House — Episode 5 (Season 7): “Unplanned Parenthood”
While the medical mystery and solution(s) were interesting, the medicine was poor in the week’s episode of House. Trivia-wise, I think this was the first time a patient of the week was portrayed by a relative of a previous patient of the week.
Kayla is an eight-hour old, full-term infant who was hypoxic (low blood oxygen level) when born and required aggressive resuscitation. House’s team is asked to evaluate her for non-specific “breathing problems.” She had been given surfactant (which means that neonatal respiratory distress syndrome should not be an issue). Her sperm-donor father had a history of asthma. House suspects the breathing problems reflect something that is going on elsewhere in the body. Chase reports that her LFTs (liver function tests) are elevated. House now believes that her breathing problem is due to pulmonary edema (fluid leaking into the lungs) because of inadequate protein production in the liver (protein keeps the fluid in the blood vessels, when there’s not enough, fluid leaks into the surrounding tissues like the lungs). He wants a closer look at the liver.
House’s team performs an ultrasound on Kayla’s liver looking for a possible abscess. They see a suspicious area, but it does not appear to be an abscess and is more suspicious for dilated bile ducts. House takes this to mean that the baby has Caroli’s Syndrome, and she is taken to surgery.
Despite their best efforts, the team is not able to perform the surgery because Kayla’s blood pressure keeps dropping. With House busy at Cuddy’s place, the team looks at a differential diagnosis that includes both heart and liver problems. Tuberous sclerosis is suggested, as is a vascular malformation. The latter seems the most likely. Surgery is the preferred treatment, but the team doesn’t want to put her through that again so instead they start her on steroids (probably for inflammation), dopamine (to keep the blood pressure elevated), and an anti-angiogenesis agent (a medication that stops blood vessels from growing). She responds to the treatment, but before the team can congratulate themselves too much, House tells them that a vascular malformation doesn’t fit the case and that Kayla will start having problems soon. Sure enough, she starts bleeding heavily again. Taub mentions hepatic fibrosis, but the symptoms don’t match. Unsure of what else to do, House has the team give Kayla a direct transfusion from her mother, which works wonders.
With Kayla improving after a transfusion of her mother’s blood, the question becomes did the transfusion work because Kayla needed something found in anyone’s blood, or because there was something specific to her mother’s blood that made her better. They hook her up to Taub who has a compatible blood type, but Kayla’s condition takes a turn for the worse. Thus, there was something only found in the mother’s blood that was helping Kayla. Taub tells Kayla’s mother that this means infection. The team gets a sample from the liver, but looking at the nearly black color of the sample tells them that it’s no infection, but a melanoma (a very nasty cancer). Furthermore, they surmise that the melanoma came from the mother in utero. Sure enough, a melanoma is found on mom, but she seems surprisingly healthy for someone with a metastatic cancer. The team surmises that she has some other condition that is preventing the melanoma from spreading — the most likely being some kind of autoimmune condition (scleroderma, dermatomyositis, Churg-Strauss, and lupus are all name checked) or a granulomatous infection (tuberculosis, for example). Autoimmune testing is all negative, so the team moves on to scanning mom for granulomas. They don’t find an infection, but they do find a lung cancer and it seems that the body’s antibody reaction to this cancer is what is keeping the melanoma at bay.
Decision time: the team wants to surgically remove mom’s lung cancer, however this means that her blood will no longer be life-saving to Kayla and the baby will need chemotherapy. Instead, knowing the risks, mom decides to put off surgery until Kayla’s melanoma has been treated by her blood. Unfortunately, as to be expected in a purposefully tear jerking episode, the mother dies of a massive blood clot. Luckily, enough of her blood was saved to finish Kayla’s treatment.
In the side story, House and Wilson suspect Cuddy’s daughter Rachel has swallowed a dime while they were babysitting her. Rather than tell Cuddy what happened, they sneak her into the hospital to ultrasound her and see what looks suspiciously like a coin. They feed her laxatives, but to no avail as no dime emerges. Just when they are ready to perform a colonoscopy, new information comes to light suggesting that Rachel did not actually swallow a dime. House is greatly relieved until later that night when Cuddy changes Rachel’s diaper and finds a dime. Rachel blames House.
There have been multiple cases of melanoma passed from mother to child. However, I could find no mention of antibodies is patients with small-cell lung cancer protecting against other cancers, but my search was admittedly brief, and I suspect there is probably a case study out there somewhere – there is usually some real world basis for House story lines.
As usual, major complaints are in red, minor complaints are in blue, and nit-picking ones in green:
Those miraculous antibodies that kept Mom safe from melanoma and cured Kayla through transfusions of mom’s blood are the same antibodies that would have passed to Kayla through the placenta and would have protected her/treated her just as easily in utero. (And I don’t buy the “melanoma was just caught in the crossfire” lame explanation House gives to try and gloss this over. If the antibodies are good enough to keep the melanoma from spreading in mom, they’re good enough to protect the baby as well.)
8 to 9 days to eradicate a cancer is incredibly optimistic and based on way too few data points to be credible. After all, Mom had the melanoma and the antibodies for over nine days and her cancer wasn’t eradicated.
Though Mom died, I would have made the same decision. Seriously, she’s had the cancer for weeks — if not months — at this point, what are a few more days?
And Let’s not forget that immobilization following surgery is another risk factor for blood clots.
Bear in mind that fetal melanoma when obtained from mom is “almost invariably fatal.” If you have a treatment that works, stick with it.
The fact that Taub is a Type-O “universal donor” doesn’t matter here. Type O- is only the universal donor when just red blood cells are given (which, admittedly, is how most transfusions are normally given nowadays). However this was a whole blood transfusion, and when whole blood is given, the antibody-containing plasma is transfused as well. For plasma transfusions, the roles are switched and O- is more likely to have antibodies that cause transfusions reactions than any other blood types. Since whole blood transfusions contain both red blood cells and plasma, they require identical blood types.
Once the dime has made it past the ileocecal valve (which is what the ultrasound showed), you’re home free. That means it’s past all the tight spots and only the large intestine remains. If anything, the ultrasound was good news, not bad news.
