House – Episode 11 (Season 4): Frozen
House lands the prime post-Super Bowl slot, and it was a strong episode overall. The medical mystery was intriguing, as were the logistical difficulties involved in solving it. There were some strong character moments, and a surprise reveal at the end that I did not see coming.
The medicine? Eh, it was OK. The rest of the show was good though.
Cate is a psychiatrist working at the South Pole on a psychological research project, as well as serving as the physician for the team stationed there. Just after treating another staffer with an injured femoral artery, she develops sudden intense right-sided flank pain, vomiting, and begins gasping for breath. No other physicians are available at the South Pole and evacuation is not an option. Since Cate is an adjunct faculty member at Princeton-Plainsboro Hospital, the Psychiatry Department asks House to treat her. Given her location, all the diagnosis and treatment must be done over webcam, and the medical supplies and tests available at the South Pole are minimal.
The initial differential diagnosis includes appendicitis, gallstone, or kidney stone. House in particular feels she has a struvite kidney stone due to recurrent urinary tract infections (large and jagged kidney stones that form due to urinary infections). She denies any history of urinary tract infections. Her Chem 7 (also known as a Basic Metabolic Panel, or BMP) shows declining kidney function, which House believes proves the existence of a kidney stone. He wants her to take a dose of intravenous Cefuroxime (a broad spectrum antibiotic) to cover any infection. She declines, telling House that there are other people who may need their limited supply more. Her kidney function continues to decline. House continues to believe this is a kidney stone, but she believes it is because of dehydration from the vomiting (and dehydration can certainly alter kidney function tests, though it usually has a very specific pattern); she wants to repeat the test after she’s rehydrated. In the middle of the conversation, she becomes tachypneic (rapid breathing) and develops chest pain. House notices that her trachea is deviated to the left which means that she has a tension pneumothorax, a life threatening emergency. Under his direction, she is able to relieve the tension by performing a needle thoracostomy (basically inserting a needle into her chest to relieve the pressure and allow the lung to re-inflate).
The differential now includes tuberculosis — but her PPD was negative, as was everyone else’s at the South Pole — and cancer in the kidney or lungs. An x-ray of her body shows an enlarged mediastinal node which could be a sign of lymphoma. Unfortunately, it is too deep for anything but a surgical biopsy, and that’s not an option. No other lymph nodes show up on x-ray (but then, x-rays aren’t very good at showing lymph nodes), so House has her perform a detailed physical exam on herself to look for other nodes, closer to the surface. She finds an enlarged node just above the belly button. Under Wilson’s direction, Cate plunges a syringe into it and withdraws about 2cc of a straw-colored fluid. No cancer cells show up in the fluid, but there are signs of inflammation. Unfortunately, Cate now begins having severe left flank pain, identical to what she had earlier on the right.
House suspects an autoimmune disease such as SLE (lupus) or vasculitis. He wants to start her on Prednisone, but she doesn’t want to use the medication unless she knows for sure that it’s an autoimmune condition. Foreman states that the normal test, an ANA, is not available, nor is an older test looking at C3. They can perform an improvised LE Prep (Lupus Erythematosus Cell Preparation). The test result is negative, arguing against an autoimmune condition, but House is still suspicious. Reluctantly, he agrees to Foreman’s plan to have Cate go outside, on the theory that the extreme cold will reduce the inflammation of the autoimmune disease and reduce her symptoms. She is about to comply when she passes out and then slips into a coma.
House, Foreman, and Wilson are now dealing with the station mechanic, as Cate is in a coma. They have him taste her urine to see whether it is concentrated (suggesting a kidney problem) or dilute (suggesting a brain problem). The urine is watery, so the cause of Cate’s coma is likely in her brain, they suspect an elevated intracranial pressure (ICP) or a hypothalamic problem. Under the team’s instructions, the mechanic drills a burr hole into Cate’s skull. This is to relieve any increased ICP. Sure enough, she comes out of her coma shortly after the hole is drilled.
