Eyes Wide    The House Fan Fiction Archive	 Home

 Quicksearch
 Search Engine
 Random Story

 Upload Story

      	

  Eyes Wide 
 by Tamarak  

 "Eyes Wide"

House had just been walking by, pondering how to get out of clinic duty
the rest of the afternoon. The ducklings had all gone running off to
answer a big MVA, truck jackknifed on the interstate, massive pile-up, so
he'd decided to loosen up his leg by walking around for a while. He was
sure Cuddy'd be helping in the ER, too, so she wouldn't notice his absence
from the clinic for at least another hour. So, there he was, walking his
leg loose, away from his usual haunts, when a code alarm went off, in
post-op, a few feet from him as he was passing. Hospital policy required
medical personnel to respond, but he wanted to keep going. He hated codes.
He didn't used to mind them; at one point, he'd even enjoyed the
challenge. But now they took too much energy, put too much stress on his
leg if he had to put aside the cane, too many people around bumping into
him, too much touching people. He glanced in, just in time to see the
nurse jump back and the patient lurch on the table beneath a doctor.
Correction. Crap. Short coat. Med student. What the hell was a med student
running a code for? The nurse seemed to be trying to say something, but
the med student was having nothing of it.

He stepped into the room and looked at the patient. Going gray from pink,
female, mid-forties looking, bruises on her face, left arm set, probably
with a pin, surgical bandage on her abdomen, bruised chest exposed with
two bright red burns from the paddles. No central line, but she had a
BP/O2 sat probe on her right index finger. And her hands were bruised from
some sort of fight. Obviously, she'd lost.

The med student yelled "clear." Yelled! He was panicked. No good yelling.
No point in such a small room, anyway. He was almost as gray as the
patient.

"Wait," House interrupted. The student stopped, turned around. He looked
relieved to see someone else in the room. "You have more time than you
think. You just called the code?"

Now House looked at the monitor. Tachycardia, BP high and rising. She was
making pressure, so why'd the med student shock her? Her blood sat was
low. Well, yeah, that breathing thing, after all.

The med student blithered, "Yes..."

"So, we've got plenty of time." Plenty if you measure in seconds. The key
is to slow time down, observe, think, put things together. Figure out why
the patient's body is doing what it's doing.

"A.B.C.," House said, as much for his own benefit as the student's.
"Airway. Breathing. Circulation." No good starting the heart if the
patient weren't breathing. And this one isn't. He moved to her head. No
movement. Eyes wide open, pupils blown, fixed. Crap. Not good. She was
losing color, getting grayer. House leaned his cane against the head of
the bed. He felt time slowing down for him as he focused.

"She's still making pressure, but not for long." He looked at the nurse,
young, but not panicked. She'd be steadier than the student. "Let's start
an airway." The nurse had a kit ready, handed him the laryngoscope, put
the stylet into the tube. She also jotted some notes on the front of her
scrubs. Good, House thought, at least she knows her job.

"Just down from surgery? What's she on? What was the surgery for?" 

The med student pulled himself together; history, he could do that,
"Atropine... her BP was next to nothing, now it's through the roof. And
Nimbex, 10 mg, IV, to sedate her before the Atropine."

"And Ringers, grav drip," the nurse added in. 

House nodded; surgeons love Ringer's. He opened the patient's mouth. No
movement, no resistance. Where was respiratory? Why hadn't the surgical
resident answered the code yet?

He spoke to the patient, "I'm Dr. House. We're going to put a tube in your
throat to help you breathe." It was training, old training which he rarely
bothered with these days, communication, in case she wasn't under too
deeply. If she was, just a few wasted words. If her dilated eyes meant
anything significant, it was all a waste anyway.

The student continued, "Broken arm, set with a pin. And exploratory on the
abdomen. She took a pretty good beating. Home invasion rape, from what the
cops said."

House used one hand to pass the laryngoscope into the patient's mouth and
leaned over so he could see the cords; with his other hand, he added a bit
of cricoid pressure to move the trachea and close the esophagus. He
slipped the tube in and down, gently, then pulled the stylet back out. The
nurse handed him the bag; he inflated it slightly, then let it go. The CO2
indicator turned yellow. CO2. Good, he'd gotten the trachea. He moved the
tube to the 22 cm marker, inflated the cuff, and held the patient's jaw
there while he started bagging, trying to keep the rhythm steady, not push
too much air in, nor too little. He could feel his own heart racing. A few
seconds had passed, but time was running slowly for House now.

There'd been a series of home invasion rapes over the past couple months
in the area, but House didn't remember hearing about any victims needing
hospitalization for injuries. This one must have fought, and lost.

