House, M.D. s02e02 Episode Script
HOU-202 - Autopsy
To aLL your friends, you're deLirious So consumed in aLL your doom Trying hard to fiLL your emptiness The piece is gone Ten-minute warning.
I'm fine.
What about your meds? Got it, Mom.
You are beautifuL no matter what they say House! Need you.
Forget it.
I'm going home.
Hay fever? Oh, you must be a doctor and everything.
Two minutes.
No.
The purple thingie on the file means that whoever is one of yours which means cancer, which means no way it's two minutes.
Fine, I'm lying.
Mystery of life.
Benadryl might help.
Already did 1,000 milligrams.
Steam room? Why, Jimmy.
We'll talk about this in the morning.
I got a 9-year-old with cancer.
Alveolar rhabdomyosarcoma.
Terminal kid trumps your stuffy nose.
Not yet.
She's hallucinating.
So the rhabdo's in her brain.
Make her comfortable.
She's got about a week.
Yeah, except there is no cancer in her brain.
Pristine CT scan, blood tests, protein markers, all negative.
The cancer's in remission.
Which means the hallucinations are unconnected.
Fascinating, huh? And not that it matters, but if you fix whatever's going on in her head, you give her maybe another year.
Long time for a 9-year-old.
No.
It'll just fly by.
Five major surgeries, a bone marrow transplant, fourteen rounds of chemo and blast radiation.
If it was me, I'd just stay home and watch TV or something, not lie here under a microscope.
Don't worry.
Anything happens to you, nobody's gonna lift a finger.
Differential diagnosis.
On your marks, get set Hallucinations could be caused by Whoa! Wait for it.
And go.
latent neurotoxicity from the chemo treatments.
No, patient's last round of chemo was two months ago.
We would've seen it by now.
Genetic component? Nothing on mom.
Dad split when she was pregnant.
His medical history's also clean.
What a guy.
What about graft versus host disease from the bone marrow transplant? Infection travels to her brain, she has hallucinations.
Blood work and LP were clean.
But where there's infection, there's meningeal swelling.
That CT shows no meningeal involvement.
True.
Get a tox screen and an MRl.
We can do that, if you wanna ignore what we just discussed.
Sounds good.
Toxic exposure doesn't make any chronological sense.
I guess there is a third option.
She's making it all up because she doesn't wanna get in trouble for breaking a mirror.
Unfortunately we can't test for that, so tox screen, MRl, and you stay away from the patient.
What'd I do? Oh, well, you'll just get all warm and cuddly around the dying girl, and insinuate yourself.
Probably end up in a custody battle.
Chase, you handle the mom.
Tell her that you'd just sit home and watch TV and die, but you've got to go through the motions and try to save her daughter's life.
It's a doctor thing.
What the hell is this? Black walnut and ginger.
It's nice.
I'll just lay you down and I'll attach this thingamajiggy.
Sat monitor.
Oh, a pro.
Don't have to explain anything.
I like it.
Central line for the chemo.
Yeah.
Doesn't hurt or anything, does it? No, it's awesome.
Instead of an IV, it saves me a lot of time and a bunch of needle sticks.
Oh, I don't think I've ever heard anyone say they like their central line before.
All right, can I interest you in a walk in the park? No, thanks.
Okay.
Don't want any butterflies, either.
Doesn't matter what the walls look like, you're still looking for cancer.
Not today.
We're looking for an infection.
But I get your point.
You comfortable? Yup.
All right.
Let's get this over with.
A pro.
I like it.
Whoa! Look at the time.
I should've been out of here You've only been here 20 minutes.
I can't slip anything by you, can I? There's a patient in One.
Nah, I'm taking a sick day.
Take some Claritin.
Everyone's a doctor suddenly.
Patient in One requested a male doctor.
Balls are in your court, doctor.
Union rules.
I can't check out this guy's seeping gonorrhea this close to lunch.
Exam Room One.
Well, it's sexist, and a very dangerous precedent.
If people could choose the sex of their doctors, you gals would be out of business.
Exam Room One! Sore throat? Well, it's not lupus.
Well, not everyone can operate a zipper.
You know, the up, down, what comes next? My new girlfriend never been with a guy who wasn't circumcised.
So she freaked, and Ah-ha.
And you wanted Rivkah to feel all gemutLicht.
I get it.
It's a shandah.
I got some box cutters and Just like Abraham did it.
I sterilized them, which I was told Stop talking.
I'm gonna get a plastic surgeon.
Get the Twinkie back in the wrapper.
House.
Hey, House.
Andie's MRl and tox screen were clean.
No infection, no neurotoxins.
Oxygen saturation is 94%.
Check her heart.
Her oxygen saturation is normal.
It's off by one percentage point.
It's within range, it's normal.
If her DNA was off by one percentage point, she'd be a dolphin.
We've got a patient who for no obvious reason is hallucinating.
Since it's not obvious, I thought we'd go with subtle.
It doesn't matter.
If her sat percentage is off, that means her blood isn't getting enough oxygen.
That's a problem with her lungs, not her heart.
And a lung problem isn't causing hallucinations.
But the lungs could lead us somewhere that is.
Welcome to the end of the thought process.
Primary pulmonary hypertension? Maybe PE or pulmonary fibrosis.
Could be some bizarre case of kyphoscoliosis.
I'm going home.
While I'm resting, you guys get some arterial blood gases, once you confirm that she is hypoxic, I want a plethysmography, chest x-ray, CT and V-Q.
But if all that comes back negative, then snake a catheter into her lungs.
Don't worry, if I don't sleep in, I'll get bagels.
You ever had this test before? What's it for? This goes all the way up the vein by your hip, into your lung.
