House – Episode 5 (Season 4): “Mirror Mirror”
A relative weak episode of House, medically. Foreman returned, and it was good, but the mind-reading/mimicking patient blew my suspension of disbelief.
All in all, while Mirror Mirror was one of the best Star Trek episodes, the same cannot be said of House (it’s not an awful episode , just mediocre). Anyway, spoilers below!!
A man walking down the street is mugged and starts coughing and wheezing during the attack. As he falls to his knees in respiratory distress, one of the muggers feels bad enough to call for an ambulance (but not bad enough to return his wallet). The patient, who identifies himself as Martin Harris, is admitted to House’s team for evaluation of his respiratory collapse.
The initial differential diagnosis includes asthma (not supported by the x-ray), food allergy (no skin findings), and pulmonary embolism (a blood clot in the lungs — but radiology studies were normal). Foreman suggests laryngospasm (a sudden tightening of the vocal cords) as a diagnosis. Though he is not happy about Foreman being present, he recognizes that his suggestion has merit and orders a methacholine challenge. The test is negative, though now the patient complains of numbness in his extremities and abdominal pain. The differential diagnosis now consists of dissecting aortic aneurysm, a spinal cord lesion, or multiple marantic emboli (clots from growths on the heart valves). None of them seem to fit the symptoms well, but the team is interrupted mid-discussion with the news that the patient has had a syncopal episode and collapsed.
As they are evaluating Martin, Foreman begins to suspect Munchausen’s Syndrome because the patient “borrowed” the name of one of the paramedics and his new symptoms match the exact symptoms of his neighbors. House, instead, suspects Giovanni’s Giovannini’s Mirror Syndrome, where a patient who has lost his memory mimics those he sees around him. House brings Martin into the operating room where Wilson is performing a procedure. Sure enough, Martin begins to mimic Wilson, confirming the Mirror Syndrome diagnosis.
A short time later, House and the team notice that Martin has a lace-like rash over his arms and legs (livedo reticularis), which House decides is due to cold agglutinins (antibodies that clot in the cold, blocking capillaries and blood flow) caused by infection. Blood cultures are ordered as well as an ultrasound. House sends Dr. 13 and Big Love to search for the patient’s car to find out who he really is. A solid liver lesion turns up on the ultrasound — the thought is either an abscess or a vascular hemangioma (a clump of dilated capillaries). Frat Guy performs a needle aspiration and gets a dark substance he believes is pus. He suggests that Martin has a tropical fungal infection and the patient is started on Amphotericin. The livedo reticularis returns and Martin is placed in a heated whirlpool. The Amphotericin does not help and what was felt to be pus ends up just being coagulated blood. The differential remains infection, but most likely viral or some rare bacteria. Because the patient has no memory, they can’t get a good history, but House suggests they run antibody tests on Martin’s blood and cerebrospinal fluid (CSF) because this will give them some idea what diseases he’s been exposed to in the past and a general idea of where he is from and where he’s been. His antibodies are high for histoplasmosis (common in the Ohio River Valley) and weak for coccidiomycosis (found in the San Joaquin Valley) and Chagas Disease (common in Mexico and Central and South America).
The livedo reticularis has returned despite aggressive hot water baths. House starts Martin on lipopolysaccharide (a toxin found on the cell wall of certain infectious bacteria) to induce a fever to raise his temperature and keep his blood flowing. While in the tub, Martin goes into cardiac arrest. Kumar defibrillates Martin before he is completely dry. This returns Martin to a normal heart rhythm, but also knocks Kumar out.
House orders a re-check of the blood cultures and Foreman recommends a heart biopsy. As Dr. 13 completes the heart biopsy, Kumar drops a hint to House that Martin regained some of his old memories while in the hot tub. Taking the items found in the patient’s car by Big Love and Dr. 13, House pretends to be Robert Elliot (the patient’s real name) in an attempt to jog the patient’s memory. With the help of vaporub, he succeeds and discovers that Robert/Martin is a traveling farm equipment salesman and has developed an Eperythrozoon infection from pig feces (a type of bacteria found in certain animals, including pigs and ruminants. It has been known to infection humans on occasion, though I can find no listing of serious infections).
There was too much bad reasoning in this episode for the medicine to be very good. Everything magically clicked into place when it shouldn’t have. Sure, methacholine can be used to detect laryngospasm, but it is better for inducing asthma – also on the differential diagnosis list. Sure, infection can cause cold agglutination, but so can many, many other things including vasculitis, autoimmune diseases (Lupus!), cancer, and tuberculosis, just to name a few.
I don’t have much to say about Giovannini’s Mirror Syndrome, because I can’t find any information about it. Whether it exists or not (and I suspect it does in some manner), the way it was presented was too unbelievable. A patient would take on characteristics of those around him, but not be magically able to see deep into their psyche; they wouldn’t become omniscient. And if patients with Mirror Syndrome do mimic the strongest personality about them, why would he copy Wilson in the ER and not House, who is clearly the dominant personality. Why did he pick one name and stay with it? Wouldn’t he pick a new name every time he encountered someone dominant? Shouldn’t he be Gregory House?
The temperature of cold agglutination does not increase as the patient becomes sicker, certainly not to over 100 degrees. Anyway, giving someone a bacterial endotoxin to cause a fever is not a good idea because it causes other serious effects besides just fever.
Funniest Line (intentional):
House (to Cuddy): I know when my Vicodin isn’t Vicodin. Do you know when your birth control pills aren’t birth control pills?
Funniest Line (unintentional):
House: He’s got Mirror Syndrome.
Foreman: Giovannini’s?
House: Do you know another Mirror Syndrome?
(um, how about Maternal Mirror Syndrome from last season?)
