House MD S3E13 - English Transcript

(MUSIC PLAYING ON STEREO) Wait. We shouldn't We shouldn't be doing this. What? You're not having fun? It's not that. I just Rather be with the boys? No. Well, then come on. (BANGING) You kids need any help? No. No, we're fine. Car trouble? No. Then why are you here? We're just talking. Does she do all the talking? Most of it. I know what that's like. I'm gonna come back through here in 10 minutes, and if you're still here, I'm gonna call your parents. Yes, sir. Thank you. Now, where were we? We were going. In nine minutes. Wait Stevie? What's wrong? Oh, my God! Help! Someone help me! (WATER SPLASHING) Sixteen-year-old with respiratory arrest. The only thing I hate more than a thief is a crippled thief. Yeah, me, too. No sign of trauma, no history of asthma or Who the hell is J. Whitner? No idea. Stevie Lipa's EKG and echocardiogram were normal, but Normal is good. Send him home. J. Whitner, doctor. Who is he, and where do I find him? She's the new researcher, works with Ereshevsky. Is she hot? She's in a wheelchair. Doesn't mean she's not hot. Just means she can't bend over, so Cuddy has to bend over backwards. Sixteen-year-old kid. ER workup revealed a bloody pleural effusion. That's odd. Yeah, that occurred to me. What took you so long to mention it? No tumors or pneumonia on the CT. He passed out while making out. If he's into sex, drugs and rock and roll can't be that far behind. I'm guessing ***. Tox screen was clean. Just means he wasn't on drugs, not that he hasn't been using drugs. Looks like a plumbing problem to me. Leaky pipes. If he popped an aneurysm, he'd be in the morgue, not the ER. That's why you're gonna do a venogram instead of an arteriogram. This is not a high-pressure burst. It's a low-pressure leak. Still could've been drugs that caused the pipes to corrode in the first place. So go look under his mattress. See if he's got any pills or powder stashed with the hand lotion. Sweet ride. I asked for the one with the sissy bar and the banana seat, but Santa gave me this instead. Guess that's what I get for being naughty. You must be Dr. House. Yeah. So looks like there's been some sort of mix-up at the parking office. They had to move me closer to the door. Had to? You don't look like the type to pull a weapon. Wheelchair. Cane. I think you should do the honorable thing and let me have my space back. Oh, well, since you asked so nicely, wheelchair. Cane. Walking long distances makes my leg hurt. And it's easy for me? Of course not. Pushing that little lever? The muscles must burn. I'm sure the last 10 yards are pure torture. Crossing the parking lot is dangerous. Cars can't see me. You ever hit a patch of black ice with a cane? No, gosh, on account of the fact that I can't walk. Maybe you should ask the parking office for some crampons. This is about who can most easily cross the parking lot. You're the winner. Oh, and the prize is apparently a parking space. There's still no answer at either one of your parent's cell numbers. Is there any other way we might be able to contact them? No, they're in a conference. They probably had to turn them off or something. What does it matter where they are? I mean, he's in pain. You gotta do something. We need them to sign this. Why can't he just sign the papers? He's 16. Still not an adult. Then call my parents. They know him, and they'll take responsibility, do whatever you need. I can't. It won't You can't just let him sit here in agony until his parents finally decide Leah, it's okay. No, it's not. I feel like there's an anvil sitting on my chest. (MONITOR BEEPING) You win. I'm doing the venogram now. We'll deal with the fallout later. (COUGHING) My fingers feel wet. That's just the dye. Your nerves can't tell the difference between the cold inside your body and the wet outside your body. The nerves can't tell the difference, or the brain can't interpret the difference? A little of both. You like science? Looks like a diffusion pattern. That's because it's the venous side. Low pressure. So Graham's law applies. You've taken physics already? No, I just sort of read up on my own. I had to teach myself a lot of stuff, too. Schools sucked where I grew up. You go to public or private? Public. Leak has to be in the pulmonary veins to get in my lungs, right? Yep. I don't see anything. Do you? No. It doesn't make sense. How can I have a bloody effusion without any bleeding? (COUGHING) This is putrid. Put food-borne parasites and infections on the list to check on. I'll take the bedroom. Oh. Sorry, I didn't know there was anyone. We were just Oh, God! I have a gun. Look, you can take whatever you want. My wallet's in my suit. Freeze! Freeze! I'm