"Bradycardia? And now she's Tachy?"

The student looked confused.

"Analgesic?"

"Nimbex, I just said," the student answered.

"15 mg Morphine." House looked at the nurse, who nodded and responded
quickly. "IV, fast." The pressure of standing on his leg suddenly
nauseated him.

He kept bagging, one hand holding the patient's jaw. He looked down at
her, hazel irises barely visible around dilated pupils. Probably the
Atropine. He hoped so, because if not, bad news. Her eyes were fixed. No
blinking, no movement. She was looking, but she wasn't looking at
anything. He wished he hadn't left his office, hell, his bed that day. He
felt sick.

The med student protested, "She's a junky, you can't give her Morphine."
He pointed to a line of light colored scars on the inside of her right
arm. Impressive, House thought. Observant student. At least he'd noticed.
He hadn't caught it all, but he'd noticed. The scars were small, clean.

House nodded to the nurse, who was hesitating at the IV. "Give her the
Morphine. What's her name?"

The med student hesitated, but the nurse spoke up, "Katherine Reynolds."

"Ms. Reynolds, this is Dr. House again. We're going to give you some
different medicine for the pain." He kept his voice even. The patient was
pinking up at least. He noticed the pain in his leg again and wished he
could reach down for a Vicodin. He wished he could have some of the
Morphine, actually. He glanced at the monitor long enough to see the blood
sat was slightly better.

He watched the nurse start injecting the Morphine into the IV tube, spoke
quietly near the patient's ear. "Ms. Reynolds, we're giving you the
medicine now. It should help pretty fast." He wondered what she was
thinking, something between terror and worse. His leg spiked pain. He kept
bagging evenly, counting.

House glanced up at the student, who looked confused, asking "Patient left
or right handed?" 

He looked back at the patient's face again before speaking to the student,
"It's winter, so no watch line. But look at the second finger on each
hand. Where's the writing callous?"

The student looked at the patient's hands. "Right hand," he said, sounding
half guessing.

Another nurse came in, brought the ventilator over. House straightened
painfully as she connected the tubes, attaching them to the ventilator and
releasing him from the burden of bagging. He picked up his cane again. He
watched the first nurse push the Morphine slowly into the IV tube, and
began to explain to the med student, "So, she's right handed, and has a
series of nice, tiny, well-healed needle scars on her right arm. The
problem is, it's really hard to inject yourself with your left hand if
you're right handed. So, someone else did it. But no pitting from
infections, so someone's been careful with those needles." He stopped for
a beat, giving the student a chance to get it while he found his cane
again.

"Nice vein, too. Same one, repeatedly. And they look like years of scars.
Junkies don't get years of scars looking that neat. Feel the scar tissue
on the vein." House watched the monitor; before, when he'd had his hand on
the patient's throat, he'd felt her pulse, but now he depended on the
monitor. The heart rate was going down, BP too. A minute in and the
Morphine was doing its work. Blood sat was fine, now. The crisis was over.
He looked at the EKG; the heart rate was still fast, but the QRS was
normal, no damage visible that way. He backed away from the patient a bit,
giving the nurses room to work.

The student felt the scar tissue, but still wasn't making a connection.
He'd calmed down, though. He was starting to think, and he'd pinked up,
now, too.

House gave the punch line. "Blood donor, probably. Use the same vein all
the time, clean needles, no infection. Makes a line of scars like that. If
so, means she's fairly clean on general health, too." A good story was
like a joke; you built up, and then got the pay off. Not a great punch
line here, but it would make sense of what the student was seeing. It
didn't really have to be right, either; that's the beauty of a good story.
It doesn't have to be the truth in any way; it just has to make enough
sense of the situation. He didn't really care if the patient were a
Morphine addict; he'd have given her Morphine even if he were sure of it.
But he couldn't tell the student that.

Finally a resident showed up. The heart rate was fast, but not badly so,
and the BP was dropping into normal range. The resident looked bored.
House felt time moving back to normal speed. He gave his orders, "Get a
central line started, and get radiology in here to check the tube and the
line. When you get the line checked, start a Morphine drip at 100 mg an
hour, then titrate. And start Mannitol until you can get neuro in here to
do an assessment." More residents showed up, and another nurse. House
moved further away from the patient, glad to be free of physical contact,
and turned back to the med student. The residents took over the work,
starting the line, doing the chart work. They had it under control now.
"And treat the burns with a topical antibiotic."

Teaching time now. He looked at the student and nodded him away from the
patient; they moved to the far end of the admittedly small room.