The medical mystery was interesting, though the symptoms were stretching incredulity — I give it a B. The medical aspect forgot the whole idea of differential diagnosis, and chose certain causes without reason. It wasn’t wrong, per se, as incompletely thought out. The Giovanni’s Mirror Syndrome seemed a little too convenient, too. It earns a C. The solution was yet another strange zoonotic disease, but not one really considered as dangerous as the show suggested; I give it a B-. The soap opera with Foreman and House and Cuddy was good (as was Chase running a betting pool), but Martin reading everyone’s mind was too much of a stretch: B.
The previous House review
A list of all prior House reviews
October 30th, 2007 at 11:17 pm
So is it normal to page a doctor and then leave a crashed patient in the middle of the lobby floor without any support personnel?
October 30th, 2007 at 11:30 pm
It wasn’t Giovanni’s Mirror Syndrome, it was Giovannini’s Mirror Syndrome. But I’m not turning up anything about a disease by that name, either.
October 31st, 2007 at 12:00 am
House generally doesn’t make up words though.
October 31st, 2007 at 12:05 am
Whenever they break with reality a little bit the results are good in my eyes. Then again I am a science fiction fan.
October 31st, 2007 at 12:20 am
Official Comment
You’re right — it was Giovannini, and I still can’t find anything.
October 31st, 2007 at 12:23 am
I’m with Brendan. House is a sitcom at heart. I don’t mind the occasional break from reality so long as it pays off in some other way. Seeing the doctors be ‘mirrored’ was fun, almost as much fun as House’s victory dance. For that, I can live with a bit of truthiness. Then again, this blog IS about the medicine so it’s not like we can blame you for the C.
October 31st, 2007 at 12:24 am
Big glaring goof I saw was that House got paged when the patient fainted, but there was no one around when the white coats got there. Who sent the page?
October 31st, 2007 at 12:29 am
Here’s something. No details, (none at all, in fact) but still proof that “maladie Giovannini” does exist.
http://books.google.com/books?id=Elx9GJ9qrtwC&pg=RA21-PA367&lpg=RA21-PA367&dq=giovannini+mirror+medicine&source=web&ots=E2GJIrsTgw&sig=xisxb90fce4Sit820oxhd334nUI
October 31st, 2007 at 12:48 am
Not quite as strong as the last episode, but not terrible either. Quite a few laugh-out-loud moments, especially the Cuddy vs House as alpha scene. But I miss Wilson! It seems like Cameron’s gotten to be the new Wilson, ie House’s pseudo-conscience.
Also, the drama of the newbs is getting way too dragged out. Not firing anyone was lame (although slightly worth it just for the racket Chase was running), Amber is still a raging bitch and Frat Boy is boring as hell. Several better go next episode, it’s aggravating to see them all continuing to snipe at each other. It was fun for the first few weeks, but now it’s just tiring.
October 31st, 2007 at 12:57 am
hahaha thanks for the picture example of a pig, Scott.
October 31st, 2007 at 1:01 am
Dr. Scott: A patient would take on characteristics of those around him, but not be magically able to see deep into their psyche; they wouldn’t become omniscient.
All I can say is, if I can buy into Dr. House’s ability to size up patients like he’s Sherlock Holmes with a medical degree, I can give “Martin Harris” his brand of seeming omniscience. (I realize last week’s episode was supposed to be the “Halloween” show, but a patient who can mimic your inner thoughts – now that’s spooky.)
October 31st, 2007 at 1:01 am
What I’m wondering is, would a eperythrozoon infection actually cause all those symptoms? Does it seem like they took a little too long to reach that diagnosis? Then again, without a patient history, I suppose there’s probably enough zoonotic diseases that there would be no chance of them narrowing down the specific symptoms to one, and that’s assuming they’re even assuming he got something from animals.
The thick blood thing seemed a little overly cinematic… then again, I’m no doctor, maybe that’s what would really happen?
October 31st, 2007 at 1:22 am
Official Comment
Refah,
Valiant attempt, but from what (little) I can find, “Giovannini’s Disease” refers to some sort of fungal infection (ICD-9 117.9 “Other and Unspecified Mycoses” for those of you familiar with medical coding).
October 31st, 2007 at 1:43 am
Am I the only one who was strongly reminded of the (wonderful, btw) Woody Allen Film “Zelig”?
I cannot imagine that the similarities were entirely unintentional… good hommage, interesting plot-device, but not a top episode.
October 31st, 2007 at 1:43 am
Just curious — why would defibrillating before the patient is completely dry cause that kind of reaction? Aren’t the paddles insulated against transmitting the charge to the person holding them? I can understand if the patient was in a pool of water, or something, but after being mainly dried off and put on a dry bed, is that possible?
October 31st, 2007 at 1:56 am
I was looking for this Giovannini Syndrome also and all I can found is more or less the same that Scott. There is a Giovannini Disease and appears to be a rare infection from some kind of trichophyton.
October 31st, 2007 at 1:58 am
What I didn’t understand was after the patient had a couple of cold agglutinin episodes why House didn’t put the guy on a macrolide antibiotic. Especially since House thought the cold agglutinin episodes were caused by an infection. I didn’t hear clearly at the end what antibiotic they did give the patient or delayed giving the patient.
I liked when House brought Dr 13 into the patient’s room so House could find out her secret. :-) I knew House was attracted to her.
October 31st, 2007 at 2:27 am
Elementary my dear Watsons… prepare to be bored. (boar’ed? I keed…) Short answer.. it was a one-time discovered fungal infection (and one-time discovered fungus for that matter) conveniently obscure enough for the episode writer’s purpose.
I think the writers intended to make this reference very obscure. Unless Giovannini’s syndrome (I.e. “mirror syndrome) is distinct from Giovannini’s disease (a mycoses reported by Sebastiano Giovannini in 1906 in Archives für Dermatologie und Syphilis), then its purpose was to act as nothing more than a deus ex machina for the episode.
