House — Episode 8 (Season 5): “Emancipation”
An above average episode of House. The medicine was better than recent episodes, though the soap opera was turned way down.
Sophia is a 16 year old emancipated minor working as a factory foreman. She sought emancipation after both of her parents were killed. While talking with a floor worker, she begins to have chest pain and shortness of breath, and then collapses, red frothy sputum flowing from her mouth.
She is admitted to the hospital for evaluation of her pulmonary edema. The initial differential diagnosis consists of parasite infection, gastrointestinal problem, pregnancy, or damage to the heart from drug use. House has Kutner perform an echocardiogram while Taub and Thirteen search Sophia’s apartment. The echo shows no structural heart disease, but the apartment search shows that she likes to build her own furniture, but it also turns up a bong. When confronted with this, Sophia claims that it is her ex’s bong, and it’s the reason that he’s an ex.
The team now considers that she may have intermittent tachycardia (occasional episodes of an abnormally fast heartbeat) due to drugs, though Kutner favors a diagnosis of vasculitis. He wants to giver Sophia steroids, but House turns him down, stating that a steroid could make an arrhythmia worse. House wants to start her on beta-blockers (a drug that lowers the heart rate) to control the suspected arrhythmia. Kutner decides to go ahead with his original plan and gives her steroids instead. A short time later, Sophia is violently yelling at the staff and having paranoid delusions. She is given Haldol (haloperidol — a potent antipsychotic) to control her outbursts. Kutner reports that labs show that her psychotic break is not due to any metabolic problem, and it was too soon to be related to the steroids.
Given the symptoms of lung problems and delirium, Foreman suggests Prinzmetal’s angina (heart pain caused by spasms of the coronary arteries) — only he suggests it involves arteries in her brain, not the heart. House thinks the idea shows promise, so has the team place her on ergonavine )a drug which can trigger blood vessel spasms) and check an fMRI (functional MRI – an MRI that looks at blood flow). Medically, this part makes little — if any — sense, but is really just used to set up the subsequent revelation. The fMRI shows no arterial spasms, but it suggests that she is lying when she talks about her dead parents. Kutner confronts Sophia and she admits that she lied about the death of her parents, and the truth is that she ran away from home because her father raped her.
The team now adds sexually transmitted disease (especially gonococcal endocarditis) and stress to her differential. House feels it is the latter and suggests that Sophia be put on diazepam (Valium) to help with the stress. As Thirteen is about to give her the medication, Foreman notes that she has reddish-brown urine which wouldn’t be caused by stress. A microscopic examination of the urine reveals “shredded red blood cells.” E.coli, Shigella, and Legionnaires Disease are all suspected, but House believes her symptoms are caused by arsenic poisoning from building furniture with treated lumber. The tests apparently support this and she is started on chelation therapy for the arsenic. After the therapy, when Sophia is ready to be discharged (which is always dangerous in House’s world), she suffers a seizure. A repeat MRI shows brain lesions that were not there just a few days before. Infection (syphilis in particular) and cancer are suggested, but shot down. Then Thirteen suggests acute promyelocytic leukemia (APL). A brain biopsy confirms the diagnosis. Arsenic is used to treat APL, so removing it from her system allowed the leukemia to spread. Giving her more arsenic may slow down the cancer, but according to House, bone marrow transplant is needed for the cure. A family donor would be best, but Sophia refuses to let them tell her parents. Disregarding her wishes, Thirteen visits Sophia’s family only to discover that Sophia has been lying and using a stolen identity. Told of this, House believes her responses are too rational and confronts her. She admits that she ran away from home because she killed her younger brother. House convinces her to contact her parents, and in the end we witness a tearful family reunion.
Meanwhile, Foreman is treating his own patient: Jonah, a four year old boy with several days of unexplained lethargy, diarrhea, and bloody vomiting. The standard tests are all normal, so Foreman proceeds with a capsule endoscopy (a swallowed wireless camera to transmit pictures of the inside of the gastrointestinal tract). As he swallows the camera, Jonah starts giggling uncontrollably with no provocation.
Foreman asks Cameron and Chase for help, and they consider meningitis, thyroid, stomach cancer, and porphyria, but all tests are negative. As they are wondering whether they should involve House, Jonah has a cardiac arrest, but is successfully revived.
Foreman does finally go to House and ask for help, but House turns him down. Commiserating with Cameron and Chase he has his own Eureka! moment when he realizes that Jonah is suffering from iron toxicity from all the extra vitamins his brother had been feeding him to make him stronger.
Major complaints are in red, minor in blue, nit-picking in green:
Once again, you do not shock a flatline.
I mentioned this above, but “Prinzmetal in the brain” to be diagnosed with ergonovine and fMRI is nonsense — and dangerous if it worked. If it did cause a spasm, then they just caused a stroke (or at least a TIA) in sixteen year old. How were they planning on correcting that?
fMRI has been studied as a lie-detector – Mythbusters featured it in one of their episodes. It doesn’t work quite as neatly as it did on the show. For one thing, small movements — like talking — will throw it off. Also, while the limbic region of the brain may house “imagination,” it is also important in emotions and long term memories — so it lighting up while talking about dead parents would be expected.
From my reading on APL, it is treated primarily with specialized chemotherapy (including arsenic trioxide) and has a very good response rate. Bone marrow transplant is not considered unless there is a recurrence.
