House – Episode 24 (Season 2 Season Finale): “No Reason”
There’s a big nasty spoiler in this week’s review of the season finale of House, so do not read this if you haven’t watched the episode. No really, I’m serious — turn on your VCR or Tivo and watch it before reading any more. And that means you, Jessica.
House and his team are discussing the case of a patient with a swollen tongue and a fever of 103° when a man comes in looking for House. As soon as he finds out which physician House is, he shoots him in the abdomen and then the head.
House wakes up in the intensive care unit. By the growth of his beard, he assumes he has been unconscious for two days. Cameron informs him that the first bullet went through his stomach and bowel before lodging in a rib. The second bullet entered his neck and nicked his jugular vein.
The tests on the patient with the swollen tongue are negative. A tongue biopsy showed no cancer or abnormal cells and all blood tests were negative. The patient’s intracranial pressure is high, which means it is dangerous to perform a lumbar puncture because the brain might herniate. House suggests that the team perform a biopsy of the lymph node under the patient’s jaw.
The man who shot House is placed in the ICU in a bed next to House. It turns out that his wife was a patient of House’s. House cured her problem, but in the course of her treatment, House discovered that her husband had been unfaithful and relayed this information to the patient. She later committed suicide and this man now holds House responsible (or at least partially responsible) for his wife’s death. Anyway, as House is ambling around the hospital, he notices that his leg is feeling better. He begins to wonder if this may be because the surgeon screwed up and somehow injured his peripheral nervous system.
Meanwhile, the patient’s tongue has swollen so much that it makes it difficult for him to breathe and a tracheostomy is performed. Foreman notes that the patient has been on broad spectrum antibiotics but it has made no difference in his symptoms. House tells them to go ahead and perform the lumbar puncture even though the pressure is high. The lumbar puncture results are completely normal and there is no elevated pressure. However, after the procedure is over, when Chase and Foreman flip the patient over, they discover that he is bleeding behind his left eye, and bleeding with enough pressure to enucleate the eyeball (pop it right out).
During the procedure, House has been talking to the patient’s wife, but he has somehow ripped his stitches open and started bleeding again. He collapses onto the floor.
The team’s diagnosis of the patient now includes a bleeding disorder, a sinus mass from Wegener’s Granulomatosis, or something wrong with the blood-brain barrier. The team elects to biopsy the blood-brain barrier and to start the patient on mebendazole (a anti-worm medication), and levofloxacin (brand name Levaquin), and azithromycin (brand name Zithromax) — both fairly broad spectrum antibiotics.
When House realizes that the patient does not have a wife and no one else saw the woman he was talking to, he realizes he has been hallucinating. He obtains his operative report and is puzzled to discover that the surgeon used ketamine on him instead on standard anesthesia (Ketamine causes a dissociative state The patient can still experience pain, but cannot react to it, or really react to much of anything at all; it’s as if the mind and body are separate. Ketamine is commonly used as in veterinary surgery and as a date rape drug). When he confronts Cuddy about this, she tells him that research from Germany has suggested that chronic pain can be treated by inducing a coma and she decided that House was a good candidate for this.
The blood-brain barrier biopsy is negative and the patient continues to run a high fever. The team wonders if the patient may have some sort of foreign object lodged inside his body somewhere. Chase is helping the patient to the bathroom when the patient’s scrotum becomes so full of blood it explodes. The group is now concerned that patient might have testicular cancer.
House continues to have hallucinations, this time involving and argument with Wilson and Cuddy and a fight with Wilson.
The patient does not have testicular cancer. A cystoscopy is also negative. House now considers the diagnoses of bacterial prostatitis or prostate lymphoma. All the prostate tests come back negative. Now House wants to perform another surgical biopsy on the patient, this time using some sort of advanced robot as a surgery aid.
House continues to notice hallucinations and memory lapses. He starts to suspect that everything has been a hallucination, even when he wasn’t hallucinating. He confronts his team as they are performing the surgery and purposefully botches the procedure, killing the patient. This jolts him out of his hallucination and he wakes up as he is being wheeled to the emergency room just after suffering two gunshot wounds.
Notice the green text in the above description. Those were the only parts that were real. All the black text in between was a hallucination. Because it was all a hallucination, it doesn’t matter if the medicine was bad (which much of it was — ridiculously bad) since that was likely the intention of the writers. I would say that most of the individual bits of medicine were fine on their own, but they didn’t come together to make a coherent whole.
- For the swollen tongue patient: How did the team know the patient had an elevated ICP without measuring it? Why biopsy a lymph node under the jaw from above — why not approach from underneath the jaw? Why put him on broad spectrum antibiotics twice since it didn’t work the first time? The sudden enucleation of the eye and scrotal explosion scenes. Plus, I don’t think you can biopsy the blood-brain barrier in the way they suggest.The logic was more warped than usual too, for instance prostatitis causing the eye to pop out?
- For House: he had abdominal surgery, including stomach and bowel repair, but he can eat tacos two days later? How could surgery to the abdomen, or even the lateral neck, injure the “peripheral nervous system” in such a way to affect his leg. Even if an induced coma could cure chronic pain, that does not mean they couldn’t uses standard anesthesia during surgery and then use ketamine to start the coma afterwards.
- Plus my usual whining about the team doing procedure they shouldn’t (and the lack of any anesthesiologist or anesthetists in the surgical scene).
Of course, all these can be explained away by “it was just a hallucination.”
I can’t really give the medicine or the soap opera a grade, since it was all a hallucination. I did like the mystery of the swollen tongue, but I would have liked a real answer, not just an imaginary one (and they didn’t find an imaginary one). I applaud the writers for trying something different, but I think last year’s episode Three Stories was a better example outside the box storytelling — and for some reason imaginary stories always make me feel cheated.
Two final thoughts:
- I don’t think it was mentioned on the show itself (except in the closed captioning) but it was mentioned at various places on the web. The patient who shot House was named Moriarty — another nod to Sherlock Holmes.
- If this was House’s hallucination and it was showing things that he didn’t want to face consciously, does that mean that he does want to undress Cameron?
Still want more great medical reading? This week’s Grand Rounds — the best medical blogging of the past week — are being hosted over at .parallel universes. As usual, there’s a plethora of fascinating reading.
May 23rd, 2006 at 11:49 pm
that was one heck of a season finale. thanks for the quick review!
May 23rd, 2006 at 11:54 pm
I thought this was a interesting episode to say the least. People will be speculating a long time if the people represented aspects of House himself. Moriarty was certainly a representation of House. Interesting that House selected the two people closest to him (Wilson/Cuddy) to represent the original situation he found himself with Stacy and his leg operation.
The exploding eyeball, scrotum and slashing open the belly were probably the grossest stuff I’ve seen on House. Some even speculated that the Swollen Tongue guy was also symbolic of House.
I was just reading up on the use of ketamine for situations similar to House.
May 23rd, 2006 at 11:57 pm
Addendum,
My take on Cameron/Robot scene is that House would like to connect with Cameron but is afraid to do so. He literally has to do it by proxy. I don’t think this is necessarily an indication that House wants Cameron sexually.
May 24th, 2006 at 12:24 am
I believe the robotic surgical device is a da Vinci system from Intuitive Surgical – used in prostatectomies. They are also being used for gynecological procedures (hysterectomies) and mitral valve repair. http://www.intuitivesurgical.com/products/index.aspx
They have about 450 installed systems worldwide. Supposedly it is better at preserving nerves (as opposed to open prostatectomy) and reducing surgical complications e.g. bleeding.
Didn’t care for the dream aspect – would have expected a better cliffhanger (obviously House is not going to die).
May 24th, 2006 at 12:33 am
Maybe this whole episode was just to show what was inside House’s mind but it dissapointing for me. It reminds me of those stories that you read and then in the end, the character wakes up and you find out the whole thing was just a dream. But to elaborate on Elais’s post…
I never thought of the patient being symbolic but now that I think about it, that patient only dropped the bullet after he was dead. Could this symbolize House’s death in some way? The way I kinda saw things were…
Shooter = He represents the human aspect of House. Questioning his humanity, humility and why he is the way he is.
Cameron= Kinda obvious there
Wilson – the realization of what defined House (his leg, his pain, his disability…)
Wilson/Cuddy – same thing mentioned in the post above
All this leading to the 2nd to last scene with the death of the patient and the bullet, if House continued down his current path then maybe it could destroy him.
Everything I just typed may sound stupid but, meh, I was never good at analysis in my English classes.
May 24th, 2006 at 12:40 am
I, personally, thought that this was the best episode of House that I’ve seen so far, solely based on the story, and I’d like to share why.
A while ago I was talking to my friends and I happened to mention House, just to see if they watched it, or if they had seen it at all. My friends mother said she had seen an episode, and began to complain about the way that House had acted. One of my friends, who had never actually seen the show, began to talk about how in a realistic situation House seemed kind of stupid, because there would always be someone who was just as good as he is who wasn’t an ass. I attempted to defend the show, however my friends mother had made up her mind, and I didn’t want to continue to argue.
