House — Episode 3 (Season 7): “Unwritten”
A better episode of House this week. The mystery and medicine was better, and the soap opera had settled down to a dull roar.
In the study in her Gothic house, Alice, the famous writer of the Jack Cannon series of young adult detective fiction, puts the finishing touches on her latest novel, then locks it away in her safe. She makes a little small talk to a teenaged boy in the room with her, and then acknowledges that he’s no more than a figment of her imagination. She opens the drawer to her desk and pulls out a pistol and holds it to her mouth. Just as she is ready to fire the gun, she has a seizure. The guns goes off early, just grazing her cheek. Upon hearing the gunshot, her maid runs in and Alice is rushed to the hospital.
House takes it upon himself to examine Alice in the Emergency Room because he is a huge fan of her books. After he accuses her — correctly — of attempting suicide, she tries to leave the hospital, but House has her placed on a seventy-two hour psychiatric hold. He calls the team in to examine her and then monitor her for another seizure. They find her an extremely unpleasant patient to deal with. Meanwhile House and Cuddy head out for a date that is actually an evening of poking though Alice’s house for clues. They talk to her maid and learn that Alice has been having a great deal of back and hand pain recently. They also learn that she eats several cans of tuna fish every day. House is unable to open the safe to find her latest manuscript, but is able to take the typewriter ribbons from which he hopes to suss out the novel.
Back at the hospital, neither Foreman nor Taub have seen any seizure activity. House arrives and shows them that Alice is sweating profusely, but only on one side of her body. Given all her tuna consumption, the team suspects that she has mercury poisoning, but the initial tests all come back negative. Nevertheless, House wants to go ahead and start her on chelation therapy while obtaining the definitive tests, but has Cuddy go in since Alice has asked for a female doctor. A short time later, after Alice fires her maid and makes snide remarks to Cuddy, she tells them she wants the male doctors back. When Taub and Chase arrive to set up the chelation, she reads Chase like a book. When she is asked to what she thinks of Taub, she remarks that he reminds her of her ex-husband and suddenly develops a severe headache and dangerously elevated blood pressure. Chase thinks it is a reaction to the chelation medication until Taub point out he hasn’t started it yet.
Alice is having symptoms of pain, seizures, and hyperhidrosis, along with episodes of elevated blood pressure. Mercury poisoning has been ruled out. Hemolytic uremic syndrome is mentioned but quickly dismissed. House points out that both of her severe episodes (the seizure and the high blood pressure) occurred at times of stress. He wonders if it may be an issue of excess adrenalin. This suggests the diagnosis of a pheochromocytoma (an adrenalin secreting tumor). The team tries to get an MRI, but the magnet in the MRI machine rips out the surgical screws in her leg — metal screws she had apparently deliberately not told the team about — causing severe burns and tissue damage.
House decides to try a different approach. He goes to Alice and tells her that she’s been going about suicide the wrong way as gunshots are painful. He offers her access to a painless lethal drug if she’ll cooperate with the team. She agrees, and when he gives her the syringe to hold onto for later, she immediately injects it into her leg. Of course, it wasn’t a lethal drug, but instead a sedative. It allowed the team to obtain a PET scan, and also allowed House to extend her psychiatric hold for another 24 hours. The PET scan is negative. However an ultrasound obtained the next day shows a pericardial effusion (fluid build up in the sac around the heart). To the team this suggest something viral or cancer. House takes a different approach, he looks at the character of “Helen” in her novels — the characters that he believes to be an analogue of her. Helen suffers from pain, fatigue, light sensitivity, and depression. When combined with Alice’s symptoms, these strongly suggest a diagnosis of lupus. Tests are run, which apparently are negative as they are never mentioned again.
Later, after Cuddy complains of seatbelt-related neck pain from an evening of go cart racing, House wonders if Alice is suffering from thyroid damage from a seatbelt injury from a long ago car accident — the same one that injured her leg. She gets angry during their discussion and develops suddenly paralysis –- which doesn’t fit with House’s hypothyroid hypothesis. Taub suggests that she may have a trauma-related syringomyelia. The symptoms fit, but she is refusing any further testing or treatment. Finally, with some help from her old medical records, House is able deduce what happened. She has a syringomyelia from the accident, but more importantly, her son was killed in the accident, and she blames herself for his death. House tells her that she is not at fault for her son’s death — he points out an aneurysm on his autopsy report that shows he was likely already dead at the time of the accident. Relieved of the burden, she agrees to begin treatment.
As usual, major complaints are in red, minor complaints are in blue, and nit-picking ones in green:
The team kept listing “hyperhidrosis” as a symptom, but kept leaving off the most important aspect — that it was only one-sided. House made a big point of this when he showed it to Foreman and Taub in the first place. This screams “neurological cause,” but it was never addressed (or even mentioned that way again). Based on this symptom alone, they should have made the correct diagnosis, or at least found the correct organ system, much earlier.
There is no such thing as a National Records Archive that stores everyone’s medical records. Each doctor/hospital keeps their own. Yes, an organized central system might make it easier to track down a patient’s medical history, but it would also be a privacy nightmare.
How does the syringomyelia explain the pericardial effusion?
It’s generally more involved than that to get a patient admitted on a psychiatric hold (it varied by state). Unless there is some urgent medical reason, patients on a psychiatric hold are placed on a psychiatry ward. If their medical condition prevents this, then they are carefully monitored, i.e. someone is in the room watching them at all times. And this would not include House or his team.
I find it hard to believe that anyone could live for 10 years with hypothyroid symptoms that severe. That being said, she did remark she hated doctors, so that may explain why she hadn’t sought care.
A PET scan is negative, and so now they’re going to ultrasound her entire body?
Not to beat a dead horse, but a halfway decent physical exam would have revealed the surgical scars on her shin and the likelihood of an orthopedic repair. A quick x-ray would have confirmed metal pins. At our facility, if the radiologists even suspect some metal in the patient’s history at all, x-rays are ordered.
Another good medical mystery this week, I give it a B+. The final solution was logical and fit most of the symptoms, more than usual anyway. It also earns a B+. The medicine overall was much better this week with an almost logical procession from diagnosis to diagnosis and less jumping around. It deserves a solid B. The soap opera remained good, but I don’t think it was as strong as the previous two weeks: B.
The review of the previous episode of House
A list of all prior House reviews
Let me take a moment to recommend the excellent comic book series Unwritten. It may share a name and some superficially similar themes to tonight’s episode, but it is a much deeper (and more enjoyable) look at reality versus fiction. What it the Jack Cannon figure Alice was imagining was real — or at least thought he was — and didn’t realize he was actually a fictional character? And what would this mean for other fictional characters. The comic is published by Vertigo (part of DC comics), though several
October 4th, 2010 at 11:18 pm
Okay was it just me that noticed the huge airbubble in the syringe that house handed her? Wouldn’t that have been an issue?
October 4th, 2010 at 11:31 pm
I knew it couldn’t be a pheochromocytoma, because they’ve already done that *twice*. And of course it’s not lupus :p Frankly, from the outset, I was expecting something involving the typewriter to be the underlying cause. Pleased it wasn’t that predictable.
