House, M.D. s06e04 Episode Script

Mr.
Randall? They're here.
Fifty-two million includes over six million already issued pursuant to the over-allotment option.
When can we close? It would be subject to regulatory approval in both Toronto I didn't say how, Oliver, I said when.
What? You sure this is a direction you want to go, Roy? This would move us from energy service into energy You don't think oil's going up? Of course it's gonna go up.
The question is when.
The question is always when.
And if we wait until the deal makes sense to everyone else, we're gonna be waiting in line behind everyone else.
All I'm saying is The same cover-your-ass crap you always say.
We're gonna have to wrap this up.
I gotta go.
Where are you going? - Upstairs.
Get the regulators on it.
I want to close by the end of the month.
Come on, Roy.
There are 10 other items on the agenda.
Which'll have to wait until next week.
You can't drag us all out of the office, get halfway through, and then just kick us out.
Yeah, I can.
The antibiotic treatment had no effect.
Both the fever and the pain are getting worse, which means it's not Clostridium difficile.
But you said that was the only diagnosis that made sense.
It was.
We need to get him to a hospital.
Dad.
I don't want to go.
I know, buddy.
But we may need to.
Am I gonna die? No.
Of course not.
How do you know? Well, I just do.
And I'm always right, aren't I? Yeah.
I want House.
I understand, but I told you Dr.
House isn't available.
Dr Call him.
Tell him I'll have a private jet pick him up from whatever island He isn't on vacation.
Dr.
Foreman is one of our best doctors.
Is House in jail? No.
Foreman is currently working with two of House's most veteran associates.
Rehab? No.
Mr.
Randall, your son will be in good hands.
My son has already been in good hands, and he's still dying.
I'm through dealing with good.
I want the best, and everyone I've asked says that's House.
So unless he's dead, comatose, or insane, I want him treating my son today.
You could have said no in good conscience.
The kid'll still be Foreman's patient, but his dad wants you making the decisions.
Then he's not my patient.
You want to give me none of the responsibility and all of the liability? Which means I get Oh, cool.
Don't let him do anything crazy.
When is he getting his license back so we can stop playing this game? Maybe never.
This game is fun.
You also need to prepare President Dibala's case for this week's Morbidity and Mortality conference.
Oh, unfortunately, I'm overdue on a mani-pedi appointment.
Not you, Foreman's department.
Oh, right.
Well, he's got all the time in the world.
We made the wrong call, he died, there's nothing to present.
It obviously garnered a lot of curiosity.
And we don't have more important things to do than satisfy everyone's idle curiosity? It's not idle.
The question of how we deal with two possible diagnoses whose treatments are contraindicated is worth discussing.
Abdominal pain increasing in severity and frequency, fever, dehydration, diarrhea, weight loss.
Mom died from kidney failure caused by type 1 diabetes, which has been ruled out.
Seventeen doctors.
Everything's been ruled out, which means we have to re-rule out.
Get a new history and physical.
Unless that's crazy, boss.
Been out of the country or on any recent camping trips? No camping.
But we were in Montreal back in January.
We went to see the NHL All-Star Game for my birthday.
Awesome.
Where's Dr.
House? In his office.
He's really more of a decider than a doer.
He's decided we should start over.
You never know what previous doctors may have missed.
Like this.
Does that hurt more when I push there? Not really.
What is it? I'm not sure.
Just keep it clean, simple.
We did a test that called into question our initial diagnosis, so we changed our mind.
And if they ask how the test was done? Why would they do that? It's a routine lab test.
Routine lab tests don't involve blood you stole from a corpse to trick me into giving the guy the wrong treatment.
Yes, and if you brought that up, it'd certainly make for a lively debate about the morality of murdering murderers.
But since you burned the only evidence of that To cover for you, not me.
You're protected.
The decision was a coin flip.
There was no right or wrong answer.
The body's underground, Nobody can prove anything.
That room will be filled, not because of a coin flip, not because of the patient, but because House's department screwed up.
They're gonna be like sharks in a chum-filled swimming pool, and there's no way I'm jumping in unless I'm in a steel cage.
So what do you want? I want to know you have everything covered.
Got what covered? We're just reviewing the Dibala case.