House’s team now considers what condition could cause kidney problems, lung problems, and increased intracranial pressure. The differential includes tumor (already ruled out), bacterial endocarditis, deep vein clots, atherosclerotic emboli or fat emboli. House is intrigued by this last suggestion. Cate was cold during the exam and had left her socks on. When they are removed a broken toe is revealed. This broken bone has been throwing off clots of fat to the kidney, lungs, and heart, causing her problems. The bone is reset and splinted and she should be fine.
Fat emboli can definitely cause lung problems in the form of pulmonary embolism (clots to the lungs), but I don’t see any way it cause a tension pneumothorax. In terms of the treatment of Cate’s tension pneumothorax, the needle thoracostomy relieves the tension aspect of the pneumothorax, but a simple pneumothorax still remains. Cate needs a chest tube (or if it’s small enough, 100% oxygen — all the time, not just an occasional breath).
That’s not how a percutaneous needle biopsy is performed, and that’s an incredible amount of fluid to get back — it’s a solid tissue structure they’re biopsying, not a cyst. PLus, I find it hard to believe the medical kit wouldn’t contain a local anesthetic such as Lidocaine.
Sending someone with an autoimmune disease or vasculitis out in the cold is not a clever idea. It may reduce their symptoms, possibly, if the moon is right. Or it could cause a bad case of Raynaud’s Disease (a cold-induced spasm of the blood vessels in the fingers and toes. It is common in people with autoimmune diseases and vasculitis).
I can see how a fat embolism in the brain could cause a coma (from causing a stroke), but I don’t know that it would increase the intracranial pressure and cause a coma that way.
How did fat embolism lead to enlarged lymph nodes?
It’s fractures of the long bones (femur, most commonly) that lead to fat emboli. I don’t think there’s enough fat in a toe bone to cause a fat embolism.
I give the medical mystery an A because it was the best mystery they’ve had in a while. The limitations imposed by the patient being at the South Pole were well done. The final solution fit the big picture (lung, kidney, and brain damage), but missed the specifics (how did clots do all that? And from the toe?) so gets a merely mediocre C-. The medicine was for the most part appropriate, especially given the limitations already mentioned. The final answer is where the medicine fell apart. Still, I’ll give it a B- overall. The Three Musketeers didn’t add much this week, but Wilson and special guest patient Cate more than made up for them. That Wilson-is-dating-who? ending is worth some points as well. A for the soap opera.
The previous House review
A list of all prior House reviews
February 4th, 2008 at 12:35 am
Actually, going out into the cold was Foreman’s idea, not House’s – in fact, House argued strongly against it.
Were there only two people at that station? Where was everybody else?
And yes, the ending was a shocker. (Almost as shocking as the outcome of the Super Bowl.)
February 4th, 2008 at 12:37 am
“[House] wants her to walk outside, on the theory that the extreme cold will reduce the inflammation of the autoimmune disease and reduce her symptoms.”
That wasn’t House, that was Foreman. House liked her too much to send her out in the cold.
So can red wine actually be used as a stain, or was that nonsense? How do stains work anyway?
February 4th, 2008 at 12:46 am
Wouldn’t treating ICP this way be extremely dangerous? If it’s a small increase in pressure, I can understand it, but then it probably wouldn’t cause a coma. Relieving high-pressure CSF this way, though, seems like it could cause herniation of… well… the brain. I know for a fact an LP would be out of the question as it could cause herniation of the brainstem.
February 4th, 2008 at 12:56 am
I thought this was one of the best, if the not best episode ever… I don’t know about the realism factor but everything else was great.
The interesting and unusual medical situation was really entertaining, it was definitely the funniest episode imo, and the dialogue between House and Wilson was awesome… I was laughing my ass off at like 4 or 5 different lines, especially when Wilson said “let me tell you something-” and then took off running, too good.
And then the end of the episode brought the awesome, and even House was surprised.. this episode had it all.
February 4th, 2008 at 1:02 am
Official Comment
MrBuddwing,
You’re right that House argued against going out in the cold, but ultimately he still was going to go along with it (but I made it clearer in the post).
At some point it was mentioned that there were twenty other people in the station, but I did wonder where they were then.
February 4th, 2008 at 1:21 am
“PLus, I find it hard to believe the medical kit wouldn’t contain a local anesthetic such as Lidocaine.”