Page 605 of Twentieth Century Practice: An International Encyclopedia of Modern Medical Science by Thomas Lathrop
Stedman. http://books.google.com/books?id=I5wwAAAAIAAJ&pg=PA575&lpg=PA575&dq=sebastiano+giovannini&source=web&ots=a-fXvgAbrp&sig=BcO0j5KXQ9AqAWHlWAsMCl2oG_Q#PPA605,M1
GIOVANNINI’S DISEASE.
Sebastiano Giovannini, of Bologna, has reported a case a° which
ought to be considered here, because it was one of a nodular disease
of the hair caused by a true fungus.
Small, firmly adherent nodules appeared repeatedly on the hairs
of the right half of the patient’s mustache, and nowhere else. The
nodules consisted of a dense mass of brilliant granules looking like
spores. This mass was seated firmly on the hair cuticle, without,
however, any of its elements penetrating the hair substance. The
spore-like bodies had a dense, double-contoured membrane, and
homogeneous, highly refractive contents. Other spores could be
seen in mycelial threads, and these threads were branched. There
was no doubt, therefore, that the parasite was a true fungus, and also
uo doubt that it did not belong to any of the ordinary pathogenic
fungi, such as that of favus, ringworm, or pityriasis versicolor. Unfortunately
the fungus could not be cultivated nor could the disease
be transmitted. Giovanniui thought that it was one of the many
non-pathogenic fungi that are so frequent in food, and that it found,
for some unknown reason, favorable conditions for its growth on the
right side of this man’s mustache. Uncleanliuess as an etiological
factor would seem to be excluded on account of the patient’s social
position, as he was a prominent politician and savant. The fungus
was quite different from ‘that found by Juhel-Renoy and Lion in
piedra.
October 31st, 2007 at 2:59 am
I thought this episode was too far fetched in all aspects. House seemed slightly out of character, but then again, he’s certainly not the same House from season 1 (the dance annoyed me).
I’m happy to accept the patient reading the doctors’ body language as it never actually says he is right. It is hinted at, but that could simply be taken as the doctors reading too much into Martin’s imitation, as I recall House alluding to at some points through the episode.
I dunno, I just don’t like the new Dr. House, I liked when the writers were happy with him being misanthropic, the goofy stuff is starting to throw me. I’d say this was the weakest episode to date.
October 31st, 2007 at 6:11 am
Giovannini’s disease is a type of mycosis, according to a French website.
http://taurus.unine.ch/icd10?term=&select=721
I found some references to a 1906 paper on mycosis by Giovannin: Alopecia areata in Verbindung mit Mycosis fungoides. Von Professor Dr. Sebastiano Giovannini.
October 31st, 2007 at 7:44 am
On second thoughts, the line with Cuddy and the birth control pills is also unintentionally funny. Why should she BE on any in the first place, seeing how she was even prepared to use a sperm donor to get pregnant?
October 31st, 2007 at 8:12 am
I was wondering about the physics of Kumar being shocked by the paddles. Wouldn’t this require either streams of water connecting his hands to the paddles, or a puddle of water connecting him with the patient? It seemed unlikely to my friends and I as we watched it, but we couldn’t agree on how unlikely.
October 31st, 2007 at 8:12 am
That is what I thought. The very first thought I had when House mentioned Birth Control was “Why would she care if House took away her Birth Control since she is trying to get pregnant?” This was followed up, about 5 seconds later, with “Why is she even on Birth Control?” Granted, they havn’t done anything with that particular subplot in a while (Season 2?) and maybe something changed that I missed, but I think it was probably an oversight on the part of the writers.
October 31st, 2007 at 8:22 am
Official Comment
Cancun,
The same thought crossed my mind. I just figured that Cuddy had decided that it was not the right time to get pregnant, and so had started birth control pills.
October 31st, 2007 at 8:49 am
I agree with #9 Charmedseed above. Everything is being further spread thin thin thin. My last comment on this board was a little snippy at the House developments of late, and the general response (which I thought was fair) was that ’tis better to give the writers a chance to play out the newbies/hiring game and regain their season 2/3 form. Well 5 eps in with this nonsense and it’s last call sez I sez I.
Just think of all the things in the show that are being marginalized, if not disregarded altogether: we barely see Wilson; Cuddy’s been reduced to a stereotype of her old self; nothing on the budding romance between Chase and Cameron; plus nothing on the success/failure of the new hospital positions for each; House flies/quips his way through every scene to save screen time for the stack of newbs; Foreman kinda likes working there now, but we don’t know why; no more clinic episodes, which were awesome; we’re meeting each newb piecemeal; and every new patient has to fit the reality-show-hiring model until we’re done.
I still adore the shore and will def watch regularly. But until we return to what made it awesome — fair screen time to each of a compact group of interesting characters, building a fairly meaningful story each episode — I gotta call bollocks. Wrap the new team, stop with the pseudo-reality show nonsense, get House and each other character back to old, good form.
October 31st, 2007 at 9:12 am
Cheers on a great post.
“Giovannini’s Mirror Syndrome” is a term I have been searching for ages, as a crude defintion for an observational study of users of 3,4-methylenedioxy-N-methylamphetamine (ecstasy).
October 31st, 2007 at 9:22 am
Ok, I loved this epsiode from a non-medical standpoint. I think I enjoy the new House because he still hates people and he’s still rude just like old times but now he does more outragrous stuff just to entertain himself. I like that. I like that he goes to such lengths to not be bored. I can safly say the new cast is growing on me except for the cut throat bitch. (did anyone else notice that she doesn’t have money, is she poor? It makes me wonder about that other job. I bet she never had one or got fired.) And I like that you call #6/9, Kumar. That is the only way I describe him to people too.
The mirror syndrome was a good way of getting to know everyone and letting us see who they really are. It may have been bad medical but I think it was good for the show. and I really want to know what is with Dr. 13. She’s probably like House’s kid from that one-night stand 25 years ago.
and oh yeah…House’s victory dance = best part of episode!!! It was just amazing.
