House – Episode 22 (Season Three): “Resignation”
It’s the most shocking House yet! Not really — I just thought I’d mimic the ads that play every week (at least on the St Louis affiliate). How can every week be the most shocking?
In reality it was just another so-so episode. The mystery was good, but House’s final deductive leap was a little too unbelievable. The medicine was just OK, but the soap opera parts were much better than the past few weeks.
Addie, a nineteen year old college sophomore is sparring in a karate match when she suddenly begins spitting up blood. In the ER, a bronchoscopy was performed (looking down her lungs with a fiber optic scope). An Upper and Lower GI were also performed, as well as multiple blood tests. All were normal.
Chase suggests that Addie might have a hyperdynamic heart — one that’s pushing more blood than it should, causing extra blood to leak into the lungs causing a bloody cough (this is quite a stretch). A stress echocardiogram is performed but is normal. Chase notices that Addie has goosebumps, yet denies feeling cold or scared. Foreman states it might be a hypothalamic injury while House believes it is a sign of infection. He orders blood cultures, a lung biopsy, and starts her on antibiotics. She later develops diarrhea, but this is blamed on the antibiotics and never mentioned again.
Addie suffers respiratory arrest and requires intubation. She has a pleural effusion (a fluid build-up around the lungs) which is drained by thoracentesis. The effusion is transudative (this has to do with how much protein is in the fluid) which usually represents liver failure or heart failure. These seem unlikely since her echocardiogram and liver function tests were normal (though kidney failure can also cause a transudate — just foreshadowing here). House spots a trace amount of blood in the fluid and believes that it confirms his infection hypothesis, while Cameron points out that blood in the fluid could also represent a cancer. House next orders an arteriogram which is also normal. He is now convinced that the patient has Complement H Deficiency, a deficiency he claims is so rare that there’s no way to test for it. And it’s untreatable and fatal. A macular biopsy is performed but is negative (the macula is the most sensitive part of the retina; there seems to be a connection between age-related macular degeneration and certain types of Complement H abnormalities.). This doesn’t confirm House’s diagnosis, but it doesn’t disprove it either, so he considers it a good sign. The rest of the team point out that her symptoms could be caused by a brain clot or tumor. Cameron states that Addie was bleeding, so she can’t have a clotting disorder (Cameron’s never heard of DIC, apparently), so it must be a tumor. House still maintains Addie’s symptoms are due to the Complement H Deficiency and infection. An MRI is obtained, but shows no clots, tumors, or signs of infection. While in the MRI tube, Addie complains of a severe headache. The team pulls her out and discovers that a chunk of her scalp has become necrotic and started to bleed out. House believes this fits with his infection theory, but Chase states that it could be an autoimmune disease. He wants to put her on steroids. House states that if Chase is wrong and House is right, then Addie will likely have a heart attack as soon as the steroids are started and die. He allows Chase can give the steroids, but only with Cameron standing by with defibrillator paddles. The steroids are given and no heart attack results.
Later that night, House is woken by the news that Addie has developed severe kidney failure due to Hemolytic Uremic Syndrome (HUS) and is on dialysis. House points out that HUS is often caused by an infection (and is more common in people with certain Complement H deficiencies), then trots out the false dichotomy of the episode: he states that since Chase was wrong, House must be right and therefore Addie must have Complement H Deficiency. This means that she will soon die of her disease. She slips into ventricular fibrillation, but Foreman is able to revive her. House takes this as the final sign that he’s right and goes to talk to Addie and her parents. Shortly after talking with them he has a conversation with Wilson, and it the middle of it realizes that Addie does not have Complement H deficiency. Instead, Addie is depressed and has a death wish. She tried to kill herself with drain cleaner, but instead of drinking it, she placed it in a gel cap and swallowed it. This way, it didn’t start to dissolve her GI tract until it hit her intestine where it ate a hole (leading to spitting up blood). Scar tissue covered the hole, so the bleeding stopped, but the damage caused an artery and vein to grow together and this mixing of venous and arterial blood is seeding infections throughout her body. By repairing the blood vessel, Addie will be able to recover physically, but still has a ways to go mentally.
Not that the House writers have ever made it a completely fair mystery, but this week they definitely weren’t playing fair with the clues. Each episode usually makes a big deal of searching the patient’s house, but it wasn’t shown at all this week (though Cameron was ordered to) — and it would have likely turned up some positives (empty gel caps and drain cleaner, for instance). A patient has a likely gastrointestinal bleed, yet no EGD or colonoscopy were performed — because one of them should have showed the healing bleed, or at least the scar tissue (and according to the links in the narrative, the GI series should have shown scar tissue as well). Addie has all these infections, yet her blood cultures are all negative?
