House, M.D. s05e23 Episode Script

It's way too fast.
It felt good.
If we can clear the stage, quickly please.
Maury, it's too fast.
It's exactly the same.
Then slow it down.
Everything all right, Jeremy? Sure.
Ready whenever you are.
From the allegro please.
What's his problem? His back's not 100%.
He can't talk to the conductor like that.
No, he can't.
She could.
You okay with the lift? I'll be fine unless you mess up the timing.
My timing is perfect.
Was last night.
Moment of truth.
Damn it.
Penelope, are you all right? She can't breathe.
Call the doctor! Are you gonna ignore me all day again? I help you.
You tried to kill Chase.
Doing what you wanted, that's all, boss.
I exist.
No, you don't.
I acknowledge my subconscious exists.
Now go away.
Saying it is one thing.
Living it is another.
You're not rational.
Not completely.
Put the phone on the receiver send the hookers home and get dressed.
We've got a case.
I'm taking a personal day.
York Ballet collapsed on stage.
I love ballet.
But as someone may have mentioned I'm taking a personal day.
Cuddy said get your ass in or you're fired.
She's not going to fire me.
She's not going to fire you? If you don't go to work? Okay.
How long, do you figure till I just disappear? Hold on.
No tumors or punctures in the lungs no bruising, no sign of trauma, no STDs.
And supplemental oxygen's only gotten her saturation level to 60.
Lungs keep collapsing despite a chest tube.
ER ruled out the obvious white count and temp are normal, so no pneumonia.
The coffee's burnt, Thirteen's wearing cherry-flavored lip gloss.
Foreman's staring at you.
Any of that helpful? House.
STD? We just said the tests were negative.
You think we should No.
She's a dancer.
What about dehydration? What about a pulmonary contusion? CT showed no inflammation on the lungs.
What about dehydration? BUN and creatinine are elevated but within range.
Hey.
I'm just the irrational part of your brain but elevated means high, right? Dehydration could hide an infection.
Dehydration could hide an infection.
Go treat her for the obvious.
IV fluids and antibiotics for pneumonia.
We're like Magic and Kareem.
Mr.
Pietramala, you have kidney cancer.
Wow.
Is that a bad one? I mean, they're all bad, but The door was closed for a reason.
Well, now it's open for a reason.
We need to talk.
He just told me I have kidney cancer.
Then you'll obviously need a moment to process.
House.
I'm hallucinating.
I'm I'll be right back.
I need you to sit in on my differentials, double-check everything I do.
You can't treat patients It's gotta be sleep apnea.
I get a good night's sleep, and I still feel exhausted.
Lack of delta sleep can lead to hallucinations.
Do you have any other neurological symptoms? Don't think so.
Aphasia? No.
Memory loss? No.
Irritability? Yeah, that one.
Don't deflect.
He cares about you.
You shouldn't be practicing.
You care about him.
Tell him At least until Enough.
Don't give me the look.
I told you I was hallucinating.
Who were you talking to? Someone who's not actually here, beyond that seems irrelevant.
Your mind made a choice.
It means something.
You know he's just gonna keep asking.
Kutner.
Good choice.
He feels bad.
You gonna help me or not? Yeah.
I could eat from this place seven days a week.
We practically do.
You can order tomorrow night.
Do you want some wine? No, thanks.
I have my husband's sperm.
Your dead husband's? We froze it when he got diagnosed.
And you kept it? All this time? I used to think, if I didn't find anyone You found someone.
I know.
But What if it goes wrong? What if I turn out to be a radical anarchist with a secret family, and that I age backwards? Nobody plans on getting divorced.
I didn't plan on my husband dying.
But he did.
So, you're saying you want a pre-nup? In liquid form? What if it's not sleep apnea? Trauma from your motorcycle accident? Vicodin abuse? You need to be admitted.
I know you're wrong about sleep apnea which means you know you're wrong about sleep apnea.
You're scared.
Tell him you're scared.
I can't sleep with you here.
Did it work? Do you see someone standing beside me? No.
Then no.
So what's next on your list of things it's not? Patient's not responding to the antibiotics.
Still can't breathe.
So run a test to confirm it's pneumonia.
