Title: The Devil's In the Details
Characters: House, Wilson, Cuddy
Summary: The Devil's In the Details again centers around the House-Wilson-Cuddy bond. The story has a lot of introspection, especially for House and Wilson. The plot (such as it is....) centers around House's undiagnosed left leg pain.
This is the third and final book of the Devil trilogy, which began with The Devil, You Say, and continued with Battling the Demons.
The previous chapters can be found by clicking Chapter One: EVASION
Chapter Two: TRUST
Chapter Three: TESTING
And today's chapters:
CHAPTER TWENTY-EIGHT: Sustenance
House is sleeping soundly, and Wilson can tell he’ll be out for several hours. His temp’s gone down, his vitals are good, and—while his breath sounds aren’t showing the improvement Wilson had hoped for—his O2 sats are low-normal.
The emotionally-charged discussion’s taken a lot out of Wilson, too, so after ascertaining that House’s condition is stable, and that he’s sleeping comfortably, Wilson decides to take a nap himself. He sets his watch alarm for two hours, and stretches out on the couch.
Sleep comes surprisingly quickly, and it’s peaceful and dreamless. When the alarm sounds, Wilson rises, and he’s pleased with how rested he feels. He goes to House’s room and finds him still asleep, still comfortable, so Wilson decides to forego the scheduled aerosol until he wakes up on his own. The only bothersome thing is that temp; a tympanic reading indicates that it’s staying around a hundred. Wilson’s glad that they’ll have the blood culture results soon.
Wilson decides that now would be a good time to place his daily call to Dick, get him up to speed on what’s been going on. The first thing he tells him is that House knows the diagnosis, and has, as expected, rejected it.
“But he didn’t get angry, Dick. He just denied it completely. Even calmly. Good thing is, I can tell that he’s thinking about it. Making jokes, comments. And when his left leg spasmed today, he didn’t reject my help.”
“What help did you offer?” Dick asks.
“The usual. I let him know I wasn’t gonna leave him alone, though I’ll admit he tried to get rid of me in the beginning. I knew he needed the med, but I gave him the choice. We talked afterwards; he seemed relieved that we’ll continue to treat the pain.”
“I don’t blame him there,” Dick says. “As you know, the medical community is pretty evenly divided on that. Half feel that psychosomatic symptoms require no medical treatment. I don’t agree, and I’m glad that you don’t, either. That can be devastating for the patient. They’re already having the veracity of their illness questioned, and then they’re left to deal with very real symptoms on their own. I’ve rarely seen that have a good outcome.”
“Yeah, well, there was a time, pretty recently in fact, where I’d have doubted the need for treatment, myself. Can’t believe I ever thought that pain could just be ignored, if it wasn’t caused by the body.”
“A lot of people feel that way—even professionals who should know better. When I lecture on the subject, the example I use is a tension headache. Everyone can relate to that. And there’s a lot of surprise when I tell them that, in the strictest sense, it’s a psychosomatic illness. It’s the brain, dumping its overload of stress on the body. And then the body manifests that psychological stress through physical symptoms. So it’s a psychosomatic reaction, pure and simple. And would any of us deny ourselves pain relief for it?”
“Wish I’d heard your lecture years ago,” Wilson says ruefully. “Might’ve saved a lot of unnecessary difficulty for House. But I know it now; no sense looking back, right?”
“Right,” Dickinson responds, pleased that Wilson isn’t sending himself on a guilt trip over this. “You sound a lot better yourself, James. Glad to know that you’re handling this in a healthy way. That’ll benefit you both. And you sound rested; the Ativan workin’ out for you?”
“Yeah; gotta say it’s a good idea, all around. It’s enabling me to keep a more consistent attitude, feel in control of things. Most of the time, anyway. And it’s having an unexpected benefit.” Wilson chuckles, and continues, “Gives House the opportunity to play the responsible one once in a while, I guess.”
“What do you mean?”
