House — Episode 9 (Season 6): “Wilson”
Almost entirely a Wilson character episode, so the medicine was fairly straightforward, if surprisingly sloppy
Wilson is out hunting turkeys with Tucker, a friend who he helped defeat leukemia five years earlier. Tucker nearly shoots Wilson when his left arm becomes suddenly numb and paralyzed. Wilson has Tucker brought to the Princeton Plainsboro Hospital emergency room for evaluation. A head CT is negative, and the blood count is normal, which tells Wilson that Tucker has not had a recurrence of his cancer. Noticing a fever blister on the lip of Tucker’s girlfriend, Wilson diagnoses him with tranverse myelitis (inflammation of the spinal cord, it can have many causes, in this case the Herpes simplex virus passed from the fever blister). He admits him to the hospital for treatment with acyclovir (an antiviral drug). House chides Wilson for his diagnosis, telling him that Tucker has cancer. Wilson disagrees and they end up betting $100 on the final diagnosis.
Paying a visit to Tucker a little later, Wilson discovers that he now complains of tingling in his left foot in addition to the continuing numbness and paralysis of his left arm. Wilson sticks with his diagnosis of transverse myelitis, but adds a second antiviral — Ribavirin — to the therapy. There is no improvement, and in the meantime Tucker has developed a nasty cough that eventually devolves into a respiratory arrest (which he survives, or it would have been a very short episode).
Perplexed, Wilson enlists House’s team in reviewing the case. Cancer is suggested, as is a subdural hematoma (bleeding around the brain), bacterial infection, or fungal infection. Wilson agrees with the fungal infection, and suspects that Tucker has aspergillosis (infection by the Aspergillus fungus) including fungal balls (exactly what they sound like) in the lungs and spine. He declares that Tucker is too sick for tests and rushes him into surgery. Chase sees no Aspergillus, but instead finds “global lung damage” suggesting PCP (Pneumocystis carinii pneumonia, a fungal infection of the lungs).
House is watching the surgery beside Wilson, and points out that a PCP infection means that Tucker must have a weakened immune system (since healthy immune systems can easily defeat the Pneumocystis carinii). He states that Tucker must have HIV (the virus that causes AIDS), acquired SCID (Severe Combine Immune Deficiency), or cancer. He suggests that Wilson test for all three.
Sure enough, this round of testing shows cancer — more specifically ALL (Acute Lymphocytic Leukemia, also known as Acute Lymphoblastic Leukemia). This is not a recurrence of Tucker’s original leukemia, but a different one, possibly caused by the chemotherapy required to treat the initial cancer. ALL is fairly treatable, so Wilson starts Tucker on chemotherapy. Twenty-four hours later, there is no change in his condition, and Tucker is concerned he may be in the 10% of ALL cases that Wilson says do not respond to therapy. Wilson decides to double the dose of chemotherapy. It works, more or less. The high dose chemotherapy knocks out the ALL, but it also severely damages Tucker’s liver (the yellow eyes were a sign of jaundice). In fact, the liver damage is so bad that Tucker will die in twenty-four hours if not given a transplant. When it becomes apparent that no transplant is available, Tucker asks Wilson to donate part of his liver to him (he know that they have the same blood type). Wilson thinks on it, and drinks on it, but eventually acquiesces and Tucker receives part of his liver. After the operation, both are doing well and expected to recover fully.
No deal-breaker errors this week, but worse than the last couple of episodes. Some real sloppiness in writing/editing/continuity as well. As usual, major complaints are in red, minor complaints are in blue, and nit-picking ones in green:
Wilson is being generous with his ALL prognosis of 90%. The remission rate of ALL in children is 95%. In adults, it is 60-80%, with patient have CNS disease (which Tucker does) having a worse prognosis.
Chemotherapy cures leukemia completely in twenty-four hours? Nonsense. That’s too soon to tell if it’s working at all. Best case scenario is usually remission in 4-6 weeks.
There is no surgeon — even Chase — who would operate on Tucker without at least getting a CT first to show where the suspected fungal ball is. You don’t just slice up the lung indiscriminately. If there were a fungal ball, it would have shown up on the CT, as would PCP severe enough to cause a respiratory arrest.
By my understanding, SCID is currently defined to be a genetic disease, not one acquired later in life. There are acquired immune deficiencies, some severe (most notably HIV), but they are not “SCID.”
I’m surprised none of Wilson’s original blood work showed the cells associated with ALL.
Not my area of expertise or interest, but would a patient with a history of two cancers (though admittedly, no liver cancer or liver metastases) be placed that high on the transplant list?
Left arm or right arm? The episode description and House referred to right arm paralysis, yet the patient was clearly paralyzed in the left arm. Wilson later mention left arm. This is just sloppy.
“PCP Pneumonia” is redundant. The second P stands for “Pneumonia.”
A real nit-pick here, but by the time a patient has PCP, it is considered AIDS, no longer just an HIV infection.
I enjoyed the scenes with Wilson and his other patients.
The medical mystery was routine (as far as House episodes go), but well constructed. I give it a B. The final solution was fairly obvious, but entirely logical: B+. Overall, the medicine was OK, but way too sloppy, and gets marked down to a B-. The soap opera was good, though I would have liked to see a little more of the team. B+.
November 30th, 2009 at 10:37 pm
who was the actress that played Josh Molina’s ex. Thanx
November 30th, 2009 at 10:41 pm
i quite enjoyed this eppie. I agree with you fully when he said ‘no more cancer’ after the chemo… i was like ‘its only been i few hours…’ and yea i was confused about the arm thingy too. I reallly liked the other patients. In all 5.5 seasons we never have gotten to see Wilson in action… on House, i thought it was a nice change.
Another thing i laughed out loud at was when the ducklings 3.0 would pop up in random scene running to the OR… like when Chase was like ‘IT WASN’T THE TENNIS!’ … maybe its just me but i thought those 2-3 times just like hahahah … that was random (:
PLEASE READ.. —-> I just wanted to thank you for these medical reviews. I really wanna be a doc one day (im only in my teens) so i really apprieciate these. And you got it up in under 3 hours… I am no conviced you have super powers (:
PS what did you think of the Cuddy/Bonnie scenes???
