CHAPTER EIGHTEEN: CHANGES
When Wilson and Chase return to the cubicle, Cameron and Foreman are getting ready to leave, and they invite Chase to join them for a late lunch.
“Go on, Chase,” Cuddy urges him. “House’s fever is still coming down, there’s been no significant change in his labs. So get while the getting’s good!”
Chase looks toward Wilson, who smiles and nods. “All right, then. Page me if anything changes?”
“Bet on it,” Wilson says.
The fellows leave, and Wilson turns to Cuddy. “How’s he doing? Been awake at all?”
“No, not since we put him on the cooling blanket. But his vitals are stable.”
Wilson takes little comfort from that. The monitors tell him that House’s heart rate and breathing are still too rapid, and even on oxygen his sats are only 91%. And it doesn’t take a doctor to figure out that House doesn’t look good at all.
Wilson moves his gaze from the monitors, and forces himself to look at House through a physician’s eyes. Patient in critical condition. Semi-comatose, with altered mental status when conscious. Mild to moderate respiratory distress. Urine output low. He moves the sheet aside, exposing House’s feet and legs. Increased edema in the lower extremities. He replaces the sheet and begins to study House’s face—and Wilson loses his objectivity.
House’s hair is damp with perspiration. His closed eyes are sunken into his swollen face; his pale lips are deeply cracked and dry. Wilson closes his own eyes for a moment, fighting off the sudden feeling of helplessness. He takes a washcloth and bathes House’s face, moves the damp hair from his forehead. While he’s moistening House’s parched lips with a glycerin swab, House opens his eyes. Wilson smiles at him. “Hey.”
House tries to say something, but no sound comes out. He tries again. “So thirsty….” There’s no volume behind the words, but Wilson understands what he wants, and reaches for the cup of ice chips. He spoons them patiently, one at a time, into House’s mouth, until House whispers, “That’s good… thanks.”
Across the room, Cuddy watches the two men interact, and she smiles sadly. Wilson’s wrong; he never did stop protecting House. Everything he did was done to try and keep House safe. Even now, he’s so focused on House’s comfort that nothing else matters to him. Certainly not his own well-being. If he doesn’t get some rest soon, though, he’ll collapse. And yeah, if Wilson’s not here, House won’t allow the rest of us in. The bond those two have… House won’t show any weakness to anyone else, but he willingly gives it to Wilson. And the amazing thing is, he accepts that Wilson’ll keep him safe.
House has drifted off again, and Wilson motions Cuddy to the bedside. “Pain’s coming back. The dialysis….”
“Already thought of that,” Cuddy smiles. “And that’s one problem I think I’ve solved. Any minute now, I’m expecting—”
As if on cue, a pharmacy tech comes through the door pushing an IV pole. Cuddy thanks him and rolls it to the bedside. Wilson looks at the contents of the pump and, slightly puzzled, looks to Cuddy.
“Yeah,” Cuddy says. “I remember that PCA stands for patient controlled analgesia. And I know that our patient is currently in no shape to control anything. Lucky for him, then, that he’s got a caring, concerned friend around to do it for him.”
When Wilson looks at Cuddy, gratitude is shining from his eyes. “This is great! Thanks, Cuddy; what a good idea. During the times he’s being dialyzed, I can keep dosing him; he won’t have to suffer.”
And neither will you, watching him. “I figured, he does have some lucid times too, and maybe it’ll also help him feel more in control to know that it’s there. Especially after what we put him through downstairs.” Cuddy’s still feeling great regret over House’s inadvertent detox.
“I don’t think he’s recalled that yet. And I don’t think we should remind him of it anytime soon,” Wilson says.
“Remind me… of what?” House asks faintly, and opens his eyes. He sees the new IV pole at his bedside, and, thankfully, doesn’t wait for an answer to his first question before asking a second one. “What’s that?”
“Dilaudid, at your beck and call,” Wilson tells him as he places the control gently into House’s left hand, helps him curl his fingers around it.
“Must be… sicker than I thought… to rate… the good stuff, huh?”
Wilson intentionally ignores the question. “Hey, beats a coloring book, doesn’t it?”
House tries to smile. “Yeah… even with… the big box… of crayons….” He weakly, but successfully, depresses the button on the control, and then allows his heavy eyes to close, and he’s out again.
Cuddy’s pager goes off, and she glances at the text screen and frowns. “It’s the lab, stat page. Wonder what’s up?” She steps just outside the room where there’s a phone on the wall.
Wilson is looking disconsolately at the monitors when he hears Cuddy raise her voice.
“That’s impossible! No, check it again; that just can’t be right.” There’s a pause while she listens, then says, “There’s got to be something. Find it.” She slams the phone into its cradle, and Wilson looks at her questioningly. She motions for him to join her outside the room.
“What’s the matter?” he asks quietly once he reaches her.
Cuddy looks up at the ceiling, presses her fingers to her temples, takes several deep breaths. When she finally looks at Wilson, he reads stunned disbelief in her eyes. In a voice barely above a whisper, she recites what she’s just been told, “At hour sixty-nine, the cultures on the specimen from the scalpel began to exhibit resistance to vancomycin. So they checked the blood cultures drawn last night from House. At hour twenty, they show no susceptibility to vancomycin, nor to any other antibiotic we use to treat MRSA.”
“Cuddy, that’s impossible!” Wilson unconsciously echoes Cuddy’s own first words on hearing the alarming news. “You’re telling me he has VRSA; there’ve been maybe five cases in New Jersey since the first one was diagnosed a decade ago.”
“And those five cases are proof that it’s not impossible,” Cuddy points out grimly. “Lab’s still hopeful that it might be VISA—vancomycin intermediate staph aureus—instead of VRSA—vancomycin resistant. So we’ll keep his vanc in therapeutic range until we know for certain.”
“Not sure that’s a good idea. Be a different story if the vancomycin weren’t affecting his renal function, but with his cultures already showing resistance….” Wilson’s already wracking his brain, trying to figure out the best way to handle this stunning development.
“Hey,” Cuddy says gently. “Helicopter, remember? Let Chase and me get this figured out, okay?”
Wilson smiles ruefully. “Can’t just forget that I’m a doctor. A doctor whose best friend… is dying. Dying of a disease that has no protocol for treatment. Don’t ask me not to try to help in the search for something that’ll work. Please.”
Cuddy looks deep into the anxious, earnest eyes of the only person on the planet House really connects with, and she’s torn. House needs him so badly. But we’re gonna need all the help we can get—and then some. “Okay, here’s the deal, then. Gonna send for your laptop so you can research this, and still be here for him. But I’m also going to get that cot up here, so you can rest. And you will rest. At least four hours out of every twenty-four—starting within the hour. Clear?” She furrows her brow and looks at him sternly.
“Yeah…. And, uh, thanks. Again.”
Cuddy dismisses his gratitude with a wave of her hand. “Thank you. It’s because of you, ya know, that House actually has a decent shot at beating this. Now, I need to go page Chase, take care of the laptop. And that cot. Which I expect to see you using when I come back.”
“I will, promise.” But Wilson’s voice is distracted, and Cuddy sees that he’s actually having a good moment, watching contentedly as House sleeps peacefully, free from discomfort.
Knowing that the good moments will be few and far between in the coming days, she leaves him to it.