House – episode 16
My vacation delayed my weekly review of House, but now I’m back and tanned (well, sunburned) and ready to review:
The ultimate solution to the patient’s problem was elegant, yet the route the team took to get there was full of dangerous assumptions. An obese 10 year-old girl has a heart attack. The lab tests and EKG all support this fact. The physicians aren’t entirely sure why she had this heart attack. Dr. Chase believes it is because of the child’s obesity, but Dr. Cameron thinks the patient may have Syndrome X (otherwise known as Metabolic Syndrome). Testing does not support this theory and the patient exhibits a bizarre mood swing while undergoing the test. Maybe it was the diet pills she was taking? Now the team decides that the patient is clotting so they start her on the anticoagulants heparin and warfarin. They believe that this clotting led to her initial heart attack as well as a small stroke that led to her mood changes. At no point does the team actually perform any tests or studies to confirm clots or to discover why the patient is clotting (if she even is), they just start her on the anticoagulants. (As a side note, if the patient had a heart attack, she should already be on the heparin). Areas of skin necrosis appear on the patient and House decides it must be warfarin necrosis. At the last minute, just before the patient is to go through some major surgical repair, in one of those “but doctor, if you’re wrong the treatment will kill the patient” moment, House discovers that the patient has Cushing’s Syndrome caused by a pituitary tumor. After the tumor is removed, the patient is cured – and even manages to drop 30 pounds by the end of the week.
The doctors on this show routinely jump wildly from conclusion to conclusion, but they normally run tests (lots and lots and lots of tests) to learn more. This episode there was a great deal of jumping to conclusions, but very little testing. There were also way too many overlooked issues. Assuming the 10 year-old had a heart attack, why? Was it due to clotting, a spasm of a blood vessel, or some other reason? No testing was done to find out, but this is a very important issue. Nobody bothered to figure out what diet pills the patient took, they just assumed “diet pills = bad” without bothering to learn what medications/herbs/placebos were in the pills. Later, an assumption was made that the patient was clotting, but no one tried to figure out why. Does the patient have a clotting disorder? Better run those tests before she starts on the anticoagulants they put her on (without checking for sure if she had a clot), because they’ll screw up the test results once she’s on them. Oh, and warfarin is a pill, not an injectable drug.
The soap opera aspects were much better than the medicine this week with House having to decide which of his three underlings he’ll have to fire. At the same time, the hospital administrator is busy playing games with people’s minds, both the young doctors and Dr. House. Who leaves? You’ll have to wait until the next (non-repeat) episode.
This episode deserves a B+ for the mystery and another B+ for the solution. Sadly, the medicine this week only receives a D+ (and that’s probably being generous). The non-medical soap opera aspects earn a solid A.
April 4th, 2005 at 11:35 am
Scott, I’m curious as to your reaction to the subplot with the new zillionaire taking over the hospital. Does that sort of thing happen in real life? And would someone doing that have the kind of latitude over personnel that the zillionaire does? (Actually, in writing this I realize who wholly ignorant I am of hospital administration…)
April 4th, 2005 at 1:29 pm
And a question on another subplot from the clinic side: could a person really grow a 30lb tumor in their stomach and be FINE? I just can’t understand how all the organs are not getting squashed around, though it didn’t look that different from pregnancy on the outside.
April 4th, 2005 at 3:00 pm
Official Comment
Chris,
It is not uncommon for there to be an administrator at the top of the hospital “food chain.” Often, they’ll be a physician or have some health-care experience — but not always. Depending on the set-up of the hospital (public vs. private, academic vs. non-academic), they can wield a great deal of power. I’ve had some run ins with administrators before all but discharging my patients to clear up bed space, long before they’re actually stable for discharge. Chi McBride’s character on House may be an extreme example, but not outside the realms of possibility.
Liz,
The abdomen is very compressible/expandable as shown by this patient (and pregnant patients, as you pointed out). A large tumor could certainly grow there and the symptoms would be similar to pregnancy in terms of stretch marks, bloating, heart burn, etc.
April 4th, 2005 at 4:52 pm
Nice. I totally agree with your grades/assessment. As bad as the medicine in that show can be cometimes, it’s still good tv thought, right?
Looking forward to your next reveiw!
April 4th, 2005 at 5:24 pm
Official Comment
House is good TV. The medical mysteries, and their ultimate solutions, are always clever (I just object to some of the steps they take to reach the answer). The characters are also well thought out and fun to watch, especially House himself.
