House, M.D. s01e03 Episode Script
HOU-102 - Occam's Razor
I didn't sleep well last night, and I woke up with a scratchy throat.
I just don't feel so good.
Uh, cough.
Yeah, um-um, I have a bit of an upset stomach too, and I think I'm running a fever.
I'm just worried I might be contagious.
Inventory.
Tomorrow.
I'm-- Yeah, I'm sure I'll be feeling better by then.
Thanks, Mr.
Innabe.
I cannot believe you just did that.
I-I really do have a cough.
Oh.
So you weren't lying.
You'd be curled up in bed with a bowl of chicken soup-- even if you didn't have a horny girl in your bed? Yes.
Because I really do-- Hey.
I really do have a cough.
You also have a little rash.
Um, I'm not sure we should be kissing.
Oh.
It's okay.
Because I have almost no interest in kissing you.
Perfect.
Good.
Uh-uh-uh.
Oh, baby.
Oh, Brandon.
Brandon.
I know I'm good, but come on.
Brandon? Brandon.
Brandon.
Brandon.
Brandon! Brandon! Any additional R.
N.
to Surgical.
Any additional R.
N.
to Surgical.
Why do you want me to treat this guy? Blood pressure's not responding to I.
V.
fluids.
No, no.
I didn't ask how you plan to con me into treating him.
I asked you why you want me to treat him.
He's sick.
I care.
I'm pathetic.
There are about a billion sick people on the planet.
Why this one? Because this one's in our emergency room.
Ah, so it's a proximity issue.
If somebody was sick in the third-floor stairwell, that's who'd we be talking about.
Yes.
I checked the stairwell.
It's clear.
Okay, then.
Emergency room guy it is.
Wait.
Why was that so easy? You know why.
- Blood pressure's not responding to I.
V.
fluids? - Yeah.
That's just weird.
C.
B.
C.
was unremarkable.
Abdominal C.
T.
scan didn't show anything.
So, people, differential diagnosis.
What's wrong with her? - Him.
- Him.
Her.
Does it matter? Does anyone think it's a testicular problem? No.
So, Chase? - Yersinia infection? - No.
You wouldn't get the rash or cough.
What about arthritis? Accompanying vasculitis causes nerve damage-- - No.
It wouldn't cause the blood pressure problems.
Allergy? - The kid's got abdominal pain.
Maybe carcinoid? No.
But then you wouldn't get the-- Foreman, if you're going to list all the things it's not, it might be quicker to do it alphabetically.
Let's see, now.
"Absidia".
Excellent.
Doesn't account for any of the symptoms.
- No condition accounts for all these symptoms.
- Oh, good.
Because I thought maybe he was sick.
But, apparently, he's not.
Who wants to do up the discharge papers? Okay.
Unless we control the blood pressure, he's gonna start circling the drain before we can figure out what's wrong with him.
Treat him for sepsis, broad-spectrum antibiotics, and I want a Cort-stim test and an echocardiogram.
You all right? Yeah.
The Cort-stim test will tell us if your pituitary and adrenal glands are working properly.
- His glands? What does that mean? - We have a few theories we're working on.
- You mean you don't know.
- Mindy.
I'm just saying, if they knew they wouldn't be testing you, they'd be treating you.
Yeah, well, that's the way it works.
First we find out what it is, then we get you better.
You're half an hour late.
Busy caseload.
One case is not a load.
So how are we doing on cotton swabs today? If there's an acute shortage, I could run home-- No, you couldn't.
Nice.
Hello, sick people and their loved ones.
In the interest of saving time and avoiding a lot of boring chitchat later, I'm Dr.
Gregory House.
You can call me Greg.
I'm one of three doctors staffing this clinic this morning.
Short.
Sweet.
Grab a file.
This ray of sunshine is Dr.
Lisa Cuddy.
Dr.
Cuddy runs this whole hospital, so, unfortunately, she's much too busy to deal with you.
I am a board-certified diagnostician, with a double specialty of infectious disease and nephrology.
I'm also the only doctor currently employed at this clinic who is forced to be here against his will.
That is true, isn't it? But not to worry.
Because for most of you, this job could be done by a monkey with a bottle of Motrin.
Speaking of which, if you're particularly annoying, you may see me reach for this.
This is Vicodin.
It's mine.
You can't have any.
And, no, I do not have a pain management problem.
I have a pain problem.
But who knows? Maybe I'm wrong.
Maybe I'm too stoned to tell.
So, who wants me? And who would rather wait for one of the other two guys? Okay.
Well, I'll be in Exam Room One if you change your mind.
Jodi Matthews? Please accompany Dr.
House to Exam Room One.
Dr.
Chase.
I'm not sure scaring your boyfriend is the best medicine for him right now.
I know.
I get stupid when I'm scared.
Don't go rock climbing.
Look, I was wondering.
Before this happened, we were having sex.
What? You're wondering if whatever he has, you might've gotten it? It-It's unlikely.
We ran a complete S.
T.
D.
panel, so-- No.
I'm wondering if maybe I did this to him.
I was kind of rough.
It was yellow.
It was? It's not anymore.
Well, that's a shame.
I thought that might be a problem, so I brought you this.
Your mucus was "pale goldenrod".
Last week, yes.
Should I be worried? Oh, yes.
Very.
Really? I thought it was okay now.
And yet, here you are.
What happened? Paramedics took a week to respond to your 911 call? You're not a very nice doctor, are you? And you are very bad at whatever it is you do.
You don't even know me.
I know you're gonna get fired.
That's why you got the new glasses.
That's why your teeth are sparkly white.
You're getting the most of your health insurance while you still can.
I might be quitting.
If you were quitting, you'd have known that last week when your snot was still pale goldenrod.
You're getting fired.
I just don't like being told what to do.
I can get you in for a full body scan later this week.
Thanks.
It's got to be viral.
We should start running gels and titers.
Maybe we should look into the girlfriend's theory.
She thinks she rode him to death.
What'd you tell her? I told her 22-year-old men don't die of sex.
- What'd you ask her? - What do you mean? I mean, I hope you got some specifics on exactly what was going on.
If the girl thinks it could kill you, it's worth knowing about.
Have you ever taken a life? We should stop the antibiotics.
It's too soon to say they're not having an effect.
They're having an effect.
His B.
P.
's falling fast.
There's fluid filling his lungs.
His creatinine is rising.
His kidneys are shutting down.
Our treatment isn't making him better.
It's killing him.
So, we had six symptoms that didn't add up to anything.
Now we got seven.
Who's excited? I don't think it complicates things.
The kidney failure was caused by the antibiotics.
- Maybe.
- Typically, low blood pressure and abdominal pain means an infection.
An abdominal infection causes sepsis, low blood pressure.
Except we checked for abdominal infections.
But what if it's the other way around? What if the low blood pressure's causing the abdominal pain? Viral heart infection.
The intestines aren't getting enough blood, and the result is belly pain.
- I know it's not the standard presentation.
- It's a 10 million-to-1 shot.
I thought that's what we dealt with here.
