tabbysnape

I failed an exam! *cries* I don't even know why. I thought I'd done ok!
I guess it sucks that so much of my self esteem is wrapped up in results. I mean, I tell myself it doesn't really matter that much, but I still feel like crap.
*growls*
bugger.
what the hell did i do wrong enough to fail the whole bloody exam? I got 0% in section one, for christs sake! wtf?!

sorry for the rant
I just needed to complain to someone! 
*cries some more*

Title: The World Keeps Spinning
Rating: T (at the moment)
Pairing: Huddy
Summary: Cuddy just wants his sperm, really. House likes the sex, but likes Lisa even more. Now he's going to be a father, whether he likes it or not! AU

Chapter 1: http://tabbysnape.livejournal.com/1611.html
Chapter 2: http://tabbysnape.livejournal.com/1854.html
 

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Disclaimer: I own a wonderful box set of House DVDs. I don't own House. Bugger.

Authors note: I've never been to America or to rehab, so I'm probably going to make a lot of mistakes. I'm a pharmacy student, so I do know a bit about drugs, but I don't know the American brand names, and which drugs are available without a prescription over there, etc. If I get something wrong, please let me know so I can fix it! Thanks :)

Also, this is set in an AU starting season 2, so ignore everything after.

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Chapter 3

---

"Hey Cuddy!" Called House from across the clinic, "I'm gonna take some time off."

"Dream on, House! You've already used up about five years of vacation leave, ten years of pretend-to-be-sick leave and you're way over-quota for 'hangover' leave."

The patients in the waiting room watched raptly. It wasn't as if they had much else to do, after all.

"How about 'voluntary rehab' leave? I seem to recall having a bit of that left."

Cuddy couldn't keep the grin from her face.

"Take as long as you need."

---

House would have preferred to simply detox in his apartment, but Cuddy organised him a bed in the PPTH Rehab Wing. He had stayed there once before, after the infarction. The staff there were used to dealing with a variety of patients; mainly people who weren't sick enough to justify a continued hospital stay, but needed further supervised therapy before they would be well enough to function fully at home. They were also quite used to coping with drug addicts.

"I'm really glad you're doing this." Wilson said as he carried House's sports bag inside from the car.

"Yippee." replied House in a monotone.

He was frantically trying to think of ways to get out of this. It wasn't that he was nervous, he told himself; no - he was terrified! He'd actually puked twice before Wilson had picked him up, and it was only 10 am. He'd taken his 'wake-up' vicodin as usual, so he couldn't even blame it on withdrawals. It was the thought of publicly admitting that his life was screwed up that he was uncomfortable with, because that was essentially what he would be doing. In a couple of hours the fact that Greg House was in rehab would be the hottest piece of gossip in the hospital. It might have been overshadowed by Cuddy's illegitimate baby, but that one wasn't public yet. The withdrawals weren't going to be a picnic either, nor the thought of reduced pain control. He pushed these thoughts from his head. Of course it was going to be unpleasant, but it was the right thing to do. He'd seen enough clinic patients to know that drug addicts weren't good parents.

They entered through the front doors , and House had an unpleasant feeling that this was really a prison or a concentration camp. He had to remind himself not to run (yet). After all, he could sign out AMA if need be.

"This looks nice." said Wilson as he dropped the sports bag onto one of the chairs by the front desk. House decided that a comment that inane wasn't even worth a sarcastic reply.

They were a few minutes early for House's initial appointment with Dr Nguyen ("Nice one, Wilson."), but a nurse set House up with a huge pile of paperwork to fill out.

"OK Mommy, you can leave now. I don't need a babysitter."

"No way! Knowing you, you'll drive the doctor to a nervous breakdown and convince the nurses to give you morphine. You need supervision."

"Hmph. Well, if you're staying, the least you can do is fill out some forms."

Wilson rolled his eyes, but dutifully took a form. House passed the rest over to Wilson too.

"How many vicodin do you take?" asked Wilson after a minute.