April 6th, 2005 at 10:07 am
Scott,
The plotline concerning the zillionnaire is totally unrealistic. He is not an administrator but is Chairman of the Board who was invited into his position because of a generous donation. I have never seen a hospital where a Board Chairman gets involved so intimately in the day-to-day operation of a hospital. In my experience as a hospital administrator the Chairman would never just wander the corridors of the hospital interfering in the hospitals operation and would never be allowed to get involved in patient care decisions. Board Members including the Chairman are involved in policy making and delgate the responsibility for running the hospital to the administration. Administrators, particularly if they are doctors, can wield immense powers in a hospital. If they are not doctors which is usually the case they have difficulty intervening in patient care decisions unless they can get the support of the Chief of Staff, the lead doctor in the hospital.
I am always amazed at the limited understanding that most doctors have about the way a hospital is operated. Most doctors tend to focus all of their energy on their patients which is a good thing. Admissions and discharge issues are always hotspots between doctors and administrators because there is tremendous pressure on most hospitals to handle patients in a timely manner. When the hospital gets full and patients are waiting on gurneys in the Emergency Room corridors, all hell breaks loose as doctors are pressed to discharge patients. It is an unfortunate fact of life in a busy and successful hospital.
I am no longer a hospital administrator and am glad that I am out of the business. It is a pretty thankless job since you are the “meat in the sandwich” between patients, doctors, board members and employees. Almost all of my peers have been fired at least once since the administrator is the ideal scapegoat although to be fair we often bring the troubles on ourselves.
April 14th, 2005 at 1:50 pm
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January 23rd, 2007 at 10:49 pm
This was a good episode but I found it unrealistic that Mcbride could change so many of the rules in the process of trying to fire someone. He is totally unreasonable! How can he say when House has chosen someone to fire that he has to pick another one? Its good drama but why would he hate House so much?
Another point was on the medicine. If the patient has had so many blood tests after seeing so many doctors and nutritionists surely she would have had an MRI earlier or even a differential of Cushings that would have been well investigated. If she showed such advanced signs of Cushings such as the moon face and heart- attck it must have been very hard to miss. Unless the tumor somehow has random cyclical activity…
March 4th, 2007 at 1:32 am
I don’t know about this episode. If I were a doctor (and I have no medical training whatsoever, so pardon my ignorance) and had a desperate ten-year-old girl who just doesn’t want to be fat anymore in my clinic as well as a mother claiming they had tried diets and exercises all across the board, checking for diseases or genetical defects or whatnot which could somehow have caused the obesity would be one of the first things I’d do, especially if that same girl had developed other very mysterious symptoms.
My main complaint: First Chase behaves like an absolute asshole, happily blaming the daughter and all children for their obesity. And the dialogue writers want me to believe that he should be the one coming up with the idea that maybe, just maybe, obesity could be a symptom?
May 21st, 2007 at 7:01 pm
The young guns *didn’t perform the brain surgery*!
I’m shocked.
July 24th, 2007 at 4:37 am
Good Point…
Good Point!…
August 5th, 2007 at 5:29 am
When House tells the mother that at least two of her children aren’t her husbands b/c the children have blue eyes and both of the parents have brown eyes — this seems off to me.
Aren’t the genes for brown eyes dominant and so it would be fairly common for two brown eyed parents with recessive blue eye genes to have children with blue eyes?
The reverse (Blue eyed parents with brown eyed kid) would be rare but according to this article possible … since apparently more than one gene controls eye color:
http://www.usatoday.com/tech/columnist/aprilholladay/2004-10-14-wonderquest_x.htm
~Scott
And btw thanks for such great reviews of the program!!
August 8th, 2007 at 11:29 am
Scott, you’re right, it is possible for 2 brown eyed parents to have blue eyed children – both my parents have brown eyes and mine are blue :)
If the parents both have dominant brown eye genes, they could also both have recessive blue eye genes, so children could be blue eyed.
November 6th, 2007 at 5:30 am
Blue eyed children – yes. But House said “Cute kids. Love her green eyes. And his baby blues. Of course, since you and your husband have brown eyes…”
So blue, green and brown doesn’t seem possible.
I love those revievs, but sometimes you really should watch episodes more careful!:)
November 12th, 2007 at 3:31 pm
The discussion about whether or not Cameron has given the patient heparine seems to imply that giving heparine would prevent warfarin-induced necrosis of the skin. As far as I know, this is not the case.
