Polite Dissent

Another tale of strange Silver Age medicine, this time from World’s Finest #87:

A new masked and super-powered bank robber appears in Metropolis and Superman tracks him to his lair only to find that the robber had been waiting for him with a chunk of kryptonite.

A few months before, our robber realized that if he wanted to be a successful criminal in Metropolis, he needed to find some kryptonite. He spent months tracking down every meteor¹ that landed nearby, looking for elusive chemical. He lucked out: not only did he find kryptonite, but he also found a box with some pills in the meteor. There is a note with the pills that reads “These radioactive capsules to be used only if needed to renew our super-powers on Earth. [Signed] Jor-El”

The robber took the kryptonite-embedded box back to his lair. He swallowed one of the pills, gained super-powers, and went on a crime spree. Then he lured Superman to his hideout and exposed him to the kryptonite. Leaving the Man of Steel for dead², the criminal flies off to commit more robberies.

Of course, Superman’s not quite dead yet — he takes his last bit of energy and uses his heat vision to break the water pipe in the ceiling, sending water cascading down on the box of pills, washing all the kryptonite away³. Able to stand up again, Superman grabs the box of pills and swallows one, figuring he needs the super-powers they’ll provide since his have been stolen by the kryptonite. Too late, he discovers that some kryptonite dust had gotten in the pills when Krypton exploded — the same explosion which sent the box to Earth. Now he’ll be completely powerless until the chemical leaves his system⁴.

Thinking quickly, Superman calls Batman and Robin. When the duo shows up, he gives them each one of the super-power pills, and they fly off to capture the robber. Since they’re not used to their new powers, not only do they let the villain escape, but they cause some serious property damage. Undeterred, Superman trains them in the use of their powers and they fly off again to capture the robber.

Meanwhile, Superman — using his crafty reporter skills — has discovered the robber’s new lair. Unfortunately, the robber catches Superman in his hideout and pulls out a gun, shooting him in the chest. About this time, Batman and Robin arrive and capture the villain, who is still gloating over Superman’s body. Could the Man of Steel be dead? Of course not. It turns out that while Superman may have been powerless, his suit was still invulnerable and it blocked the bullet, saving Superman’s life. It’s all a moot point now anyway, as the kryptonite has worn off and Superman has regained his powers. He gives the super-power pills to Batman who promises to keep them safely hidden away in the Bat-cave⁵.

Notes:
1. Yes, technically he was searching for a meteorite, not a meteor, but I’m sticking with what’s written in the comic for this review.
2. If I were a criminal who gained his super-powers through a pill, I would take the pills with me instead of leaving them behind. Sure, leave the kryptonite-encrusted box — just take the pills.
3. Apparently kryptonite is water soluble.
4. Kryptonite or not, shouldn’t the pills have given Superman super-powers? They were developed to give Kryptonians who lost their powers (like Superman) temporary powers. He took one after losing his powers temporarily from kryptonite exposure, so why should more kyrptonite dust in the pills stop them from working? It’s not like they’re affected by kryptonite — Batman and Robin got powers despite the kryptonite in the pills.
5. As far as we know, the pills are still there. Or at least, all but one of the pills…

Tags: comics medicine kryptonite superman batman robin jor-el pills

The basic concept of defibrillation is to provide enough current to knock the heart back into a normal rhythm, but not enough to do any damage.

I think Norman Osborn missed that memo.

I’m not entirely sure what to make of this scene, so I’m just going to engage is some speculation and throw out some ideas. There’s not quite enough information provided to know for sure what is going on. This may be due to cleverness on the writer’s part, or laziness. Regardless, Bendis’s glacial pacing is making this scenario last months.

We know that Luke Cage has had a “cardiac episode” — probably a heart attack — so he needs someone to restore the circulation to the arteries that supply his heart. Non-surgically, this can be done with thrombolytics (“clot-busting” drugs), or by angioplasty. Since he’s undergoing surgery, it seems he’s receiving a CABG (coronary artery bypass graft), the surgical method of restoring the heart’s circulation.

But then the surgeon mentions the pulmonary artery and also mentions a pump in the next panel (not shown here). Why is the surgeon messing with the pulmonary artery? It’s not part of coronary bypass surgery.
Is Cage’s heart so badly damaged that he requires a ventricular assist device to keep him alive (basically, a pump that helps the heart pump)? The doctor is focusing on the pulmonary artery which would mean Cage is getting a right ventricular assist device (VAD) instead of the much more common, and useful, left VAD. Frankly, neither VAD really fit Cage’s situation all that well.
Maybe he meant an intra-aortic balloon pump — which fits the circumstances better — and he just messed up the anatomy.
Or is Osborn up to something nefarious and implanting something nasty (which is my suspicion)? Time will tell, though at this rate my great-great-grandchildren will be reading the conclusion long after I’m gone.

Other thoughts:
♥ If you’re using a scalpel and the skin is “tearing”, then you’re doing something wrong. Surgical scalpels cut through skin like a hot knife through butter — if anything, it’s easy to cut too much.
♥ No mention of “cracking the chest” — opening the rib cage (because it’s hard to reach the heart, otherwise) — though the previous panel does show some rib spreaders at the ready.

Could have been a contender, but was KO’d by bad science and too many clichés

The Plot: A married man in Boston mysteriously turns to ash while waiting to spring an anniversary surprise on his wife. The Fringe team is called in to investigate. Broyles tells Dunham that he’s seen this before — there were five similar deaths several years ago at a hospital in Washington DC. He tells her he was contacted by an “Eastern European” man who provided a strange formula to him and indicated it was the solution to the deaths. Unfortunately, none of the FBI’s scientists could decipher the formula several more deaths occurred before they suddenly stopped — until now.

Dunham digs a little deeper and finds that the victim had recently been visiting his sick mother at a hospital. The Fringe team stakes out the hospital, trying to find a link between this hospital and the one four years ago in DC. They find a critical care nurse named Tomas Koslov who has worked at both institutions. Meanwhile, another ash-death has occurred on the in the hospital. A review of the hospital’s surveillance tapes show a strange being made entirely of shadow moving down the hall right before the death was discovered.

The team locates and searches Koslov’s apartment but discover he has abandoned it. They are able to find a fingerprint. When they run the fingerprint they find that their suspect is man by the name of Timur Vasaleiv who is wanted by both the CIA and the Russians because he stole something important from Russia. Broyles is told that the CIA will be taking over the case, but he decides to keep his team on it anyway. A contact at the Senate sends him Timur’s file. It turns out that his brother Aleks was a cosmonaut who returned comatose from a space mission, and it is his brother that Timur has stolen from a special Russian quarantine facility. He has been keeping him in various American hospitals while posing as an ICU nurse.

