Knots: Patient Zero (10/12)

Part One (By Pitza)
Part Two
Part Three
Part Four
Part Five
Part Six
Part Seven
Part Eight
Part Nine


Notes: This was supposed to be the final chapter, but there was a change of plans because I have a couple of loose ends that need to be tied up from Wilson’s POV, and I need to let the last scenes between House and Wilson stand pretty much alone in order to make them work. This part is about 2,300 words. Parts 11 and 12 are about the same length, which is too much material for one post. I promise that I won’t take another month.


The superbug is real; the patient’s strain of Staph A does not respond to Vancomycin, or anything else. House shudders as he looks at the microbiologist’s report. On one hand, this is a bad development for medical professionals all over the world. On the other hand, it’s better to know what you’re fighting if you’re planning on beating it.

Gorman’s team at the WHO is trying to work out where and when the patient contracted the bacteria. House wishes them luck. They’ll never be able to pinpoint the source, this case involves three hospitals on two continents, and their work won’t make any difference in his, so he chooses not to care about the source. The team at Canton University Hospital hasn't helped the patient, not one bit. If House cared about professional courtesy, he'd say that he's surprised.

His plan is to go back to square one. The others have little choice but to agree. House knows that it’s a long shot, but he takes the patient off all drugs except painkillers for 48 hours while he analyzes what hasn’t worked so far.

“Tazobactam is our best shot, it’s a new penicillin derivative,” House tells a room full of doctors. “Please tell me that stuff is legal here…” he stops, knowing full well that he wouldn’t be able to prescribe the drug in New Jersey without pulling some strings and twisting some arms. He’s not sure his bullying will translate well enough to work in a country known for knives and neutrality.

“This drug is approved since six months,” one of them says in halting English. “We have not the politics in our drug approval process…”

“Spare me the commentary and write the order,” House snaps. “And somebody get me some coffee.” The white coats scatter. One of them returns with a cup. House doesn’t thank the person he suspects is a student, but he nods, and that seems to be enough.

“You don’t have to try to frighten these people,” Gorman tells him. “They’re scared enough as it is.”

“They should be,” House says, taking a sip. The coffee is smooth and strong, much better than he’d get in any American hospital. “You wouldn’t have asked me to come over here if you didn’t need this patient to survive.”


House sits alone in a lounge studying the chart, He enjoys the leisure of working on single case, which rarely happens in his regular practice. When one of the staff doctors enters the lounge, House notices, but he sees no reason to let the guy know.

“Since the change in antibiotic, the patient’s symptoms are not improved, and the culture remains positive,” the man says. House looks up at him; he’s the same one who wrote the drug order.

“Who are you?”

“Pardon,” the man says. “I am Michel Levasseur, I direct the program for diagnostic medicine here. Frederick has mentioned your name so often that I feel I know you already.”

House takes a moment to remember that Frederick is Gorman’s first name. “Gorman talks a lot, he’s a little, you know…” He makes a face and wiggles a finger in the air. “The tazobactam isn’t working…”

He falls silent for a moment. “What do we know about his treatment in Vietnam? Are we talking about some hut in the middle of a rice paddy?”

“No no, Saigon Grall Hospital is a modern facility…” Levasseur continues to sing the praises of Asian medical care. If the patient had a post-surgical line infection, the chart would say so, but there is no such notation. The high fever and vomiting that indicated an infection showed up after the patient returned to France.

The facts of the case tell him that the infection is localized, but the damned thing is hiding, and the patient’s vitals are not helping with the answer. Pressure slightly low, but acceptable. Temperature slightly elevated, controlled with acetaminophen, sats at ninety-three percent.

He wanders away from Levasseur’s monologue. He wasn’t listening, anyway. He walks around the hospital for a while wishing he had an underling to abuse. If he were back at PPTH, each aimless step would bring him closer to the answer, but every object and every person is new to him; his active mind does not shut off the way it does at home.

That he needs familiar surroundings, that he needs anything, bothers House. What he needs is to stop thinking so much.

“The trouble with a new strain of bacteria is that we don’t know how it’s supposed to behave,” House tells Gorman shortly before lunch. “Even I can’t come up with an answer unless I know the question.” He pulls his hair in frustration. “Tell somebody to get Patient Zero another chest CT and we’ll see if that gives up any clues.”

House starts to wonder whether he is going to be able to solve this one. He doesn’t care that much about patients, but doesn’t believe the adage about a losing battle being a learning experience. An honest man admits that losing always sucks, and House is an honest man.

“I’m going out,” he says. He leaves without looking back.


He ends up across the river, at the train station. Bodies move in their own language, and he figures that the comings and goings will free him up to think properly. His leg does not bother him today, it never does when his mind is engaged with something else, but he feels each step.

He walks to the front of the station and gets into a cab, tells the driver to go; he doesn’t care where. Low blood pressure, low oxygenation, and low-grade fever means the antibiotic is not working. The infection is more than the new drug can fight, but the drug was developed before VRSA was imagined, so that’s not a surprise.

The cab stops at a light. House glances out the window. A woman leans against a wall about ten feet away. She stoops to scratch her leg. House notices that her nipples show through her tight white shirt. She makes no effort to hide them.

He has heard that Geneva has a red light district; this must be it. He motions for the driver to pull over and fumbles for a verb. “Arrêtez,” he says after a moment.

He gets out and walks down the block, losing himself in the anonymity of the Rue de Berne, which looks perfectly ordinary other than the people that walk with him. It’s odd to see hookers during daylight hours. They lose a bit of their mystique in the sun, if they have any to begin with.

He notices one of them, a small, frowzy woman who looks a little too old for the street trade, yelling at a man in a leather coat. The man grabs her by the shoulders and shakes her; maybe he’s her pimp, or maybe he’s a john. It’s none of House’s business and their dispute fades out of his head as he soon as moves past them.

