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1
00:00:04,046 --> 00:00:07,048
On your right.
On your right. On your right.
2
00:00:07,174 --> 00:00:08,216
Back, back, back, back, back.
3
00:00:08,342 --> 00:00:09,967
Come on, buddy.
4
00:00:12,846 --> 00:00:15,181
Yeah, Dan! Yeah!
5
00:00:15,307 --> 00:00:16,974
Yeah! Yeah!
6
00:00:17,142 --> 00:00:18,768
Back, back, back, back, back.
7
00:00:18,894 --> 00:00:21,062
Come on! Watch the winger!
8
00:00:32,199 --> 00:00:33,199
Yeah!
9
00:00:58,016 --> 00:00:58,850
You okay?
10
00:00:59,810 --> 00:01:04,063
Dan? Dan, talk to me. Dan. Dan.
11
00:01:05,899 --> 00:01:07,734
Get a doctor!
12
00:01:48,817 --> 00:01:50,735
- Hey.
- Close the door.
13
00:01:50,861 --> 00:01:52,195
Close the door.
14
00:01:55,616 --> 00:01:58,159
Is Cuddy down the hall counting to 50?
15
00:01:58,827 --> 00:02:01,579
She knows I'm in here,
in the clinic, as she commanded.
16
00:02:01,705 --> 00:02:03,122
She just doesn't know I'm alone.
17
00:02:03,457 --> 00:02:05,166
Well, you've got a full waiting room.
18
00:02:05,292 --> 00:02:06,751
How long do you think
you can ignore them?
19
00:02:06,877 --> 00:02:08,377
I'm off at 4:00.
20
00:02:09,546 --> 00:02:12,548
You're doing this
to avoid five minutes of work?
21
00:02:12,674 --> 00:02:14,842
If I go out there, I get assigned
a kid with a runny nose.
22
00:02:14,968 --> 00:02:16,135
That's 30 seconds looking at the nose,
23
00:02:16,261 --> 00:02:18,179
25 minutes talking to a worried mom
24
00:02:18,305 --> 00:02:20,640
who won't leave until she's sure
it's not meningitis or a tumor.
25
00:02:20,766 --> 00:02:23,059
Yes. Concerned parents
can be so annoying.
26
00:02:23,352 --> 00:02:25,561
Just tell Cuddy you've got
an urgent case. You had to leave early.
27
00:02:25,687 --> 00:02:27,980
- That would be lying.
- And that would be wrong.
28
00:02:28,106 --> 00:02:31,567
But luckily the definition
of "urgent" is fungible.
29
00:02:31,985 --> 00:02:34,695
Not the definition of "case", though.
30
00:02:37,699 --> 00:02:43,120
You have no cases?
31
00:02:43,956 --> 00:02:46,624
You've got handpicked doctors,
specialists
32
00:02:46,750 --> 00:02:49,877
working for you,
and they're sitting on their hands?
33
00:02:50,003 --> 00:02:53,631
- Cameron's answering my mail.
- Oh, time well spent, I'm sure.
34
00:02:53,757 --> 00:02:55,341
Foreman and Chase?
35
00:02:56,343 --> 00:02:57,385
Research?
36
00:03:04,393 --> 00:03:07,144
Nine letters. Iodine deficiency in children.
37
00:03:07,271 --> 00:03:08,688
Cretinism.
38
00:03:18,448 --> 00:03:21,826
So, 4:03 p.m., Dr. House checks out.
39
00:03:21,952 --> 00:03:24,495
- Please write that down.
- Dr. House.
40
00:03:24,621 --> 00:03:27,373
Sorry. Done for the day.
Plenty of docs here to take care of you.
41
00:03:27,499 --> 00:03:29,083
But we had an appointment.
42
00:03:29,209 --> 00:03:31,002
Nice try, but this is a walk-in clinic,
43
00:03:31,128 --> 00:03:32,128
which means there are no appointments.
44
00:03:32,254 --> 00:03:34,088
You walk in, sign the chart
and a doctor will see you.
45
00:03:34,214 --> 00:03:35,214
Just not me.
46
00:03:35,340 --> 00:03:38,134
Your letter says that we'd see you.
47
00:03:39,052 --> 00:03:41,971
- Not a big letter writer.
- Here.
48
00:03:44,892 --> 00:03:47,351
When did my signature get so girlie?
49
00:03:48,270 --> 00:03:49,270
I can explain.
50
00:03:49,396 --> 00:03:50,688
See that "G"?
51
00:03:50,814 --> 00:03:52,356
See how it makes a big loop on top?
52
00:03:52,482 --> 00:03:54,734
Doesn't even look like my handwriting.
53
00:03:54,860 --> 00:03:57,320
Think I have something?
What's the differential diagnosis
54
00:03:57,446 --> 00:03:59,322
for writing G's like
a junior high school girl?
55
00:03:59,448 --> 00:04:01,282
It's impossible to get to you
through normal channels.
56
00:04:01,408 --> 00:04:02,533
They have called, e-mailed.
57
00:04:02,659 --> 00:04:04,035
Perseverance does
not equal worthiness.
58
00:04:04,161 --> 00:04:06,787
Next time you want to get my attention,
wear something fun.
59
00:04:06,914 --> 00:04:10,333
- Low-rider jeans are hot.
- Sixteen-year-old male.
60
00:04:10,459 --> 00:04:12,752
Sudden onset of double vision
and night terrors,
61
00:04:12,878 --> 00:04:14,045
with no apparent cause.
62
00:04:14,171 --> 00:04:16,797
- The kid's been to two neurologists...
- Night terrors?
63
00:04:16,924 --> 00:04:20,092
- As in big scary monsters?
- Yes.
64
00:04:23,263 --> 00:04:25,932
- Where are you going?
- To see the family.
65
00:04:26,058 --> 00:04:27,058
You're going to examine a patient?
66
00:04:27,184 --> 00:04:29,810
Nine times out of 10,
there's no reason to talk to a patient.
67
00:04:29,937 --> 00:04:31,729
But night terrors in a 16-year-old
68
00:04:31,855 --> 00:04:35,900
is a very good reason to talk
to this family. Good work.
69
00:04:38,820 --> 00:04:40,738
Margins are fine.
70
00:04:41,365 --> 00:04:42,823
No lesions.
71
00:04:44,117 --> 00:04:45,868
Color is good.
72
00:04:46,536 --> 00:04:48,746
How long have you been
having night terrors?
73
00:04:48,872 --> 00:04:50,957
- Three weeks.
- He's afraid to go to bed.
74
00:04:51,083 --> 00:04:53,751
He's exhausted, can barely function.
75
00:04:55,087 --> 00:04:56,087
What does that tell you?
76
00:04:56,213 --> 00:04:58,631
Nothing. It's just fun watching him blink.
77
00:04:59,132 --> 00:05:00,633
Name as many animals as you can
78
00:05:00,759 --> 00:05:03,302
that begin with the letter "B". Go.
79
00:05:10,435 --> 00:05:11,435
Baby elephant?
80
00:05:11,561 --> 00:05:13,437
Baby elephant is actually a good answer.
81
00:05:13,563 --> 00:05:15,398
- "B" is a bear of a letter.
- What does that tell you?
82
00:05:15,524 --> 00:05:17,608
Proves two things,
no neurological damage,
83
00:05:17,734 --> 00:05:19,735
and your son is never gonna
be chief fry cook.
84
00:05:20,570 --> 00:05:24,031
In teens, there are
two likely causes of night terrors.
85
00:05:24,157 --> 00:05:25,116
Post-traumatic stress.
86
00:05:25,242 --> 00:05:26,993
Any recent shoot-outs
at your high school?
87
00:05:27,119 --> 00:05:28,327
- No.
- Well, then, Dave...
88
00:05:28,453 --> 00:05:29,996
- Dan.
- If there's no trauma,
89
00:05:30,122 --> 00:05:33,040
the other cause is sexual abuse.
90
00:05:36,128 --> 00:05:37,670
So who's molesting you?
91
00:05:37,796 --> 00:05:39,839
Teacher? Extra-friendly neighbor?
92
00:05:40,424 --> 00:05:42,425
I'd ask if either of you were involved,
but you'd deny it.
93
00:05:42,551 --> 00:05:44,135
No. We would never do
anything to hurt Dan.
94
00:05:44,261 --> 00:05:46,220
I say it here, it comes out there.
95
00:05:46,763 --> 00:05:49,181
This lack of response is
consistent with abuse.
96
00:05:49,307 --> 00:05:51,308
There's no one, okay? I swear.
