House: Histories (Season 1, Episode 10)

The team’s treatment of a delusional homeless woman is made more difficult by the fact that no one knows who she is, not even her.

The plot: (spoilers)

A broke middle-aged woman (Leslie Hope) talks her way into a rave party at an abandoned house, saying she knows someone inside named James, who is blond, friendly and a big talker. While searching the party for James, the police bust in and she is knocked down and loses consciousness.

She is taken to Princeton-Plainsboro and admitted with a suspected drug overdose, but her toxicology screen came back clean, though she is delusional and doesn’t even seem to know her name. Dr. Wilson (Robert Sean Leonard) was consulted because of some lesions on her arm, which turned out to be non-cancerous, but Wilson noticed a twitch so he brought in Dr. Foreman (Omar Epps), a neurologist. While Foreman has her do some simple tests, she goes into a seizure. Wilson checks her blood sugar and finds it to be low. Foreman thinks that she is a diabetic who overdosed on her own insulin to get a place to sleep and some food, and dismisses the twitch that Wilson thinks could be a tumor. Foreman says to monitor her and let her spend the night, then discharge her. Wilson takes the case to Dr. House (Hugh Laurie), who agrees to take it when he decides Wilson must have a more personal reason for being interested than just wanting a stranger to get medical care.

House gets the team together. Dr. Cameron (Jennifer Morrison) suggests that the twitch could be a mini-seizure unrelated to diabetes. Dr. Chase (Jesse Spencer) suggests a brain tumor, and Cameron agrees that its possible. Foreman still insists she’s faking, but suggests that they could do an MRI to make sure. House rummages through her bag (which Foreman notices also contains insulin) and finds moist vomit, which he tastes(!) and finds it is salty, suggesting an electrolyte imbalance. He holds off on the MRI and has her started on a banana bag to correct the imbalance.

While Foreman and Chase start the treatment, the patient is drawing comics, when she suddenly has a panic attack, and bites Foreman on the arm. Now really annoyed, Foreman is now determined to get her an MRI so he can throw her out. There is a 2-day wait for non-emergency MRIs, so Foreman secretly switches the patient with a woman getting her scheduled 6-month checkup on her chin implants. Dr. Cuddy (Lisa Edelstein) interrupts with the report that the preliminary CT-Scan revealed a surgical pin in her arm that the MRI’s magnet would have ripped out of her body. House insists that they surgically remove the pin so they can do the MRI, which he says is necessary because Foreman thinks she has a brain tumor. Cuddy reluctantly agrees, but says they can’t do anything else until they find out who she is so they can get a medical history. House sends Foreman to investigate, using her drawings as a guide to find where she usually sleeps, which is occupied with bats, and he finds a file of her drawings. Meanwhile, she has the surgery to remove the pin and gets the MRI, which finds nothing, but House uses the serial number on the pin to track down her identity: her name is Victoria Matsen and she broke her arm in a car accident two years ago. A hospital faxes over her medical records, which Foreman looks over, then takes off in a panic; when her electrolyte balance came back normal he put her on iron dextran for anemia, but it turns out she’s allergic to it. They get to her just as she goes into respiratory arrest and stabilize and sedate her.

More hospitals fax over records, but none have a legitimate address. Chase notices two ultrasound appointments 10 months apart, the second of which she didn’t keep. Wilson recognizes the doctor’s name as an oncologist, and surmises that they were looking for ovarian cancer, and House points out that neoplastic syndrome caused by the cancer could cause the twitch. House has them ultrasound her ovaries. In the clinic, Cuddy assigns him to a mother with a number of children; House fakes a sneeze and says he’s sick, leaving Cuddy to deal with the family while he reads Victoria’s handmade comic books, which involve a heroine who fights a villain named Mr. Fury. He questions Foreman about why he doesn’t like homeless people, annoying him by asking about his parents, who it turns out are not homeless, then House questions Wilson about why he cares. Cuddy assigns House to teach two medical students about patient histories, and House fakes a page in the clinic to hide from them while he continues to investigate Foreman and Wilson. Meanwhile, the ultrasound has found a large mass on Victoria’s left ovary, and Wilson realizes that it’s too late to do anything. House suggests that maybe it’s not really cancer but is actually a tuberculoma, which is very unlikely but since there isn’t anything they can do for advance ovarian cancer House orders the tuberculoma treatment.