Walter has been working on the formula and realizes that it represents an organism that seems to feed on radiation. The hospital patients died because they all had been undergoing radiation treatment, and the husband died because he had been on a recent cross country flight (where he had been exposed to higher than normal levels of background radiation).

Timur returns to the hospital and takes his comatose brother out of the ICU and to a hotel. The shadow tries to emerge, but using a series of car batteries, Timur shocks his brother enough that the shadow retreats. He also knocks his brother into asystole (flatline), but after a few moments, a normal heartbeat returns.

Confident that Walter can crack the formula, Agent Broyles reaches out to Timur and offers his help. Timur is trying to decide whether to take Broyles assistance when he slowly turns to ash — the shadow is loose. The FBI arrives to find the comatose cosmonaut and the dead Timur. Peter thinks Walter can shock Aleks to make the shadow return, but Walter cannot read the equipment as it is all in Russian. When they hear a young girl scream from another motel room, Broyles takes unhesitating action and shoots Aleks in the head, killing him. The girl tells her mother that there was a shadow man in the room, but he disappeared. Later, when the CIA approaches Broyles to warn him off their case, they tell him that despite being shot in the head, Aleks returned to life, and they apparently sent him back into space.

1. Glow In the Dark
There is a major misunderstanding of radiation here. While the victims had all been recently exposed to radiation, but they were not radioactive themselves. There was no “high levels” of radiation for the shadow to detect, let alone feed off of.

2. Feed Me, Seymour
What had the shadow been feeding off of for the past four years, after DC but before the husband died?

3. I See You
There is no way a patient is going to sit for four years in a hospital ICU like Aleks apparently did.
ICU beds are incredibly expensive. The hospital billing department would have been on the phone to his insurance company as soon as he was admitted. No insurance? While they wouldn’t have kicked him out (unless he was medically stable and had a place to go), they would have been looking at the records very closely.
If someone is in a permanent coma, they would be transferred to a rehabilitation hospital or a nursing home as soon as they were medically stable. They wouldn’t keep them in a regular hospital ICU indefinitely.
How did he get him admitted to each new ICU? ICU transfers are very irregular unless one is going from a less-equipped hospital to a better-equipped one, and that doesn’t seem to be the case here.

4. Eleven Herbs and Spices
In my brief look at the formula, there seemed to be a number of carbon atoms with more than 4 bonds. I admit that Ionly had two years of Organic Chemistry, but that seems quite unlikely to me.

5. Blackjack
Your Osama Tezuka link for the day: the little girl was watching Kimba, the White Lion.

The plot line had potential, but was dragged down by too much bad science, reliance of clichés, and deep piles of nonsense they didn’t even try to explain away. The clock moves closer to midnight.

UPDATE: And I should mention that I’m already dreading next week’s show, just based on the preview, where they mention the completely debunked “most people only use 10% of their brain” myth as if it were fact.

Tags: television medicine fringe sleep coma ash formula radiation

The criminal who discovered Jor-El’s super-power pills has escaped from prison and rumor has it that he has hidden one last pill somewhere. Superman, Batman, and Robin rush off to capture him before he can reach the pill, but the criminal slips by them. Batwoman (the mini-skirted all-but-incompetent Silver Age Batwoman, not the current one) decides she wants in on the act. She manages to find the villain and grabs his pill before he can swallow it. She then swallows the pill herself — and with her new super-powers — returns the criminal to prison.

Now that Batwoman has super-powers for the next twenty-four hours, how do you think she decides to use them? Stop crime, right? Wrong. She decides she is going to use her super-powers to discover the identities of Batman, Robin, and Superman.

So, not only does Batwoman — an alleged super-hero — not use her new powers to fight crime, but instead she uses them to betray the confidence of other heroes. Nice going.

Batwoman follows Batman and Robin as they drive around Gotham City in the Batmobile. They give her the slip — or at least they think they do — but as soon as they drive into the Batcave, there she is waiting for them. She tells the duo she used her x-ray vision to find the Batcave, and now, based on the mansion above the cave, she knows their identity. Next she sets out to discover Superman’s.

Batwoman catches up with Superman when he is saving a small town from an avalanche. She follows him, hoping he’ll lead her to his secret identity. He tries to scare her away by flying through a lightning storm, walking through an artillery proving ground, and floating over Niagara Falls, but none of it works. Finally, he decides what his only option is to expose her to the thing every woman is scared of: mice.

Superman’s plan works and he sneaks out through the basement, drilling through the ground, making sure to stay below veins of lead-bearing ores, but Batwoman is able to track him by sound. When he emerges from the ground, she tells him that he has fallen into her trap. She’s lured him away from his job for the whole afternoon, and since she saw what block of Metropolis he came from, all she has to do now is find the office in that block where a worker has been missing all afternoon. When she shows up at the Daily Planet, Lois tells her everyone has been there the whole day (but she only mentions Clark, Jimmy, and Perry — so in the Silver Age the Daily Planet apparently only employed four people). At this point, Batwoman’s twenty-four hours of powers are up and she admits defeat in figuring out Superman’s identity — but at least she knows the true identities of Batman and Robin. Not so fast, says Superman:

And just in case you were wondering:

Story from World’s Finest #90 (September/October 1957), by Edmond Hamilton and Dick Sprang

Tags: comics medicine kryptonite superman batman robin batwoman jor-el pills

This episode of House started well but collapsed under the weight of its ridiculous medicine in a surprisingly short period of time. The soap opera was well done and enjoyable, though

Jordan, a sixteen year-old girl, and her best friend bluff their way into a band’s post-concert party. The next morning when they are regaling their other friends with the details of the night (including alcohol, marijuana, and skinny dipping), her friends notice that Jordan’s ankles are very swollen. Seconds later, her fingers become swollen too, and then she collapses on the floor.

Admitted to Princeton-Plainsboro, House is convinced that Jordan has rhabdomyolysis (muscle damage, often caused by a crush injury. He thinks she injured herself climbing the fence to the pool to go skinny dipping). The rest of the team suggests that she may have a deep vein thrombosis (a blood clot), anaphylaxis (a life-threatening allergic reaction), or even a heart condition, but House maintains that Jordan must have rhabdomyolysis. Tests reveal that Jordan’s muscle enzymes are elevated (a sign of rhabdomyolysis), but the scans show no sign of the muscle injury House was suspecting.

