House — Episode 14 (Season 5): “The Greater Good”
The 100th episode of House. Too bad it was so absolutely mediocre with an unlikable patient.
Of course, this also makes it my 100th House review*. Sure the first reviews were just a paragraph or two, but they quickly evolved into the behemoth you see before you now. While it’s certainly true that the quality of the show has suffered some over the past few seasons, it still remains the best medical show, if not best show outright, on television.
Dana Miller is assisting a chef in teaching a cooking class when she becomes short of breath and starts to cough. She discovers that her lips are blue and realizes she has cyanosis. She complains of pain in her chest and back and diagnoses herself with a spontaneous pneumothorax before collapsing on the floor. She is rushed to the hospital and admitted to House’s service, primarily based on her name and reputation. It turns out that Dana is a rock star in the world of the cancer research, and said to be on the cusp of finding a cure for retinoblastoma. The team is sorely disappointed when she tells them that she gave up her career in medicine eight months ago after uterine surgery because she realized it wasn’t making her happy. She now devotes her time only to activities that she fully enjoys.
There is no clear cause for Dana’s pneumothorax. Foreman points out that there is no history of COPD (chronic obstructive pulmonary disease, i.e. emphysema) and no history of tobacco use or recent scuba diving. The initial differential diagnosis consists of cystic fibrosis, lung cancer, or an undiagnosed asthma. She is started on steroids to treat the suspected asthma and a CT scan of her lungs is obtained to look for evidence of hyperinflation (a sign of asthma). The CT scan is normal, making asthma less likely. Taub suggests that lingering damage from the central line from her surgery might explain the lung problem (and I couldn’t help but notice that instead of just stating she had “surgery,” he was very specific about which surgery she had. Hmmm. Wonder if this will be important later?). Kutner notes increased interstitial markings on the CT scan — which apparently everyone else missed — which means that Dana might have pulmonary fibrosis. A biopsy is ordered. When Taub is explaining the test to her, she starts to complain of left-sided abdominal pain. After a quick exam, Taub tells her she has bleeding into her abdominal cavity and withdraws a syringe of blood to prove it. (FYI: She asks if she has ascites, the build up of fluid in the abdomen).
In addition to her lung problem, Dana now has a liver problem — or problems — as well. Not only is her liver bleeding into her abdominal cavity, but they also work in the fact that she has liver failure. Foreman suggests a liver granuloma as a possible cause, and Thirteen goes one step farther and suggests blastomycosis as the cause of the granuloma. A biopsy is obtained, but the test for blastomycosis is negative. Dana starts to complain of itching, which she blames on the liver failure (the high bilirubin levels that occur in liver failure can definitely lead to very bad itching). As she sleeps, she continues to scratch, and in fact scratches hard enough that she scratches through her skull into her brain. Luckily, Taub is able to repair the skin damage (having a plastic surgeon on the team is sure handy) and announces that she has suffered no brain damage.
The differential now consists of psychogenic itching, meningitis, encephalitis, multiple sclerosis, or a brain tumor. An MRI of the brain is obtained and is negative. House now suspects that Dana has polyneuropathy and wants to shock the affected areas to “reboot” the nerves. As Taub is about to start the treatment, she begins to experience a shocking sensation — which he identifies as Lhermitte’s sign. According to the team, this can be suggestive of Behçets Disease, Vitamin B12 deficiency, a demyelinating disease, or a spinal hemangioma. An MRI is ordered to look for a hemangioma. It turns up what appears to be not just a single hemangioma, but hemangiomas in the spine, lungs, and pericardium (the sac surrounding the heart). The thought now is that she has metastatic mesothelioma (a lung cancer most commonly associated with asbestos exposure), but House is perplexed that these same lesions did not show up on the chest CT two days before. Wilson is called in to biopsy one of the lung lesions, but he is unable to perform the procedure as the lesion starts bleeding profusely, which should not happen if it is mesothelioma. He suggests she might have arteriovenous malformations (AVMs) due to schistosomiasis (a parasitic infection acquired from bathing or swimming in contaminated water), but the team counters that she shows signs of Gorham’s Disease or Kasabach-Merritt Syndrome. The brainstorming is interrupted when Dana suffers cardiac tamponade (blood fills the pericardial sac, compressing the heart and not allowing it to beat correctly). Kutner inserts a needle (read: jams a needle blindly) into her chest to relieve the tamponade, only now she is bleeding copiously through her ears, nose and eyes.
Later, Taub informs House that they are giving Dana multiple units of platelets and FFP (fresh frozen plasma) but they cannot control her bleeding. House suggests embolization — blocking off the bleeding blood vessels. He wants them to start with the ones in her lungs. He then proceeds to run into Cuddy, where in the midst of a crasser than normal conversation, he has his Eureka! moment. He reveals that Dana is bleeding so heavily because it she is menstruating. He announces that as a result of her uterine surgery she has developed endometrosis, and it is these abnormal clusters of endometrial tissues throughout her body that are doing the bleeding.
Thirteen begins to have frontal headaches. Foreman is concerned that it may be related to the experimental Huntington’s drug, but she blows it off, telling him that she has been taking the drug or the placebo for weeks now, and nothing has changed recently (Right? Right? Wink wink.) House then brings her lack of peripheral vision to Foreman’s attention. He tests her himself and finds that House is right. He confesses the truth that he switched the drugs to her, and obtains an MRI of her brain. It reveals a tumor in the optic chiasm. Within a day or so, she becomes totally blind. House and Foreman give her a directed radiation treatment to the tumor, and it regresses and Thirteen’s sight is restored. As the episode ends, Foreman confesses what he did to the drug company running the trial. He is kicked off the trial, but gets to keep his license. On the other hand, Thirteen’s data, now considered dirty, is excluded from the trial and so is the evidence that the drug may cause tumors.
As usual, major complaints are in red, minor in blue, nit-picking in green:
I had pretty much given up on even mentioning the errors in the procedures the team performs, but this week two scenes were so bad that they bear special mention.
First, Taub drawing the blood from the abdomen. He did just about everything wrong. No protection for him. God forbid he sterilize or at least clean the patient first (congratulations Taub, you just gave her a staph infection of the abdomen). You need to use a z-track technique or the higher pressure in the abdomen will push the fluid out the needle track. That 20- or 40-cc syringe was way too small to draw off any appreciable amount of fluid. I have seen multiple liters pulled off a single patient (though admittedly, those patients looked pregnant).
I have similar complaints in regards to Kutner’s technique for pericardiocentesis. Worst was when he overhand jabbed the needle blindly into her left chest. That is NOT the way to perform a pericardiocentesis. He likely gave her a second pneumothorax, not to mention injured the heart or sheared off a coronary artery. The trick is to drain off the fluid without killing the patient in the process.
There have been documented cases of endometrosis being spread due to surgery, however, in all these cases the patients had endometriosis before surgery, and it was that endometriosis that was spread, not normal endometrial tissue that became endometriosis.
My biggest problem with the endrometriosis solution is the time course. Remember your high school health class. The endometrium takes 3 -3½ weeks to slowly build up in thickness before sloughing off to start the menstrual cycle. Endometrial tissue does not go from nothing to suddenly-detectable-everywhere one day before the cycle starts. If she that much endometriosis to cause all the symptoms she had, there would have been plenty of evidence on the first CT.
Why had she been symptom free the previous 7 months?
Bronchoscopy and bronchoalveolar lavage are the preferred initial steps in diagnosing pulmonary fibrosis. It’s true that they are not as good as an open biopsy, but the risk pf complications are significantly less.
There are many fungi that fluoresce under black light and it is a fun way to diagnose ringworm, but it is not the recommended method of diagnosing blastomycosis. In fact, I didn’t find the technique mentioned in any of the main texts on the subject.
Wow, Thirteen had an incredibly fast growing tumor, didn’t she?
I was amazed at how fast the writers were able to turn it around from “Foreman screwed up” to “Those evil drug companies!”
“House was right” about the hemangioma? I though Taub was the one who brought it up.
I don’t know too many oncologists who do their own lung biopsies.
What explains the liver failure?
Other than the comic-book style shocking visuals, why was Dana bleeding from her ears, nose and eyes? Did she have endometriosis there too (a first), or was the pressure of the bleeding so much it split her skull?
