Chapter 22: Case 3 Opening - The Professor
The conference room at eight AM smells like desperation disguised as scientific inquiry.
Professor Martin Hayes sits across from House, hands trembling slightly, trying to maintain the dignified posture of a man who's spent thirty years teaching physics to undergraduates. His wife—Linda—hovers behind him, one hand on his shoulder, the other clutching a tissue.
"Explain the problem," House says without preamble.
Professor Hayes takes a breath. "Progressive memory loss. Six months. Started with forgetting names, now I can't remember conversations I had yesterday. Confusion. Personality changes—my wife says I'm more irritable, less patient."
"Alzheimer's," Foreman says immediately. "Classic presentation. Early-onset, but definitive."
"No." Hayes's voice is firm. "I don't want diagnostic tests. I don't want treatment. I've seen what Alzheimer's does. Watched my father die that way. I won't live as a shell."
Cameron leans forward. "But if we can diagnose what's causing—"
"I don't care what's causing it. The outcome is the same." Hayes meets her eyes. "I'm a physicist. I understand probability. I understand inevitability. This is my choice. Death with dignity."
"He's competent to refuse treatment," Cameron says quietly to House. "We have to respect his autonomy."
"Ethically, yes." House grins. "Ethically, I don't care. His wife consented to the workup. We're doing it."
The professor's jaw tightens, but he doesn't argue. Linda squeezes his shoulder, and I catch the look between them—fear, love, resignation.
And then the professor speaks again, and the ringing hits.
"I've accepted this."
Sharp. High-pitched. Like a needle through my temple. The lie is so blatant that I have to look down at my notes to hide the wince.
He hasn't accepted anything. He's terrified.
I watch him while House questions further. The trembling hands aren't just from neurological decline—they're from suppressed fear. The forced calm in his voice. The way his eyes dart to his wife when he says "dignity," seeking validation that he's making the right choice.
This isn't acceptance. This is giving up.
House sends us to begin the workup. Standard protocol—MRI, bloodwork, neuropsych evaluation. But I hang back as the team disperses.
"Professor Hayes." I keep my voice gentle. "Can I ask you something?"
He looks up, wary. "What?"
"You're a scientist. You've spent your career researching, testing hypotheses, refusing to accept conclusions without evidence." I sit in the chair Foreman vacated. "Why are you accepting a diagnosis without complete investigation?"
"Because I know what this is."
Ringing. Lie.
"Do you? Or are you assuming based on symptoms that match several different conditions?" I pull up a medical database on my phone. "Progressive cognitive decline at fifty-two could be Alzheimer's. Could also be frontotemporal dementia, Creutzfeldt-Jakob disease, chronic traumatic encephalopathy, brain tumor, heavy metal poisoning, medication interaction, vitamin deficiency—"
"Stop." His voice cracks. "Just stop."
"Some of those are treatable. Completely reversible." I meet his eyes. "What if you're giving up on something we can fix?"
Linda's crying now. Hayes's composure is cracking.
"What if it's not fixable?" he whispers. "What if I go through all the tests, all the procedures, and the answer is still the same?"
"Then at least you'll know. You'll die with answers, not assumptions."
He stares at me for a long moment. Then: "Fine. Do your tests."
The team reconvenes in the conference room.
House writes differentials on the whiteboard: Alzheimer's, FTD, CJD, brain tumor, metabolic disorder.
"Most likely is Alzheimer's," Foreman says. "Age, presentation, progression—all consistent."
"But treatable causes exist." Cameron adds metabolic disorders to the list. "B12 deficiency, thyroid issues, liver dysfunction—all can cause cognitive symptoms."
"What about medication interactions?" I suggest. "He's a professor. Academic environments have high stress. Could be taking something for anxiety, focus, sleep. Polypharmacy in older adults frequently causes confusion."
House looks at me. "You think he's just taking too many pills?"
"I think we should check before assuming it's neurodegenerative." I pull up his preliminary labs on the computer. "No full medication reconciliation yet. We should know what he's taking—prescription, over-the-counter, supplements."
"Chase, you're volunteering for home visit duty." House grins. "Search his office at the university. See what the professor keeps in his desk."
Of course. Environmental investigation. My specialty now.
"When?"
"This afternoon. After we get initial imaging back." House turns to Foreman. "MRI, full neurological workup. Cameron, comprehensive metabolic panel, toxicology screen. I want to know what's in his system before we assume it's his brain failing."
We disperse to our tasks. I'm documenting orders when Cameron approaches.
"That was good. What you said to him."
"Just logic. Scientists respond to scientific thinking."
