House, M.D. s02e22 Episode Script

Honey? Are you all right? Yeah.
Yeah, I'm just fighting off a stomach bug.
I'll be fine.
Did he sleep okay? Great, as long as I was holding him.
I can't wait for colic to be over.
Hold on, Mikey.
Bath time's coming.
He lifted his head yesterday.
Take the day off.
I mean, you're sick anyway, and you hardly ever see him or me.
I can't.
I've got a meeting with Crandall's Kitchens.
I think that deal's gonna close.
They called about the car payment again.
It's two months late.
We're gonna be fine, honey.
Enjoy your bath, little man.
You know, honey? Honey, I'm not gonna go in.
I'm coming down with something.
Honey? Kara? Kara? Kara! Mikey! Mikey! Kara! Mikey! Four-week-old infant submerged in a bathtub.
Don't know how long.
Non-responsive at the scene.
Get a trauma team for six.
Obviously breathing now.
Continue the Bodybox.
Stat portable chest.
Caucasian female, 32.
Where am I? Tonic-clonic seizure in the bathroom.
Brent, where am I? On one, two, three.
Where am I? One, two, three.
You're in the hospital, honey.
You're in the hospital.
Honey, Mikey's here, and the doctors say he's gonna be okay.
Hopefully.
He needs to be checked out by the NICU.
What happened? You passed out.
What? Mikey fell.
Has your wife had a seizure before? No.
I can't move my head! I want to see him! He's right here, honey.
He's okay.
He's right here.
Tonight.
L Word marathon.
You watch The L Word? On mute.
I'll pass.
Dinner with Cuddy.
Still sucking up so she'll fund your play space for the chemo kids? They really ought to save their energy for other things, like crying.
She's the suck-up.
She asked you? She's smart.
She knows if she buys me enough alcohol my defenses just might be weakened.
It doesn't make sense.
Unless she ran out of batteries.
Hey.
I'm recently single, she's single.
You're too nice for her to like you.
She's not needy enough for you to like her.
She's got an agenda, just not one that includes an appearance by little Jimmy.
I'll poll my peeps.
How many of you think that Cuddy asked Or, rather, peep.
Chase caught a case in the ER.
He wants us to take a look.
Unless Chase broke his neck falling off his polo pony, he had no reason to be in the ER.
Cuddy put him on a two-week NICU rotation.
Patient had an unexplained seizure.
Seizures are cool to watch, boring to diagnose.
What about Foreman? He needs to get his malingering butt back here.
He almost died.
"Almost" being the operative word.
Hey.
How are you doing? You look great.
Thanks.
I feel great.
Glad you're back.
Cameron makes lousy coffee.
I take mine black, the way I take my brain-damaged neurologists.
Happy to help.
How are you coming along? Tell her everything's great.
Neither of us wants to deal with her guilt.
I don't feel guilty.
Of course not.
Hell, if people felt guilt every time they accidentally lobotomized a guy I was trying to save his life.
Yeah.
Your heart was in the right place.
It's just his brain that's not quite where it's supposed to be.
Tell her everything's great.
It's true.
No more left side/right side reversals.
Still some short-term memory loss and spatial processing problems, but I'm trying not to be too hard on myself.
Yeah, might pull a muscle.
We have a case? Seizure that can't be explained by epilepsy and accompanied by elevated calcium levels.
Still bored.
Tell her why.
Because seizure with mildly elevated calcium is diagnostically simple.
It's either hyperparathyroid, cancer, or calcium-mediated neurotoxicity.
Well done.
But until you can remember how to make coffee, hands off the patients.
House.
All those reasons this case bores you, the ER has already ruled them out.
Lungs are clear.
Get an EEG.
Confirm the brain function is okay.
Can we focus on the task at hand? Why did Mommy twitch so hard that she tossed the baby in with the bath water? You don't need me for this.
Of course I need you.
We're a team.
Polyarteritis nodosa.
Inflamed arteries in the brain cause seizures.
Inflamed arteries in the kidneys cause calcium buildup.
You're a moron.
Did you even look at the file? Kidney function is fine.
Whipple's? What? Whipple's.
Test her.
Cameron thinks it starts with a "W".
I'm thinking "V".