The fundamental ideas behind the show go far beyond the characters in the show, or the basic “This guys in ass but he’s always right”. It’s not about the fact that House is an ass, it’s about the fact that House does things to help people, and that by acting polite we could be doing exactly the opposite. House has the most practical outlook on life that I can possibly imagine, however his view is also flawed in many ways. The members of his team, and people like Cuddy and Wilson, continually conflict with his point of view, thus pollishing it. It can basically be said that every character has a point of view that is wrong in some way, with House’s point of view being the most correct. As the characters interact with each other their points of view conflict and refine each other, so they each become more and more correct.
I thought this episode of House was absolutely amazing because, despite a small letdown in the story, we are able to see an incredible amount of opinions which each conflict with House’s point of view more than anything else we’ve seen in the series. The idea that House’s ideals are based on a neglect of the physical to an unhealthy extent, the question of wether or not it would be better for House to have a body that he could be happy with or simply be miserable but able to help others, the idea that House wants to do good and then be forgotten, and the other things brought up, where simply amazing, in my opinion.
I absolutely loved the finale, and I can’t wait for the next season. It’s is logically stimulating in a way that I think would benefit most people.
Now, I don’t know if I’ve mentioned this, however I have absolutely no medical knowledge whatsoever, so I’m sorry if this next thing sounds stupid.
I had my wisdom teeth out last December, and it was a rather surreal experience. They attempted to knock me out, however they were unable to locate a vein in my arm or hand. Because it was taking a long time, and they kept sticking me with a needle, they eventually put me on laughing gass. After they just couldn’t find a vein, they eventually did the procedure with me conscious.
I was curious wether or not modern laughing gass and ketamine have anything in common. During the procedure I could feel pain fully, however I couldn’t really react to it. I felt very much like my mind and body were seperate, as you put it, despite the fact that if I forced myself I could still exist in my enviroment (though movement became incredibly difficult).
Anyways, it was nice reading your reviews, and I look forward to them when the next season arrives.
May 24th, 2006 at 12:43 am
Just to append something to my last statement, when I said that I could feel the pain fully, I meant the needle in my arm and hand, as well as the shots they gave me to numb my mouth, not the actual procedure itself (which I would imagine would have been incredibly painful).
May 24th, 2006 at 12:52 am
When the eye enucleates like that (one of the most disturbing scenes I’ve never seen), can it be placed back in the socket? Is there any major damage to vision?
May 24th, 2006 at 1:50 am
I would feel cheated if not for all the character insight in the episode. And who could imagine even an hallucinating House apologizing for anything!?
Back in high school I knew someone who had done EMT work, and she related a number of nauseating stories, one of which involved fetching a prison inmate with an enucleated (hooray, new vocabulary word!) eye. Wasn’t much she could do for the guy on the way other than give him a Dixie cup to cover it. Brrr.
Dr. Scott, I have a vaguely medical question: Tonight and occasionally on the show they mention “toxins.” I doubt this is the same thing as what — for lack of a better phrase — “new age types” mean when they talk about toxins, right? I’d appreciate some real-world knowledge about this sort of thing. Thanks!
May 24th, 2006 at 2:52 am
My take on Cameron/House relationship is that House really views it ok for Cameron to approach and get to House directly (as in how when he teased her, she finally stopped him even if he overrided her again right away). But for House, if he wants to get to Cameron “directly” he has to go through an intermediary — the robot in this case. But it seems he definately does want Cameron.
May 24th, 2006 at 7:17 am
You cited the enucleation and scrotal explosion scenes as bad scenes, I’m wondering, is that because the explanations were badly explained, or because they’re so patently ridiculous in the first place? What could possibly cause an eye to pop out all on its own? Does the heart really create enough pressure that a broken artery could cause these? Or were we supposed to assume that other tissues (behind the eye, and inside the scrotum) were swelling just as the tongue was, and *that* was what caused the explosion and enucleation?
And, finally, since we never saw a good imaginary solution for the tongue, would you care to imagine one? (Just curious what could cause such a condition).
Thanks, and thanks for the great reviews here. Can’t wait for next season!
May 24th, 2006 at 8:45 am
I thought this was a good episode, especially considering the way the writers messed with our heads. It seemed obvious that House was hallucinating something; the hospital putting the shooter right next to the shootee was plainly absurd, and the shooter going from terse to insightful and eloquent seemed a real stretch, but I didn’t expect the whole thing to be a dream.
Is it possible that tongue-guy is a hallucination too? We just see House being wheeled in at the end.
May 24th, 2006 at 8:49 am
Scott, you feel cheated because you’re being cheated. This has been a complaint about dream and imaginary movies since before television was invented! There are great, great movies out there with the cheat ending.
Overall, I didn’t like the episode, because of the cheat. Also because of the cheat, we were shown unbelievably gruesome things (even for House!) for no reason; these were House’s fantasies of interesting (i.e. gross) medicine, they made no sense as part of a medical mystery.
However, there were other aspects of the show that were very enjoyable.
Think of the episode as THE WIZARD OF OZ. I mean, the parallels are perfect: A brain injury (Dorothy had a concussion) leads to a complex hallucination that fulfills the patient’s fantasies, gives insights in to his/her problems, struggles, and needs, features people from the patient’s real life, and ends when the patient returns to consciousness.
In a way, this was our turn to solve the puzzle. Normally, we watch House and his posse figure it out; it’s Sherlock Holmes. This time though, we solve along; it’s Encyclopedia Brown. There were lots of clues that this was all fantasy. Think about it: A cure for chronic pain wouldn’t have cured the gross damage to the musculature of the thigh; even without pain, House would limp. Everyone’s passivity in response to House. House expressing his sexual desire for Cameron (the one off-limits topic). The pure craziness of the shooter in the bed next to House, without guards, without any distance between them. So we have to parse out what we’re seeing and ask ourselves if it makes sense, and ask ourselves what we are to do with that information. At one point, I was convinced some kind of hallucinogen had purposely been delivered in the bullet’s casing.
Finally, we get to see the workings of House’s mind in its purest form; trapped inside a hallucination, he still works the problem and tests the variables and figures out what it means.
Okay, I may have talked myself into liking t.
May 24th, 2006 at 8:53 am
I’ve never watched an episode (though many tell me that it’s very good) — indeed all I know about this show comes from the things I read on this blog — but I have to say that in general, the it-was-all-a-dream episodes of any TV show are crap.
May 24th, 2006 at 9:05 am
I agree that an ‘imaginary’ story can make you feel cheated. But you feel a hell of a lot more cheated if you managed to guess that it *was* imaginary before they told you. The fact that the writers made things ridiculous, but just this side of believable, is a credit to their craft. This is an episode that I shall be watching many, many times over (despite all the gross stuff – I’m suprised FOX had the balls to show all that) because there are delicate, intracate, inter-connected webs of meaning over everything that happened in the episode. Despite the cheap trick of the ‘it was all a dream’, it’s obviously inspired some really deep thought and analysis and I’ve only read one blog!
One aspect I found of particular interest is that, if the shooter was trying to torture him, but the shooter was mostly a hallucination, then he was torturing himself. That’s pretty much the central issue with all of House’s idiosyncracies . . . and then he forgave himself for torturing himself; there are definitely some legendary and mythical theories concerning the ability to forgive oneself to attain ‘enlightenment’, though as first blush I can’t quote one directly. In anycase, the mental gymnastics has led to real action: he’s actually going to do something about his leg other than ingest Vicodin like candy.
About the enucleated eye question from David – yes. It can. I have no working knowledge of medicine, but I do have a fairly sound working knowledge of physics. He already had intercranial pressure, which I have to assume is going to put increased pressure on his sinus cavities (and whatever else it is that’s behind the eye and in your head). Depending on how great that pressure is, it might not even take much blood at all to enter the area for the eye to take a swan dive. Besides, if they’ve taken the time to come up with a neat little term like “enucleate” it obviously happens. :)
May 24th, 2006 at 9:07 am
I really liked this episode, actually. Although that may just be because it’s the first time I figured out what was going on before House did. . .
I feel that the mystery was Playfair, at least as much as it ever is. I think we got enough clues to deduce that the whole thing was a halucination at least as soon as House figured it out, if not sooner.
We knew that he was halucinating. So, once we know that he IS having halucinations, we have to ask HOW MUCH is halucination and how much is real.
To me, it seemed unlikely that it was even POSSIBLE for something to swell the scrotum quickly enough to explode it. Simply as a question of hydraulics. So I wondered if that was real or not. At that point, I started questioning everything — and EVERYTHING rang false. The characters were acting as charactures of themselves, rather than as themselves — but it didn’t feel like bad writing. So I had to start asking if THEY were real. And it started to make sense as ALL being inside House’s head.
So I really liked it — ’cause I figured it out. That’s never happened before, and I strongly suspect it will never happen again, so I’m savoring it.
May 24th, 2006 at 9:11 am
I found it interesting that Chase was all of a sudden the smartest scooby in the bunch this episode, he always seemed to just be a follower.
I have to agree, dream sequences aren’t my thing. Now I know why my folks were pissed when Patrick Duffy was just dreaming on Dallas in the early 80’s.
May 24th, 2006 at 9:27 am
PS – Actually, you can grade the soap opera. Granted, all the events that happened aren’t relevant to interactions between actual characters, but they ARE still relevant to what’s going on with House. The only difference is the soap opera in this case only deals with one person. Amazingly, it manages to be even more pungent than usually.
