New Fic: On Rounds
Oct. 19th, 2008 03:17 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
namasteTitle: On Rounds
Author: Namaste
Summary: People and events from the past still influence the decisions Cuddy makes today. Gen, PG, about 5,000 words.
Thanks to![[livejournal.com profile]](https://www.dreamwidth.org/img/external/lj-userinfo.gif)
leiascully, pwcorgigirl, hibernia1, redheadstpchile, and talktidy for first reader help on this one.
Sample: Cuddy sees her reflection in the glass, the courtyard outside her window just beginning to take shape in the gray light of dawn. He wasn't a shadow, she tells herself. Shadows are soft, formless, poorly defined. After the infarction, House was broken glass and twisted metal -- the debris left on the side of the road after a car crash. All edges and sharp bits of steel that hid themselves until it was too late, until you'd already gashed open your skin and blood spilled out from the cut.
She was twenty-three the first time she went on rounds.
Twenty-three.
Cuddy glances at herself in the rear view mirror, sees the faint wrinkles around her eyes, and realizes it's nearly been twenty years since that day. It's already been twenty years since the day House forced himself into her life, taking a seat next to her at the Student Union and helping himself to her potato chips.
She eases the car down the driveway and onto the road and tries to remember the way she looked back then: long dark hair forced into submission in front of the mirror every morning with the blow dryer and flat iron, the short white lab coat that marked her status as a med student, the notebook that she carried everywhere filled with scribbled bits of information about patients, about medications, about how to interpret every symptom.
House had been gone for more than two years by the time Cuddy took her first steps on rounds, but memories of him had refused to fade. She still took the shortcuts through the winding roads around the hospital that he first showed her, walked the same halls he once walked, she'd done the same lab tests he'd once done, and could hear his dismissive sigh echoed in her own frustration over the hours spent in front the microscope.
That first day she and the other students were separated into groups, and then posted to their first clinical assignments. Even then House intruded as one of the residents listed off the rules every med student should know. "And number one," he'd said, "lab supplies should not be used for recreational purposes."
Cuddy had seen him in her mind, the smile on his face the day the cafeteria had been forced to close.
Now that she's the administrator, the one making the rules, the one who has to keep both students and doctors in line, Cuddy reminds herself that she should know how much damage House did back then, but even now, she can't quite hold back her own grin when she remembers seeing how happy he was, for once.
She turns left, out of her neighborhood and into town. It's still dark, the number of cars just beginning to pick up with the steady stream of drivers heading in to work an early shift.
Cuddy had been early that first day too, had been at the hospital more than thirty minutes before her scheduled start time. She'd been both sure of herself, and yet wary of what she didn't know. She'd been at the top of her class for the first two years, flew through every exam and moment of lab work. But this wasn't the classroom. These were real patients, with real problems. She couldn't make a mistake.
But she'd been lucky. Those first months, Cuddy had been assigned to Dr. Rourke, senior attending in endocrinology. He was short, balding and slightly overweight, his hands ending in thick fingers, his fingernails cut blunt and straight.
But she also remembers how gentle those same hands could be as he'd palpate the thyroid gland, or touch someone's arm to ease their fears. Or how quickly they'd moved the first time she saw him run a code -- how he'd done CPR, then injected epinephrine, then taking the defibrillator paddles -- in constant motion as he struggled to bring a patient back from the edge, even after another doctor had said it was too late.
Even though he'd failed.
"Everyone deserves a chance," he'd said afterwards, still breathing heavily and with sweat on his forehead from the effort.
She never questioned the decision she'd made within weeks of meeting him to follow his lead and specialize in endocrinology.
Days in the hospital quickly settled into a routine. They'd begin with rounds, Rourke leading the students from room to room and bed to bed. After the briefest of pauses one of the students would step forward, fumble for notes and begin to recite the facts: age, symptoms, diagnosis, treatment.
Then the silence, everyone glancing between the student and Rourke, waiting for the first words to come out of the senior doctor's mouth.
If you were lucky, or good, he'd nod, thank the patient for their time and tell the students to move on. If you weren't, you know as soon as he asked his first question.
"What was his blood pressure upon admission?" Rourke might ask, using just a few words to shine a bright light on the one fact the student forgot to mention.
Or he'd ask about the results of a blood test, knowing that the test hadn't been ordered, and making it clear that the test could point to some flaw that the student missed in his diagnosis.
"Listen to the patient," he'd tell them. "They're more than just symptoms and test results."
Worst of all were the times when he'd turn to the other students, ask them what they would have done differently. It was the moment it was clear that you had screwed up, missed some vital clue. Rourke would never have to say those words, but Cuddy had seen the look in his eyes the first time she'd made the mistake as he'd waited for the other students to see what he'd seen, to learn for themselves what she had missed.
The disappointment she'd seen then pushed her to do better next time, and the time after that. It made her a better doctor.
Cuddy thinks now that she learned more in those months with Rourke than she had in the rest of med school about how to treat patients and diagnose diseases, and learned more from him through his steady stream of questions about being an administrator than he'd ever realize.
She lets the memory slip away as she pulls into an empty parking space in front of the coffee shop five blocks from the hospital. She reaches for her purse and opens the door, thinking that she should drop Rourke a note, let him know how much he meant to her.
The shop seems bright after the darkness of the late autumn morning. One of the baristas sees her coming. "The usual?" she asks, and Cuddy nods.
She pays, tosses a tip in the jar and realizes how much she's come to develop her own routine, years after leaving the routine of med school behind, with the soy latte replacing the instant coffee in the student apartment she shared with three other girls, lunches with executives and donors rather than cramming at the library, tennis matches at night rather than unwinding at the bar.
She even does morning rounds, in her own way. Once at the office, she sits at her desk, turns on her computer and reads through the reports and e-mails filed each night. Rather than students reporting on individual patients, she hears from department heads, each one focusing on the health of their staff.
Just as Rourke once listened to the rundown on patients from students and listened for what wasn't being said, she now reads between the lines of each report.
There's the notice from orthopedics that Simpson wants to rearrange OR assignments. Again. She knows that this really means that someone pissed off Simpson once more, and he's decided he wants a new surgical team. Simpson is a pain in the ass to work for, but he's a skilled surgeon, and the ortho chief and Cuddy have both agreed that it's worth making a few adjustments every now and then to keep everyone happy.
