House and his team try to cure a woman who sleeps 18 hours a day.
The Plot (Spoilers):
Ed (Dominic Purcell) comes home from jogging with his friend to find his wife Elise (Myndy Crist) is still in bed at almost 4 in the afternoon. She tells him to call her boss and say she’s not feeling well, and he reminds her that it’s Saturday; she hasn’t been to work or even out of bed since Wednesday. He tries to get her out of bed and she suddenly and violently slaps him, and she realizes there might be something wrong with her. Elise is admitted to Princeton-Plainsboro, where she averages 18 hours of sleep a day, which gets Dr. Cameron’s (Jennifer Morrison) attention. She brings the case to Dr. House (Hugh Laurie), who initially assumes clinical depression, but Cameron says Elise isn’t depressed. House notices that the file says Elise is “unusually irritable” according to her husband and takes the case claiming Cameron’s interest is interesting.
Ed and Elise are worried
House gets the team together. Dr. Foreman (Omar Epps) also assumes depression, but House points out that depression couldn’t cause Elise’s fever. Cameron says Elise’s elevated sedimentation rate suggests inflammation and Foreman says her other symptoms point to the brain. Dr. Chase (Jesse Spencer) suggests parasites, but Cameron says Elise has never left the country. House suggests a tumor on the brain and orders an MRI to find the tumor.
In the clinic, House treats a woman for shortness of breath, which she says is more of a tightness. House thinks she might be a little anemic and is about to perform an EEG on her chest, when he discovers she has breast implants: a gift for her husband’s 40th birthday. After “consulting” Dr. Wilson (Robert Sean Leonard), House orders an EKG and blood tests. House also notices that Wilson has a new green tie, and suspects him of cheating on his wife, because his wife hates green.
House finally enjoys seeing a clinic patient
The team doesn’t find a tumor, and Elise goes into a seizure. Chase suggests Lyme Disease, but her “clingy” husband never noticed a rash. Wilson suggests paraneoplastic syndrome caused by breast cancer. Cameron searches for breast cancer, but doesn’t find any. Wilson says that in 12% of paraneoplastic cases, no tumor is ever found and the patient dies. Wilson says they should do a PET scan. House says to treat the symptoms with IV immunoglobulin and if there is a tumor, it will get bigger and easier to find. He sends Foreman to check out where Elise works, because if its not paraneoplasitic and there is some kind of toxin responsible, it couldn’t have come from her home because her husband is healthy.
Elise works in a fancy French restaurant. The owner keeps the kitchen very clean and none of his other employees are sick. Foreman notices that the restaurant serves rabbit. Elise says her arm itches, and hallucinates spiders crawling out of an imaginary wound. They have to sedate her to calm her down.
Spiders under the skin: never a good sign
Wilson says that the hallucination is consistent with paraneoplastic syndrome, but Cameron says the fact that they already had Elise on IV immunoglobulin rules it out. House suggests an infection. Foreman says her tests, timeline and symptoms rule out almost all bacteria, viruses and parasites. House suggests African Trypanosomiasis, also known as African Sleeping Sickness, because in late stages all the parasites that cause it are in the brain and undetectable by tests, but she has never been to Africa and never had a transfusion. Foreman suggests tularemia, or rabbit fever, which she could have inhaled while chopping rabbit meat at the restaurant. Cameron says in that case she should have had respiratory symptoms but Foreman says she could’ve thought it was just a cold. House says that they rejected Lyme Disease because her husband never saw a rash and the respiratory systems would be even more noticeable. The treatment for tularemia can cause aplastic anemia and the treatment for African trypanosomiasis kills one in 10 patients.
As the team tests Elise for tularemia, House again confronts Wilson about his suspected girlfriend, and Wilson admits he had lunch with a new nurse, just to be nice. Dr. Cuddy (Lisa Edelstein) delivers the test results for the woman from the clinic. She says the tests look normal, but House notices something on the EKG and goes to talk to her. Her EKG showed a slightly decreased heart rate, and he asks if her husband has high blood pressure. She reveals that he was diagnosed six months ago and makes their oatmeal for breakfast. House tells her that her husband has been adding his blood pressure medication to their oatmeal, as the beta blockers cause a decreased sex drive and he thought as long as his were reduced, hers might as well be too. House suggests she start making her own breakfast, and have an affair. This train of thought gives House an epiphany, and he realizes that Elise could have gotten sleeping system from sex if she had an affair. Since the test for tularemia was inconclusive, House has Foreman and Chase ask Ed and Elise separately if they noticed Elise’s respiratory symptoms or if they had an affair. They both deny both the respiratory symptoms and an affair. Meanwhile, House reveals to Cameron that after he noticed how she was affected by the sick babies in “Maternity,” he checked her medical records and learned that she had never been pregnant. Naturally, the invasion of privacy upsets her, and she storms off.
With both Elise and Ed denying an affair, the team treats her for tularemia. As Cameron gives her the second dose of the treatment, Elise slips into a coma. The team realizes she doesn’t have tularemia and must have sleeping sickness.
Elise falls into a coma
House talks to Ed, and tells him the diagnosis. He again denies an affair, and House says that means Elise must have had one, which he doesn’t believe. House asks him if he thinks there’s a chance that she had an affair just one, and when Ed says he doesn’t know if he trust her that much, House has Foreman and Chase starts the treatment of melarsoprol, which comes in glass syringes and with special IV tubing because it melts plastic.
A biohazard label on your medicine: also not a good sign
Ed reveals to Cameron that if Elise recovers, it means she betrayed him and part of him hopes she doesn’t get better. He asks if that makes him a terrible person, and Cameron says yes.
Cameron tells Ed he's a terrible person
House finds Cameron in the lab, crying over a centrifuge. She tells House what she said to Ed, and House asks why. Cameron reveals that when she was 21, she got married to a man who died six months later of thyroid cancer that metastasized to his brain. House realizes that thyroid cancer would have diagnosed a over a year before he died, so she knew he was dying when she married him, maybe even when she first met him. He tells her that she can’t be that good of a person and be well adjusted.
Cameron tells House her sad story
Elise’s fever spikes and her blood pressure falls. The treatment is destroying her heart. House tells Ed, and he begs Elise not to die, and she comes out of her coma. Later, Cameron watches from outside the room as Elise tearfully admits the affair to Ed. Ed walks out on her, and Cameron goes after him, telling him how lucky his is that Elise is alive and lover him, but he says that she couldn’t have done what she did if she loved him. House asks Elise who she had the affair with and sends Cameron to notify him that he needs to be treated. It turns out to be Ed’s friend that he was jogging with at the beginning of the episode (who himself has a wife and son).
Ed begs Elise not to die
My Review:
This episode has an interesting mystery, with the diagnosis being hindered by being a very rare condition and the patient’s lies, but the highlight of this episode is the revelation about Cameron’s late husband. The episode also reveals a little more about Wilson’s past, mainly that he’s been married multiple times. This episode nicely includes some continuity with past episodes, including “Maternity” in the Cameron subplot and “Damned If You Do” in the Wilson subplot in adding support to the idea that Wilson’s marriage isn’t going too well. As usual, the clinic adds some levity to an otherwise serious episode, and this time the lone clinic patient leads House to his epiphany, as one of the clinic patients in the pilot episode did. While the mystery makes this a good episode on its own, the important information about Cameron’s past makes this a significant episode, and perhaps the most important episode up to this point in the series.
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