Chapter 59: Organophosphate Poisoning and Airborne Doctors (5000 words)
However, what David didn't notice didn't mean the Machine couldn't.
The Machine, which was nearly omniscient in this area, would naturally detect all dangerous individuals—especially those connected to it.
So after David's phone vibrated, a few words appeared on the screen:
"You are being followed. Be careful."
Having a confrontation last night and being tailed today—anyone could connect the dots.
After all, there were only twenty-five patients total last night, and David had treated nearly half of them.
The remaining physicians shared the other half.
Pete, who David had shut out, probably had a stomachache from rage after hearing this news.
However, with the Machine's assistance, David wasn't particularly worried.
He wasn't afraid of them coming—he was afraid of them not coming.
He'd wanted to extort some gold coins from his colleagues for a while now.
These malicious physicians who came after him were exactly his targets.
By the time David entered Princeton-Plainsboro Teaching Hospital, Chase, who had been waiting, suddenly approached with a smile:
"Hey, I hired two personal bodyguards for you. Take a look—I think you'll like them."
David was stunned, then instinctively looked in the direction Chase was pointing.
At the end of Chase's gesture, a beautiful woman in plainclothes with an athletic figure sat on a leather chair outside the clinic and nodded at David.
Then a male bodyguard in a suit, tie, and sunglasses—pretending to tie his shoelace while standing in the clinic queue—also looked up and nodded at David.
Afterward, one kept looking at her phone while the other took out a compact mirror, pretending to touch up makeup.
At least in terms of blending in, it was impossible to tell these two were professional bodyguards.
David looked at the male bodyguard, who seemed oddly familiar, and said to Chase with some astonishment:
"These... are the personal bodyguards you found for me?"
Chase naturally nodded, taking the astonishment on David's face as pleasant surprise.
"Yeah, Triple-A Security. World-class operation. The guy is Michael Bryce, and the woman is Sonia Kincaid—both Triple-A rated executive protection specialists. With them around, trust me, nobody's gonna mess with you."
David chuckled, his face full of helplessness.
Triple-A Security? Michael Bryce from The Hitman's Bodyguard?
David certainly recognized this guy who looked like he could be Ryan Reynolds' twin.
It's just that David remembered this guy's motor mouth was as obnoxious as Deadpool's, and his clients seemed to have notoriously bad luck.
But since they were already here, David couldn't refuse Chase's kindness.
At least these two had solid skills.
Maybe he could offer Michael another job after he inevitably lost this one.
After all, aside from being verbally irritating, the guy's character was decent enough.
After accepting this reality, the two bodyguards—who could seamlessly blend into any crowd—didn't have much impact on David's normal routine.
As usual, David first headed to the emergency department.
The ER was where people came closest to death, and also where David could most easily harvest lifespan.
Chase, walking beside him, also followed David to the emergency department:
"I was wondering why you always show up at diagnostics close to ten o'clock every morning. Turns out you come here first. You're really dedicated."
David chuckled and gestured to the white coat he wore:
"Of course. I have to be worthy of this coat. Saving lives is what we're supposed to do. People in the ER need help the most, so this is where I should be."
Hearing this noble statement, Chase's eyes held a new respect as he looked at David.
He hadn't expected a mere intern to have such a high level of professional commitment.
Compared to David, he didn't seem nearly as dedicated—so much so that he often felt invisible.
While Chase was reflecting on this, the emergency department suddenly erupted into activity.
A teenage boy in a coma was urgently wheeled into the ER by paramedics.
"Sudden loss of consciousness, severe bradycardia—I need one milligram of atropine, stat!"
...
"Atropine's not working! Heart rate's still dropping—get the crash cart!"
...
"Draw blood, run a full tox screen, and get someone from diagnostics down here!"
"I'm Chase. Let me take a look."
The two observers initially didn't intervene in the emergency treatment, but when conventional measures proved ineffective, Chase stepped forward to identify himself.
After testing the teenager's reflexes and checking his pupillary response, Chase frowned and turned to David:
"What do you think?"
Before David could respond, the teenager on the gurney suddenly began seizing!
Chase didn't wait for David's answer and immediately shouted at the nearby nurse:
"Push ten milligrams of diazepam, now! David, help me hold him down!"
As the diazepam flowed into the IV, the teenager immediately stopped convulsing and lapsed back into unconsciousness.
Seeing this, David wiped the sweat from his forehead:
"Looking on the bright side, at least we can rule out food poisoning—it doesn't present with seizures like this. And we can also cross off recreational drugs. If he were high, he wouldn't be seizing right now."
Chase gave a wry smile. David was right, but that made determining the cause even harder.
He'd actually hoped this high school student's collapse was from stupidly experimenting with his parents' prescription pills or something.
In that case, he'd only need to administer some naloxone.
