TITLE: The Devil, You SayAnd here are the next four:
CHARACTERS: House, Wilson, Cuddy
SUMMARY: A study of the psychology behind the HouseWilsonCuddy bond. Introspection, angst, hurtcomfort. Wilson and Cuddy realize that there's a difference between dependence and addiction when House's worsening chronic pain causes a collapse in front of his team.
CHAPTER TWENTY-FIVE: Weak
At Cuddy’s entrance, Wilson slowly takes the hand that’s resting on his head, puts it carefully back on the leg. Before he even looks over at Cuddy, he spends a minute studying House’s face. He’s well and truly out now; still looks so weak—that nightmare really cost him.
Cuddy has been taking this opportunity to study Wilson’s face; he looks like he’s just been through hell and back, she thinks, and he’s so tired his hands are shaking.
When Wilson turns to her, instinct sends her across the room to him, and she puts her hands around his arms and gazes appraisingly, compassionately, at him. She knows, right away, that this is not merely the fatigue that comes with broken, meager sleep; he’s ready to collapse.
“I want you to give me report on House, and then I want you to lie down. Whatever it is that happened can wait.”
He tries to protest, but she cuts him off, and she’s leading him to the lounge while she speaks. “All I need to know right now are the medical facts. All you need to know is that you are going to rest.” He doesn’t seem quite aware that she’s already managed to get him to sit down on the lounge, but as she swings his legs up, he protests.
“I appreciate the offer, but it’s not gonna happen. Just give me 30 minutes to not be…the responsible adult, okay? That’s all I need. I just started the downward titration a couple of hours ago, this is a critical time; he needs me.”
“No…” Cuddy says, slowly. “He needs a physician to titrate the morphine and monitor him closely. And I’m the Dean. Of Medicine. At a teaching hospital. Most people might say that qualifies me to handle it.”
“Cuddy, no, I’ve gotta be awake, I’ve gotta be accessible to him if he--”
She cuts him off. “Just for an hour. And you’ll be a hell of a lot less accessible to him, for a hell of a lot longer, if you force me to sedate you. Choice is yours, what’ll it be?”
“Cuddy, don’t do this. Please. I’m fine, and I can’t—“
“Hmm, yeah, 2mg of Ativan, and then you’ll miss all the fun. House’ll wake up before you do.”
She’s smiling as she says it, but her eyes tell Wilson that it's not an idle threat; there’s no room for negotiation. He opens and closes his mouth several times, starting and discarding new arguments, but Cuddy’s got her arms crossed now, and she’s tapping her foot. He gives up, sighs in resignation. “You win. But only an hour.” He begins to give her report.
When he finishes giving her the facts and starts to tell her the details of the dream, Cuddy interrupts him again. “Shut up, Wilson. It can wait an hour.”
Cuddy has absolutely no intention of waking Wilson in an hour—she’s thinking more like three. But she’s not going to tell him that, and chance upsetting him even more. So she orders him to close his eyes as she pulls the blanket over him, then moves quietly to House’s bedside.
House, too, looks bad. He’s sleeping, his vitals are good, he’s comfortable. But his face is drawn, he looks pale and fragile. Cuddy knows that whatever happened had to have been horrible, for both of them. She hasn’t seen House look this bad since the infarction, and she’s never seen Wilson look as close to the edge as he does now.
The next two hours pass calmly, and Cuddy is pleased. The downward titration is going well; as of now, 8:00am, she’s got him down to 20mg. He’s easier to rouse, and he’s moving both legs comfortably. The only problem had occurred when she’d roused him during assessment, and his hand had inadvertently found the bruise on his sternum.
She’d thought, for a moment, that the pain would actually wake him. But he’d just hitched in a sharp, short breath, sighed, and moved his hand away from the bruise. I guess, all the things he puts up with physically, that’s really small stuff for him. Everything’s relative, she thinks. The thought that something which would be agony for anyone else, just doesn’t really make a difference in House’s world, makes her sad.
Okay, House, maybe I’ve been misjudging you, maybe been a little too critical about the way you handle things with the leg. Maybe I have no right to judge the level of your pain. Maybe I’ve been…wrong. And maybe I should actually apologize when you’re awake. But that would just piss you off, wouldn’t it? So she whispers, “I’m sorry, House; I’ve been wrong.”
She walks over to the desk and sits down, looking over at Wilson. He hasn’t moved at all since he’d finally fallen asleep. Even in sleep, she notes, his face looks worried.
I pray this works, she thinks. If it doesn’t, it might kill both of them. If it works, though, we’ve saved House for a while, and Wilson will be able to live with himself again. And maybe, just maybe, I’ll be able to look them both in the eye, and not feel so damned responsible every day. Maybe.
