House — Episode 19 (Season 7): “Last Temptation”
Master’s swan song. It’s a pity this episode couldn’t have worked up better medicine for her to go out on.
Kendall is a sixteen year-old sailing prodigy who is just a few days away from leaving on a record breaking around-the-world sail when she collapses on deck. She is admitted to House’s team for evaluation. The initial differential diagnosis consists of dehydration, a seizure, or back trauma that injured her adrenal glands causing an adrenal crisis. House likes the adrenal idea so orders cortisol levels checked on Kendall every fifteen minutes for four hours. M3 and Thirteen decide to speed up the process by putting Kendall on a treadmill. While being stressed on the treadmill, her hand turned blue, requiring vasodilators to correct. This leads to a new differential diagnosis of cardiomyopathy due to mercury poisoning, Raynaud’s disease, or a cereberal vasospasm. The team decides to test the latter by infusing Kendall’s basilar artery with a calcium channel blocker. The test is (apparently) negative, but Foreman incidentally notices a calcified pineal gland. Thirteen declares that this solves the diagnosis and she is started on hormone therapy and scheduled for discharge.
When next we see Kendall, she is in an OR receiving a sympathectomy. Apparently she collapsed in the hospital parking lot and was readmitted. Her symptoms were thought to be a hypertensive crisis caused by overstimulation of the kidneys. Thus a surgery is being performed to remove that stimulation. Unfortunately, Kendall develops severe hypotension (low blood pressure) during surgery, suggesting the current diagnosis is wrong. The latest differential diagnosis consists of Wegener’s granulomatosis, dehydration, or sarcoidosis. House favors the Wegener’s idea and the patient is started on immune suppressants. Several hours later, watching House and Wilson’s latest escapades, M3 has her own Eureka! moments and deduces that Kendall must have caught Salmonella enteritis from some bad poultry and the infection is now hiding in the bone. She finds a tender area in the left upper arm that seems to support her decision. However, an MRI scan reveals no infection, but a bone tumor — a lymphoid sarcoma. Amputation is recommended as definitive treatment, but Kendall refuses to go through with it until after her sail around the world. When her parents acquiesce to her desires, M3 becomes extremely frustrated. Hearing some of the history of House’s injury from Wilson, she decides to take a play out of Stacy’s book. M3 gives Kendall a medication that causes a cardiac event, when she is rushed to the OR, incapacitated, M3 has Kendall’s parents sign a consent for the amputation. When all is said and done, Kendall’s arm is removed and her life is saved, but at the cost of her dream.
As usual, major complaints are in red, modest complaints are in blue, and nit-picking ones in green:
I have to admit that I am very puzzled by two aspects of the medicine this episode. So puzzled I’m not sure if they’re right and I missed it, or they are utterly wrong:
First, the calcified pineal gland. I’m not aware that this finding means anything significant, other than possibly a poor sense of direction. It’s not a rare finding and can be seen in 10% of adolescents. There’s nothing about it that requires any hormone therapy. I suspect they meant pituitary gland.
Second, I’m unfamiliar with lymphoid sarcoma. Searches only reveal a few hits, and nothing that remotely matches this case. Could they have meant lymphosarcoma, a cancer of the lymphoid tissues? While this can, rarely, occur in bone it doesn’t fit the history or treatment. Frankly, osteosarcoma seems the best fit.
This is another episode where the dots don’t connect well at all. So Kendall has a bone tumor of her arm — how did that cause her collapse on the boat? Did this tumor somehow cause the calcification of the pineal (cough cough) gland, which itself somehow led to the collapse (and the pericarditis, and the blue hand)?
You can have a seizure without head trauma. Most people with seizures have never suffered a head trauma.
Why would they diagnose a hypertensive crisis when they made a big deal of Kendall having normal blood pressure and pulse earlier in the episode when they discounted dehydration.
Scott’s Second Law of House: When the writers are vague about the treatment (“hormones,” “immune suppressants”) instead of giving the actual name of the medication, the medicine is almost always fishy.
I’m confused about the medical school timeline. M3 finishes medical school on one day, and starts internship the next (presumably July 1st, the traditional starting day). No graduation? What if she didn’t turn in her procedure book, was there enough time to stop her from starting her internship? And why is she choosing an internship the last day of school — it should have been decided in March during Match Day, where very hard-to-break contracts are signed.
It would be exceedingly rare for Salmonella to cause a bone infection in a healthy adolescent with a normal immune system.
This week’s medical mystery was rather dull — someone fainting. Nothing particularly special there. At best, this earns a C-. The final solution, while full of drama, didn’t answer the underlying mystery. It earns a meager D. The medicine was sloppy, confusing, and probably plain wrong. I’ll give it a D, just because I’m not entirely certain enough about what’s actually going on to give it the F it likely deserves (even with the Violet Beauregarde reference). The soap opera was good, and it was nice to see a fun Wilson/House feud (and seeing Wilson win). I give it an A.
The review of the previous episode of House
A list of all prior House reviews
April 18th, 2011 at 11:16 pm
Dr. Scott: No comment on Masters’ subterfuge? As a layman, I was totally appalled. I can’t imagine the horror of waking up to find one of my limbs surgically removed without my consent. Masters should have listened to Wilson. (Talk about chickens coming home to roost …)
April 18th, 2011 at 11:41 pm
Okay, so last week, Thirteen was everything. This week, Masters is everything. Isn’t the show called House, M.D., not Masters Ph. D.? (And yes, I do know it was her sendoff)
Anyways, the soap opera was pretty good. The boat patient was mildly interesting, but I really got a kick out of the chickens. They should have included this a few episodes later, where this would have been a larger storyline.
However, my absolute favorite part was the ending. Masters is walking away, to the tune of “You Can’t Always Get What You Want”, just like the end of the first season finale. That episode really referenced Stacy’s decision to do the surgery on House, just like what Masters did on Kendall. That was a nice piece of subtle symbolism (oh yeah, and she’s a ‘chicken’, get it?).
Then again, maybe they were just running out of music. idk.
April 19th, 2011 at 12:30 am
@MrBuddwing: Minors cannot give consent. The appalling thing here is parents who would allow a 16 year old girl to bully them into an unethical decision.
April 19th, 2011 at 12:40 am
wasn’t M3 introduced as a 3rd year student? Even if we assume she was finishing her 3rd year, did she somehow skip 4th year? She sure wasn’t doing any other rotations, so this must’ve been some sort of year off kind of program.
This makes no sense in terms of med school timeline from start to finish.
April 19th, 2011 at 12:49 am
Am I going to be the only one who finds this episode AWESOME?!? Sure the medicine stiks (I’ll trwo my two penniues there later) but the soap? AWESOME!!! We managed to see what I have been waiting to see ever since 13 disappeared for a big career on the big screen – M3 was finally broken! She was broken and turned into a House-thinking doctor she matured as a person and she managed to see the world in some other shade than B&W. And that is without a doubt the first (and hellas the last) time I liked Masters. Just as Cameron before her she just couldn’t make that last step: she saw he new world beyond and she was scared. Top notch acting from Amber Tamblyn a promising young actress in the making. At the same time we saw so many shades of both classic House and evolution House that it made me want to cry :) All the fellows were reminiscing about their younger more innocent times ( I suddenly got a backflash from 10 years ago when I was playing Throne of Bhaal and the main char was having a conversation with his innocence incarnate – you could reclaim your innocence but at the expense of all your memories at the expense of your entire life. I do not think that anyone facing that choice (If we could face it that is :) would actually make it. Masters will never be the same…Despite the fact that both Cuddy and Wilson were minor blips on the radar this episode (well not Wilson he was more like a shiny dot :) this episode deserves an A+ for the soap. Ah I do love Wilson…. House will juts not be House without him. And I loved the fact that it was Chase that made Masters “flip” her mind about what she actually wants to do. 2 minutes of acting by Jesse Spencer but golden!
The medicine:
I see things this way (bad medical consulting bad line memorization by the actors?!? pah) Either: A) they made a mistake of pronunciation/memorization and they meant “pituitary gland” and “Osteosarcoma” in which case the medicine is semi OK and deserves a B- OR B) they pronounce and meant what they say and the medicine is complete crap:
A) Let us assume pituitary calcification and osteosarcoma. In that case there was hipopituitarism (which I guess caused the adrenal crisis the vasoconstriction in her hand (how?) and may be the hipertension crisis (and also the restrictive pericardites – how on earth could you develope HIGH BP with restrictive pericardites?!? How? (frankly even as I am writing it I cannot see it but OK) And the paraneoplastic syndrom from the osteosarcoma) caused the low BP which caused her to collapce in the parking. It also caused the tenderness in the arm that M3 discovered. Basically we have TWO problems: Osteorascoma and pituitary calsification (which I suppose could be a result of the cancer…. boy those guys are stretching logic on so many levels here). Just take the two disgnoses that actually fit the major symptoms and then try to stick the other symptoms to those (she had bot HIGH and LOW BP collapces? HOW?!? And oh yeah they did mention that during the first collapce BP was normal…. shhhhhiiisshhhh. I am downgrading my medicine grade to C.
2. They really meant Lymphoid sarcoma and pineal calcification. I suppose the sarcoma could cause the calsification the tender arm the vasoconstriction in the arm the calsification of the pineal gland and…. nop I’m out. It cannot cause any of the other symptoms. And pineal gland calsification causes…. well nothing. Most adults have calsified pineal glands. It supposedly stops working around puberty. Most studies suggest that the pineal gland (a part from producing melatonin) has some significance for skin pigmentation sleep/wake cycles and may be suppression of the sex drive during childhood. I see no reaons for HIGH or LOW BP crisis adrenal Crisis and any need for sympatectomy or restrictive pericardites or…. oh just with pineal gland the medicine is straight F
If anyone can present better explanation for hte medical part of this episode please do. We’ll all appreciate it. As for the soap: I dare you to try and diss it! It was awesome :)
April 19th, 2011 at 12:51 am
Okay, Scott. I gotta ask: What are your Laws of House? Or were you just going for the giggle? If so, perhaps we ought to spend the next couple of weeks (yet ANOTHER hiatus) making up a list of laws:
Law of House #1: Real medicine is boring and irrelevant.
Law of House #2: …vague…fishy medicine (see above).
Law of House #3: Methotrexate, Streptokynase and IVIG are crowd-pleasers and sound cool to lay-audiences, even if they are prescribed inappropriately.
Come on people: I can’t do ALL the work; help me out here. Dr. R, Dr. Bulgaria – where are you??
