House — Episode 11 (Season 7): “Family Practice”
Cuddy’s mother is back in an episode of House that was more soap opera than medicine — and yet, no Wilson.
Cuddy, her mother Arlene, and sister Julia are shopping for dresses when her mother complains of an irregular heart rate. When Cuddy detects atrial fibrillation she has Arlene admitted to the hospital. While there is some hypertension (high blood pressure) and borderline macrocytic anemia (anemia with abnormally large red blood cells), there is nothing that particularly alarms House. Her treadmill test comes back normal, so he plans on discharging her. She bombards him with fifteen years worth of minor symptoms such as dizziness, diarrhea, constipation, rashes, and joint pain, so he decides to keep her in the hospital to appease her. He sends a team to search her apartment and — in addition to finding some in flagrante delicto photos — they also find a bottle of Mexican herbal medicine. Since these are often high in lead, Arlene is started on chelation therapy for possible lead poisoning.
House feels that hypochondria explains most of Arlene’s symptoms and gives her placebo pills to prove his point. When she finds out, she fires him from the case. Cuddy convinces House to stay on “behind the scenes” while Dr. Kaufman, the head of Internal Medicine, takes over. Soon, Arlene’s atrial fibrillation starts up again and Dr. Kaufman suggests cardioversion (using medications or electrical shocks to return the heart to a normal rhythm; in this case Kaufman is clearly referring to electrical cardioversion because it is painful if one is awake during the procedure — which was apparently never carried out, or if it was, it failed). Looking over her symptoms, the team suspects leukemia, which is the same thing that Dr. Kaufman suspects and is testing for. House berates them for their suggestion, insisting that Arlene has thiamine deficiency, which he blames on her likely alcoholism. Cuddy confronts her mother about her drinking, but she denies being an alcoholic, so Cuddy tricks her into taking thiamine pills.
Arlene now begins to run a fever which rules out thiamine deficiency. Taub suggests an autoimmune disease such as SLE (lupus) — which again is the same thing Dr. Kaufman diagnosed and he has already started her on prednisone. Foreman suggests endocarditis (an infection of the heart valves) and House agrees. If it is endocarditis, then the prednisone will make the condition worse because it suppresses the immune system. With the assistance of Cuddy, they switch out the prednisone for an antibiotic without Dr. Kaufman knowing.
Unfortunately, Arlene now develops an allergic reaction to the antibiotic with wheezing, shortness of breath, and pruritus (itching). Cuddy switches the antibiotic back to prednisone and the allergic symptoms resolve, but the atrial fibrillation and fever return. House now suspects Arlene has a fungal endocarditis and wants to start Amphotericin B, a particularly nasty antifungal. The team balks as there are many potential pitfalls when using Amphotericin, especially if carried out covertly. Despite being threatened by House, M3 works up the nerve to tell Dr. Kaufman what’s been going on behind his back and he is livid. Arlene is also furious and demands to be transferred to another hospital. After a discussion with House about how she never stands up to her mother, Cuddy confronts her and tells her that while the care may be friendlier at another hospital, but she’ll die there. It works and Arlene decides to stay at Princeton-Plainsboro.
As Arlene is being wheeled back to her room, she makes a comment that shows she misunderstood one of House’s clearly sarcastic comments. House quickly confirms that she is unable to detect sarcasm which suggests a problem with her right parahippocampal gyrus (a part of the brain used to decipher social context, such as sarcasm). Since the neurological symptoms started before the fever, it makes the diagnosis of endocarditis less likely. Instead, House returns to heavy metal poisoning. No lead this time, but cobalt, from a worn hip replacement. He confirms this by exposing the muscle around the implant which is discolored from the toxicity. Arlene is started again on chelation therapy and given a new hip.
This episode had a number of abbreviations mentioned without much context to figure them out:
M&M: Morbidity and mortality conferences are held by departments and hospitals to review and evaluate cases with bad patient outcomes.
DDX: Differential diagnosis
AOA: Alpha omega alpha, a national honor society for medical students
Not that much actual medicine this week, so not as much to criticize. Surprisingly, for yet another week, I found nothing I considered a major error. There were the usual jumping to unsupported diagnosis errors, but nothing that made me cringe too bad.
As usual, major complaints are in red (none this week), more minor complaints are in blue, and nit-picking ones in green:
A treadmill test will tell you if there is ischemic heart disease — which atrial fibrillation can cause, and can sometimes be caused by — but won’t help much in Arlene’s case. The key tests are to figure out why she is in atrial fibrillation. Only one test, thyroid, was mentioned and only in a discussion of outpatient care. Also, it would extremely difficult, if not impossible, to interpret a treadmill test on someone in atrial fibrillation.
That much hip muscle damage, but no significant hip pain? It should at least be worse than her other joints, and should have prevented her from performing a treadmill test.
I see many case reports of cobalt toxicity from hip replacement and cardiomyopathy and heart failure, but no mentions of atrial fibrillation.
If she had fungal endocarditis, why did her symptoms improve on the antibiotics? (Same question, just replace “fungal endocarditis” with “cobalt poisoning”)
House seems decidedly unconcerned about her atrial fibrillation. “It may get better on its own, or it may not…” If she’s in chronic atrial fibrillation, she’s probably going to need anticoagulation (blood thinning medication).
Low cobalt levels can lead to B12 deficiency which can lead to macrocytic anemia. Elevated cobalt levels lead to polycythemia — too many red blood cells — the opposite of anemia.
Yes, going against a patient’s DNR has been viewed as assault in certain cases, but M3 wasn’t initiating treatment, just running some tests. I doubt this would violate the DNR (tests of one sort or another have to be run on all patients), and she did perform the testing under House’s implied suggestion, even if it wasn’t verbal. No prosecutor would touch the case.
The medical mystery this week was only interesting because of who the patient was, not due to the mystery itself: C-. The final solution was logical — and well documented — and fit many of her symptoms. I give it a B+ The medicine was sparse, but above average. It earns a B. The soap opera was good, but was severely lacking in Wilson. For that, I can only give it a weak B.
The review of the previous episode of House
A list of all prior House reviews
February 7th, 2011 at 10:28 pm
Anyone ever consider that endocarditis could have been seen with a simple blood test? I doubt Dr. Kaufman would be that stubborn not to allow it.
