House – episode 22 (Season Finale)
There are plenty of spoilers below, so don’t say I didn’t warn you.
In the season finale, Dr. House is asked to treat Mark, the husband of his former live-in girlfriend Stacy (played by Sela Ward). Stacy is the only one who thinks that something is wrong with Mark. He denies being ill and blames his abdominal pain and mood changes on stress. All tests to date have been normal.
For one reason or another, House believes her and ultimately discovers some subtle neurological abnormalities in Mark. The team’s hypothesis is that Mark either has encephalitis or Alzheimer’s Disease. A huge battery of tests are all normal. The next suspect is Guillain-Barre Syndrome, but those tests too are normal. Finally, House realizes that Mark has some subtle delusions and is avoiding sunlight. With this information he decides that the patient has Acute Intermittent Porphyria (AIP). He confirms this diagnosis through a blatantly unethical test (unethical because the patient had explicitly not consented to it) and in the end, Mark has survived and is apparently cured.
In reality, Mark’s symptoms were never consistent with a diagnosis of Alzheimer’s, though encephalitis was a possibility. Encephalitis was properly excluded by laboratory testing, but — despite what this episode suggests — there are no easy laboratory markers for Alzheimer’s.
The symptoms do fit a diagnosis of AIP. However, urine levels of a chemical known as porphobilinogen are elevated all the time in patients with AIP, even between attacks, so checking the urine during an attack is not required (and although the suprapubic tap appeared technically proficient, I prefer my procedures to be performed using sterile technique). Also it’s important to note that AIP is not a curable condition, although its symptoms can be treated.
The soap opera aspect was good, with some nice clashes between House and Stacy, House and Mark, and Stacy and Dr. Cameron. Plus there were some great one-liners in (my favorite: “That’s her Indian name. On her driver’s license it’s ‘Stacy’”).
This episode earns a B for the mystery and an A- for the solution. The medicine was fair, and earns a B (points were deducted for Alzheimer’s and the urine-during-an-attack scene). The soap opera aspect earned a solid A. Extra credit for ending the episode with “You Can’t Always Get What You Want,” the best Rolling Stones song ever.
May 25th, 2005 at 12:01 am
Wasn’t the whole thing pretty unethical, treating someone with whom you had an emotional attachment or the spouse of same? Not that it doesn’t make sense in a soap opera way, but…
May 25th, 2005 at 1:17 am
Well, mentioning the unethicality of it is redundant, since even House knew it was inethical and didn’t want to do it. It seems that Stacy has a habit of signing people up for surgery against their wishes.
I got the impression that they were setting the show up for an eventual St. Elsewhere style ending, where the whole thing is explained as a dream during his medically induced coma.
May 25th, 2005 at 9:21 am
The whole ethics bit: They’ve been beating us over the head all year about how House’s job is to solve medical mysteries that no one else can. That’s why he’s in the hospital in the first place, right? No consults, because if House can’t figure it out on his own, no one else has the capability either. So from that very unreal set-up, it makes sense that while House is being unethical here, he’s also “THE ONE” who can treat Mark, and there is no other choice.
Say what you will about it being unrealistic, at least it’s internally consistent.
I’m not hopeful for the set-up for next season with Stacy. But then, I didn’t think the House/Cameron thing would be very interesting, and that surprised me, so we’ll see.
“her Indian name” had me laughing hard. Good stuff.
May 26th, 2005 at 1:21 am
links for 2005-05-26
SF Symphony’s Black and White Ball bummer that i’m working that night (tags: San Francisco events) Crosswalk.com – Albert Mohler’s Weblog: spirituality of star wars “Luke Skywalker and company are a form of simple escapism for many moviegoers, and…
June 4th, 2005 at 12:36 am
I just found this place today. Cool reviews. That “indian name” thing was so funny. I just want to mention also that the pilot episode also ended with the same Rolling Stone song so the season has come full circle.