She sees that yesterday's files from the ER have already been added to the system, and she scans the rundown on the number of patients seen, the hours logged by nurses and the list of needed supplies ordered from the inventory. Cuddy smiles, sips her latte. Her bet to place Cameron at the head of the department is paying off. It hadn't been the safe bet. Cameron had spent only a few months in the ER before her promotion. Edwards had the seniority, and had expected the title.
"This is because she's one of House's pets," he'd said when Cuddy took him out to lunch, and told him her plan. "She's barely figured out where we keep the meds down there."
"House has nothing to do with it." Cuddy had ignored the way Edwards had rolled his eyes. "You and I both know she's a good doctor, and she learns quickly."
She'd seen him clench his jaw, watched how he'd stabbed at a piece of his chicken piccata.
"But," Cuddy had continued, "she's not as good as you are down there."
He'd stopped, looked up at her. "So why ..."
"Because we need you working with patients, not doing paperwork." Cuddy had looked for a reaction, thought maybe she saw the frustration seep out of his shoulders as he sat back and listened. "You know as well as I do that half of the work running a department is paperwork," she'd said. "Doctor Cameron is fine doctor, but she doesn't mind shuffling papers. And you're a fine doctor who's happier when he's seeing patients."
He'd nodded as she'd explained the plan to him, to split duties from the hospital's traditional hierarchy to make him the senior attending, overseeing cases on the floor. Cameron would handle scheduling, the budget and managerial duties, which would cut into her time with patients, but keep the bureaucratic machine moving.
Cuddy knows she'd been right back then, knows it as she clicks away from Cameron's ER report and remembers Edwards' friendly wave to her in the parking lot yesterday.
She goes to the next item in her e-mail.
Brenda Previn is renewing her request to add evening hours at least one night a week for the clinic. They both know that the clinic has been getting swamped for the past few months, ever since the auto plant in Linden shut down. The university setting, and the distance, has helped insulate Princeton from some of the worst economic hits, but the area is still hurting, and the headlines Cuddy read this morning makes it clear that it'll only get worse.
From her seat in the clinic, Brenda has seen just how bad it is, and wants to do something now to get ready for the next wave. Cuddy's been trying to find funds that would let them extend the hours and buy more supplies, and Brenda keeps sending her reminders every week on the backlog of patients who need help. Cuddy knows she'll have to ask the departments to chip in extra hours every week to make it happen, and she's waiting for the right time to spring the request.
She trashes two notices on conventions that she won't be attending, then clicks on a message from Wilson. He's left her a status report on the list of candidates for a new attending position in oncology. It's just a few lines. He always says he doesn't want to bother her unless there's something he can't take care of himself. Cuddy always trusts his judgment, though she sometimes regrets it. Usually he's right, and things are under control, but when he's wrong...
She shakes her head, tries not to dwell on those times, the times when he makes a mistake and a smoldering ember from some fire he couldn't quite tame takes on oxygen and grows overnight into an inferno. Most of the time, it seems like House is standing at the heart of the flames.
House.
She lets the thought trail off, picks up her latte and turns away from the computer. If this really is her way of making rounds these days, then House is her own patient -- in more ways than one. He is her responsibility. He is the patient in the bed whose body defies every diagnosis, every cure.
Sometimes she wishes Rourke was there beside her now, so he could say one word, ask one question that would make it all so clear, so that she'll finally know what to do, give her the one answer she's been seeking since that day House had forced himself back into her life.
She'd known that House was at Princeton-Plainsboro before she even took the job -- part of the staff, but always denied tenure -- the administration's way of keeping him on a leash by letting him know they could fire him at any time. She'd laughed when she'd heard that, realized that they had no idea who they were dealing with. House never cared about getting fired. He cared about being bored, of never finding the answer to whatever mystery he was chasing.
Cuddy had half expected him to show up everywhere in her first months there: in a patient's room, or in a doctors' lounge or in one of the subcommittee meetings that she chaired as a department head. She'd spent an hour one afternoon in the cafeteria with a bag of chips on her tray and found herself disappointed he hadn't shown up. She began to wonder if he was ignoring her.
Or if maybe he'd forgotten her.
He hadn't. She'd seen the way he stared her down from his bed the first time she saw him after he was admitted. Doped up on morphine and his kidneys shutting down, he'd sized her up in a glance, waved her off when she'd started to introduce herself, explain how her committee oversaw clinic cases, and now she was taking over his.
"I've got a clot, and they send an endocrinologist," he'd said, and turned to Stacy. "We should have gone to Princeton General."
Cuddy had quietly reassured him that she was working closely with the vascular team, tried using the gentle, easy tones that she'd heard Rourke use again and again with nervous patients, the same tones that had worked for her for years.
House defied her expectations, and defied common sense. Cuddy knew he should have died from his own stubborn conviction that he was right, believes even now that he would have died if it weren't for Stacy.
But he did live. And then Stacy left, and what remained of House was just a shadow of who he'd been.
No.
Cuddy sees her reflection in the glass, the courtyard outside her window just beginning to take shape in the gray light of dawn. He wasn't a shadow, she tells herself. Shadows are soft, formless, poorly defined. After the infarction, House was broken glass and twisted metal -- the debris left on the side of the road after a car crash. All edges and sharp bits of steel that hid themselves until it was too late, until you'd already gashed open your skin and blood spilled out from the cut.
Technically, he wasn't her patient anymore after that. He'd belonged to orthopedics and rehab, the vascular specialists who pumped him full of blood thinners and pain killers until House turned his back on all of them, on everyone except Wilson, and everything except Vicodin.
She'd see him sometimes, sitting in a dark corner of a lecture hall or the cafeteria, glaring at anyone who asked how he was doing, walking the halls with his new, uneven gait.
The head of infectious diseases wanted to fire him, said House couldn't -- or wouldn't -- work regular hours anymore.
"Or make him a consulting member of the faculty," he'd added at one meeting. "It'd be better for him than just cutting him loose."
But Cuddy knew what would happen if they did. House would be forgotten, receiving fewer and fewer requests for consults until he was left behind completely, the next generation of doctors never knowing him as anything more than a legend. A myth.
And House would let them. He'd shut himself away, tell himself that he was happier when he was alone.
