Polite Dissent

38 Responses to “ House – Episode 2 (Season 2): “Autopsy” ”

1. Allison
   September 20th, 2005 at 11:07 pm
   

   I do agree with you that this was a pretty weak episode. For crying out loud, I think I even saw moisture under House’s eye while Wilson told the mom/daughter about her prognosis.

   BUT…one thing you didn’t mention…while you did mention the kiss from Chase (and yes, that was too heart-rending for words), you didn’t mention the flipped roles between Chase and Foreman. It was (almost) refreshing to see Chase have faith in the patient for once, while Foreman suspected her of having syphilis. *snort* Well, almost.

2. liz
   September 21st, 2005 at 8:43 am
   

   There was the interesting little character flip of House believing that Foreman saw the clot on the MRI even though he (House) didn’t. Oh, he is starting to trust them! Pass out the warm fuzzies. This is almost canceled out by the ridiculous “I know it’s there”/”Well I can’t find it” between Foreman and the neurosurgeon, though.

   Also, award for most disturbing clinic patient moment EVER. Self-circumcision? *shudder*

3. Scott
   September 21st, 2005 at 9:28 am
   Official Comment

   Allison, Liz,

   There were some good character moments like you mention (and the “is she really brave or is it the clot” was intriguing), but I still miss my soap opera.

   House seems to be starting to trust Foreman, but he’s always seemed to have a little more faith in his abilities than the others. He also appears to be picking on Chase more now to make up for it, though.

4. Andrew Burton
   September 22nd, 2005 at 1:06 pm
   

   Yeah, the bolt was hilarious. Especially since this is the same show that, last week, taught us the dangers of mixing an MRI with lead-based tattoos.

5. Amanda
   September 23rd, 2005 at 12:03 am
   

   Wow, it’s strange to be here picking nits on the nitpickers site.

   There’s an MRI designed to be used with standard surgical equipment. The manufacturer was listed in the credits, but I don’t have the name in front of me now. It is used in real hospitals by real doctors in various kinds of guided procedures.

   Standard dosage for diphenhydramine PO is 25 to 50 mg, not 100 mg. If he really took 1000 mg, he ought to be asleep unless he has extremely low reaction to it, in which case it’s the wrong drug. Since it can act as an enhancer for opioids such as hydrocodode, House may take quite a bit of diphenhydramine and have built up a tolerance to its effects, but a gram still ought to knock him out. even PO.

6. Diane, RN
   September 23rd, 2005 at 12:18 am
   

   First off, I’m happy to be visiting this site again and look forward to your many episode analyses. I frequent the official message boards but I yearned for the intelligent, health professional perspectives. I take refuge here! As for this episode…it made me feel a bit empty. They tried a bit too hard in all aspects and failed miserably…right down to the music. I could tune into the WB channel any day and get my overbearingly gratuitous soundtracks. I’d rather have Hugh do another ditty on the keys thanks.

7. Scott
   September 23rd, 2005 at 7:00 am
   Official Comment

   Amanda,

   You’re right in that the standard dose of diphenhydramine (Benadryl) is 25-50 mg. What I was referring to was the maximum recommended dose, which is 100 mg at any one time (or 400 mg/day). Either way as you point out, House should be fast asleep or at least very groggy.

   I was unfamiliar with surgical MRIs, but it’s nice to know they exist. Here is an article from the Cleveland Clinic about one. It states “the low magnetic fields allow many conventional surgical instruments to be used.” I’m suspicious that a metal bracket with a bolt in the skull doesn’t count as a “conventional surgical instrument” — but I’ll admit it’s outside my area of expertise.

8. Maria Vitale
   September 27th, 2005 at 7:24 am
   

   Regarding the diphenhydramine, may I offer another suggestion?

   If “Everybody Lies,” why are we so ready to accept every single thing that House says as Gospel? He might have been exaggerating about how much he took in an effort to complain about its ineffectiveness so far in relieving his symptoms. I’ve done this plenty of times myself. Haven’t we all?

   And it would also explain his decision to try a different tack at the end of the episode by chopping up the pills and snorting them in the hopes that he’d get some quicker more direct relief.

9. Lexi
   September 29th, 2005 at 9:31 am
   

   If they have an MRI that can be used with surgical equipment, would it have been useful on the convict with the lead-based tattoos?

10. Árni
    December 1st, 2005 at 10:17 am
    

    The clamp could have been made out of aluminum. That would not react in a magnetic field.

11. Ratbat
    February 15th, 2006 at 7:50 am
    

    I think House came to respect Foreman some more during the whole Vogler business – he really got on with doing his job instead of spending all his time trying to keep it by whatever other means. And around the same time, I think he started to like Chase less. Or at least decide that having him squirm around some was just payback for being Vogler’s mole.

