House - Episode 1 (Season Three): “Meaning”
The season premiere of the third season of House. Medical reviews and spoilers below!!
It’s Houses first day back at work since he was shot several months before. In the meantime, he has undergone the Ketamine treatment mentioned in last year’s season finale and no longer has pain or weakness in his leg. He arrives at the office to find that he has 3 patients to chose from. He scolds Wilson for trying to give him an easy case, and then chooses to take both of the two remaining cases.
The first patient was a young woman who was standing on her head performing yoga, when she heard something snap and found herself paralyzed. An x-ray showed no evidence of a broken neck or spinal trauma.
The initial diagnoses of Chase and Foreman were multiple sclerosis or transverse myelitis, but House finds flaws with both those suggestions. He ordered an EMG (Electromyogram — a test that checks the conductivity of muscles and nerves) but the patient flinched when the needle was inserted, suggesting that she was not paralyzed and could in fact move her legs. By holding a lighter to her foot, House showed she could feel heat as well. He discharged her suspecting she was faking. However, before she could be discharged, she developed a sudden shortness of breath. The Young Guns think she has a pleural effusion (a fluid build up around the lungs which compresses them and does not allow them to expand fully), but House noticed her distended jugular veins and realizes she had a cardiac tamponade. This is a life threatening condition that occurs when fluid builds up in the pericardium, the membranous sac that surrounds the heart. If too much fluid builds up, the heart can no longer expand properly, the volume of blood being pumped drops precipitously, and the patient goes into shock. To treat the tamponade, House plunges a needle through her chest into the sac around the heart and withdraws blood, relieving her tamponade. The differential now includes tuberculosis and vasculitis. House has a different idea: he thinks the patient has the delusion that she is paralyzed and he believes that she has a vascular tumor on her spine causing this delusion as well as her other symptoms. As she is being readied for exploratory spinal surgery, he notices that she has bled into her toenail and uses this to diagnose scurvy –- a deficiency in Vitamin C, in this case brought on by a protein heavy diet that was deficient in fruits and vegetables. This deficiency leads to a weakness in collagen which leads to spontaneous bleeding — such as into the pericardial sac and nails. Scurvy can sometimes cause a pseudoparalysis as well, so score one for House.
The second patient is a man who is eight years out from brain surgery and radiation treatment for an astrocytoma (a brain tumor). The surgery has left him just a shadow of his former self. He is essentially non-communicative, and his life consists of little more than sitting around in a motorized wheelchair. At a get together in his backyard, he drives his wheelchair purposefully into the pool and nearly drowns.
House takes the case to prove he can handle difficult cases — not difficult from the medical point of view, but difficult in terms of human interaction. By the end, he has started to view it as one of his typical challenges and tries to find what other doctors have missed over the years. After a sudden revelation while running, House decides that the patient has hypothalamic dysregulation brought about by scar tissue from his brain surgery. The hypothalamus controls the thyroid gland, adrenal glands, ovaries and testes, and a malfunctioning hypothalamus can lead to a whole host of problems including difficulties with appetite, growth, and body temperature. House suspects the patient drove into the pool because it was the only means he had to cool himself off from the persistent high temperature caused by his hypothalamic dysfunction. Furthermore, House suspects the patient’s main problem is that because of the malfunctioning hypothalamus, his adrenal glands are no longer producing enough of the hormone cortisol. This is known as Addison’s Disease, and House believes it is the underlying cause of many of the patient’s problems. He wants to give the patient a shot of cortisol to see if he’ll improve, but Cuddy vetoes the idea. After some soul searching, House accepts her reasoning. Cuddy, however, decides to see it House is right and injects the patient with cortisol. Within a few minutes he miraculously improves. Cuddy wants to tell House the results, but Wilson tells her not to, noting that House was just guessing and got lucky and the next time he might kill someone with one of his guesses. Score two for House.
For the most part, the medicine was clever and appropriate this episode. I’ll make my usual comments about the Young Guns performing tests they’re not trained to do, but at least they weren’t performing the surgery this week. I have two small complaints regarding the first patient. The first is that the team was a little too quick in assigning her shortness of breath to a pleural effusion (I suspect this was to give House a chance to have a needle in his hand) — a pulmonary embolism (a clot in the lungs) would have fit the scenario better and would have been my first suspicion. My second complaint is that House was a little too cavalier about plunging a needle in the patient’s chest. That’s not an area you want to be messing around with unnecessarily. Too deep (which it looked to me like he was) and you’ll draw blood from within the heart chamber, and not the pericardial sac. A little bit off on either side and you’re in the heart tissue — never healthy for the patient. I did think it was clever that he noticed the distended jugular veins. As soon as I saw them, I started yelling “She has a cardiac tamponade” at the TV. I think that was about the time my wife decided to move down to the other end of the couch.
I have little to say about the last patient. It was just so much of a shot in the dark that happened to be right. The patient’s symptoms and tests really did not match the diagnosis much — House just had a hunch that happened to be right. Of course, that was the whole point of the scenario, so I’m fine with it. OK, I have to make one complaint: the patient got better way too quickly and was standing incredibly well for someone who hasn’t used their legs in eight years and just had tendon surgery done.
The soap opera aspects were good, though I think the writers are still trying to feel out the new status quo. Everybody seemed to be acting a little tentatively. It also seems that while House was out for the summer, everybody had time to find a backbone — except Chase, that is.
I give this episode a B+ for the mysteries with an A- for the solutions and B+ for the medicine overall — a solid episode medically. The soap opera earns only a B because it seems the characters are still finding their way in this new season.
