Épisode Culpabilité S02E03 - House Saison 2

[Cuddy is jogging.]

Cuddy [to neighbor]: Morning.

[Cuddy reaches her front yard and stops.  There is man on a ladder working on, presumably, her roof]

Cuddy: Hey, Alfredo. You done already?

Alfredo: Ah, no, not yet.  I finish tomorrow.

Cuddy: Mexico playing Argentina on TV?

Alfredo: No, no.  My asthma is very bad.

Cuddy: For six years, Alfedro.  You can’t lie to me.  I’m throwing a dinner.

Alfredo: First thing tomorrow.

Cuddy: Party’s tonight.  It’ll rain.  I’ll have to put buckets on the dining room table.

Alfredo: No clouds, no rain.

Cuddy: I’ll tell you what.  You take off.  But if it pours into my guest’s wine glasses…

Alfredo: Okay.  Okay, senora, I’ll do it.

[Cuddy walks back towards the door, glancing towards Alfredo.]

Alfredo: No problema.

[Cuddy enters her house, throws keys on the dining room table, and goes into her kitchen.  She opens the fridge and pours herself a glass of water.  She walks to the window and starts to choke on the water.  A slight scream is heard. Suddenly, Alfedro falls off the roof.]

[Alfredo is on the stretcher, with neck collar and full spinal precautions.  Cuddy is moving a stethoscope across his chest.]

Cuddy: Spinal cord seems intact.  Take a deep breath.

[Alfredo tries and wheezes.] 

Alfredo: It hurts.

Cuddy: Try. Breath sounds bilateral.  I don’t think he has a pneumothorax.

Alfredo: [still wheezing] Just asthma.

Cuddy: That and probably a broken rib.  Tell me when it hurts the most.

[Cuddy pushes down and Alfredo squirms in pain.  Cuddy notices that two fingers on his right hand are discolored.]

Cuddy: Your two little fingers are darker than the others.

Alfredo: They feel funny…like needles.

Cuddy: How long have they been like that?

Alfredo: I’ve never noticed before.  Is bad?

[Cuddy looks up.  It’s bad.]

[Hospital Hallway.]

Cuddy: Judging by how it looks, he could lose his hand.

Wilson:  How does falling off your roof do that to a guy’s fingers?

House:  Could have tweaked a vertebrae in his neck.  Could have pinged on the ulnar…[House is staring down at a red stain on Cuddy’s tank top just below her breasts.]  Sorry, trouble concentrating.  That tank top really absorbs moisture.

[Cuddy reached to pull her sweater closer around her.]

House:  Could have pinged the ulnar nerve, cut the blood flow.  Or it could be Disseminated intravascular coagulation.

Wilson:  DIC.?  Guy falls off a roof, the first thought is it’s always a clotting problem

House: Trauma can activate the clotting enzymes.  Guy could loose more than his hand.

Cuddy: Thank you, very much.  This guy’s been working for me for a long time and I--

House [takes chart]: Do I get bonus points if I act like I care?

[Cuddy just looks at him.]

[House’s Office]

[House enters, sucking on a lollipop.]

House: Cervical MRI, work up for DIC, and start him on a heparin drip

Cameron: Who?

House: You want to know his name? [throws file down on the table]  I’m sure it’s in the file. 

[Cuddy enters.]

House: Or you could ask her.  She’s his oldest, bestest friend.  They were in Cub Scouts together.

Cuddy:  I’ll get started on the blood tests.

House: You haven’t been a real doctor in ten years, you’ll make a mess all over the sheet.

Foreman:  I’ll do it.

Cuddy:  You have clinic duty.  I still know how to handle a patient.

House:  Get me blood.  Lots of blood.

[Cameron reads through Alfedro’s chart and makes a face.  The ducklings get up.]

House: They’re better.  They’ve showered.

Hallway.

[Cuddy is peering into Alfredo’s room where Chase is taking blood.  Stacy comes up behind her.]

Stacy:  You don’t need to see him.

Cuddy:  One-handed handyman aren’t in big demand.

Stacy: Talking, that’s how law suits are lost.  I know you, Lisa, you go in, you offer to pay his medical bills, his wages, you’ll say something stupid like I’m sorry—

Cuddy: You think I’m an idiot?

Stacy: I think you’re not a lawyer.  Don’t go in there.  [puts a hand on Cuddy’s shoulder].  Trust me, House’s people can handle this.

[Stacy walks away, Cuddy still looks at the room.]

Cuddy [softly]: Yeah…

[Alfredo’s Room]

Chase:  This might sting a little bit.  The medicine will thin and the blood and help it to circulate.

[Chase looks at Alfredo left hand.  There’s four scars, lines that look like four deep
scratches.]

Chase: Those pretty nasty scars there.

Alfredo: They were construction.

[Alfredo winces in pain as Chase injects him.]

Alfredo: How long will I be in the hospital?

Chase: Depends how long it takes us to figure out what’s going on.

Alfredo: I need to work.  I’ll get fired.

Chase: I’m sure Dr. Cuddy won’t fire you.

Alfredo: I’m janitor at fast food six nights.  I need to work.  My mother doesn’t make enough.

Brother (Manny): I can work, I’m old enough.

Alfredo: You’re old enough when you finish college

Brother (Manny): Why?  You never went to—

Alfredo: I never had a big brother to tell me to shut up!

