House - Episode 7 (Season 2): “Hunting”
This medical review of House contains a whole bunch of spoilers, so don’t say I didn’t warn you…
House finds himself accosted outside his home by Kalvin, a young man with AIDS who wants House to figure out why he is having increasing shortness of breath and fever. House tells Kalvin that he simply has one of the common infections that occur in AIDS patients and to leave him alone. When Kalvin refuses to leave, House gives him a gentle shove. The patient falls, hitting his chest against a nearby car and going into anaphylactic shock — a sudden and life-threatening allergic reaction.
Kalvin is admitted to the hospital, but House is still sure that he must have an opportunistic infection such as herpes simplex, pneumocystis, or tuberculosis. Kalvin’s tests are all negative and his T-cell count is over 200. T-cells are the infection-fighting cells that are the targeted by HIV; a high T-cell count makes it unlikely that Kalvin has an opportunistic infection.
Kalvin’s drug screen is positive for methamphetamine and ecstasy, and when Cameron confronts him about this, he develops a sudden hemoptysis — a bloody cough — and some of his blood ends up in Cameron’s eye and mouth. Realizing she has been exposed to HIV, Cameron talks to the hospital infection control officer who starts her on some anti-viral drugs. She must wait six weeks before being tested because the AIDS test looks for antibodies against HIV, not HIV itself, and these antibodies take several weeks to show up.
Cameron wonders if Kalvin’s symptoms may have been caused by contaminated drugs so she and Chase search his apartment. They don’t find any drugs, but they do discover some old photographic equipment and speculate that Kalvin may be suffering from beryllium poisoning, since that was a chemical used in old flash bulbs. A subsequent lung biopsy is negative for beryllium damage.
Kalvin becomes suddenly short of breath and his distended neck veins suggest cardiac tamponade. Tamponade occurs when the pericardium, the sack that surrounds the heart, fills with so much fluid that the heart cannot expand properly. The treatment is to drain the fluid through a long needle inserted through the chest wall into the pericardium. Most tamponades are caused by blood, but when a clear liquid is withdrawn instead of blood the team suspects Kalvin must have a cancer of the heart. A CT scan confirms a tumor mass in the heart and some smaller ones in the lung. Non-Hodgkin’s Lymphoma is the diagnosis and surgery is scheduled.
Meanwhile, Kalvin’s father has come from Montana. He and Kalvin don’t get along because they both blame Kalvin for his mother’s death. When House notices the father profusely sweating, he deduces that Kalvin does not have lymphoma, but instead a parasitic infection known as echinococcus. Kalvin and his father both caught this disease years ago while hunting foxes in Montana, and it had laid dormant until recently. In Kalvin, it masqueraded as heart and lung cancer, while in his father it masqueraded as cirrhosis — a liver disease most commonly caused by heavy drinking. It was the fever that gave it away, because cirrhosis does not cause fever. When these parasitic cysts would break open, such as when Kalvin fell against the car, the body would develop an immediate allergic reaction against the parasites causing anaphylactic shock. Two quick surgeries later and Kalvin and his father are healing, both physically and mentally.
The medicine was reasonable. House’s behaviors, such as purposefully inducing anaphylactic shock in the father, were unethical and quite likely illegal, but the science behind them was sound. I do wonder what sort of radiologist could mistake a hollow cyst for a solid tumor on a CT scan, or confuse cirrhosis with a cyst.
The highlight of the show was the soap opera. Using the notes he stole last week from Stacy’s therapist, House begins to worm his way back into her life. He tries to show her that he can do all the things her incapacitated husband can’t — such as cleaning the dishes and catching the rat terrorizing her apartment. He also continues his subtle and not-so subtle jibes at her husband, like leaving the toilet seat up so that he’d know Stacy had had a male visitor. By the end of the episode Stacy realizes that House had read her file and kicks him out of her office, and possibly her life entirely.
Meanwhile, Cameron is not coping particularly well with her HIV exposure. She puts on a brave front, but is clearly scared. She samples some of Kalvin’s drugs and seduces Chase while she’s high. A very dumb move on her part, but a monumentally stupid one on his. Not only does Chase sleep with an intoxicated co-worker, but one who may be HIV positive as well. Only time (and a few more episodes) will tell.
This episode earns a C+ for the mystery, a B+ for the solution, and another B+ for the medicine overall. The soap opera, especially the Cameron and Chase subplot, earns a solid A.