And does she just go on living with her delusions of talking to her dead son? Or does the fact that she knows he’s dead mean they’re not delusions? They’re definitely hallucinations…aren’t they?…and “Oh, she’s a writer” seemed an awfully half-assed way of dealing with them.
October 4th, 2010 at 11:36 pm
Well, it’s not about medicine, but I’d like to point out that the typewriter ribbon-MRI-just-tweak-the-software scene was insanity.
Nice to see grown-ups like House & Cuddy work out quickly what they have in common and not, and what it all means in their relationship. They should get a tattoo or something.
October 4th, 2010 at 11:37 pm
I found it odd they had the MRI running before she was even inside. She hasn’t even gotten onto the little slider thing (Yeah, I’m pro) and her leg is being ripped apart.
I also found it odd they couldn’t get the patient’s medical files; they couldn’t say she was depressed and suicidial and get them that way? It wouldn’t even be a lie…but I guess that’s why they avoided it in the first place.
And as for the Soap Opera…Why can’t Cuddy just die? It’s pretty painful to watch any scene with her for me, and sadly, those scenes are making up about 40-50% of the episode these days. And of course anything House does, non medically related, has to involved Cuddy. Really disappointing.
October 4th, 2010 at 11:53 pm
Hi. I was not able to watch the show Monday night because of work. For last week’s show Nonny Amos gave a link that provided the full show on the net. Could Nonny or anybody else send me a similar link for this October 4 program, “Unwritten”. I cannot use Hulu in Canada.
Gratefully yours.
October 5th, 2010 at 12:04 am
Psychostician.. the MRI was not ‘already on’. An MRI is always ‘on’.
October 5th, 2010 at 12:09 am
@Psychostician:
AFAIK, the MRI machine is always on, it’s hard and/or expensive to turn them on and off every time.
October 5th, 2010 at 12:18 am
I find myself actually liking this episode, even in spite of my prejudice and bias against the writers …. It was ‘balanced’ in the sense that one part was not overpowering any other part and there was an almost logical flow to the way the story progressed.
It actually made me smile to see House act genuinely child like in several interactions he had with Alice when he’d get passionate about her books and Jack Cannon..
October 5th, 2010 at 12:43 am
My overall impression was, this was a good solid imitation of the episodes they used to do, back when the show seemed more fresh and over-the-top. It’s like a decent sequel to a classic film; you get the feeling that they’re retreading old ground rather than being innovative (how many hostile, uncooperative patients have there been in the past? And remember that patient who kept hallucinating about her mother?), but at least they did it competently.
Three things that made me laugh: The “smokin’ hot babe” who really was smokin’; House referring to “Dopey, Sleazy and Uptighty”; House telling Cuddy to “shut up” at the end.
It should be noted that the aneurysm explanation was a lie on House’s part.
October 5th, 2010 at 12:58 am
Hi.
I wondered about House suggesting chelation therapy.
Was that one of his jokes?
As far as I know chelation therapy is an alternative medicine scam.
Thanks
October 5th, 2010 at 1:10 am
Nice to have an episode without (a) the crash cart being called, and (b) a lumbar puncture. Lots of good House-isms, too. But we are back to the formulaic plotting, which is rather constricting
FWIW, we watched the film “Sense And Sensibility” a few nights ago. It was fun seeing Hugh Laurie in a role (brief as his screen time was) teetering between House and Bertie Wooster.
October 5th, 2010 at 2:33 am
Not a doctor but AFAIK chelation is standard for heavy metal poisoning, so not “alternative” (in the bad sense) at all. If I’m wrong at all I hope Dr. Scott will disapprove this post.
I also have to agree that I was happy that the typewriter ribbon didn’t have some mystery toxin on it… if only they could fix the patient at say the 35 minute mark they’d actually have a twist worth talking about. :)
October 5th, 2010 at 2:52 am
@Ert
Chelation therapy is an actual treatment used for removing heavy metals from the body.
However, it is also claimed by proponents of alternative medicine to cure other ailments unrelated to heavy metal intoxication, hence the “scam”. Thus, you are both correct and incorrect.
October 5th, 2010 at 2:58 am
@Ert
Chelation therapy removes heavy metals (like mercury) from the body, it is a legitimate treatment for that. It’s only a medical scam when people claims it can cure all sorts of other things (most famously autism), but House uses it right.
October 5th, 2010 at 3:26 am
Red #2 is unfair. TV shows change the names of organizations all the time and while “National Records Archive” is fictional, the MIB is a real group who does keep a copy of everybody’s medical records.
(And yes, the MIB is a privacy nightmare, but medical privacy hasn’t existed in any meaningful form since the 1970s.)
October 5th, 2010 at 3:56 am
@Montrealer you can try tubeplus.com
@Ert Chelation therapy is standard procedure in heavy metal
poisoning. http://en.wikipedia.org/wiki/Chelation_therapy
October 5th, 2010 at 4:04 am
@ Ert :
Chelation therapy is used to remove Hg or As from the body as far as I know (which they suspected at the beginning: mercury poisoning).
The method has also been applied in alternative practices, but with great controversies and lots of critics
October 5th, 2010 at 4:22 am
As somebody who learned to type on a typewriter (though mine was not nearly as cool-looking as hers), yep, I was screaming “Typewriter ribbons do not work that way!” (Incidentally, I have just been introduced to these counter things that one can use when doing a differential count of white blood cells. They make the same noise on reaching a total count of 100 that a manual typewriter does on reaching the end of a line. Very nostalgic.)
Would her leg actually catch on fire? The one time I had an MRI, I was allowed to keep my jeans on, which had rivets on the pockets. I could feel them vibrating. I assume there would be potential for considerable damage from surgical hardware, but just how much?
October 5th, 2010 at 4:28 am
Huh. A quick google suggests that surgical screws and plates are, in fact, not generally a problem, although that doesn’t excuse the sloppiness on the part of the team.
October 5th, 2010 at 4:29 am
Carl: If there really IS such a place as “MIB” and they really DO have a copy of everyone’s medical records, then I’m suing the crap outta somebody. My medical history is MY property BY FEDERAL MANDATE, and is not available for viewing by anyone not involved in my health care. I think you are confusing fiction with science fiction.
October 5th, 2010 at 4:48 am
Finally a good House episode again!
No soap (yay!), great pace, and interesting medical case with classic House ‘eureka’ moment.
Nice amount of Wilson/Cuddy/team/everybody and some fun scenes.
I really hope they’ll keep this going :)
October 5th, 2010 at 5:01 am
For the person looking for a link – I watch all my Stuff from Project Free TV seeing I am in Australia and don’t wish to wait ages.
I have Chiari related syringomyelia (c2-t10) and they did a half decent job here. I like the touch about not being able to have an MRI because that would have been an easy find with an MRI. They did better then the Chiari episode they did. Though the chances of relief after so long with the damage are not good. I would have liked her to be like more of us and still be in pain despite house’s “Promise” I thought that would be a nice set up.
Now all house has to do is Ehlers Danlos and all my zebra’s that we know (others are only suspect and in diagnosing mode) will have been done.
I love watching House because they describe the affect of pain well. I have an intrathecal pump with morphine so am no stranger to pain.
October 5th, 2010 at 5:15 am
Men in black (MIB) :)) http://en.wikipedia.org/wiki/MIB_Group,_Inc.
