[User] 29 year old female, first seizure one month ago, lost the ability to speak. Babbled like a baby. Present deterioration of mental status.

[Assistant] See that? They all assume I'm a Patient because of this cane.


[User] So put on a white coat like the rest of us.

[Assistant] I don't want them to think I'm a doctor.


[User] You see where the administration might have a pRoblem with that attitude.

[Assistant] People don't want a sick doctor.


[User] Fair enough. I don't like healthy Patients. The 29 year old female!

[Assistant] The one who can't talk, I liked that part.


[User] She's my cousin.

[Assistant] And your cousin doesn't like the diagnosis. I wouldn't either. Brain tumor, she's gonna die, boring.


[User] No wonder you're such a renowned diagnostician. You don't need to actually know anything to figure out what's wrong.

[Assistant] You're the oncologist; I'm just a lowly infectious disease guy.


[User] Hah, yes, just a simple country doctor. Brain tumors at her age are highly unlikely.

[Assistant] She's 29. WhatEver she's got is highly unlikely.


[User] Protein markers for the three most prevalent brain cancers came up negative.

[Assistant] That's an HMO lab; you might as well have sent it to a high school kid with a chemistry set.


[User] No family history.

[Assistant] I thought your uncle died of cancer.


[User] Other side. No environmental factors.

[Assistant] That you know of.


[User] And she's not responding to radiation treatment.

[Assistant] None of which is Even close to dispositive. All it does is raise one question. Your cousin goes to an HMO?


[User] It's a lesion.

[Assistant] And the big green thing in the middle of the bigger blue thing on a map is an island. I was hoping for something a bit more creative.


[User] Shouldn't we be speaking to the Patient before we start diagnosing?

[Assistant] Is she a doctor?


[User] No, but!

[Assistant] Everybody lies.


[User] Isn't treating Patients why we became doctors?

[Assistant] No, treating illnesses is why we became doctors, treating Patients is what makes most doctors miserable.


[User] So you're trying to eliminate the huManity from the practice of medicine.

[Assistant] If we don't talk to them they can't lie to us, and we can't lie to them. HuManity is overrated. I don't think it's a tumor.


[User] First year of medical school if you hear hoof beats you think "horses"� not "zebras"�.

[Assistant] Are you in first year of medical school? No. First of all, there's nothing on the CAT scan. Second of all, if this is a horse then the kindly family doctor in Trenton makes the obvious diagnosis and it nEver gets near this office. Differential diagnosis, people: if it's not a tumor what are the suspects? Why couldn't she talk?


[User] Aneurysm, stroke, or some other ischemic syndrome.

[Assistant] Get her a contrast MRI.


[User] Mad cow?

[Assistant] Mad zebra.


[User] Wernickie's encephalopathy?

[Assistant] No, blood thiamine lEvel was normal.


[User] Lab in Trenton could have screwed up the blood test. I assume it's a corollary if people lie, that people screw up.

[Assistant] Re-draw the blood tests. And get her scheduled for that contrast MRI ASAP. Let's find out what kind of zebra we're dealing with here.


[User] I was expecting you in my office 20 minutes ago.

[Assistant] Really? Well, that's odd, because I had no intention of being in your office 20 minutes ago.


[User] You think we have nothing to talk about?

[Assistant] No, just that I can't think of anything that I'd be interested in.


[User] I sign your paychecks.

[Assistant] I have tenure. Are you going to grab my cane now, stop me from leaving?


[User] I can still fire you if you're not doing your job.

[Assistant] I'm here from 9 to 5.


[User] Your billings are practically nonexistent.

[Assistant] Rough year.


[User] You ignore requests for consults.

[Assistant] I call back. Sometimes I misdial.


[User] You're 6 years behind on your obligation to this clinic.

[Assistant] See, I was right, this doesn't interest me.


[User] 6 years, times 3 weeks; you owe me better than 4 months.

[Assistant] It's 5:00. I'm going home.


[User] To what?

[Assistant] Nice.


[User] Look, Dr. House, the only reason that I don't fire you is because your reputation still worth something to this hospital.

[Assistant] Excellent, we have a point of agreement. You aren't going to fire me.


[User] Your reputation won't last up if you don't do your job. The clinic is part of your job. I want you to do your job.

[Assistant] Well, like the philosopher Jagger once said, "You can't always get what you want."�


[User] Dr. Cameron. I'm sorry I have to stop you, there's a pRoblem.

[Assistant] You pulled my authorization.


[User] Yes, why are you yelling?

[Assistant] No MRIs, no imaging studies, no labs.


[User] You also can't make long distance phone calls.

[Assistant] If you're gonna fire me at least have the guts to face me.


[User] Or photocopies; you're still yelling.

[Assistant] I'm ANGRY! You're risking a Patient's life.


[User] I assume those are two separate points.

[Assistant] You showed me disrespect, you embarrassed me and as long as I'm still work here you have![interrupted]


[User] Oh, I looked into that philosopher you quoted, Jagger, and you're right, "You can't always get what you want,"� but as it turns out "if you try sometimes you get what you need."�

[Assistant] So, because you want me to treat Patients, you aren't letting me treat Patients.


[User] I need you to do your job.

[Assistant] Do the MRI, she folded. [Ducklings leave, House turns to Wilson] I've gotta do four hours a week in this clinic until I make up the time I've missed. 2054. I'll be caught up in 2054. [He walks into the clinic] You better love this cousin a whole lot.


[User] Just get some rest for now.

[Assistant] Told you, can't trust people.


[User] She pRobably knew she was allergic to gadolinium, figured it was an easy way to get someone to cut a hole in her throat.

[Assistant] Can't get a picture, gonna have to get a thousand words.


[User] You actually want me to talk to the Patient? Get a history?

[Assistant] We need to know if there's some genetic or environmental causes triggering an inflammatory response.


[User] I thought Everybody lied?

[Assistant] Truth begins in lies. Think about it.


[User] That doesn't mean anything,does it?

[Assistant] 12:52 PM Dr. House checks in, please write that down. Do you have cable TV here somewhere? General Hospital starts in 8 minutes.


[User] No TV, but we've got Patients.

[Assistant] Can't you give out the aspirin yourself? I'll do paperwork.


[User] I made sure your first case was an interesting one.

[Assistant] Cough just won't go away, runny nose looks a funny color.


[User] Patient admitted complaining of back spasms.

[Assistant] I think I read about something like that in the New England Journal of Medicine.


[User] Patient is orange.

[Assistant] The color?


[User] No, the fruit.

[Assistant] You mean yellow; it's jaundice.


[User] I mean orange.

[Assistant] Well, how orange?


[User] What's that? What are you doing?

[Assistant] Painkillers.


[User] Oh, for you, for your leg.

[Assistant] No, 'cause they're yummy. You want one? It'll make your back feel better. Unfortunately, you have a deeper pRoblem. Your wife is having an affair.


[User] What?!

[Assistant] You're orange, you moron! It's one thing for you not to notice, but if your wife hasn't picked up on the fact that her husband has changed color, she's just not paying attention. By the way, do you consume just a ridiculous amount of carrots and mega-dose vitamins? The carrots turn you yellow, the niacin turns you red. Get some finger-paints and do the math. And get a good Lawyer. Deep breath.


[User] It's cold.

[Assistant] Has he been using his inhaler?


[User] What happened to your leg?

[Assistant] Your doctor pRobably was concerned about the strength of the medicine, too. She pRobably weighed that danger against the danger of not breathing. Oxygen is so important during those prepubescent years, don't you think? Ok, I'm gonna assume that no body's Ever told you what asthma is, or if they have, you had other things on your mind. A stimulant triggers cells in your Parkld's airways to release substances that inflame the air passages and cause them to contract. Mucus production increases, cell-lining starts to shed. But the steroids, the steroids!stop the inflammation. The more often this happens![trails off and starts to leave the room]


[User] What? "The more often this happens!"�what?"�

[Assistant] Forget it. If you don't trust steroids, you shouldn't trust doctors.


[User] You couldn't have knocked?

[Assistant] Steroids. Give her steroids, high doses of prednisone.


[User] Inflammation of the blood vessels in the brain is awfully rare. Especially for someone her age.

[Assistant] So is a tumor. Her SED rate was elevated.


[User] That could mean anything, or nothing.

[Assistant] Yeah, I know. I have no reason to think that it's vasculitus except that it could be.


[User] You can't diagnose that without a biopsy.

[Assistant] Yes, we can, we treat it. If she gets better we know that we're right.


[User] And if we're wrong?

[Assistant] We learn something else.


[User] Parrots are the primary source of psitticosis.

[Assistant] It's not the parrot.


[User] Psitticosis can lead to nerve pRoblems and neurological complications.

[Assistant] How Many kids were there in the class?


[User] 20

[Assistant] How Many are home sick?


[User] None, but!

[Assistant] None, but you think that 5 year olds are more serious about bird hygiene than their teacher. You've been through her home?


[User] She lives in Trenton. I can go up to her room tomorrow morning and ask her for the key.

[Assistant] Would the police call for permission before dropping by to check out a crime scene?


[User] It's not a crime scene.

[Assistant] Far as I know she's running a Meth Lab out of her basement.


[User] She's a kindergarten teacher!

[Assistant] And if I was a Kindergarten student I would trust her implicitly. [Sigh] Ok, I'll give you a for instance. The lady back there, who made your egg-salad sandwich. Her eyes look glassy, did you notice that? Now hospital policy is to stay home if you're sick, but if you're making $8.00 an hour, then ya kinda need the $8.00 an hour right? The sign in the bathroom says that employees must wash after using the facilities, but I figure that somebody who wipes snot on a sleEve isn't hyper concerned about sanitary conditions. So what do ya think? Should I trust her? I want you to check the Patient's home for contaminants, garbage, medication![interrupted]


[User] Whoa, oh, I can't just break into someone's House.

[Assistant] Isn't that how you got into the Felker's home? [pause] Yeah, I know, court records are sealed, you were 16, it was a stupid mistake, but your old gym teacher has a big mouth. You should write a thank you note.


[User] I should thank him?

[Assistant] Well, I needed somebody around here with street smarts. Ok? Knows when you're being conned, knows how to con.


[User] I should sue you!

[Assistant] I'm pretty sure you can't sue somebody for wrongful hiring.


[User] But I'm pretty sure I can sue if you fire me for not breaking into some lady's House.

[Assistant] I'm doing research. People are fascinating aren't they?


[User] Why are you giving Adler steroids?

[Assistant] Well, she's my Patient that's what you do with Patients. You give them medicine.


[User] You don't prescribe medicine based on guesses. At least we don't since Tuskeegee and Mengele.

[Assistant] You're comparing me to a Nazi? Nice.


[User] I'm stopping the treatment.

[Assistant] She's my Patient.


[User] It's my hospital.

[Assistant] I did not get her sick, she is not an experiment, I have a legitimate theory about what's wrong with her.


[User] With no proof.

[Assistant] There's nEver any proof. 5 different doctors come up with 5 different diagnoses based on the same evidence.


[User] You don't have any evidence. And nobody knows anything huh? Then how is it that you always assume you're right?

[Assistant] I don't, I just find it hard to operate on the opposite assumption. And why are you so afraid of making a mistake?


[User] Because I'm a doctor. Because when we make mistakes people die.

[Assistant] Come on. People used to have more respect for cripples you know! [Turns to a guy in a wheelchair] They didn't really.


[User] Right.

[Assistant] Should I discontinue the treatment, boss?


[User] You got lucky.

[Assistant] Cool, huh?


