House — Episode 11 (Season 6): “Remorse”
This episode was better than last week’s pathos-fest, but it was still lacking in the medicine department.
Valerie is a 27 year-old ruthless business woman who experiences the sudden onset of severe bilateral ear pain. She is admitted to House’s team, even though he finds her case uninteresting, because she is “hot” and yet has an ugly husband. Chase suggests that due to a recent dietary change, Valerie may have a vitamin deficiency which is causing her symptoms. House thinks that her change in diet may have boosted her already elevated cholesterol, leading to blocked arteries, heart damage, and an arrhythmia (abnormal heart rhythm) which she experiences as ear pain. Testing shows no evidence of blocked arteries, but it does confirm an arrhythmia. The team plans to start her on unspecified “cardiac medications.”
An ex-coworker of Valerie’s appears in her room, drunk, and accuses her of having an affair with him and later poisoning him to cause him to lose his job. She denies these accusations and security escorts the man out. The male members of the team jump to her defense, but Thirteen thinks that Valerie is up to something. When the team discussed the situation with House, he suggests that she may have been poisoned with thyroid medication, which would rev-up her heart and cause the arrhythmia. House and Foreman want her started on beta-blockers (to block the effects of the thyroid medication), but Thirteen sneaks her off to the MRI suite. Her testing reveals that Valerie has no emotions and is by definition a psychopath. Confronted later, Valerie admits to everything Thirteen suspects. All that her co-worker said is true — she slept with him and then poisoned him. She also admits she only married her husband for his trust fund.
Taking both the heart and brain symptoms into account, the new differential diagnosis consists tertiary syphilis (late stage syphilis where mental symptoms are common), Wilson’s disease (a disease of copper metabolism), and Hashimoto’s thyroiditis (autoimmune inflammation of the thyroid gland). The first seems the most likely, so they start Valerie on penicillin. There is a heated discussion between Valerie and Thirteen, and when Thirteen reaches to turn over Valerie’s arm, she breaks it. Further testing reveals elevated BUN (blood urea nitrogen) and creatinine levels which suggest kidney failure, which would explain the brittle and easily-broken bones.
House now feels that the Valerie’s psychopathy is something she was born with, and not a symptom of her condition. Focusing on the heart and kidney symptoms, Foreman suggests that she has paraneoplastic syndrome, likely from a lymphoma. House orders full body radiation therapy. Thirteen wants to run some tests first, but Foreman shoots her down.
There are more confrontations between Valerie and Thirteen, with Thirteen’s “innocent” questions lead Valerie’s husband to realize she’s was having an affair, and Valerie reporting her to the medical board. Eventually, Thirteen is removed from direct patient contact with Valerie, but Cuddy explains is it because Thirteen does not deserve to have Valerie inflicted upon her.
Valerie starts bleeding heavily from her mouth due to esophageal varices (enlarged, bleeding esophageal veins related to liver disease). She is taken to the operating room for a TIPS procedure (transjugular intrahepatic portosystemic shunt) — placement of a stent which bypasses the liver, relieving the elevated blood pressure in the liver which lead to the varices. This new symptom causes the team to reevaluate their diagnosis, and this time they consider and discard amyloidosis and alpha-1 antitrypsin deficiency before settling on primary hepatic fibrosis (fibrosis of the liver not due to another disease). She is started on steroids and a search begins for a liver donor for transplant. Thirteen talks to Valerie’s sister and learns that she wasn’t always a psychopath — that started during her teen years. This suggests that the psychopathy is a symptom of her condition, and not something that can be overlooked. Thirteen and House realize that she must have Wilson’s disease, which is confirmed by looking at her fingernails which are blue. She is started on chelation therapy to remove the excess copper. By the end of the episode it seems to be working
Those of you who read comic books will know what I mean when I say that the medicine of this episode was the television equivalent of a Mark Millar comic: a bunch of dramatic set pieces connected by sketchy plotting and poor logic. Sudden ear pain (hand waving) It’s her heart! (hand waving) Oh no, kidney failure! (hand waving) It’s cancer! (hand waving) Now it’s liver failure (hand waving) Wilson’s disease and presto! Iit’s cured, and now the world is safe for democracy.
As usual, major complaints are in red, minor complaints are in blue, and nit-picking ones in green:
You do not treat a patient for cancer — be it radiation therapy or chemotherapy — without knowing what sort of cancer it is first. Different cancers have different treatments. Even if it is a B-Cell Lymphoma, there are over a dozen different cancers of that type, and only some are treated with radiation therapy. This seems to be a recurrent mistake this year.
Her kidney failure is so bad that her bones break that easily and she’s stopped producing urine and nobody noticed?
There’s no way it took that long before they checked her BUN/Creatinine. They would have been checked before running any cardiac artery testing to make sure her kidney could handle the dye.
Similar arguments for no one noticing her chronic liver disease bad enough to cause bleeding varices.
Wilson’s disease should have shown up on the MRI. You know, the one they used to dismiss the diagnosis of amyloidosis.
