House – Episode 16 (Season Four): “Wilson’s Heart” (Season Finale)
The season finale of season four of House. The medical aspect remained spotty, but this was primarily a character episode, so how much you liked it is probably determined a great deal by your personal tolerance for schmaltz.
House and Wilson find Amber across town, admitted at another hospital. She is in bad shape after the bus accident. She completely damaged both kidneys in the accident and needs dialysis. She also has an elevated heart rate. Despite this, House feels that she would be better served at Princeton Plainsboro Hospital and convinces Wilson to pretend he’s Amber’s husband so that he can get her transferred. On the ambulance ride, Amber slips into ventricular fibrillation. House prepares to defibrillate her, but Wilson stops him, feeling the chemicals released by the heart after the defibrillation will cause brain damage. Instead, he convinces House to put Amber on a heart-lung bypass machine in “protective hypothermia” to buy time so that he can figure out how to save Amber.
The initial differential diagnosis for Amber’s condition is an autoimmune disorder, a congenital heart defect, blood clotting disorder, and lead toxicity. House orders an angiogram, and orders Kutner and Thirteen to search Amber’s apartment. Taub decides to order a drug screen. House has a hallucination about Amber puring him some sherry (which Kutner interprets to mean Sherrie’s Bar); he also considers deep brain stimulation to recover his missing memory of the night in question. These ideas are dropped for now, but surface again later.
Both the angiogram and drug screen are negative. Searching Amber’s apartment, the team turned up some prescription diet pills. They conjecture that these might have injured Amber’s mitral valve, leading to her heart problem. Because her heart is stopped, they can’t check a CT scan, so instead House wants the team to crack open her chest and stick a finger in the pulmonary artery to check the valve.
As Chase is setting up the surgery, he notices that her eyes are icteric (jaundiced), a sign that she now has liver failure. Antitrypsin deficiency is suggested as a possible cause and a liver biopsy is ordered. Wilson feels that since the condition is progressing, Amber needs to be cooled further. Reluctantly, House agrees.
House and Wilson talk to the bartender at Sherrie’s and learn that Amber was sneezing. House considers a parasitic infection at first (it’s quite a stretch, but not as bad as the “cancer” diagnosis for an itchy nose last week), then decides the most likely cause of Amber’s symptoms is Hepatitis B. The liver biopsy seems to agree with this diagnosis and she is started on interferon. House heads home to try to catch up on sleep and has a dream about Amber and the small of her back. He returns to the hospital, and sure enough, she has a fine red rash on her lower back (so much for a good physical exam on admission). The possible causes of the rash the team considers are influenza, dermatomyositis, an allergic reaction, abscess, or Rocky Mountain Spotted Fever. This last one seems the most likely, so House and Foreman want to start her on doxycycline to treat the infection and then warm her up and restart her heart. Wilson wants to wait for confirmatory cultures first, but this will take much longer. House agrees with Foreman, but Wilson managed to guilt him into waiting for the cultures. Foreman goes to Cuddy, and she agrees that Amber needs her heart restarted sooner rather than later. Wilson walks in while they are rewarming her and freaks out. He notes that her brain waves show slowing so her condition must have spread to the brain and he blames Foreman and Cuddy.
With heart, lung, liver, and brain involvement, an autoimmune disease is the most likely cause. House plans to start Prednisone. Wilson reluctantly agrees, but wants House to undergo deep brain stimulation first, so that he can remember more of what happened the night of the bus crash. Undergoing the procedure, House recalls Amber sneezing several times and complaining about having the flu. He then notices her taking several pills. He determines that she has been taking Amantadine for the flu, and because her kidneys have been severely damaged, the drug has not been cleared and has built up to toxic levels, causing the other symptoms. Unfortunately, dialysis doesn’t work on Amantadine and the toxicity is irreversible — meaning that Amber is going to die. House passes on the sad news to Wilson just before he suffers a massive seizure from the brain stimulation. Wilson wants Amber to pass away without ever waking up, but Cuddy convinces him to wake her up so that they can spend a last few minutes together. He acquiesces.
Meanwhile, House is in a coma. The seizure reopened his skull fracture causing a bleed on his brain. He has a dream/hallucination featuring the now dead Amber, but then slowly returns to consciousness. As the season ends, House wonders if Wilson will ever forgive him for his part in Amber’s death.
The medicine was, like recent episodes, sloppy — but it didn’t seem as haphazard as the last few weeks, probably because they focused on just 3 or 4 diagnoses over the course of the episode.
The writers are correct in that Amantadine is poorly cleared by dialysis, and there have been deaths reported on the medication. The dose for the flu is 100MG twice a day. The only size pill Amantadine comes in is 100MG, so Amber taking two means that she was overdosing herself on it, so she bears some of the blame for this.
What happened to Amber ventricular fibrillation? Did she really remain in v-fib all the way to the hospital until she was cooled? That’s unlikely. Plus, the longer she remains in v-fib, the longer the nasty chemicals Wilson was worried about will build up. Defibrillating early is still the best shot.
Heart-lung bypass and “protective hypothermia” don’t work like that. They’re designed for short-term use, like surgeries. They are rarely used longer, for transplant patients for example, but you don’t keep cranking down the temperature.
The mitral valve is not in the pulmonary vein; it’s in between the left atrium and ventricle. Unless House is suggesting sticking a finger through the pulmonary vein, and then into the heart itself to reach the mitral valve. That’s a disaster waiting to happen. And how is sticking a finger in a major vein a good idea? How are you going to get the finger in there without cutting a big hole in it?
“Diet pills don’t cause jaundice,” that may be true, but blunt trauma does cause liver damage -– like from, I don’t know, a bus accident that destroyed both of her kidneys.
Even if deep brain stimulation could restore memory (and I see no indication in the medical literature that it can), there would be no way to target a specific memory. It’s also performed under general anesthesia (the patient is asleep) [UPDATE - Not necessarily; see the comments], and the results are not instantaneous.
That wasn’t a complex partial seizure House suffered, that was a gran mal (tonic clonic) seizure.
The medical mystery was good, and the ultimate solution clever (and mostly correct), if depressing, so both earn an A-. The actual medicine was — discounting the heart lung bypass/hypothermia — above average, but that bypass and hypothermia dragged it back down to an average C. The soap opera was powerful, if a little overwrought in the end for my taste, but still earns a strong A-.
May 20th, 2008 at 12:02 am
That stuff was sad.
I wept, I’m not ashamed.
May 20th, 2008 at 12:06 am
Great acting by Amber and especially Wilson.
May 20th, 2008 at 12:07 am
Once again we see the return of Chase, the Jack of All Trades. If he’s not hypnotizing you, he’s shocking your brain, or any other of countless surgeries he qualified to perform. That man must have been in medical school for decades.
May 20th, 2008 at 12:11 am
Great, informative review as always, Dr. Scott. But “schmaltz”? I cried! (OK, so I like schmaltz.)
Pretty amazing to see the normally calm, highly competent Dr. Wilson turn into a basket case right in front of us. Thirteen was right – Amber shouldn’t have been treated at Plainsboro by people who were emotionally invested in her. (And how sad to find out that Thirteen does have Huntington’s Disease.)
The “near-death” experience/hallucination seemed a little too reminiscent of “Three Stories,” but that was a terrific scene between Hugh Laurie and Anne Dudek. I never liked her character, but I was sad to see her go – not unlike Thirteen’s reaction.
May 20th, 2008 at 12:12 am
Robert Sean Leonard comes strong as always but so powerful in the spotlight tonight. Very well done and great way to close up this season.
May 20th, 2008 at 12:15 am
So there’s nothing else to be done for a (reasonably mild, surely) overdose of Amantadine? Nothing? Not even a transfusion? Sounds like a rather dangerous drug. Based on House’s comments, I assume it binds to albumin in the plasma, so surely transfusion would get rid of it. Any comments from some MDs? (I’m only a lowly biochemist myself….)
May 20th, 2008 at 12:16 am
Ah, the episode that made men cry. ;)
I did. Only because I LIKED Amber and what her character brought to the show. I still can’t stand Kutner or the other guy…they bore me to tears.
Figures that once they figure out the formula for success the writers nuke it (imagine had she lived and the trouble she could’ve caused for House and Wilson…because you KNOW House wanted her!). Happens all the time.
I stopped watching the show when she left and started again when she was really “back”. I dunno what I’ll do now. :\
May 20th, 2008 at 12:20 am
I cried. A lot. I’m not ashamed to admit that.
I really didn’t like Amber’s character too much, but just seeing her as a person who I’ve watched and learned more about over the past episodes, it just made me really sad.
I’m also really sad for 13’s Huntington’s. I was really hoping for her to be negative for that (just so that we could have some type of hope).
May 20th, 2008 at 12:28 am
Official Comment
Chris,
That’s a good point, exchange transfusion seems like it would be a reasonable approach.
When you have zero kidney function, a surprising number of drugs become toxic — but you’re right, the amount in her blood shouldn’t have been that high. For normal kidney function, Amantadine has half life of abut 24 hours, so even double dosing the medication, she shouldn’t have had more than a few hundred milligram in her system.
May 20th, 2008 at 12:34 am
Thanks for the review Scott, as usual I couldn’t go to bed until I read it. Quick medical question though (feel free to point me elsewhere if it’s easier). What chemicals build up after the heart stops and why?
May 20th, 2008 at 12:38 am
I thought that the medicine was horrible this week.
Hypothermia has been shown to protect neurological function after cardiac arrest, so it was a good suggestion. However, the protocol is usually only be instituted after return of spontaneous circulation. Thus, Amber should have been resuscitated in the ambulance, not cooled while she was in V-fib. In this protocol, cardiopulmonary bypass would not be used.
You could use bypass + hypothermia if Amber’s V-fib was not responsive to defibrillation and epipinephrine, but ACLS should have been administered first.
I find it hard to believe that a critically injured patient without spontaneous circulation and with co-existing kidney and liver dysfunction would simply be able to be “woken up,” let alone be as lucid as Amber was (I didn’t hear mention of it, but Amber was likely comatose, especially if no life support was provided in the ambulance after cardiac arrest).
I think the bottom line is that the medical consultants for this show simply don’t understand bypass very well (I recall the final episode of season 3 where they used CPB in the place of traditional resuscitation).
