House, M.D. s08e09 Episode Script

We're in the car, honey.
We're going to the hospital for tests.
We're in the hospital.
We're going to the doctor's office.
Can you tell me what this is called? You use it to get food from inside.
Yes, but what's it called? Is it a spatula? No.
Good.
Is it a can opener? No.
It's it's.
4.
You're trying to make me look stupid.
You can go to hell! Why don'! You kill yourself? Andres.
It's okay.
There she is.
Here I am.
Here.
Come on.
You just need to answer a few more questions, then we're going home.
We'll have lunch, okay? Okay.
I'm sorry.
I have Alzheimer's.
I know.
The mood swings come on quickly, but it's under control.
Don't worry.
He's actually perfect for the drug trial.
On.
Thank God.
We can start as soon as next week.
Andres! Oh, my God! And res'? Early onset familial Alzheimer's.
Brazilian descent.
Blood chemistries showed high ammonia.
Vomiting stopped after the ER put him on antiemetics.
Any recent health issues? Just a sore throat a few weeks ago.
How advanced is he? Could be hyperalimentation.
Advanced enough, but no IV feedings.
The wife shut down her floral company to stay home and feed him every meal he's had in the last four years.
Do we owe this case to your guilt at having ignored your own forgetful mommy? My guilt over my mom is why I put up with my dad.
You're taking this case because we're running a Phase Two trial on an Alzheimer's drug.
You couldn't round up enough doddering, old guinea pigs, so you need us to fix this little piggy? I'd like to sit in.
Especially since you're short a team member.
You mean Taub? Got him in here.
He asked for personal days.
His daughter's sick.
Isn't that the point of having a spare? I denied his request After I'd already approved it, which you knew because I sent you a memo.
Dr.
Adams, taped under your chair is an index card.
Would you read ii, please? "Wednesday, 2:43 p.
m.
"A black pawn will believe he's the black king "and attempt to capture the white head of diagnostics.
" It's 10:15 on Friday.
Damn it.
{SIGHS) Look, the point is, I saw this coming.
Dr.
Foreman and I did not always see eye to eye, but he never had the power to overrule me.
Now that he has the power, he won't be able to resist the temptation to use it.
With great power comes great micromanaging.
And great vests.
I know you're the better diagnostician.
I'm not gonna interfere.
I'm only hereto help.
Could be transient nitrogen load from a GI bleed.
Not if the vomiting's persistent.
Which we won't know, because the ER put him on antiemetics.
Take him off.
Wait.
He was puking his guts out.
We'd risk aspiration.
I'm just disagreeing, not overruling.
So glad you're on board.
Take him off antiemetics.
Do an upper endoscopy to check for bleeds.
It could be a bladder infection.
We'll run a pregnancy test.
I'm not pregnant.
Any type of birth control can fail.
Not mine.
Oh, I'm sorry.
You said you were married? Yeah.
Happily It's okay.
Sex can wane in any marriage over time.
No, no.
We've never had sex.
We kiss and cuddle, but neither one of us is interested in sex.
You're both celibate? No, neither of us.
Celibacy is a choice.
This is our orientation.
We're asexual.
Not quite sure what box to check here.
You're making a mistake.
If I had the power to veto him, given all the crap I've put up with over the years, I don't know if I could use it objectively.
I do.
I can.
I have.
It might be easier if you'd stay out of the room.
I thought it'd be different.
This week.
I'm supposed to talk to his PO about getting his ankle monitor off early.
You're saying he should defer to you? No.
I'm just saying what he's doing doesn't seem rational, which makes me think it's rational in a way I'm not privy to.
He always has a plan.
And he's always self-destructive.
He may just be shooting himself in the ankle.
I know it feels strange.
Dr.
Chase is just looking in your throat.
We're in the hospital.
You're fine.
That's a pretty nice trophy there, Andres.
He coached youth soccer.
Took a team that was zero-and-six all the way to the state finals at Long Branch.
Hey, thanks for doing this in here.
Switching rooms can be very disorienting.
You take very good care of him.
I love him.
Sickness and health, right? Upper esophagus is clear, moving on to the GE junction.
Hi.
Hey.
I'm sorry, family members only during procedures.
I'll wait outside.
Oh, no, please, it's okay.
