Returning to the lounge, only House was there. Receiving me in silence he looked at me for a second before returning his attention to the board. Holding his chin with his cane completely still. "Miller try to recruit you?" he asked still without looking away from the board.
Taking a seat in one of the chairs around the lounge table. "Yup" I answered, making House scoff.
The rest of the team arrived several minutes later and with the four of us there, we started discussing theories again, without getting anywhere.
With Mary's complete chart spread across the table along with all the studies and images we had of the girl. Shaking his head. "No toxins, no tumor, no bone cancer" Chase listed, frustrated.
Tilting his head back against his chair, exhausted. "Renal failure could cause the rash, fever and muscle pain" Foreman commented, "maybe it's some sort of genetic kidney disorder" he added.
"There's no family history" I denied immediately.
"And no blood in her urine or uremia" Chase added.
Shrugging. "Not yet" Foreman murmured hopefully.
Pulling his head back incredulous. "So, you want to do a differential based on symptoms that might happen?" Chase asked irritated.
I agreed with Chase, it was a reach on Foreman's part.
Crossing his arms. "You got a better idea?" Foreman asked haughtily.
"Stop it" House ordered, now pacing back and forth, "stop looking for things we don't know and focus on what we do know" he said shaking his head, "what do we actually know besides what's up there?" he pointed at the board, "come on" he urged frustrated, "how hard can it be to tell me what you already know?"
Closing my eyes I leaned back in the chair keeping all the symptoms written on the board in my mind.
There had to be something I was ignoring. Something I was overlooking.
I was the one who knew the most about Mary, maybe unconsciously I had the answer.
"She's twelve" Chase offered.
Yes, a twelve year old girl, caucasian, five foot three, who had never left the country, good nutrition and definitely no substance abuse.
The symptoms didn't match any diagnosis with her clinical picture.
"She spends a lot of time in pools" Foreman murmured, "so exposure to chemicals."
Wait.
"She travels a lot" I heard Chase say.
It can't be.
"But never out of the country" Foreman denied.
Had her age blinded me, or did I simply not want to see it?
"What else?" House asked, "come on!" he added a moment later, receiving no response from anyone.
Straightening up I opened my eyes again, returning my attention to the board. If I ignored Mary's age and focused only on the symptoms, the range of possible diagnoses opened up, it was painfully obvious.
Fever, neck pain, rash, gastrointestinal bleeding, absence seizures and an intracranial hemorrhage.
Damn it.
Following the trail of symptoms the diagnosis reached my mind. Immediately, and with enough desperation to catch the attention of the doctors in the room, I searched through the papers on the table. "Fuck" I muttered under my breath once I found the blood tests.
Of course I wouldn't find the study I was looking for, it was the early nineties in Texas, although even in the future there still wouldn't be national standardization on the matter.
House, who was halfway out of the lounge, stopped when he noticed me searching through the papers. "Wow" he exclaimed surprised, "you kiss your mother with that mouth?" he asked me sarcastically.
Ignoring House, I pressed my hands against my face going over the diagnosis mentally one more time, each time I thought about it I convinced myself a bit more. "What if it's not a rash?" I asked annoyed.
"Then what?" Chase asked confused.
Shifting his attention to the board, House frowned thinking in silence.
"Like she's bleeding into her own skin" I explained, making House suddenly turn his attention toward me, frowning. He was clearly silently ordering me to explain myself.
Sighing I shook my head looking at the blood tests on the table in front of me. Of course there wouldn't be a pregnancy test, Mary was twelve years old.
"She's precociously sexually aware" I admitted a moment later.
It wasn't a pleasant thought at all and it was even less pleasant that I knew it but had decided to actively ignore it.
Frowning, reacting as if he'd been struck. "What?" Foreman exclaimed incredulously.
"She told us she was used to thousands of people seeing her butt" I reminded him, making Foreman frown.
The moment he remembered it was clear to everyone, even so Foreman shook his head. "I don't think that-"
Interrupting whatever the other doctor was about to say. "You told me there was nothing else relevant" House accused me angrily.
Pressing my jaw. "I didn't think it was" I defended myself without much energy, it was half true, now I saw that I simply hadn't wanted it to be relevant.
It had been a huge mistake on my part. I dismissed something that could be important to a patient's diagnosis just for the sake of my own mental health, I had preferred not to believe that a twelve year old girl was sexually active than to trust my reading of her.
Worst of all was that I knew the statistics on underage on underage sex, the number of teen pregnancies and the problems they implied, and still, knowing the whole time how much unsupervised time Mary spent with dozens of teenagers... I was an idiot for not seeing it, or rather, for seeing it and doing nothing about it.
Slamming his cane against the floor. "Well clearly it is!" House yelled at me, furious.
