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Nachos and Neuroplasticity (S09 E01)

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 Each man can be, if he so determines, the sculptor of his own brain.
 ~Santiago Ramon Y Cajal

 

House sometimes wishes he has Wilson on strings. It’s not a literal desire, exactly – more a longing borne out of many thwarted attempts to control the uncontrollable. He has a vivid image of himself perched in the rafters, with tiny filaments extending from his fingers to Wilson’s arms, legs and head.

It’s especially easy on days like today, when he is miles from the blissful distraction of an all-consuming case, to allow the fantasy to go further. Right now, for example, he wishes he could crawl inside Wilson and wear him like a second skin. If he could crawl inside Wilson, there wouldn’t be this space between them. There wouldn’t have been that moment, just now, when Wilson sped past the grimy blue West Virginia Welcomes You sign on his bike, and House found himself accelerating, because the fact that Wilson and he were in separate states, however briefly, made the gap seem wider somehow.

It isnt wider, House tells himself; because twenty feet is twenty feet the universe over, and only idiots believe an invisible border alters a standard measure of distance.

But youre not an idiot, another voice is telling him. And you didnt actually think it was wider. Why are you avoiding the issue? There is a lilting, feminine quality to the voice, and that really can’t be a good sign. It is never a good sign when House’s thoughts sound as though they belong to somebody else.

House and Wilson are tearing through miles of flat, square fields, parted neatly by the empty road. When they set off this morning, the road was a straight line that seemed to go on forever; but now House is aware there are turns up ahead, and he can see mountains cresting over the horizon. 

Everything changes, House thinks.

He rolls the throttle toward him, and the space between Wilson and him shrinks. Wilson has been watching House in his left mirror, and, to House, this is like a string of sorts. The very fact that they are watching each other connects them.

He begins to inch forward a little more, and at any second Wilson will adjust the angle of his head to better see House’s bike in the tiny round mirror. There! Wilson’s helmet swivels around, sending sunlight scattering across the edge of his visor.

House pokes the tip of his tongue out to moisten the corner of his mouth. He creeps into the blind spot on Wilson’s right. It looks like he’s preparing to overtake Wilson on the inside, which means Wilson will think he’s about to overtake on the outside. House is betting on it, as he counts to three, holds his breath and swerves out before immediately darting in.

The plan works perfectly. Wilson swerves into the oncoming lane to block House’s path, and House slips neatly past on the inside.

House slows, and fixes Wilson in his sights. I give it six seconds, he thinks. He counts backwards, and is somewhere between one and zero when Wilson begins to accelerate again.

Left, House thinks. He angles his bike just so, and Wilson instantly tries to overtake on the left. House weaves back and forth in front of Wilson’s bike, and slows right down. Wilson has no choice but to brake. And speed up, House thinks. He accelerates away, and Wilson chases after him on cue.

They continue like this for some minutes. With his jacket zipped tight and his legs straddling the bike, House can feel the two bottles pressing against his hip; the Vicodin bottle and the not-Vicodin bottle nestled side by side. One for each of us, House thinks, before he tries not to think about it at all. He looks to his left instead, and takes note of some of the more abundant species of plants: Kentucky bluegrass (long, increased risk of lyme disease), soybeans (commercially farmed, possible use of Paraquat, long-term exposure linked to Parkinson’s), rattlesnake ferns (TB cough remedy), more Kentucky bluegrass.

There’s a sharp bend up ahead, and Wilson swings out wide. Judging by his trajectory, House is betting he’s going to cut the corner obliquely. He’s already moving into the center of the road before he realizes it’s a ruse, and Wilson is coming up on the outside of the corner way too fast.

House squeezes hard on his brakes as he enters the bend. He skids through a puddle, and mud splatters the sides of his leather pants.

Wilson whizzes past, and his cheer of “Woohoo!” carries back on the breeze.

The benefit of having Wilson on strings, House decides, would be that, every once in a while, and without warning, Wilson would pull right back.


 

Pharmacology versus neuroplastic rehabilitation in the management of phantom limb pain in the lower extremities: an update.
Department of Pain Medicine and Neurorehabilitation, Research Division, Institute for Post-Operative and Trauma Care, New York.  

Hooper X, Gardner S, Brett C.

Abstract 

There are numerous treatment options for phantom limb pain (PLP) following an amputation in the lower extremities (LE). These are, broadly speaking, implicated by the mechanisms and nature of the patient s PLP.

Last year the Research Division of the Department of Pain Medicine and Neurorehabilitation was given a three-year grant to investigate the relative efficacy of two such treatment options in a large patient cohort. These treatment options are opioid-based pharmacology, and non-invasive neuroplastic rehabilitation using our state-of-the-art visual feedback therapy and motor imagery.

This interim summary of our findings to date shows favorable results for both groups...


 

They stop for lunch under a wide sugar maple tree.

House tosses the foam bedroll into the dappled shade, and upends the plastic grocery bag. Two sub sandwiches, half a bag of trail mix and a jumbo packet of nacho flavored chips tumble out, and roll in different directions.

“American politicians,” Wilson says, as he plucks two bottles of Mountain Dew from his own bag, and begins straightening out the jumble left by House.

“American politicians?” House plants himself on one side of the bedroll, and flings his jacket into the long grass. “Please tell me that’s not your choice of category.”

“Yes, and yes.” Wilson retrieves House’s jacket, folds it neatly and eases himself onto the other side. “You got to pick last time. And, by the way, I still maintain you had an unfair advantage by choosing ‘porn stars’. I am, however, taking the moral high ground by picking a category where we both have a fighting chance.”

“At least pick something interesting. Like cars or, well, porn stars.”

“American politicians,” Wilson repeats. “Donald Rumsfeld.”

House rolls his eyes, and tears off a chunk of sandwich with his teeth. “Dan Coats,” he says through a mouthful of bread and pastrami.

Wilson swallows his first bite. “I have no idea who that is. Okay, Coats ends with S, so … Sarah Palin.”

“Are you sure we’re not doing porn stars? Because, damn.When House receives nothing but a silent, withering glare he continues. “Okay, a politician beginning with N. Neal Dow.”

“W…Warren Harding.”

“Gerald Ford: a mediocre politician, and a mediocre car. Sure you don’t wanna switch categories to…” House trails off. He is craning his head into Wilson’s personal space.

Wilson’s eyes dart from side to side. “What?”

“You smiled. Except you didn’t. You kinda grimaced.”

“It was a bad joke.” Wilson shrugs.

“Have you been getting blurred vision?”

“House.”

“C’mon, I’m just asking. Blurred vision? Heavy eyelids?”

“It is not myasthenia gravis.”

“Yeah, because that would be soo unlikely in an invasive thymoma patient.”

Wilson looks away. “I am not having this conversation.”

“Hey, so long as you let me ride in front-”

Wilson whisks his head back to face House. “Do you really think I would be so irresponsible as to drive around on a bike if I thought there was even a chance my muscles were getting too weak to control it?”

