House — Episode 4 (Season 5): “Birthmarks”

An interesting mystery and clever solution weakened by a diagnosis that requires way too much coincidence and overlooking more obvious answers.

Spoiler Alert!!

Nicole is a 25 year old Chinese woman raised in New Jersey who was given up for adoption as a young infant. She is back in China trying to find her birth parents. While in a temple there, she suffered a sudden attack of excruciating abdominal pain and started to vomit blood. By the time she has returned to the US and been admitted to Princeton Plainsboro, the Chinese surgeons have removed a foot of bowel.

The team’s initial suspicion is a Meckel’s diverticulum (a defect in the small intestine), so House performs an ultrasound which is negative. Nicole’s biological adoptive parents arrive with her medications from her apartment and tell House that they are saddened to discover Nicole has been drinking “again.” Looking though her medications, House finds the licorice root prescribed by the Chinese doctors and deduces that they suspected she had SARS (Severe Acute Respiratory Syndrome. Some researchers suspect that glycyrrhizin, a chemical found in licorice root, shows benefits in the treatment of SARS). She is placed in isolation and started on ribavirin and interferon (other medications that some research suggests may treat SARS). House is then is kidnapped by Wilson, with help from Cuddy, to guarantee that he will be present at his father’s funeral.

While Kutner is examining Nicole, she develops abdominal pain again and he notices that she is becoming tachycardic (has a faster than normal heart rate) and has signs of liver failure, meaning that SARS is the wrong diagnosis. She is scanned and a clot is found in her hepatic vein which Chase is able to remove surgically. The team discusses what caused her to clot. Thirteen suspects she has a genetic disorder that, when combined with her heavy smoking, makes her more likely to clot. The team decides to run further tests to determine which part of the clotting cascade is malfunctioning. When Kutner goes to draw her blood, he discovers Nicole is not in her room; he finds her outside the hospital, smoking. He draws the blood for the tests, but is unable to get her to stop bleeding afterward. Ultimately it takes 6 units of FFP (fresh frozen plasma — derived from human blood, it contains a high concentration of clotting factors) to get her to stop bleeding. This combination of clotting and bleeding causes the team to suspect that Nicole has DIC (disseminated intravascular coagulation), “which means cancer,” according to Kutner.

A CT scan is obtained and shows a large fluid filled cyst in the pancreas. The team is able to get House on the phone briefly, and he mentions something about a steamroller. Trying to understand his cryptic comment, they consider pancreatic cancer, scleroderma, lupus, gallstones, and a pancreatic divisum (a fairly common anatomical abnormality, it can sometimes cause chronic abdominal pain or pancreatitis). They decide that she has gallstones, which are confirmed on CT. They call in Chase to remove her gallbladder, but when he is talking to her about the planned surgery, he notices that her urine is dark brown (a sign of possible kidney failure). Thirteen recommends running a “bubble test” and injecting small bubbles of air into the pancreatic cyst to see if they travel anywhere else. House agrees; however, when they try to run the test, Nicole has delirium tremens (”the DTs”) so bad she cannot stop shaking. The team places her in a Phenobarbital coma to run the test and help her through DTs. The bubble test is negative, but Nicole is found to have dilated cardiomyopathy and a mass in her right atrium. The team suspects a myxoma (a benign tumor of the heart), but House believes it is iron overload (he suspects one or both of her parents have hemochromatosis). He wants to check an MRI, but he has a sudden revelation and stops Taub from running the test just in time. A simple x-ray of the head shows Nicole’s problem — nails in her brain. It seems her birth parents did not want her as a child and pushed iron nails into her brain through the fontanelles (the “soft spots”) in an attempt to kill her. When that didn’t work, her father secretly gave her up for adoption. She encountered a hidden magnet in the Chinese temple where her symptoms began — a magnet that moved a nail onto a section of the brain that stimulated abdominal pain. House stopped the MRI because the magnet in the machine would have ripped the nails through the brain. Though it’s not explicitly stated, the rest of her symptoms (basically everything but the abdominal pain) were caused by the iron overload (from the iron nails in her brain), which apparently hit full force at the precise moment the nail shifted. What a coincidence!

headline

Major complaints are in red, minor in blue, nit-picking in green:

big mistakeA diagnosis of DIC does not equal a diagnosis of cancer. There are many other causes of DIC including infection, trauma, major surgery, burns, obstetrical complications, liver disease, and heatstroke.
DICDIC causes clots in small blood vessels, not large ones like the hepatic vein.

mistakeNicole had abdominal pain and was vomiting blood. Other than an occasional cough, what lung symptoms was she showing that caused the Chinese to treat her for SARS and House to mention the lungs as a source of her symptoms?

mistakeI’m suspicious of Thirteen’s “bubble test.” While there is a bubble test that can be used to find heart defects, it is only used on a relatively small single organ. Thirteen’s idea of trying to track microscopic bubbles wherever they may go over the entire body seems fruitless, especially when the overlying gastrointestinal tract is likely to have gas bubbles of its own. Plus this would only work if the cysts were connected.

mistakeDelirium tremens was only addressed superficially in the storyline. It is a life threatening condition, and tremors are only a small part of it. Nicole had the rapid heart rate and the tremors, but none of the other symptoms, so the diagnosis seems premature.
phenobarbPhenobarbital is not the recommended treatment for delirium tremens; Benzodiazepines are. But then, House has made this mistake before.

nit-pickNicole’s symptoms didn’t really match Meckel’s, but then it’s a tricky diagnosis and hard to make. Usually it presents with rectal bleeding, and then a technetium scan is the best choice. In cases where there’s no bleeding, an Ultrasound is the best test.

nit-pickWhat a pleasantly convenient finding that Nicole has a nail in the “addiction center” of the brain which explains away all of her bad habits.

nit-pickCT scanners don’t beep when something weird shows up.

House - 5- 1

The medical mystery was fairly interesting, so earns a B. The final solution of the nails was clever and unexpected and is awarded a B. The medicine, while better than the past several weeks, relied way too heavily on coincidental timing — even for House – and only earns a B-. The non-medical soap opera aspects of this story were by far the best part, from Cuddy tranquilizing House, to the House/Wilson moments, to Hanson, and earns a solid A.

