House - Episode 21 (Season 2)
Filed under: General
The second part of a two-episode storyline. This review builds on the last one, so make sure you’ve read it before starting. As always, spoiler warnings apply.
The story picks up where the episode ended last night. Foreman is in isolation, sick with whatever disease or condition killed Joe the police officer. Because of the possibility of an unknown and fatal disease, Cuddy has contacted the CDC (the Federal Center for Disease Control), who have taken charge of the policeman’s autopsy. They’ll get to it in a few days. This doesn’t sit well with House who wants the autopsy performed now! He brings autopsy tools to Foreman in isolation and convinces him to get a sample of the policeman’s brain. Foreman attempts the autopsy and actually thinks he has succeeded, but in reality he has developed Anton’s Syndrome (where the eyes work, but the visual processors in the brain don’t), and is effectively blind — it seems he biopsied the mattress instead of the patient, but never realized it.
At this point, the differential diagnosis includes bacterial meningitis, “toxic mold“, Guillain-Barre Syndrome (a paralyzing disease following a viral infection or vaccination), and arbovirus infections (A large group of viral diseases which are carried by bugs. In fact, that’s where the name arbovirus comes from: arthropod-borne virus. Arboviruses include Yellow Fever, Dengue, and various encephalitis infections, including the Eastern Equine Encephalitis mentioned in the previous episode. Cameron is wrong; arboviruses are found the world over, not just in “Africa.”) There is evidence against all of these diagnoses, so House widens the suspected agents to any bacteria, virus, fungus, parasite, or toxin that might cause brain damage. House starts Foreman on a wide variety of antimicrobials, hoping one will work. Foreman is given levofloxacin (brand name Levaquin, an antibiotic), acyclovir (brand name Zovirax, an antiviral), and fluconazole (brand name Diflucan, an anti-fungal), plus five other unnamed drugs.
The medications seem to be working as Foreman’s symptoms improve and he regains his eyesight, but it is not clear which of the drugs is working. Foreman’s lipase and amylase (two enzymes found made by the pancreas) are significantly elevated, meaning that Foreman has developed pancreatitis (the team assumes it is from the meds, but it seems to me it could have been from the infection as well). House gives Foreman a choice (or at least pretends to): stay on the medications and die of pancreatitis in 4 hours (which seems mighty quick to die of pancreatitis), or stop the medications and die of the mysterious brain disease in 14 hours. Foreman chooses the latter and the medications are stopped.
House has also exposed his pet rat Steve McQueen to all the things Foreman encountered in Joe’s apartment, but Steve never develops the disease.
Foreman’s father arrives and House parades him in front of Cuddy, trying to guilt trip her into letting him perform the autopsy on Joe. Cuddy is no fool and knows what House is up to; she handles herself extremely well.
Since the antimicrobials have been stopped, Foreman has started developing symptoms of the brain disease again. Cameron and House notice that the disease is progressing faster in Foreman than it did in Joe. House reasons that this is because Foreman is too healthy, whereas Joe was infected with Legionella (the bacteria that causes Legionnaire’s Disease). House intentionally exposes Foreman to Legionella, hoping the subsequent infection will slow down the brain disease. It seems to work, though Foreman develops a nasty case of pneumonia,
House now wants Chase and Cameron to help him discover which infection commonly gives false negative test results (in other words, it doesn’t show up on the tests, even though the patient is infected) and infects humans but not rats. The team decides that it must be Listeria (a rare bacterial disease caused by contaminated food), so they start Foreman on ampicillin and gentamicin, two powerful antibiotics (and with serious infections, both are given intravenously, so why is House giving Foreman pills?). The risk is that the antibiotics will kill the protective Legionella too, and this might make the brain disease worse, particularly if House is wrong and it is not Listeria.
Foreman doesn’t believe that Listeria is the cause, and wants House to perform another brain biopsy, this time a deeper one of the white matter. House is reluctant knowing that there is a strong risk of permanent brain damage from such a procedure.
As Foreman’s pain increases to an unbearable level, it is decided to place him in a medically-induced coma. He asks Cameron to be his medical proxy (make important medical decisions in his place) while he is in the coma. Cameron demands the biopsy, but House still refuses. He talks her into waiting an hour, or until Foreman’s oxygen saturation (the level of oxygen in the blood) drops below 90%, for him to inspect Joe’s apartment one last time. House hunts down what appears to be a blind pigeon, then at the last minute discovers that Joe’s marijuana plants had been irrigated with water from a rooftop cistern, a cistern that is infected by the parasitic ameba Naegleria. He phones Cameron with the information, but she has already had the biopsy performed — which shows the same germ. Foreman is started on antiparasitic medications and brought out of the coma. He is recovering from the infection but the question remains whether the biopsy did any brain damage. It looks bad in the end when Foreman tries to move his left toes and arm, but moves his right side instead.
Naegleria is a very rare cause of disease is America. There were only 24 cases of human infection between 1989 and 2000. It is acquired by diving or swimming in a contaminated pool of water and having the ameba enter the nose and then into the brain. I’m not sure inhaling a fine spray of contaminated water runs the same risk. There is no definitive treatment for the ameba. There are some drugs that should work, but the patients usually end up dying anyway.
