House – Episode 8 (Season Three): “Whac-A-Mole”
A strong episode of House with a good medical mystery, some decent medical care, and fascinating soap opera. Stay tuned for a review of this week’s House complete with spoilers.
Jack is an 18 year old who works as a waiter at a Chuck-E-Cheese-like pizza restaurant. He is also acting as a parent to his two younger siblings since their parents died in a car accident. While at work, Jack develops blurry vision and then starts vomiting (giving some poor eight year old a birthday he’ll never forget). He suffers chest pain, an abnormal heart rhythm, and a heart attack.
At the hospital, House and the Young Guns review Jack’s case. Prior to the heart attack, he had been experiencing fatigue, night sweats, and weight loss. He also complained of itchy feet and reported that cigarettes no longer tasted good. Foreman suggests Jack’s symptoms are due to an increased intracranial pressure caused by a brain tumor, while Chase suggests a acute viral gastroenteritis. House tells them they’re both wrong and that he already knows the cause. House proposes a contest: each of the Young Guns can run one test to find the diagnosis. Chase draws blood cultures looking for a bacterial infection, Foreman runs a brain MRI, and Cameron runs a heart test looking for coronary artery vasospasm. All the tests are negative, except for the single test that House ran. Jack has Hepatitis A, which explains the weight loss, fatigue, night sweats, and vomiting. It was the vomiting that led to an electrolyte imbalance, which itself led to an abnormal heart rhythm which caused the heart attack. Jack is given a course of IVIG (intravenous immunoglubulin) for treatment.
The next morning when he is set to be discharged, Jack starts bleeding from his IV site, nose, and ear. His lab tests reveal a coagulopathy which House diagnoses as DIC (Disseminated Intravascular Coagulopathy). The team suggests possible causes for his DIC. Cameron proposes a community acquired or opportunistic infection such as E. coli, Eikenella, or Strep. Chase suggests a food-borne illness, but Foreman is suspicious of a sexually transmitted disease such as syphilis or gonorrhea. Foreman performs a lumbar puncture and when he is rolling Jack over after the test, he accidentally breaks one of Jack’s ribs (a “pathological fracture“). House takes this to mean that Jack has osteomyelitis, an infection of the bone. At this time the other tests come back and all are positive. Jack has Syphilis, Eikenella, and botulism.
Jack now starts to have seizures. His white blood cell count is normal and his HIV test is negative (he does not hav AIDS). A CT scan of the head is normal as are all neurological tests. House wonders if the symptoms might be related to Jack’s past history of drug use. While the initial toxicology tests were negative, House notes that drugs can be absorbed by fat cells and are released with weight loss. He has the team sit in a sauna with Jack and sweat another few pounds out of him. His retested blood and urine are also drug free.
The brain MRI is repeated and now shows multiple lesions throughout the brain. The team suspects tumors while House thinks it is a fungal infection. A biopsy of one of the lesions reveals the fungus Aspergillus. House is now convinced that Jack has a genetic immune deficiency that has been kicked into high gear by the stress of his parents’ death. The differential includes Bruton’s Agammaglobulinemia, complement deficiency, Chronic Granulomatous Disease, and Common Variable Immunodeficiency. Concerned that genetic testing will take too long, House exposes Jack to a mixture of the germs Serratia, meningococcus, cepacia, and rhinovirus. Each of the germs targets a different genetic weakness, and whichever disease Jack ultimately becomes infected with will show the team which genetic condition he has. Jack comes down with Serratia which means that he has Chronic Granulomatous Disease. A bone marrow transplant from his younger brother will likely lead to a cure, but Jack refuses explaining that his brother is too young to decide for himself. Foreman thinks Jack’s decision is noble, but House shows him that the disease allows him to shrug off the responsibility of acting as a parent. As the episode ends, Jack’s brother and sister are heading off the foster care and Foreman tells him that he’ll change his mind one day.
Medically, I thought it was a good mystery with a not-too-far-fetched answer. Most of the medicine was good, but there were a couple of things that caught my eye. First, and a repeat offender, is that it takes forty-eight hours to determine a blood culture is negative, not just a few hours. Second, intravenous immunoglobulin is not a treatment for Hepatitis A. It can be used for prevention in pwople who have been, or are going to be exposed to Hepatitis A, but it is not used to cure the disease. Third, botulism is caused by toxins produced by a bacteria, not by infection with the bacteria itself. Chase should not have seen a bunch of bacteria in the vomit and call it “botulism.” Finally, the sauna will cause a temporary weight loss by water loss; it doesn’t affect the fat cells.
In addition to a good medical mystery, this episode is also chock-full of soap opera-y goodness. Wilson finds that his car has been towed and his DEA license suspended so that he can no longer write prescriptions. House loans him Cameron at one point to write prescriptions for him – which leads to another soap opera within a soap opera – but refuses to let Wilson borrow her another time. When he runs out of Vicodin, he asks Chase and then Cameron to write him a prescription, but they both refuse – though Cameron does offer her PMS pills. In the end, Cuddy writes House a Vicodin prescription and Wilson throws House out of his office.
I give this episode an A for the mystery, with a B+ for the solution because it was clever but a bit of stretch. Despite my concerns addressed above, I thought the medicine was above average and deserves a B-. The soap opera/non-medical aspect continues to be good and earns an A.
