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#116 : Symptômes XXL

Une fillette obèse de dix ans est amenée d'urgence à l'hôpital. Elle est en effet sous le coup d'une violente crise cardiaque. Le docteur Greg House est relativement surpris de constater une telle pathologie chez une personne aussi jeune. Lorsqu'il constate que l'enfant a des escarres sur le thorax, House comprend qu'il s'agit d'autre chose. Il prend en main l'affaire : selon lui, elle pourrait bien absorber en cachette des pilules diététiques. Parallèlement, le service médical est en pleine réorganisation. Conformément aux consignes strictes données par Edward Vogler, House doit licencier l'un des médecins de son équipe. Il a une semaine pour effectuer ce choix difficile.

Captures de l'épisode


Réalisateur : Fred Gerber

Scénariste : Thomas L. Moran

Acteurs principaux : Hugh Laurie (Dr Gregory House), Robert Sean Leonard (Dr James Wilson), Omar Epps (Dr Eric Foreman), Jennifer Morrison (Dr Allison Cameron), Lisa Edelstein (Dr Lisa Cuddy), Jesse Spencer (Dr Robert Chase)

Acteurs secondaires : Chi McBride (Edward Vogler), Rose Colasanti (Cashier), Cynthia Ettinger (Mrs. Simms), Ramón Franco (I) (Mr. Hernandez), Karen Goberman (Mrs. Ayers), Teddy Lane Jr. (Mr. Conroy), Susan Slome (Mrs. Lucille Hernandez), Jennifer Stone (Jessica Simms), Alyson Morgan (Clementine), Austin Leisle (Seth), Alec George (Classmate #1), DJ Evans (Classmate #2), Bryan Fabian (Classmate #3)


4.25 - 8 votes

Titre VO

Titre VF
Symptômes XXL

Première diffusion

Première diffusion en France

Photos promo

Edward Vogler et Gregory House dans le bureau de ce dernier.

Edward Vogler et Gregory House dans le bureau de ce dernier.

Allison Cameron et Gregory House dans les couloirs de l'hôpital.

Allison Cameron et Gregory House dans les couloirs de l'hôpital.


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Le patient : Excusez-moi, vous êtes le docteur House ? Ma femme vous a vu hier, Mme Hernandez.
House : Il est pas là.
Le patient : Ma femme m'a dit qu'il avait une canne.
House : Et aussi un gros problème de toxycomanie. Des fois, il disparaît des semaines.

* * *

Le mari : Je veux savoir pour ma femme !
House : Même si j'étais le Dr House, le secret médical et la confidentialité me protégeraient des conversations enquiquinantes !

* * *

(La patiente refuse de se faire opérer)
Le mari : Je lui ai dit... Il faut que vous lui parliez... Si ça se passe mal, je ne pourrais...
House : La tumeur est bénigne. Il ne se passera rien à part des brûlures d'estomac.
Le mari : Et si la tumeur grossit encore ? Ou se modifie ?
House : Et ben... vous savez où nous trouver ! L'hôpital va pas s'envoler !
Le mari : Dites-lui que c'est un cancer ! Visiblement, ça vous gêne pas trop de mentir...
House : Oh ! Ça c'est un argument de choc !
Le mari : On a 6 enfants. On ne peut pas prendre de risques !
House : Vous avez des enfants ! Fallait le dire avant. Ça change absolument tout. Si maman a des brûlures, l'un des p'tits risque de prendre feu !

[Opens in a child’s bedroom.  Jessica, an 10-year-old obese girl, is sitting

on her bed looking very depressed.]

Mom’s voice: Jessica!  Jessica, come on!  We’ve gotta go!  [She comes to

lean on the doorjamb.]  Move it or lose it, sister.

Jessica: I don’t feel good.

Mom: [feels her forehead]  Oh.  You don’t feel warm.

Jessica: My stomach hurts.

Mom: Honey, if you don’t have a fever –

Jessica: I don’t want to go to school, I can do my work at home.

Mom: Jessica, what’s wrong?

Jessica: Everybody hates me.

Mom: Oh, they don’t hate you.  They don’t even know you because they’

re too ignorant to try.

Jessica: I hate myself!

Mom: Jessica, don’t say that.  Oh, honey, look at me, look at me.  You are

a wonderful, beautiful, little girl.  Don’t let a few bad apples –

Jessica: A few? [She starts to cry.]  Try my whole class.

Mom: Remember the story where the guy keeps saying that he hates

green eggs and ham, and then at the end he realized he really loved them? One day they’re gonna realize what a great kid you really are.  You’ve

just gotta be like Sam I Am, and don’t give up.

Jessica: Okay.

[Cut to Jessica, at gym class.  She’s jumping rope while the rest of the

class is watching and laughing at her.]

Some classmate: Come on, Jessica, hurry!

Mr. Conroy: That’s it, keep going.  Good, nice!  You’re doing great, Jessica.  [A kid behind Jessica notices that the ground under her is moving

and mimics Jessica.]  Hey, hey Seth?  You want to spend the rest of class

sitting on the bench?

Seth: No.

Mr. Conroy: Keep going, Jess, you’ve got 40 more seconds.

Jessica: My arm hurts.

Mr. Conroy: Come on, tough it up, you can do it.

Jessica: My chest hurts.

Seth: How do you think the ground feels?

Mr. Conroy: [as kids laugh]  Hey, Seth? Two laps, bye.  Hey, Jess, it’s just

a stitch, okay?  Just keep breathing, you got it.

Jessica: I can’t.

