Written by: David Foster
Directed by: Fred Gerber
Transcribed by: Jenna (hithluin)
Betaed by: Mary Ann
DISCLAIMER: We don't own "HOUSE." It's owned by FOX and NBC/Universal, and produced by Heel and Toe Films and Bad Hat Harry Productions. This transcript is unofficial, and should UNDER NO CIRCUMSTANCES be copied or distributed, especially for commercial use.
(Scene opens on some kind of science museum with a model of a large heart that people can walk into. There is a recorded voice talking about the heart as a group of young kids and their teacher walk past.)
Voice: The human heart is a giant muscle, squeezing or contracting over 60 times each minute. That's 3000-- [fades out]
Teacher: At this point, your blood is a deep purple because it's just finished dropping off oxygen for all the parts of your body. Come on, follow me. [The kids excitedly jump around looking at the lights projecting blood cells onto the walls. They finally stop at a largish chamber, a boy raises his hand] Ian.
Ian: I have a question, and I need to go to the bathroom.
Teacher: Which would you like to do first?
Ian: The question.
Ian: Where's the bathroom?
Teacher: [gives Ian a look] Who knows where the bathroom is?
Mike: I do.
Teacher: Go with Ian to the bathroom.
Mike: I don't have to go.
Teacher: We're not at school, nobody goes anywhere by themselves.
Teacher: In case you get lost.
Ian: Or in case somebody kidnaps us.
Mike: If somebody kidnaps Ian, he'll kidnap me too. I want to stay with the class.
Teacher: Michael, go with Ian-- [she gasps and clutches at her belly. She's heavily pregnant]
Ian: Do you need help?
Teacher: I need you to find a grownup.
Ian: Is the baby coming? [teacher screams in pain] Who should I take with me?
Teacher: You’re fine. Go to the front desk or find a security guard.
Ian: I really have to pee.
[The teacher looks at Ian's white shoes, there's blood trickling down from his pants over his shoes and were pooling on the floor]
Teacher: Oh god!
Ian: Is the baby coming? I don't know how to do this.
Teacher: Are you ok, Ian?
Ian: Yeah, sure. [he kneels down next to her]
Teacher: I don't think you are. [she sees some blood on his pants, dabs her fingers in it and shines her torch on her fingers to check that it's definitely bright red blood] You're bleeding.
[Ian gets up and turns around, the whole back of his pants is saturated in blood]
(Scene opens at the front of the hospital at night. There are red carpets going in and a sign saying "Oncology Benefit" with a black tie event picture basically painted on it as well. There's nice lively piano music playing as the camera goes on ahead to the hospital lobby which has become a little minibar. Camera zooms in to a table in the centre where Cuddy, Wilson and House are playing poker with a few other people. They are all dressed up VERY nicely)
[House has an unlit cigar at his lips and he and Wilson exchange a look]
House: You'll call anything.
Cuddy: My stack's bigger than your stack. [House checks his cards again] You in or out?
House: You know that relative to their size, gorillas have smaller testicles than humans.
Cuddy: Well then you'd probably have an edge over a gorilla, but not over me.
House: Reason is, primate teste size inversely corresponds to the fidelity of our females.
Wilson: Do you think there might be a better time to annoy me about my wife?
House: I'm talking about poker.
Cuddy: Women are evil, you're right to drive them away. Call fold or raise, storytime can wait!
House: We're smaller and better than chimps, bigger and worse than gorillas. For all our rationality, our supposed trust and fealty to a higher power, our ability to create a system of rules and laws; our baser drives are more powerful than any of that. We want to control our emotions, but we can't. [Wilson looks tolerably annoyed] If we're happy, things don't annoy us. If on the other hand, we're sitting on crappy hold cards, little tiny things annoy us a whole lot more. [he puts the cigar back in his mouth and wags it up and down almost right in front of Wilson's face. Wilson seems to have a poker face on] I raise.
Wilson: So are you going to tell me an annoying story everytime I raise?
House: God that would be annoying.
[Wilson angrily slams his cards down]
Cuddy: I call.
Dr Wells: Dr Cuddy, got one of your patients in the ER. Ian Alston, 6-yrs-old?
Cuddy: Err, oh, I know him, what's the problem? [to House] I'm all in. [she shoves all her chips to the centre of the table]
Dr Wells: Bloody diarrhea. Hemodynamically stable but he's been developing some co-ordination problems.
Cuddy: That sounds like gastroenteritis and dehydration. Order fluids and I'll take it on my service. Bet’s to you, House.
House: They scan his head?
Dr Wells: No, why would they scan--
Cuddy: Don't play games. You gonna call?
House: How's the heart rate?
Dr Wells: Stable.
Cuddy: I'm sorry. House, it's gastroenteritis. I'm not going anywhere. [to Wells] Put the order in, and have someone tell Alan and Sarah that I'll be up when I'm done. [to House] You in or out?
