House, M.D. s05e12 Episode Script

Damn it, Zach.
This is the last time I'm turning around.
The next time you forget something, you're gonna be on your own.
I can't play without a stick.
Then I guess you won't play.
I don't care.
I suck anyway.
Don't say that.
I'm the worst guy on the whole team.
No, you're not.
Then who's worse? Don't worry about anyone else, just do your best.
See? You can't name anyone.
Zach, stop it.
Then name someone.
You can't, can you? Donny, Mark, Navid You really think I'm better than those guys? Yes.
Hurry up and get your stick.
Zach, get back in the car.
I need an ambulance at 860 Oakwood Avenue.
Why is Dad's car on? Get back in the car, Zach! Come on.
Don't do this to me, Jeff.
Don't do this! I'm sorry.
I just I couldn't take the pain any more.
Either I need a new watch or Mowgli is cutting into your beauty sleep.
I was up all night looking at finance reports and Rachel is doing great, thanks for asking.
Proving that you're a better foster mom than a homeless drug addict.
Departmental budgets are due this week.
I'm gonna need an extension.
I've got some time next decade Cameron already turned yours in.
That's nice of her.
Two questions, why did she, and why are you telling me? Same answer.
Now you owe her a favor.
I'm gonna need an extension.
I've got some time House, I've got a DYFS home visit on Friday.
And I've got a W-H-O-R-E visit on Mama's busy.
You two are gonna have to go play outside for a while.
with chronic pain all over.
This is the favor? I was expecting something involving whipped cream and tongue depressors.
He's seen seven different specialists over three years, no diagnosis and no relief.
Oh, I am fascinated already.
It's like I'm treating myself.
He gets cured, and I get to learn a valuable lesson about the milk of human kindness.
If I thought you learned lessons, I never would have quit.
So you're wasting a favor because I think you can help this guy.
Drug-seeking patients Don't attempt suicide with medicine cabinets full of narcotics.
Sounds like fibromyalgia.
Sounds like you don't work for House.
A diagnosis that provides neither an explanation nor a cure is, by definition, not a diagnosis.
The American College of Rheumatology would disagree.
There're specific diagnostic criteria Which this guy doesn't meet.
Putting pressure on his pain helps, doesn't make it worse.
He's got abdominal pain, severe headaches, muscle cramps that come and go.
And he tried to off himself.
He's, obviously, mentally ill.
The pain's probably psychological.
It's not a sign of mental illness to wanna be pain-free.
It is if your solution is sucking on a tailpipe.
Sane people don't attempt suicide.
Not ever? So, if you were being burnt at the stake and someone handed you a gun I'd shoot the guys with the torches.
Not one doctor this guy's seen in the past three years has been able to find a single thing wrong with him.
What does that tell you? It means they're idiots.
It means we got to start from the beginning.
And do a pain profile to rule out psychosomatic pain.
Search the home.
Go home.
Get a refill.
And a donut.
I'll help with the home.
"Choose the statement in each group "that best describes how you've been feeling lately, including today.
" I'm not depressed.
I know what I did was stupid.
"I usually sleep well.
I have some trouble with sleep.
"I have a lot of trouble with sleep.
" I have a lot of trouble.
It's up and down.
Between the pain and the meds, his sleep pattern's pretty erratic.
"He's a calm person.
He's more nervous than most people.
"He's so nervous he's miserable.
" He's definitely calm.
Sometimes calmer the worse the pain gets.
I think talking, interacting with other people, actually makes it worse.
Interesting.
Why, does that mean something? No, it's just We've seen that in other patients.
"He can do chores around the house.
"With help he can do chores.
He no longer can do chores.
" He helps all the time.
He's really strong.
He used to play hockey.
He was really good, too.
"I believe there's hope.
Hoping for things to get better is a struggle for me.
"Most of the time I feel completely hopeless.
" He still laughs, all the time.
He was always optimistic.
Still is.
It's just, it's harder now.
I guess I pray for strength more than hope.
There's nothing in there but a pharmacy's worth of pain meds.
This guy makes House look like a Christian Scientist.
He's also more compliant than House.
Kept all the inserts.