Mr. Conroy: Only 10 more seconds, you got it.  [Jessica falls to the

ground.]  Jessica, Jessica! [He turns her over on her back.]  Jessica!  [He

listens for her heart beat.  CGI of her heart beating fast, and then stopping.]  Oh, my God!  Hey, go to the office, get Miss Parsons.  Now!  [Some kid runs.  Mr. Conroy calls 911 on his cell.]  I’m on a playground at Finley Elementary.  One of my students is having a heart attack.  Yeah, she’s ten.  Don’t you think I know that?  Just send the damn ambulance!  [He starts chest compressions.]  Come on, wake up, sweetie.


[Cut to House leaving Exam Room two.  He walks up to Cuddy, who is

standing by the clinic desk.]

House: You ever see an infected pierced scrotum?

Cuddy: Um, no, but I know a few people on whom I’d like to see it happen. We need to talk.

House: Well, if pain’s what you’re after the penis is really the way to go. 

I’d recommend the Abadirabia. (sp?)

Cuddy: We’re not talking.

House: Oh?  Sounded like we were.

Cuddy: No, you’re attempting to avoid talking because you know what I want to talk about.

House: Nipples?

Cuddy: You need to get rid of one of your people.

House: Absolutely.  As soon as I do performance reviews.  And then review the reviews, of course.  Because a decision like this can’t be made without proper, you know, review.  Shouldn’t take longer than a month, maybe two. Four at the most, unless it gets complicated.

Cuddy: There’s no way out on this.  You may as well get it over with as fast as you can, like ripping off a band-aid.

House: Only instead of a two-cent piece of tape and gauze it’s a human being.

Cuddy: Like you care.

House: Like you don’t.  [The elevator opens, revealing Cameron.]

Cuddy: You have a week.  Get it done.  [Cameron gets out of the elevator.  House goes into the elevator, Cameron sighs and follows.]

Cameron: We have a referral from Dr. Linkowitz. 

House: Don’t know him.

Cameron: He knows you.

House: What’s the problem?

Cameron: Heart attack.

House: Definitely don’t know him.

Cameron: The patient’s ten.

[Cut to Diagnostics.]

Foreman: Ten year olds do not have heart attacks.  It’s gotta be a mistake.

House: Right.  The simplest explanation is she’s a forty-year-old lying about her age.  Maybe an actress trying to hang on.

Foreman: I meant, maybe the tests were wrong.

Cameron: That’s what the ER thought.  Three CKMBs were positive, the EKG shows classic signs of ST elevation.  It’s a heart attack.

Chase: She’s morbidly obese.  The “morbid” part of that raises alarms.

Foreman: Come on, it takes decades to eat your way into a heart attack.

Chase: Doesn’t take decades to kill yourself.  If I was that fat, I’d be pretty tempted to knock back a bottle of pills.

Cameron: It’s not a drug overdose.  The fatigue, muscle pain, and difficulty concentrating have been bothering her for over a year.

Chase: That’s because of her depression.

House: That’s what five pediatricians, two nutritionists, and a psychologist said.  The heart attack would seem to indicate that they missed something.

Foreman: It’s got to be something genetic.

Cameron: What about Metabolic Syndrome X?

Chase: Insulin resistance?

Foreman: Syndrome X could cause a stroke, but I don’t know about a heart attack.

House: Could, if her blood pressure was high enough.

Cameron: Which is likely, considering her weight.

House: It fits the symptoms.  Me likee.  Do a hyperinsulinemic euglyemic clamp.  [They get up to leave.]  Oh, and one more thing.  I’ve been told that I’ve got to get rid of one of you guys by the end of the week.  New sheriff, belt tightening, you know how it goes.  Okay, carry on. [He goes into his office.]

Foreman: It’s some kind of game, House’s own version of “Punk’d”.

Cameron: It’s not House, it’s Vogler.  We can’t let it get to us, we’ve got to stick together.

Chase: Why?

Cameron: What are you suggesting, we start slashing each other’s throats?

Chase: I’m suggesting it’s a zero-sum game.  Your loss is my win.  That’s not conducive to team play.

Foreman: Which is what House seems to want.  Come with Cameron.  May be a bad strategy, but I don’t want to give House his satisfaction.  Come on, sick kid, remember?

[Cut to Jessica’s hospital room.]

Mom: She’s diabetic?

Cameron: No, but it’s similar.  MSX patients don’t respond normally to insulin, which causes her body to create too much, which causes metabolic abnormalities.  We’re going to do a test to be sure, but there are certain dangers.

Mom: Is this thing treatable?

Cameron: It’s controllable through proper diet and exercise.

Mom: Wait.  Jessica already eats right.  And she exercises every day!

Cameron: I know you’ve already seen several nutritionists –

Mom: And we’ve done everything they recommended.

Cameron: I understand, but –

Mom: Why can’t any of you doctors see past her weight?  If diet and exercise are the treatment, then the diagnosis is wrong.

Cameron: It might be, but the only way we’ll know is if you’ll let us do this test.

[Cut to the clinic.]

Lucille: It’s really bad, especially at night.  It’s like my heart is on fire, like it’s, uh, oh, I don’t know, like it’s…

House: Burning?

Lucille: Exactly!

House: Hmm, sounds almost like heartburn.

Lucille: So, can you give me something?

House: Like a thesaurus?

Lucille: What?

House: I take it you never mentioned this during any of your prenatal visits.

Lucille: Prenatal?  I’m not pregnant.

House: Sorry, you don’t get to make that call unless you have a stethoscope.  Union rules.

Lucille: I know when I’m pregnant, all right?  I have six kids.  That’s why my husband had a vasectomy and we use condoms.

