House, M.D. s01e22 Episode Script

- I gotta go.
- No, no.
He'll be here.
- I'm sure he's just running a little late.
- He's canceled two exams.
He's not gonna-- He's scared of you.
Sure.
The ex-boy toy.
Yeah, that makes sense.
- He wasn't scared before.
- Right.
You think being afraid of me is a symptom of a serious ailment? Sudden mood swings, infantile regression, abdominal pain.
He's passed out twice.
Yeah, I think it might be a medical problem.
- He's 20 minutes late.
I'm out of here.
- Please.
He'll be here.
Why? Because he loves you and does everything he's told? Because I didn't tell him you'd be here.
- He likes to see.
- Yes, he does.
Stace? - What's going on? - Hey.
Hi.
I'm Greg House.
You must be Matt.
- Mark.
- Mark Warner.
Don't get up.
Sorry.
Parent conferences.
Hi.
It's okay.
- Wow.
Greg House.
- Yeah.
Wow.
No, I haven't been avoiding you.
I just didn't want to waste your time.
The other doctors checked me out.
They said it was just stress.
- College season.
Kids, parents-- They're all over me.
- Makes sense to me.
- Greg.
- What do you want me to do? - You said you'd check him out.
He says he's healthy.
What's to check out? Sorry for the mix-up, but I'm glad you two got a chance to catch up.
- Looks like you're having fun.
- Oh, he's good.
If you can fake sincerity, you can fake pretty much anything.
- I can't tell you how much I like your fella.
- Yeah, me too.
You know, I thought you'd be all sarcastic.
Bitter, you know, because Stacy married me.
We should do things together.
Maybe throw a ball around or something.
Guy stuff.
- We could go for a run together.
- Ah! It's Oscar Wilde.
Wow.
This pissing contest is really turning me on.
He needs to go to the hospital.
Here's to women.
Can't live with 'em, you can't kill 'em and tell the neighbors they're stripping in Atlantic City.
Damn straight.
- I'm definitely taller.
- I have more hair.
And I think that-- Whoa.
Mark? - Someone call 911 for a wagon to Princeton Plainsboro? - Garçon! - What happened? - It's okay, ladies and gentlemen.
Nothing to worry about.
- Unless you had the veal.
- You dosed him.
I told you I'd check him out.
I was a little worried they were gonna get here before he passed out.
Would have been tougher to get him to drink.
I'll give you a ride.
We can talk.
A tummy ache, cranky-- no apparent source.
Any thoughts? Foreman, you're gonna contribute, or are you too tired from stealing cars? - I'm being House.
It's funny.
- I know.
You made milk come out of my nose.
Morning.
You guys got the file.
What's wrong? Previous tests revealed nothing that would cause abdominal pain or the mood swings.
Then we're done.
What do you think? Ball game? Zoo? - I don't care.
I just want to hang with you guys.
- What about drugs? His tox screen on admission showed a massive amount of chloral hydrate.
Yeah.
Sorry.
That was me.
I had to dope him up to get him in here.
Guy doesn't think he's sick.
Who does? His wife.
The woman you used to live with.
That's her Indian name.
On her driver's license it's Stacy.
I assume you have a point.
You believe her over the patient himself.
That's why we're taking this case.
The truth? I hear voices all the time telling me to do stuff.
- It's crazy, huh? - What happened to "everybody lies"? I was lying.
Do the things-- the blah, blah, blah, blah.
All that stuff the other docs did.
If that's negative, ultrasound his belly.
If that's negative, C.
T.
his abdomen and pelvis with and without contrast.
- Did I miss anything? - Kitchen sink.
Well, we could certainly give that-- Oh, you minx! What you're thinking is, you're going to save him, be a hero and win her back.
It's always impressive, that level of twisted narcissism.
She's married.
Big clue I lost the game.
You can't be within 50 feet of Stacy Warner.
Thought she wanted me to treat him.
Treat the husband, stay away from the wife.
But what if they get close to each other? What do I do then? Hey.
