Disclaimer: Not my characters. Please don't sue.
Rating: G
Notes: This is set immediately pre-X3, at Princeton-Plainsboro Teaching Hospital, where an unusual patient has been admitted. There are mild spoilers here for the X2 and X3 movies. I haven't set this at any particular time in the House chronology, so there's no spoilers there.
Thanks: To lilacsigil for endless beta reading and reassurance, and to Ion Bond for much assistance with Americanisms. Please attribute any errors to me. I've only seen the start of Season Two of House, so please be mindful of spoilers in comments.
All the shouting had given Sammy a headache again, so he had climbed into the crawl space to play with the new truck that Cain had bought him. Mom's new boyfriend wasn't so bad, but he sure liked to yell a whole lot. Sammy scooted the truck along a beam, then looked at it closely: it was shaking up and down, like in an earthquake. There was a chopper going overhead again, and this time it was real close.
"Cain Marko! This is the police! We have the house surrounded."
The voice was loud and it boomed right through Sammy's body. He peeped through a crack in the wall. He could see maybe five police cars on the lawn, and a guy with a megaphone. Downstairs, the shouting got a whole lot louder. Sammy reached out to get his truck, then looked at his hand curiously; it was trembling, like a little earthquake was happening right inside his arm. Chunks of plaster sheeting were falling all around him, and, as the seizure spread across his body, his twitching arms and legs kicked up plumes of white dust.
Doctor House enjoyed watching his staff tussle with the basics. He nestled further into his chair as they squirmed with discomfort and awkwardness.
"Patient is Samuel Paré, is an eight-year-old boy, injured during a police raid on his home. Fractures, abrasions, a concussion." Foreman was in fine form, as always, stating the obvious and yet saying nothing of substance. "No internal injuries, no intracranial bleeding."
House lolled in his chair and stared at the ceiling, pointedly. "Yes, this is not surprising, given that a HOUSE fell on the poor kid. Zero points for you. Next!"
Doctor Chase stepped up to the plate.
"He has, um, some atypical stuff in his blood work-up."
"You noticed that too, huh?" House sat up and reached for the tablet vial. He crunched down a couple of tablets. "Atypical is a good word to describe this case. Can you tell me the most atypical thing about this patient?"
Chase stuttered a little, but had no answers. House snorted in disgust.
"Zero points for the marsupial, mate." He pointed his stick at Cameron. "Care to take a swing, Doctor Cameron?"
Cameron stood up, and walked to the light box where several x-ray films were illuminated. Her mouth tightened.
"Well, it's fairly obvious that there's some kind of organic neurological issue that the injuries have masked. His post-injury symptomology includes seizures and abnormal muscle contractions, even though there's no corresponding brain injury..."
House stood up, and pushed past her, snatching the films off the light box and waving them at the three doctors in disgust.
"I can't believe it. Is nobody going to address the fact that this boy has a fish head?" He snapped three of the films back onto the box, punctuating his words. "A. Fish. Head."
Cameron, Chase and Foreman stared uncomfortably at the dome-like silhouette of the patient's head and the bony crest-like fin that sat atop his skull, but had nothing to say.
"Let's let that embarrassing moment slide on past." House pushed up out of his chair, and flipped the whiteboard over. "Let me just fish for a pen… just kidding! So, seizures. Muscle spasms, muscle weakness, headache, fatigue. Pretty ordinary stuff really, except for the fish head."
Cameron, reliably, bridled at this. "The fact that he has a, a ..."
"Fish head?" House volunteered.
"... An external expression of the x-gene shouldn't interfere with the diagnosis." She frowned. "The poor kid has probably been called enough names in his life."
"What should I call it, then? What's the correct medical term for 'fish head', Doctor Cameron?"
"MRI says it's not cancer, and there's no bleeding or brain injury from the accident," Foreman interrupted, "We need to be eliminating infection as a cause, and testing for myopathies. It could be muscular dystrophy."
"Blood work is all over the place," Chase was flipping pages back and forth in amazement. "I don't believe some of these readings. The lab guys must have been going nuts."
House nodded sagely. "That's what you get if you don't tick the box that says 'Set equipment to fish head'. Go and re-run the blood work. Check his cell counts, and get in touch with his family doctor, see if we can get something to compare to. And Foreman, get over to the kid's house, see what you can dig up there. Here!"
