House, M.D. s07e02 Episode Script

Let's hear it for Della Cart.
Dude, your sister kicks serious ass.
Competed in the boys' league this year.
Kicked their asses, too.
Nice job, Del.
You I went faster on the 50-50.
You were right.
All right.
Who wants next? Yeah, yeah, I'm a little biased.
- Custom decks.
- Start the bidding at 400 bucks.
Trust me, the kids'll force their parents to buy them.
You got to see this.
You made a great event today, hon.
Fast enough for you? I'm already in a wheelchair, what are you so afraid of? All right! That wasn't what I meant! Della? You okay? Mom, Dad! We got to stop parking like this.
People are gonna talk.
Well, that's why I plan on doing some talking first.
I want us to formally report our relationship to Human Resources.
Okay.
You get them, I'll cover everybody else.
I would appreciate it if we could keep it quiet until we had that meeting.
It's gonna be hard with me grabbing your ass all day.
Grabbing stops at the threshold.
Of the parking garage.
Handicapped plates.
I get special access.
I just don't want our relationship affecting our jobs.
Or the other way around.
Why, Dr.
Cuddy, how was your weekend? I got a call about a case for you.
heart stopped while she Sounds great.
You haven't seen it yet.
I sense something fascinating about it.
I'm gonna get us in to see HR this afternoon.
Think you can hold your tongue till then? Mom! Fine.
People are gonna know soon enough.
I think I can hold it till lunch.
I'm seeing Cuddy.
Generally without her clothes on.
Use your imagination.
Hope it's got a wide-angle lens.
You don't actually need that.
I'm gonna go check my office for whoopee cushions.
This is not a prank.
This is not me walking out the door.
Really? You and Cuddy? For reals.
Foreman can translate.
So, junior miss everything.
Skateboarder, basketballer, science clubber, seal clubber.
I'm actually guessing with that last one.
Healthy one day, heart arrhythmia the next.
Are you sure it's a good idea to be yanking on the chain of command? Way to go, House.
I'm surprised you two didn't get together sooner.
EKG, echo and head CT are all spotless.
There's nothing on her neurological exam.
Interesting.
In favor, indignant, indifferent.
I think I'd like the female perspective.
Or Thirteen's.
Where is she? She's gone.
She said was taking a leave of absence, wanted us to think it was for a Huntington's study in Rome.
They've never heard of her.
Cell and home phone are disconnected, apartment's already been vacated.
And what's with the death's head cane? They didn't have a death's ass cane in my size.
I guess we'll just have to wait.
Conditions that cause intermittent heart arrhythmias.
Taub? Three years you've been trying to game out Thirteen.
Now you don't care? Sorry, not caring about Thirteen is not part of the differential for heart arrhythmia.
But you do get a home version of the game.
Patient's brother has severe congenital muscular dystrophy.
Life expectancy of about 25.
If she's had a latent case of it Wouldn't be sudden-onset.
Foreman? Do you know something about Thirteen that we don't? She's entitled to her privacy.
Just as I'm entitled to a diagnosis.
And you're glossing over Thirteen's departure because you actually respect somebody's privacy.
I agree.
It's weird of me not to care.
So either I'm a changed man because of Cuddy, or I'm pretending to be a changed man because I do know something about Thirteen and I'm trying to throw you off the scent, or I've just gone nutty-bananas because I lost a patient.
All of which you are free to discuss after I get a diagnosis.
If it's long QT syndrome, any startling stimulus in that skate park could've triggered the arrhythmia.
Loud noise, flashing lights.
Scare the patient to death to confirm long QT.
Fine.
If you insist, do it in a room with one of those thingamabobs that brings people back to life.
Scare test is insane.
The scare test is legitimate, simulates real-world conditions.
This fling with Cuddy's insane.
Flare gun? Scary enough? How about just telling her we're planning this stupid test? And I'm hoping House and Cuddy are more than just a fling.
It's clearly mellowed him out.
He didn't even care about Thirteen.
Right, the guy who ordered us to stop the patient's heart is mellowed out.
It's gonna be horrible, because it's doomed.
Which is just gonna make House Firecrackers.
We can hide them under one of those covered food trays.