House now looks over the labs and notices that Jordan has a low potassium. He has her air drum (like air guitar, only drumming), but she can only drum for a minute or two before her arms are too tired to lift. House states that this muscle weakness is a sign of low potassium, and since she would have had a low potassium the previous night as well, there was no way she had the muscle strength to climb the pool fence. In other words, he accused her of lying about what happened. Later, Jordan and her friend admit to Cameron and Chase that in reality, they only wanted to go to the party because their favorite comic book/movie writer Jeffrey Keener would be there. They then proceeded to stalk him for the next few hours (going where he went, eating what he ate, etc), before finally going to bed.

The differential now consists of an unknown food allergy, plus Cameron thinks that Jordan may be bulimic. They run a scan to look for a Mallory-Weiss tear (a rip in the esophagus seen in people who vomit frequently, like bulimics), and when they don’t find one, decide that she isn’t bulimic. As they finish the test, Jordan’s blood pressure drops suddenly and then she flatlines. Foreman starts CPR (good for him). Chase announces that Jordan has cardiac tamponade (the pericardial sac — the membrane around the heart — has become filled with so much fluid the heart can no longer beat correctly) and he plunges a needle into her chest to draw off the blood around the heart and relieve the problem. Somehow, this brief moment of tamponade has severely damaged (“constricted”) her heart, necessitating use of antiarrhythmic medications (drugs to prevent abnormal heart rhythms). Since Jordan’s blood pressure drop was sudden, House decides that this means she has an acute problem, not a chronic one. Therefore, the most likely diagnoses are toxin exposure or infection, but the team still needs to figure out which toxin or which infection.

Things continue to worsen for Jordan. She tells the team about stopping by Bruce Springsteen’s house and playing guitar with him . She is lying and does not even realize that she is doing it. Additionally, Foreman notices blood dripping from her ear and announces to her friend that bleeding in her brain is affecting her thalamus and this is causing her to lie. (When did he get an MRI to determine this? And why would bleeding in the thalamus — in the center of the brain — leak out the ear? Did she somehow rupture her eardrum too?)

The team reviews the videotapes from the hotel that night and discover that Jordan sneaked out of her room briefly in the middle of the night. They see her a few minutes later carrying Keener’s journal. He apparently left it in the restaurant and she went back to get it. They figure that she must have stopped by his room to return the journal and maybe something happened to her there. Chase and Cameron confront Keener in his hotel room — he shuts the door in their face. Cameron now suspects that Jordan was slipped some roofies (a slang term for Rohypnol, an alleged common date rape drug) and wants to start her on Flumazenil (a medication which reverses the effects of Rohypnol and similar drugs). When they return to the hospital, they find Foreman frantically working on Jordan. He tells them that she has been bleeding behind her kidneys and has required multiple units of blood. Cameron thinks it looks like a “toxic reaction.”

Cameron realizes that they must figure out what really happened to Jordan that night. Her plan is to give Jordan Amobarbital — i.e.truth serum — so they can discover the truth. Jordan is given the drug, and under questioning, admits that she went to Keener’s room where he invited her in and gave her Ecstasy — only it didn’t have the same effect on her that Ecstasy usually does — this pill made her sleepy. She then begins telling the team how Keener started to touch her. As her father gets more and more upset, Foreman points out that the scans indicate “increased periorbital blood flow” meaning that everything she just said is a lie.

Most of the action now shifts upstate, where Cuddy, House, and Wilson are at a medical conference. At one point, the team talks to Wilson and tells him that since Keener travels with his dog, Jordan may have come down with Rickettsia (not the name of an infection per se, but a genus of tick-borne bacteria that cause such diseases as typhus and rocky mountain spotted fever). A short time later, in the middle of an argument with Wilson, House has his Eureka! moment and calls the team. He announces that Jordan has Vibrio vulnificus, a not uncommon bacterial contaminant of the raw oysters Jordan ate. For most people, the bacteria present no problem (or mild nausea and vomiting), but Jordan also has hemochromatosis. According to House, this made her more susceptible to the contaminated oysters. The Vibrio infection explains her initial symptoms. Then the team, thinking she had bulimia, started her on iron-containing vitamins, which worsened the symptoms of the hemochromatosis (by causing iron overload), resulting in liver damage and bleeding. They gave her transfusions, which again worsened her symptoms (more iron overload). However, with the right diagnosis and some Cetazidime (an antibiotic for the Vibrio) and chelation (for the excess iron), she should be as good as new.

Tonight’s episode was rife with errors, far worse than usual. I did my best, but I’m sure some obvious one slipped by. As usual, major complaints are in red, minor in blue, nit-picking in green:

The truth serum idea was simply ridiculous. Amobarbital does not work like Cameron explained, and it is far from foolproof — for example, it’s easy to create false memories (and the questioner Cameron clearly had a preconceived belief of what happened to Jordan).
Telling truth from lies is not nearly as black and white and Foreman makes it seem. You can’t look at an fMRI report and definitively state “she was lying the entire time” like he did. But it sure would make police interrogations and court a lot easier if it worked as easily as Foreman implies.
Anyway, where is the fMRI? Jordan was in a bed in the center of the room. There was no MRI equipment in sight. Nothing to read the “increased blood flow” he mentions.

Cardiac tamponade or not, you don’t just plunge a needle and syringe blindly into the chest — you’re likely to do more harm than good. Yes, you can perform a needle pericardiocentesis, but it’s more involved than “plunge and pray.”
Why would 20 seconds of tamponade cause a permanent conduction problem in the heart?

A day or two of iron supplementation is not enough to cause that severe liver damage in a patient with hemochromatosis. And apparently it kicked in really fast, because it bled into her pericardial sac mere minutes after suggesting the diagnosis of bulimia, let alone giving her vitamins with iron.

Jordan’s symptoms do not match Vibrio at all. For starters, she has no gastrointestinal symptoms from what is essentially food poisoning.

When did Foreman get an MRI to determine that Jordan had “bleeding into her thalamus?” And why would bleeding in the thalamus — in the center of the brain — leak out the ear? Did she suffer head trauma which disrupted her ear canal and also ruptured her eardrum?)

Rhabdomyolysis can have other causes other that a direct muscle injury, so not seeing a specific injury on the scan means little (for example, many marathon runners end up with some rhabdomyolysis by the end of their race, but it’s not a single muscle, but most of them, so a scan would show nothing)

Not everyone with bulimia develops Mallory-Weiss tears, in fact, most don’t. So not seeing a tear does not mean she is not bulimic.

Edema is swelling of soft tissue. Effusion is the swelling of a joint. They are not the same thing and the terms should not be used interchangeably. A halfway decent physical exam, especially on someone as skinny as Jordan, should easily tell them apart.

Assuming Jordan did receive Rohypnol, the flumazenil, a benzodiazepine antidote, is a reasonable choice. But by the time Cameron would have given the drug to her, the rohypnol would have been long gone from her system.