House: Vasectomies can reverse themselves, condoms break.

Lucille: Okay. [She hops off the table and gestures to herself.]  This is what a woman is supposed to look like.  Okay, we’re not just skin and bones.  We have flesh.  We have curves.

House: You have little people inside you.  [Lucille grabs her purse and heads to the door.]  Okay, okay, I’m sorry.  I guess I must have just been brainwashed by the media, and all those years of medical training.

Lucille: Damn right.

House: Let’s see if I can find some antacids while the nurse gets some blood.

Lucille: Blood, why?

House: The heartburn, gotta make sure it’s not spreading.

[Cut to Jessica, standing in front of a scale.]

Jessica: I don’t want to.

Chase: The test involves some pretty precise measurements.  If we don’t know exactly how much you weigh, we won’t get the right answers. 

[Foreman motions for Chase to move over – he’s got this one covered.]

Foreman: Tell you a secret.  When I was your age, I was heavy, too.

Jessica: Were you over 100?

Foreman: Way over.  The kids in my neighborhood used to call me Rerun.

Jessica: Rerun?

Foreman: He was a heavy guy from TV.  I used to pretend I liked it, but I didn’t.

Jessica: How come you’re not heavy any more?

Foreman: Ninth grade, grew five inches, everything kind of evened out.

Jessica: You think that’ll happen to me?

Foreman: Well, yeah!  I mean, your mom’s tall, and you are a little short for your age.  You’ll probably spring right up.  [She steps on the scale.]

[Cut to Foreman and Chase entering Diagnostics.]

Chase: Obesity isn’t something you just grow out of.

Foreman: Take it you’ve never seen a baby?

Chase: She’s not a baby, she’s ten!

Foreman: And you figure making her feel like crap would do her a world of good?

Chase: Yeah, if it gets her off the couch!

Cameron: I’m sure she’s already under enough pressure.

Chase: Enough from mummy.

Cameron: Everything in society tells us we have to be thin to be


Chase: No, society tells you you have to be thin to be attractive.  And guess what, that’s what attractive means: that society likes looking at you.

Cameron: I think we should be telling our kids it’s fine as long as they’re healthy.

Chase: All right.  You weigh 90 pounds because it makes you healthier?

Foreman: Forget it.  He’s just cranky because he knows he’s the one to get the axe.

[Cut to House and Wilson getting food in the cafeteria.]

Wilson: So, any thoughts?

House: On what?  Sharon’s plan for Gaza?

Wilson: Who you’re gonna let go.

House: I’m thinking I can convince Vogler it would be more cost-efficient to let me keep all of them.

Wilson: Yeah, you should be able to pull that off.  Most billionaires aren’t very good with numbers.

House: It will be more cost-efficient once I’ve grabbed Cameron’s ass, called Foreman a spade, and Chase… well, I can grab his ass, too.

Wilson: You are uniquely talented in many areas, but office politics is not one of them.  Don’t take Vogler on.

Cashier: Separate or together?

House: Together.  [House leaves Wilson to pay for lunch.]

[Cut to Jessica’s room, where the team is performing the test.]

Chase: Increasing glucose to 6.9 milligrams per milligrams per minute.

Mom: Are you okay?

Jessica: I’m thirsty.

Cameron: Just a little bit longer, and you’ll be done.

Foreman: Like Dr. Chase.

Chase: Wanna put some money on it?

Jessica: I said I’m thirsty.

Cameron: Just five more minutes, okay, sweetheart?

Jessica: I’m not your sweetheart, don’t call me that.

Mom: Jessica, that’s not nice.

Jessica: You’re the ones who aren’t nice.

Mom: Jessica…

Jessica: You’re not either!  I don’t want to do this anymore!  [She rips off the nasal prongs to help her breathe

Mom: Jessica!  Jessica, you have to calm down!  [She starts flailing.]

Jessica: Let me go! [Lots of the upcoming dialogue is masked by Jessica’s screaming.]

Cameron: She’s gotta be getting hypoglycemic.

Mom: What’s wrong?

Chase: Hey, calm down!

Jessica: Let go of me!  Get it out of me, you son of a bitch!  Bastards!

[Cut to later on.  Jessica is sleeping peacefully.]

Foreman: She’s sedated.  Mrs. Simms, don’t worry.  Hypoglycemia can cause temporary psychosis and it’s a common complication during a HEC procedure.

Mom: I never wanted it done in the first place.

Chase: We understand you’re upset, but –

Mom: You were supposed to be monitoring her condition. but instead you were bickering and placing bets.

Cameron: I apologize if we weren’t paying full attention to your daughter, but I assure you that –

Mom: Oh, please.  Save your pathetic insincerity for your boyfriend.  [House walks up.]

House: You’re wrong.  She is, in face, pathetically sincere.  And they

didn’t screw it up.

Mom: Who are you?

House: I’m from the lab.  The blood tests showed your daughter wasn’t hypoglycemic, which means her psychosis wasn’t caused by anything these doctors did.

Mom: So then what was it caused by?

House: I have no idea, but you’ll be happy to hear it can’t be cured by diet or exercise.

[Cut to House entering the Diagnostic office, the Duckings trailing behind


House: What else could cause uncontrollable rage in a ten-year-old?

Foreman: Nothing that could also cause a heart attack.  [House starts to write on the whiteboard.]

House: I assume I don’t have to point out that now would be an extremely good time for one of you to distinguish yourself with a brilliant idea.

Chase: A hypocoaguable state could cause a blood clot.  Blood clots can cause a heart attack.

Cameron: More likely to cause a stroke, not the psychosis.

