House – Episode 2 (Season Three): “Cane and Able”
While the ultimate solution was clever, I felt the medicine was poor over all and a step back from last week’s show — medically, at least. Medical explanations and spoilers follow.
A seven year-old boy named Clancy has repeated nightmares that he is being abducted by aliens. One morning, his parents find him unconscious in the yard, his pajamas soiled from rectal bleeding. Clancy is brought to the hospital and placed under the care of House and team. Other than the hallucinations, Clancy’s only medical history is that he was conceived by in vitro fertilization (IVF), wears glasses for poor vision, and broke his arm when he was four. The team’s first thought is sexual abuse and the “alien abduction” story is just his way of coping with it, but no evidence was found on exam of sexual abuse. The team also thinks that he might have a bleeding disorder and that would explain the rectal bleeding. Foreman (as always) suspects a neurological cause while House suspects the alien hallucinations are nothing more than nightmares. Coagulation studies to look for a bleeding disorder are ordered, as are an EGD and a colonoscopy to look for sources of gastrointestinal bleeding.
The EGD and colonoscopy are all normal, as are the coagulation studies including a bleeding time (an old fashioned test rarely used any more) run by Chase. When Foreman repeats the test, it is abnormal and shows a bleeding disorder.
That night, Clancy runs away from his hospital room and Chase finds him in the bathroom, cutting into the back of his own neck to dig out the alien chip that he thinks is there. There is a small piece of titanium there — but Chase also notices that despite the improvised surgery, Clancy is not bleeding abnormally, so maybe Chase’s test was correct after all. The small piece of titanium is thought to come from a surgical pin used to fix Clancy’s broken arm several years before.
Chase returns to draw more blood and Clancy starts to hallucinate the Chase is an alien. He goes into a hypertensive crisis (a dangerously high blood pressure) and develops pulmonary edema (fluid building up in his lungs). Chase starts him on oxygen and sodium nitroprusside, a strong medication to bring the blood pressure down. About this time one of the blood tests shows that Clancy seems to have von Willebrand’s disease, a clotting disorder. To determine why Clancy went into a hypertensive crisis, a transesophageal echocardiogram is obtained (an ultrasound of the heart shot from inside the throat. It gives a better view of the heart valves than a normal echocardiogram) and it looks normal at first. However, when House puts it on a larger screen he notices a small area of the heart that is not beating. These abnormal myocytes (muscle cells) are removed. The Young Guns (for some reason) DNA type these abnormal cells and notice that they have different DNA than Clancy’s normal cells. Different theories are discussed about why parts of Clancy would have abnormal DNA — you’ll notice that the team is mentioning things that can mutate DNA one or two genes at a time, but not cause the wholesale difference in DNA noted here. Cameron concocts a marker for these abnormal cells and injects this marker into Clancy’s body. Hot spots in the thigh bone marrow, heart, and retina appear. The team decides the bone marrow cells are to blame for the bleeding disorder, the heart cells for the hypertensive crisis, and the retinal cells for Clancy’s poor vision. All of the abnormal cells are removed.
A short time later, Clancy suffers a hallucination and seizure. House is convinced that there must be another focus of abnormal cells in Clancy’s brain, but the marker tests didn’t show any hot spots, even when they injected directly into the cerebrospinal fluid. House suggests that the marker must not work on these abnormal brain cells so he decides to perform brain surgery. Once Clancy’s brain is exposed, House will stimulate a hallucination so he can determine which area in the brain is abnormal and then remove those cells. The surgery — despite the fact that House is not a neurosurgeon — is successful. The ultimate diagnosis is that Clancy is a chimera, which means that he is a combination of two cell lines. In other words, when he was just a tiny embryo, he merged with a twin’s embryo and all that remains of his genetically different twin were those few isolated areas of abnormal (and now removed) cells.
First, the good:
- Chimeras are real. Some experts suspect that they are more common than we realize because only rarely do we test cells for DNA. The in-vitro fertilization aspect seen in this epidose is really just a red herring as chimerism has nothing to do with IVF and chimerism can occur with non-IVF embryos just as easily.
- Chimerism does pop up in the news now and again. American pro cyclist Tyler Hamilton was banned from competitive cycling last year on suspicion of blood doping (blood cells that weren’t his were found in his blood sample). His defense is that he is really a chimera and this is a normal blood test for him.
Now the bad:
- VonWillebrand’s disease is a clotting disorder caused by the lack of a protein known as the von Willebrand factor (or by an abnormal version of this protein). If only one small portion of Clancy’s bone marrow is producing platelets with missing vWF (or with abnormal vWF), it is doubtful that would be enough to affect his bleeding at all. At most, it might extend his bleeding time a few seconds; it certainly wouldn’t cause intermittent clotting problems because the abnormal platelets are always circulating throughout the entire body.
- Human DNA codes for over 25,000 different genes. How is Cameron going to know which of these are producing proteins different from Clancy’s, let alone happen to be proteins conveniently located on the cell wall? Not to mention that she is able to produce this miraculous cell marker overnight.
- That’s a mighty clear echocardiogram. Furthermore, increasing the size of the screen doesn’t increase the resolution — that remains the same — you just get bigger and blockier pixels.
- I know some of you think that I complain too much about the Young Guns performing tests they’re not trained to do (like the transesophageal echo this episode), but even you have to admit that House performing brain surgery was beyond the pale.
The character interaction and soap opera was better this week and didn’t feel as clumsy as the season premiere. Both Wilson and Foreman were taking their digs against House, though both knew he was right. Cuddy hemmed and hawed and finally told House the truth. Of course, House’s leg pain seems to be coming back – but is it real or all in his mind. (And don’t ask me about the PET scan of the thalamus Cuddy wants to do. The thalamus is involved in pain reception, but the tests aren’t nearly as clear cut as she would like. Plus they’re damned expensive.)
