House — Episode 6 (Season 5): “Joy”
An interesting medical mystery on this week’s House, unfortunately bogged down with a solution that makes no sense. Meanwhile Cuddy is having problems of her own.
There were two medical stories on tonight’s episode of House. I will look at them each in turn.
Jerry Harmon, a 37 year old single father, is admitted to House’s service for evaluation of recurring blackouts, some lasting as long as nine hours. He has also been experiencing hallucinations. A prior work-up including an EEG and CT scan have ruled out drugs, alcohol, and epilepsy. The team’s initial differential diagnosis consists of post-concussion syndrome, TIA (transient ischemic attack, i.e. “mini-stroke”), toxins, or cavernous sinus thrombosis. An examination of Harmon’s strangely plain house also adds the possibility of a mold exposure.
The team later encounters Harmon in the hospital elevator where he ignores the doctors and makes some cryptic remarks about an appointment. They quickly realize he is sleepwalking. The differential diagnosis now consists of stress induced insomnia, narcolepsy, or a toxic exposure. House suggests that the team let him sleepwalk again and follow him to his “appointment” because it might provide more clues. Taub and Thirteen do just that and follow as Harmon climbs into his car and drives downtown to buy some cocaine, all while sleepwalking. The team now suspects that the cocaine may be causing the problems in a sort of vicious cycle (cocaine use leads to insomnia which leads to sleepwalking which leads to buying more cocaine, etc.), or possibly it is whatever the cocaine is cut with that is causing the problem. Taub and Thirteen buy some cocaine from the same dealer and find that lactose powder has been added to the cocaine. The team concludes that a lactose allergy may be causing the symptoms.
As Taub is giving Harmon a final exam he discovers that Harmon is sweating blood, and this rules out both a cocaine-induced or milk-induced cause. The team now considers a hemorrhagic fever (an infection like Ebola), DIC (disseminated intravascular coagulation), or leukemia. They all seem unlikely possibilities, but House is intrigued by the leukemia diagnosis, so orders a bone marrow biopsy. During the biopsy, Taub notices that Harmon has unusually dark skin (”bronze skin“)and this leads him to run some tests which show that Harmon is in severe kidney failure and in need of a kidney transplant. The differential now consists of hemochromatosis, vasculitis, or scleroderma. When talking to Harmon’s daughter about the possibility of donating a kidney to her father, House notices that she too is sleepwalking (or sleep talking, as the case may be). Soon she starts sweating blood. This means that whatever is affecting Harmon is affecting his daughter as well. The team comes up with three possibilities: it could be an infection, or a toxin (though tests have pretty much ruled those two out) or it could be an inherited condition, of which there are dozens to test. During a conversation with Wilson a short time later, House has his “Eureka” moment as he realizes that both father and daughter are anhedonic (they have the inability to feel happiness or joy). Foreman suggest this could be due to schizophrenia and Thirteen suggests depression, but under House’s questioning, Jerry Harmon admits that his name is really Jamal Hamoud and he is of middle eastern descent. He and his daughter have Familial Mediterranean Fever. Some colchicine and anti-inflammatory medication and they should be better.
Cuddy is excited because she will soon be adopting a baby girl who is due in 2 weeks. She meets Becca, the mother, at a local restaurant and notices a lacy rash on her left forearm. Concerned that it might be Fifth Disease (a viral infection which can be passed from mother to child and cause developmental problems, but only earlier in the pregnancy), Cuddy brings Becca to the ER for evaluation. Cameron examines her and doesn’t think it is Fifth Disease, and the labs support her. Cuddy decides to admit Becca anyway. An ultrasound reveals that the baby’s lungs are not fully developed yet. Cuddy orders steroids to help the baby’s lungs develop quicker, and magnesium to prevent any contractions. A little while later, as Cuddy is explaining things to Becca, she notices that Becca’s heart rate is accelerating and there is what appears to be vaginal bleeding. It is later confirmed that Becca has a grade II placental abruption (the placenta is pulling away from the uterus, causing bleeding. This can be fatal for the baby, who requires the placenta to live, and the blood loss can be devastating to the mother as well).
Cuddy is now faced with hard choice: deliver the baby now (better for the mother, riskier for the baby due to the under-developed lungs), or wait for a week or more (better for the baby’s lungs, but a higher risk for bleeding). She recommends waiting (but it is not clear whether it is Cuddy-the-doctor, or Cuddy-the-mom-to-be talking), but Becca is scared and elects to deliver the baby now. Chase is called in the baby is delivered by c-section. There are some tense moments after delivery, but eventually the baby starts crying and does very well. Everything seems to be moving towards a nice happy ending, but then Becca decides that she wants to keep the baby after all, leaving an emotional distraught Cuddy.
Major complaints are in red, minor in blue, nit-picking in green:
The case presentations and symptoms don’t match Family Mediterranean Fever at all (for instance, there’s a reason it’s called a fever). FMF is marked by recurrent bouts of severe inflammation including fever, joint pain, and abdominal pain that last a few days at a time. Rashes are common as well. Anhedonia can (rarely, very rarely) occur. The patients were showing no symptoms of inflammation. The medications given by House treat the attacks of inflammation only and would not have corrected the anhedonia.
Magnesium Sulfate is not a good drug for stopping premature contractions; recent studies show it is no better than placebo and it can have significant side effects.
Why give Becca a drug to stop contractions when she’s not having any? All tocolytics (drugs that stop contractions), especially magnesium, carry risks.
The most common cause of anhedonia is not schizophrenia, but depression. It’s not a common symptom of schizophrenia at all.
After 2 doses of betamethasone (a steroid) and 24-48 hours, the baby’s lungs will show significant improvement. The preferred treatment in this case would be to wait forty-eight hours (not two weeks) while carefully watching mom and the baby and then carry out the c-section. Cuddy may not have been able to talk Becca into 1-2 weeks of waiting, but 1-2 days would be a good compromise.
Classically, placental abruption is marked by painful vaginal bleeding. Painless vaginal bleeding is more likely a placenta previa.
Cameron should have caught the abruption on the ultrasound.
What is Cameron doing on the OB floor doing the U/S anyway?
Fifth disease has other prominent symptoms: bright red cheeks (hence its other common name “slapped cheek disease”) and bad cold symptoms, usually with a fever. These symptoms all occur a day or two before the lacy rash. Surely Becca would have noticed these (though admittedly the symptoms are worse in children). Fifth disease can cross the placenta and cause birth defects but only much earlier in the pregnancy.
