House, M.D. s03e01 Episode Script

Mark? Mark? Mark, please ask your father if he wants a burger.
Mom.
I know.
You're defending the free world.
Please ask your Dad if he wants a burger.
Dad? Dad? Mom wants to know if you want a burger.
Mom, I don't know what he wants.
You ask him.
Aunt Arlene! Want a burger? Okay.
The guy drove his wheelchair into a pool.
House would love that.
He'll be bored.
It's a great visual, but it's diagnostically boring.
What about post-hair-transplant aphasia guy? Infection-throwing clots.
House will shoot it down and call you an idiot.
Oh, well, we wouldn't want that.
What about yoga girl? It has a good hook.
Should we lead with it? His first day back, he might want to flex his sarcasm muscle.
Maybe we open with one of the weaker pitches.
You ran here? It's just eight miles.
Why did you Why does a dog lick its workplace-acceptable euphemism for testicles? Because he can.
What have you got for me, boss? I thought you said you needed eight weeks of rehab.
You should have been back here If I'd come back sooner, then I'd only be able to run six miles.
I never would have made it in.
What have you got for me? You're completely pain-free? The ketamine treatment can wear off.
It's been two months.
It's not wearing off.
What have you got for me? You can take as long as Why are we having this discussion? Want to hear me thank you again? Thank you, Doctor Cuddy, not just for removing the bullet, but thank you for putting me into a ketamine-induced coma and changing my life.
Happy? I am.
Middle-aged man had hair transplant about two months ago Infection-throwing clots.
You're an idiot.
Except you're not an idiot, and she is holding a file for a 26-year-old female.
What have you really got for me? Girl was doing an inverted yoga pose, neck snapped, paralyzed from the neck down, except the x-rays show no evidence of spinal injury.
And she's cute.
Oh, well played, sir.
What about Stephen Hawking trying to do the 500 butterfly? Forget it.
Brain cancer, brain surgery.
There's nothing left to diagnose.
I would take the other one.
I'll take them both.
You don't think he had brain cancer? Of course he had brain cancer.
Even oncologists don't screw up for eight years.
So if there's no diagnostic issue, why are you taking the case? Treatment can be interesting.
Not to you.
I've changed.
No, you haven't.
No, I haven't.
So why are you taking the case? The guy tried to kill himself.
The guy had cancer.
He's a lump.
He hasn't been able to touch his wife, speak to his kids.
He's been in that chair for eight years.
His muscles have atrophied.
Maybe I can help him with the pain.
Isn't that enough of a reason to want to help? Not for you.
I've changed.
No, you haven't.
Then why am I taking this case? Let's start with the cute paraplegic.
Welcome back.
Hey.
You look Healthy.
Quad with no broken neck.
Struck me as odd.
You can take a whole two minutes to ease into being back.
I would've taken a whole month to ease back, but eight weeks is the maximum rehab time for a gunshot wound to the stomach and neck, so go.
We heard they never found the guy.
There's no new leads.
What? You think he might have shot this patient, too? It would explain her symptoms.
It could be MS.
See? It's not so difficult.
It's not MS.
She had no symptoms before she climbed onto her head.
Unless she's been upside-down for the last 10 years, MS ain't it.
Could be transverse myelitis, swelling in the disks, choking off nerve function.
MRI is negative for that.
Your leg looks fine.
Totally pain-free? When did this turn into, "What did you do over your summer vacation?" It's a little weird to discuss the case while you're staring at your blood on the floor.
I asked Cuddy to replace the carpet.
I like the carpet.
What did you do over the summer? I Redo the tests.
Let's see if the source of the problem is in the limbs or the spine.
Do an EMG.
Whoa, whoa, whoa, whoa, whoa.
We've got a whole other quad to cover.
This guy's still got fluid in his lungs.
You don't think that's from the pool he drank? Give him an O2 mask.
His leg muscles have atrophied.
Tendons have shortened from disuse, causing intense pain.
Tendon surgery will make him more comfortable.
Comfortable? Scoot.
Thanks for being here.
Not a problem.
My Dad wouldn't kill himself.
You haven't spoken to him in over six years.
I know my dad.
Mark, the doctor's just trying to - He wouldn't kill himself.
- Fine.
I'm wrong.
You obviously have a better understanding of this man who drools in front of your TV set 24 hours a day.
Doctor House? Look, he must have been confused, all right? It must have been an accident.
I hope it was a suicide attempt.
If he was trying to kill himself, then he knows how miserable his life is.
It means there's still something there to kill.
It means your dad's still there.
Sorry.
Need you.
Thank you.
