Episode 15: Half Wit
Aired 3/6/07
Musical savant Patrick Obyedkov needs his father to help him button
his tuxedo in a theater dressing room. Dr. Obyedkov introduces his
son, explaining that an accident 25 years earlier caused Patrick
to have neurological disabilities. Patrick begins to play the piano
perfectly, but it then turns frantic. The muscles in his hands and
arm have fully tensed. His fingers start to bend backwards.
House pages the team at five am. Cameron is the first to arrive,
but when Foreman and Chase hear that the patient is a 35 year-old
savant with dystonia, they’re ready to go back to bed. House
comes in, and his interest in the case means that they all must
stay. Patrick had been a 10 year-old boy with no prior musical training.
After a car accident, he suddenly became a genius pianist. Foreman
argues that savantism is just one of those mysterious things, but
House orders new labs -- CBC with platelets, chem panel, thyroid
and adrenal function tests. They are to look for anything.
As he examines Patrick, Foreman quickly learns that the patient
has trouble telling left from right and he repeats whatever people
say to him. House has a piano wheeled into Patrick’s room for
another test. After he plays, Patrick mimics every note and movement.
House asks Patrick to close his eyes then mashes the keys. Patrick
perfectly identifies the cacophonous notes. With the hand fixed
for now, Foreman and Dr. Obyedkov want Patrick discharged. House
wants him to remain, and he orders Foreman to schedule a functional
MRI of Patrick’s brain.
The doctors strap Patrick into the FMRI machine. They play some
classical music but nothing flashes in the brain. Foreman observes
that listening and playing are two completely different neurological
processes. House asks Patrick to pretend his leg is a piano and
to play it. As his fingers dance on his leg, the FMRI begins lighting
up and Patrick’s heart rate rises without the limbic system
activating. House tells Foreman that they need to get Patrick into
surgery immediately.
As Foreman scrubs up for surgery, Cameron mentions that she found
an airline ticket in House’s mail. He is going to Boston. She
wonders about an opening for a Division Chief of Infectious Diseases
at Harvard. Foreman notes that it isn’t like House to be ambitious,
but he did notice House testing blood in the clinic. However, basic
medical clearance for employment would require a cholesterol and
glucose check.
Since they know that House would never tell them the truth, the
doctors decide to borrow one of his favorite moves and break into
the subject’s residence. Chase and Cameron go to his apartment.
Chase asks if she wants to have a go on House’s bed. Cameron
thinks this isn’t the time, but her smile indicates that it’s
a definite possibility. Chase comes across a phone bill with multiple
calls to a 617 area code. He dials and reaches Massachusetts General
Hospital.
Back at the hospital, Foreman is snaking a catheter through Patrick’s
femoral artery toward the heart. Patrick’s heart rate begins
accelerating to 160, then 210. Foreman has to break out the paddles
to save him. The doctors discuss Patrick’s heart attack during
surgery. House thinks a sudden bleed might explain both the attack
and the dystonia, so he orders a colonoscopy and an upper endoscopy.
If that doesn’t show anything, they can also perform an enteroscopy
to look at the small bowel.
Tipped off by Chase and Cameron, Cuddy calls Mass General and tells
a Dr. Medick that she’s not letting House go without a fight.
Dr. Medick assures Cuddy that they aren’t interested in hiring
him. Cuddy asks if House might be a patient. Indirectly answering
her, Dr. Medick says that neither he nor Dr. Kupersmith can stand
House.
Cuddy tracks down Wilson and finds out that Kupersmith’s specialty
is brain cancer. Cuddy ticks off some symptoms, wondering why House
isn’t showing any signs of cancer. Plus, he hasn’t told
anybody. Wilson explains that symptoms take time to show and that
most cancer patients keep the news to themselves because they don’t
want every conversation thereafter to revolve around cancer.
Cameron catches up with Wilson. He tries to avoid the talk, but
Cameron states that if she needs to start looking for work, then
she has a right to know. Wilson finds House in his office later
and artfully works brain cancer into the chat. House winces, claiming
that it’s nothing. Wilson asks to at least see his chart, wondering
why House wouldn’t come to him. Chase interrupts with a surgical
report. House was right -- Patrick had a bleed behind his kidney,
but there’s no cancer or ruptured arteries that would cause
it. House ignores this report as he stares at Chase. He knows the
cancer news is out. Wilson claims that he only told Cameron.
House gathers the team to confront the cancer question and he assures
them it’s not an issue. The team asks him for some blood to
double check with tests, but House is only interested in discussing
Patrick’s case. Why are his seizures getting worse? House suggests
ceasing the anti-convulsant medication to let the seizures really
kick in. Maybe that will direct them somewhere. Cameron worries
that multiple seizures will only damage Patrick’s brain. House
points out that the man’s brain isn’t in prime condition
anyway. When Patrick gets worse, they can run a PET scan.