We can't do a bronc because her lungs are still collapsed.
Transtracheal aspiration.
That's basically waterboarding.
It is pretty radical.
It's a great idea.
Regular radical, me radical or me-out-of-my-mind radical? Somewhere between regular and you.
So what's the problem? Everything okay? No.
Our patient can't breathe.
Either do the test or come up with a better one.
So we're down to infection, trauma MS, schizophrenia, or pills.
Schizophrenia usually manifests younger.
That's why it's further down the list.
I can confirm an infection with a simple blood test.
An infection can be treated, cured.
Means you've still got a job, means you've still got a life.
Doesn't make it a better idea, just a nicer one.
This the rational you talking? Can't do this on my own.
When we inject the water it's gonna feel like you're drowning.
But it'll be over in a few seconds.
And then it'll be better? A little.
Hold her shoulders down a little.
Ready? You're doing great.
Here comes the liquid.
Taub.
I slipped.
Oh, no.
What? Her skin came off.
Her skin's sloughing off faster than we can replace it with the artificial skin.
Could be autoimmune.
ANA was negative.
Focus on the lungs.
You want us to ignore the fact that she's lost 80% of her skin? We know it's not lung cancer.
Could be a liver tumor.
Eats through to the lungs.
Get an ultrasound of her liver.
If you find masses, get a biopsy.
We can't just ignore the skin.
It's obviously the most significant and dangerous symptom right now.
I don't think it is a symptom.
I think we caused it.
By doing what? I prescribed antibiotics.
Toxic epidermal necrolysis? That's a one-in-a-million reaction.
Yeah, well, maybe this is the one.
Get swabs of her old skin to confirm.
Where the hell were you? I do have a practice.
Ballerina has toxic epidermal necrolysis.
Are you sure? About to be.
I'm sorry.
I feel guilty.
You didn't do anything wrong.
You prescribed antibiotics.
Any other doctor would have done the exact same thing.
"Any other doctor"? Words can hurt, you know.
I have no reason to feel guilty.
It doesn't make any sense.
Unless there's something wrong in the limbic area of my brain.
Guilt as a symptom? It's consistent with MS.
And since the blood tests were negative, I have to apologize.
If I feel better, then you're right.
I'm just feeling an emotion.
If I feel nothing, means my limbic brain is shot.
I'm Dr.
House.
Anyone explain to you your status? They found a mass in my liver, cancer.
They said they think they can treat it.
And that the skin is starting to take.
I'll be able to dance again.
She's half-dead and she's wondering if she'll ever plié again.
Healthy priorities.
Let the mocking begin.
I'm sorry.
I treated you for infection before confirming that you had one.
That's why you lost your skin.
I know you're in pain.
I know that I caused it.
I'm sorry.
Very nice.
Thank you.
Nothing.
Maybe you didn't mean it.
I meant it.
Did you do a liver biopsy to confirm - Couldn't.
The artificial skin was too thin, she'd bleed out.
Why were you talking to the patient? I think skinless women are hot.
Do a transjugular liver biopsy.
If she bleeds, at least it stays in her veins.
Did you just check with Wilson again? No.
I felt nothing.
It's MS.
Apologies aren't supposed to make you feel better they're supposed to make the other person feel better.
In order to make you feel better.
Fine.
You want to do an LP to confirm or is guilt enough to start filling prescriptions? Last mass, about a centimeter to your right.
Problem? Short burst of flutter.
We're almost done.
Entering the right hepatic vein.
Cameron kept her dead husband's sperm.
She doesn't like yours? She likes his better.
Or at least she wants to hang on to it in case mine is unfaithful or something.
Wow.
Advancing two centimeters.
You gotta let her do it.
If you don't, you'll be stuck with her forever.
I want to be stuck with her forever.
She married a dying guy.
She has issues.
You cannot leave her.
Ever.
For any reason.
Because then you're not just the guy who left her you're the guy who killed her kids.
That's not a good rhythm.
Get out.
Narrow complex tachycardia.
She's gonna crash.
Liver biopsy was negative for cancer.
But the procedure sent her heart into A-Fib.
We don't know it was the biopsy that caused the heart problem.
Maybe the heart caused the lungs to collapse.
