Characters: House, Wilson
Word count: 4878
Spoilers: Wilson's Heart, Early Season 5
Summary: It was the sort of diagnosis that wouldn't rate a sad-face on his whiteboard. And yet it could change everything.
On bright and bitter days like this, the motorcycle was the love of his life. Illicit pleasure was the sweetest, so he’d left his pager and cell back in the office. House had already decided he was done with clinic duty. Cuddy could go ahead and fire him. She had nothing left to hold over him. That had been the one good thing that came from Wilson leaving. House no longer had anything to lose.
The rain had come down hard the night before, and oil-glazed puddles still edged the road. Even though he’d never admit it, House was a careful rider. He knew how to manage his turns on a slippery road and how to watch for potholes covered up by wet leaves. He also knew to avoid Volvos, mini-vans, and SUVs—usually manned by drivers who were convinced that because they’d made the most sensible choice in a vehicle, everyone else deserved to die. Wilson was a notable exception. For months after House had gotten the bike, Wilson had begged him to get rid of it. But House always snorted and said that he’d be fine and that most likely, Wilson would be the one to shuffle off this mortal coil while using a crosswalk.
The motorcycle compensated for a lot but not everything. Riding was all in the balance, anticipating the curves, keeping the bike centered on the road. There was something in the fluidity of motion. The thrill of speed playing counterpoint to the pain. Although he wasn’t more than ten miles away from the hospital, he could have been in a different world.
As he rode further into the woods, the air became cooler and colder, and he could see the wind shimmy through the changing leaves. Damn, he liked autumn. Soon the weather would turn crappy and the roads would be unmanageable. With Wilson gone, House would have nothing but work and the PI’s hired entertainment to look forward to during a long cold winter. Lucas had been an amusing distraction but not much more.
House was definitely going to pay a price for this ride. He was already stiff, and his leg was throbbing. Because his leg couldn’t help him balance, he tended to over-compensate with his shoulders, and it’d been a while since he’d done any adjustments to the bike. He’d be feeling every mile by the time he made it back to the hospital. Straightening his wrists, he tried to relax his shoulders by easing them forward. It took some pressure off his leg, but if it was hurting tomorrow, he’d simply go after Kutner for a refill. What the boss wanted, the boss got… It was good having minions who still believed he was all-powerful. Or so he liked to believe.
Nobody but Wilson had ever really cared about how many pills he took, unless the drugs were interfering with his work. Wilson should have known that reverse psychology would work for House. Vice wasn’t nearly so much fun without Wilson to knock it.
But he was sick of getting away with things. Wilson’s departure had knocked that thrill right out of him. He missed Wilson more than he’d ever missed Stacy, and he’d loved Stacy more than he’d ever loved anyone. This was different. He’d been the one to show Stacy the door. With Wilson, he was the one who couldn’t stop knocking.
House wasn’t completely sure why he kept trying to get through to Wilson, but Cuddy said he was like a border collie with his favorite ball stuck up in a tree. Even though he was surrounded by tennis balls, he wanted his ball, damnit. She had a point. House had never been good at letting go. But this was more than a stubborn obsession--this was Wilson. It was the singular relationship of his life. Wilson had said they weren’t friends, and he was probably right. Whatever they were was a hell of a lot more complicated than that.
He would have to go back soon. He had a consult at five, and it was actually a case that had the potential to be interesting. Besides, the road was too wet, and the turns were coming in quick succession. Strafing the bend, he felt like he had to duck to avoid low-lying branches, but God, he loved this bike. Best five grand he’d ever grifted out of Wilson, even if he had wound up repaying it. He smiled darkly, remembering how satisfying it had been to believe that there were no limits to what Wilson was willing to give.
Before Amber, codependency had worked so well for them.
That was what House was thinking when the pain began.
It slammed into his chest like a collision of nerves and synapses screaming. The impact almost knocked him off his bike. He struggled to hold on and immediately eased back on the throttle. Pressure. There was so much pressure. He couldn’t breathe through it. It was like his heart was being shoved back toward his spine.
