lit_luminary: (In my image (sort of))
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Title: Acute Management
Author: lit_luminary
Rating: PG-13 for medical realism.
Characters: Chase, Dr. Harper (of S2's disability support group), some discussion of House.
Summary: In the ICU, Chase is evaluated by a psychiatrist and waits to count his losses.  (Set before the outcome of the Cofield inquisition.)
Notes: Grateful thanks to [ profile] resourceress7 for serving as this fic’s First Reader, and also for her magnificent compilation of Resources for Sick!Fic (Hurt/Comfort) Readers & Writers (see her LJ's sidebar).

A day after the embolectomy, Chase has had an MRI, a complete blood panel, a neurological evaluation involving enough poking and prodding to eliminate whatever shred of dignity incontinence hadn’t stolen, and a small pharmacy of meds.

High-dose methylprednisolone to reduce swelling around his spinal cord.  Ranitidine to protect against ulcers—he’ll probably be on that for several months.  Thrice-daily injections of heparin to prevent clots (a measure augmented by compression stockings that he doesn’t feel).  And morphine for postoperative pain, which works beautifully as an analgesic, but doesn’t have the half-hoped-for effect of leaving him stoned enough not to care how much wiring’s offline in his central nervous system.  He’s still painfully aware of being tethered to a bed in ICU by a web of medical apparatus and his own unresponsive lower body.

There’s an NG tube and TPN to compensate for his paralyzed gastrointestinal system, and a Foley to decompress his bladder and collect his urine (lost connection to his sacral nerves means it’s not uncomfortable, but he’d rather have sensation).  A Swan-Ganz catheter in his pulmonary artery, transmitting ECG, pressure and venous oxygenation readings from his heart.  A chest tube so any fluid from the thoracotomy can drain.  A nasal cannula.

All of it feels like additional restraints, stealing what little mobility he has left.

And just to top off this nightmare, Foreman’s called in someone from New York Mercy to assess the incident and decide whether to send House back to prison.

There’s a rap on the glass, then a dark-haired woman in a lab coat steps into his room, carrying a clipboard.  “Doctor Chase?  I’m Doctor Harper.  I’m with psychiatry.  Are you feeling up to an initial evaluation?”

He considers—he’s tired, but his mind is clear—then meets her gaze.  “Will it matter if I say no?”

Harper gives him a sympathetic smile and sits down in the visitor’s chair beside his bed.  “You’ll have to talk to me sooner or later,” she says.  “And I can’t make informed recommendations to the rest of your care team until you do.”

He may as well cooperate with her.  It’s not like he has anything better to do than lie around and wait for the next nurse to help move him so he doesn’t end up with pressure sores.  “Fine.”

“Okay then.  Have you ever had psychotherapy before?”


She makes a note on the clipboard.  “My specialty is disability issues,” she says, making eye contact again.  “Basically, I’m here to help you cope with your feelings about your injury so you can make as successful an adjustment as possible.”

Right.  Talking to a complete stranger about a loss she can’t possibly understand will make this so much better.

Some of that sentiment must show in his face, because she raises an eyebrow at him.  “Not a believer in psychotherapy?”

“Telling you I hate that my legs won’t move isn’t going to make a difference.”

The disagreement he expects from her doesn’t come.  “What’s your specialty?”

“Intensive care.”

Before this, the ICU meant mastery.  Certainty of his own competence, of how to manage failing systems to keep patients alive and how, sometimes, to save the ones who looked like they shouldn’t have had a prayer.  Now, it just means the special humiliation of having worked with the staff changing his surgical dressing, feeding him by IV, checking the urine output in his catheter bag, and who’ll be managing the meds that get his bowel to work once he’s back on solid food.

“Does that make this easier or more difficult?”

Chase shrugs, musters a smirk.  “Knowing the protocols and the prognosis helps.  The irony probably doesn’t.”

“You feel hopeful about your prognosis?”

