House: Pilot (Season 1, Episode 1)

The first episode of House introduces the brilliant, misanthropic doctor and his team as they treat a kindergarten teacher who collapsed in class.

The Plot (spoilers)

29 year old kindergarten teacher Rebecca Adler (Robin Tunney) is running late, arriving at school after a bus ride and a jog. As she starts teaching her class, she has trouble speaking and manages to write “Call the nurse” on the board before collapsing into a seizure.

Rebecca Adler on the bus

At the Princeton-Plainsboro Teaching Hospital, Dr. James Wilson (Robert Sean Leonard), an oncologist, convinces his colleague Dr. Gregory House (Hugh Laurie), an infectious disease specialist who walks with a cane and doesn’t wear a white coat because he doesn’t want patients to think he’s a doctor, to take Adler on as a patient, saying she’s his cousin. She’s been diagnosed with a brain tumor but Wilson doubts the diagnosis.

Hugh Laurie as Dr. Gregory House

Robert Sean Leonard as Dr. James Wilson

House, the head of the hospital’s Department of Diagnostic Medicine, gets together with his team: Dr. Eric Forman (Omar Epps), Dr. Allison Cameron (Jennifer Morrison) and Dr. Robert Chase (Jesse Spencer). House doesn’t want to talk to the patient, as he believes patients lie, a view that annoys Dr. Foreman. He orders a contrast MRI and the blood tests redone.

Jennifer Morrison as Dr. Allison Cameron

Jesse Spencer as Dr. Robert Chase

Omar Epps as Dr. Eric Foreman

Waiting at the elevator, House is spotted by Dr. Lisa Cuddy (Lisa Edelstein), the hospital’s Dean of Medicine who confronts him about the fact that his billings are almost nonexistent and he is 6 years behind in his obligations to the hospital’s walk-in clinic. 6 years x 3 weeks = over 4 months. She tells him the only reason she doesn’t fire him is because of his reputation, but the clinic is part of his job and she wants him to do his job. House brushes her off by saying that the philosopher Jagger once said “You can’t always get what you want” and goes home.

House and Cuddy

House’s team tries to do the contrast MRI but are stopped. Cuddy has pulled House’s authorizations for tests. The next morning House storms into her office. She says she looked into that philosopher and it turns out “If you try sometimes, you get what you need.” House has to spend 4 hours a week in the clinic until he’s caught up, which he claims will be in 2054, but he gets his authorizations back and his team goes to do the test.

During the MRI, Rebecca has an allergic reaction to the contrast material (gadolinium) for the MRI and her throat closes up. Cameron realizes something’s wrong and stops the test. They have to give her a tracheotomy. Since they can’t get the MRI, House orders the team to take a history. Meanwhile, House goes to the clinic.

House’s first clinic patient is a man (Andrew Airlie) who complains of back spasms. His skin is also a dark orange. House takes a painkiller (finally identifying the bottle he’s already been seen taking pills from) and offers one to the patient for his back. House deduces that the man has been eating a lot of carrots and vitamins, due to the fact that carrots turn skin yellow and niacin turns skin red. He also suspects that the man’s wife is having an affair, since she apparently hadn’t noticed her husband’s skin color.

The Orange Patient

House’s next clinic assignment is a mother with a young son with asthma who admits that he hasn’t been using his inhaler because she’s worried about him taking such strong medicine. While explaining how the steroids treat asthma, House has an epiphany and orders Rebecca put on steroids to treat an inflammation of blood vessels in the brain.

Foreman goes to the classroom in search of mold, but doesn’t find any. The class does have a parrot, and Foreman suggests citicosis from it, but House rejects it since none of the kids are sick. House tells him to break into her house to check it out. Foreman refuses, and House point out that Foreman broke into a house when he was 16, and that he hired him because he needed someone with street smarts.

Cuddy confronts House about his treating Rebecca with steroids without any evidence to support his diagnosis, and goes to stop the treatment until she sees that Rebecca is feeling much better. Later, while talking to Wilson, Rebecca suddenly loses her vision, then has another seizure and her heart stops.

