House - Episode 6 (Season Three): “Que Sera, Sera”
An average episode of House with a definite been-there/done-that vibe to it. As always, there are spoilers in this week’s House review, so consider yourself warned.
George, a man weighing over 600 pounds, is found comatose in his apartment. He is brought to the hospital and assigned to House’s team. The first thought was diabetes, but his blood sugars and other diabetic screening tests are normal. An EEG was normal as well (except for that whole coma thing). Cameron suggests he may have eaten some bad pufferfish (improperly prepared, pufferfish contains tetrodotoxin, a potent neurotoxin). House suspects Pickwick Syndrome (also called Pickwickian Syndrome), an extreme form of sleep apnea named after The Pickwick Papers, a novel by Charles Dickens which contains a fat character who is always falling asleep.
Other thoughts include syphilis or a stroke. The MRI can only support 450 pounds, but Cameron (with lots of help) manages to get George’s head into the machine. The MRI is normal, but George wakes up once he’s in the machine and panics. They get him out, but in the process break the MRI table.
The differential diagnosis now includes head trauma, acute adrenal insufficiency, and sexually transmitted diseases. All tests are normal and these conditions are ruled out. During the exam, it does emerge that George has a history of hereditary nystagmus (a rhythmic twitching of the eyes).
Now that George is out of his coma, he wants to be discharged. House accuses him of really knowing what’s wrong, but just not wanting treatment. He suggests several extremely rare and serious diseases such as OCT deficiency (ornithine carbamoyltransferase deficiency, an inherited metabolic disease), thyrotoxic periodic paralysis, and leukoencephalopathy but George denies he has the conditions, or has even heard of them. He demands to be discharged and threatens to leave AMA (Against Medical Advice).
As George is leaving the hospital after discharge, he has a sudden episode of disorientation and crashes through a plate glass window; he is readmitted. Foreman now thinks George might have neurofibromatosis, but Cameron admits that she slipped George some medicine to disorient him so he wouldn’t be discharged.
With the chief symptoms of coma, fever, and loss of appetite, House speculates that George might have Chagas Disease, a condition caused by an parasite carried by the reduviid bug (also known as the “assassin bug” or the “kissing bug”) and he wants to test his cerebrospinal fluid (CSF). A lumbar puncture (also known as a spinal tap) is the normal way to obtain CSF, but Foreman tells House that George is to fat for a spinal tap to work. House tells Foreman to get the fluid directly from the brain. In the middle of the fancy needle-near-the-brain procedure, George suddenly goes blind, despite the fact that Foreman is nowhere near the optic nerve or visual cortex of the brain. Foreman suggests Multiple Sclerosis, but with the blindness, House once again suspects diabetes.
George refuses any further diabetes testing since he has been tested many times and has always been normal; he thinks he’s just being tested because he’s fat. When House tries to force him to drink the syrup necessary for the test, he notices that George has clubbed fingers. An x-ray confirms this (though x-ray aren’t used to diagnose clubbed fingers) and Wilson performs a bronchoscopy which shows that George has small cell lung cancer which has already spread to the lymph nodes; his prognosis is terminal. His symptoms were caused by the paraneoplastic syndrome, a rare disorder caused when the body’s immune system overreacts in the presence of a tumor and ends up attacking healthy cells.
The medical mystery was interesting, probably more so for medical professionals watching the show, because we were all convinced it somehow tied into his weight. Paraneoplastic syndrome was a clever answer, but it’s been used on House before — it’s what the teen model had in the infamous episode, Skin Deep. Additionally, I’m surprised the team missed the clubbed fingers because it is one of the first things medical are taught to look for when examining the hands – that’s a third-year medical school mistake. Since clubbing is usually caused by chronic oxygen deficiency (and that was the implication here with the lung cancer), I’m wondering why they kept reassuring us that George’s oxygen levels were normal when they shouldn’t have been.
