House, M.D. s02e12 Episode Script

All right, hold on.
I got the turn up here.
Oh! How cool was that? That was way cool! My turn.
Sorry, that's not allowed.
I just signed you gotta ride on the back of that thing.
I don't see any lawyers around.
You know that's not the point.
No.
You just wanna keep all the fun to yourself.
Come on, Dad! You go over 15, we're pulling over, all right? I mean it.
You're the best.
All right, get on there.
Put on your goggles.
Okay.
Ready? Got the clutch in? All right, that's my boy.
Adam, you're going too fast, slow it down! I mean it, you're going too fast.
Slow down! Adam! Adam! Let go of the throttle! Adam! Adam! No! What've you got? Sixteen-year-old, status post, ATV crash, Nasotracheal intubation.
Start a bag of lactated Ringer's, wide open Will he be okay? We'll be with you when we can.
Get him out! Wait, wait, wait! I'll start fluids.
Let's go get him hooked up.
Watch the line.
Been looking for you.
Been avoiding you.
Burn Unit can handle it.
If they could handle it, they wouldn't be asking for you.
Is that a journal? Friend wrote an article.
In Hindi? They have a cutting-edge neuroscience program in India.
It says so right on the cover.
Kid's heart rate's messed.
Tachycardia can be explained by the burn.
I assume the Burn Unit knew that.
His potassium's low.
Which can also be explained by the burn.
Except I'm sure the Burn Unit's pumping him with fluids which means his potassium should be going up, not down.
Could be amphetamines.
Or bacteria lunching on his heart.
Or cardiomyopathy, or some other very bad thing.
He needs an EKG.
Okay, no skin, no EKG.
Is he even gonna survive the burn? What, you got a date or something? Forty percent of his body.
If the Burns Unit can prevent an infection, his body will regenerate maybe 10%, surgeons will do 20 or so grafts, six months in this room, he'll end up with a series of nasty scars, maybe some pain, but he'll live.
Unless his heart shuts down 'cause we can't figure out what's causing the low potassium and tachycardia.
We need help from a Belgian doc named Einthoven.
He's dead.
While he was alive, he invented a little dittie called the Galvanometer.
Where do we get one? Go to any electronics store that's been open since before 1905.
There's a good chance they've got one in a corner in the basement.
We need an audio-visual setup for the lecture hall.
What for? For the lecture.
What lecture? Dr.
Weber's lecture.
Who is Dr.
Weber? A neurologist, I think.
The memo was from you.
Where is my assistant? She left.
When? Wednesday.
Seriously? Well, the temp agency sent someone, but she got lost.
Well, when she gets here, fire her.
Oh, yeah.
Did you issue this memo? Look at that.
Congratulations.
The patient that has been in a coma for two years and counting is still in a coma.
This is not my signature.
I don't know anything about this guy.
I'm supposed to introduce him? Have lunch? The coma patient has a migraine? Oh, no, no, no.
No, I gave him medication to prevent a migraine.
That's a migraine.
Increased flow velocity in his cerebral arteries.
I did subsequently give him nitroglycerin, which could possibly You induced a migraine headache in a coma patient? I gave him a little headache, similar to the one you're giving me now.
Have you even read an ethical guideline? Well, it would be wrong to try out a new migraine prevention medication on someone who can actually feel pain.
Did you sign this? Yeah.
We can talk later about the appropriate discipline.
Because of the burn, we can't perform any of our normal tests to see what's wrong.
So we're going to try a Galvanometer.
It picks up a pulse in the wrists and the ankles.
Hopefully it'll tell us why his heart rhythm is abnormal.
What have I done to him? I It was an accident.
All right? So He's got all these burns and now there's something wrong with his heart? We're trying to figure out if the two are somehow connected.
Had he been sick lately? No, nothing.
Anything unusual with his behavior? Had he been tired a lot? Nothing.
He was great, he was happy, he was just having a great time, and then If he was experimenting with amphetamines or cocaine No.
We gave him some pot about a year ago, to try It was just once.
We thought if we took the mystery out of drugs and alcohol, the less he'd experiment.
We'll know more after the tests.
