion Clise riding Aces High. The time to beat is 41.56 seconds!” It sounded suddenly far away, and not in the way she normally tuned out the announcer and crowd, and focused on the animal under her and the obstacles they were negotiating.
Over the first combination, she felt insecure in the saddle, as if one exaggerated jumping effort would toss her loose. She hadn’t felt that way in years, not even after coming back from her surgery. Approaching the next fence, a deep breath did nothing to reassure or revitalize her, and she landed in a heap on Ace’s neck, barely recovering in time to make the sharp turn to the bank.
She put all her faith in her old partner and did her best to aim him at the remaining fences, feeling worse over each of them, her vision seeming to dim around the edges before the final oxer. After the final effort, she collapsed in a heap on his neck, pointing him between the timers and letting him go.
The sweat of the horse’s neck felt clammy against her cheek, and she heard the gasp of the crowd and felt his shoulder moving out from underneath her as she slid towards the ground, and darkness.
***
House scowled as he made his way into the hospital. The May morning was fresh and sunny, far too pleasant for his tastes. Such lovely weather was not only causing an early rush of clinic patients with foolish outdoors injuries, but was causing a rush of flora to aggravate his allergies. He sneezed as he waited on the elevator.
Walking into the Diagnostics conference room, he headed straight for the Kleenex and tea, ignoring the fellows pouring over several files. Basic needs met, he turned to his team. “So what do we have today?”
“A case from Dr. Wilson. Thirty-two year old female, Marion Clise, who lost consciousness and fell off her horse. She came into the ER yesterday, with fever, nausea, muscle weakness, back pain, and nuchal rigidity.” Foreman was always succinct, which House appreciated.
“Why is she coming through Wilson? It sounds like a concussion or meningitis or both, which was a waste of Wilson’s time and will certainly be a waste of ours.”
As he stepped over to the table, glaring down at the younger doctors, Wilson entered the room. House looked up sharply and cocked an eyebrow at him. “Why are we wasting our time with this, Wilson? Is she at least hot?”
“That’s beside the point.”
“That’s a no.”
“Marion’s not your type.”
“And obviously not yours either, as she’s apparently not cancerous.”
“She was, ten years ago. Osteosarcoma of the tibia, amputated at the knee. We were worried it had returned, given her aplastic anemia, but the tests are negative for cancer markers. And there’s no concussion. She was unconscious before she fell off the horse.”
“That doesn’t rule out damage caused by the fall, but it wouldn’t explain any of the symptoms Foreman mentioned, other than nausea and nuchal rigidity.” He turned to the whiteboard and began scribbling symptoms. “So, differential. Go!”
They were quiet for a moment, then Cameron spoke up. “If she’s been treated for food poisoning recently, that would account for most of the symptoms. And Chloramphenicol is used to treat it sometimes, and that can cause aplastic anemia.”
“So do dozens of other medications,” countered Chase. “Beyond that, Chloramphenicol is used to treat several conditions. Has she been traveling and treated for typhoid? Could she have had meningitis recently? That would explain even more of the symptoms.”
“Foreman, what says the file?” House tapped the edge of the whiteboard with a marker.
“No hospital admissions in the last year.” Foreman flipped through a few pages then looked questioningly at Wilson. “She’s been vaccinated for both typhoid and meningitis. It looks like she’s had a lot of vaccinations the average person doesn’t get. Does she travel extensively?”
Wilson shrugged. “She does something with international finance. I don’t know how much disease exposure you get in Zurich.”
“Those dirty, dirty Swiss,” House drawled, staring at the vague list of symptoms. “All right. Cameron, go get me a better history on Mary.”
“Marion,” she corrected automatically.
“Whatever. Find out where she’s been lately, what sort of fun she’s been snorting to keep up with the jet setters. Full tox screen. Foreman, I want you to rule out a concussion or meningitis. CT and MRI. And recheck cancer just to be safe.” He turned to Chase. “You go check her home, her office, and her polo club. Find out if anyone else is sick, or if they’ve imported something lately without checking all its shots.”
Chase looked as if he might protest the assignment, so House cocked an eyebrow at him and waved the marker warningly. Without protest, the fellows rose from the table, making a beeline for the door before he could revise their duties. “And get her in a sterile room until we figure this out and can treat the aplastic anemia,” he called, just before the door closed behind them.
***
Cameron approached the room warily, as she could hear an agitated voice inside. As she reached the glass door, she could see a petite, flushed woman with dirty blonde hair speaking into a cell phone. Sizing her up quickly, she understood what Wilson had meant when he’d said she wasn’t House’s type. Smiling, she opened the door and caught the patient’s harsh tones.
“No, they’re desperate to get into the EU! They’ll be begging for investment capital. You need to make arrangements for….” She looked up at Cameron, and her tone changed instantly. “I’ve got to go. Another doctor is finally here.”
Cameron pasted on her warmest smile and made her way to the bedside. “Hi Marion. I’m Dr. Cameron. I’m with Diagnostics, and I’ll be working on your case.”
Marion’s gaze narrowed, eyes sweeping over Cameron. “I was told Dr. House would be treating me. He’s supposed to be the best. Why have I been pawned off on you?”
“Dr. House is the head of Diagnostics, and he is in charge of your treatment. He’s just asked me to come get a better history for him.” She smiled her brightest, most helpfully subservient smile, and settled into the chair next to the bed.
“A better history? You’ve got a novella there already. What else do you want to know?” The tone was combative, but weary.
“Well, Dr. House was curious about your recent travel history. We see you’ve been immunized with standard travel vaccinations, but there’s no record of where exactly you’ve been. There’s a possibility you’ve picked something up somewhere you’ve been, so if you can start there for me, it would be great.” Cameron picked up her pen, poised to begin.
“I work in business investment for developing nations. There’s hardly a place I’ve visited this year I couldn’t have caught something!” Marion raised her hands and began ticking countries off on her fingers. “Lithuania, Pakistan, Columbia, Tanzania, Bangladesh, and Turkey for business projects. Standard stops in Belgium, Germany, Switzerland, Italy and Britain.”
