Sunday, February 27, 2005

1:47 AM

Stayed up playing the piano -- well, just noodling around with my right hand -- until I thought I could get some sleep. But when I got up from the piano bench, I stepped off at the wrong angle. The weak muscles and damaged nerves in my thigh went crazy, and for a moment the world went black. I was able to grab onto the piano with my left hand, and that helped a lot -- I didn't fall, and the pain from my fingers did a nice job slamming shut the neural gates to the pain from my leg. I had to sit back down for a few minutes to catch my breath and take a Vicodin before I could try it again.

Finally I got myself launched. I hobbled down the hall, stopped off at the kitchen for a glass of water, and headed off to bed. I sat down and rested for a moment before starting the task of getting undressed. Lifting up my leg onto the bed so I could unlace my shoes. Tossing the shoes into the closet -- can't just leave them at the side of the bed anymore. Unbuttoning my jeans, standing carefully while I get them around my knees, sitting back down again and using my hands to lift my right leg out of my clothes. Tossing the jeans into the closet.

There was a time in my life when I didn't have to plan everything out like this, when I could just do things without thinking about them, things like leaping up from a piano bench, crouching down to the floor to pick something up I dropped, carrying in a full bag of groceries from the car. Being able to just drop into a chair instead of lowering myself in. Taking stairs.

You know, it's been five years since I've climbed a flight of stairs.

Of course, there was also a time in my life when I was adorable and cute and had no teeth and never talked back. But I don't remember that time very well either.

Once I've undressed, I sit on the edge of the bed and take a sip of water.

I look down at myself. The scar starts below the hem of my shorts. It's just as ugly as it was yesterday. I sigh, lift my leg into bed, and roll the rest of myself after it. Blanket, pillow, pillow, pills and water within reach... the routine.

As I reach over to turn out the light, something across the room catches my eye. It's the box. It's sitting on the top of my dresser (no, I haven't thrown it away yet.)

I look down at the floor for a moment before I come back to myself and snap off the light.

A hospital bed, years ago. An IV and a PCA button taped to my right hand. Eileen holding my left.

"Greg... do you want to tell me what's happened?"

"Do you want the whole saga or just the basics?"

"Just what you want to tell me."

This is what I did not tell Eileen.

I did not tell Eileen about Stacey. Not yet.

I didn't tell Eileen anything about those two manic best-of-times-worst-of-times-years, the two years that had finished like the Hindenburg about six months earlier. I didn't tell Eileen about how I'd spent the entire summer simmering in fury and loneliness, wondering if I was going to finish my thirties with nothing to show for it. I didn't tell her about how much more I'd been smoking, how much more I'd been drinking. I didn't tell her right away about how I'd finally started to pull myself together. About how I'd noticed myself getting a little winded taking the stairs, about how I'd gotten disgusted with myself and started working on quitting or at least cutting back.

I started running again and set a goal for myself -- I would train and run a 10K that October. And I threw myself even harder into work. It was just what I needed. After a month I was feeling better -- smoking less, sharper physically and mentally, thinking much more about the future and much less about Stacey.

Then my right thigh started to hurt. At first I thought I'd just strained it; I iced it and took a day off from running. It only helped a little. I called one of the orthopedists who specialized in treating sports injuries. He looked it over, agreed it was a bad strain, and sent me home with a prescription for ibuprofen and orders to rest. I took the former and ignored the latter; Dr Nussbaum, the old Director, had come up with an idea for a new multi-disciplinary department, and he'd asked me to be on the exploratory committee. I was excited about the project -- I couldn't just stay home, there was too much to do. So I cleared my calendar as best I could, put my leg up, concentrated on the committee work, popped the IB, and cracked cold packs.

The ache didn't go away. The next day, Friday, I went back to the orthopod. He did an x-ray to check for a hairline fracture; my femur looked fine, so he refilled the ibuprofen and renewed the orders to rest. He was going to be out of town that weekend and would be back Tuesday morning; we'd follow up then.