The dad vomited this morning.
Maybe they've both got strep.
You think you can do a strep-throat culture without the swab ending up in the guy's poop chute? "V" for "vasoconstriction.
" That'd be my guess.
Excess calcium makes blood vessels in the brain clamp down.
Best case scenario, seizure.
Worst case, stroke.
Do a digital subtraction angiogram.
Foreman can't tell up from down, Cameron's a girl.
All that mechanical stuff.
Sorry.
Cuddy says I'm stuck here.
You're late.
And you are in my locked office.
Again.
What you got there? Special panties for your date with Wilson? It's not a date.
And it's none of your business.
If it's not a date, it is business.
And if it was business, you wouldn't say it was none of my business.
What do you want? I want to talk about your date with Wilson.
It's not a date.
This is fun.
Spring Chase from NICU and I'll shut up about your date.
NICU is short-staffed.
Have you suddenly lost the ability to lie? Nobody's quit NICU in two years.
And if you're making up reasons, that means there is no reason, which means he asked for the assignment, didn't he? If Chase needs a break from you, he should take it.
Absolutely.
Both Mom and Dad are negative for strep.
You'll be back playing with the big toys soon.
Or not.
Either way, I'm fine.
You don't have to say that.
It's okay.
I could always work in a research lab or teach.
And you'd be okay with that? Why wouldn't I be? You were planning on pursuing grants of your own, running a department.
I'm alive.
Changing jobs, not making coffee, if that stuff bothers me now, I don't deserve this second chance.
They say that physical contact helps the healing process.
What's happening? Your son's not getting enough oxygen.
Take Mr.
Mason outside.
Lung's collapsed.
He's not getting any air.
I need an IV catheter.
Another seizure? Her chest muscles aren't contracting.
It's something else.
Her whole back is spasming.
I need two milligrams of lorazepam, stat! He's okay.
His lung wouldn't collapse if he was okay.
What the hell's happening? I have no idea.
So what causes seizures, hypercalcemia, and the thing where Mommy bends like Gumby.
Little busy here.
Uh-oh.
Baby's lungs are gonna conk out any minute.
Probably want to deal with that.
I'll get right on it as soon as I finish indulging my boss.
Multi-task.
Chemical pneumonitis.
Bubble bath got into the baby's lungs when he was underwater.
Start him on prednisone.
Keep him on high Fl02.
Let the indulging commence.
Lithium could cause all three of the mother's symptoms.
No record she's on lithium.
And the tox screen was negative.
Lithium doesn't show on a basic tox screen, Scarecrow.
Myelomatous meningitis could also cover everything.
Rare complications of a rare blood cancer.
You're not totally hopeless.
Get an S-PEP and an MRl for myelomatous meningitis.
Search the patient's place for lithium.
The baby's lung problem is bacterial and not chemical.
Start ECMO.
While you're searching for the lithium, take a water sample and check the pipes.
You want me to write this down for you? I ask you, is almost dying any excuse for not being fun? I'm not putting that baby on ECMO.
The chance of there being bacteria in bathwater Why don't you want to work for me? I'm nice, I'm fun at parties.
I'm not working NICU because of you.
The baby's x-ray suggested chemical pneumonitis.
Not to me.
The x-ray was too consolidated.
So, why are you down here? Hoping to expand your make-out pool to include the preemie to nine-year-old demographic? I needed a break.
From the patients.
They lie to us all the time.
Foreman almost died trying to save a drug-dealing cop.
I just wanted to get away from that for a while.
What a complete load of crap.
What am I? A nurse you're trying to prep with this vulnerability thing? ECMO could kill him.
You don't start him on ECMO and that infection could rampage through his body like Pistons fans after a championship.
But you do it your way.
Nothing more honest than a dead baby.
ECMO stands for extracorporeal membrane oxygenation.
Basically, we remove your son's blood Okay, all of his blood? We run it through a machine which takes out carbon dioxide and adds oxygen.
Then we re-warm the blood and run it back into his body.
There is a significant risk of internal hemorrhaging, and he may also suffer You put him on antibiotics.
Won't that take care of the infection? Not fast enough.
Are you sure this is Mikey's best shot? Absolutely.