“Come on, all I asked-”

“-all you asked me-”

“-was-”

“-a doctor who has been to medical school-”

“-oh yeah, because that’s really what this is about.”

“Drop it!” Wilson almost yells. He grits his teeth. “I only have four-and-a-half months left to live, and you clearly have no idea what that feels like.”

House clenches his jaw, and falls silent. There are precisely three responses hurtling into his mind. They are a muddle of words and sensations, and he barely bothers to put them in order inside his head; so unlikely are they to ever make it past his lips. If he were to say them out loud, they would go something like this:

If I had you on strings you wouldn't have four-and-a-half months left to live, because I would march you straight into the hospital for every test, and every treatment, possible. I would re-scan you every day and re-calibrate the radiation from scratch myself. It has to be me, because I'm the only one who can map the cancer in that much detail. I see its shape every time I close my eyes. You think I would get bored after a few days, but I wouldn't . I know because, if it were humanly possible, I would examine every cell in your body under a microscope and reassemble you using just the healthy ones, and I wouldn't get bored of that – even if it took me the rest of my life.

I want to lay you back against that bedroll, and undress you. Slowly. Do you remember that hooker I took on the double date with you and Sam? He may not have been much to look at in drag, but he could fuck like a rabbit on Proviron. He had a way of rolling his tongue round your dick from slit to ridge, while grazing your prostate in just the right way. It made you feel like your dick and ass were one organ, and it was being stroked right the way along. I want to do that to you until you’re so gone you don't even remember what cancer is. You don’t have to do anything back. After I’ve taken you to the brink and pulled back a couple of times, after you’re too delirious to notice, I'll let one hand roam over every inch of your body. I will finally know what it feels like to do that, and it will be enough.

You think only having four-and-a-half months is bad, but at least then you'll have oblivion. I've got four-and-a-half months until my whole fucking universe ceases to exist.

This last thought seems to finish itself, regardless of his feelings about it, and it’s suddenly so blindingly true it almost eclipses the other two.

House shakes his head to clear it. What he finally says is “don’t I?” and he almost manages to keep the rough edge out of his voice when he does so.

He forces his eyes to drift up to Wilson’s face. Wilson’s brow is furrowed, and he’s staring intently at House with his lips parted as if he started saying ‘oh’, but never quite finished.

House suddenly feels as if he’s said every word out loud anyway.

He rubs his thigh, and hoists himself to his feet. With his sandwich in one hand and his cane in the other, he heads off toward the river, leaving Wilson to stare after him.

As soon as he’s out of sight he fishes in his pocket, and draws out two identical bottles. The labels on both read: ‘Princeton-Plainsboro, Vicodin, hydrocodone bitartrate and acetaminophen tablets USP, Mrs. Henrietta Herschal, take 1 tablet every 4 hours as required.’

House carefully unscrews the cap of the not-Vicodin bottle. He can see one or two of the twenty Cisplatin tablets peeking out from the jumble of anti-emetics.

He takes a deep breath and closes his eyes.

These last few days have given House ample opportunity to observe Wilson, to establish a pattern. The facts sit in a row before him like specimens. Wilson wakes at 8am, and is hungry by 8:45. They always stop at a diner, and Wilson orders bottomless coffee (average caffeine consumption 180-300mg, average liquid consumption 375ml) and pancakes or waffles (average carbs 150g, average protein 20g). He takes his coffee black, and his pancakes with maple syrup (extra carbs approximately 20g). Lunch contains another load of carbs (sandwiches, hotdogs, fries), and the inevitable energy slump sends Wilson to sleep. The naps have been getting longer each time. (Increases of fifteen minutes on days two and three, then the increases almost leveled off.) House draws a distribution curve of naptime relative to days elapsed in his head, and it looks like the curve of Wilson’s shoulder when he is standing with his hands on his hips. Wilson always has a snack when he wakes up. He hates nachos, which means he’ll go for the trail mix.

Judging by Wilson’s dwindling appetite (half a sandwich left yesterday, fries shared with House the day before), he’ll probably get through half of what’s left. House calculates he must crush two tablets into the bag to get him up to a full dose, plus two anti-emetics to prevent Wilson from vomiting (90% chance). He’ll have to engineer a way of getting him to eat the rest tomorrow, which just leaves three straight dosing opportunities to manufacture before an eight or nine day break.

House will fake an upset stomach, so Wilson will put the side effects down to something they’ve both eaten. There won’t be any hair loss. If he plays his cards right, House reckons he can get well into the third week before Wilson realizes he’s being secretly dosed with oral chemo. That should be long enough to figure out if it’s worked, at least.

House unscrews the real Vicodin bottle, throws two pills to the back of his throat and swallows. A breeze shakes the branches above his head. He watches two leaves flutter to the ground and settle among the tall grass, before everything falls still. He sighs, and trudges back to the bedroll, where Wilson is sprawled with one arm over his face.

Wilson stirs, and blinks heavily up at House. “House, I-”

“Sshh, go back to sleep.” House stretches out beside Wilson, and shuts his eyes. He listens to Wilson’s breathing and the sporadic sound of the wind swaying the leaves.

When he’s sure Wilson’s breathing is low and even, he turns and watches. Wilson shaved this morning, and the morning before. All that’s left of his stubble is the dusting of hair above his mouth. House wonders about the texture of it. If he brushed his fingers from Wilson’s cheek to his upper lip would it be smooth until the edge of the burgeoning moustache, or would there be patches of roughness where he hadn’t quite shaved to the edge the second time? Would the hair still feel like stubble, or has it become softer and longer?

He curls his hand into a fist to stop himself from reaching out.

House doesn’t normally sleep after lunch, but watching the steady rise and fall of Wilson’s chest is lulling him into a semi-conscious state. Images dance before his eyes, unbidden: the straight line of the road, Wilson on his bike, their breakfast waitress from this morning in her long red apron refilling Wilson’s coffee cup from a tarnished pot.

As he drifts deeper, he realizes he is on a stage dressed in black. His left hand is grasping a wooden control bar, and a tiny little marionette Wilson dangles below on strings. The audience cheers, and House twists the bar until Wilson is dancing and skipping across the stage. The image of the marionette looms large in his mind. He can see its boots and leather pants, its chest rising and falling, and the soft brown hair on its upper lip; but when House looks into its eyes he realizes they are nothing but empty sockets.

He wakes with a start.

The blinding daylight is so incongruous with the dark theater that House has to blink hard, twice, to remember where he is. 

He props himself up on one elbow, and peers at Wilson from beneath the shade of his hand. Wilson’s eyes are still shut.

House gently unwinds the top of the trail mix bag. He grabs the fake Vicodin bottle, and unscrews it with his t-shirt over his hand to muffle the sound.

