House – Episode 23 (Season Three): “The Jerk”
A better episode this week than the last few, though there were still some strange holes in the medicine. The soap opera wasn’t as good as the last few weeks though.
Nate, a brilliant but unpleasant teenager is competing in a speed chess tournament. He wins his game easily, but becomes suddenly violent after the match and starts pounding his opponent with the time clock until he’s unconscious. Nate then complains of a terrible headache.
Once admitted to the hospital, Nate is evaluated by Chase who brings his case to the rest of the team The initial differential diagnosis includes parasites (tests are negative), brain tumor (MRI is negative), toxins or drugs (tox screen is negative). Foreman suggests an adrenal gland tumor, but House suspects Nate is suffering from cluster headaches. House wants to start Nate on blood thinners and transcranial magnetic stimulation (there’s a lot of other treatments they should have tried first). Neither treatment works, and Nate continues to complain of his headache, as well as face, shoulder, and stomach pain — but these last ones are attributed to the multiple fights he’s been in recently (but what do stomach pains have to do with fights?).
House persists in his belief that Nate has cluster headaches. Cameron suggests hemochromatosis (an iron storage disease) but House points out that it wouldn’t explain the personality changes. Chase suggests hypothyroidism but House shoots the idea down explaining that Nate does not show any of the metabolic slowing seen with low thyroid levels. A ruptured dermoid cyst is mentioned as well, but no sign of it has shown up on any scans. House decides the best treatment is to give Nate psychedelic mushrooms because the psilocybin in them is thought to help with cluster headaches (i’d be interested in how House got his hands on a Schedule I Controlled Substance). The mushrooms do seem to help his headache, but also make him very horny. He flashes his equipment at Cameron — she is underwhelmed and in fact notes that he has hypogonadism (abnormally small underperforming testicles). Concerns now include a hypothalamic lesion or a craniopharyngioma. House wants a biopsy of Nate’s pituitary gland. While he is refusing the test, he becomes dizzy and passes out. Examining Nate, Chase notes that he is showing signs of jaundice — a sign of liver failure.
The differential diagnosis of liver failure is a long list. Diseases mentioned include Wilson’s disease (a disease of copper metabolism, but his copper enzymes are fine), cancer, primary sclerosing cholangitis (an inflammatory disease of the bile ducts), alcohol abuse and Ornithine transcarbamylase (OTC) deficiency – a genetic condition where the person has trouble eliminating excess nitrogen from the body). House orders a “hamburger test” (a large meal of meat because proteins contain lots of nitrogen), but the results are negative. He next orders the Young Guns to withhold all food from Nate to rule out Diabetic Steatosis (abnormal fat accumulation in the liver caused by diabetes). Nate becomes violent and when asked to produce a urine sample and pees on the floor. It turns out that he has quite a bit of hematuria (blood in the urine) that in case shows that Nate has also developed kidney failure.
The differential now includes HIV, hepatic fibrosis, MCADD (Medium Chain Acyl-CoA Dehydrogenase Deficiency — another genetic metabolic disease. Patients with this one get very sick if they skip meals), and Von Gierke Disease (also known as Type I Glycogen Storage Disease). The tests for all these conditions are all negative, but Chase does discover that Nate has a partial HPRT (Hypoxanthine-guanine phosphoribosyltransferase) enzyme deficiency that means he may have Kelley-Seegmiller Disease (better known as Lesch-Nyhan Syndrome). House decides to test Nate by purposefully getting him angry. He plays him in a game of chess while taunting him. In the end, House appears to lose the game, but Nate has a seizure. The team discusses possible diagnoses and House now fixates on Foreman’s suggestion of Amyloidosis. He starts Nate on immunosuppressants and starts looking for a bone marrow donor. In the meantime, Foreman performs a nerve biopsy looking for the signs of the amyloidosis, but the test is negative. House is unconvinced and sends Foreman back to do another biopsy. Meanwhile, a discussion with Chase turns House on to the actual diagnosis –- hemochromatosis. The bad personality has nothing to do with disease; Nate is just a jerk. The “eureka moment” came when House realized that Nate is unable to bend his thumb so he holds his chess pieces unusually. This is due to the iron deposition from hemochromatosis affecting his joint mobility. It’s a good news/bad news scenario: Nate should be able to control his hemochromatosis with treatment, but he’ll always be a jerk.
I thought the medicine was better this week than the last few weeks, but still not as good as it’s been in the past. There was a great deal of jumping from one diagnosis to another without good flow. The whole “cluster headache” idea was handled poorly. His symptoms did not fit the condition. Steroids are not the main treatment of cluster headaches, and not everyone with cluster headaches have puffy eyes. There are many more treatments they should have tried, especially triptans and oxygen. The amyloidosis seemed like quite a stretch. Simple blood tests should easily show hemochromatosis, and I’d also suggest a liver biopsy , which is generally a good idea when there is liver failure with an unknown cause. At the very least, a liver ultrasound or CT scan should tell quite a bit, like whether there’s a fatty liver or not. I liked how the diagnosis rested on a symptom shown in the very first scene, but I’m puzzled
I give the medical mystery a B, because it was fairly interesting (though I laugh at House telling Cameron that there is always a single solution). The final solution I give an A. It was clever and actually telegraphed for one. The medicine earns a B-. Better than it has been, but it still should be better. Hemochromatosis should have been found much quicker, and they need to go back to school to learns more about cluster headaches. The soap opera was fair and earns a B.
May 15th, 2007 at 10:50 pm
I had been reading a lot about cluster headaches prior to seeing the episode and the medicine and jump to cluster headaches did seem pretty lousy and more like an excuse for house to play with shrooms…
May 15th, 2007 at 10:52 pm
Didn’t they do Hemochomatosis before in the Friend’s Daughter Episode last season around this time in the season?
May 15th, 2007 at 11:04 pm
Yah, they didnt they already do hemochromatosis…
May 15th, 2007 at 11:07 pm
House should have said, “It can’t be amyloidosis. We used that one earlier THIS SEASON! It’s one thing to recycle a diagnosis from a previous season, but this is just silly.”
May 15th, 2007 at 11:29 pm
A sufferer of Cluster Headaches… POTW didn’t have them. It is all but impossible to sit still and just lay there and groan when you’ve got an attack like this kid did. Clearly no one on staff knew how tell the kid to act like he had one, i.e. rocking back in forth clutching and clawing his head, screaming in agony, sweating, with red eyes and writihing around endlessly. He acted more like he had a migraine.
May 15th, 2007 at 11:31 pm
Incidently, when my doctor diagnosed me with CHs she put me on Verapimil and it’s worked marvelously for me. No ‘roids, no shrooms, no O2 Therapy for me. Just sweet, sweet, Verapimil which they can pry from my cold, dead, hands as it prevents me from being in utter AGONY!
May 15th, 2007 at 11:53 pm
My one very minor complaint was House playing chess against what appears to be some type of prodigy (or at least a very advanced player). From what I recall, House hasn’t been seen playing chess before. Now, House is known for tossing out knowledge of languages to limited degrees, but playing a prodigy in chess is something different. It’s too big of a stereotype for “smart people” to play chess well. House is undoubtedly intelligent (and if playing before quite possibly would make a great chess player), but being smart doesn’t mean you’re a great chess player. Having this largely just thrust out in one episode where House is at least holding his own (if in the end he would’ve made an error) against a prodigy is just not believable to me without SOME prior setup. Some glimpses of a chess board, one of his parents or Wilson asking to play a game, SOMETHING before this episode to give light that House is a chess player.