May 20th, 2008 at 12:38 am
Half the cast leaves this season in clinical deppression, death, a coma or incurable disease.
And lets no forget the greatest medical deus ex machina item of all time, the brain reading machine.
The last two episodes nothing has been proven medically, just by doing some suicidal memory reading technique, typically one performed by chase for some reason.
May 20th, 2008 at 1:10 am
I cried too.. I thought the character moments this episode were particularly powerful…
I’m wondering if we get to see more of 13… If House was able to convince her to stay and try and miraculously cure her with some experimental drug. Just a hope… =p
But the door’s open for 13 and Wilson to leave.. But House without Wilson seems a bit too much of a stretch… Their friendship’s been tested before (with the cop). Now it’s stretched to breaking point, particularly since Amber’s probably the first woman that Wilson really loved till one died (well, you can argue that they haven’t been together long enough for cracks in the relationship to show). But then again, it would seem that House is the main cause for all of Wilson’s broken marriages, so yeah…
Great way to end the season with a cliffhanger. Acting was good, though the medicine seemed unbelievable even for a non-medical person.
May 20th, 2008 at 1:14 am
A transfusion may have been a nice approach, but with so many of her organs shot would she have had much of a shot? It seems as if that would have been useless in the end.
May 20th, 2008 at 1:19 am
Scott, just curious, is it possible to be on bypass like that and be that alert and oriented? If at all? (forgetting the obvious that she appeared to be in a coma and on a respirator at the beginning for over 24 hours suggesting moderate-severe brain damage)
May 20th, 2008 at 1:20 am
A bit too melodramatic for me too
Was that a shamelessly blatent political endorsement during the bathroom scene between 13 and GH? (”Vote for Change 08″ or something to that effect)
Thanks for the reviews Scott – I’m almost as addicted to them as the show itself
May 20th, 2008 at 1:35 am
As far as the drama, I would hope Wilson would forgive House for what happened, considering he did what appeared to be everything he could think of to try to save her. Dare I say we saw actual compassion for other people?
May 20th, 2008 at 1:37 am
I agree – they must pay Chase a fortune to work there, when he’s apparently the best trained surgeon in the world.
I thought that the House memory-shock thing was a bit too much “magic.” I mean really, couldn’t House have just slowly recovered his memory on his own without it and reached the same conclusion?
Very sad and good episode though, even though I pretty much hated CTB all season I was kinda sad to see her die.
May 20th, 2008 at 1:45 am
I think Chase is secretly the Aussie Batman. Something Ranger? While they haven’t shown him cruising the night skyscape striking fear into criminals, they haven’t NOT shown him doing so…
May 20th, 2008 at 1:45 am
That should be “shown him NOT doing so…”
May 20th, 2008 at 1:48 am
Another one for the weeping team here :)
It was a powerful episode, very emotional. I really liked it when House met Amber in the bus after she died and admitted he doesn’t want to go back to the pain and be miserable – it made the haracter a bit more human.
I find it a bit annoying that when Amber was awakened she didn’t have icter in the eyes – I would have thought it should have been more pronounced than when they found it before the surgery attempt.
May 20th, 2008 at 1:55 am
It was great to see Chase doing all that stuff. Clearly he has learned the most of all the ducklings : )
They should have killed the whole “new team” in that bus accident and kept Amber for Wilson. Then everybody would be happy now.
May 20th, 2008 at 2:08 am
I sobbed for like ten minutes, and I kept telling myself that she wasn’t dying, that they wouldn’t kill the most interesting character of all time.
And couldn’t they at least wear masks while performing brain surgery?
May 20th, 2008 at 2:11 am
Well, that’s the season done. All in all, I think it had more enjoyable moments than the third, but I think the writing team really dropped the ball.
To be fair, they couldn’t have done it, but the original team should have been removed from the series. As is, their hanging around just seemed… artificial. I suppose it wasn’t possible with contractual obligations and all, but it’s pretty clear the writers had no clue what to do with them.
Chase the super-surgeon really stretched credibility… sheesh guys, pony up the money for an extra to play the part! Foreman just comes off as the incredulous guy, always surprised and skeptical of House’s latest off-the-wall suggestions. Cameron… well, she didn’t seem to do much at all except pine for House at odd moments. All three of these actors deserve better roles than this.
I actually do like the new team, though, there’s definitely a different dynamic with them. And I was warming up to Amber, it was very sad to see her go, but what a magnificent performance by Robert Sean Leonard, who’s talents are rarely seen but always appreciated.
The medicine, though, seems to still be taking a back seat to the drama, which is unfortunate. I’m guessing, based on Hugh’s tolerance, that the fifth season will be the last. Let’s hope it goes out on more accurate notes.
May 20th, 2008 at 2:50 am
yeah for Chase. Can’t help it he will always be the best of the ducklings. As House put it himself: “You have learned all that I can teach you!” And as Jesse Spencer so cleverly put it: “We’re Super-Docs now”.
Next season will surely have more Chase screentime. Because they already made clear that House goes to Chase if Wilson doesn’t want him around. So now they can go bowling – go drinking – and do all that other fun stuff together.
To bad they had to kill someone to get House and Chase back together
May 20th, 2008 at 4:15 am
According to your link to the info on Amantadine, the adult daily dosage for the flu is 200 mg; two 100 mg tablets as a single daily dose.
Your assumption that she is overdosing by taking two pills at once is incorrect.
May 20th, 2008 at 5:00 am
The truth is, the tragedy is House’s, not Wilson’s. Wilson and Amber didn’t belong together. The best he could hope for was ex-wife number three, and I don’t think he really needs more alimony payments. It may take him years to understand that. They certainly didn’t understand each other (which the bed buying scene was indicative of), and if you choose to believe that the neediness/enabling part of their relationship was a problem, you would not be wrong.
House was only slowly realizing what he had (and I probably caught Wilson’s prescient comment in 407 – Ugly before anyone else. “If they’re qualified, keep them. If not, fire them, and ask them out.” House thought he was talking about Terzy, but he wasn’t.). Likely due to the strike, things came to a head (sorry) in House’s Head, and were explored a bit more in the finale. Maybe I’m being more romantic than the writers intended, but House’s realization came the moment before Amber got hit by the car on the bus. He saw everything in one terrible instant.
Wilson ruled out the possibility of this being just physical attraction while giving House an MRI. House tried to pretend that’s all it was, but both realized it wasn’t. Given the whirlwind of brain damage and everything else that House has been through in the past day, he can be forgiven for not entirely grasping everything (and missing out on his chance to say goodbye). Why did it happen when it did? It sounds like a good question, and perhaps you can call it the moment of clarity. The truth is that the question is irrelevant. House and Amber are (were) who they are, and as such it is (was) only a matter of time. They both got each other and understood their games (witness their scenes together in Don’t Ever Change). Their compatibility would have been more obvious had we seen more of them together. Do they “need” each other? No, of course not. They don’t need anybody. But then again, maybe they do. What they do need is someone who understands them, and I’m not sure either had met anyone like that before. It would’ve been awesome watching seasons of them going out, even if hell would’ve frozen over so to speak with House having an actual girlfriend.
But of course, this would’ve torn House and Wilson apart, and then Wilson would never be on the show either, much like the original team now. But the situation isn’t actually different than it will be now. Wilson’s “mad at House” because he “killed” her (why aren’t we egging that drunk driver’s house?), but it should be House who is mad at Wilson. It was obvious that Wilson and Amber didn’t belong together from the beginning, and House said as much (as did Cuddy, and eventually me (once I caught up on Season 4 and realized who this CTB was)). But for whatever reason he continued going out with her, thus depriving House of the little time he would’ve had left with her. House and Wilson’s relationship would have repaired itself in the same way it will now. Through even years of torment and grief, Wilson will eventually realize that their (w/Amber) relationship was doomed, and that the messy breakup would’ve eventually produced a similar result (at least he should realize. With the awful relationships we’ve seen him in, he might be hopeless at his age). House doesn’t really have much to be mad at Wilson for, and he might find some consolation from him now. But House might have lost the one chance at a successful relationship he may ever have had. You can’t ever stop looking, because “the one” really is a thing of mythology. But I don’t know how you’re supposed to get over someone like her. For all I know, you never do.
I already see everyone talking about how emotional this episode was (with our own Dr. Scott giving the soap opera a higher grade than last week’s episode, which I consider one of the two or three best episodes they’ve yet produced), but I found this episode very anticlimactic. I already knew Amber was going to die. I hoped they’d find a way around it, but I once again wasn’t wrong (and no I didn’t get any spoilers from anyone. The thought process was quite simple. The new team is listed as “also starring” in the credits, while Anne Dudek was merely listed as a “guest star”. If she was going to be around as long as the other three, she wouldn’t be listed like that (it’s how the business works. The next time I see it work differently will be the first). Since she was obviously leaving at season’s end, she couldn’t just break up with Wilson and disappear. Her and House would’ve had to have gotten together at some point. So the writers chose the Sopranos route, which was sadly the only logical way to have her character leave.). While hoping for this episode to recapture last week’s magic was obviously futile, this one truthfully didn’t come close. It was like watching a nightmare play out to its inevitable conclusion. Maybe that’s just me because of my alleged vision, but I found practically no emotional content at all. Things didn’t have to be like this, but again they are. House will go on, but things will be different, even though it’ll pretty much be the same again. At some point, House is going to have to admit that he loved her, even if only to himself. It sounds preposterous with the pathetically short time they had together, but that doesn’t make it any less truthful.
May 20th, 2008 at 5:11 am
Now that four seasons of House are complete, it is time to look back. Scott, what do you think is the all time best episode of all four seasons?
May 20th, 2008 at 5:25 am
The House scene in the bus was the crux of not only the episode, but of every episode leading up to this point. The first time we’ve ever really seen the real House, and good God they did it well.
This is real character development. This isn’t Scrubs where every character learns a valuable lesson each episode and eventually these lessons mean nothing. This was a milestone event, and probably the most important episode of House, slightly moreso than Three Stories.
May 20th, 2008 at 5:36 am
I love that Chase is always ready and willing to drill someone’s head open. He’s learned well from House.
re: the Amantadine: Is it really plausible that a physician would be treating herself with it, much less OD’ing on it? I didn’t think it was that effective in the first place.