The medical mystery was fair this week. It started out small, but built up over the course of the episode and earns a B. Though I had problems with the final diagnosis medically, I thought it was clever and with a little tweaking could have fir perfectly so deserves another B. The medicine was average again: very superficial with little follow through. It earns a C. The soap opera was good, if understated. I liked the book-ending Wilson scenes, and the House/Cuddy scenes were fun, if a little out of character for her (though she did explain she had been dragged down to his level). I give the soap opera a B.
Last week’s House review
A list of all prior House reviews
*OK, technically it’s my 101st House review as I re-reviewed one of the earlier episodes. One of these days, when I have time, I plan to go back and do the same for the other early episodes.
February 2nd, 2009 at 11:55 pm
What’s your medical opinion on what Cuddy did to House? I can’ t say I agree that it was ‘fun’.
I was cringing at a hospital administrator forcing a crippled man to walk stairs he can’t walk, trip him up, and force him to walk without a cane. That could cause serious damage to someone….especially someone who is crippled and suffering chronic pain.
February 3rd, 2009 at 12:01 am
I have to brag a bit… this is what I wrote last week:
“And I just thought of an interesting direction that they could take with the drug trial story arc. Thirteen could start to experience some of the more severe (perhaps previously undocumented) side effects of the real Huntington’s drug. The researchers (other than Foreman) would then have to explain why the effects presented so late into the treatment. Meanwhile, Foreman would debate between coming clean and ruining the trial of a drug that works but he now knows to have severe side effects.”
February 3rd, 2009 at 12:06 am
Pericardiocentesis: “The trick is to drain off the fluid without killing the patient in the process.”
I think just as a rule of thumb, you could summarize most medical procedures as:
[Multi-syllabic Latin/Greek word]: “The trick is to [... fill in the blank ...] without killing the patient in the process.”
:-P
February 3rd, 2009 at 12:22 am
All they had to do to resolve the 7 month gap problem was either change it to one month after, or put her on the pill for a while. They didn’t even do that.
Intentional suspension of disbelief: I just assumed a longer-than-usual duration in show time between the previous and this episode for the 13 tumour thing to make sense: she started on the drug after the last episode, and at least several weeks lapsed before this episode.
It’s like the writers have no sense of time when writing this episode.
February 3rd, 2009 at 12:47 am
since when are House and Foreman radiation oncologists?
February 3rd, 2009 at 12:50 am
Is it really possible for someone to scratch through their own skull? I would think the fingernail would give way well before the skull did – and after that did she just rub her way through? Wouldn’t the pain wake her up? (even if she was sedated from earlier procedures) Particularly in a couple hours – It just strikes me as impossible.
Grats on the 100th review. I’ve really enjoyed them!
February 3rd, 2009 at 1:01 am
where’s chase and cameron in this episode?
they really don’t have enough time in each episode to develope all the characters
and i miss the clinet patients!
February 3rd, 2009 at 1:01 am
*clinic
February 3rd, 2009 at 1:02 am
Line of season five:
It is the worst period ever, but admittedly not by much.
February 3rd, 2009 at 1:41 am
I’m surprised that House even made it up the stairs at th start of the episode. Just a few seasons ago he struggled to get up even a few steps before giving up. Now he’s able to go up 4 flights of stairs with minimal pain? I sense lazy writing.
February 3rd, 2009 at 1:44 am
Hey, does this mean I finally break out of having zero points in the House Challenge for my uncanny prediction of “really bad PMS” (#7 on the Hart list)? I feel an epistaxis telepathica coming on…
February 3rd, 2009 at 2:51 am
I’m curious. When she had her period didn’t anyone (Dana or the nurse) think “Hm, she is bleeding from everywhere else, couldn’t that be related” or it’s just me thinking this is weird?
February 3rd, 2009 at 2:52 am
Everyone:::
Please stop complaining when the stars of the show do their own tests and other procedures. The cast is fairly large for the small stories they do, so they have the stars do the tech/grunt work to give them screen time. Hell, Chase and Cameron didn’t appear for a single second of the episode. I’d rather see them onscreen than some extra playing a technician.
February 3rd, 2009 at 3:31 am
I also had difficulty with the scratching-through-the-skull thing. Congrats on your 100th review. This remains the best review site about the nest show on television.
“I don’t know too many oncologists who do *there* own lung biopsies.” Sorry, Scott. That particular typo gives me a rash and a tic in the corner of my eye.
February 3rd, 2009 at 3:38 am
I’ll chime in on the “scratching through the skull” thing. I’m not a medical professional, but IIRC the skull bones are just about the toughest in the human body. HOW do fingernails get through THAT?
February 3rd, 2009 at 4:35 am
They undoubtedly got the “scratched all the way through to her brain” idea from here:
http://www.newyorker.com/reporting/2008/06/30/080630fa_fact_gawande?currentPage=all
They certainly claim it really happened, but I have my doubts too. Don’t they have to use a rather powerful saw to get through the skull when they do brain surgery? Or are there “soft spots” where you can scratch right through if you’re not careful?
As a non-medical-professional that was the most unbelievable part about this episode, but I guess if The New Yorker believed it I can’t really blame TV fiction writers for believing it…
February 3rd, 2009 at 5:17 am
‘I was cringing at a hospital administrator forcing a crippled man to walk stairs he can’t walk, trip him up, and force him to walk without a cane. That could cause serious damage to someone….especially someone who is crippled and suffering chronic pain.’
True, but Wilson complained to Cuddy for this reason, so it’s not as if it went unnoticed.
February 3rd, 2009 at 5:45 am
Thank you for reviewing 100 episodes of House. You add another dimension to a TV show I enjoy watching. I am always amazed at how fast your reviews are up. And, I love your sense of humor when you write them.
I have to agree with your assessment that this patient is just not that likable. Maybe I just didn’t buy the “I’m doing what I really want to do” line. Cooking class, book group and so on are activities she could have done while she was doing her research.
For me it was interesting to see how House reacted when Cuddy was playing tricks on him. He pretty much backed down and didn’t react (well, didn’t react for House).
I miss Chase and Cameron. I am not as fond of Taub and Kutner.
February 3rd, 2009 at 5:53 am
I was very disappointed that we didn’t get a scene with House and Dana Miller discussing her decision to quit. It felt like the whole episode was setting it up, and then never got there. We’re left with Miller as kind of a magical wise person, able to advise everyone else on why their life sucked, which she could see because her life was perfect. I would have loved to see House attack that…
February 3rd, 2009 at 6:04 am
This episode, to me, was just plain and simply, “BORING”…House wasn’t his usual self and the story line was questionable at best.
**YAWN**
February 3rd, 2009 at 6:19 am
As soon as they observed multiple “haemanginomas” I had a light bulb moment and thought back to my troubles with endometriosis, I bled into my spine, bowel and had chocolate cysts galore. Would cutting the endometriomas stop it recurring? I would have thought a course of Goserelin would be advisable
February 3rd, 2009 at 6:39 am
Is it just me, or did they suddenly drop the whole ‘it’s in the brain’ thing awfully quickly? If there wasn’t any problem in her brain why’d she scratch through her skull? Can you even do that?
February 3rd, 2009 at 7:03 am
Did anyone notice that the person with the bad reaction to the trial drug was in the “control” group?
Did anyone wonder if the Drug Company screened the drug trial participants for any known risk factors and put them in the “control group” to exclude them from the results?
And, that is why Foreman’s failure to follow protocol was so dangerous to the trial?
February 3rd, 2009 at 7:18 am
So is the PPTH a private hospital run exclusively for House and his cronies? Because there only appear to be about 5 people there at any one time, making it easy for 13 to nip in and get an MRI at a moment’s notice, as well as instant radiation therapy done by her friends.
Also, whenever I’ve been in a hospital, there are all these people, called, hmmm, NURSES, hanging around.
February 3rd, 2009 at 7:33 am
“Wow, Thirteen had an incredibly fast growing tumor, didn’t she?”
They did mention on the show that the drug inhibited cell death. Maybe that had something to do with it?
“Did anyone notice that the person with the bad reaction to the trial drug was in the “control” group?