"Hey, give me that one!" House said, snatching the form back from Wilson.

At last, Dr Nguyen called House to his office. Wilson trailed behind like a sad duckling.

"Morning Greg. I hope you haven't forgotten the tenner you owe me."

"Nguyen, you're looking old.... and pregnant."

Dr Nguyen may have taken offense to being told he looked pregnant, as he was, in fact, male.

“Long time since college, Greg! I hear you’ve grown a third leg.”

House whacked him in the shins with his ‘third leg’, but otherwise ignored the comment.

“Nguyen, what the hell did you do to deserve this crap job?”

Dr Nguyen bent over to rub his leg, but answered nonetheless, “It must be the bad karma from puking on your side of the dorm and nicking your tennis racquet.”

“So that’s where my racquet went!”

“Are you going to introduce me to your friend?”

“eh, Nguyen, this is my babysitter, Dr Jimmy Wilson. Wilson, this is my old roommate and the thief of my prized tennis racquet, Dr Thanh Nguyen.”

They sat in Nguyen’s office, and House put his feet on the desk.

“So, what brings you here today?”

“You aren’t a very good doctor if you haven’t even read the referral letter.”

Dr Nguyen snorted. “This is where bad doctors go to die. I hope you weren’t expecting a good one. Now I have, in fact, read your referral. Dr Cuddy is hoping you can get your Vicodin addiction under control and convert to other forms of pain management.”

“Then why did you bother asking?”

“I want to know what you think the problem is. Dr Cuddy’s opinion isn’t nearly as relevant as yours.”

House sighed. “I don’t want to be an addict anymore.”

“Good for you. Could you please tell me about what you’re addicted to?”

“ Drugs.”

“He takes Vicodin ES, at least 10 per day,” Wilson interrupted.

“Excuse me, Dr Wilson, but I’d prefer to hear it from Greg.”

“I take Vicodin ES, at least 8 per day, sometimes up to 14. Supplemented with whatever other painkillers I can get my hands on. “

“Now, I understand the Vicodin is what you’ve been prescribed for chronic pain following an infarction and muscle debridement . Is the chronic pain still an issue?”

“Yes.”

“Improving, worsening or consistent?”

“I don’t think it’s worsening, I think I’m just more tolerant to the drugs.”

“What else have you tried for pain control?”

“I started adding in diclofenac a few years ago, with some omeprazole to stop it eating my stomach lining. It doesn’t do a lot for the leg, but my shoulder sometimes plays up because of the cane. Heat packs can take the edge off a bit. I’ve got some lidocaine patches; they’re OK except that they give me a rash. Marijuana helps, but I can’t use that on weekdays because Cuddy can smell it on me. You should have heard her last time! I thought she was going to explode!”

“Go on..”

“hmph. I’ve been on St John’s Wort for a while now. Studies show that tricyclic antidepressants can help with neuropathic pain.”

“I’ve heard of those studies too, but St John’s Wort isn’t a tricyclic. I don’t understand why you would have picked it instead of amitriptyline.”

“Can you imagine what Jimmy would have done if I asked him for an antidepressant script? God, he’s worse than my mother.”

Wilson looked hurt. “House, I wouldn’t have over-reacted! I can’t believe you didn’t tell me!”

Dr Nguyen ignored Wilson, “Do you want to see if you can get a better response from amitriptyline?”

House just shrugged.

“What else do you use?”

House shrugged again, and looked almost apologetically towards Wilson. “I’ve got a bit of an emergency stash for breakthrough pain.”

“Go on...”

“... morphine, oxycontin, ... heroin.. “

Wilson looked scandalised. “House!”

Dr Nguyen, to his credit, kept a straight face.

“How well do you think the pain is managed with the opiates?”

“They work best, but the pain is only partially responsive to anything I’ve tried.”

“OK. I’m a little concerned about whether your pain management program will be effective enough without opiates. What treatment plan would you suggest?”

“Do you always ask the patient to do your job for you?”

“Only when my patient is Greg House.”