I give the medical mystery a B and the ultimate solution a B+ for being clever and not too uncommon. On the other hand, I give the medicine it took to reach the solution a miserable D. The soap opera earns a B+ this week because it was much better than last week.
The previous House review
A list of all prior House reviews
September 12th, 2006 at 10:45 pm
I would have liked this episode better if I didn’t recall chimerism from the episode of CSI a couple of years ago. I was able to figure the solution out far too early.
September 12th, 2006 at 11:02 pm
Did you catch the tiny Blackadder reference when Cameron demands Cuddy and Wilson to come up with “a cunning plan” about dealing with House? I mean, that had to be a Blackadder reference, right?
September 12th, 2006 at 11:02 pm
I just wanna say that I CALLED IT. The half way through the show when I saw that he had 2 types of DNA I remembered something from CSI about some guy who had chimeras disease and had 2 types of DNA. The symptoms were really different throughout the rest of th showbut I had a nagging feeling. WOOT. and other then the 2 types of DNA I know nothing about it
September 12th, 2006 at 11:18 pm
Oops. Forgot a name and mail the first time, having to recreate this. (I started writing in IE, but the page does not display correctly so I switched to Firefox)
Not a doc, but I completely agree with the review. Even to me, a computer programmer, it felt like they were determined to force everything to scream “aliens.” This might have made the show more exciting to people who watch House wishing it was XFiles, but unlike Chase I assumed from the begining that aliens were not involved, no matter what “evidence” they threw at me. And the pin..
Since you didn’t comment, I guess I was right that the “drifting pin” idea was possible; I thought I’d about something like that but couldn’t remember where/when – either Scientific American or This Year’s Best Sci-Fi. Possible or not, it seems mighty convenient for a kid who halucinates alien abductions to have a steel pin from their arm somehow drift to their neck. Plus, wasn’t the pin a bit large? It seemed like a major obstruction, and I’d think any obstruction in an artery in the neck would be a big deal. Verdict on that, Doc?
Character-wise, though, with only one exception I thought this episode was excellent. The one exception is Chase – his willingness to believe the kid had been abducted didn’t agree with me. Plus, what was with the “Yo mamma is so fat…” bit? Does the writer of this week’s episode just not like Chase or something? Everyone else was developed well, I thought. week’s episode just not like Chase or something? Everyone else was developed well, I thought, though. Foreman didn’t shine much, but his reaction after Cameron let him in on the secret was very revealing… no moral concern, just joins Wilson in tormenting House with his “mistake.” Cameron is really starting to shine; her new confidence is showing in her work (even if the medicine they wrote to demonstrate it was a bit out there). I like her new hair – it fits her new confidence.
And Wilson… I never trusted Wilson, even in season 1 when he hadn’t given much overt reason for it. His “indescretion” last season with his cancer patient finally gave me cause, and his behavior now is the last nail in the coffin. Even if he’s right about House, he’s lying about his reasons. He’s not doing it because it’s best for House, he’s doing it because he wants to be able to knock House down a peg so he can feel superior. The proof is the way he flaunted House’s “mistake” in every argument. So I hate him, but that’s good character development.
What House is has been clear since the pilot: he has an incredible (even impossible) intuition for medicine and diagnosis. Whether this is possible in real life or not, that’s what the character is, and Wilson and Cuddy know it or they wouldn’t have risked their jobs and given up $100Mil at the end of season 1 to save him. So if you take away his confidence, you might as well take away his liscense altogether, because despite what they said last week, he never has conclusive evidence to prove his theories until after he comes up with them, and without proof, his confidence in his innate ability is all he’s got.
Re: Dr. House, Neurosurgeon… yeah, that’s pushing it even for me. Without even an observer, just him and the young guns? I’ll forgive it, though, because it was too cool a scene to happen off-screen. Almost makes me want to have brain surgery, just to see what it feels like to have my brain stimulated directly by electrodes…
September 12th, 2006 at 11:18 pm
Normally, the whole young guns running tests doesn’t bother me, but you are absolutely right, House performing brain surgery was just dumb. How is it he knows enough about every single field of medicine except oncology, which is conveniently the specialty of
Watsonhis buddy?The part that I really liked was Forman “playing house” when he was analyzing Chase.
September 12th, 2006 at 11:19 pm
Oh, almost forgot my prediction: Despite Cuddy’s denials, House is right; she is pregnant.
September 12th, 2006 at 11:34 pm
I still don’t understand how the titanium got in his neck.
September 12th, 2006 at 11:54 pm
Yeah — the titanium thing is bugging me too.
September 12th, 2006 at 11:57 pm
By the way, isn’t Foreman a REAL neurosurgeon? Why didn’t he just do it?
September 12th, 2006 at 11:57 pm
good site, great writeups and links to more information scott.
yea, the lack of other people doing normally specialized tasks is obviously inaccurate, my gf and i joke that each of them have had over 100 yrs of medical training to have the expertise in all the subspecialties that they are portrayed to have. cardiac caths, electrophysiology, mris, cts, various pathology tests including even routine labs, etc. neurosurgery definately takes the cake…but it is entertaining, and for tv, what can ya do, it has more effect for a main character to come to a conclusion rather than a close up of some lab tech coming up with the findings. there are MANY nitpicks and little things wrong here and there (another is the rediculously high success rate of codes and lack of neurologic deficits thereafter), but for a tv show, house ‘dumbs things down’ much less than most other medical shows, which is nice.
also in regards to the prior episode, the vicodin es script also lacked the obviously required disp and sig. new jersey also appears to have instituted a standardized state prescription like the one here in new york also, which would make the pad completely inaccurate.
September 13th, 2006 at 12:00 am
john – foreman’s supposedly a neurologist, not a neurosurgeon, but in the house universe, maybe he should have done the surgery ;)
September 13th, 2006 at 12:08 am
Hey… uh, well, I’ve been reading your reviews for awhile now… I’m in college right now, planning to go into pre-med and become a doctor, and House is one of my favourite shows, so this kind of place was paradise for me.