Surprising everyone, Foreman stood up. "Hey, I was there too" he said defending me, "it was just a quick comment" he added shrugging, "anyone would have overlooked it."
House scoffed. "Yeah, anyone" he said with contempt, "he didn't" he pointed at me without even turning to look at me, "he only let it go to protect himself."
He was right.
Once again my emotions had outweighed my interest in the diagnosis and, therefore, my interest in a patient's wellbeing.
Keeping his frown throughout the whole discussion. "Even if it's true. What does that mean?" Chase asked confused.
I could imagine that House, unlike Foreman who seemed to be asking himself the same question, had already reached the same conclusion I had. "I think she has purpura" I answered, "byproduct of a pregnancy" I added a moment later seeing that neither Foreman nor Chase believed the diagnosis.
I couldn't blame them Mary was not old enough to be going through menopause, she had no history of painkiller abuse, and there was no record of the disease in her family, but the hormonal imbalance generated by pregnancy could, in very rare cases, generate a case of thrombotic thrombocytopenic purpura, a serious hematological disorder.
The blood platelets are consumed causing the vessels to become partially obstructed, thereby breaking the red blood cells that pass through forced, creating schistocytes visible on the smear that can be mistaken for a common rash.
With secondary symptoms like fever, muscle pain, gastrointestinal bleeding and neurological effects, the diagnosis fit Mary's picture like a puzzle piece.
Finding nothing to counter the theory, aside from Mary's age perhaps. "Oh, God" Chase murmured defeated.
Foreman just stayed silent staring into space. "Do you think the coach..." he asked a moment later, stopping himself perhaps out of fear or disgust at the implications.
I was about to deny it immediately, after all according to what I'd seen in the interactions between the man and the girl there was nothing to suggest it, but I could be wrong. Maybe once again I hadn't wanted to see something.
Noticing my hesitation in answering, obviously remembering the confidence with which I'd answered that same question quite a while ago. House looked in my direction again. Scoffing with disappointment and a certain disgust. "That's not important right now" he said answering Foreman, "what matters now is finding out if the diagnosis is correct" ignoring me once more, he turned to Chase. "Go do the blood smears again, look for cell fragments" he ordered, his breathing slightly agitated.
Studying my face for a second, without any mockery or condescension, at least none I could recognize at that moment. "Yeah" Chase stood up, immediately following House's instructions.
Walking up to the board, House erased the word 'rash' with a certain aggression.
"I shoul-" I tried to say.
"Go home" House interrupted me, writing the corresponding replacement on the board next to a question mark.
Shaking my head I stood up immediately. "But-" I tried to defend myself this time with genuine interest. I wanted to make sure my diagnosis was correct, as well as my prior read on the coach.
It wouldn't erase the mistake I made out of cowardice, but at least it would help Mary in one way or another.
Interrupting me once more. "I said go home!" House exclaimed slamming the marker against the small rail beneath the board, causing all the markers, including the one he was trying to set down, to fall to the floor.
Opening my mouth I couldn't make a sound while I watched House storm out of the lounge, avoiding looking at me the whole time.
Feeling my chest strangely heavy I stayed frozen on my feet in the middle of the lounge, coming out of the shock only when Foreman stood in front of me.
Keeping his face expressionless. "Don't blame yourself" he said after a moment of silence, "he can't demand that high a degree of perfection from you, he wasn't even there. I'm telling you, anyone would have overlooked it."
Maybe House can't demand that high a degree of perfection from me. But, what about myself?
Nodding robotically, I watched the man mentally debate whether to say something else, finally deciding, making a small sympathetic grimace that looked like an attempt at a smile, to leave after House toward Mary's room.
Alone in the lounge, I thought about how everything had unfolded. It was the first time House had been truly angry and disappointed with me. I didn't know how to react or how to feel about it, it was strange.
The way out of the hospital was a blur. I couldn't even remember passing the guard at the main entrance or saying goodbye to anyone along the way.
In the parking lot, getting into my car and starting it, the music that played a moment later seemed to come from underwater and the incoming light around me from the sunset was less bright than it should have been, I couldn't feel my hands despite being able to control them and my head seemed to float.
Turning over and over in my head the decisions I'd made and why I'd made them, as well as the what ifs of having made any other decision, I sank even further into how I could have spared the girl the suffering if I'd only ignored my discomfort and acted on it.
Feeling the dizziness of recognizing the beginning of a panic attack. I breathed deeply focusing my attention on my hands, I could hear over the noise of the music my heart pounding in my ear and I felt the sweat running from the base of my hairline down to the start of my back.
I knew that, unlike what people at the hospital might think, I was not at all a genius, a medical prodigy, someone incapable of making mistakes, I knew it but, despite that, there was a small part of me that hurt to be reminded with such a harsh dose of reality.