Chase: I promise, we’ll let you out of here as soon as we’re able to

Alfredo: Look, I…I am fine.  [takes pulse ox off, and reaches for the oxygen cannula].  I feel better.

Chase: No..

Alfredo: I go home now.

Chase: No, if this is a clotting problem, it could be very serious.  All right?

Alfredo: Can’t make me stay. 

[Alfredo takes to get up again.  Chase pushes him back down and Alfredo groans.]

Alfredo: You can’t make me stay.

[Chase notices Alfredo’s right hand.]

Chase: Turn your hand over.  I need to see your hand.

[Chase reaches for it.  The last two fingers are almost completely black and it’s spreading onto the middle finger.]

Alfredo: Where is Dr. Cuddy?

[House’s office.]

[House and Cuddy are there.]

Chase:  We’re got a third finger turning dark.

Cameron: His PTT is prolonged, the fibrin split products are off, he’s not clotting properly.  It looks like a middle case of DIC.

House: Well, obviously not that mild.  This keeps up and his hand will literally be dead meat.  His hand is connected to his arm, his arm is connected to…I’m not sure, but I bet it’s important.

Cuddy: All this from falling off my roof…

House: Yeah, if only he’d fallen on his head.  Then he wouldn’t have any of these symptoms.

[Cuddy looks at him in disbelief.]

Cuddy: We need something stronger than heparin.  Human activated protein C.

House: Looks like Cuddy, same cleavage.  Protein C is indicated only for severe sepsis.

Cuddy: Well, how many of his limbs have to be at stake, for it to be severe?

House: But this stuff is crazy dangerous.  It can cause internal bleeding.  If he bleeds, he could stroke, he could die. 

Cuddy: He could get better.

House: You know, if I tried a scheme like this, you’d give me that nasty, wrinkly face and screech like a hyena. [House approached Cuddy until he is barely a foot away.] It’s very sexy, I admit.

[Cuddy is speechless a second before she starts to walk away.]

Cuddy:  Do it.

[Hallway.]

[House and Wilson step out of the elevator.]

House: Protein C is border-line irresponsible.  ‘Cept that the safe stuff isn’t doing squat. 

Wilson: This is exactly the type of thing you would do.

House:  Well, obviously.

[Cuddy’s office.]

Stacy:  It’s actually the type of thing he’d do.

Cuddy: I know.  I think he’s trying to protect me.

Stacy: Now that’s not the type of thing he would do. 

Cuddy: I overruled him.  He’s the best diagnostician in this hospital, and I overrule him.

 

[Stacy and Cuddy sit.]

Stacy: You care about this kid.  You judgment should be worth more than his.

Cuddy: He also pointed out that I haven’t been a real doctor in years. 

Stacy: Now that sounds like him.  

[Hallway.]

[House reaches into a jar filled with lollipops at the nurse’s station.]

Wilson: You were just jerking Cuddy around?

[House pulls out three lollipops.]

House: You seriously thought I wanted to stop her?

Wilson: One thing Cuddy is not is clueless. 

House: No, first causality of this case is her sense of humor.

Wilson: Weird, nothing funnier than almost killing a guy.

[Foreman is treating an older African-American man.]

Patient: I’m just having trouble getting up those steps. 

Foreman: When did you start noticing?

Patient: Well, a week ago.

Foreman: Your blood pressure’s a little high.  I have something new that should help you out.  Combines a nitrate with a blood pressure pill.  It’s targeted to African-Americans.

Patient: Targeted?

Foreman: Yeah, well, see we tend to have nitric oxide deficiencies.  The studies show this drug counteracts that problem.  It’s the first drug to—

Patient: What kind of studies you talking about?

Foreman: What kind of studies are there?  They get some patients, they give ‘em some drugs…

Patient: Ah…I’ve had white people lying to me for 60 years. 

Foreman: You think this is a tan?

Patient: You think they tell you everything?

Foreman: Trouble with us black folk, we can’t tell the difference anymore between racism and everybody gets screwed. 

Patient: Yeah?  Well how about them cheap meningitis drugs they pawning off in Africa?  Gonna tell me that ain’t racism?

Foreman: That’s just greed. You really want to screw whitie? Be one of the few black men to live long enough to collect social security.  [rips off a prescription slip].  Take the medicine.

[Patient takes the script.] 

[Alfredo’s room.] 

[Alfredo realizes he can’t feel his arm.]

Alfredo:  Nurse.  Nurse!  Help!

[Chase rushes in.]

Alfredo: Nurse!  Help!  Nurse!

Chase:  What’s up?

Alfredo [very upset]:  I can’t move my arm.  I can’t move my arm!

Chase: Take it easy, take it easy.

[Cuddy’s office.]

[Chase is talking to Cuddy.]

Chase:  Protein C’s side effects we were worried about?  They happened.

Cuddy: Where was the bleed?

Chase: His brain.  It’s causing right side paralysis.  I’ve stopped the treatment.  And called a neurosurgeon. 

[Surgeon is drilling into Alfredo’s head.  Cuddy is watching from the observation deck.  Blood is pooling out from the drilled hole.]

[Alfredo’s room.]

[Cameron is flashing a penlight into Alfredo’s pupils.  Alfredo lifts his right hand and waves it back and forth slowly.]

Alfredo:  I can move it now.  It’s okay now.  Can I go home soon?

[Cameron lowers the penlight.]

Cameron: The surgery went well, but all we did was fix the problem created by the medicine we gave you.