Although I wanted to refrain from commenting because I am so young, I have to say that unlike others here, my father and I BOTH called it. I didn’t really like the solution in this episode, it seemed the fun was taken out of it right during the part when they showed the two separate DNA and my dad goes, “OH, I KNOW, IT”S CHIMERISM!” And I was like “OOHHH YEAH”, because I had seen an hour long documentary on it on Discover Health a year ago or so… It was also on CSI which seemed like they were repeating some kind of plot cliche… but that’s just me.
Good point about House doing the brain surgery. That seemed a little odd. Also it seemed odd to me how they had his brain exposed. My dad has a PHD in psychology and for a little little while I wanted to be a neurologist or a neurosurgeon, and I had watched his tapes of brain surgeries before… it seemed too much of it was exposed, I thought it was more selected in its exposure, as I assume for some sort of health reasons? Well, I’m not the doctor, but the amount it was exposed seemed odd. It seemed like the entire top of his head was taken off.
September 13th, 2006 at 12:09 am
I also have to say I cannot type… *that LIKE others here. ):
September 13th, 2006 at 12:54 am
Discovery Health Channel had a wonderful documentary on chimerism about a year ago, titled “I Am My Own Twin.” Just in case anyone was interested in the subject.
September 13th, 2006 at 1:03 am
I actually like the drama last week better and I find when the show focuses only on one patient it tends to lag a bit. I think overall this episode tried to bite off more than it could chew and in the end did all things, drama, med, diagnosis, sub par. John: The titanium reached his neck through his body. Alien junk in your body is often moved around once disloged. There is a chance that this could have happened. in fact, I recently (about a month ago) read a story in the newspaper about a man who coughed up a bullet which had been lodged in his body over 40 years ago. It took 40 years, but eventually his body moved it and got rid of it. I can’t find the link now but Im almost positive it was a boingboing.net posting. Is titanium magnetic? If so, wouldn’t an mri have ripped it out of his skin at some point or did he not get one done before it was taken out?
September 13th, 2006 at 1:04 am
Evan: It had been taken out by that point, but titanium is not magnetic – which is why they use it for surgical pins in the first place.
September 13th, 2006 at 1:06 am
Hit post prematurely there… Evan: I think everyone agrees about all things medical, but I’m currious about your reasons for thinking the soap aspects were weak, would you elaborate?
September 13th, 2006 at 1:46 am
Thanks so much for your medical analyses! It’s always interesting to learn how much of the show is correct, especially in this age of medical and forensics TV where people tend to base their self-diagnoses on what they’ve been watching recently.
I, too, remember the CSI episode, but the first thing to pop into my head when I called the chimera diagnosis (the moment they realized there were 2 sets of DNA) was the character on South Park who had a dead fetus on her head. Funny that such a far-out show should be the basis of my thought process….
September 13th, 2006 at 2:04 am
What else then Chimeara or Mozaism could explain two types of DNA? I think the medical solution was clear the moment they got DNA results.
September 13th, 2006 at 9:20 am
I agree with Will about Chase. He was incredibly poorly written this episode. Him being so hugely credulous about the alien angle was irritating.
Oddly enough, I had a bleeding time test done by a hematologist about a year ago, so I didn’t think that was odd. I was actually pleased to see some medicine with which I was familiar.
I agree about House performing brain surgery. That’s just wrong. And I’m 100% sure that in the past, when patients have needed brain surgery, they’ve had a brain surgeon do it. Maybe someone else can recall a specific episode?
September 13th, 2006 at 10:09 am
Deborah- we’ve definately seen surgeons drilling into people’s brains many times (like the autopsy episode in season 2 or the paternity episode in season 1.)
I thought Chase’s lines were especially cheesy in this one as well. I know it’s inteneded, but I almost cringed so hard I bit my toungue when he did the “yo momma” joke. Also, I thought House ruled out Cuddy’s pregnancy and that his mentioning it was just to make her uncomfterble enough to stop asking him about his leg.
September 13th, 2006 at 10:36 am
About a year ago, I remember human-animal chimeras being in the news. Someone tried to patent the idea, not to use the process but to prevent others from using it. The patent was rejected. I presume this was the “seed” for both the CSI episode and this episode.
Re: this “twin” chimera, if two clumps of embryonic cells merged early on, wouldn’t the boy’s cells be roughly 50-50?
September 13th, 2006 at 11:31 am
I forgot to mention…GREAT title this time.
September 13th, 2006 at 11:48 am
Maybe House was just doing the brain testy-poky thing, and then they had an actual surgeon do the removal-of-the-bad-dna thing. I think there was supposed to be a time lapse during the period the kid saw those nifty CGI aliens. :)
September 13th, 2006 at 12:33 pm
Well, House did do the brain biopsy on Foreman in the first half of Euphoria.
September 13th, 2006 at 12:51 pm
OK, what I don’t know about the medical field I could just about squeeze into the Grand Canyon, so take that into account here… I’m probably just revealing my own ignorance, but I do love to learn.
I thought the drama remained excellent, but the medicine this episode just seemed a little crazy. I’m willing to accept that the titanium pin moved from the boy’s arm to his neck, but how, exactly, did the boy know where it was? I know the pin produced seemed a bit big, but would he be able to feel it? I’m assuming where it was was a noncritical place, because he didn’t die from it or anything.. or indeed suffer any kind of side effects whatsoever.
I’m also wondering how drastically different a chimeric twin’s DNA would be from its “host.” We’re talking twins, right? From the same parents?
September 13th, 2006 at 2:31 pm
I wondered about the kid knowing where the pin was too; At first I assumed he could feel it, but if that was the case Chase should have felt it when he checked at the begining, since he seemed to want to believe the kid’s story.
There may be arteries in the neck which wouldn’t be immediately life-threatening if blocked, but are there any that wouldn’t cause any symptoms at all?
