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“You know, you should really check your glucose some time,” Foreman said when Chase returned from his third trip to the bathroom that morning. “You could have diabetes and not even know it.”
Chase rolled his eyes in mild annoyance.
“Thanks for the advice, but I’m fine. I’m just trying to drink more water.”
He wasn’t trying to drink more water, as much as he was trying not to trigger another coughing fit by drinking said water.
It was winter in New Jersey, which meant cold, dry air, and enough aerosolized viruses floating around to infect the entire city ten times over.
Chase had half a mind to spend those three months of the year wearing a mask everywhere he went, to protect himself from all those gnarly pathogens. If wearing a mask would be mandatory, his life—and job, would be a whole lot easier. Unfortunately, something like that was never going to happen. People were way too stubborn to do something that could potentially protect themselves and those around them. It’s in their nature to protest against everything that wasn’t their choice. Because damn safety when you can have freedom, right?
“Whatever, man. Just try not to explode like a water balloon.”
“I’ll keep that in mind.”
He sat down at the conference room table and went back to reviewing the chart in front of him. It was the last one from the pile much to Chase’s relief. With any luck they wouldn’t get a new case today and he could go home early for a change, then sit on the shower floor until his sinuses stopped hurting.
He felt another tickle coming up in the back of his throat and automatically reached for his water bottle.
Foreman frowned.
“You know there is such a thing as too much water.”
Chase didn’t answer—he couldn’t. He was too busy sipping on the water, and carefully breathing through his nose until the coughing fit passed.
It took a couple minutes before Chase felt like he could safely put down the bottle, which was almost completely empty now.
Foreman was still looking at him questioningly.
“What the hell just happened?”
Chase shrugged, eyes still watery from the exertion.
“Must have swallowed wrong,” he said, a little too quickly.
“What did you swallow? A bag of feathers?”
“Funny,” Chase said, getting up from his chair. “I’m gonna get some coffee.”
He almost ran into Cameron on his way out of the office.
“Sorry—”, he quickly apologized.
“Don’t worry about it—wait, where are you going?”
“Coffee.”
“I’ll come with you—” Cameron offered, but Chase was already gone.
“What’s up with him?” she asked, frowning.
Foreman focused back on his own work.
“Couldn’t tell you if I wanted to.”
-
Chase walked straight past the coffee machine and made a beeline toward the hospitals pharmacy.
“Hey, Chase. What’s up?” the pharmacy tech greeted.
“Morning, Jake. I was wondering if you could help me out?”
Jake looked up from his computer.
“Of course, man. Shoot.”
Chase cleared his throat, dry and scratchy.
“I have this cough, nothing serious, but it’s kind of interfering with work. Is there any chance you’ve got some DXM back there?”
Jake hesitated.
“Dextromethorphan? Yeah, I think so… are you sure you don’t want something lighter? You know you can’t see any patients when you’re on this stuff right?” he said, grabbing a small plastic bottle from one of the shelves.
“I know. I’m just catching up on some paper work. I’m not even sure House is gonna come in today.” He grabbed his wallet from his back pocket. “How much do I owe you?”
Jake huffed out a laugh.
“Jeez, Chase. You’re making it sound like I’m selling speed on the corner. Just take it, it’s on me.”
“Thanks, man.”
“No problem. Feel better!”
Chase made a short pit stop by his locker before heading back to the office to grab another bottle of water, and quickly chug some of the medicine.
He spared a quick glance at the label. ‘Cough suppressant’ it read in bold black lettering. He pushed the cap down and twisted until it came off with a small click. The smell of the bright red liquid hit him like a brick wall. He brought the bottle up to his mouth and took a few big gulps, trying not to think too much about the sweet, chemical taste assaulting his tongue.
He capped the bottle and shoved it in the pocket of his white coat before grabbing the water and making his way back to the office to finish up his paper work.
House was there when he reached the conference room.
Chase internally cursed himself.
“I didn’t think you were coming in today,” he said hoarsely.
House looked up from the white board when he heard Chase.
“Wow, you sound like you orally pleasured a member of the male sex last night,” he said, like it was the most normal thing in the world.
All three fellows fell silent.
“What?”
“Well, I would’ve said that you sounded like you sucked a ginormous di—”
“House!” Cameron cut him off.
“My point exactly. Turns out someone—not saying who—” his gaze went straight to Cameron, “complained to Cuddy about my use of ‘vulgar’ language. So in order to avoid having to attend yet another mandatory sexual harassment seminar, I will only use correct medical terminology to insult you guys from now on.”