Valium is overkill for an anxiety disorder. That class of drug (benzodiazepines) is not a bad choice for acute anxiety, but there are better choices than Valium, particularly in a sixteen year old.
I don’t know what procedure Wilson was going to perform, but it’s best to put on your surgical mask and eyewear before scrubbing.
Interesting how they immediately ruled out cancer as a cause of the brain lesions…and then ended up diagnosing APL, a type of cancer.
Neither medical mystery featured dramatic symptoms, but both were solid puzzles and earn a B+. The solutions were both logical and fit fairly well so deserve an A-. The medicine was better than the past several episodes but still had some large holes. Foreman’s case was handled better, but he was still stumbling around more than he should. Still, it was better than average (especially this season), so earns a strong B-. The soap opera aspects were minimal, though it was nice to see House interacting directly with the patient. I give this aspect another B-.
November 19th, 2008 at 12:16 am
Just a question – you say that shocking a flatline is not proper procedure. What is?
Enjoyed this episode. They’ve been returning to the humorous quips from House that made the previous seasons so enjoyable, but I feel had been lacking last season. Interested to see where the whole Cuddy/House thing is going if anywhere…
November 19th, 2008 at 12:34 am
Why wouldn’t they consider retinoic acid as treatment for the APL?
November 19th, 2008 at 12:37 am
Official Comment
KV:
The treatment of asystole (flatline) –
CPR.
If possible, fix the underlying problem (hemorrhage, pneumothorax, etc. etc.)
The drugs vasopressin and/or epinephrine and/or atropine.
Check to make sure the leads are attached correctly.
Transcutaneous pacemaker.
RM,
Storytelling. There’s no medical reason not to consider it.
November 19th, 2008 at 12:38 am
“Just a question – you say that shocking a flatline is not proper procedure. What is?”
Drugs and hope it starts up again. Or buy flowers.
Surprisingly good episode, or maybe hearing “Prinzmetal on the brain” just lowered my expectations enough. Foreman’s mystery was painfully predictable though (They didn’t even cloak the giveaway line one bit, just put it right out there).
November 19th, 2008 at 12:57 am
KV – the answer to your question about shocking a flatline was clearly answered last week.
I just had to laugh at how fast the nurses rushed in when the doctor yelled for them and diazepan when the patient was convulsing – the nurses arrived in the room before he finished his sentence. Try that in a real hospital – even in the ICU and see how long it takes.
Otherwise the show was ok although the constant lying from the girl kept me guessing and surprised. And how did she kill her brother? I only heard her say that she keeps seeing an image of him laughing, making her feel like killing him. Did I hear this correctly?
Hugh Laurie is making the rounds of the talk shows again. Today on Helen he talked about finally buying a house in L.A. He also said that limping through all the shows does not effect him adversely otherwise (this was Helen’s first question to him). Until next week then when the previews promise melodrama with guns threatening everyone. I guess the medicine will suffer for it. This kind of drama we see often enough on other shows so I hope it shows some originality.
November 19th, 2008 at 1:01 am
All season I’ve been wishing for the return of the “old House” where the medical mystery was interesting and relevant to the story, not a background story in a soap opera. I think this episode finally delivered!
November 19th, 2008 at 1:13 am
The girl didn’t “kill” her brother, she left him alone in the bath and he accidentally drowned.
Dr. Scott: I’ve been doing some quick reading online about symptoms of iron poisoning, and I still don’t know what gave that kid a fit of the giggles. Was he euphoric from all that iron?
P.S. to Daniel: Hugh Laurie was on “Ellen,” not “Helen.”
November 19th, 2008 at 1:13 am
My guess would be that she was supposed to be watching her brother, but left him alone and he drowned in the bathtub.
November 19th, 2008 at 1:22 am
Isn’t iron poisoning one of the leading causes of death for young children?
Kids take vitamins like their candy, and get serious side effects?
November 19th, 2008 at 1:22 am
=er, that should be ‘they’re’=
November 19th, 2008 at 1:39 am
Wouldn’t an iron overdose show up in blood tests?
November 19th, 2008 at 2:07 am
Worse yet, an iron overdose would put the child particularly at risk from an attack by Magneto.
November 19th, 2008 at 2:22 am
Scott,
Wouldn’t one of the first “normal” tests that Foreman runs on sick kid showing lethargy be blood work up for anemia (and it’s diagnostic non-eureka friend serum iron)?
November 19th, 2008 at 4:14 am
The older brother’s “just like we take our vitamins” line was planted so obviously that I took a mental note.
The 16 year old was way too mature and bright.
Would a doctor really have such a sink-or-swim case to prove himself? I’d have thought that whether Foreman gets to run a drug test depends on his annual review instead. But, I guess that’s not dramatic enough for a drama.
November 19th, 2008 at 6:33 am
Okay episode, but definitely needed more House/Cuddy/Wilson drama.
Honestly, I kept getting annoyed at Sophia with all of her lying.
But it was great to see House interacting with Sophia at the end. Pretty intense.
November 19th, 2008 at 8:24 am
OK, so is this really how they work in a hospital? Just keep throwing treatments at a patient until one works?
Also, how about we skip the tearful reunions in the future and go straight to a scenario where the doctors are arrested and sued for breaking into patients’ houses? Because if a doctor tried that on me, I’d have his ass, whether he cured me or not.
House has become so formulaic I can predict when the episode’s seizure will occur. Last night, when the patient was talking about being released, I said, “OK, time for the seizure!”, and you know, I was right.
