Chapter 78: Toxoplasma = HIV? No! (5000 words) (Page 1/2)
Cameron quickly caught up to David, who was having trouble walking.
Seeing someone following him, David felt even more awkward and tried his best to maintain his composure and walk normally.
Cameron didn't notice David's oddity. She was thinking about how to apologize to David for yesterday's events.
After carefully considering her words, Cameron spoke with a face full of apology:
"David... I'm very sorry about yesterday. I, I know what Vogler did was wrong.
But I didn't dare, didn't dare to speak up yesterday."
David had no mind to consider Cameron's problem at this moment. He just wanted to quickly get rid of this low-cut wearing Cameron.
Otherwise, having glimpsed the view, he was about to lose control.
"It's fine, who cares if an intern is wronged or not?
Aren't interns just for taking the blame? I understand this."
Seeing the open-minded smile on David's face, Cameron felt even more guilty.
Interns taking the blame had somehow become an unwritten rule in the industry.
But an intern is also a person and has a career plan. Sacrificing the future of a very talented intern because of internal hospital conflicts was indeed too much.
She gritted her teeth and suddenly promised:
"If something like this happens again, I am willing to resign voluntarily to ensure you are safe."
David smiled and nodded. He knew Cameron could do such a thing.
However, the hospital is not managed by Vogler anymore, so such a thing won't happen again.
Soon, with David trying his best not to look directly at the scenery, he successfully arrived at Senator Walker's room.
Chase was already there. Judging by his progress, he had likely just finished taking the medical history.
And Quinn, the man behind HR's control, was also in the room, looking worried as if he was genuinely concerned that Senator Walker would fall ill from this.
Senator Walker looked in very good spirits at this time. He smiled and comforted Quinn:
"Go back and be busy. Professional matters should be handled by professionals.
We must trust the doctor's diagnosis, and besides, I heard that although Dr. House has a difficult personality, his ability is not to be underestimated.
Under his care, I will surely recover quickly.
I don't feel like it's a serious illness. It might have just been heat exhaustion and fainting caused by the hot weather or because of that bad sushi.
After all, there are too many places where I need to give speeches recently.
As long as the doctor checks and finds nothing serious, maybe I can go back to giving my campaign speech this afternoon."
Quinn nodded and patted Senator Walker on the shoulder:
"Alright, then I'll go first. Contact me anytime if there's a situation."
Then, as he walked past David, he specifically instructed:
"Senator Walker is a good man. If he is elected Mayor, he will surely lead New York to a better tomorrow.
So you must cure him. Everything is in your hands."
Hearing Quinn's words, Walker, sitting on the hospital bed, immediately smiled:
"Quinn, don't put pressure on them. It's just a common illness. You have to trust them."
Quinn smiled and walked away from David and the others.
Chase, who was asking about family history and past illnesses, looked up at David, then stated the basic information he had learned:
"The Senator experienced sudden nausea, vomiting, headache, and mental confusion during his speech.
But based on what I just learned, besides almost biting through his tongue when he fell from a swing at the age of six, leaving a scar on the right side of his tongue base, the Senator has no other significant medical history.
Furthermore, the Senator doesn't look like he has anything serious wrong with him. Perhaps, as he said, it's just fatigue from the campaign trail, some heat exhaustion, or acute gastroenteritis caused by bad food."
David shook his head:
"If it were heat exhaustion or acute gastroenteritis, he wouldn't recover this quickly. It's only been two hours since Senator Walker had problems.
Let's give him some basic tests."
Chase spread his hands, indicating for David to proceed.
After David examined Senator Walker's eyes, checked the base of his tongue, and listened to his heartbeat.
He picked up a reflex hammer from the side and tapped Senator Walker's left knee. The Senator's left leg instinctively kicked.
This shows he has a normal patellar reflex.
Seeing David's actions, Walker couldn't help but smile:
"Young man, although I'm getting older, I walk very steadily. Is there a need for a reflex test?"
David didn't answer, he just held the reflex hammer and tapped Senator Walker's right knee. The right leg had no reaction.
At this, everyone who had just had a relaxed expression immediately focused their attention on Senator Walker's right knee.
If the technique was correct, the lack of a patellar reflex means that Senator Walker's nervous system has a problem.
Chase looked at the reflex hammer in David's hand with a serious expression and said:
"Did you hit the wrong spot? Try again."
David tapped twice more as instructed, still with no reaction. Then David handed the reflex hammer to Chase and let him try.
When Senator Walker saw the serious expressions on everyone's faces, he immediately realized something. He instantly became nervous and then asked uneasily:
"What's wrong? Is there something wrong with my body?"
Chase didn't answer, but like David, he tapped Senator Walker's right knee multiple times, confirming that Senator Walker had indeed lost his right patellar reflex. Only then, after exchanging glances with Cameron, did he say:
"Mr. Senator, I'm afraid your problem is not heat exhaustion or something you ate, but in your brain.
