บท 58: Chapter 58
As I said, "Chapters" :D
The story received its first 'bad' review with two stars. I don't agree with its content, but it's possible that I'm simply emotionally inclined to reject any negative review, given that it's the first one. I'm not sure if this is really the reason or if I'm correct.
I would like to know your opinion on the matter (those who are up to date with the updates). The review is pinned, and I will be reading the comments. By the way, asking for your opinion on the review does not mean it's an invitation to attack the person who wrote it. They were not insulting in any way, they were just giving their opinion (even though I don't agree).
Enjoy.
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Unfortunately, House was right. The vast majority of charts in the unfinished pile were from cases I had been involved in.
A couple of hours after carefully filling out the charts, House returned to the clinic. I saw him leave Dr. Cuddy's office only a few minutes after entering, probably to meet with the other three doctors on the team. "Come on, your siblings are ready," the man said, leaning on his cane. "Did you do all those charts in these few hours?" House asked, surprisingly impressed as he pointed to the charts in front of me.
"Yeah," I replied, placing the chart I had in my hands on top of the tower of charts.
"You really are efficient," House said, raising his eyebrows exaggeratedly. "Maybe from now on, I should let you handle the charts, to learn, of course, as my apprentice and all that," House said sarcastically as we walked out of the clinic where the three doctors working under him were waiting.
"P.J., Merry Christmas," Cameron said, smiling cheerfully. She was the first to greet me, handing me a small stack of papers, a CBC from the patient.
"Likewise," I replied, silently thanking her for the papers and beginning to read them immediately.
"Hey, mate," Chase greeted me, raising his hand amicably, which I mirrored.
"Can we start working?" Dr. Foreman asked, noticeably exasperated.
"Oh, come on, Foreman, where's your Christmas spirit? We had to wait for the kid," House said sarcastically, pointing at me as he walked as fast as his cane would allow. "He's here now, let's start. Ideas?"
"Her hands were red and swollen," Cameron spoke first. "Maybe she has a skin infection, cellulitis? That could manifest with tachycardia."
"No history of fever," I quickly negated while reading the data they had given me.
"And the CBC results didn't indicate an infection," added Dr. Foreman.
"The eosinophils are mildly elevated," Cameron continued, accepting Dr. Foreman's and my negation. "SED rate's up a bit. Could we be looking at a systemic allergic response?"
"It's not allergic," House immediately denied. "Allergies don't cause cardiac arrest like this. Could be inflammation of the blood vessels."
"Vasculitis?" Dr. Foreman asked incredulously. "That wouldn't give you an elevated eosinophil count," he continued.
"Churg-Strauss vasculitis would," I said, finishing reading the papers.
"And that's why we wait for the kid," House said sarcastically to Dr. Foreman, smiling amusedly. "The blood vessels of the heart, lungs, and skin become inflamed, causing asthma, rash, and heart problems. It covers all her symptoms," House continued as Cameron opened the door to the diagnostic lounge.
"You need a biopsy to diagnose," Cameron said calmly, following House into the room.
"Chest CT would be quicker," Chase argued.
"The lady just came in with a rash," Dr. Foreman said, completely incredulous.
"What the hell are those?" House stopped a few steps from the door, staring at a bowl of small candy canes on the table.
"Candy canes," Cameron responded nervously as Chase took one.
"Candy canes?" House repeated, "Are you mocking me?" he asked, pointing to his cane again, joking with Cameron.
"No, it's Christmas, and I-" Cameron began to explain nervously, "I thought-"
"Relax," House interrupted, "It's just a joke."
"Isn't the prognosis for Churg-Strauss a bit grim?" Dr. Foreman asked, looking at me sternly.
"Yeah," Cameron responded, still uncomfortable from House's joke. "Untreated, only thirty-three percent of patients survive past one year. Treated, five years," she continued, her voice lowering slightly, saddened.
"Then I definitely suggest treatment," House said sarcastically.
"If it was any other attending doctor, I'd say he made a mistake," Dr. Foreman stated dryly, "and gave her too much epinephrine."
"Saying you wouldn't say it was my mistake is saying it was my mistake," House responded cryptically. "The kid was there; I administered the correct dose, right?" House asked, looking at me for a few seconds, raising his eyebrow.