Somehow, he managed to pull off the road. He was gasping for air, trying to breathe through the pressure. When he leaned forward over the handlebars, the pressure eased up. But when he tried to sit up again, the agony almost engulfed him.
House slid off the bike and slumped to the ground, cursing himself for leaving his cell phone behind. He could have brought it with him and kept it turned it off, but leaving it on his desk had been so satisfyingly symbolic. Dialing 911 would be even more satisfying. House bit back a groan, thinking he was getting too old for symbolic gestures.
He placed two fingers against his carotid and started counting. Oddly enough, his heart rate was perfectly normal. Maybe he wasn’t counting right. His symptoms were atypical. Despite the likelihood he was going into cardiac arrest, he didn’t seem to be going into shock. He wasn’t even dizzy. All his symptoms seemed to be centered in his chest as if nobody had told the rest of his body what was going on. It would be kind of cool, if it weren’t for the part where he died alone and cold on a deserted road…
The last time he was dying, he hadn’t been so maudlin. He needed to stop taking the whole thing so personally. House had to think about his own case like it was any other set of uninspiring symptoms.
The pain was acute, devastating even, but he was still conscious. He had no idea why because the pressure in his pericardium told him that he was most likely minutes away from cardiac arrest. He wasn’t particularly dizzy, and he wasn’t even nauseous, despite the iconic elephant doing a belly flop on his chest.
House mulled his options. Nobody had driven by since he’d pulled over. Three cheers for his penchant for solitude. He wasn’t that far from the hospital, but motorcycle riding and cardiac arrest didn’t tend to play nicely together. On the other hand, waiting for his heart to give out didn’t appeal much either. Looking at the whole thing in a positive light, his leg actually felt better. Turned out a heart attack was one hell of a gating mechanism.
But something was off. He was missing something. House knew that no two heart attacks were the same, but there’d been no warning symptoms before the attack, no vague discomfort, nor was there an ominous ache in his jaw or chest. House reached to take his pulse and realized that the veins of his neck were distended. Distended veins and visceral, unrelenting pressure. Those symptoms cinched it. Somehow, he’d managed to develop an acute pericardial tamponade. He groaned and gave up trying to read his pulse. There was no point. Damn.
The diagnosis was prosaic but deadly. Judging from the rapid onset of symptoms, it wasn’t the sort of thing he was going to survive without having a big-ass needle jammed into his chest within minutes. Acute tamponade was an emergency. In the ER, they would get him hooked up to an EKG. Angled slightly up, the cath needle would go in below the rib cage and through the pericardial sac to drain the blood. Without an aspiration, pressure would build up, crushing the heart, and he would die. This was probably going to kill him before he could make it back to the ER.
House resisted the urge to lie down on the fallen leaves and let death have at it. What a stupid diagnosis. Wouldn’t even rate a sad-faced doodle on his whiteboard. There’d be no autopsy, nothing for his three suddenly unemployed new fellows to dissect and argue about afterward. The only mystery worth looking at would be – why? He had no risk factors, hadn’t experienced any trauma, and in fact, hadn’t had any symptoms until the damn thing had bowled him over. He was sure that some would say it was the culmination of a reckless life. In so many ways, House’s heart had taken a beating. Shouldn’t surprise him that it would quit on him in the end. Everything else did.
House wasn’t suicidal, but there was a part of him that had never gotten off that bus. He hadn’t forgotten that last hallucination, sitting with beautiful Amber in the back. In death, as in life, they’d understood each other. He’d gotten off the bus and stayed alive, mostly because they couldn’t both leave Wilson.
House couldn’t die today. House knew what he meant to Wilson, and for once, his self-importance was uncomplicated by ego. Wilson was bereft, angry, and alone, and House could not leave it like this. This was the sort of thing Wilson might never get over.
