House — Episode 21 (Season 5): “Saviors”
A mystery with potential, an interesting patient (in an annoying sort of way), and good soap opera all marred by very sloppy medicine (but at least they got the defibrillation right this time).
Doug is an environmental activist who starts the episode chained to a giant bulldozer. After being forced to leave, he stumbles around and discovers that he is unable to walk or even stand up. He sees a variety of specialists, but no one can cure him, so he is transferred to Princeton Plainsboro and admitted to House’s team.
Cameron tells the team that the “tox screen” is negative, and that there are no neurological, muscular, or cardiovascular abnormalities. House has Cameron perform a vestibular caloric test (irrigating cold water in the ear canal and monitoring any resulting nystagmus — eye twitching) to test his inner ear — the test is normal. Foreman suggests that Doug may have carotid atherosclerosis (hardening and narrowing of the carotid artery, leaving Doug at risk for stroke) worsened by stress. House orders a Holter monitor and a carotid doppler, both of which are normal. While performing the procedure, Cameron discovers that Doug has a serious case of the hiccups, and has had them on and off for a week. She realizes that his hiccups are somehow tied in to his condition. She suggests that he may have organophosphate poisoning from spending time protesting at commercial agricultural warehouses (organophosphates are commonly found in commercial insecticides). Taub counters that multiple sclerosis is a more likely diagnosis. House agrees and orders a lumbar puncture to test for the disease.
Cameron is having difficulty performing the spinal tap on Doug because he keeps moving when he hiccups. She gives him some chlorpromazine (better known as Thorazine, a potent antipsychotic which can be used to treat intractable hiccups). Then Foreman notices some swelling in his neck. At first, Cameron thinks it is torticollis (a severe muscle spasm) caused by the chlorpromazine, but House points out the neck is not just stiff but swollen. It also crunches when he touches it, a sign of crepitus, or air in the subcutaneous tissue. In this case, it comes from an “air leak between the lungs.” Sarcoidosis is suggested, but so is scleroderma, and House chooses to go with the latter, starting Doug on intravenous steroids.
Doug is lying in bed, wheezing (and this wheezing is never really mentioned or even addressed), when he develops a sudden excruciating pain in his left leg. The team decides it is likely osteomyelitis (infection of the bone) after deciding it is not a tumor, aneurysm, or metabolic bone disease. He is started on intravenous antibiotics and x-rays of the left leg are obtained. Surprise, surprise — the x-ray shows a fracture of his left femur. Cameron suggests it may be due to osteogenesis imperfecta (an inherited bone disease), but House is convinced it’s cancer. He wants to start Doug on chemotherapy. Meanwhile, Chase is surgically repairing the broken leg (because he’s an orthopedic surgeon this week), and Foreman asks him to obtain a bone biopsy at the same time. The biopsy is clear, showing no cancer. Unfortunately, Doug has bleeding problems after the surgery, with bleeding from the leg wound and purpura (a skin discoloration that is commonly seen in platelet disorders, vasculitis, and coagulation disorders) showing up on the other leg. Foreman orders 2 units of FFP (Fresh Frozen Plasma).
House is still convinced Doug has cancer and wants to proceed with total body irradiation. Instead Taub suggest that they give Doug Insulin-like Growth Factor, which should make the cancer grow larger, and thus they’ll be able to find exactly where it is. It should really come as no surprise that House agrees with this dangerous and unethical plan. About this time, Doug goes into pulseless ventricular tachycardia and needs several shocks to resuscitate him (and defibrillation is the right idea in this situation). An echocardiogram is normal, as is the troponin level (a blood test that is elevated after a heart attack). House and the team are stumped, stymied, and stuck. They have no idea what is happening to Doug. House decides to implant a defibrillator while they try and deduce what is going on. Then he his has his weekly Eureka! moment talking to Wilson. Despite being fervently anti-commercial-florist, Doug broke down once and bought his wife some roses after missing their anniversary. He caught sporotrichosis (a fungal infection) from those roses, and that’s what’s caused his problems.
As usual, major complaints are in red, minor in blue, nit-picking in green:
There are hundreds, if not thousands, of different kinds of cancer. Different types of cancer require different types of chemotherapy. What works for one cancer may not work for other cancers. There is no generic “chemotherapy” that treats every cancer — you need to know what type of cancer you are treating.
Similarly, total body irradiation only works on certain cancers — the blood and lymphatic cancers, primarily.
How exactly did the sporotrichosis make Doug unable to walk and start this entire situation? Are they suggesting he had a sportrichosis-related meningitis (a known, albeit rare, possibility), that didn’t have any affect on his mental status? They probably should have gone ahead with the lumbar puncture.
Cameron announces that Doug is free from cardiovascular disease, yet is quickly testing for carotid atherosclerosis — a cardiovascular disease.
A Holter monitor is a portable heart monitor that patients wear so that their heart rhythm can be recorded while they go about their normal daily business. It would be redundant in the hospital where all of House’s patients are already hooked up to heart monitors.
If Doug is bleeding out so much that he’s weak and fainting, a transfusion of blood might be a good idea in addition to the fresh frozen plasma.