He chooses a shop from the block’s wide selection and goes in. At home, this kind of place is called dirty; it is a solitary building on the edge of Anytown, USA, where the parking lot is always full. Here, colored light flashes from signs in the windows, beckoning like the girls who stand outside fidgeting and teetering.

Faces stare at him from magazine covers and video cases, distorted in something that’s supposed to look like pleasure.

Every kink is covered. He slips a movie out of the rack in front of him. An unnaturally smooth man stands behind an unnaturally blonde woman. She’s bent over, her large breasts swing out from the force of her partner’s thrust; his fingers cut into the flesh of her hips, but she’s looking at House with wanton eyes and a gaping mouth. He wonders if she’s a moaner or a screamer.

He reminds himself that the blonde is looking at a camera, not at him. She wants him to wonder about her; she wants to sell him something. He likes porn, the same way he enjoys sex with hookers: it’s all on the level. It does not to pretend to involve matters of the heart. He returns the case to its place on the shelf. There’s no shame in satisfaction until you are forced to understand what gets you off.

Matters of the heart.... He takes half a step and pauses. A body shuffles past him in the aisle. He pulls his steps along with his cane, back to the street. He hears the bell on the door jangle as he leaves. He listens to the distant chatter from a couple of the girls and tells himself that he’ll come back later.


“Where’s the Vietnamese guy, the patient?” he barks. House can’t believe he’s actually saying this, but Levasseur does not question him. House is practically leading the way as they reach the patient’s room.

House approaches the bed and reaches for the man’s mouth, roughly pulling his lips away from his gums. “Nice teeth.”

“What are you doing?” Levasseur asks. Both he and the patient seem bewildered, even beyond the language barrier.

“When was the last time you had your teeth cleaned?” House demands. The patient spits out a few syllables of gibberish around House's fingers. Levasseur says something about calling a Vietnamese translator.

House rolls his eyes and tries again. “Vous avez rendu visite un dentiste récemment?”

The patient looks from one doctor to the other and nods his head.

“The bug, it’s hiding in his heart,” House says. “Get a trans-esophageal echo, which will almost certainly show vegetation on one or more of the valves.”

“Bacterial endocarditis?” Levasseur says. “You would make a good career in diagnostics, Dr. House.”

House simply shrugs. He’s got a job. He’s tired, and he needs time to let himself fall back into place. He leaves Levasseur to order the test, not caring much about the results. If the TEE is negative, he’ll think of something else, but it won’t be negative. He’s not wrong, not this time. He can feel it.


“Two valves replaced,” Gorman tells him. “Mr. Hua is recovering very nicely. You probably saved his life.”

“Great,” House says. “Make sure to put him on Zyvox when he’s released. That’s what we’d do for a MRSA case, and I’m out of better ideas. I’m sure your do-gooders can make sure he actually gets the medication and understands that he has to take them.”

“You’re not going to stay to follow the case?”

House looks at Gorman’s expectant face. He has not much reason to go home, really; but he has no reason at all to stay in Geneva. “I’m sure you can handle it.” He smiles, because he can’t think of any other response.


His nerves are shot by the time he changes planes at Heathrow. He hates flying, can’t even blame that on his leg. House has always hated being trapped in a slow-moving herd. The so-called pre-boarding process takes so long that by the time House reaches his seat, his head hurts more than his leg. He fits himself into his seat and waits. The rest of the passengers file past with aching slowness. Their wheeled bags bump into his armrest every half-minute or so. He clenches his teeth and tries to breathe through the annoyance without snapping.

The sooner the American family with its four children and the British tourist lured to New York by the promise of discounts are seated and buckled, the sooner he can have a drink. Early drink service is the one thing that makes the higher cost of first class worth every penny. The thought gets him through the rest of the boarding process.

A few minutes before takeoff, House crunches a Vicodin between his teeth because his leg doesn’t care that stewardess hasn’t come around yet. The narcotic takes about seven minutes to kick in; he timed it once out of curiosity.


House removes the last of his clothing and leaves it in a pile on the dresser. He sees himself in the mirror; behind him, he sees Wilson's nude body stretched out on top of the covers, smoothing his hands over his torso. It’s mesmerizing.

“You still want to fuck me?” House asks the mirror.

Wilson never stops moving his hands, but says nothing. House watches the image in the glass and understands that the answer is yes. The answer has always been yes; there’s no reason to think otherwise. He crawls onto the bed and settles next to Wilson because there’s no reason not to.

Wilson crawls on top of him and rears back. “I’m going to hurt you, we both know you’ll let me.”

Light from the window makes a shadow of Wilson’s erection on his right thigh; it’s huge. There’s no way.

House stays a few feet away from the bed, facing the mirror. He watches the scene behind his back unfold before his eyes.

Wilson flips him over and mounts him; the muscles in his back and shoulders tense as he pushes in and out. He sees his legs move apart and twitch. One leg kicks back through the air and bounces when it falls back to the bed. Wilson doesn’t notice; he keeps moving, pushing and grabbing until he collapses. “I thought you told me it was going to hurt,” House says to his reflection.

Wilson sucks on the skin at the back of his neck. “Can I get you anything, sir?” he murmurs.

House watches his body turn toward the bed and shuts his eyes tight. As he opens them, the dream dissolves. Wilson is gone. The plane has leveled out and a sour faced woman has come for his drink order. He struggles to focus for a moment. He has no idea how long he was asleep.

“Double Scotch, no ice,” he says automatically as presses his eyes with his hands.

By the time his drink comes, nothing remains from his dream but an undefined sense of motion.

<http://extrabitter.livejournal.com/5268.html">Part Ten</a>