"No," Cuddy had said. She was on the board now, had moved up from subcommittees to committees to a seat representing the doctors while House had faded. "Give him a little more time," she'd said.
They had -- not for her, but because they feared a malpractice lawsuit, and convinced themselves that if House still had a job, he wouldn't sue.
But Cuddy hadn't wanted time just for him. She needed time herself to build a proposal that was just beginning to take shape; a role for House that no one else could fill. She needed time to put those rough ideas together, and she had to wait until she was in a position to put the plan into action.
A year later, the old chief of medicine was gone, and once the power struggle settled, Cuddy had been the one left standing.
A month after that, she'd formally offered House the job as head of the new department of diagnostic medicine.
"Is this supposed to clear your conscience?" House had asked. "Give me a title and a desk and expect that this hole in my leg is just going to disappear?"
She hadn't backed down, hadn't looked away. "I've got nothing to atone for," she'd said, "but if you're not interested, I could hire ..."
"I won't take it," House had said, and Cuddy had stopped short. It had been the one scenario she hadn't planned for, the thing she'd never expected.
She should have known better, she'd told herself. House had never met anyone's expectations. Cuddy had tried to think of what she could say to change his mind, and then House had taken a step closer to her, forced her to look up at him.
"Not without tenure," he'd said, and Cuddy closed her eyes, tried to hide her emotions for just a moment.
She'd waited, took a breath, then opened her eyes again, looked up at House. "That's up to the board," she'd said.
"Somehow, I think you'll be able to talk them into it," he'd said, then raised his eyebrows, "especially if you wear that top."
It had taken time, and nothing had completely gelled until he had a full team in place -- but House and his department were really becoming something other hospitals envied now, something close to what she'd dreamed of back then. It was like watching her patients in those first years of med school and residency walk out of the hospital, returning to their lives and getting stronger every day.
Cuddy turns back to her desk again, drinks down the last of the latte and tosses the empty cup in the trash. She pauses for a moment with her hand over the expense reports on her desk, sees the notice on top that the check has finally cleared for the cryostat repairs -- the bill she'd thrown out because she'd thought it was another of House's fabricated budget items. It had taken an extra month to get the account straightened out.
House isn't like the patient leaving the hospital with a clean bill of health, Cuddy corrects herself. He's the patient with a chronic condition, always needing treatment, or some new medication or a new set of tests.
And she's the one who has to keep an eye on him, to monitor him and make constant adjustments.
He won't see patients? She finds him an interesting case.
He won't do his clinic hours? Find a wager that he can't refuse.
He wants to run away from his own emotional issues? Cuddy's got just the right combination of drugs.
Vogler accused her once of trying to save House because of some history between them that he only guessed at. Tritter thought she was a fool. Cuddy told them both that she still thought House was worthwhile because he saved lives that nobody else could.
She knows that's the biggest issue in his favor, even though every week he seems to find his way out to some tipping point that marks the line between his value to the hospital and the easier option of letting him go, and she's the one forced to put the balance back in his favor, but not take down the hospital at the same time. She wishes she could quit fighting, but she doesn't.
There's more to it than just his billing hours, or the statistics of the patients he's saved, or the good publicity created with every high powered patient they get. There's more than Vogler's guesses or Tritter's accusations could even touch. But every time she's tried to define just what that is, she can't find the words, can't describe the emotions.
It's like the shadow on an MRI that can be read a hundred different ways, or a blip on a cardiac monitor that you're not quite sure you've seen.
If he really were just her patient, she'd call for more tests, look for a final diagnosis that would finally cure him, but he's not, and all she can do is trust her instincts, believe that he's worth every headache and lost donation and angry phone call.
Cuddy shakes her head, checks the rest of the bills, sees nothing in there that doesn't belong, and turns back to the computer, logs on to the accounting department to tell them to ship the payments.
She's just about to log off when she notices the icon on the bottom of her screen with incoming e-mail. She opens it up, reads the short notice from radiology, telling her that they've cleared the MRI for the maintenance shutdown for two days starting on Thursday, per her e-mailed request.
Her hand grips the mouse a little tighter and she forces herself to take a deep breath before she hits the "reply" button.
She doesn't mention House, just refers to "miscommunication" as she tells the radiology head that there's no scheduled maintenance shutdown. Half the hospital already blames House for everything that goes wrong. No reason to add to their frustration. She'll handle him herself.
She sends the e-mail, then clicks over to change her password. Again.
It took House nearly a month to hack into her account this time -- that she knows of. Then she begins to wonder how long he's just been reading her mail. She thinks of the note her sister sent, talking about the fight she'd had with her husband, and her mother's e-mails trying to set her up on a blind date with a nephew of some woman she'd met at a reception.
Cuddy's still trying to come up with the proper punishment, whether it's time to saddle him with more med students, or if she should have maintenance move all the vending machines off the fourth floor when she hears a knock.
She looks up, sees Williamson, the head of urology, at her door. She waves him in.
"Sorry to bother you," he says. He's still wearing his coat and carrying a briefcase as he crosses the carpet to her desk. "I saw that you were in early, and was hoping you'd have time to discuss the clinical work we've got coming up for the male infertility studies."
Cuddy glances at the clock, then checks her calendar. She forces her anger at House into the back of her mind and smiles, nods toward the chair in front of her desk. "I've got twenty minutes," she says. "Is that enough?"
The morning slips past her in a series of conference calls and committee meetings. Lunch is at a downtown restaurant with a donor, then she spends thirty minutes with pediatrics, discussing its plans for a holiday fundraiser.
It's midafternoon before she makes it back to her desk, and another hour before she returns all the calls and sifts through the messages waiting for her, half of them marked as urgent.
At the bottom of the stack is a note from radiology, apologizing for the mixup and confirming the new schedule for a one-day shut down on Friday.
She's halfway across the room before she finishes reading it. She's crossing the lobby when she hears Brenda call her name. Cuddy stops and takes a step toward her, but Brenda takes in her expression, reads the frustration and anger that must be present on her face.
"It'll wait," Brenda says, and heads back to the clinic.
Cuddy tries to settle her emotions as she rides up to the fourth floor in the elevator. Anger doesn't work on House. Neither does pleading. Or common sense.
He's at his desk and puts down a journal as she pushes open his door. "We are not putting a million dollar machine out of action for a day just so you can ..." she waves the radiology note at him, "settle a bet."