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103 Responses to “ House — Episode 4 (Season 5): “Birthmarks” ”

  1. Cuddy slips House a “Mickey” - loved it! (Only fair, considering how many times House has pulled that trick himself on some poor unsuspecting sod.)

  2. Yeah, I was studying here at school, and as soon as she started shaking I asked out loud to my fellow students, “Will they get it right this time and give her alprazolam or IV ethanol like before?”

    Wrong on both counts… Man the medicine keeps coming from way out of left field this season. It’s not even wierd diseases, just other oddities they can come up with.

    And the Wilson ending was a little sappy to me. Still, favorite part, was no doubt, Cuddy doping House.

  3. “Nicole’s biological parents arrive” should be “Nicole’s adoptive parents arrive”.

  4. Man, i have been reading these posts since season one, you are doing a GREAT job, keep up the great work!!!

    Also, anyone else interested to find out what will happen next week? Sounds REALLY interesting, penthouse meets medicine haha!!!

  5. Any validity House’s conclusion about his parentage based on the mismatched toe lengths?

  6. Out of curiosity, how does having pins in the brain cause any of those symptoms, like the clotting, bleeding, abdominal pain, etc.? I mean, you said it must have been from the iron but wouldn’t the pins have to actually dissolve for that to happen, and could pins of those size really have enough iron to cause such a catastrophic systemic failure?

    The conclusion makes no sense to me.

  7. How did it take her 25 years to encounter a magnet?

  8. Best Part: Cuddy drugging House.
    Second Best Part: Bickering in front of the cop. Cop’s “wait, what? You can’t skip your dads funeral.”

    Can you get dnd out of ear hair clippings? ’cause thats what it looked like he was snipping. O.o

  9. David:
    Thanks, fixed.

    BC:
    Hanson. (House’s ringtone for the team)

  10. I’ve been one episode behind and watching them on Hulu, but this week I decided to go ahead and watch ep 4 without having seen ep 3 yet…glad I did too! YAY House and Wilson have kissed and made up

    Ross: i’m guessing it was a fairly strong electromagnet? Not a run of the mill magnet since it had to be strong enough to prevent a person from picking up a statue

    I laughed at the House-kissing-his-father-in-coffin scene. How many times have we seen House do something that seems touching and sincere (like when he went into rehab, apologized to wilson, and went through withdrawal — but he was faking the withdrawal and still taking vicodin) only to find out that it was all for an ultimate purpose?

    I’m glad he and Wilson reconciled though, and I loved hearing how they first met. Wilson is much nicer than me though. When House dropped his flashlight down the grate, I would’ve punched him in the nose!

  11. “Any validity House’s conclusion about his parentage based on the mismatched toe lengths?”

    Having the second toe longer than the big toe is a dominant condition. Non-matching toes means that it’s likely that House is homozygous recessive for the trait (meaning both pairs of the gene were recessive), while his ‘father’ was heterozygous or homozygous dominant (in words words having at least one copy of a dominant gene that controlled toe length). Since the father would pass the dominant gene, House would have had this as well because all it takes is one copy of a dominant gene for expression of that trait to occur.

    As a side note, I’m pretty sure this isn’t a sex linked trait, so the genotype of House’s mother would come in to play, but I doubt the writers thought/cared about that.

  12. “MMMBop” by Hanson was the ringtone on House’s phone.

  13. I believe he was snipping a piece of the ear lobe off in the coffin for skin cells.

    Wouldn’t “nails shoved in your head after birth” cause problems prior to adulthood alcoholism? I can’t imaging that a kid with nails in her brain like that would have shown no symptoms at all during school. I would guess that she would have at best had severe learning disabilities.

  14. Is it me or would the magnet in the Buddha have to be a pretty badass magnet to have tugged on the nail after going through the Buddha frame, across the air, and through her hair/skull?

  15. I think Kuttner was lying about the addiction centers thing, personally, to shut her adopted parents up about blaming her drinking for all her discontent in life (versus the difficulties of being a transracial adoptee in a white american family).

  16. Can you get dnd out of ear hair clippings? ’cause thats what it looked like he was snipping.

    He snipped off the bottom of his earlobe.

  17. I would also like to point out the part where Wilson gets arrested because a warrant for his arrest many years ago.
    The reason why this doesn’t flow is cause back in season 3 when Tritter was around and trying to get House arrested, he definitely would have found this warrant on Wilson and used it against him.
    Aside from that little bump in the story, I really loved all of the Wilson/House scenes, and even though it doesn’t flow, I enjoyed the story of how they met.

  18. I was mostly on board until they mentioned a pin that just happened to be pressing on an “addiction center” of the brain. If only it worked like that. Addiction involves the reward pathways all over the brain. There is no one part of the brain that can be singled out; if there were, addictions could be cured by a well-defined brain surgery

  19. Hilton, while that is legally what Tritter could have done, he didn’t. He was so focused on getting House jailed the quickest way possible that he didn’t think about the fact that Wilson might actually have a warrant out for his arrest.

    But now that I think of it, wouldn’t a warrant for his arrest also impede his chances for a position at any medical hospital?

  20. I loved this episode! Purely for the House/Wilson scenes though, not so much the medicine.

    Yeah, Tritter would have found that arrest warrant for Wilson when looking for things to dig up on him, so that’s not really so believable. But the rest of the House/Wilson scenes I loved! Loved hearing how they first met.

    Also, I seriously would have punched Hosue if he dropped my flashlight down the grate like that after making me drop my keys down there too. But Wilson should have known better.

    I love this episode so much. I am so glad Wilson is coming back, I missed him so much!

  21. Minor complaint/question about slipping people mickeys in movies/TV:

    Wouldn’t a dose of a drug large enough to produce such a rapid loss of consciousness be a dangerously high does, especially for a drug addict with an unknown level of vicodin in their system, and especially when you don’t know how much of the drug they will consume (assuming it’s in his beverage)?

    Even if you could safely dose the subject unconscious so rapidly, how do you know that he won’t crack his head open on his desk when falling down?