“Well, let’s just say he’s made it his personal duty to see that I don’t miss a dose. And yeah, I’m almost caught up on my sleep. Hate to admit it, but it was a good idea. No telling what my frame of mind would be now, without it.”
Wilson and Dickinson chat a bit more, set up a time for Friday night’s planned poker game, then wind up the call. Wilson checks on House, who’s still sleeping, and decides to give him another half hour while he tries to plan out dinner with their dwindling groceries.
When House does awaken, Wilson’s alerted by the sound of coughing from the bedroom. He gathers the nebulizer and the aerosol supplies before heading in.
“Good sign that you’re coughing,” he says cheerfully to House as he enters. “Pneumonia’s breaking up.”
“Thank you, Dr. Wilson,” House says snidely. “I missed the class on pneumonia in med school; ‘preciate you filling that gap in my education.”
“Any time.” Wilson’s in a good mood after his talk with Dick, and refuses to be fazed by the sarcasm. As he readies the neb, he says, “I’m gonna call the grocery store, put in an order. Any special requests?”
House’s eyes light up. “Haven’t seen a potato chip around here in weeks. Or a Twinkie.”
“Food, House. Sustenance. Nutrition. Or did you miss that class too?”
“And those little chocolate donuts… you know, the ones with the sprinkles?”
“Okay, now that we’ve covered those life-threatening salt and sugar deficiencies you’ve been suffering from, how ‘bout something from the protein group?” Wilson asks patiently.
“Beef jerky—great idea!” House proclaims.
Wilson nods. “Got it; fish, chicken, eggs. Good choices.” He turns on the nebulizer and hands the treatment to House, who makes a face.
“I’m coughing on my own now; why are we still doing this?” House grumbles.
“Because the hydrocodone suppresses the cough. Because you’re still running a fever. Because you’re not ambulatory.” Wilson stands there, arms folded, until House reluctantly bites down on the mouthpiece. “But most importantly, because it buys me a few minutes of peace and quiet.” He responds to House’s predictable glare with a friendly smile, then leaves to place the grocery order.
He returns to the bedroom when he hears the neb machine shut off. As he moves the equipment away from the bed, he asks, “Given any thought to what you’d like for dinner? We should have actual food here soon.”
“Yeah,” House says. “Potato chips, drowning in onion dip, with a side of sour cream. Twinkies for dessert.”
Wilson cocks his head at House. “Now that’s just uncanny! Baked chicken, brown rice, asparagus—exactly what I was thinking, too! You got it.”
And he goes to await the food delivery, smiling at his little victory as he blithely ignores the mumbling, and then the shouted, “Why do you bother to ask? More to the point, why do I bother to answer?” that follows him down the hall.
CHAPTER TWENTY-NINE: Fight
House is picking unenthusiastically at his dinner when the phone rings. Wilson glances at the caller ID; the call’s coming from the Diagnostics department at PPTH.
“You up to answering that?” Wilson asks. “It’s one of your people; I’m supposed to be busy wishing I were dead.”
House picks up the receiver, listens, and makes a face. “Cameron,” he mouths to Wilson. “What are you doing there so late? Got a case?” House looks hopeful as he listens, and then his face falls. “I don’t care what Cuddy said about not bothering me with cases. Wilson’s got the ‘flu. ‘Flu’s boring…. No, of course I wouldn’t want you to defy Cuddy’s order. You know me; I’m all about the rules.” House sighs, resigned. “He’s not doing well, no,” House says into the phone as he looks at Wilson. “High fever, givin’ him some really crazy ideas. Seems to think all this is a game of ‘Let’s Pretend.’”
Wilson widens his eyes and then shoots House a dirty look. House’s own expression is mischievous, but there’s a bit of anger hidden behind the humor.
“Me? Just great…. ‘Course I sound ‘funny’; I’m a funny guy! No, not getting the ‘flu. Tiring work, keepin’ him oriented to the reality of his illness.”