If I find something up there blocking anything, I pull it out.
Simple.
It's gonna be easy.
The doctor at Sloan told me I had a great aorta.
Oh, you have had this test before.
Sorry.
I just like hearing you talk.
I've never kissed a boy.
There's time yet for that.
There was a boy last summer.
I was at one of those cancer camps.
I just never had the guts to ask him.
You know, there's a good chance I'm not gonna walk out of this hospital.
Even if I do, I'm nine.
Not a lot of kissing going on in the third grade.
You will walk out of here, all right? And you will kiss a boy.
There you go.
A smile.
Will you kiss me? No.
No one will ever know.
I'm sorry.
I can't.
I won't tell anyone.
Listen, you're nine years old.
I'm 30.
I just wanna know what it feels like.
Once.
This isn't your last chance for that.
What if it is? Please kiss me? Bagels.
You didn't sleep in.
Didn't sleep, didn't breathe.
I'm dying.
Pulmonary angiogram of Andie's lungs was clean.
Arterial blood gases and CT scan were also normal.
Her heart and lungs are fine.
Which gives us no explanation for the diminished sat percentage.
Yeah, oddly enough, sometimes normal is normal.
Sometimes we can't see why normal isn't normal.
Get her symptoms on the board.
You're letting me touch the markers? It's written out in my advanced health care directive.
Should I be incapacitated in any way, you run the board.
Then Foreman.
Chase, you're just not ready yet.
What else? Guys, I know we sort of ruled out infection, but if we forget the labs for a minute, there is one infection we didn't test for because of her age.
Neurosyphilis.
There's no way.
If the infection dipped into her cerebral cortex, all peripheral functions could be compromised.
No.
She hasn't had sex.
She's nine.
Maybe it wasn't her idea.
I mean, she's been around a lot of adults.
All the hospital visits, the counselors at the cancer camps.
You think she's been molested? And hiding it pretty well if there's any of that going on.
Yeah.
All girls who've been molested wanna talk about it.
Break out the rape kit.
She hasn't had sex.
Why are you so sure? She told me she'd never kissed a boy.
You read her diary, too? She asked me to kiss her.
I rest my case.
A regular 9-year-old girl does not have sex on the brain, not when a doctor's threading a catheter through her vein.
But she's not a regular 9-year-old.
She's got terminal cancer.
Cancer doesn't make you special.
Molestation on the other hand She wanted one kiss, before she dies.
If she's never kissed a boy, it's a fair bet she's never had sex.
Tell that to all the hookers who won't kiss me on the mouth.
Hey, here's a theory.
She has been molested, seeks refuge in romantic fantasies with older men with great hair, and I think you left out the punchline.
Victims of molestation learn to work the angles, manipulate people.
You did it, didn't you? You kissed her.
It wasn't sick.
It was one kiss for a dying girl.
One small One small kiss before she dies.
Thank you.
Thanks.
This is exactly why you can't touch my markers.
Go see if she's had sex.
Okay.
No one's ever touched me.
We just need to be sure.
I like your hair.
I used to have really curly hair.
I always wanted it to be like yours is.
Thank you.
All right, that's it.
You're fine.
With a patient.
She dying? No.
Then she can wait.
Will you excuse me just two minutes? If only she'd been molested.
Then we'd have something to go on.
No forced entry.
One hallucination.
Maybe it was just bad pork, maybe there's nothing She's not fine.
Her sat percentage dropped another point.
Which could suggest a tumor in her lung.
Lung wouldn't explain the hallucination.
CT scans showed both lungs were clean.
Which means there's a tumor in her heart.
Not a chance! Give me that.
I loosened it.
I opened it.
We've got an MRl and an echo of her heart.
There's nothing there.
Give me one other explanation for low oxygen saturation.
I can't.
There's only one condition that simultaneously affects the heart and brain, but she Perfect, let's go with that.
Tuberous sclerosis in a kid that also has alveolar rhabdomyosarcoma? Two different unrelated cancers at the same time is a statistical no-no.
What's the rate of cancer in the general population? One in 10,000? Don't.
Don't start with the numbers.
Way I figure it, one in 10,000 of them should have another cancer.
Little girl won the lottery twice.
It happens.
So you're gonna cut her open? Exploratory surgery.
I gotta find this thing.
You're just gonna grope around inside an immunocompromised 9- year-old? She could die on the table.
I know it's somewhere near the heart.
House you've got to do better than that.
Why are we here? Better acoustics.
Now listen to this.
It's a mitral heart valve.
No.
Get the wax out of your ears.
This is the patient's aortic valve.
I downloaded the audio of her echocardiogram.
What are we trying to hear? Tumor.
They tend to keep quiet on account of them not having any mouths.
But we could hear an abnormality in the sound of the valve, which would indicate the presence of something.
The tumor, for example.
If we could tell the surgeon where to look, this is no longer an exploratory surgery, it's a precision strike.
Her aortic valve sounds normal.
Too bad.
Now listen to the dulcet tones of Andie's tricuspid valve.
Normal.
And this is her mitral valve.
I don't hear anything weird.
You guys make me sad.
Listen again.
She's had one hallucination.
Why are we operating on her? Why are we risking her life? Because Wilson thinks it'd be nice to give the girl a year to say goodbye to her mommy.
Guess maybe she stutters or something.
Now shut up and listen.
Tricuspid.
Mitral.
Again.
Wait.
There.
There's an extra flap.
I'm gonna ask the surgeon to look at the mitral valve first.
Chase, I want you there.
I don't like reading surgeon's reports, they're boring.
I'm not really sure I should be spending more time with her.
She'll be unconscious.
You'll be safe.
I'll be there when you wake up.
I'm gonna be fine, Mom.