You have to treat this like a regular case.
Be yourself-- cold, uncaring, distant.
Please, don't put me on a pedestal.
We C.
T.
'd your abdomen.
Nothing that would explain the stomach pain.
- What's the next move? - Leaving.
How many more tests do I need? How many more doctors need to clear me before we can get back to our life? - Just one.
- House.
It must be awkward being treated by a man who used to be involved with your wife.
It's awkward being in a hospital when there's nothing wrong with me.
M.
R.
A.
's were clean, which means he's probably fine.
He doesn't seem paranoid.
He shows no signs of-- No.
It means we have no idea what's wrong with him.
Ben Goldstein says his schedule's locked.
He can't do it before tomorrow.
No.
Today.
Call him, tell him I'll make it work.
You're cutting him open? Oh, hold it.
There's no need for exploratory surgery.
Dr.
Cameron has a diagnosis.
No, I just think it's premature and maybe irresponsible to do exploratory surgery before we know he's actually sick.
No, it's "premature" to put him on a list for hospice care.
And it's "maybe irresponsible" to imply my actions are not rationally supported.
All we have is his wife-- Who says his stomach hurts.
Works for me.
The patient doesn't even think he's sick.
Why would he consent to-- His wife's a lawyer.
She's very convincing.
Call Goldstein.
Surgery is on.
Retract.
Insert.
Leslie versus Leslie seems to be right on point, but I'm sure they're going to try to distinguish it by-- Sorry.
They'll try to distinguish it relying on the minority opinion.
Double milk, no sugar.
I like sugar now.
Some people would be annoyed by that.
You know why people sit in waiting rooms? This is gonna be good.
People think the closer they're sitting to the operating room, the more they care.
That's why I'm here.
I'm not moving until everybody sees me.
Are you doing anybody besides Mark? It's a medical question.
Because if I am, his paranoia isn't paranoia.
It's a justified response and therefore not a legitimate symptom.
Knew you'd understand.
On the other hand, if it was really just a medical question, you would have sent one of your people.
Why just push my buttons when you can push theirs too? Hey, Dr.
Mandingo, go ask the wife if she's been messin' around.
But you're asking because if I am unfaithful, I might sleep with you.
The answer's no.
I don't sleep around.
Make sure you note that in his file.
Mrs.
Warner.
The surgery went well.
He's in Recovery.
You can see him now.
Goldstein found nothing but a distended bladder.
Neurogenic bladder isn't causing the pain.
It also doesn't cause personality changes.
On the other hand, it would completely account for Cameron's diagnosis.
The patient's completely healthy.
Get me the video of the surgery.
Dr.
Mandingo, you're needed at the plantation house.
Well, don't everybody talk at once.
There's nothing there.
Stop looking at the suspiciously empty bottle and look at the screen.
Here's why I get the big bucks.
This is nothing.
An enhanced version of nothing.
This is the problem.
- Unbelievable.
- Tremors in the muscle fiber.
That's not peristalsis.
- That's abdominal epilepsy.
- Means there's some sort of neurological problem.
A time bomb in his brain.
I forget.
Who said it was nothing? I saw a very small, diffuse abnormality in the brain waves.
Probably white matter.
Means his axonal nerves are dying.
Explains the neurogenic bladder.
Enough nerves die, he dies.
Global axonal nerve death.
Likely causes are encephalitis or Alzheimer's.
Early onset Alzheimer's.
The worst.
He won't die right away.
He'll just want to.
I'll check the blood for Alzheimer's protein markers.
Last I heard, Alzheimer's had a genetic component.
Did the patient have parents? Parents died in a car crash.
No history of dementia.
Send C.
S.
F.
for C.
B.
C.
and viral serologies to rule out encephalitis and get tau proteins to check for Alzheimer's.
And this still feels a little light.
I took a complete medical history.
Check out their house.
Take Sparky with you.
- They live in Short Hills.
Two hours away.
- You can expense the tolls.