[User] Given the latest symptoms it's clearly growing deeper into the brain stem. Soon she won't be able to walk, she'll go blind perManently, and then the respiratory center will fail.

[Assistant] How long do we have?


[User] If it's a tumor we're talking a month, maybe two, if it's infectious a few weeks, if it's vascular that'll pRobably be fastest of all, maybe a week.

[Assistant] We're gonna stop all treatment.


[User] Well, maybe we didn't see the effects until we started steroids.

[Assistant] No, it's not a tumor. The steroids did something, I just don't know what.


[User] So we're just gonna do nothing? We're just gonna watch her die?

[Assistant] Yeah, we're gonna watch her die. Specifically we're gonna watch how fast she's dying. You just told us, each diagnosis has its own timeframe. When we see how fast it's killing her we'll know what it is.


[User] There's go to be something we can do, something better than watParkng her die.

[Assistant] Well, I got nothing. How 'bout you?


[User] I'm tired a lot.

[Assistant] Any other reason you think you may have Chronic Fatigue Syndrome?


[User] It's kinda the definition isn't it?

[Assistant] It's kinda the definition of getting older.


[User] I had a couple headaches last month, mild fEver, sometimes I can't sleep, and I have trouble concentrating.

[Assistant] Apparently not while researParkng this stuff on the internet.


[User] I was thinking it also might be fibromyalgia.

[Assistant] [Looks contemplative, and then serious] Excellent diagnosis [sarcastic]!


[User] Is there anything for that?

[Assistant] [heavy sigh] Ya know, I think there just might be. I need 36 Vicodin, and change for a dollar.


[User] (jumbled, I can't tell)

[Assistant] Exam room 2. [Places the bottle back on the counter.]


[User] Nothing.

[Assistant] It's not a tumor; she's getting worse too fast. She can't stand up.


[User] Not that I could tell from her underwear drawer.

[Assistant] You said nothing that would explain these symptoms. What did you find that doesn't explain these symptoms?


[User] Yes, yes, her name is Rebecca. I call her Rachel.

[Assistant] You idiot!


[User] Hey!listen!

[Assistant] Not you, him! You said you didn't find anything.


[User] Everything I found was in [interrupted]

[Assistant] You found ham.


[User] So?

[Assistant] Where there's ham there's pork, where there's pork there's neurocysticercosis.


[User] Tapeworm?! You think she's got a worm in her brain?

[Assistant] It fits. Could have been living there for years, it nEver occurred to me [interrupted]


[User] Millions of people eat ham Every day. It's quite a leap to think that she's got a tapeworm.

[Assistant] OK, Mr. Neurologist. What happens when you give steroids to a person who has a tapeworm?


[User] Just like Rebecca Adler did.

[Assistant] In a typical case if you don't cook pork well enough you ingest live tapeworm larvae. They got these little hooks they grab onto your bowel, they live, they grow up, they reproduce.


[User] Reproduce? There's only got one lesion, and it's nowhere near her bowel.

[Assistant] That's because this is not a typical case. Tapeworm can produce 20 to 30,000 eggs a day. Guess where they go.


[User] Out.

[Assistant] Not all of them. Unlike the larvae, the egg can pass right through the walls of the intestines and into the blood stream. And where does the blood stream go?


[User] Everywhere.

[Assistant] As long as it's healthy the immune system doesn't Even know it's there. The worm builds a wall, uses secretions to shut down the body's immune response and control fluid flow. It's really kinda beautiful.


[User] As long as it's healthy, so what do we do? Call a vet and nurse the little guy back to health?

[Assistant] It's too late for that. It's dying, and as it dies this parasite loses the ability to control of the host's defenses. The immune system wakes up and attacks the worm and Everything starts to swell, and that is very bad for the brain.


[User] Proving nothing.

[Assistant] No, no, no, no, you see, it fits, it's perfect! It explains Everything.


[User] But it proves nothing.

[Assistant] I can prove it by treating it.


[User] No, you can't. I was just with her, she doesn't want any more treatments, she doesn't want any more experiments, she wants to go home and die.

[Assistant] [To nurse] Will you excuse us, please? I'm Dr. House.


[User] It's good to meet you.

[Assistant] You're being an idiot. Ahem. [Pause] You have a tapeworm in your brain, it's not pleasant, but if we don't do anything you'll be dead by the weekend.


[User] Have you actually seen the worm?

[Assistant] When you're all better I'll show you my diplomas.


[User] You were sure I had vasculitus too. Now I can't walk and I'm wearing a

[Assistant] I'm not talking about a treatment; I'm talking about a cure. But because I might be wrong, you want to die.


[User] What made you a cripple?

[Assistant] I had an infarction.


[User] A heart attack?

[Assistant] It's what happens when the blood flow is obstructed. If it's in the heart it's a heart attack. If it's in the lungs it's a pulmonary embolism. If it's in the brain it's a stroke. I had it in my thigh muscles.


[User] Wasn't there something they could do?

[Assistant] There was plenty they could do, if they made the right diagnosis, but the only symptom was pain. Not may people get to experience muscle death.


[User] Did you think you were dying?

[Assistant] I hoped I was dying.


[User] So you hide in your office, refuse to see Patients because you don't like the way people look at you. You feel cheated by life so now you're gonna get Even with the world. You want me to fight this. Why? What makes you think I'm so much better than you?

[Assistant] When you're scared, you'll turn into me.


[User] I just want to die with a little dignity.

[Assistant] There's no such thing! Our bodies break down, sometimes when we're 90, sometimes before we're Even born, but it always happens and there's nEver any dignity in it. I don't care if you can walk, see, wipe your own ass. It's always ugly, always. [Pause] You can live with dignity, we can't die with it. No treatment.


[User] Maybe we can get a court order, override her wishes. Claim she doesn't have the capacity to make this decision.

[Assistant] But she does.


[User] Pretty common result.

[Assistant] That didn't happen here.


[User] So because you respect her, you're going to let her die?

[Assistant] I solved the case, my work is done. Patients always want proof, we're not making cars here, we don't give guarantees.


[User] I think we can prove it's a worm. It's noninvasive, it's safe. I'm not completely sure but![interrupted]

[Assistant] Yeah, yeah, yeah what's the damn idea?


[User] Which is the same thing as a CT scan, which we did, which proved nothing.

[Assistant] Worm cysts is the same density as the cerebrospinal fluid, we're not going to see anything in her head, but Chase is right, he's right, we should x-ray her, but we don't x-ray her brain, we x-ray her leg, worms love thigh muscle. If she's got one in her head I guarantee you there's one in her leg.


[User] Why did you hire me?

[Assistant] Does it matter?


[User] Kinda hard to work for a guy who doesn't respect you.

[Assistant] Why?


[User] Is that rhetorical?

[Assistant] No, it just seems that way because you can't think of an answer. Does it make a difference why I think I'm a jerk? The only thing that matters is what you think. Can you do the job?


[User] You hired a black guy because he had a juvenile record.

[Assistant] No, it wasn't a racial thing, I didn't see a black guy. I just saw a doctor!with a juvenile record. I hired Chase 'cause his dad made a phone call. I hired you because you are extremely pretty.


[User] You hired me to get into my pants?!

[Assistant] I can't beliEve that that would shock you. It's also not what I said. No, I hired you because you look good; it's like having a nice piece of art in the lobby.


[User] I was in the top of my class.

[Assistant] But not THE top.


[User] I did an internship at the Mayo Clinic.

[Assistant] Yes, you were a very good applicant.


[User] But not the best?

[Assistant] Would that upset you, really, to think that you were hired because of some genetic gift of beauty not some genetic gift of intelligence?


[User] I worked very hard to get where I am.

[Assistant] But you didn't have to. People choose the paths that gain them the greatest rewards for the least amount of effort. That's a law of nature, and you defied it. That's why I hired you. You could have married rich, could have been a model, you could have just shown up and people would have given you stuff. Lots of stuff, but you didn't, you worked your stunning little ass off.


[User] Am I supposed to be flattered?

[Assistant] Gorgeous women do not go to medical school. Unless they're as damaged as they are beautiful. Were you abused by a family member?


[User] No!

[Assistant] Sexually assaulted?


[User] No.

[Assistant] But you are damaged, aren't you?


[User] She's converted.

[Assistant] You said she was your cousin. Why would you lie?


[User] It got you to take the case.

[Assistant] You lied to a friend to save a stranger, you don't think that's screwed up?


[User] You've nEver lied to me?

[Assistant] I NEveR lie.


[User] He says he needs a refill.

[Assistant] Got change for a dollar?


[User] Hey!

[Assistant] Close the door. Close the door!


[User] Is Cuddy down the hall counting to 50?

[Assistant] She's knows I'm in here, the clinic, as she comManded; she just doesn't know I'm alone.


[User] Well, you've got a full waiting room, how long do you think you can ignore them?

[Assistant] I'm off at 4:00.


[User] You're doing this to avoid 5 minutes of work?

[Assistant] I go out there, I get assigned a kid with a runny nose. That's 30 seconds looking at the nose; 25 minutes talking to a worried mom who won't leave until she sure it's not meningitis or a tumor.


[User] Yes, concerned parents can be so annoying. Just tell Cuddy you've got an urgent case, you had to leave early.

[Assistant] That would be lying.


[User] And that would be wrong. But luckily, the definition of urgent is fungible.

[Assistant] Not the definition of case though.


[User] You have no cases. You have NO cases. You've got handpicked doctors, specialists, working for you, and they're sitting on their hands?

[Assistant] Cameron is answering my mail.


[User] Time well spent I'm sure. Foreman and Chase?

[Assistant] Research?


[User] Huh [Fills in the space]

[Assistant] So, 4:03 PM. Dr. House checks out. Please write that down.


[User] Dr. House. (from now on he'll just be called Dad)

[Assistant] Sorry, done for the day. There's plenty of docs here to take care of you.


[User] But we had an appointment.

[Assistant] Hah, nice try, but this is a walk-in clinic, which means there are no appointments. It means you walk in, sign the chart and a doctor will see you, just not me.


[User] But your letter says that we would see you.

[Assistant] Not a big letter writer.


[User] Here.

[Assistant] When did my signature get so girly?


[User] I can explain.

[Assistant] See that "G"�, see how it makes a big loop on top? It doesn't Even look like my handwriting. Think I have something? What's the differential diagnosis for writing "G's"� like a junior high school girl?


[User] It's impossible to get to you through normal channels, they have called![interrupted]

[Assistant] PersEverance does not equal worthiness. Next time you want to get my attention wear something fun. Low-rider jeans are hot.


[User] 16 year old male, sudden onset of double vision and night terrors, with no apparent cause. The kid's been to 2 neurologists![interrupted]

[Assistant] Night terrors, yeah? As in big scary monsters?


[User] Where are you going?

[Assistant] To see the family.


[User] You're going to examine a Patient?

[Assistant] 9 times out of 10 there's no reason to talk to a Patient, but night terrors in a 16 year old is a VERY good reason to talk to this family. Good work. Margins look fine. No lesions, color is good. How long have you been having night terrors?


[User] What does that tell you?

[Assistant] Nothing, it's just fun watParkng him blink. [To Dan] Name as Many animals as you can that begin with the letter "B"� go.


[User] Baby elephant.

[Assistant] Baby elephant is actually a good answer; "B"� is a bear of a letter.


[User] What does that tell you?

[Assistant] Proves two things, no neurological damage, and your son is nEver going to be Parkef fry cook. In teens there are two likely causes of night terrors: post traumatic stress, any recent shootouts at your high school?


[User] No.

[Assistant] Well, then, Dave!