The previous House review
A list of all prior House reviews
November 21st, 2006 at 11:17 pm
The first half or so of this episode was a riot. The last half I think got a little frayed and choppy, but still was quite good. While it fit within the show thematically, I didn’t think the pacing/writing/acting (not quite sure exactly which element) of the confrontation with the patient, House, and Foreman after he rejected the bone marrow transplant was that great. It felt much weaker than the strength of the early half of the episode, even if it was still decent.
November 21st, 2006 at 11:19 pm
I thought this was a very, very well done episode in terms of the soap opera. For the first time this season, I found myself disappointed at the end of the episode because I wanted to find out what happens next. Obviously things are going to work out, but how is that going to happen? Is it going to be like in the case of Vogler, where Cuddy steps in and saves the day after Wilson is knocked out of commission? How are the Young Guns going to handle grilling from Tritter? In terms of my interest, the medicine seemed more like a sub-plot.
And I know you commented on this awhile ago in episode 5, but the previews are really annoying. They show the previews which reveal way too much RIGHT BEFORE THE SHOW STARTS. Grrr!
November 21st, 2006 at 11:20 pm
Good episode. Really good. Especially the scenes with Wilson..
I really sort of wanted to punch House after this. After all that, and he can’t even show a little bit of loyalty to Wilson? Sigh.
Anyway~ Thanks so much for doing these reviews. I read them every time I get a chance after an episode. :D
November 22nd, 2006 at 12:03 am
I liked the part where Cameron does her awkward best to stress out the patient. Not as bad as Chase’s “Yo momma” joke from a while back, but it ranks up there.
November 22nd, 2006 at 12:28 am
When Cameron tells House, if he cuts his Vicodins in half he’d have twice as many, my wife blurted out he can’t do that: she was told Vicodins were time-released, and cutting them in half would mess that up and possibly be dangerous. Is that true? (She had been prescribed those after a gall bladder surgery, and has a pharmacist friend that told her that.)
November 22nd, 2006 at 12:46 am
I liked the angstiness of the episode, but the extreme implausibility of Tritter’s legal machinations are killing off suspension of disbelief. He’s like a one-man Gestapo. There is no way he could pull off the stuff he’s done without having about a thousand injunctions filed; I’m pretty sure you can’t freeze someone’s assets just on one cop’s say-so, and that person is entitled to some kind of hearing. Doesn’t the hospital have a lawyer? Come on! One point I wondered about was when Wilson’s DEA license is suspended and suddenly he can’t write ANY prescriptions. I thought a DEA license was required only for controlled substances. Physicians without DEA licenses (but with a medical license, obviously) can write prescriptions for non-controlled substances like chemotherapy drugs, can’t they?
November 22nd, 2006 at 1:34 am
Official Comment
Chuck,
Vicodin is not time-released so you can cut it in half (OxyContin and MS-Contin are the time-released narcotics).
Steve,
You’re right. The DEA license is required for controlled substances, but not other prescriptions (though many pharmacies track physicians by their DEA numbers, so it would be inconvenient). Wilson would be able to write for chemotherapy and anti-nausea medication, but not for strong pain control for his patients.
November 22nd, 2006 at 3:48 am
Am I the only one that wishes they will get over this police business already? It is distracting from the rest of the show. Just get it over with.
November 22nd, 2006 at 4:09 am
Did anyone catch the physical therapist’s comment about House using the wrong arm for his cane as the cause of his arm pain? Was that a nod to all the fanboys and girls that noticed that since day one?
November 22nd, 2006 at 6:58 am
josh: Nahh, the producers were always aware of that. They commented on it before in interviews that it was to accentuate how House was just a little “different” than anyone else (and stubborn, of course). Plus it’s not really the “wrong” side, many patients feel more natural and comfortable with a cane on their dominant side.
Scott: You described the ending as “not-too-far-fetched” and then described it as “a bit of a stretch” afterwards — I think you’re basically saying the same thing, but it sounds like your attitude changed a bit while writing. What leads you to this? The rarity of this happening, or were there other medical mistakes? (That would explain the B- in spite of only minor criticisms)
Steve: Yeah, that’s been a bit of a nuisance to me too. I understand it’s just a plot device, but it makes it hard to stay ‘attached’ to the storyline when you see gross violations of reality’s rules. Freezing one’s assets isn’t so simple. The whole idea behind freezing assets is to stop someone from dissipating their money outside a court’s jurisdiction, where that might affect a judgment. In other words, it’s to stop you from “burying the hatchet” before a judge has time to check it out. Since no official charges have been filed against Wilson, it’s massively unlikely that Tritter could get a Mareva Injunction against him, even with 10 judges in his pocket. Remember the Constitution is very clear about the right to personal property, and an ex parte decision in this matter would need serious evidence besides “yeah, he’s a cancer doctor that prescribed lots of pain medication…oh, wait…”
It’s interesting how they play it up, but the whole “destroy Wilson on some cop’s suspicious whim” is legally far-fetched, I admit.
I was confused at the ending, where House looks at Wilson waiting for the bus and then just speeds off…I figured he’d offer him a ride or something (yes, I realize he didn’t have two helmets, but you get the idea, and he’s given Cameron rides before). I do like the tension they’re bringing between the two characters, it’s a very interesting twist to the normal routine of Wilson saving House’s ass whenever there’s trouble.
November 22nd, 2006 at 7:20 am
Official Comment
X,
I felt that the answer “Chronic Granulomatous Disease” (or any of the other genetic immune conditions) — though rare — would explain his condition. These are conditions that are actually mentioned in medical school, unlike some diagnoses House comes up with, hence the “not too far fetched.”