Pulmonary sporotrichosis (from inhaled fungus) is a distinctly different form of the disease than cutaneous sporotrichosis (from superficial penetrating trauma), which is what House is describing.
His femur is broken, but everyone is focusing on and looking at his calf.
I’m suspicious that defibrillating ventricular tachycardia would be enough to raise the troponin level, at least a little bit. (From what I can find, the jury is still out on this: studies suggest defibrillating atrial arrhythmias doesn’t do much to the troponin, but multiple shocks in ventricular tachycardias do affect it).
The medical mystery itself was good again this week and deserves a B+. The final solution almost fit, but should not have been as significant a puzzle as House’s team made it, I give it a B-. The medicine was very sloppy, and even the smallest amount of research would have shown that “generic” chemotherapy was wrong. The medicine earns a D, and that’s probably generous. The soap opera was good, with Cuddy, Wilson, and Cameron/Chase all having their moments. I give it a B+.
April 13th, 2009 at 10:57 pm
The generic “chemotherapy” thing really bothered me even as I watched, and I usually ignore the specifics of the medicine because I rarely understand any of it anyway. That seemed really sloppy.
And does it seem weird to anyone else that Cameron and Chase still call each other by their last names? Granted, we only see them with other members of the hospital staff, but still, I’d think they’d be on a first-name basis at this point.
April 13th, 2009 at 11:16 pm
When I saw that they shocked V.Tach (correctly) this time I immediately thought: “Oh Scott’s going to be happy about that”. :-)
April 13th, 2009 at 11:21 pm
I’m so glad I wasn’t the only one bothered by the lack of explanation for his pulmonary symptoms! And you would sure hope that an order for whole blood would folllow the FFP if the patient was “bleeding out”. Another great review Scott, thanks for all the work you put into these.
April 13th, 2009 at 11:38 pm
i didnt get the hot tub clinic patient. was the wife a trannie?
April 13th, 2009 at 11:40 pm
I think systemic sclerosis is the new lupus.
Also, great review Scott, keep ‘em coming.
April 13th, 2009 at 11:52 pm
I kept thinking Cuddy was going to show up at House’s place in the end and then he sees Amber ! Freaaaky.
April 13th, 2009 at 11:55 pm
Scott, I agree on the generic chemotherapy and TBI, but disagree on some other things:
(1) House said there was a fungal lesion of nerve VIII, i.e. the patient had vertigo and could not walk for that reason. Bad vertigo, I guess.
(2) Umm, I don’t think you can criticize for saying “no cardiovascular disease” in a case presentation and then doing cardiovascular testing. Otherwise, they could not say “no cardiovascular disease” until after an autopsy, and docs clearly do not talk that way.
(3) Big boo-boo to think that ward monitoring is equivalent to Holter monitoring. The lead hook-up is generally different, and the degree of scrutiny is totally different.
(4) Did Foreman ask for fresh frozen platelets or plasma??
(5) I figured the pneumo-mediastinum was causing the dyspnea, but kept expecting to see chest tubes. (Loved the “crunchy!”)
Love, Rhonda
April 14th, 2009 at 12:19 am
The D isn’t generous, correct use of the paddles on House should always get the grade bumped up a letter.
Good soap opera, kinda freaky ending and good to see Cameron on the show for more than twelve seconds again.
April 14th, 2009 at 1:02 am
Heh. Reading through the nitpicks I was shocked to see “fresh frozen platelets” since I work in a blood bank and we don’t freeze platelets.
So I look up top and see that it was a typo since you have “fresh frozen plasma” up there.
Checking the link I see you linked to a page on the site for the blood center I work for: The Puget Sound Blood Center! :)
This greatly amused me.
April 14th, 2009 at 1:40 am
I, for one, am glad to finally see the scene that was the setting of the April Fool’s joke on Fox. (I might have wondered at the time where Kutner was, but I guess we all know the answer to that one …)
http://www.youtube.com/watch?v=bryk4_KoO6Y
April 14th, 2009 at 4:05 am
I have to say that this episode of house really bored me. Usually I’m the first to stand up and say it was a good episode, even when most hate it, but for some reason this one just didn’t hold my attention. Next weeks episode of house doesn’t look promising either, I won’t be in the country to see the rest of this season, but I hope it gets better.
April 14th, 2009 at 5:33 am
@hi
I think the hot tub thing suggests that the woman was a swinger. I think it’s become sort of a cliche in American culture, hot tub = swinging.(See a recent Simpsons episode in which they get a hot tub and are immediately set upon by neighbouring swingers)
April 14th, 2009 at 6:12 am
The last scene with Amber was just weird… I can’t wait to see what that was all about.
btw, I like to walk into each episode completely cold, so I intentionally don’t watch the preview for the following week. I just change the channel quickly at the end of every episode and do a “la la la…. I can’t hear you… la la la” during promos throughout the week. So, if the preview did anything to explain the Amber scene, I missed it.
