House — Episode 9 (Season 8): “Better Half”
An unfortunately average episode of House where the most interesting question is left unanswered.
Andres is a man with early onset Alzheimer’s disease. He is being evaluated for possible inclusion in a drug study when he develops bloody vomiting. He is admitted to Princeton-Plainsboro Hospital and assigned to House’s service. The team’s initial thought is that the patient has a gastrointestinal bleed which is causing the bloody emesis. An EGD (upper endoscopy) is performed and it shows a Mallory-Weiss tear (a rip in the esophagus of those who vomit frequently or forcefully), but that is a consequence of vomiting, not a cause. Andres is also noted to have elevated liver enzymes, and the diagnoses of gallbladder disease and steatohepatitis (fatty liver) are mentioned. House favors the latter and decides to start the patient on statins (a class of cholesterol drug as high cholesterol is almost always seen with steatohepatitis) and double check the liver (initially a biopsy, but overruled by Foreman to an ultrasound examination), but before they can perform the testing, Andres becomes more violent that ever, punching his wife, and requires sedation. At this time, the team also notices bloody urine. The differential diagnosis now consists of rhabdomyolysis (severe sudden muscle damage) and TTP (thrombotic thrombocytopenic purpura). House thinks TTP fits best, and orders Andres started on plasmapheresis.
Overnight, Andres elopes (the medical term for a patient, especially a demented one, who leaves the hospital). In the middle of a snowstorm, the team tracks him down to an old soccer field, but by the time they find him, he is hypothermic and pulseless. CPR is started, because, as Chase reminds Adams, they’re not dead until they’re warm and dead (sudden hypothermia can sometimes be protective of a patient, though this is more common in children than in adults, so it’s medical tradition not to declare someone dead until they’re back to normal temperature). Andres is brought back to the hospital, sent to the ICU, and started on extracorporeal warming of his blood. As he warms up, his brain function returns, then his heart. He’s initially in ventricular fibrillation, but he returns to a normal rhythm after some amiodarone (a medication used to suppress heart arrhythmias) and defibrillation. Unfortunately, he seems to have lost his ability to speak English and now only murmurs in Portuguese, his native language. He also develops a fever, but is this a symptom of his original admitting disease, or a consequence of being hypothermic? Looking over Andres’ symptoms, House sticks with the diagnosis of TTP and wants to resume plasmapherises. Foreman, instead, favors a viral infection that has spread to the brain to cause encephalitis. House relents, and has the patient started on interferon.
Andres is not doing any better. He falls back into ventricular fibrillation and this time requires three shocks to correct (apparently they neglected the amiodarone this time around). Foreman maintains it is a viral infection of the brain, such as encephalitis or meningitis, while House now favors toxin exposure. This week, it is Foreman who has the Eureka! moment while talking with some hospital donors. Seeing a flower bouquet still looking fresh despite being over a week old, he recalls that aspirin in the water can prolong the life of cut flowers, and this leads him to diagnose the patient with Reye’s syndrome. Some corticosteroids and Andres is back to normal (well, as normal as someone with early onset Alzheimer’s can be.)
Meanwhile, Wilson is treating a patient with a bladder infection (which he apparently diagnoses by palpating her neck). In the course of his discussion with her, he learns that she and her husband are self-proclaimed “asexuals”, completely disinterested in sex. House finds this head to believe and wagers $100 that he’ll find a medical cause for the lack of sex. He runs tests on the patient’s blood, but everything is normal. He eventually lures the husband in for an exam and discovers a pituitary tumor (a “macroprolactinoma“) that is suppressing the normal sexual urges. With some treatment, the high levels prolactin can be treated and the patient’s symptoms (in this case his nonexistent sex drive) corrected.
As usual, major complaints are in red (red caduceus), modest complaints are in blue (blue Vicodin), and nit-picking ones in green (green pencils):
Pet peeve here: Defibrillation does not “shock the heart back into rhythm.” The shock from defibrillation momentarily stops the conduction of the arrhythmia, allowing (hopefully) a normal rhythm to take over. The shock itself does not “jump start” the heart or start the normal rhythm, it just stops the bad rhythm — an important distinction.
TTP (thrombotic thrombocytopenic purpura) -– none of three parts (the T, T, or P) fits. There was no mention of low platelets (though other lab abnormalities were mentioned), no clotting, and no purpura. (In fact, there was no mention of rash at all, and rash is almost always seen in Reye’s).
In regards to his symptoms, Reye’s syndrome is quite a stretch with few of Andres symptoms matching well, but then again, Reye’s in adults is quite a stretch in-and-of-itself.
Symptoms of death in the hypothermic do not resolve that predictably (“Ah, 93 degrees, must be time for the ventricular fibrillation”), and frankly, the patient usually remains dead.
Interferon is not a treatment for encephalitis or meningitis.
Cortciosteroids are used in Reye’s to treat swelling of the brain — something they never bothered to look for, despite the more-than-expected behavioral changes.
Third episode so far this season where there is debate whether societally atypical behaviors are symptoms or not. Charity, paranoia, and now aggression.
Before starting statins in a patient with elevated liver enzymes, I’d want to make sure the cholesterol is indeed high and require treatment, as the statins themselves can elevate liver functions.
While there is debate over the use of “chemical restraints” (sedation in aggressive patients), diazepam is unusual for a first line agent. Haldol seems the more common choice. On the other hand, diazepam can be more easily reversed if something goes wrong.
The medical mystery this week was OK, but not great — but that still makes it better than most episodes this season. The big mystery was why Andres developed Alzheimer’s so young, but answering that was outside the scope of the episode. I give the medical mystery a C+. The final solution kind of more or less fit, if you ignored the usual time course of Reye’s Syndrome. I give it another C+. The medicine was uninspiring this week, with diagnoses thrown around that could be easily tested, but never were. Plus Foreman, a neurologist, was using meningitis and encephalitis interchangeably. I give the overall medicine a C. The soap opera was enjoyable this week from the pathos (Chase), to the humorous (the yellow cards, Park and her “tapping”), to the unethical (House and Wilson). It deserves an A-. (Bonus points for the Spider-Man allusion. And what manga was House reading when first talking to Wilson? Maybe someone should tell him they’re read right-to-left, not left-to-right.)