House leans back, lifts his legs up onto the corner of his desk. "It's not just about the bet." If he's surprised that she made the right guess, he doesn't show it. "I have a legitimate medical reason to run those tests."
"Such as?"
"How does early stage trials of new contrast materials sound?"
"Like an excuse you just pulled out of your ass." Cuddy crosses her arms over her chest.
"Actually, the materials come from --"
Cuddy holds out one hand, cutting him off without a word.
"Fine," House says. "We don't need twenty-four hours. Twelve should be enough."
"How about twelve more clinic hours this month?"
"Six," House says. "It's a legitimate experiment. There have been studies in Russia on alternative contrast dyes."
"So let radiology run the tests."
"They're not interested." House shrugs. "They say there's nothing wrong with what we've got now."
"Are they wrong?"
"Nobody will know unless someone runs the tests."
Cuddy feels the argument slipping away from her, senses her anger falling away, leaving nothing but vague frustration and fatigue in its place. She sits down, crosses one leg over the other. She stares down at the paper in her hand, then looks up at House. Maybe he's right. Maybe he can find something that nobody else has tried before, something that will make a difference to someone some day.
Or maybe she's a fool, and he's just taking advantage of her.
Maybe Vogler and Tritter and everyone else is right.
She shakes her head. "Why do I even bother?" she mumbles.
"Because it's what you do." House says.
"What, beat my head against the wall? And the wall in this metaphor," Cuddy continues, "would be you."
House opens his mouth to say something, then stops himself, studies her, his eyes honing in on something beyond the length of her skirt, or cut of her blouse.
"You were an adequate doctor before you moved into that office downstairs," he finally says. "As an administrator, you make erratic personnel decisions, you hire people based on what you think they can do, rather than their resumes, and you give departments way too much autonomy."
Cuddy pushes herself out of the chair, heads for the door.
"But a trained monkey can be an administrator," House continues. Cuddy pauses next to the shelves against the far wall of his office. "Anyone can push paper or woo donors or file reports. Anyone can make decisions. The trick is to make the right decisions." He points toward the conference room, where Kutner and Foreman are going through files. "Mercy General's dean made a safe decision when she fired Foreman for going against her orders, but the safe choice is usually the easy one to make. The one anyone can make. The right choice was the one that saved a woman's life."
He swings his legs off the desk, leans forward. "No one ever did anything great by playing it safe. You don't always just take the safe bet. You play the odds, take chances. And when you take chances, people figure out what the right decision is, and not just the safe one."
Cuddy takes a step back toward him. "You said the board should have fired me after the audit this year. Would that have been the right decision?"
"That would have been the safe decision," he says. "The board wasn't looking to do the safe thing, and neither are you. You take chances, because sometimes taking a chance is the right thing. If you wanted a job that would be safe and secure and easy, you wouldn't be here. And neither would I."
She studies him, sees the graying hair, the lines in his face, the pain that always seems to be in his eyes. He's changed since she first saw him, has aged in ways that neither of them ever expected. So has she. But twenty years on, he's still pushing her to try something new, leading her down new paths, still breaking the rules.
And she's still following him.
He's right. The safe thing would have been to let him go. But the safe choice isn't always the right choice.
"Show me your studies, and I'll let you have the MRI for two hours," she says.
She sees the slight smile on his face, sees the way the pain in his eyes seems to disappear, just for a moment. "Four hours," he says.
"Two." She walks out the door, but glances into his office from the hallway, sees him lean back, put his feet back on the desk.
The elevator is empty when she steps in, and she rides down in silence. A chance. Even if the patient is dying, Rourke would have said, that patient deserves every chance. Even if you think it won't work, he deserves that chance.
Maybe that's what she couldn't define before, what she couldn't explain to Vogler, what she's tried to argue to the board.
House is worth saving -- is worth having around -- because he's a walking example of that chance that every patient deserves. The risk that's worth taking. The experimental drug that you hope will give a terminal patient just a few more months or years.
Or maybe House was just playing her. Telling her what she wanted to hear, just so he could run his tests and settle his curiosity. Maybe giving in to him this time will just lead to another setback, become another failed treatment. But she won't know unless she tries.
The elevator doors open and she walks out into the lobby. Maybe he was playing her, she thinks, but that's a chance she's willing to take.
Author: Namaste
Summary: People and events from the past still influence the decisions Cuddy makes today. Gen, PG, about 5,000 words.
Thanks to
leiascully, pwcorgigirl, hibernia1, redheadstpchile, and talktidy for first reader help on this one.Sample: Cuddy sees her reflection in the glass, the courtyard outside her window just beginning to take shape in the gray light of dawn. He wasn't a shadow, she tells herself. Shadows are soft, formless, poorly defined. After the infarction, House was broken glass and twisted metal -- the debris left on the side of the road after a car crash. All edges and sharp bits of steel that hid themselves until it was too late, until you'd already gashed open your skin and blood spilled out from the cut.
She was twenty-three the first time she went on rounds.
Twenty-three.
Cuddy glances at herself in the rear view mirror, sees the faint wrinkles around her eyes, and realizes it's nearly been twenty years since that day. It's already been twenty years since the day House forced himself into her life, taking a seat next to her at the Student Union and helping himself to her potato chips.
She eases the car down the driveway and onto the road and tries to remember the way she looked back then: long dark hair forced into submission in front of the mirror every morning with the blow dryer and flat iron, the short white lab coat that marked her status as a med student, the notebook that she carried everywhere filled with scribbled bits of information about patients, about medications, about how to interpret every symptom.
House had been gone for more than two years by the time Cuddy took her first steps on rounds, but memories of him had refused to fade. She still took the shortcuts through the winding roads around the hospital that he first showed her, walked the same halls he once walked, she'd done the same lab tests he'd once done, and could hear his dismissive sigh echoed in her own frustration over the hours spent in front the microscope.
That first day she and the other students were separated into groups, and then posted to their first clinical assignments. Even then House intruded as one of the residents listed off the rules every med student should know. "And number one," he'd said, "lab supplies should not be used for recreational purposes."
Cuddy had seen him in her mind, the smile on his face the day the cafeteria had been forced to close.
Now that she's the administrator, the one making the rules, the one who has to keep both students and doctors in line, Cuddy reminds herself that she should know how much damage House did back then, but even now, she can't quite hold back her own grin when she remembers seeing how happy he was, for once.