April 14th, 2009 at 6:21 am
I usually ignore the medicine (because I don’t understand it anyway), but I was annoyed by the way Chase was acting this week – if he loves Cameron, why is he acting like such a suspicious, mopey little bitch? Is he going to be that way when they’re married?
On the other hand, it does set us up for next week’s bachelor party.
April 14th, 2009 at 6:38 am
They used more lights to illuminate Chase’s hair than Cameron’s during the locker scene.
April 14th, 2009 at 6:49 am
I also think they were strongly suggesting sportrichosis-related meningitis, and the fact that I have fungal meningitis listed in the House Challenge does not impugn my objectivity in any way!
April 14th, 2009 at 6:53 am
I don’t get the negative reviews on the soap opera this week – imo it was great! It deserves a straight A! Frankly to bump back from a suicide of a colleague is a hard thing to do – everybody was coping as best as they can. The Chase/Cameron subplot was brilliantly played and the proposal moment almost made me cry (I am just a romantic who loves happy endings). And let’s face it was WAY TOO DAMN LONG since those two made any real contribution to the show. But both Jesse and Jennifer were brilliant and sold the product perfectly! As for Cuddy’s freaking out because somebody was stepping on her turf it was another brilliant subplot and Hugh Laurie and Lisa Edelstein played it spot on. This episode was soap opera bliss for me and most importantly it was believable every step of the way. Even House’s hallucination of Amber was freakishly realistic (I do miss Anne Dudec on the show!). OK enough with the praise my mood is so much better now after watching the episode I am ready to pick the bones of the medicine:
1. An infection: OK once again for the 10th time – if you have an infection (we are talking about a systemic infection here that affects his entire body) your blood work can’t be normal – you would have at least somewhat elevated white count. Hematocrit. would be higher too. The entry point for the infection (in this case one of the fingers probably?) would be worst – swollen, painful. And if it healed the patient might give some hint like – “I pinched my hand on a thorn last week”. Afterward he would have nodular lesions or bumps in the skin, at the point of entry and also along lymph nodes and vessels. The lesion starts off small and painless, and ranges in color from pink to purple. Left untreated, the lesion becomes larger and look similar to a boil and more lesions will appear, until a chronic ulcer develops. Let’s assume that he took care of the cut and it healed – at the moment of the full blown progression of the disease he would have the classy symptoms of fulminating infection on the blood panel.
2. How exactly did the infection affected his platelets to the point of him bleeding like this?
3. I wouldn’t bother with the general chemo issue or the total body irradiation – both things has been used on the show without as much as thinking medically from the producers (and the way they nuke people in this hospital left right and middle when there is only as much as a doubt of blood cancer or autoimmune, I’m surprised just one patient died from sepsis :). Instead I’ll point out that if there is an air leak in between the lungs he would develop mediastenum symptoms (air around the heart) before the crunchy neck. Oh and probably he’ll suffocate too because of the tension pneumo-thorax that he would develop as a consequence of the lungs leaking air (Boy that sounds corky even for House – air leak from the lungs ?!?!?).
4. What broke the leg again? While we are on the subject – how come the patient never said something like: “It hurts here!” pointing the exact source of the pain? Oh and broken bone – swelling around the fracture? Movement of the fragments (the “false joint” symptom?). One might say the steroids prevented the swelling but hey they would prevent the pain from being that bad too.
5. This is not exactly medicine but let’s clear it out anyway – House says: “Cancer”. Foreman (M-r Opposite on the action again!) says “It can’t be bone cancer”. House says: “It’s not bone cancer but it is still cancer”. Than Foreman (the guy who said it’s not bone cancer!) makes Chase perform a biopsy of the BONE looking for cancer? What kind of cancer he hopes to find in the bone – may be prostate cancer? While we are on the subject – bone cancers – all of them – are very well visible on the X-ray – no need for biopsy to find them.
6. Taub’s idea of giving growth factor to make the tumor grow was laughable on every possible level. First it was unethical and Cuddy would have come screaming the second she heard of it. Second even stimulated you would need at least a couple of days for an invisible tumor to grow enough to become visible (what kind of tumor again?). And what kind of medicine would possibly make EVERY possible type of cancer to grow. If cancers responded so similarly to drugs it wouldn’t be such a pain in the ass to treat them. There are thousands of types and all react differently to pretty much everything.
April 14th, 2009 at 7:03 am
Hello! I have a couple of things…
1) Good thing we didn’t go ahead with the total body irradiation – otherwise House would have killed a patient and it would have been two deaths in a row that he wouldn’t have seen coming and he would have become a sad depressed man..
2) The nodules then, were a symptom of sporotrichosis? Wouldn’t someone have thought of that earlier? Maybe an infectious disease specialist?
April 14th, 2009 at 7:31 am
Also… one other thing – Was Foreman right to exclude Osteogenesis Imperfecta based solely on the lack of blue sclera? Not that I thought it was that but the only bone breaking being the femur while the patient was lying down still seems odd…
April 14th, 2009 at 7:38 am
I think Chase did the right thing all along, I even think that besides from House and Wilson, he was the best acting of the episode! Cameron seemed confused to him, he gave her space and when that didn’t work and she got to the point of avoiding him, he did what every person with a little of self-respect would do; he broke up with her because, as House pointed out, that’s what she wanted anyway so she wouldn’t feel guilty by freaking out with the marriage thing and breaking up with him first. Fortunally for him, she came to her senses and he forgave her because he loves her.