Like I said, pretty minor, but it just ticked me off.
May 16th, 2007 at 12:08 am
To Scott: Do diagnostic departments with its sole purpose to diagnose difficult cases really exist?
May 16th, 2007 at 12:19 am
So why did the kid start bashing his chess opponent with the clock? Simply because he was a jerk? Or was his headache so severe that he lost control?
May 16th, 2007 at 12:46 am
Readers who have access to the NYT website may want to check this article about a person whose hemochromatosis was never diagnosed until it was too late.
http://query.nytimes.com/gst/fullpage.html?sec=health&res=9402EFD8173EF933A15756C0A9659C8B63
May 16th, 2007 at 1:00 am
Isn’t the severe anti-social behavior that this kid expresses a sign of psychosis of some kind? There’s being a jack-ass teenager with a superiority/inferiority complex and then there’s insulting every person you deal with and getting into 19 fights in a month, as I believe the episode mentioned. Put him on Ritalin or something, at least, and get him physical exercise not ’speed chess.’
May 16th, 2007 at 1:21 am
Yeah, Buddwing — that’s pretty inexcusible behavior, even for a headache-addled uberjerk. This kid will be in jail the rest of his life, once he’s 18 and can be prosecuted as an adult uberjerk.
May 16th, 2007 at 1:23 am
p.s. — how often do we hear “his/her liver’s shutting down” on this show? It’s like 24’s “setting up a perimeter”.
May 16th, 2007 at 2:18 am
Interesting “faux product placement”: The bottle of “ONS” that House washes down his vicodin with, a deliberate misspelling of the “NOS” label of energy drink. Got a lot of screen time, in two scenes no less…
May 16th, 2007 at 3:05 am
I know why no work-up was done on the aches and pains POTW initially presented with. Because, in real life, no work-up gets done on the information you, as patient, try to divulge if it doesnt fit the special interest of the physician. My own is experience is along the order of
me: “Doctor, my leg has been hurting since a walk I took. I think I tore something.”
PCP: “I’ll send you to a neurologist right away!”
me: ???
neurologist: “I must find out why your leg is so weak!”
me: “I think I tore something.”
(series of expensive, time-consuming tests)
neurologist: “The good news is that you don’t have a brain tumor. I think you have lupus. See a rheumatologist.”
rheumie: “Why do you think you have lupus?”
me: “I don’t think that. I think I tore something.”
(more blood work ensues)
rheumie: “You don’t have lupus. You should have physical therapy.”
me: “Oh, god. Not that. What about the part where I maybe tore something?”
rheumie: “Um….”
So, anyway, it seems to me that the House writers have it down accurately. Try to get a painful leg taken care of, and end up with an MRI, enough blood drawn to feed a castle full of vampires, and a differential diagnosis of lupus. Of course, in real life, patient simply stops pursuing a diagnosis and treatment, while on House, patient is starved, force-fed, drilled into, and prepped for transplant.
May 16th, 2007 at 4:28 am
Without any seriouseness whatsoever; I find it suprising that you felt the need to say:
“but I’m puzzled shy no work up was ever made of all the aches and pain he had.”
I can only figure that being “puzzled shy” must be doctor code for “embarassed,” an emotion brought on by the realization that people assume that the charachter’s failures in some way reflect on your profession or that they had good reason for their actions and you just don’t know what it is. This is probably aggravated by the damage to your ego that you mentioned in the previous post. As treatment I would recommend staying away from comic books as they tend to have “superheros,” idealized people with unmuman powers, that might further damage your ability to understand the great work you do. Instead I recommend posting a blog entry about politics full of vitriol and unsubstantiated claims, from what I’ve seen it’s a real ego booster. Just be careful as it also appears to be highly addictive and contagious.
Anyway, I hope you’re feeling better.
May 16th, 2007 at 6:25 am
Personally I found the social issue they raised in this episode to be the most interesting — how do you deal with someone who is intentionally antagonistic?
If you ever use this thing called the “internets” you’ll know that’s how everyone on planet Earth acts the instant they’re not personally accountable for what they say, but in real life it’s harder to “ignore” someone standing in front of you.
I know they say “just don’t let them get to you” but that seems like a cop-out. Short of violence (which really just plays into their hand anyway) what’s the best way to handle a jerk?
May 16th, 2007 at 6:52 am
I thought the kid actor was great – like an evil imp. I also liked the scene where Chase accused House of stirring up trouble, and House showed him some respect for a change. I think Chase is the one who really ‘gets’ House.
I enjoy the little fake product placements (a lot more than I enjoy real product placements)…where can I get a ‘CHOMP’ candy bar?
May 16th, 2007 at 6:59 am
Oh, and although I’m no expert on Magic Mushrooms, everyone I saw eating them in college also had nausea, at least at first.
May 16th, 2007 at 7:22 am
I got a kick out of this episode because I actually recognized two of the enzymes (ornithine transcarbamolylase and hypoxanthine PRPP ribosyl transferase), but hated not recognizing hematochromtosis.
Is there a text or compendium somewhere that lists standard tests, procedures, and results for the diagnosis of metabolic diseases?
May 16th, 2007 at 7:30 am
So House hired Chase for something more than just his father making a phone call? I wish the writers had expanded on that.
Did anyone think Cuddy offering that position to Foreman rather strange?
May 16th, 2007 at 8:34 am
There was a scene where House suspected Cuddy of lying about trying to sabotage Foreman’s job. He said he could tell she wasn’t telling the truth because of twitches in her eye and lip. I thought this was interesting, because I remember from a show on the human face on TLC a few years back (hosted by John Cleese) where they did a test to see if there was any group of people who could tell when someone was lying. It turned out that everyone scored about the same, including cops, civilians, FBI agents, etc… except one group of secret service agents (or something). They could tell by looking at micro-twitches in the face, extremely short time-span involuntary motions. Just thought it was cool that House mentioned that (showing how smart he really is).
May 16th, 2007 at 8:47 am
Official Comment
Nick F. and Dan,
You are right. Hemochromatosis did show up as the diagnosis in an earlier episode (Season 2, #23, “Who’s Your Daddy”)
Sean,
The House as brilliant chess player struck me as wrong too. The piano playing from a few episodes ago made sense, because we’ve seen House play piano before, but the chess ability just seemed to come out of nowhere.
Anonymous,
I’ve never known any hospital to have a ‘differential diagnosis’ department. For one thing, the cost would be prohibitive. May hospitals do have some doctors who are known unofficially to be very good at bizarre diagnosis, so they are often consulted or end up on the case one way or another.
A final thought. The disease may not have been causing Nate’s personality, but he clearly had a pathological personality disorder of some kind. He goes way beyond jerk. He will end up in prison or shot (or OD’d) by his 18th birthday,
May 16th, 2007 at 9:20 am
I don’t see why House being a chess player would be a problem. We’ve been shown and told time and time again how brillant House is and Chess is certain a thinking-man’s game and we know House is not only a deep thinker but also very observive and cerebral. Just because we’ve never seen House play Chess in the 3 years we’ve known him (of which we’ve seen only couple hundred days and at that what ammounts to just hours of his life) dosen’t mean he dosen’t play Chess. Before mid-last season we didn’t know he was “brillant” and playing poker either. House is just a good, old fashioned, Rennisance Man who can do just about everything. Holding his own against a Chess Prodigy didn’t strike me as odd. For one, House has experience on the kid for two House far more observing of people than the kid is, the kid just out-bluffed him.