RIP, Amber, you will be missed. Maybe Wilson will hook up with Thirteen now.
May 20th, 2008 at 5:56 am
So will we see 13 next season?
May 20th, 2008 at 5:56 am
First off, thanks for some quick turnaround on these episodes!
Could someone please explain further the genetics of Huntington’s disease to me? (I’m a layman with no medical training) When I googled it, it said something about the it being a dominant gene on only one of a pair of chromosomes (the 4th pair). Does this mean that
A: if two HD-positive parents mate, the child has a 75% chance of having the gene, but if he does get it, will definitely have one HD gene and one non-HD gene?
or
B: If two HD-positive parents mate, the child has a 25% chance of not getting it, 50% chance of getting one HD gene and one non-HD gene, and 25% chance of getting two HD genes (meaning that his child will have 100% chance of having HD)?
or is it more complicated than that?
May 20th, 2008 at 6:20 am
As Michael suggested, wouldn’t the massive damage to most of her organs, enough to mean she’d never qualify for a heart transplant, really be reversable enough even if they COULD do dialysis and filter out the drug (or alternately, transfuse her)? I seem to recall several episodes past in which comments like “the damage to the [organ] is already done”… though I suppose there’s some damage that will heal and other damage that wouldn’t?
Other comments: Would House and Wilson REALLY be the only ones in the back of an ambulance with a critical patient? (you know… no paramedic or anything?)
They built a nice new giant white patient room for Amber. Was there any implication as to what the purpose of this new special room was, and why Amber was in it, and not some other normal room like most House patients?
May 20th, 2008 at 6:22 am
Er, that should read… WOULD the damage really be reversable;
May 20th, 2008 at 6:33 am
and PPPS, I felt like the climax of last weeks’ episode with the wonderful bus crash memory revelation was far more emotional and touching than anything in this week’s episode. Maybe it’s the fact that we’ve only known them as a couple for all of 4 episodes, and I believe they’ve only been dating since she was fired – so like… a few weeks in House-time? It felt a little like forced emotion.
I think that’s why last week was more meaningful; because we’ve seen her relationship with House evolve the whole season to what seemed (last week anyway) like respect and caring about her, only to have watch her ripped away from him in the crash scene. Contrastingly, the Cutthroat Bitch that we knew one week just showed up a few weeks later, all of a sudden being all lovey dovey and seemingly with no hint of being evil. Her feelings for Wilson seemed more like a writer’s bright idea than anything that made character sense, which might be why her scene with Wilson also felt meaningless; because the relationship never seemed to be based on anything other than a writer’s whim.
I don’t think they utilized Amber’s death scene with Wilson very well, in that no words exchanged between the two were at all poignant. It’s also possible that Laurie is a far better actor than Leonard, and that was the reason for last week’s scene being so much sadder.
And yes, I know this is a MEDICAL blog, but I thought I’d through some story critique in here just for some light reading.
May 20th, 2008 at 6:39 am
I didn’t get all weepy, but when House had his Gran Mal with a probe in his brain, I said “Damn! That’s going to leave a mark!” I’m surprised he had any brain left after that.
Amber dying was a bummer, since I thought her character was well-realized and provided a nice foil for House and Wilson. The show suffers when none of the patients die, however. House supposedly takes only the hardest cases: you’d expect him to have more fatalities than an ordinary M.D.
May 20th, 2008 at 6:44 am
well something that drived me crazy was the whole wake up thing in order Wilson to say goodbye to amber. Ok i understand the medicine to be floppy as this is a tv show but come on!!! after a ventricular fibrillation, hypothermia etc they just put her in a by pass machine and all of sudden she opens her eyes and start chatting with Wilson. Is this soap opera or science fiction? A similar thing happened in season 3 finale with the human woman who suddenly got back to life! It seems the next season will be around wilson -house friendship but the whole story is so cliche in my opinion.
May 20th, 2008 at 6:45 am
i meant cuban woman
May 20th, 2008 at 6:59 am
For the most part, audience members watching House are encouraged to form the same kind of medical detachment that House himself usually feels. And I’m in it for the medical mysteries–I don’t care about the patients in the same way that House doesn’t care about the patients.
The reason this episode was so effective was that it totally undermined that sense of detachment. I put myself in the club of people who were crying. The pain on Robert Sean Leonard’s face throughout the episode was chillingly real. That guy deserves an Emmy.
May 20th, 2008 at 7:11 am
Hi there everybody,
now let’s have a comment from a real-life doctor – albeit ‘only’ an ophthalmologist, I’m afraid ;-)) But I once worked as a GP for three years! If that makes up a good defence – I might know what I’m talking about though.
I really disapprove with the medical facts going so off-limits throughout the third and especially the fourth season. I’ve been following the 4th season via YouTube as it’s only due on television here in Europe this autumn, and as generally being a total HOUSE-addict and respectable Hugh Laurie-follower I surely enjoyed being able to see any HOUSE at all – anything is better than nothing! – but nevertheless: why so much drama and so little medical credibility? It wasn’t like that in the 1st and 2nd season, and one thing I always enjoyed about HOUSE was that it stuck out positively as being one of the few medical television series where you could at least see a hint of a connection to the ‘real’ life of medicine. Maybe changing this could be set as a challenge to the 5th season, which in my opinion should be the last and final one, even if that means no new HOUSE-input in the future. But aren’t we all in fear for our beloved series to drift off completely into drama, soap-like storytelling and more loss of reality? Well, if you’re not – I sure am! So give us a fantastic – and credible! – 5th season and put the cream-layer top on one of the best TV-Productions ever made.
Anyway, hats down to the strong acting in this last episode, all characters really came off great. And for me it set the ultimate path to the long awaited House-Cuddy relationship. I’m not shipping anything and am not too fond of all these ‘Who’s the right one for House’-stuff, but these two really seem to be made for each other.
P.S. Don’t you think that Hugh Laurie is perfect in playing the suffering, health-deteriorating House? There’ve surely been enough (too many!) opportunities for showing off in this field throughout the last 16 episodes. House’s ability to fight off health-threatening conditions seems to be nearly limitless! I mean – fighting off a leg infarction with rhabdomyolysis and crush syndrome, three heart arrests and following CPRs, diverse drug and other pharmaceutical experiments, enduring three blood tranfusions, two bullet wounds, two electric shocks and a grand mal seizure is quite impressive, isn’t it? Wish my patients would show just a hint of this endurance…
May 20th, 2008 at 7:15 am
I sobbed, absolutely sobbed. I’ll be watching it for a third time tonight when I get home from work.
But the thing that bugged me the most was that Foreman is a neurologist and yet they had Chase doing the only neurology thing in the episode. I mean, when you think about it, Chase should be in the emergency room because his specialty is acute care, Cameron should be off in happy immunology land and Foreman should be doing SOMETHING in neurology. I think that the three of them made for a good diagnostics team, because Kutner’s sports medicine, Taub’s plastic surgery and Hadley’s… well, okay, she’s a physician. I’ll give her a pass on this one.
But yeah, depressing as hell, augh — though I was rather fond of the House/Cuddy hand holding at the end, yay! I’m looking forward to seeing how these — House and Wilson’s friendship, Cuddy and House’s relationship — play out next season.
May 20th, 2008 at 8:01 am
And the symptom House had been pursuing for two episodes was wholly irrelevant to saving “the one” since it was the crash itself that killed Amber.
May 20th, 2008 at 8:14 am
I’m still curious how House noticed the rash on her lower back – it wasn’t so much as explained but rather handwaved away by House.
May 20th, 2008 at 8:24 am
It was a touching episode. I felt more sorry for Wilson than I did for Amber. She seemed almost fascinated by her own death.
Wikipedia says Amantadine clears in 10-14 days with renal disfunction. She took a large dose just before the kidneys bought the farm. The rash could easily have been missed in the bruising. Also it would only have formed after her initial admittance while she was in the other hospital. House knew the solution but couldn’t remember it. He knew there would be the rash.
As for the deep brain stimulation causing effects like that I remember seeing films in biology class that talked off experiments in the 40’s-50’s where when they were going in to brain surgeries they would apply currents and ask the patient what’s this. When some part (can’t remember what) was hit people would re-experience memories. The problem was that the effect was somewhat random. Even knowing what you doing, you would have to poke around for hours to get the right memory, unless you were magically lucky. They also goofed around like that with the sensory and motor cortex. Touch one spot and the patient twitched the arm. Touch another and it felt to them like their arm was being touched. Very ‘Hey y’all watch this’.
May 20th, 2008 at 8:29 am
I wondered, too, why no one suggested the possibility of transfusion for CTB/Amber, but chalked it up to late dramatic timing (sort of the inverse of a “cure” not possibly being correct 19 minutes into an episode). Still, it could’ve been handled with a single, tossed-off line of dialogue.
On a non-medical note, no one yet has pointed out that House seemed to have a new best friend in Cuddy at the end of the episode.
May 20th, 2008 at 8:41 am
Deep brain stimulation (DBS)can, and often is, done without a general anaesthesia. For instance, during the pose of DBS electrodes for Parkinson or involuntary movements the surgeon needs a real-time checking of the efficacy by asking the patient, fully conscious, to make different gestures. The brain in itself (apart from the meninges), is not sensitive…
May 20th, 2008 at 8:50 am
[...] In the review for “Wilson’s Heart,” last night’s finale, Scott explains: “The writers are correct in that Amantadine is poorly cleared by dialysis, and there have been deaths reported on the medication. The dose for the flu is 100MG twice a day. The only size pill Amantadine comes in is 100MG, so Amber taking two means that she was overdosing herself on it, so she bears some of the blame for this.” [...]
May 20th, 2008 at 8:58 am
“On a non-medical note, no one yet has pointed out that House seemed to have a new best friend in Cuddy at the end of the episode.”
They act like they hate each other, but they’re really . . . I wouldn’t go so far as “madly in love,” but definitely they look out for each other. Sort of like that friend that you only talk to once a year, and he’s still mad at you because you stole his girl, but you can trust him to come bail you out of jail at three in the morning if you need it.
I just hope the House/Wilson fighting doesn’t lead to House and Cuddy hooking up. The unresolved sexual tension is what makes them work.
“Very ‘Hey y’all watch this’.”