October 5th, 2010 at 5:34 am
House already admitted, to Cuddy, that he lied about the son dying from the aneurysm. I suspect he lied to POTW about the “National Patients Archive” too. I was actually surprised they had the MRI rip the pins out of her leg as soon as she was in the room (in the past when the MRI has done something like this it happens when they “turn it on) and wouldn’t surgical metal be non-ferrous (i.e. not magnetic?)
Also, Scott, you said a Psychiatric Hold “doesn’t work like that” and that House wouldn’t be involved in her hold, post-hold care/monitoring. Perhaps you’re forgetting some of his previous stunts and the fact he’s sleeping with the boss? ;)
Interesting to see, and it makes sense that he would be, House so engrossed in a trash-culture teeny bopper fiction series. I’m “Team (whatever)!” That made me laugh pretty good.
October 5th, 2010 at 5:37 am
Scott,
After seeing some of the symptoms in this episode (particularly delusions/hallucinations, light sensitivity, seizure, paralysis), it reminded me of the diagnosis from the first season episode “Honeymoon” of Acute Intermittent Porphyria.
Would this have been a potential diagnosis to consider?
Love the reviews!
-Bryan
October 5th, 2010 at 6:06 am
I thought this was one of the best episodes in a long time (thanks to Amy Irving who seemed to pull the best out of everybody). So glad to see that the medicine was not too bad, despite the need for crazy stuff like the pins pulling out of her legs.
I am hypothyroid and lately I was pushed to think of the year and a half before diagnosis, half my life ago. Nightmare. Oddly enough, now that I think of it, the only thing that could make me live with myself was the act of writing (bad) novels (typing on a manual typewriter, yes). So long as I was in that imaginative world I could deal with it. The rest of the time I mostly got drunk.
So, Scott– you say “I find it hard to believe that anyone could live for 10 years with hypothyroid symptoms that severe.” Is she hypothyroid in addition to the syringomelia?
October 5th, 2010 at 6:15 am
Official Comment
Judy,
You (probably) became hypothyroid gradually, which is the most common way it happens. On the other hand, Alice, if House were correct, would have gone from euthyroid (normal thyroid) to hypothyroid overnight. Small gradual changes are often hard to notice, but something like that happening in one fell swoop should have been noticeable.
October 5th, 2010 at 6:31 am
Good call on Unwritten! It is a fantastic comic book series written by a man who’s already a legend for Lucifer, Mike Carrey. It and Locke and Key (written by Stephen King’s son Joe) are at the top of my pull list every month.
Love your reviews as always.
October 5th, 2010 at 6:41 am
I was curious about the MRI. When she was getting wheeled in, her pins were almost pulled out of her leg! Is the magnet really THAT strong, or was that just for dramatic effect? I know it can be dangerous, but that was a pretty intense scene!
Thanks for the review! I look forward to these every week.
October 5th, 2010 at 7:19 am
This episode was pretty average compared to older ones I think. I have almost no medical knowledge so I can’t comment on this topic. But as a student of electrical engineering: Both MRI scenes were a complete fail.
1. The metal pins would have been ripped out of her leg but not heaten up so she gets burns like Foreman said later. The big magnet of an MRI is static meaning its magnetic field doesn’t change. To cause heat in ferromagnetic objects you need to induce an electric current. This only happens when the magnetic field changes or the object is moved through an magnetic field. If she would have been inside the machine when it’s making images THEN the pins would have burned her because of the gradient coils. These coils are switched on and off several times per second and create a strong, variating field (by far not as strong as the big magnet). This is what creates the loud hammering noise inside an MRI. And then: When the team realized that the magnet is ripping out the metal pins, why did they stare at each other so long? She is screaming in pain and nobody bothers getting her out of there. Foreman even tells them to at first.
2. The tape-reading-scene was even more ridiculous. What an MRI does is: It creates cut-images through an object. To read the text they would have to cut lengthwise through the tape. How thick is the tape? .5mm? I wonder if a standard MRI can make cuts this small. Besides there is a better way. House could have used a simple X-Ray. The graphit layer is thinner were the letters were stamped out. So these areas should be a little darker than the rest of the tape (i don’t know exactly how much graphit absorbs x-rays). Of course this wouldn’t be as crazy and expensive as using an MRI so I put this in the “It’s a TV show – we need drama” category.
Last I have something concerning (I think) every MRI in the show. Why do they never use an HF-Receiver-Coil? That’s what pick’s up the resonance signals from all the H-atoms in the tissue. I have had three MRIs in my life and the reicever (a little white cage thing) was always placed close to the scanned area. Are there MRIs where the receiver is inside the big tube or is this just so the viewers can see the patient better in the MRI-scenes?
October 5th, 2010 at 9:11 am
In regards to the chelation:
Chelation carries significant risks and is properly only used in the context of a positive test for heavy metal poisoning prior to treatment. They also mentioned the tests were negative AFTER chelation as well. Testing for the heavy metal after chelation is what is known as a provoked test, and it is very likely to produce a “positive” test, when compared to the non-provoked reference; there is no standard/reference for a provoked test. The human body has some amount (usually well within safety limits) of most heavy metals such as mercury, and chelation will remove (some) of this burden from the body, which will produce a positive result on the test done after chelation. It won’t be long after treatment before environmental exposure brings the body’s mercury burden back to where it was before.
October 5th, 2010 at 9:23 am
Yes, the typewriter ribbon routine was ludicrous. Now, if Amy Irving had used an IBM Selectric with its single-use ribbon cartridges, then maybe I could buy reading the manuscript off the ribbon, but I sure wouldn’t want that job.
October 5th, 2010 at 9:38 am
@No Life: The Medical Information Bureau, now called the MIB Group, only has information from people who have applied for individually underwritten health insurance policies in the last seven years. The idea is to help insurance companies avoid fraudulent claims: http://www.mib.com/html/request_your_record.html
October 5th, 2010 at 10:10 am
@MrBuddwing – exactly what I was thinking. I wonder if anyone on the writing team is old enough to have actually used a typewriter and get the idea that ribbons differ for different models?
My favorite things about the episode were House working so hard to get her to keep writing the series, then having her decide to move on to adult books anyway, and Sam turning out to be so aggressive. Holy Amber, Batman, does Wilson have a pattern or what?
October 5th, 2010 at 11:30 am
I noticed how the slight references to where Thirteen is keeps coming back.
Somehow I find Foreman’s indifference or lack of urgency troublesome. Unless their relationship is one to never return.
October 5th, 2010 at 11:36 am
I noticed how the slight references to where Thirteen is keeps coming back.
Somehow I find Foreman’s indifference or lack of urgency troublesome. Unless their relationship is one to never return.
Someone speculated that Thirteen was hiding out at Chase’s place.
Maybe she’s hiding out at Foreman’s.
October 5th, 2010 at 12:21 pm
I detest the House-Cuddy relationship and the way they now stand side by side, like approving parents, gazing together at the Case Of The Week with adult compassion and mutual regard. Gross!
This relationship had better hit the rocks soon. When it does, the combined loathing-longing-despair between the two of them will make for wonderful fireworks. That’s all I’m waiting for; otherwise I wouldn’t continue to watch.
A House who makes up a comforting lie for his patient (the son’s supposed aneurysm) is not a House I want to invest time in.