Why is Wilson here? You were looking for cancer.
I thought it'd be helpful if We didn't find cancer.
Yes which you reported to me five seconds ago.
I thought I'd let him finish his hors d'oeuvre before getting the bouncer to take care of him.
Until we can regulate the heart we can't get any meaningful pictures so we can't tell Metoprolol can correct irregular heart.
Tried it.
Didn't work.
Is Cuddy making him oversee No.
Heart's too irregular for MRI, other scans wouldn't Then you're making him oversee your choices.
You don't trust yourself.
Why? Wilson, get out.
Are you sure? Do I need your approval to throw you out? You happy now? There's only one time her heart's going to be perfectly still for our pictures and that's when she's dead.
If it's not MS, severe mental illness and Vicodin are all that's left.
Mental illness means you can no longer practice medicine.
Vicodin means detox, which means pain.
For the rest of your life.
Which means you can no longer practice medicine.
Are you saying we should kill her? No.
If we stopped her heart, we could get our pictures and then restart it.
What if we can't restart it? Then she stays dead.
We restart hearts all the time.
It'll take four minutes for us to MRI her entire heart.
And we only have three minutes until there's brain damage.
You sure about this? Yeah.
Gonna stop her heart so I can MRI it.
I think it was her idea.
The pneumonia was her idea, almost killed the patient.
"Her"? Oops.
Kutner was secretly a woman, that's why he killed himself.
It's Amber.
Your subconscious picked my dead girlfriend? Yeah, the irrational part of my brain works like the rational part of yours.
How about that? It raises questions.
It answers questions.
Who cares? I've got competing ideas.
They can't both be right.
Everybody gets competing ideas.
Everybody has doubts.
So is it regular radical, me radical or me-out-of-my-mind radical? It's on the upper end of you radical.
Do you have any alternative? Nothing that anyone in my head has come up with.
Then you're as safe as you can be.
Great.
You get the LP results back? Yeah.
It's a big shock.
You don't have MS.
But while I had your blood sample, I checked Vicodin levels.
Way too high.
I need the pills.
Not an argument.
He knows that's not an argument.
It could still be schizophrenia.
House, if you're on anti-psych meds you're not going to be able to practice I know.
You'd prefer electroshock therapy to rehab? I'd prefer something that could actually work.
You're rationalizing.
No kidding.
I know that you're afraid of the pain, but electroshock Don't give me the cancer voice, that overly earnest tone.
Heart attack, stroke, seizure, death or worse.
Worse? Double death? You live but you damage the only thing you care about: Your rational mind.
I'll make some calls.
I'll actually be dead? Just your heart.
And just for a little while.
Hopefully.
I had an idea.
Stop having ideas.
Insulin shock.
Yes, that's marginally less dangerous than ECT puts you in a coma, could cause It could work.
If you had psychosis, which you don't.
I have no diarrhea, no sweating, no vomiting none of the symptoms of Vicodin overdose.
Yeah, except the "I see dead people" thing.
I've been popping pills for years.
I've only been seeing things for days.
Something changed.
Vicodin addiction is still more likely.
So we're no longer dealing in absolutes.
House, I'll be up in five minutes then we can talk about how you'd rather be in a coma than in rehab.
Actually, if you could be up here in two, that'd be really helpful.
Why? Because I'm about to put myself into insulin shock.
Left atrium is fine.
Left coronary artery also fine.
We're almost at three minutes.
Keep going.
Chordae tendineae clear.
Right atrium is fine.
I gotta start her back up.
We have some time.
We're over.
Right coronary artery is fine.
The three-minute threshold is a guideline.
She might have less.
We have to stop.
What's that by the aorta? I don't see anything.
I'm restarting her heart.
That's a shadow! Two centimeters You're only scared because you know this is going to work.
We're over three minutes.
I need glucose in here! You could have died.
It worked.
Where are my pants? Are you sure? She's been everywhere I've been for days.
She's not here.
Ergo This was not the next rational step.
Now who's being biased? You wanted me to detox as much as I wanted I forgot how to do my zipper.
Any other neurological deficits? You don't seem to annoy me as much as usual.
Not sure that's a deficit.
