House, M.D. s07e05 Episode Script

- Okay, you're doing good.
- You're doing good.
- You still got the thing - The stupid thing is still on! You don't have to yell at me, Mom.
I've been in labor for over a dozen hours, Justine, I have to yell.
I thought you were gonna miss the whole thing.
Mom, it's a three-hour drive.
That's why I called you yesterday after my water broke.
I'm sorry, a partner just dropped a brief on my desk.
You're doing good.
Yeah.
Right.
I remember what it's like, but family comes first.
I need you to keep pushing, I can see her head.
All right, come on, we're doing good here.
Get this, this is what I wanted.
Gross.
Crowning.
Are you getting this? Kind of.
Well, not the actual vagina.
It's your baby sister! It's my mother's vagina.
Freeing the shoulders.
There she is! Oh, my God! There she is! Get the NICU team in here.
Baby's hypoxic.
Is something wrong? What's going on? I don't know, Mom.
My baby! How's my baby? - What are you doing? - O2 sats are low 80.
Respiratory rate What are they saying? I can't tell.
Find out what's going on! You need to back up.
Turn that off.
She's not responding.
What's happening? - She's not responding.
- She's not What's wrong with my baby? Why doesn't someone talk to me? Cancel your dinner plans.
Short on medical history, she's only eight hours old.
What she's not short on is doctors.
Unfortunately, none of them have been able to solve her breathing problems.
Immature lungs? Full term.
And they gave her surfactant.
Looks like they're fully developed.
Need you a minute.
Silent reading time till I get back.
My nanny called.
Her daughter has a dance recital tonight.
She can't work late.
And I have a board meeting tonight.
That's a problem.
My mother can't come.
She has a cooking class.
You've really got a problem.
If only there were some mature adult in my life who could pinch hit in emergencies like this.
Would love to.
But I'm catching up on my back issues of Nudist Circus.
You should see what the fat lady's got under her big top.
All I need is a warm body.
And she'll be asleep the entire time.
I got a sick baby here who needs me.
Yours is healthy.
You can deal with your team by phone.
How about a little something extra when you get home? I'm not bargaining sex for babysitting.
Besides, you owe me.
For what? Sex.
I still don't see a female doctor in that room.
It's making me very unhappy.
Fine.
Out of the goodness of my heart.
Which will make you happy, which will make you desire me more, which will turn into more sex.
Be at my place at 7:00.
The sperm donor card from the father did note a history of asthma.
What if her lung problems are not coming from her lungs? Her heart looks fine.
Her liver enzymes are elevated.
When the liver fails, it stops producing proteins.
Specifically the ones that keep your plasma inside your blood vessels and outside your lungs.
Fix the liver, she'll have enough breath to keep the entire ward up all night.
Foreman, you need to stay after school.
I apparently need to apologize.
Last week, I should not have gone over your head and allowed Chase to hire a new team member.
So go hire someone who liked The Bridges of Madison County.
You want me to hire a white girl? Go find a woman.
And wipe that self-satisfied grin off your face.
This'll be quick.
I've been interviewing people all week.
Have it narrowed down to two candidates.
Narrow it down to one, before Cuddy starts withholding sex.
She hasn't said anything to me about that.
I said wipe the grin.
Yeah, she's fine.
I can hear her breathing in the monitor.
I just checked.
I'm checking every 10 minutes.
Fine, I'll check again.
Aw, she's so cute when she's asleep.
You should see this.
She's got one hand over her head.
Okay.
Well, you take as long as you need.
I'm thirsty.
Your mommy says no, 'cause she's mean.
If it was up to me Juice! No.
Go back to bed.
I said bed.
Wilson, hey! You up for a boys' night in? Believe it or not, breathing problems can be caused by a liver problem.
Then what's wrong with her liver? Probably an abscess.
If we find it with the ultrasound, we can drain it, make her better.
You'd be able to take her home by the end of the week.
Is she bleeding? She's oozing from her IV site.
It's a symptom of liver failure.
It's what we would expect to see.
Dr.
Cheng, we might need a unit of blood over here.
- Echogenic area in the liver.
- Can you make it out? Doesn't seem to have the thick walls you'd expect from an abscess.
Lift her left shoulder so we can get a better look.
Can I do it? I haven't been able to hold her yet.
She's hooked up to too many tubes and IVs.