October 5th, 2010 at 12:26 pm
Oh, and add another vote for the Typewriter Disbelief reaction.
“That’s a CLOTH typewriter ribbon! You can’t read anything off a cloth ribbon! They spool back and forth over and over again! Sheesh!” I don’t usually shout at the television, but . . .
October 5th, 2010 at 1:34 pm
This show feels like it jumped the shark and is sinking into unwatchable waters. Would be curious what others think the turning point was…somewhere along the line last season I think.
October 5th, 2010 at 1:50 pm
I can’t believe so many people liked the execution of this episode, not to mention the POTW. Am I missing some massive contextual link that would make me see the actress/character in a different light? I thought she was awful – overly mysterious, pretentious, dull, obnoxious (and not in a funny way)… I couldn’t stand her “I’m good at reading people” thing. If I write any more about this I’m going to start ranting, and I actually had something to say with this post, so I’ll stop that now -
For anybody wondering about Thirteen (and please do beware for spoilers) she has been written out of the show for several weeks due to another filming commitment. She will be coming back, but not for a while – I would be surprised if she had been hiding out with Chase for that long.
October 5th, 2010 at 1:58 pm
This was an OK episode in my book – nothing too great about it it was more like mid season quiet waters waiting for stuff to happen. It is I suppose a normal flow of the show – they cannot go “DRAMA” every week. Watching House/Cuddy/Wilson interactions made me smile because I remembered episodes that were great with nothing great in them – the real House MD that we see at least once every season. Since the drama was good but pretty much regularly soapy I will not discuss it. House and Cuddy are doing fine at the moment and that keeps me happy. The medicine:
1. I’ll start with what I really liked about this episode – patient history. Any doctor knows how difficult it is to figure out and than treat a person who is unwilling to cooperate. They managed to sell this spot on – the moment when House wrote his favorite line on Taub’s back was top notch drama/laugh. Any patient who is selling crap to his doctors is likely to be injured and/or killed in the process of treatment. Of course such patients (unless they are Munchausens) rarely finds himself in the hospital.
2. I am pretty sure you need to perform X-Rays before you get the patient in the MRI room. That should be standard for any patient and in Bulgaria they value their MRI’s too much anyway to risk it – people lie or even just forget about some metal pin from a ortho surgery. They even might not know about it if they were in shock at the time (which often is the case). So X-ray the entire body first – and when the patient is lying their ass out that is mandatory.
3. Ortho pins in our days are usually gold or titanium – rarely ferromagnetic steel. Unlikely though possible
4. The final answer did fit most of the symptoms but had one very big flow – a condition that is 10 years old presents itself with an array of symptoms and doesn’t worsen in a day. I guess the patient lying was the explanation for this as well.
5. What caused the sudden onset paralysis? Cue on sudden onset. I find it hard to believe she would not have episodes of paralysis seizures before….
6. I suppose pressure on the spinal nerves could lead to pericardial effusion (it could cause irregularities in the heart rhythm enough that to cause to form fluid in the periacardial sac) but that is a long shot in any sense of the word. Fluid around the heart is not neurological symptom – it actually points out in a different direction than all the other symptoms. Than again I am not cardio so my knowledge might be completely wrong.
The producers are playing the right tune here and I am pleased. I’ll be even more pleased if people stop complaining for the whole Huddy thing and start to enjoy it :)
October 5th, 2010 at 1:59 pm
Trauma to the thyroid usually follows a two-phase course. First, there is HYPER-thyroidism, caused by the acute release of hormone stored in the gland. As the released hormone is metabolized, hormone levels fall back to normal, where they may stay for awhile, as the pituitary ramps up TSH secretion to compensate for the damaged thyroid’s reduced ability to produce hormones.
Hypothyroidism, of variable degree, could then follow. The speed with which the patient becomes hypothyroid would depend on the extent to which the glad was damaged. With a lesser degree, the patient may drift slowly into hypothyroidism as the compensating mechanisms gradually become exhausted. With a greater degree, the entry would be quicker. So I don’t agree that the patient would necessarily become hypothyroid “overnight.”
October 5th, 2010 at 2:50 pm
Longtime reader, first time poster! A few thoughts:
-I was really expecting her overly acute sense of smell to be a symptom!
-I liked the scene where she “read” Taub and Chase… almost House-style. Would have liked to see her get more of a read on House.
-No one has mentioned the sparks/electricity coming off of her leg while in the MRI room… is this really possible?
-LOVED the go-cart scene… the apathetic employee gave one of the best lines of the night, IMO: “Ready… Set… Go away.”
-I’ve been in and out of the last few seasons and I’m loving this one! I, for one, am loving seeing House and Cuddy together. He is becoming more of a dynamic character, giving him more depth. I am really enjoying both the drama story lines as well as the medicine.
-This is the first I’ve seen of Wilson’s lady friend… lol Cantare “Holy Amber, Batman!” is right! Is there a back story to this chick or was she just thrown into this ep?
October 5th, 2010 at 4:40 pm
I had to love the scenes of House going into a ,coma patient’s room and stealing stuff, classic. But I think this is the closest to the old House we are going to get for awhile, unless the really did kick Egan and Jacobs out of the writing room.
October 5th, 2010 at 4:45 pm
Montrealer: Global TV has the episodes online, try: http://www.globaltv.com/house/video/full+episodes/unwritten/video.html?v=1607562495&p=1&s=dd#video
October 5th, 2010 at 5:39 pm
Great episode!!! season 7 keeps getting better and better.
October 5th, 2010 at 6:35 pm
she is wilsons first wife
October 5th, 2010 at 6:43 pm
I’m surprised no one mentioned the last scene. The POTW has been shown to be observant and someone who ‘reads people’ well. When House goes “Your son…” everybody with eyes can see Cuddy tense up, almost as if she is shouting “Don;t tell her you lied about him.’ The POTW would have seen that and — having already been lied to by House, known the aneurysm story was one he made up for her benefit. Where does that leave her?
I too am someone who thinks this will be the last year. I think Laurie will see that he’s taken the character about as far as he can — actually, I thought that last year but he had another contracted year.
October 5th, 2010 at 7:01 pm
@JenJen “No one has mentioned the sparks/electricity coming off of her leg while in the MRI room… is this really possible?”
I’m not a doctor, nor even a physicist, but from what I remember from school, Michael Faraday proved that electricity and magnetism are two manifestations of the same force i.e. one can make another and vice versa, so for me it’s sure damn possible…
And for Sam (Wilson’s 1st wife) – she was introduced in Season 6.
October 5th, 2010 at 7:10 pm
Thank you so much, EEStudent, for explaining why the metal pins would not heat up. That was a real shout-at-the-TV moment for me! Loved the episode, apart from that, and pleased to see it earned a high grade from Scott :)
October 5th, 2010 at 7:23 pm
For Montrealer: Just google it, you’ll find it in a few seconds. Or here’s one currently working link (if I’m allowed to post this): http://www.filestube.com/5lXitXQ5BH6TWPWMbkzxAh/House-MD-7×03-Unwritten-VOSE2.html
October 5th, 2010 at 7:25 pm
The soap opera was absolutely horrid, as it has been since the episode past ‘broken’. That is all.