A list of all previous House reviews
UPDATE: One last nit-pick. At the end of episode, House sneaks into Wilson’s office and writes himself a prescription for Vicodin, forging Wilson’s signature. I wasn’t able to get a good look at the script, but Brent was kind enough to send me a vidcap. It shows that House has written a prescription for “Vicodin ES 5-500″. Now the standard dose of Vicodin is 5MG Hydrocodone + 500MG Acetaminophen, but Vicodin ES is 7.5/750, so there is no “Vicodin ES 5-500″. As Brent points out, House of all people should know better.
September 5th, 2006 at 11:01 pm
I was waiting for your review to come up!
Yeah, it really was a bit much for that guy to suddenly be able to stand, but it certainly made for a more emotional/dramatic ending.
Another point of complaint was how active House was, given that supposedly he lost quite a bit of muscle in his thigh.
I’ve seen other people comment on how the characters seemed to be ‘off’ a little. No doubt there will be a bit of ‘feeling around’ as far as the characters/writers go.
September 5th, 2006 at 11:11 pm
Official Comment
My wife had the same complaint. “How can be running eight miles just two months after he regained full use of his leg?”
September 5th, 2006 at 11:13 pm
After eight years, even with physical therapy, wouldn’t his muscles atrophy? I think at one point House said the patient’s muscles had atrophied?
September 5th, 2006 at 11:15 pm
Great reviews, thanks :D
September 5th, 2006 at 11:23 pm
My favorite aspects of this episode involved the soap opera. The hospital’s Big Dog has just returned after a life-changing event — if everyone around him ISN’T in flux, I would have been disappointed.
I do have a question about Chase, the butt-kissing machine — when he cut off the quad dude’s air to get him to swallow, were te writers trying to portray him as being a little brutish, or was that pretty much what he HAD to do to execute the procedure?
September 5th, 2006 at 11:25 pm
I wanna know, who gets Scurvy in this day an age? Is it still common for people (”morons”) to forgo all common dietary common sense and not eat fruits or vegetable? Do you think high protein diets increases the chances for people to get scurvy?
Oh and your reviews rock.
September 5th, 2006 at 11:27 pm
Well I think I might have been a little emotionally charged for this episode because I have been watching all the old episodes in anticipation of this. I found this episode to be really exciting, as a result. Even though I did read some spoilers before the episode was aired I was still really excited to see House triumph over Cuddy once again.
Yea I did notice all of the flaws that you mentioned. Which is kind of odd since I have no medical degree. BTW if House was to do everything else, other than the “Young Guns doing their own tests” right would the show receive an A+? They have already established that they di their own tests and I see no way for them to stop doing their own tests now that the audience believes they can without damaging the realism. Personally, I am still waiting for them to acheive their first ever A+ on this show in medicine.
Ummm, one question. Couldn’t House have proven himself right if he had asked the patient to move his chair forward if that was the reason he went into the water and backwards if it wasn’t the reason? Seeing as how the guy understands what people say and the only thing he can move is his finger to make the chair move. Would that be enough to prove his diagnosis? Or atleast prove a diagnosis?
September 5th, 2006 at 11:34 pm
Official Comment
John,
A little of both. Chase’s method was the most efficient one, albeit brutally effective.
Neojanus,
Scurvy is still rare, mostly due to the vitamins companies pump into our food, but some people’s diets are so extreme that I can see it happening. I’ve seen other deficiencies, usually from a poor diet. I once had a patient who lived almost entirely off of laundry starch. She was so anemic that she had the lowest blood counts I’ve ever seen in a living person.
Colby,
There may be an A+ episode out there, but I’m skepitcal. Basically, anything B or above is pretty good medicine.
As for your question, I don’t think the patient’s hearing and thinking were all that great — remember the static in the opening scene — so I’m not sure if he could follow a command.
September 5th, 2006 at 11:48 pm
What about vision. They could write on a piece of paper and than hold it infront of him. And you just gave me another reason to believe he could be given a command, the opening scene and now that I think about it the scene where House asks him to make a noice with his voice. There are all sorts of examples of them communicating just nothing definitive. It sounds like it would be worth a try to cure his paralysis, afterally it was just a cortisol injection. I guess there is no way to be sure if the answer was right, but still.
September 6th, 2006 at 8:22 am
Scott, just wanted to say - glad to see you for another season. Your reviews have become an essential part of the “House” experience for me. Thanks so much for all your work!
September 6th, 2006 at 8:41 am
Good review. One question though. What did you think of the return (and seeming escalation) of House’s vicodin “addiction”?
September 6th, 2006 at 8:53 am
Colby, good point about getting the patient to respond to questions.
In terms of House, I’m stuck on the episode where he dropped trou and showed Cuddy the damage to his leg muscle. Where’d that go?
September 6th, 2006 at 9:18 am
Guys, stop asking if Scott will ever assign an “A+” grade to the medicine section of a House episode. He won’t.
He’s too pedantic and persnickety to ever allow an A+ grade. In reality an A+ should be a show without medical *mistakes* not minor inaccuracies attributable to the fact that this is, in the end, a *fictional* medical drama. This episode, as an example, had no medical mistakes in it, it just used literary license to make a more visually and emotionally appealing episode. I think often Scott forgets he’s judging a fictional medical drama and instead he often treats the show like a proposed medical textbook review.
All the evidence you need of this is seen in his blatantly absurd yet incessant griping about the young guns doing more than their “real-life” share of procedures. Scott, get a clue, it’s a dramatic device. Medically incorrect but totally irrelevant to grading the show.
