House - Episode 18 (Season Three): “Airborne”
A nice brisk episode of House with two good medical mysteries. One involves a woman hospitalized with neurological symptoms, and the second involved House and Cuddy stranded on a plane with a possible meningitis epidemic. Spoilers follow, so make sure you watch the episode first…
The first story concerns a 58 year-old woman who presents to the clinic after suffering blurry vision and a fainting spell. Her medical history is negative, except for a recent trip to Caracas where she went a little wild and indulged in drugs, sex, and — one presumes — rock and roll. Wilson finds a scopolamine patch (used to treat motion sickness) behind her ear, and blames the symptoms on this. He removes the patch and sends her on her way, but she has a seizure as she leaves the clinic. She is admitted to the hospital and the team’s initial thoughts are that she either has a neurological problem of some sort, or an allergy. Wilson orders a drug screen, a head CT, a chemistry panel, a blood count, and a screen for STDs (sexually transmitted diseases). He also has Cameron and Chase search her house for toxins or allergens.
The search of the house turns up nothing, the head CT is negative, and the blood tests are also negative. Wilson deduces that she must be have paraneoplastic syndrome (a rare condition where the body’s immune system over-reacts when a cancer is present) from an undiagnosed breast cancer. He orders mammograms, but as Fran is suffering through them, she develops a sudden blindness in her right eye. This makes the cause more likely to be neurological than cancer. An EEG with evoked potentials is obtained, and as the test is proceeding, Fran falls into a sudden coma. Foreman believes she has increased intracranial pressure from a bleed and that is the cause of her symptoms. He wants to drill a burr hole in the skull to relieve the pressure. Cameron is skeptical of a bleed (and rightly so) since it didn’t show up on the CT scan. She wants to perform an LP (lumbar puncture, also known as a spinal tap) to look for signs of bleeding or other causes before they drill into Fran’s skull. The spinal fluid apparently supports Foreman’s bleed theory (yet it looked clear to me), and the team proceeds to surgery (and since when is Foreman a neurosurgeon?). Meanwhile, Chase remembers that Fran’s cat seemed to have lost its appetite, and Fran didn’t each much in the hospital either, and thinks these might be clues. He re-examines Fran’s house, and finds an old pipe that leads from her house to a neighbor’s house — a house which had just been fumigated with methyl bromide. The surgery is stopped in time, and with supportive care, she recovers.
The second story occurs on a plane — a plane that House and Cuddy just happen to be flying on back from Indonesia. Mr. Peng, the passenger next to House becomes violently ill with a fever and vomiting. Upon examining him, Cuddy notes abdominal pain and a splotchy red rash on his lower back and believes that he has bacterial meningitis (a very contagious and frequently fatal disease).
Another passenger, a young woman this time, becomes sick with the same symptoms. Enlisting three passengers as stand-ins for the Young Guns, House lists other possible causes, including organophosphate poisoning, jet lag, a Dramamine overdose, a DVT (deep venous thrombosis — a blood clot in the leg) and food poisoning. He suspects that it is ciguatera poisoning from the sea bass served for dinner, but Cuddy still maintains it is meningitis.
They re-examine Mr. Peng, and House notices that one leg shows a history of a fracture and wonders if maybe the patient has radiation sickness from too many x-rays. With little warning, Cuddy herself becomes sick with vomiting, rash, abdominal pain, fever, and photophobia (eyes that are sensitive to light). In addition, 3 other passengers become sick. House collects all the medications he can from the remaining passengers and finds only a few useful antibiotics (though he does diagnose a herpes infection along the way).
Cuddy continues to insist that the cause must be meningitis, but House is still not convinced. He decides to improvise and perform a lumbar puncture using available equipment on Mr. Peng. He collects his sample, and immediately enters the main cabin, grabs the intercom, and announces to the passengers that there is a meningitis outbreak aboard the plane. He advises them all to look out for symptoms including abdominal pain, nausea, and left hand tremor. This is a ruse on his part — the spinal fluid was clear (infected spinal fluid would be cloudy) so there was no meningitis. His ruse was to show that people on the plane were panicked and easily suggestible, and everybody who had symptoms (except Mr. Peng) was suffering from conversion disorder (in other words, they thought they must be sick, so they subconsciously became sick. They never had any physical disease.)
House now turns his attention back to the only truly ill patient, Mr. Pengm. His differential diagnosis includes head trauma, cerebral infarction (stroke), and cerebral hemorrhage (bleeding in the brain). Cuddy suggests syphilis. This causes House to think of condoms, and he now believes that Mr. Peng must be a drug mule — a person who smuggles drugs stored in swallowed condoms. He thinks one of the condoms must have burst open and Mr. Peng is suffering from acute cocaine poisoning. He is ready to operate when he notices that applying pressure to Mr. Peng’s joints relieves the pain. He now realizes that Mr. Peng is suffering from the decompression sickness, better known as “the bends“. He had gone SCUBA diving on vacation and had ascended to rapidly. The low pressure in the airplane exacerbated his symptoms. House has the pilot fly at a lower altitude and places Mr. Peng on oxygen. This will help until he can get to a hospital equipped with a decompression chamber.
I felt the medicine was decent this time, particularly the airplane scenes. I do have a few concerns about Fran’s care. First, why did the ambulance take her to the clinic? Shouldn’t she have gone to the ER (unless it’s an acute care clinic that’s part of the ER)? Wilson and the Young Guns seemed to lose their focus after the initial tests came back negative and lurched from diagnosis to diagnosis, but we’ve seen that before. Cameron was right, and any bleed substantial enough to raise intracranial pressure enough to cause a coma would show up on a CT scan — and even if it didn’t show up on the first CT scan, it would be reasonable to repeat the scan after her condition worsened. When Chase performed the LP, since the team was concerned about intracranial pressure, he should have checked for opening pressure. Speaking of the LP, the fluid sure looked clear to me. Presumably, Chase and Cameron saw blood and felt that this meant Foreman was right. Of course, blood in the fluid could have come from the tap itself, and not the brain. Maybe he saw xanthochromia (a yellowish discoloration of the spinal fluid from broken down blood cells), which can suggest a cranial bleed has occurred, but it usually doesn’t appear until about twelve hours after a bleed. Finally, I wonder if Fran really would have survived. There is no treatment for methyl bromide other than supportive care, and the fact that she got worse even after being removed from the source makes me suspicious the damage had already been done.