Cameron scribbled hastily, putting an asterisk next to a few that stood out as likely disease sources. “What about travel in the US?”
“I get enough of that with work. Just up and down the east coast for horse shows a couple times a month, Florida a bit in the winter.”
Skimming through the case history, she made a few notations. Gathering her thoughts, she continued her questioning, trying to clarify details and draw out information House would find most interesting. The problem was that with House, it was hard to tell what he’d find useful. Halfway through the sheaf of papers, she paused, staring down at the fax-smudged type.
“What can you tell me about your hospitalization in Germany?”
***
Foreman glanced up from the MRI monitor, flicking on the microphone to the room where the patient lay. “We’re almost done, Marion. Just few more minutes.” He increased the resolution and zoom to get a few more images. It seemed clear to him from the scans that she was suffering from mild swelling of the brain consistent with meningitis or encephalitis.
He started cleaning up the computer terminal as he reached for the phone, calling orderlies to return Marion to her room. Foreman sighed, wishing he could just do the necessary lumbar puncture to confirm diagnosis without needing to go through House, who would undoubtedly make things more complicated than necessary.
Leaving the room, he waved at one of the orthopedic interns then proceeded to page House, letting him know the test results were on their way. His boss would be bored by the easy solution, and Foreman was looking forward to an easy week.
***
House was eating peanuts from the bag of trail mix on Wilson’s desk as the oncologist rummaged in the file cabinet. “So you treated this woman ten years ago? Interesting coincidence, her showing up here.”
Wilson turned away from the filing cabinet just in time to watch House snag a bit of his snack before sighing and settling into his chair. “She was at Wharton and got sick, the last year I was at Penn.”
With a smirk, House tapped his cane against the desk. “That would also happen to be the year things went bad with Sarah.”
“Which is why it was my last year working at Penn.”
“She left you because you slept with one of your patients. Some pretty MBA, if I recall correctly.”
Though he huffed loudly, Wilson said nothing. House stood and headed for the door. Reaching it, he turned back to ask, “Is she really not my type, or are you just saying that because you hit that and it would be awkward if I was better?”
Tapping his pen on the blotter, Wilson seemed to consider it for a moment. “She’s a blonde, one-legged Stacy.”
“Well that would just be weird.” House slammed the office door behind him, rattling several of the knickknacks on Wilson’s desk.
***
Chase hated driving into Manhattan, and was doubly annoyed that her overly modern offices had yielded nothing beyond a coworker with allergies and a mile-long travel itinerary, while her maid-maintained apartment left him with nothing but a four-year-old bottle of Percocet and a well-stocked liquor cabinet. At least he’d beaten the worst of the traffic back into Jersey, and actually enjoyed the drive out to his final stop, at the stables. A shady driveway passed in front of several large red buildings, a large riding ring to his left, where a horse and rider were currently circling around a few jumps. He watched the pair for a moment before heading into the first building. As he walked down the dirt aisle, curious heads appeared over stall doors, a few nickering softly.
“Can I help you with something?” A voice called out from somewhere behind him. Chase turned to see a man in jeans and a polo shirt, with a dark, weathered face emerging from one of the stalls.
“I’m Dr. Robert Chase from Princeton-Plainsboro Hospital. One of your riders, Marion Clise, was brought in Sunday after falling at a horse show. We’re concerned it may be something more serious than was initially thought.”
The man brushed his hands off on his jeans, then offered one to Chase. “I’m Bill Reynolds, the barn manager here. Marion’s been with us a long time now, so just let me know what you need, and I’ll be happy to help you out.”
Chase shook the outstretched hand and nodded. “How healthy is Miss Clise’s horse? Have any other horses been sick lately? Or imports with questionable vaccination histories?”
“Marion’s got two, Ace and Scarlett. The mare’s got an abscess right now, but that’s nothing catching. Nothing out of the ordinary, health-wise, with the rest of the barn, either. We run a tight ship here, best care in New Jersey.” He paused and considered for a moment. “Nobody’s imported anything since last fall, and it’s been on our vet’s health rotation since then, no problems.”
“What about chemicals or other hazardous substances?”
“Let’s see.” Reynolds let him down the aisle before stopping at a doorway that opened into a large room, full of cabinets and bins, heady with the scent of grain. “Scarlett’s on Regumate, which can do a number on the ladies, but Marion doesn’t handle that. Ace gets hyaluronic acid, but that shouldn’t do anything but help your achin’ joints. Then, we’ve got a whole cabinet of stuff here that’s prescription.”
Chase goggled as the cabinet opened to reveal a selection almost as well stocked as a small clinic. It contained everything from antibiotics to tranquilizers. “Can I take a look at these?”
“Sure. Feel free to look around then. If you need anything else, I’ll be just down the aisle. Just relock that when you’re done.” Reynolds shuffled away, boots raising a small cloud of dust in his wake.
Chase pulled out a notepad and began scanning the bottles for unusual suspects.
***
A soft tap on the glass of his office door interrupted him, and without looking away from his television, House knew it was Cameron. Only she would knock. “Some guy in Ft. Lauderdale jacked a mail truck. They’ve been chasing him for an hour and haven’t made it over thirty miles per hour. People really will steal anything.”
“I think you should see this,” said Cameron, tossing the patient file onto his desk.
House looked down at the page, furrowing his brow for a moment before realizing it wasn’t in English. “Do I have to find a Nazi to translate, or will you be playing the role of Brunhilde today?”
He always wished a dramatic eyeroll would accompany Cameron’s dramatic sighs, but it rarely happened. This time he only got a light chuff and a continuation, as if he hadn’t spoken. “She was treated at a hospital in Saarbrücken, Germany with an experimental procedure for the chronic pain resulting from her amputation. It’s apparently worked.”
“When did you learn German? It wasn’t on your résumé.”
“I didn’t. I talked to the patient, and she explained the basics of the treatment. Maybe you should try talking with her about it.”
The concern was clear in her voice, and it grated on his nerves. “And you think that this treatment could have caused the symptoms she’s exhibiting now?” He stared up at her, watching the frustration flash across her features.