House’s statements about testing for antibodies instead of the bacteria itself are true — to a point. The most common test for bacterial infection is a bacterial culture — basically waiting for the bacteria to grow in a sample — and that usually takes up to 48 hours. For some rare bacterial diseases (tuberculosis, for example) and fungal diseases, a culture can take much longer — weeks in some cases. Antibody tests tell us only whether a person has ever had an infection with a particular germ, but not necessarily that an infection is going on currently. That usually takes repeat tests over several days.
I’m interested in how House and Cameron both managed to diagnose the ameba at the same time. Did House take a microscope with him to the apartment? He must have.
I am not a lawyer, but the whole medical proxy concept seemed screwed up in this episode. Cameron may have Foreman’s proxy, but that doesn’t mean she can overrule the attending physician like she did. She could refuse a test in Foreman’s name, but not order one. Later, it seems as if she is acting as the lead physician, which is a clear conflict of interest. She can’t be both lead physician and proxy at the same time.
Overall, the mystery was good and earns an A, the final solution was clever and I’ll give it an A-. The medicine as a whole earns a B, because while there were no major mistakes, there were enough smaller ones to knock the grade down. The non-medical aspect gets an A because the Foreman/father, Foreman/Cameron, and House/Cuddy scenes were all excellent.
May 3rd, 2006 at 10:47 pm
What, no mention of the clinic visit and “Finding Nemo”?
May 3rd, 2006 at 10:56 pm
Official Comment
I simply couldn’t top House in that regard.
May 3rd, 2006 at 10:59 pm
The episode is almost over here…and they did show
House looking at the water in the apartment with some
kind of mini-microscope.
I’m enjoying your debriefs on the show immensely.
Hh
May 3rd, 2006 at 11:02 pm
I thought the most interesting part was this was the first episode to show that House actually does CARE. As much as he pretends to hate everyone, in this episode to save Foreman he was willing to sacrifice his beloved Steve McQueen as well as go the cop’s house unprotected and expose himself to whatever is killing Foreman. In the previous one, he blew up on Wilson over not only feeling guilty about exposing Foreman but also the fact that he actually was concerned for him.
Just interesting, they made it subtle enough not to make House look too sensitive, but they’re adding complexity to his character and making him less one-dimensional. Good show, I say.
May 3rd, 2006 at 11:08 pm
Official Comment
I was surprised he put Steve McQueen’s life on the line, but then his logic was impeccable.
May 3rd, 2006 at 11:24 pm
Hi, just recently found this site. First off, I must say it is nice to find someone with medical knowledge that doesn’t hate House and trys to convince everyone that the show is the spawn of Satan. On to the actually show the acting and drama were amazing, Omar Epps really showed his acting chops tonight. On a side note, I’m a 3rd year dietetics student and I always like when I see one of the disease professors keep hammering in to our heads show up on the show- in this case the Listeria.
May 4th, 2006 at 12:19 am
Loved all the euphemisms in the clinic duty scene (and how the kid was totally oblivious to them). Lots of people “discover” how to masturbate without realizing what it is they’re doing, it’s amazing how often we forget that.Also, it’s nice to see a return to clinic duty in general, that’s one element of the show that has been sorely lacking in recent episodes.
I agree with Dan, it is nice to see someone with ACTUAL medical knowledge review House, not just the trolls who fake medical knowledge as an excuse to flame the show (and insult everyone who likes it) on every message board on the net. Yikes, the stories I could tell of those trolls pretending to know more than actual docs… anyway, it’s nice to find someone with actual medical knowledge reviewing the show… did I say that already? lol…
Anyway, thanks for filling me in. The physician I go to is a fan of House as well, but he’s been very reluctant to comment on the medicine involved. I feel a strange kinship with House, since we both have limps…
May 4th, 2006 at 7:43 am
What I loved was when Cameron snapped at Cuddy. My “That was great!” was just a second before House’s.
May 4th, 2006 at 8:18 am
I thought the legal stuff sounded shaky, too- a living relative not granted medical proxy?- but I don’t have any working legal knowledge, so who knows. I enjoyed the character bits tremendously, especially between Cameron & Foreman.
Thank you for posting the synopsis for part 1- I missed it, but (after visiting your blog) didn’t feel out of the loop watching part 2.
May 4th, 2006 at 8:21 am
Apparently Nagleria is relatively common in the lakes around here (Oklahoma). I remember being alarmed when I learned that. Of course infection is still extremely rare, which is good considering how much time people spend in the lakes.
May 4th, 2006 at 8:35 am
Scott, just a heads up — on the “House Medical Reviews” page, the episode links for Euphoria (Part 1) and Euphoria (Part 2) both point to the same page (namely, Euphoria (Part 1)’s review).
May 4th, 2006 at 9:33 am
Hi, first of all I’d like to say that I greatly appreciate these reviews, it’s become almost an obsession to check here after each episode.
Then another heads up - the Listeria link points to Legionella.
May 4th, 2006 at 1:06 pm
Official Comment
Erroneous linkages fixed.
May 4th, 2006 at 1:17 pm
My interpretation of Cameron’s, “We’re doing the biopsy, NOW” (quoting from memory), was that either the biopsy would be done with House as the attending, or she’d remove him as the attending, and put herself in charge. A conflict of interest, of course, but she has been under the tutelage of House for almost two years, now.
May 4th, 2006 at 1:22 pm
Any ideas as to why a lumbar puncture wasn’t done? I would think the parasites would have shown up in the CSF.