Both of tonight’s medical mystery were good and deserve an A. The solutions fit the cases and earn another A. The medicine was a mixed bag, a B- for the hospital plot, and an A for airplane plot, so I’ll give it a B+ overall. The soap opera aspect was decent — not terribly exciting, but not bad either — and earns a B.
The previous House review
A list of all prior House reviews
April 11th, 2007 at 12:02 am
I particularly loved “House on a Plane,” especially with the three people House picked to be the replacement team. I really don’t have any complaints of the episode (I never know any medical ones!) and it had a few big laughs for me on it, so it was all around great I think.
April 11th, 2007 at 12:02 am
I found this to be a particularly good one as well. My favorite House episodes are ones where they take the formula and shake it up a bit. While it also served its purpose of making aspects of the soap opera easier, seperating House from the Young Guns made for an interesting bit of storytelling. Forcing House to operate without his usual lab and tactics (breaking into patients’ houses, for example) made him rely purely on his own ability to read what’s wrong with a patient who can’t tell him what’s wrong. Not that he often talks to his patients anyways until it’s all over, but the fact that he had no stray comments from the patient to play off of really put him through the wringer.
A few moments I loved from the episode:
*House ‘recruiting’ three random passengers to bounce ideas off of. I’d love to be a fly on the wall when Cameron, Chase, and Foreman hear about that.
*House’s mass hysteria reveal. I saw that one coming the moment he mentioned something about the left arm. They even foreshadow this when he comments to Cuddy that they’re returning from a conference about pandemics.
*Wilson calling Robin back at the end of the episode. I have trouble seeing this being a long subplot– in fact, like most relationships on the show, it’ll probably be marked for death within three seconds of House actually taking an interest in it (my guess is that he’ll recognize Robin or pick up obvious signs of her profession). But it’s interesting to see that Wilson might actually make an effort to have a life outside the hospital.
*Wilson saying that he felt sorry for House (I think that was the phrasing he used)… I have to wonder if he was talking about the cases, or the bickering Young Guns.
I was a little disappointed by the fact that House didn’t invoke the movie Airplane! even once during the episode, though.
April 11th, 2007 at 12:06 am
Scott, do you write these as you’re watching the episode? I’m very impressed by how rapidly you get these up here.
April 11th, 2007 at 12:13 am
A question about the “conversion disorder” bit: it seemed pretty clever, but is it possible for the symptoms Cuddy showed to manifest themselves to that degree? Her rash seemed pretty extreme to be entirely psychological.
April 11th, 2007 at 12:14 am
I totally enjoyed tonight’s episode. Though I found myself yelling “Where are the airsick bags??” a few times. Yuck.
House seems much like his old self in this episode. Smug and annoying, but brilliant, and not mean just to be mean.
And Cuddy is pregnant. That will be a whole lot of fun for the writers.
Thanks for the quick updates.
readz
April 11th, 2007 at 12:16 am
I gotta echo Brian; wowie on the speed at getting this up. Excellent write-up, as usual.
April 11th, 2007 at 12:18 am
Great review, as always — I just want to say that I enjoyed this episode a great deal, but I also enjoyed the fact that you finally agree with that, sort of :). I always look forward to reading your reviews after each House episode, and I appreciate your thoroughness for us ignorant fans. Keep it up!!
April 11th, 2007 at 12:24 am
Wait, wait, readzalot - is Cuddy *actually* pregnant? Our cable cut out and we didn’t get any sound during the part where Mr. Peng was actually diagnosed. (Because I kept shouting “Cuddy’s pregnant!” at the TV until everyone else made me shut up.)
Also - how effective would trolling the plane for antibiotics be, really? The likelihood of getting anything that could combat meningitis would be pretty small, wouldn’t it, given that most of the people who even had any would probably have them for a sore throat or UTI or something.
(And boo, dead cat : (. Though sick cats don’t perch in plain sight and peer at you that bright-eyed - they hide in small dark spaces and are lethargic and *act* ill.)
April 11th, 2007 at 12:25 am
I also liked the airplane thread of the plot better than the ground-based one, although both were fun, and I just wanted to add that I was calling out “Caisson disease” at the screen (new HD, too!) when House and the medical kid discovered the thing with the joints. Not often I get to beat House–not to the punch, but just to where he reveals the punch.
Also, pretty relieved we didn’t have to see mid-air surgery. :)
Best episode in quite a while, especially with the long layoff.
April 11th, 2007 at 12:44 am
The big question is, how long will we be able to enjoy this blessed respite from Chase and Cameron playing kissy-face? Because I can’t imagine they’re broken up for good.
April 11th, 2007 at 12:53 am
I do believe this is the highest ranking episode. I was thoroughly impressed with how House made his own tools for a spinal tap! They wrote the plane part with beauty.
April 11th, 2007 at 1:01 am
Doctors have special powers, over both people and speed of typing. Its what House would say. Anyways, doesnt Methyl Bromide poisoning give you kidney problems too? I would have thought the battery of tests they conducted on Fran would have at least given something back.
April 11th, 2007 at 2:12 am
I’m still stunned at the high medical ratings. Not that I disagree — I’d have no way of knowing, being a lowly designer/photographer — but sometimes I think “hey, that seems reasonable” and go on this site and it rates an F, or I think “oh there’s NO WAY that could happen” and go on this site and it rates an A or B. :)
April 11th, 2007 at 3:13 am
For me, this was a a case of: I got really caught up in the episode while watching it, and I really enjoyed it while I was watching it, but the more I think back on it, the more it starts to fall apart at the edges.
In retrospect, it’s kind of astonishing that House talked Cuddy out of recommending that the plane return to Malaysia. The only member of the airline crew we got to see was that flight attendant - shouldn’t the pilot or co-pilot have gotten directly involved? Seems to me if the chief administrator of a hospital is urging that the plane be turned around because of a possible meningitis outbreak, the pilots wouldn’t hesitate to head back.
I can sort of understand how the young woman and Cuddy developed the same symptoms as the Korean man - Cuddy saw the symptoms for herself, and the young woman overheard House talking with Cuddy. But did the other passengers who became sick also exhibit all of the same symptoms, particularly those ominous-looking splotches? AFAIR, the episode didn’t say.
And since when is “Peng” a Korean name? (OK, I’m nitpicking.)
On the plus side, I did enjoy the paralleling of medical mysteries, and watching Wilson and the Young Guns sally forth without House or Cuddy.