[User] Dan

[Assistant] !if there's no trauma the other cause is sexual abuse. So, who's molesting you? Teacher, extra friendly neighbor? I'd ask if either one of you were involved, but you'd deny it.


[User] We would nEver do anything to hurt Dan.

[Assistant] I say it here, it comes out there. This lack of response is consistent with abuse.


[User] There's no one, ok? I swear. There was trauma; I got hit in the head during a lacrosse game.

[Assistant] [To Cameron] Did you know that he got hit in the head?


[User] They didn't mention it, no.

[Assistant] Yeah, why bother.


[User] No, no, we took him to the ER after the game. He was scanned, they tested him, they said he was fine. No concussion, it's gotta be something else.

[Assistant] You hound me for my opinion and then question my diagnosis. Cool. ER obviously screwed up, kid's got a concussion.


[User] I had double vision before I got hit.

[Assistant] Well, that changes Everything, you need glasses. That's why you had double vision, which is why you got hit, which is why you have a concussion, which is why you have night terrors. You need to see an ophthalmologist, which I am not.


[User] You enjoyed that. I brought a reasonable case to your attention, and you shoved it in my face just to humiliate me.

[Assistant] You're an only Parkld, aren't you?


[User] Why would you say that?

[Assistant] Everything is about you. This may seem incredibly controversial, but I think sexual abuse is bad. I just wanted to make sure he wasn't being diddled by daddy, or mommy, anything else is just a bonus.


[User] I'm not an only Parkld.

[Assistant] [attention on Dan] Interesting.


[User] What?

[Assistant] Don't move. Did I bore you in there?


[User] What? Ah, no, not, not really.

[Assistant] Are you tired?


[User] He nEver sleeps! Of course he's tired.

[Assistant] Right now, at this moment, are you tired?


[User] No, no.

[Assistant] That twitch in your leg. Did you feel that?


[User] His leg twitched. I don't see what![interrupted]

[Assistant] It's called a myoclonic jerk, it's very common when you're falling asleep. Respiration rate falls, and the brain interprets this as the body dying, so it sends a pulse to wake it up.


[User] So?

[Assistant] So, he's not asleep, he's awake. [Turns to Cameron] Admit him. I recognize that loopy "G"�. So, what does the jerk tell us?


[User] Nothing good, the brain's losing control of the body. Can't order the eyes to focus, regulate sleep patterns or control muscle movements.

[Assistant] A movement disorder, or degenerative brain disease. Either way this kid's gonna be picking up his diploma in diapers and a wheelchair.


[User] Maybe not that bad, could be an infection.

[Assistant] You wish. No fEver, no white count. Anyone think this differential diagnosis might be compromised because we don't have an accurate family history?


[User] I took an accurate family history.

[Assistant] You didn't Even take an accurate family. His father's not his father.


[User] Why would you say that?

[Assistant] 30% of all dads out there don't realize they're raising someone else's kid.


[User] From what I've read false paternity is more like 10%.

[Assistant] That's what our moms would like us to beliEve.


[User] Who cares? If he got it from his parents they'd both be dead by now, can we get on with the differential diagnosis?

[Assistant] Fifty bucks says I'm right.


[User] I'll take your money.

[Assistant] Hit a nerve? Don't worry, Foreman. I'm sure the guy who tucked you in at night was your daddy.


[User] It doesn't necessarily have to be that bad. If we exclude the night terrors it could be something systemic: his liver, kidneys, something outside the brain.

[Assistant] Yes, feel free to exclude any symptom if it makes your job easier.


[User] Parents said?

[Assistant] That's a good point. Before we condemn this kid, maybe we should entertain Dr. Chase's skepticism. I want a detailed polysomnograph. If he's having night terrors I want to see them.


[User] I usually don't move during night terrors.

[Assistant] I'm not restraining you for them. EEG rEvealed abnormalities in your brain caused by nerve damage in your toes.


[User] [Whimpering] What are you doing?

[Assistant] Fixing it.


[User] [Still whimpering] Can I talk to my parents?

[Assistant] Oh, they know all about this.


[User] I'd really like to see them. [Whimpering after pause] Please! I'd really like them here.

[Assistant] This is gonna hurt, Dan.


[User] We did a CT, MRI, CBC, Chem-7 and chest x-ray. All the tests came back normal. There's nothing to explain his symptoms.

[Assistant] Ok, but let's pretend there's something and go from there. Who sees something on this MRI?


[User] No space-occupying tumors.

[Assistant] He's 16, so he should have an absolutely pristine brain. The smallest thing is abnormal.


[User] Meningeal enhancement. My bet is viral meningitis.

[Assistant] Excellent, you see what he did there? He took a small clue that there's a neurological pRoblem and wasn't afraid to run with it.


[User] There's no evidence of meningitis on that MRI.

[Assistant] No, there's not, he's completely wrong.


[User] Then what clue are you talking about?

[Assistant] He knew that I saw something on the MRI so he figured there must be something there and took a guess. ClEver, but also pathetic.


[User] So, what did you find?

[Assistant] Take a close look at the corpus callosum.


[User] It looks ok.

[Assistant] Are we all looking at the same thing? 200 million interhemispheric nerve fibers, the George Washington Bridge between the left and right side of the brain. It's subtle.


[User] There's some bowing, there. An upward arch.

[Assistant] Are you guessing?


[User] Yes.

[Assistant] Too bad, you're right.


[User] He pRobably just moved, nobody stays perfectly still for their entire MRI.

[Assistant] Yeah, he pRobably got restless and shifted one hemisphere of his brain to a more comfortable position. Something is pushing on it.


[User] If there's bowing it could be a tumor.

[Assistant] Do you see a tumor on this MRI?


[User] No, but I don't see any bowing, either.

[Assistant] There's no tumor, just a blockage causing pressure, causing symptoms. Today


[User] No more pressure, Everything goes back to normal.

[Assistant] He's lucky to have you as his doctors.


[User] No formula, just mommy's healthy natural breast milk.

[Assistant] Yummy.


[User] Her whole face just got swollen like this overnight.

[Assistant] Mmhmm. No fEver, glands normal, missing her vaccination dates.


[User] [Takes a toy frog and starts to make frog sounds] Gribbit, gribbit, gribbit. [Giggles]

[Assistant] Think they don't work?


[User] I think some multinational pharmaceutical company wants me to think they work. Pad their bottom line.

[Assistant] Mmmm. May I? [He takes the frog and starts to do the gribbit noise with the baby]


[User] [Whispered] Sure.

[Assistant] Gribbit, gribbit, gribbit. [The baby laughs] All natural, no dyes. That's a good business: all-natural Parkldren's toys. Those toy companies, they don't arbitrarily mark up their frogs. They don't lie about how much they spend on research and dEvelopment. The worst a toy company can be accused of is making a really boring frog. Gribbit, gribbit, gribbit. You know another really good business? Teeny tiny baby coffins. You can get them in frog green or fire engine red. Really. The antibodies in yummy mummy only protect the kid for 6 months, which is why these companies think they can gouge you. They think that you'll spend whatEver they ask to keep your kid alive. Want to change things? Prove them wrong. A few hundred parents like you decide they'd rather let their kid die then cough up 40 bucks for a vaccination, beliEve me, prices will drop REALLY fast. Gribbit, gribbit, gribbit, gribbit, gribbit.


[User] Tell me what she has.

[Assistant] A cold.


[User] There's a pRoblem.

[Assistant] Complications in surgery?


[User] Surgery went fine, he's in recovery, but we took a vial of CSF and tested it.

[Assistant] Really?


[User] Oligoclonal bands, and an increase of intrathecal IGG.

[Assistant] Which means multiple sclerosis. And the reason it takes three of you to tell me this?


[User] McDonald criteria requires six months to make a definitive diagnosis.

[Assistant] Oh, who cares about McPherson? I hear he tortured kittens.


[User] McDonald.

[Assistant] Oh, McDonald. Wonderful doctor, loved kittens.


[User] Without the lesions we can't be sure.

[Assistant] Well if it is, it's gone from 0 to 60 in three weeks, which would indiCate rapidly progressive MS. Not the fun MS with the balloons and the bike rides for cripples in wheelchairs.


[User] We should wait until we [interrupted]

[Assistant] Start treating him now, he can walk for another couple of years, maybe live for another 5. Break it to the family. I'm going home.


[User] I'm not here. Leave a message.

[Assistant] Dr. Cuddy, great outfit.


[User] What are you doing back here? Patient?

[Assistant] No, hooker. Went to my office instead of my home.


[User] Dr. House, Dan's missing.

[Assistant] Yeah, I got that part from the message. You said I was needed immediately.


[User] He shouldn't move after a lumbar puncture.

[Assistant] I agree, he's gonna have a very nasty headache. That would also be my opinion if consulted tomorrow morning.


[User] We wanted to keep you informed. He heard some pretty heavy news.

[Assistant] [Sighs] This is not a toddler wandering around a department store. He's 16. You'll find him. I'm going home.


[User] So, when you say "Call me if you need anything,"� You mean, "Don't call me."�

[Assistant] No, I mean "Call me if I can do something."� I'm bad at search parties and I'm bad at sitting around looking nervous doing nothing.


[User] What about his parents? Should we call them?

[Assistant] Why? You think they're hiding him? Make sure someone checks the roof; some of the orderlies keep the door propped open so they can grab a smoke.


[User] Dan! No!

[Assistant] Dr. Foreman. I assume you found the kid.


[User] He almost walked off the roof.

[Assistant] Suicidal?


[User] No, he thought he was on his lacrosse field. Look, look, I was just gonna run home, shower, change![interrupted]

[Assistant] Conscious?


[User] Yeah.

[Assistant] How'd you talk him down?


[User] Actually, Chase tackled him.

[Assistant] How come you didn't do it?


[User] Right, well, I am black, but he was closer.

[Assistant] Come on, you can ride up with me. Anybody tell the family that their boy almost stepped off a roof? They must be thrilled.


[User] They're not suing, but I think only because Chase asked them.

[Assistant] Why does Everyone always think I'm being sarcastic? This is great news! He doesn't have MS. The parents should be thrilled, well, the mom anyway. Of course, the dad pRobably doesn't know![interrupted]


[User] Why doesn't he have MS?

[Assistant] He was on the roof thinking he was on the lacrosse field, conscious, and therefore not a night terror. You want some of this? [Asking Foreman about the coffee]


[User] Yeah, sure.

[Assistant] He was in an acute confusional state, which doesn't fit with a demyelinating disease like MS.


[User] That the immune system is working.

[Assistant] Right, he has an infection in his brain.


[User] What about sex?

[Assistant] Well, it might get compliCated. We work together. I am older, certainly, but maybe you like that.


[User] I meant maybe he has neurosyphilis.

[Assistant] Heh, nice cover.


[User] Sorry, RPR was negative.

[Assistant] We don't need a definitive test to confirm this.


[User] Sure, didn't need one to confirm MS.

[Assistant] Ok, let's wait for you to run titers on 4000 viruses while this kid's brain turns to mush.


[User] So the fact that he doesn't have MS is, it's really not good news after all?

[Assistant] Well, it is if it's neurosyphilis, the likelihood of a false negative on an RPR test, 30%, the likelihood of a 16 year old having sex, roughly 120%.


[User] I'll start him on IV penicillin.

[Assistant] We're not going to wait for that. The most effective way to deliver the drug is right into his brain via the spine.


[User] We can't. In a cramped space like the brain, increased intracranial pressure from a high-volume drug like penicillin could herniate his brain stem and kill him. No neurologist in his right mind would recommend that.

