House S08EP18 “Body and Soul”
The countdown continues to the end of House, with just 4 episodes to go until the series finale. Hopefully, these episodes will be chock full of character development and resolution, because in its core, this show has been intensely character driven. The patient this week has violent dreams of being choked, then wakes up being unable to breath. Not a lot to go on, but maybe this will be an episode for the Respiratory Care students in BIO230 to get excited about. For comic relief, Dr. Park also has dreams, but hers are of a co-worker. House and Mrs. House (remember her?) move to a new step in their relationship. More details, and a disease recap after Monday evening at 9!
Back again Tuesday morning, and as the last several episodes will be bring some characters through some changes, I will try to actually avoid too many spoilers for where the series might be going. In tonight’s episode, House, Chase, and Park all discussed the relationship between dream and reality, which mirrored the main patient, Lue, who had a dream of being choked and woke up unable to breath. Lue’s symptoms throughout the episode continued to manifest as respiratory arrest, along with neurological involvement as seizures several times, and House early on invokes the diagnosis of Sudden Unexpected Nocturnal Death Syndrome (SUNDS), due to the boy’s Hmong ethnicity (a southern Chinese group, many of which emigrated to the United States in the 1970’s as refugees during the Vietnam War.) The team uses ultrasound to image the boy’s heart for defects, but identifies none. House ultimately proposes patent ductus arteriosus, a congenital defect between the systemic and pulmonary circulation, but which can be treated with ibuprofin.
Lue’s grandfather has an alternative explanation, which is that the boy is possessed by a demon which had been offended by his father’s actions offscreen. The treatment for that malady is a prayer vigil at the patient’s bedside, which along with the administration of a timely bolus of ibuprofin, helps to resolve the symptoms by the end of the episode. The patient’s mother and grandfather of course thank the prayer vigil for curing Lue, whereas the Princeton-Plainsboro team credit medicine.
Patent ductus arteriosis is, according to Dr. Adams, a “one in a billion” diagnosis, due to the rarity of the condition. The ductus arteriosis is a blood vessel that is important in the fetal circulation, as it allows blood to bypass the lungs in utero. It typically closes shortly after birth as the lungs are used, but House suspects that an infection has kept the ductus open. As noted on the PoliteDissent review of the episode, this is a bit of a forced diagnosis, as there were no reports of any breathing abnormalities prior to the start of the episode. Additionally, the echocardiogram performed at the very start of the episode is the definitive diagnostic tool, however it did not indicate ANY cardiac abnormalities when it was done. And then finally, I complained about reuse of a diagnosis last week. Patent ductus arteriosis was also the diagnosis of a patient from Season 5 episode 13, which first aired only in January 2009, only 3 years ago. In that case, it showed up very nicely on the echocardiogram; I guess they’ve gotten a new imaging technician in the interim!