Otherwise, I’m not clear on the use of the arteriogram to look for infection, nor am I entirely certain why her “head exploded.” And why would steroids suddenly cause a heart attack? From what I’ve been able to ascertain, it is possible to test for Complement H deficiency (molecularly, functionally, and genetically). It may not be a common test, but since when has that stopped House?
I give the medical mystery a B+, because it was intriguing. The final solution I give a C. It was clever, but the way House was able to deduce exactly what happened, down to the anatomic level, instantly and without any lead up I found too unbelievable, even for House. Yet again, the medicine was blah. Not completely horrible, but not particularly good either. This is Grey’s Anatomy level medicine — it may be fine for that show, but it earns a weak C here. The soap opera was quite enjoyable this episode, particularly the whole Wilson on speed scene. I give it an A
The previous House reviewA list of all prior House reviews
May 8th, 2007 at 10:53 pm
I want whatever Wilson spiked House’s coffee with. An antidepressant that works after only one dose with no side effects other than a better ability to sleep? It’d be a dream come true…
May 8th, 2007 at 11:04 pm
Official Comment
Nick,
I think it was a week of coffees, but that’s still a valid point. Cymbalta claims to work in a week, so that might be Wilson’s drug of choice (but I’ve never seen it actually work that way and it causes significant nausea when first started, and House would have noticed that). Any other antidepressant would take 3-4 weeks.
May 8th, 2007 at 11:28 pm
As far as the speed of the antidepressant changing House’s mood,
I don’t know if it’s the speed of the drug effect or just an idiosyncratic reaction on our part, but both my wife and I had an immediate—that is, within 3 hours—positive reaction to citalopram. What really stumps me about this episode is: what kind of wretched brew have they been drinking that would mask the taste of 3 ground-up amphetamines? These guys have no taste buds at all.
May 9th, 2007 at 12:13 am
oh man, Wilson on speed was one of the funniest scenes I can remember. classic
May 9th, 2007 at 12:13 am
Another quality review. The Australian was on fire with his analysis of Foreman and House’s behaviors. Not too much from Cameron, other than the scene where she was a prowler that was going to kill House. On a side note Doctor Scott ((”Janet!” “Dr. Scott!” “Janet!” “Brad!” “Rocky!” “Unh?” etc.), do you tape the show and review it, or are you just a writing/analysis machine marking down all medical related info as it comes along? Or do you use a Molecular Transducer?
Here’s hoping they actually add Piper Pirabo (or anyone) to the cast and that they tell the cinematographer to pan down a bit more the next time Cuddy leans over. So close!
May 9th, 2007 at 12:15 am
I was prescribed Wellbutrin, which was supposed to take 1-2 weeks to take effect, but I had a reaction within about 5 hours of the first dose (great stuff, by the way!)
House-the-jerk always amuses me, so I was very happy with the soap opera this week. :)
May 9th, 2007 at 12:24 am
I thought it was hilarious that House and Wilson drugged each other…but that’s just me.
May 9th, 2007 at 12:29 am
The vicodin would’ve covered up the nausea, and considering that coffee is usually hot the amphetamines and antidepressants probably wouldn’t be tasted.
House also looked kinda jaundiced in some scenes in this episode. Anyone else notice that?
May 9th, 2007 at 12:33 am
Scott:
In http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=8809142
Complement H deficiency was seen via western blot, and in other publications, they went as far as sequencing the gene to find the mutations responsible.
In http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=9848786
they also used immunoblotting, and used southern blotting to check for large-scale mutations.
May 9th, 2007 at 12:57 am
House vs Wilson was excellent. Chase is showing progress in his deductive reasoning.
I’m kinda bored with the “I don’t wanna become you” spiel. Are Cameron and Chase also becoming like House? Why can’t Foreman not help becoming like House if he stays there?
I also don’t see why House is suddenly attracted to the 26-year old carefree nutritionist. Is it because of the antidepressants?
May 9th, 2007 at 1:05 am
Perhaps the lack of “good” medicine is due to a lack of ideas of the House writers?
If so, then I don’t have high hopes for the next season.
This episode had a lot of “What the..” moments. With the hole in the patient’s head and the random depression diagnosis. I wonder just how he deduced drain cleaner..
