House - Episode 15 (Season 2)

Another episode of House that starts with sex and ends with a near-death condition. Sure…you want to hear more, but be warned, there are spoilers below!

Spoiler Alert!!

While involved in some rough sex play, Bob suddenly has difficulty breathing. His tongue swells so much that it cuts off his airway. He’s gasping for air and his lips are beginning to turn blue. His wife calls 911.

When he is examined several days later by Cameron, Bob mentions that he has already seen a variety of doctors who were unable to find the source of his problem; they was referred him to House. The team’s initial differential diagnosis includes food allergy and ALS (amyotrophic lateral sclerosis, better known as “Lou Gehrig’s Disease”). House suspects that there may be something wrong with the lungs and not just the throat. He is right: plethysmography shows decreased lung function and a CT scan of the lungs shows significant scarring.

Foreman diagnosis Bob with interstitial pulmonary fibrosis, but he isn’t sure what the underlying cause of the lung fibrosis is; Bob does not have arthritis or sarcoidosis, and he has not been exposed to any toxins such as asbestos, silica, or coal dust. About this time, Bob develops an intensely itchy red rash on his chest. Foreman suspects lupus while Chase continues to believe that it is a food allergy. House declares that Bob has heavy metal poisoning.

Treatment for lead poisoning — the most common toxic heavy metal — is started but does no good; to appease Chase, allergy testing is started as well. At this point, Bob complains of peripheral neuropathy — a very painful burning sensation in the feet. A short time later he begins having difficulty breathing again. Bob needs intubation, but he is vomiting so much that the team is worried about aspiration. A tracheostomy is performed instead. Additionally, he is now starting to show signs of kidney failure.

House is convinced that Bob’s wife is poisoning him, but he can find no evidence, even when she submits to a search. Meanwhile, things are going from bad to worse for Bob. He suffers a cardiac arrest that requires defibrillation to correct.

Foreman continues to believe that lupus is the cause, but House now suspects that Bob has a post-viral autoimmune reaction (basically, Bob’s body over-reacted to a viral infection and is now producing antibodies that are damaging his own body). He is started on interferon, an immune-system modulator, but it has no effect even at high doses. In a flash of sudden inspiration, House realizes that Bob is indeed being poisoned by his wife with small amounts of gold (actually, gold sodium thiomalate, an older arthritis treatment rarely used in the U.S.) He catches the wife red-handed (or purple handed, as it were) and starts Bob on dimercaprol, the treatment for gold toxicity.


I’ve really got no big medical complaints with this episode. The gold was actually quite clever. There are some nitpicks, of course (such as starting the defibrillator at 360 joules), but nothing major. I would also have run some tests differently (for example, I’d probably have performed a biopsy of the rash fairly early on), but that’s mostly personal preference.

The soap opera dealt with House and Wilson, who are now sharing an apartment since Wilson’s wife kicked him out. It also involves food and house cleaning.

This episode earns an A for the mystery, and another A for the solution, and yet another A for the medicine overall. The soap opera was minor and average and deserves no more than a C. I’ll give the herpes side plot an A of its own, because that’s an all too common situation that doctors find themselves in (and by that I mean diagnosing someone in an allegedly monogamous relationship with an STD, not getting herpes).


Still want more top of the line medical information? Check out this week’s Grand Rounds over at NHS Blog Doctor. Grand Rounds is the weekly collection of the best medical blogging on the ‘net and is well worth your time to check out.

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42 Responses to “ House - Episode 15 (Season 2) ”

  1. what was up with cameron at the end handing house a nice stack of twenties and makingthe comment that “ingnoarance is bliss”. is this somthing to lead up to the season finale or is this a reference to somthing in the past or even the present. i am completly boggled as to what it means or represents.

  2. She and House had a bet running about whether the couple involved in the case would be happily married or not. She lost (the woman was poisoning her husband), so she was paying up. The “ignorance is bliss” line has to do, I think, with surface impressions of people vs. digging deeper and finding the truth.