Had daily pill dispensers to make sure he didn't mix them up.
Guess if you're gonna go out in a car, this ain't a bad one to choose.
If I ever did it, it definitely wouldn't be like that.
Don't worry, I'm not making any plans.
I certainly wouldn't know.
Ever since we kissed, you've been avoiding me.
No, I haven't.
I've just been busy.
Metal polish could cause nerve damage, if he inhaled enough of it.
And judging by the shine on that car, he used a fair amount.
And judging by the fact that he owns a body shop, and one of these I'd say he knew not to inhale.
Busy tonight? We could get some dinner.
I don't think so.
So, making out, okay, meals, too intimate? I don't wanna kiss you again, either.
Why? Because we work together? No.
Because I like you.
That makes a lot of sense.
What doesn't make sense is me getting involved with anyone.
I thought you'd gotten past that.
That's why you agreed to the drug trial.
You can't give up on life because I'm not giving up on life, I'm just giving up on you.
I finally feel like I have a grip on things, I can handle this.
What I can't handle is dragging anyone else down with me.
Does this look like quail to you? You think he's had food poisoning every day for the last three years? Wild quail can be toxic, cause rhabdomyolysis which would explain his pain as well as the elevated CK levels.
So would the carbon monoxide he sucked out of his car.
It's not a toxic reaction, it's a psychosomatic reaction.
The pain profile showed an excessive concern about his physical health difficulty sleeping, getting out of bed He's not in pain because he's depressed he's depressed because he's in pain.
Not according to the pain profile you ordered.
It's not a diet issue.
We should start him on antidepressants, for his sake as well as his family's.
We're not diagnosing his family.
We're not diagnosing you, either.
It's rhabdo.
Push IV fluids, check his urine, do a muscle biopsy.
What muscle? He says it hurts all over.
Then she'll biopsy all over.
Where are you going? If Cuddy can come in late, I can leave early.
If you need anything while I'm gone, just ask Cameron to do it.
So if he just stops eating quail, the pain will go away? If we're right, it's definitely treatable.
My arm, it's starting to He needs more medicine.
- BP's down.
We need to get him in Trendelenburg position.
Jeff, can you hear me? - He's arresting.
We need a crash cart in here! He's not answering his cell, either.
V- Q scan showed a pulmonary embolism.
Means the pain's not psychosomatic.
Also means it's not rhabdomyolysis.
Up till now his heart and lungs were the only places he didn't have pain.
Means it's getting worse.
You gotta let the phone ring more than four times when you're calling a cripple.
Chronic pain and pulmonary embolism, go.
How'd you know he had a Call after midnight it's gotta be a heart problem.
Heart only would be consistent with rhabdo which means Thirteen and Foreman would be singing in the rain which means it has to be lungs as well.
Hypercoagulable state could cause pain and a PE.
You think the blood clot was caused by a clotting problem.
That's helpful.
What if it's a cancer syndrome, like Trousseau's? Explains blood clots, multi-focal pain, lack of obvious physical signs And why he's gone three years without anyone seeing it.
Check his chest, abdomen, and pelvis for tumors.
Why did he think only you two would be singing in the rain? Bone windows are normal.
Checking for cancerous masses in the lungs.
So, who do you know who committed suicide? Hemingway, Goebbels, Romeo and Juliet Your mom, dad? Saying I wouldn't do it under any circumstances means my whole family was suicidal? No.
But categorically insisting there are no circumstances means you've got baggage, personal betrayal, abandonment Just because you grew up in a Charles Dickens novel It's people like me who don't do it.
When your life sucks from the beginning, nowhere to go but up.
Thorax is clear, no tumors in the lungs.
The only betrayal comes from father of the year in there.
He has a wife, a kid, people who count on him to have a pulse.
Okay.
Switching to high-res cuts of the abdomen.
My parents live very happily in Queens.
They never attempted, thought about, or attempted to think about committing What? There, along his diaphragm.
That's not cancer.
No hurry.
I already bathed once this week.
I wouldn't want to look elitist.
Can't do anything till I write up an estimate.
Fine.
Pad it all you want.
Here's a check for the deductible.
Don't touch the piano, and lock up when you leave.