  22. No magnets, ever? In grade school in New Jersey, playing with magnets is part of the science curriculum.

    No doctor who reads Chinese in all of New Jersey? Are you kidding me?

    Is there really an “addiction center” to the brain?

  23. I agree with a poster from above that the nail pushing on the ‘addiction center’ is a lie, intended to re-instill hope.

  24. I like how the original young guns were back in action working together more this episode. Hopefully they will be worked back into the show with a larger role in the future.

  25. My favorite episode this season so far. Didn’t miss the PI one bit.

  26. House+Wilson=OTP. The rest was gravy.

  27. These are my thoughts, for what it’s worth (that and a buck will get you a cup of coffee)-

    1. Drugging somebody like the character Cuddy did is very irresponsible and I think unethical of her. House could have hit his head on something and hurt himself badly or even died. For all she knew he had taken a boatload of cold medicine that day and the sedative could have knocked him out permanently! I think Cuddy should have been reprimanded and punished in some manner.

    2. I’m not buying that the girl never came in contact with a strong magnet before either. Way too many silly things going on with all that.

    3. I’m pretty disappointed in the Wilson character going back to a friendship with House. What’s his reasoning- that he had “fun”? What kind of “fun” was it exactly? He could have gotten killed with House messing with his driving like that, he could have gone to jail, he ended up so angry at House he threw a bottle of liquor and ruined a stained glass window (which he’ll have to pay for and pay to replace) and disturbed the funeral! He’s taking heart-pounding danger, irresponsibility, a general lack of regard for the rules of society and respect for others and equating this with “fun”. He’s being seriously dysfunctional here. It sounds like Wilson’s problem is that he is very self-controlled, and he is using House to express his need to let loose. What Wilson ought to do is find a little more balance within himself and learn to cope, and learn to let go and function- not use House as a surrogate for his needs. I repeat- he’s much better off without House. But this is a TV show about dysfunctional people, and in tv shows people remain their dysfunctional selves or the show is over.

    4. I liked it when Kutner said “that’s why we prefer *inside*”- hahaha-

    5. I also thought the line with the officer saying something like “No you can’t skip your father’s funeral- not while your mother’s alive you can’t!” was AWESOME!

  28. I also liked that the originals were back with a larger role. Althought it bugs me how they have to stretch believability to keep Chase around, he always has the best insights into House and his thinking. I think he is most like House and “gets” him better than anyone.

    I liked that Kutner finally got to show some emotion and empathy, something his character has been sorely lacking.

    Enjoyable episode from a drama perspective, although I have to admit I’ve given up on the credibility of the medicine. I’m a veterinarian, (not an “RD”) and even I know how bad the medicine has gotten this season.

  29. I’m with Charmed. If either of them shows even the slightest homosexual tendency I’m rooting for them to elope. They’d make such a perfect gay couple, but not being gay, they make a perfect dynamic duo.

  30. Lilorfnannie, about why Wilson came back and had fun:

    Fun doesn’t necessarily mean “hah hah! I’m having fun!”, but whatever he was experiencing on that trip to the funeral was more fun than he had while grieving over Amber. And he realized where it came from.

  31. I was relieved that they don’t seem to be planning on dragging the whole “Wilson hates House” subplot out any further. I thought it was pretty thin to begin with, and in general I’ve felt that the long-running plot elements (new hospital administrator guy, Tritter) always seemed forced, unrealistic, and they overstayed their welcomes.

    If the medicine seems a little iffy this season, maybe the writers are concentrating on coming up with new and interesting life situations where a character could suddenly be dying and nobody has any real idea why. Does that really happen often? Must be hard to keep it interesting in the pre-credits sequence.

  32. I loved this episode, too, mostly because of the funeral/Wilson subplot and the fact that Wilson is back.

    The medical mystery was great. As you pointed out, the script was sloppy at many points on the way to the solution, but the thing I found most objectionable was this statement: “Let her vomit through the MRI. That’s what nurses are for.”

    I realize that House is supposed to be an asshole, but denigrating nurses isn’t something a doctor as smart as House would do. Nurses often provide essential information to physicians because they are always at or near the bedside, while the doctors flit in and out. Experienced, observant, intelligent nurses notice and communicate exactly the kinds of details House needs to do his job.

    I’m not a nurse; I’m a medical writer who has been around a long time. I’ve heard many stories about nurses (especially in ICUs) who have saved lives by picking up on almost imperceptible signs that something isn’t right, and picking up the phone to tell attending physicians, “You need to get over here stat.”

    “House” and other medical shows should show much more respect for nurses.

  33. FINALLY! House is back! This episode basically confirms that Wilson makes a MUCH better foil than Lucas. Lucas in his own show would probably be fun, but he and House just don’t click like House and Wilson do.

    I really loved the dynamic of House’s new team and House’s old team working seperately and examing House’s hint and STILL coming up with the same diagnosis. Overall, though, I’ve been really happy with the parallels of the characters- Kutner is the new Chase, seeming to think of the more extreme ideas and actually being the only one to solve a case (the guy with Chagas from “No More Mr. Nice Guy” last season), to Thirteen being a less sympathetic version of Cameron (she and House have almost as much memorable banter as Cameron and House- lol at Bubbles being her stripper name). Taub is really the only new archtype we got, and I get the feeling the writers only threw him in because of such.

  34. @ Connie Boyd

    You pointed out yourself that House is supposed to be an asshole. A doctor like him insults other doctors-he did so in this very episode- the police guy said there are surely other smart doctors and he said “You’d be surprised”. I don’t think the show was trying to insinuate anything about nurses being useless.

  35. A couple of people are going on about how seemingly impossible it is for a person not to have encountered a magnet throughout their life. But the circumstances would have to be right: a magnet strong enough to move the pins and also do it the right direction. It’s pretty easy to never encounter such a situation

    Jay: I don’t see why it’s not possible (but I’m not a doctor). I think there have been a few cases where someone has had something impaled into their brain with no obvious effect on their function. I’m pretty sure one involved a nail gun.