That’s got to be the best part of being a brain surgeon.
On the subject of everybody being sad about Amber dying, I was too.I hated her for most of the season, but then they had to go and make her HUMAN in the last few episodes right before they killed her. :(
Even so — maybe it’s because I’m desensitized from being a journalist and interviewing the spouse the day after somebody died, or maybe I’m just a jackass on the level of House himself — my first thought when Wilson crawled into bed at the end was “good thing she talked him into getting the one HE wanted.”
Then the note mad me sad again.
May 20th, 2008 at 9:06 am
I can only wonder how the writer’s strike affected the story arc for season 4.
May 20th, 2008 at 9:13 am
I was also wondering if you could be conscious and on bypass. Anyone know?
May 20th, 2008 at 9:19 am
Chris: I don’t think the main problem was the overdosing, it was that her kidneys were destroyed and she couldn’t filter -any- of it.
May 20th, 2008 at 9:38 am
Dang, Jay, I was hoping to be the first to catch a medical error by Scott instead of the show for a change! I used to work neurology and all the deep brain stimulation we did was for parkinsons, and it was all done with an awake and alert patient.
May 20th, 2008 at 9:42 am
Why was House so certain that Amber was dying before he remembered the Amantadine? Could he be sure that the bus crash damaged her kidneys that badly?
If Wilson was Amber’s medical proxy, they should have said so. If he wasn’t, he should not have been making her medical decisions.
House’s worry about what was going in in his head reminded me of this talk by a neuroanatomist about when she realized that she was having a stroke:
http://www.ted.com/index.php/talks/view/id/229
May 20th, 2008 at 9:58 am
Dialysis would not have removed protein-bonded Amantadine: then why not attempt to perform some other form of plasm transfusion? A systemic purgation with oxygenated saline would, I think, prove successful; in fact I cannot but think that a standard full-blood transfusion would have accomplished the removal of the toxins that Amber ingested in such a foolish quantity.
It would, however, have been a rather anticlimactic procedure: since her heart was still pumping, it would have taken perhaps a minute, perhaps even a minute and a half, to complete the procedure.
-0dk0
May 20th, 2008 at 10:30 am
Wow…That was an amazing episode.
The medicine was pretty spotty as reported, but I thought the drama was awesome. Robert (Wilson) did an amazing acting job, and I’ll be honest, I cried at the end…
May 20th, 2008 at 10:45 am
They really have set it up well for alot of things to be explored next season…We have the House/Wilson relationship…the Cuddy/House relationship…her holding his hand at the end was sweet it could just be a friends thing or it could be more. 13 with the Huntingtons… Kutchner the orphan unable to make emotional attachments…(i think it was great the way he was just sitting at home eating cereal and watching tv at the end!)
It did bug me that Chase was doing the brainsurgery when Foreman is the neurosurgeon…inconsistencies people!
The new big white room was funny alright but it did heighten the dramatic tension. They did mention it was ICU but its kinda weird that some of the other dying patients haven’t been in ICU before!
it was a good episode though…yeah i cried…I cry alot though! Definately was some character development especially with House risking his life for Amber. And 13 I suppose too. Anyway thats it till next Season! Tanks for the reviews Scott. Its always good to come read them after a episode!
May 20th, 2008 at 11:05 am
I always stop here the morning after an episode of House. I love hearing the real scoop- thanks Scott!
I also loved this episode, for the many open ethical questions.. about the strength of the friendship between House and Wilson meant, that Wilson could nod when House asked if Wilson wanted him to risk his life for merely a shot at more information to help Amber… and then House just nodded too and went for brain surgery.
And the really tough one- waking up Amber at the end. When Cuddy and Wilson were discussing it, I turned to my wife and said, “no way I do this.” It was really thought-provoking, this tension between “that’s what Amber would have wanted”, and this would make it better/easier for Wilson, and the fact that Wilson’s the one waking her up to tell her she’s dying.
Missmilki, I also identified with Kutner in this episode. Nice of you to bring that point up- it seemed like a throwaway line, “oh, by the way, let me just casually mention that my parents were murdered”, but I actually feel like I -get- Kutner in a way I didn’t before. Wonder if the writers actually wrote this season for him knowing that backstory. It really seems to work retroactively.
May 20th, 2008 at 11:11 am
I cried and I have elevated testosterone levels. Almost nothing can make me cry!
The whole freezing/waking up thing made me go “Quoi?!”
May 20th, 2008 at 11:44 am
I was looking up amantadine last night after the big reveal as the culprit and found a website stating physostigmine (the stuff house od’ed on for memory recovery) is listed as the primary treatment for amantadine poisoning. Seriously? That could make for an uncomfortable moment in a later episode
May 20th, 2008 at 12:01 pm
The real sad thing is when Amber woke up and put all of the pieces together.
Kidney Failure.
Amantadine.
I’m going to die.
May 20th, 2008 at 12:01 pm
Hi, so another long-time-reader joins the community :-)
The End of this season was, in my opinion, the best seasonfinal so far, but nonetheless I have some negative things to say…
I’m very unhappy by Amber dying, i thought she was by far the most intresting character they added to the show after the old team left. I also think that, if she woukd have been allowed to live on she and House would have ended up someway. Another thing that bugs me is, why is everyone so convinced that Wilson will hate House (although “hate” is probably too strong)? House risked his life more then once during these two Episodes in order to save Amber (even if he doesn’t know it’s Amber hes trying to find). He doesn’t even flinch when Wilson bluntly nods in answer to Houses question, if he should risk his life to save hers. How many people would that just like that.
May 20th, 2008 at 12:28 pm
First off, thanks for some quick turnaround on these episodes!
Could someone please explain further the genetics of Huntington’s disease to me? (I’m a layman with no medical training) When I googled it, it said something about the it being a dominant gene on only one of a pair of chromosomes (the 4th pair). Does this mean that
SNIP or is it more complicated than that
If I remember correctly, it’s less complicated than that…one copy of the bad gene is 100% fatal.
May 20th, 2008 at 12:54 pm
I will probably be drummed out of the House Fan Club but in all honesty, I felt compelled to turned on ESPN and see cancer survivor Jon Lester finish off his no-hitter.
I did switch back in time to see the final scene between CTB and Wilson. Acting was excellent all the way around, and if I am not mistaken I saw the actor who plays Wilson on an episode of Cheers recently, buying Sam’s ‘Vette and looking impossibly young.
Amber was interesting because she was unique, so she should be missed not because of her sad passing but because she won’t be around to interact with House and Wilson. I can’t understand the ‘I hate her’ comments when everyone else is so damn bland and boring!
May 20th, 2008 at 1:16 pm
Wouldn’t the tox-screen 10 minutes in have caught the Amantadine? Whether it would have done any good, it would have saved House another hole in his head, and the hospital a few thousand volts of electricity.
May 20th, 2008 at 1:18 pm
The fact I cannot understand is: If the human kidney is able to slowly filter out Amatadine from the blood, why cannot dialysis? Granted, I know that dialysis is only an inperfect and temporary solution, but if I recall correctly, a lot of people with failed kidneys manage to survive even years with dialysis before they receive their transplant organ.
Or was the problem that her heart had already been to damaged to survive even if the drugs were filtered out?
May 20th, 2008 at 1:34 pm
I agree with everyone that this episode was well acted, but, for me, it was one of those episodes were the inconsistent medicine really lessened the impact of the emotional storyline.
I think the point of this episode was that there was nothing anyone could do to save Amber after the bus accident. I had trouble believing though that what House and Wilson decided to do didn’t make things worse.
Why did they decide to move Amber? She wasn’t in stable condition. If they had just identified her, so she stopped being a Jane Doe and gotten her medical records, her doctors would have known about the Amantadine in her system since it is a prescription medicine unless Amber shared House’s tendency to take unprescribed medications. Presumably there is some way to mitigate the toxic effects. Plus, it was hard to believe that it would have been that toxic that fast. As other people have noted, that sounds like a dangerous medicine.
I left the episode wondering if the point was that House screwed up by thinking Amber had a disease that only he could diagnose. He and Wilson etc… therefore decided that moving her was her best chance to live, when actually they should have been trying to locate her medical records which would have revealed the Amantadine. But then I thought that I was probably over-thinking things. Anyway, I’m glad I can come here afterward for the medical critique.
May 20th, 2008 at 1:42 pm
“Wilson’s Heart” indeed.
This goes on the list of the two House episodes I will probably never re-watch. The first is Que Sera, Sera, which was just lousy and ended with a complete cop-out.
This one was good. . .very good. . .I didn’t sleep last night because I kept having dreams where I was trying to save Amber. . .a character that I completely detested, especially in the beginning.
It was a cheap shot by the writers, changing her personality, and suddenly making her a good person near the end.
I didn’t technically break down crying, but that’s because I left the room. I also had to tell my fiancee, that, even though it is likely a very uncommon situation, if I was ever in Amber’s situation, do not wake me up to say goodbye. Just let me die. It’s the next morning, I didn’t sleep well last night, and there is still a dark place in my mind from the episode.
Excellent, if manipulative writing.
I was also very unhappy to find out that 13 has Huntingdons. I guess she’s likely to be leaving too. . .from what I’ve read. . .assuming that she’s in her late 20’s at the youngest, and has a low number of repeats, the best case likely, she has, what, maybe five years if she’s lucky and then her brain irrevocalbly goes haywire. I also decided (because of House) that if I were at risk of Huntingdons, I would never be tested or allow myself to be tested.
I especially don’t like the way House bullied her into testing herself with his constant, “Life sucks, know everything, hope is useless.”
Two ruined lives in one episode. I guess according to Houseism, 13 is now supposed to leave the team, drop out of her life, and stoically wait to die.
I hope 13 comes back, but something tells me that the new team will be Taub, Kuttner, and Foreman. 13 was my favorite newbie, but unlike many, I actually like Taub and Kuttner. At this point, they might as well drop one of them and bring Chase back onto the team, so that Chase can hate fat people, House can hate 90% of everyone else, and Foreman can hate anybody the first two miss.