She turns left, out of her neighborhood and into town. It's still dark, the number of cars just beginning to pick up with the steady stream of drivers heading in to work an early shift.
Cuddy had been early that first day too, had been at the hospital more than thirty minutes before her scheduled start time. She'd been both sure of herself, and yet wary of what she didn't know. She'd been at the top of her class for the first two years, flew through every exam and moment of lab work. But this wasn't the classroom. These were real patients, with real problems. She couldn't make a mistake.
But she'd been lucky. Those first months, Cuddy had been assigned to Dr. Rourke, senior attending in endocrinology. He was short, balding and slightly overweight, his hands ending in thick fingers, his fingernails cut blunt and straight.
But she also remembers how gentle those same hands could be as he'd palpate the thyroid gland, or touch someone's arm to ease their fears. Or how quickly they'd moved the first time she saw him run a code -- how he'd done CPR, then injected epinephrine, then taking the defibrillator paddles -- in constant motion as he struggled to bring a patient back from the edge, even after another doctor had said it was too late.
Even though he'd failed.
"Everyone deserves a chance," he'd said afterwards, still breathing heavily and with sweat on his forehead from the effort.
She never questioned the decision she'd made within weeks of meeting him to follow his lead and specialize in endocrinology.
Days in the hospital quickly settled into a routine. They'd begin with rounds, Rourke leading the students from room to room and bed to bed. After the briefest of pauses one of the students would step forward, fumble for notes and begin to recite the facts: age, symptoms, diagnosis, treatment.
Then the silence, everyone glancing between the student and Rourke, waiting for the first words to come out of the senior doctor's mouth.
If you were lucky, or good, he'd nod, thank the patient for their time and tell the students to move on. If you weren't, you know as soon as he asked his first question.
"What was his blood pressure upon admission?" Rourke might ask, using just a few words to shine a bright light on the one fact the student forgot to mention.
Or he'd ask about the results of a blood test, knowing that the test hadn't been ordered, and making it clear that the test could point to some flaw that the student missed in his diagnosis.
"Listen to the patient," he'd tell them. "They're more than just symptoms and test results."
Worst of all were the times when he'd turn to the other students, ask them what they would have done differently. It was the moment it was clear that you had screwed up, missed some vital clue. Rourke would never have to say those words, but Cuddy had seen the look in his eyes the first time she'd made the mistake as he'd waited for the other students to see what he'd seen, to learn for themselves what she had missed.
The disappointment she'd seen then pushed her to do better next time, and the time after that. It made her a better doctor.
Cuddy thinks now that she learned more in those months with Rourke than she had in the rest of med school about how to treat patients and diagnose diseases, and learned more from him through his steady stream of questions about being an administrator than he'd ever realize.
She lets the memory slip away as she pulls into an empty parking space in front of the coffee shop five blocks from the hospital. She reaches for her purse and opens the door, thinking that she should drop Rourke a note, let him know how much he meant to her.
The shop seems bright after the darkness of the late autumn morning. One of the baristas sees her coming. "The usual?" she asks, and Cuddy nods.
She pays, tosses a tip in the jar and realizes how much she's come to develop her own routine, years after leaving the routine of med school behind, with the soy latte replacing the instant coffee in the student apartment she shared with three other girls, lunches with executives and donors rather than cramming at the library, tennis matches at night rather than unwinding at the bar.
She even does morning rounds, in her own way. Once at the office, she sits at her desk, turns on her computer and reads through the reports and e-mails filed each night. Rather than students reporting on individual patients, she hears from department heads, each one focusing on the health of their staff.
Just as Rourke once listened to the rundown on patients from students and listened for what wasn't being said, she now reads between the lines of each report.
There's the notice from orthopedics that Simpson wants to rearrange OR assignments. Again. She knows that this really means that someone pissed off Simpson once more, and he's decided he wants a new surgical team. Simpson is a pain in the ass to work for, but he's a skilled surgeon, and the ortho chief and Cuddy have both agreed that it's worth making a few adjustments every now and then to keep everyone happy.
She sees that yesterday's files from the ER have already been added to the system, and she scans the rundown on the number of patients seen, the hours logged by nurses and the list of needed supplies ordered from the inventory. Cuddy smiles, sips her latte. Her bet to place Cameron at the head of the department is paying off. It hadn't been the safe bet. Cameron had spent only a few months in the ER before her promotion. Edwards had the seniority, and had expected the title.
"This is because she's one of House's pets," he'd said when Cuddy took him out to lunch, and told him her plan. "She's barely figured out where we keep the meds down there."
"House has nothing to do with it." Cuddy had ignored the way Edwards had rolled his eyes. "You and I both know she's a good doctor, and she learns quickly."
She'd seen him clench his jaw, watched how he'd stabbed at a piece of his chicken piccata.
"But," Cuddy had continued, "she's not as good as you are down there."
He'd stopped, looked up at her. "So why ..."
"Because we need you working with patients, not doing paperwork." Cuddy had looked for a reaction, thought maybe she saw the frustration seep out of his shoulders as he sat back and listened. "You know as well as I do that half of the work running a department is paperwork," she'd said. "Doctor Cameron is fine doctor, but she doesn't mind shuffling papers. And you're a fine doctor who's happier when he's seeing patients."
He'd nodded as she'd explained the plan to him, to split duties from the hospital's traditional hierarchy to make him the senior attending, overseeing cases on the floor. Cameron would handle scheduling, the budget and managerial duties, which would cut into her time with patients, but keep the bureaucratic machine moving.
Cuddy knows she'd been right back then, knows it as she clicks away from Cameron's ER report and remembers Edwards' friendly wave to her in the parking lot yesterday.
She goes to the next item in her e-mail.
Brenda Previn is renewing her request to add evening hours at least one night a week for the clinic. They both know that the clinic has been getting swamped for the past few months, ever since the auto plant in Linden shut down. The university setting, and the distance, has helped insulate Princeton from some of the worst economic hits, but the area is still hurting, and the headlines Cuddy read this morning makes it clear that it'll only get worse.
From her seat in the clinic, Brenda has seen just how bad it is, and wants to do something now to get ready for the next wave. Cuddy's been trying to find funds that would let them extend the hours and buy more supplies, and Brenda keeps sending her reminders every week on the backlog of patients who need help. Cuddy knows she'll have to ask the departments to chip in extra hours every week to make it happen, and she's waiting for the right time to spring the request.