April 11th, 2007 at 3:41 am
Does conversion disorder really manifest that quickly? I thought it takes a couple of days…or so…not too sure. I’m no Doctor or Med-Student. But tahts just my two cents. Loved this episode though.
April 11th, 2007 at 3:42 am
i could be wrong…probably am.
April 11th, 2007 at 3:53 am
Scott…. Would someone be able to survive an abdominal surgery performed on an airplane? If the guy had been a drug mule and the cocaine condom did burst, wouldn’t there be nothing they could do for Mr Peng? Wouldn’t he have gone into shock and died?
I did like this episode. I agree with Read Cuddy is pregnant…..but who’s the dad?
April 11th, 2007 at 5:35 am
Did I miss the “Cuddy is pregnant” line, or are we just guessing?
April 11th, 2007 at 5:44 am
I don’t know anything about medicine but I thought the LP didnt so much support Foreman’s theory as it disproved Chase and Cameron’s theory (although I don’t remember what Chase and Cameron’s theory was). I assumed it was negative, which meant that Chase and Cameron were wrong, so they went with Foreman’s theory because that was the only theory left. At least that’s what I took Cameron’s comment to mean - “We were wrong, which means Foreman was right.”
By the way, I love the reviews, I always learn something :)
April 11th, 2007 at 6:32 am
The writers are clearly signaling that Chase will become the best doctor of the three Young Guns — though I suspect he’ll also turn out a lousy human being, much like House. Cameron is a good person but seems consistently portrayed as a poor doctor due to emotional weakness. Foreman’s fate is harder to read. All three are hobbled by the story format, which usually requires them to be lame so that House can be better than all of them.
Another newbie question: Leaving aside House’s superhumanly good skill, how important is it for a doctor to be a specialist in the area under discussion? House has sometimes speculated the problem might be cancer and then said, “We need Wilson.” If it’s cancer, does a non-oncologist in the real world basically just throw up his hands and pass along the patient to the specialist? How much competence does generic medical training grant in diagnosing all these different kinds of ailments?
April 11th, 2007 at 6:54 am
Please let the Cameron/Chase rutting season be over. That subplot has become very annoying to me, and has caused the characters to behave in a way which seems to me to be censurably unprofessional, not to say (in this episode at least) downright stupid.
But the rest of the episode makes up for that, and if Cameron/Chase is the price I have to pay, so be it.
April 11th, 2007 at 7:25 am
Scott - would the conversion disorder/hysterical meningitis still cause the rash that we saw on the younger woman and Cuddy? Or do you think that was just for effect?
It’s funny, I was just reading about conversion disorder earlier this week when someone was telling me that her 8 yr old was diagnosed with it. Weird!
April 11th, 2007 at 7:44 am
I dislike this new Cameron. Hopefully this Chase-Cameron nonsense is over, the character’ll be more like the first two seasons.
April 11th, 2007 at 8:20 am
Official Comment
Kent,
Technically, what the passengers had wasn’t a true conversion disorder, but more of a mass hypochondria, though admittedly the line between the two conditions is not always clear.
In a true Conversion Disorder, a patient with a poorly controlled condition such as anxiety or depression attempts to cope by “converting” the psychological symptoms into physical ones. This is why one of the common symptoms of depression are unexplained aches and pains. Another example would be a child with a bad case of school anxiety. They always develop a severe headache or stomach ache on school days, yet not on weekends. It’s not a conscious act of malingering, but instead a subconscious attempt to deal with the anxiety.
Rashes can show up as part of a conversion disorder, but it’s fairly rare, especially a petechial rash like the one shown (which does look like a meningococcal rash). More common is skin lichenification (thickening and flaking) from constant scratching.
April 11th, 2007 at 8:52 am
Last night’s episode may have been sound medically and it was certainly entertaining television, but a lot of it seemed–to me at least–downright silly.
Like with Cuddy, for instance. She’s a doctor, an administrator, and heretofore a strong woman. For her to be panicked by the meningitis scare into manifesting false symptoms seemed drastically out of character. And she wasn’t even embarrassed about it! She should have been too ashamed to look house in the face.
And take House’s announcements to the passengers. First he tells them they have food poisoning. All those who ate the seafood must rush to the restrooms, stick fingers down their throats, and urp up their lunches. Then he tells them no, they have spinal meningitis and gives them a slew of symptoms to present. Then he tells them he was just kidding, they don’t have meningitis. They don’t have anything at all! Instead of being more confused and anxious than ever, as real people would be in the circumstances, these passengers are now calm and reassured. They must have realized that the show was almost over, and that this most recent diagnosis had to be the correct one.
As for having House select three passengers to be surrogate young guns–what a silly TV-show type gimmick!
And how many times will we see an unnecessary surgical procedure interrupted just as the scalpel is piercing the skin?
This device was used effectively in the first-season episode “Detox.” Then, it was funny and exciting. (House had to gob on the surgeon to get him to lay off!) But since then with each repetition the device just becomes more and more cliche.
This is what happens with series television. An original premise with repetition degenerates to a mere formula and then a string of cliches. To hold the audience’s interest, script writers resort to increasingly far-out devices and plot twists. They have a name for this phenomenon; it’s called “jumping the shark” (from an episode of Happy Days). I hope this doesn’t happen with House!
The most telling thing in last night’s episode was the dust-up between Chase and Cameron. She’s been trying to use zipless sex as an anodyne for her emotional emptiness. Now she runs from the offer of a real relationship. She’s always seemed like a bird with a broken wing; now we’re learning the extent of her injury. Chas is pretty messed up too; think of his problems with his dad. A real relationship between Chase and Cameron could add emotional depth and dramatic weight to this series. Or maybe a real relationship between House and Cuddy. Or anything that was genuinely felt. Then they wouldn’t have to “jump the shark.”
April 11th, 2007 at 9:26 am
So is Cutty House’s Boss, or his Bitch? She is putting up with an enormous amount of crap from him.
I liked the episode, although I thought Cutty having a psychosomatic illness was another insult to her character.
I didn’t notice the part where we discovered that Cutty is pregnant - did it actually happen?
I hope Wilson gets lucky with the cute prostitute…and the scene where she is discussing her ‘vacation’ options at the beginning was fun.
