Chapter Eight - "Checking the Blueprints"
House looked in, and saw that Bonnie James now had a full oxygen mask covering her face. She was lying on her back, which led House to believe that she had been given something to sedate her; otherwise, she wouldn't have been able to tolerate the position. He became aware of both Foreman and Wilson standing next to him.
“I don't know what to say to them anymore,” Foreman said quietly.
“Why'd she code?” Wilson asked.
“Probably the pain became too intense. We were just about to restart the Dilaudid drip when it hit. Fortunately, things were under control right away.” House was silent as he watched the scene before him. Kyle alternating between sitting and standing, but always remaining in physical contact with his wife to reassure her he was there. He kept leaning over and speaking to her. House was sure Kyle knew that she couldn't hear him, but that didn't stop him. Bonnie James was physically damaged; even more than House himself. Yet this man didn't care about her defibrillator, her medications, her trouble walking or her scars. He loved her, pure and simple, even if getting her drunk on champagne was no longer redundant. He turned to Wilson and Foreman.
“So, how long are you two going to follow me around with pooper scoopers in case I make a mistake? Or do I have to remind you that I'm already paper trained?” asked House. Wilson and Foreman exchanged looks.
“House, I'm following this case as a legitimate part of the team. I really was in the ER when she was brought in,” Foreman said. House looked to the side and shook his head.
“Don't ever bother going to Atlantic City; because you're a lousy poker player.” Foreman gave him a puzzled look. “When we had to break the news to the husband and son that bodily fluids were going to be needed to work the case, you went down there as the kindly hospital paper-pusher, not a doctor needing their cooperation to get answers. Given the choice between the two, you folded and went for the deskbound geek approach.” Foreman looked at Wilson and waved his hand in the air in frustration.
“House, I don't know what my role around here is anymore. I'm still trying to figure it out. Under different circumstances, I'd embrace it, I'd love it. But I'm finding the situation difficult, especially given whose shoes I'm trying to fill.” House nodded his head.
“Yeah, size six stilettoes with four inch heels never were your style,” he said as Wilson rolled his eyes. House caught the gesture and said, “And how do you plead?” Wilson opened his arms wide.
“Guilty of caring too damn much. I hesitated in letting you come back this soon and if I knew it was going to be this complex of a case, I would have held you back a while longer. But then you would have missed meeting up with someone.” House shot Wilson a look
“You know what they say about loose lips,” said House. Wilson nodded.
“I know, they sink ships.”
“No, they get four flat tires,” replied House. He turned to Foreman. “What do you have her on?”
“Low level dose of phenobarbital.” Foreman answered, still looking very confused over House's last comment. “We were waiting for you to show up.”
“Next time, don't.” House saw Taub, Thirteen and Chase coming down the hallway.
“Get her started back on Neurontin. Kick start it with a double dose and take her off the Jimi Hendricks Experience,” House directed the team.
“Why, what's going on?” Thirteen asked.
“Come on back inside,” House said as he walked to the patient's room, “It's story time in Dr. House's neighborhood.” House went into the room and Kyle James immediately stood and approached him.
“Please, please tell me you can do something to help her. She can't deal with this pain any more. It's killing her.”
“There is something I can do, but more importantly there is something you can do,” House said.
“Anything, just tell me and I'll do it,” James said
“Grow a pair!” House yelled. “She deals with the pain so well, because she has you to lean on. If she sees you're falling apart, she's going to give up.” Kyle James sat back down.
“I need her. I love her,” he said. “She can't give up.”
“Neither can you,” House said. Don James put his arm around his father.
“You know how you asked me before what I wanted for my birthday? I want Mom back.” Kyle reached over and hugged his son. He pushed back and took a few deep breaths.
“OK. What do we do?” he asked. House turned to his team.
“Get the Neurontin started.” Chase left the room to get the medicine from the pharmacy.
“Neurontin? Isn't that what just made her so sick?” asked James.
“Yeah, but that's because it doesn't know how to play nice with Vicodin. We're going to keep Vicodin out the sandbox for now.” After several moments, Chase walked in with the Neurontin and placed it in House's extended palm. He pulled the sedative drip and replaced it with the Neurontin which he slowly pushed into Bonnie's IV. When he had finished, he looked at Taub and said, “Do a draw. Test hypercoaguable studies and neutrophic immunoglobulin G levels.” House leaned on the bedrails, obviously agitated. “We really need an MRI for absolute confirmation.”