CHAPTER TWENTY-SIX: Awakenings
Cuddy doesn’t want to awaken Wilson; he hasn’t even changed position on the lounge, and the anxious set to his face has just started to ease, but it’s 9:00am—he’s going to be annoyed that she’d slipped in the extra two hours--and while he’s normally a gracious man, she doesn’t want to push her luck. She approaches the lounge.
“ Wilson?” She puts a hand on his shoulder. “James?” His eyes fly open, and he’s instantly alert.
“What is it? Is it House?” He’s up and moving toward House’s side before he finishes the question.
“He’s fine, relax; I titrated down to 15mg just before I woke you. How do you feel?”
“Better, thanks—amazing that an hour can make--” He’s just noticed that, while it’s still raining heavily, it’s much too light outside to be just 7:00am. Confused, he looks down at his watch, then up at Cuddy. “Could you please tell me what time it is?” he asks her pleasantly.
“Well, would you look at that! Seems to be 9:00!” she responds brightly, matching the bland innocence of his tone.
He momentarily considers being angry, then decides on amused instead. After all, House is doing well, and Cuddy had acted out of what she thought was a valid concern for Wilson; how can he be upset about that? “Ahh!” he says. “Thought for a minute there that my watch was running fast; good to know there’s nothing wrong with it.”
She smiles sheepishly at him. “You needed the sleep. Forgive me? Not that it matters, I’d have done it anyway.”
“But you said an hour; I trusted you!” He’s mildly indignant.
Cuddy glances over at House, then back to Wilson, mischief in her eyes. “First law of The House Theory of Humanity: Everybody lies. Surprised you missed that one. You’re only annoyed because I managed to pull one over on you.”
He laughs. “You’re right. And yes, you’re forgiven--not that it matters, of course. So, tell me what I missed.”
Cuddy picks up the chart and hands it to him. “Not much, happy to say. As I said, he’s at 15mg now, but it’s been only a few minutes, no changes yet. The O2 is down to 2 liters; sats are staying at 96, 97 percent. He’s had a few spontaneous movements, mostly involving his leg. He’s been trying to rub it, I think, although he doesn’t appear to be experiencing any acute pain.”
“He’s just checking to make sure we haven’t amputated it yet,” Wilson says dryly. When she looks at him, shocked, he says, “Ready to hear about that dream-that-can-wait-an-hour-or-three now?”
Wilson starts at the beginning, and tells her everything. “It was frightening to watch, can’t imagine how he felt, living it. For the first time in my life, I think I really understand the expression ‘scared to death.’ If I’d had Versed available, I would’ve used it, a little retrograde amnesia sounded like a great idea at the time. But now, I’m glad I didn’t; if he remembers what happened once he’s awake, that could be a good thing, too. Now that he’s subconsciously acknowledged his biggest fear, a conscious acknowledgement might be healthy.”
Cuddy thinks this over. “He’s already said a thousand times that we tried to take his leg six years ago; still angry about it, too. He ‘acknowledges’ it on an almost daily basis—I’m usually on the receiving end of it. How much more ‘acknowledgement’ can any of us handle?”
“You just said that he’s still angry about it, Cuddy; you know that certainly doesn’t indicate acceptance—and you can’t accept something you haven’t yet acknowledged. Remember the five stages of grief? He did the denial thing right up front; he was convinced that reopening the artery would restore full use of the leg. He even rejected his own medical knowledge, because it wasn’t giving him the answers that he wanted.”
He pours himself a cup of coffee from the carafe Cuddy’s had delivered. “And then, when he finally agreed to physical therapy, he was bargaining—‘I’ll work harder than anyone’s ever worked, just give me my mobility back.’ ” Wilson remembers that stage well; House had aimed all his vitriol at Wilson when the PT hadn’t worked; it had been ugly.
He shakes his head at the memory. “And depression and anger were continuous themes throughout. They still are; he’s never moved past them. There are documented cases of people willing themselves into death while in the depression stage; that’s one of the reasons why I’ve decided to consult Dickinson. He doesn’t know House, doesn’t know his history or his…mmm… current circumstances. We need some objectivity--you and I can’t provide that for him.”
“There you go with the understatement again,” Cuddy observes.
Wilson continues, “I’m hoping… there’s some way we might be able to shepherd him through the anger, the depression, so that he’ll finally be able to reach acceptance. Maybe it can’t be done, and then we’ll have to accept that. But if he could just be…at peace… with the way things are, then we could at least lessen the psychological components of the physical pain. I think it’s worth a try. Nothing to lose at this point, really.”
