Original Airdate on FOX: December 14, 2004
Written by Sara B. Cooper
Directed by Greg Yaitanes
Transcript written by Mari
[Opens on the clinic front desk. Wilson is working on paperwork, House is playing with candies. The desk has Christmas decorations on it, and “Rudolph the Red-Nosed Reindeer” is playing in the background.]
House: We are condemned to useless labor. [House has a giant stack of charts next to him.]
Wilson: Fourth circle of Hell. Charting goes a lot faster when you eliminate the whole of classic poetry. [House flicks a candy at him.]
House: Writing down what we already know to be read by nobody. Pretty sure Dante would agree that qualifies as useless.
Wilson: You’re over two weeks behind on your charting. [House flicks another candy; it almost goes down Cuddy’s shirt.]
House: Oops. I missed.
Cuddy: What are you, eight?
House: Could an eight-year-old do this? [He makes a face. Wilson smiles.]
Cuddy: You better stop or it’ll stick that way. You have a patient in Exam Room 1.
House: Yeah, but see, see, I’m off at twelve and it’s already five of.
Cuddy: She’s been waiting for you since eleven. [Cuddy walks off.]
House: Melancholy without hope. Which circle is that?
House walks into the exam room, sees who’s in there, and makes a “oh no” kind of face. It’s three nuns.]
House: Hi. I’m Dr. House. What seems to be the problem?
Sr. Eucharist: Show him your hands, Augustine. [House pops a couple Vicodin. Augustine shows her hands, which are red, swollen, and covered in hives and sores.
Sr. Pius: It looks like… stigmata.
Sr. Eucharist: Shhhh, Pius!
House: You must be all the talk around the holy water cooler. You been washing a lot of dishes recently?
Sr. Augustine: I help out in the kitchen.
House: Anything new in the kitchen?
Sr. Pius: We just got a donation of saucepans and pots this week.
Sr. Augustine: I unpacked and washed them.
House: Should have spent your time saving souls, it’s easier on the hands. This is contact dermatitis; you’re allergic to dish soap.
Sr. Eucharist: Nonsense! We’ve always used that soap. Why is there a problem now?
House: I’ve been a doctor for years. Why do I have to keep assuring people that I know what I’m doing? A person can become allergic to substances that they’ve had repeated and prolonged exposure to. The good news is: free samples. Diphenhydramine. It’s an antihistamine. It’ll stop the allergic reaction. Take one every eight hours, it might make you feel a little sleepy. And get some of that over-the-counter cortisone cream.
Sr. Augustine: Thank you, Doctor.
House: You want some water? [He hands her the pills.]
Sr. Augustine: I have some tea.
House: Well, you just relax for a few minutes. That stuff works pretty fast. [He leaves. The other sisters help Augustine take the medication with her thermos of tea. House to the clinic main desk and throws the chart down on the pile of other ones.]
Wilson: Still out by twelve.
House: How do you solve a problem like dermatitis?
Wilson: What?
Sr. Eucharist: Doctor? I want to thank you for your patience.
Wilson: She talking to you?
House: I don’t know. She’s certainly looking at me.
Sr. Eucharist: Oh, it’s good to get a secular diagnosis. The sisters tend to interpret their diagnosis as divine intervention.
House: And you don’t? Then you’re wearing an awfully funny hat.
Wilson: Oooh, boy. Excuse me. [He leaves.]
Sr. Eucharist: If I break my leg, I believe it happened for a reason. I believe God wanted me to break my leg. I also believe He wants me to put a cast on it. [House smiles slightly.]
Sr. Pius: Doctor, something’s wrong!
Cut to Exam Room 1, where Augustine is having an asthma attack. House grabs his stethoscope.]
House: Lift up your chin. [He listens to her breathing.] Sister, you’re having an asthma attack. I need you to relax. [to Eucharist] Roll up her sleeve, please. [He grabs a syringe from the cabinet.] I’m giving you epinephrine, it’ll open your lungs and help you breathe. [He sticks the needle in her arm, CGI shot of the bloodstream going to her lungs, and the airways opening.]
Sr. Eucharist: What happened?
House: Did she take the pill?
Sr. Eucharist: Yes.
House: It’s probably an allergic reaction.
Sr. Pius: She’s allergic to an anti-allergy medicine?
House: You figure somebody’s out to get her? How’re you feeling?
Sr. Augustine: Better.
House: I’ll put you on some steroids instead.
Sr. Augustine: Is my heart supposed to be feeling so funny?
House: It’s called adrenaline, it makes your heart beat fast. [He feels her pulse.] But not this fast. [to the others] Get a nurse, please. Lie back.
Sr. Pius: Help! Somebody help us! [House opens Augustine’s shirt and listens to her heartbeat.
House: Somebody get in here! [A tech comes in.] Call a code and charge up a defibrillator. She’s got no pulse. [The tech runs out, House starts chest compressions.]
Opening credits.]
Cut to Augustine’s hospital room. Her cross and Bible are on the table next to her; the two sisters are praying at her side. Cut to Cuddy’s office.]
Cuddy: You diagnosed the patient with allergies and prescribed antihistamine, she went into respiratory distress, and you injected her with epinephrine. Presumably 1 cc.
House: 0.1 cc. That is the standard dose, that is what I gave her.
Cuddy: People don’t go into cardiac arrest from 0.1 cc epinephrine.
House: She must have a pre-existing heart condition that got exacerbated by the epinephrine.
Cuddy: It’s too bad you didn’t make a notation in the chart.
House: I can make it up right now.
Cuddy: The drawer has syringes with both dosages, you could have easily reached for the wrong one.
House: But I didn’t.
Cuddy: Everyone makes mistakes. This is why doctors pay through the nose for malpractice insurance.
House: Relax, they’re not going to sue. Worse they’d do is whack my hand with a ruler.
Cuddy: And the discipline board? Are they gonna whack your hand, too?
House: You’re going to report me?
Cuddy: What choice do I have?
House: Uh, how ‘bout not report me?
Cuddy: I can justify keeping her here for 24-hour observation. If you haven’t found an underlying cause for the cardiac arrest by then I will have to notify our attorneys. [House looks at his watch and walks out.]
Cut to House walking down the hall with Cameron, Chase and Foreman.]
Cameron: Her hands were red and swollen, maybe she has a skin infection. Cellulitis? That could manifest with tachycardia.
Foreman: There’s no history of fever. Results from the CBC didn’t indicate an infection.
Cameron: The eosinophils were mildly elevated, sed rate’s up a bit. Could be looking at a systemic allergic response.
House: It’s not allergic. Allergies don’t cause cardiac arrest like this. Could be inflammation of the blood vessels.
Foreman: Vasculitis? That wouldn’t give you an elevated eosinophil count.
House: Church-Strauss vasculitis would. Blood vessels of the heart, lungs and skin become inflamed causing the asthma, rash and heart problems. Covers all her symptoms. [They reach the diagnostic office.]
Cameron: Need a biopsy to diagnose.
Chase: Chest CT’d be quicker.
Foreman: The lady just came in with a rash. [House stops and stares at a bunch of candy canes on the table.]
House: What the hell are those?
Cameron: Candy canes. [Foreman takes one.]
House: Candy canes? Are you mocking me?
Cameron: No! It’s Christmas and, and I, I, I thought –
House: Relax. It’s a joke.
Foreman: Isn’t the prognosis for Church-Strauss a bit grim?
Cameron: Yeah. Untreated only 33% of patients survive past a year; treated, five years.
House: Then I’d definitely suggest treatment.
Foreman: If it was any other attending doctor, I’d say that he made a mistake and gave her too much epinephrine.
House: [pouring coffee] Saying you wouldn’t say it was my mistake is saying it was my mistake.
Foreman: Everyone screws up: your rule. I think you fit inside the subset of “everyone”.
House: I didn’t screw up. [Foreman shakes his head.] Order a chest CT and start the sister on prednisone, 40 mg. TID.
Chase: The sister?
House: Oh, didn’t I mention? The patient’s a nun. Sister Augustine.
Chase: Aw. I hate nuns.
House: [thinks a little] Who doesn’t?
Cut to a TV, showing a man and a women playing in the waves. Sisters Augustine and Pius are watching it raptly. Foreman, Cameron and Chase walk in.]
Cameron: Sister Augustine? [Pius hurriedly turns the TV off.]
Augustine: We weren’t watching.
Pius: [holds up remote] We were trying to see if this was the bed control.
Cameron: Oh, um, this one’s the bed control [she gives Pius another remote] and that one’s the TV control. I’m Dr. Cameron, and that’s Dr. Chase and Dr. Foreman.
Augustine: I hadn’t seen television in over twenty years.
Chase: Do you consider it the work of the devil, or do you just not get cable where you live? [pause]
Foreman: Um, how’re you feeling, Sister?
Augustine: I seem to be a little better; they gave me some medication.
Foreman: Prednisone. It’s a steroid to help with the inflammation.
Augustine: Has Dr. House figured out what I have? Will I be okay?
Cameron: We’re not sure what’s wrong yet. You’ll have a chest CT scan this afternoon that will help with the diagnosis.
Pius: Dr. House is giving her medication and he doesn’t know what she has yet?
Augustine: Trust, Sister Pius. It all happens for a reason.
Cut to the ducklings in the hallway.]
Foreman: He doesn’t know what he’s doing. The only problem that woman has is that House grabbed the wrong syringe.
Cameron: You don’t trust him?
Foreman: I don’t trust a man who won’t admit he might be wrong. I notice you weren’t so quick to tell her she has Church-Strauss and only has a couple years to live.
Cameron: I don’t tell patients bad news unless it’s conclusive.
Foreman: Because you know he might be wrong.
Cameron: About Church-Strauss, not about what happened in the clinic.
Foreman: What about you, Chase? You think he’s infallible, too?
Chase: All I know is, if House didn’t make a mistake and Sister Augustine has Church-Strauss, he’ll be self-satisfied and our lives will be good for a few weeks. If House did make a mistake, he’ll be upset and our lives will be miserable for months.
Foreman: There is that.
Cut to House and Wilson walking out of the elevator and into the clinic.]
House: If Cuddy thinks I made a mistake the least she could do is suspend me from clinic duty.
Wilson: She doesn’t confuse making a mistake with being incompetent.
House: Oh, here we go. Lesson time. I recognize that confidence is not my short suit. I also recognize that I am human and capable of error.
Wilson: So you might have screwed this up?
House: No.
Wilson: So, it’s only a theoretical capacity for error.
House: Good point. Maybe there isn’t one. Maybe that’s my error.
Wilson: You know, most people who think as much of themselves as you do like to talk about themselves.
House: Most people don’t like to listen, so what’s wrong with you? [He leaves Wilson standing in the clinic.]
Cut to House entering Exam Room 1, which is occupied by… Santa Claus? House makes a point of sniffing the air as he enters.]
House: Let me guess… inflammatory bowel.
Santa: Wow, yeah. Is it that bad?
House: Yes. It’s also written on your chart. Bloody diarrhea, gas, pain… took sulfasalazine, but it didn’t work –
Santa: No, then I –
House: Next tried steroid enemas, oral corticosteroids, 5ASAs, 6 mercaptopurine… I’m impressed.
Santa: By my medical history?
House: By how well your last doctor charted.
Santa: It’s one thing to have to go to the bathroom every hour, but when the kids sit on my lap, it’s…. The store sent me home, they’re gonna fire me. Can’t you put me back on 5ASA? Maybe it’ll work this time?
House: Not likely. I’m giving you a prescription. It’s cheap, which is good because your insurance company won’t pay for it. [He gives Santa a prescription, who puts on his glasses to read it.]
Santa: [tries to read House’s writing] Cojorius?
House: Cigarettes. One twice a day, no more, no less. Studies have shown that cigarette smoking is one of the most effective ways to control inflammatory bowel, plus it’s been established that you look 30% cooler.
Santa: Are you kidding me?
House: About the looking cooler, yeah. The rest is true.
Santa: Isn’t it addictive and dangerous?
House: Pretty much all the drugs I prescribe are addictive and dangerous. The difference with this one is that it’s completely legal. [He turns to leave.] Merry Christmas.
Cut to Chase wheeling Augustine to the CT.]
Augustine: I was talking to the nurse, Arsenio. Do you know him?
Chase: Not really.
Augustine: He can take pictures with his phone.
Chase: Cool.
Augustine: That woman from the lab was interesting, too. She studied astrophysics before becoming a nurse.
Chase: You know the staff better than I do.
Augustine: Well, I love to hear about people.
Chase: Yet you live in a monastery.
Augustine: It’s where I serve our Lord and the world best.
Chase: Our Lord, maybe. The rest of the world, on the other hand, would probably get more out of feeding the homeless or –
Augustine: Healing the sick?
Chase: As an example, yeah.
Augustine: Did you always want to be a doctor?
Chase: Always. You always want to be a nun?
Augustine: My parents died when I was six. I was raised in a foster home run by the Church. When I was eighteen, I went to the monastery where they let me take my vows. I’ve known no other life and I haven’t wanted to.
Cut to Augustine going into the CT.]
Foreman: Okay, Sister, we need to you lie as still as possible. If you get scared, just let us know.
Augustine: As Jonah said from inside the whale, “When I had lost all hope, I turned my thoughts to the Lord.”
Foreman: At least she’s got God on her side.
Cameron: I don’t believe in God.
Foreman: You’re not even a little agnostic?
Augustine: [from inside the CT] Is it supposed to smell funny?
Tech: Someone ralphed in there this afternoon. We cleaned it up, but…
Cameron: It’s normal, Sister. It’s just a few more minutes. [pause] I believe in a higher order that’s in control of what happens, but not one anthropomorphic entity called “God” that’s concerned with the everyday workings of you and me.
Foreman: What else is there to control but the everyday workings of you and me?
Cameron: It’s always about you, Foreman.
Foreman: What else are you talking about? The trees, the fish? Should they be the ones to think it’s all about them? What about you, Chase? Do you believe in God?
Chase: I believe Sister Augustine has no vascular pathology, which means no Church-Strauss.
Foreman: Which means House made a mistake.
Cameron: No, not necessarily. It could be something else. Thyrotoxicosis or a carcinoid.
Foreman: I don’t get you. You don’t believe in God, but you’re willing to put complete faith in one man?
Augustine: Please, the smell!
Foreman: Let’s get her out of there. [Augustine is panicking as they pull her out.]
Cameron: I’m coming, Sister. I gotcha, I’m coming.
Augustine: Please, please, the smell, I’m sick –
Cameron: There’s no smell –
Augustine: No, God, no – [she puts her hands in a praying position, then gestures outward] Oh, it’s Jesus! It’s Jesus! [Chase rolls his eyes. Augustine starts to laugh and cry.] He’s coming for me. He’s burning me with his touch!
Foreman: Let’s get her on some Ativan. [He holds on to Augustine’s arms as she continues to cry.] Smells, religious visions are symptomatic of temporal lobe swelling. We don’t want her to –
Augustine: Oh!
Cameron: She’s seizing!
Foreman: Help me get her on her side. [The three of them maneuver the sister onto her side.]
Chase: Religious visions?
Foreman: Yeah. And next comes… [he lifts up part of her gown, we see a rash on her leg. Chase and Foreman share a look.]
Cut to the diagnostic office.]
Foreman: Patient tested positive for herpetic encephalitis.
House: So what’s that tell us?
Cameron: Her immune system is severely compromised.
Cuddy: Ooh, I know! Prednisone compromises the immune system. Isn’t that the medicine you gave her for the thing she doesn’t have?
House: Yeah, but… hey. I’m think that’s a trick question.
Cameron: Her immune system is severely compromised. Two doses of prednisone wouldn’t do that.
Cuddy: Are you hanging your diagnosis on an adverb?
House: In ten seconds I’m gonna announce that I gave her the wrong dose in the clinic.
Cuddy: You’re gonna admit negligence?
House: Unless you leave the room. If you leave you’ll have to testify. [Cuddy stays put.] Five, four, three, two…. So, there I was in the clinic, drunk. I open the drawer, close my eyes, take the first syringe I can find – [the ducklings smile, Cuddy leaves] So, what are the options for compromised immune system?
Chase: Mixed connective tissue disease. It’d explain why she was feeling better on the prednisone.
Foreman: Sure, she was feeling better right up to the moment it almost killed her.
House: On the other hand, it explains the symptoms. Swollen hands, pulmonary problems, cardiac problems – it all fits.
Foreman: Except her ANA was normal.
House: So redraw the blood.
Foreman: But the treatment is cortical steroids, prednisone, and we can’t go there because of the encephalitis.
House: Then we’ll treat it with something that modulates the immune system but doesn’t suppress it. Hypobaric oxygen chamber.
Foreman: There’s no protocol for putting a patient in a high-pressure oxygen room to treat autoimmune problems.
House: Oh, you people. Always with the protocols. [small pause] Prep the nun and discontinue the prednisone. [He begins to erase the whiteboard and continues to talk to Foreman as the others leave.] I am both amused and annoyed that you think I should be less stubborn than you are.
Foreman: You are aware of the Hippocratic Oath, right?
House: The one that starts: First, do no harm, then goes on to tell us no abortions, no seductions, and definitely no cutting of those who labor beneath the stone. Yeah, took a read once, wasn’t impressed.
Foreman: Hypobaric treatments could cause oxygen toxicity, lung and eye damage –
House: Every treatment has it’s dangers –
Foreman: Which is why we treat when we’re only convinced the patient needs the treatment.
House: I’m convinced. You’re not. Question is, what are you going to do about it? Hmm?
Cut to Cuddy’s office.]
Cuddy: [on the phone] I have an opening Thursday at three. Do you have a fourth? Is he any good? [Someone walks into her office.] Can I call you right back? Okay. [She hangs up.] What’s up? [We see that it’s Foreman that walked into her office.]
Cut to Chase and Cameron putting Augustine into the hypobaric chamber.]
Chase: The pressure will force the oxygen into your system and saturate your blood. It will enhance white cell activity and reduce the inflammation.
Augustine: And that will help with this mixed connective tissue disease?
Chase: We’ll be doing about ten treatments and then we’ll reevaluate.
Augustine: The last treatment with prednisone cause the seizures, right? How confident is Dr. House about this?
Cameron: That you reacted so strongly to the prednisone let us know that you had an underlying problem with your immune system.
Augustine: I guess it was a blessing… of sorts.
Cut to the hospital chapel. House is sitting in the chapel watching General Hospital on his portable TV.]
Soap Doc: So, who’s your favorite reindeer, Nurse [something]?
Soap Nurse: Rudolph.
Soap Doc: I would have thought it was Vixen.
Soap Nurse: What are you implying?
Soap Doc: Nothing, but I saw you at the Christmas party with Dr. [fades out. Sr. Eucharist walks in, makes the sign of the cross, and turns to sit. She sees House in the pew.]
Eucharist: This is a chapel. A house of prayer.
House: House of prayer, huh. That explains the good reception. Also why nobody’s ever here.
Eucharist: I need to talk with you, Dr. House. Sister Augustine believes in things that aren’t real.
House: I thought that was a job requirement for you people.
Eucharist: She’s been known to lie to get sympathy. She’s a hypochondriac.
House: [turns off TV] So, you’re warning me that I may be treating a non-existent ailment
Eucharist: Sore throats, joint pains… there’s always something wrong, and there’s never a reason for it. Mother Superior plays right into it. Lets Augustine off work duties, treating her as fragile, special.
House: That must make you angry. [eats a piece of chocolate]
Eucharist: It bothers me. It’s not really in Augustine’s best interests. [She keeps looking at the chocolate bar.]
House: [offers the chocolate] Want some?
Eucharist: I shouldn’t. [takes the bar and sits down next to House]
House: I guess you’ve got to be good at reading people to be a good infirmarian, huh.
Eucharist: [around a mouthful of chocolate] Mm hmm.
House: So, we’ve got pride, anger, envy, gluttony…. That’s four out of seven deadly sins in two minutes. Do you people keep records of these things? Is there a Cathlympics?
Eucharist: They say you have a gift.
House: They like to talk.
Eucharist: You hide behind your intelligence.
House: Yeah, that’s pretty stupid.
Eucharist: And you make jokes because you’re afraid to take anything seriously. Because if you take things seriously, they matter, and if they matter –
House: And when things go wrong, I get hurt. I’m not tough, I’m vulnerable.
Eucharist: I barely know you, and I don’t know if I’m right. I just hope I am. Because the alternative is, you really are as miserable as you seem to be. [pause]
House: You know, from the way you’re looking at me right now, I’d say you just hit number five: lust. [Eucharist hands House his candy bar and leaves. House pulls out his pocket TV.]
Soap Nurse: Dr. Brown, I love you, too.
Cut to Cameron and Chase opening the hypobaric chamber.]
Chase: How’re you feeling?
Augustine: A little week.
Chase: That’s from the oxygen.
Augustine: My mouth is dry.
Chase: Okay. well, I’ll get you some of your tea.
Cut to House and Cuddy walking down a hallway.]
Cuddy: Mixed connective tissue disease? Her ANA is barely elevated!
House: Well, thanks for checking up on her. Good to know you’ve got my back.
Cuddy: 0-2 stat is down to 83, pulmonary problems, breathing problems –
House: Irritation from the oxygen is typical.
Cuddy: She comes in with a rash and you put her into cardiac arrest.
House: That well just never runs dry, does it? If there was no underlying problem, then why is she still having the rapid heartrate?
Cuddy: Maybe from the herpetic encephalitis caused by you giving her prednisone!
House: Her reaction is a symptom, not an error.
Cuddy: There’s always an explanation, isn’t there?
House: Yes, there is! And if this one doesn’t work will find another.
Cuddy: But never one involving you screwing up.
House: One that fits all the facts. Look, we obviously have a difference of opinion, and that’s fine, but unfortunately I’ve used up all the time I’ve budgeted today for banging my head against a wall.
Cuddy: I am going to do you the biggest favor one doctor can do for another. I am going to stop you from killing your patient. You’re off the case.
Cut to House, standing in his office. He gives Foreman a Look, who Looks right back at him. House then gives him quite an evil grin, and Foreman… well, he’s got nothing on that.]
Cut to the ducklings talking with Cuddy in her office.]
Cuddy: We’re going to treat the symptoms.
Cameron: Not the underlying condition?
Cuddy: There is no underlying condition. What’s her status?
Chase: The sister’s breathing is labored.
Cuddy: Pneumonitis from the hypobaric chamber. Put her on 40% oxygen until her 0-2 stats increase.
Chase: BUN and creatin’s rising, ALT and AST twice the normal range.
Cuddy: Could be from the hypertensive episode. Let’s follow them with labs.
Foreman: She still has the rash and the joint pain she came in with.
Cuddy: Order a non-steroidal anti-inflammatory.
Cameron: When we were looking at the differential diagnosis with Dr. House, we were considering –
Cuddy: I don’t need to hear what Dr. House was considering! All of this woman’s symptoms can be traced to Dr. House’s considerations. Okay. Let’s just get this patient healthy. I want her going out the front door, and not the back.
Cut to Cameron, Chase and Foreman leaving the clinic.]
Foreman: Hey, it’s not like I betrayed him. Cuddy would have found out about the hypobaric treatments eventually.
Cameron: You did what you felt you had to.
Cut to House in the clinic. He’s looking through the door with the epinephrine syringes.]
Wilson: Can’t get enough of this place, huh?
House: Came for my stethoscope.
Wilson: So, I shouldn’t read too much into the fact that you were looking for it in the drawer with the epinephrine syringes in it?
House: Okay, yeah. I’d like to clear my reputation.
