House — Episode 6 (Season 8): “Parents”
A disappointing episode, as the ones that try to make a broad point (this time: all parents screw up) usually are. There were a few clever moments — who am I kidding, there was one, maybe two clever moments, and the rest was rushing from one imagined crisis to the next
Ben is a teenager working, quite ineptly, as a clown at a kid’s birthday party. After an altercation with one of the kids and their father, he develops the sudden paralysis of an arm and a leg and is admitted to House’s service with a diagnosis of TIA (Transient Ischemic Attack, i.e. a “mini-stroke.”) The team is puzzled why a healthy teenager would have such a condition. The initial concerns are drug use or endocarditis (an infection of the heart valves). A transesophageal echocardiogram is ordered — it shows no heart valve problems, but it does reveal a thickened pericardium (the membranous sack that surrounds the heart). The differential now includes syphilitic vasculitis, histoplasmosis, or Sjögren’s syndrome. The tests for the first two were negative, so House orders Ben started on immunosuppressants to treat the Sjögren’s.
While Taub sets up the medication, Ben develops a bloody nose, then a bloody cough. Taub reports that Ben’s platelet count is low and suggests DIC (disseminated intravascular coagulation). Park reports a low red blood cell count and suggests a retropeitoneal bleed (bleeding into the tissues behind the abdominal cavity). Adams reports few white blood cells and suggests an infection. House notes that the entire blood count (platelets, red cells, and white cells) is low and reports that Ben has aplastic anemia (a condition where the bone marrow stops production of any kind of blood cell). He has Ben started on platelet transfusions and orders bone marrow testing on Ben and his relatives to prepare for a bone marrow transplant. A short time later, Ben complains of back pain and his blood pressure drops. It turns out that he is having an allergic reaction to the platelet transfusion. House orders a more specific kind of platelet transfusion so there will be less chance of a reaction. Ben suddenly starts gasping for breath and after a perfunctory physical exam, Taub announces that he has a pleural effusion (fluid building up around the lungs). A chest tube is placed, but rather than returning blood, it drains an transudate (which to me looked more like an exudate), which Park takes to mean our old friend liver failure is back. The team now has a prolonged and mostly pointless argument about whether the liver failure is due to a failure of protein synthesis or high ammonia levels. House suggests feeding Ben a high protein diet to purposefully worsen the liver, and his symptoms (heart failure or coma) will let the team know which problem he had (because this is so much quicker and easier than running a ten-minute blood test).
Of course, things quickly go from bad to worse. Ben’s left eye starts bulging out and needs steroid injections to resolve. The team now suggests angioneurotic edema, anasarca, or Burkitt’s lymphoma. House suspects that later is the most likely, so starts Ben on chemotherapy. While receiving his therapy, Ben crashes and develops multiple organ failure. The team initially suggests multiple aneurysms or cholesterol emboli as potential causes. But then Ben’s estranged and in-fact-thought-dead father stops by, and House recognizes the abnormal gait of someone with tabes dorsalis, a sign of syphilis. This causes him to realize that the father sexually abused Ben as a youngster and infected him with syphilis, which is what caused his current symptoms — well, that plus the antibiotics causing a Jarish-Herxheimer reaction (severe symptoms caused by multitudes of bacteria dying off and releasing toxins into the bloodstream).
This week’s episode was particularly weak in differential diagnoses. After the first round, they quite trying, and the newer diagnoses just explained the latest symptom and not the previous ones, so the original admitting symptoms were usually left unexplained. As always, major complaints are in red, modest complaints are in blue, and nit-picking ones in green:
Once again, House is starting chemotherapy on a patient without even confirming the patient has cancer, let alone what type he has. There is no generic chemotherapy; it is specially tailored to the specific cancer.
A few simple blood tests would determine the likely cause of the liver failure, though it is quite possible if not very likely to have poor synthesis and high ammonia livers. Despite what House says, it would be quicker too than feeding the poor patient protein and waiting for it to be processed by the liver and have an effect.
Worst diagnosis of the episode: retroperitoneal bleed. How does that even come close to explaining the TIA symptoms?
A pleural effusion is not “bleeding into the lung.” It is bleeding around the lung, a not unsubtle difference.
I have my doubts that the syphilis tests (likely an RPR or VDRL) would be negative in Ben’s case. Those tests are known for their false positives, not false negatives.
If Ben’s white count is so low as to suggest aplastic anemia, why was he not placed under neutropenic precautions?
The effusion should have been clear, not cloudy (and I’d expect it to be a little bloody as a result of the brutal chest tube placement as well).
This week’s medical mystery was a little interesting, but not terribly compelling. I give it a C. The more I think about the final solution, the less it makes sense. Ben had latent syphilis that suddenly, in the space of a minute, exploded into neuro- or at least cardiosyphilis? Really? And the Jarish-Herxheimer symptoms are a poor match as well. It earns a D. The medicine was poor as well, and was more reactive than actually thought out. I give it a C-. The soap opera, at least among the patient and his family, and among the team was interesting, though Taub surely knows that House cares nothing for his daughters’ well-being. The House/Wilson/Foreman aspect, though at times amusing, just reminded me of what a sad defeated man Wilson really is. I give the soap opera a B.
The review of the previous episode of House
A list of all prior House reviews
November 14th, 2011 at 11:07 pm
Chase with a beard is like seeing Spock with a beard in that old Star Trek episode… It makes Mr. Goody-two-shoes look downright ‘evil’… lol I hope he keeps it, the look suits him well.