“No! I thought that you’d be interested in it.”
“So you thought that I would be interested in information that’s unlikely to be relevant to the case?”
“With your leg, I thought that you-“
“You are not treating my leg, Dr. Cameron,” he said slowly, dangerously. “You are treating Ms. Clise. I suggest you go help your colleagues diagnose the patient.” He gestured through the wall at the conference room, where Foreman was just greeting a returning Chase.
He got his dramatic eyeroll as she exited stage left to join her coworkers, and he took a moment to savor it with a smirk. But his eyes couldn’t help but trail down to the foreign hospital record for just a moment. Shaking his head, he slammed the folder closed and went to the conference room.
“Find anything interesting, boys?” He tossed the folder on the table and glowered down at them.
Chase heaved a sigh worthy of Cameron, before saying, “The only thing at her home was some liquor and a four-year-old bottle of Percocet. Work gave me her travel itinerary for the last two years. But the stables,” he paused and pulled out his notes, flipping to a half-full page, “had a whole cabinet full of potential medical problems.”
“Fun!” House snagged the notebook and scanned down the list. “Did you get samples of any of this for us to enjoy? Or bother considering whether any of it would actually cause her symptoms?”
With a tired shrug, Chase answered, “I figured you’d want everything, relevant or not.”
House nodded, secretly pleased Chase seemed to be catching on, and scanned the list quickly while asking, “Foreman?”
“It’s either meningitis or a strain of encephalitis. I want to go over her travel history to see what looks most likely, then do an LP to confirm.”
Glancing up at the clock, House nodded in assent. “Do it, and we should know by tomorrow morning what’s causing most of her symptoms. Still won’t explain the aplastic anemia,” he said, walking back to his office still reading through the list of veterinary medications Chase had provided him. Two substances stood out for very different reasons.
He logged onto his computer and pulled up Google and a German-English dictionary site. Methodically, he began picking out a few terms and searching.
***
The sun had long set before House made his way to Marion Clise’s room. As he entered, she looked up stiffly from an obnoxiously pink copy of the Financial Times and gaped.
“If that’s supposed to be a joke, it’s not very amusing,” she said.
“I take my job very seriously, Ms. Clise.” House twirled his cane theatrically before resting it against the footboard. “Does my handicap bother you? A little too close to home?”
“What is your job, exactly?” She delicately folded the newspaper in her lap, as if planning a discussion with a frustrating child.
“Oh, a little of this, a little of that,” he said, pulling out her chart and skimming over it. “Running the Diagnostics department takes up most of my time, though.”
“You’re Dr. House?”
“Now that we’re all caught up, why don’t you tell me about your leg.”
“I’ve already given Dr. Cameron a history-“
“Why don’t you tell me what’s really going on? You were one of a handful of people treated for chronic pain in Germany with Ketamine four years ago. It’s allegedly worked, but you’ve been taking something else lately.”
“The pain had been pretty bad since the amputation, and I was sick of being tied to prescription painkillers. When I started trying to push myself more-transition back from sidesaddle to jumpers with Ace, traveling more for work-it became unbearable. My trainer had bought some horses from a guy in Austria who’d broken his back and was the second person treated. We were over shopping for horses, and heard about it. I contacted the hospital and expressed my interest. I can be very persuasive.”
“Which leaves the question of what you’re taking now for the pain that’s supposedly vanished. You’ve obviously moved on from the Percocet.”
“I’m not taking anything regularly. It’s just at horse shows. I’d always planned on doing grand prix with Ace, but the jumping…landing puts so much pressure down onto my prosthesis it becomes unbearable. When I’m not showing, I don’t jump. At shows, I just crush half a bute and mix it with some Gatorade. It usually gets me through,” she said frankly, with a small shrug.
The corner of his mouth twitched and his eyes narrowed. “You do realize phenylbutazone is an equine medication, and is no longer prescribed to people for a reason?”
Marion started to shake her head, then stopped with a gasp of pain and shrugged. “Horses can get ulcers, but I don’t have stomach problems. They get a lot of medications we don’t. Plenty of old-timers take it.”
“And plenty of them suffered from aplastic anemia, too. Given your medical history, you should know better. Find a real, human painkiller to treat you, or find a hobby less likely to aggravate your disability.”
House stalked out of the room as she sputtered behind him.
***
Cuddy jumped a foot, nearly dropping her briefcase, when House cheerily greeted her the next morning. She recovered quickly, though, and settled herself behind the desk with a glare before responding to him. “Awfully early for you, House. Or is it still late? That would be more plausible, if it didn’t mean you were working. I know you weren’t doing that.”
“No, but those two prostitutes sure kept me up. You might want to have housekeeping steam clean that couch. Very comfy, by the way.”
“I’ve got a busy day ahead. What do you want at this hour? I haven’t even had my coffee yet.”
He lumbered over to the side of her desk and settled himself against it, looming over her. “The patient I’m treating now, the amputee?” Cuddy nodded and he continued, “She had chronic pain as a result of the amputation. Four years ago, she underwent a procedure in Germany involving high-dose Ketamine as a treatment. It’s been a success on a day-to-day basis.”
She nodded, then was quiet for a moment. “’On a day-to-day basis’ implies that there’s still some pain.”
“Only when she’s pushing herself to pointlessly stupid limits that would cause pain in a normal person.”
“And you’re telling me about this because…?” She looked up at him expectantly.
“I did a little research last night. I’d like to try it.”
“On who? You said she already had it done.”
It was his turn to be quiet. “I’d like you to do it for me.”
“House! I don’t know anything about the procedure, and I’m not about to risk my license by just treating you willy-nilly with whatever cure du jour you happen to stumble across.”
He leaned against her desk, knuckles white where they gripped his cane. “I’ll bring you the literature, let you read over it.”
Sighing, she raked her eyes over his frame, gaze falling to rest on the tense hand on the cane. “Find a copy, in English, and I’ll look over it. My Deutsch is a bit rusty. And I’m not making any promises.”
With a curt nod, House ambled out of the office.
