House — Episode 24 (Season 5): “Both Sides Now” (SEASON FINALE)
A perfectly serviceable episode of House – for the middle of the season, anyway. As a season finale, it was a bit of a let down (until the last five minutes, that is).
Scott is a 20 year-old who has undergone surgery that cut his corpus callosum (the part of the brain that allows the left and right sides of the brain to communicate) to treat a seizure disorder. The seizures have resolved since the surgery, but he has subsequently developed Alien Hand Syndrome, where he has no control at all over his left hand and it seems to have a mind of its own. He is at a restaurant on a date, complaining of bland food, when his left hand starts throwing rolls at an obnoxious diner at another table. A fight ensues, and before the melee even starts, we notice blood dripping from his eye.
Scott is admitted to House’s service for evaluation of his bloody tears and loss of his sense of taste. The initial differential diagnosis includes autoimmune disease, nasolacrimal tumor, infection, or the common cold. House has Taub and Thirteen search Scott’s apartment and they find mold growing on the ceiling in his bathroom. They decide this is the cause of his symptoms and start him on anti-fungal medication. About this time, Scott has a fight with his girlfriend, his left hand slapping her, and she storms out. He tries to follow her out but finds that he cannot walk. The differential now consists of dehydration or a meningioma (the most common tumor of the central nervous system) — only it’s a special meningioma that is allowing the two sides of the brain to communicate again. Instead of running an MRI or CT scan to look for the tumor, they run a test to see if there is communication between the left and right brain. The test is negative, but House notices that Scott is shivering. He also detects an ammonia scent to his breath and sees a caput medusae on physical exam, all signs of liver failure. House suspects the liver failure is due to sarcoidosis and has the team perform a liver biopsy. While performing the biopsy, Thirteen sees splinter hemorrhages (a sign of trauma or tiny blood clots) under Scott’s fingernails. He then takes a sudden turn for the worse, vomiting blood while his oxygen saturation and blood pressure drop.
The team now decides that Scott has a clotting issue, and start him on heparin (a blood thinner). An echocardiogram is normal, so the heart isn’t the source of the clots. They’ve also run tests for Factor V Leiden, Protein C, and Protein S (all things that can cause a clotting disorder), but they’re also negative. Thirteen now recalls his mention of always being sweaty and wonders if that might be a symptom of whatever disease he has. Cancer is thought to be the most likely, particularly lymphoma or pancreatic cancer. House strongly suspects the latter, even when an MRI of the pancreas is normal. He has Chase perform a new test where scorpion toxin and infrared dye is painted on the pancreas and will light up any cancer cells. There isn’t any sign of cancer, but once again Scott starts to develop a dangerously low blood pressure. House now realizes that the clotting problem is caused by his heart throwing off clots, but only when he slips into an arrhythmia, which he does under stress (like surgery or a biopsy), or every now and then. Sure enough, Chase checks a transesophageal echocardiogram and finds an abnormal rhythm and clots in the left atrial appendage. The heart throwing clots explains most of Scott’s symptoms, but what explains the heart condition? The new differential includes rhabdomyolysis (muscle disease), Graves disease (an autoimmune disease that causes too much thyroid hormone to be produced), and Cushing’s Syndrome (a condition where the body makes too much cortisol, a steroid). The Cushing’s seems the most likely, and a dexamethasone suppression test is ordered. About this time, Scott’s girlfriend returns and points out that his left hand only seemed to get “agitated” when Scott’s deodorant was involved. It turns out to be a special deodorant that Scott has to special order. Taub checks on it, and sure enough, one of the ingredients has been shown in one case to cause a heart condition and therefore this is decided to be the cause of Scott’s problem. End of case. Taub also notes ironically that the chemical has been implicated in seizure disorders, and maybe Scott had not needed the surgery in the first place.
As usual, major complaints are in red, minor in blue, nit-picking in green:
Patient has neurological signs (loss of his sense of taste, inability to walk) and they even suspect a brain tumor, yet they never check a CT or MRI of the brain?
The liver failure, particularly the varices and caput medusae, developed way too quickly — or else they’ve been there for a while and the team did a piss-poor physical exam.
It caught my attention when the script was vague about propylene glycol causing “heart problems.” From what I can find, it can cause arrhythmia, particularly bradyarrhthmias (abnormally slow heart rates) and QRS abnormalities. I don’t see any connection between it and atrial fibrillation, the arrhythmia that would cause Scott’s symptoms (again, left unnamed in the script).
The patient is crashing in the OR and no one thinks to look at the cardiac monitors?
I was surprised how quickly the team accepted that propylene glycol caused his problems and just stopped there, other more likely causes left untested for.
While giving blood thinners to someone with a clotting disorder is a good idea, they might want to think twice about giving it to someone with bleeding esophageal varices (at least I assume he has them, that’s the only thing that fits and can explain the vomiting blood).
Chlorotoxin-based (scorpion venom) tumor paint has been used in animal models, but I’m not sure it’s been tested in humans yet. It seems like an extreme step to take though. One of the first things I was taught (and taught loudly) on my surgical rotation was “don’t mess with pancreas” — though the language was more colorful.
So a clot to the brain caused the lack of taste , but what caused the bloody tears?
And don’t tell me “subconjunctival hemorrhage,” that was an embarrassingly bad suggestion of Taub’s.
I like that the writers finally acknowledge that storylines are often built on single case reports (not that there’s necessarily anything wrong with that).
The medical mystery was mediocre, and they never explained one of the opening symptoms. His underlying condition (Alien Hand Syndrome) was more interesting that the mystery: C. The final diagnosis fit the symptoms, or at least the main ones, it just seemed the team accepted that the deodorant caused it too easily. I give it a B. The medicine overall was superficial and rushed, but not horrible. I give it a weak B. The soap opera was the highlight of the show, particularly the end scenes with Cuddy and Wilson and earns the show an A in this regard (though shouldn’t Cuddy have been mad that House lied to the clinic about sleeping with her, and not just yelled at him for discussing her sex-life?).
May 12th, 2009 at 12:41 am
“though shouldn’t Cuddy have been mad that House lied to the clinic about sleeping with her, and not just yelled at him for discussing her sex-life?”
Probably, but at this point it’s hard to tell what’s real and what’s delusion.
May 12th, 2009 at 12:42 am
Truth be told, the drama surrounding House, his intellect, and his psyche is what keeps me watching the show. I think the medical mystery aspect of the show has gone a bit south since season 3, but the evolution of House’s character has been superbly done. I also really am amazed how each season has a distinct cinematographic style to it. Season 5 certainly had the most creepy vibe to it.
I had a feeling the lipstick represented the vicodin bottle but I wasn’t sure…mainly just noticed the way he was handling it the same way he handled his scrip.
May 12th, 2009 at 12:44 am
Long-time reader, first-time poster.
Thanks for the awesome reviews throughout the whole season.
The episode was just terrific, and the last 5 minutes almost got me crying. Didn’t get just one thing about House. Is it schizophrenia?
May 12th, 2009 at 12:45 am
In the end i had no idea what actually happened, he never slept with her? She never helped him?
May 12th, 2009 at 12:46 am
I agree with P$. The medical aspect has not been the focus since at least season 3, but House himself is still fascinating.
The ending of this episode was absolutely sinister. When Amber’s face appeared on the screen I wanted to hide under my chair.
May 12th, 2009 at 12:51 am
Cuddy and House slept together in college
May 12th, 2009 at 12:52 am
I agree with zY. When she popped in the side of the screen, I nearly crapped my pants. And then Kutner there? AUUUGGHHH.