Before she performed the biopsy on herself, she said something like “It feels pretty numb now.” So I assume she did have some (not terribly effective?) anesthetic.
February 4th, 2008 at 1:21 am
She explained that she was keeping her condition quiet from the other (20) people on the stations so it wouldn’t panic them–she was the only doctor. Realistic? I don’t know but they did offer that explanation in the script. It added to the feeling that she was extremely isolated. I loved the McGyver medicine–although I had to close my eyes on the drinking urine part. Did you notice the guy she was embracing at the end had a limp and a crutch? Ah, nice writing and symmetry.
Thanks for the medical explanations–I can’t ever tell if it is realistic or not. I did wonder about the broken toe doing it. Kutner ruled! I knew I was going to like him.
February 4th, 2008 at 2:01 am
Isn’t this episode based [very loosely] on a real event from a year or so ago- a woman Dr. in Antarctica was actually treated remotely for cancer until the weather changed and she could be flown out?
I am a new fan, having just discovered ‘House’ and interested in all things medical since I am newly incapacitated while I wait for my own surgery, A THR.
February 4th, 2008 at 2:12 am
Isn’t this episode based [very loosely] on a real event from a year or so ago- a woman Dr. in Antarctica was actually treated remotely for cancer until the weather changed and she could be flown out?
Dr. Jerri Nielsen. You can read about her on Wikipedia.
February 4th, 2008 at 5:12 am
Maybe she didn’t want to use the Lidocane up either (like the antibiotics and Prednisone)?
The book by Dr. Jerri Nielsen is called Ice Bound by the way, I read it a long time ago and the House promo’s last week instantly reminded me of it too. I thought all South Pole people got an appendectomy before they went?
Really liked this episode, great surprise at the end too!!!
February 4th, 2008 at 7:14 am
Care was cold during the exam and had left her socks on. When they are removed a broken toe is revealed.
Scott, I think you meant Cate.
February 4th, 2008 at 7:36 am
Official Comment
Joey,
Cate was numbing her skin with a piece of ice before the procedure.
February 4th, 2008 at 7:49 am
When Wilson remarks on House’s use of the patient’s first name, House calls him “Bob.” Isn’t Wilson’s first name James? Bob is the actor’s name, isn’t it?
And when Cuddy tells House to be content with broadcast TV, he says something about Tuesday night. Another “in” joke?
February 4th, 2008 at 8:13 am
I thought the episode was pretty good… it was an intriguing problem.
The “I want my Cable!” side-plot seemed stupid to me until its resolution. Then I sort of liked it.
I guess I’m strange… I rank House episodes by great lines… And this one had some real winners.
Best line in the episode:
Cameron: “I’m sorry House, no cable TV. You’ll just have to get along with broadcast TV.”
House (after a beat): “I’ll be OK on Tuesdays…”
Second Best line:
“I have it narrowed down to three. It can’t be Cuddy, because you’re straight…”
I’m looking forward to the new Bitch Arc… but I hope it doesn’t go for more than three episodes. She’ll get really tiring after that.
And, here’s wishing that Cate comes back from the South Pole and sets up shop at Princeton-Plainsboro… she’s the only one I have seen that really can handle him.
February 4th, 2008 at 9:33 am
Did you see her feet? I think her toes do qualify as long bones.
February 4th, 2008 at 9:56 am
On the previews Tuesday’s episode, they went ahead and spoiled what was probably going to be the funniest moment in (and perhaps even the resolution of) the new Bitch arc. Oh well.
February 4th, 2008 at 10:00 am
With the number of episodes they spent developing CTB’s character, it was inevitable that she should be brought back somehow. With Wilson though… that’s a curve ball.
Yeah sure, Cameron gets “fired” from the E.D. As if we’re supposed to believe she won’t be back in the next episode. Right!
Kumar had another immaculate idea come to him at just the right moment (incredible I may say).
I think that this episode was deliberately shortened due to time constraints (but I didn’t measure or anything). You can tell that at least one normal commercial break was missing and they may have cut some of the details out to make the time slot (although it was at an irregular start time to begin with). If this was a two-hour special then I’m sure a lot of the things you’re concerned about would have been explained better. That’s too much to ask though on Super Bowl Sunday with the local news already being pushed back to accommodate.