***
Foreman stopped at the lab on his way to the office, picking up the patient’s test results. He read as he walked to Diagnostics, nodding as he skimmed the results. When he arrived at the conference room, he was surprised to see House already present.
“What ho, apothecary?” House greeted him, reaching for the sheaf of test results.
Shrugging off his jacket and handing House the labwork, he frowned. “It’s some sort of encephalitis, but the tests for Eastern Equine and Western Equine were inconclusive.”
“Hmm.” House flipped through the pages, then reached for Marion’s file and opened it. “Did you test for Venezuelan?”
“Given that she hasn’t been to Venezuela, no.” Foreman shook his head, then turned to see Cameron enter, without holding the door for Chase, who was close on her heels.
The new arrivals looked between the two of them, then Cameron spoke up. “Did you find something?”
“Since Foreman skipped the obvious test, given the patient’s history, no. She was in Columbia two weeks ago, and apparently picked up more than excellent coffee. Go test again, for Venezuelan Equine Encephalitis. In the meantime, up her antibiotics, since she’s been responding to them. We’ve got to clear this infection up before we can start treatment for the aplastic anemia.”
Foreman looked ready to object, then merely rolled his eyes and exited with Chase, who shrugged in commiseration. Cameron lingered, moving closer to him. “Did you talk to her?”
“I didn’t use my psychic powers to figure out what was causing her anemia.”
“I meant about the pain treatment,” she said, the frustration clear in her voice.
“We had this discussion yesterday. You’re Marion Clise’s doctor, not Gregory House’s. Go help Foreman and Chase.”
Cameron frowned, but followed his orders. House watched her go, then moved to his office. Pulling up the link to the article he’d saved the night before, he scanned the list of authors once again. One name caught his eye, and he reached for his phone.
***
Chase slapped the folder of test results down on the desk. “Venezuelan Equine Encephalitis. Her fever and neck pain area have been decreasing steadily with antibiotics.”
House looked up from his magazine with a startled expression. “You sound so disappointed that I was right. Shouldn’t you be used to that by now?”
With a shake of his head, Chase answered, “If it was anyone but Wilson, you’d have refused the consult. This was a boring, easy case.”
Frowning, House raised the magazine to block his view of the younger doctor. “Go treat someone and leave the dime-store psychoanalysis to Cameron.”
He watched Chase leave, then looked back down to the pile of papers concealed by Us Weekly. The translation wasn’t graceful, but it was straightforward and comprehensible. It would be easy enough to do, if he used some of his vacation time and could convince Cuddy. Putting the papers in a folder, he noticed that he was only ten minutes late for Clinic, so he took his time making his way to the first floor, lingering at the desk of Cuddy’s newest assistant to make faces at her while she met with Aylesman.
***
“No, Mare, you should’ve known better with your history, but it’s completely treatable,” said Wilson. He sat gently on the edge of the bed, patting her hand and noting the understated but sparkling engagement ring, and wondered for a moment where her fiancé was.
“Matt is in Zurich until Thursday.”
Wilson looked up, startled, to see her smiling.
“You were staring at the ring, and you used to be easier than an open book to read. It’s good to know some things don’t change.”
“You have.” He looked her over, happy to see she’d improved since he’d first seen her Sunday evening. She was still as pretty as he remembered.
“No, I’m back to being who I was before I was sick,” she said matter-of-factly. With a small shake of her head, she continued, “So you think outpatient treatment and follow-up with Dr. Roth will be enough? She’s not going to be happy with me.”
“She’s not going to be happy she didn’t notice sooner. Though if you hadn’t gotten sick now, things could have progressed to a dangerous point before you were treated. We caught it early, and you know how important that is,” he concluded, his hand resting on her good knee.
Nodding, Marion replied, “Yeah, I do. I’ve got you to thank for it, too. And Dr. House, this time.”
“Make sure you tell him that. He doesn’t hear it enough.” Wilson rose from the edge of the bed, heading for the door.
“Oh? He seems like the kind of man who’s heard it a few too many times.”
Wilson couldn’t respond, just shook his head slowly as he left the room.
***
“So?” House made himself comfortable in one of the chairs in front of her desk.
Cuddy looked up from the pile of files on her desk and stared at him for a moment before sighing, dropping her pen to the blotter. “I read over the file. But the sample was too small to prove much, and even there the success rate was only fifty percent. Putting you into a coma for fifty-fifty odds is incredibly risky.”
“This is you telling me ‘no’ then.”
Her hands spread in a placating gesture, but the regret was plain in her voice. “If we’d had this study when you were first hospitalized, or if you were going to be under for some other reason, I might consider it. But we don’t put people under just to see what happens.”
“All this ‘we’. I’d think you were the queen of something important rather than my doctor.”
“I don’t like seeing you in pain, House. But I can’t jeopardize my medical license and this hospital by testing experimental procedures on a whim.”
“I’d not a whim, it’s-“
“I know. But that’s what it amounts to. There’s too much liability.”
“Who’s going to sue you?”
“That’s not the point.” She shook her head, looking all too reasonable.
“No, the point is my leg is getting worse, and you’re refusing to help me.”
“No, I’m refusing to put an otherwise healthy man into a coma which may or may not help him.”
“Same thing,” he said, rising and heading for the door. Reaching it, he paused and turned back to her. “But if I were already in a coma, you’d consider it?”
She looked taken aback for just a second before the anger kicked in. “So help me, House, if you go wreck your motorcycle just because you think I’ll do this for you, it won’t happen. Am I clear?”
“Crystal,” he said, allowing himself a tiny sight, his frame collapsing just enough for her to notice. He didn’t want her to see how much her refusal hurt, but her guilt could be a powerful tool. Turning, he walked out without another word.
****
End
****
Title: Broken Places
Author: Ellie
Rating: PG13
Gen, ~4900 words
Spoilers: Set sometime prior to “No Reason,” but contains references to it and early S3, though no actual spoilers
Summary: Wilson refers a former patient to Diagnostics, but her illness doesn’t interest House as much as her treatment history.