November 30th, 2009 at 10:42 pm
**only house*** not ‘on house… bad typing (:
November 30th, 2009 at 10:46 pm
If I can say ‘PIN number’, then House can say ‘PCP pneumonia’
Bigger question, tho; hasn’t the OR scheduler caught on to House’s ‘emergencies’ after six years??? IRL, House should have his cases fit in after ‘Take Your Daughter To Work’ day.
November 30th, 2009 at 10:47 pm
evil wilson… YES.
November 30th, 2009 at 10:48 pm
Official Comment
austin:
Katherine La Nasa
November 30th, 2009 at 10:52 pm
The donor’s liver grows back in a couple of months, correct?
November 30th, 2009 at 10:59 pm
Just out of curiosity…
Wouldn’t Wilson have had to turn off his cellphone when he was in the hospital?
November 30th, 2009 at 11:02 pm
I’m pretty sure they called it PCP Pneumonia just so us morons at home didn’t confuse it with angel dust.
November 30th, 2009 at 11:08 pm
Love the reviews! =)
ALL w/CNS involvement, and only CNS involvement… Is that possible? Shouldn’t there be some blasts in the peripheral blood? Aren’t WBC levels and Blast % good indicators of prognosis?
Oh well I watch for the jerk that is House not for the medicine. =)
November 30th, 2009 at 11:10 pm
Not a big Monty Python fan, but I was happy to catch the “room A12 for arguments” reference.
It was interesting to see Wilson recognized as wunderdoktor by one patient at the same time as the destroyer of the liver of another.
November 30th, 2009 at 11:10 pm
I might of heard it wrong, but I think Wilson said that the blood-brain barrier (BBB) keeps the blood in the brain separate from the rest of the blood in the body, so the cancer is essentially trapped in the brain. WTF?!?
November 30th, 2009 at 11:17 pm
This has definitely been the best episode of the season. I enjoyed the Rosencrantz/Guildenstern/”Zeppo” aspect of the plot by focusing on Wilson and just seeing House’s usual madness drift by in the background.
November 30th, 2009 at 11:18 pm
Evidently, the make-up department did not realize that the jaundiced Tucker’s neck too would be in the shot along with his face. With a yellow face and a pink neck, it looked like he’d fallen asleep under the sun with a newspaper over his face, rather than suffering from liver failure.
November 30th, 2009 at 11:49 pm
Can you really drink alcohol the night before you’re doing a liver donation?
November 30th, 2009 at 11:53 pm
I am just a junior biology major, but as far as I understand, the way Wilson explained it is not how the Blood Brain barrier works. It keeps (most) of the elements of the blood in the blood, but is still connected to the rest of the circulatory system. If it wasn’t it couldn’t be oxygenated.
November 30th, 2009 at 11:58 pm
@whole s. tic – But you shouldn’t say “PIN number,” you see.
Why was the notion of Wilson donating a lobe of his liver so much of a “OMG WTF ARE YOU THINKING NO YOU CAN’T!” I mean, if he’s a match, he’s a match, so wouldn’t it be better to save the guy than kill him? Even if Wilson needs to recuperate from surgery for a while, does that automatically kill his other patients or something? (Cuddy saying “You have hundreds of patients”) I really didn’t understand this.
December 1st, 2009 at 12:01 am
“It wasn’t the tennis.” That line had me in stitches. Great episode. Seeing just glimpses of House’s goings on was great. It would be funny if they showed the episode next week from House’s side.
December 1st, 2009 at 12:17 am
Question… So, the chemotherapy drugs for ALL caused massive liver failure. I’m not sure I understand this… ALL drugs, well really all chemotherapy, is known for anemias, nausea, vomiting, etc. etc. but in my limited pharm knowledge, the only time liver failure occurs is with Tumor lysis syndrome (though that is pretty common with ALL) which can be controlled with allopurinol or rasbicurase. Even if that’s the case though, Tumor Lysis syndrome should go after the kidneys long before the liver right?
Any thoughts?
December 1st, 2009 at 12:34 am
Wait. Did an physician assistant actually have a speaking role in this episode? More than once?
Certainly somebody has kidnapped the House writers. Please, somebody follow up on this and make sure they are OK. :-P
(Creative episode title btw)
December 1st, 2009 at 12:46 am
@Alexandra: Cuddy was implicitly suggesting that there wasn’t enough Wilson to go around if he was going to donate an organ (or a portion thereof) to every patient.
December 1st, 2009 at 12:55 am
I doubt that the episode only covers 24 hours.
House manages to treat two patients, and hides for an indefinite time in-between – so, at least about 3 days in total.
I really liked the changed perspective: Wilson is mocked for consulting the team. Only, in contrast to House, he treats several patients throughout the day and manages to catch up with the bureaucracy.
Loved the random sightings of the POTW.
December 1st, 2009 at 1:05 am
As far as I know, there is a small but significant chance of a liver donor dying during the operation. I thought Cuddy was saying that Wilson could endanger hundreds of his patients by putting his life in danger.
December 1st, 2009 at 1:16 am
Of course popcorn lung comes up now, it was on my list *last* season. Ah well
December 1st, 2009 at 1:25 am
@Alexandra, @Leon
Or rather that the operation is *dangerous!* If things had gone wrong, those hundreds of patients would be without a doctor. There are always risks with surgeries, however it’s always been my understanding that a transplant like this is especially high on the list.
December 1st, 2009 at 2:12 am
No objection to the HORRIBLY unethical pressuring of the sister of the potential organ donor?
December 1st, 2009 at 2:42 am
Classic Monty Python moment: Wilson: “I’m not here for an argument.” House: “No, that’s room 12A:
December 1st, 2009 at 3:00 am
@Dr Scott: What you’re referring to is a tautology. Sorry to sound a little Evil but actually PCP is redundant. It is now common knowledge that PJP (Pneumocystis jiroveci pneumonia) is the infection that occurs in humans. PCP only occurs in animals in particular rats.