  3. I thought the “ignorance is bliss” line had to do with House saying he was happy to be right, or something.

    I found this episode to be an improvement on the last few, despite the lack of soap opera.

  4. It was cool to see Samantha Mathis, but um, where was she hiding the gold?

  5. Good question, Chuck. I can only assume House was looking for lead or arsenic and missed the suspicious vial in her purse, or maybe she was hiding it “down there.” Or they probably just ignored that plot hole.

    I was watching The American President just last week and thinking that I hadn’t seen Mathis for a few years.

  6. With all the House reviews I was curious — what’s you opinion on NBC’s Scrubs?

  7. I enjoy Scrubs whenever I watch it, but that’s only one or two episodes a year (I do have season 1 on my Netflix queue). The medical errors don’t bug me as much there because it’s a comedy and the medicine takes a back seat to the situation.
    On the other hand. Grey’s Anatomy. I had to stop watching that because the bad medicine (and lead character) drove me crazy.

  8. Nice review. I work for an ENT, so any time I see stuff relating to that area, I’m interested. I felt the trach procedure was a little iffy due to the patient still being so mobile, but I thought it was a nice touch that they remembered to have the patient occlude the trach tube to talk.

    BTW, someone on a different message board noticed that one of the saved programs that House had on his TV was “Blackadder”. Nice touch. :)

  9. It was definitely entertaining. But I’m still wondering what the first treatment for heavy metal poisoning was. Even if the patient was being poisoned (on an ongoing basis), wouldn’t that therapy show some results for gold as well. The final drug used, dimercaprol, after all, is also used as a chelating agent for lead poisoning as well.

  10. Good point, John. For some reason I was assuming they were using EDTA, but dimercaprol is the more commonly used agent for heavy metals toxicity in general.

    I think one of the explanations is that she kept dosing him with the gold, even while he was in the hospital, so that he wasn’t getting better even with chelation. They did refer to this possibility in the episode.

  11. Nearly all of my first-hand medical knowledge is trauma-related, and I don’t claim to be an expert there either, but it seemed to me in watching this episode that if House were so certain it was heavy metal poisoning he would have expanded the substances being tested after the initial lead, arsenic, etc. battery proved negative. I would have figured him to immediately expand the range of metals rather than jump to a viral diagnosis, but maybe that’s just me.

  12. Nice review, and good to see up so quickly!

  13. Not an MD here, but why would the wife bother calling 9-1-1 in the first place if her plan was to kill him? Why not just let him die, rather than having a crack team of diagnosticians figure out her secret? Why continue to try to kill him in hopsital with the same team working on finding out what is poisoning him? It is not logical.

  14. i also enjoyed this episode more than the last few.
    also i liked that they made bob remember to cover the trach tube while talking.
    i’m actually learning about pulmonary system right now so i really was excited to see the plethysmography being done (now i know what it looks like).
    a question: was the wife continuing to give bob the gold or did he just get worse coz his body had too much gold and couldn’t deal with it?

  15. I actually loved the soap opera, because I think it might be more of a set-up for something major rather than meant to stand on its own; they’ve been hammering home the “House = Holmes” idea for a while now, and, well, Holmes and Watson were roomies, Wilson = Watson, and I suspect that new housekeeper might just be Mrs. Hudson.

    And, this is maaaybe reading too much into it, but there was a definite huge contrast between two “failing” relationships (the two married couples) and the “successful” relationship, the successful one being House and Wilson’s friendship. And, uh, that was “Love and Happiness” playing over the ending montage, where House deletes the message that would lead Wilson to move out. But, nope, I’m not reading into it.

  16. Normally, I really enjoy these medically-oriented summaries of the episodes, but this time, I feel compelled to point out that you don’t mention any of Cameron’s attempts to contribute. Don’t the efforts of anyone other than the male doctors warrant a mention?

