Syncope
Title: Syncope
Prompt: #36. Wilson starts fainting at random with no detectable or underlying cause.
Author: rslworks
Rating: PG-13
Word Count: 6645
Spoilers: This story is in line with events of Season 5, post “Birthmarks.”
Characters: House/Wilson,
Disclaimer: Not mine.
Tags: fainting
It was a relentlessly busy Friday afternoon on the Oncology ward and Dr. Wilson was running behind. All 22 beds were occupied, one resident and a nurse had called in sick for the same shift, and a new patient interview specially arranged by Dr. Cuddy had seriously run into overtime. At 5:20 pm Wilson answered a call from the nurses station reminding him he had still not completed discharge papers for a teenage boy with acute lymphocytic leukemia named Steven Mitchell who was desperately hoping to enjoy the weekend at home with his family after an arduous first round of chemotherapy.
“Tell Steven to get dressed. I’m on my way down.” Tossing another file aside, he slid his chair back and trotted out his office door, skipping the lab coat and pushing his shirtsleeves a little higher as he went. Wilson’s office was actually a floor above the Oncology ward, and tonight he found himself waiting far too long for the elevator doors to open. Sighing quietly, he finally spun on his heel and opted for the stairwell.
Once through the doors the steps rang in hollow tones under his feet as he descended. At the bottom step he reached out for the heavy metal door that was his entrance to the third floor. Whether he actually took hold of the door handle he would not remember as very unexpectedly everything went black around James Wilson….
“I’m sure he’s on his way, Mrs. Mitchell. I had the impression he was coming straight over -- Oh, here he is, don’t worry about a thing.”
The redheaded nurse holding Steven’s paperwork was too harassed to bother looking directly at her Head of Oncology or she might have noticed the first swelling of a bruise on Wilson’s right cheekbone. For his part, he kept his head low, stuck out his hand for the papers and scribbled the necessary words which would free his young patient from PPTH.
Once safely seated in his office chair again, Wilson sat back and ran both hands through his hair, leaving them on his head for a few moments. What the hell just happened? I feel fine now. I felt fine a few minutes ago. How did I end up on my face in the stairwell? He reached for the pulsepoint on his wrist and counted. Sixty-four. Fine. Rubbing his cheek, he pulled out a small mirror he used for shaving and examined his face. The red mark on his cheekbone was already beginning to betray angry purple undertones. No hiding that. He’d have to come up with some story, not too lame at that if he was to get past House’s radar.
For now, however, at least a solid hour of paperwork sat before him, so he shrugged off the bizarre incident and got to work. Forty-five minutes later he detected the uneven gait and thumping of cane that was House coming down the hall and he steeled himself before the door flew open.
“Doesn’t take long to get back into the swing of slogging through paperwork, does it, oh dedicated boy wonder?” House began.
“Hmmm….no, it feels like only yesterday.”
While Wilson’s left hand curled and scribbled, his right cupped his injured cheekbone. “You done for the day, House? It’s late for you. I thought your patient went home earlier.”
“That she did. Yet another human being alive and well, indebted forever to Gregory House, diagnostician extraordinaire.” Smiling and affecting an elaborate bow, he straightened and studied his friend.
“It’s Friday night. Why don’t you knock off for tonight. We’ll get take out and crash in front of my TV. You know, something new and exciting. I’ll even pay. That’ll be the exciting part!”
Wilson smiled, but only briefly as he felt the skin over his cheek tightened. “Not tonight, House. Like I said before, we’re fine, and I’m sure we’ll do all that again, but I’m not ready to fall back into old patterns yet and besides, I don’t want to leave all this for Monday morning.” He kept scribbling while he spoke as an excuse not to look up at House or change positions.
“Killjoy! Oh well, I’ve decided I can wait because it’s YOU. Suit yourself.”
But instead of turning for the door House lurched forward over the desk and snatched Wilson’s hand away from his face. Defeated already, James dropped his pen, sat back in his chair and looked House in the eye.
“How’d you get the boo boo? Another irate cancer patient going to live?”
“It’s nothing. I was in a hurry and tripped over my feet in the stairwell. Then the wall got in the way suddenly and hit me in the face.” He gave a goofier smile this time and hoped House would let it rest. Surprisingly, he did.
“That’s why we have elevators to ride in. Use one next time.”
Heading for the door, House called back, “See you Monday then. Put some ice on that!”
Wilson finished his charting in peace that night.
Monday morning found Wilson on the ward early, eager to get started with rounds. He had a new female resident joining his team for two months and was making an extra effort to be sharp, insightful and thorough. Wilson led by example and his regular staff knew only too well what was expected of them as a result. There were two junior staff doctors on rotation today along with several nurses, and they all smiled knowingly at one another as they listened to the familiar, gentle lecturing delivered by their beloved boss to yet another ‘wannabe’ oncologist.
Whether Wilson knew it or not, he was the most respected department head at Princeton-Plainsboro. Lisa Cuddy knew this however, and as a result when Dr. Wilson shyly stepped into her office two weeks prior, stammering about whether or not his job had been filled yet, she stood up and rushed over to embrace him before he could get his hands out of his pockets.
Rounds ended when everyone congregated around him at the nursing station to organize their assignments. Wilson was getting ready to leave them all to it when his assistant Catherine appeared and pushed a clipboard through to him and pantomimed ‘sign please.’ Taking it from her, he turned back to hear what the others were riding the newbie about as giggles and taunts erupted everywhere.
Laughter died in the air abruptly and shocked gasps were heard in its place when Wilson let go of the clipboard, dropped silently to his knees and then pitched face down on the floor. His forehead narrowly missed the station counter, but definitely connected with the hard, polished floor. Ever fast-thinking nurses rushed to his side before the doctors could close their mouths.
“Dr. Wilson! Are you alright?” Jenny Caruthers and the redheaded Maureen gently rolled him over, causing him to stir.
“I should get a gurney,” the new resident offered, looking down the hall.
“No, please. Please don’t. I’m alright,” Wilson whispered from the floor as he pushed the nurses’ hands away and sat up quickly. He didn’t think it was possible for him to feel more embarrassed.
“Don’t move too quickly, James. You’re rather pale.” Dr. Brown knelt down and placed a hand on his shoulder while gently feeling his pulse. “Maybe you should lie down for a while. I’ll cover for you as long as you need.” Malcolm Brown was basically Wilson’s second in command and subbed for him whenever necessary.
“Have you been feeling sick, Dr. Wilson?” Jenny had gone for a glass of water and held it out to him.
Taking the water, Wilson tried to think of a way to deflate the situation and get everyone back to work. “No, really, not at all. I’ve been just fine. I don’t know what that was. I’m sorry. I’m fine now.” To illustrate, he hastily pushed off the floor, brushed himself off and took a sip of water.
“See? No problems.”
But Brown was frowning and pointed at his forehead. “I think you’re getting a goose egg, though.”
Crap. He gingerly brought a hand to his forehead and felt a good size lump above his right eyebrow. That smarts a bit.
“Really James, because you’ve hit your head, I insist you go and lie down for an hour or two. And Catherine or I will look in on you just to be safe.” Brown smiled when Wilson started to splutter and protest but didn’t back down.
“Don’t make me play the Cuddy card.”
This threat produced a dramatic sigh from Wilson, but he gave in and promised to go directly to his office couch. He apologized again out of embarrassment if nothing else and chided everyone half-heartedly to get to work. When one of the nurses lingered offering to walk with him up to his office, he rolled his eyes, bit back a sharp retort and insisted quietly he would make it there just fine all by himself.
Stepping off the elevator he shot a stealthy glance at House’s office before he passed it, relieved that it was still too early for House to be on the premises. Taub and Kutner had their noses in medical journals and Thirteen was sipping coffee and staring out the window.
In his office, he shed his lab coat and sat down on the couch, tenting his fingers together and balancing his elbows on his knees. What on earth is wrong with me? He began to rock back and forth ever so slightly as he tried to sort it out. He didn’t feel sick in the slightest. He wasn’t any more stressed than was usual for him. He’d had a four-month break from oncology, so it wasn’t work. He was dealing with Amber’s death as best he could, although he missed her more than he would admit to anyone. She had become a real life-affirming force for good in his life and his heart ached without her.