I just wish we would get back to the medical mystery side of things. At this point, the show has just become cruel. Granted, House was supposed to be a show about a cruel person, who just happens to be a healer. I *like* this idea. There is nothing to stop a person who is an excellent doctor from just being an evil person, and yes, House is an evil person. Self-loathing, broken, and suffering, but still evil. And that’s what made it interesting. I loved the new ad for th show Fox did that started “Sometimes a cure begins. . .witha prick.” Because it was perfect to the show.
Can we please go back to the prick curing people, instead of the writers being desperate to prove the prick’s world view to be true?
Interestingly, that brings me to my penultimate rant. . .er comment. Is House actually questioning himself? His entirely world view is that everything is meaningless and random. In the dream with the dead Amber, he states, something along the lines of, “Life shouldn’t be random. . .miserable misanthropic drug addicts should die in bus crashes, and [something like "attractive idealists in love" ] should walk away clean.” Granted, this is on a show where the characters often seem desperate to out-atheist each other. (No, I’m not a fundamentalist Christian, I’m neo-pagan, which means that Christians think I’m a sinner, and atheists think I’m too stupid to be a scientist, 176 IQ not withstanding.)
The thing about it is, House’s summary of Amber is extraordinarily generous. She’s certainly not an idealist. *Wilson* is. Attractive? Not my type, but sure. In love? Obviously. Idealist? Not even close. Try misanthropic yuppie control freak.
But do attractive misanthropic yuppie control freaks in love deserve to die in bus crashes? No. Then again, neither do miserable misanthropic drug addicts.
I’m a writer, so I’m as qualified as our gracious host (no sarcasm) is to comment on medical issues, to comment on the following: Writers seem to have these certain tricks and shortcuts that they lean on. I call it the “victim’s cat” hypothesis. It’s whatever tells writers that the victim of a serial killer must have a cat to meow sadly out the window as their owner is dragged away. It’s as if they think that somehow we can’t care that someone dies just because their life has value.
Amber was a mean-spirited control freak. That doesn’t mean she can’t love or be loved. That doesn’t mean that she didn’t have value as a person, just as she is. But they had to take two episodes to suddenly pull a 180 so that we care. Just pile on the sadness and the crying cats because we’re too numb to care that person dies simply because they’re a person.
Then again, Wilson is the kind of “geeky suffering good guy” whom such writers can’t allow a moment of happiness without taking it away and replacing it with something worse.
As soon as we saw that he and Amber were happy, we should have known that Amber had the life expectancy of a nameless guy in a red shirt that just beamed down with Kirk, McCoy, and Spock.
But we were duped anyway. I let myself be duped, because I wanted Wilson to be happy. Shame on me for falling for it. Shame moreso on the writers for trotting out the same tired, mean-spirited cliche.
We all have flaws, we all have good qualities. I have flaws: I’m an overemotional, sarcastic, grudge-holding hedonistic, intellectual who can’t write a post on a TV show without mentioning his IQ. I wonder where I fall on the writers’ House/Wilson/Amber/13 right to live scale.
Fall for the last few years has given me both football, and new season of House to get me through the reruns of summer. Now, I’m not sure that I want to see that first new episode of House. I might just skip until the second one. The remnants of this episode, and probably no 13.
Perhaps to preserve some of the remaining shreds of my sanity, I have to nitpick:
1) Shouldn’t Amber have been in worse condition to begin with? Granted, we only see the crash from House’s possibly faulty memories, but it seems as if the first major impact was directly into Amber’s lower back. The impact was apparently hard enough to destroy both her kidneys. Shouldn’t that have crushed her spine and paralyzed her as well?
2) They discard the option of a heart transplant, because she wouldn’t qualify because of the other organ damage. House has rigged the organ transplant list before, or tried, (The bridge-playing guy who gets a heart.) He still found a way around it. (Using a heart declared unusable because the patient was Chase’s pet peeve. . .er. . .overweight.) Wouldn’t it seem likely and in-character for him to have done it again. I would think that if Dr. A’s loved one is in need of a heart, it would not be unlikely that Dr. B would bump them to the top of the list and break any rule needed to get it done. This is not saying that doctors are bad people, it’s just saying that they are not any better people than anyone else, and like anyone else, would do extreme things to save the life of someone they cared about. I’m severely phobic about fire, but there are people that I have no doubt I would run into a burning building to save.
Well, time for me to shut up, pet my cats, kiss my fiancee, and head off to work.
Pentalarc
May 20th, 2008 at 2:24 pm
Scott, would you please clarify something that’s been asked above, that I’m also wondering about.
If dialysis is meant to “replicate” (as far as possible) our kidneys’ function, why would dialysis not have worked? How is it that if the kidneys were functioning, the flu medication would NOT have been lethal?
May 20th, 2008 at 2:36 pm
Am I misremembering or is it sort of a HOUSE tradition for the science to go off the rails for the last couple eps?
“Three Stories” was close to a season ender and was surreal, then we had House tripping balls cause he got shot, then what?
May 20th, 2008 at 3:08 pm
Important to keep in mind that with reduced kidney function, many drugs (including amantadine) are removed from the body at a slower rate, but this won’t magically make a regular dose toxic. The drug would accumulate with repeated dosing, but if the levels were therapeutic before the kidneys fail, they won’t get any higher without taking more. In other words, unless Amber took more pills after getting hit by the bus, she should have had no problems with accumulation of the drug to toxic levels.
That said, 200 mg as a single dose is higher than indicated for flu, although doses of 400 mg per day or higher are seen in the treatment of Parkinson’s Disease.
It might be different in the States, but up here in Canada (at least, many parts of it) we don’t even use amantadine for treating the flu, due to widespread resistance.
May 20th, 2008 at 3:13 pm
House leaves himself an emotional out when he opts for the bus. Amber follows him of her own free will after being told not to bother. Don’t know if it’ll feature in House and Wilson getting their relationship straight or not, but it would be in character for House to tell Wilson that it was her own fault Amber was killed.
Liked the soap side of this closer. Since I am utterly non-medical, the medicine has to be really really really bad before it derails my interest
May 20th, 2008 at 3:20 pm
Remind me, please, what purpose the pig, as a filter, served when plumbed to the mobster.
Wilson should return, next year, sporting the “1,000 yard stare” and be hollow. He should only be civil to House and lose his child-like enthusiasm performing his duties perfunctorily. He should respond to the perpetual baiting from House in deadpan, offer a dispassionate “as you wish”, and give a wry half-smile.
May 20th, 2008 at 4:36 pm
Donald Wilson pulls about 4 different expressions within a second before collapsing into Cuddy’s arms and blubberring – I thought it was amazing acting! From that on moment on my eyes started to well a little but I didn’t cry my heart out like many people here seem to have.
Really loved the fact that House and Cuddy are holding hands at the end – even though Amber completely overshadowed anything Cuddy may have had going on with him, and despite House playing a prominent part in her death / destruction of Wilson’s relationship with her leaving me feel like he shouldn’t be getting any in a long long time.
Maybe Cuddy will become the new Wilson.
May 20th, 2008 at 4:56 pm
Pentalarc, what’s all this about manipulative writing, being duped etc.? Do you feel it’s ‘unintellectual’ to succumb to something that plays with your emotions so blatantly? Would you prefer something more subtle? Maybe if the cat didn’t meaow but simply went to the supermarket, bought a slice of ‘man the hell up’, then got on with his short little life I would have had the oppertunity to appreciate the inherent value found in all life despite it’s less endearing qualities whilst appreciating that not everyone has a cat and still shed a tear despite not knowing a damn thing about the victim. Gotta agree with House here, if you shed a tear for every person who dies the world would come to a stand still. Good writers ‘trick’, because it’s bloody integral part of storytelling that would have seen the episode fall flat otherwise.
May 20th, 2008 at 6:03 pm
Re: “Vote for Change ‘08″
I was a staunch McCain supporter until I saw that, but like most Americans I’m easily and instantly manipulated by even a momentary glance at a message which conflicts with my current thinking. So now I’m voting for Obama.
Oh, wait. I just saw an article where the Republicans have said they’s the “party of change” this year, so I guess I’m back to McCain.
May 20th, 2008 at 6:05 pm
From the Amantadine website:
“The adult daily dosage of SYMMETREL is 200 mg; two 100 mg tablets (or four teaspoonfuls of syrup) as a single daily dose.”
So I guess the writers got it right after all.
May 20th, 2008 at 6:11 pm
How come we see Taub jumping on Thirteen in some bedroom at the end? Hadn’t seen them together before!?
And to be honest, I do like the fact the CTB character is killed off, as I disliked her all season. Unfortunately the relationship between House and Wilson will be so different next season. Not only will Wilson see House as having some part in CTB’s death, also will Wilson be responsible for House’s brain damage, as he insisted on this poking in House’s head, which we know was highly dangerous – and if something is predicted to be dangerous on the series, we know for certain the worst will happen.
Then again, the series is called House, not Plainsboro Hospital, so we can be sure House’ll survive intact, as he did when he was shot, drugged, electrocuted, had his heart attack etc. etc. ;-)
May 20th, 2008 at 7:10 pm
Scott, I’m not sure if you would know more about neurostymuli, but it seemed as though their ideas were way off
I mean first of all, even though 3-5 volts is relatively low, if the resistance is low (not something I know), then it doesn’t matter how little volts you use, the current could become infinite and you’ll fry the brain
Also at most wouldn’t you just get a rapid series of images, memories, or other little bits of info in the brain? (Again I don’t know, this is just based on what little info I picked up from an old family friend)
Good TV this week though. I liked how they showed the new people’s reactions to Amber dying. Taub embraces the fact that his wife is still alive. Thirteen faces her fears, Kutner was already well adjusted and thus is the null-reaction.
May 20th, 2008 at 7:13 pm
Pentalarc, House didn’t call Amber an idealist. He called her a do-gooder, because she had come to pick him up when he was drunk and incapacitated. She died doing a good deed, not because she’s a good person but because she was doing a favor for Wilson.
In the episode where it’s revealed that Thirteen’s mother died of Huntington’s disease, they said that Thirteen had a 50% chance of getting it. She lost the coin toss.
May 20th, 2008 at 7:18 pm
Willem, I’m pretty sure that wasn’t Thirteen – I think that was Mrs. Taub.