Joseph helps me with my husband sometimes.
He's a good friend.
Which means not family.
Wait, we're gonna be here a while.
Why don't you show Joseph where the visitor's lounge is'? Okay.
What? I'm surprised you didn't go into the diplomatic corps.
Oh, you think they're No.
If they're having sex, it's probably with their genitals.
Mallory-Weiss tear.
Vomiting must have torn the lining.
You know that close to 1% of the population identifies as asexual? We really got to get you laid.
If I have to plow that furrow myself, so be it.
I've a patient who's asexual.
Is she a giant pool of algae? It's a valid sexual orientation, according to this article, at least.
Yeah, I think I read that, too.
Is that Fugliness Weekly? She's perfectly fine-looking.
Happily married for 10 years.
To a guy who loves penis enough for both of them.
He's asexual, too.
Ran a complete physical on her.
Nothing wrong except a common bladder infection.
Hundred bucks says I can find a medical reason why she doesn't want to have sex.
You're out of your mind if you think I'm letting you anywhere near my patient.
Fine, I won't go near her.
Just give me her file and any blood samples you have leftover.
No contact whatsoever.
You talk to her, the bet is void.
No contact.
Plays to my strengths, anyway.
Right now's not a good time, House.
Not for the Dean of Medicine, but it's the perfect time if you're a member of my team.
Which one are you? What did the endoscopy show? No signs of ulcers or blockages.
But you found a tear just below the esophagus.
Explains the bleeding.
Doesn't explain why he vomited so hard he ripped his insides.
His liver enzymes are slightly elevated.
Gallstones could No complaints of pain.
Steatohepatitis would make his AST and ATL levels rise.
Are you calling his liver fat? Start the patient on statins, do a biopsy to confirm.
And knock him out, I've heard he's a wiggler.
There's no need to put him under.
We can confirm fatty liver with an ultrasound.
Just making an observation.
Well done.
And now, as a member of my team, you can make the equally useful observations that the sky is blue, I'm wearing pants, and I'm ignoring your first observation.
Of course.
Wait.
And there it is.
You're trying to screw with my confidence.
Well, if I wanted to do that, I'd tell you how much the nurses hate you.
You're trying to get me to define myself as a subordinate to keep me from ever intervening, even if it's fully in the scope of my duties.
Like now.
This isn't about diagnostics, it's about what's safe for the patient.
Do the ultrasound.
Ultrasound it is.
And the nurses love you.
You don't think I knew House was gonna tell you to ignore me and not do the ultrasound? This is an ultrasound machine.
Which you're gonna use to do an ultrasound-guided biopsy.
You've probably got a kit stashed here "Cuddy Dark will waste his afternoon chasing conspiracy theories.
" You're letting him get inside your head.
He can do a lot of damage in there.
Dr.
Chase, he started vomiting again.
This is why we stopped the antiemetics.
We needed to see if it was still a symptom.
Okay.
Here.
You want this? Get your hands off me.
You're taking my head! It's okay, Andres.
You're in the hospital.
Already on it.
Hey! NATALIE: I'm fine.
I'm fine.
Foreman.
Blood in his urine.
We resumed the antiemetics and increased his sedation.
He really went after her.
Maybe he found out about her "good friend.
" It was just paranoid rage.
Typical of Alzheimer's.
We don't even know if they were sleeping together.
A few hours ago, you were sure.
And that's significant why? Sorry, only the bleeding's medically relevant.
No' I wasn't being rhetorical.
If they are sleeping together, why do we disapprove? You're pro infidelity? She's not married.
If marriage is feeding and cleaning someone and limiting conversation to repeating a few simple commands, then I was married to my pet rat.
And a lot of people owe me wedding gifts.
And we're walking, we're walking.
I don't care how sick your spouse gets, you don't jump ship.
Alzheimer's is different.
She can't share her problems with him, or plan for the future.
The man she married no longer exists.
Yes, he does.
He's in there.
This is why you get married.
Said the divorced woman to the divorced man.
I didn't jump ship.
My husband sank it when he cheated on me.
Commitment's not conditional.
She is there for him in the only way that matters now.
She gave up her life to take care of him.
Proves she's an idiot.
If she had any sense, she'd have stuck him in a facility and jumped on that strange Dr.