She sure improved from her fifteen years of Wilson’s disease improbably fast, especially her psychiatric symptoms.
A paraphrase:
Thirteen: If she has Wilson’s, why doesn’t she have Kayser-Fleischer rings?
House: Notice how I avoid answering — or even acknowledging — your question by distracting you with another symptom. Aren’t I (and by extension, the writers) clever?
(House could have just said that KF rings only occur in 2/3 of the patients with Wilson’s. Blue nails [azure lunula] are certainly seen in Wilson’s, but less commonly than KF rings).
Technically, Broca’s area is only on one side of the brain, it is not bilateral.
I suspect the fingernail polish under the pulse-ox (oxygen monitor) had already been wiped off – the monitors work a lot better that way.
The team never “ruled out” Wilson’s, they just focused on the tertiary syphilis instead.
The medical mystery was modestly interesting, but quickly forgotten and ear-pain was never again mentioned after the seven minute mark. It deserves a B. The final solution was a bit of a stretch, but actually fit fairly well (especially if you ignore the whole “chronic” aspect of the disease). It also earns a B. Overall, the medicine was spotty, with the team missing things an intern would have noticed. I give it a B-. The soap opera was light, but generally well done. I thought Olivia Wilde held up her end better than expected, but I’m surprised House never ran any sort of background check on his classmate. I give the soap opera a B.
The review of the previous episode of House
A list of all prior House reviews
January 26th, 2010 at 12:25 am
From what i remember this is the second time that Wilson’s disease is the diagnosis. Or has there been other times? It’s definitely showed up in the differential before.
Thanks for the post!
January 26th, 2010 at 12:25 am
As far as not running a background check on the old school buddy, I took this as part of House’s even-now-unresolved self-hate. If he found the guy’s true history he wouldn’t be able to beat himself up over it. The mind loves what it already thinks is true, and House sticks with what makes him feel the worst since the only thing at stake is his own mental state (no problem to solve).
What distracted me the most about this episode was the total lack of empathy that Wilson showed House. Although it might have played into the theme of the episode, to me it was uncharacteristic for him to repeatedly belittle House over his choice of who to apologize to. He’s acting exasperated with House even though House seems to be showing signs of positive change. (To be fair, based on the preview of next week’s episode my opinion may change on this…)
I loved this episode and the POTW, this was worth waiting 2 weeks for. Fortunately for me I don’t have even a shadow of medical training to interfere with my enjoyment. :)
January 26th, 2010 at 12:25 am
An excellent review, as always, but I am curious about one thing. House mentioned offhandedly that “feeling uneasy” around a patient was medically acceptable in determining if a patient is psychopathic. How much is this true?
January 26th, 2010 at 12:48 am
Psychopathy or Antisocial Personality is a personality disorder. It doesn’t “appear” or go away. It’s developed slowly over time and permanent.
January 26th, 2010 at 1:13 am
No, he said that it’s a medically documented reaction to psychopaths. Whether or not that’s true I have no idea :)
January 26th, 2010 at 2:35 am
@ J D MD
Wilson’s Disease was the diagnosis in the sixth episode of the first season, The Socratic Method. That was the one with the supposedly schizophrenic patient.
January 26th, 2010 at 2:42 am
Not that good of an episode, I’d say.
January 26th, 2010 at 2:48 am
“Psychopath” is about as scientific as “cooties”.
January 26th, 2010 at 2:54 am
I suffered from undiagnosed Hashimoto’s thyroiditis for about three years, and my main symptoms were dry skin, depression, insomnia and paranoia. I didn’t seduce anyone (bummer!) or try and poison them, though I would probably have tried to kill myself if I hadn’t had a blood test and got treatment. Nor did I suffer from an absence of emotions — quite the reverse. In fact I feel so calm now compared to my former life that I wonder if I might have had thyroiditis for decades in a mild form.
January 26th, 2010 at 6:00 am
It seemed to me that she was more of a sociopath than a psychopath, although the terms seem to be used somewhat interchangeably.
January 26th, 2010 at 6:30 am
Thirteen: If she has Wilson’s, why doesn’t she have Kayser-Fleischer rings?
House: Meh. I guess it wouldn’t hurt to run a ceruloplasmin on her. Oh wow, that’s really low. She’s probably got Wilson’s disease. Wow, we figured that out a lot faster than normal. Guess we have some extra time on our hands…
*****BIG DANCE NUMBER*****
January 26th, 2010 at 6:53 am
Sociopathy and psychopathy are older terms for Antisocial Personality Disorder. They are used interchangeably because they mean the same thing.
I didn’t watch this episode because this show handles psychiatry very very poorly. Why they didn’t bring in a psychiatrist /psychologist to consult I have no idea. It would have been more realistic and more interesting. They should probably have a psychiatrist on the team. It would be fun to see House interact with a mental health professional on a daily basis.
January 26th, 2010 at 6:57 am
Isn’t there a blood test for Wilson’s disease? I seem to remember getting it when my doctor was trying to find a cause for my fatty liver, aside from the obvious, fatty me.