And for better or worse he had placed himself squarely back in House’s life. Much as he’d been emphasizing self-preservation over the last few months, when he stepped away from Greg House he had ended up feeling as though he had lost a limb. But hopefully, armed with the tools Amber had tried to give him, he would begin a new chapter with House; one where there was real give and take; a deeper, more satisfying friendship.
He huffed to himself as he thought, ‘Less taxing, anyway.’ So having taken stock of things, why had he fainted? Twice! He’d almost forgotten about the stairwell incident, he’d had such a relaxing weekend. There were no warning symptoms either time. He wasn’t light-headed, nauseous, off balance, in pain, over-tired or remotely sick. On the vasovagal side, he wasn’t hysterical, traumatized, emotional or anywhere close to a panic attack. It couldn’t be a drug reaction because he wasn’t taking anything. He couldn’t think of a single reason for a sudden faint. And that’s what began to niggle at him as he obsessively rubbed the lump on his forehead.
He decided that later in the day he would slip into the clinic, check his blood pressure and draw blood for a CBC and chemistry panel. He had assigned enough time to dwelling on something that was probably nothing, so he slipped off his shoes and stretched out for a bit to fulfill his promise to Brown and settle the headache which his ‘goose egg’ had produced. He drifted off trying to come up with a new pseudonym for himself so that no one, specifically House, could spy on his test results. House already knew his alter ego, “Evan James” so that oldie but goodie was out. He’d come up with something clever by afternoon.
The next morning Wilson’s radio alarm brought soft sounds of James Taylor at 7:00 am and he rolled slowly over onto his back thinking there were worse ways to wake up. Inhaling deeply, he stretched his arms and long legs and then let his breath out slowly. He recalled he had an 8 am surgical consult today, so he willed himself to swing his legs out of the warm bed and get moving. As he shuffled into the bathroom he yawned hugely and scrubbed a hand over his face.
“Ow! Crap!”
His goose egg was large and painful with a scrape in the middle and a red ring surrounding it. He was starting to look like the walking wounded. The liquid foundation he had picked up on the weekend had camouflaged the cheek bruise a little, but in combination with the lump on his forehead, he was now going to turn heads for all the wrong reasons. After his shower he grabbed his comb and tried to cover the right side of his forehead with his bangs. Besides looking dorky however, it only proved to draw attention to what he was trying to hide, so he shrugged and reached for his trusty blow dryer instead. Maybe if anyone asked he could attribute both injuries to one silly accident.
At the hospital, his consult went well and an extra biopsy was slotted in for the following day. He took note of a few curious looks in his direction, but so far no one asked him directly about his appearance. He was well aware that his luck was stretched to the limit though by the fact that he had managed to avoid House since acquiring the goose egg the day before. But as lunchtime approached he grew more and more nervous expecting the other shoe to drop. There was no way House would buy two clumsy episodes producing his recent injuries so the best course of action was total avoidance!
Clinic duty! This is great! I’m on this afternoon anyway….I’ll just show up an hour early. There’s always overflow from the morning! Ha! House won’t dare darken the door of the clinic, and I’ll get some Cuddy points as a bonus! Wilson was quite impressed with his sudden brilliance and eagerly scooped up a penlight and his stethoscope, ready to flee his office. He’d also be able to intercept his lab results in the early afternoon as well. Perfect!
Clinic turned out to be a mind-numbing succession of sore throats and fevers with the occasional migraine to break it up a little. By 3 pm James had sore feet and a cramp in his left hand from all the prescription writing and history taking. He decided to take a break and flirt with the nurses in the reception area, realizing only then that he was ravenously hungry.
Lisa Cuddy spotted him, smiled and came to his side.
“Thanks for the extra clinic help. It was - unexpected, but appreciated,” she sounded sincere but wore an appraising grin as she looked up at him. Then the grin disappeared.
“What happened to your face? What are these bruises?”
Wilson rolled his eyes and held up his hands in defensive posture. “Lisa, seriously. It was such an embarrassing bit of clumsiness on my part, I can’t even talk about it. There’s nothing you have to worry about. It was a dumb accident - end of story.”
Not sure whether to believe him or not, she nonetheless left it alone.
“Look, you’ve been a big help today, but can you see one more clinic patient? Two doctors are due down here in twenty minutes, but I’m short till then. Thanks!” She thrust the file in his hands and turned to smoothly intercept Nurse Brenda at the desk.
In exam room two an anxious, elderly woman described in great detail the type of abdominal pain she had been experiencing lately while James listened and nodded in appropriate places. Cuddy was still discussing a scheduling conflict with Brenda when Mrs. McIntyre from exam room two came bustling into the reception area with her arms in the air as if she were madly flagging down an airplane from a desert island.
“Someone come quickly! That nice young doctor’s collapsed! Somebody hurry, please!”
Cuddy and Brenda swept past the woman and found Wilson unconscious, with his face hidden in his arms and his legs splayed. While Brenda rolled him, Cuddy found a carotid pulse and the breath she’d been holding at the same time.
“Get some people in here so we can get him on the exam table!” she barked unnecessarily. When she looked up she found three other nurses rushing in to help and Wilson was laid out with his tie loosened before he even stirred.
“Wilson, can you hear me? It’s Cuddy. You passed out.”
Her concerned voice brought him back to the present quickly, and he tried to sit up, but Cuddy pressed firm hands to his shoulders, forcing him back down.
“No you don’t. You’re not going anywhere.” She kept one hand on his chest firmly and called over her shoulder to Brenda.
“Page House! ---”
“NO!! No, don’t! Please don’t call him down here! Cuddy, --I’m okay, really. I forgot to eat lunch, that’s all. I’m sure that’s it this time!” He clawed at her lab coat, thinking only of keeping House from showing up.
Cuddy’s grey-blue eyes widened. “What do you mean this time? How long has this been going on? Is this how you got those bruises? James!” She crossed her arms, waiting for explanation.
Wilson lay back on the table trying to recover his wits. Again, he had no warning. He really felt alright. Granted, this time he was hungry, but he’d missed lots of meals and never fainted.
“That’s it. I’m getting your medical file. I can’t remember the last time you had a complete physical. But you’re getting one, NOW. And if we don’t find anything obvious, I’m turning you over to House.” Cuddy turned on her heel and made for the door, calling back, “Don’t just stand there. Someone get his vitals and don’t anyone let him leave this room till I get back!”
Wilson closed his eyes and groaned. Things had spiralled out of control and he really didn’t want to become House’s latest patient of the week because of a few fainting spells. If he’d only been able to snag that lab work before anyone else caught on, he might have sorted himself out! In his very next breath the exam room door flung open abruptly, startling every staff member present, with the exception of Wilson who merely turned his head the other way and prayed the floor would open up and swallow him.
“Orson Kane?? Your lab tests are back. And they seem to indicate a pathetic lameness of the imagination. I mean, come on - Orson Kane!! Why didn’t you just rip the poster off your wall and submit the lab request on it! I’d have never guessed it was you!”
Lacing his words with the utmost sarcasm, House still eyed his friend clinically as he flamboyantly swept into the room waving Wilson’s medical file and labs. Then he stopped, placed his hands on his cane and spoke to the room at large.
“Aren’t there hospital regulations pertaining to the number of hovering nurses allowed in one room at the same time?” When no one budged he added, “Really. I’ll take it from here and I promise not to hurt him…much.” Not one nurse failed to shoot him a dirty look as they filed past him.
Wilson tried to take the offensive and sat up on the table.
“How the hell did you manage to hear about this so quickly? No one’s even had time to page you. And the labs, they can barely have flashed across your computer screen! I was waiting for those-”
“When you fainted?” House stepped closer into Wilson’s space and gave him the cerulean stare. “Lay back down.”
“But it’s just a faint, House! I feel great now. This isn’t necessary!”
“You’ve acquired a new boo boo since I saw you last. Just how many times have you fallen and why won’t you submit to a physical exam? What are you afraid we’re going to find, hmm?”
Cuddy re-entered the room before he could respond. “Wilson, you wouldn’t know where your file is would you?”
