A/N: On to the appointment. We are getting very close to what is probably my favorite chapter out of this whole story, the peak of my many favorite ones. If writing schedule pans out from mentally onto paper undisrupted (no guarantees there, as you well know!), that one should be three chapters out from here.
Thanks again for the reviews. It's encouraging to know that readers are still with me on this road, which has been far longer than I originally guessed when I posted my first House story, Pranks. It keeps going for at least two subsequent stories beyond here and glimmers of a third and will run on for as long as the muse keeps going with it. She loves the Thomas line, which is one that caught me as off-guard in mentally working out Verdict as it caught the readers. So I don't think the end is anywhere in sight.
Do remember, as one reviewer so eloquently put it, that the moment we are in is all we are really guaranteed, and enjoy times with your family and friends. Last week, almost coinciding with me having to write up the complete history for the new referral for Mom, also marked her birthday, a bittersweet occasion anymore. She is still in her 60s, in spite of already being fully immersed in hallucinations, delusions, occasional violence, and extreme loss of memory and emotional control. Far too young for the advanced state she's in, an opinion expressed often by her medical personnel. Appreciate the time you have with your people. You never know when it will end, whether mentally or physically.
On to 57. Enjoy! Next chapter is a very intense session with House and Jensen.
House was still grumbling - far from under his breath - as he and Jensen followed Dr. Nichols through the back halls to the office, and his limping path left a wake of startled medical staff and patients staring after him. "Idiots. 90% of patients at least are idiots, and more than that liars. It hasn't occurred to them that hey, we might actually medically need some of this information they aren't sharing. Course, there are two sides to that coin. Plenty of doctors are incompetent idiots, too. I've known several who might as well have gotten their license from a box of Cracker Jacks for all the good they did with it. So then you wind up with lying idiots being diagnosed by arrogant imbeciles. That's a good bit of the medical community in a nutshell."
Dr. Nichols arrived at his office, gestured the two other men in, and firmly closed the door. He walked around his desk to his chair, unable to resist a quick, defensive look at his own diplomas proudly displayed on the wall. He sat down, thinking that he might well prefer one of those lying idiot patients himself to this upcoming conversation. Yes, he, too, had seen his share over the years; House's statistics might be somewhat exaggerated, but the observation wasn't without grounds. Unfortunately, that total included the mother of the eccentric and volatile genius now across the desk from him.
"First of all, I am very sorry about your mother's death, Dr. House," he started. "You have my deepest sympathy."
The sting of the once-hated phrase was far less than before, but it still grated a little. Nichols, House realized, hadn't read every detail he could find in the media on the Chandler trial; he didn't know to avoid it. House wasn't sure whether to be annoyed or comforted by that fact. Nichols clearly was aware of his professional reputation. The man was tense, gearing up to endure cross-examination himself. Pure nerves or guilt? "Too bad your sympathy has to come after her death. You could have tried to prevent it." House went straight for large-caliber guns for his first shot. Might as well get the nerves vs. guilt question investigated as soon as possible.
Nichols flinched. Jensen annoyingly entered the field, his voice polite and steady, driving toward a touchy point as if he were talking about no more than the weather. Not a trace here of the once hot-headed child or the therapist who had admitted that his own error had possibly contributed in part to Blythe's death. He was just now as House had so often seen him, a rock, something to be counted on, calming down the room just by being in it. "What was the date of her appointment with you in December?"
Nichols turned eagerly toward him. He had no idea who this man was, and right now, he didn't care. "December 5th," he replied.
"December 5th." Jensen rolled the date around as if tasting it, then looked over to House. "December 5th. That was before your idea."
House, about to take over the questioning again, came to attention, distracted momentarily. Jensen was right. Well, not entirely right. House had been thinking of setting up those delve-into-the-past conversations with his mother for a month or two, but he definitely had not proposed it to Jensen or mentioned it to his mother before the second week in December. Whatever Blythe's motives in putting off tests, they hadn't included finally getting the chance to talk openly with her son. The only thing scheduled as of December 5th had been a simple family visit for Christmas. He considered the point, then filed it for later analysis, turning back to Nichols. "What were her symptoms?" he demanded.