Did anyone wonder if the Drug Company screened the drug trial participants for any known risk factors and put them in the “control group” to exclude them from the results?”
I’m pretty sure the first shouldn’t happen, since it’s a double-blind study, and I doubt the second is allowed; I would assume the group assignments are random.
(Disclaimer: Not a doctor. Not anything like a doctor. The closest things I have to medical expertise are two pharmacist parents and an uncanny ability to pronounce drug names.)
February 3rd, 2009 at 8:00 am
I also would like to know if it is physically possible to scratch through one’s skull into the brain matter. In one night no less!
Because if this IS possible, I have a whole new phobia….;-)
February 3rd, 2009 at 8:02 am
Can someone please hit Cuddy with a 2×4? I was glad that Wilson stood up for House. I mean, House is a jerk, but he’s also a cripple. If he wanted to sue for failure to accommodate for handicap, he can. What she was doing wasn’t “fun,” at least from my point of view. What if there was another handicapped person who works at PPTH who couldn’t use the elevator because she was pulling a prank on House?
What if he had been seriously injured when he tripped over that wire in his office? He did hurt himself, although a skinned knee isn’t that horrible.
Some administrator. I’ve always thought she was a horrible administrator. Tonight’s episode proved it.
Yes, House is a big baby, but that’s who he is. What did she think her pranks were going to accomplish? He will see the error of his ways?
Plus, he didn’t force her to come back to work. He didn’t. She told Wilson last week that she felt like a prisoner in her house. Granted that was before she “bonded” with her kid. But she was only able to bond with her kid while she was also concentrating on working last week.
And I take huge exception to her saying that working mothers are lousy mothers for having to leave their child at home.
She’s a bigger jerk than House. House at least admits it. He doesn’t have any qualms about it. He doesn’t care if people think he’s a jerk because he gets things done. Cuddy doesn’t.
She’s worse in my eyes.
Kat
February 3rd, 2009 at 8:09 am
i think you were too easy on the soap opera scenes with foreman and thriteen. the bookending scenes for them where they were in bed togehter were ok but everything in between felt so contrived. when thirteen magicaly lit up and declared she could see again i just about started laughing. i’m not sure if this issue is specific to this episode or if their entire relationship feel so artificial i have a hard time beliving anything relating to it.
February 3rd, 2009 at 8:11 am
“now she is bleeding copiously through her ears, nose and eyes.”
First thing I thought was that she must have overloaded her psychic abilities…
As regards the bad procedure when punching holes in the patient, have we had a nosocomial infection yet? Given House’s team’s tendency to start (radical)treatment first and ask questions later, I wonder how long it takes for someone to be admitted for a cold and to die of some exotic disease as the result of their treatment. Assuming, of course, that this hasn’t already happened, that the reason the team treats so many exotic diseases is because they’re also the cause. {grabs his tinfoil hat and jams it on}
February 3rd, 2009 at 8:35 am
I read a story about a woman who scratched through her skull (http://www.newyorker.com/reporting/2008/06/30/080630fa_fact_gawande?currentPage=all), but what I don’t understand is how the patient’s liver failure or endometriosis would have caused her to itch to the point that she scratched through her skull.
February 3rd, 2009 at 8:39 am
Count me with the people scratching their own heads wondering if it is possible to dig a hole that way.
Agree that for the 100th episode, it fell a bit flat, and indeed I wasn’t that interested in either patient. I’m starting to wonder what Foreman has to do to lose his license. For a person who whines about breaking into homes, it seems all other ethical concerns are up to his own interpretation. Perhaps thats the role of the character; to suggest that what House does unethically that still leads to a healthy ending isn’t something for other doctors to try at home.
February 3rd, 2009 at 11:13 am
Thanx again Scott, I really enjoy reading these.
Now I am a Medical Docotor (Pathologist) and I have certainly seen my share of “Holes in the head” but I don’t recall any ever being made by a fingernail (oh, wait there was one X-File where the Metal Man stuck his fingers into the skull and picked it up like a bowling ball:))
Could someone please answer the question is this possible! I have been “scratching” my head over this one, und untill now I have only managed a broken fingernail and a small red patch on my hairline, not even blood. I don’t want to stay up all night trying, or maybe I should go to sleep and see if it’s possible then?
Grüß,
Dana
February 3rd, 2009 at 11:44 am
I agree Cuddy’s “pranks” on House were more like sending thugs to beat him up, hardly equivalent to the merry, irritating messes he conjures up. Not witty or funny.
She’s just not good at that and should give up, as Wilson says.
February 3rd, 2009 at 11:45 am
Why was the patient “unlikable”? I liked her and agree with her 100%. I retired from practicing law at 38; I was taking between 10 and 20 aspirin each day for headaches before I left, and haven’t had a headache in the 6 months since I left. Where is it written that we have to live our lives for anyone other than ourselves? Life is short, enjoy it; and don’t worry about “doing something important” before you die.
February 3rd, 2009 at 11:49 am
I think the show has really gone downhill these past two years. House went from a brilliant doctor who happened to be a jerk, to a jerk who happens to be a brilliant doctor.
And now he’s a petty thief?
They’re going to KILL the show.
I agree that what Cuddy did was unforgivable. For a physician to purposely harm another human (one who already has a disability at that) is just plain EVIL.
February 3rd, 2009 at 12:05 pm
I also think the show has gone downhill, and I’m wondering why I’ve been missing HIMYM to watch this.
I love Hugh Laurie, and I find it sad that House is relegated to the subplot. Foreteen was plot A, which is all kinds of wrong, but House was actually pretty nice to them. PotW was plot B, and House had very little to do with her. Cuddy and her unforgivable pranks were plot C.
Is it just me who’s been noticing this, but does it seem like House’s pain is increasing? There were reasons in this episode (Isn’t the first line of the Hippocratic Oath “First do no harm”?), but it seems like House has been in pain more this season.
They are going to kill the show.
When Wilson sabotaged House’s cane in “Safe,” I found it funny. I started wondering why I thought that was funny, while I saw red in this episode.
I think I got it–
Cuddy is House’s boss, while Wilson is a peer. Cuddy is the hospital administrator at a very respected hospital. However, if this is the way she deals, she needs to be fired. It seems like her only duty is to keep House in line.
No wonder House isn’t in line.
If Cuddy wants to stay home with the baby, stay home with the baby. Don’t put the blame on House. She chose Cameron as her replacement, which everyone saw the problem in that (except for Cuddy). Go on sabbatical, hire a competitant assistant. DO SOMETHING.
Instead of playing potentially harmful pranks on a man who’s already disabled (which she had a part in that as well!)
If House wanted to, he could sue the hospital for that. He could end up owning the hospital and become Cuddy’s boss. Obviously, that never crossed his mind.
I’ll shut up now.
Great analysis, Scott. So, it is true that you can scratch through your skull? *Shudders*
Kat
February 3rd, 2009 at 12:18 pm
I am amazed by the lack of any basic grasp of clinical trials on this show. Errors so far:
- In a earlier show, a patient was “making his living” by participating in clinical trials, and ended up risking his life by participating in multiple trials. Furthermore, these trials took place over long periods of time. Since the patient was healthy, these would have been phase 1 trials, generally short in duration. Participation in trials pays very modestly – for this exact purpose – end even in multiple trials, a subject cannot make a living this way.
- in the recent episodes, issues include:
1. Being able to distinguish between the placebo and test article by smell. This would unblind and invalidate the trial.
2. The nurse then somehow knowing which of the two was a placebo.
3. The investigator knowing which one was a placebo – that is the meaning of a double-blind trial.
4. The concept that the drug company did not know about/share with investigators information about serious adverse events. There is a whole system in place for investigators to report events (which Foreman did not do) and to receive updates on them.
5. Forman did not just break protocol as he said, he invalidated the trial!
6. While the drug company could decline to do business with him in the future, they can’t stop other companies from doing so unless they reported him – resulting in debarment.
February 3rd, 2009 at 1:10 pm
Regarding the scratching through the skull thing: as I recall from the New Yorker article, the patient there only managed to make it through after weeks or months of unconscious scratching. The wound became infected and the infection softened the bone enough for her to wear it away. It wouldn’t have happened in only a day, like in the show.
