AN: dedicated with deep respect to de-em2—who reminded me that it's important to not only respect the fandom but also the reader. And to never, ever lose sight of the fact that our writing is always worthy of our best effort. Thanks for reminding me.
This one, I promise, is one hundred percent mine. Well, except for the obvious stuff. ^^)
AN2: Assumes awareness of 7th season characters but no spoilers. Ignores House/Cuddy and Wilson/Sam. Having minimized my watching this season, House et all might be ooc. I think my version's better anyway.
The Rose Parade had held his interest for most of the morning. But after it was finished, nothing else held him. At least not for long. Lying on his back on the couch, he absently flipped from one channel to another. Nothing. Nothing. Three Stooges marathon. Nothing. Weather channel. Nothing. After speeding through every channel, he finally tuned in to the Rose Bowl. TCU Horned Frogs vs the Wisconsin Badgers; he'd never rooted for either team, but found himself amused at the support shown by the blur of red in the stands. It looked like everyone in Wisconsin had shown up to watch the game. Stretching absently, he mentally reviewed the contents of his refrigerator before getting to his feet. He smiled to himself as he swung the door open. Salsa, chips and a beer; perfect for an afternoon of football.
Or it would have been, if his pager hadn't gone off. Sighing to himself, he put the beer back and retraced his steps into the living room to grab it off the table.
'ER consult-Diagnostics on call x5476'.
Perfect. Just perfect. Throwing himself back on the couch, he grabbed his landline and angrily punched numbers until he heard ringing start. Drumming his fingers on the arm of the couch, he requested the ER's resident on call. With any luck he could consult over the phone and enjoy the rest of his afternoon at home.
"This is Nelson."
"Nelson, this is Dr. Foreman. You needed a diagnostics consult?"
"Yes. This was a GI patient; presented with diarrhea and complaints of stomach upset. O&P revealed giardiasis. Patient was put on metronidazole with no improvement, switched to tinidazole, again with no noted improvement; but subsequent stool tests showed a negative parasite count. EGD was performed, biopsies taken; revealing wide-spread celiac disease. Patient was discharged with a gluten-free diet. Two weeks later, she now returns with a maculopapular rash and some signs of jaundice."
"What does ID have to say about it?" Foreman asked patiently; though he felt anything but patient.
"ID won't touch it. Mortenson called it a 'House' file."
"Sounds like an ID problem to me. Or GI." Foreman said quietly, and Nelson sighed heavily.
"Look, Dr. Foreman-I just pass cases along. I don't give a damn whether your department takes it, or it goes to ID or GI. But she can't stay in the ER. Will you take the case or not?"
Irritated Foreman ground out his acceptance of the patient and let the resident make the arrangements to transfer her to Diagnostics. He slammed the phone back on the receiver and stormed into his bedroom; angrily dressing in a pair of dress pants and a button-down shirt and tie but eschewing the jacket. Stepping into his dress shoes, he considered calling in the rest of the team; but refrained from doing so. Thus far, the patient's symptoms didn't sound too terribly urgent—she'd probably downed too many ibuprofen for the pain; or she'd imbibed too much alcohol for New Years. With any luck he could be in and out of the hospital and back at home in time for dinner.
Or so he'd hoped.
A physical examination of the patient turned up the maculopapular rash on her abdomen, as Nelson had indicated. Also arthralgia and a fever of 102.8.
He'd ordered a battery of lab tests; along with T3 for the arthralgia and fever; and gathered a thorough medical history from the patient and the family. All in all, he'd spent six hours at the hospital on a bright, cheerful Saturday afternoon. He'd considered himself to be lucky not to have spent more time in consultation—until he'd been notified of the lab results.
The patient's liver function—what little she did have—was tanking rapidly. Her PT/INR was markedly elevated, as were her liver enzymes. Her tox screen had been negative for alcohol and drugs. Whatever it was, it wasn't transient damage. She was headed rapidly for acute liver failure.
Given the absurdity of symptoms to date—he elected to ignore the GI involvement for the moment and focus on the liver. He'd conceded defeat as he'd paged the team; ignoring Taub's sharp comment about his inability to fill in for House—and Chase's slightly slurred speech. Masters had appeared shortly before he'd paged her—but he'd refused to show his surprise at her timely arrival.
The only one not to answer the page was House. And given the date, Foreman hadn't really expected him to respond. The patient would have to be a lot more interesting before House would come in on a weekend. New Year's day, no less.
"Differential diagnosis." Foreman said pointedly once they'd all assembled. Taub and Chase both looked like they'd enjoyed ringing in the New Year; both were rumpled in their jeans and sweatshirts. Chase still had bedhead, and Taub's eyes were slightly bloodshot. Foreman ignored their befuddled expressions, focusing on Masters. Ever bright eyed and bushy tailed, she was immaculately frumpy as always in her skirt and sweater.
"Where's House?" Taub asked irritably. "Shouldn't we wait for House?"
Chase snorted as he sipped at his cappuccino. "You're not going to see House on a Saturday."
"If we have to be here, he should too." Taub was scowling, and Chase grinned cheekily. Masters looked nervous.
"Can we get back to the patient, please?" Foreman asked bluntly. "Thirty-seven year old female. Presented with GI concerns originally, most of which have resolved. She went home with a diagnosis of celiac disease and returns two weeks later with unrelated symptoms of jaundice, arthralgia and fever. Maculopapular rash on her abdomen, but has not spread."
"Thrombocytopenia." Chase said promptly, and Foreman rolled his eyes.
"I said maculopapular, not petechiae."
"DIC." Taub said slowly, but Foreman was spared answering by Masters's quick return.
"Wouldn't explain the rash or arthalgia."
"Vitamin K deficiency." Chase tried again, and Foreman scowled.
"Are you still drunk?"
"Amyloidosis." Masters said, and Foreman paused with the marker above the board.
"I thought you said maculopapular, not petechiae." Chase sneered, and Foreman snorted.
"The maculopapular rash might be transitory; amyloidosis would explain the GI involvement."