The review of the previous episode of House
A list of all prior House reviews
January 23rd, 2012 at 11:23 pm
I assumed the interferon was directed at the viruses that were thought to be causing meningoencephalitis. Also, statins were directed at the fatty liver, not as hypocholesterolemic therapy. I found this abstract, for example:
http://www.ncbi.nlm.nih.gov/pubmed/21986643
Can you clarify the reasons that adult Reye’s is a stretch? Adults certainly do get Reye’s, and they get elevated ammonia and vomiting (which caused the Mallory-Weiss tear) and encephalopathy (e.g. mental status changes and degradation of language). I have to think more about the urine thing. That may not fit.
I disagree on your “rhythm” peeve. “Rhythm” is often used in the sense of a “hemodynamically effective rhythm.”
January 23rd, 2012 at 11:44 pm
I loved the soap opera this week. I expected House to have something up his sleeve to get his bracelet off though, it kind of died at the end there.
As far as the medicine, I’m a little confused on one thing. If he was laying in the snow with no pulse for god knows how long, then why wasn’t there brain damage? I thought even a few minutes of the heart not beating deprived oxygen enough to cause permanent damage.
January 23rd, 2012 at 11:53 pm
@BigBlueBear – Hypothermia can often be neuroprotective, so that the brain doesn’t suffer the major effects of oxygen deprivation (most hospitals have a ‘Hypothermia Protocol’ for people who go into cardiac arrest, though you’re right in that usually these people still have some neurological deficits)
As a complete aside, did Chase put ultrasound gel on the paddles before shocking the guy the first time? I could have sworn that’s what I say.
January 24th, 2012 at 12:09 am
Google CHEMICAL RESTRAINTS and the second hit is an emedicine article that lists benzos first among possible medications:
http://emedicine.medscape.com/article/109717-overview#aw2aab6b4
One of the shorter acting versions might have been better. Maybe they thought he was DTing?
January 24th, 2012 at 12:10 am
At normal temperatures, brain damage quickly occurs. When the body’s temperature is lowered, metabolism slows down enough for damage to be limited and proper reanimation can lead to survival, especially for younger patients.
Yes – this was an average episode but after over a month, a new show is still welcome. Foreman and House backbiting added some spice. Will it ever be resolved? The tension with Cuddy never was, so I guess not. This definitely feels like the start of the last season, wouldn’t you say?
January 24th, 2012 at 12:38 am
This woman lived with her medically asexual husband for 10 years and never strayed…no dude has ever been that lucky in real life
January 24th, 2012 at 1:52 am
You know what, guys? At this point even the most die-hard House fan has to start admitting the truth: this show is finished. I caught the House marathon last Friday night on Oxygen and the re-run episodes they aired from Season 2 made tonight’s House seem like a completely different show. This series was at its absolute peak during the first 3 seasons (2004-2007) in terms of both writing quality and ratings. There was just something special about this show during the early years that made it stand out so much and today the episodes are barely mediocre. Cuddy leaving last year was the last straw for me. Can’t wait for Seasons 1-3 to finally hit Blu-ray but that’s it, after giving tonight’s episode a try, no more House for me.
January 24th, 2012 at 4:37 am
Just wanna say that I enjoy reading your analysis of the episodes each week as much as watching the actual episodes…
January 24th, 2012 at 6:28 am
[...] for a more thorough recap of Better Half, check out the California Literary Review, while Polite Dissent have a very good review, including some in-depth debunking of the medical [...]
January 24th, 2012 at 7:14 am
I’m not a doctor so I wanted to ask something. Aren’t antiemetics for nausea? The guy was vomiting blood (which shouldn’t be caused by nausea, right?). In that case, wouldn’t it be entirely useless to treat with antiemetics?
January 24th, 2012 at 8:21 am
That explains the husband, but what about the wife?
Or are we just to assume that she is normal, but that there is no way a) a man wouldn’t be interested in sex, or b) would acceed to his wife’s opinion in the matter?
January 24th, 2012 at 8:32 am
Who is Susie Cooper?
How does showing an old newspaper in a photo prove the picture was taken before a certain date?
January 24th, 2012 at 8:52 am
So wait… he resolves that it’s a medical problem for the man to be disinterested in sex and yet it’s perfectly fine for the woman? Either I’m missing some subtext (with her having her neck palpated because she does want it and isn’t getting it) or we’re hitting that nasty double standard where society suggests women shouldn’t want sex and men always should.
January 24th, 2012 at 9:05 am
JB I think Susie Cooper was just the “name of the week” that House pulled out of his, um, hat ;)
And the photo of a newspaper would mean a certain date–usually seen in kidnapping schemes (therefore “proving” that a victim is still alive at that date on the newspaper). But of course House could have grabbed an old paper and taken the shot only hours before–typical Houseian behaviour ;)
I loved this episode…..and what’s WEIRD is that while in one of my nights of pain/insomnia (when I like to “write” House fanfic in my head to distract me) I came up with adult Reye’s Syndrome for the patient. Too bad I didn’t put it on my list!
I did feel a few “old vibes”–like the issue with Chase and the wife having a boyfriend….Didn’t 13 say nearly the same thing to him, that she hoped whomever she was with when she was dying had someone to lean on? Since her father had done the same when her mother was dying of Huntington’s.