October 31st, 2007 at 10:26 am
thanks for another nice review, scott.
perhaps this question has been asked a dozen times, but I wouldn’t know:
do hospitals really have diagnostic departments as projected in the series? (the last time I was in a hospital was at birth, and don’t know much about them nowadays :) )
October 31st, 2007 at 10:59 am
“I know when my Vicodin isn’t Vicodin. Do you know when your birth control pills aren’t birth control pills?”
I thought most women did know. If you miss a BCP, breakthrough bleeding is a common side effect.
Also, didn’t something happen last season that sort of turned Cuddy off to the idea of parenthood?
October 31st, 2007 at 11:05 am
I checked the episode description on my TiVo before the show began, and it said something along the lines of “treating a patient teaches Foreman and the interns more about themselves,” so I knew there was no point in watching.
Thanks, TiVo!
October 31st, 2007 at 11:07 am
“Do you know when your birth control pills aren’t birth control pills?”
Doesn’t this imply the following:
1 She is having sex with a regular partner whom she considers safe. (or is having unsafe sex with her pickup partners)
2 She believes for some reason that her unprotected sex has a reasonable chance to result in pregnancy even though the artificial insemination(s) was/were unsuccessful.
3 She no longer wants to get pregnant, or does not want to get pregnant by her current partner(s) at this time.
Either this plot point needs to be developed further or it was just a convenient threat for House by the writers and we’ll never hear about it again.
Maybe we will discover at some point that she and Wilson have secretly hooked up and she’s putting the child plans on hold until she finds out if it’s serious???
October 31st, 2007 at 11:57 am
When the patient’s confabulations first came to light, did anyone else think of the B-plot patient with Korsakoff’s syndrome in season 1, episode 10 (”Histories”)? (And, yes, I had to look up both the episode name and the name of the syndrome.)
October 31st, 2007 at 12:39 pm
I’m just waiting to see what kind of mayhem Dr. Kumar can cause with the paddles next.
October 31st, 2007 at 12:57 pm
House is slowly but surely becoming one of the best sitcoms on TV, and Gregory House is becoming one of TV’s greatest comedic characters. I can’t wait to see what wacky, outrageous hijinks he gets up to next week!
October 31st, 2007 at 1:28 pm
LaDeeVah:
Missing only one pill doesn’t really do anything — it’s when you miss, oh…maybe 4 days to a week, that you’ll see a period show up (depending on how long you’ve been on pills).
As for everyone’s theories on Cuddy being back on the pill: maybe she wants to regulate her period now…doesn’t need some sort of other crazy explination, does it?
October 31st, 2007 at 1:33 pm
In my opinion the reason that Wilson was mimicked in the OR is that he was clearly in charge of the operation; he was giving orders to the other people present and they were being followed. Anywhere else and House would have been the one mimicked.
October 31st, 2007 at 1:56 pm
Karl — assuming it’s not a case of the writers forgetting, yes to points 2 and 3 but no to point 1, since BCP wouldn’t protect her against STDs so whether she considers a partner “safe” is irrelevant – well, I guess if she’s dating a eunuch, a Klinefelter’s syndrome male or another woman, they would be “safe” in terms of avoiding pregnancy….
October 31st, 2007 at 2:00 pm
Sorry Karl, I just re-read your comment and realize mine made no sense. Never mind.
October 31st, 2007 at 2:47 pm
What I liked about this episode was how House goes one up on the whole no scrubbing up before entering the OR/no face mask/no eye protection thing, by actually cutting into and drawing blood from a patient with an unknown condition right next to Wilson’s open surgery on another patient!
October 31st, 2007 at 3:11 pm
On the Giovannai (whatever) Syndrome. Would it of been that bad to make him have Korsakov’s Syndrome?
October 31st, 2007 at 4:36 pm
“Would it of been that bad to make him have Korsakov’s Syndrome?”
Then House’s comedic antics would deserve a Rim(sky) shot.
October 31st, 2007 at 4:46 pm
To some of the earlier commenters:
If you look closely, you can see one nurse with the patient as he is on the floor, but she hurriedly gets up and walks off as soon as all the docs arrive. You’re right though, the nurses (assuming that they do things other than placing bets all day) should have been right on top of that right away since it happened right next to a nurses’ station!!! At least they would have put him on a gurney and not just left him on the floor.
As for the bad defib. Kumar had just helped carry the patient from the tub so he had water on him. One of the other characters yells something about arcing before he does the defib. Even though the paddles themselves are insulated, there would have been a circuit formed between the contact point (and then through the patient back out) and then the soaked bed sheets and Kumar’s soaked clothes, and then to him. I admit it is a bit of a stretch but stranger things have happened.
I’m sure that the Gio-whatever syndrome was chosen intentionally by the writers so they could make up whatever manifestations they wanted since it would be hard to track down. Clever…
Next week’s episode looks promising though from the preview.
October 31st, 2007 at 7:05 pm
And just a small note – they did the heart biopsy on the wrong side of the neck. The wire they used was too big and you can’t tell the results of a heart biopsy by just looking at it.
I know they always get results way too quickly but this was just too much.
October 31st, 2007 at 10:55 pm
House is just having more fun than he did in Season 1, I think. He’s having a lot more fun watching the candidates try to out each other. I haven’t watched any episodes from Season 1 in a long time, which means I’m not exactly sure how he’s changed, but I don’t mind the ‘new’ House at all.
October 31st, 2007 at 11:08 pm
Cancun asked, “On second thoughts, the line with Cuddy and the birth control pills is also unintentionally funny. Why should she BE on any in the first place, seeing how she was even prepared to use a sperm donor to get pregnant?”
Well, we know she can’t get pregnant. Maybe she just wants to regulate her periods, or get rid of them entirely. That was my assumption anyway.
November 1st, 2007 at 5:13 am
My impression was that the patient was less reading people’s minds, and more picking up on cues and subtext, and reflecting them back at people. For example, the female doctor who was reassuring him got the subtext of “there’s something to fear” thrown back at her.
