fic: The Price of Healing — Chapter 3/5
Oct. 10th, 2016 04:19 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
readingratChapter 3
The next time it happened, Julie wasn’t around any more to shield Wilson from House’s eyes. Besides, he’d been keeping a close eye on Wilson whenever one of his patients lay dying. If a patient’s recovery knocked Wilson over, who knew what the next death would do to him!
Old Mr Truro died, as did Jennifer McCray, with little to catch House’s attention. Wilson swung by their rooms whenever he had a free minute, he monitored their palliative treatment, he made sure they were as comfortable as was possible under the circumstances. But he didn’t spend day and night at their bedsides nor did he fall apart when they died. He was quiet and thoughtful for a day or so, and then he returned to his normal routine. House, reassured, reverted to ignoring Wilson’s work as much as possible.
Then one morning in May, little Leroy Carter was admitted, wheezing and with his oxygen saturation level way below what paediatric textbooks recommended for growing children. Leroy had been suffering from leukaemia, but had been released two years earlier with his cancer in remission. Now the cancer was back with a vengeance: it was simpler to list the organs that weren’t affected than the ones that were.
Wilson went into what House termed ‘denial mode’: he ordered chemo and radiation, he did PET scans and X-rays, he supervised everything from blood tests to potential donor searches.
House visited Cuddy. “You’ve got to stop him. The kid is as good as dead.”
“We don’t know that,” Cuddy said.
House tossed the latest scans onto her desk.
“Okay, we do know that,” Cuddy conceded after she’d looked at them. “But . . . he’s Wilson. That’s what he does. Isn’t that what you do, invest in your patients?”
“That’s because I can save them. He can’t save this boy. He’s wasting his medical know-how and his expertise.”
“It’s his call. As long as he doesn’t do anything that’s illegal, he can care as much as he likes.” Resting her chin on her hand she gazed up at him. “Are you worried he won’t have enough caring left for you if he ‘wastes’ it on this boy, House? You needn’t be.”
So much for help from that quarter.
House returned to hovering in the background. He sneaked through paediatric oncology at night to spy on Wilson sitting at Leroy’s bedside, he had a link to Leroy’s patient file on his desktop, he bribed the nurses on Leroy’s ward to inform him whenever there was any development.
One evening the telephone on his desk rang.
“Dr House? It’s Nurse Janice from paediatric oncology. You wanted to be kept updated on lil’ Leroy here.” (Long, dramatic pause.) “We-ell, ah think you can stop worryin’. He’s all better now; oxygen sat level’s lookin’ good, white blood count’s back to normal, no sign of any tumours anywhere . . . Dr House, you still there?”
Tinkle, thump, crash! Despite the wall separating Wilson’s office from the conference room, House could picture the lamp tumbling off the desk, the chair tipping over backwards, and then something (shelves?) falling down in slow motion. He dropped the phone and grabbed his cane, noting out of the corner of his eye that his team had risen too and were staring in dismay towards Wilson’s office.
It wasn’t quite as bad as his mind had visualised in the few seconds it had taken him to get to Wilson’s office. Wilson must have collapsed across his desk from the visitors’ side, causing the lamp and a few other objects to slide off before the desk itself pitched forward with Wilson on top of it. He’d crashed into the shelves, but the shelves themselves had stood firm, merely showering Wilson with assorted trophies and stuffed toys. It could have been a lot worse.
With Foreman’s help he pulled Wilson out of the rubble. Wilson moaned.
“Okay, he’s breathing,” Cameron said, “but we should get scans to make sure . . .”
“Put him on the couch!” House ordered. He was fairly sure that Wilson wouldn’t appreciate being wheeled through the hospital on a gurney. There’d be quite enough rumours when the news leaked that his office was trashed.
Wilson opened his eyes before they’d gotten him properly settled. “What . . .?”
When he struggled to sit up, House pushed him back again. “You collapsed.”
He waved an irritated hand at Foreman. “Get a wheelchair. But be discreet. Chase, get water in a cup with a straw. Cameron, bring my car round the back.” He tossed her the keys.