Awkwardly and painfully, he threw his leg over the bike and pulled back on the road. Somehow he managed to stay upright even though he’d never be able to explain how. The autumn colors on either side of the road looked surreal and almost obscene. With every minute and every mile, his pericardium had to be filling up with blood and yet he was still breathing. Wilson used to say that if the apocalypse came, the only ones left would be House and a few dozen cockroaches. Not dead yet. Wilson was probably onto something.
With only a few miles left to go, House tried to stop thinking about the pain and start figuring out how this could have happened. An acute pericardial tamponade didn’t come out of nowhere. Trauma was a common cause, but he hadn’t suffered any contusions at all. His was most likely caused by a clot or a tumor, but there was something inherently unsatisfying about that explanation. And yet he could feel the weight of the blood in his pericardium inexorably crushing his heart. What a stupid, stupid way to die.
He was probably breaking a dozen laws by riding impaired, but the motorcycle knew where it was going. He’d never been so glad to see the familiar grid of streets that led to the hospital. Two blocks ahead, turn left, and then he was there. Even from the street looking in, he could see that the ER was unusually busy. Abandoning the bike outside the ER, he grabbed his cane and staggered through the revolving door.
It wasn’t like anyone in the ER was ever glad to see him, but nobody even seemed to notice him. The place was buzzing. House tapped his cane impatiently; clearly someone could see that he was in distress. He usually counted on the fear and irritation he instilled in others to stir up some sort of response.
House was about to yell, “Man having a heart attack here!”
But even as he started to call out, the pain went away. He braced himself with his cane, as if preparing for another wave. But it was gone.
Completely. Vanished. Gone.
Pericardial effusions didn’t just go away.
Not much shocked House, but this did. He was so taken aback, he didn’t even yell at the emergency personnel who were impatiently trying to walk past him.
“Hey! Crippled heart attack survivor here… watch where you’re going!”
House wasn’t sure which offended him the most—the fact that they weren’t paying him any attention or the fact that he seemed to be the beneficiary of a miracle. He frowned, gripping his cane, as the rapid response team rushed past him. He didn’t believe in miracles. Besides, his leg was already hurting again.
He was thinking about tripping someone, when a firm hand grabbed his arm and rudely pulled him out of the way. With a frown that was way too grim for her pretty face, Cameron shook her head.
“Thank God they got a hold of you,” she said. “Why wouldn’t you answer your page? Okay, listen. They just brought him in and are still trying to assess the swelling. The bleeding is under control....”
House was beginning to suspect his poor abused brain was taking him on another ride. This was too much like one of his typical hallucinations. The heart attack, the surreal ride to the hospital, the vanishing fatal condition, and now Cameron’s conviction that she was making sense. House had to be sure he wasn’t dreaming, so he pinched Cameron’s arm as a test.
“Ow! What the hell was that for?”
“Okay, you’re real so it’s my turn. What the hell are you talking about?”
Rubbing her arm, Cameron glared. “Chase is with him, and Cuddy’s on her way. She was at a conference in Trenton. Dr. Fung is assessing him in the resuscitation area. I’m not sure how to say this, but he… Dr. Fung doesn’t want you to come in.”
Dr. Fung was the head of the trauma team and had never liked House, but he’d never barred him from the trauma bay. Didn’t make sense. But then House took a step back from Cameron’s concern, and he felt his own healthy heart beat a little faster. The phantom pain clenched and released in his chest, but this wasn’t about him. It had never been about him. But it was about Wilson.
And for the first time in his life, Greg House knew exactly what his heart was trying to tell him.
“Tell me,” House said.
“Dr. Wilson was in an accident less than an hour ago. He was trapped in his car, and they had to get him out before they could stabilize him. Didn’t they tell you when they called?”
“Nobody called me. Tell me the rest.”
Cameron looked at him strangely but continued. “A truck ran a light. Witnesses said Dr. Wilson was trying to make a left, but he was hit head on. The other driver was dead at the scene. No seatbelts. We tried to get a hold of you as soon as it was called in, but you weren’t picking up--”
House grimly started toward the resuscitation area. “What are his stats?”