Sorry, deductible doesn't apply here.
I'm no architect, but I'm pretty sure the master bedroom is part of the home, which means the home warranty Doesn't cover negligence.
This pipe goes through the ceiling, over that wall and into your shower.
It didn't burst, it was pulled apart.
Yeah, 'cause I'm clearly a guy who likes to knock out a few naked pull-ups before I greet the day.
You hang laundry in there? I'm about to hang a plumber in there.
Look, there's no rust, there's no corrosion.
I don't know how it happened, but I know what happened and it's not covered.
So, whenever you're ready to spend the $2,200, give somebody else a call.
I promise, I'm only holding your hand to check for choreiform movement.
I'm getting absolutely no intimacy from it.
I told you, it has nothing to do with you.
I know.
That's the problem.
There's 80 reasons we shouldn't date.
But you can't shut everyone out.
You're gonna need help, support.
Look at our patient.
Thirty-two years old, not dead yet and already he's traumatized his wife, his son And I'll bet they're cherishing every traumatic minute he has left wouldn't trade him for the healthiest guy in the world.
True.
And they're stuck suffering with him, hating every day only their pain has no prospect of relief.
This a bad time? No.
Yes.
No trace of cancer in the patient.
But we did find edema in his intestines air in the intestinal blood vessels, and House won't answer his phone.
His intestine must be damaged, the air's leaking into his body.
If there's a blockage in the superior mesenteric artery it could be choking off blood flow to his intestine.
Blockages all over his body would explain his pain why the cramps come and go.
Do an angioplasty on the superior mesenteric and find the other blockages, before he has another cardiac arrest.
I'll help.
Good thing we don't have a suicidal patient with a horrific, undiagnosed pain disorder.
We did, till we diagnosed it.
We found intestinal edema and air in the blood vessels.
The pain was vascular.
If it was vascular, we would've seen uneven pulses.
His blood pressure was uneven.
Thirteen and Kutner are doing an angio.
He'd have hemorrhages in his fingers.
There's air in the intestine, it has to have come from somewhere.
Yes, it does.
After we thread the catheter through his groin and into position the blood will start flowing freely again.
Will that take away the pain? It will be completely ineffective, and the pain will completely go away.
Cancel the angio.
He has air in his blood vessels.
If we don't open the artery to his intestine Where can air come from? Hmm.
Air can either come from a breach of the lumen in the small intestine or, in rare instances, air can come from the air.
Teeth marks.
I'm guessing from when he blew into his IV tube.
Air bubble caused the PE and cardiac arrest.
You tried to finish the job that you started at home.
Jeff, why? You said that I lied.
I want to die.
Please just let me die.
No.
He's in a hyperbaric chamber.
A dose of high pressure ought to chase the air out of his blood.
Is anyone keeping an eye on him? You know, because the whole idea of suicide watch was specifically created for suicidal patients.
I realize how you might have thought the name was just a coincidence Are there any visuals in this room that are key to us learning our lesson? Because the telephone I'm inconveniencing you because you inconvenienced me.
When was the last time you showered? Scent of a man.
I realize you haven't experienced it sober.
If anyone should be able to handle a depressed pain patient He insisted he was no longer Apparently, he lied.
Didn't think I'd have to remind you of that remote possibility.
I have a DYFS inspection in less than Non-motor seizures.
Sorry, I was thinking about the patient.
What were you saying? Go on.
The pain started in his abdomen near his intestine.
The first symptom's got to be key.
He's had multiple EEGs all of them cleaner and squeakier than Cuddy's rubber nipples.
What about a glycogen-storage disease, like McArdle's.
Explains the pain, plus there's plenty of muscle cells in the wall of the intestine.
Foreteen is right.
Go run an ischemic forearm test.
Take the garbage out on your way out.
If you want a man to take your crap, you have to marry him first.
Or employ him.
Good girl.
I don't think I'm ready to run a decathlon yet.
If we can get you managing your life a bit better, that'll be plenty.
Dr.
Hadley, whenever you're ready.
Janice.
You look better.
Yeah, they said my basal ganglian volume's improved.
