Welcome back folks, House kicks off 2009 with a case that has a lot of similarities to his own. Meanwhile Cuddy struggles to balance her job with new motherhood, and Thirteen and Foreman continue their blossoming romance.
This week's patient shares some eerie similarities with House. Jeff is thirty-two and has been in constant pain for years. When we meet him, he is in the middle of writing his suicide note to his wife and young son. They come home from hockey practice to find him mid-suicide attempt, in the garage with the car running.
Cameron gets House to take Jeff's case by doing his year-end finance report for him. She presents the case that began with abdominal pain and symptoms that come and go but with pain as a constant. He has seen seven different specialists in the last three years with no diagnosis.
Thirteen figures that Jeff must have fibromyalgia, but Cameron shoots that idea down because a diagnosis that provides no explanation or cure is not a diagnosis. Zing! Taub thinks that Jeff's pain has got to be psychological, so he goes off to do a pain profile to rule out psychosomatic pain. House sends Thirteen and Foreman off to search Jeff's home.
Through the pain profile, Taub finds that Jeff has a lot of similarities with House, particularly that talking and interacting with others sometimes makes his pain worse. Jeff's wife says that he still stays positive, but not optimistic about his condition. Jeff tells Taub that he prays for strength rather than hope. Taub's conclusion is that Jeff is in pain because he's depressed. But House thinks he is depressed because he's in pain.
During the home inspection, Thriteen finds Quail meat in Jeff's fridge and figures that it is toxic, and is the cause of all of his problems. Taub points out that the chances of Jeff having food poisoning every day for the last three years are pretty slim. House lets her treat him for the food poisoning mostly because he doesn't want to put Jeff on anti-depressants, which was Taub's suggestion.
As Thirteen starts to treat Jeff for food poisoning, his heart starts to fail. He now has a pulmonary embolism, and House orders to the team to check his chest, abdomen and pelvis for tumors. Taub and Kumar find an adema in his diaphram, and air in his blood vessels, which could be the cause of all of his pain and also heart failure.
The team is very proud of themselves, believing they have come up with a diagnosis, but House is not convinced. Not all of the symptoms add up. When House finds teeth marks on Jeff's IV tube, they realize the air bubbles in his bloodstream were self-inflicted. As House confronts him, Jeff begs to be allowed to die. He does this right in front of his wife and son. But House says 'No.' and walks away. Are doctors really allowed to do that?
In a pow-wow at Cuddy's house (she is changing a diaper and can't be bothered with differentials at work), Foreman comes up with a glycogen storage disease like McArdle's Disease. Which would explain the pain and the adema that Taub and Kumar found in his intestine.
During the test for McArdle's disease, Jeff's pain jumps around from his arms to his legs. Taub thinks that this might indicate a neurological problem. House wants to separate Jeff's central nervous system from the rest of his body, so they can tell if the pain is real, or if it's coming from a problem in his brain. A shot of lidocaine right into his brain stem should do the trick. Amazingly, Cuddy actually lets House do this.
During the surgery House and Jeff have a little heart to heart about handling pain. Jeff tells House that the only reason he can handle it without thinking about suicide is that he doesn't have a family, or people who count on him. He doesn't have to pretend or watch what his pain does to people he loves. The procedure shows strange results. Jeff's pain doesn't completely go away, but it is significantly reduced. The team is completely stumped.
Before they have time to figure out the mystery, the team get a page that something has happened to Jeff's son. He is on the floor in the hallway writhing and screaming in apparent agony. But...he's faking and House realizes that he is trying to help his dad commit suicide by distracting the nurses long enough for him to drink a bottle of cleaner. Three suicide attempts in less than a week, I'd say this guy is determined.
House's next theory is that Jeff's body might be misreading his pain killer medication to cause pain, so the drugs that are supposed to be helping him are causing his illness. House orders the team to take Jeff off all his pain medications and detox to allow his system to re-calibrate.
At this point, Jeff's family is completely fed up. His wife petitions House to let her take Jeff home so he can die in peace. House has no more ideas, and the pain medications are not what is causing the illness, so House finally agrees.
