HOUSE, M.D.: 39. "All In"
Micky DuPree
weeks ago, so note the date before forming replies.
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Elapsed time numbers refer to a videotape copy of the original broadcast
with the commercials left in.
I liked the Captain Ahab theme. Other things, not so much.
Inconsistent characterization continued to be made welcome. I didn't
know enough to critique the actual medicine, but the reasoning behind
the medicine seemed very unsound at times.
PROLOGUE
I figured that if they had the pregnant teacher down on the floor and
gasping in pain with the imminent-danger music cue playing on the
soundtrack, they meant business and she wasn't a red herring. I figured
wrong, which is always nice (and one of the many reasons I refuse to
watch the series promos now), although leaning on the music cue cheated
a little. I wondered if this meant that there wouldn't be a red herring
in the next episode's prologue.
Ian must have been on an afterschool field trip, since his E.R. doctor
would report to Cuddy after it had gotten dark outside, and I couldn't
imagine Ian's parents dithering too long about whether or not to take
him to the emergency room.
ACT I
4:37
On the sign outside the entrance to PPTH:
Seventh Annual
Oncology Benefit
April 11, 2006
[PPTH name
and logo]
It was weird to me that they were hosting the benefit in the hospital
lobby, and not in the cafeteria, which I assume is larger and better
able to handle food and beverages. And by "they" I mean both the
hospital event planners within the story and the series writers outside
the story.
Never having played casino poker, I was wondering how the house (small-
h; in this case, the oncology benefit) gets its cut from a poker table.
The house gets part of the ante? The house gets part of the pot? The
players have to buy their seats? No casino's going to run a table for
free.
Well, the cast spruces up nicely, but that was no big surprise. You can
get any man to look hot in a crisp white dress shirt. (Felt a little
cheated on Chase.) I expect that House owns his tux, since I can
imagine Stacy buying it for him back in the day so he could escort her
to formal functions. But I was surprised that he would voluntarily wear
it.
Since House has to shave sometime, my theory is that he waits until he
gets home from work on Friday evenings to run an electric razor over his
face, so that he'll have two and a half days' worth of growth by the
time he goes into work on Monday mornings.
HOUSE: You know that, relative to their size, gorillas have
smaller testicles than humans.
I was so reminded of a cruder version of President Bartlet distracting
people with random facts during a poker game on _The West Wing_. I also
can't help wondering about the security of guys who obsess over genital
size.
HOUSE: The reason is primate teste size inversely corresponds
to the fidelity of our females.
As opposed to the two-to-one ratio of cheating husbands to cheating
wives?
WILSON: You think there might be a better time to annoy me about
my wife?
I was thinking House wasn't on solid ground when it came to needling
others about their romantic failures, and no one should know that better
than Wilson.
HOUSE: For all our rationality, our supposed trust and fealty
to a higher power, our ability to create a system of
rules and laws, our baser drives are more powerful than
any of that. We want to control our emotions, but we
can't.
Except that first-season House was the antithesis of this point of view,
and first-season Wilson would have known it well enough to call him on
it even if House was saying it only to annoy.
Dude, if you're going to wag a cigar at someone, you should do a full-on
Groucho impression (but maybe that would have looked too derivative of
Alan Alda's Hawkeye Pierce).
WELLS: Doctor Cuddy? Got one of your patients in the E.R. Ian
Alston, six years old.
If Ian went straight to the E.R., and the doctors knew better than to
make a bleeding child wait when his parents were dropping the name of
the hospital administrator, that meant the action took place all in less
than 18 hours, probably less than 14 hours.
In the past, it was indicated that the people who were designated as
Cuddy's patients were hospital donors and their families (like Orange
Guy in the pilot and the leprosy patient in "Cursed"). There was no
mention of why Ian was Cuddy's patient here, though.
CUDDY: Uh, oh, I know him. What's the problem? [To table]
I'm all in.
WELLS: Bloody diarrhea. Hemodynamically stable but he's been
developing some coordination problems.
It looked more like Clarence's rectal bleeding from "Acceptance," and I
thought that one of the first suspicions with regard to rectal bleeding
in children, especially with a seemingly stoic lack of complaint about
pain, was supposed to be sexual abuse, but no one looked cross-eyed at
either House or Cuddy for failing to rule it out.
CUDDY: Sounds like gastroenteritis and dehydration. Order
fluids and I'll take it on my service. Bet's to you,
House.
I could have sworn she said, "gastroenternitis."
HOUSE: They scan his head?