October 5th, 2010 at 8:53 pm
Every MRI I’ve ever been in had a Metal Detector build into the door to make sure you didn’t forget any metal. Is this not standard? Also who uses iron pins? Seems like pins would be made of some other metal for just this sort of reason.
October 5th, 2010 at 9:08 pm
Something that has really bothered me, and I just want to confirm it. Is it really possible to read off ink in a ribbon using an MRI machine? I even noticed even with the implied impracticality behind using it (yeah, Cuddy was pretty mad about it), and wouldn’t there be another tool to actually do that, or was it literally for saving time in the show?
October 5th, 2010 at 11:12 pm
From http://www.radiologyinfo.org/en/info.cfm?pg=bodymr
You should tell the technologist if you have medical or electronic devices in your body, because they may interfere with the exam or potentially pose a risk, depending on their nature and the strength of the MRI magnet. Examples include but are not limited to:
•artificial heart valves
•implanted drug infusion ports
•implanted electronic device, including a cardiac pacemaker
•artificial limbs or metallic joint prostheses
•implanted nerve stimulators
•metal pins, screws, plates, stents or surgical staples
In general, metal objects used in orthopedic surgery pose no risk during MRI. However, a recently placed artificial joint may require the use of another imaging procedure. If there is any question of their presence, an x-ray may be taken to detect the presence of and identify any metal objects.
October 6th, 2010 at 12:05 am
@Soothsayer: I’ve done literally hundreds of valve replacements, and not once did I use an artificial that was anything but titanium with a pyrolytic carbon coating. Some of the older valves might have had steel struts, but not the new ones.
October 6th, 2010 at 12:06 am
“Six more clinic hours”
Y’know what? I wish he would do some more clinic hours. That’s always been one of the funniest parts of the show.
October 6th, 2010 at 1:25 am
Did anyone else watch Glee tonight? (Yeah, its my guilty pleasure.) Kurt’s dad suffered a cardiac arrythmia which caused hypoxia which caused him to slip into a coma. Now THAT is a TRUE and ACCURATE account of a righteous medical condition: A symptom leading to a condition which is diagnosed by a lab test with treatment administered accordingly. Even the way the writers woke the old man up was well done. Perhaps the writers of House should refer all of their medical questions to the writers of Glee, instead of getting their inspiration (and their answers) from a fortune cookie.
October 6th, 2010 at 9:17 am
and i think the go cart chase should go down as the pivotal moment for jumping the shark.
October 6th, 2010 at 9:18 am
Re: the typewriter ribbon. You can read the text off a carbon ribbon, but not off a fabric ribbon, which is the kind that manual typewriters (like hers) use.
October 6th, 2010 at 10:48 am
The writers may have been thinking about the effect of microwaves on metallic objects. I burned up the handle on my teapot by forgetting it had a wire core.
October 6th, 2010 at 10:51 am
Probably obvious, but each 6inch segment of typewriter ribbon would hold about one line of text, so reconstructing a single page would have taken multiple scans, and doing the whole book would have taken ages, even if the ribbon hadn’t reversed direction and begun overwriting mid-book.
October 6th, 2010 at 10:54 am
I was just thinking, could the burns be from the electrical arcs? That would explain the burning, without the metal heating (which doesn’t happen)
October 6th, 2010 at 10:55 am
George Fowler: thank you, thank you very much. The mega video link you provided was the only one to work. (Although I could have done without the Spanish subtitles.)
“Your son….. was very lucky to have you as a mother.” This line by House at the very end while Cuddy was watching – was the most powerful moment of the hour, don’t you agree?
The old cruel House who wants to have another book written even if it means having to make the mother suffer is supplanted by the new kinder House who is in love with Cuddy. I can see why some viewers are getting nauseous but it works for me.
October 6th, 2010 at 11:48 am
I cannot believe how many paeople are fascinated by the whole ink ribbon shananza… OK here is the deal at least I can say I saw it first hand. We have an old typewritesr in our house – one of the oldest types just like the one in the movie with ribbon and stroking letters. While there are more modern ones that auto reverse the ribbon ours cannot do it – which means that we manually reverse it when it runs out, and then replace it after 5-6 runs (the ink starts to fade after using it too much and the letters become uneven). You have to hit the keys stronger and stronger to get any result. And here is the deal breaker – you can write about 30 or so pages before you go through the ribbon. Of course there are different machines that use different types of ribbon but I think we can safely assume that you cannot write a whole book with ONE ribbon. Myth busted – you cannot read from the ribbon because there are at least 5-6 imprints on in one on top of each other. It looked cool though and funny. Considering that House nad Sam were hating each other last season I was surprised to see them be BFF here. I also have to say that this was the first time I was not annoyed by Samantha Watros – her parts were small but well played and enjoyable. I still think she is a very poor substitute for Amber though – kind a like drinking cheap wine after having a dose of single malts scotch. I guess Wilson is being Wilson – taking what is available and enjoying it the best he can. Slacker :)
October 6th, 2010 at 12:28 pm
Doesn’t work for me, mostly because as an obsessive reader I would have been seriously pissed off (rant, scream, throw book pissed off) by an author who ended a series with a cliffhanger without resolving any of the plot threads. That’s just lazy.
October 6th, 2010 at 4:12 pm
House M.D. is officially back on form!
Pleasantly surprised by this episode, it’s old school enough to keep me interested, finally!
Long may this season continue to restore my faith in the show, please build on this mild relief!
And please keep up the excellent coverage Scott, your blog is the only credible place to come to on the internet for an extra dosage of House related goodness (although I occasionally go hunting for spoilers too).
Cheers
October 6th, 2010 at 5:15 pm
LOVED last nights–best ep this season. I always adore when there is lots of humor esp. between House and Wilson.
I thought it interesting how well House was getting along with Sam (esp after last season). He had more in common with her than Cuddy….the gocart segment was hysterical.
I wonder if the writers were foreshadowing when they wrote the ending–how House was upset about the cliff-hanger, and she said she was going to let the readers make their own conclusions.
Loved the pop references–Stephen King’s Dolores Claiborne; Harry Potter/Twilight, possibly Phantom Menace (when House messes w/ Sam’s gocart).
The MRI/leg pin thing was NOT accurate IMO–and to the poster who asked about the little cage, I’ve not had one every time. I should get frequent MRI miles for the number I’ve had.
October 6th, 2010 at 5:16 pm
Sorry, my bad, the Stephen King reference was for Misery, not Dolores Claiborne “Dirty Birdy”
October 6th, 2010 at 6:09 pm
I’m glad I’m not the only one who noticed the typewriter ribbon thing.
I got my first typewriter as a Christmas gift when I was ten, and it had a cloth ribbon like the one in this episode. That ribbon was maybe ten feet long, at the most. When you got to the end of it, the spools automatically switch direction and you start re-typing over the ribbon. So even if the striking keys do leave some kind of readable impression in the ink-saturated cloth — which I doubt — those impressions would be obliterated as the ribbon was constantly reused.
Later on, I got a Smith & Corona that used one-time ribbon cartridges, and you could open those up and read the keystrokes off them. (But even then, I doubt one cartridge would be enough to write a whole novel, and the script has House talking as if he has read the whole thing.)
All in all it would have been more believable if House had just cracked the safe. But Cuddy wouldn’t have stood for that. . .