Foreman.
We were just looking for you.
I was right about the antiemetics.
If we kept him on them like I said, he wouldn't have gotten agitated and punched his wife.
Yes, we're back to my supposed diabolical plan to shake your confidence.
Let's see if this helps.
If you're speaking as a team member, then I'd say you're a moron.
'Cause taking him off the antiemetics gave us crucial diagnostic information.
If you're speaking as Dean of Medicine, then I'd say you're a moron.
'Cause your micromanaging kept us from doing a biopsy.
And if we had, the patient would've been anesthetized hours ago thus unable to go all Chris Brown on her ass.
Unless one of your index cards actually predicted the guy was gonna punch his wife, everything you're saying is post hoc rationalization.
Dr.
Park, would you please reach under that chair? "The patient will punch his wife.
" You clearly wrote that after the fact.
Dr.
Adams, would you please reach into my pants? "Dr.
Blackenshmurtz will accuse me "of writing about the punch after the fact.
" And look, there's a photograph of me holding a newspaper dated last Tuesday.
How could I have gotten my hands on that? You done? Rhabdomyolysis fits the vomiting, pigmenturia and renal failure.
No muscle symptoms and urine had no myoglobin.
TTP fits, though.
Start him on plasmapheresis.
Unless Unless I need to say, "Mother, may I?" And "mother's" an abbreviation.
Fresh plasma will replace the damaged red blood cells that are clogging his kidneys.
That sounds hopeful.
How's that feeling? I've never been hit in the eye before.
I feel kind of badass.
I think maybe you should go.
Look, I'm fine, okay? I'll see you tomorrow? Okay.
We're not having an affair.
It's none of my business.
I mean, not really.
'Cause nothings happened, but we've talked about it a lot and It's just really hard doing this by myself.
When's the last time you had a full night's sleep? Um I don't know.
Three years? You're not gonna get any rest here.
People who are sick are not the only ones who need to be taken care of.
Why doesn't Chase have to be here? You think he knows anything about women who don't want to have sex? Hormone levels are normal.
This woman seems perfectly healthy.
What does it matter if she says she's asexual? It's the fundamental drive of our species.
Sex is healthy.
Orgasms oxygenate the brain, lighting up over and making us forget how boring Susie Cooper is.
That last one may not be universal.
How about damage to her spinal cord, blocking the signals from her genitals? Sex drive is in the brain.
I suppose it could be psychological intimacy issues caused by childhood abuse.
She's been sharing a toilet with the same guy for the last 10 years.
It's not the same.
Sex releases oxytocin, it's the neurochemical basis for bonding.
And that's why men always marry their right hands.
It's different for girls.
No, it's not.
I've tapped over 30 guys and never wanted to see most of them again.
I lived next to a Jewish frat.
We are veering wildly off track.
Please continue.
This woman's life is probably better off without sex.
Eliminates most of her insecurities, she's immune to most advertising, and can have honest relationships with men.
Not a lot of them.
We've run every lest and ruled out all the options.
You're gonna have to accept she just doesn't want sex.
Lots of people don't have sex.
The only people who don't want it are either sick, dead or lying.
So maybe she's lying.
You think she's had a boyfriend on the side? For 10 years? Sticking around the whole time? It doesn't make sense.
What does.
“ Thirty? Everybody lies.
Higher or lower? Followed your advice and took the night off.
It seems to have done you some good.
Mmm-hmm.
Where's my husband? He's not in the hospital.
So he just walked out? All of the shift nurses had their hands full with a double code.
Perfectly reasonable explanation.
Same thing happened to me.
Couldn't find my keys for days.
The police have been notified, I have staff searching.
You told me it was okay to leave.
I'm sorry.
He has Alzheimer's! It's freezing outside! And he's sick! I mean, you don't even know what it is yet, do you'? The plasmapheresis hasn't had time to work, but TTP is our most likely Okay, I have to go look for him.
Hey.
Don't be an ass.
Can't you see she's upset? No, she's guilty.
Instead of being at her husband's side, she was under you.
Okay.
That's Yeah, he already said I was an ass.
Personally, I applaud your decision to step down off your cross and get on with your life, but your misplaced guilt is shutting down your brain.
We need you to sit, focus, and answer our questions.
So it's 6:00 a.
m.