“He’s in respiratory distress,” Cameron said, ineffectively trying to grab hold of his arm. “BP’s down, he’s unconscious. House, wait!”
He stopped short at the ill-disguised panic in her voice, and she said, “He has a skull fracture. They’re assessing him now, but they’re concerned about swelling in his brain. He had a seizure in the ambulance. They’re getting the OR ready.”
“Idiots,” House muttered, shaking her off. “He’s got an acute pericardial tamponade. Any first year med student could see that. Trauma teams always love head injuries… it’s way cooler to drill into a skull than jam a needle in a chest.”
“House, they told me not to let you in there. Besides, you haven’t even seen him. There’s no way you can make that kind of diagnosis. They have it under control.”
“Then they should know that he suffered blunt chest trauma and blood’s filling his pericardium.”
“The medics have been monitoring his heart since they pulled him out of the wreck. His heart is fine, House. It’s the cranial swelling they’re worried about.”
House could hear her behind him as he barreled toward the doors that led to trauma. “Then they’re worried about the wrong thing. It’s his pericardium, and they’re going to kill him if it’s not aspirated now.”
“Damn it House, this is Wilson we’re talking about. Everyone is doing everything possible to try and save him. I don’t know what happened to you, but I think you’re in shock. You need to sit down or I’ll call security.”
“I called security.”
They both turned, and Cuddy was right behind them. House had been so busy trying to shake off Cameron, he hadn’t even seen Cuddy coming. “House, I know you, and you are not in your right mind. You need to calm down before you get anywhere near him.”
“I’m in my right mind,” House said, absolutely furious with her for not knowing the difference. “I wasn’t in my right heart for a while, but that really doesn’t concern you. Damn it, Cuddy, get Hollers in there. He’s the best cardiologist in this hospital. Have you even paged him?”
“It’s not his heart. They’re worried about his skull—”
“And they’re wrong! Wilson’s got an acute pericardial tamponade, caused by the impact. Fire me if I’m wrong. Hell, fire me now. But you’ve got to let me in.” House eyed the two massive security guards – probably the biggest in the hospital – who were now stationed in front of the door. He only needed a minute with Jimmy. He could probably hit them over the head with his cane, grab a central venous catheter on the way in, and--
“We’ll run a CRX as soon as Fung okays it,” Cuddy was saying reassuringly.
“He’ll be dead before then.” House held onto his cane, trying to decide which armed guard to take out first.
“House, you’re not listening. The EMTs checked his heart out thoroughly. The possibility of brain damage...”
“And I’m telling you that we can deal with the skull fracture afterward. His pericardium is filling up with blood.”
“You haven’t even seen him, for God’s sake,” Cuddy said. “We’ll run an echocardiogram before they take him to the OR.”
“You’ll be too late. I’m already telling you exactly what’s wrong with him.”
Chase came through the door and around the guards. House could hardly look at his spattered scrubs, although blood had never been something that bothered him before.
“Dr. Wilson’s deteriorating.” Chase was wise enough to direct his comments toward House. “We’re going to go in to relieve some of the pressure.”
“It’s not cranial!” House shouted, and Chase’s eyes widened as he took a step back. “His pericardium is filling up with blood. You idiot! Think about what they taught you at whatever outback medical school you went to. His blood pressure’s falling, not rising like it would with cranial pressure.”
“There’s bruising behind the mastoid process, and we’re seeing blood mixed with fluid coming from his nose. If we don’t relieve the swelling, he’s likely to suffer permanent neurological damage.” Chase folded his arms across his chest.
“He’s right.” Foreman came up behind them. To Chase, he said, “I want to do a neuro check before you go in.”
“You can worry about whether he knows his mother’s maiden name after you’ve drained the blood out of his damn chest,” House said. “His well-insured brain won’t be worth anything to the hospital once he’s dead.”
