The treatment for the patient was really to do nothing and let the body handle the estrogen levels on its own. If the diagnosis was correct, Joey wouldn't take long to wake up from the coma again. He would only need to stick to a strict diet and routine, and of course, stop taking whatever supplement rich in estrogen he had been using.
After House went out to stop any treatment for the patient, I spent quite a bit of time on my own in the lounge. In the meantime, I picked up the book I had left, managing to finish a third of it before the three doctors from the team returned to the lounge.
"He's awake," Cameron said with a restrained smile.
Immediately after Cameron spoke. "How did you figure it out?" Dr. Foreman asked with genuine interest.
Fortunately, in all that time alone I had come to my own diagnosis, adding in some extra information.
"It was obvious to everyone from the start that the problem lay in the estrogen levels," I stated, making the three doctors, now seated around the lounge table, nod in obvious agreement. "House asked if there was anything that could radically raise estrogen levels."
"There wasn't," Cameron replied, surely remembering that she had been the one to answer House's question.
"That's what I thought too," I said, nodding, "but then I thought about the use of Chinese chewing gum to quit smoking."
"What about it?" Dr. Foreman asked, interested.
"There are many studies related to supplements sold in those kinds of shops, known as traditional Chinese medicine," I said, watching Chase roll his eyes immediately. "Yes, many of these studies discredit the vast majority of those supplements and 'medicines,'" I added, nodding, also generally quite skeptical of any traditional treatment not fully scientific, "but there are other very specific studies on the use of herbal aphrodisiac supplements, especially used by the homosexual community."
Raising his eyebrows, looking incredulous. "You based your diagnosis on that?" Dr. Foreman asked, not at all offensively.
"That and the fact that at the time it was the only thing that explained the sudden spike in estrogen levels in his system," I replied, nodding.
"You don't know it was sudden, the hepatitis diagnosis was just as good," Chase commented.
"I considered it a sudden spike because of the lack of symptoms," I said quickly. "There's no gynecomastia, testosterone levels are within normal range, and there's no severe hormonal imbalance," I continued. "The only thing we know is the liver failure, which is clearly caused by the hepatitis and aggravated by the estrogen."
With one hand on his chin, listening attentively to what I was saying. "That still doesn't explain the suddenness of the comas," Cameron said.
"You're right, it doesn't," I said, nodding. "But today I discovered upon arriving that one of the federal agents was under investigation for a sum of money he received out of nowhere," I added, thinking of the trunk of my car. "I'd bet a lot of money that the comas were caused by something the patient ate."
Come to think of it, it was quite obvious the three times the patient's health had declined were after mealtime.
"How do you know?" Dr. Foreman asked. "How do you know one of the federal agents was under investigation? I didn't know that," he added, confused.
"The nurses told me," I replied, slightly embarrassed.
"Of course," Cameron snorted, amused.
Remaining silent for a few seconds. "All his food was strictly controlled," Chase said, shaking his head. "It's hospital food, there's no correlation," he added a moment later.
"That's only if he ate it," I said calmly, grateful to return to the pertinent topic. "I'm pretty sure, thanks to House's new car," and for other reasons, "that the patient's 'family' gives gifts to those who do them favors. I'm sure the agent could've easily smuggled a steak into the hospital."
At the exact moment I finished speaking, entering the lounge and surprising us all. "And you'd be right," House declared.
Strangely, the man looked more somber than usual, letting his eyes wander over the other three doctors in front of him. He walked over to the board on the other side of the table and immediately began erasing its contents, figuratively closing the case. "The three times Joey Smith needed urgent medical attention at this hospital were after eating fatty meat," House declared calmly. "Do you have anything to say about that?" he asked, raising one of his eyebrows.
"The amount of fat in the meat, when consumed, generates a large amount of aromatase enzyme," I responded. "In a healthy person, hepatic metabolism slows down considerably as a normal process. In a hepatitis patient with high estrogen levels, it causes liver shock," I declared.
"If we had known about the meat from the beginning, the immediate diagnosis would have been OTD," House said, leaning on his cane.