“Right here, actually.” House lifted it off the counter for her to see.
“House, how-never mind?” Cuddy looked amazed, but pleased to see him. “He’s skipped his physical two years in a row and just passed out while seeing a patient in this exam room. He let it slip that it’s happened before, and unless someone beat him up recently, I’d say something’s going on. Examine him, House. Do whatever you need to do. Wilson, you’re off duty until House clears you. I’ll talk to Brown.”
Wilson began to protest, but Cuddy was great with quick, dramatic exits so he closed his mouth and lay down on the table in defeat.
House suppressed a smirk but turned to a drawer behind him and produced a hospital gown.
“Get naked. Back in five.”
With nothing left to hide or postpone, Wilson decided to get on with it and changed into the most unflattering gown. House, when he came back left the sarcasm at the door and was surprisingly competent, gentle and thorough in his examination even including the dreaded prostate exam with no fuss and no jokes to Wilson’s relief. He spent longer than was usual listening to Wilson’s heart, lying flat, sitting and standing. He repeated the process with b.p. and peripheral pulses. After about twenty minutes, House stepped away and leaned on the nearest counter, favouring his leg.
“You’re not saying much,” Wilson began.
“Not much to say, didn’t find anything.”
James smiled. “Great! I’ll get dressed.”
House also smiled. “Not so fast. We haven’t fixed anything yet. Cuddy doesn’t want you wandering the halls of PPTH falling down all the time. It doesn’t inspire much confidence.” He raised his hand as Wilson threatened to argue.
“Stop it. You’re choosing to ignore basic medicine here. Fainting is not serious, in fact it’s majorly boring when it presents with the typical symptoms. You run a physical exam so you don’t miss anything and then the patient gets on with life and probably never faints again.”
He grabbed his cane and started to pace at the end of the exam table. “But you appear to be symptomless, which has the potential to be much more serious, which you already know, I might add. Since you’re not dehydrated, anaemic, exhausted, drugged out or in emotional distress at this particular moment in time, we need to rule out metabolic disorders, neurological conditions and cardiovascular problems.”
Pulling out his pager, he turned his back on Wilson who’s fidgeting with his gown ties was getting on his last nerve. He untied, retied, twirled, bunched, straightened, knotted and generally fussed with the material.
“House! My bloodwork’s fine! That rules out all likely metabolic---”
He raised a hand, putting the pager away. “Fine, you get one star. I’ve actually moved on from metabolic already. Neurologic is on his way down.”
“You didn’t page Foreman about this?!”
“Well, kinda, sorta, yeah, I did,” House taunted. “And before you start whining, if I don’t do the rule outs on that, when I move on to cardiovascular, you’re going to be distracting me with, ‘maybe it was vestibular or neurological’ and I may have to kill you before I cure you!!”
Wilson blinked the way he does and said quietly, “No need to get testy.”
As House would have predicted, Dr. Foreman declared Wilson free of any neurological complaints. Reflexes were present and quick as lightning. There were no inner ear abnormalities and no nystagmus within those liquid brown eyes to betray any trauma to the brain.
House had gone for coffee, without bringing any back for anyone else, and sauntered back into the exam room they had commandeered for over an hour now.
“Are we done yet?” he chirped at Foreman.
“No neurological reason for the fainting.”
House ignored Wilson who was wringing the back of his neck. “OK, thanks for that. And by the way Foreman, on your way back upstairs, swing by Cardiology and book the stress lab for my friend here. I’ll wait for your page. Oh, and sign out a Holter monitor in Wilson’s name.”
“House!” Wilson rolled his eyes and hopped off the exam table, partly because his ass cheeks were asleep. “Enough! This isn’t necessary! My heart is fine! I’ve been cooperative, but---”
“Oh, right, for an entire hour! You ain’t seen nothing yet, pal of mine! Cuddy is looking for answers. That’s why she asked ME to find them. I can’t let her down, can I? Think of my rep, dude.”
Wilson looked pained. “Your rep? Since when have you given a crap about your reputation? You’re just enjoying playing with me!”
“Yes, there is that, but the fact is you have no choice. Stop whining, get dressed and we’ll go up to my office where I can keep my eye on you. Have you forgotten Cuddy’s taken you off the clock?”
House was trying not to sound smug but wasn’t really pulling it off in Wilson’s view. Nevertheless, they headed up to Diagnostics, where no doubt the rest of the team could soon set upon Dr. Wilson.
So, feeling beleaguered, Wilson found himself sitting on a hard chair with his head in his hands in the middle of the diagnostics room listening to his own differential. Oh, God…there’s gonna be tests and tests and more tests, and arguing. Ohhh…
House paced a line behind Wilson as he began. “Thirty-nine year old, caucasian male, disgustingly healthy presents with unexplained, apparently symptomless fainting. Three episodes in five days, all on hospital property. CBC and Chem panel BORING, no indication to run metabolic tests and Foreman pronounced him clean neurologically. GO!”
Thirteen: “No warning? No light-headedness, like ‘gosh I need to sit down…’
Taub: “Haven’t been fighting the flu, not sleeping, no complaints at all?”
House rolled his eyes dramatically. “Done this, people!”
Kutner shot him a look before offering, “Any history of heart disease?”
Wilson stopped shaking his head and looked up at Kutner. “My heart’s fine.”
“Until it’s not, Jimmy boy. There are any number of arrhythmias that temporarily interrupt blood flow to the brain resulting in loss of consciousness. Some are congenital, but they usually show up about 25 years sooner than this. Some are drug induced, like Long Q-T syndrome and are easily controlled with beta-blockers. Some are harmless and embarrassingly inconvenient, while others are potentially fatal.”
“If it’s intermittent, it’s going to be a challenge to find it, let alone diagnose it,” Thirteen interjected.
“Oh but this is where the fun begins,” House piped in enthusiastically just as his pager went off. “What’s this? Dr. Wilson! Cardiology says the stress lab is yours for the next 45 minutes! How perfect is that??” Ignoring a low moan, House placed his hands heavily on Wilson’s shoulders and addressed his team.
“You have my permission to stress test him to your heart’s content. Treadmill, tilt table, make him sweat, make him pant, but record it all. If that doesn’t show us anything, run a signal-average EKG over 20 minutes and then sign him out a Holter monitor for 36 hours.”
An hour later Dr. Wilson was tucking his shirt into his pants after debating with himself over the best place to put the bulky monitor he had to carry for the next 36 hrs. In addition to the three leads attached to electrodes placed on his chest, he now wore a belt just above his waistline, which carried the monitor itself. He was able to slide it anywhere along the belt; front, back or side and he’d been playing with its placement for ten minutes. He’d also remembered to shower before getting hooked up since that was a no-no for the duration of this latest test.
Running a hand through his damp hair, he sighed and headed back up to Diagnostics. He had been very patient with Taub, Kutner and Thirteen, allowing them to put him through all the tests the stress lab had to offer while they monitored his heart and blood pressure. After forty minutes pushing the sweaty oncologist, they had not been able to provoke any kind of arrhythmia or change in b.p.
“I don’t know how I’m going to sleep with this damn thing on.” He settled himself in House’s comfy chair across from the desk.
“Are you kidding? I’ve seen you fall asleep in every position imaginable. Almost standing up! Stop whining, you’ll be fine.” House tossed his reading glasses on the desk and assessed Wilson visually for the two hundredth time that day.
“Well, still nothing to get excited about. Are you sure you’re not bored enough with me as a patient to just forget the whole thing?”
“Nice try.”
“Yeah, well. It’s expected of me.”
“The good news is, Cuddy says you can go back to work while the Holter is in place. There’s no point seeing what your heart is doing if you’re lazing around at home. Just maybe we can catch the critter responsible for your ‘spells’ by letting you do what you do every day.”
“Whatever. I’m going to my office then.”
“Day’s over sport. Go home and try again tomorrow. That thing’s turned on, right?”
“Fresh batteries and everything. See you House.”
