House, M.D. s02e03 Episode Script

Good morning.
Hey, Alfredo.
You done already? No.
Not yet.
I finish tomorrow.
Mexico playing Argentina on TV? No, no.
My asthma is very bad today.
Six years, Alfredo.
You can't lie to me.
I'm throwing a dinner First thing tomorrow Party's tonight.
A little rain and I'm gonna have to put buckets on the dining room table.
No clouds, no rain.
I'll tell you what.
You take off, but if it pours into my guests' wineglasses Okay.
Okay, senora.
I'll do it.
Thank you.
Spinal cord seems intact.
Take a deep breath.
It hurts.
Try.
Breath sounds bilateral.
I don't think he has a pneumothorax.
Just asthma.
That and probably a broken rib.
Tell me when it hurts the most.
Your two little fingers are darker than the others.
They feel funny.
Como needles.
How long have they been like that? Never noticed before.
Is bad? Judging by how it looks, he could lose his hand.
How does falling off your roof do that to a guy's fingers? He could have tweaked a vertebra in his neck.
Could impinge the ulnar Sorry, trouble concentrating.
That tank top really absorbs moisture.
Could impinge the ulnar nerve, cut the blood flow.
Or it could be disseminated intravascular coagulopathy.
DIC? Guy falls off a roof, the first thought is always, "It's a clotting problem.
" Trauma can activate the clotting enzymes.
Guy could lose more than his hand.
Thank you very much.
This guy's been working for me for a long time, and I Do I get bonus points if I act like I care? Cervical MRl.
Work up for DIC.
And start him on a heparin drip.
Who? You wanna know his name? I'm sure it's in the file.
Or you could ask her.
She's his oldest, bestest friend.
They were in Cub Scouts together.
I'll get started on the blood tests.
You haven't been a real doctor in 10 years.
You'll make a mess all over the sheets.
I'll do it.
You have clinic duty.
I still know how to handle a patient.
Get me blood.
Lots of blood.
They're better.
They've showered.
You don't need to see him.
One-handed handymen aren't in big demand.
Talking.
That's how lawsuits 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.
" You think I'm an idiot.
I think you're not a lawyer.
Don't go in there.
Trust me, House's people can handle this.
Yeah.
This might sting a little bit.
The medicine will thin the blood and help it to circulate.
Those are pretty nasty scars there.
I work construction.
How long will I be in the hospital? Depends how long it takes us to figure out what's going on.
I need to work.
I'll get fired.
I'm sure Dr.
Cuddy won't fire you.
I'm a janitor at fast food six nights.
I need to work.
My mother doesn't make enough.
I can work.
I'm old enough.
You're old enough when you finish college.
Why? You never went I never had a big brother to tell me to shut up! I promise we'll let you out of here as soon as we're able to.
Look, I I am fine.
Okay? I feel better.
I go home now.
No.
If this is a clotting problem, it could be very serious.
All right? Look, you can't make me stay.
Wait You can't make me stay.
Turn your hand over.
I need to see your hand.
Where's Dr.
Cuddy? We've got a third finger turning dark.
His PTT is prolonged and the fibrin split products are off.
He's not clotting properly.
It looks like a mild case of DIC.
Well, obviously not that mild.
This keeps up, his hand is literally gonna be dead meat.
His hand is connected to his arm, and his arm is connected to I'm not sure, but I bet it's important.
All this from falling off my roof! Yeah.
If only he'd fallen on his head.
Then he wouldn't have any of these symptoms.
We need something stronger than heparin.
Human Activated Protein C.
Looks like Cuddy, same cleavage.
Protein C is indicated only for severe sepsis.
How many of his limbs have to be at stake for it to be severe? But this stuff is crazy dangerous.
It can cause internal bleeding.
If he bleeds, he could stroke, he could die.
He could get better.
You know, if I try to scheme like this, you get that nasty wrinkly face and screech like a hyena.
It's very sexy, I admit.
Do it.
Protein C is borderline irresponsible, except that the safe stuff isn't doing squat.
It's exactly the type of thing you would do.
Obviously.
It's exactly the type of thing he'd do.
I know.
I think he's trying to protect me.
Now, that's not the type of thing he would do.
I overruled him.
He's the best diagnostician in this hospital, and I overrule him.
You care about this kid.
Your judgment should be worth more than his.
He also pointed out that I haven't been a real doctor in years.
Now that sounds like him.
You were just jerking Cuddy around? She seriously thought I wanted to stop her.
One thing Cuddy is not is clueless.
No.
First casualty of this case is her sense of humor.
That's weird.