It explains the cardiomyopathy, the pain, the low B.
P.
, the fever.
You read the book.
Impressive.
It's a ludicrously long shot that explains every one of those symptoms-- except for the cough and the rash.
Should we just erase those? Well, anything can cause a rash.
Okay.
Cardiac infection.
- Cameron, you thought allergy.
- Mm-hmm.
Chase, what was it you thought? Carcinoid? Then there's hypothyroidism.
Could be parasites.
Finally, sinus infection.
If you're gonna list all the things it can't be, you're gonna need more colors.
Cameron was right.
No condition explains all these symptoms.
- But orange and green covers everything.
- Orange and green? Two conditions contracted simultaneously? Occam's Razor.
The simplest explanation is always the best.
- And you think one is simpler than two? - Pretty sure it is, yeah.
Baby shows up.
Chase tells you that two people exchanged fluids to create this being.
I tell you that one stork dropped the little tyke off in a diaper.
Are you gonna go with the two or the one? - I think your argument is specious.
- I think your tie is ugly.
Why is one simpler than two? It's lower, lonelier.
Is it simpler? Each one of these conditions is about a thousand-to-one shot.
That means that any two of them happening at the same time is a million-to-one shot.
Chase says the cardiac infection is a 10 million-to-1 shot, which makes my idea Get a calculator.
Run the numbers.
We'll run the tests.
Tests take time.
Treatment's quicker.
Start the kid on Unasyn for the sinus infection, and what was orange? Hypothyroidism.
My uncle has hypothyroidism.
Not like this.
Intravenous Levothyroxin is an artificial thyroid medication that should take care of it.
Also, the nurses are going to start you on Unasyn.
It's a more targeted antibiotic.
For the sinus infection? Yes.
- The other stuff is for something else entirely.
- Bad luck, huh? Don't worry.
He should be back to ditching work in no time.
Brandon? Hey, Mom.
We're his parents.
How's he doing? Um, Brandon is-- Uh, Mom.
Dad-- This is Mindy.
I was gonna bring her home for Christmas.
Um, we're engaged.
Dr.
Hall to the recovery room.
Dr.
Hall-- Did you tell the family House's theory? Two odd conditions striking completely coincidentally at the exact same time? I didn't phrase it quite that way.
They agree to treatment? Ofcourse they did.
We're doctors.
They believe whatever we tell them.
So, is that our job? House's puppets? He comes up with an insane idea, we get to pretend it's not? His insane ideas are usually right.
We've been here long enough to-- We've been here long enough to have Stockholm syndrome.
What, because we don't hate him? He thinks outside the box.
Is that so evil? He has no idea where the box is.
If you guys think he's right, go home.
Relax.
Just wait for the kid to get all better.
I'm going to the lab to test for viral infections.
Negative for Coxsackie "B" virus.
Seven down, about 5,000 to go.
You really think we're gonna come up with your mystery virus just by running gels till we guess it right? No.
I think we're gonna do it by standing around watching other people work.
I'm waiting for the Epstein-Barr virus.
- She's weird, isn't she? - Bad idea.
- What? - Bad idea.
You work with her.
What did I say? Is weird some new ghetto euphemism for sexy, like bad is good and phat is good? - Then what the hell does "good" mean? - "Ghetto euphemism"? You don't think she's hot? No.
Wow.
Then you're brilliant.
And I am using "brilliant" as a euphemism.
Obviously, the girl is hot.
Y-You're not talking about her aesthetics.
You're talking about if I want to jump her.
I don't.
Brilliant.
Your Epstein-Barr is ready.
What are you doing? Level four.
No, no.
I mean-- I know what you meant.
We're waiting.
My throat hurts.
So you said.
How long are we waiting? Two minutes less than when you asked me two minutes ago.
- Hi.
- Hi.
I'm Dr.
Cuddy.
Nice to meet you.
Dr.
Cuddy, thanks for the consult.
His throat seems to have some condition.
Say "Ah".
Ah.
He has a sore throat.
Ofcourse.
Yes, why didn't I-- I mean, because he said that it hurt, and I should have deduced that meant it was sore.
I was in a board meeting.
Patients come first, right? Wouldn't want to prescribe a lozenge if there's any doubt about its efficacy, huh? You once asked me why I think I'm always right, and I realized that you're right.
At least, I think you're right.
I don't really know, now do I? - Hey.
I'm here.
- Go home.
Drink some hot tea.
Excellent counsel.
Negative on parvovirus B-19.
I'm impressed.
Thank you.
I was born to run gels.
I meant about Chase.
What about Chase? Well, the man has no physical interest in you.
He has a completely professional relationship with you, respects you as a colleague and a doctor.
And yet, he can't look at you without thinking sex.
Because I asked what kind of sex could kill you? You now have total control over your relationship with him.
So, a woman can't express her interest in sex without it being some professional power play? No.
If you look the way you do and you say what you said, you have to be aware of the effect that it's going to have on men.
- Men should grow up.
- Yeah, and dogs should stop licking themselves.
It's not gonna happen.
What's going on? - Yeah, what are you doing here? - Looking for you guys.
- Why didn't you page us? - 'Cause I knew you'd be here.
Who told him? No one.
I assume you're trying to prove my crazy, two-illness theory wrong, so, obviously, you're gonna be in the lab.
- You spin the urine? - Not yet.
Talk to me when you have.
What'd you find out? Kidney failure.
It's acute interstitial nephritis.
- I wonder if that's significant.
- It means the antibiotics didn't cause the kidney failure.
How'd you know? If you guys hadn't been so busy trying to prove me wrong, you might've checked in on the poor kid.
You visited a patient? I was sitting by his bed all morning, just so he'd know someone was there for him.
I looked in on him.
He's much better.
Ergo, the treatment's working.
Ergo, me right, you wrong.
Hey, I'm glad for the kid.
That smugness of yours really is an attractive quality.
Thank you.
It was either that or get my hair highlighted.
Smugness is easier to maintain.
I get that you're not a big believer in the "catching flies with honey" approach, but do you honestly think you'll collect a jarful by cleverly taunting them? Flies, no.
Doctors, sure.
If I'd said to Foreman, "Nice try.
Great guess, but sorry, not this time", what do you think he'd be doing right now? I think he'd go home not feeling like a piece of crap.
Exactly.
You want him to feel like a piece of crap? No.
I don't want him going home.
Dr.
Foreman.
Still have the cough.
I'm feeling a lot better though.
His fever is gone.
His rash is going away.
I see.
Is everything okay? Just ordering some tests.
Absolutely nothing to worry about.
- How much longer? - 9:30.
I figure she was on the eighth hole when I paged her.
You probably got another half hour.
I ran a T.
S.
H.
, T3 and T4.
The patient's negative for hypothyroidism.
I'm not talking about you.
The fact that he's getting better would indicate the unreliability of the tests.
If I'm right and it's a viral infection, one of two things always happen: the patient dies, or the patient's immune system fights off the invader.
What's with her? Her leg hurts after running six miles.
Who knows? Could be anything.
He's getting better.
That doesn't prove you're right.
