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Cats' Corners: the little HOUSE in the woods....
Where House is NEVER safe...
Reparations [new one-shot] 
29th-Nov-2007 01:12 pm
collide
Title:  Reparations
Rating:  PG
Characters:  Wilson, House
Summary:  It's House's second day back at work following Rehab--and he has something to share with Wilson.
Genre:  Angst, Friendship
A/N:   This rather short one-shot came to me out of nowhere this morning; i believe that it may have been inspired by a discussion with   leaveout    following my take yesterday on episode 4.09.  And for an amazing drive-by beta, heartfelt thanks to the wonderful, invaluable   blackmare_9   !
P.S.  Yeah--you might've read this yesterday.  But then, because I continued to revise it several times after posting--and because I had a crisis of confidence based on a very weird combination of factors all coming together at the same time, I locked it.  And this morn, all those factors have been put into perspective, I've [well, some bitter white tablets have--finally] gotten a handle on an unusually bad spate of pain, and I'm finished sitting out in the garden, munching on the worms  blackmare_9  so generously offered to fry.  So I ask your indulgence with that little blip on my radar.  Here's the story, again, with a zillion minor [and likely unnecessary] revisions. I apologize.

 

 

House and Wilson glare at each other across Wilson’s desk.  House stands in an accusatory posture; Wilson sits not-quite-defensively, but he has clasped his hands together.

 

It’s House’s second day at work after the travesty that was Christmas Eve, the cosmic joke that was Rehab.  His first day back, by unspoken agreement, he and Wilson had successfully avoided one another.  But now, House has entered Wilson’s office clearly primed for a fight.  That much is easy to figure out—but still, Wilson’s utterly unprepared for House’s opening volley.

 

“You almost killed me.”

 

Wilson sighs.  “House.  When I left you on the floor, you’d vomited.  And all indications were you were gonna vomit some more.  The oxy was leaving your system.”

 

“Precisely.”

 

Wilson looks at him, genuinely confused.  “So how did I almost kill you?”

 

House takes a deep breath, in an attempt to calm himself.  It works; when he begins to speak, his tone is neutral.  “I came to you.  Asked for a scrip for anti-emetics.  Remember that?”  He waits until Wilson nods impatiently.  “You refused.”

 

Wilson waits, certain that House is going to continue, going to explain.  When House remains silent, Wilson says, “I didn’t almost kill you; if I’d given you the metoclopramide, that would’ve been murder.  All that oxy would have stayed down.”  Wilson pauses, and meets House’s eyes.  “You would’ve died.”

 

House shakes his head.  “No.  If you’d given me the scrip, the rest of it wouldn’t have happened.  I… the withdrawal, the nausea.  I couldn’t sleep.  I couldn’t eat.  And it was just…  I had to control some of it.”

 

Wilson’s eyes grow wide; he’s beginning to figure out where this is going.

 

“So I stole the oxy; figured I could take just enough to take the edge off the withdrawal, get the vomiting under control.  But by then I… wasn’t thinking straight.  You know the rest.”

 

House tone has remained calm throughout, but now the hard, accusatory look is back in his eyes—and they’re trained directly at Wilson.

 

Wilson, unaware that he’s doing it, stands as his jaw goes slack.  He stares back at House as the horror grows in his eyes.  When his face goes pale and he wavers on his feet, House instinctively takes a step towards him, hand out.  But House stops when Wilson involuntarily takes a faltering step back.

 

Wilson finds his voice.  “I… House, I….  Oh, God,” he whispers.  His legs give out then; the chair’s there to catch him as his head drops to his hands.

 

House moves to the couch and sits.  He’s still watching Wilson, but now the anger’s drained from his eyes, replaced with puzzled concern; he'd expected an argument, a denial--not this heartsick, guilty man crumpled in front of him.  He says nothing, just watches.

 

Finally, Wilson whispers, “I’m… sorry,” and House nods.

 

When House speaks, his voice is—almost—gentle.  “Just thought you should know.  Because… patients don’t always lie.  And doctors aren’t always right.”

 

The two sit, in silence, for several minutes, each lost in his own thoughts, his own memories.  It’s not uncomfortable, exactly; there’s simply a mutual air of waiting.  What comes next?  So Wilson ventures quietly, “Wanna get some lunch?”

 

Their eyes meet, and in this silent conversation, both acknowledge that there’s still work to be done, understanding and forgiveness granted—from both sides.  But they’ve taken the initial step, that very first, incredibly difficult step, and House smiles hesitantly.

 

“Who’s buying?” he asks.  Wilson knows that House knows the answer—but that he needs the comfort of the familiar, the past.  And Wilson sees the hope in his eyes, vulnerable and almost childlike.
 

