Chapter 36: The Baby's Antibodies Come From the Mother
After Foreman heard that House had ultimately adopted David's approach, he felt something stuck in his throat—unable to swallow or spit out.
He couldn't comprehend why this David had suddenly blazed across the sky like a comet.
Before this, David was clearly just a nobody.
There's no such thing as instant enlightenment in medicine.
All clinical experience is accumulated through generations—later physicians standing on their predecessors' shoulders, finding patterns in complex cases to advance treatment.
This was why House used to take calculated risks and trial medications on patients.
You must eliminate possibilities systematically to identify the correct etiology.
But this David had pinpointed the cause almost every single time without a single miss so far.
This performance far, far exceeded Foreman's own.
Foreman watched darkly as David went to collect the antibody reagents.
Although House said he wouldn't fire him because he possessed "special talents," everyone knew that before termination day, bosses always used empty platitudes to keep you working hard.
Only after finding your replacement would your boss engineer your voluntary departure.
At this moment, the sense of threat in Foreman's mind had never been more acute.
He had to discover David's true background!
He had reason to suspect that behind this David, there might even be a medical team providing consultation!
Perhaps David coming to Princeton-Plainsboro had ulterior motives!
Otherwise, it was impossible to explain why such a young intern could diagnose so accurately every single time.
Tonight, he was going to see who this David met with!
Best to photograph his collusion with other medical teams as evidence, so Cuddy could terminate him.
Only then would Foreman's position be secure!
Soon, after David collected sufficient antibody reagents, the four people in the lab immediately became absorbed in work.
In this race against death, none of the four had bandwidth to communicate.
Even Foreman, who'd always targeted David, didn't bother saying anything more after formulating his plan and with House having decided.
About an hour later, the lab's glass door was pushed open directly.
The arrival was House, who'd escaped from clinic.
He came demanding results.
"Well? Do we have anything?"
David examined the computer screen:
"Healthy infants tested positive for two of eight potential viruses.
Echovirus 11 and Cytomegalovirus.
And only Cytomegalovirus antibodies were detected in the blood of the eight symptomatic infants' mothers.
Simultaneously, the elderly volunteer's blood also tested positive for Echovirus 11."
Hearing the results David reported, House's expression immediately brightened.
As David had stated previously, infants receive all antibodies from maternal transfer before six months.
If the mother lacks antibodies to a specific virus, the infant will naturally become infected upon exposure.
Enteroviruses like Echovirus 11 generally colonize adult intestines, causing diarrhea and some flu-like symptoms or rashes in adults.
These symptoms aren't severe for adults because they're non-fatal.
This was also why, during initial differential diagnosis, no one considered viral etiology.
But they'd forgotten that many viruses non-lethal to adults are catastrophically dangerous to fragile neonates!
Fortunately, current serological results proved David's previous diagnosis was correct!
This wasn't bacterial infection—it was viral!
Which meant that following David's suggestion, they'd avoided the necessity of empiric antibiotic trials on infants.
House, maintaining external composure, finally released the tension he'd been holding.
Now that etiology was confirmed, the infants' condition wasn't frightening at all.
He exhaled slowly, patted David's shoulder before everyone, and offered:
"Well done, David!
Looks like everyone's working late tonight.
As compensation for overtime, dinner's on me afterward."
Hearing House was buying, Chase immediately whistled in agreement:
"Perfect. Let's hit Mas (Farmhouse) on Bank Street—their farm-to-table is incredible."
House glanced at the enthusiastic Chase.
Farm-to-table New American? This guy was clearly trying to bankrupt him.
He shook his head dismissively, then addressed David:
"Currently, there's no FDA-approved specific treatment for Echovirus 11 on the market.
But there's an experimental antiviral in Philadelphia that just completed Phase II trials with promising efficacy.
However, we need parental informed consent before administration.
So, David, I'm delegating the family discussion to you.
Once the infants stabilize, we'll grab that meal."
David nodded, left the lab, proceeded to maternity, assembled the symptomatic infants' parents, and explained the situation.
"...Because viral infections are more challenging to treat than bacterial, there's currently no established first-line therapy.
However, a pharmaceutical company in Philadelphia has developed an experimental antiviral, and trial data show excellent results.
Furthermore, we've already obtained compassionate use authorization for this medication, and as soon as you consent, we can immediately administer it to the infants."
David's words paused slightly before anxious parents peppered him with questions:
"Does this experimental drug have side effects? Will it make my baby uncomfortable?"
"Aren't there other options? Can we try something more conservative?"
"Can this medicine actually cure my daughter? Doctor, please just tell us straight?"
Looking at the parents before him, terrified for their children's wellbeing, David patiently waited for them to finish before responding:
"Please hear me out. Infants inherently have weaker immune resistance than adults because their organ systems aren't fully mature.
Echovirus 11 is actually a fatal pathogen for neonates—it directly attacks cardiac tissue, and progression is extremely rapid.
It requires only approximately twenty-four hours to cause infant mortality, which means every second we delay here brings your child one step closer to death.
I understand your concerns about adverse effects, but the side effect profile of an experimental drug that's reached compassionate use authorization is essentially equivalent to over-the-counter cold medication.
Therefore, its adverse effects are negligible.
Unless you plan never to use any pharmaceutical intervention for the rest of your lives—in which case, indeed, there will be no side effects.
Not only no side effects, but also no child."
Hearing David's blunt words, which carried implicit warning, several parents' faces went ashen with fear.
They immediately signed the consent forms and handed them to David.
No matter how severe the side effects, better than death.
With someone taking initiative, the other parents no longer hesitated and signed consecutively.
With parental authorization secured, David could administer the medication to the eight infants in the NICU.
The next phase was prolonged observation.