House – Episode 8 (Season 4): “You Don’t Want to Know”
Despite the use of a magician, the medical mystery on this week’s House was only a little better than average. The final solution though was unexpected and much awaited. It’s a shame the medicine was so wrong.
Cole (i.e Big Love) and Kutner (i.e. Kumar) are at a magician’s show when Flynn, the magician, performs his version of Houdini’s famous Chinese Water Torture trick. In it, the magician has his arms and legs shackled and is suspended upside down in a large glass box of water. Flynn struggles for a minute, then stops moving entirely. Cole quickly realizes something has gone wrong when blood starts oozing from Flynn’s mouth. Kutner has Flynn admitted to the hospital, telling the team that his heart stopped and he lost consciousness as soon as he hit the water. House is unimpressed and believes that Flynn just screwed up the trick, but Kutner truly believes that something is wrong. House tells him to go ahead and work up the patient, but if he’s wrong and it is nothing interesting, then he’s fired.
Kutner performs standard and transesophageal echocardiograms (ultrasounds of the heart), but both are completely normal. In the meantime, Dr. 13 is questioning Flynn about his past medical history, but he has no cardiac history or symptoms at all. Kutner turns to Foreman for help, and he suggests taking a look at the lungs because low oxygen in the blood could have led to heart failure. He suggests an MRI. As Kutner starts the MRI, Flynn starts complaining of severe abdominal pain. On exam, Kutner and Dr. 13 note bruising on his flanks (Grey Turner’s sign) and deduce that Flynn is bleeding internally. He receives a transfusion of 3 units AB blood and is rushed to surgery to find the source of bleeding. The team’s list of diagnoses now consists of liver disease, Vitamin K deficiency (Vitamin K is important in blood clotting, so low K results in easier bleeding), and an intestinal infarction (a blockage in the blood supply to the intestines). House disagrees and he marches into the surgical suite; in addition to lacerations in the digestive tract and a shredded spleen, he finds a small metal handcuff key. Flynn had this key hidden (in either his mouth or esophagus) and was going to use it to escape the shackles, but he forgot about it and the strong magnetic field in the MRI pulled it through his intestines. House fires Kutner.
Later, House goes to talk to Flynn himself. Flynn insists that he is an excellent magician and did not screw up the trick. He thinks something else must be wrong. He performs a card trick that stumps House and then suddenly develops an uncontrollable nose bleed. This intrigues House (both the card trick and the bleeding). Kutner is rehired and the differential diagnosis now includes cocaine use and polyarteritis nodosa (an autoimmune disease of the arteries). House sends Kutner and Taub to search Flynn’s house while Amber and Cole biopsy the blood vessels around his heart. The biopsy is negative, but Taub finds rabbits at the magician’s home and suspects that Flynn has Tularemia. Antibiotics are started to treat the tularemia.
A short time later, we are told that Flynn has passed out, and an ultrasound “revealed bleeding around the heart” which was subsequently drained (sound like cardiac tamponade). Tularemia is the wrong diagnosis. Cole and Amber might have botched the biopsy, or Flynn could have a clotting disorder, DIC (disseminated intravascular coagulation — a life threatening condition where both uncontrolled clotting and bleeding are occurring), or cancer. An MRI is ordered. As Flynn enters the MRI, hetells Cole that he knows he will be dead by this time tomorrow. The MRI shows fluid in the lungs, no masses, and some damage from where the key ripped through his intestines. It also reveals bleeding in the kidney and thigh. Cole reports Flynn’s suspicion that he is going to die and tells House that he believes his “sense of impending doom” could be a symptom. Amber suggests adrenal disease, blood disease, or anaphylaxis. Kutner suspects it might be tainted blood from a bad transfusion. Foreman, looking at the labs, notices a high low level of immunoglobulins (antibody proteins) and suggests Amyloidosis. About this time, Flynn suffers a gran mal seizure. The team notices leg edema (swelling of the lower legs), and then he has another seizure and “flank pain” (but how could they tell since he said nothing about pain and never even grabbed his side?) Cole and Kutner report back that Flynn has developed kidney failure which led to low sodium and seizures. House continues to suspect amyloidosis, but Kutner is firm in his belief that it was a bad transfusion. House gives Kutner and 13 two hours to proved it was transfusion related — meanwhile the rest of the team will be obtaining a subcutaneous fat biopsy to look for amyloidosis. Kutner and 13 can find nothing, and the fat biopsy in inconclusive, but House decides to treat Flynn for amylodidosis anyway with a bone marrow transfusion. First though, he will need radiation therapy to kill all his current bone marrow. Foreman — using his speaking-for-Cuddy fiat powers won;t let House go through with the radiation treatment without more evidence. House, since he has blood type AB as well, suggests the team transfuse blood from the same 3 donors Flynn had into him and see if he develops any symptoms. The transfusion is performed and House develops a fever. He blows it off as a common reaction is someone like him who has had multiple transfusions, but the team is suspicious. They suggest a Pneumococcus or Pseudomonas infection. House disagrees and stands up but begins to feel faint and realizes that they’ve spiked his coffee with narcotics. He wakes up a short time later, strapped to a chair, as Dr. 13 is performing a liver biopsy. That biopsy, along with the kidney and lung biopsy they already obtained, were all negative. Amyloidosis seems to be the cause and Flynn is scheduled for radiation. In the middle of a conversation with Wilson, House has his Eureka! moment and realizes that Kutner was right. He asks Flynn what blood type he is and Flynn tells him “A.” That means that he received the wrong type of blood. House tells the team that the laboratory doesn’t actually test the patient’s cells for blood type, but instead they test for antibodies against other blood types. Flynn has an antibody he shouldn’t have, which made the lab think he was AB when he was really A. The reason for this extra antibody? Lupus, which along with the transfusion reaction explains all his symptoms.
Huntington’s Disease is a particularly nasty inherited neurological disease. Symptoms are progressive and include an abnormal gait, uncontrollable body movements, severe dementia, and emotional changes. It is especially heartbreaking because most people don’t realize they have it until they’ve already had kids, and by then half of those kids will have inherited the disease. Having a parent with Huntington’s means that you have a 50% chance of inheriting it and there’s nothing you can do about it. Huntington’s is incurable.
Lung MRIs are rarely obtained, and is not an appropriate choice here. A much better study would be a lung CT scan or a even a ventialation/perfusion scan (VQ scan) if looking for a pulmonary embolus. Of course, those tests don’t use powerful magnets and wouldn’t fit what the writers needed to happen.
When people are transfused in the hospital, they receive a “type and cross“. Their blood type is obtained and their blood is tested against the donor’s blood in the laboratory to make sure there aren’t any unexpected reactions (like Flynn had). This takes time — about 30 minutes — so in emergencies Type O- blood (the universal donor) is used while the crossmatch is obtained. Flynn would have received 3 units type O, not type AB.
Furthermore, House’s explanation of how Flynn got mis-typed as AB is horrendously wrong Blood typing is done on blood cells, not antibodies. Anti-A antibodies are added to one sample of a patient’s blood, and Anti-B antibodies to a second. If the patient has A or B proteins on his blood cells, one or both of samples should clot as the antibodies react with the proteins on the blood cells. If neither tube clots, then the patient has blood type O (neither A nor B proteins on the blood cells). If only the A tube clots, then the patient has type A; and if only the B tube, type B. If both tubes clot, the patient has type AB. (This page has a nice explanation of the tests, with pictures!)
Antibody tests on the plasma can be performed as well, but this is never the primary means of blood typing. Anyway, House has this backwards. People with Type AB blood have no antibodies against A or B (that’s what makes them the universal recipient). If Flynn had an extra antibody, then he would be misread as type O, not type AB.
Does this hospital not test for the Rh factor (the positive/negative aspect of blood type) on its patients? It hard to hear doctors doctors talking about ABO blood types without mention the Rh factor as well. In fact, Rh mismatches cause worse transfusion reactions than ABO mismatches.
Why would you slip a narcotic mickey to someone on chronic narcotics? How could you even begin to guess what dose to give him without killing him. Benzodiazepines (the Valium class of drugs) or a major tranquilizer like Haldol would be a better choice.
It was nice to see the tables turned on House and seeing him on the receiving end of unethical experiments, but 1) those biopsies carry substantial risks, 2) it was really to soon for “tainted blood” to affect the organs enough to see on biopsy, and 3) House’s liver with his chronic acetaminophen overdosing (i.e. Tylenol, one component of Vicodin, and a known irreversible cause of liver damage) is going to already screwed up on the biopsy, transfusion reaction or not.
