House - Episode 6 (Season 2)
This medical review of House contains spoilers, so don’t say I didn’t warn you…
Jeff Forester, a champion cyclist, collapses from respiratory distress during a charity bike race and is brought to the hospital. He readily admits that he blood dopes. He also admits to using amphetamines, diuretics and sleeping in a hyperbaric oxygen chamber. He denies using any anbolic steroids or Epogen. He mentions that he stopped taking his supplements several days previously because it was “just a charity race and it didn’t matter if he won or not.”
The chest x-ray shows no signs of pneumonia or fluid build up. A spiral CT of the chest shows no pulmonary embolus. The team deduces that Jeff must have accidentally injected himself with an air bubble while blood doping and developed an air embolus (regular readers will remember that I covered this back in July when reviewing Manhunter #11). Chase is able to remove the air embolus using a catheter; however during the procedure the patient begins complaining of leg weakness and then collapses, drooling all over his pillow.
Increasing muscle weakness follows, ultimately landing Jeff once again in respiratory distress. The team considers lupus, ALS (probably better known as Lou Gehrig’s disease) and muscular dystrophy but all the tests are normal. They are suspicious of an infection, but there is no laboratory evidence of it. Noting Jeff’s dropping red blood cell count, the team diagnoses him with pure red cell aplasia (PRCA) — a condition where the body cannot make enough red blood cells. Epogen has been linked to several cases of PRCA so House accuses Jeff of lying about not using the drug. Jeff continues to deny ever using epogen, but he fires his manager because he suspects she might have given him the drug. When Jeff continues to have symptoms, the team diagnoses him with a thymoma (a tumor of the thymus) and myasthenia gravis. His blood doping and hyperbaric treatments had prevented the conditions from becoming evident until he stopped them for the charity race.
The medicine was rather muddy this episode. The doctors were all running around like chickens with their heads cut off. They were more interested in what drugs Jeff had taken and why, rather than taking a good look at his symptoms. The muscle weakness and drooling should have made myasthenia gravis an obvious choice. It’s not that the medicine was bad or incorrect, it was just ill considered and the team could have used their time and resources much better.
A few nit-picks:
- The team went to a muscle biopsy way too early in the diagnosis of weakness
- Foreman is wrong: there are several types of muscular dystrophy that strike adults — though they are very rare. One of my first patients in residency was a gentleman in his 50s who was diagnosed with muscular dystrophy only after he developed congestive heart failure.
- Blood doping can be sometimes caught by testing (just ask Tyler Hamilton); amphetamine use certainly would be caught.
- I’m still not clear how they decided that Jeff might have an infection. Something like: “His red blood cell count should be high but it’s low, so that means the white cell count which is also low must be high as well and he has an infection!” That’s quite a stretch. (And they were wrong anyway.)
It was nice to see House return to his arrogant-bastard ways in this episode. He invites himself to the therapy group attended by Stacy’s husband, he gets the cyclist’s manager fired by accusing her of sliiping Jeff Epogen and in the end he breaks into Stacy’s therapist’s office and reads Stacy’s file. This is the House I remember. We also learn a bit more about Wilson’s and Cameron’s past. Both had been tempted to commit adultery; Wilson did, Cameron didn’t.
I give the medical mystery a fair B, but its solution only deserves a C because it was too obvious. Overall, the medicine earns a B-. The soap opera redeems the show, earning a solid A.
November 17th, 2005 at 11:51 am
In terms of professional ethics and competence, both House going into the therapy session and his breaking into the file cabinet were seriously unethical. The group therapist should never have let House into the therapy group at all knowing he and Mark had a pre-existing, antagonistic relationship because it was bound to disturb the existing dynamic in the group and probably make the other members suffer. If she thought they needed to work things out in therapy, she should have scheduled a separate session for the two of them.
Breaking into the filing cabinet was typically House, but most Employee Assistance Programs specify off-site counselling even when there is a psych department in the hospital because you should never meet your therapist in a social setting.
November 21st, 2005 at 9:07 am
I have questions!
Is it ethical to give someone a diagnostic dosage and let them fall over?
Does House reflect in any way real doctoring? Or does he do things you wish you could do?
November 28th, 2005 at 3:48 am
Excellent review - I loved this episode. Had to wind back several times because I was laughing so hard . Wonderful soap opera!