Ornithine transcarbamylase deficiency, or OTD for short, affects urea metabolism basically affects how the body gets rid of excess nitrogen. Treating Joey for that would've done nothing, but if he truly had OTD and wasn't treated for it, he would've died by now.
When I thought about meat consumption, OTD had crossed my mind a couple of times, certainly worrying me. The only thing keeping me from following House at the time was, again, the estrogen levels.
"Fortunately, it wasn't," House declared, looking straight at me, obviously knowing what was going through my mind.
"How lucky," I murmured neutrally, causing House to give a small smile that quickly faded as he faced everyone in the room.
"All right," he said, placing both hands on his cane, "there will be some changes starting today," he declared seriously. I could notice something else in his eyes as they kept scanning the three doctors in front of him. "By order of the board, we have to increase our clinic hours by six per month."
Immediately, everyone, including Cameron, groaned in annoyance.
"I know, I don't like it either, but we're all in the same boat," House muttered, and again I could detect something behind his statement.
It was strange to see House uncomfortable. Apart from his obvious disdain for having to increase clinic hours, I was sure there was something more.
"As if it affects you in any way, we all know it's PJ who works your shifts," Dr. Foreman said, pointing at me.
"I have to sit there, don't I?" House asked, grinning arrogantly.
Whatever House had on his mind, he clearly pushed it aside, behaving as he normally did, at least for people not as observant as him or me.
With the case 'closed,' all that was left was to finish the chart. After giving a couple of instructions to the doctors, House left the room, urging me to follow him.
"The increase in clinic hours wasn't all Vogler imposed," he said as we walked down the hospital hallway toward the clinic.
Surprised he brought up the topic so openly. "Yeah, I could see you didn't say everything," I said.
House exhaled with a crooked smile. "I made you too good at this for your own good," he said sarcastically.
I couldn't help but feel slightly proud.
"If you don't want me to read you, don't make it so easy," I said, shrugging arrogantly.
"Oh yeah?" House asked, raising an eyebrow. "If you're so good, what else did Vogler achieve?" he asked challengingly.
It was quite an interesting challenge since there weren't many things Vogler, as chairman of the board, didn't have at his disposal, as he had already reminded me personally several times. It was definitely something related to the diagnostics department or House wouldn't care. Probably something budgetary; after all, Vogler was a businessman.
A minimum patient quota per month, maybe? I was almost sure our department was the one that generated the least money annually.
But no, that would be a logical move made by someone interested in improving the hospital. Vogler, on the other hand, just wanted to prove to House, and to anyone who challenged him, that he was the biggest dog. It had to be something personal like forcing House to wear his lab coat but that affects the entire team... shit.
Only a few seconds after his question, I stopped. House did too.
"You have to fire someone," I said, staring at him.
Without any change of expression on his face. "Like I said, too good for your own good," House replied.
Pausing for a moment, House smiled with awkward empathy.
"You're lucky you're not on the hospital payroll. For now, Vogler can't touch you, but it'd be a good idea to push your mother to find a new job."
I thought about the implications of my own deduction, completely ignoring the comment about my mom's job. After all, she would quit before Vogler could scheme something to fire her.
"Yeah... very lucky," I murmured distractedly, raising my eyebrows with irony.
"No, I'm serious," House declared. "Out of all of us, you're the most protected. The university is backing you, while we only have this magical thing that apparently serves no purpose called an employment contract with the hospital."
Shrugging, he kept walking.
I knew it. Even though I didn't like saying it out loud, my future, at least from the perspective of the university and the vast majority of doctors, wasn't something to be wasted. That's why President Hagemeyer was so interested in ensuring that, at least for now, any future work of mine would still be "part" of the university.
"So what do you plan to do?" I asked House, catching up to him without much effort.
"For now, nothing," he replied, shrugging.
"There's going to come a moment when Vogler is going to force you to choose."
"Then I'll choose," he declared calmly. "Who would you fire?" he asked after a brief pause.
Cameron was not difficult. Practically impossible for House to fire her, even if he didn't admit it.