We were doing the EMG, but we never got past the insertion of the conduction pin.
Did she just say, "Thank you"? I loaned her some money.
What went wrong? Nothing went wrong.
If nothing went wrong, then something went right.
You're not gonna tell me why she thanked you? You're not gonna tell me what went right? You did something for which she is grateful, and you're embarrassed? For you.
She saw you coming up, thought you were a 14 year-old boy.
I set her straight.
I am not telling you what went wrong or right until you tell me why she said, "Thank you.
" Oh, you got me.
You know I need to know.
I am so gonna fold.
Except you're forgetting there's one thing I can do now.
It's either that or a reflex response.
What happened? Okay.
This is Doctor House.
House, this is Caren Pleasure's all mine.
What happened? When we inserted the conduction pin, she flinched.
She flinched? Did you hear? Does that mean I'm getting better? How big is a flinch? Bigger than a twitch? Smaller than a spasm? Do you smoke? Socially, not a lot.
You do yoga, and you smoke? I know it's hypocritical, but No, the world sees your legs.
No one's checking out your lungs.
How would smoking cause It wouldn't.
I just needed a lighter.
House.
Oh, my God! The case was looking so promising.
Hey, I'm not faking.
You moved, therefore you can move.
Get this lunatic out of here before she bores again.
I'm not faking! I heard you were watching surgery with a patient's family, talking to a patient's family.
It's because of your hallucination, isn't it? After you were shot.
You chose life.
You decided you wanted meaning, so you took a case with no mystery, something any doctor could do, a case with no upside except the satisfaction of helping another human being.
She thanked me.
And you felt nothing.
I wasn't sure what I was supposed to feel.
It's like your leg.
It's atrophied.
Keep working it.
The feeling will come.
Sorry.
Need you again.
I told you to get rid of her.
It's a good thing we didn't.
Tightness in her chest.
She can't breathe.
It could be pleural effusion.
Right.
Either that or she's holding her breath like a four-year-old.
Relax.
I'm not gonna burn you again.
I'm going to stab you! Look, either you're faking, or you've got a pleural effusion.
That's a buildup of fluid around the lungs, which is very serious, and I would have no choice but to stab you in the back with this needle and suck all of the fluid out of you.
So We should give her a local.
That would defeat the point of me being nasty.
Ready? Down.
She can't breathe if she's down.
Down.
She can't Down, down, down! Come on! That's not a pleural effusion.
The problem's in her heart.
Can't fake that.
Had to relieve the pressure three times in the last two hours, so either we figure out what's causing blood to build up around her heart, or I follow her around with a needle for the rest of her life.
Echo was clean.
No structural abnormalities.
It could be an infectious process, TB.
Or vasculitis would also explain the effusion.
But not the paralysis.
Let's assume that she wasn't faking it.
She moved, therefore she could move.
She wasn't paralyzed.
Doesn't mean she was faking.
It could have been a delusion.
Now, either she was faking and coincidentally got a real cardiac problem at the exact same time, or it's a delusion, and the fake paralysis is a real neurological symptom.
Are you thinking vascular tumor on her spine? Her platelets are normal.
And she's been scanned up and down.
It's all clean.
So open her up and find it.
So what do you want us to do? Just start at her neck and just keep on cutting down her spine until we stumble on something? That should work.
His heart rate's a little high.
Should I be worried? Probably just means he's still in discomfort from the surgery.
I'm gonna up his morphine a little.
You've been so nice to us.
It's the job.
No, I mean, all the other doctors, all they did was obsess on the cancer, the treatment, the damage, just trying to fix him.
You're the first doctor that's ever given a damn about the quality of his life.
His heart rate's come down.
The morphine worked.
I was right.
What a touching moment.
That's why we become doctors, for these rare moments when our hearts are warmed Would you like to get a drink? Are you serious, or are you just trying to change the subject? No, I'm serious.
I drink.
You drink.
We could do it at the same time, the same table.
If you eat, we could do that, too.
I mean, if the answer's no, that's cool, but No, it's just you're just coming off of surgery, and you're not yourself yet, and I work for you, and even though last year's You're smiling.
I'm saying no, and you're smiling.
Well, don't take it personally.
It's just 'cause you're full of crap.
You have no interest in going out with me.
Maybe you did, when I couldn't walk, when I was a sick puppy that you could nurture back to health.
Now that I'm healthy, there's nothing in it for you.
You are not healthy.
Cuddy wants to see you.
You've been back at work and you're already playing hide-and-seek in a woman's spine.
Who won the pool? There's no tumor.
Her platelets are normal.
The scans didn't What's the worst that can happen? Might paralyze her.