I wonder how long the whole Taub “Who’s your daddy” arc will go on? Seems like after tonights ep, it’s about run it’s course.
How did Park know that the kid was “crashing and everything was shutting down”, when all there was was a few beeps on a heart monitor? Either she’s a psychic on the side or she read the script ahead of everyone else. :D
What did House mean at the end when he tells Adams “It WAS a tactic”?
The expression on Wilson’s face was priceless when he saw Foreman and House ringside on TV… looks like Foreman played both House and Wilson like a Concert Violin to get what HE wanted for once… and poor old Wilson was once again as gullible as ever, but this time the difference being that Foreman got him in a very House like manner… you’d think the guy would have learned after 8 years to trust no one working at PPTH..
November 14th, 2011 at 11:11 pm
Official Comment
House just meant that his pretending not to care about Adams’ parents was a tactic to get her to tell him about them.
November 14th, 2011 at 11:23 pm
A very “meh” episode all around, with a couple of amusing twists (I’m really enjoying Taub’s storyline), and Laurie himself being very good this week, really playing up House’s complete lack of bedside manner. A gigantic step back from last weeks episode, but pretty par for the course for this season.
November 14th, 2011 at 11:27 pm
The Good:
Wilson’s back, after it seemed he almost had been written out of the show. (And the “we’re not friends anymore” went away; as Wilson said in a previous episode, “I’m not even sure that we get to choose who our friends are.”)
Not to mention House and F-man F-ing with Wilson.
The BabyMommies finally appeared, badly-needed plot elements.
Interaction among the team is becoming somewhat more interesting, though the always-pairing of the Pretty and the Not-So-Pretty is getting a bit tiring. Chase/Park — could two dulls equal one sharp pair? Taub-Adams.. hmmm…. she discovers what 4Man was dying to know, namely, how Taub gets all the women. (SPOILER: The length of a man’s nose turns out to be related to the length of his…. )
The Stupid Clinic Pts are Back, Baby! … Yay!
The Bad: (written before seeing Dr. Scott’s review)
“Low white count = infection”? Really? After all these years of “high white count — must be an infection”?
Could be, maybe, compromised immune system? HIV or full-blown AIDS? Leukemia? Something else ending in “emia” (or “aemia” east of the Pond)? Iatrogenic?
House speaking at a Rheumatology convention? (even as a gag). By once-removed osmosis from hanging around the senior Dr. Chase’s son? (Reminder: Chase’s Dad literally “wrote the book” on Rheumatology.)
OK, House is an expert on all medical specialties, but Board-certified in infectious diseases and nephrology. Don’t see how that makes him qualified to speak on Rheum.
The “everything about the PotW and his family applies to Taub” bit was like having a ton of axes fall on you. Or being hit over the head with a brick. IOW, they way overdid it.
The Ugly:
Bad enough that Park speaks in a grating monotone, but as an allegedly-professional actor, can’t she enunciate any better? (says the former actor) Tired of replaying with CC-mute to read the txscripts of her lines.
(Before anyone engages in any epic — dissent, please note that in “the industry”, “actor” is gender-neutral.)
The Strangely Prescient:
Child rape? This episode was written well before the Sandusky allegations came out, as it was listed in Wikipedia well in advance, so unless the writers did some last-minute scrambling (unlikely, given how careless they are about all else), the timing is eerie. Which is a good bit west of plainsboro, but…
November 14th, 2011 at 11:30 pm
I liked it, but what do I know?
November 14th, 2011 at 11:47 pm
are schistocytes a definitive way to rule out DIC?
November 15th, 2011 at 12:00 am
@Medstudent: I’m pretty sure the lack of them is…
November 15th, 2011 at 12:09 am
@ Dr. Scott:
“After the first round, they quite trying,”
Not just nit-picking here; it really does change the meaning. Was “they quit trying” intended? (sorry to post so soon after the first, but the first was deliberately submitted before reading your review.)
@ All, and a Dr. S. Pet Peeve:
On last Sunday night’s rerun of “The Unit” (Army Spec Ops team), they shock a flatliner. (a wounded soldier.)
Different writers, but they probably saw “House”, and thought, “It’s a medical series, so they must know what they’re doing”. (sigh)
November 15th, 2011 at 12:24 am
@Medstudent: wikipedia has ambiguous wording but suggests that schistocytes MAY be present in DIC, uptodate seems to say that they ARE present in DIC… take that as you will!
November 15th, 2011 at 1:00 am
I know that in severe cases you often see schistocytes but I was under the impression that to rule it out you should at least do a D-Dimer. Anyway, its probably nit-picky seeing how these guys would rather almost kill a patient than do a simple blood test for liver enzymes.
November 15th, 2011 at 1:23 am
Truth… and I’m way more confident in a negative D-Dimer ruling out DIC than absence of schistocytes!
November 15th, 2011 at 3:08 am
Perhaps a lawyer can answer this question:
Since Taub didn’t tell the kid the truth, and the Mom just wants to put the whole thing behind her, essentially the biological Dad got away with raping his son, no legal ramifications? You can argue the whole being estranged from his son is a punishment worse than anything that the legal system can do to him, but honestly, I beg to differ, as pedophiles are not exactly a respected breed of criminal in prison.
Also, I don’t really like the whole clowns = pedophiles implication. I know a lot of people don’t like clowns, but come on!