Foreman let out an audible sigh.
“Can we please just focus on the case?”
Chase’s eyes went to the list of symptoms on the whiteboard. Bruising, joint pain, hematuria, nosebleeds…
“Fine,” House whined. “But only if you stop being such a huge pain in the gluteus maximus.”
“Why don’t you go ‘have coitus’ with yourself, and leave the adults to figure out what’s wrong with our patient,” Foreman shot back.
“Come on, you guys,” Cameron said in an attempt to break up the fight. “let’s get back to work.”
“You’re not my mom,” House said, in a childish voice.
Cameron pursed her lips.
“No, but I can call her.”
“You’re bluffing.”
Cameron didn’t break eye contact.
“Wanna find out?” she said, reaching for her phone.
House finally gave in and begrudgingly redirected his attention to the board.
“For those who missed it the first time around: Our patient is a fourteen-year-old male. He came into the clinic with his mother after he noticed blood in his urine. He also complained of joint pain, and his mom said he bruises easily and gets nosebleeds a lot. Preliminary bloodwork showed that he is mildly anemic and has low platelets. WBC is normal and there are no other signs of infection. Go.”
Chase stared at the words on the whiteboard. His mind felt slower than usual.
“What’s his MCV?” Cameron asked.
“Eighty. Borderline.”
“Iron deficiency could explain the anemia, but you’d expect thrombocytosis if that were the case, not thrombocytopenia.”
“What if the problem lies in his bone marrow?” Foreman chimed in.
“Unlikely. White blood cells are fine, and the anemia isn’t that bad.”
House tapped his cane against the carpeted floor.
“Chase?” he asked. “Care to partake on this differential, or are you planning to just keep staring at the eraser?”
Chase blinked slowly.
“Could be lupus.”
House stared at him in disbelief.
“Please enlighten us.”
It took Chase a moment to find the right words.
“It accounts for the joint pain, and lupus nephritis would explain the hematuria. Thrombocytopenia also isn’t an uncommon symptom.” He could hear himself speak, but it almost felt like he was observing from a distance.
“Nice story, but the mother never mentioned any fevers, weight loss or skin reactions.” Foreman added.
“Do you think diseases always follow the textbook?”
“No, but—"
“Oohh, burn!” House interrupted them. “Foreman is right. It’s never lupus. But blondie might not be that far off…” he stopped tapping his cane for a moment. “Cameron, go draw some more blood and test the kid for immune thrombocytopenia. Do an ANA for lupus too, I like proving people wrong.”
“On it,” Cameron said, before heading off to the patient’s room.
“Foreman,” House continued. “Go to the patient’s home. Make sure he didn’t accidentally mistake an entire bottle of aspirin for some skittles.”
Foreman grabbed his coat from the back of his chair, not even bothering to hide how displeased he was with the assignment House gave him.
“There I go breaking and entering… again.”
Chase quickly grabbed his coat as well and followed Foreman to the door, looking for a way out of there before the medicine fully kicked in.
“Not so fast Dr. Kangaroo,” House stopped him. “You and I need to have a little chat before you go hopping off into the horizon.”
Chase’s heart stopped for a second. He almost felt like that one time he was fifteen, and his dad caught him with a cigarette.
He turned around, ready to be scolded by House. But who could blame the older man? What he did was reckless, and he deserved to be punished for his actions.
The room kept spinning half a second longer than Chase did.
“I’m sorry,” Chase was about to say, but House started talking before he could get the words out.
“There’s a patient waiting for you in the clinic. Bounce-back… something. I couldn’t hear what Cuddy was saying over the screaming of her breasts—sorry, mammae.”
Chase stared at House for a moment. He didn’t know whether to be relieved or worried that he had to go see a patient.
“Chase?” House said, snapping his fingers in front of his face. “Clinic. Now.”
Chase quickly gathered his thoughts, or tried to at least.
“Uh—thanks for bringing this to my—uhm—attention.” He left the office in a hurry, leaving a slightly suspicious House behind.
When Chase arrived at the clinic downstairs, he was already a little hazy about why he went there in the first place. He walked up to the nurse’s station out of reflex and nearly bumped into Lydia.
“Dr. Chase, there you are,” she greeted. “We’ve been expecting you.”
“We?” Chase asked, frowning.
Lydia squinted her eyes. Chase was scared she could see straight through him.
“Yes, Mr. Miller and I.”
“Mr. Miller?” Chase repeated, like the name didn’t quite land.