February 3rd, 2009 at 2:23 pm
Add me to the people who’se suspension of disbelief cracked when the patient SCRATCHED THROUGH HER FRIGGIN SKULL AND INTO HER BRAIN!!
I mean, IANAD and all that, but seriously how in the world could anyone keep itching when all the nerves in that area were torn away and she was digging into the skull?
And considering I can split a fingernail catching a corner of a book wrong, how in the world can a fingernail dig a hole into some very hard and flat bone without giving up long before the skull did?
I love me some House, but the lazy writing for shock value is starting to kill me.
February 3rd, 2009 at 2:27 pm
I know that House is the mind, the smartest man in any room he’s in. I know that Cuddy is the heart, pumping funds throughout the entire hospital. I know that Foreman is the skeleton keeping the different crews together, and that Wilson is the consciousness. I know that Cameron is the river, and I know that Chase is the backbone, capable of performing any medical procedure. But when do Taub, 13, and Kutner get their opening credit shots? Until they do, I think they will be ‘Ambershirts.’
February 3rd, 2009 at 2:28 pm
I thought the soap opera in this one terrible but the medicine was even worse.
How is it that Thirteen develops a brain tumor that grows so fast as to cause blindness within less than an episode when no one else in the trial has ever developed one in spite of being on the drug for much longer? (Because if they had, the drug company would have informed the researchers and either told them to shut it down completely or be on the lookout. That made Foreman wanting to ask the drug company about it ridiculous.)
Why did Foreman not follow standard research protocol when he found out Thirteen was on the placebo which would be to pull her out of the study and give her the drug anyway? How is it that Foreman didn’ t lose his license? Or that it was more important to cover it up than prevent other people from getting brain tumors?
They’ve ruined Cuddy over the past seasons.. Cameron didn’t quit because House made her, she quit because he was her teacher and she couldn’t be objective about him so that was the a big lie Cuddy told . Physically causing House pain because she is venting her own frustrations at her inability to control her life is not funny and it’s not mature (and it also speaks to the fact that she shouldn’t be allowed to adopt a child if she can’t control herself). House is what she herself made him and what she allowed him to be for years without stopping him. And even he was never at the level of physically hurting someone unless there was a diagnostic reason. Cuddy has gone from being a smart, capable professional woman to a neurotic insecure woman desperate for House’s attentions. Is this supposed to be entertaining? My teenager has stopped watching because the characters on her anime shows behave better than this.
February 3rd, 2009 at 2:53 pm
I’m going to have to agree with Kathie. I’m only an undergraduate researcher, but I know damn well enough to see a lot of the glaring inconsistencies in their treatment of clinical trials. I also wonder how the patient was “months away” from curing retinoblastoma or whatever span of time it was. I did not know research ran on time-tables like that.
Also, in response to ’scratching through the skull’–wasn’t the patient scratching over her temple?
February 3rd, 2009 at 3:08 pm
This episode sucked.
February 3rd, 2009 at 4:28 pm
Gonna chime in with the gloomy comments about this episode’s quality and generally all episodes of this new year. I can’t help feeling more and more detached towards the characters. Something about the way these are done is really askew. Haven’t laughed because of house since christmas …
February 3rd, 2009 at 4:37 pm
Frankly, I think people are beginning to look on the “halcyon days” of this show with some rose-colored glasses. Having gone back to see some of the earlier episodes, many of them were pretty inconsistent (internally and externally), too. Granted, they were generally inconsistent in somewhat less spectacular, sensationalistic ways, but still inconsistent.
This was not a good episode, I don’t think, but I don’t think it sucked, either. Just thoroughly run of the mill.
February 3rd, 2009 at 4:49 pm
I don’t think Wilson is a real doctor, much less an oncologist. He doesn’t have time to see patients. He is too busy whining to Cuddy and House all day about how they need to play nice.
February 3rd, 2009 at 5:11 pm
I’ve wanted it to be mesothelioma since it became all the rage in lawsuits…and boy, was I disappointed it wasn’t.
February 3rd, 2009 at 6:42 pm
Scratched her brain!!
Did she have CIPA and Adamantium fingernails?
February 3rd, 2009 at 7:15 pm
For the first time I genuinely didn’t enjoy this episode of house. Firstly as I am currently plowing through clinical trial data in a legal capacity I have to agree strongly with Kathie. Although I could just about suspend disbelief enough to believe Foreman might have found out that she was on the placebo, why on earth he would switch her to her to the active treatment group is beyond me. Even If he truly believed that they had come across an effective drug (based on the positive experience of one patient!) this would surely have compelled him to protect the integrity of the trial. Even if he apparently loved her so much he was willing to jeopardize the thousands of people this drug could potentially help, he must have been aware of the fairly serious adverse drug effects that often occur in such trials. The idea that he would give anyone a relatively untested drug without their knowledge, and not even think that it might be risky, is ridiculous. Plus the writers seemed very quick to blame the evil drug companies for not accepting her trial data, although I’m not denying that pharmaceutical companies have been accused of some dodgy actions in this case it was absolutely correct that her data was discounted, in fact I’m surprised the whole trial wasn’t scrapped as one of the doctors running it was not only sleeping with a participant, but also deciding which patients were on placebo and messing about with their regimes.
Maybe it’s just me being pedantic but the whole thing really bothered me, especially as the entire story arc was (in my opinion) pretty dull and unnecessary and I’m more willing to forgive sloppy medical practices if it results in good story. Anyway end of stupidly long rant, thanks for the excellent reviews and I’d be fascinated to hear the plausibility of the head scratching scene.
Maybe it’s just me being pedantic but the whole thing really bothered me, especially as the entire story arc was (in my oppinion) pretty dull and unnecessary and I’m more willing to forgive sloppy medical practises if it results in good story. Anyway end of stupidly long rant, thanks for the excellent reviews and I’d be fasinated to hear the plausibility of the head scratching scene.
February 3rd, 2009 at 7:20 pm
I read that New Yorker article on a recent trip (I save up the magazines for traveling), and I knew the instant I read about the scratched-through skull that the House writers would pick it up – it was just too bizarre and scary for them to leave it alone. When she complained of itching, I knew this was the moment.
I actually rather liked the doctor patient. What I can’t stand is 13. The writers seem to have decided that we care about her and her fragility, and that putting her in jeopardy moves and enthralls us. The fact is that every time I deeply hope she dies.
Even without a medical degree I thought the timings on both patients were ridiculous. I didn’t mind the Cuddy stuff so much – it’s not like there’s any reality left in this show. Did like Wilson.
wg
February 3rd, 2009 at 8:03 pm
It’s funny you mention that Wendy M. Grossman……I was just thinking about how overly melodramatic Thirteen’s storyline has become.
Despite all these medical problems she seems to be having (blindness and a brain tumor??? what ever will the writers think of next!), I simply don’t give a damn about her. I end up feeling nothing for her or her issues.
Yet when I watched Wilson washing the dishes in those 2 scenes…….my heart broke.
He conveyed more emotion in a simple facial expression, than Thirteen did in her entire “OMG! I CAN’T SEE!!” speech.
February 3rd, 2009 at 8:36 pm
Some scattered thoughts:
The problem I’ve been having with this season’s episodes is that, by and large, I haven’t seen anything “new.” For me, the joy of watching “House, M.D.” has been the sense of seeing something I’d never seen before, whether it’s some off-the-wall diagnosis or plot twist or quirky dialogue. Perhaps the show has reached a point where it can no longer be ground-breaking, because just about all of the ground has already been broken.
I thought this was an OK episode. I take Dr. Scott’s point that Dr. Dana Miller was “unlikable,” but surely we shouldn’t expect to like every single patient. (Remember that teenage girl with the chip on her shoulder in “Emancipation”? I didn’t like her at all, but that’s what made her interesting,) Dr. Miller didn’t exactly warm the cockles of my heart, but the real problem was, I don’t think we got enough of her – the episode spent so much time on Thirteen and Foreman, it was like, “What happened to the original patient?”
Cuddy’s treatment of House was shockingly cruel. Her antics in “Let Them Eat Cake” made at least some sense (commandeering House’s office, stealing the furniture) and were funny besides, but physically torturing a cripple??? (If I were Lisa Edelstein, I would have strongly protested once I’d gotten the script.)
