HOUSE, M.D.: 1. "Pilot"
Micky DuPree
beginning. I don't think I've included any episode-specific spoilers
beyond the pilot, but I do take advantage of a general knowledge of the
series through the early second season, which the purists would indeed
consider to be spoiling information.
This is an expanded version of something I did for Television without
Pity, but TwoP has a 7500-character limit per post, which meant that I
was doomed never to be a good fit there.
SAM: I can't unleash my full potential in a two-page summary.
-- _The West Wing_, "The Lame Duck Congress"
Elapsed time numbers are for the DVD copy.
PROLOGUE
I read a lot of fans complaining about the orange tint to the pilot and
didn't know what they meant until I saw the DVD copy. The orange
patient was only in the advanced stages of what all the other characters
seemed to have. The copy I first saw wasn't that bad.
I loved the music in the pilot. Except for the occasionally sappy
commercial song choice, I did like the music in the rest of the first
season, but there was something special and cinematic about the music in
the pilot.
I wonder where they found a pedestrian overpass in L.A. (or was that
Vancouver?), because they did manage to make me think it was in the
northeast.
I suppose Robin Tunney is now better recognized as the woman running
from the conspirators on _Prison Break_.
ACT I
2:59
Princeton-Plainsboro Teaching Hospital has the busiest, most crowded
hospital corridors I've ever seen, and yet since the Diagnostics Dept.
works almost entirely in isolation, never bringing anyone in for a
consult except Wilson, the hospital nevertheless feels radically
understaffed.
I loved the film noir look to the lighting in the early days.
It took me a long time to reconcile myself to House's permanent stubble.
It's perfectly in character that House can't be bothered to put in the
time required to shave. However, in real life, it takes time and
maintenance to keep stubble at the same length day in and day out. It
looks like a Don Johnson 1980s affectation (which would not be in
character for House). But finally I realized I had to cut them some
slack for production purposes. Since they shoot scenes out of sequence,
they can't afford for House to start off clean-shaven at the beginning
of an episode and then have a week's worth of beard at the end. The
fastest, easiest, and cheapest solution to maintaining visual continuity
throughout is to artificially keep the same level of stubble all the
time.
WILSON: Twenty-nine-year-old female, first seizure one month
ago, lost the ability to speak.
They must have sent Rebecca home for a while, though, because the ham
that Foreman ate wasn't a month old.
HOUSE: See that? They all assume that I'm a patient because of
this cane.
WILSON: So put on a white coat like the rest of us.
HOUSE: I don't want them to think I'm a doctor.
WILSON: You see where the administration might have a problem
with that attitude.
HOUSE: Eh, people don't want a sick doctor.
The pilot was the only time I've caught House caring about what other
people think of him (in the first season, anyway). My theory is that
David Shore was still experimenting with where he wanted to go with the
show in general and with the character in particular.
It was also a little strange that House would wait several years after
he started walking with the cane to make this observation to his only
friend, but obviously he said it for the audience's benefit more than
for Wilson's.
WILSON: No wonder you're such a renowned diagnostician. You
don't need to actually know anything to figure out
what's wrong.
Evidence of House's reputation, albeit backhanded.
HOUSE: That's an HMO lab. You might as well have sent it to a
high-school kid with a chemistry set.
Heh.
WILSON: No family history.
HOUSE: I thought your uncle died of cancer.
WILSON: Other side.
Implying it was a paternal uncle, or House would have caught the
discrepancy in the surnames.
WILSON: And she's not responding to radiation treatment.
How did they know where to aim the radiation if they couldn't find a
tumor? Did they just assume that the undefined "lesion" that Foreman
noted was a tumor? Or is there a type of radiation therapy that isn't
directly aimed?
The point at which House was on the verge of taking the case was one of
the few times you could actually see a Vicodin pill in his hand. I
wouldn't be surprised if Laurie usually just mimes taking it.
WILSON: Come on! Why leave all the fun for the coroner?
I just like that line.
WILSON: What's the point of putting together a team if you're
not going to use them? You've got three overqualified
doctors working for you, getting bored.
A pattern of slacking.
FOREMAN: Shouldn't we be speaking to the patient before we start
diagnosing?
HOUSE: Is she a doctor?
FOREMAN: No, but --
HOUSE: Everybody lies.
CAMERON: [To Foreman] Doctor House doesn't like dealing with
patients.
FOREMAN: Isn't treating patients why we became doctors?
HOUSE: No, treating illnesses is why we became doctors.
Treating patients is what makes most doctors miserable.
FOREMAN: So you're trying to eliminate the humanity from the
practice of medicine.
Strongly implying that Foreman was very new to the team at this point
and that this was the first case they had taken on since he got there,
while Cameron had been there long enough to know House's quirks with
respect to patients.
FOREMAN: First year of medical school, if you hear hoofbeats,
you think horses, not zebras.
HOUSE: Are you in first year medical school? No. First of
all, there's nothing on the CAT scan. Second of all,
if this is a horse, then her kindly family doctor in
Trenton makes the obvious diagnosis and it never gets
near this office.
Establishing the premise that the Diagnostics Dept. would be dealing
strictly with 99.9th percentile cases in the A plots. Also reinforcing
the implication that Foreman was new to the team if he had to have the
exclusivity of zebras explained to him.
CHASE: Mad cow?
HOUSE: Mad zebra.
Snerk.
HOUSE: No, blood thiamine level was normal.
Laurie pronounced it THIGH-a-meen, one of the very few times on the show
when I've gotten a sense of a British accent off of him. Brits are the
only ones I've ever heard pronounce it that way. (On the other hand,
someone I know from Philly claims that's the way he's always heard it.)
FOREMAN: I assume it's a corollary, if people lie, that people
screw up.
Quick study. :) Also establishing a pattern that the Diagnostics Dept.
tends to distrust outside test results.
Cameron's hair was so dark in the pilot it was almost black.
HOUSE: I have tenure.
That must have been either a minor miracle (Cuddy alone couldn't have
managed that), or else House used to make more concessions to convention
before he got tenure.
HOUSE: I'm here from nine to five.
To be fair, when House has a time-critical case, he's been known to pull
an all-nighter. Ought to count for something.
