House, M.D. s03e21 Episode Script

Try not to be scared when you see him, okay? Mom, I've seen him sick.
I'm not scared.
This time's different.
The doctors gave him an extra course of radiation and chemo I know.
And you understand how proud we are of you, right? Gloves, mask.
Matty, you said you wanted to see your brother before the procedure.
I know I look like an alien, but I promise not to eat your brain.
When this is done, will you be able to play out back with me? I'll rip anything you put near the strike zone.
Let your brother rest up, while we take some of your marrow.
You don't need to be in an isolation room, but I pulled some strings so you could be next door to your brother.
How many games will I miss? Well, you only have to be here overnight, but you do have to take it easy for a little bit.
I already missed two.
Matty I know.
It's okay.
It must have been a drag.
We just had to make sure you weren't exposed to any bugs, because your healthy bone marrow is what's gonna cure your brother's leukemia.
Go on.
He sneezed.
Maybe it's just an allergy.
Not with an enlarged spleen and a fever.
He's got one of 10,000 possible infections, even if it's just the common cold, I do the transplant, he kills his brother.
How long do we have? Radiation obliterated his immune system.
Even in a clean room, he's got four, maybe five, days left.
No way we can solve this that fast.
You need to find another donor.
They're African American.
It makes it nearly impossible to find a full match.
Tell me about it.
I can't even find the one I've got working for me.
Where is Foreman? Nothing like a dead patient to send you back to your choir boy roots.
Hey, you're not gonna believe what happened.
Wilson just killed a kid same way you did.
He's not dead.
Five days are gonna fly by.
He didn't look both ways before he nuked.
You done talking to your imaginary friend? Because I thought, maybe, you could do your job and just Start the donor brother on broad-spectrum antibiotics.
Great idea, if you're looking to save exactly one kid.
Broad-spec will take at least a week to work.
We need narrow-spec.
How old is Hector? Our patient's name is Matty.
His brother's Nick.
Hector's my dog.
He's about 17? Seventeen? That's, like, a 119 in human years.
Why is he still alive? Five days minus 20 seconds talking about Wilson's dog.
We need to start testing.
Stool samples for parasites, antibody tests Blood panel was negative for all the usual suspects.
That's because the infection is too small.
We start testing now, it's like looking for a needle in a haystack.
We draw blood odds are we're just gonna come up with hay.
We need to grow more needles.
Okay, that probably needs further explanation.
We make the donor kid sicker.
We freeze him, we soak him, break down his immune system.
Suddenly we're looking at some needle that a camel can pass through the eye of.
Making him sicker risks spreading the infection all throughout his body.
True, but who cares? Once we know what the infection is, we'll know exactly how to treat it.
As long as he isn't dead yet, we're cool.
We should do what we normally do.
Go to the kid's house, check for sources of the infection.
Waste of time.
You think it's in the house.
I know it's in the patient.
Safer than intentionally making the kid sicker.
Fine, go.
So exactly how sick are you gonna make Matty? He could get quite ill.
It certainly won't be a pleasant experience for anyone, but it's our only Ever get caught in the rain without an umbrella? That's all we're talking about here.
Sign the form.
It's a little more complicated than that.
We'll also be doing leukopheresis.
We run Matty's blood through a machine that filters out his white blood cells.
But without his white cells, how could he get better in time? We'll pump the white blood cells back as soon as we have a diagnosis.
Then we should be able to cure the infection in time to do the transplant.
But you can't guarantee? We're not GM.
No recalls, no rebates.
Anymore questions while your son's life slips away? You really think we should do this? Yes.
Sorry.
Your patient, you tell them.
This is your family.
It needs to be your decision.
All you had to do was say, "Yes, I do.
" God knows it's a phrase that you've used often enough in your life.
It was a mistake every time.
Give it a break.
They said yes.
That's not enough for you.
You need them to feel good about saying yes.
I treat patients for months, maybe years, not weeks, like you.
I'm taller.
If they don't trust me, I can't do my job.
The only value of that trust is that you can manipulate them.
You should write greeting cards.
