House — Episode 4 (Season 7): “Massage Therapy”
A solid episode of House this week with a satisfying twist in the diagnosis at the end. Still, there were several large holes in the medicine. And a new doctor on the team — a psychiatrist.
Margaret is a 30 year-old woman, watching television at home alone, when she hears a suspicious noise. She gets up and finds the front door unlocked and open. She starts carefully creeping through the house, trying to figure out if something is amiss. She calls her husband and he tells her that he’s almost home, but if she’s really concerned, to head to the neighbors. She hears a slamming door and, panicked, runs to the front room — only to discover that it was her husband coming home. There’s no time for reassurance, however, as she immediately started uncontrollably vomiting and develops severe abdominal pain.
Margaret is admitted to the hospital for evaluation of her abdominal pain and vomiting. Prior to admission, she had several days of milder abdominal pain, but no vomiting. She also has slightly elevated LFTs (liver function tests). Before the team can really get started on suggesting possible diagnoses, Chase introduces the doctor he just hired to replace Thirteen: Dr. Kelly Benedict, a very attractive psychiatrist. Once introductions are made, the grilling of Dr. Benedict begins (or “pimping” as it is known in medical school) and it is clear that she is out of her depth. Her suggestions of hepatitis A and appendicitis are quickly discredited, and the team concentrates on the possible diagnoses of lead poisoning and hepatic fibrosis. A liver angiogram is ordered to look for fibrosis, and Foreman and Taub head off to search her house for lead.
The angiogram shows no fibrosis, but it does reveal a narrowing in part of the liver, apparently from old scar tissues. Old broken ribs are also seen on the study. The investigation of Margaret’s house turns up no lead, but it does show that she was in Trenton, and not where she said she was, the day the symptoms started. She tells the team she merely got confused about the dates and it was not an intentional error. She also tells them she broke her ribs back in college when she crashed while cycling.
A short time later, Margaret develops supraventricular tachycardia (an abnormally fast heart rate originating in the top half of the heart). None of the usual tricks (carotid massage, adenosine) work, so she is placed on a pacemaker. Meanwhile, the team calls around for her old medical records, but nothing turns up. Benedict takes it a step further and learns that Margaret didn’t exist until three years ago and she is using the social security number of an elderly lady. When confronted, Margaret tells the team (and her husband) that she was married before and was an abused wife. Her ex-husband beat her and gave her the broken ribs. She moved out, but he found where she was living and poisoned her dog, so she finally got a new identity and moved away. She tells them that her real name is Jenny and that she goes to Trenton for a support group for abused spouses.
Focusing on the heart and stomach symptoms, Benedict is pimped for more possible diagnoses by House and Foreman. Her suggestions of gastritis, atrial fibrillation, cystitis (bladder infection), and cholecystitis (gallbladder disease) are quickly discredited and even mocked (as they should be; those are horrible suggestions). House suggests that Jenny may have been poisoned by her ex, since he did it before and the front door was open. She is started on pralidoxime, an antidote for organophosphate (pesticide) poisoning. The treatment doesn’t work, and she develops a fever (”pyrexia”) of 103. She is placed under a cooling blanket. Endocarditis is suggested and discarded before the team elects to treat possible Legionnaire’s disease.
Jenny’s husband mentions that he called the hospital in Trenton and there is no support group for abuse victims. He wonders what else she may have been lying about. When he tries to talk to her, she starts to hallucinate — mostly worms, snakes, and fire — and starts screaming. Radiology of the brain is obtained and shows a possible lesion. The team believes this to be the cause of her hallucinations and their differential diagnosis is abscess, lymphoma, or Wegener’s disease. Dr. Benedict disagrees and thinks the brain lesion is just a coincidence; she believes Jenny is actually suffering from a mental illness — she suspects bipolar disease. The physical symptoms are from some other, yet to be diagnosed, condition. House disagrees, and has the team prep Jenny ready for a brain biopsy. Just as Chase is starting to drill into the skull, Taub points out that Jenny is no longer febrile — one of her symptoms has stopped. Questioning Dr. Benedict closely, it turns out that she had been slowly turning down the cooling blanket, so Jenny has actually been afebrile (no fever) for some time. Could the fever have just been an antibiotic reaction? (Quick answer: no, Jenny was started on antibiotics after the fever. In fact, that’s the symptom that prompted their use). At this point, it finally dawns on the team that she has not vomited since her arrival. That’s another symptom resolved. House stops her pacemaker and nothing happens — her heart rate remains normal. That was her last major physical symptom, resolved as well. Benedict suggests that Jenny’s mental symptoms — the hallucinations — may have just been caused by a stress reaction to her physical symptoms, but House realizes it is just the opposite. Her mental symptoms were primary, and the physical symptoms are all secondary. He starts her on haloperidol (Haldol, an antipsychotic) and lorazepam (Ativan, an anti-anxiety agent) and tells the team to call him when she wakes up from anesthesia. It turns out that Jenny is a long time schizophrenic. She had been secretly seeing a psychiatrist in Trenton (hence her frequent visits) and had been taking risperidone to control the schizophrenia. Unfortunately, she started to develop side effects (abdominal pain, initially) to the medication so her doctor started to wean her off the medication -– which was then stopped abruptly when she was admitted to the hospital. Her physical symptoms were all risperidone induced and her hallucinations were the schizophrenia returning.
As usual, major complaints are in red, minor complaints are in blue, and nit-picking ones in green:
So Jenny’s side effects from the risperidol worsened when the medication was stopped? She didn’t develop the fever and tachycardia until she had been off the medication for some time.
Vagal maneuvers are first line for SVT (i.e. do them before injecting adenosine). When those don’t work, then you try adenosine, several doses if needed. If that doesn’t work, then you go for cardioversion (i.e shock). Pacemakers have no role in the treatment of acute SVT.
Sorry to correct the psychiatrist, Jenny was suffering from hallucinations more than delusions.
And she has an unexplained lesion in her temporal lobe.
Angiogrophy is not the primary test for diagnosing hepatic fibrosis. It can be helpful in looking at the extent of the disease once it has been diagnosis, but it’s not very good at diagnosis. (Ultrasound, CT, or MRI are better choices, but a liver biopsy is really the gold standard for diagnosing hepatic fibrosis).
