I sit up in bed, take a drink of water, gulp another Vicodin, and lie back down.




"I can still palpate your femoral pulse, but just barely," Franklin said. "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."



I didn't tell Eileen how I felt the blood drain from my face.

I didn't tell her how I nodded dully at Franklin, about how Franklin asked me something I didn't hear, how I faintly heard Wilson saying something about I'll take care of it.

I didn't tell her how my stomach churned with fear, and what a bad combination that made with the nausea I already had.

I didn't tell her about how Franklin left the exam bay, how Wilson asked me a question, asked it again, saw my face, and grabbed a basin just in time. I hadn't had anything to eat since that afternoon -- all I could do was retch helplessly. The effort made the pain worse and set off the paresthesias again, setting off another wave of retching. At last it stopped. Wilson put the basin aside, gave me a cup of water to rinse my mouth, and put on the call light. I lay back and tried to catch my breath. I was vaguely aware of him murmuring something to the nurse.

He cursed as his pager went off. "I have to get this. I'll be back as soon as I can," he said. He looked at me, waiting for me to respond. Finally I looked at him and nodded, and he disappeared through the curtains. Once again, I was alone.


What was going to happen?

Was I going to lose my leg?

Was I going to lose it all the way up to the hip joint?

Where did the obstruction come from? Probably smoking, but I was too tired to get angry at myself.

Was I going to throw another clot? I found myself thinking that a pulmonary embolism -- a swift-moving blood clot to my lung -- might not be so bad. At least the pain would be over, and quickly.

And finally I wasn't able to think at all. There was nothing to think about but pain. I took a deep, shuddering breath and started bouncing my fist on the mattress again.


Voices again, murmuring outside the curtain. I recognized James's voice right away, and Franklin's after a little more thought. They were talking with a third voice.

The curtains parted. Franklin came in first, followed by another doctor wearing scrubs and a white coat. The new guy had a resident following him. James entered last.

The new guy came over to my right side. I waved weakly to keep him from trying to shake hands. He leaned on the stretcher rail. "Dr House? Hi, I'm Howard Taylor, from vascular. I think we've worked together before, haven't we?" He nodded towards his duckling. "This is Matthew Chang, my R-4.

"First, I'd like to take a look at your leg...."

I sighed. Of course. "Go ahead," I said. Franklin came over and drew the covers back. I shivered violently. The cold, and my movement, set off the creepy-crawly paresthesia; I clenched my teeth and gripped the stretcher rails so hard my hands trembled.

I couldn't stop myself, and looked down towards my legs, summoning what small part of my clinician's brain was still functioning. The second P -- pallor -- oh yeah: my right leg looked ghastly.

Taylor looked up. "Okay, Dr House." He nodded to Chang; Chang stepped forward and put his palms against the soles of my feet. His hands were cold; I bit down on a yelp. "Press down against Chang's hands, there... wiggle your toes for me... bend your knees..."

I couldn't do anything with my right leg, and my attempt to bend my knee was especially painful. Taylor was quickly satisfied.

He checked my femoral pulse. "Okay, now let's get you on your side...." I took a deep breath, grabbed the left rail with my right hand, and pulled myself over. Taylor and Chang helped me bring my right leg over. Wilson grabbed a pillow and handed it over the foot of the bed; Franklin, at my left, stuck it under my knee. I felt the lube on the back of my knee, felt the probe.... I closed my eyes and gripped the rail with both hands, breathing slowly and deeply, until it was over.

Taylor was merciful and was quick about it. He gently tissued off the lube. "Ready?"

"Let me stay like this... just for a minute," I whispered.

"Sure." He came around the stretcher and switched places with Franklin, so I could see him.

"Okay. We're going to get you something for the pain, and then we're gonna get you downstairs for duplex Doppler. After we get the duplex, we'll discuss the next step. See you downstairs." Taylor turned to leave. At the foot of the stretcher, Wilson stopped him and spoke to him in a low voice.

"Do it," I heard Taylor say -- to Chang, I guessed.

"Good luck, Dr House," Franklin added. I heard the curtains rustle.

And then only Wilson was left. He pulled up the stool and sat down.

"Don't you have any place else to be?" I asked.