November 19th, 2008 at 9:02 am
Once they determined that the teen most likely forged her supporting documents for emancipation, shouldn’t the hospital be contacting, say, the police or social services since she was most likely a non-emancipated minor and her parents had to be located?
That hole would have been nice if it was filled – who was the real Sophia in relation to this teenager? An old friend?
November 19th, 2008 at 9:24 am
I know that 4-year-olds have pretty small blood volume, but could one of the doctors here guesstimate at the amount of vitamins the kid would have needed to consume to have iron overdose? Also, it seems to me that in addition to the iron, he would have high concentrations of e.g. calcium, magnesium, and other minerals, as well as vitamins A, C, D, E, Bx, etc. Are these excreted more rapidly than iron by the kidneys, or is iron deleterious at lower concentrations?
One thing I found annoying about this episode (although it’s definitely a recurring thing) is how the team seems to stand around in the lobby or next to the elevator to wait for House to show up – like they have no motivation or authority to do anything on their own. I can understand waiting to talk to the attending before changing medications or doing invasive biopsies (although can’t they use a phone?), but what irks me is after a 10 second discussion, House says “you might be right, go do the test for what you think it is.” Why couldn’t they start the test before talking with House? If House is such a visionary that all things must go through him, it doesn’t seem like the team is learning much.
Who on earth builds furniture out of pressure-treated lumber? Isn’t it common knowledge that it outgasses toxins? And even if not, it’s ugly and smells, and it’s more expensive that regular 2×4s.
Did anyone else think that Sophia looked like Hellboy after her APL test? I found the scabs/wounds/whatever they were very distracting and funny.
@ Joe – I snickered.
Although Wilson didn’t get a whole lot of screen time this week, I have to say that his dialog was pretty good. My favorite line was after House complained that his being inscrutable was annoying, Wilson going “Innnnteresting…” Classic! :^)
November 19th, 2008 at 10:00 am
“The 16 year old was way too mature and bright.”
Really? I’m 16 and I think she was pretty immature. I know 15-year-olds brighter than her. Age isn’t everything, you know.
I liked this episode, but I’m really starting to miss the clinic duty hours.
November 19th, 2008 at 10:15 am
Why did they give the 16 year old 10 mg of Lorazepam?
I’m an epileptic and I have 1 mg pills to stop my seizures. I’m sure 10 would probably coma me. I’m 18.
November 19th, 2008 at 10:36 am
Official Comment
bros:
I’m pretty sure they only gave her 4MG of Lorazepam, which — while a hefty dose — is the recommended amount for status epilepticus*.
*Admittedly, Sophia has just started to seize so it wasn’t status epilepticus, but at least the dose was somewhat logical.
November 19th, 2008 at 11:02 am
I admit, I loved Wilson messing with House’s head.
Isn’t it a little late for Foreman (who appears to be a seasoned physician in his 40s) to be just now developing self-confidence? I think I’d believe it a bit better if he was younger.
November 19th, 2008 at 11:10 am
As soon as they started talking about the furniture, I was sure it was arsenic related. Recall from early season 3, Chase suggests the autistic child from episode
“Lines in the Sand” may have had arsenic poisoning from the pressure treated wood from his jungle gym/ play house.
November 19th, 2008 at 12:01 pm
You should add as a minor complaint the fact that the little boy seemed to swallow a camera the size of his head with no effort LOL. I was like wtf.
November 19th, 2008 at 12:04 pm
Note on the wilson handwashing scene- my intial reaction was that he had just finished surgery so had already taken off his mask etc. Although being house, there’s a good chance he wouldn’t have been wearing any in surgery anyway.
Foreman being down in the clinic makes me wish house was back there again…
November 19th, 2008 at 12:19 pm
I thought the medicine was off of a checklist: bunch of diagnoses thrown out a bunch of diagnoses to make it look good (isn’t a pregnancy test one of the first things they would have done in the ER?); make up a lot of stuff and don’t worry if it’s not true (if Sophia really had been raped, her limbic system would have lit up like a Christmas tree); it’s time to shock a patient, quick, write something suddenly happening.
It doesn’t make sense for Cuddy not to overrule House since a drug trial would bring money and prestige to the hospital and she’s the one who hired Foreman back, not House. With House acting so immature 90% of the time, I’m not buying that he suddenly teaching Foreman now.
Thirteen is still suffering from multiple personality disorder, one minute she’s berating Kutner for caring, the next she’s berating House for not caring that the girl was raped. (Has she ever met House before?). As well as the writers, Omar Epps phoned his performance in, Hugh Laurie seemed like he was too. Maybe he was distracted by Cuddy but since I have less than zero interest in that, I don’t care. Actually, I didn’t care for most of the episode. Only Peter Jacobson seemed like he was still trying.
I notice they’re still making Chase and especially Cameron look like they’re coming off a 72 hour shift while Thirteen and the guys are gorgeous. Not going to work to get us to like the new team more.
Completely formulaic and not too bright.. Doesn’t anyone in the production office care any more.
Question: since they had been giving her benzodiazepines because they thought she had a stress disorder ::eyeroll::, wouldn’t they still be in her system? Wouldn’t that have mitigated a seizure?
November 19th, 2008 at 12:58 pm
Try as I might, I just can’t summon up any level of interest in the new team. They just don’t interest me, and their scenes have no energy or spark. The patient also annoyed me this week, I didn’t like her and couldn’t invest in her storyline although the medicine was good. I agree with Kate, the episode did seem formulaic, and it seemed like no one was particularly interested. Even House himself didn’t seem on top form. I really enjoyed his interaction with Wilson, and the integration of Cameron and Chase. I missed Cuddy’s snarky presence, and I think a scene with Wilson and Cuddy would’ve made this episode for me.