Nichols opened the chart on his desk, although he had already looked this up several times. "She complained of fatigue and also vague GI and abdominal discomfort. She specifically said that antacids weren't working very well, and that was why she made the appointment. She wanted a prescription for something stronger so she would have it on her upcoming Christmas trip to visit you."
Remembering that bottle of Pepto in the suitcase, House clenched the head of his cane so tightly that his fingers hurt. "Didn't you try to tell her how deceptive GI symptoms can be?"
"Yes." Nichols couldn't help some added emphasis himself there. "She was only scheduled for a 15-minute appointment that day, although she was overdue for a full physical. But I spent well over twice that with her. I asked her for more details, and I told her specifically that it sounded more cardiac to me, especially since OTC meds made no difference for her. I wanted to do an immediate EKG that day, possibly even send her to the ER. I was very explicit about what it could mean. But the further I went, the more she locked into insisting nothing was really wrong." He sighed and spread his hands helplessly. "I couldn't take her hostage and send her over to the hospital, Dr. House. If the patient insists on ignoring advice, there's not much you can do."
House realized that his hands were going numb and forced his fingers to loosen up on the cane. "You didn't give her a prescription for a stronger GI med, did you?" None had been in her suitcase.
"No. She was a little annoyed at me about that, since it was the whole reason she came for the visit. I did refill her Norvasc; it had been expired for four months." House and Jensen gave a mutual sigh.
"What was her BP in the office that day?" House asked.
"172/89. She said it was only up because I wasn't listening to her and that it had been doing better lately. I did encourage her strongly to at least get back on the Norvasc."
"She had that with her in Princeton," House said softly.
"I also gave her a prescription for sublingual nitroglycerin tablets."
House came straight up in the chair. "She didn't have those with her."
"She was very resistant to the idea because she didn't think anything was wrong with her heart at all. I urged her to at least fill that and keep it always with her until more testing in January. She finally took that prescription along with the other one, but I wouldn't be surprised if she never filled it."
House was silent. Jensen gave him a moment and then stepped smoothly into the gap. "She did agree to testing after her Christmas trip?"
"Yes. She would have had a full physical tomorrow morning, and I actually already had set up a stress test at the hospital tomorrow afternoon as well as an abdominal ultrasound afterwards just to check for noncardiac causes. Talking her into that wasn't easy, but she finally accepted it provided it would be after the trip was over."
House shook his head. "But we weren't doing anything. Not that she knew about on the 5th. It was just a routine Christmas with me and the kids." Although how many of those had there been in Blythe's lifetime?
"A physical tomorrow morning," Jensen repeated thoughtfully. "Judging from your waiting room, you're booked up more than just a month out for those."
Nichols nodded. "It was an add-on appointment. I told the secretary to add her as as soon as she possibly could once I was back in town." Anticipating House's next objection, he continued quickly. "And I did suggest seeing one of my colleagues before that, even, just as soon as she got back from Princeton. She refused. Her exact words were that it was bad enough to go through all this nonsense with one doctor without involving two."
House's hands tightened up on the cane again. Damn it, he should have asked her outright about her health. But she probably would have lied to him. Probably wouldn't have considered it a lie, as her shrink had said, because she actually believed it. Nothing serious could be wrong. "She had cancer, too," he said abruptly. "They found that on autopsy, even though it was a heart attack that killed her. Signet ring cell, already with carcinomatosis throughout the abdomen."
"Damn. Would have caught that on ultrasound, but it probably was already too advanced. That one is fast, isn't it?" House nodded. Nichols looked down at the chart. "She had lost three pounds since the last recorded weight. Not enough to notice."
"Probably a pound or two more than that," House countered. "She would have been wearing winter clothes on December 5th. Unless the last appointment was winter, too."
"Last appointment before that was August of the previous year. That's when I gave her a year worth of refills on the Norvasc, and she had been out of it since August of this last year."
"You sent her reminder letters and such, of course," Jensen guessed.
"Yes. We'd tried to get her in. I pushed her a little bit about being overdue when she came in on the 5th, and she said she'd just been too busy to get down to it."