That just proves he's getting better.
It-It's not two illnesses.
It can't be two illnesses.
I am so glad you work here.
If I'm right, the antibiotics you prescribed could box his kidneys and liver, impeding his ability to fight off the virus.
- It could kill him.
- Well, that certainly would be a concern.
Fifty bucks? Don't look away.
The space monkeys will be all over you.
- You wanna bet on the patient's health? - You think that's bad luck? You think that God will smite him because of our insensitivity? Well, if God does, you make a quick 50.
- Oh.
- Go check his white blood count.
If he's fighting off a virus like you think, it'll be way up.
Hey.
Cuddy said you needed a consult.
What's up? I'm busy.
Oh! - I was just being glib.
- You haven't said anything.
No.
Before, when I was talking about Brandon's girlfriend thinking sex could kill you.
I was just making a joke because I was uncomfortable.
Oh, I don't even remember what you said.
I'm uncomfortable about sex.
- Well, we don't have to talk about this.
- Sex could kill you.
Do you know what the human body goes through when you have sex? Pupils dilate.
Arteries constrict.
Core temperature rises, heart races, blood pressure skyrockets.
Respiration becomes rapid and shallow.
The brain fires bursts of electrical impulses from nowhere to nowhere.
Secretions spit out of every gland, and the muscles tense and spasm like you're lifting three times your body weight.
It's violent, it's ugly, and it's messy.
And if God hadn't made it unbelievably fun, the human race would've died out eons ago.
Men are lucky they can only have one orgasm.
You know that women can have an hour-long orgasm? Hey, Foreman.
What's up? - Hey, Foreman.
- Hey.
- White cell count isn't up, is it? - No.
We were both wrong.
White cell count is down-- way down-- and dropping.
His immune system is shot.
We need to get him into a clean room.
Can you walk, Brandon? Yeah.
A little.
Okay.
'Cause we'll need to leave the chair outside.
Thank you.
Where's April? April? Can you take that chair, please? Thank you.
Yes, Robert.
I'll need to take your, um-- your mask and your robe too.
You might wanna block your ears for this, it's quite loud.
Something's made him immuno-compromised.
His white blood cell count is down, which means his body can't fight off infections.
If he gets sick, he'll die.
Sick? How sick? If he gets a cold, he'll die.
Okay.
I'm gonna push the needle into your hip bone and take some of the marrow.
That's not so bad.
Uh-uh.
That was just the anesthetic.
The core biopsy needle, it's a bit bigger.
Hey, man.
Take a deep breath.
This-This is gonna hurt a lot.
Your marrow makes the blood cells.
We take a peek at it under a microscope, and maybe we find a viral infection.
Maybe we find some fibrosis.
Something to explain why your blood count is so low.
There we go.
One step closer to an answer.
If you don't find one, I can't stay here forever.
- The patient could've died.
- The one with the pulled muscle? Those symptoms are consistent with a dozen other conditions.
I'm entitled to a consult.
- You are not getting out of clinic duty.
Come on.
You got a hundred other idiot doctors in this building who go all warm and fuzzy every time they pull a toy car out of a nose-- you don't need me here.
No, I don't.
But working with people actually makes you a better doctor.
When did I sign up for that course? When did I give you the impression that I care? Working in this clinic obviously instills a deep sense of compassion.
I've got your home number, right? In case anything comes up at 3:00 in the morning.
It's not gonna work.
You know why? Because this is fun.
You think of something to make me miserable.
I think of something to make you miserable-- It's a game, and I'm gonna win because I got a head start.
You are already miserable.
Uh-- Is this important? Uh, no.
Good.
What's with you and her? Don't.
You have a thing for her? The only people who can get to you-- No.
There is not a thin line between love and hate.
There is, in fact, a Great Wall of China, with armed sentries posted every 20 feet between love and hate.
Thirty-six Vicodin.
Who's the patient? I am.
You can't-- Dr.
Wilson is the prescribing physician.
Yeah.
You will lie, cheat and steal to get what you want, but you're incapable of kissing a little ass? We all have our limitations.
House? Wrong bottle.
Do me a favor.
Take one of these, wait five minutes for it to kick in, then find Cuddy and kiss her ass.
What was the kid's first symptom? You did the history.
Of his 800 symptoms, which one hit him first? Uh, the cough.
Gout.
Um, are we talking about Brandon? Gout? Uric acid crystals in the joints? The symptoms are pain, swelling, redness, stiffness.
Not one of which do I see on that board.
Because he doesn't have gout.
Every day, cells die.
We survive because the remaining cells divide and replace the losses.
The colchicine, a gout medicine, blocks mitosis and stops cell division, which will result in abdominal pain, rash, nausea, fever, kidney failure, low blood pressure and will also mess with the bone marrow.
But he doesn't have gout.
Why would he have gout medication? Because you guys were right.
He didn't have two conditions at the exact same time.
First, he got a cough.
And because he's an idiot, he went to a doctor.
In order to justify charging $200, that doctor felt he should actually do something.
Oops.
He wrote a prescription.
Seven thousand people die each year from pharmacy screwups.
Not nearly as many as die from doctor screwups, but still, not something they use in their promotional materials.
The pharmacist gave him gout medicine instead of cough medicine.
And the only thing it wouldn't do, it would do absolutely nothing to relieve his cough.
Occam's Razor-- the simplest explanation is almost always that somebody screwed up.
But once he checked into this hospital, he was completely in our control.
Our food, our pills, our everything.
So even if you're right, no more gout medication.
He'd either continue to deteriorate, or he would've gotten better.
But he got better, and then he got worse.
It doesn't fit.
It doesn't make sense.
Okay.
Two people screwed up.
Not as simple as one, but-- He's resting.
He's-- I'm Dr.
House.
I'm your son's physician.
Oh.
You're the one we haven't met yet.
You're the one he hasn't met.
How can you treat someone without meeting them? It's easy if you don't give a crap about him.
That's a good thing.
If emotions made you act rationally, well, they wouldn't be called emotions, right? That's why we have this nice division of labor.
You hold his hand, I get him better.
If I start tucking him in at night, well, that's not fair to you guys.
And if you start prescribing medicine, well, that's not fair to me.
So, what I wanna know is, who stepped on my side of the net? Who cared enough to get stupid enough to give him his cough medicine? When we checked in, Dr.
Foreman-- Tuesday, he's getting better.
Wednesday, he's getting sick again.
Somebody gave him his cough medicine Wednesday.
Come on.
Nobody's gonna be mad.
I just wanna know who tried to kill the kid.
- Dr.
House, maybe we should-- - His throat was sore.
Page Dr.
Occam.
He's gonna wanna hear about this.
I'm sorry.
He was coughing, and I just wanted to help him-- Aren't you a dear.
Where are the pills? He took the last of'em before he was switched into that room.
They're all gone? It was just cough medicine.
No, it wasn't.
Where's the bottle? We need to know exactly what you put in this bottle.
We think it was colchicine, a gout medication.
If the prescription said cough medicine, that's what I dispensed.
