Hey, did you guys know that House is on Mondays now? This week Cameron takes over PPTH as Cuddy struggles to bond with baby Rachel, Foreman debates crossing ethical and legal grounds in his Huntington's study, and the team treats a Special Ed teacher who never gets annoyed with her kids. Clearly, there is something wrong with her.
This week's patient is Sarah, a special ed teacher with a whole lot of patience. She's brought to PPTH after coughing up blood and collapsing in her classroom. The scope test showed that her lungs and stomach were clean but she continues to spit up blood from both her stomach and lungs. Foreman thinks she must have some kind of problem with her blood but Thirteen thinks she has a tumor. House thinks Thirteen's idea is stupid and she is just disagreeing with Foreman to cover up the fact that they're doing it. So the team heads off to run some blood tests.
While they are running her blood tests, Kumar and Thirteen discover that Sarah is the sweetest person alive. She talks about 'going to her happy place' during the painful tests and seeing the world through the eyes of her special ed kids. Kumar and Thirteen decide that they can't let House anywhere near her. The tests show that her blood has problems clotting.
But her clotting problems are not anything to do with the proteins in her blood, but the platelets. Kumar suggests that she might have ITP, a blood condition of having low platelets with no known cause (thanks, wikipedia!) that is easily treatable with autoimmune meds. House on the other hand wants to put her on total body irradiation (the thing they do to prepare you for a bone marrow transplant). Which is overkill, to put it mildly ("premature, reckless and potentially lethal" if you ask Kumar).
House never intended to put his patient through total body irradiation, but when Cameron calls his bluff and gives him permission he has to go through with it so he won't lose face. Thirteen suggests they pretend to perform the procedure: take Sarah through the prep and even down to the lab and then just don't turn the machine on. Aren't you glad these people are entrusted with the saving of lives? As they are performing the fake procedure, Sarah asks if she can get up to go pee, and then goes into cardiac arrest.
The good news for Sarah is that the heart attack is a new symptom. It rules out the ITP, and forces the team back to the drawing board. Thirteen thinks that Sarah's body might be reacting to cold temperatures by making a toxin that creates heart attacks? I'm not sure, the theory doesn't really make any sense to me but they cart Sarah off to put her in an ice bath to see if Thirteen's right.
As per Cameron's instruction, House has to supervise the test. As she's shivering in the ice bath, Sarah talks about her special ed kids and how wonderful they are, and how she always tries to let them become a part of her and her become a part of them. It's all very sunshine lollipops and rainbows as she tells Kumar how she accidentally went to the wrong classroom back when she was supposed to be observing a class in college (she mixed up the numbers) and ended up falling in love with special ed kids. When the test is over, it turns out she doesn't have problems with her heart but House thinks that she has something wrong with her brain.
House thinks that Sarah's number mix-up from a few years ago and her forgetting to pee before the fake nuclear procedure indicates there is something wrong with her brain's left hemisphere. House thinks she has MS, Kumar ignores the supposed brain symptoms and thinks it's a pancreatic tumor. House wants to do a brain biopsy to confirm. Kumar wants to do an ERCP.
Cameron won't let House do a brain biopsy without doing an MRI first, so in the meantime Kumar decides to do his ERCP. The problem is that both tests come back negative. House insists that Sarah's lungs will be the next thing to go because he still believes she has a brain problem. So when her lungs do start failing Cameron approves a nerve study of Sarah's brain. Basically they cut into her skull so that they can map out her brain function. Yikes!
When Cameron approves the procedure, Kumar is completely incensed. He thinks House is taking unnecessary risks and that Cameron is just an enabler. So Kumar calls Cuddy during the procedure. Cuddy is having a crisis of her own at home and can't get her baby to stop crying. When Kumar puts her on speakerphone the baby crying and Cuddy yelling really annoys Sarah. In fact it seems like it's the first thing that Sarah has ever found annoying, ever.
As her brain is processing the annoyance, and her blood pressure starts to drop, House notices that there seems to be a connection between Sarah's blood pressure and her brain function. When he is holding Baby Rachel, House has an epiphany: Sarah has a birth defect in her heart. It's called Patent Ductus Arteriosus, and essentially a part of her heart that was supposed to close after birth didn't. So now when she gets stressed and her blood pressure rises, the ductus is forced open and lets blood leak into other parts of her body, most noticeably it keeps the blood from flowing to the left side of her brain, and she doesn't get annoyed. The good news is that surgeons can fix Sarah's heart. The bad news is she's probably going to get annoyed more easily.
Cuddy is having problems with baby Rachel. While she has no problems feeding her and physically taking care of her, Cuddy has not formed any emotional attachments to Rachel whatsoever. She confides in Wilson that she just doesn't feel anything, because the baby cries, eats and poops and that's about it. Truth be told it's a really intense scene between the two of them, and one of the those moments when you can see that that Cuddy is a real character, not just House's I-hate-you-but-secretly-I-love-you sparring partner. She assures Wilson that Rachel will be ok, she's not so depressed that she's going to stop feeding her or anything. But will Cuddy be ok?