May 12th, 2009 at 12:53 am
Wow! A VERY interesting ep at the end. I agree that most of this ep would not have held up w/o the ending which wasn’t really that much of a surprise….We’ve seen it coming and told ourselves “No…. not that, ANYTHING but that”.
What DID surprise me was Amber’s return and then Kutner reinforcing that what he thought was real, really wasn’t.
And House appeared SO happy at first….
Now he has to face the consequences of choosing Vicodine (supposedly so he can continue to work pain free) or his physical AND mental health.
“Everyone Lies” and it’s finally kicked House’s ass for him to find out that even he lies…..to himself, to Wilson and worst of all, to Cuddy (about his feelings for her).
Next season hopefully will see more stronger then average episodes and it will be interesting to see if the writers can do a good job of extricating House from the mess he’s currently in….
QUESTION: Is the facility House commits himself the3 same one that Wilson’s brother was/is in?
May 12th, 2009 at 12:56 am
It’s not schizophrenia – anyway, it wouldn’t appear for the first time in a House-aged guy (right?). It’s psychosis apparently induced by the vicodin. So he never slept with Cuddy, never even had her over to his place, as far as I can tell. For one thing, there was an explanation after all for how House overcame the withdrawal so fast: he didn’t.
Man, if that psychiatric hospital didn’t look Dickensian. I wonder what the next season will be – will House’s problems be more or less solved in the first couple episodes/in the time (in the show’s storyline) between the seasons? (Honestly, that seems most likely, but would be pretty much a let down.) Or will House be solving problems of random crazies?
May 12th, 2009 at 12:57 am
Since that means the previous happenings in the prior episode did not occur, then my diagnosis of acetaminophen induced hepatic encephalitis still could be the culprit, with the new addition of delusions as well as hallucinations.
May 12th, 2009 at 12:58 am
@ Arlan: House was so loaded on Vicodin/potentially losing his mind, that he became completely immersed in his repressed emotional side: that is, that he knows he ought to quit using narcotics, and that he wants to hook up with Cuddy. This is in line with the medical mystery of the patient having disconnected brain hemispheres. Ultimately House is sent to a psychiatric hospital. Now whether or not this is a yet another hallucination will remain to be seen next season.
May 12th, 2009 at 1:05 am
Allison, I made a gif so you and everyone else can relive the creepiness.
http://i27.photobucket.com/albums/c171/zygote7/house_s5finale.gif
=D
May 12th, 2009 at 1:05 am
Blech. This one sucked even worse than last week. Total cop-out on the writing. For House OF ALL SHOWS to handle a major neurological symptom like realistic, consistent audiovisual hallucinations this poorly is just pathetic. It’s about as believable as the old “general amnesia” device. I know, why don’t we have House relive a couple past lives while we’re at it? And surely there’s room for a few undercover secret agents to come through the clinic next season? Maybe Cameron’s ex-husband can come back from the dead and turn her and Chase’s marriage on its head? It’s full steam ahead for next season’s hottest drama!
Garbage plotting, garbage characterization … just pathetic.
May 12th, 2009 at 1:30 am
I actually quite enjoyed this episode, especially – like Scott – the last five minutes or so. The fact that House had hallucinated many of the events of the previous episode was a definite curve-ball that was enjoyable in its own right (not to see House being committed, just to realize that there was yet another twist to the story.)
I’m curious as to what will happen next season. I agree with the commenters above that said that it is the personality and character of House that have really risen up to help carry the show. The journey through his eyes that the story has taken us on this season has really been quite interesting, and being a person who has bipolar disorder herself (and just being a person interested in cognitive science and psychiatry, it is neat to watch a show that depicts a walk down the psychiatric labyrinth of a person’s mind in such a vivid way.
I appreciate the show, and I appreciate the attention to and greater understanding of many aspects of the medical world (even though there is still work to be done with this – I assent. :)) Many thanks, Dr. Scott, for taking the time and effort to give us insights from a doctor’s point of view. It’s greatly appreciated.
May 12th, 2009 at 1:33 am
Oops, a typo in my previous post – I meant to say that I “appreciate the attention to and greater understanding of many aspects of the medical world that the show has brought about among many viewers…”
Yay for House! :)
May 12th, 2009 at 1:36 am
maybe House is having a hallucination of a hallucination
is that possible?
cant wait till next season, 3 and a half more months
May 12th, 2009 at 1:51 am
My big question is how did his right hemisphere know that the deodorant was causing the symptoms?
May 12th, 2009 at 1:51 am
Was disappointed that an hour was not enough to satisfy for a finale. I figured the entire thing was a hallucination once Cutty mentioned in the beginning that they should be strictly professional and that “we never had a personal relationship.” However, I never got what the writers were trying to get at by having House flash back to an earlier season episode where House insulted Cutty. If memory serves me correct, that’s also the episode where they first kissed. Or did they insert that to show us that incident was a hallucination too?
If this indeed is a case of hallucinations, I wonder how many other incidents in previous episodes were all in his head?
Finally, Amber represented his subconscious, but why was Kutner there too? To represent his guilt over his death?
Wish it was a two parter!!! Arghhhh!!!
May 12th, 2009 at 2:05 am
This is the best series ever…Watched it like 3-4 times each episode….
May 12th, 2009 at 2:35 am
“though shouldn’t Cuddy have been mad that House lied to the clinic about sleeping with her, and not just yelled at him for discussing her sex-life?”
Cuddy might have thought House was referring to their one-night stand so many years ago.
@Garrett: That scene was inserted because House thought he mentioned to Cuddy that he was hallucinating (he really did not), which prompted the kissing, the detoxing, and the sex to “happen”. They only flashbacked the previous ep.
May 12th, 2009 at 2:41 am
House was taking oxycodone since the night when he hallucinated Cuddy at his apartment. We were shown House fondling/hallucinating that lipstick all day but it was shown in the last few minutes to be a bottle of oxycodone.
Calling back to a previous episode when he was on it and had no pain… *that’s* why he felt like he had detoxed and also why he wasn’t feeling pain this whole episode.
May 12th, 2009 at 2:49 am
Hold on,
Didnt his script bottle say Oxycodone?
When/why did he start taking that?
Or am I just missing sometihng.
May 12th, 2009 at 2:53 am
Woah , i liked the soap in this episode. Season 5 has been much more “happening” in terms of the drama than other seasons. Really excited to know what is gonna happen in season 6.
May 12th, 2009 at 2:55 am
Oops, disregard that.
Said HYDROcondone aka Vicodin.
May 12th, 2009 at 2:56 am
The “revelation” scene and the finale went a long way to making up for what I thought was a rather lackluster episode. I found myself reminded of a certain movie in which a certain character says, “The dead see what they want to see.” Not that I’m implying that Dr. Gregory House is dead – but his realization of what actually happened, down to the “lipstick” he thought he carrying in his pocket, tingled with a similar horror.
It’s also kind of funny to look back at people’s objections to last week’s episode — You can’t wean yourself off Vicodin in one night! No way Cuddy would want to kiss him after all that! — and realize none of it was real.
Props to those who foresaw that it was all a hallucination. And good to see Kal Penn one more time.
May 12th, 2009 at 3:01 am
You can tell that the patient story this week was rushed badly to leave enough time at the end. Makes me wonder if they should have just dropped the patient story this time and just done a “character” episode instead.
I think the point here is that House’s hallucinations became so vivid that he can no longer tell that he’s hallucinating. He is headed down a very dark road.