    /end militant feminist rant

  17. A fair point/rant, but Cameron really didn’t do much medical detective work this episode. She was hands on: helped with the tests, heped with the cardiac arrest, repeatedly told Chase he was wrong about food poisoning — but she didn’t contribute much in the way of diagnostic ideas. She seemed to be used more as a foil to House’s relationship cynicism than anything else.

  18. I missed the first few minutes, but it did seem that the woman poisoning her husband was totally unmotivated. It seemed like she was bending over backwards to keep the guy happy. Going from that to murder is a leap.

  19. I think the idea with the wife was that she was obsessed with appearances. She weighs herself after her shower in the beginning, and her scale is one of those advanced ones that tells her how much she weighs down to a decimal point. Their quite spacious house is unbelievably clean (although, it may just seem that way to me since I’m lazy). And although it’s impossible to tell how much time passed between the initial check-up with Cameron and the bathroom scene, her make-up, clothes, and hair all remain disturbingly unruffled in every scene. You’d think a woman with a dying husband would spend less time touching up her foundation.

    House says something about her perhaps being the type of person who would rather kill her husband rather than have everyone else see that their “perfect” marriage is not that perfect, and it fits. How she appears to others is more important than how things actually are. It also explains why she called 911 instead of just letting him die. If she’d done that, a) he would have known that she wanted him dead before he died, and b) there might have been a police investigation. He’s a young guy, probably fit, and he died for no apparent reason after suddenly being unable to breath during a sex game; they’d ask why she didn’t call 911, since someone having trouble breathing would probably be obvious. And it sounds better to have a husband who died in the hospital due to some strange illness that confused all the top doctors than it does to have a husband who died in their bed while she did nothing.

    At least, that’s the idea I got from the ep.

  20. Again with the Lupus dx. I know this complaint is getting old, but as the average number of years for dx of SLE is just beginning to drop from SEVEN, it’s very curious to me that it’s always on the DD list, near the top! If only. (If I had a dollar for every doctor who suggested it during my 9 years of severe deterioration, I’d have $0–cancer was suggested quite often, but not Lupus.)

    We have so many symptoms which present throughout that long time of mystery that usually, by the time we get a dx, we have several signs nailed to our heads, all saying “hypochondriac.” Lupus is a multi-system, many symptomed chronic condition with degrees of severity that can flucuate within even a few weeks, making it hard for our doctors to synthesize the information we’re providing. I found it truly odd that the hx of this patient included no joint or muscle pain/weakness, no “fever of unknown origin” that went on for years, no strange blood work, no extreme photsensitivity, no red face or hands either then or historically, and most of all, no extreme fatigue which would have made athletic sex a real difficulty to manage, yet Systemic Lupus was the team’s most serious dx. There wasn’t even a hx of constant yet fruitless doctor visits to back up this dx with chronic symptoms that could be indicators of the disease. I am not just annoyed by this, but am trying to educate a bit here, as I would really like it to be understood that often it’s not until we’re nearly dead that we do get diagnosed, by which time much serious organ damage has occurred and we’re very, very sick and have had to accept that the dx may occur at autopsy. Of course it’s possible that doctors who watch House will start thinking of Lupus more quickly, but I don’t think that’s how docs work.

    I loved Foreman saying “We have him on Prednisone, but can also try immunosuppressors.” Which is what Prednisone is. “We’re using Tylenol, but can still try acetaminophin.” Okay…

    The gold dust poisoning was clever and unusual, but not terribly believable to me, though that could be because we never got any real sense of why she wanted her husband dead–that would have taken more time than they had, so we just had to accept it. Nor was House’s out of nowhere “hunch” believable, however famous he may for such things–death by gold? I agree with Jen about the wife having to call 911 despite the plan to kill him, but it does make me wonder what she’d planned to do when the end was in sight. If she’d done research in order to pull this off, she must have known that he wouldn’t die quietly in his sleep, and must have known that it would likely show up at autopsy. And doesn’t staining remain somewhat permanent? After years in the darkroom, I had yellow fixer-fingers. Fix doesn’t wash off very well, so would the purple coloring have just disappeared entirely every time she cleaned her hands? Wouldn’t it at least be stuck around her fingernails? I was also bewildered by the sudden intensification of syptoms. If this had been going on for some time, why did he suddenly getting a severe rash, start vomitting, suddenly have heart failure (I caught the 360 j, too; 200 is usual, yes?)?