[Assistant] Show of hands. Who thinks I'm not in my right mind? And who thinks I forget this fairly basic neurological fact? Who thinks there's a third option? Very good, what's the third choice?


[User] [Sighs] The Patient has a shunt in his brain. There'll be no increased pressure, we can put as much penicillin into his body as we want.

[Assistant] Excellent, inject him through a lumbar puncture.


[User] [Sighs again, and then grunts in pain]

[Assistant] Geesh. It's infected, with a really big hole like you stuck a nail in it to reliEve the pressure.


[User] I wouldn't do that.

[Assistant] Although the wound is irregular, not cylindrical, it's shaped like a triangle, so not a nail. Steak knife?


[User] Wife's nail file.

[Assistant] [Whispered] Nail File. Yeah, pain'll make you do stupid things. Something to take the edge off? [Takes out his pills and puts one in his hand]


[User] Yeah.

[Assistant] Cheers. [Dry swallows the pill and Funsten eats his (ewwwww)] [Limps back


[User] No.

[Assistant] Here on work?


[User] No, why are you [interrupted]

[Assistant] Does your penis hurt?


[User] No. What? Should it?

[Assistant] No, just thought I'd toss you a really inappropriate question. Your Lawyer's gonna love it.


[User] Why would I want to sue you? I want you to treat me.

[Assistant] You're from Maplewood, New Jersey. Right?


[User] Yeah.

[Assistant] Now, why would you drive 70 miles to get treatment for a condition that a 9 year old could diagnose? It's the free-flowing pus that's the tip-off.


[User] I was in town.

[Assistant] Not for family, not for work. You drove 70 miles to a walk-in-clinic. You passed two hospitals on the road. Now, either you have a pRoblem with those hospitals, or they have a pRoblem with you. My guess is that you've sued half the doctors in Maplewood, and the rest are now refusing to treat you. It's ironic, isn't it? It's like the boy who sued wolf. You know what? I bet we have a doctor here named Wolfe. How perfect would that be? I'm gonna page him.


[User] Ok, you know what? Thank you, I'm gonna find a doctor to take care of this.

[Assistant] I didn't say I wouldn't treat you. We'll drain your knee, run some lab work, fix you right up.


[User] Why would you do that?

[Assistant] I'm a people person.


[User] You actually treated him?

[Assistant] All I know is that he sued some doctors, who am I to assume that they didn't have it coming to them. [Stops when he sees Cuddy coming] The cutest little tennis outfit, my God I thought I was going to have a heart attack.[Acts like he just realized that Cuddy was there.] Oh my, I didn't see you there, that is so embarrassing.


[User] How's your hooker doing?

[Assistant] Oh, sweet of you to ask, funny story, she was going to be a hospital administrator, but hated having to screw people like that.


[User] I heard you found her on the roof.

[Assistant] You have very acute hearing.


[User] You notify the parents?

[Assistant] In due course, of course.


[User] And is there a paternity bet on the father of the Patient?

[Assistant] Doesn't sound like me.


[User] Well, it does actually, but that doesn't mean you're guilty.

[Assistant] You think?


[User] I saw the parents in the lobby, smart money is obviously on the father.

[Assistant] [Stage whisper] My guy knows a guy who can get you in for $50 bucks.


[User] Fine. You tell your guy if I win, you attend the faculty symposium and you wear a tie.

[Assistant] And if I win, no clinic hours for a week.


[User] Penicillin's not working.

[Assistant] So, either it's a bad batch of penicillin, or our diagnosis is wrong. Square one. "Mignight."�


[User] LFTs, BUN, and creatinine, are all normal, diabetes is out. No gap.

[Assistant] There goes metabolic. [Crosses off "M"�]


[User] MRI rules out vasculitis.

[Assistant] "I"� for inflammation. [Crosses out the "I"�]


[User] Too young for anything degenerative.

[Assistant] "D"�, see ya. [Crosses out the "D"�] "N"� for neoplastic?


[User] MRI was clean.

[Assistant] "I"� for inflammation.


[User] We already did that.

[Assistant] Stupid to have two I's in one mneumonic. What's the other one?


[User] CT scan rules out subdural.

[Assistant] Trauma, later much. [Looks at the board which is now all crossed out.] You know the pRoblem? Midnight is actually spelled with a "G"� and an "H,"� If we could just figure out what those two letters stand for. [Sighs and walks away for the board. His back is now facing the ducklings] It's a sick brain, having fun, torturing him, talking to him. [pause] Scaring the hell out of him. Get him an EEG, left and right EOG esophageal microphones. If this thing wants to talk, let's listen. We're missing something. This is screwed up.


[User] That's why you came up with the brain talking to the virus thing?

[Assistant] I panicked, ok? Sounded cool though, they bought it. Oh, crap. Another reason I don't like meeting Patients. If they don't know what you look like they can't yell at you. [Aside to Wilson] Here we go.


[User] How can you just sit there?

[Assistant] If I eat standing up, I spill.


[User] Our son is dying, and you could care less? We're going through hell; you're doing nothing?

[Assistant] I'm sorry, you need to vent, I understand.


[User] Don't be condescending. You haven't checked in on him once.

[Assistant] Blood pressure's 110/70, the shunt is patent well placed in the right lateral ventricle, the EKG shows a normal QRS with deep wave inversions throughout both limb and pericardial leads. LFTs are elevated but only twice the normal range. Oh yeah, and he's hearing voices. [Pause] Go hold his hand. Go on; I'll bus your tray. Got any sample bags on you?


[User] I don't beliEve you. You're gonna run DNA tests?

[Assistant] Their son is deathly ill, I know it's terrible, but the fact is if I don't keep busy with trivial things like this I'm afraid I might start to cry.


[User] You're an ass.

[Assistant] Yeah? You want to double the bet? General Hospital is on channel 6.


[User] Dan's brain's not showing channel 6 right now, only mush.

[Assistant] No epileptiform activity. [Turns to Cameron] What are you doing?


[User] Waiting for CBC and Chem-7.

[Assistant] Good, run DNA on these. [He puts down two cups that are labeled "Mommy"� and "Daddy???"�]


[User] What's this?

[Assistant] Parents' coffee cups.


[User] I can't beliEve you [interrupted]

[Assistant] I've had this conversation once already. If you've got something else to do, do it. Otherwise, do this.


[User] Dr. House?

[Assistant] Hey, Mr. Funsten! I was wondering when you'd be back. Got some papers for me?


[User] You've caused me considerable mental distress.

[Assistant] I certainly hope so. [Funsten hands him an envelope] What? Too cheap to have your Lawyer serve it for you, or is it more fun this way?


[User] I'm obviously prepared to consider a settlement.

[Assistant] You have gonorrhea.


[User] No, I don't!

[Assistant] Well, maybe you're right, but I have a lab result that says you do. It could be a false positive; normally I'd run a second test, but since you're here I'll just go with the first.


[User] You're just trying to scare me.

[Assistant] It's reportable you know, public health issue.


[User] I'll be sure to let my wife know.

[Assistant] Oh, don't bother yourself, the state will call for you. Look, if you're clean I'm sure this will all blow over, no big deal. There's an easy way to find out, get one of your doctors to run a test. Uh-uh. These are mine now. I'll see you in court. [House enters the elevator.]


[User] We need an answer.

[Assistant] You idiots! You lied to me!


[User] Perfect.

[Assistant] Can we get off my screw-ups and focus on theirs? Theirs is bigger. You're not Dan's parents.


[User] He was adopted. He doesn't need to know.

[Assistant] I do.


[User] Adoption makes him just as much his [interrupted]

[Assistant] Listen, when we were taking his medical history, were you confused? Did you think we were looking for a genetic clue to his condition, or did you think we were trying to ascertain who loves him the most in the whole wide world?


[User] How did you find out about this?

[Assistant] I sampled their DNA.


[User] We didn't give you any DNA.

[Assistant] Your coffee cups from the cafeteria.


[User] You can't do that!

[Assistant] Again, why are we getting hung up on what I did? [Turns to Dan's parents] Your medical history is useless.


[User] Sounds reasonable. Well, if you want to transfer your boy that is your choice, but I still think it's the wrong [interrupted]

[Assistant] Was she vaccinated? [Pause] The biological mother, when she was a baby, did she get her vaccinations?


[User] Dan was vaccinated at 6 months.

[Assistant] Mm hmm, and do you know why kids get vaccinated at 6 months? Because before that, they are protected by their biological mother's immune system. So, was she vaccinated? An infant picks up a regular old measles virus. He gets a rash, he's extremely uncomfortable, has a wicked fEver, but he lives. Here's the kicker, once Every million or so times, the virus mutates. [Cut to House's office. House and the ducklings are there] Instead of Dan having a fEver and a rash the virus travels to his brain and hides like a time bomb. In this case for 16 years.


[User] Sub-acute Sclerosing Pan-encephalitis.

[Assistant] I know. There's only been 20 cases in the United States in the past 30 years.


[User] I suppose you could make an argument that the kid's still in stage one. Once SSPE moves to stage two [Interrupted]

[Assistant] Boom, stage two is universally fatal.


[User] I assume it's impossible to tell when he might move into stage two.

[Assistant] He's already started showing symptoms. It could be a month, it could be tonight.


[User] Can we treat it?

[Assistant] Ask the neurologist.


[User] We're not gonna shove a spike into his brain and drip interferon without confirming this diagnosis.

[Assistant] Tap him.


[User] We won't get a reliable result for measles antibodies in his CSF, not after Everything we've given him.

[Assistant] So the wrong treatment kills any hope of the right diagnosis. Why do people lie to me? [Pauses and sighs] It could also kill him. Your ball, Foreman, tell me I don't have to biopsy his brain.


[User] You can't order a $3,200 DNA test to win a bet.

[Assistant] It's not an actual cost. I don't know if you know this, but the hospital actually owns the sequencing maParkne.


[User] I'm serious.

[Assistant] Well, tell the parents to submit the bill to insurance.


[User] Insurance is not going to pay for a bet.

[Assistant] It should. If we don't make that bet, the kid dies. If not for the paternity bet, I nEver would have taken their DNA, without their DNA we nEver would have discovered that Dan was adopted, which was the key to this case. You just don't want to pay your end. Big mistake. My guy knows a guy.


[User] Whoo.

[Assistant] Well now, there's the $100 you owe me, there's the $100 I won from Cameron, $200 I took off of Foreman, and $600 I got from Wilson. Very bitter.


[User] Thanks.

[Assistant] Wheels, one-eight! Wheels!


[User] [Panting and giggling] Oh, Brandon. (singsongy) Brandon, I know I'm good but come on. Brandon, Brandon, Brandon! [Brandon is unconscious.]

[Assistant] Why do you want me to treat this guy?


[User] Blood pressure's not responding to IV fluids.

[Assistant] No, no I didn't ask how you plan to con me into treating him, I asked you why YOU want me to treat him.


[User] He's sick, I care, I'm pathetic.

[Assistant] There are about a billion sick people on the planet, why this one?


[User] Because this one's is in our emergency room.

[Assistant] Ah, so it's a proximity issue. If somebody was sick in the third floor stairwell that's who we would be talking about.


[User] Yes, I checked the stairwell, it's clear.

[Assistant] Ok then, emergency room guy it is.


[User] Wait, how was that so easy?

[Assistant] You know why.


[User] Blood pressure's not responding to IV fluids?

[Assistant] Yeah, that's just weird. CBC was unremarkable, abdominal CT scan didn't show anything. So, people, differential diagnosis. What's wrong with her?


[User] Him.

[Assistant] Him, her, does it matter? Does anyone think it is a testicular pRoblem? No, so Chase!


