House: Occam's Razor (Season 1, Episode 3)

Dr. House and the team try to diagnose a 22 year old patient with symptoms so varied they don’t seem to have a single cause. Meanwhile, House tries to convince Dr. Cuddy to release him from his duties in the hospital’s walk-in clinic.

The Plot (spoilers)

22 year old college-student Brandon (Kevin Zegers) calls in sick due to a cough. His girlfriend Mindy (Alexis Thorpe) also notices that he has a rash. They have sex, and as soon as they finish, he passes out on top of her. He ends up in the Princeton-Plainsboro Emergency Room, where Dr. Wilson (Robert Sean Leonard) notices him. He also has a fever, nausea, abdominal pain, and low blood pressure that doesn’t respond to IV fluids. The last symptom convinces Dr. House (Hugh Laurie) to take the case.

So much for cuddling

The early tests don’t show anything, and the team can’t come up with any ideas. Dr. Cameron (Jennifer Morrison) says no condition explains all his symptoms. House says they have to stabilize his blood pressure, and has him treated for sepsis and put on broad-spectrum antibiotics, and orders more tests. The team does the tests and Mindy tells Dr. Chase (Jesse Spencer) that they were having sex just before he collapses and she was “kind of rough” and winders if that could be the cause. Meanwhile, House goes to the clinic 30 minutes late and makes a speech in which he admits he’s on Vicodin and convinces all the waiting patients to wait for another doctor.

"Maybe I'm too stoned to tell!"

Dr. Cuddy (Lisa Edelstein) doesn’t let his plan work though, and sends him a patient (Lauren Cohn) anyway. The patient says her mucus was “pale goldenrod” last week, but wasn’t anymore. House deduces that she expects to be fired and is getting the most of her medical plan. She says she might be quitting, but House says if she was quitting she would have known last week when she was actually sick. House schedules her for a full-body scan.

"You're not a very nice doctor, are you?"

The team hasn’t come up with anything, and Dr. Foreman (Omar Epps) says it has to be viral. Chase jokingly mentions the girlfriend’s theory, and Cameron suggests that maybe they should look into it after all. Foreman gets more test results, and says they should stop the antibiotics, as Brendan’s kidneys are failing. Foreman attributes the kidney failure to a side effect of the antibiotics, but House thinks it is a new symptom. Foreman suggests a rare cardiac infection that Chase says is a 10 million-to-one chance, and doesn’t explain the cough or the rash. House suggests that it could be two conditions: sinus infection and hypothyroidism. The team rejects this, citing Occam’s Razor: the simplest explanation is always the best, and one is simpler than two. House says that the odds of getting the sinus infection and hypothyroidism are each 1,000-to-one, which makes the odds of having them both one million-to-one, and more likely than Foreman’s idea. He has Brandon treated for the sinus infection and hypothyroidism. As Cameron starts the treatment, Brandon’s parents (Faith Prince & John Kelly) show up, and he introduces them to Mindy as his fiancée.

Foreman doesn’t think House is right, and goes to the lab to test for viral infections. Cameron and Chase reluctantly go with him to help. Chase and Foreman talk about Cameron behind her back, and Foreman accuses Chase of wanting to have sex with her, which Chase denies but Foreman doesn’t believe him. Meanwhile, in the clinic, House is in an exam room with a patient with a sore throat, playing his Game Boy Advance SP while “waiting.” Cuddy comes in, having left a board meeting to respond to House’s request for a consult and as House plays dumb, she diagnoses the patient with a sore throat and tells him to drink some hot tea.

House "waiting"

In the lab, Foreman determines that the kidney failure wasn’t caused by the antibiotics, and House and Wilson tell him than Brandon is feeling better. Foreman checks on him and sees that he still has the cough, and orders more tests. Back in the clinic, House is again “waiting” with a patient, having paged Cuddy for a consult while she was playing golf. He estimates they have another half-hour, and offers the patient his Game Boy. Foreman stops by and says that his tests found that Brandon doesn’t have hypothyroidism, but House says since he’s feeling better the test must be wrong. He asks about the clinic patient and House says her leg hurts after running six miles. House tells Foreman to check Brandon’s white blood cell count. If Foreman is right about a viral infection, the count will be elevated. Foreman leaves and Wilson comes in, saying Cuddy sent him to handle House’s consult.