December 31st, 2007 at 4:37 pm
PETER:
The problem was that if Cameron had given Warfarin (instead of the Heparin she was supposed to) then that wouldve meant excessive warfarin wouldve been given (eg in addition to Chase’s dose).
April 1st, 2008 at 10:26 am
Marius, I totally disagree with you about Chase acting like an asshole. I totally agree with his tirade about how Americans are ridiculously fat…I’m happy he didn’t go into all that “politically correct” junk that’s so popular nowadays. Obesity isn’t healthy. Period!
April 25th, 2008 at 10:03 am
I have dark brown eyes, which leads me to think I’m homozygous and my children will all have brown eyes, even if I marry a blue-eyed man. Are eye-colour genes expressed in this manner? This always confused me as there are so many different shades–my brothers’ eyes are nearly black, so much so that his pupils are invisible unless you shine a really bright light at them and watch the muscles contract.
April 25th, 2008 at 10:14 am
Official Comment
Em,
It seems there are multiple genes that affect eye color, but the eyes generally do follow a standard dominant/recessive scheme:
Brown >> Green >> Blue.
So yes, if you marry a blue-eyed man, all your children will have brown eyes, but you may have several blue-eyed grandchildren.
June 7th, 2008 at 2:09 am
[quote]
So yes, if you marry a blue-eyed man, all your children will have brown eyes, but you may have several blue-eyed grandchildren.
Scott,
You can marry any color eyed man or woman and still produce any color eyed children.. it just all depends on who you have the child with :)
Just thought I’d add some humor :)
July 7th, 2008 at 4:18 pm
Why do you think the girl lost 30 pounds in a week? It could have been a flash a couple months in the future and they put it out of order in the episode. Granted, that would kind of tip their hat that no one got fired.
July 9th, 2008 at 10:35 pm
@ Ryan: Because the episode specified that he had to get rid of someone by the end of the week, but all three doctors were in the shot where she happily had lost weight. I’ve not seen the next one though (I’m netflixing the DVDs, but it was heavily implied.
Also, 30 lbs in one week? With a prior heart attack? I’m no doctor, but isn’t that dangerous as all hell?
November 15th, 2008 at 9:20 pm
This episode is on as I write this. In it, House stated to a woman that vasectomies can reverse themselves. Is that possible? As a man who had one (in February 2002) I am justifiably concerned, both for myself and my girlfriend. I am 54, have one son, and definitely don’t want any more kids at this point. Any insight would be appreciated. Thank you.
November 15th, 2008 at 10:50 pm
Official Comment
According to studies, vasectomies have a failure rate of 0.05% to 0.025%. This is the lowest failure rate of any method of contraception (discounting the hysterectomy, as it isn’t generally performed for contraceptive reasons). These are older studies, and improved surgical techniques have likely lowered the risk even further. My suggestion: don’t lose any sleep over it.
December 5th, 2008 at 4:31 pm
Hello
may be I am nitpicking but according to
http://museum.thetech.org/ugenetics/eyeCalc/eyecalculator.html
two person with brown eyes, whose father has blue eyes and whose mother has brown eyes, and whose siblings also have green and blue eyes have a
11% probability of having kinds with blue eyes
14% probability of having kinds with green eyes
75% probability of having kinds with brown eyes
Uwe Brauer
January 8th, 2009 at 9:44 am
I really liked that this episode addressed the issue of prejudice against fat people, and pointedly illustrated that doctors are not immune from the bigotry of the general population. It also showed vividly that hatred of fat people goes beyond affecting their self-esteem and quality of life, it also leads to assumptions about their diet and lifestyle that can be dangerous if unchallenged.
Case study:
I’m very slightly overweight, and so when I developed really uncomfortable edema in my left leg that persisted for months (actually it’s been over a year now) after the minor injury that caused it had healed, the doctors I went to all told me that the cure would be to lose weight because my diet must be high in saturated fats and cholesterol. If they had asked, they would have learned that I’m a vegan. They also told me to exercise more, like running or jogging. HELLO, my foot is messed up that’s why I’m there! They also never asked, but I bike regularly to get to class. I had my father (a radiologist) make sure it wasn’t a clot, and beyond that my solution is just to wrap it and make sure it doesn’t get worse. I’ve seen three doctors, none of whom questioned the diagnosis of “too fat and lazy” :(
Another doctor told my mother over the phone to lose weight and exercise more to lower her slightly high blood pressure… a few months after she had successfully lost so much weight that she fit into the clothes that she wore when she was in college and a long-distance runner on the track team. And had just changed careers and become a certified physical fitness trainer.