Once the room had emptied, he turned back to Wilson. “So, what’s this about?”
Wilson draped an arm over his eyes. “Can we talk about it some other time? I feel like crap.”
“Next time, you may not be so lucky as to collapse in a hospital. You might be driving along the freeway or —“
Wilson interrupted House with more vigour than House had thought him capable of. “I’m not so stupid as to drive when I’m like this. I never leave the hospital until I’m sure . . .”
“Sure of what? What is this, anyway?”
“Overworked, too little sleep, irregular meals,” Wilson mumbled.
House picked a paperweight off the floor and tossed it up in the air, his eyes focused on the branch of a tree that he could see through the balcony door. “Your patient recovers; you crash.” He let the paperweight drop to the floor. It gave a satisfying thunk. “Not once, but twice. If Julie is to be believed, then more than twice. Why?”
Wilson struggled into a half-seated position. “How do you feel when you solve a particularly tough case?”
“Exhilarated,” House answered without hesitation.
“And then, once the exhilaration wears off?”
House was silent.
Wilson smiled wearily. “Exactly! I skip the exhilaration and go straight to exhaustion. Take me home.”
“You’re in no position to —“
“I’ll be fine,” Wilson insisted. “Twenty-four hours, give or take, and I’ll be right as rain.”
It was more like forty-eight hours, most of them spent on House’s couch while House tried to be caring but grew more and more irritated. It wasn’t just that Wilson, who was supposed to be the fit one in their relationship, was now ailing and in need of assistance. It was also that it didn’t feel . . . right.
Something was off, and he couldn’t quite put his finger on it.
On the second day Wilson said he’d be fine by himself and House should get back to PPTH and work before Cuddy descended on them breathing hellfire and brimstone. So House did just that — except for the work part. Instead, he immersed himself in research.
He swung by Wilson’s assistant. “Do you remember when Dr Wilson last took a personal day?”
The assistant wrinkled his forehead. “November?”
That was the one House remembered too. “And before that?”
“I’m not HR, you know.”
HR — of course! The paper pushers there weren’t inclined to be helpful, so House bargained with Cuddy: eight hours of clinic duty in return for a list of Wilson’s personal days. (Both of them knew his team would do the hours.) There was no pattern to the dates that House could discern. Sometimes a year would pass between two personal days, once there’d barely been six weeks between them.
“How come I never noticed him taking personal days?”
Cuddy shrugged. “I didn’t notice either. It’s not like he’s been taking an exorbitant number. Compared to other colleagues he makes modest use of the days at his disposal, and his department runs smoothly regardless. That isn’t something I can say of other departments.” After giving him a very pointed look, she returned to the report she was writing.
Armed with the list House took the elevator down to the archive.
“Patients being treated by Dr James Evan Wilson on the following dates,” he said, dumping the paper on the clerk's desk.
“I . . . don’t even know how to run a search for that,” the woman said, looking down at the list as though it was contaminated.
“What do they pay you for?” House groused.
“To search for patients by name or date of birth. Feel free to do your own search,” she snapped, vacating her chair at the computer.
It took him a while, but by midnight he had seven patients who had gone into remission around the dates of Wilson’s personal days.
“We have seven patients?” Cameron asked the next morning when she entered the conference room.
Chase walked past the seven whiteboards that House had bribed the janitor to bring there from all over the hospital, frowning as he read symptoms and status reports. “They all have — cancer.”
“Clever boy; you can read,” House mocked.
“House, none of them is our patient. They’re all Wilson’s problem. And they’re all in remission. Why are we bothering with them?” Foreman asked with the weary air of someone who knew that he was fighting against windmills.
“Maybe Wilson asked for a consult,” Cameron surmised.
“On patients who are in remission? Not likely.”
House ignored them. “What do they have in common other than that they had cancer?” he asked.
Foreman shrugged. “Nothing. Different ages, races, gender, cancers, symptoms, treatments, you-name-it. Can we get back to our patient?”
House assumed that the question was rhetorical. “No sudden turns for the worse, no history of standard treatment failing, no anomalies?”