"Yeah," I responded after thinking for a second. I wasn't entirely sure, but knowing House, if he had any doubt about his mistake, he would be trying by any possible means to prove it wasn't.
"Everyone screws up," Dr. Foreman said, ignoring my opinion completely. "Your rule. I think you fit within the subset of 'everyone.'"
"I didn't screw up," House declared seriously. "Order a chest CT and start the sister on prednisone, forty milligrams TID."
"The sister?" Chase asked, surprised for the first time in the conversation.
"Oh, didn't we mention? The kid and I dealt with three nuns, disguised and all," House said sarcastically, waving his hands above his head. "The patient's a nun, Sister Augustine."
"Oh, I hate nuns," Chase murmured, lowering his head.
"Who doesn't?" House asked sarcastically.
"The Pope?" I asked ironically.
"Yeah," House agreed, pausing. "I may have judged them too quickly. There are at least some nuns I like," House added shamelessly, raising his eyebrows suggestively, causing Cameron to sigh in exasperation.
Ignoring Cameron, House exited the room, almost immediately returning, "Come on, kid. I need you present, remember?"
Following House out of the lounge through the hospital corridors, we encountered Dr. Wilson frowning deeply with his arms extended. "I leave you alone for five minutes, and you almost kill a nun?" Dr. Wilson exclaimed, controlling the volume of his voice.
"Completely his fault," I said, taking a step away from House and pointing at him without a second thought.
"Eh," House exclaimed, feigning offense. "I expected a little more loyalty from my 'apprentice,'" he continued sarcastically.
"I know it wasn't your fault, but with you in the same room, I expected you to control House more. You're much more mature than him, after all," Dr. Wilson joked, amused.
"I know," I admitted, acting embarrassed and lowering my head slightly. "I'm sorry."
"Oh, really?" House asked, raising one of his eyebrows. "I didn't know I was under your care, Stanley Donen," House continued ironically, walking towards one of the elevators.
"Who is Stanley Donen?" I asked, exasperated, following the two doctors.
Ignoring my question, House entered the elevator that opened its doors almost immediately upon pressing the button. "How did Cuddy react?" Dr. Wilson asked as we waited inside the elevator.
"Great!" House responded immediately with a touch of contempt, causing both Dr. Wilson and me to look at him for a few seconds. "If Cuddy thinks I made a mistake, the least she could do is suspend me from clinic duty," House said as the elevator doors opened again and we exited toward the clinic.
"She doesn't confuse making a mistake with being incompetent," Dr. Wilson explained condescendingly.
"Oh, here we go, kid," House said, exasperated, rolling his eyes. "Lesson time."
Opening the clinic doors, Dr. Wilson, House, and I entered. "I recognize that confidence is not my short suit."
"Obviously," I said, greeting the clinic nurse silently with a smile.
"Oh, come on, kid," House exclaimed, pretending to be offended again. "Like my 'son,' remember?" he asked, pointing to me and then to himself with a strange smile.
"Sure," I responded uncomfortably, nodding slowly.
"I also recognize that I am human and capable of error," House continued, nodding quickly and almost immediately resuming his conversation with Dr. Wilson.
"So you might have screwed this up?" Dr. Wilson asked, surprised that House could admit an error.
"No," House immediately responded, despising the mere idea of having screwed up something.
"So it's merely a theoretical capacity for error," Dr. Wilson affirmed ironically.
"Good point," House agreed, feigning surprise. "Maybe there isn't one; maybe that's my error," House theorized, taking a new chart from the nurses' desk. "Come on, kid."
"You know, most people who think as highly of themselves as you do like to talk about themselves," Dr. Wilson affirmed sarcastically, following House and me.
"Most people don't like to listen," House said, pausing and tilting his head. "So, what's wrong with you?" he asked Dr. Wilson, intrigued, who instead of continuing and following us into the exam room, turned to enter the nurses' bay.
Inside the room, the first thing I noticed was an overweight older man dressed as Santa Claus, and the second thing was a strong fecal odor.
House obviously noticed the man's appearance and smell as well.