October 7th, 2010 at 1:58 am
The soap opera suffered on behalf of raising up the medical stuff? Count me out. Unlike everyone else who comments here, I like the DRAMA first, and the REALISM second. If you want reality, then you should probably turn off your TV and go outside. If you want to be entertained, then by all means: stop complaining.
October 7th, 2010 at 2:39 am
Nonny Amos: Clearly, you’ve missed the point. It’s not the drama, it’s the individuals involved in the drama and the contrived storyline behind it. Also, the inaccuracy of the medicine could be forgiven to a certain extent, but lately (with a few exceptions) they’ve run ‘way off the rails inasmuch as what they are attempting to get your average intelligent viewer to swallow. It’s just not the same show; something unique was lost over the past season or two and I don’t know if it can be fixed.
October 7th, 2010 at 8:53 am
One of the hardest things to explain to lay people is that all metals will exhibit magnetic properties when exposed to a varying magnetic field, or move through a static magnetic field. This is because of eddy currents produced in the metals as the magnetic field lines “soak” through them. These currents produce a magnetic field and also heat up the metal. How much depends on a lot of factors too involved to explain here but I’m sure the MRI builders have figured this all out for various metals likely to be found in a human. A static magnetic field wouldn’t heat up the metal in the potw’s leg.
Anyway, it’s easier to demonstrate then explain. Get two pipes one pvc and one copper. Get a disc magnet that will easily pass through both. Hold the magnet to both pipes and it will not stick to either. Drop the magnet alternately through the pipes and it will fall straight through the pvc but clang all the way down the copper one. The moving magnetic field creates eddy currents in the cu which creates magnetic fields which repel the magnet from one side of the pipe to the other side all the way down.
Dr Bulgari: I had an MRI done in April and I wasn’t x-rayed. I also have a permanent bridge made of SS (I believe), and it posed no problem.
October 7th, 2010 at 9:03 am
Well, this episode might be getting them back on track a bit.
October 7th, 2010 at 2:16 pm
House: …it can’t be lupus.
Chase: WHY NOT?!
Well they made it to episode 3 of the season before mentioning lupus. That’s some serious restraint, right there.
@Hibbleton
You are correct, an MRI should not interfere with any metal as it has a static field while turned off. However when it is activated, it pulses, causing nucleomagnetic resonance: it influences free protons i.e. every hydrogen atom in the body. This involves *very* strong magnetism and the pulse can absolutely move metal implants (especially stainless steel, but not titanium).
The heating effect can happen (even happen the patient’s normal tissue due to exciting the hydrogen atoms) but not until the patient was in the machine and it was turned ON
This all brings up an interesting point: how are the computers they are using able to work that close to the MRI?
October 7th, 2010 at 3:01 pm
Same old kvetches with the series, which has lost just about everything that originally made it a hit. OK, nice medical mystery. But one medical story is not enough to sustain a 43-minute show and certainly not enough to make the show stand out from whatever other drivel is on TV. Here’s what we’ve lost:
–The misanthropic, drug-addicted genius who was the show’s original premise.
–The usual second medical mystery that generally used to come in the form of a clinic case.
–The complex layering of smart people working to outsmart each other and the added mystery of who was fooling whom.
–Unique, colorful characters among the young bloods.
–90% of the humor.
I appear to be addicted to the hope that these things will return, that the writers will suddenly realize they’ve wandered onto a trail that peters off in the wilderness and grab a GPS to retrace their steps.
At least the POTW was interesting this week, in a personal sense. Not much consolation.
October 8th, 2010 at 8:42 am
In my opinion, “House” is near the end of its life cycle.
Writing a good episode of “House” requires a lot of imagination and research; writing 21 such episodes each season is a very tall order. I suspect that by the end of season 3, the “file drawer” of ideas was pretty much cleared out and the show’s staff was faced with the question “now what?”
I think that is why the focus has shifted from the medical mystery to the characters. Character stories are much easier to write and the pool of talent who can write them is much larger than the few who can come up with a compelling medical mystery.
October 8th, 2010 at 10:15 am
@Amathakathi : “This all brings up an interesting point: how are the computers they are using able to work that close to the MRI?”
The field falls off as r^3. At my MRI, the computers were about 20 feet away.
October 8th, 2010 at 3:25 pm
In addition, you will notice that the computers are behind shielded glass.
October 9th, 2010 at 12:14 am
I’m surprised no one has mentioned the return of the whiteboard, even if only for on scene. I’ve been waiting for ages for House to break out the whiteboard with symptoms since it became of a staple of the show, so I’m glad to see it hasn’t been completely forgotten.
Honestly all this episode was a funny clinic patient and this easily could have been a season 2/3 episode. Engaging medical case/POTW (at least to me), soap opera that wasn’t excruciatingly overwhelming or sappy, and some trademark humor to boot.
October 9th, 2010 at 1:11 am
I hope they continue trying to emulate the earlier episodes, they might just remember how to write a good medical mystery
October 9th, 2010 at 12:50 pm
It’s confirmed: Happy House trying to be the good boyfriend is just boring as hell.
I keep thinking back to the “tiny baby coffins” bit from I forget what episode. That’s the House I want to see.
October 9th, 2010 at 4:13 pm
I was talking at a get-together the other day of science-minded, computer-type people. After several hours of programming talk had relaxed past politics into embarrassing stories, I brought up House as my most recent obsession. I was surprised at the chorus of excitement that I got in response. I knew I was the only one there even slightly involved with the medical profession, but every single one of them both knew and adored the show- but here’s the catch. Not a single one cared a fig about the first three seasons. Every single person at the party had either started watching, or had only watched “the season where House started hallucinating and lost his mind”. I just thought that was funny, but it made for some good conversation…
October 10th, 2010 at 11:51 am
@ Dr. R: There’s x-ray and electrostatic shielding glasses but not static magnetic field glass. To demonstrate, get a small magnet and hold it to one side of a shielding glass and a piece of steel to the other side. It will stick.
October 10th, 2010 at 1:55 pm
They seriously need to start focusing on the medicine more. I like the drama, though the dialogue is making it slightly too “spot on.” But then again, House’s talent was for always pointing out subtext to point and laugh at people.
Scott, requesting an official comment. Why is in Season 5, a woman had pins in her brain and merely started puking when she got near the MRI machine. However, this patient immediately starts experiencing a burning sensational. The treatment of metal seems inconsistent?
Now, bets on what’s happening with 13:
1) She moved in with Chase and they’ve been dating for a while (he hired a chick intentionally to throw off suspicion, or they were doing a 3way…)
2) Death in the family and she wants to go it alone like Foreman
3) She’s pregnant and freaking out
4) Undergoing an even riskier experiments regarding Huntington’s
October 10th, 2010 at 5:38 pm
Ah, must have been thinking of radioshielded glass. I’m a surgeon, not a radiologist, so I don;t work around that kind of think.
October 11th, 2010 at 12:19 am
I think Juan may have put his finger on it. The original shows were an extraordinary fear. Rather than tearing my hair out that the shoe has descended to TV dramediocrity, I should feel amazed that so much was made possible for three seasons and maybe a little more.