November 19th, 2008 at 1:25 pm
It looked to me like Wilson was scrubbing up before surgery, not after, otherwise why would he hold his dripping hands upright when he was done? (Just in time for House to breathe all over them, of course…)
Love it that Foreman isn’t wearing a white coat. Remind you of any other doctor?
November 19th, 2008 at 1:49 pm
I sort of agree with the above grumblers about this season, but am not too bothered by it. I’ve lowered expectations from blockbuster levels simply because of how long the show’s been on, and am really focusing on and cherishing the way the writers are sort of polishing and meandering. I still want to see which way our dear leads will go. My only nervous moment was at the end, when Wilson tells House he’ll be all right, and H accepts this.
H’mmm ….. way too warm and uplifting. I still want H, the character and show, to keep that razor edge.
November 19th, 2008 at 1:54 pm
Another question: wouldn’t they have picked up the excess iron in the boy when they did the initial blood work, if not all the later tests they were doing?
November 19th, 2008 at 1:59 pm
Love it that Foreman isn’t wearing a white coat. Remind you of any other doctor?
I realized I’d fully arrived as a “House” fan when I saw the episode in which Wilson is apologizing to a patient for misdiagnosing him with cancer, and suddenly House barges into the office wearing an ill-fitting white lab coat – I shouted with laughter at House’s blatant subterfuge.
As for why Foreman has forsaken the white coat – isn’t that a reflection of his newfound status as Cuddy’s liaison? (Which makes the whole business about asking House permission to supervise the clinical study downright puzzling to me.)
November 19th, 2008 at 2:06 pm
I found the episode just okay, but I had a big problem in the first 5 minutes — A 16 year old working in a factory??? Esp what seemed like some type of metal-forming plant? Don’t think so. Unless I am greatly mistaken US wage laws prevent minors from those types of jobs and I doubt emancipation would make any difference. I don’t think they can even work in the offices if they’re located in the same building.
I’m glad someone else noticed the size of the camera pill. And he didn’t even flinch!
November 19th, 2008 at 2:58 pm
So they concluded during the fMRI that she was accessing her “imagination zone” when talking about the rape. I suspect that isn’t the first time she’s told that lie. Wouldn’t she be accessing the memory part of her brain, because she wasn’t actively creating a new story?
November 19th, 2008 at 3:05 pm
I have a question about the treatments and recovery times.
1. For the boy – I don’t remember if they said how they treat the iron overdose, but would he recover that quickly?
2. For the girl – same thing for the arsenic chelating…is it wham bam you’re done go home?
In general, recoveries on this show take a matter of hours – when I had a bad cold two months ago, it took me a few days after the worst was over to have any energy back!
Also – the lesions on the brain – they chelated her, then bam! lesions. Do they really come on that quickly? In a matter of hours?
It seems endemic to the show, really – once they figure out the real diagnosis / treatment at minute 57, there’s no recovery time or issues at all! They practically kill each patient every week with all their treatments – I would think they need recovery from that too!
November 19th, 2008 at 4:04 pm
At last an episode with a reasonable medical mystery. It was a good one. I really felt again why I wait for this show every Tuesday. Your review is great. I really wonder if the writers don’t know their obvious mistakes. Maybe they have to sacrifice some realistic medical points to make the show more exciting for non-medical viewers.
What Wilson was thinking, not wearing the mask? Do you guys remember how many times we were yelled at for the same mistake in the Med school! I myself learned my lesson. On the other hand, imagine the same conversation with a mask on Wilson’s face.
Someone should give the writers “101 flat-line management”. Do not use the paddles! The same here, maybe the real needed procedures for the flat-line were not exciting enough. Surely injecting vasopressin-epinephrine plus CC (chest compression) were not what the viewers expected.
Anyway all I can say: WAITING FOR THE NEXT EPISODE HOUSE WRITERS.
November 19th, 2008 at 4:30 pm
Question for any medical professionals here: Do you know of any doctors who have ever gone and inspected a patient’s home for toxins? How does this happen every week?
November 19th, 2008 at 5:13 pm
So a 16 year old girl, presumably with no references owing to a fake identity, is working as a factory foreman? Wouldn’t she need experience for that?
I wish we’d get something after series 2 here in Ireland. Ah well, these reviews lessen the annoyance.
November 19th, 2008 at 6:04 pm
Of course, Chase & Wilson don’t wear masks or eye protection, of course nurses rush right in, and of course the patients recover in the last 3 minutes, because: this is Hollywood!! We all know this show is fiction, and we shouldn’t expect it to conform 100% precisely to messy real life :) (If it did, the last scene would be…several weeks long, in real time? Someone in bed, gradually recovering, prepping a lawsuit against the flatline-shockers…)
Also, they want to show the actors’ faces as much as possible, and I’m sure the actors want that, too.
But I love the reviews on this site to learn what’s getting done right and wrong by the writers.
Scott: To me, the most puzzling detail in the epi was that sudden giggling by the boy, which was not explained later….I have never seen that euphoria is a symptom of heavy metal poisoning. Any comment?