97
00:05:52,144 --> 00:05:53,227
There was trauma.
98
00:05:53,353 --> 00:05:55,980
I got hit in the head
during a lacrosse game.
99
00:05:56,857 --> 00:05:59,608
Did you know that he got hit in the head?
100
00:06:00,110 --> 00:06:02,069
They didn't mention it. No.
101
00:06:02,195 --> 00:06:03,654
Yeah. Why bother?
102
00:06:06,658 --> 00:06:09,660
No, no. We took him to
the ER after the game.
103
00:06:09,786 --> 00:06:12,163
He was scanned. They tested him.
They said he was fine.
104
00:06:12,289 --> 00:06:13,330
No concussion. It's gotta be...
105
00:06:13,457 --> 00:06:17,209
You hound me for my opinion,
and then you question my diagnosis.
106
00:06:17,335 --> 00:06:18,419
Cool.
107
00:06:18,545 --> 00:06:20,796
ER obviously screwed up.
Kid's got a concussion.
108
00:06:20,922 --> 00:06:22,381
I had double vision before I was hit.
109
00:06:22,507 --> 00:06:24,341
Well, that changes everything.
110
00:06:24,468 --> 00:06:27,136
You need glasses.
That's why you had double vision,
111
00:06:27,262 --> 00:06:29,138
which is why you got hit,
which is why you have a concussion,
112
00:06:29,264 --> 00:06:31,557
which is why you have night terrors.
113
00:06:31,683 --> 00:06:34,685
You need to see an ophthalmologist,
which I am not.
114
00:06:35,187 --> 00:06:36,604
You enjoyed that.
115
00:06:36,730 --> 00:06:38,147
I brought a reasonable case
to your attention,
116
00:06:38,273 --> 00:06:40,149
and you shoved it in my face
just to humiliate me.
117
00:06:40,275 --> 00:06:43,152
- You're an only child, aren't you?
- Why would you say that?
118
00:06:43,278 --> 00:06:44,862
Because everything is about you.
119
00:06:46,114 --> 00:06:47,948
This may seem incredibly controversial,
120
00:06:48,075 --> 00:06:50,284
but I think sexual abuse is bad.
121
00:06:50,410 --> 00:06:53,788
I just wanted to make sure he wasn't
being diddled by daddy or mommy.
122
00:06:53,914 --> 00:06:55,956
Anything else is just a bonus.
123
00:07:06,468 --> 00:07:09,136
- I'm not an only child.
- Interesting.
124
00:07:10,347 --> 00:07:12,515
- What?
- Don't move.
125
00:07:13,350 --> 00:07:17,061
- Did I bore you in there?
- What? No. Not really.
126
00:07:17,187 --> 00:07:18,020
Are you tired?
127
00:07:19,523 --> 00:07:21,607
- Sometimes.
- He never sleeps. Of course he's tired.
128
00:07:21,733 --> 00:07:23,651
- Right now. Are you tired?
- No. No.
129
00:07:23,777 --> 00:07:27,029
That twitch in your leg. Did you feel that?
130
00:07:28,198 --> 00:07:30,491
- Didn't hurt.
- His leg twitched. I don't see what...
131
00:07:30,617 --> 00:07:32,326
It's called a myoclonic jerk.
132
00:07:32,452 --> 00:07:34,078
It's very common
when you're falling asleep.
133
00:07:34,204 --> 00:07:35,412
Respiration rate falls,
134
00:07:35,539 --> 00:07:38,082
and the brain sometimes
interprets this as the body dying,
135
00:07:38,208 --> 00:07:39,166
so it sends a pulse to wake it up.
136
00:07:39,292 --> 00:07:42,878
- So?
- So, he's not asleep. He's awake.
137
00:07:44,798 --> 00:07:46,257
Admit him.
138
00:07:49,553 --> 00:07:52,346
I recognize that loopy "G...
139
00:07:53,223 --> 00:07:55,057
So, what does the jerk tell us?
140
00:07:55,183 --> 00:07:57,810
Nothing good.
The brain's losing control of the body.
141
00:07:57,936 --> 00:07:59,145
Can't order the eyes to focus,
142
00:07:59,271 --> 00:08:00,729
regulate sleep patterns
or control muscles.
143
00:08:00,856 --> 00:08:03,107
A movement disorder
or a degenerative brain disease.
144
00:08:03,233 --> 00:08:05,109
Either way, this kid's gonna be
picking up his diploma
145
00:08:05,235 --> 00:08:06,277
in diapers and a wheelchair.
146
00:08:06,403 --> 00:08:08,529
Maybe not that bad.
Could be an infection.
147
00:08:08,655 --> 00:08:10,948
You wish. No fever, no white count.
148
00:08:11,074 --> 00:08:13,868
Anyone think this differential
diagnosis might be compromised
149
00:08:13,994 --> 00:08:16,245
because we don't have
an accurate family history?
150
00:08:16,371 --> 00:08:17,872
I took an accurate family history.
151
00:08:17,998 --> 00:08:20,499
You didn't even take an accurate family.
152
00:08:20,625 --> 00:08:22,543
- His father's not his father.
- Why would you say that?
153
00:08:22,669 --> 00:08:23,919
Thirty percent of all dads out there
154
00:08:24,045 --> 00:08:25,838
don't realize they're
raising someone else's kid.
155
00:08:25,964 --> 00:08:27,673
From what I've read,
false paternity's more like 10%.
156
00:08:27,799 --> 00:08:29,300
That's what our moms
would like us to believe.
157
00:08:29,426 --> 00:08:31,927
Who cares? If he got it from his
parents, they'd both be dead by now.
158
00:08:32,053 --> 00:08:33,554
Can we get on with
the differential diagnosis?
159
00:08:33,680 --> 00:08:34,847
Fifty bucks says I'm right.
160
00:08:34,973 --> 00:08:36,849
- I'll take your money.
- Hit a nerve?
161
00:08:36,975 --> 00:08:37,933
Don't worry, Foreman.
162
00:08:38,059 --> 00:08:39,852
I'm sure the guy who tucked you in
at night was your daddy.
163
00:08:39,978 --> 00:08:41,520
Make it $100.
164
00:08:41,646 --> 00:08:44,815
What about leukoencephalopathy
in a 16-year-old?
165
00:08:44,941 --> 00:08:47,026
It doesn't necessarily
have to be that bad.
166
00:08:47,152 --> 00:08:47,943
If we exclude the night terrors,
167
00:08:48,069 --> 00:08:49,028
it could be something systemic.
168
00:08:49,154 --> 00:08:51,739
His liver, kidneys.
Something outside the brain.
169
00:08:51,865 --> 00:08:55,201
Yes. Feel free to exclude any symptom
if it makes your job easier.
170
00:08:55,327 --> 00:08:57,578
The night terrors were anecdotal.
He could've had a bad dream.
171
00:08:57,704 --> 00:08:59,496
No. parents said he was
conscious during the event
172
00:08:59,623 --> 00:09:01,749
and didn't remember
anything afterwards.
173
00:09:01,875 --> 00:09:03,292
- That's a night terror.
- Parents said?
174
00:09:04,169 --> 00:09:05,127
That's a good point.
175
00:09:05,253 --> 00:09:08,756
Before we condemn this kid, maybe we
should entertain Dr. Chase's skepticism.
176
00:09:08,882 --> 00:09:10,382
I want a detailed polysomnograph.
177
00:09:10,508 --> 00:09:13,719
If he's having night terrors,
I want to see them.
178
00:09:36,868 --> 00:09:38,994
I usually don't move during night terrors.
179
00:09:39,120 --> 00:09:40,621
I'm not restraining you for them.
180
00:09:43,583 --> 00:09:47,127
EEG revealed
abnormalities in your brain,
181
00:09:47,254 --> 00:09:49,505
caused nerve damage in your toes.
182
00:09:55,929 --> 00:10:00,015
- What are you doing?
- Fixing it.
183
00:10:00,600 --> 00:10:02,101
Can I talk to my parents?
184
00:10:02,644 --> 00:10:06,981
- Oh, they know all about this.
- I'd really like to see them.
185
00:10:15,865 --> 00:10:19,076
Please. I'd really like them here.
186
00:10:21,204 --> 00:10:23,122
This is gonna hurt, Dan.
187
00:10:23,248 --> 00:10:24,957
Oh. Oh, God.
188
00:10:41,641 --> 00:10:43,475
That's a night terror.
189
00:10:55,113 --> 00:10:59,033
We did a CT, MRI,
CBC, CHEM-7 and chest X-ray.
190
00:10:59,159 --> 00:11:00,159
All the tests came back normal.