House snorted. “I wanna start on gabapentin 300mg and amitriptyline 50mg along with the diclofenac and some topical anesthetic. And a shot of naloxone to speed up the withdrawals so I can get out of here stat.”

“You know speeding up the withdrawals will make it more unpleasant.”

“I’m not an idiot. And plus, the amitriptyline and gabapentin will probably send me to sleep for a week.”

“OK. What if that’s not enough pain relief? You'll be way more likely to relapse if your pain isn’t controlled.”

House shrugged.

“How about we titrate in a low dose of methadone if we need to?”

House had to agree that was a good solution.

“I also noticed from your file that you gave up on physical therapy pretty quickly.”

“I gave it longer than it deserved.”

“I’d like you to have another go at it. Maybe we’ll be able to lessen the limp and help your shoulder.”

“No way! You can’t make me!”

“Greg!” warned Wilson, “Don’t make me tell Cuddy on you!”

House sulked and poked his tongue out, “Whatever.”

"Lets get you settled into a room."

House felt his anxiety returning, and had to remind himself why he was doing this.

---

Authors note:

In case you were wondering - St John's wort is a natural health product that is often used for depression. The exact mode of action isn't well understood, it interacts with quite a number of drugs, and as far as I could tell it has no documented effect on chronic pain. House picked it because you don't need a prescription.

Diclofenac is an anti-inflamatory medication that is available without a prescription where I live (though I'm not sure about America - I'm just assuming). It's basically a bit stronger than ibuprofen. The main side effect with long term use is stomach ulcers, hence the omeprazole, which prevents/treats ulcers by reducing stomach acid secretion. I have heard it is available without a prescription in America.

I just like the idea that House would be self medicating without Wilson knowing! :)

Please review!

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Title: The World Keeps Spinning
Rating: T (at the moment)
Pairing: Huddy
Summary: Cuddy just wants his sperm, really. House likes the sex, but likes Lisa even more. Now he's going to be a father, whether he likes it or not! AU

Disclaimer: I don't own. *cries*

Link to Chapter 1: http://tabbysnape.livejournal.com/1611.html


Chapter 2



House's apartment was even more of a mess than usual. Half full cardboard boxes littered every surface, together with the usual array of discarded clothing, magazines and take-away containers. When Wilson let himself in, House was haphazardly emptying a shelf into a box below.

“My God, House! You've been evicted?!”

“No,” House replied, hiding his emotions behind a mask of nonchalance, “I'm moving.”

“Um... Well, if that makes you happy.”

House grunted in reply, and continued chucking random objects into boxes.

“Where are you going to go?”

“India.”

“What?!”

“You heard me.”

“Why the hell are you going to India?!”

“Now Jimmy, stop being such a gossipy old woman.”

“I'm serious, House. What the hell is going on?"

"Are you saying you've never wanted to live in Mumbai?"

"... Well, no. Not really."

"That's your problem then."

"..."

"Just think, Indian takeaway from India!"

"Cuddy fired you, at last?"

"Jimmy, you moron. Cuddy'll never fire me. She wants to get in my pants."

"You're escaping the law?"

"You wound me, Jimmy. Do I really strike you as the type to do anything illegal?"

"Do you really want me to answer that?"

House just snorted in reply.

"How about you give me a straight answer for once. What are you running away from?"

"I'm not running away!"

"Well, explain it to me then! I left my mind-reading goggles at home today.

"Cuddy's pregnant."

"Wow! Ok. And the thought of Cuddy reproducing is so terrifying that you need to flee the country?"

House rolled his eyes.

"My sperm were involved."

"Oh my God! You had sex with Cuddy?!"

"That's generally how it works."

"... And neither of you could work out how to use a condom? That's a bit sad, actually."

"Using a condom would have defeated the whole purpose. How was Cuddy supposed to get any of my sperm that way?"

"You got Cuddy pregnant on purpose?"

"Like DUH! She's only wanted a kid since, like, forever!"