Anyone else kinda annoyed by the direction their taking the show? I think the writers are trying to keep it “fresh” by varying the character’s personalities but I’m not sure I like it. The numerous weaknesses they’re giving House kind of irk me, I liked his character. I realize they are trying to stop the show from becoming formulaic. Any thoughts?
September 6th, 2006 at 9:33 am
It seemed to me that a lot of what House does is play hunches anyway, I missed what made the cortisol hunch different from the many other treatments House has prescribed that haven’t worked.
And, has Wilson moved from being “Watson” to “Moriarity”? :D
September 6th, 2006 at 9:34 am
So, what grade does Cameron’s hair get?
September 6th, 2006 at 9:41 am
Official Comment
SDG,
I would grade a textbook much, much harsher — but you’re right in that I’m unlikely to ever award an A+.
Beta Ray,
I think the difference is that in previous episodes there was some evidence supporting House’s ultimate diagnosis, but in this case there was no evidence for the diagnosis, and acutally some against it.
Evan,
Both her hair and eye make-up were way too dark (particularly the hair). It would definitely be “below average”, so at best a C- — though I’d probably give her a week or two to see if she can bring up the grade.
September 6th, 2006 at 9:47 am
Official Comment
Loren,
Previously, I had always felt that House’s Vicodin habits were not actually an addiction, but more of a habituation with maybe some pseudo-addictive behavior (though other people’s opions vary).
Now that we see him forging a prescription and taking the medication less for pain and more for what seems to be a psychological need, I am willing to agree that this is indeed an addiction. I look forward to seeing it addressed in upcoming episodes (though I’m not looking forward to the extended arc with David Morse as he’s never been one of my favorite actors, even though he was on St. Elsewhere).
September 6th, 2006 at 10:02 am
Surprised to see you give the medicine a high grade, makes the episode go up in my eyes. A few questions though - of the cortisole injection couldn’t really have done no harm, why did Cuddy refuse, surely, even if it’s a one in a million shot, if there’s no harm, why not?
Also I don’t get the whole running around bit, from Three Stories, I remember that they removed dead muscle from House’s leg, surely that woul impede his movement even if the pain is gone. Also I’d lke your medical opinion on the whole Ketamine thing - I still don’t exactly understand how it is suposed to have worked.
Also thanks for continuing with the reviews, my darkest fear after the episode was landing up here and not finding anything, and being left with a lot of unanswered questions - you answered a lot of them :)
Ohand I like the grading system, it shouldn’t be too easy.
September 6th, 2006 at 11:04 am
Neojanus, I know a guy who heard about other people loosing weight on low carb diets, and ate nothing but hot dogs for a week until he went to the doctor feeling sick. He’s an idiot, a well known idiot among his friends, but he does exist.
Scott,
I think you’re right about the lack of a good solid status quo in this ep. I really expected to see one, and I thought it was going to be all about Houses’ “healthy” addiction behavior when we saw him run 8 miles. That just screamed marathon runner’s addiction to the second wind to me.
September 6th, 2006 at 12:36 pm
I am surprised that the guy is 8 years out for a Grade 4 Astrocytoma, also known as a Glioblastoma Multiforme. I know it is possible, but not likely. I work in radiation therapy, most GBMF’s live about a year.
I agree with the fact that the patient would not be able to stand on legs that hadn’t been used in awhile.
Oh, and Vicodin can be called into a pharmacy, if you know how, thus eliminating the “forgery.” Of course, that doesn’t make for good TV! ;o)
September 6th, 2006 at 1:12 pm
I agree with the fact that the patient would not be able to stand on legs that hadn’t been used in awhile.
Am I the only one who saw the guy try to stand up and get caught by the wife? I don’t think they showed that he could stand.
September 6th, 2006 at 1:13 pm
I’m OK with reviews of House that never give an A+. I’ve done numerous personnel reviews before, and the standard is always that a 5 out of 5 (or 10 out of 10) means it would not be possible to exceed this rating; a 4 out of 5 is generally considered to an excellent score. When grading a medical drama on the medical content in the show, an A+ would mean it could not have scored higher, the medical content in the show was flawlessly accurate. The show House has already shown that the medical aspects of a medial drama can be more accurate than in previous shows, but the standard shouldn’t be different for different shows. If Scott gave House an A+ because the only flaw was that the young guns were doing tests and we accept that that is as good as it’s going to get in House, what standard should he use to grade the medicine in a different show/ movie, that was even more accurate, should he ever find one? An A++, A+++?
September 6th, 2006 at 2:13 pm
Karl: You’re assuming there has to be one universal grading schema here that applies objectively and identically to all media. There doesn’t, there could easily be relative criteria suited to the environment, like the example of a textbook review versus a television show review.
Scott’s grading system is obviously tailored to his expectations of the show’s ideal medical accuracy, not a universal system that he would apply equivalently in all circumstances. He indicated this himself when he said he would grade a medical textbook much more harshly (and with good reason, as minor flaws there could induce mistunderstanding which could conceivably prove fatal. Admittedly my original statement was hyperbole.)
September 6th, 2006 at 3:02 pm
Wow! Didn’t expect that question of mine to get so much attention. My point was that there are several things that Scott deducts marks for in an episode of House that the show doesn’t ever really stand a chance of correcting without pissing a bunch of other people off. I know that an A+ is unlikely, but I was thinking if they ever actually went for one in medicine by having skilled doctors off set telling them what they are doing wrong would these harder to fix flaws make the A+ impossible?