Wilson: Oh, right. I forgot that you care about what people think. Prescribing cigarettes for inflammatory bowel? It could cause lung cancer, you know.
House: [leaving the exam room] You know why they have ribbons for breast cancer, colorectal cancer, prostate cancer and not for lung cancer?
Wilson: They ran out of colors?
House: It’s because people blame lung cancer patients. They smoked, they screwed up, they deserve to die. The reason people die from lung cancer is guilt. [He enters Cuddy’s office where the records are kept.]
Wilson: Huh. Well, guilt does a lot of damage.
House: You said that with great significance.
Wilson: You’re not here to find your stethoscope. You’re not here to clear your reputation. You’re here because you’re having doubts. You might have screwed up.
House: I’m here because, if I’m right, Cuddy is killing that patient.
Wilson: Okay, but if you’re wrong? [pause]
House: Then she’s saving her.
Wilson: Fine. You’re going to have to go through every record of every patient who’s been through this clinic in the last two days, and you’re gonna have to hope that those records can be trusted, which, by the way, yours can’t. [Wilson leaves.]
Cut to Chase with Augustine.]
Chase: These pills will help your kidneys function a little better, Sister. [She takes the pills.] Get your wrist? [He takes her pulse.]
Augustine: What’s that?
Chase: 104.
Augustine: Is that good?
Chase: It’s fine.
Augustine: You’re a lousy liar, Dr. Chase. [Chase’s beeper goes off. On it is the message “Call Mom!”
Chase: I have to get this. Excuse me.
Cut to House’s office. House is playing with a yo-yo. Chase enters.]
Chase: My mother’s been dead for 10 years.
House: But she’s always with you in spirit. What do you know about the nun?
Chase: Which one?
House: The cute one. I think she likes me. The sick one, obviously.
Chase: Her parents died when she was a child and she’s been with the Church ever since.
House: What’s she lying about?
Chase: Why do you say that?
House: I always say that. And the old nun says the sick nun is a big fat nun liar. You know nuns, what do you think?
Chase: I don’t know nuns.
House: You hate nuns. You can’t hate someone if you don’t know them.
Chase: Know any Nazis? Maybe I hate them on principle.
House: I have a theory on what makes good boys “good”. It’s not because of some moral imperative. Good boys have the fear of God put into them. Catholic Church specializes in that kind of training, to make good boys afraid of divine retribution so they will do what their daddies tell them, like, for example, going into medical school when it’s the last thing they want to do. What do you think?
Chase: I think if she did have a secret, her boss would know. [He leaves.]
Cut to the monastery. House is talking to another nun {I’m assuming the Mother Superior.]
House: Did you paint, or put in new carpets recently?
Nun: No.
House: Any way she could have got access to drugs?
Nun: Well, we lock all of our medications in the infirmary, and we don’t keep prescription drugs here. [Nun is making tea.] Why haven’t you asked Sister Augustine about these things directly?
House: I’ve found that when you want to know the truth about someone that someone is probably the last person you should ask.
Nun: Ah. And have you been speaking to Sister Eucharist?
House: She ratted out her fellow sister pretty quickly. If I were you I’d have her repeat a year of nun school. [Nun chuckles.]
Nun: Becoming a nun doesn’t make you a saint.
House: Becoming a doctor doesn’t make you a healer.
Nun: Just because we live in a monastery and we spend most of our time in prayer doesn’t mean we don’t find time for drama.
House: So, what is the sick one’s drama?
Nun: Sister Augustine lived in Catholic foster care until she came to us. [kettle whistles] Tea?
House: Sure. Do all of you lie? It’s a good strategy, simpler when you all tell the same lie, but she has not spent her entire life as a good Catholic. When she had a cardiac arrest I had to open her blouse to do CPR and I learned two things: nuns can have nice breasts, and she has a tattoo on her shoulder of a skunk. Now, maybe it’s the Sacred Skunk of Joseph, but as far as I know, Catholic foster care and monasteries do not keep tattoo parlors in their refractories.
Nun: We consider that our life begins when we put on our habits and take our vows. What happens before then –
House: Is irrelevant to you, but it’s relevant to me.
Nun: Sister Augustine went into foster care when she was six years old, but she left when she was twelve. She lived on the streets, she got into drugs. When she was fifteen, she became pregnant, tried to self-abort. She lost the child, she became ill. We took her in when she came back. If we had thought it was medically relevant we would have told you.
House: It’s not. [He takes a sip of tea, then looks at it.] This tea is delicious. Local herbs?
Cut to Cuddy and the ducklings in a hallway.]
Cuddy: Any change with medication?
Chase: Yeah, she’s getting worse. Lung function’s deteriorating, BUN and creatin are continuing to rise. She’s starting to run a fever and the rash is spreading. At this rate she’s not going to make Christmas.
Cameron: Maybe House was right. Maybe there is an underlying condition that explains the symptoms, something we haven’t considered.
Cuddy: Like what?
Cameron: It could be a metabolic disorder.
Cuddy: Specifically?
Cameron: Mitogenetic.
Cuddy: Specifically?
Cameron: I’m just saying –
Cuddy: You’re just saying you think House is right.
Cameron: Might be right.
Cuddy: Of course he might be right! It might be the Hand of God at work. Don’t say it’s something else unless you’ve got something concrete to offer. [A teabag is thrown onto Cuddy’s paperwork, she picks it up and stares at the entering House.] What’s this, hemlock?
House: “I’m going to do you the biggest favor one doctor can do another. I’m gonna stop you from killing your patient.” It’s figwort tea. Great for that little pick-me-up we’re all looking for in the morning. Opens the lungs, increases the blood pressure, stimulates the heart. Unfortunately, if you then get injected with even 0.1 cc of epinephrine: instant cardiac arrest. Still, what the hell, it tastes great.
Cuddy: Sister Augustine –
House: Has been drinking it religiously, so to speak.
Foreman: Take the cardiac arrest out of the equation…
House: All the rest of the symptoms can be explained by a severe long-term allergic reaction.
Foreman: That’s what Cameron said in the beginning.
House: Yes, she did. Well done. [Cameron smiles.] But your unwillingness to stick by your diagnosis almost killed this woman. [No more smiles.] Take a lesson from Foreman: stand up for what you believe. Okay, let’s go figure out how to save a nun. [He leaves.]
Chase: Damned if you do, damned if you don’t.
Cut to House and the Ducklings walking to the diagnostic office.]
House: Because it’s been untreated for so long, it’s gone from a simple watery eyes, scratchy throat allergy to a whopping I’m-gonna-kick-your-ass allergy, compromising her immune system, diminishing her ability to heal and breaking down her organs systems. So, what’s the source?
Chase: The dish soap.
House: No, symptoms persisted days after the dishwashing episode. It’s gotta be something she’s been exposed to here in the hospital as well as the monastery.
Foreman: Well, what about the tea? It caused her arrhythmia.
House: Could be, but it’s not definitive.
Chase: We’ll skin test for allergens.
Cameron: Not yet, she’s too reactive. She’d test positive for everything. We need to stabilize her, isolate her from all possible allergens. Give her system a rest.
Chase: Get her in a clean room.
House: Okay. And we’ll gradually introduce allergens and see how she responds. When she reacts to something we’ll know that’s what killing her.
Cut to the ducklings helping Augustine in the clean room.]
Foreman: There you go. No television, no books.
Augustine: Not even my Bible?
Foreman: I’m afraid not. This room has filtered air, filtered water… you even have silk sheets. Very decadent and hypoallergenic. You should be feeling better here. [Foreman and Cameron leave.]
Chase: We’ll be back to check on you in a little while.
Augustine: Can the other sisters come in and pray with me?
Chase: It’d be better if you don’t have any visitors. Once we isolate what’s causing your allergy, then we can be a little more lax. [Augustine turns away from the window and starts to cry.] I can pray with you.
Augustine: I want to die. Why has He left me?
Chase: I was in seminary school. They asked us once what our favorite passage was. I chose 1 Peter 1:7. “These trials only test your faith to see whether or not it is strong and pure. Your faith is being tested as fire tests gold and purifies it.”
Augustine: “And your faith is far more precious to the Lord than pure gold; so if your faith remains strong after being tested, it will bring you much praise and glory and honor on the day of His return.”
Chase: He hasn’t left you. The only thing in the way of your knowing if he’s left you is your fear. You have a choice: faith or fear. That’s the test.
Augustine: Do you think faith doesn’t mean I won’t die?
Chase: It will affect how you experience your death, and therefore your life. It’s up to you.
Augustine: Why did you leave seminary school.
Chase: A test. You passed. I didn’t.
Cut to Cameron and Foreman talking to Pius and Eucharist.]
Cameron: We’ll call you if anything changes.
Eucharist: Will she be all right?
Foreman: As long as she’s not exposed to anything that will aggravate her allergy, she’ll be fine. [Chase comes and knocks on the window.]
Chase: Need some help in here! [Cameron and Foreman start to suit up.] Screw the procedure, she’s in anaphylactic shock!
Foreman: No way, she’s in the damn clean room.
Chase: You kidding me? Get in here! [Cameron and Foreman run in.] 0.1 cc of epi.
Foreman: Gonna have to intubate.
Cameron: I got it. [They insert a breathing tube.] I’m in. [They start to pump air.] Breathing’s stabilized.
Chase: It’s a clean room!
Cut to House and Wilson looking through the glass.]
House: How do you get an allergic reaction in a clean room?
Wilson: Maybe it was the preservatives in the IV?
House: Checked that.
Wilson: Latex tubing?
House: Checked that. Checked everything.
Wilson: Well, it could be mast-cell leukemia. It can cause anaphylaxis.
House: Checked the blood levels. And it’s not [he mutters a couple of diseases she didn’t have, I couldn’t catch it].
Wilson: Maybe it’s just divine will.
House: It’s not my will. [takes a couple of Vicodin]
Wilson: You do realize if you’re wrong, about the big picture that is, you’re going to burn, right?
House: What do you want me to do? Accept it, pack it in?
Wilson: Yeah. I want you to accept that sometimes patients die against all reason. Sometimes they get better against all reason.
House: No, they don’t. We just don’t know the reason.
Wilson: I don’t think the nuns would agree with you on that.
Cut to House, pacing in his office. Cameron knocks on his office door and enters.]
Cameron: I just wanted to say that I know that you did everything you could.
House: I don’t need verification from you to know that I’m doing my job well. That’s your problem, not mine.
Cameron: I was just being nice.
House: Yeah, well, you don’t need to always do that. [pause]
Cameron: Merry Christmas. [She hands House a present. Chase enters.]
Chase: Sister Augustine’s been extubated.
House: Good.
Chase: She’s requested to check out against medical advice. She wants to go back to the monastery.
House: Well, talk her out of it.
Chase: I think I may have talked her into it.
Cut to House entering the clean room.]
House: Room’s paid up for the rest of the week. You might as well stick around.
Augustine: This illness is a test of my faith. If it’s His will to take me, it doesn’t matter where I am. I can accept that.
House: Does anybody believe anything you say? You’re not accepting. You’re running away. Just like you always do. You ran away from the monastery, you get laid, you ran away from the real world when getting laid didn’t work out so good. Now things aren’t working out again, so off you go.
Augustine: Why is it so difficult for you to believe in God?
House: What I have difficulty with is the whole concept of belief. Faith isn’t based on logic and experience.
Augustine: I experience God on a daily basis, and the miracle of life all around. The miracle of birth, the miracle of love. He is always with me.
House: Where is the miracle in delivering a crack-addicted baby? Hmmm? And watching her mother abandon her because she needs another score. The miracle of love. You’re twice as likely to be killed by the person you love than by a stranger.
Augustine: Are you trying to talk me out of my faith?
House: You can have all the faith you want in spirits and the afterlife, and heaven and hell, but when it comes to this world, don’t be an idiot. ‘Cause you can tell me you put your faith in God to put you through the day, but when it comes time to cross the road, I know you look both ways.
Augustine: I don’t believe He is inside me and is going to save me. I believe He is inside me whether I live or die.
House: Then you might as well live. You’ve got a better shot betting on me than on Him.
Augustine: When I was 15, I was on every kind of birth control known to man, and I still got pregnant. I blamed God. I hated Him for ruining my life, but then I realized something. You can’t be angry with God and not believe in him at the same time. No one can. Not even you, Dr. House.
Cut to a hallway. Wilson meets up with House.]
Wilson: How’d it go?
House: She has God inside her. It would have been easier to deal with a tumor.
Wilson: Maybe she’s allergic to God.
Cut to House walking down the hall with the ducklings in tow.]
House: We looked everywhere for an allergen that could be causing this reaction except one place: inside her.
Foreman: On her medical history she didn’t mention any surgery.
House: She had one.
Cameron: Can we get her records? What hospital was it at?
House: She didn’t have it at a hospital. Order a full body scan.
Chase: What if she refuses?
House: Tell her I’m looking for a miracle.
Cut to the imaging center.]
Foreman: No piercings, no fillings, no surgical pins in the arm, no implants…
Chase: It’s clean as a whistle. What’s House looking for? [Foreman shakes his head, and then squints at the screen.]
Foreman: What is that?
Chase: Don’t know.
Foreman: Lock on it. Get a 3D representation. [The image shows a piece of metal in the form of a cross.]
Cameron: Oh my God!
Cut to House, looking at the xrays.]
House: The copper cross, a form of birth control pulled off the market in the 80s.
Foreman: So, she’s allergic to copper.
House: Rare, but it happens.
Chase: Wouldn’t she know she had an IUD?
House: She had an abortion. IUD must have been left in, embedded in the endometrial tissue where it couldn’t be detected.
Chase: So, all we have to do is remove the IUD –
cut to Chase talking to Augustine]
Chase: -- and the symptoms should subside.
Augustine: I got this IUD when I was fifteen. It’s been more than twenty years.
Chase: Prolonged exposure to an allergen with minimal symptoms. But at some point, all it takes is one last contact to cause a full-blown reaction. It’s like a balloon filled with air. One last breath, it explodes.
Augustine: The first time I got the rash was when I was washing the copper cookware.
Chase: And all your subsequent symptoms came from ingesting food prepared in it.
Augustine: Dr. House found his miracle.
Chase: I doubt he’ll interpret it that way.
Augustine: You told me your favorite passage. Would you like to hear mine? [Chase nods]. “Celebrate and be glad, for your brother was dead and is alive again.”
Chase: The prodigal son.
Augustine: He’ll be waiting for you when you’re ready.
Chase: We’ll schedule your surgery for tomorrow.
Cut to the clinic desk. House is again throwing candies. Wilson enters and sits next to him, giving him coffee.]
Wilson: The sixth circle of Hell.
House: Confined in a sweat box with a bloody nose and all the tissues are soggy.
Wilson: I think that’s the seventh.
House: Nope, seventh is –
Wilson: God, we must be fun at parties.
House: I think we both know the flaw in that theory.
Wilson: How’s the Sister?
House: Kidneys functioning, heart rate is normal. You know how it is with nuns: you take out their IUDs and they bounce right back.
Wilson: Great.
House: Told you I didn’t screw up.
Wilson: You screwed up.
House: I gave her 0.1 cc of epinephrine.
Wilson: Yeah, and if Cuddy hadn’t taken you off the case, you would have killed her. [small pause] You want to come over for Christmas dinner?
House: You’re Jewish.
Wilson: Yeah, Hanukkah dinner. What do you care? It’s food, it’s people.
House: No thanks.
Wilson: Maybe I’ll come to your place.
House: Your wife doesn’t mind being alone at Christmas?
Wilson: I’m a doctor, she’s used to being alone. [House raises his eyebrows.] I don’t want to talk about it.
House: [quickly] Neither do I. [Cuddy enters.]
Cuddy: You did good with the nun. Congratulations.
House: Thank you.
Cuddy: Merry Christmas, Dr. House. Dr. Wilson. [She leaves.]
Wilson: Good night. That was sweet.
End montage. “Silent Night” is being played on the piano. Starts with House and Wilson, sitting in House’s place eating Chinese food, talking and laughing. Cuts to the hospital Christmas party for the sick kids. Foreman is dressed up as Santa. Cuts to House, now alone, playing the piano. Cuts to Cameron, in her office with a Christmas present. Snow is falling in the background. Cuts to Cuddy, who is tending a patient. Back to House on the piano. Cuts to the hospital Chapel service. The four nuns we’ve met are present. Chase is watching through the windows. Final shot of House at the piano.]
[Over and out. – Marisol]
HOUSE, M.D. 1X04: MATERNITY
Original Airdate on FOX: December 7, 2004
Written by Peter Blake (IV)
Directed by Newton Thomas Sigel
Transcript written by Mari
[Open on face of a newborn baby. Overhead speaker is calling for Radiology.]
Ethan Hartig: Amber.
Karen Hartig: [scoffs] No.
Ethan: Why not?
Karen: Amber’s a stripper name.
Ethan: Find me one stripper named Amber Hartig. [small pause] Or not, okay. Non-stripper names, okay. [baby makes a few noises] Desiree? Bambi? Candy cane?
[We see Karen in the hospital bed, holding Baby Hartig. Ethan is next to them.]
Karen: Max. Maxine. Max Hartig is a cute name, isn’t it?
Ethan: If you’re a professional boxer, maybe.
Karen: Can you believe we made this little creature?
Ethan: I know, it’s incredible.
Karen: It’s the most amazing thing we’ve ever done.
Ethan: I almost ran the marathon last year.
Karen: [to Baby Hartig] If we’re lucky you won’t inherit your daddy’s sense of humor.
Ethan: [waving a teddy bear] Hello! Say hi to Bear!
[Baby starts to spit up. The parents are taken aback a little.]
Karen: She hasn’t even eaten anything; what is she spitting up?
Ethan: Well, honey, we can’t bug them –
Karen: Just –
Ethan: Okay, okay.
[Cut to Ethan walking in with Dr. Lim]
Ethan: Sorry, it’s our first kid, we’re both a little panicky I guess.
Dr. Lim: Well, you gotta ask the pediatrician next time. I just deliver ‘em. [to Karen] She spitting up?
Karen: Yeah. Second time in an hour?
Lim: [takes Baby Hartig] You lived underwater for nine months, you’d have a lot to spit up, too. [He touches Baby’s cheek, who doesn’t respond.]
Karen: Is something wrong?
Lim: Eh, a little lethargic.
Ethan: We didn’t think –
Lim: She’s hot. [Baby starts seizing.]
Ethan: Is she, uh –
Karen: What’s happening?
Lim: [simultaneously] Baby’s seizing! Get the crash cart!
Ethan: What’s, what’s, what’s, what’s wrong?
Lim: Can I get some help in here?!
Karen: Oh, oh God! Is she all right?
A nurse: IV access?
Lim: No, ativan.[Dr. Lim puts Baby Hartig on the table, and starts to try to clear her airway.]
Karen: What’s going on?
[Credits and such.]
[Soap opera, presumably General Hospital.]
Soap doctor: MRI results are back.
Soap patient: And?
Soap doctor: It’s what we expected. The accident caused serious damage.
[House starts to talk over the soap as he walks to a chair, opening a cup of jello or something similar. Mmm, hospital jello.]
House: It’s amnesia.
Soap doctor: I’m sorry.
Soap patient: I just can’t believe it.
[Lim and Dr. Kubisak walk into the lounge, talking.]
Lim: Enjoying our lounge, House?
House: I just came in to get milk for my coffee, which you’re out of.
Dr. Kubisak: Flat or sparkling?
House: Flat.
Lim: [simultaneously] Sparkling.
[Kubisak throws a bottle to Lim.]
Kubisak: So, the Hartigs?
Lim: Their baby gets a fever.
Kubisak: Wait, don’t tell me. Their kid had a seizure.
Lim: Yep. The parents, of course, start freaking and I have to deal with that for an hour.
Kubisak: Like it was your fault.
Lim: She was perfect when I delivered her. If you want to blame someone, blame the pediatrician.
Kubisak: So, how’s the kid now?
Lim: Bowel obstruction, she’s under observation, she’ll be fine. [While all this is going on, House is “watching” the soap intently.]
Kubisak: Pediatrician’ll take all the credit.
[House exits suddenly, leaving most of his jello behind.]
[Cut to Baby Hartig.]
House: [to Wilson] Exhibit A: Baby girl Hartig. Term baby, 42 hours old. Went into seizures 6 hours ago, brought into the intensive care, diagnosed with obstruction of the small bowel. [looks at Wilson]
Wilson: I’m still amazed you’re in the same room with a patient.
House: People don’t bug me until they get teeth. [small pause] Exhibit B: Baby boy Hausen. Another term baby, 48 hours old. Brought into the NICU before the Hartig baby: fever of unknown origin, 101 degrees, trending upwards.
Wilson: Wow, that is amazing. You hung out in the OB/GYN lounge and heard about two sick babies. It’s eerie. [goes to touch something, I’m presuming a baby]
House: Don’t touch that.
Wilson: [confused] All right…
House: We have an infection spreading in the hospital.
Wilson: [unbelieving] These kids have totally unrelated illnesses.
House: They fell sick within four hours of each other. They had the same delivery rooms, maternity rooms are neighboring, so transmission’s possible. They have the same symptoms.
Wilson: The Hartig girl has a bowel obstruction. No matter how close their beds are, I’m pretty sure kids can’t share a blockage.
House: What does bowel obstruction on a chart indicate?
Wilson: Well, normally, I’d say it indicates a patient’s bowel is obstructed, but I’m pretty sure you have some deeper truth to impart –
House: It means that some random doctor of indeterminate skill thinks that the patient’s bowel is obstructed.
Wilson: [trying not to laugh] Okay, you’re upset because they threw you out of their lounge.
House: Look at the x-ray. It’s a normal gas pattern.
Wilson: You want, I can get you a key to the oncology lounge.
House: [simultaneously] Air. Air in the column.
Wilson: We’re getting TiVo.
House: If it’s air, no bowel obstruction.
Wilson: Even if it is air, it could have been there before the obstruction.
House: No. Something’s infected both these infants.
[Cut to Cuddy’s office.]
Cuddy: And you’re the only one who put this together because…?
House: Because I’m the only one who looked at both kids. I want them isolated; I want the maternity ward shut down.
Cuddy: Because you’re better at reading an x-ray than a radiologist.
House: Radiologists always over-read babies’ x-rays, especially if they’re asked to rule out a pathology. He read into it what he wanted.
Cuddy: Which is exactly what you’re doing. You’re finding a cluster because you think it’s interesting to find a cluster. Two… plain old sick babies would bore you.
House: See, this is why I don’t waste money on shrinks, ‘cause you give me all these really great insights for free.
Cuddy: [smiling] Shrink. If you would consider going to a shrink, I would pay for it myself. The hospital would hold a bake sale, for God’s sake.
House: We have an epidemic! [Cuddy stops from going out the door and turns to House.]
Cuddy: [slowly] Two sick babies is very sad, but it doesn’t prove an epidemic. [She leaves. House is left alone in her office.]
House: How many do?
[Cut to diagnostic lounge. Chase is sleeping in a chair, until House throws a big red book in his lap.]
House: Get up! We’re going hunting.
Foreman: For what?
House: Wabbits.
[Cut to some maternity room. Mother and father are resting, their baby at the foot of the bed. House and Foreman enter the room; House picks up the baby, who starts to cry, waking the father and mother.]
House: Hi. [pause] Bye. [passes the baby to Foreman, saying quietly] He’s screaming, he’s fine.
Foreman: [puts the baby down, smiling and fully aware of the awkward situation] Good looking baby.
