House – Episode 14 (Season 4): Living The Dream
Filed under: Medicine
A second episode of House in a row that felt shallow and superficial. There were two potentially great concepts in this episode: House kidnapping a soap opera star, and the hospital’s accreditation inspection, but both were essentially squandered in this disjointed episode.
House is convinced that Evan Greer, the star of his favorite soap opera, has brain cancer. House has noticed that Evan’s line readings are slower and he is pausing more which leads him to believe that Evan has bad peripheral vision from an occipital lobe brain tumor. So House does what any other self-respecting doctor would do: he kidnaps his patient by pretending to be a chauffeur.
Arriving at the hospital, House convinces Evan to let him run one test on him — a test of his visual fields to look for blind spots. House informs him that the test showed upper right quadrant blind spot and that he’ll need an MRI. Foreman picks this moment to show up and point out that House is lying and the test is normal. Frustrated, Greer leaves the room; House pauses a minute to grab something from Pyxis, then follows Greer onto the elevator. While having a conversation with Wilson, House reaches over and injects Greer with a sedative, knocking him out, so that the MRI can be performed. Surprisingly (to House at least), the MRI is normal and shows no tumor. Greer wakes up at the end of the test and is furious. He storms off to find Cuddy to complain when his right foot suddenly goes completely numb and he finds himself unable to walk. He is admitted to the hospital — officially, this time.
At this point the differential diagnosis consists of vitamin deficiency or a toxic exposure. Cameron suggests that Greer may have injured a nerve in his foot when he fell after House knocked him out and suggests an EMG. House order Kutner to pretend to perform the EMG (Electromyogram — a test that checks the conductivity of muscles and nerves), but Kutner decides to go ahead and runs the test for real. Meanwhile, House has the rest of the team watching old episodes of the soap opera for subtle diagnostic clues. Taub and Foreman think that there might be some slight neurological symptoms and suggest myxedema or demyelination. The EMG is negative, and Kutner adds atherosclerosis (hardening of the arteries) to the possible diagnoses.
House checks out Greer’s dressing room and talks to his female costar. He learns that even though Greer’s character likes his gin and tonics, Greer himself does not drink — in fact, he’s kind of a health nut. Housee also learns enough to suspect that Greer may be suffering from erectile dysfunction. House suggests that Greer has B6 toxicity and the resultant autonomic dysregulation from eating too many sunflower seeds. The team decides to test whether the impotence is physical or psychological by testing heart rate, blood pressure, and tumescence after giving Greer some pornography. He is able to have an erection, but he also develops a dangerously rapid heart rate that requires defibrillation.
The differential now includes sepsis, paraneoplastic syndrome, and Graves Disease (an autoimmune disease which leads to too much thyroid hormone), with the latter being the most likely. House wants to “nuke” Greer’s thyroid to stop the Graves, but the rest of the team actually wants to test for Graves first by performing a radioactive iodine uptake test. The test shows that his thyroid is normal, but that he is starting to develop kidney failure. Autoimmune diseases are now added to the differential. A short time later, House is talking to Greer and he finds him repeating old lines from the show and discovers that he actually believes himself to be his soap opera character. He is also running an extremely high temperature and has slipped into delirium.
The team now suspects that Greer is septic, in other words he has an overwhelming infection. They are just not sure what infection it is. Pneumococcus, Tetanus, Lyme Disease are suggested, as are fungal infections. House also mentions rat bite fever and listeria. Greer is started on broad spectrum antibiotics, but is not improving.
While helping Wilson shop for a bed, House had an epiphany. Greer is not septic, instead he a rare type of allergic reaction known as allergic vasculitis and he is allergic to the chrysanthemums in his dressing room. House wants to start him on high dose steroids, but Foreman points out that high dose steroids would kill him if her were septic. Cuddy eventually steps in and allows House to start the steroids, but runs some confirmatory allergy tests. After these tests are complete she informs House of the results — negative: Greer has no floral allergies. They return to the patient’s room ready to restart the antibiotics only to find that Greer has greatly improved; the steroids worked. Later, House realized that Greer is allergic to quinine, the chemical in the tonic water his soap opera character drinks.