I spent that weekend in my office with my leg up, surrounded by paperwork. The ache didn't let up, but didn't seem to be getting worse. My mind was unsettled -- something seemed amiss -- but I pushed the thought away. I'd been training so hard. It was just a strain. I was just fidgety because I hadn’t been running.

Monday came. The ache was no better. I'd skipped rounds on Friday so I had to go on Monday, and of course we had not only our own patients to see, but our consults scattered all over the hospital. By the time we finished rounds, my back was getting sore from my messed-up gait. I would definitely follow up with the orthopedist the next day.

I sent a scut monkey down to the caf to get my lunch, left a message for the orthopod, and spent the rest of the afternoon on the office sofa with an ice pack on my leg. Wilson stopped by to say hello. I made jokes about holding court like a Persian prince and told him he was on dancing girls detail. He thought that sounded like a great idea, but was very disappointed to hear that it wouldn't get him off call that night. His pager went off before he could do much more with the joke.

The afternoon wore on. Pasternak, my department head, came by to check and see how I was doing. He saw the wastebasket full of discarded cold packs, demanded to know why I hadn’t seen the ortho guy that day, ordered me to see the ortho guy first thing in the morning, and sent me home. I figured I might as well obey, so I packed up my papers, got to my feet, and started off down the hall. I had only made it halfway to the elevator when my right leg exploded with pain. The world went red and starry as I dropped my bag and clung to the wall. I had never, never, never imagined pain like this. I waited for the surge of pain to retreat, but it didn't, it didn't, it just kept growing worse, sending tentacles of hot pain down to my feet and up my back.

I forced myself to breathe, and breathe again, and breathe again, until finally my vision started to clear. Through a red haze, I saw a couple of my residents up the hallway and managed to squeak out their names. They looked up, saw me sagging, and came running. One of them held me up by my left arm while the other ran past me and found a wheelchair. I tried to protest but my head was swimming. By now one of the nurses had caught up with us. She held the wheelchair and helped them guide me in. It was a relief to sit and know I wasn't going to fall, but the pain didn't go away, and it became agony when they lifted my right foot onto the footrest. I started stammering something about being fine and just needing a ride home. I could feel them looking at each other over my head, and the senior resident shook his head. "Dr. House, you really need to let us take you to the E.R.”

I was in too much pain to argue. It felt strange to feel the wheelchair lurch forward and not know who was pushing me. It was the first time I'd had a ride in a wheelchair for anything but fun.

The ride down was a blur. Triage was a blur. The pain in my leg was growing worse, reaching up into my arms and up my neck.

They took me straight back to an exam room and somehow got me on a table. I heard the girl from Admissions asking me questions, but I couldn't respond. I heard Pasternak -- how did he get there? -- talking at her and then sending her away. One of the nurses helped me undress and change into an exam gown. It was an embarrassing, excruciating task – I couldn’t get off my own shoes, my own socks, or even my own boxers.

A blood pressure cuff tightening around my arm; a thermometer probe materializing in front of my face. Another nurse, sticking EKG patches on my chest and clipping a pulse oximeter probe to my index finger. A stick in my hand -- ouch -- and I glimpsed yet another pair of hands drawing the first round of labs. Some detached part of my brain started checking off the tubes for the usual E.R. blue plate special: red top, tiger top, purple top, blue top.... The hands laid the last tube aside, connected the cannula to an IV tubing set, and opened the roller clamp. Another stick -- ouch -- and the hands attached, flushed, and neatly dressed another saline lock.

Pasternak again, his angry voice coming from behind the curtain. The curtains parting. An ER doc coming in, followed by Pasternak. "Dr. House? I'm Dr. Franklin. We're going to give you something to make you more comfortable, and then get an X-ray. Meanwhile, I just want to ask you a few questions...." I managed to get out the story of the muscle strain. Cold alcohol on my left deltoid, a grip, a stick, and the burn as the Demerol hit the muscle.