It looks like they're gonna electrocute him.
Plug it in.
You plug it in.
Fine.
Give me the cord.
Works.
Prominent U waves.
No inverted T wave.
No ischemia.
Q wave normal.
That's not good.
Okay, turn it off.
Turn it off! What's happening? What is that? The seizure's getting Can't you stop that? Who electrocuted my patient? He had a seizure.
He wasn't electrocuted.
What does the seizure tell us? Move.
What are you looking for? Same as you are, love, acceptance, solid return on an investment.
Differential diagnosis.
Go.
Could be epilepsy or seizure disorder.
Not with the tachycardia.
It could be a virus in his brain.
Your specificity's impressive.
Adrenoleukodystrophy.
Could be MS.
The seizures could be caused by plaques and lesions on the brain.
Well, let's find out which.
Get him an MRl.
No nuclear imaging! He wouldn't survive the move to Radiology.
MRl and CT scan are both out.
Okay, lumbar puncture will tell us if his proteins are elevated, at least we can exclude MS.
We can't do a lumbar puncture either.
You're cramping my exits.
Don't tell me, no skin on his spine.
We'd be inserting a needle into an area that's teeming with bacteria.
If he doesn't have a brain infection already, we'd give him one for sure.
There's no other way to look at a brain.
Transcranial Doppler Sonography.
She said "brain," not "pregnant woman's uterus.
" They do sound alike.
I used one to look at a brain this morning.
Why didn't you take the patient to Radiology, get an MRA? Obviously I was doing something illegal.
Using nuclear imaging would have raised questions.
You're not gonna get a diagnosis of MS from a sonogram.
Not definitively, but patients with MS have more reactive neurons in their occipital cortex.
Okay then.
Thank you for all coming to today's lecture by Dr.
Phillip Weber, who is our guest today at our hospital to talk about headaches.
Dr.
Weber is at the Weber Center for Pain, that makes sense.
Weber, Weber.
So please welcome Dr.
Weber! Thank you Dr.
Cuddy.
I suppose I should tell you a little bit more about myself.
I went to school in Virginia.
You've never been to one of these things in your life.
Who is this guy? No idea.
What's with the outfit? Sudden chills and light sensitivity.
Inexplicable.
I received my medical degree at Johns Hopkins University, where I studied under Brightman and Gilmar Hmm.
He must be good.
You went to Hopkins, and studied under Brightman and Gilmar.
Shh.
helped me win the Doyle Internship at the Mayo Clinic.
You were supposed to get the Doyle Internship.
This guy's Von Lieberman? The guy who got you thrown out for cheating? The dean threw me out.
Von Lieberman just ratted on me.
This guy's name is Weber, not Von Lieberman.
I call Weber Von Lieberman, way eviler.
Shh.
1D receptors have improved the acute treatment of migraines, to this point So what's the plan? You gonna wait until he bends over and make a fart sound? I'm not here about the past.
He's a bad scientist.
Well, you cheated off him, how bad can he be? He got the answer wrong.
Are they trying to wake him up? They can't do that, right? He'll be in too much pain.
Don't worry, he's still under.
But the brain never completely sleeps, it's always working.
Controlling your heart rate, breathing, temperature.
The eyes respond to visual stimuli.
Blood flow increases in certain areas of the brain and we can track that with a sonogram.
With MS, blood vessels are more reactive, so flow is faster.
If Adam has an infection, there'd be swelling, which would constrict the arteries.
And the flow would be slower.
Chase.
Near the subarachnoid space.
Data from control subjects were analyzed of a two-way ANOVA with status and side as within-subject factors.
You stalked this guy for 20 years just for this shot to humiliate him? I'm trying to learn.
vessels without significant rebound He doesn't even know what that means.
You're gonna interrupt him, aren't you? If I have a question.
And what's that gonna accomplish? Why can't you just enjoy this? Why can't you just be happy for me? You have got to find less debilitating outlets than humiliating people.
I hear bowling is more fun than stalking.
But I'm better at this.
if "P" is less than point-zero Blow a ton of money on a plasma TV.
We found a subarachnoid bleed.
Bleed in the head isn't causing seizures.
It could be.