[Cut to a delivery room, where a birth is in process. Expectant dad is filming. Chase and Cameron stride in.]
Cameron: Oh, sorry, wrong room.
Chase: [half-wave] We’ll see you later.
Cameron: [out in the hall] 12 rooms, that’s it?
Chase: [closing the door to the room] Yep. We’ve definitely checked the whole floor. [They meet up with House and Foreman by the elevator.] Good news, no epidemic.
Foreman: Tragic, huh?
House: [looks at elevator] Overflow rooms, third floor. [goes into elevator]
Foreman: [to Cameron and Chase] This imaginary infection has spread to the next floor?
[Cut to mothers Kim Chen and Judy Lupino. They look worried. House enters the room.]
Judy: We were just going to call.
House: Did he get hot all of a sudden?
Judy: Yeah.
[Cut to hallway outside NICU. Cuddy is watching babies being brought in, but turns toward voices near the elevator.]
Man’s voice: Don’t worry, we’re almost there.
Cuddy: Excuse me! Hi. Intake sent you up here?
Man: Yeah, my wife’s contractions are less than –
Cuddy: Yeah, Intake messed up. I’m very, very sorry. Nurse Alpret will arrange for an ambulance to take you to Princeton General. [starts to wheel the pregnant woman back to the elevator]
Man: Wha –
Cuddy: The maternity ward is temporarily closed.
Woman: We have to leave?!
Cuddy: Yes, I am very sorry. [elevator opens, House comes out]
Man: Why are you doing this? [woman groans]
Cuddy: You’ll be there very, very soon. [elevator door closes, next line to House] Happy now?
House: No. But I am interested.
[Cut to a shot of more babies being brought into NICU. Commerical.]
[House’s office. He’s got his whiteboard out.]
House: Three sick babies, and a fourth showing early symptoms.
Cuddy: How bad?
Chase: Spiking fevers.
Foreman: BP’s plummeting. They’re barely able to keep systolic up; at this rate, they’ll be dead in a day.
Cuddy: Where did this come from?
Cameron: Two delivery rooms, four different maternity rooms, no common personnel and no common equipment.
Cuddy: Well, there’s gotta be something in common.
House: Yeah. That would be the difference between an epidemic and a coincidence.
Cuddy: I’m putting a team together. We’re going to start swabbing. [She leaves.]
Foreman: What’s she gonna swab? Every respirator, sink, vent, drain in the entire hospital? That’ll take months.
Cameron: A needle in a haystack.
House: It’s worse than that. We don’t even know what’s the needle we’re looking for. [He starts to erase the whiteboard.]
Cameron: Then why’d you let her go do it?
House: Because the hospital’s her baby, and her baby’s sick. If she doesn’t solve this soon, her head’s going to explode, and I don’t want to get any on me. [Chase and Cameron snicker softly] So let’s figure out what’s in the haystack. Differential diagnosis, people.
Foreman: Parasite.
Cameron: Spreading too quickly. [House writes “parasite” on the board and crosses it off.]
House: Next?
Chase: Virus? [House writes “virus”.]
Cameron: Kids are too sick, and the blood tests show no lymphocytosis.
Foreman: And they’re not responding to a cycle of avirarapovirin. If it’s some other virus, we’ll never find it in time, anyway. [House writes a question mark next to “virus”.]
House: Which leads us to bacterial infection. [which he writes on the board] It’s not responding to broad-spectrum antibiotics, so we’ve got something resistant. The usual suspects.
Foreman: MRSA. It’s always MRSA in hospitals.
Cameron: Maybe a contaminated food or water source? Psuedomonas.
Chase: VRE?
Foreman: H-Flu. [House writes these all down.]
House: Okay, those are the big ones. Cultures will take 48 hours, might as well be post-mortem. We’ll start them on Vancomycin for the MRSA and Aztreonam for the rest. Let’s get MRIs, check for abcesses or some occult infection. I’ll be in the clinic. Grab me if you find something important. Or unimportant.
[Cut to a hallway, where a nurse is wheeling a sick baby. The Hartigs look on.
Close up on Karen’s face as the nurse rounds the corner.]
[Cut to Chase and Cameron putting a baby (presumably Baby Hartig) into the MRI machine. Machine starts to make noise.]
[Cut to Chase looking at the MRI results.]
Cameron: [talking to Kim and Judy] We did a MRI on all the babies, and unfortunately, we didn’t find anything, so we’re starting him on the strongest antibiotics we’ve got, and we’re hoping that that’ll take care of it.
Judy: But he’s so tiny.
Kim: How sick is he?
Cameron: [pause] His fever’s up to 103.5 and his blood pressures 80 over 40.
Judy: Um, how bad is that?
Cameron: [freezes up] Ah, it…
Foreman: [behind Cameron] It, it’s low. The heart needs to circulate the blood. If it’s weak, oxygen isn’t getting to the liver, the kidneys, the brain. [Kim nods sadly.]
Judy: Um, I have to ask you something.
Kim: Judy –
Judy: No, no, Kim. Let me. Um, I had a cold last month, and I told the doctors about it, and –
Kim: Honey, this has nothing to do with you.
Cameron: Kim’s right. Your son was born healthy. He caught the infection after his birth. There’s no reason to think he got it from you.
Judy: But you don’t know, I mean – You don’t know how he got sick. [Cameron sighs and looks at Foreman.]
[Cut to Cameron and Foreman walking in a hallway.]
Foreman: Pretty standard question: how sick is my child? You couldn’t answer it.
Cameron: I answered.
Foreman: You rattled off numbers! BP, O2 stats.… That’s not what they need to know.
Cameron: What they need to know is the future. Got a magic 8-ball? [She starts to work on charts.]
Foreman: No, just eight years of medical training. Look, I realize it’s tough to break bad news to family –
Cameron: Not as tough as hearing it.
Foreman: And I guess being the poor guy dying is toughest of all?
Cameron: [pause] No. It’s easier to die than to watch someone die. [She leaves Foreman standing at the front clinic desk.]
[Cut to Cuddy and her team, swabbing.]
Cuddy: Well, we’re checking the vents, it could be airborne. Somebody get the sinks, too, and underneath them.
Med Student with the Tie: I’ll get it.
Wilson: How many med students have you got swabbing the decks?
Cuddy: Oh, what else are they going to do? It’s not like they’re delivering babies.
Wilson: Find anything yet?
Cuddy: Ah, yeah. About half the antibacterial gel dispensers are empty or broken.
Wilson: That’s bad. And diagnostically, completely insignificant.
Cuddy: Well, if the staff can’t wash their hands, it’s no wonder an infection has spread. [While they’re talking, we see Med Student’s tie has been hanging in the sink and generally being a nuisance.] Hey, tie clip!
Med Student with the Tie: Sorry?
Cuddy: We have an epidemic in this hospital and your tie is becoming a Petri dish. Put on a tie clip or take the damn thing off.
[Cut to the clinic.]
Patient (Jill): My joints have been feeling all loose, and lately I’ve been feeling sick a lot. Maybe I’m overtraining; I’m doin’ the marathon, like, ten miles a day, [House looks tired] but I can’t seem to lose any weight.
House: Lift up your arms. [She does so.] You have a parasite.
Jill: Like a tapeworm or something?
House: Lie back and lift up your sweater. [She lies back, and still has her hands up.] You can put your arms down.
Jill: Can you do anything about it?
House: Only for about a month or so. After that it becomes illegal to remove, except in a couple of states. [He starts to ultrasound her abdomen.]
Jill: Illegal?
House: Don’t worry. Many women learn to embrace this parasite. They name it, dress it up in tiny clothes, arrange playdates with other parasites –
Jill: Playdates…
House: [shows her the ultrasound] It has your eyes. [It’s a baby!]
Jill: But… that’s impossible.
House: Well, I assume you weren’t getting your period. Maybe that should have give you an inkling.
Jill: But I’m on this birth control implant…
House: Yeah, I know. I saw the scar on your arm.
Jill: …and my doctor said I might not get any periods at all if it was working.
House: Mm hmm. Interestingly enough, you also don’t get any periods if it isn’t working, which is why you were supposed to get regular pregnancy tests. [Jill makes a pained face.] I’m going to send a nurse in here to schedule your prenatal care. You’re due in about five months, so start planning the shower.
Jill: Um, Doctor? Please. Me and my husband wanted to have a kid soon, but… oh, God. Like four months ago we had this really big fight. [House looks like he knows where this is going] He moved out. I did something stupid.
House: One-night stand?
Jill: Ex-boyfriend.
House: I’ll schedule you a paternity test, too.
Jill: I can’t let my husband know.
House: Does the old boyfriend look like your husband?
Jill: [thinks a little] Yeah…
House: Then just have the kid. He’ll never know. The most successful marriages are based on lies. You’re off to a great start. [He leaves, Jill looks like she’s going to cry.]
[Cut to House’s office.]
House: Well, you look cheery. What’s going on?
Cameron: The Hartig and Chen-Lupino babies. Their kidneys are shutting down.
Chase: And the urine tests show no casts.
House: Which means the antibiotics are causing the kidney failure.
Foreman: You’re the nephrologist. Which one did it? We’ll take ‘em off that one. [pause] Don’t tell me both Vancomycin and Aztreonam can –
Chase: They both can cause this. There’s no way to know which one it is. No test. [House looks at Chase.]
Foreman: We can’t take them off the antibiotics. They’ll die of the infection.
Cameron: If we leave them on both the antibiotics they’ll die of kidney failure.
Chase: So, we take our best guess, then. Which drug’s causing the kidney failure?
Foreman: It’s like I said: it’s always MRSA in hospitals. Take ‘em off Aztreonam.
Cameron: I still think it’s the pseudomonas. I vote to take them off the Vancomycin. [long pause]
House: There’s no point in guessing. Take one kid off Vancomycin and the other off Aztreonam.
Chase: They have the same disease, you want to give them different treatment?
Foreman: What the hell are you doing?
House: Theraputic trial to find the cause of the infection.
Foreman: That’s wrong.
House: We have four sick kids, at least. Who knows how many more haven’t started showing symptoms yet?
Foreman: We have a duty to these two!
House: If these two have different reactions we know how to save the rest.
Foreman: So you’re condemning one of these kids to die based on random chance. [pregnant pause]
House: I guess I am.
[Commercial]
[NICU. Some baby is crying. Cut to Cuddy’s office.]
Cuddy: So, you’re going to flip a coin? That’s how you decide which baby lives?
House: Can I borrow a quarter?
Hospital Attorney: Do you want to get sued, lose your license, House? Well, generally I’d applaud that, but my job is to protect this hospital, so I strongly advice you to come up with a medical rationale why Baby A should get Medicine X and vice-versa.
House: Whoa, whoa, whoa, hold on there, Slick. We didn’t all go to law school. Your advice is that I should use medical reasons to make medical decisions? Hmm, that’s not going to be as easy…
Attorney: Any medical justification. Doesn’t need to be a good one.
House: Well, Hartig sounds Jewish, so does Aztreonam, so we’ll take the Hartig kid off Vancomycin, how’s that? [pause]
Cuddy: You can’t experiment on babies.
House: Doctors experiment all the time.
Cuddy: On adults. With their consent.
House: Fine. I’ll get the parents’ consent.
Attorney: Their informed consent. They have to know the other kid is getting a different treatment.
House: Sorry, can’t do that. It’d be unethical for one patient to know about another patient’s treatment.
Attorney: They have a right to know.
House: If they know, they won’t consent; that defeats the whole purpose.
Attorney: That’s their right.
House: [getting up from the couch] Two more babies have just become symptomatic. I defer to your legal wisdom: which takes precedence? Six dying babies or a missing consent form?
Attorney: You can’t do it.
Cuddy: [sighing; to House] Do what you think is best. [House leaves; Cuddy looks very unhappy about the whole situation.]
[Cut to House sitting in his office. He’s twirling a coin between his fingers. He spins it and watches how it lands.]
[Cut to Foreman talking to the Hartigs, Cameron is talking to the Chen-Lupinos simultaneously.]
Foreman: Your daughter’s kidneys are shutting down…
Cameron: Your son’s kidneys are failing.
Foreman: …so we’re going to take her of the Aztreonam.
Cameron: We’re taking him off Vancomycin.
Ethan: But, uh, but what made her sick in the first place?
Kim: What do you think is causing it?
Cameron: It seems to be a germ called pseudomonas.
Foreman: We think it’s MRSA. Methicillin-Resistant Staph Aureus. It’s a very resistant form of a very common bacteria.
Cameron: We’re hoping the Aztreonam will clear it up.
Foreman: Vancomycin is the best treatment for MRSA, so we’re gonna keep giving it to her.
Ethan: Right. Is it gonna cure her?
Foreman: Your child is very sick. You need to know that. This is a ‘hail Mary’ pass. It might cure her, it might not. [Ethan sits back on the couch, defeated.]
Judy: So, so that’ll cure him?
Cameron: We’ll know in 24 hours if it’s working. [Judy and Kim look very happy. Cameron walks away from them; Wilson is at the reception desk.]
Wilson: What did you tell them?
Cameron: I told them the truth.
Wilson: They seemed relieved. You tell them how sick their son is?
Cameron: I explained what was going on.
Wilson: Alison, their baby’s dying. If the parents weren’t in tears when you left, you didn’t tell them the truth.
Cameron: That’s not how I see it.
Wilson: Do you want them blindsided? Want them coming up and saying “My God, my baby died, why didn’t you warn me?”
Cameron: So now it’s about worrying about them yelling at us?
Wilson: No, it’s about getting them prepared for the likely death of their child.
Cameron: If their son dies tomorrow, do you think they’ll give a damn of what I said them today? It’s not going to matter; they’re not going to care; it’s not going to be the same ever again. Just give those poor women a few hours of hope. [She walks away from him.]
[Cut to House leaving his office. Jill runs up, towing her husband.]
Jill: Dr. House! Dr. House, this is my husband, Charlie.
House: Who told you where my office was?
Charlie: Jill, come on, he obviously doesn’t want us bothering him.
House: Ooh, I was trying to hide it.
Jill: Look, Doctor, this is about the mono you said you thought I had…
House: The mono?
Jill: Yes. You know, shouldn’t Charlie be tested? You know, [House looks at Jill like she’s insane] the test. The blood test.
House: [catches on] Right. Yeah, I’m sorry, I sometimes forget patients, I thought you were this idiot who doesn’t know how to use birth control. [pointed look]
Charlie: I can’t have mono. I don’t even feel sick or anything.
House: That’s very often the first sign. [He gets into the elevator.] Call my office in the morning, I’ll schedule him for bloodtests. [The elevator doors close.]
Jill: Thank you!
Charlie: I’m not even tired.
[Cut to Cuddy swabbing medical equipment. Wilson walks up.]
Wilson: Find anything yet?
Cuddy: No, just some baby formula being stored under a sink with a dripping faucet.
Wilson: Tap water contamination. You thinking pseudomonas infection?
Cuddy: I was. I wasted a couple of hours chasing it down, but of course the formula hasn’t been anywhere near the babies.
Wilson: Huh.
Cuddy: Whatever idiot stored them there –
Wilson: All right, we’ll figure it out! Just… just calm down.
Cuddy: I am calm. [She walks over to Med Student with Tie, and takes scissors to him, leaving him Med Student without Tie.]
Med Student without Tie: Aw, could –
Cuddy: I warned you. [to Wilson] I did that calmly. [She and Wilson walk into NICU as Chase walks out. Karen is looking in the windows.]
Karen: [to Chase] Hey.
Chase: Hi.
Karen: Is she any better?
Chase: Her fever’s been stable the last hour.
Karen: We’re not going to make it, are we?
Chase: Sorry?
Karen: Me and Ethan. Our next-door neighbor, their little boy died in a car crash and she and her husband split up, like, four months after the funeral. It’s just, uh, what always happens, right? [pause]
Chase: Um, what happens to patients after they leave the hospital, I don’t know, but… try not to get ahead of yourself. [Beeping is heard inside the NICU. Chase goes back in.]
Nurse’s voice: Dr. Chase? Activity on the monitor.
Chase: How long?
Nurse: I don’t know, it just started.
Chase: Pulse? [Nurse mutters something.] Fluid wide open. Do we have an arterial line?
Nurse: Not yet.
Chase: Let’s get a BP. [Karen walks into the NICU.] You can’t come in here.
Karen: Is my baby dying?
Chase: Mrs. Hartig –
Karen: Is she dying?!
Nurse: [half-pushing Karen out the door] Ma’am, you’ll have to leave.
Chase: It’s not your baby!
Chase: Fenlay, BP 60 over 20. [House walks into the NICU and stands next to Wilson.]
Cameron: Heart rate’s 180.
House They start the levofed?
Wilson: They’ve got it.
Kim and Judy come to the window.]
Chase: Still dropping. 50 over 10.
Cameron: Can’t hold BP with three pressers? We’re losing pulse.
Chase: V-fib.
Wilson: Shut the blinds. [A nurse does so. Judy starts to cry. Wilson and Chase prep the defibrillator.]
Chase: Charging. Clear. [CGI of inside the baby’s chest. We see that the shock does nothing to jumpstart the heart.]
Foreman: Still v-fib.
Chase: Charging. Clear. [another shock] Charging. Clear. [CGI shot shows no movement.]
Foreman: Still v-fib.
Chase: Charging. Clear. [shock] Charging.
House: Chase. [pause] Time of death: 6:57 PM. [long pause] The Aztreonam doesn’t work. Double-cover all the other babies with Vancomycin.
Chase: I’ll do it.
House: Cameron, you tell the parents. Tell them their child probably saved five lives.
Cameron: But Chase should –
House: Chase is busy.
Cameron: You’re the attending.
House: [to Wilson] Make sure she does her job.
[Cut to Kim and Judy. Cameron and Wilson walk out to them. We see Cameron freeze up, and Wilson starts to talk. Judy and Kim sob. As Wilson and Cameron leave, she looks back at the two women.]
[Cut to House and Wilson leaving the elevator.]
House: I asked you to make sure she does her job, not do it for her.
Wilson: She froze up.
House: She felt sorry for the parents so she shut up. You felt sorry for her so you opened your mouth.
Wilson: She has a problem.
House: Yeah, she needs to deal with it. If you hadn’t bailed her out, she would have done it.
Wilson: Great, then she wouldn’t have slept for two weeks. Maybe she should be thinking about a different specialty. Lab work, research? [Chase walks up.]
House: Yeah, what is it?
Chase: The Hartig baby. She’s getting sicker, too. The Vancomycin isn’t working, either.
[Cut to a late night in House’s office.]
House: Vancomycin doesn’t kill it. Aztreonam doesn’t kill it. What the hell is this?
Foreman: It’s a super bug.
Chase: It could be VRSA.
Cuddy: There’s only been two reported cases of it ever in the United States.
Chase: One of the kids, the Hausen baby, had a skin rash. It could be scalded-skin syndrome which would be a sign of VRSA.
Foreman: Then these kids are dead.
House: This is our fault. Doctors over-prescribing antibiotics. Got a cold? Take some penicillin. Sniffles? No problem. Have some azithromycin. Is that not working anymore? Well, got your Levaquin. Antibacterial soaps in every bathroom. We’ll be adding Vancomycin to the water supply soon. We bred these super bugs. They’re our babies. Now they’re all grown up and they’ve got body piercings and a lot of anger. [sigh] On the other hand, maybe antibiotics had nothing to do with it. Did you notice how low his BP was at the end? Even with three pressers?
Wilson: Heart damage?
House: Go home. There’s nothing more you can do tonight.
[Cut to House, preparing to do an autopsy on the dead baby. He speaks into a little microphone.]
House: Baby boy Chen-Lupino. Time of death 6:57 PM Thursday, December 2nd, 2004. [He takes the covers off of the tools and starts to remove the baby’s diaper.]
[Cut to the next morning in House’s office.]
House: This is a cross-section of the Chen-Lupino boy’s myocardium. Fibrosis, lymphocydic infiltrates.
Cameron: There was no sign of lymphcytosis in the blood tests.
House: Yes, well, we all had plenty of good reasons to think bacterial. Nobody is scolding you. [He hands Cameron his cane.] Unfortunately, all of those clever reasons were wrong. It is a virus infecting their hearts.
Foreman: We’re screwed. We can’t chase down a virus; there’s a thousand possibilities.
Cameron: We could run gels, antibody tests.
Foreman: A thousand of them? The kids don’t have enough blood.
House: Chase, you’re the intensivist. How many could we do before we risk exsanguinating the kids?
Chase: You’re talking vials, not stick tests? I wouldn’t take more than five or six.
House: [writes “Virus” on the white board’] Okay, so we have to narrow the thousand viruses down to six. Now, the autopsy’s shown us what the virus does. So, let’s go. What do we know?
Wilson: Ribavirin and encyclovir don’t knock it out.
Cuddy: Cross out the herpes viruses.
House: Also adenovirus. [House starts to make a T-chart on the board.] What else, what else? Keep talking.
Chase: Well, it, it only seems to hit children. The mothers aren’t sick, so…
Foreman: No toxoplasmosis, no rubella. Cross out the entire Torgh syndrome.
Wilson: You didn’t find any lung damage?
House: No.
Wilson: None of the paramyxoviridae.
House: Cardiac scarring, people.
Chase: CMV?
Foreman: Enteroviruses, too, I think.
House: [muttering] Echo 11.
Cuddy: Influenza A.
House: [mutters] Influ A. Yes. And? [We see more ideas being written on the board.] I’m putting RSV down as a yes. That makes eight.
Chase: Eight vials of blood is pushing it.
House: Pushing it, but we love that! Get the antibody kits, start testing the sick kids.
Wilson: All right, I’ll start looking into whether there are any antivirals for these eight.
House: Wait a second. The, the kids on the floor who didn’t get sick. Are any of them still in the hospital?
Wilson: They got moved to the fifth floor. But they’re probably all checked out by now.
Cuddy: No, the Lindpert boy had a bit of jaundice. He should be checking out today.
House: I want to test his blood, too.
Cuddy: Why?
House: ‘Cause we need all the information we can get. The healthy kid can be our control group.
Cuddy: I’ll just tell his parents he can’t check out because he has the smallpox.
[Cut to Cameron drawing blood from sick babies. Chase is taking some from the healthy one on floor five. The baby is crying.]
Chase: All done, all done.
[Cut to House’s office.]
House: What did we get?
Foreman: Well, the sick babies all tested positive for Echovirus 11.
House: Great.
Foreman: And CMV, and parvovirus B19.
House: Three viruses?
Foreman: What’s weirder, the healthy kid we tested: he’s positive for Echovirus 11 and CMV antibodies as well.
House: [sighs] They’re infants. They have their mother’s blood, their mother’s antibodies.
Foreman: So we just learned nothing?
House: Uh-uh. We have half the picture. The healthy kids survived because their mothers’ antibodies saved them.
Foreman: The mom had CMV in the past she’d have the antibodies for them, the kid would be immune from it. So we test the sick kids’ moms for Echovirus, CMV, and parvovirus.
House: And whichever they don’t have the antibodies for, that’s what’s killing their kids.
Foreman: I’ll test the mothers.
[Cut to Foreman drawing blood from Karen. The overhead speaker is asking for an inhalation specialist to go to pediatrics.]
[Cut to House’s white board. House crosses off Parvovirus B19 and CMV and circles Echo-11.]
[Cut to Foreman and Cameron, who are talking to Karen and Ethan.]
Foreman: Echovirus 11. It’s an enterovirus. It lodges in the intestinal tract.