May 9th, 2007 at 1:55 am
If you look, House is already drinking coffee at the beginning of the episode. Its logical to assume that Wilson was buying him coffee aka dosing him long before that point in the episode. Besides, when does House ever get his own food?
May 9th, 2007 at 2:28 am
When they mentioned a pleural effusion, I immediately wondered if it was really supposed to be a pleural edema, and if I was going to be reading a complaint from you later in the evening, since they did seem to have trouble confusing the two a while back.
May 9th, 2007 at 2:29 am
In the case of the vegan boyfriend, House mistakenly concluded that the boyfriend’s floating due were due to fat in the stool from eating meat. Fat does not make stools float. Only gas can do that. It’s an old medical myth that was actually put to rest 35 years ago: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=5015442&query_hl=1&itool=pubmed_DocSum
Another thing is the consuming meat would not result in excess fat in the stool. Fat is efficiently absorbed, so only a disease that causes malabsorption could cause that.
Ironically, gas is likely to come from eating resistant starches and fiber, so, in fact, one would expect people who are vegan to generally experience floating stools. So if he had come to House complaining that his stools were NOT floating, it would have made more sense.
May 9th, 2007 at 6:07 am
OH SNAP! Grey’s Anatomy diss! I missed the first 20 minutes of this episode, so when I thought the final deduction was kind of far out, I figured that (and having no medical training at all) were to blame.
May 9th, 2007 at 8:36 am
I believe that when House gave Wilson the coffee he said that Wilson had been getting him coffee for a couple of weeks. I also thought Wilson on speed was hilarious. I had taken a drink and nearly spat it out when Wilson said to that patient, “Excuse me. I have to go kill someone.”
May 9th, 2007 at 9:13 am
Scott, you mention in your review that a colonoscopy would have revealed the scar tissue from the healing hole in the GI tract. Didn’t Cameron mention early in the episode that a colonoscopy was performed when Addie went to the ER? Along with other GI tests? I remember being surprised, at the time, that House was satisfied with “common, every-day” ER doctor’s test results, and didn’t have her retested by his Young Guns.
May 9th, 2007 at 9:21 am
Ok – I’ve been obsessing about this all morning and I have to put it in writing so I can get back to work. I think House’s breaking of patient confidentiality in last night’s ep bothers me more than all the more obviously unethical actions he’s ever done in a good cause. I know it’s a slippery slope to bring up how viewers could potentially misinterpret writing, but a viewer with a mental illness is probably already a bit paranoid about confiding in their doctor, and a scenario in which a doctor tells his patient her suicide confession is legally protected as confidential, and then promptly tells her parents without thinking twice about it, kind of sends them the message: “Your doctors will lie to you, and not keep anything secret that you tell them, because you’re crazy and therefore have no legal rights.”
That said, Wilson on amphetemines was delightful, and I second the citalopram shout-out above.
May 9th, 2007 at 9:22 am
Official Comment
Jayro,
I believe the ER just ran an Upper GI and a Lower GI (which are x-ray tests) and not an EGD and colonoscopy.
I’m a little surprised the ER ran those instead of the ’scopes since ’scopes are pretty much the standard of care for a suspected gastrointestinal bleed. I can understand a dinky little community hospital running a GI series because no gastroenterologist was available — but not a high-level teaching hospital.
May 9th, 2007 at 9:28 am
Definitely the best part of this episode was Wilson on speed. When he’s rambling and not making any sense to Foreman and then finishes with “You know what I mean. And you know I’m right.” Heh. And that’d be one uncomfortable female exam to have a doctor wink at you.
May 9th, 2007 at 9:54 am
When Addie turned to her mother and said “I’m sorry” (I think it was about halfway through the episode), I instantly knew she had done this to herself. I still have no idea how House worked out the details.
May 9th, 2007 at 10:17 am
Wouldn’t the ER(or whoever was taking care of Addy before the case was referred to House) do occult bloods or test her gastric contents for blood? The blood she was coughing up was dark.
Was Addy immediately seen by House after she was admitted into the hospital? I’ve always wondered about the timeline of when a patient first presents and is referred to House.
Even though I loved the Wilson/House scenes, why would anyone continue to be friends with someone who drugged them?
May 9th, 2007 at 10:18 am
re:Moon_Custafer
once you attempt suicide I’m fairly certain most states rule that you are mentally unfit and unable to care for yourself. By telling the parents, he likely prevented a second suicide attempt.
May 9th, 2007 at 11:25 am
House mentioned that by law he couldn’t tell her parents if she promised not to do it again.
