House MD S8E11 - English Transcript

1 Original air date on February 6, 2012 (Taub) Pressure. I need pressure. (Adams) Get me sutures on a Kelly. (Taub) Need an EPI. (Adams) Get O. R. Ten unpacked. Alert trauma. [Recorder beeps] Let the record show that we are officially convening a disciplinary hearing regarding the events of February 3, 2012 in patient room 209. Dr. House, this recording will be transcribed and published along with all supporting documentation and rulings. Do you have any questions before we get started? Yeah. Who the hell are you? I'm Walter Cofield, Chief of Neurology, Mercy Hospital. I'll be deciding your fate today. Cofield. You were the Residency Director at Hopkins before you moved to Mercy, which means it's safe to assume that you trained Foreman. Which means it's also safe to assume that he trusts you. This hearing isn't about me, Dr. House. I know you'd like to make it about me, because then it wouldn't be about you. It's interesting that he'd pick the old mentor to judge the new one. Interesting, but not relevant. The facts of this case, on the other hand-- the facts are in the file. If you have trouble reading my handwriting, give me a call. I'm going back to work. If I just consider the file, the facts aren't in your favor. The facts say you should be suspended, which, from what I understand, would mean a revocation of your parole. The patient was a 32-year-old high school chemistry teacher. He collapsed while out jogging. He was paralyzed in all four extremities despite the fact that the scans Show no sign of stroke or structural lesions. Put out an APB for a car with a man-shaped dent in the grill? No broken bones, no signs of trauma. Transverse myelitis. Boring. No enhancement on the MRI. I just don't know what to do. Please, you have to help me solve this thing. [Angelic chorus] ♪ A little poetic license. What are you doing? Taking my vic-amins. Those are Vicodin? Did you have surgery recently? About a decade ago. My leg is no good at judging time. Were you taking Vicodin during this case? Uhh Yes. And during about nine years of previous cases. My process is proven. Good things usually happen. Bad things sometimes happen. And when bad things happen, we should figure out what went wrong, so we can learn from it and correct it. So that we can assign blame instead of recognizing that bad things sometimes happen. It was nobody's fault. [Writing] And then what happened? Those who can, do. Those who can't, teach. Those who can't teach, teach gym. Those who can't move their arms or legs teach us to laugh at others. House actually presented the case in that way, or are you just trying to make him look bad? Why would I be trying to make him look bad? Could be your not-so-subtle way of implying this was House's fault. Given what's happened, it's understandable that your opinion would color your testimony, but I just want to know what you said, what you did, and what you were thinking at the time. I don't think it was his fault. Just tell me your initial theory. I thought the patient had a liver problem. Hepatic encephalopathy explained why he passed out, why he couldn't move his limbs. But that's not the idea House went with. He thought Taub's idea was stupid. And what about your idea? He thought that was stupid too. [Chuckles] No, I meant, what was it? Oh. I thought the patient had normal pressure hydrocephalus. And why did House think that was stupid? (House) Oh, come on. Unless you're an idiot, you know why I thought Park was an idiot. The patient had low opening pressure on his LP. That's what I said. No, you idiot. The patient had low opening pressure on his LP. Try unsquinting your eyes and reading the labs next time. Are you intentionally trying to get me to dislike you? That wasn't me. The chair squeaked. You're testifying, for the record, that you actually used the phrasing "unsquint your eyes"? It's not the place to exorcise your guilt. I actually used the phrasing "unsquint your eyes". He's hypokalemic. Could indicate a problem with his heart, which would-- - EKG was normal. But Chase, a doctor who actually takes the time to read the lab reports, has a point. The guy's potassium is off. Could be thyrotoxic paralysis. Start him on Steroids, PTU, and beta blockers. Mm-hmm. And how did these orange smudges get on the patient files? Seriously? That's your follow-up? I eat a lot of cheetos, I forget to wash my hands. Is my snacking really relevant to this case? Might be, if these were actually cheetos' stains. What are they? Seriously, House? You're blaming me? You used Adams' shampoo. I didn't do it. (House) It was a harmless prank. My team is made up of Type-A personalities. They need something to break the tension every once in a while. So this was a team-building exercise? Is that what he called it? That's what he implied. House prefers chaos over cohesion. He believes that disagreement and mistrust lead to better ideas. He's not wrong. As opposed to being right? So you treated with steroids. - And then