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.