House – Episode 9 (Season 4): “Games”
This episode brings an end to the applicant competition, with satisfying results. The medicine tried to be clever, but succeeded mostly in being nebulous and vague (and fairly confusing).
Jimmy Quidd is a 38 year-old punk rock singer. He is hard-drinking, like drugs and fights, and has a generally poor attitude and outlook on life. He also has a severe bloody cough that causes him to pass out in the alley behind a punk rock club. He is brought to the ER for evaluation where House admits him to his service because he feels Jimmy will make a challenging case for his applicants.
Jimmy has a long list of symptoms including fever, arthralgia (joint pain), hyperinflated lungs, fatigue, anemia, low blood oxygen levels, melena (blood in his stool) and hematuria (blood in his urine). He also shows signs of hard living including a history of multiple traumas, cutting, and a drug screen that’s positive for alcohol, cocaine, opiates, and amphetamines. House suggests drug use, trauma, and “being a loser” as possible explanations for his symptoms. The team suggests endocarditis, hemorrhagic lesions of the lungs and gut, bronchiolitis obliterans (inflammatory obstruction of the bronchioles in the lungs), and bacterial meningitis.
Amber starts out by testing her suggestion of bronchiolitis obliterans. Her plan is to perform a bronchoscopy (look down the lungs with a flexible fiberoptic camera), but Jimmy sneaks a cigarette while on a bathroom break — unfortunately, he’s on oxygen, which leads to a nice little explosion (though fires are much more common since oxygen is more of an accelerant than explosive), giving him smoke inhalation making a bronchoscopy useless. Now Amber wants to perform an open lung biopsy. While prepping him for the biopsy, Foreman realizes that he is wearing all his Nicotine patches at once and overdosing on nicotine. Amber and Kutner notice blood clotting in his fingers, meaning that Jimmy has DIC (disseminated intravascular coagulation), but the cause of the DIC is unclear. Amber suggests drug impurities, but Dr. 13 suggests malaria. This intrigues House, and she now takes over the case.
Meanwhile, Jimmy has disappeared. They manage to track him down in Pediatrics, entertaining the children. He passes out and is returned to his room. The malaria tests come back negative, but other tests show that “bad blood fragments” are causing the DIC. Kutner suggests blood exposure during sex as a cause for the fragments, and 13 mentions that the malaria medication may be causing the destruction of the blood cells (but he had DIC before he was started on the antimalarials). House points out what really should be obvious: that Jimmy has been shooting up drugs with dirty needles, and this has been getting other people’s blood into his system, which explains the blood fragments and the DIC.
The new differential includes inhalant abuse, bleeding problems, and infection. Kutner suggests chronic pulmonary embolism and takes over the case. House performs an echocardiogram on Jimmy. He finds some masses near the heart, but the study is hard to read because Jimmy was moving around too much. There is no evidence of emboli, so Taub suggests Jimmy may have an abnormal blood vessel wrapping around his trachea. He wants to check an MRA, but that will be affected by patient movement as well. Instead, the team elects to do exploratory surgery of the heart (do I really have to mention what a bad idea and how ridiculously unrealistic this is?). The surgery reveals no abnormal vessels. The masses House saw on the echo were enlarged lymph nodes. About this time, the patient starts to crash with plummeting blood pressure so he is given two units of blood and started on Dopamine (a drug used to raise the blood pressure in critically ill patients).
House threatens to fire Kutner and 13, and under pressure, they suggest ARDS (Adult Rrespiratory Distress Syndrome), anaphylactic shock, or an immune overreaction from impurities in the drugs he’s been using. House starts Jimmy on Dimercaprol to treat presumptive heavy metal poisoning from contaminated drugs, but this is not successful. House then threatens Amber and Taub with their jobs, and then the whole team, but they can’t come up with any coherent ideas. House takes their four “wrong” ideas, and combines them into a single diagnosis: measles. He thinks Jimmy has measles that his drug use made him susceptible to. His immune system is overreacting in response to the measles and causing his symptoms. House wants to perform a brain biopsy. Cuddy refuses, pointing out that Jimmy would be having neurological symptoms if House were correct. Amber mentions that he has been showing some abnormal swallowing, and it could be a partial complex seizure. House then tries — and succeeds — to induce a seizure in Jimmy (a generalized tonic-clonic seizure, though, different from a partial complex seizure). This is enough proof to allow him to get his brain biopsy which shows measles, so Jimmy is started on corticosteroids.
In the end, House fired Amber for being unable to lose. He then fires 13 and keeps on Kutner and Taub. It turns out his is all a ploy — Cuddy confronts him and tells him that he can’’t fire both women and insists that he rehire 13. House acquiesces, and as Cuddy leaves the room she realizes that had been House’s plan all along.
The medicine was almost too vague this week, throwing around poorly defined phrases such as “impurities”, “bad blood”, and “immune over-reaction”.
I did have some concerns:
How did Jimmy get all those Nicotine patches? A nurse will only give one a day — and make sure the old one is removed.
The heart surgery made my brain hurt, the logic behind it was that bad. You can’t sedate the patient for an ultrasound or MRA, but you can place him under general anesthesia and cut his chest open?
Once again, the show is being vague about symptoms — was it a bloody cough, or bloody vomit? It’s referred to as both during the episode, though the differential focused on the lungs not the gastrointestinal tract.
Exactly what test is performed to show “bad blood fragments”? House already pointed out that Jimmy had schistocytes (fragmented red blood cells) as proof that he had DIC, now the writers are invoking them as the cause of the DIC as well as the result?
Why was House performing an echocardiogram? Pulmonary emboli don’t show up on ultrasound (you need a ventilation/perfusion scan or a spiral CT), and furthermore, pulmonary emboli don’t generally come from the heart — they come from the deep veins of the leg.
If the measles infection/immune overreaction was in the brain, something should have shown up on the lumbar puncture (LP) which was performed earlier in the show.
If Jimmy had been having a partial complex seizure then he would have lost consciousness (that’s what the word “complex” means in the name), not just had strange swallowing. Partial complex seizures are very different from the tonic-clonic seizure House induced later.
The medical mystery was strictly average this week. Nothing very dramatic or eye catching (and whatever happened to all the great “inside the body” animations?), just an average C. I’m still trying to make sense of the final solution (his immune system was so weak it allowed a measles infection, but still strong enough to cause an autoimmune reaction?) — I think the measles part was clever, but the autoimmune aspect not so much. I’ll split the difference and give it a B-. The medicine was just too vague. There was a lot of hand waving and terms that didn’t really mean anything. It earns a C+. The soap opera was the best part, but still not as good as a few of the earlier episodes, and earns a B+.
The previous House review
A list of all prior House reviews
November 28th, 2007 at 12:47 am
Well, see, that’s what you get. The writers spent all their time on dialog and no time on researching “Boring medical stuff”. (please note sarcastic use of quotes)
November 28th, 2007 at 12:53 am
Yay, first to post.
I liked the episode but at the same time I didn’t like the vague medicine parts. They just ran through ideas and never even let them set in with the viewers. Like I said, I did like this episode but I will love the next ones. I miss the clinic so much. And I liked the old way the show ran instead of the lecture hall setting.
November 28th, 2007 at 12:58 am
You’re right, this one was a real head-scratcher.
Something I didn’t understand from the scenes with Wilson is, was he implying that House had somehow influenced the patient to sue him? I must have seriously missed something there. I would think the most he could get is emotional distress over the incorrect diagnosis, but only if he changed his pleading to say he was distressed by being told he would die instead of feeling special, which Wilson could then dispute based on his conversations with him (and House witnessed to boot).
So I’m assuming that Amber was really fired and that Cuddy didn’t reinstate her in the last scene. Another scene that could have used a tad more details.
Well, it looks like they have decided to start the strike hiatus early and then have the remaining episodes grouped together around the big Super Bowl episode. It doesn’t seem like this was planned because the on-screen graphic at the end said “next week” while the announcer said “in the new year.” That probably means that they might have to show one of the three remaining episodes after the Super Bowl instead of the one they were originally intending, which will probably be lower quality and will disappoint on their big day. Either that or they would have produced another episode for the Super Bowl already and it would then be out of sequence since the previous weeks stories would be missing. I guess we’ll just have to wait and see.
Guess it’s time to find something else to do on Tuesday nights. :-(
November 28th, 2007 at 1:01 am
Love your site. Not a professional in any of these fields, but love it anyway.
I have to wonder about House rolling in an Ampeg bass stack and playing Johnny’s awful “music” through it to induce a seizure. A 300+ watt bass amplifier doesn’t come with a cd player attached. Why not just bring in a regular stereo?
Again, not a doctor or lawyer, but I needed to give my two cents on something that I know alot about. Everyone else seems to do it around here.
Also, just to toot my own horn, I had an idea that 13 would initially get fired because no one would see it coming. Everyone else was going for Kutner, or Taub, and EVERYONE was going for CTB. The only one everyone knew wouldn’t get fired was 13. Still glad she got hired back.
Anyways, love the site. Keep it up.
November 28th, 2007 at 1:03 am
I’m just happy cut-throat bitch is gone. Even after they spent a good chunk of this episode giving her “depth” she wasn’t a good sort of unlikable like say House is.
