House — Episode 10 (Season 8): “Runaways”
House shows some heart in tonight’s episode, unfortunately, he seems to have left his brain at home.
A teenager presents to the Princeton-Plainsboro Hospital clinic complaining of some difficulty breathing. All she wants is an inhaler for her “asthma” but House correctly recognizes that she is homeless and the man with her isn’t really her father. What really piques his interest is when she starts bleeding from her ear. He mentions that this is a sign of a skull fracture, but can find no fracture — or any other cause of the bleeding — so he admits her to his service. The team’s initial diagnoses focus on her homelessness and consist of drug use, malnutrition, or HIV. Chase goes further and suggests she may have a squamous cell cancer of the middle ear with paraneoplastic syndrome, while Taub, backed by Adams, suggests a possible cerebral (brain) infection, probably pneumococcus. House agrees with Taub and Adams and starts “Jane Doe” on ceftriaxone (a potent antibiotic).
Adams and Park check out Doe’s school — where she is doing quite well — and also check out her address on record with the school, which is a foreclosed home she has fixed up. Looking around the house, Adams finds a few beers and some mold. She now suspects Doe has a fungal infection and starts her on fluconazole (an antifungal medication). Upset that the team went behind her back digging into her history, Doe tries to leave, but collapses as soon as she gets out of bed, complaining that she “can’t feel her legs” (her symptoms are later identified as paralysis, which is different from the paresthesia she was complaining of).
Looking over her symptoms of ear bleeding, problems breathing, and lower extremity paralysis, the team’s new differential diagnosis is transverse myelitis, endocarditis with septic emboli, or the fairly vague “vasculitis” (inflammation of the blood vessels). House goes with the vague and starts the patient on steroids to treat the presumed vasculitis. Initially, she is doing better on the steroids, but then things quickly go to hell. Her estranged mother shows up, identifying the patient as Callie, and in the middle of the confrontation, Callie begins coughing up blood. Different diagnoses are considered based on where the blood may be coming from (respiratory or gastrointestinal source). Chase suggests she has a sinusitis and a bleeding disorder, and Adams suggests Zollinger-Ellison syndrome (a condition where the patient has a tumor which secretes gastrin, which causes the stomach to pump out too much acid). House thinks Adams has the better idea and orders an EGD (upper endoscopy), which reveals bleeding ulcers in the esophagus; unfortunately, this doesn’t fit any of the diagnoses discussed. The team now considers the diagnoses of HPV (human papilloma virus), alcohol-induced esophagitis, or a berry aneurysm of the brain. House thinks it is the aneurysm and wants a quick cerebral angiogram followed by surgery before the aneurysm has a chance to rupture, which would rapidly kill her. Adams favors the alcohol theory — Callie does admit drinking an occasional beer — and Callie’s mother agrees with Adams and decides to forgo the angiogram and surgery. Callie seems to be doing well and is actually talking with her mother when she suddenly falls unconscious. Coudl she have had a berry aneurysm which burst? Was House right? She is rushed to the OR suite for the cerebral angiogram, but no aneurysm is detected. Her blood pressure begins to plummet and the team buys time with some pressors (medications that increase blood pressure), but still don’t know what is wrong her. Brainstorming, Adams first suggests cancer, then recalls hearing about a trip Callie took to Florida two years before and wonders is she may have contracted dengue or cholera. House (rightfully) scoffs at those, then after learning Callie went swimming in a freshwater canal while in Florida, correctly diagnoses her with ascariasis (a parasitic worm infection). After Callie is treated, she sneaks out of the hospital to be on her own again, still unwilling to trust her mother. (I’m assuming she snuck off to the Disney Channel, where she was able to find a much happier family).
As usual, major complaints are in red (red caduceus), modest complaints are in blue (blue Vicodin), and nit-picking ones in green (green pencils):
House dismisses Adams suggestions of dengue and cholera by pointing out the two year gap between exposure and symptoms, but then diagnoses ascariasis, which has precisely the same problem. The worms would not have sat quiescent for two years, not when they had their preferred environment, no matter what the fancy graphics at the end showed.
I’ll grant that ascariasis can cause pulmonary symptoms and gastrointestinal symptoms (because the worms travel intestines to liver to liver blood flow to lungs, then up the trachea, and swallowed back down to the intestines). Ears (and even if they could get to the ears, how were they causing bleeding? Drilling a hole?)? Brain (and yet not be visible on CT scan)?
Ears should not bleed. House looked in Callie’s ear and said it was normal. I would expect him to see a bleeding source (such as a scratch, cyst, infection, etc) in the canal, or a hole in the tympanic membrane which would let blood from deeper in the ear out into the canal. He mentioned neither of these – so how could there be blood?