Foreman, his interest finally piqued, pulled a few files towards himself. “Okay, two of these didn’t respond to initial treatment at all, and they all had exceedingly aggressive tumours.”
“Okay, aggressive tumours,” House said, writing in big letters so that the two words ran across all whiteboards like a banner.
“Four of them were younger than twenty,” Chase suddenly said.
“The other three weren’t,” Cameron pointed out. “Not a common factor.”
“But a significant aberration. That’s over fifty percent of the cases we’re considering here, which is way more than the occurrence of cancer patients in that age group justifies.”
House shifted the whiteboards so that the patients were lined up according to age. “Any age patterns among the adults?”
“No. . . . They’re all married. . . No, they aren’t. That one isn’t.”
“Single dad with two kids.”
“All of them have family,” Foreman said. “Brothers, sisters, mothers, fathers, kids, partners. What does that prove, that family protects against cancer?”
“Obviously not; they’ve all gotten cancer. Except . . .” House paused, deep in thought. The connecting factor was on the edge of his field of vision, but every time he turned his head, it eluded him “Anything in common when they went into remission? Or uncommon about the way they went into remission?”
“Other than the last patient, no,” Cameron said. “His recovery is unusual, but the others improved as a result of treatment. I can’t see any pattern in the treatment, though. It’s all highly individual.”
“None of the others were classified as terminal before remission?” House asked.
Cameron leafed through a file, and then through another one. “No,” she said finally. “But I’d have been surprised if they were. One patient who recovers from what was originally labelled a terminal outcome is a fluke; seven would be bad medicine. And Wilson is a good doctor.”
“That can’t be. Give me the file of that woman, the second-last patient.”
Cameron pushed the file across the table. House sat down and took out his reading glasses. Gillian’s file was comfortingly familiar — except for the last page. Instead of documenting the rapid deterioration of her condition from the time she was admitted to the hospital, it showed steady values, a gradual response to treatment, and long-term tumour shrinkage. It was complete and utter humbug.
The entire page had been neatly documented and signed off by — Wilson.
“Gimme the other files!” House ordered.
It was the same in each and every case. The last page of every single file showed the patient’s slow improvement under treatment. And invariably every entry on the last page had been signed off by Wilson, while previous entries had been signed off by assorted nurses, doctors on duty, radiology staff, etc. The only exception was the most recent file, Leroy Carter’s.
House stared at the seven files, his mind buzzing.
“Okay, fun and games are over!” he said, standing up and scooping up the files before his team realised what had piqued his interest. “Back to our patient. When’s the last time anyone checked on him?”
His fellows looked at him blankly.
He waved his cane at the door of the conference room. “Run along and check whether he’s still alive. Wouldn’t it be embarrassing if he died while you wasted your time on other departments’ patients?”
His next stop of the day was the oncology ward. He leaned on the nurses’ desk, his arms propped on the files he’d brought from the archive. “The dean sent me to you,” he said giving the nurse his most winning smile.
She sighed. “Dr House! What have I done to deserve Dr Cuddy’s ire?”
“Seems that you guys are a beacon in the darkness as far as documentation of patient care is concerned.”
“We just do our jobs,” the nurse said virtuously.
“The dean suggested that I do mine by following your shining example. She furthermore indicated that my clinic hours would rise exponentially if my patient files didn’t show signs of improvement soon. So, . . .”
He pulled out his reading glasses, gave the nurse a half-beseeching, half-flirtatious look over them, and opened the top file. “Could you explain to me how you ensure that patient files are updated completely and consistently, regardless of who is staffing the ward? See, we have an issue with that: my fellows think the nurses are writing everything down, while the nurses believe my fellows are documenting everything in the patient file.”
“It’s quite simple, really. Whoever does anything, no matter what it is, notes it down. If more than one person is helping, then the senior-most staff member is automatically responsible. We’ve got an extra column here for . . .”
House zoned out, only returning to the present when the nurse finished with, “Did you get that?”
“Yeah, okay, that isn’t rocket science. Now when I look at this page, does that mean that Dr Wilson personally supervised each and every procedure over a time period of seventy-two hours?”