Now, who else thought PoTW’s wife was a little off? She comes out of nowhere screaming at everbody and shoving the kid story down his throat. I kept thinking he was going to say “I’ve never seen that woman in my life! Get her out of here!”
And the House/Cuddy thing is just annoying. It used to be fun but they are just dragging this throughout the season and it’s screwing with it because it used to be in the background and now it’s annoying. I wish the writers would just get this over with for our sakes and for House’s because c’mon, the guy has almost all the females on the show falling for him and he hasn’t had some since S3 ??
But maybe next episode’s the one with the whole strip club thing. They go, get drunk and they finally end up in bed together. What could turn out to be a threesome, since Amber’s gonna be there. Again, freeeaky.
April 14th, 2009 at 7:41 am
Official Comment
Batman,
As soon as I saw the nodules, I thought “sporotrichosis” as the condition is famous for them. I doubt I’m the only one who came up with the diagnosis then.
April 14th, 2009 at 8:24 am
Oh, sure, the one time I shout “don’t shock a flatline” at the TV, I’m wrong. I quit. :)
April 14th, 2009 at 8:42 am
Did anyone else notice that when House barged in on Wilson, Wilson said that it was 10:30 at night, yet it was clearly daylight in the window behind Wilson?
April 14th, 2009 at 8:44 am
David – I agree with you. I yelled “don’t shock a flatline” too. IANAD, but the continuous beep and all the numbers on the screen going to zero led me to believe this was a flatline situation, too. What was it then?
April 14th, 2009 at 8:46 am
Didn’t Wilson say in “Alone” (2 years ago!) that Cameron and Chase were already engaged? I’d assumed they were this whole time. Not a big deal, I guess…Wilson could’ve just been messing with House at the time.
April 14th, 2009 at 9:02 am
I don’t agree with the soap score at all.
The Cameron / Chase ring problem, and Cuddy’s lack of answers for Chase, and Wilson’s messing up with House, and the Amber’s appearance was all excellent!
Medically, fine, whatever, but the Soap, no… A+ this week. Great Episode, gonna watch it again and again…
Heishiro
April 14th, 2009 at 9:54 am
I loved the soap opera this week. The Chase-Cameron pas-de-deux was spot-on. The House-Wilson pas-de-deux was a delight. I loved the postlude with H & W laughing over junk food and C & C giving Cuddy the relief of her life. That Hugh Laurie got to show off his keyboard and harpoon skills was icing on the cake. I was also glad to see a reappearance of Anne Dudec as an hallucination. Maybe the show will morph into “Topper”, with Kutner dropping by for cameo “appearances” as well.
April 14th, 2009 at 10:17 am
I did not like the idea of giving the patient the insulin like growth hormone so I am happy to read Scott’s assessment that it is dangerous and unethical. I know House says for his guys to throw out wild ideas, but sometimes they seem beyond wild to me.
I liked the episode and I liked having Chase and Cameron decide to get married. Chase came across as a real solid guy. I liked the way his part was written. Certainly his character had a past with issues to deal with, but he came across as a true grown up. In the end when Cameron said she was “hoping” she came across as a real grown up also.
Amber back in House’s brain–eeeek!
April 14th, 2009 at 10:33 am
To A Different Eric: Of course Wilson was messing with House at the moment it was part of the whole: “You are seeing things out of guilt buddy!” mojo. A couple of people here on the posts (including d-r Scott) said “nodules”. Did I miss something? Were there nodules and why did nobody mentioned them?
April 14th, 2009 at 11:54 am
I liked the soap opera, but I thought the Amber scene was cheap and foolish. It’s not the first time House is seeing things. It’s getting old.
Also I’m a little confused regarding the final diagnosis. First of all, House said pretty early in the episode that they already ruled out infections, but the final diagnosis is one? Did they explain how the infection could break his femur? I’m not a doctor or a med student, just wondering.
April 14th, 2009 at 12:58 pm
Also, you don’t give insulin like growth factor. You give growth hormone which in turn promotes insulin like growth factor from being released from the liver.
April 14th, 2009 at 3:40 pm
Although i’m just a med student half way through, i was under the impression that you could use an external pacemaker instead of a surgical implanted defibrillator? Correct or incorrect?
April 14th, 2009 at 3:51 pm
This episode has really sloppy medicine. Start him on ‘chemo’ or ‘antibiotics’, as if there’s only one. I hope House has a good pharmacist checking his orders & doing rounds with him! They should add a pharmacist into the plot (like a cute Asian one … House would love that). Hahaa. I wish some medical drama would show a pharmacist & represent! (The closest we got was the nutso pharmacist on Desperate Housewives that killed the redhead’s husband).
