House — Episode 23 (Season 5): “Under My Skin”
I wanted to like this episode of House, I really did, but the absolutely horrible medical care just wouldn’t let me.
There is an accident during a ballet recital, and 21 year-old ballerina Penelope drops to floor, gasping for breath. She is admitted to House’s service and found to have lungs that “keep collapsing” despite the use of chest tubes. Supplemental oxygen can only raise her oxygen saturation to 60%. The team reports that there are no tumors is her lungs and no evidence of any lung punctures. There is also no bruising, trauma, or evidence of sexually transmitted diseases. Her white blood count and temperature are normal, ruling out pneumonia. House suggests a pulmonary contusion, but it is pointed out that her CT scan was normal. He then decides that she is dehydrated and this is masking her pneumonia, so he orders her started on intravenous fluids and antibiotics.
When Penelope fails to improve on the antibiotics, House wants to do a more invasive test to look for the pneumonia. He is told her lungs can’t tolerate a bronchoscopy, so House decides on a transtacheal aspiration. As always seems to be the case, there is a complication during the procedure. This time, her skin starts sloughing off — not just a little bit, but almost all of it. An autoimmune disease is suggested as a cause for the skin problem. House tells them that he is suspicious a liver tumor has caused the lung problem (by eroding into the lungs). Furthermore, he tells the team that her skin problems is toxic epidermal necrolysis — caused by the antibiotic they gave her.
An ultrasound shows a liver mass. The team can’t perform a standard liver biopsy because without her skin, she is at an increased risk of bleeding out. Instead, they go with a transjugular approach. They obtain the liver biopsy and it is negative for cancer, but she is knocked into the abnormal heart rhythm atrial fibrillation. Wilson suggests giving her metoprolol to lower the heart rate, but Foreman rather brusquely shoves the idea aside. The team has apparently decided that the atrial fibrillation must be caused by something within the heart itself, and want to get an MRI of the heart to get a closer look. Unfortunately, the very atrial fibrillation they are concerned about means that they would be unable to get good results from the scan (the heart would be beating too rapidly and irregularly to get a clear image). They decide to stop her heart, take the MRI, and then restart the heart. To prevent brain damage, there is a strict 3-minute deadline. Foreman thinks he sees something in the aorta, but by then the three minutes are up and the MRI is halted.
House agrees that Foreman saw something in the aorta. The differential now includes tumor, scar tissue, or abscess. Looking at Penelope’s boyfriend, House thinks he is spending so much time with her because he feels guilty, so House deduces that the boyfriend must have given her gonorrhea, which led to an abscess in her heart. The boyfriend is tested and sure enough, he has gonorrhea — only he got it from her and not the other way around. Meanwhile Penelope goes into septic shock and they can’t operate to remove the abscess until she’s stabilized. The team decides to give her dopamine (a medication used to raise the blood pressure in critically ill patients) in order to stabilize her. It works, and Chase is able to remove the heart abscess, but unfortunately the dopamine has cut off the blood flow to her hands and feet and they are turning black and starting to die (dopamine can cause occlusive vascular disease). Chase recommends that she has them amputated, but she refuses. After a fair amount of bickering among the team, Taub decides to go with the Hail Mary pass of injecting her with vasodilators to open the closed off blood vessels. Miraculously, it works and her hands and feet are saved.
House’s hallucination of Amber persists. He tells Wilson what is going on, in a round about way, and insists it must be sleep apnea — but he knows it isn’t, because the symptoms don’t fit at all. A sleep study is normal; no apnea. He has a blood test to look for infection, but it is negative as well. He decides the guilt he is feeling about causing the patient to develop TEN is a symptom of multiple sclerosis, but the tests for MS are all negative. He is down to two causes for the hallucinations: schizophrenia or his Vicodin use. He knows schizophrenia doesn’t really match, but he wants it to be that instead of the Vicodin. But eventually House realizes it must be the Vicodin causing his problems and asks Cuddy to help him go through the unpleasantness that is narcotic withdrawal, because she knows him best and won’t let him get away with anything.
As usual, major complaints are in red, minor in blue, nit-picking in green:
It’s not clear to me exactly what caused Penelope’s lung collapse that started the whole business. Was it the heart abscess? The show more or less implied it was, since the team felt that solved her problem, but I don’t know how a heart abscess would cause her lung(s) to repeatedly collapse.
They might have been able to raise her oxygen saturation above 60% if they took her off the nasal canula and used a proper oxygen mask instead.
In this episode, the writers are having a bad case “having your cake and eating it too” in terms of Penelope’s heart abscess. The abscess that is walled off, sealing the bacterial infection away from the rest of her body, making it much harder to detect and treat. However, despite being walled off, the abscess is able to:
Cause septic shock
Deflate the lungs
When we talk about dehydration hiding a pneumonia, we’re talking about the x-ray. An infiltrate (the sign that appears on x-ray showing a pneumonia) does not show up well in a dehydrated patient. Give them some IV fluids, repeat the x-ray, and boom — there’s the infiltrate. Dehydration does not mask the other symptoms he mentioned (temperature, white count — if anything, dehydration will falsely elevate the white count).
You cannot draw a “Vicodin level”. You can draw an acetaminophen (Tylenol, paracetamol) level, but not an hydrocodone level (the two drugs which make up Vicodin). Wilson could have been talking about high acetaminophen levels (which causes irreversible liver damage), but his tone and presentation suggested he was talking about the narcotic component.
The time course of toxic epidermal necrolysis makes it more likely the condition was caused by Penelope’s use of medication (say non-steroidal anti-inflammatory drugs for sore muscles from ballet) than by any antibiotics she received in the hospital.
Lack of overlying skin should not prevent a standard liver biopsy since it doesn’t decrease her blood’s ability to clot. (You could argue that it should be avoided because it would raise the risk of infection, and I’d buy that, but that’s not what they mentioned).
While I agree the heart monitor was showing a narrow complex tachycardia, it didn’t look like atrial fibrillation to me (way too regular a rhythm, for one).
Speaking of atrial fibrillation, I would have liked them to look a little harder at other causes (say thyroid) before immediately deciding it was something within her heart.
While metoprolol controls the rapid rate of the atrial fibrillation, it doesn’t covert it to a normal rhythm. There are other medications that can do that.
I’m not an electrophysiologist, but whenever I’ve seen someone’s heart stopped electrically, they’ve used internal leads, not external paddles.
A “negative ANA” does not magically rule out all autoimmune diseases. Plenty of people have an autoimmune disease without a positive ANA.
A transtracheal aspiration involves a needle, a tiny catheter, and saline. There is no knife — nothing needs to be cut!
Did they ever convert her out of a-fib, or is she still in it (or did removing the abscess clear that up)?
I assume they put her on a heart-lung machine during surgery, but it would have been nice to mention, since they made such a big deal out of stopping the heart earlier.
Eye protection in surgery, team.
The medical mystery was okay, or it would have been had they stayed with it (I’m still wondering what caused her lungs to collapse), so I’ll give it a B-. As I’ve mentioned above, the final diagnosis doesn’t really fit the presentation, or her complex of symptoms. It earns a D. The medicine overall? Well, take a look at the sheer length of this week’s list of concerns and tell me how it can earn anything other than an F. The soap opera was good, but I feel it could have been better. Still, I’ll give it a B+.
May 5th, 2009 at 1:24 am
More medicine… less soap please! The soap used to be good because they were so few and far in between. Now it’s the other way around.
When are the writers going to wake up and bring you on board their writing team?
May 5th, 2009 at 1:26 am
So wait, is House kicking his addiction for good or not? They didn’t really make it clear as the scene went from agonizing withdrawals to hot sex.
May 5th, 2009 at 1:43 am
I still don’t get why he was having hallucinations. As House said himself, he’d been taking Vicodin for years – why would it start making him have such a vivid hallucination all of a sudden?
May 5th, 2009 at 1:48 am
Why did House detox so quickly? I was wondering about that…
In previous episodes, detoxing has been a painful process that took days. This time, he was magically better overnight. Did I miss something?
Apparently the reason that I didn’t understand the patient’s treatment was not because I was only half paying attention to her case (House’s drama > some dancer) but because it made no sense whatsoever. xD
May 5th, 2009 at 1:54 am
ok yea seriously, so was it due to his obsession with Cudy or was it the Vicodin.. but then why are we disguising this it,s jut a show….hahahaa
May 5th, 2009 at 2:05 am
Scott you said “While I agree the heart monitor was showing a narrow complex tachycardia, it didn’t look like atrial fibrillation to me (no p waves, for one).”
Doesn’t the fact that there were no P waves increase the likelihood it was A-fib?