Hopefully now that the competition is settled they will start to give some decent face time to the old team too. All three were in this episode but none really had anything to add. And I still don’t believe that when House is stumped (like he was for a bit of this episode) that he wouldn’t run straight to his old team for more/better ideas.
November 28th, 2007 at 1:07 am
Tonight’s was also the most cinematic episode they’ve done in a while. Also, the intro showed a return of the surreal partially-hyper-saturated colors which they were so fond of in the first season. I’m glad they kept it to the intro this time around.
I thought the pseudo-resolution to the cancer misdiagnosis was a bit weird. It made sense but it also seemed a bit off in some way.
Anyway. Hopefully in January they can start focusing on the team medicine again. The “reality show” was fun for a few episodes but it got kind of stale towards the end.
November 28th, 2007 at 1:12 am
Well, they’re finally done playing applicant games, so hopefully the medical mystery will pick up in the following weeks. It looks like the clinic is making a return, so that’s already good news.
The attempt to humanize Cutthroat Bitch was laughable; she just went from being a manipulative bitch to being a generally bitchy bitch. I’ve wanted to see her go from Day 1, which is probably why the writers had her stay to the end: the audience needs to root against someone, after all.
I didn’t like that they went from two winners to three, but I liked how they did it. House moving away from goofy and toward clever is always a good thing, especially in the form of a satisfying Xanatos Gambit. Normally I’d say the bit about needing a woman would be hanging a lampshade on political correctness, but in this case I’m not so sure it’s not actual political correctness.
On the bright side, with three applicants on top of Foreman, we’ve got a genuine Five Man Band: House as the Leader, Foreman as the Lancer, Taub as the Dumb Guy, Kumar (I guess I have to call him Kutner now) as the Smart Guy, and 13 (whose actual character name I don’t even remember) as the Chick.
Sorry for speaking in tropes so much, but it’s hard to avoid with such transparent writing.
November 28th, 2007 at 1:14 am
Oh thank god he fired cut-throat bitch… I definitely couldn’t see her staying as a permanent character…
I was also pretty peeved when he “fired” 13 (will we learn her name next time?) but it was cool how he tricked Cuddy in to letting him keep her.
Not being a doctor myself, I didn’t notice many obscurities in the medicine part, but I feel in this sort of “end-of-an-arc” episode the focus needed to be more on the team than the mystery. I do hope they get more mystery into the january episodes though.
November 28th, 2007 at 1:24 am
I liked his reasons for firing Cut-throat bitch. She couldn’t stand losing, and sometimes in medicine that happens. You know, throwing the caring aspect in. Though to be honest… I wish he would have gotten rid of Taub.
I’d like to see Foreman step back up in these next episodes. He’s been much too much of a lame duck.
And pity points for the Avian Flu clinic “visitor”? :D
November 28th, 2007 at 1:41 am
Was I the only one who liked Cutthroat Bitch? I like her much more than 13, who is only slightly different from Cameron. Come on, you just know House is going to be fascinated by her and fall into another crush on the female underling. 13 may dislike him now, but that’ll grow to respect, then secret love. Boring.
Jay, Wilson was implying that House convinced his misdiagnosed patient to sue him, and judging from House’s response, Wilson was right. House realizes the guy will get nothing, but is doing it to teach Wilson not to be so caring.
(Xanatos Gambit? Never heard before. I’ll have to remember it.)
November 28th, 2007 at 1:54 am
I’m not sure what the writers want to do with Thirteen. I didn’t like the fact that she practically ignores the drugs issue (trying to be Cameron-esque but perhaps even more naive), and then fell on the drugs again as a crutch when her job was on the line. I guess House was hinting at that when he first fired her: she basically ignored the obvious to fit her worldview.
I also liked the measles aspect of the solution: I generally like the solutions where it’s a run-of-the-mill disease on overdrive due to some unaccounted factor. Now that you mentioned it, the autoimmune stuff does seem weird: weakened immunity leading to excessive immune system activity? Perhaps it’s related to withdrawal of one of the myriad of drugs in his system before getting admitted.
I’m still not convinced that Kumar is really worth saving. Then again I just enjoy seeing him on-screen.
November 28th, 2007 at 2:14 am
Terrible episode. The open heart surgery thing….what do they think we are total idiots??? Or are they simply idiots?
We know Hugh Laurie isn’t an idiot but I guess he doesn’t have much say over the scripts….
Kuttner has been a total idiot and completely worthless the whole time, it’s completely unrealistic that House would keep him on.
The side plot with Wilson was laughable. This episode was as bad as the first episode of this season…which is really saying something.
November 28th, 2007 at 2:15 am
Oh yeah and House plays a record out of a bass amp which isn’t even plugged in and has nothing plugged into it. Lame.
November 28th, 2007 at 2:47 am
Why did they need to do the brain biopsy before treating for measles? If the treatment is steroids, isn’t that less risky than the biopsy?
November 28th, 2007 at 3:02 am
I think you have been extremely generous with your grading of the medicine this season. Although I have loved the soap opera aspect of this show and the ever clever House comments, the medicine has been disappointing. As a member of the medical profession, I find that the lack of detail in the medical aspects is detracting from my overall enjoyment of the show. If this show has a medical advisor, he/she is not doing the job I have come to expect. Did anyone notice that the chest Xray on the light box in Wilson’s office was backwards?
November 28th, 2007 at 4:05 am
The dormant measles resolution was used already. First season, lacrosse player kid. Boo for recycling “a-ha!” moments.
November 28th, 2007 at 5:32 am
For everyone that doesn’t know, 13’s name is Remy Hadley.
November 28th, 2007 at 7:04 am
Haha even I saw some of the… glaring flaws in the episode.
I have had tonic clonic epilepsy and seizures that were simply just losses of consciousness.
I think one of my neurologists said that having Localized and Generlized seizures happens in like 1% of everyone with epilepsy.
So yeeah.
They probably could have at least TRIED to restrain him for the MRA, when I had an MRA back in August, they basically strapped me down so I couldn’t move.
November 28th, 2007 at 8:04 am
It can’t stand that he fired Amber, and his reasons were stupid. Since when has House ever been able to be wrong? And now Mini-Cameron/13 is going to have a secret relationship with him. Ugg…
November 28th, 2007 at 8:06 am
Wilson seemed confused when his patient reacted to the news he was going to live. This is very strange considering the patient acted exactly as Wilson said patients who get good news after being given a death sentance act. Do the writers watch the show too?
November 28th, 2007 at 8:32 am
Jenifer:
That first season episode, “Paternity”, wasn’t a “dormant measles” diagnosis, it was a “mutated measles” diagnosis, and the lacrosse player’s diagnosis was sub-acute sclerosing panencephalitis.
Not the same “a-ha!” moment, really. Don’t be so harsh on the writers, they’re not idiots.
I thought this was a fantastic episode and a great way to end that story arc. I’m happy with the new team, I thought the measles diagnosis was clever and I think Olivia Wilde is hot.
November 28th, 2007 at 8:39 am
Did anyone else find Cuddy’s suggestions of people to keep rather, um, odd?
Just last episode, she wanted Cole to use “the power of the thong” to get Kutner fired. Then, this episode, when she was asked who to keep, she said “Kutner and Taub”. Did Kutner and her make nice at some point that I missed?
November 28th, 2007 at 8:48 am
I did find her suggestions odd, Rob. I also found it odd that House would ask for her opinion when she gave it to him via Big Love only last week. Now we know that his asking was part of the “game” but she should have seen it too and said something like “I already told you who I’d fire…”
November 28th, 2007 at 8:57 am
Official Comment
Jay,
I think House “suggested” to the patient that he sue Wilson knowing that he had no case and would lose and thus Wilson wouldn’t end up paying him any money at all.
Rob,
Cuddy never expected House to follow her suggestions at all — in fact, she expected him to do the exact opposite of what she said — which is why she suggested her two least favorite (at least for this week) candidates.
November 28th, 2007 at 9:07 am
Once again, thanks for your review.
From the start I thought Johnny was vomiting, not coughing, (the vomitus looked like chunky style salsa to me) and given his lifestyle I deemed it to be pancreatitis, but hey I am not a member of the much vaunted medical profession, so what would I know? As the treatment progressed and became more and more vague and grasping, I sorta lost interest in the show. The dramatic elements were somewhat interesting, with Wilson’s patient’s suit against him causing me to laugh out loud. I have to admit that while I have a certain empathy for the Kutner character, every time I see him I see him as Kumar from Harold and Kumar Go to White Castle. I find Taub to be much more irksome and troubling a character than Cutthroat Bitch. CTB is overt in her intentions; Taub seems to employ a subtle malevolence in his self-service.
As far as the cast as a whole goes, I think the most valuable service the show provides is to depict — despite years of training, study, loads of responsibility and liability — the lot of physicians as no different than the rest of humanity.
November 28th, 2007 at 9:33 am
ARDS stands for Acute Respiratory Distress Syndrome, not Adult RDS. I’m so glad cut throat bitch is gone! She was a one dimensional kind of bitch….. i prefer my “love to hate ‘em” characters with more depth.
