Episode 23: The Jerk
Aired 5/15/07
Sixteen-year old chess prodigy Nate Harrison easily mows down an
older opponent while mocking his moves. Afterwards, the opponent
offers Nate a handshake and congratulations. Nate winces and begins
breathing rapidly. He picks up the chess clock and smashes it in
his opponent’s face. Nate jumps on the man, pounding him with
punches until proctors are able to drag him away. Nate holds his
head in agony, fighting for breath.
As Chase examines Nate in the hospital, the boy’s mother Enid
stands at his bedside. Nate is sarcastic and difficult to him. Chase
ignore his jibes and presses on with the exam. Chase presents the
case to the team. He says that the boy is dealing with rage and
head pain, plus various bumps and bruises from the seventeen fights
he’s been in this semester alone. House adds “personality
disorder” to the list of symptoms. Suspecting that the diagnosis
is cluster headaches, House asks them to start Nate on blood thinners
and he prescribes Transcranial Magnetic Stimulation.
Foreman performs the procedure on Nate, who continues to be obnoxious.
Outside, Chase explains to Enid that cluster headaches often cause
irritability or hostility. If they are right about the prognosis,
then treatments could change Nate. This delights Enid. She had thoughts
that she was a bad mother because she hated Nate.
The next morning, the team explains to House that the blood thinners
and TMS had no effect. They rule out cluster headaches and now suspect
hemochromatosis or hypothyroidism. House quickly shoots down both
conditions because they don’t match Nate’s personality
issues. House sticks with cluster headaches, arguing that symptoms
never lie. Cameron points out that the only approved treatment left
is brain surgery, which is not a guarantee. House smiles, noting
that they will be forced to use an unapproved treatment.
When the meeting ends, Foreman storms out. He tells House that
he had an interview lined up for the day before at New York Mercy
Hospital, but they said he cancelled. Yet he never called them.
Foreman accuses House of going behind his back and questions whether
he has a neurological issue. House claims innocence, coldly explaining
that he only sabotages people he deems worth the trouble.
House congratulates Cuddy on her cunning move of canceling Foreman’s
interview. Cuddy firmly informs him that it wasn’t her but
that she is awaiting board approval to make Foreman an offer to
stay. House asks permission to give Nate mushrooms to treat his
cluster headaches because the psilocybins in them work on the headaches.
Cuddy only permits a low dosage of less than ten milligrams given
in a tightly controlled setting. House also must obtain parental
approval.
Chase and Cameron administer the drugs and then observe Nate. He
is not feeling any pain in his head but rather the opposite. Cameron
says that this confirms a diagnosis of cluster headaches. Nate then
invites Cameron to have sex with him and he lifts up his blanket.
The doctors see that his testes are undersized but that his other
sexual characteristics are normal. They turn their focus to the
hypothalamus. House orders Chase and Cameron to biopsy the pituitary.
Enid is all for the procedure but Nate refuses to have his brain
cut open. Suddenly, Nate becomes disoriented and blacks out. Chase
notices that his gums are yellow and realizes that Nate is jaundiced.
The liver is shutting down. Chase and Cameron start the patient
on sodium polystyrene sulfonate.
The boy’s liver is operating at around twenty percent and
deteriorating fast. It’s possible that the liver failure caused
the other symptoms, but what caused the liver failure? Foreman gets
a page. House assumes it’s from Cuddy and excuses Foreman to
handle his business. Chase mentions that Nate was raised a vegetarian
but then started eating meat a few months ago. House observes that,
with an OTC deficiency, Nate wouldn’t be able to metabolize
the nitrogen and this would damage the liver. He orders the doctors
to stuff Nate full of meat and wait for his ammonia levels to spike.
Cuddy presents Foreman with a deal to double his salary and put
him in charge of his own diagnostic group. He would work parallel
to House but have complete autonomy. Foreman thinks about it and
then quickly declines. Since somebody at the hospital sabotaged
his interview, he can no longer work there.
Chase and Cameron bring Nate a giant platter of hamburger patties.
He demands a higher quality meat and won’t eat them. Chase
snaps. He threatens to strap Nate down and force the meat into his
system. Nate backs down and takes a bite.
Cuddy accuses Wilson of killing Foreman’s interview in order
to help House. Wilson says he hopes Foreman will leave so that House
realizes he needs another doctor to stand up to him. Cuddy doesn’t
believe him, labeling Wilson an enabler. Wilson calls Cuddy paranoid.
The hamburger test shows no change in Nate’s enzyme levels,
meaning he is not affected by OTC deficiency. House’s next
idea is to starve the boy because diabetic steatosis will screw
up the liver, which will allow them to see if the blood sugar pops.
Chase warns that messing with Nate’s blood sugar could set
off another rage.