Other than Chase’s mention of squamous cell cancer of the ear, none of the diagnoses mentioned are going to cause ear bleeding, particularly ear bleeding that looks normal on exam. For example, Zollinger-Ellison? How is a gastrin-secreting tumor going to cause ear bleeding? Callie only has four symptoms, and Adams still skips one in her diagnosis
Taub’s phrasing “cerebral infection” was a odd. He seems to be suggesting meningitis — for which pneumoccocus is a common cause and ceftriaxone a good choice of medication — but that doesn’t fit with Adams comment about lack of fever. You would expect a fever — and meningeal signs — with meningitis. They could possibly be referring to a brain abscess, but that would have shown up on the CT, and pneumococcus (and thus the choice of ceftriaxone) much less common.
No vaccine is 100% protective, and Callie could still get pneumococcus even after being immunized. Plus, the vaccine only covers a handful of different pneumococcus serotypes (admittedly the most common), and she could have been infected with one of the serotypes not covered by the vaccine.
Why would Adams, who doesn’t believe much of what Callie says, believe a shot record to be true? Callie likely forged or lied on her school shot records. It’s not like her parents really signed it.
When Callie stands up and collapses to the floor, she complains she can’t feel her legs (paresthesia). That’s different that an inability to move her legs (paralysis). It’s possible she has both and can’t move or feel her legs, but then the most common complaint would be that she couldn’t move her legs, not that she couldn’t feel them.
PPH is in for some tough times. In the past two weeks, they’ve let two patients escape– two they should have been watching closely. Last week, a patient with Alzheimer’s (known to be elopement risks), and this week, a minor left AMA, a minor with a history of running away.
I found the medical mystery to be more interesting than usual this week, because the symptoms were quite disparate. I give it B. The final solution was a let down, because it couldn’t really explain half the symptoms (and the most interesting half at that); it deserves no more than a D. The medicine was very sloppy this week, with many of the diagnoses not explaining all the symptoms — and there were only three or four symptoms to work with. I give it a C-. The soap opera was adequate and average. There were a couple of nice scenes, and Wilson got a few good lines, but it really wasn’t anything above average: C.
The review of the previous episode of House
A list of all prior House reviews
January 30th, 2012 at 10:56 pm
Zach Handlen over at the AV Club wrote that, after the Huddy Horror of the past two or three seasons, “House” has finally settled into a show that “you don’t have to hate yourself for watching anymore” and “that’s got to be some kind of win.” I wonder if that’s true?
January 30th, 2012 at 11:13 pm
You have to admit that ppth has never had the best security. In season 2 and in season 5 people have entered the hospital with guns. In season 6 they lost a baby in lockdown. You think they would hire better security guards.
January 30th, 2012 at 11:20 pm
Can someone really get sick from wearing cheap polyester?
January 30th, 2012 at 11:53 pm
Was no CBC/diff obtained when the patient was admitted? If so, then surely the parasitic infection would have been evident in the eosinophil count. Sloppy.
January 31st, 2012 at 12:14 am
I am not a runaway teenage girl, but personally, if I suddenly collapsed, and couldn’t feel my legs, the numbness would be concern one for me. If there’s nerve damage, it explains both, and while maybe they can’t support me for any number of reasons, being totally unable to feel them is a lot more worrisome.
January 31st, 2012 at 1:35 am
The Civil War reenactors were hilarious.
January 31st, 2012 at 4:29 am
Right you are, Chris Miller. Stephen King proved that a first-rate, full-scale, group-participating, all-out barf-o-rama is ALWAYS a crowd pleaser. Must-see TV at its bilious best.
January 31st, 2012 at 6:51 am
That guy would have to be a really lousy reenactor not to be able to tell the difference between cheap polyester uniforms and wool uniforms… in the middle of winter… in New Jersey. We clearly see snow several times. They would’ve been freezing.
January 31st, 2012 at 8:01 am
Taub is back and Wilson helps him with advice on how to entertain his two little babies – cute!
January 31st, 2012 at 8:06 am
Watching “House MD” these days is like realizing your old friend who has been battling cancer actually is dying.
January 31st, 2012 at 9:26 am
Nitpicking from me: I noticed in the opening when House checked the young girl for a fever he simply slapped the palm of his hand on her forehead to test for it. I always heard that the best way to test for a fever using this dubious method is to use the BACK of your hand as the palm of your had is, well, HOT and well throw off your test. (Though I guess House in his infinite awesome could’ve accounted for this…)
January 31st, 2012 at 1:23 pm
My mommy used to kiss my forehead to gauge my temperature.
January 31st, 2012 at 1:38 pm
That’s what my mom did. Me? I use fancy technology like digital thermometers you jam in your ear.