April 11th, 2007 at 9:43 am
I agree, in part, with PSU. The Cameron/Chase subplot wasn’t interesting to begin with and has become an annoying distraction. I can only assume that there was some point to the whole thing which has yet to be revealed. Frankly, if I wanted to watch a soap opera set in a hospital, I’d watch Grey’s Anatomy; I watch House because it focuses on the medicine and the soap opera is secondary. Unlike PSU, I can’t take much more of this particular subplot.
One other comment: I much prefer mysteries that provide enough clues to solve them along the way, like the large number of copper pots in “Damned if You Do”, rather than mysteries that do not, like the current episode - I don’t recall a single clue along the way indicating nitrogen narcosis.
April 11th, 2007 at 11:00 am
Neither did I, but then there’s not always clues. House didn’t solve it until the leg pressure thing–why would we?
Meanwhile I figured out pretty quickly that the cat had something to do with Fran. Mostly because I love cats. Poor kitty.
I liked this episode a lot, and I must say I never thought I would be cheering when two characters split on a show. THe entire Cameron/Chase thing was a dumb idea, thankfully they kept it as straight sex and it didn’t go into the realm of really annoying. Aren’t those characters engaged anyway?
Thank you, House writers, for splitting them up, and saving this show. Phew.
(Though, House does have the long-term problem of generally ending the plot. It’s structured as a soap opera, and I have to wonder how long they can keep cycling plots with the characters (outside of the medical stuff, obviously) before the show becomes unwatchable. I mean, this isn’t the sort of show that would have a defined beginning and end, like Lost or Heroes or something, but it also can’t run forever.)
April 11th, 2007 at 12:44 pm
ZC, you just realised the whole point of the season finale! Congratulations. Last season, House was shot. Usually during season finales the writers will answer big questions or tie up loose ends in case the show isn’t renewed. House may become unwatchable, but it really depends on where the writers take the show, doesn’t it? And as soon as it does become unwatchable, House would be cancelled.
April 11th, 2007 at 1:24 pm
What do the House writers have against cats, anyway? This was the second episode in two days (one was a re-run) involving a poisoned cat as the key clue.
April 11th, 2007 at 1:27 pm
It didn’t seem that Cuddy is pregnant, that was just the second sick person on the plane (the blonde one). Cuddy was just responding to anxiety.
Also I’d disagree that Cuddy is much of a strong character. Sure, she’s the boss, but we’ve seen her easily let her emotions override her logic (see every medical case she’s been involved in).
I too didn’t like the Chase/Cameron thing, but as I’ve said before, I always figured it was a cover up for the actor’s real-life relationship. I still think they’re going to expand it later in the series.
As for this episode, I just had a hard time believing the rashes would form due to belief or the anxiety as mentioned.
April 11th, 2007 at 1:43 pm
One of the best episodes I’ve seen in a while, I thought, though I was surprised at Cuddy’s passive acceptance of House’s simply offensive behavior at the beginning (speaking at the conference for only three minutes, abusing the room service privileges, then — without telling Cuddy — exchanging her first-class ticket for an economy class ticket on an international flight . . . a little purely mean, which I’m not used to House being). He’s normally insufferable and crude, yes, but this seemed worse than usual. And Cuddy just rolls her eyes and goes along with it?
Also, do we have to go through the rigamarole of House fighting against the possibility that someone is seriously ill every episode? I keep wondering when a patient will die while House steadfastly denies that he’s sick without examining the patient or his chart.
I wasn’t as frustrated at Chase and Cameron’s relationship as most people here seem to be. I assumed there was something else going on (perhaps, as Chase suggested, Cameron was using him in an attempt to make House jealous?), and I’m interested in seeing what the fall-out is going to be. How can they work together after Chase has just been brutally rejected by Cameron? I hope the writers don’t abandon this story line, now, as quickly as they’ve abandoned some others . . .
April 11th, 2007 at 2:20 pm
I enjoyed this episode very much. This season has been very jumpy shark but it keeps pulling good ones off just when you think it’s all over.
I’d also like to state for the record that I (and apparently I alone) have been enjoying the Chase/Cameron sexathon.
April 11th, 2007 at 2:47 pm
I just want to say, I’m from Malaysia. The Malaysian Pacific airlines does not exist. I don’t know what the air stewardess said to Peng right after he puked, but it’s definitely not Malay. These little things bugged me, cos it reminds me while I’m watching that this is just a show.
But the air mystery was definitely gripping. And geniuses are often eccentric, so I don’t fault the writers for the Temporary 3 Young Guns. Maybe House figures that it helps him think to recreate his usual work environment. I’d buy that.
April 11th, 2007 at 2:50 pm
I don’t think Cuddy is pregnant…yet. I’d like to see House father her baby (or is it fetus?)
I thought the rash was a little bit much for a conversion disorder…but I’m not a doctor so what do I know?
It was funny when House was examining Cuddy’s throat and abdomen. He didn’t seem to concerned about catching anything. He seemed to enjoy it way too much.
I also liked the part when they were boarding the plane and there was a whining toddler behind House and Cuddy. House snapped, “Give him 20 mg of antihistamine….or I’ll kill him!”
April 11th, 2007 at 3:02 pm
Great episode of House.
April 11th, 2007 at 3:43 pm
It was pretty clear that House was saying that the blonde girl was pregnant, not Cuddy.
Wertrew: At least House’s antics at the conference weren’t involving the life or death of a patient. That’s probably a relief to her.
I’d say there’ll be more Cameron/Chase soapiness for a few more episodes, but at least now it’ll be in line with their usual characters and not just nympho Cameron wanting sex everywhere.
And I thought methyl bromide is now pretty restricted in usage because it hurt the ozone layer?
http://en.wikipedia.org/wiki/Bromomethane
Gotta agree somewhat with John Addis though: from a layman’s perspective the episode where “it’s all in your head” and “he’s actually dying of the bends” do seem a bigger stretch than the one where an actual poison or pathogen is identified. Maybe it’s the fact that it disturbs our suspension of disbelief: most people are pretty familiar with the bends (though not bends on an airplane), and there’s always a tendency to look down psychosomatic illnesses, especially when the symptoms appear so vivid.
April 11th, 2007 at 4:55 pm
How was Mr. Pengm rash explained by him having the bends?
April 11th, 2007 at 5:03 pm
What I mean is how does decompresion sickness cause a rash?
Thanks
April 11th, 2007 at 7:10 pm
I don’t understand why so many people on here believe Cuddy is pregnant — makes me worry that I missed something. The only references to pregnancy I heard in this episode were to the teenage girl — *not* to Cuddy.