I give the medical mystery a C+; it started out slow and built up speed, but still barely finished above average. The final solution was so close to fitting exactly, and dose explain most of his symptoms, so I’ll give it a B. The medicine was was artificial (the MRI and key) and wrong (the blood typing) and earns a D-. The soap opera was strong, probably my favorite of the year so far. I was cringing when House first suggested stealing Cuddy’s thong, but the way it led to collusion between unexpected parties was inspired. I give the soap opera a strong A.
The previous House review
A list of all prior House reviews
November 21st, 2007 at 1:12 am
Question – wouldn’t the man feel the key being pulled by the magnets well before he was in the machine? Also, why doesn’t house have his mask on in surgery?
November 21st, 2007 at 1:13 am
First!
The way that the solution was explained by House felt off, and I’m glad you described it. If I recall correctly, the blood should never have A or B antibodies in it in the first place unless there was a botched transfusion, since the body would never be exposed to the antigens in the first place. By House’s logic, 99% of people would test O since they likely never got the wrong blood type and thus have the body produce the antibodies.
But yah, it’s a lot stronger than some of the stuff they’ve been cranking out this season. I was starting to worry that they were forgetting about the medicine.
And as some people might notice, the Vicodin was quite prominent this time.
November 21st, 2007 at 1:18 am
Lupus, it has finally reared it’s ugly head.
And I’m with Kelvin, I thought I had forgotten most everything about blood transfusions/typing. When they said he was AB+ I commented on the luck of the blood type being so crazy and House just happen to match it? I though it wasa the rarest of the blood types anyway. Glad I’m O- :D
Wouldn’t the key have been super hot too? Double ouch for him.
Favorite moments of this episode:
-Spiking House’s coffee
-The deliverance of Cuddy’s thong
Sad to see Big Love go though… Hopefully Taub’s next.
November 21st, 2007 at 1:26 am
Me I was hoping they would save Lupus for the series finale. It would have been such a great gag to have the whole show end on the one thing it could never be.
On the other hand it got me a bunch o’ points…
November 21st, 2007 at 1:32 am
We now have a new saying: “It’s
neveroccasionally lupus (when basic blood science is ignored)”. Not quite as catchy though. :-PSome other problems that I can think of:
On the soap opera side, putting a lighter to a sprinkler head will only trigger that individual sprinkler. This is a pretty widespread misunderstanding about how those systems work. Only if there is a pre-programmed setup where any temperature alarm mandates a full system response (say, in a chemical storage area where lots of combustibles are stored in close quarters which could allow a flash fire to develop) would something like what was depicted happen. CTB would just soak herself (and have some ’splainin to do to Cuddy).
And just in case anybody from FOX reads this, was it really necessary to zoom all the way in to Cuddy’s ass when she was bending over? I think anybody with eyes could have figured out what you were going for without needing to drive home the point. Sheesh.
I guess I’m just strange, but when the magician guy had his nosebleed zen moment I thought immediately about this blog. Not likely that House would be engaged in any psychic imposition stuff though. :-P
On that topic, in the opening scene the magician is clearly seen bleeding from his mouth, but later he is having nosebleeds only. It doesn’t seem like it would make any sense for a nosebleed to travel up into the mouth while suspended upside down. Otherwise would he not have had to be bleeding out of his throat or lungs (or have a cut in his mouth)? Certainly the ER would have caught the difference there. Perhaps I missed a detail there that linked those together.
And yes like usual, there were problems with insufficient protective equipment in surgery. It seems like the writers just don’t want to cover the faces of key characters because it would make them more difficult to identify to any new viewer who hasn’t learned all the voices yet. Dumbing down things for sure.
Four episodes to go unless the strike ends. Looks like two heads will roll next week, I predict Kumar (for liability/clumsiness reasons) and The Doctor Who Apparently Has No Need for a Name (a.k.a. 13) because the television gods will be so enraged by her lack of an identity and they will smite her. CTB and Taub… Interesting team this will be.
November 21st, 2007 at 1:43 am
I loved the little nod to Kal Penn’s Kumar character when he and Taub find marijuana at the magician’s house – “bag it anyway, you never know”
November 21st, 2007 at 1:49 am
Yeah, their explanation of blood typing made no sense to me, and I no little about blood types other than reading a few web pages. I rewound just to make sure I was hearing their incorrect info correctly. This is even worse that the Lyme disease last week, especially since it sounds like they could have just reverse the logic and have given him type A blood when really his lupus-affected body is now type O. (Yeah, that’s not realistic, but at least it’s logically consistent to non-MDs.)
Anyway, Spaz, why are you glad you’re O-? That’s my type. I’d prefer it if I were AB+ instead. I’d rather be the universal accepter and not have a chance of a (very) rare screwup. But at least being a universal donor makes my blood more valuable when I donate.
November 21st, 2007 at 1:51 am
I wasn’t a big fan of the soap opera this time. The ‘Bring me the thong of Lisa Cuddy’ command was, as Wilson put it, “creepy.” And although it resolved well, IMO, that doesn’t justify its existence.
Also, if I see House collapse in his office -one more time- I’m going to lose it.
He breaks his hand with a mortar. He gets shot. He electrocutes himself. He passes out from spiked coffee. I’m surprised last season’s drug overdose and puke was at his apartment.
“Alls well that ends well” would be a better name for this episode, as a lot of stuff that was dangerous -didn’t- blow up in the writers’ faces.
November 21st, 2007 at 1:52 am
I’m pretty desperately rooting for anyone but cut-throat bitch to make the team, although it’s looking like she will. I’m hoping for 13 – since like them, I’m assuming one female.
Also – it was a bit hypocritical firing BL for the reasons stated. The original members of the team often did an end-run to Cuddy, and she’s never exactly been one to reel House in anyway. I guess I don’t see House & Cuddy as locked in a “power struggle.” Cuddy pretty much lets House do what he wants.
And poor Kumar slinked away at the end all hurt that Big Love picked him.
Go Go Lupus!
November 21st, 2007 at 2:03 am
Regarding what type of blood the patient would have received, he was already in the hospital for a day or so. If he’d had his blood type tested during that time, they would have been able to give him type specific, rather than using the relatively more valuable Type O after the MRI incident.
Speaking of the MRI, I think proudfoot’s right. An MRI machine is always generating a magnetic field, even when it’s not actively being used to scan something. The only way to actually turn off the superconducting magnet is to quench it by dumping the liquid helium. Getting an MRI machine back into operation after a quenching is an expensive and time consuming process, so it’s only done in an emergency.
November 21st, 2007 at 2:32 am
This was one of the more entertaining episodes thus far. However all the characters (both new and old)seem shallow and unispired this year. The new team is predictable and bland, they don’t seem to have any
meaningful interactions with Wilson or Cuddy. I liked the idea of giving House a new team, and i thought it was clever to make it into a competition, but now its time to establish the new roster and start working on character depth and creating synergy with the exsisting cast members
It’s early in the year but i don’t understand what role Cameron, Forman and Chase are supposed to play in their new positions. Cameron and Chase have had little air time and No plot development. Foreman has seriously lost his edge. Foreman was so interesting because of his combination of contempt and respect for House. The writer’s worked three seasons to establish that interaction with House and then wrote it off in a single episode. Personally I would have brought Foreman
back later in the season as the head of a team consisting of Cameron and Chase. Then I would have had House’s team compete with Foreman’s team for Patients and diagnosis. I think that would have been in line with the past seasons character development.
Also what happened to the bike, Steve McQueen, and clinic duty
P.S I hate to sound negative, I just think the writers have way to much going on at the same time and the medicine and drama have suffered because of it.
November 21st, 2007 at 3:00 am
Kelvin: The anti-A and anti-B are not stimulated by the presence of the corresponding antigens in the blood, since then type O would never have either of them. Or did I misunderstand what you wrote?
BTW, you misspelled “second.” :)
Anthony: O is only the universal donor, and AB the universal recipient, in the case of the blood cells. If it’s plasma, those labels go the other way, since it’s the antibodies in the plasma (none in the case of type AB, both anti-A and anti-B in the case of type O) that cause agglutination in the presence of the corresponding antigens on the blood cells.