Despite the resentment Dr. Foreman felt toward me which, surprisingly, had decreased quite a bit, he was an excellent physician. And he knew how to work in a team.
The answer was then clear. Under a cartoonish magnifying glass, Chase had worked as a spy for the 'villain,' basically betraying the trust of his teammates. If that ever came to light, no one would want to work with someone they couldn't trust.
Still. "I don't know," I answered.
House shook his head without even turning to look at me. "As good as you are compared to other people, you still have a lot to learn," he said, immediately seeing through my lie.
After the clinic shift, and with no active case, I decided to occupy my mind by watching recordings of surgical techniques, avoiding going back to the lounge at least until it was time to go home.
The days passed, and with them came summer break. The team's comments about my paper came too. Cameron and Chase congratulated me in advance on the publication, even though I hadn't sent it to the publisher yet. Surprisingly, Dr. Foreman, even though it wasn't his field of study, was the one who offered the most notes for future publications.
Out of all the people I had sent the paper to, the most enthusiastic congratulations came from Dr. Thomas, to whom I mailed a physical copy the day after we closed the mob family's case. As soon as he received it, he called me. He hadn't even read it yet he just wanted to congratulate me.
"I can't wait for your name to reach the admissions committee," he told me during the call. "Almost seventeen years old and already ready to publish your first paper? I'll have a stopwatch ready; I bet you'll be accepted in record time even without my personal recommendation."
Besides the congratulations and the obligatory reminder to choose Harvard as my medical school, Dr. Thomas immediately offered to lend his name so the article could be accepted in any journal of my choice.
With a name as big as his, getting taken seriously by any publication would be a mere formality. Still, I declined his generous offer for now. I wanted to try it on my own, using only the university and hospital's resources. I hoped I wouldn't have to ask him for help later on.
"You have to send it to JACC or Circulation, don't settle for anything less," the man said proudly when I turned down his offer.
"You haven't even read my paper," I replied, laughing.
"Ah, but I know you. And I know your work. The editors would be idiots not to publish it..."
Embarrassed but amused, I scoffed and shook my head.
"Dottie sends her regards. She says she wants to meet Diane already," Dr. Thomas added. I could hear murmurs on the other end, probably Dottie insisting on speaking with me.
Ever since we came back from Boston, by insistence of my self-proclaimed 'mentor,' I had kept constant communication with Dr. Thomas and Dottie. Mostly through correspondence or phone calls to talk about my academic or personal progress. To be honest, Dr. Thomas was an excellent listener and very experienced.
The first weekend since the start of summer vacation, or the second depending on who you asked, as I had promised Diane, I made reservations at a high-end restaurant in Houston.
A French restaurant that, for some reason that I preferred not to ask about, Bob knew very well. So well that he secured a table without any problem.
With Kat and Mandela out of school, Diane had spent almost the entire week with her friends. Occasionally, I was included in their plans, though more as a chauffeur or the official bag carrier. That's why Saturday night dinner would be our first proper date in a while.
"Be very careful on the road. Houston is a big city, and there are lots of people who drive like they don't care about their own lives," Mom said while adjusting my shirt collar.
The shirt, along with a blazer, pants, and shoes, was the outfit London had picked when I was in Boston.
"Yes, Mom," I replied seriously. "I'll be careful," I assured her with a calm smile.
"Good," she replied, nodding. "Why don't you wear this more often? You look so good," she added, giving me a slight push to get a better look at me.
"I don't know," I said, shrugging.
But the truth was, I never knew when to wear it. It was too expensive for just any day at school, and wearing it to the hospital seemed like a crime with all the risk of getting it stained with some patient's bodily fluids. I preferred to save it for special days like this one.
Rolling her eyes, Mom smiled.
"Are you sure you don't want me to take a photo of you with Diane?" she asked as she turned to look for her camera.
I gently stopped her by the shoulders. "Mom, we're not going to prom," I reminded her for the third time. "It's just a dinner to celebrate that we finished the paper. On Monday I'm going to send it in for final review to see if it'll get published or not. I've owed Diane this for weeks," I said slowly.
