Chapter Four - "Observation Deck"
The elevator doors opened and House moved quickly toward the patient's room in the ICU. It wasn't hard to find; it was the one that had Kyle James, the patient's husband standing outside of it with Thirteen, demanding to know what had happened.
“I leave to get my son from his job and when I come back, I'm told my wife had a heart attack while you were performing tests? Why weren't you keeping an eye on what your staff was doing?" he said addressing House as he joined the two.
“I'm sorry. My potty break coincided with your wife's not-a-heart-attack-event. You know how it is; when you gotta go, you gotta go.”
“Mr. James, as I was about to explain to you, your wife didn't have a heart attack,” said Thirteen trying to restore some semblance of professionalism to the situation. “She experienced tachycardia, which is a rapid pulse rate… ”
“I know what tachycardia is,” James said cutting her off. “I've been dealing with Bonnie's heart problems for five years now and her health problems in general for twenty-four. I know a bit about medical issues: I'm not stupid.”
“Do you have unbiased proof of that?” asked House. Thirteen was exasperated and about to say something when Taub and Chase approached.
“Thank you, Mr. James,” said Chase handing him a set of keys. “It's usually much harder for us to do an inspection of a patient's house.”
“How so?” asked James.
“Well, to get in, first we have to use a credit card on the front door lock,” began House. “It has to be major card; department store and gas cards aren't accepted. Then we… ”
“Mr. James, we really need to go over test results and come up with some ideas on how to help your wife. Why don't you and your son visit with her for a while and if we need to speak to you, we'll know where to find you,” said Thirteen directing him toward the door of his wife's room. Thirteen looked around. “Where is your son?” she asked.
“He's sixteen and a human garbage pail. I sent him to the cafeteria to get something to eat.” At the mention of the cafeteria, House's mind drifted back to Lydia. He put his hand in his pocket and fingered the slip of paper she had given him. Given his current state of mind, he wondered how he was going to focus on the case…
“House!” He turned to see Thirteen staring at him. “Are you OK?”
“Yeah.” He turned away, headed for the elevator, and then to his office. The team was right behind him, gathering in the conference room; Chase and Taub got coffee, Thirteen sat down and began going through the file of test results. House paced back and forth, twirling his cane. He walked over to the table where the other three were now seated and began slowly, deliberately circling around the table. He suddenly stopped, and slapped his cane down next to Taub's coffee mug.
“Why?” Startled, Taub, Chase and Thirteen looked at each other, puzzled. They looked at House, who had asked the question.
“Why, what?” asked Taub.
“Why did you wimp out and ask for the keys? That’s not protocol around here.”
“No, but since the husband was here with his wife, he would have no chance to go and hide anything.”
“Besides,” Chase said, “It's better than taking the chance of getting arrested.” House smirked.
“Oh, I forgot to tell you. You two and Foreman got arrested for breaking and entering while I was visiting my own little personal black hole. I let you guys just sit and rot in jail. It wasn't all bad; you made lots of new friends,” House said, rather pleased with the memory.
“What did you find at the house?” asked Thirteen, bringing the patient back into focus.
“Absolutely nothing out of the ordinary. The only pets are four guinea pigs that the son keeps in his room. The cage looked clean and the animals well cared for,” Taub said. “No other pets, no plants except for a few basic houseplants; an aloe, an African violet. Hardwood floors, no carpets hiding any allergens. No unusual cleaners or chemicals; nothing remarkable.” House sat down, his brow furrowed in thought. He heard the words, but paid no attention to who was saying them.
“We should check and see what kind of contact the patient has with the animals; she could have picked up something that way,” offered Thirteen. “She has a compromised immune system.”
“Diabetes and her cardiac issues put her at an especially high risk,” observed Chase.
“Right, but it's not just that; she's taking Methotrexate for her RA,” noted Thirteen.
“How does the rest of the laundry list read?” asked House. Thirteen took a deep breath.
