House – episode 14
Another week, another episode of House. Though I pick on it every week, never doubt that I enjoy the show. The characters and actors are excellent and the mysteries are clever (even if the medicine isn’t).
A young female CEO comes in with a sudden paralysis of her right leg. A variety of labs and radiological studies are all normal. While on the table for a second angiogram, the patient develops sudden pulmonary edema (which the show confuses with pulmonary effusion. While both can be result from heart failure, the presentation and animation were consistent with pulmonary edema. Sadly, the doctors treated pulmonary effusion – chest tubes and thoracentesis won’t help for pulmonary edema). It turns out that the patient is bulimic and has been abusing ipecac for years. This overuse of ipecac has damaged her muscles (hence the leg pain and paralysis), especially her heart. Dr. House goes before the transplant committee in an attempt to get his patient moved to the top of the list and lies to the committee, telling them that she has no psychiatric issues (when bulimia is a big one).
While there is some medicine, it takes a back seat this episode to the soap opera. Dr. Cameron begins subtly manipulating people to do things her way. Meanwhile, the hospital’s new chief (played ably by Chi McBride) starts unsubtly doing things his way. As usual Drs. House and Wilson debate ethics and one wonders why they stay friends at all.
I’m amazed how fast transplant organs become available on the show. This is the second episode where a transplant organ was available almost immediately after the patient was placed on the list. All I can say if that you’ve signed your organ donor card, I wouldn’t go driving in New Jersey.
For once, the doctors didn’t perform every procedure on their own. Dr. Chase is helped on the first angiogram by a pretty blonde assistant – of course he screws up and scans the wrong leg.
Like many shows, House is full of plot clichés. The first cliché on House was that the standard diagnostic tests could not be used, so the team had to discover some new way of doing the test. Patients had convenient gadolinium allergies and spinal fluid that could only be tested once. Next, there was the cliché that the treatment would either kill the patient or save them. That’s it; all or nothing. This one has been used in almost every episode. The latest plot cliché on House is “Dr. House is the only one to notice blatantly obvious things that no competent physician should have missed.” For instance, Dr. House is the only one to notice the slash marks on the patient? He’s the only one to notice that the mute patient has paralyzed vocal cords? Give me a break.
This episode earns a B for the mystery and another B for the solution. The medicine earns a C (thanks to the pulmonary edema/effusion confusion). The non-medical side plots earn a B+.
March 16th, 2005 at 12:25 am
Didn’t Cameron also talk about her grandmother or somebody, who supposedly had a normal temperature that was a couple of degrees low? I remembered you talking about people are wrong when they say, “I’m normally a little low, so 99 is a fever for me” so that one jumped right out at me.
March 16th, 2005 at 8:49 am
I second Steve’s comments
This was my first episode, though I have been reading your reviews. i agree with yr assess, Scott. Esp. about the slash marks. Didn’t she get an exam?
March 16th, 2005 at 8:59 am
Hey Scott,
Love your House reviews. Even though the show is terribly predictable, I look forward to seeing it every week, especially for the “figuring it out” music in the last ten minutes!
And it was her “Aunt Elisa” that has a low resting temp =)
liz
March 16th, 2005 at 11:22 pm
Official Comment
That whole Aunt Elisa/temperature concept had my blood boiling (so to speak). If you’re going to ignore the test results, why even order them in the first place? That whole idea was just stupid, stupid, stupid.
March 17th, 2005 at 10:53 am
Driving, heck, I wouldn’t go within three states of House’s Jersey with an organ doner card. We have already seen him send out Dr. Troubled Urban Youth to break into patient’s houses. What are the other Broken People up to when these organs are suddenly made available, hmm?
May 15th, 2007 at 12:31 pm
First of all, I want to say it’s very interesting reading this blog. I’m a House-addict :).
But really, my experiences with doctors are that most of them/you do tend to make too many assumptions and dismiss a patient’s complains/suggestions about their own health too quickly.
My family has hereditary lower blood pressure (my BP was 90 over 55 at highest when I was 8-9 months pregnant and 80 over 45 otherwise without any problems). The doctors never realized they “underestimated” my grandfather’s “high BP” problems until he had a second stroke in the hospital.