Lydia gave him a look that said, ‘are you serious?’, and shoved a chart into his arms.
“Your bounce-back migraine. You saw him in the clinic last Friday…”
It still didn’t ring a bell for Chase.
“I know it is Monday, but I expect you docs to retain at least the slightest bit of information on your patients over the weekend. Maybe you should stay home for a change, instead of drowning your neurons in the cheapest vodka you can find.”
It sounded mean, but Lydia was one of the nurses who had to put up with all of House’s crap on a regular basis. For that reason, she had to be harsh sometimes. Not just to House, but also to his fellows whenever they started to act a little bit too much like him.
“Yes, ma’am,” Chase managed to say through the fog in his head.
Lydia nodded curtly.
“Exam three is open.”
Chase started walking in the direction of the exam room and gestured for the patient to follow him.
Luckily for Chase, Mr. Miller was almost as out of it as he was. A combination of the migraine and the meds he’d taken for it, he assumed. Ironic.
The exam was over before he knew it, or maybe he’d just lost track of time. He wasn’t sure.
What he was sure of was the new meds he’d prescribed to Mr. Miller. After checking the prescription for the fourth time, he was confident he’d gotten it right.
After Mr. Miller had left, Chase sat down on the exam table, needing a moment to breathe, to just sit there without having to question everything he did.
He reached in his pocket and took out the bottle of cough suppressant, looking at the label again, then at the amount of liquid left in the bottle. He didn’t need to calculate the dosage he’d taken to know it was way too much. That was already painfully obvious.
He should tell House that he wasn’t feeling well. Maybe the man would let him go home. But something stopped him. They still had a patient. A fourteen-year-old boy who needed them.
Looking back, Chase knew that they would’ve been fine without him there, but in that moment, it felt like he was neglecting his duties. House treated patients when he was high on Vicodin all of the time, so why shouldn’t he be allowed to do the same after taking some over-the-counter cough syrup.
With his newfound confidence in his abilities, he made his way back up to the office to help the patient.
“What the hell took you so long?” House asked when Chase walked through the door.
Chase stared at him, slightly confused about the whole situation. House was the one who sent him to the clinic, and now he was mad about it.
“I was with a patient,” he said, a beat too slow.
House tightened the grip on his cane.
“You were gone for over an hour and you didn’t answer any of our pages.”
“Oh,” was all Chase said.
“Oh?” House echoed, voice low. “You’ve been acting off ever since I came in today. Tell me something. Are you high? Drunk, maybe?”
“House—” Cameron tried to stop him, but House ignored her.
Chase blinked slowly at the older man, trying to process the question.
House stepped closer and looked him straight in the eyes.
“Let me rephrase that for you. Did you take any drugs?” he said, emphasizing the last part.
Chase swallowed.
“I didn’t take any drugs,” he eventually said, voice surprisingly steady, all things considered.
House let his shoulders relax just an inch, still not fully convinced by Chase’s answer.
“Then what? You woke up and decided to become a moron?”
In that moment, Foreman returned from his search. He immediately felt the tension in the room.
“What did I miss,” he asked, trying to get a better understanding of the situation.
“Nothing,” House said, stepping away from Chase. “Did you find anything in the patient’s home?”
Foreman shook his head.
“Nothing. The house was surprisingly clean. No harsh chemicals either. Everything was organic.”
“So we’re back to square one,” House said, his expression unreadable.
Chase tried to cough subtly into the crook of his elbow, breaking the uncomfortable silence.
“Not entirely,” Cameron reminded the others. “We’re still waiting on the results for the auto-antibody tests.”
“Those won’t be ready until tomorrow. If we’re lucky, that is.”
“The kid isn’t critical. He can wait.”
“‘Can’, isn’t the same as ‘should’.”
“So what ‘can’ we do?” Foreman asked.
House stared intently at the whiteboard.
“Foreman, go talk to the kid. Alone. Get us another history. Cameron, use your charms to get the parents out of the room for a while, and Chase… go to the lab. Run another CBC and whatever tests you can think of. Let a nurse stick the patient. He’s bleeding enough as is. I don’t need you accidentally hitting an artery.”
House followed Chase with his eyes as he left the room. Something felt off about the younger man, though he couldn’t exactly figure out what it was yet.
-
Down in the lab, Chase went to work, thankful for new technology. He couldn’t see himself counting red blood cells under a microscope, or manually spinning a crit right now.
House had told him to run whatever tests he could think of. The only problem was that he couldn’t think of anything useful.