Wilson’s becoming annoyed with House’s not-so-subtle digs, but he’s also concerned; House looks flushed, and Wilson doesn’t like the way he’s breathing. “Get her off the phone; hang up now,” Wilson whispers.
“He’ll be fine; got a great doctor…. Not necessary; this is my bestest bud—don’t trust anyone but me…. ‘Course I’m not insulting you, would I do that? This is Jimmy—I’ll handle it. Wouldn’t trust his care to Albert Schweitzer himself…. Look, Cameron, Cuddy’s got us quarantined anyway. The rules, remember? Don’t mess with the boss lady. Gotta go; I’m hearing some really unattractive retching noises, need to toss a barf bucket in his general direction. Bye.” House hangs up the phone and begins to cough.
Wilson forgets his annoyance. “I think your fever’s on its way up again; let’s get a temp.” When the reading is just over 101 degrees, and a pulse ox is 91 percent, Wilson frowns. “I’m gonna call Princeton General; we should at least have preliminary culture results by now.”
The cultures show that the PICC line’s clean, so Wilson decides to try a broader-spectrum antibiotic, in case the pneumonia’s resistant to the ceftriaxone. He calls the Hospice pharmacy and places an order for cefepime—because House had initially shown improvement on the ceftriaxone, Wilson’s thinking that they might be dealing with mixed organisms. And now, they could really use that sputum specimen.
“House, just talked with the lab over at PG; we’re clear on the PICC. Gonna switch you to cefepime, but a specimen would really help. Think you can manage it?”
The fever’s still on its way up, and House isn’t feeling so great. “No,” he answers, and closes his eyes.
“Let’s try an aerosol, see if that helps bring anything up, okay?” House doesn’t respond. Wilson sighs, and goes to collect the equipment and a sterile container. When he returns, House is feigning sleep.
“C’mon; let’s try and get this done. Almost time for your evening neb anyway.” House just flings an arm over his eyes and shakes his head.
Wilson’s trying hard to be patient. “Look, if you’re feeling that lousy, let’s just get you into bed. I’ll bring you some ibuprofen for the fever, and we’ll try this in an hour or so.”
House gives no indication that he’s even heard Wilson, just tugs up a blanket and turns his head towards the back of the couch.
Trying to ignore the worry that’s starting to twist in his stomach, Wilson picks up the tympanic thermometer. He moves the blanket away from House’s face. “Lemme get a temp.”
As he inserts the probe into House’s ear canal, an arm flies up and knocks the thermometer from his hand; it clatters to the floor as Wilson, stunned, stares at House.
House turns around quickly and sits up. His fever-bright eyes are angry; his jaw is set, and his respirations are rapid. “Just get the hell away from me! Go away! I’m sick of this, all of it. What are you worried about, anyway? Probably brought the pneumonia on myself, ‘cuz I’m too dumb to know the difference between pain and emotions, follows that I gotta be too dumb to understand my own health, right? So it’s all in my head, doesn’t matter what you do; gonna either get better or die anyway!” House, out of breath now, continues to glare at Wilson as he starts rubbing the left thigh almost frenetically.
“What’s the matter with your leg?” Wilson tries to say it calmly; he needs to bring this situation down a few notches—this isn’t good for House. But somehow, Wilson’s concern and fear, his frustration, make the question come out sounding angry, challenging.
“Absolutely nothing!” House is starting to dig his fingers into the muscle. “Told ya, I’m just too stupid to know I’m perfectly healthy. Let’s just forget that I might be too smart to create pain!”
Wilson’s scared now; House’s breathing is labored, he’s clearly in pain, and he’s showing no signs of even beginning to calm down. Wilson puts both trembling hands out, palms up, in a calming gesture—and House grabs his wrists and pushes him back.
The adrenaline’s given House’s meager strength a boost; Wilson falls backward, but the coffee table’s behind him, and he winds up sitting down, hard, instead of falling. And Wilson snaps.