Can I at least donate blood? Of course.
We'll draw your blood and see if you're a match as soon as we're done here.
That's definitely not an abscess.
It looks like dilated bile ducts.
What does that mean? Can I still take her home soon? You were right about the liver.
On ultrasound, we found intrahepatic dilated bile ducts.
Extrahepatic ducts were normal.
Are there any masses causing an obstruction? No.
Are you okay? Just talking in a soothing voice.
Not for your benefit.
Why, is it turning you on? House, there's someone here I need you to meet.
I just hired Dr.
Christina Fraser.
She's a board-certified Nice to meet you.
You're fired.
What? FOREMAN: House, you're kidding, right? I've done my due diligence.
She's the best there is.
What did I do? You had the misfortune to be the lesson that Foreman is learning.
That whooshing sound is the air being let out of his ego.
You are such an ass, House.
You could've made the same point without crushing the hopes of a young doctor who was actually excited to have this job.
I'm not sure I could have.
You keep giving me far too much credit.
Taub, it's your turn to find a young doctor who's actually excited to have this job.
For you to fire? Not until you, or she, earns it.
Dilated bile ducts could be congenital.
It means that it's a stricture in the ducts themselves.
Caroli syndrome.
So open her up.
Surgery? This is a newborn with liver failure.
She's oozing blood from every puncture site.
It's insanely risky to open her up.
Yes, it's unfortunately also the only way to fix her.
So make teeny tiny incisions with a really small scalpel.
Gotta go.
You told me you gave them your credit card.
And you were dumb enough to believe me.
Cuddy will be back in an hour and 10 minutes.
I'll be back in an hour and five.
Oh, no, you don't.
Oh, yes, I do.
You're not gonna leave the kid.
Yes, I am.
Because unlike you, I don't have a conscience.
Unlike you, I'm not having sex with Cuddy, so I actually can leave.
You're bluffing.
I'm leaving.
You're not gonna leave a two-year-old unattended.
True.
I'm leaving her with you.
A responsible adult.
You better get back in there.
The kid's all alone.
It's kind of bugging you, isn't it? Not my problem.
Since objectively, you care more about leaving a child alone than I do, it kind of is.
Objectively, since I never accepted this responsibility, it kind of isn't.
True.
And yet it is.
Because you're you.
I'm leaving.
I'm leaving.
You're not gonna leave.
You can't.
Fine.
You're right.
You know what I can do? I can go in there and call a babysitting service for 15 bucks an hour, then call Cuddy and tell her who's watching her kid and why.
I'll stay if you stay.
We were gone two minutes.
What you got there, sweetie? Come on now, spit it out.
Come on, sweetie.
Open.
Open.
Ow! Rachel.
How many coins did you eat? Isolating the common bile duct.
And mobilizing the distal end for cannulation.
BP's down to 50 systolic.
You've gotta stop the cannulation.
I haven't started yet.
Hit her with a bolus of phenylephrine.
That should buy us enough time to get in and dilate those bile ducts.
BP's rising, 70 systolic.
Nice.
I'm in the common bile duct.
Advancing past the cystic duct.
No strictures or blockages so far.
- BP's dropping again.
- Another bolus of phenylephrine.
She can't take more, the first bolus is still in effect.
BP's still dropping.
You gotta pull out.
We're done.
I was barely in.
This doesn't make sense.
A liver problem alone is not gonna mess with the baby's BP.
Whatever this is, it's gotta be affecting her heart.
Heart plus liver, could be tuberous sclerosis.
Or it could be a vascular malformation in the liver causing both problems.
So what do you guys think of Dr.
Cheng? Best treatment for a vascular malformation is surgery.
And I think your wife thinks you shouldn't think anything of Dr.
Cheng.
No surgery.
Newborn baby can't handle another trip to the OR.
I didn't mean think think.
I meant think as a potential hire.
What if we start the baby on steroids, an anti-angiogenesis agent and dopamine? Could work just as well as surgery, snap those bad blood vessels shut.
I'll call House to get approval.
So, what was that shrug? A "Dr.
Cheng could work" shrug? Or a "House is gonna crush you for even considering her" shrug? You suck.
House is gonna hate anyone we hire, because he doesn't want to hire anyone.
So you think I should abstain, just give the decision back to him? Then he'll just mock you for being a wuss.