House: [after a pause] I'm out. [he gets up to leave]
Cuddy: Oh! [she puts down her cards face up] Stone cold bluff! You might want to spend a little more time paying attention to your cards, and a little less time staring at my breasts.
House: They don't match either. I'm going to take some air.
[Cuddy self-consciously looks down at her breasts. Wilson turns over House's cards that he left behind to reveal two Aces - a guaranteed win if he had stayed]
(Scene cuts to House sweeping back the curtains in the ER to find Ian and his parents)
[House seats himself on the bed in front of Ian who is behind held by his mother, House puts his finger on Ian's chin to steady his head then moves another finger left and right]
House: Follow my finger with your eyes. [Ian's eyes seem to follow the finger just fine]
Sarah: [the mother] How much longer will doctor Cuddy be?
House: Given the number of mojitos she's knocking back at the party, I'd say it's going to be at least 3 hours before she's even conscious.
Sarah: Weren't you at the same party?
House: [pops a vicodin] I don't drink. I want you to reach out and grab my cane. [Ian's hand reaches out way to the right of the cane and grabs thin air. He gradually corrects himself and grabs onto the cane after a couple more tries]
[It's worth pointing out at this point that House has a new cane made of dark wood - looks black, but the handle is encased in a silverish metal. Fandom has labelled it his pimp cane ;) ]
Alan: [the father] What's wrong?
House: Your son's brain is losing control of his muscles.
Sarah: Dr Cuddy's message said it was just dehydration from diarrhea.
House: She's wrong. [he gets up to leave]
Alan: Is he going to be all right?
House: I don't know.
(Scene cuts to House walking into his darkened office)
[He takes out his keys and kneels down to open a locked drawer. He digs around and finds an old case file labelled "Doyle, Ester"]
(Scene cuts to Chase all in black talking to an interested woman)
Woman: So were you in one of those cages?
Chase: No! No. No no no, those are for tourists.
Woman: You were in the water with the Great White?
Chase: Sure. It's no big deal, you just have to keep an eye on them. If they get too close, punch them in the nose, send them on their way. [the woman looks skeptical but shocked, Chase starts laughing] I had you going.
Woman: You are mean.
House: [suddenly interrupts] Hey! How's that anal fissure? Did it heal yet or is it still draining? [looks at the woman] Oh, I'm sorry, didn't realise you'd come back for seconds. I figured that after the girl on the stairwell you'd be done for the night.
Chase: He's joking.
House: No Adam's apple, small hands. No surprises this time. [he smiles and nods in amusement]
Woman: [looks very uncomfortable] I'll er... see you later. [House winks at her as she leaves]
House: Got a case.
Chase: Well you could have just said that, you didn't have to screw with me.
House: Yeah if I didn't screw with you, you'd spend the whole night thinking you might get laid, which means you'd be useless. Better to extinguish all hope. Get Foreman and Cameron and meet me upstairs, stat.
(Scene cuts back to House writing on the whiteboard and taking a glance at his watch in the conference room)
[The Ducklings walk in]
Chase: What's so urgent?
House: Two cases, same symptoms. What do 6-yr-olds and 70-yr-olds have in common?
Cameron: Their immune systems don't work as well, could be Listeria.
House: I already checked for that.
Foreman: Leukemia has a higher prevalence in both young and old.
Cameron: So does asthma.
House: No no no.
Cameron: Could both be diabetes. [she and Foreman pick up the case files on the table]
House: No! The nearly dead and the newly bred have more in common with each other than with people in the middle. What's weird is the kind of circle of life thing.
Foreman: This kid doesn't have kidney failure.
House: He will.
Foreman: Based on this file, the kid just ate some bad food. Was the old man--
House: They were nowhere near each other in any of the four dimensions.
Cameron: This case is 12 years old.
Foreman: And this case is Cuddy's.
House: She assigned it to me.
Chase: She agrees with you that this is something more than gastroenteritis?
House: She wouldn't have assigned it to me if she didn't, would she?
[He turns around and sees Cameron for the first time at this point, in her chest-hugging fuschia evening dress, and he stares at her with a drawn-out out "ohhhh". She looks a little self-conscious though she smiles a little before House purses his lips and blinks]
House: What were we talking about?
Chase: Two patients with two symptoms in common. And 5 symptoms not in common.
House: While you were all wearing your 'Frankie says Relax' T-shirts, I was treating a 73-yr-old woman who went through this progression of symptoms, the last of which was... [he leans down and writes DEATH at the bottom of all her symptoms] In case any of you missed that class in med school, that one's untreatable. Kid's got the first two. Took Esther an hour and 20 mins to go from two to three. And less than a day to make it all the way to the rear exit.
Chase: This is all because a child has some blood in his diarrhea. He's got a tummy ache, if there was any reason to think it was anything worse, Cuddy would be all over it.
House: Great. Do a colonoscopy.