"But not the arthralgia." Chase rebutted.
"There isn't a single explanation for all of her symptoms." Foreman said flatly.
"So you're picking the simplest explanation for all of her symptoms? I'm sorry, explanations." Taub snorted.
"No, it doesn't." Chase countered.
"We test for amyloidosis." Foreman capped the marker and turned to face the team.
"Why are we here?" Taub asked Chase.
"Do another EGD, and get a small bowel biopsy."
"You mean us?" Chase asked after a long pause. "I don't think we should have to perform a test when we disagree on the diagnosis."
"You would for House." Foreman argued.
"Uh, yeah. Because it's House." Taub leaned forward and rested his arms on the table. "I'm not doing it. Not for you. It's not amyloidosis."
"What do you think it is?" Foreman challenged, and Taub shrugged nonchalantly.
"No clue. But it's not amyloidosis."
Pressing his fingers to the bridge of his nose, Foreman struggled to keep his patience.
"How about we treat this like a bet? If it's amyloidosis, you guys treat the patient. If it's not, I'll personally go get House out of bed."
Taub and Chase exchanged looks before getting up. Chase held a hand out, smirking slightly.
"You're on, mate."
It hadn't been amyloidosis.
Of course, by the time the biopsies had come back it had been nearly one in the morning. Sunday morning. Chase had biopsied the small bowel as well as a kidney—and both samples had yielded negative results to the Congo red dye. Foreman had gritted his teeth through Taub's smug recitation of the results and the patient's continued downward spiral as evidenced by her slowly worsening labs.
He'd even refrained from the desire to punch Chase in the face when he gleefully reminded Foreman of their condition to perform the biopsies. But it was rapidly becoming apparent that House would need to be involved, whether he wanted to get him out of bed or not. The fact that he'd lost the bet was irrelevant in the face of the patient's condition. At least in his own mind.
"You know House has a gun, right?" Chase asked smugly while Foreman pulled on his coat.
"He's got a gun. Got one after he was shot."
"Why are you telling me this?" Foreman demanded.
"Just thought you should know. Don't want him to mistake you for some random black guy breaking in to steal his electronics."
"Shut up, Chase." Foreman growled. He'd dialed House's apartment one more time; hoping he'd answer and spare him the trip over. But it rang endlessly before going to a blank voicemail message. Again.
"You said you'd go get him." Taub pointed out, and Foreman rolled his eyes.
"I'm going, I'm going."
"Watch out for the gun." Chase reminded, and Masters rounded on him.
"I think it's sad that he felt the need to buy a gun after he was attacked in the hospital."
"You would." Chase muttered.
"I'll come with you." She offered, and Foreman sighed.
"Fine. Come on." Snatching his keys out of his pocket, he hurried for the elevator. He heard Masters' grab her coat off the rack and scurry after him.
"Why are we doing this?" she asked breathlessly as he left the elevator at a fast walk and made his way through the parking garage.
"We need House." He repeated impatiently. He started the car and immediately threw it into gear without waiting for her to buckle up. Wisely, she said nothing as she snapped her seat belt on and gripped the door handle for dear life. "He's not answering any of our calls—"
"It's three in the morning." Masters said softly. "He's probably asleep."
"-and we already tried to work through this on our own. The patient's getting worse too fast."
"Do you have a key?"
Foreman snorted; smiling at her continued naiveté. "You think House would give anyone a key to his place?"
"How will we get in then?"
"The same way we get into a patient's house."
"We're breaking in to—no. I'm not doing it. I refuse to participate."
"Relax. He's home. Don't think of it as breaking in. Think of this as just…gaining access to him."
For all his professed cynicism, House was a fairly trusting person when it came to protecting his home. Feeling about on the door frame, he came up with a key that he held out to Masters triumphantly.
"I don't think he'll be happy to see us—even if you use a key instead of picking his lock." She whispered faintly. Foreman was amused to see fear in her eyes, though he supposed he couldn't blame her. Rolling his eyes, he unlocked and opened the door. Peeling off his jacket, he held it in one hand while he crept into the apartment. The TV was on, and Foreman felt his lips quirk into a smile when he made out the faint outline of his boss asleep on the couch. House was lying on his back; his bad leg propped up in a nest of pillows. His mouth hung open, he was snoring faintly. One slack hand held the remote; the other was lying limply on his chest. Foreman gently grabbed the remote to mute the set; for an instant he considered turning the sound all the way up, but he quickly changed his mind. As fun as it would be to screw with House, they did need to convince him to come in to work.
"House?" he asked aloud; surprised by the depth of silence afforded without the sound on. "C'mon. House." He reached over gently and shook House's shoulder; only to recoil in shock. House was clammy, even through the fabric of his t-shirt. Leaning forward, he put a hand on House's forehead and frowned at the warmth he found there.
"House?" he asked more urgently, and Masters looked up in concern.
"What's the matter?" she asked, crossing timidly to the back of the couch.
"I think he's sick." Foreman rubbed his forehead for a moment, before meeting her gaze. "See if he's got a thermometer." Masters all but bounded down the hallway, and Foreman reluctantly scooted closer to the couch. He squeezed House's shoulder with increasing pressure until he groaned aloud; trying to roll over. The motion jarred his leg, and he groaned again, louder this time.
"House?" Foreman kept his grip, but relaxed some of the pressure. Beneath his hand, House grabbed his thigh and opened his eyes to glare.
"What the hell?" he mumbled. Foreman winced at the sinus-y congestion in his voice. He shifted as though to sit up, and Foreman released his shoulder and leaned back. Sliding back into the pillows, House reclined and watched him passively as Masters returned with a digital thermometer and handed it to Foreman.
"Here. Open up." Foreman gestured, and House, to his eternal surprise, did so. He snorted to himself; House's temp had to be off the charts if he was compliant. When it beeped, he withdrew the thermometer and inspected it. Whistling, he held it out for House to see.
"You came over here to take my temp?" House asked faintly, lying back on the couch again. He rubbed at his temples and snorted wetly. "I'm touched. Didn't know you cared, homie."