November 19th, 2008 at 7:19 pm
Scott,
Thank you for the reviews! I’m no doctor, but I’m always fascinated to see how close to “reality” this show is. It seems to do a surprisingly good job of being accurate for a TV drama.
My question doesn’t relate directly to this episode, but to the show as a whole. I’ve been wondering how “real world” the ratio of “hits to misses” is. That is, House and Co. rarely loose a patient… I imagine in reality things are not nearly so neat. In a real Diagnostic Department, how usual is it for a Doctor/team to miss a diagnosis? From my count, House and Co. have only missed two diagnoses (Euphoria 1, House Training). Other patients have died, but usually unavoidably or from correctly diagnosed, but terminal, diseases.
In the real world, what kind of ratio would a Diagnostic team see?
November 19th, 2008 at 9:20 pm
One other nit: Arsenic is no longer used in pressure treated wood, and hasn’t been for a few years now. Also, it’s pretty expensive these days – a poor kid like her would’ve bought laminated pine for her furniture. Or just gone to Ikea.
November 19th, 2008 at 11:20 pm
If the kid got iron overdose from vitamin pills, shouldnt he also have a host of other problems from vitamintosis? Im sure those pills have more than iron in them.
November 20th, 2008 at 12:51 am
Love the reviews Scott. =) I liked this episode but thought it was pretty rediculous at the same time. It doesn’t seem that these docs do lab workups on this episode. The APL should have been caught with a CBC with differential. If she was in that bad a shape to have “shredded red cells” in her urine, she was most likely in DIC — coags should have been in the toilet too. How does Arsenic work in APL? I know that ATRA pushes the promyelocytes into the next stage of maturation but what does arsenic do?
November 20th, 2008 at 1:03 am
Right at the beginning Kutner said that a Gram stain was negative, but that there was no bacteria. How can that be? You need bacteria to run a gram stain and when you do it’s either positive or negative and that gives you an idea of what you’re dealing with. He made it sound like it was just another test.
November 20th, 2008 at 1:29 am
Phat:
When a Gram stain is “negative”, it usually means that the test is negative for bacteria. Otherwise it would say “Gram stain is “positive for Gram positive cocci” or “positive for Gram negative rods”.
November 20th, 2008 at 3:34 am
Leaving aside that she doesn’t need bone marrow transplant, isn’t bone marrow from the parents not good enough and the best bet is a sibling?
November 20th, 2008 at 3:41 am
At least Chase wasn’t practicing a different specialty this week. After wekks of him being a neurosurgeon, OB, and an anesthesiologist, it was a nice change.
Wilson was definetly going into surgery, since he was scrubbing(you don’t scrub after surgery). And both 13 and Taub should have been wearing masks during the biopsy. A mask should be worn for any procedure that requries breaking the skin.
When Foreman was consulting Chase and Cameron about his case, I thought the show was going to go in a new direction with two teams, and have it be House vs Foreman each week. It would be a good way to bring Chase and Cameron back. Hopefully it will eventually happen since we all know Foreman will get fed up with House. Again..
November 20th, 2008 at 9:27 am
Curious – when was the last time a patient died on House? Isn’t it about time? Last one I recall was Chase – back in S2? Would certainly add some interest, perhaps introduce some self-doubt for House. And the patient just dies, not some long, drawn-out process, but how it might really happen on a ward.
November 20th, 2008 at 9:52 am
The “medicine” aside, I couldn’t get past the idea that a 16-year-old, no matter how articulate, hard-working, and independent, would be in charge of a factory line full of heavy machinery. Or how, at 16, she had enough time to acquire the necessary experience *and* have an “ex”. Let alone the question of how she managed to finesse those picky details like social security numbers or coming up with first month’s rent/last month’s rent/deposit to get an apartment. Or the unlikelihood of being able to stay in the same NJ town and never meet anyone who knows her in her true identity.
As for the “medicine” it seems hardly worth paying any attention to it any more – it’s just garbled nonsense now, seems to me.
Though I guessed the big brother had done *something* from the beginning.
wg
November 20th, 2008 at 11:08 am
You say you shouldn’t shock a flatline (which has been beaten to death, I know), but did they say it was flatline? They just said cardiac arrest, which can mean v-fib can’t it? Fine v-fib is still shockable and can look like a flatline at first glance, am I wrong?
November 20th, 2008 at 2:02 pm
So they diagnosed leukemia with 2 mri’s and a brain biopsy. I guess the CBC (complete blood count) would have been to costly.
November 20th, 2008 at 3:37 pm
They showed a brief look at the heart monitor behind the patient which clearly was flat lining.
November 20th, 2008 at 4:51 pm
Lot of activity without a lot of substance. I’ve given up on the medicine. The ONLY reason I watch now if for the House/Wilson or Wilson moments.
November 20th, 2008 at 5:19 pm
The pressure treated wood could have been, er, borrowed from a construction site. If she’s poor enough to need to make her own furniture, she might have to use odds and ends to make it.
As far as the nurses rushing right in…remember, it’s a tv show. They only have 43 minutes to tell a story. If we wait a realistic 5 minutes for a nurse to show up, it’s going to take all season to solve one patient’s case.
November 20th, 2008 at 7:46 pm
Volvo–
In 97 Seconds (season four) a man died of strongyloides because he didn’t take the pills Thirteen gave him. It wasn’t House’s mistake, but he did indeed kick the bucket. (And his little dog too.)
