House, Episode 6 (Season 1): A Re-Review
This episode of House, “Damned If You Do,” is a repeat of one of the early episodes from last season. My review at the time was fairly brief. I stand by it, but I thought I’d take a second look at the episode, particularly the medicine. As usual, there are some significant spoilers in the review…
House’s final clinic patient of the day is Sister Augustine, a nun complaining of a rash on her hands. He diagnoses her with contact dermatitis and recommends an over-the-counter antihistamine and a topical steroid cream. Shortly after taking the antihistamine, Sister Augustine develops severe wheezing. House gives her a shot of epinephrine; it restores her breathing, but unfortunately it knocks her into cardiac arrest. Epinephrine is the medical name for the hormone adrenalin. Sister Augustine is successfully resuscitated and admitted to the hospital.
The team considers the diagnoses of cellulitis and vasculitis, particularly Churg-Straus Syndrome. Cellulitis is a type of skin infection and vasculitis is an inflammation of the blood vessels. Labs are drawn and Sister Augustine is started on high dose steroid therapy. The tests come back normal but Sister Augustine develops olfactory hallucinations, religious visions, and seizures — signs of brain injury. She is subsequently diagnosed with herpetic encephalitis, an infection of the brain caused by the herpes virus (though the diagnosis is forgotten halfway through the show).
The team next suspects that Sister Augustine has Mixed Connective Tissue Disorder. The usual treatment for this condition is steroids, but since they will also worsen her encephalitis, the steroids cannot be used. Steroids work by dampening the immune system. This is good for connective tissue diseases when the body is under attack by its own immune system; however, slowing down the immune system is bad idea during infections. House suggests placing Sister Augustine in a hyperbaric oxygen chamber. Foreman believes the idea is dangerous and complains to Cuddy, who takes House off the case.
Cuddy takes over and, frankly, does a horrible job. She focuses only on symptoms and doesn’t even bother to look at causes. She’s dangerous too, putting the patient on a NSAID (a Non-Steroidal Anti-Inflammatory Drug — the same class of drugs as Motrin, Advil and Aleve) despite the fact that the patient is in kidney failure and liver failure — which this class of drug can cause or worsen.
After talking to the Mother Superior, House learns that Sister Augustine lived a fairly wild life before becoming a nun. He also realizes that she’s been drinking figwort tea. According to him, combining figwort tea and epinephrine will lead to a cardiac arrest (though I can find no evidence or documentation of this anywhere).
House resumes care of Sister Augustine. He is convinced that she is suffering from some kind of severe allergic reaction. She is moved to a special non-allergenic room, but she still goes into anaphylactic shock. Belatedly, House realizes that she must be allergic to something within her, and a CT scan reveals an old copper IUD. It turns out that she was allergic to copper and the recent exposure to some new copper pans kicked the allergy into overdrive.
The medicine in this episode was pretty good excepting the problems I mentioned above. I will also point out that connective tissue diseases and vasculitis cannot always be ruled in or out by lab tests alone. This is one of the few episodes — and quite possibly the only one — where it take three separate diagnoses to explain the patient’s symptoms.
This was an early episode and the soap opera elements were just coming together. The beginnings of Cameron’s infatuation with House can be seen, as well as the start of the House versus Foreman ego battles.
This episode earns a B+ for the mystery, and an A for the solution; the medicine deserves a B overall (marked down for Cuddy’s ham handedness). The soap opera also earns a B. There’s not much, but what is there is good.
December 21st, 2005 at 6:14 am
You have a link titled “hyperbaric oxygen chamber” that leads to a link about autoimmune disease. It can’t be a typo, but it clearly isn’t what you meant to write.
December 21st, 2005 at 8:13 am
Official Comment
Thanks Carl. It was an errant anchor tag that not only screwed up a hyperlink, but lost an entire paragraph.
October 24th, 2006 at 10:51 pm
in this episode of house (Season 1 Episode 6: Damed if you do) House is noted to say that being injected with epinephrine after drinking Figwort Tea can lead to cardiac arrest.
Figwort tea is derived from the family of plants that is used to make the drug DIGITALIS.
Digitalis is a cardioactive steroid used to treat certain heart conditions. Digitals has several side effects including An irregular heartbeat that causes dizziness, the feeling that your heart has skipped a beat (palpitations), shortness of breath, sweating, or fainting.
