House, M.D. s04e16 Episode Script

Previously on House.
I don't know how I got here.
I saw a symptom before the crash.
Why was I taking a bus? Medical hypnosis can bring the brain to a Class 2 Theta state.
You're taxing an already injured brain.
Someone's dying because I can't remember It was Amber.
She was on the bus with me.
She's the one who's dying.
Her heart won't stop racing.
No idea what's causing it.
Sure it wasn't the bus that landed on her? It's not trauma.
She was stable post-op.
This didn't start until an hour ago.
My God.
Delayed reaction to the trauma.
She lost both kidneys in the bus crash, ripped up her femoral artery.
We fixed the artery, got her on dialysis for the kidneys.
Whatever's doing this to her heart, it isn't from the crash.
Check her potassium? Of course.
Why didn't you call me? She's been under the whole time.
She had no ID.
Pushed adenosine? And verapamil.
And floated a Swan an hour ago.
Coronary angiography? Three critical patients ahead of her.
We'll have her in within the hour.
We're fifteen minutes away from Princeton-Plainsboro by ambulance.
You want to move her? Her heart rate is 130.
She's hemodynamically stable.
We're moving her.
You're not her doctor, you can't make that decision.
Her husband can.
Right? Move her.
If the trauma didn't damage her heart Why was she on the bus? I don't know.
If she had any underlying condition, the accident could have exacerbated it.
Why were you with her? I don't know.
I'm not hiding anything, I just don't remember.
What else could damage her heart? Wilson.
Don't get lost.
I'm barely coherent.
I need your help right now.
V- fib.
Charging.
Okay.
Okay.
Clear! Wait.
Wait! Wait! Protective hypothermia.
You want to freeze her? Her heart's not beating.
Her heart's already damaged.
You restart it, it'll keep racing, shoot off free radicals and kill her brain.
We ice her down, put her on bypass until you've diagnosed her.
This is not a solution.
All you're doing is pressing pause.
It gives you more time to find the diagnosis.
House.
This is Amber.
Please.
Cold saline solution.
Core temperature down to 90.
Bypass circulating.
She's stable.
Why are we doing this? Bought us time to think.
The trauma must have stimulated a pre-existing heart condition.
Auto-immune, congenital anomaly, blood-clotting disorder, lead poisoning Could be anything.
Great.
Let's explore that.
Quick, get her on panacea.
We can narrow it down by looking for arterial blockages.
How? On an echo? Can't see wall motion when there's no motion.
EKG? Nope, heart's in the off position.
Thallium uptake scan? Useless on a cold heart.
Yeah, we get it.
Her heart's not beating.
It's gonna make it harder to diagnose.
On the other hand, she's not gonna die while you're whining about it.
What else? There is another way to narrow it down.
If you really did see a symptom in Amber before the crash, physostigmine helped your memory last time.
Why not cyanide? He's a mess, he needs to sleep.
I had a heart attack this morning.
I can't do any more drugs till lunch.
Get her an angiogram.
It could show damage even in a stopped heart.
Rest of you, search her apartment.
Toxins, heavy metals, drugs Anything that might make her heart race.
I need to know if there's anything medically relevant that you couldn't share publicly.
Is this a Philanderers Anonymous intervention? You were obviously drinking last night.
Maybe you took Amber to a bar? I left here on my motorcycle.
Alone.
You ended up drunk on a bus.
Together.
Maybe you met Amber in the bar? I was not having an affair with her.
You can't really say that if you don't remember.
I lost four hours, not four months.
Maybe it was the first time.
If you drank together, any chance you did any drugs? I'll run a tox screen.
You coming? Correspondence.
Letters to patients.
She could have caught something from one of them.
Copy it to a thumb drive.
Let's get out of here.
Travel.
Do you know if she's been out of the country recently? It's just video clips.
Maybe she narrates where they are.
And action! Looks like she didn't travel very far.
You look beautiful.
You look nervous.
I've never done this before.
I have.
Trust me.
You'll love it.
Hey.
Not even close to relevant.
As long as we don't know what's wrong, we don't know what's relevant.
Yeah, maybe they're having sex on a pile of asbestos.
Go watch it.
If we were in a stranger's house, you'd be watching the video.
You altered your behavior because you're friends with her.
Are you okay? We shouldn't be treating her at all.
I'm gonna search her bathroom.
Are you okay? Can't really say "yes" when it's a hallucination asking.
Don't worry, you're just dreaming.
What symptom did I see in you? A myoclonic jerk.
Boring.
An incredibly rare neurological symptom is boring? Am I in someone else's subconscious? What did we do last night? Was I meeting you for a drink? Is that all it was? A man thinks a woman is beautiful, admires her intelligence, admires the way she has to get whatever she wants.