May 20th, 2008 at 7:29 pm
I cried a lot too. I think it’s because I can relate with the whole loss of a loved one thing… Lost my older brother a few years ago. I think I liked Amber in her last few moments alive… excellent acting by her and Wilson. The scene when she’s woken up and told what happened…. it really hit me hard. And the letter at the end with the “I’m not gonna be here tonight.. picking up house <3 A”… so sad.
Thirteen’s positive test was not really that surprising, though I wonder where that’ll lead..
May 20th, 2008 at 7:29 pm
Interesting that some people don’t like watching Amber because they don’t like Amber, whereas other people don’t equate those. Nothing wrong with either–just interesting.
Wilson’s near-inability to say the words “when she dies” (or something like that) was affecting in the extreme. No tears shed here, but it was poignant. Better, in my opinion, then sticking in some Jack Handy Deep Thought in the final ICU bed scene.
May 20th, 2008 at 7:31 pm
i think that the first few episodes of next season will be a return to the in your face medicine of seasons 1 and 2. simply because house won’t have anything else. i also think that wilson will have to save house from some terrible illness or house will have to save wilson or alternatively house will have to save someone near and dear to wilson, perhaps his long lost brother?
May 20th, 2008 at 7:31 pm
Hmm, Bolton and Steph , you’re probably right about the woman being his wife and not Thirteen. Next time perhaps I ought to download the high res video. :D
May 20th, 2008 at 7:34 pm
The things that bugged me from a writing point of view are the same as every time a main character on House gets sick — they never know anyone outside the small circle of people in the show. If someone’s about to die you’d think next of kin would be notified, and friends, and extended family.
But in House land everyone is an only child with dead parents who knows only the people they work with, including characters who have only been introduced this season. Except those people whose parents we’ve met (like the seniour Houses) who still get ignored every time thier kid goes into a coma.
May 20th, 2008 at 8:09 pm
Did everyone else miss it… Fred Durst as a bartender, just like in real life
May 20th, 2008 at 8:22 pm
My wife asked me before the episode if I thought they were going to kill off Amber. I knew there was only one answer: yes.
My understanding is that David Shore was influenced by Sherlock Holmes (House) and John Watson (James Wilson) in more ways than last name alliterations. Several times (two specifically come to mind) they had pointed out that Amber is a lot like House. A story can’t have two Sherlocks (nor can Watson) ergo one had to go and it won’t be the eponymous character.
My season 5 prediction: House & Wilson will have a spat, but they’ll kiss and make up.
May 20th, 2008 at 8:31 pm
Actually, the memory thing i think was picking up on a recent anecdotal finding earlier this year. DBS is used to treat obesity; the mechanism isn’t really understood, but the idea is the hypothalamus is somehow underactive (overactive), so zapping it reduces appetite.
The hypothalamus is close to the mammilary bodies, which are the terminal end of the fornix, which is a white matter structure coming off the hippocampus. In the paper below, the diffuse stimulation associated with DBS presumably caused spreading activation to the hippocampus, and the subject had vivid episodic memories.
Of course, it happens probably very rarely, but the mechanisms in House aren’t really worried about normality, are they? It was reported on NPR a couple months ago, but i’m willing to give the writers credit for maybe surfing journals every now and again.
http://www.ncbi.nlm.nih.gov/pubmed/18232017
May 20th, 2008 at 8:37 pm
I’ve had to suffer through two scrambled cable broadcasts (including re-airs) and have missed an awful lot of dialog. 1) What prompted House to get snockered? 2) Who was the ‘Amber Pendant’ girl? 3) From what House memory did the rash discovery come? 4) Has Anne Dudek, who I did not like at all before this performance, moved into the ‘hot’ category?
May 20th, 2008 at 8:49 pm
A wonderfully written, incredibly sad episode. But on a lighter note, Amber overdosed on her own Flu medicine? Man, she would have probably been a horrible doctor ;-)
May 20th, 2008 at 8:57 pm
I don’t understand something…when House saw Amber take the pills, she and her kidneys were fine. So why did he remember seeing something that meant someone was dying, when he didn’t know about her kidneys being damaged at that point? Without knowing about the kidney damage, there would be no reason to have thought the pills would harm, much less kill her.
May 20th, 2008 at 9:08 pm
I don’t think she overdosed on it… wasn’t the explanation something like.. the bus crash damaged her kidneys and the Amantadine was not filtered out of her system because of that, causing all of the symptoms and stuff?
May 20th, 2008 at 10:12 pm
Some answers for Rick.
1.) He needs a reason?
2.) The amber pendant girl was … Amber, or a representation of her. Unless you meant who is the actress, in which case I have no idea.
3.) House realized the rash memory from his kinky little dream about Amber … but the show didn’t show us how/when House actually saw Amber’s back.
4.) Not imo, no.
May 20th, 2008 at 10:14 pm
Official Comment
The CDC recommends the 100MG twice-a-day dose of Amantadine, which is where I got my information. I don’t know why the other website recommends once a day dosing.
(Actually — as other commenters have noted — Amantadine is not recommended for the flu anymore because of the extremely high resistance of the influenza virus to the medication — greater than 90% in many cases. It also has a higher risk of serious side effects than newer medications. Amber should have known this.)
May 20th, 2008 at 10:25 pm
To answer those who have asked: Dialysis works like the kidney but not EXACTLY like it. Your kidneys filter your blood in two ways:
The first way is passive diffusion (things move from an area of high concentration to an area of low concentration). Think putting a drop of food coloring in a bathtub, it will eventually spread evenly throughout the water.
The second way your kidneys work is by actively secreting and reabsorbing substances. So if you take a drug that is dissolved in your blood and it goes through your kidneys, you expect to see some percentage of it in your urine based on diffusion alone. What really happens is that some drugs, a lot more percentage is excreted (because it is secreted) and some drugs, a lot less percentage is excreted (because it is reabsorbed). This is how your kidney would get rid of a drug like amantadine.
Here is the problem: Dialysis works by passive diffusion only. The nephrologist will choose a dialysate fluid (the stuff your blood will be filtered against) based on what levels of electrolytes they want to achieve in your body. So if you have high potassium and they want to lower it, they will dialyze against a low potassium dialysate. Diffusion takes place, the concentrations equilibrate, and after dialysis, your blood has less potassium than it started with and the dialysate (which is tossed out) has more.
This works very well for ions like potassium and sodium. It does not work well for large molecules that are too big to cross the dialysis membrane or like, amantadine, are attached to something that is too big to cross. Amantadine is protein bound. That means its firmly planted on a protein in your blood (like albumin) and will not be filtered by the dialysis membrane. However, they could have tried plasmophoresis or something of the sort, which IS used to remove drugs that dialysis cannot get out.
May 20th, 2008 at 10:31 pm
Bonnie said:
“I don’t understand something…when House saw Amber take the pills, she and her kidneys were fine. So why did he remember seeing something that meant someone was dying, when he didn’t know about her kidneys being damaged at that point? Without knowing about the kidney damage, there would be no reason to have thought the pills would harm, much less kill her.”
Me: Yeah, I kind of wondered about that, too. My only explanation, such as it is, is that when House initially said “Amber’s the one who’s dying,” he was speaking generically, having seen her being seriously injured in the bus crash (you’ll recall he dreamed about the need to tie the red sash around the Mystery Woman’s leg).
I really liked this episode. It occurs to me: How many actresses get to play a dying character who says goodbye twice? And note the wonderfully ethereal quality Anne Dudek gives off in the afterlife-bus, especially the way she moves her eyes about. Terrific performance.
May 20th, 2008 at 10:49 pm
Re Amber dying: Watson’s first wife dies in Sherlock Holmes so Wilson was due a dead love interest ( guess it couldn’t be a wife because Wilson’s wives appear a bit expendable.)
Seriously, I will miss Anne Dudek. I liked CTB all along — the one I didn’t understand being selected was 13. (I’m a Kutner fan — he is the most interesting and unique of the newbies.) I hope we see Anne Dudek on other series — she is a wonderful actress. Kudoos to the writers for the final scene so we got to see her leave looking beautiful and giving House a couple of parting shots. :-)
Yes, I hope they calm it down the first of next season and do some good medical mysteries. House (as played by the ever fascinating Mr. Laurie) seems to me best explored as he investigates the puzzles. It does concern me that he is so certain about the “wrong” diagnosis early one. I think that was less obvious with the old team when they would argue against him and were right often enough for us to listen to them. Seems to me the only consistently insightful newbie is Kutner. He has House’s detactment — albeit from a different source. Kal Penn is great.
But a good two-parter to end this shortened season. Will miss your reviews Scott — hope you write some meta-reviews over the break.
May 21st, 2008 at 12:05 am
My wife mentioned over dinner that every time Amber sneezed, she popped a couple more Amantadine. She said that Amber popped at least four (two in the bar, two in the bus). Would seem to indicate that she probably popped more than four in total that eve.
May 21st, 2008 at 12:19 am
I finally watched it tonight. Add me to the list of people who needed a bunch of tissues while watching. Fox sure wanted to make this season of their medical dramas end on a down note – first Zack gets written out of Bones, and now Amber dies? Clearly I am too emotionally-invested in television.
May 21st, 2008 at 12:27 am
RE: Amantadine to treat the flu
This is being really picky but, I read elsewhere that amantadine isn’t recommended by the CDC for treating influenza type A during the 2007-2008 flu season because the strain is resistant.
May 21st, 2008 at 12:50 am
My question, as a medical student (hopefully one of the actual doctor that frequents this page can answer this), is why in the world she was taking amantadine? Our lectures indicated that these M2 inhibitors have given way to the NA inhibitors like oseltamivir and zanamivir as the standard of care for influenza. Maybe I missed a post about that or a comment in your blog, but this didn’t make sense to me or any of my classmates. Thanks for any help that yall can give.
May 21st, 2008 at 12:52 am
Wow, I definately loved CTB all throughout the season and was very sad to see her go. She was just so badass, doing whatever it took to get what she wanted. While I’m sure if I were competing against her in real life for something I would hate her guts, I loved her character. She wasn’t another Cameron clone, she didn’t have a perfect, sexy face and was different and interesting. And I loved her relationship with Wilson. And yeah, I pretty much ignore the medicine…. it’s a drama, not a documentry. At least there was some more dry witty comments early in the episode. We need more of those…. And I loved the episode before this, I love when they make sort of artsy shows and experiment a little with the camera work and the story line, go a little deeper.