    An aside–For those who would like to watch an interesting true story about a famous poisoner, “The Life and Crimes of William Palmer” is available on DVD, as is “The Butcher Boy.” There’s something fascinating about the cold, scientific detachment of the poisoner that is very compelling.

    The whole episode felt, for the first time, very unreal and rather wooden to me (I see I’m in the minority about this). It was strange, as other eps have been more unbelievable for medical reasons but the writing and the direction made up for it. Here it just felt DOA for some reason. Flat. And to say Cameron was side-lined is an understatement. She seemed to have no purpose other than to stand in for people who believe in love (how girl-y). Maybe that’s it–the whole episode seemed to exist solely to reinforce House’s insistence on misery as inevitable (I guess he’s forgotten Stacey again?), especially within marriage. I did love House’s erasing of the message for Wilson, having decided that perhaps good cooking is worth the invasion he’s experiencing.

    Oh–I think we haven’t seen much of Mathis because she’s just not a great actor (sorry to those who like her, but she was never terribly substantial-her star rose fast, but fell even faster).

    Scott, is there a way to preview our comments? Edit them?

  21. Thanks for the rebuttal, Jen. I quite enjoy a good debate and was disappointed by the lack of response. While you raise some good points, it still seems to me that she could have delayed calling 9-1-1 until he was dead. Having him die in hospital would be no less mysterious as to the cause and would doubtless have resulted in an autopsy and exhaustive testing to determine the cause (am I a stupid optimist who thinks forensics does this?). So I ask again: why call 9-1-1 (before he dies) and then why compound the possibility of detection by poisoning him in the hospital?

  22. awi, I think the purple colouring was due to a chemical reaction with the liquid House had put on his hands before he held her hands in the bathroom(im presuming thats the liquid he got from his chest)? As such she wouldn’t be trying to remove the dye every time she went to wash her hands.

    How exactly she was managing to poison him in the hospital I don’t quite get, if she had the gold on her hands wouldn’t it affect her too? If the toxins washed off every time she washed her hands, then why would she have any on at that time of the day?

  23. Thanks, Kim. I get it now. And the presence of the poison gold on her hands after coming out of the toilet does confirm that she was hiding it…down there. And Jess! Good detective work. How funny. The whole episode certainly gives new meaning to the idea of gold rings as symbols of everlasting love! I half expected them to play “Band of Gold” at the end (”All that’s left is this band of gold…”).

  24. Hey, Elise, sorry this took so long. I think the procedure for what happens if a person dies in a hospital is vastly different from what happens if a man is found dead in his home. In the latter case, the police are called first, and their medical examiner gets the body and does a forensic autopsy to determine whether or not Bob’s death was natural, an accident, a homicide, or a suicide. This coroner would be more likely to assume, suspect, and look for signs that indicate foul play. Wikipedia says that the number of autopsies performed in hospitals has been decreasing every year since the mid-50s, and so they most likely won’t do an autopsy unless they have very strong cause to believe the death is unnatural. That’s the only case in which consent isn’t required from the relatives of the deceased.

    Of course, House being who he is, he probably would’ve had an autopsy done on the husband regardless, but Wifey had no idea her husband’s case would fall into the lap of someone so…obsessed and unconcerned with normal procedure.

  25. I didn’t find the “eureka” moment to be THAT out of reach. I can follow the thought process. The lady in Cuddy’s office throws down the gold ring, House picks it up, looks at it, realizes gold is also a heavy metal. He then remembers the wife saying something about a history of arthritis in her family and can be treated with gold sodium thaimolate which isn’t widely available in the US, but *is* available in Mexico, which he also remembers the couple saying they’ve been.