Chase: No, you’re wrong.  If the clot made it to the amicdal area of the brain, it might cause uncontrollable rage.

Cameron: Right, because anything’s possible, but nothing’s going to cause multiple clots in a kid this age.

Chase: She’s fat!

Cameron: Obesity doesn’t cause blood clots.

Chase: Extremely obese patients can get a fat embolus.

Cameron: Right, after they get liposuction which she’s clearly never had.

Chase: How do you know?

Cameron: Because we have her medical records.  And because no plastic surgeon in his right mind is going to give a ten-year-old liposuction!

Chase: Have you ever met a plastic surgeon who was in their right mind? [Cameron looks really pissed.]

House: She hasn’t had liposuction.

Cameron: Thank you.

House: But what about some other ridiculous obesity treatment?

Foreman: Like what?

House: Diet pills can cause heart attacks and blood clots.

Cameron: Her tox screen was negative.

House: Wouldn’t show over-the-counter weight loss drugs.

Cameron: Her mother wouldn’t give her diet pills.

Chase: [sarcastically] Yeah, she thinks her daughter’s perfect just the way she is.

House: She’s lying.  Okay, you two, heparin and warfarin to prevent further clotting.  And you, [to Foreman] find those pills.

[Cut to House in his office, taking a couple Vicodin.  Foreman enters.]

House: [shaking the bottle of Vicodin] Not diet pills.  You might want to broaden the search just a little.  And don’t just ask the mom, if she hasn’t mentioned yet, she’s not gonna –

Foreman: If you’re gonna fire someone, go ahead and do it, but don’t treat us like lab rats, testing how long it takes us to get us at one another’s throats.

House: So what should I do?

Foreman: I don’t give a damn what you do.

House: Yes, I had noticed your complete indifference.  You don’t even offer a medical opinion any more.  Who would you fire?

Foreman: Not my call.

House: I want your opinion.  [Foreman starts to leave.]  Fine, it’s you.  [Foreman turns around.]  Either way, you’re making a choice.

Foreman: Chase.

House: [slightly puzzle]  Wh- Because he screwed up an angio a month ago?

Foreman: Anyone can make a mistake.

House: Right, it’s the money.  You resent it, but you’re going to tell me he doesn’t need the job.

Foreman: He doesn’t appreciate the job.

House: He was ready to go three rounds with Cameron for it.

Foreman: He wants the job.  He just doesn’t appreciate it.  There’s nothing wrong with just wanting to hang out, but this is not the place to do it.

House: I’m surprised.

Foreman: You thought I’d pick Cameron?

House: I didn’t think you’d pick at all.

[Cut to House and Wilson leaving the elevator.]

House: I guess he’s not the “rise above the fray” guy he likes to think he is.

Wilson: You practically forced it out of him.

House: He’s scared of losing his job, just like everyone else.

Wilson: I’ve been thinking.  You’ve made it quite clear that you’re miserable here

House: I am not miserable. [They enter the clinic.]

Wilson: You’re not happy.

House: And you are?

Wilson: With… my job, yes.

House: I am exactly where I want to be doing exactly what I want to do.

Wilson: I think I sense a hint of sarcasm there.  Why don’t you pick

yourself?  Quit?

House: [looking at charts]  Hmmm… I was wrong.

Wilson: About Vogler or Foreman?

House: Mrs. Hernandez’s pregnancy tests.

Wilson: Who’s Mrs. Hernandez?

House: Either a woman carrying an alien baby or your newest patient. 

[Wilson grabs the chart.]

[Cut to Foreman talking to Jessica’s teacher in an empty classroom.]

Foreman: So, you never saw her with any pills?  She never mentioned


Ms. Ayers: No, of course not.

Foreman: Would it be all right if I talked to a couple of her friends?

Ms. Ayers: Her friends?

Foreman: Well, I’m not going to interrogate them, but I just want to ask if

Jessica ever mentioned anything.  It’s pretty important, she’s very sick.

Ms. Ayers: I understand, it’s just, well, Jessica really doesn’t have any


Foreman: Not one?

Ms. Ayers: I’ve tried to help, make the kids include her more, but kids can

be –

Foreman: Kids?

Ms. Ayers: Heh, I was going to say jerks. [Bell rings.]  All the fifth-graders

are assigned an eighth-grade buddy.  Maybe you could talk to her’s.

[Cut to Vogler and Cuddy by the clinic main desk.]

Vogler: What’s the status on House?

Cuddy: He asked for time to complete performance reviews on everyone in

his department.

Vogler: And you told him no and gave him how long?

Cuddy: A week.  He’ll do it. [Cameron starts to walk up.]

Vogler: Guy’s never done what he’s told.  Don’t see why he’s going to

start now.  [Vogler walks over to talk to Cameron, who is dealing with

clinic folders.]  Hi!  Edward Vogler.  Is Dr. House claiming that I’m forcing

him to get rid of one of you?  I assume his goal is to stir up antagonism

toward me.

Cameron: And your goal is?

Vogler: I am forcing him.  I’ll do whatever I can to ease the transition for

whoever he chooses.

Cameron: If you’re feeling guilty about your decision, there is an easy


Vogler: I don’t feel guilty.

Cameron: Then why approach me and tell me all this?

Vogler: I don’t feel guilty, that doesn’t mean I don’t feel bad.  I’m rich, but

I’m still human.  [He smiles.]  I just wanted you to know that if there’s

anything I can do for you, my door’s open.

Cameron: Thank you.  [Cameron walks away, and Cuddy confronts


Cuddy: You looking for info?  Thought you already had House all figured


Vogler: I do.  Don’t know his team, though.  [He walks off.]

