House S08EP1 “Twenty Vicodin”
Another Fall Microbiology semester, another new season of House. There was some good stuff last season, but there was also some bogosity. When we last left Dr. House, he had crashed his car into Dr. Cuddy’s living room, then left to reappear walking on a beach. Apparently he was unable to remain in paradise, because in the season opener, we find Greg House behind bars in the East New Jersey Correctional Facility wearing prison fatigues. He can’t walk away from interesting medical cases though, because
when another inmate’s unusual medical symptoms spark his curiosity, House must come up with creative ways to treat the patient while navigating prison rules…
Will he earn time off for good diagnosis? Updated with Spoilers!
All in all, I enjoyed this episode. I thought that the House/Cuddy subplot of last season was a significant distraction, not because I’m not a romantic at heart, but because it weakened House’s ability to do what he does best. Today, the episode started with “Monday,” and set up the premise that House was serving time for his antics in the finale, but would be released on parole on Friday. We meet his prison roomie Asofa who is very large and is taking anti-psychotic meds, Mendelsohn a lifer who is proud of his swastika tattoos and is shaking down House for the titular “twenty vicodin,” and Nick who is beginning to show some troubling symptoms.
Nick is taken to the prison infirmary, where he is being treated by Dr. Sykes and the young volunteer Dr. Jessica Adams. Adams thinks that Nick’s symptoms are due to gonorrhea and surreptitiously prescribes antibiotics to treat it. House is cleaning in the infirmary, and of course recognizes what she thinks it is by stating “It’s not gonorrhea; it’s lupus.” But as any long time viewer would be quick to realize, it’s never lupus. The symptoms progress through the episode until we get our final diagnosis of mastocytosis, and House ends up in solitary confinement.
Mastocytosis is a rare disorder of the blood cells, that results in overproduction of mast cells. Mast cells are broadly distributed throughout the body, and play a critical role in initiating the allergic response. They accomplish this by releasing stores of granules containing inflammatory mediators upon stimulus by allergens, and consequently the pathology associated with overproduction of mast cells is mainly inflammatory in nature, including rashes, anaphylaxis, abdominal discomfort, low blood pressure, and pain. Ultimately, there is no cure for mastocytosis, but treatment and management of the symptoms by administration of anti-inflammatory medication can be successful. The number of people suffering from mastocytosis in the United States currently is unknown, but the disease is considered an ‘orphan’ disease, meaning that fewer than 200,000 people have it at any one time. It is a field with active research however, and the medical database Pubmed lists greater than 5000 publications dealing with mastocytosis.
As I said above, I enjoyed this episode, not only for the way the medical diagnosis was handled, but also for the way House was handled. The big news at the end of last season was the announcement by Lisa Edelstein that she would not be returning this season to play Cuddy. Although I thought that Cuddy was a fabulous foil for House, the relationship arc of last season became tiresome. House creator David Shore was recently interviewed and commented that it was difficult to write into the show an event that appropriately punished House for his actions last season, without necessarily changing his personality. The writers further needed to be able to distance House from his past (meaning his romance with Cuddy, and his “bromance” with Wilson), and a 12 month stint in prison was able to accomplish that aim. Here’s to an excellent start; let’s see what next week will bring!