Wilson is understandably worried about Cuddy, but unfortunately for Cuddy he confides in House about it. House very matter of factly reminds Cuddy that she hasn't legally adopted Rachel yet, so she could essentially just give her back if she wants to. "It's much better than having a mother who doesn't give a crap!" he tells her. Nice.
Cuddy again goes to Wilson, telling him that she actually thought about what House said. She acknowledges that Rachel deserves to be loved and that she's not quite sure if she wants to make the sacrifices that parents have to for their children. Oh boy. Maybe she should have considered this before she took the baby.
In a very sweet and somewhat hilarious gesture, Wilson brings Cuddy a picture that he tells her is from one of those photo places that do age enhancements. It's supposedly an approximation of what Rachel will look like when she's 18. He tells Cuddy to try and think ahead to when she's get to really know Rachel: the things she likes, the things she hates, watching her grow up into a real person. Cuddy doesn't feel any different and tells him she'll pay him back for the photo. "Don't worry about it, it's just the picture that came with the frame, you can chuck it." He tells her. Haha!
In the end, Cuddy and Rachel have a little breakthrough moment when baby responds to Cuddy's voice. After deciding that she will keep her after all because they have bonded, Cuddy brings Rachel in to visit House and prove how wrong he was. There is a cute little moment where Cuddy makes House hold Rachel and he's awkward and unimpressed with the baby and I'm sure that Hugh Laurie fans the world over are swooning.
At the end of the episode we see Cuddy, racing off to work. She leaves a crying baby Rachel in the care of a nanny and the look on her face as she runs out the door is heartbreaking. She definitely feels something now.
Who's the Boss?
Cameron is filling in for Cuddy this week, and House of course needs to test the boundaries with her. He starts off by asking her to approve an outrageous and dangerous procedure. She says yes, much to House's amazement. Cameron tells Cuddy later that she only said yes because she knew House was testing her. Score one point for Cameron.
House's next procedure that needs approval is giving his patient an ice bath, which could potentially trigger a heart attack. Cameron tells House he can give her the bath if he does more blood tests to confirm his theory first. By this time the team has caught on that Cameron played House, and frankly they're impressed. Score two points for Cameron.
Cameron's next big decision is much more difficult. She must mediate between House who wants to do a dangerous brain biopsy on the patient and Kumar who wants to do a less invasive pancreatic procedure. Cameron wants to assume House is right because he usually is, but she won't let him do the brain biopsy without doing an MRI first. House says he won't do the test and that Cameron is just trying to prove she can stand up to him. Cameron narrows her eyes very authoritatively and tells him: "Do the MRI." It's very impressive. Score three points for Cameron.
Finally House comes to Cameron seeking permission to do a neural map. They argue through all the medical reasoning until finally Cameron says: "What do you want me to do, say yes because you're House!?!" To which House replies that he'd like that. Cameron caves and says yes. Score one very big point for House.
The procedure does not go smoothly, and in the end it turns out that House was wrong about her brain. Cameron feels guilty for risking the patient's life and trusting House blindly. She approaches Cuddy and tells her that she is not cut out to do the job because she will always trust House and in the end won't ever be able to say no to him...thus proving that the House always wins! (Terrible, I know. I couldn't resist).
After accidentally finding out last week that Thirteen is getting the placebo treatment and not the actual drugs in the Huntington's study, Foreman debates switching her medication without telling anyone. Chase and Cameron both advise him against it, with Chase pointing the obvious risk to the drug trial and Foreman's medical license and Cameron re-iterating Chase's main point of: "Don't be an idiot."
Foreman is mostly convinced that he can't tell Thirteen she isn't getting the real drugs. But then they go to the patient's school together to check for possible environmental causes of her illness, and Thirteen announces that she wants kids. Foreman gets this look on his face that is fairly appropriate for his girlfriend of two episodes telling him she wants to have kids. If this were a cartoon, there would be a Foreman-shaped hole in the wall. But the possibility of a future with Thirteen makes Foreman re-evaluate whether or not he should switch her meds.
Since Chase and Cameron both gave him the answer he didn't want to hear, Foreman goes to House as a very last resort (side note: aren't doctors bound to some sort of confidentiality agreement?). House gives him his objective opinion: changing Thirteen's meds will compromise the drug trial, the results and quite probably Foreman's medical career all to buy Thirteen a few more years. On the other hand...House says: "If you love her..." and doesn't say anything. Somehow I think that House was testing Foreman, rather than giving friendly advice.
In the end Foreman does decide to switch Thirteen's meds without telling her or anyone else. I have a hunch this is not going to end well.
Cuddy: "I'm familiar enough with this woman's case to know that cutting into her brain is not necessary."
Sarah: "Is she serious!?!"
House: "She certainly isn't funny."
(Rachel just threw up all over House)
House: "Is that cute?"
Cuddy: "A little."
House: "If I threw up on you, you'd be pissed."