“Let me see? Well, that’s odd!” The nurse frowned down at the file that House had pushed under her nose. “Of course he couldn’t have done that. Someone else must have . . .”
“But you just said —“
“I know what I said!” She turned the pages of the file. “Do you have any others?”
House obligingly pushed the other files towards her.
Her eyes lit up when she saw the third file. “Oh, I remember that girl! She nearly died, but then she . . . Oh!”
“What?” House asked, leaning forward.
“I’m sure I was on duty the last week she was here. And I know that I —” She stopped short and shook her head, giving a small, fake laugh, before continuing in a determined tone. “Well, I must be mistaken. Maybe I wasn’t on duty after all. Or I’m thinking of a different patient. You know how it is at our age: your memory is as full of holes as a Swiss cheese.”
“Speak for yourself,” House said, straightening and taking the files from her. Wilson, the most conscientious soul at the hospital (Cameron excepted) had altered six patient files and would doubtless edit the seventh one once he recovered from his bout of weakness and got around to it.
His preferred source of inspiration also being the source of his present problems, House had to go elsewhere for input. Lying on Cuddy’s couch and twirling his cane he asked, “Why would a doctor manipulate patient files?”
“One, to cover up malpractice. Two, to hide carelessness. And I’ve heard of files being manipulated in order to bump the patient up on the transplant list — I’m not thinking of any specific employee of mine here.” She turned her screen away so she could look at him. “Is there anything I should know?”
“What if the patients walked out of here cured?”
“Then I guess you can strike malpractice and carelessness. Are you sure the patients were really sick when they entered the hospital? If not, we’re probably talking about billing irregularities — someone’s pretending to cure healthy patients in order to spruce up their budget.”
“Nah, the patients were definitely sick.”
“Then I’d say someone’s using patients as guinea pigs for non-FDA approved drugs. Again, I’m not thinking of any specific employee of mine.” Cuddy’s glare was very suspicious indeed.
“Non-FDA approved . . . Gotta go!” House jumped up and headed for home.
The next time it happened, Julie wasn’t around any more to shield Wilson from House’s eyes. Besides, he’d been keeping a close eye on Wilson whenever one of his patients lay dying. If a patient’s recovery knocked Wilson over, who knew what the next death would do to him!
Old Mr Truro died, as did Jennifer McCray, with little to catch House’s attention. Wilson swung by their rooms whenever he had a free minute, he monitored their palliative treatment, he made sure they were as comfortable as was possible under the circumstances. But he didn’t spend day and night at their bedsides nor did he fall apart when they died. He was quiet and thoughtful for a day or so, and then he returned to his normal routine. House, reassured, reverted to ignoring Wilson’s work as much as possible.
Then one morning in May, little Leroy Carter was admitted, wheezing and with his oxygen saturation level way below what paediatric textbooks recommended for growing children. Leroy had been suffering from leukaemia, but had been released two years earlier with his cancer in remission. Now the cancer was back with a vengeance: it was simpler to list the organs that weren’t affected than the ones that were.
Wilson went into what House termed ‘denial mode’: he ordered chemo and radiation, he did PET scans and X-rays, he supervised everything from blood tests to potential donor searches.
House visited Cuddy. “You’ve got to stop him. The kid is as good as dead.”
“We don’t know that,” Cuddy said.
House tossed the latest scans onto her desk.
“Okay, we do know that,” Cuddy conceded after she’d looked at them. “But . . . he’s Wilson. That’s what he does. Isn’t that what you do, invest in your patients?”
“That’s because I can save them. He can’t save this boy. He’s wasting his medical know-how and his expertise.”
“It’s his call. As long as he doesn’t do anything that’s illegal, he can care as much as he likes.” Resting her chin on her hand she gazed up at him. “Are you worried he won’t have enough caring left for you if he ‘wastes’ it on this boy, House? You needn’t be.”
So much for help from that quarter.