December 2nd, 2006 at 3:11 am
Yeah that was cool. This is a good show… although, it’s becoming a bit too formulaic. Every episode has these 10 simple steps:
1) sick guy (who doesn’t give the entire history)
2) misdiagnosis
3) allergic reaction to improper treatment
4) detective work leads to exposing the lies and…
5) correct diagnosis – which can never entirely proven
6) decision time – a) Take houses recommended treatment which could kill you if wrong (though never is)
or b) Die
7) treatment
8) good health and happy smiles
9) a couple extra cynical witty jokes
10) credits
December 9th, 2006 at 6:05 pm
Actually there was a blatant error regarding the Guillain-Barre diagnosis. Guillain-Barre is an autoimmune disease, and while it can be caused by a virus, it can be caused by a variety of stimuli. It also does not cause abdominal pain, and the paralysis or paresis is usually ascending, and while it can progress quickly, it is not sudden as in the patient in this episode. The most important error is regarding “antibodies” as a supposed exclusion criteria for the diagnosis as per Dr. Chase.
1) The disease is autoimmune, if there were no “antibodies” there would be no disease, so the entire discussion that House and his people have (He may have the disease but not as of yet developed antibodies) is silly and completely wrong.
2) There is no specific “antibody” test for Guillain-Barre, because we have no idea what specifically triggers it, it can be a variety of things. It is diagnosed by history, elevated proteins in the CSF, and nerve conduction velocity tests. Thus the whole idea that he was “negative” for antibody tests is silly.
This is a good show with some excellent writing, but it is blatantly obvious that actual doctors are not routinely consulted regarding the medical aspects of the show. There are blatant medical errors that any practicing doctor would know.
December 13th, 2006 at 11:51 pm
Don’t forget – both House & Cuddy quoted/alluded to the Stones song in the Pilot episode.
Great reviews! I just started reading them.
January 16th, 2007 at 9:41 am
I could hardly remember an episode where House has not been unethical.
February 10th, 2007 at 6:35 pm
Just been catching up on Season 1; it was particularly fitting that they ended with YOU CAN’T ALWAYS GET WHAT YOU WANT, especially since that’s mentioned in the pilot, when House tells Cuddy that the great Philosopher Jagger says “You can’t always get what you want” when she’s trying to get him to do the clinic hours he’s supposed to.
Later in the pilot, when she effectively blackmails him into doing the hours in order to get his testing privileges returned, she tells House that she’d looked into that philosopher Jagger. Turns out that while you can’t always get what you want, “if you try sometimes, you just might find, you get what you need…”
April 23rd, 2007 at 6:46 pm
Did anybody notice, that Dr. House and Sherlock Holmes share the same street number, 221?
May 5th, 2007 at 4:58 pm
for a complete list of house-holmes connections log on to wikipedia and type in House(TV)
May 6th, 2007 at 11:54 am
It is believed that House is in fact based on Sherlock Holmes. There are many parallels supporting this as well, like the above poster said, on Wikipedia.
July 8th, 2007 at 8:30 pm
I read this somewhere:
Holmes–Homes–Home–House
(just mentioning)
October 22nd, 2007 at 12:47 pm
i’m not really sure about this so correct me if im wrong. but should the urine be red when extracted since it has porpherines.
November 5th, 2007 at 11:59 pm
Guillain Barre DOES cause abdominal pain and it is a part of diferential to AIP
December 22nd, 2007 at 8:15 am
Regarding the AD diagnosis..
One of the recent issues of Nature Medicine had a letter by Sandip Ray et al describing a battery of biomolecular tests that can be done to diagnose Alzheimer’s. Ironically, although this wasn’t published at the time that this episode was aired, it seems to have a 90% accuracy rate.
But as far as I know, AD doesn’t usually present with motor dysfunctions before more obvious symptoms like dementia.. and unless you are biopsying the brain, looking for tau proteins isn’t going to do you much good. Even then, the majority of AD cases don’t present with abnormal tau proteins.