When my younger daughter was 6 months old, I raised the question about possible lactose intolerance (I have it myself) to the pediatrician in charge of the rutine check-ups after I tried checking both her and my diets for the causes of continued diahorrea (10-12 diapers aday) and slow growth despite that she ate like a horse. (yea, she was also crying a lot with mean temper)But the idea was dismissed quickly time and time again because “every baby tolerates breast milk”! It was frustrating to be treated like a dim-witted hypocondriac mother as he kept ignoring the fact that I had an older daughter who was practically textbook example of a general average healthy baby to compare with, and that I was intelligent enough to check reference books for other more common, diet-related possibilies first. After another 2 months passed with the doctor refusing to listen (actually according to his own slip of mind, the only way to find out would be referring the baby to the specialists for testing, which was obviously very much troublesome paperworks), I decided myself to drop breast-feeding and switched to soya-based milk made for infants. Those are expensive here I live without the doctor’s note. And the diahorrea stopped the very day after and she started to gain more weight! Only then the doctor concurred that was the reason (and had obviously finally done some readings concerning this condition).
And finally I know I’ll probably chock you on this. I myself am one of those with slightly lower body temperature, and it was proven by doctors. I was admitted for 2 days in the hospital for monitoring when I was pregnant with my first child. Apart from the apparently the worst ever kind of “pregnancy-related morning sickness” (I was throwing up all the time why is it called morning…), I was totally healthy. The first morning the nurse was shocked to find me waking up with 35.9 degree Celsius (about 96.6 Fahrenheit). Later on several checks the temperature while I was awake but not doing anything was 36.3 C (about 97,3), so the doctors were more relaxed as it was within range. And when my temperature goes higher than 37.5 C (about 99.5 F), you’ll find me shivering with 2 thick woolen sweaters and under several blankets, and probably also slightly delirious and vomitting because of the fever.
May 23rd, 2007 at 4:02 pm
Dudes,
I have a query. What’s the deal with the ipecac the girl took which was found in her bag? I’m not clear, is it common for someone with bulemia to develope such dramatic heart problems? Or was it only the ipecac that did this?
Thanks in advance,
Nashspring
July 8th, 2007 at 7:04 pm
House explains to the patient that taking ipecac regularly caused muscle damage (which caused the initial symptom of leg pain) and also destroyed her heart. The only relation that bulemia had to anything else was that it was the reason she took the ipecac. Bulemia is a psychiatric problem and doesn’t damage the heart or muscles. (Scott mentions all of this in his review)
July 8th, 2007 at 7:30 pm
While I agree with several others up there (^) that it seems ridiculous that House is the only one who noticed the cuts on the patient’s legs, I have come up with two rationalizations:
First, Dr. House mentions at the very beginning that this case was sent directly to him by the patient’s assistants. This means that, unlike most of his patients, she has not been bounced around by several doctors and consequently studied up and down. In fact, it is quite possible that the only examinations done on her are the ones we see. Since we don’t see anyone looking directly at her leg (even during the two angiograms), we may assume that no one looked at the leg at all (It’s possible that the patient, who was too embarrassed to allow a colonoscopy, also prevented anyone from getting a look at her leg).
Second, the lack of direct observation of patients seems to be a recurring theme in this show. It is mentioned in the very first episode when one of the doctors remarks that House wants to dehumanize medicine, and is elaborated on in season 2, where at least two episodes deal with the issue (The Mistake where House is chided for his refusal to meet with patients after a diagnosis that involved a direct physical exam, and Failure to Communicate, where Dr. Cameron notes that the final diagnosis could have been discovered at any time if anyone had simply looked at the patients blood instead of running it through a machine). So its possible that this situation was simply a way to show the cost of House’s method of diagnosis, and the consequences of dehumanizing medicine.
Okay, that’s the end of my rant.