November 21st, 2007 at 4:23 am
Thanks for another great review!
One question, and this may be stupid but – would a doctor really perform a liver biopsy on someone who was just wearing their regular clothes, without making them wear a sterile gown or wiping down the biopsy site with iodine? I’m hoping that this is just House and that real doctors don’t just shove a biopsy needle into your liver!
And why DID House have Wilson’s blood typed?
It’s not….oh, it’s lupus.
November 21st, 2007 at 4:25 am
Yes, the thong was a lousy, lousy objective and the zoom-in to Cuddy’s ass was even lousier.
With House getting sick himself and 13’s envelope (Cameron’s AIDS test result), this episode was like a flashback. First time in this season we saw House swallow pills, and Cameron and Chase didn’t make appearances.
By House’s logic, CTB will definitely go as she’s most likely to work for Cuddy. 13 is likely to stay as House is getting attracted to her and her condition could be a source for future twists. The plastic surgeon and Kumar could both stay.
It’s also quite outrageous for Cuddy, Wilson and Foreman to spend another season single.
November 21st, 2007 at 4:50 am
I have been a quiet reader of this website for a while, so after I watched this episode and saw how completely wrong the medicine was, I thought I would post a comment.
I just did some blood typing the other day… Although it was with antibodies which had expired in 2004, it still worked! But it was very quick… Adding Anti-A to one drop and Anti-B to another drop. There was also some Anti-D around, but since the sample was from a male, I saw no point. :P
Medicine was wrong, soap was great, the problem itself was good, and FINALLY it is Lupus. What’s it going to be next week?? Something obvious again?? Maybe its Amyloidosis… LOL!
November 21st, 2007 at 5:07 am
So, let’s see if I got this right now:
House said Flynn was making antibodies to B.
But if he’s type A he’s already got the “anti B”, right?
If he was making other antibodies because of the lupus, that would have to be “anti A”..
And both “anti A” and “anti B” would result in his blood type testing O.
(and then + or – on the Rhesus factor which they completely neglected).
November 21st, 2007 at 5:26 am
“It is especially heartbreaking because most people don’t realize they have it until they’ve already had kids, and by then half of those kids will have inherited the disease. Having a parent with Huntington’s means that you have a 50% chance of inheriting it and there’s nothing you can do about it. Huntington’s is incurable.”
First sentence, not quite. Each child will have a 50% chance of inheriting the gene, so it’s possible to have 10 kids who did not (though statistically unlikely).
Having four kids is no guarantee that that two of them will inherit the disease. Each flip of a coin is independent, no matter what the previous result was.
Second and third sentences, just fine :)
November 21st, 2007 at 5:44 am
Two mistakes in your retelling the story, thought i would point them out
1. Foreman, looking at the labs, notices a LOW level of immunoglobulins
2. When House wakes after his spiked coffee, he didnt seem strapped to the table (not chair)
he just appears too groggy to prevent the sampling
November 21st, 2007 at 5:57 am
Not having a mask on in the O.R. is not so that newcomers can identify the characters, it’s so the actors can act with full visual effect. Everybody else in the O.R. had a mask on, I think we should simply grant the writers this degree of artistic license (like the doctors doing technician’s work in running various tests) and not worry about it.
The medicine may have been pretty flawed, but the soap opera was about the best ever. 13 continues to be by far the most interesting character; there is no chance that she will be leaving. (Although the writer’s strike may throw a wrench into the season continuity which could even affect staffing matters.) She has the most intense relationship with House, and she lacks any of the negative characteristics that the others have shown. Personally I think Taub and 13 are in, because of their detailed and highly personalized back stories. These have surely been elaborated in order to provide them with a background for an on-going role. Kumar and Cutthroat Bitch so far lack such a detailed back story; they merely have strong personality characteristics. I predict that whichever one is given a back story next week or very soon will be the one to stay in the trio of assistants. I’d rather keep Cutthroat Bitch. First, she is showing plenty of personality to go with her manipulation, and I have the impression (without going back and counting) that she has been more successful on the medical side than Kumar. Second, I think House would be happier with two women instead of two men, and it would offer more scope for this even more sexist House in season four. (Some of the lines have been unbearably crass and inappropriate; the worst, for my money, was House offering a position on his penis (!!) instead of on his staff to the CIA doctor.)
There has been some harsh criticism of the group dynamics here, but I think that as it has played out over seven episodes now, it has proven to be a genuinely involving device. I continue to worry that other characters aren’t getting enough time, but that will probably even out as the hiring thread concludes.
November 21st, 2007 at 6:56 am
When House woke up, it was shown that his wrists were restrained. Remember that he was already awake by the time of the liver biopsy, and protested about the lack of a local anesthetic but could do nothing about it.
November 21st, 2007 at 7:12 am
My son can attest to the fact that I was virtually screaming at the television screen several times during this episode about the completely ridiculous representation of Blood Banking. Again, I speak as a Medical Technologist with over 25 years of experience of actually DOING blood banking.
1) In the first place, unless someone has noted a transfusion reaction taking place, what the blood bank gets back is a completely empty bag. There would never be anything left to transfuse into someone else, even if someone were to overlook the the fact that the sterility of the bag has already been compromised. There are big hoops to jump through even when a unit has been signed out on a patient and then returned to the bank without being used in order to allow that unit to still be available to its intended recipient. And any of the donors who had supplied the initial blood would be ineligible (too soon after their last donation to donate again) to be giving anyone a second sampling. Even that asks us to suspend even more disbelief and think that they could go through the paperwork of finding out who donated the units to begin with and calling them back. But, of course, it appears that not only pathology but blood banking at PPTH is staffed only by House’s ducklings…..
2) As Scott pointed out, blood banking involves “typing” the patient by testing the recipients cells with known antibodies AND testing the recipients antibodies against cells of known blood type. Anytime there would be any kind of discrepancy, that is a very big issue that would have to be resolved (or, in an emergency situation, blood type O issued) before proceeding with a crossmatch. If this guy was really a blood type A, but was not presenting with a detectable anti-B, that doesn’t mean his cells would react with the typing sera as AB, he should still ‘forward type’ as A. I do recall hearing about some colon cancer patients with blood type A presenting falsely as AB, because they were shedding an substance that caused their cells to react with the commercial Anti-B, but that was years ago, before the monoclonal antibodies were developed for typing sera. Anyway, even that dubious situation would make the blood bank stop and do some serious double-checking before issuing any blood, or again, going with Blood type O.
3) An ABO discrepancy such as this is one of the biggest worries of all blood bankers. The vast majority of the time, when someone is transfused with the wrong blood type, it is due to either a clerical error or mislabeling of a specimen. We are talking a MAJOR type of reaction in an ABO discrepancy transfusion of this case: usually the recipients blood pressure plummets within minutes of starting the transfusion and you are seeing a massive, critical reaction. One of my former supervisors had a case of mistakenly transfusing type A blood into a type O recipient because of a mislabeled tube, and even though the transfustion was stopped immediately, the person suffered severe and irreversible kidney damage.
November 21st, 2007 at 7:27 am
I will add to the chorus. Is there any way they could have been MORE wrong about the blood typing?
I am concerned that the writers seem to be putting House’s character on the fast track to a big sexual harassment plot line. It would not surprise me to see the CIA doctor come back with a bit ol’ chip on her shoulder, and lots and lots of anecdotal evidence from various characters who have witnessed House’s “you’re hot, so I’ll say something inappropriate” wooing tactics.
Spaz and Anthony: My blood type is AB+. I feel so special! :)
November 21st, 2007 at 8:16 am
I work at a company that makes blood banking reagents, and I’m glad to see you call shenanigans on the blood grouping. To accurately determine the ABO blood group, both forward and reverse grouping are routinely performed for just this reason (forward: patient cells with standard sera; reverse: standard cells with patient sera.) And yes, the lack of mention of the Rh factor misses a rather big problem!
November 21st, 2007 at 8:19 am
I guess my total lack of medical knowledge allows me to enjoy the show, wallowing in my own ignorance! My guess is that lupus is done for this season, except maybe an odd mention or 2.
I enjoyed the soap opera more this time, though less Wilson and Cuddy, and no Cameron and Chase displeased me.
November 21st, 2007 at 8:34 am
I enjoyed this week’s episode more than the others this season:
1. Didn’t Laurie’s shock at finding that the Mormon had actually succeeded in acquiring Cuddy’s thong seem a bit…insincere? I thought he phoned that performance in. Maybe he was disgusted by the writing as well.