Managing to slow down my heart rate and the pace of my breathing, I managed to avoid a full blown panic attack and, even though I knew I wouldn't be able to stop thinking about the case, I drove out of the hospital.
Luckily the road home, as always, was practically deserted, allowing me, even though my concentration wasn't a hundred percent focused on my driving, to get home without any trouble.
Entering the house I immediately found mom, who was feeding Charlie her bottle while watching television. Given the time of day, and thanks to the fact that Teddy had gone with Bianca, I knew there was no one else in the house.
Turning, surprised, at the sound of the door opening. "Hey" mom said, smiling puzzled "you're home early" she added checking the clock on the wall, "do you have something planned with Diane?" she asked, arriving at a conclusion on her own, returning her attention to Charlie, who had started moving in her arms.
Oh right... dinner with Diane.
"Yes" I answered, and something in my tone must have worried mom, because she turned toward me suddenly with a frown.
"What's wrong?" she asked me.
Surprised by mom's perceptiveness and embarrassed at the same time by how easily she'd read me. Sighing heavily I closed the door behind me. "I made a mistake" I admitted several seconds later under mom's watchful gaze.
I had accepted the moment I made the diagnosis that the mistake was entirely mine, but for some reason saying it out loud hurt quite a bit more.
Stretching out her hand, urging me to come closer. "Oh honey, what happened?" mom asked with sadness.
Rubbing my neck I walked over to the couch, and feeling like I'd already been sitting for too long, decided to let myself fall lying down along it, I was completely exhausted. "There's this case-" I tried to say, but mom interrupted me, patting her leg gently.
Taking a second longer than I'd like to admit I understood what she was telling me. I crawled over on the couch resting my head on her leg.
Stroking my head carefully. "So, the case?" mom asked.
At first I was quite embarrassed to tell the story, but the more I told mom how I'd reached the diagnosis the easier the rest was to tell.
Several minutes later. "You never cease to amaze me with how smart you are" mom declared with pride, "you solved such a complicated case and now you're tormenting yourself for not having done it faster" she said laughing in disbelief.
Scoffing. "That's not it-" I denied.
Waving her hand in a dismissive gesture. "Oh no, I know what it is" mom assured me, "you were scared to trust your own judgment and now you're even more afraid it'll happen again" she added easily.
Thinking for a second. "Well, in short yeah" I nodded, it was a very good summary of how I felt.
I mean, I definitely felt bad about how poorly I'd handled Mary's case, if it weren't for my lack of action I definitely would have solved the case faster, maybe even avoided any surgical intervention. But ultimately, what hurt the most was doubting myself.
"But of course" mom exclaimed with obviousness in her tone, "and it's going to happen again."
Feeling my heart jump out of my chest. Frowning I turned on her leg.
And before I could say anything, mom continued. "Oh yeah, maybe not for a while, but I bet you it will" she assured me, "you might be the most brilliant mind in medicine seen in all of history and I know you're going to be the best doctor humanity has ever had" she fondly hit my head, as if making sure it stuck, "but right now you don't have the experience" she added, lowering the energy she'd been speaking with until then, shrugging.
Scoffing amused, I watched mom smile with complete nonchalance.
"And without experience" she raised her finger emphasizing, "the only way you have to learn is by making mistakes, and you're going to make a lot of mistakes" she said looking at me steadily, "but you as my beautiful, smart, talented and somewhat annoying son" she joked stroking my head again "you will never be confronted by any mistake you can't recover from and learn something valuable from."
Scoffing I shook my head.
I wish it were that easy.
"Mom-" I tried to say.
"No, PJ" mom interrupted me, "you need to remember this very well" she continued seriously, leaning toward me, "you're not perfect" she declared smiling apologetically.
Unable to help it, remembering how I'd nearly had a panic attack over that exact thought, I let out a dry laugh.
"No one is" mom continued keeping her seriousness, "but that doesn't have to stop you from being the best version of yourself you can be."
Feeling mom's hand stroke my hair once more, unable to help it, I smiled a bit more at ease.
"Now you might be scared of making a mistake like that again" mom murmured, "but I know that if a twelve year old girl comes in front of you with the same symptoms, you won't let any bias keep you from helping her, right?"
"Yeah" I murmured.
I had a lot of experience in dozens of other areas, I had stopped countless bleeds with my own hands, brought hundreds of people back from the dead, had dealt with the worst humanity had to offer and had come out victorious in many of those occasions, but I had certainly never gotten involved enough with a case to have to deal with child pregnancies.
I hope I'd never have to go through something similar again but, if it happened, I knew I could react much better.
Surely noticing a change in my mood. "And if one of those many mistakes you'll make in your career makes you feel bad again, well my legs will always be here for you" mom said cheerfully, "it's just that right now your giant brain is pretty heavy and mom can't feel her legs anymore" she added joking while gently pushing my head.