But..as House notices his plumber scratch his balls he has an epiphany: Jeff has epilepsy, and it's totally curable. The epilepsy has spread to the sensory region of the brain and rewired all of Jeff's pain neurons. It has also not ever shown up on any of the scans because it is in a region too deep in the brain to be picked. But the good news is, Jeff is going to be fine!
Twice on the Pipe if the Answer is No
House is having even more problems with his leg than normal, and it's compounded by problems with his plumbing. One of the water pipes in the house bursts right over House's bed. It's very dramatic. When the plumber comes to inspect, he tells House that the pipe is not rusted through, so therefore it is not covered under warranty. It's going to cost $2200 to fix it.
House goes through a lot of trouble so that he won't have to pay this plumbing bill, including setting a fire in his own kitchen and sending an angry email using a lawyer's name (not his lawyer, mind you...and he almost gets sued for that one). In the end House bribes the plumber to lie on the insurance claim so that he'll get his pipes fixed for free. Never mind that he is paying the plumber more to lie than he would to just fix the darn pipes...it's the principle of the thing.
Cuddy is struggling to balance her job and being a foster mom to little Rachel. The social worker comes to visit Cuddy and does the world's least thorough job of a home inspection. He claims that even though her house is a mess and she obviously is struggling to balance her workload and being a mom, he can still tell that she will be fine with the little baby. Apparently it's fine if you have sufficient income and care enough to be embarrassed about your house being a mess. He tells her he'll see her next year, if she hasn't adopted Rachel by then.
When Wilson comes over to congratulate Cuddy on her new little bundle of joy (bringing with him the world's largest stuffed duck), she is less than thrilled. She passed the social worker's home inspection, but not to her own standards. Wilson tells Cuddy that she needs to realize that she's not superwoman and can't do everything all by herself. He reminds her that most men in her position would have an Associate Dean of Medicine and personal assistant helping them out. It's ok to ask for help sometimes. Are we sure Wilson isn't a psychiatrist?
The episode ends with Cuddy asking Cameron to take over her job for a little while. Cameron has experience dealing with House, and can handle saying no to him and all of his neurosis, so she is the best candidate. Here's hoping that Cameron has the skills to handle the rest of the hospital too.
Thirteen has been avoiding Foreman since they kissed. She is freaked and won't go for dinner with him, but it's not that she's scared of him or doesn't like him. She admits to Foreman that she likes him and doesn't want to 'drag him down with her'. Not one to take rejection, Foreman switches the patient appointments around so that Janice is right before Thirteen. He hopes that when she sees Janice's progress she will be filled with hope for her future and want to go out with him. The good news is that it works. The bad news is that Foreman accidentally finds out that Thirteen is one of the control patients in the study...she is just getting plasma, not the new Huntington's meds.
Jeff: "You don't have a family do you?"
House: "No, I left them all back on Krypton."
House: "Come on, you're from one of the twelve tribes, you must know a ton of scheisters."
Taub: "What type of lawyer do you need? I'll bring it up at the next world domination sub-committee meeting."
You forgot to mention that in the end of the plumbing drama, House discovers that it actually IS his fault that the pipes broke - he used the pipe near the tub to get in and out... he takes baths often to help his leg pain. This was like, my favorite part of the episode, because House finds out that after SO LONG of thinking he was right about this, he was actually wrong and it WAS his fault. His facial expression is priceless.
Also, I loved when House called Foreman and Thirteen together "Fourteen"!!! I was like "YES, Sarah totally called it"!!!
Haha, I did forget to mention that part, whoops!
But I am so on the ball, otherwise.
Oh man, Jo... I totally did not catch EITHER of those things. Thanks for explaining, because both moments confused me. (YES, "Fourteen" confused me. Shut up! I wasn't entirely focused on the show when it was on.)
Wait, *I* caught something that Ariana AND Sarah didn't??
CALL THE PRESSES!
K wait a sec... epilepsy isn't curable, is it? I think it's just treatable.
That Taub quote is hilarious; good call.
Taub is actually growing on me, surprisingly. I find him the most interesting out of the new three. Whoa!