May 16th, 2007 at 9:20 am
What I still don’t get is the unprovoked beating with the chess timer. That can’t simply be written off as an asshole with a headache. I’m just a layman so I’ll use layman’s terms – it seemed like his behavior throughout the episode was neurotic but the beating was psychotic.
May 16th, 2007 at 9:58 am
Anonymous (16): That’s a typo for “I’m puzzled why…” since w and s are right next to each other on the typewriter.
binky: Yeah, that was weird. Cuddy’s assertion that Cameron and Chase would have been OK with Foreman making more money since he would be heading his own team made no sense, since they would have definitely had a problem with him heading his own team! (At least, I have to assume they would; they have the same three years under House, and it’s not clear that any of them–Foreman included–is that much better than the other two.) One has to wonder what Cuddy would have actually provided if Foreman had accepted, and if she was actually sincere, why she wanted him to stay that badly.
Tysior: I don’t think he said he could tell she was lying–I think he said he was looking for a tell that would determine if she was lying.
Scott: Yeah, that kid was pretty over-the-top. From the other side of the screen, I could sit back and chuckle, but I can see how if he was right there in front of me, I’d want to clock him a good one (no pun intended). Did it seem proper to you that Chase suggested to the mom that his personality might improve with the treatment at such an early stage of the game (first segment after the prologue, if I recall correctly)?
May 16th, 2007 at 10:05 am
Chess is all about knowledge and being able to look forward steps. He obviously wasn’t too great because Nate beat him at the start, and only after rigorous study of the board did he find a way out (which for Chess pros shouldn’t take too long).
May 16th, 2007 at 10:50 am
This has been going on for several episodes (and maybe it has been mentioned on here before) but I just noticed that each time, when Chase tells Cameron, “It’s Tuesday… you know what that means… I still like you,” the episodes always AIR on a Tuesday night too! Has anyone else noticed this?! Just more indication of the brilliance possessed by the HouseMD writers.
I, too, enjoyed the chess component. For some reason, it came as no surprise to me that House is an outstanding chess player. It fits perfectly with logical reasoning skills.
Also, IMHO, the drama this week has been some of the best ALL SEASON! I have never laughed so hard as I did when House was playing chess against the jerk kid and they were trying to distract each other from the game. The kid says, “I’m not a cripple.” House responds, “I don’t bleed from my penis.” hahahaha! HILARIOUS!
Also, the mystery about who cancelled Foreman’s interview was top notch, and I loved the cliff hanger at the end. What is House’s motivation for telling to keep working and, “It looks like it’s going to be all-nighter?” Is he trying to get Foreman to trust in himself and his own instincts as a doctor? I’m still trying to decide whether or not House wants Foreman to leave, and/or whether or not Foreman actually wants to leave. Maybe it’s clear-cut to others, but to me it’s still up in the air :) Can’t wait to see what happens!
May 16th, 2007 at 11:01 am
This was one of the few outcomes I predicted; not the hemochromatosis, but the fact that “personality changes” shouldn’t be in the differential. It’s an adolescent-onset personality change and could be anything from a temporary hormone problem to Oppositional Personality Disorder to Schizophrenia (which usually appears a little bit later, but he’s in the ballpark).
Is it me, or is every patient lately going into multiple organ failure? It’s his liver! Omigod now it’s his kidneys too!
May 16th, 2007 at 11:18 am
Anonymous: I think that ’shy’ was a typo, especially since it was struck out,followed by ‘why’. What kind of ‘charachter’
{your own typo] are you? you should take your own prescription.
Tysior. Oliver Sacks, in his book ,’the man who mistook his wife for a hat’ wrote about asphasics {aphasics? check spelling]
about people who are almost abnormally keen at detecting lies. His books are all full of interesting and scary neurological
diseases and conditions.
May 16th, 2007 at 11:26 am
When suffering from a Cluster Headache I’m no joy to be around. I suspect that if I was bit bitter temepred I’d take a clock-thingie to someone’s head too. But I wouldn’t suspect “having a headache” to get me off. But a clusterheadache is anything but “just a headache.”
May 16th, 2007 at 11:39 am
The best part, I think, was where Chase figured out that House was the one who sabotaged Foreman’s job interview. And his reasoning as to why he figured it out. As Keith said in his post earlier…I think Chase might have begun to figure out the method behind the madness so to speak.
May 16th, 2007 at 12:43 pm
X wrote:
“Personally I found the social issue they raised in this episode to be the most interesting — how do you deal with someone who is intentionally antagonistic?
“If you ever use this thing called the `internets’ you’ll know that’s how everyone on planet Earth acts the instant they’re not personally accountable for what they say …”
Maybe some people. Maybe a lot of people. But not everyone. Me, for example. And, as far as I can tell, at least 99% of the people who post on this message board. Except for the occasional clunker, they’re all very civilized.
May 16th, 2007 at 1:10 pm
Scott wrote:
“It’s a good news/bad news scenario: Nate should be able to control his hemochromatosis with treatment, but he’ll always be a jerk.”
Probably. But unless my imagination was working overtime, there did seem to be a subtle shift in the nature of Nate’s jerkiness. I’m thinking of the scene where Foreman is conducting a nerve biopsy on the kid’s ankle. Nate seems a bit more subdued. He begins by telling Foreman, “I know you’ve been busting your ass …” But instead of thanking Foreman, Nate quietly tells him that “your best sucks.” Which is not quite the nasty-for-nasty’s-sake kind of crack the kid reveled in earlier – he seems genuinely worried that the doctors won’t figure out what’s wrong with him, and he’s scared.
As a matter of fact, having one of the Young Guns being told that his best “sucks” – isn’t that the kind of remark you’d expect from House?
Of course, Nate could go right back to being the way he was before, in which case, boy do I feel sorry for his Mom.
May 16th, 2007 at 1:15 pm
The Cluster Headache diagnosis was a little goofy. With so many kinds of headaches to choose from, focusing on Cluster as the young man held both sides of his head was a bit of a jump. The fact that psilocybin (sp?) has been found to help Clusters had to have been the seed for the story line (with research on symptoms of the condition lost to the research team at House). As a cluster headache sufferer myself, we are far more prone to retreat from any contact with people when experiencing a headache than become jerky or confrontational.
Verapamil, Triptans, Oxygen and for some, a Prednisone taper are pretty standard first lines of treatment — for those that this course doesn’t work, or stops working, they move on to the “alternatives”.
May 16th, 2007 at 1:31 pm
“As a cluster headache sufferer myself, we are far more prone to retreat from any contact with people when experiencing a headache than become jerky or confrontational.”
Yeah. The kid just wasn’t acting like he had a CH more than anything else he was LAYING PERFECTLY STILL AND CARRYING ON A CONVERSATION. I’m a ball of incoherent blubber during an attack and I can do anything BUT sit still. I have gotten very rage-filled and there’s more than a few dents in my walls and broken glasses to account for that. I couldn’t see myself going “midevil” on someone with a Chess Timer, but I’m not violent towards other people. But it was clear no one on the show’s staff knew how to tell the kid to act like he had a CH.
May 16th, 2007 at 1:42 pm
Hi, cluster headache sufferer here. True, the depiction of an attack was quite inaccurate.
Also true… psilocybin (in sub-hallcinogenic doses) does work quite well as a preventative.