"And now you're running away?"

"Fuck off, Wilson."

"... because babies are oh-so-scary! Watch out! It's going to drool on you!"

"Do you have any actual reason for being here?"

"Not as such. But, my God! You slept with Cuddy! And you didn't tell me!"

"Yes! Yes, I thought we'd already established that."

"Then why the hell are you running away?!"

House stared appraisingly at Wilson for a second.

"I don't want to have a kid who only knows me only as 'the-weirdo-who-works-for-mommy'. Cuddy doesn't want me to be the kid's father. The kid won't either, for that matter. Trust me, it's better never to have had a father than to have one like me."

"...Wow. That actually almost made sense."

"Fuck off, Wilson."

Fortunately, two decades as House's friend had taught Wilson to ignore this type of comment.

"Running away won't make you happy."

"You don't know that."

"Do you think it will make you happy?"

"No."

"Well, stay then!"

"Excuse me if I don't want to have to watch my kid and Cuddy being the perfect family together!"

"You actually want the kid?"

"You can't always get what you want."

"But if you try.."

"Shut up."

"Look, House. I can see the problem, but you're missing the obvious solution!"

"Yeah?"

"Well, the reason you would make a crap father is because you still haven't grown up. You still act like a ten-year-old with no sense of responsibility. A ten-year-old would be useless as a father, but wait until they're adults and most turn out ok."

"You want me to change? People don't change."

"Of course they do! If people didn't change we would all still be wearing diapers. Hell, we'd all still be living in trees."

House couldn't come up with an appropriately witty come-back for this, so merely poked out his tongue.

"Here's how I see it. It's completely obvious that you like Cuddy. Don't even try to deny it."

House didn't deny it.

"...and it's obvious she likes you too."

"No, she doesn't."

"She slept with you!"

"Only because she wanted a baby!"

"This is Cuddy we're talking about. She chose you to procreate with, rather than anyone else or any anonymous sperm donors."

"She wants the baby to have my ravishing good looks."

"Face it, she likes you."

"She's ignored me since she conceived."

"I'm not really surprised. Cuddy has a bad habit of thinking too carefully about things. She's distancing herself because she thinks it's best for the child."

"Thanks," House replied, his voice dripping with sarcasm.

"Hey, I'm not saying she's right!"

"She is."

"What makes you so sure that you couldn't be a good father?"

"You're even more of an idiot than I thought! You can't see the problem?"

"Just tell me your reasons."

"What? Apart from being an 'immature', drug-addicted, alcoholic cripple with serious personality issues, 'no sense of responsibility’, no experience with kids, and the fact that the mother would probably file a restraining order if I go near it? If you want I can write you out a list."

"That's a good idea, actually. Write a list of the things you think would make you a bad father, then you can focus on fixing them."

"You're nuts."

"What have you got to lose?"

Title: The World Keeps Spinning
Rating: T (at the moment)
Pairing: Huddy
Summary: Cuddy just wants his sperm, really. House likes the sex, but likes Lisa even more. Now he's going to be a father, whether he likes it or not! AU



Chapter 1

House knew he was just a glorified sperm donor. It let him spend time with Cuddy though, and that was all that mattered.

Not to mention the amazing sex.

He knew that Lisa timed their dates for when she was ovulating. The rest of the time he slept alone in his apartment, comforted by a generous serve of liquor.

Lately the drink of choice had been rum.

It always reminded him of pirates.

That makes getting smashed more fun, somehow.

They'd been doing this for years, on and off. When the pregnancy test comes back positive, she stops planning dates.

She doesn't need him anymore.

She'd miscarried each time. He knew soon after, even before he saw her. He liked to pretend he's psychic, but really he just checked her medical files on the computer each morning. They were not under her real name. He understood that she wanted privacy, but if anyone were exempt from that, it had to be him. It was his kid too, after all.

What a terrifying thought.