[Mother asks a question in Spanish.]

Alfredo:  She says you look young.  Are you sure you—

Cameron:  There’s five of us working on the case.  [She smiles hesitantly]  The others are older.

Alfredo:  Why doesn’t Dr. Cuddy come to -- 

[Alfredo starts coughing and Cameron reaches for a glass of water.  She hands it to him.]

Cameron:  You don’t sound too good.

[She reaches for her stethoscope.  Alfredo’s breathing is ragged.]

[CSI shot of his lungs.  They are bleeding.] 

[House’s office.]

[Cuddy is studying an x-ray.]

Cameron:  His fingers are even darker, his temperature is 102 and spiking, and the x-ray now shows lung infiltrates.

[House writes “lung infiltrates” across the white board.]

House: The good news is he won’t be bitching about losing his hand if he can’t breathe.

Cuddy:  The trauma from the fall could cause actuate respiratory distress syndrome. 

House:  Right, I forgot.  Your roof.

Cuddy:  It would cause lung infiltrates and maybe fever and conceivably the cyanotic fingers.

House: The only question is why? 

[House shakes out a Vicodin and takes it.]

Cameron:  Why what?

House:  Why her weird psychopathology requires a diagnosis formed entirely by personal guilt.  Let’s assume we’ve been wrong up until now.  Let’s assume, just for one second, that the earth doesn’t revolve around Cuddy’s roof.  What if he was sick before he had his run-in with gravity?  He just didn’t notice anything.

Foreman:  Well, pneumonia can cause DIC, which can cause cyanotic fingers.

Chase:  Pneumonia doesn’t hit that fast.

House:  Sure, only pavement hits that fast.  It’s not pneumonia.  Might have
missed a finger turning dark, he’s not going to miss breathing problems.  What else?

Cuddy [looking at x-ray]:  It’s pneumonia.  He wanted to go home.   I thought he was lying.  I told him I had a dinner party.  I made him go up there.

House:  Well, why didn’t you just take out a gun and shoot him?

Cuddy:  I thought it was just asthma.

House: Might have mentioned this earlier, Doctor.  Maybe we could have sent some blood cultures to the lab, instead of wasting a day indulging your self-loathing. 

Cameron: If it’s just garden-variety bacterial pneumonia, he’s gonna be fine.

House:  So give him garden-variety Levaquin and a garden-variety echo-cardiogram.  And go check out the kid’s house.

Cuddy:  The blood work will show us which type of pneumonia it is, if—

House:  If he’s huffing nail polish, or pulling the wings off his pet parrot, this way will be faster.  I bet Julio is just dying to find out what’s wrong with him.  [nods to Cameron].  Go with her.

Cuddy:  It’s Alfredo.  And I can handle getting a key and—

House:  Rico and I know longer trust you deciding what’s important and what’s not.

[Cuddy stares a moment, then leaves.  Cameron shakes her head, and then follows.]

Foreman:  You ever think about writing a book on office politics? 

House:  Trust me.  It would be a lot worse if I told her you have to break into her house.

Chase:  Wait, wait, wait.  Cuddy’s house?

House:  See, it is shocking.  Guy’s been working there every day for the last three weeks.  Do you think it’s impossible that he could have picked something up?

Foreman: I’m not breaking into my boss’s house.

House:  I’m your boss.

Chase:  She’s scarier than you are.

House:  Oh, she’s a woman.  Relax, I’m coming with. 

[House, Chase, and Foreman step out of the elevator.  House is sucking on yet another lollipop.  They pass Wilson and Stacy.]

Stacy:  House is having lunch with his juniors now?

Wilson: No.  Not a chance. 

Stacy:  Then where do you think they’re going?

Wilson:  I have no idea. 

Stacy:  Then why don’t you think they’re going to lunch?

Wilson: Because it’s not like House.  That was your point, right?

Stacy:  He had that smug look on his face when he’s not pleased about something and he’s got to tell somebody and the only somebody he knows is you.

Wilson [sighs]:  He’s breaking into Cuddy’s home.

Stacy:  What? Why?

Wilson:  Um, medical reasons?

Stacy:  Why is he so curious about Cuddy?

Wilson:  Why are you so curious about his curiosity?

Stacy: Why are you so curious about me being—

Wilson: Because you dumped him.  And you’re married.  And they are neither of those things.

Stacy:  I’m just curious.  Nothing wrong with that.

Wilson:  No, nothing wrong with that.

[Cuddy’s house, exterior.]

[House, Foreman, and Chase walk up to Cuddy’s front door.]

House:  What do you think?  Red thongs?  I think red thongs.  ‘Kay…

[House takes out a credit card.]

House:  Twenty bucks says I can get through this door in twenty seconds.

Chase:  You’re on.

Foreman:  Count me in.

[Chase takes out his watch to time House.  House bends down, moves a planter, and finds key underneath it.  House grins and Chase and Foreman get out their wallets.  House opens the door and Chase and Foreman file in, each handing him a twenty.]

[Alfredo’s home.]

[Cuddy has a hall closet open.]

Cuddy: No furniture polish, no paint thinner, nor anything else worth sniffing.

[Cuddy moves into the kitchen.]

Cameron [calling from another room]: Nothing in here, either.

[Cameron comes out of a bedroom.]

Cameron:  Except a few cockroaches.

[Cameron steps on one with her shoe.]