Anyways other then that, I think you guys might be reading a little bit too much into the character changes. As far as I can see, the actors are just having a little bit of trouble getting into their roles again. Furthermore, why is someone commenting on the change in hair on Cameron in this season? Her appearance changed last season too you know. Personally, I had a lot harder of a time adjusting to her new look more last season, I thought they might have even changed Cameron’s actor on us.
I am really curious right now to see weather they make the fixed leg work in this season or if they are gonna give up and have the pain come back. They are really leaving the door wide open on that right now.
I know that there are alot of doctors in this forum so would one of you mind telling me whats your bet on a really interesting disease to cover in this season? Which one do you think has the most potential? All of the diseases that are famous with amatures have been done now. (e.g. Plague, Sleeping Sickness, Anthrax, Flesh Eating Disease, etc). The only disease I can think of I dont know how to spell and would have to look like an idiot trying to , but here it goes anyways. My guess would be the (Honda, Haunta) Virus. I know I didn’t spell that right.
September 6th, 2006 at 3:32 pm
“Tamponade” is the best fake soft drink name EVER.
September 6th, 2006 at 4:21 pm
Hi. I’m really happy I found this site. It actually helped me understand House more. Thank you for taking time and doing this Scott.
There’s one question that has bothered me ever since I first saw House. Why does he still (or should I say did) feel pain in his leg? I’m guessing it has something to do with the nerves or something like that. Not medically trained so these are all assumptions on my part.
September 6th, 2006 at 4:58 pm
SDG, I’m not saying there should be one standard for reviewing both Textbooks and Medical dramas, just one standard for medical dramas. The standard for a textbook would likely not tolerate any errors, whereas a medical show could contains errors in the practice of medicine, as long as those errors an intentional part of the drama.
For me, the whole point of the Medical review grade is that House portrays medicine more accurately than most other mdeical dramas.
How much better is medicine in this weeks episode of House compared to the average med drama? Humm, if the average medical drama was, say a C, and real life medicine was an A+, this week’s episode rates a B+. Maybe I’m reading too much into Scott’s basis for grading the medicine, but for me, the gold standard of A+ should be “could this happen in actual real life medical practice or not?”.
I understand the position that there should be a curve to reflect the best there’s going to be in any episode, but what grade would he then give if there was an episode where simply due to the way the story played out, they didn’t show the doctors doing their own tests, and all the rest of the medicine was totally accurate?
September 6th, 2006 at 5:05 pm
I think some of the soap opera jokes in this episode were a little on the self-conscious side (Cuddy’s reference to “24 times a year,” the number of mysteries shown last season), with the show sort of putting itself on trial to deflect criticism of unrealism… sort of what the James Bond series did with “Goldeneye,” so now they can start anew, sort of. Does that make any sense?
September 6th, 2006 at 7:08 pm
Finally, the new season of House started! I too was rather disappointed at the beginning of the episode when it shows House running his own personal mini-marathon without any resolution to the end of the last season. On the plus side though, seeing House nail that janitor in the head with the grape was priceless…it made me giggle like a little schoolgirl.
RE: Scott, thank you for the recognition regarding the Vicodin script error; it was much obliged. I’ll keep a look out for any more errors I might come across spontaneously.
September 6th, 2006 at 8:24 pm
I really enjoyed this episode of House. He Handles two cases instead of one =)
I had a few questions about the medicine, tough. Can Addisons disease cause such an extensive paralysis/muscle weakness (and the patient to survive). Can a patients survive tendon surgery with too low levels of Cortisol? How can Hypoaldosteronism go undetected after “all the tests”?
I’m a bit puzzled on this one. I enjoyed the miraculous cure, i dont mind him getting up 6 months to early, its got to fit in one episode. I just dont get it why he got up in the first place, even if his addisons was treated succesfully.
September 6th, 2006 at 10:15 pm
At some point, they’re going to HAVE to throw us a change-up and actually have the ultimate diagnosis BE vasculitis. It’s already become something of a running joke among fans.
September 7th, 2006 at 12:08 am
Anyone notice a new second floor to the set?
Or the “Rocky” run up the steps to the water fountain + ?
I doh no, ya no?
And, just like in the last show, the outside areas are not in the Princeton area.
There is no Mexican drive up food place like that one.
Only the arial shots are of Princeton.
The producers could have House in some way interact with the real medical school in NJ.
Just an hour north of Princeton is UMDNJ.
Robert Wood Johnson med sch is where the real stuff goes on. Would be cool for us NJ folk.
The best ep was 3 stories!
September 7th, 2006 at 12:54 pm
In reference to the post above about the outside places not being in NJ, it was clearly my alma mater, UCLA. Lots of sets come on campus to do filming. The fountain that House was bathing in was not UCLA however but the other scenes (skateboard, running in the dark up the stairs, talking with the scut monkeys, in the background was Royce Hall(Cameron, Chase, Foreman)) were. Maybe everyone was in LA for some reason or do they film there year round?
September 7th, 2006 at 4:32 pm
Well I loved this episode for being something new. It’s kinda a copy of Foreman’s rebirth which lasted only an episde though so I wonder if he stays that way. Would be a shame if all of House’s introspection went to waste.
September 7th, 2006 at 9:23 pm
I have House withdrawal symptoms, I live in the UK and will not get to see series 3 until 2007! This site is great, thanks Scott
September 7th, 2006 at 9:37 pm
Personally I am looking forward to seeing if House pays Moriarty a visit to show him that all he really did was give him full use of his leg back and that he was pain free now.
September 8th, 2006 at 12:15 pm
Awesome review. At this point, I’m having a hard time deciding what I look forward to more: a new episode of House, or your review of it.