191
00:11:00,285 --> 00:11:01,493
There's nothing to explain his symptoms.
192
00:11:01,619 --> 00:11:04,121
Okay, but let's pretend
there's something and go from there.
193
00:11:04,456 --> 00:11:06,040
Who sees something on this MRI?
194
00:11:08,293 --> 00:11:11,420
- No lesions in the white matter.
- No structural abnormalities.
195
00:11:11,546 --> 00:11:13,005
No space-occupying tumors.
196
00:11:13,131 --> 00:11:16,717
He's 16, so he should have
an absolutely pristine brain.
197
00:11:16,843 --> 00:11:19,178
The smallest thing is abnormal.
198
00:11:19,554 --> 00:11:21,388
Meningeal enhancement.
199
00:11:22,140 --> 00:11:24,808
- My bet is viral meningitis.
- Excellent.
200
00:11:25,185 --> 00:11:26,769
Do you see what he did there?
201
00:11:26,895 --> 00:11:29,063
Took a small clue
that there's a neurological problem
202
00:11:29,189 --> 00:11:30,314
and wasn't afraid to run with it.
203
00:11:30,440 --> 00:11:32,900
There's no evidence of meningitis
on that MRI.
204
00:11:33,026 --> 00:11:35,277
No, there's not. He's completely wrong.
205
00:11:35,403 --> 00:11:36,945
Then what clue are you talking about?
206
00:11:37,072 --> 00:11:38,781
He knew that
I saw something on the MRI,
207
00:11:38,907 --> 00:11:41,742
so he figured there must be
something there and took a guess.
208
00:11:41,868 --> 00:11:45,245
- Clever, but also pathetic.
- So what did you find?
209
00:11:45,955 --> 00:11:48,707
Take a close look at the corpus callosum.
210
00:11:51,086 --> 00:11:53,045
Looks okay.
211
00:11:53,213 --> 00:11:54,922
Are we all looking at the same thing?
212
00:11:55,048 --> 00:11:57,257
Two hundred million
interhemispheric nerve fibers.
213
00:11:57,384 --> 00:12:01,720
The George Washington Bridge between
the left and right side of the brain.
214
00:12:01,971 --> 00:12:02,805
It's subtle.
215
00:12:06,684 --> 00:12:10,312
There's some bowing. There.
An upward arch.
216
00:12:10,438 --> 00:12:13,524
- Are you guessing?
- Yes.
217
00:12:13,691 --> 00:12:16,610
- Too bad. You're right.
- He probably just moved.
218
00:12:16,736 --> 00:12:19,405
Nobody stays perfectly still
for the entire MRI.
219
00:12:19,531 --> 00:12:21,407
Yeah. Probably got restless
220
00:12:21,533 --> 00:12:23,325
and shifted one hemisphere of his brain
221
00:12:23,451 --> 00:12:26,537
to a more comfortable position.
Something is pushing on it.
222
00:12:26,663 --> 00:12:28,122
If there was bowing, could be a tumor.
223
00:12:28,248 --> 00:12:30,040
Do you see a tumor on this MRI?
224
00:12:30,166 --> 00:12:31,917
No, but I don't see any bowing either.
225
00:12:32,043 --> 00:12:35,170
There's no tumor. Just a blockage
causing pressure causing symptoms.
226
00:12:35,296 --> 00:12:39,091
Today, night terrors.
Tomorrow, he's bleeding out of his eyes.
227
00:12:39,759 --> 00:12:41,552
Get him a radionucleotide cisternogram.
228
00:12:41,678 --> 00:12:43,512
I guarantee you'll see a blockage.
229
00:12:50,061 --> 00:12:51,228
Okay.
230
00:12:54,816 --> 00:12:55,816
Easy.
231
00:12:55,942 --> 00:12:57,776
Okay. Squeeze my hand.
232
00:13:02,240 --> 00:13:04,199
All right. Squeeze hard.
233
00:13:06,953 --> 00:13:08,412
All right.
234
00:13:15,170 --> 00:13:18,464
Now I'm injecting a material
that's tagged with a radioisotope.
235
00:13:19,424 --> 00:13:23,093
It's gonna enter your spine
and travel up to your brain.
236
00:13:23,636 --> 00:13:26,513
It'll make you able
to think deep thoughts,
237
00:13:26,764 --> 00:13:28,348
run 100 miles an hour.
238
00:13:30,059 --> 00:13:31,101
Easy.
239
00:13:45,283 --> 00:13:48,410
Their eyes aren't the same color,
but that fleck in the eyes,
240
00:13:48,536 --> 00:13:51,079
that's maybe a 1-in-10 chance
if they're not related?
241
00:13:51,206 --> 00:13:53,499
No. House isn't gonna
pay you based on that.
242
00:13:54,876 --> 00:13:57,336
Any excuse we can give the folks
to justify a DNA test?
243
00:13:57,462 --> 00:13:59,213
We could tell them he's got Huntington's,
244
00:13:59,339 --> 00:14:02,508
whole family should be tested
or they'll all die.
245
00:14:05,136 --> 00:14:06,345
Hey.
246
00:14:07,055 --> 00:14:08,847
There's a lot of blockage.
247
00:14:08,973 --> 00:14:10,807
I've scheduled him for surgery.
248
00:14:10,934 --> 00:14:12,643
We're gonna put a shunt
into one of the ventricles
249
00:14:12,769 --> 00:14:14,853
to give the cerebrospinal fluid an out.
250
00:14:14,979 --> 00:14:17,773
No more pressure,
everything goes back to normal.
251
00:14:17,899 --> 00:14:20,400
He's lucky to have you as his doctors.
252
00:14:28,826 --> 00:14:32,454
No formula. Just Mommy's healthy,
natural breast milk.
253
00:14:33,748 --> 00:14:35,040
Yummy.
254
00:14:35,166 --> 00:14:38,252
Her whole face just got
swollen like this overnight.
255
00:14:40,421 --> 00:14:41,797
No fever.
256
00:14:42,966 --> 00:14:46,260
Glands normal.
Missing her vaccination dates.
257
00:14:46,386 --> 00:14:47,970
We're not vaccinating.
258
00:14:54,435 --> 00:14:55,477
Think they don't work?
259
00:14:55,603 --> 00:14:57,896
I think some multinational
pharmaceutical company
260
00:14:58,022 --> 00:15:01,108
wants me to think they work,
pad their bottom line.
261
00:15:02,819 --> 00:15:04,152
- May I?
- Sure.
262
00:15:10,493 --> 00:15:13,495
Yeah. All-natural, no dyes
is a good business.
263
00:15:13,621 --> 00:15:15,455
All-natural children's toys.
264
00:15:15,582 --> 00:15:18,542
Toy companies, they don't arbitrarily
mark up their frogs.
265
00:15:18,668 --> 00:15:22,045
They don't lie about how much they
spend on research and development.
266
00:15:22,171 --> 00:15:24,423
The worst that a toy company
could be accused of
267
00:15:24,549 --> 00:15:27,175
is making a really boring frog.
268
00:15:29,929 --> 00:15:32,472
You know another really good business?
269
00:15:32,724 --> 00:15:35,183
Teeny, tiny baby coffins.
270
00:15:36,936 --> 00:15:40,647
You can get them in frog green,
fire-engine red. Really.
271
00:15:41,608 --> 00:15:45,527
The antibodies in yummy mummy
only protect the kid for six months,
272
00:15:45,653 --> 00:15:48,113
which is why these companies
think they can gouge you.
273
00:15:48,239 --> 00:15:51,867
They think that you'll spend whatever
they ask to keep your kid alive.
274
00:15:51,993 --> 00:15:53,994
Want to change things?
Prove them wrong.
275
00:15:54,120 --> 00:15:56,455
Few hundred parents like you
decide they'd rather let their kid die
276
00:15:56,581 --> 00:15:58,498
than cough up 40 bucks
for a vaccination,
277
00:15:58,625 --> 00:16:01,335
believe me, prices will drop really fast.
278
00:16:06,549 --> 00:16:08,050
Tell me what she has.
279
00:16:10,970 --> 00:16:11,970
A cold.
280
00:16:13,806 --> 00:16:15,390
There's a problem.
281
00:16:15,516 --> 00:16:16,850
Complications in surgery?
282
00:16:16,976 --> 00:16:18,268
Surgery went fine. He's in recovery.
283
00:16:18,394 --> 00:16:20,270
But we took a vial of CSF and tested it.
284
00:16:20,396 --> 00:16:21,355
Really?