I give this episode gets a B+ for the mystery but only a C for the solution because it was used just last season. The medicine earns a B-, because it was a little sloppy and clubbed fingers were wrong on a few levels (the diabetes testing was also a little off). The soap opera aspects earn a strong B+ for both the Cameron/House and House/Cop scenes (not to mention the Wilson lying to the cop scenes).
My wife mentioned that the cop was particularly unpleasant. I asked if she thought he was more unpleasant than House, and she said yes because the cop was doing this for no other reason than vindictiveness. House has been petty, but never vindictive like this. I thought that was a good point.
Lyrics to the classic Doris Day song Que Sera, Sera
The previous House review
A list of all prior House reviews
November 8th, 2006 at 12:21 am
Also, House is a jerk, but he doesn’t follow people around in order to deliberately make their lives miserable.
Well, except Cuddy and Wilson. But that’s not quite the same.
November 8th, 2006 at 12:49 am
Great review as always Scott–
It seems that the writers really enjoy the paraneoplastic syndromes b/c they can cause a multitude of diverse symptoms that mimic other disease states. I predict we havent seen the rest of them. They also used a pheochromocytoma in Season 2 Episode 1: Acceptance.
November 8th, 2006 at 1:37 am
I like the review very much too.
I am not sure if I am alone on this, but I feel Dr. House has becoming meaner, and I feel uncomfortable seeing that from a doctor — the way he treated the cop, and in this episode, when he suggested to the patient complaining the pain in the clinic that the left arm should be cut off. House has also become violent. This also makes me actually sympathetic with the cop.
Perhaps I am missing something but I really begin to dislike the way House treats patients.
November 8th, 2006 at 8:54 am
He has become meaner, and a lot less funny this season. That will only be good if he cracks at some point and has to be institutionalized. If he just keeps being mean for no reason, (or at least no plausible reason) all the fun will go out of the show. He’s just not sympathetic.
November 8th, 2006 at 10:06 am
Just a question:
You said that if he had lung cancer his oxygen should be low. They said in the beginning that his oxygen levels were normal, and then House said that they were normal for an average weight person. Do the oxygen requirements of the body increase with weight? Even then, it doesn’t really explain it, but it may have been what the writers were going for.
November 8th, 2006 at 10:24 am
Official Comment
That’s good point Kevin, and the answer is yes and no.
Generally speaking, the more mass a person has, the more oxygen they are goint to require. A person’s exact oxygen requirement can be determined, but it a long involved process and doesn’t really add much to a patient’s treatment.
On the other hand, the tests we more commonly use (and the ones House mentions)just look at the end results: is enough oxygen making it to the blood and (one assumes) the tissues? According to House, these were normal. But I suspect you’re right about the writer’s intent.
November 8th, 2006 at 10:48 am
I agree that House is getting meaner, and as I said last week, it’s in a way I find uncharacteristic. The House of the previous two seasons would never have gotten into a wrestling match with a patient. It was stupid. I thought he was doing it on purpose, that he was trying to spill something “meaningful” or provoke a reaction, but no. The House I know and love/hate would certainly have gotten into a fight in order to prove something, but not just like that!
I don’t mind the arm amputation analogy for just that reason. He’s capable of being mean to prove a point. And of course, there is something wrong with waking up in pain because you slept funny, just not something House can treat. Maybe a new bed, maybe massage, or exercise, or chiropractic, or physical therapy; any of that might help a person who is unhappy with his own aches and pains. But House treats everything that he can’t do himself like so much quackery.
November 8th, 2006 at 11:27 am
Hugh Laurie and David Morse deserve a little more credit as actors. A week passed in our time between the last episode and this one, but only one night did in the world of House. Despite his bravado, House is genuinely scared about the arrest and investigation. Hence, he’s going to be meaner, less funny, and more erratic. He seems to make mistakes and bad guesses as the soap opera elements get serious. The cop may be vindictive, but he’s also being a good cop. House is breaking the law and endangering other people by doing so. The cop’s handling of the forgery with Wilson shows that he’s concerned with the well-being of everyone around House.