****
“The world breaks everyone and afterward many are strong in the broken places. But those that will not break it kills.” --Ernest Hemingway, “A Farewell to Arms”
****
Marion ignored the disquiet in her stomach and patted Ace’s neck while staring at the rider currently on course, flying, but catching a rail at the last fence. As she took a deep breath and gathered the reins, she felt her neck twinge and wondered if she shouldn’t have taken a Midol or some of her Gatorade before coming back to the ring for the jump-off.
As they cantered into the ring, the announcer’s voice proclaimed, “Last on course in the Princeton Jumping Derby’s Junior-Amateur Classic, number 416, Marion Clise riding Aces High. The time to beat is 41.56 seconds!” It sounded suddenly far away, and not in the way she normally tuned out the announcer and crowd, and focused on the animal under her and the obstacles they were negotiating.
Over the first combination, she felt insecure in the saddle, as if one exaggerated jumping effort would toss her loose. She hadn’t felt that way in years, not even after coming back from her surgery. Approaching the next fence, a deep breath did nothing to reassure or revitalize her, and she landed in a heap on Ace’s neck, barely recovering in time to make the sharp turn to the bank.
She put all her faith in her old partner and did her best to aim him at the remaining fences, feeling worse over each of them, her vision seeming to dim around the edges before the final oxer. After the final effort, she collapsed in a heap on his neck, pointing him between the timers and letting him go.
The sweat of the horse’s neck felt clammy against her cheek, and she heard the gasp of the crowd and felt his shoulder moving out from underneath her as she slid towards the ground, and darkness.
***
House scowled as he made his way into the hospital. The May morning was fresh and sunny, far too pleasant for his tastes. Such lovely weather was not only causing an early rush of clinic patients with foolish outdoors injuries, but was causing a rush of flora to aggravate his allergies. He sneezed as he waited on the elevator.
Walking into the Diagnostics conference room, he headed straight for the Kleenex and tea, ignoring the fellows pouring over several files. Basic needs met, he turned to his team. “So what do we have today?”
“A case from Dr. Wilson. Thirty-two year old female, Marion Clise, who lost consciousness and fell off her horse. She came into the ER yesterday, with fever, nausea, muscle weakness, back pain, and nuchal rigidity.” Foreman was always succinct, which House appreciated.
“Why is she coming through Wilson? It sounds like a concussion or meningitis or both, which was a waste of Wilson’s time and will certainly be a waste of ours.”
As he stepped over to the table, glaring down at the younger doctors, Wilson entered the room. House looked up sharply and cocked an eyebrow at him. “Why are we wasting our time with this, Wilson? Is she at least hot?”
“That’s beside the point.”
“That’s a no.”
“Marion’s not your type.”
“And obviously not yours either, as she’s apparently not cancerous.”
“She was, ten years ago. Osteosarcoma of the tibia, amputated at the knee. We were worried it had returned, given her aplastic anemia, but the tests are negative for cancer markers. And there’s no concussion. She was unconscious before she fell off the horse.”
“That doesn’t rule out damage caused by the fall, but it wouldn’t explain any of the symptoms Foreman mentioned, other than nausea and nuchal rigidity.” He turned to the whiteboard and began scribbling symptoms. “So, differential. Go!”
They were quiet for a moment, then Cameron spoke up. “If she’s been treated for food poisoning recently, that would account for most of the symptoms. And Chloramphenicol is used to treat it sometimes, and that can cause aplastic anemia.”
“So do dozens of other medications,” countered Chase. “Beyond that, Chloramphenicol is used to treat several conditions. Has she been traveling and treated for typhoid? Could she have had meningitis recently? That would explain even more of the symptoms.”
“Foreman, what says the file?” House tapped the edge of the whiteboard with a marker.
“No hospital admissions in the last year.” Foreman flipped through a few pages then looked questioningly at Wilson. “She’s been vaccinated for both typhoid and meningitis. It looks like she’s had a lot of vaccinations the average person doesn’t get. Does she travel extensively?”
Wilson shrugged. “She does something with international finance. I don’t know how much disease exposure you get in Zurich.”
“Those dirty, dirty Swiss,” House drawled, staring at the vague list of symptoms. “All right. Cameron, go get me a better history on Mary.”
“Marion,” she corrected automatically.
“Whatever. Find out where she’s been lately, what sort of fun she’s been snorting to keep up with the jet setters. Full tox screen. Foreman, I want you to rule out a concussion or meningitis. CT and MRI. And recheck cancer just to be safe.” He turned to Chase. “You go check her home, her office, and her polo club. Find out if anyone else is sick, or if they’ve imported something lately without checking all its shots.”
Chase looked as if he might protest the assignment, so House cocked an eyebrow at him and waved the marker warningly. Without protest, the fellows rose from the table, making a beeline for the door before he could revise their duties. “And get her in a sterile room until we figure this out and can treat the aplastic anemia,” he called, just before the door closed behind them.
***
Cameron approached the room warily, as she could hear an agitated voice inside. As she reached the glass door, she could see a petite, flushed woman with dirty blonde hair speaking into a cell phone. Sizing her up quickly, she understood what Wilson had meant when he’d said she wasn’t House’s type. Smiling, she opened the door and caught the patient’s harsh tones.
“No, they’re desperate to get into the EU! They’ll be begging for investment capital. You need to make arrangements for….” She looked up at Cameron, and her tone changed instantly. “I’ve got to go. Another doctor is finally here.”
Cameron pasted on her warmest smile and made her way to the bedside. “Hi Marion. I’m Dr. Cameron. I’m with Diagnostics, and I’ll be working on your case.”
Marion’s gaze narrowed, eyes sweeping over Cameron. “I was told Dr. House would be treating me. He’s supposed to be the best. Why have I been pawned off on you?”
“Dr. House is the head of Diagnostics, and he is in charge of your treatment. He’s just asked me to come get a better history for him.” She smiled her brightest, most helpfully subservient smile, and settled into the chair next to the bed.
“A better history? You’ve got a novella there already. What else do you want to know?” The tone was combative, but weary.
“Well, Dr. House was curious about your recent travel history. We see you’ve been immunized with standard travel vaccinations, but there’s no record of where exactly you’ve been. There’s a possibility you’ve picked something up somewhere you’ve been, so if you can start there for me, it would be great.” Cameron picked up her pen, poised to begin.