Plus, ya gotta give ‘em props for throwing an episode your way that made your grading criteria useless. That’s one hell of a curve ball. ;)
May 24th, 2006 at 9:35 am
Mike wrote: “[...]would have expected a better cliffhanger (obviously House is not going to die).”
I think it’s because he obviously won’t die that the real cliffhangers are whether the Ketamine will be effective in curing his pain and if it damages his mental faculties in the process. Of course the latter is as unlikely as his dying, so I suppose it’s all about whether he’ll still be in chronic pain. My guess is that he won’t, so they can wean him of his painkiller addiction.
I liked this episode. I agree with the poster who said that most “dream sequences” in tv shows are bad, but I think that’s because they’re typically used as a sort of Deus Ex Machina to justify an unrealistic storyline. I think there’s a big difference between that and depicting a mental breakdown in a patient who faces that very prospect on the table. To me the former seems more likely to be cheating on the part of the writers than the latter.
May 24th, 2006 at 11:46 am
I have to disagree that the “It was all a dream” device was cheaply used here. I consider it cheap when writers spin out plot event they can’t resolve, and the dream is used as a “reset button” of sorts — we become emotionally involved in events that are then taken away from us.
Not so here. The device in question was used properly, to give us a perspective on House we never could have had otherwise — we now know many of his strong and conflicting feelings about himself and the way he acts, and how he suspects others think about him. The plot events that occurred during the hallucination — up to robotically undressing Cameron and bifurcating a patient — aren’t really terribly important, (and by that time House has told us what’s going on).
I do think that every person in House’s hallucination is an aspect of himself, including the patient. The patient loses the ability to speak clearly, to see clearly, and to connect with anyone sexually — with a wife who’s hot, smart and faithful. (Also, didn’t Odin trade an eye for wisdom? Just a thought.)
Those who figured out it was all a hallucination — what tipped you off? For me, it was when Cuddy mention the “experimental German procedure” with the ketamine — it reminded me of the miraculous plastic surgery in Vanilla Sky.
Thanks for the great site. I visit after every episode.
May 24th, 2006 at 12:18 pm
I don’t think this is the same as just “imaginary”. They weren’t just dreams. In fact they weren’t dreams. They were hallucinations. And it’s like we’re taking a trip inside his head. Sure, those events didn’t really occur. But the way he thinks is real and his self-reflexivity was real. This was an episode about House the person – but of course the great thing about House is that it doesn’t give any straight forward answers.
I absolutely loved this episode. It’s by far my favourite. But that’s just me. I didn’t feel cheated at all like I usually do with those “and it was all a dream” stories, simply because the story was told in this way for a reason. It wasn’t because the writer didn’t know how to end it and did it as a hallucination – there was a point to it.
Thanks Scott again for the review – even though it was all a hallucination :)
May 24th, 2006 at 2:24 pm
About the enucleated eye question from David – yes. It can. I have no working knowledge of medicine, but I do have a fairly sound working knowledge of physics. He already had intercranial pressure, which I have to assume is going to put increased pressure on his sinus cavities (and whatever else it is that’s behind the eye and in your head). Depending on how great that pressure is, it might not even take much blood at all to enter the area for the eye to take a swan dive. Besides, if they’ve taken the time to come up with a neat little term like “enucleate” it obviously happens. :)
You’ve really got to see Spalding Gray’s Gray’s Anatomy. Enough gross eye stuff to last a lifetime.
And it’s like we’re taking a trip inside his head. Sure, those events didn’t really occur. But the way he thinks is real and his self-reflexivity was real.
And note that the first thing he thinks is that he deserved it. The woman who committed suicide…also part of his imagination. Yet the remorse in House’s face as he learns the truth…completely real. So we know he lives with a certain amount of remorse about his own behavior all the time.
May 24th, 2006 at 2:58 pm
Would House get the ketamine, though? Is Cuddy going to hear that he asked for ketamine, is her mind going to leap straight to ‘ah, he must mean he wants this new procedure for his leg!’? Would whoever he mumbled to tell her, or write it off as ‘dude just got shot in the neck, he’s probably a bit screwed up’?
May 24th, 2006 at 6:34 pm
Don’t quote me on this since I’m not an eye expert, but I think that as long as the optic nerve isn’t damaged, they can replace the eye and vision should mostly return. But shouldn’t the man have been wearing something – a bandage, a patch – over his eye for a while after it popped out? I can’t imagine the eye just slipping back into the socket that easily, but I guess you never know.
I perceived the House and Cameron scene differently. House has a serious morphine addiction, and his ability to maintain an erection could easily be affected by the drugs. So, maybe the scene represented House’s inability to truly connect with Cameron on a sexual level. He has to use a machine instead. The exploding scrotum (which was rather cheesy, in my opinion) could also support this theory.
May 24th, 2006 at 7:41 pm
I was in general agreement with another excellent review.
I wasn’t sure about the point myself, but your review of “Three Stories” confirms it: “Due to worsening pain after the procedure, the patient [House] opted to be placed in a medically induced coma until the worst of the pain was over. While he was in this coma, his significant other used the terms of his power of attorney to send him to surgery”.
So we seem to be dealing with something that was already established as a source of anxiety for House, because it had made him vulnerable. The details may not make sense, but the concept is “in character.” And his experiment to show that without morphine his leg pain was gone, but the wounds hurt, did sound like the sort of test House would propose to use on a patient. I think there was some reasonable attention to internal consistency under the dream-logic.
(If anyone wonders, I suspected that this was going on in House’s head as soon as I realized that, although Cameron was by his bedside, no one was asking him to make a statement to the police, security was still notably invisible, etc. This would be a serious lapse in basic TV-Hospital Shootings Protocol.)
May 24th, 2006 at 9:59 pm
Reportedly, Hugh Laurie was getting serious back problems from walking with the cane, so they needed a way to explain why House was no longer using the cane. So, apparently, this will cure the leg.
Honestly, that scene with Cameron and the machine was as erotic as the other scene with the machine was gory. I can no longer deny that House is warm for her form.
I think the biggest revelation here was all about House realizing that he can trust his team. Chase can solve his metaphors because Chase is smart, and House, when he can’t even trust himself, can still trust the team. It’ll be interesting to see how this plays out.
The actress who plays Cameron was interviewed in this week’s TV guide, where she indicates that this episode really will change the team’s interaction for next season.
May 24th, 2006 at 10:01 pm
Oh, and as for the diagnosis, while I have no medical experience I think that this episode was very explicit in that this scenario could not happen, and House realizing the impossibility of it all was what made him realize that he was hallucinating. So, in short, there is no way to diagnose this case.
May 24th, 2006 at 10:22 pm
Is it possible that tongue-guy is a hallucination too? We just see House being wheeled in at the end.
No, that isn’t possible. Tongue-guy’s case is being discussed before the shooter enters. Maybe (probably) it’s something much more obvious, though, without the enucleation and all the other dramatic stuff.
I knew everything was fake as soon as Cuddy had heard of research House hadn’t, particularly in an area of such obvious interest to him.
May 25th, 2006 at 8:07 am
This episode has grown on me, like I guess it will and has on many people. As first I felt cheated like Scott, did (not as much, at least I wasn’t sitting there jotting down medical errors, only to discover that they didn’t matter). The ending left me distinctly annoyed, but then when you look at the episode again, it leaves you with a whole lot of questions, a lot of things to interpret. Maybe its a device by the writers to keep us busy for a while, and then eagerly wait for the next season. I must say I had my doubts about whether House could really be sustained for 3 seasons, now I am a bit less concerned. I especially like the fact that as soon as we begin to feel that the show is getting formulaic if still entertaining, the writers change everything around. I didn’t spot it till the very end, so probably went through everything the writers wanted, it was only when House ripped through the patient that I thought this just cannot be real. Personally I prefer to suspend my critical judgement when watching something I enjoy, though only a few things actually allow that suspension of reality, House is one of them and that is why I enjoy it.
We weren’t cheated really, we would have been if the dream had nothing to do with reality, but in fact it had a lot. The episode deserves to be seen at least, maybe except for people who figured it out early, and could observe things the first time itself. Also I loved the part where House is trying to get a grip on what is real and what isn’t I have had that happen so many times in dreams.
House writing on that transparent board, it did not make any sense to me, looked like some kind of a chemical equation. Was it completely random or did it make any sense?
May 25th, 2006 at 9:17 am
I think the episode played completely fair, since the shooter had to ask which one was House.
May 25th, 2006 at 12:29 pm
Good point Joshua. I was thinking about that; how did the shooter confess to House that he’d cheated, if he didn’t know him in the beginning? Excellent catch.
May 25th, 2006 at 1:25 pm
I agree that Three Stories was a much better episode, though this one was decent…and I wish we knew what the tongue was caused by. I thought it was also pretty cool that they used that robot, since I just saw a show on it and how they were using it for heart surgeries so that the recovery time was significantly reduced.
Thanks for the review!
May 25th, 2006 at 2:26 pm
I dread “all-new, better Dr.House” in Season 3. There are hints for that…
May 25th, 2006 at 3:35 pm
There is something that has annoyed me from the beginning of this series, and since the word “addiction” appeared in several of this episode’s posts, it seemed like a good time to bring it up.