Rickettsia is a genus of bacteria, not a specific disease.

Rhabdomyolysis is very hard on the kidney. I would think twice, and then a third time, before giving such a person IV contrast (also very hard on the kidneys).

I thought the medical mystery itself, and the confusion of the always changing history, was intriguing this week and deserves a B+. It goes downhill from there. The final solution did not fit the mystery at all — either solution — and earns a D-. The medicine overall was a complete mess, with scattershot diagnoses, ideas abandoned for sloppy reasons, and missing equipment. It earns a solid dismal F. The soap opera was a bright spot — especially all the scenes at the conference — and earns an A.

Last week’s House review
A list of all prior House reviews

The House Challenge scores are now up to date here.

With Veteran’s Day tomorrow, I looked hard to find a public service ad that discussed veterans. I was truly surprised that with all the public service ads DC produced in the 1940s, ’50s, and ’60s, there don’t seem to be any about veterans — or the armed forces at all. This PSA, from April 1950, was the closest thing I could find because it at least includes a scene set in a veteran’s cemetery.

The PSA’s actual theme is tolerance for all religions — which is certainly a sound concept, but I would’ve liked it better had it acknowledged religions other than Christianity and Judaism — or taken it one step further and at least mentioned other options such as atheism. But I suspect that would have been a little too progressive for a 1950s mainstream comic book.

Click on the image for the full ad

This PSA was found Adventure Comics #151, and can be found in other DC comics from April 1950. This ad was written by Jack Schiff, with art by Al Plastino.

More PSAs

Tags: comics psa superman superman jack schiff al plastino

A medical and a military reference all in one cover, courtesy of Punch Comics #17 (April 1946)

I swear, I have this same conversation with at least two or three patients a day. When will the horror of water allergy end?

An incredibly mediocre show that didn’t meet a cliche it didn’t like (except, unfortunately, the psychic nosebleed). Sorry if the write up seems brief, but I’m really having a hard time caring about this show recently.

The Plot:The police are called for a kidnapping/hostage situation at the top of a parking garage where two guys are holding a teen hostage in a car. When the police arrive, they order the men out of the car. The duo get out of the car and then strange things begin to happen: one cop backs up and throws himself off the garage, while his partner shoots the other cops and then herself. The two guys get back in the car and drive off with the kid.

The Fringe team is called in to evaluate the case. Walter suspects that there is hypnotism of subliminal messages involved. The team heads to Massive Dynamic because the kidnapped boy is the son of one of their top aerospace researchers. By now, the two guys in the car have been identified as two local used car salesmen who had been upstanding citizens until now. The kidnappers and teen stop by a convenience store and ob it. A burly customer tries to intervene, but suddenly he is pouring scalding coffee over his head and the breaking the carafe over it. The cashier tries to shoot the men, but finds himself picking up a key and inserting it into an outlet and shocking himself unconscious.

Walter has been performing an autopsy on the cop who shot the other cops and deduces that it was not hypnosis, but instead mind control. He makes his deduction based on the fact that there are hematomas (pockets of leaked blood) on the surface of the brain, suggesting some mind/body conflict. He then infers — for no good or logical reason — that this mind control must be done via the cochlear (hearing) nerve.

A call comes in from the kidnappers demanding two million dollars. Meanwhile, Walter has concocted white noise headphones for the FBI troops to wear in the field which should block out any mind control. At an abandoned factory, the teen’s father hands over a briefcase of money to the kidnapper, who then runs into a nearby building. Agent Dunham follows. Meanwhile, Peter sees someone else running with the briefcase and follows, only to find the teen, Tyler, holding the briefcase. It turns out Tyler’s the one with mind control and the others were nothing but patsies. Unfortunately, Peter’s white noise headphones don’t protect him and Tyler orders him to drive the two of them out of town in the Bishop family roadster.

Peter tries to rebel, but Tyler forces him to drive the car as fast as it can go and plays chicken with a truck before Peter agrees to behave. A little while later, they are pulled over by a policeman. Tyler wants Peter to shoot the cop, but in the end, he lets Peter just knock him unconscious. Finally, Tyler and Peter arrive at his mother’s house (by way of a strip club), where Tyler finally gets to meet the goal of his quest — his mother. He believes that his father had driven her away and lied to him about her, but that turns out not to be the case, and when he learns she is married he has Peter pull out a gun and point it at her husband. Luckily, Agent Broyles arrives and shoots Tyler with a taser — but it’s a bad shot. Tyler has Peter shoot Broyles, and then he and Peter hop back in the family roadster and take off. Agent Dunham, Astrid and Walter are following close behind, and when they get near off, Walter activates the EMP device he has been working on. It knocks Tyler out for a split second, and that’s enough for Peter to realize what is going on and drive into a telephone pole. He survives with a mild concussion, but Tyler is knocked unconscious and captured.

1. Watching Too Many B-Movies, and Now I Need Some Popcorn
Walter’s original suggestions were nonsense. As Peter pointed out, hypnosis doesn’t work like that — and subliminal messages don’t work at all.

2. La La La! I Can’t Hear You!
Why go through all the elaborate set up of the white noise headphones instead of just using ear plugs?

3. Bleeding On The Brain
Hematomas don’t form with brain/body conflict. There are certainly medical conditions with conflict between mind and body — somatization comes to mind — but none of them cause hematomas. You could argue that the straining led to an increased blood pressure which popped the vessels, but high blood pressure related bleeds occur within the brain, not on the outside.
That was a surprisingly intact brain for someone who received a bullet at point black range.

4. On the AM Radio
Why amplify the brain waves — that should have been the team’s first realization that something wasn’t kosher — why not just make better sensors?
Amplifying the brain waves means that you are increasing the voltage within the brain itself, which is wonderful way of setting off a seizure.

5. It’s Better Than The 10% Cliche, But Just Barely
Brains are not computers. Whenever someone uses this analogy, it’s a safe bet that they don’t understand brains or computers
Having Tyler’s mother actually be a surrogate was a fairly clever twist — really the only one in an episode thick with clichés — but how does the doctor raise all five Tylers? Are they frozen until needed? Does he spend one day of the week with each one?

6. The Blind Leading the Blind
Geez, Olivia is a bad detective. She already knows Tyler’s mother died when he was young, and then can’t figure out why he’s looking at records of women who died in car crashes fourteen years before.

7. Crime And (Lack of) Punishment
Why would Tyler get off with just seeing some psychiatrists? That makes no sense at all, especially the way they explain it. He was directly involved in the murder of five people, the maiming of three others, and at least three attempted murders. He’s fifteen — old enough to be tried as an adult.

Why exactly am I still watching this show? I’m sure I have much better things to do.