May 16th, 2007 at 4:02 pm
If I recall correctly, in “Son of a Coma Guy”, House tells a story from his childhood about a Japanese doctor who was generally shunned (I forget why) and, in fact, forced to work as a janitor, but who was so good at being a doctor that he was allowed to hang around and, occasionally, asked to perform some miracle of medicine. From that experience, House learned that you can get away with a lot if you are very, very good at what you do. In “The Jerk”, the jerk’s problem is that, at his age, he’s not yet good at anything useful and so no one will put up with him. Let’s hope he’s as smart as he thinks he is.
May 16th, 2007 at 6:23 pm
“Is it me, or is every patient lately going into multiple organ failure? It’s his liver! Omigod now it’s his kidneys too!”
Well, kidney failure right after liver failure doesn’t seem that unlikely. The liver filters out all the toxins and other harmful junk out of your blood. The kidneys get rid of the waste from the blood. If the liver goes down, all the stuff that would normally be disposed of by the liver gets passed on to the kidneys.
Without your liver your whole body starts falling apart. Multiple organ failure is inevitable.
May 16th, 2007 at 6:35 pm
*shakes head*
What happened to the baseline blood investigations?! I’m so ashamed.
May 16th, 2007 at 8:01 pm
I loved House calling the kid a jerk, then walking out and ordering Foreman to waste his whole night doing pointless tests.
May 16th, 2007 at 9:32 pm
I only have two things to say.
First, the Jerk beating the hell out of the other kid with that timer was absolutely ridiculous. I don’t see, at all, why the House writers thought this was ok. Can anyone make any sense out of it? I think the writers did it more, as was said last post, to have something good for the previews.
Secondly, about the chess thing, Brian, I wholeheartidly agree that we don’t know everything about House – in fact, we don’t know quite a bit. But, this isn’t real life; this is TV. And on TV, just like in a movie, if something pivital happens (House knowing chess very well) then it definitely needs to be established early on so that we’re not blindsided, as we were in this episode. When the show is named after the main character, we should never have to go, “What the hell?” when he does something. We should go, “Oh yeah! I forgot he could do that.” That’s just good writing. The writers blindsiding us was bad, from a story-telling point of view, not necessarily a realistic one.
May 16th, 2007 at 11:03 pm
Being someone who has clusterheadaches, I am pleased to see this condition put before all the viewers of House.
Like many others, I see that this portrayal of an actual clusterheadache hit was far from the reality. Yes, we get angry and rude during a hit – but we don’t seek out someone to pin our aggression on; in fact, I will only lash out if touched during a hit. Fortunately, the reason for the aggression turned out to be an obnoxious personality.
And, as Anita said here earlier, psilocybin can be used very effectively as a preventative.
May 16th, 2007 at 11:52 pm
Usually with a chem screen on admission to a hospital you get serum iron, TIBC, and %iron saturation- it is standard on the chem 24 panel- a medical student could have diagnosed this. Also, this is a very extreme, atypical case. Hemochromatosis takes decades to do its damage, it is very slow, and the presentation is not dramatic. By the time there is liver involvement, you have cirrhosis, which can gradually reverse with proper iron overload treatment, but can also be fatal. There are so many medical inconsistensies on these shows, I wish I could get hired as a medical consultant!
May 17th, 2007 at 12:07 am
Re: House/Chess.
Well, this seems like as good an episode as any to show that House plays/enjoys Chess. Afterall Holmes played Chess (in some interpetations, that is) we’ve seen House’s house a few times, can’t recall if we’ve seen a chess-set sitting there or not. Perhaps there IS a bit of deus ex in it, but it dosen’t seem OOC that House would play chess.
May 17th, 2007 at 12:45 am
House playing chess well doesn’t seem like much of a stretch. It’s not something you forget after being away from the game for a few years; the pieces stay the same, and serious innovations in strategy are few and far between, so it’s plausible to pick it up in high school, do it competitively for a while, then stop playing except on the very rare occasion. While you will lose some of your edge after being away from the game for a while it is still pretty likely that you could come back and put up a god game against another skilled player.
Who’s to say house wasn’t first a board player on his schools chess team same as this kid?
May 17th, 2007 at 1:03 am
Well, who says that the jerk is some kind of chess genius anyway? There are a lot of good players that play in those tournaments and not all of them are grand master stuff. It is not surprising that House is a good chess player (recognizing openings, etc.), although I doubt he could beat any seriously good player. He just has a lot more important things to do than practice for hours every day.
How did House find out that Foreman had scored an interview in NY anyway?
May 17th, 2007 at 4:58 am
[So House hired Chase for something more than just his father making a phone call? I wish the writers had expanded on that.]
Of course…. House wouldn’t hire an idiot whatever the reason…
Sean… I’ve always seen House as a chess player… I’m sure I’ve seen a chess set in his flat
Oh and NO ONE cancelled Foremans interview… he was bluffing… he want to see who’d accuse who and what he got offered. I reckon..
May 17th, 2007 at 5:45 am
The cluster-headache-face-bashing bit is obviously a red herring taken too far.
This entire episode showed us how House’s team jumped from diagnosis to diagnosis, each time including ‘personality disorder’ as a symptom.
They were just setting up for the House-ian moment when he went “What if his personality disorder is not a symptom. What if he’s really as big a jerk as we think he is?”
Apparently the writers thought it’s important for the ‘personality disorder’ idea to sink in good.
May 17th, 2007 at 7:35 am
My guess is that the writers included House playing chess with the POTW simply because Hugh Laurie plays in real life. I read Stephen Fry’s autobiography a few years ago and he writes about playing marathon session of chess with Laurie while a student at Cambridge (they were roommates IIRC). Hugh Laurie is also a gifted musician which is why House is often seen at the piano. I also agree with the previous poster who points to these traits (musical talent, chess) as solidifying the link between House and Sherlock Holmes.
May 17th, 2007 at 7:36 am
I agree with Koray, I don’t think the kid was necessarily a chess genius. His bluff to House was similar to what he said to his opponent in the opening scene, so I think he’s just really good at getting his opponents to crumble.
I wasn’t bothered by House’s abilities to play chess, but I agree with Kyle that it should have been set up prior to this episode. In fiction, nothing should happen without a reason for it.
May 17th, 2007 at 7:59 am
I didn’t follow the diagnostic process in this episode at all.
If the kid has juvenile onset hemochromatosis and he is supposed to ALSO be an “evil jerk” then what was the explanation for the seizure after he was challenged at chess by House? What was the cause of the “spell” after he assaulted his young chess opponent at the start of the show?
Were we supposed to think that the headache and seizure/”spells” were supposed to be due to the hemochromatosis too ?
His behavior was more consistent with a severe attack of Acute intermittent porphyria or meth abuse. I just didn’t follow the medical aspect of this episode at all.
About the issue of House being skilled at chess, wasn’t Sherlock Holmes a skilled chess player too?
May 17th, 2007 at 8:38 am
Hey Scott:
You should apply for a job as a medical consultant on House. You’ve already got quite a bit of experience analyzing the existing episodes and it’s all very well documented. You never know…
May 17th, 2007 at 9:28 am
I’m not sure I understand the degree of dissatisfaction expressed by some over the writers’ failure to foreshadow something as mundane as experience playing chess. Haven’t most people played at one time or another? Sure, House recognized the kid’s opening move, but there aren’t that many possibilities. I recall less dissatisfaction the first time House performed brain surgery.