2. 13’s reason for not getting tested seems downright stupid.
3. I miss old bearded non-doctor.
4. It looks like cut-throat bitch is going to be on the team, and she bores me.
5. 13 bores me too, as another example of RATD (ridiculously attractive TV doctor)
6. I like both the Kumar and Taub characters, but no way are they both going to be on the team.
7. Good Wilson this week!
8. Finally, House showing some human qualities for a change.
9. Still no clinic time – but maybe when they get this tiresome Survivor/Hell’s Kitchen/America’s Top Model arc over, there’ll be more time.
November 21st, 2007 at 9:22 am
Has nobody heard of O-neg, the universal donor? Who transfuses A or AB blood? Bring back old non-doctor from the beginning of the show! As for Cuddy and her thong, for pity’s sake, just sleep with her and get it out of your system, House!
November 21st, 2007 at 9:53 am
Great info Suzanne and Techspeaking!
I’m going add my 2 cents. House giving Kumar 13 hours to prove the bad transfusion could have been resolved quickly by Kumar having a bloodbank sample drawn and tested. Part of a transfusion reaction workup is drawing another bloodbank specimen and testing it for ABO/Rh and DAT(direct Coombs). I guess non of the writers knew that. I think the writers wanted the problem to be a delayed transfusion reaction.
Also the writers blew a great chance at an interesting series finale by using Lupus for this episode. I’m not writing that because I didn’t any more points again this week. :-)
November 21st, 2007 at 10:30 am
I guess I’m just strange, but when the magician guy had his nosebleed zen moment I thought immediately about this blog. Not likely that House would be engaged in any psychic imposition stuff though. :-P
Jay, you are not alone.
13 has to go, she’s really turned into Cameron With Better Bone Structure™.
November 21st, 2007 at 10:54 am
@Kari
I’m AB+ too!
November 21st, 2007 at 11:04 am
The worst thing about this season is the continual escalating debasement of Cuddy. She was never professional enough to be a convincing hospital administrator, but now they’re going out of their way to make her a hapless sex gag.
There’s never been any doubt that 13 would be the last candidate standing, and Kumar’s the most probable choice for the other one since the show doesn’t already have a “lovable goofball” character. CTB is too much of a gimmick to be a permanent addition and a short, bald, middle-aged man doesn’t really have a chance in this game.
We’re reaching the same point in the season as this time last year, when the plot device starts wearing thin. At least we’re getting more Wilson this season (although not last night). I look forward to a return to standard medical mysteries and putting the focus back on House himself.
November 21st, 2007 at 11:23 am
“One question, and this may be stupid but – would a doctor really perform a liver biopsy on someone who was just wearing their regular clothes, without making them wear a sterile gown or wiping down the biopsy site with iodine? I’m hoping that this is just House and that real doctors don’t just shove a biopsy needle into your liver!”
No, we dont do it that way. And also he entered in the OR without a mask or hat(?)!! It happens all the time in House… a shame!
By the way, great page! It’s been very helpfull to us in Brazil to do the serie’s subtitles.
=)
November 21st, 2007 at 12:02 pm
To those who question why he would be given non-O-neg blood in the first place, I agree with Chris’s (#10) answer: being in the hospital for more than a day, and having (presumably) typed the blood, the hospital would definitely preserve their precious O+ if they can transfuse something else.
Brian Tung: I may be off on this, but I think the vast majority of people should not have the antibodies to the blood types they are not (not 99% though: I probably overestimated that one because some may be exposed prenatally or through other means than transfusion). Take me, for example, being O+ and parents both being the same. Now if I never had a blood transfusion, I shouldn’t have anti-A’s or anti-B’s floating in my bloodstream, since I was never exposed to the antigens in the first place.
Actually, working it out, I found my mistake. House’s method would overtest for AB: most people do not have the antibodies, not because they can accept different blood types (i.e. AB), but because they were never exposed to the wrong blood type in the first place. Of course, House’s method is a load of crap in the first place, so our mistakes cancel out. ;-)
November 21st, 2007 at 12:03 pm
Oops: in the first paragraph of my last comment, I wrote O+ instead of O-.
November 21st, 2007 at 12:04 pm
I think it’s fitting that you gave the soap opera an A and the medicine a C because this show has become more and more a soap opera this season and less and less about medicine.
It was obvious from the first time the new fellows appeared that Olivia Wilde’s and Kal Penn’s characters were going to be staying on the show permanently and more interesting characters such as Ridiculous Old Fraud and Cole were going to be jettisoned. And how sad that Private Practise, the GA spin-off, treated the inheritability of Huntingdon’s with more science and more compassion than this show does. Here it was yet another ploy to get us to like Thirteen. And apparently drugging your boss, restraining him and doing a biopsy on him without his consent and without anasthetic is the way to win his respect.
I admire Cole being sneaky enough to go to Cuddy to cut a deal. Since House was specifically looking for sneaky, you’d think he would keep Cole on the team.
With Cole and Amber gone, House is going to be left with a team whose specialties are internal medicine, sports medicine and plastic surgery. Would you put your life in their hands? When Cameron left he interviewed more immunologists, he’d been going to hire another neurologist before he hired Foreman and countless times Chase’s job was keeping the patients alive while they figured out what was wrong. Their specialties made sense. Now suddenly any doctor will do because choosing a team is about the power play with Cuddy, not about getting the best medical team he can.
The other thing I find sadly missing from the show this season is any form of ethical debate or meta thinking. Sara Hess, who wrote this episode, also wrote Spin, which touched on whether a doctor should break confidentiality when she knows a patient is cheating, and Sleeping Dogs Lie, which dealt with not only the article conflict (as someone who publishes in academia, I would have kicked Foreman to the curb if I had been Cuddy) but also the ethics of informed consent in live donor transplants. This season there is nothing of depth on the show, just wacky Survivors hijinks.
November 21st, 2007 at 12:22 pm
Another really stupid medical error is suspecting tularemia because the magician kept rabbits
There is basically 0 risk of catching tularemia from a domestic rabbit, eating wild rabbits, yes, catching tularemia from a pet rabbit, no way.
November 21st, 2007 at 12:29 pm
Am I the only one who is finding all the recent episodes’ references to sex – sophomoric? Yes, House and sexual harassment could have been a really interesting angle to explore but not when the dialogue seem to be written by a teenage boy looking for some cheap laughs or shock value. None of it works for me, I’m afraid.
November 21st, 2007 at 12:34 pm
It makes sense to me that they would conserve their supply of O-negative blood, what with it being the most useful and all, and it also makes sense that they’d have someone’s blood typed when they were first admitted. Magician Dude didn’t get the blood until the second day of being in the hospital, so presumably they gave him compatible blood instead of O-negative.
The rest didn’t make sense to me.
November 21st, 2007 at 12:39 pm
The lighter side of House……
Obviously, this story arc is winding down. Once it ends, I think we’ll see a return to deeper episodes of House, ones with more interactions and exploration of issues.
I am worried that 13 is becoming Cameron; I think her dialogue this week was practically interchangeable with Cameron’s, that lecture on questions and answers was so much what an angry Cameron from Season 1 would’ve said.
Also, with this season, Cuddy & Foreman have become, more or less, horror of horrors, friends of House. As far as Cuddy not reining in House, there’s a flip side to that. House gives Cuddy plausible deniability. Even Foreman’s line about, “that’s how I got the job,” or “if she’s not wearing anything at all, then we can stop doing the differential,” was more Wilson-esque than previous Foreman. Foreman now has come to terms with his relationship with House, as has Cuddy. Yes, he uses them, but it’s never for his benefit. He uses them for his patient.
November 21st, 2007 at 12:46 pm
Prediction: 2 of the remaining candidates will be thrown out next week, and Foreman will be the third winner, releasing him from his eternal ‘5th wheel’ status on the show. Lame, I know, but if you watch enough TV, lame is what you get. So, my final predicted line-up:
13 (ugh)
Kumar (hooray)
Foreman
November 21st, 2007 at 1:10 pm
sorry if this is a really dumb question, but what caused Flynn to have the problem in his water trick in the first place?
November 21st, 2007 at 1:13 pm
I’ve always been more of a lurker than commenter, but I definetly look forward to your reviews after each episode. Especially this season. Lately it seems like the episodes aren’t coherent, or even care about the patient stuff.