April 19th, 2011 at 1:22 am
@Sean I completely agree about the music. I was almost expecting that song to come on right before it did. It’s a a shame Masters is leaving. I enjoyed her more than Thirteen, although it did seem odd to me when the whole “gang” was standing in the hall together and there were so many of them, so I can see why they are choosing to keep to the four supports.
Maybe she’ll be able to pop in again though if she does decide to stay in PPH on her surgical internship or something
April 19th, 2011 at 2:17 am
The chickens were hilarious — another great instance of showing us how ridiculous House and Wilson are from the outside.
Medically a bit of a disaster, but I was moved by Masters’ dedication and it was cool to see another character getting the spotlight for a while (even if it was just because she’s leaving — and, honestly, Masters can be pretty annoying, so I’m not that sad to see her go).
The ethical issue: the tragedy was that a 16 year old was faced with the necessity of giving up an arm along with a lifelong dream. Masters obviously was legally in the wrong to administer whatever it was, but ethically, she did the right thing. The mother was reprehensible to side with her daughter’s uninformed “decision.”
Also, what was up with the emancipated minor red herring? You can’t just become an emancipated minor because you ask to, the court has to conclude that it is in the minor’s best interest, which usually includes being financially independent.
April 19th, 2011 at 3:22 am
C’mon, I swear I read on some spoiler site that MMM and 13 were going to hook up before MMM was gone for good! >:(
April 19th, 2011 at 3:29 am
I know the show is not the most medically or ethically correct, and I accept that and choose to ignore that for entertainment’s sake. But, I did expect the show to at least be consistent with the medical school-residency transition. This episode pissed me off because I felt like it disrespected every doctor who remembers what it was like to be a medical student going through the Match to determine their residency position. The whole process of applying and interviewing starts in the fall of your 4th year of medical school. The students rank their choices and the programs rank their interviewees by February. The students find out where they end up on Match Day, a Thursday in mid-March. Wherever you are Matched is where you’re going…that’s it…PERIOD. It’s as good as a year-long contract. If you back out, the AAMC will not allow you to go through the Match for a whole additional year. You don’t get to back out willy-nilly.
Next, all requirements needed to graduate (such as procedures) must be finished at least a month before graduation because if the requirements aren’t met, you’re not graduating. Plus, usually the only procedure requirements you have are finished during your 3rd year of med school, during your core clerkships such as surgery, OB/GYN, etc.
Next, when you finish medical school in mid- or end of May, you have about a month of free time to move, vacation, get married, or do whatever. Then, mid-June is when you have residency orientation. And, like the reviewer said, traditionally you start residency (intern year = 1st year of residency) on July 1. You have a ton of paperwork, medical license, DEA number, etc. to get in the meantime. There is no way that one day you go to work as a med student and the next you walk in a doctor.
These inconsistencies in the timeline frustrate me, primarily because it makes the medical system look stupid. I think it’s bad when you can say that Grey’s Anatomy has become more like the real medical world than any show like House.
April 19th, 2011 at 4:35 am
I’ve always read this site, but this is my 1st time posting.
The reason I am posting now is because I am so disturbed and disgusted by Masters’ behavior. While the amputee is indeed a minor, to induce a cardiac risk on a patient for the sole purpose of tricking her parents to sign a consent form is disgustingly unethical, even for House TV.
Masters has no right to steal another person’s dream away for her own warped sense of what’s right.
How many of us ever have the opportunity to do something amazing in our lives? There are always risks to achieving something extraordinary.
Masters forgets her responsibility: “Do no harm” is one of the most important things a doctor must remember. She crossed the doctor-patient relationship into the vigilante-victim relationship when she took the matter into her own hands like she did.
I saw that the writers tried to draw a parallel to House’s leg and his lawyer girlfriend, but at least they were related. She is a total stranger!
I never liked Masters’ goody-two-shoes attitude because it didn’t fit with the rest of the team, but at least she never got in the way of such an important accomplishment. This seems to be her final evolution, and she is really a monster with a doctor’s license.
Good riddance.
April 19th, 2011 at 5:14 am
@Anon Good that they didn’t. Bitch is fat.
April 19th, 2011 at 5:37 am
She’s a minor, but a sixteen-year-old minor – old enough to have her opinions listened to. It’s not exactly like a nine-year-old who doesn’t want her arm cut off.
The chickens were hilarious. I rather liked that the whole chicken bet was happening in the background – made it less heavy-handed and more enjoyable. Nice to see Wilson again, too.
April 19th, 2011 at 5:46 am
Wait, did I miss something, or was M^3 doing a dual MD-Ph.D.?
April 19th, 2011 at 5:57 am
Thank. God. Masters had over stayed her welcome long before Thirteen came back into the picture, in my opinion. She was just so unrelentingly annoying about everything.
Best line of the episode, Wilson: “Next week, ferrets?” Shame there’s almost no chance of the writers actually living up to that promise.
Also, and I’m not medically qualified in anyway so correct me if I’m wrong, but has anyone seen House, you know, the addict, take any Vicodin in the last couple of episodes? After his big relapse? Or he is just being more covert about taking it after the first few days of letting everyone know? The only thing I saw him put in his mouth this episode was when he was training the dog, but I’m fairly sure it wasn’t Vicodin.
April 19th, 2011 at 6:00 am
so i’m kind of confused about that part when MMM told the surgeon to push calcium chloride. Are the surgeons in Houseworld just stupid or is that something that’s not usually done.
also, i’m pretty sure the patient was 13 years old
April 19th, 2011 at 6:19 am
@Lauren: Yeah, I thought they said the patient was 13.
This one started off pretty boring but the build up to M^3 leaving was quite good. They really brought home the fact that while smart enough to have graduated Med school so young, emotionally she was still a child and couldn’t handle the grown up world of House.
Speaking of grownups, House and Wilson’s shenanigans were actually pretty funny and good comic relief.
April 19th, 2011 at 6:31 am
I had read an interview w/ Tamblyn saying she and 13 would have a “juicy” scene. Did they cut it???? WTF?
The whole episode was blah, even the chickens–esp when the dog grabbed the chicken. I know, it’s fake, the chicken was ok but still.
BUT House’s expressions upon hearing M3’s decision were fab as always. I wonder what an ep would be like if House lost his voice. He could still carry the episode just with his facial expression and eyes *swoon*
April 19th, 2011 at 6:59 am
“Dr. Scott: No comment on Masters’ subterfuge?”
He is a practising doctor and you are wondering why he never discusses the contentious issues?
This purpose of the blog is medical reviews of House, not a repository of controversial for potential lawyers in potential court cases to draw upon when wishing to character assassinate him.
April 19th, 2011 at 7:00 am
controversial statements*
April 19th, 2011 at 7:10 am
If it was osteosarcoma then that is not how it is normally treated. There would be weeks or months of chemo before there was any surgery. And they would probably be able to replace the bone with a metal rod, so no amputation would be needed. And she would be treated by a whole team of specialists.
Another lame episode. Once again I had no empathy for the POTW.
April 19th, 2011 at 7:20 am
I’m glad Tamblyn’s gone, but I’m not sure I would have chosen to endure this lame episode as the payment for getting rid of her. The chickens were fun, and it’s nice to see Wilde’s extraordinarily beautiful face again.
A doctor drugging a patient in order to cut off her arm? Against the patient’s wishes? People ought to be allowed to die, if that’s what they want.
April 19th, 2011 at 7:43 am
One could argue that the scene with Masters giving 13 a LP with her saucily splayed out on the bed saying things, “Mmmm. Very good, smooth. You’ve done this before,” could be seen as “saucy.”
“Masters forgets her responsibility: “Do no harm” is one of the most important things a doctor must remember.”
One could argue 3M didn’t do any harm. Her patient is better of than she would have been had she gotten her way. Had the patient gotten her way the cancer would’ve been much worse or had given her critical trouble enroute. The patient isn’t “harmed” for having her arm removed, the arm needed to be removed anyway and if I understand correctly in a year it may have spread past her upper arm into parts of her body that would’ve made the cancer fatal.
April 19th, 2011 at 7:45 am
I liked Amber Tamblyn very much and her character too. I’ll miss them. Actually I can’t wait for the writers to get rid of Cuddy – never liked neither the actress, nor the character.
April 19th, 2011 at 8:00 am
Jessica Watson seems to have been the youngest person to complete a sail around the world, at 16; another girl the same age, Abby Sunderland, tried but didn’t make it. I gather from online accounts that such a voyage takes about 7 months. Presumably House’s patient was a few months younger than Jessica, because she had to begin sailing soon or miss her chance at the record.
Such a sail probably requires a lot of commercial backing too, to underwrite the expenses–a pressure they didn’t bring up in the episode.
I don’t remember the time frame of the sail being discussed in the episode. I thought the girl said she would be ready for the amputation in a month. Somehow the idea that she would be spending the next SEVEN months all alone on a boat requiring a lot of physical activity, especially the use of both arms, while cancer ate into her, makes it clearer that this is a matter of life and death.
I liked the episode and liked having Masters and 13 bouncing off each other. But the ethical drama was perhaps too wrenching. It was appropriate for Masters to walk away, anyway.
April 19th, 2011 at 8:25 am
Dr. Bulgaria:
M3 didn’t mature. In fact, she regressed. If the parents are that incompetent, doctors can get court order. But that’s beside the point. What M3 did is yet another example of short sidedness among House’s team. If doctors really did things like that, or lie to their mom like Cuddy, medicine itself is in danger. The public’s confidence in doctors would erode. People would fear doctors will lie about their condition, perform treatment without consent, and other unethical actions. In turn, people who genuinely require medical attention would stop going. In short, more lives ate saved by sticking to “the rules” than not.
I had hoped for something more fitting for M3. I had hoped she would let someone, or let herself die for the greater good. And that in the end, unlike the rest of House’s team, she was unbreakable, and that House would find that some people will sacrifice everything in the name of principles; in short, I had hoped to see House’s world view shattered for once, and for him to try to rationalize it.
April 19th, 2011 at 9:38 am
I was also confused about the whole timeline thing. They kept saying Masters was a 3rd year, so why did she go from that to an internship? Now that Masters is gone and 13s back we can stop the “day in the spotlight” episodes and get back to the episodes about the cases. Well, maybe after the episode with Mrs. Cuddy.
Also, about that comment involving a Masters/13 scene, even if one of them said that it would happen that was most likely a joke. Do you really think Fox would show a girl on girl scene?