Maybe Jenny hadn’t vomited because, like most patients with nausea and vomiting, she was on strong anti-nausea medications.
While pralidoxime is used for the treatment of organophosphate poisoning, atropine is also required (in fact, recent studies suggest atropine is the key component and pralidoxime not so important).
An EKG and lack of Osler’s nodes are not good reasons for ruling out endocarditis (Osler nodes, for instance, only occur in 10-25% of endocarditis patients). Echocardiogram is better, but even at best it’s only about 90% correct. You need lots of bloodwork, especially blood cultures, to truly rule out endocarditis.
I like how House slams a patient with a major tranquilizer (haloperidol) and a minor tranquilizer (lorazepam) and expects her to wake up (even in a few hours) and be intelligible. Not going to happen.
So the whole “they’re calling from inside the house!” opening was just a red herring and had nothing to do with the diagnosis at all. So she just left the doors open?
And she has an unexplained lesion in her temporal lobe.
This was yet another good medical mystery, even though the symptoms were very common — common enough to make we wonder why she ended up on House’s service. Still, I give it a solid B. The final solution was clever and, if one ignores the timecourse, fits. I give in a B-. The medicine was about average. For the second week, the progression was fairly logical, though points are deducted for some relatively obvious errors (antibiotics/fever, SVT treatment). I give it a B-. The soap opera was still good. I liked the new doctor — even though she clearly wasn’t cut out for House’s team — but need to see more Wilson. I given it a B.
The review of the previous episode of House
A list of all prior House reviews
October 11th, 2010 at 11:01 pm
Dr. Scott, I’m glad you liked Dr. Kelly Benedict, but I think it’s pretty apparent that this was the first and last time we’re going to see her. I envision a female doctor-of-the-week until Thirteen returns. (Could one of the guest physicians possibly be Dr. Allison Cameron? I wish!)
October 11th, 2010 at 11:06 pm
My dissent from the polite dissent: :-)
The pacemaker was used to overdrive the SVT. Not a common thing, and maybe too aggressive, but it should work. The real issue is that one would not leave the overdrive going chronically.
I, too, wondered about the tranquilizers and then the comment about the patient waking up. Then I realized the “wake-up” referred to the anesthesia she was under for the brain procedure. She would wake up from that, and, presumably, be given somewhat low doses of the tranquilizers.
October 11th, 2010 at 11:10 pm
Hi! Long time reader, first time commenter. What really bugged me about this one was how it featured one of the most pervasive and wrong mistakes in psychology (note: I’m not a doctor, but a well-informed college student). Bipolar disorder is a MOOD DISORDER and can only cause hallucinations at the height of a manic or depressive episode, and generally only last for short bursts during the manic episodes of bipolar (type 1) or mania patients. It’s bad enough that most people confuse bipolar with paranoid schizophrenia, but thinking that bipolar disorder could suddenly develop in a 30-year old and cause consistent tactile hallucinations (why else get the increasing pain in the hospital) but no mood disturbances is by far the dumbest thing the new doctor (a psychiatrist) said. And yet it turned out to be almost right.
How on earth does this ill-conceived twist explain the heart symptoms? It’s like having a hebephrenic patient with a disappearing tumor that’s caused by the fact that only one of his multiple personalities has cancer — more psychology misconceptions than can be counted. And all this after an episode that said that hallucinations are a non-symptom?
October 11th, 2010 at 11:11 pm
Any one else have issues with the fact that when they went to drill into her head, it appeared (and rightly so… if this were to follow the course of other medical dramas) that her head was shaved….
then in the following scene, her flowing locks were right back where they should be???
October 11th, 2010 at 11:14 pm
What do you want to bet Dr. Kelly Benedict ends up with Chase al la Amber with wilson.
October 11th, 2010 at 11:21 pm
You forgot about the unexplained lesion in her temporal lobe.
:)
October 11th, 2010 at 11:21 pm
Perhaps they were using the Hfuhruhurr screw-top procedure.
October 11th, 2010 at 11:29 pm
The last two episodes have shown better pacing, both with the drama and the medicine. It seems to help keep the medicine, if not logical and correct, at least on the same side of the street.
Obviously, the medicine is still far from perfect, but it seems like someone on the writing team has been reading this blog. :)
I liked Dr. Benedict as well, but didn’t expect her to stick around. She was way better than the Supermodel doctor in the 4th season. I think it would have been better, though, if she told Chase to go to hell…
October 11th, 2010 at 11:49 pm
I think there was a reveal in the preview for next week’s episode. House tells them to fire the new doctor they hired without even giving her a second.
They can’t miss the chance for this drama to unfold: Chase let Dr. Kelly quit so they could date, but House is going to insist that they bring her back because she Wilsoned him this week and because he can use that to torture both Chase and Dr. Kelly. FUN STUFF!
Dr. Kelly may be in for two or three more episodes.
October 12th, 2010 at 1:02 am
Okay the medical thing was obviously a hit or miss thing as teh whole thing was based on mental illness to focus on the new lady. The whole new lady thing was an obvious play to get Chase more involved but the Cuddy House massage therapist thing was a nice diversion. It got House to focus on the fact played out nicely twice in fact that Cuddy wsn’t there in the morning. It made the fact evident that Cuddy was in fact trying to keep her distance. Which was nicely played off. The end was in fact a nice contribution that House Wanted to try to be part of her her life as a whole.
The soap opera thing is a nice turn in my opinion. It maked House more interesting.
October 12th, 2010 at 1:05 am
So she has been on her anti-psyc meds for a long time, at least 3 years, presumably with no side-affects, otherwise her husband would have noticed, and then she suddenly develops several serious acute symptoms serious enough to get her to House?
Plausible?
October 12th, 2010 at 1:18 am
Did anyone notice the game House was playing looked like the game the guy was developing in Season 6 episode 2
October 12th, 2010 at 1:26 am
The drama always needs more Wilson.