February 7th, 2011 at 10:47 pm
I’m actually glad there are no major medical mistakes (not that I could tell)
But from your grades, which episode is your favourite and which one is the most ‘factually accurate’?
I’m really, genuinely curious.
February 7th, 2011 at 10:51 pm
A confession: I’ve always found the soap opera aspects of “House, M.D.” to be the least compelling thing about the show – it’s a procedural, first and foremost, like the “Law & Order” franchise and “NCIS” and just about any other procedural you can think of. The hallmark of a procedural is that the personal lives of the main characters work their way in from the periphery, not from the center; the personal stuff always takes a back seat to the case at hand. Trying to work against this approach, once it’s established, often threatens to backfire, and we end up with half-baked subplots like the failed romance of Foreman and Thirteen.
Which is why I found tonight’s episode a fascinating surprise – it was pure soap opera, and a procedural, and it totally worked, IMHO. The personal stakes for the characters were much higher than usual, with several facing moral dilemmas.
And for the first time, I found myself hating – HATING – House because of what he was doing to Masters. That he sort of made up for it at the end was only of medium comfort.
A very intense hour, reminiscent of last season’s finale, “Help Me.”
Anyone else notice there was next to no music in this episode?
February 7th, 2011 at 11:03 pm
I suspect that House knew that the DNR stuff with 3M wouldn’t stick but rather used it to still hang a weight over her head. Regarding your reviews “explanation” of terms used in the episode that were hard to figure out, “DDx” has been used more than a few times in the series (which makes sense given that many of the earlier episodes focused heavily on the DDx scenes.)
February 7th, 2011 at 11:25 pm
I’m beginning to wonder if House is suffering from a more sever case of Hypowilsionism than I thought, the soap operas are getting rather boring.
February 8th, 2011 at 12:33 am
Another nitpick: Prednisone isn’t available IV. Would it have been so hard to choose an actual IV corticosteroid?
February 8th, 2011 at 12:41 am
What? No mention of Cuddy’s or Taub’s unethical behavior in this episode???
February 8th, 2011 at 1:10 am
One episode without Wilson… D: Really missing something. And Taub. ffs…
February 8th, 2011 at 2:34 am
Also, an M&M featured prominently in one of the episodes in the Dibala arc in season 6.
February 8th, 2011 at 3:58 am
I can’t believe I’m actualy going to say this…while I noticed no Wilson, I didn’t miss him this ep. Weird.
I love the Foreman/Taub “Bromance”.
I don’t hate House for threatening M3…he’s done this before in other eps, perhaps not so menacing–but his point is always: I’m in charge, you may not get my thought process so don’t try to go behind my back or play games. She’s not even a doctor so a little reminder to put her back in place was warranted (I love her and wish she would stay permanently)
But yikes, Cuddy’s mom is a beyotch. Interesting to see who Cuddy is because of/in spite of her mother.
Anyone help me here–on IMDB they list a “young/grown Elena”–who???
February 8th, 2011 at 4:53 am
While House has been a jerk before, that’s the first time I’ve seen him as flat-out evil. Masters was absolutely in the right here: they were administering medications without recording them on the patient’s chart, leaving no clear record of what had been done.
That scene between House and Masters went beyond uncomfortable. I’m hoping the next development is Masters quitting; at the end of the episode, she seemed to be realizing just what sort of situation she was in.
February 8th, 2011 at 6:48 am
I thought that the House/Cuddy dialogue was excellent this week. House was as nasty as usual, yet, you could feel a real compassion for Cuddy and her mom. This episode went beyond soap opera into real adult drama.
In any other episode, the switching of meds on a patient being treated by another doctor would have seemed preposterous beyond belief. However, parental child relationships are often so screwed up that I bought into Cuddy’s off-the-charts unethical behavior.
Taub’s relationship with both his ex and Foreman is a great story in its own right, although her brother should have been charged with felonious assault. He’s a psychopath.
February 8th, 2011 at 7:45 am
Mr. Buddwing said “The hallmark of a procedural is that the personal lives of the main characters work their way in from the periphery.” I felt that’s what happened here with Cuddy. Her personal life was central to the episode but it was as if we had been given the key to her character since the beginning of the show. That’s why the soap worked–it was a pressure that has been building up for years (Why does a woman who has achieved so much dress to display tits, legs, and ass? Why is she looking so hard for a mate–and having such a hard time finding one?)
I agree with you on everything except hating House. I actually felt some affection for him, as he was feeling his way through the situation, almost taking his own temperature as to whether he wants to help Cuddy’s mother, and how to help Cuddy with it. For the first time, I felt that he actually loves Cuddy.
At the end, when Taub leaned his head on his wife, I thought, “where’s the music?” Only about 5 minutes after the end did I realize–no Wilson. But I did not miss him. I felt that all the characters were well presented in this one, and maybe a strong Wilson episode is coming (which I would prefer to the obligatory 90-second weekly appearance).
February 8th, 2011 at 8:03 am
I’ll start and end pretty fast with the medicine here because for the first time (since seasons one and two at least) there was some coherence – diagnoses were mostly logicla and followed the course of the desease instead of being put on the table and tossed out left right and middle. My main consern is what this show always screws up anyway – time and time course. You cannot expect a problem that has developed over 15 years ago to worsen or get resolved in a day or two. The treatments that tehy used – all of them needed a lot of time to actually work (antibiotics – at least a day, fungal – at least a week, corticosteroids – even longer). You cannot just pop the IV bag and see a result. Actually the only logical result was the alergic reaction – it usually starts really early could start seconds aftre the alergen was present. Endocardites seemed illogical – 15 years old and nobody managed to draw a positive blood culture for anything? Seems like a strech. Alos pristene EKG? Hmmm.
The soap opera was the high point of this episode and it worked out really well. The producers were setting us up – which is why Candice was so non existent in the introduction episode. But this time she was… WOW! Great acting. The moral and ethical dilema was difficult to judge – on one side slipping medication calls for revoking the liscence of the doctor. On the other – this is House :). The one thing that really bugged me was M3 – when oh when is this girl going to realize that you cannot go and fight windmills in the real world. I know it sound so good – always ne mice always be ethical, always do the right thing – but you cannot live your life like that! You just cannot! And you are going to be the losiest doctor possible that is for sure. I am not saying be House – but whitout a certain degree of convincing manipulation and twisting the truth a bit you cannot be a doctor at all. How often you need to convince the patient to take on a dangerous path because you know it is best for him? How often you need to mislead him to help him? I mean this is what House is all about -work ethics and wheter it is better to be “honestly dead” or “dishonestly alive”. Man she is annoying. I would have fired her anyway if I was at Houses place. Cameron was Tanja Harding compared to that female Jesus.