This show loves to throw around fancy medical terms without any explanation. Why then does Taub use the vague term “mini-stroke” instead of the proper medical teram TIA? No doctor, especially one on House’s team, would ever do that. (I’d make another joke about plastic surgeons, but I think I’ve beat that dead horse enough).
There may not be any postpartum depression, but post-adoption depression is quite common.
This is another case where a good physical exam on admission would have caught the significant symptoms earlier (bronze skin in this case).
C-sections are performed by obstetricians, not surgeons. Or is Chase an OB too now?
The medical mystery had some interesting symptoms and lots of potential, so gets a B+, but unfortunately it was squandered potential and the final solution only deserves a D. The medicine, while less hap-hazard than last week, still left large parts out (suddenly he needs a transplant because of kidney failure? from bronze legs?) and earns a C. The obstetric medicine was equally mediocre and shares that grade. The soap opera was good, if depressing (and tantalizing, I guess, at the end), but we needed more Wilson: B+.
October 28th, 2008 at 11:09 pm
I was almost sure they were going to conclude it was either Creutzfeldt-Jakob or Fatal familial insomnia.
October 28th, 2008 at 11:27 pm
Apparently delivering babies is now one of Chase’s many talents…
October 28th, 2008 at 11:39 pm
Get a life!
October 28th, 2008 at 11:42 pm
Official Comment
I have a life, and a very good one, thank you.
Certainly a more fulfilling life than someone who finds the needs to anonymously troll blog comments.
October 28th, 2008 at 11:47 pm
Good episode but…
Chase the Wonder Surgeon strikes again!
I wonder what he will do next time?
Maybe Super Surgeon will perform brain surgery!
Oh wait…
October 28th, 2008 at 11:54 pm
At least Chase is doing a cesarean rather than say the nuero or heart of previous weeks.
October 29th, 2008 at 12:04 am
Dr. Scott: I don’t mean to keep calling you out in the comments on technical points, but the bottom of your review repeats your concluding comments on “Lucky Thirteen” from last week.
October 29th, 2008 at 12:08 am
Official Comment
And that’s why cut and paste can be a dangerous tool
October 29th, 2008 at 12:10 am
All I can say about Chase is that at least he’s wearing eye protection this time.
October 29th, 2008 at 12:20 am
Do the writers even bother looking these medical conditions/diseases up? I looked FMF up on the mayo clinic website after the show and went, WTF? This doesn’t match at all.
Also, shouldn’t someone have picked up the daughter’s anhedonic much earlier? 13 should have when she was talking with her….
October 29th, 2008 at 1:56 am
My sister has FMF, so I was absolutely puzzled by that diagnosis.
October 29th, 2008 at 3:18 am
I have to admit, I was disappointed by this episode (even if it did finally give me the Huddy action I’ve been waiting forever for).
I wish they’d divided this up into two episodes. The medicine in the first definitely seemed sloppy, and I know next to nothing about medicine. It’s sad, because I was actually interested in the case for the first time this season.
October 29th, 2008 at 3:38 am
Obviously constant and regular sex with Cameron has allowed Chase to to master ALL surgical techniques. Like Dr. Midnight. You know, except he didn’t have to go blind or buy an owl…
This means, in the interest of patient care, Cameron should regularly sleep with all the hospital’s surgical staff…
October 29th, 2008 at 4:18 am
I always check out your site for medical reviews, so firstly thanks very much for this, I really appreciate the work you do. I was also confused by the diagnosis, even someone like me with no medical knowledge whatsoever found it strange that Mediterranean fever presented with no fever. However, I really loved this episode as we finally moved away from the 13 storyline (I like her as a character when she’s not focus of the episode – Olivia Wilde just isn’t a strong enough actress to keep me interested a whole 45 minutes). I think you were a little mean with your B+ rating on the soap opera, in my books it was a definate A. It was heartbreaking but beautifully acted, as well as the exciting new developments in the House/Cuddy relationship! I do agree though, it was definately lacking some Wilson dynamic but from the looks of the promo we’ll be getting more next week!
October 29th, 2008 at 4:32 am
Brian Singer said somewhere between season 2 and 3 that the show will be much more for character from now on and much less about medicine. So stop quacking all of you! Enjoy House going rampant on Cuddy instead and finally getting somewhere!
October 29th, 2008 at 4:33 am
Actually a bit worried here. Does lactose intolerance cause kidney failure? I’m primarily New Orleans French creole, and because of the French part of that, I’ve been increasingly lactose intolerant. I’m familiar with the gastrointestinal symptoms, but I didn’t think it got any worse than that.
Did they mean a lactose allergy instead, or did I mishear part of the episode?
October 29th, 2008 at 6:08 am
very glad to hear you have a good life:), more reasons to keep up with these reviews. thanks
October 29th, 2008 at 6:44 am
Sloppy medicine for sure but even sloppier was the kiss between Cuddy and House. It has to be the most unattractive thing I’ve ever seen on TV.
October 29th, 2008 at 7:01 am
“And that’s why cut and paste can be a dangerous tool”
Yes, but scalpel and paste is much more precise.
October 29th, 2008 at 7:02 am
I don’t pay attention to the medicine anymore, but Cuddy not getting the baby was so obvious that I just snorted when it happened.
October 29th, 2008 at 7:12 am
Chase worked in the baby department a while back, when he was collecting double-money
October 29th, 2008 at 7:21 am
ok….so maybe the staff(writers and all) worked on the personal stuff rather than the medical stuff for 1 ep…big deal…..yay House
October 29th, 2008 at 7:46 am
When does Kutner get his big character development episode? We’ve had ones for Taub and Thirteen this season, therefore…
October 29th, 2008 at 8:18 am
So is there a final solution that fits the symptoms better?
October 29th, 2008 at 8:33 am
I can’t forgive this episode its ethical lapses – where was the mother’s own physician & the adoption agency in all this mess? Cuddy had no business acting as her doctor (& apparently keeping the mother’s advocates away) while having a vested interest in being able to adopt the baby. It was particularly noticable at the end when she’s trying to talk the mother out of keeping the baby.
October 29th, 2008 at 8:44 am
Scott:
I’m a med school student and I was wondering what your specialty is. You seem to be spot on about dissecting House episodes and I’ve only been able to catch half the mistakes you have on a good day.
