Chase insisted that the doctors continue sitting with House for the first twelve hours after he was revived.
"The ICU staff can take over once he's awake," Foreman argued. Guardian of the night hours, he suffered more than any of them from the lack of sleep.
"We don't know how he'll react when he wakes up," said Chase. "If he becomes agitated, or has hallucinations, I'd rather the ICU staff not see it. The less they can infer about what we've been doing in here, the better. I'll take the overnight if you want."
Foreman looked at his colleague. Chase was gaunt and hollow-eyed from lack of sleep and regular meals, but he also looked firmer and more sure of himself than Foreman had ever seen him. He relented.
"I'll do one more night," he said. Then, directing his remark to his boss, he added, "But I want comp time."
Chase also enforced the men-only rule when it came to deciding who would be in the room for the emergence procedure. "The room is small to begin with," he said, "and if he starts thrashing around, we'll need all the weight we can get to keep him in the bed. He's been out of commission for less than a week—he can still do some damage."
"That's not why he didn't want us in there," said Cameron.
"All right, he didn't want to risk acting crazy in front of the ladies. Okay? Can you give him that?"
Cameron adopted a hands-off pose. "Sure. Fine. Jawohl, Herr Doctor." She and Cuddy departed, their shoulders a little stiff.
"It must really suck to have two beautiful women vying to take care of you," mused Wilson, watching them go.
Chase took a deep breath. "Right. Let's take him off the ventilator."
No one moved.
Foreman laughed. "I know we're not scared to find out what kind of a psychopath he'll be after five days of ketamine, so what's the hold up, doctors?" He leaned over the bed and began gently prying the tape off the week-old growth on House's chin and upper lip. Then, as if extracting the bottom plate from a stack of fine china, Foreman withdrew the tube from his boss's throat.
Chase disabled the microdrip. There was nothing to do now but wait.
"Maybe we should wave a cup of coffee under his nose," said Foreman.
Chase laughed. "Or a cold Reuben sandwich. I think the cafeteria's still open."
"I think we'd get better results with a double shot of single-malt scotch," Wilson opined.
House's eyelashes fluttered. The men fell silent again. They clustered around the head of the bed, watching.
More fluttering; then one eye opened, then the other. They closed tightly, then snapped open again to fix a look of horror on a spot just over Chase's shoulder. Wilson followed his gaze. The Spongebob Squarepants balloon had come loose from its moorings and, helium depleted, was floating level with the intensivist's head.
"He's hallucinating," said Wilson. "Someone get rid of that thing."
"Not...hallucinating. Ugly...goddamned thing. Hate...Squarepants." The volume was low as a whisper and the timbre rusty, but five days' rest had apparently undone some of the damage caused by the surgery to remove the bullet.
"He's got his voice back," said Chase, with truly mixed feelings. House rolled his eyes towards Chase and lifted an eyebrow. "The coma's over," Chase said loudly. "How do you feel?"
"Hit by a truck," House aspirated. "Too many...bats...in here. Birds. And the phonebooth."
"Okay, he is hallucinating," Foreman said cautiously. House closed his eyes wearily.
"Just get rid of them," he commanded peevishly, and drifted back into unconsciousness.
The men waited, but there seemed to be no further message.
"Well, that was worth missing dinner for," said Chase. "What a pity the womenfolk weren't here to see it. He seems to be in reasonably good shape—I'm going home. Page me if you need me."
The hours that followed were not quite as amusing.
Although a condition called shell shock (World War I) and combat fatigue (World War II) was well known to the twentieth-century military establishment, the first systematic investigations of what has come to be called Post Traumatic Stress Disorder (PTSD) only began with the return of badly-shaken veterans from the conflict in Viet Nam. Among their shared symptoms were repetitive, terrifying dreams and "flashbacks" in which they vividly relived their most horrific experiences. The studies expanded to include similarly afflicted veterans of Dust Storm and will no doubt continue as U.S. troops return from the current war in Iraq. The scientific and medical community, having evidently concluded that prevention is not in the cards, has focused their attention instead on the symptoms in hopes of finding ways to alleviate them. Their research into dreams and flashbacks indicates links between PTSD and a complex interaction between several chemicals and brain areas.
One of the chemicals involved is norepinephrine, which is part of the internal stress response and also may strengthen emotional memory. One study shows that compared with healthy men, men with PTSD have increased concentrations of this chemical in the cerebrospinal fluid that bathes the brain. The excess norepinephrine may create excess fear and anxiety, as well as abnormal memory formation and flashbacks.
