House – Episode 2: “Paternity”
Another Tuesday, another episode of House. It was a good episode, but it just reinforced some of my complaints about the first episode.
(Yar, there be Spoilers below!)
Once again, the final diagnosis was unorthodox, but clever. Just like in the first episode, the team doesn’t so much as deduce the correct diagnoses as much as stumble toward it like a drunken sailor staggering down the street. It’s multiple sclerosis! No, it’s neurosyphillis! No wait, it’s subacute sclerosis panencephalitis! There doesn’t seem to be any rhyme or reason to their diagnostic strategy; they just jump from one convenient explanation to another.
The whole adoption issue and sub-plot was just nothing but a smokescreen. Despite what Dr. House shouted, it did not affect diagnosis. House had never asked the mother about her immunization status when he thought she was the patient’s natural mother, so why should it suddenly matter when it turns out the patient is adopted? It just gives the writers another excuse to show Dr. House’s “brilliance” and “non-conformity” (and lack of ethics).
I realize it’s only been two episodes, but I’m starting to notice a pattern: due to some unforeseen complication, the ordinary diagnostic techniques won’t work and the team has to use some clever and unconventional means of diagnosis. In the first episode, the patient had a sudden (and suspiciously convenient) gadolinium allergy, so an MRI couldn’t be used. The doctors then had to x-ray her leg looking for glow-in-the-dark worms instead. In this episode, the patient’s spinal fluid couldn’t be tested because of the treatment they’d already given him (which makes little sense), so they had to get a tissue sample from the back of his eye.
Once again, the hospital seems strangely understaffed as the young gun physicians end up running all the tests themselves.
I don’t know if I missed it in the first episode, but apparently each of the young guns is some sort of specialist. We find out this episode that Omar Epps character is a neurologist (which is lucky, since both of the first two cases have been neurological cases).
Now, don’t think I don’t like the show. It’s very enjoyable and better than 90% of what’s on television. Hugh Laurie is great as Dr. House, and the characters of Omar Epps and Sean Patrick Leonard are growing on me. I just have high expectations for a show that bills itself on cleverness and zebras.
November 24th, 2004 at 11:01 pm
You did miss it in the first episode- the scene where they young doctors are introduced in the cafeteria, each of them discusses that they have a particular specialty.
November 24th, 2004 at 11:49 pm
Ahh, I thought I missed something like that. So what is the girl’s specialty, and what is the bland guy’s specialty?
January 3rd, 2007 at 5:38 pm
Dr. Cameron (”the girl”) is an allergist/immunologist, and Dr. Chase (”the bland guy”) is an intensivist.
February 3rd, 2007 at 2:28 am
I watched this episode in tv and now I have watched it two times in DVD and there is no cafeteria scene. Did they drop it out? Have to mention my version of series is for Nordic.
February 11th, 2007 at 7:52 am
I love House! Medical series are becoming popular and I have no objections. I seem to learn more after every episode than a whole week of lectures in pathophysiology and pharmacology. Human health could indeed be interesting after all. hmmm….
March 7th, 2007 at 6:21 pm
They didnt include that scene in the TV or DVD version, it was apparently in the unaired promotional copy of the pilot episode. Check the imdb FAQ for more information
March 16th, 2007 at 9:15 pm
I actually thought that House didn’t ask about the mother’s immunisation status because the parents thought the biological mother was immunised and it only then occurred to him that they might not know.
I’m Australian but I assume immunisation is practically universal in the US, so it seems obvious that if in doubt they’d say the mom was immunised. Besides, unless I misread the literature, a food-borne medication can’t cause pharmaceutical effects unless it’s actually taken; the breast-feeding by the biological mother stopped at two weeks, and vaccination occurred at six months, leaving a long windowof opportunity for the virus.
May 30th, 2007 at 4:41 pm
When they were doing the treatment, didn’t they forget the ribavirin?
August 19th, 2007 at 9:25 pm
Erm…Not to be a nit-pick or anything, but…Sean Patrick Leonard? It’s Robert Sean Leonard who plays Dr Wilson.
September 27th, 2007 at 10:38 pm
its said in later episodes that house doesnt trust the staff to run tests and only gets his team to run them
January 4th, 2008 at 1:24 am
Also with the point with House’s team to run tests, isn’t the hospital where they’re at a teaching hospital? So it would make sense for them to run the tests, right?
January 4th, 2008 at 12:13 pm
Official Comment
Even at teaching hospitals, doctors are only allowed to do certain very simple tests (hemoccult, urine dipstick). There are strict Federal guidelines (CLIO) over who can run which tests, and the doctors wouldn’t be qualified to run the tests, and the hospital labs could lose their credentials for letting them.
January 16th, 2008 at 1:42 am
Why does House go to the game at the end of the episode?
Don’t get it, never did.
WHY IS HE THERE LOOKING SO DUMB?
Thanks
February 18th, 2008 at 8:13 pm
I think its because he is crippled so he can’t play sports anymore and it kinda seemed like he used to play lacrose. I guess the writers are trying to show him connect with his patients, but I havnt noticed that much or at all in any later episodes
May 1st, 2008 at 3:51 pm
I haven’t seen the episode, but I’ve been doing some research (library, not lab) on measles and SSPE, so I hope you don’t mind if I put my two cents in here.