Cameron: On a 6-yr-old kid who probably has nothing worse than some food poisoning?
House: If you happen to find any purple papules, do me a favour and grab a slice. I want to check for Erdheim-Chester.
Chase: A disease that there have been what, maybe 200 reported cases of, ever?
House: If Esther's family had let me to an autopsy, there'd be 201.
(Scene cuts to House and Foreman doing the colonoscopy on a sedated Ian)
Foreman: See anything?
Chase: No, and I don't expect to.
Foreman: House usually avoids cases. If he's actually stealing a case from Cuddy, there's gotta be a reason.
Chase: That's not the first time I've seen this file. About a month before Cameron was hired, some trucker came in here with these symptoms. House decided he was dying. Two days and a spinal tap, bone marrow extraction, and three colonoscopies later, we send the guy home with a bunch of painkillers and a diagnosis of a bad cheese sandwich. One of the guys who worked here before me said House tried to cure Esther at least 3 other times. You know how people see the Virgin Mary in danishes and stuff? Someone died 12 years ago and House doesn't know why. House sees that case now in... paint peeling and clouds and now this poor kid.
(Scene cuts to Cameron talking the parents)
Cameron: Erdhem-Chester is an abnormal growth of some of the cells that fight infection.
Sarah: Is that cancer? He seems ok now.
Alan: Yeah the other doctor kind of scared us about that.
Cameron: He shouldn't have. We're just testing, it'll probably be negative.
Alan: I don't understand. You don't think that's what it is but you want to do this thing to him anyway?
Cameron: We need to be sure.
Sarah: Isn't there any other way?
Cameron: It shouldn't take long.
Alan: All right.
(Scene cuts back to Foreman and Chase)
Foreman: Those ridges look a lot like purple papules.
Chase: They’re not purple, they're red. Probably just blood blisters.
Foreman: Give me the biopsy needle.
(Scene cuts to the Ducklings in the lab testing the sample taken)
Chase: How long is this going to take?
Cameron: Forget it Chase, your punching the shark story is good but she's not waiting for you. [Foreman laughs]
House: [walks in] So?
Foreman: We couldn't confirm the source of the bleeding but we did biopsy some--
Chase: Blood blisters.
House: You mean papules. Come on Cameron, who's right? [she's looking into the microscope]
Cameron: Chase is. Negative for Erdheim-Chester.
House: Let me see. [he checks] If it's not Erdheim-Chester...
Chase: It's exactly what we said before, garden variety viral gastroenteritis, can we go back to the party?
House: [taking off his bowtie] Do a kidney biopsy. Esther's shut down in exactly-- [he checks his watch]
Chase: This kid is not Esther. You screwed up, she died, I'm sorry but that does not mean this kid is dying as well.
House: Geez. You get testy when you don't get any fuzz. Come on.
(Scene cuts to Chase and House walking into Ian's room)
Sarah: What'd the test say?
Chase: Colonoscopy was clean. And the biopsy was negative for Erdheim-Chester.
Alan: So Ian’s going to be all right? It was just some sort of virus?
[House picks up the little bag that contains Ian's urine, Chase looks concerned]
Sarah: What's that?
Alan: But it's brown.
Chase: Ian’s kidneys are shutting down.
House: Still think it's not the same case?
(Scene cuts to House and the Ducklings in the conference room)
House: So, what can cause bloody diarrhea, ataxia and kidney failure?
Chase: I'll go and do a biopsy.
House: Forget it. That battle's over. His rising creatinine is his kidney's way of saying go on without me. What explains everything?
Chase: E. coli H0157 causes bloody diarrhea, and leads to hemolytic uremic syndrome. Toxins from the bacteria causes his kidneys to shut down, we should start him on plasmapheresis.
House: Clear, concise, and completely plausible. And exactly what I did last time, didn't work. What else?
Cameron: Goodpasture's syndrome. Circulating antibodies cause kidney failure and bleeding.
House: But not the purple papules.
Foreman: If you throw in Esther's next symptom - brain, makes me think heavy metal toxicity.
Cameron: His hematocrit would have to be low, it's at 44 and Esther's never dropped below...
Foreman: You have the file memorised?
House: It's my lucky number.
Cameron: What about lymphoma? Causes kidney failure, GI bleed and can infiltrate the base of the brain.
Foreman: You check Esther for that?
House: She never showed any signs of... if he has lymphoma this far advanced, we should be able to see it in his blood and brain. Chase, run a blood smear and immuno-chemistries. Foreman get an MRI.
Cameron: I'll page Cuddy.
House: No you won't.
Cameron: She thinks the kid has a stomach ache.
House: She'll come right up here and do one of two things - if she agrees with me, I don't need her, if she disagrees I don't want her.
Foreman: You can't handle people disagreeing with you? She might have a different take on this.
House: Subordinates can disagree with me all they want, it's healthy. People who can shut me down on the other hand... forget Cuddy, I'll have Wilson keep her busy.