May 4th, 2006 at 1:59 pm
Did we miss a few minutes at the end of the episode? The last scene - House tells Forman to wiggle his toes. Forman says he is, no toes are wiggling. House says raise your right arm and Forman raises his left arm. Everybody looks concerned…. Then, commercial, scenes from next weeks - and there’s Forman practicing medicine and everything is back to normal.
?!?!?!??!?!
May 4th, 2006 at 2:57 pm
*delurking* thank you for explaining the medicine behind “house”. Please continue to review “House” next season! I know you don’t read mangas, but in case you’re curious, checkout “deathnote”…
May 4th, 2006 at 4:23 pm
Alan, the last scene basically shows the consequences of the biopsy that Cameron did. Foreman’s coordination is off and he thinks he is wiggling his left toes but he was really wiggling his right toes.. and then he raised his left arm instead of the right.. so he has some neurological problems.. next week will be interesting.
May 4th, 2006 at 4:27 pm
I never watch TV, but I try never to miss an episode of House! In a real hospital, he would have had his staff privileges suspended, if not revoked, but I just love his bedside manner and the way he hands out all the symptoms and then his residents(?) and home viewers come up with all the possible diagnoses! So far, I only remember once that he called in a consultation from a specialist (the episode with the young adolescent with the cushinoid features and subsequently diagnosed pituitary adenoma)!! Other than the fact that House and his team are seemingly specialists in every field of medicine, this is a great show!
May 4th, 2006 at 8:27 pm
Hi, I’d also like to thank you for these reviews. I was wondering how often things like this happen, when a doctor gets a serious infection from a patient.
May 4th, 2006 at 8:36 pm
I don’t know if the Naegleria will show up in CSF as they cause encephalitis rather than meningitis.
The show has a recurrent problem: they don’t have the concept of the size of the inoculum. I don’t think you can catch Naegleria without having your nose directly exposed to the contaminated water, and I mean under water, not just aerosols. Otherwise this disease would be much more common.
May 4th, 2006 at 9:26 pm
A small niggle — when the combined medications were giving Foreman pancreatitis, surely House could have let him keep taking ONE of them? Then there would at least be a CHANCE that the one he keeps taking is the one that’s been working!
May 4th, 2006 at 10:30 pm
So what _do_ you make of forman’s behavior at the end? is it a documented side-effect of that procedure they did, or even a ‘recognized’ symptom with a wacky medical name like “interhemispheral dysplecia” or something? :p
May 4th, 2006 at 11:24 pm
Official Comment
Sparky,
The trouble is they don’t know which of the drug (or drugs) was causing the pancreatitis. If they had time, the best thing would have been to stop them all, and then add them back one by one.
Ariel,
Foreman clearly has suffered some sort of brain damage; it could be permanent or it could be temporary. It could be a result of the meningoencephalits or a result of the biopsy. After an injury to the brain (trauma, infection, or other), it often takes a while for full funtion to return (or it may never happen). Foreman is young and otherwise healthy, so I would not be surprised if he regained full funtion of his body after a few more days — or by the next episode.
May 5th, 2006 at 12:13 am
This is my first time posting, but i’ve been enjoying the reviews for a while. I was wondering if lateral neglect is a possible discription for Foreman’s condition? Foreman’s reflexes are shown to be functional on both his right and left hand, but he is unable to attend to his left foot and confuses his left hand for his right hand. I guess that would suggest that it can’t be neglect since (i think) neglect only occurs on the side of the body opposite to the brain lesion. In this case both sides are affected. I don’t remember where the biopsy was taken, but that could offer a clue.
Honestly, i’m hoping Foreman is just playing a really good practical joke. I’d like to think that if i were in his position, that would be the first thing to come to my mind.
May 5th, 2006 at 12:29 am
As a 16-year-old guy who has absolutely no medical knowledge at all, I’d like to thank you immensely for reviewing and critiquing every House episode. Honestly, reading these have become as much of habit as watching the show. Just had to thank you while everyone else was using the board as a thank you note.
On another note, about the whole “medical proxy” deal, I’m no lawyer or doctor but I was under the same impression that you had: A medical proxy can refuse or agree to a test but they can’t order tests. Imagine if you accidently assigned an internet diagnoser as a proxy. That would royally suck for the attending physician. And I’m sure, to hypothesize about Mike Loughlin’s comment, that you can make anyone your medical proxy (do you need their consent?) and not just your family member. There are some that have bad relationships with their family members, and what would happen in the case of a lesbian/gay couple who can’t legally wed but want to make each other their respective medical proxies? It makes sense.
Kudos to dave about the “practical joke” remark. That’s great.
May 5th, 2006 at 12:39 am
Great site. A couple comments. You would think that both patients should have had more classic signs of meningitis (e.g. headache, Kernig’s sign), and a parasitic infection seems like it should have been suggested by eosinophilia on a CBC, which would have clearly been done early in the workup - but that would have spoiled the suspense I suppose. Your comment about antibodies - IgM vs IgG would differentiate recent infection, although I’m not sure if a Naegleria IgM test exists. Again, great site.
May 5th, 2006 at 1:23 am
I heartily agree with your grades. This is the best episode of House I’ve seen in awhile in all regards and, just like House once said, “I say it here, it comes out there.” They included a clinic duty scene and got Cuddy more involved in the plot. I am a happy, happy guy, especially after getting further knowledge from your reviews.