calling the cops. Okay, you don't have a gun, and you're not calling the cops. Oh, no, I'm calling the cops unless you two get out of here right now. "Unless"? Who calls the cops unless a burglar does something? You don't want to have to explain the affair. We're not having an affair. He's got a ring. You don't. And judging from the state of the kitchen downstairs and the half-vacuumed bedroom, I'm guessing you're a better lover than you are a maid. Maid? You son of a ***. I'm not a maid, okay? This is my house, not his. Sorry. And what's wrong with my kitchen? Nothing. We're sorry. We're just here to help Stevie. Who's Stevie? Your son? It was the address you gave. The ER must have written it down wrong. Or you lied because you don't want us to talk to your parents. I gave you their phone numbers. You gave us some numbers. We haven't been able to reach anyone. I told you, they must be in a conference. He's lying. Leah. He's Romany, a Gypsy. So you don't have a home? Of course we do. What, next you're gonna ask me about dancing around campfires and stealing children? This is why I don't tell people. They share everything with each other and nothing with the gadje, the outsiders. Sharing information with outsiders has not gone so well for my people. Right now you're making yourself more vulnerable by lying to us. You can't go to my house. You'll pollute it. All we're gonna do is look around. Your presence is enough. My parents take it seriously. It's spiritual as much as it is physical. You know where he lives? Don't. Look, I'll tell you whatever you need to know. If we can't trust your answers I drink sometimes, okay? I've smoked pot. I'll tell you anything, the truth. You just You can't go in my home. The pot wouldn't cause a bleeding problem. A pesticide on the pot could. Where did you get it? Some kid at school. Stevie. He got the pot from me. He doesn't even go to school. His parents made him drop out. I'm home-schooled. He reads books. What else are you lying about? Is your father really a professor? He's a salesman. They buy and sell anything they can get their hands on. They? So you're with your dad when he's making these deals? He was just in Chicago a week ago. You fly? No, my dad's got a truck. You can't be serious. Actually, I can. See? It's my space. I want it back. It's not your space. It's the hospital's space, and the hospital thinks that the person who's worse off should get the better space. Your application for a handicap space says you can walk 50 yards. And Whitner's says she can roll 50 miles between oil changes. I can't change my leg. The space I moved you to is only 46 yards away from the front door. I measured. You'll be fine. Great. So I can collapse four yards into the lobby instead of outside in the cold. As long as it's not in my office. Do you know who won the New York City Marathon six years in a row? Guy in a wheelchair. Then go get yourself one, and leave me alone. Give me my space, I'll be happy to roll around all day. You couldn't last one week in a wheelchair. Wanna bet? What's wrong with you? Nothing that a week off my feet won't solve. Venogram's negative. No leak. You mean you couldn't find the leak. Is your leg worse? No, my parking spot is. Blood is only made inside the circulatory system, which means when we find it outside There's no leak. I even checked lymphatics. So you're gonna spend a week in a wheelchair just to get a parking space closer to the front door? Easier than chopping off my legs. We've ruled out toxins and drugs. Kind of. He's Romany. Apparently, they feel the need to keep secrets, so it's hard to know anything for sure. Yeah, he's also a human being, which means you shouldn't be trusting him to begin with. Stop relying on his answers and find some on your own. It's a deep-vein thrombosis. The kid spent 16 hours in the back seat of an old pick-up. Causes a clot, makes its way to his lungs. We should do an arteriogram, find the clot, bust it with TPA. Or we can find the leak. There's no leak. Hey, you can't yell at a guy in a wheelchair. This is a slow leak. You've got to speed it up. Thin his blood. Redo the venogram. That could cause a massive bleed. Excellent. Massive will be even easier to find. Pardon me. I guess you guys are gonna have to get the next one. I thought you were redoing the venogram. As soon as we're done with the arteriogram. Okay, you're gonna feel a little poke. Can you maybe do that? Don't worry. It's just your leg. I don't have to go any further than this. Take a look at this, bones of your forearm. Radius and ulna. How about the wrist? Lunate, hamate, the "Scared lovers try positions they can't handle. " It's a mnemonic for the wrist bones. It's the only way