There's nothing funnier than almost killing a guy.
I'm just having trouble getting up those steps.
When did you start noticing? Oh, a week ago.
Your blood pressure's a little high.
I've got something new that should help you out.
It combines a nitrate with a blood pressure pill.
It's targeted to African-Americans.
Targeted? Yeah.
Well, see, we tend to have nitric oxide deficiencies.
And the studies show this drug counteracts that problem.
It's the first drug to What kind of studies you talking about? What kind of studies are there? They get some patients.
They give them some drugs.
I've had white people lying to me for 60 years.
You think this is a tan? You think they tell you everything? The trouble with us black folk, we can't tell the difference anymore between racism and everybody gets screwed.
Yeah? Well, how about them cheap meningitis drugs they're pawning off in Africa? Gonna tell me that ain't racism? That's just greed.
You really wanna screw whitey? Be one of the few black men who live long enough to collect social security.
Take the medicine.
Nurse.
Nurse! Help! Nurse! Help! Nurse! What's up? I can't move my arm! I can't move my arm! Take it easy.
Take it easy.
The Protein C side effects we were worried about, they happened.
Where was the bleed? His brain.
It's causing right side paralysis.
I've stopped the treatment and called a neurosurgeon.
I can move it now.
It's okay now, yes? Can I go home soon? The surgery went well.
But all we did was fix the problem created by the medicine we gave you.
She says you You look young.
Are you sure There's five of us working on the case.
The others are older.
Why doesn't Dr.
Cuddy come to That doesn't sound too good.
His fingers are even darker.
His temperature's 102 and spiking.
And the x-ray now shows lung infiltrates.
Well, the good news is he won't be bitching about losing his hand if he can't breathe.
The trauma from the fall could have caused acute respiratory distress syndrome.
Right.
I forgot.
Your roof.
It would cause lung infiltrates and maybe fever and conceivably the cyanotic fingers.
The only question is why.
Why what? Why her weird psychopathology requires a diagnosis informed 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.
Well, pneumonia can cause DIC which can cause cyanotic fingers.
Pneumonia doesn't hit that fast.
Sure.
Only pavement hits that fast.
It's not pneumonia.
He might have missed a finger turning dark.
He's not gonna miss breathing problems.
What else? 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.
Well, why didn't you just take out a gun and shoot him? I thought it was just asthma.
You might've mentioned this earlier, Doctor.
Maybe we could have sent some blood cultures to the lab instead of wasting a day indulging your self-loathing.
If it's just garden-variety bacterial pneumonia, he's gonna be fine.
So give him garden-variety Levaquin, and a garden-variety echocardiogram.
And go check out the kid's house.
The blood work will show us which type of pneumonia it is If he's huffing nail polish or pulling the wings off his pet parrot, this way'll be faster.
And I bet Julio's just dying to find out what's wrong with him.
Go with her.
It's Alfredo.
And I can handle getting a key and Rico and I no longer trust you deciding what's important and what's not.
You ever think about writing a book on office politics? Trust me, it would be a lot worse if I told her that you had to break into her house.
What? Wait, wait, wait Cuddy's house? See? It is shocking.
The guy's been working there every day for the last three weeks.
You think it's impossible he could've picked something up? I'm not breaking into my boss's house.
I'm your boss.
She's scarier than you are.
She's a woman.
Relax.
I'm coming with.
House is having lunch with his juniors now? No.
Not a chance.
Then where do you think they're going? I have no idea.
Then why don't you think they're going to lunch? Because it's not like House.
That was your point, right? He had that smug look on his face.
When he's that pleased about something he's gotta tell somebody, and the only somebody he knows is you.
He's breaking into Cuddy's home.
What? Why? Medical reasons? Why is he so curious about Cuddy? Why are you so curious about his curiosity? Why are you so curious about me Because you dumped him and you're married and they are neither of those things.
I'm just curious.
Nothing wrong with that.
No.
Nothing wrong with that.
What do you think? Red thongs? I think red thongs.
Okay, 20 bucks says I can get through this door in 20 seconds.
You're on.
Count me in.
No furniture polish, no paint thinner, nor anything else worth sniffing.
Nothing in here, either, except a few cockroaches.
Nice.
Someone should fix Alfredo's roof.
So, why haven't you fired House? It's just, you guys are always screaming at each other, and I figure you hate him, so I don't hate him.
Why not? He's a great doctor, but any other hospital administrator would have fired him years ago.
Four of them did.
The question is, why did I hire him? So, how'd you know about her key? You been doing a little handyman work for Cuddy yourself? Someone as obsessive and insecure as Cuddy probably has three extra keys hidden away within 10 feet of the door.