“Foreman – I can see you again!” Given the relationship between Thirteen and Foreman, I think she’s earned the right to call him “Eric.” (Did Foreteen go to the same school of romance as Cameron and Chase?)
Dr. Scott: You proclaimed this a “mediocre” episode, but gave it three B’s and a C? (Then again, mediocre “House” is a lot better than some other shows’ best.)
February 3rd, 2009 at 8:53 pm
>… now she is bleeding copiously through her ears, nose and eyes.
Clearly the poor woman is under a withering psychic attack and they should move her to a room with high grade psionic baffles immediately.
Unconsciously scratched her brain, but didn’t do any serious damage?
February 3rd, 2009 at 11:23 pm
i miss the remarks about 13’s sexuality. always fun.
i think its obvious the downfall of the show will be running out of clever medical ideas. I think you should start a campaign to be a consultant on for the show, as long as you run on a campaign of ‘change’ you should be okay. its worked for other people.
February 4th, 2009 at 1:57 am
Not lot I can add to the loads of things true and false said for this episode. The mystery and the solution – smart a bit unbelievable in the real world but that is HOUSE after all. The way they showed with big animation how the surgeon removed the tumor thus spreading endomethrial cells through the blood stream was lovely to watch but a bit unbelievable. If I am not completely mistaken for tumor resections you isolate the tumor – cut out all the blood lines in and out, before removing it. A surgeon rarely uses a scalpel so boldly after the initial skin incision. Still it was believable. Any of the procedures in this episode was unbelievable – Kutner’s “Pulp Fiction” stab, Taub’s sucking blood from the belly with a syringe after practicably jabbing it in the pancreas or the stomach, House and Foreman performing brain surgery (not open surgery but still brain intervention) without any nurse nearby or (wasn’t that hilarious: “Here’s the nuclear isotope Foreman I hold it with special forceps but U can use bare hands (well gloved hands but still)” Hey how about 13 never needing any chemo for the cancer?(WHAT kind of tumor was that? Biopsy anyone? Or at least consult with hmmm I don’t know oncologist? before nuking and hacking into the skull? That was one fast tumor and one fast recovery – and correct me if I am wrong but brain tumors are among the most dangerous with the least successful treatment (well relatively low rate of survival anyway) It seems to me they broke the bubbly a tad too early. May be it was because “oh she is dying anyway?” Cruel. Still it was fun to watch and I think that House and Cuddy really need to get a room and stop torturing each other. Cuddy being the prankster and House suffering silently was way funny and plausible for the finnish.
February 4th, 2009 at 3:25 am
RE: Scratching through the skull –
(Ryan mentioned it earlier, but people keep asking, so I figured it’s worth repeating.) In the case of the (real) patient reported in the New Yorker article, the patient scratched at the same spot for a very prolonged period of time. In doing so, she kept her wound open long enough to sustain an infection that gradually weakened the skull such that further sustained scratching eventually penetrated it.
A human being, hell a human fingernail, is not strong enough to scratch through bone (as a point of comparison in House: In the “Frozen” episode in season 4, a guy trying to make a hole in a woman’s skull with a power drill has to lean on it, harder than usual too, to do it). So the answer is the same as most answers to “Can that happen?” for House episodes: Yes, sort of, but not in anything near that time-frame.
I’m surprising this episode got such good marks – two Bs and two Cs are high grades from you, especially for the medicine, for an episode you call “absolutely mediocre.” I think.
I’m annoyed that they made such a light deal of Foreman’s trial fuckuppery. And annoyed that there was such quick recovery time for 13. Aside from Looking Very Sad, in show terms, Foreman didn’t lose anything. If anything, 13 being removed from the trial spares us that painfully cheesy arc, for the moment. (And spares us the possibility that they were going to cure her Huntington’s by the finale, which is scarily plausible for the show – much as I love it.)
I agree that the Buddha – sorry, patient – was unlikable. Most because she was one-dimensional and self-righteous. All of her dialogue, all of it, was virtually the same line repeated over and over again.
I wish they explored the idea of getting down on House’s level a bit more. I’m ticked that people got so shocked that Cuddy would, gasp, make him go up some stairs, trip him, etc. Considering the abuse he’s put her and many many many others through, that’s small fries. Wilson was right to call her out on it, she was wrong to cave – though it’s a pyrrhic victory for House, I think, since Cuddy has now learned Something Important About Their Relationship, which decreases his power over her. Or I think that’s what the writers wanted to convey, anyway.
The “that’s just who he is” lines were such bullshit, and totally out of character.
The Wilson character scenes were, of course, EXCELLENT.
Despite the one-dimensional Guru chef, I was surprised at how well they juggled two patients (her and 13), and at least 3 sub-arcs (Cuddy, Taub, Foreman).
At times it felt distracted, like it bit off more than it could chew and wasn’t sure how to take character of the details for the big picture (which is admittedly neat overall), but the Wilson bookend scenes earned a little leeway in my book.
As ever, Scott, thank you for your reviews. I’ve come to look forward to them almost as much as the episodes themselves!
February 4th, 2009 at 4:39 am
I think it was an OK episode, at least it had a better and more S1/S2 House-like feel to it than most of S4/5.
I just wish they were a bit more consistent with the story lines in stead of this “out of the blue” thing.
There’s half a storyline with Cuddy and the baby, and Thirteen’s Huntingtons (which they’re dragging out too long..) but the rest of it makes them almost very suitable stand-alone episodes that could be watched out of order.
First House with suddenly more pain, which gets ignored before and after that episode.
And now Cuddy is intentionally causing House even more pain?
I could see the elevators (I laughed, but expected it to be one-time-only, to prove a point. And I expected House to give the stairs a go, limp down again halfway, and loudly complain to Cuddy. He didn’t know yet it was her getting revenge!)
And I just can not see a sensible adult installing a tripwire in front of the door of a man with a bad leg, (and I was very surprised that he was OK, arms, legs, head..) risking an ‘out of work because at home recovering’ employee.
I know it’s TV and all, but can you think of anyone in real life who would actually do that? I prefer at least some plausibility…
The *idea* of her doing that, eg Cuddy jokingly telling Wilson she’s THINKING of installing a trip wire: Funny!
But actually doing it – not very funny. (Brilliantly acted as usual, but I was cringing, not laughing).
Wilson still living in Amber’s apartment and being ’stuck’. Where did that come from? He seemed to be doing so ‘fine’ that I almost forgot about it…
And I really really wish they’d be done with all the soap-storylines already. Creative license I can take, sloppy/easy writing I can’t.
Cuddy wanting to adopt, and *poof* there’s an available baby.
Foreman switching the drugs (ethical disaster!) and Thirteen getting sick as a result – OK, if I have to I can live with that.
Foreman switching the drugs, Thirteen getting sick from the drugs, developing a brain tumor that compresses her optical nerve (or X chiasma as I read above), going blind, and – of course – regaining full sight the next day. Puh-lease.
I have found that watching the episodes a second time makes me like them better, but they’re still far from their original greatness.
It makes me a little sad, and House used to make me very happy.
February 4th, 2009 at 7:11 am
At least when 13 found out about Foreman’s changing the drug, she said what the rest of us were already thinking: “HELLO! We’ve only been dating for 2 weeks! What made you think this was a good idea?”
February 4th, 2009 at 8:43 am
As soon as I saw Kutner plunge the needle into her, I knew you’d say something, Scott. I’ve never been a fan of needles, but that’s always creeped me out.
February 4th, 2009 at 9:00 am
Thank you so much for 100 reviews! At least once during every episode I say, “I can’t wait to see what the medical review says about THAT!”
I had one non-medical nitpick during this episode: Her boss didn’t know she was a doctor. What did she do, claim she had never had a job before in her life? Most employers like to see at least some work history.
February 4th, 2009 at 10:39 am
Cuddy is about 30 years behind the times with her “bad mother because I have to go back to work” whine. It is done by thousands of women every year, and somehow the majority of kids do fine. It was her choice to adopt the kid. What: she didn’t plan for going back to work someday??? PUL-EASE!