WELLS: No. Why would they sc--
CUDDY: Don't play games. You gonna call?
HOUSE: How's the heart rate?
WELLS: Stable.
The same guy who played the E.R. doctor in "The Socratic Method" popped
up here again, playing an E.R. doctor named Wells. The only guest actor
listed in both eps. is Al Espinosa, so I guess the episode guides are
wrong for listing him as "Hiccuping Patient" in the earlier ep. It was
nice to have a little doctor continuity outside of the regulars.
CUDDY: You might want to spend a little more time paying
attention to your cards and a little less time staring
at my breasts.
HOUSE: They don't match either.
I thought Cuddy would have had enough cool to at least wait until she
was alone before checking for imperfections in the matched set. By now
I thought she'd zip something back, e.g., "Yeah, like men are perfectly
symmetrical," especially when she wasn't under any work pressure for
House to play on and fluster her with. They used to write her as very
difficult for House to flap unless work was getting to her. Now she's
just another of House's victims.
Maybe it was just that as an audience member, I was primed to connect
House to the case, but I was surprised that Cuddy wasn't a little
suspicious that an E.R. doc came to her with a new case and the next
thing she knew, House was leaving the poker table.
Making House's hole cards a pair of aces pretty much insured that the
audience would get that the chase was more important to House than
anything else, and that if he hadn't been interrupted by the case, he
would have demonstrated his poker diagnostic skills by wiping the table
with Cuddy.
What with House showing up at the E.R. in a tux, I was *really* rooting
for him to introduce himself in his best bad British accent as, "Bond.
Doctor Bond."
House took a Vicodin as he told the parents he didn't drink.
Visible at the bottom of House's file cabinet:
A small black plastic box, which House removed. On the label:
??????
??? MICHIGAN???
Some journals, which House removed. On the topmost journal:
DIAGNOSTIC
IMAGING
[....]ce sc[...]
[....] their potential
A PPTH I.D. badge with an indistinct photo of a short-haired light-
skinned person. A pager or cell phone? A harmonica. A cigar in the
wrapper. Yellow ruled paper with longhand writing. Four other items
whose exact nature I could not make out.
Three green files, which House took out. On the label of the topmost
file:
Doyle, Ester
ID: 45973? 295031-7455??
DOB: 04-24-24?
Dr: House ADMIT: FEBRUARY 3, 1994
I think props got the date of birth wrong, but it was a little fuzzy.
Twelve years? The medical equivalent of a cold case file. Unless the
time line swallowed its own tail again, I guess House treated Esther
before he came to PPTH, but everyone who's seen him chase after Moby
Dick since then has become acquainted with Esther's case. (The file and
the file's label didn't have the ubiquitous PPTH logo on it, although
you could claim the hospital didn't acquire the logo until later.)
HOUSE: [To Chase] Yeah, but if I didn't screw with you, you'd
spend all night thinking you might get laid, which means
you'd be useless. Better to extinguish all hope.
Cruel, but probably wise under the circumstances.
HOUSE: While you were all wearing your "Frankie says relax"
t-shirts, I was treating a seventy-three-year-old woman
who went through this progression of symptoms, the last
of which was ... [Writes "DEATH".]
I think the fellows would have been about five or six years too young to
be fans of Frankie Goes to Hollywood, and Esther didn't get sick until
after the band had been history for several years. I suppose that a
late-model baby boomer like House might not have that great a memory for
Generation-X icons, but he seems to be on top of all sorts of pop-
culture trends in the present day.
I-dotting and T-crossing dept. It probably wasn't supposed to mean
anything, but usually House is represented as writing on the whiteboard
in block print capital letters. Here he was using a partially joined
combination of print and script with lower-case letters and more
flourish. I've noticed at least three different anonymous people's
handwriting being used to represent House's and I haven't even been
looking for it. It's not a big deal, though. They can't be assured of
always having the same person on hand to do the writing, and they
certainly can't afford to have Hugh Laurie hanging around to do second-
unit work. (House's capital T's often wear their hats at a rakish
angle, though. The one in Esther's name magically changed in the middle
of this episode. :) )
HOUSE: I want to check for Erdheim-Chester.
CHASE: A disease that there have been, what, maybe two hundred
reported cases of -- ever?
The mutated measles case in "Paternity" sounded even rarer than that.
The fellows should be used to the long odds by now.