“Lantus and NovoLog recently replaced the Humulin she took for years,” Thirteen began. “Aspirin, potassium, folic acid, ibuprofen, Plavix, Coreg, Digoxin, Lasix, Methotrexate, and Vicodin. She was on Lipitor and metolazone, but they later took her off them.”
“Why?” asked Chase. Thirteen gave a little laugh.
“She says she ran out of room in her pill case.” House smiled at the comment; sarcasm, right up his alley. He didn't talk much to the patient when her husband dragged him up to her room earlier; she was in too much pain. Her husband did most of the talking, which is where House formed his unfavorable opinion of him.
“I'm going to guess she got her cholesterol under control and her heart started working strongly enough to inhibit a reoccurrence of CHF,” commented House.
“That's another crazy thing about her background. She never had any problems with her lipid profile. She's been tested yearly for the past ten years; HDL, LDL, triglycerides-all in normal range. She never had a cholesterol test above 176,” said Thirteen. Taub was looking over a section of the file; he shook his head.
“It's amazing she's alive,” he said. “Angiogram prior to surgery showed two arteries 80% blocked and two 100%. Ancillary arteries formed to compensate. Her ejection fraction was only twenty-four; but she never spent a day in the hospital before her surgery.” Chase had taken the file as Taub was speaking. He let out a long whistle.
“She had trouble coming off the bypass machine. It took three tries before they got her heart started again. A lot of damage to the left ventricle, yet her ejection fraction six months after the operation was forty-seven.”
“Much closer to normal,” noted Taub.
“The really sad thing in all this, is that she was supposed to have the defibrillator put in a few days after the operation; but when she had trouble getting off the bypass machine, they decided to wait six months. At that point, as you saw, her EF came up and the insurance company wouldn't pay for it,” Thirteen said in disbelief. “Two and a half years later, she had cardiac arrest. They worked on her for fifteen minutes. They even called TOD and pulled a sheet over her. They only knew she still with them when she said ‘I'm not dead yet.’” House chuckled; the team turned to look at him.
“She's a Python fan,” he explained.
“How do you know she likes snakes?” asked Taub. House rolled his eyes.
“Monty Python!” he shouted, sounding annoyed. “Are you really completely devoid of any culture?” He turned to Thirteen. “How much Vicodin?” She took the files from Chase and paged through.
“Five milligrams. She's allowed up to four tabs a day, but says she can get by on only two prior to her current complaints.” House nodded his head.
“Amateur.” Thirteen glared at him and drummed her fingers on the table. House gestured for her to continue.
“Mr. James said she was doing well with her drug regimen until seven weeks ago, when everything hit the fan. She continued taking her meds in the usual doses, but obviously something has gone wrong.”
“Anything remarkable from her childhood?” Chase inquired.
“Just the usual stuff: measles, mumps, chicken pox. She became a diabetic when she was eleven. She had mono twice.”
“Twice?” questioned Chase.
“Once when she was twelve; the second time when she was in college. It seemed it was rampant on campus and she caught it.”
“Floozy,” House said under his breath.
“House!” Wilson was standing at the door to the conference room. Everyone in the room turned to look at him. “While I'm glad to see that you're holding up well in you return to work, does it have to include insulting the patient's husband?” he asked.
“Can I help it if the guy is overly sensitive?” Wilson folded his arms.
“It would help if you could temper your attitude a bit. Are you making any progress with the patient?” he asked.
“Well, except for coming back from the dead, so far it seems she's so boring and ordinary that she's extraordinary. She has half dozen or so major illnesses, but nothing's jumping up saying ‘pick me.’ Anything stand out in her labs?” House asked Thirteen. Foreman walked in as she began to go through the reports.
“Nothing; in fact, her diabetes is in excellent control. Her A1C was 6.8 and her cholesterol was 158. Of course she hasn't had much to eat in seven weeks. Her potassium and sodium are low, so we'll have to address that.”
“None of which points to why Mrs. James is having the kind of pain and edema she's experiencing,” said Foreman.
“Hold on,” said House. He started patting his pockets and then walked into his office and began opening drawers on his desk.
“House, what are you doing?” Wilson asked.