Now there were far more possibilities to consider.
Could be pesticide exposure, carbamate poisoning, organophosphate toxicity, or organochlorine compounds.
Chase glanced at the heart rate, which had stabilized above fifty, and released his grip on the teenager's arm:
"We need to report this to House. He'll have to sign off on any specific treatment."
David nodded, then added:
"If it's contact poisoning, I'd suggest having the nurses bathe him first. We can send his clothes to the lab for analysis. You should be able to authorize that."
Chase looked at David with surprise. Honestly, David's mind worked incredibly fast.
Whether it was pesticide exposure or agricultural chemical poisoning, there were two transmission routes: inhalation or dermal contact.
For the former, removing the patient from the source was sufficient. But for the latter, residual toxins had to be washed off—because the poison source was on the body, continuously causing harm.
So even when the specific type of poisoning wasn't determined, isolating the poison source first was definitely the correct protocol.
Chase arranged for the nurses to bathe the teenager as David suggested.
Then he returned to the diagnostics conference room with David, who carried the torn jeans in a sealed evidence bag.
There, they unexpectedly encountered someone new—a face they'd met once before.
House saw the two arrive and first introduced the newcomer:
"Oh, everyone's here. Let me introduce you. This is the new doctor Cuddy heard about after Foreman left and insisted on bringing in—an excellent neurologist from New York, Pete. He'll be providing us with invaluable opinions in this case."
Hearing House's sarcastic tone, Doctor Pete—who had specifically come to make David's life miserable—forced a smile and extended his hand to David:
"Nice to meet you all. We'll be colleagues from now on. What should I call you?"
David directly ignored Pete's outstretched hand and turned to House:
"We've got a patient in the ER who didn't respond to atropine. Based on Chase's and my initial assessment, he's been poisoned. But judging from the subsequent seizure activity, we've ruled out both food poisoning and drug intoxication. As for the actual poison source, we don't have a consensus yet. So I'm preparing to start eliminating possibilities through contact trace analysis."
House nodded, expressing approval for David's and Chase's judgment.
However, if the poison source couldn't be determined and the patient couldn't provide information due to unconsciousness, this was indeed tricky.
They'd even have to play detective, retracing everywhere the patient had been that day to find the possible exposure point.
Just as House was about to speak and delegate tasks, Pete suddenly interjected:
"You're just an intern. How dare you make diagnostic pronouncements so confidently? Don't you understand the hierarchy of a differential? When an intern like you encounters senior physicians, shouldn't you show some respect? Go make some coffee and listen from the sidelines.
When dealing with acute poisoning cases like this, the best approach is obviously to check his home for potential poison sources. Based on my experience, this kind of neurological presentation is mostly caused by pesticides used in backyard gardens.
Intern, after you finish making coffee, run over to his house and investigate. As for those ratty jeans you're holding, just toss them. What, do you think someone would be dumb enough to soak their jeans in a pesticide barrel and then wear them? How naive."
After speaking, Pete scanned the room, apparently expecting applause.
Instead of applause, he was met with House frowning:
"Oh, good. Looks like we have a new department head. Guess we can all go home today. Let Doctor Pete follow his own brilliant plan."
Seeing House actually pick up his messenger bag and prepare to leave, Pete's expression immediately changed.
He was here to cause trouble, not to actually treat patients.
If House really left, not only would he have no way to frustrate David into voluntarily resigning, but he'd also bear responsibility for any complications that arose.
So Pete quickly changed his tune:
"Ha, you're joking. I'm just a newcomer—how could I lead? I was out of line just now. Haven't fully adjusted to my new role yet, got a bit presumptuous. My mistake, Doctor House. Please lead the differential."
House glanced at the smiling man, clearly seeing through him.
Soon he spoke:
"Alright, since Pete offered an opinion, then according to our tradition, whoever proposes the theory has to verify it. This task of checking the patient's home for poison sources goes to you.
Chase, go get the blood work results. Cameron, talk to his family and see if there are any new leads. David, test the jeans for chemical residue.
Alright, assignments made. Pete, any objections?"
House looked at Pete, whose face resembled someone who'd just swallowed a fly.
At this moment, Pete was seething inside.
He was a physician with a considerable reputation in neurology, and he was being sent out to run errands in this heat?
It was truly unbearable.
He finally understood why David was so infuriating—in this godforsaken hospital, David's boss, Doctor House, was just as much of an asshole!
He took several deep breaths, reminding himself that he hadn't achieved his objective yet and needed to stay calm.
He forced a smile:
"No objections. This is how it should be. Don't worry—with my extensive experience, I can identify the poisoning type with just one look."
House nodded:
"Great. Let's do it that way. I'm heading to clinic duty first, then I'll be back for the differential. Alright, everyone get moving."