February 4th, 2009 at 11:02 am
I don’t agree that the patient was “self-righteous”. She simply reponded to everyone who self-righteously questioned her reasons for changing the direction of her life; and in each case – especially Taub and Wilson – she was right that they aren’t happy. Nor is she selfish; she has no obligation to make the world a better place for others at the expense of her own happiness. Look at it this way: if everyone sacrificed their personal happiness for everyone else, then no one would be happy – so what’s the point? I think those who don’t like her attitude are just jealous of her freedom, and angry that the espisode made them think about how unhappy they are. The only difference between a rut and a grave is how long you dig.
February 4th, 2009 at 11:31 am
Totally off topic but I have to say….
It is always mentioned in the show how little the doctors get paid(Taub mentioned in this episode about getting paid 5$ lol). I know they work at a teaching hospital(which doesn’t stop that one surgeon in “The Mistake” from getting 600K/year), but I have always wondered what their definiton of “low pay” is.(which probably isn’t so low for a “non-doctor”) I mean, I would hope they were getting more than 40K a year or something.
February 4th, 2009 at 11:31 am
Concerning Cuddy’s rather bad “pranks”:
I understand what they were going for. Cuddy is mad at House, thinks that she’s going to play at his level, and isn’t very good at it because House is an expert at that sort of thing and she’s an amateur. But good lord, the trip wire thing? All that had to happen there was anyone other than House walk through the door first and WHAM, instant lawsuit. There was a decent chance of injury from that prank. Cuddy didn’t come off as anything other than selfish, petty, AND stupid. Bad form for the writing staff.
February 4th, 2009 at 11:40 am
Official Comment
draydray,
I suspect they’re making around $35K. When I was a resident we were paid $29-31K — but that was a decade (more or less) ago. Plus, they’re Fellows, not residents, so should make a little more. On the other hand, the hospital may pay them less because 1) there’s so many of them, and 2) they figure the privilege of working with a doctor of House’s reputation makes up for low pay.
Another way of looking at it is that Taub is probably making 10% of what he made as a private practice plastic surgeon.
February 4th, 2009 at 11:45 am
In the real world, if House weren’t completely unemployable, Cuddy easily could hire someone hard-nosed enough to keep House in line, and who would probably enjoy it. Why give up after one failed attempt? How did she get to be chief again?
February 4th, 2009 at 11:57 am
The two-by-four, painted in high-visibility yellow-and-black stripes, crashed down on me again.
“Do you see the MESSAGE now?” the man screamed, swinging the makeshift club. “Look at the MESSAGE! Look how subtle we’re being with the MESSAGE!” It had a nail through it, incidentally.
Cause of death, if anyone’s interested, was massive blunt trauma caused by a four-foot long two-by-four with a nail through it and “MESSAGE” printed down the side…
As for the rest of the episode, disregarding the show’s most tedious, self-important, selfish, and downright annoying patient to date, that was rubbish too. Cuddy’s childish antics, the idiotic Foreman/Thirteen story (seriously – revoke his medical license, and kill off Thirteen. We really don’t like her, whatever the writers think.), House becoming really little beyond a cardboard cutout to have a contrived eureka moment seven minutes from the end of the show… What a let-down for the 100th episode.
Oh, and the skull thing… I have some really annoying skin condition, which makes me itch immensely. Amongst other things, I have a really itchy scalp. The worst I’ve ever had is a three-mil staph abcess. I mean, come on, couldn’t they at least try to make the medicine believable for us non-professionals?
By the way, 123, it’s got nothing to do with “realising how unhappy” we are. In choosing to develop the skills that allow her to make a difference, she’s assuming a duty to try to make a difference. If you were a police officer and you passed someone getting beaten up, you couldn’t say “Sod it, I want to watch TV” and just walk on. And that’s why she lost all integrity and validity.
February 4th, 2009 at 12:57 pm
Andrew: So because she spent her time and money to develop the skills to make a difference, she’s stuck; but there’s no obligation to develop those skills to begin with? That doesn’t make sense to me. In your example, the police officer’s job is to help people, but if he quits his job (as the patient did), then he has no more obligation to help than any other citizen. It sounds like you’re saying that, although there’s no obligation to become a police officer (or a cancer researcher), once you become one you can never quit.
February 4th, 2009 at 2:31 pm
wow, that………..sucks
February 4th, 2009 at 5:13 pm
Great review, but I would just have to say, quit complaining about the characters.
Obviously, unless the ratings are poorly done, the characters are fine.
“Oh, but Cuddy was mean, and blah blah blah.”
So what? Have you ever noticed that maybe she was stressed out, and decided not to take House’s bullcrap anymore?
I guess people seem to forget the other times Cuddy was mean to House, but on a nonviolent level.
“What about Thirteen and her fast tumor?”
Unless you have some sort of degree in medicine, or is very knowledgeable about tumors, I don’t even think you should be able to answer that question.
“I didn’t like the patient.”
OK, because she’s decides to actually have input into other people’s lives, she’s boring. House does it on every episode, and everyone seems to eat it up. Interesting.
February 5th, 2009 at 12:05 am
It seems that I’m the only one who even likes House anymore. I actually thought that the pranks were funny. I mean, they reminded me of Wilson’s “saw the cane in half” prank, which was equally funny. I mean, stealing his cane was pure funny. Now, I don’t wan anyone psychoanalyzing me as a former kid bully, but I just thought Cuddy finally snapped, or decided to have some fun. It’s not like he hates her and is actually in physical pain after all this. For God’s sake, he stuck i knife in the wall to electrocute himself.
February 5th, 2009 at 4:32 am
I just had a funny thought – What if the endometriosis managed to get to the bones (also the skull bone) and grew in there reducing the strenght and thickness of the bone thus allowing the scratch through thing? May be in some level that is possible (or may be the bone was reduce because of the whole menstruating with the entire boddy thing?) Anyway just a thought. Mike: Some of us are doctors (well I am a dental doctor but I am sure there are people better educated than me other than D-r Scott here) so don’t worry – when I critisise it’s usually justified. The tumor thing was really unbelievable – all the way. It should have been done in two episodes at least to make it more believable.
February 5th, 2009 at 5:20 am
Has anyone even been following this show? Cuddy HAS snapped. She’s bonded with her baby and is especially emotional, so her attempts to “get on House’s level” were horribly miscalculated. It can be argued that this was a stupid and mildly offensive thing to do to the character, but it’s not like her actions came out of nowhere.
Jake makes a good point, House electrocuted himself and has needlessly risked his own (and others’) lives in the past. To do this to anyone else would be inexcusable; House is the excuse.
February 5th, 2009 at 11:16 am
Hmmm, I was awating something a bit better for this ep:-/
1. Sure, some people realize sometime that they weren´t happy with their job and make a radical chnage, but giving up on research after so many years?? Come on!
2. Endometriosis in her eyes, nose, ears etc.??? Even the pericardium was kinda overstated. Or did the endometriosis cause some kind of coagulopathy?
3. I liked the sudden eureka moment. Perhaps because I got it for House had it while talking about “28 days”.
4. Thirteen almost dying and then getting well miraculously? I think we´ve seen that before.
5. Cuddy acting like a kid wasn´t funny at all. I watched some eps of season 1 last week and she actually could stop House that times. Now he can do whatever he wants anytime he wants.
6. Seems like Thirteen was completely crossed out from the results, simply like she´d never participated.
7. Foreman surely told what he did, so nobody would say that a placebo patient had a tumour. But if the drug was so dangerous, why did no other patient get a tomour too??
8. House and Foreman operating on Thirteen? Where was universal-mister-surgeon this time? Anyway operating on somebody you have close feelings to is a very very bad idea. And House treating somebody who he knows usually does nothing! Perhaps he doesn´t give a crap about Thirteen?
9. The itching and scratching thing: Dana had liver bleeding, so there was something wrong with her liver, so she developped liver failure. The metabolic “trash” that builds up because of liver failure causes itching. But scratching through the skull?? Can´t believe this could happen!!!
February 5th, 2009 at 5:29 pm
Dr Scott, thank you for all the reviews! Sometimes, when an episode is particularly unimpressive, reading your review after is the best part.