Brave kid.
She even gave her mom a pep talk.
Mature, brave.
She's a wonder.
What's your problem? These cancer kids, you can't put them all on a pedestal.
It's basic statistics.
Some of them have got to be whiny little fraidy-cats.
You're unbelievable.
If there's not one yellow-belly in the whole group, then being brave doesn't have any meaning.
Andie handles an impossible situation with grace.
That's not to be admired? You see grace because you wanna see grace.
You don't see grace because you won't go anywhere near her.
Idolizing is pathological with you people.
You see things to admire where there's nothing.
Yeah, well, we're evil.
You find things to admire where you shouldn't be sniffing at all.
Like Debbie in Accounting.
She's nice.
You shouldn't know that.
You're married.
So, the little kid dying of cancer, I shouldn't like her? If you're dying, suddenly everybody loves you.
You have a cane, nobody even likes you.
I'm not terminal, merely pathetic.
You wouldn't believe the crap people let me get away with.
They found a tumor.
It's in her lung, extending into her heart.
It wasn't visible on the MRl because it's growing along the heart wall.
Now, because of the placement, the surgeon has to temporarily remove Andie's heart.
It's caLLed an expLant.
They cut out the tumor, repLace any damaged heart muscLe with bovine patches.
That's a patch made from the cow's pericardium.
It's a sac that encloses the heart.
What are her chances? The problem is, there might not be enough heart left once they remove all of the tumor.
And if the tumor's metastasized, there's nothing we can do.
Dr.
Murphy.
Just let me tie this off.
Doctor! What? She's got a bleed in her eye.
They got the tumor, repaired her heart, but she bled out of her eye.
She didn't bleed out of her eye from a heart tumor.
True.
The cardiac tumor was benign.
That's impossible! Statistically Oh, shut up.
If the tumor's benign, that means it didn't cause her hallucinations.
That's why I'm mentioning it.
So, the tumor's a coincidence? This is bad.
You're starting to state the obvious.
No, you said it would be there and it was there.
It can't be a coincidence.
A 9-year-old with terminal cancer gets an unrelated benign tumor growing in her heart.
Why? It's benign? That's impossible.
Talk to Wilson.
And the retinal bleed, another coincidence? A clot could create pressure behind the eye, cause the bleeding.
A clot could explain the eye, but doesn't explain the hallucinations.
A clot could cause mini seizures.
Great.
Another thing that's not causing the hallucinations.
Post-seizure psychosis.
The brain sort of corrects itself after the seizure by hallucinating.
The clot could explain the eye and the hallucinations, but what about the tumor? Tumors the size of an octopus wrapped around a little girl's heart are not just a coincidence.
She's not healthy, she's never been healthy.
What's the theory here? This girl's body's a lemon? Faulty manufacturing, everything's falling apart? The tumor is Afghanistan, the clot is Buffalo.
Does that need more explanation? Okay.
The tumor is Al-Qaeda, the big bad guy, the brains.
We went in, wiped it out, but it had already sent out a splinter cell.
A small team of low-level terrorists quietly living in some suburb of Buffalo, waiting to kill us all.
Are you trying to say the tumor threw a clot before we removed it? It was an excellent metaphor.
Angio her brain before this clot straps on an explosive vest.
Angio was clean.
There's no clot? There's a clot, we just can't find it.
You can't do exploratory surgery on her brain.
Are you sure you're not a neurologist? Okay.
She's gonna die.
Well, the clot's not gonna go away quietly.
It could blow at any time.
Are you gonna let them know? I guess so.
Can I come with? To tell Andie she's gonna die? That's very un-you.
She's such a brave girl.
I wanna see how brave she is when you tell her she's gonna die.
Go to hell.
What would you do if you were told you were gonna die? I don't know, I'd be devastated.
You'd cry like a baby.
Everybody would.
She's not doing anything.
She's a rock.
She's brave.
Yeah, yeah, yeah.
Why? She's gone through more than most people do in a lifetime.
So what? Does that mean she's ready to die? What if her bravery is a symptom? The clot is causing hallucinations and messing with her emotions.
You think her bravery is chemically based? It would tell us where to look for the clot.
Where's the fear center? The amygdala, near the hippocampus.
It's a big area and a busy one.
You blindly cut in there, you'll kill her.
Only time you're gonna see this clot is at autopsy.
Then let's do that.
Is it still illegal to perform an autopsy on a living person? Are you high? If it's Tuesday, I'm wasted.
It's Wednesday.
I want to induce a hypothermic cardiac arrest.
Once the patient's on bypass, we siphon off two liters of blood, perfuse the brain while she's in an MRl.
You're actually talking about killing her.
Just for a little while.
I'll bring her right back.
Oh, well, in that case, go ahead.
Why are we even talking? If we do nothing, she's dead in a day, maybe a week.
The kind that lasts.
We need FDA approval for any surgical technique that's used for diagnostic purposes.
Absolutely.
If we were doing anything invasive.
But there's nothing invasive You know, I'm not cutting into her head.
I'm just looking for a clot.
Not invasive? You're killing her.
Don't split hairs.
If it works, she lives.
Make sure the mom understands that this is a million-to-one shot.
I'll see that Wilson passes that along.
The plan is basically to reboot your daughter.
Like a computer.
We shut her down.
Then restart her.
How do you restart a 9-year-old girl? We cool her core body temperature to 21 degree Celsius.
Use blankets, ice.
Sort of like hibernation? Not quite.
In hibernation, a bear's heartbeat is just very slow.
In cardiac arrest, there is no heartbeat.
So she's dead.
Temporarily, yes.
By cooling her, we limit the risk of damage when we remove her blood.