“It all sounds nice and neat. Simple, even.” Cuddy says, “which is why it doesn’t sound like House."
Wilson smiles. “Yeah, I know. Just comes down to this; it’s been well over six years, and he’s still grieving… Oops—vitals time—if I can trust this damned watch.” He steals a sidelong glance at Cuddy, who is, of course, rolling her eyes. Something predictable, almost comforting about that eye-roll….
House looks more comfortable than he has in almost seven years. His posture in the bed is normal; no curling, no guarding. Even his hands are relaxed as Wilson reaches for a pulse. “House, I know you can hear me in there. Just want you to know, we’re in the home stretch now. You’re at 15mg, and it’s all good. Gonna leave you there for another hour, we’re gonna do this slow, try and let you recupe a bit from that little pre-dawn horror flick of yours.” He opens the gown to check lung sounds, winces when he sees the bruise. “Sternum doesn’t seem to be bothering him much,” he says to Cuddy.
“Oh, he found the bruise during my last assessment,” she answers. “You’re right—doesn’t seem to really impress him, guess when your daily pain scale runs at the 8 to 10 level, it only rates a 2.” They exchange a rueful glance.
House stirs as Wilson finishes up, turns easily onto his right side, settles back into sleep quickly.
“You know what was so amazing about the whole dream thing?” Wilson says as he checks the IV sites, “It wasn’t that he managed to break about ten rules of physiology by fighting off that much sedation. It wasn’t that now we really know just how deep his fear for that leg is. And it isn’t even that he took about five years off my life; if I actually added up how many years I’ve lost because of him, I’d have to fall over dead right now.” He shakes his head.
“Cuddy, he reached out. House reached out to another human being—not because it was required, or because it was polite, not because it was the right thing to do. He felt something, and he allowed himself to act on it. And that just…gives me hope, real hope for the first time since the surgery, that the infarct didn’t just…break him inside, that there’s still something good in there that can start growing again.” Wilson becomes quiet as he relives the scene in his mind, and when he begins to speak again, it’s clear to Cuddy that he’s thinking aloud, doing his best to analyze what’s happened.
“All that was important to him when the nightmare was over was that leg; it had to be tangible. Couldn’t get him to relax ‘til I finally put his arm on it. Yet he was willing to give up that security; he pulled the strength from God-knows-where to reach out to me, take his hand off his leg. Sure, the lack of pain—wait, the lack of pain! Cuddy!” She stares at him; his expression is amazed, joyous. “It worked! We did it! He went through that entire horrible ordeal—not once did it trigger breakthrough pain. And he didn’t believe the leg was there unless he could touch it—he was afraid it wasn’t there because it wasn’t hurting!”
Wilson’s laughing; impulsively he picks Cuddy up, spins around with her, plants a kiss on her cheek—and now she’s laughing, too.
Their celebration is interrupted, however, when a sleep-thick voice from the other side of the room says, “Hey! Patient trying to rest over here. Sick people need sleep. This is a hospital, quiet zone, it’s a rule, I checked. Can’t you people follow rules?”
Wilson turns to Cuddy. “He’s baaack!"
CHAPTER TWENTY-SEVEN: Quiet Zone
House is glaring at them—well, trying to glare, anyway. It would be much easier to fix them with his steely gaze, he decides, if his eyelids would follow his command to stay in the fully upright position.
“Welcome back, House.” Wilson says. “Though it’s a little premature. You should be pretty much out of it for another hour, maybe two.”
“If you two would save your rousing song and dance numbers for the stage,” House mutters, “that would so not be a problem.” And he proves it by nodding off immediately.
Cuddy and Wilson grin at each other, go over to the desk and sit. When Cuddy speaks, her voice is hushed. “So where do we go from here?”
“It’ll take a couple hours for him to wake up like he means it,” Wilson says in the same low tone. “When he’s alert, we resume the Vicodin at the therapeutic dose, and then we pray that this lasts.”
“No, I know all that. I meant what’ll we do about the Vicodin? He’s still an addict, and that’s still a problem.”
“Don’t kill the diabetic,” Wilson whispers thoughtfully.
Cuddy wonders if Wilson has well and truly lost it. “Was that supposed to be an answer to my question? Or just an indication that you could use a little more sleep?” she asks him.
"He said something to me last month--made no sense, just figured at the time it was one of those non sequiturs he likes to throw out; knock me off balance, get me off his case. We were discussing the Vicodin--well, I was trying to discuss the Vicodin--it was more of a monologue, really... And just before he stormed out of my office, he said 'You'd kill a diabetic.' He sounded...bitter. I didn't even try to figure that one out, but it was such an...interesting statement... it stayed with me. And I've got it now, and he's right."