It is in this way that mixing Figwort tea and epinephrine can cause a cardiac arrest.
http://medical-dictionary.thefreedictionary.com/digitalis
http://texasheart.org/HIC/Topics/Meds/digimeds.cfm
January 13th, 2007 at 6:40 am
Like the William said above, furthermore, Digitalis was the poison that caused James Bond to experience a cardiac arrest in the 2006 movie Casino Royale
January 17th, 2007 at 6:01 pm
What about House’s recommending smoking for IBS?
January 23rd, 2007 at 7:29 am
Hi… wanted to say that I lvoe this House MD review blog.. and answering the above question? A little bit of nicotine in the blood does have a positive effect in treatment and prevention of IBS… Can’t think of anywhere to search for this… But it’s a known fact in medical circles… Maybe Scott could look up something?
February 11th, 2008 at 11:37 pm
referring to House mentioning on the program that drinking Figwort Tea is a “pick me up” in the mornings - is this true? and i suppose if pregnant should be avoided? eager for your reply thanks
March 22nd, 2008 at 11:11 pm
If it is the nicotine that helps treat the IBS and prevent it, surely it would have been more ethical for House to have recommended nicotine patches or some other form of nicotine that would negate the other effects of cigarette. I assume that we need to consider House’s lack of enthusiasm for the clinic and these ‘trivial’ illnesses though when it comes to the cause for his encouragement of smoking.
April 21st, 2008 at 9:10 am
On the subject of the cigarette cure…
I’ve been taught that problems to your digestive track are a typical non-smoker thing, but that was said “by a friend of a friend who knows a doctor” so i didn’t pay too much attention to it…
What ticks me off as a smoker though, is the notion that if you smoke you’re guaranteed to get lungcancer, heart attacks, strokes, bloodclots and …
Ok, i know that smoking impairs your stamina and attacks your lungs etc. but i refuse to believe the doomsday scenario as is being fed to us by our (Dutch if it’s relevant) government…
So tell me, as i see that there are actual doctors here, what do you think?
May 17th, 2008 at 10:53 pm
House prescribed two cigarettes a day, no more, no less. When Wilson mentioned that smoking causes lung cancer, House should have retorted that two butts a day wouldn’t kill a hamster. Of course, that would not be PC.
Sebastian is correct. The doomsday scenario is spouted everywhere, and it is always the same. Smoking causes lung cancer! The correct medical language is, “Smoking is a risk factor for lung cancer” or “Smokers have a higher incidence of lung cancer.”
A non-smoking white male in the US has a 1% chance of dying of lung cancer. The same man who smokes increases his risk to 8%. Significant, but not doomsday.
Smoking is not a healthy habit, but neither is inactivity or a steady diet of bacon and Oreos.
May 26th, 2008 at 3:54 am
Actually, you marking down the episode’s medicine rating because of Cuddy’s “ham handedness” is a bit premature, given that if you watched a certain episode of House–I forget which one–she fails miserably at doing something medical and he reminds her that she’s a good administrator, but she’s way out of practice. I don’t think it was this episode.
May 28th, 2008 at 3:09 am
Cameron: I don’t believe in God.
Foreman: You’re not even a little agnostic?
I just wanted to mention about this little conversation that took place in this episode:
Foreman obviously doesn’t know the meaning of agnostic. It’s not an alternative to atheism. Atheist: Has lack of believe (in deities). Agnostic: Has lack of knowledge. Cameron could also be agnostic.
Also, isn’t House supposed to be atheist? Then how come he makes references to god so often? e.g., “That’s why god made microwaves” in the episode DNR.
Just seems odd to me. *shrugs*
June 10th, 2008 at 10:01 pm
Bekll,
Agnostic is not without knowledge, it is not knowable in that theism is full of false claims and that the truth is unknown.
Atheism is the belief that there is no god.
August 10th, 2008 at 4:09 am
[…] It is figwort tea, which House claims when mixed with even the smallest level of epinephrine causes instant cardiac arrest. Based on a reader’s comment in Polite Dissent’s review of this episode: Figwort tea is derived from the family of plants that is used to make the drug DIGITALIS. […]
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