Summary: A little boy presents with same symptoms as an elderly patient from long ago. House finally gets closure from this difficult and troubling case.
It was nearly five a.m. when House wearily tossed his tux jacket and silver handled cane onto the old leather sofa before collapsing himself into its deep, soft cushions. His mind was racing too fast; he was still flying too high on adrenaline to really sleep. He figured that he'd rest a moment, take his excess energy out on the piano (though not too vociferously, given the hour) and sleep Sunday away.
He smiled, thinking about the wad of 20s he had tucked in his jacket pocket—his take from Wilson's own poker tournament winnings. "Never play drunk against someone cold sober, Jimmy," he had gloated gleefully before heading home. In his musings, House nearly missed the soft knock at the door.
"Wilson, use your key. I'm not getting up." Figures. Wilson. Just moved out; now he's back. At this most indecent of hours. Probably here to request a re-match. Or continue the tirade about Ahab, white whales and Esther. And Ian. Although House was pretty confident that he'd stopped that cold with curing the kid. But with Wilson, you never knew.
But that wasn't Wilson's voice on the other side of the threshold, whispering his name, as the doorknob turned. Right. He hadn't locked the door. Too tired. He looked at the cane. Wouldn't make a bad weapon. On the other hand, it would have to be an awfully polite burglar to knock…and call to him, especially in Cuddy's husky, rum-soaked voice.
"Your door was open…I …" Cuddy was slightly surprised to find herself now standing in House's living room. Even at five in the morning, she was quite a vision. "You know, you should lock your door. Didn't your mother ever teach you…?"
"I really wasn't expecting burglars at the crack of dawn. This is a college town, the criminal set is much smarter, more of a midnight to two a.m. crew. This is Princeton, after all." Not a very good comeback, but then again, what did she want at five in the morning. The adrenaline was wearing off quickly. What was she doing here, anyway, he wondered?
"I…um. House, I just wanted to thank you…for Ian. I know that I…"
"De nada. It's fine…Look. Cuddy, I'm really, really tired. Too tired to even ask you what you're really doing here, in my apartment, dressed like…" He wasn't quite sure how to finish that thought. Aloud, at any rate. Dressed like some angelic warrior princess from a not-so-long ago fantasy? Her hair was down, loose over her nearly-bare shoulders. Her sapphire velvet gown surrounding her, making her eyes more vibrant, even in the dim light of House's living room. If he hadn't been so tired…
"I wanted to know that you were OK. Foreman told me how upset you were about…" Great. House had realized only much later, how much his this case had eroded his guard. How much the team had seen of what they were never, ever meant to see. Of him.
House had been 34 years old when she died. Helplessly he watched the old woman's symptoms speed along a timeline that should have spanned years, not hours. He had, over the course of residencies and two fellowships, watched diseases take their toll. It was his job. And it was a matter of course. Especially in his unique corner of the medical universe.
In the nine years since graduating Johns Hopkins Medical School, and "before Esther," Gregory House had been declared "boy wonder" no less than four times. In the specialty of infectious diseases, such declarations were ubiquitous. New diseases, new fixes. His ID fellowship had been at The United States Army Medical Research Institute for infectious diseases. Of course, in the time it took to say it, three new viruses could be discovered. So most people called it USAMRIID. Harder to say, but more concise.
His "boy wonder" status caught the attention of too many people outside the tight circle of researchers. Offers began to come from places that required top security clearances and promised "chance in a lifetime" opportunities within the service of the US Government. He knew what that meant. And House had no interest in any part of bioweapons research. That was the first big break with his father. It was two years until they even spoke again.
The words still stung, even now, 15 years later.
"Dad, I can't take the position. I won't participate in the destruction of life. I'm a doctor."
"You could save lives. Millions of lives. You could be the Oppenheimer of this generation." House said nothing, trying hard not to turn it into yet another political argument. "What? Are you going to say to me that we shouldn't have nuked Japan in world war II?" It was an old and bitter argument between them.
"Have you ever seen the effects, close up, of Ebola? Seen the eyes of a victim pleading for someone to simply kill him, as he bleeds to death three feet away from you? You, standing there comfortably in Level 4 gear, unable to do a fucking thing?" House had been there. Once. He'd been dying to go out into the field, and his supervising physician had accommodated him, if only to get the young doctor off his back. Once had been enough. House never shied away from the field after that, but the experience had confirmed in him that he could not be a part of any work that could lead to so much death and anguish. And when you mixed together infectious disease research and the pentagon, that meant bioweapons research. Pretty much always.