    Karl: It’s not uncommon for someone with a tolerance to safely take what could be a lethal dose for an average person. But yeah, it still has risks, especially when you take into account cross-tolerance (more the lack of, in this case) and interactions. And the bigger risk was him falling. But then again, I’m not sure how realistic that was considering he ingested it orally and therefore it should have been slower onset.

    Lilorfnannie: I think the point was that Wilson realised that moving away and dumping House wasn’t really going to help things. So I don’t think the point was that he needed to let loose, but that he needed to drop his grudge.

  36. My tv cut off the end of the episode, right after wilson says something like “you can’t chose your parents” in house’s office. Can anyone clue me in on what happened after that? From the chatter on here it sounds like he decides to come back to his old job, is that correct?

  37. Oh yeah, aside from the medical conclusion, I found it completely unbelievable how Wilson didn’t expect House to do something ridiculous and assholeish at the rest stop. Who *didn’t* see the keys-in-the-grate coming, and after that, him throwing the flashlight down there too?

  38. I found it completely unbelievable how Wilson didn’t expect House to do something ridiculous and assholeish at the rest stop. Who *didn’t* see the keys-in-the-grate coming, and after that, him throwing the flashlight down there too?

    Point taken, but Wilson *was* prepared.

  39. @Brian

    I agree with Connie Boyd. House is a jerk, but he isn’t stupid. He values smart people, especially those who can be useful to him. Given his lack of respect for traditional hierarchies and power structures, it would be entirely believable for him to insult other (especially pompous) doctors but treat at least some nurses with respect.

    This show and most others use nurses as furniture or scenery, at best.

  40. I just want to say that this episode proved how crazy Wilson is.

    That drive to the funeral, with House being such a jerk the whole time and getting him arrested, would just have punctuated all the reasons why Wilson left him in the first place. At least that’s how a normal person would feel.

    But Wilson is a masochist, and House likes dealing out pain. They are the perfect couple.

  41. Justin, my main point was about how strong a dose it would take to produce such a rapid loss of consciousness.

    In watching nature specials on TV, I have learned that tranq’ing a large animal can be quite dangerous: you can’t give them a strong enough dose to render them instantly unconscious (and safe to approach) without risking killing them, especially when the animals weight is unknown. At least Cuddy knew House’s appx weight and what drugs were likely in his system.

    The dose in House’s drink probably had to be pretty strong to knock him out so fast, I would guess dangerously strong considering that no one could be sure of what was going to be in his stomach at the time he consumed the drink.

    Hitting his head on the way down was possibly the bigger risk; what if he had taken his drink out to the parking lot and downed the whole thing just before riding off on his motorcycle?

    I have to qualify the whole slipping him the mickey thing as bad medicine, but a nitpick.

  42. I don’t know if I would classify Wilson as a Masochist. Some people have a benign personality, and get a real kick out of being with someone with such an explosive personality. Even though the participation is often minimal they are almost living the excitement through there friends antics. (Isn’t that the point of all of those reality show? - Sometimes I feel like I’m actually on that island trying to survive!!).

    It’s not like House likes dealing out pain, he just has no filter between what he thinks and what he does. Don’t we all wish we could be more like House sometimes (I’m getting a cane).

  43. Am I imagining things, or does the last scene with the patient’s parents raise some serious ethical issues?

    The doctors inform Nicole’s parents — after the fact, apparently — that the surgery to remove the nails from Nicole’s brain was successful. Then the parents ask the doctors to conceal the “nails in the brain” diagnosis from Nicole.

    (a) How can Nicole have given informed consent to the surgery if she didn’t know there were nails in her brain? She appears to have the level of mental competence required to give her own consent, and she wasn’t in a coma at the time they x-rayed her.

    (b) Does patient confidentiality cease to exist when a doctor is talking to an adult patient’s parents?

    Or have we just gotten so accustomed to House playing fast and loose with the ethical rules that we don’t even blink when the script writers have the rest of the cast do it, too?

  44. I’ve got to make a couple of points that people seem to be missing here.

    -The “mickey” was not in his drink. Do none of you remember that in the scene immediately preceding hsi passing out, Cuddy gave him a shot in his ass? She said it was to help protect against SARS, but, come on, that’s how he was drugged. It’s much easier to dose more specifically with an injection.

    -Also, House LOVES ridiculing/stressing nurses. Just the episode or 2 before, he kept ringing the emergency alarm so that the nurses would run in - proving that he had the ultimate power over them. He did it repeatedly and you could see by their reaction that they don’t like him. It’s not about him disrespecting the nursing profession - it’s about him getting his way, no matter the adversary.

    That is all.

  45. Best episode since the end of season 2 imo!

  46. Scott, the official Fox recap says:

    “At the temple, there must have been a magnet inside the Buddha. When Nicole picked it up, it moved one of the pins deeper into the sympathetic nervous center of her brain. The pins over-stimulated her sympathetic nervous system, causing the blood clot in the liver, the pancreatic cyst, and her heart problems. ”

    So it wasn’t dissolved iron that caused her symptoms, it was the pins themselves? I’ve heard of people with foreign objects in their heads who were asymptomatic for decades before, so it doesn’t seem that farfetched. I don’t understand how the Chinese doctors thought she had SARS, though.

    MJ, the episode does end with Wilson deciding to return to his old job and be House’s friend again.

  47. I loved the fact that Wilson carries not one but two (or more?) wind-up flashlights in his car, a Volvo. Also, the nonchalance with which he pulled out the back-up flashlight was priceless. Perfect belt-and-suspenders thinking.

    I used to drive through New Jersey frequently, and I appreciated that they took at least some effort to make the scenery / cop uniforms etc. look real. I’ve never been pulled over, so I can’t comment on the attitude authenticity. ;^)

    Piling onto the magnet coincidence bandwagon: even if she’d never played with magnets before, wouldn’t the metal detectors (a.k.a. magnetometers) at the airport have gone off when she walked through them? Wouldn’t that have raised some questions along the lines of “ma’am, why do you have metal in your head?” At least it’s creative.

    I also thought it was fishy that Tritter never came up with the Louisiana warrant, but that’s a minor point. Along with everyone else here, I’m happy that Wilson is back, and that Lucas didn’t make an appearance.