Not all of it, two to three liters.
Half her blood? Then we put it back.
It's called perfusing the circuit.
In this case, her brain.
And using an MRl, we'd have a very brief window to hopefully see the outline of the clot.
If it's there, and it's operable, we go get it.
And Andie walks out of here.
Signed consent forms.
Great, thanks.
You sound better.
I stacked a combo of Mentholatum, a few Vicodin, and something else which I can't remember.
Should be able to ride the high for a couple hours.
What did Andie say? About what? About this? I didn't talk to her.
She doesn't need to know the specifics of this procedure.
What if you're right about her? What if she just is that brave? That doesn't mean she's mature enough to handle this kind of decision.
Either she understands, or she's not brave.
You can't have it both ways.
If she does understand, then she deserves to know what's going on.
I'm Dr.
House.
I've seen you around.
Your mom tell you what we're gonna try? Sort of.
Tomorrow's test could take 10 hours.
Given your present condition, you might not even make it through.
My mom's done a lot of research.
How do you feel about it? If we figured maturity came from how much time you've got left instead of how long you've been here, this would be your call.
I don't have a choice, right? I could give you one.
I wanna get better.
You've got cancer.
If I fix this I have a year.
A year of this.
A lot of people wouldn't want that.
A lot of people would just want it to be over.
Are you asking if I wanna die? Nobody wants to die.
But you're going to.
The question is, how? How much you're gonna suffer, and how long.
I'm asking if you want this to be over.
What would you tell my mom? I would give her why we can't do this procedure.
I can't just leave her 'cause I'm tired.
But you can't stay for her, either.
But she needs me here.
This is your life.
You can't do this just for her.
I love her.
Thank you for joining me for tonight's dress rehearsal.
Playing the part of Andie is Morty Randolph.
For his donation to science, we give our thanks.
Once Andie is cooled and goes off bypass, we have 60 seconds to get two liters of blood out of her body, back into her for the pictures to find the clot in her head.
If our star is bumped tomorrow, while my MRl is on, these red lights will go off.
Which will mean we have no usable test results.
No test results, it's goodbye Broadway.
You guys'll be wearing bad cat suits in Des Moines.
We'll have neurosurgeons here with a view of the monitors, cardiac surgeon there in case we need to open her up.
Anesthesiologists, one by the cardiac bypass machine, one by the cooling apparatus.
Girls in the chorus, if you're over 5'10", stick with me.
Okay, give me 60 seconds on the clock.
Show time.
A five, six, seven, eight! Siphon off the blood through the arterial line.
Whoosh.
Sound of blood draining.
More whoosh.
And we kill her.
Again.
Sorry, my hand slipped.
How hard can this be? It's a little busy down here.
Again! If we didn't have to lavage her gastrointestinal Again! Again! We could bolt it to the table.
Gruesome and low-tech.
Kiss me, I love it.
A five, six, seven, eight! Here you go, Doctor.
This'll make you sleep.
A lot of people.
Big musical number, kiddo.
A lot of people here to make you look good.
You're kind of freaking me out.
He gets that sometimes.
Deep breath, honey.
Okay, go! Intubate her.
Is that one okay? Charge.
Here.
Body temperature 37 degrees Celsius.
Start the cooling.
You, go.
She's shivering.
Celsius.
We have afib.
What? She's dead, that's the whole idea.
Go! One liter out.
Two liters.
Okay, put the blood back in.
Reperfuse the circuit.
Anything, people, anything at all.
Internal carotid artery in cavernous sinus is fine.
Ten seconds! Vestibulocochlear nerve intact.
Middle meningeal artery clear.
Five seconds! Nothing.
We're over the limit.
We've got to start rewarming her or there'll be permanent damage.
Keep looking! There! I didn't see anything.
It was there.
You sure? Four millimeters lateral to the hippocampus, I saw it.
House, she's out of time, she's gonna be a vegetable.
I saw it! That's good enough for me.
They were abLe to restart her heart.
She's doing as weLL as couLd be hoped.
So they found the cLot? We think so.
The neurosurgeons are attempting to remove it right now.
And when wiLL we know if there was any damage? A few hours.
Four millimeters lateral to the hippocampus.
That's where I am.
There's nothing there.
You're not there yet, keep going.
I'm there.
Are you sure you saw There it is.
I think I can get it.
Hi, Mom.
Oh, hi.
You're treating your stuffy nose with cocaine.
Diphenhydramine.
Antihistamine.
New delivery system.
It's a blood-brain barrier thing.
It's all about speed, isn't it? One thing to another, never standing still.
You're pretty good at that.
I know my way around a razor blade.
It's time.
Just a couple more rocks.
Andie's going home.
Right.
The parade of the small bald circus freaks.
Sorry, I've got a thing.
I read her surgeon's report.
Oh? The clot was nowhere near her amygdala.
Means her fear emotions were working perfectly.
Yeah.
Yeah.
So her bravery was not a symptom.
Yeah.
I was wrong.
She genuinely is a self-sacrificing saint, whose life will bring her nothing but pain.
Which she will stoically withstand just so that her mom doesn't have to cry quite so soon.
I'm beside myself with joy.
She enjoys life more than you do.
Right.
She stole that kiss from Chase.
What have you done lately? I'm pacing myself.
Unlike her, I have the luxury of time.
She could outlive you.
In case you wanna see real butterflies.
I'm not gonna kiss you.
No matter what you say.
It's sunny outside.
You should go for a walk.
Not much for the long walks in the park.
Now get.
in 2.
8 seconds.
Four-stroke, four cylinder, liquid cooled.
You gain a lot of torque according to Right leg? Your right leg? You can still ride.
We got excellent financing right now.
