Author's note: By popular demand, I offer a sequel to A House Assessment showing Chase's first case as an attending. This story will focus on how I see him reacting to being in charge, so hopefully it won't disappoint.
Time for the standard disclaimer: I do not own any of the characters except Estelle.
The warning signs were all there. Somehow Chase got through his first day as an attending unscathed but not having a case probably helped. He didn't feel so lucky today. House was planning something devious. He knew his tormenting boss was waiting for the right opportunity to throw him under the bus. He had a feeling the page from the ER would deliver the right opportunity.
"You paged me?" Chase inquired to the head ER nurse on duty.
"Yes Dr. Chase," replied the nurse. "We have a doozy for you."
In an open corner of the very hectic room laid a noticeably overweight older white woman. She was unconscious but stable for now. She hadn't been stable for long though and her problems were in multiples.
"She came in a few hours ago. She didn't show up for work, which apparently was something she never did. A co-worker had the super check on her and he found her in a recliner unresponsive. You'll never believe what we have found so far." The nurse handed him the chart.
Chase opened the file and his eyes bugged out of his head. "How is she still alive? Her vitals are all over the map." He couldn't understand how a person's systems could all be in such distress without any of them failing yet.
"Why do you think we called you?" replied the nurse. She then moved a bit closer to Chase and starting talking in a lower voice. "To be honest, no department was thrilled more with your promotion than us. Now we don't have to go through House. That and all the nurses think you are prettier to look at."
Chase looked over at the desk to see a few nurses staring at him. They started giggling when they caught him glancing in their direction.
Chase smiled. "Cute," he said.
Despite all the nice distractions, Chase quickly turned his attention back to the patient. "So we have no idea why she is still unconscious, but yet there are plenty of reasons why. She has too many meds in her system right now, so I'm reluctant to start her on anything. Get her up to ICU and have them page me if anything changes. She's stable for now, so we'll go from there."
"Yes Dr. Chase," the nurse replied.
He took the file and went off to inform the team about their latest case.
Cameron and Foreman sat contently in the diagnostic conference room reading the paper and enjoying their morning coffee.
"Where's Chase?" House shouted from his office where he was tucked away from the others.
"He had an emergency," Cameron replied as she kept her head buried in her morning source of information.
House wasn't ready to surface yet. Chase needed to be there.
A few minutes later Chase strolled into the conference room not amused by the fact that his colleagues were having a calmer morning than he was. "We have a case," he said as he threw the file down on the table. "Estelle Anderson, white female, 58 years old. She came into the ER a few hours ago and is on her way up to ICU. Her file will blow your mind."
Cameron grabbed the file and started reading. "Wow. Blood pressure is through the roof at 180/110, pulse rate is barely at 30, ekg is erratic, breath sounds on both sides are weak, kidney and bladder function are not normal, EEG shows some brain abnormalities but nothing life threatening. Here is one cause of her symptoms; she's 320 lbs."
She paused a minute to read further into the scattered test results before dictating the rest. "Whoa, look at the amount of prescription drugs in her system. There must be 20 different kinds of chemicals in her."
"At least," responded Chase. "There are other substances too, so it is my guess she was taking over the counter drugs as well."
After taking another minute to study the file, Cameron reached her conclusion. "It looks like her body is shutting down. She's a mess."
"That's what makes this case interesting," observed Chase. "Her body isn't shutting down. It is more like each system is fighting with one another. She's battered, but not failing yet."
House saw his moment of opportunity now to barge in. "Who gave you the authority to take cases without my approval?" he said directly at Chase. "Oh, that's right, I did."
House was eager with anticipation as he turned to address all three of his underlings. "Anyway, since you are all here, I have an announcement to make. I'm taking a week's vacation, starting now." he said looking at his watch.
"Where are you going?" asked Cameron.
"Not sure," replied House.
"Whose going to run the ca..?" Cameron stopped herself at the last second as she realized the answer.
They all looked at Chase. "The diagnostic attending in charge during my absence, that's who," said House. "I love having another attending around to cover for me. This will be the best vacation ever."
House handed Chase a white board marker and headed toward his office. "I'll make sure to send you all a postcard. I'm not taking my pager either."