"So, what happened?" House moved his cane to his left arm, found his
Vicodin bottle, and took two. Then he leaned on his cane with both hands
to give his right side a needed break.

The student pulled himself together a bit to answer, "Well, we brought her
down from the OR, and everything was fine; then the residents got called
down for an MVA. She was fine. We were getting her settled, I had the
nurse give her some more Nimbex, and then all of a sudden her BP started
dropping like mad, and... I gave her Atropine. And," the student groaned
and swore, "I shouldn't have shocked her. She was still making pressure.
But I did, and then BOOM, she was tachycardic and her BP shot through the
roof. Then you came in."

House nodded. "Ever noticed how the OR is cold as a witch's tit?" He loved
a simile. This wasn't a great one, but it had a nice rhythm, and it was
good enough. House felt himself relax again. He could teach even if he
couldn't stand touching a patient or being touched. He liked language,
liked figuring out how bodies work and putting it into language. If you
could make up a good enough story out of the situation, the student would
be able to picture what was happening. Of course, the real beauty was in
the story most people couldn't make sense of, the elegance of the chemical
reactions, the intricacy of how Morphine interacts with body chemistry,
a-binding in the nervous system, hepatic metabolism, and then renal
osmosis.

The med student looked slightly shocked, but said, "Yeah, cold."

"So," House began telling the story, not the one he really wanted to tell,
the one about the beauty of chemical interactions, but the one that would
help the student understand what had happened, "you take a patient in
there, open her gut, look around, expose it to all that cold air, and as
her temperature drops, all her blood vessels constrict. Natural reaction;
keeps people alive in cold weather."

House glanced at the patient. She'd pinked up to normal color now, but
still wasn't moving. Even across the room now, he could see her pinprick
pupils showing that the Morphine was working.

House continued, "And then you bring her into a nice warm room, put her in
a warm bed, and those same vessels start to dilate. At the same time, her
blood's going to the sites of injury, her gut and arm. Remember, blood
pressure's got three components, volume, pump, and squeeze. Volume's all
the blood in there, pump's the heart, and squeeze is the relative
constriction of the vessels. So, the vessels open up, less squeeze, more
area for the volume of blood, and at the same time, the body sends blood
to injured areas, so her BP drops. The heart tries to make more BP, so it
pumps faster, and you see tachycardia. If you know it's coming, and you
should," House warned, "you warm her up slowly and push some IV fluids.
That makes more volume take up the space the vessels give you and the
heart doesn't need to beat faster to make up the pressure."

The student said, "I know this. I just..." He shook his head.

"If you think in terms of seconds, you have a lot more time than you think
you do when you call a code. Three minutes, that's 180 seconds. You can do
a lot in that time. You want to make sure you do it right, and you do that
by thinking about what's happening and why." House paused, and shifted
back, starting a new chapter of the story, "Ok, so then you gave her the
Nimbex. And Nimbex does?" House waited for the student to make the
connection. He raised his eyebrows and watched the student, hoping for a
sign he'd learned something in a semester of pharmacology.

Some people thought this was the Socratic Method. Bunch of crap, thought
House. Socratic Method my ass. It's 20 questions. He knew the answer, the
student knew he knew, and the student would try to think of the answer
House wanted, not the real answer, necessarily, or the truth, but the
answer House wanted. He liked telling stories better than pretending to
play Socrates, but he ended up pretending to play Socrates sometimes just
because most people were so much slower at putting two and two together
than he was.

The student started uncertainly, "It's a sedative. So, oh, God, that would
depress her breathing."

"No and yes. It will depress her breathing, or, in this case, pretty much
stop it altogether." House paused for effect, and shifted weight away from
his right leg. "But it's not a sedative. It's a paralytic. It has no pain
killing, and no sedative effects at all. It just paralyzes you. You can't
move, but you're awake under there."

The med student finally put things together, and turned pale. "So, she was
awake."

"Yep," House moved back into story mode to explain, "You saw the drop in
blood pressure, thought she was going bradycardic, gave her the Atropine.
Meanwhile, she was waking up from whatever Anesthesia gave her for the
surgery; she couldn't move, but she could feel the pain. First, there was
the post-operative pain, not huge, perhaps, but plenty scary, especially
if you can't move. So, you had a drop in blood pressure from vessels
dilating, and the heart starts to beat faster to keep blood circulating.
Add in the post-operative pain, the heart starts going faster. Add fear,
and adrenaline, and the heart goes nuts, and blood pressure rises. Enough
pain, and the heart begins to go so fast it will kill itself. And her."