I honestly wasn’t paying a lot of attention to the medical story tonight, I was totally engrossed with the soap opera. I cracked up when House finally admitted to Wilson that Amber was his hallucination, and they commented on what that indicated about their relationship.
May 5th, 2009 at 2:15 am
Long time reader, first time poster. I am certainly not a medical professional, and even I was aware of the incredulity of the medicine in this episode. Whatever. I just remind myself it is a tv show and appropriately suspend my disbelief. I could not, however, stop questioning the withdrawal from vicodin House experienced. He was on vicodin. He talked to Cuddy. Suddenly he is in the throws of withdrawal which, as the montage suggested, took place in the same amount of time as removing the abcess. At that rate, he should woken up puking every morning from not taking vicodin while he slept. Miraculously, the withdrawal symptoms clear up overnight, and he is well enough to get it on with Cuddy…. where was the incredible pain he should have been suffering without the vicodin? Ugh! It makes me nuts! What makes me even more nuts is that I still loved the episode and will probably watch it again… now.
Great reviews! Keep up the good work!
May 5th, 2009 at 2:18 am
would it be dangerous for the defibrillator to be in the MRI room during the heart scan?
May 5th, 2009 at 3:03 am
The show pretty much makes it seem like the hallucination was due to his unresolved issues with Cuddy … which I don’t really buy. I’ve never heard of psychological problems causin neurological problems like that.
May 5th, 2009 at 3:07 am
If they are going to keep the vicodin thing going, it’s going to be interesting to see how they get out of this one.
I actually liked Amber a lot better as House’s subconscious. (Then again, I know I’m as much in the minority for not liking Amber as I am for liking Thirteen)
So the skin problem really was TEN? Seems like a cop-out. The skin didn’t really have anything to do with the diagnosis. It seem like the whole show as spun off a red herring. I thought it would be a more important part, rather than just their excuse to have difficulty with tests.
My prediction when I saw the preview as that it would be something surpressing her immune system. . .my guess was the skin was due to necrotizing fasciitis.
I was confused by the medicine in this one too, but I’m more confused about Cameron. Does she want Chase’s sperm in case he dies, or in case they get divorced. First it seems like the former, then it seems like the latter. (Chase certainly thinks it’s the latter. . .that or he thinks he’s immortal.) If it’s the former, then Chase shouldn’t be angry and standoffish about it, or at least should be reacting differently. If it’s the latter, well, to paraphrase Fraiser, in “Lilith Needs a Favor,” “Surely someone in New Jersey must have sperm!”
During the thing with the diabetic coma, I turned to my fiancee, and said, “Yep, it’s the second to last show of the season, House is having a seizure.”
What was the diabetic coma trying to (dis)prove anyway?
May 5th, 2009 at 3:13 am
Oooh, The clips of next week’s Cuddy hookup were HOT!
Maybe I was a little right about guessing the Wernicke/Korsakoff since it was the “vicodin” causing the problems. I’m getting pretty annoyed that the show won’t acknowledge that Vicodin = acetaminophen + hydrocodone, and the acetamenophen is causing the problems. Like any good junky, i’d have expected House to move on to Norco by now (lower acetaminophen, higher hydrocodone). They are beating it to death. Give him some thiamine & some gabapentin already! I rolled my eyes when Wilson mispronounced metoprolol. It’s meh-TOE-prolol, not meh-TOP-prolol. Maybe it is pronounced different on the east coast than over here in the NW…
Scott, I’m glad I learned the difference between TEN & Stevens-Johnson syndrome …. i guess i thought they were the same thing. :)
-Pharmacy Student
May 5th, 2009 at 3:27 am
And how did he manage to go through vicodin withdrawal in a mere 14 or so hours? Vicodin withdrawal takes a minimum of 3 days, and in his case, probably a week. Then the malaise sets in. No mention of buprenorphine? Don’t they research anything?
May 5th, 2009 at 4:08 am
Hurray Huddy! The teaser left me waiting on my tiptoes all week and finally!!! I’m twice as happy because it was my guess that proved right (well if you turn my guess upside down that is). It was psychological, it was in his head, well OK it was the Vicodin but the other stuff surely managed to put the Vicodin problem on hyperdrive and that was the whole thing – Vicodin plus serious love need. :) How the producers managed to kill two birds with one stone still eludes me – he is off the Vicodin and he is with the woman he loves! I really feel like singing at the moment. Sure something tells me that it will not be all sun and flowers in the next episode but still I’m happy – it is the stuff we want to see on TV and the stuff that makes us smile and cry at the same time!!! Bravo! To be honest I didn’t really payed that much attention to the medicine in the episode (and I was way more interested by House’s DD of “seeing Amber”) yet I still managed to see a bunch of stuff that angered me. I’ll re watch the episode (with translation) before I star picking bones however. I’m still way too uplifted to nag. Suffice to say that for me the soap opera should have been an A+: not only because of the whole “Huddy” subplot but because of the amusing interactions we saw between House and his team as soon as his “talking to himself” mojo came out of the closet. Foreman, Wilson, Cuddy – all brilliant! Now I have to go to work do some doctor stuff and I’ll try and calm myself before I do some medical stuff in here too…
May 5th, 2009 at 4:36 am
And how about starting her heart after an MRI? Paddles?
May 5th, 2009 at 4:45 am
House went off the Vicodin for a whole week in season 1 (Detox) and he was still in pain after the whole week.
He also had the ketamine treatment (between season 2 and 3), he went off Vicodin for a full 2 months. He didnt have opioid dependence at that time, so why does he have it now? (i assume he does because he wasnt in that much pain or using a cane just b4 he kissed Cuddy)
May 5th, 2009 at 5:51 am
I was surprised that House was able to put himself into insulin shock within 2 minutes. The rapid-acting insulin I take still takes about 15 minutes to start acting — is it supposed to be faster for him because he injects it into a vein? Or does he have Magic Insulin?
May 5th, 2009 at 6:25 am
We were thinking the same thing about how withdrawal only took overnight, but then again the typical episode only covers a couple days. Stretching out withdrawal over a week or so kills the usual continuity of the show. This time constraint would also be why the medicine gets sloppy, especially considering the onset of symptoms, culture growth, weird diagnosis jumps, etc.
The two non-medical arcs (House’s head, Cameron’s sperm) were so wild & off the wall that we found ourselves not caring about POTW.
May 5th, 2009 at 6:32 am
This episode was great for someone who has very limited medical knowledge! I’m hoping to get into med school next year and I hope my new-found knowledge won’t diminish my liking of the show!
May 5th, 2009 at 7:06 am
Anniebee: He is a Magic Doctor, therefore it works. :)
May 5th, 2009 at 7:12 am
Last night’s episode was so unbelievable I had trouble enjoying the actors:
– House once again drugs himself (with insulin) and their are no legal, medical, or employment consequences
– House and Wilson vastly (as far as I know) overstate the dangers of ECT
– Is starting and stopping a seriously ill patient’s heart really so easy?
– Don’t MRI’s record the images that are taken? If so, why act as if you can’t go back and review them later?
– I remember the good old days on House when every patient wasn’t miraculously healed at the last minute. It made the show much more affecting.
May 5th, 2009 at 7:32 am
I’ll leave the medicine to others, butI really enjoyed this episode since Amber started to digress and disagree with House. I’d like to see Anne Dudek do more in the series, but I guess that’s beating a ‘dead’ horse. But the absolute BEST moment was when Amber appeared singing “It’s Later Than You Think” maniacally to House at the bar where he’s having dinner. It was the creepiest, scariest, most surreal TV scene since the days of ‘Twin Peaks!’
May 5th, 2009 at 7:38 am
Scott’s long list of mistakes is enlightening, and Original Keith reminded me of questions that popped into my head as I was watching last night. (NB so she is Penelope? One reason I like last week’s episode is that I actually learned the patient’s name, Seth, whereas most weeks the poor patients go by in a nameless blur.)
After reading this blog for a while, it strikes me that one can make up a list of items regarding which it is necessary to suspend disbelief when watching House.
(1) Any treatment administered will take effect immediately, so that we can watch what happens without time to forget what the treatment was. Likewise with reactions to diagnostic devices.
(2) The more important the character, the more sterile (and invulnerable to accidents) he/she is. Therefore the main characters can operate without masks or eyeshields. House can walk into an operating room in street clothes and poke his ungloved finger into the patient’s innards without causing or incurring damage.
(3) Chase is the designated surgeon for the team. He can operate on anything from the brain to a toenail. This must allow for economy in shooting on the operating-room set (they could do all the operation scenes for the season in a day or two, just rearranging the drapes on the body).