December 1st, 2009 at 5:04 am
i think its funny that a character on greys anatomy just donated a piece of her liver, (because the actress IRL was pregnant) but pulled this off of e how
“Expect to stay in the hospital one week and to be fully recovered after four to six weeks. … Plan to return to work within four weeks if you have a desk job and eight weeks if you do more strenuous work.”
it seemed like Wilson was back to work in no time at all, im not sure if the head of oncology could lie in bed for 8 weeks not to mention possible complications. but then again Wilson is a “selfless guy”.
December 1st, 2009 at 5:08 am
link: http://www.ehow.com/how_10828_be-liver-donor.html
also alcohol doesnt leave your system for about a day or so if you drink heavily takes roughly 2 hours for a beer to leave your system and your bac to go down. marinating a liver in alcohol the night before donating doesnt seem like a good idea…also could run into problems with the anesthesia…
December 1st, 2009 at 5:12 am
@LabbRatt
Liver tissue regenerates but the ducts that drain it don’t, so it’s not a very functional liver. You wind up with something that is functionally similar to cirrhosis, if I’m not mistaken.
December 1st, 2009 at 6:24 am
I thought Wilson’s ethical dilemma was real but I am not a doctor. That is, a doctor is supposed to heal his patients with his knowledge and medical resources, but not by donating essential parts of his body. I think Wilson is not in good mental shape, especially if he is planning to buy the famous 2-bedroom loft in order to make his Odd Couple relationship with House (the reference to the Pigeon Sisters!) permanent. He needs another April, not more House.
Great bait and switch by Tucker at the end. I was quite distracted by his makeup. It was yellow face-red neck for most of the show, then his neck finally turned yellow at the end, I think.. Is this supposed to be liver failure? I am pretty sure the yellow face preceded the chemo.
On the other hand, I am really bothered by Scott’s red points, esp. the one about Chase’s operation and “No time for tests or scans!” For plot purposes they had to have Tucker plan for an operation so that he could choose Melissa over Ashley to manage his decisions. But they could surely have found some other problem, or problem that looks like one thing on the scan/test but is different? This is really troubling.
The time frame. The first chemo is supposed to restore Tucker’s arm movement in 24 hours, and then the double dose zaps the cancer and his liver in another 24. Then after another 24 or so we have the liver donation, then an undefined time, possibly a week, while Wilson recovers. I don’t think we see him back at work then, just loft shopping.
However, presumably at least a week has passed since Cuddy made her offer on the loft–maybe two, while Wilson recovered. One would think she had moved on from her loft idea and Wilson’s taking it at a higher price is an empty gesture. Bonnie could even get Cuddy to bid more by telling her about the rival bid; her salary is presumably far above Wilson’s, even if House pays rent.
December 1st, 2009 at 6:27 am
@Parousia1r: Mr Google is your friend: http://en.wikipedia.org/wiki/Blood-brain_barrier. No idea how real the separation is in practice for leukaemia; I’m guessing it must be very real as Scott didn’t shoot it down but then, IANAD…
Loved the glimpses of House & Co.’s chaos through the looking glass for a change, ‘tho I think it would have benefited from a couple more of those Rosencrantz & Guildenstern moments (as Bill Reed elegantly describes them above). Good stuff: and if anyone disagrees, I’ll meet you in Room 12A in a moment…
December 1st, 2009 at 7:18 am
I thought it acute MYELOID leukemia that was secondary to chemotherapy.
December 1st, 2009 at 7:43 am
One of the challenges faced by any medical show is to convey the passing of time without slowing down the story. “House” attempts this by using exterior shots of the hospital, often from varying angles.
Everyone knows that seriously ill people don’t get discharged within a day of their diagnosis (my wife and I call this “a Star Trek cure”), but the need to wrap up the episode in one hour makes it seem so. In reality, the patient diagnosed in the last act of episode 4 probably wouldn’t be discharged until episode 8 or 9. That would be realistic, but makes for lousy drama.
Suspension of disbelief is necessary.
December 1st, 2009 at 7:49 am
PCP Pneumonia… LPG gas… PIN Number… HIV Virus… all these are example of the RAS syndrome. Redundant Acronym Syndrome syndrome… Note that the word coming from the last letter of the acronym is explicitly stated.
Can anyone tell me whether what Wilson says about the Blood Brain Barrier keeping the cancer isolated from the rest of the body is actually entirely true? If it is, then how is the barrier replenished? There must be a drain… which makes it connected to the rest of the body.
December 1st, 2009 at 7:58 am
The best line of the night is when House tells Wilson that (paraphrase) “Arguments are in room 12A” Go to youtube and view Monty Python’s “Argument Clinic”
December 1st, 2009 at 7:59 am
The blood brain barrier works like a placenta does. Nutrients and other junk get passed through the membranes through osmosis, as far as I know. If a cancer can’t cross the membrane it would indead be trapped.
December 1st, 2009 at 8:11 am
I considered this episode as “no mystery just character” so no comment on the medicine. to Joe: A tad mistaken although one can argue…basically the liver regenerates completely in 4-8 weeks in a healthy donor and if all goes well full liver function is restored. There is no loss of liver function like you have in people with cirrhosis whatsoever. The ducts reform themselves (those that are damaged; however the procedure usually involves removing the right lobe which means that the major pathways for bile remain intact in the donor). The liver is not as good looking as it was :) but is no less functional. The operation on itself is considered quite risky (around 10-15% complication rate after the surgery and around 1% risk of death from the complications overall – those numbers are old and probably need updating as the procedures are modernized and improved but that is what we have so far – which is why one cannot simply say “Oh why not do it and save the person”) Any surgery of that magnitude is risky by itself as you can have a life threatening complication in surgery alone and that is on top of the late ones. All in all I agree with House and Cuddy that Wilson was mistaking to undertake that risk for a “friend”. Otherwise I enjoyed the episode and seeing House mature and Wilson doing the crazy stuff was a really surprising and well though plot twist that was made believable by Robert Sean Leonard’s great performance – that guy is a top notch artist – it is a shame that he himself describes his acting as “lazy” and “the less screen time I have the happier I am”. I say more screen time for him! He is the second column of this show – Hugh Laurie is the life and soul of the show but RSL is the body and mind – it is not the same when he is not around. Go Wilson! And let us hope that “Luddy” does fall apart soon enough and Huddy reemerges :).