Giving the parents a chance to make a bad choice was a bad choice.
At least it would have been their choice.
One they'd regret at their son's funeral.
Kitchen and bathrooms were immaculate.
Whatever the kid's got, he didn't get here.
No, whatever the kid got, he didn't get from the kitchen or the bathroom.
Nobody cleans swing sets.
Yeah, because their kid's 10 and hasn't used it since he was six.
You obviously think your time could be better spent.
Why'd you come along? You feel bad about what happened last week.
I'm handling it.
Think the family's gonna sue? She only had her grandparents, and they weren't close.
Well, that's good.
For you, I mean.
A lawsuit makes it even harder to put behind you.
You put yours behind you? Nope.
When I woke up this morning I I couldn't remember what she was wearing when I admitted her.
Memories fade.
I killed her a week ago and I can't remember what color top she was wearing.
I was grateful when I could wake up not thinking about her.
I'm not like you.
Your patient died because you were distracted over the death of your dad.
I made a calculated decision.
You acted like a human being.
I acted like House.
Could be Mucor or Strongyloides in this dirt.
No pulmonary symptoms, setting well, breathing easily.
Mom, I'm freezing.
How long do I have to wait? Matty, we found an old water pump in your backyard.
You ever drink from it? Yeah it was gross.
We gotta test for Mycobacteria, leptospirosis.
When did you drink the water? Last summer? You sure? You haven't even taken a sip to cool off? It was really gross.
My shoulder's bugging me.
Does that matter? It could.
Did you do anything to hurt it? Just threw the ball around the other day, for a couple hours.
It's probably just a muscle ache.
Let us know if it gets worse.
So soreness and stuff, that's not 'cause I'm sick? Is something else bugging you? Sort of.
He has acute scrotum.
Adorable.
Please, I thought you were dignified.
Come on, how am I not supposed to make that joke? Best thing about big, honking gonads, well, one of the best things, is that there's only a few infections that could cause it.
Do urinalysis and cultures for E.
coli, Klebsiella, TB, and Brucella.
Blood tests for enteroviruses and adenoviruses.
Hopefully, the needles have grown as fast as his sack, and we can find it.
Can Chase and Cameron cover that? Mind if I ask why? I want to recheck the National Marrow registry for an alternate donor.
In case we're wrong? It's been known to happen.
Fine, go.
Negative for E.
coli and TB.
Why is House taking it easy on Foreman? He deserves a break.
Yeah, House is all about giving breaks to people in need.
No on Klebsiella.
And it's Tuesday.
It's got nothing to do with Foreman or House.
It's just It's the day I remind you I like you, and I want us to be together.
Thank you, I'd forgotten.
No on Brucella and both viral antibodies.
You're really gonna do this every Tuesday? You take the day off, I'll pick it up on Wednesday.
What if we're looking for the wrong thing? These are the only infections that cause swollen testicles.
Why don't you just say it four times now and leave me alone for a month? Well, what if it's not an infection? His temperature's through the roof.
There's mucous pouring out of him.
I know he has an infection, but what if it didn't directly cause the scrotum issue? What if it just caused the thing that caused the scrotum issue? CK-MB is elevated.
Slightly.
There's nothing wrong with Indicates cardiac injury.
We stuck him in that room, put his stupid, little runny-nose infection into hyperdrive.
What if it went to his heart? Pulmonary valve looks clean.
Wait.
Stop.
Mitral valve, there's a growth.
He'll need a month of antibiotics to clear that.
His brother only has four days to live.
The infection in Matty's mitral valve rules him out as a donor.
This is perfect.
We drove the infection into his heart.
Okay, perfect is too strong of a word, but it's very, very good.
Now we know where the infection is.
All we've got to do is remove the valve, ID the infection, target and destroy it.
Remove the valve? He'll be fine on antibiotics.
He doesn't need open-heart surgery.
He'll be heartbroken, on account of his dead brother.
Either way he's got a dead brother.
The infection isn't just in the valve.
Even with targeted medication, there's no way we can clear his system in time.
We don't have to.
We have to clear his marrow.