“I work in business investment for developing nations. There’s hardly a place I’ve visited this year I couldn’t have caught something!” Marion raised her hands and began ticking countries off on her fingers. “Lithuania, Pakistan, Columbia, Tanzania, Bangladesh, and Turkey for business projects. Standard stops in Belgium, Germany, Switzerland, Italy and Britain.”
Cameron scribbled hastily, putting an asterisk next to a few that stood out as likely disease sources. “What about travel in the US?”
“I get enough of that with work. Just up and down the east coast for horse shows a couple times a month, Florida a bit in the winter.”
Skimming through the case history, she made a few notations. Gathering her thoughts, she continued her questioning, trying to clarify details and draw out information House would find most interesting. The problem was that with House, it was hard to tell what he’d find useful. Halfway through the sheaf of papers, she paused, staring down at the fax-smudged type.
“What can you tell me about your hospitalization in Germany?”
***
Foreman glanced up from the MRI monitor, flicking on the microphone to the room where the patient lay. “We’re almost done, Marion. Just few more minutes.” He increased the resolution and zoom to get a few more images. It seemed clear to him from the scans that she was suffering from mild swelling of the brain consistent with meningitis or encephalitis.
He started cleaning up the computer terminal as he reached for the phone, calling orderlies to return Marion to her room. Foreman sighed, wishing he could just do the necessary lumbar puncture to confirm diagnosis without needing to go through House, who would undoubtedly make things more complicated than necessary.
Leaving the room, he waved at one of the orthopedic interns then proceeded to page House, letting him know the test results were on their way. His boss would be bored by the easy solution, and Foreman was looking forward to an easy week.
***
House was eating peanuts from the bag of trail mix on Wilson’s desk as the oncologist rummaged in the file cabinet. “So you treated this woman ten years ago? Interesting coincidence, her showing up here.”
Wilson turned away from the filing cabinet just in time to watch House snag a bit of his snack before sighing and settling into his chair. “She was at Wharton and got sick, the last year I was at Penn.”
With a smirk, House tapped his cane against the desk. “That would also happen to be the year things went bad with Sarah.”
“Which is why it was my last year working at Penn.”
“She left you because you slept with one of your patients. Some pretty MBA, if I recall correctly.”
Though he huffed loudly, Wilson said nothing. House stood and headed for the door. Reaching it, he turned back to ask, “Is she really not my type, or are you just saying that because you hit that and it would be awkward if I was better?”
Tapping his pen on the blotter, Wilson seemed to consider it for a moment. “She’s a blonde, one-legged Stacy.”
“Well that would just be weird.” House slammed the office door behind him, rattling several of the knickknacks on Wilson’s desk.
***
Chase hated driving into Manhattan, and was doubly annoyed that her overly modern offices had yielded nothing beyond a coworker with allergies and a mile-long travel itinerary, while her maid-maintained apartment left him with nothing but a four-year-old bottle of Percocet and a well-stocked liquor cabinet. At least he’d beaten the worst of the traffic back into Jersey, and actually enjoyed the drive out to his final stop, at the stables. A shady driveway passed in front of several large red buildings, a large riding ring to his left, where a horse and rider were currently circling around a few jumps. He watched the pair for a moment before heading into the first building. As he walked down the dirt aisle, curious heads appeared over stall doors, a few nickering softly.
“Can I help you with something?” A voice called out from somewhere behind him. Chase turned to see a man in jeans and a polo shirt, with a dark, weathered face emerging from one of the stalls.
“I’m Dr. Robert Chase from Princeton-Plainsboro Hospital. One of your riders, Marion Clise, was brought in Sunday after falling at a horse show. We’re concerned it may be something more serious than was initially thought.”
The man brushed his hands off on his jeans, then offered one to Chase. “I’m Bill Reynolds, the barn manager here. Marion’s been with us a long time now, so just let me know what you need, and I’ll be happy to help you out.”
Chase shook the outstretched hand and nodded. “How healthy is Miss Clise’s horse? Have any other horses been sick lately? Or imports with questionable vaccination histories?”
“Marion’s got two, Ace and Scarlett. The mare’s got an abscess right now, but that’s nothing catching. Nothing out of the ordinary, health-wise, with the rest of the barn, either. We run a tight ship here, best care in New Jersey.” He paused and considered for a moment. “Nobody’s imported anything since last fall, and it’s been on our vet’s health rotation since then, no problems.”
“What about chemicals or other hazardous substances?”
“Let’s see.” Reynolds let him down the aisle before stopping at a doorway that opened into a large room, full of cabinets and bins, heady with the scent of grain. “Scarlett’s on Regumate, which can do a number on the ladies, but Marion doesn’t handle that. Ace gets hyaluronic acid, but that shouldn’t do anything but help your achin’ joints. Then, we’ve got a whole cabinet of stuff here that’s prescription.”
Chase goggled as the cabinet opened to reveal a selection almost as well stocked as a small clinic. It contained everything from antibiotics to tranquilizers. “Can I take a look at these?”
“Sure. Feel free to look around then. If you need anything else, I’ll be just down the aisle. Just relock that when you’re done.” Reynolds shuffled away, boots raising a small cloud of dust in his wake.
Chase pulled out a notepad and began scanning the bottles for unusual suspects.
***
A soft tap on the glass of his office door interrupted him, and without looking away from his television, House knew it was Cameron. Only she would knock. “Some guy in Ft. Lauderdale jacked a mail truck. They’ve been chasing him for an hour and haven’t made it over thirty miles per hour. People really will steal anything.”
“I think you should see this,” said Cameron, tossing the patient file onto his desk.
House looked down at the page, furrowing his brow for a moment before realizing it wasn’t in English. “Do I have to find a Nazi to translate, or will you be playing the role of Brunhilde today?”
He always wished a dramatic eyeroll would accompany Cameron’s dramatic sighs, but it rarely happened. This time he only got a light chuff and a continuation, as if he hadn’t spoken. “She was treated at a hospital in Saarbrücken, Germany with an experimental procedure for the chronic pain resulting from her amputation. It’s apparently worked.”