And you consider obsession a negative quality.
Insecticide is organic.
Soap is hypoallergenic.
I got the bedroom.
This is where it all happens.
You both went to Michigan.
Did you know him while you were there? I was still an undergrad, but, yeah, I knew him.
He was already a legend.
So you just knew him as a legend? My God, you're subtle.
Anything on your mind? More cockroaches? Worse.
Beautiful.
There's no way you just deduced where that key was.
Does this count as red? You gave yourself 20 seconds and put money on it.
Oh, my God.
She's got pictures of you in here.
Just you.
It's like some kind of weird shrine.
You're kidding.
Yeah.
She uses super tampons.
What does that mean? You two are just too nasty to each other not to have been nasty.
I can be a jerk to people I haven't slept with.
I am that good.
There's nothing here.
You ready to go, or you got some more stuff you wanna sniff? Whoa! Check this out.
It's fuzzy.
It's black.
It's alive.
Patient's lung function's declining rapidly.
Levaquin's not working.
He obviously doesn't have garden-variety pneumonia.
I'm glad you learned to take his impending death in stride.
Guess what he does have.
Rats.
Scars on his hand.
Rat bites.
But he says they're from construction work so he won't have to admit he's got rats at home.
Catholics are right.
Pride will kill you.
He has streptobacillus.
Rat-bite fever.
Boogie oogie oogie.
Fits the symptoms perfectly.
That's certainly one possibility.
But what about the aspergillus fungus we found under the sink? What sink? You ought to clean your bathroom better.
You broke into my house? No.
No.
You're wrong.
I had a key.
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.
Oh, damn.
You're right.
The focal consolidation makes fungal pneumonia far more likely.
You're right I'm right.
On the bright side, it has the advantage of keeping you totally responsible.
The treatment for aspergillus is amphotericin.
That's hugely dangerous.
Yeah? Your point being? Going the dangerous and aggressive route didn't work the last time.
It's bound to work this time.
Start him on the amphoterrible.
Dr.
Cuddy? I'm Manny, Alfredo's brother.
How's he doing? He's worried about money.
I wanna work for you.
How old are you, Manny? Fifteen.
Twelve? I can paint.
I mow lawns.
I rake leaves.
I can start today.
Alfredo wants you to finish school.
Like you care.
Manny, I've known your brother He falls off your roof, and you don't come see him once? Bitch.
With a patient.
Not according to the log.
It's 3:15.
Is it a commercial? How's Cuddy doing? She's not acting like Cuddy.
It's a pleasure.
You know her.
She has trouble with these situations, feels personally responsible.
The technical term is narcissism.
You can't believe that everything is your fault unless you also believe you're all-powerful.
Wow, does she sound messed up.
I don't believe I can fix everything.
And I don't lie awake at night, tormented by that fact.
No.
You lie awake tormented by how I thought we were talking about Cuddy here.
She cares.
She enjoys feeling guilty.
Lisa cares.
It's why she drives you nuts.
'Cause it's not just a puzzle to her.
The patients are actually real, their feelings actually relevant.
And I'm telling her she can't even talk to him.
My God, it's contagious.
You're feeling guilty, too.
I'm just saying, take it easy on her.
You owe her that.
From the moment I saw you at the El Commercial's over.
So glad we talked.
Snap, crackle, pop.
You got some Rice Krispies in there? That bad, huh? 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.
I didn't fill that Oreo's prescription.
On the theory that you didn't trust him because he's black.
Well, I'm gonna prescribe the same medicine and see if you fill it this time.
I'm not buying into no racist drug, okay? It's racist because it helps black people more than white people? On behalf of my peeps, let me just say thanks for dying on principle for us.
Look, my heart's red.
Your heart's red.
And it don't make no sense to give us different drugs.
You know, I have found a difference.
Admittedly, it's a limited sample, but based on my experience of the last 90 seconds, all black people are morons.
Sorry, African-Americans.
I'll see another doctor.
Fine.
Fine.
I'll give you the same medicine we give Republicans.
I think the medicine is working.
They're lighter, right? They don't look lighter to me, Alfredo.
How's the tingling? Does not bother me.
Tell her the other thing.
He hasn't peed since yesterday.
Since last night? Afternoon.
It's not a problem.
I don't drink much.
I think we'll give you a little rest from the meds here.
She says, "That's the medicine that's supposed to cure me.
" Just making a little adjustment.
Excuse me.
He's not making any urine.
I think we just destroyed the kid's kidney with the amphotericin.
I think he's dying.