After the surgery, we harvest the marrow, marinate it in the targeted antibiotic, simmer and serve.
Could work.
It's insane.
It is better than a dead brother.
I'm running this by Cuddy.
Fine.
Go.
In fact, let's all go.
This surgery is dangerous and life-altering, and clearly not in the interest of our patient.
It is, if he likes his brother.
We have a conflict of interests.
The parents don't.
Of course they do.
They already sacrificed Matty's health to benefit his brother once.
They made his cold worse.
We screwed up his heart valve by making his cold worse.
Do you have anything to add to this debate? Wilson's right.
Foreman's wrong.
Your shirt is way too revealing for the office.
What do you want me to do? We should call child services and have them appoint a guardian for Matty.
No.
Go explain the choices to the parents, and don't let House bully them.
House.
Did he really think I was gonna do that? I didn't.
Then, why did you let him I'm trying to cut him some slack.
Nice of you.
I think he's got the yips.
Steve Blass, Scott Norwood, David Duval all got the yips.
Great athletes, lost their confidence and immediately started sucking.
And you're giving him time to work through it? Four days, and he's fired.
You don't get better from the yips.
Open-heart surgery? If you want both kids to live, it's the only choice.
Due to the valve replacement.
Matty will have to be on blood thinners to prevent potential clots.
For how long? Forever.
He couldn't participate in contact sports, because of the risk of hemorrhage.
What about the marrow registry? Maybe they'll find a match.
Maybe they'll ride it here on a unicorn.
I'm afraid finding a viable new donor isn't something we can realistically depend on.
Either we cripple one son, or kill the other.
He won't be able to play baseball.
That doesn't make him a cripple.
What should we do? You should protect your family as a whole.
You should do the surgery.
That was awesome.
Shut up.
I gotta start pretending to care.
I did exactly what Cuddy told us not to do.
No you didn't.
You did exactly what she told me not to do.
You're completely in the clear.
Oh, you've got to be kidding me.
You're actually upset.
You just said what you believed.
I also believe in patients making their own choices.
Because it lessens your guilt if things go wrong.
You're not protecting their choices.
You're soothing your conscience.
By that logic, a sociopath would make the best patient advocate in the world.
Am I blushing? You ready? Yeah.
Thanks.
You'd do the same for me.
Don't worry.
You'll be fine.
You think I'll be better in time to pitch in the playoffs? Maybe next season.
We should have told him.
He loves his brother, but if he understood what we were asking of him He loves his brother more than he loves baseball.
You did the right thing.
Putting any part of this decision on him It's impossible for you guys to deal with this.
How's a 10-year-old supposed to do it? Canula in place.
Sutures are holding.
We're all set to go.
Switch him over to bypass.
Yeah? I didn't do the surgery.
You woke me up to tell me that you're lazy? We biopsied a piece before we started cutting.
I'm tired.
Get to the point.
We didn't replace the valve because the growth was fibrous tissue.
It wasn't infectious.
We've got to be wrong about Oh, God.
What? You know what's wrong with Matty? I think Hector's committed suicide.
What are you talking about? He took some pills.
Is he alive? He ate half my stash.
Of course he's He's stoned.
I'll be right in.
We cut all the way into this kid's heart, and all we got was this lousy, non-infectious fibrous tissue.
How did we miss this? Matty had a fever.
He got sicker when we suppressed his immune system.
That all points to infection.
Yeah, yeah, yeah.
Not our fault.
Fibrous tissue.
Something is turning his healthy heart valve into gristle.
Fibrous tissue, enlarged spleen, fever Could mean autoimmune.
Autoimmune diseases aren't passed along in bone marrow.
He can still donate.
We confirm, I do the surgery.
Lupus and Behçet's are our best bet.
Do an ANA and pathergy test.
Or it could be infection.
My memory's not what it used to be, but didn't we just rule that out eight seconds ago? Just because it's not what screwed up his valve, it doesn't mean it's not in his system.
Uh-huh, and has the obvious advantage of making us right all along.
Little disadvantage of making big brother dead.
That's your argument? A better outcome? It fits.