April 19th, 2011 at 10:07 am
@Tom: I am sorry to wake you Dude but most doctors are not such sticklers to the rules (I am talking regular doctors not TV doctors :) Here’s the thing: we tend to lie to our patients a lot (generally light lies not something like Masters did) BUT! informed consent is overrated. It’s main purpose is to cover the doctors ass: because (and I’m pretty sure it was mentioned on House wayyy back in season two when Cameron and Foreman got into odds) a person without medical education CANNOT be really informed. Even a minor dentist like me needs to lie every once and a while to give the best treatment to the patient. Example: I am making a large bridge that includes both vital and non vital teeth. While vital teeth do not need to always be devitilised before we take the impression, I generally advise people in two different maners for them: if they can afford it I suggest to keep the teeth alive because even if there is a risk for them to become inflamed it is a minor risk and live teeth are better crown bearers. However if the patient is cheap and poor at the same time I tell them we HAVE to devitalize. Why? because devitalisation produces smaller risks in the long run and if a person payed a couple of thousand bucks he does not have for a bridge he cannot afford to have it drilled destroyed and replaced a couple of years ago only because we chose the “by the book” path. We measure the risks and than give our advice so that we can sway the patinet in a certain direction: and while most patients are not idiots you would be surprised how many are smart mouths just because there is the web. So we lie; twist; squirm; do the wrong thing for the right reasons. Again it’s not something like what M3 did. But the logic is the same: save the life if the patient is an idiot who is willing to trow it away. 13 years old – you’ll get a different dream, yoyu may even get a transpalt or bionic arm one day who knows? but if you are wormfood there will be no dreams no arm no nothing: jst wormfood. So Masters did evolve: she learned that sometimes breaking the rules is the right move. For every doctor.
April 19th, 2011 at 10:20 am
Fox has already shown many “girl on girl” scenes with 13. How quickly they forget.
I thought the funniest line was Foreman’s answer as to why the chickens? “They only had one pig”
I still can’t comprehend why episode after episode people keep talking about the “ethics” of the docs on House. This is fictional in every sense of the word. You step into Houseland and accept it on its own terms and stop moaning about it and expecting it to be about real medicine. House is portrayed as a medical savant and hero. He will do ANYTHING, however unethical, to save a life. None of it comes close to being realistic. Why do so many here still expect anything different?
And yes they said “pineal” gland, not pituitary.
I think this episode was set up correctly, being in Houseland. What is more “ethical”? Letting a patient die because neither she nor her parents have the strength to face the truth? Or doing something “medically unethical” to save the patient? The answer in Houseland is clearly the second choice. It always will be. I don’t think Masters will turn into House, but I do think she sees the gray areas now.
April 19th, 2011 at 10:21 am
Some of you talk as though it is an accepted truth that living as long as possible is the ultimate goal of life. The fact that MMM “saved the girl’s life” at the expense of her dream is not necessarily a good thing. Doctors and politicians have no right to interfere in any person’s right to determine the course of their own life. If a patient and their family are informed about the options and are mentally competent, then the rest of us should accept whatever decision they make regarding their own life and medical care. Stacy was wrong, House was wrong, and now Masters has “progressed” to being wrong, thanks to House. Wilson was right.
One way of looking at it is that all MMM really did was delay the inevitable death that all of us must face sooner or later. What’s more important, realizing your life’s dream or maximizing the number of years before that inevitable death? Who’s to say that she wouldn’t prefer her epitaph to read “youngest sailor to sail around the world solo” rather than “survived cancer and lived to a ripe old age?” That’s not for Masters or House to decide. I’ve been telling people for years that I’d rather live 60 enjoyable years than 80 miserable ones.
April 19th, 2011 at 10:21 am
@Eric (a different one)
“ethically, she did the right thing”
Nope. M3 administered a drug that caused the cardiac event, and then lied to the parents about the cause of the event, thus informed consent was denied to them. Informed consent is one of the cornerstones of medical ethics.
Also, if there’s any consideration that the 16 year old was entitled to give her input towards her parent’s informed consent, that was denied to her/her parents by M3 when she was intentionally taken out of the equation by M3 via the administration of the cardiac event inducing drug.
As to the administration of the cardiac event inducing drug itself, besides this being a violation of ethics (inducing a false symptom to coerce consent to treatment), it must be assumed that it carried a risk of serious complication or death. If the patient had died there’s a good chance autopsy would have revealed the drug, and that would probably be the end of M3’s medical career, and would also probably lead to felony manslaughter charges.
April 19th, 2011 at 10:44 am
John H: I hope to hell you are not a doctor!
April 19th, 2011 at 11:23 am
I expected M3 to hook up with Chase, then find out what he did to the African dictator, have a moral/ethical freak-out, turn him in to the medical board, and create huge havoc in House’s team before leaving the show.
Maybe I missed my calling and should be writing for TV.
April 19th, 2011 at 12:14 pm
“Scott’s Second Law of House: When the writers are vague about the treatment (“hormones,” “immune suppressants”) instead of giving the actual name of the medication, the medicine is almost always fishy”
What’s the First Law: never shock a flatline?
April 19th, 2011 at 12:54 pm
The bacteria is called Salmonella enteritidis, not Salmonella enteritis.
April 19th, 2011 at 12:58 pm
I had a really hard time accepting the leap Masters made from honesty at all costs to performing something that would cost her medical license and probably lead to her being put in jail. House’s girlfriend using the power of attorney that was granted to her is not an ethical issue, it’s a personal issue. What Masters did, if found out, should result in at least the permanent loss of her ability to practice medicine. At least that’s what my understanding, as neither a lawyer or a doctor, leads me to believe.
April 19th, 2011 at 1:08 pm
If Masters doesn’t have the cranial nerves memorized by now, she has no place in medicine, I had them memorized in High School anatomy!
April 19th, 2011 at 1:21 pm
@ Karl
Not the only right thing — I am sure most anyone would have done Wilson said. But certainly an ethical thing. I guess I don’t know what the numbers are (was the patient’s chance of dying in the next month 5%? 10%? 72%?), but all Masters really did was show the parents (especially the mother) the actual reality of what could happen, instead of letting them continue to live in la-la land where their daughter’s stubbornness and the power of her dream would keep anything bad from happening. (Also, in TV land, drugs to knock you out and so on don’t have negative side effects — irrelevant to the core ethical issue.)
If the patient had been 18 or 20, then say, rather than 16 (or, a fortiori, 13 – I didn’t catch it in the ep), then it certainly would have been a Very Bad Thing to cut off their arm against their wishes, but with a minor who is clearly incapable of weighing the pros and cons of this particular decision, it was ethical to impress the actual consequences of that more firmly upon her parents. (In real life, I suspect most parents wouldn’t have needed such dramatic illustration, no matter how willful their daughter. But common sense doesn’t matter much in TV land either. :) )
Legally, obviously it opens Masters up to all sorts of criminal assault charges and the hospital to malpractice suits, were it ever discovered. But that’s true for someone in almost every House episode. :)
April 19th, 2011 at 1:22 pm
The first rule of house is actually “Always shock a flat-line.” xD
April 19th, 2011 at 1:59 pm
This episode (very very likely ) was based on ‘het zeilmeisje’.
I think at the time she was 13 or 14 ? Dutch girl who wanted to sail around the world as the youngest girl ever, break the record – she announced this in a newspaper article and they dragged her and her parents to court, gave the court custody, whole drama. (I think eventually they allowed her to do it, and I think she might be sailing now? Quick glance at her website tells me she just crossed the Panama Canal.. but I’m not at all following this story so not sure..)
http://www.lauradekker.nl
http://nl.wikipedia.org/wiki/Zeilmeisje
Google translator is your friend ;)
April 19th, 2011 at 2:10 pm
Did anybody else think it weird that the girl had cancer and Wilson wasn’t consulted? Or did I miss something?
April 19th, 2011 at 2:17 pm
Okay; thanks people.
Law of House #4: Always shock a flat line.
Law of House #5: Never allow ethics to get in the way of the delivery of medical care.
Keep them coming…
April 19th, 2011 at 2:41 pm
this show must be terminated
it becomes worse and worse
m3 is the worst frustrating character i’ve ever seen
April 19th, 2011 at 2:56 pm
@Eric,
“…it was ethical to impress the actual consequences of that more firmly upon her parents.”
No.
Suffering a cardiac event from administration of a drug was not an actual consequence of her condition.
M3 deceived the parents after committing an assault on their daughter. What M3 did was an absolutely clear violation of ethics and informed consent. You can’t intentionally create false symptoms in order to impress upon people the consequences of not consenting to a recommended treatment. The parents were not properly informed; they were supplied with false information by their daughter’s physician, and they based their final decision upon that false information. They made a misinformed consent based on a lie. The that fact that it likely saved their daughter’s life is really irrelevant to the ethical question.
It’s conceivable that it could have been the moral thing to do, but it was a clear violation of established medical ethics.
Rational to you and me or not, the parents were previously fully informed as to the risk of death in delaying treatment until after the trip. As her guardians, it was their decision to make. Given the girl’s close proximity to the age of consent and her maturity, her decision in the matter is not entirely irrelevant. Had the girl been a few years younger, the next step would have been to have to involve the courts. A court could rule on whether the parents’ decision constituted medical neglect and order treatment, as in the Daniel Hauser case, but in this case I don’t think the courts would intervene.
You would think that someone would tell the parents of the probability of the daughter dying in the record attempt if she lost consciousness again and fell overboard. Loss of consciousness is what started the whole thing in the first place, after all; there’s no reason to assume it wouldn’t happen again.
April 19th, 2011 at 3:18 pm
The courts route might not have been an entirely useless option though.
M3 files medical neglect charges against the parents with the court, as she honestly believes the parent’s decision constitutes medical neglect.
A judge would probably issue a temporary injunction to prevent the girl from embarking on her trip until after the judge had time to review the case. Considering the importance of the timing for the record attempt, the girl might have missed the window and she and her parents might have been more likely to consent once the record was out of reach.
April 19th, 2011 at 3:20 pm
@Eric touches on a very important point. Masters didn’t cut off the girl’s arm against her parents wishes. They signed the consent form. Unlike Stacy, they always had that power.
April 19th, 2011 at 3:28 pm
1.) While I believe that families do have the right to be idiots, the existence of people like the family in this episode is what is leading to the growth of soft paternalism.
2.) I realize that M3 was just filling in for 13 as “random female lead” for the purpose of one story arc, but she would have been FAR more interesting a character and a true foil and intellectual equal for House if she could have accomplished things while maintaining impeccible moral standards (or at least have the ability of defending them in the face of adversity). She was like a strawman for medical ethics and truth-telling.