10% with damage to cerebral cortex have a seizure.
Or bacterial meningitis.
Viral encephalitis? There's no way to tell without Shut up! Excuse me.
Not you.
You know, if my lecture is interrupting your meeting, I can wait.
As your people say in India.
Appreciate it.
We'll figure out why later.
Fix the bleed or he dies.
Talk to you in a couple hours.
I'm in the subarachnoid space.
Can you get it? Think so.
Put the probe back where it was so I can see the wire! We're looking for the bleed in Look when I get there, I'm flying blind without a contrast CT here! and with a p-value of less than 0.
001, we have strong statistical evidence that this drug prevents migraine headaches without daily administration.
Excuse me, Doctor.
He knows his field better than you do.
It's always been my understanding that, unless you follow a daily regimen, no drug can prevent a migraine.
That's why they call it a breakthrough.
That's why you call it a breakthrough.
No, the pharmaceutical company sponsoring my clinical trials also hails it as a breakthrough.
I'm sure your wife and lawyer do, too.
Is there anybody who doesn't stand to make a fortune from it calling it a breakthrough? Who are you? Just a lunatic who desperately needs a hobby.
How exactly do these studies work? Do you give this drug to a bunch of people, and if they don't get a migraine, you go, "VoiLa, my drug works"? Excuse me, miss? Do you have cancer? Wow! Mango juice prevents cancer.
Perhaps I should have taken my medication before this lecture.
We had a very specific control group, chronic migraine sufferers.
I don't have time to go through all the math right now, but the incidence was dramatically Sure, in India.
Two plus two equals five there, right? Do I know you? I know your math skills.
They blow.
Touche.
You sound very familiar.
Why did you publish it in an obscure journal in India? Why not publish it in really, really cool head cases of South Philly? Neuroscience New DeLhi is a respected journal.
Yeah.
The guy running Slurp N' Gulp tells me it's one of the best.
Get a hooker, anything.
See, I'm thinking that publishing studies is probably the easiest way to get a pharmaceutical company to give you a reach-around.
And choosing a journal that no one can actually read, well, that's That's shrewd.
I know I know you.
Sure you do, Dick.
The name's Philip.
My bad.
Something to do with your face.
I always think your name is Dick.
House? Here.
Medical school was 20 years ago.
Give it a rest.
Grow up.
Yeah.
You were always the grown-up.
Do the responsible thing, tattletale! You cheated! I cheated then, you're cheating now! Your drug doesn't work.
Oh, yes, you would like to believe that because it plays right into your fantasy I tested it.
Oh, really? What are your parameters? Where's your study? Room 2134.
One patient? The coma patient? You haven't changed a bit.
You took shortcuts in med school, you're taking shortcuts now.
You cannot test this on an abnormal brain.
That's so close-minded.
He's not abnormal, he's special.
Cerebral cortex atrophies in coma patients.
You need live, conscious people.
You don't know everything, House! Something that disrupts brain function.
Plaques are perfect.
Interrupt neuronal communication.
MS? No, MS is complicated.
I think this is more basic.
It's just tachycardia and seizures.
How much longer the Burn Unit guys gonna keep him in that thing? Lecture's over, let's go.
House wants to Adam's waking up.
Get the anesthesiologist in here now.
He's in pain.
That's not pain.
Need some help in here! Adam had an orgasm.
What? You mean, while he was sedated What's wrong? I'm having a migraine.
Are you okay? Yes.
I was right.
I'm gonna knock you out for a couple of hours.
No, I got work to do.
Just give me sumatriptan for the pain and verapamil so it doesn't recur.
I heard the patient had fun in the hyperbaric chamber.
Yeah.
Gotta schedule me some time in there.
Weber's meds aren't even legal in the U.
S.
It's legal in India.
I was disoriented.
Moving around is a bad idea.
Hey, if you feel chest pain, you need to let me know.
Verapamil can cause congestive heart failure.
Nothing can hurt my heart.
Hey, you're gonna feel some dizziness.
Definitely gonna be constipated.
Differential diagnosis for getting off.
Is he gonna be okay? No.
Something's seriously wrong with him.