“We’re losing time.” Cuddy placed herself between House and Foreman. “If blood flow to the brain is compromised…”
“We’re losing him.” Chase was still addressing all his comments to House like nobody else mattered. House remembered why he’d bothered to hire Chase in the first place. “His BP is dropping...”
“Not rising like it would if this was due to a skull fracture,” House said, quietly this time. “Last time I checked, I was still Wilson’s medical proxy. Let me talk to him. He can decide.”
“He’s unconscious.” Cuddy enunciated each word like she was translating for a rather slow child.
“He’ll wake up for me,” House said.
Chase stood up straighter. “House should be allowed to see him.”
“Fine.” Exasperated, Cuddy waved them on. “But only for a minute. And Chase, you’re going to be the one to deal with Dr. Fung.”
Cameron protested, “But House hasn’t even looked at Dr. Wilson’s chart yet.”
Eyes narrowed, House didn’t bother thanking Chase or arguing with the others. He stormed past the now disinterested guards and through the door that separated him from Wilson. He knew the others were following, but he didn’t really care.
Wilson was the main attraction in the trauma bay and was being hooked up to every expensive toy that Cuddy had purchased during her reign. House vowed never to persecute her again for the hospital’s interminable donor campaigns. But all the expensive equipment wasn’t worth a thing if they weren’t looking for the right symptoms.
House pushed past the trauma team, propping his cane against the cart. He leaned over Wilson, purposefully ignoring the voices, the machines, and all the damage. He could see why they were distracted by the head injury. Wilson looked like he had washed his hair in blood.
The veins on Wilson’s neck were bulging and distended. His breathing was labored, but they hadn’t intubated him yet. Painfully, House crouched beside the bed, ignoring Fung’s outraged glare. House forced himself to focus. He reached for a relatively unscathed shoulder and wasn’t surprised to find it cold and clammy. Wilson was in shock and going down fast, his lips blue-tinged. His body was shutting down.
House shook his shoulder. “Wilson, wake up. I need to talk to you.”
“He’s not responding to stimuli,” a trauma nurse explained helpfully, just as House punched Wilson hard on the arm.
Wilson’s eyes opened. They were dilated and not tracking, but gradually they focused on House’s face. House leaned in, only a couple inches away, and spoke gently but firmly.
“You’ve got a pericardial tamponade. That’s why you’re feeling so much pressure in your chest and you can’t breathe. We need to aspirate now, but I need you to okay it, because these idiots want to run tests on your brain instead. C’mon, don’t fade out now. Do you trust me, Wilson?”
Wilson blinked, and his eyes started to roll back in his head.
“He’s crashing,” Chase shouted. House ignored the activity around them.
“Jimmy, do you trust me?” House was about ready to grab a needle and jam it in Wilson’s chest himself.
Wilson was panting to get the words out. “Pressure. In my chest. Hurts.”
“I know. I felt it too.”
Someone stage-whispered, “What’s he talking about?”
But there was nobody else in the world but Wilson. House waited, giving his friend the time and space he’d wanted. Then Wilson closed his eyes and nodded.
“Do it,” he said.
House swung around and glowered at Chase. “Are you going to do it or do you need me to do it for you?”
Frowning, Chase grabbed the venous catheter off the trauma cart, muttering, “Knew you were going to be right even though there’s no way you could know what was wrong before you examined him.”
The monitors were going crazy. They were on the edge of too late. Wilson was circling the drain.
“Do it!” House demanded.
And Chase did.
They were almost too late. The emergency aspiration relieved the pressure on Wilson’s heart, and as it turned out, Wilson was probably a minute or two away from cardiac arrest. He did require surgery to relieve the swelling from the skull fracture, but he would have died from a crushed heart if House hadn’t insisted on skipping the tests.
House knew everyone was talking about it. After a while, they stopped asking him how he knew once they realized he had no interest in anything but Wilson. Eventually, they would just chalk the diagnosis up to House being House. And as far as he was concerned, they were never going to find out any different.