May 17th, 2007 at 1:08 pm
Gary:
There was less dissatisfaction over house performing brain surgery (although, I am one of those who thought it was ridiculous) – or any other surgery for that matter – because he’s a doctor. Surgery – doctor, the logical jump is there; even if it is a bit of a stretch.
But the smoke clears and House comes out as some kind of chess wiz. Sure he didn’t win, but he knew what the strategies said about the person and even what they were named! I’ve played chess, for fun, my whole life (all short 21 years) and haven’t even learned that stuff. To me, it just felt like when Chase threatened to jam hamburgers down that the Jerk’s throat. We were suddenly force-fed that House is not only a great chess player (he was making precise movements in a second’s time), but he was very knowledgeable about it, too.
I just don’t think it’s good writing when the main character of a TV – again, or movie – comes out of nowhere with some random skill to prove a point. It’s a plot-device and it’s excrutiatingly annoying.
May 17th, 2007 at 3:50 pm
Gary, Kyle hit it much further upthread, that the problem is we’re not just looking at a slice of House’s life, we’re watching TV. When someone uses an ability in a plot-advancing fashion, it would be nice if that ability had been foreshadowed (or was an inevitable part of his character, like any of these characters understanding how blood pressure cuffs work).
There are many brilliant people who have never played chess, and all we picky viewers ask is that there have been some tiny “tell” early on that House played chess before the skill was used in diagnosis. If his great chess ability had been used this episode to win a wager against Wilson in a side-plot, fine. Using it as a tool to diagnose the patient in the main plot, well, it brings up too many bad memories of sloppy writers in bad shows pulling skills and devices out of their characters’ pasts & pockets, respectively, to get over a hurdle. A “plot device ex nihilo” variant of a “deus ex machina” I guess!
May 17th, 2007 at 5:24 pm
I just saw the opening scene online (I’d missed it the 1st airtime). How the hell could a completely unprovoked rage attack like that not be a symptom?! I get the guy being a total a**hole like House, but punching out someone for no reason? Makes no sense.
May 17th, 2007 at 5:32 pm
If anyone is interesred in aphasiacs go to http://www.junkfoodforthought.com/long/sacks-reagan.htm or wikipedia for oliver sacks,the president’s speech at the bottom of the page. he is a neurologist in n.y.
May 17th, 2007 at 5:38 pm
I know the promos for this ep advertised the kid as “just like House”, but I think he’s much worse than House. Whenever House is a jerk, he has a reason or motive for it. Cuddy brought this up early in the season in Episode 309 “Finding Judas” when she took the photosensitive girl into the hospital showers and House walked in and called her a sucky mom. Then (I think) Cuddy was talking to Wilson and told him House has a reason for being a jerk and that his calling her a sucky mom was out of character. Well, House has a motive most of the time, but this kid is just making a killing of people, and he calls people whatever he wants, whenever he wants. Gary had a great point about this in post #38.
I also liked the Foreman move to sedate the kid immediately when he went to draw blood. Did anybody else notice this? Even if that could never happen in a real hospital, it was still a great scene. A rather House-esque move by Foreman, if you ask me.
May 17th, 2007 at 6:18 pm
Keith, come to England. A Chomp is a small bar of chocolate-coated caramel.
May 17th, 2007 at 7:49 pm
I’m not a Dr., but I’d like to play one on TV…:) I didn’t read all the previous posts, but I agree… wouldn’t ordinary bloodwork, such as a CBC or Chem Panel show fishy iron levels? And I thought along that the kid’s behavior was from a separate disorder (ODD, Personality Disorder) or just being a jerk.
May 17th, 2007 at 10:02 pm
I suppose; it just seems to me that given everything else the writers throw out – like House reading Portugese medical journals in his spare time – being good at chess is a pretty minor thing. Maybe I’m just not appreciating the genius reflected in his play.
May 18th, 2007 at 12:38 am
House’s character is a brilliant person with a personality disorder. But what is it? He appears to be excellent at reading people and extrapolating social dynamics, which seems to contradict the personality disorder. His “symptoms” appear to be his asocial behaviour, substance abuse and a bad leg. What’s the differential diagnosis for that?
I’m probably reading too much into the show: I should just accept House as a “larger than life” character and get on with it.
Oh, I have hematuria. When it was really bad earlier this year, my urine was dark brown, not red. Nate peed yellow urine followed by bright red blood. Was that just for dramatic effect, or can it actually happen?
Geoff
/nit-picker
May 18th, 2007 at 8:10 am
Anonymous: Apparently, you can also buy Chomp bars in New Jersey vending machines!
May 18th, 2007 at 8:13 am
All this talk about Houses chess playing is missing the point – he’s obviously NOT that great a chess player, since the kid beat him, as ill as he was. That House is a medium-level chess player with a big ego is pretty believable for me. I can play chess. I just suck at it.
May 18th, 2007 at 11:24 am
House got the name of the opening right, and the kid got the name of House’s response wrong (House just played classically in the center as a respone to the Bird’s opening). As a competitive chess player this irked me. If they had done something simple like had a little banter between House and the kid while the game was going on (House: “Looks like we’re following Fischer-Mecking.” kid: “Yeah. Fisher won that.” House: “But I know where Mecking went wrong.”) it would have cemented the fact that House at least studied and followed chess at some point in his past. If this kid was truely a prodigy, then he would have mopped the floor with House. So, either the kid isn’t that good which isn’t consistent with him ripping off a 10 move combination at the beginning of the episode, or House used to play competitively of which we’ve never been given any indication. It also bugs when the team does procedures outside of their specialty.
May 18th, 2007 at 12:24 pm
I still don’t see it. The kids appeared to be playing speed chess, not regular chess. In speed chess there is very little time to consider and develop moves on the spot, so, unless all of the kids shown playing at the beginning of the show were simply moving randomly (or all of them had a master’s “feel” for the game), I would assume that all of them can name and have memorized at least some well-known sequences of moves. I also don’t recall the kid ever being refered to as a “prodigy”. So, I’m perfectly willing to assume that the kid and House are merely good speed chess players; House could have easily picked it up the same way the kid did, i.e., as a member of the high school chess club. Like his ability to juggle, ride a motorcycle, speak chinese, and wipe himself, his ability to play speed chess, in my opinion, needs no foundation.
May 19th, 2007 at 2:19 am
To Gary:
As a Chinese,I want to say House’s Chinese sucks ha.
May 19th, 2007 at 1:47 pm
eva said:
>[So House hired Chase for something more than just his father
> making a phone call? I wish the writers had expanded on that.]
House said (previous season?) that he hired Chase because Chase’s father made a phone call. I have always assumed that Chase’s father told House not to hire Chase. House, for his own reasons (his father issues and/or because Chase’s father was a prominent doctor) decided to hire Chase.
As far as I know, no real hospital has a department of diagnostics, as Scott explained. If the writers wanted medical realism (yeah, we know better), Cuddy might have offered Foreman a position in PPTH’s neurology department. Since Foreman has department-head ambitions, she might have suggested that the head of neurology was planning to retire in a few years.
Long ago I read an interesting book with a title something like “The Psychopathology of Chess Players” but I can’t find it in a web search; maybe it’s too old.