I think the soap opera was really good this week — Cuddy marking her territory, the engagement, House losing his mind = good stuff! I liked the hot tub folliculitis too; glad there are clinic patients again
-Pharmacy Student
April 14th, 2009 at 3:55 pm
Heishiro I agree 100%, A+ for me.
April 14th, 2009 at 4:53 pm
@ Thor D,
yeah but, the other times his skull was cracked and he’d pumped a lot of different drugs/hypnoses/shocked his brain to achieve those hallucinations. This time he’s completly concious !!
April 14th, 2009 at 5:41 pm
How could you confuse that off-road dump truck with a bulldozer ?
April 14th, 2009 at 6:02 pm
I would love to see House demonstrate his HARPOON skills. :)
April 14th, 2009 at 6:03 pm
It’s funny how often medical dramas “borrow” themes one from the other. House sees dead people. Not long ago one person from Grey’s Anatomy had that too. Add House “loosing the edge” – do we get a brain tumor or what?
April 14th, 2009 at 6:25 pm
The whole point of Wilson’s diet change was to get House back to normal but he’s getting incredibly slow, I figured out that Wilson was just trying to stop House from eating his food when House was in Wilson’s kitchen but admittedly I didn’t see Chase/Cameron’s story coming. But as A Different Eric said I had assumed they were already engaged.
April 14th, 2009 at 7:43 pm
Does anyone the song House was playing at the end?
April 14th, 2009 at 8:27 pm
@ Waffle: Georgia On My Mind
Um, maybe this is just a statement on my wandering eyes, but I think Jennifer Morrison (Cameron) has a spot on the her chest she needs to get checked out. In the scene when she tells House about finding the ring in Chase’s sock drawer, I noticed a pretty good sized mole that I’ve never seen before. And purely out of medical curiosity (promise!) I searched for some older pics of her and this spot was nowhere to be found. I’m no Dermatologist, but it looked like something that may need attention.
April 14th, 2009 at 8:30 pm
Waffle: song was “Georgia”.
April 14th, 2009 at 8:45 pm
I wasn’t all that surprised to see Amber at the end, the way House has been popping Vicodin since Kutner’s death. Even with his high tolerance there’s bound to be some kind of side effect.
The song Hugh/House was playing was “Georgia”.
—Kimberley
April 14th, 2009 at 8:55 pm
Loved the Wilson subplot. It was wonderful to see some of that ingeniously manipulative masterminding going on, and this season has SO needed more humor.
It was good to see Chase and Cameron get more screen time, but the plot was unconvincing to me. She lies to him repeatedly and puts off a vacation he’d spent so much time planning because she feared he was motivated by Kutner’s death to propose? Please. Still, it was well played, as was the Cuddy sup-subplot.
The medical mystery left me cold. Is the idea that he was made sick by a fungus that wouldn’t have been on the rose had it been treated with pesticides? Environmentalist that I am, that would have been a great twist.
April 14th, 2009 at 10:59 pm
Re: A Different Eric
When Wilson told House 2 years ago that Cameron and Chase were engaged, he was lying. House was seeing the two of them in the hospital at the time and was thinking “wtf?”. When they talked about it Wilson even dialed a number to another state to trick house.
Im pretty sure it was S04E02 “The Right Stuff”, when the patient is “Osama Bin Laden”
April 14th, 2009 at 11:08 pm
@ M-II, LMAO lolololol
If House gets a brain tumor like Katherine Heigl’s Izzie on Grey’s Anatomy I will never ever watch medical drama again. J/k prolly not, Izzie had sex with her dead person, maybe House will too!
-Pharmacy Student
April 15th, 2009 at 12:32 am
I thought this was a good episode because (for the first time?) House looked like an idiot throughout the whole episode.
That “slutty oak outside Portland” comment was hilarious.
April 15th, 2009 at 1:01 am
So is House becoming the new Gaius Baltar now? I guess with the BSG re-makes all done we need another brilliant erratic doctor hallucinating blondes somehere on teevee, may as well be my man House!
k, tongue is out of cheek now. I enjoyed the soap opera on this episode far more then the medical story, which is rare. What really struck me was the upbeat tone of the ending, D’AWWWW moment with Chase and Cameron, House and Wilson laughing and joking together, it stands out because it’s so rare.
Good stuff, shame about the silly chemotherapy. But gotta give em props for shocking v-tach this time, like one of the first posters, I blurted out ‘Oh, Scott’s going to be happy for a change!’. The wife didn’t get what the hell I was talking about though. Oh well.
April 15th, 2009 at 2:11 am
Oh my god somebody is comparing Grey’s anatomy to House!!! Blasphemy! How there you!!! Seriously guys seeing dead people? House would say it’s a hallucination even if dead Amber kicks him in the crouch. He is way too realistic to dream of such things (or to have sex with for that matter!). He knows there is an issue here (remember the great seson 2 finally “No reason”?) and will focus on solving the issue – that is all. He want go like – “oh I am so happy to see you I can touch you and feel you and kiss you and khmhmhmhmh you that means you cannot be a hallucination. You are way too real. So that must mean that you are back from the above to warn me I’m gonna die. 10k u 10k u and I love you, uups sorry I hate you for bringing me such a news go away !” – poof gone! Boy when the producers of Grey do stuff with the “supernatural” they really go over the edge!