She promised, but obviously House didn’t believe her. Legally, his a** was covered so he could have kept silent, but *ethically* he did the right thing by telling the parents. IMHO anyway.
May 9th, 2007 at 11:42 am
Koray asks if Chase and Cameron are also becoming like House. Well, of course–I was cracking up at Chase’s conclusion that Foreman and House were *both* ashamed of the reason Foreman was leaving. It’s exactly the kind of personal-boundary-transgressing analysis that House does on everyone else.
To live up to my handle, I ask if anyone else thinks that House taking up with someone wildly mismatched is a response to Cameron’s fling with Chase? Also, the season seems to be coming full circle, with ketamine/hitting on Cameron replaced with antidepressants/hitting on Piper Perabo. I’m wondering what’s going to happen as there’s very little time left in the season for this to play out.
May 9th, 2007 at 11:51 am
The promise of a mentally unfit patient isn’t legally binding though. House lied.
May 9th, 2007 at 12:13 pm
I’m still trying to figure out why that poor girl’s head exploded?? What kind of crazy infection would cause that to happen so suddenly?!? Hope I never get it! :P
May 9th, 2007 at 12:22 pm
Erica, it was obviously advertenza an infection which crops up when you need something special for the advertisements!
May 9th, 2007 at 2:10 pm
This is the first medical House case that confused me to bits (even after Googling and reading the above). It just didn’t make as much sense as usual. “Glad” too, to see someone else saying that except for a really funny Wilson scene nothing much happened in the episode.
I think I saw something very much looking like slightly pulsating brain when they pulled her out of the MRI, would that even be possible? Her skull cracking open like that?
(Especially with her so awake, talking, moving, and not complaining about a headache earlier)??
And yes, where did the kitchen cleaner suddenly come from and how can a merged vein/artery cause all those other symptoms?
And if it burns your throat I’m pretty sure gel caps dissolve in seconds, as in before you can swallow?
May 9th, 2007 at 2:16 pm
I agree he probably saved her life by deceiving her and teling the parents, it’s just – I don’t know, I started imagining
a viewer who was wavering on whether to tell his\her doctor about a past or future suicide attempt seeing that, and even knowing that it’s fiction, becoming afraid to trust to a statement of confidentiality.
May 9th, 2007 at 2:24 pm
I have a question. What was the point of
Wilson taking the Vicodin?
May 9th, 2007 at 2:44 pm
re: Carrie
Vicoden is a “downer” in that it makes you less energetic. Wilson was high on Amphetamines which are “uppers” Presumably the two help cancel each other out.
May 9th, 2007 at 4:09 pm
Moon_custafer,
Your scenario is different from the one House faced. A patient who tells a physician that he is contemplating attempting suicide or has attempted suicide is clearly seeking help and, we can assume, is therefore less likely to make the/another attempt. House’s patient never sought help; all he had was her insincere promise. In the end, professional ethics are different from societal ethics. House may have violated professional ethics, but I think many people would agree, including myself, that he did the right thing.
May 9th, 2007 at 7:03 pm
Hi Scott.
I’m an avid House watcher and reader of your reviews. Thanks for relieving a bit of the boredom I suffer at work.
I’ve seen all episodes twice if not more but how did Cameron get into House’s apartment?
Call me ignorant but I am dumbfounded how she got in.
May 9th, 2007 at 7:13 pm
I agree that Wilson’s speeding scenes were funny. I would have gladly stepped in to finish the breast exam, though, I must say.
May 9th, 2007 at 7:26 pm
The medicine in the last few episodes has been a let down. I thought the soap opera part last night was terrific. I wonder why the medicine was progressively worse throughout the season.
May 9th, 2007 at 7:44 pm
House has been… different for a while. The doctor that is, not the show. He’s been cheerful and really making an effort with his coworkers. I’d guess Wilson had been dosing him since “Half-Wit”, maybe we’ll be seeing a return of grumpy House. Wonder how the nutritionist will take part in the story. I’d still rather Stacey comes back! I’d also be sad to see Foreman go, he’s House’s ego after all!
To be a little pretentious and psychoanalytical- One could view Foreman’s departure, being the projected ego character, as House’s loss of self-schema. He’s changing a lot, learning to try and accept those around him. I know it’s a stretch…
May 9th, 2007 at 8:08 pm
Nick F… hahahaha “advertenza”… that’s priceless!!!