He threw a bunch of keys at Foreman. "Take Wilson's car. And while you're at it, take Wilson. He needs a little sun; wouldn't want him to get rickets."
Cuddy caught up with House as he was taking an early lunch break from the clinic. He knew she was coming; he could hear the angry click-click of her Prada heels from the moment she set foot off the elevator. There was nowhere to hide. She appeared at his elbow, like an evil gnome with cleavage.
"What are you doing?" Always the same question, never the same answer. It was a one-sided relationship, in which he did all the leg work. House looked down at her angry face, and pretended he was heading through the glass doors into the clinic, not stepping out of them.
"Well, interestingly enough, I'm doing my job. The one you beg me to do every day."
Cuddy scowled, then bustled him through the glass doors into the clinic, past the receptionist who was waving a file at House, and into a consulting room.
"You've admitted a patient, an x-gene positive patient, without clearing it through me." She crossed her arms over the manila folder she was carrying, and tapped one impeccably manicured finger on it angrily.
House raised his eyebrows.
"I'm not quite getting your meaning through all the political correctness, Doctor Cuddy. Do you mean my," he swung the door open, "MUTANT patient?"
In the waiting room, all heads turned towards them. Cuddy reached over and shut the door again.
"There are security considerations I need to put in place. There are risks involved with a patient who has known criminal associations. I've got press to organise, protesters to fence in, and then there's the vigilantes."
The two of them were fighting over the door handle. House jammed his stick between the door and the frame, and leaned his weight onto it.
"Doctor Cuddy, I'm shocked! It's not like you to turn down a patient based on their criminal background. We've had mobsters as patients before, we've had superheroes. There was that guy, the one Cameron couldn't keep her hands off; everyone said he was Daredevil. I'm sure you remember him. Good looking redhead. Visually impaired." He waggled his eyebrows suggestively. Cuddy rolled her eyes.
"Stop stalling, House. You sought out a patient, on your own. Why? Please, tell me you're not that gruesome. Tell me this isn't some kind of freak show fascination."
House surrendered the door to Cuddy, and hopped over to the cheap plastic chair.
"You're on to me. The kid has incredible kidneys. We weren't even sure that he had kidneys, had to go and see the yellow stuff coming out as proof. I'm sending the scans into Nephrology's Believe It Or Not. " He ducked the folder that Cuddy swatted him with. " I've got to get my hands on that kind of weirdness. Three hospitals have refused to admit him. He gets treated, I get a nice knotty problem, it's good for everyone."
Cuddy looked at him with narrowed eyes, suspicious of this back-handed philanthropy, then with a sigh, flipped the folder open.
"All right. Who's the referring doctor? It was blank on the admission form."
House grinned. "Better put Wilson down. He read about the kid on one of those superhero-spotting websites." He leaned towards Cuddy and whispered conspiratorially. "I think he's developing some kind of addiction."
Cameron was angrily dropping tube after tube into the centrifuge.
"It's not fair to involve the boy's mutantcy in the diagnosis. For all we know, it's a cosmetic issue." One of the tubes shattered inside the centrifuge, and she gave an exasperated shriek, then lifted each of the tubes out again and turned the machine upside down to empty out the broken glass.
"Well, for all we know, it's not just cosmetic." Silhouetted by a desk lamp in the darkened lab, Foreman was poring over a text bookmarked with a copy of the patient's bloodwork. "There may be significant differences to the human norm that we can't see yet. I'm talking metabolic differences, not just the anatomical." He slammed the book shut. "Fact is, we don't have any baseline readings to compare to. Until the accident, the kid had never even been to a doctor. As far as we know, little Sammy the fish-head boy could be as healthy as you or me."
Chase took the paperwork from Foreman and waved it.
"Except that he isn't. He wasn't having seizures, then he was. He wasn't suffering from muscle spasms, then he was. Empirically, we can see there's a disease here. We just can't use the regular diagnostic tools to identify the illness. It's a challenge. Or that's how House sees it."
"Then what the hell are we supposed to do?" Foreman asked, "Test the kid for mercury? 'Cause that's about the limit of my knowledge of fish physiology. We could kill this kid while we're trying to figure out how he works. I mean, isn't there some kind of hotline we can call?"