This is totally not related to the medicine in the show, but it drove me crazy when I saw the way the patient, Dana Miller, was chopping onions (holding the onion down with her fingers splayed over top, knife cutting under the palm and between the thumb and fingers). For some reason the unlikely medicine and questionable ethics didn’t bother me as much as the idea that in eight months, the top chef had never bothered to teach his protege how to use a knife properly. Haha!
February 5th, 2009 at 8:21 pm
Dr. Scott… Thanks for the reviews and congratulations on your 101th review.
If the show gets killed, what the heck… Someday we’ll see a movie of it, and for sure i will add the season 5 to my dvd collection (as the other 4 seasons). This episode was entertaining, not as good as usual, but was good enough for me.
Kutner has already burnt two people, and what if he inserted that needle without using the right procedure… The show is great anyway.
Heishiro
February 5th, 2009 at 9:24 pm
That was bugging me too, what happened when she had her period for all those months before? Great review as always!!
February 6th, 2009 at 1:01 am
by the by Doc, Wikipedia now has links to you reviews on their pages on each episode
its just down the bottom, ‘Medical review of “‘”
I only just noticed it cause i’ve never read one of their pages on an ep before, i usually just come here.
congrats
February 6th, 2009 at 7:03 am
We just need Lupus back. Either as the actual cause or a possibility. Then the show will return to the normalcy of awesomeness that was season 2.
February 6th, 2009 at 12:32 pm
I must say I really am fond of Taub and Kuttner. THey both add a lot to the texture of the show. Equally interesting. Probably not as much as Cameron and Chase, but close.
I like Thirteen as well, especially when she really shows smarts like the drug buying scene where she just knew how to buy the drugs from the chick selling coke. And her medical chops in general are strong–she stands up to House as well a Cameron does, without the crush…
However, I’m just not buying the Fourteen affair. Just not buying it. I feel it was a mistake to start this whole arc of 13–drug trial–love affair with Foreman–swap placebo for real drug–tumor–crisis. I feel the whole thing was a mistake. In fact, I’d really like to see the Huntington’s thing just go away. False-positive on the genetic test…
Uncle Ron
February 6th, 2009 at 3:02 pm
So now I’ve read so many of your reviews that I’ve converted and started watching House from the beginning…and now can’t read these any more because they are spoilers. Damnit!
February 6th, 2009 at 11:40 pm
I have found the reason super team to all their own tests/surgeries etc.
Was in Season 3 Episode 7 “Whac-a-mole”, When doing an LP on the patient, instead of calling a nurse Foreman get the patients sister to hold his shins.
She says: “Is this all nurses do?”
Foreman replies: ” Its all my boss trusts them to do”
And I guess you could make the same assumption for lab techs/other doctors.
Its probably not it but its a small explanation :)
February 7th, 2009 at 1:58 am
Is anyone else getting really tired of the writers coming tantalizingly close to killing off 13, then changing their mind?
February 7th, 2009 at 5:12 am
Yeah, Uncle Ron, you´re absolutely right about the Huntington´s thing. I thought about it last week when Foreman switched her meds that he could endanger her for nothing… But what about the high CAG repetition number he was talking about in “Lucky Thirteen”??? Maybe a lab screw-up?? On House no surprise, right:-)
February 7th, 2009 at 7:10 pm
Thanks, Scott, for the 100th review of House. Always both edifying and enjoyable to read, even for those of us who don’t work in the medical field (or perhaps especially for us).
When the patient began bleeding from her ears, her eyes, etc., did anyone else wonder briefly if it could be Ebola or some other form of hemorrhagic fever? And she was having that unexplained bleeding from her liver, the bleeding into her pericardium….(Maybe when Kuttner stabbed rather blindly and savagely into her chest to drain the cardiac tamponade he was flashing back to the pneumothorax. I once read a novel in which the hero diagnosed a pneumothorax in himself and produced to knife himself in the side of the chest).
Now that might be an interesting House episode, an exotic, deadly, infectious disease loose in Princeton-Plainsboro teaching hospital mandating a quarantine, all hands trapped on deck, House shut in with his minions and patients 24-7 as they race to discover the disease culprit. Hey, they’ve had patients with plague and rabies, why not the Ebola or Marburg virus?
While it would not fit into the infectious quarantine scenario, a case of hantavirus would be interesting and hard to diagnosis at first, especially in a young, previously healthy person. Taub would visit the patient’s home and only later think to mention in disgust all the mouse droppings…
Scott, I would love to hear your ideas for potential medical mysteries for House M.D.
February 8th, 2009 at 2:50 pm
Sadly once again the media has not handled the issue of endometriosis correctly. To clear things up, endometriosis is not the same as the endoemtrium. It is always in the body and bleeds whenever it so chooses. If the surgeon did not excise it correctly which is the case in more than 90% of patients, then it will remain in the body. Think of it like a mole, you wouldn’t burn the top of it off and expect it to go away. You need to cut it out. Endo also doesn’t show up via any exam be it MRI, CT, ultrasound, the only way to see it is via a laparoscopy. It also is misclassed as a gyno problem when in fact it is an autoimmune disease. Until the medical world admits to their lack of knowledge of this disease and how to treat it (there is no cure let alone doctors don’t know how one gets the disease) million of women will continue to suffer. And as to the us of the pill or or Lupron type drugs, these are NOT cures but just expensive bandaids that non-specialized doctors aka quacks will prescribe all to readily along with the old addage that you just need to get pregnant and that will fix you.
February 8th, 2009 at 6:00 pm
I actually like 13, but I think the character suffers from the arc with Foreman. She was much more interesting as a self-destructing “refuse-to-look-reality-in-the-face” doctor, with little respect for even House.
Im no doctor, but from my boxing days I remember hearing that the temple is the are of the cranium where the skull is at it’s thinnest, on some people only a bit more than a millimeter. I didn’t notice the pasients fingernails, but strong fingernails with a few coats of hardcoat nail varnish are strong enough to scratch through hardwood, so it was not completely far fetched I though.
As for Cuddy acting childish, House just turning a blind eye must just have infuriated her even more, as she probably wanted him to at least show that he was irritated. her problem is that she cant just try to put someone who don’t know House as his babysitter. That would probably just end in disaster, or House leaving. And she tried Foreman, which didnt turn out. (In fact Foreman is turning more and more into a loose cannon himself, albeit a less useful one.) Cameron was to emotionally attached still, and Chase… nah. That leaves Wilson, and while he MIGHT be able to control House, he is also rather unstable after the whole Amber dying-stuff.
And House having a chat with the patient would have been anti-climactic. House all ready does what ever he likes to do, with little regard to others, just as she preached. Not that it makes him happy, but he probably would not be happier anywhere else either.
What I liked about this episode was the way House showed that he actually cares about his staff. Enough to worry about 13 and her health, and to guide Foreman away from a pointless and destructive plan of action. And he showed a remarkable insight in how other people act and feel, which proves he _chooses_ to disregard other peoples feelings most of the time
February 8th, 2009 at 8:07 pm
I can’t read the review or comments until the current episode makes it to Hulu, but I did want to say congrats, Scott, on review 100 or 101 or whatever you want to call it. And thank you.
February 9th, 2009 at 2:33 am
Hey, Scott, where are the House Challenge score updates for this episode? I imagine it wasn’t a case where anyone got a whole lot of points, but I think I did get at least one …
February 9th, 2009 at 10:12 am
Scott,
You mention them making somewhere around $35k, which reminded me of Season 1’s episode “Heavy”, where House tries to bargain with Vogler to reduce their salaries by 17% across the board to make up the difference for firing one of the Fellows. This puts House at about a 2.88:1 ratio for salary over them, or, given the $35k figure, right around $100k. Does that sound about right, then?
February 9th, 2009 at 5:55 pm
If in fact the writers of the show read these posts, perhaps they will consider the following plea:
Ditch Cameron and Chase. Seriously, no more of them. The characters are neither funny nor sufficiently realistic to add drama to the program. Maybe they can come back in a few seasons, but for now they’re crowding the team.
p.s. more Taub and Kuttner please.
February 9th, 2009 at 8:27 pm
Just, urgh. Your reviews more enjoyable than show now.