Esther's name had no 'h' on the file label, but House spelled it
"ESTHER" on the whiteboard. Usually, House can't get even that close to
remembering a patient's name, but in this particular instance, since it
was so integral to both plot and characterization that House was haunted
by this patient, I would have expected him to have the whole case,
including the name, memorized down to the last dot. In deference to the
story line, I was willing to say that the hospital made a typographical
error (hey, it happened to me once), and House's spelling was the
correct one.
It was weird to me that House didn't put one of the fellows to work
grilling the parents on the kid's medical history so House could compare
it to Esther's medical history, whose case he seemed to have memorized.
FOREMAN: See anything?
CHASE: No. And I don't expect to.
FOREMAN: House usually avoids cases.
House used to avoid cases. These days that's not so clear. He was
interested in the immediately preceding case in "Safe" before he could
see any stripes on the beast. At least it made sense why House was
poaching a case in this episode.
FOREMAN: He's actually stealing a case from Cuddy, there's gotta
be a reason.
Nice to know that they can see through House's lies with ease.
CHASE: It's not the first time I've seen this file. About a
month before Cameron was hired, some trucker came in
here with these symptoms. House decided he was dying.
Two days and a spinal tap, bone marrow extraction, and
three colonoscopies later, we send the guy home with a
bunch of painkillers and a diagnosis of a bad cheese
sandwich. One of the guys who worked here before me
said House tried to cure Esther at least three other
times. You know how people see the Virgin Mary in
danishes and stuff? Someone died twelve years ago and
House doesn't know why. House sees that case now in
paint peeling, in clouds, and now in this poor kid.
Woo hoo! Moby Dick!
So, Chase was with House at least a month before Cameron got there. The
implication was that House had at least two subordinates (probably also
on fellowships, though it wasn't specified) before the current batch.
ALAN: Yeah, the other doctor kinda scared us about that.
CAMERON: He shouldn't have.
Whoa. Cameron undercut her own boss' authority in front of the parents
without being asked for a second opinion. Doctors on the same team
don't usually do that to one another even when they're in strong
disagreement. This didn't even seem like a moral point to Cameron so
much as a pure lack of professionalism on her part.
CHASE: How long is this going to take?
CAMERON: Forget it, Chase. Your punching-out-the-shark story's
good, but she's not waiting for you.
When would Cameron have had a chance to hear the shark story?
FOREMAN: We couldn't confirm the source of the bleeding, but we
did biopsy some --
Then where did the blood come from?
HOUSE: Do a kidney biopsy. [Undoes tie.] Esther's shut down
in exactly -- [Checks watch.]
I was surprised it took House that long to take off his tie, and I would
have expected all of Team House to change into scrubs once it was clear
that none of them was going back to the gala. I'd particularly expect
that Foreman and Cameron were still paying off their med school loans
and couldn't afford to get bodily fluids on good clothes.
SARAH: What's that?
HOUSE: Urine.
ALAN: But it's brown.
CHASE: Ian's kidneys are shutting down.
The urine didn't look so much brown to me as concentrated, which would
have supported Cuddy's theory of dehydration, but whatever.
By now I'd expect the fellows to sound more resigned rather than
surprised when one of House's unpopular predictions comes true.
ACT II
19:09
CHASE: I'll go do a biopsy.
HOUSE: Forget it. That battle's over. His rising creatinine is
his kidneys' way of saying, "Go on without me."
This seemed wrong to me, especially when later the entire plot's
resolution hinged on the reasoning that they needed to wait until the
disease reached a given organ in order to biopsy it and diagnose what
had hit it, and yet here House was waving aside the opportunity to
biopsy an organ that they knew for certain had been hit.
CAMERON: His hematocrit would have to be low. It's at forty-
four, and Esther's never dropped below --
HOUSE: -- forty-two.
FOREMAN: You have the file memorized?
It would be consistent.
CAMERON: What about lymphoma? Causes kidney failure, GI bleed,
and can infiltrate the base of the brain. [House
thumps his cane.]
FOREMAN: You check Esther for that?
HOUSE: She never showed any signs of ...
This rang really false to me. The major point of this episode was
House's obsession with Esther's case. So here they were trying to slip
it by me that House waited TWELVE YEARS to do a likely differential on
the Erdheim-Chester diagnosis? That was pure plotting bullshit. House
would have looked at the case from every conceivable angle during that
time.
CAMERON: I'll page Cuddy.
HOUSE: No you won't.
CAMERON: She thinks the kid has a stomachache.
The strange thing about the stomachache theory was that the kid never
once complained of pain. That alone should have told them something
(although I personally don't know what).
HOUSE: She'll come right up here and do one of two things. If
she agrees with me, I don't need her. If she
disagrees, I don't want her.
