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Episode 16: Top Secret

Aired 3/27/07

Outside of Baghdad, a military convoy is intercepted by an IED blast. A Hummer is tossed on its side, and a Marine whose leg was blown off below the knee is dragged from the wreckage. The Marine is House. He is startled from his dream by Cuddy knocking on the office door.

She has a new case -- a former Marine who thinks he has Gulf War Syndrome. House objects that there is no such thing, but Cuddy explains that the soldier is the nephew of a major benefactor. House is forced to deal with this patient whether he wants to or not. Furthermore, the debated existence of the Marine’s disease hasn’t stopped the man’s fatigue, rashes and joint pain.

As soon as he open the file, House is stunned. The attached photo of Sgt. John Kelley perfectly matches the man in his dream who pulled House from the explosion. In the men’s restroom, House recounts the whole thing to Wilson, who thinks it might be a sign. House is skeptical. He is also unable to urinate despite his attempts to do so. He exits the bathroom unrelieved.

The team reviews the case. Foreman and Cameron both concur that Gulf War Syndrome doesn’t exist. Studies show the same pattern of symptoms in veterans who were sent to the Gulf matched those who weren’t. John Kelley, the patient, did not serve in the Gulf War. House thinks Kelley is merely depressed and seeking a disability check. He orders a full physical as well as blood checks for HIV, hep C, malaria, schistosomiasis and T strain A baumanii. House has the team find out all clinics and hospitals the patient has visited and which cities he has lived in. They should also see if the man has ever been on TV.

The doctors perform a variety of exams on Kelley, skeptical about his claims. Kelley launches into a laundry list of his problems. He suffers from fatigue, coughs, rashes, sore throats, joints that feel like they have sand poured in them. His legs sometimes feel cold and other times it seems like his blood is boiling. He doesn’t care what they call his condition, he only wants them to cure it.

The team doesn’t conclude anything based upon the tests. Foreman is ready to prescribe a banana and discharge him. House orders a polysomnogram, theorizing that sleep apnea could cause chronic fatigue and paranoia. Suddenly, House winces in pain, clutching his stomach. Cameron takes notice, but House brushes it off.

The polysomnogram comes up negative. Chase reiterates his theory of uranium poisoning, but they haven’t been able to detect anything in Kelley’s blood. As they wait through the night for Kelley to finish a full sleep cycle, Chase and Cameron retreat to one of the hospital beds for a little romantic entanglement.

Meanwhile, House stands idly over his home toilet, still unable to urinate. His frustration is growing. He shuffles over to the sink and pops a Vicodin.

Foreman drops by the sleep lab, but Chase and Cameron are nowhere to be found. Kelley calls out for help, and Foreman listens to the patient complaining about a terrible smell. Noticing a white substance in the corners of Kelley’s mouth, Foreman takes a look inside. A creamy whiteness coats Kelley’s mouth and tongue. Foreman catches a whiff of the odor. Chase and Cameron finally appear, but too late to be useful.

House sits in the tub flipping through old news magazines, looking for a photo of Kelley that might have triggered his dream. The doctors call with news that Kelley has bacterial vaginosis in the mouth although he claims he hasn’t performed oral sex on anybody in over a year. House instructs his team to have Wilson biopsy Kelley’s salivary glands to check for parotid cancer. And they are to get a more detailed sexual history, because there is no way a Marine abstains for a full year.

The biopsy is inconclusive, and Wilson plans to move onto a sialogram. House figures it’s too late to do anything to save Kelley because the cancer is likely spreading. He asks Wilson for a new prescription, confessing that he hasn’t urinated in three days. Wilson tells him to stop taking the Vicodin, but House doesn’t want to live with the pain. Wilson figures House would be in agony if he hadn’t peed in that long. House counters that he passed agony sometime yesterday afternoon.

Wilson inserts a catheter into Kelley’s parotid gland. Soothing music fills the room to calm the patient during this procedure, and when Kelley asks them to turn it up, the nurses oblige. Despite the increased volume, Kelley complains that he still can’t hear it. Wilson shouts at him, but there’s no reaction. Kelley has gone deaf.