November 28th, 2007 at 9:46 am
Official Comment
ARDS can stand for either Acute or Adult Respiratory Distress Syndrome. The latter was the original name, to differentiate it from RDS (Respiratory Distress Syndrome, a.k.a. Hyaline Membrane Disease), a condition generally confined to premature infants.
November 28th, 2007 at 10:03 am
Since trying to believe (or even follow) the medical plot is pointless, I’ve only been rating the soap opera…I enjoyed the Wilson subplot, and was glad the the CTB character was 86′d. That said, I wish the CTB actress and 13 actresses were swapped, because I am offended by another RAD (ridiculously attractive doctor) character. CTB is a much more realistic type.
That said, you can easily find some nice nudes of Olivia Wilde by searching Google.
November 28th, 2007 at 10:10 am
Excellent review although I think you are being a bit over-generrous in your rating of this particular episode. Thanks again for making the medical jargon more comprehensible.
November 28th, 2007 at 10:34 am
>>I find Taub to be much more irksome and troubling a character than Cutthroat Bitch. CTB is overt in her intentions; Taub seems to employ a subtle malevolence in his self-service.
November 28th, 2007 at 10:35 am
—I find Taub to be much more irksome and troubling a character than Cutthroat Bitch. CTB is overt in her intentions; Taub seems to employ a subtle malevolence in his self-service.—
John: That’s what makes Taub such a good character.
If you think about it, Taub is really the most complex character of the candidates. 13 is supposed to be more mysterious, but she is really just more of an unknown. She seems to be just as one dimensional as the most of the other candidates, we just don’t have much insight into that dimension. I like that they kept Taub, because he so far seems to offer the most depth of any of the candidates. He’s not a simple black or white character with one defining trait or motivation, he has more of a personality matrix like real people.
November 28th, 2007 at 10:57 am
Scott, maybe you should ask for a vote on which doctors should have been kept. I would have kept “Big Love”, “Old Fraud”, and Taub. I don’t recall Kutner contributing much, or 13 doing anything right, so I don’t understand why they were kept. I guess Taub is supposed to be Foreman, Kutner is supposed to be Chase, and 13 is supposed to be Cameron; but it would have been interesting to bring in new personalities rather than simply substitute different people for the old ones.
Also, its not at all clear to me that Wilson’s misdiagnosed cancer patient has no cause of action. But for the misdiagnosis, he would not have spent his money or incurred a realtor’s commission he can’t pay. I have little doubt that there will be a settlement paid by Wilson’s insurer.
November 28th, 2007 at 11:26 am
See, it’s clever. It’s not that the writers and producers don’t want any women on the show, it’s that House is playing games! They had *no choice* but to hire two more men and one more woman, to keep that important 2:1 ratio.
November 28th, 2007 at 11:27 am
Ive watched house from day one and as a medical professional i found the show both comical and well written. The one thing that jumped up and grabbed me this week was when they hit on the measles infection in the brain. Doesn’t anyone remember the 2nd episode of the show with the kid with night terrors who had a measles infection in the brain? I thought that was very cool when i saw that show but last nights show was a totally recycled diagnosis, the symtoms and presentation were different but the end AH HA! moment was the same. Actually the 2nd episode was lamer because the PAternity episode diagnosis was accompanied by a cool inter body visual explanation. Im sure its hard to write a complicated show like HOUSE but I KNOW there are tons of rare deseases out there that could be utilized. When they start recycling dianosisis it seems like they either have run out of ideas for the show or they’re more into focusing on the soap opera aspect of the show then the medical sluthing that made this show unique and cool.
November 28th, 2007 at 11:35 am
They really need to bring back the computer animations, it made the medicine more interesting for those of us without a medical degree.
November 28th, 2007 at 11:39 am
As far as recycled diagnoses go, I’d be interested to see someone presenting with symptoms from an episode we’ve already seen, the team recognizing this and treating it as the same problem, but then switching it up by having an Aha! moment that reveals something completely different.
In other words, I’d like to see them revisit an episode they did poorly and do it better.
13: “Wait, this doesn’t fit [ridiculous old Aha! moment] at all. What made [Cameron/Chase] think that was the answer?”
HOUSE: “Why do you think I fired them?”
KUTNER: “Didn’t they quit?”
HOUSE: “You still don’t know when to shut up, do you?”
P.S. What’s the House Challenge I keep seeing comments about, and how do I sign up for next season?
November 28th, 2007 at 11:59 am
The jumping til January announcement is a House-like game: network/producers signaling the writers that the “only four shows left” sword has been blunted. While walking the line, I hope the writers discuss a way to beef up the wonderful Kal Penn character, and steer House away from too-goofy – otherwise the two of them will play a lot like Zac Braff and that manic head doctor on Scrubs. Though Penn is way more attractive than Braff, he does have that loopy look…and though House is way more complex that the manic MD on Scrubs, it’s an unpleasant dynamic.
And they’re going to have to find something for Foreman to do besides looking bemused. So, I hope the WGA gets a piece of the internet action, but I hope the break gives them a breath of inspiration. Time to go back to the NY Times Magazine Diagnosis columns and find some more copper in the eyeball type cool stuff. And yes, bring back the CGI – better than bloody barf!
November 28th, 2007 at 11:59 am
Official Comment
Gary,
I don’t think that Wilson did anything actionable. He was making medical decisions based on the information he had. It’s not his fault the biopsy was misread. If there is a case against anyone, it would be the pathologist who misinterpreted the results.
November 28th, 2007 at 1:10 pm
Quick point of fact. The Rocker’s name was Jimmy, not Johnny. I say this only because I’m a fellow Jimmy.
November 28th, 2007 at 1:25 pm
Also, from a quasi legal perspective, there has to be a tort. That is, the victim has to sustain some damage due to action(s) a reasonable person would consider negligent (or due to actions a reasonable person would consider intentional).
Glad they’re keeping Taub. I liked his recurring character on L&O.
Oh, and Xanatos Gambit = “Whatever you do, don’t throw me in that brier patch.”
November 28th, 2007 at 1:27 pm
Scott,
It wasn’t necessarily melena. It was said there was blood in the stool, but it could have been occult or lower GI bleeding involving undigested blood, which wouldn’t have been black and tarry like melena. Melena is obvious, but would mean lots of upper GI bleeding.
And the swallowing just looked like he had a sore throat…I’m no expert on seizures, but I would have probably just asked if his throat was hurting and looked at it.
I understand this wasn’t the same diagnosis as Paternity, since his measles was mutated. But it seems like the same 10-15 diagnoses get thrown around. I know it’s hard, and I respect the writers. I also understand many conditions exhibit the same symptoms, but I’m sick of hearing amyloidosis, sarcoidosis, etc. I don’t think they actually mentioned those this episode, which was a relief.
House needs to listen to Wilson and actually do his job. It’s a rare day these days when he actually does anything. I know he’s more of a head of division “thinking” guy, but he could get out there and actually do something like he used to. Now he just sits in the lecture hall waiting for Cuddy to come in.
Can’t a pulmonary emboli also come from fragments from the wall of the heart? It is more common is A-fib, but I suppose it is possible.
November 28th, 2007 at 1:32 pm
Hi haven’t been to this site yet… was wandering the internet for a review of the episode after i saw it.
I agree that some of the procedures (namely open heart surgery/ brain biopsies) are overboard, this is of course a fictional television series… tends to play out as an action movie more or less.
Just wanted to point out one or 2 things:
1) Schistozites are markers of intravascular hemolysis (blood smear usually reveals those). Theres an extensive ‘list’ of possible causes. DIC, malaria and ‘bad blood’(which could be translated as an ABO incompatible transfusion) are the causes mentioned in the show. A simple clotting factor panel would show reduced clotting factors and fibrinogen associated with high d-dimers for DIC. For malaria a thin blood smear *could* be sufficient, but the thick smear has more sample and is more sensitive (the test they performed after i presume). And finally the ‘bad blood’(ABO incompatible transfusion) is in fact an interesting diagnosis, but the way it is introduced is just too imprecise and poppy. In an IV drug user tricuspid endocarditis and pulmonary septic emboli are *way* more frequent and thats what should be put out of the way first (even the bloody urine / clots on fingertips fit nicely). There is no DIC with normal d-dimers which he apparently had let alone PE… so yeah its just mumbojumbo.
2)Echocardiogram is a good bedside test to exclude *important* pulmonary embolism. It can show Right Ventricle failure, Pulmonary artery hipertension, and PV or TV regurgitation. Then again if its normal you don’t exclude PE and still have to do spiral CT. You just exclude PE as a cause of hemodynamic instability. But if the patient has ‘normal d-dimers’ theres a 99% chance that he doesn’t have PE, sooo… mumbojumbo again.