what happened? - They worked. (Adams) Our patient woke up. Bill? Can you hear me? Yeah. I'm thirsty. That's normal. You've been in a coma for several hours. Can you tell me your name? Uh, Bill. Bill Koppelman. Can you tell me what happened to me? We're treating you for an overactive thyroid. We think that's why you passed out and couldn't move. Can you wiggle your fingers for me? Is he going to be okay? Excuse me, but only family members are allowed. It's okay. They're my students. Everyone back at school is so worried about you. Is he sick because of the explosion? What explosion? What explosion? What explosion? A chemistry demonstration he was doing for his class went wrong. Why was it not already in the patient history? Because the patient was unconscious. But I'm assuming Dr. House spoke to the wife. The wife didn't know about the explosion. And I was the one who questioned her, so, if there was an oversight, it was mine. Does Dr. House not attach importance to patient histories? No, he thinks they're crucial. He just doesn't think being in the same room as the patient is crucial. House thinks avoiding patients allows him to stay as objective as possible. He's not wrong. Sounds like a very diplomatic way of saying he's lazy. That's also true. Either way, I'm covered. If you want an accurate patient history, don't ever talk to the patient. Everybody lies. Except me. To you. Would never do that. Okay. Say you're right. If you had actually been in the room, questioning the patient, you could read body language, you could ask follow-up questions, warn him of the costs of lying to you. Don't forget the thumbscrews. Can you dispute the possibility that, had you visited the patient sooner, maybe talked to the wife, been directed to one of the students, that this case might have ended very differently? (Bill) It wasn't exactly an explosion. It was a controlled reaction that went a little haywire. It was too an explosion. Simon Harris filmed the whole thing on his camera phone and posted it on YouTube. It got, like, over 75,000 hits already. Looks like you've gone viral, Hon. [Coughs] (House) He had a loss of consciousness, temporary paralysis But when I was told the patient coughed up blood, then things really started to get interesting. Your patient was doubled over in pain and coughing up blood, and you found that interesting? Why, is that bad? It's interesting. I do this demonstration every year. I usually have a student aide help me set it up, and apparently this year he added extra hydrofluoric acid, which is why it exploded. The student aide was just trying to make a viral video, not hurt anyone. Ended up doing both. So we figured the patient inhaled the extra large dose of hydrofluoric acid and Burned his lungs, which is why he coughed up blood. If only burnt lungs explained the passing out and paralysis. The explosion does. Check out the video again. He smacked his head against the wall. If that caused swelling in his brainstem, that would have led to eventual loss of consciousness and paralysis. So we discussed it a little longer, and House decided to treat with Heparin. I wouldn't mind a couple more details. It was aerosolized Heparin. You skipped over the actual DDX, and now you're averting your eyes. I'm growing more and more curious by the moment. He smacked his head against the wall. If that caused swelling in his brainstem, that would have led to eventual loss of consciousness and paralysis. - [Muffled] Nobody move. - Aagh! He--he had on a what? Gas mask. The stink bomb was Chase's. He was getting revenge for the orange hair and rigged it in House's office. But House found it. Mm-hmm. You can leave when I have an answer. It might help if we knew the question. How do we treat chemical burns inside the lungs? Maybe we can use a bronchoalveolar lavage to wash 'em out with water. Sorry. My fault. Should have clarified. How do we treat chemical burns inside the lungs without killing the patient? Silver sulfadiazine works well on chemical burns. Burn cream would drown him faster than water. Well? Aerosolized Heparin. Me likey. (Park) But that's only experimental. It's never actually been used before. Not true. Been used in sheep. Uh-huh. The guy was going downhill fast. We needed a treatment that was a Slope changer. So you busted out the sulfur dioxide stink bomb? It was a team-building exercise. No. It was manipulation. You were pressuring your team into coming up with unsafe medical ideas just to get out of that room. You say pressure, I say inspire. The usual safe ideas were not gonna work. Aerosolized Heparin might. And everyone else just went along with this? No. I told House I thought it was a mistake. And those were your exact words? I think I might have said insane. You thought it was insane, and yet you let it happen. No, I-- if you disagree with Dr. House on patient safety, Doctor, it is your duty to speak up. Otherwise, you are equally to blame. I did speak up. I tried. And you failed. And that's why I went to