Cameron: Enteroviruses cause diarrhea and flu-like symptoms in adults, maybe a rash, but for newborns it can be deadly. It’s damaging her heart.
Karen: Well, is there anything you can do?
Foreman: Viruses are more difficult to treat than bacterial infections. We still haven’t found a cure for the common cold.
Ethan: So, there’s no vaccine, or…
Foreman: There’s a company in Pennsylvania developing an antiviral. It got positive results in a lab setting and we managed to get our hands on it.
[Cut to Cameron, helping with Baby Hartig.]
Cameron: Imagine not being able to touch your own baby. [She goes out to Karen and Ethan.] Can I get your guys’ help with something?
Ethan: Sure.
Cameron: Your daughter, her –
Ethan: Maxine.
Karen: That’s her name.
Cameron: We need someone to hold Maxine off of the bed while the nurse changes her sheet.
Ethan: Sure. {They enter the room, now in scrubs, and hold Maxine.]
[Cut to House, getting into of the elevator.]
House: Hey, Foreman? Got a minute? [Foreman gets into the elevator.]
Foreman: So, pulmonary resistance is stabilized for the two kids, but BP’s still –
House: No news, then. How’s Cameron?
Foreman: Dr. Cameron?
House: Sure. Let’s start with her, and move on to all the other Camerons we know.
Foreman: Sorry, I’m just not used to you asking about someone’s well-being.
House: I can understand how the question would surprise you. I don’t quite get how it would confuse you.
Foreman: Why do you want to know? [They get out of the elevator.]
House: Why do you want to know why I want to know?
Foreman: Just curious.
House: Me, too.
Foreman: You don’t get curious.
House: I’m the most curious man in the world.
Foreman: Not about trivialities.
House: Well, then, this must not be trivial. How is Cameron handling everything? [They’re at the doors of the clinic.]
Foreman: Just fine.
House: Great, glad we talked.
[Cut to House, who’s meeting with Jill.]
House: Your husband is definitely the source of your “mono”.
Jill: Oh, wow. Oh, thank God. Wow, I’m going to be a mom. Whoa, heh heh. Thank you so much; I gotta get you a gift or something.
House: Sometimes the best gift is the gift of never seeing you again.
Jill: Okay, all right! But, Dr. House, you’ve been so awesome. I mean, I really, totally trust you. Do you think you –
House: No.
Jill: -- could do the prenatal?
House: No.
Jill: Or deliver the baby?
House: That would be no.
Jill: Okay!
[Cut to Ethan and Karen sitting on a couch in the waiting room.]
[Cut to NICU.]
Foreman: Chase, take a look at this. [Chase comes over, and starts to check out Baby Hartig with the stethoscope.]
[Cut to Chase and Foreman coming to talk to the Hartigs.]
Ethan: Oh, God. It’s good news.
Chase: No, it’s great. [Ethan and Karen start to laugh and cry.]
[Cut to Karen in a room. Cameron and Chase wheel in Baby Hartig, who Karen is ecstatic to see and hold.]
[Cut to Cameron, working in House’s office. House walks in, and Cameron starts to pack up.]
House: They all gone?
Cameron: Hartigs are checking out right now.
House: You look tired.
Cameron: Thanks.
House: It’s no wonder. You’ve had a hard time the last couple of days.
Cameron: And you haven’t?
House: Not like you. [pause] Anyone who’s that awkward either has no experience around death or too much, and I’m pretty sure it’s not the former. [Cameron starts to put on her coat.] Chase told me about that ID you had: the parents holding the baby. Where’d you get that? Did you lose someone? Did you lose a baby?
Cameron: You can be a real bastard. [She leaves.]
[As Cameron leaves, she sees the Hartigs exiting via the elevator. They all look very happy, which makes Cameron smile.]
[Let’s look at the outside of the hospital for a rather lengthy stretch of time! Okay!]
[Cut to House sitting on a couch in the waiting room. Wilson walks by.]
Wilson: Unfinished business?
House: I’m in the haystack.
Wilson: Ah, because now you know you’re looking for a needle.
House: Right.
Wilson: If I tell you to “let it go,” it won’t make any difference, will it?
House: Enteroviruses are spread by humans. Fecal, oral… could be respiratory secretions, though.
Wilson: So, Cuddy got stool samples from the whole staff. Just wait until they come back.
House: That won’t do it.
Wilson: Why not?
House: The shedder, whoever he is, is so virulent, Cuddy must have noticed him.
Wilson: Hmmm.
House: And the babies didn’t share any common personnel. That’s what’s weird.
Wilson: Yeah, yeah. That’s what’s weird. [Wilson leaves. We hear coughing in the distance. A old woman is pushing a cart around with teddy bears to give to the newborns. CGI shot of inside the woman’s nose, which shows the offending virus traveling from her nose, to her hand, to the fur of the teddy bear, to the face of a baby.]
Old woman: [to House] Can I help you?
[Cut to the soap opera.]
Soap patient: You saved my life.
Soap doctor: I just ran some tests. Your will and determination are what saved your life.
Soap patient: I know who I am now.
Soap doctor: Yes, you do. And I know who I am as well. [House is watching this in the OB/GYN lounge again. The door opens.]
Lim: Hey, seriously, man, you’re not supposed to be here.
House: I’m performing a delivery.
Kubisak: You are.
House: Patient who’s prenatal care I’ve been handling. Just checking her out a couple of minutes ago. Of course, I’ll need one of you two guys to supervise.
Lim: When’s she due?
House: Late March.
Kubisak: That’s five months from now.
House: Thank God these chairs are comfortable.
[End!]
Written by Peter Blake (IV)
Directed by Newton Thomas Sigel
Transcript written by Mari
[Open on face of a newborn baby. Overhead speaker is calling for Radiology.]
Ethan Hartig: Amber.
Karen Hartig: [scoffs] No.
Ethan: Why not?
Karen: Amber’s a stripper name.
Ethan: Find me one stripper named Amber Hartig. [small pause] Or not, okay. Non-stripper names, okay. [baby makes a few noises] Desiree? Bambi? Candy cane?
[We see Karen in the hospital bed, holding Baby Hartig. Ethan is next to them.]
Karen: Max. Maxine. Max Hartig is a cute name, isn’t it?
Ethan: If you’re a professional boxer, maybe.
Karen: Can you believe we made this little creature?
Ethan: I know, it’s incredible.
Karen: It’s the most amazing thing we’ve ever done.
Ethan: I almost ran the marathon last year.
Karen: [to Baby Hartig] If we’re lucky you won’t inherit your daddy’s sense of humor.
Ethan: [waving a teddy bear] Hello! Say hi to Bear!
[Baby starts to spit up. The parents are taken aback a little.]
Karen: She hasn’t even eaten anything; what is she spitting up?
Ethan: Well, honey, we can’t bug them –
Karen: Just –
Ethan: Okay, okay.
[Cut to Ethan walking in with Dr. Lim]
Ethan: Sorry, it’s our first kid, we’re both a little panicky I guess.
Dr. Lim: Well, you gotta ask the pediatrician next time. I just deliver ‘em. [to Karen] She spitting up?
Karen: Yeah. Second time in an hour?
Lim: [takes Baby Hartig] You lived underwater for nine months, you’d have a lot to spit up, too. [He touches Baby’s cheek, who doesn’t respond.]
Karen: Is something wrong?
Lim: Eh, a little lethargic.
Ethan: We didn’t think –
Lim: She’s hot. [Baby starts seizing.]
Ethan: Is she, uh –
Karen: What’s happening?
Lim: [simultaneously] Baby’s seizing! Get the crash cart!
Ethan: What’s, what’s, what’s, what’s wrong?
Lim: Can I get some help in here?!
Karen: Oh, oh God! Is she all right?
A nurse: IV access?
Lim: No, ativan.[Dr. Lim puts Baby Hartig on the table, and starts to try to clear her airway.]
Karen: What’s going on?
[Credits and such.]
[Soap opera, presumably General Hospital.]
Soap doctor: MRI results are back.
Soap patient: And?
Soap doctor: It’s what we expected. The accident caused serious damage.
[House starts to talk over the soap as he walks to a chair, opening a cup of jello or something similar. Mmm, hospital jello.]
House: It’s amnesia.
Soap doctor: I’m sorry.
Soap patient: I just can’t believe it.
[Lim and Dr. Kubisak walk into the lounge, talking.]
Lim: Enjoying our lounge, House?
House: I just came in to get milk for my coffee, which you’re out of.
Dr. Kubisak: Flat or sparkling?
House: Flat.
Lim: [simultaneously] Sparkling.
[Kubisak throws a bottle to Lim.]
Kubisak: So, the Hartigs?
Lim: Their baby gets a fever.
Kubisak: Wait, don’t tell me. Their kid had a seizure.
Lim: Yep. The parents, of course, start freaking and I have to deal with that for an hour.
Kubisak: Like it was your fault.
Lim: She was perfect when I delivered her. If you want to blame someone, blame the pediatrician.
Kubisak: So, how’s the kid now?
Lim: Bowel obstruction, she’s under observation, she’ll be fine. [While all this is going on, House is “watching” the soap intently.]
Kubisak: Pediatrician’ll take all the credit.
[House exits suddenly, leaving most of his jello behind.]
[Cut to Baby Hartig.]
House: [to Wilson] Exhibit A: Baby girl Hartig. Term baby, 42 hours old. Went into seizures 6 hours ago, brought into the intensive care, diagnosed with obstruction of the small bowel. [looks at Wilson]
Wilson: I’m still amazed you’re in the same room with a patient.
House: People don’t bug me until they get teeth. [small pause] Exhibit B: Baby boy Hausen. Another term baby, 48 hours old. Brought into the NICU before the Hartig baby: fever of unknown origin, 101 degrees, trending upwards.
Wilson: Wow, that is amazing. You hung out in the OB/GYN lounge and heard about two sick babies. It’s eerie. [goes to touch something, I’m presuming a baby]
House: Don’t touch that.
Wilson: [confused] All right…
House: We have an infection spreading in the hospital.
Wilson: [unbelieving] These kids have totally unrelated illnesses.
House: They fell sick within four hours of each other. They had the same delivery rooms, maternity rooms are neighboring, so transmission’s possible. They have the same symptoms.
Wilson: The Hartig girl has a bowel obstruction. No matter how close their beds are, I’m pretty sure kids can’t share a blockage.
House: What does bowel obstruction on a chart indicate?
Wilson: Well, normally, I’d say it indicates a patient’s bowel is obstructed, but I’m pretty sure you have some deeper truth to impart –
House: It means that some random doctor of indeterminate skill thinks that the patient’s bowel is obstructed.
Wilson: [trying not to laugh] Okay, you’re upset because they threw you out of their lounge.
House: Look at the x-ray. It’s a normal gas pattern.
Wilson: You want, I can get you a key to the oncology lounge.
House: [simultaneously] Air. Air in the column.
Wilson: We’re getting TiVo.
House: If it’s air, no bowel obstruction.
Wilson: Even if it is air, it could have been there before the obstruction.
House: No. Something’s infected both these infants.
[Cut to Cuddy’s office.]
Cuddy: And you’re the only one who put this together because…?
House: Because I’m the only one who looked at both kids. I want them isolated; I want the maternity ward shut down.
Cuddy: Because you’re better at reading an x-ray than a radiologist.
House: Radiologists always over-read babies’ x-rays, especially if they’re asked to rule out a pathology. He read into it what he wanted.
Cuddy: Which is exactly what you’re doing. You’re finding a cluster because you think it’s interesting to find a cluster. Two… plain old sick babies would bore you.
House: See, this is why I don’t waste money on shrinks, ‘cause you give me all these really great insights for free.
Cuddy: [smiling] Shrink. If you would consider going to a shrink, I would pay for it myself. The hospital would hold a bake sale, for God’s sake.
House: We have an epidemic! [Cuddy stops from going out the door and turns to House.]
Cuddy: [slowly] Two sick babies is very sad, but it doesn’t prove an epidemic. [She leaves. House is left alone in her office.]
House: How many do?
[Cut to diagnostic lounge. Chase is sleeping in a chair, until House throws a big red book in his lap.]
House: Get up! We’re going hunting.
Foreman: For what?
House: Wabbits.
[Cut to some maternity room. Mother and father are resting, their baby at the foot of the bed. House and Foreman enter the room; House picks up the baby, who starts to cry, waking the father and mother.]
House: Hi. [pause] Bye. [passes the baby to Foreman, saying quietly] He’s screaming, he’s fine.
Foreman: [puts the baby down, smiling and fully aware of the awkward situation] Good looking baby.
[Cut to a delivery room, where a birth is in process. Expectant dad is filming. Chase and Cameron stride in.]
Cameron: Oh, sorry, wrong room.
Chase: [half-wave] We’ll see you later.
Cameron: [out in the hall] 12 rooms, that’s it?
Chase: [closing the door to the room] Yep. We’ve definitely checked the whole floor. [They meet up with House and Foreman by the elevator.] Good news, no epidemic.
Foreman: Tragic, huh?
House: [looks at elevator] Overflow rooms, third floor. [goes into elevator]
Foreman: [to Cameron and Chase] This imaginary infection has spread to the next floor?
[Cut to mothers Kim Chen and Judy Lupino. They look worried. House enters the room.]
Judy: We were just going to call.
House: Did he get hot all of a sudden?
Judy: Yeah.
[Cut to hallway outside NICU. Cuddy is watching babies being brought in, but turns toward voices near the elevator.]
Man’s voice: Don’t worry, we’re almost there.
Cuddy: Excuse me! Hi. Intake sent you up here?
Man: Yeah, my wife’s contractions are less than –
Cuddy: Yeah, Intake messed up. I’m very, very sorry. Nurse Alpret will arrange for an ambulance to take you to Princeton General. [starts to wheel the pregnant woman back to the elevator]
Man: Wha –
Cuddy: The maternity ward is temporarily closed.
Woman: We have to leave?!
Cuddy: Yes, I am very sorry. [elevator opens, House comes out]
Man: Why are you doing this? [woman groans]
Cuddy: You’ll be there very, very soon. [elevator door closes, next line to House] Happy now?
House: No. But I am interested.
[Cut to a shot of more babies being brought into NICU. Commerical.]
[House’s office. He’s got his whiteboard out.]
House: Three sick babies, and a fourth showing early symptoms.
Cuddy: How bad?
Chase: Spiking fevers.
Foreman: BP’s plummeting. They’re barely able to keep systolic up; at this rate, they’ll be dead in a day.
Cuddy: Where did this come from?
Cameron: Two delivery rooms, four different maternity rooms, no common personnel and no common equipment.
Cuddy: Well, there’s gotta be something in common.
House: Yeah. That would be the difference between an epidemic and a coincidence.
Cuddy: I’m putting a team together. We’re going to start swabbing. [She leaves.]
Foreman: What’s she gonna swab? Every respirator, sink, vent, drain in the entire hospital? That’ll take months.
Cameron: A needle in a haystack.
House: It’s worse than that. We don’t even know what’s the needle we’re looking for. [He starts to erase the whiteboard.]
Cameron: Then why’d you let her go do it?
House: Because the hospital’s her baby, and her baby’s sick. If she doesn’t solve this soon, her head’s going to explode, and I don’t want to get any on me. [Chase and Cameron snicker softly] So let’s figure out what’s in the haystack. Differential diagnosis, people.
Foreman: Parasite.
Cameron: Spreading too quickly. [House writes “parasite” on the board and crosses it off.]
House: Next?
Chase: Virus? [House writes “virus”.]
Cameron: Kids are too sick, and the blood tests show no lymphocytosis.
Foreman: And they’re not responding to a cycle of avirarapovirin. If it’s some other virus, we’ll never find it in time, anyway. [House writes a question mark next to “virus”.]
House: Which leads us to bacterial infection. [which he writes on the board] It’s not responding to broad-spectrum antibiotics, so we’ve got something resistant. The usual suspects.
Foreman: MRSA. It’s always MRSA in hospitals.
Cameron: Maybe a contaminated food or water source? Psuedomonas.
Chase: VRE?
Foreman: H-Flu. [House writes these all down.]
House: Okay, those are the big ones. Cultures will take 48 hours, might as well be post-mortem. We’ll start them on Vancomycin for the MRSA and Aztreonam for the rest. Let’s get MRIs, check for abcesses or some occult infection. I’ll be in the clinic. Grab me if you find something important. Or unimportant.
[Cut to a hallway, where a nurse is wheeling a sick baby. The Hartigs look on.
Close up on Karen’s face as the nurse rounds the corner.]
[Cut to Chase and Cameron putting a baby (presumably Baby Hartig) into the MRI machine. Machine starts to make noise.]
[Cut to Chase looking at the MRI results.]
Cameron: [talking to Kim and Judy] We did a MRI on all the babies, and unfortunately, we didn’t find anything, so we’re starting him on the strongest antibiotics we’ve got, and we’re hoping that that’ll take care of it.
Judy: But he’s so tiny.
Kim: How sick is he?
Cameron: [pause] His fever’s up to 103.5 and his blood pressures 80 over 40.
Judy: Um, how bad is that?
Cameron: [freezes up] Ah, it…
Foreman: [behind Cameron] It, it’s low. The heart needs to circulate the blood. If it’s weak, oxygen isn’t getting to the liver, the kidneys, the brain. [Kim nods sadly.]
Judy: Um, I have to ask you something.
Kim: Judy –
Judy: No, no, Kim. Let me. Um, I had a cold last month, and I told the doctors about it, and –
Kim: Honey, this has nothing to do with you.
Cameron: Kim’s right. Your son was born healthy. He caught the infection after his birth. There’s no reason to think he got it from you.
Judy: But you don’t know, I mean – You don’t know how he got sick. [Cameron sighs and looks at Foreman.]
[Cut to Cameron and Foreman walking in a hallway.]
Foreman: Pretty standard question: how sick is my child? You couldn’t answer it.
Cameron: I answered.
Foreman: You rattled off numbers! BP, O2 stats.… That’s not what they need to know.
Cameron: What they need to know is the future. Got a magic 8-ball? [She starts to work on charts.]
Foreman: No, just eight years of medical training. Look, I realize it’s tough to break bad news to family –
Cameron: Not as tough as hearing it.
Foreman: And I guess being the poor guy dying is toughest of all?
Cameron: [pause] No. It’s easier to die than to watch someone die. [She leaves Foreman standing at the front clinic desk.]
[Cut to Cuddy and her team, swabbing.]
Cuddy: Well, we’re checking the vents, it could be airborne. Somebody get the sinks, too, and underneath them.
Med Student with the Tie: I’ll get it.
Wilson: How many med students have you got swabbing the decks?
Cuddy: Oh, what else are they going to do? It’s not like they’re delivering babies.
Wilson: Find anything yet?
Cuddy: Ah, yeah. About half the antibacterial gel dispensers are empty or broken.
Wilson: That’s bad. And diagnostically, completely insignificant.
Cuddy: Well, if the staff can’t wash their hands, it’s no wonder an infection has spread. [While they’re talking, we see Med Student’s tie has been hanging in the sink and generally being a nuisance.] Hey, tie clip!
Med Student with the Tie: Sorry?
Cuddy: We have an epidemic in this hospital and your tie is becoming a Petri dish. Put on a tie clip or take the damn thing off.
[Cut to the clinic.]
Patient (Jill): My joints have been feeling all loose, and lately I’ve been feeling sick a lot. Maybe I’m overtraining; I’m doin’ the marathon, like, ten miles a day, [House looks tired] but I can’t seem to lose any weight.
House: Lift up your arms. [She does so.] You have a parasite.
Jill: Like a tapeworm or something?
House: Lie back and lift up your sweater. [She lies back, and still has her hands up.] You can put your arms down.
Jill: Can you do anything about it?
House: Only for about a month or so. After that it becomes illegal to remove, except in a couple of states. [He starts to ultrasound her abdomen.]
Jill: Illegal?
House: Don’t worry. Many women learn to embrace this parasite. They name it, dress it up in tiny clothes, arrange playdates with other parasites –
Jill: Playdates…
House: [shows her the ultrasound] It has your eyes. [It’s a baby!]
Jill: But… that’s impossible.
House: Well, I assume you weren’t getting your period. Maybe that should have give you an inkling.
Jill: But I’m on this birth control implant…
House: Yeah, I know. I saw the scar on your arm.
Jill: …and my doctor said I might not get any periods at all if it was working.
House: Mm hmm. Interestingly enough, you also don’t get any periods if it isn’t working, which is why you were supposed to get regular pregnancy tests. [Jill makes a pained face.] I’m going to send a nurse in here to schedule your prenatal care. You’re due in about five months, so start planning the shower.
Jill: Um, Doctor? Please. Me and my husband wanted to have a kid soon, but… oh, God. Like four months ago we had this really big fight. [House looks like he knows where this is going] He moved out. I did something stupid.
House: One-night stand?
Jill: Ex-boyfriend.
House: I’ll schedule you a paternity test, too.
Jill: I can’t let my husband know.
House: Does the old boyfriend look like your husband?
Jill: [thinks a little] Yeah…
House: Then just have the kid. He’ll never know. The most successful marriages are based on lies. You’re off to a great start. [He leaves, Jill looks like she’s going to cry.]
[Cut to House’s office.]
House: Well, you look cheery. What’s going on?
Cameron: The Hartig and Chen-Lupino babies. Their kidneys are shutting down.
Chase: And the urine tests show no casts.
House: Which means the antibiotics are causing the kidney failure.
Foreman: You’re the nephrologist. Which one did it? We’ll take ‘em off that one. [pause] Don’t tell me both Vancomycin and Aztreonam can –
Chase: They both can cause this. There’s no way to know which one it is. No test. [House looks at Chase.]
Foreman: We can’t take them off the antibiotics. They’ll die of the infection.
Cameron: If we leave them on both the antibiotics they’ll die of kidney failure.
Chase: So, we take our best guess, then. Which drug’s causing the kidney failure?
Foreman: It’s like I said: it’s always MRSA in hospitals. Take ‘em off Aztreonam.
Cameron: I still think it’s the pseudomonas. I vote to take them off the Vancomycin. [long pause]
House: There’s no point in guessing. Take one kid off Vancomycin and the other off Aztreonam.
Chase: They have the same disease, you want to give them different treatment?
Foreman: What the hell are you doing?
House: Theraputic trial to find the cause of the infection.
Foreman: That’s wrong.
House: We have four sick kids, at least. Who knows how many more haven’t started showing symptoms yet?
Foreman: We have a duty to these two!
House: If these two have different reactions we know how to save the rest.
Foreman: So you’re condemning one of these kids to die based on random chance. [pregnant pause]
House: I guess I am.
[Commercial]
[NICU. Some baby is crying. Cut to Cuddy’s office.]
Cuddy: So, you’re going to flip a coin? That’s how you decide which baby lives?
House: Can I borrow a quarter?
Hospital Attorney: Do you want to get sued, lose your license, House? Well, generally I’d applaud that, but my job is to protect this hospital, so I strongly advice you to come up with a medical rationale why Baby A should get Medicine X and vice-versa.
House: Whoa, whoa, whoa, hold on there, Slick. We didn’t all go to law school. Your advice is that I should use medical reasons to make medical decisions? Hmm, that’s not going to be as easy…
Attorney: Any medical justification. Doesn’t need to be a good one.
House: Well, Hartig sounds Jewish, so does Aztreonam, so we’ll take the Hartig kid off Vancomycin, how’s that? [pause]
Cuddy: You can’t experiment on babies.
House: Doctors experiment all the time.
Cuddy: On adults. With their consent.
House: Fine. I’ll get the parents’ consent.
