CHAPTER TWENTY-ONE: WHAT HE NEEDS TO KNOW
Wilson awakens when the night nurse comes in to hang the 2:00am dose of linezolid; shortly before 1:00am, his eyes had closed despite his best efforts. He looks toward House’s bed and sees that he’s awake too. As the nurse silently finishes her duties and leaves, Wilson moves to the bedside. House’s eyes are focused and alert; he’s taking in his surroundings, and appears oriented. “Been awake long?” Wilson asks him.
House shakes his head. “Nurse… woke me. Hey… how’d I rate a… TV in here?” House is still breathless, still breathing far too rapidly. Wilson begins to unobtrusively count his respirations.
“You’re in an isolation cubicle—guess the TV’s one of the perks. You having trouble breathing?”
“No… why you… wearing a... gown?”
Wilson realizes suddenly that House doesn’t know yet about the suspected VRSA; initially the isolation room had been chosen only to provide him privacy. Instinct is telling Wilson not to say anything about the new diagnosis, so he regretfully attempts to take advantage of House’s altered mental status. “Contact isolation requires a gown, doesn’t it?" he says casually. "Wanna check out the TV? I think there’s cable.”
House regards him appraisingly. “What’s… going on, Wilson? We discon… tinued… contact iso for… bloodborne… MRSA six months… ago… latest studies show… unnec… essary.” House is practically panting with the effort of speech, and when he stops speaking he gulps air audibly.
Wilson frowns at House and reaches for a stethoscope. “I’ll explain in a minute,” he says, placing the stethoscope in his ears and helping House lean forward so he can listen to his lungs. What’ll I tell him? Tell him Cuddy just changed the protocol? It’s only a precaution? No, damn it! He chose to trust me.
Wilson finishes the respiratory assessment and manages to keep the alarm he’s feeling off his face as he increases the O2 to six liters and picks up the bedside phone. He’s very much aware that House is watching him intently. “I need a nonrebreather mask in Unit 5 stat. Patient’s got pulmonary edema, and he’s in acute distress.” He recradles the phone, then sits on the edge of the bed and meets House’s eyes.
“The infection’s started to show resistance to vancomycin, House.”
House’s eyes widen briefly, and Wilson watches his left hand curl into a fist. “Damn,” House whispers vehemently. He takes several more rapid, shallow breaths, gulping air through his mouth.
Wilson keeps his voice calm and firm. “Breathe slowly, through your nose. Your sats just fell to 87%. The nonrebreather’ll be here in a minute; then you can breathe through your mouth if you need to.” Wilson presses the button to raise the head of the bed, hoping that’ll help.
“Not… worried about… breathe…ing. Wanna know—”
“That’s enough, House,” Wilson cuts in sharply. “Concentrate on controlling your breathing, and I’ll give you a full report.”
The respiratory tech appears in the doorway with the mask; Wilson goes to the door and takes it from him. He quickly switches out the nasal cannula for the nonrebreather, then waits, watching House as he tries to comply with his instructions, watching the numbers move on the monitors. “That’s good; slow, deep breaths. Slow it down; you’re doing better. Sat’s up to 90% now.”
When the pulse oximeter reading goes to 91%, Wilson nods and sits down again. “Okay. You keep breathing, I’ll keep talking. You get agitated, or feel like you just have to throw in your two cents, we’ll postpone this. Understood?"
House nods obediently; he’s not about to tell Wilson that breathing’s the only job he can handle at the moment.
But Wilson knows. Gotta get House settled down, get in a page to Chase. Need to get him on a vent before he crashes. “We have you on linezolid, 600mg IV every twelve hours. You’ve had two doses, and you’re tolerating it fine. We’ve d/c’d the vanc, of course, and we don’t know yet if the staph will be susceptible to the linezolid. Right now, though, you’re holding your own with the infection.”
House nods, and gestures to his chest and to the catheter bag.