Cameron: Nice.  [She looks up]  Someone should fix Alfredo’s roof.  So why haven’t you fired House?

[Cuddy looks up from the fridge.]

Cameron:  I mean, it’s just, you guys are always screaming at each other and I figure you hate him—

Cuddy [quick to respond]:  I don’t hate him.

Cameron:  Why not?

[Cuddy just looks at her.]

Cameron: He’s a great doctor, but any other hospital administrator would have fired him years ago.

[Cuddy moves to look under the kitchen sink.]

Cuddy:  Four of them did.  The question is why did I hire him?

[Cuddy’s house.]

Foreman:  So how did you know about her key?  You been doing a little handyman work for Cuddy yourself?

[Foreman walks into the kitchen, where House is examining the contents under the kitchen sink.]

House: Someone as obsessive and insecure as Cuddy probably has three extra keys hidden within ten feet of the door.

Foreman:  Oh, and you consider obsession a negative quality?

House: Insecticide is organic, soap is hypoallergenic.

[House closes the cabinet.]

House:  I got the bedroom.

[House enters and studies the bed.]

House:  This is where it all happens.

[House turns and launches his butt onto the bed.]

[Cameron and Cuddy enter from the hall.]

Cameron:  You both went to Michigan.  Did you know him while you were there.

Cuddy:  Ah, I was still an undergrad, but yeah, I knew him.  He was already a legend. 

Cameron:  So you just knew him as a legend?

Cuddy:  My God, you’re subtle!  Anything else on your mind?

[Cameron looks at her a moment, then bends down to look under a set of bunk beds.]

Cameron: Ugh.

Cuddy:  More cockroaches.

Cameron:  Worse.

[Cuddy bends down to take a look.  She sees a dead rat in a trap.]

Cuddy:  Beautiful.

 

[House opens the dresser drawer, while Chase looks out the window.]

Chase:  There’s no way you deduced where that key was.

[House pulls a pink/reddish thong out of Cuddy’s underwear drawer.]

House:  Does this count as red?

[He throws it at Chase, who catches it, then looks to get rid of it.]

Chase:  You gave yourself twenty seconds, then put money on it.

House:  Oh my God.  She’s got pictures of you in here.

[Chase’s eyes widen.]

House: Just you.  It’s like some kind of weird shrine.

Chase:  You’re kidding.

[Chase approaches the dresser.]

House:  Yeah.

[House shuts the drawer before Chase can see it.]

[Cuddy’s bathroom.]

[House enters and picks up a large tampon box off a shelf.  Chase follows, but stops at the door.]

House:  She uses super tampons.  What does that mean?

Chase:  You two are just too nasty to each other not to have been…nasty.

House:  Hey, I can be a jerk to people I haven’t slept with.  I am that good.

[House bends down to open the cabinet under the bathroom sink. Foreman enters.]

Foreman:  There’s nothing here.  Are you ready to go or you got some more stuff you want to sniff?

House: Whoa.  Check this out.  It’s fuzzy.  It’s black.  It’s alive.

[House reaches a finger out to the pipe under the sink.  CSI shot of the bacteria growing there.]

[House, Foreman, and Chase are walking and run into an excited Cuddy and Cameron.]

Cuddy:  Patient’s lung function is declining rapidly.  Levaquin’s not working.  He obviously doesn’t have garden-variety pneumonia.

House:  I’m glad you learned to take his impending death in stride.

Cuddy:  Guess what he does have.

Cameron: Rats.

House: Scars on his hand…

Cameron: Rat bites.

House: But he says they’re from construction work so he won’t have to admit he’s got rats in the home.  Catholics are right.  Pride will kill you.

Cuddy:  He has Streptobacillosis.

Cameron: Rat bite fever.

House:  Boogy, oggy, oogy.

Cuddy: It fits the symptoms perfectly.

House:  It’s certainly one possibility.  What about the aspergillus fungus we found under the sink?

[Cuddy picks up the x-ray.]

Cuddy: What sink?

[House dumps a tissue in the garbage.]

House:  You ought to clean your bathroom better.

Cuddy: You broke into my house?

House:  No, that would be wrong.  I had a key.

Cuddy:  You had no right to invade my privacy.  There was no medical reason for that whatsoever.  And there was certainly no moral reason for it.

[She looks at the x-ray as she’s talking and notices something.]

Cuddy:  Oh damn.  You’re right.  The focal consolidation makes fungal pneumonia far more likely.

House:  You’re right I’m right.  On the bright side, it has the advantage of keeping you totally responsible.

Cameron:  The treatment for aspergillus is amphotericin.  That’s hugely dangerous.

Cuddy:  Yeah.  Your point being?

House: Going the dangerous and aggressive route didn’t work last time.  It’s bound to work this time.  Start him on the amphotericin.

[Cameron is injecting the new drug into the IV line.  Alfredo is coughing and his family looks on.  There is a close-up of Alfredo’s little brother.]

[Cuddy’s Office]

Brother (Manny):  Dr. Cuddy?  I’m Manny.  Alfredo’s brother.

Cuddy:  Well, how’s he doing?

Manny: He’s worried about money.  I want to work for you.

Cuddy [sighing]:  How old are you Manny?

Manny:  Fifteen.

Cuddy: Twelve?

Manny:  I can paint, mow lawns, I rake leaves.  I can start today.

Cuddy: Alfredo wants you to finish school.

Manny:  Like you care.