October 11th, 2010 at 3:56 am
@Hibbleton: Stainless steel as you call it is actually Cr-Co-Mo (chrome-cobalt-molibden) which is a metal alloe not steel. It is not magnetic at all. Metal pins that are inseted in bones are usually gold or titanium BUT can be stainless steel (which is feromagnetic). So metal plates in bones – X-ray first, crowns and bridges – no need. Good history is a must of course – but still they usually perform X-Rays first to check when there is history of TRAUMA just to make sure. Then again the POTW was lying her ass out so they must have missed it. (And she did not use her real name on admission – that is one talented liar :)
October 11th, 2010 at 4:58 pm
Stainless steel and chro-moly (? not sure if you mean that) are both alloys of steel. They both contain iron. My point was that all metals exhibit magnetic properties when a current flows through them, i.e. electromagnets are made of copper which is nonmagnetic. Give me any metal and I can make a magnet out of it.
October 12th, 2010 at 12:47 am
@Hibbleton : Absolutely true – both are metal alloys however the second one (check the periodic table) has no iron in it (it actually might have traces of iron but that is not the basic meld). Trust me I asked my dental technician about it because I wanted to make sure my first year know how is not misleading me – it was 10 years ago after all. It is not magnetic (may be it can turn magnetic as all metals can but if you place that alloe in a magnetic field nothing will happen and it will not stick to magnets normally). So thee verdict is – metal from bridges and crowns can safely go inside an MRI
October 12th, 2010 at 1:26 pm
She doesn’t look hypothyroidal to me.. Skinny not fat and sweaty not dry rather points to hyperthyroidism I’d say.. Writing 10 books also does not point to hypothyroidism which make you tired not productive. And analysing chase and taub like that points to a sharp intellect while worsening of cognitive functions is a symtom of hypothyroidism… could it be love makes house a bit off in his diagnosing skills???
October 12th, 2010 at 9:12 pm
@Hibbleton, Dr Bulgaria, et. al.
I see a lot of confusion about electromagnetism and the meaning of the word “magnetic”. Allow me to clarify some adjectives first:
Ferromagnetic = basically, a material that is strongly pulled toward a magnet. This results from having atoms whose magnetic moments can align themselves with an applied field.
Conductive = allows electricity to pass relatively easily. Since all electric currents produce magnetic fields, a conductor can be used to generate a magnetic field *if you pass a current through it*. If there is no circuit pushing current through it, then a conductor doesn’t really have any particular behavior regarding a static magnetic field that is applied.
Paramagnetic = attracted very weakly to a magnet due to quantum effects.
Diamagnetic = repels a magnet very weakly due to quantum effects. Most materials exhibit this effect at least slightly, but it may be overpowered by other effects.
Metal = a very general term for a particular class of materials. Not all metals necessarily have any of the above qualities, and not all materials with one of the above qualities are metals.
Now that that’s settled: iron is ferromagnetic. It is strongly pulled toward a magnet. I very much doubt that paramagnetic or diamagnetic materials are dangerous around an MRI machine, since that effect is so very weak. I also doubt that conductors are a problem because the field does not alternate. Also, an alloy does not necessarily share the properties of its components. So an alloy that contains some iron is not necessarily significantly ferromagnetic.
And Hibbleton: not all metals conduct electricity well, but of course you can make a magnet out of any substance at all if you apply a voltage high enough to induce a current in it.
October 14th, 2010 at 3:22 pm
Did anyone else seethe with fury when the team just stood there watching her leg sparkle? They’re supposed to be doctors, and they just stood there in shock! Should they not have immediately rushed her away from the giant magnet?
October 16th, 2010 at 7:29 am
@Soothsayer, back from Oct 4:
I think the lower limit for air embolism being a problem is about 100mL of air so… Probably wasn’t an issue, then.
October 16th, 2010 at 9:18 pm
I have a bunch of metal (plates, screws, etc.) in my hip, leg, and foot, and have had plenty of MRI’s. The metal in orthopedic surgery is not magnetic.
October 17th, 2010 at 12:06 am
They re-aired this yesterday and I had most insight on the book….the boy is a detective…..women who like/love him (one presumably dead)…..scar….unknown father…..likes the yo-yo…..it’s HOUSE!
I was watching an earlier episoe with him playing with a yo-yo and it hit me.
FWIW…..I know, I’m wayyyyy too obsessed….or is there such a thing when it comes to House? LOL
October 17th, 2010 at 1:51 am
The entire writing aspect of the episode was completely ridiculous. Every single thing. The rest was much better than the previous episodes this season but still quite mediocre. I hate the Houddy element.
October 17th, 2010 at 3:35 pm
It was nice to see a Royal typewriter in use. If I’m not mistaken, a KMM (1939 model), with the original glass keys. (I used to use a 1937 KHM.) But I can only wonder if the writer for this episode has ever used an old manual; he should have known that didn’t make sense about the ribbon.
So, if I understand the medical stuff, it was sheer coincidence that she had a seizure at the very instant she was trying to shoot herself?
October 17th, 2010 at 3:41 pm
By the way — there are still plenty of those great typewriters in working order, but the ribbons are getting hard to find.
October 21st, 2010 at 12:37 pm
The reading of the typewriter-ribbon was ridiculous for more reasons than that it was put in the MRI. Manual typewriters go back and forth over the same ribbon many, many times — this is why typed pages used to get dimmer and dimmer as the ribbon got older. I don’t actually know, but I suspect the typewriter would go over the ribbon several times in the course of writing a book, so unless she’d changed the ribbon quite recently, every scrap of the ribbon would have had many, many letters typed with it.
Even if you could figure out by examination (with or without an MRI) that a particular spot on the ribbon had had an s, an e, a t, and an r typed one or more times, it would be a massive task in cryptography (or something) to figure out the actual text, if it could be done at all.
Mind you, I typed this after reading only partway through the comments, and other people have made most of these points, though not in quite the same way.
October 21st, 2010 at 12:40 pm
@April:
“I think the lower limit for air embolism being a problem is about 100mL of air so… Probably wasn’t an issue, then.”
A hundred millilitres (also known as 100 cc) is a huge quantity. It’s nearly half a cup, to put it in what may be more familiar terms. I don’t know if they even make syringes that big; the largest one I ever saw (used by a vet for injecting subcutaneous fluid in a cat — they have much looser skin than humans) was 50cc, IIRC.
Could you have been thinking of .1 ml, or even a hundredth of a millilitre?
October 27th, 2010 at 7:32 pm
Just a quick note. Even if the typewriter ribbon had been used 5-6 times you would probably be able to read of it. As simple crypthology-software should be able to filter the words from each other, given that it was a fluid text. Ive read stories of police agencies dechiffering blocks of text from notebooks with 20-30 layesr of text superimposed. So its not impossible, just improbable.
As for the POTW reading people, I found it telling that she really could not read house (he tricked her with the sedative and the story about the son). And even if she suspected he might have sugarcoated the story, she had the procedure and was in less pain, the depression was wearing of etc. So she would rather move on.
As for House being “destroyed” by Cuddy, by showing compassion, let’s not forget his ulterior motive, he wanted more Jack Cannon books! I find it quite entertaining to she “Huddy” unfold, if nothing else it makes for a new interaction and potential for character development, which a show in it’s 7th season needs not to grow stale.