    Add this to the fact that his initial gut reaction was heavy metal poisoning, and it’s no suprised he latched onto it so strongly. Sure, such a though process may be a stretch for us mere mortals, but c’mon . . . it’s House! ;)

    And it’s not like he felt his diagnosis was infinitely beyond reproach. He knew he was right and had to act fast, but he had the trio test for the gold poisoning on the off chance he was wrong.

    Even if all this doesn’t help sell the idea for you anymore than it already was . . . it was worth it for the scene between House and the maid.

    Maid:”What kind of box was it?”
    House, incredulous: “Wood!!”

    That one cracked me up . . .

  26. Didn’t that guys “parts” explode when he was going to the bathroom, i heard that.

  27. Hi Scott, I really like your summary.. Keep on :)

  28. They said that they couldn’t intubate because he was vomiting too much. Can’t you perform an intubation while using chrichoid pressure? Everytime I have helped a paramedic with an intubation they ask me to give chrichoid pressure and have explained that that is because it prevents vomiting.

  29. Scott: “On the other hand. Grey’s Anatomy. I had to stop watching that because the bad medicine (and lead character) drove me crazy.” You know, come to think of it, I can’t recall EVER really thinking about the medical aspects of Grey’s! Sad, but that show strikes me as 1% medical and 99% drama. Maybe that answers the question of why so many of us love House: it is both medical and drama…

  30. Whats the name of soundtrack that was played during this episode?

  31. Right after House looks at the wedding ring and realizes it must be gold toxicity, he calls Cameron and says “She has a family history of arthritis, doesn’t she?” If anyone questioned her possession of an arthritis medication, such as gold sodium thiomalate, she could explain it with “Arthritis runs in my family. I got it when we were in Mexico.” and no one would think twice. It was hidden in plain sight. The purple on her hands proves she’d been handling the gold despite her lack of arthritis pain and the abundant presence of better medications all around her (she is in a hospital, after all). That combined with the massive levels of gold detected by the test would be pretty convincing evidence for arresting police officers.

    Actually, the first time I watched this episode, I figured she was scraping pure gold flakes from the inside of her ring. That would be a much better hiding place, but the arthritis/gold sodium thiomalate angle is pushed pretty strongly in the episode. Somehow I missed that on my first viewing. I know they add iron to corn flakes in a similar fashion (crush the contents of a box of cornflakes with a magnet for proof).

    By the way, I love this site. =]

  32. Wow. I didn’t notice the defibrillator being started at 360 joules. I’m no doctor or anything but I know that’s NOT supposed to happen.

  33. Okay, so I liked this episode, but the stannous chloride bit was a little implausible. I work in an analytical laboratory, and we use stannous chloride for mercury analysis. The bottle has this giant label on it warning that it can cause severe burns with skin contact. Stannous chloride (or tin(II) chloride) is actually a solid, so hydrochloric acid has to be added to maintain it in solution. Although I don’t really work with it much, it’s my understanding that House wouldn’t have been able to just put some on his hands like that. Just my random thing. I don’t have my degree yet, so most of the science flaws go right by me. I was just excited to notice one relevent to my summer job!

  34. House may be a brilliant physician, but he’s not much of an etymologist. In reference to the ants in the house, he says:

    “Army ants could devour, dissolve, eat a cow in a matter of hours. Australian bull ants, on the other hand, are nasty little bastards, but more of a nuisance than a threat.”

    Actually, while bull ant venom is not toxic enough to kill humans, the rate of allergic response in humans is above 90%, and a single bull ant (AKA “bulldog ant” or “jack jumper”) sting is frequently deadly. Even bigger problem? House looks to Chase after he makes the statement, and Chase affirms the statement. ANYONE who had grown up in Australia would know in a heartbeat that jack jumpers are bad news; MUCH more dangerous than army ants, who need an entire colony to pose any real danger.