(Scene cuts to House calling Wilson's mobile at the poker table)
[Wilson picks up his phone]
House: [puts his phone on speakerphone] Keep your answers short and discrete. Is Cuddy still playing?
Wilson: The chicken is still in Picadilly Square.
House: Brilliant. She'll never suspect that Normandy is her target.
Cuddy: Is that House? Tell him that the blinds just went to 20-40 and he's running out of chips.
House: How's she doing?
Wilson: Well what's going on? The way you took off, something's obviously--
House: Love to chat but got a game to play. How's she doing?
Wilson: The patient is on life support, we're about to pull the plug.
Cuddy: Are you talking about me?
House: And what have you got?
Wilson: Hmm... does sound like high dose cardio meds.
House: [while on the phone, performs a trick to make a chip disappear, what a magician he is] Two hearts. You got the flush?
Wilson: Still waiting on the final labs.
House: She drinking her seltzer?
Wilson: No, hydration is not a problem.
House: Means she's bluffing. Push her all in. [Wilson does so]
Cuddy: Call. [flips her cards] Two pair. Show me your hearts.
Wilson: [flips his cards but only ends up having one pair] Seven of clubs. [Cuddy cackles]
House: Oh dear, sounds like I messed up. You're going to be stuck with her for a while. Talk to you soon. [puts down the phone]
Cuddy: Ohoho! Yes! [sweeps all the chips she's won in]
(Scene cuts to Foreman doing the MRI on Ian, Cameron is outside talking to the parents)
Sarah: Why are you taking a picture of his head?
Cameron: We're looking for lymphoma but--
Sarah: Wait, so it's not Erdheim something and it's not his kidneys but his kidneys are failing? Where's Dr Cuddy?
Alan: Erm Dr House mentioned another case, is there another patient with the same thing that Ian has?
Cameron: Not exactly.
Alan: What does that mean?
Cameron: Dr House had a patient a while back who exhibited the same symptoms as your son--
Sarah: Then you know what's wrong?
Sarah: So what do you know?
Cameron: We know the likely course the disease will take.
Alan: Which is?
Cameron: She had multiple system failures--
Sarah: What happened to her?
Cameron: She... died 24 hours after her admission.
[the parents take a moment to absorb this in shock]
Foreman: Mr or Mrs Alston, would you mind giving me a hand? He's having trouble sitting still and it's impossible to get the detail we need. So I figure he might feel more comfortable hearing your voices. [he turns on the mic]
Sarah: Ian honey, just sit still, they'll be done in a moment, we're here with you.
Ian: I'm scared.
Sarah: It's ok, honey. It's... it's only a big camera. It's going to take a picture of your head. You love it when I take your picture at home, don't you?
Sarah: And you have to hold still for that too, right?
Ian: But this isn't like that.
Sarah: I know it's scary, Ian, but you can do it. You're getting to be so grown up. So just hold perfectly still, just for a little bit.
Ian: Mommy are you crying?
Sarah: No, no honey, I'm just tired.
Ian: Okay, I'll try.
[Sarah turns off the mic and starts crying silently as she holds onto her husband. The MRI starts]
(Scene cuts to House in the conference room)
[He checks the empty coffee pot. The coffee machine says "Good Coffee, Cheaper than prozac!" on it. He also checks the packet of coffee beans which is empty too. He crumples it up and throws it as Foreman and Cameron enter]
Cameron: The base of his brain’s been infiltrated by a small mass. We think--
Cameron: Looks that way.
Foreman: Explains the low blood pressure.
House: [walks to the board and starts writing, Chase enters] Pretty much confirms the lymphoma. Should have started Esther on prednisone.
Chase: Err... did anyone see the lymphoma?
Cameron: No, we saw a mass. The location's consistent with--
Chase: Didn't see any in the blood either. White blood cells show no spindling, or abnormal nuclei, nothing on immuno-chemistries either. It's not lymphoma.
House: [hopes shot down again, he takes his cane and wanders out of the room with the Ducklings in tow]
[He gets to the centre where one can get a drink, but there's a metal gate closed by a lock in front of it. House uses the metal handle of his cane to whack away at the lock in the hopes of springing it. The Ducklings obviously think he's gone nuts]
House: It's a train. We don't know what kind of train--
Foreman: Woah [grabs House's cane]
House: I'm thirsty.
Foreman: It's closed!
House: [yanks his cane back and starts whacking the lock again until it does open and the gate rolls up out of the way] It's not now. We've got one advantage. We know where the tracks are going.
Chase: The fact that the end of the line is death... is an advantage?
House: The fact that we know is an advantage. [he turns on the coffee machine and gets himself a cup] Which means we can get ahead of it. Next station is the liver. We've got about 90 minutes before it gets there. Maybe we can cut down a tree across the line just outside of town.