The memory and emotional symptoms of PTSD are thought to be produced by a variety of brain structures, including the amygdala and hippocampus, which share connections and normally help maintain healthy formation of memories and emotions like fear. Brain scans show the amygdala of patients with PTSD produces an exaggerated response to sounds or sights reminiscent of the traumatic time that launched the PTSD.
There is also evidence that the hippocampus is smaller and probably impaired in those with PTSD. This is significant because the hippocampus is dedicated to "episode" memory in humans: the unique binding of places, persons, things, actions, and time. According to the neurocognitive theory of dreaming, the brain activates itself in REM sleep, erupting in waves of spontaneous neural discharge to the cerebral cortex which, lacking "real world" cues, cannot readily distinguish between what is real and what is not. The hippocampus begins to receive mixed neural messages that it processes as best it can. The result is the surreal but usually benign world most people experience at night, where a pile of broccoli represents your lost wristwatch and a Buddha-like figure stands in for your division's vice president.
In PTSD patients, however, the hippocampus begins forging connections between the neural messages and remembered horrors. Thus a combat veteran might begin to experience flashbacks of the battlefield after a series of fights—or "battles"—with a spouse. And thus a man who was shot by a stranger on an otherwise ordinary day at the office might, having glimpsed an unfamiliar "face" among his colleagues, might begin dreaming that the stranger had returned to finish the job.
It would be premature to diagnose House with PTSD. All that can be said conclusively is that he reanimated with a start at around ten p.m., kicking away the bed coverings and cursing hoarsely. When Wilson came forward to restrain him, House fought valiantly and succeeded in landing a blow to his right eye. Fortunately, Wilson had wrestled some in high school and college. Although House was taller and heavier, he was playing hurt and eventually succumbed to a shaky half nelson, giving Wilson enough riding time to grab a syringe preloaded with lorazepam from the drawer in the bedside table and inject it into the IV line. It took a little longer for House to feel the effects than Wilson would have liked, during which time the patient almost managed a reversal and possible "elopement," the preferred mental health industry term for "loony on the loose" (House's term of preference). When he finally relaxed and drifted away again, Wilson sat for a moment catching his breath. Then he paged Chase.
"Turns out you were right to put some Ativan where it was handy," he said, when Chase called.
"You didn't give it to him, did you?"
Wilson was momentarily speechless. "Yeah, I gave it to him. He was trying to leave the room with me hanging on like a backpack, and he almost made it. I had to give it to him."
"I was hoping to avoid further sedating him," Chase brooded.
"Then you come on in here and avoid sedating him. Bring a two-by-four just in case."
A pause. "All right. I'll be there in half an hour."
Wilson was slightly ashamed. "No, stay put. He's out cold now and will be for another four hours. Then he's Foreman's problem."
"Do you know what set him off?"
"I don't know what specifically got him started, but I gather he saw Hunnicutt coming after him."
"Great. So now we have a PTSD on our hands."
"It may just be temporary, from the ketamine."
"Right. Like the depression from the leg."
"You think we've done more harm than good here?"
Chase sighed. "With House, it might be hard to tell."
The rest of the night and early morning repeated the pattern. House would stay quiet until the sedative wore off, then spring into action, shouting and heaving himself around in bed until the next dose was administered.
"We were worried about the hydrocodone dependency," Foreman noted grimly. "Then we worried about the morphine dependency. Then we worried about ketamine dependency. Now we're setting him up for a benzodiazepine dependency."
"He'll never get bored," said Wilson, rubbing his eyes.
"You go on home," said Foreman. "I can handle him okay by myself."
Foreman smiled. "I'm his worst nightmare—a black man with a syringe that can shut him down in mid-insult."
The next hours were peaceful enough. Foreman turned down the lights and dozed lightly. Then, at about two o'clock, he heard a familiar, if hoarse, voice.
"Smile, Foreman, so I can see you."
Foreman snorted and raised his eyes. House was regarding him from his pillow. He sounded like his old self, but there was a glitter in his eyes than set off a minor alarm in Foreman's head.
"How're you feeling?" he asked cautiously.
House grimaced and rubbed his forehead. "I knew there might be some wild-ass dream action with Special K, but this is ridiculous," he rasped. "I wonder if it's fried my brain permanently. Speaking of which: where are your flashcards tonight?"
"In my bag."
House regarded him shrewdly. "I didn't know you were still doing them. So you're still worried about the biopsy. You've gotten better at hiding it, anyway; I thought you were over it."
"It's not a small thing to mess with the brain," Foreman said noncommittally.