House was thinking at full speed. "It would have been more than three pounds, then, given the seasonal switch. Still within routine fluctuations. Did she mention any problems eating?"
"No. She kept describing this as GI discomfort, but it sounded like two different things to me even then. Lower abdominal generalized pain, no central focus that she would admit to. I did palpate her abdomen on exam that day. Nothing I could find. Then she said there were upper GI symptoms which were periodic, but those didn't seem to be associated with eating. She didn't admit to any change in appetite. She was more annoyed than anything that OTC meds weren't working, and she thought all she needed was a prescription GI drug to fix her right up."
"And of course, she wouldn't have had a good read on exercise intolerance, because she didn't really exercise since her accident because of the balance issues," Jensen said.
"Right. I did ask her, but she hadn't noticed anything. All of her walking was done slowly with breaks anyway. She was a little tired; I had to pry that much out of her. The stress test for tomorrow was going to be chemical, not through exercise."
"I had figured that out," House snapped, but he sounded half distracted now.
Nichols looked over at his diplomas again. "Dr. House, I did absolutely everything I could trying to talk her into testing that day. I told her it could be life threatening. She wouldn't budge."
House was silent for a minute, then his eyes sharpened up on the chart. "I want her chart," he demanded.
Nichols reached for a thick envelope to one side. "The office manager copied everything for you this morning. There are all the records from our office, plus what was sent over from her prior internist a few years ago when he retired." He slid the envelope across the desk, and House picked it up.
Jensen came to his feet. "Let's go," he suggested gently, knowing that once House got buried in the chart, he wouldn't come up for air for a while. But he wouldn't have asked for it unless he were finished with direct questions. House slowly stood. "We appreciate your time," Jensen said.
Nichols shook his hand but didn't even think about trying it with House. "I am very sorry about what happened," he said. "I wish I could have prevented it, but she would not listen."
"We understand," Jensen told him. The two left the office. Nichols stayed at his desk for a few minutes, reading the notes from that last appointment once more, replaying it in his mind. He still couldn't think of anything else he might have done. As House had said, patients were often idiots. With a sigh, he stood up and headed for his next appointment.
Jensen drove as they left Nichols' office, and House hadn't challenged it when the psychiatrist firmly captured the keys as he pulled them out. Before the van even left the parking lot, House had opened the envelope of medical records and plunged in. Jensen parked at another Walmart that they had passed not far away from the office, and he retrieved the letters from the back seat and resumed his own assignment. For the first time all day, the van was as silent as a classroom during finals, no electronic beeps, no shifting, just palpable concentration.
House was used to reading charts, and he was an old hand at quickly pulling out relevant information. He went through Blythe's more slowly than usual, but he still covered it quickly. As brilliant as he was at medicine, he saw no red flags as he read, nothing except the long gap between her prior appointment and that one. He finished the chart finally, reread the notes from that last appointment five times, and then let the pages drop into his lap and just stared through the windshield. Abruptly, the silence pressed in on him, not even a rustle of papers from the adjacent seat, and he looked over. Jensen had the letters reboxed neatly and the flaps closed; he was sitting there watching House. He had actually been done for over twenty minutes, although House hadn't realized it.
"Well?" House demanded, his tone tight. His muscles all tensed up, preparing for the verdict, and his leg, as usual, led the chorus. He forced himself not to drop a hand to his thigh to rub it, not in front of Jensen, who couldn't possibly have missed that physical cue.
Jensen put the box on the back seat behind them and opened the door. "Let's take a break first before we get into it," he said.
"No way," House insisted. "I want your immediate reaction; that's the best one. If you need more time to deliberate it, there must be gray areas there after all, things that he could have picked up on, too."
Jensen slid out of the van and looked back across at House as he stood just outside. "No," he said firmly, "there isn't enough there to have worked it out from the letters alone. In those circumstances, I would have missed it, too. So, now that I've said that, shall we head on back to the hotel for an evening with everybody, or do you want to talk first?"
House slowly looked away. Cursing softly, he opened the passenger's door and carefully extricated himself from the van, and Jensen stood patiently until he was out and then started off at a gentle leg-stretching pace, the two of them mutually working out some of the physical kinks, both aware of the mental knots still waiting.