Even if coins were magnetic, there’s no way a refrigerator magnet would work. Those magnets are so weak their magnetic field doesn’t even make it through the skin (which is yet another reason all those magnetic bracelets and wraps and shoes are bunk – they use the same weak magnets).
Taub’s statement that “it must be infection” after his transfusion didn’t work was quite a jump. What other signs of infection did Kayla have? Fever? High white count??
Wonder why they didn’t mention herpes as a potential protection/treatment against cancer since they had an entire episode based on that.
It was another interesting medical mystery this week; except for the first episode, they’ve been pretty good this season. It earns a B. The final solution of prenatally acquired melanoma was clever, but the protective antibodies against another cancer was stretching it — still, I give it a B-. The medicine was below average. There was no logic behind most diagnostic choices, and House’s random and unsupported decision to transfuse the baby with mom’s blood was out of character. It deserves no better than a weak C-. The soap opera was still good. The Wilson/House interplay was good, and I also liked Dr. Cheng’s dressing down of Taub at the end. I give it a B+.
The review of the previous episode of House
A list of all prior House reviews
October 18th, 2010 at 11:34 pm
So-so episode, IMHO. I don’t necessarily object to straying from the formula – which in this case meant no “eureka!” moment from House or anyone else. But I think we have a right to expect something equally compelling in its place (and no, House’s adventures in babysitting wasn’t it, at least for me. Forgive a layman’s ignorance, but why didn’t House and Wilson X-ray Rachel if they were so worried that she’d swallowed a coin?)
The way TPOW was handled struck me as a bit strange. Jennifer Gray played a woman having her second child relatively late in life. Her grown daughter is visibly resentful. Obviously, mother and daughter have major issues, but those were skimmed over for the most part. If the writer(s) wanted to be sketchy or cryptic about the relationship, fine, but don’t be surprised if we’re less than moved by the outcome of the story.
Dr. Cheng made for an interesting subplot – wish they’d done more with her. In fact, I wish they’d done more with everything in this episode.
October 19th, 2010 at 12:03 am
I also though Taub’s “I’m O-. Me, me!” was off. I remember an episode of LOST, of all shows, where they said O- blood is only a best-fit when an exactly matching blood type can’t be found, and that it could cause anaphylactic shock. Any truth to that?
I also had to raise my eyebrows at the beginning when the Mom asked “Can I donate blood to her?” and the doctor said “We’ll test you to see if you’re a match.” Um, doesn’t a baby only a few hours hold have her mom’s blood? Like, literally exactly her mom’s blood? I remember that being the big “Eureka!” moment of episode 1.04 “Maternity”
I enjoyed House’s adventures in babysitting, and it was definitely nice to get some more Wilson. He’s been a little absent lately. Rachel saying “House!” right at the end was just perfect.
The 20-something daughter sure did a quick 180 on Mommy Dearest, especially considering that *she’s* probably left to raise the kid, I don’t know that I’d be that forgiving, especially with whatever there was that was obviously hanging between them.
October 19th, 2010 at 12:51 am
And the pediatrician who hates kids was a nice typically “House” touch.
Stupid World Series pre-empting the show. Especially since I’m guaranteed to hate one of the teams in it.
October 19th, 2010 at 12:58 am
I have to say, this return to medical mysteries is restoring my faith in House. Anyway, loved Dr. Cheng’s “It’s not Lupus” moment while they were running the autoimmunes (Now a pediatrician is running lab work?)
October 19th, 2010 at 2:28 am
You’re telling me to do the right thing while climbing out a window!! Hahahaha
Also the patient soap opera was weirdly detached tonight. I want to say this is the first episode where I felt like that.
October 19th, 2010 at 3:11 am
[Insert joke about Baby being in a baby-centric episode here]
The whole “mother’s blood cures cancer” thing seemed rather ridiculous to me even as a layperson, so I’m glad to see that it struck you odd as well. Other than that, it was a decent episode of House with the highlight for me being House and Wilson’s interactions concerning Rachel. Although, I don’t quite understand how Cuddy could have overlooked Wilson’s car in front of her house and not wonder where he was.
Oh, and side note- you forgot to erase the House Challenge link from the last review. I clicked on it, was excited to see that I was still just outside the top ten, and then realised there was no way I could have earned points this week.
October 19th, 2010 at 3:23 am
I agree that this is the first time the patient soap opera felt compeltely detached, tacked on, and out of place. I almost never feel like that, but maybe it was the lack of exposition. It came out of nowhere and felt very tacked on, and was a very emotionless patient death. While episodes 2 and 3 of this season had patients I could see being emotional about if they were killed off, this lady was not one of them. Dissapointed in that.
Also as to the person who said why not X-Ray, they addressed that in a line, Wilson didnt want to subject the baby to unnecessary radiation he said…I know nothing about anything medical so I dont know whether that would be an actual risk, but thats what he said.
October 19th, 2010 at 5:16 am
Spent the whole episode shouting at the TV “If I wanted to watch mother-daughter glurgy emotional crap I’d watch the Lifetime Movie of the Week!” Which is quite a lot to shout. So when Mom got all heroic-sacrificy I was, honestly, rooting for her to kick off.
The side plot with the dime was entertaining, though.
October 19th, 2010 at 7:10 am
I thought it was one of the best episodes in a while. I loved Wilson and House with the kid. The mother daughter drama was interesting but hardly expanded upon.
The cancer causing clotting thing was spot on. It happened to me and I also got a PE among other clots.
I imagine that the mother wasn’t given heparin because of the baby’s bleeding problem.
I thought that melanomas are terrible cancers that spread quickly once established. Wouldn’t they have removed it at once? It was the lung cancer that was causing the antibody production.
October 19th, 2010 at 7:13 am
I knew Dr. Cheng would never be hired – she’s not conventionally beautiful. She would have added a nice touch of class to the team, however.
October 19th, 2010 at 7:57 am
I’ve mostly gotten accustomed to the superhero attributes of House’s assistants, but watching Taub perform a procedure on a 2-year-old was over the top even for me. When did he become a pediatric anything?