She trashes two notices on conventions that she won't be attending, then clicks on a message from Wilson. He's left her a status report on the list of candidates for a new attending position in oncology. It's just a few lines. He always says he doesn't want to bother her unless there's something he can't take care of himself. Cuddy always trusts his judgment, though she sometimes regrets it. Usually he's right, and things are under control, but when he's wrong...
She shakes her head, tries not to dwell on those times, the times when he makes a mistake and a smoldering ember from some fire he couldn't quite tame takes on oxygen and grows overnight into an inferno. Most of the time, it seems like House is standing at the heart of the flames.
House.
She lets the thought trail off, picks up her latte and turns away from the computer. If this really is her way of making rounds these days, then House is her own patient -- in more ways than one. He is her responsibility. He is the patient in the bed whose body defies every diagnosis, every cure.
Sometimes she wishes Rourke was there beside her now, so he could say one word, ask one question that would make it all so clear, so that she'll finally know what to do, give her the one answer she's been seeking since that day House had forced himself back into her life.
She'd known that House was at Princeton-Plainsboro before she even took the job -- part of the staff, but always denied tenure -- the administration's way of keeping him on a leash by letting him know they could fire him at any time. She'd laughed when she'd heard that, realized that they had no idea who they were dealing with. House never cared about getting fired. He cared about being bored, of never finding the answer to whatever mystery he was chasing.
Cuddy had half expected him to show up everywhere in her first months there: in a patient's room, or in a doctors' lounge or in one of the subcommittee meetings that she chaired as a department head. She'd spent an hour one afternoon in the cafeteria with a bag of chips on her tray and found herself disappointed he hadn't shown up. She began to wonder if he was ignoring her.
Or if maybe he'd forgotten her.
He hadn't. She'd seen the way he stared her down from his bed the first time she saw him after he was admitted. Doped up on morphine and his kidneys shutting down, he'd sized her up in a glance, waved her off when she'd started to introduce herself, explain how her committee oversaw clinic cases, and now she was taking over his.
"I've got a clot, and they send an endocrinologist," he'd said, and turned to Stacy. "We should have gone to Princeton General."
Cuddy had quietly reassured him that she was working closely with the vascular team, tried using the gentle, easy tones that she'd heard Rourke use again and again with nervous patients, the same tones that had worked for her for years.
House defied her expectations, and defied common sense. Cuddy knew he should have died from his own stubborn conviction that he was right, believes even now that he would have died if it weren't for Stacy.
But he did live. And then Stacy left, and what remained of House was just a shadow of who he'd been.
No.
Cuddy sees her reflection in the glass, the courtyard outside her window just beginning to take shape in the gray light of dawn. He wasn't a shadow, she tells herself. Shadows are soft, formless, poorly defined. After the infarction, House was broken glass and twisted metal -- the debris left on the side of the road after a car crash. All edges and sharp bits of steel that hid themselves until it was too late, until you'd already gashed open your skin and blood spilled out from the cut.
Technically, he wasn't her patient anymore after that. He'd belonged to orthopedics and rehab, the vascular specialists who pumped him full of blood thinners and pain killers until House turned his back on all of them, on everyone except Wilson, and everything except Vicodin.
She'd see him sometimes, sitting in a dark corner of a lecture hall or the cafeteria, glaring at anyone who asked how he was doing, walking the halls with his new, uneven gait.
The head of infectious diseases wanted to fire him, said House couldn't -- or wouldn't -- work regular hours anymore.
"Or make him a consulting member of the faculty," he'd added at one meeting. "It'd be better for him than just cutting him loose."
But Cuddy knew what would happen if they did. House would be forgotten, receiving fewer and fewer requests for consults until he was left behind completely, the next generation of doctors never knowing him as anything more than a legend. A myth.
And House would let them. He'd shut himself away, tell himself that he was happier when he was alone.
"No," Cuddy had said. She was on the board now, had moved up from subcommittees to committees to a seat representing the doctors while House had faded. "Give him a little more time," she'd said.
They had -- not for her, but because they feared a malpractice lawsuit, and convinced themselves that if House still had a job, he wouldn't sue.
But Cuddy hadn't wanted time just for him. She needed time herself to build a proposal that was just beginning to take shape; a role for House that no one else could fill. She needed time to put those rough ideas together, and she had to wait until she was in a position to put the plan into action.
A year later, the old chief of medicine was gone, and once the power struggle settled, Cuddy had been the one left standing.
A month after that, she'd formally offered House the job as head of the new department of diagnostic medicine.
"Is this supposed to clear your conscience?" House had asked. "Give me a title and a desk and expect that this hole in my leg is just going to disappear?"
She hadn't backed down, hadn't looked away. "I've got nothing to atone for," she'd said, "but if you're not interested, I could hire ..."
"I won't take it," House had said, and Cuddy had stopped short. It had been the one scenario she hadn't planned for, the thing she'd never expected.
She should have known better, she'd told herself. House had never met anyone's expectations. Cuddy had tried to think of what she could say to change his mind, and then House had taken a step closer to her, forced her to look up at him.
"Not without tenure," he'd said, and Cuddy closed her eyes, tried to hide her emotions for just a moment.
She'd waited, took a breath, then opened her eyes again, looked up at House. "That's up to the board," she'd said.
"Somehow, I think you'll be able to talk them into it," he'd said, then raised his eyebrows, "especially if you wear that top."
It had taken time, and nothing had completely gelled until he had a full team in place -- but House and his department were really becoming something other hospitals envied now, something close to what she'd dreamed of back then. It was like watching her patients in those first years of med school and residency walk out of the hospital, returning to their lives and getting stronger every day.
Cuddy turns back to her desk again, drinks down the last of the latte and tosses the empty cup in the trash. She pauses for a moment with her hand over the expense reports on her desk, sees the notice on top that the check has finally cleared for the cryostat repairs -- the bill she'd thrown out because she'd thought it was another of House's fabricated budget items. It had taken an extra month to get the account straightened out.
House isn't like the patient leaving the hospital with a clean bill of health, Cuddy corrects herself. He's the patient with a chronic condition, always needing treatment, or some new medication or a new set of tests.