October 29th, 2008 at 9:10 am
Very good points, Athena. Forget the medical inconsistencies, what about the legal/ethical ones! Dr. Cuddy has an obvious conflict of interest and shouldn’t be giving medical advice to the prospective mother of her adoptive child. Another legal question: Who is paying for all this medical care she’s getting? If Dr. Cuddy is giving her free medical care in exchange for a baby, that’s a misuse of company resources and possibly fraud and embezzlement. A good prosecutor would have a HAYDAY with this case.
October 29th, 2008 at 9:11 am
Official Comment
I am board certified in Family Medicine. So basically, a little of bit of everything — which helps when reviewing shows like House.
October 29th, 2008 at 9:19 am
I’ve got to admit, I was a little bummed by this week’s review. I was really interested in hearing your perspective on the various adoption issues in this episode.
October 29th, 2008 at 9:33 am
Official Comment
Karl,
That would have taken me at least another paragraph or two, but here goes:
Cuddy’s ethics in the episode, as others have pointed out, were atrocious. There is no way she should be acting as Becca’s physician and likely adoptive mother of her child. That’s a conflict of interest as bad as any seen on the show before.
It’s interesting that House was being more ethical, realizing he needed a guardian ad litum, which is something Joy should have had appointed.
In terms of who’s paying for the healthcare, many adoptions have an agreement that the adoptive parent(s) will pay for the pregnancy-related healthcare of the mother, and that is likely what happened here.
As for the lack of adoption agency input, I can only speak from personal experience, and say that for our adoption, the agency was nowhere to be seen for the vast majority of the process, and when they finally decided to show up, they acted more as a hindrance to all parties involved than providing any actual benefit. But of course they wanted to be paid.
Due to the ending of the adoption storyline, I strongly suggested that the Polite-wife not watch this episode because that scenario still upsets her, even with the happy ending to our adoption.
October 29th, 2008 at 9:34 am
And, honestly, there’s nobody in the hospital who can make decisions when Cuddy’s not there? Nobody who can sign off on anything while Cuddy’s watching the baby be born?
On googling it sounds like about 5% of babies have underdeveloped lungs at 38 weeks, which I wouldn’t have guessed. But they didn’t mention any possible causes for the abruption except her earlier drug use. Surely they should have been looking into that?
October 29th, 2008 at 9:45 am
I was watching with my girlfriend, and during the scene where cuddy was painting the room she asked “Where is the Baby”. I answered that obviously she was in neonatal icu because of the under developed lungs. She then asked “Then why was Cuddy holding and cuddling the babe after delivery – wouldn’t they have rushed the baby to the icu immiedietely after birth?” Is this just a normal “House” inconsistancy or did I make the wrong assumption.
BTW – Scott: I really enjoy your reviews. I know it must be a lot of work in an already hectic schedule, but we really appreciate it. Looks like you will get a week off – so get some rest :)
October 29th, 2008 at 9:45 am
Great review as always! I personally really enjoyed the dramatic aspects of the episode, but the medicine I found boring this time around. Any body else really missing the cool inside body animations that we used to always have? Now we get one every three episodes or so. Not like I understand any of the medicine, but we used to have House and the team at least throwing out a metaphoric explanation after their medical jargon to help get their point across (and put it into words that an average Joe the Plumber- I mean, average Joe- could understand). Seems like there’s a lot less of that these days.
And I lol’d at Wilson’s last part of the episode. I love it when he gives House the answer.
October 29th, 2008 at 10:05 am
Official Comment
Max:
The baby had a (surprisingly) high APGAR score, and at 38 weeks is considered full term, so unless the lungs were really bad, probably avoided the NICU.
On the other hand, most states have a waiting period for the infant when there’s an adoption (3 days in our case), so Joy was probably just hanging out in the regular nursery during this time.
October 29th, 2008 at 10:11 am
Why was the drug screen negative if the dude was regularly abusing cocaine?
October 29th, 2008 at 10:11 am
I can’t understand how they missed the cocaine in the first place. Wouldn’t a drug screen be part of the initial bloodwork? That drove me nuts the entire episode.
October 29th, 2008 at 10:16 am
Wait a minute. Scott, I just read your “who is Scott” thing. Am I to understand that you worked at Area 51?
October 29th, 2008 at 10:20 am
Even with the medical, administrative, ethical, and geographic lapses (Iraq – or better yet, wherever Arabs may live – really stretches the definition of Mediterranean) I still thought it was a great episode – definitely one of my favorites. There were a few directions the Cuddy soap opera could have gone, and people would still have seen it coming from a mile away. So color me suckered in.
I just wished they had actually tested for Ebola so I could have gotten more points.
October 29th, 2008 at 10:24 am
I guess he only tested positive for cocaine while sleeping. Shoulda done a sleep drug test. And, of course, he could have been arrested by sleeping policemen.
What was the baby’s APGAR score? I must have missed that bit.
October 29th, 2008 at 10:35 am
Official Comment
The baby’s 1 minute APGAR was 9.
As for the drug test — it could be that he did Cocaine rarely and it had cleared his system by the time they did the test.
October 29th, 2008 at 10:38 am
Ledasmom:
The APGAR was 9/10.
Am I the only one who thought Dissocitative Identity Disorder in the beginning? Losing chunks of time, unexplained appearance/disappearance of objects (coffee pots)…
October 29th, 2008 at 10:46 am
“Polite-wife”, that’s better than her being the “dissenting wife”.
Wouldn’t you want to have the room painted at least a couple of weeks before the baby arrives to cut down on the fresh paint fumes?
October 29th, 2008 at 11:02 am
Official Comment
Karl:
A lot of adoptive parents wait until they know the adoption is going through until they set up the nursery. Superstition? Maybe. But it’s more that you don’t want to be left with a reminder if things don’t work out.
We didn’t paint our nursery until we got back from the hospital, child in tow. He slept in a bassinet in our room for the first month or so anyway, so paint fumes weren’t an issue.
October 29th, 2008 at 11:22 am
HP: Nope, I totally thought that too. “Oh, he’s losing time. Must be DID.”
October 29th, 2008 at 11:23 am
Although strictly not a medical issue, the KISS at the end of the show was really inappropriate. Maybe a long hug with House consoling a grieving Cuddy. And then, MAYBE, that could have led to something even more initimate. But that sudden surprise kiss left a bad taste in the mouth. I know House has been teasing and flirting with Cuddy but this just did not feel right. What a relief when he said goodnight and left her at the door.