"You're telling me. Everything that makes us who we are has its origins in the mind/brain; toy with that, and you risk remaking a life. Talk about playing god. Stick an instrument into the white matter and suddenly a brilliant neurologist has trouble putting his own pants on."
"Actually, I'm good with pants now."
"Prolonged use of a psychoactive that reroutes neurons can have the same effect," House continued, as if Foreman hadn't spoken. "Too late to worry about it now; I've had five days' worth of K and the damage, if any, is done. If worse comes to worst, you and I can retire to a long-term care facility and spend the rest of our lives wiping the drool off each other's chins."
"If it comes to that, I dibs the lower bunk."
House didn't answer—he was staring at the doorway. "You brought him back!" he suddenly barked. "Jeeziz, Foreman, why'd you let him in here?" To whatever it was he saw in the doorway, House shouted hoarsely, "I told you, I'm sorry about your damned wife. I didn't kill her. Get out of here, you sick bastard. Get out!"
He started to rise from the bed. Foreman blocked him and rode him back to the mattress, fumbled a syringe out of his pocket and administered more Ativan. House fought more feebly, then seemed to give up. His eyes sought Foreman.
"You couldn't stop him," he remarked, "but I appreciate your trying..."
Exhausted as he was, Foreman offered to stay with Cuddy when she arrived at four for her shift. She declined, even after hearing why.
"I don't think you should be alone with him," Foreman said stubbornly.
"He's still missing his sartorius muscle," Cuddy pointed out. "If it comes to a footrace I can dust him, even in heels."
As if on cue, House's eyes flew open and fastened on his boss with a look of outrage.
"Oh, boy," muttered Foreman, sidling toward the bedside table and quietly opening the drawer.
"Wait," said Cuddy, impatiently. She leaned forward and said, loudly, "House! You're okay. It's just residual hallucinations from the ketamine. The coma is over."
House looked past her shoulder, his expression still grim and frightened.
"Hunnicut is not here," Cuddy said firmly. "The police have him. Foreman saw him in their custody. Right, Foreman?"
The neurologist nodded hesitantly. House threw him a skeptical look, then turned his attention back to Cuddy.
"How about taking this fucking tube out of my dick, then?" he demanded.
Foreman moved as if to comply, but Cuddy was ahead of him.
"Fine," she said coolly, and went to the cabinets for the necessary equipment. She snapped on gloves and went to work.
"While you're at it, take off those damned stockings," House whispered. "I feel like a drag queen."
Cuddy complied. "Will there be anything else?" she asked ironically.
A familiar grin played around House's lips. "Well...as long as you're down there..."
She snapped a finger, hard, on his thigh. "Behave yourself," she ordered, but as she turned away with the catheter in hand, there was a relieved smile on her face.
Foreman, seeing no need to hang around, staggered off to find coffee and/or a vacant cot.
"So how do you feel?" Cuddy asked, settling in a chair by the side of the bed.
"Dazed. Confused." House hesitated, then asked carefully, "You didn't...send me to Germany at one point, did you?"
Cuddy tried not to laugh and failed. "No. You were right here all the time. Why, did you smell sauerkraut?"
"I thought someone was speaking German to me," House said seriously. "She said Keira Knightly was going to give me a sponge bath." Cuddy raised her eyebrows.
"That's creative. This ketamine sounds like a fun trip. Maybe I'll do a coma next, and you can take care of me. I could use a vacation."
House regarded her somberly. "I don't recommend it," he said. "Check out the cruise lines instead."
Cuddy took a deep breath. "Well, it was only five days, and now they're over. The point is, was it worth it? Did it work?"
House stared at the ceiling. "I'm afraid..." he began, and Cuddy's heart sank. "I'm afraid to think it did," he finished, hesitantly. "I don't feel any pain, in my leg or anywhere else. But that could be the morphine."
Her heart back on sinus rhythm, Cuddy said, "You're not getting any morphine."
Startled, House looked at his IV unit. He looked at Cuddy, who broke into a wide smile. House grinned back.
"Goddamn," he whispered. "It worked. It actually worked. Thank you, Dr. Cuddy—you're back on my Christmas card list."
Chase sauntered in around seven, expecting cries of gratitude from the patient. Instead, House had prepared a merciless critique of the intensivist's handling of a case Cameron had "told" him about during the coma, when she finally got up the nerve to talk to him.
"There was no need to do an MRI; a blood test would have told you what you wanted to know a lot faster, without scaring the poor kid and his parents. Doing a biopsy was overkill; not doing a second urinalysis in 12 hours was criminally negligent. You were covering your ass with one hand and flashing it with the other. Bad diagnostics. Bad doctoring."
Disheartened, Chase turned to leave.