April 19th, 2011 at 4:11 pm
Hibbleton,
But the parents did not have true informed consent due to M3’s deception.
April 19th, 2011 at 4:34 pm
One thing really bothers me about doctor House. I’m from Poland (in Europe) and I don’t know American law regarding medical care, but:
Was it really legal for House’s medical proxy to sign his amputation? He wasn’t incontrollably unconscious, AFAIR he was in chemically induced coma, therefore they could have woken him up and ask him whether he wanted it or not.
I thought medical proxy is only when patient can not be woken up or is otherwise incontrollably absent-minded. In my opinion, none of these matches the situation when House was in chemically induced coma.
Otherwise, when I sign for an appendectomy for example, I would have to be scared that when I go under narcose, my wife would sign me for an SRS because she suddenly might feel like having lesbian sex with me? This is insane. I sign for appendectomy to wake up after an appendectomy. House signed for no operation to be undertaken and in such state he should have been woken up.
And now about this episode. This show presents not only medical weaknesses but also moral ones. I can not imagine real doctors fighting for good for their patients in a way that is absolutely against the patient’s will. Doctors are surrounded by death and suffering from the very first day in the medical school. Would they really care that just one more patient dies off his/hers own will? Of course not. Doctors are taught to not engage emotionally in their patients case, because for one, emotions would interefere with their professional view and for two, in the long run, there would be thousands doctors’ corpses hanging from the ceiling. No doctor could stand it if they would engage emotionally in every case.
BTW. This episode reminds me a case of Polish sailor, mr Teliga, who when learned that he has cancer, bought a yacht and sailed around the globe. He died in his sixties only few months after finishing his trip. Check it out:
http://en.wikipedia.org/wiki/Leonid_Teliga
April 19th, 2011 at 4:44 pm
There’s still time for Masters to be devoured by the nutcase cannibal. And hope!
April 19th, 2011 at 4:51 pm
@Karl W.: Not trying to be flippant, but I think that they were better informed after M’s demonstration.
If KP was already exhibiting pain in the bone, wouldn’t it break doing something as strenuous as sailing a boat?
April 19th, 2011 at 5:02 pm
Dr. Scott–
It’s a minor note, but I couldn’t help but notice that no one mentioned this. When Masters was doing the LP, Thirteen said that she had Huntington’s by way of explanation as to why she’d had quite a few LPs in the past. I had no idea what the connection was until I googled it and found a recent journal article linking LPs to reduced chorea. Is this legitimate? If so, I thought that was quite clever of the writers– using recent research to explain away Thirteen’s apparent lack of symptoms.
April 19th, 2011 at 5:23 pm
I looooooved the chickens! House and Wilson were so hilarious. And of course Taub has the best line of the night: “Damn him!”
April 19th, 2011 at 5:38 pm
Uhm, so they diagnose (bone?) cancer in her arm and instead of regular chemo and radiation they decide to take the arm off right away? pretty sure that wouldn’t happen …
April 19th, 2011 at 6:13 pm
@Brian: “One could argue 3M didn’t do any harm. Her patient is better of than she would have been had she gotten her way. Had the patient gotten her way the cancer would’ve been much worse or had given her critical trouble enroute. The patient isn’t “harmed” for having her arm removed, the arm needed to be removed anyway and if I understand correctly in a year it may have spread past her upper arm into parts of her body that would’ve made the cancer fatal.”
Who was Masters to decide the fate of her patient? Especially one who had the opportunity of a lifetime. It would be like cutting off Michael Jordan’s arm before the NBA championship or Michael Phelps’s arm before the Olympics. The patient has the right to refuse treatment.
I know some people said the patient is only a minor, but in the episode her father mentioned that she had once filed for emancipation to go on a dangerous water trip. She is very determined and I think cutting her arm off without her consent is indeed doing harm.
We are all going to die some day, sooner or later. Masters robbed the patient of her chance to do something few people could ever aspire to accomplish.
April 19th, 2011 at 6:28 pm
I agree with John H.
April 19th, 2011 at 6:39 pm
John H, I agree in principle that people should make their own decisions and that should be respected. But in this particular case, the girl was being stupid, the mother was being stupider, and the father was being a coward. The choice between “living your dream” and “living a miserable life” is a false dichotomy, because she would have died screaming in agony, alone on a boat in the middle of the ocean — and I’m pretty sure anyone, no matter how committed, would regret their choice. The parents’ responsibility was to take a more balanced view.
You close by saying you would rather live 60 excellent than 80 miserable years, as if that proved your point. Well, it doesn’t. Who wouldn’t prefer that? – But it wasn’t the choice the patient faced.
April 19th, 2011 at 8:10 pm
The chickens were hilarious! I love how House and Wilson always stay kids in their hearts, they remind me of myself ;)
Concerning M3: It was interesting to see that she was capable of taking the House route. House, in all respect, did his part in forging her that way, he wanted to see if she was able to fit into the team, whose mandatory mottos are actually lying, stealing, breaking in and doing other ‘unlawful’, ‘unethical’ things all the time.
In House’s manic desire to solve every puzzle, no matter the cost, this is actually the only way to do things (at least in the fictional setting of a TV show).
While he might have seem forceful, coercive and “nasty” in a way, he was actually pretty straightforward and honest – being somehow out of the boundaries of the ‘regular’ procedures simply is the PPTH’s diagnostics department’s way of handling things under the observation of the Grandmaster of Loopholes, Gregory House, M.D.
I liked the episode and will miss M3, I’m still looking forward to see Thirteen again more often, though
April 19th, 2011 at 9:07 pm
My sister had a tumor in upper arm in her early 20s – about 24 years ago. They used donor bone to replace the bone, screwed it in and she never had chemo. Obviously the cancer hadn’t spread. She also apparently walked around with this tumor for a few years as she always had a lump there but she and our family thought it was fatty lump since she was overweight. An extra before a knee surgery revealed the tumor. There was no real need to amputate the arm and really, a month would probably not have been a death sentence. While we can’t say for sure if the cancer would have spread, the replacement of the bone using donor bone is something that’s been done for at least, if not more, than 25 years.
April 19th, 2011 at 9:10 pm
x-ray* not extra. Gah. Long day, tired fingers. Excuse typos. I did however, love the chickens. And yes, they said 3rd year student. And yes, I too found it odd that Wilson wasn’t consulted. Lots of mistakes this week. I love this show but I wasn’t thrilled with the medicine and I am far from a doctor. If I notice mistakes, it’s got to be bad!
April 19th, 2011 at 9:22 pm
Alyssa: the cancer had already spread to a lymph node.
April 19th, 2011 at 9:39 pm
@Eric – I agree that this patient’s choice was not necessarily between 60 happy years vs. 80 miserable ones, but I contend that her choice involved the same principle, just a matter of degree. There was no certainty, especially given the recency of the diagnosis, that she could not complete her trip and then undergo successful treatment for her cancer. Predicting how long someone has to live is a very inexact science. And my point is that regardless of the degree, it’s always the patient’s (and in this case, her parents’) decision whether and when to pursue treatment, not the doctors’.
@RAK – let me guess, you’re a Democrat, right?
April 19th, 2011 at 10:15 pm
John H, let me guess, you equate common sense with being a Democrat. You’re a Republican right? Or just one crazy dude (they are a bit alike).
Actually, politics aside, I’m just a rational human being who thinks that a girl of 16 has no conception about how good or bad the rest of her life may be, and allowing her to decide that “sailing around the world” is the only thing worth doing at this point in her life is asinine. IMO, her parents ought to lose custody if they made that decision for her.
Furthermore, have you any conception of how long it takes to sail around the world? It takes months. How was she going to do that with a cancer growing in her arm? One does need one’s limbs to sail.
April 19th, 2011 at 10:38 pm
Last night’s episode reminded me of a true story: I once interviewed a beautiful young woman who had been diagnosed with bone cancer. Her treatment was delayed because her doctor was just about to leave on a two-month vacation in Europe. She was a Medicaid patient who received her care at an academic medical center. By the time the physician returned, her cancer had spread so that her right arm and shoulder had to be amputated. She was an artist, and she was right-handed. She didn’t sue for malpractice, but she should have, in my opinion. She later taught herself to draw and paint perfectly with her left hand.
April 19th, 2011 at 10:49 pm
Medicine & Honesty
I would advocate not lying to patients. They are asking strictly for the medical opinion. As I mentioned, lying to the patients will erode the faith the public has in them, and ultimately do more harm than good. For example, now that I know you lie to patients (albeit for the best of intent), I now question my faith in some of my medical professionals. Will they tell me a treatment is necessary, like an auto repairmen trying to sell me on something, simply because they are trying to steer me to the decision they want, rather than truly informing me of all my options? Losing credibility in a field as great as medicine is too large a price to pay. There was a study a year ago on doctors giving placebos without the patient’s knowledge (well obviously, hence placebo). But after that article was released, how many people lost trust their doctors actually were giving them valid medicine, and not just sugar pills?
Like House, I’ve been in chronic pain for a while. I begged one of my doctors to run more tests but he didn’t care enough to do so. I now wonder if he could have done more, but simply lied to me in order to avoid more work for what he considered a “minimal chance” of finding an answer.
I do however, empathize with you (Dr. B) because I have to advise people on things I disagree with. However, I always document my dissent and provide substantive reasons behind it. If I feel strongly enough, I’ll even demand a formal review of the decision and submit that i) the merits of my case constitute exigent circumstances, and thus warrant special handling, or ii) the decision in question is in violation of policies and procedures, without proper justification. Like M3, I’m not popular or liked sometimes. However, people have always told me one thing — I’ve always done the right thing, no matter the costs (sometimes major) to myself. I think it’s a lot harder to do the right thing than the hard thing.
However, I think it’s important to note M3 doesn’t always follow the rules. She and House gave someone Hepatitis C to treat Hepatitis A, though Cuddy clearly said not to do so (calling Cuddy a coward to her face has got to be one of the bravest things I’ve ever seen!) She understood that when a patient has no other hope, there is no harm in experimental treatment if you have the patient’s consent. She also told House to examine a body to prove the patient doesn’t have small pox, despite the CDC telling her to stop. She understood that the ownership needs to be on the CDC to perform more due diligence.
Freedom of Choice
I agree with the earlier comments mentioned. The persuasion/honesty discussion aside, I believe every human being has the right to determine his/her own fate, so long as it doesn’t directly affect someone else. If she was 18, would we be having this discussion? If she was legally emancipated, as she had planned earlier, the question of age would be irrelevant.