October 29th, 2008 at 11:31 am
“I think I’ve beat that dead horse enough”
WRONG!!! Keep ‘em coming! In addition to the Chase jokes such as…”C-sections are performed by obstetricians, not surgeons. Or is Chase an OB too now?” LMAO!
That was almost as funny as this from last night:
“Who’s that?”
“Dr. House, the one you’ll be suing when you become septic..”
ZINNGGGG!!!
October 29th, 2008 at 11:40 am
I’m afraid I was waiting for Cuddy to tell Becca “If you want to take responsibility for the baby, you have to pay the hospital bill.” My grandson was just born for $38k and that was without a C-section.
It was all very peculiar, with Cuddy meeting Becca for the first time, rushing her to the hospital, and then deciding not to let her out of her sight.
I don’t mind the convention that whenever there is surgery Chase is doing it (I think this goes back to the first season). I assume that is because his voice is the most distinctive so even with a mask you know who is talking. I don’t mind that House’s team does stuff nurses should be doing, or that the plastic surgeon or neurologist has a very wide range of medical knowledge and skills.
I do mind being given medical nonsense to pad out a soap opera. It’s fine and dandy to have lots of character development. If you are going to do that, then cut back on the barrage of symptoms or at least extrapolate them from a possible actual disease!
October 29th, 2008 at 11:41 am
Chase, the wonder surgeon! to the rescue, as always ;D
I read elsewhere that adoptions in NJ aren’t valid until 72 hours after the child’s birth, presumably to give the birth mother time to reassess her options etc, but it also seems to me that Cuddy actually brought the mother’s change of mind on herself. If she hadn’t been so close to the mother, but had actually done the right thing & appointed a guardian & kept out of the decision process the mother wouldn’t have had the same basis on which to change her mind. At some level she got punished for being a bad doctor.
October 29th, 2008 at 11:48 am
I can totally understand the waiting to paint, superstition aside. That would be a painful reminder.
I am not superstitious, but there are things I don’t do (like talking smack in a competition), not because I am superstitious, but because I look or feel like an idiot if things turn out differently than predicted.
I am guessing you are off today, as you have so much time to post. I am working, but have time to post while waiting for pre-production servers to reboot after patching.
RE: the kiss at the end- I didn’t buy it at first, but upon further reflection, it makes sense.
Cuddy, was obviously vulnerable, feeling depressed and alone, and needing to feel something, anything else. (She also has deep respect and admiration for house’s intellect and abilities, and also, it would seem, an underlying attraction to him as well)
House, is desperately insecure about the people who are important to him. He treats them like crap so he can pretend it doesn’t matter if he looses them, but panics when anything changes to affect his relationships. He has always been attracted to Cuddy, and apparently has a crush on her.
October 29th, 2008 at 11:50 am
Danial – Say it ain’t so. The sexual tention between house and Cuddy has been thick since season one. I think the only reason House was upset about the adoption was because he wanted to make one with cuddy (from scratch). …..And apparently cuddy was thinking the same thing because the kiss was Hot !!
October 29th, 2008 at 12:00 pm
Still wondering about the lactose-theory. I never heard of a “lactose-allergy”, only intolerance caused by lactase-deficiency (which wouldn´t have caused an allergic reaction). Have I missed something here?
October 29th, 2008 at 12:05 pm
Anyone notice how Scott ignored my Area 51 comment? He must not be allowed to talk about it……spooky eh?
October 29th, 2008 at 12:21 pm
Izzy, I’ve talked to Scott about that in the past, but all I can remeber is a bight white flash, and then I’m back at home watching TV.
Please shut down your computer and wait for the men in black to arrive.
October 29th, 2008 at 12:48 pm
Chase’s “That’s Dr House, whom you’ll be suing when you become septic” was possibly the best line in an otherwise-disappointing episode. For me, at least, it definitely didn’t live up to the hype–the kiss at the end was a new development, but I’ve never been a strong shipper for any pairing and really don’t care to see so many soap-opera elements in a medical show (there’s a reason why I detest Grey’s Anatomy). The only upsides to this episode were the absence of the private investigator, whom I continue to dislike (though wouldn’t he have been the natural choice to go buy the cocaine?) and the presence of Wilson.
I have to say, I’m considering ending my steady relationship with the show–it’s fine to move onto more character-based storylines, but at least let the medicine be more than a vehicle for a soap opera! Please!
One final question–was the rash on Becca’s arm ever explained, or are we to assume that it was something irrelevant and harmless?
October 29th, 2008 at 12:50 pm
ML- Maybe they meant a milk allergy but managed to get it wrong. People with milk allergies are allergic to caseine or whey rather than lactose, but since the source would be the same for all of them, they probably weren’t careful about looking up the proper term.
October 29th, 2008 at 1:02 pm
I think the father/daughter’s symptom they referred to as anhedonia would more correctly be described as flat affect–definitely a symptom of schizophrenia.
October 29th, 2008 at 1:15 pm
I think that all of my gripes with this week’s episode have been covered already by others… that’s what I get for scheduling early-morning/all-day meetings on Wednesdays. :-/
Two things I will mention, though: (1) The clinic scenes were always very good at bringing comedy into the show (viz. contraceptive “jelly,” the cow lover, etc.). With the emphasis on character drama, we’ve lost the clinic and a lot of the humor. (2) The preview for the next episode suggests we’re taking another step on the road to a GA-like soap opera, which at least means ever more fun reading Scott’s medical slice-and-dice.
October 29th, 2008 at 1:17 pm
I am board certified in Family Medicine. So basically, a little of bit of everything — which helps when reviewing shows like House.
So, basically, you’re the “Chase” of your hospital. 8^)
October 29th, 2008 at 1:19 pm
House’s white board has returned!!!
It was missing for the past five episodes.
October 29th, 2008 at 1:38 pm
despite all the ethical/medical lapses of this episode it was by far my favorite this season (apart from the one where wilson comes back- adverse events?). house has FINALLY shown his feelings for cuddy, which anyone with two eyes and a brain can see has been on the agenda since the first episode. really enjoyed the cuddy storyline. yep, it was obvious she wasn’t getting that baby but i think the writers get some sort of morbid pleasure out of keeping their characters in a state of constant misery. the medicine had me interested the whole way through even if the diagnosis didn’t work. still missing clinic duty. im excited for next episode- looks like JM and JS will finally get some screen time. thanks for the review, interesting and thought-provoking as usual.