"You are touched." Foreman agreed, and got to his feet. "But I didn't come over here because I care. We have a patient, and you wouldn't answer your cell or pager."
"Sorry, I think I'll call in sick today." House muttered.
"Need you on this one. Patient presented with giardiasis; ran two courses of Flagyl and Fasigyn. Patient's symptoms remained though the parasite count was negative; EGD was done with biopsies revealing moderate celiac disease. Sent home with a gluten-free diet. Came back two weeks later to the ER with a maculopapular rash on her abdomen and mild jaundice." Foreman paused, watching House for his reaction. House was lying with his eyes closed, but Foreman could tell he was still awake by the periodic twitch of his fingers on the back of the couch.
"Lab work?" he asked drowsily, and Foreman sighed.
"Elevated PT/INR. Liver enzymes elevated. She's headed for liver failure."
"Negative. This wasn't an overdose."
House was silent for a moment, and Foreman began to fear he'd fallen asleep again when he snuggled down deeper into the pillows and folded his arms in close for warmth. "Do a liver biopsy. Wake me up when it's done."
"Not so fast." Foreman sat down on the table again and put a hand on House's shoulder. "You have any Tylenol?"
"Thought you didn't care?" House mumbled, opening his eyes again in irritation.
"I don't." Foreman agreed, grinning smugly. "I'm covering my own ass. We need you for the differential. You can take some Tylenol, drink some water and let me leave knowing I've done something. Or I can leave Masters here to babysit you."
"I don't—" Masters started to say when House interrupted.
"It's just a cold. I'm fine."
"No, you're not." Foreman said flatly, and felt surprised when House finally nodded.
"There's Tylenol in the medicine cabinet."
"Any decongestants?" Masters asked levelly, and House shook his head.
Masters retrieved the Tylenol while Foreman found a glass and ran the tap cold before filling it. House sat up slowly to take the Tylenol, and sipped at the water before laying back. Without being asked, Masters unfurled a fleece blanket over House. Foreman snickered to himself at House's dismayed look, but wisely said nothing. Masters also left a box of Kleenex on the table within reach.
"Need anything else?" she asked, and House shook his head as he huddled down in the blanket.
"No." he mumbled.
"Good." Foreman got to his feet once more and donned his jacket. Spying the phone on the charger on an end table, he snatched it off the base and lay it next to the Kleenex box.
"I'll call you when the liver bopsy's done. If you need anything, call Wilson." He ordered. House snickered sleepily before pulling the blanket over his head. Gesturing to Masters, he followed her to the door and closed it before drawing out his cell phone.
"Who are you calling?" she asked as she stepped out of the building.
Initially, Wilson had been pissed. At least until he'd mentioned that he was concerned about House. That alone, he reasoned, was enough to capture Wilson's attention. But House's temp was fairly high, and he'd been out of character enough—in his own mind—to warrant a call to Wilson. Even at three-thirty in the morning.
"How high is his temp?" Wilson asked again, and Foreman patiently repeated himself as he pulled into his parking space.
"103.2. Masters and I got some Tylenol and water into him; he was going back to sleep. I didn't examine him thoroughly, but he was definitely congested."
"Why didn't you do a more thorough exam?" Wilson demanded, and Foreman sighed.
"We have a patient in acute liver failure. He wants a liver biopsy."
"Does he need to be admitted?"
"I doubt it. But I think it could be worth it to check his temp in another hour or so." Foreman followed Masters back across the parking lot and into the elevator, unzipping his coat as he went.
Sighing heavily, Wilson agreed to go check on House. Foreman agreed, and hung up; removing his coat swiftly.
"Is Wilson going to check on him?" Masters asked quietly.
"Yes, he'll check his temp in another hour. Hopefully the Tylenol will kick in by then." Foreman left the elevator with Masters; though he headed for the floor while she returned to the conference room. After another check on the patient, he left orders for the liver biopsy to be scheduled and returned to Diagnostics to finish the argument with Chase and Taub.
"I don't see House." Taub said the instant he walked in the door. Masters gave him a sympathetic look, and Foreman blinked in surprise.
"You probably won't. He's not coming in."
"Couldn't get him out of bed?" Chase sat on the edge of the table smugly.
"He's sick." Masters blurted out, and Foreman rolled his eyes.
"Sick? No way. House is never sick." Chase tapped a pencil against his teeth thoughtfully.
"He's running a temp. 103.2." Masters confirmed. "He's not coming in."
"Convenient." Taub snorted.
"Look, he'll consult from home." Foreman said finally. "But he is sick. Wilson's headed over to check on him. In the meantime, he wants a liver biopsy."
Chase straightened sharply. "Did he say what he thinks it is?"
"No. But clearly he's got an idea, or he wouldn't have ordered the biopsy." Foreman sank down in one of the chairs and rubbed his temples tiredly. "Chase, you want to handle it?"
Sliding off the table, Chase nodded. "Sure."
"It's already scheduled. Radiology room three." Foreman told him quietly.
"I'll head down there, then." Chase motioned to Taub, who reluctantly followed.
The liver biopsy revealed hepatocellular necrosis and sinusoidal bleeding. Also, shortly after the biopsy the patient had begun to show signs of pulmonary edema and catecholamine syndrome. Foreman had ordered vasopressors and additional fluids to replace the volume. Unfortunately, additional edema seemed to be the only response so far.
"We need to talk to House." Taub repeated, and Foreman gripped the edge of the conference table to keep from strangling him.
"He's not answering his phone again." Foreman said through gritted teeth. Wilson had at least confirmed that his temp had fallen somewhat—102.6—but he hadn't stayed, and House was off the radar again.
"If we can't bring House to the case, we'll have to bring the case to House." Chase intoned, and rose to his feet to grab his coat.
"You don't mean—"Foreman began, only to pause when Taub and Masters got to their feet and grabbed their coats.
"Yep." Chase zipped his coat up, and Foreman sighed loudly.
"You're waking him up this time." He warned, and Chase chuckled darkly.