And I rolled my eyes a bit at Cuddy and the teenage girl getting not only a rash like Peng, but the *same* rash (even though the girl, for one, hadn’t even seen the original version). But what the heck — I’m easy. As long as they give me a reason, even if it’s a bizarre and unlikely one, I’m willing to accept it.
April 11th, 2007 at 7:56 pm
Official Comment
Sorin,
That’s a good question and I’m not sure that anyone really knows why decompression sickness can cause a rash. Here’s a quote from Auerbach’s Wilderness Medicine (4th ed.), from the chapter on Decompression Sickness:
April 11th, 2007 at 7:58 pm
Nice tight episode, IMO the best in several weeks.
I liked the way the two stories mirrored each other. It was fun to watch House with his substitute Young Guns, while back at the ranch the real Young Guns dealt with Wilson (and he with them) as a substiute for House. On the soap opera side, I confess I’m glad to see an end to the Chase/Cameron sex. I didn’t object to it as much as some others did but I think they’d taken it as far as it could go. Poor Chase. At least the writers made up a bit for his rejection from Cameron by letting him solve the mystery. Poor cat.
Questions: If Mr. Peng had been a drug mule, with loose cocaine all over his digestive tract, what could House have accomplished with surgery? What exactly would he have done after poor Mr. Peng was opened up? How would he have gotten the cocaine out?
Didn’t any of the airplane passngers know about those little bags in the seat pockets? Good grief.
Scott, thanks as always for your informative and timely review.
April 11th, 2007 at 8:38 pm
Am I the only one who noticed a weird parallel between this episode and Detox? Both have cats dying and whereas one was killed by termites, this one was killed by an exterminator.
April 11th, 2007 at 9:45 pm
Once House takes a patient seriously he always wants a complete history, since they were on a plane, looking at Mr. Pengs wallet is about the only thing he could have done, who knows, he might have found an address or a phone #, maybe even a dive card, anything to help with a diagnosis. Of course if this was done at the beginning as usual there would be no story - which is why he didn’t look at it til the end. Still it was a very enjoyable episode, and a great web site.
April 11th, 2007 at 9:51 pm
First time poster- really like this site!
Gotta say that I didn’t dig the rash:conversion disorder connection. Vomiting, abd pain, sweats, photophobia- even pseudoseizure- yes, rash… a bit out there. Rash didn’t look petechial coalesing to pupuric enough (esp. to the legs- middle of the back??) for me to think meningococcal disease. Had to look up the rash:decompression sickness connection myself. Cuddy having all that…hmm, think someone needs an HCG drawn. (pregnancy test)- they have been hinting at that for way too long this season for there not be something with that soon. Nice improv with the LP on the plane though- don’t think his 18 ga. 1 1/2 inch needle was long enough though…
The lady’s mystery was a typical “House” toxin no one has heard of thingy, but man, do they rush to the Black & Decker in the OR or what? Good gore factor I guess.
April 12th, 2007 at 12:23 am
I would have preferred if the breakout on the plane was real and Cuddy’s life was at serious risk, which could have lead to some good House/Cuddy drama.
April 12th, 2007 at 1:04 am
I’m surprised one of the doctors didn’t suddenly remember reading an obscure journal article about a new anti-methyl-bromide-poisoning drug that had shown promising Phase II results in goats or something.
April 12th, 2007 at 1:15 am
For the record, I didn’t find the Chase/Cameron sex world tour that annoying, just a little bizarre. It did seem a bit out of character for Cameron, but I’m expecting them to tie some loose ends in that regard. Like someone else said, I’d also be upset if they just dropped it now. There must be repercussions (beyond a couple of awkward moments) or it was a wasted arc.
April 12th, 2007 at 2:08 am
Wertrew:
“Also, do we have to go through the rigamarole of House fighting against the possibility that someone is seriously ill every episode? I keep wondering when a patient will die while House steadfastly denies that he’s sick without examining the patient or his chart.”
I agree with what you are saying and it is kind of dangerous for House to just write off these people as not being sick, but House has said himself, even in this episode, “I believe in statistics.” Usually at the beginning of the episodes the patients show symptoms that House explains immediately. It’s only when contradicting symptoms, or ones that aren’t supposed to be there at all, show up that House admits the patients are mysteriously sick.
It all boils down to: statistically, most people are not inflicted with mysterious, rare, life-threatening diseases, so why should he be so ready to admit they are?
April 12th, 2007 at 2:10 am
Also, did anyone else see Cuddy get her face extremely close to House’s face at the end of the episode - so close that he was forced to move his head and look out the window? Also, her incredulious look while House was trying to work his magic on that stewardess at the end makes me think that not too far in the future we will have some House on Cuddy action.
April 12th, 2007 at 7:56 am
To Benmast Tomworth: What the flight Attendant said sounded Filipino to me. “Malalagnat ka ba?” roughly translates to “Do you have a fever?” in Filipino. But it has the wrong tone though, that’s why I thought it was Malay or Bahasa or something. It sounded very South East Asian.
Personally, I loved the episode and I love the reviews. Keep up the good work Scott!
April 12th, 2007 at 9:11 am
I’m a first time poster here, but I very much enjoy reading the site’s reviews on “House”!
My Dad and I were trying to figure out the whole “bends=rash?” thing…one of my friends was rolling her eyes about the episode and saying “The BENDS? How could it be the BENDS?”, but I think if you get pain when you just come up above the water, imagine being 30,000 feet ABOVE that water! I also wondered about the rash, but Dad reminded me that the bends is nitrogen in the blood, yes? ((I don’t remember exactly :s correct me if I’m wrong, please!)) And a rash is blood vessels bursting under the skin…if nitrogen is in the blood, wouldn’t that make the blood vessels burst? :s I don’t really know…
I enjoyed the episode very much…it’s one of the best ones I’ve ever seen, I think, and I’m hoping that the show only continues to do this well!
My only problem was that here I thought it was going to be a huge epidemic, and it turned out to be the bends…I realize they don’t want to give everything away on the commercial, but I think that’s borderline false advertising :P Also, what? Cuddy’s pregnant? :s Or, like many of the preceding posters think, was it referring to the blonde girl?
April 12th, 2007 at 9:32 am
Cuddy’s symptoms are the same as the blond girl’s, and House insists she’s pregnant-I think that’s why people think Cuddy may be pregnant. Near the end House presses the button on Cuddy’s chair to raise the seat back, causing her face to get close to his. Then he looks away. He wants her close but not too close.