“I'm looking for something to give Foreman for his lips. He's going to need it after all the ass-kissing he did to shut the husband up.”
“I wouldn't have to do anything, if you had a more sympathetic attitude toward people,” admonished Foreman, “It would go a long way.”
“Again with this attitude thing,” House said as he walked back into the conference room. “I don't have an attitude. I have a personality that most people can't handle.”
“That's for sure,” Chase said as the others nodded in agreement.
“Anyone have something useful to offer on the differential?” House asked. Thirteen kept looking through the lab reports and shaking her head.
“None of this makes any sense. No elevation in white count, minimal fluid in the mastoid, no mastoiditis. Her sinuses cavities are small but basically clear. Again, a minimal amount of fluid present. Cultures of mucus and sputum are negative.”
“So clinical evidence suggests no cause for what the patient is experiencing,” said Chase.
“But clearly she is exhibiting severe symptoms of… ” Taub trailed off. He shrugged his shoulders as he was unable to suggest anything.
“Something,” finished House. He rapped his cane repeatedly on the floor. Everyone in the room was silent, as none of them could come up with an idea; they could all see House becoming more agitated. “What are we missing?” No one spoke. “That wasn't a rhetorical question,” said House, his voice getting louder.
“Maybe it's time you talked to the patient,” offered Wilson. “Observing her might give you the insight you need to figure things out. Besides, it would be the diplomatic thing to do.” House let out a disgusted sigh.
“Fine,” he said. “Give me a minute while I go collect some rocks.” The team gave Wilson puzzled looks as House left the room and made his way down the hall.
“We'll be back,” he said following House. Wilson caught up with House as he walked to the elevators. He could sense the tension in House by the look in his eyes and the quickness of his gait. Not wanting to add to the problem, Wilson thought things through carefully before speaking and decided he was damned no matter what he did. “So… who is she?”
“I don't know,” said House in an annoyed voice. “And I don't care who she is. I just want to know what's making her sick and make it go away. After that she can go to hell.” Wilson stopped walking and grabbed House's arm.
“House, I know it's bothering the hell out of you that you don't have an infinite number of ideas at your fingertips. But that's been true in many of your cases in the past. It's no reflection on your ability to handle the work at this point.”
“At this point,” House repeated. “What if it's an indication of the future?” He started to walk away, turned, and said, “What if I can't do this anymore? What if getting hit in the head took away what I need to do this job? Why do you think I wanted to get back here? I've got to see what I have left.” House shouted, a tone of desperation creeping onto his voice. Wilson looked down and walked over to him. He never heard House question his abilities with the intensity he was now.
“I told you when you came out of the coma; there was no brain damage at all. You're… frustrated; you want to go whizzing through things to prove that you're OK. You will be; just not yet. You still have too many things to work out.” House took a minute to consider Wilson's words; he finally nodded and continued to walk, with Wilson following. He still wanted to ask about the woman that was with House. He considered the possibility that she was one of the things on House's mind. He saw the way House looked when he was near her. This could be a mistake, thought Wilson, but here goes.
“House, who was the woman I saw you with earlier?” Wilson saw House visibly squirm.
“Someone looking for free medical advice. She assumed I was a doctor. Must be the cane.” House reached over and pressed the button for the elevator. Wilson shook his head.
“I'm not buying it. I saw the way you were behaving. I can't remember the last time you were reacting that way to a woman. Not with Cuddy for sure.” House shot him a look. Whirring sounds indicated the arrival of the elevator. They got in and House pressed the button marked ‘P.’
“Why are we going to the parking garage?” Wilson was clearly confused.
“Because, it's our own personal Bat Cave, boy wonder.” House looked up at the panel and made a face of disgust when he realized they were stopping at the lobby. As the doors opened, he began to cough violently. He looked at Wilson and said, “So I have no idea where I could have caught the typhoid from,” as he continued to cough. Wilson's eyes widened as he turned to the people waiting to enter and said,
“I think you may want to take the next one.” The door closed and House stopped coughing. “Congratulations; I don't think DeNiro could have done any better,” observed Wilson as he shook his head. House didn't answer. Wilson watched him closely as he stared off into space with his hand in his pocket. He had to find out what was bothering him. They stepped out of the elevator and Wilson let House take the lead. He walked down past a few support pillars, stopped and leaned against one. House looked at his watch.