January 31st, 2012 at 5:02 pm
well i think the bloody ears were due to the “fall” House mentioned she took during volley practice or whatever.
January 31st, 2012 at 7:40 pm
Harking back over fifty years to my High School biology, I wonder how her “dominant trait” dimples prove non-dimpled homeless guy is not her father?
January 31st, 2012 at 8:04 pm
John A — it doesn’t at all. House qualified that by saying as much, but that her lack of a response to his statement “proved” that the guy wasn’t really her father.
Also, I liked the subtle bit in that scene with House asking about what treatment she received for strep throat. He suggests neomycin, a topical antibiotic. Had she agreed with him, she’d have been caught in the lie.
January 31st, 2012 at 8:27 pm
Worst episode this season. Differentials didn’t fit. Diagnosis didn’t fit. Drama was weak. I thought after last weeks episode this show would redeem itself
January 31st, 2012 at 9:15 pm
Ah, well, with the collapse of Megavideo, I haven’t seen either of the last two episodes (no TV reception at our house). Instead, I rented a DVD of the first disc of Season 4. (we already own seasons 1-3) and we enjoyed the first episode like crazy….the mystery of the misidentified patient, the traded sadness and joy of boyfriends, the hilarity of the janitor suggesting lupus and Wilson’s hysterical kidnapping of the guitar and imitation of a string being tightened to the point of breaking.
January 31st, 2012 at 10:23 pm
“Taub’s phrasing “cerebral infection” was a odd.”
a odd, never heard of AN a odd. maybe AN odd. Your a doctor. I would figure after 24 hours you would realize a mistake in English language grammar. I’m a semi drunk (tonight) used car salesman that appreciates both the show and your reviews but for some reason that stood out to me….
January 31st, 2012 at 10:55 pm
@Carl
If you want to nitpick at Scott for his grammatical error, it only seems fair to point out yours. It should be “You’re a doctor” not “Your a doctor” as you indicated. Unless you were going for irony, but that might be giving you too much credit.
January 31st, 2012 at 11:35 pm
I wanted Mr Chips to win the race too.
the hilarity of the janitor suggesting lupus
That’s Dr Buffer to you, Lisa. ;^)
BTW, it’s “you’re a doctor”, Carl.
January 31st, 2012 at 11:36 pm
[I guess I should refresh the page before commenting.]
February 1st, 2012 at 1:15 am
I used to like reading your medical reviews, but since neither you nor anybody else seems to like the show anymore, I am going to stop reading. I don’t know enough about medicine to really care if you are just going to be critical of every episode from now on. I like it becasue the acting and production values are awesome, and the stories always keep me interested. Buh bye.
February 1st, 2012 at 1:18 am
Yeah, Carl. You aren’t capitalizing sentences or really making any sense. I wouldn’t post if I were you.
February 1st, 2012 at 5:25 am
At the turtle race, Adams says: She got worse after being on steroids, so autoimmune is out.
But before that they said, that she is respondig to corticosteroid.
And at the differencial later, Adams says: She got a little better when we put her on steroids, which can attack tumor cells. Maybe she has cancer.
So what is with the steroids?
February 1st, 2012 at 5:52 am
I had so many hopes for this episode….ah well.
Though the soap opera stuff was pretty good, I mean A TURTLE RACE. And how cute was Taub reading the kids a sports magazine? (Um yeah one of those is NOT his kid).
I kept waiting for some “big shocker” like mom pimped out her daughter to score drugs.
NEXT WEEK OMG. I watched the preview on slo-mo a few times. My guess: Either Chase or Wilson
February 1st, 2012 at 10:29 am
Guys, in all fairness, Carl did admit to being semi-drunk. I guess drunk posting is kind of like drunk dialing – another one of those things you shouldn’t do because it makes you look so stupid.
This was the first episode in a long time that didn’t make me hate myself for watching. My two favorite parts were Chase entertaining Taub’s daughters and educating them about what swine men are at the same time because they’re going to learn it eventually anyway, and House reminding Foreman again that he’s just like House. My least favorite part? There’s just way too much barfing on this show. I was eating dinner while watching. Not good.
February 1st, 2012 at 11:29 am
Can someone really get sick from wearing cheap polyester?
It’s been asked before, but I’m wondering if anyone here can answer that…
Since it hasn’t been covered in any of the points I’m guessing that part is true. But I really don’t want to believe that :(
February 1st, 2012 at 12:45 pm
Anyone got reasonable explanation for this paralysis/numbness? Cause I just had a pretty extreme Biology exam which covered mainly parasites and there wasn’t a single source which linked it with ascariasis… I’m gonna fail it though, so I’m not the best source :)
February 1st, 2012 at 12:45 pm
I suppose this is just one more chapter in the slow decline of House…
February 1st, 2012 at 4:19 pm
Anyone wonder about the commercial against bullying featuring Cuddy, Thirteen, and a few of the other doctors (but not House). And when the story returned, the first thing brought up was bullying. That seemed intentional, although I was puzzled that it contained the older cast, maybe they’ve used it before?