Cuddy's trash? Not anymore.
I paid good money for it.
Look at what she bought.
Red clover.
What is red clover used for, Dr.
Wilson? Also used to treat asthma, psoriasis, joint pain She doesn't wheeze, flake, or ache.
And she didn't ask a pulmonologist or a dermatologist for dinner.
She invited an oncologist.
It's not a date.
It's a consult.
Mom's MRl was negative for masses, abscesses.
There's no sign she has myelomatous Fascinating.
Call me when we have She has a subarachnoid bleed.
So, why is our patient bleeding into her brain? Her blood workup shows her pro-time's elevated.
She's bleeding because she's not clotting.
So, why is she not clotting? What did you bring us, Daddy? The only mood-altering drug was vodka at the back of a drawer.
Hiding booze is a classic alcoholic behavior.
That'd explain the bleeding.
What bleeding? You don't remember? She bled all over you this morning.
Kidding.
Idiots are fun.
No wonder every village wants one.
If she's an alcoholic, she would also be more prone to hypercalcemia.
But the tox screen was negative for alcohol.
Hey, it was your idea.
Now, it's even better.
Mommy quits.
She gets the DTs.
Even explains the seizure.
It also fits conversion disorder.
They're deep in debt, he's working around the clock, they got a new baby.
I think the seizure was a physical response to psychological stress.
Boozy Mommy covers more symptoms.
Put her in a nice phenobarbital coma before the DTs kill her.
Where are you going? To put her in a pheno coma.
What if I'm wrong? What if Daddy's the drunk? Do you want us to give her the pheno or not? I want him to argue his point.
I assume you considered the father and ruled him out.
What's that saying? When you assume, you become a pain in the ass to me.
Why should I argue? You'd just overrule me.
Enough! Get a pony or a watermelon farm.
House? I need him to react.
I need him to act like a human being.
I need him to get over this boring near-death rebirth.
I have changed.
That's not something you get over.
Nearly dying changes everything forever.
For about two months.
Two months is too long.
I need the guy I hired back.
Now.
No matter how much your misery loves company, it's not getting mine.
I'll talk to the dad.
Cameron can take the mom.
We'll figure out if Mom was the drinker.
Waste of time.
Put her in a coma before the DTs kill her.
So, is this a separation, or Well, lawyers have been hired, friends divvied up.
Oddly, she didn't fight me for House.
At least there aren't kids involved.
You just have each other to deal with.
If there had been kids, maybe we would have done more of that.
Do you want kids? Listen, is there anything in particular you wanted to Hospital business or Catching up.
I mean, you know, it's not like either one of us has anybody to run home to.
No.
How are you feeling? Okay.
A little groggy.
There's somebody here to see you.
Hey, Mikey.
Mommy's awake.
Oh, Mikey.
Gosh, I was so scared.
Oh, I love you.
I love you so much.
Oh.
I'm sorry.
You don't have anything to be sorry about.
You were sick.
Turns out she and her husband met in AA.
Obviously, she slipped.
Good call.
It wasn't hard, considering my other choice was your stupid psych theory.
Which was not stupid.
I'm telling you, I'm gonna drop the N-bomb if I have to.
You're addicted to conflict.
Did they change the name? You could have handled this patient without dragging Chase in.
But the fact that he didn't want in killed you.
Just like the fact you can't get a rise out of me.
Where's the baby? Get off me! No! I have to do this! No breath sounds.
Crash cart and epi! Stat! I told you your psych theory wasn't stupid.
Your son is stable.
But the lack of oxygen damaged his kidneys.
She must have rolled over on him by mistake.
Mr.
Mason, I was there.
Your wife tried to smother your son.
That's impossible.
Kara would never hurt Mikey.
He knows.
They said Mikey knows.
You hear voices? They wouldn't quit saying that Mikey would be better off if They were right.
We've been trying to diagnose a seizure that didn't exist.
She faked it when her husband caught her.
I don't think she faked it.
She just happened to seize right in the middle of drowning her child? Lucky break for the kid.
Hey, take it easy on Foreman.
He's playing with one lobe tied behind his back.
Postpartum psychosis makes her want to drown her kid.
The internal conflict triggers a seizure.