Cameron stood up, and walked to the door of the lab. On the television in the waiting room across from the lab, CNN was showing footage of Doctor Henry McCoy, Secretary of Mutant Affairs, speaking at a press conference. She waved a gloved hand at the screen.
"We could call him."
"So, what?" Doctor House was moving at top speed, striding down the corridor at a cracking pace, "Life slings you a puzzle, and do you rise to the challenge? Do you slug it out with the textbooks and databases?" He pressed his finger to his chin as he walked, looking thoughtful. "Let me think… No! The freaky patient freaked you out, and you ran screaming to the White House."
Foreman scooted ahead of House, and walking backwards, spread his hands out in a placating gesture.
"We just thought that it was a good idea to ... Ow!"
House had swung his stick down hard on Foreman's knuckles. He was sure it was okay to do this to employees when they really deserved it.
"The thing is, Doctor Foreman, you didn't think at all, you just picked up the phone and dialed 1800-BLUE-GUY." House pushed past Foreman and turned sharply into his office, falling back into his chair with an angry exhalation. "We don't need help. We need analysis. We need investigation. We don't need governmental hand-holders who are going to milk this for every photo-opportunity they can squeeze out of us. Let me tell you, children, this never goes well."
His staff clustered together on the other side of the desk, ready to defend themselves against further attack.
House screwed up his face and sniffed loudly. "Do you smell wet dog?"
The junior doctors looked sideways at each other, then sniffing more delicately, looked around the office. In the adjacent room, where the sun streamed through the windows, a large blue man in a well-cut grey suit was reviewing details on the white board. He turned around, and blinked mildly through his wire-rimmed glasses. The sleek blue fur on his neck and hands was tousled into damp little curls.
"Ah, inclement spring weather, I'm afraid," he said in a sorrowful voice. "I regret that I neglected to bring an umbrella."
"What do you think it's like, living that way?" Cameron whispered to Chase, as they watched Doctor McCoy through the cheerful decals and paint on the window of the pediatric ward. He was perched on a chair like a blue gargoyle, explaining something to Sammy. The child lay limp and barely awake in his hospital bed. His fin was drooping, and his eerie dark eyes were murky and clouded.
"Who do you mean? McCoy?" Chase hadn't taken his eyes off McCoy since his appearance in House's office. His breath fogged up the glass as he spoke.
"Both of them, really. Looking so very different, being judged by your appearance, denied the basics just because you're not like everyone else."
Chase shrugged.
"Same old, same old. It's always been this way. The odd one out is punished for it. It's not right, but it's the way the world works."
"Yes, but then to work with the people who hate you, to try and bridge that gap? That must be so hard." Cameron watched Doctor McCoy teaching Sammy the sliding thumb trick.
Chase snorted and curled his lip.
"You're obsessed. You're a sucker for any sort of good Samaritan story. Look at him: teeth, claws, he's built like a predator. I don't think it's wrong to admit that I'd be nervous standing next to him on the bus."
Cameron raised an eyebrow.
"Nervous? You're practically licking the glass." Shaking her head, she walked over to Sammy's room, knocked on the glass and walked in.
"Ah, Doctor Cameron, could we organise a humidifier? I believe Sammy loses moisture through his skin a lot faster than most people. I think he's a little dehydrated." McCoy gestured towards some dry, flaky patches on Sammy's head.
"Sure." Cameron took Sammy's hand in her own. The coral coloured skin was pale and papery. She caught the eye of a nurse, who hurried over.
"Get a line hooked up, and we need a humidifier, I want to keep the air moist." Cameron slipped her stethoscope under the neckline of Sammy's gown. She frowned at what she heard.
"Is there a problem?"
Doctor McCoy had retreated to the corner of the room to allow the staff easier access to the bed. Cameron was surprised at the nimble way he moved, despite his bulk. His feet made no noise on the floor. She scooted out of the way of the bustling nurses, and pressed her back against the wall next to McCoy.
"I think there's an irregularity: the dehydration may be more severe than it looks. It's hard to say more right now. I'll ask Doctor House to schedule an echocardiogram, we can get a better idea of what's happening."
"Where is Sammy's mother? Is he here all alone?" McCoy spoke softly, but Cameron could feel the vibrations of his deep voice through the wall behind her.