CUDDY: Your billings are practically nonexistent.
HOUSE: Rough year.
As another character would later describe House's department: a
financial black hole. I wonder if House just loses billing paperwork on
purpose for patients without insurance or if this was just indicative of
the low number of patients he treats.
CUDDY: You ignore requests for consults.
HOUSE: I call back. Sometimes I misdial.
This seemed stranger to me. You'd think that if other doctors are
already baffled, that would increase the odds that they've got some
interesting zebras for House to look at. Or does he just get Cameron to
screen out the horses with dye jobs?
CUDDY: You're six years behind on your obligation to this
clinic. [....] Six years times three weeks -- you owe
me better than four months.
You'd think that Cuddy would have brought this up six years ago, but
again, this was mostly for the audience's benefit.
So House had been at Princeton-Plainsboro Teaching Hospital for at least
six years. Someone else would later say House had been working at PPTH
for eight years. Maybe House got tenure after two years and then
stopped working clinic duty on the assumption that he could no longer be
fired?
6 years x 3 weeks standard clinic duty/year = 18 weeks backlogged clinic
duty x 40 hours/week = 720 hours backlogged clinic duty.
HOUSE: It's five o'clock. I'm going home.
CUDDY: To what?
HOUSE: Nice.
House never gets mad at personal digs. But it's also a valid question.
If House lives for his work, but all but the most challenging cases bore
him, then what does he do to keep from getting bored at home?
CUDDY: Look, Doctor House, the only reason why I don't fire you
is because your reputation is still worth something to
this hospital.
More evidence of House's reputation.
CUDDY: The clinic is part of your job.
It's been a great conceit for the series, forcing House to work the
clinic, but it's still a conceit. I can't see a major cost-conscious
public hospital putting renowned and expensive specialists to work doing
what amounts to primary-care intake. In a lot of places, you'd have two
nurse practitioners or physicians' assistants overseen by one primary-
care physician doing that job.
There was what looked like a female secretary in the outer chamber of
Cuddy's office when House came barging in.
HOUSE: [To Cuddy] You showed me disrespect. You embarrassed
me. And as long as I work here you have no legal --
Once again, this was the only (first-season) episode in which I could
remember House seeming to care what others thought of him (House
embarrassed?), although in this particular instance, I could see him
going on about all that more to light a fire under Cuddy than to salve
his pride.
CUDDY: That's scary, but I'm pretty sure I can outrun you.
House never gets mad at cripple digs. He did take a Vicodin, though.
And I loved the way Cuddy calmly talked him down.
HOUSE: I've gotta do four hours a week in this clinic until I
make up the time I've missed. Two thousand fifty-four.
I'll be caught up in two thousand fifty-four.
3 weeks standard clinic duty/year x 40 hours/week = 120 hours standard
clinic duty/year.
1.7 hours/week extra clinic duty = 423.5 weeks or 8.1 years until
backlogged clinic duty is worked off.
Either House was exaggerating for effect, or there's something I'm
missing about the math.
That business of background:green/foreground:white in the MRI room dates
back to the pilot. I just didn't notice it until the second season.
There was a technician present in the MRI room, but she had only one
line during the first attempt, and she was mostly out of shot during the
second attempt. In a lot of later episodes, there would be no
technician present at all.
Rebecca had the first of many allergic reactions, seizures, etc. to make
an MRI or other test or treatment unfeasible and complicate the plot.
If story time paralleled real time, then Rebecca was deprived of oxygen
for 1:13 minutes.
ACT II
13:20
House took another Vicodin while waiting for the fellows to finish up
with Rebecca.
HOUSE: Can't get a picture, gonna have to get a thousand words.
Is gadolinium the only contrast medium you can use with an MRI?
HOUSE: Twelve fifty-two p.m., Doctor House checks in. Please
write that down. Do you have cable TV here somewhere?
_General Hospital_ starts in eight minutes.
According to my schedule, _General Hospital_ is on at 3 PM ET.
House took another Vicodin while listening to Orange Guy.
HOUSE: Your wife is having an affair.
What if Orange Guy's wife had been blind? Or totally color-blind? Or
out of town for work? Or if Orange Guy was an ex-husband or a widower
who sentimentally never took off his wedding ring? There are
differential diagnoses for visual inattentiveness.
HOUSE: But the steroids ... the steroids ... stop the
inflammation. The more often this happens ...
Lesser _satori_. (Actually, in this case, false _satori_, since it
wasn't vasculitis.)
CHASE: You should have told her the truth. It's a long-shot
guess.
CAMERON: [....] If House is right, no harm. If he's wrong,
we've given a dying woman a couple days' hope.
CHASE: False hope.
CAMERON: If there was any other type available, I would have
given her that.
Interesting how Cameron would have a problem with lying later, but she
was cool with simply concealing the truth as long as it was an
unpleasant truth.
FOREMAN: Do you have any pets in this class?
SYDNEY: No, but we used to have a gerbil, but Carly L. dropped
a book on it.
At this stage, I originally thought the gerbil was going to end up being
the disease transmitter.
I've been told that the footage on the cafeteria TV was from _All My
Children_. I wouldn't know. _General Hospital_ was acknowledged in the
closing credits while AMC wasn't.
FOREMAN: Parrots are the primary source of psittacosis.
HOUSE: It's not the parrot.
FOREMAN: Psittacosis can lead to nerve problems and neurological
complications.
HOUSE: How many kids were in the class?
FOREMAN: Twenty.
HOUSE: How many are home sick?
FOREMAN: None, but --
HOUSE: None. But you figured that five-year-olds are more
serious about bird hygiene than their teacher.
Wouldn't it be more likely that the care of the parrot was entrusted to
another adult, not to the students? And people can't have allergic or
other individual reactions to parrots?
HOUSE: The lady back there, who made your egg-salad sandwich.
Her eyes look glassy. Did you notice that?
Sweet, a triple rack focus, extreme background to extreme foreground to
close-middle ground.
HOUSE: Now hospital policy is to stay home if you're sick, but
if you're making eight dollars an hour, then you kind
of need the eight dollars an hour, right?
Nice of House to notice.