How about that House ad appearing over Eli’s head as he hoisted the trophy? The ratings for this episode had better be massive! You can’t get better placement than that.
Overall I liked this episode as well despite its imperfections. This wasn’t even supposed to be the Super Bowl episode (strike) and I was worried that a dud episode would be substituted for it instead but FOX has managed to keep the ship going.
February 4th, 2008 at 10:55 am
Didn’t House tell Cate to X-ray her whole body? Or did he say to X-ray just the places that have lymph nodes? If she had X-rayed her foot they would have noticed the broken toe.
How long would it take for a fat embolism to develop and cause the problems? If she broke her toe when she went out to help the mechanic with the damaged femoral artery, the symptoms developed fast (while she was still outside).
February 4th, 2008 at 11:09 am
Wilson points out to Foreman that House’s obnoxiousness towards Cate means that he likes her. Meanwhile, House has sent his team on a bogus mission to see if they’ll stand up to him, but for some reason this mission involves harassing Cameron. I don’t think that thread’s over yet, particularly since her relationship with Chase would make such an outcome the kind of train wreck we’ve come to expect, rather than the “happily ever after” that would kill this show.
February 4th, 2008 at 11:38 am
So my big question though is about the superglue at the beginning of the episode — can you really just glue a femoral artery closed like that??
February 4th, 2008 at 11:57 am
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I’m looking forward to the new Bitch Arc… but I hope it doesn’t go for more than three episodes. She’ll get really tiring after that.
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I am fairly certain that I read that only three episodes remained from the pre-strike shooting schedule, and they decided to use them before, immediately after, and then one week beyond the Super Bowl. So we may not see the Bitch again for a while.
February 4th, 2008 at 12:12 pm
geat medical story that hung together. The patient and the situation were excellent. I absolutely loved all the House/Wilson moments and the ending was absolutely perfect.
February 4th, 2008 at 1:44 pm
@20 MEH: No, you can’t. There are fibrin glues (or fibrin sealants) available, but they are only suitable for stopping bleeding from small vessels, for the (supportive?) treatment of ruptured organs like the liver or the spleen and for wound healing (replacing or supporting a skin suture).
A perforated artery however, has to be surgically sutured, especially if the vessel is as big as the femoral. The fibrin sealant simply wouldn’t work:
“4.3 Arterial Bleeding
TISSEEL should not be used for treatment of severe or brisk arterial bleeding. In these situations, TISSEEL will be
washed away in the flow of blood before hemostasis can be attained.” http://www.baxter.com/products/biopharmaceuticals/downloads/Tisseel_PI.pdf (Baxter TISSUSEEL, or TISSUCOL as it is called in Europe is one make of fibrin glue.)
For more information, check out http://www.surgeryencyclopedia.com/Ce-Fi/Fibrin-Sealants.html
Another thing which upset me was the whole ICP thing.
How does an embolus cause increased ICP (as you said)? I think they rather should have linked the renal issues to the increased ICP (osmotic edema comes to mind, although I’m not sure if it would fit here). The improvised trepanation procedure was laughable as well. I understand that House has always been about ad lib medicine, but some repairman performing neurosurgery with his Home Depot type drill is just ridiculous…
Also, I wonder what a burr hole without inserted external ventricular drain would result in: I figure the ambient pressure and the ICP would enter some state of equilibrium. Given that the ambient pressure is about 750mmHg (physiological ICP is 5-10mmHg, this would put even more pressure on her brain. But I might be completely mistaken here, and of course I’m not a neurosurgeon either; though I worked as a circulating nurse in a neurosurgical OR for a couple of months.
February 4th, 2008 at 1:49 pm
One more thing: Can an embolus from her toe even reach her brain and kidneys? How can it pass the pulmonary circulation without getting stuck there (resulting in pulmonary embolism, of course).
February 4th, 2008 at 3:23 pm
I loved the story, good job guys. Whoever was doing the House-isms for this eppy was spot on, there were quite a few great ones.
