House MD S3E22 - English Transcript

(BOTH GRUNTING) She almost took my head off. Your fault. You didn't guard your left side. Point. Stop, stop, stop! Addie, you're bleeding. I never even hit her. Good morning. This is funny. People don't Not done reading. Go away. Most likely, she coughed it up. Which would mean it's from her lungs. Drugs, toxins, infection No fever and no elevated white count. Which rules out infection. And blood panels found no drugs, no toxins. The bronchoscopy was pristine. So much for the lungs. Good morning. Not yet. So then, the blood came from her stomach. Which would mean it's an ulcer or a GI bleed. ER also did an upper and lower GI. No occult blood in her stool. Which means no ulcer or GI bleed. Which means it's not from the stomach, either. Which means it didn't come from anywhere. You guys get to the point where the blood didn't come from anywhere? Rupture in her sinus cavity? Drip through the back? Not that much blood. Trauma from karate? No trauma. She kicked the other guy's ***. Now a good time? If you can tell me how blood can mysteriously appear in a Now. This includes you. What's going on? Feel free to speculate amongst yourselves. Are you sure? Yeah. Why? He's afraid of turning into me. Well, that's a good enough reason. Sign here. Doesn't look promising. Good luck. Thank you. That's it? You're not going to tell him that we're a family and families don't abandon each other? You want me to? No. Would it make any difference? No. Good luck, Dr. Foreman. So, where were we? College sophomore coughing up blood. Not the case. The speculation. The palace intrigue. The rising self-doubts. HOUSE: Did Foreman get a promotion? I resigned. What? Personally, I can't believe I've had the same three employees for three years. Patient could have a heart problem. Yes. Life goes on. Look at the eager beaver combing his hair. Hyper-dynamic heart could force too much blood into her lungs. She coughed up the overflow. Wouldn't leave a trace in her lungs because it's traveling through normal plumbing. Foreman, go do a stress echo test to see if he's right. Cameron? Check out the dorm, then re-do the ER labs. I'll get going on Foreman's farewell party. Everybody good with a "Mermaid Under the Stars" theme? So, why are you leaving? Or is it just some sort of power play? You can have my parking space, my locker. Is it about House? Let me get all sensitive and confide in you. Addie? Pedal harder. Need your heart rate at 170. Why wouldn't you want to tell me? I don't like you. Never have. Never will. You want me to share some more? Even if you do hate me, if you'd found another job, you'd tell me. If House did something to drive you out of here, you'd tell me. The fact that you won't tell me means that whatever the real reason is you're ashamed of it. ADDIE: Guys? I'm at 170. Pulmonary artery looks good. It's not a heart problem. Are you cold? No. Scared? I'm okay. Why? On your arm. Addie has goose bumps. No recovering from those babies. You don't have goose bumps for no reason. They're a reaction to the body thinking it's cold. She wasn't cold. Her temperature was normal. But her body thought it was. Which means What? A brain problem? A messed up hypothalamus could cause goose bumps but they're not going to cause her to cough up blood. She has no neurological issues. She had a shiver. I think there's an infection. We've ruled out infection because no fever, no white count. I think there's an infection. Blood goes where it's needed. Infection likes nice, wet places. Her lungs. Start treatment. All that cool stuff for bacterial, fungal, and atypical infections. Get a lung biopsy. I want to see the little *** up close. Why is Foreman quitting? He wants to breed llamas. Interesting. You're ashamed of the reason, too. No one writes tamoxifen like you. Well, I use a "G. " Foreman resigned. I'm sorry. It's okay. No biggie. Right. He give a reason? He said he didn't want to end up like me. I had a brilliant retort. I can't remember what it was at the moment. You don't want to end up like you. Good point. Can I resign? What's up with that? With what? You yawned. I just told you something interesting, so you're not bored. It's 11:00 in the morning, you're drinking coffee, so you're not tired. I didn't yawn, so it's not a mirror-neuron reaction. Which leaves symptom. Vasovagal issue, maybe a heart problem. My heart's fine. I was up late. You're just deflecting having a conversation about Foreman. I'm okay with Foreman leaving. Either you're lying, or you don't really think he's leaving or you just jumped right to acceptance. I'm sorry. I yawned because I was trying to communicate boredom. You could try bargaining with him. Give him a raise. How much do you think it would cost to make him want to be like me? Thanks for the coffee. She seems fine. She is fine. She coughed up blood. Past tense. She has diarrhea. From the antibiotics for the infection. Lung biopsy says she doesn't have an infection. Well, then, you screwed up the biopsy. Or you're wrong about infection. If I'm wrong, then so is her body. Because it obviously thinks she's got an infection, or it wouldn't have gotten better from the antibiotics. What is pandiculation symptomatic of? Yawning is a symptom of