July 17th, 2007 at 6:58 pm
My qualm with this episode is not a medical one so much as a technical one. Chase claims that the x-ray machine will “fry” her cell phone, but I have enough degrees in Nuclear Engineering to know that ionizing radiation actually doesn’t affect electronics all that much. If the airport security screening machine (a high-dose machine which is not approved for human use) won’t destroy it, a medical imaging device (a machine which, given a good radiologist/technologist, is applied with the specific intent of MINIMIZING dose) won’t either.
July 20th, 2007 at 1:27 pm
I don’t think Chase really meant what he said, my guess is he was just trying to persuade the woman to put her mobile down, and exaggerated a bit so she won’t argue, assuming she doesn’t know anything about x-ray machines anyway.
Btw, great blog, it’s quite interesting to read about the mistakes. Though for me it doesn’t really matter, since I know nothing about medicine anyway ;). I just like the show.
August 31st, 2007 at 7:48 pm
Just so you know, bulimia can lead to heart damage. Besides ipecac, bulimics purge in many ways, none of which is good for the body. It can lead to hypokalemia, causing cardiac arrest, cancer of the esophagus, and plenty of other nasty things. So stay away from it!
September 6th, 2007 at 3:08 am
When I saw this ep, I got the impression the patient was extremely self-conscious (this might be the cause of her bulimia, right?). I think Demosthenes is right – she made sure no-one looked at her leg. It even occured to me she might have presented Chase the wrong leg on purpose, to prevent him from seeing it.
December 26th, 2007 at 8:39 pm
That one was smart, Hekko, hadn’t thought about it. There wasn’t an explanation for Chase’s mistake, this way it could make some sense.
Really nice reviews, by the way. First time I comment but it’s the first place I go after watching a House episode.
January 2nd, 2008 at 2:08 pm
I think Chase made the mistake because he was busy hitting on the blonde assistant he was doing the test with.
As for missing the scratches, the patient did seem to want to avoid being closely examined. She refused to have the colonoscopy in favor of the more expensive CT scan just to avoid being examined in such a way. These kinds of things could have lead to the failure to find the scratches. When watching the show, I wasn’t able to tell where on her body those scratches were.
February 2nd, 2008 at 7:52 pm
well… the patient was admitted due to leg pain and paralysis… the pain made her shout… after some time we found out about ipecac intoxication… why did biopsy show nothing if it was miopathy?…. the patient had severe cardiomiopathy (why was it completely asymptomatic till moment of hospitalization?… she had heart transplantation – she was saved… but what about her symptoms – terrible pain and paralysis – was it left without any cure?
anyway Hugh Laurie is excellent
February 14th, 2008 at 3:37 am
I just watched this episode and read the comments (great blog BTW!), I’ll you my two cents worth of insight.
The issue of shame, or her self-consciousness is first shown about midway through the episode when the patient is talking with her assistant. Her assistant asks something along the lines of “Your father wants to know when you’ll be back from your trip” and the patient replies, “E-mail him back, he doesn’t need to see me like this.” Her assistant then asks the same question regarding her brother and she gets the same response. The show often does something like this this; give the audience a little clue as to what the breakthrough will be at the end of the episode at some point before it’s noticed or discovered and it’s relevance is made clear by the team or House.
Consider the story of the scar on the tongue by the black politician (Joe Morton, no one can hyperventilate the way he does) a few episodes later.
So her not wanting to show them anything at any point in time would make sense as to why no one noticed the cuts. Now, if some of those tests would have revealed them, I do not know because I know nothing of medicine or their practices, but that’s how I rationalized/interpreted it as an audience member during my second viewing, as I was like everyone else in that “how could they not notice?” I think the clue was probably a tad bit too subtle and no one ever asked “why doesn’t she want her family being seen,” (although I don’t think a team member was present when the conversation took place), not to mention that there were two side-plots to eat up the time as well.
I suppose, if they had 10 more minutes or one less subplot, they could of done a better job with revealing this as it did seem a bit messy the way House discovered the diagnosis. Shame leads to cutting leads to ipecac(?) leads to heart failure.