Where was Taub? *pout*
Loved all the House/Wilson rapport as usual. They sure do keep teasing all the Hilson fans tho! lol
January 24th, 2012 at 9:11 am
JB: Susie Cooper must be a first love or life-lesson person in House’s past. Assuming this because Susie Cooper sounds like a name you’d use in Jr. High. He’s saying that he learned that having sex with a boring person (Susie) is, well, just boring. I’m guessing even Wilson might not have heard the name before but, knowing House so well, picked up on the reference almost immediately…
Showing an old newspaper in a photo doesn’t –prove– anything, that’s why it’s funny.
Uncle Ron
January 24th, 2012 at 9:16 am
The manga reads バッドメディスン which is the phonetic equivalent of “Bad Medicine”. Volume 9, and the subtitle is 「食べて」which means “eat” given as an order (or probably in this case “eat me” with a sexual connotation which makes sense given the context of their conversation)
Frantically Googled every possible combination of the above strings but got nothing… Too bad because I too am very curious.
January 24th, 2012 at 10:11 am
Your first blue Vicodin said that Reye’s was a stretch for adults. Funny thing is, House said that too.
January 24th, 2012 at 10:52 am
Language nitpicking: “Andres Taveres” is not a brazilian name, “André Tavares” would be the common form. “Me sinto quente” is a direct translation of “I’m feeling hot” but it’s not how a brazilian would say it “estou com calor” would be the normal translation. “Barraco Azul” does translate as blue shack. But in brazil the word “barraco” denotes a shanty town house, not a shack as a garden or tool shack. That would be translated as “Casinha Azul” (little blue house). And Mr Ivo Nandi has a TERRIBLE accent.
January 24th, 2012 at 11:35 am
“The big mystery was why Andres developed Alzheimer’s so young … ”
I believe the explanation given at the beginning of the episode was that Andres had early-onset familial Alzheimer’s, but I am not sure if that really answers the question or not.
January 24th, 2012 at 11:41 am
I had a pituitary adenoma removed and still have high prolactin. I have zero interest in sex. No one ever told me why. I would like to know what the treatment was that was suppose to give this guy his sex drive back. Then I will have a few words with my endocrinologist.
January 24th, 2012 at 12:52 pm
I was hoping that House would prove that the Alzheimer diagnosis was wrong, and that some other disease was responsible for all of his symptoms, including his early onset dementia.
I think they missed a huge story opportunity there.
January 24th, 2012 at 1:08 pm
@juan, I dont know, I feel like they always go down this road and this was a nice change.
January 24th, 2012 at 1:46 pm
I’m fairly sure “Susie Cooper” has shown up (in the same context) before this episode.
January 24th, 2012 at 1:49 pm
@David Oakes & Sean Duggan
The wife’s (presumed) asexuality was actually quite well explained – she wasn’t, in fact, asexual, just pretended to be because she was in love with the guy. It’s all in her acting – she’s clearly relieved when she hears the news, she practically admits she had sex before and calls the experience “pretty fun”, and she even said something along the lines of “I know being with you would mean certain sacrifices”.
January 24th, 2012 at 2:36 pm
@jason m, you’re right, perhaps it would have been too obvious. I was thinking that way because I’ve heard it said that the only way to definitively diagnose Alzheimer’s is via an autopsy. (I don’t know if it is true or not).
January 24th, 2012 at 3:38 pm
Some internationalized magna’s can be changed to read left to right.
January 24th, 2012 at 5:46 pm
Where’s Tommy T? I’ve been waiting for his didactic diatribe on asexuality and/or the systematic euthanization (is that a word?) of rich family members at the first sign of drool on their chins.
January 24th, 2012 at 7:02 pm
@ChefSotero actually his accent was a spot on brazilian accent as was were the senteces he used.
The forms you told on the other hand were how a Portuguese would speak but not a brazilian.
I assume you study portuguese but are not a native speaker so congrats mate :)
January 24th, 2012 at 9:30 pm
Well, well… well. I think I can definitively say that this episode was probably the best one of the season, not for the medicine but actually for the character dynamics.
It was good to see some quality screen time for Wilson, and even though he lost the bet (as usual) he gained insight in to his character which is something we dont get to see Wilson do a lot of.
Chase feeling remorse at being disconnected for so long from what family he las left (his sister) was compelling, it was good to see him realize that especially after him saying that he’d want to kill himself instead of seeing himself as a burgen to those around him..
POTW, who cares? It’s boring medicine. The wife of sick guy cheats on sick guy with wife’s close male “friend”… been there done that in too many episodes already, ‘CMON writers you can do better that….can’t you?
If this season runs the full 22 episodes, we are almost half way through what is presumably the last one for House, so what does everyone here think should happen in the last half of the season to prep for the end?
January 24th, 2012 at 11:06 pm
@Juan, re autopsy as the only true diagnosis of Alzheimer’s, that used to be the case. Absolute confirmation is possible only with an autopsy. But diagnostic procedures have improved enough that many competing explanations for dementia can be eliminated, and brain scans can show plaques that are characteristic of Alzheimer’s. See alz.org. (I’m not a medical professional, so any misstatement here is my own.)
I’m beginning to get the sense that the show is going to end with House’s suicide or murder. I hope I am wrong, but something in passing last night made me think so — and I can’t put my finger on what it was. I heard Pink Floyd’s “Comfortably Numb” on the radio today, and I think that’s where House is headed. I imagine his death scene where he smiles and says, “The pain — it’s gone,” then he dies.
If they do kill off the character, I would prefer the method to be murder and not suicide. I’m against any romanticizing of suicide.
January 24th, 2012 at 11:51 pm
Googling says Susie Cooper was an early-20th Century ceramicist at the art deco Clarice Cliff pottery and elsewhere including her own workshop. [Actually, just checking now, the lady lived from 1902-1995]
I’ll have to re-watch the episode to see if it means anything special in context. Or maybe it has something to do with Hugh Laurie like he’s a big collector so they’re using it as an old flame’s name as an inside joke.