Foreman starts the treatment, but Victoria can tell that he’s not hopeful. Foreman apologizes for not believing her, and she admits to having taken too much insulin to get a place to sleep. Foreman offers to help her find James, but she suddenly spikes a fever of 105 degrees and starts panicking about Mr. Fury coming after her, displaying extreme sensitivity to light and believing water to be poison. Foreman sedates her and tells her that the bad guys can’t get here there; as she loses consciousness she says Mr. Fury’s not the bad guy: she is.

Foreman reports to House that the fever means she can’t have a tuberculoma, but Chase arrives with lab work saying that it is a tuberculoma after all. In addition to the tuberculoma, she has something else that is causing the fever. Chase suggests a bacterial infection, and Foreman says she could’ve picked up something on the streets, but she didn’t have a fever on admission. Cameron suggests that the Prozac they put her on could have caused serotonin syndrome. House orders blood and urine tests and a chest X-ray, and switches her off Prozac, and she is put in an ice bath to lower her body temperature.

The two med students report to House (who is again reading Victoria’s comics) on the patient they were assigned to interview: a 17 year old female with abrasions and trauma to her wrist. One says that patient fall off her horse at the county fair, while the other says she fell off the steps of her beach house. Both went to the same room. House says the patient is either under 90 pounds or has a red nose, and leaves them with a medical dictionary, saying the patient’s condition starts with C.

The team reports that the tests point towards an infection. Not all the tests are back, but they think Victoria has meningitis. House tells them to start treatment, but when they get to her room, Victoria is gone, despite having been sedated, leaving behind comics drawn on the wall indicating she has gone looking for James. Foreman wants to go looking for her, saying that in her comics Mr. Fury lives in Sloan Harbor and the rave party she was picked up at was a 1408 Sloan Street, but Cuddy tells him to just call the police.

House, wearing a bird-shaped pin and carrying a binder with a picture of a Ferris wheel on it, is being pursued by the med students, who are desperately guessing conditions starting with the letter C. House goes into their patient’s room and asks her what happened. She says she was riding on a Ferris wheel when a seagull flew at her and she swung her arm at it and hit the Ferris wheel. House says she has Korsakoff’s Syndrome, which has left her without the ability to process ideas, so she uses visual clues to fill in the gaps; one of the med students has a small horse embroidered on her shirt and the other has a clipboard with a beach scene on it, which is where her previous stories came from. One of the med students points out the Korsakoff’s doesn’t start with C, and House says the lesson is to treat everyone as if they have Korsakoff’s because they all lie anyway.

Paramedics bring Victoria back to the hospital unconscious with her heart rate over 150 beats per minute, and Foreman stabilizes her. A police officer says he found her passed out on the grass at Battlefield State Park. House bribes the cop for the real story, and it turns out he tazered her twice. The first time he hit her in the thigh and she didn’t stop. House pokes her in the same spot and gets no response, but when he pokes her in the toe she reacts. Foreman tries to think of what it could be, and while he’s looking away, House pokes him with a needle where Victoria bit him, and he doesn’t notice until he looks back.

In the lab, House lists Victoria’s symptoms: localized numbness, sensitivity to light, disorientation, paranoia, ineffectiveness of sedatives and hydrophobia, which leads them to rabies from the bats in the alley where she slept, which the tests confirm. Wilson gives Foreman a rabies shot, but its too late for Victoria. Wilson and Foreman go out to try to find James so Victoria won’t die alone. They go to the house where the rave party was held and use Victoria’s drawings to find a hidden metal box with clues to her life.

She was married to a man named Paul Furia and James was their young son. The house was their home. They were killed in the car accident when Victoria broke her arm, and she was driving. Foreman sits at Victoria’s bedside out of sight, pretending to be Paul and saying he forgives her.

House follows Wilson to a rundown part of town. Wilson reveals that he has a second brother he has never told House about, because he hasn’t seen him in nine years and he doesn’t even know if he’s alive. They are at the last place Wilson saw him.