And then I found myself alone. I wanted to curl up on my side, but between managing my leg and dealing with the tubes and wires, it didn't seem worth the trouble.

Time passed. A mechanical, whining sound, and then the portable X-ray looming over me. The pain as a nurse and the X-ray tech lifted my leg and slid the film plate under my thigh, and then again when they took it out. Waiting, waiting, concentrating on not screaming. What was happening to me? Franklin reappeared, telling me that the X-ray hadn't shown anything and that he’d ordered a CT.

Time passing. Pasternak again, looking worried. I told him I would be okay and begged him to leave.

Alone again. Then the orderly arriving, the nurse unhooking the monitors, and I was off on the long, horrible trip to CT. Being lifted on the sheet over to the table. Trying to hold still during the scan. Then back on the stretcher and back to the ER.

Don't scream don't scream don't scream... Riding on the stretcher was a weird sensation. I couldn't look at the ceiling; the pattern of the tiles made me dizzy. I tried to think again -- what was happening? -- but the clinical part of my brain kept getting drowned by the pain.

How long had I been in the ER? I wasn’t even sure about that. I asked the orderly for the time. He gave me a funny look and told me it was around six-thirty. That long already? It wasn’t until we got on the elevator that it occurred to me that I still had my watch on.

When I got back, there was a dinner tray waiting for me. The smell of the food turned my stomach. A nurse came in to hook me back up to the monitors and get another blood pressure; I got him to take the tray away when he left.

Franklin reappeared, looking grave, telling me he was concerned about the CT scan; he thought I might have compartment syndrome but there was something else he wanted to rule out. I nodded. Whatever. The only thing worse than the pain was the helplessness.

Time passed. I lay stiff and still on the stretcher, trying not to provoke the pain any further, trying to shut out the bright lights and the commotion of the ER. I started gently bouncing my fist on the mattress.


I looked up. It was Wilson. "Uhhhh. What're you doing here? Did my residents tattle?"

"No, Franklin called me. I wanted to check with you first."

I squinted at him. What the hell was he talking about?

"Franklin called me to look at your CT. I wanted to check with you first." Please, don't make me spell this out for you, his eyes added.

At last it dawned on me. Wilson was getting my permission to do a consult. Wilson was the oncologist on call that night. Franklin thought I had cancer. My stomach heaved with dread.

I nodded.

He disappeared for a while, and my thoughts started to race -- well, as quickly as they could race through the pain from my leg. Sarcoma? Surgery, chemo, radiation, amputation? Running the 10K next year with a prosthesis? Maybe I'd get on the local news: Local doctor wins the race of his life....

I stared at the ceiling for a moment and then closed my eyes. I'd think about it later. I was starting to feel nauseated again. I was also starting to feel really twitchy. A trip to the roof for a cigarette sounded like nirvana.

Wilson reappeared and told me he'd ordered an MRI. He asked if there was anything he could get me, and then had the nerve to just smile patiently when I asked for a Scotch and a ride to the loading dock for a smoke.

Another wait, another trip, another horrible slide over to the MRI table. Into the microwave. I concentrated on staying still and not throwing up. Out of the microwave.

I shuddered as the stretcher appeared -- this was getting old. The MRI tech had forgotten the draw sheet, so I had to scoot over as best I could. It was even more difficult this time around: I was tired, and by now even my head was pounding with the pain. I jarred my leg as I dragged it over, and a horrible wave of pins-and-needles shot from my toe to my back, knocking the wind out of me. I had to stop for a moment, stuck in the crack between the table and the stretcher, before I could finish the transfer. I ended up in a sorry heap at the foot of the stretcher. I began to hope that whatever it was was fatal.

Back to the ER. The orderly tried to chat with me as he pushed the stretcher along, but all I could do was breathe.

A nurse appeared. When he saw the state I was in, he grunted in annoyance and put the thermometer he was carrying aside. He stepped out and returned with a heavy blanket and a friend.

