Excerpt: Occlusion

'Do you have specific questions about the patient?'

'Just start talking,' House said. 'We have a dearth of information on this end, so surely you'll come up with something we haven't heard about yet.'

'Alright,' Agbo said, closing the file and folding his hands over it. 'Twenty-nine-year-old Caucasian female arrived by private vehicle to our acute care centre two weeks ago. She was unconscious but accompanied by her assistant Anna Cader, a nurse, who provided her history and present symptoms.'

Agbo pushed the file across the desk and House and Cuddy reached out at the same time to grab it -- Cuddy gave him an 'I'm the attending' look and he for whatever reason actually backed off.

'The only medically relevant history was seizures and depression,' Agbo continued. 'Cader also stated that cancer is relatively prevalent in the family -- lung cancer was the cause of death for both of her parents. A blood test on intake showed that she is HIV positive.'

'Her assistant didn't know that?' asked Cuddy, pressing her hands to the top of the file.

'She didn't appear to,' Agbo continued. 'And it wasn't long after that that she insisted on leaving and returning to Sumpini.'

'I wish we'd known that before we left the States,' Cuddy said with a hint of distaste, leaning back a bit in her chair.

'A huge drop in communication, I assure you,' Agbo replied. 'But it's worth noting that she was already aware of her HIV status. According to her, she's been HIV positive since she was twelve as a result of a blood transfusion given before Australia really screened their blood. She's an elite controller.'

'Australia?' House asked in an undertone, then looked at Cuddy and noticed she didn't even have the file open. After a very questioning glance, he held his hand out. 'Let me see the file.'

She hesitated and sighed before handing it to him. He glanced at the name and scoffed.

'Natalie Chase,' he said with a tone of disbelief. 'You've got to be kidding me. Who is she?'

'An Australian doctor. She works with Médecins Sans Frontières in Burkina Faso and Côte d'Ivoire but maintains a clinic in Sumpini. She moved here three years ago and actually worked here at KATH for a year before leaving to work in Damongo,' Agbo rattled off. 'She keeps a house in Damongo but is constantly traveling now that Cader is there.'

House waited a moment after he stopped the Alice-like chatter, then spoke. 'The reason I ask is that one of my employees is an Australian named Chase.'

Agbo raised his eyebrows. 'Is that so?'

'And this certainly explains why Cuddy was called,' he said, then turned to Cuddy. 'But doesn't explain why you didn't bother telling Chase about this.'

'I don't know what relation she is to him, but in case you've forgotten, when his father died, he killed a woman,' Cuddy said in a quick, snippy tone. 'Until we know something definite, I'd like to keep this off of his radar. When Dr Chase became ill, Dr Agbo called Princeton-Plainsboro and specifically asked not for Chase, but for you. The way he was talking, I'm not even sure he's aware there's an Australian named Chase on your --.'

'Cader specifically requested I call you, Dr House,' Agbo interrupted, trying to cut the tension that was clearly growing between a pained, belligerent House and an exhausted Cuddy. 'She did her Masters at Johns Hopkins and said that your being expelled was the greatest loss that Hopkins ever experienced. She didn't say a single thing about Chase having any living family, and considering that she lives with Chase, I think this is something that would have come up before. Regardless, she didn't ask me to speak to anyone besides you, Dr House.'

They sat in the humming near silence for a few moments before House looked over at Cuddy once more. 'But you weren't going to bring me.'

Cuddy returned the look. 'Because I figured it would hurt you too much to do all of the travel. Besides, I was going to call you if new symptoms came up.' She paused and gave him a dry look. 'It's not like you ever see or touch your patients anyway.'

House didn't grace her comment with a response, instead turning back to the file and opening it to flip through the pages. 'You said that you did a blood test that found her to be HIV positive, but there's no record of CD4 count being performed to determine her staging.'

'We use the iDiagnostics test here, so we only collected a drop of blood. When she woke up, we asked for her permission to do a CD4 count and CBC, but she refused,' Agbo replied. 'And if a patient tells me she doesn't want a test performed, I won't perform that test. When she came in here unconscious, Cader was able to act as a medical proxy and demand that tests be performed, but once Chase woke up, she started taking her treatment into her own hands.' Agbo shrugged. 'Unfortunately her choice was to leave against medical advice, but there's nothing that we can do when that happens.'

After a few minutes filled with House looking at the scant file for Natalie Chase, Agbo stood and switched off the air conditioner. Leaning over the desk, he held a hand out for the file and House gave it to him. After picking up his stethoscope and throwing it over the back of his neck, he walked to his file cabinet and dropped it in, closing and locking the drawer.