I can understand why House thought Greer had a brain tumor — that makes at least a little sense (though I think a frontal lobe tumor would fit the suspected symptoms better than an occipital lobe tumor). The rest of the medicine in tonight’s episode barely made sense, and the team basically haphazardly stumbled from one unsupported diagnosis to another to another. Here’s what caught my eye tonight:
The final solution of allergic vasculitis doesn’t really fit the case well. The symptoms Greer had are rarely, if ever, seen in allergic vasculitis and he was missing the common symptoms such as the distinctive rash. I would also like to point out that the team dismissed an autoimmune cause because he had a fever, but no one batted an eye at a fever being caused by allergic vasculitis — another type of overly aggressive immune response (in truth, both autoimmune diseases and allergic vasculitis can cause fever. Just give me a little consistency in logic, please). And why was House convinced that chrysanthemums were the cause — where did that come from? On a daily basis, people are exposed to hundreds if not thousands of allergens, it could have been any of them.
B6 toxicity doesn’t match his symptoms either. It can cause nerve toxicity, but not like Greer had. Sunflower seeds do contain a large amount of B6, but he would have to eat a hell of a lot of them to develop toxicity. An ounce of sunflower seeds contains 0.23mg B6. Toxic doses start around 500mg/day, or over 2000 ounces of seeds per day.
Giving someone porn and then watching them to see if they get an erection is not the way to differentiate physical from psychological causes. That situation is enough to cause psychological impotence in anyone.
Graves disease is an autoimmune disease. An ANA is not the definitive test for autoimmune — there really isn’t any one single test. ESR (”sed rate”) is probably one of the most common, but if the team had run that, they would have figured out the vasculitis much sooner.
100mg of IV methylprednisolone (”Solu-Medrol”) is not that uncommon a dose. When high doses are needed, it’s generally an emergency (acute asthma attack, for instance) and having to wait for Cuddy to sign off on it is a delay in treatment and a lawsuit waiting to happen. And you’d think the pharmacist would learn to lock his door by now.
Ampicillin is not an appropriate drug for sepsis, particularly sepsis of an unknown cause.
Accreditation inspections involve a team of inspectors, not just one, and are not usually carried out on an annual basis unless there is a known problem.
I give the medical mystery a B+ because it was a clever idea: House deducing something is wrong just by watching an actor on television. Unfortunately, neither the final solution nor the medicine leading up to it were all that good; I give them both a C-. The soap opera was fairly average. There were a couple brief glimmers of cleverness, but nothing really memorable, so it deserves no more than a C.
May 5th, 2008 at 11:19 pm
Now I know exactly how much of a Soap Opera nerd House is….
May 5th, 2008 at 11:24 pm
I’m not so fond of House being that big of a soap nut. It just doesn’t go well, I don’t think. This episode also kind of sucked. Hopefully next week’s will be better.
On the upside, Hugh Laurie is going to be on Craig Ferguson tonight!
May 5th, 2008 at 11:36 pm
What a disappointing episode. I really hope the next episode will pick it up.
May 5th, 2008 at 11:51 pm
I am still watching this episode, so I haven’t read your writeup yet, but I just have to say that seeing “tumescence monitor 1″ in the sleep lab was pretty funny. I love the implication that there are additional tumescence monitors in the hospital.
May 6th, 2008 at 12:12 am
I didn’t much care for the medical mystery, though as a layman I’m in no position to criticize the medicine itself. And House being THAT much of a soap opera fan is a bit grating.
That being said, I couldn’t help but pay attention to Wilson’s soap opera this week. I previously commented on House/CTB/Wilson seeming to be some sort of warped Dom/Domme/sub relationship, and tonight I saw more Domme/sub interaction between CTB and Wilson. It’s interesting to see Wilson – a sub dominated by passive-aggression for (apparently) years by everyone around him – have the jarring experience of a direct order. It makes me wonder if someone on the writing staff is a fan of D/s.