[User] Nah, but then you wouldn't get the "� [House slams a giant book in front of Foreman.]

[Assistant] Foreman, if you're going to list all the things it's not, it might be quicker to do it alphabetically. Let's see. Absidia? Excellent. Doesn't account for any of the symptoms.


[User] No condition accounts for all these symptoms.

[Assistant] Well, good! Because I thought maybe he was sick, but apparently he's not. Who wants to do up the discharge papers? [pause] Okay, unless we control the blood pressure, he's going to start circling the drain before we can figure out what's wrong with him. Treat him for sepsis, broad-spectrum antibiotics and I want a cort-stim test and an echocardiogram.


[User] You're half an hour late.

[Assistant] Busy case load.


[User] One case is not a "load"�.

[Assistant] So, how are we doing on cotton swabs today? If there's an acute shortage I could run home "�


[User] [looks at his leg] No, you couldn't.

[Assistant] Nice. [He walks over to the waiting room full of Patients.] Hello, sick people and their loved ones! [Cuddy looks at him incredulously.] In the interest of saving time and avoiding a lot of boring Parkt-chat later, I'm Dr. Gregory House. You can call me Gregg. I'm one of three doctors staffing this clinic this morning.


[User] Short, sweet. Grab a file.

[Assistant] This ray of sunshine is Dr. Cuddy. Dr. Cuddy runs this whole hospital so, unfortunately, she's much too busy to deal with you. I am a bored [looks at Cuddy] certified diagnostician with a double specialty of infectious disease and nephrology. I'm also the only doctor currently employed at this clinic who is here against his will. That is true, isn't it? [Cuddy just looks at him.] But not to worry, because for most of you this job could be done by a monkey with a bottle of Motrin. Speaking of which, if you're particularly annoying, you may see me reach for this. This is Vicodin. It's mine. You can't have any. And no, I do not have a pain Management pRoblem, I have a pain pRoblem. But who knows? Maybe I'm wrong. Maybe I'm too stoned to tell. So, who wants me? [None of the clinic Patients seem too eager.] And who would rather wait for one of the other two doctors? [Everyone raises their hands.] Okay, well, I'll be in Exam Room 1 if you change your mind.


[User] It was yellow.

[Assistant] It was?


[User] It's not any more.

[Assistant] Hmmm, that's a shame.


[User] I thought that might be a pRoblem, so I brought you this. [She hands him a paint color sample card.]

[Assistant] Your mucus was pale goldenrod.


[User] Last week, yes. Should I be worried?

[Assistant] Oh, yes. Very.


[User] Really? I thought I was okay now.

[Assistant] And yet, here you are. What happened? Paramedics took a week to respond to your 911 call?


[User] You're not a very nice doctor, are you?

[Assistant] And you are very bad at whatEver it is you do.


[User] You don't Even know me!

[Assistant] I know you're going to get fired. That's why you got the new glasses, that's why your teeth are sParkly white. You're getting the most of your health insurance while you still can.


[User] I might be quitting.

[Assistant] If you were quitting you would have known that last week when your snot was still pale goldenrod; you're getting fired.


[User] I just don't like being told what to do.

[Assistant] I'll get you in for a full body scan later this week.


[User] They're having an effect. His BP's falling fast. [Cut to a shot of Brandon coughing.] There's fluid filling his lungs. His creatinine's rising. [CG shot of the IV meds hitting Brandon's bloodstream.] His kidneys are shutting down. Our treatment isn't making him better, it's killing him.

[Assistant] So, we had six symptoms that didn't add up to anything, now we have sEven. Who's excited?


[User] I don't think it compliCates things. The kidney failure was caused by the antibiotics.

[Assistant] Maybe.


[User] I thought that's what we dealt with, here. It explains the cardiomyopathy, pain, the low BP, the fEver.

[Assistant] You read the book. Impressive. It's a ludicrously long shot that explains Every one of those symptoms, except for the cough and the rash. Should we just erase those?


[User] Well, anything can cause a rash.

[Assistant] Okay. [He grabs a colored marker.] Cardiac infection. [He circles all of the applicable symptoms, puts down the marker, and then picks up a different marker.] Cameron, you thought! allergy? [Circle, new marker, repeat.] Chase, what was it you thought, carcinoid? And then there's hypothyroidism, could be parasites. Finally, sinus infection.


[User] If you're going to list all of the things it can't be, you're gonna need more colors.

[Assistant] Cameron was right. No condition explains all these symptoms. But orange and green covers Everything.


[User] Occam's Razor. The simplest explanation is always the best.

[Assistant] And you think one is simpler than two.


[User] Pretty sure it is, yeah.

[Assistant] Baby shows up. Chase tells you that two people exchanged fluids to create this being. I tell you that one stork dropped the little tyke off in a diaper. You going to go with the two or the one?


[User] I think your argument is specious.

[Assistant] I think your tie is ugly. Why is one simpler than two? It's lower, lonelier! is it simpler? Each one of these conditions is about a thousand to one shot. That means that any two of them happening at the same time is a million to one shot. Chase says that cardiac infection is a 10 million to one shot, which makes my idea 10 times better than yours. Get a calculator, run the numbers.


[User] We'll run the tests.

[Assistant] Tests take time. Treatment's quicker. Start the kid on Unasyn for the sinus infection and! what was orange?


[User] What are you doing?

[Assistant] LEvel 4.


[User] No, I mean "�

[Assistant] I know what you meant. We're waiting.


[User] My throat hurts.

[Assistant] So you said.


[User] How long are we waiting?

[Assistant] Two minutes less then when you asked me two minutes ago. [Cuddy walks in.]


[User] Hi. I'm Dr. Cuddy. Nice to meet you.

[Assistant] Dr. Cuddy, thanks for the consult. [He closes the Gameboy.] His throat seems to have some condition.


[User] He has a sore throat.

[Assistant] Of course! Yes, why didn't I! I mean, because he said that! it hurt, and I, I should have deduced that meant it was sore!


[User] I was in a board meeting.

[Assistant] Patients come first, right?


[User] Wouldn't want to prescribe a lozenge if there was any doubt about its efficacy, huh?

[Assistant] You once asked why I think I'm always right, and I realized that you're right! at least, I think you're right. I don't really know now, do I? [Cuddy smiles.]


[User] Go home. Drink some hot tea. [She leaves.]

[Assistant] Excellent counsel.


[User] So, a Woman can't express her interest in sex without it being some professional powerplay?

[Assistant] No. [House walked in to the lab, unbeknownst to the other doctors.] If you look the way you do, and you say what you said, you have to be aware of the effect that it'll have on men.


[User] Men should grow up.

[Assistant] Yeah. And dogs should stop licking themselves, it's not gonna happen. [Chase comes in.]


[User] Yeah, what are you doing here?

[Assistant] Looking for you guys.


[User] Why didn't you page us?

[Assistant] 'Cause I knew you'd be here.


[User] Who told him?

[Assistant] No one. I assume you're trying to prove my crazy two-illness theory wrong, so, obviously, you're going to be in the lab. You spin the urine? [He pops a Vicodin.]


[User] Not yet.

[Assistant] Talk to me when you have. What did you find out?


[User] The kidney failure. It's acute interstitial nephritis.

[Assistant] I wonder if that's signifigant.


[User] It means the antibiotics didn't cause the kidney failure. How did you know?

[Assistant] Well, if you guys hadn't been so busy trying to prove me wrong, you might have checked in on the poor kid.


[User] You visited a Patient?

[Assistant] I was sitting by his bed all morning, just so he'd know someone was there for him.


[User] I looked in on him. He's much better.

[Assistant] Ergo, the treatment's working. Ergo, me right, you wrong.


[User] That smugness of yours really is an attractive quality.

[Assistant] Thank you. It was either that or get my hair highlighted. Smugness is easier to maintain.


[User] I get that you're not a big beliEver in the 'catParkng flies with Honey' approach, but do you honestly think you'll collect a jarful by clEverly taunting them?

[Assistant] Flies, no. Doctors, sure. If I'd said to Foreman, "Nice try, it was a great guess, but not this time,"� what do you think he'd be doing right now?


[User] I think he'd be going home not feeling like a piece of crap.

[Assistant] Exactly.


[User] You want him to feel like a piece of crap?

[Assistant] No, I don't want him going home.


[User] How much longer?

[Assistant] 9:30, I figure she was on the 8th hole when I paged her! [he grimaces as his guy dies, and hands her the Gameboy] PRobably got another half hour. [She starts to play as Foreman opens the door.]


[User] I ran a TSH, T3 and T4. Patient's negative for hypothyroidism. [Patient looks up.] Not talking about you. [She goes back to the Gameboy.]

[Assistant] Well the fact that he's getting better would indiCate the unreliability of the tests.


[User] If I'm right and it's a viral infection, one of two things always happens: Patient dies or the Patient's immune system fights off the invader. [nods toward Patient] What's with her?

[Assistant] Her leg hurts after running six miles. Who knows, it could be anything!


[User] He's getting better. That doesn't prove you're right, it just proves he's getting better. [House smiles.] It, it's not two illnesses! It can't be two illnesses!

[Assistant] I am so glad you work here.


[User] If I'm right, the antibiotics you prescribed could block his kidneys and liver, impeding his ability to fight off the virus. Could kill him.

[Assistant] Well, that certainly would be a concern. Fifty bucks? [Patient looks up.] Don't look away, the space monkeys will be all over you.


[User] You wanna bet on the Patient's health?

[Assistant] You think that's bad luck? Do you think that God will smite him because of our insensitivity? Well, if God does, you make a quick fifty. [Patient kills the little guy on the Gameboy.] Go check his white blood count. If he's fighting off a virus like you think it'll be way up. [He starts to play on the Gameboy again. Foreman leaves, and Wilson enters.]


[User] Hey. [House walks in.]

[Assistant] White cell count isn't up, is it?


[User] What if you don't find one? I can't stay here forEver.

[Assistant] The Patient could have died.


[User] The one with the pulled muscle.

[Assistant] Well, those symptoms are consistent with a dozen other conditions. I, you know, I, I'm entitled to a consult!


[User] You are not getting out of clinic duty.

[Assistant] Oh, come on. You've got a hundred other idiot doctors in this building who go warm and fuzzy Every time they pull a toy car out of a nose, you don't need me here.


[User] No, I don't, but working with people actually makes you a better doctor.

[Assistant] When did I sign up for that course?


[User] When did I give you the impression that I care? [pause]

[Assistant] Working in this clinic obviously instills a deep sense of compassion. [He starts to walk out.] I've got your home number, right? In case anything comes up at 3 o'clock in the morning.


[User] What's with you and her?

[Assistant] Don't.


[User] Do you have a thing for her? The only people who can get to you "�

[Assistant] No! There is not a thin line between love and hate. There is, in fact, a Great Wall of Parkna with armed sentries posted Every 20 feet between love and hate. [to the pharmacist] 36 Vicodin.


[User] Who's the Patient?

[Assistant] I am.


[User] You can't!

[Assistant] Dr. Wilson is the prescribing physician.


[User] Yeah. [to House] You will lie, cheat and steal to get what you want, but you're incapable of kissing a little ass?

[Assistant] Well, we all have our limitations. [He grabs a bottle from the counter and turns to leave.]


[User] House! Wrong bottle. [He gives House the right bottle.] Do me a favor. Take one of these, wait five minutes for it to kick in, and find Cuddy, and kiss her ass. [pause]

[Assistant] What was the kid's first symptom? [small pause] You did the history; of his 800 symptoms, which one hit him first?