House returned to hovering in the background. He sneaked through paediatric oncology at night to spy on Wilson sitting at Leroy’s bedside, he had a link to Leroy’s patient file on his desktop, he bribed the nurses on Leroy’s ward to inform him whenever there was any development.
One evening the telephone on his desk rang.
“Dr House? It’s Nurse Janice from paediatric oncology. You wanted to be kept updated on lil’ Leroy here.” (Long, dramatic pause.) “We-ell, ah think you can stop worryin’. He’s all better now; oxygen sat level’s lookin’ good, white blood count’s back to normal, no sign of any tumours anywhere . . . Dr House, you still there?”
Tinkle, thump, crash! Despite the wall separating Wilson’s office from the conference room, House could picture the lamp tumbling off the desk, the chair tipping over backwards, and then something (shelves?) falling down in slow motion. He dropped the phone and grabbed his cane, noting out of the corner of his eye that his team had risen too and were staring in dismay towards Wilson’s office.
It wasn’t quite as bad as his mind had visualised in the few seconds it had taken him to get to Wilson’s office. Wilson must have collapsed across his desk from the visitors’ side, causing the lamp and a few other objects to slide off before the desk itself pitched forward with Wilson on top of it. He’d crashed into the shelves, but the shelves themselves had stood firm, merely showering Wilson with assorted trophies and stuffed toys. It could have been a lot worse.
With Foreman’s help he pulled Wilson out of the rubble. Wilson moaned.
“Okay, he’s breathing,” Cameron said, “but we should get scans to make sure . . .”
“Put him on the couch!” House ordered. He was fairly sure that Wilson wouldn’t appreciate being wheeled through the hospital on a gurney. There’d be quite enough rumours when the news leaked that his office was trashed.
Wilson opened his eyes before they’d gotten him properly settled. “What . . .?”
When he struggled to sit up, House pushed him back again. “You collapsed.”
He waved an irritated hand at Foreman. “Get a wheelchair. But be discreet. Chase, get water in a cup with a straw. Cameron, bring my car round the back.” He tossed her the keys.
Once the room had emptied, he turned back to Wilson. “So, what’s this about?”
Wilson draped an arm over his eyes. “Can we talk about it some other time? I feel like crap.”
“Next time, you may not be so lucky as to collapse in a hospital. You might be driving along the freeway or —“
Wilson interrupted House with more vigour than House had thought him capable of. “I’m not so stupid as to drive when I’m like this. I never leave the hospital until I’m sure . . .”
“Sure of what? What is this, anyway?”
“Overworked, too little sleep, irregular meals,” Wilson mumbled.
House picked a paperweight off the floor and tossed it up in the air, his eyes focused on the branch of a tree that he could see through the balcony door. “Your patient recovers; you crash.” He let the paperweight drop to the floor. It gave a satisfying thunk. “Not once, but twice. If Julie is to be believed, then more than twice. Why?”
Wilson struggled into a half-seated position. “How do you feel when you solve a particularly tough case?”
“Exhilarated,” House answered without hesitation.
“And then, once the exhilaration wears off?”
House was silent.
Wilson smiled wearily. “Exactly! I skip the exhilaration and go straight to exhaustion. Take me home.”
“You’re in no position to —“
“I’ll be fine,” Wilson insisted. “Twenty-four hours, give or take, and I’ll be right as rain.”
It was more like forty-eight hours, most of them spent on House’s couch while House tried to be caring but grew more and more irritated. It wasn’t just that Wilson, who was supposed to be the fit one in their relationship, was now ailing and in need of assistance. It was also that it didn’t feel . . . right.
Something was off, and he couldn’t quite put his finger on it.
On the second day Wilson said he’d be fine by himself and House should get back to PPTH and work before Cuddy descended on them breathing hellfire and brimstone. So House did just that — except for the work part. Instead, he immersed himself in research.
He swung by Wilson’s assistant. “Do you remember when Dr Wilson last took a personal day?”
The assistant wrinkled his forehead. “November?”
That was the one House remembered too. “And before that?”
“I’m not HR, you know.”