fatigue or cholinergic excitation. Does this have anything to do with Addie? Let's say yes. Cerebral tumor, epilepsy Could also be a medication reaction to antidepressants or some meds for end-stage liver failure. Let's say no. You don't want to leave this job. Three years you've been here. You've never once laughed at anything he said. Because I wasn't kissing his ***. But now, you are? No. Now, you're nervous. Uncomfortable about your decision. Wasn't even that good a joke. Oh, crap. Most of your jokes are excellent. I just meant in comparison. Shut up. I think she may not have an infection. Better deal with her before she crashes. She can't breathe. Get off the bed. Need a crash cart. What's happening? Let's get her down. Now. Pressure's collapsing her lungs. She's not getting any air. Oh, my God. CHASE: She couldn't breathe because she had a pleural effusion. Thoracentesis revealed low protein count, effusion was transudative, which means she has cirrhosis of the liver, or she's in heart failure. Heart was fine, liver enzymes were normal. There's something called "blude" in the pleural effusion. Oh. It's not "blude," it's blood. Which is great. Not for her, but for me. Because it means I think it's an infection. Labs indicated minute traces of blood. You can't ignore the blood because it's a minority. Can you, Foreman? If we count the traces of blood as significant, the differential isn't just infection. Could be lung cancer, breast cancer, lymphoma Great. Go tell her she's got one of those. Or you can tell her that we haven't given her enough antibiotics for her infection. Double the dose. Then check her lungs. We checked her lungs. They're clean. On the outside. She needs an arteriogram. It's about my bowel movements. What isn't, these days? You sure you want to be here for this? We do everything together. Of course. A toilet can be a lonely place. Drop your pants. I'll suit up. They float. Huh? My bowel movements. Honey says they're not supposed to? I'm a nutritionist. Yes, I could tell from the cool toe-loop sandals. Thank you. You're welcome. And the natural fiber clothing, I assume, means some kind of vegetarian denomination? We're vegans. At first, I was a little concerned about the lack of protein but Honey showed me you can get it from lots Well, whatever floats your poop. And you've been together how long? Six months? How did you know? Because after six months, poop love fades and if you'd been together shorter than that, then I'll explain right after this break. Three 10-milligram pills of your finest amphetamines. Arteriogram was normal. CHASE: Which means her lungs are fine. What if the clear arteriogram is significant? It is significant. It means there's no infection. I think there's an infection. CAMERON: Infections don't come and go. People don't get better then worse on the same treatment. Unless her body can't finish off the fight. Maybe goes a couple of rounds, then gives up. Why would it give up? Maybe its name is Foreman. Come on. Where's that smile? That laugh that makes the whole world sunny without contributing to global warming? Maybe she's missing a protein. Blood panel and enzymes show her proteins are normal. You can't have tested for every protein. I can think of at least one you can't test for at all. Complement factor-H deficiency. If she has that, she's dead. No way to fend off bacteria. She'll get one infection after another until her body shuts down. Maybe we can get ahead of the game. Manage each symptom as it comes up. Give her five miserable years instead of six miserable months. There's no diagnostic test for complement factor-H deficiency. So we isolate the cells that are yummiest for it. Stick a needle in her eye. You're cheating on Honey. What? No. I'm not. Oh, yes, you are. It's okay. I get it. Well, I was going to say relax. But, oddly enough, you seem pretty relaxed already. You're accomplished. You're funny. You can have whatever you want. Women are gonna He's not cheating with another woman. He's cheating with another food group. What? His floaters float because they're full of fat. Probably had a big cheeseburger for lunch. You're eating flesh? It's just a hamburger. Not all the time You're disgusting. Soy cakes taste like cardboard. Unsalted cardboard. I'm accomplished. I'm funny. Can I have whatever I want? Can we wait a second? What's wrong? I feel good. Do you really need to put that needle in? You felt good yesterday, and then you almost suffocated. And you know that, that thing is in my eye? We think it could be. If we find it, the hope is that we can treat it. You hope? Mom. Don't hang on every word. He said he hopes. That means he doesn't know. I just want to understand what's going on. We won't know anything until we do the test. Addie, this all looks really scary, but you'll feel nothing. Okay? Okay. You rang? You called me. I bought you an espresso. You've been buying me coffee for a couple of weeks. I thought I'd pay you back with one. How did you walk with the cane and the two coffees? Why are you suspicious? Because it's either that, or accept the fact that you've done something nice. And then I have to deal with the horsemen and the rain of fire and the end of days. You think I spat in yours? Or worse. I