You know what else might be a trigger? A physical illness.
It's a wild idea, I know.
Especially since she doesn't have any obviously physical symptoms, like internal bleeding or excess calcium.
I'll draw some blood, test for Oh! Jeez! You've done it again! Will you argue with me? Drinkers don't eat right.
That explains the bleeding and the calcium.
This might just be some crazy drunk, and I'm telling you that she's about to die of myelomatous meningitis.
We already tested for Exactly.
It's an insane idea.
Okay.
What do you want me to do? Have an original thought.
In the meantime, stress her into having another seizure.
We can't.
She's on haloperidol.
You also can't because it's dangerous and highly unethical.
Therefore, if you get caught, pretend you can't make coffee.
Mental defectives get tons of slack.
Take her off the haloperidol, hook her up to an EEG, flash some lights, make her pant, shoot her up with a placebo.
When she starts twitching, if the machine twitches along, it's real.
If not, well, call the cops, 'cause she's a psycho killer.
Stop pushing him.
Stop protecting him.
He needs it.
Not if he wants to get better.
He might not be able to get better.
Well, then, I need a new neurologist.
He got sick doing his job.
If he got killed doing his job, I wouldn't keep him on the payroll.
I don't care how guilty you feel or how touched you are by his reborn spirit.
I am not touched.
Then you're guilt-ridden.
I'm not guilt-ridden.
Then you're pathetic.
Right now, I'm annoyed.
Keeping him up all night in the seizure lab is not the way to advance his recovery.
It's too much.
You're right.
You should stick around.
Make sure he doesn't screw up.
Kara, look directly into the light.
Keep looking.
Thought you'd be gone for the day.
Thought I'd wait for the bone marrow biopsy results.
House sent you to baby-sit me, didn't he? He asked me to wait for the results.
Cameron, it's fine.
Of course it is.
Look, a few weeks ago, you were upset that I didn't consider you a friend.
Now you're upset that I'm happy? What can I say? Apparently, I'm a bitch.
I didn't say that.
It's annoying.
Insisting every day of your life is a blessing is basically calling everyone else shallow.
It gets old.
Sorry.
Oh, give it a rest.
How was dinner? Cuddy did not mention cancer.
She lost her nerve.
It was a date.
What are you doing? PCR test.
You're doing it yourself in the middle of the night.
On a spoon.
Cuddy's spoon.
I'm checking her saliva for cancer markers.
Yeah.
I do that after all my dates, too.
People think you're the nice one.
Why are you so worried about Cuddy? You go first.
You desperately want this to be a date.
Because the alternative is cancer.
Just admit that you like her.
She's smart, funny, got a zesty bod.
I think it's great you can look beyond the fact she's the devil.
I stole a spoon.
You stole her garbage.
She's my boss.
If she gets sick, the hospital might replace her, especially if she dies.
I'd have to learn how to manipulate someone new.
Whoa.
I think I'm gonna cry.
Find me when the results come in.
Mr.
Mason, because of the damage done to your son's kidneys, his potassium is climbing.
That's causing irregular heartbeats.
I'm doubling the meds and starting him on dialysis.
But unless we get his potassium down, he's gonna have a heart attack.
Kara, just another few minutes.
Biopsy's back.
She's negative for myelomatous meningitis.
And she's not seizing.
So, we're wrong and House is wrong.
And you're okay with that? She's seizing.
She's not doing anything.
Her brain activity isn't accelerating, it's slowing down.
Muscle rigidity, involuntary grasping and sucking motions.
She's in an encephalopathic delirium.
Hmm.
A genuine physiological illness.
That rules out a few things.
Like what, I wonder? Postpartum psychosis and conversion disorder.
The thing about being a good loser, you're still a loser.
Ouch.
The delirium means her brain is shutting down, reverting to its most instinctual functions.
And since it's progressing, I think we can assume it's progressive, which means it won't be long before the brain closes shop altogether.
Ideas? He's in V-fib.
His potassium's still too high.
No pulse.
Get him off the machine.
Charge to 10.
Clear.
Still in V-fib.
Another amp of epi.
Chase shouldn't be wasting his time in NICU.
Could be Wernicke's.
No.
Treatment for Wernicke's is thiamine.