Wilson grins.  “Stupid question.  I’m buying.” 

 

As they leave the office together, Wilson thinks that lunch—the first, Wilson suspects, in a long line of reparative meals provided, of course, by him—is a ridiculously small price to pay.



Thoughts 
29th-Nov-2007 11:37 pm (UTC)
I want to make one thing clear (before I start my neverending rant about how Wilson SO is innocent!ha ha) - there's nothing wrong with the fic as such, I like how you did their reactions and stuff. Actually, it's the kind of fanfic I enjoy reading: except when the author's theories doesn't agree with my view on things.. like in this case (sorry!!) ^___^

Because I don't see at all how House could blame Wilson, for any of it. Just like House told him in his little apology. (Yes, he stayed on the vicodin, but he DID apologize sincerely about the rest.)

I don't know where to start, or where to end this, so let's just ...go.

Some of House's pain IS actually just in his head, like when he's feeling guilty and stressed. That's been proven when Cuddy gave him the "morphine" placebo and he felt "great" EVEN though he really never got any medication! Knowing that, naturally Wilson will think twice before prescribing whatever drugs House wants. Anything else would be irresponsible.

ALSO about him being reluctant to admit that maybe House really IS in pain; maybe he just doesn't want to believe it himself? Like, "if I don't acknowledge it, it'll go away"? Sure, a DOCTOR can't think like that, BUT he and House are NOT just doctor and patient! This is just him being House's FRIEND who knows how manipulative he can be, and also about whom he worries a lot. And there's a reason as to why doctors often don't treat people close to them - they might not be able to stay objective or reasonable in their thinking.

Getting him the deal? Nothing AT ALL wrong there. He was ready to go TO JAIL for House! But when he realized both of them would go, then what good would that do? And what would be wrong with going into rehab??!

House IS addicted to the Vicodin, that's a fact. YES he takes them to relieve the pain, but if a lot of that pain isn't actually physical, but in his head? Then he's actually medicating for nothing! And waning him off Vicodin and looking into changing his meds into "healthier" stuff would be bad.. in what way exactly!? I just don't see how anyone can even argue with this. Wilson did it FOR HOUSE'S OWN GOOD, because NO! a drug addict DOESN'T always know what's best for them!

Buuut~ I'm gonna end this rant just like that, because I'm so tired I can't even think straight, not to mention WRITE...I'm not even sure any of this came out coherent enough for anyone to understand :'D and also, because I'm soothed by the fact that in canon, House doesn't blame Wilson, only himself for the overdosing-thing (remember he went to Tritter by himself after that? clearly he realized he's in the wrong).

Though...sometimes I wonder if I'm the only one supporting Wilson 100% when it comes to everything that went on in season 3...?

(Uh.. anyway. I swear no offence is intended, because if I hadn't liked your fanfic, I wouldn't even have stayed long enough to comment a word, trust me on that! I just get defensive when someone talk down on people I like, be that in real life or just characters of a tv show! ha ha!)

nightZzzz
29th-Nov-2007 11:50 pm (UTC)
I am going to say that I have never, nor do I now, nor will I ever blame Wilson for leaving House on Christmas Eve. I know a lot of people thought it was horrible, it shocked me, I really didn't expect him to leave but it was a rare moment when I was genuinely proud of Wilson. He's had his fair share of screw-ups, no doubt, but in that particular instance, I didn't blame Wilson, I was proud of him (once the initial shock wore off.)
30th-Nov-2007 12:12 am (UTC)
i don't blame him either. although his leaving was medically questionable, even dubious, emotionally he did the right thing, the only thing. and i felt some of that pride in his courage as well.
30th-Nov-2007 12:06 am (UTC)
i've a real feeling that someone as quick-minded as you obviously are would particularly enjoy a study of the points you've made concerning addiction versus dependence--and i'd be grateful for your take on it, should you decide to read it.

