Tonight’s episode started well, but seemed to make less sense as the episode went on. Medically, that is. The character relationships and interactions just got better and better as the night progressed. Spoiler and a long narrative (sorry folks) below:
Hannah is a teen-age girl with CIPA (Congenital Insensitivity to Pain and Anhidrosis), a rare condition in which she can not feel pain, hot, or cold. She is also unable to sweat and regulate her body temperature. As the episode begins, Hannah’s mother is rushing her to the hospital emergency room on a snowy night. Hannah had been playing on the ice with some friends and slipped and fell. Her mother is concerned that Hannah may have injured herself, so she wants her to get checked out at the hospital. Unfortunately, they are involved in a serious car accident — Hannah takes a nasty laceration to the leg while her mother is knocked unconscious.
The ER is overcrowded, so Foreman is filling in and treating Hannah, who has purposefully neglected to tell Foreman about her CIPA. House strolls into the room and immediately diagnoses her when she mimics flinching to a painful stimulus, but does it wrong. He decides to admit her and run x-rays, blood tests, and an EEG. He also wants to perform a spinal nerve biopsy, but Cuddy tells him there is no need for a nerve biopsy unless the EEG is abnormal.
Hannah is a very reluctant patient. She is worried about her mother and won’t sit still for the test. House asks Foreman to sedate her, and Foreman tells him that they tried but she fought back and they were afraid of pushing any harder for fear of breaking one of her bones. House decides to take matters into his own hands. He and Hannah have a “whine-off” over whose life is more pitiful (and I think this scene does an excellent job of showing what Hannah’s daily life is like). When Hannah turns around to show House the scars on her buttocks, he injects her with the sedative and they run the EEG. In the end, all the tests are normal.
When Cameron goes to tell Hannah the results, she finds her unresponsive with a temperature of 105° (that’s 40.6°C for you non-Americans). Her temperature is brought back to normal, but there is no clear cause of her fever. A lumbar puncture (spinal tap) was negative, suggesting no meningitis. While there is an elevated bilirubin, the rest of her liver tests are normal. Her urine drug screen is negative. House decides to talk Cuddy into letting him perform the spinal nerve biopsy. Meanwhile, the Young Guns decide that a spinal nerve biopsy is too risky, and they want to find a better way to diagnose Hannah. Chase suggests that if the pain levels are high enough, Hannah may be able to feel some pain after all and pinpoint where the problem is. He recommends that they purposefully overload her pain sensors and monitor what happens. Chase has Hannah alternate her hand between warm water and boiling water while he runs a brain scan. Unfortunately, she is so worried about her mother that she leaves her hand too long in the boiling water and gives herself second degree burns. Foreman tries the next test. He has some bizarre set-up where he is drilling into the skull and injecting some medication into her brain to stimulate pain receptors. It seems to be working as Hannah starts screaming in pain. However, as soon as they unhook her from the machine, she bolts for the door. She was just faking the pain in order to escape because she has developed a full blown paranoia and thinks everyone is out to get out.
Hannah runs to the lobby balcony and threatens to jump off. The team tries to talk her down, but her legs suddenly become numb and lose control and she falls to the lobby below. She now has several broken bones and a concussion in addition to whatever is causing her fever and leg numbness. House suspects some form of nerve disease. HIV and syphilis are suggested, but he points out that all STD tests were negative. He also states that the cause can’t be vascular because her ANA (Anti-Nuclear Antibody) is normal. Cameron suggests thyroid storm (a rare life-threatening condition where the thyroid gland goes into massive overdrive) as the cause. He checks with Cuddy (who is apparently an endocrinologist) but she shoots down that idea.
House wants to proceed with the spinal nerve biopsy. Wilson talks to him in private, accusing House of wanting what’s best for himself, and not what’s best for the patient. House relents and grudgingly allows the Young Guns to perform a much less risky peripheral nerve biopsy. The results show a demyelinating disease that is affecting outside fibers first. (If you think of a nerve as a wire, then myelin is the insulation surrounding the wire. Demyelinating diseases strip this insulation.) House now suspects some sort of metabolic disease. Hearing that Hannah had a headache after visiting her mother in the ICU, he decides that it was an emotional — a guilty — headache and this guilt means that she has a vitamin B12 deficiency. Foreman points out that she received B12 in the ER. House is now concerned about leukemia and the team is ready to start a bone marrow biopsy. Talking to Wilson (and eating his food), House has a sudden realization and stops the biopsy. He rushes her to the OR in a ridiculous scene where he personally opens up her abdomen and stomach to reveal a long tapeworm. This tapeworm led Hannah to become B12 deficient which led to her loss of sensation in her legs. With some B12 replacement, Hannah should be good to go (of course, she’ll still have CIPA).
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Knowing Wolfie as well as Buzzy does, why would he think getting in a car with him would be a good idea? Especially since seat belts weren’t a standard feature back in 1953.
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