And I agree with Juan that I thought the Alzheimer’s was going to turn out to be a misdiagnosis with the “real” solution explaining it away.
January 24th, 2012 at 11:55 pm
Not that I want it to happen but Sherlock Holmes retired to become a rural beekeeper once he tired of being a consulting detective.
January 25th, 2012 at 12:44 am
@Evilbanana, nope, native brazilian. Born and raised in Rio de Janeiro, and my english can get messed up but i’m preatty confident with my brazilian portuguese skills. U are a portuguese student or a native speaker?
January 25th, 2012 at 2:32 am
I thought Foreman should have been more freaked out with the fact that the patient had escaped. After all, the hospital was liable if he died.
January 25th, 2012 at 4:07 am
Coincidentally, I was in for my first aid refresher course today, and one of the instructor’s pet peeves was how TV shows have created the myth that you shock a flatline. Then he said the only time you might bring someone back from a flatline was if they had been deeply hypothermic.
Maybe this episode deserves credit for pointing out that they *weren’t* shocking a flatline? The message is getting through!
January 25th, 2012 at 9:01 am
Do I remember wrong, or did Foreman say something about the patient overdozing on aspirins (Since he forgets he takes them)? In that case, wouldn’t the wife notice?
January 25th, 2012 at 9:34 am
@ChefSotero, another Brazilian here and I have the same issues that you had with his Portuguese…. all the sentences sounded a bit off and the accent was really weird.
January 25th, 2012 at 10:21 am
Another Brazilian agreeing with ChefSotero and Sizi.
January 25th, 2012 at 11:57 am
As an admitted Phineas & Ferb watcher, I can’t believe you didn’t mention the “Dr. Blackenshmertz” comment.
January 25th, 2012 at 12:08 pm
Hello Again! Missed me? I bet at least few of the regulars on this forum will sigh: “Ah him again! Damn…” Well after a life changing decision and switching to another country of living and after few erratic months of settling in and getting adjusted to the fact that my English is completely un-comprehensible to most of the so called “Englishmen” in Lankashire UK I am back with vengeance. So is House! Yepeeee! Francly I do not know why so many people (including our host) did not like this episode. At least from soapy point of view it had everything (Exept Taub…. Gash I miss the tiny pipsquick :) I’ll rate the soap opera with A- exactly because Taub was not here. Otherwise it would have been an A+ because:
1. Foreman was on the butt of the joke for most of the episode
2. We heard crazy remarks about sex from the least expected direction – I sort of though Kato was a virgin :)
3. Chase stunned Self Assured Lady into silence (it was about time!)
4. Wilson put himself into a silly situation and was all over the place looking funnier than ever
5. Last but by no means least – We had a long elaborated clinic plot with sort of unexpected outcome that was a happy ending of a sort and was hilarious (It is quite fun! From what I can ahem remember…. Come on I love you but girls have needs)
Let us nitpick the medicine a little bit this week:
1. Reyes syndrome should START with fever and rash. Not end with them. Overall most of the symptoms fit but timing and coherence is patchy
2. I am actually quite surprised they never questioned the “Alzheimer” I was convinced the known disease would turn out to be a symptom of an underlying condition. Too bad cause they never explained why his mental symptoms worsened and he punched his wife. What caused that?
3. How exactly he managed to get to the aspirin? Was he drinking water from vases? His wife gave it to him for his trout but never mentioned it to his doctors…. talk about blurry explanation.
4. He was in the hospital for 3 days with no contact with the aspirin. I am pretty sure that even without treatment his symptoms should be subsiding not worsening
5. I am pretty sure patients with hypothermia should be in ICU not just in a quiet room with two doctors casually chatting by their side
6. Hypothermia is usually lethal (but hey this is House. At least they do not do that annoying greys anatomy thing where every impossible patients gets better and walks into the sunset…)
My grades would be D+ for the mystery (how many times have we seen gushing blood from the mouth as a first symptom? I can recall at least 5 just in the last 2 seasons.) C+ for the solution (OK may be B- it fitted more or less) and B for the medicine ( for once they were testing before or at least simultaneously with treatment)
House is back! Hurray! TTFM for now and special regards to Epic Bitchery – I have not forgotten you sweet pea it just tiss soddin wedar is makin me sad. I’ll write you ASAP. Cheers!
January 25th, 2012 at 12:42 pm
Silly complaint, but I’m tired of them pretending House has such amazing language skills when Hugh Laurie’s pronunciation of all these languages is so awful. His Chinese is just ridiculous, as was that of a POTW earlier in the season. (FWIW, Emily Deschanel of Bones has easily the best fake Chinese of any TV show I’ve seen, good enough that I suspect she’s taken classes.)
Anyway, it doesn’t really detract from the show, but it is a bit grating. I don’t know Portuguese, but I could tell Mr. Laurie’s Portuguese was bad as well (because it was all English phonemes). And from the comments here, I take it Ivo Nandi is not a speaker of the language, either.
January 25th, 2012 at 1:21 pm
I think there is a typo in the post; it says, “House finds this head to believe and wagers $100″ – should be *hard* to believe?
January 25th, 2012 at 5:47 pm
I want to see House with Stacy at the end. Or Wilson. No death please :X
January 25th, 2012 at 5:48 pm
Scott, you are right to question diazepam. I would never give that to an agitated patient with dementia. Patients with dementia are very vulnerable to delirium and in fact he is clearly already delirious, which is what is making him agitated! You know, like the classic scenario — pleasant old lady/man with a touch o’ the Alzheimer’s, gets a little UTI and becomes a holy terror. A benzodiazepine is going to worsen any delirium (unless it happens that he is in alcohol withdrawal delirium, aka delirium tremens, then it will help). Haloperidol, as Scott suggests, is a better choice. You could give it IV or IM. If for whatever reason you are committed to giving a benzo, why give such a long-acting agent for acute agitation? Go with lorazepam. You can give that IV or IM too.