Pete's face was ashen as he turned away. He hadn't expected House to be this kind of person.
The diagnostics department here was completely different from the hospital he used to work at.
You know, in his previous hospital, seniority was everything, and those with insufficient years of practice had zero voice.
Having not worked formally in a while, he'd been parachuted in this time thanks to a friend on the State Medical Board, and he'd originally thought he'd easily handle David.
He hadn't expected to encounter someone as difficult as House.
But it wasn't a major problem. His friend was interested in acquiring a hospital for cancer clinical trials.
He just needed to get through this period.
After that, it was unclear who'd be calling the shots. Thinking about this, a smile involuntarily appeared at the corner of Pete's mouth.
Dare to provoke him? Then he'd take them all down!
...
Soon, when House returned to the diagnostics conference room, everyone came back with results.
First was Cameron, who'd spoken with the patient's mother. She hadn't gotten much useful information—only that the mother was extremely controlling.
She'd even secretly taken her son's hair for drug testing to confirm he wasn't using.
And she maintained a deeply distrustful attitude toward the doctors' treatment, questioning every procedure.
This was undoubtedly the most difficult type of patient family to deal with.
Next was Chase with the blood work.
He confirmed the teenager did have organophosphate poisoning, but couldn't determine whether the source was high-concentration malathion, parathion, or one of the forty-plus other organophosphates.
So the problem was back to square one—identifying the specific poison source.
Then, at this moment, Pete, who'd been out on his assignment, stood up proudly:
"Seems like you didn't get much useful information. Why don't I tell you what I found?
I found an empty can of insecticide in their backyard shed—ethion. Now you just need to administer the corresponding cholinesterase reactivator. See? My suggestion was spot-on, wasn't it?"
Pete's gaze swept past David, finally landing on House.
House didn't rush to make a diagnosis but looked at David instead.
If he remembered correctly, David had taken the boy's jeans for residue testing.
David handed his report to House:
"The residue on the jeans is mevinphos. I have reason to suspect the poison entered through dermal contact. The patient's subsequent symptoms should include cardiac failure before other organ involvement."
As soon as David finished speaking, Pete said sarcastically:
"What kind of person doesn't wash their clothes before wearing them? Besides, this mevinphos might just be surface contamination that hasn't penetrated the skin.
As for ethion, he used an entire can. It's entirely possible that while spraying insecticide, he got distracted by some hot girl walking by and accidentally inhaled it.
I don't think he was poisoned by two different substances simultaneously. In fact, I believe he was poisoned by ethion."
House frowned, deep in thought.
This time, what Pete said wasn't unreasonable.
But what David proposed was also possible.
After brief consideration, House raised his head:
"Since we can't be completely certain which is the poison source, let's start treatment with pralidoxime for ethion exposure. The patient's subsequent reaction will tell us which one's correct.
Pete, have the family sign the consent forms. Prepare to start treatment."
David wasn't surprised by House's choice.
When House encountered difficult diagnostic decisions, he typically administered medication first, then observed the patient's reaction to find the correct approach.
This method, though crude, was highly effective.
At this moment, as Pete passed by David with the medication consent form, he whispered:
"Kid, you'll be out of a job soon. Got it?"
Then, with a smile on his face, he walked toward the patient's room.
After he left, Chase came over and asked:
"If I remember correctly, this is the same guy we ran into last night, right?"
David nodded.
Chase continued:
"I just asked around. He's a neurologist who was parachuted in by the State Medical Board—last-minute decision. Cuddy could only accommodate them politically. However, I heard House has already filed a protest, saying he doesn't need a fourth fellow. I think Pete should be leaving soon, but you should be careful—since he tracked you down here, he might use some underhanded tactics."
David smiled:
"It's fine. Don't I have the bodyguards you hired? He can't touch me yet."
Suddenly, Cameron's voice interrupted their conversation:
"Hey, what are you two whispering about? Go get the pralidoxime and prepare to administer treatment."
"Oh, coming."
Soon, everyone hung the IV containing pralidoxime specific for ethion poisoning, followed by a period of waiting and observation.
Pete looked at everyone waiting outside the glass-walled patient room and seemed supremely confident:
"No need to stand around waiting here. Go grab lunch when it's time. I won't be wrong—that empty can of ethion in their backyard is all the proof we need."
But just as Pete finished speaking, the teenager in the patient room suddenly began convulsing violently.
The mother, who'd been sitting vigil, immediately went pale and ran out into the corridor in a panic, screaming:
"Nurse! Doctor! Help! Somebody help him!"
Everyone's faces changed, and they immediately rushed inside.
Chase took over emergency management:
"Push ten milligrams of diazepam—he's not responding! Give another ten!"
Watching the doctors frantically trying to save her son, the mother cried and accused from the sidelines:
"You're killing him! You're going to kill him!"
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