In the office, after Cameron and Chase have an amusing chat about sex, Foreman reports that the white cell count is down, meaning both he and House were wrong. Brendon’s immune system is severely weakened and they put him into a clean room. Foreman tests Brandon’s bone marrow for a viral infection or fibrosis.

In Cuddy’s office, House tries to defend his request for a consult for a pulled muscle. Cuddy says she’s not letting him out of clinic duty, and House says she has plenty of other doctors and doesn’t need him in the clinic, but Cuddy says the working with people makes House a better doctor.

House and Cuddy

Leaving Cuddy’s office, House runs into Wilson, who asks House if he has a thing for Cuddy. House denies it as he orders a bottle of Vicodin from the pharmacy. House picks up the wrong bottle as he walks away, and Wilson points it out to him. This gives House an idea, and he asks Wilson what Brandon’s fist symptom was. Wilson says it was the cough.

House has his epiphany

House goes to his office and spends the night thinking and researching, eventually coming up with the idea that colchicine, a gout medication, would account for all Brandon’s symptoms except for the cough, and suggests that when Brandon went to the doctor and got a prescription for his cough, the pharmacist made a mistake and gave him colchicine instead. House says this fits Occam’s Razor because the simplest explanation is always that someone screwed up. Cameron points out that if that were the case, once he were in the hospital and under their supervision, he should have either gotten better or gotten worse, but instead he got better and then got worse. House says that means two people screwed up. He asks the parents and fiancée who gave Brandon his cough medicine back, and the mother reluctantly admits it. Brandon took the last of the pills shortly before he was moved into the clean room. The team takes the bottle back to the pharmacy and his the bottle refilled, but the mother says the round, yellow pills the pharmacist puts in the bottle under Chase’s watchful eye look just like the ones Brandon took.

House can’t understand how he was wrong, because his explanation was so perfect. He tried to figure out what the cough medicine could have done. Wilson suggests lymphoma, which House says they ruled out because all the tests were negative, but Wilson says to do an exploratory surgery. House can’t think of a better idea, so he agrees. While the team is doing some prep for the surgery (I’m no doctor but as a House fan I’ve picked up a little; this looks like an echocardiogram) Brendon complains that his fingers are numb, then the procedure causes his heart to stop. The team restarts his heart, but they have to postpone the surgery.

House is in the clinic, where his patient is a young man with tattoos and piercings. From the fact that he hadn’t sat down after waiting for 30 minutes or admitted why he was there, House deduced that he had something humiliating up his rear end. House says that after being a doctor for 20 years nothing will surprise him, but the patient does manage to surprise House after all when he admits it’s an mp3 player. House checks out, leaving the patient for Cuddy to deal with.

Cameron finds House, telling him that Brandon crashed during the surgery prep and is feeling pain in his fingers. House goes into Brandon’s clean room and finds that he has pain in his fingers and toes and the beginnings of hair loss, two more symptoms that fit perfectly with colchicine poisoning. House asks Brandon if he does Ecstasy, and he admits to trying it twice. House suggests that it must have been cut with colchicine, or suggests a few other possible ways for Brandon to have been exposed to it. He orders him treated for colchicine poisoning.

The treatment works, and House searches the pharmacy for every form of colchicine to figure out how Brandon got it, not convinced two doses of Ecstasy cut with colchicine would be enough. Brandon still has the cough, and is given the correct cough pills, which he notices have a letter on them. His old pills didn’t have a letter on them. Meanwhile, in the hospital pharmacy, House finds colchicine in the form of round yellow pills with no letter on them.

House's search of the pharmacy yield's results

My review:

It’s only the third episode, but of the three, this episode has the most interesting mystery. This was largely a Foreman episode, with him spending most of the episode trying to prove House’s two-illness theory wrong. Chase and Cameron were regulated to their minor side plot that reveals that Chase is attracted to Cameron. By itself, that isn’t very interesting, but knowing where the series will eventually take them makes it interesting looking back. House trying to get out of clinic duty and his interactions with the clinic patients is particularly fun in this episode, and we learn House has a double-specialty in infectious disease and nephrology. Wilson and Cuddy get more time with House in this episode, which fleshes out the characters a little more. I’m not sure how Wilson, an oncologist, originally got involved in the case though. We know the doctors have to work in the clinic, but Brandon came in through the ER, and I don’t think cancer was considered at the beginning. Otherwise, this is an enjoyable episode with an interesting mystery.