I heard an interview on NPR recently of the show’s producer and medical consultant. One of the questions was if the medical consultant ever got upset about House and staff always doing their own tests and such. The producer said something to the effect of, “He does, but I tell him, ‘They are the stars of the show and it’s more exciting to see them do it. Deal with it.’”
I immediately thought of you, and laughed heartily.
September 8th, 2006 at 7:55 pm
My cousin in dental school was taught about “rebound scurvy”
If somebody regularly takes megadoses of Vitamin C, the body can get dependent on that dosage.
Then if the person drops back to more normal amounts, the body will develop scurvy.
Interesting factoid…
September 8th, 2006 at 9:10 pm
Maybe you mentioned this before- this is my first visit. But did it ever bug you that House, a seemingly intelligent man, carried his cane in the wrong hand? That has always bothered me.
September 8th, 2006 at 9:19 pm
Has anyone else wondered why House takes 5/500s instead of 10/660s or something? Less APAP, and more efficient too considering how much he takes… (It’s not just the prescription in this ep, the tablets he takes definitely look like 5/500s too.) Maybe I’m overthinking this, but hey, it’s a legitimate question. (And it does basically make sense why he’d stay with Vicodin, because stronger opioids are Schedule II.)
I was also wondering in this episode about the guy in the wheelchair: if he could eat, operate his chair with his finger, and seemingly understand speech, then you’d think the family would have figured out a way to communicate with him.
September 9th, 2006 at 1:13 pm
Also, something I noticed, why does Princeton-Plainsboro Teaching Hospital have its own prescription blanks? I thought all doctors and practices in the State of New Jersey had to use the official blue Rx blank. Can anyone confirm?
And yea, the show is filmed in LA and such, but they do a good job keeping with the local nomenclature. Short Hills really is 2 hours away from Princeton, House correctly called it the turnpike, not a freeway, remembered the tolls. (Season 1 finale) The license plate blanks are correct (color and all) but the format of the numbers is off. But overall, they pay more attention to detail than other shows. And since I live in Jersey, take me to PPTH anyday!!
And who here wants an episode where House gets fed up with Cameron’s bangs and cuts them off? Cause i would.
September 9th, 2006 at 6:29 pm
[…] Further Reading: The PoliteDissent medical review of this episode, Television Without Pity recap […]
September 10th, 2006 at 4:14 am
Scott: Just found your reviews a few days ago, and I’ve just finished reading them all. Wonderful stuff, very informative. Memory being the funny thing it is, I’ve got a bad tendency to remember little snippits of information, without having any idea where or when I heard them; it’s nice to have a resource now that becan help me correct most of the bogus info I’ve been absorbing for the past two years. I was quite shocked to find how little criticism of the show you had; the episodes you gave very low ratings to on medicine mostly seemed fishy to me already; instead, some of your reviews have validated things I previously seemed ridiculous to me.
Everyone: Regarding the final scene, where House forges himself a perscription for vicodin: isn’t it possible that, despite Wilson’s dismissal of his complaint, his pain actually is starting to return? Clearly they don’t want to leave us with this impression, but the pieces are there, so it seems like a possibility…
September 10th, 2006 at 6:35 am
Will,
It’s more than possible that House’s pain has returned but it may be for completely legitimate reasons. Here’s a guy who’s basically been immobile for a number of years following his infarction. But following the shooting and the surgery, plus the miracle ketamine, he’s temporarily pain free.
Anyone would be bound to feel some pain if they pushed themselves over the edge. Running 8 miles to work, running up and down the stairs, doing tricks on a skateboard — and he had to eventually feel some pain. Remember the clinic patient who came in complaining of sore legs after she’d run 6 miles?
Much of his pain has always been real but a good portion of it has also been psychosomatic. He was very depressed for the latter part of the episode, what with Cuddy shooting down his idea of the cortisol and Wilson’s incessant psychoanalyzing.
Wilson was right about one thing though. He always was a buzz-kill (when he wasn’t actively feeding into House’s mania by playing games with him instead of working) but in this episode Wilson’s “tough love” approach seemed out of character and over-kill and it will be the cause of House’s further decline, although he’d hardly be likely to see it that way. He’ll see it as House’s fault and proof that he was right all along.
Btw, does anyone have a problem giving a damn about Wilson after “All In” and the revelation that he’d been sleeping with one of his terminal patients? I can’t stand to hear him “preach” about anything following that episode. Someone should let it slip about his affair. He needs to be taken down a peg or two.
September 10th, 2006 at 6:50 am
One of the reasons I love coming here to read Scott’s reviews is to get his medical take on the show. Having no medical background, I usually end up doing a lot of research on the Interweb (gotta love that word!) following each episode. But I think what bothers me most, despite the outcries that “it’s only a TV show,” is that despite that claim, the producers do a hell of a lot of boasting about how much they get right as opposed to what they get wrong.
For some viewers though, many of whom are suffering from some of the diseases that have been featured on the show, it’s the minor things that bug them most, especially when you realize that they have three or more doctors on staff acting as medical advisors. Sometimes you have to wonder if they even take a look at the scripts or if they’re just cashing their checks each week. That Vicodin script is a perfect example. Someone who takes the meds would definitely know enough to catch the mistake but the four (and this season they do have four again) didn’t? More importantly, David Shore himself is personally acquainted with Vicodin and they still made such a simple mistake? It kind of makes it difficult to excuse much of the rest sometimes.
Side note to John:
Vasculitis did finally make a rather anticlimatic appearance in one episode last season. Hence the reason they stopped using it so prominently in their differentials. It happened in “The Mistake.”