FOREMAN: Oh, I can't just break into someone's house.
HOUSE: Isn't that how you got into the Felkers' home? [Off
Foreman's look.] Yeah, I know. Court records are
sealed. You were sixteen. It was a stupid mistake.
But your old gym teacher has a big mouth. Should write
a thank-you note.
FOREMAN: I should thank him?
HOUSE: Well, I needed somebody around here with street smarts.
O.K.? Who knows when they're being conned, knows how
to con.
Hmp. I think Foreman's only selectively wise to cons.
FOREMAN: I should sue you!
HOUSE: I'm pretty sure you can't sue somebody for wrongful
hiring.
FOREMAN: But I'm pretty sure I can sue if you fire me for not
breaking into some lady's house. [Takes a pointed bite
of his sandwich.]
Foreman defiantly eating that last bit of sandwich cracked me up.
The cover of the magazine that House was reading in exam room two:
Goss[ip]
SPRING'[S]
HOTTEST
PEOPLE
[...]ver 100 pages of the most
intriguing, most famous
and most sought after
CUDDY: Why are you giving Adler steroids?
I wonder what put Cuddy on to House's case in the first place.
CUDDY: You don't prescribe medicine based on guesses. At least
we don't since Tuskegee and Mengele.
HOUSE: You're comparing me to a Nazi? Nice.
House doesn't even get mad at professional digs (which I would have
expected to mean more to him). He just brushes those off too.
(In "Humpty Dumpty," I think it will be important to look back at this
reference to the Tuskegee study.)
HOUSE: There's never any proof. Five different doctors come up
with five different diagnoses based on the same evidence.
Ain't that the truth.
REBECCA: Am I ever gonna meet Doctor House?
WILSON: Well, you might run into him at the movies or on a bus.
Seriously, House takes the bus with all that hoi polloi around him? Or
was Wilson kidding?
ACT III
24:55
FOREMAN: When you break into someone's house, it's always better
to have a white chick with you.
LOL.
You would not BELIEVE the shitstorm that got kicked up on the official
Fox _House_ forum because fibromyalgia sufferers mistook the portrayal
of the hypochondriac diagnosing himself with fibromyalgia for a
portrayal of fibro sufferers as hypochondriacs. There were people
complaining who hadn't even seen the episode, because some sort of call
to action was circulated on some support-group network.
HOUSE: I need thirty-six Vicodin and change for a dollar.
No normal pharmacist would dispense narcotics without a prescription,
and we would later see it confirmed that a doctor can't just prescribe
narcotics for himself, so I don't know what they were thinking here. I
find it hard to believe that a pharmacist would leave a bottle of 36
narcotic pills unlabeled and sitting on an unattended counter in a
public place. They don't usually give that stuff up without a police
escort and an armband to identify you as an addict in the making. Plus,
the pills that the pharmacist gave House as "Vicodin" were small and
round, not large and elongated like House's later Vicodin.
CAMERON: [To Foreman] House doesn't believe in pretense.
Figures life's too short and too painful. So he just
says what he thinks.
I guess they were setting Cameron up to idealize House pretty early,
since this line came immediately after House prescribed placebos for the
hypochondriac. It was also another indication of how new Foreman was to
the team, with Cameron continuing to explain the lay of the land to him.
CAMERON: Well, if you wanted to be judged for your medical
prowess only, maybe you shouldn't have broken into
someone's home.
FOREMAN: I was sixteen! [....]
CAMERON: I managed to make it to seventeen without a criminal
record.
FOREMAN: Yeah? Well, you obviously didn't grow up in my
neighborhood.
A lot of fans seem to think this meant that Cameron got a criminal
record when she was 18, but it just seemed like sarcasm to me, because
if she had a criminal record at all, especially as an adult, she
wouldn't have been able to criticize Foreman's juvie record from her
moral high ground.
FOREMAN: You know what, after centuries of slavery, decades of
civil rights marches, and more significantly, living
like a monk, never getting less then a four-point-oh
GPA, you don't, you don't think it's kind of disgusting
I get one of the top jobs in the country because I'm a
delinquent?
Which was an indication of the prestige of Foreman's fellowship,
probably of all their fellowships to a greater or lesser degree, and
indirectly an indication of House's reputation again.
CAMERON: You went to Hopkins, right?
FOREMAN: Yep.
CAMERON: So, you went to a better school than I did, got better
grades than I did.
FOREMAN: [Laughs.] So how'd you get the job? Did you stab a
guy in a bar fight?
LOL!
FOREMAN: I had ham at her apartment!
And the greater _satori_ was set in motion.
Text of the open medical book in House's office. Note especially the
name of the physician on an earlier similar case. :)
[...]n of a common tapeworm
[...]with a short trial of Albenda-
[...]ays. Side effects of this drug
[...]condition known as hotdog
[...]ute hunger, diarrhea, vomiting
[...] cases where tapeworms have
[...]and migrated through the body.
[...]omenon originate in the United
[...]own diagnosis was made by Dr.
[...]ian in the Dales country. Word of
[...]ad for over twenty years due to the
[...] local patois, but in 1948 a similar
[...]the very young Marcus Welby, MD in
[...] confirmation of the diagnosis was
[...]atments were slowly perfected to kill
[...]nywhere within the body
in length to the entire length of the intes[...]
more. These parasites rely on specialised hooks o[...]
(SCOLEX) that help them attach to the intestines and absorb
digested nutrients. In some cases the worm can compete
with the host for absorption of food, resulting in weight loss.
[caption]
Taenia saginata (Tapeworm) 400x Magnification
The symptoms of tapeworm
infection generally begin to
appear 10 days after egg in-
gestion, but some people
[...]tice any symp-
[...]ction
[....]
A quick google says that Taenia Saginata is beef tapeworm, not pork
tapeworm.
ACT IV
33:16
HOUSE: [To Rebecca] When you're all better, I'll show you my
diplomas.
Unwarranted arrogance, since other doctors have diplomas too, but that
doesn't mean that House would trust them on that basis. But it would be
nice if we could get a look at House's diplomas.
REBECCA: You were sure I had vasculitis, too.
Actually, for once, House wasn't sure. He just thought that vasculitis
was worth a shot.