It lists for ten-eight.
I'll let you steal it out the door for ten-three.
No, thanks.
Could I test drive one of these things?
I'm fine.
What about your meds? Got it, Mom.
You are beautifuL no matter what they say House! Need you.
Forget it.
I'm going home.
Hay fever? Oh, you must be a doctor and everything.
Two minutes.
No.
The purple thingie on the file means that whoever is one of yours which means cancer, which means no way it's two minutes.
Fine, I'm lying.
Mystery of life.
Benadryl might help.
Already did 1,000 milligrams.
Steam room? Why, Jimmy.
We'll talk about this in the morning.
I got a 9-year-old with cancer.
Alveolar rhabdomyosarcoma.
Terminal kid trumps your stuffy nose.
Not yet.
She's hallucinating.
So the rhabdo's in her brain.
Make her comfortable.
She's got about a week.
Yeah, except there is no cancer in her brain.
Pristine CT scan, blood tests, protein markers, all negative.
The cancer's in remission.
Which means the hallucinations are unconnected.
Fascinating, huh? And not that it matters, but if you fix whatever's going on in her head, you give her maybe another year.
Long time for a 9-year-old.
No.
It'll just fly by.
Five major surgeries, a bone marrow transplant, fourteen rounds of chemo and blast radiation.
If it was me, I'd just stay home and watch TV or something, not lie here under a microscope.
Don't worry.
Anything happens to you, nobody's gonna lift a finger.
Differential diagnosis.
On your marks, get set Hallucinations could be caused by Whoa! Wait for it.
And go.
latent neurotoxicity from the chemo treatments.
No, patient's last round of chemo was two months ago.
We would've seen it by now.
Genetic component? Nothing on mom.
Dad split when she was pregnant.
His medical history's also clean.
What a guy.
What about graft versus host disease from the bone marrow transplant? Infection travels to her brain, she has hallucinations.
Blood work and LP were clean.
But where there's infection, there's meningeal swelling.
That CT shows no meningeal involvement.
True.
Get a tox screen and an MRl.
We can do that, if you wanna ignore what we just discussed.
Sounds good.
Toxic exposure doesn't make any chronological sense.
I guess there is a third option.
She's making it all up because she doesn't wanna get in trouble for breaking a mirror.
Unfortunately we can't test for that, so tox screen, MRl, and you stay away from the patient.
What'd I do? Oh, well, you'll just get all warm and cuddly around the dying girl, and insinuate yourself.
Probably end up in a custody battle.
Chase, you handle the mom.
Tell her that you'd just sit home and watch TV and die, but you've got to go through the motions and try to save her daughter's life.
It's a doctor thing.
What the hell is this? Black walnut and ginger.
It's nice.
I'll just lay you down and I'll attach this thingamajiggy.
Sat monitor.
Oh, a pro.
Don't have to explain anything.
I like it.
Central line for the chemo.
Yeah.
Doesn't hurt or anything, does it? No, it's awesome.
Instead of an IV, it saves me a lot of time and a bunch of needle sticks.
Oh, I don't think I've ever heard anyone say they like their central line before.
All right, can I interest you in a walk in the park? No, thanks.
Okay.
Don't want any butterflies, either.
Doesn't matter what the walls look like, you're still looking for cancer.
Not today.
We're looking for an infection.
But I get your point.
You comfortable? Yup.
All right.
Let's get this over with.
A pro.
I like it.
Whoa! Look at the time.
I should've been out of here You've only been here 20 minutes.
I can't slip anything by you, can I? There's a patient in One.
Nah, I'm taking a sick day.
Take some Claritin.
Everyone's a doctor suddenly.
Patient in One requested a male doctor.
Balls are in your court, doctor.
Union rules.
I can't check out this guy's seeping gonorrhea this close to lunch.
Exam Room One.
Well, it's sexist, and a very dangerous precedent.
If people could choose the sex of their doctors, you gals would be out of business.
Exam Room One! Sore throat? Well, it's not lupus.
Well, not everyone can operate a zipper.
You know, the up, down, what comes next? My new girlfriend never been with a guy who wasn't circumcised.
So she freaked, and Ah-ha.
And you wanted Rivkah to feel all gemutLicht.
I get it.
It's a shandah.
I got some box cutters and Just like Abraham did it.
I sterilized them, which I was told Stop talking.
I'm gonna get a plastic surgeon.
Get the Twinkie back in the wrapper.
House.
Hey, House.
Andie's MRl and tox screen were clean.
No infection, no neurotoxins.
Oxygen saturation is 94%.
Check her heart.
Her oxygen saturation is normal.
It's off by one percentage point.
It's within range, it's normal.
If her DNA was off by one percentage point, she'd be a dolphin.
We've got a patient who for no obvious reason is hallucinating.
Since it's not obvious, I thought we'd go with subtle.
It doesn't matter.
If her sat percentage is off, that means her blood isn't getting enough oxygen.
That's a problem with her lungs, not her heart.
And a lung problem isn't causing hallucinations.
But the lungs could lead us somewhere that is.
Welcome to the end of the thought process.
Primary pulmonary hypertension? Maybe PE or pulmonary fibrosis.
Could be some bizarre case of kyphoscoliosis.
I'm going home.
While I'm resting, you guys get some arterial blood gases, once you confirm that she is hypoxic, I want a plethysmography, chest x-ray, CT and V-Q.
But if all that comes back negative, then snake a catheter into her lungs.
Don't worry, if I don't sleep in, I'll get bagels.
You ever had this test before? What's it for? This goes all the way up the vein by your hip, into your lung.
If I find something up there blocking anything, I pull it out.
Simple.
It's gonna be easy.
The doctor at Sloan told me I had a great aorta.