The joke is that for Season 1, the likely culprit was vasculitis while in Season 2 it was lupus. I wonder what it’ll be in Season 3.
Also, has anyone else noticed how a good portion of the patients in S1 had seizures and in S2 they had rectal bleeds? Can’t wait to see what they’ve got in store for us now!
September 10th, 2006 at 7:34 pm
On the Vicodin, its really, and sadly, not too odd for a doc to jumble the name of one of the bajillion vicodin/lorcet/lortab/etc name with a strength that doesnt match.
September 10th, 2006 at 9:12 pm
I have a question about when they did the pericardiocentesis on the woman with scurvy. Chase said he had to drain the fluid three more times and that if they didn’t find out how to treat her he would have to follow her around with a needle for the rest of her life. Wouldn’t they have put in a catheter if it needed to be drained so often? Would there be a reason where putting in a catheter would have been dangerous? (Bear in mind that I am not a medical person but my mom is a nurse and that just struck me as odd).
By the way, I just discovered this site and I love it!
September 11th, 2006 at 1:22 am
Great analysis. I just discovered your site so I expect I’ll be here every week for an evaluation of the medical side of the show. Here’s my question. I reviewed the symptoms list for wheelchair patient and based on that wondered if there were any contraindications for the cortisol shot. I ask this question for two reasons: at the end Wilson tells Cuddy - “just because House was right doesn’t mean he wasn’t wrong”; wheelchair patient returns next week - one scene shows him in the clinic and the other shows him getting another endoscopy. Looking forward to your comments.
September 11th, 2006 at 9:09 am
[…] If you’ve ever wondered how accurate the diagnoses are on House or just wondered what the heck they were talking about, this site is for you. PoliteDissent.com reviews each episode with an emphasis on the medicine. Very interesting (but with spoilers, obviously.) […]
September 11th, 2006 at 9:14 am
Just found your site…this is great stuff. I’ve been interested in knowing how the medicine stacks up for a long time.
Did anyone notice a similar kind of respect for the paralyzed man’s wife that he had for the jazz singer and the terminal cancer patient girl? I always find it fascinating to see who earns his repect, and why.
September 11th, 2006 at 11:03 am
Did anyone consider that the vicodin prescription might have been intentionally wrong to stop Joe Public trying (and getting away with) the same stunt?
September 12th, 2006 at 2:57 pm
I am curious as to why he couldn’t have written his own prescription on his own pad. He has certainly done it before. In one episode he single handedly got himself Nitroglicerin, LSD, and anti depressants. You can’t tell me those are easier to get a prescription for than pain killers.
September 12th, 2006 at 8:54 pm
Maria: First, I absolutely agree with Wilson. funny thing, I couldn’t rationalize it, but Wilson always seemed “too good to be true.” If I’d met him in real life, I would have assumed he was just a slick talker, good at getting people to see things the way he wants them to. His role in the hospital backed that up (as house put it, “You can tell a patient they’re dying and they’ll thank you.” or something to that effect) The only other thing I could point too for support of this belief was the fact that he was friends with House at all. How would a doctor as honest, ethical, and good as Wilson have ended up being so close with a doctor like House in the first place? To me, one of the most interesting aspects of the show on the soap side is the fact that Wilson seems like a better person than he is, while House seems like a worse one.
Re: the vicadin, haven’t seen tonights yet (it’s in the DVR, ready to go) but re: the leg, again I can’t back it up very well but my impression is that the pain really is coming back. Remember, house’s leg is as much part of the soap opera as it is of the medicine.
Now to watch tonights ep! Huzzah!
September 12th, 2006 at 9:02 pm
Non-medical person here, but when you are knocked out on the operating table, doesn’t all the nail polish come off for monitoring purposes? Why didn’t the pre-op team notice the scurvy toe?
September 12th, 2006 at 9:54 pm
Wow, these are great reviews! You guys will definitely interested in my new House MD fan forum over at DrHouseForum.com
We’re a small, friendly community, so come over and get in on the House chat!
September 13th, 2006 at 11:35 am
In regard to Colby’s question: doctors cannot write narcotic prescriptions for themselves.
And, in response to TVD: It is very possible for the doctor to mix up the doses of Vicodin/Lortab/Lorcet and even Percocet for that matter. My docs write prescriptions for pain all the time (cancer) and they STILL sometimes ask me what the dose is. Or, the pharmacy will call because the doc mixed it up.
I do buy that they may have done it on purpose to keep Joe Public from trying the same stunt.
September 15th, 2006 at 4:33 am
About Brad’s comment: “The joke is that for Season 1, the likely culprit was vasculitis while in Season 2 it was lupus. I wonder what it’ll be in Season 3.”
One of the rare complications of lupus is vasculitis, so that would explain Cameron’s fondness for this diagnosis. :)
I yelled out “He’s got a cardiac tamponade!” at the same time as Scott did. Hehe… I’m feeling good about my first year of med school when I can actually spot some of the stuff going on before the curtains are pulled aside.
September 15th, 2006 at 10:50 am
I’m so glad these reviews got continued! As someone here already said, it is an essential part of the “House” experience for me now. Kudos to Scott for keeping them up!
September 19th, 2006 at 1:32 pm
I thought the Ketamine was part of the hallucination? How then did it carry over to this season as working unless he is still hallucinating?