January 26th, 2010 at 6:59 am
And once again I’m terribly disappointed that, when she was finally diagnosed with Wilson’s disease, Wilson didn’t pop in to say “And I’ve got hers!”
January 26th, 2010 at 6:59 am
“Thirteen sneaks her off to the MRI suite. Her testing reveals that Valerie has no emotions and is by definition a psychopath.”
I didn’t notice this part before. Ugh!
a) You don’t diagnose any mental illnesses with MRI. The technology isn’t advanced enough for that. The brains of the mentally ill do look different from a normal person. However, you can’t point to a scan and say “That’s a bipolar brain, etc.”
b) Psychopaths most definitely have emotions. It’s the lack of empathy that is the defining characteristic of the disorder.
January 26th, 2010 at 7:29 am
Psychiatrist here… most of us do not necessarily equate Antisocial Personality Disorder with sociopathy or psychopathy. The terms are used interchangeably in common parlance, but most of us feel psychopaths should be more closely associated with malignant Narcissistic Personality Disorder. Antisocials lack empathy and feel little remorse for wronging others, but they generally have legitimate emotional attachments to some exceptional people and can experience feelings. In contrast, a true psychopath is incapable of forming such attachments and does not feel normal human emotions (which has been substantiated by testing galvanic skin response, PET scans, etc while subjecting someone to emotional stressors). They are able to imagine how someone else feels, but they just don’t care. There’s a great book on the subject and how blurred the diagnostic lines are… it’s called Psychopathy: Antisocial, Criminal and Violent Behavior.
January 26th, 2010 at 8:13 am
I think House may have not run a background check on his old classmate because he really is changing.
From seasons 1-5, he would do things like that just to screw with people, but now perhaps he is actually learning to trust people (maybe from the Dibala episode where he did that background check on Wilson’s neighbor and almost got himself evicted), and actually becoming a nicer person, evidenced by the end of the episode where he gave his classmate the check anyway.
January 26th, 2010 at 8:54 am
I know it isn’t spoken of much here, but the actress playing the psychopath did an excellent job which gave the episode an unnerving sense of discomfort that served it well. The shows have to function, primarily, as art and the means of achieving this end up being very different from rigidly sustaining medical accuracy. Still, the episodes that are medically strong also seem to be some of the better ones. Love the site by the way.
January 26th, 2010 at 9:02 am
@Akshay
I found it odd that House gives it anyway. I think he does it to give himself a better feeling. Since the old classmate didn’t want the check because it was not entirely House’s fault that he had to move.
January 26th, 2010 at 9:12 am
It’s really not that serious. So why take it that way? It’s called ‘Entertainment’, which means that it was made to ENTERTAIN you. I mean, I love to watch it too, but I don’t go by whats said, cause its a tv show.
January 26th, 2010 at 9:18 am
Finally! Someone who gets it.
January 26th, 2010 at 9:39 am
Official Comment
Yes, someone with an identical IP address.
Being obnoxious is bad enough, but I can excuse it because it’s probably a personality disorder. On the other hand, sock-puppetry crosses the line and even I have my limits. Good bye and banned.
January 26th, 2010 at 9:42 am
Isn’t 13s behaviour extremely unprofessional? If I was the patient I would sue her ass, the hospital’s ass and the husband’s ass. Even if I didn’t get any money out of it I’d make sure I atleast got 13 fired.
And if I was a psychopath I would later find out where she lives too.
January 26th, 2010 at 9:50 am
Official Comment
Hasan,
Yes, Thirteen was certainly very unprofessional. However, I think she was very careful and never actually broke patient confidentiality laws — she skirted the edges — so I’m not sure there’s anything she could successfully sue over.
But if I were Thirteen, I’d watch my back and invest in a good security system.
January 26th, 2010 at 9:52 am
Official Comment
And than reminds me that there was something else I forgot to mention:
Medical boards don’t move that fast. They are ponderously slow — arguably way too slow. They’d send certified mail anyway, something with a paper trail.
January 26th, 2010 at 10:02 am
I thought Wilson was a tad “unsympathetic” with House because, of all the people House owes an apology to, Wilson ought to be at the top of the list.
January 26th, 2010 at 11:16 am
Some psychopathy experts have documented cases in which people describe lifelessness in the eyes of psychopaths (of course without knowing that they actually are in presence of one). According to Robert D. Hare psychopaths also often speak very rapidly using more hand gestures and body language than an average person would.
January 26th, 2010 at 11:32 am
A pretty poor episode, in my opinion. The medical side was laughable and the soap-opera = one huge yawn for me. The writers really need to start getting their acts back together.
January 26th, 2010 at 11:51 am
I didn’t think they did 13 well this episode, writing-wise. She doesn’t seem the type to fly off the handle at any time, MUCH less directly to an ill patient (a healed one possibly, but even that seems like a stretch.) She always seems to be in control, so the outburst seemed so out of character it took me right out of the story. Booooooooooooo this epi.
In contrast, they made House TOO emotional for House. I know supposedly he’s turning a corner to being more self-aware of his emotional state, but again too much too quickly.