November 15th, 2011 at 3:09 am
“these guys would rather almost kill a patient than do a simple blood test for liver enzymes.”
In all fairness, I’ve known two separate medical professionals that told me–at completely different times–that if I ever got sick, do not go to a hospital…”they will kill you there”.
November 15th, 2011 at 3:33 am
@TT: “Plainsboro” is a proper name and therefore should be capitalized. For someone with such a diverse, albeit inspirational, resume, I am surprised that such an obvious error escaped your notice.
Additionally, it is not so strange to have a nephrologist speak at a rheumatology conference; one of the first organ systems attacked by auto-immune disease are the kidneys. They are the most vulnerable in that the entire blood supply is filtered through them, and many of the drugs used in connection with these types of disorders are what we call “first pass kidney” or they are an immediate secondary metabolite to the liver. Any of these can evoke an inflammatory process (interstitial nephritis, glomerulonephritis) which can lead to kidney failure. To that end, the treatment perspectives offered by a nephrologist experienced in these unique problems would be a welcome addition at such a conference.
November 15th, 2011 at 4:10 am
SNARK ALERT:
It would appear as if the writer of this particular opus once again supped at Fat Freddie Fong’s Fu-Man-Chu Fine Dining and Intimate Apparel establishment (edible eel panties, anyone?) and divined this week’s miasmic medical mystery from a post-prandial fortune cookie.
If DNA Dad was exhibiting tabes dorsalis, then I sure didn’t see it; after all, he took three, possibly three-and-a-half on-camera steps, which were more reminiscent of testicular torsion than tabes dorsalis. The diagnosis was a bigger stretch than a porn star’s post-coital va-jay-jay.
But I will say this: I heart bald guys and I’m starting to have sex dreams about the back of Hugh Laurie’s head. Awesome.
November 15th, 2011 at 7:49 am
Joel Kazoo: I’m a law student in Sweden, so that’s the law I’m most familiar with. In Sweden, a doctor is obliged by law to report even suspicion of child abuse – sexual or physical. I would suspect that the US has similar laws on the matter, the protection of children is a pretty basic point of most legal systems. But then again, haven’t most of House’s staff broken the law on several occasions on the show?
November 15th, 2011 at 9:51 am
Foreman and House at the boxing match, tipping glasses of beer. I LOVE IT!
November 15th, 2011 at 12:28 pm
(1) Of course low white count can be a sign of infection. Prognostically, it’s worse than having a high white count.
(2) Of course RPR and VDRL have false negatives in late syphilis. That’s why the FTA-Abs test exists.
(3) Pleural effusions are never clear (as in CSF clear). They are straw colored, even when free of cells.
(4) I’ve never seen a tabetic gait, and the web is not too helpful. Here is a guy with posterior column disease:
http://www.youtube.com/watch?v=ZSIUzJjomSE
If anyone can find a good video that is specifically of tabetic gait, please post a link! Thanks.
November 15th, 2011 at 12:44 pm
Official Comment
It’s always been my understanding that the FTA is used to rule out false positives, not false negatives. If you used it to rule out false negatives, you’d end up running it on 95+% of the people you order RPRs on.
The effsusion was white and turbid, not straw colored.
November 15th, 2011 at 12:52 pm
More chemotherapy without proof and that’s annoying even for non doctors. The episode was meh, but it had a coupe of good moments, like the House vs the patient convinced he had diabetes, how he ruins Foreman’s video conference or the very ending of the episode, in the boxing match :P
November 15th, 2011 at 1:38 pm
@Joel Kazoo: I agree. I don’t know what the statute of limitations is in Jersey for that particular crime; however, you would think that there would be some legal obligation there on behalf of House and his team. They should report it to the police and let them sort it out. Bad medicine and bad law.
November 15th, 2011 at 2:04 pm
My understanding is that PRP and VDRL can produce false negatives in tertiary syphilis. FTA is indeed used to rule out false positives only in everyday practice, hence in fact some infections may remain undetected. But it would be impractical to use FTA is every case, when PRP works really well (but not perfectly).
November 15th, 2011 at 3:54 pm
Forgive my soap-biased mind but what are the odds that Ben’s father had syphilis and gave it to his son but not to his then-wife? Also when it turns out your only son is dying of violent unknown causes, and his doctors keep talking to you about his secretly abusive dad, what are the odds that you WON’T feel compelled to spill the beans and make them swear to keep it a secret?
I am usually really easy to please when it comes to House but this week the main storyline did not make any sense at all to me, it relied on nothing logical.
Plus I don’t like Wilson not getting at least a little bit angry when he finds out he’s been played..
The only good thing though: can’t get enough of Peter Jacobson!
November 15th, 2011 at 4:30 pm
I was really hoping that House would recover this season, but I suppose that was wishful thinking. And with that, I think that I am done watching it.
November 15th, 2011 at 5:35 pm
@Dr. R
I’m with you on this one. This episode was the final nail in the character development coffin for me.
If prison can’t change House even the slightest, then it’s clear the writers are frozen in time and have no interest in advancing the characters’ storylines.
When the reviews and comments here on PD are more interesting than the show itself, it’s time to go and find something else to watch.
I’ll check back from time to time to see when Wilson finally snaps and guns down the main cast, but for now, it’s off my PVR. Unfortunate, really. The show held such promise, but feels – to my mind – unwilling to evolve.
November 15th, 2011 at 5:41 pm
This show has gone beyond stupid. Halfway through this episode, I hoped a giant meteor would strike the hospital killing everyone.