Things I miss: What happened to House’s feud with Sam? That was looking like it could be fun…
Also, I was watching old episodes and I miss the animation and the explanations to the dumb patients aka the nonmedical members of the audience (like me). I used to feel like I could vaguely follow what was happening medicine-wise and I feel the recent seasons are harder for me to follow.
@Kyle, Yeah I thought that was the point of showing the game. I liked that.
October 12th, 2010 at 4:39 am
So, am I the only evil, insensitive jerk who laughed her head off at “Billy – I’m schizophrenic!”? And spent the rest of the show mocking it (”Fred – I’m psychotic! Jerry – I’m bipolar!”)?
It also seems to me that if House has found a massage therapist who makes his leg hurt less, he should damn well continue hiring her, no matter what their past history, but also that his sending a prostitute to massage Cuddy was beyond inappropriate. Seems to be a lot of Cuddy and House nudity going on, too, though nobody at our house was exactly complaining about that.
We did appreciate evil Chase not telling Dr. Benedict that House wasn’t firing her, though.
October 12th, 2010 at 5:33 am
The brain lesion is not the only unexplained matter. After it was established that she was lying rather randomly about everything (Carl, Trenton), they never pinned down how she broke her ribs, whether she was bigamous (relevant to the husband’s dilemma!), etc. It seemed to me that they would insist on getting more of her original name than “Jenny,” and if they did they could get her medical history, and if they got that…. I found the whole episode rather weak, though Scott as usual sheds some light.
October 12th, 2010 at 7:37 am
I found the episode weak as well. Compared to last week’s excellent episode, this one was a letdown.
The dialogue this week was gullible overall. I wish the episode creators had spent more time on dialogue, plot, flow, etc., and less time on the useless shock elements they seemed to put a lot of effort into this week: the red herring suspense at the beginning; the demonic hallucination of the patient’s husband; Cuddy stark naked in her office (yeah right. that got a huge rolleyes from me); blah blah blah.
Perhaps the only redeeming aspect of the episode was the medical mystery, but I’m not a medical person, so I’ll have to take Scott’s word for it on that.
October 12th, 2010 at 7:58 am
Well, it was obvious it was going to be a mental illness case as soon as we saw that female-of-the-week was a psychiatrist.
October 12th, 2010 at 8:10 am
Well the med student who ends up being 13’s replacement until her return comes in 2 weeks from now, so my guess would be that since Chase’s attempt at a hire failed, Foreman got a chance to hire the doctor we’ll see next week, only to have her fail as well.
October 12th, 2010 at 8:39 am
first of all the treatment for schziophrenia is not risperdal, but clozaril. secondly, the plot was awful, house was awful, cuddy theme was awful, kelly was awful, and the entire movie show was awful. they are going to have to do alot better than this if they want to keep the movie going forward. chase will bang kelly, she will leave and another jerk will show up. this is the beginning of the end of the show iti s very apparent to me. so far each week since they began it with the new season has gotten worse and worse. this show now sucks. i hope it meets it’s demise in a dignified manner at least
October 12th, 2010 at 8:49 am
dr scott knows nothing about psy disorders. if he did, he would have known that you treat schziophrenia with clozaril, and not risperdal. clozaril has been around since 1990. it is the only med bascially used for this treatment and especially after anything else fails. this show sucks now…..!!!!!!!!!!!!!!!
October 12th, 2010 at 8:57 am
quoted from ruby
first of all the treatment for schziophrenia is not risperdal, but clozaril.
Uh… there are lots of treatments for schizophrenia. Basically any 2nd generation antipsychotic will do, but there is a lot of trial and error to see which medication works best for each individual patient. Risperdal though is a quality option.
October 12th, 2010 at 9:00 am
Also Clozaril is basically the last line drug after everything else fails due to its horrible side effects.
October 12th, 2010 at 9:09 am
Great episode.
Jax is right, though. You should have at least mentioned the lesion on the temporal lobe.
October 12th, 2010 at 9:09 am
@Kyle, I noticed the game too. Nice detail indeed, though I’m rather surprised they didn’t use product placement.
I was also perplexed when the psychiatrist suggested bipolar disorder based on the hallucinations. Schizophrenia does usually manifest younger, but 30 doesn’t deviate that much from the norm. It could also have gone undiagnosed or – as it turned out – the patient could have been hiding it. I guess people just don’t lie where she did her residency.
I really liked the Chase thing though. Hiring someone just to get to sleep with/date her was very “Housean” of him.
October 12th, 2010 at 9:15 am
It’s funny what people do to save money these days, when they can just call State Farm and request a gay masseur.
October 12th, 2010 at 9:16 am
Official Comment
Harvey, Jax:
I did mention it, briefly. It’s the last of the bullets.
October 12th, 2010 at 9:18 am
Scott, I think they were joking about the fact that you mentioned it twice, but I guess you didn’t do that intentionally.
October 12th, 2010 at 9:20 am
I thought the line “Billy – I’m schizophrenic!” was just terrible, lazy writing. Her admitting to her husband that she’s mentally ill was the big medical payoff of the episode. As Ledasmom pointed out, the line was outright comical.
Otherwise, I enjoyed the episode. I hope they chuck Dr. Kelly really soon. She’s about as dumb medically as Cuddy used to be portrayed.
October 12th, 2010 at 9:30 am
I didn’t understand how being schizophrenic tied at all with her ripping off someone’s identity, and gaining a new SS number.
It was proven that her “reason” for doing those things (being abused by her previous spouse) was false…so…was this just an unexplained red herring?
Or did they somehow tie it to the schizophrenia and I missed it?
October 12th, 2010 at 9:56 am
I’m not a medical doctor and don’t play one on TV…just your average “Joe bag-o-donuts” fan.
HOWEVER: Not explaining the multiple broken ribs, the brain lesion and failing to establish her true identity and medical history were HUGE omissions.(IMO). Don’t know whether it’’s sloppy writing, laziness or whatever. Petty loose ends don’t bother me, but those were pretty major.
October 12th, 2010 at 10:05 am
I loved it when Taub called Forman “dude” and he freaked out
October 12th, 2010 at 10:18 am
Official Comment
While talking to the patient at the end, House mentioned that due to her schizophrenia she was “probably” living on the streets and that’s where the rib injury occurred. She silently assented to his supposition.