The family is prepared to waive liability, all right? We just need to know what it was, what dosage it was-- It was cough medicine.
Refill it.
He's gonna be okay.
You don't know that.
Does Brandon like that quality in you? You're a little negative.
Things don't always work out for the best.
Doesn't hurt to hope they do.
No.
Not unless that makes you figure you can do whatever you want, like give people cough medicine.
This is cough medication.
This is what Brandon was supposed to get.
They're small, round and yellow.
Can you tell this man what the pills in your son's medicine bottle actually looked like? They were small, round and yellow, exactly like this.
Those were the pills that Brandon was taking.
Hey, I'm just a pharmacist, but I know what cough medicine looks like, Doctor.
It was so perfect.
It was beautiful.
Beauty often seduces us on the road to truth.
And triteness kicks us in the nads.
So true.
This doesn't bother you? That you were wrong? I try to work through the pain.
I was not wrong.
Everything I said was true.
It fit.
It was elegant.
- So, reality was wrong? - Reality's almost always wrong.
The cough medicine did something.
Aggravated the condition.
It's all over the place.
Must be in his blood.
- What if it is his blood? - Lymphoma? Unless you've got something better.
We foolishly ruled out lymphoma because his C.
T.
scan showed no adenopathy, C.
B.
C.
showed a normal differen-smear, bone marrow showed no-- Screw the tests.
Do an exploratory laparotomy and find out what's in there.
He has no blood pressure, no immune system and no kidneys.
Surgery will kill him.
Yeah, you're right.
Let's stick with the wrong pill theory.
I'll schedule him for surgery.
Okay, Brandon, we're running this tube through your heart.
and into the pulmonary arteries in your lungs.
The sensors will give us information we need for the exploratory surgery later this afternoon.
- My fingers are numb.
- Try not to move.
We're in the right atrium, trying to catch the flow through the tricuspid valve.
I think the catheter's curling in the atrium.
Got it.
We're in the R.
V.
now.
Ectopy.
- You must've irritated the heart wall.
- It'll calm down.
- He can't tolerate any cardiac arrhythmia.
Pull back.
- He needs the surgery.
Pressure's dropped.
- You still with us, Brandon? - Get the curtains.
V.
F.
Charging.
Clear.
Sinus rhythm.
I got a pulse.
Yeah, but no surgery today.
- How're you doing? - Okay.
Great.
I'm doing good too.
I get to knock off an hour early today.
You know why? Because I kissed my boss's ass.
Do you ever do that? I think she just said yes 'cause she wants to reinforce that behavior.
Wants me to kiss a lot of other people's ass, like she wants me to kiss yours.
What would you want? A doctor who holds your hand while you die, or a doctor who ignores you while you get better? I guess it would particularly suck to have a doctor who ignores you while you die.
- I should go.
- You think it's gonna come out on its own? Are we talking bigger than a breadbasket? Because, actually, it will come out on its own.
Which for small stuff is no problem.
It's wrapped up in a nice, soft package, and plop.
Big stuff, you're gonna rip something, which, speaking medically, is when the fun stops.
How did you-- You've been here half an hour, you haven't sat down.
That tells me its location.
You haven't told me what it is.
That tells me it's humiliating.
You have a little birdie carved on your arm.
That tells me you have a high tolerance for humiliation.
So I figure it's not hemorrhoids.
I've been a doctor 20 years.
You're not gonna surprise me.
It's an MP3 player.
Mm.
Is it-- Is it because of the size, or the shape, or is it the pounding bass line? What are we gonna do? - I'm gonna wait.
- For what? Okay.
It's 3:00.
I'm off.
Would you tell Dr.
Cuddy there's a patient in Exam Room Two needs her attention? And the R.
I.
A.
A.
wants her to check for illegal downloads.
Brandon's not ready for surgery.
Okay.
Let's leave it a couple of weeks.
He should be feeling better by then.
Oh, wait.
Which way does time go? He crashed during prep.
He's also experiencing pain in his fingers.
Think some bug may have gotten in the clean room.
I think we should double his dosage of G-CSF to temporarily boost his white blood cell count.
Pain in his fingers.
Right.
Hi again.
He can't-- Where's he going? Hey.
How you all doing? Interesting fact.
Every seven years, it's a whole new you.
Inspiring metaphor, huh? Dr.
House, this is a clean room.
Yeah.
I read the sign.
But cells of different organs reproduce at different rates.
- So, you get a new kidney every three years.
Get a new stomach lining every week.
This is why colchicine poisoning causes all these symptoms, but not all at once.
But we went to the pharmacy.
We saw the pills.
Colchicine does its damage in a very specific order.
First of all, there's the pain in the abdomen, the rash, the fever.
Isn't that what you got first? Then the kidneys go, which is exactly what happened to-- - Brandon.
- Right.
Then it screws up your bone marrow, and then neuropathy.
A painful tingling in the fingers and toes.
And what do you suppose happens after that? Hair loss.
The bad news is your special boy is doing drugs.
No, he's not.
Ecstasy? No.
- Twice with Dan and Mike.
- You know what they cut that stuff with? Apparently, colchicine.
Unless you ingested the colchicine through your contact lens solution, or skin cream or some other drug you're lying about.
I don't know how it happened.
I don't care how it happened.
It happened.
Start, uh-- - Brandon.
- Lovely name.
Start Brandon on FAB fragments, and get him some Tylenol for the hair I pulled out.
And get some air in here.
Make a note.
I should never doubt myself.
I think you'll remember.
You know, it wouldn't hurt you to be wrong every now and then.
What, you don't care about these people? The colchicine interferes with the ability of the heart muscle to contract, pumping blood, lowering your blood pressure.
The antibodies we're giving you should neutralize the colchicine, allowing your heart to beat at its normal rate.
When will you know? We know now.
Thank God.
Mmm.
Big weekend? It's not for me.
I'm fully stocked.
- Cuddy got you doing inventory? - Nope.
Trying to solve that kid's case.
The gout medicine O.
D.
? Yeah.
The fact that I know it's a gout medicine O.
D.
would indicate the case is already solved.
Well, you'd be wrong.
What about the fact that the kid is now-- I believe the technical term is-- "not sick"? You know how many forms of colchicine there are on the market? - Stop it.
- Neither do I.
But it's a lot.
Pills, powders, liquids, I.
V.
fluids.
Somewhere at a party, in his coffee, up his nose, in his ear, this kid had some.
You're not happy with your Ecstasy theory? - He said he used it twice.
- People lie.
- If you're gonna lie, it's-- - You know what? I'm not interested.
- Not curious? - No.
Because I'm well-adjusted.
Right.
Temperature's normal.
I want cousin Sharon there.
If we invite Sharon, we have to invite all the cousins.
So what? My side of the family doesn't need anything.
I don't suppose I could have some of those cough pills, huh? They're okay, right? - Yes.
You're doing great.
- You should invite Dr.
House.
- Will he come? - No.
But he'll send a gift.
I'll make sure it's a good one.
There's a letter on the back of these pills.
Your old pills didn't have a letter on them? No.
Round and yellow, but no letter.