I must say, I was very impressed with Cameron’s development in this episode. Over the series, it seems to me that the writers often have a hard time figuring out how to properly develop her, but I think the apporach of having her slowly get less naive (while still being “Polyanna”, as you put it) is the appropriate direction for her character to go in. Especially given that she is constantly being influenced by House and Foreman, and even Cuddy and Wilson to a smaller extent. Nice to see her stand up for herself with Foreman and Cuddy. She eventually caved in both cases, but it’s progress. :)
May 5th, 2006 at 8:40 am
Dustin,
One thing that I think the writers are doing with each of the three ducklings is something that is most obvious in Foreman– they are all slowly morphing into House. At a minimum, they are becoming more House-like.
With respect to Cameron, the rejection of the apology from Foreman springs to mind. She sounded a bit desperate at the end of her retort, showing that she still is Cameron, but the rest of her rejection sounded so clinical, oh intellectual, cynical (what’s that from?). It sounded House-like. Go back a few episodes and there was the bizarre cut-down of Chase’s sexual stamina that seemed so out-of-character for her. It was the kind of snark which would seem perfectly in-character for House.
For Foreman, the writers have been a lot more obvious about drawing the comparisons. He could just be further along, though, on a road they are all heading.
I can’t say that there are too many examples that are popping into my head right now for Chase, though. Seeing as he, despite The Mistake, remains the least developed character of the three ducklings, this makes sense. I am going to be looking for examples going forward of Chase showing symptoms of Housishness.
You know what else I really liked about the two episodes? Yes, House was obviously affected by Foreman’s plight more than he is by most patients’ plights, but there was something a bit more subtle. When dealing with Foreman in these two episodes, he remained just as caustic, biting, and unsympathetic as ever. For examples, see how much of an ass he was acting like while infecting Foreman with the Legionella, or his snark as he took the first, unauthorized brain biopsy. However, when it came to constant, unrelenting and severe pain, House became extremely sympathetic and understanding. His voice hushed. Chase was in a near panic as Foreman started to inject the morphine into CopJoe’s carotid artery, but House was using the same tone of voice he used when he told Cameron last season that he would not crush her, or that an uncalibrated centerfuge is a crying matter. There were other examples in part II as well, such as his pointing out that pain is an incredible motivator, and the fear of pain is almost as potent. I took this to be a subtle nod that one of the reasons House was so affected by this case was not just that he cared what happened to one of his charges, but also because he metaphorically felt Foreman’s pain and literally remembered his own.
May 5th, 2006 at 12:01 pm
What are the risks involved in a white matter biopsy, what makes it so dangerous that you would hesistate to do it even in a life critical situation?
Read the official preview on the fox website, it tells you a bit about Foreman. Too much actually, kinds of spoils the cliffhanger ending. See it at your own risk, I regret looking already :(
May 5th, 2006 at 12:10 pm
Clues from the Preview
My wife and I went back and watched the final scene and the previews once or twice. There are hints in the preview that Foreman won’t be back to normal by next week. House mentions needing “the man he hired” back, indicating some type of menal or personality change. He also seemed to be a bit more obviously cheerful, although the preview scenes were barely flickers.
The cast must have the same cell phone service Jack Bauer uses on “24.” It seems to work everywhere! (Great reference to Jack Bauer with the House/Cutty dialogue as well.)
And, the episode ended very abruptly: I believe even the closing theme music was missing. Snipping due to American Idol?
There’s some great potential for drama in the future working relationship between Cameron and Foreman. Despite the apology, even Cameron ought to be affected by Foreman’s attempt to infect her with his apparently deadly disease.
May 5th, 2006 at 3:03 pm
I watched about as much of this House story as I could stand. This show is awful in so many ways. First of all, there is the emphasis on extremely rare diseases and also highly improbable if not impossible scenarios.
Secondly, this episode was one of the worst I’ve seen as far as suggesting that an individual physician or small team of physicians “do it all” — operating MRI scanners, supervising brain surgery, doing independent investigations of a home environment, even becoming patients and caregivers. And this doesn’t even count the shooting the corpse incident(!).
Finally, this show is about as bad as it gets in suggesting that people routinely come close to death’s door, then miraculously come back to full health with an intact brain once the “cure” is found.
May 5th, 2006 at 3:32 pm
Okay, I posted this under Episode 1, but it fits here. I looked up several sites about Nagleria f. They all agree on the symptoms, and none of them include euphoria, blindness, hand contractures, or hyperalgesia. What’s up with that?
It’s like they picked a disease and gave it random symptoms.
May 5th, 2006 at 4:40 pm
I spent quite a while trying to diagnose the disease based on the symptoms and progression of illness; having a two-part episode gave us a unique opportunity. I wasn’t successful.
I agree with Greg P.’s criticisms about how House’s team does everything. I expect to see them greasing the gurney wheels and mopping the floors, next. But, although it is quirky, it doesn’t affect my enjoyment of the show. In the “real world,” a doctor like House wouldn’t be employed very long, regardless of how good a diagnostician he is.
The fun is in a plausible medical story and the interactions between the fascinating characters.
I suppose it’s like Star Trek–If it were real, would one ever expect a starship captain or first officer to go on dangerous away missions? Not a chance.
May 5th, 2006 at 9:51 pm
Wouldn’t the initial amphoterecin B treatment help the naegleria? They seemed to try that when they treated him for C. neoformans. Why stop? Because the culture was Neg?
May 5th, 2006 at 10:01 pm
David, it seems that naegleria infxn has at least been reported in cases without actual swimming or submersion in water.