Three distinct conditions are most frequently associated with the use of opioid medications for chronic pain conditions: tolerance, dependency, and addiction.
Tolerance occurs when a dosage no longer works and must be titrated up as each successive dosage ceases to work. Unlike the common perception that the dosage will continue needing to be raised indefinitely for however long the person remains on these medications, research indicates that the dosage will eventually plateau.
Dependency occurs when a person has been on opiod meds long enough so that their body physically depends on the drug, meaning that usage must be gradually tapered off, as stopping “cold turkey” will cause serious (and sometimes even deadly) withdrawal symptoms.
Addiction is purely behavioral. For example, someone who is addicted will take these meds even if they don’t suffer pain, for the purpose of getting high. Most people who take opiod meds for pain control aren’t even capable of getting high from them–unless they were to take a massive dose, way higher than the amount needed to control their pain.
This is why House’s mind is able to function at the higher levels needed, and why he never appears high. He takes his meds for PAIN CONTROL, not to get high. He has a legitimate chronic pain condition. He is absolutely dependent on the drugs, sure, but not addicted. I truly wish the show would adress the drug aspect from a factual standpoint, instead of the ever-popular “War on Drugs” standpoint in which all narcotic use is bad. It is difficult enough for true chronic pain sufferers to get the help they need, and the show does no favors by consistently and incorrectly labeling House as an addict.
Don’t get me wrong. I *love* the show–all except for their treatment of that one issue.
Apols for the length of this post.
May 25th, 2006 at 4:00 pm
I LOVE the comment above about addiction. That’s something that ticks me off when fans dismiss House as a junkie – he’s not taking Vicodin and morphine for the high, he’s taking it so the pain in his leg doesn’t eat him alive.
Tongue guy’s exploding-body-parts-syndrome sounds more to me like something straight from House’s subconscious – not that House had an actual disease in mind and was trying to solve it, but that his subconscious was purposely giving him something inexplicable to work with – and since House didn’t figure out for a while that it was all a hallucination, he didn’t realise that Tongue guy’s symptoms weren’t real.
…Because I hope there’s no disease that makes your eyes and genitals explode. Uh.
If the writers are worth their salt, House will still have a limp next season – his quad muscle has been diced up, and unless he has starfish genes, that won’t magically regrow. He’ll still have a disability, just not chronic pain. If the K-coma works, that is.
I loved this episode – we already knew House was screwed up and miserable, but this subconscious roller-coaster ride showed us just HOW screwed up and miserable. I’d never expected House to be quite so self-deprecating – why is Cameron, and no one else, there when he “wakes up?” Not because he wants to be with her, and not even because he thinks she cares, but because she’s CAMERON, the one who’s always at the patient’s bedside. Because she has some moral obligation. Even Wilson and Cuddy, his two best friends, aren’t there – and in his hallucinations, they both pull a Stacy on him.
Sorry if this doesn’t make a lot of sense, I’m trying to keep this comment from getting two pages long, haha.
May 25th, 2006 at 5:17 pm
You forgot one thing, though: if I’m not mistaken, House specifically told his team to tell Cuddy to put him on Ketamine when he was being wheeled to the ER.
May 25th, 2006 at 6:45 pm
So Hugh Laurie is having trouble with his back from using a cane? Maybe if he had been using the cane in the recommended fashion instead of making a dramatic statement by using it improperly, his back wouldn’t hurt. Those of us who use canes on a daily basis don’t normally appear to be limping when we walk with our canes. It’s when we don’t have the cane that the limp is noticable.
May 25th, 2006 at 6:48 pm
House ditching his cane because of Laurie’s back problems is a *very* specious rumor spread by Starpulse — in other words, don’t believe it until you see it.
May 25th, 2006 at 7:02 pm
“2. does that mean that he does want to undress Cameron?”
Wouldn’t most heterosexual men?
(It was interesting that Cuddy was dressed more conservatively than otherwise and House’s interactions with her were for once entirely and only professional.)
There were two aspects that particularly intrigued me this episode. The first was Wilson’s point that in order to come to terms with his physical disability, House had to downplay the significance of his physical self and become entirely about his mental ability. So even while he abuses his physical body with vicodin and morphine and alcohol and refuses to do rehab because his body doesn’t really matter, he also denies himself the good parts of being physical such as being able to directly enjoy touching a woman who he is attracted to (unlike the hookers where it’s just a business transaction). It’s a theme that Wilson has mentioned through earlier episodes but never so blatantly as here.
And because House has become only about his mental abilities, it throws him into a near panic when he thinks he’s losing them in exchange for greater physical prowess, Wilson and Cuddy’s betrayal. This struck a chord with a physician I know who could still teach taught House a thing or two about diagnosis but decided to retire when in her 70s because she thought her mind was becoming less sharp and she was not as effective at her job any more. Like House, she defined herself by her medical ability and I think the shock of being less than she was before was as great as any the fictional character felt.
May 25th, 2006 at 10:38 pm
It’s Thursday night andI just got around to watching it. :)
It was a slightly confusing episode, but I guess it came together at the end.
I enjoyed it!
May 26th, 2006 at 1:05 am
I wonder if Connie Willis has seen this episode. It strongly reminded me of the near-death experiences that she depicted in her novel Passage. Specifically, I wonder if House coded while he was being wheeled to the theatre, and the hallucinations were the result of that.
May 26th, 2006 at 4:50 am
Okay. I originally thought that the opening scene and the closing scene were real. However, after reviewing the episode several times, I realized that everthing is part of House’s hallucinations/dreams. In the opening scene, House does not have a cane. House is not limping and does not appear to be in any pain. This is inconsistent with what we learned in the previous episode that the pain was getting worse. I think House is still in his apartment shooting up morphine.
May 26th, 2006 at 5:39 am
To the point of addiction, I agree, the term is used quite frequent and freely by the staff, mostly I’ve noticed from Foreman but to me it seems to stem from an inability to connect with House on anything less than a professional level. He’s as emotionally detatched as House is (as depicted in the first season, the episode with the pants/pesticide, where they drew great parallels with the two characters, but I digress) and as such is really almost unable to sympathise with someone being in chronic pain. He doubts that House is honestly in pain at times and decides that since “everyone lies” House must to, and thus is simply addicted.
It was also in the first season that they brought up the issue of House and whether he is addicted or not (the ep where he went in to trying to detox). There was never a real and firm “This is the way things are” answer given, just each of the characters perceptions, and really that is all we have with which to form our own. The general answer was if he is an addict, he’s a highly functioning one at the very least.
This episode actually leans a little more towards the idea that he’s not addicted so much as he, for lack of a better word at this time, enjoys putting on the front of being broken in more ways than one. Granted, he is broken, but not in the ways he presents to his patients, which is something that was brought up in the pilot, if vaguely.
I felt this episode was rather enjoyable, and I was believing it was all a hallucination right up to the point where the mystery patient was split stem to stern. It was that point where they held on just long enough to make me think “Oh #(%*…He was wrong”. A masterful touch that most of your average “dream sequence episodes” frequently leave out. They just pop you immediately out once the character ‘wakes up’.
I’ll actually have to sit down and watch this one a few more times before I can get too in depth into analizing it myself, but there were interesting points brought up here that I felt compelled to reply to such as it is :)
May 26th, 2006 at 12:32 pm
Man, I hated that episode. I liked the headgame stuff, the use of reasoning to coax himself out of a particular hallucination, but overall the episode was just over the top gorey and horrible. And I normally like to think I have a pretty good tolerance for that kind of thing. Maybe I need to re-examine that, though.
May 26th, 2006 at 2:45 pm
It was an excellent episode. Yes, it does make one feel cheated if the writers use the “it was all just a dream” ending just to make the events irrelevant. I’m sick of that kind of thing too. But if it’s being used in such a clever way, to study the workings of the main character’s mind and feelings for an entire episode, it’s something that was quite unimaginable in any TV show before. This kind of masterful characterization is usually used by great artists like David Lynch – one of his movies was clearly similar to this House episode, but I don’t want to write down its title for those who haven’t seen it yet but may want to later. You know what I’m talking about if you’ve seen it.
(and since it’s my first post here I have to mention that I love this blog, keep it up!)
May 26th, 2006 at 7:14 pm
Dave, I, too thought of Connie Willis’s Passage — particularly in the way that, when House sees the bullet at the end, he looks pained and says “Goodbye”.
Gametheory, in the very first scene House’s cane is hanging on the whiteboard. We’ve seen him stand in one place without a cane plenty of times.
May 29th, 2006 at 1:10 am
hmm, well i for one couldnt help but notice that the most recent episodes were becoming more gorey and graphic, and little more looney in the logic of the story. but i guess i must admit that the last 5 episodes or so have become less medically straight-forward (ie patient, differential diagnosis, weird conflict/problem, house saves the day with some of his classic brilliance) and more character development through these weird little struggles. like with foreman’s whole situation, we saw the professional boundaries of house and his team, with house not being able to commit himself to treating foreman as just another patient. and with the last episode, we actually had to examine house as a character in order to make any sense of the illogical mess.
i guess the average viewer would feel cheated because it wasnt what we have come to expect of classic house. that was my initial reaction to the whole hallucination thing, because there was no disease and there was no cure for the nonexistant disease. it was sort of irritating, yet fascinating because of the way that house still managed to make an episode out of it (nothing), through his hallucination. i mean, it made no sense medically and midway through the episode i lost track of what was hallucination and what was real, until of course the ending. this will forever be one of those masterpieces that you know was utterly amazing and genious, yet you dont completely know why. perfect character development though. did anyone else notice how awkward it felt for the audience when house actually apologized to his own inner conscience?