December 1st, 2009 at 8:21 am
I loved the soap opera in this one. First, Wilson gets suckered into donating part of his liver so that his friend could reunite with his family, only to have his friend go back to his girlfriend. Then, Wilson pulls a House maneuver by outbidding Cuddy on the loft. I thought this was a great Wilson-centered episode.
December 1st, 2009 at 8:51 am
IANAD, so can somebody please explain me how can you possibly have leukemia in the brain? I understand that it wastnt a metastatic tumour, as otherwise blood count would show something. As it was implied that cancer didn’t show markers on blood test because of BBB, but how did it get there in the first place?
Anyway, Blood Brain Barrier separates cardiovascular system from CNS, how can it shield cancer IN the CVS from the rest of CVS?
December 1st, 2009 at 9:19 am
I love that Hilson is now canon. It’s the only thing that makes sense – we’ve seen House and Wilson on dates lots of times.
And if they adopt some kids, House’ll show that floozie he doesn’t need her. Huzzah!
December 1st, 2009 at 9:20 am
Remind me to never go hunting or shooting with Tucker. Guns don’t just go off if you’re being safe. For Tucker to accidentally discharge his firearm over Wilson’s head, he had to violate several fundamental rules of firearms safety.
1. He had the safety off when he was not in the process of shooting. The severity of his breach of safety is compounded by that fact that he had the safety off while someone was down range of him. The safety only comes off just before you shoot, and comes back on right after shooting.
2. He had his finger on the trigger (or inside the trigger guard- same thing as safety goes) when he was not in the process of shooting. Same note about someone being down range. Do not touch the trigger (finger out of the trigger guard) until you want the gun to go off.
People who are not shooters may think it is natural to hold a gun with your finger inside the trigger guard and resting on the trigger, but it is absolutely against one of the most basic and fundamental rules of firearms safety.
It’s not plausible that any muscle spasm would cause him to release the safety and place his finger inside the trigger guard. They only way the gun could accidentally discharge like that was if he already had the safety off and his finger inside the trigger guard.
December 1st, 2009 at 9:37 am
@Karl I think the premise of the hunting scene was that neither of these guys knew anything about hunting. I’ve gone turkey hunting in Jersey a bunch of times and while everyone has to take a multi-session hunter safety course (including firing a gun in front of an instructor) before getting a license, I’ve run into enough hunters who act like they’ve never handled a gun before to find the scene plausible.
@judy Glad someone else got the pigeon sisters odd couple reference.
December 1st, 2009 at 10:29 am
Unless the patient mentioned at some point that he had no family and no friends whatsoever, I can’t quite see why a living donor wasn’t a possibility. Maybe he didn’t have any who were willing to donate which,considering what an ass he was, I would believe.
I was a tad bothered by Wilson’s “She hurt my friend, she should suffer” bit (can’t remember the exact quote). What, she hurt House by – rejecting his stalkerish advances and dating someone else? Can’t quite see how that merits punishment. Applause, maybe.
December 1st, 2009 at 10:50 am
Lymphoblasts do cross the blood brain barrier. This complication makes them more difficult to treat, as many medications used in chemo do not cross the BBB. I suppose that it’s harder for them to reverse-permeate the BBB: they would have to be metabolized or actively transported into the bloodstream (in the same way the blood rids itself of everything else). I’m only speculating tho: I don’t know much about lymphoblasts.
December 1st, 2009 at 11:58 am
It’s really bad that the blood work didn’t show ALL. Flow cytometry should have shown it.
December 1st, 2009 at 12:18 pm
“I can handle it when things go wrong”
I can’t believe the writer actually made House say that.
December 1st, 2009 at 12:34 pm
I find it hard to believe that there’s anything Chase wouldn’t do.
December 1st, 2009 at 12:36 pm
Just when I thought the series was going somewhat downhill, a great episode likes this comes up. I really liked this one, of of my favourites out of this season. Wilson is great!
Having that said, there are some minor details that bugs me. Not so muh just this episode, but things that seem to occur in almost every epiosde, in various shapes and forms. Some examples:
1. When Wilson was making the phone call to the patient’s daughter – why did he make such a sensitive call out in the hallway instead of in his own office?
2. Why do they always tell the patient what they think is the diagnosis and start the treatment BEFORE they run any tests to check first? That seems very sloppy. Not to mention going so far as to do open surgery on a sick man to fix something they think might be there, but they haven’t run the tests yet.
3. Why do Wilson starts talking about the legal paperwork, signs and forms five seconds before reaching the surgery? Shouldn’t all of that have been taken care of before they start running to surgery?
It’s details like these that makes House lose some credibility, although I still think it’s one of the best tv-series I’ve seen in years.
Some questions:
1. Could Wilson be a donor if he got drunk the night before?
2. Some people here was surprised how quickly Wilson recovered, but I was actually surprised the other way around. How long do you take to recover from something like that? Wilson was healthy, and “only” had a small part of his liver removed and then being sowed back up. Would he need a wheelchair and weeks of bedrest for something like that? Would he need more than just having his operation wound heal?
December 1st, 2009 at 1:33 pm
If liver damage was a near-certainty, couldn’t the patient have self-donated, cutting out a lobe of his own liver before starting the chemo and putting it in after his remaining liver was destroyed? Or can a liver lobe not be preserved long enough out of the body for that to work…
December 1st, 2009 at 1:38 pm
Wouldn’t the patient have been tested for HIV before the surgery?
Minor nitpick: When leukemia comes back, it’s not a recurrence. It’s a relapse.
December 1st, 2009 at 1:40 pm
How tight is the logic of “Wilson and Tucker have compatible blood, therefore they have compatible livers?”
It just kind of jumped out at me. It seems to me that blood’s antigens are pretty simple compared to the body as a whole.
December 1st, 2009 at 2:43 pm
I’m still on a high from catching that Monty Python reference. Classic British humor!
December 1st, 2009 at 2:45 pm
Official Comment
JME,
I wondered about that too, did some research, and for liver transplants — like kidney transplants — matching blood types is usually enough.
December 1st, 2009 at 3:23 pm
@Hibbleton,
I didn’t mean to imply the scene wasn’t plausible, just that Tucker is a really unsafe shooter, and that what is implausible is that there is any way he wasn’t being horribly unsafe.