(4) House’s team will–at least once but usually twice or more per episode–give a treatment or use a diagnostic device which causes the patient’s heart, liver, or lungs to fail dramatically. Respiratory and cardiac problems may occur in the middle of a segment between commercials, so that we can see the doctors respond. In the earlier seasons, there was emphasis on emergency intubation, while in Seasons 4 and 5 the use of paddles to revive a failing patient has been the method of choice for dealing with a crisis. If the crisis occurs just before a commercial break, it is more likely to have a physically dramatic visual quality (weird urine, skin coming off) but less visually compelling solutions, which are implemented off-screen and discussed when the team re-unites after the break.
(5) Cuddy, the head of the hospital, is an efficient and successful professional woman, with no love life at all, who dresses as if her tits and ass were her greatest assets. The only person who ever reacts to her short skirts, decolletage, and glimpses of frilly undies is House. Everyone else treats her as if she were a (sensitive) man.
Maybe House is hallucinating Cuddy.
May 5th, 2009 at 7:41 am
“Speaking of atrial fibrillation, I would have liked them to look a little harder at other causes (say thyroid) before immediately deciding it was something within her heart.”
Funny you should mention this, a few years ago I went to the doctor because my heart had been beating irregularly for over three days. It took that long to go in because I’d been experiencing such episodes all my life, they had just never lasted very long. The doctor sent me immediately to the ER stating I was in AFib. Considering I had Grave’s Disease with hyperthyroidism, that was the presumed cause, but during my hospitalization they discovered a Wolffe-Parkinson-White node on my heart and I realized these episodes I’d experienced all my life were AFib. I eventually got the node ablated and the thyroid irradiated.
When they finally got around to shocking me, they placed leads on my chest with patches, and then knocked me out while they did it. This was also in a teaching hospital, so I was surrounded by a half dozen students as well :)
May 5th, 2009 at 8:05 am
Official Comment
Marie,
A valid point. I rewrote the bullet to make it more clear.
May 5th, 2009 at 9:36 am
During the transtacheal aspiration, when there is the skin falling off and stuff, Chase pulled the tool he was using out pretty quickly. Wouldn’t that have caused more complications? What’s the name of the tool as well, a needle or another more specific name?
May 5th, 2009 at 9:37 am
First time commenting here. Great job on reviewing episodes of House. It gives the series an extra dimension and the credibility of medicine. By which people never should lead them to believe they have something. Even the thought that you diagnose yourself just by watching a medical drama. Just…as realistic as this show is.
Also this was maybe subtle or irrelevant but when House went to Cuddy Amber disappeared at some moments. As if Cuddy is a part of this problem which makes not any sense. Or it could be some new plot in which Cuddy has damaged House in very twisted way. Which seems even more unlikely. But at this point anything seems possible.
Everything before 30 minutes in seemed fine but then everything turns. House rapid detox, patient rapid recovery, Amber disappearing and the House/Cuddy. I do hope that this pattern only remains for this episode. Since to me it made little sense or to anyone I think.
May 5th, 2009 at 9:41 am
When they finally got around to shocking me, they placed leads on my chest with patches, and then knocked me out while they did it.
I would have been scared witless if Chase had come toward me with the paddles the way he did with that ballerina. The idea of being electrically shocked is bad enough, but to make my heart stop? Yikes!
Anyone else notice this was the second case in a row in which it wasn’t House who saved the patient?
And didn’t Amber look totally evil during her rendition of “It’s Later Than You Think”? (Sad to realize we’ve finally seen the last of her. Sad for me, anyway.)
May 5th, 2009 at 10:05 am
I hope this is the last we’ll see of Amber since, in my book, her reappearance qualifies as jumping the shark. After 5 seasons of House, I’m a bit tired of pretty much the same thing week after week. I’d like to see the series end, perhaps with an episode where House saves the day by dying performing the one and only selfless act of his life, or something like that. You know, end with a surprising bang. Or just end.
May 5th, 2009 at 10:28 am
Just to touch on the “Magic Insulin”.
When I take a large dose of insulin (say.. 40 units or more), I get a serious headrush almost instantly. I do mean within five seconds of injecting. Now this might just be my bodies reaction to taking a shot, but the effect is very fast. (Which has always surprised me since it should take about 15 minutes).
May 5th, 2009 at 10:28 am
And another thing – I doubt that stopping your heart immediately causes you to pass out I should think there would be a few minutes of terrified flopping first.
May 5th, 2009 at 10:31 am
@Anniebee : I’m not certain if he injected it into his vein or just his muscle (which would be bad enough) but as insulin works faster the more you inject at once … it could be possible.
If he drew from a 5 ml vial of insulin that would be 200 or 500 units depending of what type it as after all.
I’m more surprised that Wilson did not call for glucagon too.
May 5th, 2009 at 10:36 am
I’m new here, but I wanted to check in because the overnight detox annoyed me so much. Since it has always taken so long for him to detox, I could not believe that he was up and at ém and ready for either work or hot sex by the next morning. I understand the constraints of television, but this was ridiculous.
Also, I have more than a passing acquaintance with mental illness, and while this forum is obviously about purely medical issues, the fact is, schizophrenia would not be treated with electroshock, and electroshock is not given “six times a day” leaving you a drooling moron. From what I have observed it is given at most twice a week, and it is given fo severe, intractable depression. There are many prominent people out there with severe mental illness who function at a high level.
Disappointing on every level for this viewer.
May 5th, 2009 at 10:36 am
Does anyone not think that House may still be hallucinating? That could explain the “rapid detox,” and it’s not like we haven’t been led astray before (No Reason #224). It wasn’t until Amber was finally gone from House’s mind that things got pretty heated between House & Cuddy.
Granted, I could be way off, but that’s just my two cents. Guess we’ll find out in 6 days.
May 5th, 2009 at 12:23 pm
Speaking of eye protection, one of the Discovery channels has a show called Untold Stories of the ER (or something like that) in which emergency room staff and trauma surgeons discuss past cases and use actors to recreate the situation.
Often the actors portraying the trauma surgeons are shown doing what they do, and they never wear eye protection. The actual doctors and staff are interviewed and there are medical consultants in the credits. You’d think someone would bother to point out the SOP.
May 5th, 2009 at 4:16 pm
“But the absolute BEST moment was when Amber appeared singing “It’s Later Than You Think” maniacally to House at the bar where he’s having dinner. It was the creepiest, scariest, most surreal TV scene since the days of ‘Twin Peaks!’”
This was the defining highlight of this episode, I agree. I don’t mind House taking a few episodes to explore the soap part of the show more then the medical one and “Psycho Amber” was not my jumping the shark moment.
However, the rest of the episode was painful:
1. Medicine was horrendous
2. The Cameron/Chase subplot seemed contrieved and recycled drama (Chase is fed up with Cameron’s commitment issues …. AGAIN)
3. The plot seemed erratic, rapid scenery switching without any explanation what the characters are doing there.
4. The already mentioned rapid detox
5. The mere fact that the addiction and/or House/Cuddy issue will dissolve itself AGAIN in the next episode or season to reestablish the status quo. I don’t believe in any permanent change in this series until I see the corpse.
May 5th, 2009 at 4:40 pm
“(2) House can walk into an operating room in street clothes and poke his ungloved finger into the patient’s innards without causing or incurring damage.”
LOL @ Judy.
Maybe House is Doubting Thomas.
May 5th, 2009 at 4:55 pm
Why is it that every time I absolutely love an episode, I come here only to see it torn to shreds?
Actually being a doctor must really take all the fun out of House.
May 5th, 2009 at 5:15 pm
I just hope House had time to brush his teeth after
vomiting so much during his power detox before
sharing the hot, hungry kiss with Cuddy…
The writers are trying too hard to shock us, methinks.
I would be satisfied with just a well told story -
though I have to agree that Amber’s sinister rendition
of Enjoy Yourself ! It’s Later Than You Think ! was
TV Noir at its best.
May 5th, 2009 at 5:38 pm
Heartily agree with “Anonymous”.
I guess I won’t be enjoying medical dramas (unless it’s poking fun at them :) ) once I get closer to becoming a doctor.
May 5th, 2009 at 5:39 pm
Bad news, Niall: it totally, totally will. I started watching this show back when I was studying for the MCATs and loved it. Now, in my 2nd year of med school, I spend a lot of the show yelling at the TV and trying to predict what things Scott will blog about. :P
May 5th, 2009 at 5:53 pm
Hey I really wanted to like this episode, but the ‘overnight detox’ really REALLY bothered me, being party to more then one real dextox from opiates. The ‘crawling to the pill’ was a bit much too. :\
Then right to Huddy hot sex the next morning….House would most definately be horny as a hound, optiates supress the sexual urges, and they come back fiercely during detox, but he sure wouldn’t have been feeling as perky as that. (and also would have probablly lasted 10 seconds max.)