Making sure we didn't miss anything.
We didn't.
Except, of course, the thing that killed him.
He's constipated.
Physical revealed a mass in his abdomen, so I repeated the X-ray.
Old one was clean, new one shows that his colon is almost completely impacted.
Obstruction would explain the pain.
You think they just screwed up the old X-ray? Nope.
Hirschsprung's? It's a congenital disorder of the nerves in the colon.
Very rare in a child your son's age.
Most doctors would never think of it.
And you came up with this? It's House's idea.
We need a barium enema and biopsy to confirm.
Let me guess, it tastes really bad, but it's gonna make me feel a lot better.
Actually, you're not gonna taste it.
You should try searching for "Misty May digs for gold.
" Make sure you put it in quotes.
I'm making travel plans.
I just need to get away, have some time to myself.
You getting the hint? So that's it? You're done with your little experiment with Foreman? It wasn't an experiment, it was a relationship.
You may wanna look into the difference.
I'm glad you're better, House.
I actually liked working for you, but I'm not coming back.
Good.
Because if you came back, Foreman would try and save the relationship, and he'd give up being the boss.
Are you here to try to save my relationship with Foreman? God, no.
I'm trying to save my relationship with Foreman.
Right now, I'm Kobe, playing the game I love, however the hell I want, and Phil Jackson has to listen to everyone else bitch about it.
Enjoy Cabo.
I'm going to Thailand.
Really? Interesting.
Goodbye, House.
Goodbye, Thirteen.
Last week, yesterday, today.
I can't believe it.
He's pain-free for the first time in months, he's even hungry.
I'm starving.
We're still waiting for the biopsy results, but obviously it's a good sign.
You're gonna want to take it slow.
Don't try to regain all the lost weight in one meal.
What's wrong? The abdomen feels normal, but looks bigger.
Jack, are you feeling Jack? Hey, Jack, you okay? Right eye is fixed.
Lateral rectus palsy.
He's seizing.
Need five milligrams of diazepam.
What's happening? Hold down his head and turn off the lights.
I need to see his optic disk.
Heart rate's elevated.
Come on, hold his head.
I'm trying.
Wait.
Where's House? Mr.
Randall, we need you to step back.
His optic disks are swollen.
He's got intracranial hypertension.
Furosemide, If we could intubate him Need five more milligrams of diazepam.
DC the monitors.
Push 500 milligrams of phenytoin.
You can't push that much.
We gotta relieve the pressure, or his brain can herniate.
Oh, my God.
Fifty milligrams of phenytoin in.
Page Chase.
Tell him to meet us in the OR.
We need your consent.
What's happening to him? The pressure in his skull's too high.
If we don't reduce it, it could irrevocably damage his brain.
But he was just talking.
He was smiling.
We need to drill burr holes.
Drill into his head? Phenytoin's not working.
Paralyze him.
Three milligrams of pancuronium.
Then intubate and hyperventilate.
Where's House? House isn't here.
Do we have your consent? Do we have your consent? Ready? One, two, three.
Injecting three milligrams of pancuronium.
Look at the monitors.
He's still seizing.
We need to do this now.
Go! Electrical seizure activity's stopped.
Intracranial pressure's declining.
Come on, keep going.
Pressure's down to eight.
I'll go tell the dad.
What happened? I have no idea.
He hasn't had any more seizures, and cytological examination of the subdural fluid showed no abnormalities.
Don't usually see brain damage after a rectal biopsy.
He was fine after the procedure.
No headaches, no mental status change.
It wasn't anything we did.
It's not just his brain.
He's continuing to build up fluid in his abdominal cavity as well as the dura.
We've inserted shunts to drain it.
It's got to be some sort of systemic infection.
Not after spending the last week getting pumped full of IV antibiotics.
You notice anything odd about the shape of the fluid collection? Oh, God.
Virgin Mary! The edge should be tapered, lens-shaped.
Unless the dural layer was already separated from the brain when the fluid started to build up.
Get a dural biopsy to confirm brain cancer.
Nice catch.
Bangkok.
Flight 799.
Wow, Bangkok.
That sounds awesome.
How long? Not sure yet.
Luckily, I have a friend who's staying at my place taking care of my dog.