REBECCA: I just want to die with a little dignity.
HOUSE: There's no such thing. Our bodies break down,
sometimes when we're ninety, sometimes before we're
even born, but it always happens and there's never any
dignity in it. I don't care if you can walk, see, wipe
your own ass. It's always ugly, always! We can live
with dignity. We can't die with it.
Great speech, pure House, a revelation of something he's passionate and
sincere about, rather than the glib sarcasm he routinely surrounds
himself with. It was the earliest glimpse we got that while the thrill
of the mystery is what hooks him on any given case, there's more to his
professional motivation than just the intellectual exercise.
HOUSE: No treatment.
FOREMAN: Maybe we can get a court order, uh, override her
wishes, claim she doesn't have the capacity to make
this decision.
HOUSE: But she does.
CAMERON: But we could claim that the illness made her mentally
incompetent, right?
FOREMAN: Pretty common result.
HOUSE: That didn't happen here.
Another point on which the characterization felt experimental. Here, it
was Foreman and Cameron who were suggesting violating patient autonomy
without batting an eye while House categorically refused. This was the
only time I could remember these characters taking these respective
stands on the issue.
WILSON: He's not gonna do it. She's not just a file to him
anymore. He respects her.
Another line that seemed to be for the benefit of the audience. And it
ain't necessarily true of the rest of the series.
HOUSE: Patients always want proof. We're not making cars
here. We don't give guarantees.
More of an art than a science, as Cameron would later admit. Actually,
I've heard of experiments to computerize medical diagnostics by
combining vast databases of symptoms with AI that unfortunately
performed so well that M.D.s felt threatened. But the M.D.s did like a
modified version that offered up alternatives for the doctors to choose
from instead of directly competing with the doctors. Why insurance
companies haven't rammed such programs down doctors' throats yet I don't
know.
CHASE: I think we can prove it's a worm.
And it was Chase who came up with the bright idea.
Chase and Foreman were sitting in the x-ray control room, but there was
a nameless technician actually aiming the x-ray machine.
HOUSE: [To Cameron] Does it make a difference what I think?
I'm a jerk. The only thing that matters is what you
think. Can you do the job?
It should make a difference what House thinks. His judgment and
experience are supposed to be better than Cameron's. Otherwise, why
should she bother studying under him?
HOUSE: [To Cameron] Would that upset you, really, to think that
you were hired because of some genetic gift of beauty
instead of some genetic gift of intelligence?
Well, the latter is more substantive and relevant to Cameron's chosen
career.
CUDDY: [To ex-Orange Guy] Either your wife is having an affair,
or she's not having an affair and you have come here
because you rightly think I should fire him. But I
can't, even if it costs me your money. The son of a
bitch is the best doctor we have.
Another reason Cuddy is reluctant to fire House. But we would later
learn that Cuddy can manage to place an upper dollar figure on him.
The class' greeting card:
We Miss
You!
We're happy you're
not dead, miss
Rebecca
I imagine that getting parental permission for such a field trip in real
life would be a nightmare, but it gave us that Kodak moment between
teacher and students.
REBECCA: I wanted to thank Doctor House, but he never visited
again.
CAMERON: He cured you; you didn't cure him.
Another line that seemed to be predominantly for the benefit of the
audience.
TV: Because we're doctors. If we make mistakes, people die.
I've been told that the clip that House and Wilson were watching in the
exam room at the end was actually from _General Hospital_. Again, I
wouldn't know, but that surprised me. Since everyone was masked up on
the screen and the dialogue just conveniently happened to echo an
earlier line of Cuddy's, I originally assumed that this footage was shot
just for _House_.
Some of the location footage might have been shot in Canada. I
recognized one of the casting people from some Canadian-based
productions.
_House_ suffers a little from time compression. It can often seem like
a patient starts out in perfect health, falls down, is at death's door,
and gets cured, all in a day or two. While the timetable is obviously
speeded up for dramatic effect, it's not usually quite as bad as it
seems. They just don't bother to call attention to the passing of time.
Often the only clue that a day has passed between adjacent scenes is
that the characters have changed clothes. Sometimes the only clue that
even more time has passed is a quick mention in the dialogue, a
suggestive montage, or even just the implication that time must have
passed.
Based on the wardrobe changes, the action in the pilot took place on six
distinct days. The first day was a month before the others, when
Rebecca first seized. The last day could easily have been several weeks
after the middle days, once Rebecca had recovered enough to receive
visitors. Plus, Orange Guy had flushed the excess vitamins out of his
system and Hypochondriac Guy had had time to use up all his placebos.
All in all, I found the pilot mediocre by the high standards set by the
rest of the first season (but superior by and large to the second
season). I didn't dislike it, but I felt it suffered from an evident
pressure to hit the ground running in establishing who these characters
were and what their relationships were to one another. Hence the
characters would sometimes make pointed pronouncements about House in
particular to make sure we didn't miss things, like, "Caring's a good
motivator. He's found something else," and, "She's not just a file to
him anymore. He respects her," and, "He cured you; you didn't cure
him."
Vicodin count: 4
Medical synopsis
A plot:
aphasia preceding a seizure
mildly elevated sed rate
initial diagnosis of undetectable brain tumor
unresponsive to radiation
differential diagnosis: aneurysm, stroke, or some other ischemic
syndrome; Creutzfeldt-Jakob disease (mad cow); Wernicke's encephalopathy
complication: allergic reaction to gadolinium (no contrast MRIs)
tracheostomy
diagnosis of cerebral vasculitis
responded well to prednisone, then got worse
temporary blindness, seizure, cardiac arrest
intermittent neurological dysfunction
nonambulatory
loss of control of bladder function, bowel function, or both
final diagnosis: pork tapeworm in the brain (neurocysticercosis)
treated with albendazole
Clinic patients:
1) megadosing with niacin and vitamin A
2) asthmatic not using inhaler
3) self-diagnosing hypochondriac
Chelsea Christenson
news:dneuvh$par$1...@pcls4.std.com...
> CUDDY: You ignore requests for consults.
> HOUSE: I call back. Sometimes I misdial.