April 12th, 2007 at 11:06 am
Kyle: Yeah, I know that House usually starts to show interest when all the apparently-conflicting symptoms are presented to him. But couldn’t he assume, once, that Cameron, Cuddy, et al, wouldn’t come to him with an uninteresting case? Couldn’t he just say, “tell me more,” or “why do you think it’s not just morning sickness” or something like that?
Except, of course, in a cutting and wildly inappropriate way . . .
In this episode, for instance, in fact, I think Cuddy was right and they should have turned the plane around (though not, as she believed, because Peng had meningitis). House’s refusal to even *consider* Peng’s symptoms serious until it was too late to turn around could have killed both Peng and the other passengers — it was damned irresponsible not even to examine him.
April 12th, 2007 at 12:50 pm
>Keith says:
>So is Cutty House’s Boss, or his Bitch? She is putting up with an enormous amount of crap from him.
Cutty puts up with a lot of crap from House because he’s good (presumably the best) at what he does. I’ve had bosses who put with a lot from me because I was good at what I did and they needed me. One boss covered for me when some co-workers saw me in a Starbuck’s drive through when I was “out sick” (”Oh, I’m sure it was just someone who looked like him, driving the same kind of car”).
April 13th, 2007 at 9:42 am
Conversion disorder is the wrong label for the airline passengers - ‘mass hysteria’ gets it better. Put people in a crowded, uncomfortable situation, surrounded by strangers, with no exit and mysterious goings-on, and fascinating things can happen. If stigmata, why not a rash? Headaches, nausea, vomiting, tremor are most common. The girl beside House heard a number of the details, so she could have been primed (as was Cuddy). next time you hear of a high school being evacuated from a ‘mysterious toxin’ (or the seizures after that Pokemon episode), remember House.
Refusing to turn back just sounds like part of the lifeboat scenario, one of those things they do to keep interest. I was worried about trimming the airliner when everyone rushed aft.
April 13th, 2007 at 7:32 pm
PLANE ERROR PLANE ERROR!
The plane in the show was organized 2:3:2 (seats) in coach. That is a 767-only configuration. A 767-200ER has the longest range of all the 767 planes. The 767-200ER has a range of 6600NM.
As you can see from this range map:
http://www.boeing.com/commercial/767family/pf/pf_rc_sydney.html
Even those Sydney isn’t super close to Singapore or Malaysia, its not hard to see going over the top of the earth and to EWR/Newark or JFK/JFK NY is NOT going to be possible. This is apparently a 9500 mile flight. That’s a heck of a long flight. I think the only planes that can do it are the A340-500 or the Boeing 777-200LR Worldliner. Who has been on this flight?
Starting from either Singapore or Malaysia doesn’t cut the flight down by much.
The great circle mapper here: (Changi Singapore SIN to JFK)
http://gc.kls2.com/cgi-bin/gc?PATH=SIN-JFK&RANGE=&PATH-COLOR=&PATH-UNITS=mi&SPEED-GROUND=&SPEED-UNITS=kts&RANGE-STYLE=best&RANGE-COLOR=&MAP-STYLE=&ETOPS=120
It is clear, particularly with ETOPS/120 (767 have to be 120 mins from a landing spot at all times due to ETOPS rules for twinjets.)
Can anyone confirm if I have missed a detail that is causing me to miscalculate this?
April 13th, 2007 at 10:34 pm
Can I ask a question? There’s this awesome scene where House pretty much sexually harasses Cuddy saying that he was trying to determine the type of bacteria by the smell. Scott, you may not know the answer or you may, but do different bacterial infection have different smells. Also, and this is more of a question of personal “ethics” but; if you had to, to save a life, would you do what House did. You know what I mean :winks:.
April 14th, 2007 at 10:14 am
I’ve checked nearly every post and I don’t think anyone’s pointed this out yet - the medical symposium was in Singapore, not Indonesia, which is why the plane left from Singapore. I assume Peng went scuba diving in Malaysia, which is right next door.
April 14th, 2007 at 10:22 am
Neojanus,
I can’t necessarily tell you what infections smell like in patients, but certain bacteria do have distinctive smells. A lot of people think that psuedomonas smell grapy or fruity, but it smell exactly like a wet corn tortilla to me (it makes it hard to eat corn tortillas). I had a Proteus yesterday, and supposedly some people say it smell like chocolate- it just smells bad. A lot of anaerobes are the same, they just smell strong and they smell bad. Clinical Microbiologists do sometimes use smell as a help in identifying bacteria. I suppose it might be possible to smell it in a patient as well.
April 14th, 2007 at 12:49 pm
An A for the airplane medical plot???
Like someone else pointed out, conversion disorder (CD) is the wrong diagnose - at least the wrong nomenclature for it. You just don’t “get” CD by proxy (sugestion), or this fast, or this serious. I’ve seen skin lesions in patients with CD, but they are insidious and usually hiperchromic, not purpurea or petechea-like. If you’re going for that long a strech a better diagnose would be mass hysteria, even though I’m not happy with that one either…
Second of all, shame on House for attempting to perform abdominal surgery (!) on Mr. Peng, how is he going to sow him up afterwards, with his shoelaces??? But I guess after a LP with no ANESTHESIA or ANTISEPSIS, hey, wath the heck, anything goes.
April 15th, 2007 at 4:49 am
I loved this episode. as a non-medical person everything seemed to line for me, as for the rash being a bit over the top, honestly the human body does some pretty weird things when stressed so i didn’t even give it a second thought.
as for the Cameron/Chase thing, the running consenses in my group of House watchers is that Cameron is actually the one pregant. it explains her personality change and her driving need for constant sex (anyone who dosen’t think this is a sign of early pregnancy has never been pregnant). so I’m hoping that is the explanation.
as for the Young gun substitues, I laughed so hard at that. the fact that the chase stand in was the only useful one (helping him dignose the problem) i thought was an interseting commentary.
April 15th, 2007 at 8:00 am
Nice reviewing!
You didn’t really spend all that much time on critiquing the air plane medicine. Can I assume then that it was quite good? I thought some of the things he tried to do (like cutting the guy open on a bouncing plane) were a bit too far out.
Anyway, keep up the reviews! It’s good to get a little bit of knowledge, and see if the show is actually somewhere near real life(tm).