February 28th, 2008 at 2:39 pm
This epsiode made me really angry. As someone who may have to recieve a heart transplant someday and as I know people that have recieved heart transplants at young ages it made me very angry at Dr. House who does not think that the person that he may have bumped into 2nd, 3rd, 4th whatever place could be a child who has never done a thing in his or her life to deserve the heart complications or even and adult who has worked hard at maintaining her health because of a heart condition that they did not cause and instead makes it so that the person who gets the next heart at that hospital is someone who brought it on themself! I hope that this does not happen in real life, because if it were me that needed that heart that someone got because of things they did themself and I died, well I suppose I would have no opnion as I would be dead but even so I would be beyond angry and upset.
March 25th, 2008 at 1:17 pm
Hey, Colleen, I understand your anger, but bulimia is a mental disorder. It’s not just silly self-mutilation. Mentally ill people deserve to live just as much as the rest of us!
March 26th, 2008 at 1:11 am
Are you sure you don’t mean a pleural effusion instead of a pulmonary effusion in your review Scott?
May 9th, 2008 at 7:50 am
About the cell phone, I’m amazed to see so many cellulars in the hospital, never mind the x-ray. Where i live (holland) hospitals have a policy for keeping cell phones off or out (try walking past a room with a MRI scanner in it, it’s sure to mess up your phone)…
So what’s the policy in House, do they figure that since a cell cant interfere with medical equipment, it’s all right?
September 22nd, 2008 at 3:50 pm
About organ transplants, I worked as a chaplain at a Trauma 1 hospital for a summer and there learned from the Kentucky Organ Donor Association that its a myth that people can be “bumped up” the list and also a myth that vital organs get rushed to and fro in a beer cooler. Did anyone else notice these common transplant myths?
December 21st, 2008 at 2:27 pm
On the count of bulimia, it can also cause a tear in the esophagus (it’s called Boerhaave syndrome). Now if the esophagus tears open, that’s death within minutes, so I thought I’d mention that if you thought about frowing up for fun:)
January 8th, 2009 at 9:21 am
I don’t think ipecac causes any significant toxicity on its own (I could be wrong, but since the point is that you vomit it up as soon as you take it, it seems unlikely that it would interact with anything except the lining of the upper digestive tract, briefly) However, bulimia can cause major organ failure issues regardless of the method of inducing the vomiting. Heart failure is definitely associated with long histories of chronic bulimia.
Abstract of Cardiovascular complications of eating disorders. Casiero D, Frishman WH. Cardiol Rev. 2006 Sep-Oct;14(5):227-31. Review. PMID: 16924163 :
“Much of this mortality and morbidity stem from cardiovascular complications such as arrhythmia related to a prolonged QTc interval and/or electrolyte disorders, hypotension, and bradycardia. Structurally, the heart in patients with eating disorders is atrophic, which may relate to longstanding hypovolemia. These patients have low cardiac output and demonstrate increased peripheral vascular resistance despite the presence of hypotension. The treatment of eating disorders is incremental caloric feeding, which can have its own intrinsic cardiovascular risk (refeeding syndrome) manifested by arrhythmia, tachycardia, congestive heart failure, and sudden cardiac death.”
January 15th, 2009 at 3:25 pm
Sorry, beth but ipecac toxicity does happen in bulimics due to their propensity to take large doses of the syrup. The toxicity does cause the symptoms shown in the episode like myopathy, abdominal pain, cardiomyopathy which eventually will progress on to CHF. The abstract you have quoted does show cardiac involvement but the presentations are of a completely different nature. Bulimia can eventually cause enough deterioration to involve any organ of the body but the presentation of the case in the episode fitted ipecac poisoning.
@stunda, tear in the oesophagus due to retching is Mallory-weiss not boerhaave which by the way is a much more serious condition involving rupture of the oesophagus.
April 5th, 2009 at 12:04 am
just a note on the board meeting. why are the members of the board smiling like a clown? :-)
May 1st, 2009 at 2:49 pm
everything in this show is exaggerated. I.e. if the patient had such a cardiomyopathy that needed a new heart she would have a lot more symptoms and she would be in a much worse condition.
as it comes to the guy with paralized vocal cords, House in his explaination was wrong – he said botox tightened every part of the face, but loosened tongue. 1) tongue? – the problem was in his vocal cords 2) botox paralises the muscles, they are inable to contract – so it does exactly the opposite of what House had said.