Boo on Cutthroat B being back, I would’ve preferred a new character for Wilson instead of her.
Agreed with poster above (sorry forgot your name), about Wilson running out the door to elude House. Wilson rarely does blatantly “that’s just so wrong” behavior. Love it.
February 4th, 2008 at 3:41 pm
JAY Says:
Yeah sure, Cameron gets fired from the E.D. As if we’re supposed to believe she won’t be back in the next episode. Right!
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Actually, Cameron wasn’t fired. That was a ploy by Cuddy to teach House that “Some things are more important than cable” — a bad ploy that House saw through at once.
BTW, I agree that Kumar is the new “go-to” guy. Not sure I like that. But I’ll tell you what I like: At least the hospital looks a little more real now. How many hospitals have you been to that there were NO INDIAN doctors? Bad enough that the offices and patient rooms all look like they were designed by “Queer Eye for the Straight Guy” — all doctors being white (and gorgeous/handsome) was a bit too much.
Now we have the short, balding jewish guy and Kumar… a little more believable…
February 4th, 2008 at 4:23 pm
…well, Cameron still tips the beauty scale one way… ;]
This was probably the funniest [H]OUSE so far. The “Tuesday” joke was just amazing.
February 4th, 2008 at 6:26 pm
Excellent writing this week! It’s like a trip back to the first season…
Foreman: “Oh my God, House has been wooing me all this time!”
February 4th, 2008 at 7:10 pm
First, props to Mira Sorvino, she could easily steal the show,
hey are we ready for a spinoff? Even somewhat believable as a shrink.
The guy with the drill press – didn’t he even know how to set the depth limit?
It looked like he drilled an extra inch into her brain when he broke through,
they could at least have reshot the scene!
Also, I thought the major Antarctic stations are now rather larger in
resources and population, than suggested here.
And, while I check here to get some perspective on the medicine, and am
only a somewhat informed layman, I rather suspected an edge-of-the-writers-strike
plot here, an awful lot of the symptoms, cause, and treatment, seemed
rather more convenient than usual.
February 4th, 2008 at 9:31 pm
Thanks for the awesome review, Scott. I HATE that Cutthroat Bitch is back, especially with Wilson. I hope that doesn’t last long.
I loved all the jokes this episode, though.
Although I must say, when she wouldn’t take off her socks, I knew immediately that the problem had something to do with her feet.
February 4th, 2008 at 10:10 pm
Would you really get a bacterial infection in the antartic? I was told that the air there was the purest in the world because hardly any bacteria can survive in it. Also its far away from smog and whatnot.
February 5th, 2008 at 1:51 am
Chris,
Not that it necessarily makes it possible, but protocols (such as using glue to stop a femoral bleed) may be quite different in a -70 degree environment. Also a patent foreman ovale is a classical case presented in many medical schools for how you can get embolisms to the brain causing stroke (it’s a congenital defect that allows some passage of materials from the right atrium to the left atrium).
Trying to think of ways to make the case possible…how about she had a shunt for hydrocephalus and the emboli being thrown off became lodged in it? Yeah, ridiculous i know, but couldn’t think of many ways to increase ICP. Or how about constricted blood flow caused by embolism that traveled through a PFO, knocking out nuclei for baroreceptors, which causes decreased BP, causing her to pass out. Whatever way you do it, a embolism induced change in BP that caused her to pass out would have been much more believable (medically possible). Plus, you can pretty much make it be a really simple problem and solution if the patient is out in the middle of nowhere, because they are monitoring or testing even the most common causes of problems. The brilliant dr. house, “AHAH, I have the solution, test her BP”.
Also, i don’t think they were trying to claim the lymph node enlargements were caused by the embolism. I think we (the audience) were supposed to conclude that that was an irrelevant and misleading symptom unrelated to the final diagnosis.
February 5th, 2008 at 10:08 am
One more thing – have you seen the new Antarctic research stations? I doubt that it’s cold enough inside one to mask the pain of a broken toe. Oh, well. I don’t really watch for the medicine, anyway. The House/Wilson action was top-notch.
February 5th, 2008 at 11:58 am
I loved the Apollo 13 reference at the very beginning, with House dumping the equipment on a table in front of his team. That and the “Tuesday” line alone were enough to make the episode.