Chase: I'll do an ultrasound.
House: No, treatment will tell us more faster.
Cameron: How can we start treatment if we have no idea what we're treating for?
House: [angrily knocks back some stuff on the counter with a crash] Treat him for everything! Give him acetylcysteine and interferon and silymarine and whatever else you can think of to protect the liver.
(Scene cuts to Wilson's phone ringing again, he picks up)
Wilson: What's going on?
House: Oh just catching up on some TV. How're you doing?
Wilson: Well thanks to your last consult, the patient has improved dramatically.
Cuddy: Tell House the patient is about to kill the doctor.
Wilson: She says the patient--
House: I heard. What've you got?
Wilson: Well Cuddy just raised and err...
House: You're paired.
Wilson: [momentary shock, he looks around to check whether House is standing behind him or something] How do you know?
House: Anything lower, you wouldn't sound so excited. Jacks are higher, your voice sounds like Debbie from accounting is sitting in your lap. Ask Cuddy if she can beat a pair of threes.
Wilson: Wait, wha... what's going on? If you're going to mess with me, wouldn't it be more fun to do it in person?
House: Yes, it would.
Wilson: [to Cuddy] Erm... can you beat a pair of threes?
[Cuddy gives a scornful look and starts drinking her seltzer from two straws at the same time]
House: What did she do?
Wilson: I left orders for PO fluids, doctor.
House: Enough with the codes, she obviously knows it's me.
Wilson: She's drinking her seltzer. [Cuddy looks surprised and stops]
House: Did she stop?
House: Go all in.
Wilson: Umm... but...
House: Just do it.
Wilson: You couldn't care less about this charity event, you claim not to be messing with me, obviously you're either trying to keep me--
House: Shut up! Look, last time I wanted the game to go on. I still do. Means that this time you get to win.
Wilson: Hold on. [he shoves his meagre bunch of chips forwards. Cuddy looks wary, Wilson gazes at her challengingly]
Cuddy: I fold.
Wilson: [picks up the phone again] Ohohoho! [House is staring at the whiteboard] House, are you sure you're ok? [House puts down the phone on Wilson suddenly]
(Scene cuts to Foreman and Chase giving treatment to Ian, House stands outside the room observing. Chase walks out to talk to him)
Chase: Meds seem to be working. Liver's holding its own.
Chase: But the platelets are dropping.
House: Even better.
Chase: Why? It means he's getting sicker.
House: It's new. New is good. Because old ended in death.
[Meanwhile in the room...]
Ian: I can't breathe. [he starts choking, alarms start beeping]
Foreman: Chase! [Chase rushes back in]
Sarah: What? What's happening? Ian come on now, honey, just relax! Ian, breathe, come on honey! Please! Please, honey!
[They proceed to intubate him]
(Scene shifts back to the conference room)
[House is writing "Resp. distress" on the board under Ian's column. On Esther's corresponding side, it says "Resp. failure". He also draws an arrow pointing from Pituitary fail. down to Resp. distress. The arrow noticeably shows how Ian skipped Esther's Liver fail. and Splenic Impact to get to the respiratory problems. House morosely uses his cane to shove the whiteboard down to the floor, breaking the lamp behind it in the process. He simple stares at what he's done]
(Scene changes to House and the Ducklings in the conference room)
[Chase helps House to put the whiteboard back up again]
Foreman: We had to put him on a ventilator.
House: He's back on Esther's path. We managed to make the train skip a few stations which means that instead of 12 hours, he's probably got less than two. Which begs the question why. What did we do?
Chase: Acetylcysteine could mess with the lungs.
House: Mess with them, not shut them down in 20 minutes.
Cameron: Interferon modulates the immune system. It could affect a cancer of the blood like one of the leukemias.
Foreman: Doesn't speed them up it slows them down.
Cameron: Slows down all five hundred of them? [Foreman concedes her point]
House: Anybody know where we can find an oncologist at this hour?
(Scene cuts to House on the phone with Wilson again)
House: What effects would interferon have on leukemia?
Wilson: Depends on what type. Could make it better, could make it worse.
House: Four-year fellowship to learn that.
Cuddy: Tell House if he wants to play cards he can get his ass back down here and play.
House: You hear that? She wants me off the phone, means she's vulnerable. Go all in.
Wilson: But um... the party's over in less than 3 hours.
Cuddy: It's over in less than 2 hours. Which means you either have 3 of a kind or just 3's. I'm guessing 3's. I bet five hundred.
House: Go all in.
Wilson: You obviously want to bust me . Why would you--
House: Either you go all in or I tell everybody in the building that you wear toenail polish.
Wilson: I'm all in. [he shoves his pile of chips into the centre]
Cuddy: I'll... call. I'm betting you have a pair of threes, but even if you have three, it's not going to beat Trip nines.