"Santa," I greeted the man on the bed, amused, before House could say anything.
"Oh no, Jack," House said, putting his hand on my shoulder and inventing another name for me, exaggerating his sadness. "He's not the real Santa," House explained seriously, speaking slowly and with his hand still on my shoulder.
"What?" I asked House, completely serious, feigning surprise.
"Yeah, sorry," House said, nodding and pressing his chin. "Now, let's guess, Jack," he continued, pointing to Santa Claus, who had a strange expression on his face.
"Inflammatory bowel," I responded easily. Santa Claus was breathing through his mouth for some reason, making each exhalation smell extremely bad.
"Wow," the patient exclaimed, embarrassed. "Is that bad?" he asked, worried.
"Yes," House responded immediately.
"It's also written on your chart," House added, raising the papers in his hand. "Bloody diarrhea, gas, pain," he began to read. "Took sulfasalazine, but it didn't work," House read the chart, surprised.
"No," Santa Claus said, upset. "Then- Then I," he pressed his face as if trying to remember, stuttering.
"Next, tried steroid enemas, oral corticosteroids, five ASA, six-mercaptopurine," House continued reading, increasingly astonished. "I'm impressed."
"By my medical history?" Santa Claus asked, worried.
"By how well your last doctor charted," House admitted, lightly hitting the chart with the back of his hand. "Look, Jack, this is how it should be done," House sarcastically added, handing me the chart.
Obviously not interested in House's jokes, the patient was nervous on the exam bed. "It's one thing to go to the bathroom every hour, but when the kids sit on my lap, it's-" he stopped, shaking his head sadly. "The store sent me home; they're going to fire me," he declared, lamenting with his head down. "Can't you put me back on five ASA? Maybe it'll work this time."
"Not likely," House denied calmly. "I'm giving you a prescription. It's cheap, which is good because your insurance company won't pay for it," he continued.
I had no idea what kind of medication House could be talking about, possibly something experimental, which wouldn't make sense for being 'cheap.'
"Cogaritis?" Santa Claus read the note House gave him, confused, with a pair of glasses on his face.
Oh.
"Cigarettes," House clarified. "One twice a day, no more, no less. Studies show that smoking cigarettes is one of the most effective ways to control inflammatory bowel," he continued seriously. "Plus, it's been well established that you look thirty percent cooler, right?" House asked, raising his fist to me.
"Is he kidding me?" Santa Claus asked me, pointing to the prescription in his hand.
"No, he's not," I responded slowly to the patient, ignoring House.
"Okay, you got me," House admitted, lowering his hand. "The part about looking cooler, yeah," he rolled his eyes. "The rest is true."
"Isn't it addictive and dangerous?" Santa Claus asked, worried.
"Pretty much all the drugs I prescribe are addictive and dangerous," House admitted, not really caring about the implications. "The only difference with this one is it's completely legal," House said, handing me the chart and smiling strangely. "Merry Christmas," he concluded, walking out of the room.
"Merry Christmas, sir," I said, nodding to the man as I walked behind House.
"Likewise, Jack," Santa Claus said with a slight smile, making me stop in the doorway.
"That's not my name," I murmured to myself before continuing to walk.
"Why?" I asked House, frowning as I approached him.
"I'm so sorry, kid," House said after a moment, looking puzzled. "Santa isn't real," he whispered, looking around and putting his hand on my shoulder again.
"You know that's not what I meant," I said seriously, removing his hand from my shoulder. "Stanley Donen? Jack?" I asked, intrigued. "It's not even funny; it's just weird."
"I got bored," House admitted shamelessly. "Oh, you're PJ the kid from the newspaper," he continued faking an exited voice with disdain.
"You know my name isn't PJ, right?" I asked, pressing the bridge of my nose. "PJ stands for Patrick John," I said, beginning to fill out the last chart.
"What?" House asked with feigned surprise, imitating what I had done a few minutes earlier in the clinic.
After a couple more fairly basic patients, a cold and an ear infection, House's pager went off. "Uh, there's news," he said, waving the small device and truly excited to leave the clinic as he walked toward the exit.
Leaving the chart I was working on with the nurse in charge, I followed him out.