Dying? Cheese it, the cops.
I guess she understands a little English.
His kidneys are shutting down due to the direct toxicity to the proximal tubule epithelium.
Proof that my brilliant idea of giving him amphotericin is killing him.
That wasn't a complete waste of time.
His reaction shows that you don't need to clean under your sink.
It wasn't aspergillus.
And blood cultures show he was negative for rat-bite fever.
There's still plenty of other cool pneumonias.
Tested negative for Moraxella, Nocardia, cryptococcus.
He has a low titer for chlamydia antibodies.
Maybe No, no.
His chest x-ray's all wrong for chlamydial pneumonia.
But the titer points to He had an STD last year.
That explains the titer.
He has low sodium.
Maybe it's Legionella.
No.
His antigen is negative.
Well, that all sucks.
Maybe we were right to begin with.
His problems are all caused by DIC precipitated by falling off my roof.
DIC wouldn't cause a fever this high.
See? My lap dog agrees with me.
How high? Two hours ago it was 103 with acetaminophen.
What about on St.
Alban's Day? Only temperature I'm interested in right now is his temperature right now.
Open up.
Okay.
Let me clarify.
Open up and keep it open.
Yeah.
Okay.
Under your tongue.
You're using your left hand.
Right one hurt? No, I feel better.
What, it really doesn't hurt, or you just figure if you say no, you'll get out of the hospital sooner? It doesn't hurt.
I feel good.
You don't smell too hot.
Your hand is starting to rot.
Why are we here? We are talking about cutting off a kid's hand.
Yes, we're talking about cutting it off, not subdividing it and putting in condos.
It's not a legal issue.
Are you being intentionally dense? I think it's premature.
I've heard enough.
What? She says one word and you take her side.
You should at least wait until she actually gives a medical reason.
Otherwise I might take it personally.
Shut up.
If I were to somehow find out that you two were 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? Okay? All of his symptoms are caused by his underlying problem and the medicine we gave him.
What underlying problem? You have no idea what the underlying problem is.
You're the diagnostician.
Fine.
It's all my fault.
Does that make you feel better? His hand still has an arterial pulse.
His hand is a cesspool.
And the crap is spreading.
You are being pretty aggressive about destroying a man's livelihood.
I don't give a damn about his livelihood.
He loses that hand, he loses his job, all of his jobs.
He's not like us Can't work as a cripple? He loses his home.
His kid brother drops out.
An American dream destroyed.
Very sad, very emotional, not one medical fact in the whole pathetic tale.
You have lost perspective, Cuddy.
You've stopped looking at this as a doctor.
You're acting like someone who shoved somebody off their roof.
You wanna make things right? Too bad, nothing's ever right.
I am happy to report that we're now so in sync we're actually wearing each other's underwear.
Chop-chop time.
Is this true? No.
I'm lying.
It's stupid to do it with her in the room, I guess.
This is a big decision.
We made it.
We should convene a meeting of the ethics committee.
No! Look, she is making a medical decision based on never wanting to feel regret.
You're making a legal decision based on wanting me to be wrong.
Greg, you have a history of aggressive You wanted superficial agreement.
You wanted everybody's asses covered.
You got it.
Now can I do the surgery? Pretty, pretty please.
Lisa, are you sure you're okay with this? I should be the one to tell the family.
Your hand is dying.
The bacteria are eating it.
When they run out of food there, they go somewhere else.
If you cut off my hand, I'll be cured? 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.
I quit school when I am 12 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.
He's the best in his class.
Well, maybe Manny doesn't have to quit school.
Maybe you can Are you sure I need to do this? Yes.
Okay.
Okay.
I gave one of my clinic patients a follow-up call.
Your name came up.
I'm guessing an old black guy who thinks the CIA invented rap music to make your people want to kill each other.
He said you gave him the white folks' stuff.
This is exactly why black people don't live as long This isn't about race, unless annoying is a race.
Is he not getting better? He's fine so far.
I'm calling him back in.
I'm getting him on the right stuff.
Relax, Foreman, he already is.
I told him it was the white stuff.
I gave him the black stuff.
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.
Just a white lie.
Good one, massa.
Right, and I'm a racist.
Too bad that idiot will never know for the rest of his long, long life.
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.
We'll give him four walls, a bed.
We'll civilize the heathen.
I'll tell you what.
Stop doing 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.
You okay? You wondering if you made the right call? I've wanted to be a doctor from the time I was 12.
I wanted to be a lawyer from the time I was six until my second week of law school.
Sorry.
Your story.
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 Sad story.
If I had been Alfredo's doctor You are his doctor.