May 9th, 2007 at 9:58 pm
I too enjoyed House and Wilson drugging each other. Wilson on speed was hilarious! And House did seem to change due to his being drugged by Wilson. I’ve thought House needed some SSRIs or SOMETHING other than Vicodin for a long time. I’ve personally had to experience of Lexapro/Celexa “working” for me fairly quickly…in subtle ways.
Better living through pharmacheuticals!
May 10th, 2007 at 8:25 am
Chriss:
That comment about Foreman leaving and taking part of House’s personality with him is very clever. If that really is what they were trying to do, I think it adds an interesting layer of depth to the whole Foreman scenario. Perhaps the other two are also like repressed bits of his personality, though now I’m probably stretching it a bit.
May 10th, 2007 at 11:14 am
Moakek:
Considering how often they seem to go into a patient’s house to search for clues, I’m guessing House had them train as ninjas back in the first season.
May 10th, 2007 at 12:10 pm
I loved all the Wilson-House stuff. I loved Wilson handing House the (dosed) coffee without looking up. I loved House double-blinding the coffees for Wilson; dosing the one he didn’t give him, and I loved Wilson’s Four Horsemen of the Apocalypse joke.
I was on Prozac back when it was a brand new thing. They told you 2-3 weeks (and Wilson has been buying House coffee for two weeks) but in fact, it’s about 2 days in that euphoria hit like a m***erf***er. I loved House’s inappropriate smiles throughout the episode.
May 10th, 2007 at 3:30 pm
Tysior: Perhaps the other two are also like repressed bits of his personality, though now I’m probably stretching it a bit.
Well, Tysior. The Psychoanalysis theory would say that Chase is the “Id” and Cameron is the “Superego”, the theory actually fits the order of which House met all three characters. Chase first, then Cameron then Foreman.
May 10th, 2007 at 9:49 pm
I thought the great psychological moment was when he sees his own distorted reflection and realizes something’s wrong with him. Thank heavens Hugh Laurie usually underplays scenes like this and lets them speak for themselves.
May 10th, 2007 at 10:03 pm
I thought it was unrealistic for House to ask the pharmacist for 30mg of “your finest amphetamines.” There’s certainly no way he’d get them without at least a patient’s name, data, and diagnosis. In fact, I would suspect that House’s admitted abuse would have resulted in his not being able to prescribe narcotics (CII). I did see the pharmacist make a face at the order–that, at least, would be in character.
May 11th, 2007 at 12:00 am
As a professional writer, I’d like to offer my observations on the “segments of House’s personality” comment above. It’s long, but please bear with me.
Dynamically:
House was extrapolated from Sherlock Holmes and lays it out fairly broadly: House/Holmes, Wilson/Watson. Brilliant deductive (actually, inductive) reasoning through observational powers far above anyone else but a Monk-like obsessive-compulsive.
Wilson and the Young Guns were designed as a fragmented externalization of House’s character to play out his internal dynamics without the lead character having to stand and give speeches about his view of the world.
Wilson is House’s connection to humanity, being the only person who can be his friend and still tolerate his “inhumanity.” In awe of House’s brilliance, he accepts the “lesser companion” role to witness these tour-de-force accomplishments from a sympathetic POV.
Chase, as introduced, was aloof, self-centered and naturally used to getting his own way as a result of privilege. He also detested contact with patients. He’s a personification of House’s professional ego and aversion human/patient contact. Also, as a failed seminarian and current ethical opportunist who sees no problems with betraying House for his own benefit, he reflects House’s conscience-free manipulation of others’ moral urges.
Cameron, as introduced, is the externalization of all the humanity that House lacks. She’s caring, empathizes with the patients (to the point of detriment to her job-demanded distancing), and worries about moral conflicts. She’s the externalized conscience and heart.
Foreman is a bit more complex than the other two in his construction. Partly, he represents the dynamic of personal drive/betterment, having dodged a criminal/outlaw career to focus himself on excellence above expediency. He exemplifies the conflict between ethics and pure accomplishment, contrasted to the experience of asocial criminal opportunism. He crossed from the ethical negative to embracing the ethical positive, a line House crosses constantly to get what he wants from other people. As with the Arthur Conan Doyle prototype, he’s there to demonstrate the parallels between Holmes and Moriarty. Holmes used his skills to solve criminal puzzles—simply because he chose_ to. If he was so inclined, Holmes could have been a greater criminal genius than Moriarty. His position is strictly an intellectual choice, not a moral or ethical decision. House would make an extremely successful con man/politician.
I apologize for being long-winded, but building characters like this is what I do for a living, and I am blown away by the sheer craft of creating a show this good.