stacked them. What do you think of me hiring a nutritionist instead of a neurologist? I mean, they sound almost the same. I take it you've met a hot nutritionist. Don't cheapen this. We had an in-depth conversation about proteins and fats. I was about to examine her boyfriend's ***. You asked for a date while your finger was in her boyfriend? I got her number. No. No. No way. This is an employment application. She doesn't want to go out with you. She's looking for a job. Oh, God. She's 26. But with the wisdom of a much younger woman. Have you spoken to Foreman? Several times. We laughed You're going to lose him. And that will be depressing. But it will only make me appreciate all the good things that I do have. Macular biopsy was negative. Which means you're wrong. There's no complement factor-H deficiency. Most likely cause of altering blood flow in the brain is a clot or a tumor. We can rule out a clotting issue because she has a bleeding issue. Which means we should be looking for a tumor. I think there's an infection. Just 'cause the cells in her eye aren't dead yet doesn't mean they're working. So, why did we do the test? Because if it had been positive, it would have proved I was right. But negative doesn't prove you wrong? That's the beauty of the test. She needs an MRI of her brain. Absolutely. As long as you're scanning, you mind having a boo for an abscess for something caused by an infection? I didn't expect House to beg me to stay. But it seems like he's in a better mood since I quit. Nothing in the axial view. You haven't asked me why I'm leaving. I figured you'd tell me when you wanted to. I don't want to be like him. You're not a jerk. Thank you. I mean, sometimes you are. But I don't think we can pin that on House. And you're a better doctor than when you came through the door. I'm better at some things. Worse at others. Again, not House's fault. It's a job. We're supposed to take the good and leave the bad. It's easier for you. Why? Because you think I need to toughen up? You think I'm weak? Yeah. See? I am a jerk. I've got to get out of here. (ADDIE GROANING) What's wrong, Addie? My head hurts! Her brain's clean. No tumor and no abscess. We're all wrong. My head! (SCREAMING) My head! My head! Grody. Looks like massive tissue death. Who cares? Her head blew up. How cool is that? CAMERON: It's not ***. Meaning you don't think it's an infection and you'd be right, if you weren't wrong. Here we go again. She's got infections that come and go. Which means It means it has to be something else. Good guess. But no. It either she's got a leprechaun in her colon, which is playing with the doggie door, letting bacteria in and out, or she's got complement factor-H deficiency. You enjoying this? I'm saving a woman's life. I'm saving a woman's life! Actually, I'm diagnosing her. Technically, I'm diagnosing her with something that's going to kill her. But, other than that, I'm saving her life. An autoimmune problem makes more sense. You can't explain a transudative pleural effusion with giant cell arteritis. You'd need three whiteboards and 100 different colored markers. No, it's much more likely she has an invisible protein that allowed bacteria to arbitrarily invade her lungs then arbitrarily invade her pleura, then arbitrarily jump into her head. If it's autoimmune, she can live. But we have to give her steroids, now. Before her heart ruptures. If you're wrong, and you give her steroids she dies, now. Foreman. Want to run down how it feels to go with your gut and kill a person? You can get into the whole spiraling out of control, and the self-doubt, and the resigning thing. Do it. Worst that can happen is you quit. Cameron, want to explain to the parents why you'll be holding paddles while he's doing it? Because if her heart goes "boom", it will "boom" right away. She really has to be awake for this? If there's a problem, she could tell us what she feels. Relax. We're scared. I don't want you to be scared. Then, get better. Okay, sweetie? We love you. I'm sorry. Ready? Ready. My patient's about to have a heart attack. It's going to be massive. Oh, wow. That's too bad. Because I just got tickets to a stroke on the third floor. Have you had a conversation with Foreman? Do me a favor? You haven't. Because then you would have to confront your own emotions. Is bile an emotion? Because I definitely feel something here. Get me some liquorice. This is going to be the best heart attack of all time. Oh! Wait, wait, wait, wait! She's going to shock her. There's always tomorrow. You wanted to see me? Pretty sure the label is straight. Are you really going to leave? Where are you going? You lined up interviews yet? I'm not sure. You're pissed at House. I get it. You're symbolicating killing him. Symbolicating. What? Symbolicalating. Gosh, that's a hard word. Are you okay? Hey, I'm not the one I'm not the one I'm not the one pretending to kill someone. What would it take for you to stay? Is it money? He wants you to stay. He said that? If I said he said that, (PHONE RINGING) Would that make a difference? Are you sure you're okay? Hello? I'm leaving now. I'm late for a breast thing. You know he wants you. You know he's good. You know he can make you good. I don't know what