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doodlebears Celebration AmbassadorAug 20, 2006

My daughter asked me to remove the story earlier in the week as it was not yet posted in the complete form. However it is now so all you HUGH LAURIE fans and fans of the TV program HOUSE here is the forst chapter and the link to the rest. Sarah has had good reviews and so many emails saying how she has captured the essence of 'House'. I hope you like it.

           

Breathless

by Sarah Martin

A perfect day dawned over Princeton Plainsboro Hospital, but Dr. Gregory House was less than impressed. Leaning heavily on his cane he limped into his office, expertly ignoring the furtive glances being shot in his direction by the trio of young doctors awaiting his arrival. Maintaining his silence he proceeded to pour himself a steaming cup of coffee, then, turning his back on them again, he wrote a list of symptoms on the white board.

Turning to face the room House bounced lightly on his heels, surveying Foreman, Cameron and Chase expectantly.

“Well?”

“Well what?” Foreman said, apparently unimpressed by the list now presented to them.

“Perhaps the question was too difficult. Let’s start with something simpler, shall we?” House turned and gesticulated elaborately at the board.

“These,” he said, his voice heavy with false sincerity, “are symptoms…”

Trying his best to tune out House’s inane blustering Chase slumped lower into his seat. His head was throbbing and he was pretty sure his sinuses were on the verge of rupturing.

“… When someone is feeling poorly sick, they –”

“Alright House, we’ve got the point,” Foreman interrupted. “Who’s the patient?”

“Fifty-six year old male. Presented with headache and vomiting.”

“That could be practically anything.”

“Well luckily were not looking for just anything.”

“So what’s the deal with this patient?”

“Aha!” House turned back to the board and wrote myokymia.

“Myokymia?”

“Unusual, eh?”

“Muscle tremors? I don’t see how that fits in with the other symptoms.”

“Exactly. So – ”

The telltale irritation of a sneeze began to prickle at the back of Chase’s nose, and he tried to suppress it, failing loudly.

The volume was enough to stop House mid-flow, but after an annoyed glare he continued.

“ – suggestions people?”

“Parkinsons?” Chase offered.

“Please.” House scoffed, “Myokymic discharges are far more pronounced than Parkinson tremors, and anyway, there’s no history. What else?”

“Guillain-Barré can cause myokymic tremors” Chase tried again.

“Tap the spine, see if the protein level is elevated. Give me another.”

“Myasthenia gravis? We could test for striated muscle autoantibodies.”

“Do it.”

“Could be a focal lesion. We should scan the brain.”

House nodded his assent.

In the corner, Chase sneezed again

“What’s wrong with you?” Foreman asked, shooting a look at Chase.

“Nothing” Chase replied, sniffing.

“You look flushed.” Cameron said, frowning.

“I’m fine.”

“Are you sure?”

“The wombat said he’s fine, so let’s all ignore the fact that he’s blatantly ignoring hospital policy and get back to work, shall we?”

Cameron fell silent, although she continued to flick concerned glances at Chase.

“Right.” House said, “Cameron, I want you to do the workup. Get a full history. Foreman, do the CT. Get a chest x-ray and run a full panel,” He paused, then added as an afterthought, “include a tox. screen. Chase – ” House hesitated momentarily as he took in the sheen of sweat that beaded Chase’s forehead. “You go with Foreman.”

Everyone stood, preparing to go about their set tasks.

“Is that it?” Chase asked, aggrieved by the lack of purpose to what he had been assigned.

“Yup.” House replied, turning his back on him.

Chase sighed. He was becoming accustomed to House’s indifference. He pulled a small plastic bottle from the pocket of his lab coat, his throat felt rough and sore and although he wanted to insist on a more purposeful activity, he felt ill-disposed to do so.

“What’s with the water?” Foreman asked, gesturing towards bottle Chase was clasping in one hand.

“This? It’s nothing… I’m trying to stay hydrated.”

“When you girls have finished sharing your beauty secrets,” House said, pushing between the two men, “we have a patient in need of having his boo boos fixed.”

………………………………………………………..

Stan Jameson lay in his hospital room, pale and listless, but not without a temper. “About time!” he snapped, shifting restlessly in his bed. “I’ve been here for hours.”

Cameron offered him a conciliatory smile and ignored the harshness of his tone – she was well adapted to the demands of her patients.

“I’m sorry to have kept you waiting,” she said, her tone soft.

“Well,” Jameson huffed back, placated somewhat.

“Mr. Jameson I’d like to ask you a few questions.”

“What sort of questions?”

“Just some standard background information: medical history, symptoms, that sort of thing… is that ok?”

Jameson fidgeted with his bed sheets, the ghost of his bad temper lingering. “I went through all of this earlier when they admitted me.”

“If you don’t mind sir, the more information you can give us the better we’ll be able to plan your care.”

“Oh, alright then.” Jameson snapped.

Cameron flipped open her chart and prepare for what was undoubtedly going to be a long morning.

“So then,” House said, toying with his bottle of vicodin and surveying Cameron and Foreman, “what say you?”