He's really big, so he needs a lot of exercise.
Remy Hadley.
H-A-D-L-E-Y.
What, you think I'm gonna rob the place? No.
Of course not.
In case you haven't noticed, I have a job.
Look, I'm sorry, I don't know you.
You're either honest or dishonest, I figured the safer choice is to Is to treat a stranger like an ass.
Nice way to live your life.
Bitch.
I said I'm sorry.
Oh! Hello.
I was wondering if there are any Business Class seats open that I could use my miles to upgrade to.
I don't know you, but I assumed I could trust you, welcomed you into my car.
Okay, you're a saint.
That's impossible, I confirmed my reservation last night.
So re-book it.
Well, obviously, it was a mistake on your end, not mine.
No.
I'm on my way to the airport right now.
They didn't believe you, huh? Brain cancer? We should know for sure by the morning.
Our luck just keeps getting worse, huh? Treatment options are getting better every day.
There's no visible mass, so even if the biopsy comes back positive, we've caught it early.
Oh, so, you're telling me this is good news? I'm saying we will do whatever we can.
Right.
I'm sorry.
I gotta go.
Foreman needs more help with the M&M prep.
Okay.
I'll come up and help after I finish the biopsy.
We can handle it.
I'll see you at home later.
If you're here, I might as well be.
Go home.
Get some rest.
'Cause I'm gonna be waking you up as soon as I get home.
Stay out of my life.
Okay.
I know you canceled my reservation.
You obviously saw me log in when you were spying on me in the coffee shop.
I was talking to you.
I was spying on the MILF in the running shorts.
I'm not coming back on the team.
I don't want you back on the team.
I cannot work for, with, or around Foreman.
Which is why I don't want you back on the team.
Now that you're out of the picture, he's better than ever, which is gonna make me less miserable than ever, which is why neither of us gives a damn how, when, or on what island in the Bahamas you wanna get away from it all.
The Bahamas? Costa Rica? I told you, Thailand.
I assumed you were lying because it would have been idiotic of you to tell me the truth.
Yet another reason I have no use for you.
We've got a problem.
When Cameron sent Dibala's blood to the lab, she specifically asked for the anticentromere antibodies test.
So? The printout they sent you included just the anticentromere antibodies, but the lab also did a full blood panel.
So? I'm not an idiot.
I obviously made sure the cadaver I got the sample from had the same blood type.
You apparently didn't check his cholesterol.
How far off? Twenty percent.
Dibala didn't die of high cholesterol.
Why would anyone even bother to compare the two reports? The same reason I did.
Because they're looking for anything we might've screwed up.
We could claim the blood analyzer broke.
We can't.
Cameron documented that it was perfectly calibrated when she did the test.
So the numbers are off.
It's weird, who cares? If it comes up, just act surprised, like it's some irrelevant curiosity.
I can't do this.
I can't go in there and stack lie upon lie.
You've got to figure out a way to explain this.
Hey.
Hey.
Missed you this morning.
Yeah, sorry.
I needed to get in early.
I didn't want to wake you.
I thought you did want to wake me.
At least that's what you said last night.
I'm out of here.
No, no.
I got the biopsy results.
It's not cancer.
How can so much be wrong with nothing being wrong? Since when is cancer being considered nothing? I just said it's not cancer.
The cell morphologies were all normal.
And so are the most recent CT scans.
On the other hand, adenocarcinoma of the stomach would cause pain, constipation, and nutritional deficiencies that could cause seizures.
And wouldn't show on a CT.
You were right about the cancer, just wrong about the place.
Continue to say nothing if you agree.
Go scope him, get another set of biopsies.
I get canceling her ticket, if you then showed up with two more to somewhere better.
What are you talking about? Or showed up at all.
But how does just ruining her plans get her to agree to yours? You talking about Thirteen? Where's she going? Nowhere this week, thanks to you.
I didn't stop her.
I'm not gonna stop her.
I've already done all I could.
Now all I can do is move on.
I think I actually believe you.
If you're telling the truth, you're even more rational than I Well, not more.
Then again, more sane.
You're gonna be a good boss, boss.
I told you, there's nothing wrong.