May 21st, 2008 at 12:57 am
And as for the Amantadine… We don’t know how much she had had that day, we just knew that she was “taking it” … She could have easily had several pills, not everyone flips out when they go a couple of pills over the dousage… And if she hadn’t gotten struck by that bus, it wouldn’t have mattered… She was probably concentrating on how annoying her flu was, not the possibility that both of her kidneys fail
May 21st, 2008 at 1:23 am
Tbird: Ahh, you’re right. I still wouldn’t call her a do-gooder either. They completely changed her character in the last couple of episodes, in order to set us up for this. My point (which some seem to have missed) is rather that was really necessary. See below:
Rob: Ahh, well, excuse me a second while I man the hell up. Ahh, that’s better. As I said before, I am a writer. As such, I am perfectly qualified to say when I think writing is bad. Now, this was an excellently written episode, and the writers generally have quite a bit of talent. That’s why I’m so disappointed in the overboard manner they for the “hopeless” atmosphere.
Here’s why the victim’s cat hypothesis: (Came up with the name after it was used in two separate serial killer movies that I saw within a few days of each other, one was Silence of the Lambs, can’t remember the other, where an almost identical shot of a cat watching it’s owner being dragged off) is in my opinion bad writing:
1) It’s lazy: Rather than come up with an actual reason to like the character, the most the writer feels like doing is coming up with a quick emotional scene to pluck the heartstrings on some random level. How many movies have we seen where as soon as a character has good news or something to live for, we immediately know the character is doomed? Too many. It’s become a signal, “We didn’t show you enough, so let’s just slide this in here to give you an extra dose of “I care” right at the end.” As I said before, as soon as they changed Amber’s character, we should have known her life expectancy could be timed with a stopwatch. I’m irritated with myself for not knowing it immediately. But instead of telling me to man the hell up, you might have wondered why I didn’t expect it. Frankly, I thought the writers of House were better at that. Okay, sports metaphor, that should be manly enough: It’s like a great cornerback who gets two pass interference calls a game. They’re good enough, why are they messing it up by trying to take the lazy way out?
2) It brings in things that have nothing to do with the character or plot, and only serve to try to add caring. In the cats ‘n’ killers example, if the serial killer was looking for victims by trolling cat fanciers clubs, it would be logical in the plot to show the cat. The thing is, they completely changed Amber’s character in the last few episodes. She suddenly went from “jerk” to “strong.” She suddenly went from trying to control and dominate everyone around her to wanting Wilson to stand up for himself. This was out of character, especially if we are supposed to be seeing her as a female equivalent to House. House gets people to stand up for themselves by pushing them to the breaking point. (We’ve seen him do it, *with Wilson) This is natural for someone whose nature is hypercompetitive and always on the attack. Best example, the beds. It was not in character for Amber to get upset that Wilson submitted to her. If she did want him to stand up for himself, it is in character for her to be disappointed, even disgusted by his caving. Not sad.
The writers have done things like this before without resorting to cheap tactics. In the episode where the homeless woman is searching for her son. Advanced rabies, can’t be cured, character dies. We care. We care because the entire episode used good characterizations to good effect to make us care about her.
In the episode where the guy with spinal atrophy dies because his dog ate his medicine, killing the dog in the process, we cared. And it was handled well, despite the fact that it was almost literally the cat moment with a different species.
So why did the writers mess up this time? Because they had developed the character a certain way, and took too long doing it before they killed her off. So they had to write her out of character in order to try to make sure we cared enough. See below:
3) It doesn’t give the audience enough credit: Even if you don’t like Amber, and I don’t like Amber, you can still care because a human being is dying. I’m sorry if that seems unmanly to you, but to parody your House quote, “if you don’t care if anyone dies, you should see a shrink.” How about this, unless you detest both Amber and Wilson, you should care. On the other hand, if you just don’t care in general if people die, why bother watching a serious drama like House anyway? Just rent Faces of Death and a full season of 24, and you should be happy.
Amber is/was a bad person. She was meanspirited, manipulative, a bully, self-centered, and hypercompetitive. She lived that way, Wilson fell in love with her that way, and she should have died that way. Yes, Wilson is a good person, so why would he fall in love with a bad person? Well, he seems to have a track record of that. We saw one of his previous wives on screen, and she was essentially Amber with black hair. His “type” seems to be skinny, preppy, mean, petty, and manipulative. Gee, that never happens in real life.
So here’s why we should care:
1) She’s a person. Oh wait, that’s not enough, I need to man the hell up. No wonder the world’s in the shape it’s in.
2) Wilson love her.
3) She loves Wilson.
So why did they have to try to pull a 180 all of a sudden and try to make her an angel? In retrospect, I’m surprised we didn’t hear about her extensive charity work, and how she read to blind orphans on her day off.
Yes, Robert Sean Leonard did an *amazing* job. Ditto for Anne Dudek, and the rest of the cast. In fact, it was the excellent acting which saved the bad writing.
May 21st, 2008 at 2:15 am
About House knowing about the rash.
Isn’t it possible that he guessed Amber had the rash because he saw her taking the flue pills? This information was stuck somewhere in his mind, but still released the clue through his dream.
(I hope my english is comprehensible ^^)
May 21st, 2008 at 2:47 am
This episode is the ultimate tribute to the daytime soap operas that house is such a fan of.
May 21st, 2008 at 3:59 am
Great episode. Though it wasn’t as emotional for me as last week’s, it’s given me a lot to think about over the summer.
I appreciated the fact that the writers didn’t set up some sort of torrid affair between Amber and House. I think that’s part of what binds the episode together (dramatically speaking). Had they been romantically involved, it would have undone Amber’s rapid character restructuring (although I’m sure, if it weren’t for the writer’s strike, her change from manipulative CTB to a more likeable love match for Wilson wouldn’t have seemed so abrupt). And even though it’s apparent House harbored -some- kind of feelings for her, he did not act on them and in doing so prioritized Wilson’s friendship before all things. That makes House’s personal risk and the Wilson/Amber scenes that much more powerful.
Since House was still in a coma, he didn’t get to say goodbye to Amber. I’m wondering if this will affect him on an emotional level next season. Will he feel guilt for his part in Amber’s death? Will he feel guilt more over her death or its effect on Wilson? House/Wilson interaction will be interesting to watch in season five.
On a lighter note, I loved the clip in the end montage of Foreman, Chase, and Cameron at a bar together. Just sort of gave me the warm fuzzies.
May 21st, 2008 at 4:20 am
1. I believe 2 * 100 mg is not an unusual dose – it can be the normal dose in the first day!
2. Amantadine is poorly cleared by dialysis, but IT IS CLEARED !
3. Amantadine does not ‘bind’ in a non-reversible way, so dialysis still works and blood transfusion works even better.
4. Somebody with femural artery hemorrhage would have lost enough blood that serious blood transfusion would have been needed, so enough of the amantadine would have been cleared – unless she took like 20-50 pills I see NO WAY how the story could have been even remotely true …
May 21st, 2008 at 5:15 am
I’ve been trying to reconcile what Bonnie commented on, assuming that this wasn’t just a case of poor writing. The problem is House’s memory, because we see different versions of the events that happened. In House’s Head, when he finally sees a smiling Amber, the realization is very much of a “holy crap, she’s ‘the one’” (or a one), replaced a second later by “oh crap, she could die”. Was his realization that Amber was/could be dying what he remembered, and then he later assumed it had to be a symptom he saw?
In Wilson’s Heart, we see a different version. Amber is popping pills shortly before the crash, and House can only mutter “don’t do it” now that he knows what’s going to happen. However, this cannot possibly be what actually happened, since she obviously would have reacted if he had actually said that. House reacts to the entire scene with detachment since he knows what’s going to happen, which means we have not seen how he actually reacted to the scene the first time. The one thing that does get her attention is when he says her name, but he does this before he could possibly see the truck (the bus hasn’t entered the intersection when she turns her head).. The question still remains as to what he was thinking that caused him to say her name.
Additionally complicating things is House’s reaction after the crash. His concern was for the pole that had impaled her leg, but he made no mention whatsoever as to what would cause her impending doom. As such, when and what he noticed are still very much on the table.
House’s attitude during that entire episode was also quite strange. Generally, he really cares about saving the patient du jour, which often leads him to try crazy and unethical solutions. This refusal to lose is despite the fact that he could care less about the actual patient. In Wilson’s Heart, he seemed entirely detached and nonchalant. Yeah, he’s probably tired, but that hasn’t stopped him before. Plus his attitude doesn’t change even when he does get some sleep. Everyone around him is emotional, but he can’t even be bothered to make many suggestions. Someone else says something, and he goes along with it. Even his “I’m so sorry” to Wilson is very questionable in its believability. He says it like he thinks it’s what he’s supposed to say in that situation.
Where he does finally show some emotion is at the end with Amber. His choice of words is again very strange. He makes a point to say “stay here with you” (instead of just “stay here where it doesn’t hurt” or “in purgatory”) to Amber, and his explaining to her why he doesn’t want to leave takes him a moment as it brings him to tears. “Because it doesn’t hurt here”. No reference to the leg whatsoever, and he looks at Amber with a quick glance after saying it. “I don’t want to be in pain, I don’t want to be miserable”. Again, ostensibly about the leg, but is it? We haven’t really seen House before the leg injury, but the characters state that he really wasn’t much different before the injury personality-wise. “Curing” his leg might stop the pain, but it wouldn’t stop him from being miserable. Somewhat glossed over in this series is how alone he is. For as long as he’s been alone (and he never really got back together with Stacy, as close as that came), he probably feels most of the time that he wouldn’t want somebody else. But this candid admission here shows otherwise. He would’ve jumped at the chance to be with someone again if the situation was right.
“And I don’t want him to hate me”. As Scott said, this was probably in reference to House having “been responsible” for killing Amber. But as many have said, Amber essentially killed herself by taking medication she really shouldn’t have been on, and was in the wrong seat on a bus that got broadsided by an ostensibly drunk driver (who somehow has remained blameless throughout this situation, even assuming he didn’t survive). And House did put his head through much trauma in futile efforts to save her. But assuming that this is what he meant by Wilson hating him is just that. House doesn’t reference this at all. If House, say, wanted to go out with Amber (and correctly so, IMO), it would be next to impossible for this to not affect his relationship with Wilson. He would certainly hate him for stealing his girlfriend, especially given his rough history with relationships and that he seemed somewhat happy with her. House may have tried to figure out a solution to this puzzle, but of course to no avail.