Cuddy:  Manny, I have known your brother—

Manny:  He falls off your roof and you don’t come to see him once?

[Cuddy is unsure what to say.]

Manny: Bitch.

[Manny turns and leaves.]

[House is sitting in a chair, his feet propped up on the exam table.  He is twirling his
cane and watching his mini-TV.  There’s a knock.]

House: With a patient.

Door opens.  It’s Stacy.

Stacy:  Not according to the log.

House:  It’s three-fifteen.

Stacy:  Is it a commercial?

[House responds by picking up a soda and sipping it.]

Stacy: How’s Cuddy doing?

House: She’s not acting like Cuddy.  It’s a pleasure.

Stacy:  You know her.  She has trouble with these situations, feels personally responsible.

House:  Technical term is narcissism.  You can’t believe everything is your fault unless you also believe you’re all powerful.

Stacy: [sarcastic] Wow, doesn’t she sound messed up.

House:  I don’t believe I can fix everything.  I don’t lie awake at night tormented by that fact.

Stacy:  No, you lie awake tormented by—

House: We were talking about Cuddy here.

[House starts to get up.]

Stacy:  She cares.

House:  She enjoys feeling guilty.

Stacy:  Lisa cares.  It’s why she drives you nuts.  ‘Cause it’s not just a puzzle to her.  The patients are actually real, their feeling actually relevant.  And I’m telling you, she can’t even talk to him.

House:  My God, it’s contagious.  You’re feeling guilty, too.

Stacy: I’m just saying take it easy on her.  You owe her that.

[House pauses a second.]

House:  Commercial’s over.

Stacy:  So glad we talked.

[House is listening to the chest of the same African-American man we saw with Foreman earlier.]

House:  Snap, crackle, pop.  Got some Rice Crispies in there?

Patient:  That bad, huh?

House:  You were here yesterday.  I see from the chart that Dr. Foreman prescribed medicine, not a miracle.  Got to give this stuff more than a day.

Patient: I didn’t fill that Oreo’s prescription.

House:  On the theory that you didn’t trust him because he’s black…well, I’m going to prescribe the same medicine.  See if you fill it this time.

Patient:  I’m not buying into no racist drug, okay?

House: It’s racist because it helps black people more than white people?  Well, on behalf of my peeps, let me say, thanks for dying on principle for us.

Patient:  Look.  My heart’s red, your heart’s red.  And it don’t make no sense to give us different drugs.

House:  You know, I have found a difference.  Admittedly, it’s a limited sample, but it’s my experience in the last ninety seconds that all black people are morons.  Sorry, African-Americans.

Patient: I’ll see another doctor.

House:  Fine.  Fine.

[House crumples the first prescription and writes another.]

House:  I’ll give you the same medicine we give Republicans.

[House hands the prescription to the patient.  Patient smiles and takes it.]

[Cameron is examining Alfredo’s hand.]

Alfredo:  I think the medicine is working.  There’s lighter, right?

Cameron:  They don’t look lighter to me, Alfredo.  How’s the tingling?

Alfredo: Not bothering.

Manny:  Tell her the other thing.

[Alfredo shoots Manny a look and mutters something in Spanish.  Manny answers in Spanish, insistent.]

Manny:  He hasn’t peed since yesterday.

Cameron [concerned]:  Since last night?

Manny: Afternoon.

Alfredo:  It’s not a problem.  I don’t drink much.

Cameron:  I think we’ll give you a little rest from the meds here.

[Mother asks a question in Spanish.  Cameron looks to Alfredo.]

Alfredo:  She says that’s the medicine that’s supposed to cure me.

Cameron: I’m just making a little adjustment.  Excuse me.

[Cameron leaves and walks out into:]

[House stands outside the room and Cameron approaches him.]

Cameron:  He’s not making any urine.  I think we just destroyed the kid’s kidney with the amphotericin.  I think he’s dying.

[Mother walks out of the room during Cameron’s admission.]

Mother: Dying?

House:  Geez, it’s the cops.

[Mother starts crying and muttering in Spanish.]

House:  Guess she understands a little English.

[Shoot of Alfredo’s room with his family by his side cuts to:]

 

[House, Cameron, Foreman, Chase, and Cuddy are reviewing Alfredo’s case.]

Cameron:  His kidneys are shutting down due to direct toxicity to the proximal tubular epithelium.

Cuddy:  Proof that my brilliant idea of giving him amphotericin is killing him.

House:  That wasn’t a complete waste of time.  His reaction shows that you don’t need to clean under your sink.  It wasn’t aspergilllus.

Foreman: And blood cultures show he was negative for rat bite fever.

House:  There’s still plenty of other cool pneumonias…

Foreman:  Tested negative for Marcella, nocardia, crytococcus…

Chase: He has a low tider for chlamydia.  Antibodies, maybe?

Foreman:  No, no his chest x-ray’s all wrong for chlamydial pneumonia.

Chase:  But the tider points to…

[House gets up and starts to walk away from the table.]

Cameron: He had an STD last year.  That explains the tider.  He has low sodium, maybe it’s legionella.

Chase: No, his antigen is negative.

House:  Well, that all sucks…

Cuddy: Maybe we were right to begin with.  His problems are all caused by DIC precipitated by falling off my roof.

Chase: DIC wouldn’t cause a fever this high.

House:  See my lapdog agrees with me.  How high?

