Summary: Wilson is given an unexpected opportunity to prove his friendship to House. This story is my own attempt to make sense of the unsettling disruption of the House-Wilson dynamic in Season 3, so mention is made of many of the S3 plotlines and character development. House-Wilson-Cuddy angst, hurt/comfort, introspection--my usual gig. ;) x-posted
Chapter OneChapter Two
CHAPTER THIRTY-FIVE: PUZZLES AND SOLUTIONS
“First things first,” Wilson tells his anxious audience. “I’ve brought the medication that’ll cure House; it’s down in the pharmacy right now. As soon as the pharmacist finishes verification, we’ll get it up here, get it started. I’ve spoken with the drug company that supplies it in England; they’re providing a list of trials and locations here in the States. We should have the next dose in plenty of time. We’re also gonna need to get dalbavancin, but that can wait until tomorrow. ”
“England? What? Wilson, start at the beginning, please!” Cuddy’s expression is a study in contradiction—both laughter and tears are bubbling to the surface—but mostly she’s just puzzled.
Wilson smiles and looks down at House. “Hate to break this to you, House, but you really are a great teacher—sorry about that.” Then he turns back to the others.
“We’ve all seen House’s… unorthodox methods of solving cases. Guess more of it rubbed off than I knew.” He turns to Cuddy. “Remember what we were doing just before I left?”
“Of course. We were watching that absolutely incomprehensible English comedy. And discussing British slang. Then you… pulled a House… and left me wondering what I was supposed to say to House. So I told him you’d figured it out. You did, too. But how?”
Wilson sits down in the bedside chair; Cuddy smiles when she notices that he’s still holding onto House’s wrist. “The day of the incident, when I came down to the clinic, I hadn’t been there long when Leigh showed up, wanting to apologize to House. And—if you’ll remember—she had some language delays.”
Cuddy and Chase nod; the young woman’s speech had been slow, and she’d had difficulty with pronunciation. They recall that Wilson had helped her out when she’d become frustrated trying to explain the reasons for the outburst that had led to House’s injury.
“She seemed to be having trouble with the word television, and at the time I didn’t think anything about it. But tonight, when Cuddy and I were trying to make sense of the slang, something occurred to me. Leigh had already said TV, and she hadn’t had any problem with it. So why not just say it again, instead of trying a four syllable variation?”
Cuddy, Foreman, and Chase look questioningly at one another, each of them wondering what they’re missing.
Wilson continues, “But she had finished the word; she was trying to go on with her explanation when I filled in the blanks for her. Remember Leigh’s speech patterns? At no time did she use baby talk, or substitute nonsense words for what she was trying to say. Hell, she even made an effort to pronounce spastic correctly.”
“You’re right,” Chase remembers. “And when she couldn’t say angry, she just changed it to mad.”
Wilson nods. “So I was thinking; why try so hard to pronounce television, and then replace it with baby talk, instead of simply going back to TV? It just didn’t fit with the rest of her pattern of speech. And then, when Cuddy and I were discussing British slang, it came to me; telly isn’t baby talk. But it’s also not used in the United States.”
Chase is smiling; he’s latched onto Wilson’s train of thought. “So you figured she’d been to England recently, and contracted VRSA there. And that’s why House’s infection hadn’t responded to our usual protocols for treatment.”
“Exactly. And it makes sense; she’d come in from a group home, so it didn’t occur to anyone to ask her if she’d been out of the country. I did think of it a couple days later, even pulled her history from Records on Sunday. One of the first things that occurred to me when we found out that the bacteria weren’t susceptible to vanc was that maybe Leigh had traveled out of the area, went somewhere they were already having problems with vancomycin resistance. But the attendant who brought her in here had just started working at the home; he didn’t know that Leigh’s parents had taken her out of Princeton-Vale, much less that she’d been in England.”
Wilson pauses in his narrative, and peers at House’s face. “You in pain?” he asks House, before reaching over and depressing the button on the PCA.
The others look at him questioningly; even Cuddy can’t detect any change in House’s demeanor that would indicate discomfort. “I felt the tendons in his wrist tightening up—his fingers were curling, and his heart rate’s gone up eight or ten beats in the last half a minute or so,” Wilson explains matter-of-factly, as if it should’ve been obvious to all of them.