Scoffing incredulous I sat up with exaggerated effort.
Amused by my theatrical display. "Hold her" mom said passing Charlie and her bottle to my arms.
Holding my sister, I watched her in silence drink her formula smiling, noticing how she was completely focused on my face, without any change of expression she drank vigorously.
"You're going to be the cutest nun of them all" I joked softly, making mom, who was stretching standing in front of the couch, scoff loudly laughing outrageously a moment later.
Since I had a couple of hours to kill before my date with Diane, I decided to spend the time with mom and Charlie in the living room. With just a couple of seconds watching television I recognized the same soap opera House watched daily and having nothing else to do, settling into the couch I paid attention to the television.
I have to admit somewhat embarrassed that, without realizing it, I slowly got lost in the plot of the soap opera. Despite the medical inaccuracies and the exaggerated acting of the actors, the story had a certain bizarre captivation, in other words, it was so bad that somehow it was good.
So absorbed was I in the television that, when the front door suddenly burst open, I jumped startled, snapping out of the trance.
Gabe, carrying one of his guitars, ran into the house heading toward our room. "Hey mom" he said, not noticing I was sitting there.
Not taking her eyes off the television. "Don't run in the house" mom ordered him.
Much calmer but feeling the embarrassment of having been so absorbed in the soap opera, I let my eyes wander to the clock on the wall, freezing a moment later at the sight of the time. "I'm running late" I exclaimed worried. I had to take a shower and change my clothes to get to Diane's on time.
At the same time as Bob was coming through the front door, I stood up and practically jumping over the couch ran to the bathroom. "Hey, you're home early" Bob said as I passed by him.
Already halfway to my room. "Yeah, sorry can't talk" I said out loud.
Inside my room, Gabe, who was halfway through taking off his shirt, had the bad luck of being in my way.
Even though I could well have made the effort to dodge him or maybe waited the second it would take for him to step aside on his own. With Gabe having his head halfway through his shirt, I chose the more fun option.
Suddenly flying through the air until he hit his bed. "Hey!" Gabe shouted, terrified. Pulling his head out through the hole of his shirt, he frowned at me.
Grabbing my things, I turned on my feet running, again, out of the room. "No time" I said in passing, unable to help smiling mockingly at my brother.
"What is wrong with you?" he exclaimed at my back, obviously annoyed.
Getting ready in record time, I came back out to the living room. "All right, what do you think?" I asked adjusting my shirt collar, making mom, who was still on the couch, turn to look at me.
Smiling widely. "You look absolutely handsome" she assured me.
Relieved. "Thanks" I nodded.
I had no idea what kind of dinner Diane had prepared and therefore had no idea what kind of outfit was appropriate, so I bet on something semi formal, a shirt with a blazer over it, London had given me so many clothes that it was an outfit I hadn't worn yet.
Coming out of the kitchen, now fully dressed to train with Case. "Are you going to train dressed like that?" Gabe asked me incredulously.
"Oh" I had forgotten, glancing at mom sideways, "where's dad?" I asked Gabe with a bit of anxiety. Even though it would be funny, I couldn't send Gabe with mom to the training.
Pointing behind him, at the kitchen, Gabe quickly moved out of my way. He seemed to have learned his lesson.
In the kitchen, Bob was in front of the open refrigerator door, probably looking for a snack before dinner. "Dad" I said, startling him.
"Hey" he said pulling his head out of the fridge, "you look good, got a date?" he asked me raising his eyebrows.
"Oh, yeah" I answered looking at my clothes again, "I'm actually a little late" I added, I hadn't really agreed on a specific time with Diane, other than knowing she was expecting me after my usual time getting back from the hospital.
Shaking his head with exaggerated disappointment. "Never keep a lady waiting" he reprimanded me raising one of his fingers, "you need money" he declared, immediately pulling out his wallet.
"No, no," I answered, avoiding taking the bill the man was offering me "it's Gabe-"
"Yeah, yeah, I'll take him" he interrupted me, forcing the bill into the front pocket of my blazer, "now get out of here" he added shooing me away, "be a gentleman" he reminded me while pushing me out of the kitchen.
"And be responsible and smart" mom added as a warning.
Walking on my own to the front door, I grabbed my keys and checked one last time that I had all my things, wallet and keys. "I always am" I declared with exaggerated confidence, bordering on arrogant.
Scoffing mom shook her head. "I'm being serious" she said raising an eyebrow.
Nodding. "I know" I answered raising my hands.
...
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, not Capone, not Tiger Woods, not Sam Fisher and not Greg Louganis.
Another chapter has passed, so new thanks are in order. I would like to especially thank:
11332223
Victor_Venegas
RandomPasserby96
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
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