He forgets House’s fragility, he forgets the building spasm, the labored respirations, the rising fever. He forgets his own medical training. He’s not a doctor now; he’s not even a rational human being. He’s simply a frightened family member who’s finally, completely, overwhelmed by it all, and angry that it’s happening, and feeling powerless to stop it. So he lashes out.
“You’re right; absolutely correct, as usual! The brilliant Dr. House has it all figured out. We don’t need to treat anything; we’re just wasting our time, because you can just will yourself well! Or dead. Let’s not forget that option.” Now Wilson’s breathing rapidly too, and he’s shaking as he stands. And the very small corner of his mind that’s still rational tells him that he’s not making sense, not helping the situation, tells him that he’s over the top. And he doesn’t care. Wilson's done trying to be diplomatic. His patience has worn thin, and he knows that they shouldn't be having this argument right now. But here they are, and he's gotta get House to start facing the truth.
"Don't try to tell me that you're too smart to be having psychosomatic pain! That argument would be a lot more credible if I hadn't seen you self-induce a migraine, just so you could tell yourself that a twenty year grudge was valid! Or fracture your own fingers to win a damned bet! And just last week you let yourself get to the brink of hypovolemic shock rather than admit that you were having trouble with your meds. Yeah, House, you're smart. And you're also self-destructive. Dangerous combination, buddy. Makes you a prime candidate for psychosomatic pain, ya know that?"
House looks up from the left leg; his efforts to calm the spasm have been fruitless, and the pain’s building quickly. But anger’s driving him now, and he yells viciously, “Do us both a favor. Get the hell out of here! And you're right; friends like you, I don't need to be holding onto twenty year grudges."
He’s right, Wilson thinks. Gotta get out of here; gotta calm down. Wilson takes a step towards the kitchen, but suddenly sways, and grabs at the edge of a bookcase to keep from falling. He notes that his fingertips are tingling, he’s dizzy, and then he realizes he’s been hyperventilating. He forces himself to slow his breathing. As House, eyes narrowing, watches him, he makes his way unsteadily out of the room.
As Wilson enters the kitchen, another wave of dizziness overtakes him. He puts both hands on the counter’s edge and leans over the sink. When he hears the sound of House’s cane behind him, he hasn’t the strength to turn, or stand upright, or even to speak.
“What’s the matter with you?” House demands. When Wilson doesn’t answer, House moves closer. Wilson lifts a hand to wave him away, to try to indicate that he’s all right, but the hand’s still shaking visibly, so he quickly lowers it back to the counter’s edge, and then lowers his head to rest there too. He’s dimly aware that House is moving around, but doesn’t lift his head until House taps his arm.
House reaches over him to fill a glass with water. “Here,” he says, thrusting the glass into Wilson’s numb, unresisting fingers. When the glass falls from Wilson’s hand and shatters in the sink, House sighs, fills a second glass, and sets it on the table. Then he sets down his cane and grabs Wilson’s shoulders, propelling him to a chair.
Wilson doesn’t try to gather the strength to resist; he sits. House hands him the glass again, then a small white pill—lorazepam. “Take it,” House orders. When Wilson just looks at him blankly, House bends down until he’s meeting Wilson’s eyes. “Take. It.” House waits until Wilson’s swallowed the pill, then retrieves his cane and exits the kitchen.
Wilson sits there for fifteen minutes, twenty—he isn’t certain. But once the quiet solitude and the medication do their work, and reason returns, he remembers the seriously ill man, the pain, the fever, the respiratory distress.
He goes rapidly to the living room, and feels a moment of panic when House isn’t there. He heads to the bedroom, and stops short in the doorway.
House is lying on the bed, propped up on several pillows. He’s clearly just finished an aerosol treatment, and on his bedside table sits the sterile cup—with a sputum specimen in it. And House is currently engaged in putting on the nasal cannula for the O2.
