House, M.D. s08e19 Episode Script

Three, two, one! Ah! Whoo! What do you want to do next? Uh Swings? Okay.
Crawl tube? Nah.
Nah? Well, I think we're running out of options, honey.
I want to go on the merry-go-round.
The Again? But this time all by myself.
Oh I don't know, jelly bean.
Daddy, I'm six.
I'm not a baby anymore.
Please? Thank you.
You ready? Uh-huh.
All right.
Come here.
I'll take Beary.
Now, you promise you're not going to tell Mommy, right? She'll kick my butt if she finds out.
Pinky swear.
All right.
Go get 'em.
- Remember to hold on tight.
- I will! Stop the ride! Emily! Emily! Where are you! Em? Emily? Emily? Emily' where are you, honey? Emily? Emily? Honey? Help me! Is that our precious little bundle of tumor? They grow up so fast, don't they? How do you think? How did you know I was here? Foreman.
Actually, that would have been easier.
No, I followed you.
It didn't occur to you that that might mean I don't want you involved in my cancer treatment.
I'm not here as a doctor.
I'm here as a towering pillar of strength.
Be a pillar in the parking lot.
No.
How many times have I told you I wanted to be alone and you've made yourself a pain in the ass? I owe you.
My word, not a word.
Realizing I'm most likely going to regret this, all right.
What are you doing? My best friend has cancer.
Cut me some slack.
Also, it's spring break.
I'm on vacation.
Although looking at you now, I can tell that the wet t-shirt contest is probably going to suck.
House taking time off is a bad sign.
"A bad sign.
" You think the apocalypse is coming because House wants to be there for Wilson? Yes.
You're new.
We've got a case.
Six-year-old with a nose bleed and breathing problems.
She was born with a rare mutation of A-T.
Emily has a unique variant on both of her ATM genes.
Her disorder mimics A-T, but not all of the symptoms.
This is Dr.
Elizabeth Lawson.
She's a developmental geneticist attached to JHU and an expert on the girl's condition.
Elizabeth Lawson.
Emily Lawson.
I'm here as a doctor, not a mother.
Nose bleeds and breathing problems are common symptoms of ataxia telangiectasia.
We could just be seeing the natural progression of It's not.
A-T patients have a life expectancy of 20 years.
Emily is only six.
It's something else.
I examined her lungs two days ago.
They're functioning normally.
It says she fell off a carousel.
Head trauma could If the diagnosis was easy, I wouldn't need you people.
I'm here because according to Eric, you're the best.
We are.
Have you considered Wegener's granulomatosis? It's a good fit.
But she can't have x-rays.
A-T makes her hypersensitive to ionizing radiation.
I'll get her prepped for an MRI.
She knows more about her daughter's genetic condition than any of you.
She'll be an asset.
Or she won't, Eric.
This isn't a request.
Use her.
The tumor's spread to the surrounding tissue.
We're gonna have to shrink it before we remove it surgically.
I'm more interested in exactly how you plan to do that, Mike.
We start conservative.
Daily radiation treatments for three weeks.
And if it doesn't shrink enough after that, we'll add the chemo And if it hasn't shrunk enough after that, I'm dead.
Look, you have over a 75% chance that the radiation alone is enough.
Relax.
We've caught this in time.
Catching it in time would have been before it invaded the tissue around my thymus.
I want the radiation and the chemo concurrently.
Why stress your immune system unnecessarily? Let's just go with my plan.
Okay? The radiation first and I'm gonna get a second opinion.
Are you serious? Look, I've seen you recommend this exact treatment dozens of times.
We're done here.
I'll look for a doctor with some actual balls.
Hey, you need to talk to your friend.
He's embarrassing himself.
A doctor should be able to handle his own illness with a little bit more dignity.
I agree with Wilson.
My recommended treatment is sound.
No, I meant about the ball-less part.
Explains the office.
It was a merry-go-round.
She's a kid, Liz.
We were having fun.
You should try it sometime.
Fun? She's six, not you.
You know she has balance issues.
I know that she's This is Emily's father, Simon.
He was with her when the symptoms occurred.
I had her all week.
She was fine.
- We could come back.
- No need.
Patient's ready for transport.
Wake up, sleepy head.
I saw it in the gift shop.
I know how much you like them.
Thanks.
They're going to take you for an MRI now.
It means "magic really cool images.
" I thought it stood for magnetic resonance imaging.
We've spent a lot of time in hospitals.
B-9.
Hit.
And I hate you.
I'm done.
I sunk your battleship? No.
But I think I'm going to puke.
Good.
Now that you're sufficiently buzzed, what was the reason behind you freaking out on Kondo? You scared? In denial? I know you get confused any time someone thinks that you're wrong.
But it's not considered freaking out for a patient to ask for a second opinion.
Okay, well, here it is.