February 5th, 2008 at 12:31 pm
Face it, the medicine is incredibly unrealistic every week in House. A significant fat embolus would never arise from a toe, and even if it did, the problem certainly would not be fixed with a little traction. The fat couldn’t get to the brain without a right-left shunt, which I think House dismissed (pfo).
Squirting a little glue in the wound would never close a laceration in the femoral artery.
etc, etc, etc.
February 5th, 2008 at 12:44 pm
Argh. CTB is back. :\
February 5th, 2008 at 2:03 pm
So she took her socks off and noticed the broken toe. Does this mean she was wearing the same socks for several days? Possible, I guess.
What bothers me more is urine-tasting as a diagnostic test. If she can run a chemistry panel, shouldn’t she also have a few urine dipsticks lying around that the mechanic could use to check a specific gravity?
February 5th, 2008 at 2:24 pm
One thing bothered me at the end of this episode. What’s the Cate character supposed to do now that she has a HOLE IN HER HEAD? Isn’t that a rather risky thing to go be walking around with since the cranial cavity is supposed to be sterile?
How would they mend something like that?
February 5th, 2008 at 2:43 pm
Can someone explain to me why pneumothorax would be life threatening the way it was shown in this episode. I always thought that a human can function with only one lung relatively ok.
February 5th, 2008 at 3:43 pm
You don’t need your appendix either, but it can still kill you when it screws up. The collapsed lung is still connected to the circulatory system, and still affecting pressure in the chest cavity, and from what I understand (admittedly not much), it does bad things to both.
February 5th, 2008 at 3:56 pm
Tension ptx way dangerous: http://en.wikipedia.org/wiki/Tension_pneumothorax
February 5th, 2008 at 4:28 pm
One of the funniest episodes ever! But can somebody explain me the “Tuesdays” joke, please? Living in Europe, I didn’t get it… Thanks in advance
February 5th, 2008 at 4:57 pm
Pavel,
House normally airs on Tuesdays in the US.
February 5th, 2008 at 6:49 pm
Does anyone know if there’s been a shake up in the writing staff of “House”? The dialog in the last two episodes has been much sharper, more clever than the first part of this fourth season. It had reached the point where I no longer truly looked forward to a new episode, which would have been unthinkable during the first two seasons. Wonder whom I could thank for reviving the writing?
Scott, thanks so much for your medical analysis of the shows. Makes me sound like I know what I am talking about around the water cooler Wednesday mornings.
February 5th, 2008 at 8:25 pm
‘TISSEEL should not be used for treatment of severe or brisk arterial bleeding. In these situations, TISSEEL will be washed away in the flow of blood before hemostasis can be attained.’
She says that ‘glue is best way to heal a wound at these temperatures’. Given that his leg was exposed to -70 degrees, couldn’t that minimize the blood flow and stop the glue being washed away?
February 5th, 2008 at 8:44 pm
Am I the only one bugged that SHE DIDN’T NOTICE HER DAMN TOE WAS BROKEN?! Even if her foot was too numb to feel the pain, wouldn’t she report that as a symptom? I had a real problem w/ this, as you can tell.
February 6th, 2008 at 4:16 am
“Even if her foot was too numb to feel the pain, wouldn’t she report that as a symptom?”
She didn’t know, idiot.
February 6th, 2008 at 6:06 pm
Some reviewers have commented on the Cyrano de Bergerac angle to House’s temperament. I thought this episode played to that angle more than any other I remember, and I wonder if it was intentional (at least in part). I even think I remember some indication that the series creators did have Cyrano in mind as a minor inspiration; if so, an intentional allusion wouldn’t be so far-fetched.
February 6th, 2008 at 10:54 pm
If it is winter in the Northern Hemisphere it is summer in the Southern Hemisphere and restocking a camps in Antarctica is relatively easy.
I found this an annoying flub
February 7th, 2008 at 11:28 am
Or how about constricted blood flow caused by embolism that traveled through a PFO,
——————————–
The problem is that House and Foreman explicitly ruled out PFO (an opening on the inner walls of the heart that allows venule and arterial blood to mix), saying that would certainly have shown up on her pre-mission physical and made her ineligible for the trip to the pole.