Wilson: [fakes a rather anguished face before turning over one card, and then the other rather enthusiastically] Oh, oh, oh no, oh no! Ohhhh that's gotta hurt. [The glee on Cuddy's face turns to horror]
House: What happened?
Wilson: I just killed two birds with one straight. Goodbye.
House: Fine, keep playing, but I need you to recommend a good Oncologist because if I don't get one up here in the next few minutes, I got a dead 6-yr-old. [Wilson puts down the phone]
(Next scene, Wilson's in the labs with House and the Ducklings looking in the microscope)
Wilson: If you need help, ask. These games are insane.
House: Games have a higher success rate.
Wilson: Well, I don't see anything that looks like leukemia. You do a bone marrow biopsy?
House: No time.
Wilson: Even if there is an occult blood cancer, you wouldn't expect interferon to make it worse. And certainly not this fast.
House: What would move this fast?
Cameron: Auto-immune diseases. His body's own defenses are attacking him and beefing them up is just going to put fuel on the fire.
Foreman: Sarcoidosis could be in his brain and lungs.
Cameron: No, no enlarged hilar lymph nodes on his chest x-ray.
Chase: The systemic nature suggests juvenile rheumatoid arthritis.
Wilson: Or Kawasaki's disease.
Foreman: Can't be Kawasaki's. That doesn't affect the elderly.
Wilson: Err the... this is a kid's x-ray.
Cameron: House had another patient.
Wilson: Who may or may not have had Kawasaki's. This kid on the other hand, he makes antibodies that are eating the inside of his arteries, choking off blood to his major organs one by one. First the GI tract, then the kidneys, then the brain, now the lungs.
House: Can anyone think of a reason why Kawasaki's can't affect the elderly? Other than it doesn't. [no reply] Nice.
Foreman: We can confirm with bloodwork. We need an ANA, sed rate--
Cameron: Labs will take 2 hours.
Chase: What was the old lady's sed rate?
House: Elevated. 98.
Wilson: You can't use another patient's labs to diagnose Kawasaki's disease!
House: Is that like a dare or something?
Wilson: You don't have time to be wrong.
House: Fine. We'll look for Kawasaki where he lives, Ian's coronary arteries.
Wilson: This other patient... the old lady... Esther?
[House nods, Wilson has a "not again" look on his face, they both walk out into the corridors]
Wilson: Have you read Moby Dick?
House: It was a book?
Wilson: It was 10 years ago.
Wilson: Obsession is dangerous.
House: Only if you're on a wooden ship and your obsession is a whale. I think I'm in the clear.
Wilson: You do realise it's a metaphor?
House: You do realise that the point of metaphors is to scare people from doing things by telling them that something much scarier is going to happen than what will really happen? God I wish I had a metaphor to explain that better. Go back to the game. Don't worry, I'm not going to get eaten by witches. [he gets into the elevator and leaves Wilson standing alone]
(Cut to Chase and Cameron checking Ian's heart with an ultrasound)
Chase: Coronary arteries clear. No aneurysms.
Cameron: Flip the mode, let's see the flow.
(Cut to Foreman talking to the mother)
Sarah: How did that other woman die?
Foreman: She went into respiratory distress. Her heart and liver were already--
Sarah: No. Did she suffer? Was she in pain?
Foreman: I don't know.
(Cut back to Chase and Cameron)
Chase: No blood clots, no ragged edges.
Cameron: Damn. Shut it down, we're just wasting time.
[Chase flips it back to see the heart and he stares at something curiously]
Chase: Look at the right atrium.
Cameron: That's not Kawasaki's.
(Cut to Ducklings and House looking at the computer in House's office)
Chase: It's small, but it's there.
Foreman: Esther didn't have a mass in her heart.
House: Ian's younger. He can take more of a pounding. Esther died before the disease reached her heart. The disease made a mass and made it fast.
Cameron: Could be bacteria.
Foreman: Or muscle.
Chase: Connective tissue?
House: Kid can't take any more theories. Only thing we know is that whatever that mass is, that's what he's got. We need a piece of it. I'm doing a biopsy.
(Cut to House and Chase in Ian's room trying to do a heart biopsy, the blinds are open and the parents are watching from outside)
Chase: I'll shut the blinds.
House: No let them watch, I do my best work on the big stage. Passing through the superior vena cava.
Chase: You're in the atrium. Pull back. You've hit the wall of the heart.
House: These procedures would be so much simpler if you could do them on healthy people. And out again. [as he's pulling the biopsy needle out, alarms start beeping] V fib!
Chase: Cardiac arrest! Call a code.
House: [takes off Ian's robe] Come on, paddles! Come on.
House: Clear! [he shocks Ian, no effect]
[outside in the nurse's station]
Over the announcement system: Code blue, Iso room. Code blue, Iso room. [nurses run to the alert]
[Meanwhile back in Ian's room]
House: And again. [shocks Ian, Chase checks for a pulse]
House: Again. [shock, check for pulse]
[Time passes as the nurses and the two doctors scurry to restart Ian's heart]
House: You got a clock on this?