November 29th, 2005 at 6:15 pm
You’re asking if it’s ethical for a diagnostician working on a patient’s case to let a patient lay on the floor while you call any available nurses to his aide?
Can’t even blame it on the cane.
Dr. House does indeed reflect the ego that some diagnosticians and even LPNs or RNs have.
That’s just life, and there are people that act just like House and they still have jobs that help large or small amounts of people. It’s just being human.
February 10th, 2006 at 4:42 pm
Apparently you’d be surprised what doctors can get away with, or so I’ve been told. The medical errors aren’t what bother me. Nor are the things that differ from real life for obvious story/dramatic reasons. The thing that bothers me most on this show (which U lvoe dearly, as a note) is House’s ocassional tendency to grasp for diagnosises and hit upon the correct solution by sheer chance, and the fact that the team alternates between doing that and passing over things too readily.
House breaking into the files was a scene which some fans complained about. But I agree, it’s tje old House back. I think some people labor under the delusion that he is nothing more then a mishuided fuzzy teddy bear. Considering how he’s behaved in the past, his ethics leave much to be desired. Some seem to conveniently ignore how he’s behaved in the past.
February 28th, 2006 at 3:25 pm
If all the doctors were indeed as efficient and conginitively aware as in real-life, we wouldn’t have a show.
Things have to be manipulated to cause suspense, provide dramatic twists and turns, and of course you have the overarching- and side-plotlines. Even the Discovery channel has problems doing anything over half an hour in that respect.
Yes, you’re correct - logically, patients’ charting, cases, beginning to end- wouldn’t happen like it does in real life (diagnostically, at the least.)
But then again, I don’t think the average person would continuously (over two “seasons”) walk around a hospital during rounds for fun. So there we have it, the wonders of the entertainment industry.
I’m glad there are complaints - that means people actually watch the show. This is all I can sit still for besides the Food Network. (I’m Cajun.)
June 21st, 2006 at 4:42 pm
Is that syringe-as-javeline trick that House does to the cyclist’s thigh a real thing (ie., even when done less dramatically, it does work and is used by ral doctors) or was that totally made up for the show?
June 21st, 2006 at 5:41 pm
Official Comment
I guess it could be done, but there are more practical ways of gathering the same information.
October 14th, 2006 at 2:05 pm
The “Tensilon” test is a real test for helping doctors to make a diagnosis of miasthenia gravis.
November 23rd, 2006 at 11:06 am
There´s one thing I don´t understand at all:
Why was the cyclist able to compete in races?
Patients with myasthenia gravis without proper treatment should not be able to do any sports at all.
What has hyperbaric treatment to do with myasthenia?
January 12th, 2007 at 3:22 pm
Hi,
The hyperbaric chamber thing makes no sense, if I understand things correctly. That’s a chamber with higher partial pressure of oxygen? If so that’s backwards. A few athletes use altitude tents, to simulate the natural boost in hematocrit that you would get from living at high altitude. Less than normal oxygen, which boosts the natural production of epo. It’s currently legal, although some want to eliminate it (it’s not clear if they also want to eliminate living and training at high altitude).
tom
August 21st, 2007 at 12:41 pm
The best part of the group therapy scene was watching the therapist. She was having a clear struggle with her conscience–yep, totally wrong to let House in and start an argument, but she really wanted to know the stuff they were throwing at each other. So curiosity and professional ethics had to go for about three falls out of five.
December 2nd, 2007 at 6:43 pm
So we discovered that floorboy again in SEASON 4 as NR 39, LOL
January 25th, 2008 at 7:23 pm
Just one thing that I noticed was when they passed around the ideas of ALS and so on and Foreman dismisses it as “He’s too young for that”. I was not aware you could be too young for ALS. Now if I’ve got my facts right, Jason Becker was diagnosed with ALS when he was about 21 years old and given three years to live back in 1990/91. Seems the doctors were wrong about that and he’s still alive but as far as I can tell, it means Foreman claiming he was too young for ALS is completely inaccurate.
So not only was he wrong about muscular dystrophy but also about ALS? That doesn’t say “great doctor” to me.
(Do correct me if I’m wrong)
June 11th, 2008 at 10:33 pm
I love Cuddy’s expression right after House says “assuming I’m more ethical than your patient.”
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