She won't even notice.
Her lawyers might.
You're not doing the surgery.
And lower the morphine on your other patient.
Fine, I'll lower it if you let me do the surgery.
What? You want to trade? We're not swapping a couple of goats for your help putting up a barn.
You want something.
I want something.
We compromise.
It's the grownup way to resolve our differences.
There already is a mechanism for that, it's called the employer-employee relationship, I get what I want, and you don't.
You tried to swap? Ran a few more tests.
They came back negative.
The surgery's on.
You really don't give a crap, do you? Does that make me evil? Yeah.
The girl's life is at stake.
All we're talking about with the guy is All we're talking about is the reason you took the case, to help someone.
Too bad for them.
Too bad for you.
The reason we crave meaning is because it makes us happy.
The first level of happiness I'm not going away.
The fifth level of happiness involves creation, changing lives.
The sixth level is heroin.
The seventh level is you going away.
You're saving lives, which is tantamount to creating lives, but all you're taking away from this is the game.
You don't have to listen to them thanking you.
You don't have to change the cases you take or even how you handle them.
You just have to know that you made a difference.
House! You're not I'm not an idiot.
Move.
House, leave her alone.
Close her up.
You want to know why? The room's no longer sterile.
True, but it's not the most interesting reason.
That is not a sexy big toe.
You'd never put that in your mouth.
What the hell does that got to do I told you it was interesting, but it gets even better.
Scurvy? Yeah.
Drink.
Like what sailors get when they don't eat right? Aye, aye.
Your arms and leg tissues are choked with blood.
It makes it hard to move.
It also damages your hair and toenails.
But I'm on this great diet, lots of protein, lots of No vitamin C.
Now drink.
Well, thank you.
And thank Doctor House.
You can send him a note.
The nurse changed his morphine.
I thought you were worried about It's just post-op discomfort.
He's ready to go home.
So he won't have any pain? Eventually.
Thank you.
Everything else will be the same.
Well, you took away his pain, and that changes a lot.
Why don't you put him in some sort of facility, some place without a pool? Yeah, I could dump him there, except he's my husband.
He's my son's father.
Right.
Kids need a dad, someone to play catch with, talk about girls.
You know, Mark's learning that you don't have to abandon someone just because Get a dog.
I'm taking care of him for the same reason you helped us.
Because some guy shot you, and you hallucinated? I have a responsibility.
So he's just an anchor, weighing you and your family down, sapping your energy, wasting your life? That's the meaning you take from this? I want to take care of him.
You enjoy this? I can't abandon him.
So you don't want to take care of him? Taking care of him doesn't fulfill you, make you happy, but not taking care of him would make you miserable? Hmm.
Okay, here we go.
Okay, slowly.
I don't need your help.
I've done this a million times.
Here, lie him like that.
Do that again.
Make that sound.
What was that? That was talking.
You guys are lousy doctors.
You were in such a rush to make the patient feel better, you forgot to check what was wrong.
Yoga girl walked out of here two hours ago.
You fixed her.
Not her.
The other guy.
He had brain cancer.
They removed it eight years ago.
His condition's been the same ever since.
Until last night.
He spoke.
What'd he say? He grunted? You want us to dissect eight years of medical history with grunting in the differential? Sounds good.
Call me when you're done.
You're fabricating a mystery because you're bored.
I am not bored.
Damn it! You didn't tell the wife it was only a grunt? Of course not.
'Cause then she would never have consented to I don't remember you being this bitchy.
The Vicodin dulled it.
In the sober light of day, I'm a buzz-kill.
You're giving false hope to a family that's been wrecked.
Don't torture them.
Let it go.
Tell the wife it was only a grunt.
Tell her to go home.
I can't let her down like that.
I pumped her up with too much false hope.
I stuck that primo! How rad am I? Dry eyes plus a grunt.
It all makes sense.
Could be a neurological issue.
I get hay fever, I put drops in my eyes.
I don't go to a neurologist.
Dry eyes could indicate an autonomic dysfunction.
It goes on the board.
What about coughing or boogers? Should we include boogers? I'm happy we're doing this.
I'd much rather do this than lengthen some guy's tendon.
Patient's headaches increased.
Doc scanned his head, found a tumor.
You like wasting your time? I'm learning.
To do what? Reconsider solved cases because you don't wanna deal with the real world? He's pushing where there's nothing.
Cameron, you are an excellent doctor.
You'll get lots of tearful thank-yous from grateful patients.
Yeah, aren't I such a bitch for wanting that? No, it's not a bad thing, but it's not why I'm here.
I took this fellowship to learn from House.