Tell me again why it was decided to kill Amber off? She’s contributed more to this season as a dead character than some of the living ones!
May 12th, 2009 at 3:28 am
Oops, I was in error up there. House was taking methadone when he was feeling no pain back in “The Softer Side”. But I am 99% sure he was taking oxycodone this episode. I’ve capped slo-mos of the bottle dropping and run them through a sharpen filter in Photoshop. It’s oxycodone.
May 12th, 2009 at 3:41 am
Blerg! The mind sees what it wants to see.
The Fox.com recap confirms it’s Vicodin House dropped on the floor of Cuddy’s office.
May 12th, 2009 at 3:54 am
I just wanna ask, can’t they just TIE the left limb while performing tests? I mean, that alien limb caused a lot of trouble for the team, and they just let it do those things.
Another thing, before watching this episode, I was suspecting (more of having a WILD GUESS) that House really had another hallucination, and the whole Cuddy thing was a hallucination, turns out I was right. But I was still shocked when Amber and Kutner appeared. Anyway, the show really fooled us this time, and even though I was HOPING that House would go nuts about Kutner’s death, seeing it happen made me feel really sad. Can’t wait for next season…
May 12th, 2009 at 4:01 am
i can’t wait to see the next season. this is my favorite tv series!
i can’t comment on the medical aspects of this series. i’m not in the medical world. all i can do is get affected and be concerned about my health…but i love the show because of gregory house,the wilson and house friendship and the house and cuddy love-sex life. i also like foreman because of his angst. if not because of him, i would really find house’s team boring. i prefer the previous ones. and please stop the cameron thingy being fixated to his ex-husband’s memory.please!
May 12th, 2009 at 4:49 am
Well, to be honest it was disappointing for me to see the outcome of this storyline after Kutner’s death. If House is to be the one to solve mysteries, then why didn’t he concentrate on finding out who killed Kutner? Saying that Kutner just killed himself with no reason whatsoever is just dumb… I hope they will find out who really killed Kutner, maybe its House?
May 12th, 2009 at 6:24 am
The bottle was pretty jumbled, all i could see was (jumble)CODONE. I’m assuming it’s hydro-? All prescription labels will say HYDROCODONE/APAP if it’s generic because just plain hydro isn’t available; it has to be in combination which is why it’s schedule III. Oxycodone is available by itself though. The writers aren’t that great at making the drug therapy part of the show authentic (remember that ambien bottle, lol).
This episode was sweet. I need to watch it again (and the ep before) now that we know what’s really going on. Bravo to House for committing himself, that’s a really bid deal. Back in mid April when CTB first reappeared, I thought it was Wernicke-Korsakoff syndrome (encephalopathy secondary to acetaminophen abuse which progressed to Korsakoff’s psychosis which presents with symptoms such as anterograde/retrograde amnesia, CONFABULATION, that is, invented memories which are then taken as true due to gaps in memory sometimes associated with blackouts, meager content in conversation, lack of insight, or apathy). Okay either that or House is just plain old schizo, in that case just get him some risperidone and he’ll be in good shape for the next season!
-Pharmacy Student
May 12th, 2009 at 6:36 am
Hah, the detox in on day thing seemed too unreal to be real. And it was luckily. POTW seemed fine for most of the time it seemed except for his cool Alien Hand Syndrom. (And of course his liver failure, his blood pressure dropping and puking blood). Which makes me wonder if this episode would be better only opera and less medicine. Just for once.
Also House killing Kutner? Seems unlikely since his symptoms are now just getting worse. From having hallucinations to a delusion.
So that House had a delusion and killed Kutner seems very unlikely. Would be cool though but also creepy and maybe too melodramatic.
Schizophrenia seems most likely now I think, that’s why he sent to a psychiatric hospital. But for the love of God or House I don’t hope that he will stay there for a couple of episodes. But at least 4 episodes or else it seems that either the psychiatric hospital has magic powers or schizophrenia or the other thing causing his hallucinations and delusion are just nothing.
May 12th, 2009 at 6:46 am
How is a schizophrenic doctor going to practice, anyway? I was under the impression that if House were committed he would lose his medical license.
May 12th, 2009 at 7:00 am
I would have thought that was discrimination.
May 12th, 2009 at 7:19 am
How is a schizophrenic doctor going to practice, anyway? I was under the impression that if House were committed he would lose his medical license.
^^^
This was my first thought as well. If I recall correctly, this is what had been keeping house from comitting himseld once he realized he was having hallucinations to begin with. Can’t really have House MD the TV show if the main charactor looses his medical license. Then again…. I suppose I can think of dozens of times in the pas that House should have had his license revoked so… who knows?
May 12th, 2009 at 7:20 am
Another medical question: when they were doing the test showing visual stimuli to the different eyes, they mentioned that what was shown to one eye would be communicated to the opposite hemisphere of the brain. I thought that I remember from my 1 anat/physio class that the eyes are an anomaly to that, and they connect “straight back” to the *same* hemisphere. Or am I hallucinating that memory? ;) I could accept if the writers did it on purpose to keep consistency and not have to explain that it’s different, and why, I just want to know if I remember that right.
May 12th, 2009 at 7:32 am
At GG from VA
Lose not loose
I don’t get it too, is House schizo or just hallucinating from Vicodin addiction?
May 12th, 2009 at 7:34 am
Official Comment
Zypchick,
The visual fields get confusing: some of the nerves from the eyes cross in the optic chiasm, some don’t. Here’s a diagram, albeit a somewhat confusing one. In general, the medial (inner) aspect stays on the same side, while the lateral (outer) aspect crosses over. If memory serves, the screens were set pretty far to the side, so the lateral vision would be involved.
May 12th, 2009 at 7:41 am
@Andrew: I’m not a psychiatrist, but… my understanding is that many suicides do occurr without anyone knowing anything is wrong beforehand or being able to figure out why afterwards. It’s scary, but true, and exactly the sort of uncontrollable, tragic irrationality that House is desperately ill-equipped to deal with.
May 12th, 2009 at 7:49 am
I was interested to see that everybody who claimed last week that the soap made no sense (Cuddy abandoning/being able to arrange an instant overnight sitter for her baby, overnight cold turkey, even kissing someone who’d been throwing up all night) was proved right.
Did everybody misunderstood what Cameron wanted from Chase in the previous episode? It seemed as if she was asking him for a vial of sperm to keep as her own, along with her first husband’s (a “liquid prenup”). But in this episode it is clear that he wants her to destroy the first husband’s sperm. This situation was perhaps not well thought out by the writers and certainly not well presented.
It was also noticeable that House had little to do with the solution to the main patient’s problem. The patient’s girlfriend gave the team the clue to the solution. In the meantime, House had diagnosed the wrong patient with pancreatic cancer, dismissing the cancerous patient as suffering from a minor complaint. It seems that it is House’s realization that he diagnosed the wrong patient which makes him desperate enough to try to get a real confrontation with Cuddy.
A medical question (from one who does not watch other medical TV series and has had exactly one operation): do doctors really choose the middle of an operation to condole with each other on breakups (Foreman and Chase) or makeup after breaking up (Cameron and Chase)? No wonder “no one thinks to look at the cardiac monitors” as Scott notes.
May 12th, 2009 at 8:03 am
For me the medical mystery this week and last week is House. The medical cases of the ballerina and the roll tosser serve to demonstrate to me the confusion in House’s mind. In both of these cases he makes suggestions that House himself later realizes are not based on true perceptions. He sees guilt in the ballerina’s boyfriend and he sees problems with a pancreas and transfers the diagnosis to the roll tosser. There is no white board style differential diagnoses performed in these cases. The differential diagnosis was done by House in the last episode on the case of House and he has narrowed it down to his drug addiction or schizophrenia.