Each miscarriage was a roller coaster of emotions. He felt awful in sympathy for Lisa. Her dreams were crushed once again. She was getting older - soon she would stop trying and push him away forever. He loved her, even if he'd never admit it. He wanted her to be happy. He was also unbelievably relieved. The thought of being a father horrified him, and he knew he'd need to move away before the child was born. Better to grow up never knowing your father than to have a father like him. Cuddy doesn't need him, and the child will be better off having never met him.

Each pregnancy, he ended up looking on the internet for rental properties in other countries. Australia could be OK - the weather looked good. Maybe China? He didn't mind the idea of living on totally authentic Chinese takeaway. Or Italy for the pizza. Nowhere was perfect though, because he didn't actually want to leave. He wanted to stay in Lisa's bed forever, not just for the strategically planned intervals for optimal chances of fertilization. He wanted to hang out at the cafeteria with Wilson and steal his chips. He wanted to stay at PPTH, because even considering the compulsory clinic hours, he'd never had a more interesting job, nor better friends. But he couldn't be a father.

Lisa knew he didn't want to be a father. She was glad he seemed to have no interest in it, because he wouldn't be a good role model for the child. He's an alcoholic, rude, arrogant drug addict. They had discussed it, and whenever she became pregnant, their relationship would stay a secret. Her friends and family thought she'd tried IVF again. That way, no one would know of Greg's involvement, and he was free to pretend he had nothing to do with the foetus. Greg thought it was all very well to pretend that the speck sized foetus was nothing to do with him. So far Cuddy had miscarried long before he could see any difference to her body, let alone a baby shaped creature sharing half his genetic material. Greg was sure he wouldn't be able to ignore that, but he didn't mention it. He knew he'd end up seeing the child too much, whenever he saw Lisa. He was sure he'd get attached, then he'd actually give a damn about the kid and then he wouldn't be strong enough leave. It was hard enough to think about leaving even before he had a child to factor in. He knew he had to leave before he could get attached, because even if no one ever knows, he would still be the child's father, and as long as he stayed he could still ruin the child's life.

This time, his ticket was booked for Mumbai. The pregnancy had lasted over two months longer than any previous ones, and the best obstetrician at PPTH was positive about the chances of a successful, full term pregnancy. Cuddy was positively dancing around the hospital. She hadn't broken the news yet, but it was only a matter of time before the rumor mill would pick up on her growing belly.

When Wilson next visited House, he was in the middle of packing his apartment into boxes.



Chapter 2: http://tabbysnape.livejournal.com/1854.html

Yeah, I know... Fanfics don't really need medical details. Hardly any of us know what we are talking about, so fics with invented medical conditions can be just as satisfying as a medically correct one. You may find this information interesting though!

This section is for people interested in House's addiction/dependance on Vicodin. No prior medical knowledge needed.



*What is Vicodin?*


It's an nifty painkiller. It actually contains two different types of painkillers, which work in different ways, and have different problems/side effects.



Firstly - there's paracetamol (or acetaminophen if you are American, or para-acetylaminophenol if you are a nerd). I'm going to stick with paracetamol because I am neither a nerd or American (and it's the only version I can spell). House is set in America, so in your fanfics it would be best to refer to it as acetaminophen. It's the stuff you probably take when you have a headache, and its probably in your cold and flu tablets. The exact mechanism of action isn't really known, and chances are you don't care anyway. Basically, it has fever reducing (antipyretic), pain reducing (analgesic) and very slight anti-inflammatory effects. Side effects are rare.