He stops, and watches Wilson closely this time to make sure he really is asleep. Wilson has his spare t-shirt rolled under his head. It’s an impulse buy they picked up at the outlet mall on their way out of Jersey. The uneven white writing on the front reads:

“There was NOWHERE to go but everywhere,
so just keep on rolling under THE STARS.”
~Jack Kerouac

House can see a large “S” from the word “stars” and the smaller “rouac” of “Kerouac” peeking around one dark crease.

There’s something about the font that pulls House back to an earlier time. It’s his birthday, and he’s just spilt up with Stacey. Wilson shows up with a six-pack tied with a green ribbon, and a greetings card with the same uneven white writing. It says: ‘Once upon a time a prince asked a beautiful princess “will you marry me?” The princess said “no;” and the prince lived happily ever after; and rode motorcycles; and fucked cute skinny girls; and went to naked bars; and drank beer and JD; and drank milk from the box; and never heard bitching; and went to rock concerts; and kept his apartment and his favorite jeans; and never got cheated on while working; and all his family and friends thought he was cool as hell; and he had tons of money; and he left the toilet seat up. The end.’

He was going to pin it to the fridge, House is sure of that, but he didn’t, and the reason was significant. Suddenly he remembers. He sees himself with his bottle-opener fridge magnet hovering just over the corner of the card. He reads the front again. The princess said yes, House’s brain supplies. And he was forced to buy a sensible car, stay in every night, was yelled at if he so much looked at another woman – or man, had to use a coaster, got bitched at constantly, moved to the suburbs, wore polyester shirts, was permanently overdrawn, and was happy.

He remembers jabbing the pedal of the kitchen bin with his foot, and tossing the card inside.

House digs his cane into the soft ground beside him, and pulls himself to his feet. There’s a wooden bridge curving over the river, and he lumbers toward it with stiff, aching steps. He stands on the bridge with his arms dangling over the sides. The not-Vicodin bottle is still open in his curled hand.

House slowly tilts the bottle, and watches the pills spill into the river.

He scratches the label from the bottle, and tosses that in too. The water is racing beneath him, flinging garlands of bubbles around the protruding rocks. House watches it for a long time after the bottle and pills have been carried away.


 

Pharmacology versus neuroplastic rehabilitation in the management of phantom limb pain in the lower extremities: an update. 

Methodology

306 participants were recruited from local and national support groups upon full disclosure of ethics approval.

The cohort comprises 42 patients (13.7%) with foot amputation (36 Chopart amputees and 6 Lisfrance amputees), 12 Syme amputees (3.9%), 69 patients (22.5%) with transtibial amputation or knee disarticulation, 53 transfemoral amputees (17.3%) and 18 patients (5.9%) with hip disarticulation. A further 112 patients (36.6%) had suffered LE amputation on both sides.

A randomized strata of 153 patients were placed in each group, and pain was ranked on a monthly basis using a visual analogue pain scale.

Following an analysis of our preliminary results, we are now actively recruiting participants with other amputations…


 

“You guys ready to order?”

House’s eyes flick from the page in front of him to the waitress’ face by way of her carefully ripped jeans and the see-through shirt with the crooked nametag that reads ‘Brandi’. As he does so, a number of things become apparent to him in rapid succession.

The first is the slight swelling in the curve of her belly that’s stretching the buttonhole of her jeans.

The second is that the areola around her sore nipples has darkened recently. He knows it’s recent because the slightly frayed bra is the functional-but-frilly kind usually purchased in bulk at K-Mart, and if she’s intentionally bought a pack of bras to wear under her work shirt that shows her nipples then routinely doing up the top button is pretty redundant. He knows her nipples are sore because of the unpracticed way she stands with her shoulders hunched, causing the cups to gape.

The last two things he notices are the faint but unmistakable odor of stale vomit on her breath, and the dark circles that ring her heavily made-up eyes.

This isn’t what House consciously thinks, though. What actually happens is that he angles the crumpled cover of Femme Fatales toward her for effect, before lasciviously trailing his eyes over the curves of her body and thinking abdominal swelling, recent darkening of areola, sore nipples, vomiting, fatigue, then saying “I’ll have the nachos and a Bud,” without pause. By the time his gaze is back on the magazine a split second later, he’s diagnosed an early case of pregnancy, and is pretty sure the guy with the spike through one ear who’s setting up the stage for tonight’s band is the father.

As he listens to Wilson order a medium-rare steak with fries, he contemplates asking Brandi-with-an-I if spike-eared-guy knows she’s carrying his child; but irritating Wilson the day before Phase Two of his plan would not be a smart move.

House remains silent, and Brandi turns on her heel before ripping their order from her coffee-stained notepad.

Wilson raises his eyebrows at House. “Seriously, nachos again?” 

“What?” House asks the inside of the magazine. “I’m on vacation. Anyway, you’ve ordered red meat three nights running. That stuff can give you cancer, you know.” He snaps his eyes up to deliver a pointed glare, before sighing heavily at the reading material.

Wilson leans across the cheap plastic tablecloth to speak quietly. “House, seriously, do you have to read this stuff here?”

“Huh?” House yells, cupping his ear in an extravagant gesture. “Oh, you mean my one-handed reading. Pretty hard to read on a bike, what with needing both hands to steer and all.”

Wilson attempts to grab the magazine, but ends up swiping the stale air as House snatches it away.

“You get your own,” House tells him.

Wilson retrieves the magazine seconds later by saying “catch,” and throwing the motel key at House’s head. He catches it deftly while House is deflecting the flying key, and is about to fold it out of sight when something slips from between the pages. He holds it up to the light. “House, there’s a journal article in here.”

“Gets me in the mood.”

Wilson scans the page. “This is about the relative merits of drugs and neurorehabilitation. Most of this article is about people who actually choose to avoid drugs when managing their pain, imagine that.” He glances up at House. “So this is why you were in the bathroom for forty minutes last night, you’ve devised a version of these feedback techniques to use on your leg?”

“No, I was masturbating.” House looks Wilson up and down, slowly. “You will ride in front of me wearing those tight leather pants.”

Wilson shakes his head, and returns to the article. “Oh, it’s a clinical trial. Which is looking for new participants. Interesting.”

“Jeez, you’ve got me. When you’re gone, and I’m all alone, I’m going to turn over a whole new leaf. I’m going to take up yoga, meditation, neurorehab and maybe even volunteer at a soup kitchen for homeless dolphins.”

The band is warming up now. A steady baseline shakes the floor like a pulse. The lead guy strikes a couple of chords from Smoke on the Water, and strides across the stage to adjust the amp.

“House, look.” Wilson leans across the table again. “I’ve been meaning to say I’m sorry about earlier.”

“It’s fine.”

“No, it’s not fine. And you’re right; we should talk about these things. I also think we should talk about you. What you’re going to do, you know, after.

There is no ‘after, House thinks. What he says is “Oh, don’t worry about that. I’m headed over the border to Mexico with whatever money you leave me. I’ve heard that doctors with criminal records are pretty much the norm over there. They may even have a union.”