The main point of this comment is about CTB, who definetly wins the “Dumbest Person” award last night. Setting off the sprinklers in the hospital? Who knows how many people she could’ve gotten sick because of that! Even more disturbing was the sprinklers spraying water **directly onto the nurses’ computers**. Not only was she endagering lives but potentially destroying hospital equipment.
November 21st, 2007 at 1:24 pm
I miss the ridiculously old fraud. He was awesome. And I nearly started crying when I saw Foreman moping around in the back with a newspaper. “Not another ‘depressed Foreman’ episode…” But it turned out okay. I thought the soap opera aspect was pretty good. IMHO, I think that 13, Cutthroat bitch, and the plastic surgeon guy are really annoying. And Cuddy really needs to start doing more to control House. Yes, we get that he is manipulative, but does that mean you should just lie down and make his job easier? It definitely is way more boring…
November 21st, 2007 at 1:25 pm
“The worst thing about this season is the continual escalating debasement of Cuddy. She was never professional enough to be a convincing hospital administrator, but now they’re going out of their way to make her a hapless sex gag.”
Oh man, I so have to agree with you there. Rewatching bits of S1 just make me mourn the loss of such a fabulous character. She used to be House’s equal: they would have debates in her office, she could snark with the best he had to offer, but ultimately overrule him (as was her duty). And now? Ugh.
When the camera showed her stomach first, I thought it was to show that, maybe, she was pregnant. My mind wasn’t thinking about, y’know, if she was wearing a thong. So disgusting to pin the camera right *there*.
Personally I’d prefer less of Cameron!clone – aka 13 – and more of the Cuddy from S1-S3.
November 21st, 2007 at 1:39 pm
Kelvin: If I’m not mistaken you intrinsically have IgG blood group antibodies. Type O has Anti-A and Anti-B, Type A has Anti-B, Type B has Anti-A, and Type AB has neither. This is why Type O blood will react with Anti-A and Anti-B antibodies, while Type AB will react with neither. It’s not a matter of being exposed to the antigens in this case – it’s a matter of already expressing those antibodies even before exposure to any antigen. =) And this is why blood type testing using Anti-A and Anti-B antibodies works…
November 21st, 2007 at 1:47 pm
This might be the article that inspired the episode.
http://dx.doi.org/10.1016/S0140-6736(06)69417-8
Pretty interesting. It would probably be a solution to the medical mystery this week.
(Note: I can’t seem to get the whole thing clickable, even using an html tag, so you’ll have to copy/paste it into your address bar.)
November 21st, 2007 at 2:47 pm
Am I the only one who doesn’t see much similarity between Cameron/13? Personally I thought that Big Love was the one who was a bit of a Cameron clone. Maybe, like House, I’m blinded by the fact that 13 is ridiculously hot. Either way I’d rather have her than Cut-throat Bitch. I like having Kumar as sort of the team idiot (which is something I didn’t like when they did it to Chase – but Kumar fits the role much better). Taub is ok – I liked him better early on before they made him as slimey as they have the last two episodes. But Taub, Kumar and 13 would be my choice for new team. I still miss ridiculously old fraud though – I hope he pops up from time to time.
November 21st, 2007 at 2:57 pm
Spoiler!
http://www.zap2it.com/movies/news/zap-wildepennjacobsonhousecasting,0,1163039.story
Haha, I can’t wait ;)
November 21st, 2007 at 4:08 pm
The sexism and misogyny in this show is really getting to me.
As far as Huntington’s Chorea, one of the more famous people who had it was Woody Guthrie. Arlo does not have it.
November 21st, 2007 at 4:24 pm
Am I the only person here who saw the close up of Cuddy’s ass and was thinking, ‘And NOW I see how she could become Dean of Medicine’. And, although it was overlooked by most people, I though they actually fleshed out Kutner somewhat as being defiant of House, especially when House dismisses the magician’s case because he saw it as simple and boring.
November 21st, 2007 at 4:52 pm
And here I am grousing because there’s no way POTW could’ve done the trick without an assistant present and having the card pre-planted on the glass.
November 21st, 2007 at 5:52 pm
My guesses for the doctors to stay: Kutner, Taub, and Thirteen.
November 21st, 2007 at 7:15 pm
Kelvin: O blood has both anti-A and anti-B antibodies. AB blood has neither. That’s why it’s the universal recipient (for red blood cells). If you were to get AB blood cells, your blood would clump up like strawberry preserves. Apparently, you develop the IgM antibodies through environmental factors, not from your own blood.
Aaron: Next time, you might try percent sign escape codes, like this: http://dx.doi.org/10.1016/S0140-6736%2806%2969417-8
Those are ASCII codes: %28 is for the left parenthesis, %29 is for the right.
Brian (50): Possibly multiple cards, too, depending on how the trick works.
Like many others, I find this Survivor theme to be dragging on way too long. And the reasons for some of the ejections are getting silly. Some of them made sense: Chucking the Russian girl way early on because she didn’t do anything wrong (or right) was dead on. But kicking Big Love out because he made a power play with Cuddy? That’s a rationalization–a reason you make up for a decision you’d already made (possibly subconsciously).
November 21st, 2007 at 7:22 pm
One more thing: The medicine was particularly frustrating this episode because it really wouldn’t have taken that much of a change to make it dramatically better. A proper treatment of blood type would have left much less of a bitter taste in the mouth.
Oh, and by the way, updated House grades in the gratuitously sycophantic http://astro.isi.edu/misc/HouseGrades.xls
(Is “gratuitously sycophantic” redundant?)
November 21st, 2007 at 7:29 pm
Volakis has always been doomed, because her character is built entirely around competing for the fellowship. Once that plot’s over, she’s got absolutely nothing going for her.
I’m really glad the final selection’s over after next episode- Maybe without the metric ton of guest stars eating the show’s budget they can rehire their medical advisors. Unless they haven’t been fired, in which case they should be. When you can find out how wrong the medicine is by three minutes of Googling, you know someone’s sleeping on the job.
November 21st, 2007 at 9:00 pm
keith, i will tell you that CTB is not going to be on the team, according to who has signed a long term contract…
November 21st, 2007 at 9:12 pm
The one thing I want to know is how the hell the magician did that trick in the hospital room.
An explanation for that will make up the terrible blood-typing explanation.
Still, |H|OUSE will always be my favorite show
November 21st, 2007 at 9:55 pm
Thanks for another great review!
I concurr with poster Jay about the Zen nosebleed.
Prediction: Cuddy will interfere, like she did with foreman.
remaining candidates will be
Cole (i.e Big Love)
Taub
Foreman
13 (at least until we know her name)
November 21st, 2007 at 10:03 pm
The writing lately has really been bad for all the female characters. I like 13, and have since Black Donnellys, but she’s not written all that well and neither is Cuddy. Ever since her dumb ‘biological clock’ subplot, she’s been a weak character. Before that she was awesome (as well as easily the hottest woman on the show).
Trivia point: Lisa Edelstein played your partner in the Blade Runner computer game.
November 21st, 2007 at 10:15 pm
Cole should’ve been fired. House did have a point, albeit a rather cobbled up one, for the whole panty-raid subplot.
The point was to get things done without administration knowing what’s going on (heck, if nothing else, House sees to it that Princeton-Plainsboro -remains- a non-profit). Cole instead informed administration, and should be tossed.
Besides, I couldn’t stand his hairdo. Grow an afro already, or don’t! That’s a 2nd grade haircut on a grown man. It’s the black equivalent of the “Moe”.
November 22nd, 2007 at 12:32 am
Good week for me, as three of my Chosen 10 showed up in one episode.
For what it’s worth, this is just as fun as my fantasy football league.
November 22nd, 2007 at 9:14 am
Man, I miss Big Love. Before this ep, I thought it would be BL, Taub, and Kutner. But now I guess it’ll have to be 13, Taub and Kutner. As long as it’s not cutthroat bitch. IMHO, Foreman should take two of them, House gets two, and then they both get a new, un-annoying person. Bring back the janitor!!!!
November 22nd, 2007 at 11:24 am
Did I blink, or did House really make no comment at all about the size of the first thong presented to him? Considering his history of making gross comments about the size of Cuddy’s behind, is that at all credible?