October 29th, 2008 at 1:46 pm
Since I don’t have enough medical knowledge to comment on the medical stuff, but I can comment about the paint! Actually, there’s little danger of paint fumes causing a problem for anyone after about 24 hours. Once the paint is dry, there may be a paint odor, but the fumes are only released when applying the paint, and settle quickly afterwards. A good vacuuming of the floors 24 hours after painting will make the room completely safe. And really, interior paints aren’t usually that volatile anyway. So, the point is, Cuddy wasn’t really out of line painting when she did. And besides that, she’s a busy woman! Superstition aside, maybe she had it on a to do list and thought she had an extra two weeks to get it done!
What doesn’t make sense to me is how the baby scored a 9/10 Apgar! Both my children wailed like banshees the second their heads were out, and they both scored 9’s. How does it happen that the baby doesn’t cry for almost half a minute, then weakly starts mewling, and they evaluate her at a 9?
October 29th, 2008 at 1:56 pm
So we kind of explained the anhedonia with FMF (like Dr. Scott said, far-fetched diagnosis), but what about the sleep walking? Did I miss something? And what caused Jamal’s kidney failure or was that a coincident. I am confused…
October 29th, 2008 at 2:09 pm
I have found as this season of House has gone on that I pay increasingly less and less attention to the medicine and more to the other aspects of the show. In fact, I paid so little attention to the medicine in last week’s episode that I had to come here to remember what the heck had happened. I don’t have a heck of a lot of medical knowledge, but even I can tell that the medical aspect of the show seems to have become “come up with interesting symptoms, find something that only vaguely fits later.” To a certain extent this would be bearable if the rest of the show was being written well, but the soap opera is coming off flat as well. The only episode I’ve truly loved for the non-medical aspects is the one with House’s father dying, everything else has been a bit bland and predictable.
This episode really should have emphasized the House/Cuddy relationship more-no, not the shipping stuff, the conflict of interest Cuddy was having and how she was dealing with it versus how House deals with things. I also am starting to think that the writers are perfectly aware of how silly it is for Chase to keep popping up everywhere and are seeing how many places he can show up wielding unexpected surgical knowledge as a study in absurdity. That would make his skill make sense. Instead of, you know, being lazy writing.
October 29th, 2008 at 2:31 pm
I think two major complaints should also be noted:
I have narcolepsy and the remark about narcolepsy being caused by cocaine abuse (at 16m15s) is very insulting to me. Actually, I was not able to find a single medical opinion that says so. The authors might have confused that with the fact that modafinil, the primary drug used in the symptomatic treatment of narcolepsy is used experimentaly in the treatment of cocaine addiction. It should also be noted that the definitive cause of narcolepsy has not yet been established, with genetic predisposition and autoimmune causes being yet to be proven hypothesis.
At about 20:45m, House suggest treating for allergic reaction since the patient was lactose intolerant. Lactose intolerance is not an allergy since, as far as I know, no immune reaction is involved, only a genetic lack of a specific enzyme. It is not even considered a desease in, say, China, where the overwhelming majority of the population is lactose intolerant.
October 29th, 2008 at 3:23 pm
i dont understand a lot about medicine, but i am fairly disappointed that the medical issues get more and more inaccurate. i love this site as it straightens out the errors and i dont have to believe those medial lies.
i have to say though that i was so excited by the kiss in the end! i agree with karl and max there. seems like house is letting in some human affection istead of always running away from it in his great cynical way.
but honestly, i think this would have been a great end to the whole show, because i cant imagine house now being (happily) evolving his relationship to cuddy and then i would also be disapointed if it is just a kiss that keeps up the sexual tension between them…
i am indeed very curious what will happen but i m quite sure ill be disappointed.
October 29th, 2008 at 3:26 pm
Favorite part- Kutner joins the baby pool.
House writes down ….Kutner
Kutner: “Wait- I’d rather use a pseudonym.”
House: “Good idea.”
House adds an s …. SKutner
October 29th, 2008 at 4:03 pm
My mind has already learned to block away Chase whenever he’s doing surgery. Jesse Spencer stops being Chase and becomes Generic Doctor #3.
Anyway. YES. That ending is everything I was hoping for for the last few years. All the way through the episode I was so distressed because House was torturing Cuddy at a terrible time.
And the intro sequence is just SO interesting. Well directed, well thought out. I was really into the two patients before the opening had even started.
October 29th, 2008 at 4:39 pm
Regarding milk, lactose, allergies, intolerance…
The problem was first described, reasonably, as a “milk allergy”. This is an allergy to some part of the protein component of milk, and could indeed lead to kidney problems.
House himself let slip the “lactose intolerant” term later in the episode, which was either sloppy scripting, or a slip on HL’s part. Lactose intolerance is not an allergy, but a failure to digest lactose, part of the sugar component of milk.
That bothered me quite a bit, though not as much as Cuddy never being called out on her unethical behaviour (I’d expect Cameron to speak up), or that nobody noticed that Dad & Daughter were zombies from the get-go.
October 29th, 2008 at 4:47 pm
This doesn’t pertain to the episode, really, but as a general comment:
The few times Chase has referred to Cameron since their roles were reduced, he has used her surname instead of her given name. I don’t remember the specific episode where Chase mentioned not allowing “Cameron” to own a cat (something about allergies?). If they were in an intimate relationship, would he not call her Allison?
It’s kind of a staple of the series for everyone to be called their surname, even close friends (Wilson never calls House “Greg”, though Cuddy does sometimes), but in the case of Chase and Cameron, it seems a little… off-key.
October 29th, 2008 at 4:50 pm
Based on reading others, I guess I was alone in seeing the whole baby angle as an arc across many episodes. I expected a least an episode of House trying to save “Joy”. Then again, I guess that story can still come.
I completely agree with the FMF diagnoses. It really was an intriguing scenario, but didn’t need to jump the tracks with the “mediterranean ” angle. Furthermore, what was the quack by “13″ that the daughter was healthy enough to “toss over a kidney”? Does he still need a kidney? Is the daughter’s consent still valid, once she was diagnosed with FMF, and more importantly gave consent when she apparently was “sleepwalking”?
These may seems minor twits, except for the show, they added what in terms of drama or length to the show? The FMF was certainly a twist, but the scene necessary to explain the “mediterranean” aspect was short and could have easily been filled with “character development”. The kidney line at the end was definitely throw away.
