Category Archives: House Party!

House S08EP23 “Everybody dies”

I can’t believe this is the end!

According to the WordPress stats, there have been 43 posts out of roughly 260 tagged “House Party!” House has been a complex show, with a need to walk a tightrope between giving the audience characters that they can become invested with and watch grow over time, and at the same time creating a situational environment week after week that can maintain interest. The writers and producers also endeavored to make the necessarily contrived plotlines (after all, how many cases of Nagleria would you really expect to see in Central New Jersey???) at least pass some sort of credibility level. This was mostly successful over the past 8 seasons, but did occasionally make me frustrated. However, my frustration was never with the portrayal of the characters, but only because the contrived situation of the week came close to the limits of my ability to suspend disbelief.

This week brought us the final episode of House, which aired following a series retrospective. The medical mystery of the week in the finale was inconsequential, and the diagnosis of the patient (a drug addict, who came into the clinic seeking narcotics) occupied about 5 minutes of the total episode. House admits him based on his suspicion that he had additional medical issues beyond heroin addiction, due to bruising around his navel (Cullen’s Sign) suggesting either an ectopic pregnancy or pancreatitis. I will leave it to the astute BIO230 reader to decide which cause is more likely.

The ongoing story arc picked up from the previous week, where House’s final act while coming to grips with Wilson’s mortality resulted in the destruction of the hospital’s Magnetic Resonance Imaging unit. This led to the police becoming involved, and the realization that House would have to return to prison to serve out the rest of his sentence while Wilson dies from his cancer. This week’s plot then was driven by several attempts by House to defer going back to prison. Attempt number one (taking on a massive caseload) is nixed by Foreman, and attempt number two (getting Wilson to take the fall) is nixed by Wilson. This leaves House with the Reichenbach Falls as his only logical solution, as he realizes that the only way that he will be able to avoid prison is by being dead.

Much of the episode, including the diagnosis of the heroin addict, was shown in flashback, with House waking up at the start (next to the now dead junkie) inside a burning warehouse. This ends (apparently) poorly, with Wilson and Foreman arriving just in time to House engulfed in flames while the warehouse explodes. During the eulogy, Wilson receives a text “Shut up you idiot;” House managed to escape out the back, and the body of the dead junkie was ID’d as House’s body following some lucky dental record switching. The episode ends with House and Wilson riding off on motorcycles.

My aim in watching and talking about this show was not to nitpick, although it might come across that way some times. I want all BIO230 students to be in a position to be able to give an honest assessment of the things that they watch and read; we don’t have to be medical experts in a specific specialty, but we should be able to use the information we are given and do just a little bit of research if things do not seem as they should. The show House, MD managed for the most part to create a scenario week after week, that although it may not have been likely, it was at least plausible. And the holes that inevitably appear with closer examination are always instructive.

House S08EP21 “Holding On”

ImageSorry 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.

House S08EP20 “Post-mortem”

On the next episode of House, one of the Princeton-Plainsboro staff doctors becomes the patient of the week. However, he does not trust House’s team, and wants the man himself to make the treatment call. House and Wilson are on a road trip, so the team has to make the patient believe that House is calling all of the shots. Just the sort of strategy that House would admire! Will it work? Find out Monday at 9, then Tuesday for a recap! Read the rest of this entry

House S08EP19 “The C-Word”

via Fox.com

Just a few more episodes to count down to the season finale of House. The title of this week’s episode refers to [SPOILERS], and that plotline appears to be secondary to this evening’s story about Emily, a six year old girl with multiple preexisting conditions that must be solved, and how the team deals with Emily’s mother–who also happens to be a doctor, and is involved in Emily’s care.  As the team searches Emily’s home, they find something that appears to be relevant towards the case, and that the mother’s efforts to cure her daughter may not be beneficial. Read the rest of this entry

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!

House S08EP17 “We need the eggs”

Via Fox. com

Only about a month of episodes left in the series before House rides off into the sunset. This week on House, the team takes on the case of a man who starts crying blood. The hijinks half of the episode is provided by House’s efforts to retain the services of his favorite “companion.” My quick Google searching for “tears of blood” turns up a variety of hits, most pointing at recent head trauma as the cause of the condition. Others remain a mystery! Back Tuesday morning, with the diagnosis recap and episode spoilers!

Full disclosure: I did not get to watch the episode this evening, as we only have one television, and my daughter wanted to watch Eureka, so I will rewatch House when it pops up next week On Demand. I did go through the episode recap on the Fox.com website however. As I surmised, head trauma was the very first diagnosis, and was discounted in about 2 seconds due to no evidence of head trauma. The patient Henry exhibits a number of recurring symptoms including respiratory “crackles,” liver failure, neurological dysfunction, and a fever spike.

A number of diagnoses are considered and discounted in turn: a sinus thrombosis, drug abuse, clostridial bacterial infection, and finally meningitis. It is this last diagnosis that turns out to be correct when House recognizes “a strange looking teapot” as a Neti Pot, a device that is designed to spray water into the sinus cavities in order to relieve allergy symptoms. House concludes that Henry has primary amoebic meningoencephalitis, due to infection with the protozoan pathogen Nagleria fowlerii, which was the point that I had to haul out the “Bogus” tag, due to the producers’ choice in trotting out an already extremely rare infectious disease for a second time on the show. The patient was put onto the anti-protozoan medication metridnazole to resolve the infection.

Nagleria infections are not common in the United States, with just 32 infections over the past 10 year period. Most cases of Nagleria infection occur during the summer months, particularly in the Southern tier states, as the organism is normally found in warm bodies of water and is acquired when people dive into the water forcing water into the nasal cavities. The seasonal and geographical associations make it extremely unlikely that two cases would occur in New Jersey, in mid-April (the last episode featuring Nagleri fowlerii aired almost exactly 6 years ago.)

The Centers for Disease Control Nagleria website does specifically include instructions how to minimize risks of infection using Neti Pots, so presumably this mode of transmission has been documented, but my quick search of Pubmed did not turn up any relevant hits, so I think it is safe to assume that the risk of acquiring amoebic meningoencephalitis via nasal irrigation is pretty minimal. The CDC’s recommendation for eliminating the risk is to use distilled water during irrigation or water that has been filtered to remove organisms, and to wash the device between uses.

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