Wednesday turned out to be a boringly regular day, and if Wilson’s Holter monitor were to be consulted it would have shown an endlessly repetitive sinus rhythm. As for Wilson himself, he wasn’t happy about being unable to shower and managed to lean on, elbow or fuss with the device at least a dozen times during the day. Currently it resided on his right side, just above his belt. Only House, Cuddy and the new team knew he was wearing it and no one else picked up on the little hiccup in the flow of Wilson’s long white lab coat down his body. House actually left him alone except to sponge lunch from him and Wilson was beginning to think by day’s end that whatever his problem was, it had come and gone.
Selecting the files to come home with him that evening, Wilson scissored the compartments of his briefcase open and sorted, ignoring House’s entry.
“I’m hungry and my proverbial cupboard is bare. Want to get Chinese on the way home?”
“On a weeknight? Wow, aren’t we splurging.” He grinned at House, feeling charitable and added, “Sure. I’m ravenous.”
Following House in the Volvo so he could leave at a reasonable hour, Wilson backed the vehicle out of its spot and caught up to House at the traffic light. Reaching for the play button on the CD player, he recoiled suddenly as his heart began to pound in his chest with palpitations. He recognized them as a common side effect of panic attacks as he had experienced a few of those in the last couple of years, but he didn’t feel any stress at the moment. Holding tight to the steering wheel he tried to ride it through and concentrate on driving. He considered pulling over but didn’t want to alarm House. So he told himself to breathe evenly and deeply and tried not to be alarmed by the rapid, irregular banging within his ribcage.
As suddenly as they had come, they subsided and Wilson exhaled loudly in the privacy of his darkened car. He took stock. No sweating. There was no chest pain. His carotid pulse felt steady and quiet. There was no light-headedness or ringing in his ears. Most importantly he hadn’t fainted. As headlights whizzed past he considered telling House what had happened. They couldn’t consult the Holter at this point without shortening the test by more than 12 hours, so they wouldn’t learn anything now anyway.
Spotting the Chinese place at the last moment, Wilson made a sharp right and parked while House continued home. The bum leg always meant Wilson picked up the food. If he were really fortunate House would open a beer and pass it to him when he got in. He took his time paying for the food and headed carefully back to the car, but he felt fine again.
He decided not to bring up the incident for now, and they ate in a companionable silence that reminded him of better days. He watched as House flipped through the channels looking for some stupid movie, but Wilson was no longer interested.
“I’m gonna head home, House. I brought a lot of work home tonight.” He gathered the take out refuse and tossed it in the kitchen garbage. When he came back he was surprised to see House had gotten to his feet to walk him to the door.
“I can find my way out like always, House.”
“Uh huh.”
“What?” Wilson couldn’t quite meet the intense, cerulean stare he was faced with.
“You okay?” House stood toe to toe with him, scanning.
“Yes!” he hissed, reaching up to rub the back of his neck, “I just want to go home.”
“You’ve gone pale, --- grey actually.” He reached down for Wilson’s wrist without taking his eyes off his face. “Hmm, tachycardia. Sit down, Wil---“
James chose that moment to roll his eyes back in his head and sink to the floor without a sound. House still had a light hold on his wrist, but favoured his leg instinctively and let him fall, hauling up on his arm at the last second so Wilson didn’t crack his head on the floor.
“Shit!”
Kneeling awkwardly over Wilson, House felt for a carotid pulse. It was still rapid and shallow. He hauled himself to his feet and hobbled quickly to the hall closet to fetch his medical bag, grabbing his cell phone from the hall table on the way.
“911? I need an ambulance sent to 221B Baker St. immediately. Possible impending cardiac arrest. Thirty-nine year old, Caucasian male, unconscious and tachycardic. Suspected recent history of arrhythmias, cause as yet unknown. Hurry.”
Secretly panicked, House had to run through his emergency ABCDs like some hapless bystander. He fell on his knees at Wilson’s side, viciously tearing away his tie and ripping open his shirt, scattering buttons at will. His lips were still pink and that took care of A and B. But House knew that ventricular tachycardia could quickly decompensate into ventricular fibrillation and he had no defibrillator in his back pocket.
Placing his stethoscope slightly left of his sternum House listened to the rapid heart rate, taking in the pale, smooth chest rising and falling beneath him. Try as he might, he couldn’t pick up an arrhythmia though that was pointless at the moment. Where are those ---
The door burst open in answer to his unspoken question and two burley EMTs immediately wheeled a gurney to Wilson’s side. The next 5 minutes were spent placing an IV, oxygen mask, removing the Holter, placing new electrodes for the portable ECG the EMTs carry and arranging James on the gurney. A discussion began as to whether or not to intubate him, when House finally lost it.
“Not now! I don’t know why he’s still unconscious, but he’s breathing well enough on his own for now. We need to get to Princeton-Plainsboro before he goes into v-fib! We can intubate in transit if we have to! I want a fully stocked crash cart and a cardiologist sooner than later!! Move him now!”
In the ambulance, House’s eyes were fixed on the tracing from the ECG monitor and he hung on every beep. He stole a look at Wilson’s boyishly vulnerable face and felt his own heart skip a beat. Every few minutes Wilson’s heart would slow slightly and beat more strongly and he would stir - moving his head and moaning softly, but never more than that. Not until they were six minutes out from the hospital did House remember to call Cuddy directly, barking instructions and demanding she clear the way. After only a few seconds of stunned disbelief, she hung up from House and did just that, tracking down Petersen from cardio and heading toward Emergency and Dr. Cameron.
When the emerg bay doors swung open, Cuddy and Cameron were standing ready for one patient only. Except for the white-knuckle grip Cameron had on Wilson’s patient file, she exuded readiness and confidence. Cuddy’s eyes went directly to House’s pale face. Somewhere he had lost his cane and he used the rolling gurney to hoist himself off his bad leg and keep up.
“ER bed number 2, left side!” Cuddy directed, getting the next door. Petersen, cardiology’s best at PPTH, was already moving toward them from inside the ER. House backed out of the way to catch his breath as the team moved in to lift James hastily off the gurney. But House was watching the monitor that still sat between Wilson’s legs and his face fell.
“V-fib!! Paddles! Now!”
They let him down again in the disarray of tubes and wires and Cameron flung the ambulance blanket away. Cuddy moved in and forcibly tugged House out of the way, saying something House never did hear. Peterson himself charged the defibrillator and House watched it in use as he had hundreds of times before. But this time it was Wilson’s body lurching off the bed in response to the electrical jolt and Cuddy’s hand covered House’s gently as she heard him gasp.
* * *
Wilson was falling down a hill, uneven ground bruising his hips and shoulders. If he opened his eyes bright light would filter in and he kept them shut just a little longer. Voices began to flood into his consciousness and he felt afraid, sensing urgency and concern around him. He heard moaning and mumbling, but he couldn’t make it out and suddenly his chest was on fire and it was too hard to breathe.
“He’s coming around.”
“Look at the monitor.”
“What?”
“Petersen. The QRS pattern. See it?!”
“House, I see it, but I need to stabilize him first -
“No! This is the source of the problem. Convert him now, before he’s fully awake!”
“That’s crazy! We do that under sedation in a more controlled -
“Half the ER is here for back up! Fix it now while we can see it, for God’s sake!”
“House! Don’t -
“House!!”
James heard a scream erupt that echoed through the ER, and things were hazy for a few seconds. Hands gently cradled his limbs and supported his head, placing him in a softer bed. He tried to speak, but searing pain took his breath away and tears leaked out of his tightly closed eyes. He felt a hand grasp his left one, a thumb moving gently and reassuringly over his knuckles, back and forth, back and forth…
“Steady on….try to slow your breathing. You’re okay now.”
Some time later he thought he wanted to know who was speaking, so he moved his head to the left and opened his eyes. House was looking at the monitors and bouncing his cane on the floor.
“Hey?”
“Hey yourself.”
“Where am I?”
“ER. How’s your chest?”
“Hurts.”
“Morphine coming up.” He heard a thin beep.
“House?”
“Yeah?”
“You held my hand.”
“Nah. You’re mistaken. That was Cameron.”
Comforting warmth began to spread through his limbs, carrying away the pain and making his eyelids heavy. He struggled to open them one more time.
“House?”
“Yeah?”
“Tell Cameron she needs to do something about those calluses.”
House’s face cracked into a grin as he looked at his sleeping friend. I’ll get right on that.