"I think she works. She's here sometimes. There's been some problems with the police as well, I think."
They both watched the nurses working swiftly, rolling in equipment, taping wires out of the way.
"Notice," said Doctor McCoy, "How they avoid meeting his eyes? They don't want to talk to him. I don't say this in reaction to the medical care Sammy is receiving — I'm confident that Princeton-Plainsboro is providing the best care available — but there is a certain atmosphere in this room. A hesitancy, perhaps."
Cameron watched a nurse peel the backing off an electrode and press it carefully onto Sammy's chest. He pushed around the edge of the adhesive disc without allowing his fingers to contact Sammy's pale orange skin.
"Do you worry about treating Sammy? It must be confronting to be responsible for his well-being when he's so very different to other patients." McCoy watched Cameron's face carefully as he spoke. "The potential for causing harm, that alone must be intimidating."
Cameron was silent for a few moments while the nurses worked.
"It's hard, because we've never seen a patient like Sammy before. And the chances of us being able to apply what we learn from treating Sammy to the next patient … I mean, what are the odds that another patient even has similar physiology? I don't think that it's Sammy's appearance so much as the fact that we don't know how to help him. It's hard to face a patient, knowing that."
McCoy nodded. "So, lack of information is an obstacle to good care?"
"Yes! We've got no training, no references, nothing to back up our decisions. And it doesn't help that this is the first time that Sammy has been sick. It would make our diagnosis safer if we had a more accurate picture of his health."
McCoy pressed his lips together in a grim smile. "Oh, my dear, please don't make the assumption that because Sammy's never been to a doctor, he therefore has never been ill. His mother has simply been too afraid to ask for help."
The Paré house was demolished, piles of rubble festooned with crime scene ribbon. The front lawn had been churned up by tires and countless sets of footprints. Foreman dug his spatula into the ground, spooned some of the crumbly earth into a sample bag, then waved it in the air.
"Here, label this, will you?"
Wilson took the bag, and gestured at the field of destruction that had been Sammy's home.
"Can you believe one person did all that damage? I can't believe it. And they caught the Juggernaut here. Right here!"
Foreman heaved himself back to his feet, and took the bag back from Wilson.
"Is that why you wanted to come with me? Kinda gruesome to pick over the debris like that." He labeled the bag himself and tucked away in his pocket. "We're supposed to be looking for sources of heavy metal contamination, not picking up memorabilia."
Wilson stopped kicking over planks of wood and looked a little bashful.
"I'm not going to be selling Juggernaut rubble on eBay." He helped Foreman lever up a half-buried pipe, and held it while Foreman swabbed inside the opening. "It's just, think about it. Dr Henry McCoy. He's a big kahuna in politics now, but he WAS an X-Man. A superhero. Can you imagine it? Being an X-Man, risking your life to save others?"
Foreman rolled his eyes.
"No, it's stupid. They're a bunch of childish attention seekers who put people in danger because they like to dress up. We save lives. We don't kill bystanders. So if you're done getting your Spider-Man underoos in a bunch, come and help me find what might be killing this kid."
The two men picked their way to the back of the property, which looked over a marshy expanse that led down to a river bank. In the distance, smoke stacks billowed into the grey sky. The water was brackish and sludgy, dotted with clots of foam.
"So," said Wilson, poking some alarmingly solid foam with his toe, "You got any ideas where we might find that?"
Dr McCoy sat gingerly on a chair with his hands folded in his lap, waiting for the discussion to begin. House was leaning back in his chair, face tilted at the ceiling, breathing soft and rhythmic, eyes closed. Minutes ticked on. Chase and Cameron looked at each other.
Foreman sighed and stood up.
"So, the patient, Samuel Paré ..."
"Sammy." Doctor McCoy had raised a finger to politely interrupt, "He prefers to be called Sammy. Samuel, I am told, is a dorkus name. As is Henry, apparently." He gave a wry shrug, then smiled at everyone.
House stood up again, his face twisted in exasperation.
"Click! Mr Secretary, we have a Kodak moment. And while we're on the subject of visiting hours, I'm so glad to see that it's hospital policy to allow an uncertified, hairy blue guy with mandibles to visit with and consult on patients." He leaned over and knuckled McCoy's chin. "Welcome to the team."