The ducklings all looked at each other with surprised glances, but they weren't too surprised. After all, this was House. He was up to something, and it looked like Chase was the benefactor of his latest stunt.
"Okay, whatever," Foreman said in reaction to House's antics this time. "My advice is to write small on that board. There a lot of symptoms here." he said to Chase as he read the file.
"Nothing is going on that white board yet," replied Chase as he put back the marker. Cameron and Foreman looked at him like he was creating a mutiny.
Chase went on to explain his reasoning. "If she has this many prescription drugs in her system, and several other substances by the looks of it, she likely has a few doctors who prescribed them. She must have a few conditions that we don't know about. We need to get a history and figure out how she got here. Who wants to talk to her son? He's on his way."
"Sorry, I've got a consult," said Foreman as he checked his silent pager and left.
Chase looked at Cameron. "Clinic duty," she said and quickly followed Foreman.
Chase knew her clinic duty was later this afternoon, but he let her go anyway. The dreaded moment was upon him. His uphill battle had begun.
"Mr. Anderson," Chase said to a young man in his thirties waiting in a private area. I'm Dr. Chase. I'm in charge of your mother's case."
"What's wrong with her?" the young man asked as they both sat down.
"We don't know. There are a number of things wrong with her. We just aren't sure what's causing her condition." Chase said directly.
The son didn't seem to be shocked at all by that comment. "Yeah tell me about it. She has been checked out for every condition and disease known to man. I'm sure her doctors have looked for some unknown things as well."
Chase was rather curious about this man's indifference to his mother's issues. "Do you know which doctors she is seeing and what she is being treated for?"
"I have no idea. She calls me almost daily talking about a visit to this doctor or that doctor and what they think she has this time. I never knew what the actual problem was since she never told me if she was officially diagnosed. I only ever heard the words "they think" then she would move onto something else the next time. It was my guess that none of it was real and she just liked going to doctors for company."
"What were some of the problems she mentioned?" asked a curious Chase.
"Diabetes, breast cancer, hormonal imbalance, slipped disk, osteoporosis, arthritis, cataracts, high blood pressure, heart disease, anemia, allergies, fluid in ears, migranes, muscle weakness, carpal tunnel, sleep apnea, bladder issues, fibromyalgia, severe depression…"
Chase interrupted him after the last item mentioned. "She had mental health issues?"
"Yeah, that was another thing that always came up. Those problems I believe since she hasn't been quite right my entire life. No one doctor could ever figure out her mental health problems either. One time it was OCD, then when the treatment for that didn't work it changed to GAD. Once that didn't get better they moved onto severe depression and she had alternated between one anti-depressant after another. None seemed to do the trick. The latest quack said she had adult ADD."
Chase at first tried to write notes, but stopped. There was no way he was going to be able to get all this down quickly, and he was way too interested by the story this man was telling. "Does she have trouble concentrating? That is usually a sign of all those conditions."
"Hell yes, all the time. Her brain is so weird. She can't remember the time for a doctor appt or to pay her bills, yet she will tell me with great detail the items she had on the seafood buffet five years ago. As you can tell, she loves to eat."
Chase nodded and tried to process where to go next with his line of questioning. "Okay, aside from the mental health problems, is there anything you know for sure that she has?"
"She has had thyroid problems her entire life. She is on medication for that. Also, she had complications when she was pregnant with me. She and dad tried for seven years to get pregnant and once she did it wasn't a good one. Apparently she almost died. I don't know the whole story though since neither of them wanted to talk about it. I know she had a hysterectomy after I was born."
"Is your dad deceased? I don't see a mention of a spouse anywhere in her chart." asked Chase.
"No dad's alive. Four years ago one afternoon mom just packed up the car and left. She didn't say a word to my dad indicating anything was wrong. He was so mad that he didn't talk to her, so the divorce was handled through me."
Chase stopped for a moment to rub his forehead. Was this man actually telling the truth? Sadly, yes, he believed he was. "Okay, let's go back to her medical history. Is there any other problem or accident that has happened to her?"