it's a novella-length story i wrote, starring house, wilson, cuddy and vicodin. it's called the devil, you say. in case you're interested, here's the link to the first chapter. if you should decide to read it, i'd much appreciate knowing what you think!
30th-Nov-2007 01:00 am (UTC)
Can I just interupt to say that being susceptible to the placebo effect does NOT prove, in any way, that House's pain is psychosomatic? Granted, the writers on the show set it up to play out that way by emphasizng the emotional turmoil House was in and then letting Cuddy have the last word on it, but since the writers and Cuddy both occasionally screw up where medicine is concerned, I just wanted to add that. The fact that House felt better after the saline is only evidence of the fact that, in that one instance, he had the placebo effect. Now, in different medical situations, the supposed benefits of placebos is almost entirely psychological, but it can and does work a bit differently when pain is in the picture, because the experience of pain is so connected with neuro-endocrine responses. To steal an easily understood summary - "People can be conditioned to expect analgesia in certain situations. When those conditions are provided to the patient, the brain responds by generating a pattern of neural activity that produces objectively quantifiable analgesia." House has had morphine before, he knows its effects, and his brain provided those effects to him to fill the gap between the time the "morphine" was administered until it kicked in. Maybe that was enough to get him to the point where the massive amount of Vicodin he'd already taken levelled out his pain enough for him to feel normal again. I'm not saying his moods don't change his pain levels, but just like the writers screwed up the difference between addiction and chemical dependence in Season 1, they screwed up the meaning behind the placebo effect in Season 2.
30th-Nov-2007 03:24 pm (UTC)
House IS addicted to the Vicodin, that's a fact. YES he takes them to relieve the pain, but if a lot of that pain isn't actually physical, but in his head? Then he's actually medicating for nothing! And waning him off Vicodin and looking into changing his meds into "healthier" stuff would be bad.. in what way exactly!? I just don't see how anyone can even argue with this. Wilson did it FOR HOUSE'S OWN GOOD, because NO! a drug addict DOESN'T always know what's best for them!

xantemortemx, I don't know your background and if I'm about to tell you a lot of things you already know but simply disagree with, then I'm sorry. Likewise if you feel that I'm ranting at you. I'm not. I'm merely expressing my thoughts on the subject.

Is it really a fact that he's addicted? I don't think so. I'm very much on the fence on that one. He's said so but at no time have the writers (or HL) made a compelling case for it. They've shown him experiencing withdrawal and they've hinted that he's built tolerance to the drug. Those are indicative of one thing only: Physical dependence which is *not* a sign of addiction in the chronic pain patient but rather par for the course. They've showed him capable of illegal acts to obtain medication and overindulging. Sadly, that is also entirely expected in chronic pain patients denied relief. One of the seven signs of psychological drug dependence (what laypeople tend to call addiction although that has a very uncertain - and mostly useless - definition) is a strong urge to obtain and take the drug irrespective of consequences. Pain, rather than obtaining a 'high', can be the strongest possible motivator and those cases are referred to as pseudoaddiction. It is emphatically *not* addiction and should not be treated as such – doing so can cause a world of harm. Pseudoaddiction must always be ruled out in cases of aberrant drug use before a diagnosis of psychological dependence can be made. The writers royally screwed up their portrayal of dependence and pain management. Sadly, many medical professionals do so as well – and in the case of the US not, I suspect, because they don't know any better but because they're scared senseless of the might of the DEA.

No, addicts probably don't know what's good for themselves but it's my experience that addiction counsellors don't know what's best for pain patients. I've seen patients enter 12-step programmes and come out in terrible shape. It can do a lot of harm. The idea that opioids are inherently 'unhealthy' compared to other pain management methods is a peculiar one. Opioids have relatively few side effects – and mainly manageable ones such as constipation - compared to e.g. SSRIs and anticonvulsants (which are also used in pain management). The addictive potential is good reason for concern but true addiction in patients with chronic pain is exceedingly rare. It's something in the vicinity of 1-5% depending on the patient group. That means that for every potential 'addict' stopped, there are 20-100 patients who could potentially have been treated efficiently with opioids and regained some quality of life with few side effects. But they're not because of the current opiophobia among law makers and, I'm sad to admit, doctors.

I'll finish this by explaining something: All pain is in your head. All of it. Pain is the brain's interpretation of stimuli from the nerves scattered throughout the body – sometime strongly interpreted, sometimes weakly so. The interplay between stimuli, mood and the intensity of perceived pain is highly complex and we can't say 'oh, but he's a bit depressed to we should only treat 64% of his pain – the rest he'll just have to deal with'. All pain requires treatment. There's nothing cathartic about pain. It won't make you stronger or teach you to be a better person. It raises blood pressure and pulse, causes a sedentary lifestyle that puts the patients further at risk of life-style diseases. It causes emotional isolation and depression. Pain kills.
30th-Nov-2007 07:01 pm (UTC)
I have a sister with both MS and Fibromyalgia that used to be psychiatric nurse before she became disabled. You have just stated what she's always told me about pain (I also have fibromyalgia): Pain is pain, no matter what degree or level. Pain sufferers are entitled to pain management, period.

People have varying degrees of pain tolerance. Women handle internal pain better, men external, which is why we have the babies and men defend the nest (theoretically, that is *g*).