May 29th, 2006 at 9:01 am
I knew that most or everything was halusination when House was talking with the three outside of a taco stand, a *fish* taco stand (dirty joke much) about the tongue patient, and something they said there was refereced in the ICU.
May 29th, 2006 at 10:15 am
@ DrObviousSo
The fish taco stand *might* be a dirty joke . . . but then so is every Taco del Mar in America. And joke or not, that place is scrumptous.
May 29th, 2006 at 5:51 pm
I liked how it wasn’t House killing a patient that shocked him out of the hallucination, but him being totally wrong.
May 30th, 2006 at 9:57 pm
For House: he had abdominal surgery, including stomach and bowel repair, but he can eat tacos two days later? How could surgery to the abdomen, or even the lateral neck, injure the “peripheral nervous system” in such a way to affect his leg. Even if an induced coma could cure chronic pain, that does not mean they couldn’t uses standard anesthesia during surgery and then use ketamine to start the coma afterwards.
-Taco thing – hallucination. Heh.
-It wasn’t the surgery that injured the peripheral nervous system in such a way to affect the leg, it was the ketamine resetting the peripheral nervous system. They used ketamine as opposed to “standard anesthesia”, because ketamine IS standard anesthesia. Ketamine does work as proposed on the show; more information can be found here.
May 31st, 2006 at 5:08 am
Ketamine is also mentioned in a recent NYT article discussing chronic pain treatment.
May 31st, 2006 at 5:55 pm
Siren: I’ve complained and explained about the so-called addiction problem, too. Everything you said is correct. And you needn’t apologize about the length of your post: though Zach may complain about it, Scott hasn’t imposed a limit and until he does, people are aparently free to say what they wish.
This wasn’t just a dream that House had. It was, from his last words “Tell Cuddy to use Ketamine,” as he was being wheeled into the ER, a precognitivie experience which somehow “told” him that Ketamine should be used to solve his pain problem. The only question is why he didn’t think of it before getting shot–shouldn’t it work whether surgery is required or not?
June 2nd, 2006 at 11:56 am
@Awi -
Think about the long discussion that House and Wilson had during that episode and how upset he was with Cuddy initially. That’ll tell you why he never bothered to research or think about it before.
June 7th, 2006 at 11:50 am
Siren
man you need to do research before you post this is how people get the he said she said
this is what you wrote…
“Dependency occurs when a person has been on opiod meds long enough so that their body physically depends on the drug, meaning that usage must be gradually tapered off, as stopping “cold turkey” will cause serious (and sometimes even deadly) withdrawal symptoms.
Addiction is purely behavioral. For example, someone who is addicted will take these meds even if they don’t suffer pain, for the purpose of getting high. Most people who take opiod meds for pain control aren’t even capable of getting high from them–unless they were to take a massive dose, way higher than the amount needed to control their pain.
This is why House’s mind is able to function at the higher levels needed, and why he never appears high. He takes his meds for PAIN CONTROL, not to get high. He has a legitimate chronic pain condition. He is absolutely dependent on the drugs, sure, but not addicted”
1st of all you cannot die from withdrawls on opiets (heroin, codine, morphine etc.)
second he IS addicted. its the same as dependent, the 90 year old woman on oxycontin or percocet is ADDICTED..
lastly i just want to say that I knew it must have been a DMT release because he was near death, it was just the chemicals in the brain doing what they do when a person thinks he is dieing. some people see god or a tunnle ect. near death experances, he just saw himself and things that make him who he is. i knew this before the end because of one thing.. ketamine will not cause those kind of reactions like blackouts after the procedure. if it did it would not be a used for this and phycelldics only cause HTTP in less then 1% of people and its still unknown due to the fact that more then 1% of people will have some kind of mental disorder before the age of 30. and if a person would have a so called flashback from psycellics LSD or Ketamine it would only last a few minents and they would not be vissions or real visuals or dreams, that is even if flashbacks can happen, it has yet to be proven medicaly that is why i knew something was up if the show was atleast somewhat based on science.
email me at projump2001@aol.com if you have questions.
June 11th, 2006 at 5:12 pm
The difference is quite simple. A drug-dependent person has improved function with their use of the drug while the drug-addicted person does not.
An addict uses a drug compulsively, despite the fact that it causes harm — the key component of addiction. Most smokers know cigarettes are damaging to their health. Most want to quit, but can’t overcome the cravings to the drug (nicotine).
Dependence is a physical state that occurs when the lack of a drug causes the body to have a reaction. A good example is a heavy coffee drinker. If one is used to drinking several cups of coffee each day, they soon learn about physical dependence when they suddenly miss a day or two. This does not mean they are addicted to the caffeine; it only means the body is surprised not to see what it has come to expect.
As any diabetic will testify about insulin, or any heart patient will testify about blood pressure medication, dependence is not necessarily indicative of addiction. In fact, regular use of these medications is essential for good health. Addiction and physical dependence often occur together — but you can have addiction without physical dependence, and physical dependence without addiction.
(from http://www.gdcada.org/ask/askA.htm)
see also: http://www.thedaily.washington.edu/index.php?storyID=16334
June 11th, 2006 at 5:32 pm
additionally:
“Heroin Detox can be extremely uncomfortable. Heroin withdrawal can cause physical and emotional trauma: including stroke, heart attack, and even death. Methadone is often used for heroin detox, to ease the pain of heroin withdrawal. The outcome of methadone treatment typically ends with the individual acquiring an addiction to methadone, and continued heroin use.”
and
you meant: “opiates,” “withdrawals,” “psychedelics,” “dying,” “minutes,” “visions..” shall I continue?
do some research yourself, oh doctor of the inflatable castle.
Also, Gregory, yes.. laughing gas is also a dissociative anaesthetic.
June 18th, 2006 at 12:57 am
Er. I don’t know if this has already been mentioned, but the whole episode was a hallucination.
He didn’t get surgery…he didn’t eat tacos. All of it was a hallucination – watch the last few minutes, and you’ll get it.
October 17th, 2006 at 10:50 pm
^^^
Yup, if you read scott’s review, he did mention that it was just a hallucination, except for the parts in GREEN.
November 30th, 2006 at 1:12 pm
Id like to say for the record that despite a slight cop-out ending I felt it was an interesting idea for the season
finale and that it was just about pulled off. It was an episode to create talking points and the amount of discussion from people on this site has shown that. One thing that has got me thinking though is that as this was all an hallucination, what caused the hallucination? The ‘hallucinations within hallucinations’ are related to the ketamine that House was given, and the surgery. At the end of the episode when he wakes up on his way to the ER there is no obvious reason to me for him having had an hallucination of any sort. Any thoughts?
January 15th, 2007 at 7:59 pm
This episode didn’t sit right with me for some reason. I agree with above posters who have said that last season’s Three Stories was the better of the two “surreal” episodes we’ve seen thus far. I didn’t care for the over-the-top shock-value scenes. Still, I thought the final “dialogue” between House and Elias Koteas was fascinating. There were interesting elements in this episode…but they can and have done “dream” sequences better.
January 22nd, 2007 at 11:14 pm
First, there was a problem with the course of the bullet in his neck. Cameron said the bullet went through his neck and exited. She also said it knicked his jugular vein. The wound was on the right side of the neck behind his ear. When House was shot, he fell backward, but he was still facing the gunman. He was shot in rapid succession. House would have had to roll over to his left side to have the bullet enter the posterior aspect of his neck on the right side. He couldn’t do that because the bookshelves were in the way. He was facing the shooter a few seconds before the second shot. The angle of the bullet would have to be anterior to graze his jugular vein. Where was the exit wound? It would have had to be in the front of his neck! He would have had to roll almost completely over.
The first shot was to the right side of his abdomen. Cameron told him it pierced his stomach, knicked the bowel, and lodge in the posterior rib. The bullet would have had to damage his liver, and
it was too far right to pierce his stomach.
Would House walk barefoot in a hospital?
house finds out why he got shot, and then he goes and repeats the same thing. In the beginning, he thinks he does nothing wrong regarding anything he does. He told the shooter’s wife her husband had an affair, and then he ask’s the patient’s fictional wife the same thing.
Why does House realize the tongue guy’s wife is a hallucination, but the taco stand right after that isn’t?
It all seems to be the same day, but Cuddy is wearing different clothes when he confronts her about the Ketamine. The ducklings have changed clothes too. Again, the ducklings change clothes after the explosion. House says he has known what Cuddy did for 6 hours. The time frame is distorted. It should be the third day, according the the clothes. Then, there is another change of clothes.
When House apologizes, he has shed a tear. House showing emotion? House then returns to the analytical to bring himself back to reality. In order for him to exist, he has to return to the way he actually is. He can’t function by emotions and sentments. His subconscious brought him to the point where most of us exist-with emotion, to appreciate the value and goodness of people, etc., and he falls apart. The closer he is to this point, the more out of control he is.