Unfortunately,I found the House-Wilson interactions forced and unfunny. I felt at moments that Hugh Laurie was trying to be, well, winsome or something. They reminded me of the scenes between Data and the engineer played by LeVar Burton in Star Trek NG (like trying to train the cat). Also forced and therefore not funny.
LOVED the pediatric doctor who was brighter than anyone else and unintimidated by House. A fantastic change from the usual trying-to-please subordinates. I hope they have her back in future story lines.
October 19th, 2010 at 8:57 am
Was I the only one who thought that the actress playing Cuddy’s daughter Rachel was a bit old for the role? Still, that subplot carried the episode for me; I got a great laugh out of the House-Wilson interplay.
October 19th, 2010 at 9:13 am
For the “transfusion from mom to baby” to work, shouldn’t mom have been higher (off the floor) than baby? Looked as if mom was lower, although maybe it was a confusing camera angle.
October 19th, 2010 at 9:42 am
Your heart can pump up. I’m not sure how far up but I know if you stand on your head, your feet still get blood flow. I believe that a transfusion uses the donor’s heart as a pump and not gravity to feed the blood (unlike a simple IV), but I could be wrong.
October 19th, 2010 at 10:27 am
From the get go I was floored that the doctors, nurses and whomever that were in the delivery room with mom, just turned away with the baby and left her hanging. Doesn’t anyone care about the placenta etc and mom’s after care? How about the obstetrician who is supposed to be mom’s doc and the pediatrician who is the baby’s doc? Has medicine changed that much since I had my kids 25 years ago? Also, having had friends whose babies had medical issues at birth, the neonatal team was right there to intervene. I kept asking my husband “where’s the neonate team?” – especially when House’s team were doing their procedures on this wee patient.
October 19th, 2010 at 10:51 am
I can’t speak to the medical side, but will comment about the soap side of the the show. I personally like that they’re letting the House Cuddy relationship play out after years of build up. Since the show is now in it’s 7th season, it was probably inevitable. Left simmering too long, the fire goes out and all you’re left with is a lump of coal. I also like the new, kinder, saner House. They exhausted the anger, hostility and anti-social behavior motif, and seeing him struggle with being human gives Hugh Laurie more room to show his acting chops.
However, I really hope this baby episode was a one-time thing (Cuddy’s, not the POTW). No matter (or maybe because of) how cute a baby might be, it almost always sucks all the oxygen out an adult drama or comedy. Moonlighting, Mad about You, X-files and Frasier are just a few examples.
October 19th, 2010 at 10:59 am
ok one quick question,
They conduct transfusion b/w mother and child even after the mother’s diagnosed with melanoma and Lung CA, so what’s the chance that the Lung CA was spread through this, to the child? isn’t it a possibility?
October 19th, 2010 at 11:17 am
Help me out here. The newborn baby was born with the melanoma the mother had but also had the antibodies for it, right? But it needed a constant supply of the mom’s blood to retain those antibodies? Once it has the antibodies from the mom would the baby’s body figure out how to make it’s own magical cancer-curing antibodies?
October 19th, 2010 at 12:00 pm
Official Comment
Brian,
The antibodies from the mother just provide passive immunity, which is purely temporary — you’re essentially “borrowing” somebody else’s antibodies.
This is different from active immunity, which is long term (often lifetime) and obtained from being exposed to the disease in question (including vaccination) and forming your own antibodies.
October 19th, 2010 at 1:19 pm
So the baby had the disease (the cancer) was borrowing the mom’s antibodies it still seems to be the baby’s body could’ve figured things out and start producing its own antibodies given the “head start” and help it had from the mom.
Anyway, the medicine for POTW seemed partly manufactured and forced for the sake of soap opera it seemed sketchy to me, but I’m not a doctor. On another front, the mom having a baby so late in her reproductive life-cycle strikes me as needlessly risky to the potential child (Downs).
Scott also comments that the dime was fairly far along in the child’s digestive system to be safe to pass. We’ve actually seen House tell a parent this in a similar situation (Third Season’s “One Day, One Room”) where surgery was suggested by another doctor. A full day also strikes me as quite a long time for the kid’s digestive system to pass it through.
October 19th, 2010 at 1:46 pm
House’s decision to try the transfusion did not appear quite so random to me – admittedly only when viewing the episode the second time.
In the preceding scene, when Taub calls House out of the ultrasound booth, House wonders ‘not why she’s worse *now* but why she got better in the first place.” Taub’s (second) response is ‘After the transfusion we gave her steroids, dopamin and… (more medo-babble).’
So it was probably meant to look like House didn’t make the connection at first either, but after he then went back into the ultrasound and made the quip about Wilson being a great Mommy some day, that made his mind jump from ‘Mommy’ to ‘transfusion’ to ‘Baby got better’.
If you need to view it a second time to get this though, dialogue and direction should have brought the chain of thoughts out more clearly in the first place.
October 19th, 2010 at 1:55 pm
any pre-natal care here for mommy? no bp,lung function all during 9 mos of gestation? No hubby to deal with greiving daughter, stupiddddd.
And mommy could have been A+ while baby is AB-, guess what no blood donation then.
No overt lung coughing, no itching on her body, no RBC/no WBC, lymphoctes check for anything on mom? they should have had a hubby so someone else gave a dam about her death besides a daughter who was conflicted. Now she is gonna raise baby without a name…shessh
good part was at end when rachel ratted out house’s name!
good part when dr chung figured out both taub and house and said forget it to walk away…wilson, what jumping out of windows, reminded me of larry david’s curb your enthusiasm show with him climbing out of window in bathroom after putting water bottle down his pants and hugging kid, after kid rats larry out for saying there was this man in the bathroom and he had something hard in his pants….larry makes a hasty exit out the window….
mr chase hope you got more up your sleve for next show…
October 19th, 2010 at 2:26 pm
Dr Cheng “not conventionally beautiful?” I thought she was lovely.
I’m still a bit baffled by the “mother’s antibodies resulting from her lung cancer will cure her babies melanoma” thing. Was that just completely made up?