And she's the one who has to keep an eye on him, to monitor him and make constant adjustments.
He won't see patients? She finds him an interesting case.
He won't do his clinic hours? Find a wager that he can't refuse.
He wants to run away from his own emotional issues? Cuddy's got just the right combination of drugs.
Vogler accused her once of trying to save House because of some history between them that he only guessed at. Tritter thought she was a fool. Cuddy told them both that she still thought House was worthwhile because he saved lives that nobody else could.
She knows that's the biggest issue in his favor, even though every week he seems to find his way out to some tipping point that marks the line between his value to the hospital and the easier option of letting him go, and she's the one forced to put the balance back in his favor, but not take down the hospital at the same time. She wishes she could quit fighting, but she doesn't.
There's more to it than just his billing hours, or the statistics of the patients he's saved, or the good publicity created with every high powered patient they get. There's more than Vogler's guesses or Tritter's accusations could even touch. But every time she's tried to define just what that is, she can't find the words, can't describe the emotions.
It's like the shadow on an MRI that can be read a hundred different ways, or a blip on a cardiac monitor that you're not quite sure you've seen.
If he really were just her patient, she'd call for more tests, look for a final diagnosis that would finally cure him, but he's not, and all she can do is trust her instincts, believe that he's worth every headache and lost donation and angry phone call.
Cuddy shakes her head, checks the rest of the bills, sees nothing in there that doesn't belong, and turns back to the computer, logs on to the accounting department to tell them to ship the payments.
She's just about to log off when she notices the icon on the bottom of her screen with incoming e-mail. She opens it up, reads the short notice from radiology, telling her that they've cleared the MRI for the maintenance shutdown for two days starting on Thursday, per her e-mailed request.
Her hand grips the mouse a little tighter and she forces herself to take a deep breath before she hits the "reply" button.
She doesn't mention House, just refers to "miscommunication" as she tells the radiology head that there's no scheduled maintenance shutdown. Half the hospital already blames House for everything that goes wrong. No reason to add to their frustration. She'll handle him herself.
She sends the e-mail, then clicks over to change her password. Again.
It took House nearly a month to hack into her account this time -- that she knows of. Then she begins to wonder how long he's just been reading her mail. She thinks of the note her sister sent, talking about the fight she'd had with her husband, and her mother's e-mails trying to set her up on a blind date with a nephew of some woman she'd met at a reception.
Cuddy's still trying to come up with the proper punishment, whether it's time to saddle him with more med students, or if she should have maintenance move all the vending machines off the fourth floor when she hears a knock.
She looks up, sees Williamson, the head of urology, at her door. She waves him in.
"Sorry to bother you," he says. He's still wearing his coat and carrying a briefcase as he crosses the carpet to her desk. "I saw that you were in early, and was hoping you'd have time to discuss the clinical work we've got coming up for the male infertility studies."
Cuddy glances at the clock, then checks her calendar. She forces her anger at House into the back of her mind and smiles, nods toward the chair in front of her desk. "I've got twenty minutes," she says. "Is that enough?"
The morning slips past her in a series of conference calls and committee meetings. Lunch is at a downtown restaurant with a donor, then she spends thirty minutes with pediatrics, discussing its plans for a holiday fundraiser.
It's midafternoon before she makes it back to her desk, and another hour before she returns all the calls and sifts through the messages waiting for her, half of them marked as urgent.
At the bottom of the stack is a note from radiology, apologizing for the mixup and confirming the new schedule for a one-day shut down on Friday.
She's halfway across the room before she finishes reading it. She's crossing the lobby when she hears Brenda call her name. Cuddy stops and takes a step toward her, but Brenda takes in her expression, reads the frustration and anger that must be present on her face.
"It'll wait," Brenda says, and heads back to the clinic.
Cuddy tries to settle her emotions as she rides up to the fourth floor in the elevator. Anger doesn't work on House. Neither does pleading. Or common sense.
He's at his desk and puts down a journal as she pushes open his door. "We are not putting a million dollar machine out of action for a day just so you can ..." she waves the radiology note at him, "settle a bet."
House leans back, lifts his legs up onto the corner of his desk. "It's not just about the bet." If he's surprised that she made the right guess, he doesn't show it. "I have a legitimate medical reason to run those tests."
"Such as?"
"How does early stage trials of new contrast materials sound?"
"Like an excuse you just pulled out of your ass." Cuddy crosses her arms over her chest.
"Actually, the materials come from --"
Cuddy holds out one hand, cutting him off without a word.
"Fine," House says. "We don't need twenty-four hours. Twelve should be enough."
"How about twelve more clinic hours this month?"
"Six," House says. "It's a legitimate experiment. There have been studies in Russia on alternative contrast dyes."
"So let radiology run the tests."
"They're not interested." House shrugs. "They say there's nothing wrong with what we've got now."
"Are they wrong?"
"Nobody will know unless someone runs the tests."
Cuddy feels the argument slipping away from her, senses her anger falling away, leaving nothing but vague frustration and fatigue in its place. She sits down, crosses one leg over the other. She stares down at the paper in her hand, then looks up at House. Maybe he's right. Maybe he can find something that nobody else has tried before, something that will make a difference to someone some day.
Or maybe she's a fool, and he's just taking advantage of her.
Maybe Vogler and Tritter and everyone else is right.
She shakes her head. "Why do I even bother?" she mumbles.
"Because it's what you do." House says.
"What, beat my head against the wall? And the wall in this metaphor," Cuddy continues, "would be you."
House opens his mouth to say something, then stops himself, studies her, his eyes honing in on something beyond the length of her skirt, or cut of her blouse.
"You were an adequate doctor before you moved into that office downstairs," he finally says. "As an administrator, you make erratic personnel decisions, you hire people based on what you think they can do, rather than their resumes, and you give departments way too much autonomy."
Cuddy pushes herself out of the chair, heads for the door.
"But a trained monkey can be an administrator," House continues. Cuddy pauses next to the shelves against the far wall of his office. "Anyone can push paper or woo donors or file reports. Anyone can make decisions. The trick is to make the right decisions." He points toward the conference room, where Kutner and Foreman are going through files. "Mercy General's dean made a safe decision when she fired Foreman for going against her orders, but the safe choice is usually the easy one to make. The one anyone can make. The right choice was the one that saved a woman's life."