He stood in front of the machines and tried to remember the symptoms written on the whiteboard back in the office.
Hematuria? He should probably check the kidneys so… creatinine? Uric acid? And maybe electrolytes. There was something off with the platelets too. He should check those as well.
During moments like these, he was glad he’d spent so many nights in the lab running endless tests every time House had a hunch. He might not be able to think clearly, but he still knew the machines like the back of his hand.
He tried to start the automatic cell counter, hovering over the controls for a second longer than usual, frowning as if the layout had changed overnight.
He eventually managed to start the machine and sat down on the stool next to it. It was one of those cheap metal stools you could spin around. He pushed himself off with his foot. The mechanism whirred to life with a loud mechanical squeak that made his ears hurt.
He immediately stopped spinning. The room kept moving for a second longer before finally coming to a standstill.
He heard a short beep coming from one of the machines in the back. He didn’t bother getting up since the results would be sent to the computer anyway.
When all the tests were finished, he printed out the results and headed back to the office to give them to House, hoping the man was no longer mad at him.
Cameron and Foreman had gotten back before him and were sitting at the table, watching a very annoyed House repeatedly throw his ball against the glass divider.
“Good, you’re back,” the older man said when he saw Chase standing in the door opening. “Did you find anything? A functioning brain perhaps?”
Chase handed the piece of paper to the older man, too scared to tell him he hadn’t actually looked at the results yet, after hearing his tone of voice.
House scanned the paper.
“CBC hasn’t changed much, kidneys look fine…” he stopped reading after that and frowned before looking back up at Chase.
“What possessed you to run a PFA on a patient with thrombocytopenia?”
Chase hesitated. Now that he thought about it, it wasn’t a very useful test indeed. A platelet function analyzer would always give a prolonged closure time in patients with platelets this low. There was no sense in running the test.
“Either you had some kind of epiphany, or you blindly stumbled into something useful.”
Chase blinked slowly, trying to figure out what House was getting at.
House, who had apparently lost all patients, shoved the piece of paper with the results on it back into Chase’s hands.
“Look.”
Chase did.
“98 seconds— but that’s normal, right?”
“What? That can’t be right,” Foreman said, walking up to Chase to see it with his own eyes. “How can the closure time be normal? The kid has almost no platelets.”
“Or does he…”
Everyone’s eyes fell on House.
“What? You think they’re hiding?”
“Not the platelets, no… but the antigens.”
You could practically see the gears start to turn in House’s head, like they did whenever a piece of the puzzle finally clicked into place.
“It’s EDTA-phenomenon.”
“EDTA-phenomenon?” Chase mindlessly repeated.
House limped over to the whiteboard and erased everything that was written down on it.
“Inside our patient’s body, the platelets roam around freely, binding to collagen fibers every time a vessel springs a leek.” He used a marker to draw the blood vessel. “Now here’s the thing…” He drew two vials, labeling them EDTA and citrate. “When we run a CBC we use EDTA as anticoagulant, because it preserves the cells oh so nicely. Under normal circumstances that is.”
Foreman folded his arms.
“Let me guess, these aren’t normal circumstances we’re dealing with?”
“Correct! Roughly 0.1% of all people make antibodies against their own platelets. These antibodies don’t cause any problems inside the patient’s body, because the antigens they bind to are shy. They hide just below the platelet’s surface and only come out when they come in to contact with EDTA…”
“…And when that happens the platelets start to aggregate inside the vial, forming clumps that the automatic cell counter picks up as red— or even white blood cells because of the size,” Cameron finished.
“Exactly.”
“So how come the PFA was normal?” Chase asked, not even caring about how obvious the answer probably would be if he weren’t so out of it still.
“Very simple,” House said, tapping the board with the back of the marker. “You were stupid enough to run the test even though there was absolutely no indication to do so, but not stupid enough to forget that platelet function studies are done with citrate blood. No EDTA, so no aggregates, thus normal closure time. There is no problem with the kid’s primary hemostasis.”
Foreman stared at the board questioningly.
“Are we sure about this? pseudo thrombocytopenia would explain the normal PFA, but it doesn’t fit the symptoms. How else do you want to explain the nosebleeds, hematuria, petechiae—”
“The patient doesn’t have petechiae,” Cameron corrected him.
“That doesn’t make any sense.”
“Yes, it does,” House interjected. “Petechiae are a common symptom in disorders of the primary hemostasis, which like I said, he doesn’t have.”
Foreman frowned.