3)Complex partial seizures… hmm post is getting long. I’ll quote everyones favorite medical encyclopedia (wikipedia): ‘Once consciousness is impaired, the person may display “automatisms” such as lip smacking, chewing, swallowing, and undressing oneself. There may also be loss of memory (amnesia) surrounding the seizure event. As the person may still be able to perform routine tasks such as walking or shopping, witnesses may not recognize anything is wrong.’ … so yeah assuming swallowing *might* be complex partial seizures has nothing wrong… then again it might be just nervousness or 500 other things. A nightly EEG might get it if its suspected not a brain biopsy thats just crazy…
To end it: From an isolated symptom perspective of differential diagnosis theres probably nothing *seriously* wrong. But putting the pieces together for a patient it lacks coherence and common sense that should be part of any complex endeavor
November 28th, 2007 at 2:08 pm
Oh, and if I caught the discussion right, the difference between measles-lacrosse guy and measles-punk guy is that measles lacrosse guy caught the disease early, showed no symptoms, the disease went dormant, only to emerge later in his brain.
Measles-punk guy was never vaccinated, caught measles from somewhere, and ignored the symptoms because he’s a druggie, with the disease eventually ending up in his brain.
At the large state university I -didn’t- go to, the one with the med school, they’ve had a few measles outbreaks. Always surprises me, as you are supposed to furnish proof of vaccination to get admitted.
November 28th, 2007 at 2:14 pm
No surprises here. Taub stays: yay! 13 stays: erm, duh, she’s ridiculously hot for a reason. CTB is gone: pity, but it would have been difficult to keep her cutthroat routine. Kuttner stays: Ok, but Big Love would have been better.
Does anyone else wonder why House was hiding behind his whiteboard while 13 was saying something smart? (I hope he didn’t get an erection.)
Best line goes to Chase: Keep Taub & Amber.
Yes, could we have the animations back please?
November 28th, 2007 at 2:19 pm
Regarding measles:
First, did they ever indicate if he was really supposed to have been immune in the first place (whether due to previous infection or vaccination)?
Second, how common is it to get measles and not have the rash?
Finally, if it was in his brain, does this mean he had the panencephalitis version which is really really lethal?
November 28th, 2007 at 2:31 pm
Also, I don’t know if this was mentioned, but there was a funny shout-out to Internet spoilers (the new team was known 1 month ago already) about the quadruplets in the soap: “She keeps them, I read it online. There, I ruined it for you, happy now?”.
November 28th, 2007 at 2:48 pm
He wasn’t immune, and got the rash, but because he’s a druggie, the rash & fever was not noticed. At least that’s the rationale presented. Also, allegedly, the drug addictions were the reason for the hyperactive immune response.
Also, Gonçalo: The brain biopsy was to confirm the measles diagnosis, not to determine the type of seizure.
November 28th, 2007 at 2:52 pm
Boo on the animations!! They weren’t that realistic in the first place–does anyone actually believe that your heart emits tiny bolts of lightning?
Their absence is a real highlight for me.
November 28th, 2007 at 2:56 pm
So we just had an argument here at work, can someone help? Did he end up with 4 on his team (counting Foreman) or did hiring 13 mean firing Kumar?
The whole episode was confusing and disjointed. Amber “showed depth” by proving she couldn’t act, and therefore deserved to be fired.
It’s awkward keeping the Old Young Guns on the show; they each get a contractually-obligated scene which adds little to the plot and takes time away from the new cast and the patient. They either need to go or come back in a real way.
November 28th, 2007 at 3:00 pm
Koray: A few weeks ago House figured out that his critical reasoning facilities shut down when he’s looking at a hot chick (namely the dumb CIA doctor).
One thing I’ve noticed about recent episode is that House is much quicker about actually interacting with the patient. He used to have to be practically dragged into the patient’s room.
November 28th, 2007 at 3:09 pm
I have no medical credentials, off the top, so bear that in mind:
Re:
“I’m still trying to make sense of the final solution (his immune system was so weak it allowed a measles infection, but still strong enough to cause an autoimmune reaction?”
I have to admit that was my first reaction, too, but an incorrect one, I believe. Immune systems aren’t just on/off and don’t just have a volume control. It’s perfectly possible to confuse the immune system; so that it misses much it should attack, and busily attacks what it should leave alone. In fact, it’s very possible that getting busy whacking the wrong things will impair, distract or deplete your defenses in general, or just be symptomatic of broader failures.
Unless I’m missing something, by anecdotal reports anyway, MS is a lot like this – you may be more vulnerable (or at least as vulnerable) to infection; but obviously way too prone to (presumably) needless inflammation in the brain. Of course, you’re vastly more likely to notice and be worried about infections, too, since they can trigger attacks, so you may simply think you’re more prone to infection.
Pardon a very shallow dip into recent Pubmed articles here but:
Atopy may make infection more likely (for example PMID: 17666105) but needless to say it doesn’t follow that allergies make infection more likely (other than locally PMID: 17889291). At least some of the time it will make infection more likely or severe for the obvious reason, that is, skin breaks (”Children with atopic dermatitis are particularly prone to bacterial superinfection.” PMID: 17910669) but I’m reluctant to grant that a confused immune system is necessarily going to be more competent, even if (that’s if) it is more active. And in the late stages of drug abuse, it might not be so very active, at a guess; just mucked around.
More idiosyncratically: drugs which are designed to keep the party going seem to me at first glance to be a pretty good model of severe chronobiological disturbances of the immune system (light also being psychoactive), and any dysfunction seems possible in such a case since you’re rolling dice.
Again, no medical credentials here…
November 28th, 2007 at 3:19 pm
Re: 20
:Wilson seemed confused when his patient reacted to the news he was going to live. This is very strange considering the patient acted exactly as Wilson said patients who get good news after being given a death sentance act. Do the writers watch the show too?”
Agreed, but this is the actor’s fault, not the writer. Probably.
The same lines could have been said ironically and passed muster, but instead, we got innocent surprise. The actor who plays Wilson was hired to be a perennial innocent, so maybe we shouldn’t be shocked that he can’t do irony, or tell a joke well for that matter. Of course, maybe the writers should have known his limitations.
If said actor can do irony, then it’s the director’s fault. These days, writers aren’t allowed to include extensive stage directions such as “Dude, this is, like, irony, not the shock a perfect idiot would show in the same situation. Seriously, check your backstory.” or even “(ironic)”) (Some, ok lots of) Actors hate to be treated like idiots, they’d much rather the writer or director look like an idiot for not correcting them and maintain the illusion of their genius.
November 28th, 2007 at 3:25 pm
Scott and Rich,
Rich, you’re right, but there clearly are monetary damages and whether or not there was negligence is a question of fact for a jury. For example, surely any diagnosis that a patient has a life-ending illness must be confirmed by additional testing before the patient is informed that he has six months to live. If not, I would argue that alone constitutes negligence; if so, clearly someone screwed up or the diagnosis would not have been confirmed by different tests. Scott, I didn’t realize that Wilson was just the messenger, but, as the head of the oncology department, he presumably has supervisory responsibility. As an attorney, I can tell you that the justice system is about money, not right and wrong. So there is no doubt in my mind that a medical malpractice attorney would bring the case and ask for some outrageous amount, and the hospital’s insurer would settle for something substantially less to avoid paying at least that much in defense attorney fees while still risking a judgment.
November 28th, 2007 at 3:27 pm
Oy veh, too tired to order my grammar. I mean:
Infection may make atopy more likely (for example PMID: 17666105) but needless to say it doesn’t follow that allergies make infection more likely (other than locally PMID: 17889291).
OR less. For example, probiotics are (at least sometimes,it seems) immunomodulatory rather than just cranking the volume up on the immune system PMID: 17922968 (hygiene hypothesis and all that)
November 28th, 2007 at 4:39 pm
I figured House was up to something when he asked Cuddy for her opinion on who to fire. If she didn’t want House to hire three people, couldn’t she just fire Taub or Kutner after he said he would bring back 13? She is still his boss, despite the way this season makes her seem.
November 28th, 2007 at 5:16 pm
didnt he vomit in the begining… you can see solid stuff in the blood too… why didnt they focus on the GIT…?
November 28th, 2007 at 5:43 pm
“whether or not there was negligence is a question of fact for a jury”
Right, that’s where the ‘reasonable person’ standard comes into play; the jury consists of the ‘reasonable people’ who decide whether there was actual negligence or intent to harm…
When this was explained to me in business law class, it was a real “ah-ha” moment, suddenly the tort system actually made sense.
That said, the victim would make, under present circumstances, a pretty unsympathetic case. Of course he -can- sue, but would a reasonable person conclude that negligence had occurred?
“why didnt they focus on the GIT…?”
The whole episode was about the git. Eventually they cured him. Oh, wait, you meant gastrointestinal tract.
November 28th, 2007 at 6:00 pm
Re: 20
:Wilson seemed confused when his patient reacted to the news he was going to live. This is very strange considering the patient acted exactly as Wilson said patients who get good news after being given a death sentance act. Do the writers watch the show too?”
Russ: Agreed, but this is the actor’s fault, not the writer. Probably.
Wilson gave that speech about patients with false positives in HIV tests reacting badly when they get the good news in “No Reason” – technically, this was during House’s hallucination, and was not the “real” Wilson, so his confusion is not, in my opinion, down to bad acting.
November 28th, 2007 at 6:05 pm
Gary: Not trying to be pedantic with the jury=reasonable people statement, just trying to provide context for other readers…..
November 28th, 2007 at 6:29 pm
Two things -
If Punk Rock Dude’s immune system was so weak that he contracted something that no healthy person would, wouldn’t steroids be a really bad idea, since they supress immune response?