Attorney: Their informed consent. They have to know the other kid is getting a different treatment.
House: Sorry, can’t do that. It’d be unethical for one patient to know about another patient’s treatment.
Attorney: They have a right to know.
House: If they know, they won’t consent; that defeats the whole purpose.
Attorney: That’s their right.
House: [getting up from the couch] Two more babies have just become symptomatic. I defer to your legal wisdom: which takes precedence? Six dying babies or a missing consent form?
Attorney: You can’t do it.
Cuddy: [sighing; to House] Do what you think is best. [House leaves; Cuddy looks very unhappy about the whole situation.]
[Cut to House sitting in his office. He’s twirling a coin between his fingers. He spins it and watches how it lands.]
[Cut to Foreman talking to the Hartigs, Cameron is talking to the Chen-Lupinos simultaneously.]
Foreman: Your daughter’s kidneys are shutting down…
Cameron: Your son’s kidneys are failing.
Foreman: …so we’re going to take her of the Aztreonam.
Cameron: We’re taking him off Vancomycin.
Ethan: But, uh, but what made her sick in the first place?
Kim: What do you think is causing it?
Cameron: It seems to be a germ called pseudomonas.
Foreman: We think it’s MRSA. Methicillin-Resistant Staph Aureus. It’s a very resistant form of a very common bacteria.
Cameron: We’re hoping the Aztreonam will clear it up.
Foreman: Vancomycin is the best treatment for MRSA, so we’re gonna keep giving it to her.
Ethan: Right. Is it gonna cure her?
Foreman: Your child is very sick. You need to know that. This is a ‘hail Mary’ pass. It might cure her, it might not. [Ethan sits back on the couch, defeated.]
Judy: So, so that’ll cure him?
Cameron: We’ll know in 24 hours if it’s working. [Judy and Kim look very happy. Cameron walks away from them; Wilson is at the reception desk.]
Wilson: What did you tell them?
Cameron: I told them the truth.
Wilson: They seemed relieved. You tell them how sick their son is?
Cameron: I explained what was going on.
Wilson: Alison, their baby’s dying. If the parents weren’t in tears when you left, you didn’t tell them the truth.
Cameron: That’s not how I see it.
Wilson: Do you want them blindsided? Want them coming up and saying “My God, my baby died, why didn’t you warn me?”
Cameron: So now it’s about worrying about them yelling at us?
Wilson: No, it’s about getting them prepared for the likely death of their child.
Cameron: If their son dies tomorrow, do you think they’ll give a damn of what I said them today? It’s not going to matter; they’re not going to care; it’s not going to be the same ever again. Just give those poor women a few hours of hope. [She walks away from him.]
[Cut to House leaving his office. Jill runs up, towing her husband.]
Jill: Dr. House! Dr. House, this is my husband, Charlie.
House: Who told you where my office was?
Charlie: Jill, come on, he obviously doesn’t want us bothering him.
House: Ooh, I was trying to hide it.
Jill: Look, Doctor, this is about the mono you said you thought I had…
House: The mono?
Jill: Yes. You know, shouldn’t Charlie be tested? You know, [House looks at Jill like she’s insane] the test. The blood test.
House: [catches on] Right. Yeah, I’m sorry, I sometimes forget patients, I thought you were this idiot who doesn’t know how to use birth control. [pointed look]
Charlie: I can’t have mono. I don’t even feel sick or anything.
House: That’s very often the first sign. [He gets into the elevator.] Call my office in the morning, I’ll schedule him for bloodtests. [The elevator doors close.]
Jill: Thank you!
Charlie: I’m not even tired.
[Cut to Cuddy swabbing medical equipment. Wilson walks up.]
Wilson: Find anything yet?
Cuddy: No, just some baby formula being stored under a sink with a dripping faucet.
Wilson: Tap water contamination. You thinking pseudomonas infection?
Cuddy: I was. I wasted a couple of hours chasing it down, but of course the formula hasn’t been anywhere near the babies.
Wilson: Huh.
Cuddy: Whatever idiot stored them there –
Wilson: All right, we’ll figure it out! Just… just calm down.
Cuddy: I am calm. [She walks over to Med Student with Tie, and takes scissors to him, leaving him Med Student without Tie.]
Med Student without Tie: Aw, could –
Cuddy: I warned you. [to Wilson] I did that calmly. [She and Wilson walk into NICU as Chase walks out. Karen is looking in the windows.]
Karen: [to Chase] Hey.
Chase: Hi.
Karen: Is she any better?
Chase: Her fever’s been stable the last hour.
Karen: We’re not going to make it, are we?
Chase: Sorry?
Karen: Me and Ethan. Our next-door neighbor, their little boy died in a car crash and she and her husband split up, like, four months after the funeral. It’s just, uh, what always happens, right? [pause]
Chase: Um, what happens to patients after they leave the hospital, I don’t know, but… try not to get ahead of yourself. [Beeping is heard inside the NICU. Chase goes back in.]
Nurse’s voice: Dr. Chase? Activity on the monitor.
Chase: How long?
Nurse: I don’t know, it just started.
Chase: Pulse? [Nurse mutters something.] Fluid wide open. Do we have an arterial line?
Nurse: Not yet.
Chase: Let’s get a BP. [Karen walks into the NICU.] You can’t come in here.
Karen: Is my baby dying?
Chase: Mrs. Hartig –
Karen: Is she dying?!
Nurse: [half-pushing Karen out the door] Ma’am, you’ll have to leave.
Chase: It’s not your baby!
Chase: Fenlay, BP 60 over 20. [House walks into the NICU and stands next to Wilson.]
Cameron: Heart rate’s 180.
House They start the levofed?
Wilson: They’ve got it.
Kim and Judy come to the window.]
Chase: Still dropping. 50 over 10.
Cameron: Can’t hold BP with three pressers? We’re losing pulse.
Chase: V-fib.
Wilson: Shut the blinds. [A nurse does so. Judy starts to cry. Wilson and Chase prep the defibrillator.]
Chase: Charging. Clear. [CGI of inside the baby’s chest. We see that the shock does nothing to jumpstart the heart.]
Foreman: Still v-fib.
Chase: Charging. Clear. [another shock] Charging. Clear. [CGI shot shows no movement.]
Foreman: Still v-fib.
Chase: Charging. Clear. [shock] Charging.
House: Chase. [pause] Time of death: 6:57 PM. [long pause] The Aztreonam doesn’t work. Double-cover all the other babies with Vancomycin.
Chase: I’ll do it.
House: Cameron, you tell the parents. Tell them their child probably saved five lives.
Cameron: But Chase should –
House: Chase is busy.
Cameron: You’re the attending.
House: [to Wilson] Make sure she does her job.
[Cut to Kim and Judy. Cameron and Wilson walk out to them. We see Cameron freeze up, and Wilson starts to talk. Judy and Kim sob. As Wilson and Cameron leave, she looks back at the two women.]
[Cut to House and Wilson leaving the elevator.]
House: I asked you to make sure she does her job, not do it for her.
Wilson: She froze up.
House: She felt sorry for the parents so she shut up. You felt sorry for her so you opened your mouth.
Wilson: She has a problem.
House: Yeah, she needs to deal with it. If you hadn’t bailed her out, she would have done it.
Wilson: Great, then she wouldn’t have slept for two weeks. Maybe she should be thinking about a different specialty. Lab work, research? [Chase walks up.]
House: Yeah, what is it?
Chase: The Hartig baby. She’s getting sicker, too. The Vancomycin isn’t working, either.
[Cut to a late night in House’s office.]
House: Vancomycin doesn’t kill it. Aztreonam doesn’t kill it. What the hell is this?
Foreman: It’s a super bug.
Chase: It could be VRSA.
Cuddy: There’s only been two reported cases of it ever in the United States.
Chase: One of the kids, the Hausen baby, had a skin rash. It could be scalded-skin syndrome which would be a sign of VRSA.
Foreman: Then these kids are dead.
House: This is our fault. Doctors over-prescribing antibiotics. Got a cold? Take some penicillin. Sniffles? No problem. Have some azithromycin. Is that not working anymore? Well, got your Levaquin. Antibacterial soaps in every bathroom. We’ll be adding Vancomycin to the water supply soon. We bred these super bugs. They’re our babies. Now they’re all grown up and they’ve got body piercings and a lot of anger. [sigh] On the other hand, maybe antibiotics had nothing to do with it. Did you notice how low his BP was at the end? Even with three pressers?
Wilson: Heart damage?
House: Go home. There’s nothing more you can do tonight.
[Cut to House, preparing to do an autopsy on the dead baby. He speaks into a little microphone.]
House: Baby boy Chen-Lupino. Time of death 6:57 PM Thursday, December 2nd, 2004. [He takes the covers off of the tools and starts to remove the baby’s diaper.]
[Cut to the next morning in House’s office.]
House: This is a cross-section of the Chen-Lupino boy’s myocardium. Fibrosis, lymphocydic infiltrates.
Cameron: There was no sign of lymphcytosis in the blood tests.
House: Yes, well, we all had plenty of good reasons to think bacterial. Nobody is scolding you. [He hands Cameron his cane.] Unfortunately, all of those clever reasons were wrong. It is a virus infecting their hearts.
Foreman: We’re screwed. We can’t chase down a virus; there’s a thousand possibilities.
Cameron: We could run gels, antibody tests.
Foreman: A thousand of them? The kids don’t have enough blood.
House: Chase, you’re the intensivist. How many could we do before we risk exsanguinating the kids?
Chase: You’re talking vials, not stick tests? I wouldn’t take more than five or six.
House: [writes “Virus” on the white board’] Okay, so we have to narrow the thousand viruses down to six. Now, the autopsy’s shown us what the virus does. So, let’s go. What do we know?
Wilson: Ribavirin and encyclovir don’t knock it out.
Cuddy: Cross out the herpes viruses.
House: Also adenovirus. [House starts to make a T-chart on the board.] What else, what else? Keep talking.
Chase: Well, it, it only seems to hit children. The mothers aren’t sick, so…
Foreman: No toxoplasmosis, no rubella. Cross out the entire Torgh syndrome.
Wilson: You didn’t find any lung damage?
House: No.
Wilson: None of the paramyxoviridae.
House: Cardiac scarring, people.
Chase: CMV?
Foreman: Enteroviruses, too, I think.
House: [muttering] Echo 11.
Cuddy: Influenza A.
House: [mutters] Influ A. Yes. And? [We see more ideas being written on the board.] I’m putting RSV down as a yes. That makes eight.
Chase: Eight vials of blood is pushing it.
House: Pushing it, but we love that! Get the antibody kits, start testing the sick kids.
Wilson: All right, I’ll start looking into whether there are any antivirals for these eight.
House: Wait a second. The, the kids on the floor who didn’t get sick. Are any of them still in the hospital?
Wilson: They got moved to the fifth floor. But they’re probably all checked out by now.
Cuddy: No, the Lindpert boy had a bit of jaundice. He should be checking out today.
House: I want to test his blood, too.
Cuddy: Why?
House: ‘Cause we need all the information we can get. The healthy kid can be our control group.
Cuddy: I’ll just tell his parents he can’t check out because he has the smallpox.
[Cut to Cameron drawing blood from sick babies. Chase is taking some from the healthy one on floor five. The baby is crying.]
Chase: All done, all done.
[Cut to House’s office.]
House: What did we get?
Foreman: Well, the sick babies all tested positive for Echovirus 11.
House: Great.
Foreman: And CMV, and parvovirus B19.
House: Three viruses?
Foreman: What’s weirder, the healthy kid we tested: he’s positive for Echovirus 11 and CMV antibodies as well.
House: [sighs] They’re infants. They have their mother’s blood, their mother’s antibodies.
Foreman: So we just learned nothing?
House: Uh-uh. We have half the picture. The healthy kids survived because their mothers’ antibodies saved them.
Foreman: The mom had CMV in the past she’d have the antibodies for them, the kid would be immune from it. So we test the sick kids’ moms for Echovirus, CMV, and parvovirus.
House: And whichever they don’t have the antibodies for, that’s what’s killing their kids.
Foreman: I’ll test the mothers.
[Cut to Foreman drawing blood from Karen. The overhead speaker is asking for an inhalation specialist to go to pediatrics.]
[Cut to House’s white board. House crosses off Parvovirus B19 and CMV and circles Echo-11.]
[Cut to Foreman and Cameron, who are talking to Karen and Ethan.]
Foreman: Echovirus 11. It’s an enterovirus. It lodges in the intestinal tract.
Cameron: Enteroviruses cause diarrhea and flu-like symptoms in adults, maybe a rash, but for newborns it can be deadly. It’s damaging her heart.
Karen: Well, is there anything you can do?
Foreman: Viruses are more difficult to treat than bacterial infections. We still haven’t found a cure for the common cold.
Ethan: So, there’s no vaccine, or…
Foreman: There’s a company in Pennsylvania developing an antiviral. It got positive results in a lab setting and we managed to get our hands on it.
[Cut to Cameron, helping with Baby Hartig.]
Cameron: Imagine not being able to touch your own baby. [She goes out to Karen and Ethan.] Can I get your guys’ help with something?
Ethan: Sure.
Cameron: Your daughter, her –
Ethan: Maxine.
Karen: That’s her name.
Cameron: We need someone to hold Maxine off of the bed while the nurse changes her sheet.
Ethan: Sure. {They enter the room, now in scrubs, and hold Maxine.]
[Cut to House, getting into of the elevator.]
House: Hey, Foreman? Got a minute? [Foreman gets into the elevator.]
Foreman: So, pulmonary resistance is stabilized for the two kids, but BP’s still –
House: No news, then. How’s Cameron?
Foreman: Dr. Cameron?
House: Sure. Let’s start with her, and move on to all the other Camerons we know.
Foreman: Sorry, I’m just not used to you asking about someone’s well-being.
House: I can understand how the question would surprise you. I don’t quite get how it would confuse you.
Foreman: Why do you want to know? [They get out of the elevator.]
House: Why do you want to know why I want to know?
Foreman: Just curious.
House: Me, too.
Foreman: You don’t get curious.
House: I’m the most curious man in the world.
Foreman: Not about trivialities.
House: Well, then, this must not be trivial. How is Cameron handling everything? [They’re at the doors of the clinic.]
Foreman: Just fine.
House: Great, glad we talked.
[Cut to House, who’s meeting with Jill.]
House: Your husband is definitely the source of your “mono”.
Jill: Oh, wow. Oh, thank God. Wow, I’m going to be a mom. Whoa, heh heh. Thank you so much; I gotta get you a gift or something.
House: Sometimes the best gift is the gift of never seeing you again.
Jill: Okay, all right! But, Dr. House, you’ve been so awesome. I mean, I really, totally trust you. Do you think you –
House: No.
Jill: -- could do the prenatal?
House: No.
Jill: Or deliver the baby?
House: That would be no.
Jill: Okay!
[Cut to Ethan and Karen sitting on a couch in the waiting room.]
[Cut to NICU.]
Foreman: Chase, take a look at this. [Chase comes over, and starts to check out Baby Hartig with the stethoscope.]
[Cut to Chase and Foreman coming to talk to the Hartigs.]
Ethan: Oh, God. It’s good news.
Chase: No, it’s great. [Ethan and Karen start to laugh and cry.]
[Cut to Karen in a room. Cameron and Chase wheel in Baby Hartig, who Karen is ecstatic to see and hold.]
[Cut to Cameron, working in House’s office. House walks in, and Cameron starts to pack up.]
House: They all gone?
Cameron: Hartigs are checking out right now.
House: You look tired.
Cameron: Thanks.
House: It’s no wonder. You’ve had a hard time the last couple of days.
Cameron: And you haven’t?
House: Not like you. [pause] Anyone who’s that awkward either has no experience around death or too much, and I’m pretty sure it’s not the former. [Cameron starts to put on her coat.] Chase told me about that ID you had: the parents holding the baby. Where’d you get that? Did you lose someone? Did you lose a baby?
Cameron: You can be a real bastard. [She leaves.]
[As Cameron leaves, she sees the Hartigs exiting via the elevator. They all look very happy, which makes Cameron smile.]
[Let’s look at the outside of the hospital for a rather lengthy stretch of time! Okay!]
[Cut to House sitting on a couch in the waiting room. Wilson walks by.]
Wilson: Unfinished business?
House: I’m in the haystack.
Wilson: Ah, because now you know you’re looking for a needle.
House: Right.
Wilson: If I tell you to “let it go,” it won’t make any difference, will it?
House: Enteroviruses are spread by humans. Fecal, oral… could be respiratory secretions, though.
Wilson: So, Cuddy got stool samples from the whole staff. Just wait until they come back.
House: That won’t do it.
Wilson: Why not?
House: The shedder, whoever he is, is so virulent, Cuddy must have noticed him.
Wilson: Hmmm.
House: And the babies didn’t share any common personnel. That’s what’s weird.
Wilson: Yeah, yeah. That’s what’s weird. [Wilson leaves. We hear coughing in the distance. A old woman is pushing a cart around with teddy bears to give to the newborns. CGI shot of inside the woman’s nose, which shows the offending virus traveling from her nose, to her hand, to the fur of the teddy bear, to the face of a baby.]
Old woman: [to House] Can I help you?
[Cut to the soap opera.]
Soap patient: You saved my life.
Soap doctor: I just ran some tests. Your will and determination are what saved your life.
Soap patient: I know who I am now.
Soap doctor: Yes, you do. And I know who I am as well. [House is watching this in the OB/GYN lounge again. The door opens.]
Lim: Hey, seriously, man, you’re not supposed to be here.
House: I’m performing a delivery.
Kubisak: You are.
House: Patient who’s prenatal care I’ve been handling. Just checking her out a couple of minutes ago. Of course, I’ll need one of you two guys to supervise.
Lim: When’s she due?
House: Late March.
Kubisak: That’s five months from now.
House: Thank God these chairs are comfortable.
[End!]
HOUSE, M.D. 1X03: OCCAM'S RAZOR
Original Airdate on FOX: November 30, 2004
Written by David Shore
Directed by Bryan Singer
Transcript written by Mari
[Cut into an older looking building and then into a room with a boy sitting and talking on the telephone without a shirt on.]
Brandon: I didn’t sleep well last night, and I woke up with a scratchy throat. I just don’t feel so good. [Pause] Uh, cough, [clears his throat] Yeah, I’m, I’m, a bit of an upset stomach too, and I think I’m running a fever, I’m just worried I might be contagious. [Coughs] Inventory, tomorrow, yeah I’m sure I’ll be feeling better by then. [Pause] Thanks, Mr. Nobby.
[Turns off the phone and lays back, we can now see that there is a young girl in bed with him.]
Mindy: I cannot believe you just did that.
Brandon: I really do have a cough.
Mindy: Oh, so you weren’t lying, you’d be curled up in bed with a bowl of chicken soup even if you didn’t have a horny girl in your bed?
Brandon: Yes, [laughs] Because I really do, hey, I really do have a cough.
Mindy: You also have a little rash. [giggles]
Brandon: Um, umm, I’m uh not sure that we should be kissing.
Mindy: Oh, that’s ok, because I have almost no interest in kissing you.
Both: [Laugh]
[Cut to a very explicit sex scene. All you really need to know is that it was very rough, and his next-door neighbors are probably hating him right now.]
Mindy: [Panting and giggling] Oh, Brandon. (singsongy) Brandon, I know I’m good but come on. Brandon, Brandon, Brandon… [Brandon is unconscious.]
[Cut to back out of the building, you can still hear the girl calling for Brandon.]
[Cut to Credits]
[Cut to a room at PPTH, you can see Brandon in the bed hooked up to a bunch of stuff, and the Girl is sitting there with him. You can see that his rash has spread and he is looking very uncomfortable.]
House: Why do you want me to treat this guy?
Wilson: Blood pressure’s not responding to IV fluids.
House: No, no I didn’t ask how you plan to con me into treating him, I asked you why YOU want me to treat him.
Wilson: He’s sick, I care, I’m pathetic.
House: There are about a billion sick people on the planet, why this one?
Wilson: Because this one’s is in our emergency room.
House: Ah, so it’s a proximity issue. If somebody was sick in the third floor stairwell that’s who we would be talking about.
Wilson: Yes, I checked the stairwell, it’s clear.
House: Ok then, emergency room guy it is.
Wilson: Wait, how was that so easy?
House: You know why.
Wilson: Blood pressure’s not responding to IV fluids?
House: Yeah, that’s just weird.
[House enters elevator. Cut to House’s office with Ducklings.]
House: CBC was unremarkable, abdominal CT scan didn’t show anything. So, people, differential diagnosis. What’s wrong with her?
Cameron: Him.
House: Him, her, does it matter? Does anyone think it is a testicular problem? No, so Chase…
Chase: Absidia infection?
Foreman: No, you wouldn’t get the rash or cough. What about arthritis? Accompanying vasculitis causes nerve damage –
Cameron: No, it wouldn’t cause the blood pressure problems. Allergy?
Chase: The kid’s got abdominal pain. Maybe carcinoid?<
Foreman: Nah, but then you wouldn’t get the – [House slams a giant book in front of Foreman.]
House: Foreman, if you’re going to list all the things it’s not, it might be quicker to do it alphabetically.< Let’s see. Absidia? Excellent.< Doesn’t account for any of the symptoms.<
Cameron: No condition accounts for all these symptoms.
House: Well, good!< Because I thought maybe he was sick, but apparently he’s not. Who wants to do up the discharge papers? [pause]< Okay, unless we control the blood pressure, he’s going to start circling the drain before we can figure out what’s wrong with him. Treat him for sepsis, broad-spectrum antibiotics and I want a cort-stim test and an echocardiogram.<
[Cut to the echocardiogram.< Brandon is coughing.]
Chase: You all right?
Brandon: Yeah.
Foreman: Cort-stim tests will tell us if your pituitary and adrenal glands are working properly.
Mindy: His glands?< What does that mean?
Chase: We have a few theories we’re working on.
Mindy: You mean you don’t know.
Brandon: Mindy…
Mindy: I’m just saying if they knew they wouldn’t be testing you, they’d be treating you.
Foreman: Yeah, well, that’s the way it works. First you find out what it is, then we get you better.
[Cut to House entering the clinic.]
Cuddy: You’re half an hour late.
House: Busy case load.
Cuddy: One case is not a “load”.
House: So, how are we doing on cotton swabs today? If there’s an acute shortage I could run home –
Cuddy: [looks at his leg] No, you couldn’t.
House: Nice. [He walks over to the waiting room full of patients.] Hello, sick people and their loved ones! [Cuddy looks at him incredulously.] In the interest of saving time and avoiding a lot of boring chit-chat later, I’m Dr. Gregory House. You can call me Gregg. I’m one of three doctors staffing this clinic this morning.
Cuddy: Short, sweet.< Grab a file.
House: This ray of sunshine is Dr. Lisa Cuddy. Dr. Cuddy runs this whole hospital so, unfortunately, she’s much too busy to deal with you.< I am a bored [looks at Cuddy] certified diagnostician with a double specialty of infectious disease and nephrology. I’m also the only doctor currently employed at this clinic who is here against his will.< That is true, isn’t it? [Cuddy just looks at him.] But not to worry, because for most of you this job could be done by a monkey with a bottle of Motrin.< Speaking of which, if you’re particularly annoying, you may see me reach for this. This is Vicodin. It’s mine.< You can’t have any.< And no, I do not have a pain management problem, I have a pain problem. But who knows? Maybe I’m wrong.< Maybe I’m too stoned to tell.< So, who wants me?< [None of the clinic patients seem too eager.] And who would rather wait for one of the other two doctors? [Everyone raises their hands.] Okay, well, I’ll be in Exam Room 1 if you change your mind.