Wilson looks like he’s about to say something else, but Brandi has come back with their drinks, and the band has started up.

“Hey there, we’re Tribute 2. Here’s some Motorhead!”

Wonderful.

Wilson swivels in his seat to watch, and House studies the way the hair at the back of his head grazes his neck. His thoughts have taken on that unsettling feminine tone again. Reach out, they almost whisper. Reach out to him. House’s fingernails are digging into his palms.

He stops staring at Wilson when Brandi comes back with the food, and Wilson turns around to snatch the motel key out of her way.

Wilson’s steak is approximately eight ounces (protein content 50g), and the sea of fries is slick with fat (carbs 65g, protein 6.5g, trans fats …yikes). Wilson cuts tiny pieces from his steak, and sucks them slowly into his mouth. The fries sit untouched.

House makes a show of licking the cheese from his nachos. “Mmm,” he comments, loudly.

The waitress serving the tables on the other side of the restaurant walks past with three large plates fanned across each arm. She crosses the aisle beside Wilson’s chair, and tenses suddenly. A fork clatters to the floor.

“Hey, Candice, you okay?” Spike-eared guy is jumping over an empty chair and weaving around tables to get to the aisle. “You saw him again, didn’t you?”

She shakes her head, and lets him take a couple of plates from her. “No, it was more like a flash of light. I thought it might be him, but … no, it’s gone now. Thanks, Brad.”

House watches them carry the plates to the door behind the bar.

Cool, he thinks.

There’s a pause before Brad strolls back out, and starts collecting empty glasses. Candice emerges shortly afterwards, her back ramrod straight. She is carrying two glasses of soda, and her gaze is locked on them as though she is afraid to look up.

House watches her place the drinks in front of an overweight woman in short pants and her much younger date. She smiles, but keeps her eyes on the floor. It’s only after she’s wiped down the adjacent table, picked up a stray coffee cup and pointed a customer in the direction of the restroom that she freezes again.

Her eyes widen, and there’s a crash as the coffee cup smashes against the hard wood of the floor. She starts to back away.  “No, oh god, get off me! Get off me!” She scrabbles madly at her forearms. “No!”

The band stops abruptly, leaving nothing but a high-pitched whine from the speakers. 

It’s Brandi who runs over this time, her breasts bouncing inside her see-through bra. “Oh, God, Candi, you’ve seriously got to calm down or they’ll fire you for sure this time.”

“I can’t calm down,” she sobs. “He was right there, he was trying to get me.”

“Who was?” House asks.

“It’s fine, Sir, she’s just sick,” Brandi tells him.

“It’s her dad.” Brad materializes behind House’s left shoulder. “He used to work here. Until he died last year. Now he won’t leave her alone.”

“Wow.”

“I know.”

House looks him up and down. “No, not ‘wow’ at the story, ‘wow’ at your stupidity. And I repeat: wow.”

Brad crosses his arms. “Well, how else d’you explain the fact that she sees him every week on the day he used to have his shift, then?”

House shakes his head, and steps into what looks roughly like the center of the gathering crowd. He reckons it’s easier to set a group of idiots straight in one go than answer the same ill-informed questions one by one. He raises his voice slightly. “Unfortunately the waitress who managed to misspell ‘steak’ on our order is actually right. Candice is sick. More accurately, she’s suffering from music-induced seizures.”

Candice blinks, and wipes the tears from her eyes. “No, I’ve never had a seizure.”

“It’s a common misconception that seizures always involve falling on the floor and shaking. What you have experienced is a simple partial seizure, probably in one of the temporal lobes. It explains the hallucinations. As to your daddy issues,” he stretches his mouth and sucks air through his teeth. “Well, I’d hardly want to pry into that in front of all these people.”

He turns to Brad. “You asked why every week. Something tells me this is the band’s regular night to play. Most of their music is pretty baseline heavy: Three Days Grace, Motorhead, Alice Cooper. Which are good choices, by the way,” he tells the two guys holding guitars “since your vocal range basically sucks. May I?”

House holds out an arm to the lead guy, who looks like he wants to break House’s jaw. He snatches the guitar strap off his shoulder and hauls it over his neck, before handing the guitar to House.

House takes it, and says: “Your nervous system is like the wiring in a house. If something goes wrong, it can cause blackouts in one of your circuits. Maybe even throw out the power all together. But, faulty wiring cannot do this alone. First, you have to pump energy into the circuitry.”

House strums a few chords on the guitar, before making a disgusted noise in the back of his throat. He throws an exasperated glare at the lead guy, and tightens the string while he continues. “At the start of the set, the music only went above A5 twice, and then it was just one guitar playing a C5 and D5, and the keyboardist playing A6. Although I don’t think that’s the note she meant to play. Then there was the short Alice Cooper guitar solo when you saw the flash of light. Two bars of that were played above A5 in a syncopated rhythm. Same as the whole of the excessively long guitar riff that was playing when Daddy appeared.” He towers over Candice. “This leads me to believe that the particular trigger for your seizures is syncopated rhythm above A5 in pitch.”

He slings the guitar strap around his neck, and launches into a short jazz riff, which he repeats an octave higher, and then another until his hand is practically sliding off the fret.

The effect on Candice is instant. She covers her face with her hands as if to block out the light, and, when her hands drop away, her eyes are rolling back into her head.

House feels a hand gripping his wrist, and looks up to see Wilson standing beside him. “That’s enough,” he tells House. He helps Candice into a seat, and sits facing her on the same side of the table. “Can somebody please get her some water?” He peers at her face, and gently lifts her eyelids one at a time with his thumbs.

House hands back the guitar, and crouches in front of Candice. “You okay?”

“Ngh,” she manages. She tries again. “Yeah, I think so.” Her voice is weak, and her eyes are looking around, rather than at, him.

“Good. Go to the Neurosurgery Department of West Virgnia U, and ask for a PET scan. Here.” House grabs Brandi’s notepad, and writes ‘West Virgnia U, Neurosurgery, PET scan’ across one yellow-brown stain. “They have to scan you both with and without the music. If that doesn’t work, give this guy a call.” House writes Chase’s details below the stain. “He was trained by a legendary medical genius who died tragically in a fire.”

Wilson rolls his eyes.

“Tell them Dr. James Wilson - that’s me - has diagnosed you with music-induced simple partial reflex epilepsy.” House writes the diagnosis on the other side of the paper. “It’s very important that they know your trigger is syncopated music played above A5. Take one of these guys…” He surveys the musicians. “Take someone who can play,” he amends.

Wilson stands, and squeezes the bridge of his nose. “I’m going back to the motel room,” he announces, throwing a couple of twenties onto the table.

“Hey, wait up.” House chases after Wilson, who is pushing a path through the gaping onlookers. Wilson, he thinks, and the thought has taken on that lilting female tone. It’s only now that he realizes just how still and calm his thoughts had been while he was helping Candice.

For just a few moments, everything had been perfectly silent.

