Dr. House and his team treat the schizophrenic single mother of a teenage boy.
The Plot (spoilers):
38-year-old schizophrenic Lucy (Stacy Edwards) and her teenage son Lucas (Aaron Himelstein) are at the unemployment department, when Lucy experiences pain in her leg. She is also hearing voices. When they have a moment alone, Lucas slips her a shot of vodka to calm her down, which she desperately sucks down. The then goes into respiratory arrest and collapses.
Lucy's leg starts to hurt
Lucy is taken by ambulance to the Princeton-Plainsboro Emergency Room. As Lucas paces nervously in the waiting room, Dr. House (Hugh Laurie) is also there, hiding from Dr. Cuddy. Lucy is diagnosed by the ER doctor with a small pulmonary embolism, a blood clot that got stuck in her lungs, originating from a deep vein thrombosis (DVT) in her calf. The ER doctor, having noticed her blood-alcohol content, attributes the DVT to alcoholism, but House overhears and ends up taking on the case. The team, especially Dr. Foreman (Omar Epps), doesn’t understand what House finds so interesting, and Dr. Wilson (Robert Sean Leonard) suspects that House is more interested in the schizophrenia than the DVT.
House takes on the case
House talks to Lucy and discovers she stopped shaving her legs two months ago because of her tremors, but Dr. Chase (Jesse Spencer) points out that the tremors aren’t new, so House surmises that the amount of blood must have changed and orders tests and has her meds stopped. Dr. Cameron (Jennifer Morrison) wishes House a happy birthday, having seen the date on a form in his mail. Foreman tries to draw blood for the tests, but Lucy panics, so Foreman gives her 5mg of Haldol to sedate her.
House talks to Lucy
In the clinic, House reports to a mother and daughter that the lab found that the girl does not have strep, plus that she has none of the symptoms for strep, but House thought running the tests was easier than arguing. The mother wants House to convince the daughter to accept a sugarless cake for her birthday. House refuses and tells the mother to get an ice cream cake. Outside, Lucas is upset with House for Foreman giving his mom Haldol, saying it changes her.
House talks to the mother and daughter in the clinic
Lucy starts vomiting blood. House yells at Foreman for giving Lucy Haldol, as it could hinder their diagnosis. Foreman says it couldn’t have caused the bleed. The only thing the blood tests showed was a prolonged PT time, which could mean Foreman made a mistake drawing the blood, but House doubts that and says it could also indicate a Vitamin K deficiency, which Cameron says would account for the bleed but not the clot, but House says that without Vitamin K, Protein C doesn’t work, which would lead to clots. Cameron suggests that it could be the result of another drug interacting with the heparin the ER doctor gave her to thin her blood, and says that she was prescribed ampicillin for a sore throat, but House says Lucas’s notes say she never took it. Chase says it’s more likely than malnourishment, and attributes the rest of her symptoms to alcohol causing the DVT and cirrhosis and says they should ultrasound her liver.
Lucy starts vomiting blood
House sends Chase and Foreman to check out her home for drugs and diet and after that they’ll do the ultrasound. Chase and Foreman find that she never took the ampicillin and lives off of frozen microwavable hamburgers. Lucas says they are the only thing she’ll eat, but they don’t contain any Vitamin K.
Foreman and Chase find Lucy's favorite food
House deduces that Lucas isn’t 18 like he’s claimed, but is only 15. Lucas worries that House will turn him in to social services. Meanwhile, Chase doesn’t think the Vitamin K deficiency is Lucy’s only problem and ultrasounds her liver himself. He finds signs of cirrhosis, as well as a 5.8-centimeter cancerous tumor, which Wilson diagnoses as the real cause of the bleed. Chase says if they do nothing, she’ll die of liver failure within 60 days. She needs a liver transplant, but as an alcoholic schizophrenic her chances of getting one aren’t good. They could operate to remove the tumor, but it’s too big and outside the surgical guidelines. House has Wilson inject the tumor with 95% ethanol, which dehydrates the tumor cells and temporarily shrinks it so they can trick the surgeon into operating.
Wilson and Cameron plan to trick a surgeon
House runs into Cuddy (Lisa Edelstein) in the clinic and inadvertently hints to Cuddy that he’s done something he doesn’t want her to know about. He tries to use his birthday as an excuse, but Cuddy doesn’t buy it and pulls the charts on House’s patient. While House is treating a clinic patient with hiccups, she confronts him about shrinking the tumor but doesn’t stop the surgery. The surgeon figures out what House did during the surgery. He warns Cameron that if House ever tries it again, he’ll stop the surgery. The entire tumor was removed, but Lucy will need some chemotherapy. While Chase tried to comfort Lucas, a social worker arrives to take him in to protective custody due to his being in a difficult living situation. House sees Lucas being taken away, and he accuses House of reporting him. House suspects that Lucy might not really be schizophrenic.
The surgeon warns Cameron
House checks the phone records and finds that Lucy called social services herself, because Lucas would be better off. He says that self-sacrifice, plus the late presentation and the fact that none of her medications ever helped proves she’s not schizophrenic. He makes some late-night calls to her previous doctors, none of which are particularly responsive considering the time. House gets his team together instead in to determine the real cause of Lucy’s psychological symptoms. Cameron suggests Wilson’s Disease, the accumulation of copper in the body. House likes the idea, and points out that Lucy missed an appointment with an ophthalmologist (Wilson’s Disease causes cataracts) and causes cirrhosis. They check her eyes and find the copper-colored Kayser-Fleischer rings that indicate Wilson’s Disease.
Kayser-Fleischer rings
They treat Lucy for Wilson’s Disease and her psychological symptoms go away. Lucas is returned to her and they go home. On their way out, they run into House and Wilson in the elevator. Lucy thanks House but Lucas still blames him for turning him in. Rather than tell him the truth, House keeps up the lie to protect Lucy, saying he had Cuddy call social services. They leave and House tells Wilson he was right: it WAS the schizophrenia that interested him, and she’s not nearly as interesting anymore.
Lucy thanks House
My Review:
The Socratic Method features an interesting mystery and the team doesn’t follow their typical formula of making several bad diagnoses, instead they are pretty much always right, until it turns out there’s another layer. Lucy sure is lucky, though, that Chase didn’t accept the Vitamin K deficiency as her only problem, or her cancer would never have been discovered. Guest star Stacy Edwards gives a good performance as schizophrenic Lucy. Aaron Himelstein does a decent job as Lucas. There’s not a lot of development for the main characters, but it is implied that Chase had to deal with an alcoholic in his past. If this episode took place close to its original air date, House’s birthday would be in December. Overall, this isn’t a standout episode, but it’s an enjoyable one.
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