Again, the specifics of the medicine in this episode kind of sucked but Chase’s revelation that his assumptions might have been baseless (did he ever even ASK about her diet or lifestyle?) and its consequent importance in saving the girl’s life illustrated a meta-principle valuable in real life.
February 4th, 2009 at 10:40 pm
The medicine is horrible in this episode. Why do they not bother any kind of endocrinological blood tests? Cushing’s would be an obvious part of the differential, far more than metabolic syndrome. Did they do an echo either? Especially after she develops skin ulcers – no one notices that her skin might be unusually thin? No imaging? Aren’t they all internists?
Disclaimer: I’m only a first-year med student, and I enjoy the show, but the procedures they go through make no sense.
February 12th, 2009 at 9:24 am
Brown-eyed parents can have blue-eyed OR green-eyed children. 9th grade biology. Two brown-eyed parents can each have a recessive blue. If they each pass on their blue, a blue-eyed child. If one passes on a brown and the other passes on a blue, you can have a green-eyed child. If they both give a brown, the child’s eyes will be a shade of brown. The medicine on this show was one thing, but the biology was WRONG on this one. To do this correctly, you have to have two blue-eyed parents give birth to a green or brown-eyed child — that’s when the father calls the divorce lawyer.
February 21st, 2009 at 1:54 pm
@Sandy: From my super limited knowledge of eye genes back in eighth grade, I think you’re right. If both parents have blue eyes, there is no possible way their children can have eye colors other than blue (as a side note, the teacher who taught me this has blue eyes, as does her husband, and all four of their children have blue eyes). Because blue eyes are recessive, if a person has blue eyes, they have no brown eye genes (or they would have brown eyes), and therefore makes it impossible for two blue-eyed parents to have a child to have an eye color other than brown. However, if two parents have brown eyes and they both have a blue recessive gene and pass that one down, a blue-eyed child will be the result. Case example: Both my parents have brown eyes, but while I have brown eyes, my brother has blue eyes.
June 4th, 2009 at 2:17 pm
According to many websites it is unlikely but possible for two blue eyed people to have a brown eyed child.
I wonder if any marriages have been destroyed from such occurances.
July 6th, 2009 at 1:48 am
Hi Scott,
Great blog! Very interesting to read!
If my blue-eyed self and my brown eyed Chinese girlfriend would ever get a baby, I guess chances on a non-brown eyed child would be practically 0%. Not so many blue eye genes going around in China. I guess practically the same for the Hispanic background the husband seems of? I would guess the 11% probability of having kinds with blue eyes is not for him, probably many times smaller and making house’s assessment that he fathered 3 or maximum 4 of their children quite legit.
September 1st, 2009 at 7:54 pm
“Oh, and warfarin is a pill, not an injectable drug.”
I don’t know about an injection, but I know it’s available as an IV solution, because I gave it to my father on a weekly basis.
October 9th, 2009 at 5:22 am
Considering that the couple in question was Hispanic, I would actually consider it quite probable that they would have a child with green eyes, as that phenotype isn’t uncommon amongst Hispanics. Blue eyes I don’t see as being as likely – but I don’t think it could necessarily be discounted. No reason why one of them couldn’t have had that allele..
January 20th, 2010 at 3:36 pm
I agree with this assessment. Just look at the opening DDX. They suggest the heart attack might be because of her high blood pressure, and Cameron agrees that the hypertension is “likely due to her size.” (Something like that.)
The patient would have been on a cardiac monitor on the way to the hospital, and BP is the #1 vital sign that all EMTs and Paramedics monitor. They would have checked it again when she got to the ER. It would have been checked every time she went to the doctors office. Cameron is sitting there with the patient’s file. Couldn’t she have just looked to see that the patient had hypertension, rather than just guessing that she did?
May 16th, 2010 at 2:04 am
I found Chase’s issues against American obesity really bad on the writer’s part. It was sudden and had no real impact on character development, nor was explained in his past (i.e. being beaten up by an American fat kid). Also, just because he’s Australian, doesn’t give him the right to judge lifestyle issues in America. I’m Australian and I can honestly say we have just a bad problem here as over there if not worse. The only difference is we don’t have supersize in our fast food restaurants.
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