It is a sadly plausible scene in that such things happen all the time, and occasionally people get shot even by vice presidents.
There is no excuse for having your finger on the trigger with the safety off while your buddy is ahead of you.
I tend to generally lean to the liberal side these days, but I am annoyed by the unconcerned portrayal of lax gun safety for the artistic effect of having the gun just miss hitting Wilson. It’s typical of TV’s portrayal of guns as inherently dangerous things that go off almost at random. To paraphrase, guns aren’t dangerous, people are.
December 1st, 2009 at 4:02 pm
Dr. Scott wrote: I wondered about that too, did some research, and for liver transplants — like kidney transplants — matching blood types is usually enough.
Well, it was enough for the couple in the second season episode “Sleeping Dogs Lie.”
Glad to see I’m not the only one who thoroughly enjoyed the turned-inside-out POV of this episode – Wilson in the foreground, House & Co. shunted to supporting roles.
Hugh Laurie has been quoted as saying when he first read the (untitled) script for the pilot episode, he assumed that Wilson would be the main character, not the more abrasive House. I guess what we got was an example of that alternate approach. (Maybe the episode should have been titled, “Wilson, M.D.”)
My nitpick is: I found it hard to care all that much about that supposedly close friend of Wilson’s, since it’s the first time we got to “meet” him. But I thought it was a very nice twist to have the guy turn out to be a jerk who dumps his ex-wife and daughter a second time in favor of his trophy girlfriend after he escapes death.
No preview for next week. No new episodes for a while?
December 1st, 2009 at 4:03 pm
totally unrelated to this episode, but did you guys know that Olivia Wilde (13) real name is Olivia Cockburn?
http://www.imdb.com/name/nm1312575/bio
December 1st, 2009 at 4:25 pm
I enjoyed this one. It’s sad when I think that even House could be a better administrator than Cuddy! She was getting on my nerves last night. I mean, House was being how he always is–an irritating jerk. I’d like to expect more from Cuddy. So, I loved it when Wilson outbid her for the loft!
Line of the night: “I’m not here for an argument.” “No, that’s room 12A.” Loved it! Love Python!
I enjoyed it.
Kat
December 1st, 2009 at 4:34 pm
Well, the blood-brain barrier does not separate the blood in your brain from the blood in the rest of your body. There’s only one pump (the heart) and al the vessels are connected to that.
It prevents the substances in your blood vessels, from crossing over to brain tissue. Which is why Parkinson’s patients recieve L-Dopa instead of Dopamine, since Dopamine cannot cross the blood brain barrier.
December 1st, 2009 at 5:37 pm
” that Olivia Wilde (13) real name is Olivia Cockburn? ”
COME ON! Now seriously, that’s even better than “Bubbles” :D:D
December 1st, 2009 at 6:29 pm
That guy was a jerk. I thought the ex-wife was hotter than the girlfriend. In fact, I could see Wilson hitting on that now that Liver McLazarus is out of the picture.
Also, I don’t know if it’s my HDTV but Cuddy doesn’t seem to be aging very well. Lately, her face has the look of someone who’s under the stress of running a major hospital.
December 1st, 2009 at 6:55 pm
IANAD, but if Tucker’s arm became numb and paralyzed how exactly did he pull the trigger. I am under the impression that paralyzed means “can not move” and there were scenes later showing that he couldn’t move his fingers which I assume was the case from the onset. I loved the episode though and watching House’s team work in the background was a great touch.
December 1st, 2009 at 8:18 pm
Isn’t that a uterus they show in the ultrasound of that fat man?
December 1st, 2009 at 9:31 pm
Was I the only one who thought that it’s a lot easier to donate/receive blood than an organ? Isn’t there a lot more extensive testing involved? No mention of HLA typing or anything…
December 1st, 2009 at 9:44 pm
Thanks for the reply, Scott!
December 1st, 2009 at 11:04 pm
This episode really hit home for me because my best friend had AML, chemo put it in remission, then got ALL, just like this patient. He’s going in for a marrow transplant in 2 weeks, and I know he watches House, so I was really hoping the patient survived, or he might get bummed and extra nervous.
December 2nd, 2009 at 1:26 am
“IANAD, but if Tucker’s arm became numb and paralyzed how exactly did he pull the trigger. ”
It looked like he dropped the gun to me.
December 2nd, 2009 at 1:59 am
Wilson’s Last Line
” A Problem Delayed… Is a Problem Denied”
Nice play on “A Justice Delayed… Is a Justice Denied”
But I think
“A Problem Delayed…. Creates several Problems”
Any thoughts?
December 2nd, 2009 at 3:40 am
Just wanted to add my thanks for posting these reviews every week! I’m a physicists, and regularly critique sci-fi (or crime :) ) for its physics, so it’s great to read such high quality reviews of the medicine.
Keep up the awesome work!
December 2nd, 2009 at 6:33 am
Pretty good episode, enjoyed the focus being on Wilson. I did have a question tho – there was a joke I didn’t get. In the beginning, after House has woken up Wilson (by playing Faith of all things, very funny moment) – House says Tucker is not his friend, that he calls Wilson ‘Jim’ and not ‘James’. Wilson says his retort, ending it with ‘Lim’, referring to House. Why call him Lim? It’s bugging me that I can’t figure it out.
December 2nd, 2009 at 7:58 am
Official Comment
It was a pretty stupid joke, really:
James = Jim, thus
lame = Lim.
December 2nd, 2009 at 9:25 am
Ah man, that’s AWFUL. Boo. I didn’t get the Monty Python reference, kudos to the watchers who picked up on that. Well done. Nee.
December 2nd, 2009 at 11:09 am
Ummm… the BBB does *not* separate “the blood from the brain from the blood from the rest of the body”. It separates the blood from the brain, period. If Tucker has a leukemia, it’s in his blood and would be everywhere, not just in his brain. If it somehow formed a lymphoma that had crossed the BBB and was magically eliminated everywhere else, then this makes sense.
On the other hand, the reason they put a shunt in his skull for the chemo was because they were using a drug that does NOT cross the BBB, so the idea of it killing his liver is impossible (which is on the other side of the BBB from the brain directed chemo).
