Chapter 5: First Exposure
The clinic smells like industrial cleaner and desperation.
House drops three clipboards on the conference table at eight in the morning, looking far too pleased with himself for someone who just limped up three flights of stairs to avoid the elevator.
"Clinic duty. Four hours each. Try not to kill anyone." He grins at our collective groans. "Think of it as penance for existing in my department."
"This is a waste of our expertise." Foreman picks up a clipboard like it's contaminated. "We're diagnosticians, not primary care—"
"You're fellows who do what I say or you can go back to Hopkins and explain why you only lasted three days." House doesn't even look at him. "Chase, you're up first. Cameron, you've got afternoon shift. Foreman, evening. I'll be upstairs watching you fail."
He limps toward his office. Through the glass walls, I watch him settle into his chair with the careful movements of someone whose pain is at an eight today. The Vicodin bottle comes out. Three pills.
That's more than prescribed.
Cameron sighs and heads to her desk. Foreman mutters something about bureaucratic nonsense. I grab the clipboard and head downstairs.
The clinic is exactly what I expected—fluorescent lights that make everyone look half-dead, plastic chairs bolted to the floor, a TV playing morning news that nobody watches. The waiting room is packed.
Here we go.
Patient one: college kid with a hangover who wants a sick note for his exam.
The lie detection kicks in the moment he opens his mouth. "I think I have the flu—" Sharp ringing, like someone driving an ice pick through my temple. I grit my teeth and keep my face neutral.
"You were drinking last night." Not a question.
He blinks. "How did you—"
"You smell like a distillery, you're dehydrated, and your pupils are dilated from alcohol withdrawal, not fever." I write "acute alcohol intoxication" on the chart. "Drink water, take ibuprofen, and study harder next time. No note."
"But my exam—"
"Is your problem. Next patient."
Patient two: elderly woman with genuine knee pain. Osteoarthritis. I prescribe physical therapy and a different anti-inflammatory. She thanks me three times.
Patient three: mother with a sick toddler who's actually sick. Fever, cough, the works. I examine the kid carefully, prescribe antibiotics, and send them to the pharmacy.
Patient four through nine: mixture of hypochondriacs, people with actual minor issues, and one guy who definitely just wants to hit on the nurses.
My head is pounding. Every lie in the waiting room hits like a hammer. "I've been sick for weeks" (three days). "I never miss my medications" (prescription was filled six months ago). "I'm not here for pain pills" (that's exactly why they're here).
The ringing builds. Overlapping. Constant. I press my fingers against my temples and try to focus.
Patient ten walks in, and I know he's trouble before he sits down.
Mid-thirties. Hunched posture. Sweating despite the air conditioning. He won't meet my eyes.
"I need something for my back." His voice is tight. "OxyContin. Forty milligrams. I've been on it for months and I ran out."
The ringing is immediate and sharp. He's lying. But about what? The pain? The prescription?
I study him while he talks. The sweat isn't quite right—not the cold sweat of withdrawal, but hot, feverish. His eyes keep darting to the exam table, not to the prescription pad on my desk. He's leaning forward, protecting his right side.
Pain response. Not drug-seeking behavior.
"When did the back pain start?" I ask.
"Three days ago." Truth. No ringing. "I threw out my back moving boxes."
Lie. Sharp spike of pain in my skull. I ignore it and stand.
"Let me examine you."
"I just need the prescription—"
"Take off your shirt."
He hesitates. Then complies. The moment he moves to lift his arms, I see it—the way he guards his right abdomen, the sharp intake of breath, the grimace that has nothing to do with back muscles.
"Lie down on the table."
"Look, I really just—"
"Lie down or I'm not prescribing anything."
He does, reluctantly. I press gently on his abdomen. Right lower quadrant. He flinches before I even apply pressure, and when I release, he gasps.
Rebound tenderness. Classic McBurney's point sensitivity.
"When's the last time you ate?" I ask.
"Yesterday. I haven't been hungry." Truth. "Because my back hurts." Lie.
"You have appendicitis, not a back problem." I reach for the phone. "I'm calling surgery."
His eyes go wide. "Wait, what?"
"Your appendix is inflamed and probably about to rupture. The pain tolerance from chronic opioid use masked the symptoms. You thought it was your back because the inflammation is irritating your psoas muscle." I'm already dialing. "You need emergency surgery, not OxyContin."
"But I—"
"You're welcome. Try not to die."
Three hours later, the patient is in recovery with a successfully removed appendix. I'm documenting the case when House's cane taps against the doorframe.
"Impressive." He leans in the doorway. "Foreman was about to write him a script and send him home. You stopped him."
"The symptoms didn't match." I don't look up from the chart. "Pain presentation was wrong, sweating was wrong, eye tracking was wrong."
"You noticed all that in thirty seconds?"
"Close to a minute. But yes."
House limps fully into the exam room and closes the door. The space suddenly feels smaller.
"How?"
I set down the pen and meet his eyes. "He was sweating from fever, not withdrawal. Withdrawal sweating is cold and clammy. His was hot. He kept looking at the exam table like he was afraid I'd make him move. Drug-seekers watch your hands, waiting for the prescription. He wasn't watching my hands."
"Body language reading."
"Pattern recognition. Same thing you do, just slower." I stand and grab the clipboard. "Is there a problem?"
"You've been here three days and you're already diagnosing things other doctors miss." House's eyes narrow. "You're either very good or very lucky. I don't believe in luck."
"Believe what you want. I just saved that guy's life."
"Yes, you did." He steps aside to let me pass. "And now I'm watching to see if you can do it again."
I walk past him into the hallway. My head is still pounding from four hours of lie detection overload. The clinic crowd is thinning, but every conversation in the waiting room is a minefield.
Cameron is at the nurses' station, reviewing charts for her afternoon shift. She looks up as I pass.
"Chase." She gestures to the closed exam room. "That was impressive. Catching appendicitis when the patient was asking for pain meds?"
"He had peritonitis signs. Just needed to look past the initial complaint."
"Still." She smiles—genuine this time, not just professional courtesy. "Good catch."
It's a small moment. Brief. But it's the first time she's actually acknowledged me as more than another colleague taking up space.
"Thanks." I keep walking before she can see me wince from another spike of pain. Someone in the waiting room just lied to a nurse about their symptoms, and the ringing is getting worse.
I need aspirin. And quiet. And about twelve hours of sleep in a room where nobody is lying about anything.
Four more hours until this shift ends.
I head back to the clinic rotation, grab the next chart, and try to ignore the constant noise in my head.
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