After much debate, they had all opted to ride over to House's together. Their trek was hampered twice; first when Taub had discovered a Starbucks, and then again when Masters had sidetracked them to a Walgreens for decongestants and Kleenex. By the time they finally arrived, Foreman was relieved to find House's apartment dark and still; much as it had been earlier. But now the TV was off, and House was in bed instead of on the couch.
He was awake by the time they trooped into his bedroom—but Foreman supposed their bickering and scuffling in the doorway was enough to wake anyone up. He looked—and sounded—terrible; cheeks tinged pink with fever, skin sallow, eyes bloodshot. His voice was deeper and more gravelly; the mucus had settled deeper into his chest and he chuckled wetly when Masters presented him with the cough syrup, cough drops and a new box of Kleenex.
"I love you." He declared hoarsely.
Masters flushed to the roots of her hair, and Chase laughed. Sitting up, House dug into the bag of cough drops and unwrapped two before popping them in his mouth. Sighing, then coughing; he doubled over for a minute before he spoke again.
"So you kids had to come crawling to daddy. Still not ready to be alone in the big diagnostic sandbox."
"Are you sick?" Taub asked. House glared at him.
"God, I hope you're more observant than that for our patient's sake. How was the liver biopsy?" House asked, and Chase shook his head tightly before answering.
"Hepatocellular necrosis and sinusoidal bleeding."
"You bring the pathology report?"
Chase held it out, and House took it; rapidly reading one page and then flipping to the second. He stared at the pathology images for a long moment before shaking himself.
"Any other changes?" he asked faintly.
"Pulmonary edema. We're pushing vasopressors and adding volume; but so far no change. She is showing signs of catecholamine syndrome." Foreman recited.
"How are her pancreatic enzymes?" House's nasal congestion sounded more and more prominent by the minute. Foreman suspected his being upright more than likely had something to do with it.
"What about her pancreatic enzymes?" Taub asked, and House snorted, then started coughing again.
"Where are her amylase and lipase levels?" he demanded once he'd gotten his breath back..
"High, but still within range." Chase answered..
"Keep an eye on them." House ordered. "If she heads for pancreatitis, call me."
"Wait, that's it?" Taub demanded, though he got no answer as House settled down in bed again and closed his eyes. Foreman rose to his feet, sharing a bemused look with Chase. Taub threw his hands up in the air and stormed down the hallway with Masters trailing in his wake. Smiling, Chase began to follow only to turn around with a question in his eyes. "House? You need anything before we go?"
Chase spun and left without another word, and Foreman rose and followed. Pausing in the living room, he snatched the cordless off the table and carried it back into House's bedroom. He stuck the phone in House's slack hand, ignoring the smirk House gave him in lieu of a reply.
How did the man do it?
Foreman leaned back from the table he'd grabbed in the cafeteria and surveyed the message on his pager in chagrin. Latest lab draws showed the patient was headed for pancreatitis. Damn House anyway. He clearly knew—or at least suspected—where the patient's symptoms were headed. Somewhere in the medical rolodex that was House's mind, the diagnostic criteria were lining up to some obscure diagnosis. If only he'd deign to share that information with the mere mortals who worked for him.
Taking out his cell, he shot off a text to the rest of the team—who had disappeared to shower, change, and eat before agreeing to meet up again. Foreman had stayed—mainly because he had drawn the short straw and landed the pager for the holiday weekend. Smiling slightly, he cheerfully sent the recall and returned to his eggs and toast. Only one person left to contact. And Foreman would bet good money the man still wasn't answering his phone. Why bother trying him? He toyed absently with the remnants of his breakfast before setting the tray aside. Keying up his phone, he entered Wilson's cell number without a second thought.
"Wilson. It's Foreman."
Foreman paused, uncertain how to phrase his question. Wilson clearly wasn't feeling charitable at the moment. Either Foreman's requests were wearisome—or, more likely—House was. Having spent seven years working for the man, Foreman knew House's hijinks while sick varied with his symptoms. House hadn't seemed like he'd have been up for much when the team had stopped by earlier.
"I, uh—wondered if you've talked to House. Since earlier, I mean."
"Yeah." Wilson said shortly. Irritation flared, and Foreman struggled to keep his voice level despite the frustration he felt at Wilson's one word answers.
"Are you there now?" he settled for asking.
"Can I talk to him?" he asked in exasperation.
There was silence for a moment, and then the sound of the phone being passed over. Foreman listened closely; he could hear House's noisy breathing, and then a wet chuckle. In a raspy voice, House said; "You owe me a hundred bucks."
"What for?" Foreman demanded.
"Not you. Wilson." He chuckled again, and then started to cough. "Said you wouldn't call before noon."
At least that explained Wilson's reticence. Foreman tried to hide a smile and played with his pager while House regained his breath. "Patient's headed for pancreatitis."
"Good." House said hoarsely.
"I imagine the patient feels differently."
"There's a lot of things that cause liver failure. A lot less things cause liver failure and pancreatitis." House rasped. "Do an ERCP. See if she's got stones plugging a bile duct."
Foreman wasn't entirely surprised when House simply hung up without saying anything further. It was just as well. He'd been about to ask how his boss was doing. House hated personal conversations.
At least it had been easier to convince Chase and Taub to do an ERCP than it had been to convince them to take biopsies for amyloidosis. This time around, he supposed doing another procedure was even warranted. In any case, he'd been pleased when they had simply gathered the latest lab work and gone off to set up a slot with GI. Bereft of the rest of the team, and lacking new information for a differential, he'd done the only reasonable thing he could think to do.
Only for minutes at a time, stretched out on the couch in the ID lounge. Foreman had shrugged out of his lab coat and pulled it over his head. The starched white fabric was rough against his skin, and did nothing to dilute the intensity of the fluorescent lights overhead. Unable to fall asleep, he found himself attuned to the sounds in the room; the quiet hum of the vending machine, the distant murmur of voices in the hallway . Lying with his eyes closed, he heard the door to the lounge open and close; the scuffling of tennis shoes on linoleum and the loudly whispered conversation all the way from the door to the kitchen area.