May 5th, 2009 at 5:58 pm
Just a side note here: We now have undeniable proof that House writers watch Medical Incredible for some of their ideas.
See Episode 12, Season 1 – Antibiotic Aftershock (Aired Nov/21/05)
May 5th, 2009 at 6:37 pm
pentalarc said:
I think the issue is that Cameron still has her first (dead) husband’s sperm, and doesn’t want to destroy it. Chase feels that by keeping it, she is showing less than a full commitment to him.
As far as I know, she can get Chase’s sperm anytime she wants.
May 5th, 2009 at 7:24 pm
“There is an accident during a ballet recital, and 21 year-old ballerine Penelope drops to floor, gasping for breath.”
What was depicted was not a recital, but a *rehearsal* (no audience; just director and other such personnel observing).
The spelling of “ballerina” was noted in several posts.
Penelope did not drop (in the active sense) to the floor; rather, she *was dropped* by her partner when his back, at least momentarily, gave out. Did her “winding” by her impact with the stage initiate her breathing problem, or was it just coincidental?
May 5th, 2009 at 8:03 pm
Judy your list is delightful!!!
May 5th, 2009 at 8:13 pm
House cheated in Endocrinology? That explains the hostage episode, I guess.
May 5th, 2009 at 8:50 pm
“Did they ever convert her out of a-fib, or is she still in it (or did removing the abscess clear that up)?”
“They might have been able to raise her oxygen saturation above 60% if they took her off the nasal canula and used a proper oxygen mask instead.”
First one is a minor complaint and second one is major? C’mon you must have had them mixed up. I can totally see how the writers would not use the right equipment on-screen (so we can see her face), but forgetting a symptom altogether!
Anyway, seems you really had to be outside the medical world altogether to appreciate this episode. It’s my new personal favorite, besides “Euphoria” (2-parter, season 2 I think) maybe.
May 5th, 2009 at 9:48 pm
Judy: L O L. That needs to be reposted somewhere.
“We’re like Magic and Kareem!” Loved Anne Dudek in this.
I don’t think the PoTWs are even integral parts of the story in these last five episodes before the finale. >> We don’t even know why the ballerina’s inability to breathe started in the first place!
May 5th, 2009 at 10:27 pm
Boo-ya
May 5th, 2009 at 10:29 pm
Since the episode where methadone “cured” his pain, the fear of detoxing from Vicodin just didn’t ring with me. Why not try another narcotic that does have Tylenol it? Tylenol is supposed to prevent abuse, it doesn’t really add to the analgesic effect. Also, I think Scott’s point about Tylenol induced liver damage was good. Since it can damage the liver, it can raise ammonia level, which would lead to hepatic encephalopathy. That would been a better explanation for his visual hallucinations; it also would have explained the insomnia (day-night reversals).
May 5th, 2009 at 11:13 pm
Amber’s singing = totally creepy. I almost couldn’t watch, because it was, well, totally creepy.
But Hot Huddy Sex? Well, totally hot. “I always want to kiss you.” Loved it. Too bad it was the first epi I let my 4 y/o stay up late to watch with me…had to cover his eyes.
May 5th, 2009 at 11:39 pm
what an epic episode!
i was so impressed by hugh’s acting..
May 6th, 2009 at 12:12 am
Count me among those who were really disappointed in this episode. The skin sloughing off made for some impressive visuals, but just about everything else seemed off.
What I don’t get is why, whenever they have a “House needs to detox” episode, the automatic assumption is that it’s going to be cold turkey? I had a pill-popping friend who tried to quit that way, and when he finally decided to see a doctor (about three days later), the doc told him he could have killed himself. House of all people should know that the best way to detox is under medical care and supervision (and that doesn’t mean “have Cuddy hold my hair while I throw up”). And the idea that it only takes one long, dark night of the soul to get clean is just insulting to anyone who’s tried.
Speaking of Cuddy, she must be pretty desperate. Would you want your tongue in that mouth on that particular morning?
And the whole thing about Cameron and the semen — I was just confused. When she first brought it up, I thought she was trying to say that she wanted Chase to be the father to her dead husband’s baby. But she wasn’t saying that… she was saying something about a prenup. Or something? Honestly I didn’t get it at all, but if she was my girlfriend the whole episode would have made me think she was pretty cracked.
I’m also getting a little tired of boyfriends, girlfriends, husbands and wives who find out their significant others have cheated on them and immediately lose all compassion for the fact that their partner is rapidly dying in agony from a mysterious, sudden-onset disease. Go downstairs to the clinic, kid, get a shot for the gonorrhea, and bring some flowers on your way back up.
The thing with the ultrasound and the veins at the end confused me, too. We saw that her fingers and toes were already black. She was told the tissue couldn’t be saved. Now we’re supposed to believe that necrosis will reverse itself once blood flow is re-established? And I guess we’re meant to assume she’s going to be dancing again, too? Happy ending all around.
One bright part in the episode: When Chase pointed out that, technically, the reason the patient is dying is because House wasn’t there AND they weren’t smart enough to come up with the answer without him. I think that point has been lost in a few episodes in the past.
May 6th, 2009 at 1:18 am
Huh, guess I am the solitary skeptic. I thought the whole “Huddy” thing being a hallucination was a pretty good idea. Guess not. I was kind of at least hoping for some kind of response . . . “You know? I didn’t look at it that way. That’s an interesting perspective.” Or even, “Shut it moron. That’s the dumbest thing anyone’s ever said in the history of ever.” But I got nothing. Not a nibble. Maybe I should start talking about potential melanomas on Cameron’s cleavage again.
Oh, and not that anyone cares & not that it’s relevant to anyone other than me, but I’m pumped, so I’m telling you anyway. I’m gonna have to change my name on this forum after tomorrow! See ya, 2nd year! Bring on the clinical rotations! Woooh!!
May 6th, 2009 at 2:37 am
While Wagner’s post makes about as much sense as Richard Wagner’s writings, I do have to at least agree that the writers put themselves into a position where Amber couldn’t be brought back without totally destroying the show’s credibility. However, the last episode showed just what Amber brings/could have brought to the show, and I suppose I will always be grateful for the small chance they gave us to experience it again.
This episode, on the other hand, took everything gained in that one and blew it out of the water. House spent the entire episode either ignoring Amber, or trying to get rid of her, in foolish ways. She had a few hilarious moments (the high 5, trying to ballet dance), but her “existence” was ignored by everyone such that there was almost no point for her to be in this show. Which is a shame. I understand that House was doing the right thing in the situation, because if I started seeing stuff like that, I’d know something was very wrong. Still, it’s as I said before. The writers made a bad decision, such that they can no longer do what’s best for the show. The problem wasn’t bringing her back for this go around, but getting rid of her in the first place. This was only a tease which only ends up showing how big a mistake killing her off was.
As this was the penultimate episode of the season, I couldn’t help but reflect on the vastly superior House’s Head from about a year ago now. Ironically enough, that show explains perfectly the problems with this one. All of the Huddy shippers are going nuts right now, and let’s face it, Lisa Edelstein is one of the hottest woman in her 40’s that you’ll ever see. Again, I thought of the great stripping scene from House’s Head. But what Huddy shippers apparently will never understand is that’s all their relationship could ever be. It’s only about the sex, because they obviously find each other attractive. But they don’t understand each other at all, which is proven time and time again on the show.
It may have been subtle, but House’s Head wasn’t really about figuring out who the mystery patient was. House finds Cuddy very attractive, but he loves Amber (or at least would have if the season wasn’t cut by eight episodes thanks to the strike). That’s why he walked away from Cuddy’s house earlier in season 5, and that’s also why he refuses to objectify Amber (mentioned both in House’s Head and House Divided). House divided, indeed. Hey, I understand that we all get urges. And who knows how long it’s been. House needs his medicine. That’s fine. But that’s all that final shot was. The truth is, if you’re a Huddy shipper, you don’t understand anything about relationships. Amber was the only answer, and a year has gone by without him admitting it. Maybe it will never happen now, but that’s the true cause of his problem. He must admit his feelings for her, or he’ll never move on. That hasn’t changed. But Cuddy never will be anything more than a sex buddy. Yes, they can and should be friends, but it shouldn’t ever be anything else. House knows that, but Huddy shippers live in denial. Sorry.
(Those creepy scenes with Amber were really unnecessary, although Dudek was fantastic with a side we really didn’t see during her initial run. There would definitely have been some kinky sex between her and House (as if the sex tape wasn’t enough evidence). Would’ve been fun, but alas.)
May 6th, 2009 at 4:44 am
POTENTIAL SPOILER ALERT.