Last comments/questions. on the pin: Unless I’m mistaken, it shouldn’t have looked metallic, but been coated in calcium deposits by the immune system. Also, if the pin had fragmented, presumably durring removal, wouldn’t they have noticed the piece they removed was broken, done an xray, and gone back for the fragment? It was in his elbow, after all, so I wouldn’t think removal would have been a sufficient risk to leave it, as is sometimes the case with bullet fragments. This is based on logic as much as medical knowledge; if I’m wrong, someone please correct me?
September 13th, 2006 at 4:18 pm
Any opinions on the Tyler Hamilton case?
September 13th, 2006 at 4:39 pm
seems to me that Chase didn’t seem to be taking the alien thing quite as seriously as you read into it. He looked fairly jocular to me as he discussed it. Although maybe it’s because Jesse Spencer sometimes seems incapable of NOT looking like a smartass.
September 13th, 2006 at 9:22 pm
I just started reading your reviews — thank you for the medical insight and for posting them!
I agree that the “young guns” seem to be too versatile… they’re doctors, surgeons, lab techs…. that and the fact they are, well, young.
I still don’t understand the migration of the titanium chip, this was never explained to my satisfaction
As for the immunological assay that Cameron uses… Since they needed a cell membrane antigen, maybe the two different cell types had different MHC class I markers… antibodies are readily available for most (but how fast they could be obtained and with an appropriate fluorophore is debatable). But the timeline, as per usual, is way too fast — but they need to keep up the suspense and drama, right??
I’m not familiar with this diagnostic procedure, presumably they have antibodies specific to different tumour cell antigens, but does anyone know what they use to tag them with?
September 13th, 2006 at 10:09 pm
Hi… I’m a new House fan and this is my first time reading your site, and first time commenting.
>I’m also wondering how drastically different a chimeric twin’s DNA would be from its
>”host.” We’re talking twins, right? From the same parents?
They’d be fraternal twins, which is to say, their DNA would be as different/similar as that of any two siblings. I imagine if identical twins merged, no one would ever know!
I also agree with everyone who said that House performing brain surgery was ridiculous.
September 13th, 2006 at 11:02 pm
Well, the leads doing everything is basic series TV logic- your protagonists (i.e. regular signed cast) do as much as possible themselves (it makes them look assertive and you save on hiring supporting cast). It’s the same reason why, on the various Star Trek series, you always have the commanding officer beaming down into dangerous situations along with other senior staff members.
September 14th, 2006 at 8:11 am
“…let alone happen to be proteins conveniently located on the cell wall?”
FYI, animal cells do not have cell walls. The term you were looking for is “cell membrane.” And yes, the “Cameron producing the ‘tag’” was , to me, the most ludicrous aspect of this awful episode.
September 14th, 2006 at 9:49 am
Evan Waters got there before I did. House and the Ducklings are going to perform all the tests and do all the surgeries for the same reason the CSI crew will not only collect and analyse evidence but also interrogate people and go along for the arrest – television producers don’t want huge casts. It’s better viewing (and cheaper) if the the Ducklings are all present for the surgery, rather than seeing other patients or sitting around drinking coffee while waiting for a team to page them.
September 14th, 2006 at 3:44 pm
since when to human cells have cell walls? i think you meant cell membrane.
September 14th, 2006 at 4:30 pm
I had no problem with the chimerism, but what I don’t accept is that chimerism should have led to the various problems listed. The “twin”’s cells would be perfectly capable of working within a sibling’s neuronal network, twin myocytes would contract normally, eyesight would be unaffected, and likewise they would produce normal, useable clotting factors (as would the host twin’s cells)… unless, in fact, the “twin” had separate defects to explain all of these conditions! That was one unhealthy little embryo. The only explanation for such far-reaching effects I could muster was a late onset immune response to the foreign MHC (or GvH for that matter), though that seems unlikely as 1. there was no sign of such a response, and 2. the foreign cells have been around since birth, apparently not hidden (based on their distribution), so there’s no reason to expect a response instead of tolerance, right?
September 14th, 2006 at 4:53 pm
Hey, you always have great medical reviews. I’m watching the scene again now when they are doing the “really cool” brain surgery and I was wondering how accurate was it. I know, I know that House is not a neurosurgeant and all the others wouldn’t be doing the surgeries in real life but I just want to know if people actally expose the brain like that to probes. I especially found it hard to believe when House was in sensory, the kid felt tickling in his feet. Thanks, and I hope to see your review for the next one. I know what you say about character episodes.
September 14th, 2006 at 5:03 pm
Sorry, I forgot to put something in my last (And actually first) entry. I agree that House performing the surgery is unrealistic (Although the show would be boring to me if the young guns asked other people to do the tests while they sit arund waiting) but this is not the first time House has pulled a stunt like this. Anyone remember “Euphoria, Part 1″?
September 14th, 2006 at 8:17 pm
Yes, but THE AMAZING PLANT-CHILD has cell walls! Beware THE AMAZING PLANT-CHILD, with his poisonous tendrils of doom and foul-tasting fruit of … uh, also doom.
September 15th, 2006 at 7:48 am
“That’s a mighty clear echocardiogram. Furthermore, increasing the size of the screen doesn’t increase the resolution — that remains the same — you just get bigger and blockier pixels”
Unless ,the second LCD that House is using is HDTV(high-def) which can reach the resolution of 1920×1080p, in contrast to SDTV(standard-def ) which is 704×480.
September 15th, 2006 at 3:55 pm
I think this was my worst episode so far :(
September 15th, 2006 at 10:28 pm
I don’t believe anyone has remarked on this subject yet. After “tagging” the suspect cells with the antigen-antibody complex, they find the “hotspots” using an MRI! I have noticed this in several episodes now; all the special imaging instruments/technology are used as magical devices that can be used to view any tissue for any abnormality. Just as long as their is no ferrous!!
Let me know if I’m wrong, but I can’t see how using an MRI can help find tissue labeled with fluorescing antibodies.