    Being that Bob’s first symptom was anaphylaxis (and the ant question came up early in the show) the ant question should have been explored - granted, it’d be strange to find Australian bull ants in an apartment in Jersey, but the symptoms fit.

  35. The motive question bugged me at first, until I realized that House et al would have no real way of discerning it. A tearful confession of her misdeeds and motives would have ruined an otherwise excellent episode.

    In my speculations, however, my first thought was a psychological disorder. I’ve been attempting to track down the name, but I don’t have a DSM-IV on hand (and the symptoms are difficult to search for online). Basically, the person poisons or harms a loved one in order to care for them. It’s both a means of control and a misguided attempt to show affection. The person believes that only while caring for a sick or dying loved one can they truly show the depth of their affection. The poisoning is justified as a means of creating an outlet for love.

  36. What Adam was refering to sounds a lot like Munchousen’s Syndrom. Speaking of syndroms, the best thing entertainment like this can do is foster curiosity.

    My research into the possible effects of gold poisoning brought me across several references to mercury poisoning, where I found a group of physical symptoms I personally had as a child listed under Acrodynia. As a child I had also been diagnosed with a range of behavioral disorders that can be attributed to mercury poisoning. Thus, like a good novel the show was able to engage at least one viewer in the critical thought process.

    Of course shows like this aren’t meant to help anyone, but those who discount entertainment TV as brain candy might like to reconsider their position.

    As for the dropping of the gold ring causing House to have his epiphany, I found it totally believable…similar things happen to me all the time :p

  37. I second Chris’ bullant comment - Chase can’t be a dinky-di Aussie MD if he lets House’s ignorance pass unchecked, not to mention that NJ isn’t exactly over-run with them. Of course, perhaps Dr Chase never had the experience of being bitten by one in his childhood, but *very* hard to swallow that he’d not be aware of dozens of patients who’d presented with all the nasty symptoms pointing to just such (unless he got his training entirely outside dear old Oz).

  38. I am a respiratory therapist and have taught and performed pulmonary function testing for several dozen years. I have worked for more than a dozen pulmonologists, and not one of them could operate a body plethysmograph; In fact, I would be surprised if any of them could explain how the device worked without looking it up. The patient in this episode was not performing any spirometric or pulmonary test I am aware of (”Keep blowing out….now breathe normally.”) Furthermore, you would never use a flexible hose in a body plethysmograph, as any compressible air space would alter the thoracic gas volume (since the diagnosis was a restrictive disorder, the test must have measured lung volumes.) Also, the patient was not wearing a nose clip, meaning any lung volume or flow measurement would be inaccurately low. Finally, I have no idea what was being displayed on the video monitor, but it was absolutely not body plethysmography! The graphics of real body plethysmography are not 3-D and are rather simple (see the video example cited by Scott, above.) For TGV, you would see a narrow loop on a flat X-Y graph, not some overlapping colored semicircles in three dimensions. But of course, this is TV, and they need to make the graphics dramatic.

  39. The weird thing is that Jesse Spencer is Australian, so he should know right off the bat something is off with this scene…unless the Ant thing is something only Australian MDs regularly know about…but isn’t Jesse’s father a Doctor? Wouldn’t he warn his son about those bad ants during childhood?

  40. I love this site so much …

    ‘“Army ants could devour, dissolve, eat a cow in a matter of hours. Australian bull ants, on the other hand, are nasty little bastards, but more of a nuisance than a threat.” … House looks to Chase after he makes the statement, and Chase affirms the statement. ANYONE who had grown up in Australia would know in a heartbeat that jack jumpers are bad news”‘

    I assumed House looked at Chase because the whole comparison was a gag at Chase’s expense, as an Australian whom House considers (on some level) to be a nasty little bastard, but more of a nuisance than a threat.

  41. […] I’m watching an old episode of ‘House’ (Season Two, Episode Fifteen) on Channel Ten - around 9.20pm, that advertisement comes on the screen. Three or so years since it was last screened. […]

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