Dr. Foreman. The Heparin could cause the patient to bleed into his lungs even faster. It is crazy, but House doesn't do crazy just for crazy's sake. If he thinks this is the only way to help your patient (Cofield) You did not tell me you were involved in this case when you asked me to do this. I wasn't. The Heparin decision didn't have anything to do with the outcome. If signing off on everything House does is a pattern, it affects the way House behaves, it affects the way House's team reacts to the way House behaves. House is brilliant. I give him the benefit of the doubt most of the time because I've seen what he can do. Getting House out of prison is the biggest decision you've made as Dean of Medicine, right? And if he's suspended as a result of this hearing, he violates his parole and he goes back. And that probably leaves you as former Dean of Medicine. I suppose so. You didn't choose me to oversee this because you thought I could be objective. You chose me because you thought I'd have your back and I'd think twice about making a decision that would get you fired. Eric. I'm sorry. But if your get-House-out-of-jail-free experiment blows up in your face, it's not my job to get you out of it. After you'd administered the Heparin, I see there was a discharge order on the chart, and yet the patient never left. House ordered a therapeutic bath first to wash off any residual chemicals from the blast. But we wound up finding something. You have a bit of a rash. Can you raise both your arms? I just need to see how far it goes. (Bill) You told me i was going to be okay. And now there's still something wrong with me. It probably doesn't mean anything, but we want to make sure. Of course you do. I got to get out of here, okay? Just relax. Please just let me get out of here. It'll just take a minute. We just need to get a good look at the rash. The rash? That was nothing. Just some irritation from lying in bed all day. The problem was the patient's brain. He freaked out. I got to--I got to get out. I got to get out of here. "Freak out" is a little strong. In my opinion at the time, it was the rash that was gonna kill him. Invasive strep. Reasonable theory, supported by the evidence. The evidence pointed to psychosis. We caused it by giving him steroids when he first came in. What'd you think? I thought Park and Adams were both right but that their conclusions were both wrong. The neuro symptoms and the rash were both signs of an underlying disease. Together with the lung, it added up to Wegener's. How does Dr. House handle it when three smart doctors come up with three different but equally valid ideas? I run a diagnostic trial. Start the patient on high-dose steroids. Multiple birds, single stone. If Taub is right, then he will walk out of here cured. If Adams is right, he'll spike a fever, get hypotensive, we can treat it. He can walk out of here cured. If Park is right, he goes all Cuckoo's Nest on us, we can cross "brain" off the list, diagnose him, and he can walk out of here cured. Are you trying to make this easy for me? By your own admission, if you give the patient steroids, two of the three outcomes are gonna make him worse. What was making the patient worse was not having a diagnosis. This was the fastest way to get it. It was a perfect diagnostic moment. In light of what happened, you still think it was the perfect diagnostic moment? Yes. My theory accounted for all the medical outcomes. It did not account for the disobedience of my own team. What are you doing? I think you're right about the strep. Can't hurt to biopsy the rash while we're waiting. Thanks. At the time, it seemed like a good idea. I know this is hard, but please tell me exactly what happened next. Draw up a little anesthetic. Two ccs Lidocaine. Get away from me. [Yelps] [Both men grunting] You're in a hospital. Calm down. Code Grey! So your position is that your team's disobedience caused this? That's not what I said. You said you didn't anticipate their defiance. You implied that all would have been fine otherwise. So who do you blame, Dr. Adams or Dr. Chase? Or both? I don't blame either one. So who do you blame, Dr. House? [Shouting] Code Grey! Get haloperidol. Got it. [Yells] AhAh Oh, my God, Chase. Prep the O. R. and get a gurney. Start an I. V. Come on. The bleeder's got to be in here. Got it. Which artery? It's his heart. Fortunately, only the knife tip reached the cardiac muscle. Made a laceration in the left ventricle about the size of the tip of my index finger. At that moment, he could only stay alive as long as my finger plugged the hole. It could have been me on the floor. It should have been me. It was my theory. I held the needle in front of the patient that set off his paranoia. If you're looking for someone to blame blame me. Please continue. Getting some ectopy. Coming through. Good carotid pulse. (Adams) Regular? No. Got a PVC. Got to move it, people. My diagnostic test worked. It proved the patient had a steroid-induced psychosis. And that's what you