I’m with everyone else as far as the surreal opioid detox House went through in roughly 12 hours. I think someone else even mentioned the possibility of him still in hallucination mode when he got his freak on with Cuddy as she was about to leave. Apparently on some of the spoiler websites, they stated they have set up shop at an old abandoned psychiatric hospital a few weeks ago, most likely filming for this final episode of the season. I would actually bet money he’s still seeing Amber next Monday, and will find himself in a pretty pink padded room with a lock on the outside.
Thinking about Chase and Cameron…I think they still stand the possibility of staying together, but they aren’t getting married any time soon. They still have WAY too much of her past and his trust issues with Cameron to deal with. I just don’t see it happening any time soon (the marriage).
Dealing with House’s “Vicodin levels”, we all know you can’t measure hydrocodone levels, only acetaminophen. Hasn’t a single doctor at that hospital got the bright idea to start him on Silymarin and/or N-Acetylcysteine!? After all, it has been mentioned before that he has once taken “more than 12 a day” so taking one “Vicodin ES 5-500″ (Yes, that was me that caught that one S3E1) q2h is 6000mg. I think the FDA recommends no more than 4000mg in an acute setting and 2600mg in a chronic daily setting. Thus, he’s effectively taking over twice the normal APAP dosage. Forget Norco, he just might end up needing a new LIVER. That would make for a fantastic story line though…House getting a new liver because he destroyed his own with toxic amounts of APAP.
All of that aside though…there’s a good chance he’s still in hallucination mode, it’s just progressed ultra-rapidly. I kinda wonder if he just went ape-sh*t and tried to attack someone and he ended up getting knocked out with some Vitamin H and got transported to the insane asylum. That would be a House move for ya.
May 6th, 2009 at 4:50 am
Horrible episode. Not merely ridiculous and full of medical inaccuracies, but irresponsible and pernicious to boot.
Foisting these kinds of fallacies about opioids has real negative consequenes for pain patients and other users, and greatly impacts the way society views and treats them, including doctors who should know better (far too many physicians are ignorant about opioids and undertreat pain, resulting in completely unnecessary suffering worldwide).
May 6th, 2009 at 5:19 am
Well this episode medically sucked, but the soap was great!
The hospital must be very happy with chase as a surgeon, because he is now a general, cardiac and neurosurgeon!
and he can remove an aortic abcess without cardiopulmonary bypass!
i guess that the other surgeons earlier in the series got fired when chase joined the staff:p
May 6th, 2009 at 5:36 am
One last personal opinion about pain management:
I can’t believe Wilson hasn’t considered the idea of a longer acting opioid medication, or even a different one. I can think of several different combinations that would benefit him a lot more than a fistful of Vicodin any day.
Tramadol + Nortryptilyne + Cymbalta
Tapentadol (new synethetic narcotic just released a few weeks back under the trade name Nucynta) + Neurontin
Some long acting morphine drug like MS Contin – depending on how trustworthy he is with sticking with his schedule. Obviously he’s a full blown addict so he’d end up having Wilson or his ol buddy pharmacist friend down in the clinic give him his daily dosage one day at a time.
Methadone – that was a very good idea if it was a low enough dosage, but his tolerance would increase over time and his withdrawals would have been much worse.
Duragesic patches – The Mylan kind – they are pretty much tamperproof and unabusable unless you resort to the street methods to extract the fentanyl out of the matrix layers (will not discuss the methods on this website…period) and a breakthrough pain drug like the tramadol or tapentadol.
NO OXYCONTIN. That’s just begging for more trouble from house. You guys remember when he was jonesing so bad he stole that dead woman’s prescription of Percocet straight from the pharmacy? Yeah, that’s bad news for House.
Wilson should have had his license suspended a long time ago prescribing that much Vicodin to House.
May 6th, 2009 at 8:02 am
after looking thru your reviews im glad im not a doctor lol. my ignorance of medicine allows me to enjoy the show instead of seeing holes everywhere.
i majored in fundamental physics and i cannot bring myself to watch fringe.
May 6th, 2009 at 10:32 am
lol, when I watched this episode I knew the medicine was definitely going to get a D- or possibly your first ever F. The drama was nice, I thought Amber was actually pretty scary.
May 6th, 2009 at 11:34 am
Why CAN’T hydrocodone levels be measured? I don’t think it’s obvious at all that acetaminophen addiction is the problem, it’s the opioid hydrocodone.
May 6th, 2009 at 11:48 am
Official Comment
The acetaminophen isn’t causing his hallucinations, it’s the hydrocodone. They can’t measure a hydrodone level because
1) No reliable test exists to determine a hydrocodone “level” (in living individuals, anyway)
2) Even if a test existed, there is no set scale to let us know what a “normal” level would be and what would be “too high.”
I mentioned the acetaminophen because it is the only part of Vicodin that can really be tested for, and if that’s what Wilson was referring to, then House is in trouble because high levels of acetaminophen are painfully and irreversibly fatal (unless caught and treated very quickly).
May 6th, 2009 at 11:55 am
I almost became addicted to hydrocodone some years ago, thankfully my doctor refused to give me another Rx. I’ve always been of the opinion that when TV medical dramas have medical experts on staff, it is mainly to help them get the pronunciations of the medical terminology correct.
May 6th, 2009 at 12:43 pm
Daniel, you are right, the episode should be prohibited, Hugh Laurie should be killed, and all the other actors should go to jail, or maybe you just can see a movie without thinking that the world will come to an end.
I liked Amber’s return because we could see how House is thinking.
May 6th, 2009 at 12:59 pm
OK, I haven’t watched this episode, but I’ve read recaps of it and read forum comments…
Is it possible that House hallucinated the entire second part of the episode? People have pointed out that his detox was miraculously short, that he could walk without his cane–and pain free–and then the sex with Cuddy.
It sounds a little too far-fetched to be believable.
Kat
May 6th, 2009 at 1:31 pm
Tarnation! I’ve been on metoprolol for years and pronouncing it wrong–if there can really BE a mispronunciation of a made-up name!
May 6th, 2009 at 1:49 pm
I still can’t figure out why the soap points are low when the actors play the story great. Amber’s face while singing in the restaurant mocking House, the final scene between House and Cuddy beginning with the “lie from 20 years ago”, the “knoooow” of Cameron, the way the team seems completely guessing as soon as House is off the case, the music, everything!!!… The chapter was great, and again i don’t agree with the soap points. Medically? Fine, wear the damn glasses, and pay more attention to those details that Scott mentions, but i simply CAN’T WAIT for the next episode (and last one this season).
I’m sure House is going to screw it up completely…. again….
Enjoy the show people!!!!
Heishiro
May 6th, 2009 at 2:03 pm
Hey Scott,
Is there any chance we can get you on the writing team for this show.
I love House, but besides enjoying the House Wilson and House Cuddy soap opera I have never been as disappointed in a episode as I was last night.
May 6th, 2009 at 2:04 pm
I really like the theory that House’s jumping of Cuddy’s bones was just another detox hallucination. That would remove the objections to his miraculous 12-hour detox and leave open the possibility for more Dudek next week. I couldn’t abide her alive, but I can’t get enough of her dead–what a helluva hellucination she makes!
May 6th, 2009 at 4:58 pm
I feel a drastic House move coming on now that I’ve had time to digest the last episode. I suspect that the last bit of the episode was quite possibly a hallucination like lots of people here do, but I think they come back with a serious vengence next week.
Personally, I can see House making a suicide attempt of his own just to get end it all. Either that, or pull a quasi-body dysmorphic disorder and try to non-surgically amputate his own leg to stop it all once and for all.
May 6th, 2009 at 7:10 pm
Just a reaction and suggestion on defibrilation near the MRI.
MRI works as a electromagnet positioning the spin angular displacement of atoms. To become a magnet, it uses liquid He(superconducting) and of course electricity. So when el. power is shut down after the scan, there is no electromagnetic power to grab that paddles. And He is in hard case(due to temperature it must be) and have little secret button if something goes wrong.
If there still be magnetic power, you can´t even transport pacient on bed or wheelchair from his room to scan his. But I really don´t know if is clever idea defibrilate through bandage.
Anyway great review.
And please excuse my poor english.
May 6th, 2009 at 8:16 pm
Uhoh! Shark jump at the end of the episode. They should hire Ted McGinley as a Janitor to clean up House’s toilet. Shudda cudda wudda been better to have him grope her (HONK HONK!) and she slap him silly. But I aint no TV writer. THEY DID IT! It’s all downhill from here, folks.
May 6th, 2009 at 8:32 pm
Yes, this comment has been posted, multiple tumes, but still…
I am a high school student. The most medical experience I’ve had is biology in 8th grade. And I still know that detoxing from a vicodin dependency of (a lot) of years would take more than one night!
I liked CB even when she was alive, personally.