It was also nice to see CTB not trying to out-House House, for once. If this keeps up, I might actually find the character tolerable (if still one-dimensional).
May 6th, 2008 at 4:31 am
Well, House had originally said that the patient had peripheral vision loss, which would point to a tumor in the optic chiasm. However, when he runs the vision test, he ends up changing that to upper right quadrantanopsia, which, though not in line with the original symptoms (and also a lie), would indicate a tumor in the occipital lobe, presumably pressing against the optic radiation of the left hemisphere. This would be a huge tumor, though…
May 6th, 2008 at 5:15 am
I just loved the shot with House holding the Emmy. I found that hysterical.
May 6th, 2008 at 6:08 am
Can one actually be allergic to quinine? It’s a relatively simple alkaloid, can it really trigger an IgE reaction?
May 6th, 2008 at 6:29 am
My big issue is that if it really was an allergy, wouldn’t he have gotten better the longer he stayed in the hospital, not worse? I don’t remember seeing any shots of him drinking (or asking for) tonic water once he was in the hospital, so his allergic reaction would have lessened the longer he went without the allergen.
May 6th, 2008 at 7:31 am
It is possible to be allergic to quinine.
Personally I thought it was a great episode, especially considering some of the content this season.
I like that House had the humility to admit that they should have stopped him.
May 6th, 2008 at 10:27 am
I am so unhappy with House lately. He is more and more out of control. I do like that his team is pushing back harder than the old team did. I like Kuttner more every week. Yay Kal Penn.
There was also this whole depression/sadness/affect issue that was raised/dropped/raised/dropped and ended up unrelated to the diagnosis. Irritating.
The only compelling part of the show was Wilson/Amber.
May 6th, 2008 at 10:48 am
Anyone remember the accreditation quote from Cuddy? My hospital is going through CCHSA at the end of this month and I’d love to pull that one out…
Something like “and try to pretend it’s not a huge pain in the ass…”
May 6th, 2008 at 11:20 am
It makes sense that House enjoys his soap opera. He is doing mental gymnastics, on a regular basis. Watching a soap, is the mental equivalent of popping BubbleWrap. It seems logical that he would watch a soap.
I have to agree, that this episode wasn’t exactly top drawer.
May 6th, 2008 at 11:30 am
I have stopped watching House a while ago, but still stop by your blog for the medical analysis. Guess we know where the writers got their idea from
http://www.nytimes.com/2008/04/13/magazine/13wwln-diagnosis-t.html?pagewanted=print
May 6th, 2008 at 11:38 am
just a thought… could it be possible that the hospital has annual inspections because of House?
May 6th, 2008 at 12:00 pm
One of the interesting quirks in this episode is that House was wrong about virtually everything. He correctly diagnosed that there was a problem with the actor, but from that point on every theory he had–about the medicine and about Amber–was completely wrong. That’s relatively unheard of in this show, but even more bizarre was the fact that nobody really commented on this: his overwhelming wrongness was virtually ignored. In the third season they made “House screwing up” into a multi-week story arc, but now nobody notices.
May 6th, 2008 at 1:58 pm
As I recall, I don’t think they were trying to differentiate physical and psychological causes for ED with the porn test, they were just trying to see whether or not he could get an erection at all. I’m not a doctor, so I’m not too sure what the difference is, but I think giving someone a porno is a good way to find that out.
May 6th, 2008 at 2:39 pm
I like how House stole the guy away. It was just the particular brand of crazy that House is. The fact that he has been trying to tell it to him trough the phone but was ignored and then deceided that he takes things into his own hands makes it better.
The show’s medical logic has been detoriating since the writer’s strike. Does anybody have any idea why? I mean two badly-written shows after eachother does seem suspicious. Either the Shore got a little lazy or the proffesional consultant left.
What I did like that House now did a bit more then just prence around in differentials.