FOREMAN: You can't handle people disagreeing with you? She
might have a different take on this.
HOUSE: Subordinates can disagree with me all they want. It's
healthy. People who can shut me down, on the other
hand ....
Yeah, but that should have been obvious to all of them long ago, at
least as far back as the tumor-shrinking fraud in "The Socratic Method."
This exchange felt like it was inserted solely for the benefit of new
viewers, because neither Foreman nor House should have had any need to
revisit these points. (On the other hand, I wish the person(s) who
wrote House as not wanting the fellows to second-guess him in "Skin
Deep" could have been shown these lines.)
WILSON: The chicken is still in Piccadilly Square.
HOUSE: Brilliant. She'll never suspect that Normandy is our
target.
Oh please, I'd expect better of Wilson, maybe even a real WWII reference
because he was watching the History Channel after House went to bed the
night before. I liked House's line, though.
HOUSE: Is she drinking her seltzer?
WILSON: No. Hydration's not a problem.
HOUSE: She's bluffing. Push her all in.
Except that Cuddy drank her seltzer when she bluffed in the first act.
Since House was deliberately misleading Wilson here, that meant House
would have definitely taken that earlier pot if he hadn't wanted to slip
away from the table. It probably meant that Wilson would be on to the
seltzer tell after this, too.
SARAH: What happened to her?
CAMERON: She died twenty-four hours after her admission.
Huh. If it kills within 24 hours of presentation, I imagine most cases
remain undiagnosed or misdiagnosed. Not every hospital has a House in
it.
Going into detail about another case seemed like a little too much
information to me, but I guess it was better than giving the parents
unsubstantiated hope, like Cameron did when she undercut House.
Given the urgency of the case, I was surprised they didn't sedate the
squirming child to get a clear MRI. (Ian seemed to be out of it for the
colonoscopy.) In fact, I'm surprised they don't use sedation for
difficult imaging cases more often. And we never heard about the
pictures of butterflies etc. in the MRI room after "Autopsy."
Sign on the coffeemaker:
Good
Coffee
Cheaper than prozac[sic]!
Not at the prices some coffee fanatics are willing to pay.
House breaking into the coffee shop was gratuitous lawbreaking,
something I couldn't remember him doing in the first season. They could
have sent down to the party or sent out for some coffee, or perhaps even
poached some from the obstetrics lounge, the nurses' lounge, or the E.R.
(Surely the floor nurses and the E.R. have pots of coffee going all
through the night.) It would have been a lot funnier seeing the fellows
stage a raid on another department's coffee than seeing House commit
vandalism and commercial theft for the sheer bloody-mindedness of it.
HOUSE: Next station is the liver. We've got about ninety
minutes before it gets there. Maybe we can cut down a
tree across the line just outside of town.
I was never comfortable with House's premise that the disease would
follow exactly the same time progression in a 6-year-old as it had in a
73-year-old. Since he didn't know what it was, it seemed more like a
tenuous hope that the response times would be identically predictable.
CHASE: I'll do an ultrasound.
HOUSE: No. Treatment will tell us more, faster.
CAMERON: How can we start treatment if we have no idea what
we're treating for?
HOUSE: [Shoves objects around.] Treat him for everything!
Give him acetylcysteine and interferon and silymarin
and whatever else you can think of to protect the
liver.
I had to wonder if treating the liver alone was going to help with the
disease as a whole, and that did seem to turn out to be a concern. I
also had to wonder, what with throwing the whole pharmacy at the problem
simultaneously, if they were clouding the diagnostic potential of
treatment rather than improving it as House claimed, since if there was
an effect, particularly if it was a negative or mixed effect, they
wouldn't know what caused it, and they didn't have a lot of time to sift
through the results.
Evidently, House diagnosing the poker players substituted for clinic
duty in this episode, and even provided the "aha" moment. I thought it
was a little strange that House would go at the game entirely from a
psychological standpoint and not bother to add in data from counting
cards. I would have expected more of a two-pronged approach. But as
usual, he was the undisputed master. He was calling infallible audibles
on the phone and he couldn't even see anyone's body language or the
table cards.
Visual continuity glitch: As Ian went into respiratory distress, they
lowered the head of the bed and removed his pillow. Then we got a shot
of Ian with pillow and with his head elevated.
I guess that tipping over the whiteboard was supposed to be a sign of
House's frustration, but since it was a diagnostic tool still in use,
I'd expect him to knock over something he wasn't using instead.
ACT III
33:51
FOREMAN: We had to put him on a ventilator.