October 19th, 2010 at 3:22 pm
It was the big tease from last week, but did anybody else think that House firing the new doc sight unseen was out of the blue? It surely wouldn’t have been effective at deflating Foreman’s ego, of all people… It struck me as petty and unnecessary, especially for House the New Man.
@Crystal – Cheng was ‘lovely’, but Cameron was ‘hot’ and Thirteen was ’stupidly hot’. For better or worse Keith’s comment is probably right.
October 19th, 2010 at 3:52 pm
I loved Dr. Cheng. She had a sharpness that has been missing since House himself has mellowed a wee bit (I like this development of House’s character but it makes the others seem even wimpier when they kowtow to him.)
The dime plot made me laugh, but….. The cancerous newborn plot just confused me, even after reading all the above. Not only did they forget to develop (or edit to show) the woman’s state of mind and relationships with her daughters, but it would have been a better use of Wilson to have him intervene instead of or in addition to counting pancakes. The House plot was about ducking Cuddy–fun but old stuff; the POTW plot got short shrift and suffered.
October 19th, 2010 at 4:32 pm
I think the developing competitive relationship between Rachel and House is rather fun – you can’t really direct a toddler, so I’m not surprised the actual kid is a bit older – and Rachel seems to have grasped how to make trouble for House.
Even so…I swallowed five pennies when I was little, and so I found it very hard to believe there was any threat to Rachel’s life. It would have been more logical and perhaps funnier if everyone had told House she was fine and he’d gone on obsessing nonetheless.
wg
October 19th, 2010 at 5:44 pm
If the mom has hyper IgM syndrome, then the baby would not be affected by her mothers antibodies in utero, hehe this is just stretching the medicine as they do in House nowadays…
October 19th, 2010 at 6:25 pm
Thoughts.
Chang was cool. Unfortunately Keith is right. Not hot enough for the role, plus she had the added disadvantage of being shorter than Taub. You can’t make short jokes about someone who isn’t the shortest and short jokes about asian women are … pointless, obvious, unfunny and racist.
I was surprised that melanoma could pass through the placenta. Thank you for confirming that wasn’t bunk.
One thing that I don’t think has been mentioned. I think they are setting Rachel(? Cuddy’s daughter) as having pica and being a future patient of the week. People mentioned the cane last week, then the dime this week.
October 19th, 2010 at 6:28 pm
The episodes are getting better and better, at this rate we will get an 8th season.
October 19th, 2010 at 6:35 pm
2 things: 1st – Rachel is sooo cute :) More of her :)
2nd – In what way the “patient of the week” is related to the previous one? I didn’t catch it while watching the episode :/
October 19th, 2010 at 6:36 pm
I really liked Dr. Cheng. She was smart without being overbearing. And very likeable without being schmaltzy. And I especially liked that she wasn’t a young hot white chick that the producers seem to think all female doctors need to be (and that we’re getting again next week).
When they were searching for conditions that would keep cancer from getting too bad too fast…what about pregnancy?
October 19th, 2010 at 6:38 pm
Sorry, I just had a “house moment” -you meant the ACTORS, not their characters :) More to add, Jennifer gray is the famous “Baby” from “Dirty Dancing”. Baby in baby episode – House writers are cunning :)
October 19th, 2010 at 6:46 pm
I’m amazed that I seem to be the only person here who found the House-baby interaction offensive, i fact, horrible. House is shown as totally neglecting the human being he is in charge of even at the beginning. But the ‘game of chicken’ he and Wilson are playing — all the while leaving the child alone — was potentially deadly. Even the swallowing of the dime could have killed the child, and there were, I am sure, many other things that she could have swallowed that would have been more dangerous. (The fact that Cuddy has not baby-proofed her house with gates was another blunder on the writer’s part.)
The whole cover-up scenes were played as slapstick — am I the only person who caught glimpses of Lucy and Ethel — but this wasn’t a Three Stooges short with cartoon violence. This was hiding from a parent that you put her child in serious danger, and her realization that you had hidden that from her. I don’t believe any sexual relationship could stand that, or any friendship (because Cuddy knows Wilson was involved.) In fact, I would find it hard to imagine a parent even sustaining a working relationship with someone who did that to her child. (And I am ignoring the potential legal consequences.)
No this one was a mistake, a serious one, and hopegully can be forgotten quickly — and I would, personally, remove the episode from any syndication package.
But i seriously wonder if you think I am over-reacting, and if so, why.
October 19th, 2010 at 7:00 pm
Hi Scott, medical student here making my first post. I really enjoy your site. I have a couple quick things I’m curious about:
If the team was initially worried about a liver problem causing pulmonary edema, wouldn’t low albumin levels have shown up on regular blood tests?
The team said they would give antiangiogenics to baby when they were treating for an arteriovenous malformation in the liver. I would assume that these are contraindicated in infants since blood vessel growth is crucial, but I can’t recall.
Also, the baby came directly out of the womb with cyanosis… I realize it’s more dramatic that way, but I would assume that it would take at least a few minutes for cyanosis to present after the cord is clamped. Also, I don’t remember seeing an umbilical cord.
Thanks!
Colin
October 19th, 2010 at 8:11 pm
I’m far from having any solid knowledge of medicine, so I’ll just say that I loved the House-Wilson moments, those two are the real couple in this show, I’d definitely go for a “Wuddy” :)
I’m not from the States, maybe anyone can tell me why there is a two week break now and the sixth episode will air only on November 8?
October 19th, 2010 at 8:13 pm
EDIT: Sorry for double-posting but I can’t find an “edit”-button, of course “Wuddy” was totally wrong, it’d be more a “Wouse” or “Hilson”, of course ;)
October 19th, 2010 at 8:14 pm
Dr. Cheng really made this episode. Haven’t seen such an intriguing character on House in a long time. Sorry that she won’t be around. Too bad Taub wasn’t fired and Cheng hired.