November 8th, 2006 at 11:43 am
I think House is getting meaner, but it’s more of a symptom of pressure. Throughout the series’ villains, House always knew he had some sort of upper hand. In the case of Vogler, he had tenure. In the case of Warner, he was the doctor and therefore an authority figure (that to me was more about comic relief anyway). In this case, we see House a lot more vulnerable than he has been before, because he’s fighting someone outside of his home turf of the hospital. For this reason, he’s more stressed out and he’s taking it out on his patients/ those around him. We also see him becoming more careless with his interactions with others (like when he mentioned Cuddy’s sperm search to Foreman and Cameron).
I think what’s even more interesting is the Scooby Gang’s attitude. It seems that they’re getting more reckless in terms of the rules and are adopting more and more of House’s tactics (like we see with Cameron drugging the guy in this episode to keep him in the hospital or Foreman setting House up in his bet in the previous).
November 8th, 2006 at 1:42 pm
Yes, House is getting meaner, but I think that is consistent with an addict’s behavior. The ones I have known do tend to go through a general decline in their treatment of others, more so when put under stress, and especially when that stress is direct confrontation about their addiction (like, say, getting arrested and having their drugs confiscated).
What was up with Chase disappearing from the episode after House told him to do nothing? Were the writers unable to think of any more ways for him to be dismissive of a fat person (which he’s done before, in Season One’s episode “Heavy”)? Or did Jesse Spencer need a vacation?
And I’d like to say, it was a pleasure to see Pruitt Taylor Vince (George). He always plays side characters, but he is an excellent actor and I always like seeing him - even behind that fat suit. I am pretty sure the nystagmus lines were thrown in there strictly because they cast him.
November 8th, 2006 at 4:17 pm
Its interesting to hear your comments about the medicine on this show. When watching it, I actually felt at one point that the whole patient issue was thrown in purely because this is a medical show, and they didn’t want to have a whole hour devoted to the soap opera side of things (which today I felt was excellent, even with all of the Fox spoilers they’ve thrown around). Now I’m wondering about Wilson, potentially more than House.
November 8th, 2006 at 4:38 pm
I’m a bit confused on the lumbar puncture. I’m in the midst of an anatomy class (not a medical student, just a curious guy earning some science credits and learning some fascinating things) and in learning about the spinal column we talked about LP and CSF. I was under the impression that going to the brain for CSF is a very bad idea and isn’t done. Can it be done in extreme cases like this? Or is this just tv show stuff?
November 8th, 2006 at 4:53 pm
My suspicion is that Chase is as usual buckling to authority. I think he’s dropping the cop information, and that’s why we didn’t see him - he was busy doing that.
November 8th, 2006 at 6:27 pm
Hi Scott - I have a medical question…is there some reason that House couldn’t try the ‘Ketamine treatment’ a second time for his leg pain?
K
November 8th, 2006 at 6:34 pm
I think the reason House is meaner is because of his failed muscle treatment — Wilson and Cuddy said as much in the early episodes of the season.
November 8th, 2006 at 8:52 pm
I also was disappointed with the final diagnosis. Not only was paraneoplastic syndrome used before, it was mulled over as a possibility in at least 2 other episodes. I wonder if the writers just hate to waste their research?
November 8th, 2006 at 9:01 pm
I have to say I was rather surprised with the sloppyness of the medicine in this episode. Firstly why did they keep harping on diabetes so much? If the A1C test was normal when he was admitted it would not change drastically over the course of a few days, no matter how much House insists it could. Secondly the jump to neurobromatosis was pretty premature, especially with no visible neurofibromas or cafe-au-lait spots (then again there was a lot of… area to cover).
Can’t complain too much though, the soap opera is getting quite interesting. I hope House doesn’t put Wilson through any more sorrow… but we all know that is going to happen!
November 8th, 2006 at 9:33 pm
I wasn’t bother too much by the medicine. I was more intrigued by the problems of handling an extremely obese patient, a somewhat topical problem.