He's teaching you to be a masochist.
Dry eyes goes on the board.
In eight years, the patient experienced 214 symptoms, many of them repeated.
Any patterns? Fever plus frequent urination could mean prostatitis.
Or a urinary-tract infection.
White count was normal.
No infection.
If you add pain into the mix, fever, frequent urination could indicate a kidney problem.
I like it.
No, creatinine and BUN were both normal.
Not the kidney part.
The pain part.
Abdominal pain plus all that stuff could equal a pancreatic cyst.
Perfect.
You managed to pick the one symptom he never had, abdominal pain.
It's the first symptom on the board, "grunt.
" Grunting isn't pathognomonic for abdominal pain.
No, the traditional diagnostic marker is compression of the diaphragm, vibration of the larynx, leading to the audible sound, "I have a pain in my abdomen.
" Richard's symptoms are culled from eight years of medical history.
They're not patterned.
These are random, individual events over time.
Illnesses have incubation periods.
Do an upper endoscopic ultrasound.
His throat will collapse.
Muscle degeneration in his neck won't tolerate the scope.
It's an automatic trach.
You're talking about him like he's an invalid.
We were insensitive.
Does he drool? Can he hold his neck straight? Does he choke on his food? His neck's fine.
His throat's not gonna collapse.
Cameron, get consent from the wife.
Open.
I need you to swallow.
Sorry about that.
Here we go.
We're passing through the lower esophageal sphincter into the antrum of the stomach.
There's the tail of the pancreas.
Looks clean.
Moving medially.
The body and the head of the pancreas look clean.
Get it out.
Get it out.
It's stuck.
I can't move it.
His throat's collapsed.
His vitals are all over the place.
We're losing him.
Cutting.
We trached him, endoscopically removed the probe, and he's breathing again, so, all in all, great idea.
Get a look at the pancreas before the world ended? It was clean.
Which means, barring anything else, meaning you, he can go home tomorrow.
This man nearly died.
How can you discharge him? His throat collapsed because of what we predicted.
You stick something down someone's throat, they gag, spasm, which he did.
It took us a half an hour to get the thing out.
Except our patient's throat was sedated, which means the brain should have sent a signal not to do anything.
This could be cancer or some bizarre neuro-degeneration, even a new type of vascular Stop it.
You're enjoying this.
I find it interesting.
It's interesting only if you're right.
If you're wrong, we're torturing this guy to amuse you.
Half hour to remove the probe? House.
It's not a spasm.
His throat didn't collapse.
It locked down.
The brain is supposed to tell every muscle in the body to relax and contract at the same time.
This muscle was only contracting, which means the signal from the brain was not getting through.
There are no lesions on his brain, nothing to interrupt any orders.
All it takes is one wire down.
You have no evidence of any wires down.
A few microtumors on the meninges, and suddenly you're choking to death.
You want to look at the lining of his brain? The amount of contrast material you need to pump up there just to see He'll bleed into his brain! No, he won't.
Because that wouldn't be interesting.
You can get permission this time.
The brain is enclosed in a sack called the meninges.
Does this mean the cancer's back? No.
No, no, no.
House.
If we found cancer, it wouldn't be the original cancer.
It'd be new.
So, what, more surgery, more radiation.
Might not be the worst thing.
If this isn't just ancient history, then maybe it's something we can correct.
Might even get some brain function back.
He could get better? No.
But understanding what you're saying will be nice.
Maybe you could figure out ways to communicate.
Thank God he spoke to you.
Mrs.
McNeil, the test to do this is very risky.
He could die.
He's already dead.
Chase, go slow.
I've already injected it into his spinal canal.
Next stop, his brain.
Contrast material entering into the fourth ventricle.
No parenchymal bleeds.
Blood pressure's high, but it's holding.
Meninges are intact.
No bleeding.
Oh, God.
Foreman, get in here.
Surgeon repaired the CSF leak.
You're lucky he didn't die.
I'm lucky? He's the one who didn't die.
We told you he'd hemorrhage.
You told me he'd bleed into his brain, not out of his ear.
You've got to drop this.
We're missing something.
We did a dangerous test, and something bad happened.
That's all this is.
Give me a tour of the brain, Foreman.
Walk me through the scans.
Five-centimeter, grade-four astrocytoma between the parietal Nothing.
Next? The speck on the superior temporal region.
It's a re-growth, benign.
The star thingy next to the Rathke cleft? Scar tissue from a biopsy.
House, every speck is not a suspect.
It's years of surgeons digging around in his head.
Let him go.
Redo every blood test he's ever had.
Rescan his head.
No.
He's been sick and suffering for eight years.