Oh, you have had this test before.
Sorry.
I just like hearing you talk.
I've never kissed a boy.
There's time yet for that.
There was a boy last summer.
I was at one of those cancer camps.
I just never had the guts to ask him.
You know, there's a good chance I'm not gonna walk out of this hospital.
Even if I do, I'm nine.
Not a lot of kissing going on in the third grade.
You will walk out of here, all right? And you will kiss a boy.
There you go.
A smile.
Will you kiss me? No.
No one will ever know.
I'm sorry.
I can't.
I won't tell anyone.
Listen, you're nine years old.
I'm 30.
I just wanna know what it feels like.
Once.
This isn't your last chance for that.
What if it is? Please kiss me? Bagels.
You didn't sleep in.
Didn't sleep, didn't breathe.
I'm dying.
Pulmonary angiogram of Andie's lungs was clean.
Arterial blood gases and CT scan were also normal.
Her heart and lungs are fine.
Which gives us no explanation for the diminished sat percentage.
Yeah, oddly enough, sometimes normal is normal.
Sometimes we can't see why normal isn't normal.
Get her symptoms on the board.
You're letting me touch the markers? It's written out in my advanced health care directive.
Should I be incapacitated in any way, you run the board.
Then Foreman.
Chase, you're just not ready yet.
What else? Guys, I know we sort of ruled out infection, but if we forget the labs for a minute, there is one infection we didn't test for because of her age.
Neurosyphilis.
There's no way.
If the infection dipped into her cerebral cortex, all peripheral functions could be compromised.
No.
She hasn't had sex.
She's nine.
Maybe it wasn't her idea.
I mean, she's been around a lot of adults.
All the hospital visits, the counselors at the cancer camps.
You think she's been molested? And hiding it pretty well if there's any of that going on.
Yeah.
All girls who've been molested wanna talk about it.
Break out the rape kit.
She hasn't had sex.
Why are you so sure? She told me she'd never kissed a boy.
You read her diary, too? She asked me to kiss her.
I rest my case.
A regular 9-year-old girl does not have sex on the brain, not when a doctor's threading a catheter through her vein.
But she's not a regular 9-year-old.
She's got terminal cancer.
Cancer doesn't make you special.
Molestation on the other hand She wanted one kiss, before she dies.
If she's never kissed a boy, it's a fair bet she's never had sex.
Tell that to all the hookers who won't kiss me on the mouth.
Hey, here's a theory.
She has been molested, seeks refuge in romantic fantasies with older men with great hair, and I think you left out the punchline.
Victims of molestation learn to work the angles, manipulate people.
You did it, didn't you? You kissed her.
It wasn't sick.
It was one kiss for a dying girl.
One small One small kiss before she dies.
Thank you.
Thanks.
This is exactly why you can't touch my markers.
Go see if she's had sex.
Okay.
No one's ever touched me.
We just need to be sure.
I like your hair.
I used to have really curly hair.
I always wanted it to be like yours is.
Thank you.
All right, that's it.
You're fine.
With a patient.
She dying? No.
Then she can wait.
Will you excuse me just two minutes? If only she'd been molested.
Then we'd have something to go on.
No forced entry.
One hallucination.
Maybe it was just bad pork, maybe there's nothing She's not fine.
Her sat percentage dropped another point.
Which could suggest a tumor in her lung.
Lung wouldn't explain the hallucination.
CT scans showed both lungs were clean.
Which means there's a tumor in her heart.
Not a chance! Give me that.
I loosened it.
I opened it.
We've got an MRl and an echo of her heart.
There's nothing there.
Give me one other explanation for low oxygen saturation.
I can't.
There's only one condition that simultaneously affects the heart and brain, but she Perfect, let's go with that.
Tuberous sclerosis in a kid that also has alveolar rhabdomyosarcoma? Two different unrelated cancers at the same time is a statistical no-no.
What's the rate of cancer in the general population? One in 10,000? Don't.
Don't start with the numbers.
Way I figure it, one in 10,000 of them should have another cancer.
Little girl won the lottery twice.
It happens.
So you're gonna cut her open? Exploratory surgery.
I gotta find this thing.
You're just gonna grope around inside an immunocompromised 9- year-old? She could die on the table.
I know it's somewhere near the heart.
House you've got to do better than that.
Why are we here? Better acoustics.
Now listen to this.
It's a mitral heart valve.
No.
Get the wax out of your ears.
This is the patient's aortic valve.
I downloaded the audio of her echocardiogram.
What are we trying to hear? Tumor.
They tend to keep quiet on account of them not having any mouths.
But we could hear an abnormality in the sound of the valve, which would indicate the presence of something.
The tumor, for example.
If we could tell the surgeon where to look, this is no longer an exploratory surgery, it's a precision strike.
Her aortic valve sounds normal.
Too bad.
Now listen to the dulcet tones of Andie's tricuspid valve.
Normal.
And this is her mitral valve.
I don't hear anything weird.
You guys make me sad.
Listen again.
She's had one hallucination.
Why are we operating on her? Why are we risking her life? Because Wilson thinks it'd be nice to give the girl a year to say goodbye to her mommy.
Guess maybe she stutters or something.
Now shut up and listen.
Tricuspid.
Mitral.
Again.
Wait.
There.
There's an extra flap.
I'm gonna ask the surgeon to look at the mitral valve first.
Chase, I want you there.
I don't like reading surgeon's reports, they're boring.
I'm not really sure I should be spending more time with her.
She'll be unconscious.
You'll be safe.
I'll be there when you wake up.
I'm gonna be fine, Mom.
Brave kid.
She even gave her mom a pep talk.
Mature, brave.
She's a wonder.