There is just no way that anything coming back from the veins can bypass the tiny capillary network in the lungs and still be big enough to get stuck in the brain.
February 7th, 2008 at 11:59 am
I thought the best part was Kate refusing to go along with House’s shotgun suggestions. She kept asking “Why should this work? You’re diagnosis is incomplete!” He really met his match in this one. I’d love to see her show up at PPH later.
+1 to the post about snow on the roof of PPH and a lock-out in Antartica; winter in both hemispheres – really dumb.
You can have your toe stomped on and not know that it’s really broken for several days – I should know.
If you can do a trache with a Bic pen, you can drill a hole in the skull with a drill press. Foreman was clear about drilling in short steps, which is proper use of a drill press. Using the preset stop only works if you know the exact depth. It was a good McGuyver method.
February 7th, 2008 at 4:15 pm
How can fat embolism can cause brain or kidney problems?
Unless you have a comunication between the right and left atrium, the fat embolus only goes to the lungs.
Isn’t that right?
February 7th, 2008 at 10:56 pm
I’m not an engineer (or a doctor!), but the opening scene had me gaping in disbelief. Who’d be *dumb* enough to built a cluster of windmills at the south pole! The maintenance on those things, on anything big with moving parts, in a hostile environment, would be a nightmare – they’d never do it.
If you’re interested in reading more about life on the great southern continent, try http://www.bigdeadplace.com/welcome.html – it’s hilariously cynical and realistic view of the reality of working there.
February 8th, 2008 at 1:30 pm
I’m inclined to give them a pass on numbing the biopsy with an ice cube instead of lidocane (or something similar) on the assumption the writers felt they needed to set up the idea of “cold stops pain” for the big toe finale.
February 8th, 2008 at 8:07 pm
A lot of the Antarctica stuff bothered me (I’m a geologist, and I have many friends who have done research down there). Let me be nit-picky about things I know about– yeah, no windmills. They were not stationed at McMurdo, which is the main research station, but at the South Pole itself, which is much smaller and less well-staffed. The rooms are not heated to comfortable level– most of the satellite research stations (which are little more than clusters of tents and maybe one permanent shack) have no real heating at all, so I’m not surprised she didn’t feel pain in her foot. I wouldn’t be surprised if she thought the break was simply a bad toe-stubbing the day before, and never really took off her socks to look.
The medical kits are also better stocked– acute medical care is at best 12 hours away, if the plane leaves right after you get injured.
No, they do not all get appendectomies before going down there. They have very thorough exams and have to do things like get their cholesterol down (about which one of my friends always complains), but invasive surgery is never a requirement.
They do get a quota of four candy bars a day, though.
February 10th, 2008 at 12:30 pm
The broken toe —there’s a reason that we nurses call it the “head-to-toe” assessment when we give patients daily physical examinations. Any competent professional would have examined hereself carefully before getting a consult half a planet away, cold feet or not.
February 10th, 2008 at 3:31 pm
I loved this episode again… the fourth season IMO is back up to par after the disappointing Tritter arc – but what’s a few bad moment among friends?
I had my doubts about the initial scenes with the ruptured artery and the “glue” cure – but also that the bleeding stopped so soon outside (as soon as he pressed his hand on it).
Could she really have missed the broken toe for several days?
Thanks again for the review! They should really employ you at the set – it would certainly make the eps a lot closer to reality (and reality always is stranger than fiction).
February 11th, 2008 at 6:08 pm
A few comments.
For “Grass”, I assume since they mentioned that she was a psychiatrist and not a practicing physical physician, they were implying that she didn’t have the practical experience to do a complete physical check. Pretty lame, I agree.
I still find it hard to believe that there were 20+ other people at the station and they couldn’t get someone else to check up on her or help her out with her “tests.” Even if no one else was available, mechanic-guy knew about her collapse and should have been checking up on her. He should have done the x-rays, and the biopsy, not her. Trying to conduct tests on yourself like that should only be done in extreme emergencies as many mistakes could be made (such as missing the stab?). They tried to divert us from this with the “don’t want to cause panic” line, but still, mechanic-guy should have been there to help. Just too much of a suspension of disbelief problem.