I'm not gonna help you make it worse.
I'm not gonna help you make it interesting.
That's okay.
Foreman's better at that stuff than you are.
We need five-millimeter cuts through the occipital and hypothalamic regions.
No.
How many millimeters? I can help him.
That's it? That's your argument? It seems like a good one.
If I thought for a second you wanted to help him, you'd have carte blanche.
You're doing this because it's fun.
Does nobody in this hospital have anything better to talk about than my motives? My motives have nothing to do with the case.
Your motives have everything to do with your judgment.
For the first time in years, I got no opiates in my body.
Now you question my judgment? Twenty-four times a year, you come storming into my office, spouting that you can help someone, only you never say those words.
You say something like, "His pancreas is gonna explode because his brain is on fire.
" You come here with medicine, not with platitudes.
I didn't wanna bore you with the details.
There are no details.
You have a hunch.
House, you don't use hunches.
You always have reasons.
This hospital doesn't exist for your whims.
I'm sorry.
As of 7:00 a.
m.
tomorrow morning, I'm sending your patient home.
The answer's no.
Cuddy called 30 seconds after you left and said you'd try an end-around.
My leg hurt.
How bad? Enough that I'm telling you.
Did it go away? Ached for a while.
First time I've felt anything there since the surgery.
But it went away? It was muscular.
There was some cramping.
What are you smiling about? You're 40-something years old.
You've been running God knows how many miles a day, fallen a hundred times off that skateboard, and you're shocked to have some soreness? Just give me a prescription.
For Vicodin? House, people get aching joints, cramps.
They put on an ice pack.
They take some ibuprofen.
I know what the pangs of middle age feel like.
No, you don't because you've been stuffing Vicodin every five minutes since you turned middle-aged.
The surgery didn't work.
Don't play me.
You think this is a scam? I think you want me to feel sorry for you and either do the end-around on Cuddy or give you the drugs.
Either way, you get the high you think you need.
House, your surgery worked.
You're fine.
It's just gonna take time for it to feel good.
Circumventricular system senses cytokines released in the early stages of the immune response, but CVOS releases prostaglandins that reset the hypothalamic set point upward unless it's countered by antipyretic therapy, so, yeah, his brain is on fire.
The suicide attempt was not a suicide attempt.
He drove that wheelchair into the pool because he couldn't regulate his body temperature.
He had a hypothalamic dysregulation.
And you discovered this when you stepped into the university pool? Fountain.
I can cure him.
Cure him! Even if the fountain proved anything, fixing hypothalamic dysregulation isn't gonna regenerate brain.
No, but if the scar tissue on his hypothalamus is resting against the pituitary, the adrenals would shut down.
Addison's disease.
You didn't see any scar tissue on his MRI, his CT scans His brain is functional.
His temperature's normal.
There is nothing wrong with his hypothalamus or his pituitary! I can make him walk.
I can make him talk.
This is a wild guess that came to you because you were sweating.
Inject him with cortisol.
The guy will have sex with his wife again.
He'll hug his kid again.
Hopefully, that's the combination he was using.
It'd be a shame if I had cured a pedophile.
You're smiling.
That's a bad sign.
You're high.
I told you, I haven't had anything in three months.
This is as high as you get, a theory that ties your case up in a neat little bow, but you don't have a lick of substantiating proof.
Your decision doesn't make any sense.
There is no risk to a cortisol injection.
If I'm wrong, big deal.
He goes home a vegetable like he already is, but if I'm right This is not about downsides or risk management.
It is a big deal for you to understand the word "No.
" I'm sorry, House.
He's on his way out of here.
I figured you'd be on your scooter, racing down the halls to stab the patient in the neck with cortisol.
She was right to say no.
I had no objective reason to think that I was right.
Just needed the puzzle.
Hold on a sec.
Is everything all right? Yeah, it's just something I forgot.
What's that? This is cortisol, and it's to fight infection.
Want to hold onto that? Let's put a bandage on it.
Is he okay? Yes.
Can we go now? You can go.
Excuse me.
Richard.
Richard.
Dad, you okay? Richard? Richard! Richard! Richard! Richard.
Richard, you're standing.
Thank you.
He got up.
I have to go tell House.
No.
Cuddy, you can't tell him.
I have to tell him.
He was right.
Why did you do it? Why did you think he might be right? Because he's House.
Medically, what made you think he was right? Nothing.
He got lucky.
That's all that happened.
Telling him no was a good thing because next time, he won't get lucky.
He'll kill someone.
Just because he was right doesn't mean he wasn't wrong.
I see him every day.
I can't just Everybody lies.