Chase: Two hours ago, it was one-oh-three. With acetaminophen.

House:  What onset abens ob-ay?  Only temperature I’m interested in right now is his temperature right now.

[House walks out.]

[Alfredo’s room.]

[House enters, thermometer in hand.  Manny is standing next to bed talking to Alfredo in Spanish.]

House: Open up.

[Alfredo says something in Spanish to Manny.]

House:  Okay, let me clarify.  Open up and keep it open.

[Alfredo and Manny exchange a few words in Spanish.]

Manny: Okay.

[Manny leaves.]

House: Under your tongue.

[Alfredo takes the thermometer with his left hand and places it under his tongue.]

House: You’re using your left hand.  Right one hurt?

Alfredo:  No, I feel better.

House:  It really doesn’t hurt?  Or you just figure if you no you’ll get out of the hospital sooner?

Alfredo [insistent]: Doesn’t hurt.  Feels good.

[House sniffs.]

House:  You don’t smell too hot.

[House grabs Alfredo’s right hand.  Alfredo gasp, sits up, and drops the thermometer.]

House:  Your hand is starting to rot.

[Stacy’s office.]

[House and Cuddy are standing in front of Stacy, who is seated at her desk.]

House:  Why are we here?

Cuddy:  We’re talking about cutting off a kid’s hand.

House:  Yes, we’re talking about cutting it off, not subdividing it and putting in condos.  It’s not a legal issue.

Cuddy:  Are you being intentionally dense?

House: Huh?

Cuddy:  I think it’s premature.

Stacy:  I’ve heard enough.

House:  What?  She says one word and you take her side.  You should wait until she at least gives a medical reason.  Otherwise I might take it personally.

Stacy: Shut up.  If I were to somehow find out that you two are in disagreement over the proper medical course of action, it could make it awkward for my client in court.  My client being the two of you.  So guys, I’m a little busy here.  Why don’t we pick this conversation up in half an hour.  K?

[Hallway outside Stacy’s office.]

Cuddy:  All of his symptoms are caused by his underlying problem and the medicine we gave him.

House: What underlying problem? You have no idea what the underlying problem is.

Cuddy:  You’re the diagnostician. 

House: Fine.  It’s all my fault.  Does that make you feel better?

Cuddy: His hand still has an arterial pulse.

House:  His hand is a cesspool.  And the crap is spreading. 

Cuddy:  You are being pretty aggressive about destroying a man’s livelihood.

House:  Don’t give a damn about his livelihood.

Cuddy:  He lose that hand, he loses his job.  All of his jobs.  He’s not like us.

House:  He can’t work as a cripple?

[Cuddy is shocked by that statement, but recovers.]

Cuddy:  He loses his home, his kid brother drops out…

House:  American dream destroyed.  Very sad, very emotional.  Not one medical fact in the whole pathetic tale.  You’ve lost perspective, Cuddy.  You’ve stopped looking at this as a doctor.  You’re acting like someone who shoved somebody off their roof.  You want to make things right? Too bad.  Nothing’s ever right. 

[Stacy’s office.]

House:  I’m happy to report that we’re now so in synch we’re actually wearing each other’s underwear. Chop, chop time.

Stacy:  Is this true?

House:  No, I’m lying.  Stupid to do with her in the room, I guess.

Stacy:  This is a big decision.

House: We made it.

Stacy:  We should convene in a meeting of the ethics committee.

House: NO!  [throws hands up].  Look.  She is making a medical decision based on never wanting to feel regret.  You’re making a legal decision on wanting me to be wrong.

Stacy:  Greg, you have a history of –

House: You wanted superficial agreement.  You wanted everybody’s asses covered.  You got it.  Now can I do the surgery?  Pretty, pretty please? [Stacy looks at Cuddy.]

Stacy:  Lisa?  Are you sure you’re okay with this?

[Cuddy takes a second to reply.]

Cuddy:  I should be the one to tell the family.

[Cuddy exits.]

[Alfredo’s room.]

[Alfredo’s mother is standing by his bedside as Cuddy speaks.]

Cuddy:  Your hand is dying.  The bacteria are eating it.  When they run out of food there, they go somewhere else. 

Alfredo:  If you cut off my hand, I’ll be cured?

Cuddy: Unfortunately, no.  We still have to find the disease that’s making you sick to begin with.  But you won’t die of gangrene while we’re looking.

[Mother looks like she is going to cry,]

Alfredo: I quit school when I am twelve to get a job.  To help my family.  I know I never get a good job, never save money, or own my own house like you.  But Manny, he’s smart.  The best in his class. 

Cuddy:  Well, maybe Manny doesn’t have to quit school.  Maybe you can…

[Alfredo shakes his head.]

Alfredo:  Are you sure I need to do this?

Cuddy: Yes.

Alfredo:  Okay.  Okay.

Alfredo’s room.  Later.

[Alfredo’s mother is singing to him in Spanish. Scene shifts to:]

 

[Alfredo is in surgery.   Once again, Cuddy is watching.  Mother’s singing can still be heard.]

[House’s office.]

[House is staring at the white board and twirling his cane.  Foreman enters.]

Foreman:  I gave one of my clinic patients a follow up call.  Your name came up.

House: I’m guessing an old black guy that thinks the CIA invented rap music to made your people want to kill each other.

Foreman:  He says you gave him the white folks’ stuff.  This is exactly why black people don’t live as long.