So there were multiple medical mistakes all based on the misdefinition of the BBB.
December 2nd, 2009 at 2:46 pm
That’s a really Lim joke.
December 2nd, 2009 at 3:45 pm
Dr. Scott:
t was a pretty stupid joke, really:
James = Jim, thus
lame = Lim.
Or perhaps “Limb.” (Not unlike the nurse who once sarcastically referred to House as “the Artist Formerly Known as Gimp.”)
December 2nd, 2009 at 3:47 pm
@HJ: Cuddy was refering to if Wilson died, his patients would all suffer by loosing their doctor.
Scott: I’m an immune deficient patient (CVID/hypogammaglobula animia, depending on how you want to call it…they’re the same thing), and can confirm 100% SCID can NOT be acquired. It is genetic, and diagnosed at (or very close to) birth. CVID, on the other hand, CAN be acquired (as mine was…I was diagnosed at 16 years old…my dad was diagnosed in his 20s, and my sister was DXed at 14).
December 2nd, 2009 at 4:02 pm
Thinking about what Finster and others have said:
Tucker originally had leukemia, a disease of the blood which was treated with chemotherapy, bone marrow donations, and blood transfusions.
The chemotherapy caused him to develop ALL; when I click on Scott’s link to ALL, it is described as a disease of the blood.
“ALL starts with a change to a single cell in the bone marrow. Scientists are studying the exact genetic changes that cause a normal cell to become an ALL cell.”
However, five years after the chemo and presumably the genetic change to the cell which began ALL, his blood tests show no signs of cancer. Wilson checked them himself. So the ALL has left no trace in his bloodstream.
However again, he has from the ALL a lymphoblast in the brain which entered by crossing the BBB and which is depressing his immune system, as per Chase’s OR discovery. It also has paralyzing effects.
So he has developed a cancer of the blood over the past 5 years which is now residing in his brain and nowhere else at all. It came from the blood but is no longer in the blood.
Moreover, the lymphoblast, once established in the brain, can’t spread outside the brain again.
Moreover, this lymphoblast is resistant to chemo. Since the ALL developed as a result of chemo 5 years earlier, this last surviving outpost of the ALL cannot be defeated by the usual dose of chemo. This doesn’t make sense to me since what the chemo did was change the DNA of a cell, not kill off all but a resistant bit of the original leukemia. Did I mishear/misunderstand Wilson’s comments?
Moreover, because of the BBB, this lymphoblast can not be treated by general chemo. The chemo cannot enter the brain from the bloodstream. It can be treated by chemo delivered via shunt to the brain
However, the chemo crosses the BBB in the other direction, and leaves the brain via the bloodstream and trashes his liver.
Medicine is so full of mystery….
December 3rd, 2009 at 12:10 am
I loved the episode. I mean it was about Wilson my favorite House character. And I never ever tire of the fabulous chemistry between HL and RSL’s characters. This episode was all meat and no fat.
December 3rd, 2009 at 6:13 am
Judy pretty much has it down, except that the marrow where the ALL forms is not in the brain… it would take the *single* mutated marrow lymphoblast (unlikely to be only one cell, btwf) crossing the BBB *before it even divided* ( which would leave behind an equally cancerous ALL cell in the blood). Extravasation is a process of generally late term cancers (and I’m not even certain ALL ever extravasates) so I would go so far as to suggest that this is impossible.
With regards to the chemoresistance, it’s really unlikely that they would treat the ALL with the same drug they treated the previous leukemia, especially since they hypothesize that the original chemo caused the tumor. They’d pick something different to reduce the chances of resistance… in fact they’d pick a cocktail that would pretty much eliminate that possibility.
And to get really nitpicky, the whole concept of “doubling the dose” of the chemo… a chemo that the cancer is resistant to, mind you… is pretty laughable. Wow, really *twice* as much? Wilson, you crazy rebel!
December 3rd, 2009 at 7:47 am
Unusual episode for another reason: a Nurse had a speaking part! She was directing Wilson all over the oncology ward.
December 3rd, 2009 at 7:57 am
Purely on the drama side I loved this. I’m not sure you can complain too much about not seeing much of the team – I think the point was to get a perspective on what dealing with House and his minions is like for those working around him. Just pure chaos.
Also nice to see Wilson get some meaningful and justified character development. I doubt we’ll get another House-lite episode any time soon, but I for one would love to see the Wilson equivalent of “Three Stories”.
December 3rd, 2009 at 8:07 am
I’m mad at myself. I missed the classic MP “Argument clinic” joke. How’s that possible? Last time I cought the “duck” immidiately!
December 3rd, 2009 at 8:27 am
Just wondering, can one transplant part of a liver into another person when just the blood type is the same? Aren’t there multiple factors that have to be the same in order to succesfully transplant? Or is the liver a little less picky on it’s new host? (I probably get the wording all wrong, but I hope it’s clear what I mean. ;) )
December 3rd, 2009 at 10:23 am
Regardless of anything else – what kind of an upper-floor loft for someone with an aching leg like House’s??? Thay don’t seem to have an elevator there. It’s Wilson’s revenge to House rather than to Cuddy.
December 3rd, 2009 at 11:15 am
Totally crazy episode, I´d like to say no comment, but I have some (as usual:-))
1. Perfectly normal blood count in a patient with acute leukemia??? (no matter what kind) WOW!!
2. Hoped all the time House would find another reason for Tucker´s hepatic failure and stop the surgery.
3. Wilson could undergo it just like that? Last night he was drinking, probably had breakfast in the morning, running around the hospital 2 hours previously?? Believe this can´t happen in any hospital!
4. Tucker recovered incredibly fast. No clean room, no massive immunosuppression, eating normal food with Wilson while Wilson was still hospitalised (and Wilson also recovered really fast)
December 3rd, 2009 at 11:59 am
Your reviews are always interesting to read. I didn’t notice the chemo-success-time thing until you pointed it out, but that is a pretty big screw up.
I’m not sure the medicine is supposed to be taken as seriously as you take it, but hey, no harm in yelling at people!
Also, agree with a few people who said it… The scenes of House’s hamsters running around made me lol too, especially when they just come rolling around a corner, mid-conversation, with Foreman straddling the patient and giving him CPR.