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 home and ignored mine.
I would have watched him die trying to save his hand.
If I didn't have House looking over my shoulder Are you saying you're not as good a doctor as House is? I'm saying House is right.
I was so anxious to get ahead.
I haven't been a doctor in years.
His little finger is dusky.
Yeah, that's why we're doing this.
No.
I mean the other hand, the one we haven't chopped off yet.
His O2 sats are down to 88.
His lungs are giving out.
He needs a ventilator.
And dialysis.
You're getting distracted by the multisystem organ failure.
Pinkies are supposed to be pink, right? I mean, they're not called "gray-ies".
But the organ failure is gonna kill him.
But the pinky is weirder.
What does it tell us? The same thing the right hand told us before we cut it off.
It's the same symptom.
But at a different time.
His blood work indicates mild DIC.
What if it's mild in the way that when you get out of the ocean, the water clinging to your body makes the sea level drop? It's technically true, but it's completely irrelevant.
A lack of DIC would explain everything if there were also a lack of anything to explain.
Endocarditis.
His heart's infected.
Little bacteria cauliflowers, clinging to his valves.
Except sometimes 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.
And we all know what Saturdays are all about.
Party with the left hand.
Also explains the fever.
It's perfect except for the little fact that we already tested for endocarditis, and he was negative.
Which means he either is negative or What infection can cause pneumonia and culture-negative endocarditis? Prize value goes down with every clue.
You're thinking psittacosis? Alfredo doesn't have any pet parrots.
Quit your squawking.
Give him doxycycline.
No! That'll just make his clotting problem worse.
I liked you better when you were coming up with wacky drugs for us to try.
We give him the doxy now, damn it, maybe we can save his pinky.
He can teach his brother to count all the way to five.
If you're wrong, he'll end up with no hands and no feet.
Technically, if I'm wrong, he'll end up dead, but I take your point.
What's his night job? He cleans up at some fast food joint.
What, you think he got it from a chicken nugget? Since when do fast food joints allow 12-year-olds to mop floors? Alfredo is 20.
Really? Looks younger.
Where were you going to work tonight? What job do you do on Saturday nights? What are you doing? Wake him up.
We just cut off his hand.
Yeah.
We need to talk about it.
It's not happening.
Honest, I've got no idea what I just said.
Why didn't you say you spoke Spanish? Well, because she'd wanna talk to me.
Or something like that.
She says he doesn't work Saturday nights.
Give me the talking juice.
The fact it doesn't fit your theory doesn't make it a lie.
When she was out of the room, the kid brother insisted he was gonna cover for Alfredo at work tonight.
Saturday nights he goes dancing.
Either it's a lie or he's dancing with birds.
Give her the talking juice.
She doesn't know what you're talking about.
Odds are it's gonna be close to his house.
It's probably an abandoned warehouse or factory.
Take the Scooby gang and spread out.
What the hell are we looking for? Find somebody who looks like crap.
Tell him you want to place a bet.
It's Cuddy.
I already put him on the psittacosis meds.
As soon as you left.
You're welcome.
What do you think the record for one-handed juggling is? You can yo-yo one-handed.
Good point.
I always wash my hands.
If a bird is infected, you can get psittacosis just from breathing his dust.
But then, why do I get sick and nobody else? Your asthma made you vulnerable.
You're gonna be all right now.
Yes.
For saving my life.
He thanked me.
He should have.
We cut off his hand.
If we'd figured it out earlier If you'd figured it out later, he'd be dead.
I never figured it out at all.
Hello.
What do you want, House? If you're wallowing in self-loathing, I've got something that might help.
We're getting sued.
You saved his life.
He admitted that.
We'll settle.
He's got a stub where his hand used to be.
We have insurance.
Case seems pretty solid to me.
The new American dream.
Happy ending.
Kid's gonna be just fine.
Cuddy, your guilt.
It's perverse and it makes you a crappy doctor.
It also makes you okay at what you do.
You figure a perverted sense of guilt makes me a good boss.
Now, would the world be a better place if people never felt guilty? Makes sex better.
You should have seen her in the last months of our relationship.
A lot of guilt.
A 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.
And what you don't see is what everybody else sees, the giant gaping chasm in between.
House, I'm not naive.
I realize If you did, you never would have hired me.
You're not happy unless things are just right, which means two things.
That you're a good boss, and you'll never be happy.
By the way, why does everybody think you and I had sex? You think there could be something to it? Cuddy feels guilty about not diagnosing psittacosis any earlier? I think so.
There's no way she could have.
No.
No way she could have.
It's raining.