January 25th, 2012 at 6:12 pm
Having watched it again in context it looks like House was working on the asexual couple problem when he first mentioned having “to forget how boring Susie Cooper is” when he was with the ladies going over the asexual couple’s tests.
Then when he figures out that a brain tumour is causing the husband’s lack of libido and that the wife is just going along with the asexuality out of loyalty/love or whatever, he says giving him the drug treatment will get him back to being sex-crazed like the rest of us “completely fascinated by Susie Cooper.”
So I think it was either a reference to the wife pretending to be interested in her husband’s supposed asexuality hoping he’d change (or she’d change him) or the husband becoming once again like every other guy who will pretend interest in something that bores him (like art deco chinaware) to get laid.
I liked the “Cuddy Dark” shot at Foreman alot too.
January 25th, 2012 at 7:39 pm
Aw, shite, Dr. Bulgaria; yer turnin’ into a righteous tight-arsed Brit, aintja?
January 25th, 2012 at 9:55 pm
Agree with ChefSotero, Sizi and ninguem that Nandi’s accent wasn’t pure Brazilian. More a mix of Brazil and Portugal. Great acting, though.
Re. “Third episode so far this season where there is debate whether societally atypical behaviors are symptoms or not. Charity, paranoia, and now aggression,” add a fourth behavior to this episode — chastity.
January 26th, 2012 at 2:27 am
@ChefSotero @Lena Indeed it wasn’t the best translation or accent but let’s face it, compared to House speaking “oh kay ay ess-oh?” instead of “o que é isso?” it was amazing! xD
And it’s not exactly chastity right? I guess Wilson outright said “we proved assexuality doesn’t exists”. Yes he said as a joke but just considering also the portrayal of DID or mixing up “schizoid” and “schizophrenia” in the last episodes… I mean House always underplayed any kind of psychology as a byproduct of medicine but in this season it’s despite over that field is reaching epic levels…
January 26th, 2012 at 1:35 pm
Regarding the detective apects of the show, some peeves:
1. Did they really know POTW had escaped the hospital? Was a thorough search conducted? How did he get past security? Does none of the staff know anything? When something like that happens, you don’t start with abstract theories (and even moreso – act on them to the exclusion of everything else), you start with basics and eliminate possibilities. This speaks to House’s presumed investigative expertise, which has always bothered me because more often than not House betrays some pretty foolish premeses that wouldn’t fly in the real world. Yet he’s always the ‘go-to’ guy …. nonsense, get somebody in there who really knows what’s going on, not someone full of assumptions and biases like House. Let him do the doctoring, and let investigators do the investigating. I imagine the director of security at the hospital would be better qualified to run that operation. (Plus, it’s, you know, his job, not House’s.)
2. Did no no one notice that POTW was gone before Chase and the wife got there in the morning? I would think the search would have been on long before they showed up … presumably when the guy was first found absent during nurse’s rounds? I find it hard to believe that a “double code” or whatever Foreman said had happened during the night would mean that all other patients get completely ignored for hours. The liability would be staggering.
3. It was snowing. Follow the guy’s tracks to his hiding place rather than try to deduce where he was most likely to go at the soccer field. (Assuming they should have been there at all.)
4. Did POTW know exactly where he was at PPTH? How would he know where the soccer field was, even if it was near, and its orientation as relates to the hospital? Pretty immpressive for someone with cognitive issues.
In the real world, POTW would never have been at the soccer field and Foreman/House would look like idiots for sending doctors and paramedics on a wild goose chase when they could have been put to much better use.
Re: the end of the series, I had always supected House would go out via suicide, but not so much anymore. For one thing, that’s been done already (Kutner). For another, House seems comparatively well-together now. Apparently being in jail, near-murdered, on and off vocodin, and losing the love of his life isn’t enough to throw him off … not sure much else could.
That leaves House to just ride off into the sunset, which no matter how you look at it sounds kind of lame.
IMO, season 5 was the real end of the show. House’s admission to the Psychaitric hospital should have been his fate and the last we heard of him.
January 26th, 2012 at 2:11 pm
I be tryin me best not ta lassie but hay tis kin’a fun here. And nay Englishmen are not Gay (except Mr Fry o’course) and English lassies be hot they be :) At least some’othem
January 26th, 2012 at 2:36 pm
Not only an ademona in the hypophysis causes hyperprolactinemia. The is also the thyroid gland in discussion
January 26th, 2012 at 2:46 pm
[...] [...]
January 26th, 2012 at 7:55 pm
“Third episode so far this season where there is debate whether societally atypical behaviors are symptoms or not. Charity, paranoia, and now aggression.”
I think you mean asexuality, not aggression. I don’t recall much discussion about the aggression other than “paranoid rage is a normal symptom of Alzheimer’s” or something of that nature.
January 27th, 2012 at 1:54 am
@Bulgaria-in-Britain
> 1. Reyes syndrome should START with fever and rash. Not end with them.
You have made this mistake before. You must be humble in the face of medical disease. All cases do not follow the textbook course. I’ll bet you $857 million that there have been cases where fever and rash occur late.
> they never explained why his mental symptoms worsened and he punched his wife. What caused that?
CNS involvement of Reye syndrome.
> Was he drinking water from vases?
That was implied.
> never mentioned it to his doctors
Of course not: he had Alzheimer disease and would not remember taking the aspirin.
> 4. He was in the hospital for 3 days with no contact with the aspirin. I am pretty
> sure that even without treatment his symptoms should be subsiding not worsening
No. Once Reye syndrome is launched, you’re pretty much hosed. One thing I didn’t look up: does aspirin trigger Reye in adults, or just in children?
January 27th, 2012 at 2:00 am
@ Lumbergh
I forgot how the patient was dressed when they found him. If he was wearing street clothes, he could have easily walked out of the hospital.