November 23rd, 2005 at 10:10 am
Is the risk of contagion from sex only a few hours after the initial exposure (that happened at another part of the body) all that high? As a layman I wouldn’t think the virus reproduces fast enough in the blood for that to be non-trivial…
November 23rd, 2005 at 10:18 am
Official Comment
Jeff, it’s very unlikely, but certainly possible.
November 23rd, 2005 at 2:56 pm
Hiya,
I live in Britian and love this site. I love to be spoiled as I can’t wait for these epiosdes to show here.
I have a few questions/comments. Surely Cameron and Chase would use condoms, making the risk of exposure much smaller? I also find it slightly ironic that Cameron was so judgemental about the cyclist in Spin using drugs and now she is indulging…or has she been around House too long? Also, what is the difference between non-Hodgkins and Hodgkins? One is more aggressive than the other?
Again, fab site, and great to get a medical opion of the program. It certainly doesn’t spoil my enjoyment of this show. I certainly don’t watch for the accuracy, although I certainly will be more careful about talking about clubbed fingers and heart disease without first looking it up!
November 23rd, 2005 at 3:46 pm
How could you NOT talk about the all important rat diagnosis?
And now House seems to have a pet, and he’s even named it (sentimental old softy). Aww, talk about a soap opera! (I find the soap opera parts largely boring and unstatisfying, so the rat actually does seem an improvement.)
No, seriously, neat review; it’s cool to learn just how goofy the medicine on the show generally is.
November 23rd, 2005 at 10:18 pm
I was thrilled to see that House’s house number is “221B,” as it well should be.
November 24th, 2005 at 12:10 pm
Chase used a condom… but Cameron is a biter. She drew blood on his lip, which is why Chase was staring at himself in the mirror later in the episode. I guess it’s easy for him to tell Cameron not to worry, but a little harder when he too has been exposed. Let’s see, the big reveal should come right around February sweeps, right?
November 24th, 2005 at 1:03 pm
After Cameron was exposed, House was not only disinterested, but also shut down anyone who did show her any concern (Chase, Wilson).
The psych literature suggests that while this may work for some people, others need to be able to talk and process the event otherwise they have difficulty dealing with it and it may balloon into something even more emotionally traumatic than it needs to be. As it did in Cameron’s case; chance are that had her colleagues been willing to process the events with her in a professional manner, she might not have listened to the patient and tried the P&P route. Her shower after the exposure, if it was unduly long or overly vigorous scrubbing, should have given them a clue,
November 24th, 2005 at 9:37 pm
Sorry, I’m a little fuzzy-minded from a turkey overdose right now, but I can’t figure out what “P&P” stands for in this context. The only thing that comes to mind right now that fits the situation is “Pills & Passion”; while that is indeed suitable, I doubt it’s the acronym you meant.
December 6th, 2005 at 5:19 pm
P&P (more frequently abbreviated “PNP”) is “Party and Play,” sex, often group sex, while on drugs or alcohol. The most commonly used drug during PNP is crystal meth. I don’t know if the term was first used offline or online, but it’s commonly used on online hookup boards to meet strangers for sex. It’s a very high-risk activity.
It almost always refers to gay sex, though the term is becoming slightly more common in heterosexual circles.
Thanks for the great content on the site, Scott. I wandered in via one of your comics posts and got instantly drawn in here. I have only a somewhat medically educated layperson’s point of view (one of my work responsibilities is tracking health trends and risk behaviors, which is how I know the PNP info) and these lucid but thorough explanations are magnificent!
March 9th, 2006 at 1:48 pm
I think you missed a key medical issue in the episode — Cameron’s casual use of methamphetamine. Meth is almost always extremely addictive on the first use — something Cameron should have known, I would think. This sent a horrible message about casual use of a drug that just shouldn’t be used casually, and was especially egregious on a medical drama.
April 5th, 2006 at 9:30 pm
I didn’t think Cameron *bit* Chase - I thought it was a cold sore!
April 5th, 2006 at 9:35 pm
Another point. Early on, they say they screened Kalvin for parasites, which came up negative. Yet later it seems the collapse was caused by House making one of the parasite-laden cysts to break, thus releasing a heap of the parasites for the body to react against. Surely at that point the parasites should have been visible on tests?
April 9th, 2006 at 7:37 am
I thought the point of Cameron not asking Chase the condom question showed that they didn’t use one. She was asking if the guys always used condoms, so I thought that meant she knew Chase didn’t at least once. (That seems unwise on his part, but Chase is known to be an idiot on occasion.)