The supporting players in the program are constantly trying to change House. They tell him he is addicted to Vicodin, and he can get along without the drugs. They tell him he is too analytical, too fixated on the puzzle, not compassionate. He doesn’t care enough about the people part of it. All of this has been building up in his subconcious mind. When he became what they thought he should be, he couldn’t function. The only back to reality was to become what he was before the shooting.
January 23rd, 2007 at 11:43 am
I know we all hate Freud these days, but I was just wondering if anyone had thoughts about “dream consciousness”. I.e. that Houses mind is so “superior” as to enable him to logically work out, and see through hallucinations. Does anyone else have any thoughts of this. The reason I am curious is because I recently heard an interview with a swedish schizofrenic (properly diagnosed,fairly severe one) who one day just decided not to listen to “the voices” or the thoughts anymore, and who had lived without medication for a couple of years by identifying and logically asses every negative thought or voice that he experienced in his daily life, and by actively not paying them any heed after he had deemed them as part of his illness. He still heard the voices, he just ignored them.
Is this really possible, and wouldn’t he have to have either a remarkable will power or intelligence in order to make that work? I have also recently heard that it is possible that as many as 25% of us may experience “voices” during a life time, but a number of people choose not to seek help because their voices are benign and do not in any way impair their life or quality of life. They may actually be “nice” voices that tell them to be kind to people or that encourage them and tell them they are doing good etc.
My other question is for anyone who feels able to reply: Is it possible that there are people who are unable to hallucinate? Who will hallucinate neither under severe fatigue, nor under common hallucinogens (Is that the word? I do appologize for any language errors, I am not a native english speaker), or other situations that may induce a hallucination. Like – House can recognize and see through his hallucinations by using logic – this is obviously a tool of the story teller, though we do know that a lot of people can recognize and even start to control their dreams – but he is able to have the hallucination. (When is a hallucination actually a dream?) But are there people who _can’t_ hallucinate? Who can dream during regular sleep, but can’t hallucinate in any other state of consciousness?
I’m sorry if the question seems off topic and irrelevant. Here in UK, season 3 is not yet available, so I have a lot of time to ponder the season finale and come up will all kinds of crappy questions to keep myself from worrying that they are taking the series into a direction I won’t like.
Is it possible to be unable to hallucinate (I am now talking about all the senses), and if so: If your mind is unable to think up things that don’t exist, does that mean that you are incredibly boring? The closest thing to hallucinating that I have come close to is smelling a fart that noone will own up to, and I am starting to worry that I am either abnormal, or just incredibly boring.
March 17th, 2007 at 5:13 am
A dead giveaway to it being a hallucination is that a guy who got a significant amount of muscle removed from his leg can walk quite normally and with easy (let alone climb the stairs).
March 22nd, 2007 at 6:36 pm
Great site. I enjoy the even-handed treatment and medical review of all the episodes; I think it’s amazing (and wonderful) that someone takes the time to do this consistently for so long. A few comments about this episode, and the show in general.
Someone asked about the symbols on the improvised dry erase board near the end of the episode. They are logical predicates, but like the rest of the episode, they seem jumbled to me. Roughly speaking (and I’m guessing based on his hand movements on some of these), they seem to say
equiv P or Q or S
K implies Ta or Va or Ya
Tb or Vb or Yb
not P and S
therefore not S
therefore emptyset
Presumably, House is proving logically that nothing makes sense, that his hallucination world is inconsistent, but it’s certainly not obvious to me how the above lines say that (or indeed what they even mean, for the most part). You can sort of see how the last couple of lines might say that, but the lines before that are mostly opaque. There are logical systems dealing with rational belief where Tb, Fb (not Vb), and Yb refer to belief in b’s truth, belief in b’s falsity, and lack of belief either way, respectively; someone might have pointed Laurie to some expressions along those lines, but they don’t look coherent to me.
The whole issue of logical consistency intrigues me with respect to House (and other nominally science/techie drama shows). I recognize that the medicine, or mathematics (Numbers), or forensic science (CSI whatever) is sometimes faulty. In most cases (as with House), I don’t know enough for it to bother me. But even with Numbers (closer to my field), where I *do* recognize the flaws (usually that the theory is applied over-broadly with insufficient training data), it doesn’t bother me too much, because what’s important to me as a viewer is that the show be logically consistent, even if the underlying assumptions are not valid in the real world. So, here, even though I know it’s unrealistic for the YG to do every last test, or for tests to come back negative in two hours, that doesn’t disrupt my enjoyment of the show in the least because the show is consistent–it’s just that testing in the show doesn’t map directly onto testing in the real world. It’s just a (nearly) weekly hallucination–and an enjoyable one.
Certain concessions have to be made in order for the shows to be both self-contained and roughly synchronous with real time. Holiday shows happen in December; Valentine’s shows happen in February. The rule of Blackpoleon Blackaparte lasted about a month both in real time and on the show. If coma patients didn’t recover unrealistically fast, there would be a lot of “two weeks later” epilogues, and that would get tiresome. It would make pacing of character development arcs pretty difficult, I think.
That’s not to say that none of the medical goofs are fair game. It’s perfectly useful to observe that a given condition could have been ruled out in such-and-such a simple way, so as to make the succeeding train of medical thought more supportable. But once a discrepancy between the House world and the real world occurs many times, I think it’s time to accept that it’s intended to be there. They clearly don’t mean to use the word “addiction” the way that I usually understand it; they use it to mean “dependency,” and that’s the way I hear it now.
What I like about this episode, and what I think it does even better than Three Stories (another favorite, by the way), is that you get to go back over the show and figure out what each of the different scenes tells you about House. I mean, when you watch it the first time (most of you, not the real sharp ones who caught onto the ruse right away), you might think, is House suddenly repentant when he finds out that he indirectly led this woman to commit suicide? It’s only after the show is revealed to be mostly a hallucination that you realize that the woman (even if the guy is married) is a figment of House’s imagination, that he never told his wife (if any) that he had an affair, and so this is something that weighs on him generally. Even if he comes out of it and tells the hallucinatee (who was right after all, about being a hallucinatee!) that he’s full of crap, we know better because he still thought about it during the hallucination. This kind of thing would be difficult to express any other way: He’s not going to reveal it to anyone else, and he has no reason to talk about it out loud when he’s alone. Acting out his subconscious, for lack of a better phrase, is as close to his head as we’re going to get through TV. (In a book, it would be different, of course.)
Another aspect of House that comes out, aside from the obvious preference for the mental over the physical, is his “Rubik’s complex”: He’s not satisfied with the mundane, he doesn’t feel alive unless he’s mystified, so with the tongue patient that we eventually realize is mostly made up, House’s brain keeps on inventing reasons not to figure out what the patient’s problem is. The tests always come back negative (”force of habit”) because otherwise, the problem would be solved. It’s not even that he has to solve the puzzle, it’s that he’ll torture a good puzzle out, even if there doesn’t seem to be one to begin with. Ultimately, House himself is the patient, diagnosing himself as having hallucinated the last few days, and I have to wonder whether he figured it out while looking at the dry erase board and the symbols on it, saying to himself, “I’m not a logician! This is totally screwed up!”
Well, maybe not, but the episode certainly was substantial food for thought.
March 22nd, 2007 at 6:45 pm
P.S. When House said, “I’m *almost* always *eventually* right. You have no way of knowing when ‘eventually’ is,” I was thinking to myself, sure we do. It’s about ten minutes before the end of the episode.
March 24th, 2007 at 2:15 pm
I loved this episode. It could have been a disappointment but, because of the way it was written, it was a nice insight into House’s mind. My only nitpick was, why did the team and EMTs drag House down four floors without any oxygen or monitoring?
April 6th, 2007 at 2:31 pm
house really is amazing and this episode is the best ever it cannot disapoint, even if you dont like house!!
April 8th, 2007 at 7:04 pm
Just one thought… I don’t really agree there was no diagnosis. OK, there was no diagnosis of the swollen tongue (which was real, pre-hallucination) but effectively, during his brief spell of unconsciousness, House diagnoses himself – and recommends the ketomaine-as-anaesthetic as he is being wheeled into surgery.
This treatment, we find out in the third series, has (at least for a few episodes) does in reality “cure” his bad leg. House heals himself.
(Apologies if this point has already been discussed. I didn’t read the preceding 60-odd posts.)
April 20th, 2007 at 8:59 pm
There arguably shouldn’t need to be a diagnosis of the guy, not by House anyway; he just took the guy’s case because it was fun to listen to him speak, like the way he told Cuddy “You had me at “teenage supermodel”,” except that he took Alex’s case out of what seems to have been an opportunity to hang around a teenage supermodel. It only became a medical puzzle in the hallucination.
Also, I think the bit with Moriarty telling House he admitted infidelity to him was basically either that House-playing-Moriarty was hinting that this is a hallucination or that House considers his team to be a part of him: He was reluctant to fire one of his team, just like he was extremely reluctant to lose his leg. Either that or he was talking about Cameron
My personal favourite part of the episode was when they cut from the House’s room to the stairs as if they edited out walking through the corridors and then House asks how he got there: Way to mess with our perception of real time. I wonder if after that happened, House found out how to will himself to places and was including that in his logic: They did the tests he ordered during what was definitely a hallucination, therefore this is one too and I can teleport to the OR just in time to defeat the boss and exit the level.