April 15th, 2009 at 3:56 am
Predictions for next episode:
Things that commonly cause hallucinations: schizophrenia, dementia, temporal lobe epilepsy, barbiturate abuse, narcotic abuse, & Vitamin B12 deficiency. My money’s on narcotic abuse. I wonder how many opiate side effects the writers are going to use as story arcs? (Respiratory depression, urinary retention, addiction, etc have already been used). Vicodin causes liver damage which can cause thiamine (Vit B1) deficiencies which can cause Wernicke-Korsakoff syndrome (and hallucinations are a symptom)…..
-Pharmacy Student
April 15th, 2009 at 4:25 am
I was watching episodes from season three right before I watched this episode–”Lines in the Sand” with the autistic boy. I am genuinely worried that it isn’t Dr. House who has lost his mojo, but the makers of House.
The things that made House special haven’t been present at all for three episodes. The suicide episode was the worst episode they’ve ever had. As far as I can tell, Season 3 was as good as House ever got.
In the last few episodes, we’ve had
-suicide
-engagement
-hallucinations
All they need now is for Foreman’s brother to break out of prison and kidnap Cuddy unless House can diagnose his brain cancer.
April 15th, 2009 at 11:05 am
You have to admit, the show is getting fairly ridiculous and makes uncompelling viewing now. If I was a new fan coming to the show, I would seriously be wonderring what all the fuss was about and how people can make any sense of it. It’s all gone a bit ‘after school special’ for sure.
Good to have Cammy back, a breath of fresh air, she is a key ingredient of the show, perfect balancer – an absolute travesty that she has not been utilized for two seasons, and really hits home again that they messed uneccesarily with things. Seriously it’s awful now, why did they have to change that core dynamic, it’s like in Red Dwarf when they lost Rimmer – lost the spark.
Blah blah blah, the usual stuff…
Like the fact Kutner was downplayed until the end when Amber apeared to screw with House. Got pins and needles! Seriously can’t believe that it too him so long to figure out Wilson was screwing with him though, that was pretty lame.
April 15th, 2009 at 3:27 pm
I thought that everyone thinking poorly was pretty much the idea of the episode (regarding the bit where the puzzle’s difficulty seemed exaggerated), but that doesn’t account for poor medicine. Oh well.
I was hoping that Chase and Cameron would break up for a while, creating drama food, but now I don’t know where this is going.
April 15th, 2009 at 3:44 pm
I guess it’s spoilers, but isn’t the hallucination caused by insomnia? Or is what you guys are discussing causes for the insomnia?
April 15th, 2009 at 7:49 pm
JJThof said:
“I guess it’s spoilers, but isn’t the hallucination caused by insomnia? Or is what you guys are discussing causes for the insomnia?”
The trailer for the next episode rather flew by me, but I got the impression House didn’t want to sleep because he’d be seeing Amber in his dreams again.
But I’ve been wrong before.
—Kimberley
April 15th, 2009 at 8:49 pm
Cameron missed a golden opportunity to mention again how she hates sports metaphors.
April 15th, 2009 at 10:50 pm
I’m not a physician but it seems to me that aspiration of synovial fluid might have been done fairly early in the case and the sporotrichosis found by the lab.
April 16th, 2009 at 11:48 am
Its pretty obvious that the writers strike from last year meant that they had to change/remove writers. The whole vibe this season seems so strange and serial. Some people say its the new cast, while they are relatively flat, its not the actors fault if they were brought on board with uninterested writers. They’ve gone back to promoting the old set which if fine by us fans ;)
Also, the excessive psycho-analysis of the characters toward each other has to go! Can’t we just keep it real…half of the time?
April 16th, 2009 at 12:10 pm
M-H, regarding Morrison’s mole:
What’s the matter with you? Has House taught you naught? The sensible way to deal with this matter is to kidnap her. Also, regardless of the ultimate diagnosis, I strongly recommend you immediately perform: 1 brain biopsy, 1 whole body irradiation, 2 wrong diagnoses of autoimmune diseases, 1 lumbar puncture, and 1 course each of wide-spectrum antibiotics and antifungals, at minimum. Of course, further treatments should be added ad lib and glib.
Good luck and keep us updated.
April 16th, 2009 at 12:35 pm
@ Daniel-
I think the first course of action would be to induce a flat-line, the get out the paddles. Isn’t that how it’s normally done? ;)
April 16th, 2009 at 3:04 pm
This is a small detail but caught my attention. No one in real life would, in an argument with his/her wife/husband, say: “I love our SON”. You just say the child´s name.
This means that the writer doesn´t have kids.
OK, I´ll stop playing House.
April 16th, 2009 at 4:52 pm
I might be wrong because the image is not clear (and i’m just a med student) but it seems that the femur was fixated externally (osteotaxis). I don’t believe that is necessary because that is only done when there’s an exposed fracture or there’s a risk of a re-fracture in an unstable bone. That was a single-trace fracture of the femur’s shaft distal end, it should be fixated internally.