Conscious again, Foreman tells Rebecca that they had to shock her heart to restart it. She also shows intermittent altered mental status. The team doesn’t know if it’s a tumor, an infection or a vascular problem, but each has a different time course. House says they can just monitor her and when they see the progress they’ll have an answer, but Cameron worries that they might not figure it out in time to save her. With no other options, Foreman decides to break into her house, and he brings Cameron with him. Meanwhile, House is back in the clinic, seeing a middle-aged man who is tired a lot and thinks he has chronic fatigue syndrome. He also complains of a couple headaches, a mild fever and trouble sleeping and concentrating and suggests fibromyalgia. House humors him, goes to the pharmacy and asks for 36 Vicodin and change for a dollar. He buys white, somewhat pill-shaped candy from a vending machine and covertly dumps the Vicodin in his pocket, replacing it with the candy and having it “prescribed” to the patient.

Foreman and Cameron don’t find anything at Rebecca’s house, but Foreman helps himself to some ham from her fridge, and Cameron reveals that Foreman went to a better school (Johns Hopkins) and got better grades than she did, and she wonders why House hired her.

Foreman helps himself to a snack

Reporting back to House, Foreman says that the ham means that Rebecca can’t be the cousin of Wilson, who is Jewish. Wilson points out that the ham doesn’t mean anything, but he inadvertently calls Rebecca “Rachel,” giving away that they aren’t really related. The ham does give House a clue though; he surmises that someone who eats ham probably also eats pork, and might have a tapeworm in her brain. Cameron is suspicious, but House asks Foreman, a neurologist, what happens when you give steroids to someone with a tapeworm, and Foreman says they get a little better and then worse, just like Rebecca. House wants to treat, but Rebecca doesn’t want any more treatments unless they’re sure, after what the other treatments have done to her, and wants to go home and die. She asks House how he became crippled, and he tells her that he had an infarction in his thigh muscle that wasn’t diagnosed in time and led to muscle death. She says she just wants to die with a little dignity. House says there’s never any dignity in death; you can live with dignity, you can’t die with it.

House confronts the patient

She's not convinced

Rebecca still refuses treatment. House says he’s solved the case so his work is done, but Chase has an idea. He says that worms are clearly visible on an x-ray. House says that Chase is right, although worms are the same density as brain tissue so they wouldn’t see one in her brain, but worms love thigh muscle and they could see one there. They x-ray her leg and find a worm larva. Chase gives her the treatment: two pills every day for a month. Rebecca is happily surprised at the simple treatment.

Chase shows the patient the tapeworm larva in her leg

Cameron asks House why he hired her. He admits that he hired Foreman because he had a criminal record, Chase because his dad made a phone call, and Cameron because she is extremely pretty. She worked hard to get where she is, and she didn’t have to, and that’s why he hired her. House also suspects that she is damaged in some way.

The formerly-orange patient is meeting with Dr. Cuddy. After House said he suspected his wife was having an affair, he followed her. Cuddy doesn’t want to hear the end, because it can’t end well for her; either House was right, or he was wrong and the patient wants him fired. Cuddy says he’s the best doctor they have. The patient doesn’t finish the story, but he’s no longer wearing a wedding ring.

Feeling better, Rebecca is visited by her students. Meanwhile, House and Wilson are watching a portable TV in a clinic exam room, when a nurse comes in and tells House he has a patient who says he needs a refill. Through the window, he sees the middle-aged man from the clinic earlier and asks Wilson for change for a dollar.

My Review:

This first episode of House gets the series off to a good start. Since this is a pilot, the actors don’t quite have the chemistry they will eventually have. They all do a decent job, but it’s the lead, Hugh Laurie, who steals the show. The guest stars also all give credible performances. It’s never made clear, but Foreman seems to be the new guy, as Cameron keeps giving him advice on working with House. As far as the team goes, most of the episode focuses on them, with Jesse Spencer’s Chase fading into the background until near the end, when he has a brilliant idea that allows them to convince the patient that they’ve got the right diagnosis. The episode establishes a lot of the elements of the series, and aside from the music, which is probably the result of not having a budget for music royalties, the pilot isn’t that different from other early episodes. The medical mystery isn’t all that interesting, but Rebecca’s talk with House is worth it, and reveals a bit of the background behind his character. We also learn that House, and presumably Cuddy, have been at Princeton-Plainsboro for at least 6 years. These details aren’t really necessary to enjoy the show and the interactions between House and the other characters, which are the main reason to watch the show.

Overall, the pilot episode of House is a good start to the series.