Differential diagnosis for ejaculation.
Don't make me say it again.
We're not stalling, we just don't know.
Then guess.
Could pain medication cause an orgasm? I wish.
Maybe pain caused the orgasm.
You get a tattoo, the brain releases endorphins which create pleasure.
Most people don't orgasm from a needle prick.
Well, Chase has a point.
The brain is like a huge train station, if the switches You're the neurologist, talk for me.
If sensory information got misinterpreted by the medial forebrain bundle, it's possible for bad to feel good, and good to feel bad.
He's a lucky kid.
Let's not fix him until the burns heal.
So what attacks the medial forebrain bundle? Infective neuropathies, vasculitic neuropathies Krabbe's disease, metachromatic leukodystrophy.
All very bad things.
No way to look for any of them in his condition.
Could be an infection.
I said infection about eight seconds ago.
You listed some brain infections.
But what if it's just a regular old infection festering in the burned skin? Pus on his arm isn't causing problems in the forebrain.
He's on 20 different medications to manage his pain, his heart, how often he urinates.
His brain is like a waiter that's got too many Hey, hey.
I do the metaphors.
The brain is stressed.
An infection elsewhere could put it over the edge.
So we just wait for his burns to heal to see if you're right? If you're wrong, he doesn't have that kind of time.
Dominic Larrey.
He another dead doctor? He's Napoleon's Surgeon in Chief.
Cleaned a lot of battle wounds.
By amputating legs.
And with bugs.
Maggots are implanted directly into Adam's burns.
Maggots, they eat dead people, I Maggots eat dead flesh.
Only dead flesh.
So they're perfectly suited to clean wounds.
They also kill the bacteria that thrive in injured tissues.
Dr.
Jekyll, I presume.
They found a half-eaten sheep in the zoo.
The police wanna ask you a few questions.
I need something to wash it down.
Coffee? Bad idea.
You're better off with water! Coffee's closer.
Foolproof plan, by the way.
Either his meds would work, and you'd be in psychic pain because Von Evil is gonna be rich.
Or they wouldn't, and you get to be in agony all day.
Perfect lose-lose situation.
Very you.
I had to prove You've proved nothing.
Right.
This isn't a migraine.
Yeah.
"Dear New EngLand JournaL of Medicine, "I took this guy's drug and still got a headache.
"Thus, scientifically proving that my arch enemy is an idiot.
" You just wanted the pain.
Meds are supposed to prevent migraine.
You get distracted by pain.
Leaves less room for the things you don't wanna think about.
Like the Flyers sucking, or the price of gas, or the fact that you pushed the love of your life out of your life.
God, I wish the pain would go away.
Next time you need to get your mind off her, stick a needle in your eye.
It's less annoying to the rest of us when you can still walk.
Did you sleep here? Lower.
Do you want a pillow? Not softer, lower.
Frequency of your voice is grating.
You should've been better by now.
I'm super.
Patient? The maggots did great for the burn.
But the brain waves are still all over the map.
Which means your regular old infection isn't causing his brain dysfunction.
Which means there's an underlying condition, which means we've gotta get inside his head.
Do a lumbar puncture.
We've already established that we can't get a lumbar C2, C3.
No.
No.
No way.
I only saw a cervical tap once, and that guy got paralyzed.
Ask the parents if they prefer to have their son in a wheelchair or dead.
Something's causing his brain to lose control.
Eventually it'll shut off.
We need to do a lumbar puncture to get some of the fluid in his spine so we can test it.
You need us to sign a consent? I have to warn you.
There's a serious risk of paralysis or death.
Are you saying we shouldn't do this? You have to do this.
Then why are you telling us what can go wrong? I just think you should know Either you're cruel or this clipboard is a way for you to cover your ass, in case you cripple our son.
This isn't his fault.
No, it's not.
It's yours, that's what you keep telling me.
My son is lying in there half-dead, I am just trying to find a way to get through this.
I'm sorry.
Yeah, I know.
Needle.
It's not going in.
Don't force it.
I'm going one space higher.
It's too close to his brain stem, it'll herniate.
You're gonna paralyze him.
You're not helping.
His blood pressure's spiking, stop.