"And?" Cuddy prompts; Wilson is so deep in thought, she's afraid he's forgotten she's here.
"He was trying to tell me that there's a difference between being addicted, and being dependent. A diabetic is dependent on insulin to function, to live. House is dependent on Vicodin to function. To live. If I were to judge a diabetic by the same standards I use to judge House, I'd want to take away the insulin. I'd kill the diabetic."
It’s Cuddy’s turn to be thoughtful now. “That may be the most brilliantly constructed analogy I’ve ever heard. And it’s the truth. So we lay off him about the Vicodin?”
“No, not by a long shot—we can’t. But we do it differently from now on. I’ll pay a lot more attention to the time interval on his scrips. If his intake starts climbing, we find out why. There are still things we can do—switch him to Percocet, or even Oxycontin if necessary. We monitor his liver function. We monitor his mental state just as closely. And...we listen. He tried to tell us for, what, four months? This time, we listen.”
Cuddy nods, says “He’s not gonna be happy with us watching him...he’s gonna make our lives miserable...”
Wilson laughs quietly. “And we’ll be able to tell the difference, how?”
“Good point,” Cuddy smiles.
“There’s this, too,” Wilson continues. “I don’t think he’s going to be quite so...resistant...to our concern. Oh, he’ll talk a good game, but he’ll realize that this time around we’re really hearing him. And big, bad Dr. Wilson is gonna be laying down a couple of non-negotiable ground rules.” He grimaces at the thought of that upcoming conversation.
“And, when the pain starts to become too much for him again—because it will—we repeat this procedure, ‘cuz we’ve had so much fun this first time.” He looks skyward.
“Sounds like a plan. But...I’m still worried. Odds are excellent this...dependence...will shorten his life...” Cuddy’s eyes are sad.
“I know that, Cuddy—and so does he. But I’d rather he has some quality of life, and be around for the next thirty years, than that he’s in intractable pain for the next forty...or until he decides that he can’t deal with it...and then he’s not around at all.”
Wilson stands up. “It’s 10:00am. Time to bring Sleeping Beauty up another level, gonna titrate him to 10.”
And for the next few minutes, Wilson loses himself in caring for his patient as Cuddy thinks a very private prayer.
CHAPTER TWENTY-EIGHT: Negotiations
House wakes up, for real, during the 11:30am assessment. He keeps his eyes closed, works on keeping his breathing even as Wilson finishes auscultating his lungs, checks both IV sites, does something with the pump carrying the morphine.
“Ya know what’s really cool about being a doctor?” Wilson says in a normal conversational tone. “If you happen to have a stethoscope to someone’s chest as they wake up, and if you’re really, really skillful, you can actually detect the change in their breathing pattern from sleep to waking! Whaddaya think, House, cool, huh?”
House smiles and opens tired eyes. “Busted. And I didn’t even get to hear anything juicy.”
Cuddy walks over to the bed. She isn’t certain how House wants to play this—she’ll take her cue from him. She doesn’t have to wait long.
“Cuddy! You’re here; I’m touched! And you brought the twins; those two are getting bigger every day.”
“Cute, House. So happy to see the lobotomy hasn’t affected your enjoyment of the little pleasures in life.”
“Little? Nothin’ little ‘bout those babies. Now, you three get over here. I need some help getting’ rid of all this paraphernalia, and I figure if we do this just right, the view oughtta be spectacular. For both of us.” Wilson shakes his head, smiling, as he walks over to the desk.
“House, I know this’ll be a real challenge for you,” Cuddy says, “But try, just this once, not to be stupid—you’re not getting up, you’re not going anywhere—got it?”
“Sorry, places to go, people to ignore—if you’re really nice, I might even let you pull the cath.” He lifts his eyebrows, smiles suggestively.
“House, I’m glad you’re back with the program,” Wilson interrupts in his best professional voice as he returns to the recliner, carrying a folder. “I need a second opinion on a patient—got a real problem.”
House looks interested. “Listening. Shoot.”
“Forty-five year old female, malignant melanoma left ankle. Had a wide-excision removal yesterday; damned resident nicked a nerve. Poor woman was in screaming pain, said she felt like her leg was on fire. Admitted her overnight, put her on a Dilaudid drip which we discontinued an hour ago. Now she wants to leave AMA, says she’s gotta get home before her kids tear the place down.”
“Send your common sense on that vacation to Tahiti, Jimmy? This one’s so easy, even Cuddy here could handle it. You’re the doctor—she’s just the idiot you got stuck with. She stays. How tough was that?”
