House - Episode 5 (Season 2)
As usual, there are House spoilers below, so I’d suggest you watch the episode before you read (unless you’re one of those people who read the last page of a mystery first).
An interesting and enjoyable episode of House with a good medical mystery.
Cornell, a young black man, is at a party celebrating his graduation from Princeton when he begins to convulse from intermittent and excruciating shock-like pains. Initial work ups are negative except for a low white blood count, and an MRI rules out multiple sclerosis. House thinks the patient might have Type II Neurofibromatosis, but the genetic tests are normal.
Cornell looses control of his bowels. This is a worrisome symptom because it indicates that the central portion of the spinal cord has been compromised. The gang decides that he has transverse myelitis, but they don’t know what caused it. House suspects that it is pesticide exposure, so he starts pralidoxime, an antidote for pesticide poisoning . The medication seems to work at first, but then Cornell starts running a fever of 106°F and his symptoms recur. He develops a perforated bowel from the raging infection and requires immediate surgery.
One of Cornell’s friends from college, who we already knew had a weird rash, starts vomiting blood and is brought to the hospital. House is finally able to put the full story together and realizes that the patients have been exposed to radiation. Cornell’s father runs a scrap yard and gave his son a scrap metal weight as a key chain to remember “where he came from.” Unfortunately, this keychain was radioactive. The father and friend have mild cases of radiation poisoning but Cornell has a much more serious case. The radiation has killed off his white blood cells, leaving him open for infections. It also caused a spinal cord tumor (a cavernous angioma) which explains his neurological symptoms. The surgeons are able to remove the tumor, but as the episode ends it seems unlikely that Cornell will survive his infection.
The medicine was fairly sound in this episode. I have a few nit-picks, but no major complaints. Time course is a concern. It is unlikely that an exposure to a pesticide over spring break would have caused symptoms to appear months later at graduation. Radiation poisoning, especially exposure to long-term low-dose radiation, can take months for symptoms to surface — so the time course there was reasonable. It does seem that the tumor developed awfully fast though. Finally, if Cornell had a white count as low as the story suggests, he should have been in isolation shortly after admission, and his father should have been wearing a mask and gloves (and probably a gown) when he went in to see him at the end.
On the non-medical, soap opera side, the action picks up. House has borrowed $5000 from Wilson to buy a new motorcycle. Of course, it turns out that House didn’t need to borrow that much money — he was just testing Wilson to see how much he’d lend him by asking for increasing amounts over the course of a year. Surprising no one (except maybe House), this annoyed Wilson. Also, House’s parents are in town for a brief layover at the airport and want to go to dinner with him. He is trying to avoid them, but doesn’t want to lie to them. He concocts various schemes to get out of dinner, but ultimately sits down to share a meal with them at the hospital cafeteria. The interactions between House and his father (a bushier-eyebrowed than usual R. Lee Emery) drive home the underlying theme of this episode: fathers and sons, when do they lie to each other, and when do they tell the truth?
I give this episode an A for the mystery with a B+ for the final solution. The medicine overall earns a B and the soap opera also deserves a solid B.
November 9th, 2005 at 8:55 am
Timing of this topic couldn”t have been better. I teach General
Chemistry and last night started chapter on nuclear chemistry.
Will certainly use some of the episode relating to radiation
poisoning in class on Thursday night.
Thanks for the great analysis of each episode. TV Guide analysis
seems to miss the intricate science of each story line.
Evelyn
November 9th, 2005 at 11:29 am
I thought the radioactive waste bit may ultimate derive from a real-life incident in a Brazilian favela where kids were playing with carelessly-discarded radiotherapy scrap metal; but then while googling for that incident, I found this link to a junkman in Ohio who’s suing the Feds to get compensation for accidentally selling him radioactive scrap, tainting his entire operation and possibly poisoning him and his daughter:
http://www.unknownnews.net/030925everybodymakesoccasionalmistakes.html
November 9th, 2005 at 4:44 pm
cool review
November 10th, 2005 at 9:25 am
Nort a House watcher, but my friend and co-worker is. Sent her the link to your House reviews, which I enjoy despite being only vaguely aware of the reference points, medically and storywise.
November 10th, 2005 at 9:30 am
And she JUST wrote me: A great Web site. Thanks for sharing!