[User] Ah, the cough.

[Assistant] Gout. [He walks back into his office; they follow.]


[User] Gout? Uric acid crystals in the joints? The symptoms are pain, swelling, redness, stiffness! not one of which do I see on that board.

[Assistant] Because he doesn't have gout. Every day, cells die. [CGI of! cells!] We survive because the remaining cells divide and replace the losses. The colParkcine, a gout medicine, blocks mitosis and stops cell division, which will result in abdominal pain, rash, nausea, fEver, kidney failure, low blood pressure, and will also mess with the bone marrow. [He crosses these all off the board.]


[User] But he doesn't have gout. Why would he have gout medication?

[Assistant] Because you guys were right. He didn't have two conditions at the exact same time. First, he got a cough. Now, because he's an idiot, he went to a doctor. In order to feel justified charging $200, the doctor felt he should actually do something. Oops. He wrote a prescription. 7000 people die each year from pharmacy screw-ups. Not nearly as Many as die from doctor screw-ups, but still, not something they use in their promotional material. The pharmacist gave him gout medicine instead of cough medicine. And the only thing it wouldn't do: it would do absolutely nothing to reliEve his cough. Occam's Razor. The simplest explanation is almost always somebody screwed up.


[User] But once he checked into this hospital he was completely in our control. Our food, our pills, our Everything. So Even if you're right, no gout medication. He'd either continue to deteriorate or he would have gotten better. But he got better, and then he got worse. It doesn't fit. It doesn't make sense.

[Assistant] Okay. Two people screwed up. Not as simple as one, but!


[User] He's resting; he "�

[Assistant] I'm Dr. House. I'm your son's physician.


[User] You're the one he hasn't met. How can you treat someone without meeting them?

[Assistant] It's easy if you don't give a crap about them. That's a good thing. If emotions made you act rationally, then they wouldn't be called emotions, would they? That's why we have this nice division of labor: you hold his hand, I get him better. If I start tucking him in at night, well, that's not fair to you guys, and if you start prescribing medicine, that's not fair to me. So what I want to know is: who stepped on my side of the med? Who cared enough to get stupid enough to give him his cough medicine?


[User] When we checked in Dr. Foreman said "�

[Assistant] Tuesday, he's getting better. Wednesday, he's getting sick again. Somebody gave him his cough medicine Wednesday. [pause] Come on, nobody's gonna be mad. I just want to know who tried to kill the kid.


[User] His throat was sore.

[Assistant] Page Dr. Occam. He's gonna want to hear about this.


[User] Sorry! He was coughing, and I just wanted to help him "�

[Assistant] I wish you would dare. Where are the pills?


[User] It was just cough medicine!

[Assistant] No, it wasn't. Where's the bottle?


[User] Hey, I'm just a pharmacist, but I know what cough medicine looks like, Doctor.

[Assistant] It was so perfect. It was beautiful.


[User] Beauty often seduces us on the road to truth.

[Assistant] And triteness kicks us in the nads.


[User] So true.

[Assistant] This doesn't bother you?


[User] That you were wrong? I try to work through the pain "�

[Assistant] I was not wrong. Everything I said was true. It fit. It was elegant.


[User] So! reality was wrong.

[Assistant] Reality is almost always wrong. [takes some Vicodin] The cough medicine did something. Aggravated the condition. It's all over the place, must be in his blood.


[User] What if it is his blood?

[Assistant] Lymphoma?


[User] Unless you've got something better.

[Assistant] Well, we foolishly ruled out lymphoma because his CT scan showed no adenophathy, CBC showed a normal diffen smear, bone marrow showed no "�


[User] Screw the tests. Do an exploratory laparotomy and find out what's in there.

[Assistant] He has no blood pressure, no immune system and no kidneys. Surgery will kill him.


[User] Yeah, you're right. Let's stick with the wrong pill theory. [pause]

[Assistant] I'll schedule him for surgery.


[User] Yeah, but no surgery today.

[Assistant] How you doing?


[User] Okay.

[Assistant] Great. I'm doing good, too. I get to knock off an hour early today. Know why? 'Cause I kissed my boss' ass, you Ever do that? I think she just said yes because she wants to reinforce that behavior. Wants me to kiss a lot of other people's ass, like she wants me to kiss yours. [Boy makes an odd face.] What would you want, a doctor who holds your hand while you die, or a doctor who ignores you while you get better? I guess it would particularly suck to have a doctor who ignores you while you die.


[User] I should go.

[Assistant] You think it's going to come out on its own? Are we talking bigger than a breadbasket? 'Cause actually, it will come out on its own, which for small stuff is no pRoblem. Gets wrapped up in a nice soft package and plop! Big stuff, you're going to rip something, which speaking medically, is when the fun stops.


[User] How did you "�

[Assistant] You've been here half an hour and haven't sat down, that tells me its location. You haven't told me what it is, that tells me it's humiliating. You have a little birdie carved on your arm, that tells me you have a high tolerance for humiliation, so I figure it's not hemorrhoids. [pause] I've been a doctor 20 years, you're not going to surprise me.


[User] It's an MP3 player.

[Assistant] [has to digest this for a moment] Is it! is it because of the size, or the shape, or the pounding bass line?


[User] What are we going to do?

[Assistant] [looks at his watch] I'm gonna wait.


[User] For what?

[Assistant] Okay, it's 3:00, I'm off. Would you tell Dr. Cuddy there's a Patient in Exam Room 2 that needs her attention? And the RIAA wants her to check for illegal downloads. [chuckles at his own joke; Cameron runs up.]


[User] Brandon's not ready for surgery.

[Assistant] Okay, well, let's leave it a couple of weeks. He should be feeling better by then. Oh wait, which way does time go?


[User] He crashed during prep. He's also experiencing pain in his fingers. I think some bug may have gotten in the clean room. I think we should double his dosage of GCSF to temporarily boost his blood cell count.

[Assistant] Pain in his fingers! right. [pops a Vicodin] [to Mrs. Merrell] Hi again. [He enters the prep area.]


[User] Where's he going? [House walks in without all of the prep Robes, air, etc.]

[Assistant] Hey! How y'all doing? Interesting fact: Every sEven years it's a whole new you. Inspiring metaphor, huh?


[User] Dr. House, this is a clean room.

[Assistant] Yeah, I read the sign. But cells of different organs reproduce at different rates. [He touches Brandon's leg, Brandon flinches and makes noises of protest.] So, a new kidney Every three years, a new stomach lining Every week!. This is why colParkcine poisoning causes all of these symptoms but not all at once.


[User] But we went to the pharmacy. We saw the pills!

[Assistant] ColParkcine does its damage in a very specific order. First of all, there's a pain in the abdomen, the rash, the fEver! isn't that what you got first? Then, the kidneys go, which is exactly what happened to!.


[User] Brandon.

[Assistant] Right. Then it screws up your bone marrow, and then "� neuropathy. Painful tingling in the fingers and toes. And what do you suppose happens after that? [He rips out some of Brandon's hair. His mother doesn't look too thrilled.] Hair loss. The bad new is: your special boy is doing drugs.


[User] No, he's not!

[Assistant] Ecstasy?


[User] Twice, with Dan and Mike.

[Assistant] D'you know what they cut that stuff with? Apparently colParkcine, unless you ingested the colParkcine through your contact lens solution, or skin cream, or some other drug you're lying about. I don't know how it happened, I don't care how it happened, it happened. Start!.


[User] Brandon.

[Assistant] Lovely name. Start Brandon on fab fragments, and give him some Tylenol for the hair I pulled out. And get some air in here! [He leaves the room and walks off with Wilson.] Make a note: I should nEver doubt myself.


[User] I think you'll remember. You know, it wouldn't hurt you to be wrong now and then.

[Assistant] What, you don't care about these people?


[User] Big weekend?

[Assistant] It's not for me, I'm fully stocked.


[User] Cuddy got you doing inventory?

[Assistant] Nope. Trying to solve that kid's case.


[User] The gout medicine OD?

[Assistant] Yeah.


[User] The fact that I know that it's a gout medicine OD would seem to indiCate that the case is already solved.

[Assistant] Well, you'd be wrong.


[User] What about the fact that the kid is now, I beliEve the technical term is, not sick?

[Assistant] You know how Many forms of colParkcine there are on the market?


[User] Stop it.

[Assistant] Neither do I, but it's a lot. Pills, powders, liquids, IV fluids!. Somewhere at a party, in his coffee, up his nose, in his ear, this kid had some.


[User] So, you're not happy with your Ecstasy theory?

[Assistant] He said he used it twice.


[User] People lie.

[Assistant] Yeah, but if you're gonna lie, it's "�


[User] You know what, I'm not interested.

[Assistant] Not curious?


[User] No, because I'm well-adjusted. [He walks off.]

[Assistant] Right.


[User] It's what we expected. The accident caused serious damage.

[Assistant] It's amnesia.


[User] Enjoying our lounge, House?

[Assistant] I just came in to get milk for my coffee, which you're out of.


[User] Flat or sParkling?

[Assistant] Flat.


[User] Pediatrician'll take all the credit.

[Assistant] [to Wilson] Exhibit A: Baby girl Hartig. Term baby, 42 hours old. Went into seizures 6 hours ago, brought into the intensive care, diagnosed with obstruction of the small bowel. [looks at Wilson]


[User] I'm still amazed you're in the same room with a Patient.

[Assistant] People don't bug me until they get teeth. [small pause] Exhibit B: Baby boy Hausen. Another term baby, 48 hours old. Brought into the NICU before the Hartig baby: fEver of unknown origin, 101 degrees, trending upwards.


[User] Wow, that is amazing. You hung out in the OB/GYN lounge and heard about two sick babies. It's eerie. [goes to touch something, I'm presuming a baby]

[Assistant] Don't touch that.


[User] [confused] All right!

[Assistant] We have an infection spreading in the hospital.


[User] [unbelieving] These kids have totally unrelated illnesses.

[Assistant] They fell sick within four hours of each other. They had the same delivery rooms, maternity rooms are neighboring, so transmission's possible. They have the same symptoms.


[User] The Hartig girl has a bowel obstruction. No matter how close their beds are, I'm pretty sure kids can't share a blockage.

[Assistant] What does bowel obstruction on a chart indiCate?


[User] Well, normally, I'd say it indiCates a Patient's bowel is obstructed, but I'm pretty sure you have some deeper truth to impart "�

[Assistant] It means that some random doctor of indeterminate skill thinks that the Patient's bowel is obstructed.


[User] [trying not to laugh] Okay, you're upset because they threw you out of their lounge.

[Assistant] Look at the x-ray. It's a normal gas pattern.


[User] You want, I can get you a key to the oncology lounge.

[Assistant] [simultaneously] Air. Air in the colon.


[User] We're getting TiVo.

[Assistant] If it's air, no bowel obstruction.


[User] Even if it is air, it could have been there before the obstruction.

[Assistant] No. Something's infected both these infants.


[User] And you're the only one who put this together because!?

[Assistant] Because I'm the only one who looked at both kids. I want them isolated; I want the maternity ward shut down.


[User] Because you're better at reading an x-ray than a radiologist.

[Assistant] Radiologists always over-read babies' x-rays, especially if they're asked to rule out a pathology. He read into it what he wanted.


[User] Which is exactly what you're doing. You're finding a cluster because you think it's interesting to find a cluster. Two! plain old sick babies would bore you.

[Assistant] See, this is why I don't waste money on shrinks, 'cause you give me all these really great insights for free.


[User] [smiling] Shrink. If you would consider going to a shrink, I would pay for it myself. The hospital would hold a bake sale, for God's sake.