I can buy House being meaner than usual because of the stress of having Moriarity on his case. He can’t easily dismiss him like the patients or the ducklings.
November 8th, 2006 at 11:08 pm
I’ve been wondering how much of House’s behavior surrounding the Vicodin is due to Pseudo-addiction, where a person has pain that is insufficiently treated and they exhibit behavior that the clinicians label as drug seeking behavior. Also, of course House was meaner this episode. Not only is he being harrassed by “Moriarty” but he just tolerated a forced detox over night in jail so his pain would be out of control. He would also be suffering from opiate withdrawal as he is physically dependant on the opiates due to taking them so long for chronic pain. He should never have been trying to practice medicine after going through that and Wilson should have just made him go home. Shame on you Wilson! Hugh Laurie and David Morse did a wonderful job with the acting on this episode. They have a wonderful antagonism that had me on the edge of my seat for the whole episode, wondering when David Morse would pop up again. Hugh Laurie’s subtle expression of horror at his slip about Cuddy trying to become pregnant was a gem. Even if the medicine on this show is shoddy it is still the best on TV due to the Wonderful acting and fun soap opera details.
November 9th, 2006 at 1:47 am
Jono,
We have seen Cameron trick a patient to manipulate the situation to achieve what she thinks is best for the patient. She “accidentally” left some pills in the room of the woman with Munchausen’s. She often manipulates people (patiends and doctors) to get what she thinks is best for them.
I actually liked how House slipped about Cuddy’s fertility issue. He’s only human (gasp!) and we all slip sometimes,but it says a lot about how he respects his friendship that he did such a good job covering it up (at least to the gullable, like me).
With the cop story, I wonder if House can claim that the cop has a personal bias, and therefore at least some of the evidence is inadmissable. Don’t they do that all the time in TV? It almost seems as if House has room to counter-sue for harrasment, if most of the charges don’t stick.
~Sam
November 9th, 2006 at 5:57 am
I had a thought last night - suppose Chase is not reporting to Morse on House, but is out gathering information on Morse for House? He’s a sneaky little worm, and House might use him.
If I’m right, I demand kudos (and I mean the chocolate bar) from everyone.
November 9th, 2006 at 10:23 am
Long time lurker, first time poster. I was wondering how hospitals actually do deal with seriously obese patients. MRI machines (and presumably other equipment) can only cater for people of a certain size and our society is getting increasingly overweight. An episode of Scrubs I watched mentioned using equipment normally used by zoos (which seems degrading). Surely this isn’t a new situation and most major hospitals have work arounds.
I love House and have enjoyed reading your reviews since series 2. If you want to see Hugh Laurie as House’s exact opposite watch Blackadder the Third where he plays the Prince Regent.
November 9th, 2006 at 1:31 pm
A question for the medical professionals:
How do you do a CT scan or MRI on someone that obese, if the machines have a weight limit?
November 9th, 2006 at 2:16 pm
Official Comment
Jack,
Open MRIs can handle more weight, but even they have an upper limit. Plus their resolution is not as good as a standard MRI.
The reality is that some patients are simply too big for MRI or CT scanners.
November 9th, 2006 at 3:08 pm
I wish that the next House antagonist would be more like House — not just stubborn but funny about it.
Could the scoobies have missed the clubbed fingers because of the patient’s size?
November 10th, 2006 at 7:11 am
Chris - The scoobies swing from one extreme to the other: they either ignore the obvious because they’re being ‘politically correct’ (I hate that phrase) or because they automatically assume a patient’s problems stem from some moral weakness, like overeating. Aren’t we all learning a lot from them? It’s like an after-school special from the seventies…
November 10th, 2006 at 4:49 pm
I dunno whether I’d say the drama was really good. I thought the sub-plots were interesting, but we didn’t get anywhere with them. Then again, I’m always irked by unresolved issues, like the whole “Who was fat in your family”‘ House pulled on Cameron. Since the cop seems to be this Season’s antagonist, I didn’t expect that subplot to develop too much, but those were the main two, and they basically went no where by the end of the episode.