"At the moment? No," he replied.

The nurse came in. "Dr House? I've got some more Demerol for you, and something for the nausea. I'm going to give you a new wristband, and then we're just waiting for Radiology to call you."

Wilson stepped out of the way and let him give the injection. The nurse cut off my old wristband and snapped the new one on. I left my hand draped over the rail -- I wasn't in the least bit interested in peeking at my new inpatient number. Wilson helped him cover me back up.

Wilson sat back down after the nurse left. "I'm going to have to go back upstairs soon."

I just nodded. The pain was still getting worse, and it was hard to talk.

"Listen... do you want me to take your stuff? Your clothes?"

"Yeah. Thanks. They should all be in that bag back there. Wallet and keys too. Just... just stick 'em in my office."

"I think I'll stick them in your living room, if you don't mind."

"Fine, whatever. Just stay out of my beer."

Wilson chuckled a little. Then he rubbed the back of his neck and looked back up. "Listen... do you want me to call anybody for you?"

"Call anyone? I think Pasternak's already figured out I'm not going to be in tomorrow."

"No. I meant like your family. Do you want me to call your mom? or your brother?"

"No. No, that's okay," I said. "I... it's late, and... no, I don't want to bug them. It's okay."

I saw him giving me a look. I lifted my head off the pillow and gave him the best glare I could. "It's OKAY. I'm FINE. Let them be."

Wilson smirked.

"What's so damn funny?"

"Nothing," he said. You, his eyes added.

Whatever. I dropped my head back down to the pillow, closed my eyes, and let my brain idle for a bit. Wilson pulled some index cards out of his coat pocket and started to write....

Something jolted me -- alert? awake? had I fallen asleep? My right hand certainly had, from where I had draped it over the rail. I snarled and started to bang it against the rail, which of course set off all the other pain. Wilson looked up.

"Hey, what time is it?" I asked. As soon as the words were out of my mouth I realized that I was still wearing my watch, and that if I had lifted my head I could have seen the clock on the wall.

"Ten-twenty," James said. "Looks like that antiemetic's doing some good."

"Well, that's about the only thing. Here, take my watch."

"Sure."

I fumbled with the buckle and, after a couple of tries, got the watch off. Wilson took it and put it on his own wrist.

The nurse stuck his head in the door. "Dr House? Radiology's here for you."

Wilson stepped out, while the nurse helped me sit up so I could pee. My head pounded with the motion.

When I was ready, the nurse rolled me out of the bay. No switching of stretchers this time, but the nurse-sadist wouldn't let his precious pillow leave the ER, so I was slumped on my back again. Wilson picked up my stuff and walked with us as far as the elevators. The orderly pushed the button.

"Okay, House. Page me if you need anything," Wilson said.

I nodded. The doors slid open. "Thanks," I whispered. "And stay out of my beer. I mean it."

He smiled as I was rolled into the elevator. I looked back out as the doors started to close. His smile abruptly fell away the second before the elevator doors slammed shut.

The doors opened again, and we rolled out into the basement corridor. It was dark and quiet. At this time of night, the ER used a satellite room or portables for their x-rays; only serious emergent cases went to main Radiology.

Into the Doppler studies suite. I saw Chang, the resident; he'd gathered up another couple of ducklings from vascular's flock. Great. I'd become an "interesting case" -- a teaching moment.

The operator started saying something to me: Dr House, hi, I'm Keisha. I'm going to need to see your leg.... I nodded and braced myself. The covers going back, the cold, the shivering, the burning and prickling, the burning cold conduction gel -- all over my thigh, behind my knee, over my feet....

I clenched my teeth until my jaw muscles were sore. I was sweating again. I found myself being almost grateful for the pain -- it was helping me keep paying attention to the sounds of the test, from wondering what it was showing. The screen was turned so I couldn't see it. Chang stook behind the operator, staring at the screen; he spoke only to her, and she spoke only to give me directions. I couldn't tell whether their reticence sprung from mercy or fatigue. The residents were silent.