November 20th, 2008 at 8:15 pm
The whole pressure treated lumber thing made me chuckle because, as caltran said, arsenic-or to be precise, Chromated Copper Arsenate, the material used to treat lumber-is no longer used in most pressure treated lumber. It is still used in a few applications-guard rail posts, wooden piles, and wood used in salt water marine applications. The general public can’t get their hands on pressure treated wood with CCA in it…and speaking as a construction superintendent, we generally don’t leave enough of that wood laying around to build a match box, let alone a desk. It’s too darned expensive to throw any usable length away, let me tell you. Which isn’t saying someone wouldn’t throw it away, but man, I sure wouldn’t.
So yeah, if the girl made a desk out of guard rail posts and wooden piles, she’d have had some trouble. Even then, though, I’ve worked with people who have cut up pressure treated lumber for decades and none of them have contracted arsenic poisoning. Maybe they got off lucky.
November 20th, 2008 at 9:21 pm
In over 20 years of working w/oncology patients, with >10 yrs primarily working in a bone marrow transplant unit, I’ve never seen a leukemia diagnosis made based on a brain biopsy. APL (the M3 subtype of AML) usually presents with bleeding disorders, or is found when abnormalities are found in blood counts done for some other reason. Blood tests to identify the chromosomal translocation involving chromosomes 15 and 17, and the PML/RAR alpha fusion protein confirm the diagnosis… not a hole in the head.
Treatment with all-trans retinoic acid and idarubicin is the standard induction therapy with a > 90% complete remission rate, with more than half of the patients cured with chemotherapy. Arsenic, while normally reserved for relapse, has been used first line. Very few patients go to transplant.
November 20th, 2008 at 9:34 pm
Okay guys, you make me angry… You must remember that House is a MEDICAL DRAMA, nothing else, if you want a whole explanation of medicine take a book or read something in the internet. You can’t ask for a tv show with perfect medicine, otherwise, it will be kind of boring: In House the dramatic presentation of sympthoms (and the soap opera, obviously) is one thing that make the show able to watch for non doctor people.
There are more ridiculous tv shows about medicine and they have less critical than House…
By the way I love this reviews Scott… thanks for your time!!!
November 21st, 2008 at 1:51 am
Scott,
Haha, thanks for the explanation to my question. Love the reviews; I read them every week. I’m just a med student so it’s lovely to get an explanation on a lot of these things (that I feel like I should know sometimes!).
November 21st, 2008 at 4:57 pm
Yosax, we understand that House is a medical drama, but one of the characteristics of fiction is that it has to be realistic. Now, if you take a person with 10 years of experience in Medicine and you show him an episode of House in which they shock a flatline, you might as well show him Lord of the Rings. What I’m trying to say is this: what’s realistic for you might not be realistic for someone with experience in Medicine.
Besides, things like not wearing eye protection while doing surgery don’t add anything to the drama, they just break the illusion and let us know that it’s a TV show… while watching it!
November 21st, 2008 at 5:38 pm
Volvo: Foreman killed Lupe in season 3’s Housetraining because House was more interested in what was going on in Wilson and Cuddy’s relationship than in his patient. At the time, I thought it was a metaphor for what was going wrong with the show. Now I think it definitely should have been.
I never expected real medicine from Grey’s Anatomy. It, like Boston Legal, is a surrealistic drama about relationships, not a real medical or legal show. House used to be a decent medical show but since it’s started to focus on relationships instead the medical case (e.g. the title of last week’s episode The Itch referred to the soap opera plot not the patient), the medicine gets even less realistic. The problem with changing focus is that unlike Shonda Rhimes, Shore can’t hit the emotional notes or write even half decent romance.
November 21st, 2008 at 6:17 pm
Thank you, Chris. When I read this, the first thing that came to mind was “sixteen year old girl working as factory foreman, overseeing many people both older and with more experience than her, what’s wrong with this picture”.
November 22nd, 2008 at 2:18 am
“but one of the characteristics of fiction is that it has to be realistic”
In what world do you believe that? Not in never-never land, or down the rabbit hole. Or, hell, the Bible.
Just saying.
November 22nd, 2008 at 4:06 am
Forman commited 2 jobs at once, does that prove he can do what House can?
November 22nd, 2008 at 10:18 am
I actually was kinda disappointed with Foreman. I’m not a doctor, I’m a highschool student, (something like that) but when I heard “vitamine pills” my first thought was hypervitaminosis, most probably an overdose of vitamin A or D, which is not that far from iron toxicity. Foreman should’ve picked up on that and asked the kid how many pills he took and then he could have tested for vitamine and mineral related diseases, which would have led him straight to the solution.
Well, the writers probably needed Foreman to have some difficulties figuring it out to show his emancipation from House. Still, a mistery that even I can diagnose seems a bit easy for a House episode to me.
November 22nd, 2008 at 4:29 pm
nin:
I think that iron overdose is the first symptom likely to arise from children overdosing on multivitamin/multimineral supplements. Yes most of the other vitamins and minerals are toxic in overdose, but iron is toxic at much lower levels than most of them, and it’s the one most likely for the symptoms to arise right away.
November 22nd, 2008 at 8:18 pm
Wondering: don’t they also have to wait a little longer before continuing with shocking (in general throughout the episodes), not boring the viewers aside? (I seem to have forgotten all of my first responder training.)
Anyway, these are great, although I’m not surprised by the creative liberties Fox is taking.
November 23rd, 2008 at 6:59 am
While I thought Foreman’s case was far more interesting than House’s, I was surprised that it took him so long to diagnose something as simple as iron toxicity. (and why on earth didn’t the iron show up in the kid’s bloodwork?)