"No. You saw his fear. Addressed it directly." She leans against my desk. "House would've just ordered the tests and ignored the emotional component. You actually talked to him like a person."
"He is a person."
"I know. But most doctors forget that when they're focused on the diagnosis." She pauses. "How did you know he was afraid? He seemed pretty calm."
Because the lie detection told me he was lying about acceptance. Because I can see the micro-expressions that betray his forced composure.
"Body language. The trembling wasn't just neurological—it was emotional. His voice was too controlled, like he was fighting to maintain it. And he kept looking at his wife for validation. That's not someone who's accepted their fate. That's someone who's terrified and trying to be brave."
Cameron studies me. "You really do see things others miss."
"Just paying attention."
"House pays attention. You're doing something else." She doesn't elaborate, just heads back to her desk.
She's noticing too. Everyone's noticing.
The MRI comes back three hours later.
Foreman puts the images up on the light box. "Moderate atrophy in frontal and temporal lobes. Consistent with neurodegenerative process. Could be Alzheimer's, could be FTD."
"But not definitive," I point out. "Atrophy could be from other causes. We need more data."
"Which is why you're going to his office." House tosses me car keys. "University of Pennsylvania, physics department. Find out what he's been exposed to. Chemicals, radiation, stress, whatever academics poison themselves with these days."
I catch the keys. "Going alone?"
"Cameron's going with you. She needs to learn environmental investigation." House grins. "Try not to fall in love with each other while breaking into faculty offices."
Cameron and I exchange a look. This is either House being randomly cruel or deliberately pushing us together.
Either way, we're going.
The drive to the university is quiet at first.
Cameron stares out the window, watching Philadelphia suburbs roll past. I focus on driving, giving her space to think.
Finally: "Do you think we can help him?"
"Depends what's causing it. If it's Alzheimer's or CJD, we're limited to supportive care. If it's something else—toxin, deficiency, medication interaction—then yes."
"But you think there's something else."
"I think assuming the worst without complete evidence is bad medicine." I take the exit toward the university. "He deserves a thorough investigation."
"You really care about him. As a person, not just a case."
"He's terrified of losing himself. Who wouldn't care about that?"
She's quiet for a moment. Then: "This is why I like working with you. You remember they're human."
She likes working with me. That's progress.
We pull into the university parking lot. The physics building is old brick and academic pretension, the kind of place where brilliant people think profound thoughts and publish papers nobody reads.
Professor Hayes's office is on the third floor.
Cameron picks the lock—apparently immunologists have unexpected skills—and we slip inside.
The office is chaos. Papers everywhere. Books stacked precariously. A whiteboard covered in equations that might be genius or gibberish. Coffee cups in various states of decay.
"Okay." I start with the desk. "Look for medications, supplements, anything he might be taking. Also environmental clues—chemicals, unusual materials, radiation sources."
Cameron checks the bookshelves. I search the desk drawers.
And that's when I find them.
Vitamin bottles. Dozens of them. Not standard multivitamins—specialty supplements, herbal remedies, nootropics ordered from questionable online sources.
"Cameron. Look at this."
She comes over. I lay out the bottles:
Ginkgo biloba. "For memory."
B-complex, high dose. "For cognitive function."
Fish oil. "For brain health."
Copper supplements. "For neurological support."
And more. So many more.
"He's been self-medicating," Cameron says. "Trying to prevent cognitive decline."
"Or causing it." I check the copper supplement dosage. "This is 500 milligrams daily. Recommended intake is 0.9 milligrams."
"He's been overdosing?"
"For how long?" I photograph the bottles, check expiration dates. "Some of these are a year old. If he's been taking this much copper for months—"
"Copper toxicity can cause neurological symptoms. Memory loss, confusion, personality changes." Cameron pulls up the symptoms on her phone. "It mimics neurodegenerative disease."
This isn't Alzheimer's. It's poisoning.
"We need to get these analyzed. Confirm the copper levels." I bag the supplements as evidence. "If this is toxicity, it's treatable. Chelation therapy, discontinue the supplements, his cognition should improve."
"He was trying to prevent decline and actually caused it." Cameron's voice is soft, sad. "How do we tell him that?"
"Carefully. But also honestly." I finish photographing the office, documenting everything. "He deserves to know the truth."
We leave the office, locking it behind us. The drive back is faster, urgent with the possibility that we might actually save this man.
Copper toxicity. Treatable. Reversible.
Another case where deduction and systematic investigation might mean the difference between death and recovery.
House is going to love this. And he's going to ask me how I knew to look for supplements.
Later. Deal with House later. First, save the professor.
We head back to PPTH, carrying evidence of hope wrapped in vitamin bottles and good intentions gone wrong.
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