Prompt: #36. Wilson starts fainting at random with no detectable or underlying cause.
Author: rslworks
Rating: PG-13
Word Count: 6645
Spoilers: This story is in line with events of Season 5, post “Birthmarks.”
Characters: House/Wilson,
Disclaimer: Not mine.
Tags: fainting
It was a relentlessly busy Friday afternoon on the Oncology ward and Dr. Wilson was running behind. All 22 beds were occupied, one resident and a nurse had called in sick for the same shift, and a new patient interview specially arranged by Dr. Cuddy had seriously run into overtime. At 5:20 pm Wilson answered a call from the nurses station reminding him he had still not completed discharge papers for a teenage boy with acute lymphocytic leukemia named Steven Mitchell who was desperately hoping to enjoy the weekend at home with his family after an arduous first round of chemotherapy.
“Tell Steven to get dressed. I’m on my way down.” Tossing another file aside, he slid his chair back and trotted out his office door, skipping the lab coat and pushing his shirtsleeves a little higher as he went. Wilson’s office was actually a floor above the Oncology ward, and tonight he found himself waiting far too long for the elevator doors to open. Sighing quietly, he finally spun on his heel and opted for the stairwell.
Once through the doors the steps rang in hollow tones under his feet as he descended. At the bottom step he reached out for the heavy metal door that was his entrance to the third floor. Whether he actually took hold of the door handle he would not remember as very unexpectedly everything went black around James Wilson….
“I’m sure he’s on his way, Mrs. Mitchell. I had the impression he was coming straight over -- Oh, here he is, don’t worry about a thing.”
The redheaded nurse holding Steven’s paperwork was too harassed to bother looking directly at her Head of Oncology or she might have noticed the first swelling of a bruise on Wilson’s right cheekbone. For his part, he kept his head low, stuck out his hand for the papers and scribbled the necessary words which would free his young patient from PPTH.
Once safely seated in his office chair again, Wilson sat back and ran both hands through his hair, leaving them on his head for a few moments. What the hell just happened? I feel fine now. I felt fine a few minutes ago. How did I end up on my face in the stairwell? He reached for the pulsepoint on his wrist and counted. Sixty-four. Fine. Rubbing his cheek, he pulled out a small mirror he used for shaving and examined his face. The red mark on his cheekbone was already beginning to betray angry purple undertones. No hiding that. He’d have to come up with some story, not too lame at that if he was to get past House’s radar.
For now, however, at least a solid hour of paperwork sat before him, so he shrugged off the bizarre incident and got to work. Forty-five minutes later he detected the uneven gait and thumping of cane that was House coming down the hall and he steeled himself before the door flew open.
“Doesn’t take long to get back into the swing of slogging through paperwork, does it, oh dedicated boy wonder?” House began.
“Hmmm….no, it feels like only yesterday.”
While Wilson’s left hand curled and scribbled, his right cupped his injured cheekbone. “You done for the day, House? It’s late for you. I thought your patient went home earlier.”
“That she did. Yet another human being alive and well, indebted forever to Gregory House, diagnostician extraordinaire.” Smiling and affecting an elaborate bow, he straightened and studied his friend.
“It’s Friday night. Why don’t you knock off for tonight. We’ll get take out and crash in front of my TV. You know, something new and exciting. I’ll even pay. That’ll be the exciting part!”
Wilson smiled, but only briefly as he felt the skin over his cheek tightened. “Not tonight, House. Like I said before, we’re fine, and I’m sure we’ll do all that again, but I’m not ready to fall back into old patterns yet and besides, I don’t want to leave all this for Monday morning.” He kept scribbling while he spoke as an excuse not to look up at House or change positions.
“Killjoy! Oh well, I’ve decided I can wait because it’s YOU. Suit yourself.”
But instead of turning for the door House lurched forward over the desk and snatched Wilson’s hand away from his face. Defeated already, James dropped his pen, sat back in his chair and looked House in the eye.
“How’d you get the boo boo? Another irate cancer patient going to live?”
“It’s nothing. I was in a hurry and tripped over my feet in the stairwell. Then the wall got in the way suddenly and hit me in the face.” He gave a goofier smile this time and hoped House would let it rest. Surprisingly, he did.
“That’s why we have elevators to ride in. Use one next time.”
Heading for the door, House called back, “See you Monday then. Put some ice on that!”
Wilson finished his charting in peace that night.
Monday morning found Wilson on the ward early, eager to get started with rounds. He had a new female resident joining his team for two months and was making an extra effort to be sharp, insightful and thorough. Wilson led by example and his regular staff knew only too well what was expected of them as a result. There were two junior staff doctors on rotation today along with several nurses, and they all smiled knowingly at one another as they listened to the familiar, gentle lecturing delivered by their beloved boss to yet another ‘wannabe’ oncologist.
Whether Wilson knew it or not, he was the most respected department head at Princeton-Plainsboro. Lisa Cuddy knew this however, and as a result when Dr. Wilson shyly stepped into her office two weeks prior, stammering about whether or not his job had been filled yet, she stood up and rushed over to embrace him before he could get his hands out of his pockets.
Rounds ended when everyone congregated around him at the nursing station to organize their assignments. Wilson was getting ready to leave them all to it when his assistant Catherine appeared and pushed a clipboard through to him and pantomimed ‘sign please.’ Taking it from her, he turned back to hear what the others were riding the newbie about as giggles and taunts erupted everywhere.
Laughter died in the air abruptly and shocked gasps were heard in its place when Wilson let go of the clipboard, dropped silently to his knees and then pitched face down on the floor. His forehead narrowly missed the station counter, but definitely connected with the hard, polished floor. Ever fast-thinking nurses rushed to his side before the doctors could close their mouths.
“Dr. Wilson! Are you alright?” Jenny Caruthers and the redheaded Maureen gently rolled him over, causing him to stir.
“I should get a gurney,” the new resident offered, looking down the hall.
“No, please. Please don’t. I’m alright,” Wilson whispered from the floor as he pushed the nurses’ hands away and sat up quickly. He didn’t think it was possible for him to feel more embarrassed.
“Don’t move too quickly, James. You’re rather pale.” Dr. Brown knelt down and placed a hand on his shoulder while gently feeling his pulse. “Maybe you should lie down for a while. I’ll cover for you as long as you need.” Malcolm Brown was basically Wilson’s second in command and subbed for him whenever necessary.
“Have you been feeling sick, Dr. Wilson?” Jenny had gone for a glass of water and held it out to him.
Taking the water, Wilson tried to think of a way to deflate the situation and get everyone back to work. “No, really, not at all. I’ve been just fine. I don’t know what that was. I’m sorry. I’m fine now.” To illustrate, he hastily pushed off the floor, brushed himself off and took a sip of water.
“See? No problems.”
But Brown was frowning and pointed at his forehead. “I think you’re getting a goose egg, though.”
Crap. He gingerly brought a hand to his forehead and felt a good size lump above his right eyebrow. That smarts a bit.
“Really James, because you’ve hit your head, I insist you go and lie down for an hour or two. And Catherine or I will look in on you just to be safe.” Brown smiled when Wilson started to splutter and protest but didn’t back down.
“Don’t make me play the Cuddy card.”
This threat produced a dramatic sigh from Wilson, but he gave in and promised to go directly to his office couch. He apologized again out of embarrassment if nothing else and chided everyone half-heartedly to get to work. When one of the nurses lingered offering to walk with him up to his office, he rolled his eyes, bit back a sharp retort and insisted quietly he would make it there just fine all by himself.
Stepping off the elevator he shot a stealthy glance at House’s office before he passed it, relieved that it was still too early for House to be on the premises. Taub and Kutner had their noses in medical journals and Thirteen was sipping coffee and staring out the window.
In his office, he shed his lab coat and sat down on the couch, tenting his fingers together and balancing his elbows on his knees. What on earth is wrong with me? He began to rock back and forth ever so slightly as he tried to sort it out. He didn’t feel sick in the slightest. He wasn’t any more stressed than was usual for him. He’d had a four-month break from oncology, so it wasn’t work. He was dealing with Amber’s death as best he could, although he missed her more than he would admit to anyone. She had become a real life-affirming force for good in his life and his heart ached without her.