You're not interested in a medical history.
You're a Peeping Tom trying to spy on your ex.
Her secret diary-- That's the main thing.
But as long as you're there, take a peek in the medicine cabinet.
Check for toxins, heavy metals-- anything that might explain this other than encephalitis or Alzheimer's.
And get receipts for the tolls.
Making lunch? I assume that's for Mark.
We know about his parents.
What about further back? Grandparents, uncles, aunts.
How was their health? Greg hates fishing.
He's got a theory.
Most likely candidate right now is Alzheimer's.
No.
There's been no memory loss.
I mean, he forgets where he left his keys, but who doesn't? Any family history? Of whacked-outness? His sister voted for Nader, twice.
That's about it.
You were with House when it happened-- to his leg? Oh.
You're interested in him.
We went on one date.
It didn't go very well.
Our first date didn't either.
I was never gonna see him again.
A week later, I moved in.
Five years.
What would you like to know? What was he like before his leg? Pretty much the same.
He's clear.
No Alzheimer's.
Yeah, that's what I figured.
Serious mountain bike.
Hasn't been used in a while though.
He switched to yoga.
Brand-new yoga mat and tape.
Man's getting older.
Or it might indicate back pain.
Wife would have mentioned it.
Yoga's good for picking up the ladies too.
Not when you do it in your own home.
Change could be just a change, not a symptom.
Chase.
"Dear 'House' boys, a snack for your highly illegal search.
Hope you like oatmeal raisin.
Love, Stacy".
Whoa.
In a desk drawer, hidden in the back under some papers.
Secret stash.
Amphetamines.
Regular use could lead to neurotoxicity.
Explains the axonal nerve damage and the personality issues.
On the other hand, "Prescribed to W.
Brown".
Fake name.
Fake prescription.
Could be, but the prescribing doc, his name's real.
This guy's just had his license pulled for writing illegal prescriptions to high school kids.
Mark's a high school guidance counselor.
And Mr.
Brown's birth date makes him 17 years old.
Do you think maybe these were confiscated by a high school guidance counselor? Anything else? Um, yeah, he switched from mountain biking to yoga.
- Could indicate-- - He's getting older.
- What did the C.
S.
F.
say about encephalitis? - Said no.
Champagne tap.
No red cells, no white cells.
Serology's negative.
Which means we're back to Alzheimer's.
I told her he didn't have it.
The marker tests were negative.
Well, then you should have told her that.
He could still have it.
PET scan will reveal any changing metabolic activity in the cerebral cortex.
Run him through and check his memory.
We're going to inject a chemical marker called F.
D.
D.
N.
P.
- Then I'm gonna ask you a series of questions.
- Test my memory.
Yeah, but first we're gonna map out some specific brain functions.
You know, check out the engine before we take the car for a drive.
Checking up on me? - I like all the pretty lights.
- Yeah.
Okay.
Here we go.
Your full name? Mark Warner.
- Is your mother living? - No.
Limbic system's intact.
Okay, say you find a stamped envelope on the street.
What do you do? - Find a mailbox and mail it.
- Geez.
What a guy.
His frontal lobe is working way better than mine.
Do you remember when you got married? Three years ago this July.
Who is that? What? Could be a problem with his long-term memory.
- Big church wedding? - Is that House? He remembers voices.
This serves no diagnostic purpose.
I thought you skimped on the limbic system there.
Emotional reactions.
I just want to be thorough.
Did the atheistic bride wear a pretty white dress? Was she thinking of you? Is that what you medically need to know? What jewelry did your bride wear? She never wears any jewelry, except the cross her mother gave to her.
No underwear either, at least not that day.
I remember 'cause she ripped her pretty white dress off in the car.
That the sort of answer you're looking for, Doctor? I think I upset him.
You gotta stop this now.
I remember the honeymoon was in Paris.
I remember 'cause we didn't leave the room for two weeks.
- You want the details on that? - A little defensive.
It's not paranoia if someone's out to get you.
