This week, the team must diagnose the 21 year old star of the New York City ballet. House finally opens up to Wilson about his hallucinations and the two of them work together to diagnose the good doctor.
This week's patient is Penelopy- the 21-year-old star of the New York City Ballet. She collapsed on stage after her ballet dancing boyfriend (what is the male word for ballerina, anyway?) failed to keep her aloft. Now that she's in the hospital, her lungs keep collapsing despite a chest tube. She has no tumors, no sign of trauma and no STDs.
For most of this diagnosis, House is fairly useless as he's trying his best to ignore his hallucinations. Initially, he poses that dehydration could hide an infection (a suggestion from Cutthroat Bitch). So the team heads off to re-hydrate and give her some antibiotics for any infection she might have.
When Penelope doesn't respond to the antibiotics, House recommends the team try something he calls transtracheal aspiration. For the first time, wikipedia has totally failed me so I have no idea what this test is (or if it's actually a theory, disease or diagnosis), but it involves Foreman cutting a hole in the patient's throat and sticking a tube down it. It doesn't really matter though because as Taub is trying to hold her down for the test, her skin starts coming off in his hands.
So you'd think that losing 80% of her skin would be a new symptom, right? Wrong. House is convinced that he caused it by prescribing antibiotics before confirming and infection. House thinks the skin loss was caused by toxic epidermal necrolysis and has nothing to do with Penelope's underlying condition. The team did find a mass in her liver that they think is cancer but they have to do a biopsy to confirm and they can't because her skin is still healing and too thin to cut through.
House has Foreman do a trans-jugular liver biopsy (which sounds horribly painful). It comes back negative for cancer, but the procedure put the patient into heart failure. They can't do an MRI on her heart because it's moving so obviously the images will be too blurry. House gets a crazy idea (from crazy hallucinated Cutthroat Bitch) that they should stop her heart so that they can MRI it. Thirteen reminds everyone that they can only leave her heart dead for three minutes before permanent damage sets in.
The team gets most of the way through the MRI of her heart, but just as Foreman spots a shadown on her aorta, Chase interrupts the scan to restart her heart. They were over the three minute line and he was the only doctor in the room not willing to kill the patient in order to diagnose her. And then House has an epiphany (all by hisself): the ballerina has the clap and it disseminated into an abscess heart. Gross. They can't test Penelope but they test her boyfriend and sure enough, he's got the disease.
But they can't operate to remove the abscess because the gonorrhea infection has made her septic. The team (working sans House now) decides to try giving her dopamine to close her blood vessels to stop her from bleeding out. The dopamine allows Chase to go in and repair the abscess in Penelope's heart, but during surgery one of the nurses notices that Penelope's fingers and toes have started turning black.
It appears that the dopamine caused the blood vessels in Penelope's heart to constrict and now gangrene has developed. Chase wakes her up from surgery to tell her the bad news that they need to amputate her hands and feet, but Penelope says no. She's a dancer and she'd rather die than lose her feet. So the team goes back to the drawing table and gives Penelope vasodilators to widen her blood vessels and try to reverse the damage done by the dopamine. It's a long shot, but it miraculously works. It appears that Penelope is going to be ok- is it me or did this girl almost die about 8 times. This is one of those episodes where I really wasn't sure if she would make it or if they would turn it into some dramatic death/House failure. Well, good for her.
The Bitch is Back
House finally lets Wilson in on the secret that he is hallucinating- but he tells him that he's seeing Kutner rather than admit his hallucination is Amber. He asks Wilson to sit in with him on the diagnosis and get him to help run a bunch of tests on himself to determine why Cutthroat Bitch is following him around all day long.