Jain R., Prabhakar S., Modi M., Bhatia R., Sehgal R. (2002). Naegleria Meningitis : A Rare Survival. Neurology India 50: 470-472. http://bioline.utsc.utoronto.ca/archive/00000408/01/ni02125.pdf (Accessed on 5/5/06)
Lawande RV, Abraham SN, John I : Recovery of soil amebas from nasal passage of children during dusty Hasmattan period in Zaria. i1979; 71 : 201-203. (as cited in Jain et al 2002).
As House says, though, everybody lies.
May 5th, 2006 at 10:21 pm
Though I’m sure it has been discussed ad nauseum elsewhere, the fact that the team does everything doesn’t bother me at all. This isn’t a reality show, it’s a dramatization. Not very exciting to watch doctors sit around waiting for lab results, and it’s not so dramatic to watch them open the lab results slowly to see what they are.
This also means that they would only show rare and interesting cases. The whole premise of the “Department of Diagnostic Medicine” is that they get the cases nobody else can figure out. When you watch the news, do you complain that none of those things actually happen regularly in anyone’s life?
Stop trying to compare it to reality. The medical concepts are very realistic and I give the writers credit for that. If you want to watch a show about how real doctors work, just hang out in a hospital.
May 6th, 2006 at 3:20 am
Absolutely a big thank you to Scott for doing this review. This review work in combination with the series to give me a wee bit of clinical insight (though I know that House cases are more of an exaggeration..). At least it kills my boring time of a preclinical student.
Anyway, I am having an exam on microbiology in a couple of weeks. And I am so suprised that these people (House and his mate) were able to identify all these microbes!! Is that the kind of standard you need to have to be a doctor? I am having trouble just to memorise a few, what more if I have to remember all,especially those rare microbes… Are all doctors like that?..I wonder what the use of microbiologist if that is the case..
May 6th, 2006 at 7:28 am
So, both the cop and Foreman both contracted the infection from the water in the apartment? It isn’t transferrable from one person to another, is it?
Did they both just happen to get it it sprayed in their eyes (or their noses) or did they inhale the water droplets and get it? Did I miss something or did the show just skip over that part and leave it up to the imagination?
May 6th, 2006 at 8:10 am
This is mostly in response to the three underlings doing everything, and Greg’s posting, and to piggy-back on what Mike said.
I have a theory about dramas that helps me put my mind at ease about little quirks. Dramatic television shows are based in reality - they have to be at least a little to get us to accept the drama of what’s going on - but it’s a different take on it. Even a show like House or ER obviously doesn’t exist in a universe that has the same rules and reality as ours, even though it’s close to it. For instance, in that show would you expect them to realize that actors like Omar Epps and Hugh Laurie existed? They can’t, otherwise that would be a paradox.
Ergo, there are going to be some tiny differences between the expectations of reality on the show and in real life. Given that the three ‘Young Guns’ doing everything is a ‘mistake’ maken time and time again, it is simply something that we must accept as being normal in their world, or at the very least normal in House’s office.
It can be rationalized as well. As for myself, I figure in that in this show House is portrayed as one of the best diagnosticians in medicine. He’s famous for it, so he must be one of the best, if not the top dog. So, to be one of his underlings, a young doctor must be at the top of his/her respective game as well, as well as possess talents that set them apart from the rest of the field. This naturally would mean that, despite the fact House belittles them constantly, he trusts them and their judgement. (A likely corollary is that their high skill nets them constant high-complexity cases.) But House trusts almost no one else. “Everybody lies.”
So, in the context of the reality of the show, it isn’t all *that* far fetched that Cameron, Chase, and Foreman do everything themselves if he doesn’t trust anyone else to do them when it comes to his patients. They are, after all, the only people knowledge-able and smart enough (in his opinion) to be working with him, and they are the only people that know the details of each particular case. If someone is going to be doing tests or searching apartments, House would rather it be someone he trusts; someone qualified enough to be working with high-complexity cases. It’s just the way things work there.
Sure, it may be different from what we would expect, but, as many others have pointed out, it almost never takes away from the enjoyment of the show. Actually, given that these practices give the underlings significantly more screen time then they’d have otherwise, it actually successfully adds to the drama on the show.
Of course, this is just my opinion. I could be wrong.
May 6th, 2006 at 9:11 am
Houses’ team doing everything is just a dramatic device; it allows them a chance to chat while the patient is being tested. Having “Joe the MRI guy” would not advance the sub-plots. Also, it means that the gang is on hand for the next step of the patients’ deteriorating condition.
The team searching the patients house gets the action out of the hospital, which can seem claustrophobic.
May 6th, 2006 at 1:16 pm
First I just want to thank you for another great review, I have come to look forward to these after each episode. But also, when Foreman developed pancreatitis, wouldn’t it make sense to stop half of the drugs (Maybe choose the ones thought to be most stressful to the pancreas?) and see what happens? That way they would have it narrowed down to four either way. Then they could stop two more and have it narrowed down to two etc. Does anyone know if there is a medical reason that would prevent this from working?
May 6th, 2006 at 6:43 pm
I’d like to comment on the interaction with Foreman and his father. It seems to me that his mother might have Alzheimers or some other disease that affects her mental faculties. Could this possibly be the reason Foreman became a neurologist?
By the way Scott, I love your comments. Keep up the great work!