House:  This isn’t about race. Unless annoying is a race.  Is he not getting better?

Foreman: He’s fine so far.  I’m calling him back in.  I’m getting him on the right stuff.

[Foreman starts to walk away.]

House:  Oh, relax, Foreman.  He already is.

[Foreman stops and turns, confused.]

House: I told him it was the white stuff.  I gave him the black stuff.

Foreman [shaking his head]:  He was right.  You did exactly what white people do.  You figure we don’t need to know the truth or can’t understand it.  So you just lie to us.

House: It’s just a white lie.

Foreman:  Good one, Master.

House:  Right, I’m a racist.  Too bad that idiot will never know for the rest of his long, long life.

Foreman:  Every slave master thought they were doing the black man a favor.  Negro can’t take care of himself, so we’ll put him to work.  Give him four walls, a bed.  We’ll civilize the heathen.  I’ll tell you what.  Stop don’t us favors.  If you’re right and we end up back in the jungle with lousy blood pressure medicine, it won’t be on your head.

[Foreman leaves.] 

[Alfredo’s surgery is in progress.  They are about to detach the arm.   Chase is present and notices something on the other hand.  Cut to:]

 

[Cuddy still watches as the surgeons finally remove the hand. Stacy enters.]

Stacy:  You okay?

[Cuddy looks at her, but doesn’t answer.]

Stacy:  Wondering if you made the right call?

Cuddy:  I wanted to be a doctor from the time I was twelve.

Stacy:  I wanted to be a lawyer from the time I was six until my second week of law school.  Sorry, your story.

Cuddy:  I graduated medical school at 25, pissed off that I was second in my
class.  Chief of Medicine at 32.  Second youngest ever, first woman. 

Stacy:  Sad story.

Cuddy:  If I had been Alfredo’s doctor—

Stacy:  You are his doctor.

Cuddy:  I insisted on giving him Protein C.  We had to cut his skull open.  I insisted on amphotericin; killed his kidneys.  I missed the pneumonia.  Completely.  I would have searched his house and ignored mine. I would have watched him die, trying to save his hand.  [closes her eyes]  Oh, if I didn’t have House looking over my shoulder…[she shakes her head]

Stacy:  You say you’re not as good a doctor as House is?

Cuddy:  I’m saying House is right. I’m so anxious to get ahead I haven’t been a
doctor.  In years.

[Chase enters.]

Chase:  His middle finger is dusky.

Cuddy:  Yeah, that’s why we’re doing this. 

Chase:  No, I mean the other hand.  The one we haven’t chopped off yet.

[Alfredo is still getting worse and now has a pressurized oxygen mask attached to his face helping him breathe.  Cuddy lifts his other hand.  The last two little fingers are quickly turning dark.]

[Chase, Cameron, and Foreman are sitting around a small table.  House is laying across a couch.  Cuddy puts a piece of paper in front of Cameron.]

Cuddy:  His O2 stats are down to eighty-eight.  His lungs are giving out.  He needs a ventilator. 

[Cameron picks up the paper and looks at it.]

Cameron:  And dialysis.

House: I’m getting distracted by the multi-system organ failure.  Pinkies are supposed to be pink, right?  They’re not called grayies. 

Cuddy: But the organ failure is gonna kill him.

House:  But the pinky is weirder…[sits up]  What does it tell us?

Foreman:  Same thing the right hand told us before we cut it off.  It’s the same symptom.

House: But at a different time.  His blood work indicates mild DIC.  What if it’s mild in the way you get out of the ocean, the water clinging to your body makes the sea level drop.  It’s technically true, but completely irrelevant.

Foreman:  Well, the lack of DIC would explain everything if there were also a lack of anything to explain.

House:  Endocarditis.  His heart’s infected.

[CSI shot of Alfredo’s heart.]

House:  Little bacteria cauliflowers clinging to his bowels.  Except something they can’t hold on.  They go swimming in his bloodstream.  Thursday, one breaks off, goes to his right hand.  Black fingers, gangrene.  Friday’s child heads for the kidneys.  We all know what Saturday’s are all about.  Party with the left hand. [Also explains the fever.]

Cuddy:  It’s perfect.  Except for the little fact that we’re already tested for endocarditis and he was negative. 

House:  Which either means he is negative or what infection could cause pneumonia and culture negative endocarditis?  Prize value goes down with every clue.

[House squawks like a bird twice.]

Chase:  You’re thinking citicosis?  Alfredo doesn’t have any pet parrots.

House: Which are squawking.  Give him doxiciclean. 

Cuddy:  No!  That will just make his clotting problem worse.

House:  I liked you better when you were coming up with wacky drugs for us to try.  We give him the doxeen now, damnit, maybe we can save his pinky.  He can teach his brother how to count all the way to five.

Cameron:  If you’re wrong, he’ll end up with no hands and no feet.

House:  Technically, if I’m wrong, he’ll end up dead.  But I take your point.  What’s his night job?

Foreman:  He cleans up at some fast food joint.  Why?  Do you think he got it from a chicken nugget?

House: Since when do fast food joints allow twelve year olds to mop floors?

Cuddy:  Alfredo is twenty.

House:  Really?  Looks younger.

[Alfredo’s mother is sitting by his bedside.  House enters.  Cuddy is three steps behind him.]

House [to Alfredo]:  Where were you going to work tonight?

[Alfredo can’t answer.  He’s unconscious.]