On the other hand, I felt that the fact that the condition suddenly kicked in and a previously healthy person would come down with 3 serious diseases that severely and that quickly was harder to believe. And the comment by House that living in suburbia was like living in a germ-free bubble was simply ridiculous. That’s where the “bit of a stretch” came in.
November 22nd, 2006 at 7:53 am
I was pleased to see the writing of last night’s episode back up to the standards I admired during the first two seasons. If you can ignore how unbelievable Tritter’s law powers have become, the show itself was tightly written and full of excellent acting. The scene with the Scoobies hanging out in the sauna together made me laugh, as did House’s subsequent comment about Cameron.
The ending, where the patient turned his siblings over to child-care was the kind of ambiguous, realistic ending I like to see from House. No nice clean ‘Hollywood’-style denouement. Life is messy.
November 22nd, 2006 at 9:16 am
Steve:
Having watched a loved-one die of cancer I can affirm that opiate painkillers are the most important tool an oncologist has. Taking his DEA license on whatever pretext effectively terminates his career like that of no other specialty. The relationships that make the series are being forced to a point of no return, as confirmed by the spoilers flashed at the end.
November 22nd, 2006 at 9:48 am
Here are the things I noticed:
They didn’t try to divert your attention from who the real patient was in the opening scene, realizing that Patrick Fugit is too famous (teehe) to pull that off. Good call, as soon as you see him, you know it’s him.
They answered two oft-repeated fan complaints. One, that House uses his cane on the wrong side, and two, that the Young Guns do all the tests (Foreman says the nurses aren’t allowed to do anything).
The medical mystery was excellent to the layperson. I was baffled.
The soap opera and writing are back on track. I feel, at last, like I know these people. I was afraid the best days of House were behind us. Cameron and Foreman have both grown and changed in ways consistent with their characters. Good for them!
House is really, really proving he’s an addict. For him to say “how will I get my Vicodin?” as his first reaction to Wilson’s loss of DEA licensure; well, he spoke too fast for it to be a House-style put-on, it was genuinely his first concern, the sonuvabitch.
November 22nd, 2006 at 10:47 am
[...] Oh, I made a terrible mistake last night. My wife and I conduct a ritual viewing of HOUSE every Tuesday. After it was over, I channel surfed, looking for more high-definition programming, and I found it in the form of 3 POUNDS, the new medical drama on CBS starring Stanley Tucci. After the first 10 minutes my wife asked me if I wanted to change the channel and I had to admit that no, I can’t resist train wrecks. [...]
November 22nd, 2006 at 11:47 am
RE: The Tritter subplot. Wouldn’t the hospital’s own lawyers and its no-doubt locally powerful and well-connected board of directors have gotten involved by this point? The plotline is just plain boring and unbelievable.
November 22nd, 2006 at 11:47 am
Although I am not qualified to judge in this matter, to me the medical side of the story seemed pretty good this week, too.
Cameron scaring the guy was a little bizarre (because it didn’t seem to fit Cameron’s character) … but that’s what made it funny (of sorts).
I really had to laugh when they opened the envelope and it said “… Nice try Cameron”
-funniest moment of the episode IMO.
The drama… I have to say I wasn’t as impressed as with episodes like “Need to know”, “No Reason”, “Meaning” or last week’s episode (see my comment)… but we certainly got the strongest “Wilson-moment” in a long time here (…ever, IMO).
I was honestly scared he and House would fall apart for a long time… this is gonna need some effort on House’s side to patch up… which in turn is gonna require him to let his guard down, admit to himself that he screwed up the only thing that kept him grounded and gave him support, a person to rely on (though he would never admit that he needed that)… his friendship with Wilson. That’s gonna be at least as tough on him as the conclusion of the Stacy-arc.
Last episode’s House-(Tritter)-Wilson drama was way more revealing, this weeks’s had a very strong Wilson and we really got to see how House’s addiction is ruining his friendship with Wilson (”how will I get my Vicodin?” and his refusal to let Cameron go just to punish Wilson for not giving him his drugs) which makes it a straight B for that part of the drama IMO.
I’m really anxious to see how they’re going to work that out.
The family-drama… a little boring. Somehow it didn’t really touch me. Can’t really say why, though I guess it was because there was no real tension. The situation was dramatic, yes, but not as much as last week’s and it wasn’t really tense. So the patient’s personal drama receives a weak C from me.
And then there’s one more minor thing: Is it only me or have all the characters on House who don’t believe in god or an afterlife been portraited as miserable? Of course there’s Cameron, but she too believes in a “Higher order” (”…Damned if you do”, so she’s practically a mystic, not a theist) and.
It’s not a big thing… and maybe I’m a bit too sensitive, but you know it’s not really uncommon that atheism/anti-mysticism or whatever gets misrepresented…. Just seems that I’ve never seen a well-adjusted person of whom we know that s/he is neither a theist nor a mysticist on american television since Star Trek TNG and (maybe?) Frasier (but “well-adjusted”…okay, maybe not in that case ;-)
Nevermind I guess, didn’t mean to offend or annoy… I was just being curious.
Good episode altogether. B+ for the House-(Tritter)-Wilson drama and a weak C for the patient drama makes a B- from me for the drama as a whole.