I could definitely see that either drug addiction or schizophrenia, if left untreated, could disqualify a physician from practicing. Is there any standard for doctors who have undergone treatment? And, presumably, there is a sliding scale of severity for both problems, although House seems to be at a pretty severe stage to me.
Was House’s self-done differential diagnosis correct? What would happen next in his case? Detox and then see if he is still seeing dead people? Or therapy and detox at the same time?
I thought the Cameron and Chase scenes were well done and the brief, very normal wedding was a perfect contrast to the dark wanderings of House’s brain.
May 12th, 2009 at 8:05 am
Hey, you missed the POTW!
It’s was *Carl Reiner.* The whole DDx of the obvious patient of the week is messed up by House, because, mentally, he’s treating the old guy that he knows has pancreatic cancer, not the kid. This is why they don’t really resolve the issue with the kid — he’s not the patient that we’re focusing on.
That realization — that he was really treating Reiner — is the real start of the downfall into reality. The ending is when he pulls the “lipstick” out in front of the one person he knows isn’t going to believe that it’s Cuddy’s lipstick. At that point, he see Amber again, who calls him on his bullshit, then he see Kutner, who condemns him. To me, however, the real payoff is when Cuddy and House walk into Wilson’s office — no words are said, the faces say it all.
I knew something wasn’t right at the start — the camera work was shaky enough to make me nauseous, the lipstick on House’s face disappears, and Cuddy’s actions didn’t make sense.
So, when you go scoring the contest, remember, you had two patients — plus House.
May 12th, 2009 at 8:09 am
I’m pretty sure it’s not schizophrenia guys…it’s been said above, a complication of either acetaminophen or Vicodin abuse.
Also I can’t believe people are so confused about the big awful plot twist in this episode. The _whole_ detox was a hallucination/fantasy, not just the Cuddy helping/sex bit (god damn it). He never even asked Cuddy to help him, and he definitely never detoxed from Vicodin. He maaaaay have insulted her baby in her office (if he even went to her office that night) but that’s about it.
Which is really frustrating…seriously, it was all a dream…?
Rewatching this episode is horrible. Everything that made me ecstatic in the beginning is now horribly, somberly crazy-coloured.
May 12th, 2009 at 8:16 am
Two questions about the episode:
1) did he go to detox or for inpatient psychiatric treatment at the end?
2) I am not a cinematography expert — can’t even spell it — but I noticed a couple times in the episode that the cameras were kind of shaky and there were some weird camera angles, like it was a mockumentary type thing. I wonder if that is a clue to when it is a hallucination?? Did anyone else notice it? This was way before the twist at the end, which I thought was really cool and had me yelling, “no way?!?!?!?” at the TV!
May 12th, 2009 at 8:20 am
This was a powerful episode although it left me with a bitter taste in my mouth. The fact that I was happy about something that never actually happened was…well unpleasant. However it was so “House” so in the stile of the show I couldn’t help but applaud it. The replays of him realizing his hallucination were creepy to the point of me shivering. Amber and Kutner were the cherry on the top of the cake. I’m too shaken to talk medicine so I’ll just leave it there – I’ll re watch the episode again and again it is without a doubt among the best in the whole run of the series.
May 12th, 2009 at 8:45 am
Long time, first time.
After this episode, I’m really looking forward to the start of the next season. We may infer, for example, that while House is away, Cuddy will put Foreman in charge of the department. Since it is assumed that time passes in TV Land, Foreman will have spent 3.5 months running the show. When this happened between season 2 and 3(while House was recovering from being shot), it was probably understood that Foreman was “keeping the seat warm” or somesuch. With this situation, however, there’s no way for any of the characters to know when(if) House is coming back(of course, we viewers can expect a bombastic return, I’m sure).
Because of this, I sincerely hope that we get to see a couple of cases where Foreman is truly in charge, having settled into his role as a department head, with House getting sane/sober as a completely separate B-plot. Then, when he returns, the power struggle begins in earnest.
May 12th, 2009 at 8:57 am
Was the Chase/Cameron wedding real or delusional?
House already tried to kill Chase at the bachelor party and who gets married to “As Tears Go By” ?
May 12th, 2009 at 9:07 am
Physician diagnose thyself!
I think that will be the theme of next season’s early episodes. House will find the underlying cause of his condition, and true to his world view, it will be something physical rather than psychological.
May 12th, 2009 at 9:13 am
i don’t know whether it was already answered, but the question of whether they will include “psychical recovery” of House in the next season should be at least to some extent answered by this:
http://www.nj.com/news/index.ssf/2009/04/tv_show_house_to_film_at_greys.html
Really looking forward for S06!
May 12th, 2009 at 9:29 am
Head Amber is back! I thought she would have been more malicious during his “detox” but now I can’t wait to see her really cut loose next season.
May 12th, 2009 at 9:33 am
@ bex
He went to a psychiatric facility because of the vicodin abuse(or as it was written on the bottle pill/lipstick this episode “Oxycodone”).
Drug-induced psychosis. And I read that the hallucinations and delusions can present even if the person has been clean for some time.
And when House started walking towards the facility the way they filmed him totally ruined the moment for me. I kept thinking of scenes from “final destination/scary movie” where the person gets hit by a bus !
http://i41.tinypic.com/2dsqyj5.jpg
May 12th, 2009 at 10:02 am
@ bex re: cinematography: I had noticed that, too. For the past several episodes (since Kutner’s suicide, amybe?), the camera seems to have been doing one of two things when something isn’t quite right:
- In the early hallucination episodes, they seem to have been applying a blown out look to the hallucination scenes, ie, everything gets sort of whiter and softer in focus.
- In last night’s opening scene, for instance, they’ve been using a cooling filter, handheld camera, and shallow depth of field (e.g., House’s eyes would be in focus but his ears wouldn’t be)
I’d assume there’s some sort of logic at work, but I am under caffeinated right now. :)
May 12th, 2009 at 10:29 am
Remember the ending to St. Elsewhere? Maybe this whole season was a hallucination. When Obama fires “Kutner” he’ll be back as if nothing ever happened.
May 12th, 2009 at 10:45 am
I think that Carl Reiner deserves at least an honorable mention. His change in demeanor as he goes from thinking he has heart burn to pancreatic cancer was a subtle but noteworthy performance. It also foreshadowed House’s own change in demeanor as he goes from thinking he was cured off drugs and pain to realizing he’s psychotic.
May 12th, 2009 at 10:51 am
The reason Cuddy wasnt mad about lying is part of the mystery of House when he was in Med school, think back to the earlier eppisodes (cant remember which) when he makes reference to one night when he gave her everything she wanted. This is supposed to be a hint at what may have happened between them in past wish would be why she never accused him of lying.
May 12th, 2009 at 10:51 am
Oh, and I’d like to add that the emergence of Wilson’s brother now makes more sense. When I first read about House filming in Greystone last month (I live in Jersey and it was in the local papers), I thought that it would involve Wilson’s brother. If not for that, House’s committal would not have been a surprise. The producers must have known they needed to give fans a reason for filming there.
May 12th, 2009 at 10:52 am
@joseph — Chase/Cameron wedding — something that didn’t match up was that Taub had asked if the wedding was really “black tie” but what they showed at the end was definitely not black tie…maybe it is another hallucination.