Find any itching powder in your hanky? Any fake poo in your desk drawer? Yes, the lack of dime-store pranks is proof that you're actually dating Cuddy and not just mocking me for being worried about you.
What do I have to do to prove this to you? Tattoo a cane on her inner thigh? Tattoo her inner thigh on my cane? You told everybody, didn't you? Repeatedly.
This one's not buying it.
Need a little help.
I'm not selling it.
And it's time for our meeting at Human Resources.
Human Resources.
Now why would I need to go to Human Resources? House, you've been to Human Resources Never after doing this.
Well, I'm convinced.
Come on, one peck.
Just enough to arouse him a little.
Hey, I'm not even I didn't mean you.
If I confirm it, can we leave? Yes.
It's true.
I've been more passionate with my great-aunt.
Mabel? Up high.
Are we done here? She didn't even ask me to cough.
I think you straightened out my limp a little.
Now, how would you describe the exact nature of the relationship? Have you ever seen Wild Kingdom? Those insects that rip their partners' heads off after copulating.
It's a sexual relationship.
Go slowly now.
He's writing it down.
I believe that I can still supervise Dr.
House effectively, but we both want to follow hospital policy to the letter.
Our concern is to make sure that there's no conflict of interest, no liability for the hospital You think we're gonna sue if things go south? Let me tell you, she actually does go House.
Let him talk.
I know that you're not going to sue, because you are both going to sign love contracts, consensual relationship agreements.
Well, obviously outside counsel will have to review the crotchless undies clause.
We'll also need to watch for any favoritism toward Dr.
House.
Does that mean she has to sleep with everyone? I promise not to give him a raise or a promotion of any kind.
There's got to be a joke there about keeping up with inflation.
Or bias against him.
Are there any supervisory issues with Dr.
House's current caseload? Nope.
Current case is solved.
Patient has long QT, we're gonna scare her into a cardiac arrest to confirm.
No, we're not.
Okay.
No, we're not.
See? Everything is under control.
I know you're still planning your ridiculous scare test.
But the patient is nowhere near sick enough to justify the risk.
An angiogram and an EP study are much safer, and very effective.
Fair point.
I'm not doing the scare test.
I'd invite you to watch me not doing the test, but having not done it many times before, trust me, it's pretty not interesting.
- House? - Scare test was not approved.
Do an angio and an EP study instead.
First of all, that's not as effective as How come you're not doing the more specialized test? This test is virtually just as effective.
And Dr.
House puts a premium on patients' safety.
But frequently changes his mind? Hugo, give him a break.
I'm fine.
You should go to the bathroom before we go.
We've been hydrating you for quite a while.
I don't have to pee.
Once we start the test, you won't be able to move for at least an hour.
I really don't have to pee.
How much fluid have we given her? When's the last time you went to the bathroom? Last night, I guess.
What does that mean? Your daughter's kidneys seem to be failing.
So what could cause her heart to stop, and her urine not to drop? House, I was expecting your relationship with Cuddy to complicate our work long-term.
I am now concerned it might be affecting us short-term.
All due respect.
None taken.
I listen to Cuddy all the time.
She's my boss.
Also yours, by the way.
You'd listen, then tell her she's being an idiot, and do whatever you want.
I find I can skip the idiot part when she's not being an idiot.
And since the scare test would've led to this same dead end, she was right to stop it.
Which means your problem's about you.
This should be interesting.
Losers love company.
And if even a misanthrope like me has a chance at happiness, it's gonna be pretty lonely on that landfill of loser-dom you call a marriage.
Heart, kidneys, go.
Could be Fabry disease.
Lipid deposition in her tissues.
Dad's history was clean.
What about protein deposits? They wouldn't show in her parents' history.
Amyloidosis.
Explains both the symptoms.
Marrow transplant to treat.
Her brother's a match.
Confirm and do.
I've been experiencing fatigue and weakness.
Wouldn't have anything to do with the fact that you're 102 years old? Usually he's strong as an ox.
He has tingling in his feet and his legs.
I want a full battery of tests.
Carbon dating? I'll pay cash if it's not covered.
It's nice of you to float your friend He's not my friend, he's my father.
He's 22 years older than me.