As for the identity theft, I suspect it was simply because she didn’t want anyone to know about her history of schizophrenia — look how far she went to make sure her husband never found out.
The unexplained temporal lobe lesion is more of an issue. I’m willing to bet good money there’s a missing/delted scene. You’ll notice there’s no scene of them ordering the brain scan — or even an explanation of what scan (CT or MRI) they’re looking at. In this missing scene, the team probably mentions that there’s a spot in the temporal lobe and then say something like “it’s probably just an artifact, but it may be something” — now start the scene where they’re arguing over possible causes. This would also explain why Benedict took such a contrary stance — she believed there was no brain lesion and that it was just an artifact. I don’t see her taking such a stand if there was a definitive brain lesion. (So I would chalk this one up to sloppy editing).
October 12th, 2010 at 10:23 am
Finally.. my kind of episode of House! Let me preface this by saying that I work in Bipolar and Schizophrenia research, and also work in partnership with NAMI (the National Alliance on Mental Illness) which got a brief plug at the very end, after the credits I believe. As soon as the “shrink” started mentioning Bipolar, I scoffed, and was concerned this would be yet another TV show that completely misses the mark on psychiatric diagnoses. It’s extremely unlikely that acute psychosis would be the very first (and seemingly only) symptom of Bipolar disorder. But then when House mentioned Risperidone (commonly called by the commercial name, Risperdal) and told the “shrink” she couldn’t be more wrong, I had a feeling where it was going.. and I told my wife “Sounds more like schizophrenia.” Then sure enough, the patient admits she has SC, and has been secretly treating herself. (Although House’s comment about her “not being more wrong” was kind of misleading, as BP and SC are in the same diagnostic spectrum, and often patients can be diagnosed with both, or misdiagnosed with one or the other. So really, he Bipolar recommendation set things in the right direction) As mentioned though, the side effects and withdrawal from Risperdal can indeed cause physical symptoms, but I wasn’t clear on what was causing her problems.. the side effects initially?. then the withdrawal? I didn’t quite follow. Also, someone who just finished their psychiatry residence wouldn’t typically miss the mark that badly. Bipolar with no history of mania? I think the script was written just to make the character look bad. Anyway, glad to see an episode dealing with these disorders, and glad to see NAMI get some airtime, as they do excellent work.
October 12th, 2010 at 10:29 am
Broken ribs: They tried to explain it by having House remark that Margaret was probably injured during her time on “the street” (as a homeless person?) because of her schizophrenia.
The whole identity theft angle did kind of bother me. While it might have seemed in character given the number of lies Margaret told, it was a little too elaborate a conceit to be plausible.
Nice bit of coup d’oeil involving the burning table.
Isn’t Lisa Edelstein getting a little tired of playing scenes while seminude? (Although the look in Cuddy’s eyes when she realized the identity of her “masseur” made me laugh. But why didn’t Cuddy shut all the blinds in her office?)
October 12th, 2010 at 10:51 am
Quote: #
ruby
October 12th, 2010 at 8:49 am
dr scott knows nothing about psy disorders. if he did, he would have known that you treat schziophrenia with clozaril, and not risperdal. clozaril has been around since 1990. it is the only med bascially used for this treatment and especially after anything else fails. this show sucks now…..!!!!!!!!!!!!!!!
Ruby, not sure where you’re going with this, but Risperidone/Risperdal is actually in a class of drugs called “atypical antipsychotics,” so yes, it is indeed quite frequently used to treat the symptoms of Schizophrenia.
October 12th, 2010 at 11:08 am
I think people will go to great lengths to hide a history of schizophrenia. I once worked for an organization in which an employee did this. She was terrific to work with at first, but she couldn’t maintain the facade. She started missing deadlines (which was actually normal behavior in that place). She seemed a bit spaced out from time to time when I spoke with her. Strange, inexplicable things began happening. For example, she started inserting “secret code words” into office communications, and nobody could figure out who was doing it or why. She finally suffered a psychotic break. I felt really sorry for her; she had been trying so hard. This was a great idea for a case, in my opinion.
I agree with Scott–more Wilson!
October 12th, 2010 at 1:13 pm
Also, does anyone think grabbing the cane, sticking it in her mouth, and chewing on it was developmentally inappropriate for a 2 1/2 year old?
That’s something that kids do in the 6 month -15 month range. For a kid to still be doing that at 2 1/2 is not really normal.
Kinda indicated to me that whoever wrote the episode either had no children and/or couldn’t be bothered enough to google age appropriate behavior.
October 12th, 2010 at 1:38 pm
When she started hallucinating my wife suggested DT’s and it struck me that many of the symptoms could be caused by withdrawal from some medication. I don’t know if risperidone can cause a fever with withdrawal, but I know some drugs do.
I saw it coming that House would hire a hooker to give Cuddy a massage. I was thinking he would have Brandi give her a massage, to demonstrate the quality.
I agree that the blur in the brain was somewhat ignored and that they jumped a bit quickly to cutting the head open and then ignored it just as quickly. They just needed a dramatic situation to have the epiphany.
October 12th, 2010 at 1:53 pm
Dr. Benedict’s deduction of the ID theft is implausable. There are no “one of those websites” available to the public that contain and disclose consumer credit histories, and social security numbers are tightly protected. Even if we ignored both of these things, Dr. Benedict’s jumping to the conclusion that PotW has committed identity theft would still be a stretch, as errors occur with SSNs all the time are are most often attributed to … errors. The lack of any kind of history going back further than three years would be more of a red flag, but again, Dr. Benedict would not be privy to consumer credit histories.
