[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 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. 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.
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. 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.]
Un étudiant s'évanouit dans les bras de sa petite amie. Le jeune homme est hospitalisé au CHU de Princeton, où son état ne fait que s'aggraver. Il présente un tel panel de symptômes que tout diagnostic semble impossible. L'équipe du docteur House tente plusieurs traitements. Après avoir bien réagi à une thérapie, le jeune homme s'enfonce : il n'a plus de défenses immunitaires et doit être placé en chambre stérile. Le docteur House émet alors une hypothèse : et s'il s'agissait d'une overdose de médicaments incompatibles ? Son équipe est sceptique.