I can remember them. (GROANING) FOREMAN: You okay? My stomach. Did you hit something? I barely started. Lie flat. No, I can't. It hurts too much. I'm getting out. It's our only chance to see what's going on. If he moves, I could shred his artery. Get it out now! It's gonna be okay, Stevie. Just inject the dye. Dye's going into his liver, but it's not coming out. Clot's gotta be constricting the flow in the hepatic vein. It's not constricting it. It's completely blocking it. His whole liver's fried. The kid's liver's failing because of a massive clot that's blocking his hepatic vein. How can he have both a bleed and a clot? It's not a clot. You must have blocked the vein with a catheter wire. Not a chance. Increased pressure downstream could also stop the blood. There's no heart failure or cirrhosis. Means it has to be a clot. Massive clots block veins. They don't make them leak. And since he clearly has some kind of You having a little problem? Would you mind? Boy, that was humiliating. How does Whitner make it through the day? "Pride goeth before the fall. " Lucky for me, I'm sitting in one of these babies. So what other theories can I shoot down? DIC would explain both the His platelets are normal, and his PTT isn't elevated. Leukemia? Normal CBC, and differential? You guys are still thinking like doctors when you should be thinking like plumbers. Come on, I wanna see some butt crack. Something inside the liver is punching holes in the pipes. Blood bleeds through the opening, sticks to the intruder, forms a mass. A clot. A mass. Cancer? A tumor could erode a blood vessel. Well, so could a granuloma from tuberculosis or sarcoidosis. Do a CT, MRI, sputum and ACE level. Excuse me. Sorry. Cripple coming through. He says his throat hurts. That phrasing means you think it doesn't. No, I don't. Good enough for me. Where are you going? Mothers know best. Get yourself a sucker on the way out. Look, I think he's just faking so he doesn't have to go to school. How did you know I was a truant officer? I told him he had a choice, go to school or the doctor. Right. He's wasting your precious time, so you decided to waste mine. How thoughtful. I'm in a wheelchair, so I can't examine him all the way up there. Hop down. My life is just one horror after another. Open. Does it look like it hurts? No. What's that? Syringe. I'm with you. Make him hate the doctor's office more than he hates school. That's okay. I don't think that's It's just saline. Hurts like hell when it's injected directly into the muscle. So what do you think, arm or ***? I think he's learned his lesson. Oh, I don't know. We better check. Jack, is your mommy a big, fat idiot? Well, what do you know? I guess you were right. Just hold still, Stevie. This shouldn't take long. Sorry, I'm guessing the mike in this thing doesn't pick up nods. Smart kid. Too bad it's all gonna go to waste. Nothing wrong with being a salesman. He should be able to pursue his own life, not be stuck helping his parents sell old toasters. He's still young. You never know what he'll end up doing. Unless he goes back to school, I know exactly what he'll end up doing. Wait. A lesion? CHASE: Magnifying times five. CAMERON: It's a granuloma. It means Wegener's is the most likely. Stevie! Mom, is that you? Get him out of this now. Your son is sick. The sign on the door The sign says, "No metal. " We took everything off. It says, "No admittance. " What's wrong with our son? We don't know yet. He's not gonna die, is he? Your son is very ill. We're still trying to figure out why, which is why we need you to leave the room. What are you gonna do now? Oh, now I've got to slide my butt from one padded seat to another. What if I bump my knee? MRI showed a granuloma in his liver. Fantastic. Wanna give me a hand here? No. Clotting, bleeding and a granuloma equals Wegener's. I know. That's why I said fantastic. I was being sincere. Now, give me a hand. Wouldn't be fair. We're gonna biopsy the liver to confirm. Wouldn't be fair not to. People are good and kind and gentle and help people in wheelchairs. You don't believe that. But you do. No, I don't. Foreman, forget the biopsy. His liver will be gone before you get the results. Start treatment with cyclophosphamide before the Wegener's punches a hole in another pipe. What's with the clothes? You're not being discharged. I know. It's my parents. They insist that I wear this stuff. We insist on our on food, gown and furnishings for a reason. Hey, my chest burns. Are you sure the treatments are working? Wegener's causes the body to attack itself. That doesn't get undone overnight. Be patient. Where's your soup? It's in the garbage. It has willow-bark extract. Willow-bark extract is