The medicine is way too confusing for me, usually… I don’t even try to have it make sense. However, it’s fun to come here and see how many things the characters dais, that I beleived, that make no sense at all:)
May 6th, 2009 at 8:49 pm
The whole idea of House hallucinating is old. In my opinion the writers are progressively flattening a character who had, still has, a lot of potential for further developing. When I started watching House I was fascinated by the Sherlock Holmes parallel. Then, as seasons went by, House “involved” in the stereotype of the brilliant doctor / drug addict, his excesses and the recurring hallucination theme. I’m starting to feel that a fantastic actor such as Hugh Laurie is almost wasted for a character that, apparently, is going more and more nowhere.
Cheers,
Rick
May 6th, 2009 at 11:06 pm
Well. The “quick detox” might just mean his “vicodin levels” are back to semi-normal. And its not the first time he and Cuddy have engaged in some tongue-twisters. They both obviously are attracted to each other. They would make a horrible couple though.
The medicine seemed a bit slap dash, but seriously, the soap rightfully took center stage.
As for House seeming to perk after a withdrawal, actually getting rid of “Head-Amber” might have made him suppress most of the pain from his leg. How much of that pain is just psychological or a result of his substance abuse is up for discussion anyway.
May 6th, 2009 at 11:12 pm
One of the things that kind of bothers me about House’s withdrawal is that it’s overblown. I have been taking Percocet 7.5/325 for over five years. Some days I take a couple, some days I take seven or eight, some days I take none at all. My doctor is often slow about mailing my refill script, so there are times when I have to go an entire week or even two without the narcotics. I never really get any withdrawal symptoms (maybe a little irritability or sleeplessness, but not much); I only suffer because I’m not treating my chronic pain adequately.
I don’t buy this hallucinating, vomiting, sweating Vicodin addict. If he were taking that much that consistently, wouldn’t he have shot his liver long ago?
I’m not a doctor, so I only speak from my own experience. I’ve withdrawn from IV Dilaudid after an extended hospital stay (more than once), and I definitely suffered badly from flu-like symptoms. But from Percocet or Vicodin? Never.
May 7th, 2009 at 12:13 am
“Since the episode where methadone “cured” his pain, the fear of detoxing from Vicodin just didn’t ring with me. Why not try another narcotic that does have Tylenol it? ”
Or just go back to using the methadone. The problem I had with the resolution of that story was that House now KNOWS he has another option for controlling his pain. And his reason for not taking it, because it supposedly interfered with his briliant reasoning, is shot when the Vicodin starts creating hallucinations so severe he can no longer trust his own reasoning.
But I don’t believe the 12 hour detox either. It must be a hallucination.
May 7th, 2009 at 3:27 am
One of these days, I’m gonna write the House writing staff and tell them they have to hire you. Seriously, the show is getting crazy (in a bad way, it was good crazy to start off with), and they need you. I can’t really blame them though. It’s like either kill off the show with style right now or keep it dragging on for another three seasons, keeping the money coming in and fans interested. It’s been five seasons, they have to do something to keep it interesting. Although at this point it’s almost trashy soap opera Nip/Tuck interesting – for some reason I just can’t stop watching.
May 7th, 2009 at 6:41 am
Loved Anne Dudek. I’ve liked her in everything I’ve seen her in and think she’s a terrific actress, but the two episodes she’s really been a blast to have back. I’m beginning to fast-forward through the patient scenes; they’ve become useless filler.
wg
May 7th, 2009 at 8:57 am
Mad Capellan: I’m learning more than one type of jargon on this blog. “Shippers” must be people who want something to happen whether it makes sense or not. Is this writers’ jargon or just web jargon?
May 7th, 2009 at 10:51 am
Ok after the Champions league and the football euphoria (Glory glory ManUtd!!!), I’m ready to do some medical nitpicking. Considering how many people did that already (it took me about 40 minutes to read all the opinions!) I’m a little out of date and out of things to say, so I’ll be brief. Pretty much everybody doctor or not have mocked medicine and I can’t but agree on 95% of the stuff said. Here is my contribution to the shredding:
1. TEN is much more likely to be a complication to the gonorrhea (time course!) than to the antibiotics. But than if that was true House wouldn’t of felt guilty right? (And he needs that for his own DD :)
2. Pneumonia can be caught by a simple physical: Very specific lung sounds (cracking, popping stuff like that specific for bacterial or viral pneumonia) After all doctors knew how to diagnose pneumonia BEFORE scans and X-rays
3. Stopping the heart with external paddles was funny, shocking through the bandage was hilarious, placing dirty paddle in such close proximity to an exposed area for infection was the cherry on the top of the cake! (oh and Chase didn’t even had a mask at the time!). I’m pretty sure he gave er the sepsis
4. As a “reverse nit pick” I’ll say that her lungs probably collapsed due to the fall on the floor that “stressed” her heart into a short lived a-fib. The heart went back to normal but the lungs did not. The sepsis was a result of in hospital infection from the TEN not the gonorrhea!
5. Sepsis is actually quite a serious condition by itself and not because of the low BP. She would of/should of died from that alone not the gangrene or the heart problem.
6. Test for gonorrhea should be positive even if it is an “encased” case. And infection like that is caught (again!) with a simple physical and good history
So I give the medicine a weak D myself but I still insist the soap opera is a solid A+
May 7th, 2009 at 11:42 am
As I understand it, shippers are hardcore fans who imagine and yearn for certain sexual pairings of tv series or sometimes movie series characters, and often write (bad) fan-fiction about the characters hooking up. When opposing groups of shippers (say, Huddy vs Chouse) get to arguing, it’s called ’ship to ship combat’.
Anyone else notice that the ‘I wanted to kill Chase’ angle was dropped and never looked back upon? or I missed it if it was.
May 7th, 2009 at 2:07 pm
Rooster:
It was mentioned early in the episode in an argument between House and “Amber” when he accused her of trying to make him kill Chase and arguing that that was yet another good reason for ignoring her and not following her advice any further.
May 7th, 2009 at 7:19 pm
As always I won`t talk about medicine (cause I don`t have clue about it) but about other parts of show:
It was ok, episode. Not too special, and my guess is that writers is leaving room for really extra season finale!
When I take a look at 24th episode preview I was really excited about it. (at least narrator voice was intense and scary).
In this episode I liked part when House take a reach to grab that last Vicodin, I guess scenarist wants to show us that House is human beeing too, that can also irationalize things and act like some junkey.
It was interesthing thouse Chase-Cammeron story, that in season finale I expect to finally give us some unexpected conclusion.
I didn`t like Wilson easy accepting of Amber as House halutination. I think that it could be litlle more substance for drama there, but ….
13 and Taub lose every authority in this show, they didn`t have much to say, do or help almost whole 2 episodes, which is probably feadback from audience and not the best acceptance of thouse 2 characters.
Hugh Laurie was superb again, giveing the show lot of intense, mystery and colorit.
Wilson, my favourite, should in my opinion get some significant role in season finale- and prepare for bigger part in season 6.
I really can`t wait untill next monday… and like narrator said: episode that we won`t stop talking about!
May 7th, 2009 at 8:20 pm
I was actually hospitalized for severe depression about 5 years ago, and was administered ECT at MOST once a day, and not every day at that. As my aftercare, I received ECT once every two weeks on an outpatient basis. It’s certainly not pleasant, but as others have stated, Wilson’s list of the dangers of ECT are FAR overstated. I did get better, so I can surmise it works. The show made it seem like some kind of medieval (if they had electricity then!) practice.
May 7th, 2009 at 11:20 pm
Training psychiatrist here. You can give ECT multiple times a day. It’s primarily hospital logistics that prevent this from the norm. The number of ECT treatments matter more than the time course over which they are given. I agree they overstated the side effects of ECT probably because Wilson really wanted to deter House from a very shoddy diagnosis. For a physician who “can’t take anti-psychotics to practice,” ECT is an alternative. It can treat schizophrenia as well as depression. Of course it was a lousy differential for him as he didn’t show any other symptoms besides hallucinations.
May 8th, 2009 at 1:24 am
@ Scott: “high levels of acetaminophen are painfully and irreversibly fatal”
I’m sure your use of “irreversibly fatal” has a proper medical meaning and doesn’t imply that there is something out there that is “reversibly fatal”, but it made me laugh anyway. That, and House’s “double death” line, reminds me of the line from Blackadder 4:
“A fate worse than a fate worse than death? That’s pretty bad.”
(Delivered by Rowan, not Hugh)
@Kes
I was in a mental hospital once, for depression (I was going to lie and say I worked there or something, but I’m posting anonymously, so what the hell), and one patient there was being treated with ECT three times (if I remember correctly) per week. She had severe problems talking and thinking. When asked a question she would take a long time to respond, and gave only rudimentary answers. She drooled almost constantly, needed to be in a wheelchair at all times, and at least once lost control of her bowels in public.