Dramatic Impact of Show
The main reason I didn’t want House to “break” M3, my self observed likeness of her aside, is that House always “breaks” people. The other doctors have all caved into him, even sweet little Cameron drugged someone once. An interesting article mentioned that while it is amusing to watch House go “head to head” with others, it leaves little dramatic room now. He always wins, at least the battles that matter. To see him try to do everything to break M3 and ultimately fail in the end, that would’ve been a welcome change. I’d argue the only person who ever broke him was Kutner. House believed he could see everything, but he never saw Kutner’s suicide coming. Moreover, he left House with a puzzle he could never solve.
April 19th, 2011 at 10:53 pm
I suppose “always have your fellows do everything that they aren’t qualified for, and pretend like there isn’t any support staff in the hospital” would be a House rule
April 19th, 2011 at 10:53 pm
Oh, yeah, and always ignore scope of practice laws
April 19th, 2011 at 10:56 pm
This one may already have been done, but here goes: “always prescribe nearly obsolete thrombolytics like streptokinase, since that name sounds really impressive (also, always ignore the prescribing guidelines)”
April 19th, 2011 at 11:15 pm
@RAK – youI’ll be relieved to hear that I’m not a doctor (which probably doesn’t make much difference in this case, since as many have pointed out, the medicine in House-land doesn’t necessarily correspond with the real world), so I don’t know the exact probabilities (and I don’t think a doctor would either – it’s just an educated guess). And I’m also not a sailor, so I don’t know how long it takes to sail around the world. But I stand by my point that a patient (or the parents, in this case, since she was a minor) should be have the right to decide when and if to seek medical treatment, and no doctor should subvert that decision. The doctor’s job is to inform, as accurately as possible, which Masters certainly didn’t do. The final decision is the parents’ alone.
And I would respectfully disagree that their decision was asinine, and grounds for losing custody of her. That’s what gives your political leanings away – the fact that you think you know better than they do which choice they should make, and that the state should intervene if necessary and force them to make the “right” decision. That’s classic Obama/Pelosi/Reid/Hitler thinking.
April 20th, 2011 at 12:15 am
I thought the chickens stole the show. The rest of it was chewed up garbage.
It was hardly a difficult decision for M3, I mean go home and sleep well, the kid wants to die. Her choice.
The whole oncology department, according to Wilson, was discussing it, and every one of them went home and slept well. It’s just not a dilemma.
Besides, she was never getting into that boat. The insurance and sponsors would have dropped her like a brick. She’d have been back in a week on her own.
Is that really the best moral dilemma they could cook up for M3? With Greg House standing next to her? Really? C’mon…
April 20th, 2011 at 12:23 am
Thank you Dr. R. Also, please refer for Law #3 in re: meds. As for your other suggestion(s):
Law of House #6: “Scope of Practice” only applies to veterinarians.
Law of House #7: Informed consent is for suckers and has no place in the delivery of medical care.
Nice job people. But there’s a whole lot more of them out there…keep ‘em coming!
April 20th, 2011 at 12:28 am
John H: No point attempting to discuss these issues with someone as insane as yourself. You’re just a Glenn Beck wannabe! Wow, Democrats and Nazis…together again. The fact that I’m Jewish makes that even more entertaining. But just for the hell of it: a doctor is NOT the state. He/she is an individual who makes decisions about what he/she deems best for the patient, and theoretically is in a better position to understand the options than a lay person. I’m just sitting here envisioning all the possible scenarios where you would NOT intervene. Should we allow religious cultists to sacrifice their children’s health in the name of religion? Hey, they’re adults..it’s their choice if they don’t believe in modern medicine. It’s actually YOU who thinks you’re right about everything, not me. I’d actually listen to my doctor thinking that he/she knew a hell of a lot more than me about a medical problem. But I’d also get a second opinion..
April 20th, 2011 at 12:39 am
Oh, one more thing: I WOULD sic the state on parents who would allow their child to die when it could have been prevented. That’s a form of child abuse, or at the very least, bad parenting. Oh those Horrible, horrible Democrats!!
April 20th, 2011 at 1:34 am
To the anonymous person who said:
“The reason I am posting now is because I am so disturbed and disgusted by Masters’ behavior. While the amputee is indeed a minor, to induce a cardiac risk on a patient for the sole purpose of tricking her parents to sign a consent form is disgustingly unethical, even for House TV.”
Really? Have you watched the show ever before this episode?
Anyone remember House having Lucas switch a patient’s meds so that House could get his patient into surgery?
Shrinking a tumor so that a surgeon would operate on something he wouldn’t otherwise touch with a ten foot pole?
Waking up the burn victim to ask him a question when he was in extreme pain?
Injecting a patient with something to exaggerate the symptoms she should be having when everyone else figured she was suffering from Munchausen syndrome?
House is certainly not above deception to achieve his goal.
Hell… even Cameron drugged a patient because he wanted to leave the hospital, and she figured he shouldn’t because he was sick.
You may disagree on principle, and that’s fine.
But it’s not more unethical than what House (or apparently even Cameron) would do.
April 20th, 2011 at 1:35 am
The burn victim thing had nothing to do with deception, but some would argue it was fairly unethical.
April 20th, 2011 at 1:43 am
@Tom: You deliver a perfect argument mate :) however we often have that same argument in the office and we always conclude that it comes down to this – doing by the book and have a completely clean spotless conscience and a good night sleep OR steering away from the book just enough to give the patient the best possible treatment. That kind of decisions almost inevitable blows up in our face and that is the main reason most doctors in Bulgaria are nervous wrecks. To stick by the book is the easiest way to live: that basically means to always follow other peoples rules instead of making your all rules. And it is a bit borring as well….But it is an arguemnet that neither side can win. I’ll still lie to give the best than be honest and condemne my patients health though… As for placebo: it is cruel. But sometimes it’s the only way to open a patients eyes. Either that or get him off your back – it’s a win win. People you cannot argue with: they need the sugar pill. Better than to prescribe antibiotics without the need to and create resistant strains for the future.
As for the laws of House: I’m surprised that none of you thought of one of the most important laws of House! I’m putting it on the table right now:
Law of House # 8: It’s never Lupus
Some of the others I would like to see are:
Law of House # 9: Aways treat before you run the tests to confirm (scratch that actually I have better: Alwayst treat never test! If you are right the patient will heal anyway. If you are not he’ll be saved by House’s genious anyway :)
Law of House # 10: If the patient is hot/lesbian/wierd/crazy/religeous/daredevil (underline nessessary) admit him no matter what he has
April 20th, 2011 at 4:39 am
How low this show has fallen. First of all, your differential diagnosis is based on focused history and physical, neither of which was performed. A real MD would run some basic labs, get orthostatics, EKG… in other words, looking for the most common causes of syncope. It’s surprising the team even considers “zebras” like Wegener’s first when simple H&P and workup would have provided clues. Also I was disturbed the way House ordered treatments on whim without definitive diagnosis. And what is this one-day transition from med student to intern all about? Also 10 LPs required for graduation? Sheesh.
April 20th, 2011 at 7:10 am
I’m also fairly sure that NJ required supervision for med students doing procedures, especially something like a lumbar puncture. the other comment brings me to law of house #8: always suspect diseases with cool sounding names that no one has heard of before. (Instead of considering that what you have may be an uncommon presentation of a common disease)
ROH#9: Always ignore breaking and entering laws (and as a corollary, all medical doctors are also really good at picking locks.)
ROH#10: Everybody (except M3 for a while) lies
April 20th, 2011 at 7:12 am
oh, yeah #11: No matter what the patient has, their kidneys must “be shutting down”, or they must be coughing up blood
April 20th, 2011 at 9:28 am
@Hibbleton
Not to be repetitive, but though they may have made a better decision, it was not because they were better informed. The parents were clearly deceived into making the safer decision.
I’m not sure how you are defining informed. If I come to the correct conclusion through incorrect information, I am not better informed; I am right for the wrong reasons.
April 20th, 2011 at 9:53 am
@Eric
In this particular case, the girl probably would have died, probably in agony., and the mother was being stupid, the father was being a coward, but unless it meets the legal definition of medical neglect, it’s within their rights to make the informed decision.
In principle, who defines the limit of when it’s OK to deceive guardians in order to get them to make what the doctor believes is the right decision? People are allowed to make stupid decisions for themselves and their children. If the parents are guilty of medical neglect, the ethical thing to do is take the legal route and involve the courts &/or child protective services, not deceive the parents into making the decision the doctor feels is the correct one; that would put too much unchecked power into the hands of physicians. If the girl was younger, the courts would probably overrule the parents and compel treatment, but in this case, the judge would try to determine if the girl was capable of understanding the risks of her decision, and might determine that the girl was capable of informed consent, however stupid her decision.
This is not quite the same as the Daniel Hauser case; he was 3 years younger, but the courts worked fine in that case, no false cardiac event was required.
Frankly if one is going to advocate lying to to the parents to compel them to make a particular decision, why even have the pretense of consent at all? Just do what you think is right. Get the laws changed to allow the doctors to make the decisions for patients, at least the ones that are minors. After all, they are less emotionally biased than the parents and can be trusted to make the best decisions, right?
April 20th, 2011 at 9:57 am
I have not seen all the episodes this season, and I didn’t see this week’s episode. From your discussion, it appears that Masters threw her ethics under the bus and committed a major violation. But from the episodes I did see this year, there was never any indication whatsoever that Masters was beginning to even soften her super strict ethics, let alone commit an act so unethical that it would prevent her from ever practicing medicine. It is just impossible to believe that the character as previously portrayed would resort to drugging a patient to produce fake symptoms rather than going to Cuddy to get the courts involved.
For those of you who think what Masters did was not outrageous because the patient was a minor with idiotic parents, and especially for those who insinuated it was the only reason this kind of thing would happen in Houseland, somebody else already pointed out that Cameron drugged a patient to keep him in the hospital.
But a much better analogy is the episode Moving the Chains, where the patient was a 22 year old football player who was graduating from college and hoping for his shot at the pros. He refused immediate treatment because he wanted to play in front of the pro scouts. Foreman decides that he should start the treatment immediately, and that patient rights have no place in medicine. When discharging the guy, Foreman gives him medication which causes the guy to feel supersick and even become unable to see, so that he’ll return to the hospital for treatment rather than getting his shot at his dream career. So in Houseland it doesn’t matter who you are or how old you are, you’re getting the treatment they want you to have regardless of your wishes, which would never, or should never, happen in real life.