November 10th, 2006 at 8:22 pm
Missing the clubbed fingers is all I’ll remember from this episode. Maybe not as easy when fingers are stubby? That and the fact that I couldn’t help thinking of the XFiles episode that Pruitt Vince was in. A nursing colleague of mine did say that they’ve sent bariatric patients who were too heavy for the hospital MRI to the zoo “where they do elephant MRIs”. Glad to see these boards are getting a fan base. Props to you Scott for helming this forum.
November 11th, 2006 at 4:30 pm
I thought Cameron’s explantion for doing the MRI on the patient even though he was above the weight limit for the machine was interesting. She argued that since morbid obesity was a recognised medical condition, the patient could have sued the hospital if he had failed to receive an accepted standard or care. I wonder if that would also apply in this case as he saw nothing wrong with his weight.
While Tritter may be going after House with more than usual pursuit, House did blow off his concerns in the clinic by failing to give him a proper examination and disregarding his worries about his condition. (And Tritter had to wait to see House for 2 hours, not surprising that he wanted more than a 20 second exam.) House then humiliated him by leaving him with a rectal thermometer, throwing the swab in the garbage and heading off home. As Tritter said,House is a bully and bullies don’t learn unless they’re confronted by bigger bullies.
In an interview, David Morse said that Tritter recognised an adict’s behaviour in House and that’s why he pursued him. In terms of the soap opera, it’s possible Tritter has encountered a previous doctor who was an addict and negligent in his treatment of his patients. Doctors and cops, both using their authority to make things happen their own way (and ranked numbers 1 and 2 respectively on studies of spousal abuse).
November 12th, 2006 at 1:52 am
Tritter attacked House just because he was rude, i.e. picking a fight, and then he followed that up by abusing his position to get revenge. Why was he doing this? Because House was rude to him. Tritter is the only bully I see.
November 12th, 2006 at 10:29 am
“…Foreman tells House that George is to fat for a spinal tap to work.” You used the wrong word. The sentence should read, “Foreman tells House that George is too fat for a spinal tap to work.”
November 15th, 2006 at 12:38 pm
Odd Question: WHO CALLED THE FIRE DEPARTMENT TO REPORT THAT GEORGE WAS DEAD????
We know George’s parents live elsewhere, and the young woman who let Cameron into his apartment said “I THINK his bedroom is over there,” indicating it wasn’t she who found George’s apparently lifeless “body” lying on his bed.
So WHO called 911? …A hooker? …With a key? The front door wasn’t damaged, so the emergency personnel must have been let in by someone…
Odd Confession: I sat through the entire episode wondering how they did the nystagmus effect so convincingly, and trying to figure out how nystagmus fit into the overall diagnostic puzzle. What a dufus! It never ocurred to me that the actor himself might have it.
Duh.
November 16th, 2006 at 1:23 pm
Scott:
Wouldn’t Pickwick Syndrome result in chronic oxygen deficiency and account for the clubbed fingers?
November 17th, 2006 at 7:33 am
Scott,
I’ve decided to finally go to medical school (my mother is an epidemiologst) but I’m a little older than your average student (almost 30). Will I have issues with getting admitted due to my age? Also what specialties are popular/not popular these days–I am interested 8in pain management. Can you tetll me a bit about what med school is like?
Also, is ketamine actually used medicinally these days?
November 17th, 2006 at 8:51 am
Official Comment
MSB,
Age has little to do with admission to medical school; in fact, many schools are looking for the “non-traditional” student, who has real world experience prior to medical school.
Popular specialties vary somewhat depending on what school you’re attending. Many of the surgical subspecialties and ER remain popular, while primary care is less so (mostly due to increasing hours and declining reimbursements). My recommendation would be to go with what interests you since you will (hopefully) be doing it for the rest of your life. Most pain management specialists are anesthesiologists by training.