We gave her that together with the pheno.
Delirium points to lithium.
I know we didn't't find any, but She'd have to be smuggling it in to be getting sicker.
Whipple's causes encephalopathic delirium.
The test was negative.
The test could have been wrong.
Ideas are not soda cans.
Recycling sucks.
Give me something new and shiny.
Or go retro.
Take an old idea, shine it up, and add a new symptom.
Encephalopathic delirium.
Pellagra.
She drinks.
Alcoholics get pellagra.
They eat lousy diets, so no niacin.
He agrees with me.
What a shock.
Well, you're right.
Lack of niacin starves the brain.
Neurons shut down.
Causes seizures, encephalopathic delirium and psychosis.
We give Kara niacin, she'll come out of her delirium and she'll be totally sane.
Don't think she's ever gonna be sane again.
Her son just died.
How do you feel? Uh My stomach kinda hurts.
I need to ask you some questions, see how you're doing.
Mmm-hmm.
Tell me your name.
Kara Mason.
Is my son here? When were you born? Please.
Where's Michael? Is he okay? Do you hear any other voices besides mine? No.
Answer me.
You've been suffering from delusions.
They were caused by a vitamin deficiency, pellagra.
It made you believe things that were not real.
Like the voices.
I remember doing things to Mikey.
Were those real? I'm afraid so.
So, I You tried to suffocate your son.
But You You stopped me.
And that other doctor, he got Mikey breathing.
Your son's organs were damaged too severely.
He passed away this morning.
Oh, no, no, no, no, no, no! No! Oh, my God! No! Oh, my God! Pellagra doesn't cause bloody vomit.
She's still sick and getting worse.
So what causes pellagra and crimson spew? Dead baby, while sad, not our problem.
I should have given him more polystyrene.
You killed him.
If you don't get over it, you're gonna kill Mama, too.
Her alcoholism caused the pellagra.
Maybe it also explains the vomiting.
Gastritis.
Gastritis meds aren't helping, which may confirm her story.
She only slipped once.
You remove drinking from the equation, internal bleeding, hypercalcemia, seizure, and pellagra are all back in.
Chase, will you get your head out of the dead baby's butt and focus on the barely alive? How much polystyrene did you give the kid? One gram.
His potassium just kept rising.
I need your son.
Who are you? Your wife's doctor.
Your son may have had the same condition she does.
My son didn't have a condition.
She killed him.
If I biopsy her intestine, she'll bleed out.
He obviously won't.
You're not using my son's body to help her.
Okay.
How about trading him for a beer? Or maybe you're more of a whiskey guy.
You didn't have strep or a stomach bug the morning you came in.
You puked because you were hung over.
Accuse a recovered drunk of slipping and most of the time, you'll be right.
So I drink.
You're acting like this is my fault.
People are gonna feel sorry for you, and they'll tell you that you can't anticipate the unthinkable.
The fact is, you can.
It's just not all that pleasant.
Look, you don't know anything about I know that people don't get crazy enough to kill someone without first being crazy enough for someone to notice.
How many times did you go out for a drink because she was crying? How many times did you stay at work because you couldn't listen to her telling you what a bad mother she is? You were relieved when she shut down and just sat staring for hours at a time.
She held the pillow over his head.
You slept while she went nuts.
Not exactly a draw, but What is wrong with you? What kind of a person says those things now? Let me do the test.
It'll be one less thing for you to feel crappy about.
I got a dead baby for you to biopsy.
Let Cameron do it.
Love working NICU? I could get you transferred.
I told you.
I just wanted to trust patients.
You don't give a crap about patients.
Your paycheck.
You've been double-dipping.
Taking your vacation time here, while drawing a salary in NICU.
Strange.
Rich boy doing all that for some extra cash.
I'm not rich.
But your dad was.
Now he's dead.
If you're not rich, that means that Daddy cut you out.
I'm not rich.
Don't let it change you.
And do the test.
God of compassion, take Michael into your arms and welcome him into paradise.
Let there be no sorrow, no weeping, and no pain.
Peace and joy forevermore.
I'm sorry.
It was a date.
Cuddy's negative for all cancer markers.
It was a date.
The baby's intestine shows slight villous atrophy.