“Forgot to get the ibuprofen when I was in the kitchen,” House tells him; his voice is matter-of-fact. “And of course, I had to disconnect the IV, so ya might wanna get that, too. If you wouldn’t mind.”
Wilson nods wordlessly and turns from the doorway. When he returns, he hands House the pills and reconnects the TPN without speaking. Then he sits in the bedside chair. “How’s the leg?” he asks quietly.
“Fine. Must’ve been a false alarm.”
“Good. That’s… good.” Wilson stands and picks up his stethoscope, and he’s even more gentle than usual as he assesses House’s breath sounds. He sees the way House’s limbs have melted, unmoving, into the pillows, and how his head seems too heavy to lift, and he knows how much strength House had had to martial, to do everything he’d managed to do in the last half hour. And Wilson knows better than to try to thank him, or even to mention it. He ends his assessment with a hand on House’s shoulder, and a question. “Can I… get you anything?”
House smiles, just a bit. “A doughnut would really taste good, about now.”
Wilson looks at the frail patient, lying so still in the bed—this stubborn child, this loving friend, this concerned physician; this complex, frustrating man, who had willingly put Wilson’s needs ahead of his own, more dire, problems tonight. House may have created the awful situation they’d both just suffered through, but he’d also done his damnedest to try to make it right again. And he had.
“I’ll bet two doughnuts would taste even better,” Wilson says softly, and leaves to get him the treat.
CHAPTER THIRTY: Fever
Wilson returns to the bedroom with four doughnuts, and two glasses of milk. House smirks at him.
“Just couldn’t resist those amazing little multi-colored sprinkles, could ya?” House asks.
Wilson smiles back. “Well, actually, I was having one of those life-threatening sugar deficiencies myself. That, and I figure my cholesterol’s probably too low.”
“So they’re medicinal doughnuts.” House nods sagely. “Now there’s a rationalization worthy of the great Gregory House himself; you’re learnin’, Jimmy.”
“I’m trying, God knows, I’m trying….” Wilson mutters, as he bites into the doughnut. Then he notices that, while House is contentedly watching him enjoy the junk food, he hasn’t touched his own snack. “Hey, how come I’m the only one eating?”
“Antibiotic’s messing with my stomach, I guess. Not as hungry as I thought I was. I’ll eat ‘em later.” House sets his plate next to the milk on the bedside table, and leans back into the pillows.
Wilson regards him thoughtfully; skin’s still flushed, lips are dry and chapped, eyes red-rimmed. “Fever’s still high, too; ibuprofen hasn’t kicked in yet. Hospice should be here shortly with the cefepime; by this time tomorrow, you’ll be feeling well enough to win a doughnut-eating contest. And the lab courier’ll be here soon; I’ll get the blood now, then I’ll let you rest a little while.”
After he draws the blood, Wilson bags the tubes and the sputum specimen for the courier. The messenger from Hospice arrives shortly after the courier, and Wilson’s anxious to hang the new antibiotic.
When he enters the bedroom, he initially thinks House is awake; he’s turned his head towards the door, and is moving about in bed. But when Wilson turns on the light, it’s evident that House isn’t conscious; he’s lost inside a fever-induced dream.
Wilson quickly hangs the cefepime and reaches for the tympanic thermometer. The 103.5 reading surprises him; it’s been over an hour, and the Motrin should be working by now.
He sits cautiously on the edge of the bed; House is mumbling in his sleep, and Wilson doesn’t want to startle him. He places a gentle hand on his arm, an arm so hot it’s uncomfortable under his fingers. “House, wake up. House.”
House’s eyes open wide, dazed, and he tries to sit up.
“Easy, buddy, it’s okay. Your fever’s way up, gonna try some acetaminophen. I need to get a listen to your lungs, too. Just relax; it’s okay.” House is still struggling to sit up, and when Wilson notes the sibilant sound of his breathing, he stops trying to restrain him and instead helps him to a sitting position, propped against the pillows.