basically aspirin. Yes, for the fever. He's already on meds, our meds. We can't risk any adverse interactions. We need all this stuff to go. We need to control this environment. So do we. People get sick for a reason, 'cause something in their life is out of balance. Dad, he's a doctor. He doesn't want to hear your talk. Balance is just starting to be restored now that that girl is gone. That girl took pretty good care of your son while you were away. Yes, we can see that. Look, all this stuff may make him feel more comfortable, but it's not gonna How long is this treatment gonna take? We should start to see some improvement in his liver function soon. Soon. Very scientific. I'm sorry. I'll be back in a little bit to check on you. Ah, yes, if it isn't Dr. Ironside. Ah, if it isn't Dr. "I Had No Friends When I Was Growing Up, "So All I Did Was Watch TV by Myself, "Which Is Why I Can Now Make Constant Pop-Culture References "Which No One Understands but Me. " That's my name. Don't wear it out. (EXCLAIMS) Safe from Cuddy, but I guess not from her trusted rat-complice. Reasonable people don't debate the relative merits of their handicaps. Reasonable people make rules based on evidence, like difficulty covering a distance, say, 50 yards, not on some preordained patheticness scale. Last I checked, pigheadedness was not the eighth heavenly virtue. It's only pigheaded if you're wrong. If you're right, they call it, "Sticking to your principles. " Give it up. You're demeaning yourself. That's what they told Rosa Parks. Don't stand up in there. I'm watching your feet. Get out of our home. This is not a home. It's certainly not It's our home as long as our son is here. Mom, Dad, will you please just calm down. You're not family. You have no right to be here. What are you gonna do? Throw me out? You can't even touch the gadje. I'll touch you. What is going on? I'm the one who brought him here. I should be able to see how he's doing. He wouldn't even need to be here if it weren't for you. Right. I'm so unclean, I caused his liver to shut down. Enough. No one is leaving. He's our son, and we want her out of here. (GROANING) It hurts. It's your stomach again? No. What? FOREMAN: His liver's actually improving. We plug one hole and end up poking another. Are we talking about the patient or how to get a raise from Cuddy? The Wegener's treatment gave him a massive hemorrhage in his bladder. Which means it's Wegener's. What did I just say? We were treating him for Wegener's when everything went wrong. Not everything. Yeah, it was a very lovely day outside. On the other hand, the treatment made him worse. Treatment made his bladder worse, not his liver. Clot in the liver's breaking up. And MRI, sputum and ACE ruled out TB, sarcoidosis and lymphoma, which leaves us with Still could be a cancer with multiple A cancer we can't see on MRI, CT or blood tests? It's Wegener's. It's not the wrong diagnosis. It's the wrong treatment. We could increase immunosuppression. Add methotrexate. We can't give methotrexate to a kid who's already had lung problems. Methotrexate is carpet bombing. Hits everything. We need a smart bomb. We don't suppress the immune system. We change it. Immune modulation. FT28. His antibodies are attacking his blood vessels. The irritation causes it to bleed and clot. We change his immune system so the antibodies don't interact with his blood vessels but work fine everywhere else. FT28 is still experimental. It's not FDA approved. It's worked for Crohn's disease and rheumatoid arthritis. He doesn't have Crohn's or arthritis. Let's say that he does and start the treatment. Absolutely not. My people have been experimented on before. Never again. Mister Lipa, with all due respect, comparing this hospital with Auschwitz, it's ridiculous. FT28 has been proven safe in hundreds People always say you can trust them. Why would they say anything else? Why do they think we would listen? You think I don't understand what it's like to come from a people who've been enslaved, mistreated and experimented on? Tuskegee went on for 28 years after World War II. And the laws that made it illegal for the Romany to even set foot in this state were still on the books until 1998. It's not ancient history. Conventional therapy hasn't worked. Your son may be dying. He needs a targeted approach, and you need to trust us. I'm sorry. A lifetime of experiences tells me I can't trust you, and the past three days have done nothing to change that. We want our son treated, not experimented on. If you don't know how to do that, then just tell us, so we can take him someplace where they do. They're absolutely right. Stay away from that unproven, experimental stuff. Much better