HR — of course! The paper pushers there weren’t inclined to be helpful, so House bargained with Cuddy: eight hours of clinic duty in return for a list of Wilson’s personal days. (Both of them knew his team would do the hours.) There was no pattern to the dates that House could discern. Sometimes a year would pass between two personal days, once there’d barely been six weeks between them.
“How come I never noticed him taking personal days?”
Cuddy shrugged. “I didn’t notice either. It’s not like he’s been taking an exorbitant number. Compared to other colleagues he makes modest use of the days at his disposal, and his department runs smoothly regardless. That isn’t something I can say of other departments.” After giving him a very pointed look, she returned to the report she was writing.
Armed with the list House took the elevator down to the archive.
“Patients being treated by Dr James Evan Wilson on the following dates,” he said, dumping the paper on the clerk's desk.
“I . . . don’t even know how to run a search for that,” the woman said, looking down at the list as though it was contaminated.
“What do they pay you for?” House groused.
“To search for patients by name or date of birth. Feel free to do your own search,” she snapped, vacating her chair at the computer.
It took him a while, but by midnight he had seven patients who had gone into remission around the dates of Wilson’s personal days.
“We have seven patients?” Cameron asked the next morning when she entered the conference room.
Chase walked past the seven whiteboards that House had bribed the janitor to bring there from all over the hospital, frowning as he read symptoms and status reports. “They all have — cancer.”
“Clever boy; you can read,” House mocked.
“House, none of them is our patient. They’re all Wilson’s problem. And they’re all in remission. Why are we bothering with them?” Foreman asked with the weary air of someone who knew that he was fighting against windmills.
“Maybe Wilson asked for a consult,” Cameron surmised.
“On patients who are in remission? Not likely.”
House ignored them. “What do they have in common other than that they had cancer?” he asked.
Foreman shrugged. “Nothing. Different ages, races, gender, cancers, symptoms, treatments, you-name-it. Can we get back to our patient?”
House assumed that the question was rhetorical. “No sudden turns for the worse, no history of standard treatment failing, no anomalies?”
Foreman, his interest finally piqued, pulled a few files towards himself. “Okay, two of these didn’t respond to initial treatment at all, and they all had exceedingly aggressive tumours.”
“Okay, aggressive tumours,” House said, writing in big letters so that the two words ran across all whiteboards like a banner.
“Four of them were younger than twenty,” Chase suddenly said.
“The other three weren’t,” Cameron pointed out. “Not a common factor.”
“But a significant aberration. That’s over fifty percent of the cases we’re considering here, which is way more than the occurrence of cancer patients in that age group justifies.”
House shifted the whiteboards so that the patients were lined up according to age. “Any age patterns among the adults?”
“No. . . . They’re all married. . . No, they aren’t. That one isn’t.”
“Single dad with two kids.”
“All of them have family,” Foreman said. “Brothers, sisters, mothers, fathers, kids, partners. What does that prove, that family protects against cancer?”
“Obviously not; they’ve all gotten cancer. Except . . .” House paused, deep in thought. The connecting factor was on the edge of his field of vision, but every time he turned his head, it eluded him “Anything in common when they went into remission? Or uncommon about the way they went into remission?”
“Other than the last patient, no,” Cameron said. “His recovery is unusual, but the others improved as a result of treatment. I can’t see any pattern in the treatment, though. It’s all highly individual.”
“None of the others were classified as terminal before remission?” House asked.
Cameron leafed through a file, and then through another one. “No,” she said finally. “But I’d have been surprised if they were. One patient who recovers from what was originally labelled a terminal outcome is a fluke; seven would be bad medicine. And Wilson is a good doctor.”
“That can’t be. Give me the file of that woman, the second-last patient.”
Cameron pushed the file across the table. House sat down and took out his reading glasses. Gillian’s file was comfortingly familiar — except for the last page. Instead of documenting the rapid deterioration of her condition from the time she was admitted to the hospital, it showed steady values, a gradual response to treatment, and long-term tumour shrinkage. It was complete and utter humbug.
The entire page had been neatly documented and signed off by — Wilson.
“Gimme the other files!” House ordered.