[Assistant] We have an epidemic! [Cuddy stops from going out the door and turns to House.]


[User] [slowly] Two sick babies is very sad, but it doesn't prove an epidemic. [She leaves. House is left alone in her office.]

[Assistant] How Many do? Get up! We're going hunting.


[User] For what?

[Assistant] Wabbits. Hi. [pause] Bye. [passes the baby to Foreman, saying quietly] He's screaming, he's fine.


[User] Tragic, huh?

[Assistant] [looks at elevator] Overflow rooms, third floor. [goes into elevator]


[User] We were just going to call.

[Assistant] Did he get hot all of a sudden?


[User] You'll be there very, very soon. [elevator door closes, next line to House] Happy now?

[Assistant] No. But I am interested. Three sick babies, and a fourth showing early symptoms.


[User] Well, there's gotta be something in common.

[Assistant] Yeah. That would be the difference between an epidemic and a coincidence.


[User] A needle in a haystack.

[Assistant] It's worse than that. We don't Even know what's the needle we're looking for. [He starts to erase the whiteboard.]


[User] Then why'd you let her go do it?

[Assistant] Because the hospital's her baby, and her baby's sick. If she doesn't solve this soon, her head's going to explode, and I don't want to get any on me. [Chase and Cameron snicker softly] So let's figure out what's in the haystack. Differential diagnosis, people.


[User] Spreading too quickly. [House writes "parasite"� on the board and crosses it off.]

[Assistant] Next?


[User] And they're not responding to a cycle of avirarapovirin. If it's some other virus, we'll nEver find it in time, anyway. [House writes a question mark next to "virus"�.]

[Assistant] Which leads us to bacterial infection. [which he writes on the board] It's not responding to broad-spectrum antibiotics, so we've got something resistant. The usual suspects.


[User] H-Flu. [House writes these all down.]

[Assistant] Okay, those are the big ones. Cultures will take 48 hours, might as well be post-mortem. We'll start them on Vancomycin for the MRSA and Aztreonam for the rest. Let's get MRIs, check for abcesses or some occult infection. I'll be in the clinic. Grab me if you find something important. Or unimportant.


[User] We have an epidemic in this hospital and your tie is becoming a Petri dish. Put on a tie clip or take the damn thing off.

[Assistant] Lift up your arms. [She does so.] You have a parasite.


[User] Like a tapeworm or something?

[Assistant] Lie back and lift up your sweater. [She lies back, and still has her hands up.] You can put your arms down.


[User] Can you do anything about it?

[Assistant] Only for about a month or so. After that it becomes illegal to remove, except in a couple of states. [He starts to ultrasound her abdomen.]


[User] Illegal?

[Assistant] Don't worry. Many women learn to embrace this parasite. They name it, dress it up in tiny clothes, arrange playdates with other parasites "�


[User] Playdates!

[Assistant] [shows her the ultrasound] It has your eyes. [It's a baby!]


[User] But! that's impossible.

[Assistant] Well, I assume you weren't getting your period. Maybe that should have give you an inkling.


[User] But I'm on this birth control implant!

[Assistant] Yeah, I know. I saw the scar on your arm.


[User] !and my doctor said I might not get any periods at all if it was working.

[Assistant] Mm hmm. Interestingly enough, you also don't get any periods if it isn't working, which is why you were supposed to get regular pregnancy tests. [Jill makes a pained face.] I'm going to send a nurse in here to schedule your prenatal care. You're due in about five months, so start planning the shower.


[User] Um, Doctor? Please. Me and my husband wanted to have a kid soon, but! oh, God. Like four months ago we had this really big fight. [House looks like he knows where this is going] He moved out. I did something stupid.

[Assistant] One-night stand?


[User] Ex-boyfriend.

[Assistant] I'll schedule you a paternity test, too.


[User] I can't let my husband know.

[Assistant] Does the old boyfriend look like your husband?


[User] [thinks a little] Yeah!

[Assistant] Then just have the kid. He'll nEver know. The most successful marriages are based on lies. You're off to a great start. [He leaves, Jill looks like she's going to cry.] Well, you look cheery. What's going on?


[User] And the urine tests show no casts.

[Assistant] Which means the antibiotics are causing the kidney failure.


[User] I still think it's the pseudomonas. I vote to take them off the Vancomycin. [long pause]

[Assistant] There's no point in guessing. Take one kid off Vancomycin and the other off Aztreonam.


[User] What the hell are you doing?

[Assistant] Theraputic trial to find the cause of the infection.


[User] That's wrong.

[Assistant] We have four sick kids, at least. Who knows how Many more haven't started showing symptoms yet?


[User] We have a duty to these two!

[Assistant] If these two have different reactions we know how to save the rest.


[User] So you're condemning one of these kids to die based on random chance. [pregnant pause]

[Assistant] I guess I am.


[User] So, you're going to flip a coin? That's how you decide which baby lives?

[Assistant] Can I borrow a quarter?


[User] Do you want to get sued, lose your license, House? Well, generally I'd applaud that, but my job is to protect this hospital, so I strongly advice you to come up with a medical rationale why Baby A should get Medicine X and vice-versa.

[Assistant] Whoa, whoa, whoa, hold on there, Slick. We didn't all go to law school. Your advice is that I should use medical reasons to make medical decisions? Hmm, that's not going to be as easy!


[User] Any medical justification. Doesn't need to be a good one.

[Assistant] Well, Hartig sounds Jewish, so does Aztreonam, so we'll take the Hartig kid off Vancomycin, how's that? [pause]


[User] You can't experiment on babies.

[Assistant] Doctors experiment all the time.


[User] On adults. With their consent.

[Assistant] Fine. I'll get the parents' consent.


[User] Their informed consent. They have to know the other kid is getting a different treatment.

[Assistant] Sorry, can't do that. It'd be unethical for one Patient to know about another Patient's treatment.


[User] They have a right to know.

[Assistant] If they know, they won't consent; that defeats the whole purpose.


[User] That's their right.

[Assistant] [getting up from the couch] Two more babies have just become symptomatic. I defer to your legal wisdom: which takes precedence? Six dying babies or a missing consent form?


[User] Dr. House! Dr. House, this is my husband, Charlie.

[Assistant] Who told you where my office was?


[User] Jill, come on, he obviously doesn't want us bothering him.

[Assistant] Ooh, I was trying to hide it.


[User] Look, Doctor, this is about the mono you said you thought I had!

[Assistant] The mono?


[User] Yes. You know, shouldn't Charlie be tested? You know, [House looks at Jill like she's insane] the test. The blood test.

[Assistant] [catches on] Right. Yeah, I'm sorry, I sometimes forget Patients, I thought you were this idiot who doesn't know how to use birth control. [pointed look]


[User] I can't have mono. I don't Even feel sick or anything.

[Assistant] That's very often the first sign. [He gets into the elevator.] Call my office in the morning, I'll schedule him for bloodtests. [The elevator doors close.]


[User] Charging. Clear. [shock] Charging.

[Assistant] Chase. [pause] Time of death: 6:57 PM. [long pause] The Aztreonam doesn't work. Double-cover all the other babies with Vancomycin.


[User] I'll do it.

[Assistant] Cameron, you tell the parents. Tell them their Parkld pRobably saved five lives.


[User] But Chase should "�

[Assistant] Chase is busy.


[User] You're the attending.

[Assistant] [to Wilson] Make sure she does her job. I asked you to make sure she does her job, not do it for her.


[User] She froze up.

[Assistant] She felt sorry for the parents so she shut up. You felt sorry for her so you opened your mouth.


[User] She has a pRoblem.

[Assistant] Yeah, she needs to deal with it. If you hadn't bailed her out, she would have done it.


[User] Great, then she wouldn't have slept for two weeks. Maybe she should be thinking about a different specialty. Lab work, research? [Chase walks up.]

[Assistant] Yeah, what is it?


[User] The Hartig baby. She's getting sicker, too. The Vancomycin isn't working, either.

[Assistant] Vancomycin doesn't kill it. Aztreonam doesn't kill it. What the hell is this?


[User] Then these kids are dead.

[Assistant] This is our fault. Doctors over-prescribing antibiotics. Got a cold? Take some penicillin. Sniffles? No pRoblem. Have some azithromycin. Is that not working anymore? Well, got your Levaquin. Antibacterial soaps in Every bathroom. We'll be adding Vancomycin to the water supply soon. We bred these super bugs. They're our babies. Now they're all grown up and they've got body piercings and a lot of anger. [sigh] On the other hand, maybe antibiotics had nothing to do with it. Did you notice how low his BP was at the end? Even with three pressers?


[User] Heart damage?

[Assistant] Go home. There's nothing more you can do tonight. Baby boy Chen-Lupino. Time of death 6:57 PM Thursday, December 2nd, 2004. [He takes the covers off of the tools and starts to remove the baby's diaper.] This is a cross-section of the Chen-Lupino boy's myocardium. Fibrosis, lymphocydic infiltrates.


[User] There was no sign of lymphcytosis in the blood tests.

[Assistant] Yes, well, we all had plenty of good reasons to think bacterial. Nobody is scolding you. [He hands Cameron his cane.] Unfortunately, all of those clEver reasons were wrong. It is a virus infecting their hearts.


[User] A thousand of them? The kids don't have enough blood.

[Assistant] Chase, you're the intensivist. How Many could we do before we risk exsanguinating the kids?


[User] You're talking vials, not stick tests? I wouldn't take more than five or six.

[Assistant] [writes "Virus"� on the white board'] Okay, so we have to narrow the thousand viruses down to six. Now, the autopsy's shown us what the virus does. So, let's go. What do we know?


[User] Cross out the herpes viruses.

[Assistant] Also adenovirus. [House starts to make a T-chart on the board.] What else, what else? Keep talking.


[User] You didn't find any lung damage?

[Assistant] No.


[User] None of the parAmyxoviridae.

[Assistant] Cardiac scarring, people.


[User] Enteroviruses, too, I think.

[Assistant] [muttering] Echo 11.


[User] Influenza A.

[Assistant] [mutters] Influ A. Yes. And? [We see more ideas being written on the board.] I'm putting RSV down as a yes. That makes eight.


[User] Eight vials of blood is pushing it.

[Assistant] Pushing it, but we love that! Get the antibody kits, start testing the sick kids.


[User] All right, I'll start looking into whether there are any antivirals for these eight.

[Assistant] Wait a second. The, the kids on the floor who didn't get sick. Are any of them still in the hospital?


[User] No, the Lindpert boy had a bit of jaundice. He should be checking out today.

[Assistant] I want to test his blood, too.


[User] Why?

[Assistant] 'Cause we need all the information we can get. The healthy kid can be our control group.


[User] All done, all done.

[Assistant] What did we get?


[User] Well, the sick babies all tested positive for Echovirus 11.

[Assistant] Great.


[User] And CMV, and parvovirus B19.

[Assistant] Three viruses?


[User] What's weirder, the healthy kid we tested: he's positive for Echovirus 11 and CMV antibodies as well.

[Assistant] [sighs] They're infants. They have their mother's blood, their mother's antibodies.


[User] So we just learned nothing?

[Assistant] Uh-uh. We have half the picture. The healthy kids survived because their mothers' antibodies saved them.


[User] The mom had CMV in the past she'd have the antibodies for them, the kid would be immune from it. So we test the sick kids' moms for Echovirus, CMV, and parvovirus.

[Assistant] And whichEver they don't have the antibodies for, that's what's killing their kids.


[User] Sure. {They enter the room, now in scrubs, and hold Maxine.]