Cuddy: Jodi Matthews?< [Jodi stands.]< Please accompany Dr. House to Exam Room 1.
[Cut to Chase walking in the hallway. Mindy runs up to him.]
Mindy: Dr. Chase!
Chase: I’m not sure scaring your boyfriend is the best medicine for him right now.
Mindy: I know, I get… stupid when I’m scared.
Chase: Don’t go rock climbing.
Mindy: Look, I was wondering…. Before this happened, we were having sex.
Chase: What, you, you’re wondering if whatever he has you might have gotten it? It’s unlikely, we ran a complete STD panel, so –
Mindy: No, I was wondering if maybe I did this to him. I was kind of rough.
[Cut to House in the exam room with Jodi.]
Jodi: It was yellow.
House: It was?
Jodi: It’s not any more.
House: Hmmm, that’s a shame.
Jodi: I thought that might be a problem, so I brought you this. [She hands him a paint color sample card.]
House: Your mucus was pale goldenrod.
Jodi: Last week, yes.< Should I be worried?
House: Oh, yes.< Very.
Jodi:< Really? I thought I was okay now.
House: And yet, here you are.< What happened?< Paramedics took a week to respond to your 911 call?
Jodi: You’re not a very nice doctor, are you?
House: And you are very bad at whatever it is you do.
Jodi: You don’t even know me!
House: I know you’re going to get fired. That’s why you got the new glasses, that’s why your teeth are sparkly white.< You’re getting the most of your health insurance while you still can.
Jodi: I might be quitting.
House: If you were quitting you would have known that last week when your snot was still pale goldenrod; you’re getting fired.
Jodi: I just don’t like being told what to do.
House: I’ll get you in for a full body scan later this week.
Jodi: Thanks.
[Cut to Chase, Cameron and Foreman in the lab.]
Foreman: It’s got to be viral. We should start running gels and tiles.
Chase: We should test the girlfriend’s theory. She thinks she rode him to death.
Foreman: [laughs] What did you tell her?
Chase: Well, I told her 22-year old men don’t die of sex.
Cameron: What’d you ask her?
Chase: What do you mean?
Cameron: I mean, I hope you got some specifics on exactly what was going on. It’s a girl who thinks it could kill you… it’s worth knowing about. [pause]
Chase: Have you ever taken a life? [Cameron gives him a dirty look. Foreman gets the lab results from the printer.]
Foreman: We should stop the antibiotics.
Cameron: It’s too soon to say they’re not having an effect.
Foreman: They’re having an effect. His BP’s falling fast. [Cut to a shot of Brandon coughing.] There’s fluid filling his lungs. His creatine’s rising. [CG shot of the IV meds hitting Brandon’s bloodstream.] His kidneys are shutting down. Our treatment isn’t making him better, it’s killing him.
[Cut to House’s office.< Cameron is adding “kidney failure” to the list of symptoms on the white board.]
House: So, we had six symptoms that didn’t add up to anything, now we have seven.< Who’s excited?
Foreman: I don’t think it complicates things. The kidney failure was caused by the antibiotics.
House: Maybe.
Foreman: Typically, low blood pressure and abdominal pain means an infection. An abdominal infection causes sepsis, low blood pressure…
Chase: Except we checked for abdominal infections.
Foreman: I know, but what if it’s the other way around. What if the low blood pressure is causing the abdominal pain?
Cameron: Viral heart infection. The intestines aren’t getting enough blood, and the result is belly pain.
Foreman: I know it’s not the standard presentation.
Chase: It’s a 10 million to one shot.
Foreman: I thought that’s what we dealt with, here. It explains the cardiomyopathy, pain, the low BP, the fever.
House: You read the book.< Impressive. It’s a ludicrously long shot that explains every one of those symptoms, except for the cough and the rash. Should we just erase those?
Foreman: Well, anything can cause a rash.
House: Okay. [He grabs a colored marker.] Cardiac infection. [He circles all of the applicable symptoms, puts down the marker, and then picks up a different marker.]< Cameron, you thought… allergy? [Circle, new marker, repeat.] Chase, what was it you thought, carcinoid?< And then there’s hypothyroidism, could be parasites. Finally, sinus infection.
Foreman: If you’re going to list all of the things it can’t be, you’re gonna need more colors.
House: Cameron was right.< No condition explains all these symptoms. But orange and green covers everything.
Chase: Orange and green?< Two conditions, contracted simultaneously?
Foreman: Occam’s Razor.< The simplest explanation is always the best.
House: And you think one is simpler than two.
Cameron: Pretty sure it is, yeah.
House: Baby shows up.< Chase tells you that two people exchanged fluids to create this being. I tell you that one stork dropped the little tyke off in a diaper.< You going to go with the two or the one?
Foreman: I think your argument is specious.
House: I think your tie is ugly. Why is one simpler than two?< It’s lower, lonelier… is it simpler?< Each one of these conditions is about a thousand to one shot. That means that any two of them happening at the same time is a million to one shot.< Chase says that cardiac infection is a 10 million to one shot, which makes my idea 10 times better than yours.< Get a calculator, run the numbers.
Chase: We’ll run the tests.
House: Tests take time.< Treatment’s quicker.< Start the kid on Unacin for the sinus infection and… what was orange?
Cameron: Hypothyroidism.
[Cut to Brandon’s room.]
Brandon: My uncle has hypothyroidism.
Cameron: Not like this. Intravenous levothyroxine is an artificial thyroid medication that should take care of it. Also, the nurses are going to start you on Unacin, it’s a more targeted antibiotic.
Mindy: For the sinus infection?
Cameron: Yes.
Mindy: And the other stuff is for… something else entirely?
Cameron: Bad luck, huh?< Don’t worry, he should be back to ditching work in no time. [The door opens, Brandon’s parents come in {referenced as Mr. and Ms. Merrell)]
Mrs. Merrell: Brandon?
Brandon: Hey. [coughing]
Mr. Merrell: We’re his parents. How’s he doing?
Cameron: Um, Brandon is –
Brandon: Um, Mom, Dad, this is Mindy. I was going to bring her home for Christmas, so…. We’re engaged. [Cameron raises her eyebrows. Brandon’s parents smile.]
[Cut to Cameron leaving the room, Chase and Foreman catch up to her.]
Chase: Tell the family House’s theory?
Foreman: Two odd conditions striking completely coincidentally at the exact same time?
Cameron: I didn’t phrase it quite that way.
Chase: They agree to treatment?
Foreman: Of course they did, we’re doctors. They believe whatever we tell them. [pause] So, is that our job? House’s puppets? He comes up with an insane idea, we get to pretend it’s not?
Cameron: His insane ideas are usually right. We’ve been here long enough to –
Foreman: -- been here long enough to have Stockholm Syndrome. [Chase and Cameron laugh.]
Chase: What?< Because we don’t hate him?< He thinks outside the box, is that so evil?
Foreman: He has no idea where the box is! If you guys think he’s right, go home. Relax.< Just wait for the kid to get all better.< I’m going to the lab to test for viral infections. [He walks off; Chase and Cameron follow.]
[Cut to the lab, where the ducklings are working on gels.]
Foreman: Negative for Coxsackie-B virus.
Chase: Seven down, about 5000 to go. You really think we’re going to come up with your mystery virus by running gels until we guess it right? [We see that Cameron is in a separate part of the lab from Foreman and Chase.]
Foreman: No, I think we’re going to get it by standing around watching other people work.
Chase: I’m waiting for the Epstein Barr virus. [looks at Cameron] She’s weird, isn’t she?
Foreman: Bad idea.
Chase: What?
Foreman: Bad idea.< You work with her.
Chase: What did I say?< Is “weird” some new ghetto euphemism for sexy, like “bad” is good and “phat” is good? Then what the hell does “good” mean?
Foreman: “Ghetto euphemism”? [Chase laughs.] You don’t think she’s hot?
Chase: No.
Foreman: Wow, then you’re brilliant. And I am using “brilliant” as an euphemism.
Chase: Obviously, the girl is hot. You, you’re not talking about her aesthetics, you’re talking about if I want to jump her.< I don’t.
Foreman: Brilliant. [long pause, a test beeps] Your Epstein Barr is ready.
[Cut to the clinic, where House is very involved in his Gameboy.]
Clinic patient: What are you doing?
House: Level 4.
Patient: No, I mean –
House: I know what you meant.< We’re waiting.
Patient: My throat hurts.
House: So you said.
Patient: How long are we waiting?
House: Two minutes less then when you asked me two minutes ago. [Cuddy walks in.]
Patient: Hi.
Cuddy: Hi.< I’m Dr. Cuddy.< Nice to meet you.
House: Dr. Cuddy, thanks for the consult. [He closes the Gameboy.] His throat seems to have some condition.
Cuddy: Say “Ah”.
Patient. Ah.
Cuddy: He has a sore throat.
House: Of course!< Yes, why didn’t I… I mean, because he said that… it hurt, and I, I should have deduced that meant it was sore…
Cuddy: I was in a board meeting.
House: Patients come first, right?
Cuddy: Wouldn’t want to prescribe a lozenge if there was any doubt about it’s efficacy, huh?
House: You once asked why I think I’m always right, and I realized that you’re right… at least, I think you’re right. I don’t really know now, do I? [Cuddy smiles.]
Patient: Hey!< I’m here.
Cuddy: Go home.< Drink some hot tea. [She leaves.]
House: Excellent counsel.
[Cut to the lab.< Now Cameron and Foreman are working together, with Chase off in the separate room.]
Cameron: Negative on parvovirus B19.
Foreman: I’m impressed.
Cameron: Thank you, I was born to run gels.
Foreman: I meant about Chase.
Cameron: What about Chase?
Foreman: Well, the man has no physical interest in you. He has a completely professional relationship with you, he respects you as a colleague and a doctor, and yet he can’t look at you without thinking sex.
Cameron: Because I asked what kind of sex could kill you?
Foreman: You now have total control over your relationship with him.
Cameron: So, a woman can’t express her interest in sex without it being some professional powerplay?
House: No. [House walked in to the lab, unbeknownst to the other doctors.] If you look the way you do, and you say what you said, you have to be aware of the effect that it’ll have on men.
Cameron: Men should grown up.
House: Yeah.< And dogs should stop licking themselves, it’s not gonna happen. [Chase comes in.]
Chase: What’s going on? [Cameron abruptly stops laughing.]
Cameron: Yeah, what are you doing here?
House: Looking for you guys.
Foreman: Why didn’t you page us?
House: ‘Cause I knew you’d be here.
Chase: Who told him?
House: No one.< I assume you’re trying to prove my crazy two-illness theory wrong, so, obviously, you’re going to be in the lab.< You spin the urine? [He pops a Vicodin.]
Foreman: Not yet.
House: Talk to me when you have.
[Cut to House’s office, later. House and Wilson are sitting there; Foreman enters.]
House: What did you find out?
Foreman: The kidney failure.< It’s acute interstitial nephritis.<
House: I wonder if that’s signifigant.
Foreman:< It means the antibiotics didn’t cause the kidney failure. How did you know?
House:< Well, if you guys hadn’t been so busy trying to prove me wrong, you might have checked in on the poor kid.
Foreman: You visited a patient?
House: I was sitting by his bed all morning, just so he’d know someone was there for him.
Wilson: I looked in on him.< He’s much better.
House: Ergo, the treatment’s working. Ergo, me right, you wrong.
Foreman: Hey, I’m glad for the kid. [He leaves.]
Wilson: That smugness of yours really is an attractive quality.
House: Thank you.< It was either that or get my hair highlighted. Smugness is easier to maintain.
Wilson: I get that you’re not a big believer in the ‘catching flies with honey’ approach, but do you honestly think you’ll collect a jarful by cleverly taunting them?
House: Flies, no.< Doctors, sure.< If I’d said to Foreman, “Nice try, it was a great guess, but not this time,” what do you think he’d be doing right now?
Wilson: I think he’d be going home not feeling like a piece of crap.
House: Exactly.
Wilson: You want him to feel like a piece of crap?
House: No, I don’t want him going home.
[Cut to Foreman entering Brandon’s room.]
Brandon: Dr. Foreman. [coughs]
Foreman: Still have the cough.
Brandon: I’m feeling a lot better, though.
Mrs. Merrell: His fever’s gone, and his rash is going away.
Foreman: I see.
Mindy: Is everything okay?
Foreman: Just ordering some tests. Absolutely nothing to worry about.
[Cut to House in the clinic exam room. He’s again playing on the Gameboy.]
Patient: How much longer?
House: 9:30, I figure she was on the 8th hole when I paged her… [he grimaces as his guy dies, and hands her the Gameboy] Probably got another half hour. [She starts to play as Foreman opens the door.]
Foreman: I ran a TSH, T3 and T4. Patient’s negative for hypothyroidism. [Patient looks up.]< Not talking about you.< [She goes back to the Gameboy.]
House:< Well the fact that he’s getting better would indicate the unreliability of the tests.
Foreman: If I’m right and it’s a viral infection, one of two things always happens: patient dies or the patient’s immune system fights off the invader. [nods toward patient] What’s with her?
House: Her leg hurts after running six miles. Who knows, it could be anything!
Foreman: He’s getting better.< That doesn’t prove you’re right, it just proves he’s getting better. [House smiles.] It, it’s not two illnesses!< It can’t be two illnesses!
House: I am so glad you work here.
Foreman: If I’m right, the antibiotics you prescribed could block his kidneys and liver, impeding his ability to fight off the virus. Could kill him.
House: Well, that certainly would be a concern. Fifty bucks?< [Patient looks up.]< Don’t look away, the space monkeys will be all over you.
Foreman: You wanna bet on the patient’s health?
House: You think that’s bad luck? Do you think that God will smite him because of our insensitivity? Well, if God does, you make a quick fifty. [Patient kills the little guy on the Gameboy.]< Go check his white blood count.< If he’s fighting off a virus like you think it’ll be way up. [He starts to play on the Gameboy again. Foreman leaves, and Wilson enters.]
Wilson: Hey, Cuddy said you needed a consult, what’s up? I’m busy.
[Cut to Cameron and Chase in House’s office. Chase is pouring coffee, and, after looking at Cameron, spills it.]
Chase: Ah!
Cameron: I was just being glib.
Chase: You haven’t said anything.
Cameron: No, before when I was talking about Brandon’s girlfriend thinking sex could kill you.< I was just making a joke because I was uncomfortable.
Chase: Oh, I don’t even remember what you said.
Cameron: I’m uncomfortable about sex. [Chase turns quickly.]
Chase: Well, we don’t have to talk about this…
Cameron: Sex… could kill you.< Do you know what the human body goes through when you have sex? Pupils dilate, arteries constrict, core temperature rises, heart races, blood pressure skyrockets [Chase is starting to look uncomfortable], respiration becomes rapid and shallow, the brain fires bursts of electrical impulses from nowhere to nowhere and secretions spit out of every gland [Chase starts to look for an escape route], and the muscles tense and spasm like you’re lifting three times your body weight. It’s violent, it’s ugly, and it’s messy, and if God hadn’t made it unbelievably fun… the human race would have died out eons ago. [small pause] Men are lucky they can only have one orgasm.< You know that women can have an hour-long orgasm? [Chase is very wide-eyed; Foreman walks in.] Hey, Foreman.< What’s up?
Chase: Hey, Foreman!
Foreman: Hey. [House walks in.]
House: White cell count isn’t up, is it?
Foreman: No.< We were both wrong.< White cell count is down, way down, and dropping. His immune system is shot.< We need to get him into a clean room.
[Cut to Chase and Brandon, in prep for the clean room.]
Chase: Can you walk, Brandon?
Brandon: Yeah, a little.
Chase: All right, okay. ‘Cause we’ll need to leave the chair outside. [to the nurse helping him] Thank you. Where’s April? April!< [April comes in.]< Can you take the chair, please?< [to Brandon] I’ll need to take your mask and your robe, too.< You might want to block your ears for this, it’s quite loud. [They’re blasted with air. Next we see Cameron, Foreman, the Merrells and Mindy watching Chase and Brandon in the clean room.)
Foreman: Something’s made his immune system compromised.
Cameron: His white blood cell count is down, which means his body can’t fight off infections.
Foreman: If he gets sick, he’ll die.
Mrs. Merrell: Sick.< How sick?
Foreman: If he gets a cold, he’ll die.
[Cut to Brandon, coughing.< Foreman is prepping him for a marrow sample.]
Foreman: Okay.< I’m going to push the needle into your hipbone, and take some of the marrow. [He inserts a needle.]
Brandon: That’s not so bad.
Foreman: Hah, that was just the anesthetic. The core biopsy needle, it’s a little bit bigger. Okay man, take a deep breath, this is, this is gonna hurt. A lot. [Brandon seizes the bed and grimaces in pain.] Marrow makes the blood cells. You take a peek of it under a microscope, and maybe we find a viral infection.< Maybe we find some fibrosis.< Something to explain why your blood count is so low. [He fills the syringe with marrow.] There we go. One step closer to an answer.
Brandon: What if you don’t find one? I can’t stay here forever.
[Cut to Cuddy’s office.]
House: The patient could have died.
Cuddy: The one with the pulled muscle.
House: Well, those symptoms are consistant with a dozen other conditions. I, you know, I, I’m entitled to a consult!
Cuddy: You are not getting out of clinic duty.
House: Oh, come on.< You’ve got a hundred other idiot doctors in this building who go warm and fuzzy everything they pull a toy car out of a nose, you don’t need me here.
Cuddy: No, I don’t, but working with people actually makes you a better doctor.
House: When did I sign up for that course?
Cuddy: When did I give you the impression that I care? [pause]
House: Working in this clinic obviously instills a deep sense of compassion. [He starts to walk out.] I’ve got your home number, right? In case anything comes up at 3 o’clock in the morning.
Cuddy: It’s not going to work. You know why?< Because this is fun.< You think of something to make me miserable, I think of something to make you miserable: it’s a game!< And I’m going to win, because I got a head start. You are already miserable. [Cuddy leaves her office, and runs into Wilson.]
Wilson: Uh…
Cuddy: Is this important?
Wilson: Uh, no.
Cuddy: No. [She leaves, as House exits her office.]
Wilson: What’s with you and her?
House: Don’t.
Wilson: Do you have a thing for her? The only people who can get to you –
House: No!< There is not a thin line between love and hate. There is, in fact, a Great Wall of China with armed sentries posted every 20 feet between love and hate. [to the pharmacist] 36 Vicodin.
Pharmacist: Who’s the patient?
House: I am.
Pharmacist: You can’t…
House: Dr. Wilson is the prescribing physician.
Wilson: Yeah. [to House]< You will lie, cheat and steal to get what you want, but you’re incapable of kissing a little ass?
House: Well, we all have our limitations. [He grabs a bottle from the counter and turns to leave.]
Wilson: House!< Wrong bottle. [He gives House the right bottle.] Do me a favor. Take one of these, wait five minutes for it to kick in, and find Cuddy, and kiss her ass. [pause]
House: What was the kid’s first symptom? [small pause] You did the history; of his 800 symptoms, which one hit him first?
Wilson: Ah, the cough.
[Cut to House thinking in his office, staring at the white board. He starts looking through medical texts and searching online; Chase watches him through the glass wall.]
[Cut to Brandon, who is still coughing.]
[Cut to the ducklings, sitting in their office. House walks in.]
House: Gout. [He walks back into his office; they follow.]
Chase: Um, are we talking about Brandon?
Foreman: Gout?< Uric acid crystals in the joints?< The symptoms are pain, swelling, redness, stiffness… not one of which do I see on that board.
House: Because he doesn’t have gout. Every day, cells die. [CGI of… cells!] We survive because the remaining cells divide and replace the losses. The colchicine, a gout medicine, blocks mitosis and stops cell division, which will result in abdominal pain, rash, nausea, fever, kidney failure, low blood pressure, and will also mess with the bone marrow. [He crosses these all off the board.]
Chase: But he doesn’t have gout. Why would he have gout medication?
House: Because you guys were right. He didn’t have two medications at the exact same time. First, he got a cough. Now, because he’s an idiot, he went to a doctor. In order to feel justified charging $200, the doctor felt he should actually do something.< Oops. He wrote a prescription. 7000 people die each year from pharmacy screw-ups. Not nearly as many as die from doctor screw-ups, but still, not something they use in their promotional material.< The pharmacist gave him gout medicine instead of cough medicine. And the only thing it wouldn’t do: it would do absolutely to relieve his cough.< Occam’s Razor.< The simplest explanation is almost always somebody screwed up.
Cameron: But once he checked into this hospital he was completely in our control. Our food, our pills, our everything. So even if you’re right, no gout medication.< He’d either continue to deteriorate or he would have gotten better. But he got better, and then he got worse. It doesn’t fit. It doesn’t make sense.
House: Okay.< Two people screwed up.< Not as simple as one, but…
[Cut to the Merrells and Mindy sitting in a waiting room. House and Co. come walking up to them.]
Mindy: He’s resting; he –
House: I’m Dr. House.< I’m your son’s physician.<
Mrs. Merrell: Oh, you’re the one we haven’t met yet.
Mr. Merrell: You’re the one he hasn’t met. How can you treat someone without meeting them?
House: It’s easy if you don’t give a crap about them. That’s a good thing. If emotions made you act rationally, then they wouldn’t be called emotions, would they?< That’s why we have this nice division of labor: you hold his hand, I get him better. If I start tucking him in at night, well, that’s not fair to you guys, and if you start prescribing medicine, that’s not fair to me.< So what I want to know is: who stepped on my side of the med? Who cared enough to get stupid enough to give him his cough medicine?
Mindy: When we checked in Dr. Foreman said –
House: Tuesday, he’s getting better. Wednesday, he’s getting sick again. Somebody gave him his cough medicine Wednesday. [pause]< Come on, nobody’s gonna be mad.< I just want to know who tried to kill the kid.
Foreman: Dr. House, maybe we should –
Mrs. Merrell: His throat was sore.
House: Page Dr. Occam.< He’s gonna want to hear about this.<
Mrs. Merrell: Sorry!< He was coughing, and I just wanted to help him –
House: I wish you would dare.< Where are the pills?
Mrs. Merrell: He took the last of them before he was switched into that room.
Cameron: They’re all gone?
Mrs. Merrell: It was just cough medicine!
House: No, it wasn’t.< Where’s the bottle?
[Cut to a pharmacy.< Chase, Mindy and Mrs. Merrell go to talk to the pharmacist.]
Chase: We need to know exactly what you put in this bottle. We think it was colchicine, a gout medication.
Pharmacist: If the prescription said cough medicine, that’s what I dispensed.
Chase: The family is prepared to waive liability, all right? We just need to know what it was, what dosage it was –
Pharmacist: It was cough medicine.
Chase: [gives him the bottle] Refill it.
Mrs. Merrell: He’s going to be okay.
Mindy: You don’t know that.
Mrs. Merrell: Does Brandon like that quality in you? You’re a little negative.
Mindy: Things don’t always work out for the best.
Mrs. Merrell: It doesn’t hurt to hope they do.
Mindy: No.< Not unless it makes you figure you can do whatever you want, like give people cough medicine. [Chase and the pharmacist come out from the back.]
Chase: This is cough medication. This is what Brandon was supposed to get. [He shakes out three onto his hand.] They’re small, round and yellow. Can you tell this man what the pills in your son’s medicine bottle actually looked like?
