doc_on_duty (doc_on_duty) wrote in clinic_duty,

House MD - 1.05 Damned If You Do

Originally Aired: Dec 14 2004

Written by: Sara B. Cooper
Directed by: Greg Yaitanes

Transcribed by: Mari (musikologie)

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.

[Opens on the clinic front desk. Wilson is working on paperwork, House is playing with candies. The desk has Christmas decorations on it, and “Rudolph the Red-Nosed Reindeer” is playing in the background.]

House: We are condemned to useless labor. [House has a giant stack of charts next to him.]

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

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

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

House: Oops. I missed.

Cuddy: What are you, eight?

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

Cuddy: You better stop or it’ll stick that way. You have a patient in Exam Room 1.

House: Yeah, but see, see, I’m off at twelve and it’s already five of.

Cuddy: She’s been waiting for you since eleven. [Cuddy walks off.]

House: Melancholy without hope. Which circle is that?

House walks into the exam room, sees who’s in there, and makes a “oh no” kind of face. It’s three nuns.]

House: Hi. I’m Dr. House. What seems to be the problem?

Sr. Eucharist: Show him your hands, Augustine. [House pops a couple Vicodin. Augustine shows her hands, which are red, swollen, and covered in hives and sores.

Sr. Pius: It looks like… stigmata.

Sr. Eucharist: Shhhh, Pius!

House: You must be all the talk around the holy water cooler. You been washing a lot of dishes recently?

Sr. Augustine: I help out in the kitchen.

House: Anything new in the kitchen?

Sr. Pius: We just got a donation of saucepans and pots this week.

Sr. Augustine: I unpacked and washed them.

House: Should have spent your time saving souls, it’s easier on the hands. This is contact dermatitis; you’re allergic to dish soap.

Sr. Eucharist: Nonsense! We’ve always used that soap. Why is there a problem now?

House: 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.

Sr. Augustine: Thank you, Doctor.

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

Sr. Augustine: I have some tea.

House: 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.]

Wilson: Still out by twelve.

House: How do you solve a problem like dermatitis?

Wilson: What?

Sr. Eucharist: Doctor? I want to thank you for your patience.

Wilson: She talking to you?

House: I don’t know. She’s certainly looking at me.

Sr. Eucharist: Oh, it’s good to get a secular diagnosis. The sisters tend to interpret their diagnosis as divine intervention.

House: And you don’t? Then you’re wearing an awfully funny hat.

Wilson: Oooh, boy. Excuse me. [He leaves.]

Sr. Eucharist: If I break my leg, I believe it happened for a reason. I believe God wanted me to break my leg. I also believe He wants me to put a cast on it. [House smiles slightly.]

Sr. Pius: Doctor, something’s wrong!

Cut to Exam Room 1, where Augustine is having an asthma attack. House grabs his stethoscope.]

House: Lift up your chin. [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.]

Sr. Eucharist: What happened?

House: Did she take the pill?

Sr. Eucharist: Yes.

House: It’s probably an allergic reaction.

Sr. Pius: She’s allergic to an anti-allergy medicine?

House: You figure somebody’s out to get her? How’re you feeling?

Sr. Augustine: Better.

House: I’ll put you on some steroids instead.

Sr. Augustine: Is my heart supposed to be feeling so funny?

House: 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.

Sr. Pius: Help! Somebody help us! [House opens Augustine’s shirt and listens to her heartbeat.

House: 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.]

Opening credits.]

Cut to Augustine’s hospital room. Her cross and Bible are on the table next to her; the two sisters are praying at her side. Cut to Cuddy’s office.]

Cuddy: You diagnosed the patient with allergies and prescribed antihistamine, she went into respiratory distress, and you injected her with epinephrine. Presumably 1 cc.

House: 0.1 cc. That is the standard dose, that is what I gave her.

Cuddy: People don’t go into cardiac arrest from 0.1 cc epinephrine.

House: She must have a pre-existing heart condition that got exacerbated by the epinephrine.

Cuddy: It’s too bad you didn’t make a notation in the chart.

House: I can make it up right now.

Cuddy: The drawer has syringes with both dosages, you could have easily reached for the wrong one.

House: But I didn’t.

Cuddy: Everyone makes mistakes. This is why doctors pay through the nose for malpractice insurance.

House: Relax, they’re not going to sue. Worse they’d do is whack my hand with a ruler.

Cuddy: And the discipline board? Are they gonna whack your hand, too?

House: You’re going to report me?

Cuddy: What choice do I have?

House: Uh, how ‘bout not report me?

Cuddy: I can justify keeping her here for 24-hour observation. If you haven’t found an underlying cause for the cardiac arrest by then I will have to notify our attorneys. [House looks at his watch and walks out.]

Cut to House walking down the hall with Cameron, Chase and Foreman.]

