Characters: House, Wilson, Cuddy, Chase with some appearances by the rest of the Scooby Gang.
Rating: Gen; a mild R for language; H/W strong friendship (slash if you wear slash goggles)
Summary: The fallout from House's recent misadventure. Follows Sleeping Man: Outside.
Timeline: Set in the early fall of last season, around the events of Cane and Able, Informed Consent, Lines in the Sand.
A/N: The prequel to this, Sleeping Man:Outside, is here: http://maineac.livejournal.com/8929.html#cutid1)
By the time they got to House’s room in the ICU, he had stopped seizing.
“What’s going on?” Wilson demanded, but Chase was on the phone and deliberately turned his back to him.
“That’s no excuse,” Chase said in a voice Wilson had never heard him use before. “Get me the goddam lab reports now!”
“What happened?” asked Cuddy as soon as he put the phone down. “He was stable. You were giving him fluids. He should be getting better, not worse.”
Wilson, meanwhile, had snatched a set of x-rays from the table and was holding them up to the light. He pointed to several white blotchy areas. “He’s obviously got a whopping case of pneumonia, and he’s dehydrated, but as long as you’re giving him fluids he shouldn’t be seiz—“ He broke off, staring at the IV pole. “You’re not giving him saline? What—“
“Dr. Cuddy, you’re the Dean of Medicine,” Chase interrupted, clearly doing his best to speak calmly and patiently. “And Dr. Wilson’s got House’s medical proxy. Your’re both his friend. I understand that. But you need to let me do my job. Unless you’d rather put someone else in charge.”
Cuddy nodded, and shot Wilson a warning look. “You’re quite right, Dr. Chase. Why don’t you tell us what happened?”
Chase looked relieved. Then he walked over to House’s bed and held up the Foley bag. “This is why I stopped the fluids.” The bag was empty. “We’ve pushed three liters of saline into him, and he still hasn’t produced a drop of urine.”
“So what?” said Wilson. “You could put five liters into him before he started producing any—“
“Shut up, Wilson,” said Cuddy. Wilson dropped the x-rays down on the table, but he nodded at Chase to continue.
“I haven’t got the labs back yet, so I can’t know for sure,” said Chase, “but trust me. I’ve seen a lot of this in the ER. I don’t think he’s just a little dehydrated. I think he’s in acute kidney failure. Prerenal ARF. That's why he seized.” He turned to the nurse as she hurried by with the blood draw. “Start him on calcium,” he told her. “And get the crash cart in here.” Then back to Cuddy and Wilson. “Yeah, he badly needs fluids. But until his kidneys are working again—if they ever work again, if they aren’t already toast—more fluids will kill him.”
“If he’s not hyperkalemic, that calcium you just ordered could stop his heart,” added Wilson, gesturing at the nurse as she returned with an IV bag.
“But if his potassium is as high as I suspect it is, his heart could stop any minute now unless he gets calcium right away. It’s a calculated risk,” Chase said gravely. “You’re his proxy. If you tell me to wait till the labs are back to confirm it, I’ll wait.”
Wilson hesitated. He saw the nurse hanging the calcium on the IV pole. She reached for the stop cock to start the flow, but Chase stayed her hand, eyes fixed on Wilson.
It was a hideous choice to have to make, and Wilson fell back on something he’d never had to rely on before. What, he wondered, would House do in these circumstances? Wait for results? Or trust his fellow’s hunch and start treatment? Put that way, the answer was clear.
“Go ahead,” he muttered. Cuddy gave him a smile that was meant to be reassuring, but he felt nothing but dread as he watched the ICU nurse start the flow.
One minute later, for the second time in his life, House’s heart stopped.
“V-fib,” shouted the nurse, above the noise of the heart monitor.
Chase grabbed the equipment from the crash cart. The nurse opened House’s gown and Chase applied the paddles. “Clear!” he called, and just before Chase released the charge Wilson found himself being propelled rapidly backward. A male nurse had yanked him away from the bed, which he hadn’t realized he was clinging onto as he tried with every ounce of his being to will House’s heart to start beating again.
Thereafter, he had the sensation of watching from a very great distance. The sounds were muted and tended to run together, the frantic alarm of the monitors, the peculiar whining of the defibrillator as the paddles re-charged. The thump of the current being applied. The sight of House’s body reacting, the muscles of his torso contorting, arcing him up off the bed. And finally the announcement from the nurse: “Normal sinus rhythm.” An audible sigh from the entire room.
The three doctors moved out of the way and let the nurses take over as soon as House’s heart was beating normally again. It would have been hard to say which one of the three of them looked worst. Cuddy was pale and subdued, Chase looked deeply shaken, and Wilson knew he must look just as bad. Chase was the first to speak.
“Listen,” he said to Cuddy, and he couldn’t have sounded less like the confident doctor he had been ten minutes ago. “I think I should take myself off this case. House is my boss, he’s…I’m too close to it all. And I just nearly killed him.”
Cuddy pulled herself together with a visible effort. “If that’s the case,” she said with something resembling a smile, “he’ll have something to say about it when he comes to. Remind me not to be here to witness it.”
“You don’t know if you nearly killed him,” said Wilson, who found he was not remotely able to joke about it. “You won’t know until you get the lab reports.”
Chase’s reply was cut off by the entrance of the charge nurse, bearing a sheaf of papers. She was a large and buxom woman of few words. “Labs,” she said, thrusting the papers toward Chase. “At long last.” Then, with an anxious glance at the bed, “How’s he doing?”
“Touch and go,” said Cuddy as Chase studied the reports. “Touch and go.”
Chase walked over to a chair and subsided into it, leaning his head back against the wall and closing his eyes. Wordlessly Cuddy removed the lab reports from his hand and read them herself. When she was done, she placed a hand on Chase’s shoulder and squeezed.
“Nice call,” she said. “His potassium was through the roof. Looks like you saved his life.”
Chase opened his eyes for the first time. “For the moment,” he agreed. “But those labs are scary. He’s in ARF. He’s got a virulent pneumonia, pericarditis, and a bunch of other problems as well caused by the dehydration and ARF. I’ve got to be honest. House is seriously ill—critically ill.”
“I know,” said Cuddy. “But he’s in good hands.” As she left the room, she passed the labs silently to Wilson. “You’ll be particularly interested in this result,” she added, pulling out a green form and sticking on top of the stack.
Wilson recognized the tox screen form. Suddenly he didn’t want to know what it contained. He rolled the lab results into a tube and stared over at the bed containing House.
“I’ll save you the trouble,” said Chase, pointedly, as he followed Cuddy out of the room. “It’s negative.”
“For Vicodin?” asked Wilson, unable to keep the surprise from his voice.
“For everything. He’s as clean and sober as a newborn baby. Cleaner and more sober than some newborns these days, in fact.”
[Earlier chapters can be reached by clicking on the green "previous entry" arrow at the top of the page.]
A/N: I'm sure there are, have been, and will be medical inaccuracies in this part of the series. That's for two reasons: (1) I'm not a health care professional, and (2) although I strive for accuracy, I have the same motto as the show's producers: sometimes the medicine has to take a back seat to the story. But if there are any glaring errors you feel I should know about, feel free to PM me.