Well, if that's true, he's definitely had his jowls done.
Statistically, if he didn't have these symptoms, he'd be like most people of his age, dead for the past several decades.
Do the tests, I'm sick.
You have a bad case of natural causes.
Do the damn tests.
If the vial fills with sand, we take that as a bad sign.
Hugo should be here.
Why'd you ask him to leave? We wanted to be able to discuss this openly.
But it obviously affects him.
Honey, let the doctor finish.
It's a standard procedure.
We use general anesthesia, harvest a very small amount of his No.
I'm not taking my brother's marrow.
Del, it's These harvests are harmless.
With the meds we give, there's almost no pain, almost no risk of infection Almost? His life's hard enough as it is.
Small problem with the treatment.
Patient won't take marrow from steel wheels? We're finding another match.
And how do you know? What other problem could there be with a problem-free procedure? Boys' sports, science club.
She's living his life, not hers.
Makes sense she's being a self-denying moron.
She loves her brother, she's thinking selflessly.
How is that at all Moronic? Hmm.
If I could only think of a harm-free medical treatment she'd turned down lately.
You're right.
If everyone were more selfish, the world would be a better place.
See? I can skip the idiot part when you're not being an idiot.
Yeah, I had that same facial expression for the first 48 hours.
Had another one, too, but only for 15 seconds at a time.
I'm happy for you.
You're happy for you.
This is huge.
So who's gonna supervise you? Cuddy.
I guess maybe that can work.
Maybe? Nothing's changed.
You showed up for clinic hours, voluntarily.
Fine, a little bit has changed.
House, everything's changed.
You're sleeping together.
You want something from her besides sign-off on scaring your patient to death.
You talked to Taub.
He's worried about you.
He's a jerk.
I'm worried, too.
Do I need to say it? I want this to work.
I'm not doing anything differently.
She changed my mind about one diagnostic test.
And she was right.
Even though it's your emotional default, stop worrying.
I can handle it.
I hear you're a pretty fierce skateboarder.
I do okay.
All your activities, don't they seem like things a 16-year-old boy would do? Some people might think you're trying to live his life for him.
I am.
Sort of.
I got into skateboarding when some of Hugo's classmates did, and he realized he could never do it.
It's the same with a lot of things.
We live through it together.
And you're not worried you're being selfless to the point of self-denial? You've never been inspired by someone? Why don't you take your pills.
Need some help in here.
Hemothorax, we need to bronch her now.
Clear an OR.
She's drowning in her own blood.
It's not amyloidosis.
She's bleeding to death, out of her lung.
I want to fill a quarter of it with foam.
That'd stop the bleeding, all right.
Thought it made more sense than diet and exercise.
And if she doesn't have enough lung function left, you'll have killed her.
The only alternative is slowly suturing the lung, hoping the bleeding stops in time and she doesn't die on her own.
But we would walk away with clean hands.
Except for all the blood.
You're right.
Faster and riskier is better.
Foam the lung.
You got a green light? No.
Suture the lung.
Scalpel, rib spreader.
I can't handle it.
What happened? She said yes, I heard no.
But I didn't actually hear no.
I just was sure that's what she meant.
The way she tilted her head and half-arched her eyebrow.
But what do I even care what she meant? She said yes, that's all that matters.
I'm screwing this up.
It's not completely bad, House.
You care enough to pull your punches.
That's not a bad thing.
But you and Cuddy have got to figure out a way of avoiding this problem.
Set some ground rules.
Yeah.
I have to avoid this problem.
If I can restrict our interactions to places where neither of us are wearing pants.
Yeah.
That's not avoiding the problem, that's avoiding the issue.
Since avoidance is my plan for dealing with the issue, technically, that's not avoiding it.
Thanks.
No problem.
The stitching worked.
This time.
No guarantee bowing to Cuddy'll work next time.
Heart arrhythmia, kidney failure, and now a bleeding lung I don't want to criticize your girlfriend, but Hey, you've been on me for years to respect someone's opinion.
Just because I had to go outside this group to find one I respect Multi-system involvement centered in the lung.
Sarcoidosis.
Doesn't explain the hemothorax.
TB can infect all three organs.
Skin test was negative.