“When did you learn German? It wasn’t on your résumé.”
“I didn’t. I talked to the patient, and she explained the basics of the treatment. Maybe you should try talking with her about it.”
The concern was clear in her voice, and it grated on his nerves. “And you think that this treatment could have caused the symptoms she’s exhibiting now?” He stared up at her, watching the frustration flash across her features.
“No! I thought that you’d be interested in it.”
“So you thought that I would be interested in information that’s unlikely to be relevant to the case?”
“With your leg, I thought that you-“
“You are not treating my leg, Dr. Cameron,” he said slowly, dangerously. “You are treating Ms. Clise. I suggest you go help your colleagues diagnose the patient.” He gestured through the wall at the conference room, where Foreman was just greeting a returning Chase.
He got his dramatic eyeroll as she exited stage left to join her coworkers, and he took a moment to savor it with a smirk. But his eyes couldn’t help but trail down to the foreign hospital record for just a moment. Shaking his head, he slammed the folder closed and went to the conference room.
“Find anything interesting, boys?” He tossed the folder on the table and glowered down at them.
Chase heaved a sigh worthy of Cameron, before saying, “The only thing at her home was some liquor and a four-year-old bottle of Percocet. Work gave me her travel itinerary for the last two years. But the stables,” he paused and pulled out his notes, flipping to a half-full page, “had a whole cabinet full of potential medical problems.”
“Fun!” House snagged the notebook and scanned down the list. “Did you get samples of any of this for us to enjoy? Or bother considering whether any of it would actually cause her symptoms?”
With a tired shrug, Chase answered, “I figured you’d want everything, relevant or not.”
House nodded, secretly pleased Chase seemed to be catching on, and scanned the list quickly while asking, “Foreman?”
“It’s either meningitis or a strain of encephalitis. I want to go over her travel history to see what looks most likely, then do an LP to confirm.”
Glancing up at the clock, House nodded in assent. “Do it, and we should know by tomorrow morning what’s causing most of her symptoms. Still won’t explain the aplastic anemia,” he said, walking back to his office still reading through the list of veterinary medications Chase had provided him. Two substances stood out for very different reasons.
He logged onto his computer and pulled up Google and a German-English dictionary site. Methodically, he began picking out a few terms and searching.
***
The sun had long set before House made his way to Marion Clise’s room. As he entered, she looked up stiffly from an obnoxiously pink copy of the Financial Times and gaped.
“If that’s supposed to be a joke, it’s not very amusing,” she said.
“I take my job very seriously, Ms. Clise.” House twirled his cane theatrically before resting it against the footboard. “Does my handicap bother you? A little too close to home?”
“What is your job, exactly?” She delicately folded the newspaper in her lap, as if planning a discussion with a frustrating child.
“Oh, a little of this, a little of that,” he said, pulling out her chart and skimming over it. “Running the Diagnostics department takes up most of my time, though.”
“You’re Dr. House?”
“Now that we’re all caught up, why don’t you tell me about your leg.”
“I’ve already given Dr. Cameron a history-“
“Why don’t you tell me what’s really going on? You were one of a handful of people treated for chronic pain in Germany with Ketamine four years ago. It’s allegedly worked, but you’ve been taking something else lately.”
“The pain had been pretty bad since the amputation, and I was sick of being tied to prescription painkillers. When I started trying to push myself more-transition back from sidesaddle to jumpers with Ace, traveling more for work-it became unbearable. My trainer had bought some horses from a guy in Austria who’d broken his back and was the second person treated. We were over shopping for horses, and heard about it. I contacted the hospital and expressed my interest. I can be very persuasive.”
“Which leaves the question of what you’re taking now for the pain that’s supposedly vanished. You’ve obviously moved on from the Percocet.”
“I’m not taking anything regularly. It’s just at horse shows. I’d always planned on doing grand prix with Ace, but the jumping…landing puts so much pressure down onto my prosthesis it becomes unbearable. When I’m not showing, I don’t jump. At shows, I just crush half a bute and mix it with some Gatorade. It usually gets me through,” she said frankly, with a small shrug.
The corner of his mouth twitched and his eyes narrowed. “You do realize phenylbutazone is an equine medication, and is no longer prescribed to people for a reason?”
Marion started to shake her head, then stopped with a gasp of pain and shrugged. “Horses can get ulcers, but I don’t have stomach problems. They get a lot of medications we don’t. Plenty of old-timers take it.”
“And plenty of them suffered from aplastic anemia, too. Given your medical history, you should know better. Find a real, human painkiller to treat you, or find a hobby less likely to aggravate your disability.”
House stalked out of the room as she sputtered behind him.
***
Cuddy jumped a foot, nearly dropping her briefcase, when House cheerily greeted her the next morning. She recovered quickly, though, and settled herself behind the desk with a glare before responding to him. “Awfully early for you, House. Or is it still late? That would be more plausible, if it didn’t mean you were working. I know you weren’t doing that.”
“No, but those two prostitutes sure kept me up. You might want to have housekeeping steam clean that couch. Very comfy, by the way.”
“I’ve got a busy day ahead. What do you want at this hour? I haven’t even had my coffee yet.”
He lumbered over to the side of her desk and settled himself against it, looming over her. “The patient I’m treating now, the amputee?” Cuddy nodded and he continued, “She had chronic pain as a result of the amputation. Four years ago, she underwent a procedure in Germany involving high-dose Ketamine as a treatment. It’s been a success on a day-to-day basis.”
She nodded, then was quiet for a moment. “’On a day-to-day basis’ implies that there’s still some pain.”
“Only when she’s pushing herself to pointlessly stupid limits that would cause pain in a normal person.”
“And you’re telling me about this because…?” She looked up at him expectantly.
“I did a little research last night. I’d like to try it.”
“On who? You said she already had it done.”
It was his turn to be quiet. “I’d like you to do it for me.”
“House! I don’t know anything about the procedure, and I’m not about to risk my license by just treating you willy-nilly with whatever cure du jour you happen to stumble across.”