Tags: television medicine fringe mind control hypnosis subliminal

Another thing I have to tell patients and their families at least a couple of time per week.

The mystery was fairly bland in this week’s episode of House, but the medicine was much better overall. Good bye Cameron. Don’t let the door hit you on the way out.

Hank, a successful porn star is admitted to Princeton Plainsboro Teaching Hospital after developing a severe headache and photophobia (sensitivity to light) while on set. House starts off by ordering a series of tests: an STD panel (to look for sexually transmitted diseases), a toxin screen (to look for common toxins), C-Reactive Protein (”CRP”, a measure of inflammation), ANA (antinuclear antibodies, to look for autoimmune diseases) and a lumbar puncture (to look for viral encephalitis). While the patient is having his spinal tap performed, he develops severe muscle spam and pain (tetany) in his arms. Foreman orders meperidine (Demerol, a strong pain medication).

About this time, House starts hitting up Taub and Thirteen for ideas, trying to lure them back on the team. Taub suggests that Hank must have a brain problem, such as a tumor or seizure. Foreman believes that Hank suffers from cerebral vasculitis (inflammation of the blood vessels in the brain). House agrees with Foreman’s assessment and starts the patient on steroids. He also orders a brain angiogram (an x-ray of the arteries in the brain), as well as an EEG and a nerve biopsy, just to be sure. Foreman convinces Chase to perform the angiogram, but he and Cameron suspect that the patient is suffering from Vitamin D deficiency, so instead of checking the angiogram, they decide to start Hank on light therapy and intravenous vitamin replacement. Unfortunately, while undergoing the light therapy, Hank develops a nosebleed and is found to have petechiae on his legs.

Hank is now diagnosed with disseminated intravascular coagulation (DIC, a weird, but very serious, condition, where the patient is both bleeding too much and clotting too much). Sepsis is suggested as a possible cause, but since he is showing none of the shock associated with sepsis, the idea is discarded. Bacteremia (bacteria in the blood) is suggested, but Cameron shoots it down suggesting instead Meningococcemia (meningococcal bacteria in the blood — really a subset of what Chase suggested). House concurs with Cameron’s diagnosis and Hank is started on heparin (a blood thinner, for the clots) and a broad spectrum antibiotic that covers meningococcus (but if you know which bacteria you’re treating, then you don’t need a broad spectrum antibiotic).

Hank does not improve and he starts to run a fever. Taub suggests that he might have an infection hidden away in his sinuses, where the antibiotics have difficulty reaching, so Chase performs sinus surgery to clear out the sinuses. Now Hank begins to complain of severe abdominal pain and Cameron discovers something on the exam (apparent ascites — fluid in the abdomen) that makes her diagnose liver failure. She suggests a Klatskin tumor (cancer of the bile duct), but it doesn’t quite fit the symptoms. Foreman suggests that Hank has sclerosing cholangitis (a disease that damages the bile ducts). House agrees and an ERCP (an endoscopic exam of the bile duct and pancreas) is ordered — surprisingly it shows a mass in the common bile duct that ends up being a large clump of worms. Hank apparently has strongyloides (”whipworm threadworm”), and is given mebendazole to kill the worms.

Once again, Hank’s condition dramatically worsens. He develops severe pulmonary edema (fluid build up in the lungs). Chase thinks it might be a combination of a hematological (blood) problem and cardiomyopathy (a heart problem). Foremen suspects Hank has lymphoma, with peritoneal carcinomatosis (malignant spread of cancer across the abdomen) and paraneoplastic syndrome explaining his symptoms. House sides with Foreman, and Hank is started on chemotherapy. A short time later, Hank’s condition takes another turn for the worse when he starts urinating blood. Next, his blood pressure and heart rate skyrocket, and he starts to bleed from his mouth. He then suffers a cardiac arrest, but the team is able to stabilize him.

The latest labs are back and show that Hank barely has any red blood cells, white blood cells, or platelets. The differential diagnosis now includes hypopituitarism (an underfunctioning pituitary gland), renal cell carcinoma (a type of kidney cancer), or aleukemic leukemia (a leukemia that is associated with low white blood counts instead of the normally high counts found in leukemia). House tells the team that the latter is the most likely and orders them to ablate (destroy) Hank’s bone marrow in anticipation of a bone marrow transplant. There is a lot of hemming and hawing about whether this is the right thing to do, since it could make Hank sicker or kill him, but at the last moment, Thirteen and Taub call in with the correct diagnosis: extraintestinal Crohn’s disease. According to them, Hank’s exceptionally clean childhood made him more likely to develop diseases such as Crohn’s, and the worms were actually helping him keep the disease in check. Once the worms were killed off, the Crohn’s flared up with a vengeance. With some methylprednisolone (steroids), Hank should get better — but the team wants to give him some worms again, just to make sure.

I found no massive errors in tonight’s episode. There was the usual: jumping randomly between unrelated diagnoses, bizarre test interpretation, and Chase being a specialist surgeon, but nothing horrible. Of course, that’s not to say I have no complaints (as if!). As usual, minor complaints are in blue, nit-picking ones in green:

Where exactly was the extraintestinal focus of the Crohn’s?

Why did he develop a headache and photophobia in the beginning? Was that the Crohn’s? Why did everything suddenly worsen when he got in the hospital? The steroids he was given for the vasculitis should have calmed down the Crohn’s.

The strongyloides worms may not have been the cause of his disease, but their blockage of the bile duct would still cause serious problems for the patient.

Again, no oncologist is going to start chemotherapy for cancer without a tissue diagnosis.

Special precautions are taken for patients who are neutropenic (dangerously low in white blood cells, and thus more susceptible to infection) including gowning and gloving everybody in contact with the patient. You do not roll them down the hospital’s common hallway without a mask and with the wife holding his hand.

The CRP should have been significantly elevated with the Crohn’s disease (and the cerebral vasculitis too).

While the ANA is generally strongly positive for certain types of autoimmune diseases, it is not found in every autoimmune condition (or even most autoimmune conditions), so a negative ANA does not mean there is no autoimmune disease (and positive ANAs in the absence of autoimmune pathology are also possible).

How about checking the vitamin D level — an easy thing to do — before treating the patient.

I noticed how they avoided actually saying the word “ascites” and instead chose a wordier explanation. Probably because of their problem pronouncing it last time.

Cameron shoots down Chase’s idea of bacteremia, but then suggests meningococcemia, a type of bacteremia. The same argument she used against Chase would go against her as well.

Why would you ablate the bone marrow without finding a donor first? (OK, maybe House was never planning on really following through with it, but why would the others go along?)