Cameron asks House to sign a letter of recommendation she wrote
in his name because she is applying for a job at Penn. House brings
up the cancer and Cameron pauses. They move closer to each other
and suddenly begin kissing. While their lips are locked, Cameron
reaches into her pocket for a syringe. House, sensing the movement,
grabs her hand. She pleads that they need his blood for tests. House
directs her to his file in the records room. Everything they would
want is in there.
Cameron finds the CAT scan in House’s file and takes it to
Foreman. He spots a six-centimeter mass in House’s dorsal midbrain
extending into the temporal lobe. The brain cancer is inoperable.
Foreman figures that House has less than a year to live. The team
continues poring through House’s file, noticing that he has
a consent form for a drug trial. However, it’s not a cancer
treatment but a drug used to treat depression in cancer patients.
The procedure involves implanting drug-eluting chips into the pleasure
centers of the brain.
House brings the team Patrick’s PET scan, which reveals several
more hot spots in no distinct pattern. The left brain is working
harder than the right. Cameron pronounces bleeding in the brain.
House goes to perform an angiogram to look at the vasculature in
the brain. House notices tiny dots. The MRA confirmed small collections
of blood throughout the white matter of Patrick’s right hemisphere.
That could be trauma, an aneurysm, cancer or autoimmune disease.
They will need a biopsy of all parts of the brain. The team argues
that House can’t just randomly pluck out pieces of a patient’s
brain. Foreman suggests an internal EEG. An external test can get
confused, but an EEG from inside the skull would reveal exactly
where to biopsy. It’s risky, but worth it.
Later, Foreman finds House alone in Patrick’s room. Before
he hands over the test results, Foreman wants to discuss something
personal. Despite House’s attempts to drive everybody away,
Foreman still likes him. He turns back to the patient’s EEG.
There are no electrical abnormalities. What it did show is that
Patrick’s entire right hemisphere is brain dead.
House mentions that Patrick is left handed and can still speak,
so perhaps the right hemisphere still has some random neurons firing.
House and Foreman head to Patrick’s room with a small electronic
piano. Foreman covers Patrick’s right eye and asks him what’s
on the table. Patrick identifies the piano. Foreman then covers
the left eye and asks again. Patrick has no idea. House plays a
few bars of a tune and then spins the piano around to Patrick. He
plays it perfectly. The doctors exit. In the hallway, House argues
that Patrick’s right brain has always been damaged. Yet this
is irrelevant to the current issue. Foreman realizes this means
the problem is autoimmune and they can begin treatment.
Chase finds House in his office and asks to chat. House sighs at
another emotional moment. Chase ignores him and hugs House. Then
he says that Patrick is responding to treatment. Unfortunately,
now comes the next step. House rings Cuddy’s doorbell in the
middle of the night. House lets her know that Patrick has Takayasu
syndrome, which Cuddy points out is manageable with steroids. House
wants a hemispherectomy since the right side of Patrick’s brain
is basically useless. It would stop the seizures. Cuddy responds
that they will need to ask Dr. Obyedkov about his son’s treatment.
House appeals his idea to Dr. Obyedkov. With the right brain removed,
the left brain could stop compensating and function on its own.
Patrick would begin learning new things but would lose the ability
to play the piano. Dr. Obyedkov argues that Patrick is doing fine
and that he doesn’t mind taking care of his son. House counters
that he has made Patrick into a trained monkey, but that this procedure
would allow him to grow into an adult. Is Dr. Obyedkov is afraid
to let him go?
Dr. Obyedkov asks his son if he’s happy. When Patrick merely
repeats his father’s words, Dr. Obyedkov picks up the phone
to grant consent for the procedure. The hemispherectomy is performed
successfully.
The doctors study a scan of House’s brain, hoping to get him
approved for a clinical trial. Unfortunately, he is negative for
protein PHF and thus doesn’t qualify. Suddenly, Chase notices
something odd on the scan. They rush to House’s door and announce
that he doesn’t have cancer. There was an abnormal presence
of IgC and IgM in his brain, plus a gumma, which is usually found
in the liver. House mentions that he doesn’t have syphilis
because his VDRL was negative. The team did a new test, which means
that House got a false negative. House pauses and asks if they sent
the results to Mass General. When they admit they did, he calls
them idiots.
It wasn’t his file. House tells them that the real patient
is in the Witherspoon wing of Princeton-Plainsboro. They can tell
the man’s wife that he’s not dying of cancer but is cheating
on her. The doctors angrily ask if House was faking cancer. He wanted
the doctors at Mass General to think he had cancer so that he could
take part in the drug trial that places an implant in the pleasure
center of his brain. Exasperated, Cameron asks House if he faked
cancer to get high. The doctors stumble away in shock.
The next day, House does a follow up on Patrick. He doesn’t
respond to House’s verbal cues, but then Patrick buttons his
own shirt and smiles.
- From Fox.com
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