I am fairly sure my commnet will provoce a mini stomr about “Real doctors do not do that!” but I am sticking to my guns here – you want to always tell the truth, be honest about everything and never hide deceive or twist anything an a conversation – go preach in a Church or go to Tibet. You want to be a doctor – either in Houseland or in the real world – learn to be at least a bit like House (just a bit!).
February 8th, 2011 at 8:52 am
Two comments from above: “This episode went beyond soap opera into real adult drama” (Hibbleton) and “For the first time, I felt that he actually loves Cuddy” (Judy). Yes, yes, yes. I thought both things while I was watching it last night. I thought both House and Cuddy grew up a little bit in this episode.
I also thought M3 grew up some. She’s been so black and white in her thinking, and I think House forced her to really examine what she has been tossing off as knee jerk reactions, without a lot of thought about the consequences of what she’s had to say. We all know she’s going to leave when 13 comes back – I’d like to see her character mature and change some before that happens. She’s an interesting character.
Overall, I thought this was one of the best episodes in a long time. Good writing, good acting all around.
February 8th, 2011 at 8:53 am
I think M3’s real ethical dilemma will come when she has to decide between letting a terminal ill cancer patient suffer in agony or administer a lethal dose of morphine when the time calls for it. If she choses the former then she really has the ethical maturity of a 5 year old.
February 8th, 2011 at 9:24 am
“If she choses the former then she really has the ethical maturity of a 5 year old.” Well it is about: does the patient want it or not. Here in Holland we do have euthanasia and so on, but even I wouldn’t agree with this option at all when someone was doing it covertly. Besides, I myself wouldn’t do it at all.
But I didn’t really like the whole story. Although the relationship between House and Cuddy made this episode not complete boring. I did miss the medical side of the story. But that might be me…
February 8th, 2011 at 10:07 am
@JWvdVeer : I’m assuming the patient is asking for it, but it is illegal here for a doctor to perform euthanasia. What would M3 do? It is clearly against the law.
February 8th, 2011 at 11:07 am
Did anyone notice that the fake “anti-acid pill” label was mispelled?
It was named calcium corbonate, instead of calcium carbonate.
Also, wouldn’t you better be off giving something like a sodium [bi]carbonate or magnesium hydroxide, like you get for home treatment, for anti-acid purposes?
February 8th, 2011 at 11:22 am
This episode was very dark and gloomy.
Enjoyable, but a real departure from the usual setup.
February 8th, 2011 at 11:42 am
Ampho B is a yellow solution- no way you could sneakily swap a bag of it for another IV. Also as mentioned by “Jones”, Prednisone is not an IV medication. These errors are very distracting!
February 8th, 2011 at 11:44 am
Taub part is quite cool. Building his character. Man, remember when he went back to plastic surgery thing then House and 13 tempted him to come back even with a lower pay.
Taub doesn’t care about lawsuit, all he wanted is the patient or something he knows, may be wrong, but he didn’t take chance at all, he go to see the family.
House properly piss off and actually care to save patient, much of time, he went against so much just to save patient.
M3 on giving morphine scenario is was being explored by Wilson. House went on to speak Wilson confession on the medical conference.
Yup, missed Wilson scene. Chase was against doing lite House stuff. He believe what he believe.
The dude thing between Taub and Foreman is cool.
February 8th, 2011 at 11:46 am
I stopped watching the last episode about 1/2 way through when I realized I didn’t care what happened to anyone…it all seemed so unrealistic, the doctors seemed so clueless, and the soap opera so heavy-handed that I just went channel surfing. I think the show is better when they don’t try so hard.
February 8th, 2011 at 12:02 pm
I can’t believe nobody’s mentioned the lighting yet. Over-all a very good episode, but the depressing mood lighting was distracting – too obvious (add the rainy night theme as well). And no funny moments this week – I miss laughing my ass out.
Also, to my own point, the timeline seemed wiggy to me. It seemed to be night (and raining) then Taub got a page to do his “working interview”, then it’s daytime and sunny and he’s at the faux-brain bleed’s house, tells them to meet him at “the hospital” (which one?), then he’s back to PPTH and it’s a dark and rainy night again. how much time was supposed to have elapsed?
February 8th, 2011 at 12:37 pm
Time to get rid of Masters, she’s ruining the show. Bring Thirteen back.
February 8th, 2011 at 12:46 pm
man, talk about forced drama. and what’s with the cinematography in this episode? everything was so dark everywhere.
February 8th, 2011 at 12:58 pm
Dr. Bulgaria: Your knowledge of medicine is impressive; however, you’re a dentist. You would never be faced with the type of ethical dilemmas you see on House. However, can you really say that you would out-and-out lie to one of your patients if you thought it was best for him/her? I don’t know what professional standards you are held to in your country; I assume they are just as rigid and even unforgiving as ours. But the bottom line is that House and Cuddy broke so many laws and rules in this episode, its ridiculous. M3 was absolutely correct in turning them in; the attending physician MUST know everything that is going on with his patient. What is even more disappointing is that not a damn thing will happen to House or Cuddy in the way of discipline. A badly drawn episode all around. This isn’t soap, its Sci Fi.
February 8th, 2011 at 1:30 pm
I loved the episode. And it’s nice to know that in the future, Arlene will have her “sarcasm” back…because she sure knows how to use it!
February 8th, 2011 at 1:30 pm
I actually think it would have been better if Cuddy’s mum was an alcoholic; having known a few irl she fit the profile and i think i said so before but i can’t find to prove it; i think it would be funny if a script writer had decided that that is a good twist, i’ll use that…
I think Taub’s ex’s brother should have been charged for assault but Taub probably just wanted to let it slide. I think the summary “good person, lousy husband” was accurate.
I had to use prednisone to treat viral pneumonia and i had no idea it was supposed to be so dangerous. Oh well, i guess viral pneumonia is no walk in the park either.
