Chapter 24: Case 3 - Testing Copper
The lab results come back at 2 PM.
I'm in the clinic when my pager goes off—911, conference room, now. I finish suturing a kid's forehead laceration and head upstairs, expecting either vindication or House preparing to mock me for being wrong.
Foreman's already at the whiteboard, writing numbers.
Serum Copper: 247 mcg/dL (Normal: 70-140)
Ceruloplasmin: 18 mg/dL (Normal: 20-60)
ALT: 156 U/L (Normal: <40)
AST: 183 U/L (Normal: <40)
I read the numbers twice to be sure.
"Copper toxicity," I say. "Confirmed."
"Massively elevated copper, low ceruloplasmin rules out Wilson's disease, liver enzymes show hepatic stress from metal accumulation." Foreman caps the marker. "You were right. Acquired toxicity from supplementation."
Cameron's already pulling up treatment protocols. "Penicillamine or trientine for chelation. Monitor liver function closely. Discontinue all supplements immediately. He should start recovering within weeks."
"If he consents to treatment." House limps in, coffee in hand. "Which he didn't. He refused treatment for presumed Alzheimer's. Does this change that?"
"He refused treatment for a terminal diagnosis," Cameron argues. "This is completely different. This is curable."
"Legally, he refused treatment. We can't force it just because we changed the diagnosis."
"Ethically, we have to present the new information." Foreman looks uncomfortable. "He has the right to know it's treatable."
"And then what? He says no anyway and we watch him die from something we could fix?" Cameron's voice rises. "That's not medicine. That's murder by bureaucracy."
House shrugs. "Medical ethics says competent patients can refuse treatment for any reason, including stupid ones."
Everyone looks at me. I've been silent, watching the debate, thinking about what I heard earlier.
"I've accepted this."
Ringing. Lie.
The professor doesn't want to die. He's terrified of dying. He's just more terrified of living as a shell of himself, watching his mind dissolve while his body persists.
But that's not happening anymore. The diagnosis changed. The prognosis changed.
Time to use the lie detection ethically.
"Let me talk to him," I say.
House's eyebrows rise. "Why you?"
"Because I'm the one who found the supplements. I can explain what happened, why it's different from Alzheimer's, why treatment will actually work." I meet his eyes. "And because I think he'll listen."
"Fine. Go." House waves dismissively. "Cameron, go with him. Make sure he doesn't get too emotionally invested."
Professor Hayes is in his room, staring at the ceiling. Linda sits beside him, holding his hand. They look like people waiting for an execution.
"Professor Hayes." I knock on the open door. "Can we talk?"
He doesn't look at me. "If you're here to convince me to consent to treatment, save your breath."
"I'm here to tell you we were wrong."
That gets his attention. He turns his head, eyes focusing on me.
"Wrong about what?"
"The diagnosis. It's not Alzheimer's." I pull up a chair, sit at eye level. Cameron stands by the door, silent support. "It's copper toxicity from the supplements you were taking."
Silence. Then: "What?"
"The copper glycinate chelate. Five hundred milligrams daily for over a year. Your body accumulated toxic levels of copper. It caused neurological damage that mimicked Alzheimer's—memory loss, cognitive decline, personality changes. But it's not Alzheimer's. It's poisoning."
Linda's hand goes to her mouth. "The supplements? The ones he was taking to help his memory?"
"Yes. The intention was good. The execution was dangerous." I hand Hayes the lab results. "Your serum copper is almost double the normal range. Your liver is showing stress from processing the excess metal. That's what's causing your symptoms."
He reads the numbers, physicist brain working even through the fog. "If it's toxicity... that means it's treatable?"
"Yes. Chelation therapy—medication that binds the copper and helps your body excrete it. Discontinue all supplements. Within weeks, maybe months, your cognitive function should start returning. Not complete recovery overnight, but substantial improvement."
"You're sure?" His voice cracks. "This isn't—you're not giving me false hope?"
"I'm giving you evidence-based medicine. The diagnosis is confirmed. The treatment has established efficacy. I can't promise perfect recovery, but I can promise this is nothing like Alzheimer's." I lean forward. "You can get better. You can get your mind back."
He's crying now. Linda's crying. They're holding each other, and for a moment I look away, giving them privacy.
Then Hayes speaks again: "I said I accepted decline."
Ringing.
"That was a lie," I say quietly.
He freezes. "What?"
"You told House you'd accepted your fate. That was a lie. You're terrified. You've been terrified since the symptoms started. That's why you researched so desperately, tried every supplement you could find, fought so hard to prevent what you thought was inevitable." I meet his eyes. "A man who's truly accepted death doesn't fight that hard to prevent it."
"I—" His voice breaks. "I told myself I accepted it. Tried to believe it. Dignity, choice, control—all the right words."
"But underneath, you wanted to live. Wanted your mind back. Wanted more time." I pause. "Am I wrong?"
He shakes his head. "No. God, no. I don't want to die. I don't want to lose myself. I just—I couldn't face years of slow decline. Becoming nothing while my body kept going."