Bob, with a beer in hand from watching a basketball game, said from my bedroom door, "Oh look at you, the Duncan genes doing their job. You look good, son."
"Thanks," I replied immediately.
"Do you need some cash?" he asked, raising his eyebrows significantly.
"I'm good," I replied quickly, hoping Mom wouldn't notice her husband's behavior.
"All right, be a gentleman," he warned, raising a finger, "but more importantly, be a Duncan," he added, winking.
"Sure," I responded, nodding enthusiastically.
Without saying anything more, Bob left my room surely the game had started again.
"What does he mean by 'be a Duncan'?" Mom asked, puzzled.
"I have no idea," I replied.
Patting what was probably lint off my blazer, Mom nodded, obviously proud. "One last time, just one photo?" she asked, pointing at the camera.
Sighing. "Mom..." I said, slightly exasperated.
Honestly, if it were just one photo, I wouldn't have any issue, but I knew Mom, and seeing her insistence and anxiety to take photos, it was clear that one wouldn't be enough.
"But you look so good," she said, frustration in her words. "And with all that raw strength on the other side, I'm sure Diane will look absolutely stunning."
"Yeah," I chuckled, amused.
Across the street, in front of Meemaw's house, I knocked on the door and waited a couple of minutes. Meanwhile, distracted, I played with the tips of my shoes, mentally reviewing the contents of my pockets, the route I'd take to the restaurant, and some conversation topics. I wouldn't admit it out loud, but with Sheldon's help, and a couple dollars less after buying a comic, I had studied a bit about the latest topics in the field of mathematics.
For some reason, maybe due to the time without proper dates, this one felt very important.
When the door finally opened, I looked up ready to greet… and I froze.
Diane was there, wearing an elegant black dress that fell gently over her figure. Over her shoulders, she wore a kind of light scarf that didn't seem to provide any warmth at all. Her makeup was subtle but enough to bring out the color of her eyes and lips. She was carrying a small black purse in her hands, and her hair was beautifully styled.
She was beautiful. Truly beautiful. And for a second, really several, I stood completely spellbound, unable to say a single word.
It was only when Diane raised her eyebrows with a barely contained smile that I realized what was happening around us.
Behind her, standing in the foyer, were Meemaw and Mrs. Cooper, smiling broadly. Kat and Mandela were peeking their heads out from the side. Teddy was there too, arms crossed, watching me intensely as if trying to communicate something with her eyes. Even Missy was present, smiling mischievously.
All the 'raw strength' on full display, lined up like a watch committee.
A single throat-clearing from Teddy was enough to remind me where I was standing. "Wow," I finally said awkwardly, twisting an embarrassed smile at how long it had taken me to react, "you look... astonishing."
Diane laughed softly and walked toward me. "Thanks," she said quietly, "you look very handsome too," she added gently.
Meemaw, who like the rest of the women behind Diane had been completely silent, suddenly spoke up. "Okay, that was definitely more than five seconds of shock, pay up," she said, extending her hand in front of Kat and Mandela.
Silently, the two teenagers pulled out a bill each and handed them to the older woman.
"Mom!" Mrs. Cooper exclaimed, outraged.
Diane turned to see the scene, laughing softly, while her hand found my arm.
"All right," Mrs. Cooper sighed, rolling her eyes as she saw Meemaw carefully inspect the two bills, "please don't come home too late and PJ, be very careful on the road," she said nervously.
"Don't worry, Mrs. Cooper. I'll be careful," I assured her, remembering the conversation I had had with Mom not long ago. If Mrs. Cooper started asking for pictures, I would genuinely worry about some kind of hive mind.
"Okay, the show's over, everyone out of my house. Tonight is bowling night," Meemaw ordered, waving her hands as if she were shooing away birds. "Especially you two, you've got a reservation to get to," she added, pointing at Diane and me.
Approaching her, Mrs. Cooper gently caressed Diane's face. "Have fun, sweetheart," she said tenderly, "but not too much fun," she added, turning her face to look at me directly.
Behind Mrs. Cooper, without the woman noticing, Mandela caught Diane's attention, shaking her head emphatically and giving a double thumbs up, immediately after being pulled back by Kat, who for some reason looked embarrassed.