I'm afraid you won't be discharged this afternoon. We need to arrange a full-body MRI and a lumbar puncture for you."
Then Chase looked at David. David nodded and immediately took Senator Walker to get tested.
Due to the privilege of a Senator, the report regarding him was quickly released.
In the diagnostics department conference room, David held the report and said:
"The lumbar puncture found no infection, and the MRI found no abnormalities.
However, an anomaly was found in the Broca's area, it's very small, looks like artifact, it could also be a brain tumor or infection.
But it cannot be confirmed. I recommend a brain biopsy."
Chase frowned and said:
"You can't perform a brain biopsy just because of a spot on the MRI.
This is very dangerous, a brain biopsy can cause permanent neurological damage.
Moreover, he is a politician. If it fails, it can easily plunge the hospital into negative public opinion."
House frowned and thought for a while, then decisively adopted David's opinion:
"Does that mean if he were a homeless person, we could perform a brain biopsy?
Everyone is equal in this hospital, at least here.
Permanent neurological damage is better than a rapidly growing tumor.
Let's do it this way, David, you go inform the patient.
Chase, you go inform the OR and schedule the surgery as soon as possible."
After speaking, House limped toward the clinic.
Although the hospital had changed ownership, his extra six hours of clinic duty had not decreased.
So he now had limited time for consultations; the rest of his time had to be spent in the clinic.
With House making the decision to perform craniotomy on the Senator, David immediately found Senator Walker, who was sitting worriedly on the hospital bed.
Holding significant power, he was quite concerned about his mortality.
He still had a lot of money in offshore accounts that he hadn't had time to use.
So upon seeing David, he immediately asked:
"Doctor, how is the situation?"
"We found an anomaly in your brain's Broca's area, and now we need to do a brain biopsy."
"Brain biopsy?"
This term didn't sound very good, and Senator Walker's face immediately paled.
"Then do you know what is causing my symptoms?"
David could clearly feel Walker's panic.
"If we knew what was causing your symptoms, then we wouldn't need to do this brain biopsy.
But it's clear that an infection that even a lumbar puncture couldn't detect could very likely kill you.
So I suggest, for the sake of your life, you sign this surgical consent form.
After all, a brain biopsy only might cause neurological damage; there's a high probability that nothing will happen.
But if you don't do it, then the rapidly growing tumor or other unknown diseases could take your life."
As a member of HR, Senator Walker naturally made the correct choice in the face of a death threat and accepted this seemingly frightening craniotomy.
On the way to the operating room, Walker kept asking David about the success rate of the surgery, what the side effects were, and whether the chances of recovery after the surgery were high.
In the face of the risk of death, he was no longer that high and mighty Mr. Senator, but just an ordinary person afraid of death, like any patient in the hospital.
"Don't worry, our hospital has the best surgeons, Mr. Senator, you will be fine."
At the same time, David added in his mind, he still needed Walker as bait to get that list of officials bribed by HR, so how could he let him die?
Under House's arrangement, Mr. Senator immediately jumped the queue for surgery.
As the anesthesia took effect, Senator Walker, who had been chattering incessantly and worrying about his life, finally shut up.
Next was drilling into the skull; as bone fragments were removed, a hole leading directly into the brain appeared.
Then the biopsy needle was slowly inserted to retrieve brain tissue, and finally the skull was closed. The brain biopsy surgery was considered successful.
David, who had come in as an observer under the guise of learning, quietly observed the entire surgery, once again increasing his surgical experience.
After a while, Dr. Wilson, the oncology expert in the hospital, handed over his report.
"This is not a tumor, nor is it a bacterial infection."
Dr. Wilson said with a strange expression in the consultation room.
"This is toxoplasmosis."
As soon as these words were spoken, everyone's expression became strange.
As is well known, toxoplasmosis is common in AIDS patients, because AIDS patients cannot defend against toxoplasmosis at all.
House chuckled, stood up, erased the marker on the whiteboard, and began writing:
"Toxoplasmosis is a very common parasite.
The usual ways to get infected are either by eating undercooked meat, or by touching cat feces, contaminated soil, and so on."
"In a very small possibility, this parasite can travel through the bloodstream to the brain and attach, causing damage or inflammatory reactions."
"But it only causes brain damage in one situation, which is when the patient's own immune system is already very weak."
"And the most common disease that can cause a patient's immune system to be weak is AIDS."
"So, does this mean our great Mr. Senator is an AIDS patient?"
Everyone knew the implication of House's words; there are only a few ways to contract AIDS.
First, excluding mother-to-child transmission, the next possibilities are blood-to-blood transmission that might occur during IV drug use, and bodily fluid transmission.
No matter which type it was, if it got out, it would be a significant blow to Senator Walker's reputation.
This matter was not easy to handle.
House continued to look at David; it was clear he needed David to inform Senator Walker of this result.
However, David was not in a hurry to inform Senator Walker of this result. He suddenly spoke up and raised an objection:
"Is it possible that it's not AIDS?