HOUSE: He's back on Esther's path. And we managed to make the
train skip a few stations, which means that instead of
twelve hours, he's probably got less than two.
The arithmetic seemed wobbly to me. If Esther was dead 24 hours after
admission, then by House's figures, that should have meant that Ian had
been at PPTH for 12 hours. But it was dark outside when the E.R. doc
reported the case to Cuddy, and it was still dark outside according to
the establishing shot that opened Act III.
I couldn't say that I found it surprising that protecting the liver
didn't necessarily stop the systemic attack of the disease. But I
thought it was stretching a point to say that the arrival of respiratory
distress necessarily meant that the kid had only two hours to go. When
dealing with an unknown disease, there's no way to guarantee that any
two given patients will respond exactly the same way, particularly after
you've introduced new elements to the treatment of the second patient.
And yet the story and the other doctors in the story seemed to treat
House's time pronouncements as the gospel truth even when they were
skeptical about everything else he was saying.
I think they made a tactical error specifying two hours before death and
then doing test after test after test with what we knew had to be
breathtaking speed (because we already knew the deadline they were
working to). I think their eagerness to figuratively show us the
countdown display on the time bomb ran away with them, because even if
the original countdown had taken 48 hours instead of 24, it still would
have been tense, and the main drama derived from House's obsession with
the past, not the insane time pressure of the present. Still, it was a
tinkerable problem, not a fundamental miscalculation.
It looked like Chase was the one who helped House put the whiteboard
back up.
HOUSE: What effects would interferon have on leukemia?
WILSON: Depends on what type. Could make it better, could make
it worse.
HOUSE: Four-year fellowship to learn that.
Wow. A four-year oncology fellowship? I didn't know they went on for
that long.
WILSON: But, um, the party's over in less than three hours.
CUDDY: It's over in less than two hours. Which means you
either have three of a kind or just threes.
Very clever, to let them know you've broken their code.
HOUSE: Either you go all in or I tell everybody in the building
that you wear toenail polish.
I couldn't definitively tell from Wilson's expression if he actually
uses toenail polish, but I would have expected some sort of protest if
he didn't.
WILSON: If you need help, ask. These games are insane.
HOUSE: Games have a higher success rate.
And yet the games almost drove Wilson to hang up the phone, while the
mention of a dead six-year-old got him to come running.
Since they paint House as a character who's supposed to be excellent at
reading people, this sounded like so much authorial bullshit. Games
shouldn't have a higher success rate in the long run. These aren't one-
shot patients that House can scam and then never see again. These are
the only people who'll have anything to do with him. Not only has House
generally behaved worse this season, but his associates have acted like
abused children or spouses. As a joke, Foreman once said that Chase and
Cameron had Stockholm Syndrome. This season, it's playing out as if
there's something to that, and I think it's contagious. They don't like
his behavior. They do have the ability to establish consequences for
bad behavior, but they very rarely do. They just take it. Even Stacy
claimed not to want to be with him after the file-reading incident, but
hell, what professional woman can resist melting over a total lack of
respect for her autonomy when you come right down to it?
The fellows in particular should have been keeping journals of House's
unethical behavior towards them, not because they particularly want to
bust him, but to threaten him with when he gets out of line or if he
should ever threaten to fire them. Wilson should just walk away from
House for a while. Cuddy was supremely cool when she took away most of
House's practicing privileges in the pilot to get him to acquiesce to
clinic duty. She should smack him more often for his lapses, but
nowadays the writers let her smack him only when she's medically in the
wrong, so she gets to look like an idiot. I think it's a safe bet that
the only way they would write Cuddy as firing House now is if she were
to come crawling to him later, begging for him to come back, when once
upon a time Cuddy knew that it's actually House who would stand to lose
more if he lost his current job. None of the characters is willing to
draw a line on his gratuitous bad behavior.
That said, most of House's gratuitous jerk moments in this episode were
directed towards Wilson (gratuitous because Wilson has always backed
House's medical plays in the past, and even ran interference for him
with Cuddy on his own initiative just last episode, despite being
privately annoyed with House). On the other hand, most of House's jerk
moments towards the fellows in this episode were akin to his classic
jerk moments: i.e., there were reasons behind them, like prying Chase
away from his booty target to get his undivided professional attention.
WILSON: This kid, on the other hand, he makes antibodies that
are eating the inside of his arteries, choking off
blood to his major organs one by one, first the GI
tract, then the kidneys, then the brain, now the lungs.
The defect in brain-muscle coordination showed up in the E.R., before
the kidneys.
