I had hoped we were done with the whole pyschiatrist/pyschologist thing, but apparently not.
Leonard Samson has long been established as a psychiatrist with an MD, not a PhD. There have been numerous mentions of his attending medical school, including multiple references in Loeb’s own Hulk series.
Heh, heh. Nice one, Foster. Use his “mallet” indeed.
Oh wait, you were being serious? Damn.
In all her appearances, did Jane Foster perform any actual nursing?
Tonight’s episode of House tried to hard to be edgy and ended up losing a coherent plot and any semblance of logical medical care along the way.
Abby is a seventeen year old high school senior who becomes unresponsive while on a school outing to the planetarium. Foamy red sputum drips from her mouth and her boyfriend reports that she’s not breathing; she is rushed to the hospital and admitted to House’s service.
Abby is found to have pulmonary edema (fluid build-up the lungs). The team understands this to mean that she has either a heart problem or a lung problem. Her drug screen was negative and her blood alcohol level was barely positive. Foreman suggests she may have developed heart disease from binge drinking. A C-13 pyruvate MRI is ordered (a test that looks at blood flow within the heart muscle itself). It doesn’t show the heart disease Foreman was looking for, but there appears to be something wrong with the mitral valve. Fungus is considered as a possibility, but the team decides a fastidious enteric bacteria infection is more likely (enteric bacteria are found in the human intestine, and fastidious means they are difficult to culture). A TEE (transesophageal echo — an echocardiogram performed from the inside of the throat which offers good views of the heart valves) is ordered to get a better look at the mitral valve. Under echocardiography, the valve appears normal, but during the test Abby develops an aortic dissection (a tear in the wall of the aorta), a life threatening emergency. She is rushed to emergency surgery where Taub and Thirteen manage to successfully resuscitate her.
The question now is how did Abby develop the aortic weakness which led to the dissection? A genetic defect is mentioned, but quickly dismissed with the aside that she is not Marfanoid (Marfan’s syndrome is known to cause aortic dissections — of course, there are other genetic defects besides Marfan’s). An allergic reaction is also suggested as a likely cause. Thirteen believes that a severe immune reaction could have led to the aortic weakness. She goes on to suggest that Abby may be allergic to her boyfriend’s semen. A quick test is performed but shows no reaction. However, during the test, Abby develops excruciating abdominal pain and is found to have blood in her urine. “Kidney failure,” screams Chase.
The differential diagnosis now consists of neuropathy (by which they mean syphilis, which can lead to a weakened aorta), a blood clot, insterstitial cystitis, or cancer. A full body scan is suggested, but, for the second week in a row, House mentions how much he hates them (a point on which we agree — of course, House’s opinion would carry more weight if they hadn’t already ordered five or six this season — and he wasn’t a fictional character). Out of other options, House agrees to the full body scan, which is negative. This being House, no test can go smoothly, and Abby starts to hallucinate during the study. This causes the team to reevaluate their differential, which now consists of a vascular disease (probably vasculitis from the way Foreman is talking) or an aneurysm. An MRA (an MRI that looks specifically at blood vessels) is ordered to find the aneurysm, but it also is negative. Foreman suggests a parasite found in the Middle East, but House shoots him down abruptly, saying it was too ridiculous to even consider.
Abby continues to hallucinate, but now has also started to have seizures. House convinces the team to try an experimental technology (conveniently available at that very hospital): cognitive pattern recognition. In a scene more at home on Fringe than House, the team see the image of her boyfriend playing baseball, then the universe, then an older man (“her late father” they surmise) from Abby’s brain. Unfortunately, this isn’t enough to build any sort of diagnosis. Grasping at straws, Thirteen suggests something may be wrong with the liver. Chase suggests she may have polycystic kidney disease (which really would have been seen on that full body scan he wanted). Foreman notices the MRI shows that her pineal gland is calcified (which is normal), but wonders if it may be hiding a tumor. A high powered MRI is ordered to check but is completely normal. House is at a loss until a conversation with Taub triggers his Eureka! moment. It turns out that Abby boyfriend’s father travels extensively, to the Middle East even, where he picked up the parasite that Foreman mentioned earlier, which he passed on to Abby in a drunken sexual encounter. The parasite itself died, but it left enough behind to cause a severe allergic reaction which is causing all of Abby’s problems (Cerebellar schistosomiasis hypersensitivity allergy). A quick brain surgery (to the remove the parasite, presumably) and she is fine physically. Emotionally…is a different story.