My review:

Histories is a great episode of House, and is an episode that almost demands multiple viewings, as there are a lot of subtle clues and details that are easy to miss the first time through, most notably that the abandoned house that the rave party takes place in used to be Victoria’s home. There are other things that Victoria says that stand out when you know how the story ends. There are actually several mysteries going on at once here, and not all of them get resolved. Two of them involve the patient. The first is the medical mystery, which actually has two separate components to it. The second is the mystery of her past, which continues even after the team has her name and her medical history, and even though we find out who James is, the mystery isn’t fully resolved. It had been 2 years since the car accident, and she had to have gotten the rabies fairly recently that led to some of her mental symptoms, so what happened in the meantime? How did she end up on the street, and why did she leave that box with important documents behind in the house? (And if she was driving when the accident occurred, how could the hospital not have her address? Didn’t she have a driver’s license?) Then there’re the mysteries about Foreman and Wilson. We never really do find out what Foreman has against the homeless in this episode. Though it seems like he at least starts to resolve it by the end, we don’t know what’s behind it, if anything. At least we find out about why Wilson cared about this homeless stranger: he has a brother on the streets somewhere himself. Then there’s the poor girl with Korsakoff’s; we never do find out her real story either, although it’s a minor point that’s not related to the main plot, so it’s not really important. Leslie Hope gives a good performance as Victoria, a challenging role requiring not only the portrayal of the neurological symptoms of rabies, but also a dip in an ice bath. Foreman and Wilson have some great bickering throughout the episode, before coming together in the end, and in this episode even House and his antics seem to take a back seat to them. Several episodes have seemed to focus on Foreman, but this is the first episode that focuses on Wilson and allows Robert Sean Leonard to show his acting talent. With all that is going on and all the detail, this is one of the standout first season episodes that stands up well to repeat viewing.

House: DNR (Season1, Episode 9)

When a wheelchair-bound trumpet player develops trouble breathing, he decides he is ready to die, but House thinks he can not only save him, but also make him walk again.

The Plot: (Spoilers)

At a recording session with Brandy (herself), wheelchair-bound jazz legend John Henry Giles (Harry Lennix) stops breathing.

John Henry is taken to Princeton-Plainsboro, and Dr. House (Hugh Laurie), fascinated by his paralysis, asks Dr. Cuddy (Lisa Edelstein) for the case. Cuddy tells him that John Henry’s primary doctor, Marty Hamilton, with whom Dr. Foreman (Omar Epps) did his residency, has already asked for House’s team, which doesn’t include House, to diagnose and treat John Henry’s pneumonia only. Foreman is put in charge of the case, and has John Henry kept on broad spectrum antibiotics. House wants to investigate the paralysis, which Dr. Hamilton has already diagnosed as ALS aka Lou Gehrig’s Disease but House doesn’t believe it, and wants to do an MRI to check Dr. Chase’s (Jesse Spencer) suggestion of multifocal motor neuropathy. Foreman says that the ALS fits and even predicts the pneumonia, which suggests the paralysis is ascending, and overrules him.

Foreman's in charge!

Foreman gives John Henry the prognosis that the symptoms will likely keep getting worse. When John Henry asks how long he has, Foreman mentions the MRI and House, and John Henry asks which doctor Foreman agrees with. Foreman says he agrees with Dr. Hamilton about the ALS and John Henry says no to the MRI and requests to sign a “Do Not Resuscitate” (DNR) form. When Foreman tells House about the DNR, House suggests that Foreman start John Henry on IVIG, the treatment for multifocal motor neuropathy, and Foreman does it.

While in the clinic seeing a patient who wants Viagra (House determines the patient has diabetes from subtle clues, which he suspects has led to heart disease that would make Viagra dangerous for him, but prescribes them anyway, leaving the choice up to him) House gets an emergency page about John Henry, who has gone into respiratory failure from the IVIG. House arrives to find the team standing around, unable to act because of the DNR. House himself intubates John Henry, violating the DNR to save his life, just as John Henry’s wife/girlfriend arrives.

John Henry is put on a ventilator. His reaction to the IVIG proves House’s theory wrong, and as he questions Dr. Cameron (Jennifer Morrison) and Chase for a new theory (Foreman had stormed off over House’s lack of concern for the patient’s wishes) House is served with a 50-foot restraining order against the patient and notice of battery charges. House has them test for Cameron’s idea of Wegener’s granulomatosis and has John Henry moved to a room directly above the clinic, using the restraining order as an excuse to get out of clinic duties. Cuddy offers House a lawyer (when she hired him she also set aside $50,000 a year for legal fees for him, and somehow he’s under budget) and tells him that Dr. Hamilton is flying in to pull the plug.