House, who never sat with patients, couldn’t bring himself to leave Wilson even after he was out of immediate danger. In the ICU, Wilson was in and out of twilight sleep, barely conscious, let alone lucid. He’d developed a fever as a result of the pericardial effusion, and antibiotics had only started to get it under control. If Wilson woke up and ordered him out of the room and out of his life, then House planned to plunder his savings. He’d hire a dozen PIs to follow him around the clock. It would be worth every penny. He was done with giving Wilson his personal space. Their shared heart attack had taught him that.
After a couple days, Wilson started to improve and was moved into a private room in deference to his star status at the hospital. House moved with him, and for once, nobody tried to get rid of him. Wilson’s sympathetic nurse even had a cot brought in, and House’s scowl dared her to ask if he wanted to use it. He looked to Wilson instead.
Do you want me to stay?
Wilson nodded somewhat diffidently, and House threw his cane in the center of the cot, claiming it. Even though he hadn’t kicked House out, Wilson had hardly said anything, only answering “yes” or “no” or shrugging, when House checked his vitals several more times a day than anyone else thought necessary.
That got boring fast, so House found an orderly from Peds who moonlighted as a hacker and was able to tap into the hospital’s premium cable feed. Wilson only raised an eyebrow when House brandished Cuddy’s remote control in victory.
On Wilson’s third day out of the ICU, they spent the afternoon watching a “Destroyed in Seconds” marathon. As another gas station pump went up in flames, House realized that Wilson was watching him and not the screen.
“How did you know?” Wilson asked.
House didn’t even bother pretending he didn’t know what Wilson was talking about. He’d been waiting for the question for the past three days.
“It’s what I do. It’s why they pay me the big bucks.”
“No. Cameron said that you knew what was wrong before you examined me and even before you saw my chart.”
“Chase told me that nobody knows how you found out I was coming in since you were out on your motorcycle and like an idiot, you left your phone and pager behind.”
“Cameron’s rubbed off on him. Drama queens.”
“How did you know, House?”
All the bruising and bandages made Wilson harder to read. But House knew better than to make a joke out of it. Almost dying had to change something.
Averting his gaze, House leaned forward in his chair. No sarcasm, no deflecting jabs, no fortifications. If Wilson turned him away this time, House would have no defenses. He knew exactly how Jericho felt when the walls were tumbling down.
But House said quietly, “It was my heart. I felt it too.”
“I don’t understand.”
There was an edge to Wilson’s voice that made House uncomfortable. House knew that emotions could be volatile after a cardiac episode. The last thing Wilson needed was to get upset by something he didn’t need to know. And yet, House knew he had no choice but tell him. It was private but only between them. House turned and looked Wilson in the eye.
“I thought I was having a pericardial effusion. Had all the symptoms. Rode back to the hospital, but it turned out to be you instead. My heart was fine. I ran an EKG on myself afterward just to be sure.”
House shrugged like his least favorite word was no big deal. “Maybe.”
Frowning, Wilson turned back to the show, which had escalated from blowing up gas pumps to detonating entire service stations. House tried to watch even while keeping an eye on the bank of monitors. Wilson’s numbers looked good considering what he’d been through, but House wasn’t going to let anything slip by him. Wilson let out a low whistle when an explosion spewed molten shrapnel into the air. It reminded House of life before Amber, and he smiled.
Not looking away from the screen, Wilson said, “They’re never going to let me out of here. I guess we can try to figure it out while we’ve got the time.”
“Yeah, well you know where to find me,” House said, stretching his leg out and kicking back in his chair. He reached in his pocket and dry-swallowed a Vicodin.
Wilson’s hand, the one with the IV, came out from beneath the blanket, and House’s hand found a place right beside it. House stopped holding his breath when Wilson didn’t pull away. The moment when Wilson forgave him came and went, and House felt that too.
This thing they had. Call it friendship, codependence, symbiosis, whatever it was. It resisted easy explanation. But he’d be damned if he called it idiopathic. There was always a reason even if nobody knew what it was. House hated to admit it but a differential diagnosis of a miracle wasn’t something that could be ruled out.