Kondo was right.
You should be in radiology right now.
Well done.
You've kept your word for almost two hours.
Every day you wait, our pal, Tumie, is growing larger in your chest.
You want to live, stop screwing around and do something about ii.
Good idea.
I think I'll start with spending spring break on my own.
How are you feeling in there, Emily? Good, I guess.
Something wrong? I was only pretending to be asleep.
You think that's dishonest? That's My daughters do that, too, but they know that sometimes when it seems like mommy and daddy are fighting, it's really only because they're worried about you.
And does your wife ever want a divorce? No.
Everything's fine at home.
Hold still now.
No more talking.
What do you think of her mother? She called her daughter "the patient.
" If my kids were born with an expiration date, I don't Where does it hurt? I want my daddy! Where's my daddy? We were able to restore circulation to her hands and feet before any permanent damage set in.
Primary Raynaud's? The cold inside the MRI room could have set it off.
Stress can also precipitate the condition.
She's shown no evidence of cold sensitivity and she has no problems with MRI machines.
There are other kinds of stress.
She heard you and your husband fighting.
Unfortunately, she's heard a lot worse than that before.
It's not stress.
Could be secondary Raynaud's.
Lupus is consistent with Emily's symptoms.
Her lymph nodes aren't enlarged and she has shown no signs of immune activation.
It could be heavy metal poisoning.
From what? The carousel? She was only on it for a minute.
Simon moved into an old apartment building three weeks ago.
I'm sure he has no idea what the insulation's made of, what kind of paint.
He's a good father, but when it comes to Emily's health I'm gonna get his keys and check for environmentals.
Lupus is a better fit.
I don't mean to pull rank here, but I am her mother.
I thought you said you were here as a doctor.
And as a doctor, I need parental consent.
See above.
While I'm gone, please start her on chelation therapy.
She's the mother.
So let's treat her like any other mother.
I think we just hit the environmental mother lode.
Funny she never mentioned an entire basement full of dangerous chemicals and drugs.
You think she'd even let Emily down here? Yeah.
And apparently a lot.
You ever heard of LEX-2? I've read about it.
It's an experimental aminoglycoside antibiotic.
Supposedly it can override DNA errors in the ATM gene.
Doesn't mean she's giving it to her daughter.
Anyone studying A-T would be researching it.
How? You see any lab rats down here? The only cage I see is right there.
Go away.
I have a headache.
We don't have to have sex.
Sometimes it's nice just to cuddle and talk.
Me first.
You don't want a second opinion.
You're already on your fifth.
You have Evans at Mercy, Shaw at County, Foster at Johns Hopkins.
Every one of them has given you the same advice.
You're nuts.
You don't just want chemo.
You want a dose so high there's a one-in-three chance it will kill you outright.
The question is, why didn't you tell me? Because you knew I'd stop you.
Which means you've already found someone insane enough or desperate enough to give you what amounts to a death dose of chemicals.
But who would be that stupid? I'm thinking that the "who" is you.
Where exactly were you planning on killing yourself? 'Cause I don't think Foreman is going to let you do it here.
My place.
I've been stockpiling equipment.
No.
No! Stop.
I'm still healthy, why not go the extreme route now when there's a better chance of surviving it'? Statistically, this treatment has about the same chance of killing you as the thymoma does.
But a hell of a lot faster.
Nancy Wells.
Cervical cancer, 70% survival rate.
Died November 6, 1998.
Bernie Jones, melanoma, October 10, 1999.
He was 52.
John Taylor.
Thyroid, I promised him he'd be fine.
Eight years old.
I am not going to die slowly in a hospital bed under fluorescent lighting with people stopping by to gawk and lie about how I look.
Even a small chance of that happening is too big a chance for me.
You're an idiot.
And the odds say you're going to die.
We'll do it at my place.
The only environmental factors we think caused your daughter's illness are the ones you shot her full of.
I tested the drug.
This is what I did for a living for 10 years.
She's your child, not a guinea pig.
I tested it first.
On myself.
And in six months I didn't document any adverse effects.
A trial of one is basically irrelevant.
Respiratory infections are common with A-T.
With Emily's mutation, they are deadly and they get worse every year.
LEX-2 won't be approved for at least the next five years.
Emily, on the other hand, wouldn't have survived the winter.
What was I supposed to do? There's a reason for FDA requirements.
A study at Jackson Memorial I know about Gaines' research.
He's publishing next month.
Was.
I just spoke to him.
His team just linked the use of LEX-2 to renal failure in mice and rats.
She needs an ultrasound-guided renal biopsy to check the damage.
Hopefully, ifs reversible.
To stupidity.
Not quite done.
To muscle aches, spasms.
To your joints feeling like they've been ripped out and replaced with shards of broken glass.
Should I be writing any of this clown? Your stomach fills with bile.