to stick with the "moving the furniture until he gets better" approach. Yes, you're right. We're gonna have to come up with something else. Do you mean another last-ditch, desperation move? You got anything? Go back and don't take no for an answer. What kind of salesman are you? The kind who avoids the house with the crazy couple who put tin foil over their windows. They got money for tin foil, they got money for whatever you're selling. What's that mean? It means that if they don't trust you, you should earn that lack of trust. What does paying for tinfoil mean? Why should I have to answer all the questions? Oops. Sorry. Still getting used to the power steering. I assume you've heard the news? I'm not worried. From what I hear, what you lack in shame, you also lack in willpower. My will may be weak, but my backbone is strong and pain-free now that I've stopped using the cane. Of course, it's harder to look down Cuddy's shirt, but then the vantage point on her *** has much improved. Then that's just me, always looking on the bright side. I'm the guy who said that her C-cups are half full. They are nice, aren't they? Oh, no, no, no, you're not gonna win me over that easily. You may have a wheel. It doesn't mean you get the grease. You gotta squeak. What's that? It's cyclophosphamide. We're continuing the standard treatment as you requested. I have to ask everyone to leave the room for a few minutes while I apply some bandages. Why do we have to leave? They're for his ***. You lied to them. The bleeding's stopped. I don't need any bandages. I need to change your treatment, but your parents won't let us. They've got it in their minds that we want to try some sort of inhuman experiment on you. The treatment's experimental? FT28 has been through extensive clinical trials. It's also been used successfully for other conditions. The fact that you're recommending experimental treatment means you have no other options. Sorry. We stop the pleural effusions, your liver almost fails. We save your liver, the bladder fails. If we don't get ahead of the curve on this What do you need me to do? Take the medicine, but don't tell your parents. I don't like lying to my parents. The rest of the world, though The rest of the world I can't trust. You can trust me. How do I know? Because if you do this, then tell your parents, I lose my license. (GROANS) God. Get in here. Wow, his spleen basically exploded, huh? Got another bleeder. Got it. I believe you ordered your meat rare. Keep him open. If I confirm Wegener's, might as well stage the disease while he's still on the table. What's taking so long? External capsule's ruptured but still intact. No signs of a clot or a bleed. Normal follicles, normal lymphoid tissue. His spleen is ripped to shreds. There's gotta be granulomas. Keep looking. Come on, can't leave Humpty Dumpty like this forever. I don't see anything but normal spleen. No granulomas. Means no Wegener's. That's all I need to know. Let's go people. Run his bowel. No need. I'm closing. Suture. Run his bowel. Nothing suspicious in the spleen. Get him out of here. You missed it. He had a granuloma in his liver. No, it was just scar tissue. Looks like a granuloma on the MRI, but it's not. I don't know why I'm debating this. Pass me the Kelly clamp. I'm closing. Not unless you're gonna sew my hand into this kid's stomach. Get out of there. He's unstable. He's got Wegener's, which means he's got granulomas. I'm calling my lawyer. It's only 26 feet. If you were an ostrich, you'd have a 46-foot wait. (BEEPING) Blood pressure's dropping. Hang another bag of Ringer's lactate. I'm having nothing to do with this. Foreman, hang another bag Ringer's lactate. Got it. Come on. Come on. It's gotta be in here. It's gotta be in here. It's not. Mind if we close? It's a good thing we never sold him on FT28. His parents were right. There's no way his parents are gonna let us near him again. They won't be able to transfer him until he's recovered from the surgery. You can add the surgical team to the list of people who won't let us near him. Bleeds, clots, bleeds, clots, spleen explodes. We should test for Von Willebrand's. Or just play tic-tac-toe. Okay, X's are bleeds. O's are clots. We started in the lungs, right? What did we do? CT, sputum, two venograms. It's one bleed, one clot, then what? Liver shut down, MRI, labs, treated with cyclophophamide. Whereupon he peed out three units of O-negative, another bleed. Where is this going? I don't know yet. What's next? Bladder, kidneys. High-resolution CT scan, UA and urine sediment. GI tract? You ran his small bowel in the OR. The large bowel's fixed to the abdominal wall. I didn't run that. Because there was no reason to. He