May 6th, 2006 at 7:00 pm
To Yusuf: I certainly don’t believe it is common for doctors to be able to identify rare organisms on the spot. House is a world-class specialist in infectious disease, so I guess it is reasonable for him to recognize it. The CDC autopsy and the biopsy results could have been done with the aid of reference materials, they don’t really talk about what happened there. It’s not beyond the realm of possibility for a person to know all the information that the characters supposedly know, but if they did they would probably be one of the world’s top diagnosticians, too.
To follow up on what I posted before, I guess this is the main issue with portraying the daily activities of the characters incorrectly. It is bad if the general population believes that all doctors act like House or any of the other doctors. It seems clear (to me, at least) that doctors don’t normally shoot corpses or break into patients’ houses. Some of the ethics is certainly a gray area, but that is a gray area in real life as well.
I don’t know what harm comes from people believing that doctors draw their own blood and operate MRI machines, though. Maybe phlebotomists and MRI techs don’t get the credit they deserve? At least future doctors may believe they have to learn how to do the procedures themselves, which can’t hurt. The patients all seem to respond to treatment remarkably well, which again just makes for better television. It would be a depressing (and low rated) show to watch House do all the work to diagnose patients just to see them die every week.
May 7th, 2006 at 8:02 am
Mike,
I think you raise a good point, but although people are demanding more realism from their TV, they are also demanding far more entertainment than they used to. To be successful, TV has to have world-class writers, action, suspense, drama, high-tech looking graphics and special effects, and other pap.
Realism MUST take second place for a show to be successful, period. People need to recognize this, and anyone self-diagnosing or basing their view of the world on TV needs to be sent to the Third Floor of Princeton Plainsborough. ;-)
That would be almost as annoying as the people who think 15 minutes on the internet makes them a certified diagnostician, like the Finding Nemo girl’s mother. Or people who demand certain drugs because they saw a convincing commercial on them. People need to realize that just because they watch CSI they are not a forensic scientist.
May 7th, 2006 at 11:33 am
Thanks for all the theories about Foreman’s condition. I found this site specifically because I was so confused by the right-arm/left-arm ending, and the fact that the in the previews for next week, Foreman looked normal. You came right up up on Google.
May 7th, 2006 at 1:12 pm
I like the suggestion that Foreman might be playing a practical joke - He’s definitely the feisty one of the group (House being the exception)! I also thought his trying to infect Cameron was beneath him - what happened to the Hippocratic oath he swore to in medical school - “First do no harm”!? I guess that makes him a bit hypocritical? I know he was sick and delirious, but I always think doctors are above that no matter what they are going through personally!
May 7th, 2006 at 5:23 pm
I just wanted to make a note about the most recent (or past 2) episodes. Foreman was started on Amphotercin B for his Cryptococcus infection which he turned out not to have. Oddly enough Amphotercin B is also the reccommended treatment for Naegleria as well. All of the people who have lived from the parasite were on Ampho B (6 of 24 in the US). Just a side note, Foreman would have been cured even though they made the wrong diagnosis.
As far as the Foreman diagnosis, there’s really no telling. It’s not hemineglect syndrome as these people don’t recognize one side of there body,. Although I have to agree, I think it’d be great if Foreman were just joking.
Also someone mentioned earlier that Foreman’s symptoms were not those common to Naegleria infection, but I think the reason that his symptoms were what they were was due to where the parasite was in his brain. It is possible that every person who is infected has different symptoms because the parasite could be in a different location every time.
May 8th, 2006 at 11:29 am
Dunno if you’ve seen, but on Fox’s official House website, they link to a survey about TV’s portrayal of health topics.
Given your medical reviews, I thought you’d have some interesting answers for them…
May 8th, 2006 at 11:18 pm
I agree, this was one of the best 2 hours of television I’ve ever seen. Omar Epps should get an Emmy. I also loved the reference to my favorite man on TV, Jack Bauer of 24.
May 9th, 2006 at 1:47 am
From a thermodynamics standpoint, it is very possible for there to be enough water in the air to transmit a microorganism. Further, because the water is being sprayed into the air, it is quite likely that the microorganism will be airborne as well. If the Naegleria were in a pool, one most likely would not catch it from sitting around the pool because only the water would evaporate. The bug would not transfer with the water in that case.
May 9th, 2006 at 9:10 am
Treatment for Primary Ameobic Meningoencephalitis is not usually successful, nor is laughing (or hysteria) one of the primary symptoms . Almost all people who develop PAM die. Drugs are hard to test b/c usually people die within 7-10 days of onset of symptoms. Furthermore, while it is possible (I guess) for the amoeba to be transmitted through sprinkler systems, it is primarily a freshwater organism. I like the show, but these fallicies made me lose some respect. Don’t they have medical staff there assisting with technical issues? Great web site.
May 17th, 2006 at 9:56 am
“The cast must have the same cell phone service Jack Bauer uses on “24.” It seems to work everywhere! (Great reference to Jack Bauer with the House/Cutty dialogue as well.)” - Doug Wilcox
I couldn’t agree more, however have you notice that cameron’s cell phone displayed a “No service” sign (thus forcing her to run to Foreman) in the part 1 of this two parters? To me that is such a goof
May 17th, 2006 at 10:16 am
Oh I have another question as well: Is the potrayal of CDC correct? Are they really that slow? It is said in the show that House could only get the autopsy result in 3 days time (well I am awared that Cuddy mentioned that her hospital doesn’t have the facility to conduct autopsy on the cop at the risk that even his corpse would be contagious). But what about the time it takes for CDC to collect the corpse?!! Certainly there isn’t any evidence to varify that but I can tell that it take an awful lot of time for them to even collecting the corpse, shouldn’t they have a rapid response team or some sort?