Finally, the test was over. One of the residents grabbed a printout and scurried out of the room. The operator started to wipe the gel off my leg, but I begged her to just leave it, to leave my leg alone. She looked up at Chang. Chang shook his head. "I'm sorry, Dr House, we need to get that gel off. I'm waiting for Dr Taylor to call me back, but I'm pretty sure -- " -- the other resident stuck his head in the door -- "Yes. Dr House, Dr Taylor's ordered an arteriogram."

I started asking about the Doppler, but Chang stonewalled -- he obviously wanted to wait until Taylor was there. Fine. I didn't have the energy to fight.

They rolled me into a holding area. A nurse came in, carrying an armload of supplies. "Hi, Dr House, I'm Stephanie. I'll be getting you ready for a-gram. It won't take long, they're setting up for you now."

She flushed my IVs, hung a new bag of saline, and stuck new EKG patches on my chest. Then she picked up the next item in the pile -- a urinary catheterization kit. I made an annoyed grunting noise. She shrugged apologetically. "Yeah, I know. It's pretty standard down here -- you're going to have to lie flat for a long time and this'll be much more comfortable for you."

I made an if-you-must face. Whatever. She slowly lowered the head of the bed -- I gasped before I could stop myself -- and adjusted the pillow. I braced myself for the pain and burning as the covers went back again. I closed my eyes and listed to the rustle of the sterile drapes and the snap of the glove wrapper. "Okay, this is going to feel weird," she said. I gasped as she started -- no kidding. But it was over quickly. She taped the tubing to my left thigh; I felt it get warm as my bladder emptied again. She finished gathering up the trash and stepped to the door. "Ready?" she called. "Okay."

I didn't tell Eileen anything about the arteriogram because they gave me some blessed sedating substance and I don't remember much about it. The radiologist introduced himself, but I immediately forgot his name. They stuck the first needle into my groin -- that was just the local. Then came the really big catheter.

They squirted dye through the catheter and took pictures of it going through the arteries in my leg. A lot of pressure as they positioned the catheter; a sore back from lying flat on the hard table... there's a lot to be said for amnesia.

I came back to myself in the holding area. Stephanie was sitting next to me, charting.

"Hi, Dr House. How are you feeling?"

It took a minute for me to digest the question and come up with the surprising answer: "Not so bad."

"Glad to hear it. I don't know if you remember, but we hit you pretty hard--"

"With a mallet?"

"Oh yes! And Versed and Demerol, too. We want to keep you comfy, so let me know if the pain starts coming back. Dr Taylor's reviewing your films right now and he'll be in to talk with you in a few minutes. But remember -- you've got to lie flat. You still have the catheter in your leg. We've put a... reminder on your ankle, to help you remember."

I craned my neck to look. Sure enough, they'd used a soft restraint to tie my ankle to the bed frame.

Taylor came in, empty handed. I wasn't going to be allowed to look at my films.

He sat down beside the stretcher. "Well, it's a clot... It's in your femoral artery, close to one of the branches.

"I want to leave the catheter in overnight and treat with thromobolytics, try to break up the big clot and any little ones that might be trying to form in there. You'll have to lie absolutely flat, but we'll try to keep you as comfortable as we can. Now that a-gram's over, we can be a little more liberal with the Demerol, and I'm going to write for a sleeper once you get up to the floor. We'll take you back to a-gram in the morning."

I couldn't manage much in the way of intelligent questions, especially since I couldn't see my films, so once they were satisfied with my recovery and with the appearance of the cath site, I was rolling back upstairs. It was past midnight.

As we rolled onto the darkened step-down unit, I was greeted by a petite, wiry, impossibly young-looking nurse who introduced herself as Denise. She helped the orderly transfer me onto a regular hospital bed and hooked up the catheter to a bedside monitor. She peered at the waveform. Another nurse came in and hooked me up to a heart monitor. Together they double-checked the connections, the saline, the bag of thrombolytic medicine.

The second nurse set up a bedside table on my right hand side with a box of tissues, a cup of ice chips, and a spoon. Denise came back with a cup of water and a medicine cup. I peeked inside and recognized the diazepam. Cool. I tossed it right back.

For the rest of the night I drifted in and out of a light, fitful sleep. Denise was as quiet as possible, but she was in and out of the room constantly, checking the cath site, getting blood pressures, looking at the monitors. The pain started to come back after a while. She was quick with another dose of Demerol but it wasn't enough, and every time she did her hourly check of the cath site, the paresthesias kicked up a little more.