The changes do cause Nate to rage, and the doctors find him jaundiced
in his room. Nate is swinging around his IV pole and threatening
the nurse and his mother to feed him. The doctors tell Nate that
once they get a urine sample he can eat. Nate defiantly pees on
the floor. Yet his urine changes from bright yellow to blood red.
A chem panel confirms that the bloody urine is due to kidney failure.
Nate is put on dialysis, which he will need for the rest of his
life. Now the team is stuck for answers. Foreman throws out hepatic
fibrosis or MCADD. Considering that it might be a genetic disorder,
House asks them to acquire the sequencing primers and figure out
if it’s one of the genetic diseases they can actually fix.
Foreman announces that he has to leave and House questions if he’s
going to a job interview. Foreman wants to know whether House will
stop him if it is.
Wilson tries to get Cameron to believe Cuddy is going to fire him
for sabotaging Foreman’s interview but she sees right through
his weak attempt. Wilson becomes annoyed, noting that she would
have fallen for this three years ago. Cameron asks whether he thinks
she was the culprit, but she denies it. Cameron finds Chase in the
lab and asks if he did it because he wanted to sabotage Foreman.
Chase is stunned that she would consider him to be that petty.
The genetic lab tests show that Nate has a partial HPRT enzyme
deficiency, which means he could have Kelley-Seegmiller syndrome.
Yet since it’s partial, he might not have it. Cameron argues
that patients with this syndrome self-mutilate, and Nate hasn’t
been chewing his lips or banging his head. Chase points out that
self-mutilation only happens when the patient is stressed. House
wants to stress Nate to the breaking point in order to receive their
confirmation.
House walks into Nate’s room with a chessboard and immediately
starts mocking him for not wanting to play. This gets Nate riled
up. As the game progresses, Nate is surprised that House is a good
match for him. House begins taunting Nate, pointing out that nobody
likes him. House tells Nate that he’s dying and then takes
the boy’s knight with his queen, which puts Nate in check.
Nate’s breathing quickens, but then he moves his bishop and
smiles. He asks House if he wants to lay down his king, explaining
the next four moves that will put House in checkmate. Looking at
the board, House realizes that Nate is right. Yet the greater surprise
is that Nate is starting to convulse with a seizure.
The next day, House is studying a chessboard and announces to the
team that he hates Nate. The team despairs, realizing that they
have one more symptom and one less explanation. Chase asks if Nate
took any medication and lied about it. This sparks an idea in House.
He crosses personality disorder off of the whiteboard and declares
that now they are dealing with a normal jerk who suffers from amyloidosis.
House tells the team to flush Nate with immunosuppressants, perform
a biopsy to confirm and find a bone marrow donor.
The biopsy, however, comes back clean with no signs of amyloidosis.
Yet House isn’t deterred, and tells Foreman to biopsy the sinuses
for a different reading. Foreman resists, but House says that he
can either argue about it and then do it or just do it. Foreman
shrugs and walks away. House shouts after him that he wasn’t
finished. The third option was to not do what House asked. He could
have stuck Nate on antibiotics but he didn’t because he still
trusts House’s judgment more than his own.
Chase finds House in his office that night. He knows House was
the one who sank Foreman’s interview. Everybody has been chasing
ghosts over this, so either nobody did it or somebody wants everybody
chasing ghosts. He thinks this sounds like House’s doing. House
smiles, admitting that sometimes he forgets why he hired Chase.
If House wants Foreman to stay, Chase advises him to just simply
tell him. At least it will make Foreman see that House isn’t
evil. This idea gives House an epiphany about Nate’s case.
When they crossed off personality disorder, they forgot to add another
symptom.
House strolls into Nate’s room holding two chess pieces and
asks if he wants white or black. Nate grabs for a piece and House
notices that he keeps his thumb straight when grabbing objects.
House bends the thumb backwards and Nate yelps in pain. He cannot
bend his thumb because the bones have formed abnormally due to the
junk that has pushed its way between them.
Nate has hemochromatosis, and his body is absorbing iron from his
food but he can’t process it. The iron is building up in the
organs and joints, creating havoc. As for the personality disorder,
House points out that Nate is simply a jerk and that this has nothing
to do with the iron. House pulls out the IVs and pokes Nate’s
wrist with a scalpel. He calls in a nurse, instructing her to stop
the bleeding when three pints have dripped into the garbage can.
Nate will need dialysis and a blood drain about every three months
for the rest of his life. Other that that, he will be fine.
House finds Foreman in the lab and asks whether he is still running
the biopsy for amyloidosis. House has Foreman run it again to recheck
his results, and warns him that he will probably have an all-nighter
in front of him.
- From Fox.com
|