May 6th, 2008 at 3:04 pm
I wish the medicine on this show was better–I try to get caught up in trying to solve the mystery, but keep getting distracted by the sloppy workups and diagnoses, and get miffed when solutions make no sense. It’s not even “dumbed down”–all of the jargon and tech is still there, but it’s not appreciably organized.
I really wish the writers would take the time to prepare better medical plot devices–it wouldn’t have taken much to turn this episode into a probable but nevertheless interesting case of cinchonism.
Seriously, they need to start attending CPCs.
May 6th, 2008 at 3:28 pm
I have a talent for correctly guessing the endings to movies and television shows (among my accomplishments: I correctly guessed the ending to The Sixth Sense halfway through). So, unsurprisingly, I deduced that the patient had an allergy in the first quarter of the episode. However, the writers were not as creative as I had hoped. I am not a doctor, so I do not know if this is possible, but I think a better ending would have been that the patient was allergic to the stuff that House sedates him with in the elevator. This would make House himself the cause of the disease he was looking for. Just my opinion.
May 6th, 2008 at 3:42 pm
Isn’t the test for Graves disease supposed to be for the anti-TSH-receptor antibodies? And plus, it’s an autoimmune disease leading to hyperthyroidism.. destroying his thyroid gland would do nothing. In fact, due to negative feedback from T4 and T3, his thyroid’s probably already shrunken..
May 6th, 2008 at 3:44 pm
House never seemed like the type to go out of his way to get a patient…and certainly not by kidnapping someone and sedating them to keep them from running away. That’s just creepy.
I like the show, but for some reason, the last 2 episodes have been worse than any others this season. His team has more personality than the last one, though.
May 6th, 2008 at 4:09 pm
JBob,
House really didn’t care about the actor himself getting sick; he was worried about about the character in the soap opera not continuing if the actor died
May 6th, 2008 at 5:15 pm
I thought this week was much better than last week’s. I could be biased because I have a real soft spot for the Cuddy/House relationship. Last weeks episode was abysmal, I thought Hugh Laurie even looked bored at some points although that could be my imagination because I was bored at those points. This show has been going for four or five years now, maybe that’s as much as anyone can hope for from a great show.
May 6th, 2008 at 5:42 pm
Wow! you type fast! As someone who’s just got a B.Sc. I love science and medecine and I looooove House!
I agree with what you said in the beginning about the superficiality and such.I do think that it has a lot to do with the strike however. It takes time to build up new characters and there was little time for a good story arc due to the interruption of the strike. The 2 parter looks like it will be good though and there is a time to start fresh next season- don’t give up yet!
In terms of the medecine the only main problem I saw was that the allergy of quinone was hastily found which was a one in a million shot really. Also, from taking microbiology I would agree that ampicillin would be inappropriate to use as well.
May 6th, 2008 at 5:52 pm
My unending question about House is–Cuddy is always saying he’s “the best doctor in this hospital” and he is apparently world-renowned for his savant abilities–why does he have to almost kill the patient every week before he figures it out (and always with the prop of some serendipitous event). I love the show, I think Hugh Laurie is brilliant–but I’d like it to be less cartoonish sometimes….
May 6th, 2008 at 6:30 pm
I guess that is what makes it dramatic and drags it out for an hour, am I the only one to comment first about Cameron pushing her chest in House’s face after his demand for some reajl knockers.
May 6th, 2008 at 6:49 pm
I guess that is what makes it dramatic and drags it out for an hour, am I the only one to comment first about Cameron pushing her chest in House’s face after his demand for some real knockers.after looking looking at thirteen’s , a very british joke i think. Anyone want to get into a debate why Hugh Laurie (a brit ) pulled this show off so magnificentlly in a country without irony.
May 6th, 2008 at 8:00 pm
Why did his allergy get worse in the hospital, when he wasn’t drinking the tonic water any more?