I can get it.
He's 180 over 120, he's gonna stroke.
I'm in the space.
Give me the vial.
He doesn't have MS or an infection.
His proteins aren't elevated? Wrong protein.
IgM, not IgG.
Elevation was probably caused by the bleed.
What if there was tingling in his extremities prior to the crash? How can you still be on MS? I gotta be on something.
Something's interrupting his neurons' chitchat, like lesions.
We can't scan for them.
The only test we can do, we just did and it was negative.
He has no tingling, no numbness.
And you read his history, parents didn't say anything about What about Adam? We can't look into his brain, but you want us to read his mind? Good point.
Yeah, you can finish the sponge bath in a minute.
They're just re-doing his dressings.
He's out, he's fine.
I didn't page you to put him out.
I paged you to wake him up.
Why are these lights so damn bright? Thank you.
Come on, I need to talk to him.
House, you can't wake up a burn victim to play twenty questions.
It's torture.
He won't remember.
He's gonna be in extraordinary God, you're good! You're putting me to sleep.
I know he's gonna be in pain, I know you disapprove.
I'm his attending.
Wake him up.
Oh, my God! I'm Dr.
House.
It hurts! It's gonna get a lot worse, so answer fast.
Before the accident, did you experience any numbness or tingling in your fingers? You got burned, it's healing, I need an answer.
It really hurts! Any tingling in your arms or legs? You gotta do something, I can't Adam, you gotta listen to me, did you feel anything? I pissed in my pants and then I don't remember Was he okay? Get everyone in my office.
Where you going? Kid's screaming gave me a headache.
I gotta take an aspirin.
House, you okay? We've been waiting for you.
I'm hallucinating.
Hallucinations with migraines are pretty uncommon.
What did you see? I saw music.
Sensory deception makes no sense.
You took something.
The kid's fighting for his life.
Hey, you find him? He was hallucinating in the locker room.
He okay? He's feeling no pain, he's high.
Vicodin high? Past that.
He's seeing sounds.
Took something.
Why is it so dark in here? It's a beautiful day outside.
Open the shades, let the sun shine in.
It's nighttime.
It's still Tuesday, right? You look better.
I took something.
Mind if I ask what? Little of this, little of that.
I know what's wrong with our patient.
He's depressed.
He told you that when you woke him up? Nope.
He told me he pissed his pants and blacked out.
That's not diagnostic of depression.
Lack of appetite, isolating yourself.
Uncontrollable urination and blacking out are good predictors of what? Seizure.
Which means the seizure he had when you tested his heart was at least his second seizure.
So what? Depression and seizures aren't correlated.
No, but you know what is? Depression and anti-depression medicine.
Tox screen was clean.
Yeah, but you know how much crap he's got in his system for dealing with those burns.
The guy could have the Spanish Armada floating through his bloodstream and we wouldn't know about it, till they started firing cannons.
Antidepressants have been known to cause seizures in kids, but not orgasms.
This is a brain in trouble.
This is a brain with too much serotonin.
Serotonin affects mood, appetite, it doesn't cause the brain to shut down.
Antidepressants fake brains into thinking they have more serotonin than they actually do.
Every ten million or so cases sets off a chain reaction.
Produces too much, enough to fry itself.
If Adam has Serotonin Storm, it's deadly.
But treatable.
Cyproheptadine.
Unless he doesn't have Serotonin Storm.
He could just as easily have too much dopamine as serotonin, but if it's dopamine, the cyproheptadine will kill him.
Where are you going? Gonna talk to the kid again, he seems nice.
You can't.
Why? Did he say he doesn't like me? Anesthesiologist told the parents what you did.
Everyone's a tattletale.
Is your son depressed? No.
Who are you? I'm Dr.
House.
Oh, you're the idiot who thought I heard him screaming all the way down the hallway.
If I didn't wake him up, I wouldn't have learned what caused the crash.
He had a seizure.
This wasn't my fault? Well, if he hadn't had the brain problem, he wouldn't have the burns.
On the other hand, if you hadn't put him on the ATV, he also wouldn't have the burns.
You can debate your personal responsibility after I leave.
I need to wake him up again.