April 15th, 2007 at 8:39 pm
I’m very impressed by the amount of dedication that all of you place in creating this website (if only one person runs it, then I’m further impressed). I only really help slightly with one website myself, and I know how much chaos that is. And further all the medical research is incredible. Well done. However I’m most impressed by the work the “Dr. House” writers do in attracting an audience. It appears that there is a large range of people this appeals to from my friends who are as young as 7 and all of you who are probably about 30.
April 16th, 2007 at 12:28 am
Did it seem wierd to anyone that the chase substitute was present for the “surgery”? It’s hard to believe his parents would allow him to assist.
April 16th, 2007 at 1:56 pm
You would think that House would have recruited the biggest, burliest passengers on the plane to hold that poor guy down. I don’t think that a shot of vodka would be enough.
Ouch!
April 17th, 2007 at 11:12 pm
In response to Dan, he’s wearing a tag around his neck that says “unaccompanied minor,” so really, his parents wouldn’t have much say, heh.
April 17th, 2007 at 11:35 pm
Ahh thanks alice, I didn’t see that.
April 20th, 2007 at 8:34 am
ETOPS doesn’t apply to 4 engined aircraft. We don’t know it was a large twin, but evidence suggests it wasn’t a 747. It actually looked pretty small inside… However, the route is unlikely to pass over the north pole. There is not just the point of departure and the destination that are options, there are (almost) always alternates along the route. In addition to that, if the plane was forced to fly at 5000 ft for over half the journey it would run out of fuel *way* before it got to wherever it was going. For a flight of that duration there’s going to be 2 sets of flight crew on board and the likelihood of *someone* from the flight deck not making an appearance is *really* small.
April 23rd, 2007 at 4:14 am
Steve: Yes, I was also about to mention that - that if they flew below 10,000 ft with any speed it would stress tha airframe horribly, so they have to slow down and going slow and flying low = bad gas mileage so bad.
I think I predicated that this was a twinjet due to the tiny internal cabin size.
April 24th, 2007 at 3:17 am
Did this turn into House, FAA while I wasn’t paying attention? :)
April 30th, 2007 at 6:24 pm
Yes, actually, we DO know it was a large twin, because it is definitely a 767-200, which was obvious from the shots of the interior. No way even the LR version could make Singapore-JFK nonstop.
And by the way, Steve, there IS a flight from Singapore to Newark and it DOES go straight over the north pole. The plane used for this is an airbus A345, with reduced capacity to cut down weight. Even the 747 wouldn’t have a chance on this route.
May 2nd, 2007 at 2:48 pm
If they dropped to 5,000 ft like House asked, “low enough to club baby seals”, yes, they would have run out of gas, belly-landed on the snow, and then House could have indeed gotten out and clubbed baby seals. I wouldn’t put it past him either to use his cane, and cite it as their only hope for survival until rescue came.
Then, if he was lucky enough to have ‘Flight of the Phoenix’ co-star Dennis Quaid on board, they could have recrafted the remains of the airframe into a new plane and escaped before the tribe of nomad eskimos got them- oh, never mind….
July 6th, 2007 at 3:16 pm
Another aviation nerd here trying to show-off. Would the pilots/FAA really allow a commercial airliner to fly that low (ignoring the fuel problem) to save a person, given the circumstances it was diagnosed? Flying that low could put many lives at risk in the unlikely event of an emergency, as they say — altitude is your friend. Just how much of a risk is it?
July 22nd, 2007 at 4:41 am
Hi = Just seen this episode in the UK. The reason that Cuddy is asusmmed to be pregnant is NOTHING to do with anything in this episode, or confusion with the blonde girl..
The reason that we can assume Cuddy is pregnant is from the way she ran in to House’s office at the end of the previous show and thanked him so emotionally for giving her the fertility injections - they obviously have had the desired effect.
Other than that, good episode - I have a fear of flying though so it was a tough watch for me!
September 10th, 2007 at 1:54 pm
I was expecting House to arrive back at the hospital and he and the call girl recognize each other and exchange a “Hey there.”
Other than not getting that, great episode.
September 11th, 2007 at 3:44 pm
Another aircraft Eu 0,02: The creators of the show might have tried to pretend the aeroplane was a 767-200, but it would not be consistent with it being a Malaysia plane: their long-distance aeroplanes are the Boeing 747-400, Boeing 777-200 ER and Airbus A330-200 (which would not be able to fly the whole distance in one go).
Anyway, the plane would probably never go further than 180 (or perhaps 207) minutes from a diversion airport, thus negating Cuddy’s worries and possibly even her panic attack (she was scared to be locked up in an aeroplane for 15 hours with a meningitis patient).
But then again… the average creators’ knowledge of aeroplanes could be placed in a timble. And not a large-sized one at that. I wouldn’t be surprised if they indeed used a Boeing 767-200 for the interior shots, even tho (a) it’s not used by Malaysia and (b) it would not be able to fly the distance.
One last note: “bends” are a standard subject in any pilots’ course so they, when alerted by cabin crew, would have known what to do (land at the nearest alternate).
October 3rd, 2007 at 10:55 am
Here’s the part I did not get. Okay, the patient has bends. He is in a thin atmosphere. Therefore, it becomes worse. Cuddy and house tell the pilot to lower the altitude. This is assumably to increase the air pressure inside the plane. But if it is a pressurized plane, as it obviously is, would this work? Wouldn’t the pressure inside a pressurized plane remain the same?
October 4th, 2007 at 7:41 pm
Peter2: I’m pretty sure ressure is gradually equalized as the plane descends. For instance, I’ve noticed that my repressurization symptoms (ear pain, mostly) are worst upon descent, which they wouldn’t be if the pressure equivalent stayed at 8,000 feet all the way down. Also, I don’t remember any “giant sucking sound” when the crew opens the doors. Is there one?
However, there’s a separate issue. The difference between 8,000 feet and sea level is about 1/4 of an atmosphere; that is, the pressure at 8,000 feet is roughly 3/4 of an atmosphere. At 5,000 feet, it’s about 5/6 of an atmosphere. So I’m not sure that dropping to 5,000 feet really accomplishes so much. (At the top of Mount Everest, the atmospheric pressure is only about a quarter to a third of what it is at sea level. I am amazed at the notion that anyone would even attempt to climb that without oxygen.)
Also, how does breathing from the oxygen masks help with repressurization? Does it somehow get the nitrogen to redissolve in the blood? What is the mechanism there?