This was a few years ago, so I may not be remembering perfectly, but the impression I got was that this was a side effect of the ECT. In fact, the very reason I knew she was being given ECT at all was because a therapist mentioned it apologetically after she had to abruptly leave a group session to explain why she was having difficulties.
It could be that some or all of these problems were there before the ECTs, but if so I think probably she would’ve been cared for in the other, more intensive psychiatric ward, which we were not in.
May 8th, 2009 at 4:59 am
“Tylenol is supposed to prevent abuse, it doesn’t really add to the analgesic effect” -parousia15, did you get your MD from the Google School of Medicine? You are incredibly wrong. Seriously, just read some wikipedia on it!
-Pharmacy Student
May 8th, 2009 at 6:48 am
I’m no doctor, nurse, or other medical professional, nor do I ever intend to be. I haven’t taken bio since the 10th grade, even, but I noticed some weird things in this episode:
1. as everyone mentioned, House finished (and began?) withdrawal rather swiftly. I didn’t see him take any pills this episode, but it didn’t seem like he would have given them up before he saw Amber singing in the bar.
2. House was NOT in excruciating pain after withdrawal. He didn’t even look tired. Perhaps it was the allure of possible sex that kept him going.
3. Cuddy MAGICALLY got her babysitter to stay overnight with a single phone call. Impossible (though not medically relevant).
4. Gangrene: Can’t be cured, right? I realize they were implying it’s NEXT to impossible and everyone was SHOCKED that this EXPERIMENT worked, but COME ON… that would be a big deal.
5. If House hasn’t been sleeping soundly since Kutner died (which he mentioned in the previous episode, and one can only assume he has not been getting MORE sleep since Amber showed up), how was he able to sleep in the observation room (which was too well lit for a real sleep study room)?
I thought it was a great episode, but I doubt he got rid of Amber that easily. It’s possible she’d show up in the middle of sex or something… which would be incredibly awkward I imagine.
Also, perhaps the reason they used the paddles to stop her heart for the MRI is because the last time they touched her heart, she had a major cardiac event, so they were concerned about direct contact again causing a problem before they were ready.
May 8th, 2009 at 7:28 am
Hey, I agree witk the general opinion-bad medicine, interesting soap.
1. Didn´t get the patient´s condition and time course, really. Was it so bad and made-up??? Of course, I´m no MD, so there are lots of things I don´t get.
2. As far as I can remember, A-fib is difficult to manage, especially when you don´t know and correct the underlying cause.
3. Where exactly was House injecting the insulin? I thought it was the vein at first, but then it seemed too on the side. Of course he might have atypical vein formation (I have one on my right hand, either). But with the insulin syringe? Can´t believe you can get that tiny needle to the vein, even with the onset of hypoglycaemia suggesting it.
4. What the hell was the pill doing on the floor in House´s bathroom???
5. I guess House will see Amber again!
May 8th, 2009 at 7:34 am
Do we understand WHY ECT works? Last I checked no one seemed to be able to explain what it actually does to help you. I mean, it causes brain seizures, and somehow those can help… but why?
May 8th, 2009 at 9:24 am
I must admit that I loved this episode so much, I rated it 9.5 points out of 10 possible.
Someone once said that the great singer is someone who can mistake the lyrics and the audience doesn’t notice, because they are too captivated. That what this episode was to me: I know about the improbably short detox, the Chase/Cameron sperm subplot was appaling and the medical mistery shallow and unintersting but despite that, I’m willing to say that it was a great episode.
May 8th, 2009 at 11:23 am
Thank you, Joseph. I blame the kids. :)
May 8th, 2009 at 6:12 pm
btw, Anne Dudek in this ep reminded me very much of Jessica Lange in Bob Fosse’s All That Jazz. In that movie, Lange played a beautiful, smiling angel of death dressed all in white with a gauze veil.
At one point, Joe Gideon (Fosse’s fictionalized alter ego) lists his sins for her (women, drugs, etc.) and says, “Real turn-off, huh?”
She looks at him with a broad smile and shakes her head gently and says lightly, “Just the opposite.”
I kept thinking of that moment while watching Dudek here, particularly in the scene where she sings “It’s Later Than You Think”.
wg
May 8th, 2009 at 6:18 pm
P.S. I don’t think the patient with her skin sloughed off was in *nearly* enough pain. That would be absolute agony, and she’d have to be totally sedated because the slightest move would set it off.
wg
May 9th, 2009 at 7:04 am
That makes sense, that the detox Huddy scene was another hallucination.
I like the Jessica Lange/ All That Jazz comparison, Wendy. Amber too is an Angel of Death, a personification of a destructive anima, to go all Jungian. This got me wondering– if House is upset at the detached personality Amber for trying to kill Chase, perhaps the sleepless nights reflect his not yet stated concern that Amber/House killed Kutner…remember House’s insistence that Kutner was murdered. Maybe the way House savages other people’s psyches is catching up with him. Bizarre plots are about all House fans have left, for as the medical people here make clear, the medicine jumped the shark a long time ago. House is currently a very dark comedy, and reminds me of the film Blood Simple. Terrific, if you are in the mood for twisted humor. It strikes me as something that Hugh Laurie, now co-producer of the show, would really enjoy, especially if House is the one who ends up in the cuckoo’s nest. Bravo !
May 9th, 2009 at 5:00 pm
I wonder if the use of vasodialators to open up Penelope’s blood vessels in her hands and feet are really an option for people who suffered gangrene. If so, why didn’t they try it on the POTW in Humpty Dumpty’?
May 10th, 2009 at 1:54 am
Considering TEN I just remembered that while it is a very serious and life treatening condition you have to be able to differentiate TEN from other skin-peeling conditions. Patients with TEN only lose the upper most layer of the skin (wich is increadibly peanfull but not as much as burnt wounds or infectious epidermolisys (both can go way down and under the surface!). I guess they had her on morphine for that one (I would sedate her completely though!). As for the gangrene Heil Mary treatment – yeah that was without a doubt the biggest blow in the whole show. People with sespis die in about 75% of the cases (ok that is what was written in my 1997 book of surgery may be persentages are better now). They require broad spectrum antibiotics, IV fluids, electrolites all kind of stuff just to hang in there. Curing it with dopamine and surgery? And than saving potentially gangrenous limbs? And let’s not forget that she developed TEN from the first round of antibiotics (well according to House anyway). What kind of antibiotics are they going to use next?
May 10th, 2009 at 2:39 am
Can´t stop the development, they didn´t know this method yet in Humpty Dumpty! But I also doubt this would reverse the gangrene. I think it would just release the toxins from the dead tissue and kill the ballerina (remember Three Stories and Cuddy warning House what reperfusion will cause).
And btw. which mother would leave her baby at home and go supervise her employee´s narcotic withdrawal???
May 10th, 2009 at 6:26 pm
The soap was awfully bad in that episode… really hope they won’t turn house into an healthy man redempted by love, please!
The medicine was clearly bad either, even for the ones who don’t usually know much about that…
May 11th, 2009 at 2:17 am
Just a thought – when you have opioid dependency (like House) and you are showing serious neurological problems (seeing dead people) is the use of Naloxon justified? Cause if Cuddy used it that would explain the rapid detox…
May 11th, 2009 at 6:21 am
I have to say that if I was Chase…I would be a little creeped out that the woman I’m planning to marry keeps her dead husband’s sperm, and would like mine to put beside it. Note, she didn’t exactly point out “instead of”…
To echo a previous comment, and I’m so glad somebody else thinks this – but why do couples never talk to each other in this show?
Chase and Cameron – for instance – he’s more than once just ended everything as opposed to have a conversation with her…
Pretty much every patient couple – one finds out the other has cheated on them, or done something secret…and the reaction is never, “We need to talk about this.” but always, “I can never forgive you, and will happily abandon you on your deathbed.”
One of the only couples I remember staying together off the top of my head, are the lesbian couple – and that was because one of the girls wanted to punish the other one forever because she couldn’t leave someone who had given her an organ.
Come on…seriously…I realise the main character is cynical about love, but I’m willing to bet that even after finding out that – most people wouldn’t gladly abandon someone they love to potentially die on the operating table…cheater or not.
May 11th, 2009 at 9:41 am
Gee Alice it seems to me as if you are trying to prove a point…we are all House fans here right? I mean – have you cheated? Cause it seems like you are trying to say something here and it isn’t the best place to do it – if people in this forum are half as intuitive as House (or the dumbest member of his team) is then you are busted. Hope your significant other isn’t reading this…
May 11th, 2009 at 12:49 pm
I dunno. I agree with Alice, and she’s talking about the show so this is a fine place to discuss it. I DO think that Chase really jumped the gun when he decided to break up with Cameron a few eps ago. But I think he’s in the right for wanting to wait until Cameron is ready before getting married.
