House S08EP21 “Holding On”
Sorry for not getting teaser up prior to the episode, but since the BIO230 students have all disappeared for Summer Vacation, the readership has dwindled to a few intrepid Googlers, plus Facebook Friends for the next 14 weeks. We hit the penultimate “House” episode last night, and the writers are doing all they can to wrap up the House/Wilson relationship in their remaining time. Consequently, the “A” plotline about Derrick, a 19 year old cheerleader who collapsed during practice, was pretty short and to the point.
While imaging Derrick for a possible inflammatory condition behind the sinuses, they realize that the auditory area of his brain is receiving stimulus, even though he is in total silence; Derrick is hearing and responding to sound. Upon obtaining further history, it is learned that Derrick had a younger brother who was killed by a drunk driver a decade previously, and it is the brother’s voice that Derrick believes he hears.
Because most of the episode focuses on House and Wilson, Derrick’s story doesn’t get hugely fleshed out. The team suspects psychological issues, due to grief avoidance for his brother, or toxicity issues from living with Derrick’s stoner roommate. House makes the final correct diagnosis, a persistant stapedial artery, a congenital condition which results in an artery of the inner ear pushing against the temporal lobe. Normally, this artery disappears during fetal development, but in this case it did not. Treatment is surgery to correct the defect, which in turn will eliminate the signs and symptoms of the condition. The incidence of PSA is not high, with only 56 cases reported in the literature since the original description in 1836, however it is likely that the majority of the cases are asymptomatic. Although rarely diagnosed, it is surprising that none of the imaging procedures that Derrick had performed were able to pick up this anatomical defect prior to House inserting a tuberculin needle into the patient’s eardrum.
Most of the episode focused on House trying to convince Wilson to undergo an additional round of chemotherapy to treat his cancer, using a combination of childish and touching approaches. The aggressive treatment attempted two weeks ago has been unsuccessful, and Wilson doesn’t feel that the additional time that further treatment might buy him would warrant the poor quality of life that he would experience in the interim. The end of the episode was truly touching and sad, as House realized that he had let his friend down again.