As for the adoption, I wondered the same thing about the paint fumes, and asked my wife, who is level 3 NICU qualified RN, about that. Her response was “38 weeks? That baby should be fine”. I’ve seen some of her 23 weekers. Major differences between 23 weeks and 24 weeks. Not so major difference between 38 and 40. Come to think of it, perhaps no story remaining with Joy, unless Becca changes her mind again.
I’m glad to here House left Cuddy after the kiss. My DVR cut out during the middle of the kiss, so I assumed the show ended there. I agree with many of the characterizations of House’s character made by commenters here. One thing though is as much as House is a jerk at times and will often take advantage of certain situations; he seems to have a line he doesn’t cross when taking sexual advantage of a woman when he otherwise might try. Besides adding a hint of being a gentlemen, I find it more believable for a doctor of his stature. If he’s in it for the sex, he would taken advantage of that gravy train long ago, and he would never be where he is now (neither would the show).
October 29th, 2008 at 4:51 pm
Just wanted to say that I am a big fan of both House, and your medical reviews. Keep ‘em up!
Second thing: Is it just me, or does anybody else miss the clinic scenes?
October 29th, 2008 at 4:51 pm
Just curious…why don’t you post at the end of every review a plausible medical diagnostic,that fits the symptoms… or at least the major ones :) It’d be more fun to read like that :P
October 29th, 2008 at 4:58 pm
I’m not a doctor, but a medical student that just finished his ob/gyn rotation. We were taught that you cannot rule out abruption with ultrasound — retroplacental clots are only present 30% of the time, although personally, I don’t think any residents have ever seen such a finding.
October 29th, 2008 at 6:04 pm
i just can’t laugh enough over those two lines:
Cuddy: “You are going to pay for that”
House: “I’m already paying for it ….. with wisdom”
and
House: “I’m a humanitarian”
Priceless :D
October 29th, 2008 at 6:49 pm
To all commenting on the supposed development of the House-Cuddy relationship:
You IDIOTS! (I’m quoting House here.)
There is no development and there is no relationship. House is obviously screwing with her mind and her hormones. He said she was “cheating” on the pregnancy, so he must also believe she is “cheating” on the “stillbirth” of “her child”. The depression would likely have taken care of itself, but the hormones….
I look forward to see how long it goes on before Wilson steps in and puts a stop to it, since he considers Cuddy a friend, and also sort of wants to jump her.
October 29th, 2008 at 8:26 pm
Two complaints from the L&D peanut gallery here:
1) Betamethasone is used prior to 34 weeks LMP to speed development of the lungs, not to treat pulmonary hypoplasia. Also, it does not require hospitalization “because of risk of infection”.
2) Pulmonary hypoplasia, if severe, is always fatal. If it’s bad enough that Cameron (an ER doc! They HATE pregnancy!) can pick it up on ultrasound, there’s no way this kid’s apgars are going to be 9/10.
October 30th, 2008 at 2:11 am
Harvey,
Iraqis and Armenians could certainly have FMF. The name is not to be taken so literally.
October 30th, 2008 at 2:14 am
I have FMF. What a silly episode. They were totally way off with their understanding of the disease and causes.
October 30th, 2008 at 4:33 am
Lactose Intolerance? Really??
OK, so Jerry is allergic to the milk in his BLACK coffee that he NEVER DRINKS to begin with?
October 30th, 2008 at 6:00 am
As a doctor (albeit dental one) I could not help but wonder – this fever thing that they pulled up as the answer should show up on ANY of the blood works right? I mean elevated WC count increased hematocrit that kind of stuff? Apparently it is not a medical mistery anymore unless everything is normal at the begining and then suddnely starts crashing in the middle of the episode. Also kidney failure this severe (requiring transplant) without any symptoms exept the LEGS? If I really start picking the medicine here it will truly never end(and as I said I am but a dentist) Abusing the House/Cuddy interactions by the comments however hurts me. I honestly think that she is as much attracted to him as he is to her – and that is why the kiss makes sense – it is the solution to the mystery she asked about 5 secs before that. And yes, in case nobody noticed, House is a 8 years old who does not know how to show a women how he feels and needs to abuse her to the point of crying and swearing to get some sugar from her.
October 30th, 2008 at 6:31 am
Whoops, rewind.
I was contesting the Ducklings citing milk in the fridge as proof of Jerry’s lactose tolerance (see aforementioned reasons), plus House’s lack of noting the second argument. ‘How would he get an allergic reaction by SMELLING the milk swirling in his coffee, you idiots?’
October 30th, 2008 at 6:57 am
Dr Scott I really appreciate the work you do, most people watching this show no nothing about medicine and your analysis is perfect and easy to understand.
I’m a physician too, no in US, so the doctor-patient approach is very different. I ‘ve always assumed that these kind of TV- shows had medical advisors to avoid bad medicine. Unfortunately lately in House the medical stories are far fetched more like case reports, symptoms and therapy are sloppy. This episode is one of the many saved by the soap opera story than the medical mystery.
Thank you again, i enjoy reading your reviews.
October 30th, 2008 at 8:33 am
Nonny Amous:
The cocaine was cut with milk powder.
October 30th, 2008 at 9:35 am
Great review. I was really interested in the father/daughter case and wished the writers had spent more time on the development of the solution. Not even close to enough Wilson.
My, my, my, Cuddy is extremely unethical but that’s not a surprise. She’s done many unethical things to save House. The kiss was extremely nasty. Just disgusting.
One poster said that House is like an eight year boy and doesn’t know how to approach a woman. What about Stacy? What about Honey, or the dwarf mother? I don’t think House is interested in a relationship with Cuddy. It took one week for Stacy to move in. House and Cuddy have worked together for eight years and this is the first time that he feels this overwhelming sense of desire for Cuddy. Not buying it.
October 30th, 2008 at 9:52 am
Too bad for my late father that he never got to be checked out by House’s team. The doctors at the local hospital put him through every conceivable test but didn’t even think that it might be a recurrence of his FMF (30+ years after the last one) until my mother brought them an article about FMF, at which point they all said “Of course, we knew it all along.” Then again, since my father’s symptoms actually matched those of FMF, maybe the House team wouldn’t have figured it out after all.