Perhaps the dumbest story line is Taub not getting DNA done with is alleged daughters and the mothers not insisting on it. Then there was the moment last night when mom of baby #2 declared that day care cost more than her job paid–uh, Taub would be paying her a boat load of child support–probably over $1000 a month (which would cause him to get DNA testing in a heartbeat.) Mom #1 would also demand child support and probably DNA testing.
November 15th, 2011 at 5:51 pm
Correction: assuming the woman was a CNA and Taub is making the average salary for physicians, according the the New Jersey Child Support calculator, Taub would likely be paying $1600-$1800+ a month in child support. (This is set by law, judges can only change it in rare circumstances and wouldn’t in the case of the father being a doctor.)
November 15th, 2011 at 5:53 pm
Sorry, but one other point: New Jersey law requires that Syphilis be reported within 24 hours of diagnosis.
November 15th, 2011 at 7:04 pm
@ Joel Kazoo:
I’m not a lawyer, although I have had lawyers ask me for my opinion on certain matters. (More of that amazing resumé of which MedMavRx has only the iceberg’s tip so far.) In 2:13, “Skin Deep”, Dr. Scott notes:
“Alex father admits to having had sexual relations with Alex once. When House does not report this immediately to the authorities (which he is legally obligated to do in every state, even New Jersey),… ”
So yes, but the writers have ignored that before.
In the state in which I live (utter chaos), the statute of limitations on sexual abuse of a child doesn’t start to run until the child becomes legally an adult. We’re told that the PotW is 16, so the statutory period hasn’t even started to run yet.
@ Faiw:
“Forgive my soap-biased mind but what are the odds that Ben’s father had syphilis and gave it to his son but not to his then-wife?”
Clearly not a happy marriage, so he might not have had sex with the wife after conceiving Ben, then contracted the disease from another lover (male or female, as it’s plain he bats from both sides of the plate). Subsequently, he txmits the disease to Ben. … Yeah, that’s giving the writers a lot of latitude, but at least it’s “possible’, which is more than one can say for the most egregious errors.
@ MedMavRx
““Plainsboro” is a proper name and therefore should be capitalized.”
Puns are formed by giving words an unexpected meaning or twist in meaning, which provides the humor. I’m changing the meaning of “eerie” to Erie, Pennsylvania, so because “eerie” is not capitalized, “plainsboro” also was not, to make the analogy in the pun more clear. (although apparently not clear enough. I can do explanatory footnotes in the future.)
Thanks for the edification on Neph@Rheum conference.
See how easy that was? It didn’t hurt a bit, and I didn’t try to hurt you back, either. I learned something from your post.
Do you think there could possibly be a correlation between welcoming corrections and having a steadily-expanding knowledge base, versus hurling vile insults at others and staying at the same level of knowledge all of one’s life? It would be hard to do a placebo-controlled, double-blind study, but there appears to be not only a strong correlation, but a mechanism to explain it, thus going beyond the “correlation ≠ causation” bar.
The nick and the posts suggest a physician, pharmacist, or student of same. I’d rather not employ the services of one apparently unwilling to learn anything new, but I do understand that med school is very establishment-oriented and doctrinaire, and that it leaves many (not all) believing that they know everything about everything, when many don’t know a lot about medicine. Simple example: I know from several personal experiences and those of friends that many doctors are unaware of the adverse effects of what they prescribe, or understate them, causing physical damage. More: Being Rx’d a med that not only was not indicated (yes, “off-label use” is permitted), but whose FDA-approved insert indicated that it would worsen *the very condition for which it was being prescribed”.
OMG, I’m actually living in House’s world…
When I was teaching snow-skiing, we instructors all knew that the most difficult students were physicians and lawyers, because both are accustomed to telling others what to do, while believing that others cannot possibly tell them anything, even outside their own fields.
Needless to say, it’s a logical fallacy to go from the general from the specific (the root of prejudice), so none of the above necessarily applies to Dr. Scott, or to any other individual physician. But the group generalization has many adherents. Cheers.
November 15th, 2011 at 9:29 pm
Am I the only one who thinks House is really improving? Sure, the medicine kind of sounds ridiculous and all (dormant bacteria? Is that even possible?) but the soap part with the patient, and especially House/Adams and House/Wilson/Foreman were incredible, in my opinion.
November 15th, 2011 at 11:10 pm
I’m not usually one to worry too much about the medical aspects of this show, but it bothers even me when House (now frequently) comes to some conclusion after a one minute differential that merely discussed possibilities and immediately orders (oftentimes radical) treatment – chemo, etc. That just seems silly. No consultation with patient, etc.?
And I don’t get Taub anymore. First, he’s a House veteran now and should be fairly immune to House’s personal intrusions (I never really did understand why anyone played ball with House on that score anyway). Second, if House does upset him, why is he even there? He supposedly makes a lot more money as a plastic surgeon. More money + less headache = pretty much no reason to be there. And any notion of serving the greater good would go out the window with his newfound financial responsibility to two small children. I’m afraid that in the real world, Taub would be nowhere near PPTH.