And for better or worse he had placed himself squarely back in House’s life. Much as he’d been emphasizing self-preservation over the last few months, when he stepped away from Greg House he had ended up feeling as though he had lost a limb. But hopefully, armed with the tools Amber had tried to give him, he would begin a new chapter with House; one where there was real give and take; a deeper, more satisfying friendship.
He huffed to himself as he thought, ‘Less taxing, anyway.’ So having taken stock of things, why had he fainted? Twice! He’d almost forgotten about the stairwell incident, he’d had such a relaxing weekend. There were no warning symptoms either time. He wasn’t light-headed, nauseous, off balance, in pain, over-tired or remotely sick. On the vasovagal side, he wasn’t hysterical, traumatized, emotional or anywhere close to a panic attack. It couldn’t be a drug reaction because he wasn’t taking anything. He couldn’t think of a single reason for a sudden faint. And that’s what began to niggle at him as he obsessively rubbed the lump on his forehead.
He decided that later in the day he would slip into the clinic, check his blood pressure and draw blood for a CBC and chemistry panel. He had assigned enough time to dwelling on something that was probably nothing, so he slipped off his shoes and stretched out for a bit to fulfill his promise to Brown and settle the headache which his ‘goose egg’ had produced. He drifted off trying to come up with a new pseudonym for himself so that no one, specifically House, could spy on his test results. House already knew his alter ego, “Evan James” so that oldie but goodie was out. He’d come up with something clever by afternoon.
The next morning Wilson’s radio alarm brought soft sounds of James Taylor at 7:00 am and he rolled slowly over onto his back thinking there were worse ways to wake up. Inhaling deeply, he stretched his arms and long legs and then let his breath out slowly. He recalled he had an 8 am surgical consult today, so he willed himself to swing his legs out of the warm bed and get moving. As he shuffled into the bathroom he yawned hugely and scrubbed a hand over his face.
“Ow! Crap!”
His goose egg was large and painful with a scrape in the middle and a red ring surrounding it. He was starting to look like the walking wounded. The liquid foundation he had picked up on the weekend had camouflaged the cheek bruise a little, but in combination with the lump on his forehead, he was now going to turn heads for all the wrong reasons. After his shower he grabbed his comb and tried to cover the right side of his forehead with his bangs. Besides looking dorky however, it only proved to draw attention to what he was trying to hide, so he shrugged and reached for his trusty blow dryer instead. Maybe if anyone asked he could attribute both injuries to one silly accident.
At the hospital, his consult went well and an extra biopsy was slotted in for the following day. He took note of a few curious looks in his direction, but so far no one asked him directly about his appearance. He was well aware that his luck was stretched to the limit though by the fact that he had managed to avoid House since acquiring the goose egg the day before. But as lunchtime approached he grew more and more nervous expecting the other shoe to drop. There was no way House would buy two clumsy episodes producing his recent injuries so the best course of action was total avoidance!
Clinic duty! This is great! I’m on this afternoon anyway….I’ll just show up an hour early. There’s always overflow from the morning! Ha! House won’t dare darken the door of the clinic, and I’ll get some Cuddy points as a bonus! Wilson was quite impressed with his sudden brilliance and eagerly scooped up a penlight and his stethoscope, ready to flee his office. He’d also be able to intercept his lab results in the early afternoon as well. Perfect!
Clinic turned out to be a mind-numbing succession of sore throats and fevers with the occasional migraine to break it up a little. By 3 pm James had sore feet and a cramp in his left hand from all the prescription writing and history taking. He decided to take a break and flirt with the nurses in the reception area, realizing only then that he was ravenously hungry.
Lisa Cuddy spotted him, smiled and came to his side.
“Thanks for the extra clinic help. It was - unexpected, but appreciated,” she sounded sincere but wore an appraising grin as she looked up at him. Then the grin disappeared.
“What happened to your face? What are these bruises?”
Wilson rolled his eyes and held up his hands in defensive posture. “Lisa, seriously. It was such an embarrassing bit of clumsiness on my part, I can’t even talk about it. There’s nothing you have to worry about. It was a dumb accident - end of story.”
Not sure whether to believe him or not, she nonetheless left it alone.
“Look, you’ve been a big help today, but can you see one more clinic patient? Two doctors are due down here in twenty minutes, but I’m short till then. Thanks!” She thrust the file in his hands and turned to smoothly intercept Nurse Brenda at the desk.
In exam room two an anxious, elderly woman described in great detail the type of abdominal pain she had been experiencing lately while James listened and nodded in appropriate places. Cuddy was still discussing a scheduling conflict with Brenda when Mrs. McIntyre from exam room two came bustling into the reception area with her arms in the air as if she were madly flagging down an airplane from a desert island.
“Someone come quickly! That nice young doctor’s collapsed! Somebody hurry, please!”
Cuddy and Brenda swept past the woman and found Wilson unconscious, with his face hidden in his arms and his legs splayed. While Brenda rolled him, Cuddy found a carotid pulse and the breath she’d been holding at the same time.
“Get some people in here so we can get him on the exam table!” she barked unnecessarily. When she looked up she found three other nurses rushing in to help and Wilson was laid out with his tie loosened before he even stirred.
“Wilson, can you hear me? It’s Cuddy. You passed out.”
Her concerned voice brought him back to the present quickly, and he tried to sit up, but Cuddy pressed firm hands to his shoulders, forcing him back down.
“No you don’t. You’re not going anywhere.” She kept one hand on his chest firmly and called over her shoulder to Brenda.
“Page House! ---”
“NO!! No, don’t! Please don’t call him down here! Cuddy, --I’m okay, really. I forgot to eat lunch, that’s all. I’m sure that’s it this time!” He clawed at her lab coat, thinking only of keeping House from showing up.
Cuddy’s grey-blue eyes widened. “What do you mean this time? How long has this been going on? Is this how you got those bruises? James!” She crossed her arms, waiting for explanation.
Wilson lay back on the table trying to recover his wits. Again, he had no warning. He really felt alright. Granted, this time he was hungry, but he’d missed lots of meals and never fainted.
“That’s it. I’m getting your medical file. I can’t remember the last time you had a complete physical. But you’re getting one, NOW. And if we don’t find anything obvious, I’m turning you over to House.” Cuddy turned on her heel and made for the door, calling back, “Don’t just stand there. Someone get his vitals and don’t anyone let him leave this room till I get back!”
Wilson closed his eyes and groaned. Things had spiralled out of control and he really didn’t want to become House’s latest patient of the week because of a few fainting spells. If he’d only been able to snag that lab work before anyone else caught on, he might have sorted himself out! In his very next breath the exam room door flung open abruptly, startling every staff member present, with the exception of Wilson who merely turned his head the other way and prayed the floor would open up and swallow him.
“Orson Kane?? Your lab tests are back. And they seem to indicate a pathetic lameness of the imagination. I mean, come on - Orson Kane!! Why didn’t you just rip the poster off your wall and submit the lab request on it! I’d have never guessed it was you!”
Lacing his words with the utmost sarcasm, House still eyed his friend clinically as he flamboyantly swept into the room waving Wilson’s medical file and labs. Then he stopped, placed his hands on his cane and spoke to the room at large.
“Aren’t there hospital regulations pertaining to the number of hovering nurses allowed in one room at the same time?” When no one budged he added, “Really. I’ll take it from here and I promise not to hurt him…much.” Not one nurse failed to shoot him a dirty look as they filed past him.
Wilson tried to take the offensive and sat up on the table.
“How the hell did you manage to hear about this so quickly? No one’s even had time to page you. And the labs, they can barely have flashed across your computer screen! I was waiting for those-”
“When you fainted?” House stepped closer into Wilson’s space and gave him the cerulean stare. “Lay back down.”
“But it’s just a faint, House! I feel great now. This isn’t necessary!”
“You’ve acquired a new boo boo since I saw you last. Just how many times have you fallen and why won’t you submit to a physical exam? What are you afraid we’re going to find, hmm?”
Cuddy re-entered the room before he could respond. “Wilson, you wouldn’t know where your file is would you?”