You're screwed.
Unless House feels like hiring her is his idea.
He's still not answering.
We should just start the treatment.
She opened up a Chinese food bag to eat money.
What an idiot.
Okay, you ordered the moo shu pork and the orange cashew chicken, right? Like I always order.
Have you cleaned up in there? Yeah, it's good enough.
Okay, so with tax, the change should have been 68 cents.
There's only 58 cents out there.
There's a dime missing.
Well, they could have short-changed you.
Fridge magnet is not getting anything.
That's because it's a fridge magnet.
And unless she swallowed a Canadian dime, it's not magnetic.
Really? I mean, kids swallow things all the time, right? She swallowed a dime, she poops it out, she'll be fine.
Absolutely.
Unless it gets stuck in her intestines, causes a blockage.
Which could kill her.
- Then she won't be fine.
- You have to tell Cuddy.
Well, then, I won't be fine.
If you don't tell Cuddy, I will go out there and tell her myself.
Yeah? What are you gonna tell her? You're gonna tell her that you left coins out and you left her child unsupervised? Hey, hey, hey! You are not gonna pin this on me.
Rachel needs to be monitored for 24 hours to see that the dime passes.
You know, just to make sure she doesn't die.
You're telling me to do the right thing while climbing out a window? Tell her! She wake up at all? One time.
That's not like her.
Is she all right? She's fine.
How about I stay the night? And you can really thank me.
I have to get up early.
You won't be able to sleep in.
I'm a deep sleeper.
Round two.
Did Justine go home? She said she was going downstairs for a few minutes.
A few hours ago.
So you two are close.
It's been getting better, actually.
At least she's here in the building.
That's pretty supportive for her.
What is it? She's pinker.
Is that bad? That's good.
That's very good.
Is that her? Can I hold her? I think it's long overdue.
Oh! My first time.
Finally.
Technically, it's your second time.
I didn't mean I know, Mom.
Looks like it was a vascular malformation.
The Grogan baby is better.
Nice job.
Okay, ready, honey.
So stay very, very still.
And hold your breath.
Don't move.
She moved.
They always move.
It is a good job.
Diagnostics.
Solve a mystery, save a life.
But I suppose you're pretty attached to pediatrics.
- I'm sorry, Mrs.
- Young, but I'm going to have to ask you to restrain your daughter.
And now the mom's not gonna want to do it, because she'd rather I just keep blasting her daughter with radiation.
You're telling me there's an opening in House's department? Would you be interested? No more kids? No more parents? One case at a time instead of 17? Set up the interview.
It's possible you won't need to interview.
Relax, I got this.
Thanks.
Is everything okay? Yeah.
Sorry.
Just new to all this.
You want me to reset the alarm? God, no.
Case is under control.
I'm sleeping in.
Your boss must really like you.
Hey, Marina.
There's pasta in the fridge for lunch.
I assume, since you're calling so early, that the surgery was a rousing success.
And I assume since you still think we actually did the surgery, you haven't checked your messages in eight hours.
Where are you? I believe this is what your people term a "poopy call.
" Uh, the word's "booty.
" I don't know what you're doing, but this is a poopy call.
- It's not Caroli Syndrome.
- Dr.
Cheng spotted What? I knew about the Jew, the black and the croc hunter.
But when did we get our Asian persuasion on? Dr.
Cheng is the NICU attending on the case.
And she's not here.
Well, I just wasted a perfectly good racial epithet.
She spotted a vascular malformation in the baby's liver.
Good call.
Except for everything you just said.
There's no way that our patient has a vascular malformation.
And you can tell that from the vast amount of information you've gleaned from not being here? Don't need to be there to remember that the patient's ALTs were three times normal.
The baby's liver damage is far too extensive.
Dr.
Cheng's an idiot.
In fairness, it wasn't completely her idea.
More of a Foreman kind of thing.
Well, then you're an even bigger idiot for trying to cover for her.
House, we treated for a vascular malformation.
And she got better.
No, she didn't.
Call me when she crashes again.
That went well.
Everything okay? Come on.
I know that look.
I'm just not used to seeing such emotion coming from you.
Well, I just gave birth.
I'm like one big vat of hormones right now.
It's not just the hormones, Mom.
You're different with her.
It's okay, it's good.