January 26th, 2010 at 12:36 pm
IanG
January 26th, 2010 at 6:00 am
“It seemed to me that she was more of a sociopath than a psychopath, although the terms seem to be used somewhat interchangeably.”
For quite some time I never understood the differences either. I just assumed sociopathy was a milder form of psychopathy, or perhaps another word for severely anti-social. After some research (and maybe I’m being simplistic here) it seems the main differences between the two are that the latter is characterized by a frontal assault on others — an overt in-your-face approach to getting one’s way, while the former is more sneaky, devious, and underhanded about it. In other words, more hypocritical, more given to put on an act to achieve one’s ends, rather than by being the meanest SOB in the valley in order to get one’s way.
A touch of irony perhaps that the treatment got the patient to drop the manipulative act and behave in a way that was openly counterproductive to her previously covert selfish ends?
As someone who has criticized the writing of the show on this blog, was this perhaps some brilliant work for a change? I’d like to give credit where credit is due.
Anyway, the bottom line with mental illnesses is that there are no strict rules, no box in which one must operate. For example, there are said to be four main groups of psychotic behavior, and I have known someone who demonstrated traits from all four separate groups.
Interesting episode, to say the least. There was even an extra layer of drama with the husband’s sick codependency going on in the background…
January 26th, 2010 at 12:45 pm
I don’t think that 13 was in any danger of losing her license. The fact that they were looking at syphilis would be reason enough for a husband to get suspicious about his wife’s fidelity.
The patient’s threat was not credible, so I was surprised that 13 reacted so strongly to it. Ditto for the sexual harassment complaint.
January 26th, 2010 at 12:54 pm
Liked the POTW (convincingly creepy/lacking empathy)!
But I didn’t like the episode – too .. I don’t know, not a House story (too fluffy? not really too soapy, but too soapy?), jumping all over the place, and the characters were off.
Also – Would 1 dose of thyroid meds really mess with someone’s health like that?
I’ve got Hashimoto’s too.
I am usually very good with taking my meds, but very occasionally I accidentally take a double dose or skip one. This does not land me in hospital with weird symptoms.
If there was any thyroid meds poisoning, wouldn’t that have to be over months to cause any symptoms? (does other hormone stuff kick in first to compensate?? That’s what the doc told me when my only Hashi symptom was weightloss – and high antiTPO.)
January 26th, 2010 at 2:17 pm
I recently was re-reading the HOUSE article in wikipedia (funny thing – you write house or House in the search engine – nothing out of the ordinary happens if you write HOUSE – you jump straight to the show :) ). Anyway what I read was that the show was intended to be a CSI type of TV with germs as suspects – however the initial success and ratings studies forced Brian Show to re-direct the show to character study and development. I suppose we have to thank Hugh Laurie for that because no one else could have turned the show upside down like that and make it a hit so fast in his own manner. My point is while in the first season medicine was the focal point of the series while character interactions and soap opera was just a background. Now it is the other way around – which is what makes the medicine in the show less and less realistic. If one should read D-r Scott’s comments from season one he will see that his biggest complaint was that no one wears eye protection in surgery – while now he does not have time for such minor details as the writers are striking big and by far in all areas of medicine. It is getting harder for me to pick the bones of the medicine myself – as a matter of fact I have trouble following the teams reasoning lately. So my comments on this episode medicine will be short since our host here have already pointed all the major weak spots and I am not sure if anyone cares for the minor details, like:
1. How can Wilson cause ear pain exactly?
2. If it was ear pain why did the writers make it sound like ear ringing or something like that – loud noise or hearing of non existing sounds?
3. The initial symptom is ear pain – anybody actually bothered to check the ears?
4. One might think that for six seasons the writers would have figured out how to present liver failure with credibility – I mean you can’t just have one symptom of liver failure and ignore everything else. A patient with acute liver failure presents such a constellation of symptoms that only an idiotic doctor would miss it or wait for the uncontrollable bleeding to start to diagnose it.
5. It is amazing how fast they harvest livers in House – you need it you got it :) I would say (not from experience since in Bulgaria the first liver is yet to be transplanted) that you get into the list of people waiting and you only get a liver if you are lucky – otherwise you most likely die from the complications. What exactly is the probability to get a new liver in time if you have acute liver failure in USA? May be one of the other doctors can contribute with that info.