In the diagnostic lounge, the three doctors working under House and Dr. Cuddy were waiting at one end of the table. "What?" House asked, walking to the board.
"The patient tested positive for herpetic encephalitis," Dr. Foreman said seriously.
"So what's that tell us?" House asked, pointing at me.
"Her immune system is compromised," I responded, lowering my head slightly. House obviously would come to, if he hadn't already, the diagnosis of Churg-Strauss vasculitis, but that didn't stop me from feeling a bit bad.
"Oh, I know," Dr. Cuddy said arrogantly, raising her hand. "Prednisone compromises the immune system," she declared. "Isn't that the medicine you gave her for that thing she doesn't have?" she asked, annoyed.
Really, with such few doses, the prednisone wouldn't do that.
"Just because Patrick John here diagnosed Churg-Strauss vasculitis," House said, pointing at me and taking the opportunity to mock my name.
"Don't try to blame PJ," Dr. Cuddy immediately defended me, putting a stop to House's joke. "It's your responsibility to teach him, and if you accepted his diagnosis, it means it was good enough for you to think it plausible."
"I'm starting to think this whole conversation is a trick," House said suspiciously.
"Her immune system is severely compromised," Cameron repeated. "Two doses of prednisone wouldn't do that," she continued.
Correct.
"Are you hanging your diagnosis on an adverb?" Dr. Cuddy asked incredulously.
"In ten seconds, I'm going to announce that I gave her the wrong dose in the clinic," House declared, ignoring Dr. Cuddy's question.
"You're going to admit negligence?" Dr. Cuddy asked incredulously.
"Unless you leave the room," House said, nodding perplexedly. "If you stay, you'll have to testify," he declared.
"Five, four, three, two," House counted down. "So, there I was in the clinic, drunk," House exclaimed, making Chase and Cameron hide weak laughs. "I opened the drawer, closed my eyes, took the first syringe I could find," he continued, causing Dr. Cuddy to leave the room quickly and completely serious, obviously not finding the situation amusing.
"So, what are the options for a compromised immune system?" House asked once Dr. Cuddy left the lounge.
"Mixed connective tissue disease," Chase said immediately. "It'd explain why she was feeling better on the prednisone," he continued.
"Sure," Dr. Foreman exclaimed sarcastically. "She was feeling better right up to the moment it almost killed her," he added, raising an eyebrow at me.
"On the other hand, it explains the symptoms: swollen hands, pulmonary problems, cardiac problems. It all fits," House said reflectively.
"Her ANA was normal," I said, shaking my head before Dr. Foreman could say anything.
"Yeah," Dr. Foreman said, pointing at me with a small nod.
"So let's redraw the blood," House responded easily.
"But the treatment is corticosteroids, prednisone, and we can't go there because of the encephalitis," Dr. Foreman continued.
He was right, but it wasn't the only way.
"Then we'll treat it with something that modulates the immune system but doesn't suppress it," House offered calmly.
"Hyperbaric oxygen chamber," I said a little more excitedly than I should have, catching the attention of all the doctors present. I was eager to see one with my own eyes.
"Yeah," House said, smiling sinisterly.
"There's no protocol for putting a patient in a high-pressure oxygen room to treat autoimmune problems," Dr. Foreman immediately rejected.
"Oh, you people," House exclaimed with disdain, making Dr. Foreman raise an eyebrow, offended. "Always with the protocols," House added. "Prep the nun," he ordered seriously, making both Chase and Cameron stand up, "and discontinue the prednisone."
"Can I go?" I asked, pointing to the two doctors leaving the room, hiding my strange excitement about seeing the machine. I'd never been able to see one.
"Yeah, sure, I have an appointment anyway," House said, nodding at what I knew was code for watching his soap opera.
Following Cameron and Chase, I quickly caught up with them in the hallway walking to the nun's room.
"You're really interested in the hyperbaric oxygen chamber, huh?" Chase asked amusedly, putting his hand on my shoulder.
"I want to sleep in one of those," I admitted. I wanted to experience it at least once.
"Yeah, makes sense," Chase agreed with me, amused.
When we reached the patient's room, the nun was completely asleep and alone.
"Sister Augustine," Chase gently shook her shoulder, calling her softly.