Foreman shakes his head in wonder. “You really are the House Whisperer,” he says.
“Years of practice,” Wilson says dryly. “Even if I have been… underutilizing that particular skill lately….” He waits until he feels House’s pulse rate fall again before continuing.
“Anyway, I was sure that it’d turn out she’d returned pretty recently from the UK. The only thing that was still confusing me was why she appeared to be responding so well to the routine oral antibiotics for MRSA.”
“But I thought I explained that,” says Chase. “Sometimes a non-systemic infection will be susceptible to treatments that have no effect once the bacteria go systemic.”
“It still didn’t make sense; Cuddy even mentioned that it looked like she’d had the boil a long time. And when MRSA goes untreated for a while, it’s usually more resistant to treatment. It’ll respond, but not as quickly as Leigh’s did. So I went to the group home to speak with her, try to get some confirmation for my theory, and make sure she was recovering well. And she was very helpful.”
“What did she say? Was she able to confirm what you’d thought?”
Wilson nods. “She not only told me that she’d been to England with her parents, she said they’d been there almost four months. After she told me that, I figured I’d better go have a word with the parents. Dad’s still out of the country, but mom and I had… an illuminating discussion.” He smiles wryly.
Foreman catches the tone of Wilson’s voice, and grins knowingly. “So I take it this wasn’t all… on the up and up.”
“You could say that,” Wilson says, while Cuddy groans softly. “Mom told me that they’d gone on an extended vacation, and they decided to take Leigh with them. But she wasn’t coping well with the lack of structure, and she’d started to have some difficulties—she’s used to an atmosphere where she can socialize, and their vacation home was isolated. So they decided to put her in respite care for a month while her father was part of some sort of exchange program in Scotland. They figured she’d be better off there than having to make the trip back to the States without them. When her parents returned from Scotland, they discovered the furuncle. The usual treatments were started, and when the infection didn’t respond, Leigh’s father stepped in.”
“Her father?” Cuddy asks. “What did he have to do with it?”
“You’re not gonna believe this,” Wilson smiles. “He’s a scientist, a pharmaceutical researcher. So happens his team’s been working on new superbug compounds, so he’s known—and very well connected—in that community.”
“House would love this,” Foreman observes.
“Oh, it gets better. They put her on dalbavancin, which is concluding phase III trials here in the States—but it was providing only partial coverage of the infection. So they combined it with WCK 771—so new it doesn’t even have a name yet. It’s an arginine salt of nadifloxacin. It’s currently in Phase II-B trials at University Hospital in South Manchester.”
“So Daddy pulled a few strings,” Foreman comments dryly.
“He did more than that. Didn’t even enroll her in the trial for the new stuff. Just made a few phone calls, got a supply of the compound. Then he hired a private nurse so she could be treated at home—apparently the family’s got a country place in a rural area, quite a distance from the nearest hospital.”
“But it mustn’t have worked!” Cuddy interjects. “Looked pretty bad when she first came in. I’m assuming you think this… WCK 771… is going to cure House. How can it help him, if Leigh’s infection wasn’t helped?”
“But it was,” Wilson says. “Here’s the thing. Dalbavancin has a half-life of up to 300 hours. And—especially with a non-systemic infection like hers—dosing once a week, or even just twice a month, normally provides adequate coverage. As a matter of fact, non-systemic MRSA sometimes responds in as little as two doses. Combine it with WCK 771, and even this mutant strain of VRSA is completely susceptible to treatment, according to Leigh’s dad.”
“So how’d she end up here?”
“When they returned to the States a few weeks ago, Leigh went back to Princeton-Vale Convalescent Center. But they live nearby, take her home for dinner most evenings, and bring her home on weekend passes. Didn’t… uh… bother to mention to anyone at Princeton-Vale that the nurse they’d hired to care for her while she was home also happened to be administering the WCK 771 and the dalbavancin intravenously. They knew there’d be… problems with giving her an unapproved medication, especially a med that was brought in from overseas. So they circumvented that little obstacle, told the group home that they’d hired the nurse for wound care. And Leigh’s on anti-seizure meds, gets frequent blood tests, so I guess no one thought to question the needle sticks. If anyone even noticed.”
“Everybody lies,” Cuddy whispers.