FOREMAN: We can confirm with blood work. We need an ANA, sed
rate --
CAMERON: Labs will take two hours.
And yet all the other labs they did seemed to take mere seconds.
WILSON: This other patient. The "old lady." Esther? [House
nods.]
Apparently, it took Wilson this long to clue in.
WILSON: Obsession is dangerous.
HOUSE: Only if you're on a wooden ship and your obsession is a
whale. I think I'm in the clear.
WILSON: You do realize it's a metaphor.
HOUSE: You do realize that the point of metaphors is to scare
people from doing things by telling them that something
much scarier is going to happen than what will really
happen.
Only if your IQ is 75. Prime example: sports metaphors. How genuinely
scary was it that Mighty Casey struck out compared to what House was
facing here?
HOUSE: God, I wish I had a metaphor to explain that better.
Oh, tut, writers. Another sour character moment. House used to use the
most colorful and effective metaphors on the show ("When the Inuit go
fishing ... "), and both he and everyone in the room were aware that it
had nothing to do with scaring people. This entire scene felt like it
was written by someone who never did well in English lit. and never lost
their resentment towards it.
HOUSE: Don't worry. I'm not gonna get eaten by witches.
_Hansel & Gretel_? I had to admit, I didn't see how this was a
particularly clever counter to an accusation of being Captain Ahab.
On the echocardiogram:
06 JAN 06
Probably the date the image was taken.
I thought it was stretching a point for an intensivist to have done
almost all of the intravascular work to date. For an infectious disease
specialist to snake something into the heart was even weirder,
especially since he wasn't the one who had been getting the practice. I
got that it was supposed to show House's obsession, but I would have
thought his obsession would want the guy who's done more of this kind of
work recently. Are they going to have House personally perform brain
surgery next?
They made it seem like a lot of time passed on the cardiac arrest, yet
at no time were chest compressions performed. In fact, I thought that
was a big deal in first aid these days: chest compressions have been
numerically emphasized.
Heh. The kid moved his hand during the code.
CHASE: His brain's been oxygen deprived for over eight minutes.
As I said, it seemed strange to me that none of the people responding to
the code would have performed chest compressions between shocks.
ACT IV
45:24
CAMERON: You're not worried about --
HOUSE: -- things I can't do anything about? I try not to.
FOREMAN: Yeah, things just roll off you like water off a duck.
Historically, though, all of them, but Foreman in particular, should
appreciate that they've had some of their most heated disagreements over
where to draw the line between things they can do something about and
things they can't. I'd have to check to make certain, but I think that
either way, House has won all the arguments over that particular point
once he's accepted a case. He was able to let go of the five patients
he's lost since the series began, but his persistence was the key to
saving other patients that the rest of the doctors had given up on, so
by now, I'd think that when House wants to be persistent, his associates
would clue in that he's worth listening to.
CUDDY: [To House] No, but you're done with him. It's my case
now. Go home. Go ride your motorcycle. Go brood in a
dark room. Just don't go near Ian again.
I was trying to remember instances when Cuddy throwing House off a case
actually helped matters, and the only time I could come up with was
"Damned If You Do." You'd think a normal person would start having
healthy mathematical doubts about the error rate involved in this
particular move.
CHASE: We should have called her.
HOUSE: I'm surprised YOU didn't.
A sour character note for me. At this point, all of the fellows have
gone over House's head, including Foreman re treating the nun in "Damned
If You Do," and Cameron re the LSD in "Distractions" and re the
incestuous dad in "Skin Deep." When the pretext is medical
disagreements, I'd sooner expect Foreman to rat House out than Chase.
Chase usually goes with the medical flow unless he thinks his job is in
danger, which it wasn't here. House gave the fellows plausible
deniability by telling them that Cuddy had signed off on the case
(though everyone knew it was a lie), so normally, Chase would be the one
to go along with whatever House said while the other two, particularly
Foreman, balked.
Actually, it was interesting that none of the fellows went over House's
head this time. I guess the writers were still sticking with the
literary template up to here. Even though the fellows were dubious at
several points, they stuck with him on the voyage, like Ahab's crew, and
I could buy the fellows standing behind House in this episode because he
was taking it personally.
HOUSE: So Foreman, you agree with both of them. Thanks for
playing.
FOREMAN: If we have enough tissue for two tests, why not do
both?
HOUSE: Then we don't have to think as hard. Taking the
pressure off the choice makes us less likely to think
critically.