"Ah, Dr. Chase, do you need anything else?" the nun asked weakly, with a kind smile.
"We need to go to another room. We're going to do a new procedure," Chase said, helping the nun to sit up gently while Cameron pushed a wheelchair near the bed.
"A new procedure?" the increasingly awake Sister Augustine asked, puzzled.
"Yes, we'll go to a pressurized chamber to modulate your immune system," Chase explained slowly, helping the nun to stand up so she could sit in the wheelchair.
"Dr. Cameron, I didn't greet you. How rude of me," the nun said, embarrassed, noticing Dr. Cameron holding the wheelchair and still maintaining her kind smile.
"Don't worry about that, sister," Cameron said softly, putting her hand on the nun's shoulder.
"Ah, you too, Mr. Donen," the nun noticed my presence a moment after sitting in the wheelchair, apparently remembering the false name House had given me.
"Donen?" Cameron and Chase asked simultaneously, puzzled.
"There was a misunderstanding, sister. My name is not Stanley Donen. I'm PJ Duncan. I apologize for not introducing myself properly," I said, taking one of the nun's bandaged hands with a bit of embarrassment.
"PJ Duncan?" the woman asked, slightly surprised, opening her eyes and seeing my face. "I can't believe it; I didn't see it before. You're the boy from the newspaper. You look very different from the photograph," she continued.
And I was very grateful for that. The photograph they used was an old one where I still had my old hairstyle and a bit more fat on my face. It wasn't different enough to avoid being recognized by those who were good with faces, but it was different enough from my current self to prevent immediate recognition.
"That's right. PJ here is the 'local hero' who actually also helped save your life when you arrived here," Chase said, shaking my shoulder lightly, smiling broadly and amused.
"Then I guess a thank you is in order," the nun said kindly, squeezing my hand gently.
"It's nothing, sister. I was just doing my job," I replied immediately.
"And I thank God for that," the nun said softly, releasing my hand and resting in the wheelchair.
Without much else to say, we all left the room heading to where the machine was. Along the way, Chase explained the new diagnosis of her illness in simple words, making an effort to ensure the nun could fully understand it.
In the room where the incredibly massive machine was, Cameron and Chase, along with the technician present, quickly prepared everything necessary for the sister's treatment.
"The pressure will force the oxygen into your system, saturate your blood, and it will enhance white cell activity, reducing inflammation," Chase explained while preparing the nun on the gurney.
"And that will help with this mixed connective tissue disease?" the nun asked, somewhat worried.
"We'll be doing about ten treatments and then we'll reevaluate," Chase continued.
"The last treatment with prednisone caused the seizures, right? How confident is Dr. House about this?" the sister asked, concerned, as the machine moved her.
"The fact that you reacted so strongly to the prednisone let us know that you had an underlying problem with your immune system," Cameron quickly explained, slightly diverting the sister's question.
"I guess it was a blessing of sorts," the sister said as the gurney stopped inside the machine.
"Yeah," Cameron said, smiling and slightly nodding her head.
When the door of the machine closed and the pressurization process began, I discovered it wouldn't be as interesting to see the machine from the outside as experiencing it inside the machine.
"The sister is
right; you look different from the photograph," Chase said slowly, sitting in a chair next to me in the monitoring room.
"His face is more angular and he has a different haircut," Cameron explained calmly.
"Angular?" Chase asked.
"Yes, if you lost a few pounds, your face would be angular too," Cameron said, pointing at Chase's face. "Look at his chin; there's almost no extra fat or skin," Cameron said, moving her chair closer to me and pointing at my face.
"I get it," Chase said, nodding, looking more closely at my face. "Wait a minute, did you call me fat?" Chase asked, surprised a moment later, remembering what Cameron had said.
"No," Cameron responded calmly. "You smell surprisingly good, PJ, congratulations," Cameron added, moving her chair back again, truly surprised.
"Thanks?" I asked, confused. It was a compliment, but the way she said it for some reason felt like an insult.
"I hadn't noticed before, but your muscles are growing, mate," Chase said, surprised, changing the subject abruptly.