Mrs. Merrell: They were small, round and yellow, exactly like this.
Mindy: Those were the pills that Brandon was taking.
Pharmacist: Hey, I’m just a pharmacist, but I know what cough medicine looks like, Doctor.
[Cut to House’s office.]
House: It was so perfect.< It was beautiful.
Wilson: Beauty often seduces us on the road to truth.
House: And triteness kicks us in the nads.
Wilson: So true.
House: This doesn’t bother you?
Wilson: That you were wrong?< I try to work through the pain –
House: I was not wrong.< Everything I said was true.< It fit. It was elegant.
Wilson: So… reality was wrong.
House: Reality is almost always wrong. [takes some Vicodin] The cough medicine did something. Aggravated the condition. It’s all over the place, must be in his blood.
Wilson: What if it is his blood?
House: Lymphoma?
Wilson: Unless you’ve got something better.
House: Well, we foolishly ruled out lymphoma because his CT scan showed no adenophathy, CBC showed a normal diffen smear, bone marrow showed no –
Wilson: Screw the tests.< Do an exploratory laparotomy and find out what’s in there.
House: He has no blood pressure, no immune system and no kidneys. Surgery will kill him.
Wilson: Yeah, you’re right.< Let’s stick with the wrong pill theory. [pause]
House:< I’ll schedule him for surgery.
[Cut to Brandon’s clean room.< Mindy and the Merrells are looking on as the three doctors are working on Brandon.]
Foreman: Okay, Brandon, we’re gonna run this tube through your heart and into the pulmonary arteries in your lung.
Cameron: Sensors will give us information we need for the exploratory surgery later this afternoon.
Brandon: My fingers are numb.
Foreman: Try not to move.< We’re in the right atrium, trying to catch the flow through the tricuspid valve.
Chase: I think the catheter’s curling in the atrium.
Foreman: Got it.< We’re in the RV in now. [A monitor beeps.]
Chase: Ectopy.< You must have irritated the heart wall.
Foreman: It’ll calm down.
Chase: He can’t tolerate any cardiac arrhythmia. Pull back.
Foreman: He needs this surgery. [Another monitor starts to beep.]
Cameron: Pressure’s dropped.
Chase: You still with us, Brandon?
Cameron: Get the curtains! [Chase closes them. They prepare the defibrillator.]
Chase: Charging. Clear! [Shock.] Sign of rhythm.
Cameron: I got a pulse.
Foreman: Yeah, but no surgery today.
[Cut back to the clinic.< House enters to find a boy standing in the room.]
House: How you doing?
Patient: Okay.
House: Great.< I’m doing good, too.< I get to knock off an hour early today.< Know why? ‘Cause I kissed my boss’ ass, you ever do that?< I think she just said yes because she wants to reinforce that behavior. Wants me to kiss a lot of other people’s ass, like she wants me to kiss yours.< [Boy makes an odd face.]< What would you want, a doctor who holds your hand while you die, or a doctor who ignores you while you get better?< I guess it would particularly suck to have a doctor who ignores you while you die.
Patient: I should go.
House: You think it’s going to come out on its own? Are we talking bigger than a breadbasket? ‘Cause actually, it will come out on its own, which for small stuff is no problem. Gets wrapped up in a nice soft package and plop! Big stuff, you’re going to rip something, which speaking medically, is when the fun stops.
Patient: How did you –
House: You’ve been here half an hour and haven’t sat down, that tells me its location.< You haven’t told me what it is, that tells me it’s humiliating. You have a little birdie carved on your arm, that tells me you have a high tolerance for humiliation, so I figure it’s not hemorrhoids. [pause] I’ve been a doctor 20 years, you’re not going to surprise me.
Patient: It’s an MP3 player.
House: [has to digest this for a moment] Is it… is it because of the size, or the shape, or the pounding bass line?
Patient: What are we going to do?
House: [looks at his watch] I’m gonna wait.
Patient: For what?
[Cut to House leaving the exam room.]
House: Okay, it’s 3:00, I’m off. Would you tell Dr. Cuddy there’s a patient in Exam Room 2 that needs her attention?< And the RIAA wants her to check for illegal downloads. [chuckles at his own joke; Cameron runs up.]
Cameron: Brandon’s not ready for surgery.
House: Okay, well, let’s leave it a couple of weeks. He should be feeling better by then. Oh wait, which way does time go?
Cameron: He crashed during prep. He’s also experiencing pain in his fingers. I think some bug may have gotten in the clean room. I think we should double his dosage of GCSF to temporarily boost his blood cell count.
House: Pain in his fingers… right. [pops a Vicodin]
[Cut to the hallway outside the clean room.]
House: [to Mrs. Merrell] Hi again. [He enters the prep area.]
Mrs. Merrell: He can’t go in –
Mr. Merrell: Where’s he going? [House walks in without all of the prep robes, air, etc.]
House: Hey!< How y’all doing?< Interesting fact: every seven years it’s a whole new you. Inspiring metaphor, huh?
Chase: Dr. House, this is a clean room.
House: Yeah, I read the sign.< But cells of different organs reproduce at different rates. [He touches Brandon’s leg, Brandon flinches and makes noises of protest.] So, a new kidney every three years, a new stomach lining every week…. This is why colchicine poisoning causes all of these symptoms but not all at once.
Mrs. Merrell: But we went to the pharmacy. We saw the pills!
House: Colchicine does its damage in a very specific order. First of all, there’s a pain in the abdomen, the rash, the fever… isn’t that what you got first? Then, the kidneys go, which is exactly what happened to….
Cameron: Brandon.
House: Right.< Then it screws up your bone marrow, and then – neuropathy. Painful tingling in the fingers and toes. And what do you suppose happens after that? [He rips out some of Brandon’s hair. His mother doesn’t look too thrilled.] Hair loss. The bad new is: your special boy is doing drugs.
Mrs. Merrell: No, he’s not!
House: Ecstasy?
Mrs. Merrell: No!
Brandon: Twice, with Dan and Mike.
House: D’you know what they cut that stuff with? Apparently colchicine, unless you ingested the colchicine through your contact lens solution, or skin cream, or some other drug you’re lying about. I don’t know how it happened, I don’t care how it happened, it happened. Start….
Cameron: Brandon.
House: Lovely name.< Start Brandon on fab fragments, and give him some Tylenol for the hair I pulled out. And get some air in here! [He leaves the room and walks off with Wilson.] Make a note: I should never doubt myself.
Wilson: I think you’ll remember. You know, it wouldn’t hurt you to be wrong now and then.
House: What, you don’t care about these people?
[Cut to the clean room, where Foreman and co. are inserting an IV.]
Foreman: The colchicine interferes with the ability of the heart muscle to contract pumping blood, lowering your blood pressure. [CGI of his heart.] The antibodies we’re giving you should neutralize the colchicine, allowing your heart to beat at its normal rate.
Brandon: When will you know?
Cameron: We know now.< [Foreman gives the people outside a thumbs-up. Mrs. Merrell hugs her husband, and then hugs Mindy.]
[Cut to House pawing through the hospital pharmacy.]
Wilson: Big weekend?
House: It’s not for me, I’m fully stocked.
Wilson: Cuddy got you doing inventory?
House: Nope.< Trying to solve that kid’s case.
Wilson: The gout medicine OD?
House: Yeah.
Wilson: The fact that I know that it’s a gout medicine OD would seem to indicate that the case is already solved.
House: Well, you’d be wrong.
Wilson: What about the fact that the kid is now, I believe the technical term is, not sick?
House: You know how many forms of colchicine there are on the market?
Wilson: Stop it.
House: Neither do I, but it’s a lot. Pills, powders, liquids, IV fluids…. Somewhere at a party, in his coffee, up his nose, in his ear, this kid had some.<
Wilson: So, you’re not happy with your Ecstasy theory?
House: He said he used it twice.
Wilson: People lie.
House: Yeah, but if you’re gonna lie, it’s –
Wilson: You know what, I’m not interested.
House: Not curious?
Wilson: No, because I’m well-adjusted. [He walks off.]
House: Right.
[Cut to Cameron and Chase checking up on Brandon.]
Cameron: Temperature’s normal.
Brandon: I want Cousin Sharon there.
Mrs. Merrell: If we invite Sharon, we have to invite all the cousins.
Mindy: So what?< My side of the family doesn’t need anything. [Brandon starts coughing.]
Brandon: Don’t suppose I could have some of those cough pills, huh? They’re okay, right?
Cameron: Yes, you’re doing great.
Chase: You should invite Dr. House.
Brandon: Will he come?
Chase: No, but he’ll send a gift.
Cameron: I’ll make sure it’s a good one. [She give Brandon the cough pills.]
Brandon: There’s a letter on the back of these pills.
Cameron: Your old pills didn’t have a letter on them?
Brandon: No.< Round and yellow, but no letter. [pause]
Cameron: Well, these will help your cough. [She starts to leave.]
Chase: Hey, you want to go get some –
Cameron: No.
[Cut to House, once again in the hospital pharmacy. He finds the colchicine and compares them to the cough medicine: small, round and yellow, but minus the letter.]
[End! Hope you enjoyed – Marisol]
Written by David Shore
Directed by Bryan Singer
Transcript written by Mari
[Cut into an older looking building and then into a room with a boy sitting and talking on the telephone without a shirt on.]
Brandon: I didn’t sleep well last night, and I woke up with a scratchy throat. I just don’t feel so good. [Pause] Uh, cough, [clears his throat] Yeah, I’m, I’m, a bit of an upset stomach too, and I think I’m running a fever, I’m just worried I might be contagious. [Coughs] Inventory, tomorrow, yeah I’m sure I’ll be feeling better by then. [Pause] Thanks, Mr. Nobby.
[Turns off the phone and lays back, we can now see that there is a young girl in bed with him.]
Mindy: I cannot believe you just did that.
Brandon: I really do have a cough.
Mindy: Oh, so you weren’t lying, you’d be curled up in bed with a bowl of chicken soup even if you didn’t have a horny girl in your bed?
Brandon: Yes, [laughs] Because I really do, hey, I really do have a cough.
Mindy: You also have a little rash. [giggles]
Brandon: Um, umm, I’m uh not sure that we should be kissing.
Mindy: Oh, that’s ok, because I have almost no interest in kissing you.
Both: [Laugh]
[Cut to a very explicit sex scene. All you really need to know is that it was very rough, and his next-door neighbors are probably hating him right now.]
Mindy: [Panting and giggling] Oh, Brandon. (singsongy) Brandon, I know I’m good but come on. Brandon, Brandon, Brandon… [Brandon is unconscious.]
[Cut to back out of the building, you can still hear the girl calling for Brandon.]
[Cut to Credits]
[Cut to a room at PPTH, you can see Brandon in the bed hooked up to a bunch of stuff, and the Girl is sitting there with him. You can see that his rash has spread and he is looking very uncomfortable.]
House: Why do you want me to treat this guy?
Wilson: Blood pressure’s not responding to IV fluids.
House: No, no I didn’t ask how you plan to con me into treating him, I asked you why YOU want me to treat him.
Wilson: He’s sick, I care, I’m pathetic.
House: There are about a billion sick people on the planet, why this one?
Wilson: Because this one’s is in our emergency room.
House: Ah, so it’s a proximity issue. If somebody was sick in the third floor stairwell that’s who we would be talking about.
Wilson: Yes, I checked the stairwell, it’s clear.
House: Ok then, emergency room guy it is.
Wilson: Wait, how was that so easy?
House: You know why.
Wilson: Blood pressure’s not responding to IV fluids?
House: Yeah, that’s just weird.
[House enters elevator. Cut to House’s office with Ducklings.]
House: CBC was unremarkable, abdominal CT scan didn’t show anything. So, people, differential diagnosis. What’s wrong with her?
Cameron: Him.
House: Him, her, does it matter? Does anyone think it is a testicular problem? No, so Chase…
Chase: Absidia infection?
Foreman: No, you wouldn’t get the rash or cough. What about arthritis? Accompanying vasculitis causes nerve damage –
Cameron: No, it wouldn’t cause the blood pressure problems. Allergy?
Chase: The kid’s got abdominal pain. Maybe carcinoid?<
Foreman: Nah, but then you wouldn’t get the – [House slams a giant book in front of Foreman.]
House: Foreman, if you’re going to list all the things it’s not, it might be quicker to do it alphabetically.< Let’s see. Absidia? Excellent.< Doesn’t account for any of the symptoms.<
Cameron: No condition accounts for all these symptoms.
House: Well, good!< Because I thought maybe he was sick, but apparently he’s not. Who wants to do up the discharge papers? [pause]< Okay, unless we control the blood pressure, he’s going to start circling the drain before we can figure out what’s wrong with him. Treat him for sepsis, broad-spectrum antibiotics and I want a cort-stim test and an echocardiogram.<
[Cut to the echocardiogram.< Brandon is coughing.]
Chase: You all right?
Brandon: Yeah.
Foreman: Cort-stim tests will tell us if your pituitary and adrenal glands are working properly.
Mindy: His glands?< What does that mean?
Chase: We have a few theories we’re working on.
Mindy: You mean you don’t know.
Brandon: Mindy…
Mindy: I’m just saying if they knew they wouldn’t be testing you, they’d be treating you.
Foreman: Yeah, well, that’s the way it works. First you find out what it is, then we get you better.
[Cut to House entering the clinic.]
Cuddy: You’re half an hour late.
House: Busy case load.
Cuddy: One case is not a “load”.
House: So, how are we doing on cotton swabs today? If there’s an acute shortage I could run home –
Cuddy: [looks at his leg] No, you couldn’t.
House: Nice. [He walks over to the waiting room full of patients.] Hello, sick people and their loved ones! [Cuddy looks at him incredulously.] In the interest of saving time and avoiding a lot of boring chit-chat later, I’m Dr. Gregory House. You can call me Gregg. I’m one of three doctors staffing this clinic this morning.
Cuddy: Short, sweet.< Grab a file.
House: This ray of sunshine is Dr. Lisa Cuddy. Dr. Cuddy runs this whole hospital so, unfortunately, she’s much too busy to deal with you.< I am a bored [looks at Cuddy] certified diagnostician with a double specialty of infectious disease and nephrology. I’m also the only doctor currently employed at this clinic who is here against his will.< That is true, isn’t it? [Cuddy just looks at him.] But not to worry, because for most of you this job could be done by a monkey with a bottle of Motrin.< Speaking of which, if you’re particularly annoying, you may see me reach for this. This is Vicodin. It’s mine.< You can’t have any.< And no, I do not have a pain management problem, I have a pain problem. But who knows? Maybe I’m wrong.< Maybe I’m too stoned to tell.< So, who wants me?< [None of the clinic patients seem too eager.] And who would rather wait for one of the other two doctors? [Everyone raises their hands.] Okay, well, I’ll be in Exam Room 1 if you change your mind.
Cuddy: Jodi Matthews?< [Jodi stands.]< Please accompany Dr. House to Exam Room 1.
[Cut to Chase walking in the hallway. Mindy runs up to him.]
Mindy: Dr. Chase!
Chase: I’m not sure scaring your boyfriend is the best medicine for him right now.
Mindy: I know, I get… stupid when I’m scared.
Chase: Don’t go rock climbing.
Mindy: Look, I was wondering…. Before this happened, we were having sex.
Chase: What, you, you’re wondering if whatever he has you might have gotten it? It’s unlikely, we ran a complete STD panel, so –
Mindy: No, I was wondering if maybe I did this to him. I was kind of rough.
[Cut to House in the exam room with Jodi.]
Jodi: It was yellow.
House: It was?
Jodi: It’s not any more.
House: Hmmm, that’s a shame.
Jodi: I thought that might be a problem, so I brought you this. [She hands him a paint color sample card.]
House: Your mucus was pale goldenrod.
Jodi: Last week, yes.< Should I be worried?
House: Oh, yes.< Very.
Jodi:< Really? I thought I was okay now.
House: And yet, here you are.< What happened?< Paramedics took a week to respond to your 911 call?
Jodi: You’re not a very nice doctor, are you?
House: And you are very bad at whatever it is you do.
Jodi: You don’t even know me!
House: I know you’re going to get fired. That’s why you got the new glasses, that’s why your teeth are sparkly white.< You’re getting the most of your health insurance while you still can.
Jodi: I might be quitting.
House: If you were quitting you would have known that last week when your snot was still pale goldenrod; you’re getting fired.
Jodi: I just don’t like being told what to do.
House: I’ll get you in for a full body scan later this week.
Jodi: Thanks.
[Cut to Chase, Cameron and Foreman in the lab.]
Foreman: It’s got to be viral. We should start running gels and tiles.
Chase: We should test the girlfriend’s theory. She thinks she rode him to death.
Foreman: [laughs] What did you tell her?
Chase: Well, I told her 22-year old men don’t die of sex.
Cameron: What’d you ask her?
Chase: What do you mean?
Cameron: I mean, I hope you got some specifics on exactly what was going on. It’s a girl who thinks it could kill you… it’s worth knowing about. [pause]
Chase: Have you ever taken a life? [Cameron gives him a dirty look. Foreman gets the lab results from the printer.]
Foreman: We should stop the antibiotics.
Cameron: It’s too soon to say they’re not having an effect.
Foreman: They’re having an effect. His BP’s falling fast. [Cut to a shot of Brandon coughing.] There’s fluid filling his lungs. His creatine’s rising. [CG shot of the IV meds hitting Brandon’s bloodstream.] His kidneys are shutting down. Our treatment isn’t making him better, it’s killing him.
[Cut to House’s office.< Cameron is adding “kidney failure” to the list of symptoms on the white board.]
House: So, we had six symptoms that didn’t add up to anything, now we have seven.< Who’s excited?
Foreman: I don’t think it complicates things. The kidney failure was caused by the antibiotics.
House: Maybe.
Foreman: Typically, low blood pressure and abdominal pain means an infection. An abdominal infection causes sepsis, low blood pressure…
Chase: Except we checked for abdominal infections.
Foreman: I know, but what if it’s the other way around. What if the low blood pressure is causing the abdominal pain?
Cameron: Viral heart infection. The intestines aren’t getting enough blood, and the result is belly pain.
Foreman: I know it’s not the standard presentation.
Chase: It’s a 10 million to one shot.
Foreman: I thought that’s what we dealt with, here. It explains the cardiomyopathy, pain, the low BP, the fever.
House: You read the book.< Impressive. It’s a ludicrously long shot that explains every one of those symptoms, except for the cough and the rash. Should we just erase those?
Foreman: Well, anything can cause a rash.
House: Okay. [He grabs a colored marker.] Cardiac infection. [He circles all of the applicable symptoms, puts down the marker, and then picks up a different marker.]< Cameron, you thought… allergy? [Circle, new marker, repeat.] Chase, what was it you thought, carcinoid?< And then there’s hypothyroidism, could be parasites. Finally, sinus infection.
Foreman: If you’re going to list all of the things it can’t be, you’re gonna need more colors.
House: Cameron was right.< No condition explains all these symptoms. But orange and green covers everything.
Chase: Orange and green?< Two conditions, contracted simultaneously?
Foreman: Occam’s Razor.< The simplest explanation is always the best.
House: And you think one is simpler than two.
Cameron: Pretty sure it is, yeah.
House: Baby shows up.< Chase tells you that two people exchanged fluids to create this being. I tell you that one stork dropped the little tyke off in a diaper.< You going to go with the two or the one?
Foreman: I think your argument is specious.
House: I think your tie is ugly. Why is one simpler than two?< It’s lower, lonelier… is it simpler?< Each one of these conditions is about a thousand to one shot. That means that any two of them happening at the same time is a million to one shot.< Chase says that cardiac infection is a 10 million to one shot, which makes my idea 10 times better than yours.< Get a calculator, run the numbers.
Chase: We’ll run the tests.
House: Tests take time.< Treatment’s quicker.< Start the kid on Unacin for the sinus infection and… what was orange?
Cameron: Hypothyroidism.
[Cut to Brandon’s room.]
Brandon: My uncle has hypothyroidism.
Cameron: Not like this. Intravenous levothyroxine is an artificial thyroid medication that should take care of it. Also, the nurses are going to start you on Unacin, it’s a more targeted antibiotic.
Mindy: For the sinus infection?
Cameron: Yes.
Mindy: And the other stuff is for… something else entirely?
Cameron: Bad luck, huh?< Don’t worry, he should be back to ditching work in no time. [The door opens, Brandon’s parents come in {referenced as Mr. and Ms. Merrell)]
Mrs. Merrell: Brandon?
Brandon: Hey. [coughing]
Mr. Merrell: We’re his parents. How’s he doing?
Cameron: Um, Brandon is –
Brandon: Um, Mom, Dad, this is Mindy. I was going to bring her home for Christmas, so…. We’re engaged. [Cameron raises her eyebrows. Brandon’s parents smile.]
[Cut to Cameron leaving the room, Chase and Foreman catch up to her.]
Chase: Tell the family House’s theory?
Foreman: Two odd conditions striking completely coincidentally at the exact same time?
Cameron: I didn’t phrase it quite that way.
Chase: They agree to treatment?
Foreman: Of course they did, we’re doctors. They believe whatever we tell them. [pause] So, is that our job? House’s puppets? He comes up with an insane idea, we get to pretend it’s not?
Cameron: His insane ideas are usually right. We’ve been here long enough to –
Foreman: -- been here long enough to have Stockholm Syndrome. [Chase and Cameron laugh.]
Chase: What?< Because we don’t hate him?< He thinks outside the box, is that so evil?
Foreman: He has no idea where the box is! If you guys think he’s right, go home. Relax.< Just wait for the kid to get all better.< I’m going to the lab to test for viral infections. [He walks off; Chase and Cameron follow.]
[Cut to the lab, where the ducklings are working on gels.]
Foreman: Negative for Coxsackie-B virus.
Chase: Seven down, about 5000 to go. You really think we’re going to come up with your mystery virus by running gels until we guess it right? [We see that Cameron is in a separate part of the lab from Foreman and Chase.]
Foreman: No, I think we’re going to get it by standing around watching other people work.
Chase: I’m waiting for the Epstein Barr virus. [looks at Cameron] She’s weird, isn’t she?
Foreman: Bad idea.
Chase: What?
Foreman: Bad idea.< You work with her.
Chase: What did I say?< Is “weird” some new ghetto euphemism for sexy, like “bad” is good and “phat” is good? Then what the hell does “good” mean?
Foreman: “Ghetto euphemism”? [Chase laughs.] You don’t think she’s hot?
Chase: No.
Foreman: Wow, then you’re brilliant. And I am using “brilliant” as an euphemism.
Chase: Obviously, the girl is hot. You, you’re not talking about her aesthetics, you’re talking about if I want to jump her.< I don’t.
Foreman: Brilliant. [long pause, a test beeps] Your Epstein Barr is ready.
[Cut to the clinic, where House is very involved in his Gameboy.]
Clinic patient: What are you doing?
House: Level 4.
Patient: No, I mean –
House: I know what you meant.< We’re waiting.
Patient: My throat hurts.
House: So you said.
Patient: How long are we waiting?
House: Two minutes less then when you asked me two minutes ago. [Cuddy walks in.]
Patient: Hi.
Cuddy: Hi.< I’m Dr. Cuddy.< Nice to meet you.
House: Dr. Cuddy, thanks for the consult. [He closes the Gameboy.] His throat seems to have some condition.
Cuddy: Say “Ah”.
Patient. Ah.
Cuddy: He has a sore throat.
House: Of course!< Yes, why didn’t I… I mean, because he said that… it hurt, and I, I should have deduced that meant it was sore…
Cuddy: I was in a board meeting.