“You have five minutes to do your worst. Then Dr. Killjoy, the patient's husband is going to send out a search party. I don't want to be found with you like this. There's already enough gossip.” Wilson put his hands on his hips and tried to find the words that would actually get House to talk. Blunt was best.
“Who is she?” House waited to answer. He really didn't want to talk to Wilson about Lydia. Not yet.
“I met her at rehab and no, she was not a patient. She was visiting someone there. We talked a couple of times… and now she's stalking me. I threatened to call the cops and she left. End of story.” House shrugged and gestured with wide open hands. Wilson slowly moved his head up and down and walked over to him.
“I think you may be sending mixed signals to your ‘stalker.’ One doesn't usually hold their hand and kiss them on the lips” House looked shocked.
“What makes you think I would do something like that?”
“Because I followed you from the cafeteria and saw you from the walkway above the lobby.” House narrowed his gaze as he looked at Wilson.
“I stand corrected; you're better at the cloak and dagger stuff than I gave you credit for.” Wilson reached up and rubbed his forehead.
“House, I don't want to pry into your personal life… ” House scoffed at Wilson’s statement.
“Are you kidding me? Prying into my personal life is full time hobby of yours; second only to the ongoing search for the next Mrs. James Wilson.”
“I'm worried about you,” said Wilson raising his voice. “You're letting the case get the better of you and you are still trying resolve things that happened at the collapse, including Cuddy. Now this woman shows up and you look… dazed, at the very least.” House looked around the garage not wanting to make direct eye contact with Wilson.
“I really did meet her at Mayfield,” he began quietly. “Her name is Lydia. I don't even know her last name. Her best friend was at the hospital.” He finally looked at Wilson. “We became friendly. Spent some time together. That's it.”
“Became friendly? Spent some time together? Is that secret code for something more?” Wilson asked looking at House closely.
“We made love,” House admitted “There I said it in plain English. Happy?” Wilson was taken aback.
“Oh, God… House, she's pregnant?” House turned and looked at him with abject amazement.
“No, she's not pregnant! Not unless she's had the longest gestational period of any human in history. In which case I'm switching specialties.” Wilson held up his hands.
“Okay, so I got the timeline wrong. Then why is she here?” Trying to act casually, House replied.
“She was just in the neighborhood and wanted to say hello. Wanted to catch up. I didn't have time to talk; Thirteen called me.” Wilson looked at his watch.
“Speaking of your team, someone's going to come looking for us. We'd better get upstairs.” They headed back to the elevators. Wilson reached out and pushed the button.
“You're going to have to come up with some really shiny rocks for me to be diplomatic with the husband. He thinks he's a walking Merck's manual,” House noted. Wilson nodded.
“He's had to deal with his wife's problems for a long time now. I think the stress of the situation is getting to him. What's your problem with him? A little sympathy might help.” House shook his head.
“People with a little knowledge are dangerous. In the case of medical knowledge, it can be deadly. I don't suffer those people gladly.” The elevator doors opened and both stepped inside. Wilson looked at House and studied him for a moment.
“She really got to you, didn't she?” he said. House made a face.
“What are you talking about?”
“Any time you refer to physical relations with a woman, you say 'having sex'; or you use a rude, inappropriate phrase.” House looked at him.
“You said ‘we made love.’” Wilson gave a slight smile. “She got to you.” House didn't reply. “Do yourself a favor. Call her.”
“Her number's unlisted.” Wilson looked House over from head to toe.
“I think you'll find it on a piece of paper that I saw you put inside your left pocket. House, call her,” Wilson said firmly. House stepped out as the elevator doors opened on the ICU floor, then stopped. He looked concerned.
“Wilson… I think I got to her, too.” Wilson smiled.
“Call her.” House started to walk, hesitated and looked over his shoulder at his friend.
“I already did.”