He could.  Nothing is certain yet.  It’s possible—not likely, but possible—that the clot did only minor damage, and what he’s experiencing now is just spinal shock.  Possible to hope for a full recovery once it resolves.

But that hope would assume a just universe, assume that life is fair.  It isn’t, and experience tells him that hoping for too much is the most dangerous thing he could do.  If he lets himself believe he’ll heal from this, walk unaided, and finds out later that he never will…

No.  Recovery is going to be painful enough without setting himself up to crash.

“Realistic,” he corrects.  “We’ll know more once the swelling goes down and we can get accurate imaging, but L5 injury gives me a decent chance of walking again.”  Maybe walking supported by a walking frame, or forearm crutches and orthoses to brace his legs, but walking.  For that, he can be grateful.  “Doesn’t mean there’s not permanent damage.”

Harper nods.  “That’s true.  But you will be able to adapt.”

She doesn’t have to tell him that.  He’s had his life upended before and survived.  He also knows, intellectually, that tens of thousands of people with injuries like his and worse are leading fulfilling lives, that they have careers and families.  He knows that feelings of depression, frustration, helplessness are normal.  He’ll feel better with time, and especially with being allowed out of bed and starting to relearn how to move, how to regain his independence.

But knowing that doesn’t do anything to make him feel better now.  Not when his body’s handed him a long list of probable losses he hasn’t dared count, and the only person who understands anything of what he’s going through could be back in prison tomorrow.

“Can I have a brief description of what happened for the history?”

He’ll have to dredge up the rest later, recount the circumstances so the doctor Foreman appointed can judge who and how to punish.  For now, he gives facts.

“A patient stabbed me with a scalpel, making a small laceration in my left ventricle.  It was repaired surgically.  I woke up in PACU and couldn’t feel my legs.”  He draws and releases a breath, reaching for the detached, efficient calm he’s always relied on in crisis, but it won’t come.  “House diagnosed occlusion of the radicular artery.  He was right.  I had an embolectomy.”

“Thank you.”  She makes a few notes.  “You said you’ve never had psychotherapy.  Have you ever had any psychiatric conditions?”

She could probably pull several diagnoses out of an account of his childhood, and he’s certain of acute PTSD after he’d killed Dibala.  None of it’s germane to what’s happening now.  “No.”

Harper’s expression says she doesn’t believe him, but she can’t call him on it.  She records the list of his current medications, his basically nonexistent social history, his mother’s alcoholism and depression and his father’s smoking, and assorted other facts that have nothing to do with his being trapped in this bed.  Finally, putting the clipboard aside, she asks, “Have you called anyone to be here with you?  A friend?”


“Are you going to?  Or is there anyone?”

“House,” he says, half to see her reaction.  “If he doesn’t go back to prison.”

Raised eyebrows, pursed lips, and the reappearance of the clipboard for a few scribbled notes.  Then, “You’ve worked with Doctor House for how long?”

“Nine years.”  He gestures at the clipboard.  “Diagnosing Stockholm Syndrome?”

Harper shakes her head.  “You’re much better off with any kind of support than with none.”  Still, she looks concerned.  “Best-case, this investigation is unnecessary additional stress.  Worst-case…”

Worst-case, revocation of House’s parole.

He’s handled crises on his own before, and it’s not as though he’d be left alone with this.  He has an intensivist, a physiatrist, a physiotherapist, an occupational therapist, a psychiatrist, nurses all overseeing his case, all willing to give as much help as they can.  But what medical science can do for him is limited.

He wants House here because House knows what it’s like to be stuck in a bed, stuck being dependent on others, stuck in a body that doesn’t work the way it should and never will again.

Harper could put him in her support group, give him a room of other disabled people to talk to (he supposes he’ll resort to that if there’s no other choice), but even strangers going though similar experiences would still be strangers.