November 22nd, 2006 at 11:49 am
Why is it, exactly, that Wilson doesn’t have at least one lackey of his own? Is the oncology department that much less important than House’s Zebra Squad?
Let me say up front right now that I’m going to be amazingly disappointed if they have the Tritter subplot resolve by having him come down with some extremely rare and painful condition…
November 22nd, 2006 at 12:23 pm
Not only should the hospital have a team of lawyers on this Tritter thing, but Wilson is simply not stupid enough to go to his divorce lawyer. What kind of idiot doesn’t get a criminal lawyer for a thing like this? It’s not like he doesn’t have the money for it.
November 22nd, 2006 at 1:15 pm
Joebeets, no question that the ability to prescribe narcotics is critical to an oncologist’s practice in general. My point was that, in this specific case, Wilson did not need another physician to order the meds he described to Cameron. He could have written those prescriptions himself and only asked her or another doctor* for help with scrips for narcotics. Where I work, we used to have a few house staff who did not have DEA licenses yet (trying to save money). When they had to order controlled substances, they asked their supervising attendings.
*I know it’s a TV convention, but the likelihood of Wilson being in solo practice as an oncologist is pretty low, especially at a teaching hospital but really anywhere. The patients are too needy and time-consuming, and there’s too much hospital work, for an oncologist to survive without a colleague to share the burden. Also, a good oncology practice provides a lot of ancillary support to its patients, and one physician can’t generate enough income to support that, even with the big bucks that come from dispensing chemotherapy. I’m sure there are a few lone eagles out there, but it’s a killer job (no pun intended) to do by yourself. It’s even more unlikely that a teaching hospital like PPTH would have only one oncologist on staff. Then again, they seem to have only a handful of nurses, so I guess anything’s possible.
November 22nd, 2006 at 2:29 pm
Deborah, if I recall the dialog properly, I believe the scenario was that Wilson’s divorce lawyer referred him to the (assumed criminal) lawyer that we see on screen. I believe Wilson said something about being told that he (the onscreen lawyer) could get Wilson’s car out fast, and the onscreen lawyer saying something to the effect of that divorce lawyers don’t know anything about criminal law, implying that he (the offscreen divorce lawyer) didn’t know what he (same) was talking about.
November 22nd, 2006 at 2:37 pm
My guess is Tritter will come down with Nicotine poisoning and House will be torn about saving him, will save him then apologize and it all goes away.
November 22nd, 2006 at 10:06 pm
…I forgot: I thought the part of Jack’s sister was well written and especially well acted (especially for a girl that young). Pleasant surprise. Gave the episode a little extra quality.
November 22nd, 2006 at 10:13 pm
Steve: I remember from an episode on season 1 when Vogler was trying to get Wilson he said that someone else from oncology was one of the people who voted to keep him in.
I have a query, when they did the MRI that showed all the brain tumors, one of them said brain stem was clear (Chase i think) and then Cameron said midbrain was clear. Isnt the midbrain part of the brain stem (midbrain, pons and medulla?)
Also Scott, did u do this on person?
Medically, I thought it was a good mystery with a not-too-far-fetched answer. Most of the medicine was good, but there were a couple of things that caught my eye. FIRST, AND A REPEAT OFFENDER, IS THAT IT TAKES FORTY-EIGHT HOURS TO DETERMINE A BLOOD CULTURE IS NEGATIVE, NOT JUST A FEW HOURS. Second, intravenous immunoglbulin is not a treatment for Hepatitis A. It can be used for prevention in pwople who have been, or are going to be exposed to Hepatitis A, but it is not used to cure the disease. SECOND, AND A REPEAT OFFENDER, IS THAT IT TAKES FORTY-EIGHT HOURS TO DETERMINE A BLOOD CULTURE IS NEGATIVE, NOT JUST A FEW HOURS. Third, botulism is caused by toxins produced by a bacteria, not by infection with the bacteria itself. Chase should not have seen a bunch of bacteria in the vomit and call it “botulism.” Finally, the sauna will cause a temporary weight loss by water loss; it doesn’t affect the fat cells.
haha if it was on purpose i missed the joke and should walk away quietly… :)
November 22nd, 2006 at 10:41 pm
Official Comment
Matt,
Nope. That was a typo.
November 23rd, 2006 at 12:05 am
Tritter is already suffering from a mystery ailment that it will take House to cure: The same thing that brought him into the clinic in tbe first place. They implied in the second episode that he still had it.
Personally, I completely despise the Tritter subplot. While I suppose it’s realistic that the police department around there is just that corrupt, but they could have at least made Tritter either sympathetic or entertaining. I personally hope his storyarc ends with him getting hit by a bus and turned into a fine cloud of dust on camera so that we can be assured that he will never darken our door again. Hopefully they can assure us that there are no surviving members of his family that will show up again.
November 23rd, 2006 at 12:47 am
Wilson likes operating his practice solo because he doesn’t want any competition for terminally ill babes looking for hot monkey oncologist sex.
November 23rd, 2006 at 11:19 am
I thought only the IRS could freeze accounts.
November 23rd, 2006 at 7:37 pm
Freezing accounts would take a court order, and there would have to be probably cause showing that money in the account was being used for a crime or were profits from a crime. So no, he wouldn’t be able to do that. Impounding the car would require a warrant, or finding illegal drugs in the car (which would allow a drug seizure). So he wouldn’t be able to do that either.