And for those of you who are medical practitioners (even just dentists) who believe it is okay to lie to patients and/or trick them into doing what you want them to do, I certainly hope you get caught doing it and end up facing the professional and legal consequences. Contrary to what you apparently believe, you are NOT God, and you do NOT have the right to overstep your role. And your role is to explain things as best you can and explain all the options and make your recommendation, but leave the decision up to the PATIENT. You may sometimes have patients who are idiots, but they have every damn right to be idiots if they want to, without some damn doctor taking matters into their own hands. And if the idiots are parents of a minor, then there are LEGAL and ETHICAL ways to deal with it.
April 20th, 2011 at 10:13 am
@ Dr. R — Yes! I was reading through everyone’s suggested House rules saying aloud, “Folks! What about ‘Everybody lies’??!!” This entire episode was about lying and proved that not even M3 was above it.
A corollary to the rule about “treat first” should be this quote from episode 122: “If it works, we’re right. If he dies, it was something else.”
April 20th, 2011 at 11:01 am
@RAK – we’ll obviously have to agree to disagree, but Karl Withakay and Mary T above said what I was trying to say in a much clearer way. I don’t mind you disagreeing with me, but I just hope you are not misunderstanding my point, which your latest response leads me to believe might be the case.
And I sincerely apologize if the Hitler reference offended you. Obviously I didn’t know you were Jewish.
April 20th, 2011 at 11:10 am
I honestly didn’t care much about the patient. But I enjoyed Masters finally acting like House and the final scene with feeling nothing and “You can’t always get what you want”. I know it’s awkward to expect something and then feel nothing, but still. Maybe sometimes the right feeling comes later? The chicken subplot was stupid!
April 20th, 2011 at 11:32 am
John H: I appreciate the apology, however I must ask: If I wasn’t Jewish would you still consider it OK to lump Democrats and Nazis together as if their beliefs are the same?
Anyway, to get back to our discussion: I don’t think you understand where I’m coming from either. All along I have stated that what happens in Houseland is NOT realistic and is NOT what one would expect to happen in the real world of medicine. I have always thought that discussions of ethics or even medicine on the show are pointless because it is a universe unto itself. From the very beginning of the show House and his underlings have acted “unethically”. What are we arguing about here, that a particular action is MORE unethical than the others we’ve seen? Once you enter Houseland you suspend belief. To me it’s more like a fantasy than a medical show. What doctor in the real world has AHA moments like House or treats his patients like House?
What do I believe should happen in the real world? Adult patients should be free to do what they want to do, once given all the information they require to make an informed decision. If they decide to do something stupid, too bad. OTOH if parents are given medical information about their child and persist in endangering the life of that child, I believe legal action should be taken to stop them. They have the right to do as they wish about their own lives, but NOT to potentially harm their child.
April 20th, 2011 at 11:47 am
@Karl W.: They were better informed by being shown the logical outcome of their decision. The fact that it was a staged event doesn’t change that. They weren’t tricked into signing the consent form. Masters didn’t hand them a blank piece of paper and ask for their autograph. They were convinced after seeing the evidence. Would they have been more more informed if Masters had shown the parents a girl with a similar condition in another hospital dying in agony ? Just the fact that such a girl exists makes Master’s stage play informatively valid.
April 20th, 2011 at 12:34 pm
A Lot of Built-Up Frustrations Here
I get the impression that there is a lot of pent-up angst among the House fans here, and I feel the same way. What a hodgepodge of contradictions, schizoid behavior, social ineptitude and downright dysfunction, not to mention sometimes sociopathic – if not out-and-out psychopathic behavior is House, M.D.
There are some Houseisms I like to quote. I loved the way he would keep people from deflecting, changing the subject to avoid the hard issues, etc. “How is what you just said supposed to contradict what I just said?” And the way House is drawn to a case as a test of his ingenuity and determination to beat it is commendable. Up to a point, anyway. But then he goes and gets obsessive and tramples people’s rights so he can beat the challenge before him.
House may be patterned after Sherlock Holmes, but he is also the product of his modern-day creators, and as such is a much more degenerate (read decrepit) version of Holmes. The original Holmes may have had his eccentricities, but he didn’t need an underling like Watson to point out what a bastard he was. He didn’t steal from others or stick his friends with the tab for his eats, didn’t probe into people’s personal lives for his own sick gratification, etc.
It’s basic screen writing 101 that once you have a successful formula you don’t go changing it mid stream. Lucas McCain didn’t marry but stayed a widower (nor did Jim Turk enter into a relationship for that matter – he was married to his ship). I had to wonder what were they thinking when they decided to pair up House and Cuddy – both dysfunctional human beings in their own rite and in no way compatible together. It had to be a desperate move on the part of the writers who are apparently running out of new material.
Then along comes Masters and instead of supplying dramatic conflict she just rubs people the wrong way and gives people yet another reason to bail out of watching the show. She comes off (at least to me) as arrogant and a spoiled brat who has been raised (or neglected being raised) to think she can always have her own way. If she had any sense she wouldn’t go around taking charge when she is the youngest and newest member of the team. She’s a bleeding-heart liberal who thinks she has the right to dictate to others how they should live their lives. A patient who thinks she would rather live a short but supremely successful life is wrong and she should be forced to opt for a long but mediocre one.
The kid knows best. LOL
It’s no secret that there is a lot of mental illness in Hollywood. Marlon Brando is reported to have said that the benefit of making it big in Hollywood was the way he could afford the best shrinks. And the fact that mental problems so spill into the House series and thus reflects true life is noteworthy. People are messed up on House, and it takes messed up people to create them, apparently. The separation between fiction and real life is kind of blurred here.
The actor playing House says the Second Amendment = insanity. Not the first foreigner to come here and get rich while hating the very system that makes them wealthy. We have enough of our own schizophrenic Hollywood types who think that way without importing them. Reminds me of the doctor who came to see me in the hospital when I was first admitted for lung problems. She was from India, or maybe the Middle East – not sure. Anyway, my feet were sticking out from under the sheet and she looked at my swollen feet and ankles and poked them with her finger. “You noticed my edema,“ I said. She spat back at me. “There is no such thing as edema in this country!!” The disdain in her voice was palpable. She was full of resentment -even downright hatred – against the country that had welcomed her in. Not having much experience she assumed there is no such thing as poverty in this country, no such thing as someone whose diet was so poor that he could have edema due to a lack of sufficient nourishment.
And they accuse US of being racist xenophobes!
I’m all for quality immigrants. I just object to the ones who come here to make it big while bringing with them the same mentality, “culture”, goofy beliefs and ways of doing things that made their own countries good places to be FROM. Our Founding Fathers in their great wisdom gave us the Second Amendment because they well knew what life was like where they came from, and that without it there wouldn’t be a First Amendment for very long, or any other liberties for that matter. They would be appalled if they could see how far we have come in the loss of those liberties, but just imagine how much further along the subverters of our freedoms would be if they didn’t have to tread so lightly.
No, Mr. Laurie. The Constitution of the United States of America isn’t insane. America may have problems, but they are due to the hearts (or lack thereof) of her people, not in her form of government which has been called (at least in principle if not in the way it is practiced today) the best ever on Earth.
I’ll tell you what’s insane. Stomping little people to death because you don’t like how they dress or dance. What kind of sicko uses that as his trademark? And speaking of an armed citizenry, such a one would not qualify for a license to carry a firearm – at least not here in Texas anyway. You have to pass a thorough background check and not have had any mental problems or been under the care of a psychiatrist. Down here, disorderly conduct will get your license revoked, and that includes giving someone the finger.
I’m not sure if it was on this site or somewhere else, but a reviewer said that only the first three seasons of House were keepers in his opinion. After that it was all downhill. He may have something there. I for one dearly loved the first episode of Season Six and found it quite moving. Yet I have to wonder if what I saw in House’s eyes when he walked out of Mayfield was a hint of smugness. As in, “Ha! I finally figured out how to get them to let me out of there.”
I watched House because I wanted to look for and see some humanity in the guy. The more I have watched the less hopeful I have become.
Now I just want to add my voice to the others who think that the time for this series to die is upon it.
April 20th, 2011 at 12:44 pm
@RAK – Don’t misunderstand me, I was merely apologizing for any offense taken. I wasn’t retracting my point, which is that while Republicans and Libertarians push toward less government intrusion and control in our lives resulting in more freedom, Democrats and Nazis push for more government control which necessarily results in less freedom. Obviously the Nazis took it way farther than American Democrats have (so far), but the direction is the same.
I agree 100% with your second paragraph. Not sure why you even thought there was ever any disagreement there.
In fact, I can pretty much agree with your third paragraph, the way you’ve worded it. Taking legal action to override their decision in this one case is a very different thing from taking custody of the child away from them. In a perfect world, parents would have their child’s best interests at heart and would make decisions with the same care and consideration that they would give decisions about their own care. (I still think that the parents know better than either the doctors or the courts what constitutes the child’s best interests, and that decision may involve more than just length of life.) But some parents cannot or will not rise to that responsibility, so there needs to be a legal escape hatch. I don’t think this fictional case rose anywhere near that level, and I understand you disagree strongly with that assessment. Regardless, Masters completely bypassed that process, and forced her idea of “best” upon the parents by illegal, unethical, and deceptive means, which I’m sure you would agree would be completely indefensible in the real world.
Incidentally, I hope you’re one of those few Liberals who are on the pro-life side of the abortion issue, because if you’re pro-choice, your last couple of sentences above would make you look awfully hypocritical. ;-)
April 20th, 2011 at 1:05 pm
@Hibbleton,
They absolutely were not shown the logical outcome of their decision; they were shown the logical outcome of M2 administering a particular drug and told it was the outcome of their decision.
M3 did not tell the parents, “I just gave your daughter a drug that simulates what she will experience when she begins to die from the cancer because she’s not having the surgery now. Does it change your mind at all?”
They were not shown evidence of anything but what can happen if an unethical physician decides that ethics and informed consent don’t matter as long as a successful outcome is reached.
They were told a fairy tail to induce them to make the choice the story teller wanted them to make. This is not how ethical medicine is practiced.
“They weren’t tricked into signing the consent form. Masters didn’t hand them a blank piece of paper and ask for their autograph.”
That the form was not blank has nothing to do with anything at all. They were coerced to sign that form based on false information supplied by the physician. In contract law, that would be fraud by false representation. It’s unethical and criminal.
They were tricked into signing the consent form, I can’t see how anyone can disagree with that, regardless of whether you think it was the right, moral, or ethical thing to do or not.