November 1st, 2007 at 9:51 am
Absolutely loving the new season of House. I think this is the best season so far. I’m jus loving House.
November 1st, 2007 at 10:17 am
How is “Do you know another Mirror Syndrome?” unintentional when the patient is male?! *ZING*
November 1st, 2007 at 11:39 am
I really liked this episode…. lets face it they can’t all be perfect medicinewise….. but the true show it’s not the cases, although they are great, but how House treats people….
And it couldn’t be mother mirror syndrome because he was nos a woman and he was not pregnant….
November 1st, 2007 at 10:11 pm
Im actually surprised that Forman suggested the House vs Cuddy alpha dog scene and that Cuddy, Wilson and a significant portion of the staff went along with it.
Delaying a patients treatment for personal amusement? House must be rubbing off on the whole hospital.
November 2nd, 2007 at 2:49 am
“Im actually surprised that Forman suggested the House vs Cuddy alpha dog scene and that Cuddy, Wilson and a significant portion of the staff went along with it.
Delaying a patients treatment for personal amusement? House must be rubbing off on the whole hospital.”
I’m not surprised at all. Foreman’s entire character development stems from the fact that House is rubbing off on him. The rest of the staff aren’t about to overrule Foreman (who they should consult before doing anything), House (who they need to consult before doing anything), and Cuddy (who will probably end up signing the paychecks of those who make it).
Scott, I agree with your medical review, but I would’ve given the drama an A. Yes, the patient was pretty psychic, but on the other hand, it was a whole lot of fun. Foreman learning about himself (Foreman making a sarcastic joke in front of the hopefuls has been a defining moment of the season), House & Wilson arguing about their dominance, House & Cuddy arguing about their dominance . . .
Important for Foreman, and flat out hilarious otherwise.
November 2nd, 2007 at 6:08 am
There was an episode last season which ended Cuddy’s motherhood arc. I don’t remember much, but she was trying to save a little girl, screwed up, and House told her that it was a good thing the treatments never took, because she’d be a terrible mother. The scene of her crying in the shower implied she took it a bit harder than House’s usual insults.
November 2nd, 2007 at 1:34 pm
How come no one has mentioned the insinuation that House and Cuddy are sleeping together? When House says “Do you know when your birth control pills aren’t birth control pills?” it’s possible that he could potentially rifle through her purse/drawers.
BUT later House and Foreman are in the elevator, and House says something my boyfriend and I aren’t sure about. My boyfriend thinks House says “It’s simple math. I anger Cuddy, you work elsewhere….” blah blah blah and then he says, “…and Cuddy is going to be pregnant,” with Foreman saying “WAIT a minute, what does your having sex have–”. I think House said “…or else Cuddy is going to be pregnant.” Either way though, House seems to be insinuating that he and Cuddy are sleeping together since he lets Foreman believe that…or is he just hinting at something to lead people on for the shock value?
November 3rd, 2007 at 4:06 am
I heard, that in a parallel universe, where politedissent.com is operated by me, the “doctors being mirrored” device, coupled with the betting thing et al, boosts the soap opera to A-.
November 3rd, 2007 at 10:43 am
Quick question(s): Wouldn’t House realize his Vicodin aren’t Vicodin any more? Or are there laxatives that look like Vicodin? (I guess he might pop the first dosage without looking.)
Harder to explain the other pill switch though. Don’t birth control pills come in blister packs? Are there other pills that look like birth control pills and also come in blister packs of 28? Or are there birth control pills that don’t come in blister packs?
November 3rd, 2007 at 1:04 pm
The dialogue about Cuddy getting pregnant:
House – Oh god, does everything have to be about you? It’s simple math.
I’m not gonna back down, you’re not gonna back down, Cuddy’s not gonna back down. No one’s gonna be happy here… and Cuddy’s gonna wind up pregnant.
Foreman – What!?
House – Doesn’t matter.
Foreman – Are you sick? What does you having sex …
House – Starts Monday! I can help you pack.
Foreman – I don’t want the job.
House – :(
By the way, we’ve seen House breaking into Cuddy’s flat before, so that doesn’t say much.
But to me there’s no logic in them sleeping together, as this is the first real hint at it. Then again, the writers have made more continuity errors in this fourth season than ever before.
Thank god it’s a medical drama, or by now a sitcom, but it’s not yet a soap. :)
November 4th, 2007 at 11:51 am
Speaking of Cuddy and Birth control pills. I know in some women (it’s rare, yes) that being on birth control pills does nothing to stop pregnancy. It actually makes them more fertile.
So maybe Cuddy is taking them becuase she’s one of those few, rare women where birth control pills make her more fertile, or at least more able to get pregnant.
November 5th, 2007 at 12:56 am
I live rather close to Hamilton, OH, the victim’s hometown. (I’m a Californian, though) I’m not sure if they have pig farmers there, but they probably do.
November 5th, 2007 at 2:17 pm
I found one thing odd. In the end, when Cuddy and House are using the guy to establish who is more powerful, Cuddy says “I can fire him … don’t even need a reason,” was she being facetious, lying, or did the writers get something wrong? As far as I remember, it’s actually very hard to fire House – Cuddy would need unainamous board approval, because House is tenured, as we saw in Season 1 when Vogler tried to fire him.
November 5th, 2007 at 6:08 pm
Is it just me, or is Kumar the anti-Wilson/anti-Foreman in that Wilson is clear cut on moral issues, or at least when he is involved in skullduggery, it’s usually because House tricked him, while Kumar seems to have no morals whatsoever in that he seems even excited at the prospect of digging up and removing parts of the brain from a corpse.
Also while Foreman has pride, in fact he’s so prideful he would only consider it ‘decency’, Kumar is easily the most shameless of all the candidates, as evidinced in his flipping his number to stay on the team.