The family has one kid with leukemia and one with autoimmune.
I wouldn't stand next to them in a rain storm.
That's your argument? It sucks for them? It fits, and we can still help big brother.
National Marrow Registry came up with four out of six donors.
Six out of six is two better than four out of six, right? I mean, I know two is so small, but since it means that he's gonna get Graft-Versus-Host Disease, the marrow will attack his body, and he'll die a painful death.
Find out what autoimmune it is.
Is this autoimmune better or worse than the new heart valve? It depends on which autoimmune it is.
With early detection, most are manageable.
How long will testing take? That's the other good thing about this.
There's literally thousands of possible infections, but only a handful of autoimmune conditions.
We'll have the answer in a few hours.
Hey, Doctor? Is this bad? Wanna catch a movie? It's one in the morning.
I know a place.
Although, I wouldn't recommend wearing those shoes.
How exactly does a dog unscrew a bottle of pills? Is that a riddle? It requires an opposable thumb.
I must have left it off.
On the floor? I think he hopped up onto the bathroom counter.
He has arthritis.
Not me this time.
No! It's your damn dog.
He chews everything.
I was missing a file.
Found paper in his stool.
An original Sun Record 78 Elvis recording, gone.
Who the hell chews vinyl? He's vindictive.
He's had a good, long life.
It's his time.
Are you okay? I just tripped over Wilson's self-righteousness.
What do you got? Matty's negative for everything.
It's not autoimmune.
So, we're back to infection.
Nick's starting to deteriorate fast.
He's got bruising all over his arms.
His capillaries are leaking blood.
If it happens in his brain, he's dead.
We've got to go with the four-out-of-six donor.
Did I mention my concerns about four being less than six? Wilson's first wife ignored a similar issue.
Of course, that time, it was only fatal to their marriage.
It's either that, or we start randomly testing Matty for infections.
I know how you hate the word "random.
" Do it alphabetically.
We're not doing that damn transplant.
Where's Foreman? We've found a donor.
It's not an ideal match, but four out of six still gives Nick a chance.
A partial match transplant is extremely dangerous.
Doctor Foreman explained Did he also explain what sort of pain your son will experience if he gets Graft-Versus-Host Disease? Yes.
Apparently, he didn't explain it vividly enough.
Let me give it a whack He also explained that if we did nothing, Nick could start bleeding into his brain.
Matty is a perfect match.
Just give us a little more time to figure out How much time? Doctor House is the best diagnostician How much time? I don't know.
And Nick can start bleeding into his brain without any warning? Yes, but the chances of complications from a mismatch are My boys have suffered enough.
Get Matty better, and give Nick the transplant from the new donor.
Foreman screwed us.
No, you screwed us.
What is the point in being able to control people if you won't actually do it? It's like training a dog and letting him go on your rug, which, by the way Once Foreman got his mitts on them, well, there was no way You don't explain chances and probabilities, you lie to them.
You tell them Foreman's a moron, which isn't even much of a lie right now.
You've got to talk to him.
I've got no problem with what Foreman did.
He undercut us, and he may have cost that kid his life.
Foreman did what he thought was right.
You, on the other hand, sucked out.
When the decision really mattered, you didn't have the guts to tell them what to do.
If that kid dies, it's because Foreman was wrong, and because you're a coward.
Oh, goodness, I've left my door open.
My poor dog must have run away and been hit by a car or a truck or a train.
Or an anvil.
Thank God, you're still here.
He's still here! Where's my stereo? How are you feeling? A little itchy.
It's weird, huh? You still have no idea what's wrong with me, but those meds will make me better.
We put you on a variety of medications that will fight all kinds of infections.
Nick, you know exactly what's wrong with him, but maybe he's gonna die, anyway.
Hopefully, the new marrow will I can't go in there, can I? Your infection would kill him.
So, I won't be able to be with him when he dies? You'll be able to be with him when he gets better.
What's wrong? It really itches.
Hello? Why am I meeting you here? You're paying for my new cane.
It was your dog.
So, that's it? You call me a coward, life goes on? Apparently.
You showed up.