And please pardon my english as it isn’t my first language =)
October 11th, 2006 at 4:09 am
house episodes are mindblowing.especially the determination the doc has for his determination.a good blend of medicine and emotions.
keep going.
December 11th, 2006 at 10:26 pm
Is it true that rats don’t get Naegleria? If it’s true, why don’t they? Thanx!
January 13th, 2007 at 5:57 am
About the question that how HOUSE notice that is the ameba infection. If people had a chance to play with these little creatures. They would have noticed that you can actually see them with naked eyes. And on that roof with that concentration. I believe HOUSE must ve seen them.
I am doing Biomedicine in Melbourne,like this show so much that I want to change my career to medicine.
P.S this is a great!!!site!!! by the way.
January 14th, 2007 at 3:40 pm
An interesting two-party story with a lot less snarking from House (apart from the one clinic scene, which was prime) than usual. I thought Omar Epps and Charles S. Dutton were both fantastic in the second episode. House was more shamelessly manipulative than he’s been in a long time (I was glad Cuddy kept a level head), but it was interesting to see him fraying at the edges for once, even putting Steve McQueen on the line, which for some reason surprised me more than Foreman’s stabbing of Cameron in the first episode.
February 16th, 2007 at 5:28 pm
First if all - thanks for all the reviews you do on House, I wont be able to understand it without you cause im russian and obviously cant figure out all the medical terms and whatnots.
To continue the praise for the makers of the series - the whole euphoria part was just amazing, you expect the usual irony and who-cares-about-patients-stuff and the pot beginning just nurturing this expectations, and then boom! a whole knot of nerves!
But the only question i have in general - does every person who leaves house’s “table” have a hole in the head from brain biopsy? They seem to do it a lot, same with other complicated tests, i think it negates the whole idea of House’s brilliance, cause you can just run every possible test and find something. And then give all the possible antibiotics? But mind you, maybe im just from russia and used to “ancient” diagnostic methods
February 17th, 2007 at 7:13 pm
hi, i just found this site and already like it but i can’t beleive no body has talked about this. houses theory that the Listeria infection helped by antibodies (Ab) for it being made and then the immune system seeing the other infection. this is completely rubbish i believe. i am only a second year genetics student and have only dont one module in imunology that took you through everything briefly but Ab for Listeria will not affect a parasite at all. also i thought it took days for the adaptive immune system and Abs to be made. i think they came up with a better reason why Listeria did slow it down for the end but house is suppose to be the expert and Cameron is an immunologist!!!
does anyone with more knowlage of immunology know if my ideas are right?
March 27th, 2007 at 1:39 pm
It was Legionella, not Listeria that helped via its antibodies, I think.
April 2nd, 2007 at 5:39 pm
yeah i think it may have been Legionella. but it makes no difference to the points i made, an immune respose takes ages to make Ab and a bacterium like Legionella wont have any of the same antigen for the T cells and B cells to go after!
April 20th, 2007 at 6:47 am
House’s theory was the antibody crossfire; if Legionella and Listeria are close enough in terms of their proteome, cell wall, cell membrane, or whatever the antibodies target, the antibodies will go after them both, like with PNP and the 2-05 molecular mimicry theory: It’s the microscopic equivalent (as described by Television Without Pity’s House recapper, Sara M) of wanting a coke but only finding a pepsi vending machine and settling for that, except that in this case (if the theory were correct) it would be a good thing.
I remember Cameron telling Rod Foreman that the Legionella had travelled to his son’s brain where they were attacking the parasite.
May 2nd, 2007 at 10:25 am
I had a small problem with the euphoria episode of House 2. During the operation of the child with that special technique, after the hypothermia reaches and child goes to circulatory “arrest”, then he gets chills. they inject him with (I think)atracarium the chills stops. Since it was a generalised chills and there was no circulation, then how it stoped.
June 4th, 2007 at 9:45 pm
Just rewatched this episode and thought I’d mention (for those who like interesting connections and neat stuff to read).
The cop was named Joe Luria. Alexander Luria was a Russian neuropsychologist (died in 1977) who wrote a couple of very interesting books: _Mind of a Mnemonist_ and _The Man With a Shattered World_, both reprinted by Harvard University Press in the 80’s. If I remember correctly the second title is the case history of a patient who suffered severe brain trauma after being hit with a bullet.
Thanks for making a great site with interesting information and links.
July 11th, 2007 at 9:39 am
Re: Sayed Morteza, I think the episode your discussing is “Autopsy” where they Temporarily kill the cancer patient, drain her blood then put it back in to locate the clot in her brain…
September 28th, 2007 at 4:49 pm
In a case of life imitates fiction, Brain-Eating Amoeba Kills Arizona Boy. From the article:
Who says you never learn anything from TV?
October 16th, 2007 at 1:09 pm
I love House very much, however, they got some things wrong with the primary_amoebic_meningoencephalitis. First, it does not cause cortical blindness (or any kind of blindness!) but impaires smell and taste; also, the cop may not have nose bleeding onto the show, but foreman should have had nose bleeding; this is the first sign, caused by penetration of the nasal mucosa.