I will stop now since I am beginning to be peckish and I actually liked the episode. The soap opera was good and I was pretty convinced that the guy House supposedly ruined was an actor hired by Wilson to provoke guilt in House – after all Wilson played that kind of tricks beforehand. The outcome of this story was intriguing and unexpected and I liked it a lot. Some really bad carma for House though – when Cuddy came to tell him that she likes him she found a hooker in his office and walked away – when he came to tell her that he is feeling actual remorse for his past deeds he founds her happy and completely ignorant of his existence. I suppose he will have to suffer some more before he actually achieves his goal – to be happy – with or without Cuddy. It’s a long way House… A good soap episode and Fore-teen is apparently back on track. The one thing that irritated me is that Chase and Taub are being overlooked from the writers – may be that will change in the future. I certainly hope so… And RSL should get more acting! He is great as always even with 3 lines in the whole episode he is still great pleasure to watch :)
January 26th, 2010 at 2:21 pm
I thought the three-way duel between the patient, 13 and Dr Cuddy to be the most interesting part of the story. And they just dropped it. (N.B.: I’m from legal, not medical.) Why was 13’s behavior worse in this instance compared to any other of the outrages perpetrated on patients because the team is trying to winkle the truth out of someone, or because House wants to Teach Someone A Lesson, or because House is bored? I thought it was smartly played by 13 (who then turned into a screaming mimi, why?) and wanted to see her square off against the smart, professional version of Cuddy (if they can find that version) over the issue.
As for the rest, I am beginning to think you’re getting soft on your grading, Dr. S. Even with the required bag of salt because it’s TV, it sounds like the medicine was a mess and the rest was soapy wet treacle.
January 26th, 2010 at 2:39 pm
” Even if it is a B-Cell Lymphoma, there are over a different cancer of that type, and only some are treated with radiation therapy.”
FYI:
I think you left out a word (perhaps “dozen”) between “over a” and “different”
January 26th, 2010 at 2:40 pm
PS: “cancer” would also need to be changed to “cancers”
January 26th, 2010 at 4:17 pm
I noticed that Chris Taub reached for his stethoscope when standing next to the patients bed and he had it in his ears backwards. That is definitely a medical students mistake on their first day of rounds. Ha ha
January 26th, 2010 at 4:31 pm
The writers dropped the ball with 13. Cuddy took her off the case and then 5 minutes later she is back in on the differntial, she is back “treating” the patient…talking to the patient and her husband.
You would think that if the hospital had even a halfway decent counsel, they would keep Dr. Hadley far away from a patient threatening a lawsuit.
January 26th, 2010 at 4:41 pm
My understand of House paying the guy off:
He did it to try to erase all his guilt. He does not know how to deal with guilt and rather than going to each person and making amends (he can’t anyway, he has hurt too many people to even know all their names) he is trying to do it with one big check. I think it is pretty obvious when he goes to see Cuddy and she is with her new man so he goes and drops the check off at his friends house in such a way (the mail slot) that the friend can’t refuse taking it. He is trying to buy forgiveness. I think it was funny that he would do this during the same episode that they have a patient that supposedly doesn’t feel guilt. Perhaps that is why he went to see the patient twice.
I also think his love for Cuddy is linked to how intense his guilt is (ongoing drama, all seasons). The more he wants her (like when she is with someone else) the more he feels he is not worthy of her and the gilt sets in. In this one I like to think that he was trying to free himself of guilt so that he felt worthy of her.
Also I find it funny that House has this big reputation of never going to see patients, yet he does it all the time. Granted not as much as a doctor should see his patients, but he does go see them.
January 26th, 2010 at 5:06 pm
Wouldn’t overbilling Medicare patients as House’s old friend did get him in legal trouble as well as getting him fired?
January 26th, 2010 at 5:08 pm
For the psychopath/sociopath thing. Copy/pasted from Wikipedia because I’m lazy, but I’m sure I came across this in more academic settings before.
“David T. Lykken proposes psychopathy and sociopathy are two distinct kinds of antisocial personality disorder. He believes psychopaths are born with temperamental differences such as impulsivity, cortical underarousal, and fearlessness that lead them to risk-seeking behavior and an inability to internalize social norms. On the other hand, he claims sociopaths have relatively normal temperaments; their personality disorder being more an effect of negative sociological factors like parental neglect, delinquent peers, poverty, and extremely low or extremely high intelligence. Both personality disorders are the result of an interaction between genetic predispositions and environmental factors, but psychopathy leans towards the hereditary whereas sociopathy tends towards the environmental.”
Regarding the episode, I had to laugh when they said that psychopaths feel no emotions. Really now, that’s a careless mistake on the writers’ parts.
Or maybe it’s just them exercising artistic license or whatever for that crying scene at the end.
Good review as always, Dr. Scott.
January 26th, 2010 at 5:30 pm
I was a little baffled about the MRI which revealed the psychopathy. Can someone really only use the Brocka’s area of the brain when they’re answering questions? Shouldn’t at least the Wericke’s area be activated too? How else would she understand the questions? Also, the patient was answering questions regarding her own experiences so hippocampal activation should also have been seen.
January 26th, 2010 at 5:54 pm
Ethan, every doctor overbills Medicare.
January 26th, 2010 at 6:40 pm
Does anyone know the song that was playing at the end of the epiode?
January 26th, 2010 at 6:45 pm
I believe that when Wilson was angry at House for apologizing to his old classmate, he was alluding that of all the people House should apologize to, Wilson is number one. In my opinion, it seemed like Wilson was jealous.
January 26th, 2010 at 7:20 pm
The song is “Why Try to Change Me Now,” music by Cy Coleman, lyrics by Joseph A. McCarthy (not to be confused with the probably tone-deaf Joseph R. McCarthy R-Wis.).