It saddens me to say that this was the first episode of house that really disappointed me. I still LOVE the balance between science, medical drama, and storyline, but if the science is going to go the way of CSI, it looks like I will have no TV this season.
September 15th, 2006 at 11:49 pm
“…plus, what was with the “Yo mamma is so fat…” bit? Does the writer of this week’s episode just not like Chase or something?”
It was in response to House’s reference to “the dozens” (http://en.wikipedia.org/wiki/The_dozens). “Yo mama” jokes are the canonical staple of the dozens, and I thought it was perfect; just the sort of comeback a rich white kid might come up with in that context, and by falling deservedly flat, and coming several minutes too late, it played off House’s assertion that Chase was at a “great cultural disadvantage.” I thought that was the funniest scene in the episode.
September 16th, 2006 at 5:03 pm
ceibatree, one apparently can label your antibody of choice with iron oxide, and can then use MRI to visualize the localization. I hadn’t thought of that, but looked it up in response to your comment (I don’t recall the show mentioning fluorescence in this context). I don’t know if that’s ever been done in humans, I didn’t dig deep… and of course it’s, err, far-fetched for Cameron to whip this up overnight.
September 16th, 2006 at 5:36 pm
I do not believe that Wilson has self-serving motives for not telling House about the Addington’s patient. If you’re familiar with Classical mythology, you’ll see the affection Wilson has for House when he says, “I didn’t want your wings to melt.” When Daedalus made his son Icarus and himself wax wings to fly out of the labryinth, he warned Icarus not to get too near the sun or they would melt. Icarus, of course, flew too near the sun; his wings melted; and he died. So Wilson is clearly taking a paternal role toward House. Throughout the episode, he had misgivings about lying. Some people (like House) are too intractable to admit that they need help. Tha’s what this and the “Detox” episode are about: helping someone in spite of themselves. Now, I’m not sure why Cuddy was lying to House. But these two seem the most genuinely fond of House. Remember friendships can be based on respect; not all friendships are teddybears and a warm fuzzy blanket.
September 17th, 2006 at 6:50 am
Thank you for giving the medical aspects of this episode a D, because I thought it was more between a D- and F+. I was absolutely stunned when they showed House doing brain surgery. Unfortunately, my brian was unable to suspend disbelief. The thing that I found so disturbing about the brain surgery scene was the fact that a large brain surface area was EXPOSED to the surgical theater and that House used the same electrical probe to stimulate different areas of the brain. Extremely unsanitary, which I would imagine would increase the risk of brain swelling. Also, I would imagine that most neurosurgery requires detailed mapping of the patient’s brain as well as a TEAM of skilled surgeons at the helm.
Today, TV viewers are much more sophisticated due to the vast web information highway and people’s willingness to point each other in the right informational direction. One of the comments I have seen over and over again about this episode is that: (1) the public had heard of Chimera from CSI and L&0 (both storylines were excellent; (2) most people gave House a pass on his brain surgery scene; and (3)most interestingly, because most people figured out the problem early on, they found the story arc boring. (Source Fox House MD Boards, TWOP, House MD LJ areas)
September 17th, 2006 at 4:27 pm
Furthermore, increasing the size of the screen doesn’t increase the resolution — that remains the same — you just get bigger and blockier pixels. Yup. That has been a complaint of mine about CSI from early on. House has been much better, occasional lapses, but not nearly as frequent.
So, are they running short of ideas, or are they trying to get more way out, or was this episode an anomaly?
September 17th, 2006 at 7:07 pm
So, are you smarter than House then?
If you were placed in these situations could you do better than he does. Do you figure out what most of the things are by the end of the episode. and also, you said you dont really notice his brilliance, can you elaborate?
September 18th, 2006 at 7:28 pm
Dr. Scott,
I came for the comics but have really come to enjoy your House recaps. In popular fiction, I often encounter doctors like House who are said to be “brilliant diagnosticians” who almost have a “sixth sense.” They are usually well known for this.
So, what’s the story? Are there really doctors like that? Do you nudge friends at coctail parties and say, “That’s Winslow. Brilliant diagnostician. He can look at kid with a rash on his neck and black toenails and tell you that he had bananas for breakfast in Zambia.”
I wonder the same thing about “cops who can think like the killer” and “weathermen who can sense how tornadoes think”, but maybe you can help me with the doctor question.
Thanks,
September 19th, 2006 at 2:24 pm
Imn curious to know that too, The matt’s question and House-fan’s are good. Hopefully you’ll answer!!!
September 19th, 2006 at 10:30 pm
Speaking of Cameron’s hair–besides its darkness, her skin is yellow and she has black circles under her eyes. Is there a “sick or dying” storyline in her future?
September 20th, 2006 at 11:31 pm
“Thats a mighty clear echocardiogram. Furthermore, increasing the size of the screen doesnt increase the resolution that remains the same you just get bigger and blockier pixels. ”
There are a few problems I have with the above statement.
1) “that remains the same”: Only if you take a screen and somehow make it physically bigger. Using a different screen means you can’t assume the resolution is the same.
2) “you just get bigger and blockier pixels”: And this is bad why? Let’s say I make a monitor that’s 1900×1400 pixles, but it’s only 4 inches big. Would you be replacing your desktop monitor with my gadget any time soon?
3) What is the resolution of an ECG anyway? If it’s something like 300×300 pixels, then the above two points are moot and a 10 year old tv is probably as good as it gets anyway.
September 22nd, 2006 at 5:42 am
This was one lousy episode.
I’m surprised that only one commenter here, Gary, was as annoyed as I was about the assumption that the “alien” cells would somehow be responsible for all the problems. That was the point when it became totally impossible for me to suspend my disbelief. And what was the deal with the brainsurgery (disregarding the stupidity of House doing it, the too large exposed area etc) – stimulate for a seizure, to be able to cut out the individual cells that DO NOT become active in the seizure??! WTF? Even if it was possible to do, what would be the point of it?