He took two rolling steps towards the whiteboard, picked up a pen and yanked the cap off with his teeth, but kept talking around it. "Shall we continue? Or should we pose for a group photo? It'll look great on the website."
McCoy stood up, pincered the cap out of House's mouth with two claws, and waved it at him.
"Choking hazard." He put the cap on the ledge. "I'm here to consult on a patient with variant anatomy, and that is something on which I am qualified to advise, as you know. I'm also here as an advocate, to ensure that Sammy's care is equal to that provided for non-mutant patients. And hopefully, my visit will contribute to the development of guidelines that will allow you to provide the best care possible for all of your patients, regardless of their x-gene status."
He walked back towards his seat, but turned back to face House. "In reference to my jaw bone, Doctor House, everybody has one. There's no need to point, just because mine doesn't look like yours. I assure you, it's quite normal for them all to look a little different. And I believe it is insects that have mandibles, in the plural."
Doctor McCoy sat down, and neatly crossed his legs. House rubbed his chin absently.
"Right, forget insects and bears. The topic is fish. Let's jaw, people!"
"MRI was clean, apart from some granular material in the cartilaginous tissues of his fin." Foreman brought the scans up on the laptop. "Muscle biopsy, electromyogram were both clean. No myopathies. No cancer."
"I've got basically normal cell counts for a kid his age and weight, and there's no elevated temperature. I think we can eliminate infection," said Cameron, "But his electrolytes are strange. He's hypocalcaemic: that could explain the arrhythmia, the fatigue and muscle abnormalities. I'm not sure about his parathyroid levels, since he doesn't seem to have any parathyroid glands. I guess that would explain a low blood calcium..."
"But Sammy has lived his whole life without parathyroid glands." McCoy reached an astoundingly long arm all the way up to the ceiling and poked at the rafters experimentally. "Surely he has been able to maintain calcium homeostasis up until now, regardless of the organ system that he uses to do it."
House walked over to McCoy and peered at the ceiling with him.
"You want me to have someone hang a swing for you? Chase can push." He turned to face the table. "Come on, kids! Why would the system fail now?"
"Something is displacing the calcium." Foreman suggested. "Heavy metals – he lives in an environmental cesspool. Explains the spasms, muscle weakness."
"It would have shown up on the tox screen." Chase tore his gaze away from McCoy. "A nutritional shortage? I don't think that his mom is the most nurturing, and she did have a new boyfriend."
Cameron slapped his arm.
"You don't know that. You don't know anything about her."
"I know she was doing the Juggernaut," Chase smirked. "I'm sure she had more to think about than whether Sammy was getting a glass of milk every day."
Cameron took in a deep breath, but before she could launch into her defence of Ms Paré, her beeper leapt to life, followed systematically by all the others in the room.
Sammy was arched up under his blankets, rigid from top to toe. His jaw was clenched, his teeth showing through lips drawn back in a horrible smile. House watched through the window as the doctors and nurses worked on the tiny, salmon coloured figure, pushing diazepam, intubating and ventilating.
While he was working, Foreman met House's eyes through the glass, and mouthed a question.
"Tetanus?"
House shrugged and walked away from the room.
Doctor McCoy sat in an alcove near by, with Sammy's mother. House perched on the edge of the sofa, and leaned down towards McCoy's ear.
"I assume that vaccines work on you people."
McCoy frowned at him, then excused himself to Ms Paré. He gathered House up by the lapels, and dragged him, with seemingly little effort, to an empty cubicle.
"Do you speak to all of your patients' family in such a disrespectful manner? Or is it just the mutant families that you prefer to intimidate and belittle?"
House slumped against the bed, and scrambled to get his feet under him.
"Well, I wasn't actually speaking to her, but yes, I think I do. If I have to speak to them at all. Why? You ever eviscerate anyone for being rude?"
McCoy looked at him gravely.
"Not yet."
House waggled his eyebrows. "Wow! Scary! Tell you what, let's exchange witty banter while the patient dies! Or maybe you can tell me if there's an increased vaccine failure rate in mutants."
McCoy released House's jacket and folded his arms.
"If there's a healing factor present, the vaccine may not take, but, of course, the same accelerated immune system will usually chew up the actual disease just as easily. I believe that Sammy has no such healing abilities."
House spun his cane; McCoy easily dodged the stick as it whirled past his head.