What about Goodpasture's? Affects the lungs, kidneys.
And autoimmune explains the out-of-the-blue arrhythmia.
Goodpasture's it is.
Immunosuppressants and plasmapheresis to treat, kidney biopsy to confirm.
Dr.
House! Don't tell me.
Your father's hairline is receding and he needs more tests.
He's 102, his next test is an autopsy.
Look, I love the old man, but I've got to get him out of the damn house.
He can't do anything without me.
He needs to be in a care facility.
So tell him.
He's a big boy now.
I can't.
I'm his whole life.
But if it comes from a doctor That's very generous.
When you were 30.
Pretend to run the tests.
And then tell him he can't live with me anymore.
I didn't run into you all afternoon.
I missed you.
Busy day.
Maybe we should plan on lunch tomorrow.
Problem is, at lunch you tend to wear tops.
This is much better.
Cuddy and I are naked.
So I'm having trouble focusing.
Use small words.
Kidney biopsy was clean, so we re-checked a piece of her lung from the OR.
You lost me.
Sorry, who is this calling again? It's not Goodpasture's.
There's intimal thickening of the blood vessels.
- And lymphocytic infiltrate.
- We tested for LAM, it's positive.
Plus her lung's fried.
She needs a donor lung to live.
Which is the only treatment for LAM anyway.
Taub's gone to the transplant committee.
They may have found a donor lung.
So this call is purely expositional? We should really get dressed.
I told the nanny I'd be home by 9:00.
And I slipped the nanny 40 bucks, told her to stay till 10:00.
Really? Really.
Good news.
Surgery was uneventful.
But the donor lung started failing about an hour into recovery.
We know we're right about LAM, tests confirmed it.
Well, that leaves us with two options.
Her body is rejecting the new lung, or we should've rejected the new lung because it's infected.
Let's biopsy, see which one it is.
No guarantee we'd hit the affected spot.
If we give steroids for rejection, it'd make an infection worse.
If we give antibiotics for infection, it'd make rejection worse.
Which worse is worse? If we treat her for infection and we're wrong, she'll be dead within hours.
And if we treat for rejection and we're wrong? She'll probably hang on a day or two.
You're assuming her rejection's hyperacute.
Odds are it isn't.
Got to head off the worst worse first.
I studied under Dr.
Seuss.
Start with IV methylprednisolone for hyperacute rejection.
If that fails, we'll switch her to broad-spectrum antibiotics, and hope we're not too late.
Cat got your legs? We just decided to give meds that could kill the patient, based on a guess.
You need approval from Cuddy.
And she'll want to take the safer course.
And you're gonna fold like an origami crane.
So I'll just wait here until we get our actual orders.
Fine.
You do it.
Tell her she's being an idiot for always choosing the safer course.
She's sitting on her ample, if well-formed, bureaucratic ass while our patient's dying.
We'll see who folds like an origami shrimp.
You want me to get Cuddy's approval? I've gotta be somewhere important.
Sitting at your desk? I'm running late.
Forget the tests.
I think junior might have a few words to say about that.
I love him but he can't let go.
I can't do anything without him helping me like I'm senile.
If I go back there, I'm gonna rip his throat out.
You sure you won't warm up to him over time? Skip the blood work.
Tell my son it's grim news, I need to be in a nursing home.
A private room.
Make it a suite.
It'll be our little secret.
I sit around on my "bureaucratic ass"? I was relaying your words.
I said "well-formed.
" I said "well-formed"! What were you I needed to be aggressive.
You're an idiot.
She was siding with Foreman's analysis.
The odds are against it being hyperacute rejection Stop.
I agree with you.
That was our analysis from the start.
If you've got a problem with a team decision, you come to me.
I'm sorry.
I'll deal with him later.
I said "well-formed.
" People who have not seen Cuddy naked should not throw stones.
She does have great cans.
Cuddy has House on such a short leash, she might as well start giving him chew-toys.
Let's give the antibiotics at least another hour.
Amazing.
And House hasn't given you one ounce of grief for your complete lack of interest in his love life.
Did it ever occur to you that House is just happy, and could give a crap about other people's lives because of it? Well, that's ironic and depressing.
And by that logic, the reason you don't give a crap is because you're happy.