"But the coma thing," House added. "You did good with that. You did the coma thing perfectly."
"Thanks," said Chase, in a muffled voice.
"No," said House, only half-joking, "thank you."
By the time his parents appeared, House was almost completely lucid and in much better spirits; enough to spend half an hour talking to them before asking when they planned to leave. He still had trouble looking his father in the eye. But he smiled at most of John's jokes.
Cameron arrived just after the Houses left for lunch, her laptop under her arm. She had heard about the night before and peered at him apprehensively before sitting down. But House looked much the way he always did: smug, self-satisfied, ready for mischief.
"Dr. Cameron!" he hailed her. "How go the negotiations with your landlord? Is he going to spring for coral, or will you be forced to endure another year of oyster shell white?"
Cameron froze in horror—if House had heard that while in a coma, what else had he heard?
"So...you could hear while you were unconscious," she said carefully.
"On and off," House said evasively. "It's amazing what people will say in front of a guy with two good ears, just because his eyes are closed. Mr. Wentworth will probably write a book if he ever comes to. Which he won't. The point is, you hear stuff that explains things—like, for instance, why you've spent nearly 20 hours alone with me, helpless and unaware, and never peeked under the sheet."
"If you've seen one man in a hospital gown, you've seen them all," Cameron snarked lamely.
"You've never seen anything like this," House grinned, and whipped off the sheet.
Cameron gasped and averted her eyes—then looked cautiously back to see that House was wearing boxers.
"Look at it," House challenged her, lifting the hem of the right leg. "You know you want to. Look and tell me what you think."
And Cameron looked, absorbing the sight of the arroyo of ruined flesh on his leg. Gaining confidence, she coolly ran her fingers over the ridges.
"The surgeon did a really neat job," she said. "Does it hurt?"
"I don't feel a thing," House bragged. "Before you know it, I'll be up and around and no longer the pathetic case you've known and loved." He turned bright, calculating eyes in her direction.
"You'll always be a pathetic case to me," Cameron said flippantly. Hearing her own words she halted, horrified (he's ill! he's been shot! and you're picking on him!), and began to stammer an apology. House held up a peremptory finger.
"Ah ah ah," he chided. "If you're going to play with boys, you have to have the courage of your crudeness."
Then he changed the subject to the pile of slightly worse-for-wear gifts.
"What's up with all that? Are those for me or the guy who shot me?"
"It's all for you," Cameron smiled. "You might have to get used to the fact that people like and respect you."
"I don't care one way or another, as long as they're frisked at the door from now on," House groused. Then he asked, too casually, to have the list read to him.
"The list you've been making since they first started arriving, Miss Manners."
Cameron opened her laptop and found the file where she had indeed been listing the gifts and their givers, and began to read it aloud to him. House listened, tense and abstracted.
Wilson entered just as Cameron was getting to the end of the list.
"John Henry sent a Thelonius Monk anthology," she reported. "He suggested that you find a new career where if you get a dissatisfied customer, you're in a position to shoot back."
House smiled, but it was half-hearted.
"That's the list," Cameron summarized, closing her notebook. "I've written up thank-you notes that you can sign as soon as you feel up to it." House nodded. She looked at him, concerned.
"Are you okay? Do you need anything?" He shook his head and looked at Wilson. Cameron followed his gaze, puzzled. Wilson shifted his feet a little and looked away. She got the picture and rose.
"If you don't mind sitting with him a minute, I'll run down to the cafeteria and get something to eat." Wilson nodded, and Cameron left.
"Great exit line," House whispered. "Not very credible, though. She's already had half a yogurt today, and that should keep her going until midnight."
Wilson snorted. Then he stepped forward and handed House a small box.
House glanced at his friend apprehensively and opened it. Inside was a small medallion on a chain. The medallion was etched with a Greek character.
"Pi," House explained. "The ultimate puzzle."
He closed his hand around the medallion and relaxed for the first time since he asked Cameron to read her list. After a moment, he spoke.
Wilson opened his mouth to answer; hesitated.
"Come on, I can't imagine her being at a loss for words."
"She wrote to me. She said she didn't want to make things worse for you, but she couldn't do nothing, either. She told me to use my best judgment as to whether and when to give this to you."
House settled back against his pillows and closed his eyes.
"Good old-fashioned Southern manners," he whispered. "Someone can make you miserable, almost break up your marriage, and send you packing, but if he gets shot you send a present because it's the polite thing to do."
His tone bespoke a world-weary cynicism; but Wilson noticed that he was smiling faintly, and that the medallion was still cradled protectively in his hand.