I also don’t believe that he would toss the Huntington’s test results – even if 13 didn’t want to see them, surely House would want to know. I miss the House from a couple seasons back. This version of House is a collection of unpleasant personality traits with occasional flashes of out-of-character compassion.
And aren’t we ever going to get to see Ridiculously Old Fraud having coffee with House?
November 22nd, 2007 at 11:45 am
IMHO, I think that it will come out that 13 is actually Cameron’s sister. I’m guessing this for several reasons:
While we have met House’s, Foreman’s, and Chase’s family members, we have heard very little about, and never met anyone, from Cameron’s family. The only thing we do know was that, in a previous episode, Cameron said that she was not an only child. Maybe she has a sister that also became a doctor?
While 13, who’s name has been speculated to be Remy Hadley, and Cameron have different last names, I’ll bet that Cameron kept her dead husband’s last name. It would be entirely consistent with Cameron’s character.
13 has avoided telling anything about herself to House, other than about her mother having Huntington’s. My guess is that she doesn’t want House basing his choice to keep her or not because she is Cameron’s sister. She wants to make the team on her own merit.
13 has had no interaction with Cameron in any of the episodes so far. Sisters who don’t see eye to eye, maybe?
There is a certain physical resemblance between 13 and Cameron which would be more evident if Cameron hadn’t dyed her hair blonde. In some aspects, their personalities are similar, too.
In “97 Seconds”, while the girls are holed up in House’s office coming up with a diagnosis, we see 13 in her street clothes and she says that she has to step out for a bit. The next time we see her, she comes into Stark’s room, by herself, with the Thailand threadworm diagnosis and the pills. How did she come up with that? I have never heard of threadworms in America. Considering that Cameron is back with Chase, maybe 13 consulted with them privately. Chase, being Australian, would know about threadworms from living in that part of the world.
In the second episode this season, 13 quickly keyed in that the woman was a pilot even though no one told her. We found out it was Cameron who recommended House to the patient. It makes me wonder if she and Cameron talked.
This is just speculation on my part, but it fits. What do you think?
November 22nd, 2007 at 2:22 pm
“This version of House is a collection of unpleasant personality traits with occasional flashes of out-of-character compassion.”
Uhhhh, and how’s that’s different from “Helllllloooooo sick people! …. Most of you could be cured by a -monkey- with a bottle of Motrin” before he orders a full body scan for a woman who doesn’t like being told what to do?
November 22nd, 2007 at 4:24 pm
pprovost, those are so pretty good connections but I doubt the sister thing. Although, after reading that I do think there is something between them. and now that you brought it up, I do wonder how 13 came up with that diagnosis for Stark and same with the knowing that the pateint was a pilot. Hmmmm, I do wonder what the connection is.
November 22nd, 2007 at 5:57 pm
I’m not a doctor but the medicine in this episode did not make sense. While I mainly watch for House/Wilson scenes, I initially started watching the show for the medical mystery and procedural elements. I think one of the challenges of this show is that it may be written into some actors’ contracts that they have so many scenes with the show’s lead, HL. I am thinking that may be the case for OE and LE. I think KJ even mentioned that LE half-jokingly demanded (mind you half) that she get to do a love/sex scene during S4. I think RSL is getting more screen time because he’s the second most popular character after House (he’s my favorite character. I can barely tolerate S4 House when he’s not interacting with Wilson).
I said all that to say, HL has to be onscreen more often than most lead characters so that he can meet whatever demands are being made by the main supporting cast contracts. That’s too bad. It seems to me that the quality of the show has suffered with this approach.
I loved the House/Wilson foosball scene and Wilson’s shock at House knowing his blood type. I really didn’t like the thong plot but I loved the final scene where Big Love gets canned.
The 13 subplot was just ridiculous. And the final scene between 13 and House almost appeared as if HL and OW were being guided by two different directors. The pacing and timing were off. And the writers expect me to believe that the same doctor who didn’t make sure a patient took his meds is the same doctor who has insights into House’s personality AFTER 8 weeks!! I am not a fan of the wide-eyed, parted lips look so 13 does nothing but irritate me just like her predecessor.
I just hope they get back to the medical mystery/procedural aspects of the show. I will miss Big Love and CTB. And Cuddy is just ridiculous.
November 22nd, 2007 at 6:30 pm
I was happy to see Huntington’s treated as the heavyweight curse that it is since most television treatments of it (sorry, I don’t watch Grey’s) merely make it sound bad but livable. My wife has it and probably won’t be with me by this time next year, and I watch others in my caregivers group struggle with the battle of ‘Should I get tested or shouldn’t I?’ I thought it was a powerful scene when she explained her reasons and House accepted them, to the point of tossing the letter and not just looking at it later. Personally, I’m 100% for getting tested, but that’s easy for me to say as a spouse and not the son or daughter of someone afflicted.
For the record, I didn’t think Thirteen’s depiction of the chorea symptoms were very accurate though. That rhythmic finger twitching seemed far more reminiscent of Michael J. Fox’s description of his early symptoms in ‘Lucky Man’ than anything I’ve seen in the HD patients I know. Still, any exposure is good exposure for something so devastating yet so widely unknown. (If you want to know more, the Globe and Mail’s ‘I know how I am going to die’ at http://www.theglobeandmail.com/servlet/story/RTGAM.20071012.wcover1013/BNStory/specialScienceandHealth/home is an excellent read.)
Thanks Scott, been reading these reviews for a while now, excellent job!
November 22nd, 2007 at 6:48 pm
To clarify some blood points –
Everybody carries antibodies for the ABO blood types that they dont have, whether or not they were exposed to them, even if they never had a blood transfusion, because they occur naturally in food that we eat. Everyone who is type A has anti-b antibodies, and so on. I know it sounds ridiculous, but look it up.
Therefore, a botched transfusion would cause an acute hemolytic reaction, DIC, etc…
However, our bodies are not exposed naturally to Rh blood groups and so the antibodies do not exist in our body until someone who is Rh negative is exposed to Rh positive blood. THerefore, the reaction will be much more delayed, and much less dangerous (for the first transfusion). So you could even give o+ blood to someone who never had a transfusion if they were RH-.
I’m not sure why you think the reaction to Rh blood groups is worse…
November 22nd, 2007 at 10:02 pm
I used to work in a blood bank. I was also puzzled by the blood type explanation. At our blood bank, and I am sure that this is standard procedure everywhere, many samples of both the blood and plasma are taken and frozen from each bag of blood just in case there is a suspicion that the blood may be tainted. But instead of testing a sample of the ACTUAL BLOOD that was transferred into the patient, he chose to use other blood samples that were not given to the patient to test on himself? Not very scientific at all.
November 22nd, 2007 at 11:24 pm
I wish they would have saved Lupus for the series finale
November 23rd, 2007 at 1:52 am
Well if you really want to be a purist, they didn’t diagnose lupus properly, so it really should be a future wildcard. :-P
November 23rd, 2007 at 3:17 am
Regarding CTB, do doctors really run around in short skirts and high boots ? Wouldnt that be a bit uncomfortable if you’re making long days ?
November 23rd, 2007 at 3:10 pm
Knowing CTB, she’s probably trying to look sexy to get House to hire her as eye candy. It’s why he hired Cameron, after all.
November 23rd, 2007 at 7:50 pm
hi!
I have a medical question… I didn’t undestand, 13 drinks decaf coffee, can a couple of cups of regular coffee make her loose control of her hands??
besides that, I think it’s turning into a soap opera, and the medical issues are just a bit of the serie, that’s horrible :(
November 24th, 2007 at 1:18 am
Kevin T; 13 didn’t HAVE any symptoms of Huntingtons; it was all due to the caff overdose House forced on her. Good on her dosing him right back (although IRL that could have killed him, which would make her 0 for 2.5, including that guy’s dog.)
November 24th, 2007 at 10:57 am
As a magician, I thought the tricks were ridiculous. The card in wallet and window were completely ‘hollywood’. The only thing that required some magical skills was House doing some sleights at the table (tenkai and shapeshifter to be precise). The fans the magician did was also crummy.
November 24th, 2007 at 3:52 pm
I don’t like to say this, as much as I like the show, I’d highly doubt that “House” will
see another season. With the writers strike taking it’s effect and the writers of
the show losing their way, I can’t see it continuing on much further to be honest.
The show has had it’s run and although the injection of new characters had it’s
moments, it’s gotten old…real fast!
The shark has been jumped in my opinion back with the “Tritter” arc and I see
nothing coming up to take it’s place.