"How did you ever get to be such a bleeding heart? I've seen…"
"I know what you've seen, and I know what you've done. I know what pilots did in 'Nam back in the early days…"
"Don't you dare…." House thought his father was going to have a heart attack then and there.
"It's my life, Dad. I can't do this."
"Have you any idea what I called in to get you that cushy fellowship at USAMRIID? Do you? And now…you're nothing but an embarrassment to me and your country." And John House turned his back and walked away, leaving House standing speechless in his dust. He'd had no idea. And he'd never hated anyone so much in his life as his father in that moment.
House might have stayed in ID, but the really lucrative work had the potential to lead him in directions his ethics forbade him to venture. Nephrology seemed a natural progression, since so many infectious diseases eventually affected the kidneys. Well, everything eventually affected the kidneys. A classy fellowship back at Hopkins (fuck you, Weber) and a then a move to New York city, where he could practice medicine, do a little clinical research and hear the best jazz in the world. Even play a little, time permitting.
He was 34, single, reasonably well off (except for all those loans), published in the New England Journal of Medicine, the Lancet and co-author of a textbook. He was attached to Cornell University Medical Center as an adjunct professor, while beginning a lucrative career with a prestige nephrology practice.
Esther. Seeing patients was something House had viewed as a necessary evil. To him, the devils he battled were illness and time, and where they intersected. It wasn't so much that he hated patients, not all of them at any rate. He hated the beseeching, pleading eyes, looking at him as if he were some god, expecting that he wave his hand and produce a miracle. He hated to see the frustration and disappointment in their eyes when there was no answer—no diagnosis. Their faces stayed with him, their old and knowing eyes calling out from beyond the grave that he had failed them. Doctors more senior to him told House that he would overcome this, develop the thick skin that is only borne of experience and seeing too much suffering. But House knew better. It was not something he would "get over" or grow out of. "They" weren't cursed with a photographic memory.
Esther had come to him, old and frail. Seventy-two years old. He had practically begged her not to show him the photos of her 10 grandchildren and three great-grandchildren. Flirting was one thing. Inviting him into her family was quite another. One day and she was gone. She hadn't been that ill when she met her at the hospital that morning, filling in at the Cornell free clinic for a close friend.
He disliked working the walk-in clinic. It was a waste of time and skill. Most of the patients could be diagnosed by a first year med student and sent home with a sample pack of Motrin or a Band-Aid, or both. Esther presented with enteric symptoms and coordination issues. And his first instinct was to put her on a DW50 drip to rehydrate her and attribute the coordination issues with her age. He admitted her and hours later she was dead. Never dismiss a symptom. By the time he'd figured it out, that it was Erdheim-Chester, it was too late to do anything about it. The family expressed its gratitude for everything he had done. But what had he done? Not a damn thing. If he had, she would have survived. He had failed her.
He had asked, no, he had pleaded with them to let pathology do an autopsy. He had wanted to confirm the diagnosis. Help other people, he had told the grieving daughters. "Let her be at peace." He couldn't argue with that. With them. So he would never know. Not for certain. Closure was for the mourners, not for the doctor who couldn't save her.
Twelve years. Twelve years, and every moment was still emblazoned in his memory as if had occurred yesterday. Cuddy and Wilson thought he was crazy, keeping that file. Maybe he is. Probably is. But this disease. So fucking fast. At the time he'd doubted he'd ever see another case, not as a nephrologist. By the time the kidneys were affected and he'd be called in on a consult, it would almost be too late. The file, he told himself, was "just in case."
So now Cuddy was standing in his apartment at five a.m. asking him if he was "OK." His defenses were too worn away to send her off with a glib retort, especially when she gazed at him with those eyes, lasers wearing away the last vestiges of his guard.
She sat on the arm of the sofa, the velvet skirt of her gown rustling near his ear. He groaned, sitting up, as his right thigh protested the movement. He bit his lower lip to prevent himself from crying out as sudden and intense pain gripped his leg. "I'm not OK," he said finally. "Far, far from it."
To be continued……