September 23rd, 2006 at 10:49 pm
The neuroscience is pretty spotty on this one; scanning the parietothalamic interactions wouldn’t confirm anything, and i still fail to see how alien DNA in the brain would manifest in hallucinations.
I think Cameron is referencing “Blackadder” when she asks Wilson & Cuddy to come up with a “cunning plan”.
September 26th, 2006 at 4:52 am
but even you have to admit that House performing brain surgery was beyond the pale.
And it’s not the first time either – remember ‘Euphoria’? ‘Autopsy’? And there’s never been any explanation as far as I can tell!
January 14th, 2007 at 7:13 am
Pin migration is no infrecuent, specially in children, after the surgical treatment of a fracture with K wire or Targon (titanium) implants. In medical literature you can find reports of pins migrating into the lungs, brain and other parts of the body. That´s why there is some polemic statements wether pins should or should not be removed after the fracture is cured.
(Four year resident of pediatric trauma and orthopaedic, Mexico City, Mexico)
January 18th, 2007 at 10:03 pm
Two scenes made me laugh particularly hard this week. One, Chase’s completely ineffectual and badly timed Yo Mama joke (and House and Foreman’s reaction), which further cemented his place as my favorite of the three young guns. And two, House’s remark that while he didn’t know what Cameron meant by her “cheating” comment, he could smell what the Rock was cooking. I thought it was a solid, entertaining episode as far as the mystery and the soap opera were concerned. My one nitpick (apart from the medicine, which I can’t judge because I know nothing about medicine) is the title. It was just a bit too obvious this time around. I suspected the eventual solution from the start simply based on the title, and when the disparity between the two DNA samples was discovered, that clinched it for me.
February 20th, 2007 at 6:23 pm
I just hated how Cameron came up with the idea. in theory it was a good idea if you were looking for chimeric cells but she suggested it for mutations! yes fine if they happen in the womb (stupid but fine with her ideas) but then when she saw it affected his eyes she was surprized the ‘mutation’ had been there so long! (sorry if i am slightly off, its been a while since i saw it)
i had just finished studying immunology when i saw it and my head nearly exploded lol.
i was not impressed with the medical stuff in this but thought other than that it was ok. i need to re-watch it i think, asap.
February 27th, 2007 at 10:23 am
First off, I’d just like to say that its cool that there is a site like this for House. It’s a great TV show, but its just that, a Show. Quit nit picking at the show and just enjoy it. I don’t see any of you with your own show or writing for a big network. Oh and to Colby, you wouldn’t of known the out come if it weren’t for CSI, a basic anatomy and physiology class would of helped more. Good day House fans!!
March 18th, 2007 at 1:50 pm
Well about the resolution thingy, if the input resolution is 2048×1536 from the beg.
And he uses his tiny 15” 4:3 TFT screen @ his office that might only support 1024×768, then uses a HDTV maybe 1920×1080 then jumps to a good projector that support the full 2048×1536 he wins resolution wise every step of the way ;)
April 6th, 2007 at 3:42 pm
[...] And since you’re wondering, the Polite Dissent verdict on the episode mentioned above is: I give the medical mystery a B and the ultimate solution a B+ for being clever and not too uncommon. On the other hand, I give the medicine it took to reach the solution a miserable D. The soap opera earns a B+ this week because it was much better than last week. [...]
April 20th, 2007 at 10:01 pm
About the doubts about the chimera cells being under attack by Clancy’s immune system, I think that there is one possibility for what seems to be an acute-onset alloimmune condition. This isn’t just an alloimmune disease, it probably has to be a post-viral alloimmune reaction or not one at all*. If Cameron was lazy and looked for Ig variable regions which attached to sibling cells but not to Clancy cells (probably quite a lot of it if this is an alloimuune reaction) and created antibodies with prosthetic groups that had distinctive Nuclear Magnetic Resonance features (Eg, trimethylstannyl has four quite strong peaks at iirc +/-51 and +/- 53 ppm (I’m not saying it’s safe but there are probably hundreds of groups Cameron could have used)), which would stand out on [Nuclear]Magnetic Resonance Imaging, although there would still be problems explaining the brain problems.
* Correct me if I’m wrong, but immune cells are apparently trained not to cause autoimmune conditions in the thalamus, where they wouldn’t learn about the brother’s cells. Is it similar to transplant rejection or does that proceed differently?
May 27th, 2007 at 5:48 pm
What Matthew Goldfinch says about immunology for the thalmus is kinda true i think but he is a chimeria so the cells could be in the thalmus as well, his brother cells could be the only ones in the thalumus lol. however their are more than one way not to react to an Ag! for example tolrence! we eat things so constant exposure to it causes to immune reaction. i dont know much about this stuff so pelease correct me if wrong.
and Camerons Ab idea was just crap. how would the isolate only the brothers cells and isolate a Ag to make monoclonal Ab. otherwise you would make Ab to proteins that would be the same for all people no matter how related. humans are more than 99.9% the same in nucleotide sequences therefore evern more so in protein sequences! she is a crap immunologist and geneticist!
July 12th, 2007 at 6:59 pm
Everyone seems to be mentioning Cmaeron’s hair being darker
1) It was that dark in season one
2) Forget colour, what the “work-place acceptable euphamism for testicles” is up witht the actual hair cut…
July 12th, 2007 at 11:50 pm
Love the responses. I have some comments that actually adresses Scott’s concern about the “hotspots.” This is obviously just a nifty way of doing Western Blotting (fancy lab technique were specific antibodies are used to detect the presence of a protein in a cell). It is true that you can label the antibodies with a fluorescent tag or iron oxide and have it show up. So that part isn’t far fetched. In fact, the whole scene isn’t too far fetched (except for the time table). If these are two different genomes, a DNA analysis would very easily find a sequence of DNA in the chimeric cells that is completely unique from Clancy’s DNA. Then with the help of a lab tech (I guess Cameron would do this too), the unique chimeric DNA would be transcribed to mRNA, retrotranscribed to cDNA, and then a protein could be assembled (or in theory you could just use a technique called knock-down to block every bit of the genome except for the gene of interest and then just let the cells make the protein and harvest it, but that’s really tricky and unreliable). Then you could inject the protein into an animal, such as a mouse, and raise a unique polyclonal antibody (that takes like 3 weeks, which is why her overnight magic is so hollywood fabricated), and then you could inject it into Clancy to look for “hotspots.” So that scene, contrary to popular belief, is plausible, just not under those time constraints. By the way, the molecular genetics in this show is horrible. For example, a good western blot takes two days to do at least! Whatever, love the reviews Scott. Keep them up.