I liked this episode, both aqs a medical mystery and a soap.
February 8th, 2011 at 1:35 pm
http://www.playbill.com/news/article/147445-Robert-Sean-Leonard-Will-Inspire-a-New-Dawn-in-Born-Yesterday-on-Broadway
This may help explain the absence of Wilson from some episodes.
February 8th, 2011 at 1:50 pm
If the mom didn’t get sarcasm, why did she respond so archly and with sarcasm of her own in the early exchange with House about smartphones and laptops? How was she able to be so arch in her first medical visit with House a few weeks ago, at dinner and shopping with her daughters?
This wasn’t my kind of House episode, though I see it worked well for others. The soap was really sudsy, and the plot points so clicheed. You could see the mother-daughter “Why did you always treat me differently?” hashout coming from Minute One.
The Taub subplot, though, was great. Complex and genuine-sounding relationships with wife and Foreman, who, by the way, got by far the best line with his “running out of letters.” Avoided all the cliches that the mom plot fell into.
February 8th, 2011 at 2:15 pm
This was an Episode that I can honestly say that I liked for most of the reasons why people so far have disliked it..
It was dark to reflect the dank nature of the storyline…. House putting it all out there to please his girlfriend who wants to save her mother ‘by any means necessary’ just as long as she doesn’t have to know about it.
It was gritty to see House actually wrestle with a clear conflict of interest even tho he eventually ‘gave in’ to Cuddy’s demands to stay on the case…
The Taub sub-plot was forgettable on an Epic scale and I’m glad he got his nose broken (again) as that signals the end of that story arc…
Remy is supposed to be back…where is she and when is she coming back??
Unless Remy is the person who….dies at the end of the season?… :o
February 8th, 2011 at 2:15 pm
What stuck out at me was this…Arlene was on ‘Prednisone’ for a while, and then she had an allergic reaction to antibiotics? Shouldn’t a corticosteroid squash that reaction? About the drama, it does seem a bit forced :(
February 8th, 2011 at 2:34 pm
Can someone smarter than me translate the ending dialog from House to M3:
“When Cuddy was protecting me before, she was protecting a doctor. She’s now protecting a boyfriend. The hospital’s not going to put up with that for long. So I need you to protect me from doing something Cuddy will regret. (pause) See you bright and late tomorrow.”
Is he trying to convince her to not back up Kaufman when he brings all this malpractice to ethics boards?
Or can the patient decline to press ethics charges?
February 8th, 2011 at 3:17 pm
@ RAK – Wouldn’t that explain his absence from _future_ episodes?
I didn’t much care for this episode. It was hyped to the gills, but I didn’t really care about what happened to anyone. Well…that’s not entirely true. The House/Cuddy dynamic kept me watching, but Mama Cuddy could have died and I wouldn’t really have cared.
February 8th, 2011 at 3:18 pm
@ polacola – Reminded me of the Kutner suicide episode. Likely a conspicuous decision.
February 8th, 2011 at 3:24 pm
@Jen: Good point about the “prednisone” stopping the allergic reaction. Just one thing – time. She neede to be on the immune suppressant for at least a day to really squash the imune systeme that much. But rushed effects from medicine is now a common thing in House :) I am not sure if it is just an USA thing but we have methilprednisolone (which is another name for prednisone – the generic name :) in an IV solution. Bummer nobody uses it :) – we prefer administering via inhaler or shots :) I think it is a leftover from the soviet era but not sure.
February 8th, 2011 at 4:00 pm
This was a really solid episode IMHO. I watched twice to catch the mumbled one-liners. I think Masters is going to bail anyway, now that she knows her position. When 13 comes back, I’m following Masters. Enough already.
February 8th, 2011 at 4:06 pm
If another physician, or two physicians (especially if one were the Dean of Medicine), undermined me with a patient the way House and Cuddy did in this episode, I wouldn’t rest until the Board of Medicine threw the book at them. Sorry, D-r. Bulgaria; there’s is no way their behavior can be excused in this episode. It was just bad medicine and bad story-telling from start to finish.
February 8th, 2011 at 5:08 pm
If this situation happened in the real world, which of the doctors (if any besides the cardiologist) would still have medical licenses after the investigation? Would M3 be allowed to stay in med school?
February 8th, 2011 at 5:56 pm
Those suggesting an ethical dilemma via a cancer patient and morphine for Masters have forgotten that we already saw this with Cameron in Season 3’s Informed Consent. I cannot see the writers using it again. I suspect that Masters will *try* to hold to her guns and it will result in a patient fatality to “break the cutie,” and send her character spiraling out of her idealistic and thoroughly naive worldview… and possibly out of medical school.
February 8th, 2011 at 6:08 pm
Ok, so this might be on my list of worst House ethical violations. In addition, the cinematography in this one was very “Pilot,” perhaps the producers are trying to remake the show? (Probably a bad thing)
February 8th, 2011 at 6:22 pm
Two things:
1) She had an artificial hip implanted, shouldn’t that be in her chart? I think they should have at least considered it could have something to do with her symptoms earlier on
2) @Eric: no funny moments? I ROTFL-ed at least 2 times during the ep. First, House’s comment about “Bite vs. me” case, second – the whole “I-am-not-talking” bit to set up Triple M. That was funny.
February 8th, 2011 at 6:30 pm
I kind of loved the Masters/House story. Ever since Huddy happened, House has been so weak and… mushy. It was good to see an episode where you’re reminded what he’s really capable of. It wasn’t evil, it was amoral – just doing whatever was necessary to get the outcome he needed, no matter what the consequences. Plus: I hate the Masters character most of the time but this was just such a great episode for her. I don’t know if she’ll hang around for much longer, but even if she doesn’t, at least they’ve finally managed to make her more interesting than Cameron.
February 8th, 2011 at 6:33 pm
By the way, with regards to the cinematography: I thought that was to do with the gravity of the episode. The last time I noticed it was Kutner’s suicide; I think the point they were trying to make with this one was how shocking the ethics were.
Spoiler (kind of):
Hugh L., where did you get your information about somebody dying at the end of the season?
February 8th, 2011 at 7:06 pm
Alexandra: re Wilson’s absence from this particular episode, I read somewhere that there were originally a couple of scenes with him that were edited out, probably because they weren’t necessary to tell the story. As for the future, I have no idea if this play is only going to be on for a limited run or for a longer time. I believe they only have about 6 more episodes to shoot on House and it’s only early February, so I think they could work around his schedule this season.