"You end up taking a look at the file before the ER gave it to Diagnostics?"
Fredricks. Giving up on sleep for the moment, Foreman perked up beneath his lab coat, listening closely. There was almost always good gossip to be had when jealousy reared its head.
"Looked to be fairly straightforward, but Nelson disagreed with me. Practically ripped it out of my hands to hand-carry it to Diagnostics. No idea why they even maintain an Infectious Disease team here at the hospital. Just take everything to House."
Foreman struggled to place the voice of Fredricks' companion. Mortenson? Had to be.
"Volume. House only takes one case at a time. Somebody has to absorb the overflow." Fredricks sounded bored, and Foreman could hear him trying to force-feed a dollar bill into the vending machine.
"I heard House isn't even here for this one." Mortenson said casually.
Fredricks said nothing for a long moment as he made his selection on the vending machine and a can dropped down. "Thought he was too much of a control freak to sit out a case. Where'd you hear that?"
"Nurses. Said his team was running differentials without him today. And he's had his current batch of fellows for three years now. And two of them are from the batch before that. You'd think after so long they'd be able to figure out a case without him holding their hands." Mortenson's voice sounded a little more distant than it had previously, and Foreman guessed he'd put his head in the refrigerator.
"Chase and Foreman, right? From the previous batch? I thought they both went out on their own." Fredricks opened the can and gulped half of it down noisily.
"They did for a while. I heard Foreman got fired from Mercy. And Chase was in surgery, but he went back to diagnostics after House's stint in the nuthouse." Mortenson laughed as he closed the refrigerator door. Secure beneath the privacy of his lab coat, Foreman felt his ire rise. He'd had his own opinions on House's mental state since the day he'd met the man; but the idle speculation of his peers rankled him. House's reasons for going to Mayfield were his own, and even Foreman had to admit he'd come back a changed man. A better man, even. A kinder, gentler ass.
"…you ask me, I think both of them are afraid to leave House's shadow. I'd think they'd head for the hills after a fellowship with House." Mortenson continued.
"You have to admit, though, three years under House would be damned impressive on your CV." Fredricks admitted grudgingly. Foreman felt his estimation of the man rise slightly.
"Would you do it?" Mortenson demanded slyly.
"A fellowship under him. He's due to take on a whole new group sometime this year. Hope he doesn't decide to hire by his Survivor rules again. God, that was a nightmare."
"I'm not deluded enough to think I'd be a candidate. I never had the grades or the references to make it onto his top list of candidates." Fredricks said honestly. "House is an ass, but he does know his stuff."
Foreman longed to listen to the rest of the conversation, but a buzz from the pager against his hip distracted him from his eavesdropping. By carefully wiggling it off of his belt, he peered at the blue screen to find a message from Chase indicating they were done with the ERCP. Grinning slightly, he returned the pager to its clip and threw his labcoat off. He rose to his feet slowly; taking in Mortenson and Fredricks' dumbfounded looks.
"House is a world-renowned diagnostician." Foreman said shortly. He made certain his gaze rested steadily on Mortenson before speaking again. "He deserves his reputation. And he doesn't need me—or anyone else—to defend it. My reasons for coming back to House are my own, and the same goes for Chase. House is an ass. But he's an honest one. That makes him a better man than you are."
Spearing Fredricks with a look, Foreman inclined his head genially. "If you ever decide to vie for a spot on the team, let me know. House rarely picks candidates because of how good they look on paper. If he found you half as insightful as I just did, you'd make the cut." He turned on his heel then and left the lounge, smirking at their stunned reflections in the plexiglass window across the hall as the door closed behind him.
He walked all the way back to diagnostics. Given that it was a Sunday afternoon—the first one of the New Year—he wasn't surprised to find the hallways virtually empty. He enjoyed the warmth of the late afternoon sun, and the relative quiet of the entire fourth floor. Arriving to an empty conference room, he hung his labcoat on the tree near the door and surveyed the room critically. Textbooks were strewn all over the table, along with case notes, coffee cups and bits of trash. Chase's sweatshirt hung on the back of one of the chairs, and Taub's suit jacket over another. The only tidy spot at the table belonged to Masters; her chart notes and texts were neatly stacked in a pile. Rolling his eyes, Foreman crossed to the coffee pot and rinsed the pot before refilling the reservoir and dumping a packet of grounds into the filter.
"Oh good, you're starting a new pot." Chase said as he strode into the lounge. He was still in his scrubs from the procedure and he hurriedly shrugged into his sweatshirt. Even standing some distance away, Foreman realized he could see gooseflesh all over Chase's arms. He looked pale, and his lips even had a slight bluish tinge.
"You okay?" Foreman asked quickly. Chase nodded, and put his hands in the pocket on the front. With some effort, Foreman suppressed the kangaroo joke that came to mind in House's voice.
"I think House screwed with the thermostat in the GI rooms during that last case."
"Didn't know he had a problem with anyone in GI." Foreman said in puzzlement.
"He went rounds with the guy doing ablations." Chase offered in explanation. "He wouldn't authorize a transfer for the case 'til he was able to prove the patient's candidiasis wasn't from the ablation he did."
"That's right." Foreman remembered the case now. House had attempted bribery and blackmail to gain access to the patient. When his old stand-bys had failed; he'd resorted to physically stealing the patient from the GI wing. He'd refused to return him; but luckily for the patient—Cuddy—and the GI attending—lab tests had revealed his candidiasis hadn't been caused by the procedure and House had been at liberty to take the patient and treat him.
"How was the ERCP?" he asked lightly. The smell of brewing coffee was pungent, and Foreman found the endorphin rush in anticipation almost euphoric.
"Bile ducts are clear. Taub's downloading the file in a compressed zip to send to House. Whatever is causing the pancreatitis, it's definitely connected to the liver failure."
"Not artifactual." Foreman mused. "Where's Masters?"
"Waiting for the new labs. Urine output has been slowly decreasing."