July 25th, 2007 at 1:50 am
sorry JAS, picking a unique site between the two sets of DNA would be far trickier… not only would you have to ensure it was expressed but it would need to be on the cell membrane as well, not easy when you are sorting through that much DNA. furthermore it would have to be universally expressed by all cell types to be feasible for this purpose. i don’t even need to mention the amount of time it would take to generate sufficient amounts of antibody even if the protein tag could be cloned (definitely more than 3 weeks though). i think the mention of MHC I antibodies as detectors may actually be plausible IF different MHC alleles exist between the “twins”. wonder what the dosage would have to be, the cost of that much conjugated antibody would be astronomical…
a knock-down would never work on the entire genome, these are tricky to perform on single genes, knocking-down the entire genome would not only be next to impossible but would also interrupt transcription and translation thus undermining the whole purpose of the experiment.
August 7th, 2007 at 8:42 pm
I quite enjoyed this episode, but like others, I picked up chimerism quite early on. I’d read an article about it at the start of the summer, and the moment the second DNA sequence appeared I thought, he’s a chimera! Makes a pleasant surprise, but I found it unusual that House – the walking encyclopaedia – didn’t think of it.
Love the site, Doc, I check your reviews after each episode I watch.
September 26th, 2007 at 6:13 am
As soon as they started going on about 2 different lots of DNA, the answer was obvious as all the comments above demonstrate. I’d read about chimerism in New Scientist magazine so I too thought of this straight away. I enjoyed House up until this episode, but became really disillusioned with it after this. Suddenly House’s brilliance didn’t seem so brilliant after all. What if other episodes were equally obvious to those in the know.
So… question: – are any of the other episodes obvious ?
December 11th, 2007 at 9:22 pm
Umm, is it just me or shouldn’t the young guns have picked up on him being a chimera much earlier. Honestly if you open up a high school biology textbook it will have chimerism.(sp?) Okay, maybe not the book, but I remember them bringing it up when I was in high school
January 16th, 2008 at 8:03 pm
Andrew- I definitely agree! I think they made him doubt his conclusion because of Wilson’s trick. He should be able to figure that out even if he’s doubting himself, like you said: he’s a limping encylcopedia!
February 12th, 2008 at 3:32 pm
Very possibly the episode where House jumped the shark. Was there anything right about the medicine? Sure chimera’s exist, but you can’t just suck out the fraternal cells. The pin in the neck was never plausibly explained. The bowel bleed out was not caused, alone, by von Willebrand’s. The echo was pure science fiction (and a modern lecture theatre would have a laser pointer). The genetic marker was impossible in anything like the time frame used here. The puppies decision to do a DNA analysis of the excised myocardium is both inexplicable and technically impossible. House wouldn’t be allowed to use blunt electrodes on the cerebral surface like some kind of exhibit at a science fair. And finally the hypertensive crisis induced by the stimulation in surgery could be treated with a number of rapidly acting drugs that wouldn’t affect the test.
Next week Chase marries Chani and The Fonze goes water skiing.
May 19th, 2008 at 10:13 pm
I have to agree with Kim on the screen sizing, as long as you don’t exceed the input resolution, you can size up all you want…
And i’ve now figured out why the team (almost) never masks up for surgery, am I the only one who couldn’t take Chase seriously in that close-up in the end?
June 8th, 2008 at 2:26 am
I was disappointed in this episode… at the end the big “ah ha!” moment was that he was a chimera? The MOMENT they mentioned he had two sets of DNA I immediately thought chimerism. It took them several more hours to figure it out. *sighs* What ELSE could it be people??
June 17th, 2008 at 8:12 am
I found the medicine to be disappointing also. All of the examples of chimerism that I have heard about, both “people” coexisted just fine. The writers needed to make a better case for why both sets of DNA were at war with each other.
June 21st, 2008 at 1:53 am
I want to know what Cameron knows about creating a monoclonal Ab overnight! I make these things for a living and believe me, it would take a LOT longer than that. Let’s say that the kid’s immune system were attacking his “twins” cells. That would mean there were Abs. I like the MHC idea. If there is some immune response to the twins cells, you wouldn’t necessarily have to wait for an animal to do the work of making the Abs for you. The work is already done. It would take alot of time and be really freaking expensive, but she could create monoclonals to the twins MHCs by isolating the kid’s cDNA library and panning from a polyclonal library on the twins MHCs, and couple those to some NMR reactive compounds. However, there is the further problem of expressing and purifying that conjugated mAb. That is another bottleneck that would be time consuming and expensive. Maybe in 15 to 20 years when science has the ability to effectively do in vitro expression, coupled with new emerging and more powerful selection techniques can they tailor make conjugated mAbs overnight, but not now.
August 4th, 2008 at 9:03 pm
no doubt ‘cunning plan’ is a reference to Blackadder. And a few minutes before there was another. Cameron says that something will ‘light up like a (pause) lightbulb.’
Blackadder characters were always speaking in fractured similes as in, ‘it will bend like a really bendy thing.’
September 26th, 2008 at 7:23 pm
Let’s say Cameron produced that magical marker; and let’s say these bad cells are responsible for all that’s happening with the kid; and let’s say House is a brilliant neuro-surgeon.