February 8th, 2011 at 7:08 pm
@LabbRatt: Everybody except House and Cuddy. And yes, Masters would still be in med school.
February 8th, 2011 at 8:18 pm
Thanks, Huddleton, for making my point before I did.
Well, another episode, another felony. But first let me say House’s so-called “leverage” over Masters was shockingly weak. She drew blood. According to him “buried somewhere in the paperwork” is a document saying not to treat the patient and now she’s committed “a criminal assault”. Drawing blood isn’t treatment (not in this century anyway) and a needle prick is not an assault that anyone would prosecute. House’s points seem so weak it almost seems as if he WANTS Masters to be able to brush them aside. And I have to say it’s about time someone turned House in, I was cheering her on. I know a lot of people think she’s naive but I find her admirable.
So, drawing blood may not be an assault. On the other hand, what does New Jersey law think about a broken nose?
Let’s read the statute:
2C:12-1. Assault. a. Simple assault. A person is guilty of assault if he:
(1)Attempts to cause or purposely, knowingly or recklessly causes bodily injury to another; or
(2)Negligently causes bodily injury to another with a deadly weapon; or
(3)Attempts by physical menace to put another in fear of imminent serious bodily injury.
Simple assault is a disorderly persons offense unless committed in a fight or scuffle entered into by mutual consent, in which case it is a petty disorderly persons offense.
A disorderly persons offense, surprisingly, is not a crime in New Jersey:
b. An offense is a disorderly persons offense if it is so designated in this code or in a statute other than this code… Disorderly persons offenses and petty disorderly persons offenses are petty offenses and are not crimes within the meaning of the Constitution of this State…
HOWEVER:
Check out section (5)(c) of the following:
b.Aggravated assault. A person is guilty of aggravated assault if he:
(1)Attempts to cause serious bodily injury to another, or causes such injury purposely or knowingly or under circumstances manifesting extreme indifference to the value of human life recklessly causes such injury; or
…
(5)Commits a simple assault as defined in subsection a. (1), (2) or (3) of this section upon:
(a)Any law enforcement officer acting in the performance of his duties while in uniform or exhibiting evidence of his authority or because of his status as a law enforcement officer; or
(b)Any paid or volunteer fireman acting in the performance of his duties while in uniform or otherwise clearly identifiable as being engaged in the performance of the duties of a fireman; or
(c)Any person engaged in emergency first-aid or medical services acting in the performance of his duties while in uniform or otherwise clearly identifiable as being engaged in the performance of emergency first-aid or medical services;
I’m pretty sure DOCTOR Taub in a HOSPITAL could be identified as being engaged in the performance of medical services. And since they were in the hospital, where was security? Why didn’t Taub yell for them to arrest his brother-in-law after being assaulted by him for the second time? Maybe he’s some kind of masochist or subconsciously thinks he deserves it? And why couldn ‘t he convince the brother-in-law to get his clients to go for a X-ray? Then the lawyer would have looked like he cared about them, and maybe even have saved the boy’s life! Why would the lawyer object to doing that? I guess he’s just that big of a prick. “Well, hey, he is a lawyer”, must be what the writers thought.
But no one will lose their medical license and no one will lose his law license and no one will be prosecuted for aggravated assault. This is Houseland, not New Jersey. @Oh Snap: It’s not sci-fi, it’s pure fantasy.
February 8th, 2011 at 10:39 pm
@ Dr. Bulgaria: In re your 2/8, 8:03 a.m post: You’re full of shit.
@ Muser: Well said; however, to simplify things, “assault” is the “threat” of an ass kicking and “battery” is the “actual” ass kicking. Very few people are actually charged and prosecuted for an “assault,” aggravated or otherwise. At least that’s what they taught us in medical and paramedic school. Any lawyers out there?
Here’s something else that adds at least one extra zero to the malpractice check:
Negligence – defined as:
1. Failure in duty to act (not applicable)
2. Comparable negligence – performing below the established standard of care (guilty)
3. An act of omission (not applicable) or commission (guilty)
4. The act itself caused injury or harm to the patient, i.e. proximate cause (guilty)
5. The harmful act was intentional (guilty)
4 out of 5 makes a case for medical negligence in most states. But your right; it’ll never happen in Fantasyland.
February 8th, 2011 at 11:31 pm
Eric, they knew what hospital it was because he said “My name is Christopher Taub, I am a doctor at Princeton Plainsboro”
February 9th, 2011 at 12:29 am
Stephan wrote:
“Did anyone notice that the fake “anti-acid pill” label was misspelled?
“It was named calcium corbonate, instead of calcium carbonate.”
Well, House did admit he typed the label himself!
February 9th, 2011 at 1:03 am
Why are people still debating House’s ethics? For Pete’s sake, in the real world he would have lost his license 7 years ago. This is a TV SHOW…why do people still not get this??
February 9th, 2011 at 2:23 am
I do have a rather naiive question. Why do you refer to Masters as M-cubed? Maybe, I missed that episode. In any case, I feel as though I am in the majority opinion when I say that I don’t really like her character. Perhaps, it is intentional, since she is a temporary character. She is unduly pouty, self-righteous and underplays or understates her purported “genius.”