May 19th, 2007 at 2:17 pm
I don’t know about medicine (I think they should find problem with iron) but soap opera was brilliant. Full cycle “whodunit” plus great, hyper-House’ish final moment. And child beating House at chess, not by laying better, but by bluffing. Plus Iron Butterfly (it was an episode with iron problems, right? I think they put in all this mushroom stuff to have opportunity to play I Da Gadda Da Vida of certain group) and magic mushroom. Plus Wilson to Cuddy trick with “You’re paranoid”. Plus Chase face when Cameron started to be interested with little jerk little wheenie.
Scott, it was brilliant soap. At least A-.
May 19th, 2007 at 2:34 pm
As for chess: Tony, I was irked too about this nonsense “sicilian defense” stuff. Probably writers just used a words, which for typical viewer look professional.
And I agree that House doesn’t heve to be a good chessplayer. In speed chess it is easier to make a good fight against better player. And House has lost to teen, who was literaly laying on death bed. When liver fails brain doesn’t work at full capacity.
May 19th, 2007 at 6:49 pm
Thank you for confirming my belief that a differential diagnosis department does not exist anywhere. It seemed particularly unlikely to have four expensive people doing little or nothing else in a relatively small primarily teaching hospital like the one on the show.
Does House have a specialty? I don’t recall that ever having been mentioned. He seems to just sit in his office watching daytime TV when he’s not meeting with his gang or grumpily putting in time in the clinic.
It would not have been necessary, would it, to create an improbable department. Some doctors are exceptionally good at diagnosis. I’ve known one who was just an old-time GP, who could instantly put his finger on an obscure problem more often then not. Anyway, if that is the sort of doc House is, it is possible that when the ER docs or someone on the staff is puzzled about a diagnosis, they would call him in, and he would assemble an ad hoc team of appropriate specialists — quite likely including a neurologist and an oncologist. Come to think of it, do you recall it’s ever having been mentioned that Chase or the pretty woman doc (temporary lapse here — I forgot the character’s name) have a specialty?
May 19th, 2007 at 9:03 pm
Well, about the House playing Chess, I’ve noticed House tends to have a lot of skills that he hasn’t persued very much. After a certain level, almost EVERY talent starts to get similar, you move on to a technical level, House would probably stop then, I think.
May 20th, 2007 at 1:32 am
What do stomacaes have to do with fights? Ummmmm He could be punched in the stomach? Ever thought of that?
May 20th, 2007 at 1:50 am
I’m puzzled by some of the group on this blog being put off by House’s recognizing that Nate used the Sicilian defense. It’s the most popular defense for advanced chess players these days when they get the black side, because it’s aggressive and most of its variations get quite complicated.
We didn’t get a very good look at the board, but I did see Nate make the opening pawn move of the Sicilian. For Dr. House to recognize it would not be nonsense, or “just words” thrown in by a script writer. Rather, it would show that he knows something about the game and might have played it seriously at one time. What’s the problem with that?
It’s like House playing the piano. It’s no big deal. Viewers can suppose that he studied seriously when he was much younger, just as Laurie did in real life. Or as I did, for that matter, even though I’m now a writer by trade and don’t play very much any more. That Hugh is a fairly good pianist is well known in Great Britain. Maybe he’s a fairly good chess player. He’s a complex and multi-talented guy.
May 20th, 2007 at 5:19 am
Lee, please
Sicilian defense is played by _blacks_. It starts typically
E2-E4 C7-C5
Meanwhile Nat started with F2-F4 (and then NG1-F3), which House properly recognized as Bird opening. And House answered by typical in Bird opening D7-D5. After two first moves there was no way to get into position of Sicilian defense.
Hugh Laurie actually is good chessplayer (on amator level, of course). But “little jerk” had no reason to mumble about Sicilian defense.
May 20th, 2007 at 5:31 am
Speaking about chess, the game went
1 f4 – c5 (bird opening)
2 Cf3 – e6
3 e3 (if white had played e4 this would be a sicilan defence … not usual but possible, but there are two flaws then… when white moves e3 if my eyes arent wrong the king has swapped positions with the queen, later the king goes back to its position… so Dr. House maybe is a great chess player in fiction, but hugh is not… anyone would have seen that :) it is like playing a piano upside down. The flaw is not in the sicilian defence mentioning, but it was not House option, it is white which can play either e3 (still a bird) or e4 (converts the opening in a sicilian defence)
May 20th, 2007 at 6:18 pm
Chess masters can predict moves up to 22 turns in advance, both house and the jerk can do 6 or 7, while this is more than most people for people who regularly play chess that would be considered normal. Also, house is far from a chess genius, it takes him hours (maybe days) to work out how to win the match
May 21st, 2007 at 12:14 am
I miss his Reubin sandwich fixes.
=(
Remember the first season? He had one every 3 episodes.
May 21st, 2007 at 12:57 am
Lee: House has a double specialization in nephrology and infectious diseases. Cameron is an immunologist. Foreman is a neurologist–this is probably the easiest one to keep up with. Chase is an intensivist. Wilson is an oncologist–another easy one. Cuddy is an endocrinologist. I think House also plays left field, the early races at the OTB, and first oboe. These get mentioned in various episodes…different ones for different characters.
Obviously, they stray radically outside their specializations. Foreman apparently dabbles as a neurosurgeon (why not, he’s a brain specialist, right?), but the real kicker is that House sometimes does the same. They all do some “nurse stuff”–in fact, House just asked Foreman to do the “nurse stuff” while Chase and Cameron did the “doctor stuff.” And of course, they all run the tests themselves, because PPTH has blown its entire wad on the diagnostics department and can’t afford the people who would usually be charged with that kind of “test stuff.”
May 21st, 2007 at 6:21 am
I believe the reason for House’s skill at chess is simple.
As discussed last week, House parallels the great fictional detective Sherlock Holmes. Holmes was good at chess. House is good at chess. Making a chess episode is an easy way to dig deeper ‘House’’s footsteps in television history, and a way to appeal to yet another viewer demographic.
I think it’s time to rotate things. Perhaps soon it will be Cameron’s turn to be consistently brilliant. Chase has had long enough of a run, and Foreman has had his moments throughout the seasons. I think they’ve overplayed their “dumb looking blonde surfer dude guy actually has brains” card. Why not an “emotions can occasionally match reason for helping make informed decisions” card?
May 21st, 2007 at 6:33 am
“Making a chess episode is an easy way to dig deeper ‘House’’s footsteps in television history”
what I mean is that they reminded everyone that this series has real roots in famous great literature. It has roots, a niche.
BTW, keeping a core group of actors is great, but whenever they have a “someone is leaving” story, or whenever something threatens to disrupt the total order of the relationships in the series, people just expect it to fail. I know I do. This has left viewers jaded. The basic order of things hasn’t changed since day one, or when they do they tend to snap back really quickly. They been threatening reduction (Wilson, Foreman, Cameron, even house himself) for awhile…maybe threaten addition? Maybe follow through with a hint or suggestion once in awhile? House viewers expect at the moment that the writers won’t stick to their guns, that this will always be the way it is (in fairness, this has been the case with many of the good recent series, like frazier and friends…messing with the formula permanently may not always be the best solution).
Then again nothing much ever really happened to Holmes…Watson had several wives, but mentioned only in passing, and affecting his life only inasmuch as the affected his ability to chronicle Holmes’ exploits…but Holmes himself remained static. Maybe this is the formula for success? Maybe we can expect nothing to ever change, the hospital and characters being the fixed points in the chaos of real life that revolves around them?
May 21st, 2007 at 10:44 pm
House specialises on infectious disease and nephrology, Cameron is an immunologist, Chase is an intensive care specialist, and Foreman is a neurologist.