[Cut to Wilson and House in the exam room with a sad-looking Lucille.]

Wilson: The ultrasound and biopsy confirmed our worry.  The tumor is

extremely large, at least thirty pounds.

Lucille: Oh, God.

House: It’s actually a personal record for this clinic.

Wilson: [gives House a “you’re not helping” kind of look] But it’s completely

benign, there’s no sign of cancer at all.  I’ve already spoken with Dr.

Bergin, and he’s available first thing in the morning.

Lucille: For what? [House and Wilson look a little puzzled at this.]

Wilson: For the surgery.

Lucille: But if it’s not cancer, it can’t kill me, right?

Wilson: [looks to House for help, but he’s keeping his mouth shut on this

one] …No.

Lucille: I’ll have a huge scar!  I won’t be able to wear a bikini!

House: You wear a bikini now?

Lucille: Yeah, you got a problem with that?

House: Nope, but I’ve never gone swimming with you.

Lucille: I knew it.  That’s what this is all about!  You are trying to force me

to have cosmetic surgery!

House: Yeah, that’s exactly why I planted a thirty pound tumor on your


Lucille: It’s not gonna kill me.  [House and Wilson share a “are you hearing

what I’m hearing?” kind of look.] The only thing surgery is going to do is

change the way I look.  That is the definition of “cosmetic surgery”.

Wilson: Uh, it would also relieve your heartburn and discomfort.

Lucille: Yeah, right.  Why give an antacid when you can cut someone up

and make them look a little easier on your eyes?  [She hops off the table,

grabs her purse, and sort of saunters to House.]  My husband loves my

body.  He can’t get enough of it.  [At this point, Wilson is totally checking

her out.  Bad Wilson.]  you think he’s gonna want to touch me if I look like

I’ve been gutted like a fish?  [She leaves, slamming the door behind her.]

Wilson: That was unexpected.

House: [nodding] Yeah, it was.

[Cut to Foreman talking to Jessica’s eighth-grade buddy.]

Clementine: All she does during recess is run laps around the playground. 

She says she’s exercising, but everyone knows it’s just because no one

wants to play with her.  I mean, I’m only her buddy because Ms. Ayers

assigned her to me.  That does not mean I am her friend.

Foreman: I’ll make sure her doctors are all clear on that.

Clementine: Thanks.

Foreman: So, has she ever said anything to you about diet pills?

Clementine: Heh, she told you that, too.

Foreman: What do you mean?

Clementine: I totally busted her for taking drugs one day.  She totally lied,

said they were diet pills her mom had given her.  Come on, get real.  No

way a girl like that is taking diet pills.

[Cut to Foreman talking to Jessica’s mom in the hospital.]

Mom: I didn’t give her diet pills, I would never do that!

Foreman: Right, so it was her imaginary mom.

Mom: She didn’t take any pills, the girl’s lying!

Foreman: Why would she lie?

Mom: Because she’s another mean little jerk?

Jessica: Mom.

Mom: I’m sorry, honey.

Jessica: Clemmie didn’t lie.  I did.  I took the pills.  I told her you gave

them to me ‘cause I didn’t want to get in trouble.

Foreman: Where did you get them?

Jessica: I took them.  From the store.

Mom: Why?  Why would you do that?

Jessica: Because I didn’t want to be ugly anymore.

Mom: Oh, baby.  You’re not ugly.

Jessica: Yes, I am!  I know you don’t think so, but I am!  I’m disgusting.

Mom: Jessica, please, don’t say that.

Jessica: I just, just wanted to fit in.  You know, have friends?  Or at least

have one person my age be nice to me.  [Mom and Jessica are both


Foreman: Listen, the pills cause blood clots, heart attacks, and insomnia. 

It explains everything.  We’ll keep her overnight to make sure, but she’ll be


Mom: Thank you.

[Cut to the team, gathered in Diagnostics.]


Cameron: I can’t believe she was that desperate.

House: Yeah, I’m sure that if everyone I knew hated me, I couldn’t bear to look at me.  I wouldn’t go so far as to shoplift.

Cameron: I’m not talking about the shoplifting.

Foreman: I’m sure she didn’t even know they were dangerous.  She probably saw them advertised on TV or over the internet.

Chase: Right, so I guess it’s the media and pharmaceutical companies’ fault now? [He hands House a cup of coffee.  House is puzzled at this gesture of sucking up.]  Not the fact that she can’t stop shoving food down her throat.  No one forced her to get fat.

Cameron: No one forced a cancer patient to get cancer.

Chase: Give me a break, it’s not a disease.

Foreman: Have you seen the latest research?

Chase: Yes, I have.  What I haven’t seen lately is a kid eating an apple or riding a bike.  You Americans can’t even compete with the rest of the world in basketball anymore, unless, of course, it’s the type you play with a remote control on a big screen TV.

Foreman: Right.  [He gets up and starts to walk off.]

House: [stuttering] Wait!  Are you going to let him say that?  He insulted our basketball teams!  [Foreman’s beeper beeps, then Chase’s, then Cameron’s… they all have different beeps that sound quite nice together, but that’s not the point of this.]

[Cut to the Ducklings running down the hall.]

Jessica: Oh, my God!!  Mommy, they hurt so bad!

Foreman: [entering] What happened?

Jessica: Please help me!

Mom: She’s bleeding!

Cameron: From where?

Jessica: Oh, my god! [Cameron lifts the neck of Jessica’s gown to reveal open, bleedling lesions on her chest.]  Just please stop it, please!