The DEA license I would suspect would actually be easy for him to do, because he could show that Wilson prescribed an unusually high amount of Vicodin for House, who was obviously hording them. However, I’m not as familiar with medical law and licensing as I am with the basic laws of search and seizure.
November 23rd, 2006 at 7:41 pm
hey scott, how come you dont do a whole review of the show ‘3 lbs’ its a good medical show also. Seems really realistic!
November 24th, 2006 at 1:13 am
i definitely agree with Ideaman. Scott, if you are interested, I would love to read what you thought of 3 Lbs.
Being only in med school, my knowledge of the brain is… sadly lacking. I’m just happy I heard of AVMs before. Other than the focus in the brain, it seemed very similar to House: even the music seemed at times very similar. I seriously don’t think they can do much in making the audience interested about the medicine since the brain is so much more complicated to understand… so I’m guessing they’ll just concentrate on the soap opera (which i really hope they don’t do)
November 24th, 2006 at 2:35 am
House’s strongest suite has always been its realism. Take away that realism (whether in medicine, or as is the case now, the law) and you’re left with done-before soap opera that not even witty dialogue will salvage.
Is it 3rd season malaise? Whatever it is the writers had better buck up and get their legal (and medical) facts right. As a law student I cringe at the disbelievability of Tritter’s gestapo jaunts. Hell, you don’t even have to be a law student to know that “stupid gestapo tricks” are disbelievable on the face of it.
November 25th, 2006 at 2:32 am
Didn’t anyone find it strange, that Forman is such a weak neurologist, that he immediatly claimed (during the second MRI) tumors, even if NO primary brain tumors look like this from the start, and obviously it was a start since the first MRI was clean. And there’s not a chance in hell any tumor could grow and spread that fast. So that was really weak.
And the intitial simptoms warranted a look into Family Hyperholesterolemia which was skipped altogheter without even a mention.
November 25th, 2006 at 9:10 am
Zach,
I think the assumption that the Police Department is corrupt as hell is a relatively good one, since this is Jersey, after all (Well, apparently a combination of Jersey and UCLA, according to the first episode of Season 3).
Also, yeah, the subplot is irritating me to no end. I hope they kill it next episode of the following one.
November 25th, 2006 at 9:13 am
Whoops, my last post was supposed to address Zach, not have my name be read as Zach. Could you fix that?
November 25th, 2006 at 11:57 am
From a long time dedicated watcher and sometime reader, I’ll take a stab at the problem of House using his walking stick on the wrong side.
Due to screwed up cartilage I walked with a stick for years. Sometimes my left knee would be painful and I’d favor it, then the right knee would start hurting more and I’d favor that. I always used the same hand and just changed technique.
Eliot
November 25th, 2006 at 12:32 pm
I enjoyed the medicine in this ep, however I was a little disappointed in the way they explained the bone marrow transplant option. They made it seem like he could have gone along fine without the transplant, when in reality he would most likely eventually contract an infection, virus or fungus the doctors couldn’t get on top of, and die. Also, they kind of overplayed the risk to the donor making it sound like huge invaisive surgery, when in reality they put the donor under, and extract the marrow from the hip bone with a needle, and don’t even make an incision. The transplant is much riskier for the recipient, as their immune systemis is wiped out then replaced, but it was the patients best option, with a high likelihood of death if he went on with his messed-up immune system.
I always enjoy reading these reviews, keep up the good work!
November 25th, 2006 at 6:34 pm
Why do they always hold a patient down when they have a seizure? That’s wrong. Somebody will get hurt if you actually do that. Not to mention the bruises on the person holding them down. All you have to do is protect their head and take away anything that flailing hands and feet could get hurt on. Turn them on their side so they don’t choke on their drool. I’ve had epilepsy since I was three and know that it’s the wrong way to react to a seizure victim. The writers should do more research before writing these shows.
November 25th, 2006 at 8:17 pm
I don’t see Tritter as corrupt at all. The beauty of this story arc is he’s right. House is a pain pill addict, he bullies people, and Tritter is trying to stop a man whom he sees as dangerous, even if it means being a jerk to those surrounding him. Just because we’re not on his side, doesn’t mean he’s wrong.
November 26th, 2006 at 4:18 pm
I wish they would consult a microbiologist once and a awhile. I am darned curious to know how they know which bacteria it is purely by looking at it under a microscope. That’s a neat trick, and it sure would make my life easier. Reality is, you can get an idea if you Gram stain, but a lot of them look alike and require a lot more than a visual to ID. There are hundreds, maybe thousands of options for gram negative rods, but they knew visually they had Eikenella? Sorry, that’s my personal rant for the episode.
November 26th, 2006 at 6:51 pm
perpetual_student,
The aim of the show is purposely to make people interested in the crazy things the brain does. It is the show’s primary focus, not the soap operah drama behind it. Plus, the surgeries and the tests are done by the actual professionals, not like in House with the young guns doing everything.
They also show cool “brain” sequences of what the person is going through during the surgery. its a suprisingly good show.
November 26th, 2006 at 9:17 pm
Tritter, not corrupt at all? Besides the fact that he’s completely violating something known as “due process” with no regard for anyone’s Constitutional rights?
Yeah, I’d call that corrupt. And also, completely unbelievable from a legal standpoint. I hate this arc because I just can’t buy all the crap Tritter is able to do.
November 27th, 2006 at 4:06 am
Just wanted to say that I thought it was clever of the writers to tie in House with Sherlock Holmes even more with his prediction envelope titled “The game is a itchy foot.” Sherlock Holmes was fond of saying “The game is afoot” when solving his cases.