May 21st, 2007 at 10:58 pm
BTW, I now think Kyle (42) is right. The personality disorder is just another case of advertenza.
May 22nd, 2007 at 3:10 am
Incidentally, I have a very bad feeling about the season finale (as in I’m concerned the episode will stink, based on the House MD Guide teaser synopsis). But I guess we’ll wait to see what happens next week.
May 24th, 2007 at 1:17 am
Hey guys, we just watched the downloaded avi file for this episode and at the end it seems to cut-off without a normal screen wipe/transition, and the scene just didn’t seem to finish. Anyone else get this?
May 24th, 2007 at 9:19 am
How many of the diseases they mention do you recognize Scott, without checking any references?
May 24th, 2007 at 10:28 am
Tyler, the episode ends with House telling Foreman, “Looks like it’s going to be another all-nighter,” or something along those lines.
Does anyone know when the season finale/next episode is?
May 24th, 2007 at 2:36 pm
Kyle: The next episode, entitled “Human Error,” is indeed the season finale, and it airs next Tuesday, May 29. See http://www.housemd-guide.com/ for additional details; see link to episode capsule on the right side of that page. Warning: The episode capsule contains various spoilers, so don’t look beyond the front page if you prefer to watch the episode completely cold.
May 26th, 2007 at 12:08 pm
It seems like they didn’t really wanna be around the kid for longer than a few minutes, perhaps explaining the lack of tests they did, and the jumbly way they handled diagnosing him. Good episode, though. Foreman will be missed.
May 27th, 2007 at 2:45 pm
Any doctor will recogize every disease mentioned on every episode of House…..but knowing the pathophysiology, treatment and diagnostic work up of every disease is what makes Dr. House super-human.
May 28th, 2007 at 2:39 pm
does anyone know the quote by forman about TB when he is sedating nate…for being anoying??
May 28th, 2007 at 11:15 pm
@Colby:
ENID: Did he need a sedative?
FOREMAN: I did.
[...]
ENID: He’s sick. The rudeness isn’t his fault.
FOREMAN: If he had tuberculosis it wouldn’t be his fault either. But I still wouldn’t let him cough on me.
June 11th, 2007 at 7:01 pm
I always get a kick out of the one-liners… best in a series to date IMO
June 14th, 2007 at 8:55 pm
2 things i didn’t get…why did house cut the kid’s wrist after telling him about his disease. was he testing his blood? cuz why wouldn’t he get it the normal way. and what was the point in making foreman pull an all nighter? teach him a lesson or something?
June 27th, 2007 at 3:22 am
@ Michael
House making the kid bleed is one of the treatment for hemochromatosis.
July 4th, 2007 at 2:24 am
Scott,
thanks a lot for the fantastic medical reviews. A must read after each episode!
As a geneticist, I found the genetic tests in this episode absolutely ludicrous. They should borrow a real sequencer (or some print-outs, at least) from CSI. No, the nucleotides (the A, C, G, T in DNA) don’t pop up as letters in a screen. And quite often, tens to hundreds of different mutations can cause a genetic disease. Not even a specialist in a single disorder would be able to just call a mutation in real time as the sequence is appearing on the screen. One usually alings the patient’s sequence with a normal reference, highlights the differences, checks into the relevant database of mutations, and, if it’s not there, then quite a lot of basic biological reasoning goes into deciding whether that’s a normal polymorphism or indeed a disease-causing mutation.
I know, it’s TV, it has to happen in ten seconds, but that’s a part they usually miss in CSI as well: a lot of interpretation goes into genetic testing
July 20th, 2007 at 7:19 am
Well I havn’t seen this episode yet (we’re at season 2 in The Netherlands) but from what I read here, I allready know this episode is going to be interesting.
I suffer from CH for some years now, and the things that work for me are, O2, Verapamil and Imigran (injectors) when the O2 or Verapamil won’t work i give myself a shot of Imigran, that works, really!
Still I’d hate to miss this one episode, cause there’s almost no attention to CH, and just a few people actually know how to react when I have a moment with CH (for about 2,5 hrs, when treatment doesn’t work).
Good luck to all the ones that suffer from CH, but indeed, it s silly they haven’t tried anything with O2 in the series, that’s the first thing to try when having an attack. Even my doctor knew that and I’m his first CH patient!
Luckily, in The Netherlands, these Mushrooms are legal when fresh, but illegal when dried (strange huh?) So I tried and bought myself some fresh “shrooms” and indeed it worked within a few minutes. I just didn’t like being all wuzzy and woozy the rest of the day. (you know what I mean, I guess, pardon my French, but I m Dutch)
Oh by the way, smoking pot won’t help either, my doctor prescribed marihuana to me (have I mentioned that this is a strange country when it come to drugs?)
It didn’t work at all. (I know cos I smoke marihuana for about 20 yrs now, and it never worked for anything, accept for the pain in my lower back, hernia…) And smoking can be a trigger for causing a CH-attack… so I rather not try smoking anything.
Greetings, wXLp, male, 40yrs old, Netherlands.
August 3rd, 2007 at 2:21 am
I didn’t like the Jerk episode. For some reason, I didn’t think a teenager behaving like a sociopath was funny or interesting. I thought the mother’s character was interesting. I’ve met many parents with children like the Jerk and usually the children are involved with the juvenile justice or in a group home. I thought some parts of the episode were just plain gross. Difficult to enjoy a bowl of popcorn.
There were no House/Wilson scenes so it’s not an episode that I am likley to rewatch. Cuddy’s accusation that Wilson sabotaged Foreman was just ridiculous. Where did that come from. And the Cameron’s you think I care about House as much as you do” to Wilson was also ridiculous – Wilson’s is House’s best friend and Cameron is House’s employee for 3 years.
September 12th, 2007 at 5:07 pm
I just discovered these series of ‘medical reviews’. I saw this program last night here in Montreal (Tuesday from nine to ten on September 11, 2007). I was in France and England from late April to Mid-August so I can now have the pleasure of seeing some of the programs without groaning that it is a repeat. I give this review of the “Jerk” episode a B – (B minus). Cheers.
September 15th, 2007 at 12:57 am
“House’s character is a brilliant person with a personality disorder. But what is it? He appears to be excellent at reading people and extrapolating social dynamics, which seems to contradict the personality disorder. His “symptoms” appear to be his asocial behaviour, substance abuse and a bad leg. What’s the differential diagnosis for that?”
I’m just a layperson but I always sort of suspected House had ASPD (psychopathy.) His childhood abuse by his father (mentioned in One Room, One Day) might have led him to develop attachment disorder in childhood, which can develop into conduct disorder in adolescence, which in turn develops into psychopathy. Of course, House can experience some guilt (as psychosomatic pain) but not much.
—
I found the Lesch-Nyhan guess interesting because I actually knew what it was and was able to recognize that it fit some of the symptoms, (hypogonadism and hyperuricemia), even though it was later discarded as a diagnosis. Now, I know House doesn’t always use the most “conventional” diagnostic tests :), but out of curiousity would there have been another way to test for this, like an MRI to see if he had decreased dopamine in his basal ganglia, (the neurological phenotype of LNS)? Or would that not even be needed and in reality anyone with a deficiency of that gene would have the syndrome?
—
And making Foreman do the pointless re-test was just mean – usually House being mean is funny, but other times he just makes me mad!