The first two years of medical school are mostly classroom work, while the last two years are in-hospital clinical work. It’s a good idea to try out different specialties as you go through medical school to see what you find the most interesting.
Ketamine is very rarely used in medicine. It is more commonly used in veterinary medicine, however.
November 17th, 2006 at 9:19 am
Dear Dr. Scott,
Thanks for getting back to me so soon! I was really worried that I was too old even to apply. If you have any other advice for me on applying/choosing a school etc., please feel free to email me. I love your site–my mother actually introduced me for it, but she found it through a story about a comic book doc who seemed to carry aound his own pharmacy of painkillers…now that was hilarious.
Best wishes…
November 19th, 2006 at 1:20 pm
Sorry, Scott, but I give you a “C” on your medical review. Clubbing is *not* caused by a dip in oxygen levels. It’s caused by some humoral factor(s) on the venous side of the circulation that somehow reach the systemic side. Presumably these humoral factor(s) are normally filtered out in the lungs. Thus, I take clubbing as a sign of a right-to-left shunt. In fact, unilateral clubbing is present in certain congenital circulatory malformations, which your theory would be completely unable to explain. It’s also possible, I suppose, that a lung tumor could synthesize these humoral products, a la a paraneoplastic phenomenon (or the tumor could have associated shunting). Not all shunts are detectable using oxygen saturation.
I’d also point out that dilantin in distributed in adipose tissue. Hence, three grams for a 600 pound man does not sound like an excessive dose.
Yok
November 29th, 2006 at 6:14 pm
First timer here.
I have to agree with the fact that House kind of deserves the cop’s ire. As brilliant as House is, he’s made a lifetime habit of defying the Mores of the society he lives in. His success at what he does has bought him some leeway, but eventually the conflict between the Mores of society and the Mores of an individual has to resolve itself, and of course society frequently wins through simple scale.
Moral violations;
House is an addict. America considers addiction to a substance a moral violation.
House operates daily on his addiction; he conducts medical procedures, rides a bike, etc, all while doped up on Vicodin. Whether this *actually* impairs him or not is academic, the perceived risk is enough to render this a moral lapse according to American society.
House disregrards procedure and ethics as easily as the majority of American drivers disregard traffic law; Considering the number of medical tort cases America has to deal with every year, this is not a small matter in peoples’ minds.
Then there are the folkway conflicts (a more is an ingrained and nigh sacrosanct social norm, from which we derive the term moral. a folkway is a lesser norm, on par with “you don’t start conversations in a public restroom”).
House routinely disregards all manner of folkways, which needn’t be gone into in depth.
So House, a figure of particular infamy, then comes up against a force of authority tasked with the enforcement of societal mores. They are of equal willpower and mental capacity, this much is clear. The difference is, House is relying on smoke and mirrors (the value others place on his abilities, primarily speaking) to carry out his lifestyle, whereas Tritter (the cop) relies on a vested legal authority with actual powers of punishment.
Essentially, one *cannot* strike out against society as much as House does without society eventually imposing serious consequences, and I applaud Tritter. House shouldn’t get a pass simply because he’s always right.
December 9th, 2006 at 12:33 am
The part about this episode that really got me yelling was right at the beginning, when the scoobies are told that the hospital doesn’t have a weight that can register over 350 lbs. What?? What kind of rinky dink hospital is this? I live in Hicksville, NY, and my hospital has a bedweigth that can go to 600 lbs. before we pull out the special scale. Were they trying to make it seem that a gentleman of his weight is uncommon in a hospital? Because that’s just not true!
January 2nd, 2007 at 9:38 pm
Good review, but I have a question,
cant Chagas be tested for from a blood sample. Would they really need a sample of CSF?
June 10th, 2007 at 7:04 pm
To Yok, commenter #37 … According to Harrison’s “Clubbing of the digits can be found in lung cancer, interstitial lung disease, and chronic infections in the thorax…” “Clubbing can also be seen with congenital heart disease associated with right-to-left shunting …” Either way the end result is hypoxia in the peripheral blood vessels. And “humoral factors”??? the only “humors” I can remember from my first 2 years of med school are the aqueous and vitreous of the eye. Or are we talking medieval medicine where his “blood humor” must be out of whack, so we should do some blood letting?