“You can't,” said Kyle. “They told her when the defibrillator was put in, that she could never have an MRI.”
“Yeah, but 'they' never knew she was going to be a featured story on 'Unsolved Mysteries’,” said House.
“House, what are you looking for?” asked Chase.
“Shingles,” he answered. “She had chicken pox as a child, shingles as an adult often follows. But, consistent with her tendency toward being interesting and unusual, our patient has zoster sine herpes.” House turned to Kyle. “I'm glad she wasn't awake to hear me call her unusual. She hates that.” He turned back to the others in the room.
“Shingles without a rash?” questioned Taub. House rolled his eyes.
“Yes, shingles without a rash. Even a pre-med student knows about that.” House glanced at Wilson and caught him smiling over the reference to Lydia.
“But, why did it attack her sinuses and not around the trunk of the body like shingles usually would?” Thirteen asked.
“Because it didn't feel like traveling. And it never did invade her sinuses,” House said. “When the zoster virus is dormant in the body, it stays in the nerve roots along the spine. I'm going to say that in the patient's case, most of her chicken pox lesions she had as a child weren't around the trunk of her body, but around her head. If you notice,” he said as he parted her hair. “There's some scarring from the pox part of the chicken pox here, at her temple, and in the corner of her nose and eye.”
“All on the right side,” said Chase. House nodded.
“So, it stayed dormant in the C-3 nerve root and when it became active again, it didn't bother traveling down the spine,” Taub said.
“But, why didn't it go anywhere?” Foreman asked.
“Location, location, location. It had the perfect host right where it was. Why go on a vacation when you can do a staycation,” said House. “It affected the nerve trunk here,” he said placing his hand on the upper right side of Bonnie's head and face. "It irritated all the ancillary nerve bundles include those in her sinus cavity, imitating a whopper of a sinus infection.”
“What about her mouth and throat?” asked Wilson.
“That was because she continued to take her Methotrexate, which lowered her immune system further. The mouth sores and throat irritations were always there; they were just exacerbated by the virus reactivating,” House said. “She was caught in a vicious circle.”
“But can you help me?” a muffled voice said. Bonnie James had her eyes open. Her husband and son jumped up to be nearer to her. Kyle James was holding her hand and gently brushing the stray hairs off her face. House looked up at the monitor.
“Your heart rate and BP are holding for now. I'm going to keep you on Neurontin for a few days. We’ll have confirmed the shingles and put you on an anti-viral medicine at that point. We can then switch you off Neurontin and get you back on Vicodin. You'll be in some pain from the Fibro and RA without the Vicodin, but considering how you've dealt with the shingles you can handle it.” He turned to Chase. “Start standard dosage for acyclovir and ease her back down to normal protocol for Neurontin with the next dosage.” House started to walk out of the room.
“House?” called Bonnie. “Thank you so much.” He nodded, then turned to Thirteen.
“I need to see you outside for a private conference.” Thirteen looked at the rest of the team and followed House out of the room. House walked a few feet and then turned to quickly face Thirteen. “When you choose to withhold the fact that you have a personal relationship with a patient, you endanger not only the ability of the team to properly function; you endanger the patient as well.” Thirteen looked down at the floor and shook her head.
“I'm sorry; I was afraid if you knew that Mrs. James and I knew each other, you wouldn't want me to work the case or worse, you wouldn't take it.” House looked around.
“The fact that a doctor has a relationship with a patient can affect their judgment. You've been here long enough; you've seen it firsthand. If a case is worthy of this team's time and talents, then I'll take it whether it's a stranger, a friend or relative. I don't care. I do care that the team works at their best so that we can do our jobs.” House studied Thirteen for a second. “Go back to her.” Thirteen took a few steps and turned to House.
“How did you know?”
“Other than your ex, your teammates, and Wilson, the only people who know your first name, would be me and someone who knows you from outside the hospital. Mrs. James referred to you as Remy. I'm going to guess that she's related in some way to your neighbor you were talking about earlier in the day.” Thirteen nodded.
“He was her brother. Mrs. James was ten years younger than him and had left for college by the time everything hit with my mother.” Thirteen started to turn toward Bonnie James' room, hesitated, then turned back to House. “Can I ask you something? Completely off topic?” House looked around to avoid making eye contact with her. “If I asked you, would you… ”
“Yes.” Thirteen looked startled.