January 16th, 2008 at 7:27 pm
Besides the medicine, i have conflicting feelings about Stacy. She’s nice but i hate how she’s so stubborn, agressive, and how she manipulates House. Of course, I almost always hate it when people undercut him. She’s too much like House. AND she betrayed him, then dumped him, then pops up and asks him for a favor-treating the dying husband (even though House is supposed to be ‘The One’ who solves everything.
January 17th, 2008 at 8:16 pm
I actually HAVE the very rare genetic disorder called AIP. AIP does not present with light sensitivity. That’s another type of porphyria altogether. Severe abdominal pain-yes, but I would rate it as much WORSE than natural childbirth. NOT something you’d blame on “stress.” And no, he couldn’t have both. That would like someone having 100 different cancers that all popped up at the same time for no reason.
March 3rd, 2008 at 8:22 pm
I just recently got hooked on this show, even though I have been a fan of Hugh Laurie since his 80s comedy work for the BBC (Young Ones, Blackadder, Jeeves and Wooster, etc.)
I went and rented the DVDs and have watched Seasons 1 and 2. I’m not an expert about the medical stuff, but just from theme and plot standpoint, there is only one thing that just does not work for me so far in the series.
After watching the episode where he tells the 3 stories to the Diagnostic class and one of them is about him and how his leg got permanently damaged, you would assume that after what his ex-girlfriend Stacy did to him, he would never talk to her again. I would go so far as to say that he blames her for his chronic leg pain more than anyone else.
But then, in the very next episode, she shows up and they become close again. I could just never get my arms around that one. I could even see how he would put aside his resentment and anger just long enough to heal her husband. A good doctor might do that, but when they started dating again, that just seemed unrealistic. The only way he could have done it is if somehow he was not resentful about his leg anymore and forgave her, but as any fan of the show knows, he never does lose his resentment and hurt.
Did this element bother anyone else or was it just me ?
On a lighter note, I think it would be great if some of the British comedians that Hugh Laurie used to work with came and did a guest spot on the show. My personal favorites to see would be Rowan Atkinson (Mr. Bean), Rik Mayall, and/or Stephen Fry. There was an episode in the 4th installment of Blackadder which featured all of the above actors and ranks as one of my all time favorites. It was the one where they all try to join the Flying Corp to escape the front lines.
Cheers
March 9th, 2008 at 11:36 pm
Dig Dug, the way I see House and Stacy is that Stacy did exactly what House would have done. Since he’s that kind of guy, he can’t find fault, really, with what she did. The tissue was removed, whether surgically or through his body flushing it out, doesn’t really matter since the chronic pain was probably going to be there either way.
What House DIDN’T like was that HE wasn’t in control which has something more to do with his relationship with his dad than with Stacy (see One Day, One Room season3 ep12). The fact that she would do it indicates she is enough his equal for him to respect her. Besides, he actually does love her. What he has a problem with is that she took control from him and it is THAT he finds hard to forgive. Don’t know if this clarified anything but I do hope it helped.
March 18th, 2008 at 9:34 pm
Interesting take on it NeoLotus. Thanks for your thoughts on it. I agree with you that Stacy was possibly the only woman House ever loved. It would fit in that she was the only one he ever let himself fall for. This surely contributed to his heartbreak.
But, I am not sure if its the losing control of the situation that he resented more or just that he really thought his method was going to work and he would have been able to walk like a normal person had Stacy not stepped in against his wishes. Either way, what I thought really did not fit the puzzle was if we are to believe that he resented her enough for whatever reason, to break up with her after the initial operation, then what changed for him to suddenly get over it enough to go after her at the end of season 1 ? The writers in my opinion never explained what change if any happened. It was more like, we need 3 or 4 episodes of Stacy to kick off season 2.
Whatever happened to House for him to try to go after Stacy again, it was not enough for him to not tell her to go back to her husband once she was ready to come back to him for good. Never could figure all that out.
On a side note, remember when House was shot and then after he was operated on for that, he could walk again, even ride a skateboard? I imagine he would be even more bitter and resentful after that wore off than he was before the shooting.