April 16th, 2009 at 7:46 pm
It was good episode, certanly lot better than last two of them.
I don`t comment on medicene (I don`t have a clue about that), but I have some crithics on logic and psychology in this episode.
First I didn`t like that House/Wilson sub-story. It was kind a stupid, make no big logic and was very childish. It was not clever/inteligent way for Wilson (who I like his personality and his inteligence almost equall like House) to play games with House. Even I like end scene when they both were laughing and eating potato`s.
Second I was bothered by flash braking and rebounding relationship with Chase and Cammeron. Another little childish part of scenario, when he broke up with her based on subjective (not too much sexual) suspisions, then they back each other with some irony on Chase face.
Last but not least there was not so much pro/against environmentalist in this episode (even I was sure that House will show us some deaper racionalisym on that subject).
I like`d that “lost mojo” thing, and I like`d House`s Q&A on 3 different levels in this episode.
It look`s like House M.D is backing to “old school” team and there was less 13/Taub- and more Cameron/Chase/Wilson.
And about last scene when he played his Piano, I like that mistery in “to be continue” style that keep us guessing.
If I have to guess, I will say that House will be our next patient, and that this season last episode`s will be similar to last season`s finale, when there will be lot of emotions, and disaster of losing biggest diagnostisian and friend for all.
April 16th, 2009 at 8:51 pm
By the way, wasn’t implanting a defibrillator unnecessary, considering he was in a hospital, hooked to monitors, with a bunch of superdocs devoted solely to his condition? Indeed, not merely unnecessary, but extremely risky considering his state at the time? So perhaps praising the defibrillation depiction was premature.
The writers just can’t win here.
April 17th, 2009 at 11:04 am
Yay! Head Amber is back!
April 21st, 2009 at 4:34 am
House hallucinating Amber??? WOW! but not impressed, just wondering what caused it. Vicodin usually doesn´t to House, right? Radiation, generic chemo and defibrillation are classic things but I wonder what the ICD was supposed to be good for.
April 22nd, 2009 at 8:10 am
NOt to be a spoiler, but House isn’t sleeping since Kutner’s death….not sleeping will lead to some freaky hallucinations. The question is what’s up with his insomnia, and can it be cured?
April 22nd, 2009 at 1:50 pm
Stephen asked: “And does it seem weird to anyone else that Cameron and Chase still call each other by their last names?”
Maybe so. But in the movie and TV series (at least the first season – that’s all I’m familiar with) of “The Paper Chase”, the law students called each other by their last names. Hart. Ford. Bell. Of course, they weren’t engaged to each other. Still, I never understood why they didn’t use first names. (James, Franklin and Willis, if you remember.)
April 22nd, 2009 at 6:36 pm
@Drew: Nope, they didn’t replace the writers in 2008. I just checked imdb – the only writers who left in 2008 had only worked on 3 and 5 episodes each.
April 23rd, 2009 at 12:22 pm
I just have one question……why aren’t the doctors rich in this hospital ??……
April 23rd, 2009 at 2:46 pm
Cause Cuddy won’t let them?
House: I want a raise.
Cuddy: No.
Heishiro
April 24th, 2009 at 7:54 am
Make Foreman go away!!!
April 24th, 2009 at 12:56 pm
Anyone else think Taub’s suggestion of MS based on possible Swedish ancestry was a bit of a red herring since the reason Swedes and other north places (like Scotland) have higher rates of MS is not thought to be due to genes but instead lack of immunosuppression from vitamin D synthesised from sunlight. So a Swede living somewhere NOT in the bleak north does not have an elevated MS risk.
April 25th, 2009 at 11:49 am
heheh nice rationalization….but really…in the episode the greater good …taub complains and makes u feel he is poor (somethin about making 5 $) ….I mean any doctors here that know the standards(scott go for it :p)
April 25th, 2009 at 5:55 pm
Stephen asked: “And does it seem weird to anyone else that Cameron and Chase still call each other by their last names?”
Those are last names that might be first names, though. It’s easy to think that those are the only names they have (DO they have first names? I know she does, but I’m not so sure about our all-around surgeon).
I could psychologize it, though: Cameron doesn’t want a lover who calls her by the name her first husband used for her, and Chase is so messed up by his upbringing that he prefers not to be called by the name his parents used.
Now if we ever get “Cuddy, baby” and “House, honey,” THAT will be weird.
April 26th, 2009 at 1:27 am
Scott,
Onde thing crossed my mind but I´m not sure I´m right.
Isn´t it weird that Cameron suggested a diagnosis of osteogenesis imperfecta in a patient this age?
From what I know (Im a biologist, though I havent been working in the field for quite a while), osteogenesis imperfecta is usually found out during infancy/childhood, isnt it?
And someone who posted there is right, you couldn´t rule out osteogenesis on the sole basis of “the patient does not have blue sclerae, which it is not a feature exclusive to OI.
Plus, if he had OI, they would have seen the brittle bone aspect in other bones
April 26th, 2009 at 2:39 am
As already mentioned, Chase and Cameron can both be first names.