, patient wakes up, and the first thing he sees In moments of confusion, Alzheimer's patients regress to old routines.
So what would your husband do on a Saturday morning? Nothing.
Be at home.
What about a year ago, five years, or 10? I don't know.
He trained for a marathon once.
Soccer practice.
We took a cooking class.
The soccer trophy you were telling me about, it's gone.
Where was practice? It was close to here, on Chesterfield.
Okay, he comes, he thinks he's wailing for practice.
He'd want to get out of the wind, but somewhere he could see the kids arrive.
There.
Over here! On three.
One, two, three.
Nothing.
Not dead till he's warm and dead.
Get him to the ICU.
Start him on extracorporeal circulation.
That'll raise his temperature too quickly it'll cause acidosis.
We can deal with his metabolism crashing.
We can't reverse brain damage if we go too slowly.
Either way, if we don't get his temperature above 95, it's not gonna matter.
Multiple warm lavage is safer.
Do what House says.
He has no heartbeat, he's not breathing.
How can he not be dead? Body slows down when it cools, but it doesn't fully stop.
We're warming his blood outside of his body and then putting it back.
It'll raise his temperature enough that his heart should naturally start.
Then we can shock it back into rhythm.
And if it doesn't start? Then there's nothing we can do.
You think it's possible he knew what he was doing? Like some part of him gets what he's putting his wife through, so he tried to Kill himself? It's what I'd do if I were him.
At least I wish I would.
I meant run away.
You think you should kill yourself if you become a burden to the people who love you? If you really loved them back, then yes.
That's really dark.
It's not naive.
I just believe people are capable of more than you do, apparently.
We've got brain activity.
Temp's at 93.
His heart should start soon.
My dad left me alone to care for my alcoholic mom and raise my baby sister.
I was just a teenager.
I spent half of my time changing diapers and the other half cleaning up my mom's vomit.
But it must have been important that you stayed for both of them.
Mom died after a few years.
It was ugly and painful, and she went with me hating her.
My sister ended up drinking half of her life away and hating me because I couldn't help.
After Mom, I had nothing left.
So do I wish Mom had used a gun instead of a bottle? Yes.
I didn't know.
That's why I told you.
Ventricular fibrillation.
Give him 300 milligrams amiodarone.
Be careful.
Once we establish rhythm, any accidental movement could crash him back into V-fib.
Clear.
We still have a long way to go.
Cold can be protective to the brain, but there is a possibility of damage.
We also need to confirm and treat whatever's making him sick.
I just gotta do a standard battery of tests.
Blood, urine, EEG.
Is that really necessary for a free flu shot'? Excuse me, I have to deal with someone who's having a panic attack.
I specifically said the bet was off if you contacted the patient.
Exactly.
You never said anything about the patient's husband.
The deal was a medical reason why she doesn't have sex.
I admit I was stuck until I realized that the medical issue was not hers, but his.
She's lying to compensate.
It's a tale as old as time.
Boy meets girl.
Girl falls for boy.
Boy says, "I'm asexual.
" Girls says, "Yeah, me, too.
" Your twisted logic can't hide the fact that tricking a patient into being tested is completely unethical.
Come on.
Don't you think she deserves to know why her husband won't bend her over the kitchen counter? You love all that caring crap.
You're not doing this out of the kindness of your heart.
You're not even doing this out of medical curiosity.
I thought I made it clear I'm doing it for the cash.
Two people are happy, and your natural impulse is to destroy it.
How do you know she's happy? Did she tell you? No, chirping birds flew out of her butt carrying a banner.
All right' I admit that my natural impulse is to doubt people's claims to happiness, but yours is to be a sucker for them.
You tell me which one's worse.
He just opened his eyes a little while ago.
His heartbeat's doing well and his body temperature stabilized.
There he is.
Is that Portuguese? Yeah.
Honey, I don't understand.
What's he saying? I don't know.
I tried to learn when we got married, but I just It's okay, it's okay.
His body temperature is rising.
It's above normal.
Wait, I thought you said it was stable Why is it still rising? I don't know.
Vomiting, liver, kidneys and now fever.
I don't want to tell you how to do your job, Dr.
Foreman, since telling people how to do their job is your job.