Be that as it may, I enjoyed this episode. I agree that one of the funniest moments was when House cited the fictitious case of, “Bite vs. Me.” The humor and drama continue to draw me to the series. Maybe, the sudden epiphany drawn from an inability to note sarcasm in order deduce a diagnosis of Cobalt poisoning was a small (large?) stretch, but not being able to detect sarcasm does not necessarily have medical roots. lol
February 9th, 2011 at 3:20 am
@Oh, Snap @MedMavRx – I agree with you guys but only for this particular episode. On this instance M3 was right and House and Cuddy did things that are practically impossible in real life. That was Sci Fi. However when I first got out of Med school I was a lot like Masters – bright sunny and thinking: Oh well my duty is to heal to inform and let the patient decide what is best for him to always tell him everything. I am just and executioner of a sort – I apply medicine it is somebody elses responsibility to make the decisions. See where I am going ParaMedIV? Or R U full of it :) Are you even a doctor? Judging from the choice of nickname NO. Than why on earth do you whant to open that can of worms? I gradually learned a couple of things after med school: You cannot just inform than sit back and relax while the patient is ruining their health. You have to ENFORCE the best possible treatment (if you wanna be a good doctor!) You have to mislead to the best possible treament (if you want to be a good doctor!) You have to hide the truth or at least parts of it (if you want to be a good doctor!). You have to learn how to give the choices to the patient in sucha a manner that they choce what is right not what sounds right in their UNPROFFECIONAL ears (AGAIN just if you want to be a good doctor!). If you want to be an OK doc then by all means careen through your patients never take any perosnal interest in their choices inform away and leave them to rot in their doubs or welll there is the internet: leave them to serach for answers and ideas there. The whole idea of informed concent is rigged; it is booby trapped it is a mine field and IF just IF you want to help people instead of sell health like it is beer – you need to be a bit Housy (just a bit – he is a TV char after all). This episode was of course a blattant example of 2 thing: why you should not treat your relatives or friend and why you should never make (or someone else to make them!) decisions whithout the person who is actually in charge of your treatment knowing. Now since the whole issue was with M3 let us go back to the episode when they were treating a senator. They had two options: one was dangerous and with a better chance of working (chemo) the other less dangerous but with a bigger chance of failure (steroids). What M3 did was: Let us explain impartially to the patinet the two options and let him choose. CRAPPY idea! What House suggested was: do not tell him about the safer option (he will chose it and screw his chances of getting better). Another CRAPPY idea.If you are the doctor and you care for your patient you will enforce what you think is best while informing him for both (it is difficult and that is why M3’s aproach pissed me an continue to piss me: always tell always be hoinest and impartial). She would have sparkling clean conscience at the end of the day: she folloed the rules to the letter she did what she had to do it was not her fault whatever happened happened. And she will kill a lot more patients that way.
Oh and of cource me being a dentist saves me from a lot of the high drama moral dilemmas. Sure thing. But when I fail to enforce a decision and as a reasult patient looses a tooth looses the ability to chew or looses his smile I feel as crappy as those REAL doctors (thank you very much). BTW if I failed to mention I am also an Oral-facial surgeon whit a sub specialty implantology, so I kind of have my hands full with moral dilemmas – not directly life treatening ones but still pretty big a deal ones. Yeah I kind of am a real doctor even just a dental one :)
February 9th, 2011 at 7:20 am
Eric asked for a “translation” of House’s comment that he needs M3 to stay on his team.
I think he is admitting that his impulse to cross ethical lines has to be curbed. He had a very close call re. the IV bags, and it was a close call in which Cuddy herself was implicated. (So long as M3 trusted Cuddy things were OK; when she saw that Cuddy was conspiring with House, that’s when things turned nasty). I think he is looking towards the future and seeing that his protected/favored position, in which the hospital director trusts him to end up curing the patient and ethics be damned, is now in the past. He could take Cuddy down with him next time. He wants to be stopped–or at least to be reminded by a voice he respects–when he is crossing the line.
Robi, the hip replacement was mentioned when House offered a summary of the contents of Arlene’s file. So the fact was planted. I think House’s working assumption was that most of Arlene’s past complaints were either psychosomatic or real but unrelated to her current crisis, so they were looking for a recent change (e.g. the herbal supplement, although that too turned out to be from a longstanding partner and not necessarily a recent change in her regime).
Reading all these comments, I am bothered by the confused timeframes, both re. the weather as Eric pointed out and re. the time it takes for various medications to have an effect. Of course, since the only effect any IV actually had was allergic, I guess this could be glossed over. Scott’s point that Arlene would have had pain and disability at the location, though, pretty much undermines the mysteriousness of the illness.
February 9th, 2011 at 11:29 am
@Chris: We call Masters M^3 because her name is Martha M Masters, thus M^3
February 9th, 2011 at 12:01 pm
Question for those in the know: do real world differential diagnoses (or “DDX!”) get carried out over the course of a few minutes like on House? I have no idea myself, but somehow I imagine they might actually take a while.
February 9th, 2011 at 5:16 pm
To Taub’s brother in law: You don’t attack a man in the bathroom. That is against the Guy Code!
Overall I really liked this episode. The tone was darker, and House went from being a funny jerk to pure evil.
It was kinda awesome in a way.
And I actually care about Taub now. His story is a lot more interesting.
But I do miss Wilson. This seemed a perfect episode for him to give his oppinion.
February 9th, 2011 at 7:23 pm
RE: Why did she get better on antibiotics if she had fungal endocarditis/cobalt poisoning?
Wouldn’t it be possible that this was due to a placebo effect?
February 9th, 2011 at 7:34 pm
Official Comment
I doubt it, because Arlene’s condition changed when the team switched her off the antibiotics and back on the steroids — which was all done without her being aware of the change — so no placebo effect.
February 9th, 2011 at 7:44 pm
Wasnt she allergic to the antibiotics?, she didnt get better.
February 10th, 2011 at 12:13 am
I think Dr. Bulgaria’s comment is more about giving advice the way Foreman did in one early episode – “Here’s what you should know: It’s dangerous. It might kill him. You should do it.”
February 10th, 2011 at 12:21 am
Official Comment
ryus,
While she was allergic to the antibiotics, her other symptoms (the atrial fibrillation, the fever) resolved while on them. Cuddy made a big deal about those symptoms returning when they had to stop the antibiotics.
Lumbergh,
From my experience, that’s not too far off. When discussing a patient on rounds, we’d use two white boards. On one we would list all the symptoms, and on the other, the differential diagnoses. Sometimes we’d just use the second board. As lab tests and reports came back, we’d narrow down the diagnosis list.
February 10th, 2011 at 5:55 am
ParaMedIV:
House and Cuddy may be out on their asses in the real world thanks to ethics violations, but for a lawsuit you need damages. Since the patient got better, those might be hard to prove. Plus, that would require the patient to sue her daughter and her daughter’s boyfriend.
Muser:
The brother is technically guilty of something. But no prosecution isn’t really straining belief. Unless Taub goes to the police, that’s not going anywhere. Conversely, I rather doubt the brother follows through on any of his hot-tempered threats, since the attack is likely to come up in that context.
February 10th, 2011 at 7:18 am
I agree about this being a good Taub story but i wish there was some hope of follow-up of the assault. The brother in law just seemed dangerous.