Wilson swings open the door, and the chill of the night air hits House full in the face. “You’re not pissed that I used your name, are you?” He asks.

“No, I-” Wilson shakes his head. “I’m glad you helped her, really. I’m just tired.”

House watches their feet as they cross the road between the restaurant and the motel block. Wilson’s boots are clean and catch the light from the streetlamps. His steps are even and sure. The desire to crawl right inside Wilson suddenly returns. This time he wants to experience every single electrical impulse that’s firing through his brain. He feels he could spend a lifetime studying and cataloguing each one, but for now he would be happy just to understand what Wilson is thinking at this very moment.

House decides to change the subject. “I can’t believe Brad tapped Brandi and Candi,” he says. “If there’s an Andi working at that bar, he can make it a hat trick.”

“What are you talking about?”

“Brad, that spike-eared idiot. He slept with Candi and got our waitress pregnant. Didn’t you notice the identical cold sores on the upper left corners of their mouths, and the upper right corner of his?”

Wilson stops in his tracks, and cocks his head. “And you knew this the whole time you were talking to them.

“Well yeah. It was kinda hard to miss.”

“Are you sure about it?”

“I can’t be sure without asking them, but you’ve gotta admit it’s unlikely to be a coincidence.”

Wilson makes a gesture somewhere between a head-tilt and a nod. “Okay. So when are you going to ask them?”

“I’m not. We’ve got a schedule to stick to, remember?”

“I’m - wow. House, that’s amazing. You are leaving a puzzle only maybe-solved in favor of The Schedule. Not only that, but you had the opportunity to wreak absolute havoc on those people’s lives, and you resisted. I’m impressed. We’d best tell Satan to buy some snow tires for his commute to work tomorrow.”

 “That girl’s gonna be okay, you know.”

“I know she is. You’re a regular Mother Theresa.” Wilson waves his hand. “Facial hair not withstanding.”

“Speaking of facial hair, I’m not the one who’s growing a moustache like an 80s gay porn star.” House drops his voice an octave. “If you’re not careful you’re going to give me ideas.”

A smile tugs up one corner of Wilson’s mouth. “House, are you going to spend this entire trip coming on to me?”

House pretends to consider this. “Depends if you’re going to put out.”

“Fair point,” Wilson nods once. “Okay.”

The split second before House answers seems to stretch into eternity. When he does reply, all he manages is a slack-jawed “huh?”

“Okay, I’ll sleep with you.” Wilson takes a half step forward and presses his lips firmly against House’s, before turning and striding toward the stairs. “I’ll see you in the room,” he says without looking back.

House continues to stare open-mouthed, as Wilson crosses the black pool of asphalt and plants one hand on the railings. Wilson’s booted foot connects with the first step, and he starts to climb the stairs while reaching into his pocket for the key.

A group of girls stumble across House’s path, gripping onto each other for balance. Their peels of laughter and the hollow clopping of their heels echo through the parking lot. Wilson turns the key in the lock, and enters the motel room. 

House’s mouth has gone dry. He’s forgotten how to blink.

The girls round a corner, and Wilson’s sudden call of “House!” cuts through their distant chatter.

House snaps to life, and bolts across the parking lot. He races up the stairs with his cane under one arm, and both hands physically lifting his bad leg onto alternate steps. He grips the doorframe forcefully to prevent himself from all but falling into the room.

Wilson is reclining on House’s bed with one hand behind his head. His boots stand side-by-side under the chair, and his jacket is draped over the back.

A heavy, involuntary breath escapes House’s chest, ending in a sharp surprised groan. He stares at Wilson without moving.

Wilson swings his legs over the side of the bed, and pads toward House. “Hey, relax. If you don’t want to-” the rest of the sentence is cut off when House grabs Wilson with both hands, and crushes their mouths together.

Wilson’s knees buckle, and House somehow catches him. He trails one hand from the small of Wilson’s back to the curve of his hip, before cupping his ass.

Wilson’s right leg curls around House’s hip, and he tries to push up on his woefully unstable left one. The door is still bumping open and closed against the latch as House propels them both toward the bed.  He’s distantly aware of a sharp, shooting pain, but it’s as if it belongs to somebody else.

They tumble onto the bed. There’s a trill and a jarring clunk, as the phone and bedside lamp crash to the ground. House rolls on top of Wilson, threads his hand in his hair and gently tugs his head back against the pillow. He looks down.

Wilson’s eyes are unfocussed. His wide, dark pupils are flecked with orange glints from the overhead light. Wilson can’t quite keep his hips still, and the hard bulge of his cock is bumping against House’s. He hisses, and reaches up to stroke the stubble on House’s cheek. This cant be real, House thinks. He has the oddly irrational feeling that this moment is made of glass, and if he had a hammer he could reach out and smash it. Everything would shatter into a myriad of jagged fragments - Wilson, the bed, the motel, the weak orange light coming from the ceiling – and he would be utterly alone.

House does his best to shake the thought from his mind by grabbing the hem of Wilson’s t-shirt, and tugging it over his head. He tosses it onto the shade of the overturned lamp. He yanks his own t-shirt off so quickly he hears a seam rip. House dives toward Wilson, and pauses millimeters from his swollen lips. Wilson has to lift his head from the pillow slightly to connect with House’s mouth. It’s as if a magnet draws Wilson to him, and House can feel the pull.

Things are becoming frenzied now. House kicks his boots off, and hears one of them thump off the end of the bed. The other is lost somewhere in the tangle of sheets. Two pairs of pants join the t-shirts on the floor, the underwear still bunched inside.

Wilson’s skin is warm and slick with sweat. House trails a hand over his hip, and then up over his side, collarbone and neck. He traces the point where their lips are joined without breaking the kiss, before exploring Wilson’s face with his fingertips. Wilson’s cheeks are soft and smooth. House detects one – no two – tiny rough patches where stubble is breaking through the skin. His moustache hair is soft, almost downy.

House’s hips begin thrusting wildly, almost of their own accord. Wilson reaches between them and slides their cocks together in his hand.

House hooks his wrist under Wilson’s thigh and draws it up. He strokes his thumb from Wilson’s perineum to his smooth, tight sack, then down into the crease of his ass.

House knows he has lube in his bag somewhere, together with a single condom. They might as well be on Mars for all the chance he has of getting to them, especially when Wilson is thrusting just like that, and panting, oh, and … and

He bites his lip to keep from crying out. He thrusts hard against Wilson’s cock, inside the circle of Wilson’s curled hand, before pressing two fingers against Wilson’s entrance and twisting them.

Wilson’s body goes rigid. He throws back his head and opens his mouth as if he’s screaming, but no sound comes out. Thick ribbons of spunk pulse over Wilson’s hand and stick in the hair on House’s abdomen. Wilson yells, as he suddenly finds his voice. He bucks hard against House several times, and the bed hits the wall so loudly that the neighbors start banging on the other side.