October 30th, 2008 at 11:34 am
Two comments:
1. re: people calling each other by their last names – I don’t really mind that, because it made the differentiation all the more sharper when in earlier seasons, Stacy was the only person who referred to House as “Greg”, underlining the fact that she is the only one who has ever been close enough to House (and the only character on the show to be close to another main character on the show…) to call him Greg. Plus she was the only one whose relation to House did not begin by being colleagues (even though she worked in legal, it’s not like she’s a colleague of House the way Wilson is)
2. Huddy: my boyfriend made the astute observation that while there is a lot of sexual tension between the two of them, House is more like a kid of Cuddy’s. Especially in the scene in her office where he deliberately knocks over her lamp, it’s like a bratty little kid testing the limits of an adult, giving her a sidelong look as he pushes it off the table. Maybe he didn’t want Cuddy to adopt because the baby would replace HIS role as the child :D. Plus Cuddy is incredibly indulgent of House, as is Wilson…they’re almost like his mommy/daddy figures.
October 30th, 2008 at 12:08 pm
love your work Dr. Scott!!!
October 30th, 2008 at 12:53 pm
Tom Canada:
The reason Chase said he didn’t want Cameron to get a cat was because he was removing a bezoar from a patient’s stomach and compared it to a hairball that a cat would cough up.
October 30th, 2008 at 12:55 pm
One thing that bothered me is why are all the babies in the cribs in one room with no mothers?
That’s just a terrible way for babies to start life, where’s the bonding, getting breastfeeding established….the rooming in? Surely they don’t still practice the archaic and detrimental idea of seperating newborns and their mothers? Be like cutting my arm off to have my newborn in a different room to me.
October 30th, 2008 at 1:34 pm
Karl: That was funny man, I’ll let the Area 51 thing go. For now………
October 31st, 2008 at 4:05 am
Am I the only one to think that the House – Cuddy kiss was totally out of place?
Is House about to turn into a mediocre soap with just a medical touch-up to only make it look smarter? I certainly hope not.
All the while the characters on House are interesting to follow, it is the medical mystery and lack of cheap romance that sets this show apart.
October 31st, 2008 at 4:51 am
I think Wilson will be surprised should House seriously develope a relationship with Cuddy, which seems come out from nowhere.
October 31st, 2008 at 7:36 am
I didn´t get this episode very much. The diagnosis in their main case made absolutely no sense. Mismatching lactose intolerance as milk allergy was a great medical mistake doctors wouldn´t make. And I´m sorry about Cuddy not having the baby. I somehow knew she couldn´t have her cause then she´d stay at home and she´s necessary for the show, but this went too far! I hope her dream fullfills one day. Maybe she´s gonna have a kid with House?:-))
October 31st, 2008 at 8:25 am
I buy Chase calling Cameron by her last name. I know a couple that does that just as pet names, and since Chase called her Cameron for a couple of years before they became more than colleagues, I can believe he would not make the switch to Allison.
What I am curious about is Cuddy not wearing a mask during the C-section. Even if that was acceptable, it seems as though that would be a risk she wouldn’t want to take around what she thought was her own baby.
October 31st, 2008 at 9:40 am
I’m not a doctor, but I believe anhedonia or, more fancily, lack of affect, really is a common symptom of schizophrenia. Quick (and vulgar!) google searches offer these:
http://schizophreniabulletin.oxfordjournals.org/cgi/content/abstract/32/2/259
http://jama.ama-assn.org/cgi/content/abstract/286/4/427
http://www.springerlink.com/content/951026g437473264/
Make of that what you will. Great reviews, though. Always a fan.
October 31st, 2008 at 11:26 am
This is for Leland (and everybody really) re: “My DVR cut out during the middle of the kiss…” SO DID MINE. This happens quite often on House and on many other shows. The Guide and the actual broadcast are not the same and the recorder just stops at whenever the guide says.
Is there some way we can protest to FOX or or cable companies or Scientific Atlanta or somebody when a show goes over the “scheduled” time and the last FIVE minutes are lost. This included the end of the episode and all of the preview of the next episode.
The only way I can avoid this is to set the time individually for each episode and not use the “Record all New” because that is always the wrong block of time.
Very Frustrating…
P.S: Scott, THANKS, THANKS, THANKS, for this blog. You’re terrific for doing this for other fans. House is the -only- TV that I watch, other than the Simpsons. So having this group of fans and you with the expertise is just great.
October 31st, 2008 at 12:48 pm
I didn’t get the soap opera angle at all.
I knew from the start, pretty much, that there was no way in hell the desperately yearning Cuddy was going to be given a baby. And I pretty much surmised that the unspoken motivation behind House’s more than usually spiteful observations to her was going to be his jealousy of her as a surrogate mother for himself.
But that kiss at the end? Does that mean he’s going to offer himself to be the father of her child? Or as a lover?
All I’m asking is, for god’s sake, writers, please don’t turn this putative relationship into a multi-episode, cross-season, he-does-she-doesn’t-and-vice-versa, Ross-and-Rachel thing because, whatever your producer is telling you, it isn’t suspenseful and is in fact grindingly annoying and alienating.
October 31st, 2008 at 2:50 pm
I can’t wait to see how House and Cuddy will act once they make it back to the hospital after that kiss. I predict they ignore it and pretend nothing happened, but that Wilson will figure it out. Just wondering what everyone else thinks.
The kiss really suprised me, though. I thought House would see it as taking advantage of her in her emotionally distraught state. Maybe he just wanted to convince her that he wasn’t just jerking her around to be mean.
And, yes, I know. I didn’t say one word about the medicine. Ah, maybe next time.
October 31st, 2008 at 9:32 pm
i’m with studento…you can’t r/o abruption with u/s!
October 31st, 2008 at 9:46 pm
Cuddy needs 2 units of O negative for the patient? Where’s the Rhogam? Or, alternatively, why didn’t she type & screen the pt when she first came in?
October 31st, 2008 at 9:55 pm
and why isn’t cuddy wearing a mask in the OR? no circulating nurse worth her salt would let ANYONE get away with that. no bladder blade either. and i agree with an earlier poster…i think that dad & daughter’s appearance is more consistent with flat affect than anhedonia.
November 1st, 2008 at 6:02 am
The diagnosis is not completely wrong. But it misses out the most obvious symptoms, inflammation and abdominal pain. only 5% of FMF patients don’t develop any abdominal pain.
The rest fits, though with too much coincidence. On75% of patient experience joint pain. 25% with fever but no symptoms (they should have found out the fever!) It’s hard to believe those two patients don’t experience joint pain and have undetected temperature spike.