November 28th, 2007 at 6:27 pm
mmdude,
most if not all LPs are performed sans anesthetic. I know because I had a particularily poor one performed on me once. And I begged for anesthesia beforehand, trust me.
Scott, I’m no doctor, but I am a scuba diver and I think I know why decompression sickness results in a rash. Since after scuba diving the blood stream has elevated nitrogen concentrations, and flying within 24 hours of scuba diving is not reccomended because as you ascend, the decrease in pressure allows the nitrogen a chance to escape the blood stream and forces itself out. I’m pretty sure that bubbles of gas coming out of your circulatory system would lead to some form of skin irritation. Either in reaction to the dermal/epidermal layer or because some blood would escape as well and be visible in areas
All speculation, because I’ve avoided the possibility of getting it and have never seen it
December 4th, 2007 at 9:46 pm
My ex was an captain on international flights (I was dating him when this episode first came out) and a SCUBA diver as well. He told me that in order to stop the bends in that guy, they would be able to fly at 30,000 ft, which would be high enough to likely conserve the fuel needed. And yes, a member of the flight crew would have been communicating with the doctors, not some glorified waitress (which is essentially what a FA is). However, that case of decompression sickness seemed advanced enough to kill the guy at that point anyway. Would he really have survived the rest of the flight, regardless of the altitude?
December 5th, 2007 at 3:51 am
“To Benmast Tomworth: What the flight Attendant said sounded Filipino to me. “Malalagnat ka ba?” roughly translates to “Do you have a fever?” in Filipino. But it has the wrong tone though, that’s why I thought it was Malay or Bahasa or something. It sounded very South East Asian.”
It is Filipino. “Malalagnat ka ba?” literally translates to “Are you going to be having a fever?”, which is actually awkward asking someone of having a fever in the future. “Have you got a fever?” is “Nilalagnat ka ba?”
December 6th, 2007 at 10:25 pm
Was I the only one who noticed the reference to “Airplane!”?
January 2nd, 2008 at 11:29 am
PETER-TWO: Apparently planes don’t always actually maintain sea-level pressure in the cabin; sometimes they allow it to drop to the pressure equivalent of an altitude of up to 8000 feet. I also read that it’s rare for DCS to become a serious problem at lower than 5000 feet, which is probably why they cited that height to fly at.
Brian Tung: Rest and oxygen are common emergency first aid treatments for people suffering light forms of decompression sickness; something I had to learn as part of a scuba diving course. In a case that severe it probably won’t make much difference but it would be better than nothing. I don’t know the exact mechanism, but I guess breathing pure oxygen would help to increase the percentage of oxygen compared to inert gases like nitrogen in the blood that could come out of solution?
I’ve also read that skin rashes are a common side effect in serious cases of DCS, so that was probably a reasonable symptom. Although personally, while I watching I thought it was a bit ridiculous that conversion disorder/mass hysteria could cause that kind of skin rash; so I was (pleasantly!) surprised to find out that it’s not as far-fetched as I thought.
A question about the ’surgery’: is there any conceivable way House could have successfully performed that mid-air surgery? As someone already pointed out, how could he have possibly removed the cocaine or closed the incision up afterwards?
March 16th, 2008 at 11:59 pm
A few minor things to add. Early on when House has diagnosed Peng with radiation sickness, House suggested giving him some iodized salt to protect his thyroid. On one hand, you gotta give the writers props for “improvising” potasium iodide pills like that. Alas, the medicine is completely ridiculous. KI pills are only useful if you’ve been exposed to radioactive iodine (which presumably you’ll only see in a lab, a hospital, or a nuclear reactor). Since House is thinking x-rays, KI wouldn’t do anything at all. Moreover, even assuming the problem was radioactive iodine, KI would only help the body excrete any that had been absorbed. It certainly wouldn’t reverse what would have been a massive radiation exposure.
Just a minor nitpick, but damn, this must’ve been the quietest airplane ever flown. Good luck trying to *shout* from one end of a plane to the other, even assuming he’s the only one talking - and good luck hoping for that considering their circumstances.
Finally, to comment on the Cuddy thing, I’m in the weird position of not having yet seen later episodes. If I had to guess, I’d say the last episode was definitely setting up a reveal later on - the writers spared no effort in characterizing her as ultra-ultra-maternal. Also, assuming the blond *was* pregnant (House commented on the breasts, which had nothing to do with the conversion), it would lend some hilarious irony to his noting that statistically, 2 people on the plane should be pregnant.
May 8th, 2008 at 6:24 pm
“bacterial meningitis (a very contagious … disease).”
You silly doctors… ;-)
Bacterial meningitis could be caused by a couple of organisms. I believe you intended to suggest meningococcal meningitis, a specific organism.
However, neither meningococcal nor the other 2 most common bacterial meningitis organisms (pneumococcal and h-flu) are “very contagious”.
Meningococcal bacteria are “droplet spread” and not truly airborne as is commonly believed. That means one is exposed if you get spit in your face or kiss the patient. When determining who to prophylax after exposures in health care settings, we consider contact to be close face to face interaction or performing a procedure such as intubating the patient.
Health care workers often panic and start gobbling the Cipro or Rifampin when they hear the word meningococcal, but that would not be following standard post exposure protocols. Look those up from a reliable source and you’ll see.
And unless the plane passengers had all been somewhere together 2 days prior, why would there be an instantaneous onset of symptoms? Incubation for meningococcal meningitis is 2-4 days.
Also, except for getting the patient antibiotics ASAP, there would be no reason to send the plane back. Any patient with meningococcal septicemia or meningitis would not even require special handling at the airport except face shields on the medical attendants taking over his care. None of the passengers on the plane would be given antibiotics unless they had been exposed to the patient’s saliva.
And if House had gotten any body fluids in his face, a single dose of Cipro or 2 days of Rifampin is all that would be needed.
Some general info just as an FYI:
~5% of the population have meningococcal bacteria in the nasopharynx at any one time. Secondary cases in the US are rare and are most often in a household member. Certain settings increase the risk of meningococcal disease, such as college dorms and military barracks. Still even there cases are rarely linked epidemiologically. There is endemic disease in equatorial Africa which we do not see in the US (nor do they see in Malaysia as far as I know).
May 28th, 2008 at 8:26 pm
“I was a little disappointed by the fact that House didn’t invoke the movie Airplane! even once during the episode, though.”
Actually, he did. Once informed that both of the pilots had steak and not sea bass, he remarks that he was looking forward to landing the plane on his own.
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