And now credit where credit is due:
The hygiene hypothesis is a legitimate and controversial scientific theory concerning the rise in asthma and allergy rates in industrialized nations. Some researchers link it to autoimmune diseases as well.
Helminthic therapy — treatment of disease using intentional infestation of parasitic worms — is being tested in a variety of diseases, including Crohn’s/
Shocking ventricular tachycardia, like Foreman did this episode, is the right treatment.

The mystery was okay, but seemed to get lost in the shuffle as the show progressed. I give it a B. The final solution was a stretch, especially when you look back at the original symptoms. It earns a C. Overall, the medicine was better that it has been the past few weeks and earns another B. The soap opera was decent as well. I enjoy Tab and Thirteen, so I’m fine with having them back, though I know many will disagree. The soap opera earns still another B.

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In this public service ad, Binky’s younger Allergy and his friends ponder the future — the far, far distant future — of 1976.

Click on the image for the full ad

This PSA is found in DC comics from June 1956. The writer, as always, was Jack Schiff. Art by Win Mortimer.

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A fairly light episode of Fringe, but an enjoyable one

The Plot:The Observer is patiently standing in front of a museum in Boston, taking notes, and spying on brunettes. After a few minutes, he finds the one he wants, grabs her, throws her in the back of a stolen car and drives off. Arriving at an out of town motel, he gags her and ties her to a chair, and then leaves.

With the Observer involved, the Fringe team is called in. The kidnap victim is identified as Christine Hollis, and seems to be an entirely normal young woman. They review the surveillance camera footage and realize that this is a different Observer than the one they first met. It turns out that the Observer accidentally left his notebook behind, so it’s turned over to the team; however, they are unable to decipher the code/language in the book. Astrid identifies over 1200 different symbols, without any repeats. Looking online, she discovers that one of the researchers at Massive Dynamics is also interested in the code. He has not been able to solve it either, but he has documented evidence of Observers at important historical events including the Boston Massacre, the beheading of Marie Antoinette, and the shooting of Archduke Ferdinand. Peter finds a drop of what appears to be blood in the Observer’s journal. Walter notes its orange cast and wonders if the Observer might not have hemophilia.

At a restaurant across town, a group of three Observers are meeting to discuss the actions of the rogue Observer, whom they call “August”. They mention a plane flight and imply that Christine is supposed to be dead, so they send an assassin after her.

August returns to the hotel room, unties Christine, and shows her the television news, which reports that the flight she had booked to Rome crashed en route with no survivors.

The labs tests come back and the drop in the journal wasn’t blood, but hot pepper sauce — and sauce from a particular hot pepper: the King Cobra Chili. Astrid is able to find the address of the individual who imported some last year, so Olivia and Peter head over to check it out. As luck would have it, the Observers’ assassin is there at the same time. There are some fisticuffs and Peter sustains a small wound, but the assassin escapes.

August meets with the other Observers. They tell him that Christine must be killed to set things right. This is not what he wants to hear. He manages to set up a meeting with Walter, asking for his help. All Walter can tell him is that he must somehow make Christine important to the Observers, so they won’t kill her.

August returns to the hotel room and unties Christine. He tells her that she must do exactly as he says. A short time later, the assassin appears at the hotel and in the ensuing battle, August is shot and critically wounded. Olivia and Peter arrive, and August gives his gun to Peter. Together, Peter and Olivia are able to kill the assassin. They find Christine and return her home.

The first Observer picks up August and drives him away from the hotel. As August lies dying in the back, he tells the other Observer that he had developed “feelings” for Christine, even loved her — and that is why he saved her. The first Observer tells August that she is safe now because she is responsible for the death of an Observer, and that makes her important.

Overall, the science — what little there was of it — was passable this episode, so I just have a few nit-picks an observations:

1. Hot, Hot, Hot
The King Cobra Chile is the hottest chile known to man, scoring 850,000 to 1,000,000 Scoville units. It is also known as the “ghost chile”, which should be familiar to you if you watch Man v. Food.

2. 15% Tip
Why would it be a surprise that the tip about August was called in from the same hotel? Would it really be a shock that one of the other guests, or an employee, saw him and phoned it in?

3. Color of Love
This is the first I’ve ever heard of hemophiliacs having orange blood, and I don’t buy it. Hemophilia affects the clotting of the blood, not the hemoglobin (which is what gives blood its red color), so why would the blood be a different color?

4. You Go That Way, I’ll Go This Way
I would not want to be Olivia’s insurance agent, and I hate for her to be my backup. Tonight she: 1) was easily distracted by the assassin, 2) nearly shot Peter, and 3) only avoided being shot by the assassin due to dumb luck and Peter.

A much better episode this week. The show does much better when they stick with the Pattern. There is a one-minute improvement on the Doomsday Clock.

Tags: television fringe observer hemophilia scoville

The Last Days of Animal Man
Gerry Conway, writer
Chris Batista, penciller

I just finished reading The Last Days of Animal Man, and I’ve got a couple of problems with it, particularly the last issue.

1.
Animal Man defeats the villains by using his powers to infect them with Yersinia pestis, the Bubonic Plague. At first read, this is extremely clever — in a Merlin versus Madame Mim sort of way. But the more you think about it, the less sense it actually makes.

Animal Man’s powers allow him to gain the abilities of any animals he is near. He can gain the strength of a gorilla, the flight of a bird, the swimming ability of a fish, and so on. In this case, it appears he used his powers to gain the virulence of the bacteria.

Animal Man doesn’t become the animal in question; he just gains some of their abilities. So if he had won by incapacitating his opponents with a nasty bacterial toxin, that would make a certain amount of sense. But instead he actually infected them with the bacteria. How did he manage this? His powers don’t work this way. You need the actual bacteria to cause an infection, let alone one which is “overwhelming their immune systems.” Animal Man wasn’t infected himself, and he didn’t come into contact with the bacteria, so how did he infect the villains? He seems to have achieved abiogenesis – creating life (in this case the bacteria) from nothing.

2.
The biggest problem is basic biology. It goes back to something I first learned in seventh-grade science. Everyone read what Superman says, and then repeat after me: bacteria are not animals.

They belong to a separate kingdom entirely.

I’m not going to explain what’s wrong with this caption from The Last Days of Animal Man #6 — I’ll leave it to you.

House Challenge scores are up to date through Episode 8.
I also corrected the scores from Episode 5 where I forgot to count “paraneoplastic syndrome”

Overall, TRad remains in the lead with 44 points. Noether is close behind in second with 42 points. Corien is third with 29 points, Heidi is fourth with 28 points, and Theta Sigma rounds out the top five with 27 points.

Click here to see the full scoreboard.

A so-so mystery, but an interesting patient on this week’s episode of House.