Although the phenomenon of toxoplasmosis causing brain damage is typically due to the patient's weakened immune system."
"But what if Senator Walker's immune system disease is not caused by AIDS?"
"Perhaps his immune system developed a problem due to other medications?"
House shook his head and smiled:
"Impossible, if there's toxoplasmosis in the brain, it's definitely AIDS."
"I stand by my opinion. A Senator running for Mayor wouldn't risk getting AIDS.
I think there's something else going on. Besides, finding out if he actually has AIDS is simple; just test him."
"To prevent errors, I suggest doing it twice."
House frowned. He had no idea why David was so insistent this time.
"Twice? The false positive rate for AIDS is 1/5000, there's no need, right?"
"Doing it one more time ensures the result is correct, after all, this is an absolute scandal for the Senator.
We should be more cautious regarding this matter."
House shrugged, accepting David's suggestion.
"Alright, do an ELISA test to detect HIV."
House paused, then continued:
"Twice."
...
After learning from House that he might have HIV, Senator Walker's face was full of disbelief.
"Impossible, absolutely impossible!
I might have cancer, or some other disease, but definitely not HIV!
I don't do drugs, I don't go to prostitutes, and I use protection! There's no reason for me to get HIV!"
The agitated Senator Walker immediately started coughing, unable to even speak completely.
House quickly stepped forward to listen with a stethoscope and asked:
"What's wrong?"
Senator Walker said with a face full of pain:
"I feel like I can't breathe. Is it caused by toxoplasmosis?"
House's expression changed when he heard the abnormal heart rate:
"Quickly get a ventilator."
When the emergency treatment was finished, David also happened to walk in with the HIV report.
Looking at House who was deep in thought by the hospital bed, David held up the report in his hand:
"One positive, one negative. He doesn't have HIV."
Even when proven wrong, House's expression remained unchanged.
"Is that so? Then that's bad. We are once again completely in the dark about the disease causing his symptoms.
Currently, his respiratory system is severely compromised, his blood oxygen saturation is 89, and his T cell count is very low."
"Silver stain shows Pneumocystis pneumonia (a deadly fungal infection), which is consistent with hairy cell leukemia."
"So, David, who is always right, what are your thoughts?"
David ignored House's sarcasm, organized his thoughts, and said:
"Viruses. We can test for Human T-lymphotropic virus and Adult T-cell leukemia/lymphoma virus, and do a viral panel."
"Okay, go ahead and do as you think."
Chase couldn't help but say as he watched David walk away:
"How did he know the Senator didn't have HIV?"
House rolled his eyes:
"How should I know? Sometimes I really want to crack open this kid's brain and see what's different from ours.
His perspective on illnesses is always unexpectedly accurate."
"There's no such perfect person in this world, right, Chase?"
Chase thought for a moment and said:
"Maybe he's just lucky?"
House narrowed his eyes and began to review:
"Luck? We don't talk about luck, we talk about evidence.
Come to think of it, his theory is actually correct."
"A Senator running for Mayor must keep himself clean to avoid scandals being dug up by opponents."
"So it's a low probability event for him to get AIDS. After all, if a Senator has AIDS, his political career is completely finished."
"And it was indeed too hasty for us to conclude he had AIDS just because toxoplasmosis caused brain damage."
"It's obvious that the current symptoms tell us that viruses can also cause immune system damage, which in turn leads to toxoplasmosis causing brain damage."
"Now we just need to wait for David's results."
Even after hearing House's explanation, Chase still felt it was a bit far-fetched.
In America, scandals among politicians are nothing new. What if Mr. Senator just liked taking risks?
Condoms aren't 100% effective at preventing HIV transmission either.
Chase shook his head and stopped thinking about it. In short, for some unknown reason, David was clearly right again.
Soon, David had the results.
He returned to the conference room with the report and said:
"Human T-lymphotropic virus types 1 and 2 are both negative, and Adult T-cell leukemia/lymphoma virus is also negative, which doesn't match the symptoms of hairy cell leukemia."
"But while doing the virus test, I found that the patient's EBV test was positive."
House stroked his chin, didn't answer, but instead asked thoughtfully:
"So, under what circumstances would Epstein-Barr virus cause problems with the patient's immune system, thus allowing toxoplasmosis to invade?"
As he expected, David seemed to be waiting for him to ask, and answered almost without thinking:
"The patient must have concealed his past medical history. There must have been medication in his past that reacted with the EBV, leading to an abnormal immune system."
"Patients always lie, don't they?"
David looked at Chase as he finished speaking.
Chase was the one who took the initial patient history.
Chase gave a wry smile:
"He's a Senator, you know. Expecting them to tell the truth is too difficult, isn't it?"
"Perhaps he chose to lie because he was afraid we would dig up some dirt from his past?"
House tapped the floor with his cane, scanned everyone in the conference room, and finally looked at David and said:
"Then I'll leave it to you, David."
"Your interrogation skills have always been very effective. I have faith in you."
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