June 13th, 2006 at 2:17 am
Hey I had a question…how was Wilson able to diagnose anaphylactic shock so quickly and definitively in the begining of the episode?
July 3rd, 2006 at 4:54 pm
So, one thing that always puzzled me about this episode was the HIV test turnaround time. I had a friend who had the unfortunate scare of having unprotected sex with someone who later contracted HIV. For a time, it was uncertain as to when she had it, so my friend might possibly have gotten it. His HIV test came back in 48 hours, not six weeks. Why the time difference?
July 4th, 2006 at 11:39 am
Official Comment
Pungee:
The turnaround time for an HIV test depends on whether it is positive or negative. Negative results come back within 2-3 days. If the initial test is positive for HIV, then the lab runs a different confirmation test (on the same sample of blood) and this adds several days to the turnaround time, about a week. Because of this time difference, many labs which offer HIV testing will only release the results after a set period of time, usually 7-10 days. This way patients don’t start freaking out if their results aren’t back quickly and think they are positive, when it could just be a busy day in lab or broken equipment.
The HIV test does not detect the virus itself, but rather out body’s antibodies against the virus. It akes about six weeks for these antibodies to develop after exposure. Thus if Cameron were infected with HIV, she may not test positive for six weeks.
November 9th, 2006 at 8:12 pm
At that very beginning they announce that Kalvin has a CD4 over 200. That would make the diagnosis of non-hodgkin lymphoma unlikely as well.
November 28th, 2006 at 8:15 pm
Hey,
If she was on a PEP shouldn’t that further extend the window period for an HIV test? I found something about it here: http://www.iasociety.org/ejias/show.asp?abstract_id=2172342
July 6th, 2007 at 1:07 pm
Small point, but I don’t think House put the toilet seat up to make Stacy’s husband suspect that a man had been there. One of the things House had read in Stacy’s therapist’s notes was that she thought her husband was being passive-aggressive and doing annoying things, like leaving dishes in the sink and leaving the toilet seat up, to get under her skin. I think House moved the toilet seat up so Stacy would see it and get irked at her husband.
Love the reviews!
July 6th, 2007 at 8:08 pm
Not an entirely relevant question but more one of clarification. Meth’s was mentioned and someone above used the phrase methamphetamines, this makes more sense than what I thought (methylated spirits, very poisonous smart doctor like Cameron would know better.)is when the abreviation Meth. is used which is it normally refering too and secondly what about crystal meth. I just realised that my meth=methylated spirits was just assumed by me and I don’t think I’v ever questioned the assumtion. Anyone?
July 22nd, 2007 at 2:25 am
Pill:
“Meth” is generally an abbreviation for methamphetamine; “crystal meth” is a common term for the smokable version of methamphetamine.
August 15th, 2007 at 12:13 pm
just as an answer to bob braley: this is a common mistake and government propaganda. meth is only psychically addicting, not physically, and there’s no drug in the world that makes you psychically addicted on the very first usage (or on rare usage). Even heroine needs to be used at least 2-3 days to make you feel withdrawal. meth isn’t even addicting to some people, everyone is different.
the drug that comes nearest to the “first time use addiction” would be crack cocaine because of the extreme onset and extremely short duration.
December 14th, 2007 at 3:18 am
I agree with msh … leaving the toilet seat up had nothing to do with letting Mark know about the visit and everything to do with getting Stacy annoyed.
Mark could have assumed that Stacy was cleaning and forgot to put the seat down, but Stacy is sure to assume that Mark left the seat up on purpose.
January 5th, 2008 at 12:57 am
in response to pills question. generally “meth,” at least here in california, refers to methamphetimine. crystal meth is a purer form of methamphetimine, so called because of the snow flake like appearence of the dope. the difference has to do with the ratio of iodine to other chemicals used during manufacture.
February 23rd, 2008 at 9:13 pm
Use your powers of deduction here… two of you stated that the toilet seat thing was to irk stacey and and have the blame fall on mark. There is a tiny little detail in marks life that makes such a thing HIGHLY unlikely… The guy is in a friggen wheelchair! If the man can’t walk, I doubt he’d be able to (or even want to) stand up while urinating.
April 18th, 2008 at 9:15 am
It is stated that Mark already leaves the toilet seat up by Stacy’s notes in the sheet. It’s clearly obvious Mark is doing it to intentionally annoy her.