"Let's get you straightened up here, Dr House. Bend your knees for me, as best you can?" They took off the tangled top sheet and I flinched as the pins and needles sensation scuttled swiftly up my leg. I closed my eyes, bent my knees as best I could, and steeled myself. The nurses helped me hitch myself back up in the bed -- one pulling me up by my right armpit, the other holding my right foot. I kept my eyes closed as they straightened out the sheet and blanket. It seemed to take forever. Finally they covered me up again, leaving my right foot bare. The first nurse took my vitals and then gave me a cup of ice and a can of Shasta. He popped the tab for me; I took a couple of sips while he looked at my right foot and asked me a couple of questions about the pain. He left and I tried to drink a little more, but gave up when my stomach started to complain. Nothing to do but wait and endure.

Wilson finally reappeared. "How're you doing?"

"Never better," I whispered. "Got my discharge papers?"

He pulled a stool over and sat down. "I've looked at the films...."


"You've got some kind of mass in your quad. I don't think it's cancer, but -- "

Franklin came in. Wilson repeated the story and put up the films. I twisted around, trying to get a peek, but I couldn't see them. Wilson pulled them down and held them where I could see them while he talked some more with Franklin. I gave up on trying to make sense of the films and lay back down on the stretcher.

They were talking at me again. Wilson said something about a biopsy and drew the covers back. I shuddered violently with the cold -- I realized I had been sweating. He pointed to a spot on my right thigh.

Franklin took the films, put them back up, and gazed at them. Then he came over to my right side and put down the side rail. The rail was sticky, and he had to jerk it to get it to move. It suddenly dropped with a clang. I cried out as the impact set off the burning pins-and-needles sensation again, shooting from my toes to my neck.

"You okay? Pain getting worse?" Franklin said. I shot him the most withering look I could manage.

He stared at my leg for a moment, reached over, and drew the covers off the other leg. I so wanted to push myself up on my elbows and try to see what he was seeing, but I couldn't -- I was still recovering from that last wave. He gently laid the backs of his hands on the soles of my feet, and then pressed his fingers against the arch of my right foot to take the pulse. The touch sent off more pain and prickling.

"Must you?" I snarled.

"Okay, House, got it, the pain's getting worse. Is it different?"

"It's getting... sharper." It dawned on me what he was asking. I should have said something earlier. I was developing paresthesias -- whatever it was, it was affecting my nerves and altering their perceptions. "Burning, prickling."

Wilson looked over at Franklin.

Franklin stepped out and came back with a Doppler stethoscope. Uh-oh. He put in the earpieces and opened a package of surgi-lube. I shuddered as the ice-cold lubricant hit my foot, and gasped as the burning started again. It was getting worse every time. Another wave of burning as he touched the probe to the arch of my foot and started gliding it around, listening to the pulse. He listened for a long time and then asked me to move my foot to my right. I tried to obey, but my leg felt heavy with pain and hurt far too much to move. He picked up my foot to move it for me and I saw stars.

Another cold dollop of lube, this time behind my ankle; another gentle touch of the probe, another wave of burning and pain... was this how it felt to be electrocuted?

"Hurry," I whined. Franklin laid the Doppler aside.

"Okay, House. I know this is going to hurt, but I need to you press against my hands." He laid his hands against the soles of my feet. It was hard to feel anything through the pain. "Now, press." I screwed my eyes shut and pressed as hard as I could. "Again." I obeyed, pushing down with my feet until I couldn't stand the pain any longer. "Okay, now bend your knee." I clenched my teeth and did as I was told. It wasn't good enough for him, though; I felt him pulling my leg up further. Finally he told me to roll over onto my left side.

I grabbed the rail and pulled myself over, gripping the rail as tightly as I could; Franklin helped position my leg while Wilson held me steady. More poking, more horrible cold caustic lube, this time on the back of my knee. Ow ow ow ow -- What was he doing back there? playing Pictionary with a cautery pen? A vague memory of that Operation game -- the one where the guy's nose lights up and buzzes -- floated through my mind. I would never laugh at that poor suffering bastard again. Breathe in, breathe out, don't scream....