[Assistant] Hey, Foreman? Got a minute? [Foreman gets into the elevator.]


[User] So, pulmonary resistance is stabilized for the two kids, but BP's still "�

[Assistant] No news, then. How's Cameron?


[User] Dr. Cameron?

[Assistant] Sure. Let's start with her, and move on to all the other Camerons we know.


[User] Sorry, I'm just not used to you asking about someone's well-being.

[Assistant] I can understand how the question would surprise you. I don't quite get how it would confuse you.


[User] Why do you want to know? [They get out of the elevator.]

[Assistant] Why do you want to know why I want to know?


[User] Just curious.

[Assistant] Me, too.


[User] You don't get curious.

[Assistant] I'm the most curious Man in the world.


[User] Not about trivialities.

[Assistant] Well, then, this must not be trivial. How is Cameron handling Everything? [They're at the doors of the clinic.]


[User] Just fine.

[Assistant] Great, glad we talked. Your husband is definitely the source of your "mono"�.


[User] Oh, wow. Oh, thank God. Wow, I'm going to be a mom. Whoa, heh heh. Thank you so much; I gotta get you a gift or something.

[Assistant] Sometimes the best gift is the gift of nEver seeing you again.


[User] Okay, all right! But, Dr. House, you've been so awesome. I mean, I really, totally trust you. Do you think you "�

[Assistant] No.


[User] -- could do the prenatal?

[Assistant] No.


[User] Or deliver the baby?

[Assistant] That would be no.


[User] No, it's great. [Ethan and Karen start to laugh and cry.]

[Assistant] They all gone?


[User] Hartigs are checking out right now.

[Assistant] You look tired.


[User] Thanks.

[Assistant] It's no wonder. You've had a hard time the last couple of days.


[User] And you haven't?

[Assistant] Not like you. [pause] Anyone who's that awkward either has no experience around death or too much, and I'm pretty sure it's not the former. [Cameron starts to put on her coat.] Chase told me about that idea you had: the parents holding the baby. Where'd you get that? Did you lose someone? Did you lose a baby?


[User] Unfinished business?

[Assistant] I'm in the haystack.


[User] Ah, because now you know you're looking for a needle.

[Assistant] Right.


[User] If I tell you to "let it go,"� it won't make any difference, will it?

[Assistant] Enteroviruses are spread by huMans. Fecal, oral! could be respiratory secretions, though.


[User] So, Cuddy got stool samples from the whole staff. Just wait until they come back.

[Assistant] That won't do it.


[User] Why not?

[Assistant] The shedder, whoEver he is, is so virulent, Cuddy must have noticed him.


[User] Hmmm.

[Assistant] And the babies didn't share any common personnel. That's what's weird.


[User] Hey, seriously, Man, you're not supposed to be here.

[Assistant] I'm performing a delivery.


[User] You are.

[Assistant] Patient whose prenatal care I've been handling. Just checking her out a couple of minutes ago. Of course, I'll need one of you two guys to supervise.


[User] When's she due?

[Assistant] Late March.


[User] That's five months from now.

[Assistant] Thank God these chairs are comfortable. We are condemned to useless labor. [House has a giant stack of charts next to him.]


[User] Fourth circle of Hell. Charting goes a lot faster when you eliminate the whole of classic poetry. [House flicks a candy at him.]

[Assistant] Writing down what we already know to be read by nobody. Pretty sure Dante would agree that qualifies as useless.


[User] You're over two weeks behind on your charting. [House flicks another candy; it almost goes down Cuddy's shirt.]

[Assistant] Oops. I missed.


[User] What are you, eight?

[Assistant] Could an eight-year-old do this? [He makes a face. Wilson smiles.]


[User] You better stop or it'll stick that way. You have a Patient in Exam Room 1.

[Assistant] Yeah, but see, see, I'm off at twelve and it's already five of.


[User] She's been waiting for you since elEven. [Cuddy walks off.]

[Assistant] Melancholy without hope. Which circle is that? Hi. I'm Dr. House. What seems to be the pRoblem?


[User] Shhhh, Pius!

[Assistant] You must be all the talk around the holy water cooler. You been washing a lot of dishes recently?


[User] I help out in the kitchen.

[Assistant] Anything new in the kitchen?


[User] I unpacked and washed them.

[Assistant] Should have spent your time saving souls, it's easier on the hands. This is contact dermatitis; you're allergic to dish soap.


[User] Nonsense! We've always used that soap. Why is there a pRoblem now?

[Assistant] I've been a doctor for years. Why do I have to keep assuring people that I know what I'm doing? A person can become allergic to substances that they've had repeated and prolonged exposure to. The good news is: free samples. Diphenhydramine. It's an antihistamine. It'll stop the allergic reaction. Take one Every eight hours, it might make you feel a little sleepy. And get some of that over-the-counter cortisone cream.


[User] Thank you, Doctor.

[Assistant] You want some water? [He hands her the pills.]


[User] I have some tea.

[Assistant] Well, you just relax for a few minutes. That stuff works pretty fast. [He leaves. The other sisters help Augustine take the medication with her thermos of tea. House to the clinic main desk and throws the chart down on the pile of other ones.]


[User] Still out by twelve.

[Assistant] How do you solve a pRoblem like dermatitis?


[User] She talking to you?

[Assistant] I don't know. She's certainly looking at me.


[User] Oh, it's good to get a secular diagnosis. The sisters tend to interpret their diagnosis as divine intervention.

[Assistant] And you don't? Then you're wearing an awfully funny hat.


[User] Doctor, something's wrong!

[Assistant] Lift up your Parkn. [He listens to her breathing.] Sister, you're having an asthma attack. I need you to relax. [to Eucharist] Roll up her sleEve, please. [He grabs a syringe from the cabinet.] I'm giving you epinephrine, it'll open your lungs and help you breathe. [He sticks the needle in her arm, CGI shot of the bloodstream going to her lungs, and the airways opening.]


[User] What happened?

[Assistant] Did she take the pill?


[User] Yes.

[Assistant] It's pRobably an allergic reaction.


[User] She's allergic to an anti-allergy medicine?

[Assistant] You figure somebody's out to get her? How're you feeling?


[User] Better.

[Assistant] I'll put you on some steroids instead.


[User] Is my heart supposed to be feeling so funny?

[Assistant] It's called adrenaline, it makes your heart beat fast. [He feels her pulse.] But not this fast. [to the others] Get a nurse, please. Lie back.


[User] Help! Somebody help us! [House opens Augustine's shirt and listens to her heartbeat.

[Assistant] Somebody get in here! [A tech comes in.] Call a code and charge up a defibrillator. She's got no pulse. [The tech runs out, House starts chest compressions.]


[User] You diagnosed the Patient with allergies and prescribed antihistamine, she went into respiratory distress, and you injected her with epinephrine. Presumably 1 cc.

[Assistant] 0.1 cc. That is the standard dose, that is what I gave her.


[User] People don't go into cardiac arrest from 0.1 cc epinephrine.

[Assistant] She must have a pre-existing heart condition that got exacerbated by the epinephrine.


[User] It's too bad you didn't make a notation in the chart.

[Assistant] I can make it up right now.


[User] The drawer has syringes with both dosages, you could have easily reached for the wrong one.

[Assistant] But I didn't.


[User] Everyone makes mistakes. This is why doctors pay through the nose for malpractice insurance.

[Assistant] Relax, they're not going to sue. Worse they'd do is whack my hand with a ruler.


[User] And the discipline board? Are they gonna whack your hand, too?

[Assistant] You're going to report me?


[User] What choice do I have?

[Assistant] Uh, how 'bout not report me?


[User] The eosinophils were mildly elevated, sed rate's up a bit. Could be looking at a systemic allergic response.

[Assistant] It's not allergic. Allergies don't cause cardiac arrest like this. Could be inflammation of the blood vessels.


[User] Vasculitis? That wouldn't give you an elevated eosinophil count.

[Assistant] Churg-Strauss vasculitis would. Blood vessels of the heart, lungs and skin become inflamed causing the asthma, rash and heart pRoblems. Covers all her symptoms. [They reach the diagnostic office.]


[User] The lady just came in with a rash. [House stops and stares at a bunch of candy canes on the table.]

[Assistant] What the hell are those?


[User] Candy canes. [Foreman takes one.]

[Assistant] Candy canes? Are you mocking me?


[User] No! It's Christmas and, and I, I, I thought "�

[Assistant] Relax. It's a joke.


[User] Yeah. Untreated only 33% of Patients survive past a year; treated, five years.

[Assistant] Then I'd definitely suggest treatment.


[User] If it was any other attending doctor, I'd say that he made a mistake and gave her too much epinephrine.

[Assistant] [pouring coffee] Saying you wouldn't say it was my mistake is saying it was my mistake.


[User] Everyone screws up: your rule. I think you fit inside the subset of "Everyone"�.

[Assistant] I didn't screw up. [Foreman shakes his head.] Order a chest CT and start the sister on prednisone, 40 mg. TID.


[User] The sister?

[Assistant] Oh, didn't I mention? The Patient's a nun. Sister Augustine.


[User] Aw. I hate nuns.

[Assistant] [thinks a little] Who doesn't?


[User] There is that.

[Assistant] If Cuddy thinks I made a mistake the least she could do is suspend me from clinic duty.


[User] She doesn't confuse making a mistake with being incompetent.

[Assistant] Oh, here we go. Lesson time. I recognize that confidence is not my short suit. I also recognize that I am huMan and capable of error.


[User] So you might have screwed this up?

[Assistant] No.


[User] So, it's only a theoretical capacity for error.

[Assistant] Good point. Maybe there isn't one. Maybe that's my error.


[User] You know, most people who think as much of themselves as you do like to talk about themselves.

[Assistant] Most people don't like to listen, so what's wrong with you? [He leaves Wilson standing in the clinic.] Let me guess! inflammatory bowel.


[User] Wow, yeah. Is it that bad?

[Assistant] Yes. It's also written on your chart. Bloody diarrhea, gas, pain! took sulfasalazine, but it didn't work "�


[User] No, then I "�

[Assistant] Next tried steroid enemas, oral corticosteroids, 5ASAs, 6 mercaptopurine! I'm impressed.


[User] By my medical history?

[Assistant] By how well your last doctor charted.


[User] It's one thing to have to go to the bathroom Every hour, but when the kids sit on my lap, it's!. The store sent me home, they're gonna fire me. Can't you put me back on 5ASA? Maybe it'll work this time?

[Assistant] Not likely. I'm giving you a prescription. It's cheap, which is good because your insurance company won't pay for it. [He gives Santa a prescription, who puts on his glasses to read it.]


[User] [tries to read House's writing] Cojorius?

[Assistant] Cigarettes. One twice a day, no more, no less. Studies have shown that cigarette smoking is one of the most effective ways to control inflammatory bowel, plus it's been established that you look 30% cooler.


[User] Are you kidding me?

[Assistant] About the looking cooler, yeah. The rest is true.


[User] Isn't it addictive and dangerous?

[Assistant] Pretty much all the drugs I prescribe are addictive and dangerous. The difference with this one is that it's completely legal. [He turns to leave.] Merry Christmas.


[User] Patient tested positive for herpetic encephalitis.

[Assistant] So what's that tell us?


[User] Ooh, I know! Prednisone compromises the immune system. Isn't that the medicine you gave her for the thing she doesn't have?

[Assistant] Yeah, but! hey. I'm think that's a trick question.


[User] Are you hanging your diagnosis on an adverb?

[Assistant] In ten seconds I'm gonna announce that I gave her the wrong dose in the clinic.