    I hope that next week’s episode has some content to it, and isn’t either a shameless ratings grab (look! steamy girl scenes!) or a rehash of doctors being stupid (a la Cameron using the MDMA or whatever it was several seasons back).

  48. Tbird:
    FOX’s recap really doesn’t make any sense. An overstimulated sympathetic nervous system is not going to cause a clot or cyst. Heart problems? Sure — fast heart rate and maybe even a heart attack, but not a mass in the right atrium. I suspect whoever wrote that recap wasn’t clear on what House was implying at the end of the episode.

  49. Good episode, hopefully a nice return to better writing and, well, slightly more plausible medicine.

    I rather liked the end. House found out that he’d been right at age 12. But in the end, he WAS his dad, because he was the man who had raised him. That’s what he meant when he said to Wilson “My dad’s dead.” The realization that it didn’t matter that they weren’t biologically related.

    Also note that while House is a rude bastard, he wasn’t so stupid as to insult the cop. No pig, donut, or backwater hick comments, if you noticed, and he took the cop’s comments that he had to go to his father’s funeral with a sullen silence.

  50. so… despite removing the nails from the brain, she still has iron overload in her blood
    so… no deferoxime?

  51. Did anyone else notice that in the preview of the next episode House fires Thirteen/Bubbles ?

  52. @ Justin: My point was that the pins / nails / whatever were inserted just after birth. The growth of the brain during childhood certainly must have been impacted somehow, right? It’s not the same as an adult construction worker getting hit in the head with a nail gun and presenting to the ER with no obvious neurological impairments.

  53. Ah yes, the shot was the mickey… Still, he went from fully conscious to out cold pretty fast, and there is still the head cracking possibility.

  54. Impressively strong magnets in the buddha figure, to move some iron nails a good metre away.

    I assume the nails would have rusted - shouldn’t that have some side-effects? Would certainly have increased their volume.

  55. Also, were the nails disinfected before being pushed into her head? (Would someone disinfect the nails they were about to push into their daughter’s brain?) Shouldn’t there be a massive infection if not?

  56. I just wanted to post two things. Love reading this blog, though. Very informative.

    1. I disagree that Kutner lied to instill hope in the parents. Nothing in the episode or Kutner’s character leads me to believe that he’d lie to a patient’s parents just to make them feel better. The parents wanted Kutner to lie, but if Kutner was to lie, there should have been a heart to heart moment between Kutner and the patient to lead the viewer to that conclusion. Has to be supported by the context of the episode.

    2. I have a theory about why WIlson and House are friends again. This is unsupported by anything except my own perceptions. House and Wilson fell out of friendship back in episode 1 of this season (though the fallout was looming back at the end of season 4). I think the writers wrote themselves into a situation that was unappealing to fans: they tried replacing Wilson with a PI, but fans were still not buying it, and then 4 episodes into the new season where Wilson declares he and House not friends, they are suddenly friends again. I think the writers wanted to get the show’s status quo back to normal (back to what the fans loved) and this was the easiest way to do it. If the House/Wilson feud had real story importance, I think the writers would have explored it deeper over the course of the season like the Vogler/Stacey storylines.

    I also think this theory has some validity (although way premature and unsupported again) to why the sudden drug addiction of 13 in next week’s episode.

    Anyway, we shall see. I may be entirely wrong.

  57. Mike NvP: Interesting theory, but not really plausible. Episodes are written and filmed months before they air. The writers had this whole arc well worked out long before the fans or ratings gave their approval or disapproval of even the first episode.

  58. Wilson’s warrant wouldn’t have been *any* leverage for Tritter:
    1. At worst it would cost travel expenses, lawyer expenses, and a fine.
    2. It doesn’t inconvenience House.
    3. It’s not enough to trigger House’s empathy/guilt like a yearlong sentence for Wilson might.
    4. For a while Tritter had Wilson on felonies instead.
    5. As someone savvy to the legal system, he’d know they’d be dropped.
    6. I doubt Tritter would be obligated for such minor charges.

    That’s my speculation anyway.

  59. I thought the “pins moved” bit was meant for when the girl leaned over to pick up the Buddha the second time, where the top of her head was, what? within a foot, only a couple inches away from the magnet inside? Especially if the magnet is rigged to “go off” only when the statue is moved.
    But hwere’s the question the show never answered: Did the girl get her wish fufilled?

  60. As any MR tech will tell you, “the magnet is always on”, and she would have died from the pins the first time they got her within 10 ft of the bore (MR magnets being roughly 5 million times stronger than Buddha magnets), nevermind “flipping the switch on” the second time, since THE MAGNET IS ALWAYS ON.

    Also, the idea that removing pins from her “addiction center” (no such central locus in the brain) would change her behavior, the pins having been with her during the entire course of development, is also a pain in the brain to any cognitive neuroscientist watching this episode.

  61. Shouldnt the patient be killed the first time she was put in the MRI. Regardless of how strong a magnet is in the buddha, I would imagine a superconducting magnet in an MRI is much stronger.

    Combine that with an iron nail in her skull and that thing should have shredded her brain.

  62. Shouldnt the patient be killed the first time she was put in the MRI.

    I do believe that was a CT scanner the first time around.

    As for complaints that not all the symptoms fit the diagnosis of needles in the brain, didn’t the episode establish that Nicole was pretty much of a mess to begin with, due to her addictions? It wouldn’t be the first time the team went batty trying to reconcile different symptoms, only to find that the patient had more than one malady.

  63. This episode was a vast improvement over the first few episodes, but the metal + MRI thing is getting ridiculous.

    I count four different House episodes where metal entering an MRI results in bad consequences. I don’t mind the theme itself, but it seems pretty obvious by now that running an X-ray first to check for metal inside the body should be a routine procedure. Especially if the suspected cause of the symptoms is an excess of iron in the body.

    Heck, they even telegraphed the ending by sending Taub to do the MRI in the last five minutes of the episode, and then focusing on House to wait for his epiphany, implying that the MRI is a bad idea, for which there would be only one reason.

    Do they really randomly shove people in MRIs without checking for metal first?