September 19th, 2006 at 10:27 pm
After having lost a great deal of my left thigh muscle due to deep and severe infection, I limp, and have had pain for years. People who lose muscle to the degree that House did use canes to walk, as I did for some time, not for pain. Losing as much muscle as he did should, painful or painfree, require extra support to make up for the loss of natural support. I understand that Hugh Laurie was sick of the cane, but can we at least agree that canes, walkers, and wheelchairs generally don’t cure pain, only make up for what’s been lost or severely compromised? I know, too, that they used this to justify his Vicodin habit, but I never found anything that even came close to killing mine–not even Morphine or Dilaudid, so I gave up and just worked on my posture.
This whole story line is completely unbelievable, but as long as we still get to see Hugh, it’s okay. I am tired of the others, though.
January 4th, 2007 at 10:25 am
I’m pleased to see a professional doctor giving good grades for the medical aspect
of this tv show. I was often wondering how a human being can keep all those details about nearly anything
to do with medicine in mind while having some - let’s say - psychological problems. Not to mention a
massive drug abuse. Maybe it’s this absurdity I like so much.
January 7th, 2007 at 10:49 am
I had a problem with this site, being an Addison’s patient myself, you cannot inject ‘cortisol’ - it isnt on the market! Its called ‘hydrocortisone’ :)
Cortisol is its name inside the body, but the preparation inside the needle is hydrocortisone, and the body will make it into what it needs if the patient is truly Addisonian.
And another thing - patient probably wouldn’t have survived tendon surgery if he was truly Addisonian, the stress would’ve killed him.
January 10th, 2007 at 11:58 am
Dear Scott,
I read your comments from Spain during all the last season. The third season has just started here. I am Orthopaedic Surgeon and I have enjoyed very much your comments.
Regarding this episode, I have a big problem with it. I saw the episode at the hospital with other doctors and we found ridiculous the final scene with that man standing up like Lazarus resurrecting, but this is not my main complain.
To my knowledge, quadriceps muscle is very useful for running and a muscle necrosis means pain sometimes but loss of function nearly always. I can accept that treatment applied to House can relieve the pain, but it cannot restore the function. Perhaps the limping may diminish in absence of pain, but not dissapear to that point: running, skating, stair climbing…
January 16th, 2007 at 6:36 pm
House Rocks man…even doctors like me are hooked. some of his actions little bit disired for. if i do this NHS i will be sacked. but he is cool. i wish he is good as me.
February 1st, 2007 at 7:01 pm
I’ve diagnosed scurvy before. The patient was a truck driver doing long distance hauls and living on meat pies.
I think he was anaemic, and had the corresponding macrocytosis, and bruising. No pseudo-paralysis, and yeah, it’s very rare. Never seen another case in the following 20 years.
February 7th, 2007 at 10:29 pm
I am watching this in Australia (down here from the US for the year). I don’t have the ability to re-watch the episode but I don’t think Addison’s disease is a complete explaination, wasn’t there mention of pressure on another structure- it was thrown out there so fast that I got a muddled understanding of his theory on hypothalamic/pituitary dysfunction. Addison’s disease can be fatal, but I don’t believe it can cause stupor for 8 years without the patient dying. He also likely would’ve had crisis with surgery without stress dose steroids and been more tan than George Hamilton. Also- if the patient just went through a tendon lengthening procedure on his legs he wouldn’t try to stand because that would cause extreme pain, even with opiate analgesia, but it makes for good TV.
The scurvy girl isn’t that far fetched, especially with the Atkin’s type diet crazes. I still have a hard time believing it would cause sudden paralysis, maybe a gradual paralysis, without a spontaneous bleed into the spinal cord/brainstem. This would also end up likely causing autonomic dysregulation depending on the level. Another question to those who can rewatch the episodes- did she have a Foley catheter bag? If I was considering someone having a spinal cord lesion I’d also be discussing rectal tone and want to know about urinary retention/incontinence..
I think it would’ve been more convincing if she just had lower extremity paralysis…
Thanks for explaining the show Scott- I’ll be getting the DVDs when I get back to the states. I didn’t watch it last year cuz I was in internship- also the early episode where he diagnoses 5 patients in a few seconds put me off the show. But his quotes now are almost as priceless as Dr Nick Riviera’s! (simpsons)
Keep it up!
Sorry for the long medical post
Tim
March 17th, 2007 at 6:24 am
Why does he have an electric scooter if he is basically brain dead? And how would he be able to eat a hamburger? And wouldn’t he be able to at least blink out answers to show he has cognition (for those 8 years)? You’d think his wife would have noticed.
The needle into the pericardial sac comment is quite valid. You would need (ideally) an echo cardiograph machine to guide you so that you wont hit the heart.
April 26th, 2007 at 6:33 am
I’m so glad these reviews got continued! As someone here already said, it is an essential part of the “House” ……….. experience for me now. Kudos to Scott for keeping them up!
May 20th, 2007 at 11:55 am
We had a case of scurvy here a few years ago. It was a university student living on primarily KD because they couldn’t afford are more balanced diet. Quite the catch for the diagnosing physician who just happened to be reading about the Franklin Expedition.
July 12th, 2007 at 5:49 pm
I want a deeper discussion about Cameron’s new hair cut. Scott, maybe a small forum attached to this site…
July 19th, 2007 at 1:25 pm
>>I am curious as to why he couldn’t have written his own prescription on his own pad. He has certainly done it before. In one episode he single handedly got himself Nitroglicerin, LSD, and anti depressants. You can’t tell me those are easier to get a prescription for than pain killers.
September 11th, 2007 at 12:13 pm
I’m new here, but found it interesting and thought I’d say so. I will be back.
September 25th, 2007 at 2:18 pm
My GF just bought House Season Three, so I get to read these again! w00t!