It's just I can't help thinking, "Where was this mom when I was growing up?" Well, I never realized you considered me such a failure as a mother.
I don't consider you a failure.
I just I never knew that there was an alternative.
Mmm.
I think she feels wet.
Can you hold her a sec? I'm gonna grab a diaper.
Okay.
Mom, something's wrong.
Oh! Nurse! She's bleeding again! All right, she's in her office.
Move fast.
You see a double-wide tuchus coming this way, you scream like a girl.
If Rachel wakes up, she's gonna tell Cuddy everything.
She's two.
Last night she was whining about the giant moose that lives outside her window.
Medusa at six o'clock.
Don't look back.
Move, move.
Hello.
Hello.
I'm the friendly moose who lives outside your bedroom.
She hates that moose.
Hand me the gel.
Okay.
Make it short.
And do not pardon the pun.
- She's crashing again.
- - Where are you? Is it actually important that I understand what you say? What? Yeah.
The baby's bleeding again.
I'm shocked.
Oh, no, wait a minute.
That's you.
Yes, you're a genius.
The bleeding means her liver is still failing.
It's not a vascular malformation House, come take a look at this.
Hold that thought.
House, no.
I need to Just past the ileocecal valve.
It's nothing.
Just an irregularity.
It's a dime.
Or a pocket of air.
Yeah, with FDR's face on it.
That's not a face.
It's a shadow.
House, the thing is perfectly round.
Move the wand to the side.
Tickles! That's because I'm the tickle monster.
Look at that.
We need an X-ray to be sure.
Great.
Just give her an unnecessary dose of radiation? It's a dime.
- House? I know you're in there.
- Open the door.
I saw your extension on the call.
What are you doing down here? Uh, Wilson's got a two-year-old with cancer.
She's in a lot of pain.
It's very sad.
He also has an outstanding bedside manner.
Her liver failure is getting worse.
You were right.
Now what? The interesting question is not why she's worse now, but why she got better in the first place.
Could've been something we did that temporarily relieved the What'd you put her on again? After the transfusion, we gave her steroids, dopamine, and the anti Steroids can treat idiopathic hepatic fibrosis.
Would explain why she got better, then worse.
But not the multiple dilated ducts.
House, I need you back in here.
Cancer kid trumps liver kid.
Sorry, confidentiality.
There are rules, you know.
That is a dime.
Looks mobile, it's right in the middle of the colon.
Prime location for pooping out.
We'll give her some laxatives to help it on its way.
Sounds to me like someone's going to get some yummy chocolate.
Chocolate.
Yum, yum, yum.
You're gonna make a great mommy one day.
Thanks for waiting.
Hook the mom up to the baby.
Direct blood transfusion.
And what else? Nothing else.
It's amazing.
She's pink and healthy again.
Mother's touch.
It's a miracle.
Thank you.
A blood transfusion isn't a cure.
Or a miracle.
Then why does the baby seem like she's cured? I have no idea.
Our patient can either go through life with the world's longest umbilical cord, or we can discuss the differential for magic blood.
Baby's O2 sats are holding.
Either you're Dr.
Cheng, or you're early for my mani-pedi.
I thought her expertise could Tell us the O2 sats? I hope you come with some original ideas.
Either the mom's blood is special, which would mean it's treating something specific, which means the baby has a disease.
Or Mom's blood is just blood, and it's replacing something the baby is missing, which means the baby has a simple deficiency.
Given the liver failure, deficiency of clotting factors, enzymes, or vitamins are the most likely.
So let's find out.
Hook the baby up to someone else's blood and see if she gets better.
Find a donor.
I'm O negative.
Universal donor.
Hook yourself up.
Dr.
Cheng, hook me up.
Walk with me.
My team seems to have taken a shine to you.
I like them, too.
I assume you're hanging around, because you want a job.
That would be a fair assumption.
Well, I'm gonna have to test you.
Let's say, two-year-old.
Swallowed a coin 20 hours ago.
She's gonna be fine, right? Any signs of obstruction? For the purposes of this quiz, let's say not yet.
I'd give laxatives, although I wouldn't wait too long.
Her bowel could become ischemic, or worse, an intussusception.
Define "too long.
" Another six hours, max.
By then, her system's clear.
If it's not out, it's not coming out.
And then what do I do? I mean, what do you do? It's your test.