May 6th, 2008 at 9:22 pm
What bothered me most about this episode is that House thought it was an allergy to the chrysanthemums in his dressing room. House himself would have shot down any of the other staff members for suggesting that, as he would have quickly, and correctly, pointed out that since the patient was in the hospital, and not in his dressing room, he should not be getting worse. I didn’t see any flowers in his room when they showed it, so that should have been eliminated as a cause immediately.
As for House being the best doctor in the hospital, I think House himself put it best; “I am almost always eventually right.” Unfortunately, that also means almost killing every other patient he has under his care at some point in his or her treatment.
May 6th, 2008 at 9:44 pm
Will we ever learn Thirteen’s name? I mean, it was a kind of funny running gag at first, but it’s gone on way too long. As I remember someone saying, “Even Seven of Nine had a name!”
May 6th, 2008 at 9:56 pm
Having just had RAI ablation this morning (I “saved” this week’s House for when I’m on … well, house arrest) I could’ve seriously done without the dissertation on what a dumb thing it is to “kill one of your major glands.”
I’ve never heard of Grave’s being this IMMEDIATELY threatening without some other symptoms – seriously, did anyone ever consider putting their hand on his neck?
May 6th, 2008 at 11:05 pm
So was the vision “problem” actually a symptom? They included it in their differentials but Foreman said that Greer didn’t have any blind spots. Does anyone know what the deal was with that?
May 6th, 2008 at 11:32 pm
Official Comment
Allergic Vasculitis is a little different from traditional allergies in that damage has been done to certain blood vessels and this is what causes the symptoms not the classic short-lived histamine reaction of a regular allergic response. Because the damage has already been done, symptoms can continue for quite a while even after removal of the allergen. So Greer could still have symptoms even after he stopped drinking the quinine.
May 6th, 2008 at 11:35 pm
Official Comment
Sammy,
The eye symptoms were presumably caused by vasculitis (i.e. inflammation) of the arteries within the retina which would interfere with Greer’s vision — or else it was caused by inflammation of arteries within the visual cortex of the brain. Probably the latter, now that I think about it, because that would explain better (but still not particularly well) why only the peripheral vision was affected. I can’t explain why it was only intermittent though.
May 7th, 2008 at 1:11 am
Will you be updating the house challenge scores?
May 7th, 2008 at 5:17 am
“B6 toxicity doesn’t match his symptoms either.” – why not?
“Graves disease is an autoimmune disease. An ANA is not the definitive test for autoimmune — there really isn’t any one single test. ESR (”sed rate”) is probably one of the most common, but if the team had run that, they would have figured out the vasculitis much sooner.”
the whole thing doesn’t make sense… 1. ANA were proposed to rule out autoimmune disease, not Graves in House 2. ANA is more ‘definitive’ for autoimmune then ESR, ESR and CRP are additional… not specific 3. 1/3 of Graves patients are ANA positive 4. ESR wouldn’t help to rule out vasculitis…. the only thing i agree with – there really isn’t any one single test for autoimmune…
May 7th, 2008 at 5:37 am
I actually liked this episode, especially after some of the shows this season but then again maybe my expectations were low after last weeks show!
I admit the medical mystery was poor, which was a pity because the concept of House identifying an illness from seeing on tv then kidnapping him was good, so opportunity wasted there.
But there were some great lines in it…..”What do you want?” ” A signed autograph would be nice…oh and i’m going to save your life”…creepy! Hilarious! And thirteens dry wit ” I think I kissed that nurse…oh wait..no” and of course “sweet sauce” and…”the contract clearly stated no takie backies”
I think I liked it mostly because of theHouse/Cuddy, House/ Wilson and House/Cameron dynamics. The newer characters just don’t interact with him as well as the good old ones!
And then there was the funny echo between the soap and ‘House’ the show, did anyone else get that or was I just imagining it? House’s obsession with Brock echoing the fans (our) obsession with House. Foreman saying…” This isn’t a soap, people don’t just wake up out of a coma when you give them drugs” when things like that always happen on House!
Its probably because I’m not a doctor but the shoddy medicine doesn’t seem to bother me as much as long as there’s some good character interaction!
