"Cold, tumor, or STD?"
World famous diagnostician, Doctor Gregory House, asked this question as he limped into clinic room two, not even looking at the patient.
House flipped open the patient chart, and scanned it, making some 'uh-huhs,' as he went. "I said," he repeated. "Cold, tumor, or STD?" He looked up at the clinic table to see a middle aged woman with her small, teenaged daughter.
House immediately began looking for symptoms. He knew it would just be a routine cold, but he was always looking for puzzles, always searching for clues. That was his job, his life.
He noticed the girl's laboured breathing, the wheezing sound that happened every time she took a breath.
He noted her small stature, and the way her hands shook slightly. He noticed the slight hunch in her posture. A tired hunch, as if the girl didn't have the strength to keep herself up.
House looked up quickly, his crystal blue eyes landing on the mother. "That's my name, don't wear it out." He hung his cane on the counter and limped over towards the girl. Pulling out his stethoscope, he slid it under the girl's shirt on her back.
"Breath in," he instructed. She did, and his eye brows crinkled as he heard what could only be described as crackling. Then, he grabbed a thermometer from the drawer on his left. Sticking it into the girl's mouth, he waited 'till it beeped.
"103.4," House said, looking curiously at the girl. He got a strange feeling this wasn't the first time this girl was this sick. The mother was too calm.
Either that or she just didn't care about her daughter.
But whichever one it was, House had a hunch. A hunch that this was no normal case of pneumonia. Usually, House's hunches were worth following up on. "How often do you get these chest infections?" He asked.
The mother bit her lip. "She never used to get them often, but this is the third this year."
Weakened immune system, House though immediately. He stood up, grabbing his cane from its spot on the counter.
House was just about to speak when he realized something. The girl hadn't said a word. Neither the mother nor the girl had introduced themselves. "What's your name?" he asked gruffly.
"Josie," the girl answered hoarsely.
"Well, Josie," House said, a glint in his eyes at the possibility of a new case. "I'm admitting you."
House M. M. M. M. M. M. M. M. M. M. M. M.D.
"15 year old female presents with pneumonia, muscle weakness in one leg, and delayed motor functions. Go."
Cameron pursed her lips. "People with pneumonia usually have some muscle weakness. She's probably just tired. And she could just be slightly mentally retarded."
"That," House said, his marker squeaking as he wrote the symptoms down on the white board, "would be a coincidence, which I hate. And if you had done a patient history, you would have found out the muscle weakness was there before she got sick."
Chase choked on his coffee. "You did a patient history?" he asked, amazement creeping into his Australian voice.
"Didn't have to," House answered, striding over to the glass table where his duckling sat. "She was walking with a pronounced limp, which wouldn't happen if you were just tired everywhere."
Foreman nodded his head, agreeing with House. "And if it was just muscle soreness or fatigue from the pneumonia, it would be everywhere, not just in one limb."
"Thank you," House said, annoyance creeping into his voice. "Now can we skip the ass kissing part and get back to the whole, patient could be dying, part?
"Right," Chase said. "It could be epilepsy. Patient has a focal seizure, she becomes slightly confused afterwards and presents with muscle weakness after having a few more seizures than normal."
"All of which could be accounted for by the rise in her temperature due to the pneumonia," Cameron finished, flipping through the patient's file. "Do you have her on a fever reducing medication?"
House glared at Cameron. "Yes." He turned back to Chase. "Epilepsy doesn't account for her weakened immune system."
"Weakened immune system?" Foreman asked, leaning forward. "You ran the tests already?"
"Yet again," House said. "Didn't have to. She's had three bouts of pneumonia already this year. Her immune functions are down." He threw the whiteboard marker in the air, catching it again. "Come on people, think! What could it be?"
"West Nile," Foreman put out.
House nodded. "Very good."
"Could be anemia," Cameron added in. "She's just the right age."
"Okay," House said. He glared at Chase. "Come on, spit it out, Wombat! Everyone else has some good ideas! You're just sitting there, waiting for a good idea to mooch off of!"
"It could be Lyme disease," Chase suggested. "Or a number of toxins or prescription medication."
"Alrighty then," House said. "Cameron, go get a patient history. Chase, take some blood and run a full blood panel, and check specifically for West Nile and Lyme. Foreman, go do a tox screen."
His ducklings all got up from their chairs, and started to leave. "Oh, one last thing," House said, an evil grin on his face. "Foreman, pick up my dry cleaning when you're done."