House: Damned If You Do (Season 1, Episode 5)

In this Christmas-themed episode, House tries to treat a nun whose problems might have been complicated by his own error.

The Plot (spoilers):

Dr. House (Hugh Laurie) and Dr. Wilson (Robert Sean Leonard) are in the lobby working on charts, which House considers a waste of time. Dr. Cuddy (Lisa Edelstein) tells House he has a patient who’s been waiting for nearly an hour.

House takes charting seriously

House goes to see the patient, a nun named Sister Augustine (Elizabeth Mitchell) who has red, swollen hands. One of her fellow nuns says it looks like stigmata. House diagnosis her with contact dermatitis, an allergic reaction which he attributes to dish soap from washing pots and pans. House gives her a pill of diphenhydramine to counteract the allergic reaction, which she washes down with tea she brought with her. House goes back out to the lobby, but Sister Augustine soon has trouble breathing. House gives her an injection of Epinephrine to help her breathing, which it does. House deduces that she is allergic to diphenhydramine, and decides to prescribe her steroids instead, bet before he can do anything, she goes into a cardiac arrest.

Stigmata?

Sister Augustine is admitted to the hospital. House claims that he only gave her 0.1cc of epinephrine, but Cuddy says that small amount couldn’t have induced a cardiac arrest and he must have accidentally given her 1.0cc instead, since they are in the same drawer. House insists he didn’t screw up, and she must have a pre-existing condition. Cuddy gives him 24 hours to find it, or she’ll have to report him to the disciplinary board.

House suspects Churg-Strauss Vasculitis, a condition with a short life expectancy, even with treatment. Dr. Foreman (Omar Epps) thinks it’s possible House just screwed up and gave her too much epinephrine, but House again insists he didn’t screw up. He orders a chest CT scan and puts the patient on prednisone.

In the clinic, House treats a store Santa (Dakin Matthews) suffering from inflammatory bowel. He has already tried a number of treatments, none of which have worked. House prescribes him cigarettes: one twice a day. The patient is shocked, but House says that cigarette smoking is one of the most effective ways to control inflammatory bowel. When the patient expresses concern that cigarettes are addictive and dangerous, House replies that pretty much all the drugs he prescribes are addictive and dangerous, but cigarettes are perfectly legal.

Dr. Chase (Jesse Spencer) and Sister Augustine chat as he takes her for the CT scan. She says her parents died when she was six and she was raised in a foster home run by the church and took her vows when she was 18 and has known no other life. The team runs the test, which shows no signs of Churg-Strauss Vasculitis. As they get her out of the machine, she hallucinates smells and a vision of Jesus, which Foreman interprets as temporal lobe swelling, then goes into a seizure.

Is that you, Jesus?

Sister Augustine tests positive for herpetic encephalitis, indicating her immune system is compromised, which Cuddy points out could be caused by the prednisone, but Dr. Cameron (Jennifer Morrsion) says that her immune system is too severely compromised to be the result of only two doses of prednisone. House gets Cuddy to leave, and Chase suggests Mixed Connective Tissue Disease, which fits all the symptoms, but the tests were negative and the treatment is prednisone, which they can’t go back to because of the herpetic encephalitis. House says to redo the tests and put the patient in a hypobaric (high-pressure) oxygen chamber. Foreman doesn’t think House is right and the side effects of the hypobaric chamber are too great a risk, so he goes to Cuddy.

The hypobaric chamber

House is watching his portable TV in the hospital’s chapel when one of the nuns comes in to talk to him, telling him that Augustine is a hypochondriac. He offers her candy and they have a little chat.

It's not House's fault the reception is so good

Cuddy confronts House and takes him off the case. Taking over House’s team, she decides there is no underlying condition, and treats the symptoms directly. Wilson finds House in the clinic counting the epinephrine syringes in the exam room. He points out that House will have to go through the records of every patient in the clinic in the last two days to prove he’s right. While Chase is checking on Sister Augustine, he gets a page reading “Call Mom.” He goes to House, saying his mom’s been dead for 10 years. House asks Chase what he knows about the nun and what she’s hiding. Chase says that if she does have a secret, her boss would know. House goes to the monastery and has a cup of tea with the Mother Superior (Ann Dowd), who tells him that Augustine left foster care when she was 12 and lived on the streets, dabbled in drugs, got pregnant when she was 15, tried to self abort and lost the child. She eventually came back to the church. House says its not relevant and takes a sip of tea, which he then asks about.