November 6th, 2007 at 6:52 am
i liked him flipping his number :)
but somehow i still feel the first young guns were far more interesting from the start of season 1, than any of these guys are up till now. i liked old fraud, except for his final episode, but of course that was just to get rid of him. neither of the guys are more than cardboard, amber is plain irritating and no. 13 is cute but it’s time they give her some back story.
or do i just long for the past?
November 6th, 2007 at 10:48 am
I think you just long for the past. :)
I think the new crew is fine. There are still just too many of them for any single one of them to grab a hold of us, that’s all. I’d wait until they at least get down to the final three (within the next, oh, three episodes, I hope) before taking a close look at how well they’re doing, cinematically speaking.
November 6th, 2007 at 12:36 pm
[...] Veniamo all’unica nota dolente: per la prima volta decido di scoprire se la malattia del paziente della settimana esiste davvero. Non l’avessi mai fatto! Mi sono persa nella rete per ore e quando ho capito che sarebbe stata una ricerca inconcludente era ormai troppo tardi. Voglio comunque rendervi partecipi dei risultati e, se scoprite qualcosa in proposito, fatemelo sapere per favore! Dunque: su wikipedia non se ne parla, google mi ha fornito alcuni risultati, ma niente di definitivo. Tra i commenti in questo sito (linkato anche da House MD Guide), si parla di un’invenzione pura e semplice e di una malattia omonima che non ha niente a che fare con quella del nostro POW, ma io ho trovato questa notizia, che forse potrebbe avere a che fare con il caso di Mirror mirror. Maggiori dettagli sono riportati qui (dove sono riportati i nomi dei ricercatori-psicologi che hanno seguito il malato) e qui (dove sono indicate alcune iniziative collegate alla “scoperta” dei questa sindrome) mentre in questo articolo si parla del paziente come del signor Giovanni, e anche se le iniziali non corrispondono il caso è sicuramente quello degli altri articoli. Tra la ricercatrice-psicologa Giovannina, il nome falso Giovanni, e la sindrome di Giovannini ci sarò qualche connessione? Il caso della Zelig Like Syndrome del napoletano è sicuramente simile alla Giovannini’s Mirror Syndrome. Dall’articolo nel sito dell’Ordine dei Medici di Palermo: Dopo un arresto cardiaco con ipossia cerebrale il paziente ha riportato danni alla parte del cervello deputata a controllare i comportamenti. Subito dopo il trauma, l’ammalato, che soffre di amnesia, ha manifestato un perfetto trasformismo, riuscendo a immedesimarsi nelle persone con le quali entra in contatto. Prima dell’arresto cardiaco, il paziente era un vulcano di attività: laureato e brillante, libero professionista, faceva sport e persino l’attore per passione. Oggi dopo aver visto un film si identifica con i cow boy, o durante una visita medica dice di essere a sua volta un medico. In pratica cambia ruolo sociale, ma non personalità. Il suo è l’unico caso accertato al mondo. [...]
November 6th, 2007 at 12:50 pm
Oh yeah, and the “other mirror-syndrome” was probably excluded by House on the grounds that the patient obviously is never gonna be amother =;-)
November 6th, 2007 at 6:56 pm
I think this Giovannini’s actually refers to a case study in Neurocase Feb 2007. A man had frontal-temporal damage as a result of cerebral hypoxia caused by a cardiac arrest. The brain damage caused anterograde amnesia and a strange form of environmental dependency syndrome. One of the authors is called Giovannina Conchiglia.
Scott, I’m copying links to sites I found stuff about this, please feel free to remove them from my post if they are no use:
http://www.informaworld.com/smpp/content?content=10.1080/13554790601160558
http://bps-research-digest.blogspot.com/2007/03/brain-damage-turns-man-into-human.html
Oh, and I’m not a doctor so I might be wrong on this.
November 7th, 2007 at 10:15 am
Sarah: my point about a partner she considers safe meant that she considered the partner safe enough to not need a condom for protection against STDs, and could rely on the pill for pregnancy prevention, not needing protection from STDs.
In general, if you are having sex and not using a condom, you are either being unsafe in regards to STDs, or are have reason to believe there is no risk of STD from your partner(s).
November 7th, 2007 at 10:26 am
I have to agree episodes like this turn me away from the show. It wasn’t very believable and they don’t show the patient afterwards in this episode either. Shouldn’t he have permanent brain damage?
Episodes like the one with the man who had the assistant dog too were on that level as well. Honestly wouldn’t he notice if he didn’t take his pills? Wouldn’t he ask for them if he lost them? And even if he was too out of it, helper does are really well trained. The dog wouldn’t just eat the guys pills.
This series was really good when it started, but not it’s turning into the CSI level of unbelievability. There’s only so much you can do in a hospital I guess. I am glad I found this blog though. It’s nice to find someone who takes a look at the science behind each show.
November 8th, 2007 at 1:29 am
Giovannini’s Mirror Syndrome
Actually, this should probably be “Giovannina’s Mirror Syndrome”. Giovannina Conchiglia was the primary author on the paper “On a Peculiar Environmental Dependency Syndrome in a Case with Frontal-Temporal Damage: Zelig-like Syndrome”. (Though, I see spinacker beat me to the punch.) Of course, calling a single medical case a ’syndrome’ is laughable in itself, and it is unusual to use the author’s first name in naming the condition. Alas, popular culture strikes again.
November 8th, 2007 at 8:44 pm
Don’t You remember when House got two future-doctor girl (from) to supervise them?
They were sent to a woman, who broke her arm (or sth) and when the 2 came back and told House how she’d broken her arm, they said two different version, than House went to the woman, he heard a third version, but he knew it from the start, from the different pattern (or the picture) of the girls maps. He said that she lost her memories, and tried to fill them with what she saw. I don’t know weather he mentioned mirros syndrome, but as I remember, he did, or said sth like that.