There's obviously something wrong, and I'm not even saying we need to talk about it right now.
I just don't see why you have to deny it.
I'm not.
Now you're denying you're denying.
No.
I'm denying that there's anything to deny.
Robert, you can't do this.
You can't hide things from me.
There's a problem with the Dibala M&M.
The HDL numbers on one of his early blood panels don't match a later panel.
That's weird.
Yeah.
It's no big deal.
Cholesterol didn't have anything to do with his death, but after being let go from Mercy, and then that thing with Thirteen's drug trial, Foreman's paranoid about people questioning the way he handled the case.
Well, that's ridiculous.
If anything, Foreman should be feeling secure.
He's the one who had the right diagnosis, we talked him out of it.
I know.
Don't tell him I told you.
He doesn't want to show any signs of weakness, especially now that House is claiming he wants him to stay in charge.
All right.
So it's still cancer.
It's just somewhere else.
That's what we're looking for, but it would explain all the symptoms and all the normal tests and imaging studies.
Got biopsies of the mucosa and the submucosa.
I'm moving towards the pylorus.
It's my fault.
Adenocarcinomas aren't caused by diet or environmental factors.
I inherited a $10 million pipeline business when I was 24.
By the time I was 30, it was worth over a billion.
Since then, I have been involved in over 50 deals that make that first one look like a loser.
Everything I do, everything I touch, turns to gold, except my family.
First, my wife and now my son.
This is my fault.
It's karma.
That's obviously not true.
He's seizing again.
Get the scope out.
We need five milligrams diazepam.
How's the ICP? It's eight.
But the shunt's open and clear.
This isn't intracranial pressure.
Then what the hell is it? Seizure's stopped, but he hasn't regained consciousness.
No sign of any masses in his stomach or esophageal lining.
And he's still accumulating subdural and peritoneal fluid.
And every time we look to see where it's coming from, he starts seizing.
You think we're setting this off? I think something is.
One of his stomach biopsies shows an arteriole partially occluded.
But with no abnormality in the other layers, and no evidence of a cellular inflammatory reaction.
It's definitely not cancer.
Then it has to be some sort of infection.
We already ruled out infection.
Only because he was treated for it and got worse.
Seems like a sound reason.
Unless it's a drug-resistant strain.
Drug-resistant strain of what? Bacterial cultures, viral serologies, ANA and ANCA were all negative.
Everything's negative.
We obviously missed something.
Maybe the seizures aren't a new symptom, they're an old one.
No doctor noticed a thrashing kid? Abdominal epilepsy.
The seizures would just look like pain until it spread to his motor cortex.
Wouldn't explain the fevers.
Protein malnutrition can cause fevers.
And nothing causes malnutrition like excruciating stomach pain that gets worse every time you eat.
I'd be a lot more certain if it was my idea, but it's the best we got.
Start him on gabapentin, hook him up to an intracranial EEG for continuous monitoring.
I gave him statins.
What? If they ask about the cholesterol, just say I prescribed a statin and forgot to put it in the chart.
You want to solve a problem in the records by creating another problem in the records? There's no problem with the records, there's a problem with my recordkeeping.
There's no way anyone can prove me wrong.
How did you get access to the statins? You gonna get someone in the pharmacy to confess to yet another recordkeeping problem? I saw an open cart.
I just took it.
Why would you steal a drug you can just as easily ask for? 'Cause I'm trying to get you off the hook.
A story that raises more questions than it answers only puts the hook deeper down my throat.
It's all right.
I'll handle it.
How? By telling the truth.
The truth is, I don't have the time, I'm not in the mood, and I don't see the point.
You don't want to do the M&M because you're not in the mood? This kid is dying, and I've got House trying to push all his responsibilities onto me.
They're not his responsibilities, they're yours.
You're the one who wanted to be in charge.
I wanted to be in charge, not a figurehead.
Then do the M&M, it's all yours.
You want me to get flogged? For what? So you can have an academic debate about a diagnostic dilemma no one's ever gonna face again? What the hell's going on here? I just don't want to do the M&M.
Did it work? Not even close.
Everything okay? Just waiting for whatever is about to go wrong.
Thirteen called.
She have a theory that makes more sense than abdominal epilepsy? She said someone hacked into her e-mail account and canceled her airline reservation.