>
> This seemed stranger to me. You'd think that if other doctors are
> already baffled, that would increase the odds that they've got some
> interesting zebras for House to look at. Or does he just get Cameron to
> screen out the horses with dye jobs?
This could be House holding his fellow doctors in disdain, and not wanting
to let them dump their cases on him. But using his fellows to screen out
the uninteresting cases seems perfectly legitimate. It could be
interesting, seeing the weeding process one day.
> CUDDY: That's scary, but I'm pretty sure I can outrun you.
>
> House never gets mad at cripple digs.
I think House relishes a worthy opponent. And to him, worthy is someone
who's not afraid to "go there."
> CHASE: You should have told her the truth. It's a long-shot
> guess.
> CAMERON: [....] If House is right, no harm. If he's wrong,
> we've given a dying woman a couple days' hope.
> CHASE: False hope.
> CAMERON: If there was any other type available, I would have
> given her that.
>
> Interesting how Cameron would have a problem with lying later, but she
> was cool with simply concealing the truth as long as it was an
> unpleasant truth.
It's active lying that bothers her, not passive lying. (Hello, and welcome
to "Cameron's Issues". We'll be stopping by on a regular basis.)
> HOUSE: Patients always want proof. We're not making cars
> here. We don't give guarantees.
>
> More of an art than a science, as Cameron would later admit. Actually,
> I've heard of experiments to computerize medical diagnostics by
> combining vast databases of symptoms with AI that unfortunately
> performed so well that M.D.s felt threatened. But the M.D.s did like a
> modified version that offered up alternatives for the doctors to choose
> from instead of directly competing with the doctors. Why insurance
> companies haven't rammed such programs down doctors' throats yet I don't
> know.
I'm seeing more and more references to "scientific medicine." A lot of
medical practices are the result of tradition rather than science. I'm sure
that some doctors have been scientifically examining various medical
practices, but now there seems to be an actual movement devoted to it.
What's interesting about the pilot A plot is that Wilson is not as much an
idiot as House, who assumed that Rebecca was Jewish, let alone observant.
(Although if it were a beef tapeworm, then even Jews who keep kosher would
be susceptible.) So it's not the best introduction to a diagnostic genius,
although it does a good job of laying out the recurring themes (including,
alas, Cameron's Issues and House's fascination with Foreman's delinquent
youth).
Micky DuPree
"Fidelity," "Poison," "Detox," "Cursed," and "Heavy."
In article <y4udncAX_LHS7gbe...@comcast.com>, "Chelsea
Christenson" <nob...@nowhere.com> writes:
: "Micky DuPree" <MDu...@theworld.com.snip.to.reply> wrote in message
: news:dneuvh$par$1...@pcls4.std.com...
:: You'd think that if other doctors are already baffled, that would
:: increase the odds that they've got some interesting zebras for House
:: to look at. Or does he just get Cameron to screen out the horses
:: with dye jobs?
:
: This could be House holding his fellow doctors in disdain, and not
: wanting to let them dump their cases on him.
I could easily see an argument that if it weren't a chore to get a
consult, callous doctors would use the Diagnostics Dept. as a dumping
ground for patients who are merely difficult to treat, not difficult to
diagnose, thus improving their own treatment success statistics. I'd
love to actually hear House or even a fellow catching a doctor
red-handed trying to do that. As things stand, it sometimes looks like
House discourages zebras from even getting close merely because the
referring doctors don't fight hard enough to get their cases heard.
: But using his fellows to screen out the uninteresting cases seems
: perfectly legitimate.
We know that goes on to some extent (and Wilson plays advocate sometimes
too), but we have no way of knowing if that process is haphazard or
routine.
We know from "Paternity" that Cameron answers House's mail, so
presumably any requests for consults that arrive by snail mail, like
that episode's A-plot patient, pass through her filter.
Wilson pitched the A-plot case to House in "Occam's Razor," despite the
fact that the patient had entered the hospital via the emergency room
and there was no indication of cancer involvement. So how did the case
come to Wilson's attention?
The A-plot case had explicitly passed through several doctors' hands in
"Fidelity" before it came to Cameron. We never did see how that
happened, but the implication was that one of the other doctors
approached Cameron, because they all explicitly refused to approach
House:
CAMERON: Three E.R. doctors, two neurologists, and a radiologist
have all figured out what it's not. We need to figure
out what it is.
HOUSE: If any of the abovementioned doctors were interested in
my opinion, they would have asked for it.
CAMERON: None of them are willing to subject themselves to you.
HOUSE: No pain, no gain.
Foreman pitched the case of the collapsed poison victim to House in
"Poison." We never did find out how it came to Foreman's attention,
though.
In "Detox," Cameron pitched the A-plot case:
CAMERON: Sixteen-year-old MVA victim. He's been in and out of
the hospital for three weeks with internal bleeding.
No one can find the cause.
So the patient had already been seen by other doctors. Somehow, someone
brought the case to Cameron's attention. Since she's just a fellowship
doctor, the point of getting her involved must have been to get House
involved. Cuddy also knows the trick of making the pitch, because she
looked at the chart and swatted some of House's objections too.
In "Cursed," even though House spotted that Cuddy was trying to get him
to treat the son of a hospital donor, she still knew the right bait to
lure him in:
HOUSE: As a special favor to you --
CUDDY: No! Admit it, I got you with the rash.
And in "Heavy," we even got to hear the word 'referral':
CAMERON: We have a referral from Doctor Lenkiewicz.
HOUSE: Don't know him.
CAMERON: He knows you.
HOUSE: What's the problem?
CAMERON: Heart attack.
HOUSE: Definitely don't know him.
CAMERON: The patient's ten.
So it's easy to get the impression that Cameron (or Foreman, Chase,
Wilson, or occasionally Cuddy) had to personally make the pitch (i.e.,
confirm the presence of equine stripes) before House would have paid
attention to Dr. Lenkiewicz's request. (Strangely, though, I can't
recall Chase pitching a consult case to House.)
: It could be interesting, seeing the weeding process one day.
It would, and I don't see any reason why they shouldn't do it. It would
go a lot further towards making the hospital feel real than messing with
the lighting or magically changing the hallways around if they made this
process of insulating House more explicit, maybe even having other
hospital docs do rock-paper-scissors to see who gets the unpleasant
chore of trying to talk to House or corral one of the fellows in the
hallway for an impromptu consult.