Hey.
I'm sorry.
You're pathetic.
I didn't actually mean that.
Yes, you did.
No, I didn't to infinity.
Yes, you did.
You're pathetic.
Yeah? When? What did the labs say? Why don't you buy your cane at a medical supply store like a normal cripple? Fewer bitching choices.
Okay.
What do you got in bitching? Right this way.
That was Cameron.
The kid that wasn't all that sick is now all that sick.
He's bleeding out of his ears.
Blood counts? Down.
Schistocytes on the smear? His body's not making new blood cells.
His bone marrow's crashing.
This is one of our top sellers.
It's a little too Marilyn Manson in a retirement home.
The meds are suppressing his bone marrow.
Or the infection's doing it.
Pretty cool.
Genuine bull penis, stretched over a metal rod.
Penis canes are murder.
Right.
Let me see the one on the end.
You got it.
We need to stop Matty's meds.
If the marrow rebounds, it's the meds.
If it doesn't, it's an infection.
And if it's the infection? Maybe I was wrong about which kid's gonna die.
Bitching.
Flames? It makes it look like I'm going fast.
Now, how's our dying kids? Nick's developed blisters all over his feet and legs.
He's got grade four Graft-Versus-Host.
Increase his dosage of methylprednisolone.
Already did.
It's not working.
Feeling guilty? I did the right thing.
Always a comfort.
Okay, what's the other kid's status? We're done with Nick? God is done with Nick.
We know what he has.
We know how to treat it.
We're doing it, it's not working.
Life is for the living.
Matty's been off his meds for a few hours, but his blood count's still tanking.
Means the meds aren't to blame.
It's the infection.
If we don't get this under control, his blood will literally turn into water.
Cultures still aren't growing anything.
Why not? Because you did the right thing.
Convinced the parents to treat the kid.
All you did was yank the weed out of the ground.
Its roots are still killing their beautiful lawn.
We just can't see it.
If we can't see it, we don't know what it is.
If we don't know what it is, we can't kill it.
So we got to wait for it to grow back again.
Now, the soil is arid.
So with he and his brother we'll be dead by the time What if the dandelion was in fertile soil? What if we take the roots from Matty, and put them in Nick? Turn the kid into a petri dish, only better.
A petri dish can't tell you when it hurts.
You want to give him his brother's infection? The very thing we've been trying to avoid since the brother sneezed? Leukemia kid's got no defenses.
Which is why he'll die.
But before he does, the infection will spread fast.
Fast enough to tell us what it is, in time to save his brother.
Do you see any other way? The infection is decimating Matty's bone marrow.
But if we give that marrow to Nick, his symptoms could let us diagnose Matty.
But, it'll kill Nick.
Yes.
You're You're saying we should kill one son to save the other? Nick is gonna die either way.
You don't know that.
I mean, he's in pain right now, but Nick's Graft-Versus-Host is not responding to medication.
That can change.
Maybe he He'll rally.
Hey, my Nick is a fighter.
Graft-Versus-Host isn't gonna go away because of Nick's sunny smile and positive outlook.
Nick has survived three reoccurrences of his leukemia.
He's being torn apart from the inside out.
His pain's gonna get worse and worse, until he dies.
You're just dragging it out.
You have only one decision to make.
You can leave here with one dead son, or two.
Tell them.
You should let us do this.
No! We're not giving up on Nick.
Not! The patient's parents apparently don't want to be parents anymore.
You're a sneaky bastard.
Any ideas how we get around this? Court order? It's hardly sneaky.
We can still save Matty.
Run more tests, find out what infection is destroying his marrow.
Ten-thousand possible infections at least 20 minutes per test it'll take you approximately eight years.
Actually, four months, assuming the last one I test is the right one, and, if it's the first, it will take me approximately 20 minutes.
He's right.
It's worth a shot.
He's timid.
Testing blindly is not gonna save this kid.
But standing around here will.
Wow, he sure is hurting.
The nurses say he maxed out on his pain meds.
If I had a nickel for every time I heard that Pharmacy's on the ground floor.