House is more alert now, but he doesn’t seem to be fully oriented. “What’s going on? Hot in here; hard to breathe.” He looks around the room. “Can you open a window?” he rasps out.
“I’m gonna do better than that. Gonna get you some Tylenol, and some cool cloths. And let’s go up to three liters on the O2, okay?” Wilson’s voice is soothing, assured, and House has focused in on it, and on Wilson’s face, and is nodding obediently at him like a kid, like Wilson has all the answers right now.
Wilson takes advantage of House’s acquiescence to prepare an extra aerosol treatment. He hands it to House. “Breathe as deep as you can; we need to get some of that junk broken up. Already have the first dose of cefepime running; we’ll be on top of this inside of twelve hours or so. Keep it up with the deep breaths; I’ve gotta go get the Tylenol. Be right back; you be okay?”
House nods and continues to inhale the neb, so Wilson hurries to the kitchen. He grabs a bowl, fills it with cool water and several washcloths. Then he gets the bottle of acetaminophen and returns to the bedroom.
House has dozed off, the mouthpiece still clenched in his teeth. The treatment’s finished, so Wilson gently removes it and shuts off the machine. House stirs and opens his eyes, reaches for the pills that Wilson’s holding.
“Let’s wait just a minute on that,” Wilson tells him. “Try and give me some good coughs first.” He sets the medication down and reaches for his stethoscope. He listens carefully as House coughs, and finally Wilson looks up, satisfied. “Good job. Breathing easier now?”
House takes a few more breaths. When he speaks, he sounds more like himself. “Well, I’m not suffocating anymore, if that’s what you mean. But it’s still too hot in here.”
Wilson hands him two Tylenol, and wrings out one of the washcloths. After House has swallowed the pills, Wilson offers him the cool cloth. House takes it, swipes it half-heartedly, weakly, across his forehead, then closes his eyes and lets his arm drop heavily. “That’s better,” he whispers, handing the cloth back to Wilson.
“Liar.” Wilson smiles, rewets the cloth, and sponges it across House’s face. When House doesn’t object, Wilson then leans him forward and removes his T-shirt. He places one of the cloths around his neck and another over his chest, then continues to bathe his face and arms with the cool water.
“You make a damn fine nurse,” House mumbles. “May not be much to look at, but you sure have that ‘bedside manner’ thingy down pat.” He sighs, finally starting to feel comfortable.
“Did I hear that right? You’re actually saying something that borders on nice? Must be delirious from the fever.”
“Yup, that’s it. Fever. Delirious,” House agrees contentedly. The lines of his face have relaxed, and he hasn’t even bothered to open his eyes.
“Too bad we can’t find a way to get rid of the pneumonia, keep the fever. You’re much easier to deal with when your brain’s frying.”
“Uh-huh. Easier. Fried brain,” House parrots pleasantly.
Wilson shakes his head, both amused and concerned. A ‘nice’ House is… interesting, but I think I’d prefer a little griping right now.
When the fever finally breaks, half an hour later, Wilson doesn’t need a thermometer to tell him the news. House is bathed in sweat, his teeth are chattering, and he’s complaining loudly that it’s too cold, and what moron opened the window?
Wilson hides the cane, and gets the wheelchair. “C’mon. A nice, tepid shower will make you feel better. I’ll get your sheets changed, we’ll do your meds, and you’ll get some sleep.” He disconnects the IV, removes the O2, and helps House transfer to the wheelchair. House is steadier than Wilson expected him to be, but still, the fever, and all his activity earlier in the evening, have left him without much energy.
When they reach the bathroom, Wilson chances asking House if he needs help. And House’s “Hell, no!” which he accompanies with an indignant glare, lets Wilson know he’s turned the corner. Just a little bit of sweet, docile House goes a very long way; Wilson’s glad to have his sarcastic, cranky friend back. He’s smiling as he heads down the hall to find clean linens.
Chapter Thirty-One: OPINIONS