I dozed again. When I opened my eyes again I saw James sitting at the bedside. He'd changed into scrubs. He looked asleep, so I didn't say anything, but then his eyes opened.

"Hey," he whispered. "How's it going?"

I shrugged. "Aside from the IV Drano, not too bad. What time is it?"

"Go back to sleep," he said.

"What time is it?"

He checked his watches. "Three-thirty."

"Don't you have sick people to visit?"

"I do a better job sedating my patients than the vascular service seems to do. Although considering your baseline, Taylor's no slouch. He should give Pasternak some tips, maybe slip some Versed into your morning coffee."

I tried to come up with an appropriate retort but couldn't -- a wave of pain knocked the snark out of me.

He stood up. "Go back to sleep. I'll see you in the morning after rounds. Page me if you need anything."

I wasn't able to get back to sleep. I tried looking for something on TV but the choices were dismal -- I had to settle for CNN with the sound off. It certainly added a new dimension to the viewing experience. I found myself wondering if Larry King was able to catch flies with his tongue. The pain was starting to get as bad as it had been in the ER.

Denise came in about half an hour later and found me staring at an infomercial. "Hi, Dr House. How are you doing?"

I shrugged.

She started going about her checks. She drew back the covers to check the cath site; I sucked in my breath as the pins-and-needles got worse. "Having any pain?"

I steadied my voice. "Yes."

Her pen flew over the clipboard. "Pain rating?"

"Five --"

"Five?"

"Okay. Six. No, seven."

"Ready for more pain medicine?"

"Sure. "

She finished writing. "I'll be right back."

And she was, but by the time she got back the pain was up to an eight. She gave the Demerol intravenously. There was a rush of relief, but it didn't last long. The pain started coming back quickly, quickly.

The next time Denise came, she found me sweating and gripping the bedrails. The pain was now as bad as it had been in the ER, and the paresthesias were going full tilt. She checked the cath site, paged Chang, and helped me change into a fresh exam gown -- and into a second one when, nauseated from the pain, I retched all over the first one. Another nurse came to help her. They changed the pillowcases and put some pillows under my arms and my left knee. Chang came to see me and prescribed another hit of Demerol with an antiemetic.

It didn't last. I started to feel sick to my stomach again. I saw another nurse in the hallway and managed to call out to her. She rushed in just in time to hand me a basin.

The night shift was coming to a close. Denise came in, made her checks, and swiftly wrote her numbers. She emptied the Foley bag, got out a calculator, and started to add up my ins and outs.

"Dr House, it's around five-thirty. I've paged Dr Chang again; he's going to be here soon with the vascular team."

I nodded weakly.

"Pain rating?"

"Nine."

"Nine?"

"Make it a ten." Oh, hell, twenty, why not.

I closed my eyes and started bouncing my left fist against the mattress. The pain was getting even worse, and I was starting to sweat again. I could hear the unit starting to wake up -- the clatter of carts and clipboards as the nurses got ready for rounds, for their own report, for the breakfast trays. I could tell that they'd turned the hall lights back up. Someone was making coffee -- my stomach turned even as my nose woke with delight. It was so damned cheerful. I wished Denise would shut the door but there was no use asking -- she needed to be able to hear and see the bedside monitors from the hallway.

I heard Denise's quick footsteps again. I braced myself for whatever peek or prod she needed this time around. But it didn't come. "Don't mind me, Dr House," she said, "I just wanted to look at something, that's all." Her voice seemed to be coming from the floor; she must have been checking the ankle restraint.

Voices outside the door. I peeked out and saw Chang, Denise, and Chang's gaggle of residents and med students. Chang, Denise, and a duckling came in. As they came in, Denise snatched a pair of gloves for herself and a pair for Chang. They came over to the left side of the bed and knelt down.

"What's up?" I said. I tried to get myself up on one elbow but couldn't do it.

"I just wanted to talk with Dr Chang about your I's and O's before rounds," Denise said. "Please, Dr House, I know you're in a lot of pain, but please try to relax."