Here we go.
He's sick, paranoid, and you keep hammering him about me? The questions were designed to define the operational parameters of his limbic system.
Elevate the words all you want.
You were just screwing with him.
Low, even by your standards.
Medical screwing.
It's what I do.
Then you run away like a 12-year-old.
Go hide on the roof like you always do.
I haven't been up here in five years.
I don't know what's wrong with him.
It's not Alzheimer's.
It's not encephalitis.
It's not environmental.
It's not immunological.
Every test is negative every time.
He's perfectly healthy, but his brain is dying.
It never occurred to me that you couldn't figure out what's wrong.
I haven't given up.
So what do we do? We wait.
For what? Something to change.
It's one of the great tragedies of life.
Something always-- Something always changes.
Nurse? Nurse! What happened? What's wrong? My toes-- They were numb, tingling, then nothing.
No pain.
Nothing.
It's okay.
They're going to take care of you.
I'm scared, Stacy.
Hold my hand.
What? What's happening? Time marches on.
He's paralyzed.
His symptoms mimic a peripheral nervous system under attack.
But he's experiencing significant paresthesias, and he can't move his hands or toes.
It's peripheral.
Guillain-Barré syndrome attacks there, not the brain.
No.
No.
I already did an indirect Coombs' test.
No agglutination, no antibodies.
Initiative.
Like that.
Start him on I.
V.
immuno-- No antibodies means he doesn't have Guillain-Barré, period.
Period? More like dot, dot, dot.
What if he has the virus but isn't producing those antibodies? Come on.
The chances of that-- Didn't ask about the Vegas line.
I said "what if".
It would mean he's sick, and his body's not doing anything about it.
So we either fight it for him or it's fatal.
Fatal sounds very bad to me.
Well, without the antibodies, we can't even test for it.
Don't know if we're right.
Treatment isn't all that dangerous.
Plasmapheresis and I.
V.
I.
G.
If it works, we're right.
If he dies it was something else.
So the paralysis might not be permanent.
That's our hope, but the brain's tricky.
You never know.
What was that? What? - With the head.
The look.
- He just wants to talk to me.
- Well, if it was medical, he should be talking to me.
- I'll be just outside the door.
Leave! Go talk to him.
- You're going to leave me anyway.
- No.
That's not gonna happen.
You left him, and he had a limp.
If I can't walk or hold you? Honey, I'm not going anywhere.
I'm not going to talk to him.
- If I can't feed myself? - Mark, what you're feeling-- It's not real.
It's the virus.
- Mark? What is it? - Mark? His throat's closing up.
He can't breathe.
Code blue! Hurry! He's having a reaction to the I.
V.
I.
G.
I need epi, stat.
- I can't get the scope in his throat.
- Stop that.
- He's having an allergic reaction.
He's crashing.
- No, he's not.
Look at his vitals.
O2 sats are within range.
I'm betting the only abnormal sign is sweaty palms.
Push two milligrams Ativan.
No allergic reaction.
Just a panic attack.
Something obviously freaked him out.
Can we talk now? You couldn't just come into the room? He's had five visitors drive down.
I didn't recognize any of them.
Six more have sent him flowers, candy and a teddy bear, which I'm sure he finds very comforting.
But I didn't recognize any of the names on the cards.
Shockingly, Mark has friends, and I have some new ones.
No, it's not shocking that you have new friends, but it is shocking that you apparently dumped all your old ones.
- I haven't.
- No, I didn't think so.
I just think you didn't tell any of them that you were down here.
Now, why would that be? What are you up to? It's gonna take a little while.
Why would you not tell your oldest friends that you were taking Mark to Princeton Plainsboro Teaching Hospital to try to save his life? I've been busy.
I haven't kept track of who knows what.
See, my old friends are telling me to be careful.
They seem to think-- He.
And he sent me the bear.
Figures.
He seems to think that I'm not over you and that it might be dangerous for me to spend time with you.
I'm thinking your friends might have similar concerns, and so you didn't tell them you'd be here with me.