Also, I take back what I said above about not tasting the speed in the coffee. House has been dry-swallowing Vicodin for years. He has no taste buds as we know them. Lick one someday and you’ll know what I mean.
May 11th, 2007 at 12:08 am
Oops, I made a mistake on the speed comment. I confused Wilson and speed with House and the anti-depressants. I still don’t know why Wilson couldn’t differentiate between expresso bitterness and amphetamines. They’re very different.
May 11th, 2007 at 12:56 am
David,
Then what do you think of what happened back in the episode (titled Meaning iirc) where House was shot? I thought that the swollen tongue, exploding eye and penis belonged to House himself.
May 11th, 2007 at 12:33 pm
Koray,
That episode was designed to demonstrate that House’s deductive powers work on an innate, subconscious level. After all, House deduced _from inside an hallucination_ that what he was experiencing was an hallucination, then rationalized that the only way to break through back into reality was to grossly violate the “rules” of the delusion, destroying its reality by imposing his own reality on it by sheer force of will.
As for the gross stuff, where else on PG TV can the writers/producers get away with splatterflick gore? I think they do it for the fun of grossing out the audience. In the same vein, there are subtle jokes worked into the show that it _is_ a show. In the arc where the new corporate boss wanted to fire House, his complaint was that “he had a budget of $3 million, but only treated one patient a week.” Later, Cuddy complained, “22 times a year you storm in here and….” House and the mouse alludes to the 3 Stewart Little movies Laurie did as Stewart’s Dad. And in this season, Chase tells Cameron that “every Tuesday” he’ll gently remind Cameron that he likes her. What night does House air on?
BTW, I forgot to add the final Holmes/House parallels: Holmes had a cocaine addiction, House has a Vicodin addiction. Holmes lived at 221B Baker street and House in apartment 221B. Holmes played the violin, House plays guitar (admittedly, the piano is there because Laurie is an accomplished pianist and singer).
May 11th, 2007 at 10:54 pm
That reminds me of something I was wondering abvout, actually. If House can reference 24 and other shows that are on in the real world, what’s on Fox at 9 on Tuesdays in House-world? Holmes?
May 12th, 2007 at 12:08 am
Ben; pick any one of FOX’s brilliant and cancelled series. Firefly, perhaps?
May 12th, 2007 at 2:33 am
That reminds me: I thought, while watching the first-season DVDs, that on occasion House would be watching a soap opera on one of the hospital TVs, and Chase would be on as a doctor (well, Jesse Spencer). Is it him, or just someone who looks vaguely like him? If it is him, did it air on TV like that, or is it just a DVD joke?
May 12th, 2007 at 9:40 am
David,
My friend and I also picked up on the Holmes thing rather quickly. There’s another comparison that you forgot, in the books of Sherlock Holmes, Watson is quite the ladies man (Wilson has been married 3 times and working on his 4th).
May 12th, 2007 at 10:38 am
About floating stools: :)
Jus read the following:
“Floating stools are seen in a variety of different situations. Most are diet-related, or caused by episodes of diarrhea that accompany an acute gastrointestinal infection. A change in dietary habits can lead to an increase in the amount of gas produced by bacteria in the gastrointestinal tract.”
A change of diet, meat instead of veggie may cause the “floating” so .. I guess Greg was not crazy this time :)
May 13th, 2007 at 1:23 am
Nick F: I don’t think House’s promise was “legally binding” either, really.
May 13th, 2007 at 9:48 pm
On the ‘promise you wont try to kill yourself again’, someone who has tried to kill them self is more likely to try it again than someone who hasn’t for the first time. Suicidal tendency (IMHO) can be a symptom of depression and/or anxiety requiring psychiatric help. But if the person’s suicidal tendency is determined enough, they are not likely to seek the help they need, probably smart enough to dodge it. The only reliable way they could be treated would require intervention from family/loved ones. I hope doctors are not held liable for violating any laws or oaths when they ‘tattle’ on an adult who is suicidal to their family.
May 14th, 2007 at 10:50 pm
To Scott: Do diagnostic departments with its sole purpose to diagnose difficult cases really exist?
May 16th, 2007 at 12:37 am
I’m curious why a woman with a lump in her breast was hooked up to a pulse oximeter. Did they expect her to go hypoxic while waiting for Wilson to show up? It also seemed like that probe had gotten an awful lot of information from a simple LED/photodiode attenuation measurement, but for all I know that might really be the state of the technology.