The first test they run is to see if House has sleep apnea. After spending a night in the sleep lab with no results, House comes up with the following list of possible diagnosis for his hallucinations:
· Vicodin addiction
After his patient starts losing all of her skin. House feels guilty, but he doesn't have any reason to. So he thinks that he either is feeling the emotion or there is something wrong with the limbic region of his brain. After he apologizes to the patient and feels nothing, House is convinced that he has MS. Wilson asks if he wants to do an LP test to confirm or if guilt is enough to start prescribing medication. The LP comes back negative, which only leaves Schizophrenia or the Vicodin addiction.
Wilson goes over the options with House. If it is psychosis then he could either go on anti-psychotics, which would mean he has to stop practicing medicine, or he could get electroshock therapy. House will not consider living without pain medication.
Before he puts himself through electroshock therapy, House tries one last ditch effort to get rid of Cutthroat Bitch. He decides to put himself into insulin shock, which could kill him. He calls Wilson first to tell him what he's going to do but, still...he could have died. When he first wakes up, Amber is gone. And things appear to get better right away: he makes a brilliant deduction about the patient's boyfriend, and then heads off to a diner for some onion rings. But while he's at the diner he looks up and Amber is singing a totally creepy song into an old school microphone. He calls Wilson and asks him to come get him.
So they are finally at the bottom of the list: Vicodin addiction. Wilson calls a rehab center he knows just outside of Philly and gets House a bed. But in the end, House doesn't want to go to the rehab facility because he knows that he'll cheat. He'll find a way to get Vicodin somehow. Instead House goes to Cuddy and tells her that he's hallucinating, and it's from the vicodin. He asks her to help him detox because he knows if anyone else helps him through it he'll find a way to cheat them. Cuddy agrees, because when Hugh Laurie looks into your eyes and deploringly says "I need you", you help him out.
Cuddy spends the night at House's apartment, and does a thorough search of the place getting rid of his secret stash. At first despite lots of shaking and pain he has the willpower to tell her about the pills stuffed in his shoes in the closet. But later on once the true desperation sets in, he spots a lone pill on the floor in the bathroom and when Cuddy goes out of the room to get him a cup of tea he makes a break for it. Luckily, she makes it back to the bathroom before he can pop the pill and she dramatically flushes it down the toilet as House sticks his ands in and tries to rescue it.
The next morning after House is feeling better (vicodin detox only takes one day??) Cuddy spills the beans that back in college she audited an endocrinology class that House was in just so she could meet him. She thought he was an interesting lunatic even back then. As a university student, can I just say that that is a sign of true love? After the detox, Amber is gone and House and Cuddy are aloooooone. You know what that means... the long awaited House/Cuddy makeout session! Woooo! It only too them five years to get down to business.
Next week's season finale should be dramatic what with the after affects of making out and detoxing and all.
After a lovely dinner, Cameron spills the beans to Chase that she still has her dead husband's sperm and she wants to keep it. The way she says this almost makes it seem like she's got it in the fridge or something. Cameron tells Chase that nobody plans on getting divorced and she wants to keep her backup baby just in case things with them don't turn out. "So...you want a pre-nup...in liquid form?" Chase asks. Cameron shrugs like this is a perfectly normal request.
Chase asks Foreman what he should do in this crazy situation. Foreman (who is suddenly the kind of relationship advice?) tells Chase he should let Cameron keep her dead husband's sperm or he'll be 'stuck with her forever'. Nice. When Chase points out that he wants to be stuck with her forever and that's kind of the point of marriage, Foreman just says "She's got issues and you won't be able to leave her ever, for any reason. Because then you're not just the guy who left her you're the guy who killed her kids."
In the end Chase tells Cameron that he can't marry her and let her keep the sperm. It's a symbol of her doubts, and he doesn't have any. Cameron tells him that she loves him and wants to spend the rest of her life with him now, but what if something changes down the road? She can't know...because no one really knows. "I do." Chase says, and he will wait until Cameron knows too.
House: "The problem with speculation is that you make a speck out of you and some guy named 'Lation'."
Wilson: "Do you have any other neurological symptoms?"
House: "I don't think so..."
Wilson: "Memory loss?"
House: (yells) "Yeah, that one!"