When you vomit it feels like someones forcing a white hot hammer down your esophagus, tearing your flesh.
Blood's dripping down the back of your throat, choking and gagging you with the slick, coppery taste of burnt pennies.
I am an oncologist, I know If you did, we wouldn't be sitting here.
Day two.
Your white blood cells are gone, opening up your system to attack.
Your temperature skyrockets.
One second, your skin feels like it's on fire, the next second, it's entombed in ice.
Every pain sensor in your body is firing at the same time until agony isn't even a word or a concept.
It's your only reality.
You hallucinate.
You dream of death.
And then the race begins.
Can your body claw its way back in time before the hostile organisms and parasites claim you permanently? Win, you live.
Lose, you die.
Now, what are we doing here, Wilson? Kidney number one looks good, which means we'll probably take the biopsy from two.
Hey.
You're doing great.
Brave as always.
Pretty cool, eh? Wanna try? What's wrong? My chest hurts.
Definitely not her kidneys.
I promise this'll taste just as good coming up as it did going down.
If things go wrong, I just want you to know If you're going to say that you've always been secretly gay for me, everyone always just kind of assumed it.
I just want you to know that I appreciate the risk you're taking.
Pumping a human being full of lethal chemicals in your living room.
If I die, it probably won't go over well with your probation officer.
That's not going to be an issue.
I'm glad at least one of us is confident.
Not me.
I've already identified a couple of spots to dump your body if this goes south.
I've always enjoyed Trinity Park.
It does have a nice access to the lake.
Muscle spasms already? No.
It's nothing really.
Good news.
Takes most people two bags to get to that stage.
You're way ahead of schedule.
You'll think it's stupid.
That hasn't stopped you before.
I just always thought when I got old or sick I'd have a wife or kids to look after me.
And in this scenario, are your loving wife and kids holding the life-support cord or are they thumbing through your will? I'm in it, right? You have everything you need right here.
We both do.
Painkiller, industrial strength, level awesome.
We're on vacation.
That is nice.
Her kidneys are fine.
I don't think we're looking at side effects from the LEX-2.
She's prone to respiratory infection.
Pneumonia? No persistent cough, chills, or excess sweating.
What about a pulmonary embolism? Fits coughing up blood, but a clot? From what? Bruising from when she fell off the carousel.
Contusion damages a deep vein, causes a clot.
Piece breaks off, travels to her lungs.
We need to get her on heparin now.
Another embolism could cause a heart attack or a stroke.
What's wrong? Is it Emily? Sort of.
You can't do this.
I'm taking her to Mercy.
Everything you people have done has just made her worse.
You don't have the right.
We have joint custody.
Where was my right when you were treating our daughter like a lab rat? She'd be dead if I hadn't.
Stop it.
Your daughter deserves better than this.
It's okay, sweetie.
Mommy and I are just going to talk.
Okay? Wanna get some candy? We believe Emily has a clot in her lungs.
If you leave now, she could die before her new doctors are even up to speed.
What, from her A-T? From the fall off the carousel.
Now can we just stop blaming each other and do the right thing here? What, you're really going to equate the two? No.
You were giving her two minutes of fun.
I was trying to save her life.
What's her best friend's name? What's the name of her favorite teacher? Why did she hate that stuffed animal you gave her? She's been having nightmares about penguins all month.
What's her blood type? Rh factor? Her serum immunoglobulin levels? I don't care.
Those are letters and numbers.
That's not her.
What about the variant in her E14 ATM intergenic promoter region? 'Cause that's what's killing our daughter.
Unless I can find a way to reactivate it.
Just make her better.
You don't look too good, mister.
How did you get in here? The door.
Are you, like, sick or something? Where's House? Where are your parents? I know you.
You live in the building, right? What's your name? You don't remember? House.
You promised me I'd go home again, Dr.
Wilson.
You said it wasn't my fault.
It wasn't, John.
If I didn't do nothing wrong, why did I die? I don't know.
I shouldn't have done this.
Am I dead? Not yet.
Not yet.
It just feels that way.
Are you okay? Apart from the pain, vomiting, diarrhea and cramps? I worked six months in a research lab after med school.
You get so focused.
Once I didn't eat for two days.
It's easy to forget what actually matters.
I didn't.
Yeah, it sucks I got her the wrong doll but Good news.
Emily's lungs are clear.
No clot.
And bad news.
We still don't know what's happening to her.
Whatever it is, there's liver involvement.
Her eyes are jaundiced.
Her liver is failing.
We found a blockage in her hepatic vein which is restricting blood flow to her liver.
Polycythemia vera? Her red blood counts are normal.
Could be some sort of connective tissue disorder.
What if What if we're just seeing the end result of her condition? She's unique.
One screwed up gene from each of us Let's stick with our process.
I shouldn't be here.