November 9th, 2007 at 2:26 pm
“And if patients with Mirror Syndrome do mimic the strongest personality about them, why would he copy Wilson in the ER and not House, who is clearly the dominant personality.”
Really?
The whole point of going into the OR was so he wouldn’t be the dominant. Wilson is performing surgery, giving orders, etc…Not to mention the fact that he lectures House in front of everyone. Remember, WE know House to be dominant, the patient knows nothing about House.
November 9th, 2007 at 2:35 pm
I liked the episode. Season 4 is way better than season 3, although its true that the new team is getting tiresome and the medecine isnt as solid as in back 2 (as far as ai can tell – im not a doctor).
But Im surprised you havent pointed out the operation scene. I thought you wanted to keep score?
And in this episode house and the Giovanninis patient not only wear no googles, they dont wear protective mouth gear AND house even cuts the patients hand right beside the operation table! I dont think thats to sterile…
November 10th, 2007 at 12:33 am
This is just a response to a bunch of the posts. One, House would not make a diagnosis of Korsakov’s…it was the diagnosis for the show “Histories” (Season 1 I think). Also, I believe Korsakov’s is associated with Wiernicke’s encephalopathy, and the patient exhibited none of those symptoms. As for symptoms, did the patient even exhibit any of the ones associated with Chaga’s? Also if he did have Chaga’s wouldn’t his heart biopsy and ECG be abnormal as a result of the chronic or even acute phase of Chaga’s? Though I like the creativity; the bug that causes Chaga’s is related to the bug that causes African sleeping sickness, which we saw in an earlier episode. As for the whole Cuddy and BCP thing: I just think House knew from the get go his pills had been switched by Cuddy and was pulling a fast one on her by making her think he could have switched around her pills…I think it’s too much to read into her sex life (though…it may be more interesting). Also I think the writer’s tried to pull a quickie on the viewer: I think the “Giovannini syndrome” is a case of environmental dependency syndrome that they named after the author of a study (see posts above); the only Giovannini syndrome is, as pointed out, not at all related to brain function and psychoses.
Great review Scott! Thanks!
November 12th, 2007 at 4:30 pm
hi, I am just kinda confused: This diagnose doesn’t explain why the Rober Elliot has mirror syndrome. Why would a bacteria infection cause Mirror sydrome? And how does it couse Mirror syndrom?
November 16th, 2007 at 12:07 pm
[...] Finalmente algum percebeu! Vamos todos para a Frana lavar as roupas! Momento Curiosidade Intil: Andei pesquisando sobre a Sndrome de Giovanini, e no consegui achar nada alm de resumos de episdios de House. Acho que inventaram a doena apenas para o programa, mas enfim… se vocs estiverem interessados em saberem mais sobre a doena, encontrei esse site. Ok, ele no fala quase nada, mas tem um link sobre Asperger, ento vale a pena. E se quiserem um comentrio sobre a medicina do episdio, esse site o melhor. Prximo Episdio: 6 de novembro [...]
November 26th, 2007 at 6:56 pm
Thank you for noticing the mirror syndrome exchange between House and Foreman.
House: He’s got Mirror Syndrome.
Foreman: Giovannini’s?
House: Do you know another Mirror Syndrome?
I coun not belive they made that mistake when a character in an episode only a few earlier also had a type of mirror syndrome. I’m not a doctor, but I do watch a lot of House and this mistake was quite a surprise to me.
November 28th, 2007 at 12:03 pm
great site!! I’ve often wondered the medical validity of the diagnoses of the show and you seem to know the faults
But, how does an xray prove or disproved diagnosis of asthma?
wouldn’t the patient have to be in the middle of respiratory distress brought on by some environmental stressor?
December 16th, 2007 at 6:40 pm
[...] Finalmente alguém percebeu! Vamos todos para a França lavar as roupas! Momento Curiosidade Inútil: Andei pesquisando sobre a Síndrome de Giovanini, e não consegui achar nada além de resumos de episódios de House. Acho que inventaram a doença apenas para o programa, mas enfim… se vocês estiverem interessados em saberem mais sobre a doença, encontrei esse site. Ok, ele não fala quase nada, mas tem um link sobre Asperger, então vale a pena. E se quiserem um comentário sobre a medicina do episódio, esse site é o melhor. Próximo Episódio: 6 de novembro [...]
February 7th, 2008 at 10:34 am
reading these reviews is a nice change of perspective after watching the show. I agree that the mirroring of the doctors was a bit much, but I think many people would be surprised at the amount of subconscious information we give away through body language. What got me was his quick, House-like deductive (actually more like inductive) reasonings from each observation. But the idea of a mental disorder which allows you to sieze upon normally subconscious information, is not too far-fetched in my opinion. But I’m not a doctor.
February 27th, 2008 at 7:06 am
“(um, how about Maternal Mirror Syndrome from last season?)”
Pretty sure men can’t get a Maternal Mirror Syndrome, men can’t get pregnant and thus can’t present the same symptoms as the babies that can’t be inside them.
March 18th, 2008 at 4:04 am
How come everyone finds it incredulous that the patient could effectively read people? Remember that before the onset of his condition, he was a salesman, and some good salespeople are extremely adept at reading people’s body language and at reading between the lines. In fact, most of the salespeople I know are extremely good at adapting to different social groups, and always come off as very friendly.
Oh, and like what some people said, the illness of the week is based off of a study by an Italian doctor named Giovannina Conchiglia.
April 17th, 2008 at 4:17 pm
giovanini’s has only ever been recorded in one person. lots of people have said that it has been made up and i agree that some aspects are unbelievable (seeing more than what you could pick up from body language etc) but the condition is real.
these links might be helpful:
http://www.tv.com/house/show/22374/lack-of-medical-realism/topic/10498-872729/msgs.html
http://en.wikipedia.org/wiki/Mirror_Mirror_%28House_episode%29
April 17th, 2008 at 4:21 pm
Rimsky, of Korsakov, but Charles Bonnet syndrome is the one that worries me cos maybe one day it will catch up on me and I shall start filling in the gaps with what is not there and comes to hand (most likely electricity pylons not little people)
But isn’t that what scriptwriters do,? Fill in the gaps with whatever comes to hand, well so long as it is not lupus, but it will be one day.