As usual, major complaints are in red, minor complaints are in blue, and nit-picking ones in green:
Schistosomiasis is infection by the liver fluke. It is endemic in much of the world, including the Middle East. So far so good, however:
1. It is the eggs of the fluke that illicit elicit a potent immune response. The fluke can cause an immune response itself, but not the level the eggs do (the level Abby demonstrated)
2. The body walls the offending agent off in a granuloma which absolutely should show up on a scan.
3. Schistosomiasis is not transmitted from person to person; it has a complex life-cycle and needs an intermediate host.
Coincidentally, just this past Thursday, NPR ran a segment on using a computer and pattern recognition to read human minds. Suffice it to say that the scene on House bore little in common with reality.
5cc of Adrenalin is a high dose. Even in emergencies, it is generally given in 1cc doses (though it will likely take more than a single dose). Plus, in the medical profession in the United States we call it “epinephrine,” half the OR staff wouldn’t know what you wanted if you asked for “adrenalin.”
Taub is suddenly a cardiac surgeon now? There’s a great deal of difference between a plastic surgeon and a cardiac surgeon. They only share one year of residency — the rest is completely different.
We’ve discussed this before, many times, and in great detail last week, but once more: blood in the urine is not a sign of kidney failure.
If the offending parasite’s body was so small it didn’t show up on a scan, how did they know where to operate to remove it?
Only in the hospital for a few minutes, Taub breaks HIPAA (Health Information Portablilty and Accountability Act, a Federal law which deals with, among other things, patient privacy) by telling Abby’s boyfriend about her medical condition. That’s a big fine for the hospital. $$$$ Nice going, Taub.
I know I often complain about the unrealistic time course of tests on the show, but this week’s deserves a special mention: fungal cultures are very slow growing — weeks, not days — so there’s no way they’d be negative so soon.
To my knowledge, there are no blood cultures for parasites. They are generally detected by O&P (ova and parasite) studies of the stool and blood smears.
She seized for just about a minute, yet in that time they managed to hook up a multi-lead EEG and record the waveforms. That’s damn impressive.
And can we stop the “OMG! If she has another seizure she’ll stroke out!” That’s unrealistic and insulting to people who actually have a seizure disorder.
The medical mystery was average — nothing we haven’t seen before: C. The final solution really didn’t make much sense. If they wanted her to have schistosomiasis, they should have given it to her in a way which could actually happen. If they wanted the edginess of sex with her boyfriend’s father, they should have just made her allergic to his semen, as was discussed earlier. Combining the two was a bad decision: D. The medicine had holes this week, though no more than usual, other than House giving up so fast. I give it a B. The soap opera was good, though not as strong as the last couple of weeks: B+.
The review of the previous episode of House
A list of all prior House reviews
Sorry Doc, but you don’t treat a black eye by putting some sort of cream on it. Think of it this way: a black eye is essentially a bruise around the eye — and when do you put anything on a bruise? The real treatment of a black eye is easy: ice, and time. That’s it. Nothing fancy needed.
(Now in his defense, I guess the skin around the eye could have been broken open by the punch, and Blake might be putting some sort of antibacterial ointment on it, but that’s still a stretch).
Filed under: Comics
Here’s a scene from the first story in Moonstone’s Airfighters #1. The setting is the Normandy beaches on D-Day, and one American commander is running into more resistance than expected. What’s wrong this panel?
Previous picture quizzes
Valkyrie was on the cover of this comic, yet there is no Valkyrie inside. Where is my Valkyrie?
Filed under: Comics
With spring just around the corner, this week’s public service ad features young Allergy Biggs wondering why no birds have moved into his birdhouse. His family offers their advice, and then their help, to make Allergy’s birdhouse a success.
Despite being the title character, Binky seems to leave most of the work to the others — though he does offer some unhelpful platitudes. Everyone else in the family actually contributes something meaningful. (Well OK, Binky’s holding a hammer in one scene, but what exactly is he hammering? Binky has the birdhouse, Dad is sawing the roof, and Mom is working on the perch. I bet he’s just smashing some walnuts to munch on while the others work).
It seems pretty clear where poor Allergy inherited his looks. I would consider this a good argument for adoption.
This PSA was found in DC comics from November 1955, including Action Comics #206 and Adventure Comics #214 (the source of this ad). The script was by Jack Schiff with art by Win Mortimer.
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