November 16th, 2011 at 2:49 am
@Calendar Dog: A tabes dorsalis gait is presented as not walking heel-to-toe. Rather, imaging walking through a foot-high snow drift, where you not only have to high-step, but you also plant your heel and toe simultaneously. The gentleman in the video you referenced kind of demonstrated a tabes dorsalis gait once or twice on the left (I think). It’s caused by damage to the dorsal spinal cord which houses the sensory nerve tracts, interferring with the afferent pathway to the brain and therefore screwing up one’s spatial cognition (known as proprioception). Although not exactly unusual, it is still a very interesting neurological phenomenon, in that a sensory nerve pathway damage causes a motor nerve pathophysiology. The one patient I’ve seen with tabes dorsalis kind of “weaved” a little as well and held his arms out as if trying to keep his balance, due to his cerebellum association cortex’s inability to properly interpret and integrate the interrupted or absent sensory information. Interesting stuff. Thanks for the link.
November 16th, 2011 at 2:53 am
@Tommy Turtle…whoa whoa whoa there. JUST because he is a pedophile and raped his son does NOT make him bisexual. It makes him a sick *uck.
Raping a human is an act of violence, not an indication of their “sexuality”.
Since 13 is gone, the resident bisexual needed to speak up.
Very very meh about this episode. I laughed some at the end (poor Wilson!) but that’s it. And hasn’t the mom been on House before? I keep thinking the ex-GF of the cop in Brave Heart.
November 16th, 2011 at 3:29 am
He agreed not to do plastic surgery when he quit that job, as a part of the settlement, if I remember correctly.
November 16th, 2011 at 9:14 am
wish the team embrace everyone’s lie. the chemo is overuse. Wilson outplayed. ..Aww.
November 16th, 2011 at 10:23 am
My post is more on the other patient, the guy who thought he had diabetes. I was diagnosed with type II back in July and the treatment for me was not insulin, but to lower my sugar levels/intake through food and a marvelous drug called Metformin (crashes are possible with this by the way).
Why would this guy want insulin for type II? Is this given in some cases? Would they have given insulin to his dad and his brother?
It also would seem that just lowering his intake of sugar, while not medicated, would be just a good idea for weight purposes. Is it possible for the specialized foods he was eating to cause a thyroid issue? (I’ve never heard of foods like this until this episode. I just eat a low sugar/carb diet.)
November 16th, 2011 at 10:34 am
Official Comment
WatchOut4Keith,
This topic demands more explanation than just a brief comment can provide, so I’ll just hit a few highlights:
1. Proper diet and exercise are necessary for any diabetic. Weight loss is almost always a key point in the treatment of Type II diabetes as well.
2. Insulin works well in lowering the blood sugar in either Type I or Type II. It is necessary for Type I, but only one option of many for Type II.
3. That being said, in most people with Type II Diabetes, over time, the pancreas slowly gives up the ghost and oral medications stop working as well. Eventually you are likely going to need some insulin supplementation.
November 16th, 2011 at 5:00 pm
About whether they’re obligated to report the sexual molestation: after Adams incredulously ask “are we done?!”, I’m pretty certain that House explicitly mentions calling the cops as one of the things left to do. So probably yes, they are going to do it. Why this fine team of geniuses think it would not get back to the patient, is a different question. A difficult one, too.
@TommyTurtle: I’ve googled Sandusky and found few similarities. A father abusing his son v. a coach charged with 40 counts of sex crimes against eight underage victims – I wouldn’t even suspect an analogy if you hadn’t pointed at it.
November 16th, 2011 at 6:50 pm
Not that it makes it any better, but I think they ordered the “generic chemotherapy,” and then weaseled out of it by saying his latest symptoms (multiple organ failure) began RIGHT BEFORE they could start the chemo.
Good timing by the patient, then.
November 16th, 2011 at 8:34 pm
I agree with Hugh L., who pointed out Park’s ridiculous line, “He’s crashing! Everything’s shutting down!” I paused my DVR and said aloud, “He’s crashing — and EVERYTHING IS SHUTTING DOWN??”
It’s bad when a non-medical type notices these egregious errors, like the generic chemotherapy. Did he also flat-line and get the paddles? If so, we hit the trifecta of bad medical drama.
November 16th, 2011 at 9:06 pm
@Seph. Yeah, buddy, I’m afraid you might indeed be the only one.
One of the worst episodes I’ve ever seen, despite the many attempts to make it like the “old” House, with tricks on top of tricks, and House teasing out of people the confessions they swore they wouldn’t make. All very unconvincing.
When Wilson put on his fakey-concerned look and said, “You’re right!” to Foreman’s completely weird assertion that Wilson could only help his friend survive probation by giving up his fight tickets, I felt like screaming. Wilson has generally been outwitted by House, but he’s at least had a brain and knew how to play the game. What about Foreman’s pseudo-argument remotely rang true to him? Has he lost all sense of irony?
Yes, and unfortunately so has the show, it seems. Sure, Adams was faked into her pat little admission by House not asking anymore. The medicine made no sense at all, and I’m one of those ignorant, easy-to-please types when it comes to the medical facts.
November 17th, 2011 at 4:12 am
@ Headacheslayer:
“raped his son does NOT make him bisexual.”
If he were strictly heterosexual, even though a violent pedophile, he would have raped a little girl instead of a little boy. (It happens, alas.) Perhaps a few pedos may do both — can’t remember a case offhand — but most are consistent in the gender of their victims.
“Raping a human is an act of violence, not an indication of their “sexuality””
Of course it’s an act of violence. But since sex is the “weapon” of choice, the choice of victim-gender is indicative. Rapists of adults either rape women or they rape men. Can’t remember any who did both here, either. (Oops: Caligula ;)
I had some indirect links to the trial of serial rapist-killer Ted Bundy, whose trademark was biting off the nipples of his (exclusively female) victims. His mother was a prostitute, so little Ted had the “pleasure’ of watching a dozen or so strange men schtup his Mom every day. He took out his hatred of his mother by biting the most intimate (post-partum) connection between mother and child. (Yes, I did just don my Siggy Freud hat. Thanks for noticing.)