POTW seemed like a ripoff of the Babies and Bathwater episode from Season 1, in which the pregnant mom has lung cancer but puts off treatment to save the life of her (unborn) baby. Mom dies, baby lives, and the reluctant other relative (husband, daughter) is left to take care of the baby.
Medical question for Scott or others who know these things: The melanoma was supposedly late stage enough that it would be passed to the baby. But it was the antibodies to the lung cancer that kept the mom healthy. Yet they tell the mom that they found her lung cancer early and that surgery would cure it. Wouldn’t the lung cancer have had to appear not too long after the melanoma to keep it from harming the mom, and therefore NOT be in such an early stage?
And if the antibodies from the lung cancer kept the melanoma in check butnever cured it in the mom, why would it cure it in the baby?
and yes, as someone else mentioned, the delivery room aspect seemed weird. Didn’t seem like they even had time to cut the umbilical cord before they rook the baby away. Then everyone abandons the mom rather than checking that she’s OK, delivering the placenta. And…OK, maybe I didn’t deliver in the fanciest places, but hardwood floors in the delivery room?
House/Wilson was pretty funny. Fairly enjoyable episode, but the POTW story was not engaging.
October 19th, 2010 at 8:24 pm
As much as it pains me to say this–this is really the first House episode I really did NOT like at all. Was excited by promos (Jennifer Grey looking more like her “old” self) and House babysitting.
I felt nada for the POTW–and I weep at everything.
There were things about the whole House/Wilson/Rachel thing that bugged me as a parent–crib mattress WAY too high esp for a child her age AND one that can crawl out (I’m not going to knock it for still being in a crib, my kids were).
I do like the new Rachel, cute kid. The banter between House and Wilson was funny as usual.
I really liked Dr. Cheng–tho she’d still be dealing w/ kids and parents if she worked for House (just not as many perhaps). However if you don’t like kids….? My sis, a pathologist, passed on pediatrics for that reason. Loved kids, hated the parents.
Didn’t think about the link between Jennifer & Joel Grey until you mentioned it. Neat.
I hope the season picks up in Nov. Not all that impressed so far :(
October 19th, 2010 at 9:29 pm
@Houseismyvicodin: Generally there are 22-24 episodes /year for a TV show like House. This means there are going to be breaks in the season. Since the baseball playoffs and World Series are on Fox at around this time, it is convenient for shows to break here. And this is true not just at FOX but at other networks as well. You will see many repeats in the coming weeks on all networks. We also have “November sweeps”, a time during which shows try to do their best to get good ratings, so there are generally new episodes during that time. There will be 3 House episodes in November and then there will be another even longer break until the new year in January. This is probably due to all the holidays falling during this time. People are busy doing things other than watching TV and there are also lots of special holiday specials. I hope this explains it, at least somewhat.
October 19th, 2010 at 9:31 pm
remove the first “special”!
October 19th, 2010 at 9:34 pm
Scott (or anyone who knows: what was Wilson’s gadget that House was scratching in the shower stall? Thanks.
October 19th, 2010 at 9:46 pm
@HouseIsMyVicodin: Some television shows with high production costs (like House) will take these kinds of breaks to stretch out their seasons. All of the episodes we are watching now were recorded some time ago, so they aren’t taking a break to record new ones.
October 19th, 2010 at 10:03 pm
Scott (or anyone who knows: what was Wilson’s gadget that House was scratching in the shower stall? Thanks.
It was a radiation detection badge; House sabotaged it so it would read positive, meaning a possible radiation leak somewhere in the hospital, meaning that Cuddy would have to work late again, meaning that House would have an excuse to babysit Rachel again and try to track down the ingested dime.
October 19th, 2010 at 10:18 pm
Fox is carrying the World Series at that time. However, as Dr R points out, high cost shows often take production breaks mid-season. Doing it during the Baseball championship is a convenient time for the network.
October 19th, 2010 at 10:23 pm
MrBuddwing – Appreciate the clarification.
October 19th, 2010 at 11:54 pm
Were we meant to believe that the UV lamp House used on the radiation badge was exposing it? That’s the most ridiculous thing in this episode, to me at least.
October 20th, 2010 at 12:00 am
And (so far) the Dam’ Yankees are getting their asses kicked!
October 20th, 2010 at 12:32 am
With regards to the coin side plot, I’m surprised they made the mistake of calling it an issue when it had passed into the colon when an episode from an early season of House had him diagnose a clinic patient who had swallowed a magnet and declare him home free under similar conditions.
October 20th, 2010 at 1:02 am
MrBuddwing – Appreciate the clarification.
You’re welcome. I should clarify that, as evan pointed out, House was using a UV light on the badge, and that House was also scratching Wilson’s name off.
October 20th, 2010 at 1:36 am
@evan what’s so fundamentally ridiculous about a UV lamp causing a false positive on a dosimeter? thermoluminescent dosimeters detect radiation through heat, which a UV light certainly could cause. maybe the physics makes it impossible, but it’s not obviously so.
also, the image they showed as the “lung cancer” was wrong on multiple levels. taub just pointed to the heart, they weren’t viewing it in proper windows (i.e. brightness and contrast levels) to see the lungs (they were all black), and the image was labeled with “left” being on the right. plus, if you can clear the lungs for granulomas, you probably would have noticed a cancer.
finally, it makes no sense that they couldn’t have put in an IVC filter to prevent massive pulmonary embolism like the one that killed the patient. or at least checked an ultrasound of her legs to see if there was a clot that could kill her.
October 20th, 2010 at 2:32 am
I really am sad Dr Chang isn’t staying. I liked her and I always find it annoying that every woman on the show (including many of the female patients) has to be a hot skinny white chick. She was sharp and interesting. It’s a shame they didn’t decide to run with her.