285
00:16:21,481 --> 00:16:22,939
Turns out the bowing
wasn't the cause of his problems.
286
00:16:23,066 --> 00:16:24,066
It was a symptom.
287
00:16:24,192 --> 00:16:26,943
Oligoclonal bands
and increased intrathecal IgG.
288
00:16:27,070 --> 00:16:28,820
Which means multiple sclerosis.
289
00:16:28,946 --> 00:16:30,864
And the reason it takes
three of you to tell me this?
290
00:16:30,990 --> 00:16:33,158
Because we're having a disagreement
about whether or not it is MS.
291
00:16:33,284 --> 00:16:34,618
No lesions on the MRI.
292
00:16:34,744 --> 00:16:36,370
It's early. He's had the disease
for maybe two weeks.
293
00:16:36,496 --> 00:16:39,289
McDonald criteria requires six months
to make a definitive diagnosis.
294
00:16:39,415 --> 00:16:41,041
Who cares about MacPhearson?
295
00:16:41,167 --> 00:16:43,001
- I hear he tortured kittens.
- McDonald.
296
00:16:43,127 --> 00:16:45,170
Oh, McDonald.
Wonderful doctor, loved kittens.
297
00:16:45,296 --> 00:16:47,881
The VEP indicates slowing of the brain.
298
00:16:48,007 --> 00:16:49,091
Without the lesions, we can't be sure.
299
00:16:49,217 --> 00:16:51,593
Well, if it is, it's gone
from 0 to 60 in three weeks,
300
00:16:51,719 --> 00:16:54,137
which would indicate
rapidly progressive MS.
301
00:16:54,263 --> 00:16:55,889
Not the fun MS with the balloons
302
00:16:56,015 --> 00:16:57,641
and the bike rides
for cripples in wheelchairs.
303
00:16:57,767 --> 00:17:00,602
- We should wait until...
- Start treating him now,
304
00:17:00,728 --> 00:17:02,521
maybe he can walk
for another couple of years,
305
00:17:02,647 --> 00:17:05,023
maybe live for another five.
306
00:17:05,149 --> 00:17:07,317
Break it to the family. I'm going home.
307
00:17:07,443 --> 00:17:10,195
It'll take months for a definitive diagnosis.
308
00:17:10,321 --> 00:17:11,655
What'll happen to me?
309
00:17:13,199 --> 00:17:15,951
MS is an incredibly variable disease.
310
00:17:16,077 --> 00:17:19,204
If it is MS, and we're not 100% sure.
311
00:17:19,330 --> 00:17:21,790
What do you think is gonna happen?
312
00:17:24,961 --> 00:17:27,003
There are some medications
to manage the symptoms,
313
00:17:27,130 --> 00:17:31,174
but as the disease progresses,
the problems will become more severe.
314
00:17:31,300 --> 00:17:33,218
Bowel and bladder dysfunction,
315
00:17:33,344 --> 00:17:35,470
loss of cognitive function, pain...
316
00:17:35,596 --> 00:17:37,013
So it's gonna hurt?
317
00:17:39,183 --> 00:17:41,727
The brain's like a big jumble of wires.
318
00:17:41,853 --> 00:17:44,896
MS strips them of the insulation,
and the nerves die.
319
00:17:45,022 --> 00:17:47,065
Brain interprets it as pain.
320
00:17:47,191 --> 00:17:51,194
But by starting treatment, we're gonna
prevent that for as long as possible.
321
00:17:51,320 --> 00:17:52,946
We're looking into a couple of specialists,
322
00:17:53,072 --> 00:17:56,825
and until we get you squared away,
you'll stay here, okay?
323
00:18:17,555 --> 00:18:20,140
Security checked the videotapes
from all perimeter cameras.
324
00:18:20,266 --> 00:18:21,266
He's still gotta be in the hospital.
325
00:18:21,392 --> 00:18:22,350
Where's Chase?
326
00:18:22,477 --> 00:18:23,643
- Main floor.
- Okay.
327
00:18:23,770 --> 00:18:25,145
You take the cafeteria
and administration.
328
00:18:25,271 --> 00:18:27,606
I'll hit the research annex
and work my way back to you.
329
00:19:05,436 --> 00:19:06,603
Dan?
330
00:19:12,819 --> 00:19:14,903
I'm not here. Leave a message.
331
00:19:20,576 --> 00:19:23,328
Dr. Cuddy. Great outfit.
332
00:19:23,454 --> 00:19:25,539
What are you doing back here? Patient?
333
00:19:25,665 --> 00:19:26,998
No. Hooker.
334
00:19:27,124 --> 00:19:28,917
Went to my office instead of my home.
335
00:19:39,804 --> 00:19:41,012
Dr. House.
336
00:19:41,931 --> 00:19:43,139
Dan's missing.
337
00:19:43,266 --> 00:19:44,975
Yeah. I got that part from the message.
338
00:19:45,101 --> 00:19:46,059
You said I was needed immediately.
339
00:19:46,185 --> 00:19:48,061
He shouldn't move
after a lumbar puncture.
340
00:19:48,187 --> 00:19:50,939
I agree. He's gonna have
a very nasty headache.
341
00:19:51,065 --> 00:19:53,900
That would also be my opinion
if consulted tomorrow morning.
342
00:19:54,026 --> 00:19:55,402
We wanted to keep you informed.
343
00:19:55,528 --> 00:19:57,946
He heard some pretty heavy news.
344
00:19:59,073 --> 00:20:01,700
This is not a toddler
wandering around a department store.
345
00:20:01,826 --> 00:20:03,952
He's 16. You'll find him.
346
00:20:05,079 --> 00:20:06,705
I'm going home.
347
00:20:07,623 --> 00:20:09,916
When you say, "Call me if you need
anything", you mean, "Don't call"?
348
00:20:10,042 --> 00:20:12,294
No, I mean call me
if I could do something.
349
00:20:12,420 --> 00:20:13,503
I'm bad at search parties,
350
00:20:13,629 --> 00:20:16,715
and I'm bad at sitting around
looking nervous, doing nothing.
351
00:20:16,841 --> 00:20:18,633
What about his parents?
Should we call them?
352
00:20:18,759 --> 00:20:21,136
Why? Do you think they're hiding him?
353
00:20:21,971 --> 00:20:23,972
Make sure someone checks the roof.
354
00:20:24,098 --> 00:20:28,268
Some of the orderlies keep the door
propped open so they can grab a smoke.
355
00:21:03,054 --> 00:21:04,888
Dan. You okay?
356
00:21:12,313 --> 00:21:14,564
There are experimental treatments.
357
00:21:14,690 --> 00:21:15,899
Ongoing research.
358
00:21:16,567 --> 00:21:18,944
Who knows what they'll discover
in a year or two.
359
00:21:19,070 --> 00:21:20,862
This is where I dropped the ball.
360
00:21:20,988 --> 00:21:24,074
Dan, we're standing
on the roof of the hospital.
361
00:21:25,993 --> 00:21:27,077
Dan.
362
00:21:28,079 --> 00:21:29,996
Dan, you're not on the field.
363
00:21:30,873 --> 00:21:32,666
- He doesn't know where he is.
- Dan!
364
00:21:32,792 --> 00:21:33,875
Foreman.
365
00:21:35,378 --> 00:21:36,544
Dan.
366
00:21:38,172 --> 00:21:39,756
- Dan?
- Dan, no!
367
00:21:51,227 --> 00:21:52,686
Dr. Foreman.
368
00:21:54,605 --> 00:21:56,314
I assume you found the kid.
369
00:21:56,440 --> 00:21:58,942
- He almost walked off the roof.
- Suicidal?
370
00:21:59,068 --> 00:22:01,236
No, he thought he was
on his lacrosse field.
371
00:22:01,362 --> 00:22:03,321
Look, I was just gonna run home,
shower, change...
372
00:22:03,447 --> 00:22:05,323
- Conscious?
- Yeah.
373
00:22:06,701 --> 00:22:07,742
How'd you talk him down?
374
00:22:07,868 --> 00:22:10,996
- Actually, Chase tackled him.
- How come you didn't do it?
375
00:22:11,122 --> 00:22:13,498
Right. Well, I am black,
but he was closer.
376
00:22:16,669 --> 00:22:18,920
Come on. You can ride up with me.
377
00:22:24,760 --> 00:22:27,178
Anybody tell the family that their boy
almost stepped off a roof?
378
00:22:27,304 --> 00:22:28,346
They must be thrilled.
379
00:22:28,472 --> 00:22:31,057
They're not suing,
but I think only because Chase asked...