How the hell was he able to cut these specific cells from the kid’s brain?? Chimeric cells do not sit in clearly-marked chunks, they are mixed up with surrounding tissue…
The area that was shown to lit up on the screen during the seizure was the size of a quarter; and every pixel on the screen probably correspond to a square millimeter of the brain…
October 1st, 2008 at 10:27 am
I’ve a question about IVF and chimera. The article says that it doesn’t care if Clancy had conceived by IVF. But is the chance of getting a chimera not bigger if they put more than one fertilised egg in Clancy’s mother. Normally there wouldn’t be two eggs in the mothers womb. That’s why there are not as many twins as none-twins.
October 14th, 2008 at 7:42 pm
Out of curiosity, why did Clancy have the hallucinations? It may have been stated right in front of my face, but I probably missed it if it was.
November 21st, 2008 at 11:02 pm
An MRI COULD detect antibodies if labeled with gold particles (the so-called immunogold method), as sold by Aurion or Janssen. These are normally used for electron microscopy, are non-ferrous, and available for detecting a wide variety of proteins. In theory, you could even selectively heat the things to burn out anything the antibodies stick to, enabling one to selectively knock out the target.
And gold would be appropriate for a “gold plated” diagnostic team!
December 21st, 2008 at 9:52 pm
I totally agree with Eli. I could have died when Chase stood up and told that joke. It was hilarious, and random. I dont think that the writer was going way too out of the box with that joke. House is the kind of show where the writers can say that kind of crazy crap and get away with it.
January 10th, 2009 at 4:08 pm
A few comments:
1. IVF can theoretically increase the risk of chimerism as in this procedure more than one embryos are used and they can possibly fuse while it’s not so common during normal pregnancies
2. chimerism should not show as a abnormal cells doing strange things and that in completely different parts of the body (at least they should be coming from the same germ layers) – they should incorporate and perform normal function and the only problem could be autoimmune disease
January 27th, 2009 at 3:48 pm
Love this site! I always enjoy reading it after watching an episode.
Are bleeding time tests realy done so crude in the USA? I was tested in ~ 1974 here (Netherlands), they used some small plastic device that made a standardised double-cut. (The nurse doing the test got a bit nervous after a few minutes, I was later diagnosed vW, but the clotting problem seemed to have gone away a few years later)
June 11th, 2009 at 9:43 pm
From my point of view (I’m an Ophthalmologist), this episode was the worst I watched. First, you can’t enter the eye from the center of the cornea, you’ll leave a scar there forever, and then you puncture the lens, that will cause a cataract, and finally taking cells from the retina can’t improve an uncorrected vision (without glasses).
July 12th, 2009 at 6:55 pm
This was the first episode of House I’ve seen where I figured it out way before they did, and I was actually mad at the team for suspecting a mutation first, especially given the clumsy setup that made it overly obvious (in vitro fertilization, DNA comparison).
But why on earth would they have even checked DNA when they did, especially if they hadn’t suspected chimerism to begin with?
And I’m regurgitating Biology 102, but every mammal XX female (or XXX female, or XXY male) is chimeric in some sense, since most of the genes on one X chromosome are inactive, and which X chromosome it is depends on where you look (thus the coloration of calico cats and the fact that they’re almost always female). I would guess the same is true of male birds, but I’ve never read anything specifically saying so.
I’m hoping House is back to his old self from the next episode, though he had a few good lines this time at least (”Even a 17-year-old can figure that out”).
October 18th, 2009 at 3:06 am
My exposure to genetics may mainly come from one or two courses, but that was certainly enough to know how screwed-up this episode was. I was flabbergasted by Cameron’s “well, we’ll tag it because it’s different!” approach. They must live in a world where genomic sequencing and knowledge (Cameron’s most of all!) is extremely advanced. To know WHAT to tag, which would have to be a taggable allele that differs on both that they can derive and engineer the protein for, IN A DAY is some years away.
Also, the way they kept referring to “alien DNA” instead of the situation of tetrameric chimerism (which I called as soon as there were 2 diff sets) was straight out silly.
Though it might’ve been controversial had they aired it as such, I came up with a better solution to the problem. If the boy’s twin had just had a chromosomal disorder, like Down’s Syndrome, or the boy himself had a barely-detectable case of Mosaic DS, that would’ve better explained why the spots with different DNA were an issue. Tagging a chromosome is a lot easier than the overly-involved and fantastic procedures Cameron went to.
However, having a sister with Mosaic Down’s Syndrome myself, I probably would have been angered at the implications of the whole “excising the bad parts” treatment anyway. Perhaps the twin having another chromosomal disorder – certainly one of the more fatal ones to make it more dramatic – would’ve been best. I just feel like this episode didn’t explain or explore the possibilities as well as it should’ve.
December 17th, 2009 at 6:28 am
Thanks for your review. I smelt a rat and came here to check it out. The Series became exceptional in Series 2, and I was looking forward to it improving in Series 3. The Wilson/Cuddy holding out thing in S3E1 bugged me; I figured “ok, it’s tv” but S3E2 was a huge disappointment. Like everyone else, I picked Chimera as soon as they said 2 sets of DNA. But the medicine was damned terrible. From Cameron’s overnight marker “we do this with cancer”, to the craziness that the “twin’s DNA” in the kid’s brain was causing the hallucinations (and that they could so easily burn it out). This is a medical show. I expect the medicine to be plausible, but this was like Star Trek when they just make the science up. The following are the authors of this piece of utter crap: Skip anything their names are attached too: Russel Friend & Garrett Lerner & Lawrence Kaplow & David Shore
March 8th, 2010 at 4:25 pm
First time commenting so just gotta dd the usual “I love this blog”. I’m a first year med student currently working my way through House having never watched it before, and since finding this I always come and read after each episode!
Anyway, my main reason for commenting was because I did actually figure this one out before House and the rest of the team did at the whole 2 cell lines thing. We had a question on it last term in a study session, and it popped back into my brain. Though it seems this happened for a lot of people so ah well. :)
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