January 26th, 2010 at 7:29 pm
Oops, they’ve run out of interesting diseases, they’re starting to repeat them, that doesn’t sound good.
I wonder when they’d write something for Cuddy: House was sick, Foreman was sick, Thirteen is still sick with her Hutington’s, but when Cuddy would have to trust House and his Team after she would develop some nasty, let’s say, fever?
January 26th, 2010 at 9:30 pm
The cancer thing was a red flag for me. Can you imagine the radiologist’s reaction to House suggesting he treat a patient without even knowing where the tumor is? What do you do, just irradiate at random and hope you hit it?
They used 13’s name (”Dr. Hadley”) often enough in this episode. Maybe they’re trying to break the fans from thinking of her as 13. (Fat chance, guys; she’s 13 until the day she dies. Or the show is canceled, anyway).
January 26th, 2010 at 9:57 pm
I like Beck’s comment explaining House’s actions at the end of the episode.
From the beginning, I suspected that the woman was a psychopath. I attribute this to excellent, subtle acting on her part. Re 13’s reactions to the patient: Apparently some people are extraordinarily skilled at recognizing psychopathy. I once read that some women approached by Ted Bundy sensed that he was dangerous and refused his requests for help in carrying a pile of books to his car despite the fact that he was handsome, charming and using crutches or had a (phony) cast on his arm. (Helplessness was the ruse he used to lure victims.) One woman told the police that when he approached her, the hairs on the back of her neck stood up. She sensed that he was evil.
January 27th, 2010 at 12:05 am
could someone explain me the clinic patient scene?
January 27th, 2010 at 1:36 am
Juan: I think Thirteen reacted strongly to the sexual harassment argument because of her bisexuality. Patient would have probably had a field day exploiting homophobia against Thirteen. I agree though that otherwise she’s being way too emotional, too much like Cameron. One thing I like about Thirteen is that she really doesn’t have anything in common with Cameron, so I hope they won’t erase Thirteen’s personality in favor of having a genuine Cameron 0.2 around.
January 27th, 2010 at 2:10 am
Can cardiac arrythmia really present itself as ear pain?
January 27th, 2010 at 3:45 am
I really don’t get one thing about House….Why the he starts giving the meds before even confirming the disease….like pennicilin for lues and radiation for ALL ?? without any proof beside suspicions And it happens of course in every show. btw. great site!
January 27th, 2010 at 5:59 am
@Beck et al.: I don’t think House gave his old classmate the check out of guilt. Surely the guilt would have been erased not only by the facts but by the guy’s attempt to con him with the story.
He gave it to him because the guy owned a house with a maple tree sitting under which in Fall was “paradise.” He wanted to participate in the guy’s chance at being happy. Cuddy doesn’t need his apology to be happy, but Dr. A+ needs the check to make the mortgage.
Also, of course, he is trying hard to be “human,” to perform gestures of generosity and humility as part of his ongoing therapy. And after dismissing the notion and possibility of happiness for most of his life, he is considering it now.
Thanks to Dr. r. Bulgaria for his analysis of the soap/medicine ratio. I was thinking “they wanted House to confront a real psychopath at this point in his story arc, so they had to think of a disease that involves psychopathology.”
Ironically, what House should have felt towards the deceptive doctor was anger.
January 27th, 2010 at 7:08 am
Did anyone else notice that there was no seizure in this episode? I consider THAT a major change of direction!
January 27th, 2010 at 7:56 am
“The song is “Why Try to Change Me Now,” music by Cy Coleman, lyrics by Joseph A. McCarthy (not to be confused with the probably tone-deaf Joseph R. McCarthy R-Wis.).”
And it was sung by Fiona Apple
January 27th, 2010 at 8:34 am
@D-r Bulgaria: Regarding point 3, the show mentions that the POTW had seen 6 other doctors already. Presumably they would have ruled out all the ‘horses’ leaving House’s team to look for the ‘zebras’
The entire premise of the show is that Dr. House is the man you are referred to when no one else can figure out what is going on. Occasionally the writers have deliberately broken this rule when House plucks a patient out of the emergency ward. But more often, in the rush to get the story going, the premise gets forgotten as the patient goes from first symptom in the opening scene to his/her consultation with House in the next, with no indication of the passage of time.
January 27th, 2010 at 12:37 pm
I also thought that Wibberley was a “plant” by Wilson. I’m kind of glad he wasn’t, though. We learned more about House that way.
January 27th, 2010 at 2:20 pm
I can´t stop wondering how chronic patients suddenly collapse without any preciding symptoms. And everybody gets a lot worse under House´s care.
1. Radiation just like that? No way.
2. The radiation room door was surely leaking. I wouldn´t like to walk around while treatment was going on inside!
3. No initial complete blood work? Of course, some tests can be left out if suitable, but all of them??
4. LOL at House and his former class-mate though it was all absurd.
January 27th, 2010 at 3:26 pm
When I saw the title of the episode, “Remorse”, I thought we were going to see the reappearance of Detective Tritter. Heh heh.