October 12th, 2010 at 2:06 pm
Hmmm it was a nice episode overall. What I liked the most here was the pace – it was more dynamic than the last couple of episodes yet it was coherent and easy to follow. House was a lot like the original House form seasons 1-4 his verbal parry ing skill in top form. The flow of his romance with Cuddy is logical and still fun to watch (and his idea of a male hooker was funny as hell :). The way he handles the issue with jealous Cuddy was typical House – go talk to Wilson listen to his advise, then “house ” the advice (am I the only one thinking that it is a good new idea to introduce this in english language as a verb – let’s house it :):):) to Greg House an idea :):):) Anyway it was fun and I think the writers are playing the right tune for both old and new fans of the show. The medicine:
A. The general idea was good – just psych condition the treatment was giving the side effects, the lack of treatment was giving the other effects. Here is how I see it:
1. Abdominal pain was from the original drug (risperidal)
2. Initial hallucinations were from waning the drug out – reducing the dosage of a drug she is so used to would bring the schizophrenia back – that is for sure.
3. I think we can assume that while this was never mentioned in the episode the psychiatrist treating her put her on some other drug (chlorazil?). I do not see a psych doctor just stopping a medication and forgetting that the patient still needs something to keep her mental health in check. I suppose the worsening of the symptoms in the hospital was from the complete lack of drugs – sort of like withdrawal effects from narcotics. Would explain the tachycardia and even the fever.
4. Heavy hallucinations from the schizophrenia kicking in.
5. The “thing” in her brain (they never specified what exactly did it look like could be unrelated at all – could be from trauma – same one that broke her ribs and damaged her liver. The damage on the liver could be from the drugs she was taking for the last 3 or more years
All in all I would say solid medicine here – the final diagnosis covers the symptoms and makes sense. Some jumps of faith are required but is plausible
B. Appendicitis is not such a bad idea at the time – it starts as mild abdominal pain and could worsen in the course of few day before finally settling in the lower right abdomen where it belongs. In the meantime it could be misdiagnosed or thought of something else. Of course with the later symptoms it is an idiotic idea but not when Foreman so abruptly shoots it down.
C. @Ruby – I only have a C on my psych exam but even I know that schizophrenia is not so easily treated – bang one drug and that is all. It is quite the opposite – you try drugs or even combos before you find out which makes the most effect with the least nasty side effects. It is a trial and error and could take months. The choice here was obviously working so that is why her doctor was using it – and he stopped when side effects kicked in. So your comment is just plain stupid.
D. The way House handled the problem at the end – “you see me place my hand on the burning table so you’re hallucinating” was funny but ridiculous form a medical point of view – you cannot logic out a hallucinating person out of his hallucinations. I’ll have to remind again that a crazy person never follows the normal logic – she might think that House is Satan and scream but she would not say: “Oh thank God I am just imagining things”
Well I like this episode as all and I thing that after seasons 5 and 6 we are watching a much lightly mooded and funnier show – no drama to the point of choking or gasping for air. I am sure there will be plenty of DRAMA soon but for now I enjoy the light mood this show is bringing. Let’s have some more please :)
October 12th, 2010 at 2:18 pm
Almost forgot: Yeah more Wilson. Wilson rules! More WIlson more Wilson!!!
October 12th, 2010 at 2:24 pm
Thinking back to the episode where Cuddy’s kid was born, didn’t she speculate that due to the nature of the birth there was the possibility of some reduced mental function?
Maybe that’s why she’s a cane chewer.
Or maybe she’s actually advanced for her years and it’s a mind game, screwing with House for the sake of it =)
October 12th, 2010 at 2:57 pm
To add a bit more to the dialogue about Schizophrenic symptoms.. it helps to understand that there are positive and negative symptoms. A positive symptom would be a delusion or hallucination. Negative symptoms include catatonia, loosened associations, flattened affect, etc. The patient only seemed to suffer from visual hallucinations, which of course makes for the best TV/movies. Just to nitpick some, but being off her meds leading to hallucinations that severe in someone who otherwise appeared high-functioning enough that her spouse had no clue she was ill, is highly unlikely. Another fairly big nitpick was the “shrink’s” (or the writers really) mistaking hallucinations for “delusions,” as Scott had pointed out. A hallucination is, as the show dramatized, hearing or seeing something that isn’t physically there. A Schizophrenic-induced delusion would be something like believing you were the President, or watching a beer commercial and believing you were just sent a secret message to paint your house purple. Delusions/hallucinations are certainly not the same clinically, and typically don’t even get confused on TV. A doctor just having finished her Psych. rotation would certainly know the difference.
October 12th, 2010 at 3:05 pm
“So Jenny’s side effects from the risperidol worsened when the medication was stopped? She didn’t develop the fever and tachycardia until she had been off the medication for some time.”
I thought the idea was something like this:
1. The nausea and vomiting was a side effect of the risperidol, which got her into the hospital.
2. After she was admitted, she suddenly went off the risperidol completely, and started going through withdrawal, causing the fever and tachycardia.
I’m not sure whether risperidol withdrawal can cause fever and tachycardia, but it sounds plausible enough.
“Also, does anyone think grabbing the cane, sticking it in her mouth, and chewing on it was developmentally inappropriate for a 2 1/2 year old?”
House does. He mentioned this when he was explaining to Wilson why he had been avoiding spending time with her:
House: “That is one boring child.”
Wilson: “House, she’s a toddler!”
House: “I know. I’m grading on a curve. It’s that bad.”
Wilson: “You think you were a scintillating wit at two and a half?”
House: “I wasn’t trying to eat shoes. Cuddy could’ve adopted a golden retriever.”
October 12th, 2010 at 3:07 pm
It’s funny since I’m doing my undergrad in psychology and I have a presentation on schizophrenia next week, in the very first scene at the beginning my mind jumped to schizophrenia, based solely on possibly imagined intruders in the house.
When it was revealed at the end it was a bit surreal, since this is only the second episode of House to feature schizophrenia, and the first one where it wasn’t actually Wilson’s disease.
October 12th, 2010 at 3:57 pm
If House didn’t want Rachel to chew on his cane, he shouldn’t have put it on her eating tray! The idea that folks here are diagnosing the intelligence of a small child based on this activity is ludicrous. Kids frequently put things in their mouths. This is why they put warnings on lots of toys. House finds everyone boring. He’s actually scared of Rachel. She could cause the whole relationship to blow up in his face. As much as some here would like that, I am not among them.