A just-fallen snow would not show footprints.
( I like reviewing the reviewers. :-)
January 27th, 2012 at 5:21 am
“head to believe”?
January 27th, 2012 at 5:43 am
@pseudonomian: the POTW should have had a perfect Brazilian accent, however House having a horrible one isn’t so strange, and in fact it’s pretty common especially if you never live in the country (my written English is pretty good, but the way I speak has provoked open laughter).
This episode pissed me off big time for the “asexuals are just sick or faking” undertones.
January 27th, 2012 at 7:55 am
Usually I am two days late, lots longer this time. well…
rotrightelf asked above, and will probably never see this reply. Nor am I in the medical professions. But I am a patient. Anyhoo, aspirin overdose has the side-effect of nausea, including vomiting, and even normal dosage can cause bleeding in the stomach/digestive system.
Someone else asked how he got aspirin, did he have to drink from the wife’s vases of flowers: oh come now. There would be aspirin around even if she was not a florist who occasionally used it for plants – and who notices if there are ten fewer aspirin than expected of a bottle of 500?
January 27th, 2012 at 12:07 pm
Official Comment
Macaco,
No, I meant aggression. Andres was showing a sudden increase in aggression, so the team was debating whether it was what was expected in Alzheimer’s or something more. As others have pointed out, I did forget the asexuality, which would have been case #4.
CalendarDog,
There is the same association between aspirin, viral infections, and Reye’s in adults as in children. From my understanding, the warning to avoid aspirin with viral infections is given in regards to children because Reye’s is worse in children (also, I suspect because children is where you usually see Chicken Pox, a virus that seems to have more of an association with Reye’s. Hopefully a thing of the past with varicella vaccines now.)
January 27th, 2012 at 12:21 pm
He wasn’t drinking the vase water. Alzheimer’s didn’t turn him into a dog. The wife kept a supply of aspirin for her flowers probably in a normal aspirin bottle. He felt sick and took aspirin because he remembered that aspirin is something you take when you’re sick. He felt sick and took aspirin because he remembered that aspirin is something you take when you’re sick –forgetting that he’d already taken some. He felt sick and took aspirin because he remembered that aspirin is something you take when you’re sick –forgetting that he’d already taken some. Etc, etc.
January 27th, 2012 at 12:26 pm
@Calendar DOg
The thing with the aspirin in vase water was poorly explained. I was left with the impression that he took the aspirin for his sore throat and that may be his wife gave it to him. Then SHE forgot to mention it to the doctors. The other explanation was that he was drinking water from the vases because he had a sore throat. That makes even less sense. Alzheimer does not equal crazy – he needs some rational justification to suddenly start drinking vase water. Again it was left fuzzy to me
Progression of symptoms – I agree that rash and fever could be present at later stages of Reyes. And we are talking about House where deceases usually are unusual. The problem I have with time course is this – the writers when trying to invent a medical mystery are taking the whole batch of symptoms and then adjusting their timing and appearance in accordance with the plot they have in mind. They have been doing that from 3-4 seasons now and that is patchy writing.
Aspirin in conjunction with certain viruses can cause Reyes in Adults as well as children – that much we know. However the absence of aspirin and the fact that the patient is in a hospital setting where he is being pumped with fluids and his vitals are constantly monitored means that he should at least not worsen even if he does not heal by itself. Another usual thing they do in House – Pt had the problem for years but the moment he is admitted his symptoms steamroll into the red zone :) TV man ….
January 27th, 2012 at 10:23 pm
Ah yes, Hibbleton’s explanation of the aspirin ingestion is perfectly reasonable and must be true.
Thanks, Scott+Bulgaria, for clarifying the role of aspirin in adult Reye’s. But withdrawing aspirin and giving fluids and monitoring vitals will not cause improvement in Reye’s. If anything, fluids could worsen cerebral edema. Also, Reye’s is an acute problem, not chronic.
I don’t have a problem with the House writers designing a plot that maximizes entertainment value at the expense of lowered probabilities (as long as the probabilities remain above zero). Consider the alternative: If the diseases ran their typical course, the genius doctors could not be forgiven for failing to make the diagnosis until the end of the show!
January 28th, 2012 at 3:17 am
@Callendar Dog. You would actually be surprised how often a disease is following her usual course but the doctors have trouble figuring it out genius or not. Of course I am only talking about my field here and diagnosing correctly a tooth/mouth problem is not so hard as diagnosing a hidden cause for cardiomiopathy for example. Unfortunately as most Doctors here would agree with me it is usually the patients that provide the necessary distraction to send the doctor on the wrong way. Just yesteday I was dealing with this guy who stubbornly claimed that the problem was on the upper jaw even thought I was seeing the inflamation aroud his lower wisdom tooth. His complaint was: “I have trouble chewing and cannot open my mouth” After some treatment the inflamation was resolved and then the real problem reared it;s head – he had a cracked tooth on the upper jaw that has been hurting him for awhile but he failed to mention it untill the tooth actually cracked. He said: “that was minor and was going on for months so I thought it is not important. Final diagnosis – thrysmus (inability) to open mouth – was due to the wisdom tooth while inability to chew was due to the cracked tooth one AND partially to the wisdom as well. Pt was insisting to leave the wisodm there as This has nothing to do with my problems you just want to pull my tooth. I guess my example isn’t the perfect outlining of the problem but it is that: Full history the questions you have to ask plus the questions you want to ask even if they appear irrelevant at the moment. Ahhh if House and his team were doing some history taking as they suppose to the show would have to close by the end of season 4 :)
January 28th, 2012 at 3:25 am
@Hibbleton – your explanation makes perfect sense. This must be it. Unfortunately that gives me the ammo for some more bitching:
1. Loving caring wife leaves a bottle of Aspirin unattended while stashing all the other meds so carefully? What a moron. Either that or not so loving caring one :)
2. Remember Foreman desparately trying to play the Boss? “No! You no go to Pt House as we ALWAYS do as I did a million times! Treat my way instead. ” Why did House just push his pencil cup instead of sticking it in Foreman’s face – I was actually right it was a toxin (sort of) and if we went to the House we would have resolved the issue yesterday. 10x for the ankle bracelet but U stupid man! Seems the writers just needed the angle where Foreman is the hero but that was lousily played
January 28th, 2012 at 11:29 am
Seriously. Is it that hard to believe in asexuality? Sex is not a basic need like sleeping, breathing and having food and water. Maslow was wrong, IMHO.