House:  What job do you do on Saturday nights?

[House opens a draw and pulls something out of it.]

Cuddy:  What are you doing?

[House opens a syringe.]

House:  Wake him up.

Cuddy:  We just cut off his hand.

House:  Yeah.  We need to talk about it.

[Cuddy grabs the syringe.] 

Cuddy:  It’s not happening.

[House sighs and starts questioning the mother.  In Spanish.]

House [to Cuddy]:  Honest, I have no idea what I just said.

Cuddy:  Why didn’t you say you spoke Spanish?

House:  Well, because, she’d want to talk to me.

[House questions the mother again in Spanish.]

House [to Cuddy]:  Or something like that.

[Mother answers.]

House:  She says he doesn’t work Saturday nights.  Give me the talking juice.

Cuddy: The fact it doesn’t fit your theory doesn’t make it a lie.

House:  When she was out of the room, the kid brother insisted he was going to cover for Alfredo at work tonight.

[He asks the mother another question, yet again in Spanish.  She answers and House doesn’t like the answer.]

House:  Saturday nights he goes dancing.  Either it’s a lie or he’s dancing with birds.

[House tries again to ask the Mother where Alfredo goes.  She has no clue.]

House:  Give her the talking juice.

Cuddy:  She doesn’t know what you’re talking about.

House:  Odds are, it’s going to be close to his house. Probably an abandoned warehouse or factory.  Take the Scooby gang and spread out.

Cuddy:  What the hell are we looking for?

House: Find somebody who looks like crap, tell him you want to place a bet. 

[Cuddy turns back to bed.]

Cuddy:  Ah…

House:  Sayonara!

[There are a lot of people and Spanish music plays in the background.  Cuddy and Foreman enter and find a ring and people holding fistfuls of cash.  It’s a cockfight.   Cuddy and Foreman exchange a look.  Another minute passes when Cuddy spots Manny, picking up the dead chickens.  Cuddy shakes his head and they leave.]

[House is tossing two balls into the air with one hand.  Wilson sits in a chair.  A cell phone rings.  Wilson picks it up and looks.]

Wilson:  It’s Cuddy.

[House takes it while still throwing the balls in the air.]

House:  I already put him on the citicosis meds.  Soon as you left. You’re welcome.

[He hangs up and stops tossing the balls.]

House:  What do you think the record for one handed juggling is?

Wilson:  You can yo-yo one handed.

House:  Good point.

[House starts to juggle again – this time with both hands.]

Alfredo:  I always wash my hands.

Cuddy:  If a bird is infected, you can get citicosis just by breathing his dust.

Alfredo:  Then why do I get sick and nobody else.

Cuddy: Your asthma made you venerable.  You’re gonna be all right now.

Alfredo [softly]: Yes.  Gracias. 

[He lifts his left hand to shake Cuddy’s hand.  Cuddy takes it and squeezes.] 

Alfredo:  For saving my life.

[Cuddy’s office.]

Cuddy:  He thanked me.

Stacy:  He should have.

Cuddy:  We cut off his hand.  If we’d figured it out earlier—

Stacy: If you figured it out later, he’d be dead.

Cuddy:  I never figured it out at all.

[House enters.]

House: Hello.

Cuddy:  What do you want House?

House:  if you’re wallowing in self loathing, I’ve got something that might help. 

[House takes out a bundle of papers.]

House:  We’re getting sued.

Stacy [surprised]:  You saved his life.  He admitted that.

Cuddy:  We’ll settle.  He’s got a stub where his hand used to be.  We have insurance.  Case seems pretty solid to me.

House: Ca-ching.  The new American dream.  Happy ending.  Kid’s gonna be just fine.

[House starts to leave, but pause just in front of the door. ]

House:  Cuddy. 

[He turns to face Cuddy again.]

House: Your guilt.  It’s perverse, and it makes you a crappy doctor.  It also makes you okay at what you do. 

Cuddy:  You figure a perverted sense of guilt makes me a good boss?

House:  Now would the world be a better place if people never felt guilty?  Makes sex better.  [points to Stacy with his cane]  Should have seen her in the last months of our relationship.  Lot of guilt.  Lot of screaming.  I know this wasn’t just because it was your roof.  Cuddy…you see the world as it is and you see the world as it could be.  What you don’t see is what everybody else sees.  The giant, gaping chasm in between.

Cuddy: House, I’m not naïve.  I realize—

House:  If you did, you never would have hired me.

[Cuddy doesn’t answer.]

House:  You’re not happy unless things are just right.  Which means two things.  You’re a good boss.  And you’ll never be happy.

[House starts to walk out again.]

House:  By the way, why does everybody think you and I had sex?  Think there could be something to it?  I don’t know.

[House opens the door and leaves.]

[House’s office.] 

[First shot is the exterior revealing a balcony, looking in at House and Wilson.  It’s pouring.] 

Wilson:  Cuddy feels guilty about not diagnosing citicosis.

[Cut to inside the office.  House is playing with a yo-yo.]

House: Think so?

Wilson:  There’s no way she could have.

House:  No.  No way she could have.

[House turns and looks out the window.]

House:  It’s raining.

[Alfredo’s room.]

[Alfredo lifts the stump where his hand used to be and touches it, thinking.]

[Cuddy’s house.]

[Rain drips from the roof and pounds the dining room table.  Cuddy takes a pot from the kitchen and puts it under the drip before heading to bed.]