August 3rd, 2007 at 2:33 am
Nick,
I think it was a week of coffees, but that’s still a valid point. Cymbalta claims to work in a week, so that might be Wilson’s drug of choice (but I’ve never seen it actually work that way and it causes significant nausea when first started, and House would have noticed that). Any other antidepressant would take 3-4 weeks.
House was on the anti-depressant for at least two weeks – see Housetraining: H/W scene, House’s office. In Resignation – House doping Wilson scene, he tells Wilson that he bought him an expresso to pay him back for the two weeks worth of coffees.
Wilson may have been on anti-depressants since after Words and Deeds because on the official Fox episode summary, it says Wilson was “devastated” when he found out House had been getting Vicodin the whole time he was in rehab. Also, in Half-Wit, we see Cameron running after Wilson as he’s leaving work. Wilson tells her that he’s late for an appointment. So based on the episodes – HW; TS; AYA; HTrng; Family; Resignation, Wilson would have been on anti-depressants for at least five weeks – excluding Resignation.
December 27th, 2007 at 10:12 am
as to how cameron got into his appartment… in a previous epsode in season 4 cameron and chase decide to search his appartment when he is suspected to have cancer. cameron finds his spare key on the frame above his door. thats how i assumed she got in. that or house just left his door unlocked.
December 27th, 2007 at 10:13 am
sorry its actually season three.
January 10th, 2008 at 6:57 am
I just watched this episode over in Germany and was a bit puzzled about the brain surgery scene. Did anyone realize that no-one was wearing any masks while working on the open brain? I am no physician, but this setting didn’t look very sterile at all. Weren’t they supposed to wear appropiate garment?
January 25th, 2008 at 10:21 pm
if the AD would have been Cymbalta, House would’ve definately feel something pretty fast. And why should Vicodin cover the nausea? House is on Vicodin for years, it’s pretty unrealistic that he’d still had nausea or he would have changed the opioid. Also, as I’m a pain patient, I know both and the Cymbalta nausea is different. Also, House would have behaved differently, cause frankly, Cymbalta is almost like meth, it speeds you up, leaves you sleepless and makes you somehow erratic. the nausea is barely reduced by metoclopramide. I for one took it for three days and I’m never doing it again, it’s unbearable as an AD, and most people withdrawing from it are pretty messed up for months.
That wilson-on-speed scene was hilarious, the soap opera in this episode is one of the best in the whole series. I even suspect that this were the amphetamines house kinda “stole” from Mark Warner.
February 7th, 2008 at 4:58 am
as an aside, cymbalta might be more likely to cause reflux and/or acid indigestion rather than nausea – similar to wellbutrin. As an aside, how many times can amyloidosis be mentioned on the show?
regarding floating stools – this is one of those useless diagnostic tools House uses all the time: A non unique symptom is described as unique or pathognomonic. Stools float for lots of reasons but the most common reason I can think of is gas. Vegetarian diets can be quite gassy for example, so I’d say floating stools is more likely confirmation of veg. diet than refutation. I heard someone tell me that they thought they had worms because their stool was floating. It could be worms, but again, diagnostically not very specific.
I’m not sure about this but steatorrhea or fat in the stool is often accompanied by lots of gas and diarrhea. But a large man used to eating fat would not have steatorrhea from eating a hamburger unless there was something wrong with his digestion. Even if he had been on a veg diet for awhile and “backslid” to meat, I don’t think he would be excreting undigested fats. Anyone have experience with this?
February 17th, 2008 at 10:42 pm
Many months late on this, but like David and his wife above, I literally had a huge positive turnaround within 2-3 hours from my first dose of Celexa (citalopram) also. It is an SSRI and they are all supposed to take 3-4 weeks, but maybe there are exceptions to that rule.
March 28th, 2008 at 7:27 pm
Not sure if this has been covered, but re: first post about anti-depressants taking several weeks to work:
After slipping amphetamines into Wilson’s coffee, he explains his behavior to Wilson by saying: “You’ve been buying coffee for the past couple of weeks” or something to that effect. So Wilson had probably been dosing House for a while by that point, and House was just beginning to feel the effects.
May 16th, 2008 at 4:58 pm
As for drug related issues:
1. 30mg of amphetamines shouldn’t raise someone’s heart rate to 185 bpm unless they are extremely sensitive or have a heart condition. Wilson would have got speedy, but not THAT speedy. Maybe it was a higher dose, I just assumed 30mg based on an earlier post. (The caffeine in the coffee could have contributed to the jittery and unpleasant nature of the effects though)
2. Why would Wilson ask for vicodin when he is speeding? That would just make for a risky speedball combination that would be even more dangerous! If he asked for benzodiazepines it would have made more sense. Unless, of course, he figured he might as well get more high and take the edge off, risks notwithstanding.