May 12th, 2009 at 12:56 pm
This was a crappy episode until the last 5 minutes which totally made up for it actually. I had to watch that part two times.
May 12th, 2009 at 12:57 pm
@merp
I seem to recall the blown out lighting happening in the episode where House was taking excessive amounts of caffeine to stay awake and continue hallucinating. A similar effect happened to me when I’d been up for 36 hours studying while popping caffeine pills — everything looked very, very bright (probably had something to do with my eyes being dilated, but don’t quote me on that). Might have been an attempt to show how the world looked to House.
May 12th, 2009 at 1:38 pm
Carl Reiner made this episode for me. And Jennifer Morrison had some great acting. The second scene between Cameron and Chase (not the OR scene) could have been really cheesy, but she sold it perfectly.
I had to watch it three times, and there’s only one thing I’m still unsure of.
Was the scene where Cuddy pulls House away “to talk” real? House makes the comment: “Isn’t that like locking the barn door after the horse has put is face between your breasts for an hour and a half?”
Cuddy doesn’t seem confused at all by the statement. Because it was the two of them alone, it feasibly could have been another invented memory in place of what they really talked about. Hopefully they’ll do a commentary on this episode for the DVD, and we’ll get a full explanation.
As has been mentioned, in the scene where Cuddy fires House, she’s referring to the hookup 20 years ago.
Also, if Vicodin was responsible for the Amber hallucinations, it could be responsible for the delusions. Maybe that doesn’t make perfect medical sense, but it’s good enough to fool someone like me. Getting him off Vicodin (or replacing it with another drug) could be how they get out of this next season. As much as the House writers are willing to stretch the bounds of medical reality, even they couldn’t think that a diagnosed schizophrenic could be practicing medicine.
We’ve been teased with the “House quits Vicodin” plot a thousand times, but this is the first time I could really see it sticking.
May 12th, 2009 at 2:27 pm
Who the hell is Carl Reiner?
May 12th, 2009 at 2:29 pm
You know, if they wanted to, they could blame the bus crash from last season as being the cause of House’s hallucinations. They could then claim that Amber never really died. House imagined it. (They could still say Kutner committed suicide or simply left the hospital for any other reason they chose.) Basically, they can reset the series back to the end of last season if they chose. As it is, they could always say the motorbike accident in “Locked In” is what caused the head injury bringing about House’s delusions. If they don’t blame the Vicodin.
May 12th, 2009 at 2:31 pm
“Who the hell is Carl Reiner?”
Alan Brady on “The Dick Van Dyke Show”, producer of that series, writer for “Your Show of Shows” and father of Rob “Meathead” Reiner.
May 12th, 2009 at 2:49 pm
Judy,
When Chase said, “You want a prenup… in liquid form?” he was referring to the “liquid” of her dead husband. The “prenup” is allowing her to keep it in case she and Chase get divorced before they have kids. Then Cameron still has the old “liquid” to use.
I initially thought that the phrase meant that she wanted Chase to give his own “liquid”, but they made the meaning pretty clear in this episode.
May 12th, 2009 at 5:54 pm
“(though shouldn’t Cuddy have been mad that House lied to the clinic about sleeping with her, and not just yelled at him for discussing her sex-life?).”
Scott,
House and Cuddy have slept together at least once. This was revealed in S4, Top Secret. House said one night he gave Cuddy everything she wanted and she returned the favor with a job. I’m paraphrasing but that’s the gist of it.
May 12th, 2009 at 5:54 pm
This is who Carl Reiner is:
http://www.imdb.com/find?s=all&q=carl+reiner&x=0&y=0
May 12th, 2009 at 5:55 pm
Sorry.. This is a better Link
http://www.imdb.com/name/nm0005348/
May 12th, 2009 at 6:08 pm
Opps!! Correction TOP SECRET was in Season 3
May 12th, 2009 at 6:09 pm
Hell, you get another person of your nationality to comment on the blog you’re frequently reading and he MUST show how ignorant and painfully juvenile he is.
As for the usual thing: long time, first time, you know the drill. I must say I’m quite impressed with the way they handled crappy shippers’ fanservice from the previous episode. Then again, I’m afraid they might jump the shark with the whole madHouse arc.
May 12th, 2009 at 6:28 pm
Hey guys, I’m pretty sure that if a doctor is a diagnosed schizophrenic AND stabilized on medicines + a psychosocial rehabilitation program, then they could prolly practice as a doctor in some capacity (some non-autonomous role). Buuut, co-occurring disorders (like substance abuse!) limits symptom and functional improvement and increases the risk of relapse — so House would probably be screwed. HOWEVER, for House to be schizo this is really late onset (usually manifests in males in early 20s & females in late 20s). It’s something else… prolly related to his beloved Vicodin, because everything on House revolves around it.
If they pull some brain tumor crap and everything is cured with some surgery (like Thirteen’s blindness), i’ll be pissed, lol!
-Pharmacy Student
May 12th, 2009 at 6:57 pm
Keep in mind that the last few eps of EVERY season of House have been surreal, trying to capture the fantastic ‘Three Stories’ ep again.
A shift toward mental illness type subjects might be interesting. Hugh Laurie has talked about his own depression, and his longtime comedy partner Stephen Fry has been very public about having
bipolar disorder.
May 12th, 2009 at 6:59 pm
Man, I hated that ending. H-aaaaaa-teeeeddddd. I wish, wish, wish, for once, the writers of this show would accept the consequences of a plotline without throwing it all away an episode later.
May 12th, 2009 at 7:19 pm
Hello!
Never wrote here before, loyal reader though…
Here is what I was thinking after seeing last ep.:
What about in season six, instead of princeton plainsboro we”ll see this psychiatric hospital and House unofficially working on psychiatric cases?
I think it’s quite possible, because on the one hand at the end of season 5 IMHO it’s getting little SSDD, same disorders, different ways of finding them out. On the other hand I don’t recall any cases involving any psychiatric disorders or mental illnesses, which actually might be intersting, people like this stuff :) And the last thing- starting season 6 at princeton plainsboro after putting him in the mental instituttion (if it wasn’t his dillusion of course) is so-not-house style :))
P.S. excuse my english
May 12th, 2009 at 7:29 pm
@Erik That realization — that he was really treating Reiner — is the real start of the downfall into reality.
______________________
What was startling about this scene is how gently House treated Reiner — “Take him to radiology and stay with him” even while the panic is starting to take hold. And Reiner’s bewilderment mirrors House’s when he realizes he has made everything up. It was beautifully handled, I thought. I couldn’t believe how sad those last moments were, especially since most of the episode had me laughing so hard. Well, I feel bruised and beaten.
Thanks for this blog. I read it every week.
May 12th, 2009 at 7:37 pm
House was not on vicodin. He was on acetaminophen–which makes me think his problem is caused by the opiate itself.
LOVED THE ENDING
May 12th, 2009 at 7:46 pm
Can’t really have House MD the TV show if the main character loses his medical license.
It didn’t stop Dr. Buffer (although he turned himself in) or Ridiculously Old Fraud (although he got fired).
I’m also wondering about the reality of the wedding. Would Wilson and House not at least put in a quick appearance before heading to the Psych Hospital? (BTW, there was a good-looking woman walking into the hospital along with House and the other doctors/attendants.)
Maybe this whole season was a hallucination. When Obama fires “Kutner”, he’ll be back as if nothing ever happened.
I believe the phrase, ironically enough, is ‘being thrown under the bus.’
May 12th, 2009 at 7:55 pm
…psychiatric hospital and House unofficially working on psychiatric cases?