They were basically told that the cardiac event was caused by her condition, and that immediate surgery including amputation was required or she would die right there. This was not the case. It was not even the case that it was 100% certain that the girl would die if she delayed surgery until after the record attempt. It was just very highly probable.
“Would they have been more more informed if Masters had shown the parents a girl with a similar condition in another hospital dying in agony ?”
Duh, YES! Assuming she could find such a patient, that would have been an ethical action, assuming she had the approval of the other patient. Do you really not see a significant distinction between this and what M3 did?
April 20th, 2011 at 1:16 pm
I tried to read all of the comments before I posted and hope this wasn’t mentioned.
I do know that the idea of going to the court was mentioned and in the episode “finding Judas” I think, House went to the judge b/c the divorced parents didn’t know how to treat the daughter which was having reactions to sunlight or UV or something. The one that Chase figures out and gets punched in the face right before the child was maimed.
I think that while it’s not the doctor’s choice to take action or have the parents rights taken away, I believe that it’s all within their realm of professionalism to take it to the courts and have them decide. If a judge were to tell M3 that the parents are informed and are making their decision and that’s that, then fine. Or the judge could say, you parents are not thinking clearly and have a gaurdian ad litem or whatever they may do for a child at the age of 16, but in the end, who is really going to be able to make that decision for them.
So, obviously that was a choice, but the realization of this episode was to break M3, which I was suprised happened.
I did like the answers from the lackeys for what M should do, especially when 13 blatantly said that she’d have no place on the team if she stood by her “tell the truth ideals.” and Chase’s response and slight reflection on his own transformation.
April 20th, 2011 at 1:16 pm
Dear John H. and RAK:
I find it rather amusing (and sad) that two intelligent, well-spoken individuals assume that people with either Democratic/Liberal or Republican/Conservative leanings are homogeneous, monolithic, and march in lockstep to each and every plank in a platform or page in a playbook.
I, for example, believe in both Choice And personal responsibility; social safety nets And keeping the fruits of one’s labors And making people earn/repay society’s benefits; allowing people to keep reasonable firearms And to use marijuana for personal recreation; rehab and re-entry programs for people who commit non-violent crimes And throwing away the key for those who engage in violence (I’m actually willing to pay higher taxes for the requisite prisons – wonder whether Oliver Wendell Holmes considers that part of “buying civilization”); rationally examining and making best use of solar, wind, And nuclear power; negotiation And strong defense; stem cells And the rights of faith-based organizations, etc.
I vote mostly as I suspect John H. suspects RAK does And agree with John H. that people should get to make the call, however stupid or wasteful it might be, about the direction, purpose and length of their days.
So please don’t fence me in, tread on me, or a tar me with a brush.
Oh, and I’m Jewish (And love a good lobster).
April 20th, 2011 at 1:20 pm
The # lie told by all medical professionals:
“This won’t hurt”
:-)
April 20th, 2011 at 1:55 pm
Nowhere in my paragraph did I mention ethics. I addressed informed consent. Whether ethical or not, I believe that the parents were better informed as to the consequences of their actions by what Masters did.
Informed consent doesn’t come from reading the consent form. It comes not from understanding, basically impossible, but in believing what your doctor tells you. The consent form itself is just a bunch of legalese. Masters told her story and the parents believed it.
Ultimately, I.C. comes long before you sign the form. It comes from picking the right doctor.
April 20th, 2011 at 2:29 pm
M. Scott, you make many good points. I agree with most of them. I don’t appreciate being pigeonholed with John H since I was merely responding to his assessment of my beliefs. I expect that I am more anti-religious than you are and I despise the way the Christian religion has taken over the politics of this country. I vote Democratic, but I think both parties are spouting mostly BS these days. I’m over 70 yrs old so I can still remember a time when there were intelligent people in both major parties and things could actually get done. IMO, the Dems are now mostly useless wusses and the Repubs are unrecognizable as sentient human beings. It’s a tough choice. BTW, I’m not kosher, but I hate seafood.
John H: Just because YOU equate a fetus with a live baby doesn’t mean that everybody does. Are you against stem cell research too? Personally, I’m pro-choice, but not to the extent that some people are. I abhor the use of abortion as a form of birth control when there are so many other options, so I’m repelled by women who use it that way. However, I have no problem at all with abortion in the case of rape, incest or health of the mother. And I’m sick to death of men telling women what they can or can’t do with their bodies. If men were the pregnant ones there would be abortion on demand. Count on it.
One more thought: I think Arthur is in serious need of psychological help and I’m glad I don’t live in Texas.
April 20th, 2011 at 3:21 pm
@RAK
I *do* live in Texas, and I completely agree that Arthur needs some serious help, psychological or otherwise.
April 20th, 2011 at 3:58 pm
@Hibbleton,
I mention ethics because informed consent is one of the cornerstones of medical ethics. What M3 did was unethical (in part) because it violated the concept of informed consent.
“I believe that the parents were better informed as to the consequences of their actions by what Masters did.”
Yes, the parents made the better decision, but not because they were better informed. Would you think it was informed consent if M3 had sedated the girl, broken her arm, and said, “See, this is what can happen if you don’t have the surgery. I told you that your weakened arm bone might break from laying on it wrong.”?
You seem to believe that being given false information to lead one to the right decision is the same as being correctly informed, and/or you are maintaining that inducing a false symptom is not deception.
Can you perhaps clarify why it wouldn’t violate informed consent to simulate a severe cardiac event for anyone else who declines recommended treatment for any life threatening condition like someone who declines surgery for high risk cancer?
“Informed consent doesn’t come from reading the consent form. It comes not from understanding, basically impossible, but in believing what your doctor tells you”
Nope. What you are describing is religion.
Informed consent is where a person with adequate reasoning faculties who is in possession of all relevant FACTS makes a decision as to whether or not to consent to the recommended treatment. If the person is determined to not be in possession of adequate reasoning faculties, legal remedies are available to address that. If the decider is provided with false information, such as induced, false symptoms, informed consent has been violated.
Informed consent involves the right of a properly informed person in possession of adequate reasoning faculties to decline any treatment for any reason they want.
April 20th, 2011 at 4:14 pm
@RAK – we finally found something we can agree on! Built-Up Frustration Guy has some issues.
April 20th, 2011 at 4:59 pm
Disgusting episode. I have no idea how Masters equates a life that is finite as it is to the breaking of a record that then will probably belong to that girl forever. Utterly repulsive.
April 20th, 2011 at 5:14 pm
Oh, and Arthur (sorry for double post): no one except those hailing from your country would call its government even close to the best. You should try being from Europe and experience what real liberty is like, where there aren’t murder rates of hundreds per million and we don’t have to fear clinically insane people to decide our lives and our safety for us.
You obviously have never even tried to look up any of the results of your second amendment, nor have you ever tried to understand the crucial difference between 1) a country at war with itself without an organized militia or military or proper communication and 2) one that is completely safe and has thousands of people actively safeguarding its inhabitants and has light-speed national and international information transfer like America does today. Nor do you see the difference between single-shot muskets and fully automated assault rifles. (Notice it isn’t called a “defense rifle,” wink wink.)
Of course, that goes beyond your insipid reasoning.
April 20th, 2011 at 7:10 pm
Dr. B
Even the use of placebos concern me. Picture this:
1. A patient comes in complaining of symptom “A” and goes to the ER
2. The patient states he/she is taking medicine “B”
3. The patient is actually being given a placebo, not medicine A, by the primary care physician
I think the above illustrates the problem with placebos. What happens when doctors can’t even trust other doctors? The above situation could be a disaster. House wonders why his patients lie…maybe because they are afraid he’ll lie to them!
April 20th, 2011 at 7:10 pm
I’m a medical student. As for the medicine, well, I knew it was stupid, but it got exceedingly stupid when they said “lymphoid sarcoma”… what the hell is a lymphoid sarcoma in the bone? Must be one very very rare disease for no doctor I’ve asked to know what the heck it was.
The ethics in this episode were too much even for House’s taste. If the girl, who was fully mentally competent, decided not to have the surgery and WAIT A MONTH, she could easily have done so. They could have found a middle ground, done radiation and chemo to reduce the tumor size, and then amputated once she was done. Ultimately however it is THE GIRL’S DECISION, not to mention her parents’. It’s beyond ridiculous and insane and stupid to portray it like that. It bothers me to no end.
Also I concur with the fact that they show utter disregard and disrespect for their source material by not even bothering to research the structure of medical school. I think earlier they even said that she’s a second year… to which I was confused and wondered why the hell she was on rotations.. and now she’s a third year who’s GRADUATING and STARTING INTERNSHIP THE NEXT DAY. You have GOT to be kidding me. And in what world do you get to choose what you’re gonna do the day before? There’s a long application and interview process that starts in the fall before, culminating in a rank list, which is fed into a computerized system that matches you to where you will do your residency in your specialty of choice (which is almost always decided near the end of your third year… and by all accounts Masters should have been a 4th year if that was about to start her residency). Then you find out if you matched on a Monday before your match day in mid-March, and then that Thursday you open an envelope at a predetermined time to find out WHERE you matched. It’s a ceremonial, long process and it shows utter disrespect to the whole process by making it look so flimsy.
/rant
April 20th, 2011 at 7:20 pm
@D-r Bulgaria
The problem is whether a doctor should do more or do less.
If a patient ask you about an antibiotic and you give him a sugar pill, then you do less. There is nothing morally wrong about doing less. Even in the worst case, if the patient dies, it is only your mistake. People are no God, they can make mistakes.
Another situation is what was depicted in the episode. Doctor Masters did more. She tricked patient into an operation, which while rationally desired, was unwanted by the patient. So she got into God’s competences – she believed that hers opinion in more important than the patient’s. What she really acomplished is to create in patient a large psychological scar. Not because of amputated hand but because of the fact that she was treated like an object rather than a subject. Observe that House and the rest of his team took the do-less position. It was only Masters initiative to do this stunt.
For me this is especially emotionally touching, because I had an overauthoritative mother and my whole childhood was me fighting for my right to make my own decisions. Even today it is still important for me that I disallow anyone aside to make my decisions for me.
And BTW. Congratulations on your view on antibiotics. My colleague recently graduated medical school and he shares the same view. I wish Polish older-dated doctors would share this view too.
April 20th, 2011 at 7:45 pm
Hooray! M3 is gone! As we all know, it was her and only her that was dragging down the quality of the episodes, and with her out of the way, 13 can finally arise like a mighty Phoenix and not just return House back to its former glory, but send it to heights of unbridled quality us mere mortals cannot grasp!