[Cut to the team in front of the whiteboard, where “skin necrosis” has been added.]

Cameron: Diet pills don’t cause skin necrosis.

Chase: Could be something related to the pills.

Cameron: Or not.

House: Or both.  Diet pills brought her to us, we gave her the sores.

Foreman: You think she got a staff infection from something here?

House: I’m not saying the hospital gave the sores, I’m saying we did.  By treating her.  Warfarin-induced skin necrosis.

Cameron: Highly unlikely.  We started her on heparin before the warfarin.

House: Who gave her the heparin?

Chase: I gave warfarin, she gave heparin.

House: Sure you didn’t both give her warfarin?

Cameron: Yes, I did not screw up.

House: [to Chase] Did you actually see her prepare and administer the heparin? [pregnant pause] Enough said.

Cameron: You were standing right there.

Chase: I was preparing my own dose.

Cameron: Yeah, right.  There’s gotta be some other cause.

House: None that I can think of.  Let’s fix the mistake.  Give her unfractionated IV heparin and low molecular weight heparin by subcutaneous injection stat.  [Cameron, Chase, and Foreman leave into the hallway.]

Cameron: Making me look bad is not going to save your job.

Chase: You think you’re incapable of making a mistake?

Cameron: You think that I am that weak that I am just going to roll over and take this?

Chase: House isn’t just going to protect you because you kiss his ass!

Cameron: Vogler wants to know what he can do for me.

House: [shouting out the door] Hey!  Stop worrying about your asses and start worrying about the patient’s.

[Cut to Foreman taking a sample from Jessica’s lesions.  Vogler enters.]

Vogler: She sleeping?

Foreman: As a result of the sedatives, yeah.  Can’t let her wake up, too much pain.

Vogler: [looks at a clipboard]  “Warfarin-induced skin necrosis”.  I have no idea what that means.  But it says here we gave her the warfarin, and I do know what “induced” means… we did this?

Foreman: At this point it’s not exactly clear.  You know, I should probably talk to Dr. House.

Vogler: Oh, you two need time to get your story straight.

Foreman: He doesn’t tell me what to do.

Vogler: So you don’t just blindly follow his commands.  You’re your own man.  And yet, here you are working for a man you can’t stand.

Foreman: I respect him.

Vogler: What exactly is it you respect?  His attitude toward humanity?  He thinks we’re all idiots and liars.  How ‘bout his attitude toward you, plays with you like a cat with a ball of string –

Foreman: What do you want?

Vogler: I want to know if you want to keep your job.

Foreman: If he chooses to let me go, I can live with that.

Vogler: That’s not an answer.

Foreman: You offering to protect me?

Vogler: Still not an answer.

Foreman: I want my job.  [Chase enters.]

Vogler: Dr. Chase.

Chase: Boss.  [Vogler leaves.]  What was that about?

Foreman: Wanted to know what warfarin is.  I don’t know.

[Cut to House entering pathology.  Cameron is there.  He stares at her through the glass, but she keeps concentrating at her microscope.]

House: Brrrr.  Icy.  Definitely think twice before correcting one of your mistakes again.

Cameron: [still at her microscope]  Correct all you want.  Of course, it’s a bit more productive if there’s an actual mistake.

House: Right, I always forget that part.

Cameron: I gave her the heparin, which means the necrosis is not a reaction to the warfarin, which is probably why she’s not responding to your treatment.

House: Yet. If you didn’t screw up, then what is it?  You don’t have an answer.

Cameron: Yet.

House: When you come up with something, let me know.  I’ll be in the clinic, warming up.

Cameron: [turning to look at him]  I’m the only one who’s always stood behind you when you’ve screwed up.

House: Why? Why would you support someone who screws up?

Cameron: Because I’m not insanely insecure.  And because I can actually trust in another human being and I am not an angry, misanthropic son of a bitch.

House: I’m sorry, you said you weren’t angry.  Who would you fire?

Cameron: No one.

House: Not an option.

Cameron: If everyone took a paycut and put in a few more hours we could all stay for the same amount of money.

House: Figures you’d try and come up with a solution where no one gets hurt.  The problem is, the world doesn’t work that way just ‘cause you want it to.

Cameron: Figures you’d stall and refuse to deal with the issue.  Problem is, the world doesn’t go away just because you want it to.  [House leaves, and Cameron goes back to her microscope.]

[Cut to House entering the clinic.]

Mr. Hernandez: [getting up] Excuse me, Dr. House?  My wife saw you yesterday, Lucille Hernandez?

House: Uh, he’s not in today.

Mr. Hernandez: My wife said he walked with a cane.

House: He’s also got a bit of a drug problem.  Sometimes doesn’t show up for weeks.  [He walks into Cuddy’s office.]

Cuddy: [to Vogler] The MRIs are rented, but… Did you make a decision?

Vogler: He’s not gonna fire anybody.

House: Yes.  I’m going to cut the pay of all four of us.  17% across the board will allow you to keep us all for the same amount of money.  I believe it’s what you suits call “win-win”.

Cuddy: All right, if you can –

Vogler: No.

Cuddy: If he can work it so we can keep the current staff for the same

amount of money, what difference does it make?

House: It’s not about the money.

Vogler: This is not a negotiation, it never was.  I need to know that whatever I ask you to do, no matter how distasteful you find it, you’ll do it.  And just as importantly, you need to know that.  [Cuddy sighs, and House leaves, slamming the door behind him.  Mr. Hernandez confronts him on the way out.]

Mr. Hernandez: What’s going on with my wife?