The student interrupted, voice horrified, "And that's when I shocked her.
70 Joules on the biphasic machine... Oh, god, I can't imagine how that
felt."

House could. He dropped his head, tired, "I wouldn't ask her." He took a
deep breath. Nasty to think that being raped probably wasn't the worst
part of her day. The only useful thing to do at this point was make sure
the student learned something from what he'd done. Now that the student
could tell the story, he'd understand the way the body worked a bit
better. He wouldn't really need House to tell him more. But House wasn't
ready to stop yet. He hesitated, glanced at the patient again. Everything
moving back to normal, apparently. Foreman walked in, looked surprised to
see him, and went to assess the patient.

"Don't be afraid to medicate for pain. Even were she a junkie, she's going
to die faster from the pain than from the Morphine we're giving her. And
we can wean a patient from Morphine when we have to. It's not fun, but we
can do it a lot more easily than we can get someone a new heart."

The student nodded, now horror had fully replaced panic and he'd lost
focus again. House needed to bring him back, help him process and learn
from the experience. He started a new story, one that would help the
student think ahead next time, "Now, we gave the patient Morphine, her
heart rate and BP came down. What else do we need to think about?"

The student looked up at him and started to think out loud, processing.
"Well, you got an airway, Morphine, she started to get some color.
Fluids?"

"She's going to need some fluids. You want a resident to start a central
line so you can get whatever you want in fast. But first you need to
figure out where her ICP is, and keep it down. So start Mannitol and get a
neuro consult. If she got beat up, she could have some bruising. If she
does, and she's had a really high bp, you can get brain swelling. You
don't know until you get a bolt in there or neuro clears her. Mannitol
will dry her out a bit, help prevent swelling."

House edged left slightly to where he could watch Foreman work. The
patient was moving a little now, responding to Foreman's orders, though
hesitantly. Her eyes followed Foreman's hand as he moved it in front of
her. House winced when Foreman squeezed her right pinky against a pen and
asked her if it hurt. She tried to move her hand away, and she had tears
in her eyes. Her mentation looked good so far, which meant the Atropine
had dilated her pupils. That was something, at least. If things worked
out, she'd recover, not too much the worse for her experience in here. And
maybe the med student wouldn't be raked over the coals. House wouldn't
mind raking the charge resident a bit, but he didn't much like surgeons
anyway. Anyway, this particular student would never under medicate for
pain. House found that satisfying. It might be a valuable mistake if it
taught the student to take care of pain well.

The original nurse had written up the chart, and handed it to House for
his signature on his orders. He signed, and handed the chart back to her
with a nod of appreciation. It was all he could muster to acknowledge that
she'd done a good job.

He turned back to the student. "Last thing. If you shock someone, check
for burns, and treat them. You don't want an infection biting you in the
butt." He turned and hobbled off, feeling as if he'd been beaten up
himself. He'd have had a less miserable time in the clinic.

 -* - * -

It had taken almost a week for the surgical attending to get in touch with
him about the code. Not surprisingly, they'd agreed. The med student had
potential, and would learn from the experience. It was a teaching
hospital, and they'd done some teaching. The MVA was a pretty unique
situation; the ER had needed all the help they could get from the
residents. And the hospital code system had worked the way it was supposed
to: a senior doctor had stepped in, run the code, and the patient was
recovering. She'd be little the worse for wear. No need to write up a
disciplinary report or involve the administration. House was glad not to
have to write a useless report, and doubly glad not to have to waste his
time with the disciplinary committee. It had been a remarkably quick,
painless conversation.

 -*-*-

House looked up at the sound of knocking on his door to see an orderly
with a woman in a standard issue robe. He didn't recognize her, but he
recognized the tightness around her eyes, a tautness of skin. He signaled
the orderly to wait, and looked back down at the computer screen for a
moment to save his GraveDigger fan fic. When he looked up, he saw the
orderly pat the woman on the shoulder lightly, and walk away. The woman's
reaction, not pained, but expecting pain, struck him. He picked up his
cane from where he'd left it hooked on his desk and got up, limping to the
door.

He opened the door and stood in it, leaning against the glass, making sure
the woman in the wheel chair would need to move back, and making sure she
wouldn't have room to start rolling into the room. She reached down,
awkwardly, and rolled herself backwards a few inches. House raised his
eyebrows and waited, watching her.

"Dr. House?" the woman asked, or not. It wasn't quite a question, and she
was sitting in front of a door with his name painted across it. He waited.

"I'm Kate Reynolds," she began quietly. "You," she hesitated and started
again. "There was," she stopped again, frowned, and started again. "You
gave me some Morphine."