“I didn't even ask the question,” she said. House fidgeted with his cane.
“When the time comes, I won't allow you to suffer in pain needlessly. You say the word, I'll help end the pain for you.” House finally made eye contact and could see tears welling up in Thirteen's eyes.
“Really?” she asked. House held up the index finger on his left hand.
“Scout's honor,” he said. Thirteen narrowed her eyes and gave him a look.
“You were never a Boy Scout.”
“I told that group of Girls Scouts I met when I was hiking as a kid that I was. I earned a lot of merit badges that day,” he said with a smirk. Thirteen widened her eyes and threw her hands up in the air. She once again started to walk away, then stopped. She turned to look at House.
“Thank you.” House nodded and watched as Thirteen walked back into Bonnie James' room. Before the door could close, Chase and Taub emerged carrying a phlebotomy tray. House could see that the vials were empty.
“What's going on?” he called out as he approached them.
“We can't draw the blood. Her veins are collapsing. She says she's always had rolling veins, but this is going beyond that,” said Chase.
“Yeah, these aren't rolling; they're running away,” noted Taub. House rested his elbows on the edge of the nurses' station. He tapped his cane against the bottom of the counter as he pondered what to do next. Thirteen came out of the room.
“Her IV in the left arm is starting to infiltrate. It looks like the arterial line in her right is still clear,” she said.
“For now,” said House. “Let's see what kind of shape her diabetic feet are in.”
“Putting an IV in a diabetic's foot is not usually recommended,” said Foreman walking back to the group with Wilson.
“No, but this isn't your usual kind of patient. We've got to rehydrate her and get her veins to stop being rude by not letting us in. Start a small bore needle on each foot. Use a butterfly and find something on the back of her hands, her fingers or her toes even; get the blood you need for the tests,” instructed House. “And get the other IV out before it completely screws up her arm.”
“Immunoglobulin tests being the priority in case we can't pull a full draw?” asked Taub.
“No, poke her multiple times if you have to so we can get enough for both tests.”
“House, you're turning her into a pin cushion,” protested Wilson.
“She's been through worse. Since we can't do the MRI to confirm the inflammation at C-3, we need the blood work to prove that we're right about the type of inflammation.” Wilson thought for a second.
“What about placing a subclavian line like we do with a chemo port?” he asked.
“That's no good; in case we have to do CPR or paddle her, it would be in the way,” Thirteen said. House turned and looked at the James family.
“I'm going to suggest that father and son make another trip to the cafeteria. You're not going to want them anywhere near the room when you start treating mom like a voodoo doll.” House started to walk toward Bonnie's room.
“Wait… House, you're going to tell them?” asked Foreman. House turned with his hand on the sliding door.
“Yeah, I thought I'd see what it felt like to be an inert administrator rather than a pro-active doctor.” House slid the door open and walked in.
“Hello again one and all. Since your veins are collapsing faster than a Ponzi scheme, we're going to have to try a few of the more unusual spots to get some blood to confirm we're treating you properly. You two,” House said looking at Kyle and Don. “Are going to be in the way if you stay here. So, I would suggest you pay yet another visit to our lovely dinning facility. Dr. Foreman will be glad to keep you company. I'll have him paged when the coast is clear.”
“Dr. House, do they really have to go?” asked Bonnie. House was about to answer when Kyle spoke up.
“Babe, you'll be fine. Let me go get Don something to eat before he starts gnawing on his own hand.” Bonnie started to laugh.
“Oh… oh, don't do that. Don't make me laugh. That still hurts,” she said. Kyle smiled, leaned over and gave her a kiss on her cheek.
“I'm so happy to see you laugh again.” He turned to his son. “Come on; let's let the docs do their job.” Don nodded, leaned over and kissed his mother.
“See you later, Mom.” Kyle and Don filed past House out to the hallway and House followed close behind. Once out in the hall, House turned to Kyle.
“You must be very fertile.” He looked at House, puzzled. “You grew that pair we spoke about really fast.” Kyle James smiled weakly.
“I had to. It was the only way to get out of there and let you do your job.” House nodded and turned to Foreman.