February 1st, 2012 at 5:52 pm
According to this link:
http://voices.yahoo.com/environmental-impact-polyester-industry-8194149.html
“Polyester production often includes the use of heavy metals, including the toxic metal antimony trioxide. Antimony harms human skin, lungs, hearts and livers[...]“.
February 1st, 2012 at 5:58 pm
Right after posting the previous comment, I realized it was more about the environmental effects. As to whether *wearing* polyester is harmful:
http://oecotextiles.wordpress.com/2010/02/17/will-the-antimony-in-polyester-fabric-hurt-me/
“But what about the antimony that remains in the PET fabric? We do know that antimony leaches from PET bottles into the water or soda inside the bottles. The US Agency for Toxic Substances and Disease Registry says that the antimony in fabric is very tightly bound and does not expose people to antimony, (3) as I mentioned earlier. So if you want to take the government’s word for it, antimony in PET is not a problem for human health – at least directly in terms of exposure from fabrics which contain antimony. ”
“Antimony is just not a nice thing to be eating or drinking, and wearing it probably won’t hurt you[...]“.
February 1st, 2012 at 8:23 pm
@elwing: Of course you can. Go back and that a look at what we were all wearing during the Great Disco Days and see if it doesn’t cause you to have an acute, uncontrolled, visceral personal protein spill all over your Ruby Slippers.
February 1st, 2012 at 9:26 pm
In response to the second-to-last point, it’s not exactly a far stretch to be unable to stand when you can’t feel your legs, if you’ve ever tried walking on a foot that’s gone completely numb, it’s surprisingly difficult, and if one can’t feel your entire legs, then it would probably be fairly easy to collapse.
Of course, I don’t remember the episode in that much detail, did she/the doctors later say that she couldn’t move her legs?
February 2nd, 2012 at 7:32 am
What a reunion with Darlene Vogel! Remember how hot she was in “Back to the Future II”, one of the very few sequels ever to be worth watching?
February 3rd, 2012 at 10:10 am
The fact that there was no eosinophil count mentioned is the problem in this episode! Sure they did lab tests and sure it had a very high eosinophilia, wich would make them search for a parasitic infection right away, making this episode very, very short!
February 3rd, 2012 at 11:05 pm
This just reminds me why I love House. Yes, the earlier series were sharper – that’s natural. Still,there’s nothing else on the box like it. It does. If they went for series nine, hey, I’d be in there. What else is there to watch?
Scott, you yourself deserve medal they haven’t invented yet! Why we love you …
February 8th, 2012 at 10:22 pm
[quote]Zach Handlen over at the AV Club wrote that, after the Huddy Horror of the past two or three seasons, “House” has finally settled into a show that “you don’t have to hate yourself for watching anymore” and “that’s got to be some kind of win.” I wonder if that’s true?[/quote]
I think so. Ironic that I say so after watching the first (imo)real boring episode of the season. Even the idiotic clinic patients who I usually love were just a bit too random and strange to keep me suspending my disbelief. I mean come ON, not even the most hardcore LARP’er, or any other human with any ounce of self-respect is going to stay in character (or in costume) when going to the ER for any reason.
And for that matter, who the hell goes to the hospital for the runs, unless they are massively dehydrated or someting? I bet that was the most expensive bottle of Imodium that guy ever bought when House tossed it to him.
February 17th, 2012 at 11:22 pm
I’m only a first year, but it seems to me like berry aneurysm fits none of her symptoms except possibly her paralysis/paresthesia. That seems like a really glaring error in this episode that ruined the entire thing for me. House is supposed to be an expert – why would he think an aneurysm would cause ear bleeding (prior to any other symptoms, etc), difficulty breathing, and GI bleed? Where’s the headache and vision changes? Alcoholism was a poor diagnosis too, but seemed to fit the clinical picture way better than aneurysm. I found this episode really frustrating as someone who is attempting to actually learn medicine.
March 11th, 2012 at 3:25 am
I accept from the experts that the handwaving explanation for the two-year delay was inaccurate, but at least they did *try* to explain it. That doesn’t excuse their omission of parasitic diseases from the very first differential diagnosis, although, as others have already pointed out, had they done so, it would have been the shortest episode of _House_ ever.
What I don’t understand is why House made that bet with Adams. Knowing her background, he must have been able to figure that there was a reasonable chance that she might have learned skeet shooting.
You have to give them points, however, for House’s final comment about the Civil War re-enactors (”Brother against brother”).
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