I am with the group thinking House is going down the toilet as they run out of story ideas and focus more and more on absurd soap opera and rehashed scenarios. They’ve been repeating the same character conflicts and “insights” between characters over and over for at least a season, sometimes breaking up the pattern with something completely uncharacteristic and out of place.
I am getting increasingly annoyed with the patient fake-out they do at the beginning of EVERY episode now. It got me once, with the fitness trainer episode, and ever since then I’ve been expecting it and it just keeps happening. It’s probably even worse for those who actually watch the previews.
As far as the relationships go, I have a rule that once the writers break up Chase and Cameron just to jerk the audience I will stop watching the show. I was pleasantly surprised by this episode. While Foreman and Thirteen are more obviously an audience-manipulation tool, I do like their interaction – it’s been cut down enough to be a pleasant minor element in the episodes instead of outright soap-spinning. We’ll see how long that lasts.
I was a little disappointed they didn’t even reference Taub’s sudden display of emotion at the end of the previous episode.
As for the once-a-month clinic session, they are just reminding us of the theme of the entire series – EVERY marriage involves at least one affair.
April 26th, 2009 at 11:41 am
Hi,
I wonder how many people here, including Scott have heard of Low Dose Naltrexone as a treatment for auto-immune and other conditions and what the medical folks think of it?
As a Crohn’s patient who has recently been administered LDN to some success, I’d love to see House prescribe it to an auto-immune sufferer as it would fit his image of being the doctor who solves the puzzle and administers the right treatment even if it does appear controversial, unusual or otherwise off the wall.
April 26th, 2009 at 5:51 pm
I’m with PharmStu on this one. As soon as I saw the hallucination I reasoned House’s addiction is coming back to attack, it’s been laying low for too long.
I’m gonna guess the obvious:
Kutner has depressed him,
he’s popping more than usual,
he’s going to start getting stronger neurological episodes,
assume it is actually from guilt over Kutner,
followed by some more serious symptoms,
he plays it off and self-medicates,
then passes out and wakes up chained to a hospital bed on dialysis.
By the way, Scott – just noticed your “disclaimer”, it’s genius!
Enjoying the reviews, keep it up!
April 26th, 2009 at 10:59 pm
Judy – Chase’s first name is Robert. I don’t think I’ve heard it since season 1, but that’s his name.
April 28th, 2009 at 4:24 pm
Damn, I’m glad I’m not a doctor. Otherwise, I wouldn’t be able to concentrate on the show itself. D:
August 24th, 2009 at 3:59 pm
A vestibular caloric test would requiere using fresnel or something to look to his eyes while avoiding fixation. Cameron does not even look at his eyes to see if something is wrong.
Toghether with a previous episode with a dix-hallpike the vestibular tests were never performed correclty.
September 1st, 2009 at 11:58 am
@siobhan-
And Cameron’s first name is Allison
October 1st, 2009 at 3:07 pm
First let me start by thanking Dr Scot for this brilliant site and his reviews which are sometimes far better to read than the show itself. IMO I think the show went down hill when one of the producers stated in an interview (end of Season 2 I think) “there definitely needs to be more/some sex
In the show!” She was in effect saying “I’m an admirer of “sex and the Hospi”(Grey’s Anat.) and that’s the direction the show should take.Fortunately it never got that bad but the quality of the medicine took a dive.
October 2nd, 2009 at 12:32 pm
Not a medical complaint:
An environmentalist that hard-core would not have a child. (More people = greater use of resources.) Also, as Lisa mentioned above, Dude didn’t get pesticide poisoning, he got not-enough-pesticide poisoning! So why’d the roses have to be not-organic?
- From a soft-core future-breeder environmentalist with a commercial pesticide applicator license
November 5th, 2009 at 9:18 pm
I’ve got a nit-pick, albeit not medical related, why do tv and film production companies insist on pining the badge on Pennsylvania State Police Troopers when the uniform is otherwise perfect? PSP issues badges to their Troopers, which are NOT to be worn on the uniform, reminding us our conduct, not badges, provides our authority.
January 25th, 2010 at 12:29 pm
About Chase and Cameron calling each other by their last names — I think that can happen when a couple started out as mates and got used to it, especially if they keep spending their days among people who use these names. In such situations, calling someone by the first name has a special significance, reserved for special situations.
I’ve noticed a similar thing with teachers, at least in the schools I’ve studied or worked at — they almost always know and often use the nicknames of their students (sometimes it just sounds downright stupid to say a name no one else ever says), but there is the rare occasion where using the real first name carries a weight, sets them in a different context. It happens with Cameron and Chase, too (in Season 6, the Dibala episode, but no spoilers, there might be a few unfortunates who haven’t seen it yet).
July 14th, 2010 at 10:06 am
Regarding the last name calling.. When I was a member of the ATC (Air Training Corps), I had a friend who I only called by his last name. All the time. So, as Chic said, people who start as colleagues, calling each other by their last name, are likely to carry on doing that, even when they become more than colleagues. It’s a habit.
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