May 23rd, 2009 at 7:35 am
Agcias, learn your metaphors ;) In this case it does loosen the tongue, since it makes him able to talk again. And Botox makes a face look tighter. House wasn’t talking medicine here, he was talking so a common person oculd understand.
June 10th, 2009 at 11:32 pm
@stunda was right about Boerhaave syndrome – it’s a tear of esophagus due to strong retching. Mallory-Weiss is hemorrhage from ruptured dilated esophageal veins resulted from portal hypertension, which can happen when vomiting in alcoholics
June 12th, 2009 at 3:18 am
“#
lola
March 25th, 2008 at 1:17 pm
Hey, Colleen, I understand your anger, but bulimia is a mental disorder. It’s not just silly self-mutilation. Mentally ill people deserve to live just as much as the rest of us!
”
What about the person who can’t get a heart because it went to her? Did that person deserve to die? Giving her a heart probably means killing someone else. Suicidal people frequently have mental disorders too, does that mean we should give a liver transplant to someone who tried to overdose on hydrocodone? Or to an alcoholic who we know is statistically likely to relapse? When you have a very limited resource, you have to make choices. Transplant committees don’t decide based on who ‘deserves’ to live more, or who is nicer\more polite (I hope); they decide based on who is less likely to screw it up.
Giving an organ to a woman who is clearly much more likely to kill herself again based on past behavior isn’t all that noble. It’s understandable, but irresponsible.
August 20th, 2010 at 2:16 pm
@Colleeen
Not House’s problem. His patient wasn’t the little kid or the hardworking guy. His obligation was to her and her alone. He didn’t have to give a crap about anyone else. Watching this show, you should have figured by now the guy who would use newborn infants as guinea pigs or forcefully treat patients to satisfy his own curiosity is an egoist who doesn’t give a shit.
October 13th, 2010 at 2:08 pm
@ Colleen and consequent arguments
Colleen isn’t the only one that has argued this point of view (why should alcoholics, druggies and crazy people be allowed health care if they’re just gonna waste it?).
As a registered nurse, I find that most of these sort of arguments passionate but also unaware of reality. Alcoholics who are in liver failure DON’T get liver transplants (barring certain special circumstances) and drug addicts DON’T get heart transplants. Keep in mind that Matt1618 already mentioned that bumping people in transplant myths is not real and just a TV trope.
What I’m focusing on here is that people feel that others in certain circumstances should only help themselves and lay in the bed they may/may not have made. The amount of people I’ve heard commenting on a depressed person “why don’t they just snap out of it” are the same people who will whine the most when they finally suffer it themselves and ask why people aren’t helping them. We are not all on our own island and pretend we can’t do something about another person’s island sinking.
October 19th, 2010 at 12:58 am
House seemed a bit out of character the way he went out on a limb to get the heart transplant. In most episodes, his obsessiveness and rule-breaking involves trying to crack the mystery and find the cause of the problem, but in this one, the case was already cracked when the rule-breaking began. Certainly a nice human gesture, but a bit strange for House, especially considering her uncertain mental future.
By the way, hilarious scene with the mute dad (”BOO! Uh, sorry”)
October 31st, 2010 at 2:36 am
If/when I wind up in need of a nurse’s care,
I hope there’s someone there like you.
October 31st, 2010 at 2:38 am
Diseraph – I hope there’s someone like you.
November 5th, 2010 at 12:18 pm
So the question remains. Does Botox affect the vocal cords the way he said it does?
November 12th, 2010 at 5:37 am
drug addicts CAN recieve transplants, there was a case here in Australia of a young drug addict getting a liver, she returned to drugs and her new liver failed, the WA government paid to send her overseas for another transplant as she was not allowed back on the transplant list, this time using a partial liver from her auntie, this girl died not long after. so yeh people who are going to waste that precious gift do get them.