But when your less-than-competent administration of this hospital affects what's written on my whiteboard Get to the point.
The word "fever.
" Could come from the patient's illness or it could come from the fact that you allowed him to saunter out of your hospital and take a nap in the snow.
He couldn't have caught a virus while he was outside, fever came on too fast.
The hypothermia could have caused cell necrosis.
TTP was the diagnosis when he walked out.
Fever's a little high, but it still fits.
We should continue plasmapheresis.
We're missing symptoms.
We should add language loss and aggression.
Should we also add forgetfulness? He's got Alzheimer's.
We've just been assuming.
Because the patient's wife said he exhibited both for a year.
He's never hit her before or lost all his English.
We have to consider any change since he's been admitted as relevant.
"Have to?" Do I need to pull out another card? Disseminated viral infection, with encephalitis.
Patient complained of a sore throat a few weeks ago.
Start him on interferon.
Encephalitis makes his brain swell, which causes symptoms that are hard to distinguish from his Alzheimer's.
With the interferon, his English should come back and the aggression should subside.
But you're not sure? Unfortunately, no.
And you're not sure if he has brain damage from being frozen? So best-case scenario, I just had a glimpse into his future? I can't take care of him anymore.
Chances are his menial state will improve.
You could get more time with him.
We married six months after I met him.
A year after that, he started forgetting things.
I've known my husband longer with his Alzheimer's than without.
I've watched more of him disappear than I ever got to know.
I just can't do this anymore.
You lose.
Blood work shows high levels of prolactin.
Add that to some peripheral red-green confusion, puts my money, excuse me, your money, soon to be my money, on a tumor near his pituitary.
Probably started growing in his early teens.
Lowering his libido and causing erectile dysfunction.
A year on dopamine agonists and he'll be a sex-crazed creep just like the rest of us.
Completely fascinated by Susie Cooper.
I would prefer to be paid in a single $100 bill.
Always wanted to use one to light a cigar.
Hooray for us.
We disproved his asexuality.
We also probably ruined his life.
He'll thank us.
Then he'll doze off.
And then, in a couple of hours, he'll thank us again.
It could destroy his identity.
It's like a gay person being told they're really straight.
So don't tell him.
Yeah, why bother telling a guy he has a tumor growing in his head? He'll notice it eventually when it starts leaking out his ears.
It's a slow-growing tumor.
He'll probably die of boredom long before that.
You always do this.
You meddle and force me into impossible situations.
You knew the second you told me about this case that I'd get involved.
You wanted me to meddle.
'Cause no matter how much you wanted to believe in this chaste romance, you didn't buy it either.
Where's that petition House's PO sent over about him getting his ankle monitor off? On your desk.
You played me.
This whole thing was about your ankle monitor.
You weren't trying to undermine my confidence, you were trying to inflate it.
You manufactured conflict with me so, eventually, you could let me win.
You knew it was encephalitis, but you waited for me to say it, because then, with my ego boosted, you thought I'd be in the mood to take off your monitor.
Because I'd think I could control you.
You're right.
Take off my monitor.
See, the beauty of the plan is if ii works, then you think you can control me.
If it fails, then you will actually have proven that you can control me.
It's pretty genius.
These are your training wheels.
If you think you're up to this job, it's time to lose them.
Second half of my plan might need work.
V-fib.
Two rounds at 360 without establishing a rhythm.
Wait! Dr.
Foreman! Clear.
He's back.
I sure hope this Alzheimer's drug trial is worth a lot to this hospital, 'cause we're wasting a crapload of time and man power just to let this guy watch his mind shrivel and keep his wife miserable.
Heart attack while he was on interferon rules out encephalitis, but I still think I'm right about the neuro symptoms.
It's probably aseptic meningitis.
We would have seen meningeal signs.
Given his abnormal mental status, not necessarily.
Dr.
Foreman! Would you please reach under your chair'? It's just wet gum under here.
Where's the card? What card? I'm happy to leave if you have a better theory than aseptic meningitis.
Toxins.
If this guy went on a walkabout, chances are he's done it before.
Wife keeps the doors in the house locked.
There's plenty of nasty stuff to get into during the middle of the night.
We asked about toxins on the history.
The wife said she was sure to clear the house for her husband's safety.
And I'm sure she succeeded.