Hugh Laurie has managed to somehow keep the flame alight, but is quickly
fading regardless of his demure as a derelect creature in the medicinal
sense.
The story lines and plot synopsis has left most with a “what next”
mindset and regardless of what they plan on doing, the original cast
has been “cast aside” to make even the most loyal follower question
just what’s next? They have lost any direction that they may have had
and in doing so, have taken a great cast of characters and put them aside.
Don’t be surprised when it’s gone in May, if in fact it can make it
to that point.
Better shows have been axed for lesser reasons.
The series has been a hoot though…one that can be enjoyed
through seasons 1-3 in the purchase of the videos.
Thanks
Jazz
November 25th, 2007 at 1:41 am
I also appreciated the handling of Huntington’s. It’s not an easy thing to know how you will die. I didn’t even know until I was an adult that it ran in my family; I knew my grandmother had died young but not the reason. My father told me – after my mother died in her fifties of something unrelated – that she had always been terrified of dying the way her own mother had, and had never had herself tested.
The main plot of this episode was pretty weak, though.
November 25th, 2007 at 2:30 pm
I am much happier with this year’s episodes than most of commenters here. Fourth season seems to me definitely better than third, House is still himself, cases are on average better than 3rd season, “young guns” in 3rd were stuck in character pitfalls, while this year newbies are still showing something new. I think that by end of season one of the newbies will stay, and Cameron and/or Chase will be back.
November 25th, 2007 at 10:42 pm
Slowly but surely House is getting on my nerves: where he used to be witty, now he is solely a jerk. Season 4 is a major disappointement so far. Maybe it is just me, but the lack of moral principles in House is annoying. He used to have his own morality in the last seasons – now he has not even that and acts only arbitrarily. Firing the Mormon was the epitome.
November 25th, 2007 at 11:20 pm
Fourth season is WAY better than last season.
No stupid cop subplot.
November 26th, 2007 at 1:47 am
I have a generalized question about many of the comments that I have seen posted across several of the House episodes. Those comments are around the doctors performing many of the procedures in the show that would typically done by specialist in a specific medical field.
Some of the posters here argue, for instance, that a real-life neurologist would never perform an MRI or do such-and-such a surgery that the character on the show does. It feels like the character is crossing a sort of line in the sand and that it a slight to those posters who are the medical professionals who perform those duties in the real world.
My question is, can doctors not have multiple specialties where they may really be qualified to perform such varied roles like the fictional characters in House? In purely educational environments, I have seen professors that are certified in multiple areas that are non-medical in nature. For instance, a professor in advanced mathematics also being a professor in computer science. Does that not occur in the medical field? I do realize that an educational environment is somewhat different than that of private/public.
Please forgive my ignorance, as I’m not in the medical profession and in no way wish to offend or contest those here who are. I have nothing but respect for those in the medical community and what you do. I’m merely curious as an outsider looking in.
November 26th, 2007 at 8:53 am
one more thing about huntingtons. One of my dear friends has it on BOTH sides of his family and he refuses to get tested, why? Insurence. no insurence will touch him if it turns out he has it. I thought that 13 refusal to find out was very acurate. It disturbed me to see all the people who thought it was silly that she wouldn’t. To find out could mean knowning she would die painfully in dementia at a relavtively earily age. I understand not wanting to know a death sentence is around the corner.
November 26th, 2007 at 4:13 pm
To add my Eu 0,02 / $ 0,03: I can relate what the people who are unhappy about this show are saying, but… I like it! Even though the medicine has many flaws (even I can identify some of the misstakes and I’m a medicine know-it-not), there is some lightness and humour about the show. It may distract from the “good” medicine, but I didn’t understand zilch of that anyway… I watch it first of all for the soap opera and House’s snide remarks.
Comparing this season to the way S3 dragged on, I really love this one much better.
November 26th, 2007 at 6:59 pm
sal (November 25th, 2007 at 10:42 pm): “… acts only arbitrarily. Firing the Mormon was the epitome.”
Sal, at the start of the episode, House did make it clear the test was to assess the Cottages’ ability to get things done despite the wishes of administration. Very clearly Cole failed this test, using a method completely contrary to its spirit. How can you expect House to suddenly become a stickler for “the letter of the law” in honouring his agreement with Cole, over the much more important honouring of the principle? This wouldn’t be House at all, especially since it would mean keeping an admin stooge on the payroll.
We may disagree with his decision, but it’s not at all immoral by House’s standards.
I do agree that he’s become more of a jerk for its own sake, however. I also find it more interesting when both Cuddy & Wilson are able to hold their own against him.
November 26th, 2007 at 7:50 pm
#82 pprovost: the issue is less about “turf” or departmental politics; it’s more the case that in real life, there are such wildly different skill-sets.
To use your analogy, House himself *is* double-boarded in Infectious Disease and Nephrology, and those are two different sub-specialties following Internal Medicine training… so it’s a little like a PhD in Mathematics teaching Calculus courses in the Math department as well as Programming Algorithms in the Computer Science department.
What’s not the same would be Foreman, a Neurologist, doing a bone-marrow biopsy (which we have seen him do). That’s more like an Engineering prof taking over a dance class for a day. Sure, he can probably get through it, but his daily skill set and knowledge base are almost no help in a meaningful way.
My theory of choice stems from the fact that Diagnostic Medicine isn’t a real-life specialty. I like to think that in the world of the show, it was traditional in the early days of the specialty for “D-Med” practitioners to perform all tests themselves, to maintain an unbroken chain of possession of the information. In the here and now, even though there are lots of perfectly qualified people around, House is a total stickler for tradition.
Either that, or House and his team have annoyed every ultrasound technician, medical technologist, phlebotomist, radiologic tech, and Interventional Radiologist in the place, and nobody will DO their stupid tests anymore.
November 26th, 2007 at 11:40 pm
Thanks for the explanation, Febrifuge. It was very enlightening and educational.
November 26th, 2007 at 11:45 pm
I don’t know why, but as soon as I saw the shaky hands thing, my first thought was Huntington’s. Funny.
November 27th, 2007 at 10:22 pm
you guys need to chill out, its just a tv show, its not the new york journal of medicine, and its not like other medical dramas dont take liberties with the facts.
also, is anyone else suspicious that this guy isnt actually a doctor?
on the internet its as easy as saying “hey im a doctor” then look at some websites and criticize medical dramas based on readily available public knowledge, and make sweeping generalizations about doctors that noone can refute and pass it off as first hand knowledge.
November 28th, 2007 at 1:38 am
Official Comment
Anonymous,
If you don’t like what you’re reading here, then by all means stop. Nobody is holding a gun to your head and forcing you to read it, and it’s not like you’re paying for it. Just read another site. No great loss.
As far as my credentials, I would hope that 3 1/2 years posting about various aspects of medicine (not just television) would be enough to establish my bona fides. Alternately, you can look back to last March where I had a (brief) article published by the AMA. If you can’t trust the American Medical Association about who is and who isn’t a doctor, who can you trust? Finally, if that’s not enough, you could find out my last name — it’s a few places on this site — and run it through the Department of Profession Regulation of my state (also mentioned on this site occasionally) where you’ll see that I’m a fully licensed and board certified Family Practice physician.
November 28th, 2007 at 4:18 pm
One Yay for Scott! $ 0.10 (Eu 0.07) says Anonymous was a first (and prolly one-time) poster.
November 29th, 2007 at 1:52 am
Ha, I totally called Lupus for this season!
November 29th, 2007 at 6:27 am
don’t know if it is mentioned afore, but the AB0-Blood types are determined by GLYCOproteins in the erythrozytes’ plasmamembrane, not proteins.
November 30th, 2007 at 10:51 pm
What annoyed me, tiny as it was, was the unquestioned acceptance by everyone else in the room of House’s assumption that all women always wear matching bra and panties every single day, and so the first pair brought in couldn’t possibly be Cuddy’s.
December 1st, 2007 at 3:40 am
Night wrote: As a magician, I thought the tricks were ridiculous. The card in wallet and window were completely hollywood’.
If by “Hollywood,” you mean that the tricks were accomplished through camera editing rather than prestidigitation, I would agree that’s one possible explanation.