House: Even if I was Dr. House, physician-patient confidentiality protects me from annoying conversations.

Mr. Hernandez: But she told me about the tumor.

House: Yeah?  She also tell you why she’s refusing to have it removed?

Mr. Hernandez: I don’t care about a scar.  And she can always gain the weight back.

House: You want her to regain the weight?

Mr. Hernandez: Yeah.  I mean, only if she wants to.

House: Why?

Mr. Hernandez: I’ve always thought she’s looked sexiest when she was pregnant.  [House looks slightly disturbed.]  Something ‘bout knowing she’s a mother makes me want to –

House: Yeah, tell her that and leave me alone.

Mr. Hernandez: I did.  You gotta talk to her, I couldn’t bear it if something happened to her –

House: The tumor is benign, nothing’s gonna happen.  Except maybe some more heartburn.

Mr. Hernandez: What if it gets even bigger?  Or if it changes?

House: You know where to find us.  Building’s not going anywhere.

Mr. Hernandez: Tell her it’s cancer.  [House pushes the elevator button.] You obviously don’t have a problem with lying.

House: Oh, way to win me over.

Mr. Hernandez: [takes out wallet of pictures]  We have six kids.  She can’t afford to take a chance.

House: You have kids!  How novel!  That changes everything.  So if Mommy has heartburn, one of them might catch on fire.

Mr. Hernandez: Please, I don’t know what we’d do.  [House takes the pictures.]

House: They are cute.  Have her come back in.

Mr. Hernandez: What?

House: Your plight has moved me. [Elevator dings.]  Tell your wife to come back.

[Cut to House entering Diagnostics.]

Foreman: Her necrosis is getting worse.

Cameron: Maybe because we’re treating her for the wrong thing.

House: Have you found the right thing?

Cameron: No.

House: Then we continue the treatment.  Hope it’s just taking longer than it should.

Wilson: At this point it doesn’t matter what caused the necrosis.

House: Or who.

Wilson: If we don’t stop it from spreading it will kill her before the end of the day.

Foreman: What else can we do?

Wilson: Get rid of it.  Remove the dying flesh before it penetrates the abdominal wall.

House: Do it.

[Cut to Foreman and Wilson talking to the mom.]

Foreman: There’s still a chance that the heparin treatment could start to take effect.

Wilson: We’re gonna wait as long as we can, but if there’s no change in the next few hours, we’re gonna have to treat the symptoms directly.

Mom: So you can get rid of the sores.

Foreman: Through surgery.  Technically, it’s an amputation.

Mom: Amputation?  But the sores are –

Wilson: Warfarin-induced necrosis attacks fatty tissue, mainly in the breasts.

Mom: Wait, are you talking about cutting off my daughter’s breasts?  She’s ten years old!

Wilson: A radical mastectomy may be her only chance of survival.

Foreman: I’m sorry, but I’m gonna have to ask you to sign this.

[Cut to House looking pictures of Jessica’s sores on his computer.  Cameron enters.]

Cameron: Can we talk?

House: What, no roses, no chocolates?  If you’re here to apologize –

Cameron: I’m not here to apologize.

House: Uh-oh, that means you’re here for something more complicated.  [He takes Vicodin.]

Cameron: Do you want to fire me?

House: Yes.  I was just waiting for an excuse.  Thank God Vogler came along.  Phew!

Cameron: It’s the only reason I can think of that you’re insisting that I made a mistake.

House: Really?  Because there is another explanation. [He stands up.]  Perhaps not as much fun as your Freudian analysis, but maybe you actually made a mistake.

Cameron: You’re doing this because you can’t deal with your feelings for me.

House: I believe that you are the only one to express feelings.  And if we’re going to look at this from a first-year psych point-of-view, maybe you want me to fire you.  Maybe that’s why you’re acting weird.  You –

Cameron: You’re the one being different!  You’re always pushing things, pushing the rules, pushing us, but not this time.  You just jumped on this idea like a life raft.  Not one question about what else it could be, no riding us for other answers.

House: I have the answer.

Cameron: Then why aren’t you watching TV?  Or playing your damn Game Boy, or whatever else you have fun doing by yourself?  Maybe I should just quit.  Make it easy for everyone.

House: Maybe you should.  [Cameron leaves, making the door shake behind her.]

[Cut to House, sitting on the exam room table, talking to Lucille, who’s


House: Men are pigs.

Lucille: You call me in to tell me –

House: I should have realized the vasectomy and condoms was overkill, but this was too obvious.  [He holds up Mr. Hernandez’s photos.]  Cute kids.  Love her green eyes.  And his baby blues.  Of course, since you and your husband have brown eyes…

Lucille: Where’d you get that?

House: From the father of three, maximum four of your six children.  So I’m thinking maybe the reason you don’t want surgery is, while your husband may find you attractive no matter what, all the other men you’re sleeping with might not be so open-minded.  Which brings me back to my original thesis: men are pigs.  You got nothing to worry about.  You know, pretty much have sex with anyone, fat, skinny, married, single, complete strangers, relatives –

Lucille: You?  You’re sick.

House: So are you.  I’m sure there are websites full of men looking for married women with surgical scars.  [He hands her back the pictures.]  So have the surgery.  Please?

Lucille: Okay.  [House leaves.]

[Cut to Chase entering Vogler’s office.]

Chase: Why have you been talking to Cameron?

Vogler: Well, if House picks you I’ll be needing a new source in that room.

Chase: If he picks me?

Vogler: Sure.  Foreman’s smarter, House has got a thing for Cameron.

Chase: I’ve been feeding you information so you’ll protect me.