Why would a baby have flattened villi? He was being treated with polystyrene.
Polystyrene shouldn't It didn't.
The question is, what do they use in the NICU to bind it together? Wheat gluten.
It's great stuff.
Unless your body can't tolerate it.
The baby didn't have colic? He had celiac disease? Just like Mom.
Celiac can be triggered by all kinds of stress.
Bills, childbirth, drunk husband Every time she had a bowl of pasta or a slice of bread or a slosh of soy sauce, her small intestine became more damaged, less able to absorb the vitamins and minerals into her bloodstream.
Her body couldn't absorb enough niacin, caused the pellagra.
Couldn't absorb vitamin K, caused the bleeding.
And celiac is why the baby's meds didn't work.
His body just couldn't absorb them.
Switch Mom to IV nutrition.
It's gluten-free.
That'll spruce her villi right up.
No.
Celiac causes nutritional deprivation.
Our patient has excess calcium.
Tell them what causes excess calcium with a chaser of bloody vomit.
Celiac patients are susceptible to cancer of the stomach lining.
She has MALT lymphoma.
Well, she's your patient, now.
And it wasn't a date.
You don't have cancer.
You don't have dwarfism.
You have no proof of that.
I, on the other hand, have this.
You ran a PCR on me without my consent? Hey, it's good news.
Really? It's just hard to access because of this overwhelming sense of personal violation.
Deal with it on your own time.
Bad news.
Estrogen is too high.
No matter how many people you tell otherwise, I am and always have been a woman.
Estrogen is normal.
Not this much.
Not for, at least, another week.
That's when you ovulate.
You monitor my periods based on when I get bitchy or Once a month, when you leave the kids' cancer ward, your eyes glisten.
And about three days later, you break your ban on sugar and chow down a bucket of frozen yogurt in the cafeteria.
Sprinkles included.
Based on the last yogurt sighting, you've got another week before you ovulate.
You're on fertility meds.
With red clover as an herbal booster.
And the dinner with Wilson was an audition.
It's too bad he didn't land the gig.
He would have had fun.
I was considering a donation.
Not a party.
So when's our dinner? Oh, he's gonna be so disappointed.
Right.
You two are gonna have a lot of fun with this.
Your patient won't let me touch her.
I killed my son.
Is it my turn to say something obvious now? Oh, I know.
You were insane.
I did it.
I chose to do it.
Yeah.
Like diabetics choose to not produce insulin.
Listen.
Someone got sick.
Someone died.
It happens every day.
The only difference in this case is, it wasn't the same someone.
I could have stopped.
I didn't have to listen to those voices.
Spoken like a true sane person.
This is not your fault.
You're healthy now.
Except for the cancer.
Those voices felt as real to me as Michael's hand right here, when he nursed, and the smell of his hair.
You do not deserve to die.
Maybe.
I don't want to live.
She said no.
So we get her declared unstable, appoint a medical proxy She was unstable.
Now, she's sane.
She's entitled to refuse the treatment.
You have to change her mind.
You can't just walk away.
Fine! Go on in there and tell her that every day is a blessing.
"So you killed your baby? Shake it off.
Think positive.
At least you're alive.
" Hmm.
Kinda hard to sell when you don't believe it, huh? And you never believed it.
You just wanted all that crap you went through to mean something.
Well, it didn't mean anything.
It never does.
Welcome back.
Why are you doing this to me? I was happy.
You were aspiring to be content.
Don't give me a semantic argument.
I was content with the way things were.
That's what happiness is.
Yeah.
If we were all just satisfied with what we had, what a beautiful world it would be.
We'd all slowly starve to death in our own filth, but at least we'd be happy.
Listen.
I need your self-worth to hang on this job.
Kicking ass here to be all that lets you rise above miserable.
If waking up in the morning is enough, I don't need you.
I can live with that.
No, you can't.
Not anymore.
If you got treatment, then maybe we could When you see Mikey, tell him his dad says he's sorry.
Hi.
Night.
Night.
Did you tell Cuddy we tested her for cancer? Yeah.
And? It wasn't a date.
Turned out she had some skin lesions.
Guess there was no genetic predisposition.
You TiVo The L Word?