May 7th, 2008 at 5:52 am
The Inspector was a nice surprise. That guy is dangerous. The last time they let him practice medicine he took over people’s minds and help advance a plot to destroy Gotham. I find it hard to believe that a de-frocked pShrink would then score a job as an inspector of hospitals. That is unless he is still using his mind control gas and mask.
Seriously though, that actor has an interesting face and I hope he gets more work.
May 7th, 2008 at 7:59 am
Official Comment
B6 toxicity manifests as weakness and numbness of the peripheral nerves — similar to diabetic neuropathy — not as “autonomic dysregulation.”
I wasn’t saying that the ANA was used to rule out Graves, I was just lumping all my autoimmune complaints into one paragraph. On the show, ANA was used as a blanket test for “autoimmune diseases” and it isn’t effective for that. You are right that the ESR is a non-specific test, but I never said it was a better test, just a commonly ordered one; it seems to end up on every autoimmune lab panel. It would be elevated in a patient with vasculitis (and, admittedly, about a hundred other conditions), thus prompting a further work-up as to what caused the elevation which would have concluded with the team discovering vasculitis about two-thirds of the way into the show.
May 7th, 2008 at 1:05 pm
I honestly thought the actor was going to be allergic to sunflower seeds, so I was proud that they at least didn’t make it THAT obvious.
I’m so glad to be ignorant of all these medical things, i know my frustration would be endless.
That said – I expected Wilson to do his random “show up” while cancer was being discussed, and I’m so glad they’ve decided to stop doing that – I don’t think Wilson would just show up unless they knew, for sure, it was cancer.
May 7th, 2008 at 1:45 pm
FalsusLupus, I think you may be confusing Rob Benedict (the inpector) with Cillian Murphy. They look similar. However, Rob Benedict was in the short-lived CBS show “Threshold” about aliens mutating human DNA. Maybe the aliens got ahold the House writers this season; that’s why the quality has lapsed. Cilian Murphy would make a SCARY inspector.
May 7th, 2008 at 10:41 pm
A visual field test typically involves a dark screen on which tiny bright spots appear randomly. The patient clicks a button when s/he sees a spot. The computer keeps track of where the patient sees, or doesn’t see, the spots. A deficit in the visual field can be caused by many conditions. Glaucoma is a common suspect. Often a deficit is ideopathic, medspeak for “shrug.”
Hospitals get inspected whether House works there or not. The rule about not having anything less than 18″ from the ceiling is true, at least for medical research facilities. The idea is to prevent cartons etc. from blocking the sprinklers if they go on.
May 8th, 2008 at 1:28 am
The only part I really enjoyed was the Wilson/Amber + House subplot.
I hope the medical mysteries return in S5. And I really hope spends as little time with the patient as possible.
May 8th, 2008 at 6:16 pm
“I’m not so fond of House being that big of a soap nut. It just doesn’t go well, I don’t think.”
“And House being THAT much of a soap opera fan is a bit grating.”
lol that’s probably an oxymoron. You can’t criticize your favourite soap opera character of being a soap opera fan…! What does this make you?
May 8th, 2008 at 11:41 pm
WAP, thank you for setting me straight and even moreso for the gentlemanly manner, in which, you accomplished it. I’ve now viewed pictures of both actors and think that it’s a case of their being made to look alike in certain roles than any natural resemblance.
May 9th, 2008 at 9:28 am
Worst House episode. Ever.
May 9th, 2008 at 6:19 pm
Thirteen’s remark concerning the “once dated” nurse :
irony or a new look into this soap’s character ?
the last being the aim it would shed light on the Cameron-Thirteen balance, wouldn’t it ?
May 11th, 2008 at 1:04 am
It seems House’s season finale is yet another near death experience for House.
May 11th, 2008 at 10:09 pm
Recently episodes seem to be going downhill :-/
I hope it will get better again soon :)
May 12th, 2008 at 1:09 am
Non-doctor question: What’s up with the photocopier that dispenses syringes that House uses pre-drugging Evan? (And yes, I get that it’s not a photocopier). Is that sort of drug-safe? Seemed like a cool thing they’ve never shown before.