Which means you've got someone new giving you chew-toys.
You're one-fourth right.
Wait.
Are you saying You're dating four women? BP's dropping.
Means the antibiotics aren't working.
Put her in Trendelenburg.
Can we save the lung? Believe it or not, we've got a better chance now.
This means it's rejection, not infection.
We'll start her on IV methylprednisolone right away.
Wow.
You hate salad.
She's really got you tied up in knots.
I caved.
Through an intermediary.
I need a plan C.
What you need is a plan that you actually develop with Cuddy.
Antibiotics didn't work.
And then steroids didn't work.
Her new lung's ruined and it's not rejection or infection.
The only two options were wrong.
Unless it's not LAM.
It is LAM, the test was positive.
Then the test had to be wrong.
Deep fryer's working again.
Still working on that? That was here when I sat down.
I need to think.
I want to make sure you're trying everything to save my sister.
Everything.
That must be it.
See, I thought you guys checked the box marked, "Try every other thing.
" I'm the one that's supposed to die first.
I'm the damaged one, not her.
She never even gets a cold.
Damage has a way of spreading to everyone around you.
For example, your obvious emotional damage is now making me have a philosophical conversation, instead of dealing with your sister.
See how that might be damaging? Never? When's the last time you had a cold? Any minor aches, swelling, anything? It's been years.
She never gets colds.
I didn't ask when's the last time she mentioned it, I asked when she had one, even a tiny one.
It's nothing.
Sometimes my ears ache a little.
So now tell me the rest of the nothing.
My chest, soreness, some congestion You never said anything about that.
I barely noticed it until that skateboarding tournament in Denver.
How long ago? A year? Cold's nothing.
When I think of what Hugo goes through every day Yeah, we get it.
Your brother, the saint, his sister, the martyr.
Thank God you followed me.
Now you can go back to the transplant committee while I get confirmation.
Confirmation of what? What causes low-level cold symptoms for a year, can ruin two lungs, is immune to drug therapies and gets worse in cities nicknamed Mile-High? A clotting disorder? She has a nasty case of sickle cell trait.
Her heart arrhythmia wasn't sudden at all.
The screwed up blood cells screwed up the blood vessels, which gave us the screwed up positive for LAM.
If she'd told us about her symptoms sooner, like, ever, she might not be dying.
You were right after all.
I never said sickle If everyone were more selfish, the world would be a better place.
So she's gonna die.
Unless we can find She burned through one donor lung, transplant committee's never gonna give her a second one.
Well, then, I guess you're right again.
Unless we don't need their approval.
You can't advise your patient's parents to take marrow and half a lung from their son.
Guess I could just chat with them about the weather.
But the blood tests just confirmed sickle cell trait, so they might be curious about the only treatment option.
Though we are having weird weather lately.
There is a huge reason not to take lungs from living patients.
So their siblings can die? Their son has CMD.
As it is, he's gonna die of respiratory failure by 25.
We could cut whatever time he has left in half.
That qualifies as a bad reason for them to reject the idea.
It's a much worse reason for them not to get the choice.
It's coercive to tell them.
You ever hear of "do no harm"? That was second year, right? I had mono all that fall.
Their son's not even our patient.
Why don't we just take half a lung from some guy in the clinic with a toothache? It's a great idea.
Now I can give the parents two options.
We don't compromise one life for another.
Okay.
"Okay"? Seriously? You made an argument.
If you don't want me to defer to you, why make it at all? But are you deferring to me just because we're seeing each other? Maybe.
Yeah.
I think so.
Look, this is screwing me up.
Why is it not screwing you up? It is.
I don't know why I okayed you foaming that lung.
I realized it was wrong as soon as I said it.
I knew it! I knew when you tilted your head.
House, we are screwing this up.
I'm gonna call HR.
And find someone else to supervise you, as soon as they can.
I've got your test results.
You have the metabolism, blood counts, liver and kidney function of a 92-year-old.
Which is great 'cause you're 102.
What's not so great is the average life expectancy is 78.
It is my recommendation that you move into a home with round-the-clock care.
I can't believe it.
Can't my son give me round-the-clock care? Not unless you've done your two-year certification in Tiburon swab technology.