//so not a doctor.
Also, “Thelonius Monk and the sound a trash compactor makes when you crawl inside it” is the best music description ever. :)
November 28th, 2007 at 6:42 pm
My downloaded House episode didn’t show the preview for the next ep. When will the new one be shown in the US? Do we get one next week, or has the darn writers’ strike finally gotten its effect on House? I read something about the Super Bowl hiatus in comments above, but a little Googling tells me that’s in Feb 2008, so I’m getting a bit confused. Please help me out. :)
November 28th, 2007 at 6:43 pm
Also, I think that Cuddy wasn’t fooled by House at all – she should know him too well, bad screenwriting aside, to ever take House at face value. Come on! He’s used the “ask for something I don’t really want” ploy dozens of times throughout the past seasons.
November 28th, 2007 at 6:54 pm
Rich,
This issue is actually very relevant to the show because House almost always deviates from standard medical practices, which is the first rung on the negligence ladder (of course, House always has good reason for doing so). If the misdiagnosis resulted from Wilson or the pathologist cutting corners or otherwise not following standard procedures, then a reasonable person could not avoid finding negligence. In this particular case, the misdiagnosis of a life-ending illness is, I would argue, itself evidence of negligence – either someone failed to follow standard procedures and confirm the diagnosis or the standard procedures don’t require confirmation and are therefore insufficient.
I also disagree that the patient is unsympathetic. Sure, he should be grateful that he isn’t going to die, but its not like Wilson cured him – the guy was never going to die anyway. Wilson took the guy on an emotional rollercoaster which caused the guy – very understandably in my opinion – to spend his money and attempt to sell his house so he could enjoy his last few months of life. A jury would eat that up.
November 28th, 2007 at 7:05 pm
Wait Thelonious Monk was disparaged on the episode? I didn’t hear that, a good thing because I would have thrown something at the TV. Hopefully you are making that up, because Monk has absolutely nothing to do with that drek.
Nobody has yet put forth any possible reason (especially the writers!) as to why Kutner would have been kept on this long, never mind why he would have been hired. Makes absolutely no sense at all.
November 28th, 2007 at 7:17 pm
@62 Gothic Llama: sure, he’s used that tactic, but I’m not sure what he’s asked for has been input and opinion before. He did a nice job of playing confused and embarrassed to be asking Cuddy for her advice. I can believe that she’d buy it, because, well… I did. (Just for a minute, of course.)
November 28th, 2007 at 9:06 pm
To 64: at the end, where House is playing Punk Rock Dude’s music on the magical speaker, that’s how he describes it. So not quite a slur. :)
Then again, I *liked* Punk Rock Dude’s music.
November 28th, 2007 at 9:37 pm
Yeah but Thelonious Monk is one of the musical geniuses of the 20th century, and his music is not random, chaotic, or grating in any way.
Should have said Merzbow or something like that.
Thanks for the clarification, even if it is disappointing.
November 28th, 2007 at 9:45 pm
Well I know it’s a little late in the game here to add new comments but I wanted to follow up on a theme so far in the other comments.
House is hiring fellows. People he will train using clinical experience. If they knew everything they needed to know in terms of medical experience, they wouldn’t need to be fellows. What House was looking for in his candidates was for the personality traits he thought would be most useful to him (e.g. don’t rat to Cuddy, don’t rat to the patient, be persistent with your diagnosis, investigate everything fully, and don’t be afraid of unconventional ideas).
As you may know last week I predicted CTB and Taub would win out. House said he fired CTB because she wouldn’t accept losing (or something to that effect). How many times have we seen House go outside of the rules to prove himself right instead of losing? My thinking here is that she would be too much like him (sans the fatalism) and that would be problematic.
I don’t care what the preview says, I don’t see Kumar staying. Unless the writers are just going to use him for comic relief or something. House fired Chase for crying out loud, there’s no way that Kumar is staying.
Some of the comments here don’t think CTB is bitchy enough to be a grade-A bitch. Seriously people, come on. She’s a doctor. She’s not going to literally go around backstabbing people for her amusement. She has to have people work with her, so if she did that, everyone would shun her. Instead, she is just bitchy enough to achieve her objectives. It’s this fact that makes people infuriated at her. She gets under people’s skin by her discourteous actions (yeah that’s a light way of putting it). This is why people who know her hate her. Somebody who doesn’t know her doesn’t really have as much basis to hate her. Instead of trying to explain this whole concept, we have developed a single word to describe it: bitch. Take it or leave it.
I’m still dissatisfied with 13. She really needs to pick up the pace medically if she wants to be another Cameron. The writers will be forever stuck trying to frame her against Cameron and we will all get tired of it eventually. Furthermore she will turn into the conscience voice for House like Cameron was. This is why I thought CTB would have worked better for him since she would have just done what was necessary instead of trying to argue the morality of it with House. Unless House really does feel like he needs that good conscience voice…
Interesting theory about the Wilson patient, however it would depend on what the hospital lawyers would do about it. If they are particularly “risk averse” they may just try to settle everything instead of going to trial, including the “slam dunk we’d kill ‘em” cases. They probably would be displeased either way if they knew one of their staffers had deliberately encouraged a patient to sue another staffer. Awkward!
November 28th, 2007 at 10:47 pm
Reading your reviews is becoming addictive. House is my favorite show on TV.
I’m noticing something that I hope they will fix. House is always having these back and forths with the other characters. It’s either about having compassion, or about motives, or passing unfair judgement, or about pride. But the writers are taking a speech that they would have given to Cameron and just handing it to 13 instead. They’re starting to give Wilson-like speeches to Cuddy. The characters are supposed to be different people. Just because the writer wants some dialog to be said doesn’t mean that it’s interchangeable who gets to say it.
November 28th, 2007 at 11:53 pm
To MightCondrias -
LOL Merzbow. But the description also involved a trash compacter: a mechanical, screeching, horrible thing mixed with something freeform, elegant and coherent. Then, I just dig the comparison.
I won’t argue with you on his being a musical genius, though.
November 29th, 2007 at 12:17 am
“If the misdiagnosis resulted from Wilson or the pathologist cutting corners or otherwise not following standard procedures, then a reasonable person could not avoid finding negligence.”
Gary: My assumption is based on Wilson and/or the pathologist following standard procedures; mostly because they’re not House.
I’m not a big bundle of information on how tests like this (or AIDS, etc.) are performed; it’s my assumption that you’re given the initial test results, and a follow-up test is scheduled.
In a case such as this, I don’t know to what extent false positives are discussed either, especially if the odds of such are quite low.
If it was mentioned at the initial session, “now Mr. Patient, there is an extremely small chance that this test returned a false positive, that you don’t really have cancer, so we’ll want to retest you in a few weeks. But I want you to understand, these tests are very accurate, and you shouldn’t pin any hopes on this test being wrong,” and the test was performed properly, I’m guessing negligence would be hard to establish.
Of course that assumes a lot of information we don’t have….
November 29th, 2007 at 2:02 am
Isn’t it awesome how many people are reading this blog? I stumbled upon it waaaaay early in Season One of House and re-visit every House night. It’s like Television Without Pity with a medical degree and a faster post time. And I feel smarter after reading your reviews, which I can’t say for anyone else, other than Ebert.
November 29th, 2007 at 5:45 am
I’ll miss Cutthroat Bitch.
November 29th, 2007 at 7:26 am
Anthony way up on #10 and Marionette above me: No, you are not the only one who liked Cutthroat Bitch.
I hate, hate HATE this “new team”. Kumar is annoying, STUPID (hello, shocking himself like that) and, as Cuddy thinks, liable to blow up part of the hospital. Taub the dumb@ss doesn’t even give a crap about patients–he’s just there because he’s a dumbass who cheats on his wife (ugh, the women who sleep with him must be getting paid) and his partners forced his ass to resign or they’d've told his wife.
Cutthroat Bitch? My girlfriend hates her, but *I* think she’s an interesting character. Much more interesting than the plastic surgeon who screws around and friggin’ Kumar.
And imagine the sexual tension between House and CTB. So she’s not as outright gorgeous as 13, but who the Hell cares–it’s her attitude that’s attractive. “Winning” -does- translate to saving the patient; it just sounds bad (but you know, House does stuff that sounds bad ALL the time, but he WINS–so how does that differentiate much from what CTB does?). That’s why House said at the end that “both of the women” cared for the patients, and that’s why CTB is somewhat of a kindred spirit with House. I can only imagine the bitchy banter that would’ve transpired between CTB and 13…and the possibly competition for House’s affections (THINK about it…and then think about what we have to look forward to with Taub and Kumar…and now tell me what would be for better television ;D).
That’s my story and I’m sticking to it.
November 29th, 2007 at 7:40 am
Re: 68 “House said he fired CTB because she wouldn’t accept losing (or something to that effect). How many times have we seen House go outside of the rules to prove himself right instead of losing? My thinking here is that she would be too much like him (sans the fatalism) and that would be problematic.”