Foreman has worked under House for almost 5 years (disregarding the fact that he *technically* hasn’t been House’s employee for the last season) but still struggled with simple cases. It annoys me that the writers make Foreman so useless. He’s good enough to start up his own department – Maybe even his own Diagnostics department to go into direct “competition” with House. That would be far more interesting than Foreman’s current “am I a good doctor on my own?” plotlines.
I agree with Debbie … The only reason I’m watching House now is for the House and Wilson moments. I used to love the medicine, but now it seems the writers are trying to be “clever” and “wacky” rather than realistic and intriging. The new team doesn’t do much for me, and I often find myself struggling to keep up during the differentials because the team’s suggestions are so confusing and random. (and what ever happened to House’s whiteboard? It was good for helping me remember symptoms).
Even the Cuddy/ House plot isn’t interesting me, and the show has been leading up to a romance between them for years now! (maybe a few seasons ago it would have interested me, but now … not so much).
I’m more interested in watching House and Wilson. It was nice seeing Wilson finally deciding to not be House’s enabler, and letting him make his own decisions regarding Cuddy, while supporting him either way. Now House can’t blame Wilson if his relationship with Cuddy goes wrong, because Wilson hasn’t given him any suggestions with what he thinks House should do (does this mean no more “Wilson lectures”?). Maybe this is the start of Wilson and House’s friendship becoming healthy?
November 23rd, 2008 at 12:58 pm
Hi, I read these reviews all the time and even go back to old ones when I catch a rerun. I want to thank everyone for their insights..almost as good as the show in most cases…I hope the show writers read this site. Anyway, as a viewer without much medical background, I love the show because it allows me to just “go with it” and I enjoy the soap side as well. I would love to see a well written, intriguing story with a great beginning, body and end…perhaps “House”, the movie? could be fun and a great show..although it could suck too..oh well..looking forward to next week..thanks to all!
S
November 23rd, 2008 at 2:19 pm
I thought this episode was really boring. Medicine and everything aside, Foreman’s character is just really boring on his own, so having him get his own case, and therefore get lots of screentime without any other major characters to back him up, was a bad choice. I can’t believe people really want him to regularly get his own case, that would be terrible.
I mean, his character works fine as a counterbalance to House, but when House is absent, he’s boring as hell. The only good parts of this episode were the Wilson/House interactions and the scene where House finally goes to talk to the girl.
November 23rd, 2008 at 7:47 pm
I love the reviews and all of the nitpicking. I have to wonder why someone who doesn’t want to see the medical facts pulled apart is reading this blog…
Pressure-treated lumber: I just assumed she got it used. Like if someone was replacing their deck and put the wood out on Freecycle (or the street). This would also mean it wouldn’t have the toxic smell, though it would still be leaching arsenic. I’d like to think “everyone” knows it’s toxic but it’s not the case. I was pretty shocked to see a preschool’s sandbox made from it.
I agree with the 16 year old not being a foreman. A factory worker, sure. 16 year olds can work FT (some state laws may vary) with parental permission (which isn’t needed if the minor is emancipated). But she was the supervisor of several people who had been there for years. Not bloody likely.
Here’s what I don’t get and no amount of “it’s Hollywood” can explain it away. Why are the doctors House has hired so bloody incompetent? They sit around waiting for his insights, or his opinions of their own ideas. Granted, House likes to hire young doctors, but Foreman’s been around the block and he can’t do basic bloodwork and his former Houseites can’t come up with anything either, even though they are trusted in their own departments? I’ve never seen anything like it. ER, Scrubs, and many other shows handle the balance well but House just doesn’t.
November 23rd, 2008 at 11:13 pm
Scott,
Many thanks for the reviews. I’m a “long-time reader, first-time poster.”
@Cyndi: The writers are being “clever” by having the girl work as a _foreman_. The mirroring here is between the POTW and our not-so-young gun: both are trying to be “emancipated,” she from her parents (because of guilt), he from House (because of claiming not to want to be House).
November 24th, 2008 at 9:48 am
There’s no way Foreman can compete with House in that hostital, simplely because House is unique and irreplaceable.
November 24th, 2008 at 7:50 pm
Granted, this week was better than most this season, esp. the little boy and House actually interacting with a patient.
But I am a diehard fan who is very close to giving up on this show. Prime-time medical soap opera I can get by the bucketload. What I loved about this show was the sharp wit, the great writing, the excellent acting, the mental puzzle of just trying to keep up with what they were talking about. OK, so the medical puzzles aren’t as engaging for the most part; this I can live with. But I want to be wowed by the sharpness of those lines again, the comic situations that came up in clinic (”You have little people in you”), the repartee between House and Wilson, House and Cuddy, House and just about everyone.
The new “team” is for the most part so lackluster that House doesn’t even bother teasing them with hysterically funny lines. Thirteen is written as a perpetual downer; even her gorgeous face can’t make up for this. Each member of the former team had defining personality characteristics that together made a witty ensemble.
Am I the only one who’s losing the enchantment?
November 25th, 2008 at 1:46 am
Who wouldn’t to a show lack of the sharp wit, the great writing, the excellent acting, the mental puzzle of just trying to keep up with what they were talking about?