“So you’re saying it’s a coincidence that the kid is bleeding from every orifice?”
“No, it’s a coincidence that his body is attacking his own platelets when they come into contact with certain anticoagulants.”
“So what’s wrong with him then?”
House sighed deeply.
“I wouldn’t have hired any of you if I knew I was gonna have to do all of the thinking anyway—if the problem doesn’t lie in the primary hemostasis, it’s probably an issue in the secondary hemostasis. Most likely hemophilia. Foreman, go see if the little rascal is deficient in any clotting factors. Cameron, do a peripheral smear to confirm EDTA-phenomenon. Put it in his chart so even less competent doctors won’t kill him later on. Chase, stay for a minute, will you?”
There it was again. That weird feeling inside Chase’s chest that had nothing to do with his cold. With everyone focused on the patient, he had almost forgotten his own predicament. Even though the effects of the medicine were already starting to wear off slightly, he still had enough of it in his system to make a fool out of himself in front of House, possibly even get in trouble for treating a patient under influence, despite the fact that he never touched the boy.
He carefully walked over to the table, trying not to walk into anything, and sat down in on of the chairs. He looked down at his own hands, not sure what was going to happen next. He suddenly felt hot, like an ant getting cooked alive by a child with a loop on a warm summer’s day. Only it wasn’t a child looking at him closely, it was House.
Chase couldn’t tell if the man was still mad at him, or if he was starting to genuinely be concerned by his behavior. House wasn’t one to worry about the little things. Especially if those things were his employees, but it had been known to happen on occasion.
“How about you start talking now,” House said, not unkindly, but not very happy either.
“About what?” Chase answered, trying to gage the situation best he could.
“I don’t know, you tell me.”
Small drops of sweat beaded on Chase’s forehead. His breathing had picked up slightly.
House stepped closer.
“you got lucky today. Whatever is going on with you didn’t cause harm to any of your patients—and yes I can see you thinking about the patient you saw in the clinic today. I checked his chart after you showed up acting like you went on a scavenger hunt for the bottom of a tequila bottle. You did everything right.”
Chase let out a relieved breath.
“That still doesn’t excuse your behavior.”
House’s words sent a pang of guilt through him. The heat in the office felt suffocating. He tried to shrug off his white coat, clumsily moving his arms to free them from the fabric.
The bottle of cough syrup fell from his pocket and landed on the floor next to him. For a short moment both of them just looked at it.
House closed the distance between him and the bottle and picked it up, reading the label out loud.
“Dextromethorphan.”
Chase froze. A million thoughts raced through his head, none of them of much help.
“Did I not ask you whether or not you’d taken any drugs?” House asked, voice dangerously low.
“Well, yes,” Chase said softly. “But technically it’s medicine, not drugs.”
“It’s a drug, that’s why you can get it at the drug store.”
Chase didn’t have anything to say to that.
“How much did you take?” House asked, trying to figure out what he was dealing with.
Chase looked at the bottle in House’s hands. There was about two thirds of the liquid left in it.
“All at once?”
Chase nodded sheepishly.
House put the medicine down on the table.
“No wonder you’re so out of it. You took enough to cure an elephant of bronchitis.”
That deserved a small smile from the younger man.
“I didn’t think we would have a case today,” he finally said, a bit more serious.
“I gathered that. Still, you should’ve come clean and gone home at the beginning of the case.”
“I probably shouldn’t have come in at all,” Chase said, beginning to feel the lingering symptoms of his cold again as the meds wore off.
House pressed the back of his hand to Chase’s forehead.
“You do feel a bit warm.”
Chase closed his eyes for a moment, relishing House’s touch while it lasted.
“Go home. Sleep.”
Chase’s eyebrows drew together.
“Aren’t you going to punish me?” he asked, having expected to be reported to Cuddy.
“That would be a bit hypocritical of me, don’t you think?”
“Oh yeah…”
House watched as Chase got up and started grabbing his stuff.
“Give me your car keys.”
“What?”
“Your keys,” House repeated, holding his hand out to Chase. “You’re not allowed to drive as long as you’ve got DXM in your system.”
“Right.” He handed his keys to House. “I guess I’ll have to take the bus.”
“If you can survive a differential like this, you can survive the horrors of public transport as well.”
Chase chuckled weakly.
“I suppose so.”
“And Chase—” House said as Chase was about to walk out the door. “Couldn’t have made the diagnosis without you.”
Chase smiled at the older man.
“See you tomorrow, House.”
“Yeah, see you tomorrow.”