Another commenter suggested the same thing, above, Nina. And that would be interesting. Who knows–maybe the Greystone staff will find House so useful, that they’ll try to keep him committed even after he’s cured? ;^)
May 12th, 2009 at 8:39 pm
Did anyone notice that when Wilson was driving House to the psych hospital, there was a brief scene that was IDENTICAL to the scene in episode 4, “Birthmarks”, when Wilson was driving House to his father’s funeral? (House looking out the car window and then at Wilson quizzically?
Also, to muddy the waters, I had a thought, probably VERY far-fetched, that perhaps the whole episode was an hallucination, the patient symbolizing House’s ’split’ with reality? Maybe that’s why the medicine was sloppy and not really ever having a solid conclusion? I mean, have you EVER seen Taub act like that, the way he was badgering Chase, with whom he barely had any kind of relationship at all? It seemed that all the characters were a bit ‘off’.
And finally, I enjoyed the symmetry of the pilot and this episode both featuring Rolling Stones’ songs, and BOTH having to do with some sort of House/Cuddy confrontation!
May 12th, 2009 at 8:48 pm
My Quibble Of The Week, since I am not a doctor, is with how they performed the visual fields test. They didn’t even bother with SINGLE-blind! Yes, I know the audience needs it explained, but IRL human suggestivity means that telling them what the results should be = bad idea.
RE: Kutner — Kal Penn has already confirmed that it was a suicide. No foul play.
May 12th, 2009 at 8:54 pm
Excellent chapter!!!!
The acting was great. Cameron’s reaction when Chase told her about her problem was lovable! House’s expression when entered Wilson’s office with Cuddy was priceless! The “no words” reclusion of House in the mental institution was great. Amber OMG!!!! The way she appeared; and the moment!!! The timing was perfect!!!! Just like the “enjoy yourself” part in the previous episode. I didn’t care about the patients at all, i was too busy trying to figure out what was going on with House and Cuddy.
I HATE to wait so much for next Season, and i hope the DVD comes out asap so i can grab it and continue my collection of this great series.
I would like to sincerely thank Scott for writing and maintaining this site. Cya guys next season.
Heishiro
May 12th, 2009 at 8:57 pm
Joseph ~ I thought the same thing – weird that Cameron & Chase would be married to As Tears Go By. In reflecting on
it, I think the song is meant to speak to House’s mental state: House is the one who : ” Smiling faces I can see but not for me”. Moreover, the show has a history of using Rolling Stones theme songs for House. Compare with season finale where House throws vicodin bottle in the air to the tune of I Can’t Get No Satisfaction, which was played as well for opening song of Season I.
Can someone who saw the show more than once cite the line when House realizes that the Carl Reiner character may have pancreatic cancer? House says something like, ‘my subconscious was trying to tell me that’. He had taken to ignoring that subconscious voice, personified by Amber, because it was scaring him, especially after she/he endangered Chase’s life. It seems in his efforts to gain control of himself and circumstances that
cannot be controlled – Amber’s death, Kutner’s suicide -
that House is in such conflict with himself that he has lost
his gift for diagnosis, long the key to his sense of himself, as well as his tenuous hold on sanity. No doubt that House had a serious personality disorder long before surgery and vicodin came into his life. All three characters: House, Wilson, Cuddy, played that realization of the
loss of self scene beautifully at the end. Great TV.
May 12th, 2009 at 9:04 pm
Two more notes:
1. Taub harassing Chase in the cafeteria was hilarious.
2. I haven’t seen the redhead girlfriend in anything since “Strangers With Candy” almost a decade ago. That was a pleasant nostalgia.
May 12th, 2009 at 9:24 pm
Well it seems Tritter (remember the mean cop from season 3?) was right all along …
May 12th, 2009 at 9:26 pm
Yay for me! I’m not that flexible but I’m trying my damnedest to pat myself on the back. I haven’t gotten a diagnosis in two years, yet I’m lucky enough to call the hallucinated detox/sex romp. House reaching the realization while at the hospital was a surprise (I expected him to still be sitting on his bathroom floor or already in the mental hospital), but I think it was a pretty cool way to allow everything to unfold as if we were in House’s head.
As for the POTW, I thought the Alien Hand was awesome and I, too, am really upset that wasn’t discussed/investigated more. Glad this season’s over so I can focus on studying for Step 1, but I’m already looking forward to Season 6.
May 12th, 2009 at 9:26 pm
Also the bottle House thought was lipstick, was it Oxycodone? If so how did he get it?
May 12th, 2009 at 9:39 pm
Well it seems Tritter
Who?
May 12th, 2009 at 9:55 pm
About Cuddy and House, please remember that 1st season episode (I think it’s “Mob Rules”) when Vogler infers that Cuddy has slept with House sometime in the past. Cuddy just says the assumption is rude and/or inappropriate, but never says she never did sleep with House. Just food for thought…
May 12th, 2009 at 10:31 pm
Oxycodone, vicodin, who cares? And I really can’t believe that some of you actually went frame by frame to read what the label said. And photoshop!! Seriously, get a life.
May 12th, 2009 at 10:58 pm
Tritter was a police detective who was obsessed with convicting House on drug charges after House humiliated Tritter as a clinic duty patient, giving an insincere ‘apology’.
http://en.wikipedia.org/wiki/Michael_Tritter
May 12th, 2009 at 10:59 pm
As an earlier poster said, how did Right Brain know the deodorant was the problem? I was expecting them to mention some sort of sore or something in his underarm. But then, the right brain is better at pattern matching, so maybe it does make sense that it determined a connection between application of deodorant and Bad Stuff.
As for what actually happened — my wife noticed that Wilson looked especially tired in some scenes. I think in those scenes, that wasn’t Wilson; that was a House hallucination (representing an aspect of himself). Several of the scenes with Cuddy probably never happened. The first one, where she’s pissed about his remark, he misunderstands. The announcement to the lobby (and subsequent firing) never happened.
The bottle seemed to say just “Hydrocodone” (not Hydrocodone/APAP), but we couldn’t see the whole bottle and they’ve done the bottles wrong before.
May 12th, 2009 at 11:25 pm
Didn’t Grey’s Anatomy do the seeing-dead-spouseslovers/thing? And wasn’t the cause a tumour pressing on the temporal lobe? This jumped out at me when House had his list of possible causes on last weeks show; there was no cancer on it. Maybe his are from the drugs or late-onset schizophrenia (surely he could have had minor episodes that would have been dismissed due to his odd and perplexing behaviour that is ‘normal’ for house, and he does have a strong tendancy to isolate. No one may have seen it….) or maybe not. I don’t understand how Wilson, as a cancer doc could not have considered it. Maybe that is what season 6 will resolve, because I don’t know how they are going to get House out of the looney bin.
May 12th, 2009 at 11:28 pm
A few random comments/questions:
Since we know that the last part of the previous episode was House’s hallucination, can we be sure that everything we saw in this episode actually happened? Obviously, the lipstick was not real. But was the patient real?
As far as what medication House is taking, when he dropped the bottle, it definitely said OCODONE. The part previous to that was unreadable, but I think that eliminates the possibility of oxycodone. I was watching in high definition on a large screen, so there is no doubt that the character before the CODONE was an O.
Knowing that House abuses his painkillers, isn’t it malpractice for Wilson/Cuddy/whoever to prescribe Hydrocodone, with the possibility of liver damage from the acetaminophen? Considering that the Hydrocodone does not seem to be sufficient to relieve House’s pain, why wouldn’t they try oxycodone or oral morphine, rather than the jump to methadone, as they did in one episode.