May 12th, 2008 at 9:05 am
[quote]Accreditation inspections involve a team of inspectors, not just one, and are not usually carried out on an annual basis unless there is a known problem.[/quote]
And, just who is the head of diagnostic medicine at PPTH? It’s a wonder they don’t have an accreditor on hand at all times.
May 12th, 2008 at 4:38 pm
TH, that cabinet is “Pyxis”, and Scott provided a link to an online brochure for it in his review (middle of the second paragraph after the spoiler warning).
May 13th, 2008 at 9:06 am
Re: Brian (and previous comments)
While that would resolve the issue, I would GUESS that if the annual inspections were due to House, the inspector would have spent most of his time observing and checking up on House, whereas he didn’t seem to do so very much at all. He would at least know who House was, I would think. I’m pretty sure the inspector in this episode was not particularly familiar with House.
May 13th, 2008 at 9:06 am
Re: Gary
Ah, thanks. I didn’t notice that. Cool gadget. Must be new.
May 13th, 2008 at 7:13 pm
I’m amazed NO ONE has alluded to the most intriguing minor aspect to the show.
When House was “trying” to get Cameron back to his service, he was first wiling to boot 13, then even offered Kuttner as an alternative. Why on earth would he want Taub over the other two? I can’t think of a point where Taub has “saved” the day (I fault the writers), and its been Kuttner and 13 that has provided the few “Hail Mary” saves of the patients.
May 15th, 2008 at 12:15 pm
I would’ve thought House is a known problem. And if he wasn’t before, he sure as sh** should be now
May 15th, 2008 at 6:23 pm
I thought this episode had a lot more funny lines than other recent episodes. I did wonder, though, when Cameron started being smarter than everyone else. And why has Chase suddenly become mean in the last couple episodes? Did I miss a plot twist?
I think they should take Cameron and Chase out of the main credits if they’re not going to appear in every episode as main characters.
May 20th, 2008 at 8:39 am
“Accreditation inspections involve a team of inspectors, not just one, and are not usually carried out on an annual basis unless there is a known problem.”
Beaten, but seconding the notion that House counts as “a known problem.”
“Seriously, they need to start attending CPCs.”
Or fire their technical consultant and hire Scott! But then we wouldn’t get these great reviews . . .
[the final diagnosis]
Makes me glad I take my gin in Martinis. OH GOD WHAT IF I BECOME ALLERGIC TO OLIVES?
Wait, I’ll just have Manhattans instead. (For the non-drinkers/people who think a Martini has vodka in it, they’re both a glass of straight hooch. The small round fruit makes it sophisticated.)
May 22nd, 2008 at 1:20 pm
Does anyone else feel that instead of “We’re all in planes”, it would’ve been better, or at least more constant with earlier episodes, for House to say “We’re all in a room”?
(The episode where the girl was raped)
May 22nd, 2008 at 1:36 pm
By the by, I think House thought that the chrysanthemums were the cause because
a) the initial symptoms were intermitent and occured when the patient was on set
and b) floral allergies are more common than an allergic reaction to quinine (I think?)
so, yes no maybe?
June 20th, 2008 at 4:26 am
I really hope that this episode was some kind of in-joke for the production crew. Otherwise, I stake an early claim that this is the point where a truly great show finally Jumped the Shark, knowingly – and with a parting wink to the audience.
June 28th, 2008 at 1:56 pm
This is the worst episode of House m.d. House was happy even nearly euphoric. Where is the misanthropic House m.d. the season 4 was very disappointing in terms of both medicine (as this blog revealing) and soap opera (Foreman is nonfunctional and no need to mention about Chase and Cameron)
September 30th, 2008 at 7:01 am
“Accreditation inspections involve a team of inspectors, not just one, and are not usually carried out on an annual basis unless there is a known problem.”
Are you saying that having House on staff isn’t a known problem?