I need to know if he's taking antidepressants.
He's not.
He's the happiest kid I know.
But you don't know, do you? He's my son.
That's sort of my point.
At 16, they'll tell anyone anything, except their parents.
Adam talks to us about everything.
Yeah, I know about the pot and the cocaine.
There was never Cocaine.
What Are you sure? Are you having him followed? He told us when he got drunk at a party.
He told us when he started having sex.
At 16? Way to go.
He told us when he cheated on a math test.
He told us when his girlfriend cheated on him.
He doesn't hide anything from us.
But if he was depressed? He'd tell us.
We don't judge, he's not depressed, we're sure.
"Bet his life on it" sure? Just hypothetically.
Yeah.
Okay.
Kid's happy.
Happy, happy, happy.
Then we're back to where we started.
Seizure disorders.
Seizure disorders aren't causing orgasms.
Vascular malformations? Would've seen it on the sonogram.
Hepatic encephalopathy? Liver enzyme tests were normal.
Where are you going? Take a leak.
What are you doing? You can't come in here, you're not sterile.
Don't touch our son, we told you Seriously, millions of bacteria, microbes on you.
He'll die of sepsis.
If you go in there I think he's gonna wake him up again.
I know he is.
House, you can't do this.
Oh, if I had a nickel for every time I've heard that.
Relax.
Are they gonna sue us? If I'm right, I save his life.
If I'm wrong, he's dead no matter what I do.
Either way, how much have I really hurt them? Leave him alone! You're not sterile.
Do you wanna kill the kid? Give me the syringe.
No pain, no gain.
Hey, you gotta stop this.
They're right.
He's not depressed.
Yeah, sure.
I'm not letting you go till you give me that syringe.
What's that on his wrist? A burn.
Why on his wrist? Why not on his wrist? His back, his torso, everything's a mess.
His forearms are clean.
Except right there.
So what? It's a perfect circle.
So a drop of burning gasoline fell on his wrist, a screw from the ATV.
Maybe.
Why are you torturing him? Does your son smoke? I'd kill him.
So, he can talk to you about sex, crack, anything except cigarettes.
He has a cigarette burn on his wrist.
Also a fading nicotine stain between two fingers.
Bad news, your son has a filthy, unhealthy habit.
Good news, he's trying to quit.
Bad news, the quitting's killing him.
Good news, I can cure him.
Bad news Nope, that's the end of it.
Quitting smoking can kill? No-smoke meds are antidepressants.
The crappy ones you get over the Internet are loaded with whatever antidepressants they can get cheap.
And since Mommy and Daddy obviously didn't take him to a pediatrician Sorry, I was wrong about him being depressed.
Treat him.
Hey! Did you drop acid? Why would I do that? To annoy me.
Or maybe because you're miserable, or because you want to self-destruct.
Pick one.
How about because LSD acts on serotonin receptors in the brain, which can stop a migraine in its tracks.
I'm just saying that's also a possibility.
How did you know about it? Cameron is worried about you.
I told her that LSD lasts up to 12 hours, if you were functional, she must be wrong.
Either that or I also took a whole bunch of antidepressants, which short-circuited the LSD.
I'm just saying that would also explain it.
Thank you for ruining my clinical trials.
Pharmaceutical company's shutting me down.
You're kidding.
Really? How could that surprise you? You sent them an email complaining about my math, telling them about your stunt.
I didn't know people actually read emails.
Delete button's so conveniently located.
So what's next? You gonna follow me my whole life? Torture me? Why would I do that? You waited 20 years to do this.
What's next? Break up my marriage? No.
We're even.
Right.
Oh, thanks for setting me up.
Eye for an eye, LSD and antidepressants.
Everything in balance.
Buddhists call it Karma.
Christians call it the Golden Rule.
Jews call it I don't know, Rabbi Hillel said something poignant.
Universe always settles the score.
Does it? No.
But it should.
Do you think you'll ever be able to look at him and not blame me? Yeah.
Will you? I'm Paula.
Hey, Paula.
How you doing? You work over at the college, or are you full-time over at the I'm looking for a distraction.
You don't need to talk to do that, do you?