November 25th, 2008 at 6:08 pm
No former, you’re not. I’m login the enchantment as well. But I’ve got to tell you, I’m a Cubs fan. I can sit through a lot of bad seasons of House just to wait for one triumphant return. I felt this week’s episode was better then most this season, like others have as well. We’re starting to see a stronger House/Wilson dynamic, which was always an important part of the show. There’s trouble on the horizon with the House/Cuddy situation. Hey, maybe the show is just getting back into it’s groove. It suffered a hard hit when the original young guns began to grow up, and they needed some fill-ins for the parts. Unlike some, though, I feel the new team has potential to make a very well formed group of characters. Thirteen showed us that she had some potential in “Lucky Thirteen”, though most of it was wasted on Fox showing us lesbians then showing us how her character could be the medical version of the Bad News Bears.
However you and I are in total agreement about one thing … they need to bring back clinic duty. No where else have I seen House reflect his namesake so aptly.
November 26th, 2008 at 12:29 am
Are you talking about Thirteen’s BI joke?
November 26th, 2008 at 4:42 am
I’m not a doctor or follower of medical process (actually makes me sick, I nearly threw up in a health class in high school from pure diagrams alone), but I can see where drama has been put above reality.
Case in point, and something I’m surprised you missed in your nitpicks, Scott. The camera pill that Foreman had the boy swallow, that’s not taken right away. They first have you take a test pill of the same size to see that it can traverse the entire intestine safely. If it gets stuck, it safely dissolves in a short period of time… 12 hours I think.
I know this because my brother has been diagnosed with Crohn’s disease, and as part of the diagnostic they had him take the test pill. Unfortunately, it got stuck somewhere between the upper and lower intestine and caused him some nasty pain until it dissolved, so they weren’t able to do the camera test. (They think there’s scar tissue there, which causes his pain at times, especially with high fiber intake.)
Anyway, so I knew the whole scene of the boy taking it wasn’t credible. But I could accept this as part of the drama, as in reality, medication, diagnostics, and results all take way longer, enough that the dramatic elements are lost. It IS a TV show, after all, and still a damn shade better than soap opera drek like Grey’s Anatomy.
November 26th, 2008 at 10:32 am
Three things:
1. Couldn’t they have determined Arsenic Poisoning by looking at the patient’s fingernails?
2. The way the older brother doted on the younger one suggested guilt to me. I would’ve leaned on him.
3. Did you check out that Cracked link I emailed you?
November 26th, 2008 at 10:41 pm
The only way that they could do anything remotely close to a realistic time frame in this show would be to make it like 24, with a whole season being dedicated to an interesting and reasonable disease or some such, and have the doctors need to provide around the clock diagnosis and care, lest the patient die by morning. The whole season would be in “real time”, and allow for more drama as the patient is flatlining, stroking out, seizing, etc., and the nurses take a few minutes to actually get to the room.
November 29th, 2008 at 10:46 am
I was actually refering to the fact that Thirteen is finding a weird sense of fulfillment in her manipulation of the well meaning girls she brings home. The last scene in “Lucky Thirteen”, for me at least, was a clear broadcast of saying “I hate what I do, but damn it, I’m good at it”. I think there’s a lot of potential for her to bring the manipulation skill to a whole new front.
In case I’m not being clear (and re-reading that last paragraph leads me to believe I’m being a little obtuse), let me eleborate a little.
One of the things I picked up on was House’s breaking down of why Thirteen acted like she did. She wasn’t just going out and sleeping with anyone in some sort of reckless downward spiral. She was looking to control someone to feel more in control of her own situation. Well, that ability to control people (and looking the way Thirteen does, it can’t be too hard), could potentially make an awesome plot vehicle. I think she has serious villian potential, I mean, all the best villians you can identify with, or at least that’s what early Italian film makers believed.
December 2nd, 2008 at 2:42 am
A 16-year-old factory FOREMAN? yah right. It’s remotely possible she could have gotten a job on the line or some menial, entry-level job, but no way could she have accrued enough experience/seniority to become a foreman. I thought she was just a young-looking woman, maybe late 20s early 30s in the opening sequence. When the differential team presented her as a 16-year-old, my first thought was “16?! in charge at a factory?! are you kidding me?” but perhaps there are no hollywood writers with blue-collar backgrounds… ;) hah.
I was also confused by the little boy’s giggling, which was never explained as far as I can tell…
December 7th, 2008 at 12:20 am
Haha, i love reading your reviews, Scott, as well as the other people here. Some of you are just too critical. :) I still love the show, and medical issues aside, i want Cameron and Chase to have more screen time. I really do miss their interactions with House. I also love Wilson and House interactions.
Continue with your interesting reviews!
April 20th, 2009 at 7:51 pm
Daniel — so KV’s question was answered last week, too. you don’t have to be a dick about it
April 28th, 2009 at 7:18 am
I didn’t get the pot connection. Sure, people can “freak out” when smoking pot, but that’s not a medical condition, and is the heart rate increase when “freaking out” even referred to as tachycardia?
Or can’t the writers tell the difference between a bong and a crack pipe?
November 8th, 2009 at 9:05 pm
Not sure if this has been addressed in the comments, but why would they consider gonococcal endocarditis when the echo was normal?
November 12th, 2009 at 3:42 pm
You wrote shocking a flatline will do nothing but increase the problem.
I’m curious what to shock but a flatline. (I’m no sort of medical student, just interested)
nik
January 17th, 2010 at 10:39 am
if the older brother thought more would make Jonah stronger
chances are that Evan took more himself and so Evan should have had Iron poisoning aswell
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