He leaned against her desk, knuckles white where they gripped his cane. “I’ll bring you the literature, let you read over it.”
Sighing, she raked her eyes over his frame, gaze falling to rest on the tense hand on the cane. “Find a copy, in English, and I’ll look over it. My Deutsch is a bit rusty. And I’m not making any promises.”
With a curt nod, House ambled out of the office.
***
Foreman stopped at the lab on his way to the office, picking up the patient’s test results. He read as he walked to Diagnostics, nodding as he skimmed the results. When he arrived at the conference room, he was surprised to see House already present.
“What ho, apothecary?” House greeted him, reaching for the sheaf of test results.
Shrugging off his jacket and handing House the labwork, he frowned. “It’s some sort of encephalitis, but the tests for Eastern Equine and Western Equine were inconclusive.”
“Hmm.” House flipped through the pages, then reached for Marion’s file and opened it. “Did you test for Venezuelan?”
“Given that she hasn’t been to Venezuela, no.” Foreman shook his head, then turned to see Cameron enter, without holding the door for Chase, who was close on her heels.
The new arrivals looked between the two of them, then Cameron spoke up. “Did you find something?”
“Since Foreman skipped the obvious test, given the patient’s history, no. She was in Columbia two weeks ago, and apparently picked up more than excellent coffee. Go test again, for Venezuelan Equine Encephalitis. In the meantime, up her antibiotics, since she’s been responding to them. We’ve got to clear this infection up before we can start treatment for the aplastic anemia.”
Foreman looked ready to object, then merely rolled his eyes and exited with Chase, who shrugged in commiseration. Cameron lingered, moving closer to him. “Did you talk to her?”
“I didn’t use my psychic powers to figure out what was causing her anemia.”
“I meant about the pain treatment,” she said, the frustration clear in her voice.
“We had this discussion yesterday. You’re Marion Clise’s doctor, not Gregory House’s. Go help Foreman and Chase.”
Cameron frowned, but followed his orders. House watched her go, then moved to his office. Pulling up the link to the article he’d saved the night before, he scanned the list of authors once again. One name caught his eye, and he reached for his phone.
***
Chase slapped the folder of test results down on the desk. “Venezuelan Equine Encephalitis. Her fever and neck pain area have been decreasing steadily with antibiotics.”
House looked up from his magazine with a startled expression. “You sound so disappointed that I was right. Shouldn’t you be used to that by now?”
With a shake of his head, Chase answered, “If it was anyone but Wilson, you’d have refused the consult. This was a boring, easy case.”
Frowning, House raised the magazine to block his view of the younger doctor. “Go treat someone and leave the dime-store psychoanalysis to Cameron.”
He watched Chase leave, then looked back down to the pile of papers concealed by Us Weekly. The translation wasn’t graceful, but it was straightforward and comprehensible. It would be easy enough to do, if he used some of his vacation time and could convince Cuddy. Putting the papers in a folder, he noticed that he was only ten minutes late for Clinic, so he took his time making his way to the first floor, lingering at the desk of Cuddy’s newest assistant to make faces at her while she met with Aylesman.
***
“No, Mare, you should’ve known better with your history, but it’s completely treatable,” said Wilson. He sat gently on the edge of the bed, patting her hand and noting the understated but sparkling engagement ring, and wondered for a moment where her fiancé was.
“Matt is in Zurich until Thursday.”
Wilson looked up, startled, to see her smiling.
“You were staring at the ring, and you used to be easier than an open book to read. It’s good to know some things don’t change.”
“You have.” He looked her over, happy to see she’d improved since he’d first seen her Sunday evening. She was still as pretty as he remembered.
“No, I’m back to being who I was before I was sick,” she said matter-of-factly. With a small shake of her head, she continued, “So you think outpatient treatment and follow-up with Dr. Roth will be enough? She’s not going to be happy with me.”
“She’s not going to be happy she didn’t notice sooner. Though if you hadn’t gotten sick now, things could have progressed to a dangerous point before you were treated. We caught it early, and you know how important that is,” he concluded, his hand resting on her good knee.
Nodding, Marion replied, “Yeah, I do. I’ve got you to thank for it, too. And Dr. House, this time.”
“Make sure you tell him that. He doesn’t hear it enough.” Wilson rose from the edge of the bed, heading for the door.
“Oh? He seems like the kind of man who’s heard it a few too many times.”
Wilson couldn’t respond, just shook his head slowly as he left the room.
***
“So?” House made himself comfortable in one of the chairs in front of her desk.
Cuddy looked up from the pile of files on her desk and stared at him for a moment before sighing, dropping her pen to the blotter. “I read over the file. But the sample was too small to prove much, and even there the success rate was only fifty percent. Putting you into a coma for fifty-fifty odds is incredibly risky.”
“This is you telling me ‘no’ then.”
Her hands spread in a placating gesture, but the regret was plain in her voice. “If we’d had this study when you were first hospitalized, or if you were going to be under for some other reason, I might consider it. But we don’t put people under just to see what happens.”
“All this ‘we’. I’d think you were the queen of something important rather than my doctor.”
“I don’t like seeing you in pain, House. But I can’t jeopardize my medical license and this hospital by testing experimental procedures on a whim.”
“I’d not a whim, it’s-“
“I know. But that’s what it amounts to. There’s too much liability.”
“Who’s going to sue you?”
“That’s not the point.” She shook her head, looking all too reasonable.
“No, the point is my leg is getting worse, and you’re refusing to help me.”
“No, I’m refusing to put an otherwise healthy man into a coma which may or may not help him.”
“Same thing,” he said, rising and heading for the door. Reaching it, he paused and turned back to her. “But if I were already in a coma, you’d consider it?”
She looked taken aback for just a second before the anger kicked in. “So help me, House, if you go wreck your motorcycle just because you think I’ll do this for you, it won’t happen. Am I clear?”
“Crystal,” he said, allowing himself a tiny sight, his frame collapsing just enough for her to notice. He didn’t want her to see how much her refusal hurt, but her guilt could be a powerful tool. Turning, he walked out without another word.
****
End
****