Well, these will help your cough.
Hey, you wanna go get some-- No.
I just don't feel so good.
Uh, cough.
Yeah, um-um, I have a bit of an upset stomach too, and I think I'm running a fever.
I'm just worried I might be contagious.
Inventory.
Tomorrow.
I'm-- Yeah, I'm sure I'll be feeling better by then.
Thanks, Mr.
Innabe.
I cannot believe you just did that.
I-I really do have a cough.
Oh.
So you weren't lying.
You'd be curled up in bed with a bowl of chicken soup-- even if you didn't have a horny girl in your bed? Yes.
Because I really do-- Hey.
I really do have a cough.
You also have a little rash.
Um, I'm not sure we should be kissing.
Oh.
It's okay.
Because I have almost no interest in kissing you.
Perfect.
Good.
Uh-uh-uh.
Oh, baby.
Oh, Brandon.
Brandon.
I know I'm good, but come on.
Brandon? Brandon.
Brandon.
Brandon.
Brandon! Brandon! Any additional R.
N.
to Surgical.
Any additional R.
N.
to Surgical.
Why do you want me to treat this guy? Blood pressure's not responding to I.
V.
fluids.
No, no.
I didn't ask how you plan to con me into treating him.
I asked you why you want me to treat him.
He's sick.
I care.
I'm pathetic.
There are about a billion sick people on the planet.
Why this one? Because this one's in our emergency room.
Ah, so it's a proximity issue.
If somebody was sick in the third-floor stairwell, that's who'd we be talking about.
Yes.
I checked the stairwell.
It's clear.
Okay, then.
Emergency room guy it is.
Wait.
Why was that so easy? You know why.
- Blood pressure's not responding to I.
V.
fluids? - Yeah.
That's just weird.
C.
B.
C.
was unremarkable.
Abdominal C.
T.
scan didn't show anything.
So, people, differential diagnosis.
What's wrong with her? - Him.
- Him.
Her.
Does it matter? Does anyone think it's a testicular problem? No.
So, Chase? - Yersinia infection? - No.
You wouldn't get the rash or cough.
What about arthritis? Accompanying vasculitis causes nerve damage-- - No.
It wouldn't cause the blood pressure problems.
Allergy? - The kid's got abdominal pain.
Maybe carcinoid? No.
But then you wouldn't get the-- Foreman, if you're going to list all the things it's not, it might be quicker to do it alphabetically.
Let's see, now.
"Absidia".
Excellent.
Doesn't account for any of the symptoms.
- No condition accounts for all these symptoms.
- Oh, good.
Because I thought maybe he was sick.
But, apparently, he's not.
Who wants to do up the discharge papers? Okay.
Unless we control the blood pressure, he's gonna start circling the drain before we can figure out what's wrong with him.
Treat him for sepsis, broad-spectrum antibiotics, and I want a Cort-stim test and an echocardiogram.
You all right? Yeah.
The Cort-stim test will tell us if your pituitary and adrenal glands are working properly.
- His glands? What does that mean? - We have a few theories we're working on.
- You mean you don't know.
- Mindy.
I'm just saying, if they knew they wouldn't be testing you, they'd be treating you.
Yeah, well, that's the way it works.
First we find out what it is, then we get you better.
You're half an hour late.
Busy caseload.
One case is not a load.
So how are we doing on cotton swabs today? If there's an acute shortage, I could run home-- No, you couldn't.
Nice.
Hello, sick people and their loved ones.
In the interest of saving time and avoiding a lot of boring chitchat later, I'm Dr.
Gregory House.
You can call me Greg.
I'm one of three doctors staffing this clinic this morning.
Short.
Sweet.
Grab a file.
This ray of sunshine is Dr.
Lisa Cuddy.
Dr.
Cuddy runs this whole hospital, so, unfortunately, she's much too busy to deal with you.
I am a board-certified diagnostician, with a double specialty of infectious disease and nephrology.
I'm also the only doctor currently employed at this clinic who is forced to be here against his will.
That is true, isn't it? But not to worry.
Because for most of you, this job could be done by a monkey with a bottle of Motrin.
Speaking of which, if you're particularly annoying, you may see me reach for this.
This is Vicodin.
It's mine.
You can't have any.
And, no, I do not have a pain management problem.
I have a pain problem.
But who knows? Maybe I'm wrong.
Maybe I'm too stoned to tell.
So, who wants me? And who would rather wait for one of the other two guys? Okay.
Well, I'll be in Exam Room One if you change your mind.
Jodi Matthews? Please accompany Dr.
House to Exam Room One.
Dr.
Chase.
I'm not sure scaring your boyfriend is the best medicine for him right now.
I know.
I get stupid when I'm scared.
Don't go rock climbing.
Look, I was wondering.
Before this happened, we were having sex.
What? You're wondering if whatever he has, you might've gotten it? It-It's unlikely.
We ran a complete S.
T.
D.
panel, so-- No.
I'm wondering if maybe I did this to him.
I was kind of rough.
It was yellow.
It was? It's not anymore.
Well, that's a shame.
I thought that might be a problem, so I brought you this.
Your mucus was "pale goldenrod".
Last week, yes.
Should I be worried? Oh, yes.
Very.
Really? I thought it was okay now.
And yet, here you are.
What happened? Paramedics took a week to respond to your 911 call? You're not a very nice doctor, are you? And you are very bad at whatever it is you do.
You don't even know me.
I know you're gonna get fired.
That's why you got the new glasses.
That's why your teeth are sparkly white.
You're getting the most of your health insurance while you still can.
I might be quitting.
If you were quitting, you'd have known that last week when your snot was still pale goldenrod.
You're getting fired.
I just don't like being told what to do.
I can get you in for a full body scan later this week.
Thanks.
It's got to be viral.
We should start running gels and titers.
Maybe we should look into the girlfriend's theory.
She thinks she rode him to death.
What'd you tell her? I told her 22-year-old men don't die of sex.
- What'd you ask her? - What do you mean? I mean, I hope you got some specifics on exactly what was going on.
If the girl thinks it could kill you, it's worth knowing about.
Have you ever taken a life? We should stop the antibiotics.
It's too soon to say they're not having an effect.
They're having an effect.
His B.
P.
's falling fast.
There's fluid filling his lungs.
His creatinine is rising.
His kidneys are shutting down.
Our treatment isn't making him better.
It's killing him.
So, we had six symptoms that didn't add up to anything.
Now we got seven.
Who's excited? I don't think it complicates things.
The kidney failure was caused by the antibiotics.
- Maybe.
- Typically, low blood pressure and abdominal pain means an infection.
An abdominal infection causes sepsis, low blood pressure.
Except we checked for abdominal infections.
But what if it's the other way around? What if the low blood pressure's causing the abdominal pain? Viral heart infection.
The intestines aren't getting enough blood, and the result is belly pain.
- I know it's not the standard presentation.
- It's a 10 million-to-1 shot.
I thought that's what we dealt with here.
It explains the cardiomyopathy, the pain, the low B.
P.
, the fever.
You read the book.