House comes with four strangled, choking gasps. He just about manages to shift his weight off Wilson before everything goes black.


 

Pharmacology versus neuroplastic rehabilitation in the management of phantom limb pain in the lower extremities: an update.
 

Results

…Approximately 20 participants have left the opioid-based pharmacology group. Of these, 1 moved away, 1 died of an unrelated condition and 18 left the trial in order to receive neuroplastic rehabilitation as private patients.

As yet, nobody has left the neuroplastic rehabilitation group…


 

The benefit of having Wilson on strings, literal or otherwise, House decides again, is that you will never be able to predict when he is going to pull back. The downside on this particular day, however, is that the plan, such as it is, has been shot to all hell. 

It’s precisely 09:05 when they see the gas station’s sign peeking out from behind a stand of trees. Three pick-up trucks in various states of disrepair are parked in the lay-by out front. There are no other buildings in sight.

House nods to Wilson, and they slow down before veering off the road.

After they’ve parked and unstrapped their helmets, House tilts his head toward the sign above the door that reads ‘Bob’s G rage’. “Well this looks much better than the restaurant,” he says.

“Don’t start with me.” Wilson swings his leg off his bike. “I said I didn’t want to run into our neighbors over breakfast, and I don’t recall you objecting.”

“Only because that woman looks like she hasn’t been laid since 1997. I saw the way she was looking at me when we checked in. Last thing I need is some retired schoolmistress thinking she can get a slice of what I gave you. I have got some standards, you know.”

“I’m flattered.” Wilson prods open the dusty door with his fingertips, trying to touch as little of it as possible.

“Oh great,” House surveys the rusting metal shelves. “Looks like our breakfast choices are candy bars or candy bars. Oh, wait, I stand corrected.” He picks up a couple of packets. “Twinkies.”

Wilson slides open the rickety door of the fridge. “There’s milk.”

A guy with a checked shirt and drooping moustache lumbers out from the back room. “Mornin’ fellas.” He tugs his waistband over his protruding stomach. “What can I do you for?”

“Is there anywhere around here where we can get breakfast?” House asks.

“Yeah, there’s a motel and restaurant about thirty miles thatta way.” He points in the direction from which they’ve just come. “It’s real popular with the locals.”

“That’s great, thanks. Anywhere else?”

“Afraid I don’t know the area much. This here is my brother’s place. It’s a real shit hole.”

“Is it? Hadn’t noticed.”

“You’re only about an hour outside town if you want to go down the road in the other direction.”

Wilson grabs his cell. “Maybe there’s somewhere to eat off one of the turnings…oh, look.”

House stands beside him, and peers at the phone.

“This is part of the hiking trail.” Wilson points to a line snaking close to the ‘your location’ dot. “We could leave our bikes here. Would that be okay?” He asks checked-shirt guy.

“I reckon there’s some space by Herb’s pick-up. It’s the blue one on the bricks. Wouldn’t leave them out there overnight, though. Not if you’re attached to your wheels.” 

“We won’t.” Wilson grabs a packet of Twinkies and a pint of milk, before handing over four folded singles. “We’ll be back later today. Thanks.”

They exit the store, and push their bikes into the lay-by.

Wilson is wearing the same crumpled t-shirt from the night before. The wrinkles bunch together and smooth out in time with his steps. House watches them as they set off along the road. “How long’s this trail again?” He asks.

“It’s just a seven-mile loop. It’ll be fine. We can finish it this morning, and head into town for lunch. Well, here we go.”

“You’ve gotta be kidding me.”

Wilson is throwing his bag over a five-foot high wooden fence. He grabs the bar at the top, and begins to climb. “It’s just one private field. I can see the trail from up here. I’m sure nobody will mind. Here.” He sweeps his leg over the top and drops down. “Give me your cane and your bag.”

House bundles the items into Wilson’s outstretched arms, and plants his good leg high on the fence.

There’s a moment, after Wilson has helped hoist House over the top and guided him down the other side, when House lands on the uneven ground and they stumble together. Wilson grabs House’s arm to steady him. House realizes they are standing inches apart and touching, and Wilson notices him realizing. Their eyes connect for a split second, and House thinks: if I had you on strings, I would tell you I love you right now. I would tell you I love you, and freeze you in this exact position so you couldnt lower your eyes or turn away. It would look like you dont mind me saying it, even if I cant make you look like you love me back.

No sooner has he finished the thought than Wilson has turned around, and is cutting a path through the fallow field. House follows after, leaning heavily on his cane.

Once they have reached the clearing on the other side, House unfurls the bedroll. They sit propped against the trunk of a thick oak, tearing off chunks of Twinkie and taking turns swigging milk straight from the bottle. The trail twists up the hill ahead of them.

“I never thought I’d be craving salad,” Wilson says, before popping a piece of slightly stale Twinkie into his mouth.

House makes a face, shovels another piece between his lips and washes it down with milk. “On the plus side, I’ve heard there are wild turkeys around here. Maybe we can tempt one over with a piece of this sugary crap. Saves us the trouble of having to kill it ourselves.”

“I don’t think even the turkeys would touch these,” Wilson says before jerking his head up. His cell is vibrating against the lining of his jacket. He grabs it, looks at the screen and frowns. “Foreign number.” He thumbs the answer button. “Hello?

The distorted murmur of a female voice carries on the breeze.

Wilson’s eyebrows shoot up. “Liz, hi! My god, it’s been ages. How are you?”

House takes another swig from the milk carton. 

“Oh, you heard, huh? Who told you, was it Steve? Really…? No, no, it’s just I didn’t realize he knew we were acquainted…Uh huh.”

A heavy vehicle thunders past in the distance. 

“You don’t say … I see …yes.”

There are two thoughts vying for attention inside House’s head. The first is hes not going to figure it out, relax, and the second is tell him. They are so insistent that they almost sound like real words, shot out by two persistent people who are unaware the other is speaking.

Wilson stretches his arm above his head. “Okay, thanks for thinking of me - really. When do I need to let you know by? And is this number the one to call you back on? Yeah, okay, I will. It was really good to hear from you… You too. Bye.” He jabs the ‘end call’ button on his phone.

“Old girlfriend?”

Wilson’s jaw is slack, and his lips are slightly parted. The color has fled from his cheeks. “Actually, that was Liz Norris. You know, the one from my old study group at McGill? Apparently Foreman told her about me, and she wants to see me in London. They’ve got funding to trial CyberKnife on invasive thymoma patients.”

“Interesting.” House purses his lips. “I didn’t hear you telling her no.”

“Well, it was kind of a surprise. It’s not a common form of cancer, and CyberKnife’s a relatively new form of radiation. It’s not like we even had a machine at work.”

“I know. So what are you going to do?”

Wilson shakes his head, and rakes his hair back from his face. “I honestly have absolutely no idea. God, I feel so tired all of a sudden.” He slumps lower against the tree and stretches his legs. After a few moments he fidgets, shifts again and frowns.