^Sarcasm
Seriously, this was a very enjoyable episode, and it was nice to see them send M3 off with a bang.
April 20th, 2011 at 8:10 pm
While I found it hilarious, I thought it was kind of strange that House and Wilson brought Chickens into the hospital. I mean…chickens are pretty dirty animals and isn’t one of the leading causes of death in hospitals infection? From House I would expect this, but Wilson???
April 20th, 2011 at 8:59 pm
http://latimesblogs.latimes.com/showtracker/2011/04/house-writers-room-the-cut-of-masters-jib-.html
“I’m still mulling: Why did Kendall fall on her boat in the opening scene if the cancer is in an arm bone? She never talks about any arm pain.
The cancer in her arm caused a paraneoplastic syndrome that made her a bit unsteady on her feet, hence the fall. Kendall’s long days of training gave her many aches and pains. Kendall ascribed her arm pain to just one more bruise that she got sailing.”
So that was the writer’s explanation at least.
Personally i thought it was ethical to chop off her arm without consent. I didn’t buy the whole emancipation thing … going to a judge and saying “my parents cut off my arm to save my life and so they are unfit to be parents because i wanted to race around the world by myself and die hideously in the process…” I can’t see that working.
Getting your name in the history books as the youngest woman to attempt something at the price of dying hideously of cancer deserves a Darwin Award, certainly.
It’s interesting that euthanasia is illegal to the point where it is murder to help someone avoid a protracted and terrible death, but the show was saying a judge would have let a minor choose death? If an adult is not allowed that responsibility, why let a minor? How can wanting to get a medal at the price of your life be evidence that you are so mature you don’t need parenting?
I thought this was a great Masters episode and i found the character very desirable, probably because she was more human here than the obligatory squeak of morality. I also think she made the right call. I would hope that she continued in surgery… i doubt moral dilemmas of that nature are really that common!
The chicken and the dog bit made me wince; i could well imagine the chicken getting killed or terribly injured, but heck, i eat the stuff,and i guess dying in a dogs mouth isn’t much worse than dying in a factory. It was quite funny and made sense anyway as a form of extreme stress relief that wasn’t destructive like jumping out of a hotel window blind on booze and painkillers.
Here’s a thought; youngest amputee to sail the world!
http://www.amputee-online.com/amputee/sportrec.html
The team could have sold that being an amputeee isn’t the end of the world and being dead… is! I think they contrived the weight of it on Masters shoulders … still, the parents seemed unable to do their job, it was an emergency situation, and … the record was pointless. It’s not like choosing to die to save someone’s life or help humanity as a whole. It was chasing glory for it’s own reward, which is something we let adults do, but not children. We have to draw the line somewhere. Still, i Know what Judge Judy would have said to her argument for emancipation!
April 21st, 2011 at 12:01 am
I think the girl should have sailed. We’re all going to die, what better way than while doing something you love?
April 21st, 2011 at 2:48 am
@Keith (way back up there) “it’s nice to see Wilde’s extraordinarily beautiful face again.”
Really? Her face? I find it a little weird looking. But I’ve never been a fan of women with jaws of steel.
But that body…
April 21st, 2011 at 9:22 am
The world record for a solo mono-hulled west-east sail around the earth is 84 days. Everyone seems to be quoting one month for some reason.
Since this seems to be a cancer, lymphoid sarcoma, that doesn’t medically exist in the real world, it’s plausible that in the House world the preferred treatment is surgery.
In the real world, no sane doctor would induce a cardiac event to prove a point. All my comments are related to the fact that in the House world you could give someone a heart attack without any risks.
Under normal circumstances, House would never have allowed the parents to make the decision they did. Just refer back to Stacy’s speech when he refuses his leg operation. He did nothing because he knew that in the end saving the patient’s life was at the heart of Master’s ethic, in the sense that she’s a doctor and that’s what doctors do. Just as House is driven to save the patient, or solve the puzzle (chicken or egg?), at any cost regardless of rules, she is driven to live by her ethic (never lie, act by the rules, blah, blah). House shows her that her ethic is internally inconsistent. That’s why she quits.
April 21st, 2011 at 10:36 am
I don’t want to be a pain in the back, but i’m pretty sure that the only reason they named the calcified pineal gland was to ensure the adisson’s disease diagnosis, but like has been said above in the 10% of the population is normal (they expected to be something rare, but it turn out to be normalish)
Overall, just comment this ’cause I’m picky, but i love this site; always checking here if the medicine was correct (at least the didnt said blood in the urine was kidney faillure)
April 21st, 2011 at 3:04 pm
I think there is more than one Tom here! Maybe I should go by Thomas or something else?
April 21st, 2011 at 6:17 pm
I thought this episode was very good. The show seems to be on an upward trend again. I will miss Amber Tamblyn. She did an awesome job with the character of Masters. I found her to be very believable as a young prodigy who was like a fish out of water at times: intimidated, inexperienced but at the same time very gifted. She brought a breath of fresh air to the series. She leaves and that pathetic, whining loser Taub remains. Go figure.
April 21st, 2011 at 7:27 pm
I’m pretty sure more bone cancer does not require the removal of the limb–even if it spreads into the axial lymph nodes. And the removed bone is easily replaced with donor bone (usually from cadavers) or a steel substitute. At least temporarily, one could use chemotherapy and radiation.
That said, one can get quite good artificial limbs nowadays, so the removal of a limb is not quite the setback it once was.
April 21st, 2011 at 9:50 pm
Dear Scott:
I don’t know you, so I can only assume the best about you. I assume that when you critique the House episodes you do so as critically about the medicine as you do about the humanity. And when the humanity in the characters falls short (or apart) you are looking for others to come here and point it out.
If not? I do not belong here. But you belong in decent society, don’t you. You do not hide behind anonymous initials, you do not obfuscate you name or your location. You don’t make ridiculous statements like my country does not qualify while being ashamed to name your country. You don’t spew spittle about assault rifles when the AK-47 was invented by a Russian, not the NRA (or some other ridiculous scapegoat.
Funny he should mention that. Some years ago the daughter of the Soviet inventor of the AK-47 was here in Dallas at some Shot convention or another (not sure- it’s just an insider thing) and she said to the reporters for the record that even in Russia gun control was a joke. “If you are bad you will get a gun! Even in Russia!”
(I for one am willing to back up that statement with a cite from the Dallas Morning News’ article to any decent human being who wishes to have evidence.)
You at least don’t say this person needs help while being afraid to say why for fear of being exposed. But you do let them get away with it, don’t you?
You have not spat venom and told me that I need help while being afraid of saying why for fear of having to defend such a position, in other words.
No, you just sit back and watch, and create the arena. But the fact that you didn’t moderate away my post makes me think that just maybe you are a real person in real life, and just maybe that I made some valid points as far as you were concerned, and touched a chord in your heart that was nagging at you. Am I wrong?
When you talk about the soap portion of the House episodes I can only assume you mean the dramatic interplay between the characters. On the other hand, it is apparent that you have your share of folks who come here to your blog because they see House, M.D. as a real soap opera and look on the characters as a way to feel good about themselves (as in “Yeah, I finally found someone as messed up as me, or better yet, even more so!!!)
You can’t be a medical practitioner without having seen your share of mental problems. I cannot believe that you can’t see how some of these folks are using your site as their security blanket, and feel threatened if someone comes along and insinuates that their comfort thingy has some serious holes in it.
This isn’t the first site I have seen that got taken over by the misfits who thought they found a home. The question is if that is why you founded it in the first place?
Me? I would not allow verbal attacks (as in ew he needs help!) without demanding why these “experts” decided such help was necessary, if this were my site that is. In fact, I would demand they refrained from ANY personal attacks and just kept it rational, cogent, and topical.
But it’s your site, not mine. I will not seek to wrest it from you. I will not march in with my jack boots and demand that you see things my PC way or I will spit venom at you, call you vile names, or in any other way I can use try to destroy you or your career….
I can’t believe you aren’t a decent human being and a loyal citizen of these United States of America who swore allegiance over his heart and who has his limits. I just hope I am not wrong.
It took guts to generate this site and keep it going. Keep up the good work from now on, ok?
Please?
Arthur Warchol
Wylie, Texas
April 22nd, 2011 at 1:57 am
Dear Arthur Warchol of Wylie, Texas: Go check out the AV Club and its reviews and blog comments of House. That site makes Polite Dissent look like a first grade primer (See Spot run. Run, Spot, run.).
Also, part of being a United States citizen is our right to free speech as outlined in the First Amendment.
That aside, you may want to ask yourself why you feel so threatened by those who express diverse, unique and oftentimes unpopular opinions?
Finally, I would like you to offer a Law of House for our ever-growing list. Perhaps by contributing you will feel less isolated and have some fun with the rest of us. We all welcome your input.
April 22nd, 2011 at 5:57 am
@Tom
Sorry Tom, I didn’t know the this name was taken. I will choose a different one next time.
April 22nd, 2011 at 8:45 am
@Lisa Hertel
But it’s okay, because this is a magical new “lymphoid sarcoma” that can only be cured by amputation. Never mind using chemo or radiation to shrink the tumor/kill it (which you would probably have to do ANYWAY just to eradicate any possible mini-metastases…) – CHOP IT OFF
It’s kind of pathetic how badly they misrepresented both the process of medical school, the ethics of being a doctor, and the general medical thought process this episode. The diagnosis was so stupid and random that ultimately it shows how House is going downhill.
April 22nd, 2011 at 9:14 am
Just to make one thing clear. Salmonella enteritidis does almos always need either a sickle cell patient or diabetes mellutus or other immunodepressing condition to cause osteomyelitis. Also there are several serotypes of salmonella and i dont rememver enteritidis being the one which caused osteomyelitis the most.
April 22nd, 2011 at 10:20 am
@theV: there are cancers where surgery is the first treatment, melanoma comes to mind. There are others.
April 22nd, 2011 at 11:04 am
MedMaxRx: i had never heard of the AV club so I moseyed over there and …you sure are correct. It’s certainly not for everyone! I’m thinking, why are these folks watching the show? The major focus of most of them seems to be to hate something…doesn’t matter what. Nothing constructive. Maybe it’s just their way of stopping themselves from going on a shooting spree. Whew!!…staying away from there in the future.
April 22nd, 2011 at 2:09 pm
What? no House Challenge scores yet?
April 22nd, 2011 at 2:18 pm
Official Comment
The speed with which the scores are posted is inversely related to how busy we are in the clinic…and this week we’ve been swamped.