  64. “Also, were the nails disinfected before being pushed into her head? (Would someone disinfect the nails they were about to push into their daughter’s brain?) Shouldn’t there be a massive infection if not?”

    Long time reader, first time poster.

    It depends on what kind of infectious diseases were on the nails. Some bacteria/virii are more aggressive than others. I was under the assumption that the nails moving due to the magnet would’ve caused some sort of iron leakage into the blood, not making it coincidental?

  65. Re: Lilorfannie: WIlson’s “fun” with House:

    As Nietzsche once said, “In Heaven, all the interesting people are missing.”

    House is “interesting”. And “fun”.

  66. Couple of things:

    Things I loved:

    * House and Wilson scenes were great, even though sometimes I had the urger to cover my eyes (like when he used nail-clippers on the ear-lobe).

    * Cuddy drugging him was sweet. I even likied the slight smile on his face when he realized she did it.

    * The cop being a bad-ass until he heard House was dodging the funeral was a nice touch, as was the back-story on how House and Wilson met.

    * LOVED the old team together again doing a differential without the newbies. I also thought it was interesting that they tried to diagnose the “Medicine” while the newbs were trying to figure out the House metaphor — just shows that the first three were doctors, while the second three are groupies.

    *LINES: Wow, almost too many to mention — I was pausing the DVR and rewindinbg because I was laughing through dialog.

    Didn’t Like: The reconiliation was too fast. I wanted Wilson back as much as anyone, but to think he caved that fast is unbelieavble.

    Even though they explained it that Wilson was not “mad” House, but rather trying to distance himself so he wouldn’t have to worry about “losing” him… it doesn’t sound right to me. It’ salmost liked they just dropped the whole: “We’re not friends anymore House. maybe we never were…” bit.

    I still don’t like the new doctors,and the contrast between them and the old three in this episode just showed once again why we just don’t need them.

    @ MJ: What you missed was:

    [INTERIOR: HOUSE’S OFFICE - LATE ]

    House: Is that why you’re here? A colleague checking up on a patient? [House sips Scotch from a glass on his desk.]

    Wilson: Something going on? [Wilson points to bottle on the desk]

    House: I’m celebrating. [hands Wilson a sheet of paper.] My mom hated him too.

    Wilson: [Reading paper] Your DNA test showed no match? That’s incredible. At the age of twelve you actually figured out your father wasn’t your birth father? That’s what you wanted, wasn’t it? Why should it depress you?

    House: It doesn’t depress me. It doesn’t make any difference at all. And that’s what depresses me. [Takes another sip.]

    Wilson: Well. I guess nobody gets to choose who their parents are. I’m not sure even sure anymore we get to choose who our friends are. (beat) I spoke with Cuddy. She hasn’t filled my position yet.

    House: If you’re coming back just because you’re attracted to the shine of my neediness… I’d be okay with that.

    Wilson: I’m coming back because you’re right. That strange, annoying trip we just took was the most fun I’ve had since Amber died.

    House: You hungry?

    [Wilson nods. House gets up from his desk, and they start to move towards the door.]

    House: Wilson?

    Wilson: Yeah?

    House: My dad’s dead.

    Wilson: Yeah. My sympathies.

    [They start to walk down the hallway together.]

    FADE TO BLACK:

  67. Ok, I don’t think there was anything in House’s drink. I think it was the shot in the ass that knocked him out. This was one of my favorite episodes ever. If the past 3 episodes had to suck for this one to be this good that is cool with me. I loved the way they used the old team to analyze the new team. I would like to make a prediction. I’m certain Kutner will leave the show one way or another due to Kal Penn’s movie career. Thirteen is fired next week and even if she stays she is going to die anyway. Now for the boldest prediction, I think Taub will commit suicided or at least try and House will fire him for it. Taub is clearly very depressed.

  68. Just goes to show what my kids & I figured out two seasons ago. While Wilson gives the appearance of being “normal” and mentally healthy, he’s really just as screwed up and damaged as House is. He’s given ample proof that his assessment of any particle situation, especially regarding House, isn’t necessarily accurate.

    But he does pass for normal a lot more easily than House does, giving the illusion that he is right and knows what he’s doing.

    House and Wilson are both messed up, and do rather deserve each other. And we still love them.

  69. Sorry: first instance where metal conflicted with MRI is this episode, not the one linked at the word “four”.

  70. Also wanted to point out the scene at the funeral home where Wilson says to Momma House, “Yes, I’m sure you know him much better than I do,” with a meaningful look.

    With House’s frequent accusatory “insights” into Wilson, it seems like House knows Wilson better than Wilson knows himself, but Wilson sometimes seems to know House better than House knows himself. In the past we’ve seen eps where Wilson yells at House, telling him that he wants to be miserable because he wants to be special, etc. etc., and it usually seems like he’s right, and he’s the only one that gets the underpinnings of House.

    Plus, regarding Wilson having “fun” with House, I’m sure after they go to dinner, have a few drinks, they’ll chuckle together and House will say “I got you good, making you drop your keys and dropping your flashlight down the grate,” with Wilson saying “I’m too prepared to be slowed by you,” and laughing together at the post-hilarity of the whole arrest scene. Kind of like how in real life, some things are much funnier in retrospect.

  71. Is it that easy to have those nails removed from the brain without any damage?

  72. 1. I’m pretty sure iron particulates wouldn’t cross the blood-brain barrier.

    2. The nails wouldn’t rust. Rust is caused by oxidation. There isn’t any oxygen in the brain for the nails to rust. The only way for the nails to become exposed to oxygen would be if they were also exposed to blood. That would only happen if the nails penetrated a vein, which would have caused a lot more problems.

    3. I agree it was the shot that knocked him out, not the drink. Also, House didn’t have to be completely unconscious, just out enough to not fight them. Something like a fast acting benzo or even haldol could do it if a large enough dose is injected IM.

    4. I do think Kutner was lying to the parents. The only time we have really seen him be really open about himself was when he confessed he was also adopted by a white family and that he knew how hard it was. He probably was sympathetic to the patient, and wanted to try and make things easier for her with her parents.