Munchausens by internet by way of Wikipedia durch metanoia. Where is Whitman when you want him?
May 24th, 2008 at 6:07 pm
Hi from France!
Cocerning Giovannini’s syndrome there is a mistake,the real name is Giovannina Conchiglia.
If you look thet up (as well as the zelig-like syndrome) you will find that the condition does exist.
July 6th, 2008 at 1:37 pm
Why did they decide that the Cold Agglutinin Disease was associated with an infection and not a lymphoma?
July 11th, 2008 at 10:20 am
I thought it was fairly clear that House’s comment about Cuddy windind up pregnant was a reference to his interfering with her birth control pills – which he would do if Foreman stayed and the power struggle continued.
wg
September 9th, 2008 at 9:16 pm
But Foreman clearly thinks they’re sleeping together – I wonder why? Does he know about her in vitro attempts…?
September 15th, 2008 at 3:39 pm
I did read the first 30 post and there is a syndrome called Giovannis Syndrome
http://bps-research-digest.blogspot.com/2007/03/brain-damage-turns-man-into-human.html
It’s pretty interesting.
October 19th, 2008 at 3:01 pm
Giovanni’s Mirror Syndrome is not a real disease. It’s a theoretical condition based on the philosophical idea of someone who has lost their identity. The director of the show was intrigued by the concept and elaborated it to fit the episode. There is no medical relevance to Mirror Syndrome, it doesn’t exist.
I researched this on my own time after watching the episode due to my own curiosity. Hope this information helps clear things up.
October 20th, 2008 at 3:49 am
From Wikipedia:
Environmental dependence syndrome (http://en.wikipedia.org/wiki/Environmental_dependence_syndrome) in relation to anterograde (http://en.wikipedia.org/wiki/Anterograde_amnesia) amnesia (referred to as “Giovannini’s Mirror” in the episode) is misrepresented as conferring special insight into the thinking and motivations of complete strangers within mere moments. In reality, Giovannina Conchiglia’s work is highly controversial and in its initial stages. At this point EDS only seems to cause sufferers to imitate others’ mannerisms and occupations.
God Save Wikipedia!
Daniel
October 31st, 2008 at 7:01 pm
Just a note here, horrible out of date but whatever.
Am I the only one that thought he wasn’t mimicing Cuddy or House but Wilson at the end? I think he was visible inbetween them through the glass.
November 7th, 2008 at 5:57 am
Call me crazy, but I thought the whole point of the patient mimicking Wilson was to show that Wilson is, in fact, the dominant person in his and House’s relationship.
We all assume that House is the dominant one because he’s loud, abrasive and an ass (while Wilson just puts up with it).
But really, Wilson is the one who holds all the cards. House needs Wilson more than Wilson needs House. (which is later shown at the start of season 5).
Sure, this adds to the unrealistic factor that the patient is “magically able to see deep into their psyche” but I think we were supposed to disregard the unrealistic aspect for the soap-opera elements in this episode … I genuinely believe that’s what the writers were trying to portray between House and Wilson.
December 10th, 2008 at 10:16 am
Sorry for the (really really) late post, but this is an (exciting) new website I discovered recently, as a result of my obsessed House research.
I want to talk about your favorite unintentional quote…
Since the patient is a male, it is difficult for him to have Maternal Mirror Syndrom. I am no doctor (only a Languages student from Portugal) but I think that is quite unlikely. If there’s any other Mirror Syndrome he could be referring to, I don’t know. But House’s “come-back” is acceptable.
January 6th, 2009 at 9:28 pm
Just watching this episode now. I miss the old House of Seasons 1 and 2 (and to some extent 3) which focussed more on an interesting formula than often spotty characterization.
Also, why was Wilson performing surgery here? I’d been under the impression that he’s a *medical* oncologist all this time.
January 21st, 2009 at 12:17 am
About the unintentional funniest line, he knew it wasn’t maternal mirror syndrome, given that the patient was a GUY, right? It’d be different if we were dealing with a female who might be pregnant, but a middle aged man is not pregnant, therefore cannot have MATERNAL mirror syndrome. Still a funny line(especially w/ house looking at 4man like he was crazy), but the comment below was a little harsh for the circumstances.
Great review, and thank you for taking the time (it looks like it takes a lot, and a lot of re-watching epis to get this right) to do all this right. I find it very interesting, and would LOVE it if you kept doing them :)
January 21st, 2009 at 12:19 am
Sorry, didn’t see the comment above mine before I posted. Zé Pedro expressed the same concerns
March 31st, 2009 at 8:53 pm
Well Scott, he may not have been psychic, but he had a chance to observe their personalities for several days. But it is a mistake that a Mirror Syndrome patient does not mimic the most dominant personality present but rather the personality most suited for the situation.
May 27th, 2009 at 2:06 am
to answer Paul’s question:
“But, how does an xray prove or disproved diagnosis of asthma?”
It doesn’t, x-rays of asthmatic patients are usually normal, may show hyperinflation if taken during an attack but a normal x-ray does in no way rule out asthma. in fact no (good) doctor would request a CXR to confirm asthma, their value is to rule out complications (eg pneumothorax) or to exclude other causes of wheezing (eg inhaled foreign body).
June 20th, 2009 at 9:24 pm
Why is Cuddy even on birth control? Didn’t she spend half of season 2 or 3 trying to get pregnant?
November 15th, 2009 at 2:06 pm
Just want to point out for the record that Spinaker did a good job tracking Giovannina down, but the italian posting from 6hours 20 minutes earlier from “serialmente” said the same thing in more detail.
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