It’s true that House has no problem breaking rules when he thinks he’s right, but he’s also great at knowing when he’s on the wrong path and taking what he learned from his mistakes and moving on to the next potentially right answer (at least, when it comes to medicine. Not so much in his personal life.) Like he said in “Three Stories,” just because you don’t know the answer, even if there’s no way you could no, doesn’t make you’re answer right or ok. You’re just plain wrong. Sure, he might be speaking about ethics here, but I’m wondering if his concern about CTB’s need to win is that she will cling to her ideas a bit too long in her desire not to lose, instead of moving on and throwing out the next idea and letting House judge if it’s time to move on. I think House wanted to keep all four of them, but someone had to go and I’m not too sad to see the back of CTB (mainly because in this last episode…not the best of actresses).
November 29th, 2007 at 9:33 am
I just LOVED the dialoge in this show. Sometimes it is so great I have to pause and rewind just to relive it.
I have to admit that the purely medical part is getting weaker and weaker. Before it was possible to actually crack a diagnose or two. Now is it just guessing; the medical facts, info and hints just don’t add up anymore.
November 29th, 2007 at 9:58 am
Hi,
I’m also pro-CTB. I think she gets things done, and that’s what matters. And I love her bitchy attitude.
Still, regarding the last scene: if House is indeed keeping 13 who will be fired instead? Taub or Kutner?
November 29th, 2007 at 11:29 am
I assumed that his immune system was just messed up from the drugs, so it was weak enough to expose him to measles and let him get sick, but eventually the measles would be a big enough problem and, since he kept doing drugs and continued messing up his immune system, it eventually would freak out and cause his symptoms. Does an immune system have to be strong to attack the wrong thing, or could he still have a weak immune system that happened to do the worst thing possible?
November 29th, 2007 at 11:52 am
Nobody else will be fired. He gets to keep all three, that was the point of his original firing of her.
Besides, if he now fires a man specifically to hire a woman at Cuddy’s request, that’s quite
the discrimination suit in the making (even if this show does completely ignore most of those
issues all the time).
November 29th, 2007 at 12:23 pm
Dialog and delivery -was- sparkling on this episode.
Loved the ‘engaged participant’ House/Wilson argument that ‘detached observer’ House interrupted with, “That couldn’t possibly be as poignant as it sounded.” One of the reasons to watch this show is because all the actors come -this close- to breaking down the 4th wall, but they never do it. Wilson in the first season, “Oh, this must be the thinking out loud part. Do I even need to be here?”, Cuddy, “What am I supposed to be afraid of? More yelling?”
November 29th, 2007 at 2:29 pm
Is there anyone else out there who thinks maybe testing for measles IgM or doing a PCR for the virus might have been more straightforward (though not as photogenic) than inducing a seizure?
November 29th, 2007 at 3:05 pm
Everyone knew 13 had to stay, or the male viewership (including me, probably) would riot outside the FOX office building. I was really hoping Taub (aka Sleazy McSleazerson) would be fired though. I’m completely indifferent to Kumar. Chase was more entertaining because of the accent.
I’m hoping that the writers take 13 away from being a Cameron-clone. She has the potential, I think – I mean, she drugged House and operated on him without his permission. Cameron, Cuddy, and probably even Wilson would never do that.
I also hope they find a good way to resolve the old young guns’ status. Foreman doesn’t do jack anymore, and I remember being so happy he was staying. He barely even practices medicine these days.
November 29th, 2007 at 4:19 pm
Foreman was there to keep an eye on House during his Survivor: House Edition. I’m sure that now he’ll be back on the diagnostic team with the other three idiots (because hello, he needed three people, there were two slots open, but there’s an extra one now because of 13).
November 29th, 2007 at 4:36 pm
“Did anyone notice that the chest Xray on the light box in Wilson’s office was backwards?”
This might be a nod to Scrubs (they did it intentionally).
I’m glad CTB is gone but 13 and Kutner are boring, they’re clones of Cameron and Chase. Taub’s slightly more interesting because of the plastic surgeon angle but really, the only candidate I found really interesting was the Old Fraud, it’s a shame they didn’t keep him on in some capacity.
November 29th, 2007 at 4:49 pm
As I see it, 13 brings nothing to the dance except a pretty face (and how often we see these
in hospitals, right?) and an oh, so caring nurturing nature. Blah. Cameron at least developed
some personality quirks. Cutthroat Bitch had more nuance and I wish she had been kept on.
Aside from which she was the better actress.
November 29th, 2007 at 7:37 pm
I don’t watch for the medicine or the mystery anymore because thereisn’t any. I watch solely for the House/Wilson scenes which I love.
To respond to an earlier poster regarding RSL’s acting. The conversation that House had with Wilson regarding patients being told that they were going to live instead of die as they were originally told was part of House’s hallucination (Reasons – S2 finale). What they were trying to convey was that Wilson is rarely if ever wrong about his diagnosis. In other words when he gives a death sentence, it normally sticks. Wilkson tells us through his conversation with the patient that he’s about to tell him something that he never get to tell patients – that his test was a false positive and in fact he’s going to live. Wilson was shocked by the patient’s reaction because WILSON’s reality does not match House’s hallucinatory assumptions about Wilson’s knowledge of patients who get “medical clemency” from their death sentence. RSL’s acting was pitch perfect based on what we know about Wilson’s actual work with terminal patients.
I want to say a couple of things about my overall impression of this episode. I wish the writers would remember that House is in his late forties. In other words almost 50. There’s nothing sexy or attractive or endearing about a man who looks 50 acting like an adolescent. The vagina chronicles that we had to endure during the Whatever It Takes and UGLY episodes was just over the top. And I really, really wish they would replace OE with EG (Big Love/Cole) because he has a great voice, he tall and he’s pretty and he made Kutner tolerable. I also loved CTB (Amber) and hope that they bring her back. I really enjoyed her interactions with House. I love Taub’s low life sneakiness. Geez so much love. I’m just waiting for him to stab House in the back. I don’t like Remy Hadley (13) but that’s an easy fix. I just TiVo right past her scenes. I hope they get rid of OE, JS, and JM. Didn’t like them the first go around and don’t miss them at all. And Cuddy need to take a leadership training course. I’ll keep watching as long as there as House and Wilson. When that stops, I’ll stop watching.
November 29th, 2007 at 8:19 pm
I don’t think it was meant to disparage Thelonius Monk. It was contrasting it to a garbage disposal, the irony in how Monk is really good, and this guy is really really bad. House seems like a jazz fan, I don’t think he’d think Monk is crap. Just irony, nothing more, more like the punk guy seems to be attempting to work with discordant tonality but unlike Monk he totally failed and just made total crap.
In regard to the amp, I’m pretty sure that that model amp has a direct input in the back that House could have plugged into, and running straight into the power amp might be good enough if the cd player/mp3 player has enough output gain. All he’d need is the right adapter and it’d work. I think he’d use a bass amp either because it was somehow onhand or because the bass amp has a bigger speaker and can output longer waveforms, more effective in having a physical impact on someone to cause a seizure. Like how big speakers can make your chest thump in ways that 10″ or less can’t. Maybe, or the production staff just screwed up.
I think Cuddy would believe House asked her opinion. It’d be him showing humanity, and she’d be gullible for that, simply because she wants it to be true and authentic so badly. Doesn’t mean she wouldn’t try and play off him though. She has a soft sappy side to her that House can manipulate so well.
In regard to 13, people say she is hot, but I do not see it. I did not think Cameron was either. Cuddy yes, but not 13. She looks like she walked out of a cubist painting with those cheekbones, like she was made to be really hot too much so she’s not. They really haven’t had that much of her, and I don’t really see her as a Cameron, too many character differences, but I haven’t been that impressed with her thus far. I like Taub because he doesn’t resemble anyone that has already been on the show. As far as Kutner, I simply cannot get over waiting for him to pull out some kryptonite or a white castle and torture house with it while looking like a dork. I think they may be going for the young naive doctor that none of the original team embodied, more of an opportunist than chase but without the self preservation streak chase had. I think that the writers have given themselves a pretty broad field to play with with these characters, so either they’ll really develop them and it will be good, or they’ll just leave them static and it’ll be not so good.
I liked the episode, but the medicine bounced around so much from it could be this to no it’s that to no I was wrong, it’s that, that I didn’t really follow it as well as I could have, I had to watch it again. Either I’m not as intelligent as I think, or they were vague with the logic in the medicine. I never liked CTB, I’m glad she is gone. I didn’t fully buy the character development, she was meant to be more one dimensional to serve as a contrast to the other characters, so developing her (other than her crying at the end which i thought worked well) doesn’t do her character justice. Old Fraud never would have worked, he’d be too crippled by the fact that he can’t directly treat the patient since he isn’t a doctor, and he is too much of the same mind with House. He was great in his role, but he couldn’t have lasted in it.