took away from this situation? The brain was not a symptom of an underlying disease. Your colleague was stabbed. Are you telling me you didn't care? How bad is it? (Taub) Bad. Patch. Ready? (Adams) I can't take my finger out. He'll bleed. I don't think he can take it. (House) Oxygenation's at 100%. He's as ready as he's gonna be. We got to go for it. (Adams) On my count. One, two, three. (Taub) Suture. Got it. BP is stable. Patch is holding. What was his heart rate? He doesn't have one. He's on bypass. (House) Not Chase. The patient. You're DDX-ing? Park, come with me. Taub's got this. (Park) My friend is here because you didn't listen to me. I did listen to you. Chase didn't listen to me. At this point, being he makes you feel better. You're not helping Chase or our patient. Fine. So he just walked out? There really was nothing for him to do. Speaks to a certain callousness on Dr. House's part, don't you think? Who cares if House was callous? Are you gonna punish callousness? But you agree that empathy is a useful quality for doctors? House is not the problem. Your friend got stabbed. He may die from those wounds. If you had been in that room, maybe that could have been you. I wouldn't have been in the room. Implicitly, you just said that Chase was at fault. We all knew a psychotic episode was one of the three possible outcomes. And Chase brought a scalpel in there. He endangered Dr. Adams, he endangered himself, and he endangered the patient. Thank you. Lungs, rash, now excessive R-R variability. Go. (Taub) It's a hospital. There are lots of doctors who can take care of him. And your thinking is that only you guys are qualified to sit in this room, doing nothing? If you're motivated by caring, just bear in mind he's a dedicated chemistry teacher with a pretty wife and adoring students, baby on the way. She's not pregnant. Would it make a difference? 'Cause I could knock her up. - Autonomic dysregulation. - Shut up. Could you guys keep it down? You made it, Bud. (Adams) You're in the PACU. Been in surgery. The anesthesia's just wearing off. Did I have an epidural? Uh No. 'Cause I can't feel my legs. [Door slides open] Dr. Chase? Robert? Yeah. I'm Walter Cofield. I'm a neurologist over at-- I know who you are. Good. Think you're up for answering a couple questions? Well, it's not like I can get up and run away. Wasn't my best joke. I'm smiling because, for the last 12 hours, I've been picturing you with orange hair. I dyed it back. [Recorder beeps] Were you angry with Dr. House? It was a prank. It wasn't uncommon. So I've heard. That doesn't mean you couldn't get angry. Might actually contribute to that reaction. May I ask why that matters? Are you trying to prove that I was distracted, that my judgment was compromised? Who do you think was at fault for what happened to you, Dr. Chase? Again, why does it matter? You're a smart doctor. You know what happened here better than anyone, and you've worked with Dr. House longer than anyone. And I suspect that you've spent every minute since this has happened trying to answer that very question. I don't think it was anyone's fault. I was angry, but I wasn't distracted. And I think that, if there's any chance I'm gonna walk again, it's because Dr. House is a genius. How about warmth? Can you feel the sheets on your skin? I just said I don't feel anything. Objectivity, House. What about posttraumatic syringomyelia? Syrinx formed in the subarachnoid space, blocking the flow of cerebrospinal fluid. That'd mean the damage was permanent. No. Forget the nerves. House, if it's total paralysis, he must have-- not necessarily. Think arteries. Blood flow to his spinal column is cut off. It's a clot in the radicular artery. That could be fixable. Prep a room for an embolectomy. Let's get that thing out of there before it does any more damage. And if it's not a clot? Then you can ask Foreman if hospital insurance covers ramp-vans. You're through the aorta. (Chase) There. Sensory level is at l5. It must be the descending branch. Can I see the monitor? Stop there. Shoot the dye. There it is. Don't get too excited. We still got to get it out. Still could have done permanent damage. Patient does not have autonomic dysregulation. There's blood in his urine bag. Kidneys are failing. House, not now. Got to be now. Foreman is transferring our guy to Princeton General as soon as there's a bed available. Says the doctors here can no longer be objective since the stabbing. (Cofield) In the middle of a procedure that could basically save your life, House is actually trying to drag people away? How do you work with a guy like that? He wasn't trying to pull anybody away. Everyone had already refused to work on that case. He knew the answer. He wanted to check on me. But he needed an excuse. Otherwise, he could be accused of caring. So your testimony is that Dr. House's complete lack of concern is evidence of his deep concern? Did you just do that? What? Wiggle your toes. [Clatter] Do you feel that? Congratulations. It was