“That’s more of an immediate concern,” Wilson tells him. “Fluid overload is causing pulmonary edema. And… you’re beginning to show arrhythmias on the cardiac monitor. Urine output’s fallen a little. But we’re hopeful that now that you’re off the vancomycin, all those things will begin to improve in the next forty-eight hours, maybe sooner.”
Wilson wonders if he should mention the probability of a ventilator. But he can’t bring himself to do it. He justifies his decision by telling himself that the news would agitate House, who must be kept as calm as possible—he’s already in respiratory distress. And now, House is attempting to speak again.
“Told… Chase….” Whatever House is trying to say is lost as House goes into paroxysms of coughing. The head of the bed is already as high as it will go, so Wilson puts a hand behind House’s back and leans him forward, supporting House’s chest across his own arm. He yanks off the mask, and grabs for an emesis basin to catch the frothy white sputum that’s a hallmark of pulmonary edema.
When the coughing finally ends, Wilson replaces the mask and lowers House back to the pillows. House’s face is white; his lips are pale gray. But he’s still trying to talk. Wilson shakes his head, puts a finger to his own lips. “We’ll talk later. Try to rest now; I’m not going anywhere. Later.”
House’s eyes flare briefly with frustration, and Wilson thinks that he might argue. But then House shakes his head almost imperceptibly, and finally closes his eyes.
Wilson dampens a washcloth and cleans House’s face and mouth. Then he gets another cool cloth and gently runs it across House’s forehead and eyes, presses it to his temples. He repeats these motions again and again, all the while coaxing House to relax, let go, get some sleep. After just a few minutes, House’s heart and respiratory rates slow a bit, and his respiratory effort is less shallow; he’s back to sleep.
Wilson staggers over to the cot and opens his laptop; the latest labs should be available.
The first thing Wilson sees is that the linezolid is still showing activity in the cultures, and he sighs with relief. The staph isn’t indicating as much susceptibility to the antibiotic as he’d hoped—but it’s still enough to hold the infection at bay, give them time to come up with something more effective.
There’s been no change in renal function, but there has been one change; House’s liver enzymes are higher now. Still no cause for alarm, Wilson tells himself. Kidneys aren’t getting better, but they aren’t worse, either. And we’ll just have to monitor liver function. Gonna take a couple days for the vanc to clear his system. He’s okay. We’re okay. Just in a holding pattern, that’s all. He’ll be fine.
Wilson closes his laptop and walks quietly to the bedside. “You can do this, House,” he whispers. “You’re strong; you’re stubborn. You don’t like to lose; remember that. You win; that’s who you are. That’s what makes you special—not the leg, not the drugs. Not the miserable attitude. You don’t give up. And people live because of that. People live because you won’t just… give the hell up. Someone said once that the distance between insanity and genius is measured only by success. That makes you a genius by anyone’s definition. But you’re also insane, ya know; you push that distance beyond all reason. You don’t admit failure, not as long as the patient’s still alive.”
Wilson blinks, then brushes impatiently at the sudden moisture that’s blurring his vision. “You’re still alive, House. And what you’ve gotta do is stay alive. That’s all; we’ll do the rest this time. Give us a chance to solve the puzzle. Hey—you’re all about the teaching, right? You’ve taught us—now give us a chance to prove it. And give me a chance to… give me a chance to…. Just gimme a chance, okay?”
House moves restlessly; his heart rate’s climbing, and he moans as he reaches for his right leg. Wilson quickly pushes the button on the PCA, and waits until House’s heart rate has returned to baseline, until the furrow between his eyes is smooth again. Then he takes a moment to do some passive range-of-motion exercises on the leg—House can’t tolerate not being able to move it; makes him cranky. So Wilson’ll do it for him. He continues speaking softly as he works.
“You die on me now, I swear I’ll make you buy your own lunch from here on in. And I’ll… I’ll file all your canes in half.” Wilson’s voice cracks. “Then what’ll you do, you limping twerp?” That pesky dampness on Wilson’s face is really interfering with his vision now. Before he turns away from the bed, he whispers one more word. “Live.”