Lastly, let me end with a prediction :
Someone comes in to the picture, (perhaps Mira Sorvino for a permanent role) and starts a new relationship with House.
Time will tell if House changes his personality due to this new relationship. It would fit with the gradual warming up of his personality through the course of the series so far.
Just my 2 cents.
: ‘ )
July 22nd, 2008 at 4:47 am
I love the other one-liner: when the young guns try not to let House to give an injection to Mark, he says:
‘I like the three musketeers thing”
July 30th, 2008 at 2:07 pm
Looking back into it, I think the Rolling Stones music was used as a framing device for the entire first season. Everything was built around not getting what they wanted. Cameron wanted House, Vogler wanted control, and Cuddy wanted House to do his job seriously. Even in Three Stories, he inability to get what you want was highlighted. It seems like the entire season had a main idea, and I will have to look at other seasons carefully to determine if they have any thematic links like this one.
August 25th, 2008 at 10:11 am
AIP doesn´t cause light sensitivity, while most porphyrias do so.
September 25th, 2008 at 8:42 am
Would the “suprapubic tap” (House plunging the syringe into his bladder to extract urine) result in urine escaping into his body?
December 1st, 2008 at 8:50 pm
I know they need to ramp up the suspense, but AIP isn’t usually fatal, is it? Maybe Trexlor could comment.
Hugh Laurie’s comedy partner Stephen Fry (”A Bit of Fry and Laurie”) has appeared as a psychiatrist on “Bones.” It would be cool to get them together again.
December 16th, 2008 at 12:44 pm
Matt1618 wrote:
“Would the “suprapubic tap” (House plunging the syringe into his bladder to extract urine) result in urine escaping into his body?”
I’m not a doctor, but I doubt it. I happen to know that it’s the standard way of getting a urine sample from cats, who after all cannot be trusted to obey an order to pee into a cup. :-) It seems unlikely that other mammals’ bladders would be significantly different structurally from cats’ bladders.
In any case, if a drop or two of urine did escape, it’s sterile and would presumably just be eliminated by the normal clean-up mechanisms of the body.
February 21st, 2009 at 10:59 am
As for the diagnostic Alzheimer’s assay – they were searching for a specific type of early-onset Alzheimer’s which is quite distinct from senile dementia type Alzheimer’s (the patient seemed to be in his 30-40s). Early-onset Alzheimer’s (AKA Familial Alzheimer’s) is due to specific gene defects, which hence can be tested.
March 6th, 2009 at 8:05 pm
trexlor and jamie are right…AIP doesn’t have light sensitivity as a Sx…that’s cutanea tarda, erythropoietic porphyria and a couple others. in addition to the mistakes regarding guillian barre already mentioned, i think it’s pretty messed up that thiamine deficiency, MS, celiac & crohn’s (and the neurological sequelae of malabsorption associated vitamin deficiencies) didn’t even make the DDx before encephalopathy did. they really really need to hire more competent med consultants (hell, they’d be doing better if they hired some of my med school classmates!).
i’m getting really really sick of the “we can’t test for it! time’s running out! just treat him!” formula. three quarters of the Dx that house throws out have simple tests that take little time. the writers need to find some other, less annoying, more credible way to achieve their suspense quota.
July 21st, 2009 at 1:27 pm
No, AIP isn’t fatal (or I’d be dead!!!)
It’s just very painful. Everything shuts down and stops working–kind of like your body is on strike. And during an attack symptoms don’t come and go–they are severe and persistent. It can cause nerve damage. I, for one, had trouble walking and writing/typing after my first attack. Two years later I got a black belt in TKD.
The “cure”–well, there isn’t one. Glucose helps allay symptoms to a degree, and a transfusion of heme will provide the necessary enzyme that people with AIP don’t make. But that’s only given during an attack.
February 16th, 2010 at 5:48 pm
Couldn’t it be reasonably assumed that Mark is delusional when he thinks he isn’t sick despite the fact that he has “sudden mood swings, abdominal pain, and that he passed out twice”?
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