12. Pryftan
    April 18th, 2006 at 12:55 am
    

    I don’t know if this’ll be seen, it’s been ages since the episode aired.. but I have to ask – the whole scene with House sitting with speakers and an iPod listening to the sounds of various heart valves looking for an anomaly.. how realistic is that? Is there actually an audible problem in the sound of her mitral valve? If it’s there, is it subtle enough for only House and Cameron to hear?

13. Orrion
    April 25th, 2006 at 6:44 pm
    

    As to the trusting Foreman thing.. if you watch the episode during the part where they’re studying the MRI appearing on the screen, House isn’t even looking at it, he’s looking to the neurologists to see if they see something. As you’d expect, it is the brain they’re looking at, not the kidney. And of course Foreman would be the neurologist to see the clot, he’s the only one of the main characters who is a neurologist. It’d wouldn’t have made sense if some random Joe bit-character neurologist saw the clot, would it? The show was just using Foreman’s field of expertise. House can’t be a medical expert about EVERYTHING, after all.

14. Gman
    June 9th, 2006 at 7:23 am
    

    I was rewatching this episode and had the same questions regarding the MRI. Aside from the episode with “Death Row Guy” and his tattoos, I do remember “Mythbusters” and their exploration of the MRI and ink. Most dramatically, the way their “heavy” ferrous ink in a plastic container rocketed into the MRI during testing and it took the technician using BOTH hands to get it out of the field. (And then the “Delirious” part one with the testing of the MRI with a bullet to the head that winds up destroying the MRI.) Thanks for the forum to explain it.

    Funny thing is that until I watched it again, the science of it didn’t bother me. But I’m one for letting reality slip a little to tell a story, just that I like to know if it is really possible.

15. anonymous
    November 19th, 2006 at 1:02 am
    

    If he had taken 250-500 mg of benadryl (diphenhydramine, or dyphinhydrinate if its the non-drowsy variety), unless he had a tolerance beyond reason, he would be hallucinating; not the good kind either. Diphenhydramine is an anticholinergic (like atropine and other tropane alkaloids), so he would be having delusions indistinguishable from reality (unlike your common LSD trip which we know he is used to, you have to be pretty deep into drugs to be able to get a hit of LSD in about four hours like that one episode).

16. MrDeodorant
    November 27th, 2006 at 1:39 pm
    

    Re: Árni Says: The clamp could have been made out of aluminum. That would not react in a magnetic field.

    Aluminum reacts in a magnetic field. There’s a rather famous (in the physics community, at least) experiment involving aluminum rings around a solenoid; turn the power up and they float, turn it up fast and they launch themselves. It’s an induced current, and it’s a potentially catastrophic effect.

    You’re right that aluminum isn’t attracted to magnets, but that isn’t the only way to interact with magnetic fields.

17. John Lutz
    December 11th, 2006 at 10:38 pm
    

    I have no medical background whatsoever although that isn’t particularly relevant to the issue of magnetism. Certain companies manufacture tools, instruments, and parts that are entirely nonmagnetic. This is for the specific reason of not being detected by various anti-personnel magnetic field sensing explosive devices. The composition of these tools includes but is not limited to Titanium and Beryllium. Additionally some sensing devices are specifically designed to detect “typically” non-magnetic metals.

18. Jason
    January 5th, 2007 at 7:14 pm
    

    Amanda said: “The manufacturer was listed in the credits, but I don’t have the name in front of me now.”

    It’s the “Polestar-N20 Intraoperative MRI system” as listed in the credits.

19. Trily
    January 8th, 2007 at 6:20 am
    

    So can someone tell us something about the heart sounds?

20. Stellah
    March 7th, 2007 at 3:08 pm
    

    Norway is a little behind, so forgive the lateness of my question:
    Will a cancer patient who has lost all her hair also loose her eyebrows?

21. Scott
    March 7th, 2007 at 3:15 pm
    Official Comment

    Sometimes, but not usually. Cancer treatments target the faster growing cells in the body under the idea that cancer is a quickly growing cell. Hair, particularly scalp hair, also grows fast so is affected by the cancer treatment. Hair elsewhere on the body, including the eyebrows, doesn’t grow as fast so isn’t as susceptible to the cancer treatment.

22. Kristen
    March 21st, 2007 at 9:13 pm
    

    I was just diagnosed with an abnormal mitral valve today (mitral valve prolapse). Apparently it’s fairly common. After years of having my heart listened to by doctors (and hearing nothing strange), a cardiologist (who I had been referred to for a different reason) heard it right away. He then scheduled me to have an echocardiogram, which confirmed his suspicions by adding a conclusive picture to what he “heard” through the stethoscope. So, in response to Pryftan, the mitral valve can be audible when it’s abnormal.