House will never show him what most people would recognize as concern, never ask how he is or sit at his bedside, but he knows what he’s going through and knows him. Whatever support he decided to give would be unusual and very probably annoying, but it would be the best thing for him.

“He’ll help, if he can be here,” Chase says.

“The kind of support you’ll need… that’s something you think Doctor House would do well?”

Chase smiles wanly.  “I don’t expect flowers and sympathy.  But that’s not what I need.  That’s just what people do when something tragic happens.”  It’s a way of saying they’re sorry, acknowledgement that his being crippled is horrible.  Not so unlike the wave of concern and advice he’d gotten after Cameron left, really.  Well-meaning, but having more to do with their own feelings than with him.

He’s got very little patience for that sort of thing.

“And what do you need, Doctor Chase?”

“Right now?  To sleep for a while, I think.”  It’s not only an excuse to cut this evaluation short.  Between his injuries and the morphine, he’s going to fall asleep before much longer.

It’ll be a welcome escape.

Harper picks up her clipboard and stands, pausing in the doorway.  “Doctor Cofield will probably visit later to ask you about the incident.”

To judge what happened so he can place blame.  As if choosing someone to condemn will do anything but more damage.

Chase nods.  “Thanks for the warning.”

He knows that from the outside, House’s methods seem like madness, but he’ll try to make Cofield understand that they aren’t.  What happened to him was an aberration, not anyone’s fault (it was his own, but he knows better than to say that for the record).  House had given him a chance of recovering function, and what looks like callousness is House’s particular way of giving a damn.

He’s learnt to rely on House’s help when things go catastrophically wrong.  He doesn’t want to find out if he can handle having that taken away along with everything else.

Note: For the purposes of this ‘verse, Chase is an only child.  I found canon’s attempt at retroactive continuity in S8 utterly ridiculous.

Next Chapter:
No Such Thing as Absolution

Date: 2012-07-30 04:01 pm (UTC)
From: [identity profile]
I really liked this. A very good insight in Chase's feelings, and a great research work on the actual consequences of such a spinal lesion.
My only complaint is that it makes me more aware fo what canon did NOT do.
So good to have you write again!

Date: 2012-07-30 05:59 pm (UTC)
From: [identity profile]
Thank you so much for your comment! It's good to be writing again.

This 'verse is going to be an ongoing project: I want to explore Chase's adaptation to this injury, and House's to being called upon to give support. (Needless to say, it's going to be difficult for them both. But that, of course, is what makes it interesting.) You can expect another story within a week or so.

Canon could have done so much with the parallel between House and Chase created by the SCI, and instead, the writers simply threw the opportunity away. So I'm going to do what they wouldn't: look at the medical and psychological realities of this kind of injury, and compare Chase's response to disability to House's.

Date: 2012-08-09 02:38 am (UTC)
From: [identity profile]
Really enjoyed 'Adaptations,' as well as the Daemonverse. This certainly makes more sense than canon did on the matter of Chase's injury. Then again, the writers have often played fast and loose with the medicine, despite having 'medical advisors' on set.

Date: 2012-08-09 06:18 pm (UTC)
From: [identity profile]
Thank you for your comment! The "Adaptations" 'verse will be continuing; I have quite a few more chapters planned, and have found excellent co-researchers to ensure a realistic depiction of spinal cord injury and its consequences. I'm particularly looking forward to exploring the parallels between Chase's response to disability and House's.

(The Dæmonverse will also eventually continue, by the way; I'm glad to hear you enjoyed it.)

Date: 2013-07-27 10:30 pm (UTC)
From: [identity profile]
This is exactly right. The emotional distance and numbness, but being forced to deal with day-to-day reality, and knowing no one around you can ever really understand what's happening--even you have trouble with it . . . perfect.

Date: 2013-07-27 11:05 pm (UTC)
From: [identity profile]
Thank you so much. The tone and psychological landscape had to be just right here, and it's nice to hear I achieved the right effect.


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