October 20th, 2010 at 3:21 am
I think that this episode of House made me laught he most this season. Sure the reasons for lughing was not so “House” but it was still funny as hll to see two grown man being outsmarted by a todler (and when one of those is Hugh Laurie than you are guarantted to roll of your chair). When he couldn’t sleep and when poo digging the first time was the funniest moment of the season so far “I got it!” “What are U doing?” (Was that one cute PJ Cuddy was wearing or what :)?). Any way to the medicine:
Instead of breaking it in parts like I usually do I’ll sumarize my point into two sections dealing with the two sides of the show – diagnostics and medical procedures:
1. Diagnostics/diagnosis: I liked the final solution and found it plausible mostly because there is no real information out there to compare. People who have two cancers are rare; people with two cancers who are pregnant are rarer; poeple with two cancers transmiting one of those to their fetus are rarerer (10x House). So I say it is possbile and valid, and if someone has a problem with it – well call mythbusters and they’ll do the check for you :). Cross imunity is a valid hypothesis (when you are sick and producing antibodies for one thing and something else is affected as well. That is how flu vaccines work – you get vaccinated for flu but other respiratory infections caused by similar viruses are reduced/mellowed as well). The way they got to the diagnoses was jumpy and illogical but that seems to happen a lot on House lately so boo – I close my eyes. A side note on blood transfusion – you can transfuse blood from O type (both RBC and plasma) but in small quantities – up to a pint FOR AN ADULT!!! That is roughly 10% of the whole quantity of blood in an adult and you do it when you have no other choice – I am pretty sure they have pleinty of matching blood in the hospital. For a baby that is less than a week old you can transfuse no more than a tablesppon of O type so that was a blunder and unnessessary. They were atoher jumps of logic as well (infection Taub? Really?). But OK at the end.
2. Tranfuse mothers blood directly? Why? No medicine here just House :)Leave the mother to cure the baby? Why? Get her blood (she has more than enought o supply a week old baby for a month of transfusions without even fainting) and start curing her. Better yet use her blood to produce monoclonal antibodies and use those to treat the baby. Siphon the antybodies out of the blood and put it back in her (even better). So many options but that would kill the martir angle right? Speaking of which – boy the mom was annoing. If House was not so busy with Rachel he would have probably shredded the idiot in House style :) He does love self sacrifising jerks sooo much :).
So as a whole sopa opera was clear A+ for me (and WIlson was here – Yey!) while the medicine was around B- but still good.
October 20th, 2010 at 3:32 am
So let me clarify once again for the blood transfusion because people seem to have misunderstood both D-r Scott and ohters explanations:
1. You can transfuse RBC from O negative as much as you like – they have no surface antigenes to provoke a reaction. Transfusing RBC from O negative as universal donors – correct – check!
2. Croos matching the blood is done sooner or later and you switch to same type as soon as possible – check! (they messed it up at the show) The baby was bleeding and they were transfusing from a long long time – it is safe to assume they checked blood type and knew exactly which type she is so no need to transfuse O type.
3. Small quantities of O blood – up to half a liter can be transfuse in critical situations. The chanse of a reaction from the plasma antibodies increases with the quantity – the plasma of O type can cause the patints own blood to react. So no O type are not universal donnors for blood unless it is an emergency and you have no time to croos check the blood type. In that case you transfuse ceiline and RBC form O type and only in critical situations when no other option is there – direct blood transfusion (up to half a liter).
4. Anaphilactic shock from transfusing O blood is rare but is possible.
October 20th, 2010 at 6:29 am
The whole birth scene was bizarre. Apparently there just wasn’t time to bother with such niceties as umbilical cord or placenta, to say nothing of waiting for the baby to take a few breaths. The doctors found her in a cabbage patch and she was blue, so they had to do something about it. Probably she was blue because Mom was using up all their oxygen screaming “Yes! I want the crotch shot!”
October 20th, 2010 at 8:45 am
There’s one more thing bugging me: can mom donate her blood few hours after giving birth? Wouldn’t it be dangerous for her to lose more and more? Or was that just a miracle delivery with no blood loss?
October 20th, 2010 at 10:07 am
I loved the first look at Rachel – standing there in the doorway in pink striped pajamas. All I could think was “House’s nemesis!” My favorite line from the show was House – “I wish I was nicer” so that he could use niceness to manipulate Cuddy. Classic House.
I’m now imagining the combination of Rachel and Candace Bergen against House. That should be fun.
October 20th, 2010 at 11:04 am
Good writing! As a writer – I am jealous and in awe!
October 20th, 2010 at 8:14 pm
D-r Bulgaria, thanks for your long and detailed account about blood type matching and such. Now I know I’m not smart enough to be a doctor.
October 20th, 2010 at 9:30 pm
I think the thing that annoyed me the most of this episode was the “jump” House takes towards “let’s transfuse mum’s blood directly”. Now, House usually makes a lot of inductive jumps, but there is no reason for this one at all.
We know that the mother donated blood for the baby the first time the baby crashed. But the show makes it look as if that transfusion had made the baby better (and therefore we have House’s inference). The first transfusion couldn’t have logically have made the baby better for a couple of reasons: 1) In all likelihood, if the baby needed a transfusion, the hospital would have used blood from their bank and then use mum’s blood to replace it. 2) Even if they used the mother’s own blood, there’s no medical reason why they would have used whole blood and not just red blood cells, in which case there wouldn’t have been any antibodies to make the baby better.
So how did the baby get better the first time?
Thanks to Drs. Scott and Bulgaria for all the clarifications. I had forgotten completely that whole blood transfusions were possible from an 0- donator in small quantities!!
October 21st, 2010 at 1:24 am
@Prup – yeah, you’re radically overreacting. This was not a great episode, don’t get me wrong. But you mention Cuddy hasn’t baby proofed her house – it seemed to me that they’re somehow working an angle where Cuddy wasn’t so interested in the kid in the first place. Note how she’s totally focused on House and basically ignoring the kid while House is changing the diaper. (Watch twice if needed to get past just watching her pajamas. I did. Well played, House producers.)
I’m in the camp that this show is showing House’s narcissistic worldview, which explains the distortion of what would be truly horrible situations if we were seeing reality. And that’s every week, not just the ones that include characters cute enough to be sympathetic.