I don’t know a lot about medicine but i would have thought the style of attack he used had a fair chance of breaking more than his nose, it looked serious.
February 10th, 2011 at 9:10 am
I agree that if he’s spent five years in anger management therapy, Taub’s not the first guy his bro-in-law has hit. Maybe the therapy was court ordered? However, following up on him would take us too far away from mainstream House.
February 10th, 2011 at 10:27 am
@Scott – thank you.
February 10th, 2011 at 11:06 am
@Scott
Ah, of course. Forgotten about that.
February 10th, 2011 at 1:33 pm
Apparently, Thirteen is coming back within the next few episodes, but I guess the question is: Should she be back? Comments?
February 10th, 2011 at 4:03 pm
Olivia Wilde is hot. M3 is dull, annoying and boring. Bring back Olivia!
February 11th, 2011 at 2:02 am
@Brian: Agreed. Bring the hottie back :) Although I am pretty sure Amber Tamblin could look great they are just giving her that geeky sluggish genius outlook for the show :) It kind of suits her :)
February 11th, 2011 at 5:22 am
I wasn’t a fan of this particular episode of House. It just… wasn’t as interesting as the other episodes. I Masters BEYOND annoying. Her ethical values are there for the sake of being there. They have nothing to do with the patients’ best interest. She is adamant on telling them the truth for the sake of telling the truth. It is so damn annoying. She’s like Cameron except infinitely more naive. 13 was perfect.. they should really, really, really REALLY bring her back. Watching House is painful with Masters there.
February 11th, 2011 at 12:15 pm
One more thing, aren’t artificial limbs usually made from titanium, not cobalt?
February 11th, 2011 at 2:11 pm
I’ve been reading reviews of re-runs I’ve been watching the past week or two, started after “Carrot or Stick”, this is my first chance to post. Does anyone agree that the new girl makes Cameron look like Kim Jong Il? Also, I’ve noticed the question of when Foreman became a neurosurgeon occur several times, he’s been one the whole time. In Euphoria House says something to Cuddy about needing his neurosurgeon. Also, House always looks to him for neurological symptoms. Also Chase has always been a surgeon(I don’t know what specialty unless there’s a such thing as a general surgeon, like a GP of surgery). Also, I’ve seen a LOT of major and minor medical complaints that in my opinion are very nitpicky, usually they’re major plot points that lead to something important in the episode uncovered. This is a drama show, and a very compelling one at that because as a lay-person I’ve hardly noticed a single error. Also, where are the nurses, why do the young guns do all the tests, etc.? It’s all part of character development. They chose not to have any nurse characters, tests let u hear what the team has to say w/out House around and sometimes allows them to interact on a non-medical basis, i.e., a conversation about a relationship w/out House hearing. Also, some episodes wouldn’t have even happened if a mistake hadn’t been made in the history. House jumps to a “seemingly” unrelated dx to make him seem so genius when he’s right.
February 11th, 2011 at 2:20 pm
It was so funny.2 or 3 years ago they made an Omar Epps/Mike Tomlin joke. Then, Super Bowl night Omar was trending on Twitter from ppl making the same joke. They were quite out of date with that joke. Also, I’d like to see the review actually touch on the drama more, and maybe give a letter grade to the humor also, because some episodes House and/or the patients have many good joke lines in an episode while some others are completely serious and lacking in any humor.
February 11th, 2011 at 2:27 pm
Why do people complain about the timeline? Do ya’ll expect them to start a treatment then the next scene have a caption say,”Three days later.”? Come on, its tv and it has to move along. Besides, even w/out a timeline caption we don’t know if 1 hour, 1 day, or 1 week has passed between scenes so how can we complain?
February 11th, 2011 at 3:46 pm
Robi: Some implants are alloyed
February 12th, 2011 at 10:05 am
I actually loved this episode because the conflict was on top. No Wilson, so what? I like him, but he’s a sidelines/cheerleader anyway. It’s rare he DOES something. We had major conflicts between Taub and his ex’s brother, House and Cuddy, Cuddy and mom, House and mom, House/Cuddy and M3. Things felt like they were truly at stake this episode…
Two solid moments arose from this episode. M3 choosing to tell Cuddy’s mom what was happening behind her back, and House finally yelling at Cuddy “I hate how you let your mother treat me. IT PISSES ME OFF!”
***M3***
Hats off to M3!!! I don’t think any other character has EVER been so bold, standing up to both Cuddy and House, in addition to risking being fired, kicked out of medical school, (not to mention criminal and civil charges, though highly unlikely). In one action, she potentially sacrificed everything for a complete stranger. She has the moral integrity even Cameron never demonstrated…
Regarding the concern she has no maturity: I’m guessing she has a form of autism. However, I dare say she is more mature than the other characters. At the end of the day, she goes by rules, despite her desires (a true test of strength). The rules are there for good reasons. However, she has recognized there are certain circumstances where breaking a rule is the right thing. Remember when House wanted to give someone Hep A for treatment against Hep C? She actually called Cuddy “cowardly” for choosing the hospital’s desire not be sued vs the patient having a 10% chance to live.
In short, M3 is my new favorite character. She is objective and principled, and doesn’t succumb to her own emotions, like the other characters. She is unique to the team. I’m sad that she will be leaving the show upon 13’s return. I think the 5 of them would have made a great team.
February 12th, 2011 at 10:52 am
Robi: I believe that the cobalt alloys are now more common than titanium alloys in hip- and knee-replacement surgery. ASTM F-75 is representative: it’s about 63.3% Co, 28.5% Cr, 6% Mo (with lots of other small-percentage contributors). There was a recall of one of the metal-on-metal designs because of cobalt poisoning. also, some patients have had allergic reactions to the chromium content; maybe we’ll see this problem in a future episode.
February 12th, 2011 at 1:35 pm
I’m not sure if getting 13 back is gonna be a good idea. Yes, M3 is annoying and irritating most of the time but even if 13 is hotter weirdly her personality is quite cold (what a paradox there!) So…i’m just not sure
February 12th, 2011 at 5:41 pm
Re the characters:
I too love Masters, who showed real courage, whether we believe she was right or not. And her (not the actress’s) lack of hotness is an asset. Will be gutted when she leaves. Way more interesting and challenging than Cameron, who simply inspired loyalty as one of the original characters. 13 is OK, overlap there would be good – they’d make an interesting contrast, in a way that happens much more often with the male characters.