November 12th, 2005 at 3:52 am
I still don’t get why they wouldn’t let him be English.
May 27th, 2007 at 1:57 am
This one just repeated on USA tonight (just now) What I want to know is how House has such BRIGHT, clear blue eyes and his parents…don’t.
>_____>.
May 28th, 2007 at 11:28 am
The amount of radiation and type needed to cause such symptoms would have to be extremely high. The type of radiation is also important. There are no really radioactive metals (with half lives that are considerable) that would be found in scrap that would be releasing the high energy gamma/beta to cause that sort of injury. The incident in Brazil was related to Cesium-137 powder that was highly radioactive and was actually stolen from an abandoned hospital. (Cs-137 can be used in radiation treatments, especially in older facilities)
Furthermore, you would NEVER be able to leave a US airport, even private, without a full screening to confirm you are not carrying anything out of the country. You would never be able to smuggle high density nuclear material into or out of the country in such a fashion.
June 8th, 2007 at 10:40 am
John House,
Although I’m not a Doctor and certainly not a geneticist (nor do I play one on TV), I do know that the gene for blue eyes is recessive. It’s perfectly possible for parents with non-blue eyes to have a child with bright blue eyes. My mother has dark green eyes, and my father has dark brown eyes, yet both my brother and I have bright blue eyes - at least comparable to House’s, if not lighter. And, yes, I do know for certain that they are both my real parents.
July 19th, 2007 at 7:26 pm
In addition to Richard Rogers’ comments above, it’s also worth mentioning that if a radioactive substance is suspected, a radiation safety officer would be needed to check out the unknown package, or at the very least an authorized radiation user of some type (radiologist, radiographic technologist, oncologist, nuclear medicine specialist). medical doctor, or the hospital would have the NRC to answer to. Aside from that, House and Foreman weren’t even wearing radiation badges, much less have any sort of shielding on.
Also, from what I’ve learned in my radiation science training, bone marrow transplants are a last resort to treat radiation hematopoietic syndrome, as they don’t typically work all that well. The best thing to do with a radiation dose this large - somewhere between 1 and 5 Sv is my guess - is isolation and simple palliative care. The fact that his exposures were fractionated probably saved his life (if he did live; the episode doesn’t make that clear). Still, I’m not a medical doctor, so it’s always possible a bone marrow transplant could help in some cases.
December 25th, 2007 at 11:18 pm
This episode was on again tonight. Is a BAC of 2.0% normal after partying? I thought 0.4% was generally the LD50.
December 29th, 2007 at 8:00 pm
Harvey: maybe they didn’t need protection for a short time exposure to low radiation? I’m almost guessing, mind.
January 10th, 2008 at 7:33 pm
I love the reviews you put on this website. The tv guide ones don’t seem to get it all. I was wondering about House’s parents having different colored eyes. I looked it up last night and find out about the recessive thing. Odd coincidence.
January 13th, 2008 at 5:14 pm
@fluffy: after a graduation party, with what he was downing? Haha, of course it is.
June 24th, 2008 at 1:43 pm
This was a very good episode. I myself have one nitpick. While looking at Cornell’s chart Chase remarks that his blood Alcohol was 2.0.
Shouldn’t that have killed him, since .55 is high enough to kill you.
October 2nd, 2008 at 7:19 pm
Aidy (re: eye color)–
Actually, there gene for blue eyes is not recessive. In fact, there is no gene for blue eyes or any specific eye color. Eye, hair, and skin color are all determined by the amount of melanin present. These traits are called polygenic because they use information from more than one gene.
There are several genes with information about melanin amounts. Each of these is either dominant (more melanin) or recessive (less melanin), and in combination they determine pigmentation.
If I remember correctly, there are ten genes responsible for eye color. So if 7-10 are dominant, the person will have brown eyes; 5-6, green; 1-4, blue. Brown and blue have a higher probability than green, which is why more people have those eye colors. Numbers very close to the next color (7 and 4) would likely be the reason for hazel and blue-green. As for such anomalies as violet, we can probably chalk that up to a mutation, hence the rarity.
Note: the numbers are approximate. I’ve seen them listed differently, but this is how we learned it in biology, so these are the numbers I remember.
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