"That's not what's happening anymore. The diagnosis changed. This is acute, fixable, survivable." I hand him the consent form for chelation therapy. "You don't have to pretend to be brave anymore. You can actually fight this and win."
He takes the form with shaking hands. Stares at it for a long moment.
Then he signs.
"Thank you," he whispers. "Thank you for not letting me give up."
Cameron and I walk back to the conference room in silence.
She's processing something. I can see it in the way she keeps glancing at me, then away, then back again.
Finally: "How did you know he was lying? About accepting his fate?"
Because the lie detection told me. Because I hear the ringing every time someone speaks a deliberate falsehood.
"Body language. Micro-expressions. The way he gripped his wife's hand when he said 'acceptance'—that's not resignation, that's fear seeking comfort. The trembling in his voice. The forced calm." I keep my tone casual. "People who've genuinely accepted death have a different quality. Peaceful, resolved. He was performing acceptance while drowning in terror underneath."
"You read people really well."
"So does House. Just different methodology."
"House uses cynicism and cruelty. You use... empathy, I guess. Observation plus compassion." She stops walking, turns to face me. "That thing you said to him, about not having to pretend to be brave anymore. That was perfect."
"It was true. He was exhausted from the performance."
"Most doctors wouldn't have seen it. Wouldn't have cared." She pauses. "You're different from anyone I've worked with."
Because I'm literally from another world with supernatural abilities trying not to get caught.
"Different good or different concerning?"
She laughs. "Different good. Definitely good."
We reach the conference room. House is waiting, feet on the table, looking entirely too pleased with himself.
"Did he consent?"
"Yes. Starting chelation therapy tonight." I pull out my notes. "Penicillamine, 250mg four times daily, escalate as tolerated. Monitor liver function, renal function, complete blood count weekly. Discontinue all supplements. Dietitian consult for proper copper restriction."
"And emotional support for the man who poisoned himself trying to stay sharp enough to teach quantum mechanics." House grins. "Good work, Chase. You found the answer, convinced the patient, saved the day. Very heroic."
"Just thorough environmental investigation."
"Right. Thorough." House's grin doesn't fade. "How'd you know where to look in his office? Fifty bottles in the drawer, you found them in under twenty minutes."
Here we go again.
"I checked the obvious places first. Desk drawers for personal items. Found the bottles, recognized the pattern, followed the evidence." I keep my voice steady. "Basic investigative methodology."
"You also knew he was lying about accepting his diagnosis. Before the new information. Before we had evidence of toxicity." House leans forward. "How?"
Cameron answers before I can. "He observed the professor's behavior. Body language, micro-expressions, emotional tells. It's impressive observational skill, not magic."
House looks between us. "You're defending him."
"I'm explaining what I saw him do. He's methodical, thorough, and really good at reading people." Cameron crosses her arms. "That's not suspicious. That's good diagnostic medicine."
"Uh-huh." House doesn't look convinced, but he drops it. "Labs every three days. Watch for copper levels declining. He should start showing cognitive improvement within two weeks if we're right."
"We are right," I say.
"Confidence again. You're really committed to this whole 'being right' thing." House stands, grabs his cane. "Meeting adjourned. Go away. Except you, Chase. You stay."
Cameron and Foreman file out. I stay seated, waiting.
House closes the door.
"You're getting too good at this," he says without preamble.
"At diagnostics? That's literally the job."
"At reading people. At finding evidence others miss. At being right when you shouldn't be." He sits on the edge of the table, studying me. "That's three cases. Rebecca Adler—you found the travel evidence. Maternity ward—you found the chemical connection and the secondary heart condition. Now this—you found the supplements and recognized the toxicity pattern."
"Pattern recognition improves with practice."
"Not this fast. Not this accurately." House tilts his head. "You're hiding something. I don't know what. But you're too competent, too observant, too fearless around infectious diseases and dangerous chemicals. Something's different about you."
I meet his eyes, keep my voice calm. "I'm a good doctor who pays attention. That's what you hired me to be."
"I hired you because you were pretty, foreign, and had daddy issues I could exploit. You're turning out to be something else entirely."
"Is that a problem?"
"Not yet. But it will be if I can't figure out what you're hiding." He stands, grabs his cane. "I'm watching you, Chase. Closely."
"I noticed."
He limps to the door, pauses. "That thing you did with Hayes. Using his fear to convince him to consent. That was manipulative."
"That was honest. I told him the truth he was hiding from himself."
"Same thing." House grins. "You're learning. That's good. That's dangerous. Keep it up and you'll either become brilliant or destroy yourself. Maybe both."
He leaves.
I sit alone in the conference room, staring at the whiteboard full of lab results that prove I was right.
Three cases. Three successes. House is watching. Cameron is noticing. The balance is collapsing faster than I thought.
My phone buzzes. Text from Cameron: "That was impressive. Coffee tomorrow?"
I reply: "Yes."
One problem at a time. Save the professor. Build the relationship. Survive House's investigation.
Tomorrow. Always tomorrow.
I head to check on Hayes, document his first chelation dose, and pretend I'm not walking a tightrope between brilliant and impossible.
The headache from lie detection pulses behind my eyes. The price of truth-telling.
Worth it. Always worth it.
For now.
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