Concerning the condom question, it depends on your interpretation. She asks Foreman and House, not Chase because she knows the answer, she slept with him, however the answer could have easily been “Chase uses a condom” just as easily “Chase doesn’t”.
May 9th, 2008 at 6:44 am
Somebody asked why they say 6 weeks for HIV test than few days. I think that they meant Dr Cameron has to wait 6 weeks for the HIV test to be of some use. I’m not a doctor or anything, but i don’t think a drop of infected blood would have enough virus to show positive in the test if done immediately. My understanding is that, they will give meds to stop the virus, and test her after 6 weeks,3 months, 6 months ….. Thats what they said, right?
On another note, this is a great website,. It really helps to know what is real and what is not.
June 25th, 2008 at 1:58 pm
I drew a completely different conclusion about the toilet seat - for some reason, I assumed that House did it so that if Mark sat on it without paying much attention, he’d sort of fall in a bit! I have very strange thought processes!
And yes, as everyone says, this site is great! It’s nice to see everyones’ thoughts on what’s happened, as well as to see how accurate things are! I’m sort of watching series 1 and 2 simultaneously at the moment, and I’m loving it, as I only discovered House a couple of weeks ago!
July 28th, 2008 at 1:02 pm
I assumed the toilet seat was to mock Mark - since he can’t stand, and Stacy can’t pee standing, obviously a man was in the house using their toilet when he was away.
September 6th, 2008 at 10:41 pm
Is there any reason to think he can’t stand at all? He uses the wheelchair to get around normally, but that doesn’t mean he can’t stand up long enough to pee.
September 29th, 2008 at 12:22 am
If the father had hydatid cysts in his liver, and House ruptures one, wouldn’t that cause a massive reinfection throughout the abdomen?
October 2nd, 2008 at 7:44 pm
The longest known time between contraction and onset of HIV was 10 years, right? So even if the test were negative six weeks later, that wouldn’t necessarily rule it out. Wouldn’t it theoretically be possible to have the test be negative but find out a year or so later that you have it after all? Or are the antibodies present from the start, just no symptoms?
On the subject of drugs, LSD is another that probably should not be taken even once. As for meth…well, did Cameron take the patient’s meth or get her own? Because it seems unlikely that someone as ‘morally upstanding’ as Cameron generally is would even know where to get meth, let alone actually get it. I mean, she might know a few people who *probably* deal, but I doubt she would be too familiar with the local dealers, particularly for something like meth, which is generally just made at home.
December 21st, 2008 at 10:48 pm
Not really sure where I stand on the condom thing. There are plenty of clues pointing to wether or not he did ( obviously Cameron knows wether or not he did because she slept with him), but at the same time Chase doesnt seem very worried about the possibiltity of having HIV. I kind of saw this happening at some time. Chase had always had the hots for Cameron, but I just wasnt expecting sweet little Cameron to get high and seduce someone that “House would do Wilson” before she did. *Ha*
January 12th, 2009 at 3:23 pm
Stacy’s husband can’t walk or stand at all. You see that a few episodes later when he tries to follow House up some stairs.
January 21st, 2009 at 10:22 am
Did anyone else noticed that House added an extra syllable when making the final diagnosis? He said “ecihnocococcus,” not “echinococcus.” Thank God for Tivo.
May 16th, 2009 at 3:23 pm
One interesting thing I found in this episode is the background story for the patient and the dead mother. After the scene where House confronts the boy and his father, Cameron summerizes what Kalvin had lied about: he “killed’” his mother by not being a valid kidney donor because of his AIDS.
I found that hard to believe, although I don’t know much about medical practice in such situations. In my point of view if someone was dying of kidney failure and could’t find a transplant other than one with HIV (but otherwise healthy and good for the operation), the doctors would give her that kidney.
The chance that you can live several years before dying of AIDS is still better than just dying right then in my opinion. Or is there something I’m missing here?
Also HIV might even make the transplantation easier by lowering the chance of rejection since it hinders immune response.
June 2nd, 2009 at 11:53 am
Why do people see Cameron as moral?
She commits selfish felonies just as often as House.
She is more squeamish about watching suffering than upstanding. She lies and manipulates to the detriment of her patients even more than House.
June 2nd, 2009 at 9:16 pm
She is moral because she is hot and tries to look that way.
She has one thing House will never have and press that advantage all the time, she is attractive so she can pull all kinds of stuff and get away with it while she is at it.
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