James Sidas was a brilliant physics prodigy who quit the field twelve years ago and now works as a deliveryman. While he is delivering some books one day, he develops a hand tremor and some confusion. He is admitted to House’s team at Princeton-Plainsboro Hospital, with the presenting complaints of ataxia (loss of coordination), anemia, and a mild cough. A CT scan was negative, as was a screen for toxin screen. The team’s initial differential diagnosis consists of West Nile Virus, hyperbilirubinemia (high bilirubin levels in the blood), meningitis, sickle cell anemia, or TTP (thrombotic thrombocytopenic purpura). The last one seems the most likely so House has his team check a blood smear and AdamTS13 antibodies. The blood smear shows schistocytes (fragmented red blood cells), a sign of TTP, so they decide to begin treatment. Usually, plasmapheresis is treatment of choice, but James is allergic to one of the components of the procedure, so instead they perform a splenectomy — a removal of his spleen. The surgery goes well, but while Chase is examining him afterward, James begins to show symptoms of a stroke. He is rushed to the cath lab, where the clot in the brain is removed by a special catheter, “blood flow is restored,” and there is no permanent brain damage.

The fact that James suffered a stroke after his spleen was removed suggests that he did not have TTP. The differential now consists of CNS vasculitis (inflammation of the blood vessels in the brain), DIC (disseminated intravascular coagulation), acquired pancytopenia (low white cells, red cells, and platelets), or a toxin exposure. The team reasons that the basic toxin screen only tests for a few toxins, and they need to test for more. Chase and Taub are sent to search James’s apartment, while Thirteen and Foreman run an expanded toxicity screen. The apartment shows signs of mice (and Taub suggests James may have Leptospirosis), and a hidden bottle of booze.

The team now suspects that James has liver failure, probably due to alcohol abuse. When confronted, James admits to having a shot of vodka each day after work, but denies being an alcoholic. The team proceeds with a liver biopsy, which is normal. The liver function tests show a slightly elevated albumin, but are otherwise normal. Thirteen now deduces that James has renal (kidney) failure, not liver failure. The reasons for the kidney failure could be rhabdomyolysis (muscle damage), multiple myeloma (cancer of the blood forming cells), polycystic kidney disease, or Goodpasture’s Syndrome (an autoimmune disease that affects the kidneys and lungs). Goodpasture’s seems the most likely, so James is started on unnamed “immunosuppresant drugs” and dialysis. After a Eureka! moment in a conversation with Wilson, House realizes that James has been abusing dextromethorphan (DXM, also known as the DM in “Robitussin DM”). He has been taking it to suppress his intelligence, and taking the alcohol along with it to make it work better. The chronic abuse of the drug has caused his symptoms.

With an aggressive regimen, the drug is cleared from James’s system and his natural intelligence once again emerges. Due to his brilliance, he finds it impossible to relate to his wife anymore, and she herself realizes that he is no longer “the man she married.” While Foreman is trying to explain the situation to James’s wife, he begins to complain that he can’t feel his legs. Foreman evaluates and finds that James has no feeling in his legs at all. The team half-heartedly throws out some ideas including vitamin B12 deficiency, bone marrow malignancy (i.e. cancer of the bone marrow), and lupus, but none of them fit well. House talks to James who admits he had been abusing the dextromethorphan because, while he was intelligent, he was extremely unhappy. He tried to commit suicide once by jumping off of a tall building, but he survived, just busting some ribs. It was while he was in the hospital recovering from these injuries that he was given some narcotic pain medication, and he enjoyed the way it made him feel dumb. After discharge, he sought out the dextromethorphan because it made him feel the same way. Hearing about the history of broken ribs, House realizes that in the suicide attempt, James injured his spleen, causing it to split into multiple smaller (accessory) spleens. Chase thought he removed the spleen, but he removed only one and James still has several more. His ultimate diagnosis is the same one he started with: TTP. Once the rest of the spleens are removed, his TTP will be under better control. He decides to go back on the dextromethorphan though because he’d rather be dumb and happy than intelligent and alone.

For the second week in a row, There were no major errors that jumped out at me in tonight’s episode. The team did their usual combination overlooking certain findings and overtesting/undertesting (diagnosing renal failure without checking renal labs, for instance). Once again, that’s not to say I have no complaints…As usual, minor complaints are in blue, nit-picking ones in green:

Surely before Chase operated on James, he got an abdominal CT scan to double check the anatomy, and surely he would have seen at least one extra spleen (or unexplained mass) on the scan.

If James’s problem had been due to the DXM abuse, which they said caused brain damage, then clearing the drug from his system would not have returned him to his baseline but would have left behind some permanent damage.

Liver biopsy is not performed that early in someone with liver failure. There is much you can discover with labs and CTs/ultrasounds before you go plunging a needle into the liver of someone who is low on platelets.

Did James have accessory spleens or splenosis? It sounds more like the latter to me, but this is not my area of expertise.

The “Otis Campbell” mnemonic is for seizures, not strokes.

I’m not an expert on street drugs, as shown in my review a few weeks ago, but the affects of DMX that House and James describe don’t match what I see in the literature. Unless they’re saying that James went around high and tripping all the time, which you’d think somebody would notice.

What’s the House team going to do when they encounter someone who actually knows how to close a vent?

So James has Thrombotic Thrombocytopenic Purpura without the thrombocytopenia or the purpura? (OK, they implied a low platelet count late in the episode when they mentioned pancytopenia, but that was the only mention. Purpura? Never mentioned).

Schistocytes can be seen in other conditions besides TTP. DIC, for instance.

The team just gives up when James can’t feel his legs? And this is House’s All Star team?

Whatever happened to the ADAMTS13 testing from the beginning of the show? Might it have remained unmentioned because it would have given the final solution away too early?

Convenient how it was mentioned in the beginning that James’s CT was “clear”, but it was never mentioned what the CT was of…

A few brief words about the soap opera: while I enjoyed the way Cuddy tricked House, I found most of the Cuddy/House/Lucas scenes to be excruciating. On the other hand, I appreciated the fact that both Chase and Taub (especially Chase) were shown to be more devious than previously suspected.

The medical mystery was pretty good this week, but more due to the patient than the mystery itself. I give it a B. The final solution made a certain amount of sense. Spleens can “multiply” after trauma, and there have been cases where doctors removed the largest thinking it was the only one. I give in another B. Overall, the medicine was fairly strong, and earns yet another B. The soap opera had a few good parts, but was weighed down by the House/Cuddy/Lucas scene earning a meager C.

Last week’s House review
A list of all prior House reviews

The House Challenge scores for episode five are up and available here.