And then he asked Wilson to come around and listen! I started making buzzz noises in my brain to divert myself as the probe glided around. Finally they let me roll back.

"Are you really so bored that my popliteal pulse is that entertaining?" I groused weakly. "Got any med students who want a listen? Nursing students? Maybe you could sell tickets to the general public --"

Franklin ignored me and stuck two fingers on the pulse point in my groin. He looked at Wilson.

Wilson looked grim. "House... you have no popliteal pulse," he said. "Not even by Doppler."

No. Oh, no. The mnemonic suddenly came to me: pain, pallor, paresthesia, paralysis? -- the nurse holding my foot for me, Franklin moving my foot for me -- and pulselessness: the five P's of a peripheral arterial obstruction.

Franklin turned back to me. "I can still palpate your femoral pulse, but just barely," he added. "You've lost circulation. I'm calling vascular to admit you and start running some tests. We need to figure out what's going on. Fast."

part two


Anonymous sy dedalus said...

Oh man, oh man, so not fair to leave us hanging like that! So not fair! *whines* *whiiiiiiiiiines*

Love the nod to Russian literature, intentional or no. :)

The details in this update, so incredible. Feels exactly like being in the ER again--the smell of alcohol, the lights, the endless back and forth for tests, time stretching out, the curiosity/dred, the helplessness, the feel of needles & drugs. C'est magnifique!

Love the part with House on the couch ordering Wilson to round up dancers! And the snatches of dialogue later, how well they convey the situation, what's going on in Wilson's head as well as House's--the finely-placed brushstrokes that create the larger picture. Masterfully done!

And the details of daily life at the beginning--ahhh, so nice. Taking stairs. The little things. Ouch.

Now I must read again and again until the next update. Stacey....


February 26, 2005 10:52 PM  
Anonymous MoAp said...

Detail is incredible.


February 27, 2005 9:29 AM  
Anonymous benj said...

Love this - so perfect! Incredible detail and the beginning - the stairs- heartbreaking

February 27, 2005 2:06 PM  
Blogger Sanlin said...

Newsflash, Doc--you're *still* adorable (even with teeth ;-) ) and I'm glad you've started "talking back." It can only do you and the people who are important in your life good to talk/work through all of this.

I'll admit I read this, yesterday, but had to wait to 'digest' it for a day, because we're getting into it, now... Talking about the earliest days when no one, not you or your Docs, knew what was happening. Learning the details of how things unfolded, I can see, easily, how a misdiagnosis could have occurred. Sometimes things happen that aren't pleasant, good, or desirable--but they're not anyone's fault, either. Virtually everyone has to experience things in life that they'd much rather *not,* and everyone I know is "damaged" in one way, or another. But, here we are, frail and fabulous human beings, and we have to do the best we can, anyway. I think you're figuring out that you don't necessarily have to do it all *alone,* though. Not everyone is close to their biological families, but you're getting some good people around you in your life, Doc. And, you deserve that, because, beneath all the projected 'grump' and defensive maneuvering, you are an extremely good man. :-)

I understand what it's like to have limited energy and to have to live a life impacted by chronic pain or illness. Reading what you've gone through brings back a lot of memories and, 'oh, yeah--I recognize *that*' reactions. I've gone through several year periods, at different times, from car accidents and such where my existence mostly consisted of visits to healthcare/physical therapy professionals. A person never truly appreciates their basic body/framework until it suddenly *doesn't* work. LOL

So, as difficult as it must be to think about/recall all of this, thank you, Doc. More people, to varying degrees, have been 'in your shoes' than you know about. You may not realize it, but you're an inspiring and heroic person. And, I happen to *like* your sense of humor... LOL

Wishing you strength and healing as you continue your journey through some of the lower Circles that Virgil and Dante probably skirted through quite quickly, rather than applying for residency status... ;-) May your own personal 'Beatrice' find you soon, Doc.


February 27, 2005 7:12 PM  

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