“Right here, actually.” House lifted it off the counter for her to see.
“House, how-never mind?” Cuddy looked amazed, but pleased to see him. “He’s skipped his physical two years in a row and just passed out while seeing a patient in this exam room. He let it slip that it’s happened before, and unless someone beat him up recently, I’d say something’s going on. Examine him, House. Do whatever you need to do. Wilson, you’re off duty until House clears you. I’ll talk to Brown.”
Wilson began to protest, but Cuddy was great with quick, dramatic exits so he closed his mouth and lay down on the table in defeat.
House suppressed a smirk but turned to a drawer behind him and produced a hospital gown.
“Get naked. Back in five.”
With nothing left to hide or postpone, Wilson decided to get on with it and changed into the most unflattering gown. House, when he came back left the sarcasm at the door and was surprisingly competent, gentle and thorough in his examination even including the dreaded prostate exam with no fuss and no jokes to Wilson’s relief. He spent longer than was usual listening to Wilson’s heart, lying flat, sitting and standing. He repeated the process with b.p. and peripheral pulses. After about twenty minutes, House stepped away and leaned on the nearest counter, favouring his leg.
“You’re not saying much,” Wilson began.
“Not much to say, didn’t find anything.”
James smiled. “Great! I’ll get dressed.”
House also smiled. “Not so fast. We haven’t fixed anything yet. Cuddy doesn’t want you wandering the halls of PPTH falling down all the time. It doesn’t inspire much confidence.” He raised his hand as Wilson threatened to argue.
“Stop it. You’re choosing to ignore basic medicine here. Fainting is not serious, in fact it’s majorly boring when it presents with the typical symptoms. You run a physical exam so you don’t miss anything and then the patient gets on with life and probably never faints again.”
He grabbed his cane and started to pace at the end of the exam table. “But you appear to be symptomless, which has the potential to be much more serious, which you already know, I might add. Since you’re not dehydrated, anaemic, exhausted, drugged out or in emotional distress at this particular moment in time, we need to rule out metabolic disorders, neurological conditions and cardiovascular problems.”
Pulling out his pager, he turned his back on Wilson who’s fidgeting with his gown ties was getting on his last nerve. He untied, retied, twirled, bunched, straightened, knotted and generally fussed with the material.
“House! My bloodwork’s fine! That rules out all likely metabolic---”
He raised a hand, putting the pager away. “Fine, you get one star. I’ve actually moved on from metabolic already. Neurologic is on his way down.”
“You didn’t page Foreman about this?!”
“Well, kinda, sorta, yeah, I did,” House taunted. “And before you start whining, if I don’t do the rule outs on that, when I move on to cardiovascular, you’re going to be distracting me with, ‘maybe it was vestibular or neurological’ and I may have to kill you before I cure you!!”
Wilson blinked the way he does and said quietly, “No need to get testy.”
As House would have predicted, Dr. Foreman declared Wilson free of any neurological complaints. Reflexes were present and quick as lightning. There were no inner ear abnormalities and no nystagmus within those liquid brown eyes to betray any trauma to the brain.
House had gone for coffee, without bringing any back for anyone else, and sauntered back into the exam room they had commandeered for over an hour now.
“Are we done yet?” he chirped at Foreman.
“No neurological reason for the fainting.”
House ignored Wilson who was wringing the back of his neck. “OK, thanks for that. And by the way Foreman, on your way back upstairs, swing by Cardiology and book the stress lab for my friend here. I’ll wait for your page. Oh, and sign out a Holter monitor in Wilson’s name.”
“House!” Wilson rolled his eyes and hopped off the exam table, partly because his ass cheeks were asleep. “Enough! This isn’t necessary! My heart is fine! I’ve been cooperative, but---”
“Oh, right, for an entire hour! You ain’t seen nothing yet, pal of mine! Cuddy is looking for answers. That’s why she asked ME to find them. I can’t let her down, can I? Think of my rep, dude.”
Wilson looked pained. “Your rep? Since when have you given a crap about your reputation? You’re just enjoying playing with me!”
“Yes, there is that, but the fact is you have no choice. Stop whining, get dressed and we’ll go up to my office where I can keep my eye on you. Have you forgotten Cuddy’s taken you off the clock?”
House was trying not to sound smug but wasn’t really pulling it off in Wilson’s view. Nevertheless, they headed up to Diagnostics, where no doubt the rest of the team could soon set upon Dr. Wilson.
So, feeling beleaguered, Wilson found himself sitting on a hard chair with his head in his hands in the middle of the diagnostics room listening to his own differential. Oh, God…there’s gonna be tests and tests and more tests, and arguing. Ohhh…
House paced a line behind Wilson as he began. “Thirty-nine year old, caucasian male, disgustingly healthy presents with unexplained, apparently symptomless fainting. Three episodes in five days, all on hospital property. CBC and Chem panel BORING, no indication to run metabolic tests and Foreman pronounced him clean neurologically. GO!”
Thirteen: “No warning? No light-headedness, like ‘gosh I need to sit down…’
Taub: “Haven’t been fighting the flu, not sleeping, no complaints at all?”
House rolled his eyes dramatically. “Done this, people!”
Kutner shot him a look before offering, “Any history of heart disease?”
Wilson stopped shaking his head and looked up at Kutner. “My heart’s fine.”
“Until it’s not, Jimmy boy. There are any number of arrhythmias that temporarily interrupt blood flow to the brain resulting in loss of consciousness. Some are congenital, but they usually show up about 25 years sooner than this. Some are drug induced, like Long Q-T syndrome and are easily controlled with beta-blockers. Some are harmless and embarrassingly inconvenient, while others are potentially fatal.”
“If it’s intermittent, it’s going to be a challenge to find it, let alone diagnose it,” Thirteen interjected.
“Oh but this is where the fun begins,” House piped in enthusiastically just as his pager went off. “What’s this? Dr. Wilson! Cardiology says the stress lab is yours for the next 45 minutes! How perfect is that??” Ignoring a low moan, House placed his hands heavily on Wilson’s shoulders and addressed his team.
“You have my permission to stress test him to your heart’s content. Treadmill, tilt table, make him sweat, make him pant, but record it all. If that doesn’t show us anything, run a signal-average EKG over 20 minutes and then sign him out a Holter monitor for 36 hours.”
An hour later Dr. Wilson was tucking his shirt into his pants after debating with himself over the best place to put the bulky monitor he had to carry for the next 36 hrs. In addition to the three leads attached to electrodes placed on his chest, he now wore a belt just above his waistline, which carried the monitor itself. He was able to slide it anywhere along the belt; front, back or side and he’d been playing with its placement for ten minutes. He’d also remembered to shower before getting hooked up since that was a no-no for the duration of this latest test.
Running a hand through his damp hair, he sighed and headed back up to Diagnostics. He had been very patient with Taub, Kutner and Thirteen, allowing them to put him through all the tests the stress lab had to offer while they monitored his heart and blood pressure. After forty minutes pushing the sweaty oncologist, they had not been able to provoke any kind of arrhythmia or change in b.p.
“I don’t know how I’m going to sleep with this damn thing on.” He settled himself in House’s comfy chair across from the desk.
“Are you kidding? I’ve seen you fall asleep in every position imaginable. Almost standing up! Stop whining, you’ll be fine.” House tossed his reading glasses on the desk and assessed Wilson visually for the two hundredth time that day.
“Well, still nothing to get excited about. Are you sure you’re not bored enough with me as a patient to just forget the whole thing?”
“Nice try.”
“Yeah, well. It’s expected of me.”
“The good news is, Cuddy says you can go back to work while the Holter is in place. There’s no point seeing what your heart is doing if you’re lazing around at home. Just maybe we can catch the critter responsible for your ‘spells’ by letting you do what you do every day.”
“Whatever. I’m going to my office then.”
“Day’s over sport. Go home and try again tomorrow. That thing’s turned on, right?”
“Fresh batteries and everything. See you House.”