She's a PhD in toxicology, right? She's an ex-florist.
Search the home for toxic plants, methyl bromide, any medications.
Stop.
You're not infallible.
You were wrong about encephalitis.
Just before you were.
Run CSF tests, find out what's causing the meningitis.
You said you weren't gonna overrule me, diagnostically.
And you said I wouldn't be able to help it.
Apparently, you were right about that one.
Fine.
I'll look for toxins myself.
You can't go to their house without Foreman's permission.
Don't need it, I'm gonna talk to the toxicology PhD upstairs.
What about gifts from South America? Anyone send any fruits or vegetables? I don't think so No.
I'm gonna need your boyfriend to collect samples of plants in and around your house.
Toxins are the most Wait.
You understand him? What's he saying? He's repeating "blue shack.
" You know what that is? Is it somewhere where pesticides may be kept? It's where we had our first date.
Do you have a cleaning lady who might bring her own supplies? What's he saying? If it's not relevant to the case, I don't care, and neither should you.
Please.
This might be the last time I ever know what he's thinking.
"When I saw her waiting "Waiting for me at the table "The way her eyes looked when she smiled "I felt like crying.
"I knew she was the woman I wanted to marry.
"And every time I see her, I say "There she is.
" "There she is.
" He's still in there.
What did he say? He asked who you were.
Don't get your hopes up.
Have your boyfriend get me those samples.
How did you even know to look for a tumor? Dr.
House noticed hormone levels in your blood and consulted with me as an oncologist Who cares how they found it, okay? They found it.
Are there any side effects to the treatment? Some nausea, dizziness, and as the tumor shrinks, there will be behavioral changes.
Like what? Well The tumor interferes with certain natural systems.
It lowers libido and causes erectile dysfunction.
You mean the treatment will make me want to have sex'? What if I don't want the treatment? I would strongly advise Look, you have a brain tumor, okay? You have to have the treatment.
Okay, look, I know who I am, okay? And I'm not one of them.
Hey, look, we'll adjust.
Okay? We can go through this together.
You mean have sex? I can't make you do that.
Maybe it won't be so bad.
It'll be terrible.
It's actually pretty fun.
From what I remember.
But you said that I know.
I know.
I wanted to spend my life with you and I knew that meant making certain sacrifices.
But a girl has needs.
You dropped in the US.
News rankings.
only because we temporarily shut down our diagnostics department.
It's up and running again.
I'm actually concerned it might be because of the change in management.
If you want my money, I'll need to see a five year plan.
Am I boring you? No, I just, those flowers are from last week.
They should be dead by now.
Excuse me? Sorry, I have to go.
It's Reye's Syndrome.
Patient had a sore throat a few weeks ago before he was admitted.
Reye's in adults is a reach.
Not if he took aspirin.
Aspirin in adults is a reach.
Especially in a house with locked medicine cabinets.
It wasn't in the medicine cabinet.
The wife used to run a floral company, still does a few orders from home.
She uses crushed aspirin in the water to make the flowers last longer.
So the husband has a sore throat, takes an aspirin without her knowing, realizes he's got a sore throat, takes an aspirin, realizes he's got a sore throat You can stop me whenever you like.
Have Chase start him on steroids.
I already did.
Then why are you telling me? Because I wanted you to hear it from me.
There she is.
Here I am.
Your eye.
What happened? It's nothing I can't handle.
MRI confirmed macroprolactinoma.
He's doing the treatment And the wife? Come on.
We saved a man's life, course-corrected two people's wildly screwed up worldviews.
Not bad for a day's work.
I think they were happy, even if it was based on lies.
Most happiness is.
Better to have shtupped and lost than never to have shtupped at all.
We can't smoke in here.
We also can't summon people into the clinic based on a lie motivated by a petty bet, and yet it happens.
It's an imperfect world.
Well? Disgustingly satisfying.
He said it was okay.
Is one of you Dr.
House? You've seen Spartacus, right? I got an order here to deactivate and remove his ankle monitor.
Robbie? Hey, sis.
It's been years.
I know.
I thought of you on Mom's birthday.
Is everything okay? Yeah, yeah.
Fine.
I just wanted to see how you were.
I'm fine.
Bikes go faster without training wheels.
Now get out, I have work to do.
Whoops.