380
00:22:31,183 --> 00:22:33,184
Why does everybody
always think I'm being sarcastic?
381
00:22:33,310 --> 00:22:36,396
This is great news. He doesn't have MS.
382
00:22:36,522 --> 00:22:38,648
Parents should be thrilled.
Well, the mom anyway.
383
00:22:38,774 --> 00:22:39,899
Of course, the dad
probably doesn't know...
384
00:22:40,026 --> 00:22:41,568
Why doesn't he have MS?
385
00:22:41,694 --> 00:22:43,737
He was on the roof,
thinking he was on a lacrosse field.
386
00:22:43,863 --> 00:22:45,155
Conscious, and
therefore not a night terror.
387
00:22:45,281 --> 00:22:47,657
- You want some of this?
- Yeah, sure.
388
00:22:48,075 --> 00:22:50,201
He was in an acute confusional state,
389
00:22:50,327 --> 00:22:52,662
which doesn't fit with
a demyelinating disease like MS.
390
00:22:52,788 --> 00:22:53,788
Oligoclonal bands...
391
00:22:53,914 --> 00:22:55,040
Were real.
392
00:22:55,166 --> 00:22:56,958
They just mean
something other than MS.
393
00:22:57,084 --> 00:22:58,752
So, what are they telling us?
394
00:22:58,878 --> 00:23:00,003
That the immune system is working?
395
00:23:00,129 --> 00:23:01,171
Right.
396
00:23:01,297 --> 00:23:02,964
He has an infection in his brain.
397
00:23:03,090 --> 00:23:06,718
- What about sex?
- Well, it might get complicated.
398
00:23:06,844 --> 00:23:07,886
I mean, we work together.
399
00:23:08,012 --> 00:23:09,429
I'm older, certainly,
but maybe you like that.
400
00:23:09,555 --> 00:23:11,264
I meant maybe he has neurosyphilis.
401
00:23:12,141 --> 00:23:13,141
Nice cover.
402
00:23:13,267 --> 00:23:14,517
Sorry. RPR was negative.
403
00:23:14,643 --> 00:23:16,352
We don't need
a definitive test to confirm this.
404
00:23:16,479 --> 00:23:18,271
Sure. Didn't need one to confirm MS.
405
00:23:18,397 --> 00:23:20,982
Okay. Let's wait for you to
run titers on 1,400 viruses
406
00:23:21,108 --> 00:23:23,026
while this kid's brain turns to mush.
407
00:23:23,152 --> 00:23:24,944
So the fact that he doesn't have MS,
408
00:23:25,071 --> 00:23:27,030
it's really not good news after all.
409
00:23:27,156 --> 00:23:28,990
Well, it is if it's neurosyphilis.
410
00:23:29,116 --> 00:23:32,118
The likelihood of
a false negative on an RPR test, 30%.
411
00:23:32,244 --> 00:23:35,872
Likelihood of a 16-year-old having sex,
roughly 120%.
412
00:23:35,998 --> 00:23:37,040
I'll start him on IV penicillin.
413
00:23:37,166 --> 00:23:38,166
No. We're not gonna wait for that.
414
00:23:38,292 --> 00:23:39,876
The most effective way
to deliver the drug
415
00:23:40,002 --> 00:23:41,294
is right into his brain via the spine.
416
00:23:41,420 --> 00:23:43,379
We can't. In a cramped
space like the brain,
417
00:23:43,506 --> 00:23:46,257
increased intracranial pressure
from a high-volume drug like penicillin
418
00:23:46,383 --> 00:23:48,676
could herniate his brain stem.
It'd kill him.
419
00:23:48,803 --> 00:23:50,804
No neurologist in his right mind
would recommend that.
420
00:23:50,930 --> 00:23:53,681
Show of hands.
Who thinks I'm not in my right mind?
421
00:23:54,391 --> 00:23:57,644
And who thinks I forget
this fairly basic neurological fact?
422
00:23:58,270 --> 00:24:00,772
Who thinks there's a third option?
423
00:24:02,191 --> 00:24:04,109
Very good. What's the third choice?
424
00:24:04,235 --> 00:24:07,278
No idea. You just asked
if I thought there was one.
425
00:24:09,740 --> 00:24:11,491
The patient has a shunt in his brain.
426
00:24:11,617 --> 00:24:12,784
There'll be no increased pressure.
427
00:24:12,910 --> 00:24:15,203
We can put as much penicillin
into his body as we want.
428
00:24:15,329 --> 00:24:18,164
Excellent.
Inject him through a lumbar puncture.
429
00:24:21,168 --> 00:24:25,463
One of us is gonna do this to you
twice a day for the next two weeks.
430
00:24:27,633 --> 00:24:28,633
I'm ready. Go.
431
00:24:28,759 --> 00:24:32,387
He could get syphilis
even if he's not sexually active?
432
00:24:33,389 --> 00:24:36,850
Well, it's unusual, but it's possible.
433
00:24:37,810 --> 00:24:39,727
Okay. Relax.
434
00:24:52,783 --> 00:24:56,077
It's infected, with a really big hole,
435
00:24:56,203 --> 00:24:58,538
like you stuck a nail in it
to relieve the pressure.
436
00:24:58,664 --> 00:24:59,622
I wouldn't do that.
437
00:24:59,748 --> 00:25:00,790
Although the wound is irregular.
438
00:25:00,916 --> 00:25:02,917
It's not cylindrical.
It's shaped like a triangle.
439
00:25:03,043 --> 00:25:05,211
So, not a nail.
440
00:25:05,337 --> 00:25:07,255
- Steak knife?
- Wife's nail file.
441
00:25:07,381 --> 00:25:08,965
Nail file.
442
00:25:09,800 --> 00:25:12,594
Yeah. Pain will make
you do stupid things.
443
00:25:13,012 --> 00:25:14,888
Something to take the edge off?
444
00:25:15,014 --> 00:25:15,889
Yeah.
445
00:25:18,434 --> 00:25:19,809
Cheers.
446
00:25:24,148 --> 00:25:26,941
So, you have family here in Princeton?
447
00:25:27,067 --> 00:25:28,109
No.
448
00:25:29,028 --> 00:25:30,028
Here on work?
449
00:25:30,154 --> 00:25:31,863
- No. Why are you...
- Does your penis hurt?
450
00:25:31,989 --> 00:25:34,240
No. What? Should it?
451
00:25:34,366 --> 00:25:38,077
No. Just thought I'd toss you
a really inappropriate question.
452
00:25:38,204 --> 00:25:39,412
Your lawyer's gonna love it.
453
00:25:39,538 --> 00:25:40,705
Why would I want to sue you?
454
00:25:40,831 --> 00:25:41,789
I want you to treat me.
455
00:25:41,916 --> 00:25:42,957
You're from Maplewood,
New Jersey, right?
456
00:25:43,083 --> 00:25:44,083
Yeah.
457
00:25:44,210 --> 00:25:46,920
Now, why would you drive 70 miles
458
00:25:47,046 --> 00:25:47,921
to get treatment for a condition
459
00:25:48,047 --> 00:25:50,715
that a nine-year-old could diagnose?
460
00:25:51,884 --> 00:25:54,302
It's the free-flowing pus that's the tip-off.
461
00:25:54,428 --> 00:25:55,386
I was in town.
462
00:25:55,512 --> 00:25:57,347
Not for family. Not for work.
463
00:25:57,473 --> 00:25:59,432
You drove 70 miles to a walk-in clinic.
464
00:25:59,558 --> 00:26:00,850
You passed two hospitals on the road.
465
00:26:00,976 --> 00:26:03,186
Now, either you've got a problem
with those hospitals,
466
00:26:03,312 --> 00:26:04,437
or they have a problem with you.
467
00:26:04,563 --> 00:26:07,232
My guess is you've sued
half the doctors in Maplewood,
468
00:26:07,358 --> 00:26:09,067
and the rest are now
refusing to help you.
469
00:26:09,193 --> 00:26:10,443
It's ironic, isn't it?
470
00:26:10,569 --> 00:26:13,112
Sort of like the boy who sued wolf.
471
00:26:13,697 --> 00:26:16,115
You know, I bet we have
a doctor here named Wolf.
472
00:26:16,242 --> 00:26:18,201
How perfect would that be?
473
00:26:18,744 --> 00:26:19,744
I'm gonna page him.
474
00:26:19,870 --> 00:26:21,037
Okay. You know what? Thank you.
475
00:26:21,163 --> 00:26:23,539
I'm gonna find a doctor
to take care of this.
476
00:26:23,666 --> 00:26:25,667
I didn't say I wouldn't treat you.