I'd go in with a scope and get it.
Did I pass? It's not up to me.
Talk to Taub.
Men's room? Turns out toilets are handy in this situation.
And I felt relatively sure that Cuddy wouldn't come in.
Oh, Cuddy's been in here.
Seriously? This must be a terrible place to have Is there such a place? We have six more hours, then we're going in with a scope and pulling it out.
Scope a two-year-old? It's dangerous.
And as you keep pointing out, so is a dime ripping through her intestines.
Cuddy will be home from work in six hours.
But no big deal.
I'll just scream, "Look over there" while you quickly shove a scope up her daughter's rectum.
I could offer to babysit again.
Let her have the night out.
Sure, that won't raise any suspicions.
I wish I was nicer.
Give me your radiation dosimeter.
Why? Because it matches my eyes.
I think we can say this isn't working.
We'll get her back on your blood.
That'll help for now.
But this means there's an infection.
First we need to identify it.
We know it's in her liver, so we'll get a sample.
Then we can figure out how to help her get better.
I had this baby because I wanted a chance to be a special mom, but not this way.
Problems in radiology.
A radiation dosimeter badge turned positive.
I could have a CT scanner that's leaking, or a spilled vial of thallium somewhere.
I don't even know whose badge it was.
The code was scratched off.
That had to be intentional, I mean, why would anyone I don't know.
All I know is that I'm gonna need to work late.
I was actually hoping that you could babysit.
No.
Not two nights in a row.
Please.
Please? I have a life, you know? I will make it worth your while.
I am not going to bargain babysitting for sex.
Who the hell said that? Of course I will.
Thank you.
That thing's nearly as big as she is.
Don't worry.
I've done this at least once before.
Advance another centimeter, and you're in.
God, that looks awful.
Is that from the infection? No.
Means we were wrong.
It's a melanoma.
You mean like skin cancer? How did she get that? She's never been outside.
But you have.
You're saying I gave my baby cancer? I found a mole under the nail on her left index finger.
The biopsy revealed it's melanoma.
That's it? And how come no one got me food? What do you mean, "That's it?" The woman has melanoma, she could die if we don't Boring.
Since the baby has a melanoma, we kind of already knew Mom had it.
Yes, but now we know where it is, so we can treat it much more effectively, so Great.
So treat her.
Also boring.
What's interesting is that Mom's melanoma spread to the baby in utero, which means it's metastatic, which means it's late stage.
How many people with late-stage melanoma are as healthy as she is? Clearly something's going on in Mom's blood that's treating her melanoma as well as her baby's.
Antibodies.
If her immune system was fighting the melanoma, it never would have spread.
Exactly, which means it's fighting something else.
And the melanoma cells are getting caught in the crossfire.
So what's Mom's immune system really shooting at? Scleroderma can cause cancer-fighting antibodies.
So can Churg-Strauss, pretty much any auto-immune disease.
Or infections that cause granulomas, TB, mycobacteria.
See, Dr.
Cheng? This is not boring.
Start with auto-immune.
Go test her blood.
And leave your food.
Just a little pinch.
So I'm not actually making her better, I'm making her sick.
You can't blame yourself.
I ate all the right foods, I read all the books and the studies.
And I even hired a private detective to research each sperm donor.
I just missed one big thing, my own cancer.
I'm all done here.
We'll have the results soon.
And if that's what this is? An auto-immune disease? The treatment's fairly simple.
And if it's something else? Let's just take this one step at a time.
And stop beating yourself up.
I'm sorry, Mom.
Not just for this.
But for what I said earlier.
I was jealous and angry and I lashed out.
You were a great mom.
You are a great mom.
I don't deserve such a good daughter.
Negative for scleroderma.
So, what did House want earlier? He just gave me a little quiz.
Then said he was okay with hiring me.
But that it was your decision.
Negative for dermatomyositis.
He's just saying that to set me up.
So, you're not offering me the job? If he wants me to offer you the job, something's going on.
That was my thinking, too.
It's not lupus.
Things with House are never as simple as they seem.
Trust me, he's got an ulterior motive, and I gotta figure it out before I do anything.
Okay.
- Mom's negative for Churg-Strauss.
- This isn't auto-immune.
Time to scan her for infections that could cause granulomas.
Third poop in the last half-hour, still nothing.
All right, that's it.