House: Patients come first, right?
Cuddy: Wouldn’t want to prescribe a lozenge if there was any doubt about it’s efficacy, huh?
House: You once asked why I think I’m always right, and I realized that you’re right… at least, I think you’re right. I don’t really know now, do I? [Cuddy smiles.]
Patient: Hey!< I’m here.
Cuddy: Go home.< Drink some hot tea. [She leaves.]
House: Excellent counsel.
[Cut to the lab.< Now Cameron and Foreman are working together, with Chase off in the separate room.]
Cameron: Negative on parvovirus B19.
Foreman: I’m impressed.
Cameron: Thank you, I was born to run gels.
Foreman: I meant about Chase.
Cameron: What about Chase?
Foreman: Well, the man has no physical interest in you. He has a completely professional relationship with you, he respects you as a colleague and a doctor, and yet he can’t look at you without thinking sex.
Cameron: Because I asked what kind of sex could kill you?
Foreman: You now have total control over your relationship with him.
Cameron: So, a woman can’t express her interest in sex without it being some professional powerplay?
House: No. [House walked in to the lab, unbeknownst to the other doctors.] If you look the way you do, and you say what you said, you have to be aware of the effect that it’ll have on men.
Cameron: Men should grown up.
House: Yeah.< And dogs should stop licking themselves, it’s not gonna happen. [Chase comes in.]
Chase: What’s going on? [Cameron abruptly stops laughing.]
Cameron: Yeah, what are you doing here?
House: Looking for you guys.
Foreman: Why didn’t you page us?
House: ‘Cause I knew you’d be here.
Chase: Who told him?
House: No one.< I assume you’re trying to prove my crazy two-illness theory wrong, so, obviously, you’re going to be in the lab.< You spin the urine? [He pops a Vicodin.]
Foreman: Not yet.
House: Talk to me when you have.
[Cut to House’s office, later. House and Wilson are sitting there; Foreman enters.]
House: What did you find out?
Foreman: The kidney failure.< It’s acute interstitial nephritis.<
House: I wonder if that’s signifigant.
Foreman:< It means the antibiotics didn’t cause the kidney failure. How did you know?
House:< Well, if you guys hadn’t been so busy trying to prove me wrong, you might have checked in on the poor kid.
Foreman: You visited a patient?
House: I was sitting by his bed all morning, just so he’d know someone was there for him.
Wilson: I looked in on him.< He’s much better.
House: Ergo, the treatment’s working. Ergo, me right, you wrong.
Foreman: Hey, I’m glad for the kid. [He leaves.]
Wilson: That smugness of yours really is an attractive quality.
House: Thank you.< It was either that or get my hair highlighted. Smugness is easier to maintain.
Wilson: I get that you’re not a big believer in the ‘catching flies with honey’ approach, but do you honestly think you’ll collect a jarful by cleverly taunting them?
House: Flies, no.< Doctors, sure.< If I’d said to Foreman, “Nice try, it was a great guess, but not this time,” what do you think he’d be doing right now?
Wilson: I think he’d be going home not feeling like a piece of crap.
House: Exactly.
Wilson: You want him to feel like a piece of crap?
House: No, I don’t want him going home.
[Cut to Foreman entering Brandon’s room.]
Brandon: Dr. Foreman. [coughs]
Foreman: Still have the cough.
Brandon: I’m feeling a lot better, though.
Mrs. Merrell: His fever’s gone, and his rash is going away.
Foreman: I see.
Mindy: Is everything okay?
Foreman: Just ordering some tests. Absolutely nothing to worry about.
[Cut to House in the clinic exam room. He’s again playing on the Gameboy.]
Patient: How much longer?
House: 9:30, I figure she was on the 8th hole when I paged her… [he grimaces as his guy dies, and hands her the Gameboy] Probably got another half hour. [She starts to play as Foreman opens the door.]
Foreman: I ran a TSH, T3 and T4. Patient’s negative for hypothyroidism. [Patient looks up.]< Not talking about you.< [She goes back to the Gameboy.]
House:< Well the fact that he’s getting better would indicate the unreliability of the tests.
Foreman: If I’m right and it’s a viral infection, one of two things always happens: patient dies or the patient’s immune system fights off the invader. [nods toward patient] What’s with her?
House: Her leg hurts after running six miles. Who knows, it could be anything!
Foreman: He’s getting better.< That doesn’t prove you’re right, it just proves he’s getting better. [House smiles.] It, it’s not two illnesses!< It can’t be two illnesses!
House: I am so glad you work here.
Foreman: If I’m right, the antibiotics you prescribed could block his kidneys and liver, impeding his ability to fight off the virus. Could kill him.
House: Well, that certainly would be a concern. Fifty bucks?< [Patient looks up.]< Don’t look away, the space monkeys will be all over you.
Foreman: You wanna bet on the patient’s health?
House: You think that’s bad luck? Do you think that God will smite him because of our insensitivity? Well, if God does, you make a quick fifty. [Patient kills the little guy on the Gameboy.]< Go check his white blood count.< If he’s fighting off a virus like you think it’ll be way up. [He starts to play on the Gameboy again. Foreman leaves, and Wilson enters.]
Wilson: Hey, Cuddy said you needed a consult, what’s up? I’m busy.
[Cut to Cameron and Chase in House’s office. Chase is pouring coffee, and, after looking at Cameron, spills it.]
Chase: Ah!
Cameron: I was just being glib.
Chase: You haven’t said anything.
Cameron: No, before when I was talking about Brandon’s girlfriend thinking sex could kill you.< I was just making a joke because I was uncomfortable.
Chase: Oh, I don’t even remember what you said.
Cameron: I’m uncomfortable about sex. [Chase turns quickly.]
Chase: Well, we don’t have to talk about this…
Cameron: Sex… could kill you.< Do you know what the human body goes through when you have sex? Pupils dilate, arteries constrict, core temperature rises, heart races, blood pressure skyrockets [Chase is starting to look uncomfortable], respiration becomes rapid and shallow, the brain fires bursts of electrical impulses from nowhere to nowhere and secretions spit out of every gland [Chase starts to look for an escape route], and the muscles tense and spasm like you’re lifting three times your body weight. It’s violent, it’s ugly, and it’s messy, and if God hadn’t made it unbelievably fun… the human race would have died out eons ago. [small pause] Men are lucky they can only have one orgasm.< You know that women can have an hour-long orgasm? [Chase is very wide-eyed; Foreman walks in.] Hey, Foreman.< What’s up?
Chase: Hey, Foreman!
Foreman: Hey. [House walks in.]
House: White cell count isn’t up, is it?
Foreman: No.< We were both wrong.< White cell count is down, way down, and dropping. His immune system is shot.< We need to get him into a clean room.
[Cut to Chase and Brandon, in prep for the clean room.]
Chase: Can you walk, Brandon?
Brandon: Yeah, a little.
Chase: All right, okay. ‘Cause we’ll need to leave the chair outside. [to the nurse helping him] Thank you. Where’s April? April!< [April comes in.]< Can you take the chair, please?< [to Brandon] I’ll need to take your mask and your robe, too.< You might want to block your ears for this, it’s quite loud. [They’re blasted with air. Next we see Cameron, Foreman, the Merrells and Mindy watching Chase and Brandon in the clean room.)
Foreman: Something’s made his immune system compromised.
Cameron: His white blood cell count is down, which means his body can’t fight off infections.
Foreman: If he gets sick, he’ll die.
Mrs. Merrell: Sick.< How sick?
Foreman: If he gets a cold, he’ll die.
[Cut to Brandon, coughing.< Foreman is prepping him for a marrow sample.]
Foreman: Okay.< I’m going to push the needle into your hipbone, and take some of the marrow. [He inserts a needle.]
Brandon: That’s not so bad.
Foreman: Hah, that was just the anesthetic. The core biopsy needle, it’s a little bit bigger. Okay man, take a deep breath, this is, this is gonna hurt. A lot. [Brandon seizes the bed and grimaces in pain.] Marrow makes the blood cells. You take a peek of it under a microscope, and maybe we find a viral infection.< Maybe we find some fibrosis.< Something to explain why your blood count is so low. [He fills the syringe with marrow.] There we go. One step closer to an answer.
Brandon: What if you don’t find one? I can’t stay here forever.
[Cut to Cuddy’s office.]
House: The patient could have died.
Cuddy: The one with the pulled muscle.
House: Well, those symptoms are consistant with a dozen other conditions. I, you know, I, I’m entitled to a consult!
Cuddy: You are not getting out of clinic duty.
House: Oh, come on.< You’ve got a hundred other idiot doctors in this building who go warm and fuzzy everything they pull a toy car out of a nose, you don’t need me here.
Cuddy: No, I don’t, but working with people actually makes you a better doctor.
House: When did I sign up for that course?
Cuddy: When did I give you the impression that I care? [pause]
House: Working in this clinic obviously instills a deep sense of compassion. [He starts to walk out.] I’ve got your home number, right? In case anything comes up at 3 o’clock in the morning.
Cuddy: It’s not going to work. You know why?< Because this is fun.< You think of something to make me miserable, I think of something to make you miserable: it’s a game!< And I’m going to win, because I got a head start. You are already miserable. [Cuddy leaves her office, and runs into Wilson.]
Wilson: Uh…
Cuddy: Is this important?
Wilson: Uh, no.
Cuddy: No. [She leaves, as House exits her office.]
Wilson: What’s with you and her?
House: Don’t.
Wilson: Do you have a thing for her? The only people who can get to you –
House: No!< There is not a thin line between love and hate. There is, in fact, a Great Wall of China with armed sentries posted every 20 feet between love and hate. [to the pharmacist] 36 Vicodin.
Pharmacist: Who’s the patient?
House: I am.
Pharmacist: You can’t…
House: Dr. Wilson is the prescribing physician.
Wilson: Yeah. [to House]< You will lie, cheat and steal to get what you want, but you’re incapable of kissing a little ass?
House: Well, we all have our limitations. [He grabs a bottle from the counter and turns to leave.]
Wilson: House!< Wrong bottle. [He gives House the right bottle.] Do me a favor. Take one of these, wait five minutes for it to kick in, and find Cuddy, and kiss her ass. [pause]
House: What was the kid’s first symptom? [small pause] You did the history; of his 800 symptoms, which one hit him first?
Wilson: Ah, the cough.
[Cut to House thinking in his office, staring at the white board. He starts looking through medical texts and searching online; Chase watches him through the glass wall.]
[Cut to Brandon, who is still coughing.]
[Cut to the ducklings, sitting in their office. House walks in.]
House: Gout. [He walks back into his office; they follow.]
Chase: Um, are we talking about Brandon?
Foreman: Gout?< Uric acid crystals in the joints?< The symptoms are pain, swelling, redness, stiffness… not one of which do I see on that board.
House: Because he doesn’t have gout. Every day, cells die. [CGI of… cells!] We survive because the remaining cells divide and replace the losses. The colchicine, a gout medicine, blocks mitosis and stops cell division, which will result in abdominal pain, rash, nausea, fever, kidney failure, low blood pressure, and will also mess with the bone marrow. [He crosses these all off the board.]
Chase: But he doesn’t have gout. Why would he have gout medication?
House: Because you guys were right. He didn’t have two medications at the exact same time. First, he got a cough. Now, because he’s an idiot, he went to a doctor. In order to feel justified charging $200, the doctor felt he should actually do something.< Oops. He wrote a prescription. 7000 people die each year from pharmacy screw-ups. Not nearly as many as die from doctor screw-ups, but still, not something they use in their promotional material.< The pharmacist gave him gout medicine instead of cough medicine. And the only thing it wouldn’t do: it would do absolutely to relieve his cough.< Occam’s Razor.< The simplest explanation is almost always somebody screwed up.
Cameron: But once he checked into this hospital he was completely in our control. Our food, our pills, our everything. So even if you’re right, no gout medication.< He’d either continue to deteriorate or he would have gotten better. But he got better, and then he got worse. It doesn’t fit. It doesn’t make sense.
House: Okay.< Two people screwed up.< Not as simple as one, but…
[Cut to the Merrells and Mindy sitting in a waiting room. House and Co. come walking up to them.]
Mindy: He’s resting; he –
House: I’m Dr. House.< I’m your son’s physician.<
Mrs. Merrell: Oh, you’re the one we haven’t met yet.
Mr. Merrell: You’re the one he hasn’t met. How can you treat someone without meeting them?
House: It’s easy if you don’t give a crap about them. That’s a good thing. If emotions made you act rationally, then they wouldn’t be called emotions, would they?< That’s why we have this nice division of labor: you hold his hand, I get him better. If I start tucking him in at night, well, that’s not fair to you guys, and if you start prescribing medicine, that’s not fair to me.< So what I want to know is: who stepped on my side of the med? Who cared enough to get stupid enough to give him his cough medicine?
Mindy: When we checked in Dr. Foreman said –
House: Tuesday, he’s getting better. Wednesday, he’s getting sick again. Somebody gave him his cough medicine Wednesday. [pause]< Come on, nobody’s gonna be mad.< I just want to know who tried to kill the kid.
Foreman: Dr. House, maybe we should –
Mrs. Merrell: His throat was sore.
House: Page Dr. Occam.< He’s gonna want to hear about this.<
Mrs. Merrell: Sorry!< He was coughing, and I just wanted to help him –
House: I wish you would dare.< Where are the pills?
Mrs. Merrell: He took the last of them before he was switched into that room.
Cameron: They’re all gone?
Mrs. Merrell: It was just cough medicine!
House: No, it wasn’t.< Where’s the bottle?
[Cut to a pharmacy.< Chase, Mindy and Mrs. Merrell go to talk to the pharmacist.]
Chase: We need to know exactly what you put in this bottle. We think it was colchicine, a gout medication.
Pharmacist: If the prescription said cough medicine, that’s what I dispensed.
Chase: The family is prepared to waive liability, all right? We just need to know what it was, what dosage it was –
Pharmacist: It was cough medicine.
Chase: [gives him the bottle] Refill it.
Mrs. Merrell: He’s going to be okay.
Mindy: You don’t know that.
Mrs. Merrell: Does Brandon like that quality in you? You’re a little negative.
Mindy: Things don’t always work out for the best.
Mrs. Merrell: It doesn’t hurt to hope they do.
Mindy: No.< Not unless it makes you figure you can do whatever you want, like give people cough medicine. [Chase and the pharmacist come out from the back.]
Chase: This is cough medication. This is what Brandon was supposed to get. [He shakes out three onto his hand.] They’re small, round and yellow. Can you tell this man what the pills in your son’s medicine bottle actually looked like?
Mrs. Merrell: They were small, round and yellow, exactly like this.
Mindy: Those were the pills that Brandon was taking.
Pharmacist: Hey, I’m just a pharmacist, but I know what cough medicine looks like, Doctor.
[Cut to House’s office.]
House: It was so perfect.< It was beautiful.
Wilson: Beauty often seduces us on the road to truth.
House: And triteness kicks us in the nads.
Wilson: So true.
House: This doesn’t bother you?
Wilson: That you were wrong?< I try to work through the pain –
House: I was not wrong.< Everything I said was true.< It fit. It was elegant.
Wilson: So… reality was wrong.
House: Reality is almost always wrong. [takes some Vicodin] The cough medicine did something. Aggravated the condition. It’s all over the place, must be in his blood.
Wilson: What if it is his blood?
House: Lymphoma?
Wilson: Unless you’ve got something better.
House: Well, we foolishly ruled out lymphoma because his CT scan showed no adenophathy, CBC showed a normal diffen smear, bone marrow showed no –
Wilson: Screw the tests.< Do an exploratory laparotomy and find out what’s in there.
House: He has no blood pressure, no immune system and no kidneys. Surgery will kill him.
Wilson: Yeah, you’re right.< Let’s stick with the wrong pill theory. [pause]
House:< I’ll schedule him for surgery.
[Cut to Brandon’s clean room.< Mindy and the Merrells are looking on as the three doctors are working on Brandon.]
Foreman: Okay, Brandon, we’re gonna run this tube through your heart and into the pulmonary arteries in your lung.
Cameron: Sensors will give us information we need for the exploratory surgery later this afternoon.
Brandon: My fingers are numb.
Foreman: Try not to move.< We’re in the right atrium, trying to catch the flow through the tricuspid valve.
Chase: I think the catheter’s curling in the atrium.
Foreman: Got it.< We’re in the RV in now. [A monitor beeps.]
Chase: Ectopy.< You must have irritated the heart wall.
Foreman: It’ll calm down.
Chase: He can’t tolerate any cardiac arrhythmia. Pull back.
Foreman: He needs this surgery. [Another monitor starts to beep.]
Cameron: Pressure’s dropped.
Chase: You still with us, Brandon?
Cameron: Get the curtains! [Chase closes them. They prepare the defibrillator.]
Chase: Charging. Clear! [Shock.] Sign of rhythm.
Cameron: I got a pulse.
Foreman: Yeah, but no surgery today.
[Cut back to the clinic.< House enters to find a boy standing in the room.]
House: How you doing?
Patient: Okay.
House: Great.< I’m doing good, too.< I get to knock off an hour early today.< Know why? ‘Cause I kissed my boss’ ass, you ever do that?< I think she just said yes because she wants to reinforce that behavior. Wants me to kiss a lot of other people’s ass, like she wants me to kiss yours.< [Boy makes an odd face.]< What would you want, a doctor who holds your hand while you die, or a doctor who ignores you while you get better?< I guess it would particularly suck to have a doctor who ignores you while you die.
Patient: I should go.
House: You think it’s going to come out on its own? Are we talking bigger than a breadbasket? ‘Cause actually, it will come out on its own, which for small stuff is no problem. Gets wrapped up in a nice soft package and plop! Big stuff, you’re going to rip something, which speaking medically, is when the fun stops.
Patient: How did you –
House: You’ve been here half an hour and haven’t sat down, that tells me its location.< You haven’t told me what it is, that tells me it’s humiliating. You have a little birdie carved on your arm, that tells me you have a high tolerance for humiliation, so I figure it’s not hemorrhoids. [pause] I’ve been a doctor 20 years, you’re not going to surprise me.
Patient: It’s an MP3 player.
House: [has to digest this for a moment] Is it… is it because of the size, or the shape, or the pounding bass line?
Patient: What are we going to do?
House: [looks at his watch] I’m gonna wait.
Patient: For what?
[Cut to House leaving the exam room.]
House: Okay, it’s 3:00, I’m off. Would you tell Dr. Cuddy there’s a patient in Exam Room 2 that needs her attention?< And the RIAA wants her to check for illegal downloads. [chuckles at his own joke; Cameron runs up.]
Cameron: Brandon’s not ready for surgery.
House: Okay, well, let’s leave it a couple of weeks. He should be feeling better by then. Oh wait, which way does time go?
Cameron: He crashed during prep. He’s also experiencing pain in his fingers. I think some bug may have gotten in the clean room. I think we should double his dosage of GCSF to temporarily boost his blood cell count.
House: Pain in his fingers… right. [pops a Vicodin]
[Cut to the hallway outside the clean room.]
House: [to Mrs. Merrell] Hi again. [He enters the prep area.]
Mrs. Merrell: He can’t go in –
Mr. Merrell: Where’s he going? [House walks in without all of the prep robes, air, etc.]
House: Hey!< How y’all doing?< Interesting fact: every seven years it’s a whole new you. Inspiring metaphor, huh?
Chase: Dr. House, this is a clean room.
House: Yeah, I read the sign.< But cells of different organs reproduce at different rates. [He touches Brandon’s leg, Brandon flinches and makes noises of protest.] So, a new kidney every three years, a new stomach lining every week…. This is why colchicine poisoning causes all of these symptoms but not all at once.
Mrs. Merrell: But we went to the pharmacy. We saw the pills!
House: Colchicine does its damage in a very specific order. First of all, there’s a pain in the abdomen, the rash, the fever… isn’t that what you got first? Then, the kidneys go, which is exactly what happened to….
Cameron: Brandon.
House: Right.< Then it screws up your bone marrow, and then – neuropathy. Painful tingling in the fingers and toes. And what do you suppose happens after that? [He rips out some of Brandon’s hair. His mother doesn’t look too thrilled.] Hair loss. The bad new is: your special boy is doing drugs.
Mrs. Merrell: No, he’s not!
House: Ecstasy?
Mrs. Merrell: No!
Brandon: Twice, with Dan and Mike.
House: D’you know what they cut that stuff with? Apparently colchicine, unless you ingested the colchicine through your contact lens solution, or skin cream, or some other drug you’re lying about. I don’t know how it happened, I don’t care how it happened, it happened. Start….
Cameron: Brandon.
House: Lovely name.< Start Brandon on fab fragments, and give him some Tylenol for the hair I pulled out. And get some air in here! [He leaves the room and walks off with Wilson.] Make a note: I should never doubt myself.
Wilson: I think you’ll remember. You know, it wouldn’t hurt you to be wrong now and then.
House: What, you don’t care about these people?
[Cut to the clean room, where Foreman and co. are inserting an IV.]
Foreman: The colchicine interferes with the ability of the heart muscle to contract pumping blood, lowering your blood pressure. [CGI of his heart.] The antibodies we’re giving you should neutralize the colchicine, allowing your heart to beat at its normal rate.
Brandon: When will you know?
Cameron: We know now.< [Foreman gives the people outside a thumbs-up. Mrs. Merrell hugs her husband, and then hugs Mindy.]
[Cut to House pawing through the hospital pharmacy.]
Wilson: Big weekend?
House: It’s not for me, I’m fully stocked.
Wilson: Cuddy got you doing inventory?
House: Nope.< Trying to solve that kid’s case.
Wilson: The gout medicine OD?
House: Yeah.
Wilson: The fact that I know that it’s a gout medicine OD would seem to indicate that the case is already solved.
House: Well, you’d be wrong.
Wilson: What about the fact that the kid is now, I believe the technical term is, not sick?
House: You know how many forms of colchicine there are on the market?
Wilson: Stop it.
House: Neither do I, but it’s a lot. Pills, powders, liquids, IV fluids…. Somewhere at a party, in his coffee, up his nose, in his ear, this kid had some.<
Wilson: So, you’re not happy with your Ecstasy theory?
House: He said he used it twice.
Wilson: People lie.
House: Yeah, but if you’re gonna lie, it’s –
Wilson: You know what, I’m not interested.
House: Not curious?
Wilson: No, because I’m well-adjusted. [He walks off.]
House: Right.
[Cut to Cameron and Chase checking up on Brandon.]
Cameron: Temperature’s normal.
Brandon: I want Cousin Sharon there.
Mrs. Merrell: If we invite Sharon, we have to invite all the cousins.
Mindy: So what?< My side of the family doesn’t need anything. [Brandon starts coughing.]
Brandon: Don’t suppose I could have some of those cough pills, huh? They’re okay, right?
Cameron: Yes, you’re doing great.
Chase: You should invite Dr. House.
Brandon: Will he come?
Chase: No, but he’ll send a gift.
Cameron: I’ll make sure it’s a good one. [She give Brandon the cough pills.]
Brandon: There’s a letter on the back of these pills.
Cameron: Your old pills didn’t have a letter on them?
Brandon: No.< Round and yellow, but no letter. [pause]
Cameron: Well, these will help your cough. [She starts to leave.]
Chase: Hey, you want to go get some –
Cameron: No.
[Cut to House, once again in the hospital pharmacy. He finds the colchicine and compares them to the cough medicine: small, round and yellow, but minus the letter.]
[End! Hope you enjoyed – Marisol]
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