I wonder what would’ve happened if House didn’t kill the patient: Would he have snapped out of it anyway or would he have been trapped for a week dealing with more bizarre symptoms from the tongue guy?
PS: I think it would be fun to have a science-fiction version of House: There’d be less trounble doing mundane things such as diagnosing MS but it would be fun to see what new diseases they could invent, or even alien patients (Diplomats? Captured-and-suicided-to-prevent-interrogation spies? Random not-previously-encountered crashlandees?) the government forces them to diagnose. At least with the aliens we could see simple problems because how do you treat an alien for a cold, although it would be funny to have House working out the previous doctor nerve-gassed a patient by prescribing a vitamin:
Dr: “I nerve-gassed him? That’s ridiculous!”
House: “In the 2219 Terran-Kilrathian war the Kilrathians had a really bad reputation because they ensured their PoWs had a good supply of vitamin F, which transpired to also be known as VX gas.”
May 27th, 2007 at 6:16 am
This episode scared the shit out of me. For the past few months I’ve been battling psychological trauma. I’ve been trying to prove that I am not hallucinating after having a *very* bad trip on a strong dissociative (Salvia). Despite only taking it once, I’ve relapsed into a Salvia trip multiple times since I took it.
I have two problems with it’s realism:
* It didn’t accurately portray the fear that someone trying to figure out if they were hallucinating or not would feel.
* No amount of logic used while hallucinating can ever prove you are or are not hallucinating. If there was some logic that could be used, I wouldn’t be struggling with Salvia 3 months later.
June 7th, 2007 at 8:34 am
hey there…
… i also love this episode. for the same reasons as
the other ones, wo said they do, do. realy love it.
i kind of figured it out befor house did, but i
can’t tell where… it just came to me slowly.
i won’t say more, ’cause it will just sound
like repeating for you readers, you know.
and did i get it right that the Ketamine really helps
house with his pain for a few episodes (but that
he will still limp and be the same) and
then he has to go back to vicodin?
i’m german and will have to wait till autumn
to see season 3 (at least if i don’t want
to spend lots of money to get the dvd’s
from us), so i’m reall excited. ;)
June 21st, 2007 at 10:44 pm
Didn’t get the chance to read all 72 posts, so sorry if I’m stepping on anyone’s toes here, but: Who got the first hint that this was all a hallucination?
Moriarty opens the episode not knowing what House looks like.
In his backstory exposition to House, he explains that he told House he’d had an affair.
Either he was blindfolded, the writers need to keep tracck of their hallucination plotlines better…or it was just an easter-egg for the over-analytical amongst us, to tip us off.
July 6th, 2007 at 1:18 am
Forgive me if I’ve forgotten that Moriarty mentioned that he talked to House before in person, but isn’t it possible that they talked over the phone?
July 6th, 2007 at 1:19 am
Sorry, I should’ve phrased that better. I meant “.. forgotten IF Moriarty mentioned..”
July 6th, 2007 at 5:15 pm
Why do many here think it is a case of either House being a junkie, or taking the meds only for pain? Last time I checked, humans where complex beings and their motivations are often based on many factors. The fact that he has a legit use for the meds gives him a good excuse to also use them to block out some issues he has.
July 9th, 2007 at 11:24 pm
I agree with Justin, especially since several episodes have pointed to the possibility that his pain is not 100% physical.
July 20th, 2007 at 9:47 am
Could anybody tell me why House thought that killing the patient can help him get rid of the hallucination? I can’t see the connection. please reply to my email: wudeg(at)tom.com
July 27th, 2007 at 9:41 am
One thing that hasn’t been brought up is when they are outside the Taco stand and House throws some theories out and the kids don’t respond he says’ Fine, ill just impersonate all of you’ or something to that effect. And from that moment on, the kids start to respond. Didn’t get me at the time, but that’s probably the first major giveaway of the fact that its all in House’s head. A great episode i thought, and one i want to go and watch again right away
September 2nd, 2007 at 2:30 pm
@Mani:
The funny thing is, that part (Moriarty asking who House was) was not in the hallucination! The strange thing about the episode is that (a) there was no solution to the ‘main case’ (which also was real), and (b) we don’t get to know why House was shot. He thinks he was shot because he told the wilfe about the affair and she then commited suicide, but this is not certain.
Otherwise, I found the episode very confusing and perhaps the worst I’ve seen yet.
September 17th, 2007 at 2:18 pm
Peter…
I was pointing out that what little knowledge we get before he is shot, contradicts the further elaboration we get during the hallucinations: Real-world Moriarty obviously did not know what House looked like. In the Hallucinations, Moriarty explains that he told House about his affair. The two are virtually irreconcilable.
As for the “main case,” in the real world, it never progresses beyond “He has a swollen tongue and House makes fun of him” in that episode. There isn’t really a “main case” in that episode – the hallucinated version of Harpo’s illness is a bunch of subconscious gibberish in House’s head.
And Moriarty’s last lines at the end of the teaser give us enough as to why he shot House – how many people has House done absolutely outrageous things to? Is it that much of a stretch that someone would snap and decide to violently reciprocate?
December 7th, 2007 at 8:34 pm
It was all psychological. House’s subconscious was dramatizing the eternal fierce fight he wages to stay emotionally detached and in total control mentally . . . with possible side effects being guilt (the suicide) and extreme stress from repressed urges, sexual (exploding genitals), emotional/erotic when a mechanical arm does a better job than a human could. And even the ducklings that he constantly berates can’t be trusted because they’ve become subjugated. Maybe too far. Maybe he’s gone too far in mastering himself, can’t see the more tender parts of himself that he really needs to hear from sometimes. Out of “balance.”
He struggles to survive, for him that basically means mentally, but the turning points are his apology (possibly to his shadow side, Jungianly speaking), and “spilling his guts” so that the bullet falls out. And in this mirror world he’s not a cripple, but agile and not in pain. But his knowledge gets shaky. Is he afraid he’d have to trade all his competence, and proud identity as a doctor, to have his human needs nourished at all?
Can’t wait to rent the next one!!
December 14th, 2007 at 3:23 pm
After reading all the above posts (I have too much free time), I find I still have some questions and comments. Some people have kind of hinted at it, but I want to ask plainly: Would the ketamine treatment have been anything like anesthesia awareness? Does the brain record the events? What about PTSD? ** SEASON 3 SPOILERS: When they do discuss it, it seems to be treated exactly like any normal surgery, other than the reboot of the CNS. **
Anonymous (58): Are you color-blind, or does the green text not stand out enough? In fairness, maybe that feature wasn’t implemented when this page was at its peak. I’m a year late or whatever, but I’m still annoyed. You have power over people, go into politics.
Matthew Goldfinch(70): Grats on working in a “Wing Commander” reference. Not easy any day.
Bradon(71): Here’s the bottom line: We exist in an interpretive reality, which means that we can not guarantee that others will see, hear, experience, or do the same things that we do. It sucks that you’re losing your mind. I’m watching my mother go through it… It may be my fate. But all I can say is enjoy the reality you have, instead of wondering if someone else’s is better or more “realer”.
BTW:I tried that salvia looking for a legal alternative to pot. Green, flakey product you smoked or ate. I used it as a “snowcap” on pot. Weird high, like… annoying, almost. Tingly, almost painful buzz in my extremities, racing thoughts and slight burning in my brain.
I didn’t experience any long-term side effects, but 1) I had a friend along for the ride, and 2) I had no expectations of psychological side effects, having poorly researched the product beforehand.
It’s a shame that poisons like this are legal while we go to jail if we get caught smoking pot (a plant that actually produces an enjoyable, long-lasting buzz with almost no ill effects). Would you wait in a dark alley to pay a hundred dollars for an ounce of lettuce? Or let police officers and prisons treat your son’s bi-polar disorder or heart arrhythmia?
To attack your point and not your position, however, I must say that House wasn’t afraid of hallucinating. He is so distanced from the physical that it honestly didn’t matter. He had good-tasting food that filled his appetite, he had puzzles to play with… it was *almost* good enough for him to stay.
Because House wasn’t experiencing a long-term battle with sanity, he was experiencing the immediate after-effects of his brain trying to process what had just happened. He needed that little dream to come to the realization that he was worth saving, that House was the patient again, and he had a chance to do better for “House-of-the-future” than “House-of-the-past” had done for him. Physician, heal thyself, or whatever.
Look at how it changed him when he woke up. His first reaction, in the dream, unchanged, is that he doesn’t care. Doesn’t even want to know. Because he can’t process it yet. It’s only after he goes through his psyche, sees the choice in front of him: his brain or his body… It’s only then that he realizes he really does care what happens.
And for what it’s worth, he chooses pain-free and agile. Whether he did it to save Cuddy from her inevitable choice or because he’d actually prefer to be pain-free and useless is something for later episodes to unravel.