It’s nice that you finally came out to us, unless I missed it in a previous episode’s comments. But doesn’t really affect the comment. Of course bisexual ≠ rapist or pedophile. But the converse: He had sex with a female, apparently, to produce a son (let’s say, more than once). Then he had sex with a male, probably more than once and probably with others after being kicked out. Someone who has more-than-curiosity sex with each gender is, by definition, “bisexual”, even if by force.
Not counting prison, where there isn’t the preferred outlet for straight men, and where it’s as much about establishing top dog (literally) and the pecking order. (resists punning)
Describing PotW as bi does *not* put him in the same category of human being as 13, yourself (AFAIK), two bi women I know (dated one; other is a relative of a friend), etc. It makes him a very, very sick man who has sexual activity with both genders.
Are we cool?
@ mcb:
“I’ve googled Sandusky and found few similarities. A father abusing his son v. a coach charged with 40 counts of sex crimes against eight underage victims – I wouldn’t even suspect an analogy if you hadn’t pointed at it.”
I’m sorry if it was unclear. I was saying it was quite a coincidence, as the episode was undoubtedly taped before the Sandusky case broke, but aired very shortly thereafter.
However, what the two do have in common is a position of authority over the victims — as in the Catholic Church scandals (don’t bother flaming; I know the bad ones are the minority), Boy Scout leaders, teachers, etc. As opposed to going to the nearby playground and picking a victim.
November 17th, 2011 at 9:16 am
It is my sincere hope that the final episode of House consist of Wilson machinegunning the hospital and everyone in it, then blowing up what’s left with a mountain of C4, having finally snapped after being the butt monkey for eight seasons.
November 17th, 2011 at 1:04 pm
Stopped watching this episode after 20 minutes. That never happened before. It’s really time to end this show. Drama is poorly written ,there is no clever “Houseisms”, no funny clinic cases… And medicine is just terrible.
November 17th, 2011 at 3:52 pm
As you can all see I’m posting on friday night after watching the episode about two hours ago. Busy, busy week, I am between jobs and between places to live even between countries to live :) I’l be as brief as possible and go straight to my marks:
Mistery: B-. Sudden one side paralysis? This had potential. Especially when the patient is talking, and staying in contact which means that the brain is affected but only a tidzy bit :). Kind a cool. Medicine: F. Frankly I cannot even remember when was the last time when I heard so many idiotic suggestions while they were doing DD. One of the most idiotic came from my idol Chase! Endocarditis?!? NOT WITHOUT A FEVER AND SOME CHANGES IN THE HEART TONES! Just for once I would like them to do a physical well instead of jumping to the invasive para clinical studies! Low white count=infection?!? How on earth did Adams pass her bar exam on infectious diseases? High WBC=infection, Low WBC=HIV, late stage cancer some other immune deficiency. Retro peritoneal bleeding?!? Bleeding around the lungs? From what?!? Enough of that! Solution – variable somewhere between B+ and C-. From my point of view there are two sets of symptoms: those presented before the treatment with the antibiotics and the others presented afterwords. The first set must be explained by the Syph, while the second might be explained by the Syph the J-H reaction or some weird combo of both. Well…..
1. Ministrokes – Houses explanation is kind of possible. There are many reasons it is a long shot though…. those who want to delve there just check how the circulation works in general. I would expect a clot thrown in the leg to end up in the lungs or the liver not the brain.
2. Thickened pericardium – could be caused by the Syph.
3. How exactly did the kid stay alive for 10 or so years with syphilis inside his body without any of the symptoms of syphilis? Plenty of those to go around – Google them if you want. One good explanation is that some other doctor prescribed Amoxicillin for a sore trout and that put the bacteria to sleep without killing them. Another long shot but I guess possible.
4. Blood caugh: Jarish-Herxheimer reaction – or liver failure. Possible
5. Low RBC WBC and platelettes – same as above. Probably the liver (they just love to skrew with the liver do they?)
6. All the others until the end as well as the liver failure – Jarish-Herxheimer reaction. Could be.
So with about 10 could be’s Houses explanation makes sense.
The soap was entertaining and the fact that House and Foreman teamed up to play such an evil trick to poor Wilson was a pleasant twist. Taub was funny as always now. Chase was a minor but still funny blip on the background. I kind of feel we need one new centric episode on him….Park was practically non existant and frankly I liked that. Adams is beginning to insert some personality to the series and is a pleasure to watch (plus she’s hot). I give the soap a B+ (it was not as good as the previous two weeks but still entertaining). TTFN!
November 19th, 2011 at 3:47 am
@Tommy Turtle heck yeah, we’re cool ;)
I understand what you’re saying–I do see your point–but whose to say that if he’d had a daughter he wouldn’t have molested her? I know we’re going way way OT (so thank you Scott for putting up with this discussion). He, most likely, was molested (not an atypical pattern and NOT an excuse). The gender of his child probably had no affect of how he mistreated him. And we don’t know for sure who he got the syphillis from, so if you take that out of the equation, you can’t really judge sexuality (or at least I can’t).
And I’m really glad you–unlike some people–do not equate GLBT with pedophilia.