I'm saying. You know I don't You know what I'm saying. And you know I'm right. I've got to go. Sorry it took me so long to get down here. I'm Dr. Wilson. I guess Dr. Stein is gone. Don't worry about it. I'll talk to him when we're done. Dr. Stein said they're probably calcium deposits. But with your medical history, you don't want to take chances. I can't seem to put my gloves on today. That's weird. Okay. Well, that's fine. One's enough. Well, let's have a look. You sure talk fast. This is nothing. You should see me when we're busy. I just winked at you. I just I've never winked at a patient in my life. I have no I am so sorry. I have no idea what I was thinking. It's okay. No, it's not. I was hitting on you. I mean, I wasn't I wasn't consciously hitting on you, but I What else could you think? That you were being reassuring? Yeah. That would make sense. On the other hand, I I feel like my heart's going to explode. Are you okay? I feel a little sweaty. Am I sweating? Yeah. Is something wrong? I can't I put on gloves to do a breast exam. Perfect. Sorry. It's 185. One eighty-five. One eighty-five? Excuse me. I have to go kill someone. (BANGING ON DOOR) You dosed me! Yes, I did. But only because you didn't trust me. Your best friend! You could have killed me! Amphetamines aren't going to kill you. You don't know my medical history! I could have I could have You could have given me a heart attack! A heart attack is not going to kill you. You were in a hospital. You yawned! You tried to kill me! I put you on uppers and you still yawned. Means it's a symptom of being a big, fat liar. Yawning is a side effect of some anti-depressants. Apparently, the ones you're on. I'm not on anti-depressants, I'm on speed. That means it's a symptom of a cerebral tumor. You got six weeks to live. Mr. Well-adjusted is as messed up as the rest of us. Why Why would you keep that a secret? Are you ashamed of recognizing how pathetic your life is? It's not a secret. House, it's It's It's personal. How long has it been personal? It's personal. Yawning is recent. So, either you just started, or you changed prescriptions. This is why I take them. They're anti-depressants, not anti-annoyance-ants. You'd think this would naturally come up in conversation. Oh, don't act hurt. You don't care. On one of the occasions when you were pompously lecturing me on what to do to fix my life. You wouldn't take them. You'd rather OD on Vicodin or stick electrodes in your head, because you could say you did it to get high. The only reason to take anti-depressants is because you're depressed. You You have to admit that you're depressed. Give me. Are you going to admit that No, I'm gonna prove that I'm not depressed. Well, I can't give you my prescription. You've got to meet with a psychiatrist. You You need a whole work-up. Give me a Vicodin so I don't stroke. I wouldn't drink that. My leg hurt, and I (PHONE RINGING) (DOOR UNLOCKING) (DOOR CREAKING) House, why didn't you pick up the phone? We've been calling. I was sleeping. What did you do? Nothing. This is how regular people look when you wake them up. Chase was wrong. Addie's kidneys shut down. Hemolytic uremic syndrome shut down Addie's kidneys. Peripheral smear of red cells had schistocytes. HUS is usually caused by an infection or protein deficiency. What a coincidence. I know a patient with an infection and a protein deficiency. Do you think it's possible there's a connection? I want to hear you say it, Chase. It will please me. Doesn't mean you're right. You predicted cardiac arrest, instant cardiac arrest. There were only two choices. Since yours was wrong, mine must have been right. Either that, or we missed the leprechaun. If you're right, there's nothing to be done. The steroid treatment we gave her means when the next infection hits, it will hit hard. Liver failure, cardiac arrest. On the bright side it confirms my diagnosis. Don't you see how incredible this call was? A protein deficiency. It can't be tested. Can't be seen. I called it based on coughing blood. You're happy about this. She's going to die. That's not my fault. She was going to die, anyway. And now, thanks to me, at least she'll know why. I'm sure you'll see that gratitude in her eyes when you tell her. I'm not telling her. I'm not telling her. No one's telling her. Not until we're sure I'm right. But we're waiting for her to stroke or have a heart attack to confirm before we tell her? Seems like the humane approach. Her heart went into V-fib. Brought her back, barely. Congratulations, you have your confirmation. What's her name? Who? The co-ed? Sure. Dead sophomore girl? You know her father's name? Dad. Her mother's name is Mommy. Ben and Jody are about to lose their only daughter, Addie. You think that they're gonna give a crap if I know their names? Five years from now, when the father's looking at photographs of his daughter graduating from high school, they're not going to remember the nice black doctor who called them by their first name. You don't wanna quit. You saying you don't want me to quit? Didn't sound like I said that. I'm saying that suddenly you're trying to turn me into a kinder, gentler ***. Because you know who you are. And you figure if you can make me decent and