"You don't think—"
"Renal failure?" Chase snorted. "Not yet. But her output's only 0.5 ml/kg since her admission yesterday."
"Damn." Foreman muttered. "Three organ systems failing or headed that way. What the hell is this thing?"
Chase shrugged as he snatched his mug off the table and moved to wash it. Coffee streamed steadily down into the pot, and Foreman opted to follow suit. Mugs rinsed, animal crackers retrieved, Chase had his hand on the handle of the pot when the coffee maker finally signaled it was done. Without waiting, Chase immediately poured a mug full before offering the handle to Foreman. Accepting the full carafe gratefully, Foreman breathed deeply as coffee splashed into his mug. Careful not to spill, he filled the mug within an inch of the top and set the pot back on the warmer. He wrapped his hands around the mug and sipped, happy with the warm, bitter taste that flowed over his tongue and down his throat.
The way he liked it.
Chase, too, seemed happy to have coffee on board. He returned to the conference table and settled down in his customary spot. Neither spoke for a time; enjoying silence so comfortable that not even the crunching of animal crackers was enough to disturb it.
Until the phone rang. Jolted unpleasantly back to reality, Foreman reluctantly answered.
"It's Wilson. House wants to know if the ERCP is done."
Chase leaned back in his chair and eyed Foreman speculatively. Foreman shrugged. Wilson calling could mean House was worse. Or House was screwing with them.
"Done. Bile ducts are clear." Muted rustling filled the connection as the phone changed hands.
"No stones?" House rasped breathlessly. Foreman exchanged another look with Chase. House was definitely worse.
"No stones. No nothing. Gallbladder was clean. Liver looked as good as you could expect given the hepatitis. Whatever's causing the pancreatitis has to be connected to the liver failure." Chase reported calmly.
"Want to see the procedure." He croaked, and Foreman nodded, forgetting House couldn't see him.
"Taub's formatting it into a zip for you."
"Mnemonic." House started to cough, and Foreman headed for the whiteboard. He left the patient's ever-growing list of symptoms on one side, but cleared the other to write out the mnemonic SMASH.
"Steroids: not a body builder." He said aloud. "Mumps: patient vaccinated when appropriate."
"See ya." House said in a garbled voice.
"Autoimmune: no sign of asymptomatic lupus. Scorpion sting: not in Jersey in January."
It was hard to tell, but it sounded like House was chuckling. Or trying to. Chase smirked.
"Hypercalcaemia: not according to the labs. Hypertriglyceridemia: none of that either. Hypothermia: no way."
"No help from the mnemonic." House breathed.
"Does it ever help?" Chase asked rhetorically.
Foreman paused and looked up to see Taub come striding into the lounge confidently.
"Got the procedure all formatted?" he asked expectantly. In lieu of a reply, Taub held out a flash drive. Foreman nodded, and Taub helped himself to the coffee.
"Taub has the procedure ready for you to view. Want me to email it, or do you just want to log in and see it?" Foreman asked. House was silent for a moment, and then spoke wetly.
"Log in." he said. Over the speaker phone came more rustling sounds, and then Wilson was speaking again.
"Anything else he should know right now?"
Foreman hesitated before answering. "Pretty sure the patient's headed for renal failure. No labs to confirm it yet, Masters is waiting for them."
"He'll see them when he logs in, so I won't mention them now." Wilson said quietly. "You'll upload the video shortly?"
"I am now." Foreman mumbled, even as he logged into his laptop and plugged the flash drive in. Almost immediately, the video began to download into the chart.
"He sounds pretty bad." Chase said faintly.
"He's not good." Wilson confirmed.
"Bronchitis?" Chase asked.
"Are you staying with him?" Foreman asked, even as Taub sank down beside him at the table to slurp at his coffee.
"I think for now, anyway." Wilson said finally. "Call my cell if you need to talk to him. If he manages to fall asleep I don't want to wake him up if I don't have to."
"Okay." Foreman agreed. "Keep an eye out for the updated labs."
"Will do." Wilson promised before hanging up.
Foreman fell into silence after Wilson hung up; he watched the file finish downloading while Taub finished doctoring his coffee and settled at the table.
"What's up with the labs?" he asked after he'd taken his first sip.
"Patient's only produced 0.5 ml/kg of urine since admission yesterday." Chase said soberly.
"Kidneys are compromised." Taub mused. "What'd House say?"
"Don't have the labs yet." Foreman said shortly. "He'll see them when he logs in the chart."
Getting to his feet, Foreman crossed to the white board. He snatched the eraser out of the tray and erased the mnemonic. Adding 'kidneys' to the bottom of the list, he studied the entire smattering of symptoms; looking for something, anything they might have missed.
"Liver failure, pancreatitis, and now the patient's kidneys are compromised." He said aloud. In his periphery, he could make out a blur of color and he turned to find Masters skidding to a halt to push the glass door open.
"Elevated BUN/creatinine?" he asked when she opened her mouth to speak. Frozen, she could do little more than nod as she held the still-warm paper out for him to inspect.
"Renal failure." He said grimly, and tossed the page down on the table for everyone to see.
The rest of the afternoon had passed in a blur. More labs had been ordered, dialysis cleared with nephrology for the first available slot the next day.
Dinner had been picked up; Chinese for all, save Masters, who had opted to pick up her own salad. No one had spoken, really, beyond their failed attempt at a differential on the renal failure. Without House, there was nothing left but to go through the motions.
"Any change in her status?" Foreman asked quietly, and Chase shook his head.
"She's holding her own, for now. All we can do is treat the symptoms. Without a diagnosis—"
"I know." Foreman said shortly.
"Should we try again?" Taub asked, and Chase shook his head.
"Do you have any ideas you didn't mention a while ago?" he asked.
"If House had an idea, he'd have had Wilson call us back." Foreman pointed out. "He knows we need him on this one."
"Maybe House is stumped, too." Taub said flatly.
"House has good reason to be off his game." Chase snorted. "If you had a moderate fever and congestion you'd be sacked out on your couch. Not running a team differential."