I liked the episode, but there have been some threads running in this season that are less than impressive and impede the show’s quality, and I hope with ending the hiring arc that they’ll leave them behind and move on back toward more dramatic presentation and downplay the goofiness. And as for last episode, I believe the zoom in on Cuddy’s ass was absolutely necessary to the plot – I had to really believe, she’s not wearing underwear, not just take House’s word for it, to really experience it first hand as an integral part of the plot as if I hadn’t studied the moment closely, I wouldn’t have been able to follow the rest of the show with the thong thread, so that sort of attention to detail in showing that Cuddy had no underwear on by that zoom in had an essential purpose for establishing the ethos in the moment, to identify with House’s shock in an authentic way, so we can really identify with the character and the moment. At least that’s what I told my girlfriend when my mouth dropped and I said ‘oh crap’…
November 29th, 2007 at 9:24 pm
I miss seasons 1-3
This season the medical diagnosis seem to jump from one to another in an instant, and it really becomes confusing and pointless. I liked the old team better, it was much more interesting to watch. I hope future episodes really kick it up more.
November 29th, 2007 at 9:27 pm
Ok. I have to say this cause I noticed everyone complaining about the writers. Has it occurred to anyone that the writers were getting sloppy on purpose. If you are trying to negotiate a better contracted or know a strike is coming up and not very satisfied with your current situation, your work is going to get sloppy. IMHO it’s the writers way of proving a point. The writers had to continue to produce scripts until a strike was called, but who says they have to be good. I expect the episodes to get better once the strike is over.
Now that is said. I think there was more to it then got shown, maybe suppose to be a two parter. There were two key points I don’t think they touched on, as far as the punk guys personal life, he really enjoyed playing with the kids and the record at the end. My personal opinion is that in the story somewhere they were planning on have a back story about the guys family/kid dieing and then him going to drugs. I.E. The folk song at the end was the guys music five years ago, why go from that to punk?
In closing I will just say so judge the writers so hard, hindsight is 20/20 and there is a lot of stuff that goes on we don’t know about.
November 29th, 2007 at 9:30 pm
to respond to post 42:
I assumed that the reason House tried to induce a seizure in the patient was to determine if the weird swallowing was or was not a complex partial seizure, and that they considered the swallowing to be a CPS because that would fit House’s diagnosis. If they hadn’t been able to induce a seizure they would have concluded that the swallowing was not a seizure and would have gone on accordingly…
I think that 13 has potential but I do think that some of her speeches seem to be suspiciously Cameron-esque. If the writers can move away from making her a Cameron clone there could be some interesting moments. I did enjoy the Huntington’s angle.
November 30th, 2007 at 12:07 am
Another CTB fan here (I guess that makes what — three of us now?). Thirteen (aka Remy Hadley, a made-up name if I ever heard one) is dull as dishwater. Does Olivia Wilde have more than one facial expression? A total Cam-clone, only without the dimension that made Cameron such a compelling character. I think Kutner’s pretty much a waste of space, too, much as I love Kal Penn. I have to wonder how the hospital will stay in business now with him and House on the same team — that is, if one or the other doesn’t manage to blow the place up first.
For what it’s worth, producer Katie Jacobs says the “House” team is looking for a way to bring CTB back in some capacity. She also reveals a lot about the casting of the new “ducklings,” though nothing, sadly, about why the medicine has been so shoddy this season. Here’s a link to the full interview, if anyone’s interested: http://community.tvguide.com/blog/TVGuide-Editors-Blog/Ausiello-Report/700000049.
November 30th, 2007 at 3:53 am
First of all, the not a medical professional caveat.
I agree that “bad blood fragments” seems like a very unclear result, and seems contradictory. However, I interpreted “bad blood fragments” to mean “fragments of bad blood” which I figured was either a) partially clotting or agglutinating blood cells, such as either red cells sticking to each other or platelets to red cells. I know that sounds close to “the DIC caused the DIC” but is that possible? Or b) thicker globules in his blood, some parts of his blood being thicker than others. Could something like that could hypothetically cause DIC?
November 30th, 2007 at 3:57 am
In response to #89:
I certainly hope the writers weren’t being sloppy on purpose. What I’ve gathered from seeing interviews and behind the scenes stuff is that David Shore wouldn’t tolerate it, that he’s sort of like House in that respect, things have to be the best they can, be just right. Like a doctor intentionally making sloppy incisions so the patient has an ugly scar on purpose, just because he didn’t like his job or the patient. Sometimes things don’t turn out as well as you’d intend, and that is why some episodes are weaker since the schedule is so tight that you don’t have the chance to fix much and it leaves room for regrets and half started plots (also the fault of editing), but I am very skeptical about the writers slagging off on purpose. I just don’t know what goal that would accomplish. They’d either get fired, make House a crappy show and make the ratings take a nose dive which would get the show canceled, take hits to their reputation, and whatever job they seek in the future, they would have the poor quality of episodes they intentionally tanked attached to them forever, as well as any future employer knowing that if the writers get unhappy, they play childish vindictive games to get what they want, instead of putting the show and their writing first no matter what tension is around them. It’d be so grossly unprofessional, much less to the writers who I would imagine have a love for the show and the characters (I’d imagine they’d be protective of their creations, not negligent). What I wonder is, are the scripts good, but is the editing bad? My understanding is that editing can kill a tv show, no matter how good the script or the acting. That is where I think I’d look, it’d be interesting to see if any of the editors or new producers have come in.
November 30th, 2007 at 9:38 am
Love the site – this is my first post….
I had been rather upset at this season’s portrayal of Dr. House as a buffoon. His sex jokes and inattention have made the show something of a comedy. But this week’s episode was different. The interactions between House and the patient were dramatic gold. House came across as a brutally honest person. He was once again a good person, but not a nice person. It is the tension between “good” and “nice” that made his character so interesting in the first two seasons, and it was the tension that this season was dropping completely.
Think of that clinic duty where House embarrasses a mother for bringing her son to the clinic as punishment. Not a nice thing to do – but there was something morally satisfying about it. The same thing happened this week when House told Wilson’s patient to sue. Sure, it wasn’t nice nor ethical – but Wilson was feeling guilt about giving good news to someone. When Wilson realized that his patient wasn’t hurt so much as he was greedy, the spell was broken. Wilson’s inappropriate guilt dissipated. House cared more for the truth than he did Wilson’s feelings. But unlike the previous episodes this season, there was a REASON for him acting the way he did. He wasn’t _just_ being a jerk, but doing so in service of revealing the truth.
I was very happy to see that aspect of the show return.
November 30th, 2007 at 11:35 am
I think that the ambiguity of CTB’s emphasis on winning is neglected by the writers. To most of us, it refers to making the correct diagnosis or curing the patient. To CTB, these two goals may be means to her end of looking good or making her colleagues look bad. If she had been chosen to stay on the team, I wouldn’t expect any change in behavior: instead of trying to secure a slot on the team, she would shift to trying to be the the preeminent team member. Without interruption, she’d continue her sycophancy and back-stabbing, regardless of destructive consequences for the patients or hospital.
I’m glad to see her go.
November 30th, 2007 at 2:34 pm
Hi,
I’ve discovered House just recently, spent nights trying to catch up old episodes. This episode IMHO was the worst one- all those suspected procedures vide open heart operation were just way off even for me. And was I the only one who has noticed that the rtg picture while wilson-House discussion were put reversly (?) I mean in a way that suggested dextrocardia. This is a quite big neglect, first time seen in House. It’s true that it’s no longer a medical show- it becames a soap opera, literally.
This site I love. THX.
November 30th, 2007 at 9:18 pm
Russell has it: House was a good person, but not a nice person. I think one of the reasons that I like the character so much is that he’s got this Steppenwolf thing going on – he’s smart, introspective and observant, and he’s a total misanthrope because of it.
Now he’s just unpleasant.
I would have preferred to see Big Love stay on, but oh well. 13 is just a boring character, and dollars to dimes they’re going to try to make her interesting by making her all tragic. Blah.
December 1st, 2007 at 12:03 am
Just out of curiosity, I checked IMDB and it appears that this episode is the writer’s first, though it was co-written, rather significantly, with David Chase. Interestingly, the writer is also listed as a co-executive producer — but only for this season. He was previously a co-executive producer for that great big dud “Studio 60 on the Sunset Strip” and before that in various capacities for “The West Wing.”
Perhaps even more curiously, one of the co-executive producers of another big dud, “The Black Donnellys” (Who is it that starred in that, again?), is now working in the same capacity on House. Wonder how that came about?
On another note, their on-set medical advisor (a former R.N., who’s actually appeared on the show in that capacity) left last year and it doesn’t look like she’s been replaced. They currently have three official medical technical advisors listed, two of whom are supposedly M.D.s and credited with 32 episodes each. The third, who has 13 episodes to his credit and doesn’t appear to be an M.D., may no longer be on the staff since none of them are from this season. There’s another (also an M.D.) who was on the staff from 2004-2005 and is credited with 17 episodes.
The permanent editorial staff does appear to be quite a bit smaller than it has been in previous years, though I don’t know what’s normal so it’s hard to say. They may also hire temporary workers as needed.
You all can see this stuff for yourselves if you’re interested by going here: http://www.imdb.com/title/tt0412142/fullcredits.
December 1st, 2007 at 1:11 am
you can’t criticise a fictional television show for not sticking to the medicine accurately all the time. it’d be a documentary otherwise. yes, the medical aspects can be way off, but that’s not the purpose of the show. i enjoy picking up on the wrongs here and there but it’s ridiculous to lambast the show/actors/writers for the medical inaccuracies.
on a side note…did anyone see the clubbing of his fingers??? i was sure they would be mentioned at some point.