November 27th, 2006 at 12:18 pm
Mike B.,
If I remember correctly, every character on House is an atheist or a non-religious theist, and the only person who could be considered miserable is House himself. I am pretty sure Foreman and Wilson are atheists. They are not unbalanced and miserable, especially Foreman (because Wilson, though very “balanced,” has had major relationship problems).
Cameron, early on, said she doesn’t believe in a God but is somewhat spiritual, and I’ve gathered that Chase is a firm believer in God but dislikes religion, and many of their problems so far in the show seem to stem from either their spiritual beliefs or the personality traits that cause them to have those spiritual beliefs, especially Cameron. I have also noticed that most of the religious characters have been made out to be complete idiots. All in all, it’s probably the most atheist-friendly show on television and possibly in television history.
I am going to go back and watch all of the episodes that deal with religion.
November 27th, 2006 at 2:39 pm
Danielk, I think the problem with your statement is the assumption that it’s Tritter’s business to stop House. Yes, House is an addict, but he’s a functioning addict. We have never, as far as I know, seen his addiction interfere with his ability to do his job. In fact, the only addiction-related problems (other than whatever physical or psychological damage he’s causing himself) that have happened came about as the result of people trying to “cure” or otherwise stop him from using his drug of choice. I’m no expert on drug addiction, but my impression is that a person with a stable, securely supplied opiate addiction (for example, someone on methadone therapy) is capable of being a fully functioning member of society.
This is not the place to debate issues about drug laws, or appropriate policies for durg-using physicians, but it seems to me that Tritter’s efforts to stop House – which are shown to be based on vengeance, rather than any real concern for public safety – are causing vastly more trauma than his pill-popping ever caused. I have trouble interpreting that as being “right.”
November 27th, 2006 at 9:21 pm
Tritter does not get complimented for his behaviour simply because his conclusion happened to be right. It’s kind of like he sees a guy driving and making a small swerve. The Tritter method of reacting is to assume that the guy’s a drunk driver, run him off the road, slash his tires, steal his keys, track down all of his friends, slash their tires and steal their keys just in case they might loan him their car, then call the police and get everyone’s driver’s licenses taken away. Now, even if the guy really was a drunk driver there was no evidence and the reaction is definitely an overreaction.
And, yeah, that pretty much is what the House/Tritter bit feels like.
November 28th, 2006 at 6:21 am
what if… at the end of the season we find out the detective isnt really a detective, he is a terrorist. Then we find out the house is really an undercover NSA agent on a mission to bring the evil detective down (whose real name is ahmad ahkmed ali paula abdul [with a lot of kkgkhkg sounds]). Cameron would walk around naked the whole episode and cuddy and her will perform uncensored sexual acts on each other. I would enjoy that episode.
November 28th, 2006 at 9:00 am
@Daniel W.
Interesting points. Though we don’t really know about Foreman’s and Wilson’s metaphysical orientation. Okay… Cameron is a mystic, Wilson and Foreman we don’t know (though after reading your reply and rethinking it I guess there are hints towards them being non-religious), House seems to be an atheist (but again, damned if you do left us without an answer to that), Chase is a theist and the rest we don’t really know about.
But not all religous people have been portayed as idiots (which is good), think of the nuns in Damned if you do, think about Jack etc.
The most atheist friendly series in television history is IMO still Star Trek TNG (see e.g. “Who watches the watchers” et al.)
While we only suspect that Foreman is an atheist, yes, he’s not miserable (and Wilson, of whom we don’t know that either is certainly a troubled man).
Anyway… thanks for your reply.
@Zach: You have internet access… there certainly is a not-annoying outlet for your fantasies, or as House would say: “Internet-Porn…”
Looking forward to tonight’s episode…
Goodbye!
November 28th, 2006 at 11:07 am
As an attorney, I don’t find Tritter’s actions unbelieveable. Being a drug user is one thing, being a drug dealer is another. House had enough pills stashed in his apartment to presumptively qualify as the latter. While Tritter knows that House isn’t a dealer, his superiors and the judge signing the warrants don’t, so I expect them to give him a relatively free hand in the investigation. I’m surprised there hasn’t been more discussion on this site about House’s stash.
Also, I’m surprised at the disbelief regarding the “young guns” performing so many different tests and procedures. Are health professionals really so specialized that each test is performed by a different person? Attorneys specialize as well, but certainly not to that degree.
November 28th, 2006 at 11:14 am
Gary:
No, but I don’t think doctors do tests at all: lab techs do them.
November 28th, 2006 at 11:21 am
Maybe; but when I want something done immediately – as House’s team almost always does – I generally have to do it myself. I doubt the rest of the hospital would appreciate House monopolizing the lab techs’ time.
November 28th, 2006 at 11:57 am
Gary (and Scott) are doctors even qualified to do lab tests? It seems like a specialized field. And why is the lab always empty except for the YGs?
Although I suspend disbelief for the show, it seems unlikely that any doctor (especially one as universally disliked as House) could have the influence to jerk staff around like House does. The nurses and techs would be greasing the bottom of his cane and putting laxative in his coffee (my mom is a nurse, and her pranks, like her name, will remain anonymous.)