Cameron: Her hands were red and swollen, maybe she has a skin infection. Cellulitis? That could manifest with tachycardia.

Foreman: There’s no history of fever. Results from the CBC didn’t indicate an infection.

Cameron: The eosinophils were mildly elevated, sed rate’s up a bit. Could be looking at a systemic allergic response.

House: It’s not allergic. Allergies don’t cause cardiac arrest like this. Could be inflammation of the blood vessels.

Foreman: Vasculitis? That wouldn’t give you an elevated eosinophil count.

House: 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.]

Cameron: Need a biopsy to diagnose.

Chase: Chest CT’d be quicker.

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

House: What the hell are those?

Cameron: Candy canes. [Foreman takes one.]

House: Candy canes? Are you mocking me?

Cameron: No! It’s Christmas and, and I, I, I thought –

House: Relax. It’s a joke.

Foreman: Isn’t the prognosis for Churg-Strauss a bit grim?

Cameron: Yeah. Untreated only 33% of patients survive past a year; treated, five years.

House: Then I’d definitely suggest treatment.

Foreman: If it was any other attending doctor, I’d say that he made a mistake and gave her too much epinephrine.

House: [pouring coffee] Saying you wouldn’t say it was my mistake is saying it was my mistake.

Foreman: Everyone screws up: your rule. I think you fit inside the subset of “everyone”.

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

Chase: The sister?

House: Oh, didn’t I mention? The patient’s a nun. Sister Augustine.

Chase: Aw. I hate nuns.

House: [thinks a little] Who doesn’t?

Cut to a TV, showing a man and a women playing in the waves. Sisters Augustine and Pius are watching it raptly. Foreman, Cameron and Chase walk in.]

Cameron: Sister Augustine? [Pius hurriedly turns the TV off.]

Augustine: We weren’t watching.

Pius: [holds up remote] We were trying to see if this was the bed control.

Cameron: Oh, um, this one’s the bed control [she gives Pius another remote] and that one’s the TV control. I’m Dr. Cameron, and that’s Dr. Chase and Dr. Foreman.

Augustine: I hadn’t seen television in over twenty years.

Chase: Do you consider it the work of the devil, or do you just not get cable where you live? [pause]

Foreman: Um, how’re you feeling, Sister?

Augustine: I seem to be a little better; they gave me some medication.

Foreman: Prednisone. It’s a steroid to help with the inflammation.

Augustine: Has Dr. House figured out what I have? Will I be okay?

Cameron: We’re not sure what’s wrong yet. You’ll have a chest CT scan this afternoon that will help with the diagnosis.

Pius: Dr. House is giving her medication and he doesn’t know what she has yet?

Augustine: Trust, Sister Pius. It all happens for a reason.

Cut to the ducklings in the hallway.]

Foreman: He doesn’t know what he’s doing. The only problem that woman has is that House grabbed the wrong syringe.

Cameron: You don’t trust him?

Foreman: I don’t trust a man who won’t admit he might be wrong. I notice you weren’t so quick to tell her she has Churg-Strauss and only has a couple years to live.

Cameron: I don’t tell patients bad news unless it’s conclusive.

Foreman: Because you know he might be wrong.

Cameron: About Churg-Strauss, not about what happened in the clinic.

Foreman: What about you, Chase? You think he’s infallible, too?

Chase: All I know is, if House didn’t make a mistake and Sister Augustine has Churg-Strauss, he’ll be self-satisfied and our lives will be good for a few weeks. If House did make a mistake, he’ll be upset and our lives will be miserable for months.

Foreman: There is that.

Cut to House and Wilson walking out of the elevator and into the clinic.]

House: If Cuddy thinks I made a mistake the least she could do is suspend me from clinic duty.

Wilson: She doesn’t confuse making a mistake with being incompetent.

House: 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.

Wilson: So you might have screwed this up?

House: No.

Wilson: So, it’s only a theoretical capacity for error.

House: Good point. Maybe there isn’t one. Maybe that’s my error.

Wilson: You know, most people who think as much of themselves as you do like to talk about themselves.

House: Most people don’t like to listen, so what’s wrong with you? [He leaves Wilson standing in the clinic.]

Cut to House entering Exam Room 1, which is occupied by… Santa Claus? House makes a point of sniffing the air as he enters.]

House: Let me guess… inflammatory bowel.

Santa: Wow, yeah. Is it that bad?

House: Yes. It’s also written on your chart. Bloody diarrhea, gas, pain… took sulfasalazine, but it didn’t work –

Santa: No, then I –

House: Next tried steroid enemas, oral corticosteroids, 5ASAs, 6 mercaptopurine… I’m impressed.

Santa: By my medical history?

House: By how well your last doctor charted.

Santa: 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?

House: 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.]

Santa: [tries to read House’s writing] Cojorius?

House: 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.

Santa: Are you kidding me?

House: About the looking cooler, yeah. The rest is true.