23. Kevin
    April 12th, 2007 at 2:51 am
    

    I’m no doctor, far from it, but I do know a bit about electromagnetic physics. There are really only 3 metals that are inherently magnetic, those being nickel, iron, and cobalt. Granted, other metals can have magnetic properties, but many do not. The one in particular I’m thinking of is titanium. As far as I know, it would in no way be affected by a magnet. Please correct me if I’m wrong, but I see it as entirely possible for the bolt and surgical equipment to not interfere with the MRI. That, and seeing as it’s a portable MRI, I assume the magnet is not as strong as the larger version.

24. Sandy
    May 17th, 2007 at 2:25 am
    

    What i am wonderinng about the most is whether such a procedure can be done..?? I mean, to induce a heart attack, keep the body at a certain temperature and flush out half the amount of blood from the body to find a clot in the brain??

25. Martin U
    May 22nd, 2007 at 12:42 pm
    

    Hi, I’m a 4th year Computation Physics student and whilst I cannot claim to have a definitive answer to the whole metal/magnetism discussion here is my take: it is true that many metals are ‘non-magnetic’ in the sense that they do not experience a force when placed in a magnetic field. Aluminium is indeed one of these as it is used to make containers to hold hydrogen and other gases that are used to fill NMR machines (roughly similar to MRI machines except with stronger magnetic fields). There is another aspect to consider though, which has to do with what MrDeodorant said. This has to do with the fact that metals contain delocalised electrons which will experience a force when placed in an electric field (which is present as a result of the aforementioned solenoid), this force causes the electrons to move with some common velocity. Now a moving charge will induce a magnetic field opposing the motion that created hence the ring goes shooting upwards in the famous experiment. Notice this only applies to situations where an electric field is present which is not the case when using a medical MRI.
    In conclusion it is my belief that an aluminium bolt would be perfectly stable and unaffected by the magnetic field of an MRI machine.

26. Dan
    May 26th, 2007 at 12:58 am
    

    I agree with Martin U about the aluminum in the MRI. I’m a physics postdoc and have done some research in models of magnetism. Most metals (and almost all substances) are either diamagnetic or paramagnetic, which means they are magnetized only very, very slightly by an applied magnetic field, and as a result are very, very slightly attracted to areas of weak or strong magnetic field (respectively). The materials which react strongly to magnetic fields of MRI strength are ferromagnetic materials, such as iron, cobalt, and nickel (and other fancier compounds). As long as the bolt didn’t have much ferromagnetic material in it (e.g. steel would be bad, since it around 98% iron!), it wouldn’t react much at all. For instance, an aluminum bolt would be magnetized about 10 million times less than an iron bolt.

    If some ferromagnetic component was in the tattoo ink in the other episode, it could experience a significant force. It’s hard for me to say if it would be enough to cause serious pain, but it’s possible…

    Re the show… this episode wasn’t really written to be funny, but I still thought the story was effective.

27. Linda
    May 28th, 2007 at 11:51 am
    

    Something different about the MRI episode also bothered me (pre-clincal MR researcher). Foreman was the only one who saw the clot in real-time. Fine, understandable — he is the neurologist. And nice that House is starting to trust his judgement. But it is a rather odd clinical MR scanner that does not save the images obtained. Why did they not take the 60 seconds needed to call the images up again and go through them at slow speed and/or freeze them at the appropriate moment, so that everyone could see the clot? Most especially the neurosurgeon who had to remove it.

    Scott, thanks for maintaining this site. House is fun, despite its frequent lapses of (medical) accuracy, but dissecting House with knowledgeable colleagues is just as much fun!

28. PSIKOTICSILVER
    October 25th, 2007 at 12:09 am
    

    Hi. You’re all very, very wrong.

    Think about it for a minute…

    She’s got her head bolted to the table, yes? Directly in the middle of two magnets. The magnetic pull from each direction would simply nullify itself, wouldn’t it?

29. Scott
    October 25th, 2007 at 8:32 am
    Official Comment

    It’s not that simple. A small amount of metal — even if it is equal and oppositely arranged — warps the magnetic field and distorts the image. Look at the lower cuts of an MRI of someone’s head — the minuscule amount of metal in amalgam fillings is enough to cause artifacts on the image.

30. Peter
    November 20th, 2007 at 11:12 am
    

    What is medically definitely wrong is the notion that removing the clot would restore function to the brain. If this were the case, strokes wouldn’t be a problem. In reality, clots have to be removed within a few hours in order to restore function. After several days it’s no use. Anyway, a clot large enough to obstruct flow would show up on contrast MRI or angio CAT scan without the complicated procedure.

31. Rob Haswell
    January 18th, 2008 at 9:51 am
    

    Some trivia for you:

    At the end of the Episode, House is seen chopping up some pills with a razor blade, and making lines, as if to snort them. Wilson asks if he’s treating his blocked nose with cocaine, yet House claims it’s Benadryl with a new delivery system.