This did not follow at all to me. The team had what they believed at
that time to be the two most likely candidates. Taking some of the time
pressure off the choice should have made them less likely to choose
conservatively, which House usually approves of. It was weird and
illogical to me that House would have had the fellows running the final
three tests sequentially instead of simultaneously. In the absence of a
genuine diagnostic reason for waiting until each successive test was
completed before choosing the next test, it seemed to me that House
would have insisted on having all three fellows run the tests on the
three samples at the same time because of the EXTREME TIME PRESSURE that
they kept hitting us over the head with. (I didn't count the number of
times House looked at his watch in this episode, but it was a repetitive
visual reminder.) In fact, in real life, given the timetable they gave
us, I didn't see how they could have completed all three sequential
tests before the kid died, unless the disease wasn't running according
to schedule, which would have cast doubt on the presumption of identical
cases that House was operating under.
What actually happened in the episode was that doing the tests
sequentially bought House time until a completely unrelated event
occurred that triggered his suspicion of the right answer in the case.
But at no point in the episode did House say that they needed to stall
for time. On the contrary, he made a huge deal about how they didn't
have time to follow each step of the standard protocol and that DEATH
was imminent. As Wilson was to tell him, House got lucky.
House took a Vicodin after the second test was negative.
It seemed a little too sentimental to me that House sat at the kid's
bedside. It works better when House watches through the glass walls,
concerned but literally keeping his distance. I was also wondering how
he got anywhere near the kid once Cuddy kicked his butt off the case. I
could understand that she was feeling open to suggestions by that point
since her tests would have come up negative, but I would have thought
that having run out of ideas herself, she'd want to pool resources with
House instead of waiting to run across him sitting up with the kid.
It would have at least made Cuddy seem a little less useless if she had
reported to House, "Negative for sarcoidosis" (to which House would have
said without looking around, "I guessed as much," but at least she would
have looked like she was contributing solid test results instead of
looking completely irrelevant).
There was another poster in Wilson's office, probably for a movie,
featuring the face of a stocky Caucasian man (kind of like W.C. Fields,
but I don't think it was he) and what was probably the title in red.
The last word started with "E."
WILSON: I won the poker tournament.
Yeah, often it is the cool head that prevails, but you don't see that
every day on TV. I assumed Wilson took the knowledge of his and Cuddy's
tells, which he learned from House, and put it to good use.
HOUSE: The aces were hiding all along.
The "aha" moment. Except that the disease wasn't "hiding all along."
The GI tract was where the first symptom appeared. (P.S., the aces
were a much less scary metaphor.)
HOUSE: It slow played us. We biopsied the colon. It hadn't
reached the GI tract yet. It's there now.
This really bugged me, for two reasons. 1) If the Erdheim-Chester
"hadn't reached the GI tract yet," then what caused the rectal bleeding/
bloody diarrhea that brought the kid to the hospital in the first place?
2) What with House having had TWELVE YEARS to obsess about the case, it
seemed like the kind of thing he would have thought of years earlier but
just didn't have a chance to test for until he got a new patient.
CHASE: You want it to be there. Because then you didn't screw
up twelve years ago.
That didn't follow either. It seemed to me that since House had already
figured out when he was treating Esther that the disease didn't progress
to all organs equally rapidly, then he did screw up if he biopsied the
wrong part of Esther too soon, and he did screw up by not biopsying
Ian's failed kidneys and testing that for Erdheim-Chester. But once the
writers had Chase put the matter to him this way, it meant that we in
the audience were intended to accept that once the second test on Ian
for Erdheim-Chester was positive, it was supposed to vindicate both
House's failure with Esther and his failure to diagnose Ian earlier. I
would have been willing to give House a break on both failures since it
sounded like a really difficult catch, but no, the writers had to
somehow make out like House had in fact succeeded when he had actually
failed on the first case and was so slow on the second one he put the
patient at risk for brain damage.
House's reaction when the final test came up positive seemed to say that
he felt vindicated. I really didn't see why. Since House figured out
the diagnosis in the present day without the aid of, for example,
improved technology since Esther's time, I'd fully expect House to blame
himself for not similarly figuring out the diagnosis twelve years ago as
well. Since he had suspected Erdheim-Chester all along for twelve
years, why did it take a chance comment from Wilson about poker to get
House to focus on the relevance of the timetable of the disease?
Originally, House's associative intuition looked like flashes of genius,
because he could see similarities in seemingly disparate events where
others could not. However, the way the writers have abused the lesser
_satori_ device in the second season has made House look like he's too
stupid to run through a problem deductively at all, and *only* through
these random, unpredictable, unrelated triggers can he solve problems
anymore.