Chase: How much longer are you going to keep doing this?
House: Clear. [shock, check for pulse]
Chase: Wait! I've got something.
House: He's back. [he starts to finish taking out the biopsy needle which is still stuck where it was before Ian went into cardiac arrest]
Chase: What are you doing?
House: Doing what we came here to do.
Chase: It almost killed him.
House: I know, I was right here. Give me a vacutainer.
Chase: His brain's been oxygen-deprived for over 8 minutes. There might be nothing left, he might--
House: Tell the parents. Where the hell is that vacutainer? [a nurse hands him one]
(Scene cuts to House and Ducklings in the conference room)
House: So, what's he got?
Foreman: Brain damage.
House: Good chance. I was talking about before that.
Cameron: You're not worried about--
House: Things I can't do anything about, I try not to.
Foreman: Huh, yeah, things just roll off you like water off a duck.
Foreman: Very unlikely in a 73-yr-old.
House: Whatever this is is very unlikely. Come on, more ideas, let's go people.
Cameron: Genetic disorders could cause masses everywhere. Tuberous sclerosis.
Foreman: If it's genetic he's had it all his life, why now?
House: I don't know, it sure fits nice enough.
Chase: We haven't ruled out leukemia yet.
Cameron: Or sarcoma. He could have multiple soft tissue tumors.
Foreman: Or sarcoidosis.
Cameron: Multiple neurofibromatosis.
House: How's it going? You win?
Cuddy: I got called away. By the angry parents of a patient. There are THREE of you here, none of you had the sense to stop him, to pick up a phone and call me.
House: I told them you'd signed off. The parents are mad because their kid is dying, that's understandable. But if he doesn't die, they won't be mad anymore.
Cuddy: Well if he's brain-damaged, they might still be a little ticked.
House: I had to do it to save him.
Cuddy: You had to do it to diagnose Esther. You may have killed a 6-yr-old because you're obsessed with a woman who's been dead for 12 years. Sometimes you lose, House. You're not God!
House: He's not dead yet.
Cuddy: No, but you're done with him, it's my case now. Go home, go ride your motorcycle, go brood in a dark room, just don't go near Ian again. [she storms off]
House: So, anything else or is it just these seven?
Foreman: Drop it House, she's right.
House: No she's not. You know she's not.
Chase: We should have called her.
House: I'm surprised you didn't.
Cameron: You're going to have to find a way to let this go. We can't go near Ian.
House: We don't need to go near him, we have his tumor. Cuddy may be right that we screwed up the protocol, she may be right about my screwed up obsession, but I'm right about the medicine. [he takes the tumor slice out of the fridge in a container and puts it in front of Cameron] How many tests can we do with that? [Cameron sighs] Look, we cure the kid we solve everybody's problems. How many?
Cameron: Maybe two good pieces.
House: How many okay pieces?
Cameron: Three would be pushing it.
House: [turns around to look back at the whiteboard] Three tests, seven choices. Okay, what's first?
Chase: Sarcoidosis seems most likely.
House: Yeah, so likely that Cuddy's going to think of that all on her own. She's got the kid's whole body to play with. Let her do that test. What's next?
Foreman: It's moving too fast to be spreading. It has to be growing from something that's already--
Cameron: Genetic disorder - tuberous sclerosis.
Chase: Or it's his immune system, histiocytosis.
House: Well there are more documented cases of histio amongst older people than tuberous sclerosis, let's start with that. [he circles it on the board, Ducklings exit]
(Cut to Ducklings in the labs, Chase is about to cut a piece of the tumor)
Chase: Wing or drumstick?
Foreman: Going to need a little more than that.
Cameron: A little more is more than a third.
Foreman: If we have to repeat this test because you didn't cut us enough...
[Chase carefully cuts off a third, puts it on a slice and puts it under the microscope]
Chase: Adding one micro litre of the immunoperoxidase.
Foreman: Make it two. I don't want House biting off our heads because we weren't sure if it turned red or not.
Cameron: [looks into the microscope] That's definitely not red.
(Cut back to the conference room)
Chase: The problem could still be an abnormal cell growth but a different cell line.
Foreman: Sarcoma? Muscle cells throughout his body? Would explain the geography.
Cameron: Genetic disorder's far more likely in a 6-yr-old. Tuberous sclerosis.
Chase: Pretty unlikely to cause a GI bleed.
Foreman: Time course fits.
House: Mr Foreman, you agree with both of them? Thanks for playing.
Foreman: If we have enough tissue for two tests, why not do both?
House: Then we don't have to think as hard. Taking the pressure off the choice makes us less likely to think critically.
Foreman: Sarcoma is more likely to hit a 6 and 70 yr old.
House: Tuberous sclerosis it is.
Foreman: You think sarcoma's less likely?