And as far as the Dilantin (phenytoin) thing, the dose for status epilepticus is 15 - 20 mg/kg which at a max dose would be about 5.5g but with a max of 1500 mg/day … 3 grams is twice that!
June 14th, 2007 at 9:18 pm
This has to have been one of my least favorite House eps ever, and I am a big fan. I felt entirely cheated on the medical end. Besides the great actors they have normally, they had a great guest actor in the form of Pruitt Taylor Vince, and they completely wasted it. Aside from the You-have-diabetes/no-I-don’t debates, no one really seemed interrested in looking for another cause. THey did off and on, but of course it came back to a weight issue over and over. And then, at the end, lung cancer comes out of the middle of nowhere.
I agree, there is no way that they should have missed the clubbed fingers. In *Sports Medicine* House picks up on it almost immediately while talking to a man sitting on the bleachers.
If they’re going to use paraneoplastic syndrome, which can do so many different things, there should be something interesting about it. Instead we get an 11th hour, “oh, it’s lung cancer.” And Pruitt Taylor Vince’s sudden, “but I never smoked.” (Which was entirely out of character for the character, who seemed more like the type to get hit by a bus, and say, “Hrumph, what are the odds they didn’t see me?”
To be perfectly honest, I think the writers came up with the idea, “Well, what we we did a show with a really *fat* guy like a *really* fat guy.” And then got all caught up in that, and never bothered to write an ending to the episode. So it’s just “paraneoplastic syndrome/lung cancer,” a very un-interesting diagnosis. Did they just jump on that so they could put in the obligatory anti-smoking message?
I just think it’s funny that when the main character of a show pops Vicodin constantly, drops LSD to treat a migraine, and has a best friend who helps provide his patients with medical marijuana (which House has no compunctions about trying to get his hands on, nor does Wilson act very surprised that House did so) the they are still pressured to try to drop in anti-smoking messages whenever possible, to the point that it seems entirely artificial.
I would have much preferred it turn out to be something that mimicked diabetes, but had nothing to do with his weight, something that *caused* his weight,(And they got distrcted by symptom vs. sickness) or how about something related to the nystagmus? Instead, none of those. It’s all coincidence, and we’re given a diagnosis at the end out of left field.
Granted, speaking as someone who is not a medical specialist, but who has a fairly good layman’s grasp of medicine, and a large amounts of scientific interest and knowledge, we may not be able to say, “Oh, I bet it’s So-And-So’s Syndrome,” but we can say, “I bet it’s something affecting his thyroid.” (I also thought about fugu poisoning, but I figured it was moving too slowly. Then again, fugu poisoning that had a delayed onset because of the body mass of the person poisoned, would have been very interesting. (The guy liked gourmet food, liked cooking, and had a pretty big ego and a good ammount of money from what we can see. Does it seem unlikely that he is the type would try to prepare his own fugu and then botch it? Seems possible to me.
But no, let’s not go into any of the interesting possibilities. Let’s just say it’s. . .oh, I don’t know. . .lung cancer, why not? Do we really need a lesson in chasing horses instead of zebras? The point of this show is to chase zebras.
September 12th, 2007 at 4:37 pm
Actually, this is the third time that paraneoplastic syndrome has been used. The first one was an episode with a pregnant woman towards the end of season one. She actually had lung cancer too. I wonder if it will show up in season 4…
October 5th, 2007 at 4:07 pm
Is it possible to fall thru a plate-glass window without cutting yourself to ribbons?? George didn’t seem to have a scratch on him!
I like my House mean. I just love his biting sarcasm. And his accent!
October 10th, 2007 at 12:39 pm
Thanks, that’s just what I thought! Why do they speak of “normal oxygen levels” in the beginning and end up with clubbed fingers? Just doesn’t make sense.