I guess my thoughts are that pedophiles take advantage of whom they have power over–whatever gender the victim is–and it has less to do with the sexuality of the perpetrator than the power. Which would fit the prison example you gave as well. (Don’t resist punning. It may result in disintegration of your funny bone lol).
Ah one reason I do so love this forum and why I want House to NEVER end–the types of intelligent convo I can have here.
The hat looks good on you, btw ;) Thanks for keeping this a mellow discussion TT!
November 19th, 2011 at 10:01 am
About the drinking of “pee” — a client (a psychiatrist) told me that pee sampling was one of the techniques used in past centuries to determine a patient’s condition. So even if it were apple juice laced with pee… well…
November 19th, 2011 at 10:25 am
I went back and re-watched the urine ‘drinking’ segment again and I got the distinct impression that House was implying that the guy substituted apple juice for his urine so when it was tested they would find water and a high sugar content consistent with being a diabetic, NOT that he was actually drinking the stuff…. House could tell what it was from the smell before he ever tasted it.
Remember this clinic guy is a chronic hypochondriac and would do ANYthing to get a cure for what in his mind he’s afflicted with so its not a stretch to think he’d pull a bait-and-switch maneuver like that….
November 19th, 2011 at 10:30 am
Oh, hey Dr. Scott, any chance the House Challenge Scores for this week are coming soon?
I know you get to them when you can but I need my fix!!!
November 20th, 2011 at 10:30 am
Per the house news on facebook:
Meet the Medical Technical Advisor (aka fact-checker) for HOUSE: John Sotos.
So – now you know who to blame for the crappy medicine.
November 20th, 2011 at 3:45 pm
@ Scott
As the gold standard, the difficult-to-perform FTA-ABS can also be used to rule-in lues, viz.: “if syphilis is highly probable and nontreponemal tests are negative, the FTA-ABS test should be requested.” (The Journal of Emergency Medicine, Vol. 18, No. 3, pp. 361–367, 2000)
@ Epic Bitchery
I’d always understood the tabetic gait to involve foot-slapping, leading to Charcot joints. But this old description suggests that high-stepping is part of it, too, as you say:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2045885/?page=1
@ D-r Bulgaria
There are certainly cases of endocarditis with normal heart sounds. And there are certainly cases of endocarditis with no fever. (Even febrile patients are not febrile all the time.) And syphilis is well-known to hide out asymptomatically for years or decades in its “latent” stage, whether or not antibiotics are taken. I had trouble understanding several of your other points.
November 21st, 2011 at 1:54 pm
Official Comment
This week’s House Challenge scores have FINALLY been posted
November 22nd, 2011 at 1:58 am
@ Headacheslayer:
Yes, I’m aware that most sexual offenders (not just pedophiles) were victimized themselves. This is why pedos are the lowest-ranked scum in prison, despised by murderers, robbers, drug lords, etc. — Most violent people had violent upbringings, sexually-abused or not, so they see the pedo as their father (or whoever abused them), and target pedos in the can.
(There! A pun! — how is the humorous humerus doing? ;-D … and *please* don’t ask me how I know that, LOL. … no, never done time.)
“I guess my thoughts are that pedophiles take advantage of whom they have power over–whatever gender the victim is”
Your hypothetical question is well-taken, but I look at it the other way (we’re into a punning gold mine here): Men who like to abuse boys are likely to choose paths that put them in such authority: the rogue priests, Scoutmasters, coaches (alleged or convicted), teachers, etc. Those who like to molest girls may become teachers, daycare workers, orphanage, …. they’ll choose what gives them the opportunity and authority.
If PotW were strict hetero, my guess is he’d express the violence by beating his wife and probably raping her (now that that’s against the law, and no, that’s not funny), and express the pedo part by going after a niece or other relative where he’s Uncle Peter (oh, another one! Are you keeping count? ;), drive an ice cream truck, go to the playground with lollipops (Suck on this, little girl!)…. etc.
And TUVM for the hat comment. I’m the cool Cat in the Hat.
(House: “We have to treat the worst ‘worst’ first.” … team stares… House: “I studied under Dr. Seuss.”
*Loved* that line.)
As for GLBTphobics: Both GL and pedo are anti-evolutionary, in that neither procreates the species (pedo in the sense of pre-pubescent; plenty of “primitive” cultures still marry off girls as soon as they’re fertile), but in an overpopulated world, I applaud all G/L for mitigating the problem. xD … Can you guess who said this, in response to proposed homophobic legislation aimed at schoolteachers?:
“Whatever else it is, homosexuality is not a contagious disease like the measles. Prevailing scientific opinion is that an individual’s sexuality is determined at a very early age and that a child’s teachers do not really influence this.”
(answer at the end of the post; no fair looking it up!)
Whereas pedo, as you said, is pretty much a role-model, pass-the-hot-potato of abused children growing older and abusing children. (gross oversimplification, I know.) Regardless of ZPG, it’s the non-consensual nature that means that something is definitely wrong with the circuitry, not just evolutionarily, but both mentally and legally.