Did they not know I was also a nephrologist? Apparently not. I heard a crinkle of plastic, a quiet splash. They were taking a urine sample. "What's going on?" I asked, more loudly this time.

"Your output isn't where I'd like it to be," said Chang. "With all that dye last night, I just want to send a urine sample down. " Denise had her back turned as she bagged the sample. Chang produced a tourniquet, some blood tubes, and an R-1. "We'll just get your morning labs while I'm here, it'll save them some time in Radiology." As the resident tapped a vein on my hand, Chang started giving Denise orders: CBC, Chem-12, type and cross, PT/PTT....

She left for a moment while he drew the tubes. When she came back, she had the order slips and stamped labels ready to go. Chang labeled the tubes and dropped them into the carry bags. A med student in a short coat stepped in, took the bags, and vanished.

"Okay, Dr House, I'm going to call Dr Taylor now and see what he wants to do about your discomfort. I'll see what I can find out about arteriogram this morning, too."

Fine. I found myself getting irrationally impatient with the residents. I figured I'd see them after breakfast.

Instead, Denise turned back up about fifteen minutes later. "Dr Taylor just called. They're going to take you to a-gram first thing, they're going to try to get you in about twenty minutes." She started bustling around. "Just in case you don't come back up to us, does someone have your clothes and your valuables? Yes? Okay."

She was back about twenty minutes later, accompanied by a short, plump nurse wearing little round eyeglasses and fresh makeup: the day shift was starting to arrive. "Hi, Dr House, I'm Liz," she said. "I'm the charge nurse on the day shift this morning. I'm just helping Denise get everything ready." She took a long look at my Foley bag before she went back to writing in my chart.

In came the stretcher. Liz shoved some furniture out of the way while Denise raised the bed and undid my ankle restraint. Denise got up and knelt on the side of the bed, holding up the draw sheet; Liz stood by my feet, and the orderly stood on the far side of the stretcher. Denise counted -- one, two, three -- I clenched my teeth, and in one smooth, decisive motion I found myself on the stretcher before I could yelp. Liz grabbed the Foley bag and hung it off the edge of the stretcher, but she wasn't quick enough -- I caught a glimpse of what everyone had been gawking at.

Normal urine, of course, is a nice pale yellow color. If you don't drink enough, it turns deep orangey yellow; certain drugs, dyes, and vegetables can turn it all kinds of exotic colors, like orange, greenish, or even blue. And those can all be perfectly innocuous colors.

The stuff in my Foley bag was the color of coffee. And that is not an innocuous color.

I caught Liz's eyes. I know, they said. And now, you know too. But now is really not a good time to freak.

"Good luck, Dr House," she said, slowly and deliberately. "Come back to us soon."

The orderly rolled me out into the hall. Liz went back into the room, bringing a hamper with her; Denise walked with me down to the double doors.

"Haven't you seen enough of me?" I asked.

"Nope. With that cath in your leg, I'm taking you down to Radiology myself."

We rode down in silence. The doors opened and we set off down the bright, busy hall.

As we approached Radiology, the orderly hit the switch to open the doors. They didn't open. He grumbled something profane and went ahead to pull them open. I heard a familiar voice -- Taylor's. I turned my head and saw him in the hallway, in deep conversation with another doctor over a single sheet of paper.

"Hey," I said.

The two doctors looked up. "Good morning, House," said Taylor. "I'll see you inside in a quick minute. "

The other guy was a tallish, red-haired guy in scrubs. He nodded, and I realized I'd seen him before. But where? The pain was so bad, it was difficult to remember my own name, much less some other random doctor's.

The stretcher started to roll forward and I lost sight of them. As we headed down the hall towards holding, I remembered where I'd seen him before: in the morgue. MacTierney, that was his name. A pathologist. A pathologist who, this morning, had felt the need to venture out of his cave and personally deliver lab results to an attending physician, instead of just sending them up in the tube.

Were those my labs?


I was so screwed.



I listlessly said goodbye to Denise and hello to the new guy, a nurse named Mike. I didn't care anymore. The pain and burning was all I could think about. All I wanted was to not scream and not throw up. The thought of a pulmonary embolism drifted through my mind again. One swift clot and the pain would be over. Forever.