What are we missing? Advanced Lyme disease? Would have seen it in the blood.
He said "advanced.
" We wouldn't pick it up in her blood if it's in her organs and nervous system now.
It fits everything but the nose bleed.
But why is it attacking now, all at once? What's changed? Elizabeth has.
She stopped giving Emily the LEX-2.
It's an aminoglycoside antibiotic.
It's what was keeping the Lyme in check.
We need to start her on amoxicillin.
You lied.
It doesn't taste better coming back up.
Here's another one.
You look good.
What's the white blood cell count? It's down to 1,000.
Still dropping.
I need more morphine.
We're out.
You've been using my personal supply of pain killers for the last eight hours.
You have enough for both of us? I've got enough stashed around here for a minion.
Just remember they're a gift, so it's rude to keep throwing them up.
Found that out with those candlesticks you got me.
We think it's Lyme.
I would have seen signs of that.
Not if the LEX-2 was keeping it in check.
We live in the city, we don't have pets.
She's never even been in the woods.
Yes, I have.
With Daddy.
I should have told you, but I know how you feel about it.
I grew up hunting with my dad.
I wanted to share it with my daughter at least once.
We only took pictures.
You don't need to be mad.
- Maybe we should step outside.
- No.
We can't protect her from everything.
I assume you'll need a lumbar puncture lo confirm.
You lost a contact? Going to the little boy's room.
They're called adult diapers for a reason.
Use it.
I did.
And if you think I'm gonna let you change me It's okay.
I'm a doctor.
Hey, just leave me alone! It's pathetic.
I'm pathetic.
An oncologist with cancer.
Of all the things that could be killing me It's like the universe is giving me the big middle finger.
The universe doesn't care.
Why me? I was always telling my patients not to torture themselves because there's no answer.
Sound advice.
It's cruel advice.
They were just trying to make sense of what was happening to them and I'm there telling them not to bother? I should've spent my life being more like you.
I should've been a manipulative, self-centered, narcissistic ass who brought misery to everything and everyone in his life.
You'd still have cancer.
Yeah.
But at least I'd feel like I deserved it.
Do you think my parents will get back together? I don't know.
I'm sure they love each other but They only fight about me.
That's because they care so much.
So, maybe when I die, they'll get back together.
Emily, what's wrong? I can't move my arm.
Keep your arms up for me.
What's happening to her? She's having a stroke.
Okay, your heart rate's up, BP's tanking.
White blood count'.
-s at 500.
We have to go to the hospital now.
No.
I don't have the equipment or the meds to handle this.
No! Win or lose.
Win or lose.
That was the deal.
That was the deal when there was an "or.
" You can't win this.
No.
No.
I'd rather die here, not in an ambulance.
Not in the hospital.
I can't Please.
You can't do that to me.
House, please promise me that you won't do that to me.
Promise me.
Okay, I promise.
Stroke, a blockage in her hepatic vein, coughing blood, trouble breathing and Raynaud's.
If we hadn't already ruled it out, it sounds like textbook pulmonary embolism.
What mimics a clot, but isn't a clot? Fungal infection? Her CSF was clean.
No bacterial or fungal markers.
Anyone tried calling House? He's not picking up.
Or returning messages or texts.
We're on our own here.
So just give me some theories we can use.
Hematologic malignancies.
A-T patients are more prone to that form of cancer.
You think cancer would present and kill her in three days? Not cancer, but a tumor could act like a clot.
An atrial myxoma.
A primary heart tumor.
The swinging motion of the myxoma intermittently blocked the flow of blood through the right atrium.
Inflow blockage stagnated the hepatic vein, which clotted and caused liver failure.
Outflow blockage caused the Raynaud's phenomenon and stroke.
Pieces of the tumor broke off and lodged in the lungs, causing Emily's breathing problems and the coughing blood.
We'll remove the tumor surgically and hopefully the biopsy reveals it's benign.
You really look like crap.
Been fighting a cold lately.
Seven to 10 days for the swelling to go down, then we rescan and schedule the surgery.
I seem to recall I said some things to you You talked a lot.
I stopped listening after you confessed your fear of dolphins.
Can we just tone down the bromance a few notches'? My leg is killing me.
One last favor? I'd like to actually make it to the bathroom this time.
I thought you said you had plenty of Vicodin.
Everybody lies.
So the way I felt, you feel that, what? Most of the time? It really does suck being you, doesn't it? At least I don't have cancer.
The tumor was benign.
And we were able to remove all of it.
Does this mean I'm not sick anymore? No.
Honey, the tumor didn't cause your genetic condition.
You're still sick.
But we never let that stop us before, right? So what do you want to do when we get out of here? You been to the aquarium? It's pretty cool.
Can we go, Daddy? You bet.
Me too? Can she come with us? You know Mommy never has to ask.
I'll see you at lunch.