Wednesday turned out to be a boringly regular day, and if Wilson’s Holter monitor were to be consulted it would have shown an endlessly repetitive sinus rhythm. As for Wilson himself, he wasn’t happy about being unable to shower and managed to lean on, elbow or fuss with the device at least a dozen times during the day. Currently it resided on his right side, just above his belt. Only House, Cuddy and the new team knew he was wearing it and no one else picked up on the little hiccup in the flow of Wilson’s long white lab coat down his body. House actually left him alone except to sponge lunch from him and Wilson was beginning to think by day’s end that whatever his problem was, it had come and gone.
Selecting the files to come home with him that evening, Wilson scissored the compartments of his briefcase open and sorted, ignoring House’s entry.
“I’m hungry and my proverbial cupboard is bare. Want to get Chinese on the way home?”
“On a weeknight? Wow, aren’t we splurging.” He grinned at House, feeling charitable and added, “Sure. I’m ravenous.”
Following House in the Volvo so he could leave at a reasonable hour, Wilson backed the vehicle out of its spot and caught up to House at the traffic light. Reaching for the play button on the CD player, he recoiled suddenly as his heart began to pound in his chest with palpitations. He recognized them as a common side effect of panic attacks as he had experienced a few of those in the last couple of years, but he didn’t feel any stress at the moment. Holding tight to the steering wheel he tried to ride it through and concentrate on driving. He considered pulling over but didn’t want to alarm House. So he told himself to breathe evenly and deeply and tried not to be alarmed by the rapid, irregular banging within his ribcage.
As suddenly as they had come, they subsided and Wilson exhaled loudly in the privacy of his darkened car. He took stock. No sweating. There was no chest pain. His carotid pulse felt steady and quiet. There was no light-headedness or ringing in his ears. Most importantly he hadn’t fainted. As headlights whizzed past he considered telling House what had happened. They couldn’t consult the Holter at this point without shortening the test by more than 12 hours, so they wouldn’t learn anything now anyway.
Spotting the Chinese place at the last moment, Wilson made a sharp right and parked while House continued home. The bum leg always meant Wilson picked up the food. If he were really fortunate House would open a beer and pass it to him when he got in. He took his time paying for the food and headed carefully back to the car, but he felt fine again.
He decided not to bring up the incident for now, and they ate in a companionable silence that reminded him of better days. He watched as House flipped through the channels looking for some stupid movie, but Wilson was no longer interested.
“I’m gonna head home, House. I brought a lot of work home tonight.” He gathered the take out refuse and tossed it in the kitchen garbage. When he came back he was surprised to see House had gotten to his feet to walk him to the door.
“I can find my way out like always, House.”
“Uh huh.”
“What?” Wilson couldn’t quite meet the intense, cerulean stare he was faced with.
“You okay?” House stood toe to toe with him, scanning.
“Yes!” he hissed, reaching up to rub the back of his neck, “I just want to go home.”
“You’ve gone pale, --- grey actually.” He reached down for Wilson’s wrist without taking his eyes off his face. “Hmm, tachycardia. Sit down, Wil---“
James chose that moment to roll his eyes back in his head and sink to the floor without a sound. House still had a light hold on his wrist, but favoured his leg instinctively and let him fall, hauling up on his arm at the last second so Wilson didn’t crack his head on the floor.
“Shit!”
Kneeling awkwardly over Wilson, House felt for a carotid pulse. It was still rapid and shallow. He hauled himself to his feet and hobbled quickly to the hall closet to fetch his medical bag, grabbing his cell phone from the hall table on the way.
“911? I need an ambulance sent to 221B Baker St. immediately. Possible impending cardiac arrest. Thirty-nine year old, Caucasian male, unconscious and tachycardic. Suspected recent history of arrhythmias, cause as yet unknown. Hurry.”
Secretly panicked, House had to run through his emergency ABCDs like some hapless bystander. He fell on his knees at Wilson’s side, viciously tearing away his tie and ripping open his shirt, scattering buttons at will. His lips were still pink and that took care of A and B. But House knew that ventricular tachycardia could quickly decompensate into ventricular fibrillation and he had no defibrillator in his back pocket.
Placing his stethoscope slightly left of his sternum House listened to the rapid heart rate, taking in the pale, smooth chest rising and falling beneath him. Try as he might, he couldn’t pick up an arrhythmia though that was pointless at the moment. Where are those ---
The door burst open in answer to his unspoken question and two burley EMTs immediately wheeled a gurney to Wilson’s side. The next 5 minutes were spent placing an IV, oxygen mask, removing the Holter, placing new electrodes for the portable ECG the EMTs carry and arranging James on the gurney. A discussion began as to whether or not to intubate him, when House finally lost it.
“Not now! I don’t know why he’s still unconscious, but he’s breathing well enough on his own for now. We need to get to Princeton-Plainsboro before he goes into v-fib! We can intubate in transit if we have to! I want a fully stocked crash cart and a cardiologist sooner than later!! Move him now!”
In the ambulance, House’s eyes were fixed on the tracing from the ECG monitor and he hung on every beep. He stole a look at Wilson’s boyishly vulnerable face and felt his own heart skip a beat. Every few minutes Wilson’s heart would slow slightly and beat more strongly and he would stir - moving his head and moaning softly, but never more than that. Not until they were six minutes out from the hospital did House remember to call Cuddy directly, barking instructions and demanding she clear the way. After only a few seconds of stunned disbelief, she hung up from House and did just that, tracking down Petersen from cardio and heading toward Emergency and Dr. Cameron.
When the emerg bay doors swung open, Cuddy and Cameron were standing ready for one patient only. Except for the white-knuckle grip Cameron had on Wilson’s patient file, she exuded readiness and confidence. Cuddy’s eyes went directly to House’s pale face. Somewhere he had lost his cane and he used the rolling gurney to hoist himself off his bad leg and keep up.
“ER bed number 2, left side!” Cuddy directed, getting the next door. Petersen, cardiology’s best at PPTH, was already moving toward them from inside the ER. House backed out of the way to catch his breath as the team moved in to lift James hastily off the gurney. But House was watching the monitor that still sat between Wilson’s legs and his face fell.
“V-fib!! Paddles! Now!”
They let him down again in the disarray of tubes and wires and Cameron flung the ambulance blanket away. Cuddy moved in and forcibly tugged House out of the way, saying something House never did hear. Peterson himself charged the defibrillator and House watched it in use as he had hundreds of times before. But this time it was Wilson’s body lurching off the bed in response to the electrical jolt and Cuddy’s hand covered House’s gently as she heard him gasp.
* * *
Wilson was falling down a hill, uneven ground bruising his hips and shoulders. If he opened his eyes bright light would filter in and he kept them shut just a little longer. Voices began to flood into his consciousness and he felt afraid, sensing urgency and concern around him. He heard moaning and mumbling, but he couldn’t make it out and suddenly his chest was on fire and it was too hard to breathe.
“He’s coming around.”
“Look at the monitor.”
“What?”
“Petersen. The QRS pattern. See it?!”
“House, I see it, but I need to stabilize him first -
“No! This is the source of the problem. Convert him now, before he’s fully awake!”
“That’s crazy! We do that under sedation in a more controlled -
“Half the ER is here for back up! Fix it now while we can see it, for God’s sake!”
“House! Don’t -
“House!!”
James heard a scream erupt that echoed through the ER, and things were hazy for a few seconds. Hands gently cradled his limbs and supported his head, placing him in a softer bed. He tried to speak, but searing pain took his breath away and tears leaked out of his tightly closed eyes. He felt a hand grasp his left one, a thumb moving gently and reassuringly over his knuckles, back and forth, back and forth…
“Steady on….try to slow your breathing. You’re okay now.”
Some time later he thought he wanted to know who was speaking, so he moved his head to the left and opened his eyes. House was looking at the monitors and bouncing his cane on the floor.
“Hey?”
“Hey yourself.”
“Where am I?”
“ER. How’s your chest?”
“Hurts.”
“Morphine coming up.” He heard a thin beep.
“House?”
“Yeah?”
“You held my hand.”
“Nah. You’re mistaken. That was Cameron.”
Comforting warmth began to spread through his limbs, carrying away the pain and making his eyelids heavy. He struggled to open them one more time.
“House?”
“Yeah?”
“Tell Cameron she needs to do something about those calluses.”
House’s face cracked into a grin as he looked at his sleeping friend. I’ll get right on that.