January 9th, 2011 at 10:08 pm
I get that a lot of people have anger towards doctors and their behavior and I’m not a doctor but I think Scott can appreciate what I’m trying to say here…
Most people are idiots and liars. I’ve had that in mind for a long time before I even started watching House so maybe that’s why I like the show so much, lol.
The biggest bain of a doctor’s existence these days has to be the internet. At this point in the show (first season) and at this point (7th season) we’ve seen many examples of patients who’ve gone on the internet and simply googled their symptoms and tried to self-diagnose. For every person who actually turns out to be correct there’s probably a million who wasted their time obsessing over a condition that, had they spent 10 mintues in medical school, would know they had no chance of having for many reasons. I mean no offense but just reading the comments on this blog I see lots of people offering their own medical opinions who aren’t doctors. People think they know too much.
I don’t think doctors ignore a patients symptoms as a rule, I think they just know the odds and know that symptoms on their own do not a diagnosis make. Everything can come with a headache. The fun part about a show like House is that the ultimate diagnosis is usually something very simple or common that is presenting with uncommon symptoms or something very obscure that most doctors rarely encounter. in real life we’re probably more likely to have a cold or the flu than Kuru but it makes for interesting television if it’s something exotic.
The biggest complaint my mechanic has is that people are horrible at describing what’s wrong with their car. I think sick people can be the same way. Most people in any profession tend to move toward the more common explanations rather than something exotic. Common illnesses are common for a reason. Also I think people don’t have the same kind of relationship with their doctor as maybe the did in the past or that they should. An underlying theme in House is that patients lie all the time or omit details that could have helped. We common folk have no idea what’s medically relevant or we’re embarassed to tell our docs the truth about what we’ve been doing. Sometimes the big reveal in House is a stretch, sure, but it does ultimately help.
True there are bad doctors out there, same as any other profession, but I think doctors have become an easy target for people’s anger- specifically since sick people are easily angered to begin with. I don’t love my doctor but I go to him when I need to and usually he helps.
At the end of the day though, House is a television show and should not be taken as medical Gospel. As Scott has pointed out the medicine is wonky at times and it’s often crammed into place (sometimes badly) by the writers to fit the needs of the story or subplot. It’s meant to entertain first and occasionally to educate but if you’re interested in the science behind it I’d stick to this blog or do some research on your own. Part of the fun for me is watching the episodes then coming here to get the real scoop and clicking on Scott’s links to find out more about the conditions or treatments I find interesting
Either way House may be a brilliant doctor but in the end you’ll wind up losing three fingers and a kidney before he realizes you have a tick bite :-)
March 18th, 2011 at 10:37 am
well said billy!
March 24th, 2011 at 8:42 pm
@Sebastion I think that an MRI messing up a phone is a myth. I had an MRI of my femur (to look for deformations). My mom was sitting right outside texting my father the entire time, didn’t mess up the phone at all. And my MRI tech was using her cell as well.
September 25th, 2011 at 3:57 pm
@AJ An MRI will not bust a phone which is in the console room, but try taking a phone into the scanner room itself… you’ll have a hard time wrenching it free from the damn machine in the first place (they have a really powerful magnetic field) and your phone will most likely get a memory-wipe!
February 1st, 2012 at 10:01 am
Did anyone else notice the open epiphysial plate on the scout film of her leg? Does anyone else think that maybe she is a bit old to still have an open growth plate? A detail as minute as using an adult knee film for the adult being imaged should really not be so difficult.
Leave a Reply
Contact Me
About
Subscribe:
The Best Of...
Special Topics
Archives
Categories
Twitter
See Also
Comic Blogs
Medical/Science Blogs
Currently Reading
Arbitrarily Interesting Medical Condition
Syndrome
The Net:
Contents may have settled during shipping. Past results are no guarantee of future performance. No animals were harmed during the production of this product. Void where prohibited by law. All rights reserved. Not valid with other offers or specials. Professional driver on a closed track. Your financial institution may impose other fees. All models are over 18 years of age. Employees must wash hands before returning to work. Results not typical. Many suitcases look alike. 18% gratuity added to tables of six or more.
Do not taunt Happy Fun Ball.
© 2004-2012 Polite Dissent. Powered by WordPress