January 28th, 2012 at 5:01 pm
> You would actually be surprised how often a disease
> is following her usual course but the doctors have
> trouble figuring it out genius or not.
No, I wouldn’t be surprised.
January 28th, 2012 at 5:05 pm
What’s the big deal about the accent? It’s about him having some knowledge about the language not his perfect accent. It wouldn’t bother me if someone spoke English that I could barely understand if he knows how to speak four others. Hell I can’t understand half the people in the US and I live here. It’s a TV show. They shoot an episode a day. Do you know how many months it takes to shoot 45 minutes of a movie?
(Gotta admit though it is kinda interesting. I couldn’t understand spanish from Spain. I learned latin American spanish)
January 28th, 2012 at 5:07 pm
I meant episode a week..kinda messed up the flow of my overreactionary rant…
January 28th, 2012 at 8:50 pm
Robbie: When thousands of years of evolution has been dependent on keeping organisms sexually active to propagate their species past the first generation… yes.
Not to say it’s impossible, just saying that it’d be rare and unbelievable to find one, despite it existing.
January 28th, 2012 at 11:05 pm
@ Poor, Sweet, WRONG-Headed Robbie: God gave us Sleep, Golf, Sex, Rock ‘n Roll and Cheesecake, all of which are necessary for the successful evolution of Man.
January 29th, 2012 at 9:06 am
Ashton: Homosexuals can’t reproduce with their mates. So why do they exist despite the thousands of years of evolution?
Impossible made possible. Nice to meet you, folks. I’m Robbie and I’m asexual.
Why is Dr. House not in jail? Didn’t he almost kill Cuddy and the folks by driving through the wall of her house? Are they still letting him to be a doctor??? That’s insane.
January 29th, 2012 at 10:54 pm
Robbie: There are billions of humans. Genetic variation can cause those things. 0.1% of a billion is still a number that ranges in the millions. I think there have been records of animals being homosexual due to hormone or genetic causes. Like I said, it’s not impossible, but it’s exceedingly rare considering the circumstances of evolution.
For your other questions, see the first few episodes of the season.
January 30th, 2012 at 5:45 am
@Robbie, hi :)
The same argument could be made for straight people who are infertile.
I’m the resident bi (someone had to take over for 13). So I am definitely not one to judge. If you’re happy–then that’s what matters! I may not understand it but that doesn’t mean asexuality doesn’t exist.
I take it back….actually I do understand it to a degree. With my health problems and medication I rarely have any interest. But I know that mine is due to those reasons whereas yours is your nature.
House was let out to work on a case thanks to Foreman. Cuddy et al were in another room. He didn’t fight to stay out of jail so perhaps the medical board decided to be lenient? It can be scary how the AMA police their own.
January 30th, 2012 at 5:43 pm
Maybe asexuality is on the rise due to population expansion. Evolutionarily, it would make sense to try and control populations biologically, and this would be a way to do that, along with homosexuality. Or maybe it’s the fact that many folks have computers, iPhones, DVDs, etc etc that they find more interesting playmates than their former beloveds. Hard to tell.
There was a new episode of House on this week?
Dr. Bulgaria, you think it rains a lot in GB? Try living in the pacific NW in fall and winter. My sunglasses are hibernating!
January 31st, 2012 at 4:50 pm
@Robbie: The gay argument is actually extremely stupid dude. Gay people are sexually active :) different style but same drive. Considering that sexuality (in humans!) as House shrewdly pointed out is dependent on certain hormon levels asexuality is technically a disease. Well not a disease per se but at least an abnormality like the cross bite. And since cross bite can be treated with braces why not go check with a doctor if there isn’t something not quite there with you? I’m not saying a tumor in the brain (that’s House and it’s also TV) But may be there is something fixable and you are missing a whole lot of fun for nothing :) On a side note before you start acting offended – sexuality is not the kind of dependency like drugs or cigarettes. It is scientifically proven that people with regular normal sex life live longer. It’s healthy so missing on it is not just sad it’s bad for your life. You do not NEED it it;s just good for you even from a physiological point of view if we drop the philosophical one.
February 1st, 2012 at 9:01 am
This article from Salon discusses the episode.
http://www.salon.com/2012/01/31/house_gets_asexuality_wrong/?source=newsletter
February 1st, 2012 at 9:29 pm
D-r Bulgaria:
There’s nothing “stupid” about the analogy of gay people. Homosexuality is also “abnormal”. It also couldn’t have evolved naturally. Whatever mechanism in humans normally points people’s attraction toward the opposite sex is “broken” in them. Whatever mechanism in humans normally creates people’s attraction in the first place is “broken” in us asexuals. You should ask yourself why you’ve decided that homosexuality is normal and asexuality is a disease.
Regarding “why not check with a doctor”, you’re assuming that if someone is asexual, then they must not have ever been to a doctor, because surely a doctor would have “cured” them. This is an extremely stupid assumption on your part. Of course I’ve been to a doctor. I’m not an idiot. There was nothing wrong with me.