477
00:26:25,793 --> 00:26:27,919
We'll drain your knee,
run some lab work. Fix you right up.
478
00:26:28,045 --> 00:26:30,755
- Why would you do that?
- I'm a people person.
479
00:26:32,091 --> 00:26:33,508
You actually treated him?
480
00:26:33,634 --> 00:26:35,009
All I know is he sued some doctors.
481
00:26:35,135 --> 00:26:37,679
Who am I to assume
they didn't have it coming to them?
482
00:26:37,805 --> 00:26:39,555
The cutest little tennis outfit.
483
00:26:39,682 --> 00:26:41,641
My God, I thought
I was gonna have a heart attack.
484
00:26:41,767 --> 00:26:43,643
Oh, my. I didn't see you there.
That is so embarrassing.
485
00:26:43,769 --> 00:26:45,103
How's your hooker doing?
486
00:26:45,229 --> 00:26:46,980
Sweet of you to ask. Funny story.
487
00:26:47,106 --> 00:26:48,564
She was gonna be hospital administrator,
488
00:26:48,691 --> 00:26:50,858
but just hated having to
screw people like that.
489
00:26:50,985 --> 00:26:51,985
I heard you found her on the roof.
490
00:26:52,111 --> 00:26:55,154
- You have very acute hearing.
- You notify the parents?
491
00:26:55,281 --> 00:26:56,406
In due course, of course.
492
00:26:56,532 --> 00:27:00,702
And is there a paternity bet
on the father of the patient?
493
00:27:00,828 --> 00:27:01,828
Doesn't sound like me.
494
00:27:01,954 --> 00:27:04,122
Well, it does, actually,
but doesn't mean you're guilty.
495
00:27:04,248 --> 00:27:06,457
- You think?
- I saw the parents in the lobby.
496
00:27:06,583 --> 00:27:09,127
Smart money's obviously on the father.
497
00:27:09,253 --> 00:27:11,421
My guy knows a guy
who can get you in for 50 bucks.
498
00:27:11,547 --> 00:27:13,256
Fine. Tell your guy, if I win,
499
00:27:13,382 --> 00:27:15,258
you attend the faculty symposium,
and you wear a tie.
500
00:27:15,384 --> 00:27:18,720
And if I win, no clinic hours for a week.
501
00:27:18,846 --> 00:27:20,847
My guy will call your guy.
502
00:27:22,725 --> 00:27:24,851
She's very good at her job.
503
00:27:29,356 --> 00:27:31,566
The treatments
should start helping soon.
504
00:27:31,692 --> 00:27:35,653
Let us know if it gets easier
to focus on things, remember stuff.
505
00:27:36,905 --> 00:27:38,031
Hey, Dan.
506
00:27:38,157 --> 00:27:40,783
Isn't Dr. Cameron's necklace a beauty?
507
00:27:40,909 --> 00:27:43,036
Something South American, I think.
508
00:27:43,162 --> 00:27:44,912
Yeah. Guatemalan.
509
00:27:45,956 --> 00:27:47,957
It's a cool necklace.
510
00:27:49,585 --> 00:27:52,170
- Thank you so much.
- The kid's in pain.
511
00:27:54,131 --> 00:27:55,673
Don't fight it. Just let it happen.
512
00:27:55,799 --> 00:27:56,758
No.
513
00:27:56,884 --> 00:27:58,051
- You'll be dead in two days.
- "No" what?
514
00:27:58,177 --> 00:27:59,135
I give it a day.
515
00:27:59,261 --> 00:28:00,970
Dan? You okay?
516
00:28:01,096 --> 00:28:02,388
- Dan?
- Night terrors.
517
00:28:02,514 --> 00:28:04,849
Body decomposition
once he's in the grave.
518
00:28:04,975 --> 00:28:06,267
Say goodbye to your mother and father.
519
00:28:06,393 --> 00:28:07,393
He's hearing voices.
520
00:28:07,519 --> 00:28:09,979
You're dying. It's all over, Dan.
521
00:28:11,982 --> 00:28:13,024
You're dying. Dying. Dead!
522
00:28:13,150 --> 00:28:15,068
You're a dead man!
523
00:28:15,944 --> 00:28:17,987
Push 2 milligrams IV Ativan, stat.
524
00:28:18,113 --> 00:28:19,947
It's all over.
525
00:28:20,282 --> 00:28:21,449
Come on, Dan.
526
00:28:21,575 --> 00:28:23,117
Get out of my head!
527
00:28:25,996 --> 00:28:28,581
Auditory hallucination shows
further brain degeneration.
528
00:28:28,707 --> 00:28:29,916
Penicillin's not working.
529
00:28:30,042 --> 00:28:32,835
So either it's a bad batch of penicillin,
530
00:28:32,961 --> 00:28:34,796
or our diagnosis is wrong.
531
00:28:36,423 --> 00:28:39,425
Square one. MIDNIT.
532
00:28:39,551 --> 00:28:42,553
LFTs, BUN and creatinine are all normal.
533
00:28:42,679 --> 00:28:43,805
Diabetes is out, and no gap.
534
00:28:43,931 --> 00:28:46,474
- There goes metabolic.
- MRA rules out vasculitis.
535
00:28:46,600 --> 00:28:47,850
"I" for inflammation.
536
00:28:47,976 --> 00:28:49,268
Too young for anything degenerative.
537
00:28:49,395 --> 00:28:50,853
"D", see ya.
538
00:28:50,979 --> 00:28:53,398
- "N" for neoplastic.
- MRI was clean.
539
00:28:54,691 --> 00:28:56,609
- "I" for inflammation.
- We already did that.
540
00:28:56,735 --> 00:28:59,028
Stupid to have two I's in one mnemonic.
What's the other one?
541
00:28:59,154 --> 00:28:59,987
Infection.
542
00:29:00,114 --> 00:29:01,489
Oligoclonal bands
still have to mean something.
543
00:29:01,615 --> 00:29:02,657
But no fevers.
544
00:29:02,783 --> 00:29:04,075
White count's elevated, but within range.
545
00:29:04,201 --> 00:29:06,994
We've tested for anything remotely
possible. Everything's negative.
546
00:29:07,121 --> 00:29:08,663
CT scan rules out subdural.
547
00:29:08,831 --> 00:29:10,415
Trauma. Later much.
548
00:29:16,046 --> 00:29:17,255
You know the problem?
549
00:29:17,381 --> 00:29:20,800
"Midnight" is actually spelled
with a "G" and an "H".
550
00:29:21,135 --> 00:29:24,720
If we could just figure out
what those letters stand for.
551
00:29:27,975 --> 00:29:31,060
It's a sick brain, having fun,
552
00:29:33,105 --> 00:29:35,773
torturing him, talking to him.
553
00:29:40,946 --> 00:29:42,864
Scaring the hell out of him.
554
00:29:45,117 --> 00:29:49,370
Get him an EEG, left and right EOG,
esophageal microphones.
555
00:29:50,122 --> 00:29:53,875
If this thing wants to talk, let's listen.
556
00:29:56,003 --> 00:29:59,964
We're missing something.
This is screwed up.
557
00:30:00,090 --> 00:30:03,885
That's why you came up with the brain
talking to the virus thing?
558
00:30:04,011 --> 00:30:06,095
I panicked, okay?
559
00:30:06,221 --> 00:30:08,681
Sounded cool, though. They bought it.
560
00:30:12,352 --> 00:30:13,478
Crap.
561
00:30:14,021 --> 00:30:16,022
Another reason I don't
like meeting patients.
562
00:30:16,148 --> 00:30:19,025
If they don't know what you look like,
they can't yell at you.
563
00:30:19,151 --> 00:30:20,568
Here we go.
564
00:30:25,324 --> 00:30:27,450
How can you just sit there?
565
00:30:28,577 --> 00:30:29,994
If I eat standing up, I spill.
566
00:30:30,120 --> 00:30:33,331
Our son is dying,
and you could care less?
567
00:30:34,124 --> 00:30:37,168
We're going through hell.
You're doing nothing?
568
00:30:38,504 --> 00:30:40,630
I'm sorry. You need to vent. I understand.
569
00:30:40,756 --> 00:30:42,590
Don't be condescending.
570
00:30:43,091 --> 00:30:45,718
You haven't checked in on him once.
571
00:30:45,928 --> 00:30:47,970
Blood pressure is 110 over 70.
572
00:30:48,764 --> 00:30:51,182
His shunt is patent, well-placed
in the right lateral ventricle.