November 1st, 2008 at 10:36 am
I think that the medicine is starting to go down because they could use all the rare diseases in the world, but it has to fit supporting the story and its continuity.
It may not be so obvious for some people, but since ‘the drama’ is what makes a drama a success I think that the producers sacrificed some technicalities to make the story a little more powerful.
Remember that most of the times House figures out the solution with lateral thinking from analogies from unrelated situations, like talking about “adoption” with cuddy-> fake parents -> different race -> FMF (…and walking out without saying anything)
If rare diseases and real medical solutions became a priority in the show, probably the stories around it would be modified substantially.
November 1st, 2008 at 11:54 am
I have to correct you. As a person interested in the psychiatric nursing field (I’m only a student at the moment) I know that anhedeonia is a common NEGATIVE symptom of schizophrenia. It is a common symptom of depression as well, but also schizophrenia.
November 1st, 2008 at 5:33 pm
I’ve reached the point where I block out 90% of the medical trainwreck–otherwise I just scream at my tv and that frightens my cat. Did they have to cut a medical consultant’s job last year when they added the Russian novel sized cast of secondary characters? Can’t they at least afford a subscription to an ID journal? Despite the lackluster medical plot line, this entire season the institutional/professional issues have been driving me nuts. The hypnotist with Hollywood hair and mad surgical skillz has to be stopped, yes, Chase Superstar must die.
Where are the other doctors at PPTH??? There’s got to be one ob/gyn floating around…
November 1st, 2008 at 10:38 pm
Cant we all just accept the fact that Chase is the
super-surgeon, he can do surgeries, deliveries, neurosurguries, anything that requires a sharp object.
Oh and he can also cure leprosy with his touch.
November 2nd, 2008 at 5:28 am
It seems in all of your things it says “a good physical would’ve caught this” or something to that effect. Isn’t that the point of the show that people miss things in first series of physicals? Otherwise House’s team wouldn’t really be necessary would it?
November 2nd, 2008 at 6:54 am
Scott, I love your site, awesome medical analysis! I’m a medical student thinking of going into primary care myself and am impressed by your field of knowledge about basically everything – you seem to be very well trained. If you don’t mind me asking where did you go to med school and where did you do residency?
November 2nd, 2008 at 8:02 am
I don’t think Wilson will step in – I think House will make him say stuff to Cuddy to better gauge her feelings.
Why? Because that’s what he’s like. I think Wilson wants them to get together as well :D
November 2nd, 2008 at 6:08 pm
Although magnesium sulfate isn’t properly supported by studies, I have seen it work very well by the OB in my hospital.
PD: I wanna be a wonder surgeon like chase.
November 2nd, 2008 at 6:13 pm
I think Chase could operate a hangover if he wanted.
November 2nd, 2008 at 8:32 pm
Scott – how on earth have the House team not recruited you yet to screen the scripts?
November 3rd, 2008 at 3:56 am
“What is Cameron doing on the OB floor doing the U/S anyway?”
Not sure why she’s doing the U/S, but without being a doctor myself, I can hazard a guess why she’s on the OB floor: Cuddy thinks the rash might be Fifth Disease, the CDC site said that the physical symptom should be confirmed with a blood test “to look for antibodies to parvovirus.” Cameron’s an Immunologist, so that sounds to me like exactly the sort of thing to call her in for.
November 3rd, 2008 at 7:27 am
There´s no logical reason for Cameron doing the ultrasound. Perhaps Cuddy wanted her to be Becca´s attending. Btw. why did Cuddy take Becca to the ER? She obviously wasn´t accute, so she should have taken her to the clinic. The only reason is, again, Cameron. Magnesium sulphate can be used for tocolysis when beta-sympathomimetics are contraindicated. And why this preventive tocolysis anyway?
November 3rd, 2008 at 8:00 am
Official Comment
Jim,
Cameron already ran the test in the ER (”twice,” as she said).
November 3rd, 2008 at 11:50 am
Having no medical training whatsoever, normally the medicine is not a problem for me. In this ep, however, I did go WTF a couple of times. The cocaine vs. clean blood test was one (sorry, Scott: your explanation for it, though plausible, does not convince me: if he consumes rarely, how lucky is it that they get to witness the purchase, and come he seems to be a regular costumer). Another one was when the guy starts sweating blood and they go “that rules out allergies”. Maybe I missed the point, but the fact is the only register I’ve ever had of someone sweating blood is, precisely, a woman who was allergic to cats and had this reaction while at my place.
And of course milk allergy and lactose intolerance are NOT interchangeable… I guss that goes hand in hand with the EP blunder from some weeks ago.
As for SuperSurgeon!Chase and DoingNursesDirtyWork!Doctors, I simply accept them as conventions of the show, for storytelling purposes.
I did like the drama, though, and actually howled with the kiss, though I also admit it could get messy from here if they don’t pay attention.
November 3rd, 2008 at 8:17 pm
Ok, well here’s a question for you. Television Without Pity covered this, but it’s something I wonder about now every time I see the show: In the credits, everyone gets some medical image for their credits, then we get to Jennifer Morrison and we’ve got…people canoeing? What’s with that?
November 3rd, 2008 at 10:27 pm
Are you smoking crack? No postpartum depression, you obviously have never given birth!
November 3rd, 2008 at 10:30 pm
Official Comment
Sue:
First, you left the comment on the wrong post; I moved it for you (unless you were referring to Teddy Roosevelt, in which case I apologize).
Second, the “no postpartum depression” statement, as anyone who watched the episode would recognize, was a comment made by Wilson when he was referring to Cuddy who had never given birth and therefore could not have postpartum depression. He also implied that there was no such thing as post-adoption depression, which is incorrect and what I was referring to.
November 4th, 2008 at 12:07 am
No doubt the drama is getting better but the real medicine just can’t get any worse. Previously, the cases in HOUSE were common but with rare complications. Now the cases are very very rare+very very rare complications.
November 4th, 2008 at 2:16 pm
I was surprised to see Becca consicuos and talking during her c-section. Here in Russia (I am Russian) c-sections are performed under general anaesthesia so the patient is sound asleep till the very end of the operation. Is it different in Princeton Plainsboro?
November 4th, 2008 at 2:31 pm
Official Comment
Anne:
In the U.S., most c-sections are performed under epidural anesthesia so the patient is awake.
On another c-section note,
The father (or other family member) is generally allowed in the room and stands next to the head of the patient, in the non-sterile area. This is where Cuddy was.