:: CUDDY: That's scary, but I'm pretty sure I can outrun you.
::
:: House never gets mad at cripple digs.
:
: I think House relishes a worthy opponent.
House at least seems to have more respect for people who dish back. But
he also seems to have an image of himself as supremely rational,
impervious to the attempts of others to get under his skin whether by
positive or negative means.
: And to him, worthy is someone who's not afraid to "go there."
House gave Cameron a hard time in "Damned If You Do" when he pretended
to be offended by the presence of candy canes and she fell for it. In
fact, he sort of models that impervious behavior for the fellows. He
seems to feel that digs shouldn't affect his focus on his work, and
neither should racial, sexual, or other remarks affect the fellows' job
performance (on the theory that you can't control others' behavior, only
be responsible for the quality of your own work).
A friend of mine couldn't understand for the longest time why Cuddy
didn't fire House or at least send him to a disciplinary board because
of sexual or racist remarks. But based on his actions, House seems to
be unusually indifferent to race or gender. He uses offensive remarks
to see who gets thrown off their game and who stays focused on work. By
his criteria, if he managed to get Cuddy to crack, he would have "won."
She won't give him the satisfaction.
:: Interesting how Cameron would have a problem with lying later, but
:: she was cool with simply concealing the truth as long as it was an
:: unpleasant truth.
:
: It's active lying that bothers her, not passive lying.
Cameron also seems to me to confuse sparing the patient's feelings with
sparing her own, which is irresponsible, immature, weak, and selfish, to
put it bluntly. Just because *she* suffers when she breaks bad news
doesn't mean that the patients wouldn't prefer the truth over deceit.
And from a medical ethics standpoint (which she's willing to flog when
it suits her), deceit even by passive lying is wrong, so she's not a
moral absolutist by any means, despite the fact that House will later
inexplicably claim that she is.
: (Hello, and welcome to "Cameron's Issues". We'll be stopping by on a
: regular basis.)
"When did I sign up for that course?" -- House
:: HOUSE: Patients always want proof. We're not making cars
:: here. We don't give guarantees.
::
:: More of an art than a science, as Cameron would later admit.
: I'm seeing more and more references to "scientific medicine." A lot
: of medical practices are the result of tradition rather than science.
I've seen a lot of fads in medicine come and go, a lot of Old Doctors'
Tales debunked over the decades. Most doctors are what I think of as
cookbook doctors. They've memorized the recipes for various diseases
but have only the haziest idea of the underlying science and have no
capacity for improvisation with individualized symptoms. It's a rare
doctor who's willing to admit when he's exhausted what the textbooks and
journals say, and just try something to alleviate the patient's
suffering.
: I'm sure that some doctors have been scientifically examining various
: medical practices, but now there seems to be an actual movement
: devoted to it.
None too soon. A more hidebound profession styling itself as forward
thinking is hard to imagine.
: What's interesting about the pilot A plot is that Wilson is not as
: much an idiot as House, who assumed that Rebecca was Jewish, let alone
: observant.
Actually, House never weighed in on the subject of whether or not
Rebecca was either Jewish or observant. Foreman seemed to be under the
impression that because she was supposedly Wilson's cousin, that must
have meant she was both Jewish and observant. Wilson chastised Foreman
for managing to get all the way through medical school without learning
a little more about Jews. (Foreman probably had his nose in a book and
didn't notice that some of his Jewish classmates were partying on Friday
nights.)
: (Although if it were a beef tapeworm, then even Jews who keep kosher
: would be susceptible.)
I'm not an expert, but I suspect that genuinely kosher beef would be
prepared in such a way as to kill tapeworms. Anything that gets fussed
over that much ought to be safe as well as observant.
: So it's not the best introduction to a diagnostic genius, although it
: does a good job of laying out the recurring themes ...
I think we were introduced to the idea that House makes large intuitive
leaps that are reasonably inspired even when he's wrong, practices very
aggressive medicine, and ignores the niceties of statutory law and
medical ethics. I'm sure that the writers fudge the medicine sometimes
for the convenience of the plot, and that they advance and delay House's
brilliance as needed for optimal dramatic timing. In the show, House is
defined as brilliant and without equal, at least no equal that we've
seen so far. In real life it's hard to imagine none of the other
doctors reaching the right answer first at least once in a blue moon, if
for no other reason than that they happened to run across or hear about
a similar case before.
: ... (including, alas, Cameron's Issues ...
Like herpes, the gift that keeps on giving.
: ... and House's fascination with Foreman's delinquent youth).
Although if I had to guess, I'd say Foreman was his favorite. Maybe
they're about to change that.
-Micky
Micky DuPree
Elrod <dr...@cornell.edu> writes:
: In article <dneuvh$par$1...@pcls4.std.com>,
: MDu...@theworld.com.snip.to.reply (Micky DuPree) wrote:
:: HOUSE: See that? They all assume that I'm a patient because of
:: this cane.
:: WILSON: So put on a white coat like the rest of us.
:: HOUSE: I don't want them to think I'm a doctor.
:: WILSON: You see where the administration might have a problem
:: with that attitude.
:: HOUSE: Eh, people don't want a sick doctor.
::
:: The pilot was the only time I've caught House caring about what other
:: people think of him (in the first season, anyway). My theory is that
:: David Shore was still experimenting with where he wanted to go with
:: the show in general and with the character in particular.
:
: But does he *really* care? Or is it just something he's noticed that
: he can use, say as an excuse against actually seeing patients?
If House had let it go at "I don't want them to think I'm a doctor," it
would indeed sound like nothing more than a strategy for ducking
patients (and even for ducking other doctors who don't know what he
looks like). But the line about "people don't want a sick doctor"
immediately made me wonder, "Why would he care about what patients
want?" If he were explaining this to a patient who had asked why he
didn't wear a lab coat, it would make sense as an excuse to avoid
explaining the real reason. It would even make sense as an excuse to
feed to Cuddy, though I doubt she'd buy it. But there's no reason to
try to snow Wilson. A guy who, in the same conversation, went on to
say, "And your cousin doesn't like the diagnosis. I wouldn't either.