December 3rd, 2009 at 2:22 pm
i found the episode entertaining on the whole but also was left with the aprehesive feeling that the trend of focusing on characters other than house will continue in the future. with wilson it’s not so bad, we still get constant doses of house from his perspective and it plays well. what’s going to happen if they try to do this with 13 or, god forbid, taub?
December 3rd, 2009 at 3:36 pm
Thirteen coming back with multiple lab results in about 90 seconds from running out of the room is what threw this episode off for me. I understand they want to still have House cases on House even when the focus isn’t House, but come on now.
December 3rd, 2009 at 4:12 pm
Nice episode. It’s clear that Cuddy doesn’t have a shot….House has shown who his true love is…….Wilson! Hope Stephan Fry isn’t jealous!! And why is everyone so hung up on how much time elapses between activities on House? It’s TV, not real life…don’t you guys have any imagination??
December 3rd, 2009 at 9:58 pm
“Not my area of expertise or interest, but would a patient with a history of two cancers (though admittedly, no liver cancer or liver metastases) be placed that high on the transplant list?”
I don’t think a hospital can deny a living donor transplant. Were you referring to the Japanese lady? I’m surprised House and Wilson were even allowed to talk to the woman.
December 3rd, 2009 at 9:59 pm
P.S. I think Wilson and House just go gay already. I think they’ve always liked each other as friends. Let’s just say they transcend friendship/sexuality and needed another warm, affectionate body.
December 4th, 2009 at 12:35 am
Official Comment
I was referring to the mention made by Wilson that Tucker was placed on the “liver transplant waiting list.”
Hospitals have specially trained teams that talk to the family in situations like this. The ones I have seen in action are firm, but respectful and not pushy. Wilson and House were way over the line here — and probably in violation of HIPAA (the federal law safeguarding patient’s privacy) as well.
December 4th, 2009 at 12:52 am
Does it really make sense for the POTW to develop symptoms sudddenly 5 years after beating cancer the first time? It seems that follow-up checks should have caught this sooner if he was going to get cancer again. Either that or he shouldn’t have gotten cancer at all. This is from someone with no medical experience, so I would appreciate a response from someone who knows what they’re talking about. Thanks!
December 4th, 2009 at 4:16 am
I love the ending
it was awesome when wilson bought the house
since im not a doctor i dont normally notice the medical errors
but the chemotherapy one even i noticed
but still…
house is awesome
December 4th, 2009 at 6:30 am
“I doubt we’ll get another House-lite episode any time soon…”
Actually I believe I read that during this season there will be a Cuddy episode. After seeing this Wilson episode, I can’t wait, I hope it’s just as good!
December 4th, 2009 at 12:22 pm
Man, I didn’t get the “Lim” joke either. If that’s the joke, then boo! It was incredibly, uh, lim.
Oh, yeah, add me to the list of those who loved those scenes with the Cottages racing down the halls with their own PotW. “It wasn’t tennis!” Hee! If we were following their story, something dramatic would have happened. As it was, it was just hilarious. More of that, please?
Kat
December 4th, 2009 at 12:33 pm
http://ausiellofiles.ew.com/2009/11/24/house-exclusive-lisa-edelstein/
Mitch is correct. There will be a “Cuddy” episode in Feb. This is an interview with Lisa E. She’s quite the bawdy one, and she doesn’t sound too thrilled about Lucas and Lisa either!
December 4th, 2009 at 4:10 pm
Scott, could you or one of your medically ept readers confirm whether it’s true that chemo can cause the formation of new cancers? (Or, perhaps, that the damage chemo does to the immune systems makes it less able to fight off any new cancers than form?) Thanks.
December 4th, 2009 at 8:41 pm
This is to Anne; You obviously have never had abdominal surgery. I have twice and is sucks. I sincerely doubt that he could even walk upright for the first few days.
December 4th, 2009 at 11:26 pm
I came here to say the same thing Karl. There is no reason for that gun to go off. Did Tucker get brain damaged from his cancer or what?
December 5th, 2009 at 3:10 pm
About the hunting. I was expecting something to go wrong so the gun firing accidently didn’t surprise me.
I was bothered by the way they hunted though. Just shooting at birds and missing?? Rule number one of hunting is: Don’t shoot if you are not 100% sure of a kill. While it fits the premise of them having no idea what they are doing, it is essentially animal cruelty. The bullet or pellets can be stuck in the surviving birds. so unless they are absolutely sure to miss completely, why would Wilson accept something like that? I find nothing wrong with skilled hunting, but careless shooting is bad.
December 6th, 2009 at 4:53 am
I was just perusing the Straight Dope (http://www.straightdope.com/columns/read/2911/do-truth-serums-work), and came across this interesting piece of trivia:
“The pioneer of truth serum research, a small-town Texas obstetrician named Robert House, claimed his patients always answered truthfully during these times, and from this concluded the drug rendered them unable to lie.”
Coincidence, or did the show’s writers know about this?
December 7th, 2009 at 10:41 am
Lisa-
Yes, chemo can cause cancer. Many cancers are DNA damaging agents, meant to cause so much damage in a rapidly dividing cell that it can’t survive. On the other hand, a non dividing cell (and some dividing cells) can repair the damage, but if they make a mistake, that’s a mutation, possibly leading to cancer.
December 7th, 2009 at 10:41 am
and I should say that if the DNA damage isn’t overwhelming, most cells will be able to repair the damage, including the cancer cells, also causing more secondary mutations
December 8th, 2009 at 11:58 am
When is the next episode due? Can’t find it on the IMDb or Wikipedia House pages.
December 8th, 2009 at 9:35 pm
Why would Wilson have needed to transfuse his own blood into the patient? Did they completely run out of blood, or what?
I don’t know anything about cancer treatments, but the “CHEMOTHERAPY” label on the IV bag reminded me of “BEER” brand beer.
December 9th, 2009 at 11:10 am
Hank, it will be late January, after the traditional US christmas scheduling break that happens every year, it seems – I can’t find a specific date either though.
No doubt it will be trailled heavily a couple of weeks before it comes back on.
Steven R
PS: Long time reader, first time poster – I like this wee section of the site.