Impressive.
It's a ludicrously long shot that explains every one of those symptoms-- except for the cough and the rash.
Should we just erase those? Well, anything can cause a rash.
Okay.
Cardiac infection.
- Cameron, you thought allergy.
- Mm-hmm.
Chase, what was it you thought? Carcinoid? Then there's hypothyroidism.
Could be parasites.
Finally, sinus infection.
If you're gonna list all the things it can't be, you're gonna need more colors.
Cameron was right.
No condition explains all these symptoms.
- But orange and green covers everything.
- Orange and green? Two conditions contracted simultaneously? Occam's Razor.
The simplest explanation is always the best.
- And you think one is simpler than two? - Pretty sure it is, yeah.
Baby shows up.
Chase tells you that two people exchanged fluids to create this being.
I tell you that one stork dropped the little tyke off in a diaper.
Are you gonna go with the two or the one? - I think your argument is specious.
- I think your tie is ugly.
Why is one simpler than two? It's lower, lonelier.
Is it simpler? Each one of these conditions is about a thousand-to-one shot.
That means that any two of them happening at the same time is a million-to-one shot.
Chase says the cardiac infection is a 10 million-to-1 shot, which makes my idea Get a calculator.
Run the numbers.
We'll run the tests.
Tests take time.
Treatment's quicker.
Start the kid on Unasyn for the sinus infection, and what was orange? Hypothyroidism.
My uncle has hypothyroidism.
Not like this.
Intravenous Levothyroxin is an artificial thyroid medication that should take care of it.
Also, the nurses are going to start you on Unasyn.
It's a more targeted antibiotic.
For the sinus infection? Yes.
- The other stuff is for something else entirely.
- Bad luck, huh? Don't worry.
He should be back to ditching work in no time.
Brandon? Hey, Mom.
We're his parents.
How's he doing? Um, Brandon is-- Uh, Mom.
Dad-- This is Mindy.
I was gonna bring her home for Christmas.
Um, we're engaged.
Dr.
Hall to the recovery room.
Dr.
Hall-- Did you tell the family House's theory? Two odd conditions striking completely coincidentally at the exact same time? I didn't phrase it quite that way.
They agree to treatment? Ofcourse they did.
We're doctors.
They believe whatever we tell them.
So, is that our job? House's puppets? He comes up with an insane idea, we get to pretend it's not? His insane ideas are usually right.
We've been here long enough to-- We've been here long enough to have Stockholm syndrome.
What, because we don't hate him? He thinks outside the box.
Is that so evil? He has no idea where the box is.
If you guys think he's right, go home.
Relax.
Just wait for the kid to get all better.
I'm going to the lab to test for viral infections.
Negative for Coxsackie "B" virus.
Seven down, about 5,000 to go.
You really think we're gonna come up with your mystery virus just by running gels till we guess it right? No.
I think we're gonna do it by standing around watching other people work.
I'm waiting for the Epstein-Barr virus.
- She's weird, isn't she? - Bad idea.
- What? - Bad idea.
You work with her.
What did I say? Is weird some new ghetto euphemism for sexy, like bad is good and phat is good? - Then what the hell does "good" mean? - "Ghetto euphemism"? You don't think she's hot? No.
Wow.
Then you're brilliant.
And I am using "brilliant" as a euphemism.
Obviously, the girl is hot.
Y-You're not talking about her aesthetics.
You're talking about if I want to jump her.
I don't.
Brilliant.
Your Epstein-Barr is ready.
What are you doing? Level four.
No, no.
I mean-- I know what you meant.
We're waiting.
My throat hurts.
So you said.
How long are we waiting? Two minutes less than when you asked me two minutes ago.
- Hi.
- Hi.
I'm Dr.
Cuddy.
Nice to meet you.
Dr.
Cuddy, thanks for the consult.
His throat seems to have some condition.
Say "Ah".
Ah.
He has a sore throat.
Ofcourse.
Yes, why didn't I-- I mean, because he said that it hurt, and I should have deduced that meant it was sore.
I was in a board meeting.
Patients come first, right? Wouldn't want to prescribe a lozenge if there's any doubt about its efficacy, huh? You once asked me why I think I'm always right, and I realized that you're right.
At least, I think you're right.
I don't really know, now do I? - Hey.
I'm here.
- Go home.
Drink some hot tea.
Excellent counsel.
Negative on parvovirus B-19.
I'm impressed.
Thank you.
I was born to run gels.
I meant about Chase.
What about Chase? Well, the man has no physical interest in you.
He has a completely professional relationship with you, respects you as a colleague and a doctor.
And yet, he can't look at you without thinking sex.
Because I asked what kind of sex could kill you? You now have total control over your relationship with him.
So, a woman can't express her interest in sex without it being some professional power play? No.
If you look the way you do and you say what you said, you have to be aware of the effect that it's going to have on men.
- Men should grow up.
- Yeah, and dogs should stop licking themselves.
It's not gonna happen.
What's going on? - Yeah, what are you doing here? - Looking for you guys.
- Why didn't you page us? - 'Cause I knew you'd be here.
Who told him? No one.
I assume you're trying to prove my crazy, two-illness theory wrong, so, obviously, you're gonna be in the lab.
- You spin the urine? - Not yet.
Talk to me when you have.
What'd you find out? Kidney failure.
It's acute interstitial nephritis.
- I wonder if that's significant.
- It means the antibiotics didn't cause the kidney failure.
How'd you know? If you guys hadn't been so busy trying to prove me wrong, you might've checked in on the poor kid.
You visited a patient? I was sitting by his bed all morning, just so he'd know someone was there for him.
I looked in on him.
He's much better.
Ergo, the treatment's working.
Ergo, me right, you wrong.
Hey, I'm glad for the kid.
That smugness of yours really is an attractive quality.
Thank you.
It was either that or get my hair highlighted.
Smugness is easier to maintain.
I get that you're not a big believer in the "catching flies with honey" approach, but do you honestly think you'll collect a jarful by cleverly taunting them? Flies, no.
Doctors, sure.
If I'd said to Foreman, "Nice try.
Great guess, but sorry, not this time", what do you think he'd be doing right now? I think he'd go home not feeling like a piece of crap.
Exactly.
You want him to feel like a piece of crap? No.
I don't want him going home.
Dr.
Foreman.
Still have the cough.
I'm feeling a lot better though.
His fever is gone.
His rash is going away.
I see.
Is everything okay? Just ordering some tests.
Absolutely nothing to worry about.
- How much longer? - 9:30.
I figure she was on the eighth hole when I paged her.
You probably got another half hour.
I ran a T.
S.
H.
, T3 and T4.
The patient's negative for hypothyroidism.
I'm not talking about you.
The fact that he's getting better would indicate the unreliability of the tests.
If I'm right and it's a viral infection, one of two things always happen: the patient dies, or the patient's immune system fights off the invader.
What's with her? Her leg hurts after running six miles.
Who knows? Could be anything.
He's getting better.
That doesn't prove you're right.
That just proves he's getting better.
It-It's not two illnesses.
It can't be two illnesses.