573
00:30:51,308 --> 00:30:53,059
The EKG shows a normal QRS
574
00:30:53,185 --> 00:30:55,937
with deep-wave inversions throughout
both limb and precordial leads.
575
00:30:56,063 --> 00:30:58,981
LFTs are elevated,
but only twice the normal range.
576
00:30:59,107 --> 00:31:01,400
Oh, yeah. And he's hearing voices.
577
00:31:06,532 --> 00:31:08,115
Go hold his hand.
578
00:31:10,160 --> 00:31:12,245
Go on. I'll bus your tray.
579
00:31:25,842 --> 00:31:27,677
Got any sample bags on you?
580
00:31:27,803 --> 00:31:30,846
I don't believe you.
You're gonna run DNA tests?
581
00:31:30,973 --> 00:31:34,308
Their son is deathly ill.
I know. It's terrible.
582
00:31:34,434 --> 00:31:35,768
But the fact is, if I don't keep busy
583
00:31:35,894 --> 00:31:38,229
with trivial things like this,
I'm afraid I might start to cry.
584
00:31:38,355 --> 00:31:39,480
You're an ass.
585
00:31:39,606 --> 00:31:41,816
Yeah? You want to double the bet?
586
00:31:52,911 --> 00:31:55,705
General Hospital is on Channel 6.
587
00:31:55,831 --> 00:31:58,833
Dan's brain's not showing
Channel 6 right now. Only mush.
588
00:31:58,959 --> 00:32:00,960
No epileptiform activity.
589
00:32:02,879 --> 00:32:03,921
What are you doing?
590
00:32:04,047 --> 00:32:07,758
- Waiting for CBC and CHEM-7.
- Good. Run DNA on these.
591
00:32:10,804 --> 00:32:13,222
- What's this?
- Parents' coffee cups.
592
00:32:14,641 --> 00:32:15,641
I can't believe you.
593
00:32:15,767 --> 00:32:16,934
I've had this conversation once already.
594
00:32:17,060 --> 00:32:20,021
If you've got something else to do,
do it. Otherwise, do this.
595
00:32:28,155 --> 00:32:29,780
Dr. House?
596
00:32:29,906 --> 00:32:31,157
Hey. Mr. Funsten.
597
00:32:31,325 --> 00:32:32,867
I was wondering when you'd be back.
598
00:32:32,993 --> 00:32:34,577
You got some papers for me?
599
00:32:34,703 --> 00:32:36,704
You've caused me
considerable mental distress.
600
00:32:36,830 --> 00:32:38,497
I certainly hope so.
601
00:32:39,041 --> 00:32:41,500
What? Too cheap to get your lawyer
to serve it for you,
602
00:32:41,627 --> 00:32:42,877
or is it just more fun this way?
603
00:32:43,003 --> 00:32:45,087
I'm obviously prepared
to consider a settlement.
604
00:32:45,213 --> 00:32:46,881
You have gonorrhea.
605
00:32:49,426 --> 00:32:50,551
No, I don't.
606
00:32:50,677 --> 00:32:53,304
Well, maybe you're right,
but I have a lab result says you do.
607
00:32:53,430 --> 00:32:55,890
Could be a false positive,
and normally I'd run a second test,
608
00:32:56,016 --> 00:32:57,558
but since you're here,
I'll just go with the first.
609
00:32:57,684 --> 00:32:58,851
You're just trying to scare me.
610
00:32:58,977 --> 00:33:01,020
It's reportable, you know.
Public health issue.
611
00:33:01,146 --> 00:33:02,897
I'll be sure to let my wife know.
612
00:33:03,023 --> 00:33:04,982
Don't bother yourself.
The state will call for you.
613
00:33:05,108 --> 00:33:08,069
Look, if you're clean, I'm
sure it'll all blow over. No big deal.
614
00:33:08,195 --> 00:33:09,362
There's an easy way to find out.
615
00:33:09,488 --> 00:33:11,447
Get one of your doctors to run a test.
616
00:33:13,450 --> 00:33:14,450
Uh-uh.
617
00:33:15,202 --> 00:33:17,995
These are mine now. I'll see you in court.
618
00:33:22,209 --> 00:33:25,294
West Nile, negative. Not
surprising since not too many mosquitoes
619
00:33:25,420 --> 00:33:26,754
passing through Jersey in December.
620
00:33:26,880 --> 00:33:27,922
No eastern equine encephalitis.
621
00:33:28,048 --> 00:33:29,298
You guys aren't gonna believe this.
622
00:33:29,424 --> 00:33:30,466
What's that?
623
00:33:30,592 --> 00:33:33,010
House is right.
The father's not the father.
624
00:33:34,471 --> 00:33:36,263
Dude doubled up on me.
625
00:33:36,932 --> 00:33:39,058
You're not gonna believe this.
626
00:33:39,184 --> 00:33:41,018
The mother's not the mother either.
627
00:33:43,522 --> 00:33:46,273
It's not a good idea
to move your son in his condition.
628
00:33:46,400 --> 00:33:48,693
- We just want a second opinion.
- We need an answer.
629
00:33:50,195 --> 00:33:53,155
You idiots. You lied to me.
630
00:33:53,281 --> 00:33:55,074
We didn't lie about anything.
631
00:33:55,200 --> 00:33:58,035
You, on the other hand,
accused us of molesting our son.
632
00:33:58,161 --> 00:34:00,079
- Perfect.
- Can we get off my screw-ups
633
00:34:00,205 --> 00:34:02,164
and focus on theirs? Theirs is bigger.
634
00:34:02,290 --> 00:34:04,917
- You're not Dan's parents.
- We're his parents.
635
00:34:05,043 --> 00:34:06,544
He was adopted.
He doesn't need to know.
636
00:34:06,670 --> 00:34:07,628
I do.
637
00:34:07,754 --> 00:34:09,171
Adoption makes us just as much...
638
00:34:09,297 --> 00:34:13,175
Listen. When we were taking
his medical history, were you confused?
639
00:34:13,343 --> 00:34:15,678
Did you think we were looking
for a genetic clue to his condition,
640
00:34:15,804 --> 00:34:17,096
or did you think we were
trying to ascertain
641
00:34:17,222 --> 00:34:19,849
who loves him the most
in the whole wide world?
642
00:34:19,975 --> 00:34:22,101
How did you find out about this?
643
00:34:22,853 --> 00:34:25,896
- I sampled their DNA.
- We didn't give you any DNA.
644
00:34:26,022 --> 00:34:27,982
Your coffee cups from the cafeteria.
645
00:34:28,108 --> 00:34:29,400
You can't do that.
646
00:34:29,526 --> 00:34:31,986
Again, why are we getting hung up
on what I did?
647
00:34:32,112 --> 00:34:33,529
Your medical history is useless.
648
00:34:33,655 --> 00:34:37,867
No. We gave you a detailed history
of his biological mother.
649
00:34:38,118 --> 00:34:41,162
Her history. Non-smoker, good health,
650
00:34:41,288 --> 00:34:44,081
low cholesterol,
no blood pressure problems.
651
00:34:44,207 --> 00:34:46,125
Dan was adopted two weeks
after he was born.
652
00:34:46,251 --> 00:34:47,793
You have his history.
There's nothing you need to know
653
00:34:47,919 --> 00:34:50,087
- that we didn't tell you.
- Sounds reasonable.
654
00:34:50,714 --> 00:34:54,049
Well, if you want to transfer your boy,
that is your choice.
655
00:34:54,176 --> 00:34:55,301
I still think it's the wrong...
656
00:34:55,427 --> 00:34:57,136
Was she vaccinated?
657
00:34:58,346 --> 00:34:59,764
The biological mother.
658
00:34:59,890 --> 00:35:01,474
When she was a baby,
did she get her vaccinations?
659
00:35:01,600 --> 00:35:04,185
Dan was vaccinated at six months.
660
00:35:05,604 --> 00:35:08,856
Do you know why kids get
vaccinated at six months?
661
00:35:08,982 --> 00:35:10,441
Because before that they are protected
662
00:35:10,567 --> 00:35:13,903
by their biological
mother's immune system.
663
00:35:14,029 --> 00:35:16,238
So, was she vaccinated?
664
00:35:19,785 --> 00:35:22,912
An infant picks up
a regular old measles virus.
665
00:35:23,288 --> 00:35:26,040
Gets a rash.
He's extremely uncomfortable,
666
00:35:26,166 --> 00:35:28,292
has a wicked fever, but he lives.
667
00:35:28,418 --> 00:35:29,835
Here's the kicker.
668
00:35:29,961 --> 00:35:33,631
Once every million or so times,
the virus mutates.