Vogler: I will protect you as long as I need you.  And you will feed me information as long as you need me.  I spoke with Cameron because if I have alternatives, I don’t need you.

Chase: She’s not gonna rat on House.

Vogler: Foreman ever said anything about talking to me?  Interesting.

[Cut to House, looking into Jessica’s room.  Chase and Foreman walk up.]

House: It’s been almost three hours, still no change in her condition.

Foreman: I think we should get her into surgery.

Chase: So what do you want to do?

House: Assume that Cameron didn’t screw up.  What if it’s not the warfarin?

Chase: It has to be.  The sores presented right after we –

House: Right, right, right, but let’s just say it’s not.  Come on, come on, what have you got?

Foreman: Can I have a second to think?

House: No, there’s no time to think!  Say the first thing that comes to you head.

Chase: She’s fat.

Foreman: Enough already, okay?  We’ve got it, you hate fat people.

Chase: That’s not what I meant.

House: We already considered obesity as a cause.

Foreman: So did all her other doctors.

Chase: No, what if it’s not a cause?  What if it’s a symptom?

House: Okay, so what could cause obesity and skin necrosis?  Listen, I don’t care if it makes sense, just give me something.

Foreman: Ulcers secondary to vaculitis.

House: No, that’s just sores, not obesity.

Chase: Pyoderma gangrenosum?

House: More sores.  Okay, let’s look at it from the other side.  What has obesity as a symptom?

Chase: Hypothyroidism?

Foreman: Genetics are more likely.  Her mom’s heavy, too.

House: She’s not just heavy.  She’s tall.  We have any history on the dad?

Chase: Yeah.  6’1”.

House: Kid’s short.  We’ve got stunted growth, high blood pressure, blood clots, obesity – it’s Cushing’s. 

Chase: No, necrosis doesn’t present in –

House: In rare cases Cushing’s can cause hypercalcemia, which can lead to the same skin necrosis as warfarin.  It’s perfect.  It explains everyting.

Foreman: Except it’s not Cushing’s.  She’s had multiple blood tests and none show abnormal cortisol levels.

House: The hypercortisolism could be cyclical, we just didn’t catch it in the right phase.

Chase: We’ll have to do another UFC.

House: There’s no time!  We’ve got less than an hour to make the call.

Chase: If we treat for Cushing’s and we’re wrong, she’s dead.

Foreman: If we assume it’s not Cushing’s, she’ll lose her breasts and may still be sick.

House: Do an MRI.

Foreman: You want us to look for hypercortisolism with an MRI?

House: No, I want you to look for what could cause hypercortisolism with an MRI.

[Cut to Jessica in the MRI machine.]

Foreman: Nothing on the adrenals.  Heard Cameron went home, she sick?

Chase: Go back to the pituitary views.  She seemed okay.

Foreman: Think she’s got another reason for leaving?

Chase: I hope so.  Wait, stop.  There.  [He points to a black spot on the

MRI.]  What’s that?

Foreman: A tumor.

Chase: It’s Cushing’s.

[Cut to Foreman talking to Jessica’s mom.]

Foreman: The tumor causes Cushing’s.  Cushing’s messes with hormone production.  Hormones control everything: growth, weight –

Mom: Can you fix it?

Foreman: She’ll need surgery to remove the tumor.  Once it’s gone, everything will get normal very fast.

Mom: No mastectomy?

Foreman: No.

Mom: Thank God.

Foreman: The surgery’s dangerous.  The pituitary is located between the caverns of the sinuses, basically right between the eyes.  The area contains the nerves that control eye movement and the major arteries that feed the brain.

Mom: Oh, my God.

Foreman: Your surgeon will approach the gland transphenoidally.  [While Foreman is talking, the surgery is taking place.]  An incision will be made under the lip in which he’ll insert a fiberoptic microscope.  Once the tumor’s found, he’ll cut it into small pieces and remove it from the same hole under the lip.  The whole procedure should take about three hours and your daughter should be able to go home in a few days.  The sores will go away, as well as her fatigue and her muscle pain.  She’ll even start losing weight.

[Cut to Jessica’s mom, nervously meeting the surgeon.  He talks to her, and she gives him a hug.  They are all smiles.]

[Cut to Jessica being wheeled out of the hospital.  Foreman sees her by the door, and gives her a hug.  Awww.]

[Cut to a few days later.  We see Jessica in a room, sitting on a table and much thinner than she was previously.]

Foreman: Jessica.

Jessica: Hi.

Cameron: Is that really you?

Jessica: Yeah, it’s me.

Chase: You look fantastic!  [Chase, checking her out, is a dirty man.  Bad Chase.]

Mom: She always looked fantastic.

Foreman: Yeah.  [Jessica smiles.]

[Cut to House entering his office.  Cuddy and Vogler are standing inside of it.]

Cuddy: It’s been a week.

House: Actually, it’s over a week.  Where have you guys been?

Cuddy: Who is it?

House: Chase.

Vogler: No, Chase stays.  Pick someone else.

House: The deal was –

Vogler: Deal’s changed.  Pick someone else.

House: No.

Vogler: Pick someone else or it’ll be the whole department.  [He leaves.  Cuddy gives him a “I don’t know what’s up, either” look, and leaves, too.]

[Cut to Vogler walking down the hallway, Cuddy hurrying after him.  They

walk by Chase, who keeps his head down until they pass.]

[Cut to Cameron, who is editing her CV.]

[Cut to Cuddy and Vogler, coming out of the elevator.  They walk past

Foreman, who turns to look at them.]

[Cut to House, twirling his cane and looking Very Unhappy.]

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