Since today is the 150th anniversary of Charles Darwin publishing his most famous work, On the Origin of Species, I thought that natural science would be the perfect subject for tonight’s public service ad.

Unsurprisingly, DC comics published no evolution themed PSAs in the ’50s and ’60s. I did manage to find some interesting science PSAs (or more correctly, SCIENCE! PSAs), speculating about the future from a 1950s perspective, but they didn’t really fit the theme I had in mind.

I also came across this Buzzy nature PSA, and I think it’ll do just fine.

As a bonus, the PSA features birds. Sure, they’re no Galapagos finches, but it’s a start.

Click on the image for the full ad

This PSA was found Action Comics #182, and can be found in other DC comics from July 1953. This ad was written by Jack Schiff, with art by Win Mortimer.

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Tags: comics psa buzzy nature jack schiff win mortimer

Comic Cavalcade #18 (December, 1946)

That’s one helluva turkey if it takes three superheroes — including the fastest man alive — to catch it!

How head mirrors are really used…

Nellie the Nurse #5

Not a lot of high scoring this episode. A handful of 5s, 4s, 3s, and 2s.

Overall, TRad remains in the lead with 44 points. Noether is close behind in second with 42 points. Corien remains in third but closes the gap with 33 points, atg moves to fourth with 29 points and Heidi drops to fifth with her 28 points.

Click here to see the full scoreboard.

Almost entirely a Wilson character episode, so the medicine was fairly straightforward, if surprisingly sloppy

Wilson is out hunting turkeys with Tucker, a friend who he helped defeat leukemia five years earlier. Tucker nearly shoots Wilson when his left arm becomes suddenly numb and paralyzed. Wilson has Tucker brought to the Princeton Plainsboro Hospital emergency room for evaluation. A head CT is negative, and the blood count is normal, which tells Wilson that Tucker has not had a recurrence of his cancer. Noticing a fever blister on the lip of Tucker’s girlfriend, Wilson diagnoses him with tranverse myelitis (inflammation of the spinal cord, it can have many causes, in this case the Herpes simplex virus passed from the fever blister). He admits him to the hospital for treatment with acyclovir (an antiviral drug). House chides Wilson for his diagnosis, telling him that Tucker has cancer. Wilson disagrees and they end up betting $100 on the final diagnosis.

Paying a visit to Tucker a little later, Wilson discovers that he now complains of tingling in his left foot in addition to the continuing numbness and paralysis of his left arm. Wilson sticks with his diagnosis of transverse myelitis, but adds a second antiviral — Ribavirin — to the therapy. There is no improvement, and in the meantime Tucker has developed a nasty cough that eventually devolves into a respiratory arrest (which he survives, or it would have been a very short episode).

Perplexed, Wilson enlists House’s team in reviewing the case. Cancer is suggested, as is a subdural hematoma (bleeding around the brain), bacterial infection, or fungal infection. Wilson agrees with the fungal infection, and suspects that Tucker has aspergillosis (infection by the Aspergillus fungus) including fungal balls (exactly what they sound like) in the lungs and spine. He declares that Tucker is too sick for tests and rushes him into surgery. Chase sees no Aspergillus, but instead finds “global lung damage” suggesting PCP (Pneumocystis carinii pneumonia, a fungal infection of the lungs).

House is watching the surgery beside Wilson, and points out that a PCP infection means that Tucker must have a weakened immune system (since healthy immune systems can easily defeat the Pneumocystis carinii). He states that Tucker must have HIV (the virus that causes AIDS), acquired SCID (Severe Combine Immune Deficiency), or cancer. He suggests that Wilson test for all three.

Sure enough, this round of testing shows cancer — more specifically ALL (Acute Lymphocytic Leukemia, also known as Acute Lymphoblastic Leukemia). This is not a recurrence of Tucker’s original leukemia, but a different one, possibly caused by the chemotherapy required to treat the initial cancer. ALL is fairly treatable, so Wilson starts Tucker on chemotherapy. Twenty-four hours later, there is no change in his condition, and Tucker is concerned he may be in the 10% of ALL cases that Wilson says do not respond to therapy. Wilson decides to double the dose of chemotherapy. It works, more or less. The high dose chemotherapy knocks out the ALL, but it also severely damages Tucker’s liver (the yellow eyes were a sign of jaundice). In fact, the liver damage is so bad that Tucker will die in twenty-four hours if not given a transplant. When it becomes apparent that no transplant is available, Tucker asks Wilson to donate part of his liver to him (he know that they have the same blood type). Wilson thinks on it, and drinks on it, but eventually acquiesces and Tucker receives part of his liver. After the operation, both are doing well and expected to recover fully.

House’s first patient had Popcorn Lung, and diverticulitis (from the popcorn kernels). The second, apparently, had a screw in his lung.

No deal-breaker errors this week, but worse than the last couple of episodes. Some real sloppiness in writing/editing/continuity as well. As usual, major complaints are in red, minor complaints are in blue, and nit-picking ones in green:

Wilson is being generous with his ALL prognosis of 90%. The remission rate of ALL in children is 95%. In adults, it is 60-80%, with patient have CNS disease (which Tucker does) having a worse prognosis.
Chemotherapy cures leukemia completely in twenty-four hours? Nonsense. That’s too soon to tell if it’s working at all. Best case scenario is usually remission in 4-6 weeks.

There is no surgeon — even Chase — who would operate on Tucker without at least getting a CT first to show where the suspected fungal ball is. You don’t just slice up the lung indiscriminately. If there were a fungal ball, it would have shown up on the CT, as would PCP severe enough to cause a respiratory arrest.

By my understanding, SCID is currently defined to be a genetic disease, not one acquired later in life. There are acquired immune deficiencies, some severe (most notably HIV), but they are not “SCID.”

I’m surprised none of Wilson’s original blood work showed the cells associated with ALL.

Not my area of expertise or interest, but would a patient with a history of two cancers (though admittedly, no liver cancer or liver metastases) be placed that high on the transplant list?

Left arm or right arm? The episode description and House referred to right arm paralysis, yet the patient was clearly paralyzed in the left arm. Wilson later mention left arm. This is just sloppy.

“PCP Pneumonia” is redundant. The second P stands for “Pneumonia.”

A real nit-pick here, but by the time a patient has PCP, it is considered AIDS, no longer just an HIV infection.

I enjoyed the scenes with Wilson and his other patients.

The medical mystery was routine (as far as House episodes go), but well constructed. I give it a B. The final solution was fairly obvious, but entirely logical: B+. Overall, the medicine was OK, but way too sloppy, and gets marked down to a B-. The soap opera was good, though I would have liked to see a little more of the team. B+.

The House Challenge scores have been posted here.

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