Everything I read describes SSPE as “invariably fatal,” but Dan doesn’t die in the end, does he? (Occasionally, people go into remission, but that’s only a temporary reprieve.)
The episode summaries I’ve seen say Dan was ok because they did some miracle surgery on him that somehow involved “intraventricular interferon,” which is pretty impressive surgical technique, as the mutated measles virus is inside each individual brain cell. (If I understand it correctly, the virus gets in, then mutates so it can’t get back out.)
Ok, I was just showing off with the mutation stuff, so that’s not a real criticism. But if a disease has a 100% fatality rate in real life, shouldn’t the patient die on the show, too?
Just wondering: did the show mention that SSPE is caused by wild measles infection, but not by measles vaccination? (ref. below)
Subacute Sclerosing Panencephalitis: More Cases of This Fatal Disease Are Prevented by Measles Immunization than Was Previously Recognized
William J. Bellini, et al
The Journal of Infectious Diseases 2005;192:1686–1693 This article is in the public domain, and no copyright is claimed. 0022-1899/2005/19210-0004 DOI: 10.1086/497169
Thanks! Enjoy the show.
June 5th, 2008 at 8:16 pm
I’ve only just discovered your blog and as a pharamceutical advertising copywriter (essentially I ’sell’ drugs for a living) I’m finding it – all the links – utterly fascinating.
I’ve rented out the first two seasons of House – most of which I missed when they first aired – and I’m thoroughly enjoying reading your comments after each one.
Thanks for writing them!
xxx scarlett
June 9th, 2008 at 8:42 pm
I suppose that the scenes in the Clinic are not that important for the main storyline (except, of course, the traditional final inspiration that House gets from one of his irritating patients), but I’d expect someone to comment on them once in a while. They are really fun. That Mr Funston, especially, and how House gave him a run for his money. Are such crooks a common problem in the American health system?
And are DNA tests really so expensive? $3,200 sounds a lot…
July 1st, 2008 at 11:43 am
[...] Polite Dissent’s review of House 102: Paternity [...]
July 1st, 2008 at 11:54 am
hey there
i just got to watching house and started doing a more detailed medical review. hop on over to my blog to check it out!
http://jeffreyleow.wordpress.com/house-md-reviews/
January 4th, 2009 at 7:46 pm
What was that mnemonic device they used in the differentials, MIDNITE or something like that?
February 19th, 2009 at 7:43 am
Does anyone actually diagnose meningitis with a mild deviation of the corpus callosum? Granted you could push towards an early hydrocephalus but that would depend on the csf findings and the ventriculogram. Intraventricular antibiotics is a cute idea, but is it actually practiced? Chemotherapy I’ve heard about.
The Lumbar puncture scene was suggestive of torture porn, it actually made me cringe. The bone marrow biopsy in the next episode was even worse. It may make for good drama, but my bet is more patients would try to defer their procedures.
Linking myoclonus to parenchymal brain disease was a nice touch.
March 3rd, 2009 at 11:36 pm
Brian wondered:
“What was that mnemonic device they used in
the differentials, MIDNITE or something like that?”
No “E” at the end:
Metabolic
Inflammation
Degenerative
Neoplastic
Infection
Trauma
April 15th, 2009 at 7:22 am
God dag! Kan jag ladda ner en bild fran din blogg. Av sak med hanvisning till din webbplats!
May 11th, 2009 at 5:47 am
I’ve got to say, it’s pretty obvious why the “young guns” do the procedures, and that is for aesthetic reasons, not for medical ones. Unfortunately, if we followed them waling round the hospital asking everybody else to do their tests for them – they wouldn’t make wonderful main characters now, would they?
Granted, it’s not accurate – but the show hired three young, attractive people so the audience could watch three young attractive people doing complicated medical procedures and enjoy the show more for it. If it was realistic, we’d hardly ever see them (and to be honest, House would be better off hiring older, more experienced people – wouldn’t he?)
June 22nd, 2009 at 11:55 pm
Since when was a PCR paternity test $3200?
October 26th, 2009 at 8:07 am
The ending with the lacrosse game is very simple. Number 18 is in fact House himself, as he remembers of his old days where he used to play lacrosse. Its just a way to show the small human signs in him, the fact that he misses a sport he used to play.
Thats why the field is empty in the end. Its all in his head.
December 17th, 2009 at 11:20 am
just started watching house and its pretty impressive show….
As final year medical student want to point out some medical inconsistency [actually i am fan of house....most brilliant doctor i have ever seen even if he is fictional and has somewhat similarities to holmes] yet writers not so brilliant..!
Transpupillary retinal biopsy is not possible , such procedure would result in corneal scarring and cataract formation, with likely resulting in ectopia lentis [lens dislocation], vitreous hemorrhage, and retinal detachment. Retinal biopsy can be done by experienced ophthalmologist using vitrectomy techniques.
who is writing script of show anyways? are they having some medical background? because rest of medical data seems pretty convincing i suppose…
February 6th, 2010 at 10:46 am
[...] House – Episode 2: “Paternity”, Polite Dissent, 24.11.2004 [...]
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