BTW, one my best friends has scurvy and didn’t notice ’til it started affecting her teeth. A poor diet of fast-food crap and soda can apparently lead to vitamin deficiencies — who knew? *grin*
September 28th, 2007 at 2:09 pm
I was wondering why her gums weren’t anything like Jack Sparrow’s. At that stage of scurvy was it realistic?
September 29th, 2007 at 1:50 am
Nick, I was thinking the same thing. She looked extremely good for someone with scurvy. For a more accurate description of modern scurvy, see this NYT article:
http://www.nytimes.com/2006/02/26/magazine/26wwln_diagnosis.html
December 10th, 2007 at 9:40 pm
Regarding the prescription for “Vicodin ES 5-500.”:
I think that “mistake” might have been deliberate. The producers of the show have to keep in mind that a viewer might watch the show, see what House is writing on Wilson’s prescription pad, and then steal a real physician’s prescription pad in real life and write exactly the same thing. To guard against that, the producers might have deliberately had House write something that no real pharmacist would accept as a valid prescription.
It’s similar to the habit of using non-working telephone numbers with the “555″ prefix on television and in the movies. If you don’t think that’s necessary, just ask the unfortunate people who had the phone number 867-5309 in the 80s.
December 12th, 2007 at 11:03 pm
I found it hard to believe that he could run so well for someone missing a chunk of his major muscle group. I kept wondering if those scenes were more hallucinations. Seemed unbelievable. It wasn’t just pain that was crippling him, after all.
But I could see how the mere fear of that pain returning would spur him to stock up on the Vicodin. He never wants to be there again. He needs the reinforcement of confidence, I think it was wrong of Wilson to conceal his success from him. W seems to think this is the old House who needs taking down a peg, unusually insensitive for W.
January 10th, 2008 at 9:29 pm
Now that season 4 has started I’d ask this. If House needed more Vicodin why didn’t he just dip into his secret stash which was revealed during the Tritter arch instead of using wilson’s pad. Why was he able to run if a chunk of his leg was gone. Answer: It’s a TV show. The one flaw, writers sometimes need to write unrealistically so the season can continue. Another thing. Episode 4 season 3, Lines in the Sand: House walks into Cuddy’s office demanding his carpet back-Notice he WALKS not LIMPS into her office.
January 18th, 2008 at 2:49 am
I saw the first 2 episodes of season 3 2days ago on french tv. It was my first encounter with the series and i just loved it. Thanks for your commentaries, i’ll try not to read them ahead.
January 31st, 2008 at 3:17 am
As a reply to comment 62, seeing as I also have Addison’s it’s unlike he’d have lived long enough to even make it to the surgery let alone be in a wheelchair - He’d have already been hospitalized and in a coma if not dead.
The cortisol/hydrocortisone dissection also bothered me, but I don’t like how nobody else picked up on how that even if it was the correct injection, it would’ve run its course through his body within 8 hours, unless he was injected with prednisolone (4x strength) or dexamethasone (40x strength). A simple injection cannot ‘cure’ this condition, and if it could I would’ve had it done when I was diagnosed at 2 years.
February 17th, 2008 at 10:46 am
Cookie, I’m no expert but as far as I know, there’s no “wrong hand” for the cane. It’s usually more helpful to the injured leg to carry it on the opposite side, but eventually it’s down to the personal preferance of the patient. If House feels more comfortable using his right side/hand, they’d let him.
March 28th, 2008 at 1:34 am
I have a serious issue with this episode that I’m shocked you didn’t mention: the fact that he stood after having a tendon release surgery. I had that a few years ago on bilateral hamstrings and left achilles tendon, and it is by far the most painful and weakening surgery I’ve ever had. I have ataxic Cerebral Palsy due to a right IVH brought on by hypoxia from prematurity, and hadn’t walked for 6 years since the surgery. I assumed they released his hamstrings since those are usually the muscles that atrophy after using a chair, but at any rate, why didn’t they have a cast? I know it’s just TV, but that’s what polite dissent is, I guess…
March 28th, 2008 at 1:38 am
“OK, I have to make one complaint: the patient got better way too quickly and was standing incredibly well for someone who hasn’t used their legs in eight years and just had tendon surgery done.” Crap. I hate when I miss stuff like that. Would you please delete my previous comment?
May 5th, 2008 at 12:52 am
Of course, but what do you think about that?,
June 16th, 2008 at 10:59 pm
Does anybody know the type of shoe house is wearing when he is skateboarding? I saw they were nike’s, but I have no clue of the model. They look very nice, and I would like a pair.
Does anybody know which shoe it is or have a screen cap?
Thanks.
July 5th, 2008 at 12:28 pm
Sorry, but to be honest I did not get it at all!
Why should someone with addison be paralyzed and or suffer from a- or bradykinesia for 8 years?!
And then again, how should this not show up in the blood test since the main symptom of the disease is hypocortisolemia?
And in addition shouldn’t the lack of adrenocortical hormones in this, as I understood it secondary adrenal insufficiency screw around with all kinds of other blood values( e.g. Hyponatremia,Hypokalemia, pH (lower), Glucose, Free Fatty Acids,…)
And shouldn t the guy suffer from low blood pressure and most importantly recurrent infections too?
To sumarize all my doubts, how should 8 years of severe addison disease not have shown up anywhere? Especially in the blood tests.
Did no one ever test for hormone levels if the guy suffers from reccurent infections? And how did he not develop addisonian crisis if the depression was big enough to cause such major problems?
I d be very thankful for an answer.
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