Over to the table. Sweet relief as the sedation hit and I started to drift, barely tethered to the table by the pain and the creepy-crawly burning and the pressure in my groin as they manipulated the catheter. The hot, bright lights; the looming presence of the cameras. The team worked in almost complete silence.

And then I was back in holding, with Mike standing to my right, applying direct pressure to the cath site.

Taylor came in and sat down on my left.

"Well. Um... You saw what was in your Foley this morning?"

My eyes narrowed. "Yes, I saw it. Nice of your team to finally play straight with me."

Taylor let it pass. "Your a-gram this morning... we did not have the... success we would have liked with the thrombolytics. We made some progress on the big clot in the femoral artery, but there's a clot wedged into one of the branches of the circumflex that we weren't able to do anything with. You're spilling myoglobin into your urine -- the muscle in your leg is dying.

"We're out of time. I want to take you straight to the OR for an embolectomy."

As Taylor produced the consent forms, he explained that he didn't think it would be necessary, but just in case, would I please sign for possible amputation of the right lower extremity as well? And of course, that meant an additional three forms giving the hospital permission to dispose of the amputated limb.

Mike held the clipboard for me as I signed the consent forms, one after the other, and then turned it over and signed his own name as a witness.


I didn't tell Eileen about the fear and despair I felt rolling down the hall to the ER. I didn't tell her about lying in pre-op, feeling the familiar horror of the pain coming back again, blowing past the meds they'd given me in Radiology. I didn't tell her how weak and defeated I felt, how I wished I were upstairs on rounds, stomping around with a bagel in my pocket, instead of getting ready to go to sleep to possibly wake up with my leg gone. I didn't tell her how I longed to curl up in a fetal position, and couldn't even do that for fear of hurting the cath site and provoking the pain even further.

A voice in my ear. "Dr House, you have visitors." I looked over and saw Pasternak standing next to me.

"Dr House... Gregory... I am so sorry. SO sorry." He looked away. "It's a damned shame. But I talked to Taylor, he's optimistic." He smiled. "Next fall, that 10K is yours for sure."

"Thanks," I muttered. He stuck out his hand and I listlessly shook it. "Oh -- tell Dr Nussbaum -- "

"Don't worry, I've got your briefcase," Wilson interrupted. "I'll give him your papers later this morning."

Pasternak babbled a little bit more and finally left. Wilson sat down next to me.

He was silent for a while before he finally spoke. "I'm taking a couple of days off. After you're settled, I'm going to go home and get a little rest, and then take your stuff over to your house. Then I'm going to drink all your beer."

I smiled weakly. "Then what? You'd better not ralph on my rug."

"No. But I might not drink all your beer either, in case you need me for anything."

"Like what?"

"Like, I don't know, running out for Jello. Just let me know if you think of something."

"Okay." This conversation was going somewhere and I had no idea where that somewhere was. A wave of pain was coming fast and I really didn't have the brain cells to try to figure somewhere out.

He swallowed and tried again. "Is there anyone you want me to call?"

I couldn't think of anyone -- I couldn't think at all. I clutched the stretcher rails as the pain hit its crescendo. It finally peaked and started to fall off. James quietly, patiently, persisted: "Greg, Greg, your family. What about your mom? Do you want me to call your mom?"

"No!" I croaked, "no -- it's okay--"

"No, Greg, you're sick, you are sick as crap. She needs to know. Greg, let me do this for you. Do you have her number with you?"

"Wallet--"

"It's in your wallet?"

I nodded and held on as another wave came. Wilson looked grim.

Finally I relaxed a little. "Okay," he said, "I'll call your mom. Don't worry, I'll take care of it."

The nurse came to roll me into the OR. Wilson walked with me as far as the double doors. "See you on the other side. You're almost there."

I met his eyes, and the doors swung shut.

I saw the OR nurses laying out the supplies, pairs of bright eyes over their masks and under their caps. Another pair of eyes appeared and sat down next to me.

"Dr House? I'm Valerie. I'm the nurse anesthetist who'll be working on Dr Taylor's team today...." She ran through her list of questions, and then turned to the table behind her. She picked up a syringe and flushed the IV port on my right hand.

She picked up another syringe.

"Okay. You're going to go to sleep now...."

part three