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This article is about the prisoner House treated in Twenty Vicodin. For other uses of "Nick", see Nick.
Nick had been imprisoned for trafficking in drugs. He started experiencing unusual pains in his knees and elbows. Hearing that Gregory House, who was in jail for property damage, was a former doctor, he approached him in the cell block and told him about the symptoms. House referred him to the prison’s clinic.
Nick went to the clinic and was seen by Dr. Adams. She took his body temperature, which showed a slight fever of 99.9. She guessed it was gonorrhea and went to write a prescription for ceftriaxone. Her supervisor Dr. Sykes complimented her on her diagnosis. However, Dr. House was in the clinic at the time and took exception to her conclusions. He told her it wasn’t gonorrhea, even though he hadn’t heard her mention the diagnosis. He told her that he figured that it was her diagnosis because she added up joint pain, fever and the patient’s lifestyle. Nick protested that he had only been in jail a week and he knew his girlfriend didn’t have it. Dr. Sykes told Dr. Adams that Dr. House used to be a practicing physician. Dr. House pointed to Nick’s eyebrows, which were subtly thinner. He diagnosed lupus. Dr. Adams examined Nick and found no discoid or malar rash, but Dr. House noted she had only examined his head. Dr. Sykes agreed a lupus sufferer could have a rash elsewhere, but Dr. Adams protested that lupus usually presents on the face first. Dr. House stressed “usually” and said that her work was probably good enough for prison.
Later, Dr. House went to Nick and tried to find a rash. He found one on Nick’s left thigh and reported it to Dr. Adams. He told her to start him on prednisone. She wondered why he thought she would do it. He said it’s because she was bored and would find the case interesting.
Later, while going through the cell block, Dr. House heard Nick cry out in pain. He went to see him and he was grabbing his left forearm, saying he had been jostled and fell into the wall onto his forearm. Dr. House touched the arm where Nick was holding it and Nick quickly drew away in pain. He told Nick he didn’t have lupus.
Dr. House told Dr. Adams that Nick didn’t have lupus because he broke his arm just by falling against the wall. However, Dr. Adams figured that Nick had broken his arm in a fight and was lying about it to avoid solitary confinement. However, Dr. House told her that Nick had no reason to lie to him. Dr. House suggested a viral syndrome or MRSA. However, he realized neither would weaken bone that fast and it might be medication. He asked to see Nick’s file, but Dr. Adams reminded him that would most likely cost her her job. However, she told him to assume he hadn’t received any medication lately. Dr. House had noticed nicotine stains, and Dr. Adams realized he was talking about lung cancer. She agreed to give him an x-ray two days later when her portable x-ray machine would be on site. Dr. House told her that Nick would probably be dead from a stroke due to clotting by then and suggested blood thinners. She refused because House had no proof.
Dr. House went to examine Nick by percussing his chest and listening to his back. He brought Nick in to have Dr. Adams repeat the procedure, this time with a stethoscope, to find the same anomaly he did. She found the acoustic shadow that indicated the presence of a tumor. She was astounded House found it without a stethoscope. However, she still wasn’t convinced it was a tumor despite House’s insistence it had to be lung cancer. She realized a bleeding time test would assist them with a conclusion. Dr. House agreed it was a good idea. She made a small incision in Nick’s earlobe and told him a little clotting was normal, but if it was completely clotted after two minutes he most likely had cancer. However, when they performed the test, Nick bled profusely from his ear - a completely unexpected result.
Dr. Adams rushed the x-ray, but the shadow was just a lipoma. She let Dr. House see Nick’s file. She thought it was a toxin, but Dr. House pointed out that no-one else was sick, so it had to be in his cell or the laundry where he worked. He asked for an escort to make an environmental scan, but Dr. Sykes caught them and asked what House was doing with the file.
Dr. House went to Nick to help with the environmental scan, but he noticed Nick was getting slower and weaker. He realized that in addition to his bones and joints, the disease was affecting his blood. However, Nick became angry with House for telling him that he wouldn’t get his girlfriend back and turned him out.
Dr. House went back to Dr. Adams to get swabs to do the environmental scan, but she was angry with him for lying to her about why he was in prison. She couldn’t figure out why he got prison time as a first time offender who didn’t hurt anyone. When Dr. House said he had a bad lawyer, she refused to talk to him about the case anymore.
However, Nick came back to see Dr. House, but by this time Dr. House did not want anything more to do with the case. However, as Nick pressed him, Dr. House noted his lips were swelling. He examined Nick’s mouth and asked if he had eaten anything he had an allergy to. However, Nick collapsed and was suffering from anaphylactic shock. Dr. House called for help and performed an emergency tracheotomy. He managed to get Nick breathing again.
Dr. House used the bottom of his cellmate’s bunk as a whiteboard. The next morning, he saw a hot cup of coffee and realized that it was the change in temperature from drinking hot liquids was setting off Nick’s symptoms. He immediately went to see Dr. Adams and Dr. Sykes to suggest mastocytosis. Dr. Sykes was sceptical as it usually affects the skin, but Dr. Adams pointed out it can affect any organ and would explain the joint pain, osteopinia and anaphylaxis. Dr. Sykes agreed to run blood tests, but Dr. House pointed out those would be inconclusive. Instead, he suggested giving Nick five standard aspirin tablets - that would set off an anaphylactic reaction if he had mastocytosis. Dr. Sykes thought it was too dangerous, but Nick agreed to the procedure. Dr. Sykes still refused as performing an experimental procedure on a patient would mean a certain lawsuit. Dr. House pointed out that if Nick had anaphylaxis in his cell, he would almost certainly die. Dr. Adams was supportive, but Dr. Sykes still refused. Dr. House went to do the test himself, but Dr. Sykes had him thrown out of the clinic and threatened to have his parole revoked if he came back. Dr. Adams followed him out and told Dr. House they would take care of Nick.
However, Dr. House managed to get himself injured and sent back to the clinic. He made an attempt to give Nick the aspirin, but he was stopped by the guards. However, Dr. Adams gave Nick the aspirin instead. Nick didn’t have an immediate reaction, but he eventually developed anaphylaxis, confirming Dr. House’s diagnosis.