"Look—as long as she's stable we'll just watch her." Foreman had felt his temper flare with Taub's baffling lack of understanding. House was good, but he wasn't good enough to trump his own physiology. "We need a break on this case. Since we can't come up with one, we'll have to see what happens. We need more clues."
"So we just sit here and watch her die?" Taub asked skeptically.
"Yeah. Or as House says, watch how fast she's dying." Foreman rubbed his forehead tiredly. "I think we should all stay close. One of us can watch her, and the rest of us can try to catch up on some sleep. Hit the on-call rooms."
"I'll take first watch." Chase offered, and Foreman shook his head.
"Let Taub do it. You did most of the procedures."
"I'll go after Taub. Masters can take the third watch." Chase finished his dinner and rose to throw his trash away. "You stayed last night and all day."
"I'll stay." Foreman said quietly.
"Then you'll be last." Chase motioned to Taub, who had also finished and had gotten to his feet. "Come on. I want to run one more set of labs before I crash for a while."
The on-call rooms had been too quiet. And sterile. The fluorescent lights and the stark white paint, white bedding and bleached out scrubs he'd slipped on had done nothing to relax him. After lying quietly for nearly an hour, he'd reluctantly slipped his shoes back on and headed back to House's office. Sitting in House's desk chair had proved uncomfortable to his spine; his Eames chair had proven similarly uncomfortable for his restless thoughts. He settled for the floor, lying with his head hidden by the desk. Head pillowed on his folded arms, he'd closed his eyes and willed himself to relax.
At some point, he realized he'd fallen asleep. For when he woke next it was to the overhead lights blazing and Masters' shrill voice calling for him.
"Dr. Foreman! Are you in here? She's bleeding!" Masters cried, and Foreman sat up sharply from his nap to find the med student standing in the doorway. Her cheeks were flushed, hair disheveled. For a second, he hoped that he had misheard her. But her expression lent an urgency to her incomprehensible words and he knew that the diagnosis would be found shortly; either in time to cure the patient, or during her post-mortem.
"She's hemorrhaging. Chase said he tried to page you—"
Foreman was on his feet and brushing past her almost before he could think.
Hemorrhaging. Acute bleeding from every orifice including ears, eyes, nose, mouth and anus. Coming to an abrupt halt in the doorway to the patient's room, Foreman froze into inactivity for a split second at the sight of the ever-growing blood splashed vividly on the bed.
"Gown up!" he ordered, thrusting an arm across the door to block Taub's entry behind him. "Double glove." He snapped. "You—"he called to a passing nurse; "I want 2 units of blood prepped and standing by. We need platelets and PCC stat!"
The patient was stable. For the moment. Procoagulants had been successfully introduced; the hemorrhaging had been stopped. But they were no closer to a diagnosis than they had been when she had presented with liver failure a day—two days—earlier.
They had failed. Foreman struggled to block that thought from his mind as he picked up the conference room phone and dialed Wilson's cell. Mortenson had said it himself—they'd been under House long enough. All of them. Finding the diagnosis should have been easy. Or at least obtainable. And if they couldn't—if he couldn't—find the diagnosis without House holding his hand, what did that mean? For himself? For his career? For his patients?
"Wilson, it's Foreman. We need to talk to House."
"No." Wilson said flatly, and Foreman ground his teeth together in frustration.
"We need him. The patient's hemorrhaging, and we can't do this without him."
"He's not going to be able to help. I'm sorry. His temp's up, his voice is gone, and I don't think he's entirely with it. He shouldn't be working at all right now. You're going to have to solve it by yourselves."
Dimly, he could feel the hard plastic shell of the phone in his hand and hear Wilson's voice as though from a great distance. Sweat slicked his palms and broke out along his hairline. Awash in the tumult of his thoughts, an ocean tide of fear washed over him. The roaring was in his head and it was all he could hear and see and feel for a long moment.
"Foreman? You there? Did you hear me?" Wilson asked, voice echoing hollowly. He felt as though he was trembling from head to toe. Was he coming down with what House had? Was it fever that crept through him; this rushing inferno of heat and fear and doubt that seeped outward through his skin where it forever stained him with proof of his cowardice.
"Yeah. I'm here."
"I'm sorry." Wilson said again.
"Okay. I—okay. "
"As soon as he seems like he might be able to help, I'll give you a call." Wilson promised, and Foreman licked his lips before answering.
"Thanks." Sliding the conference room phone back onto the hook, he closed his eyes tightly. Pinching the bridge of his nose, he sought relief from the headache that resided there.
"No House?" Chase asked quietly, and Foreman nodded.
"Wilson says his voice is gone. Fever's up again, too."
"What do we do?" Taub asked. "House's ideas were all we had. None of us specialize in ID."
"We do now." Foreman said flatly. "We've been with House long enough—all of us—we can do this. We have to do this without him."
"We can't—" Taub started to say, only to fall silent when Foreman strode past him and stormed into House's office. Scanning the bookshelves, he made out a series of texts bearing titles such as Infectious Maladies, Clinical Infectious Diseases, Viral Haemorrhagic Fevers, and Medical Helminthology and Protozoology. His hand stayed of its' own accord; hovering near the Clinical Infectious Diseases book that occupied a five-inch space on the shelf. Reaching out, he rested his fingers on the edge of the book's spine. It was cool and solid beneath his fingertips. The answer rested inside. Just below his reach.
"It'd be smarter to send the case on to the ID department." Taub was saying loudly in the conference room.
"If ID could handle it, they'd have taken the case in the first place!" Chase was arguing. Masters said nothing, sinking down to sit at the table in silent defeat. Closing his eyes, Foreman did his best to block out their voices and ran over the differential in the silence of his mind.
Diarrhea. Stomach upset. O&P with confirmed giardiasis.
Responded to two courses of antibiotics. Subsequent stool tests were negative.
"Then we transfer her to another hospital." Taub snapped.
"She's not stable. She wouldn't survive a transfer." Masters said quietly.
"You figure another team would figure out what we can't?" Chase demanded.