January 27th, 2010 at 4:19 pm
Personally, the soap opera wasn’t that enjoyable…mostly because of that improbable ending. The House-Wibberley thing was a little better, but it just seemed so slow.
Thanks for the medical information!
January 27th, 2010 at 6:23 pm
Well, it’s not like House knows a private eye or something. ;^)
January 27th, 2010 at 6:44 pm
Would a single man in the USA be able to pay for such a home when his day job is ‘bagging groceries’?? That must be like the worst paying job there is.
I find it very hard to believe that House would accept that story. Like some others, I pretty much expected this to be another one of Wilson’s attempts to screw with our favorite diagnostician. ;)
January 27th, 2010 at 9:33 pm
All that matters is that House thought he screwed over a Wibberly (even if he spelled it without that second “e”). Maybe one of the writers is a fan.
January 28th, 2010 at 12:57 am
Scott,
Requesting an official comment please.
In this (and another episode, the one where the boy is an intersexed child and the contrast was basically the diagnosis), I may not be a doctor, but I have to question the certainty of the assertion that kidneys would automatically be tested.
I will say why. I had appendicitis. Before they figured it out, they made me drink a bunch of very nasty tasting stuff (tasted like very sour milk with artificial sweetener). I believe this was contrast for a scan of some sort. In short, this let them see my appendix was going to rupture without intervention. However, they never tested my kidneys to see if my kidneys could handle the contrast.
Is there a certain rule when you have to test if contrast will hurt a patient’s kidneys or not? Or am I off base and thinking of different tests/substances?
January 28th, 2010 at 1:02 am
P.S.
Regarding 13. I’m kinda sick of Foreman. He basically whines to House that she is being disrespectful, when he PURPOSELY made her do a test she respectfully disagreed with and ended up having a valid reason to dissent. The only real mistake 13 made was making the comment (reminds me of someone I know) was saying it in front of the patient. On the other hand, she never said who it pertained to…
But to make a long story short, Foreman needed to see he was wrong for a change. While I strongly feel taking the high road is the only real answer, you can’t dish out disrespect and cry foul when disrespect is returned.
January 28th, 2010 at 7:11 am
What’s a Wibberly?
January 28th, 2010 at 8:47 am
Judy:
Brilliant analysis, Judy.
House on drugs was close to having the same “psychosis” as the potw, at least outwardly. House is now so mentally stable that a lying, cheating ex-colleague moves him to compassion not derision.
Just like getting well hurt the patient emotionally at the end of the show (but we all smile because we know it’s for the better), I expect House to also hurt and react, probably poorly or even viciously as he is so capable of, as he grows emotionally.
January 28th, 2010 at 9:19 am
Official Comment
Tom,
There’s two types of contrast. First is oral contrast, which you drink. It is used for various abdominal/bowel scans. It is not metabolized by the kidneys so blood tests are not necessary.
Second is intravenous (IV) contrast. This is used for almost everything else that requires contrast. It is harsh on the kidneys and it is routine procedure to know the kidney function before administering it. For example, just last week a patient of mine was found at the last minute to have bad kidneys, so I had to switch to a non-contrast CT rather than the contrast CT I had wanted.
January 28th, 2010 at 10:24 am
“Would a single man in the USA be able to pay for such a home when his day job is ‘bagging groceries’?? That must be like the worst paying job there is.”
It is implied (from him saying that he had to quit med school to take care of his father) that it’s his dad’s house.
January 28th, 2010 at 9:46 pm
Yes, can someone please explain the clinic-patient scene.
January 29th, 2010 at 11:23 am
How unfortunate for House. Even in change, he ends up being, looking miserable. This may all end up with him concluding that all the effort just isn’t worth it. Oh my, our great doctor is getting sappy.
I love your website man. I love this show: I can imagine how hard it must be, and what kind of extraordinary research/experience must go into making a plausible medical mystery every week, as well as maintaining an engaging soap. There can only be so much material to go around, and I imagine a lot of the best was used in seasons 1-2.
Chase’s haircut is annoying me. Methinks he’ll never be the one to solve a case til he grows it back out.
January 29th, 2010 at 12:06 pm
D-r Scott: I absolutely agree that kidney functions tests are performed by any “real” doctor before trying contrast CT. Don’t you think however that if you mentioned that last year (can’t remember the name of the episode with the boy/girl that was completely healthy but the team made him sick by injecting him with contrast for a CT) that would also mean that the whole premise for an episode is screwed and the medicine/mystery/solution all deserve a straight F :) I mean the writers not only already made that mistake they used is as a plot engine? Not the first time this happens… and kind of reminds me of my own mention of liver failure – hello liver failure as an explanation for …. (write whatever you like here) :). You’d think they learned to diagnose kliver failure before the guy starts dying or to make a difference between acute and chronic liver failure (two completely different conditions btw) :):):)
January 29th, 2010 at 2:40 pm
Shouldn’t they have found her blue fingernails from the admitting examination?