The things he likes about himself.
And maybe she always had a little thing for him.
His mind, his blue eyes.
But someone gets between them.
So they decide to meet one night at an out-of-the-way little bar Does that sound familiar? Do I feel familiar? What do you feel? Electricity.
Electricity.
I know I saw the symptom.
I know the memory is locked in my brain, now I know how to get it.
No.
You don't even know what I'm talking about.
You need to rest.
I have yet to hear about any study linking electricity and rest.
Deep brain stimulation.
It's been proven.
Electrical impulses applied directly to the hypothalamus can evoke detailed memories.
My mistake.
Drilling a hole and shooting lightning bolts into an already cracked skull is very restful.
It's not fatal at all.
She's right.
You need to sleep.
Brain activity spiked.
Amber? Amber? It's me.
Random spikes are common.
Shut up.
It's gonna be okay.
I'm here with you.
The team has found something.
Can you ask her if we can be excused? What? The coronary angio was negative.
So was the tox screen.
That's what you found? Negative tests? I could have told you she doesn't do drugs.
I found these in her apartment.
Sorry.
Prescription diet pills, SSRls, amphetamines.
Diet pills cause structural damage to the mitral valve, could explain the tachycardia.
She'd have to be an addict to take enough for her to damage her heart.
I'd know.
Did you know she was hiding them in her vitamins? We have to warm her back up, get her heart beating so we can do a CT to confirm.
No.
We've been over this.
Starting her heart could cause brain damage, could burn out the heart muscle.
Test her heart without starting it.
Crack her chest open.
Reach a finger inside the pulmonary vein, run it across the valve.
That's the safer course? It is if we're wrong.
When did we start assuming we're wrong? If this were any other patient If the valve is calcified, that's our answer, that's our cure.
Go.
Thirteen.
Who found the diet pills? Kutner.
You didn't even go in the bathroom, did you? You're suddenly mute in the differentials.
A blow-up doll would be more useful.
And yes, that's the first time I've ever implied something negative about a blow-up doll.
It's Amber.
I don't Normally, I'd be fascinated.
Today, don't care.
Get over whatever it is and do your job.
Wait.
Look at her eye.
She's jaundiced.
Her liver's not working.
Diet pills don't kill the liver.
Put her back in ICU.
Liver failure means whatever this thing is, it's spreading.
Despite the fact that she's frozen.
Hepatic and heart failure could mean anti-trypsinase deficiency.
We can stick a needle in her liver.
We see fibrosis, she's right.
Does Amber drink sherry? Nocardia fits just as well, but there's no way we can tell, since we can't take her temperature.
I had a dream she was pouring me a glass.
And since I'm a scotch, beer, gin and rum man If we warm her back up, we should be able to tell if she's got an infection.
Yes, we can get a diagnosis by letting the disease run rampant until it kills her.
If it's spreading, we need to slow this even more.
We've got to cool her down further.
I know you love her and you're scared she's going to die.
But just making her colder and colder isn't a cure.
It's not dealing with the reality.
Sherry means something.
Amber doesn't even drink sherry.
House, can we get back to If she did drink sherry, it would mean nothing, but since she doesn't, my subconscious is obviously trying to make some other point.
There's a Sharrie's Bar on Third, right off the bus route.
Wilson's right.
We need to make her colder.
Putting more ice on her is just delaying the diagnosis.
Not on, in.
Fill her lungs with slurry.
Where are you going? Taking Wilson out for a drink.
Is this the place? Maybe.
Hey.
I assume you are here for these.
Did you see me here with a tall, blonde woman? Yeah, I think she joined you after scotch number seven.
Did she seem sick? She sneezed.
I gave her a napkin.
Did you see the color of the sputum? I assume sputum means snot.
Look, I see lots of drunk chicks in here.
I didn't have time to stop and analyze the color of your girlfriend's boogers.
She's not my girlfriend, genius.
She was hot, you seemed into her and she bought you drinks.
Last night, she was your girlfriend.
Blood in her sputum.
It could mean parasites.
Any recent travel? You seemed into her? If he had a brain, he wouldn't be tending bar.
Sneezing's a new symptom.
Let's assume the runny nose means an infection.
What did House have to say? He told me I was raised by wolves, and that's why I use the same hand for my fork and knife.
Whoa.
Not that one.
The slurry tube.
I know this is different.
But it's not.
Everyone dies.
She's not dead.
You're reacting this way because she might be soon.
Yeah.
I am.
Why aren't you? I'm an Indian guy named Kutner.
Ever wonder what happened to my parents? I'm sorry, I didn't I was six years old.
I used to like helping out in my parent's store after school.
A guy walks in to rob the place, ends up shooting them both.
Wasn't fair.