Amber’s quoting of the Stones is obviously a product of his imagination, and did enough to convince him to rejoin the world of the living for whatever reason (perhaps just in realizing that this bus wasn’t real, but of course I can only speculate here). But he certainly doesn’t do it happily. Cuddy quashes whatever he was trying to say, which unfortunately remains unintelligible, and he silently stares as the episode fades out. Wilson does at least seem forgiving as he stared at House, although he was already figuring out that House was interested in Amber. Of course, that is now sadly moot.
After my previous post, I’ve been trying to decide if I was reading too much into House’s actual interest in Amber. I still can’t help but think that he was being just vague enough on the bus so that it sounded like he was talking about his leg, when in reality it had nothing to do with it. House would certainly never admit his feelings for Amber if he had them, and it is certain that she didn’t return his interest, at least for the would be time being. Again, maybe this was just poor writing, but I’m starting to doubt that. House’s strange attitude both before and on the purgatory bus at the end is just too much to be ignored. I must again rule that what I said before still stands. While admitting his feelings for Amber to Wilson will probably never be a good idea, he still must at least do it to himself. For all we know, this process has already started.
Hoping for such from a TV series is often futile, but this cannot possibly be over and will have to be dealt with once Season 5 commences. House can’t really be the same after this, even though he of course pretty much will be.
May 21st, 2008 at 8:23 am
This was a great episode overall, but the part bugging me was the DBS and the hypothalamus. I could have sworn the hypothalamus was primarily involved in maintained homeostasis, etc, NOT learning or memory. shouldn’t they have stimulated (not that it would probably have worked) the hippocampus instead?
May 21st, 2008 at 8:48 am
Paul:
“A: if two HD-positive parents mate, the child has a 75% chance of having the gene, but if he does get it, will definitely have one HD gene and one non-HD gene?”
25% healthy, 50% on HD gene, 25% double HD gene, but….
That entirely depends on parents genotype (they can be homozygote (”double” HD gen) or heterozygote(one HD, one “healthy” gen).
Child of a homozygote HD person will ALWAYS have HD, child of a heterozygote person have 50% chance to receive it. If two people with Huntigton’s (heterozygote) mate it is obviously 25% chance for the child to be HD free. Actually two HD patients mating would be extremely rare occurence, that’s why a homozygote HD patient was documented only few times – and rpringly very first documented gen. dominant disease that actually does not express itself worse in homozygote than heterozygote patients.
I hope this shed some light on HD.
Setting aside the enormous emotional load, this year’s episodes bring I really hope next season will bring more medical mysteries with classic House brilliance and goofing around. And maybe making Thirteen’s Huntington a main plot (but from medical point fo view) more than Wilson’s suffering. HD symptoms can show themselves as late as age of 50, so there is no hope lost for her I think.
May 21st, 2008 at 10:38 am
For me, the moral of the story is to not take drugs for minor conditions. Amber was a healthy young woman who’s body would have had no trouble overcoming the flu naturally within a few days, but instead (like many people) she decided to risk all sorts of potential side effects and possible adverse outcomes, one of which was realized.
BTW, maybe I’m the only one who didn’t make the connection, but the rash on her back was, I believe, “livedo reticularis”, which is a side effect of Amantadine; so the rash was an important clue.
May 21st, 2008 at 11:40 am
Why does everyone seem to be stuck on the idea that CB took two pills on the bus? She TAPS the container twice, reaping a grand total of ONE pill.
This show likes to foreshadow. I was watching episode 12 “Don’t Ever Change”, right after CB was revealed as Wilson’s secret love interest in episode 11 “Frozen”, and came across this gem:
(http://community.livejournal.com/clinic_duty)
GREG HOUSE: Cross-species mating. I feel like Darwin in the Galapagos.
JAMES WILSON: Amber and I have a lot in common.
GREG HOUSE: She’s a Cutthroat Bitch. You cry over Dark Victory.
JAMES WILSON: Bette Davis – another strong, assertive woman.
GREG HOUSE: You don’t like strong, you don’t like assertive. You like needy.
**She’s not dying, is she?**
May 21st, 2008 at 12:00 pm
Though it’s never explicitly said, there are two separate mystery symptoms. In the previous episode, just after the crash, it’s Amber’s severed femoral artery and the gigantic bus pole sticking out of her thigh. Not particularly subtle, and it’s enough to give House a strong sense of imminent danger despite his memory loss. In this most recent episode, once he finds Amber at the other hospital and learns that she has kidney failure due to the accident, he unconciously recognizes the previously minor detail of her Amantadine use as the new mystery symptom.
On a different note, am I the only one who doesn’t see House as being at fault in Amber’s condition? He’s looking for a ride home from a bar across town, not to be airlifted from a pool of starving grizzly bears with rocket launchers. As favors go, that’s trivial compared to helping a friend move or picking them up at the airport. It’s just bad luck, the same could’ve happened to her if she’d been running to the store to grab Wilson some nachos or just on her way to the post office. On the contrary, at every step he does everything he can to save her and it took him 3 seconds to decide to risk his life after having had a skull fracture, a heart attack, and a boatload of phisostygmine all on the scant possibility that there’s more relevant information in his missing memory AFTER they already have a suitable diagnosis. That seems really selfless to me, am I missing something?
May 21st, 2008 at 12:06 pm
cucu: Thank you for # 4.
I meant to mention that as another reason that this episode didn’t work for me at all. Unless House hallucinated Amber’s leg injury, I just can’t imagine that she could have had enough of an overdose to cause catastrophic organ failure after a massive blood transfusion. Maybe she died because all her organs were damaged in the bus accident or something…oh wait that’s not the plot.
My conclusion: Amber is dead because the writers wanted her dead. They just didn’t find a plausible way to kill her.
May 21st, 2008 at 2:32 pm
IJ:
Agreed completely. I don’t see how Wilson can possibly blame House at all. On top of everything you mentioned, House didn’t even call Amber to come get him. He called Wilson, and she answered. He told her to find Wilson and tell him to come get him. Then she came to the bar of her own accord. House gets on the bus, tells her to go home. She follows him onto the bus, again of her own accord. She then takes some pills and gets raged by a garbage truck. It’s just a series of incredible coincidences that if any one didn’t happen, she would not have been killed.
House just wanted a ride home from the bar, is that such a horrible thing?
Of course, the argument could be made that Wilson won’t be able to look at House without thinking of Amber. Ya know, the girl he’d been dating for all of what, 2 months? Sucks that she died, but gimme a break. House has been his best friend for at least 10 years. The writing in this show for the 4th season has gotten unapologetically bad. It also doesn’t take a doctor to see that all this bypass, hypnosis, and brain stimulation nonsense is just science fiction. I was literally cringing when they started doing that. I was hoping Scott would blast it in his review more than he did, but I guess he was just being nice. =D
Also, Chase the super surgeon is basically comic relief now. The past few shows I’ve been looking forward to seeing what ridiculous crap they’ll have him doing next. Classic.
May 21st, 2008 at 3:09 pm
IJ (2008-05-21-1200): It is selfless, but guilt isn’t always rational. (Sometimes, it’s caused by a 25-foot-long tapeworm.) It’s not clear that House remembers why he went to the bar and had that much to drink; it’s not as though he can’t drink an equal amount at home. Even though he isn’t to blame, it’s still the case that if he had done things differently, or more conventionally–less House-like, in other words–she would still be alive. That can translate into guilt.
May 21st, 2008 at 3:11 pm
I too am hoping for more solid medicine next season, instead having this show become yet another GA or ER. And stop having Chase do everything, before we know it, he’ll be doing Cuddy’s job! Have to agree with previous posts, Robert Sean Leonard is such an excellent actor, he totally stole the show in finale.
May 21st, 2008 at 6:01 pm
Yes I cried and sobbed and sniffled and fell apart too. RSL is the made of awesome. Wilson just completely broke my heart. I am still in shock. And please, please let Amber continue her conversations with House. Loved it.
What I found totally jaw-dropping was that House set this into motion with 7 shots of scotch in a bar. It wasn’t intentional. It just happened. And when House realized he had set everything in motion with that one call to Dial-a-Wilson, he was completely devastated. Wilson really was the innocent bystander.
So Chase does brain surgery too? Just totally ridiculous even for a TV show.
May 21st, 2008 at 6:36 pm
WOW, there are a lot of posts on here for one episode. Just based on the amount of feedback this episode has caused here and on other web sites is the first clue this was a monumental episode.
My first reaction was this 2 part story was a courageous plotline to write because it could easily have been messed up or come across wrong. I think they hit it out of the ball park myself. And the actors and actresses really held up their end of the bargain. Amber and Wilson were especially great !
This story line reminded me of the 3 Stories episode, in that I find myself wondering if Wilson will be able to forgive House for being the indirect cause of Amber’s death, the same way that I wondered how House would ever forgive his ex-wife Stacy for indirectly causing his leg to be forever injured.
I think going forward, Wilson might be the one who becomes more bitter, while House is forced to change his personality a bit. But we shall see in Season 5.
May 21st, 2008 at 7:28 pm
For about a split second I thought House was going to end up brain-dead from the seizure and his organs generously donated to Amber ;-)
I am also puzzled by the insistence that House “saw a symptom” – taking a pill for flu is not a “symptom” – it could have just been a decongestant or antihistamine (not that I’m advocating taking this stuff but it could have been).
So before he even realizes Amber is the one who was seriously hurt, never mind have any inkling that her kidneys had been damaged, he had seen a “symptom”? Is this another of the “House is psychic” attempts?
I’ll give it one more season but if the medicine doesn’t smarten up I’ll simply curl up with Season 1 and 2 DVDs whenever I feel like a “House” attack.
May 21st, 2008 at 7:30 pm
When I see the main characters doing tests and procedures that would normally fall to either the meanest technician or the most skilled surgical hand I think they are doing it to get around some portion of the system. They do the tests to get the results quickly and the surgical procedures because no one wants to risk his mal-practice insurance on one of House’s excentricities.