    5. Yay for Wilson and House making up. I do think the writers could have played it a little better, and had it take longer for Wilson to forgive House. I hope they don’t get rid of the PI completely, he was worth a few laughs, especially with Cuddy.

    6. I wonder if there is going to be a story line with House and his bio-dad? Would be a nice out of hospital bit of drama. I wouldn’t object to Stacey coming back either….

  73. The stuff related china,nails& parents,sound convincing.I heard several incidents ( i am chinese guy that happens to be born just before implement of birth control policy )
    I am still intriguing of watching this show,although having a little troublesome of delaying because of depending on the uploaders of network.

  74. Interesting episode though there were quite a few things I couldn’t rationalise.

    Is it possible to drug someone, leave and then they lose consciousness rapidly as soon as they stand up? I don’t know how much time passed between Cuddy injecting House and leaving the room but I always presumed anesthetic worked almost instantly or had the effect of keeping someone unconscious?

    Also I didn’t really understand Wilson’s logic for coming back - nothing had changed in his relationship with House, if anything House’s antics on the car journey would’ve been a sobering reminder of how badly he gets treated, and as an intelligent guy I thought it was rather astute of him to realise that “I don’t think we ever were friends” in a prior episode. Obviously I’m glad he’s back from a viewers perspective I’m glad he’s back, but I don’t really understand it.

    The appearance of Cameron & Chase seemed contrived too, it must surely suck for them as actors to be given such weak material compared to what they had in Seasons 1-3. It’s kinda strange that the new gang aren’t even on the main credits when the original gang are.

  75. This is long, but bear with me:

    I too questioned the writers in their choice of how to bring Wilson back… “fun”? But after watching the episode again (for the first full time thanks to the cable lines in my area being run by hillbillies), I realized how excellent it actually was:

    Four key things happened in this episode that turned Wilson back around:

    1. He was forced to rehash the earliest parts of his relationship with House, during which he remembered one of the things House has done for him that he believes was purely philanthropic (though, I think House may have initially decided to bail Wilson out because House was in need of somebody who is afraid to lose - otherwise, House won’t have a long-term friend).

    2. Wilson was able to get his mind off of the misery he has been experiencing grieving Amber’s death for a time. When anyone is working through a problem, it helps to take your mind off of it from time to time. This trip, although full of obvious pains in the ass, did that for Wilson. Also, Wilson actually does genuinely does enjoy the Houseisms as much as anyone (for Wilson, they’re somewhat liberating by proxy). In fact, Wilson’s relationship with Amber proved to him that House is an excellent match for his personality.

    3. Wilson gets momentum from House. Up until this episode, the arc has shown Wilson attempting to move on, but doing nothing towards that goal. In this episode, he wasn’t merely grieving, he was working through some of his problems (most notably in the “Admit it admit it admit it” scene). As most would agree, and as has been demonstrated in this arc, without Wilson House would be even more socially inept, his manipulation tactics would fail due to a purely misanthropic view of the human race, and he would be nothing but miserable having no one he trusts with the personal details of his life. In actuality, a similar thing is true for Wilson: he would, quite simply, have no fun. He would be a stuffy person who is utterly miserable with the monotony of life. Seeking an outlet for his need to be needed, he would channel his issues through even more failed relationships with people that wouldn’t stick around (because they don’t need a person who needs to be needed - it gets annoying, as House has so often said).

    4. This one didn’t so much happen in this episode as over the entire arc: he began to realize the truth in Cameron’s noting that it doesn’t matter how you change the scenery, Amber’s memory will still haunt him. Moving away from Princeton-Plainsboro and House really made no difference.

    Realizing that moving away made no difference to his grief, that being around House for a time did make a small dent, and that House’s insistent poking forced him to think about things more honestly during a period where he focused on their past and history as the dynamic duo, Wilson made the choice. Clearly, it wasn’t just simply because he had “fun.” Blame the writers for the oversimplification in that final scene, but not for a bad job of laying the foundation for it.

    Sidebar: Anyone who thought the PI would replace Wilson needs to pay more attention to the show. House, Wilson, and Cuddy are permanent cast members as they are irreplaceably important to the show - the show being Dr. Gregory House.

  76. The nail in the “addiction center” of the brain was almost a deal breaker for me as well. I’m not a doctor (just a well-read layman), but to my understanding brain science isn’t that specific. I suspect he was lying to the parents just to make them feel better. He was probably right about one thing, though: Nails in the head probably warped that poor girls personality quite a bit. They might not know their own daughter.

  77. “There’s a lot of people here today.”

    I almost died when House said that line. I’m a French history fan, and that’s the best I’ve ever seen any pop culture reference to Marie Antoinette’s line (when she finally caved after a long refusal to speak to DuBarry). Hilarious.

  78. WILSON is back. I love, love Wilson!!! Best episode EVAR for all the House/Wilson - just totally awesome. I’ve been rewatching and rewatching the H/W scenes non-stop. The two actors need to make a made for TV movie about their nearly two decades of friendship.

    The solution was fascinating, especially since I recall 60 minutes doing a segment on China’s one child policy in the early eighties. It broke my heart.

  79. Can the nails be easily removed anyway?

  80. welcome back, wilson :)

  81. Doesn’t House read Chinese? He knew Mandarin in an earlier episode.

    My other question was addressed earlier too: How do you go 25 years without coming into contact with a magnet?

  82. Another thing about the nails: For that matter, how does someone go 25 years without passing through a metal detector? Wouldn’t she have had to in order to go to China and back?

  83. I think that a magnet strong enough to hold that statue in place against someone trying to lift it would likely have to be several orders of magnitude stronger than the average magnets you run into in everyday life.

  84. When House ‘breaks down’ whilst speaking at the funeral - “I just wish that….” - was that faked just so he could get it over with/get close to the coffin? It was quite an emotional moment, I was almost impressed that we were finally seeing House overcome, then I was uncertain and almost annoyed if it was just another trick.