Time's up.
Operation Valkyrie is now in effect.
Either it's a trap or it's not.
Just hire her.
Lungs clear for granulomas.
Yeah, who cares? Did you enjoy that bear trap snapping on your leg yesterday? You realize it's just a metaphorical trap.
You'll still have all your limbs.
Fourth rib, about the mid-clavicular line.
You're over-thinking this.
House fired my pick sight unseen.
He was never even interested in Chase's pick, he was only obsessed with how she reflected on Chase.
Dr.
Cheng is the only candidate he's actually responded to.
You wanted House invested.
He is.
Hire her.
And you think I'm over-thinking this? Shut up and hire her.
Look.
Oat cell lung cancer.
She has two cancers? Cancer treating cancer.
You have lung cancer.
I thought I had skin cancer.
As unlikely as it sounds, you have both.
Actually, the lung cancer is basically treating the skin cancer.
It's why you're not feeling sick.
And why your blood's helping your baby.
We found it early, so it should be treatable.
In a way, your daughter saved your life.
We'll get you set up for the surgery and start you on chemo.
What about Kayla? She'll only need the chemo.
Can't you just keep giving her my blood? Not once we cut out the tumor.
Your body will stop making the antibodies that are keeping your baby healthy.
Can you hold off on my surgery? Over the last day, your baby's liver tumors have shrunk 15%.
Projecting forward, it would take eight or nine days to completely eradicate her cancer cells.
So let's take the eight or nine days The cancer probably won't spread in the next nine days, but there are other risks.
Cancer thickens your blood, which could cause clots And what are the risks to putting my baby on chemo? It could damage her brain, or affect her development.
But these risks are small compared to the risks that you would be taking by leaving your cancers untreated.
I want to wait.
Mom, are you listening? This is way too dangerous.
I'll take the risks.
I want what's best for my daughter.
I'm your daughter, too.
She's a baby.
You're an adult.
So, what? I don't need my mom anymore? No.
You never did.
Because I wasn't there for you.
But look at you.
You turned out great.
You don't know if I'm great.
You don't know me at all.
And I'm not gonna let you martyr yourself for a two-day-old infant just because you feel guilty, because you weren't around for me.
I'm not martyring myself.
It's nine days.
Let's hold off on the surgery.
You brought food? This is a medical procedure, not a dinner date.
I'm aware that this is a delicate procedure.
I'm also aware that my hands are shaking from low blood sugar because I haven't eaten all day.
So while this may seem insensitive, this crucial lifesaving moo shu Where are my extra pancakes? Damn it.
They forgot the extra pancakes in my moo shu pork.
Every time that new girl with the blue streaks in her hair answers the phone, they screw up.
Was she there when you picked up the food? You ordered extra pancakes? How much do they cost? I ordered two.
So that means the total on the last bill was Was $18.
42.
$18.
42.
Rachel couldn't have eaten a dime, because there was no extra dime.
Yeah.
So, the image that we saw on the ultrasound Was obviously just a pocket of air like I said all along.
But you saw the worst-case scenario, like every irrational, worried parent.
You'd make a terrible mommy.
Throw me some dumplings.
Mom, I brought you some Mom? Mom! Mom? We need help in here! Somebody help us! - Massive pulmonary embolism.
- She died in seconds.
Wouldn't have happened if she'd let us remove the tumor.
Probably not.
Post-mortem, we were able to harvest all of her blood.
It's enough to treat the baby.
That's something.
Pretty amazing case.
Thanks for your help.
I was glad for the chance to work it with you.
I've thought about it, and I'd like to formally offer you the job.
It's funny.
I wanted to work on House's team until I started working with his team.
Yeah, I know.
Chase and Foreman can get a little Actually, it's you.
I get that House is an ass, but at least he owns it.
You don't understand.
This whole thing was just a game to House.
I didn't have a choice, but You're a grown man, Dr.
Taub.
You can make whatever choices you want.
And instead of hiring me when he said you could, you chose to act like a paranoid, scared little kid.
I hate kids.
Goodbye, Dr.
Taub.
I'll make sure you never forget her.
And what she did for you.
She was just trying to be the best mom in the world.
She was.
This one's all yours.
What happened to helping out? I did.
- Did someone go poopy? - RACHEL: Mmm-hmm.
What How did you eat a dime? House.