All I know is, for the first time in two years I can drink a cup of water without spilling it all over myself.
Thank you for getting me back in the study.
I haven't even seen you in weeks I didn't even know our appointments were back-to-back again.
Well, they weren't.
Mine got switched this morning.
We're gonna take your blood repeatedly.
If the increased strain makes your arm hurt more, you have a muscle abnormality.
If you're right about this McArdle's disease, can you take away the pain? With gene replacement therapy, with lifestyle changes, we can reduce it.
Keep squeezing the ball.
How long does he have to Maybe you and Zach should eat something.
Honey, don't worry about us.
I'm not.
Please, get out of here.
These tests are all I can handle.
They're trying to help you.
They can't.
Then how about helping them? You know, by not being An ass? You have no idea what I'm going through.
I know it's better than what you tried to go through.
Sure, no baggage at all.
Where's the pain worst right now? In my left arm.
Does it hurt more? Couldn't.
And lactate level's steady.
It's not any kind of glycogen Oh, God! Pain jumped to my leg.
This never happened before.
Your chest, your abdomen, you feel anything there? My leg feels like it's being sawed off.
Nice.
What? Switching Janice's appointment time, so I can see the skies brighten like a Lifetime TV movie.
I don't know what you're Sticking your most improved study participant in my face.
Is that your way of getting into my pants? I don't make the schedule, and if I did, I wouldn't use it as a social lubricant.
And this is the first I've heard of Janice improving at all.
So, hey, thanks for the good news.
Pain started in his abdomen.
Now it's hopped from his left arm to his left leg, skipping the trunk entirely.
I need the name of a good lawyer.
We're getting sued? Probably.
That's Cuddy's problem.
Hopping pain.
Means it's something in his brain, not his body.
Except the pain's in two places that connect two separate regions of the brain which means you're not using yours.
Come on, you're from one of the Twelve Tribes you must know a ton of shysters.
What type of lawyer do you need? I'll bring it up at the next world domination subcommittee meeting.
I didn't say I needed a lawyer, I said I needed the name of a lawyer.
Pain hopped to another limb on the same side, it's gotta be central Could still be peripheral.
If multiple areas of disc disease Were consistent with a completely spotless MRI.
Who represented the hospital when you set that patient on fire? Chris Carrick.
Chris.
That doesn't sound like a very good lawyer.
If we can't even resolve body versus brain, we're never gonna diagnose the guy.
What was the name of the firm? Caddell and Carrick.
It's not like we can chop off his head to see if the pain goes away.
Why not? Need to cut off a guy's head.
Gotta figure out if his pain's coming from his brain or his body.
Stiff shot of Lidocaine below the brain stem should numb him all the way down to his tippy-toes.
And hearing me say "no" over the phone wasn't good enough? I'm inconveniencing you because you inconvenienced me.
You know that foster care official is coming in the morning If they weren't there'd be no inconvenience.
Do not try and force me to choose between my child and this I'm forcing you to do your job.
If you can't also Fine.
You want to separate a patient's central nervous system from the rest of his body.
If the pain stays, it's in his brain.
If it vanishes What about options three, four and five? His respiratory system freezes, or he dies of infection or he leaks CNS fluid like a fire hydrant, which would make him wish he were dead.
Scratch option five, he's already there.
You preach objectivity, but as soon as a patient comes in, in pain all you want to do is look under the hood.
You don't care if there's a one-in-three chance you'll kill him.
If I don't diagnose him, there's a one-in-one chance he'll kill himself.
I gotta go.
Do whatever it is you think is right.
Tammy.
You said you were gonna be a little late.
DYFS is gonna be here in an hour, and this place is a disaster.
Never mind.
This should numb everything from your shoulders down.
Any pain that's peripheral should be gone.
What are you doing here? Just stretching my leg.
Carry on.
Bad pain day today? About to get better.
Don't worry, he's making yours a double.
I remember when the drugs still made things tolerable when I still thought I had good days left.
Turns out you have to live to find out.
You don't have a family, do you? Left them all back on Krypton.
You're alone.
That's why you can handle your pain.
No need to put up a front, to be what anyone else wants you to be.
You're having more bad days lately, aren't you? Yes.