Wilson breaks the news to House that Kelley has brain cancer. He puts the CT scan on the light board, showing at least six tumors. Kelley’s sight will probably be the next to go, and House assumes death can’t be too far off.

House, Wilson and Foreman review the numerous scans on Kelley’s brain in radiology. Chase and Cameron enter after secretly sneaking off for another quickie outside of the hospital. They cover themselves by mentioning that all of Kelley’s stories check out. Wilson asks House if he is having the team research his weird dream. When House doesn’t have a suitable answer, the other doctors walk out, leaving him alone.

As Foreman and Wilson prepare to biopsy Kelley’s brain tumors, House briefs Cuddy that there is no hope for a cure. The questions remain where these tumors came from and why they weren’t detected earlier. Cuddy points out on the VA’s brain scan the surgical pin inserted at the top of neck. The VA didn’t make any mistakes on Kelley, no matter what House thinks.

House has Chase send a sample of Kelley’s urine to a doctor in Leicester who has developed a new technique that allows for greater radiation detection. Then House asks Cameron to call Kelley’s uncle and find out if he ever brought his nephew to hospital functions.

Foreman drills into Kelley’s head using a portable CT scanner as guidance. Curiously, there are now no tumors in Kelley’s brain. Foreman and Wilson share baffled looks. They confer with Cuddy and House to ascertain a possible explanation. Is it an abscess or an infection? Suddenly, Kelley begins screaming that he can’t feel his legs.

The doctors retreat to the meeting room with a list of Kelley’s numerous symptoms. Chase bursts in with the news that Kelley is excreting depleted uranium in his urine. Yet House is no longer interested since they are no longer searching for a cancer cause. House asks for Wilson’s keys and then departs. He’s going home for some sleep.

Standing around monitoring Kelley, Foreman suggests to his colleagues that they follow Chase’s lead and start treatment for uranium toxicity. At home, House inserts a catheter into his bladder through the urethra and finds instant relief. He shuffles to his bed.

Chase and Foreman begin the IV drip. Kelley complains that he can’t feel his stomach. Realizing the paralysis is ascending, Foreman and Chase worry that Kelley will need a respirator soon. Four hours later, House is still wide awake in his bed. He finally gives up at 6 am and gets out of bed.

House finds Chase and Foreman sleeping in the doctor’s lounge. The team moves to Kelley’s room, where an angry Cuddy is questioning who approved the uranium detox. Kelley is now pale and his blood pressure is plunging. House insists that it’s a bleed out and orders a transfusion, despite a clear lack of signs that this is the problem. Chase moves around the bed to help and slips in a yellow puddle. Chase lifts House’s pant leg to reveal a catheter bag with a tear on it. As an incredible amount of urine gushes from the bag, House’s nose begins to bleed. Then House wakes up in his bed at home, finding the catheter bag broken in his bed. He was dreaming.

House goes to the hospital and leads his team to Kelley’s room. He peers into Kelley’s nostrils and finds exactly what he was looking for -- cauterization scars. Kelley cauterized his nose to stop the same nosebleeds that plagued his grandfather. They both had the same condition, Hereditary Hemorrhagic Telangiectasia. The nosebleeds are a result of arteries and veins merging together, which means blood doesn’t get fully oxygenated or filtered. Dirty blood causes the fatigue, infections and joint pain. Further, AVMs in Kelley’s brain caused fake tumors, the ones in his spine caused paralysis and weakness while some in the lungs caused exhaustion. Fortunately, a few surgeries will clean everything up.

House tracks down Cuddy, having finally figured out where he remembered Kelley’s face. Two years ago, Cuddy had brought Kelley with her to a hospital function. She thinks House remembered him out of jealousy. Cuddy tells House to get over her. She hired House when no one else would. House claims that she only hired him because of their “one night.” She again tells him to get over her.

House barges into a supply closet where a shirtless Chase is kissing Cameron. The two awkwardly freeze as House dumps some files into a garbage can. House closes the door and walks down the hall with a smile.

- From Fox.com