“They might’ve managed to carry it off, too,” Wilson continues, “except that mom flew off to join dad at a symposium in Paris one weekend, and figured that Leigh could miss a few doses without any problems. She didn’t bother to run that theory by Dad; he just assumed she’d made some sort of arrangements. And mom’s timing couldn’t have been worse; she hadn’t realized that Leigh would actually be an entire month without dalbavancin if they omitted a dose entirely. And WCK 771 is effective, but it has to be given daily.”
“But that’s exactly why we’re getting into so many difficulties with antibiotic resistance; those missed doses just give the bacteria a chance to rebound even more strongly!” Cuddy explodes. “And clearly, it’s beginning to have global implications.”
“The only implications I’m concerned with right now are the ones that affect House,” Wilson points out grimly. “We can worry about the rest of the world later—starting with the employees and residents at Leigh’s group home. We’ll need to get a team out there, first thing in the morning, to get swabs on everyone—see if anyone else is infected or colonized. The irony of all this is that the FDA’s set to approve dalbavancin this year—and VRSA’s already showing resistance to it, at least overseas. By the time they’re ready to give WCK 771 a name, who knows if it’ll even be effective.”
“You said you’ve already got the first dose for House,” Chase says. “Do we want to know how you managed that?”
Wilson grins at Chase. “You and Foreman are gonna appreciate this.” Then he turns to Cuddy. “You, on the other hand, may want to plug your ears.”
Cuddy’s voice is dry. “Oh, no, Dr. House; please! By all means, do tell how you managed to get your hands on an experimental drug, currently being manufactured only overseas. I can hardly wait; and the sooner I find out, the more time I’ve got to come up with a plausible story for the hospital’s legal department. Just in case… someone… should feel the need to go running to the board with the exciting news that we’re dosing our patients with unauthorized, unapproved substances that we’re acquiring from… private homes.” Cuddy takes a deep breath and gazes skyward.
“Won’t be me!” Chase interjects cheerfully.
Wilson gives Cuddy an apologetic smile. “Dad had just sent over a new shipment—still in the original packaging, still in powder form. And Mom felt bad about the consequences of Leigh’s little tantrum in the clinic, so she insisted that I take a dose for House. I checked with our pharmacist; he said if it was still sealed, he could verify the contents with Wockhardt—that’s the company that manufactures it, in India. So that’s what he’s doing right now. Then he’ll get it reconstituted; he promised to send it up the second it’s ready for administration. He… just asked that I… uh… spare him the details about how I acquired it.”
Chase looks to Cuddy. “Didn’t I hear you mention recently that House is coming in under budget with lawsuits this year? Because you might want to earmark that extra money now….” He grins teasingly at Wilson.
“Is that supposed to be funny, Dr. Chase?” Cuddy asks with mock severity—she’s grinning too.
“And here’s the best part of the whole thing,” Wilson says.
“There’s more? Of course there’s more; there’s always more,” Cuddy mumbles, putting her face in her hands.
“Yeah—but this is really good news! As I said, both meds are still in clinical trials, but so far they haven’t had to make any dosage adjustments for patients with renal or hepatic insufficiency. Of course, we’ll have to monitor House carefully, but looks like these meds won’t add to his current problems, and his kidneys’ll continue to recover!”
As Wilson finishes speaking, a nurse enters, ready to hang the new medication. Cuddy shakes her head and takes the IV bag from the nurse, then dismisses her from the room. She hands the bag to Wilson. “You started the process that’s going to save his life,” she tells him solemnly. “So you deserve to be the one to see it through.”
Wilson nods once, gravely. He studies the bag a moment, looks at the deceptively clear solution contained within; it’s as innocent as water, as complex as House himself.
Wilson hangs the bag, attaches the tubing to a port, and turns on the pump. Three sets of eyes are glued to the drip chamber as the first drops fall. The fourth set of eyes is on House’s face, and they’re sending a silent message: I kept my promise, House—and it’s all gonna be okay.
AUTHOR’S NOTE: Both of these compounds do exist, both are in clinical trials, and the FDA is expected to approve dalbavancin this year (although I just read a report of an unexpected delay in approval). And yes—there is already at least one strain of VRSA against which dalbavancin is ineffective, although all MRSA strains remain susceptible. The superbugs are indeed upon us, they’re mutating every day, and it’s frightening.
Chapter Thirty-Six: THE END!