Brain tumor. She's gonna die. Boring," isn't trying to sugarcoat why
he's avoiding patients to Wilson.
I got the impression that in the pilot, Shore was angling at letting
Rebecca's critique of House's behavior contain a lot of truth:
REBECCA: [To House] So you hide in your office, refuse to see
patients, because you don't like the way people look at
you. You feel cheated by life so now you're gonna get
even with the world.
By the fifth episode, though, I think there was evidence that they were
undercutting this idea. By the time the first-season DVDs came out,
David Shore, Bryan Singer, and Hugh Laurie all went on record as saying
the character was pretty much heedless of the opinions of others, and I
think that's exactly the way the character came off, with the exception
of "TB or Not TB."[1] From the first-season DVD extras:
SHORE: [House is] a guy who doesn't care what anybody thinks of
him. And we all do care that, and we all should care a
little less. On a certain level, I do wish I could be
that free.
SINGER: [Of House] A character that doesn't want or require
your sympathy is in some strange way a strong character.
LAURIE: The thing that I admire about [House] most is that he
just doesn't care what the world thinks. Now, some of you
could say, "Well, that, that's 'cause he's a
psychopath." But it's not that just -- It's not just
that he doesn't care that the world thinks, uh, he's a
bad person. He also doesn't care if the world thinks
he's a good person. You know, he'd be happy to do a
good thing and not have anyone know about it.
-Micky
--
[1] Actually I can think of four specific exceptions. House seems to
care what Wilson, Stacy, and his parents think, to at least some extent.
But they're pretty rare and particular exceptions. From the standpoint
of caring what people in general think of him, I can come up with only
the pilot (not wanting patients to think of him as sick and not wanting
to be disrespected and embarrassed by Cuddy) and "TB or Not TB"
(jealousy over another doctor's media attention) as examples.
Chelsea Christenson
> Spoilers for "Pilot," "Paternity," "Occam's Razor," "Damned If You Do,"
> "Fidelity," "Poison," "Detox," "Cursed," and "Heavy."
>
>
>
> In article <y4udncAX_LHS7gbe...@comcast.com>, "Chelsea
> Christenson" <nob...@nowhere.com> writes:
> : What's interesting about the pilot A plot is that Wilson is not as
> : much an idiot as House, who assumed that Rebecca was Jewish, let alone
> : observant.
>
> Actually, House never weighed in on the subject of whether or not
> Rebecca was either Jewish or observant.
House called Wilson an idiot for LYING to him about the relationship. The
only way Wilson's an idiot (and House is so upset) is if his lie interfered
with the diagnosis. The implication is the House ruled out a tapeworm based
on his assumption that Rebecca didn't eat pork.
House also makes the reverse mistake by immediately assuming that the
presence of ham meant Rebecca _wasn't_ Jewish.
> : ... and House's fascination with Foreman's delinquent youth).
>
> Although if I had to guess, I'd say Foreman was his favorite.
I think it's because Foreman is the most independent. When Chase and
Cameron disagree with House, they tend to think he's probably right.
Foreman tends to think House is wrong. In a way, Foreman isn't willing to
let House do his thinking for him. This kind of goes along with what House
tells Foreman in "DNR," that doctors shouldn't sleep easily at night.
Doctors have a tremendous resbponsibility toward their patients, and Foreman
is the one who seems most willing to accept that kind of burden, while Chase
and Cameron are more willing to let House carry the load. Foreman is not
the thinker House is, but he's hard-headed enough to be House's kind of
doctor.
Micky DuPree
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In article <NPmdnXp4v8-TsgLe...@comcast.com>, "Chelsea
Christenson" <nob...@nowhere.com> writes:
: "Micky DuPree" <MDu...@theworld.com.snip.to.reply> wrote in message
: news:dnj49e$8hu$1...@pcls4.std.com...
:: In article <y4udncAX_LHS7gbe...@comcast.com>, "Chelsea
:: Christenson" <nob...@nowhere.com> writes:
::: What's interesting about the pilot A plot is that Wilson is not as
::: much an idiot as House, who assumed that Rebecca was Jewish, let
::: alone observant.
::
:: Actually, House never weighed in on the subject of whether or not
:: Rebecca was either Jewish or observant.
:
: House called Wilson an idiot for LYING to him about the relationship.
There was some whipsawing going on in that exchange. House called
*Foreman* an idiot for not similarly making the sudden leap from the
presence of ham to the symptoms for tapeworm. Wilson mistakenly thought
House was talking to him at first, but then House corrected that
impression. The exchange with stage directions added:
FOREMAN: [To Wilson] You don't even know her name! You called
her Rachel. Her name is Rebecca!
WILSON: [To Foreman] Yes, yes, her name is Rebecca. I call
her Rachel.
HOUSE: [To Foreman] You idiot!
WILSON: [To House] Hey, listen ...
HOUSE: [To Wilson] Not you. [Indicates Foreman.] Him! [To
Foreman] You said you didn't find anything.
FOREMAN: Everything I found was in my --
HOUSE: [To Foreman] You found ham.
FOREMAN: [To House] So?
HOUSE: [To Foreman] Where there's ham, there's pork. Where
there's pork, there's neurocysticercosis.
House later asked Wilson why Wilson had lied to him, but he never called
Wilson an idiot for it.
: House also makes the reverse mistake by immediately assuming that the
: presence of ham meant Rebecca _wasn't_ Jewish.
Did you mean to type 'Foreman' instead of 'House'? That was Foreman's
mistake, and Wilson scolded Foreman for that:
FOREMAN: She's not Jewish!
WILSON: Rachel Adler's not Jewish?
FOREMAN: I had ham at her apartment!
WILSON: Doctor Foreman, a lot of Jews have non-Jewish
relatives, and most of us don't keep kosher. I can see
getting through high school without learning a thing
about Jews, but medical school ...
House never weighed in on the subject of Adler's Jewishness nor on the
subject of keeping kosher.
::: [...] and House's fascination with Foreman's delinquent youth).
::
:: Although if I had to guess, I'd say Foreman was his favorite.