Take a look at your future.
Let's hope the drugs work this time.
I really wasn't expecting you till later.
Had a cancellation, so I thought I'd knock you off the docket.
Well, I'm sorry this place is such a mess, it's been a bit of a difficult work week.
Any guns in the house? No.
Pets? Besides the ants? No.
Nice bag.
Pricey way to ditch the diapers.
That's not what I usually I sort of panicked.
Mr.
Carlton, if you'll just give me a minute to explain Everything looks fine.
Really? Dr.
Cuddy, you've got sufficient income a high degree of personal and professional stability and you care enough to be embarrassed by what a mess this place is.
Believe me, that puts you head and shoulders above most of the foster moms I visit.
See you next year, if you haven't adopted her by then.
My legs, they're different, better.
No pain at all? No, but less.
Four out of 10, maybe five.
Can't be.
If whatever's causing the pain's in your brain, it's still a 10.
In your periphery, a zero.
It is.
Some of the pain is gone, but not all of it.
What does this mean? Maybe Taub was right, it's psychosomatic after all.
Which one of you is House? The big black guy.
Chris Carrick.
Next time you use my name in a threatening e-mail it won't be just a bill, it'll be a lawsuit.
Can you blame me? Last time that happened, the guy shot me.
What if the spinal block triggered some sort of placebo effect? Guy's taken the finest opiates Blue Cross can buy how come they didn't trigger a placebo effect? What happened? He just started screaming.
Do something! Please, God, do not let it be what his father has.
I think he's faking.
How dare you? What makes you think House, the kid's in excruciating Where is it? Where's what? His idiot son distracted the orderlies so that Daddy Deathwish here could down a bottle of isopropyl.
Put him on dialysis or in half an hour he'll be a corpse.
You're hurting me.
Remember the feeling.
Maybe next time you wanna help Pops, you'll do a better acting job.
You can't help him.
Zach, why did you do this? Because he's not Dad any more.
He just wants it to be over with.
Please, please, just let him die.
Fabry disease might be able to cause central and peripheral pain.
No angiokeratomata.
Lightning pain from syphilis.
All the syph tests were negative.
Why aren't you guys still talking? Because we ran out of ideas.
Nothing explains this.
Something has to.
Unless nothing does.
So now you think it's Mine's a more interesting version of nothing.
It used to be something.
We can't find anything because whatever injury caused the original pain healed a long time ago.
The only thing left is the drugs.
Opioid-induced pain.
Pain and the drugs that treat pain work by changing brain chemistry.
Sometimes to the point where pain receptors read painkillers as killer pain.
Take him off the drugs.
We can't cure him, so we're gonna torture him? Torture is the cure.
Eventually his body will recalibrate itself.
Assuming you're right.
Yes, I find it confusing to assume otherwise.
How would you like to stop taking Vicodin? Good thing I'm not the patient.
It's open.
Thank you.
Is it too big? She'll grow into it.
Put it there.
I take it the home inspection was pushed back? I passed.
You do realize that's a good thing? This place was a disaster.
I had to stash a dirty diaper in my briefcase.
So you buy another briefcase.
I let House supervise himself.
That's like handing a 12-year-old the keys to the liquor cabinet and the car.
You passed the inspection.
The patient lived.
The car is still in the driveway.
And the next time my nanny gets sick? When House wants to saw someone in half? Did I mention you passed the inspection? I passed by their meager standard, I failed by mine.
Why do women always do that? Fail? Create ridiculous standards that no human could meet.
With your careers, with your kids.
You gotta be more like us men.
Be lazy? Blame others? Get help.
Most men in your position have a deputy and two assistants at work and a wife and two nannies at home.
You're not Superwoman, don't be a martyr.
We'll be injecting you with naloxone which will knock the opioids out of your pain receptors.
If we're right, your system will recalibrate within a few hours and most of the pain will be gone.
Hours? I need those drugs.
Not if they're causing your pain.
Then knock me out, sedate me while you That takes drugs, too.
We need to clear everything out of your system.
Please, I'll try anything else.
That's what we're trying to stop.
So it's not your parents, then it's your wife, someone you were close A colleague.