February 10th, 2009 at 7:10 am
How the hell does having random endometrosis cause insatiable itching? And yes, I did notice the writers plucked a leaf out of a previous case where a woman DID scratch through her skull, but that was indeed a localized thing. (At least to what I remember).
This epp has one of the most possibly-logical-yet-completely-illogical diagnosis I’ve seen in a while.
February 10th, 2009 at 6:29 pm
Could someone please explain the House challenge scores: what are they composed of, and where do you find them? Is it who can guess the correct dx most quickly as the show proceeds?
February 10th, 2009 at 6:30 pm
Thanks for another great review. I love how you didn’t comment on the skull scratching nonsense and left us all here scratching our heads in disbelief. :)
February 11th, 2009 at 3:05 am
Playing with the elevator didn’t bother me, because House is just the sort of person to walk up the stairs because someone is messing with him when he has a perfectly fine alternative. I’ve never seen a hospital with only one elevator. He could have just gone to a different elevator, at least that was my assumption, but no, he has to go up the stairs even if it’ll hurt and cause him problems because the he suspected the elevator being out was specifically to bother him. Or he’s just so stubborn about not changing things that he won’t change his route enough to use a different elevator.
February 11th, 2009 at 12:35 pm
I had a “Eureka!” moment of my own last week – after watching this episode of House, later that evening I watched CSI:Miami, where Calleigh developed smoke inhalation problems, was eventually hospitalized, intubated, dangled near death, had to be given some miracle med, and oh dear is she gonna make it? Of course, by the end of the episode she was sitting up in bed, chatting normally, no scratchy throat or hoarseness.
This made any episode of House look like a med school documentary in comparison! Just to give some perspective…
February 12th, 2009 at 8:30 am
@Kim – The House Challenge. Basically, at the beginning of the season, people submitted lists of 10 possible illnesses/conditions. You get points for a mention, more points if it’s seriously considered, even more if treatment is started for it, and the most points if it turns out to be the condition the patient has.
February 14th, 2009 at 9:47 pm
Not meant to be picky, but I think if they trully think pulmonary fibrosis is the most likely diagnosis, an open lung biopsy coupled with a high-resolution CT would be the best diagnostic methods as pulmonary is a patchy process that requires evaluation of a large specimen. But of course, they’d need to do bronchoscopy with bronchoalveolar lavage and transbronchial biopsy first to R/O other causes.
Thanks for your weekly reviews though, it’s always fun to read them.
February 14th, 2009 at 10:12 pm
LOL at Kat about Cuddy. Please relax and don’t take it too seriously. I swear all your past comments have been rants about Cuddy. However, I do agree – the character has been thoroughly ruined. True, the earlier seasons weren’t perfect, but in Cuddy’s case, she was at least tolerable and likable. Now, not so much.
February 16th, 2009 at 7:06 pm
my lungs collapse due to endometriosis :) its called catamenial
February 17th, 2009 at 1:31 am
So Princeton Plainsborough has only 2 elevators? The hospitals around here are smaller than the building they show, yet one I know, has elevators all over the place. There are 6 in the central tower alone. And several of them even have staff-only elevators along side the general ones. Something about needing to transport patients to the various floors in a decent amount of time.
Oh, and about brain tumors: Don’t know about tumors induced by a mythical trial drug, but my dad’s glioblastoma multiforme killed him within 6 months of diagnosis. Even with the chemo and radiation. In fact he died within weeks of “graduating” from the regimen. He went to the hospital suspecting a stroke because one morning he woke up and was uncoordinated on his left side. By the time he left the hospital, he was completely paralyzed. Of course by then the necrotic tissue was already the size of a golf ball and probably had been growing for a while.
So yeah, a tumor that starts up and causes blindness within a week is still pretty far-fetched, when even a grade 4 cancer takes months.
Oh, and for radiating a localized tumor: Have they ever heard of a gamma knife?
February 17th, 2009 at 8:47 pm
GREAT episode as ALWAYS. Show’s gonna last a long time…
February 18th, 2009 at 2:01 pm
Scratched through her skull? Oh come on.
Lets suppose she actually could do that with her finger nail. The “itch” was not a “true itch”, ie there was no real skin iritation(yes I know there are meds that cause ppl to itch), so if scratching through too her brain would have helped her releive this itch, wouldn’t it have quickly come back and she would have started digging again? At least until she either A) suffered a seisure possiblely causing her to thrust her finger deeper into her skull where Foreman, or a nurse would have found it, or B) She emptied her skull of any gray matter her finger would have been able to reach.
Come to think of it, the writers may have suffered from the same condition the patient had, and actually succeded in option B. Then they wrote that scene.
February 22nd, 2009 at 10:14 pm
Happy 100th episode! :)
March 24th, 2009 at 12:57 pm
Just a random, extremely late comment:
I found an article talking about this type of endometreosis. Pretty fascinating stuff, IMO.
http://discovermagazine.com/1995/mar/thearethafrankli483
Though I am also pretty sure that every article written to the Vital Signs column in Discover Magazine will eventually become an episode of House.
April 24th, 2009 at 7:52 am
KILL Foreman, PLEASE!!
May 8th, 2009 at 8:53 pm
I liked this episode and enjoyed the medical mystery. Imperfect as the details/timing were, a close friend of mine went through something similar with widespread endometriosis, so the broad strokes are not that implausible IMO.
For the first time in months I have warmed to 13, and enjoyed the upfront and apparently uncomplicated connection with Foreman. Nice change of pace from another extended, over-angsty relationship build-up. It can end happily or splintered, and still be credible. (I’ve always liked Kutner and Taub.) I liked Foreman’s self-sacrificing decision to pass on the crucial information that his unethical actions had uncovered and take the consequences, and was relieved that the scriptwriters allowed him to do it without being written out.
I liked the Taub subplot, and agree with the poster who saw the multiple storylines as in keeping with an episode examining ‘the Big Picture’.
I liked House’s response to Cuddy’s PMS response to her frustration with him and saw it as a potential development of the increasing pain thread, in nice parallel to the Foreman plot – House came close, a few eps ago to adopting Dana’s viewpoint by deciding to live painfree via health- and intellect-compromising use of Methadone. That he consistently rejects ‘happiness’ in favour of his distinctive need to be effective is part of his questionable unique charm. I also liked that Cuddy felt the pangs that many new professional mothers experience, who had expected it to feel easier to leave their babies. That felt real. I assume the elevator prank continued past its sell-by date because House figured it out before Cuddy thought to update her accomplice (and for what? House knew). Before someone says PMS – not to mention baby-related sleep-deprivation – doesn’t make you foolish, out-of-character and downright violent, I can only say that, in my experience, it can.
I had the same initial reaction as others to Kutner’s chest-jab but can accept typical TV licence. As for the scratching-through-her-skull incident – for me the silver lining was finding that fascinating article on the RL parallel. So no complaints there, either. House and Foreman operating on 13 alone – I took that to be shared guilt/fear of discovery over the compromised trial/13’s health/Foreman’s career. But Foreman was the man who actually did it; thus Foreman got the plum job of directly handling the nuke-stuff.
123: I like your take on the patient, whom I did not dislike. (I wish we had seen more of her boss!) But you could look at it this way: if everyone sacrificed their personal happiness for everyone else, then everyone would be happy. If I were religious (or a career Socialist) I would point up a sermon that posits Hell as a banquet at which the diners have eating utensils attached to their hand that are too long to let them feed themselves and everyone starves. Heaven is a banquet at which everyone has eating utensils attached to their hands that are so long that they can feed the people around them – everyone enjoys dinner. (Oops, I’m neither, and did it anyway.) Nevertheless, I accept that she made her choice and was comfortable defending it. The problem that other characters had with it was both understandable and unfair. Make that call for yourself, not someone else, guys …
Scott, thank you so much for 100 reviews – it has made the House experience more informative and even more enjoyable.
October 13th, 2009 at 6:38 pm
Did anyone notice that Foreman spotted a tumour in Thirteen’s optic chiasm when there was no image (onscreen) of the optic chiasm? Almost seems pointless to do that MRI sceen!
January 22nd, 2010 at 5:12 am
Not Dr Den — Why pointless? It’s the dramatic discovery that needs to be onscreen, not the tumor.
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