Cameron flicked Jameson’s chart open and surveyed the pages of her own neat handwriting.

“Mr. Jameson has no family to speak of, he’s got a son but the two have been estranged for around ten years. Mrs. Jameson died of leukaemia four years ago.” Cameron looked up from her notes before continuing.

“Mr. Jameson complains of a history of anorexia, fatigue and weight loss and a couple of episodes of nose bleeds.”

“Nose bleeds?”

“Uh huh, apparently lasting two to three days each time.”

“Hmmm.” House said, his tone contemplative.

“The myokymia has only been present for the past couple of days, the headache has been present for approximately five days… Previous history of illness is limited to three ‘bad’ colds in the past few years, and there’s no current use of prescription medication, although…” Cameron rifled through her pages of notes, “It would seem that Mr. Jameson is somewhat into holistic medicine.”

“Holistic medicine?”

“Yeah. He’s a strict vegan, grows his own organic food and takes a bunch of vitamins every day – a real health nut.”

“You must remind me to congratulate him,” House scoffed, “The tofu burgers seem to have done him a world of good.”

“No prescription meds though,” Cameron continued, ignoring House’s interruption. “Physical exam reveals pale and dry skin and ulcerated mucosal membranes.”

Chase entered the room just as Cameron finished speaking, an air of dishevelled discomposure about him.

“How nice of you to join us!” House exclaimed, casting his eyes to his watch. “And only twenty minutes after I paged you, that must be some kind of record.”

“Jameson coded.” Chase said simply. He slumped into a chair and rested his head back for a moment. The headache that had been plaguing him for the past few days was continuing unabated; pain hammering within his skull as he tried to focus his thoughts.

“What happened?” House asked, frowning.

“He went downhill fast.” Chase responded, pulling himself back upright.

“Grand mal seizure, respiratory arrest. I had to intubate him.”

“Seizures? That’s new.”

“Yep. Last vitals showed blood pressure to be 138/84; heart rate is 94 and regular; respiratory rate is 20, temperature 98.9°.”

“Low grade fever.” House mused, more to himself than anyone else.

Chase pressed the heels of his fists into his eyes, more tired than he would have thought possible only a few short hours into his shift.

“Foreman, maybe you can shed some light on this.”

“CT shows an area of low density. Could be a lesion, maybe a cyst. We’d need to do an MRI with a higher resolution to get a closer look.”

“What about the chest x-ray?”

“The lungs were clear. Heart looks in good condition, no enlargement. But…” Foreman got to his feet.

“…the blood shows massive irregularities. Red and white cell counts are at around 50, platelets are at a third the normal minimum, and haematocrit is at 32.” An undeniably self-satisfied smile on his face, Foreman turned to face House.

“It’s not an infection. I think we’re dealing with aplastic anaemia.”

House considered Foreman for a moment, then nodded.

“You’re wrong.”

“What?” Foreman cast around at Chase and Cameron, looking for support.

“These symptoms are classic aplastic anaemia. Combine the blood results with the weight loss, fatigue and nose bleeds and – ”

“Not about the anaemia, the infection.”

“There’s only a mild fever and the white cell count is – ”

“The white cell count is low because his bone marrow isn’t producing any white blood cells. Yeesh! What med school did you go to?”

“So what makes you think he has an infection?” Foreman asked, frowning.

“Well,” said House, feigning concentration, “There’s the fever, for one. The nausea, vomiting, headaches, the myokymia, the seizures,” House nodded towards Chase, “and the CT scan results.”

“The CT scan was inconclusive.”

“No, not inconclusive, just open to interpretation. An area of low density is typical of an abscess, which my little friends, brings us to the myokymia.”

“You think he has a brain abscess?”

“You think he doesn’t?” House shot back.

“Brain abscesses are incredibly rare. They usually only occur in…”

“In immuno-compromised patients. Ding! Give this man a prize!” House smirked at Foreman who glared back.

“So,” Cameron interjected, heading off Foreman before he could snipe back at House, ““How do you think we should go about treating Mr. Jameson?”

“Start the empiric antibiotic regimen, penicillin and chloramphenicol IV push, and load 12mg of dexamethasone to reduce the intracranial pressure.”

“And what do you think caused the aplastic anaemia?”

“Exposure to radiation, heredity, a viral infection.” As Chase spoke his voice sounded tired even to his own ears. “That’s if it is aplastic anaemia.”

“I thought we’d established the anaemia.” Foreman said, a tinge of annoyance in his voice.

“All the blood results show is pancytopenia, we won’t actually know what’s caused it without doing further tests.”

“Hmm,” House mused, “The wombat seems to be onto something.”

“So what should we do?”

“Aspirate the bone marrow and call Wilson in for a consult.”

“Is that?”

“Well, we have to keep him busy somehow, don’t we?” House stood. “And,” he flexed his neck, “Chase, I want you to go to Jameson’s house. See what you can find.”

Here's the link, go to chapter 2........ http://www.fanfiction.net/s/3092876/1/  on right side of page highlighted in grey.

Hugs Jane.