3. Most anti-depressants have such high incidence of easily noticeable side-effects you’d think that House would get suspicious sooner.
July 14th, 2008 at 12:40 am
Anon- I’m not really an expert on drugs, but consider that Wilson was already taking his antidepressants. If we do assume he’s taking Cymbalta, it blocks the reuptake of norepinephrine and seratonin. Amphetamines do this also. So, that’s also why Wilson accused House of almost killing him– he had both his anti-depressant AND the amphetamines in him.
And as for the Vicodin… Wilson was obviously high, plus he knew House had the Vicodin on hand, and Vicodin is a downer. It is dangerous to combine uppers and downers (yay speedballing /sarcasm), but as Wilson said, it was “so I don’t stroke.” And he only took one (as far as I could see) which was probably only like 5 – 15mg, so it was about as cautious as he could’ve been.
…and I’m sure he felt pretty fine afterwards, lol.
July 19th, 2008 at 7:30 pm
To the person who wondered what kind of syndrome could cause someone’s head to explode that suddenly… maybe Sudden Exploding Head Syndrome?
Just kidding. That is a real thing (wikipedia it), but isn’t actually related to the patient’s head bursting open.
November 15th, 2008 at 12:53 pm
Did anyone else think that when House is sleeping and we hear a knock at the door, and the door open, and footsteps, and we see a shadowy figure that it was Stacy!?
December 17th, 2008 at 8:39 am
You do a macular biopsy sticking a needle in the middle of the cornea and through the lens will make the patient immediately blind in many many ways. They never do anything related to ophthalmology right.
December 28th, 2008 at 6:39 pm
How would connecting an artery to a vein allow infection to spread faster through the body? Aren’t veins already connected to arteries by way of capillaries? If infection is in the blood, it is going to spread throughout the body anyway. There are so many things wrong with this show medically on so many levels…..
Anderson, I thought the same thing about the macular biopsy. The macula lutea is the area where light is focused on the retina. Sticking a needle in there would cause irreparable vision loss.
Also, wouldn’t spiking someone’s coffee with drugs result in an arrest and immediate suspension of one’s medical license?
February 6th, 2009 at 12:30 am
And nothing on Wilson’s yawning bit? Aw…
Wilson happens to yawn during the conversation in which he has just learned of Foreman’s resignation notice (at 7′:23″ in the episode). House picks up on that clue, pointing out that Wilson couldn’t possibly be tired late in the morning, drinking coffee moreover, nor could he possibly be bored with the conversation, and proceeds to start interrogating Wilson about it, starting off listing possible causes: “Vasovagal issue, maybe a heart problem.” Moments later (8′:35″), during a meeting with his team for the case at hand, House throws in the question “What is pandiculation symptomatic of?” (and here i had to look it up, and apparently it has more to do with stretching than yawning, the latter often being an accompanying phenomenon. Even the etymology of the word points to stretching. Wilson had not stretched, he had simply yawned. Hum.) Foreman starts with “Yawning is a symptom of fatigue or cholinergic excitation.” Chase offers “Cerebral tumor, epilepsy… ‘could also be a medical reaction to antidepressants or some meds for end-stage liver failure.” Later (25′:50″), when Wilson confronts House for having spiked his coffee, although still on the “speed”, he yawns again, at which point House resumes the interrogation about it, this time suggesting but either a cerebral tumor (in which case Wilson would have “only six weeks left to live”), or the antidepressants.
The Wikipedia article on “Yawn” seems to differ quite a bit on the causes of yawning. What say you?
March 3rd, 2009 at 7:01 pm
If Wilson happened to choose an MAOI as an antidepressant, House might just have killed him. Now that would be excellent comedy/drama. Also, it’s well in keeping with the show’s tendency of greatly exaggerating the risks and adverse effects of drug use, but ‘amphetamine withdrawal’ following a single dose? Just a regular come-down, which had been made more comfortable with the hydrocodone he took, plus a benzodiazepine he could’ve prescribed himself ad lib. Lest we forget, for all the demonization of methamphetamine (particularly), it is the staple of Air Forces around the world as a safe and reliable method of keeping pilots awake during long missions (’Go’ and ‘No-Go’ pills). Methamphetamine is also prescribed for daily use for recalcitrant ADD or excess fatigue/sleepiness of various causes.
What was with the exploding head?
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