"Not tetanus, then. Kid was vaccinated right after the accident. Right. Come on!" He planted the cane on the ground, and headed for his office.
Foreman and Chase were back first, and they were exhausted enough that all they wanted was coffee and a place to put their feet up. Cameron followed afterwards, and ever-vigilant, she was the one who noticed what Wilson was writing on the white-board.
"What's 'blue slime disease'?"
"Ichthyobodo necratix, a protozoan infection, found in the gills." The voice came from the corner, where McCoy was hanging upside-down from a metal span across the ceiling, holding a heavy book. Cameron squeaked and jumped back. Chase boggled.
Foreman bent his head around to read the title.
"Veterinary Microbiology? You're using a veterinary textbook to diagnose a patient?"
"Why not?" House was clicking away furiously at the computer, "We're not getting anywhere treating him as a human. Here's one, look up 'white spot disease'. These names are great, by the way. It would save so much time if we could diagnose our patients by looking for blue slime."
Wilson wrote the disease on the board. McCoy flicked through the book.
"Ichthyophthirius multifiliis. No good, it's an external parasite. Doesn't fit our symptomology."
Wilson erased the disease again.
Cameron peered over House's shoulder at the computer screen.
"Tanks-a-lot.com. Is that a fish care website?"
"Uh huh." House clicked an icon and a buxom, bikini-clad woman appeared on the screen, holding a net. "Mrs Tanks-a-lot is really pretty, thus I judge her fish care to be completely on the level. But just in case, Doctor McCoy is double checking the facts in the vet book. That was his idea."
McCoy turned the page.
"Myxobolus cerebralis, black tail or whirling disease."
"Disease of aquaculture. And our boy doesn't whirl." House clicked buttons on the screen furiously. "Needs a tube worm to complete its life cycle. Did the river look like a place tube worms would go?"
"That river looked like Grand Central Station for worms," said Wilson.
"Whirling, that could be a muscular dysfunction, couldn't it?" Cameron was catching on.
McCoy continued to read.
"A myxosporidium with a tropism for cartilage and bony tissues."
Foreman took his feet off the table and opened Sammy's file. "There were those granular patches in Sammy's fin. Do you think that could be related?"
"The parasites digest cartilage and young bone, then migrate to the CNS. It certainly sounds like a possibility. Here's a scan." McCoy flipped the book round the right way and showed Foreman the colour plates. There were definite similarities.
"So, where's the calcium?" asked Chase. "He should have high blood calcium, if his bones are crumbling away. But it's low."
"He should have kidney stones too," said House. "But he doesn't. He has a super-kidney, and he's peeing his bones away with it. Check his urine for calcium."
"What's the treatment?" Cameron was frantically scribbling notes in Sammy's file.
McCoy flipped the pages back and forth.
"There doesn't seem to be a treatment listed here."
"Of course there isn't," House snatched the book out of McCoy's grip and threw it at Chase who caught it with a grunt.
"It's not economically viable to treat a fish, but do we care about economically viable in this hospital? Hell no! Let's burn some money on this little fish. Let's try furoxone first." He raised his eyebrows and struck a meditative pose. "Of course, he'll be no good for eating."
It was warm for an afternoon in October, warm enough to entice House onto his office balcony to eat his lunch and catch his soap. Wilson, naturally, had brought the food. House brought the television.
"Sammy Paré went home this morning." Wilson handed one sandwich over, and peeled the paper away from his.
"Who?" House was engrossed in a tragic scene of betrayal.
"Fish head? Parasites? Remember him? McCoy got him into some kind of private school."
"Oh. Great." House bit into his sandwich, then sprayed crumbs over the screen. "No, wait! Is this the place where Chase has been doing consultations?"
Wilson nodded, his mouth was full. He chewed vigorously, then swallowed. "They used to have a doctor in-house, but now they don't."
"And McCoy's involved with that place?" House snorted. "Suddenly Chase's dedication to volunteer work makes sense." He leaned back in his chair, and balanced the tiny television on his chest to better appreciate the sordid details.
"We interrupt your regular program to bring you a news flash from Alcatraz Island, home of Worthington Laboratories ..."
"Oh for god's sake!" House reached out and snapped the television off. "If I wanted to know about real life, I'd get a job in a hospital."