Taub has always been a good character, IMO.
February 12th, 2011 at 10:47 pm
i don’t think masters is naive or overly principled, she comes across as incredibly well-drawn to me. if house had put cameron in that position, she probably would have yielded not because she was less self-righteous than m3 but because she couldn’t ‘push through’ the fear.
as Tom mentioned above, she seems able to weight ethics against consequences. more often than not her judgment falls on the side of ethics and she is able to follow through on such judgments – much in the same way as house, which is why he is keeping her around. they counterbalance each other perfectly.
February 13th, 2011 at 2:19 pm
Why do you call the redhair bitch M^3?
February 13th, 2011 at 2:21 pm
On Wikipedia they list Claire Rankin as Elena Ramonovich… who is she?
February 13th, 2011 at 3:34 pm
If M3 did what she did because of courage I would have saluted her too. However I think it was fear: the omnipresenr fear that any ” good education victim” as my mom phrases it feels when he is about to break the rules. A father professor (in his 40ties – 50ties I guess when she was born) nad a young “gourgeous” mom student = single child who is completely unable to improvise think outside the box or do anything that is not already written in a regulations book somewhere. She is a tipical superego freak: she is just afraid to bend or break the rules in any way. God saves us from that kind of people! :)
February 13th, 2011 at 11:40 pm
She is a tipical superego freak: she is just afraid to bend or break the rules in any way. God saves us from that kind of people! :)
I might agree with you, if the person involved doesn’t face any potential consequences for being morally inflexible. That M3 was willing to face the ruination of her medical career and possible (albeit unlikely) criminal prosecution to do what she honestly believed was the right thing speaks extremely well of her, not badly.
(If only we had more of that kind of person in the last administration before we re-invaded Iraq!)
February 14th, 2011 at 12:13 am
Watched every episode, usually enjoy, this episode ranks as the worst. Risk a parent’s life, a career, jail, all because an adult (daughter) can’t stand up to another adult (mother)? Daughter does not love mother to allow ego to block health and life. Look forward to better show and mother’s exit or daughters thumb free and clear of her body.
February 14th, 2011 at 12:43 am
Anyone else getting tired of Masters getting unfired?
It’s cool that she’s a genius and has saved House’s life (maybe) at least once and all that jazz, but every other aspect of her situation seems to be just terrible for her.
I think she’s an interesting character, but as a greedy audiencemember, I’m much more interested in more sustainable (and less uncomfortable) character dynamics.
February 14th, 2011 at 8:20 am
Tonight’s episode promises Wilson, perhaps enough to overcome the hyopwilsonemia of this episode.
February 15th, 2011 at 9:10 pm
I’m still not digging M3. She’s still just simply a one-dimensional moralizer who has to be kept out of the way, and still not interesting to me. Why did she have to be so predictable? Why couldn’t they have gotten us to root for her? Just a little bit even?
This episode was too dark for my taste and not funny enough. By the end of it, I hated every character except Taub, who we’re apparently now supposed to believe is a good guy (sorry, not buying it — I’ve watched the show. But it’s nice that he did one good thing for once).
You have to like the characters a little bit for a show to work. At least, *I* think so.
February 16th, 2011 at 12:59 am
methilprednisolone –it’s called methylprednisolone. And I’m on the pills right now–for an ear infection that wouldn’t go away with antibiotics alone. (In my case, it’s oral.)
House in the early episodes was fun as a doctor’s fantasy character in the clinic. But for anyone to hold him up as anything but a horrific example of an actual doctor–that’s pretty scary in my book. He’s horrible across the board. The ethical dilemmas are completely contrived for this story. But it makes good TV.
February 16th, 2011 at 5:57 pm
Xezlec saidWhy couldn’t they have gotten us to root for her? Just a little bit even?
They did; I was rooting for her. But beware of rooting for Masters: look what happened!
If M3 did what she did because of courage I would have saluted her too. However I think it was fear … She is a tipical superego freak: she is just afraid to bend or break the rules in any way. God saves us from that kind of people! :)
I’m not a brave person, but have once or twice done brave things (most people probably have?) and thus know what it looks/feels like. It’s scary enough to make you vomit, which isn’t helped by the knowledge you may be diagnosed as a typical superego freak (House might have put ‘career-shattering acts of bravery’ down as a symptom. Except he didn’t …) So I identify with Masters’ predicament because, while she is not written as being obviously or innately brave, what she did was clearly a brave thing. And thus on behalf of the character, I feel stung by the ego-freak comment. (Not sure if being dismissed as ‘typical’ is better or worse than being atypical.) I generally have a lot of respect for your opinion, D-r B, but to be so down on a character for behaving as she did seems a bit defensive.
February 17th, 2011 at 4:10 am
You must understand that I have met chars like her in real life chars that are so narrowminded we here in bulgaria call them “puller horses” (you know how when a horse is pulling a chariot or cart they have little round lids on their eyes allowing them to only watch in one direction?). Such people can never see a moral dilemma in any other way than black or white. Adn they just cannot react in any other way – they are programed by their parrents they have “God’s fear” so to speak in their hearts. It is just the SUPEREGO crushing the poor EGO to nothing – they will abide by the rules even if the House is on fire. No treats no bribes no deals of any kind – actually the only way to work them aournd the corner is to give them a point of view that is at least looking “moral” (kind of like Chase did in the next episode) Such people are actually well suited for military service but are and allways will be crappy doctors. Of course life takes care of them – they either learn to compromise or they burn… a lot. Oh and I have to specify again that I liked M3’s actions in this episode – Huddy were wrong in many MANY ways. But I just hate her as a char because I just hate that sort of people.
February 18th, 2011 at 4:36 pm
Wait. Did they screw up the timeline with Taub’s unfaithfulness?
How could el cuñado (the brother-in-law) have known about his unfaithfulness five years ago, when he only told his wife about it as of season 5, episode 3, “Adverse Effects”, in response to her buying him the car?
March 22nd, 2011 at 12:49 pm
I just wondered where did that scalpel he used to cut the poor woman on no anesthesia came from…
June 12th, 2011 at 8:45 pm
Cuddy is so unlovable
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