Marriage means different things to different people, and for some people it’s only acceptable for it to mean the same thing to their partner. From Chase’s point of view, marriage is about “trust” and if Cameron isn’t exhibiting trust, then she’s not ready to be married to him.
May 12th, 2009 at 9:07 am
@Anonymous – “A fate worse than a fate worse than death?”
“Irreversibly fatal” in this context refers to the damage the acetaminophen/paracetamol in vicodin can cause to the liver.
Once lethal damage has been done, there can be a delay of several days before the patient dies; during which time nothing can be done to reverse the damage (short of a liver transplant).
May 12th, 2009 at 10:26 pm
I’m no expert… but, I was wondering why they couldn’t use echocardiogram instead of stopping her heart for an MRI. Do you know??
May 13th, 2009 at 5:22 am
Another patient fake-out? *Shocking!*
And once again, there’s the theme of the show
1
2
Three
FOUR
How does it go?
Everybody cheats (Duh nuh nuh nuh NAA Nuh nuh nuh)
Everybody cheats (Duh nuh duh nuh NAA naa nuh)
Everybody cheats (Naa naa duh nuh DOO doo dee doo)
Everybody cheats (Duh nuh nuh nuh NAA naa naa)
TAMBORINE SOLO!
May 13th, 2009 at 5:39 am
Forgot some stuff:
Alice must have missed the episode with Meatloaf.
(cue theme song again)
Also, of course more drama with… Chameron. I haven’t seen the finale yet but I have this strange feeling it will be the last episode I watch.
Which brings me to my last tangent – they air episodes online eight days after broadcast. This essentially means if you miss one episode and don’t want to skip it, you are stuck watching the rest of the season online, because you can’t get “caught up” – you will always be at least a week behind. Maybe they make more money from online advertisements? But then why do the cartoons all appear online one day after airing? It’s a conspiracy!
I for one am glad House and Cuddy finally
May 13th, 2009 at 8:53 pm
As long as we’re nitpicking… that ballerina didn’t have dancer’s feet.
May 14th, 2009 at 6:52 pm
Did House brush his teeth between the detox and the “hot sex”?
May 14th, 2009 at 6:58 pm
Sorry, just read that someone else pointed out the same thing as my just-posted comment (about whether House brushed his teeth). Please ignore my comment.
May 16th, 2009 at 8:25 am
There are a lot of things I couldn’t believe about this episode, even leaving aside most of the bad medicine:
I couldn’t believe they could cure gangrene. I also couldn’t believe gangrene would set in THAT FAST.
I couldn’t believe Cameron has frozen sperm from her dead husband. What i really want to know is, did it get frozen before or after he died? If it was before, then he was kind of hopeful about being able to survive and have kids with Cameron. If it was after, well, that’s just creepy. But Cameron has always been creepy to me.
I couldn’t believe Cameron expected Chase to be OKAY with possibly raising kids that were her dead husband’s, or just knowing she’s got this reserve sperm so she doesn’t “really” need Chase to have kids.
My husband said that whole thing just raised Cameron’s ick factor really high.
I couldn’t believe House detoxed that fast.
I also couldn’t believe Cuddy ditched her baby for a whole day and night to help a pathetic addict like House, even if she is helplessly attracted to him.
Just…gah. The season finale better be a lot more believable.
May 17th, 2009 at 11:40 pm
if its TENS affecting 80pct TBSA then it’s SJS
May 18th, 2009 at 11:57 pm
I had a thought… this is more directed at the review itself. It would be a coincidence when considered with her other symptoms, but the initial lung collapse could easily have been caused by trauma from falling directly onto her back. Then maybe we could BS something together about how the other condition(s) aggravated the pneumothorax or something.
May 25th, 2009 at 10:02 am
In regards to the MRI and the defib, yes there are specially made ones that can be taken into the MRI chamber. There’s all sorts of MRI-compatible equipment made, but it normally costs about 2-10x what the normal equipment costs.
However, one thing about MRI which this show (and several commenters here) seem unaware of is THE MAGNET IS NEVER SWITCHED OFF!!! The only way to turn it off would to be to boil off the cryogen (liquid helium, typically) so that the Solenoid coil is no longer superconducting. This would ruin the coil, and to restart it would take the replacement of many expensive parts (cryogen, solenoid coil, insulation), days to weeks of re-calibration and shimming, and an enormous amount of QA by medical physics.
IT DOES NOT JUST GET SWITCHED ON AND OFF!! THE MAGNETIC FIELD IS ALWAYS PRESENT!!! Look for “mri foreign object” on youtube if you don’t believe me, and see the film of people trying to get an office chair out of the gantry (”hey, why don’t they just switch the magnet off? Oh, right…”)
(rant over).
And yeah, it would have saved the images acquired up to the point where it was stopped. They do that.
Also, couldn’t they have just done a cardiac CT, rather than the whole “stopping her heart” malarky? Much quicker, retrospective gating allows for adjusting for irregular heart rates, and I’m pretty sure it could differentiate an abscess from the heart wall. Although don’t quote me on that last bit…
May 28th, 2009 at 11:33 am
It seemed simple enough for me… take House to Cuddy’s, watch the baby, there shouldn’t be any vicodin hidden in HER coffee cups… silly.
June 6th, 2009 at 11:27 pm
You forgot to mention Dr. House pronounced necrolysis incorrectly… it’s necro lie sis, not nec rol isis…
June 7th, 2009 at 7:33 pm
TENS is a really obvious diagnosis. After giving antibiotics, TENS is a diagnosis that would be screaming at anyone. I did not know that it did not start as erythema multiforme. I thought that there was a progresion from that to Stevens-Johnson to TENS, but even if not, still! They would have put her in the burn unit at that point due to all the problems that come with having no skin.
July 2nd, 2009 at 4:18 pm
Why is the cam really shaky lately?
July 24th, 2009 at 10:24 pm
So… they used paddles to stop her heart while she was conscious (what?!?)… and then used them again to try and restart her heart, despite the fact that paddles can’t start a flatline (she was in flatline, right? I mean, otherwise how do they get a picture?)… even house has mentioned in an episode that paddles won’t help except with fib…
Also, why on earth is there so much aci. in Vicodin? Some might help with pain, but is it true that the other reason is to prevent people from becoming addicted to hydrocodone? That seems absurd, since the effects of too high a dose of aci leads to irreversible damage.
August 16th, 2009 at 5:27 pm
What a great site! I’m hoping you also vet Grey’s Anatomy (I’ll check after this comment). Anyhow, I’ve marathoned the entire House series over the past month and am just finishing up season 5.
You know, the thing that I keep getting stuck on is House’s addiction to Vicodin. I happen to be on monitored pain management and the pain management doctor I see doesn’t even use Vicodin, because it’s such a low level painkiller. As well, one’s PCP has to refer a patient directly to pain management – I can’t imagine that Cuddy and Wilson could be House’s ongoing prescribing physicians as is represented in the show. Anyhow, it’s not House’s opioid dependence that I question, it’s that it’s Vicodin. Can Vicodin be addicting? Of course. But for someone who loves his narcotics like Dr. House does, I would expect that this would be the guy, the medical professional, who’s surreptitiously dipping into the Fentanyl, Dilaudid, Percocet, and Morphine supply there in the hospital. It is unusual to see a person with opioid dependence who doesn’t eventually seek to increase their narcotic intake due to the tolerance that develops, and more often than not they will seek out stronger opioid drugs rather than stick to the milder narcotic and have to double, triple, or quadruple the amount of pills they take in order to maintain the desired effect.
Also, where is House getting Methadone? Methadone is HIGHLY regulated and not readily available. In fact, here in my state, a physician has to apply for and be granted a special license to dispense Methadone, so it’s not like one can just run into the ER and get an RX for it. Now, Methadone is a solid option for the treatment of opioid dependence, but it’s unusual for someone to just have access to Methadone without, again, being fully supervised by a pain management physician or, conversely, a licensed Methadone clinic that treats addiction.
I disliked and found disingenuous that House was told he would lose his license to practice medicine if he were diagnosed with Schizophrenia, implying he would then be too dangerous and unstable (like he hasn’t been dangerous and unstable for the entire series?!). Anyhow, Schizophrenia would be covered by ADA protection, so it’s not like House could be fired just at the drop of a hat. Presenting Schizophrenia in that kind of ostrasizing light only encourages general ignorance about psychiatric illnesses, and reinforces stigmatization of mental illness.
Finally, I’ve noticed that Ativan seems to be the drug of choice that the doctors call for whenever there is any kind of emergency or crash. Is Ativan such a multipurpose drug?