And I'm all better.
Is she really gone? Absolutely.
I can feel myself repressing all kinds of icky things.
I check out, don't I? Damn.
He didn't see anything.
He saw an artifact on the monitor.
It was a shadow on her heart.
She'd already been technically dead for three minutes.
I thought keeping her alive took precedence over prolonging the photo op.
Any brain damage? No, all tests indicate that Obviously you had more time.
Best of luck.
I assume we can't kill her again, take more pictures.
You don't want to check with Wilson? Good one.
It's something, a lesion.
Tumor, scar tissue.
Could be an abscess.
Infection.
Explains why it's invisible in the blood.
It's doing its damage behind closed doors.
Sealed off.
See, the problem with speculation is you make a "spec" out of you and some guy named "Lation," which really doesn't affect me at all.
We have to guess.
It's all we've got.
We can't do a biopsy.
Last time we went into her heart she had a major cardiac event.
Which just leaves What are you looking for? I don't know yet.
Picture doesn't change.
She lies there in pain, he sits there worried.
Nothing changes.
I just had an epiphany.
All by myself.
Popped into my head out of nothing.
Care to share? He's too devoted.
Too devoted? You think he feels guilty? Right, I'm being cynical.
People can care because they care, and not because they cheated.
Theoretically true, but gonorrhea fits better.
No.
No STDs.
We tested her.
You tested her blood.
That is the test.
That's not where her problem is.
Gonorrhea disseminated to her heart.
If it got walled off in an abscess, it'd be invisible.
And would look like a shadow.
No need to test her again.
But we can check Prince Charming.
Once you confirm, cut the abscess out of her heart.
Here are your onion rings, extra well done.
Thank you, Molly.
And another beer when you get a chance.
I'm celebrating.
Alone? Thank goodness.
Don't tell me, I was right.
Yep.
Boyfriend has gonorrhea.
And everyone's a winner.
He's not too happy about it.
He insists he's never cheated, must have gotten it from her.
Don't think so.
Timing would fit.
He's got no symptoms and she's dying.
Lying would fit, too.
He's not hanging out in her room anymore.
What does it matter? You were right.
We're prepping her for surgery.
I saw guilt in him.
If he's not actually guilty, I wasn't right, I was lucky.
House, you made a brilliant deduction about her heart.
And if I was just lucky Enjoy yourself It's later than you think Enjoy yourself While you're still in the pink.
The years go by As quickly as a wink Enjoy yourself Wilson, come get me.
It's later than you think I know a nice facility outside Philly.
I went to undergrad with one of the directors.
Thanks.
How many shirts do I need? They said three.
They have laundry.
Like living with Mom again.
Delightful.
It's probably Foreman.
He's unavailable.
Tell him the infection's made her septic.
We can't remove the abscess until we get her BP up and it's not responding to fluids, it's not He's off the case.
Patient okay? Yeah.
He's lying.
Why don't I feel scared? I'd say you're unaware of what you're feeling at this moment.
I feel like crap, my life is falling apart, but I don't feel scared.
Not of the rehab, anyway.
We've always been able to find a way to cheat.
It won't work.
You want it to work this time.
Do we? House, it's your only option.
And what do I do if my only option won't work? You don't give up.
It's either that or electroshock every six hours.
Good night, Wilson.
What if we put her on a heart-lung machine? She's septic.
We don't need a heart-lung machine.
We need a blood vessel holder-together machine.
We could try a high-dose dopamine.
It's a vasoconstrictor.
It'll close the blood vessels so she won't bleed out.
Her heart can't take that much dopamine.
It'll explode.
And if we don't use the dopamine, it'll implode.
Is House really done? Sounded that way.
Dopamine it is.
It's late and I'm tired.
Can we get to the talking part of this conversation? I quit.
Great.
My nanny is off the clock at 7:30.
So your week off, bigger desk tighter nurses' uniforms, or whatever other stupid thing you're about to demand is gonna have to wait until You can go suckle the little bastard child who makes you feel good about yourself.
Screw you.
Don't do this.
I'm hallucinating.
From the Vicodin? Ruled out everything else.
We can admit you through the ER under a pseudonym.
No one has to I'll cheat, scam, find some way to keep using.