What's your problem? These cancer kids, you can't put them all on a pedestal.
It's basic statistics.
Some of them have got to be whiny little fraidy-cats.
You're unbelievable.
If there's not one yellow-belly in the whole group, then being brave doesn't have any meaning.
Andie handles an impossible situation with grace.
That's not to be admired? You see grace because you wanna see grace.
You don't see grace because you won't go anywhere near her.
Idolizing is pathological with you people.
You see things to admire where there's nothing.
Yeah, well, we're evil.
You find things to admire where you shouldn't be sniffing at all.
Like Debbie in Accounting.
She's nice.
You shouldn't know that.
You're married.
So, the little kid dying of cancer, I shouldn't like her? If you're dying, suddenly everybody loves you.
You have a cane, nobody even likes you.
I'm not terminal, merely pathetic.
You wouldn't believe the crap people let me get away with.
They found a tumor.
It's in her lung, extending into her heart.
It wasn't visible on the MRl because it's growing along the heart wall.
Now, because of the placement, the surgeon has to temporarily remove Andie's heart.
It's caLLed an expLant.
They cut out the tumor, repLace any damaged heart muscLe with bovine patches.
That's a patch made from the cow's pericardium.
It's a sac that encloses the heart.
What are her chances? The problem is, there might not be enough heart left once they remove all of the tumor.
And if the tumor's metastasized, there's nothing we can do.
Dr.
Murphy.
Just let me tie this off.
Doctor! What? She's got a bleed in her eye.
They got the tumor, repaired her heart, but she bled out of her eye.
She didn't bleed out of her eye from a heart tumor.
True.
The cardiac tumor was benign.
That's impossible! Statistically Oh, shut up.
If the tumor's benign, that means it didn't cause her hallucinations.
That's why I'm mentioning it.
So, the tumor's a coincidence? This is bad.
You're starting to state the obvious.
No, you said it would be there and it was there.
It can't be a coincidence.
A 9-year-old with terminal cancer gets an unrelated benign tumor growing in her heart.
Why? It's benign? That's impossible.
Talk to Wilson.
And the retinal bleed, another coincidence? A clot could create pressure behind the eye, cause the bleeding.
A clot could explain the eye, but doesn't explain the hallucinations.
A clot could cause mini seizures.
Great.
Another thing that's not causing the hallucinations.
Post-seizure psychosis.
The brain sort of corrects itself after the seizure by hallucinating.
The clot could explain the eye and the hallucinations, but what about the tumor? Tumors the size of an octopus wrapped around a little girl's heart are not just a coincidence.
She's not healthy, she's never been healthy.
What's the theory here? This girl's body's a lemon? Faulty manufacturing, everything's falling apart? The tumor is Afghanistan, the clot is Buffalo.
Does that need more explanation? Okay.
The tumor is Al-Qaeda, the big bad guy, the brains.
We went in, wiped it out, but it had already sent out a splinter cell.
A small team of low-level terrorists quietly living in some suburb of Buffalo, waiting to kill us all.
Are you trying to say the tumor threw a clot before we removed it? It was an excellent metaphor.
Angio her brain before this clot straps on an explosive vest.
Angio was clean.
There's no clot? There's a clot, we just can't find it.
You can't do exploratory surgery on her brain.
Are you sure you're not a neurologist? Okay.
She's gonna die.
Well, the clot's not gonna go away quietly.
It could blow at any time.
Are you gonna let them know? I guess so.
Can I come with? To tell Andie she's gonna die? That's very un-you.
She's such a brave girl.
I wanna see how brave she is when you tell her she's gonna die.
Go to hell.
What would you do if you were told you were gonna die? I don't know, I'd be devastated.
You'd cry like a baby.
Everybody would.
She's not doing anything.
She's a rock.
She's brave.
Yeah, yeah, yeah.
Why? She's gone through more than most people do in a lifetime.
So what? Does that mean she's ready to die? What if her bravery is a symptom? The clot is causing hallucinations and messing with her emotions.
You think her bravery is chemically based? It would tell us where to look for the clot.
Where's the fear center? The amygdala, near the hippocampus.
It's a big area and a busy one.
You blindly cut in there, you'll kill her.
Only time you're gonna see this clot is at autopsy.
Then let's do that.
Is it still illegal to perform an autopsy on a living person? Are you high? If it's Tuesday, I'm wasted.
It's Wednesday.
I want to induce a hypothermic cardiac arrest.
Once the patient's on bypass, we siphon off two liters of blood, perfuse the brain while she's in an MRl.
You're actually talking about killing her.
Just for a little while.
I'll bring her right back.
Oh, well, in that case, go ahead.
Why are we even talking? If we do nothing, she's dead in a day, maybe a week.
The kind that lasts.
We need FDA approval for any surgical technique that's used for diagnostic purposes.
Absolutely.
If we were doing anything invasive.
But there's nothing invasive You know, I'm not cutting into her head.
I'm just looking for a clot.
Not invasive? You're killing her.
Don't split hairs.
If it works, she lives.
Make sure the mom understands that this is a million-to-one shot.
I'll see that Wilson passes that along.
The plan is basically to reboot your daughter.
Like a computer.
We shut her down.
Then restart her.
How do you restart a 9-year-old girl? We cool her core body temperature to 21 degree Celsius.
Use blankets, ice.
Sort of like hibernation? Not quite.
In hibernation, a bear's heartbeat is just very slow.
In cardiac arrest, there is no heartbeat.
So she's dead.
Temporarily, yes.
By cooling her, we limit the risk of damage when we remove her blood.
Not all of it, two to three liters.
Half her blood? Then we put it back.
It's called perfusing the circuit.
In this case, her brain.