December 2nd, 2007 at 10:24 am
CTB has to go. The whole her motivation was to win “survivor game”. It was an interesting person during the game, but when it has ended – she’s lost the reason to be on House. Actually I like possibility of her trying to replace some winner (if producers really want to keep her in the show). CTB as overambitious outsider is more interesting than as a member of House’s penis, I mean staff.
December 2nd, 2007 at 11:45 am
So, it definitely wasn’t a realistic bloody cough. Heamoptysis blood is bright red and kind of bubbly and foamy. Been there done that enough times to know. Also, it wasn’t a huge amount of blood either, so I don’t see how that small bloody cough would have made him pass out. I know I know, could always be other reasons.
Also, they have an actor with nicely clubbed fingers and they don’t even mention it… but when they had that fat guy without any visible clubbing at all they sure did mention it. Sad sad.
/A professional patient
December 2nd, 2007 at 1:38 pm
If House and Cuddy were on rollerskates, it would’ve been the Xanadu Gambit.
December 2nd, 2007 at 3:00 pm
Count me in as another one who misses CTB. What can I say, the girl had personality. I have to say the rest of the new team doesn’t really attract me all that much. Can anybody seriously see that doofus Kutner as a real doctor? And Thirteen is just Cameron with all of her flaws and personality quirks sucked out of her. I’m seriously getting some scary Mary Sue vibes from that character. House is way too nice and pleasant towards her for one thing. And Taub just strikes me as being even more unpleasant than Foreman. He’s the only one though that makes a realistic doctor. Except for the fact that he’s a plastic surgeon. While Kutner’s speciality is sports med/rehab. What the heck is up with that?
December 2nd, 2007 at 9:50 pm
Does anyone remember who originally sang the folk song that was played at the end? House said it in the episode right before he played the song but I am unable to find it anywhere.
December 3rd, 2007 at 1:07 am
you know, I think they’re looking for a few writers… ha ha..
December 3rd, 2007 at 1:51 am
Suggestion for Scott…is there a way to split the discussion board into 2 different boards, one for posting by medical folks interested in the medicine, and the other to talk about the soap opera part (or really bad medical comments by non-medical people).
December 3rd, 2007 at 6:51 am
For Kristen;
The song played during the firing is fictional, supposedly played by the patient long before he was messed up, and used by House to explain CTB the reasons for her firing. I have the intuition that Hugh played that song for the show since he has played some songs in the piano and guitar during the show.
December 3rd, 2007 at 9:43 am
http://www.housemd-guide.com/season4/409games.php
It seems that it was actually Hugh Laurie piece.
December 3rd, 2007 at 9:24 pm
I’m not sure i like this new team thing. I’ve been power-viewing. going through the other 3 seasons in 2 weeks. i finished the last episode last night. Why did Cameron quit? I hated Amber! I think House should get rid of…….(need to remember name) the one who doesn’t talk and did something bad? uh……setting buildings on fire……..n/m
December 3rd, 2007 at 10:44 pm
Why was House performing an echocardiogram? Pulmonary emboli don’t show up on ultrasound (you need a ventilation/perfusion scan or a spiral CT), and furthermore, pulmonary emboli don’t generally come from the heart — they come from the deep veins of the leg.
Just to add a possiblity to your original question. You can occasionally see signs of right heart strain on Echo that would suggest a PE. In cases where the patient is acutely decompensating, I have seen this used to help shift the decision to start anticoagulation when the patient is too unstable to be sent to the CT scanner to rule out PE.
December 4th, 2007 at 6:52 am
Now that they are taking a break for a few months, let me offer a small prediction: NOW they will reedit the visuals of House walking with his original team that runs under the end of the credits, and add in some visuals involving the new team. That shot doesn’t make any sense now.
I think many of the people here have been too critical of the new team and the selection process. I enjoyed it thoroughly, and think the right people won. The actors are first rate (have you seen Kal Penn in The Namesake? It’s a wonderful movie), and 13 is nothing remotely like a clone of Cameron. I think there is great potential for rejuvenating the show.
December 4th, 2007 at 7:43 am
Seriously, I want the old team back! It may sounds ridiculous, but there is somekind of chemistry between House and his old team. If the old team doesn’t come back or the medicine doesn’t get any better, I’ll drop this show.
December 4th, 2007 at 5:58 pm
When is the next episode due?
December 5th, 2007 at 12:26 am
First – I am so glad to see I am not the only one who thought the whole ‘let’s kick out 99% of the cast’ thing kinda sucked. There have been three seasons with these people. They had backgrounds, history with each other and House, possible INTERESTING future storylines to explore….I dk, honestly, this kind of change on such a great show is odd; I’m still waiting for the latest issue of InTouch! or whatever to tell me the cast change was due to some ridiculous scandal.
Second – THANK YOU GOD the Amber bitch is gone. I so wanted her and Taub to die/I mean, get fired..Point is, now we have these unlikeable people on House’s team. Yes, Foreman/Chase/Cameron were all unlikeable in some ways, but the audience liked them because you could tell that they – along with House – were good people in their own various ways, and more importantly, were there for the patient. Being there for House’s NJ version of Survivor? Not as endearing.
Third – It’s ironic that when it comes to the actual medical facts concerning the episodes, the writers for this show seem to have gotten themselves a doctor’s note. (hopefully their note is creative at least, something like lupus…oh wait..)
December 4th, 2007 at 6:04 pm
Official Comment
No new episodes until January
December 5th, 2007 at 5:26 pm
“House already pointed out that Jimmy had schistocytes (fragmented red blood cells) as proof that he had DIC, now the writers are invoking them as the cause of the DIC as well as the result?”
Aren’t we getting to the point in the season that the scripts are just about to run out because of the onset of the writer’s strike? Maybe these episodes are originating from when the strike was forthcoming and the writers’ patience was at an end.
December 6th, 2007 at 12:54 pm
Sorry I’m so late in posting. With this episode, I’m convinced that this show was not made for people in the medical field, and for those of us who are, we need to ignore the medicine aspect of it and just enjoy the soap opera, and the weekly fireworks.
Case in point: Over the series we’ve seen Wilson as a Medical Oncologist, Surgical Oncologist and Radiation Oncologist.
Now he’s a Pathologist?
My husband can enjoy the series on a different level than I, becuase he’s not medical and can’t speak medical terminology. The general public can’t differentiate between the different Oncologists and a Pathologist, all they know is that Wilson is the “cancer guy”, and when cancer comes into play in any form, Wilson’s the doc for it.
Those of us in the medical field, cancer especially (I’m a radiation nurse) need to bite our tonuge and enjoy it for what it is. Good acting, and pretty good stories.
What happened to the days when the writers tried hard to make sure the medicine was right?
December 7th, 2007 at 1:07 am
I’ve been having trouble posting to the blog–sorry for the test.
December 8th, 2007 at 9:14 pm
I don’t know about the medical aspects so much other than they re-used measles and it was more poorly done this time but the medicine has got lost in the soap opera this season. And the audience manipulation this season has been nasty and the jokes crude.
Everyone knew Thirteen wasn’t going to be fired because they had been doing cartwheels to keep her on all season in spite of being the most boring character on the show ever because of her absolute perfection. So they shock the audience into thinking for a moment that maybe this is still a show that dares to be different and then Cuddy reverse her position of season 1 (where she didn’t care how many men were on the show) and, proving that she doesn’t actually know what goes on in the diagnostics department, tells House to hire “the one who cares” (not the one who actually spent time talking to the patient and noticed the swallowing problem). This used to be an intelligent show, now it just takes the easy way out in the medicine and the characterizations.
December 9th, 2007 at 2:48 pm
I have a medical question for anyone that can answer it. A lot of the times on House, they will treat without actually testing for a disease because it just “fits”. Do real doctors do that? And if they don’t then what if they don’t have the time, literally, to test for something? Do they just let the patient die because the test haven’t come back?
December 9th, 2007 at 4:00 pm
“The side plot with Wilson was laughable.” Yes, literally. Dr. Reid was sued by a patient she misdiagnosed on “Scrubs.” Do the writers watch sitcoms for ideas?
December 11th, 2007 at 5:27 am
I’m actually kind of interested in what they might do with 13. Some here have suggested that she’ll just be another Cameron, but the original is still around. It looks to me like they’ve split the romantic and medical parts of the character. Hadley (13) can be the empathetic doctor on the team, but will (hopefully) find other things to do than obsess on House. And House was *way* less distracted by her than by Terzi. Meanwhile, Cameron seems to be spending most of her time thinking about House (returning to PPTH, sending him cases, blurting on camera), rather than on patient care. Good thing she’s out of the way in the ER! :-O
Kutner has been kind of a clown, but one thing we’ve been missing is a character that really wants to work with House and is enthusiastic to be there. To me it lightens the show, which (for me) got way too heavy with the Tritter storyline. I anticipate that as the Chase/Cameron/House triangle worsens, Chase will make a pretty good long-term antagonist. Unlike everyone else he has no reason to support House, but unlike Tritter or Vogler it’s not a short fight to the death.