October 12th, 2010 at 4:03 pm
Ledasmom wrote: “It also seems to me that if House has found a massage therapist who makes his leg hurt less, he should damn well continue hiring her, no matter what their past history…”
I agree. I suffer from chronic back pain, and I used to get better massages in college from the guys in the dorms than I’ve ever gotten from a professional (massage therapist, physical therapist, chiropractor). They tend to hurt me and make the pain worse. The guys in the dorms were friends, wanting to help me, and possibly hoping for their own “happy endings,” whereas many professionals just do it the way they believe is correct. (Typical treatment conversation: Me: “Please stop, that hurts!” Massage therapist: “Work with me, breathe through it.”)
Therefore, I can imagine that a hooker might give her client a better massage than professional therapist, since she’s used to being sensitive to the feelings of her clients.
Maybe House should try Cuddy’s massage therapist, but if it doesn’t help him as much, they should have a heart-to-heart conversation about it, House should ask the hooker to come over wearing sweats (or whatever clothing he finds non-sexy), and he should tell Cuddy that she’s welcome to hang out during the treatments if she wants, and then, after the hooker leaves, they can have their own happy ending.
The important thing is to keep House managing without drugs, and if he’s found a non-chemical form of pain relief that works for him, he should stick to it.
October 12th, 2010 at 4:52 pm
It’s a long long time that I’ve been waiting for the team to exhaust all physical diagnoses and to switch to mental. Woohoo, go psychiatrysts!
October 12th, 2010 at 5:03 pm
Benedict !?! – Phychiatrist. Maybe the writers are positioning her to become House’s nemesis.
Favourite line – Cuddy “My wrists are sore”.
October 12th, 2010 at 5:50 pm
To the people saying clorazil: It’s true clozapine is used to treat schizophrenia, risperdal (risperidone) is used to treat schizophrenia, schizoaffective disorder, the manic states of bipolar disorder, and irritability in autistic children. I’ll concede Clorazil may be more common (I don’t know), but it doesn’t mean the medication they mentioned was wrong.
It’s amazing what you can learn from a quick google search.
October 12th, 2010 at 6:34 pm
@ MrBuddwing
I don’t think it was the last time we saw her. I imagine a little fling between Chase and Dr. Benedict. Still, one of the promo shots of Season 7 has been showing Chase touching Thirteen’s shoulder in a way which could be hinting at a thing between those two going on, actually… if it comes to this, I wonder how Foreman will react… :)
October 12th, 2010 at 6:36 pm
Hmm, at first I thought that House not smiling and goo-gooing with the kid was just him being his curmudgeonly self. However, after reading the comments here, I wonder if his grumpy face is because he sees a defect in the kid that the mother doesn’t. She wouldn’t be the first mother to overlook obvious symptoms of retardation or autism.
October 12th, 2010 at 6:37 pm
I have a 2.5 year old.
She’s articulate, cunning and mobile to the point of being able to reach anything and be anywhere.
She will also put anything into her mouth, large or small, if she believes it will piss anyone off.
A 6 month old would probably not have tried to tackle something as big as House’s cane, and would certainly have relinquished control of it much more easily. Putting up a fight requires a 2.5 year old.
I’m with the writers on this.
October 12th, 2010 at 7:43 pm
Agree with others – more Wilson! I LOL’ed and ROTFL’ed on “You’re the Rosa Parks of hooker massages” :)
And about the frequent illness’ off-time-course progress – I always explained it to myself that they don’t show every day someone’s in the hospital. E.g. they show 2-3 days what might have been 2-3 weeks of admission (the commercial breaks being put instead of those lacking days).
October 12th, 2010 at 8:10 pm
Everybody lies? No way does house/team get past the first phony story without enough investigation to figure out she is mentally ill. Way out of character for everybody.
October 12th, 2010 at 9:33 pm
Why did they immediately jump to schizophrenia when they found out she was taking Risperidone (not Risperidol, Scott)? Even though she did obviously affirm it, it could have been for a ton of things- aggression, mania, depression. I’ve even heard of it being used as a treatment for Tourette’s (although for Tourette’s it’s not too worth it as antipsychotics have the side effects of making people living zombies).
October 12th, 2010 at 9:38 pm
Is it possible that the opening scene was not a red herring but the first signs of her being off the risperidone?
October 12th, 2010 at 9:52 pm
“Why did they immediately jump to schizophrenia when they found out she was taking Risperidone (not Risperidol, Scott)? Even though she did obviously affirm it, it could have been for a ton of things- aggression, mania, depression.”
Because schizophrenia offers a straightforward explanation for the hallucinations.
And you’re right, it’s not spelled Risperidol, it’s Risperdal, the brand name version of Risperidone.
October 12th, 2010 at 10:37 pm
As I type this, the miraculous rescue of those 33 Chilean miners is under way. What makes this on-topic for this thread? It seems that one of the miners is a paramedic who was tasked with looking after the medical welfare of the men while they were trapped underground.
His nickname: “Dr. House.” Apparently, the show’s very popular in Chile.
October 12th, 2010 at 11:59 pm
I had a manipulative, liar ex-girlfriend who would make up stories about all kinds of things. I’m still not totally sure why she did it; she may have been bipolar, I don’t know. But the story about an ex- who battered her and stalked her would be EXACTLY the kind of thing she would turn to when called out on a previous lie — it allows her to deflect blame for her past behavior and creates sympathy.
This kind of manipulative behavior is also classic among drug-seekers and people with certain types of mental illness, and people who work in hospitals are VERY familiar with it and don’t fall for it easily. House, who has seen every form of weird ailment under the sun and who operates on the assumption that EVERYBODY lies, shouldn’t have given the patient’s story credence for one second, especially given the fairly dramatic nature of the lies she’d been caught in already.
So kudos to the psychiatrist for mentioning that it might be mental illness. Bipolar might not be a particularly good diagnosis, but at least it puts them within the spectrum of mental illness. Hey, the patient is telling lies — or maybe she’s delusional? That would be a mental illness. Her lies are fairly complex and elaborate. Grandiosity? Could be a symptom of bipolar. Mental illness, then. Or wait — if she’s lying about the source of her injuries and her symptoms, maybe they’re also faked or self-inflicted. Munchausen syndrome? A mental illness?