October 21st, 2010 at 1:43 am
@Hibbleton and others: You have no idea how peckish the profs are about two issues when the examination topic is blood – transfusions and clotting :) After all these are the two things that a doctor can mess up :) So no room for error there because of all those nasty lawyers waitng at your doorstep day and night ready to eat you malpractice insurance :):):) You either answer for A on those topics or you go take another shot at that exam :):):) Dental doctors like myself get some slac on other topics (say stomach ulcer:)) but not on those!
October 21st, 2010 at 1:46 am
@Hibbleton : Sure you are :) but you know around year 3 or 4 a person starts getting anoyed by all the data you need to memorize. Enthusiasm begins to wear off. I know how patients sometimes become suspisious when a doctor reaches for a pharmaceutical manual or another textbook while examining or writing a prescription, but believe me – we need to check things we supposedly know all the time :). Too much data too much numbers to remember them all.
October 21st, 2010 at 8:52 am
I get the feeling that the writers are using Wikipedia as the basis for their medical writing…
October 21st, 2010 at 6:24 pm
@Zimbabwe and Prup: I agree and disagree. I thing the PTB are trying anything and everything to jack up the ratings at this point. People are already bored with “Huddy”, but the writers have to exhaust, and re-cyle, every trite and old comedy routine involving “nasty old man and cute baby,” as well as buff up every cliche involving couples, such as idiot man pulling dipshit stunts and hiding them from the sensible girlfriend. Cuddy seems too perfect to be true and House seems to be more jackass than usual. I though perhaps the writers were going to try something different and creative with this relationship; I guess I was wrong.
Now the latest buzz is that HL married his wife only because she was pregnant, and that now he’s doing the cheating cha-cha with LE (since he hasn’t been wearing his wedding ring for about a year and she’s been very publically vocal about wanting to jump HL’s bones). According to some critics (professional and otherwise), that explains the “great chemistry” between HL and LE. Hmmmm… Hope that gooses all of you “Huddy” fans.
October 21st, 2010 at 6:42 pm
@Keith: That wouldn’t be all bad actually, Wikipedia’s medical information is actually surprisingly accurate. (Apparently they have some kind of rule forcing editors of medical articles to cite reliable sources)
October 22nd, 2010 at 2:58 am
@D-r R They have that rule about everything. But considering how more and more people tend to rely on internet about selfdiagnosis, it is no wonder wikipedia are extra peckish about medicine. Stuff there is usually 100% true. It is a whole other question whether people without medical education should read it, and another matter alltogether whether a person should selfdiagnose :)
October 22nd, 2010 at 9:31 am
Was it just me, or did anyone else notice that after the baby was born and removed to the other side of the room, and the camera panned back over to the mother, her abdomen was still distended?
October 22nd, 2010 at 6:22 pm
@D-r Bulgaria, Thanks for the insight and a laugh.
October 23rd, 2010 at 11:09 am
Thanks for the clarifications concerning the breaks! Damn, I hate waiting :)
October 23rd, 2010 at 9:38 pm
OMG your Red#1 is so right!!
Obviously the medicine was overrated,
but I enjoyed the episode anyway.
btw, I like D-r Bulgaria’s #2 .. Direct blood transfusion…pffffff…
October 24th, 2010 at 6:04 pm
I have a question: House claims to know who his biological father is due to a similarity in birthmarks. Is this possible? I thought most, if not all, birthmarks were not inherited. Anyone know the answer to this? Thanks.
October 24th, 2010 at 10:28 pm
I enjoyed the episode, but the medicine was borderline laughable. First, the delivery room was ludicrous. There’s no need to “call the NICU” because a neonatal nurse +/- RT will be there before the baby comes out. The obs team does NOT take the baby and leave the mother alone; they hand it to the NICU team! And you can’t tell whether a baby is cyanotic instantly on delivery.
Next, for all the talk about the baby being “pink”, was she ever jaundiced given her, oh, liver failure? If so, was there no concern about hyperbilirubinemia? And why would a whole blood transfusion be indicated? I must have missed the reason for the baby’s respiratory distress too.
Finally, if mom’s risk of blood clots was so high, why did she not receive heparin at the very least? Platelets or plasma could surely be given to the baby (or simply protamine) to relieve any coagulation deficiency that might result. And what about compression stockings? I don’t know… the poor mom’s death seemed preventable, or at least possibly so.
Having said that, I liked the House/Wilson interactions and the Rachel-swallowed-a-dime subplot. And Dr. Cheng, even though her bedside manner was beyond horrible. I can’t imagine hating kids, though… perhaps some of their parents. (And, indeed, I just finished my peds rotation, so I’ll refrain further comment about House’s adult medicine team yet again practicing neonatology and even neonatal surgery.)
October 24th, 2010 at 11:16 pm
The best part of the episode were the House/Wilson scenes. Still rewatching those scenes. But the medicine was really bad this episode.
October 25th, 2010 at 4:03 pm
I’ve a question re: Wilson’s radiation dosimeter. Are these something he just has lying around in order to get another one with his name on it? Wouldn’t it be a bit suspicious when he has to order another one out of the blue when Cuddy just found one, with name scratched off, that had been set off?
October 26th, 2010 at 2:54 am
Jessica – the mother specifically mentions having sperm donors investigated. Thus, no father in the wings. Nor was there any reason for there to be one. Another character would have diluted the tension between the mother and daughter. I thought the conflict with the daughter lent more credence to the reason why the mother chose to postpone the surgery. She felt she’d let her first daughter down and wanted to try harder with the second. Understandable.
Granted, I know that most mothers (okay, *I* would, anyway) wouldn’t hesitate to do that for their child, but non-moms (and I would have been one of this crowd at one time) would probably roll their eyes if more character motivation wasn’t given.
Also, my pregnancy experience (and I had a tough one) was that most of the tests and such relate to the baby or, rather, how the baby affects the body. I’d expect the lungs would be particularly difficult to check, since you’re not supposed to have X-rays while pregnant. Thus, I find it entirely reasonable that nobody had yet detected the lung cancer, especially if she was relatively asymptomatic.
As for the rest, however, I do agree…a little of Rachel will go a long way. But I did like that House got caught. :)
October 26th, 2010 at 2:04 pm
Long time reader, first time posting :)
This episode wasn’t so entertaining – seeing a sick baby with possible fatal condition, no – no amount of nice soap will balance it for me. That is simply too disturbing. So I was kind of numbed to the whole patient(s) storyline.