caring, then maybe there's hope for You're about to tell a girl she's dying and you think it's about you. God, I hope I'm not you. I'm sorry. Addie, you're dying. Are you sure? Yes. Your infections will get worse. The toxins will spill into your blood. How long? Two days, maybe less. You have a condition called Does it matter? It's a very rare protein deficiency that only manifests I don't want to hear it. Okay. It's what's killing you. This is what's killing you. You're not interested in what's killing you? Will it make any difference? Will I live any longer? Please, could you just leave? What's the point in living without curiosity? Without craving the So, I'm screwing up my last few hours because I won't listen to you? Get out of here. It's It's like the dark matter in the universe. You're smiling. No, I'm not. You can only diagnose a problem by looking at what's Missing. Oh, God. I have to go. Nineteen-year-old didn't want to hear the coolest explanation of why she's going to die, begged me to shut up. If you can't shut up, at least talk quietly. Amphetamine withdrawal's a ***. She thought that I was happy. You were happy? No, I was hazy. And I don't get hazy on Vicodin, or anything else I throw down. Which means I was throwing down something I didn't know I was throwing down. Which got me to wondering Why didn't you give me those happy pills? I told you. You've got to be checked out by No, you just didn't want me double-dosing. You dosed me! Those coffees They worked! You've been smiling, relaxed, happy. A dying girl thought I was happy. A moron thought I was happy. Who the hell doesn't want to know why she's dying? House was happy. Hazy. Happy. Hazy! Oh, right. A dying girl mistook hazy for happy. Because dying people see happiness everywhere. She's miserable. She wasn't miserable. Of course she was miserable. You just told her She was no different than she'd ever been. She was no different than she'd ever been. Oh, God. I gotta go. Need a minute with your daughter. Dr. House, get out of here before She's gonna live. Does that help? Now, get out. Are you jerking us around Get out. You have got leprechauns in you. Depression manifests in lots of different ways. Some people can't get out of bed all day, others have serial relationships and become oncologists. I'm dying, I'm not depressed. Wrong. And wrong. You tried to kill yourself by throwing down kitchen cleanser. Now, most normal suicidal morons would have just drank the stuff. Burned the hell out of their mouth and throat. Painful, but not deadly. But being a college-educated suicidal moron, you wrapped it in gel caps or gum. Which left no trace, but it burned a hole in your intestine. But the body can repair almost anything, which is cool. In your case, scar tissue closed up the hole. But it also formed a bridge between a vein and an artery. Now, veins are supposed to help the intestine flush bacteria away. But the bridge allowed the bacteria entrance to the artery. Where they got a free ride everywhere. Can you fix me? Surgery to fix the bridge'll take about two hours. The psychotherapy's going to take a little longer. Why'd you do it? I don't know. I've just never been happy. Please don't tell my parents. They'll blame themselves and it's not their fault. Please, you can't tell them. Technically, all you have to do is promise me that you won't do it again. Then, legally, I can't tell them. I promise. Yeah, sure. We can't thank you Your daughter tried to kill herself. That's why she's here. Legally, I'm supposed to keep that between me and her. Which makes sense, she's obviously an adult, capable of her own well-reasoned decisions. You're sure? If she doesn't die in the next couple of hours, yeah, I'm right. How could she hide this? Everyone has secrets. We'll take care of her. Figure it out. Make her happy? We'll get her into therapy. Might want to try some meds, too. Can we call you? If we have any questions? No. What's up? Nothing. You wanted to see me? Yeah. House's patient? Yeah. The one that would have died, if not for him. Subtle. Thanks. You're really scared you'll turn into him. Don't tell me I'm better than him. Don't tell me, take the good and leave the bad. Cameron already tried. I'm telling you there are worse things to turn into. It's not worth it. (MUSIC PLAYING) I didn't think you were going to show. Sorry, surgery went a little late. So, you really think I have all the necessary qualifications? I can't discuss this with a dry mouth. What do you got there? Peppermint tea. I'm going to have a mug of peppermint tea, please. This isn't a job interview, is it? It's some kind of interview. You're judging me. I'm judging you. You have the upper hand. I don't know anything about you. I'm on antidepressants because a doctor friend of mine thinks I'm miserable. I don't like them, they make me hazy. I eat meat, I like drugs. And I'm not always faithful to the women I date. You don't seem depressed. You do realize you just skipped over several deep character flaws that most women would run screaming from. You told the truth. Yeah, I don't always do that, either. Well, how miserable can you be, saving lives, sleeping around, and doing drugs? Were you on the debating team in high school? Also, I hate tea.