669
00:35:34,633 --> 00:35:37,218
Instead of Dan having
a fever and a rash,
670
00:35:37,344 --> 00:35:41,305
the virus travels to his brain
and hides, like a time bomb.
671
00:35:41,932 --> 00:35:44,809
In this case, for 16 years.
672
00:35:44,935 --> 00:35:47,603
Subacute sclerosing panencephalitis.
673
00:35:48,313 --> 00:35:50,147
I know. There's only been 20 cases
674
00:35:50,273 --> 00:35:51,816
in the United States in the last 30 years.
675
00:35:51,942 --> 00:35:55,236
I suppose you could make an argument
the kid's still in Stage 1.
676
00:35:55,362 --> 00:35:57,446
Once SSPE moves to Stage 2, it's...
677
00:35:57,572 --> 00:36:00,866
Boom. Stage 2 is universally fatal.
678
00:36:00,992 --> 00:36:01,951
I assume it's impossible to know
679
00:36:02,077 --> 00:36:03,494
when he might move into Stage 2.
680
00:36:03,620 --> 00:36:05,663
He's already started showing symptoms.
681
00:36:05,789 --> 00:36:07,998
Could be a month. Could be tonight.
682
00:36:08,375 --> 00:36:10,251
- Can we treat it?
- Ask the neurologist.
683
00:36:10,377 --> 00:36:12,586
Intraventricular interferon.
684
00:36:12,712 --> 00:36:14,004
Not gonna shove a spike into his brain
685
00:36:14,130 --> 00:36:16,757
and drip interferon
without confirming this diagnosis.
686
00:36:16,883 --> 00:36:18,926
- Tap him.
- We won't get a reliable result
687
00:36:19,052 --> 00:36:20,594
for measles antibodies in his CSF.
688
00:36:20,720 --> 00:36:21,762
Not after everything we've given him.
689
00:36:21,888 --> 00:36:24,974
So the wrong treatment kills any hope
of the right diagnosis.
690
00:36:25,100 --> 00:36:27,017
Why do people lie to me?
691
00:36:29,145 --> 00:36:31,981
Could also kill him. Your ball, Foreman.
692
00:36:32,107 --> 00:36:34,066
Tell me I don't have to biopsy his brain.
693
00:36:35,986 --> 00:36:38,112
Well, there is one other way.
694
00:36:39,781 --> 00:36:41,824
You sure this isn't gonna hurt?
695
00:36:41,950 --> 00:36:43,993
Yeah. It's just scary as hell.
696
00:36:44,411 --> 00:36:45,995
See, we go through the pupil.
697
00:36:46,121 --> 00:36:48,622
But you won't feel it.
The eye's been paralyzed.
698
00:36:48,748 --> 00:36:50,416
The needle travels to the back of the eye,
699
00:36:50,542 --> 00:36:53,794
which is where we'll perform
the biopsy on your retina.
700
00:36:59,009 --> 00:37:02,177
So we've confirmed that the problem
is this mutated virus.
701
00:37:02,429 --> 00:37:05,848
The treatment for SSPE is
intraventricular interferon.
702
00:37:05,974 --> 00:37:08,976
We implant an Ommaya reservoir
under the scalp,
703
00:37:09,102 --> 00:37:10,853
which is connected to
a ventricular catheter
704
00:37:10,979 --> 00:37:13,939
that delivers the antiviral
directly to the left hemisphere.
705
00:37:14,065 --> 00:37:15,399
You want us to consent to this?
706
00:37:15,525 --> 00:37:17,234
I don't even understand
what you're talking about.
707
00:37:17,360 --> 00:37:19,194
Well, the antiviral...
708
00:37:22,824 --> 00:37:24,325
Look. I'm sorry.
709
00:37:24,451 --> 00:37:26,493
I can explain this as best I can,
710
00:37:26,620 --> 00:37:29,538
but the notion that you're gonna
fully understand your son's treatment
711
00:37:29,664 --> 00:37:33,000
and make an informed decision
is kind of insane.
712
00:37:35,045 --> 00:37:37,296
Here's what you need to know.
713
00:37:38,089 --> 00:37:41,800
It's dangerous. It could kill him.
714
00:37:42,844 --> 00:37:44,386
You should do it.
715
00:37:55,649 --> 00:37:57,816
Did you need something else?
716
00:38:16,753 --> 00:38:19,964
You can't order a $3,200 DNA test
to win a bet.
717
00:38:20,090 --> 00:38:22,049
It's not an actual cost.
718
00:38:22,467 --> 00:38:23,509
I don't know if you know this,
719
00:38:23,635 --> 00:38:26,011
but the hospital actually owns
the sequencing machine.
720
00:38:26,137 --> 00:38:27,262
- I'm serious.
- Tell the parents
721
00:38:27,389 --> 00:38:28,722
to submit the bill to insurance.
722
00:38:28,848 --> 00:38:30,933
Insurance is not gonna pay for a bet.
723
00:38:31,059 --> 00:38:32,017
It should.
724
00:38:32,143 --> 00:38:34,061
We don't make that bet, the kid dies.
725
00:38:34,980 --> 00:38:37,398
If not for the paternity bet,
I never would have taken their DNA.
726
00:38:37,524 --> 00:38:39,024
Without their DNA,
we never would have discovered
727
00:38:39,150 --> 00:38:42,361
that Dan was adopted,
which was the key to this case.
728
00:38:42,904 --> 00:38:45,364
You just don't want to pay your end.
729
00:38:45,782 --> 00:38:48,033
Big mistake. My guy knows a guy.
730
00:38:48,159 --> 00:38:51,203
Fine. I will let you
out of clinic duty for one week,
731
00:38:51,329 --> 00:38:54,289
after you pay
the $3,200 for the PCR test.
732
00:39:03,925 --> 00:39:06,760
Well, now, there's the $100 you owe me.
733
00:39:08,138 --> 00:39:10,264
Here's the $100 I won from Cameron.
734
00:39:10,390 --> 00:39:12,808
$200 I took off of Foreman.
735
00:39:14,144 --> 00:39:17,771
And $600 I got from Wilson.
736
00:39:20,859 --> 00:39:21,900
Very bitter.
737
00:39:25,947 --> 00:39:27,573
Hey. Good morning.
738
00:39:27,991 --> 00:39:29,575
Good news on your EEG.
739
00:39:29,701 --> 00:39:30,951
Treatment is working.
740
00:39:31,077 --> 00:39:33,037
And your immune system is responding.
741
00:39:33,747 --> 00:39:36,999
I know it's early,
but I just want to take a look.
742
00:39:38,084 --> 00:39:39,418
All right.
743
00:39:39,544 --> 00:39:41,920
Let's see what that brain of yours can do.
744
00:39:42,047 --> 00:39:43,380
Name as many animals as you can
745
00:39:43,506 --> 00:39:45,299
that start with the letter "O".
746
00:39:46,092 --> 00:39:47,384
Ostrich.
747
00:39:48,386 --> 00:39:51,096
Ox. Old elephant.
748
00:39:51,806 --> 00:39:54,475
Well, that's two better than last time.
749
00:39:54,851 --> 00:39:57,352
How you doing
with the whole adoption thing?
750
00:39:57,479 --> 00:39:58,854
I knew since fifth grade.
751
00:39:59,731 --> 00:40:00,898
How's that?
752
00:40:01,024 --> 00:40:02,274
Cleft chin.
753
00:40:03,693 --> 00:40:06,195
I have one. My dad doesn't.
754
00:40:06,905 --> 00:40:07,821
Looked it up on the Internet.
755
00:40:07,947 --> 00:40:10,532
It's one of those trait things.
756
00:40:10,658 --> 00:40:13,202
That's right. It's autosomal dominant.
757
00:40:13,828 --> 00:40:15,954
Since neither of your parents
have cleft chins,
758
00:40:16,081 --> 00:40:19,041
it's highly unlikely
you're biologically related.
759
00:40:21,002 --> 00:40:22,461
Are you sure you're okay?
760
00:40:22,587 --> 00:40:25,005
I've got no problems with being adopted.
761
00:40:26,382 --> 00:40:27,966
I love my parents.
762
00:40:31,096 --> 00:40:32,096
How's he doing?
763
00:40:32,222 --> 00:40:35,140
He's doing pretty well. He's a smart kid.
764
00:40:35,850 --> 00:40:37,184
I think he's gonna be fine.
765
00:40:41,189 --> 00:40:43,065
- Hey.
- Thanks.
766
00:41:19,102 --> 00:41:21,186
Wheels, 18. Wheels.
55937
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