November 28th, 2006 at 4:42 pm
Is the general disbelief in the YG’s hands-on approach because (1) doctors generally don’t have and can’t pick up the training to run lab tests or (2) doctors generally have better things to do (like see patients) than run lab tests? I don’t believe the former, and, with regard to the latter, remember that the YGs aren’t typically doctors – they seem to focus only on the one patient that House finds interesting each week or so. So, if we assume that they have the smarts, and we know that they have the time, why is it not believeable that they run their own tests?
November 28th, 2006 at 11:40 pm
Official Comment
While it’s certainly possible that the Young Guns could run all their own laboratory tests, they would each also have to meet the fairly onerous federal CLIA guidelines, which are a real pain (and I speak from personal experience). I also doubt the people in charge of the lab would like the Young Guns poking their noses in and messing up their machines.
In terms of the medical procedures that they’ve been performing, that’s a whole ‘nother bucket of worms. To be allowed to perfom specific procedure at the hospital level, the physician in question has to be credentialed by the hosptial (generally by the credentials committee). They are very strict about who is allowed to do what procedure and would be extermely unlikely to credential someone for a procedure outside their specialty for 1) medicolegal reasons — it’s a good way to get the hosptital sued, and 2) competitive reasons. Specialists are very protective of their “turf” and don’t want “outsiders” encroaching on it. A gastroenterologist (and there will be one on the credentialling committee) would never approve of another specialty performing a colonoscopy or EGD when he (or she) could be doing and getting paid for it (and frankly, he would be better at it as well as he would perform many many more of the procedures and be much more experienced).
November 29th, 2006 at 3:01 pm
anon:
It dismays me to see someone who claims to be in law school use a misconstruction like “disbelievable” twice in one paragraph. Didn’t they learn you no better in pre-law?
December 4th, 2006 at 6:14 am
Only a pedantic anal-retentive nitpicker would take issue over a harmless neologism. Oh wait:
page 148: “… like a bull or some such, and commence to do disbelievable things. …” (Toni Morrison, Beloved)
page 57: “… be of either of two kinds; the supposition may be disbelievable, or repugnant to the intellect or judgement; or it may …” (Paul Grice & Judith Baker, The Conception of Value)(OUP)
page 300: “But even with adequate understanding some self-evident propositions seem disbelievable by rational persons.” (John Greco & Ernest Sosa, Blackwell Guide to Epistemology)(Blackwell)
page 54: “… withholdable, and even disbelievable, even given comprehending contemplation . This, in turn, allows that …” (Robert Audi, The Good in the Right: A Theory of Intuition and Intrinsic Value)(Princeton University Press)
page 367: “… of being either true or false, and consequently believable or disbelievable. …” (Lambert Zuidervaart citing Beardsley, Artistic Truth: Aesthetics, Discourse, and Imaginative Disclosure)(Cambridge University Press)
And so on. The august presses are held to account by the mighty pedant “joebeets”.
December 4th, 2006 at 11:31 am
Gary,
“Are health professionals really so specialized that each test is performed by a different person?”, to a degree I would say yes. Even in the lab the technologists (not to be confused with technician- the former implying the four year degree typically attained) specialize into varying departments. I don’t know how law works, but there is a lot of knowledge to be attained by in medicine and specialization = better results. In terms of doctors in the lab, I have had urologists come in to do a quick urine microscopic, and the oncologists will look at peripheral and bone marrow slides- which makes sense as those are their specialties. Beyond that, and this is no slam towards doctors, quite a few really don’t have a good understanding of how lab results are generated and do not spend any time in the lab, excluding the obvious like pathologists. I base that on questions, discussions, and comments from doctors I’ve talked with. As far the the “YGs” lab, I’ve always assumed the lab they use is their own. It is very obviously not the hospital’s main lab- that is probably in a deep dark hole somewhere, as is typical.
December 7th, 2006 at 1:23 pm
id_mt,
Specialization provides benefits in every field. But specialization beyond a certain point simply isn’t practical in the real world. A smart attorney knows his limits and will refer cases that he can’t handle; but every referral is money out of his pocket, and too many referrals will cause clients to look for attorneys able to handle more of their work – no one wants to run all over town seeing different specialists. But doctors have a more captive clientele than attorneys, both because of the nature of the service and less competition, i.e., people have to go to the hospital and there aren’t that many hospitals to choose from. From the discussion on this site, I get the impression that hospital doctors are overspecialized. I assume that doctors in private practice are more like attorneys.
I agree with you that the lab the YGs use seems to be their own – they can use it anytime and there’s never anyone else around.
January 26th, 2007 at 2:20 pm
This episode made me want to smack both House and Tritter upside the head. House is being petty and cruel because of his interrupted Vicodin supply, and Tritter…is so wrong it’s not even funny. It’s clear that he’s meant to parallel House in many ways, but even House hasn’t shown such a capacity for sheer vindictiveness. Yes, House has often been spiteful, and he sought revenge on his old med-school nemesis, but Tritter, through his apparently godlike legal superpowers and the mysterious lack of intervention on the part of the hospital’s lawyers, should realize that he isn’t making House suffer half as much as those around him. The victims here are Wilson and his patients. Whether he’s correct in his certainty that House is an addict or not, the man is directly responsible for denying pain medication to cancer patients who have nothing to do with the bullying match between House and Tritter. Shame on House for not giving a damn about his already fragile friendship with Wilson.