House has tea with the Mother Superior

Cuddy and the team haven’t made any progress. Cameron thinks House was right about an underlying condition, but doesn’t have a specific idea. House returns with a sample of the monastery’s figwort tea, which Sister Augustine has been drinking a lot of and which when combined with even 0.1cc of epinephrine can cause a cardiac arrest. The rest of the symptoms could be explained by a severe, long-term allergic reaction, which Cameron originally suggested but didn’t stick with after House immediately rejected it because it wouldn’t cause the cardiac arrest.

In order to figure out what Sister Augustine is allergic to, the team puts her in a clean room, so they can introduce possible allergens one at a time. In the clean room, she can’t have visitors, but Chase offers to pray with her. She says she doesn’t want to die and asks why God has left her. Chase reveals he was in seminary school and tells her his favorite passage was 1 Peter 1:7, “These trials only test your faith to see whether or not it is strong and pure. Your faith is being tested, as fire tests gold and purifies it, and your faith is far more precious to the Lord than mere gold, so if your faith remains strong after being tested, it will bring you much praise and glory and honor on the day of his return.” He tells her that she has a choice of faith or fear. She asks him why he left seminary school, and he says it was that test: she passed, he didn’t.

Sister Augustine has her faith tested

Soon after that, Sister Augustine goes into anaphylactic shock, an allergic reaction despite being in a clean room. They give her 0.1cc of epinephrine and intubate her, stabilizing her. House has ruled out everything he can think of that could have caused the anaphylactic shock. Cameron gives House a Christmas present, and Chase reports that Sister Augustine has been extubated and is now requesting to check out against medical advice and return to the monastery. Chase thinks he might have talked her into the decision in their discussion earlier. House tries to talk to her, to no avail. She says that when she was on the streets she was on every kind of birth control and still got pregnant and was angry with God until she realized she can’t be angry with God without believing in him, and she says that God is inside of her whether she lives or dies. When House tells Wilson “she has God inside her,” Wilson replies “Maybe she’s allergic to God.” House realizes the only place they haven’t looked for an allergen in inside her body and orders a full-body scan.

Intubating Sister Augustine

The full-body scan reveals a “copper cross” Intra-Uterine Device (IUD), that was apparently left in when she tried to have an abortion. She is allergic to copper, with minimal symptoms until she started washing the monastery’s new copper cookware, contact which caused the allergy to become serious. They remove the IUD, and she recovers.

The Copper Cross

Wilson tells House that he did screw up, just not in the way he thought, because if Cuddy hadn’t taken him off the case he would’ve killed the patient going down the wrong track. Wilson invites House to Christmas/Chanukah dinner, which he declines, and Wilson says maybe he’ll go over to House’s. House asks if Wilson’s wife wouldn’t mind being alone, and says she’s used to it with him being a doctor, and then says he doesn’t want to talk about it. Wilson and House have Chinese food in House’s apartment, and House is seen playing the piano.

House plays the piano

My Review:

After an episode focusing more on Foreman and an episode focusing more on Cameron it is only fitting that we get an episode focusing more on Chase, and of the three, Chase gets the closest look. In this episode, we learn that chase went to seminary school, but quit before finishing, we learn that Chase’s mom has been dead for 10 years, and it is implied that Chase went to medical school to please his father, even though he didn’t really want to. This is a lot more than we know about the other fellows so far. We also learn a little about Wilson, namely that his friendship with House extends beyond being colleagues and outside the hospital, and that Wilson is married, but maybe not so happily. And we learn that Cameron is an atheist, which struck me as a surprise the first time I saw this episode, as of the three fellows she was the one I most expected to be at least a little bit religious. Since this is a Christmas-themed episode with a nun for a patient, religious debate was bound to come up, and while it shouldn’t surprise anyone to discover that House doesn’t think much of religious belief, the episode does a pretty even-handed job of portraying both sides. As for the medical mystery, this one laid out the clues nicely, and a layman with knowledge of old birth control methods could perhaps solve this one before the characters do, with little to no medical knowledge. This is a nice change from previous episodes that required specific medical knowledge, often about a rare condition, to solve. I am usually not a fan of Christmas-themed episodes, but in this case, a solid mystery and the revealing of information about the characters make Damned If You Do an enjoyable and important episode of House.