“Ah one reason I do so love this forum and why I want House to NEVER end–the types of intelligent convo I can have here”
Hmm… some of the posters here think the show should pass on peacefully in its sleep, rather than keep sliding downhill like an ingenue trying to play ingenues when she’s in her forties. (Or middle-aged men getting hair transplants, dying out the gray — equal-opportunity trasher here. :)
But if/when it is canceled, and you want to chat occasionally, I chose for this post’s (non-commercial) signature link a tribute to trans (-vestite, not -sexual. Transvestute?). Right after the copyright notice, there’s one of those reCaptcha thingys that will give my e-mail address. (Yeah, I know they’re a hemorrhoidal pain, but spambots are an even bigger PITA — not to be confused with PETA, or Pita bread, or gyros, or heroes (phonetically homophonic – you’re right, I’m tolerant; a closet homophone), or gyroscopes, or scopes used to diagnose — n/m, that’s enough of the runs for now.)
Please bare in mind (heh heh!) that all such parody is (or might be, wink) *fictional* — the number about boffing sheep is well into double digits by now. 8=))
@ All “Urine-drinking” commenters:
How soon we forget! South Pole lady in 4:11, “Frozen”.
“They have him taste her urine to see whether it is concentrated (suggesting a kidney problem) or dilute (suggesting a brain problem)” – Dr. S.
@ Headacheslayer The Solution:
Then-former-Governor and then-future-President Ronald Reagan, who was preparing to run for the office, and risked offending “conservatives”. Reagan was a true conservative, in the sense of conserving the values of the Constitution and the Dec of Independ, including “the pursuit of Happiness (sic)”, non-consensual excluded, of course.
Look up “Briggs Initiative” in Wikipedia. If you live in CA, that’s cheating lol.
btw, I appreciate being allowed to include in the sig one non-commercial link to my own original song parodies, and wouldn’t abuse that by putting two links in one post. So in some other post, I’ll work in the TTrashing of Citrus-Queen-turned-homophobic-activist Anita Bryant.
(or I’ve heard that there are these things called “search engines”, but n/m… )
xoxoxo –
TT
November 23rd, 2011 at 2:42 pm
new testing for syphilis is reverse from what was taught yrs ago.
EIA, a treponemal test comes BEFORE the RPR, if EIA positive an RPR, which is of course a non-trponemal test.
Even if the RPR is negative our lab automatically does a TPPA, another treponemal test, thus positive even if syphilis
has been treated or gone dormant’
. Check the algorhythm in one of last yrs. MMWRs. My question is…the kids shot to the pts groin ‘dislodges’ latent treponemes and stirs up the whole episode?
November 26th, 2011 at 10:38 am
first if I diagnose aplastic anemia, the first is bone marrow aspiration after CBC to know what cause the hell of that problem
2nd suddenly the aplastic anemia disappeared and just his liver is failing, known by pleural effusion which should first start with jaundice, as protein synthesis & amonia detoxification is a base function of the liver so if he goes into it (requires a large percent of the liver to be damaged before it appears), he has fulminant hepatic failure which requires liver transplant, no others would help him
3rd the pleural effusion is one of the very late (rarely seen) symptoms of liver failure, but a good symptom of other causes like pleursy, pneumonia, late heart failure, late renal failure
4th the allergic reaction doesn’t cause back pains as we were taught @ medical schools
5th proptosis doesn’t get like this fantasy, it’s avery slow process, even in angioneuritic edema, which should imclude swollen face, limbs, lips, and +_ effusion in the pleura, peritoneum and pericardium, and it’s some kind of allergy that need a search for what factor cause it, although pain uis not required for diagnosis
6th burkits lymphoma, where the hell is the tests for lymphoma, at least CBC, lymph node biopsy, CT abdomen & pelvis
7th syphilis, an old history disease, didn’t the boy ever get a sinusitis or upper RTI that involved giving him pencillins that would wash the dorminant infections, or even how the infection would stay that long in his CNS and didn’t cause any symptoms.
8th Jarish-Herxheimer reaction wouldn’t explains half his symptoms, the pancytopenia etc!
after all………….. this is like watching idiots talking about medicine, the worst medical practice i have ever found!
November 28th, 2011 at 3:32 am
@Changeling
Yes, syphilis in the latent stage can be activated by local tissue trauma.
@just a man
As noted earlier, syphilis is the disease par excellence for lurking without symptoms for decades.
Also, I gather from House’s explanation that the Jarisch-Herxheimer reaction was responsible for only the rapid worsening toward the end of the show (proptosis, multi-organ failure), after he was given antibiotics.
@Scott
It might be helpful to review not only what the medicine gets wrong, but also what it gets right — it’s kind of a teachable moment that might help readers, e.g. those who question the lurking ability of syphilis.
March 23rd, 2012 at 11:39 pm
?? The blow to the groin ‘released’ the spirochetes and caused the JH reaction?
The Jarisch Herxheimer is seen in people with EARLY Syphilis, esp those with high antibody titers.
Doesn’t make sense, but then I’m not an MD just an epidemiologist who has been dealing with Syphilis patients for 39 years.
Leave a Reply
Contact Me
About
Subscribe:
The Best Of...
Special Topics
Archives
Categories
Twitter
See Also
Comic Blogs
Medical/Science Blogs
Currently Reading
Arbitrarily Interesting Medical Condition
Syndrome
The Net:
Contents may have settled during shipping. Past results are no guarantee of future performance. No animals were harmed during the production of this product. Void where prohibited by law. All rights reserved. Not valid with other offers or specials. Professional driver on a closed track. Your financial institution may impose other fees. All models are over 18 years of age. Employees must wash hands before returning to work. Results not typical. Many suitcases look alike. 18% gratuity added to tables of six or more.
Do not taunt Happy Fun Ball.
© 2004-2012 Polite Dissent. Powered by WordPress