House: It's more likely, the test for it on the other hand, is less reliable.
(Scene cuts back to Ducklings doing the test)
[The results come in one at a time]
Cameron: Nestin's negative.
Foreman: Oh that's ok, if the tumor cells haven't matured, the KR67 protein wouldn't have turned off. What happens if we don't solve this?
Cameron: Kid dies.
Foreman: I mean for the next 12 years.
Chase: KR67's negative. And PCH antigen is negative.
(Cut back to the conference room)
[House is shaking his bottle of vicodin]
House: Mighty Casey is down to his last strike.
Foreman: Mighty Casey struck out.
House: Thanks a lot, didn't read that this weekend. [pops a vicodin]
Cameron: Chondrocytoma. Connective tissue has been in all the places that we've been looking.
Foreman: The kid is too sick for that, we're better off testing for sarcoma.
Cameron: We would have seen signs of that when we tested for tuberous sclerosis.
Foreman: The tumor cells looked like muscle under the microscope.
Cameron: No, they didn't. They looked like fat.
Chase: I vote for neurofibromatosis.
Chase: Because the other choices suck worse.
[House takes his pimp cane and walks out]
House: Give me a minute.
(Scene cuts to House sitting on Ian's bedside and simply watching him)
House: You want me out of here?
Cuddy: You come up with anything?
[he walks out]
(Scene cuts to House morosely staring out at the sunrise from his balcony)
[Wilson joins him on the balcony]
House: We can talk about it tomorrow.
Wilson: [he starts walking back to his office, then turns around again to address House] I erm... I won the poker tournament. [House is immediately interested] I totally played this guy Burman from Business Affairs. I got great cards, but I don't bet. Just call, no raises. Burman pairs his king on the flop, I keep calling, the river turns, I check. He can't stand it. He goes all in, he's sure he's won. [Wilson dramatically makes hand gestures about flipping the cards] I call. I flip 'em. Oh! [he looks victorious]
House: Pocket aces.
Wilson: I nailed his ass!
House: [smiles indulgently, then suddenly realises something] The aces were hiding all along.
(Cut to House walking in on the Ducklings at the drink station)
House: Test him for Erdheim-Chester disease.
Foreman: Erdheim-Chester? That's not even on the list!
Chase: Because we already did it. He tested negative.
Cameron: So did Esther.
House: Disease lied.
Cameron: Yeah, the tumor's got it in for you. Diseases don't lie.
House: Fine, it didn't lie, it slow played us. We biopsied the colon, it hadn't reached the GI tract yet. It's there now. It's in his liver, his lungs--
Chase: You want it to be there. Because then you didn't screw up 12 years ago.
Foreman: We can't waste our one test on the one disease we know it's not.
House: Run the test. [The ducklings look disappointed but do it anyway]
(Cut to House and Ducklings in the labs)
[Chase puts the last piece of the tumor on the glass]
Chase: You sure about this?
House: Wait, let me think about that. Don't pressure me. Just run the damn test.
[Cameron puts on her glasses and looks into the microscope]
Cameron: Cells look like macrophages.
House: That's a good start.
[They add the reagent to the tumor]
House: [walks away and stares at the wall] Take your time and say it loud.
[Under the microscope, the tumor turns red]
Foreman: CD 68 positive [he smiles]
[House lets out his emotions by banging his hand hard against the wall. The Ducklings are startled and jump. House collapses onto a chair and the Ducklings look at him warily]
House: Start the treatment. [Ducklings exit]
(Music montage starts - House is playing the piano to the song "Hymn to Freedom". Scenes of Ian's treatment going well, of Cuddy extubating him, of House playing the piano and the parents looking happy flip by)
[Wilson walks through the lobby. He has taken off his bowtie and like House, now just has his coat on top of his white shirt. The boys spot each other and smile and House stops playing the piano. As things from the lobby from the party the night before are being cleared out, House and Wilson are seated at the same old poker table, just the two of them, playing poker. House starts to deal the cards after he lights up his old cigar]
Wilson: So Esther can rest peaceful now huh?
Wilson: [peeks at his cards] Forty. [they are betting with real money this time] You got lucky. You going to call?
House: What I do, is not just based on the flip of a card.
Wilson: You guessed. You got lucky.
House: It fit.
Wilson: It could just as easily have been sarcoma or tuberous sclerosis.
House: No, not just as easily.
Wilson: Maybe not. But it wasn't impossible. Are you going to call?
House: [the piano music starts up again in the background, House smokes his cigar] You know, relative to it's size, the barnacle has the largest penis of any animal. [said with a poker face]
[Wilson tries to keep a straight face but bursts out laughing, House follows suit. The camera pans out on the boys as they continue playing their game and happily joking and laughing with each other (and I mean really nice free laughter from House, pretty much like the end scene in 1.05 Damned If You Do) proving once again that House doesn't really laugh unless he's with Wilson ;)]