"The patient needs a team with more ID knowledge. We don't have that."
Stomach upset persisted. EGD performed with biopsies. Wide-spread celiac disease. Discharged to home with a gluten-free diet.
"All right, so we go over this case again. Step by step." Chase turned one of the chairs around and sat down.
"It's over, Chase." Taub said quietly. "House was the only one guiding this case."
"So, what? You're going to just let her die? Because House is sick?" Chase asked in exasperation. "We'll just explain that to her family. Sorry, folks, our boss was sick and we couldn't figure it out without him."
Jaundice. Maculopapular rash. Arthralgia. Fever. Elevated liver enzymes. Acute liver failure. Liver biopsy revealed hepatocellular necrosis and sinusoidal bleeding.
Pulmonary edema. Catecholamine syndrome. No response to vasopressors. Pancreatitis.
"…then it's something we missed." Chase snapped. Taub threw his hands up in irritation.
"We didn't miss anything—"
"Stop it!" Masters shouted, and Foreman finally looked up to see the young woman get to her feet. "You're supposed to be professionals. We're supposed to save her! Not sit back here fighting about what to do!"
Chase snorted. "It doesn't always work that way." He muttered in a low voice.
"Are you giving up?" she demanded hotly.
"Maybe Taub's right." Chase said after a tense moment. "We don't know what it is. Maybe the best we can do is make her comfortable."
"And lose the chance to help cure her."
"Maybe there isn't a cure." Taub said quietly. "Maybe it's her time to go."
"She was healthy two weeks ago." Masters countered. "No sign of liver involvement. No jaundice. And none of her other symptoms. It's something she contracted. It has to be a virus!"
"Which one?" Chase shouted. "There are thousands of possible viruses. We don't have time to run titers on all of them!"
Closing his eyes, Foreman turned back to the shelves and let his fingers slip away from the book's spine. Hands balled into fists, he stood in indecision; breathing in the musty smell of the books and caught the faintest whiff of House's scent mingling with the smell of leather and detergent and bleach.
What would House do, he wondered. House would go and bother Wilson. Or juggle his ball. Or play his DS. But he would find the answer. He always did. Feeling lost, he lifted his hands and unclenched his fists. Wiggling his fingers, he dropped his left hand and reached out to touch the books on the shelves. He ghosted a hand over their covers from one end of the shelf to the other; noting the difference in height and breadth beneath his questing fingertips—there was no way to know the answer. No way to save the patient without House. Hewasn'—his eyes flew open and his hand dropped as he sought to gain control over himself. Reprimanding himself for his spiraling thoughts, he steeled himself to return to the task at hand. Panicking didn't do anything to help the patient. Nor did arguing about it. Lifting his chin he turned to survey the bickering in the conference room; only to realize his hand had come to rest on the cracked spine of one of the books on the shelf. Purely out of reflex, he squinted to make out the faded gold lettering on the spine.
Viral Haemorrhagic Fevers.
The patient's coagulation factors had decreased sharply; leading to bleeding from all orifices within the past hour. She was hemorrhaging.
"It's a hemorrhagic fever." Foreman breathed aloud, and the rest of the team froze.
"Where would she have come in contact with it?" Chase demanded. "There's been no recent travel in her family."
"I don't know." Foreman snatched the book off the shelf and carried it into the conference room. He dropped it on the table and dove into the text; his sweat slicked fingers caught the glossy pages easily as he scanned the table of contents and turned quickly to the chapter titled Viral Haemorrhagic fevers.
"Do you think House was onto it?" Taub asked breathlessly.
"He had to be." Foreman thought back to the way House had asked for the liver biopsy. How he'd received the news of hepatocellular necrosis and sinusoidal bleeding.
He'd predicted the pancreatitis. The subsequent renal failure and hemorrhaging—Foreman felt a tickle in his mind; the name of a virus presented in his one course of Infectious Disease arose to the forefront of his thoughts as though it were a great neon sign.
"Marburg virus." He said aloud in amazement.
"What's that?" Taub asked at the same time Masters drew in a deep breath in alarm.
"Masters?" Foreman asked smoothly, and the girl hesitated for only a moment before launching into the virus's particulars.
"It's from the same family as the Ebola virus. Single stranded negative sense RNA-virus. Marburg fits with all of her symptoms."
"It's not Ebola?" Taub asked doubtfully, and Masters shook her head. "Ebola and Marburg act on different antibodies." No one spoke for a few minutes, and Foreman stared down at the cheerful color image of enhanced Marburg virus particles on the book's open page.
"Get her into isolation, and pull blood for an ELISA. Get samples from her family, too." Foreman spoke at last. "And yourselves."
"Any treatment?" Chase asked as he rose to his feet, and Foreman scanned the book briefly; using the moment to gather his own recollections about the disease. The book confirmed his memory; supportive care was all medicine could offer.
"No." he said finally. "The virus has to run its' course."
Masters got to her feet and all but sprinted to the door, while Taub moved stiffly in her wake. He was on his phone before the conference room door closed behind him; ordering their patient be moved into isolation and that blood sampled be gathered and run to confirm the virus stat. Chase lingered for a moment, finally holding a hand out to Foreman.
"What's this?" Foreman asked suspiciously.
"Congratulations." Chase said quietly. "House'd be proud."
Foreman snorted, and Chase shook his head. "You know what I mean." He said in exasperation.
"Thanks." Foreman said finally. He took Chase's hand and they shook before Chase headed down to help with the patient's transition. Alone with the book, Foreman reverently closed the cover and picked it up; finding comfort in the weight of the knowledge contained within its pages. Sliding it back into place on the shelf, he let his fingers linger on the spine before letting his hand fall away. Shaking his head in amusement, he struggled to keep a smile from tinging his lips. Obscured by his hand, the significance of his choice of text had been lost on him. Smiling at the irony, he supposed he shouldn't have been surprised.
Viral Haemorrhagic Fevers by Gregory House, M.D.
Even when he wasn't present, the cranky bastard still had the final say on a diagnosis.