A lot of fanfic writers will try to tell you that paracetamol is killing House's liver. This is actually possible, and makes a nice plot device. Studies show that 'paracetamol toxicity' is the most common cause of liver failure in the Western world, and that the risk can be increased in alcoholics. I think most of the fanfic writers stop researching at this point or before, which is a bit lazy, so read on... Once paracetamol is used, the body needs to get rid of it. The paracetamol travels in the blood to the liver, where it is 'metabolised', or broken down. Normally it is broken down in two seperate ways. Most is broken down into inactive forms, which then end up in the urine and faeces. A smaller amount is broken down into a toxic form, which is then 'detoxified' pretty much immediately while it is still in the liver. In normal doses (4 grams/day), it is safe (considered the safest pain reliever on the market). The toxic amount varies from person to person but is apparantly around 10 grams. At that point, the liver can't increase the rate that it metabolises the paracetamol into inactive components, so more is metabolised into the toxic component, and the liver can't keep up the the 'detoxifying'. This causes a build up of toxic stuff in the liver, which causes liver failure, which causes a slow and painful death (unless you conveniently have an organ donor nearby). It's safe to say that House may take a bit more than the recommended dose, but he doesn't take enough to cause an 'acute overdose'. We know this because he isn't dead. Theoretically it is possible (I think...) that he could be taking enough to cause only a small amount of damage at a time, but it is debatable. "Long-term ingestion of paracetamol and liver disease" (an article by Neuberger, Davis, Williams), claims that there isn't suficient evidence to suggest that chronic use of paracetamol causes an increased risk of liver disease, but this isn't a particularly good resourse. If there is liver damage, this can be picked up in 'liver function tests' and the patient my notice pain in the lower right area of their chest and/or 'jaundice' (where the skin and whites of the eyes turn yellow).




Secondly, Vicodin contains hydrocodone. This is the fun, addictive part. It acts in the brain and spinal cord on opioid receptors to block pain signals. Possible side effects include dizzyness, lightheadedness, drowsiness, nausea, constipation and euphoria (the euphoria is the fun bit). Because one common side effect is constipation, patients on high doses often also take laxatives. One nifty tidbit is that you can increase the pain control effect by taking the hydrocodone with hydroxyzine (Carisoprodol, Nefopam, Orphenadrine and antihistamines work also). It can cause hearing loss if used for a long period of time. In one episode (season 1) Cuddy mentions that House is taking more Vicodin than he was when she hired him. This is probably (at least partly) because people become tolerant to the effects of hydrocodone over time (ie, they need a higher dose to get the same effect). It is also addictive. ...

Quoting from http://www.drug-addiction.com/hydrocodone_withdrawls.htm :
"If a regular hydrocodone user stops taking hydrocodone, he or she will experience withdrawal symptoms within six to twelve hours but the symptoms are usually not life-threatening. The intensity of withdrawal symptoms from hydrocodone depend on the degree of the addiction. For example, the symptoms withdrawal from hydrocodone may grow stronger for twenty-four to seventy-two hours and then gradually decline over a period of seven to fourteen days. The duration of withdrawal symptoms from Hydrocodone varies greatly from person to person. Hydrocodone withdrawal symptoms include but are not limited to:

intense cravings for the drug
irritability
nausea or vomiting
muscle aches
runny nose or eyes
dilated pupils
sweating
diarrhea
yawning
fevers
chills
inability to sleep
depression"



Sneaky people, nerds and drug addicts are probably aware that you can separate the hydrocodone from the paracetamol (a bit, anyway) by dissolving it in water. Hydrocodone is a lot more soluble in water than paracetamol, so House were to dissolve some tablets in a glass of water, the paracetamol would mostly stay as gunk at the bottom, and there would be more of the hydrocodone in the water. It's not a very good idea, really, because you don't really know what dose you are actually taking. It just strikes me as the type of mad/nerdy/stupid thing that House would do.




Further Reading:
Vicodin: http://en.wikipedia.org/wiki/Vicodin

Paracetamol: http://en.wikipedia.org/wiki/Paracetamol
Paracetamol Overdose: http://en.wikipedia.org/wiki/Paracetamol_poisoning

Hydrocodone: http://en.wikipedia.org/wiki/Hydrocodone
Hydrocodone Overdose: http://en.wikipedia.org/wiki/Hydrocodone#Overdosing_risks]
Hydrocodone Withdrawal: http://www.drug-addiction.com/hydrocodone_withdrawls.htm

Narcotics Anonymous: http://www.na.org/index.htm