January 29th, 2010 at 5:27 pm
Drew:
I think upon admission the patients fingernails were painted and that is why 13 brought the nail polish remover in to see the entire nail to help with the diagnosis. Once the nail polish was removed the white half circle on the fingernail (called the luna) was exposed and in Wilson’s Disease the lunula can be a bluish color. When this occurs it is called azure lunula and is a clue to diagnosing Wilson’s Disease.
January 30th, 2010 at 1:21 am
Although not doctor… I just can’t imagine, how patient did not break ALL of her bones before clinic. They are sooo fragile… )))
January 31st, 2010 at 7:23 am
This potw’s behaviour strongly reminded me of House’s cold-blooded manipulation of the neighbor he wanted to have sex with, in the episode “the down low”. House had been manipulative before, but that time was particularly off-putting. He took advantage of a naive person’s trust for personal gain, knowing that it would hurt her feelings if she found out. I don’t remember him being so blatantly insensitive until then, even when he did manipulate people.
I hope talking to a psychopath shocked some sense into him.
January 31st, 2010 at 12:05 pm
D-r Bulgaria : (can’t remember the name of the episode with the boy/girl that was completely healthy but the team made him sick by injecting him with contrast for a CT)
The Softer Side.
House humored the family with a scan he knew was unnecessary. He humored them because he was in a good mood because he was happy because he was pain free because he was on methadone.
February 1st, 2010 at 8:13 am
To Mike: got you. But than again he should have tested kidney function beforehand which would have found out the dehydration which would have found out the whole thing. Either A.) He doesn’t know the basic requirements for running such a test B.) His fellows don’t know the same thing (which makes them idiots that they are not) or C.) the writers screwed up the whole plot from the very beginning.
February 1st, 2010 at 2:35 pm
Questions for the MD’s. If this diagnosis was true, would the brain be ‘permanently rewired’ into psychopathy? How does that work? If not (or is possibly to be reversible), how quickly would you recover? Is it more like a debt/recovery plan where “if it took you 5 years to get into debt, it is going to take you at least ~5 years to get out”?
February 1st, 2010 at 6:46 pm
Has anyone with Wilson’s ever presented with only a personality disturbance and no motor abnormalities? This is far from the typical presentation I learned in second year.
February 2nd, 2010 at 12:30 pm
I think this episode was like so. The writers go into a meeting, and they’re like, “Ya know, Olivia’s really beautiful when her character is mad. Let’s write a whole episode about that.”
February 2nd, 2010 at 1:59 pm
I did a little googling for the medical definition of psychopathy (which, apparently, I have been mispronouncing for a decade or so). An article from Scientific American: seemed relevant.
WebMD cites that same publication as a source. Above, the self-described psychiatrist Jane (I assume that’s true, but this is the internet after all…) also distinguishes between psychopathy and ASPD. Is this a dispute even between experts?
There also seems to be a discrepancy about whether psychopathy is treatable or not. Wikipedia says:
while Popular Science says:
Apparently Dr. Jennifer Skeem is a doctorate and associate professor of Psychology who politically advocates on issues pertaining to the sentencing of the mentally ill with a special interest in psychopathy.advocates on political issues dealing with criminal trials for the mentally ill, especially psychopaths. (Man, the more you research something, the more interesting it gets.)
Thought that all might be interesting to y’all.
February 3rd, 2010 at 3:11 pm
@medstudent
I was wondering that too. It seems odd that she’d have psychopathy, but no other neurological symptoms, especially give how long the disease had been affecting her. :\
February 5th, 2010 at 3:55 pm
I have a love/hate relationship with this website.
I love medicine, and I love House, so it sometimes makes me sad to see the episode sometimes ripped apart :) I think I am the perfect viewer, I take exactly what is shown and miss the poor logic, bad reasoning, and farfetched diagnoses. I think it’s an awesome show!!
I do, however, appreciate reading the “behind the scenes” of what a case like this (however unlikely to occur in real life) requires; however in most reviews the missing figure seems to be TIME. :)
I think I like reading the comments as much as the reviews!! The “BIG DANCE NUMBER” comment near the top had me dying with laughter! I can so picture it!!! lol! :)
February 19th, 2010 at 2:25 pm
@gamik et al
the Clinic, yes
apart fron the weird “House’s recited-from-memory spanish”, after two views, it indeed had sense:
Wilson is treating the chican guy with his injured finger
House finds it odd, suspects, and asks about how happened
Chican guy says: my work can be very dangerous, or sort of
Then House tells him: next time you’re taking drugs at work, don’t mistake your finger for a nail (SORT OF)
Reasoning: too much crying came (because it didnt match), not from pain, but because of overdose of eye drops… which are used for red eyes..and red eyes came from taking marijuana… which made the worker slow and not so much dexterous with the hammer, so he hit his own finger
cool huh
February 26th, 2010 at 3:26 pm
From the beginning, I suspected that the woman was a psychopath.
But that might have been due to last week’s promo.
Maybe Thirteen saw the promo as well.
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