And 13? I still think House knows more about her where abouts than he lets on. Maybe that’s why he’s stalling finding a replacement. He seems to respects her in a different way than Chace, Taub and Foreman, because she is less of a push around.
November 29th, 2010 at 9:06 pm
Am I the only one who thought the emotional arc here was kind of lukewarm?
The moment she lovingly acknowledged a boy with a scar who wasn’t there and then pulled a gun out of her desk, I immediately called “Son died in a car crash.”
Hell, I thought that was so clear from the beginning that I got a little confused later on, and it took me a second to realize the writers had meant for us to understand it as “He’s the character from the book/her muse.”
Maybe I’m too big a cynic and/or watch too much drama – anyone else make the same read of the opening scene?
December 24th, 2010 at 2:37 am
I hadn’t guessed the “son died in a car crash” thing until House brought up the idea of a car crash, but I try not to guess ahead, I like it better to be surprised.
Re: “Your son… was very lucky (etc)”- I interpreted it as that she would know he had meant to end that sentence differently and was holding back, but I would think the most logical intended end would be something that would attempt to make her change her mind, like “Your son would have wanted you to finish Jack’s story!” And then she would see it as House wanting to badger her into finishing the story but choosing instead to leave her in peace.
Re: ending on cliffhangers- hell yeah. I would be super frustrated if I was reading that book. One of my favorite book series ended on a cliffhanger, and I immediately went to the author’s website and found that all her contact info was taken down, and the main page was replaced with a note saying “chill out. they’re not real” (etc). Apparently I was not alone.
Re: the boy being House- dunno if that was intentional or not, but if so, that is AWESOME!
February 15th, 2011 at 6:45 am
MRI being my area the two scenes with it made me cringe.
First scene:
1) A static field does not induce currents. She would have to be moving relative to the MRI at impractical speed for sparks/burns to be possible. Switching gradients won’t do it either.
2) Basic mechanics! If the field is strong enough to rip out the surgical pins, it will certainly pin her leg to the machine first.
3) Just from (bad) experience with high-field research magnets: she’s way too far away from the magnet for it to have the force it has on such an object. Although the field is of course not spherical, the relationship with distance is roughly quadratic.
Second scene:
1) The resolution is completely infeasible at present, especially if you use the body coil, like they always do in the show as EEStudent pointed out.
2) MRI is a poor choice for a dry typewriter ribbon since it’s not very sensitive to the pigment in the first place. How about something that is very sensitive to stuff that absorbs light… say an optical microscope?
April 28th, 2011 at 8:17 pm
Regarding the Psych hold. He puts her on a 5150 (72 hour) hold. He’s running out of time when she tries to kill herself again using the syringe from House. This lets him put her on an additional 24 hour hold.
Wouldn’t (couldn’t) he just put her on a 5250 (14 day) after the 2nd attempt? This is what would normally happen to a patient who tries another suicide attempt during the 5150.
I suspect the additional 24 hour hold was for dramatic (race against the clock!) rather than realistic purpose.
June 17th, 2011 at 4:01 pm
Scene in MRI actually made me laugh. As i recall almost every time, it’s been pointed out that MRI is a giant non-stop working Magnet. Meaning that should someone with pins or screws or even Tattoo enter MRI chamber they will have… a problem.
Even before, in very House we had at very least two patients, one Chinese and one convict that had this problem. Oh! And don’t forget the dead guy with a bullet! XD
I liked this change. ^_^
Another thing that i found amusing is the fact that House instantly knew that she tried to kill herself.
I mean how did he? Sherlock Holmes… Riiight.
That Archive – most likely an Archive =)
I mean that Cuddy requested information about Helena, based on her screws. When she found out where that operation took place, she also found out her real name AND her history. Or is it just me watching too much CSI?
Again thanks for the review =)
July 24th, 2011 at 1:50 am
Was I the only one for whom the return of the whiteboard was a welcome (and long overdue) change of pace?
August 5th, 2011 at 10:16 am
Regarding the MRI, some more details for those who are interested (the rest, please skip onwards, this is quite long!):
(1) An MRI always has a static magnetic field associated with it. Turning this off or on (’ramping the magnet up or down’) takes about 3 days (!), which is why it is not done unless absolutely necessary (such as when the janitor in our facility decided to buff the floors in the MRI room one evening, and his huge metal buffer flew through the air and got jammed in the bore — the field IS that strong). In an emergency (if there was threat of personal injury, which was thankfully NOT the case in the episode I mentioned), the magnet can be quenched, stopping the magnetism very quickly. This happens by releasing the liquid helium which is used to keep the electromagnet supercooled. Refilling the magnet with helium costs about $50,000 and quenching can damage the magnet (purchase price $1.0-2.5 million), not to mention what the downtime does to the clinical schedule, so a cloud of helium outside the MRI building is one time you will see a hospital administrator RUN through the building.
(2) If you ever have the opportunity, it can be very interesting to hold a (single and VERY small) key on a very strong rope while bringing it towards the magnet — this shows quite well how the strength of the field increases dramatically as you approach. The key will ‘hover’ in the air, pulling towards the magnet, more strongly the closer you get. Nevertheless, firmly-bound items like zippers, bra-clasps, and such will not suddenly rip out of your clothing, much less a screw out of bone and through flesh, at least at the ‘power’ level usually found in a clinical MRI = 1.5-7 Tesla. In combination with the vibration of point (3), however, it can cause metal fragments embedded in the body to move about, which is why welders (who get miniscule metal fragments embedded around their eyes) are refused MRIs.
(3) Most dangerous for internal metal is when the image is being made — when the machine is making the loud noises. This is because the magnetic field changes orientation (as a previous respondant mentioned) very quickly, potentially causing the magnetic objects to vibrate and potentially causing electrical currents in metal objects, both of which can lead to heat-production, although this takes a little while to really heat up.
(4) In order for an MRI to create an image, it has to pick up very slight radiowaves which the molecules in the body produce in response to the changing magnetic field. In the ‘normal’ world, these would get lost among all the phone calls, radio stations, and so on. So the room in which an MRI is, has a Faraday cage built into the walls, ceiling, floor, door, and any windows around it, to isolate it from outside radiowaves. A Faraday cage is essentially a contiguous cage of copper wires, which prevents radiowaves from entering the room, so that the only radiowaves in the room are those produces by the patient’s molecules. This is why the window looks odd. You can see part of the Faraday cage as you go into the room: a row of copper strips along the edges of the door.
(5) Those plastic cages (RF-coils) which the technician may put around your head or leg or chest are basically special radio antenne’s to pick up the radiowaves being produced. There is a big one (the body coil) built into the magnet, but you get more detailed pictures if you use a coil as close as possible to the thing you want to image, so they are used for making images of small things, like the head, heart, or joints. Contrary to what a previous respondant said about the typewriter ribbon, it IS possible to make very detailed pictures with a clinical magnet (I know researchers who have imaged single cells in culture), but this involves VERY small fields-of-view (1cm x 1cm x 0.1 mm), one-of-a-kind coils, and extremely long image acquisition times (between 1-11 hours/image). To image an entire book worth of typewriter ribbon would take months of scanning at $400/hour, so this aspect of the typewriter ribbon thing is also completely unfeasible.
Well, that is my 2-cents on the MRI issue. I hope someone found it interesting or useful!
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