In court, House’s lawyer uses the argument that John Henry’s DNR might not be valid because of a low thyroid level, and that allowing him to die would violate House’s Sixth Amendment right to face his accuser at a trial. Dr. Wilson (Robert Sean Leonard) asks what House hopes to gain, as the restraining order and charges would still stand, and House replies “time.” Wilson points out that while other doctors have a messiah complex and need to save the world, House has a “Rubik’s Complex,” and needs to solve the puzzle. House interrupts the proceedings to point out that he notices clubbing on the judge’s fingers, a sign of heart disease, and advises the judge to see a doctor. This sway’s the judge in House’s favor. After the trial, House admits that he didn’t actually notice any clubbing; he bluffed, knowing that every family has some history of heart disease. Back at the hospital, Cameron and Chase report that their tests were inconclusive. House orders treatment with Cytoxan anyway, but they refuse to do it, as it would threaten their medical licenses. House sneaks into John Henry’s room and gives him the treatment himself. As he leaves, he runs into Dr. Hamilton (David Conrad), who has just arrived.

Hamilton says that he already ruled out Wegener’s, and is going to take John Henry off the ventilator. When House points out his court order to keep John Henry alive, Hamilton says that all the charges have been dropped, so the court order no longer stands. House and Wilson watch as John Henry is taken off the ventilator, knowing that is House is right about Wegener’s, John Henry won’t be able to breathe without it, but John Henry starts breathing on his own, proving House wrong. John Henry’s breathing is stable, but now one of his arms is paralyzed. The team thinks this is a progression of the ALS, but House wants to consider other possibilities for the arm’s paralysis. Cameron suggests a blood clot from a stroke and House decides to do an MR angiogram. He sneaks back into John Henry’s room and, after a talk where John Henry compares his own obsession with his music to House’s obsession with medicine, House takes him to do the test. Meanwhile, Hamilton takes Foreman out to lunch and offers him a partnership in his practice in Los Angeles.

The team discovers a blood clot in John Henry’s brain. Foreman recommends treatment with Heparin, a blood thinner, to John Henry, but he rejects it because of the possibility of bleeding into his lungs that would keep him from ever being able to play the trumpet again. Foreman then suggests an embolectomy, a surgery to remove the clot. It is more dangerous, but wouldn’t harm the lungs. John Henry chooses the surgery, as it will either help him or kill him. Cameron and Chase do the surgery to remove the clot without incident, while House and Foreman discuss the differences between House and Hamilton.

House gets a page about John Henry, and they report to his room to find that he now has use of his arm back, as expected, and Hamilton wanted to congratulate House. House points out that a phone call would have sufficed, and sarcastically gives John Henry a reassuring pat on the leg as he turns to leave. John Henry says that he felt House touch his leg.

House realizes one of the treatments they tried has helped John Henry’s paralysis, but they don’t know which one, and the others could kill him. House has all his treatments stopped so they can add them back one at a time and see which one helps. Hamilton thinks that his treatments are finally working, but House thinks that if it were Hamilton’s treatments they would have been working before. After stopping the treatments, Hamilton comes to House to ask what treatments he stopped, and House realizes that John Henry’s legs are completely paralyzed again. The first treatment they gave John Henry was steroids for the pneumonia, and House has them restarted and orders an MRI to see what changed. As the MRI is done, House and Foreman discuss Foreman’s job offer. House tells Foreman that he should work with whoever he thinks is the better doctor, and says that the difference between them is that Hamilton does his job and accepts the results, while House thinks their decisions matter. Cameron and Chase interrupt with the MRI results. An intradural arteriovenous malformation (AVM) is compressing John Henry’s spine, causing the paralysis. It had always been there, but was hidden on previous MRIs by the inflammation it caused. The steroids relieved the inflammation, which slightly relieved the pressure on the spine and also allowed the AVM to be seen on the MRI. John Henry has surgery to remove the MRI and after physical therapy is able to walk again. As he leaves the hospital, John Henry gives House his trumpet as a gift to thank him, and Foreman keeps his 2-year fellowship with House.

My Review:

I think this is the point where House turns from good to great. The focus of this story is on House and his approach to medicine, and this is probably the first episode to really look at House’s personality, by comparing him to a patient with a similar obsession about music. Harry Lennix also did a great job as patient John Henry Giles and I absolutely believed he was an old jazz musician. This is also the first episode with a celebrity guest star, with Brandy playing herself in the opening sequence. The other guest stars are ok, though none of them stand out like Lennix does. There is a little bit of Foreman’s background revealed here as well, but the episode is really about House. The medical mystery follows the show’s predictable format, and its no surprise that House makes the patient walk in the end; the fun of this episode is in between with the DNR and the legal twists it leads to, and House’s great speeches to Foreman. That is what makes this episode stand out and makes it one of my favorites.