March 28th, 2007 at 10:00 pm
I’m starting to get the idea that the Young Guns (the ‘Cottages’, down our way) doing all their own tests and whathaveyou is atypical even in the House Universe. That it’s a knock-on from House’s maverick methods/high abilities leeway. (Which possibly also means there’s a few regulations they’ve ‘forgotten’ along the way, knowing House (and Cuddy’s willingness to blind-eye him now and again).)
As for the cane, I’ve occasionally needed support for my walking, and when that happens I’ve been known to change sides based on how my arm and shoulder are feeling, rather than my leg/s. So maybe House prefers to use that arm?
April 21st, 2007 at 11:52 pm
Of course House is being petty and cruel: Pain loves company; when House isn’t in as much pain, he’s historically been compassionate enough to give people his beloved vicodin and he even made up an excuse to help Foreman deal with his psychological stress about imminent extreme pain (pain-induced stress cardiomyopathy*). Tritter, who thinks he is suffering, has no idea how much worse House was suffering already (physical leg pain, psychological pain about the DEA enforcing House not being allowed reasonable amounts of opiates, possible psychological pain about the events in episode 3-01, and psychological pain from the failure of drastic measures): He probably doesn’t care about House’s pain and thinks it’s the vicodin behind the cruelty; he (since you have to be an algesiologist or a pain-sufferer to know how serious extreme pain is) has no idea how dangerous House-in-pain is and also has no idea about how much suffering will occure if Wilson loses his DEA number, because he only knows narcotics as addictive street drugs that are far too dangerously addictive to prescribe to people. If only the war on drugs didn’t exist, Tritter would never have been so dangerously misinformed and there’d be no chance of losing the main character to PISCM.
Oh, and there’s a guy who appeared on a television show in Aus who said all you needed to do to beat nicotine (not just smoking and apparently without SA, RR, or Zyban) was to realise how the benefits of smoking that kept you smoking despite the risks are illusiory and that the actual balance of physical and psychological dependence was far in favour of psychological (he said studies with radioactively-labelled nicotine showed that the withdrawal symptoms are alleviated before the nicotine gets there).
* A friend borrowed it for a SF story for an English assignment and gave me it for proof-reading, drawing me here: This woman is treated for a disease which causes the local peripheral nervous system at the point of infection to, often irreversibly, cause constant pain that she describes as “like being exposed to molten tungsten and superfluid helium at the same time”, described as “Peripheral Hyperalgesia”; the character is described as having been put on the strongest painkillers available only after she suffered five pain-induced cardiac arrests and threatened to sue the doctor for “dangerous malpractice” and charge him with torture.
April 27th, 2007 at 4:49 am
Wouldn’t it be absolutely impossible to get Jack’s puke from the dumpster?
Even if it was possible, it wouldn’t be only the puke anymore. Pieces from the carpet, then stuff mixed with the other garbage, and some more left behind on the vacuum cleaner or whatever.
May 3rd, 2007 at 4:09 pm
interferon alpha is a quite legitimate treatment for chronic relapsing hep C. ok its no cure but its not way out.
May 16th, 2007 at 5:10 pm
As a fully qualified Biomedical Scientist (BSc Microbiology Msc Clinical Chemistry)
I find the YGs interest in our work refreshing. Most of the Doctors I work with have no
concept of what we do, or how we do it, most of the time I think they only order tests
that were on ER or Casualty (the British version for all you Americans) the previous night.
They seem to have no clinical significance what so ever. At least House tries to order
relevent tests.
September 5th, 2007 at 1:10 am
Steve, I understand your problem with the idea that House’s team performs all their own tests, lab work, and procedures, especially given the list of excellent reasons in your earlier response (54). However, there needs to be a small amount of suspension of disbelief in enjoying any sort of narrative. In the course of this episode, Foreman mentions that House “doesn’t trust nurses to do anything [but hold legs during lumbar punctures, etc.].” Though in reality it would be highly far-fetched for three doctors to be credentialed to perform all of the procedures these guys do, having specialists and random characters pop in to do the tests would probably clutter the show, and it’s not /impossible/ because their department isn’t specialized per se…
Don’t take my nit picking of your nit picking as anything more than that. I love your reviews and wish the writers would hire a proper medical consultant to bolster that half of the show’s appeal. Also, I love having a question or hunch that something is amiss when I’m watching and know where to go to get my answer.
August 23rd, 2008 at 6:05 pm
Yeah, i felt that the episode was both good and enjoyable, but how hot is Cameron?
Very hot, and clever.
nice.
February 19th, 2009 at 4:38 am
Hmm a comment on DIC- sure its ok to bleed from IV sites that have not healed yet- but bleeding floridly from the ears with no trauma seems over dramatic.
DIC has more internal petechial haemorrhages to my understanding. I guess for TV’s drama factor it is used but it is not fully correct!
April 24th, 2009 at 6:02 pm
Am I the only one who thought it a bit ridiculous for Chase to be digging around in a dumpster, searching for vomit to test, when anything in that dumpster would be so contaminated that any test results would be pretty meaningless? I mean really, anything they did manage to find would have all sorts of fun little germs and such in it after being in that dumpster, I’d think.
May 14th, 2009 at 5:15 pm
I didn’t get the part about House’s arm hurting being psychosomatic pain. Even if he feels guilty about what he’s doing to Wilson, I think it’s a stretch that that would cause the arm pain. Isn’t it just the cane usage over time, beginning to cause pain now that he’s no longer on Vicodin?
September 20th, 2009 at 5:25 pm
Hey, does Hep A really causes sudden nicotine intolerance?
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