“Here”. House folds his jacket against his good leg, and gestures for Wilson to lie down. “I promise not to molest you if you fall asleep. Not that I think you’d mind.”

Wilson stretches his mouth into a smile. “Thanks” he says, before laying his head against House’s thigh. His ass just reaches the end of the bedroll, and he plants both feet flat against the floor with his legs forming a triangle above the ground.

House watches Wilson close his eyes and force three deep, steady breaths. He wants to plunge his hand into Wilson’s hair, but he’s not sure he’s allowed. Instead he rests his hands in his lap, and lets the joint of his thumb brush lightly against the soft brown strands on top of Wilson’s head.

Wilson’s breathing gets gradually shallower over a period of a few minutes, before he takes a deep breath and opens his eyes. “Are you sure this is comfortable?”

“I’m fine. You?”

“I feel much better.” Wilson squeezes his eyes tightly, and opens them again.

House’s mouth twists into a grin. “Hey, Wilson, while you’re down there...” he waggles his eyebrows.

Wilson looks straight into House’s left eye. “Actually, that’s not a bad idea.” He reaches a hand to grasp House’s zipper, and slowly pulls it down.

House’s breath catches. His eyes are so wide he can feel the cool breeze against the side of his eyeballs.

Wilson opens House’s button with a flick of his wrist, and slowly pulls his cock free. It swells in his hand. There’s a soft sound of fabric scraping against the bedroll, as Wilson rolls onto his belly and licks a deliberate stripe up one side. He flicks his eyes up toward House just as his tongue is poised to lick straight back down with the underside.

The shift in texture makes House shiver. He finally threads his hand into Wilson’s hair, and takes a long shaking breath.

Wilson nuzzles House’s stomach with his face twice, before closing his mouth around the head and swallowing. He brings House off with slow, even sucks, his tongue occasionally flicking House’s frenulum.

After House comes with a wordless cry, Wilson plants a knee either side of House’s outstretched legs and unzips his pants. He fucks House’s face with one hand braced against the tree trunk and the other cupping House’s cheek.

House slips his hands inside Wilson’s underwear, and cups his ass. He concentrates on the way each muscle contracts and relaxes in time with his thrusts, and the way Wilson pushes into his tongue just so.

When Wilson comes, he cries out so loudly that a bird is startled from the trees. House watches it soar into the air and disappear, as Wilson’s cock slowly shrinks in his mouth.

Their lips meet, briefly, before House gently guides Wilson’s head back to his good leg, and watches his eyes drift shut. 

House cards his fingers through Wilson’s hair for a long time. There is a difference in texture between the long thin slice at the front and the darker wavier hair at the back. He imagines he can see the architecture of each hair follicle, and spends many minutes categorizing them by width (20-49 micrometers, 50-99, 100-150) and growth phase (early anagen, anagen, late anagen, catagen, telogen).

The other thoughts are still jabbing at the periphery of his consciousness, like voices speaking over each other in their eagerness to be heard.

He ll never know-

-you can t get away with it-

-tell him.

House’s leg begins to throb. He reaches in his jacket pocket for the Vicodin bottle, unscrews it and pinches two pills between his thumb and forefinger. He looks at them for a second, before letting one drop and flinging the other into his mouth. He shuts his eyes, just for a moment to rest them, but they fly open again when he is sure he can hear a woman calling him in a lyrical, singsong voice.

 Wakey wakey

The shadows around him have shifted subtly. Wilson stirs against his lap, and when House looks down he can see that he’s wide-awake and holding the creased journal article in front of his face with one hand.

“Was I asleep?” House asks.

“Yeah, but it’s okay. I’ve had your article for company.”

“Lucky you. Learn anything?”

“Not really.” He looks up. “It got me thinking about Marmaduke, though.”

“Marmaduke?” House blinks to clear his head, and narrows his eyes. “Who is this Marmaduke? Is he hotter than me? Wait, no, don’t answer that.”

“Foreman’s Marmaduke, you know the impaired vestibular function patient from his old hospital.”

“Foreman had a patient called Marmaduke?”

“Oh, you so do know that. It’s part of the reason you hired him. That and the questionable moral past.”

“Oh, right, you mean misdiagnosed-falling-over guy. What kinds of parents name their kid Marmaduke?” House sighs. “Poor bastard.”

“I was just remembering. Thinking about hospital stuff, I guess - I don’t know. Foreman told me Marmaduke was so disorientated he couldn’t even walk, and that he fixed his balance by flying all the way to Wisconsin to borrow a tongue strip and a computer interface that he’d only ever read about. I never really stopped to think about how impressive it was before. Not only did he figure out the best way to make the thing work, but he also managed to pull together his own version and train Marmaduke’s brain to balance using electrical impulses in his tongue. And you’ve got to admit it: Foreman getting a guy’s brain to re-route its sense of balance through his tongue got your attention.”

“Yeah, but Marmaduke. And anyway, that’s not why I hired Foreman. I was just impressed that he managed to diagnose a stroke in a young guy who wasn’t displaying any typical symptoms. The cool tongue-balancing stuff was just a delightful bonus.” House raises his eyes to the heavens. “God, seriously, is Marmaduke even a real name?”

Wilson reaches one pale index finger to House’s chin, and draws it down with the tip. “You know his surname was Snook.”

“Seriously? Marmaduke Snook? You have got to be yanking my chain.”

There’s a pause before Wilson says. “Yes, I am actually,” without breaking his well-trained breaking-bad-news-to-cancer patients façade.

House rolls his eyes. “Oh you.”

“You know, now I come to think of it, the history of neuroplasticity is a real testament to medical arrogance.” Wilson proclaims this so seriously and clinically that House could almost believe he dreamed the salty slide of Wilson’s cock in his mouth just a few minutes ago.

It’s unsettling how close the hospital is to them all of a sudden. They’ve put miles of road between them and it, and House thought there were miles of road between them and their hospital selves. “I’m so glad I can put these erotic thoughts in your head. Why, oh do please tell, is the concept of a plasticine-like brain such a testament to medical arrogance?” And it’s suddenly alarmingly incongruous for Hospital House to have his hand in Hospital Wilson’s hair and have the taste Hospital Wilson’s semen in the back of his throat.

“Because getting a guy’s brain to balance using his tongue is meant to be impossible.” Hospital Wilson is saying. “In fact, fifty years ago, doctors knew the brain couldn’t change after early childhood. They knew you couldn’t change your IQ, or the way you experience pleasure or pain. Now scientists know otherwise. The guys in this journal article are using everything from brain-machine interface to computer games to get their brains to map new neural pathways around their pain so they don’t even notice it’s there, and fifty years ago we knew that was impossible too. Fifty years from now – who knows. Maybe they could rewire the circuitry in that waitress’ head. But if she goes to West Virginia U they’ll tell her thats impossible. They may even end up cutting part of her brain out.”