October 10th, 2007 at 12:41 pm
However, I would argue, that it may be hard to diagnose clubbed fingers on a person of that weight. You could easily think he’s just fat and his fingers, too. ;)
October 14th, 2007 at 3:53 pm
Could someone pls tell me the name and the intpret of the song House is playing on his e-guitar at the end of this episode (around 10 sec.).
Sounds a bit like Bob Dylans “Like a Rolling Stone” etc…
Please help! Thanks.
Regard
Merk
December 22nd, 2007 at 6:06 am
Maybe it´s a bit late to leave comments on this episode, but I just got 3. season on DVD since they don´t show it on danish television. We´re usually a year behind on american shows on TV anyway.
I´m suprised on the way they describe the treatment on SCLC in the show. Cameron described the treatment as radiation but without much hope, as I remember.
In anonther show they jumped right to experimental protocols.
Where I work (I´m a nurse on a cancer ward), we always treat with chemotherapy (80% response or so), even if the patient is in a very bad condition, and with at least one or two other possible treatments of chemotherapy in case of remission or remaining tumours after 6 courses of chemotherapy.
We add concommintant radiation to the thorax in case of limited disease or as palliative treatment, and sometimes profylactic brain radiation as well.
I believe its possible to have limited disease despite the presence of paraneoplastic syndrome.
I think they were a bit fast in dismissing treatment on this patient. I hope it´s due to bad writing and not bad medicine in your country.
Thanks for putting in the work on this website; I enjoy reading your reviews though I must admit it spoils the fun of watching the show a bit.
I think the show should hire you as medical consultant in stead of the morons they use now.
And like you I am embarrassed every time they confuse pleural effusion with lung oedema.
January 29th, 2008 at 3:37 pm
I like reading your reviews, thanks a lot for them, Scott.
One thing that nagged me about the episode, though, would be why they had to go and break their MRI table. I mean, didn’t they have a portable MRI that they used in a couple previous episodes? Specifically Season Two, Episode 2 where they bolt the little girl’s head to the table and I think it gets mentioned in the Euphoria two parter after House blows up the MRI with the bullet and the rest of the hospital falls back on the portable one as backup.
Seems to me that this is a convenient writer oversight.
February 17th, 2008 at 4:07 pm
I just discovered this website, so please excuse my being late to the party. I work for a major manufacturer of medical equipment and must comment on how the MRI table failed in this episode. First and foremost, ALL of our patient tables are tested to four times their rated weight bearing capacity in order to provide an adequate margin of safety. The table would NOT have failed in the manner that it did in this episode. The creaking timbers sound effect made me laugh. When a carbon fiber table fails, it sounds more like a shotgun report. The more likely (and less dramatic) failure mode would have been that the table simply would not have been able to move. Glad to get that off my chest once and for all.
February 19th, 2008 at 6:15 am
will C, of course it’s just my shot, but I really don’t think House deserves what the detective does to him. It is true that ethics is not House’s greatest strength(more than it seems actually though. Like when he couldn’t lie about Vogler’s rip-off.), but that cop doesn’t care about it. He is just blindly focused to destroying House because of the clinic thing. And even that is not entirely justified, as House, a doctor, diagnosed him correctly, but he insisted on getting tested quite unnecessarily. While House was rude to him, it was not his place to order around a doctor.
March 28th, 2008 at 5:29 pm
In regards to the Tritter arc, I’m surprised there isn’t more mention (here or on other House forums) of the fact that Tritter kicked House’s cane out from under him. That seems to me clearly to be ASSAULT. House was rude and Tritter physically assaulted him in return! That was a completely disproportional response to the situation. House just barely got *even* with the thermometer stunt, which (correct me if I’m wrong) isn’t likely to cause injury anyway, whereas if House had fallen badly he could have been injured. Tritter was WAY out of line.
April 7th, 2008 at 11:25 pm
I believe the guitar lick at the end is ‘Like castles made of sand, melt into the sea, eventually… < Hendrix.
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