  85. I’m at last feeling a sense of acquiescence with the new cast, the choices do at last seem to make some sense, and I’m at ease with them, now to the point of not even wanting to return to the good old days. They are some great characters. Just imagine if we had Greys Anatomy situation where there’s far too vast an array of characters that typically tend to be boring hunky males or dolly birds still in teen dating mode, at least House is being quite selective and elitist in this regard. Very much looking forward to Thirteens story arc - it will be as if Cameron had actually contracted HIV. Foreman is looking more and more like an equal to House and Wilson, which I love. It is moving forwards for sure, after the chaos of season 4 things are settling in and beginning to sit quite well I think. Although the credit sequence is still bugging me along with the Chase/Cameron thing…And Greg and Lisa clearly need to quit their jobs and retire to some sleepy old town together, they are perfect and their roles and this new PI guy are going to ruin everything, blast. I like the fact that we had a bit of an anologous scene in this episode with Cuddy giving the shot in ass this time round, harks back to an episode in season 2 I believe. And House didn’t even flinch!!! Quality.

  86. Regardng the “DIC means Cancer” from Kutner bit, the writers SHOULD no better, as evidenced from this sites own review of the episode, Whack-a-Mole, in Season 3.
    “The next morning when he is set to be discharged, Jack starts bleeding from his IV site, nose, and ear. His lab tests reveal a coagulopathy which House diagnoses as DIC (Disseminated Intravascular Coagulopathy). The team suggests possible causes for his DIC. Cameron proposes a community acquired or opportunistic infection such as E. coli, Eikenella, or Strep. Chase suggests a food-borne illness, but Foreman is suspicious of a sexually transmitted disease such as syphilis or gonorrhea.”

    Boom. Three diagnoses (I have no idea how plausible they are) that aren’t cancer. If E. Coli or food-borne illness are legitimate theories then those certainly should have been explored since she just got back from China, which isn’t exactly known for its sanitation standards.

    Obviously, the “DIC means cancer” didn’t come from any of the characters who had previously proposed several non-cancer causes, but nobody called Kutner an idiot.

  87. Jim,
    House speaks Mandarin. That doesn’t mean he reads it. With its long and complex ideogram alphabet, it’s a very difficult language to learn.
    Darren,
    Good point on the fact that the old team is still on the credits and the new one is nowhere to be found. I’ve noticed that several times, and it makes me wonder how the new cast feels about that. Having a major role for more than a full season and being left out of the credits would kinda piss me off.

  88. Thank goodness! House (as I remember it from series 1-3) is back. I didn’t like series 4 at all, but series 5, and especially this episode, show that the writers have got the plot back!

    Let’s just hope Dexter stays as good!

  89. To all of those scoffing at the ‘addiction center’ comment- I have no idea how nails would affect it, but I am pretty sure they were referring to the nucleus accumbens. The National institute for Drug Abuse (NIDA) has been releasing a lot of research regarding changes in the nucleus accumbens (which from my understanding is like a pleasure/reward central hub) over time in people who develop addictions.

  90. Nails removal worries me too… There have been many cases when it was safer to leave the objects in the brain, rather than remove it, and those were even much bigger and singular objects (like a pipe for example)… And here we have few quite small nails all over the brain and we know that their movement cause all those symptoms and yet - there’s not problems about digging down 5 or 6 paths to remove them??? That was a big let down from otherwise decent episode.
    And Kuttner’s phrase about “addiction centre” totally sucked - if it was sort of intended by him for the parents (coz he empathised with the patient) - it should’ve been made clear for the viewers.

  91. Good review, as always :)

    Next week looks interesting yet ridiculous. Suddenly, out of nowhere, Thirteen decides to do drugs and have some girl-on-girl action? We never heard if Thirteen did drugs in her past, so I hope next weeks episode will tie up some loose ends about her.

  92. I’ve never even studied medicine but I had to laugh when they said one of the pins was stimulating the “addiction center” in her brain. Addiction center!? That sounds like nonsense even to my untrained ears. What possible purpose could an addiction center in the brain serve? There must not be any such thing.

  93. Oh, and they said the Chinese mom thought her daughter was dead, and therefore thought she was seeing a ghost when her daughter showed uo, because the husband had told the mom the daughter was dead before he secretly gave her up for adoption.

    Didn’t the daughter’s missing body clue the mom in? I’m certain there would have been a funeral…

  94. This is based on a true story. A chinese woman was found with 26 sewing needles embedded in her body, including one that had broken into three pieces in her brain.

    See link for more details.

  95. […] Last week’s House review A list of all prior House reviews Tags: television medicine house sjogrens syndrome seizure bone marrow renal tubular acidosis pneumothorax […]

  96. I am not so skeptical about the magnet. The only time I have encountered magnets that strong has been when doing academic research on mass spectrometry and nuclear magnetic resonance which was on a graduate level in chemistry.

    I think most people would only encounter a magnetic field like that in an MRI.

    Refrigerator magnets or something you give to children would not have that effect.

  97. The protection face masks for House were not sufficient for the SARS virus. One needs a full seal around the mouth and nose, and the virus is smaller than the cavities in the masks. Should have been N95 masks.

  98. Re. Webgrunt’s query about the dead daughter. There would be no funeral for the baby because the baby was murdered. It was murdered because it was a girl and the couple wanted to try for a boy. So they hid the pregnancy and tried to kill and bury the baby, which would otherwise exhaust their right to have a child. Infanticide of females was a famous result of the Chinese one-child policy.

    I loved the rhyming medical and soap-opera plots, and the whole road trip thing. The metal detector question seems pretty hard to get around, all medical weaknesses in the story aside, though.

    Judy

  99. the “nails” everyone keeps talking about are PINS as in the kind used in sewing. They’re pretty damned small so in order for a magnet to affect them through her skull and all that brain would probably have to be a pretty big one.

  100. Judy, your explanation makes sense, except for one thing–if they hid the fact of her existence, then why did they try to hide the fact that she was murdered by attempting to kill her with needles pushed through hair follicles? They could have suffocated or drowned her, as horrible as that is to imagine, it makes more sense than trying to disguise the cause of death in a baby no one knew existed.

  101. Webgrunt, you are right. I actually thought about that after I posted–that if the baby “died naturally” that would allow the couple to have another child. So the pregnancy need not be hidden. But you can have a funeral without a body, I think.

  102. Seriously, this epidsope’s Chase’s HOT!

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