the clot. Short occlusion time of the artery, when the swelling goes down, you should Gain back at least some of the function. One more thing. Sorry. You knew that your patient was at risk for a psychotic break when you brought a scalpel within his reach. Why did you ignore that risk? I thought I was right about the rash. I would do it again. I thought so. [Beep] What, that's it? "I thought so"? What the hell does that mean? You brazenly defied your boss. Now that happened either because Dr. House has established that that's okay in his world, or his prank war distracted you, or House makes medicine a game, and you just wanted to beat him. Whatever the reason, it boils down to the fact that you may never walk again because House created an atmosphere that promotes recklessness. This will be our last round of questions. I've spoken with Dr. Chase. You know he regained movement. No. [Beep] Are you really this indifferent to the fact that Dr. Chase is hurt? We're going off the record because this is irrelevant, or are you gonna hit me? Why don't you go tell the guy you're sorry-- I didn't do anything wrong. It's not an admission of guilt. He's your friend, and he's not well. He's a coworker. Coworker whom you've known for almost ten years who nearly died and who's still scared he may not walk. Are you going to have me fired for bad manners? Just trying to understand you. Why a man in your position, with your abilities, is incapable of shaking the impulse to act like an ***. Could we go back on the record and get this over with? [Beep] Put the Vicodin away, Dr. House. My leg hurts. Pop! [Chuckles] Is that supposed to be funny? Two explosions. We're not done here. Hey, hold on. Close it up. Take him out of there. Dr. Foreman said you'd try this. Said to tell you he's no longer your patient. Let's go! Hey! [Siren wailing] Wait. Wait. I have to get to my car. Your husband has a tumor in his lymph nodes. You've been wrong every time. Yeah, well, not this time. The explosion in the classroom caused the cancer cells to break open. It's called tumor lysis syndrome. His body's flooded with an excess of phosphates, potassium, acids, all kinds of cancerous junk. It explains the paralysis, the bleeding, the heart and kidney issues, everything. What about the psychotic break? Turns out we caused that. [Elevator bell dings] This is treatable. Okay? You have to tell the new doctors that he needs total body radiation and plasmapheresis. Move your cane, please. Where's Cofield? He said you walked out. Well, I'm walking back. I'm not done testifying. Apparently you were. Said he'd have his decision tomorrow. [Beep] (Cofield) This case is a fiasco. Didn't sleep last night. Dr. House is obviously brilliant Well, I think we've heard enough. But Dr. House is also a fiasco. If I were to exonerate him, condone his completely reckless, immature, almost misanthropic behavior, I would essentially be sending a message to all the other doctors in this hospital that it's okay to act that way and-- Sorry. We're in the middle of something. (Emily) I know. I came to speak with Dr. House. And when they told me he was in here, I thought I should say something. I mean He wasn't the nicest doctor I've ever met. Well, I think we've heard enough. But he was right. They found the tumor. They are removing it, and they are starting plasmapheresis. They expect a full recovery. He saved my husband's life. Well I guess that's it. Thanks again. [Door shuts] As I was saying, Dr. House's process is dangerous, inappropriate. But he is effective. I've decided that I would be doing this hospital a disservice if I did anything to change that process. Congratulations, Dr. House. This unfortunate stabbing incident is officially nobody's fault. [Beep] Coward. Excuse me? You've got, like, 20 pages of notes there. You were expecting to bore us for at least half an hour. You got my parole form in here. You were gonna send me back to prison. House, stop. Good things usually happen; bad things sometimes happen. The fact that that would-be widow came in just in time to sob all over your soft, mushy heart and the fact that her husband's gonna live does not change whether or not I did the right thing. [Grunting, sharp breaths] How'd you get the firing wire into the Vicodin bottle without me noticing? Why'd I even have to? What was the point of the orange hair? Your hair smelled like Adams. And since there's no way that you're doing her without me knowing, it means you were just doing her shampoo. Which means you were out late drinking with some new girl or because there is no new girl. You were trying to make up time by showering at the hospital because you're too lazy to buy your own shampoo. So I found a way to let you know to not be late. You couldn't just ask me to stop being late? What fun would that be? None of this is fun, House. They decided that your being stabbed Was nobody's fault. They're wrong. I'm sorry. Anything else? I'm kind of busy. No. That was it. I've got it. [Panting, grunting]