I'm guessing Foreman.
Really? You're accusing Foreman, not me.
Cool.
You really want Foreman to stay in charge of the team? Makes sense.
He loves power, I love puzzles.
You love power and puzzles.
True.
And when I had them both It wasn't Foreman.
How do you know? He said he's moved on.
And you believe him? I believe that he believes him.
Looks like it's time for me to get off the bench.
What's up? Are you Dr.
House? I understand you're a big fan.
I'll have my guy send over a signed glossy.
Continuous EEG shows no interictal spikes.
It's not abdominal epilepsy.
You paged me to tell me what it's not? I paged you to show you this.
That, I did not expect.
What the hell is that supposed to mean? Darn it.
I knew I should've stayed outside.
The fantasy is always much better than the reality.
You think this is a joke? That's my son.
He's dying, and not one of you seem to have the slightest clue why.
I know.
That's why it's so interesting.
Fever, stomach pain, seizures, peritoneal and subdural fluid collection and now spots.
Could be an allergic reaction to one of his meds.
That suddenly developed eight hours after he started the meds? If it's not cancer or infection, it has to be autoimmune.
Systemic lupus complicated by a CNS vasculitis would explain the rash, fever, ascites CNS vasculitis would cause a stiff neck along with the headache.
And would've showed up on the dural biopsy.
What about polyarteritis nodosa? It can occur in kids.
Except you can't have arteritis without inflammation.
Okay, you come up with something better.
Go on.
There was some inflammation in the skin biopsy.
Plus he's got elevated diastolic pressure.
It's barely elevated, which you'd expect given the number of procedures he's undergone.
Well, barely is more than not barely.
Not my decision.
But if it was, I'd say start him on prednisone and get a testicular biopsy.
If he's gonna have any real inflammation, it'll be down there.
Cameron and I will do it.
Why? It was Chase's idea.
Kid's father is not gonna be happy about a fourth set of biopsies, and you've got a better rapport.
What's really going on here? You need Chase to help you over-prep for the M&M? Yes.
Then say so, don't be a child.
Is it on his penis? The kid's rash? Yeah, why? Means it's most likely affecting the small blood vessels.
That's why we didn't see any inflammation on the biopsies.
It's not polyarteritis, it's Degos disease.
I'll do it.
Your son has Degos disease.
It causes micro-blood vessels in the brain, skin, and GI tract to break down, clot off.
It sometimes manifests early on with atrophic papules on the penis.
In your son's case, we don't know why, but they came much later.
What's the treatment? There isn't one.
It's incurable.
You're wrong.
You've already been wrong a bunch of times.
We rechecked the biopsies.
It's definitely Degos.
I'm sorry.
I wish there was something we could do.
How long? Not much longer.
What does that mean? A day at the most.
All right.
Great.
We need to talk.
Unless it's life or death, it's gonna have to wait.
It's about Dibala.
Let me rephrase, unless it's a current Foreman can't present the case at the M&M.
I know you guys are busy, but he's just gonna have to suck it up and make the time.
It's not the time.
Then what is it? The anticentromere antibodies test, the test that caused us to change the treatment from blastomycosis to scleroderma, it wasn't It wasn't what? Dr.
Cuddy, they need you in the Pediatric ICU.
Who's they? I don't know, but I think they're lawyers.
If you guys screwed something up, just come clean.
It's not gonna be that bad.
With all due respect, you don't know what's at stake here.
What's going on? You need to stop him.
He's about to ruin his life.
Like you give a damn about my life.
Roy, he's right.
You're borrowing money to buy options that are already out of the money.
Even you won't be able to cover the losses.
Your house, cars, bank accounts, you'll lose everything.
That's the point.
The billionaire thinks that the gods will treat him better if he's broke.
I suggested he give it to me There has got to be some sort of balance.
You can't have all the good fortune in just one area of your life.
That's not how the world's supposed to work.
Who said the world was supposed to work? Don't just wipe everything out.
Put your assets in a trust, give it to a charity I can't get anything back.
He's insane.
He's irrational, so are most people.
Unfortunately, it doesn't make them insane.