October 2nd, 2008 at 3:01 pm
Cuddy saying that 100 MG of Solumedrol is an “overdose” was completly ridiculous….Not even close to the truth.
Scott, I know you said that 100 mg is common, but I have had 1000 mg of IV Solumedrol for 3 days in a row.
(Yes, I said one thousand X3 days=3000)
I can’t recall the episode, but they also did the same thing regarding Valproic Acid and it being “lethal”….
October 24th, 2008 at 3:39 pm
Quinine causes maculopathy, so reduced VA could cause the reduced reading rate.
December 11th, 2008 at 5:51 am
“It seems House’s season finale is yet another near death experience for House.”
THANKS FOR THE SPOILERS!
Agh…
April 6th, 2010 at 1:24 am
According to the package insert of methylprednisolone for injection, recommended “high dose” therapy (for life-threatening situations) is 30 mg PER KILOGRAM over 30 minutes. For a 150lb (68kg) person, that’s over 2 grams. Sure, over a 3 minute period (the time he asks Cuddy to wait until she calls security) it’s a mere 200mg, but that’s twice what was called an “overdose.”
But hey, I consider the medicine in House to be like the science in science fiction. I still love watching the show. :)
April 23rd, 2010 at 12:16 am
@wkmaier : That would be odd, as an avid soap watcher* such as House should know that soaps will replace a character if an actor dies.
*As established back in Season 1 or 2, House loves his mindless TV.
June 4th, 2010 at 4:03 pm
Watched the rerun of this ep for the first time and, with the benefit of hindsight, I think it’s actually a sly commentary on Kal Penn. It’s also wonderful satire.
I have no medical knowledge at all but–after the first ten minutes–felt confident the diagnostic stuff would be goofy. When the POTW bitches about how ludicrous his soap opera is, House says something like, “Right, unlike TV shows that are completely true to life, like … hm, can’t think of any.” In this context, having the “House” actors run around spewing medical nonsense actually makes sense. (Yeah, I know my argument would be more persuasive if the writers didn’t fudge the medicine as often as Scott says they do … but at least here they have a clever excuse.)
Back to Kal Penn. At this point, the producers knew he was quitting the show to work for the Obama administration. So they come up with an episode where an actor playing a doctor on a medical soap longs to do something more meaningful and “real.” And the first person he discusses these longings with is Kal Penn’s character, Kutner. Penn must have been the writers’ creative jumping-off point for this episode.
Also, the reason behind House’s uncharacteristic wrongness was sophisticated in a literary (if not medical) way. The POTW — a “fake” doctor–is abusing “fake” alcohol that causes a “real” allergic reaction. But House, the character, is an addict in the reality of the show. There’s something deliciously through-the-looking-glass about House missing a symptom–and stumbling professionally–because of the fake doctor’s make-believe substance abuse. I dunno … am I giving the dumb writers too much credit here? :)
October 8th, 2010 at 5:34 pm
“Tonic water is loaded with quinine” Cuddy dixit.
Yeah, um… That’s only if you’re used to drinking from the bottles that your great-grandma forgot in the attic from her days as a registered nurse in the British Empire.
Nowadays, only trace amounts of quinine can be found in tonic water – and the FDA limits its use to 83 ppm.
That being said, nice episode anyway.
Leave a Reply
Contact Me
About
Subscribe:
The Best Of...
Special Topics
Archives
Categories
Twitter
See Also
Comic Blogs
Medical/Science Blogs
Currently Reading
Arbitrarily Interesting Medical Condition
Syndrome
The Net:
Contents may have settled during shipping. Past results are no guarantee of future performance. No animals were harmed during the production of this product. Void where prohibited by law. All rights reserved. Not valid with other offers or specials. Professional driver on a closed track. Your financial institution may impose other fees. All models are over 18 years of age. Employees must wash hands before returning to work. Results not typical. Many suitcases look alike. 18% gratuity added to tables of six or more.
Do not taunt Happy Fun Ball.
© 2004-2012 Polite Dissent. Powered by WordPress