These people know what they're doing.
These people don't know me.
You do.
She's not your keeper.
She has no responsibility for you.
I need you.
Let me call my babysitter.
Blood pressure is 90 over 60.
We know.
I'm just saying, it's still Abscess is intact.
Doesn't look like any of the surrounding tissue is affected.
She's gonna be fine.
Doctor.
We've got a problem.
Lie down.
I'll get you some tea.
Yeah, then I'll be better.
You really think she hasn't searched this place for your secret stash? I already did this room, and the bathroom and your bedroom.
Where should I look in the kitchen? Coffee cup.
In the top shelf.
That was a test.
I already did the kitchen.
Nicely played.
She'll think you've come clean, given her everything.
There's more.
Don't.
You're hurting already.
It'll only get worse.
House, you should tell me where it is now because you won't have the will to tell me in two hours.
In my shoes.
In the closet.
It's like I don't even know who you are anymore.
It's okay.
Hold my hand.
Am I okay? We were able to successfully remove the abscess from your heart.
But the dopamine caused the blood vessels in your hands and feet to clamp shut.
We need to amputate or the gangrene will spread, and you'll die.
My feet? And your hands.
I'm sorry.
No.
I'm a dancer.
The tissue can't be saved.
No.
We know what House would do.
House would have never woken her up to ask for consent.
If you can't live with the answer, don't ask the question.
You're saying we should accept her decision? Bold idea, I know.
Maybe we can get the boyfriend to convince her to do it.
Yeah, boyfriends get everything they want.
Forget it.
The boyfriend doesn't want to talk to her at all.
Where are you going? Home.
The case is over.
No, it's not.
Not until we come up with something that might work.
It's a shame that she might die because House has some personal crap to work through.
Technically, if she dies it's because House has some personal crap to work through and we weren't smart enough to get the answer without him.
False alarm.
Drink this.
That's your advice? Drink this? It's ginger.
It'll ease the nausea.
You know what would calm the nausea? Vicodin.
Marijuana.
A coma.
Don't pretend you didn't see it.
I saw it, which means you saw it.
Send her away.
Too bitter.
I already have enough bitter.
I'll add some honey.
You're pathetic.
If you want the pill, just send her home.
But you can't, because that would be admitting defeat to her.
Now this is interesting.
If you take the pill, you don't deserve her.
If you secretly take the pill, you don't deserve anyone.
No! No.
No! This isn't going to work.
It might work.
That's all we're going for.
Vasodilators can Big jump from reopening to reanimating.
I'm out of the ulnar.
Not seeing any clearing.
This won't work.
This probably won't work.
Radial artery's really tight.
Don't go too fast.
If it clots, she loses the hand.
If it clots, she's dead.
I can't believe it.
What? It might be working.
Can you stop? The breathing.
Air goes in, air goes out.
Use your nose.
You're supposed to feel like crap.
You're doing great.
And after? You come back to work.
What if I can't? Opioid dependency can make you think you have more pain than you really have.
You're going to be okay.
You're telling me what I want to hear, with no evidence.
I'm telling you what I believe to be the truth.
With no evidence.
You're hardly the most unbiased observer.
Neither are you.
I'm your hospital's biggest asset.
Is that why you think I'm here? That's why you're here, that's why you're lying to me about I haven't lied to you in 20 years.
Sure you have.
Which means that you just said that because you want to tell me what you lied to me about 20 years ago.
You're an ass.
Am I wrong? I wasn't in your endocrinology class.
You sat next to me.
I cheated off you in the mid-term.
I audited your endocrinology class.
Why would you Because I thought you were an interesting lunatic even then.
I'm not here protecting hospital property.
We're alone.
We've been alone all night.
No, I mean Amber.
She's gone.
Where's Jeremy? He left.
You okay? The surgery worked.
Congratulations.
I can't do it.
You have doubts.
You don't? No.
That's naive.
I want to spend the rest of my life with you.
I love you.
That's how I feel right now but I don't know.
I'll wait until you do.
I can't know.
No one knows.
I do.
I'll see you in later? I have some papers to push for you.
Thank you.
You want to kiss me, don't you? I always want to kiss you.