I am just a layman, but it seems to me that the show dramatically overstates the dangers of opiates/opioids when used for pain relief. In particular, there seems to be very little evidence of opiate-related psychosis. Dr. Lawrence Kolb, Assistant Surgeon General of the United States Public Health Service, said in 1962, “Chronic psychoses as a result of the excessive use of opiates are virtually non-existent.”
See:
May 12th, 2009 at 11:47 pm
Did anyone else feel incredibly cheated by House’s sudden onset of an unexplained, cartoonish, ambiguous, and overall cheesy insanity?
The writers definitely did not earn this turn of his character. Yes, they were building up to it. But they skipped way to the end. Why is he crazy? How is he crazy? Why did that come up all of the sudden?
And “House can’t tell what’s delusion and what’s reality” is a euphemism for “We’re too sloppy to have consistent narrative, so we’ll explain plotholes with a metaplot gimmick, a “Gotcha!” moment, and a wink-and-nudge at the audience” or in fewer words “We’re just covering our asses.”
May 13th, 2009 at 12:03 am
I was disappointed with this episode until the end. I’ve been disappoiinted with this entire season. The medical mysteries have been hit and miss since season 3, and as much as I like the drama behind House, I originally watched for the medical mysteries and jerky doctor that solved them.
The end seems to fit with House as a character. Most, if not all, season finales have been from inside of House’s mind. I hope next season is good, and can return to some of its original form. I’m tired of being disappointed in House.
May 13th, 2009 at 1:19 am
I’m still looking for an answer:
Is the facility House commits himself to the same one that Wilson’s brother was/is in?
If it is, this would open a whole new direction for thew writers to go in next season.
May 13th, 2009 at 1:47 am
I suppose much of us will be looking for the answer to “What exactly is wrong with House?” the whole summer?…I still must stick to my guns though – it is psychological it has something to do with Cuddy, Amber and Kutner and it is aggravated (not caused!) by Vicodin abuse. Just had a funny though (and an idea – may be the writers will pick up on me?) about season 6. House will need psych counseling along with the detox right? So why not bring Myra Sorvino back to do the couseling? She had House “all figured out” way back in season 3 (the episode with the best ratings ever “Frozen”). Then sinse she expressed interest in returning to the show as House’s love interest may be a triangle can be formed between House her and Cuddy (who I think was hiding her pain by not walking House to the mental hospital instead of going to the wedding). House getting cured by her/by love is interesting storry line and I think he will not be magically cure – may be we’ll still see more of Amber (and Kutner?) from time to time just as a reminder of what he’s been through and what still lurks in the darkness for him. Anyway speculations will go on and on the one thing I’m actually happy about (and is 100% sure) is that Hugh Laurie is contracted for another season so we’ll see more of him. And HE is the one man show here – he’ll rise from the ashes stronger then ever and keep on abusing people while saving their lives! :-)
P.S. Unless it was a hallucination in the previous episode Wilson and House searched his head for tumors (and his blood for tumor markers) So no tumor and stop making comparisons to Grey’s anatomy guys – they jumped the shark way way long ago and the waning ratings are confirming it – the once proud star show of ABC is circling the drain.
May 13th, 2009 at 1:56 am
How realistically was Alien Hand Syndrome portrayed? I thought I would come here to find at least a few complaints about it being exaggerated, but neither Scott nor any of the other posters have complained. I didn’t know AHS even existed until I saw this episode.
I agree this episode wasn’t anything special, but the end more than makes up for it. House is really starting to break. I don’t think we’ve ever seen him as pants-crappingly scared as he was at the end of this episode.
May 13th, 2009 at 2:58 am
Looking at the psychiatric staff that escorted House in, they are basically the same racial and sexual makeup of his last two teams: one white woman, a black (colored) man, and a white (light-skinned) man. Either disregarding Foreman for the majority of the second team, or disregarding Kutner for being dead, he a nearly identical group of people walking him into the center. Maybe they’re all just cameos and will have nothing to do with the next season. But knowing how much the writers try to plan stuff out for the long term, they may be the next “team” for the show.
May 13th, 2009 at 4:15 am
I liked the finale very much…When I thought that finally House was gonna have a “happy ending” with Cuddy and for once become “normal” (in love, pain free, no addictions, planning to move in with Cuddy), the shows goes head over hills and tells us that everything was just hallucination..That was super!
And Amber and Kutner, haunting him…very nice!
The “right”brain of House had been telling him that he was “substituting Vicodine for Cuddy”(while talking to Wilson), and when he had his wake up…Man, I felt PITY and so SORRY for him… Let’s see what the next season is gonna bring us, I hope a better House, the writers have to put him out of his misery! Poor guy!
I always watch the episodes online, cos I live in the Netherlands and here they are still busy with the 4th season, it’s such a pity cos most of the times the videos aren’t HD… I can’t wait to watch the 6th season!
May 13th, 2009 at 4:59 am
It did seem to me that the patient’s previous doctors had been a tad precipitate in performing brain surgery on him – what, he was never, with all of the testing and so forth that would have to lead up to that, without his deodorant?
May 13th, 2009 at 6:40 am
gosh, everyone seemed really OOC this episode. cuddy in a good way, she finally got some back and told house where to go. wilson though, encouraging house to make her mad? so not to type. and taub following chase was funny, but do they even know each other? strange. im thinking the whole season has been one massive hallucination. though some of these scenes were incredible. cuddy shouting at house down the hallway and then that laughter? brilliant. and house smiling thinking she was going to say yes. heartbreaking. and those end scenes where he realises the hallucinations.. i honestly got the creeps. the lipstick was such a nice touch. this show will always be 100x better than anything else on tv, even if it does suck in some areas.
May 13th, 2009 at 6:50 am
Guys,
There is no way House could have schizophrenia….he is waaaay beyond the two main age ranges of onset. It is clearly drug-induced psychosis…
May 13th, 2009 at 6:59 am
Hey Scott,
Love the reviews….been reading them since season 2.
Going a little off-topic here:
Has anybody seen the new Star Trek movie yet? Cameron (Jennifer Morrison) is playing the character of Winona Kirk (James T. Kirk’s mom).
Saw it last night, great movie, but probably not as good as a House movie. ;-)
-mike
May 13th, 2009 at 7:56 am
Gardenator. The line was something like this….
That’s not a pop belly, it’s a tumor. That’s why pancreatic cancer was in my mind. My brain was trying to tell me.
Heishiro
May 13th, 2009 at 8:27 am
I am surprised that there were no references to “Dr. Strangelove” in this episode. POTW’s affliction reminded me of that excellent film.
May 13th, 2009 at 8:38 am
“though shouldn’t Cuddy have been mad that House lied to the clinic about sleeping with her, and not just yelled at him for discussing her sex-life?”
Remember, it was hinted in an earlier episode (season 3, the one with the marine, I forget the exact name) that Cuddy and House had slept together before; that might have been what Cuddy was referring to.
May 13th, 2009 at 8:55 am
I think House in a psychiatric hospital could be a great setting for the first couple of episodes in Season six… imagine some strange symptoms on other patients in that hospital and House diagnosing them to distract himself from the withdrawel… could be a blast!