:
: I think it's because Foreman is the most independent.
Because Foreman is independent of mind for a reason. He's not merely
rebellious for the hell of it. Right or wrong, he comes to his own
conclusions and then stands behind them.
: When Chase and Cameron disagree with House, they tend to think he's
: probably right.
That is the percentage guess, so I don't fault Cameron and Chase for
that, but even when they think House is wrong, they tend to let him
slide, and House doesn't give out brownie points for that. Like in
"Damned If You Do":
HOUSE: All the rest of the symptoms can be explained by a
severe long-term allergic reaction.
FOREMAN: That's what Cameron said in the beginning.
HOUSE: Yes, she did. [To Cameron] Well done. But your
unwillingness to stick by your diagnosis almost killed
this woman. Take a lesson from Foreman. Stand up for
what you believe.
And in "Heavy," Cameron didn't get that House doesn't look on it as a
matter of personal loyalty:
CAMERON: I'm the only one who's always stood behind you when
you've screwed up.
HOUSE: Why? Why would you support someone who screws up?
: Foreman tends to think House is wrong. In a way, Foreman isn't
: willing to let House do his thinking for him. This kind of goes along
: with what House tells Foreman in "DNR," that doctors shouldn't sleep
: easily at night. Doctors have a tremendous resbponsibility toward
: their patients, and Foreman is the one who seems most willing to
: accept that kind of burden, while Chase and Cameron are more willing
: to let House carry the load.
Exactly. Right or wrong, Foreman at least takes what he's doing
seriously enough that he takes responsibility for his positions.
It would be nice to see Chase become a little more conscientious after
missing that ultimately fatal perforated ulcer, but there were
approximately seven episodes in between where I didn't notice any
difference one way or the other. I'm not convinced the earliest
episodes of season two were written with the idea in mind that Chase's
father had already died and Chase had already screwed up.
: Foreman is not the thinker House is, but he's hard-headed enough to be
: House's kind of doctor.
I think House is trying to get Foreman to be a less conventional
thinker. For a guy who was breaking into houses when he was 16, going
on to become a strait-laced model student *was* thinking outside the
box. As far as Foreman is concerned, since House is constantly breaking
rules and even laws, working for House must be like staring everything
he swore to get away from back in the face again.
-Micky
Micky DuPree
Elrod <dr...@cornell.edu> writes:
: In article <dnlu23$oh9$1...@pcls4.std.com>,
: MDu...@theworld.com.snip.to.reply (Micky DuPree) wrote:
:: In article <dre1-1D7F86.1...@newsstand.cit.cornell.edu>,
:: Doug Elrod <dr...@cornell.edu> writes:
:
: But the immediately preceding line is about the *administration*. So
: the implication in that line is that the administration is allowing
: him not to wear a white coat, because if he did it would be apparent
: that there was a "sick doctor" hobbling around. Or at least that's
: the excuse he has ready, if Cuddy asks him :-)
But that wouldn't explain why House seemed to be bothered by people
thinking he was a patient just a few lines earlier. I think that
between the time Shore sent the pilot to Fox and when Fox ordered more
episodes, Shore changed his mind about giving certain insecurities to
House and decided instead to go with giving him the proverbial duck's
back, which everything and everybody would roll off of.
They went through the whole white coat bit later. I've appended the
relevant passages of dialogue. Spoilers for "Control" follow.
-Micky
========================================================================
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When Vogler showed up and made an issue about the white coat, at no
point did either House or Cuddy offer up the "People don't want a sick
doctor" explanation, not even when House was alone with Wilson, so I
don't buy it as a mere excuse that House was keeping handy in case he
ever needed it.
VOGLER: Who's that? [Indicates House.]
CUDDY: That's, uh, just one of our doctors.
VOGLER: Aren't doctors supposed to wear lab coats?
CUDDY: He's ... different.
VOGLER: Everyone's buddy.
CUDDY: No, not exactly.
VOGLER: Then why does he get away with it?
CUDDY: It's just a coat. He's very good.
VOGLER: Hmm.
CUDDY: I need you to wear your lab coat.
HOUSE: I need two days of outrageous sex with someone obscenely
younger than you. Like half your age.
CUDDY: Wear the coat.
HOUSE: Man oh man. Someone got spanked real good this morning.
CUDDY: Guy gives a hundred million dollars to cure cancer,
pretty small concession to wear a lab coat.
HOUSE: "Cure cancer." Is the hospital getting out of the dull
business of treating patients?
CUDDY: You know that's not what he's doing.
HOUSE: I know exactly what he's doing. He's using us to run
clinical trials.
CUDDY: Oh, shame on him! Saving lives like that!
HOUSE: It's unethical. [Enters office.] Oh, are you coming
in, too? I thought I had you convinced.
CUDDY: Clinical trials save thousands of lives.
HOUSE: He's using patients as guinea pigs.
CUDDY: Pharmaceutical companies do that every day.
HOUSE: Are we a pharmaceutical company? We're gonna wind up
pressuring desperate patients into choices that are bad
for them, good for us. You're gonna compromise patient
care.
CUDDY: Who the hell am I talking to? Suddenly ethical lapses
are a major concern for you?
HOUSE: What's interesting is it suddenly doesn't bother you.
CUDDY: So, if you ignore ethics to save one person, it's
admirable, but if you do it to save a thousand, you're a
bastard. All he's done is taken your game and gone pro.
HOUSE: He's not going to kill a few patients. He's going to
kill this hospital.
CUDDY: It took him three seconds to size you up, and surprise?
He doesn't like you. Wear the damn coat.
WILSON: Just keep your head down, that's all I'm saying. And
put on your coat.
HOUSE: It itches.
WILSON: O.K., see, now you're just being stubborn. It's cold:
perfectly good excuse to wear your lab coat.
VOGLER: He's still not wearing a coat.
CUDDY: Well, I told him --
VOGLER: I'm sure you did. And yet, he's not wearing it. I'm
just wondering if that's a reflection on him, or on you.
VOGLER: I'm Edward Vogler, new chairman of the board. In a way,
I guess that makes me your boss.
HOUSE: I am sorry about the lab coat thing. The dry cleaners
destroyed it.