Of course Foreman has to survive this, and House-like also via rescue in the last minute; however, time is the most important factor here. If they treated them in that stadium that was showed, he’d had much higher chances of dying - or significant brain damage if surviving.
But of course blindness is a much more frightening status and is way easier to present, compared to taste and smell problems; and foreman survived. This has to be done that way because of drama and, well, it’s a show. and I love it!
December 4th, 2007 at 10:36 pm
Whatever became of the first symptom – the euphoria? Is it typical of the parasitical infection? Was not referred to again as a symptom, or explained as a consequence. I’m late to House and am working my way through the episodes. This site is great! I check back after viewing each Netflix rental.
December 6th, 2007 at 11:03 pm
Little late on this, so I’m not expecting much by way of resolution, but here goes.
Naegleria, as I understand it, simply eats brain tissue. So whats this excruciating pain both the cop and Foreman are experiencing? Do holes in the brain lead to uncontrollable excitation of pain receptors, or through some ’short-circuit’ make the brain think the body’s in pain? I’m sure it’s possible, but (and I’m guessing) wouldn’t it need to go after specific areas to do so? Does Naegleria pick certain spots to eat through first?
Also, wouldn’t the brain damage from the Naegleria be much, much more prevalent than a biopsy? After all, dead nerve cells are still dead, regardless if they died from a germ or a medical procedure, no?
December 14th, 2007 at 9:23 am
Just a quick note on medical proxies: They can be chosen by the patient, with appropriate documentation, and they can be any adult who is willing. Or they can be assigned (in an emergency) on a familial/promixal basis. If someone of higher “rank” arrives later, the docs usually includ them in the discussions. One can also refuse to accept responsibility for another’s medical decisions, in which case, I assume, either the lead doc or someone else is designated. (They didn’t tell me.)
On two separate occasions I’ve been required to make medical decisions for family members. My wife had a kidney infection that got real bad, she ended up hallucinating and being gutted by the surgeons before it was all done. I’ve never been the same, not since that day I looked down into her eyes and thought for sure it was the last time I’d see them sparkle.
The second time, my mother took a handful of her percocet and called 911. She’s been on heavy opiates (and topamax, and lexapro, and bentyl, and has since moved from percs to ms-contin and oxycontin, among other things), she’s been taking these for a long, long time and the disassociative factors are starting to kick in. That time, since I had no idea what caused it or what could cause it again, I refused to let them discharge my mother until she had a psych referral.
Since most legal proxies are simply the nearest, closest (by blood) family members and not doctors, the idea of your average proxy ‘ordering’ a test or procedure is laughable, at best. How would they even know what to request? But you can ask for a specific treatment or refuse a specific treatment, if you think it wise.
In the end, it was just Cameron standing up to House, just like Foreman knew she would, always the one to do what was best for the patient, regardless of the consequences.
December 14th, 2007 at 9:26 am
Of interesting, but ultimately worthless note: While my wife was in the ICU recovering from the abcess, her mother called and said if anything goes wrong to pull the plug and donate her organs. It would have been interesting to see if the mother or the husband won, I’d like to think that since mom was 600 miles away and I had been in the waiting room for @72 hours, they’d talk to me first. Luckily my wife was awake by this time, so I didn’t have to go to court either way.
December 14th, 2007 at 9:35 am
Sorry for the triple post: Worthless because I didn’t find out who would win such a battle, I mean.
February 21st, 2008 at 12:19 pm
>>>
when the combined medications were giving Foreman pancreatitis, surely House could have let him keep taking ONE of them? Then there would at least be a CHANCE that the one he keeps taking is the one that’s been working!
The trouble is they don’t know which of the drug (or drugs) was causing the pancreatitis. If they had time, the best thing would have been to stop them all, and then add them back one by one.
February 23rd, 2008 at 1:12 am
62: Here’s one possible (crazy, and probably fan wanking) alternative. Legionella is an intracellular parasite, and in the “wild” legionella is only too happy to go after amoebas. Indeed, in the lab, it’s cultured with Dictyostelium (a kind of err, amoeba-like slime mold) in some cases. Dictyostelium is probably about as related to Naegleria as we are to goldfish (or ants, for that matter), but for all I know Naegleria could be a target for Legionella. In that case, it’s at least “TV-plausible” that the Legionella (which ps, probably wouldn’t have been transmitted via that broken vial, and pps, probably can’t infect someone with a healthy immune system - there’s a reason it’s named after (old) Legionaires) could have gone after the Naegleria and thus slowed down their growth temporarily, almost like the cancer-attacking-virus a few episodes back. Odds that the writers were thinking of this: probably zero. But still, it’s at least sorta-kinda plausible.
June 2nd, 2008 at 2:10 am
I’m rewatching all the episodes while reading your comments(great stuff by the way), and it occurred to me, wouldn’t the best solution be to remove half of the meds given to foreman(based on which were most likely to harm the pancreas), and keeping cutting in half, mathematically this is the shortest number of steps to absolutely getting the right med.
June 15th, 2008 at 2:02 am
@Dustin:
I agree with you; it’s not that hard to justify. People just lack imagination these days. ^_^
June 15th, 2008 at 2:10 am
@Mike, re diagnostics
My grandfather was exactly like House, only… not really all screwed-up and stuff.
Anyway, he was amazingly good and also very much in-demand, even after he retired.
Anyway, just wanted to let you know that not only is it indeed possible for one doctor to know a whole bunch of names, but it actually had happened. ^_^
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