After saying goodbye to the rest, Diane and I got into my car and headed toward the restaurant moments later.
We had only been driving for a few minutes, the music playing at a moderate volume, and without saying a word, silence settled between us.
Truth be told, for some reason it was slightly uncomfortable. As if the formality of the date was getting in the way.
I glanced at her out of the corner of my eye, distracted, and for a dangerously brief moment, lost focus on the road. Diane was illuminated by the warm light of sunset, sitting with total ease, a charming smile faintly drawn on her lips as she looked out the window. She didn't seem uncomfortable in the slightest.
I realized that all that time, that tension, that strange feeling in the air wasn't coming from both of us, or from her. It was entirely from me.
I silently scolded myself for feeling that way, especially with her. I exhaled, almost as an attempt to shake off the discomfort, and that was enough to catch her attention.
"What can you carry in that bag?" I asked improvising, pointing at the small purse in her hands.
"Oh, it's really useful," she replied immediately, excited, as if she had been waiting to talk about it, "Until today I didn't understand why women always bring purses to important events I went to," she added, gently shaking her small bag, "these kinds of dresses don't have pockets."
Recalling the image permanently etched in my mind of Diane in that dress standing in front of me, I realized that the only thing that differentiated it from fabric tied around her body was the actual tailoring of the dress.
"Oh, I never thought about that," I said, slightly embarrassed. Even when she used to dress as fake Diane, she was always bundled up with a sweater or coat with pockets.
"I know, right?" Diane replied, smiling broadly, "It's quite surprising how many things you carry outside your house once you have nowhere to keep them, and how many things you can carry once you've got one of these," she said, opening her purse. "For example, I always carry my house keys and some cash, but with the purse I can bring tampons, a few pens, my migraine meds..."
"Migraine?" I interrupted, concerned. I had no idea Diane suffered migraines frequently enough to carry medication.
"Oh, I really carry it out of pure habit," she assured me, noticing my expression. "I haven't had one in a long time, not since I got to Medford," she added, surprised, after thinking for a second.
You didn't have to be House to get it. Diane had come from living in a high-pressure, constantly stressful environment, pushing herself every hour of the day to make progress in mathematics. Changing her routine, surrounding herself with people who cared about her, and adopting a much more balanced lifestyle had clearly given her the mental break she needed.
Taking her hand, which rested on her leg.
"I'm glad," I said, smiling sincerely. Diane gave me a small but sweet smile in return. "But if you ever feel sick again, please tell me. I don't know if you're aware, but I know a thing or two about medicine," I added jokingly.
"Yes, I knew that," Diane replied, amused.
"Sorry, I interrupted you," I said, letting go of her hand. "What else do you carry in there?"
"Oh yeah, just a couple more things. I always carry tissues with me," she said, pulling out a small colorful pack, "and today Mandela told me that it was appropriate for me to have preservatives ready," she added casually, pulling a strip of foil-wrapped condoms from her purse.
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I know, I know... Cliffhanger, I'm sorry.
I decided to split the chapter in two (there are approximately 3k words left until the end) because with the rainy season, it's been pouring daily in my city, the electrical system on my street has been fluctuating horribly. I'm quite worried about keeping powered my computer on for too long in case there's a blackout, since my voltage regulator isn't very good and I really don't want to lose my computer.
On top of that, someone commented that they can "smell my 'desperation' in every chapter of the story to be validated through comments in some sort of social experiment," so I decided to prove them right, muahahahaha (evil laugh or something, just to get a reaction and be validated on the internet, pretty please).
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Author Thoughts:
As always, I'm not American, not a doctor, not a fighter, not Magnus Carlsen, not Michael Phelps, not Arsene Lupin, not McLovin, not Elliot and not Capone.
Another chapter has passed, so new thanks are in order. I would like to especially thank:
11332223
RandomPasserby96
Victor_Venegas
I think that's all. As always, if you find any errors, please let me know, and I'll correct them immediately.
Thank you for reading! :D
PS: PLEASE LEAVE A REVIEW.