What's your point? That I'm still in love with you? I should abandon my dying husband, and we should head for Rio.
No.
Greg, I appreciate what you're doing for us, but I think maybe Wilson's right.
Maybe you should just stay away from me.
What's up? Love the bear.
It's adorable.
My wife's gonna kill me.
We're having company.
She cooked.
I got Mark's latest blood work.
He's not responding to treatment.
I'm sorry.
I was happy.
He's my patient.
I'm sure he's a good guy.
He's probably a great guy.
He's apparently a much better guy than I am.
And some part of me wants him to die.
I'm just not sure if it's because I want to be with her, or it's because I want her to suffer.
Hey.
Is it okay if I talk to Stacy for a minute? I'll be just outside, honey.
You two are good together.
You know nothing about Mark.
He took you to Paris.
That's good enough for me.
We never went to Paris.
Your honeymoon.
It's been your dream city.
You wanted to go since you were 16.
He actually took you.
No, I had to work.
We spent the night in New York.
Then we went back to Short Hills.
What is it? When did Mark switch from mountain biking to yoga? About a month ago.
The same time he started getting sick.
What does that mean? We have two more symptoms.
The patient was asked a series of questions to determine the functionality of his brain.
- You grilled him about Stacy.
- Whatever.
Yeah, the point is, he told us everything we need to know to diagnose him.
That is, if we use your fancy PET scan as a lie detector.
See, it's a very creative process, lying.
Now, telling the truth is a much simpler process.
See here.
Question nine.
This is where Mark gives a long, rambling answer about taking Stacy to Paris.
- What does the PET scan say? - Minimal involvement.
Just the frontal and temporal lobes.
He said he went to Paris, and the PET confirms it.
So, what? They didn't go.
They didn't go to Paris, and yet Mark's brain apparently thinks that he really did spend 40 francs on a tour of the bastille.
So we have an intermittent syndrome that presents with abdominal pain, polyneuropathy, paranoia and delusions.
Now, here's the thing about Acute Intermittent Porphyria.
It'll jump you in a dark alley, beat the crap out of you, leave you bleeding.
But it wears gloves, so no fingerprints.
Doesn't show up in blood tests, urine tests, nothing unless you catch it red-handed in the middle of an attack.
But there are other symptoms of A.
I.
P.
- Such as? - Light sensitivity.
Yeah.
One of the true tragedies of this condition is it makes you want to stick your cool new mountain bike in the garage and take up an indoor sport like, say, yoga.
Start the treatment.
Hematin and glucose.
If you give him Hematin now and you're wrong, he dies today.
There's only one way to confirm A.
I.
P.
-- urine sample made during the attack.
And there's no way to predict when he'll have another attack.
Sure there is.
Acute Intermittent Porphyria has very specific triggers.
Barbiturates, alcohol, high levels of protein will set off an attack.
Which trigger do you think set off Mark's? Not the faintest idea.
That's why I'm gonna give him the combo plate.
All of it.
So if he has this, and you trigger an attack, the attack makes him worse, right? Yeah.
But then we'll know what it is and we can treat it.
But if I don't have this thing and you give me that shot, what happens? No idea.
If we don't know what's messing up your brain, we don't know how you'll react.
Okay, I-- I need a minute with my husband.
He doesn't want the trigger.
He wants to wait, see if we can come up with another explanation.
If it is A.
I.
P.
, how much time does he have? No idea.
Next attack could be fatal.
Could be six months from now.
Could be five minutes from now.
I want you to test him.
Fine.
I'll send for an H.
M.
B.
-synthase mutation.
Genetic test.
Lab will get back to us in a month.
Give him the cocktail, set off an attack.
No.
Why not? Because he doesn't want me to.
I'm not gonna sue you.
I'm not gonna report you.
He might.
He's paralyzed.
Either you cure him, or he won't be writing any letters.
I'm not gonna do it.
Why not? You keep asking me that question.
My answer doesn't change.