I'm gonna go get you some more pain medication, okay? Thank you.
It's not gonna help.
You're dying.
Nothing's gonna change that.
These drugs will just make you go easier.
I know.
Fourteen years on the planet, most of them spent suffering.
Dying before you even got to drive a car, take off a girl's bra, drink a beer.
Believe me, there's plenty you haven't done.
Really good stuff.
Must make it hard to believe in God, or fairness, larger purpose.
But your life doesn't have to be meaningless.
You can save your brother.
How? Negative for CMV.
Negative for amoebas.
House called you timid.
He's called me a lot worse.
To him, there is nothing worse.
He's gonna fire you.
Even if we run 100 tests, that only gives us a one percent chance of saving these kids.
Better than zero.
You don't care if you get fired? I don't know.
There's got to be a way to better our odds from a 99-percent chance of death.
You've got to know.
It's not food-borne, because no one else in the family is sick.
You either care about your job, or you don't.
And Matty's the only one who drank from that water pump in the back yard, and we eliminated Pseudomonas and cholera.
If you care, you fight to keep it.
If you don't, you quit.
I thought they lived in the suburbs.
They do.
Why? And they've got a water pump? Please, I I want to do it.
No, Nicky, it's not your decision.
I'm dying.
There's nothing that's gonna change that.
Hey, hey, hey.
Don't say that.
Okay? You can't give up.
It's time for me to go, Dad.
You got to let me go.
No.
Please, son.
I can't I can't I can't! Let me do it for Matty.
Let me do it for you guys.
So you won't be alone.
Are you sure? No, but he is.
Get Nick back to the clean room.
The parents agreed to infect him.
We figured out what's wrong with Matty, histoplasmosis.
Well, what is that? I mean, why did it Fungal infection.
It grows in chicken feces.
The dirt that Matty used to build his pitcher's mound must have sat under a chicken coop.
Your whole neighborhood was built on top of farmland.
We didn't test for it earlier, because we didn't Can you fix him? Full course of amphotericin and he should be fine.
And Nick? I mean, can you clean Matty's marrow? Just like you were talking about doing it, but do it fast, and get it into Nick.
I'm sorry, the reason Matty is so sick is because the infection is attacking his marrow.
He doesn't have enough left to safely take from him and give to his brother.
I'm gonna get better now? That's it? That's it.
And what about Nick? Your brother was willing to risk his life to save you.
Are you willing to do that for him? I can't sedate you.
You're too sick.
Please, please stop.
Please.
Please.
You're done, right? Sorry, I need a lot more.
No, stop! Stop! How much heat are you taking from the parents? They're calming down.
I think it has something to do with both their kids being alive, awake, and eating.
The marrow transplant took.
Welcome back, Foreman.
You should talk to him.
Tell him how proud I am? Hey, if you're ashamed of him, tell him that.
Pride and shame only apply to people we have a vested interest in, not employees.
How many hours a day do you have to spend with someone before they're basically family? Good point.
But, first, I've got to tell Cameron and Chase that they're violating God's will.
I'm just asking you to have an adult conversation to let him know That he did a good job? He knows it.
Adults don't need adult conversations, just like I don't need this conversation.
Have you killed Hector yet? Obviously not.
Oh.
He's quiet.
He's Is that my stethoscope? Bad dog.
Listen Bonnie joined her homeowner's association and staged a coup.
Pets are now allowed.
Oh.
If you want to keep him, she wants a new puppy anyway.
She'll understand.
Why would I want to keep him? You're sure? Come on, boy.
Accidents happen.
Candy? Good boy.
Good boy.
You did good.
I did what you would have.
Well, maybe I'm biased, but I tortured the kid.
Because you knew it was right.
You knew you were saving his brother.
I know.
I don't like that I know.
I hate that I can listen to a kid screaming in pain and not even take a moment to question whether I'm doing the right thing.
I hate that in order to be like you, as a doctor, I have to be like you as a human being.
I don't want to turn into you.
You're not.
You've been like me since you were eight-years-old.
You'll save more people than I will.
But I'll settle for killing less.
Consider this my two weeks notice.