And I have to say, that I find the idea of the cold numbing the broken toe believable. Have you ever been somewhere with your extremities cold for an extended period of time? Say walking around a concrete floor in a basement in the winter with bare feet? After an extended period of time, you won’t feel your feet and major pain becomes merely uncomfortable.
February 15th, 2008 at 9:19 pm
“And you’re afraid the tumor might overhear, and know we’re onto it.”
Love that line.
I’m getting the vibe that he knew her when she was in the hospital there or something. The way he looked at her the first time he walked into the room…I dunno, there was this recognition thing going on.
February 15th, 2008 at 10:28 pm
Love these comments–I missed the post-superbowl airing so I just saw the episode now. Re. the Antarctic windmills: The opening scene, with the guy checking the windmills and then looking up and them and seeing them sort of wobble and then one crumble and fall–I thought he was hallucinating. It was surreal. Until it became clear that the imaginary blade had really cut him. Even then, when he said that he had stopped bleeding, she explained that was because of the cold…. I was still wondering if he was wounded or had imagined it.
February 16th, 2008 at 4:50 pm
here’s a very unlikely scenario: becouse of the increased thoracic pressure(caused by the pneumothorax)it can be considered that a fat/trombus embolus in the veins of the leg making its way through the inferior vena cava could have past in the spinal venous circulation and from there to the brain… and I’m not completely sure it’s possible
#sorry for my english
February 16th, 2008 at 8:59 pm
Saw the end of this episode for the first time.
It’s interesting that they’ve had two episodes in a row that involve people being in relationships with someone else over guilt about their health. It sure didn’t look like she wanted to be with that guy, but jeez, he’d saved her life.
March 2nd, 2008 at 8:49 am
Surely the woman showered at some point, or at least changed her socks. The case lasted more than one day didn’t it?
May 8th, 2008 at 12:29 pm
i loved this episode! so many funny moments!
and i thought the guy was hallucinating too (with the blade seeming so unreal)
anyways, i thought the ctb storyline is gonna be a bit annoying but i hope for the best
May 22nd, 2008 at 3:24 pm
As for it being winter in both hemispheres, it may have been October or November: mid-fall in New Jersey, making snow a definite possibility, and mid-spring at the South Pole, making snow pretty likely. So it might not really have been a mistake.
May 30th, 2008 at 6:19 am
Stunning episode. Maybe the remedial level CG on the Antarctic wind turbines was deliberate, or a comment on what a dumbly overpraised idea wind power really is? The main point of difference from Apollo 13 was not knowing the ending in advance (though good guys never die on House, especially when he has a crush on them, yes?). Okay, getting the Bitch back on board was unexpected.
I love the way this hospital-set soap has the audacity to have a lead character who is soap-addicted. It’s one level of an internal culture of product placement: Hi-Def, webcam and cable. Dell and Apple. Diagnose-all MRI imaging.
Apologies for late posting – I’m British.
March 23rd, 2009 at 8:07 am
Isn’t it true that a trachea deviation to the left is most commonly a late physical sign of a tension pneumothorax? Often when the symptom is visible it is too late for the patient. This at least seems to be the case when in combat situations, where a patient has a tension pneumothorax.
July 26th, 2009 at 2:31 pm
@Dr. Scott:
Thanks a lot for your great reviews. I really enjoy reading here after each episode and not only for your reviews but also for all those quality posting by the others.
The ending of this episode was great:
“Cutthroatbitch?” – “I call her Amber.”
October 8th, 2009 at 5:34 pm
The whole premise of the toe is just bad. I’m sorry, but not removing ones socks at all? don’t believe it, not one bit.
December 22nd, 2009 at 4:04 pm
If Cate x-rayed her all body and sent pics to House,why didn’t he find the broken toe?
February 8th, 2010 at 8:40 pm
When Wilson remarks on House’s use of the patient’s first name, House calls him “Bob.” Isn’t Wilson’s first name James? Bob is the actor’s name, isn’t it?
I notices this too!
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