We were residents together.
I should've done more to stop it.
He had the mother of all God complexes.
So busy treating everyone's problems, he was blind to his own.
Helped himself to a vial of insulin.
It's a miracle he survived.
His friends and family almost didn't.
He was a selfish ass.
It'll be over soon.
This is lunacy.
You're torturing this guy on a hunch.
It's the only hunch we've got.
If I really wanted to torture him, I'd manipulate a clinical trial in the hopes that he'd sleep with you.
Are you suggesting I got Thirteen in that trial because of some personal I think you got her in because of your usual messiah complex.
I think you messed with the appointment schedule because of your l- Like-to-have-sex complex.
I checked the logs.
You moved your most promising patient right before her.
False hope being quite the aphrodisiac.
How's it false if the trials are showing results? If it were that promising, you wouldn't have to change the schedule.
But, hey, hope springs eternal.
This was a cooking accident? First time making Cherries Jubilee.
Awfully big fire.
If you ask me, some of the portions in that recipe were off.
I sure hope it happens to be covered, under, say, section three subsection 2.
2, paragraph one.
"Accidental fire damage.
" In which case you'd have to replace the entire water line to fix the sagging pipe.
I guess so.
I'd hate to have your next-door neighbors end up with no hot water.
Lucky the fire skipped your pipes entirely.
It's not working.
I know.
I've started him back on the pain meds.
Which means you can leave.
My son was right.
I've tried for so long to protect him from But I'm the one who's been selfish.
This is no way for him to live.
Until we get an answer, it's the only way.
There is no answer.
There's always an answer.
Then what is it? He's been here for four days.
Three suicide attempts.
You don't have an answer.
When I saw you, when I saw the cane I thought, "Thank God, a doctor who will understand.
" Because I sure as hell don't.
My husband thinks it's over.
So look me in the eye, tell me you'd want to live like that.
Then stabilize him get him in decent enough shape for the drive home so he can finally Okay.
There's gotta be something we can do.
We can't just let the patient leave.
We didn't, House did.
Because he realized there's nothing he could do.
There's always something we can do, something else we can try.
You're insane.
You know that, right? Because I have principles? Because you paid more to bribe me to lie on your claim than the entire cost of the repair.
I don't care if I pay as long as the people who pocketed my premiums for the last nine years also pay.
I didn't break the pipe.
Whatever.
You wanna stick it to the man, that's fine by me.
You happy? No.
But I'm right.
Lock up on your way out, and don't touch the piano.
Testicles.
What do they make you think of? STDs, testosterone issues, that summer on Fire Island.
Oh, so close.
The correct answer is epilepsy.
Epilepsy doesn't cause chronic pain.
It does if it spreads to the sensory region of the brain then rewires the pain neurons.
Would've shown up on an EEG.
Not if the seizures are in a place you can't see on an EEG a place too deep in the brain like the area that controls the muscles supporting the Testicles.
Feels like you got kicked in the nads, doesn't it? The abdominal pain, how it all started.
It wasn't the stomach.
It was lower, right? It's everywhere.
But when it first started.
It started in the stomach, cramps.
Like bad gas or a permeating pain? Like your kidneys were being pulled out through your scrotum? Why? Because epilepsy is treatable.
Looks like we shot the guys with the torches.
Yeah.
Pays to hang around.
That selfish ass with the God complex who almost made the stupidest decision of his life it wasn't your colleague, was it? It was you.
No.
See you tomorrow.
You're here early.
I'm feeling better.
What's wrong? IV's leaking a little.
It's no big deal.
I'll be right back.
Foreman.
You busy tonight? No.
Rita, the spike on Dr.
Hadley's IV bag wasn't pushed in all the way.
I don't want any dosing errors.
Sorry.
It won't happen again.
Stinks, doesn't it? What? The medication.
When we switch out the bags you can smell it.
It's disgusting.
I didn't smell anything.
She must be on the placebo, then.
You offered to do House's budget because you wanted him to owe you wanted him to take that case.
Why? I thought it would help House, seeing someone worse off than him possibly curing a guy with even less to look forward to.
Can I ask you something? How would you like my job?