I can also honestly say it doesn't make you stronger - if anything it makes me more withdrawn from society, struggle more with mood stabilization (I have bipolar disorder as well) and yes, less likely to get any exercise at all. You've touched all of that wonderfully.
30th-Nov-2007 10:10 pm (UTC)
I probably should have read this post before putting my own two cents in. Nicely done SiljaB, you had me cheering, Yes! as I read this. Also, regarding this:
Sadly, many medical professionals do so as well – and in the case of the US not, I suspect, because they don't know any better but because they're scared senseless of the might of the DEA.
I'd say it's a combination of the two, unfortunately. There is a fair amount of fear of litigation and regulation, but there's also a tremendous dearth of knowledge amongst not only physicians, but healthcare workers in general. Studies show physicians undermedicate pain by 50% and then when given flexible orders (as they typically are) nurses undermedicate by another 50%.
My generation of physicians is one of the first that has been truly educated on pain and pain management during medical school, and even we spend just a handful of days dedicated to it in all four years of medical school.

ps sorry again kidsnurse, your story has sparked quite the discussion
1st-Dec-2007 02:16 am (UTC)
Anonymous
Gaah, how is it that whenever I discuss ANYTHING about this show, I'm somehow pitted against a bunch of people who are either born geniuses or have a medical degree or something!?! *cries* :'D I know close to nothing about, and rarely pay attention to, the medical stuff on the show. My medical knowledge pretty much ends with the fact that I know you can take ibuprofen if you suffer from headaches or menstrual pains. ;)

Though I still see House as an addict, from what the show's given us on this. You make valid points, but I still don't think it's possible to make such a clear distinction between him being an addict, as opposed to having a physical dependence. I mean, sure he depends on his meds to avoid the pain, but hasn't it also been mentioned that he gets a "high" from them?

(Oh..One thing worth mentioning: addiction and dependence is only one word in Swedish. Might have something to do with why I'm having trouble seeing a distinct line between the two.)

"[...] experiencing withdrawal and they've hinted that he's built tolerance to the drug. Those are indicative of one thing only: Physical dependence which is *not* a sign of addiction [...]"

But those are signs of addiction, as in drug abuse, as well, aren't they? Like people who do narcotis; it's not uncommon that they start out with just "lightweight" drugs, then slowly move on to stronger stuff. A kind of "tolerance" resulting in the need of something stronger.

"[...] addiction counsellors don't know what's best for pain patients."

Ok, so perhaps rehab can do more harm than I thought, (NOTE: though, I still want to say House would fit perfectly into those 1-5%...) but medical facts aside, I just want to point out that Wilson isn't some councellor, only House's friend, and it's just the fact that people keep BLAMING Wilson for TRYING to help that annoys me! It's not like anyone else even tried, least of all Cameron.. *mutters*

"All pain is in your head."
Sure, if you see it THAT way, then of course it is. But I meant more like "it's in his head" = it's not actually his infarction that's acting up, but stress in general making the pain(-signals in his brain) seem stronger. And if he keeps increasing his Vicodin intake for these kinds of stress-and-otherwise-mentally-induced pains, taking even more than his already (apparently) too high intake of meds, he's not doing himself any good.

Eh, anyway, this is just how I see the situation. I'm not saying everyone has to agree with me. ^__^
30th-Nov-2007 09:59 pm (UTC)
I don't know your background, but speak as a soon to be physician (18 months and counting) who is planning to specialize in pain management.
I'm not quite sure what you mean when you say House's addiction and such are facts, but wanted to offer information regarding medical facts. There are a fair number of studies (almost all gold-standard double-blind randomized clinical studies) that support the points I make below, which is the basis upon which I am calling them fact.

Use of placebo absolutely does not offer information regarding the nature of pain (ie whether it's psychogenic or physiologic). Additionally, it is overtly against clinical practice guidelines put out by the American Pain Foundation.

Given the medical definition of addiction, House IS NOT deinitely an addict. He does however appear to suffer from pseudoaddiction. The two can be differentiated by the fact that a patient with pseudoaddiction does not enact any behaviors that might be considered addictive when they are free of pain (ie House when the Ketamine was working)

"Weaning House off the meds" as you say would be a bad thing if it were not part of an overall treatment plan that addressed his pain, which would mean it would have to consist not of weaning him off the meds but changing his pain management regimen, which is certainly inadequate from what we get to see on the show. Also, weaning him off would certainly be more humane than the stopping "cold turkey" so to speak, that has been done on two occasions on the show, which is both unethical and unsafe.

I hope this helps you understand the medical aspects of pain management and addiction a bit better.

PS My humble apologies for getting on my soapbox here kidsnurse.