An interesting approach, thought House, remembering where he'd seen the
woman before. No more bruises now, just that tightness around the eyes,
fear, tension. Now he also noticed a stiffness in her posture as well. He
waited, fidgeting with his index finger on his cane, feeling the texture
of the lacquered wood.

The woman continued, "They're checking me out this afternoon. But, I
wanted to ask you about the Morphine. There was pain..." She stopped
again, and started. "I'm, I don't know, but the pain... I remember your
name, and the Morphine."

She thinks I know, House thought. Because of the Morphine, because I made
her pain stop for a time, she thinks I know. She wants me to tell her that
she'll forget the pain, that nothing will ever hurt that much. She wants
me to make sense of it for her. He felt his mouth work, wanting a Vicodin.
He could enjoy the irony, but bitterly. I only know the pain, not any way
to make sense of it. They all think I know things, just about anything.
And I can't figure out the one thing I most want to make sense of.

The thing was, House considered, his pain, bad as it was, had never sent
his heart into dangerous territory, never threatened to kill him. Hers
had. She could probably tell him a thing or two about pain, if she knew,
really knew, what the Morphine would have helped her forget about that
day. And House knew that.

House looked at her, and shook his head, before responding slowly, "I
don't think I can help you."

He stood in the doorway a moment, looking down at her, saw defeat in her
posture. She frowned, nodded once, and started to back the wheelchair
clumsily. She looked up at him again, unsatisfied, the skin on her face
paler now, tighter. House turned, closed the door behind him, and limped
to his desk without bothering to look back.

 -*-*-

The local network affiliate interrupted Entertainment Tonight for the
second time in two nights. House reached out in his leather chair to twist
the blinds a bit tighter, to block the evening sun from his eyes. Even the
sun seemed to hurt these days, too hot, too intense, putting him at odds
with the three layers of clothes that made his public body armor. Now,
alone at home, with no one around to touch him or bump him, he wore only
his t-shirt and jeans.

Last night, the news had broken in to raise the alarm after a liquor store
robbery had gone terribly wrong. He'd switched channels, choosing the Soap
channel instead. He didn't have any illusions that he was going to stop a
liquor store robber.

Tonight, though, the robbery was apparently in progress, with news cameras
zooming in through the windows of the gas station convenience store to
show the shadowed outline of a person apparently holding a gun on someone
behind the candy racks. A darker shadow spread over the floor below.
Something about the way the gunman held the gun struck House, a stiffness
in the shadows.

The station cut to show a grainy security video from the liquor store the
night before, with a voice over explaining the victim's injuries; shot in
each knee, the groin, the gut, and finally the chest, he'd died on the
scene. House tensed; that had to hurt. The video only showed the gunman,
dressed in black pants, black leather jacket, then, for an instant, a
woman's face, with taut skin drawn around the eyes. House frowned, trying
to remember where he'd seen that face before. She moved stiffly,
carefully. The video ended when the victim--the guy behind the counter, 20
something, white, well-muscled, in jeans and a t-shirt--and the woman
moved out of camera view.

The station cut back to show the scene on the ground, a ring of police
cars, lights flashing in the evening sun. The voiceover explained that the
police had thought the shooting the night before was a robbery gone wrong,
but investigators were now saying that the woman had been a regular
customer at the store, and was known to the other employees. So she'd
apparently been staking the scene out for months. The police were still
uncertain about motive. They were trying to make a connection between the
liquor store and the convenience store, but so far had no leads.

The camera shot cut back to zoom through the window again, just in time
for House to watch the shadowed woman raise her gun to her head. The
television blipped black for a moment, then on again, showing feet and
legs on the ground, the rest of the body hidden behind the candy rack, and
a dark flow spreading downward across the floor.

The next cut showed police rushing into the store; House found the remote
and switched to the Soap channel. He reached for his coat jacket, found
the Vicodin, and took two. The police would try to make sense of it, tell
a story that fit what they found so that the public would understand what
had driven this woman to kill two men and herself. House knew their story
wouldn't really make sense of it at all.  
   Please post a comment on this story.  


Legal Disclaimer: The authors published here make no claims on the
ownership of Dr. Gregory House and the other fictional residents of
Princeton-Plainsboro Teaching Hospital. Like the television show House
(and quite possibly Dr. Wilson's pocket protector), they are the property
of Fox Television, David Shore and undoubtedly other individuals of whom I
am only peripherally aware. The fan fiction authors published here receive
no monetary benefit from their work and intend no copyright infringement
nor slight to the actual owners. We love the characters and we love the
show, otherwise we wouldn't be here.