As for “missing a whole lot of fun”, HA! You don’t fool me! I have Facebook. I read my friends’ updates. I know what having a sex drive is like. It’s horrible. It’s a few tiny, brief moments of pleasure that requires an enormous expenditure of effort and a huge amount of sacrifice, all the time. Relationships are the #1 thing that makes everyone I know miserable. Nobody really thinks it’s worth it, and you probably don’t either. You want to believe asexuals don’t exist because you don’t want to have to accept that some people don’t suffer as much as you.
FInally: “On a side note before you start acting offended – sexuality is not the kind of dependency like drugs or cigarettes.” The fact that you imply that we are offended because of some weird hangup or belief about “dependencies” or something proves that you don’t get it. Asexuality is not some kind of psychological problem. It’s just the way I am. I’m not offended because you’re saying I “need” something and I “don’t want to need things” or whatever, I’m offended because you’re accusing me of being either a liar or a disease.
February 1st, 2012 at 9:29 pm
And for anyone who doesn’t think shows like this help encourage people’s prejudices against asexuals, just read D-r Bulgaria’s comment above.
February 3rd, 2012 at 3:34 am
I just can’t excuse a number of the oddities in relation the pt’s hypothermic cardiac arrest (I mean I know its TV and we shock flat lines, well dressed 23 year old models are leading consultants and we all do terrible compressions because the actors we’re doing them on probably don’t want a # sternum, but seeing as though we’re all banging on about it).
1. Honestly, why collar a SCA pt. I know the yanks are obsessed with it but really…in preference to airway management and compressions?
2. The collar was backwards.
3. An asystolic pt with no compressions being done? While hypothermia is neuroprotective to an extent, you can’t just sit an asystolic pt on a bed and wait for them to warm up. While it is slower, cell death in relation to poor perfusion still continues. Your can’t just not do compressions (assuming you want to work the arrest).
4. Arrythmias at low temperatures are more common but I can’t be bothered translating the F to C so I won’t comment on the particulars, but none the less, you don’t simply sit around with an asystolic (dead) pt who has been without compressions, probably for hours now, reading “the Lancet for dummies” until they suddenly pop on into VF.
There were some other problems but these were the only ones that pulled me away from a really really good glass of cab sav to comment.
February 6th, 2012 at 11:35 am
Homosexuality or assexuality don’t need evolutionary “reasons.” Minimally, they simply don’t need to hurt the overall population growth of the species (which they don’t).
Assexuality is not “on the rise.” It’s under-reported.
It’s commonly said that ~10% of people are gay. But do you honestly think that people think it’s even 1% likely? People have a mental block and don’t go around imagining that 1-in-10 strangers they meet are actually gay.
February 8th, 2012 at 4:03 am
@Headacheslayer: Hi! :)
Too bad they let House once again near patients. I wouldn’t let him to touch, diagnose, or treat me in anyway.
February 8th, 2012 at 4:07 am
@D-r Bulgaria: Well, I don’t understand why I should stick my body parts inside someone. Why would that be of any fun???
“It is scientifically proven that people with regular normal sex life live longer.”
So, kids will die very young, because they don’t usually have a regular normal sex life? Too bad they won’t see the adulthood…oh wait!….they will!
February 8th, 2012 at 6:03 pm
First of all, IANAD, but what, no bonus points for actually shocking a patient in v-tach instead of asystole?? This may be the first time (at least that I can recall) that they actually got it right!
Admittedly their reasons were not exactly correct, but the client did come out of flatline with arrhythmia, and defib was the correct action after pushing the amiodarone, no? ( I assumed the second time, they had administered the amiodarone already before House arrived.)
Thad all aside, I have to admit I am really liking House all over again after losing interest in season 6 and skipping almost all of season 7. And I truely LOVE the addition of Dr. Park, she may not be hot in the accepted sense, but the character is funny as hell, and now that she’s speaking loudly and clearly, a pleasure to watch interact.
(Also, a lot of American-printed manga still print left-to-right, except those marketed to hardcore North-American otaku.)
Skipped most of the comments so my apologies if these have already been mentioned. Cheers!
February 10th, 2012 at 6:18 pm
@Xezlec:
Your whole explanation of how relationships make people miserable, and that’s why you avoid them, is NOT a description of asexuality!
I am not an asexual, but I have read a lot about asexuality. And everything I’ve read says that asexuals CAN and DO have relationships. Hell, in this episode of House, the man identified as asexual, but he was in a relationship with the woman (regardless of her own sexuality) for years.
I have read posts on other forums/blogs written by asexuals claiming that they have no sexual desires, but they still are in relationships with people that they claim to love.
What you are describing, as far as I am aware, is “aromanticism”. Asexuality and aromanticism can exist together, or separately. At least, that’s what I understand from my cursory research.
As for the rest of your comments, well, every aspect of every single one of us has either a genetic or medical cause. The whole reason medical ethics exist is because these things are debated all the time. Many things can be “fixed” (or at least “changed”) by application of medicine, but that doesn’t mean we all agree on whether or not it is ethical to do so.
The point is, I guarantee that at least some asexuals can be “changed” (note I am not saying “cured”) through medicine. And I also guarantee that some can’t. But even for those who can be changed, that doesn’t mean it’s always right to change them.
That’s why we have such a thing as informed consent. I could choose not to have my cancer treated if I didn’t want to. Just like if a doctor hypothetically found some medical cause for your sexuality, you could choose not to have it treated, and no one would have a problem with your refusal.
One other thing… not all doctors see or notice the same things. That is the whole point of House, isn’t it? Asexuals may very well have been to doctors tons of times, and may even have discussed their asexuality with their doctor. But that doesn’t mean they still don’t necessarily have a medical cause that has gone unnoticed.
February 17th, 2012 at 9:30 pm
How hard can it be to at least give a “brazilian” patient a real brazilian name? It’s bad enough that every foreign sentence has terrible grammar, but they couldn’t even be bothered to browse some .br news site and pick a real name and surname…? If that’s beyond their writers’ abilities, no wonder the medicine is so nonsensical sometimes.
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