"Yeah, I've been working out practically every day for a couple of months now," I responded, still taken aback by Cameron's compliment-insult.
Several other minor topics continued for a while until it was time to end Sister Augustine's treatment and get her out of the machine.
While Cameron finished what was necessary with the valves on one side of the machine, Chase and I opened the compartment that served as a door. "How are you feeling?" Chase asked immediately.
"A little weak," the sister replied, her voice a bit rough.
"That's from the oxygen," Chase explained.
"My mouth is dry," the sister continued, gently stroking her throat.
"Okay, well, I'll get you some of your tea," Chase said kindly, waiting for the machine to finish moving the sister.
"Is she still taking her homemade tea?" I asked, puzzled. Usually, when patients were admitted to the hospital, they weren't allowed access to food outside the hospital's control.
"Oh yeah, the other sisters brought the tea bags here. It's pretty safe," Chase explained calmly.
Several minutes later, the sister was back in her room. Cameron and Chase performed some quick physical exams, finding discrepancies in her oxygenation levels, which could be explained by oxygen irritation but were still somewhat alarming.
Back in the diagnostic lounge, Dr. Cuddy, once again with Dr. Foreman and House, were waiting inside. "What's going on?" Chase asked.
"What's happening is that I'm off the case and, therefore, the kid is too; after all, he is my responsibility," House said with distaste, emphasizing the last word. "Let's go, Patrick," he continued, mocking my name as he walked out of the room, surprising everyone except Dr. Foreman and Dr. Cuddy.
Following House, I quickly caught up to him. "Why?" I asked, puzzled.
"Apparently, Mom doesn't trust me to continue with the case," House said sarcastically. "Though it's even possible there isn't a case in the first place."
"What do you mean?" I asked, confused.
"The other nun, the pretty one, who I think likes me," House said, raising his eyebrows provocatively, "said that Sister Augustine is a hypochondriac—sore throats and inexplicable joint pains," House continued sarcastically.
"You think the patient is a hypochondriac?" I asked, puzzled.
"Oh no, I just wanted to brag that a woman dedicated to God wants a piece of me," House replied arrogantly, smiling.
"Understandable," I replied to the doctor, following him through the hospital hallways. "Wait," I remembered what House said after falsely accusing the woman of being a hypochondriac and stopped abruptly. "Sore throats and joint pains," I murmured, "Cameron was right."
House, puzzled by my behavior, also stood a couple of steps away from me, watching me curiously.
"Long-term allergic reaction," I reminded the man, whose expression immediately changed. "If we exclude the cardiac episode, all the symptoms fit," I continued before House could stop me.
"Nice theory, kid, but I already told you, symptoms don't just 'get excluded,' and definitely I don't think it's divine intervention, at least not here," House said sarcastically.
"The tea," I said, unwilling to continue House's joke, taking him by surprise. "While I was with Chase and Cameron in the hyperbaric chamber, Chase offered her more of her tea. She's been drinking it even in the hospital. I bet she drinks it even more regularly outside of here."
My words left House silent for a few seconds, looking thoughtfully at the floor. "There are certainly teas that open the lungs, increase blood pressure, and stimulate the heart."
"If you regularly drink that kind of tea and get even point one cc of epinephrine, what could happen?" I asked proudly.
"Cardiac arrest," House proclaimed slowly, smiling sinisterly. "Five dollars and you let me brag about it to Cuddy," he offered, raising his hand immediately.
"I won't do the charts for you anymore," I counter-offered, seizing the opportunity.
"Ten dollars," House offered, pressing his lips with pain on his face.
"I assure you I can run faster than you, and Dr. Cuddy would believe me without a doubt," I threatened him seriously, making House lower his head in disappointment for a few seconds.
"Deal," House murmured, defeated.
"You won't regret it, Frederick. It was a great deal," I said arrogantly while shaking his hand.
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Author Thoughts:
As always, I'm not American, not a doctor, and not a fighter.
Another chapter has passed, so new thanks are in order. I would like to especially thank:
RandomPasserby96
keyakedo
11332223
It happened!!!, there has been a change at the top.
With that said,
I think that's all. As always, if you find any errors, please let me know, and I'll correct them immediately.
Thank you for reading! :D
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