Zowie(72): First: Think about it. Moriarty probably told Cameron that he had an affair, after all he immediately recognized her. House probably *loved* making Cameron tell his wife about it, too, after rubbing her nose in how imperfect the couple was. When has House ever concerned himself with the consensual activity of legal adults without his immediate benefit or gratification? (In other words, House never worries about fun other people are having, but he can’t.) And Moriarty, at least the dream version who made the statement, is smart enough to know who’s really in charge.
Second: As Peter(80) said, Moriarty in the real-world doesn’t recognize House. All the exposition about the wife is in the dream-state, which could just be what House’s mind concocted to fill in the blanks.
Justin(76): House *loves* getting high, *and* he suffers from extreme pain. If he wasn’t in it for the buzz, he wouldn’t drink, crush pills, ect. That doesn’t mean he doesn’t need the pills, whether it’s pain or psychological, because it’s both.
Oh, Mark(9): New Age references to “toxins” are usually spiritual in nature. You use incense to cleanse the “toxins” (sometimes “bioenergetic toxins” or “weight-loss inhibiting toxins”) in your chi, or whatever, though this is a *gross over-simplification* which is not intended to be offensive.
Sometimes, new age “medicine” steals a page from the medical journals and you end up with citrines helping with food disorders, or they steal a page from the Bible and you get attunement to intelligent energies. Mostly it’s just studying iris pigmentation maps and hoping your ear candles don’t burn your hair.
Here’s a quick test, say “Om Namah Shivaya”.
Feel anything?
I didn’t think so. (That just means, “I honor the inner self” and it’s supposed to be a sacred utterance of sound.)
When they refer to “toxins” on House, they mean radon, carbon monoxide, most pesticides, ect. Again, this is a deliberate over-simplification of the sincere beliefs of millions of people, and not a deliberate attempt to offend.
Finally: “2054… I’ll be caught up in 2054. You better love this cousin a whole lot.”
December 19th, 2007 at 9:19 pm
Two things:
First, the episode. I think I would have found it much more entertaining if I hadn’t began to suspect it was a hallucination very early. The moment the shooter was wheeled into the same room as House without a police escort I started to have doubts.
Second, in response to Scott’s comment, “If this was House’s hallucination and it was showing things that he didn’t want to face consciously, does that mean that he does want to undress Cameron?”
Of course. Seriously, who wouldn’t?
December 21st, 2007 at 4:17 pm
I’ve just watched it (late bloomer, sorry), and I think they could have gone WAY further with the dream sequency storyline. Make it _really_ screwed up, push him even further. Without the visual goreyness, more mental scariness.
But then, that was always the main point that bothered me about the House storylines: They don’t follow the small, good ideas on the side all the way through.
(about the “what’s bugging me” statement: If I didn’t love the show, I wouldn’t be posting here, so I’m not gonna state how much I love it.)
About Laurie’s rumoured back pains from the cane… I don’t have any medical knowledge apart from your usual “if you cut yourself, put a plaster on it” etc., but I was pondering if faking a limp for 4×24 episodes of a telly series, ie. for quite a big amount of time, wouldn’t have some unpleasant side effects. So it sounds plausible to me.
And WHY does House want ketamine, if he knows it might screw up his mind?
January 13th, 2008 at 3:15 am
ugh. what’s with the “date rape drug” garbage? the oral dose required for anything near complete anesthesia is huge, it tastes terrible, and the effects are noticable before they become incapacitating. so are rapists carrying around syringes full of ketamine these days and somehow getting IV access before their victim notices? because there’s no problem remembering IM administration, and everything before IV use can be recalled, up until it’s actually in the blood. see “Trends in the use of alcohol and other drugs in cases of sexual assault” by I Hindmarch and R Brinkmann (1999) regarding “date rape” drugs in general.
February 21st, 2008 at 10:09 am
gimme the ketamine instead!
April 6th, 2008 at 11:56 pm
One aspect of the House/Holmes connection that the writers have neglected to exploit thus far has been Holmes’ expertise at disguise. It would be marvellous to have House experiment with disguise in his efforts to extract information, and would take full advantage of Hugh Laurie’s wonderful talents.
May 13th, 2008 at 8:49 am
I love these reviews, but agree with dan on the Ketamine as date-rape drug issue. I find it disappointing that Scott regurgitated prohibitionist propaganda like that, read some actual research on the subject. Alcohol is and will continue to be by far the most popular date-rape drug. Ketamine is highly unlikely as a candidate unless a person willingly induces a k-hole and is then taken advantage of. Even in that case, you generally don’t get amnesia unless the dose is excessive so it would be remembered.
May 20th, 2008 at 11:21 am
I do not think the first green passage is about reality. I think House shot himself we a gun he had in his table and had had used on a corps some eps ago.
July 20th, 2008 at 10:51 pm
I actually liked this better than the usual “this is all a dream” plotline. I thought it was rather Cartesian, particularly the issue of “how can one separate the real from the unreal”. In previous episodes, we’ve seen House drinking and using LSD. I believe one of the criteria Descartes used was internal consistency. His examples of “things we think are real that later turn out to not be” were dreaming and being drunk.
January 9th, 2009 at 3:27 am
By the way, the writers deliberately put medical errors in this episode to hint that it was a dream. For example, Foreman says at one point that the bladder drains into the ureter! Surprised and a little alarmed you didn’t mention any of those.
February 17th, 2009 at 3:08 am
To Abeer, who wrote, “House writing on that transparent board, it did not make any sense to me, looked like some kind of a chemical equation. Was it completely random or did it make any sense?”
I realize this is probably too late for Abeer to read this, but in case anyone else was wondering, House was writing out propositional logic equations. He wrote out the chain of events of the episode, using shorthand in the logic equations, and that’s when he realized, “This does not make sense…” and then he stormed into the OR and “killed” the patient to end his hallucination.
I’m a med student who took a logic course in undergrad to fulfill my humanities requirement. :-D
May 11th, 2009 at 3:46 am
I know this question is really late… But why DID the shooter shoot House? Is it ever revealed? I’ve reached Season 5 now, and this question still eludes me.
The only explanation given was, as far as I can remember, in THIS episode, where he says he shot house because he drove his wife to suicide…
But that very clearly is part of the hallucination… House reaching into his subconscious to try and reason it out… he basically concocts a situation where he acts like a jerk… which should be easy.
But then this explanation does not tally… Cos the shooter had to ask who House was before he shot him. Also, he says he was a former patient, not that his wife was. And this happened in the pre-hallucination real world. This is all I know. Any trailing clues left in subsequent seasons?
May 23rd, 2009 at 1:36 pm
What I found weird is that in this episode and the next, House’s leg is fully restored. How? Doesn’t he lack a whole leg muscle or am I imagening things?
I thought Houses condition was more than just a matter of chronic pain, but also a lack of actual important bits.
July 23rd, 2009 at 3:16 pm
My friend, great site. I’m going through all your reviews. And allow me to say: who doesn’t want to undress Cameron…??
August 3rd, 2009 at 10:11 am
mike. how can you WASTE your time reading this blod (reviews) but not watch the show? you are indeed useless.
September 21st, 2009 at 10:14 am
I’ve just seen the episode, and think that’s no contradiction between the fact that Moriarty didn’t know who was House and the explanation that the wife killed herself because of a revelation made by House.
House never went to know the patient, who actually was Moriarty. He got the infidelity’s information from his team, and he told that to the wife, in a conversation exactly that he had in the hallucination (4 marries 4…)
September 22nd, 2009 at 6:52 pm
luis–
I also didn’t think there was a contradiction there, but for a different reason.
He asked who House was, and when he said it was Cameron, he said he knew her, and that his wife was a patient. I personally thought the asking who House was was so that he could get in the room and a bit closer. Give House a little more time to know what was going on (and therefore suffer more, theoretically) rather than shooting him before he had any idea of what was happening or who the guy was.
I couldn’t help but wonder myself, if the guy even shot House because his wife killed herself, or if his reasoning was what House predicted in the beginning, since it was all a hallucination.
I didn’t really understand why he would say that he wanted the ketamine, if there was a chance he would lose his mind. Especially since there most likely wasn’t any reason to give him ketamine at all, since he hallucinated the information from Germany.
Overall, I was disappointed in the episode, and disappointed that the writers apparently like to end seasons with hallucinatory episodes.
January 16th, 2010 at 5:18 am
To what Michelle said (a long time ago, I know) — House hallucinated that *Cuddy* told him about the ketamine, but actually he had heard about it before and his subconscious was “sending the message” that it was a good occasion to try it. That’s how I interpreted it anyway.
Leave a Reply
Contact Me
About
Subscribe:
The Best Of...
Special Topics
Archives
Categories
Twitter
Comic Blogs
Medical/Science Blogs
Currently Reading
Arbitrarily Interesting Medical Condition
Syndrome
The Net:
Contents may have settled during shipping. Past results are no guarantee of future performance. No animals were harmed during the production of this product. Void where prohibited by law. All rights reserved. Not valid with other offers or specials. Professional driver on a closed track. Your financial institution may impose other fees. All models are over 18 years of age. Employees must wash hands before returning to work. Results not typical. Many suitcases look alike. 18% gratuity added to tables of six or more.
Do not taunt Happy Fun Ball.
© 2004-2010 Polite Dissent. Powered by WordPress