I am so glad you work here.
If I'm right, the antibiotics you prescribed could box his kidneys and liver, impeding his ability to fight off the virus.
- It could kill him.
- Well, that certainly would be a concern.
Fifty bucks? Don't look away.
The space monkeys will be all over you.
- You wanna bet on the patient's health? - You think that's bad luck? You think that God will smite him because of our insensitivity? Well, if God does, you make a quick 50.
- Oh.
- Go check his white blood count.
If he's fighting off a virus like you think, it'll be way up.
Hey.
Cuddy said you needed a consult.
What's up? I'm busy.
Oh! - I was just being glib.
- You haven't said anything.
No.
Before, when I was talking about Brandon's girlfriend thinking sex could kill you.
I was just making a joke because I was uncomfortable.
Oh, I don't even remember what you said.
I'm uncomfortable about sex.
- Well, we don't have to talk about this.
- Sex could kill you.
Do you know what the human body goes through when you have sex? Pupils dilate.
Arteries constrict.
Core temperature rises, heart races, blood pressure skyrockets.
Respiration becomes rapid and shallow.
The brain fires bursts of electrical impulses from nowhere to nowhere.
Secretions spit out of every gland, and the muscles tense and spasm like you're lifting three times your body weight.
It's violent, it's ugly, and it's messy.
And if God hadn't made it unbelievably fun, the human race would've died out eons ago.
Men are lucky they can only have one orgasm.
You know that women can have an hour-long orgasm? Hey, Foreman.
What's up? - Hey, Foreman.
- Hey.
- White cell count isn't up, is it? - No.
We were both wrong.
White cell count is down-- way down-- and dropping.
His immune system is shot.
We need to get him into a clean room.
Can you walk, Brandon? Yeah.
A little.
Okay.
'Cause we'll need to leave the chair outside.
Thank you.
Where's April? April? Can you take that chair, please? Thank you.
Yes, Robert.
I'll need to take your, um-- your mask and your robe too.
You might wanna block your ears for this, it's quite loud.
Something's made him immuno-compromised.
His white blood cell count is down, which means his body can't fight off infections.
If he gets sick, he'll die.
Sick? How sick? If he gets a cold, he'll die.
Okay.
I'm gonna push the needle into your hip bone and take some of the marrow.
That's not so bad.
Uh-uh.
That was just the anesthetic.
The core biopsy needle, it's a bit bigger.
Hey, man.
Take a deep breath.
This-This is gonna hurt a lot.
Your marrow makes the blood cells.
We take a peek at it under a microscope, and maybe we find a viral infection.
Maybe we find some fibrosis.
Something to explain why your blood count is so low.
There we go.
One step closer to an answer.
If you don't find one, I can't stay here forever.
- The patient could've died.
- The one with the pulled muscle? Those symptoms are consistent with a dozen other conditions.
I'm entitled to a consult.
- You are not getting out of clinic duty.
Come on.
You got a hundred other idiot doctors in this building who go all warm and fuzzy every time they pull a toy car out of a nose-- you don't need me here.
No, I don't.
But working with people actually makes you a better doctor.
When did I sign up for that course? When did I give you the impression that I care? Working in this clinic obviously instills a deep sense of compassion.
I've got your home number, right? In case anything comes up at 3:00 in the morning.
It's not gonna work.
You know why? Because this is fun.
You think of something to make me miserable.
I think of something to make you miserable-- It's a game, and I'm gonna win because I got a head start.
You are already miserable.
Uh-- Is this important? Uh, no.
Good.
What's with you and her? Don't.
You have a thing for her? The only people who can get to you-- No.
There is not a thin line between love and hate.
There is, in fact, a Great Wall of China, with armed sentries posted every 20 feet between love and hate.
Thirty-six Vicodin.
Who's the patient? I am.
You can't-- Dr.
Wilson is the prescribing physician.
Yeah.
You will lie, cheat and steal to get what you want, but you're incapable of kissing a little ass? We all have our limitations.
House? Wrong bottle.
Do me a favor.
Take one of these, wait five minutes for it to kick in, then find Cuddy and kiss her ass.
What was the kid's first symptom? You did the history.
Of his 800 symptoms, which one hit him first? Uh, the cough.
Gout.
Um, are we talking about Brandon? Gout? Uric acid crystals in the joints? The symptoms are pain, swelling, redness, stiffness.
Not one of which do I see on that board.
Because he doesn't have gout.
Every day, cells die.
We survive because the remaining cells divide and replace the losses.
The colchicine, a gout medicine, blocks mitosis and stops cell division, which will result in abdominal pain, rash, nausea, fever, kidney failure, low blood pressure and will also mess with the bone marrow.
But he doesn't have gout.
Why would he have gout medication? Because you guys were right.
He didn't have two conditions at the exact same time.
First, he got a cough.
And because he's an idiot, he went to a doctor.
In order to justify charging $200, that doctor felt he should actually do something.
Oops.
He wrote a prescription.
Seven thousand people die each year from pharmacy screwups.
Not nearly as many as die from doctor screwups, but still, not something they use in their promotional materials.
The pharmacist gave him gout medicine instead of cough medicine.
And the only thing it wouldn't do, it would do absolutely nothing to relieve his cough.
Occam's Razor-- the simplest explanation is almost always that somebody screwed up.
But once he checked into this hospital, he was completely in our control.
Our food, our pills, our everything.
So even if you're right, no more gout medication.
He'd either continue to deteriorate, or he would've gotten better.
But he got better, and then he got worse.
It doesn't fit.
It doesn't make sense.
Okay.
Two people screwed up.
Not as simple as one, but-- He's resting.
He's-- I'm Dr.
House.
I'm your son's physician.
Oh.
You're the one we haven't met yet.
You're the one he hasn't met.
How can you treat someone without meeting them? It's easy if you don't give a crap about him.
That's a good thing.
If emotions made you act rationally, well, they wouldn't be called emotions, right? That's why we have this nice division of labor.
You hold his hand, I get him better.
If I start tucking him in at night, well, that's not fair to you guys.
And if you start prescribing medicine, well, that's not fair to me.
So, what I wanna know is, who stepped on my side of the net? Who cared enough to get stupid enough to give him his cough medicine? When we checked in, Dr.
Foreman-- Tuesday, he's getting better.
Wednesday, he's getting sick again.
Somebody gave him his cough medicine Wednesday.
Come on.
Nobody's gonna be mad.
I just wanna know who tried to kill the kid.
- Dr.
House, maybe we should-- - His throat was sore.
Page Dr.
Occam.
He's gonna wanna hear about this.
I'm sorry.
He was coughing, and I just wanted to help him-- Aren't you a dear.
Where are the pills? He took the last of'em before he was switched into that room.
They're all gone? It was just cough medicine.
No, it wasn't.
Where's the bottle? We need to know exactly what you put in this bottle.
We think it was colchicine, a gout medication.
If the prescription said cough medicine, that's what I dispensed.
The family is prepared to waive liability, all right? We just need to know what it was, what dosage it was-- It was cough medicine.