However, the card-sticking-to-the-outside-of-the-window trick was very similar to one David Copperfield performed in one of his specials, taped on the Orient Express. He and Jane Seymour were sitting at a table on the train, he had her pick out a card, he threw the bunch of cards at the closed window, all of them fell down except, of course, for the card Seymour selected, and of course it was stuck to the outside of the glass. Maybe that was a camera trick too, but I’d like to think otherwise.
December 5th, 2007 at 12:15 pm
Thong? THONG???!! Did anybody think it was utterly ridiculous to assume that Cuddy, a woman in her late thirties (*ahem* early forties) would be wearing a thong? With a skirt like that, to even choose a red thong would be idiotic. And that’s the type of thong you’d wear for about 10 minutes immediately prior to getting some action…not what you’d pick for a 10-hour workday of hospital administration. Please. Is there not a single female writer in the pack anymore? Even to fit in with Cuddy’s sometimes over-the-top sexuality-in-your-face personality, at a stretch I’d bet on a pair of black lacy high-waist panties with a stomach-control panel. (Well-placed Spanx product-placement, anyone?) I was just waiting for Cuddy to stand up to House and tell him she was wearing a high-powered flesh-colored knee-length girdle, which would be way more plausible. Still waiting…
January 13th, 2008 at 5:39 pm
Regarding the magic trick… (this is still bugging me D
January 24th, 2008 at 8:55 pm
My mom is in her forties and still wears thongs. For them to put grannie panties, or even a plain thong, would pull away from the shock when Cole appears with them. They were red and lacy for dramatic reasons.
January 24th, 2008 at 8:58 pm
LoL PS….when I found out it was lupus…the first thing I thought of was “House didn’t know that because he can’t read his lupus book, its full of pills.”
January 27th, 2008 at 3:55 pm
Kristen, re: Lupus: LOL!
I was bothered by the testing of the suspected-tainted blood on House. With three transfusions, doesn’t that make him the most likely person to have a transfusions reaction? Is transfusion reaction that easy to distinguish from, well, a reaction to tainted blood? Surely, they could have found someone else to use as a guinea pig. It did make for a good scene between House and 13, though.
My favorite scene was Flynn doing the magic trick for House — it was excellent trick. And House’s response: “There’s no such thing as magic.” How like House to deny the existence of stage magic.
Dr. Wilson is my favorite character. Rock on, Robert Sean Leonard.
Scott, thank you for explaining the type and crossmatch procedure. This ’site is cool!
February 22nd, 2008 at 11:38 am
MrBuddwing – yes, the tricks are real. But they can’t be performed impromptu in a hospital room without props and assistance.
Both the tricks were actually the same – forcing a card on the person “picking” it. The “wow” factor is in the reveal, be it a flame-spouting wallet or a card appearing in the window.
The wallet trick, if it had been real, would have worked by the magician’s assistant pickpocketing the mark, putting the card in the wallet and adding some sort of pyrotechnic substance, then replacing it without the mark noticing. Magician then forces the card on the mark and lights the pyrotechnics on the wallet when opening it. All of this requires amazing skill and coordination, and it can’t be done by some goober with tubes up his nose in a hospital bed, to someone who just walked in at random.
I disliked the magician’s “you’ll lose the magic” explanation. Yeah, they don’t reveal their secrets, but a well-executed trick is sometimes even more impressive when you know how it’s done. Sometimes the trick is sublime, sometimes it’s just so crude it’s hilarious. Like the one where Penn asked people to pick a card and then revealed that an oversized replica of the card picked was hidden on the beach all along. The trick, of course, was hiding all 52 cards somewhere on the beach and learning their positions by rote. Magic is practicing something more than any sane person would imagine possible, not being cryptic and pulling rabbits out of one’s hospital gown after just regaining consciousness.
March 2nd, 2008 at 10:49 pm
I dont think house was saying that ALL women wear matching bra and panties, more that Cuddy specifically does.
Also why are people calling Kutner “Kumar” Just wondering
March 24th, 2008 at 6:41 pm
Isn’t a patient who gets so much blood of the wrong type supposed to die?
May 9th, 2008 at 2:18 pm
This episode has just been transmitted in the UK so I’m coming to the discussion a bit late. As an ex-blood-banker I certainly sat up in astonishment at the blood typing and House’s explanation was certainly wonky….however….people with lupus may well have other auto-immune diseases such as auto-immune haemolytic anaemia in which the patient develops antibodies to their own red cells. In that particular case, a patient who was group A could seem to possess anti A and anti B (in reality they have an unspecific auto antibody that reacts with all other red cells including their own). I have also seen cases where the patient’s auto antibody coats their own cells to the extent that the cells agglutinate even in the absence of test anti-sera. A group A patient’s cells, agglutinating in all tests could then appear to be AB. Of course this assumes that the lab didn’t use basic controls to rule out this sort of thing – in reality such anomalies would spotted straight away.
Could this be what the writers were trying (without understanding it very well) to get at?
May 11th, 2008 at 3:57 am
I’d like to correct the review point that the magician tells house he’s A. The guy pretty clearly says AB (the wrong type), but that doesn’t seem like it makes sense (I thought House’s point with Wilson was that noone bothered to converse with the guy and ask what his blood type was and that would have resulted in him simply saying the correct type.
But when House asks, he pretty clearly says AB.
May 13th, 2008 at 12:51 pm
i LOVED the detail of house having AB blood, the universal “taker,” and wilson having O(-?), the universal “giver” blood. what an excellent and apt detail :)
July 22nd, 2008 at 3:58 pm
I don’t really think lupus explains the initial symptoms during his water trick…
The medicine in this episode was just awful. However, psychic nosebleed magicians rule.
August 8th, 2008 at 7:24 am
> but he forgot about it and the strong magnetic field in the MRI pulled it through his intestines. House fires Kutner.
House does NOT fire Kutner. He says “Now you disappear” referring to both “magical” theme of the episode and the fact that they only entered the surgery room so that House could show Kutner the key “trick”. He doesn’t mean that Kutner is fired.
January 18th, 2009 at 11:12 am
You could also do a “magical review” on this one. ^^
The magic tricks are really good but also impossible without material and/or preparation.
Even the “fire-wallet” trick requires a special wallet to have an effect like this.
February 2nd, 2009 at 9:29 am
Thanks for your reviews Scott – I am watching House on DVD and always read your reviews straight after. I just wanted to say a big :-( to Universal for putting the photographs of the winning candidates on the DVD. The mystery of this season was completely lost!
I actually have enjoyed season 4 more than season 3, although not as much as 1-2.
Finally this episode made me cry – my mother has Huntington’s but we didn’t find out till two years ago when my sisters and I were in our 30s and 40s. I’ve been tested but don’t have the gene; one of my sister’s has been tested – and does have the gene; and the other takes number 13’s view. It is indeed a lottery but no winning ticket. Even if you don’t have it, you have to watch people you love suffer and think, ‘why is this happening to them, not me?’. We don’t know at present if grandchildren have been affected and potentially there are 6 of them at risk. I just pray that one day, a cure is found.
April 16th, 2009 at 10:50 pm
About the magic… if Flynn is doing the Chinese Water Torture cell and his only assistant doesn’t know if he’s supposed to have a nose/mouth bleed, he’s seriously incompetent. It seems like NPD (No Permanent Damage, and S&M principle that applies to magic) would be what’s kept him from getting killed already doing this kind of stuff.
There is a lot of argument among magicians between Flynn’s POV (telling will destroy the magic, audiences believe magic is “real”) and House’s POV (it’s even cooler if you know). House reveals/exposes how he can tell interesting stuff about Flynn. I wonder if angry magicians will beseige them about House revealing how he cut the IV line (probably not).
July 3rd, 2009 at 1:47 am
To the people who called foul on the MRI scan yanking the key around…
You’re absolutely right. Most clinical MRI equipment uses superconducting magnets. I worked with NMR equipment in grad school and re-energizing and re-calibrating after a quench required most of a day and payment of about ten grand to the manufacturer to send a tech out to do it. It’s possible for the magnet to be “turned off” but it’s quite rare and it’s NEVER done casually.
The problem would have started as soon as he went into the field, not when they actually started the scans. The writers have made this same mistake in a couple of other episodes as well.
July 3rd, 2009 at 8:24 am
anyone else wonder how they could see bleeding in the thigh on a chest MRI?
July 27th, 2009 at 1:02 pm
I check the writers for seasons 4-5 they are new guys and they are terrible in medicine Everybody knows blood types Rh + or Rh- .
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