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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 
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. ^__^