So at the end of the show, what does House do? He calls the new doctor a bad psychiatrist because she failed to suggest that the symptoms might be caused by mental illness.
Are we meant to believe, then, that House is that stupid? That he’s never observed patients exhibiting strange behaviors and tried to classify them?
I think it’s all just more lazy writing. Not only did they cheap out on their new character, but they sold the whole profession of psychiatry short and they sold House and the team short, too.
October 13th, 2010 at 5:33 am
Two months trapped in a mine with Dr. House.
Either your worst nightmare or quite a popular fanfiction. Or, probably, both.
October 13th, 2010 at 7:48 am
A few untied strings in this episode, but the medicine was better than in others. The “Huddy” wasn’t overwhelming here either.
October 13th, 2010 at 2:56 pm
Completely off-topic and irrelevant to boot – sorry, while I realise it is merely a variant spelling, in medical matters seeing “artifact” rather than “artefact” was jarring.
But then, when I was in college there was a minor war on over whether DNA should be “Deoxy…” or “Desoxy…”
October 13th, 2010 at 3:36 pm
@ John A: “Artefact” is a purely Commonwealth/UK spelling, that is not seen elsewhere.
October 13th, 2010 at 3:36 pm
With regards to your second-to-last green bullet:
When the pre-credits scene is playing I like to try to figure out who is sick before they collapse. In this case I had three main theories, seeing the woman thinking someone had broken into her house.
1.) Someone had broken into her house, and would collapse when she confronted them.
2.) Someone had broken into her house, and she would collapse when she confronted them.
3.) Nobody broke into her house, she’s schizophrenic.
Given my amazingly-non-medical prediction, I assume that the “I think someone’s in the house” was supposed to be her first symptom of schizophrenia, presented to the audience but not the team.
October 13th, 2010 at 5:24 pm
Great episode, season 3 and 2 quality. If this continues we will get an 8th season!!!
October 13th, 2010 at 6:42 pm
In my family, about halfway through we were all feeling embarrassed for watching. Everything felt forced. The direction was stiff. The dialogue was moronic. I’m a long-time reader, and I’m surprised you thought there was anything good about this episode. I could feel the actors straining to do something with the material. And the House/Cuddy stuff was just dull.
And being a persistent liar isn’t worse than schizophrenia? Plus, every one of her lies just made us laugh. Nothing felt right. It’s TV, so the show is often borderline dunderheaded anyway, but this made me want to walk away for good.
October 13th, 2010 at 8:17 pm
I was surprised at a third straight female POTW, and the previews for next week look like it’ll be four.
I think any criticisms of Dr. Babe-of-the-week should be tempered by the fact that she was meant to be inept.
I never quite reached the point where I cared about anything in this episode. Don’t care about House and Cuddy fighting about their masseuses. Don’t care about a wife lying to her husband. Don’t care about Chase getting his rocks off with Dr. Babe-of-the-week. Just nothing really seemed like that big of a deal this week.
October 13th, 2010 at 8:22 pm
1) The New Female Doctor will be coming along shortly to take 13’s place (while the actual actress is off shooting a movie) – she is played by Amber Tamblyn, whose name i recognize, but nothing else.
2) ‘House” is (or was a year or two ago) THE MOST watched TV program in the whole world! Yay, House – I am glued to the weekly House-a-thons on USA or Bravo. No wonder the Chileans called the guy Dr. House, maybe they get House-a-thons, too.
3) …aaaannnd…this is a two parter.
a) Didn’t House blat out “you’re mentally ill” or something at the end, in front of the husband, violating Patient Confidentiality, for which he should be decapitated or something? and b) didn’t that woman seem to have a remarkably easy time of disguising her illness? Like she just popped a pill in secret every day and everything was just fine for who knows how long. … I say this because I have a brother who is both bipolar AND schizo, is currently in a psych ward after being taken to the regular hospital part for what we think is a TIA, and no one will tell us a goddam thing, due to Patient Confidentiality. And. Though he’s been taking Clozaril, Clonapin, Depakote, you name it, he has never been able to pass as normal as he now weighs close to 400 lbs. because of this stuff, currently is not fine, whatever they’re giving him doesn’t seem to be working, and all he does is mutter into his beard about wanting a pack of cigarettes. Needless to say, I found this episode of House somewhat lacking, he ought to stick to mysterious zits and bleeding from orifices.
October 13th, 2010 at 10:01 pm
uh sorry guys. peeps w/ schizophrenia who have tried risperdal should be on clozaril if the chick was seeing another doc in trentron should have had her on clozaril while titrating off of risperdal. and they give out risperdal to lots of people not just schizophrenia patients. I know b/c i had a mother-in-law who had this disorder/disease most of her life and for the last ten years she was on clozaril b/c it was the only thing that worked to some degree albeit not very well. you can not treat this disorder, period. and you bascially can not have a relationship with peeps who have this disorder. nearly impossible to do in reality.
October 13th, 2010 at 10:55 pm
I was wondering why the psychiatrist’s first diagnosis of mental illness was bipolar disorder. I’m sure it’s been mentioned by now but hallucinations aren’t exactly a major symptom of bipolar, and if she were manic enough to be having them I doubt she could have hidden it so effectively. Also, I was kind of annoyed that it was never explained why the patient decided to compulsively lie, or how her ribs got broken; seems like the sort of thing House would be curious about too.
October 14th, 2010 at 12:53 pm
@Trav. When House says “You couldn’t be more wrong,” he was referring to the course of events. She had theorized that the physical injury set off the mental illness. But it was the mental illness that led to the physical symptoms.
I appreciated that they were trying to get back to the more traditional show format in this episode, with more parrying, more of the staff outguessing each others’ deep motives, and more humor. It still seemed a rather weak echo of its former self in terms of compelling narrative of the medical mystery, staff interactions and so forth. missed wilson. and the idea that cuddy, with the french-door entry of her office and the open-slat blinds behind her desk, would get buck nekkid for a massage seemed pretty weird.
October 14th, 2010 at 4:01 pm
Re: Rachel… chewing on canes IS inappropriate for a 2-1/2 year old… it’s even somewhat inappropriate for the age the kid actually is. She was born at Christmas time in season five (episode Joy to the World), which makes her 3 months away from turning 2. Of course, maybe the writers decided to count from the date of her conception as opposed to the date of her birth… that would make her 2-1/2.