“Dr. Foreman, I told Mr. James that you would go with him down to the cafeteria; keep them company, answer any questions, and make sure the hospital administration is handling things well.” Foreman looked startled.
“I think I'd be of better use up here assisting with things,” said Foreman.
“Oh, no… you go with them. My team will handle things here.” Foreman was about to speak when Wilson interrupted.
“I need to speak to Dr. House about a few things,” Wilson said. “I'd appreciate it if you'd handle this.” Foreman let out a sigh.
“If Dr. Foreman is needed up here for my wife, we can just go downstairs by ourselves. Although I know Don wanted to ask some questions of one of you,” Kyle said.
“What about?” asked House.
“Becoming a doctor. I've got the grades and SAT scores to make a couple of the really good pre-med programs. I just wanted to talk to someone from diagnostics because I think I'd want to make that my specialty,” said Don. “I've even been taking notes on Mom's case trying to figure it out. I thought it sounded like shingles from things I was looking up, but without the rash, it didn't make any sense.” House gave a slight smile.
“Remember to look for zebras,” he said. He looked at Foreman who was also smiling.
“Come on; I'll be glad to answer your questions.” Foreman led Kyle and Don to the elevators. House turned to the team.
“Page him when she's settled back in.” Chase, Taub and Thirteen all nodded. Taub picked up the phlebotomy tray and the team walked back into Bonnies James' room. House turned to Wilson. He could clearly see that Wilson was overwhelmed, playing the part of doctor and interim dean.
“So,” said House. “How do you like being part of the diagnostics team?”
“I'm not part of your team. I was just trying to help.” House twirled his cane between his palms as he turned his back to the counter and watched his team try to do what was needed to help Bonnie. He could hear her crying out, but under the circumstances, she was relatively quiet.
“You made a more concrete suggestion than any of them did. Foreman told me what couldn't be done and the rest of them stood there like lambs to the slaughter. If oncology and ass-kissing get to be boring let me know.” House started to walk over to the elevators with Wilson following him.
“Where are you headed?” Wilson asked.
“To where the finest of rodents dine.”
“The cafeteria? You're still hungry?” House pushed the button to call for the elevator.
“Actually, I never did get to eat much. Small talk led to bigger things and the next thing I know, I'm back at Potentially Perturbing Theories Hospital. I was … ” The sound of Wilson's phone interrupted House. Wilson looked at his phone.
“OK, very funny. Why are you calling me?” he asked.
“I'm not,” House said. He started patting his pockets. “Where's my phone?” Wilson shrugged.
“I'll find out. Hello?”
“Hello, James? It's Lydia Strohman, Greg's frie…girlfriend.” Wilson's eyes opened wide at the sound of her voice.
“Hello, Lydia. You didn't have to clarify things; I know exactly who you are.” House looked at Wilson.
“Give me the phone,” he said reaching for it.
“No. Why should I? She wants to talk to me.”
“She doesn't want to talk to you. It's me she wants.”
“How do you know?”
“Um… hello?” said Lydia “Greg dropped his phone in my car and I just want to return it to him.” Wilson glanced over at House with a knowing look.
“Oh, he ‘dropped’ the phone in your car, did he?” Wilson winked at him. “Well, we'll be right down so he can pick it up.” House vigorously shook his head from side to side and pointed to himself.
“James, could you please let Greg come down by himself. I would like a moment with him.”
"Oh… sure… of course. I understand. I'll see you soon.” Wilson looked crestfallen as he ended the call. “She wants just you to come down. She wants a moment with you.” House smiled.
“Sounds better than anything they're serving in the slop shop.” He saw the disappointed look on Wilson's face. “Do me a favor; deal with the fact that she wants what I’ve got; that you have no chance with her. I'm not going to be able to take it if every time she chooses me over you, you're going to act like a reject from ‘The Bachelorette.’”
“House, I have no problem with the fact that you were a lucky SOB and got to meet someone like her. I just enjoyed talking to her for the little bit that she was here. She's a lovely, lovely lady.” House rolled his eyes.
“Will you please stop saying that?”
“That she's a lovely lady. It makes me uncomfortable. Like you're hitting on her in absencia.” The elevator doors opened and House stepped in.
“Okay," said Wilson putting up his hands. “I'll stop saying it.”
“Why? She's a lovely lady,” said House as the elevator doors closed. Wilson was about to respond, but realized it was pointless.