It was the same in each and every case. The last page of every single file showed the patient’s slow improvement under treatment. And invariably every entry on the last page had been signed off by Wilson, while previous entries had been signed off by assorted nurses, doctors on duty, radiology staff, etc. The only exception was the most recent file, Leroy Carter’s.
House stared at the seven files, his mind buzzing.
“Okay, fun and games are over!” he said, standing up and scooping up the files before his team realised what had piqued his interest. “Back to our patient. When’s the last time anyone checked on him?”
His fellows looked at him blankly.
He waved his cane at the door of the conference room. “Run along and check whether he’s still alive. Wouldn’t it be embarrassing if he died while you wasted your time on other departments’ patients?”
His next stop of the day was the oncology ward. He leaned on the nurses’ desk, his arms propped on the files he’d brought from the archive. “The dean sent me to you,” he said giving the nurse his most winning smile.
She sighed. “Dr House! What have I done to deserve Dr Cuddy’s ire?”
“Seems that you guys are a beacon in the darkness as far as documentation of patient care is concerned.”
“We just do our jobs,” the nurse said virtuously.
“The dean suggested that I do mine by following your shining example. She furthermore indicated that my clinic hours would rise exponentially if my patient files didn’t show signs of improvement soon. So, . . .”
He pulled out his reading glasses, gave the nurse a half-beseeching, half-flirtatious look over them, and opened the top file. “Could you explain to me how you ensure that patient files are updated completely and consistently, regardless of who is staffing the ward? See, we have an issue with that: my fellows think the nurses are writing everything down, while the nurses believe my fellows are documenting everything in the patient file.”
“It’s quite simple, really. Whoever does anything, no matter what it is, notes it down. If more than one person is helping, then the senior-most staff member is automatically responsible. We’ve got an extra column here for . . .”
House zoned out, only returning to the present when the nurse finished with, “Did you get that?”
“Yeah, okay, that isn’t rocket science. Now when I look at this page, does that mean that Dr Wilson personally supervised each and every procedure over a time period of seventy-two hours?”
“Let me see? Well, that’s odd!” The nurse frowned down at the file that House had pushed under her nose. “Of course he couldn’t have done that. Someone else must have . . .”
“But you just said —“
“I know what I said!” She turned the pages of the file. “Do you have any others?”
House obligingly pushed the other files towards her.
Her eyes lit up when she saw the third file. “Oh, I remember that girl! She nearly died, but then she . . . Oh!”
“What?” House asked, leaning forward.
“I’m sure I was on duty the last week she was here. And I know that I —” She stopped short and shook her head, giving a small, fake laugh, before continuing in a determined tone. “Well, I must be mistaken. Maybe I wasn’t on duty after all. Or I’m thinking of a different patient. You know how it is at our age: your memory is as full of holes as a Swiss cheese.”
“Speak for yourself,” House said, straightening and taking the files from her. Wilson, the most conscientious soul at the hospital (Cameron excepted) had altered six patient files and would doubtless edit the seventh one once he recovered from his bout of weakness and got around to it.
His preferred source of inspiration also being the source of his present problems, House had to go elsewhere for input. Lying on Cuddy’s couch and twirling his cane he asked, “Why would a doctor manipulate patient files?”
“One, to cover up malpractice. Two, to hide carelessness. And I’ve heard of files being manipulated in order to bump the patient up on the transplant list — I’m not thinking of any specific employee of mine here.” She turned her screen away so she could look at him. “Is there anything I should know?”
“What if the patients walked out of here cured?”
“Then I guess you can strike malpractice and carelessness. Are you sure the patients were really sick when they entered the hospital? If not, we’re probably talking about billing irregularities — someone’s pretending to cure healthy patients in order to spruce up their budget.”
“Nah, the patients were definitely sick.”
“Then I’d say someone’s using patients as guinea pigs for non-FDA approved drugs. Again, I’m not thinking of any specific employee of mine.” Cuddy’s glare was very suspicious indeed.
“Non-FDA approved . . . Gotta go!” House jumped up and headed for home.
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