I gave him the parameters.
It's his call.
You want him to die.
I diagnosed him.
I did my job.
You want somebody to tie him down and force him into treatment, you're way better at that than I am.
Is that what this is? Payback for your leg? How many times have we been over this? I saved your life.
Yeah, maybe.
You're gonna kill my husband to teach me a lesson? No.
He's gonna die 'cause he's too stubborn to make the right choice.
Now we're in your territory.
I'm respecting your husband's decision.
I don't see why you've got a problem with that.
Because it's crap.
Because you browbeat patients, intimidate them, lie to them.
If you think you're right, you don't give a damn what they think.
I did what you do all the time.
The only difference is, I did it to you.
He'll never forgive you.
Yeah.
He will.
Still no change.
He's not getting worse? - No.
No change at all.
- And that's consistent with A.
I.
P.
, right? Until he has another attack, his condition's stable.
Yeah.
- Mark, you've got to.
- I don't want to take that test, not until they're sure.
- You don't know Greg.
- Not like you do.
I only met him when he drugged me.
Boy, are my ears burning.
- What's that? - Cocktail hour.
Just 'cause you can't hoist a few doesn't mean you should be left out.
- Get away from me.
- Mark, if this is what he thinks is wrong with you-- You trust his judgment more than mine? His medical judgment.
And you'd bet my life on that? I would.
I don't.
Smart.
It's too bad you're paralyzed.
Bing! Paging Dr.
Foreman.
Leave the room.
It's not your problem.
You need the consent from him.
But, Doc, he ain't right in the head.
Then you need a court order.
Okay.
Then get one.
We'll wait here.
I won't do nothin'.
Oh! Love the Musketeer thing.
- I got goose bumps.
- Give me the syringe.
Please.
If you're right, this may be his only shot.
So what's your plan? You take the big dark one, I've got the little girl, and the Aussie will run like a scared wombat if things turn rough.
I can't do it.
You son of a bitch! See what I did there? - When does it happen? - If he had A.
I.
P.
, should've already happened.
- Everyone's different.
- This is not good.
He could have an embolism, tachycardia, stroke.
What's happening? Two milligrams of Ativan.
Is that an attack? - Here.
- No.
You'll pollute the sample.
- Chase, get urine from the catheter.
- It's not an attack! He's stroking.
He needs Ativan! This is not a stroke.
The delta-wave burst is just a vasospasm.
- Catheter's out.
There's no way to collect the sample.
- Heart rate's in the 40s.
Bradycardia.
- We're losing him.
- Hold him down.
- Give him something! No painkillers.
You were wrong.
Straight from the bladder.
That's as fresh as it gets.
Would you give him the Ativan already? He doesn't need to be awake for this.
It's still yellow.
Move.
- What? - You think another light's gonna make the difference? Organic chem-- more light, more oxidation.
Does that ring any bells? Start the patient on 150 milligrams glucose, Hey.
Hey.
You wanna thumb wrestle? Come on.
Oh! He's still a maniac.
I know.
Dr.
House? How's he doing? Never better.
I thought you were too screwed up to love anyone.
I was wrong.
You just couldn't love me.
That's good.
I'm happy for you.
You fixed him.
De nada.
Thank you.
You were right.
He's gonna be fine.
No.
About me.
I'm not over you.
You were-- You were the one.
You always will be.
But I can't be with you.
So I'm the guy, but you want the other guy, who, by definition, can never be the guy.
What's so great about you is you always think you're right.
And what's so frustrating about you is you are right so much of the time.
You are brilliant, funny, surprising, sexy.
But with you, I was lonely.
And with Mark, there's room for me.
Okay.
I want to run something by you.
I will not have sex with you! Not again.
It was miserable that first time.
All that desperate administrative need.
Stacy's husband is going to need close monitoring at the hospital, and since we can definitely use her back here, I've offered her a job-- general counsel.
Did she say yes? She said only if it was okay with you.
Yes or no? Fine.
Good.