As far as Rachel’s part – it was scary :) I have a toddler myself and always worried what can end up in his mouth when I’m looking in a different direction :) I don’t think it’s a reason to end up relationship though given how much he did to prevent any harmful consequences (it doesn’t matter that mostly to safe his butt)
A little off-topic – recently I started to wonder about recurring complaint here – that doctors from House’s team do too much, know everything and any procedure. Is it really so much off the reality when I heard just week ago that some physician assistant before his final exams was removing cancer from a breast?
October 26th, 2010 at 9:37 pm
@ John H: Sure it was. It takes awhile for the belly to deflate. =)
October 27th, 2010 at 12:15 pm
Prup: Why on earth would she have baby gates up with a kid that age??? Even at 22 mo old (the real baby’s age, rather than the 3.5 yo they get to play her–the words are appropriate to the age, but the clarity is way too high), and baby who isn’t an imbecile can CLIMB any baby gate he/she wants to pass, for goodness sake. You take baby gates down when the kids get skillful at climbing stairs–for my daughter, about 15 mo or so. What you DON’T do is keep them up long after the baby can push a handy chair to the gate!
The correct procedure for a kid swallowing a small coin is monitoring it. You don’t go in with stupid, unnecessary procedures for no reason.
My last birth was done in a hospital room with wood floors. Yes, it is stupid, but babies mean money for the hospital–easy money, usually, and a good profit–so they add all sorts of crap to the delivery rooms (labor, deliver, and recovery) these days–and make sure any woman who occupies one for too long for the profits get a nice little C-section. (No, I didn’t. But I don’t use any medical intervention at all during childbirth other than having a baby in a hospital.)
The OBGYN would be working on the mother and wouldn’t have anything to do with the baby. A problem with her heartrate would have been evident well before birth (the who setup makes NO sense, of course), many babies come out blue and need help breathing without there being an underlying problem, BP would have been checked at delivery, and there would have been a bunch of NICU people hovering by if there was ANY indication of a HR problem at birth. NICU hovers at the drop of the hat. They hover for every case of meconium-tainted amniotic fluid. They hover when the heart rate drops. They just hover.
October 27th, 2010 at 12:24 pm
k you for your reviews of “House MD”!
First of all, I have noticed a small error: in the list of series this episode is named 4, though it actually the fifth. Am I not right? :-)
Also, i want to ask about direct transfusion. How often is it used in medical practice in the USA?
I’m studing in medical university in Russia, and in our country doctors don’t use this method and method of whole blood transfusion.
I am sorry for bad knowledge of English language. :(
October 27th, 2010 at 2:53 pm
@Anton: Probably more often than you’d expect. I live in Alaska with a lot of small isolated villages and “bush” communities. There are only a few blood banks available in the State. To that end, direct transfusion is often all that is available in the interior communities where a supply of blood is needed quickly and the patient cannot wait for it to be flown in. It’s not exactly a first choice option for a number of very good reasons, but sometimes its all you’ve got.
October 27th, 2010 at 8:44 pm
When I was doing some charity work in India a few years ago, I had a patient who had lost three liters of blood, with no bank for miles. I had to use a direct transfusion then, but I would never do one in my hospital unless there was some insane reason why I had to.
October 28th, 2010 at 12:41 am
i loved this episode…….
October 28th, 2010 at 11:49 am
The bit with the dosimeter was annoyingly stupid. Was that a UV light House was using? And even if that had worked, the effect was to create a false impression of a major safety problem that could shut down Radiology, cause an investigation and screw up the course of diagnosis and treatment for multiple patients — all as an alternative to telling Cuddy that Rachel swallowed a dime. That’s not mischievous, it’s sociopathic; possibly criminal.
October 28th, 2010 at 2:13 pm
@ Manuel Royal: Have you not yet figured out that House IS a sociopath? He has a more acute personality disorder than “Dexter.” It’s not because he’s a genius; it’s because he’s a nut job.
October 30th, 2010 at 1:05 pm
So… where did the dime come from after all? Or are House and Wilson just terrible at arithmetic?
Also, has anyone else noticed that House’s team seems to be eating constantly these days?
October 30th, 2010 at 6:36 pm
Well, one’s not supposed to wear dosimeters outside, supposedly because UV light can affect them. A quick google search suggests that heat might be a more important source of falsely high readings.
It amazes me that House and Wilson weren’t a little more concerned about the popcorn that the kid was eating – that’s one of the big choking hazards for young children.
November 1st, 2010 at 5:54 am
Why did Wilson climb out a window when his car was parked out front, which cuddy would have seen?
November 1st, 2010 at 7:49 am
That girl is a horrific voice actor. The beginning of the episode was painful rather than engrossing because she was doing such a bad job.
November 8th, 2010 at 11:28 am
I too really wish Dr. Cheng was to be a regular. Not only is she calm and competent and not prone to losing her head in serious medical situations; not only is she fully believable as an experienced doctor; not only is she not a skinny white chick; she’s the only one on the team who is an emotional adult.
November 9th, 2010 at 9:02 am
Scott what specialty do you have? I am going to Med School next year(October 2011)
November 21st, 2010 at 8:53 am
Hi Dr Scott
I have question to ask you and would be grateful if you reply. The antibodies against melanoma are mainly of the IgM type which cannot cross the placental barrier and the a very low percentage of IgG antibodies which can cross the barrier are actually made against melanomas.
Thanks
January 24th, 2011 at 10:59 pm
Add me to the list of those who liked the House/Wilson scenes. The way they were trying to figure out what Rachel swallowed by counting the change from the restaurant bill reminded me of chemistry class problems, where they have you measure things that can be measured to figure out things that can’t (”you have 9g of solid; what is it?”).
October 17th, 2011 at 10:43 am
Dr. Scott,
why are people always compatible in terms of blood type on this show? I don’t suppose the chances of Taub being compatible with Kayla are very high.
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