House sighs. “It’s not medical arrogance, it’s medical stupidity. Everybody just assumed you couldn’t do it because nobody ever had. Not disproving something doesn’t make it true, proving it does. Anything else is just bad science.”

“Perhaps.” Wilson folds the article, and reaches around to slip it into the back pocket of House’s pants. “Got anything else to eat? I’m starving.” He sits up, and props himself against the tree trunk. His shoulder gently bumps against House’s.

House reaches into his bag, and pulls out the quarter packet of trail mix and the bag of nacho flavored chips from the day before.

Wilson grabs the chips, and tears the packet open. He takes a fistful and begins shoveling them into his mouth, before handing the open bag to House.

House pops one chip into his mouth, and chews. “I thought you hated nachos.”

“I don’t hate nachos, I like them. I just hate that you get that yellow crap from the chips all over your hands when you eat them.”

“Yeah, well, surprise, surprise – yellow crap!” House grabs Wilson’s hand and waves it, before popping two of Wilson’s fingers into his mouth and sucking them slowly clean.

“I’m mapping a new neural pathway around the crap. Just like I’m mapping a new neural pathway around the pain in my ass sitting next to me.”

“If you think you’ve got a pain in your ass now, I can arrange a much, much bigger one. And by pain I mean my penis. And by your ass, I mean … well, your ass.”

Wilson’s face splits into a grin, despite his best efforts.

“Oh, and by bigger I mean-”

“Ah, okay, stop. I’m still seduced from ‘while you’re down there.’ Let’s not overdo it.”

House leans over, and kisses Wilson softly on the mouth. Wilson starts to press back. His lips are loose and warm.

There is an insistent, lilting voice humming in House’s head. House’s brain supplies the words.

Love is just like a merry-go-round,
With all the fun of the fair.
One day I'm feeling down on the ground,
Then I'm up in the air.
Are you leading me on?
Tomorrow will you be gone?

The same thoughts are clamoring to be heard. Tell him, dont tell him, you dont want him to hate you.

He doesn’t even realize he’s pulling away until he’s already done it.

Wilson’s eyebrows draw together. Five small ceases appear on his forehead. “What is it?”

House fixes his eyes on a spot directly ahead of them. There’s a jagged patch of blue sky on the horizon, framed by the branches of the trees on either side of the trail. He suddenly wants to grab Wilson’s hand, get up and just keep walking. Instead he says: “There’s something I have to tell you” in a quiet, hoarse voice.

Wilson crosses his hands in his lap and waits.

“The call from Norris just now, I knew it was coming. Foreman didn’t call her. I left a message with her assistant almost two weeks ago saying I was him. I checked her vacation schedule - this is her first day back after a fortnight’s leave. I knew she’d call you this morning our time. I’ve known it all along.”

Wilson nods slowly. He steeples his fingers, and touches them to his chin. “Why?” He asks, finally.

“Because when you turned down treatment, you thought you were turning down radiation and chemo. You thought you were turning down three years of misery and ill health before the inevitable happened anyway. If CyberKnife actually works it’ll be more effective with fewer side effects. If it doesn’t work, you haven’t really lost all that much.”

Wilson shifts a little on the ground. There’s an inch of space between them now, but to House it is a chasm.

“No, I know that. I mean why are you confessing? Is it because I said I was thinking about it? You think I want to do the treatment but don’t want to leave you behind, so you’re trying to make me mad at you. That way I won’t care about leaving. ”

House squints into the sunlight. “It’s not like that. Really. It’s nothing like that.”

“What is it like then, House? Are you even capable of telling me the truth?”

House jerks his head around violently, his face grazing the bark of the tree. He swallows, and his throat feels as if it’s lined with sandpaper. “Because I don’t want to control you!” He sucks in a breath, and lowers his voice. “I thought about not telling you, but you deserve for me to be honest, and the honest truth is that I did this so you would have a choice. I don’t care what you decide. I mean, I do care; obviously I care. But it’s not about that. There’s an option you didn’t know you had, and I wanted you to have all the facts before you made your final decision. And as final decisions go, this one is pretty final.”

“I know.” Wilson tilts his head back against the tree. “It’s final either way. If it doesn’t work we won’t get those days back.”

“That’s why it has to be your choice.”

Wilson scrunches up his face. “It’s a lot to take in. I think I’m gonna need at least a day.”

House forces a nod. “Okay.”

Wilson stares at House for some time, before cocking his head and saying: “So this article you’ve been carrying around; where does that fit into all of this? I know you say you’re trying to be honest, but are you sure you didn’t intend for me to find out about the neurorehab trial in New York for you and the CyberKnife one in London for me to see which one I’d pick? I can’t help but notice the one here needs people to sign up in the next two months.”

“The article? Why would you even -? No, okay. I’m not interested in that. It’s for amputees, for Christ’s sake. Come on Wilson, have you actually read that article properly? They’re just pretending it’s new and innovative to fleece their military funders for money. And, of course, said warmongers are only too happy to throw money down that particular black hole to assuage their guilt over making these guys lose their legs in the first place.”

House blows out a breath, and looks at his lap. “Look, fine, if you want to know the whole boring history behind why I happen to have it, here it is. I didn’t just sneak into the hospital to switch my dental records. About a week later, I went back for Vicodin. I left my hospital ID in Foreman’s office, then I pulled out the article he was reading from the American Journal of Neuroscience and replaced it with an article about the CyberKnife thing. Actually, the CyberKnife article was only one page, so I had to glue it to the back of some gay porn so he knew which side he was meant to read.”

House can barely see Wilson on the periphery of his vision, but he knows he is massaging his eyebrows. “Of course. Naturally.”

“The point is that Norris could’ve called him to confirm the message - or your contact details - and at least if she did, he’d know what she was talking about. I just kept the missing article for something to read.”

“That actually makes some kind of sense.”

“You see?” House scans Wilson’s face. “You’re reading way too much into this. I don’t even know why I still have that crappy article. Look, I’m new at…” he waves his hand around. “…this. But I am trying. I called Norris for you, and only for you. I know I’ve said it before, but there is no hidden agenda this time. Everything, the article, the trial, none of it has anything to do with anything, okay?”

“Okay.”  Wilson sighs, and rests his head against House’s. The sky is clear, and strangely empty. They watch together as two rabbits leap onto the trail up ahead, and bound down the path. Wilson reaches for House’s hand. “Okay.”

House squeezes Wilson’s fingers against his palm, and for a long time there is nothing but silence.


 

Pharmacology versus neuroplastic rehabilitation in the management of phantom limb pain in the lower extremities: an update.

Summary of findings to date

…85% of all patients with PLP who took part in the neuroplastic rehabilitation program reported a reduction in pain on the visual analogue pain scale after just one month. By the end of the year, 50% of these reported a complete absence of pain for periods ranging between two and nine days after treatment, as well as positive changes in pain perception.

It is our hope that with continued neuroplastic rehabilitation, these changes will become permanent.

 

Read S09 E02: A Diagnosis by Any Other Name