Refill it.
He's gonna be okay.
You don't know that.
Does Brandon like that quality in you? You're a little negative.
Things don't always work out for the best.
Doesn't hurt to hope they do.
No.
Not unless that makes you figure you can do whatever you want, like give people cough medicine.
This is cough medication.
This is what Brandon was supposed to get.
They're small, round and yellow.
Can you tell this man what the pills in your son's medicine bottle actually looked like? They were small, round and yellow, exactly like this.
Those were the pills that Brandon was taking.
Hey, I'm just a pharmacist, but I know what cough medicine looks like, Doctor.
It was so perfect.
It was beautiful.
Beauty often seduces us on the road to truth.
And triteness kicks us in the nads.
So true.
This doesn't bother you? That you were wrong? I try to work through the pain.
I was not wrong.
Everything I said was true.
It fit.
It was elegant.
- So, reality was wrong? - Reality's almost always wrong.
The cough medicine did something.
Aggravated the condition.
It's all over the place.
Must be in his blood.
- What if it is his blood? - Lymphoma? Unless you've got something better.
We foolishly ruled out lymphoma because his C.
T.
scan showed no adenopathy, C.
B.
C.
showed a normal differen-smear, bone marrow showed no-- Screw the tests.
Do an exploratory laparotomy and find out what's in there.
He has no blood pressure, no immune system and no kidneys.
Surgery will kill him.
Yeah, you're right.
Let's stick with the wrong pill theory.
I'll schedule him for surgery.
Okay, Brandon, we're running this tube through your heart.
and into the pulmonary arteries in your lungs.
The sensors will give us information we need for the exploratory surgery later this afternoon.
- My fingers are numb.
- Try not to move.
We're in the right atrium, trying to catch the flow through the tricuspid valve.
I think the catheter's curling in the atrium.
Got it.
We're in the R.
V.
now.
Ectopy.
- You must've irritated the heart wall.
- It'll calm down.
- He can't tolerate any cardiac arrhythmia.
Pull back.
- He needs the surgery.
Pressure's dropped.
- You still with us, Brandon? - Get the curtains.
V.
F.
Charging.
Clear.
Sinus rhythm.
I got a pulse.
Yeah, but no surgery today.
- How're you doing? - Okay.
Great.
I'm doing good too.
I get to knock off an hour early today.
You know why? Because I kissed my boss's ass.
Do you ever do that? I think she just said yes 'cause she wants to reinforce that behavior.
Wants me to kiss a lot of other people's ass, like she wants me to kiss yours.
What would you want? A doctor who holds your hand while you die, or a doctor who ignores you while you get better? I guess it would particularly suck to have a doctor who ignores you while you die.
- I should go.
- You think it's gonna come out on its own? Are we talking bigger than a breadbasket? Because, actually, it will come out on its own.
Which for small stuff is no problem.
It's wrapped up in a nice, soft package, and plop.
Big stuff, you're gonna rip something, which, speaking medically, is when the fun stops.
How did you-- You've been here half an hour, you haven't sat down.
That tells me its location.
You haven't told me what it is.
That tells me it's humiliating.
You have a little birdie carved on your arm.
That tells me you have a high tolerance for humiliation.
So I figure it's not hemorrhoids.
I've been a doctor 20 years.
You're not gonna surprise me.
It's an MP3 player.
Mm.
Is it-- Is it because of the size, or the shape, or is it the pounding bass line? What are we gonna do? - I'm gonna wait.
- For what? Okay.
It's 3:00.
I'm off.
Would you tell Dr.
Cuddy there's a patient in Exam Room Two needs her attention? And the R.
I.
A.
A.
wants her to check for illegal downloads.
Brandon's not ready for surgery.
Okay.
Let's leave it a couple of weeks.
He should be feeling better by then.
Oh, wait.
Which way does time go? He crashed during prep.
He's also experiencing pain in his fingers.
Think some bug may have gotten in the clean room.
I think we should double his dosage of G-CSF to temporarily boost his white blood cell count.
Pain in his fingers.
Right.
Hi again.
He can't-- Where's he going? Hey.
How you all doing? Interesting fact.
Every seven years, it's a whole new you.
Inspiring metaphor, huh? Dr.
House, this is a clean room.
Yeah.
I read the sign.
But cells of different organs reproduce at different rates.
- So, you get a new kidney every three years.
Get a new stomach lining every week.
This is why colchicine poisoning causes all these symptoms, but not all at once.
But we went to the pharmacy.
We saw the pills.
Colchicine does its damage in a very specific order.
First of all, there's the pain in the abdomen, the rash, the fever.
Isn't that what you got first? Then the kidneys go, which is exactly what happened to-- - Brandon.
- Right.
Then it screws up your bone marrow, and then neuropathy.
A painful tingling in the fingers and toes.
And what do you suppose happens after that? Hair loss.
The bad news is your special boy is doing drugs.
No, he's not.
Ecstasy? No.
- Twice with Dan and Mike.
- You know what they cut that stuff with? Apparently, colchicine.
Unless you ingested the colchicine through your contact lens solution, or skin cream or some other drug you're lying about.
I don't know how it happened.
I don't care how it happened.
It happened.
Start, uh-- - Brandon.
- Lovely name.
Start Brandon on FAB fragments, and get him some Tylenol for the hair I pulled out.
And get some air in here.
Make a note.
I should never doubt myself.
I think you'll remember.
You know, it wouldn't hurt you to be wrong every now and then.
What, you don't care about these people? The colchicine interferes with the ability of the heart muscle to contract, pumping blood, lowering your blood pressure.
The antibodies we're giving you should neutralize the colchicine, allowing your heart to beat at its normal rate.
When will you know? We know now.
Thank God.
Mmm.
Big weekend? It's not for me.
I'm fully stocked.
- Cuddy got you doing inventory? - Nope.
Trying to solve that kid's case.
The gout medicine O.
D.
? Yeah.
The fact that I know it's a gout medicine O.
D.
would indicate the case is already solved.
Well, you'd be wrong.
What about the fact that the kid is now-- I believe the technical term is-- "not sick"? You know how many forms of colchicine there are on the market? - Stop it.
- Neither do I.
But it's a lot.
Pills, powders, liquids, I.
V.
fluids.
Somewhere at a party, in his coffee, up his nose, in his ear, this kid had some.
You're not happy with your Ecstasy theory? - He said he used it twice.
- People lie.
- If you're gonna lie, it's-- - You know what? I'm not interested.
- Not curious? - No.
Because I'm well-adjusted.
Right.
Temperature's normal.
I want cousin Sharon there.
If we invite Sharon, we have to invite all the cousins.
So what? My side of the family doesn't need anything.
I don't suppose I could have some of those cough pills, huh? They're okay, right? - Yes.
You're doing great.
- You should invite Dr.
House.
- Will he come? - No.
But he'll send a gift.
I'll make sure it's a good one.
There's a letter on the back of these pills.
Your old pills didn't have a letter on them? No.
Round and yellow, but no letter.
Well, these will help your cough.
Hey, you wanna go get some-- No.