    Wilson’s next line goes something like “It’s all about speed, isn’t it? You like doing things quickly.”

    Amphetamine (speed) is a powerful decongestant, one of the most potent available. That is almost certainly what House was preparing.

32. Jeff H
    February 8th, 2008 at 6:37 pm
    

    You say “House decides that the only way to find this clot is to chill her body to 21° Celsius (about 70° Fahrenheit) , stop her heart, remove two liters of blood, add the 2 liters of blood back while performing an MRI to find the clot, and then restart the heart.” If a clot doesn’t show up on standard scans (CT, MRI, etc.) what else do you do? I’m no doctor, but I seem to recall the blood-brain barrier presents some extra challenges in getting good pictures of the brain? I’m just curious as to what other options were available. I’ll agree the procedure was fishy, but then, Cuddy did call it experimental to the point she felt they needed FDA approval – clearly this is not a routine thing the hospital does.

    Likewise for the heart tumor – does the explanation that it was growing along the heart wall carry any merit?

    Finally, I’m interested in Peter’s comment above… would removing the clot have actually made things better? What if it was only a partial clot, so some blood was getting through?

    (As for the magnets, I just assumed the bolt was made of titanium or something.)

33. Johnny
    February 28th, 2008 at 3:43 pm
    

    There’s no way that House took 1000mg of Benadryl like he said at the beginning. That high of a dosage causes some freaky, freaky hallucinations.

34. Anonymous
    March 15th, 2008 at 1:57 am
    

    Do you really get brain damage after 60 seconds without blood and while being cooled? I’m no doctor but I always thought that the whole point of chilling the body was to preserve the tissue during longer procedures. As someone else pointed out strokes have to be reversed within hours to avoid damage, so why the need to cool someone for such a short procedure?

    Also doesn’t it take longer to cool someone down that much? Or did they just speed it up?

35. Nimby
    June 11th, 2008 at 7:21 pm
    

    It is highly possible that House was exaggerating about the Benadryl dosage. As in, “Man, I told you a million times…” or “That’s a thousand to one chance!”.

36. Nimby
    June 11th, 2008 at 7:46 pm
    

    And, Anonymous, I believe the reason given was that if the brain was “alive”, it would shut down–once there was lowered activity, it didn’t realize anything was going on–I’m not explaining it very well, and I’m not entirely sure that I understood it, but I think I’m close, at least.

    To explain the reasoning (or, at least, my understanding of it, that is):
    Let’s say that the patient is, instead, a computer with a worn power cord. Let’s say you need to replace that cord. If you turn the computer on, and have programs running, and you’ve just finished typing up your resume (let’s pretend the word processor doesn’t auto-save), and you’re painting something by hand in Adobe Photoshop, and you cut through that power cord, you will lose all of that data. And your computer might suffer hard drive damage, etc. (You’d also get electrocuted, but that’s not really applicable to a patient and doctor). Now, if you shut your computer down properly, then cut off the power cord and replace it or whatever, and then turn it back on, everything is fine.

    Something like that, I think.

    Can someone back me up/correct me?

37. Lisa
    August 4th, 2008 at 9:02 pm
    

    As stated earlier, the MRI, is a PoleStar N20 IntraOperative (low-field, 0.15 Tesla) MRI. These were originally manufactured by a company named Odin, purchased by Medtronic Navigation approximately two years ago. The head holder and pins are made of titanium. The magnet is relatively weak compared to full-strength magnets. Rooms with intra-operative MRIs are specifically designed to ensure the noise is low and the instruments are compatable, namely titanium. However, the magnet is often moved out of the surgical field during surgery and items like retractors do not remain in place during scans.
    I hope this helps.

38. alexey petrovsky
    October 4th, 2008 at 12:35 pm
    

    I an NOT a doctor at all but here are some clues that I can expect from myself to recognize. (I am kind of monitoring fanatic and like to detect slight disturbance in different kind of stuff, like networks or relationships.)

    It’s way too hard to scan and regocnize all the scene from MRI, so the doctors have to watch ‘their’ zones they are paying high attention. They claim which one of the zone are clear or not.

    So Foreman was ‘lucky’ to look exactly where the clot is and ‘lucky’. Others should to monitor their sectors. House could look at another trouble-free sector and see nothing. It’s kind of induced tunnel vision that drivers have in high speed (and the final cut is just to approve my guess).

    As I understand, the blood was used as a contrast agent in this case. As I see usual scans and graphs (like in MRI section in Wikipedia) they are all the scans of static planes but in this case MRI was used as controlling device that shows ONE plane but on a time scale.

    So, there maybe an interest in dynamic time-spatial picture on a choosen plan but the spatial snapshots of different planes.

    So, House did use MRI as a hacker and bear a respect for this.

    This Ep is attractive to myself, so I can get an brain atlas and TRY to figure myself.