October 14th, 2010 at 6:39 pm
@A. Nonymous: SORAS. She could have been five or six by now. I don’t know why you’d quibble over a few months.
October 14th, 2010 at 11:27 pm
So the way to “test for” lead poisoning is to go to someone’s house and check their pipes and a couple other things? Big fat OY for them ruling it out that easily. In my world they, gosh maybe, run a blood test?
Yes folks, 2 year olds put things in their mouths. It’s normal. There’s a reason why most games and toys for preschoolers on up say “not for under age 3.” Because they have small pieces that the child can choke on when it ends up in the mouth (which it usually does).
It’s also normal for a 2 year old to be done with mouthing stuff. But the cane was right in her eating space and probably got some sauce on it too.
October 15th, 2010 at 3:04 pm
I liked the new doctor. I’m not sure why she was treating the patient’s husband’s wounds in the ER when they have their own staff to do that. Still, she seemed sensitive and caring. No one on House’s team possesses those qualities since Cameron left. (Sigh) Cameron, come back!
October 16th, 2010 at 10:35 pm
RE: the unexplained lesion.
I can’t remember exactly what they said was there, but temporal lobe structural abnormalities can be seen in pts with schizophrenia. Odd that they never brought that up when schizophrenia was the final dx.
October 18th, 2010 at 2:01 pm
Isnt it expected for a psychiatrist (like Dr Benedict) not to be able to contribute to a differential diagnosis concerning physical (not psychological) problems?
I know that in House universe all doctors are capable of performing nearly anymedical procedure, from lab tests to CT scans, but I think that goes too far.
October 19th, 2010 at 4:11 am
Sorry, but yes, even 2 1/2 year old kids will chew on things! Most have stopped putting small objects in their mouths, but they will still occasionally put larger things in to chew and taste. I didn’t find it developmentally off at all.
October 20th, 2010 at 4:45 pm
I realize it was just one of the middle differentials, but I have an issue with the diagnosis of possible organophosphate poisoning. Perhaps I am more sensitive to it because of my background in emergency medicine and medical intensive care, but I would have hoped that the writers would have done a bit more research on this subject and realized that it made no sense.
Organophosphate insecticide poisoning absolutely does not fit the patient’s symptoms. Organophosphates destroy the enzyme needed to breakdown and uptake the neurotransmitter acetylcholine in the synaptic cleft. High levels of acetylcholine overstimulate the parasympathetic division of the autonomic nervous system, the “rest and digest” half. It is the same mechanism of action as nerve gases. This results in slow heart rate (definitely not SVT), and a SLUDGE toxidrome (salivation, lacrimation, urination, defecation, gastrointestinal effects, and emesis). The only one of those the patient exhibited was emesis (vomiting).
October 21st, 2010 at 10:35 pm
Not a fan of this one. It’s hard to listen to when the team is saying stupid things to have someone else’s stupid things viewed as more stupid. I mean, I can suspend disbelief to a point, but I can’t think that some of the totally inappropriate WAGs (with no history taken, of course) are smart and others are dumb. And the inability of ANYONE to tell that she was having HALLUCINATIONS was beyond the normal silliness of House.
The Houdy element is really killing this show for me. Blech. Cuddy + kid + House isn’t working at. all.
October 22nd, 2010 at 1:53 pm
Regarding the weekly soap opera:
So Cuddy wants to protect her kid from the trauma of getting attached to a man who then disappears. Interesting. Was she thinking about that a few weeks earlier when she abruptly broke up with her gentle, loving fiance, who was probably great with the kid, so she could take a huge gamble on an angry, bitter, spiteful man with a history of mental illness who doesn’t like children?
October 23rd, 2010 at 2:35 pm
schizophrenics have been shown to have decreased blood flow to the cerebral cortex and temporal lobe. that could be what they were alluding to…but more appropriately a PET scan would have demonstrated that.
October 25th, 2010 at 12:38 pm
Forgetting all the fuss about the programme, House’s reaction to the kid was not what bothered me , but they zoomed right in,and I really don’t like to say this, but the actual kid actress seemed really thick to me. Both of my kids at two and a half years old chattered away non stop, even though they still put things in their mouths! I really hope I’m wrong about the child.
October 26th, 2010 at 9:30 pm
Regarding the kid who puts things in her mouth, I think it might not seem as odd if the kid didn’t look about four years old.
October 30th, 2010 at 9:07 pm
Let me get this straight: She’s on Risperdal, which she takes at high doses (probably something like 12-15 grams), and her husband never finds it in the house. She’s been taking it for years, and he has never noticed? And whether she’s bipolar or has schizophrenia, when has any patient with a disorder requiring psychoactive meds done well on just one med? Oh, and I’m sorry, but this patient is scared when she’s supposed to be scared, worried when she’s supposed to be worried, her thoughts are always connected, her symptoms are always so under control that her husband never notices that there’s a problem, and he’s shocked that she has a severe mental illness like schizophrenia?? The “split” in schizophrenia is between thought and affect. Her affect throughout the episode has always been appropriate! Where is there any plausible evidence that she’s schizophrenic? I mean, if we believe this episode, not only does she have this disorder, but she’s been suddenly yanked off her AP, and she doesn’t act a LOT schizophrenic?
Oh, and while we’re on the subject, Haldol is used as a chemical restraint but it is also a powerful antipsychotic.
Finally, most people who take atypical antipsychotics at doses high enough to palliate schizophrenia would struggle with weight gain. None of those APs are weight-neutral. She’d have a weight problem, or have to be on a low-carb diet and even then would struggle.
I don’t believe that she could have gone through a marriage as a schizophrenic and her husband not thinking that something was wrong.
March 3rd, 2011 at 8:47 am
I was wondering about the suggestion of bipolar disorder too, because I thought hallucinations are more likely to be a symptom of schizofrenia (without any mania, depression). and I am just a nursery student at university of applied science. Happy that other people also noticed it, so I wasnt wrong about it :)
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