Took years, but I had to accept that's just the way it was.
So, you gonna help me fill her lungs up, or not? Tell me the liver biopsy showed infiltrates, minor inflammation.
Yeah.
How Snot on a napkin.
Add the heart, the infiltrates Hep B.
Start her on IV interferon.
I'll go tell Wilson.
Good idea.
And I'll go nap, because I was concussed last night and had a heart attack this morning.
I'll tell Wilson.
You go sleep.
Hepatitis B is a lame diagnosis.
Oh, God, I get less rest when I'm asleep.
I rise from the dead and that's reaction I get? I'm sorry.
If I had known, I would have started a breakaway Jewish sect.
Hep B fits.
Why are you doing that? Because Hep B doesn't fit.
Turn her over.
We're about to start her second course of interferon.
Which she might not need once you turn her over.
The small of her back.
She's bruised.
Why is that significant? Look closer.
A rash.
How'd you know what was on the small of her back? Well, either I'm still asleep, or I'm starting to remember.
Looks like an influenza rash.
The flu wouldn't be killing the organs one by one.
Dermatomyositis.
Wouldn't speed up her heart.
Maybe it's an allergic reaction to the interferon? Yes, the symptom I saw on the bus was a rare interferon allergy that flares up two days before you take it.
How'd you see the rash down there? I don't know.
Maybe she leaned over.
Maybe it's not a rash at all.
Could be an abscess.
Thirteen, stick a needle in there.
If there's pus, Foreman's right.
Ultrasound is safer.
I'm not asking you to stick a needle all the way through her.
Taub, you do it.
No.
Wait, I can do it.
No, apparently, you can't.
It's not fluctuant.
Clear, it's not pus.
Means it's vesicular.
Rocky Mountain Spotted Fever.
We had dinner with a friend last week.
We walked their dogs.
I guess she could've gotten a tick.
It's treatable, doxycycline.
Allow eight hours for the antibiotics to take effect, then we warm her up, shock her heart.
Wait a minute.
Wait a minute.
If we're wrong, restarting her heart could kill her.
Run blood cultures first.
Fastest way to test is to treat.
If we're wrong, still should give us time to try something else.
We are not starting her heart until we're 100º/º certain.
We're never 100º/º certain.
Run the blood cultures.
After we get confirmation, we'll restart her heart.
He's wrong.
And you know he's wrong.
You can't change your mind just because a family member starts crying.
They're always scared.
I said run the blood cultures.
Sorry.
Wide stance.
You're right.
I'm screwing up.
Why are you screwing up? I didn't even like her.
Did you hate her? Not enough to want her dead.
So it's not guilt.
That just leaves fear.
A young woman dying.
A young doctor dying, in fact.
That sound familiar? Yeah, I'm at risk for Huntington's.
I've dealt with it.
By not getting tested.
Dealing with it by not dealing with it.
It's clearly working beautifully.
You're the champion of not dealing with your problems.
My grandson gave me a mug that says that.
Okay.
Enough hand-holding.
Deal with it, get back in there, or pack up your stuff.
You're screwing up this case worse than I am.
House is gonna kill the patient.
What are you What are you doing? She's up to We're gonna restart her heart.
No, you're not.
There's still time to undo this.
Cool her back down.
You weren't taking the safe approach.
We've got to know if the antibiotics are working.
Her EEG's slowed.
Amber.
Amber.
Well done.
We still don't know what it is, but you've just let it spread to her brain! This is exactly what I said would happen.
It's in her brain now.
The brain involvement gives us a new symptom.
That wouldn't be there if you hadn't It's where the disease was going.
We needed to know that.
This was not your decision to make! You went behind my back.
You went behind House's back.
Inside voices.
House wanted to warm her up.
You just guilted him into changing his mind.
Heart, liver, rash and now her brain.
Auto-immune fits best.
Crash trauma could've set it off.
Start her on prednisone, then we'll warm her up again.
House, if this is some other infection, the steroids will trash her immune system.
He's the attending.
You're the family.
Go spend more time with the patient.
You can't do this.
That's not a good argument.
It's not an argument at all.
I'm sorry.
Cuddy's right.
I was afraid to do anything.
I thought if everything just stopped, it would be okay.
And it's gonna be.
Taub's starting treatment, we're doing everything Not everything.
Before you warm her up You said you wanted to try deep brain stimulation.
But there's no reason.
We know the symptom.
We know what I saw.
What if it's not the rash? What if you saw the rash in the ambulance, or when we were putting her on bypass? What if there is still something else stuck inside your head? You think I should risk my life to save Amber's.
I'm inserting the IPG probe into your ventral hypothalamus.
Give me 3 volts.
I can't hear him.
Can't hear who? Everything's in black and white.