January 24th, 2008 at 8:49 pm
Dear Person:
House’s personality disorder isn’t a normal personality disorder. He has attachment problems and is scared to get too close to anyone. Most of the time when it seems he is doing something mean, there is a more sentimental reason behind it. EX: When the black politician running for president comes in, he tells House that the only way to make a difference is not by winning. House actually takes this to heart and uses this advice, which is why he does not give the speech, resulting in cameron quitting. (Temporarily)
CHESS PEOPLE:
The reason chess came into the story is because the actors play chess off stage when they’re not in the scene being shot. The writers noticed this and wanted to incorporate it into the show somehow.
January 26th, 2008 at 1:13 pm
Bird’s opening can transpose into the Sicilian defense:
1w – f4
1b – c5
2w – e4
http://www.eudesign.com/chessops/bisv-02b.htm
So they probably didn’t get the names wrong.
I’ve been looking for a record of the moves they made…
February 7th, 2008 at 5:11 am
To Judith Volpe, MD
What hospital does chem24s on every admit or every ED pt even? I agree that it would be a good idea in this episode but TIBC, ferritin, etc. are never ordered indiscriminantly or as a screening tool at the hospital where I work.
March 11th, 2008 at 1:49 pm
“they need to go back to school to learns more about cluster headaches.” – Scott
I don’t know if that was a typo or if you were making a joke, but it’s funny either way.
April 14th, 2008 at 12:52 pm
a good episode especially if you think about it that this was the first episode (of which I can remember) where someone could stand up to house in an intellectual battle (chess)….
I do understand and know that shrooms are very helpful against cluster headaches and migraine, but as far as I know, LSD is better and has much less adverse effects than shrooms (nausea etc.) – and since season 2 we all know that house has, or at least HAD, a stash of LSD. Also, I’m very sure that the trip would have at least leave some changes, even if only short-timed, in the kid’s personality.
To the poster with the japanese doctor: house was impressed by a burakumin (japan’s untouchables, for example, one whose ancestors where butchers or toilet cleaners, any kind of “unclean” work), which was a janitor only because they could not show him as an official doctor.
May 18th, 2008 at 10:36 am
#
Joey
May 17th, 2007 at 5:24 pm
I just saw the opening scene online (I’d missed it the 1st airtime). How the hell could a completely unprovoked rage attack like that not be a symptom?! I get the guy being a total a**hole like House, but punching out someone for no reason? Makes no sense.
He’s a jerk who always gets in fights. We don’t know whether he has any reason for that. Someone of the CH-troubled people who post in here mentioned he or she would punch a wall and break things during an attack – well, this kid is aggressive to start with and he’s in pain, probably the worst pain he’s ever been in. He just turns more aggressive and attacks people. Definitively not normal reaction, but the kid is not normal.
Marius: Oh by the way, smoking pot won’t help either, my doctor prescribed marihuana to me (have I mentioned that this is a strange country when it come to drugs?)
What’s strange about that? I would find it more strange if it were prohibited to prescribe marihuana simply because it’s mostly misused. When it can help, well, what’s the difference between marihuana and Vicodin?
–
RE House telling Foreman to redo the (useless) testing: It seemed to me he wanted to ask Foreman to stay, but found it too hard (it would be hard for House to admit he wanted Foreman to stay) and said something mean instead.
July 28th, 2008 at 6:07 pm
I wish they showed more of his package
July 26th, 2009 at 8:57 am
MrBuddwing:
I can’t remember the exact study, so forgive me, but I do remember reading a couple that would seem to support this idea. People wearing lab coats (ie “high status” clothing) used greater levels of profanity when describing their parents, indicating a willingness to ignore at least some social nicities when they can get away with it. Another one (also, forgive me, I can’t remember the exact one, it’s in one of my textbooks) showed people will be more likely to bait a person threatening suicide if it’s night, also if there are more people around.
Just saying.
July 27th, 2009 at 8:14 pm
I was watching this episode on dvd and thought I’d look up hemochromatosis online-everywhere they talk about the “bronze diabetes.” If diabetes is the primary symptom, why wasn’t it discussed? Do most or all those who suffer from it have the bronze skin? Or is House MD all about unusual presentations of disorders, in order to make it more complicated and interesting?
September 11th, 2009 at 1:04 pm
Chess: (yawn). I learnt to play chess at the age of 7. Was an exceptional player by the age of 10. Was bored of having to let people win before thrashing them (just to make it interesting) by 16. House has to be at least 50. If he’s half the genius I am he would’ve lost interest a long time ago. As geniuses we master then move on. Hence why he’s not played in any previous or subsequent episodes (have u noticed?). House does play the PSP (playstation) perhaps fascinated by this technology of our generation.
September 11th, 2009 at 1:28 pm
As for “the jerk” his issues are psychosocial. Not pathophysiological, as some have suggested, implying there is a disease state at work. Again understanding the mind of a genius facilitates an understanding of his problem. His situation is analagous to someone living with their parents into their 40s when in essence they should leave home. Except he can’t. He’s physically a child deemed by the rules of society to remain 1. At home being looked after like every other teenager. 2. Amongst class mates of ….
January 9th, 2010 at 11:26 pm
[...] Dr. House folgen beschäftigt und auch er scheint auf die gleichen Fehler zu kommen wie ich (siehe hier) Tags » Autor: Markus Datum: Sonntag, 10. Januar 2010 6:26 Trackback: Trackback-URL [...]
August 5th, 2010 at 5:06 pm
well i think the episode was fairly good and nate has a problem and he has issues and i like this show it deserves an A and its in my top 5 fav episodes
August 5th, 2010 at 5:10 pm
and i think that all the characters r awesome and that nate kid has a weird accent it sounds like a wart
November 13th, 2010 at 1:18 pm
What pisses me off about this episode is that the personality disorder IS a symptom of hemochromatosis and most doctors don’t know it. I speak from personal experience. After 4 types of cancer in myself the doctors were no help on, I found the cause.. hereditary hemochromatosis. At the same time my teenage son was freaking out uncharacterisitcally, not unlike Nate. Turns out HH was the cultprit for his suicidal behavior, his violent mood swings, angry outbursts, depression etc. My mother’s dementia is iron overload dementia. 50% of the people in my family have had cancer because of this disease. The good news? By taking out our blood regularly, the cancer is gone (with no chemo or radiation!), my sons personality disorder is gone and his learning disabilities are going away. its too late for my mom but everyone else in my family now has a much better prognosis.
February 7th, 2011 at 4:33 pm
The chess game opens as follows (Nate is White, House is Black):
1. f4 c5
2. Nf3 …
(House says: “Bird’s opening. Passive approach.”)
2 … d5
(House says: “Sign of a coward.”)
(Nate says: “Sicilian defense.”)
3. e3 …
(Nate says: “Sign of an idiot.”)
(House days: “Arrogance has to be earned.”)
3. … Nf6
Although arrived by a different sequence, the game starts with the Bird’s Opening, Lasker Variation (A03) == 1. f4 d5 2. Nf3 Nf6. 3. e3 c5
http://www.chessvideos.tv/chess-opening-database/A03
Nate’s play of 1. f4 is correctly identified by House as a Bird’s Opening. However, Nate’s claim of House playing a Silician Defense–most likely referring to House’s play of 1. … c5–is incorrect since a Sicilian Defense (1. e4 c5) is a semi-open game response to e4 which is not yet in play (or ever) when Nate says “Sicilian Defense”.
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