If he signs that paper, he's not only gonna destroy his own life, but the lives of thousands of people who rely on this company to make a living.
If he is insane, we will sue this hospital Mr.
Randall, I know you're upset, but you shouldn't make a decision like this right now.
Give it some time.
My son doesn't have any time.
Your son's dying from an incurable disease, not bad karma.
No.
He's not dying.
It's not gonna happen.
I'm not gonna let it.
Roy.
Please.
I'm sorry.
I can't let him die.
People don't get what they deserve.
They just get what they get, and there's nothing any of us can do about it.
Deliver it, or I'll make sure you end up the ones with nothing.
Call a code.
He's flat-lining.
Thanks.
You're welcome.
For what? For thinking I was worth breaking the law to keep around.
That's just the way I am.
But still don't know what you're talking about.
Cuddy had IT trace all the IP addresses who've logged into my e-mail account.
There were two.
Mine and yours.
Obviously House decided he needs you more than he's willing to I already asked House.
And he'd certainly never lie.
No, he'd lie.
Except he wants me gone.
And he'd do a lot better job of lying than you just did.
Really? It was that bad? No, actually.
But it doesn't matter any more.
Why? Because of House or Foreman? You're good for both of them, but Foreman's not my best friend.
House will be fine.
Maybe.
But with you on the team, he'd be better.
He needs someone who doesn't need him.
You're the only one he's never really been able to suck into his crazy House vortex.
Keeps him grounded, his ego in check.
Why didn't you just come to me? I figured you'd only stay if House asked.
And I knew he would, eventually.
Bye, Wilson.
This is a great job.
Maybe even better, now that House is at least trying to have real relationships with people.
I said trying.
It doesn't matter.
The job you love doesn't matter? Don't throw it all away just because of a bad breakup.
Bye, Wilson.
I just confessed.
I told Thirteen I was the one who canceled the plane ticket.
Why? You mean why did I confess, or why did I do it? I know you didn't do it, so I guess the first.
You want her to stay because you want her back, or because Foreman does? Why would I care what Foreman wants? Because you're not as big a jerk as everyone thinks.
Yes, I am.
No, you're not.
I just made a $10,000 short sale on a stock I know is gonna crash because of what I saw a grief-stricken dad do on his son's deathbed.
No, you didn't.
Yes, I did.
You are a jerk.
She's making a mistake.
So you did it for her? She's a good doctor.
So you did it for you? I'm not the one in charge any more.
So you did it for Foreman? She's a smoking-hot, newly-single bisexual.
Why don't you just admit that you like having her around? She's good for you.
You need her.
Because I was born with a heart three sizes too small.
No, you weren't.
Yes, I What? He still alive? Yeah.
Good.
Start him on heparin and IV immunoglobulin.
For Degos? The cardiac arrest wasn't just an "everything goes to hell in a hand basket" arrest.
It was a coronary event.
Coronaries are large vessels.
Means it can't be Degos.
But the biopsies confirmed Obstructed blood vessels.
They can't be obstructed because of Degos.
Means it's primary antiphospholipid syndrome.
Are you sure? Nope.
But I will be if he responds to the heparin and immunoglobulin.
By the way, someone screwed over your girlfriend, and she ran to me, Cuddy, and Wilson, everyone but you.
She's not over you.
Or she is.
Where did you find it? Find what? Niacin-bound chromium supplements.
It was right on top of the file.
You don't know about it? No, been here all night.
One of Dibala's previous docs was prescribing ultra-high doses of niacin-bound chromium to boost his HDL.
So? So, it gives us something to point to.
We can explain the wide variation between the HDL numbers.
We're safe.
We're covered.
You really didn't request the info? No.
And obviously you didn't either, which means It worked.
The medicine worked.
It worked.
How did you find it? Fat, old, black guy.
I knew he had to be taking something for his cholesterol.
And what now? I'm not the boss.
You don't think I should be fired? Why? I doubt we'll ever be treating a genocidal dictator again.
Better a murder than a misdiagnosis.
Whether you want to be in charge or not, you are.
And you always will be.
presented to our hospital following a rapid onset of hemoptysis.
He had been fine prior to onset.
No chest pain, fever, coughing or chills.
He does note a nine-hour plane flight