Not only was the disease breathtakingly fast, but the treatment got Ian
off the ventilator and seemingly in possession of all his faculties
within a few hours.
I was wondering if there was any significance to the music House was
playing at the end, and the closed captions weren't forthcoming this
time, so I went hunting on the music thread of the Television without
Pity _House_ forum
<http://forums.televisionwithoutpity.com/index.php?showtopic=3127751&pid=4975027&st=160&>,
and lo, there was the answer. According to "SnoodMasterK":
"There've been some questions in the episode thread about what
House was playing at the end of 'All In'. It's one of my very
favourite jazz pieces, the beautiful and inspirational Hymn to
Freedom, by Oscar Peterson."
Plus a link:
<http://www.collectionscanada.ca/oscarpeterson/m3-6030-e.html>.
Hm. It wasn't as bad as when they played "None of Us Are Free" over the
characters' romantic problems in "Spin," but somehow it still seemed
pretentious to me to put civil rights music to House's medical success.
I kept expecting that if House was going to play the piano in a public
place, it was going to provoke a comment or at least an appreciative
look from another character, but it seemed more like a throwaway scene.
Partly for that reason, I didn't think that scene worked as well as
other piano-playing scenes on the show.
House finally lit his cigar near the end. At the very last, someone
showed up and turned on a monitor at the front desk, probably the first
receptionist to come into work, putting the time at roughly eight or
nine a.m., so there was no one around before to bug House to put it out.
WILSON: You got lucky. You gonna call?
HOUSE: What I do is not just based on the flip of a card.
WILSON: You guessed. You got lucky.
HOUSE: It fit.
WILSON: It could just as easily have been sarcoma or tuberous
sclerosis.
HOUSE: No, not JUST as easily.
WILSON: Maybe not. But it wasn't impossible.
Pertinent point. I liked the Captain Ahab angle a lot, but it got my
hopes up that House would actually fail in the present day, and either
diagnose the kid too late or else fail to diagnose him at all (Moby Dick
got away). Instead, House not only saved the day in the present, but
was also (at least according to the way the writers framed the dialogue)
vindicated in the past as well.
House has claimed that he plays the percentages. That means that he's
going to win most of the time. It also means that he should eventually
lose some small percentage of the time. But while he's lost the
occasional patient here and there, he's never misdiagnosed or failed to
diagnose by the closing credits. That's getting really hard to believe
when you consider just how much in the dark modern medicine still is
about so many things.
WILSON: Are you gonna call?
HOUSE: You know, relative to its size, the barnacle has the
largest penis of any animal.
If I were Wilson, I'd be casting my thoughts back to the last time House
pulled that trick (pocket aces), and I'd fold.
The entire episode took place from some unspecified time around or after
sunset on one day to right around when the workday would have begun the
next morning, maybe 14 hours in all, max.
Vicodin count: 2
Medical synopsis:
rectal bleeding/bloody diarrhea
ataxia
Diagnosis: gastroenteritis and dehydration
fluids
colonoscopy
purple papules
biopsy negative for Erdheim-Chester
kidney failure
rising creatinine
hematocrit 44
blood smear, immunochemistries, head MRI
lower brain mass, pituitary failure
hypotension
blood smear negative, immunochemistries negative
acetylcysteine, interferon, silymarin
falling platelet count
respiratory distress
ventilator
antibodies attacking the arteries
echocardiogram
cardiac tumor biopsy
cardiac arrest
defibrillation
Differential diagnosis: histiocytosis, tuberous sclerosis, leukemia,
sarcoma, sarcoidosis, multiple neurofibromatosis, chondrocytomas
cardiac tumor negative for histiocytosis
cardiac tumor negative for tuberous sclerosis
cardiac tumor positive for Erdheim-Chester
Final diagnosis: Erdheim-Chester
Poker "patients":
Wilson folds in the face of annoyances
Cuddy sips seltzer when she's bluffing
--
Barry Margolin
MDu...@theworld.com.snip.to.reply (Micky DuPree) wrote:
> HOUSE: The reason is primate teste size inversely corresponds
> to the fidelity of our females.
>
> As opposed to the two-to-one ratio of cheating husbands to cheating
> wives?
Yes. I think chimpanzee males may be as promiscuous as gorilla males.
But because gorilla females are more faithful, their males have smaller
testes.
--
Barry Margolin, bar...@alum.mit.edu
Arlington, MA
*** PLEASE don't copy me on replies, I'll read them in the group ***