hasn't been having any symptoms in his bowels. Do a colonoscopy. Because he's had no symptoms? You lose your keys, the first thing you do is look everywhere you might logically have placed them. When you don't find them, then you start looking in other places. The medicine cabinet, freezer, mailbox. We need to look in this kid's mailbox. Why don't we x-ray his feet? They're fine, too. Because we need to take the center square to block. Okay, even if that did make sense, it's kind of hard to do a colonoscopy on a kid you can't get near. He's in the ICU now. His parent's only have limited visiting privileges. I like that kid. He's got ***. Can't talk now. On guard duty. You're still in that thing? What thing? Oh, this? Forgot it was even there. You know, even if you manage not to get struck down by a bolt of lightning, and make it a week, Cuddy's not gonna give you the space. She can't. A bet's a bet. Yes, and that rule outranks the Americans with Disabilities Act. You think you've got logic on your side, but Whitner's got the legal system, and legal beats logic every time. Just ask OJ. You're right. I am? Yeah. So you're doing this even though you know you've got no legal leg to stand on? Who needs legs when you got wheels? I'm gonna get that spot. No way Cuddy is going to gyp me. What did you say? I'll see you later. Gonna have them yelling at me for the next 20 minutes. Mucosa looks normal, healthy. No lonely diverticula. Blood pressure's dropping. He's bleeding again. CHASE: I'm in his colon. Hurry up. I am. There's nothing there. Wait. Wait. What's that? A reflection? No, it's something. Looks like a Toothpick. Are you sure? He must have swallowed it accidentally and just figured he'd digest it eventually. When you two were making out in the car, he must have folded awkwardly, pushed the toothpick through the wall of the intestine and into the lung. Then it moved on to his liver and made its way to his bladder and spleen. So that's it? He's gonna be okay? Yeah, small holes. It shouldn't take that long to heal now that we've got it out. See? See what you did? Me? If you hadn't been kissing him That's what you heard? It was the toothpick. It was that disgusting habit that you It would have just passed right through him if he hadn't been writhing around. Isn't that right That's it? Yeah, that's it. Wood absorbs water, becomes the same density as the tissue around it. That's why it didn't show up on the CT or MRI. That's cool. I mean, not cool for me, but a lot of damage for something so small. You know, the lab here, they have a paid intern position. It's usually given to one of the kids from the universities, but if you want, I could probably get you an interview. You know, some entry-level stuff, some gopher work, but you'd also have access to a lot of cool things. Thanks, really, but I can't. Yes, you can. Stevie, you're bright. You have more curiosity than 90% of the doctors on this staff. No, it's not that. It's just I go to work every day with my family, you know? People I've known my whole life. I don't want to lose that. You can have both. No, I can't. Because they don't want to let you. They shouldn't be making you choose. Maybe not, but they are. I'm choosing them. Change is hard. Trust me, I know. But it worked out for me. You're a successful doctor. Your name is on journal articles. I would love that. It's just I see you with Doctors Chase and Cameron, and you all got empty ring fingers. You're alone. (LAUGHS) This is my last day living a life of leisure. So are you gonna tell Doctor Whitner she's out of my space, or can I? Why would I do that? Because you said that you would, and lying is wrong. I said I would give you the space if you made it a whole week Which I Didn't. The bet didn't stipulate that you had to be in the chair for a week unless you had to barge into an operating room and shove your hands in a kid's bowels. You know about that? You lost. I saved a life. Two minutes out of the chair to save a kid's life. You lost, House. I earned that space. No, you didn't. I earn that space every day I limp into that building and do my damn job. You lost. Hey! You were never gonna give me that space, were you? I saw Whitner the other day. She knew about the bet, didn't seem that worried. She knew I'd win. She doesn't know me. In fact, she doesn't know anything, except what you tell her. You told her that you were never gonna give me that space, didn't you? Just tell me, do you at least feel a little guilty? You wanna teach me lessons, don't make commitments you can't keep. How's it going? How guilty does she look? About an eight. That space is mine. Vini, vidi, vinci. 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