There must be some other way.
Just because he has a little tingling, and some trouble feeling hot and cold, and some difficulty You can't feel hot and cold? Not lately.
But at my age Show me your teeth.
Dentures.
Fairly worn.
I'm guessing 10-years-old.
Show me your denture cream.
Why would he carry denture cream? Because he has zinc poisoning.
To get it from denture cream, he'd have to take so much of it.
Trust me, he never leaves home without it.
How much do you use, Pop? About a tube a day.
I buy it online.
So what does this mean? Bizarrely, this explains all your symptoms.
Better-fitting dentures, you'll be fine.
Medically, there's no reason to go anywhere.
Hospital rebate.
You might want to put it toward couples therapy.
The transplant committee's never gonna give my daughter another lung, are they? No.
Are there any other options? We're looking into it.
Looking into what? Please.
Tell me, give me some kind of hope.
I'm afraid I can't do that.
We're talking about my daughter's life, what can't you tell me? If there's any chance you can save her, anything you can try.
We can take marrow and half a lung from your son.
It would likely shorten his life significantly.
He'd never be able to go on a respirator if he needed to.
Most people with CMD need to as their respiratory function declines.
How long do we have to decide? Morning at the latest.
Thank you.
Where are my parents? They're probably dealing with committee issues or something.
They were arguing.
I saw my mom crying, looked like my dad was yelling at her.
They care about you a lot.
Hugo was a marrow match.
We're way past that now.
They want a lung from him, too.
Is that what this is about? No.
It's nothing you need to worry about.
Everybody's working on getting you the best care possible.
How do they expect us to go on from here? We make a choice, we live with it.
There's no living with it, no matter what we decide.
Still cold and clammy, she had a respiratory arrest.
Oh, my God! What is she doing here? She figured out what was going on.
She's pinking up.
She must have yanked off her IVs and oxygen.
Came here to die.
By unhooking herself from everything, she delivered a hypoxic insult to her body.
It started a downward spiral.
If you're gonna make a decision, you're running out of time.
HR can't find you a new supervisor.
How come? Because you're unsupervisable, House.
Two department chairs threatened to quit.
Well, I guess we're stuck with each other.
I have no idea why I'm making this call, or if it's the right call to make.
But if you feel strongly about presenting the parents your treatment option, you can do it.
Thank you.
I will.
Several hours ago.
You told them? I told him.
He came to my office.
I'm sorry.
Well, I should probably be more mad at you.
Yeah.
Dr.
House? We've decided.
We're not gonna take the lung from our son.
She's still on the waiting list.
We're gonna do whatever we can to find her another What ginormous crack pipe have you people been sucking on? House! Are you gonna pretend that you're not choosing your own daughter's death? Our daughter doesn't want it.
Probably doesn't want to floss her teeth either.
She's a mindless teenybopper.
Don't put this on them.
What do you mean "put it on"? It is on them.
As much as they may want to "pass the lung" here Of course they do.
You're handing them an impossible choice Life has handed them a crappy choice.
And they're picking the crappier option.
Trading who-knows-how-many healthy decades for four or five years in which roller-boy will be a limp rag.
Not everything is a math equation.
You need me to explain the difference between decade and year? Their son is a human being.
You know what they are, right? Intrinsic value.
We don't get to decide Come on.
We do it every day.
The two of them needed the same lung He needs to keep the one he's got.
You don't get to play God by ripping out That train left the station when we learned to do transplants.
The rest is just paper-pushing.
And of course now, we're onto your real area of expertise.
I thought we were moving onto yours, bullying your patients into embracing your own lack-of-a-moral Hugo, honey We didn't mean for you to hear any of this.
Hugo, please.
I want you to take half my lung.
No.
I am not.
You do so many great things.
I just watch.
I get to watch and coach and cheer.
But that's not me out there.
Never will be.
If you take this piece of me, carry it with you, then I really can share in everything you do.
This is the great thing I can do with my life.
Don't make me live without you.
We got lucky.
I did give them an impossible choice.
The kid took it away from them.
That fight was the first honest interaction you and I have had since we came back to work.
If we're painfully, brutally honest with each other, maybe we'll get lucky again.
You've got a big ass.