He swings his legs off the desk, leans forward. "No one ever did anything great by playing it safe. You don't always just take the safe bet. You play the odds, take chances. And when you take chances, people figure out what the right decision is, and not just the safe one."
Cuddy takes a step back toward him. "You said the board should have fired me after the audit this year. Would that have been the right decision?"
"That would have been the safe decision," he says. "The board wasn't looking to do the safe thing, and neither are you. You take chances, because sometimes taking a chance is the right thing. If you wanted a job that would be safe and secure and easy, you wouldn't be here. And neither would I."
She studies him, sees the graying hair, the lines in his face, the pain that always seems to be in his eyes. He's changed since she first saw him, has aged in ways that neither of them ever expected. So has she. But twenty years on, he's still pushing her to try something new, leading her down new paths, still breaking the rules.
And she's still following him.
He's right. The safe thing would have been to let him go. But the safe choice isn't always the right choice.
"Show me your studies, and I'll let you have the MRI for two hours," she says.
She sees the slight smile on his face, sees the way the pain in his eyes seems to disappear, just for a moment. "Four hours," he says.
"Two." She walks out the door, but glances into his office from the hallway, sees him lean back, put his feet back on the desk.
The elevator is empty when she steps in, and she rides down in silence. A chance. Even if the patient is dying, Rourke would have said, that patient deserves every chance. Even if you think it won't work, he deserves that chance.
Maybe that's what she couldn't define before, what she couldn't explain to Vogler, what she's tried to argue to the board.
House is worth saving -- is worth having around -- because he's a walking example of that chance that every patient deserves. The risk that's worth taking. The experimental drug that you hope will give a terminal patient just a few more months or years.
Or maybe House was just playing her. Telling her what she wanted to hear, just so he could run his tests and settle his curiosity. Maybe giving in to him this time will just lead to another setback, become another failed treatment. But she won't know unless she tries.
The elevator doors open and she walks out into the lobby. Maybe he was playing her, she thinks, but that's a chance she's willing to take.
![[identity profile]](https://www.dreamwidth.org/img/silk/identity/openid.png){kind=small}
(no subject)
Date: 2008-10-19 08:11 pm (UTC)I found a few grammatical nitpicks:
She was 23 the first time she went on rounds. The number should be spelled out.
She'd seen him clench his jaw, watched how he'd stabbed stabbed at a piece of his chicken piccata. "Stabbed" is repeated.
The right choice was the one to that saved that saved a woman's life. "that saved" is repeated. Do you need the "to"?
Lovely character study.
(no subject)
Date: 2008-10-19 08:19 pm (UTC)(no subject)
Date: 2008-10-19 08:31 pm (UTC)This was a beautiful examination of Cuddy.
(I caught one more typo: Doctor Cameron is fine doctor, but she doesn't mind doing shuffling papers)
(no subject)
Date: 2008-10-19 09:40 pm (UTC)(no subject)
Date: 2008-10-19 08:45 pm (UTC)(no subject)
Date: 2008-10-19 09:21 pm (UTC)(no subject)
Date: 2008-10-19 08:50 pm (UTC)P.S.: I've learned that you only have to spell out the numbers 1 - 11, every higher number can be written in figures (I'm not sure if that's just a German thing, but that's what I learned at school).
(no subject)
Date: 2008-10-19 09:41 pm (UTC)Wow....
Date: 2008-10-19 09:51 pm (UTC)Re: Wow....
Date: 2008-10-19 10:54 pm (UTC)(no subject)
Date: 2008-10-19 11:23 pm (UTC)that was very nice character study and you did a brilliant job showing the depth and complexity of Cuddy's professional commitments. the patient metaphor was nicely constructed and followed throughout. bravo
(no subject)
Date: 2008-10-20 12:22 am (UTC)(no subject)
Date: 2008-10-19 11:45 pm (UTC)Typo alert: "...then House and taken a step closer to her..." should be "House had taken". "...studies in Russia on alternative contrast dies" should be "contrast dyes."
(no subject)
Date: 2008-10-20 12:25 am (UTC)I do like playing with their background, and it struck me that theirs was long and storied enough that it had to have some reverberations.
(no subject)
Date: 2008-10-20 02:16 am (UTC)(no subject)
Date: 2008-10-20 10:50 am (UTC)(no subject)
Date: 2008-10-20 04:09 am (UTC)(no subject)
Date: 2008-10-20 10:52 am (UTC)(no subject)
Date: 2008-10-20 05:05 am (UTC)He is her responsibility. He is the patient in the bed whose body defies every diagnosis, every cure.
Beautifully put.
(no subject)
Date: 2008-10-20 10:53 am (UTC)(no subject)
Date: 2008-10-20 11:26 am (UTC)I think this is the best description of House I've read. So poetic...wow!
I loved the detail of Cuddy's daily routine, I really felt like I had a peek into her life. A side which we don't see enough of on the series, especially why she puts up with House and why she doesn't give up.
You're the voice for the writers, who aren't able to expand on the time Cuddy is given.
Sensational! It has been such a long time since I've read anything that has held my attention for longer than 5 minutes.
(no subject)
Date: 2008-10-21 12:02 am (UTC)(no subject)
Date: 2008-10-20 02:30 pm (UTC)(no subject)
Date: 2008-10-21 12:03 am (UTC)(no subject)
Date: 2008-10-20 03:03 pm (UTC)I am so pleased that you devoted detailed attention to Cuddy's job as an administrator and the talent and intellect that is required by her difficult position. Too often the assumption is made that she must be a mediocre doctor to be a good administrator, but you have shown how necessary it is for her to understand the full array of medical arts and the complex human psychology underlying all of them in order to stay on top of her hospital. Great job!
--blacktop
(no subject)
Date: 2008-10-21 12:04 am (UTC)(no subject)
Date: 2008-10-20 04:01 pm (UTC)(no subject)
Date: 2008-10-21 12:04 am (UTC)(no subject)
Date: 2008-10-20 08:27 pm (UTC)(no subject)
Date: 2008-10-21 12:05 am (UTC)(no subject)
Date: 2008-10-21 02:50 pm (UTC)*mems*
(no subject)
Date: 2008-10-22 07:52 pm (UTC)(no subject)
Date: 2008-10-23 02:45 pm (UTC)(no subject)
Date: 2008-10-23 07:39 pm (UTC)