It takes House a full minute to realize that both his colleagues are just staring at him, arms folded, bemused expressions on their faces.
“Ooh. Ooooh. But you--she—me—I—but—” Cuddy’s and Wilson’s smiles are growing wider. “Oh, that was just so wrong, on so many levels.” He wags his finger at Wilson. “Jimmy, I’m impressed!”
“Hoist by his own petard!” Cuddy mutters to herself—she’s enjoying this.
“You’re still on the morphine, House. I’ve got it down to 5mg now, and it’s gonna stay there for another couple hours. You had a rough time of it, not gonna take any chances.” Wilson doesn’t mention that House is a lot weaker than they’d expected; he’ll figure that out on his own soon enough. “Just lie there quietly, enjoy the extra two hours. And, in case you haven’t noticed—it worked.”
House’s eyes widen slowly as he carefully—and then not so carefully—moves his right leg around, bends it, rubs the thigh. Wilson and Cuddy turn in tandem away from the recliner, suddenly very busy at the desk, their backs to House as they exchange smiles. Wilson gives House a couple more minutes’ privacy to process the news before he turns back to the bed.
House’s eyes are closed; there’s a grin on his face—and one small tear, easy to miss, leaking from the corner of his eye. Wilson doesn’t miss it. “Glad you’re pleased. Pretty gratifying, gotta say.”
House opens his eyes, glances a brief, wordless thanks at Wilson. Then he starts to remove the nasal O2.
“Leave it, House.” As House continues to remove the tubing, Wilson tries again. “Leave it, or I’ll super-glue it to your face.” House finally lowers his hand.
Next he starts to worry the monitor leads on his chest. “These are really buggin’ me. Can we at least—” He winces sharply; he’s found the sternal bruise. “What the hell?” He pulls open the top of the gown and peers down. He looks up into his friend’s guilty, crestfallen face. Same friend who's killing himself making sure I live a few more years...
“Sometimes,” House says slowly, quietly, “sometimes we have to do medical procedures, necessary medical procedures, and the results are…unpleasant for the patient. But that doesn’t negate the need for the procedure.” Now it’s Wilson’s turn to look a thanks at him. “But really, Jimmy, you woulda gotten much quicker results just threatening to take away my GameBoy!” When Wilson and Cuddy both dissolve into laughter, he’s pleased with himself.
“I’ll remember that, should we ever find ourselves in that situation again,” Wilson says wryly. “And no, nothing comes off, or out, until you’re off the morphine, so do us all a favor and give it up.”
House gazes imploringly at Cuddy. “Don’t look at me,” she says. “I’m just second chair here, and besides, I concur with Dr. Wilson.”
“Cut it out, House,” Wilson says. “If you keep it up, I’m gonna forget to deflate that little balloon holding the Foley in when I yank it out. Operative word here being yank.”
“Ouch, Jimmy, no need to get nasty.” House pouts, crossing his arms—gingerly—across his chest.
“Aw, cheer up,” Cuddy tells him. “I’m gonna go arrange for you to have a week off, seeing as how you completed all those charts and everything.” She rolls her eyes at him. The time off hadn’t been in the plan—but neither had House’s coming out of this so frail.
“So I wasn’t hallucinating about the charts; no one else knows what happened?”
“And Dr. Wilson,” Cuddy continues as if House hadn’t spoken, “I’ve decided you need a little time off to work on writing up that research grant you’ve been talking about. I figure about a week’ll do it.”
She and Wilson smile at each other, giving House the time he needs to figure out that his privacy’s been protected; he won’t have to face questions, or pity, on his return.
“Dr. Cuddy, would you mind leaving us alone for a while? I need to have a word with my patient,” Wilson says after a moment.
“Of course; I need to go arrange for that time off anyway.” She looks again at House, and tries not to feel pained at how wrung-out he looks. “Good luck,” she whispers to Wilson on her way out.
Once she’s gone, Wilson takes a seat next to the recliner. “I’m not gonna like this, am I?” House mumbles, as he turns his face away and closes his eyes.
“This can wait, if you’d like to take a little nap. Just rest; it's okay. I’ll be right here when you wake up.”
“I’m sure you will. Which is exactly why we might as well get whatever it is over with now.” House opens his eyes and turns around to face Wilson. “Listening,” he says. His expression as he gazes at Wilson is carefully neutral, but Wilson can see defiance already creeping into the weary blue eyes. “Spill it, Jimmy.”
And HERE ARE THE CONCLUDING FOUR CHAPTERS: Chapter Twenty-Nine: Battle