"Accidents?" Mr. Anderson perked up like the magic word had been uttered. "You aren't going to have enough room in that chart for her entire accident history. One story I grew up hearing from relatives was when she was a teenager she fell down the stairs and had a head injury. In my lifetime she has numerous workplace accidents on her record. Mostly slips and falls, but she was in food service for ten years and constantly had problems with burns and cuts. Worker's comp won't even grant claims anymore because of too many pre-existing incidents/conditions. She has broken several bones by just banging into something around the house. Recently her toes were breaking for no apparent reason. She has also been in several car accidents."
"Any serious injuries?" asked Chase.
"To the cars, yes, several have been totaled. Another than a banged up body though, she has always recovered."
"The ER nurse mentioned a co-worker. Is she is still working?"
The young man started laughing. "Yes, doing the most absurd thing a woman in her condition should be doing. She is a nursing aide in a nursing home. She spends all day doing a physically demanding job that she is not capable of doing. I don't know why this place doesn't fire her. My guess is because she didn't sue after her last workplace accident. She has to work though. She lives in poverty now. If she didn't work she'd be on the street."
Chase had seen his fair share of children who were cruel and negligent to their parents. He always bit his tongue, but he really felt like slapping this jerk. As usual though, he restrained. "Is there anything else?"
Mr. Anderson paused trying to think of what moment he should share next. "Oh, she has trouble sleeping. She is up several times and night and I don't think has gotten 8 hours in years. Her weak bladder forces her to get up and go to the bathroom a lot. Also, she is a chronic pill popper."
This time Chase heard his magic word. "What type of pills does she take? How many a day?"
"Anything the GNC carries. She will get a twinge somewhere and all it takes is some lady at work telling her about the latest vitamin or herb that helps the pain and she gets it. She will take a pill without hesitation and not worry if it might cause problems with the other stuff she is taking. She recently has gotten into buying supplements in bulk. She found an Internet site that does buy one get two free. She has boxes of these bottles stacked underneath all the other junk that litters her apartment."
"She has a messy place?" Chase asked knowing they were going further into the quagmire with that question.
"She is easily the worst housekeeper in the world. Growing up was shameful. I couldn't invite friends over because the place looked like an atomic bomb had hit it. We could never find anything."
"Has she been diagnosed for Hoarding?"
"I'm not sure what they call it, but if Hoarding involves not throwing a single thing away, buying lots of stuff in stores and yard sales compulsively, and stacking all that junk everywhere in your home then yes, she has that too."
"Okay," Chase said trying to get some focus. He had a feeling that there was a lot more to be learned but he was suffering from too much information. More details would have to be gotten later. "I need a list of the doctors she has been seeing. We need to see her medical records."
Mr. Anderson fished in his pocket, pulled out a set of keys, and then proceeded to take a single key off the ring. He handed it to Chase. "Have at it. You have my full permission to go on an expedition through her apartment and see if you can find that info. You will likely find what you need through her unread mail containing all her unpaid doctor bills. I'm not going anywhere near that pig sty."
Chase took the key and stared with disbelief at this completely insensitive bastard. He was making House look like a saint. "Thanks, I'll let you know what I find." He left Mr. Anderson behind to continue waiting.
As he was walking back to the conference room Chase had to admit having permission to perform a search was a big plus on his first case. No breaking and entering rap on his watch. House would be so disappointed in him though.
Chase got back to the conference room, dropped the file on the table, and took a deep breath while running his right hand through his disheveled blonde hair. He looked at the empty white board. How in the world was he going to plow through this mess? He thought. Then he heard a noise coming from House's office. He went in to see what was going on.
"House, why are you still here?" Chase asked. House was sitting at his desk, feet up, leaning back and listening to the ipod through headphones with his eyes closed.
"I'm on my flight to Cancun. The music helps me relax since I don't like flying to much." House replied.
Chase got very agitated and finally figured out what House was up to. "You're staying here in this office all week, aren't you? You want to spy on me."
"Cancun is lovely this time of year. The part I'm looking most forward to is the babes in bikinis." House replied obviously not acknowledging Chase's comment.
"Fine, listen in. You will be bored all week." Chase snapped as he exited the office.
A huge devilish smile appeared on House's face. This was going to be a great vacation.