And using an MRl, we'd have a very brief window to hopefully see the outline of the clot.
If it's there, and it's operable, we go get it.
And Andie walks out of here.
Signed consent forms.
Great, thanks.
You sound better.
I stacked a combo of Mentholatum, a few Vicodin, and something else which I can't remember.
Should be able to ride the high for a couple hours.
What did Andie say? About what? About this? I didn't talk to her.
She doesn't need to know the specifics of this procedure.
What if you're right about her? What if she just is that brave? That doesn't mean she's mature enough to handle this kind of decision.
Either she understands, or she's not brave.
You can't have it both ways.
If she does understand, then she deserves to know what's going on.
I'm Dr.
House.
I've seen you around.
Your mom tell you what we're gonna try? Sort of.
Tomorrow's test could take 10 hours.
Given your present condition, you might not even make it through.
My mom's done a lot of research.
How do you feel about it? If we figured maturity came from how much time you've got left instead of how long you've been here, this would be your call.
I don't have a choice, right? I could give you one.
I wanna get better.
You've got cancer.
If I fix this I have a year.
A year of this.
A lot of people wouldn't want that.
A lot of people would just want it to be over.
Are you asking if I wanna die? Nobody wants to die.
But you're going to.
The question is, how? How much you're gonna suffer, and how long.
I'm asking if you want this to be over.
What would you tell my mom? I would give her why we can't do this procedure.
I can't just leave her 'cause I'm tired.
But you can't stay for her, either.
But she needs me here.
This is your life.
You can't do this just for her.
I love her.
Thank you for joining me for tonight's dress rehearsal.
Playing the part of Andie is Morty Randolph.
For his donation to science, we give our thanks.
Once Andie is cooled and goes off bypass, we have 60 seconds to get two liters of blood out of her body, back into her for the pictures to find the clot in her head.
If our star is bumped tomorrow, while my MRl is on, these red lights will go off.
Which will mean we have no usable test results.
No test results, it's goodbye Broadway.
You guys'll be wearing bad cat suits in Des Moines.
We'll have neurosurgeons here with a view of the monitors, cardiac surgeon there in case we need to open her up.
Anesthesiologists, one by the cardiac bypass machine, one by the cooling apparatus.
Girls in the chorus, if you're over 5'10", stick with me.
Okay, give me 60 seconds on the clock.
Show time.
A five, six, seven, eight! Siphon off the blood through the arterial line.
Whoosh.
Sound of blood draining.
More whoosh.
And we kill her.
Again.
Sorry, my hand slipped.
How hard can this be? It's a little busy down here.
Again! If we didn't have to lavage her gastrointestinal Again! Again! We could bolt it to the table.
Gruesome and low-tech.
Kiss me, I love it.
A five, six, seven, eight! Here you go, Doctor.
This'll make you sleep.
A lot of people.
Big musical number, kiddo.
A lot of people here to make you look good.
You're kind of freaking me out.
He gets that sometimes.
Deep breath, honey.
Okay, go! Intubate her.
Is that one okay? Charge.
Here.
Body temperature 37 degrees Celsius.
Start the cooling.
You, go.
She's shivering.
Celsius.
We have afib.
What? She's dead, that's the whole idea.
Go! One liter out.
Two liters.
Okay, put the blood back in.
Reperfuse the circuit.
Anything, people, anything at all.
Internal carotid artery in cavernous sinus is fine.
Ten seconds! Vestibulocochlear nerve intact.
Middle meningeal artery clear.
Five seconds! Nothing.
We're over the limit.
We've got to start rewarming her or there'll be permanent damage.
Keep looking! There! I didn't see anything.
It was there.
You sure? Four millimeters lateral to the hippocampus, I saw it.
House, she's out of time, she's gonna be a vegetable.
I saw it! That's good enough for me.
They were abLe to restart her heart.
She's doing as weLL as couLd be hoped.
So they found the cLot? We think so.
The neurosurgeons are attempting to remove it right now.
And when wiLL we know if there was any damage? A few hours.
Four millimeters lateral to the hippocampus.
That's where I am.
There's nothing there.
You're not there yet, keep going.
I'm there.
Are you sure you saw There it is.
I think I can get it.
Hi, Mom.
Oh, hi.
You're treating your stuffy nose with cocaine.
Diphenhydramine.
Antihistamine.
New delivery system.
It's a blood-brain barrier thing.
It's all about speed, isn't it? One thing to another, never standing still.
You're pretty good at that.
I know my way around a razor blade.
It's time.
Just a couple more rocks.
Andie's going home.
Right.
The parade of the small bald circus freaks.
Sorry, I've got a thing.
I read her surgeon's report.
Oh? The clot was nowhere near her amygdala.
Means her fear emotions were working perfectly.
Yeah.
Yeah.
So her bravery was not a symptom.
Yeah.
I was wrong.
She genuinely is a self-sacrificing saint, whose life will bring her nothing but pain.
Which she will stoically withstand just so that her mom doesn't have to cry quite so soon.
I'm beside myself with joy.
She enjoys life more than you do.
Right.
She stole that kiss from Chase.
What have you done lately? I'm pacing myself.
Unlike her, I have the luxury of time.
She could outlive you.
In case you wanna see real butterflies.
I'm not gonna kiss you.
No matter what you say.
It's sunny outside.
You should go for a walk.
Not much for the long walks in the park.
Now get.
in 2.
8 seconds.
Four-stroke, four cylinder, liquid cooled.
You gain a lot of torque according to Right leg? Your right leg? You can still ride.
We got excellent financing right now.
It lists for ten-eight.
I'll let you steal it out the door for ten-three.
No, thanks.
Could I test drive one of these things?