May 13th, 2009 at 9:30 am
None of the possible causes mentioned is consistent with House’s symptoms – a vivid delirium, occuring both continuously and continually, yet with no mental deficits otherwise. In fact, I doubt any disease presents in such a manner. Nevertheless, this is consistent with the usual faulty disease presentations in the show, where symptoms seem to occur in isolation without affecting general health (as in this POTW who has liver failure to the extent that serum ammonia is present, yet excepting specific stated symptoms, seems to be in remarkably good general health). In fact, this is reminiscient of the similiarly unlikely Ukrainian female patient who hallucinated her dead mother. So allowing this ridiculousness, here are other objections to the major diagnoses offered in the above posts:
1. Opioid-Induced Neurotoxicity. This exists. It is unknown why it occurs, but the leading hypothesis is accumulation of toxic neuroexcitatory metabolites (many nor- metabolites are neuroexcitatory). The solution is reducing the opioid dose, and/or rotation to a different opioid (as has been mentioned many times, House shouldn’t be on Vicodin anyway). Withdrawal is not the solution, and pain patients do need their medication. This is easily manageable and doesn’t require hospitalization, least of all a psychiatric hospital.
2. Encephalopathy secondary to liver failure caused by acetaminophen (AKA paracetamol, the active agent in Tylenol and an additive to the hydrocodone opioid in Vicodin). House would be in terrible general health with liver failure. It would’ve been easily uncovered with liver enzyme blood tests, which surely must have been performed. A psychiatric hospital would not be appropriate.
3. Schizophrenia. The age of onset might be unusual, but that doesn’t make it impossible, just uncommon (not nearly as rare as many of the diagnoses made on the show). Also, House’s behaviour is consistent with latent shcizophrenia. The major problem is that the writers might have a difficult time getting out of this. How is House to continue practising medicine? (actually, creative answers to this question might make for a good sixth season) Antipsychotic medication has terrible side effects, including detrimental effects on alertness and cognition.
What other options do we have? Brain tumors. Brain infections. Epilepsy. Maybe effects from repeated brain trauma? (such as that little bump from the bus crash).
Another note: the writers seem to have a psuedoscientific mythical perception of the subconscious. It knows everything, it doesn’t forget. The patient’s right brain somehow knows the deoderant is the culprit. It also somehow understands the conversation between the doctors and likes the suggestion that the patient announce things to it. The patient with “Mirror Syndrome” also seemed to magically understand the inner feelings of everyone around him. House has a hallucination representing his subconscious, and rather than it being a rambling incoherent associative synaesthetic entity, it is a coherent sagacious (omniscient?) being with concrete “suppressed” drives and desires. It’s all very Freudian/Jungian. Bleah.
May 13th, 2009 at 9:41 am
Cuddy should hire the right side of the patient’s brain, as it is obviously a skilled diagnostician…
May 13th, 2009 at 9:41 am
Love the reviews, read them religiously.
Small correction: After House noticed the “ammonia breath” it was not caput medusa on his abdomen, but a big ole’ spider angioma (imho). I believe the lesion is shown off center and near the waistline.
So it’s just another long term consequence of liver failure that should have been picked on the team’s original physical exam.
May 13th, 2009 at 10:12 am
I’ve been wondering if everything from the previous episode’s scene of Wilson and House in the car to Monday’s scene of the two in the car was hallucination/delusion.
May 13th, 2009 at 10:46 am
jojo
May 12th, 2009 at 1:51 am
My big question is how did his right hemisphere know that the deodorant was causing the symptoms?
_______________________________________
Because the right brain is much better at making intuitive connections than the left. It picked up subtle clues his left brain missed.
May 13th, 2009 at 10:48 am
Arlan
May 12th, 2009 at 12:45 am
In the end i had no idea what actually happened, he never slept with her? She never helped him?
_______________________________________
Not only did he not sleep with her and she never helped him, but he never even stopped taking the Vicodin. He hallucinated that part as well–he continued to take it while thinking he had quit.
May 13th, 2009 at 10:52 am
Propolene glycol is used as a food additive and as a food-safe antifreeze. It’s relative is ethylene glycol which is the antifreeze used in vehicles and is highly toxic. It’s very unlikely he could have absorbed/ingested enough to cause that level of harm, even using the spray (deodorants still come in spray form??) several times a day for years.
May 13th, 2009 at 11:57 am
I love the lack of clarity they’ve had going ever since House started hallucinating. That’s the whole point of the last few episodes: what’s real? The hallucinations of Amber were obviously hallucinations; she was dead. The hallucinations of Cuddy were still possible… House’s brain (heart?) was trying SO hard to get around the concept of the addiction affecting his performance that it finally brought on a full on, no holds barred hallucination that he couldn’t distinguish from reality. That was all he had left; that or the insanity brought on by the Vicodin. And if he ‘needs’ the Vicodin so much… well, there you are. He created a reality in which it was acceptable, because it wasn’t drugs anymore. What Wilson said about Cuddy replacing the drugs was very telling; that’s precisely what House’s brain was presenting him with.
I was stunned by Hugh Laurie’s acting in the final scenes. I’ve never seen House look so broken as he did when they walked into Wilson’s office. Not a great episode, but a good one considering. Can’t wait to see where it goes.
May 13th, 2009 at 12:35 pm
I’m still stunned by the final episode. I also almost crap my pants when I saw Amber, and I barely dropped the coffe mug. I personally think that the image of everybody enjoying Chase an Cameron’s marriage while Wilson stood in the rain as House entered the psichyatric was sublime. I almost couldn’t stop crying.
May 13th, 2009 at 1:37 pm
The writers are leaving it to us to speculate about all this: where the hallucinations actually began: a week ago, a season ago. That’s all to play out. Genius.
I was a little slow to sense something off, but I definitely hit the brakes when Cuddy very angrily shouted down & fired House because of “zero tolerance” for sex talk….and then, practically the next minute, they’re in her office and she’s smiling, almost apologetic about overreacting.
Was she really referring to the baby comment of a previous episode? We don’t know! Did this conversation even take place? We don’t know!
In any case, such a quick turnaround just seemed totally out of bounds for both the situation and the character. Now I see why.
May 13th, 2009 at 1:38 pm
Excellent twist at the end. Its pretty ironic that this whole season has been hit and miss story elements…and then as soon as we accept it BAM…it was all it in his mind; but how much? Deserves repeated watching. Every episode since the bus crash probably has clues.
Next season will be very interesting because he could be in the psych for several episodes. I can definitely see House in his gown standing in the hallway on the phone with Foreman; in an unofficial capacity, of course. He just can’t stay away from the mysteries…
May 13th, 2009 at 1:44 pm
I think House is going to be in the psychiatric hospital for at least a few episodes next season, I found this link that says they’re going to be filming in there: http://www.nj.com/news/index.ssf/2009/04/tv_show_house_to_film_at_greys.html
May 13th, 2009 at 1:46 pm
this is probably the best episode ever, even better than 4-15 “House’s Head”, the
ending scene was one of the best, i ever saw
May 13th, 2009 at 2:08 pm
Daniel.
If House has Schizophrenia you asked how is House to continue practising medicine?
That should be House dream coming true. In Season 3 (Son of a coma guy) the guy asks House why is he a Doctor, why work with people when obviously he is not a “people person”. He told a story about a friend of his when he was in Japan that had an injury, and they took him to the hospital. There, they passed a janitor, and the doctors didn’t know what to do with the infection, and they called the janitor that was really a doctor. A baracku (or something like that he said). People in the hospital only called him when they needed him cause “he was right”…
I guess the writers should have something planned for House getting into that mental institution. Perhaps at the end it’s just as someone else said, he was psychotic because of the acetaminofen… Who knows. We’ll have to wait for that one.
Heishiro