Who was talking? Is Amber there? You're supposed to be jolting my hypothalamus.
Not petting it.
We don't want to overload it.
As long as I'm risking my life, I might as well be watching a talkie.
Increasing from Sending impulse.
You're not getting them back.
Hey! You take my keys, you gotta give me a phone call.
Who are you calling? Dial-a-Wilson.
I was on call.
Amber was home.
I told her to find you, have you pick me up.
I said to find Wilson.
He's working.
And I'm willing to suffer this indignity on his behalf.
Does she seem sick? Not yet.
Come on, time to go.
Need another round and a drink for what passes for a lady around here.
What's your poison? Nothing.
We're leaving.
We're leaving, leaving, leaving.
Cosmos.
I remember Wilson buying cranberry juice.
I'll have another, and she'll have a Cosmopolitan.
The obstinate drunk thing is not flattering.
Come on, you called for a ride.
Drink your drink, or I'll drink them both.
One, and you leave voluntarily.
Let's go.
Hey! Need another Cosmo, here.
She sneezed.
What color is it? Thanks.
Looks like snot.
Seems like a cold.
Nothing else? No.
Where are you going? You think I paid? House, what are you doing? You can barely walk.
Go home.
I'll take the bus.
Hey, someone's gotta pay for this.
Hi.
You forgot something.
Boy, you don't give up, do you? Yeah, I'm an idiot that way.
You doing this for me, or for Wilson? For Wilson.
Well, then, it's even more impressive.
Damn.
Do you have a Kleenex? I got a sleeve.
I got two, actually.
Gonna need more than that.
I'm getting that nasty flu.
Is that it? The flu? Is there any rare complication? No.
It'll explain the rash, but nothing else.
Unless What? Don't do it.
It wasn't the flu.
It's what she did for it.
She has amantadine poisoning.
The crash destroyed her kidneys, her body couldn't filter the drugs, she ODs on amantadine, explains the heart, the liver We just need to start on her dialysis and flush the drugs out.
What? What's wrong? Amantadine binds with proteins.
Dialysis can't clear it out of the blood.
There's nothing we can do.
I'm so sorry.
Amber.
Amber.
He's seizing.
Wilson! I need help, here.
House suffered a complex partial seizure.
The violent shaking widened his skull fracture, causing a brain bleed.
We won't know if there's any cognitive impairment until he's out of the coma.
He was right about the amantadine.
Amber's body couldn't filter it out.
That's what caused her heart to beat too fast for too long.
It caused irreparable structural damage.
Didn't matter if they shocked her or froze her or Her heart was dead once it stopped in that ambulance.
What about a new heart? Transplant? All of her organs are damaged.
She can't qualify.
There's nothing we can do.
Nothing we could have done.
We should call time of death.
Technically, she's still alive.
Could probably survive a few more hours on bypass.
We could wean her off anesthesia.
Wake her up.
Give you a chance to It'd be cruel.
Don't Wake Amber up.
See her again.
Tell her what she means to you.
Wake her up to tell her that she's You are waking her up so that you can both say goodbye to each other.
She would want it.
Hey.
Hey.
You're in the hospital.
I'm on bypass.
Yeah.
Do you remember what happened? I got on the bus.
I shouldn't have gotten on the bus.
No.
No.
It's not your fault.
It's not your fault.
How bad? You had tachycardia, complicated by complete renal failure.
The tachycardia degenerated into V- fib, followed by hepatic failure.
The flu pills Yeah.
I'm dead.
I love you.
I love you, too.
We should say goodbye.
She didn't even like us.
We liked her.
Did we? We do now.
What do we say? We don't need to say anything.
I'm tired.
I think it's time to go to sleep.
Just a little longer.
We're always gonna want just a little longer.
I don't think I can do it.
It's okay.
It's not okay.
Why is it okay with you? Why aren't you angry? That's not the last feeling I want to experience.
BP stable.
Still non-responsive.
Pupils are equal, round and reactive.
Heart rate's normal.
Respiratory rate is You're dead.
Everybody dies.
Am I dead? Not yet.
I should be.
Why? Because life shouldn't be random.
Because lonely, misanthropic drug addicts should die in bus crashes, and young do-gooders in love who get dragged out of their apartment in the middle of the night should walk away clean.
Self-pity isn't like you.
I'm branching out from self-loathing and self-destruction.
Wilson is going to hate me.
You kind of deserve it.
He's my best friend.
I know.
What now? I stay here with you.
Get off the bus.
I can't.
Why not? Because Because it doesn't hurt here.
I lied.
I don't want to be in pain and I don't want to be miserable.
And I don't want him to hate me.
Well You can't always get what you want.
Hey.
I'm here.
Blink if you can hear me.
No.
Don't try to talk.
Just rest.