December 9th, 2009 at 11:18 am
Oh, the unofficial house wiki has been updated – it’s showing as Jan 11th, which seems realistic, although I’m unsure of their source for that.
http://house.wikia.com/wiki/Season_6
I’m not a massive fan of fan sourced Wikis, but they are worth keeping tabs on as they do the legwork on chasing the schedules so you don’t have to!
Also, RE the ‘it wasn’t tennis’ comment – I’m not sure if I missed a reference to something there, but I did got a laugh out of it as it shows how preposterous some of the House cases/scenarios are when they are taken out of context, and how they must appear to the other in-series characters.
Ho ho, etc. :-)
Steven R
[again]
December 9th, 2009 at 11:37 pm
I really liked the scenes of Wilson with his other patients as well. I’m a first-year medical student, and Wilson was demonstrating how you’re supposed to interact with your patients.
Wilson realizing there was something wrong with one of his patients based on the patient not bragging about his grandchildren is a classic example of why being a doctor isn’t simply memorizing diseases. It’s the personal bond a physician forms with his patients that make him a better physician. It’s not necessarily a friendship so much as a knowledge of who the patient is as a person, not just a collection of illnesses.
I especially liked the contrast of Wilson realizing his patient was depressed based on his relationship with that patient, as opposed to House, who discovers things about patients based on their lies.
P.S. There’s nothing inherently wrong with Wilson donating a piece of his liver to a patient.
However, you worry about the precedent – right now, patients don’t view their doctors as potential organ donors, and you have to wonder why if this patient was worth a donation, all of the other patients with poor liver or kidney function aren’t worth a donation.
Put another way, what if Wilson were married, and later that week his WIFE needed a liver transplant. Wilson wouldn’t be able to donate to his wife because he had just donated to a patient. Ultimately, when it comes to live-organ donations, it’s best to keep your pool of prospective donation recipients to your friends and family – that list should be big enough without adding hundreds of patients.
December 10th, 2009 at 11:09 am
Long time reader, first time post. Kudos on a fantastic thing you’ve got going here.
A comment about one of your nitpicks:
“Not my area of expertise or interest, but would a patient with a history of two cancers (though admittedly, no liver cancer or liver metastases) be placed that high on the transplant list?”
I figure Wilson’s position on the transplant committee might have had something to do with it.
December 11th, 2009 at 8:10 am
If the patient had a new form of leukemia the second time, how would his previous treatment with chemotherapy have made him resistant?? Wouldn’t the new cancer be a “virgin” to any chemotherapy?
I also found it laughable that Wilson decides to just double the chemo even though it might kill the patient. Is there no alternative, like maybe increase the chemo by 30% and not kill the patient? Or clinical trials? Why choose a course of action so drastic when he has six months to live without first trying anything else? Take a day or two and consider the options.
December 11th, 2009 at 8:20 am
Official Comment
Different chemo regimens so resistance shouldn’t be much of an issue.
December 12th, 2009 at 6:54 am
When are we getting House challenge scores for this episode?
December 13th, 2009 at 7:42 am
newbie here..
nice review!
just wondering if you watch royal pains?
December 14th, 2009 at 7:04 pm
@ singulair: I think it might have been a joke. After all, someone on House’s team made the comment: You’re not pregnant!
@ Allen: I agree about the animal cruelty. On the other hand, maybe they were missing deliberately. After all, Tucker hits the chemo bag straight on. So maybe the hunting was simply and excuse. . .
It’s interesting that Wilson didn’t simply use the excuse (even if not true) that giving blood is not like donating an organ and therefore he couldn’t donate a piece of his liver to Tucker because they need a better match.
December 14th, 2009 at 10:23 pm
Last week I commented on the medicine, this week we are going to hit on the costumes. They were turkey hunting in Blaze orange as if they were deer hunting. Turkeys have great vision and you would never be out turkey hunting in orange. Stick with Camouflage for Turkeys and wear your orange for deer or upland game. That is a MAJOR complaint. Ha Ha
December 15th, 2009 at 7:20 am
According to Wikipedia, the next new episode of House will air January 25th.
BTW: I thought the Family Guy parody of House was uninspired. Even Hugh Laurie seemed bored.
December 17th, 2009 at 1:57 pm
I finally got to watch this episode on Hulu. Very good episode overall, I was glad they stopped focusing on the Cottages (especially Chase, he is irritating beyond belief now, and I used to like him better than Foreman and Cameron combined). It was hilarious to see bits of them rushing around with their patient, but honestly it made them look pretty incompetent. You wonder why Cuddy puts up with a department of diagnostic medicine that pretty much just tries out different treatments until they get one that works…kind of like tossing darts at a dart board. Oh well.
I finally liked Wilson in this episode. I mean, really liked him. Saw him as a multi-faceted character. I understood why he was giving part of his ilver to this guy, and I understood why he bought the condo out from under Cuddy. (Sweet revenge, BTW.)
The POTW was a jerk. House was right. Wilson should remember, takes one to know one.
December 18th, 2009 at 12:14 am
A nice episode. I particularly like the part where the patient says, “You’re my family. I’m sorry I forgot that.” Good to see the element of forgiveness in his ex wife so so characteristic and defining of true love. Marriage comes with its fair share of challenges and pain, not only joy. True love is what enables one to forgive in the most difficult of circumstances. If you cannot forgive the ones you love how about those you don’t? Why expect God to forgive you? Merry Christmas. X X X X X
December 18th, 2009 at 6:58 pm
An interesting factoid about Michael Weston. He was born Michael Rubinstein. He is the son of actor John Rubinstein and grandson of the even more famous Artur Rubinstein. He changed his name because there was already an actor named Michael Rubinstein.
December 19th, 2009 at 4:31 pm
Jennifer Francis–true, but the comment loses its wonderfulness when the character, no longer at the brink of death, goes back to his young girlfriend. He tells Wilson, “The person you want around when you’re dying isn’t the person you want when you’re living.”
JERK. So, he only had these fuzzy warm feelings for his ex wife and daughter when he was dying; once it was clear he was going to have a few good more years, he wanted his young, frisky girlfriend. He even told Wilson he didn’t know why he divorced his wife; he probably just had a midlife crisis and started chasing skirts.
Feh.