Santa: Isn’t it addictive and dangerous?

House: 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.

Cut to Chase wheeling Augustine to the CT.]

Augustine: I was talking to the nurse, Arsenio. Do you know him?

Chase: Not really.

Augustine: He can take pictures with his phone.

Chase: Cool.

Augustine: That woman from the lab was interesting, too. She studied astrophysics before becoming a nurse.

Chase: You know the staff better than I do.

Augustine: Well, I love to hear about people.

Chase: Yet you live in a monastery.

Augustine: It’s where I serve our Lord and the world best.

Chase: Our Lord, maybe. The rest of the world, on the other hand, would probably get more out of feeding the homeless or –

Augustine: Healing the sick?

Chase: As an example, yeah.

Augustine: Did you always want to be a doctor?

Chase: Always. You always want to be a nun?

Augustine: My parents died when I was six. I was raised in a foster home run by the Church. When I was eighteen, I went to the monastery where they let me take my vows. I’ve known no other life and I haven’t wanted to.

Cut to Augustine going into the CT.]

Foreman: Okay, Sister, we need to you lie as still as possible. If you get scared, just let us know.

Augustine: As Jonah said from inside the whale, “When I had lost all hope, I turned my thoughts to the Lord.”

Foreman: At least she’s got God on her side.

Cameron: I don’t believe in God.

Foreman: You’re not even a little agnostic?

Augustine: [from inside the CT] Is it supposed to smell funny?

Tech: Someone ralphed in there this afternoon. We cleaned it up, but…

Cameron: It’s normal, Sister. It’s just a few more minutes. [pause] I believe in a higher order that’s in control of what happens, but not one anthropomorphic entity called “God” that’s concerned with the everyday workings of you and me.

Foreman: What else is there to control but the everyday workings of you and me?

Cameron: It’s always about you, Foreman.

Foreman: What else are you talking about? The trees, the fish? Should they be the ones to think it’s all about them? What about you, Chase? Do you believe in God?

Chase: I believe Sister Augustine has no vascular pathology, which means no Churg-Strauss.

Foreman: Which means House made a mistake.

Cameron: No, not necessarily. It could be something else. Thyrotoxicosis or a carcinoid.

Foreman: I don’t get you. You don’t believe in God, but you’re willing to put complete faith in one man?

Augustine: Please, the smell!

Foreman: Let’s get her out of there. [Augustine is panicking as they pull her out.]

Cameron: I’m coming, Sister. I gotcha, I’m coming.

Augustine: Please, please, the smell, I’m sick –

Cameron: There’s no smell –

Augustine: No, God, no – [she puts her hands in a praying position, then gestures outward] Oh, it’s Jesus! It’s Jesus! [Chase rolls his eyes. Augustine starts to laugh and cry.] He’s coming for me. He’s burning me with his touch!

Foreman: Let’s get her on some Ativan. [He holds on to Augustine’s arms as she continues to cry.] Smells, religious visions are symptomatic of temporal lobe swelling. We don’t want her to –

Augustine: Oh!

Cameron: She’s seizing!

Foreman: Help me get her on her side. [The three of them maneuver the sister onto her side.]

Chase: Religious visions?

Foreman: Yeah. And next comes… [he lifts up part of her gown, we see a rash on her leg. Chase and Foreman share a look.]

Cut to the diagnostic office.]

Foreman: Patient tested positive for herpetic encephalitis.

House: So what’s that tell us?

Cameron: Her immune system is severely compromised.

Cuddy: Ooh, I know! Prednisone compromises the immune system. Isn’t that the medicine you gave her for the thing she doesn’t have?

House: Yeah, but… hey. I’m think that’s a trick question.

Cameron: Her immune system is severely compromised. Two doses of prednisone wouldn’t do that.

Cuddy: Are you hanging your diagnosis on an adverb?

House: In ten seconds I’m gonna announce that I gave her the wrong dose in the clinic.

Cuddy: You’re gonna admit negligence?

House: Unless you leave the room. If you stay you’ll have to testify. [Cuddy stays put.] Five, four, three, two…. So, there I was in the clinic, drunk. I open the drawer, close my eyes, take the first syringe I can find – [the ducklings smile, Cuddy leaves] So, what are the options for compromised immune system?

Chase: Mixed connective tissue disease. It’d explain why she was feeling better on the prednisone.

Foreman: Sure, she was feeling better right up to the moment it almost killed her.

House: On the other hand, it explains the symptoms. Swollen hands, pulmonary problems, cardiac problems – it all fits.

Foreman: Except her ANA was normal.

House: So redraw the blood.

Foreman: But the treatment is corticosteroids, prednisone, and we can’t go there because of the encephalitis.

House: Then we’ll treat it with something that modulates the immune system but doesn’t suppress it. Hyperbaric oxygen chamber.

Foreman: There’s no protocol for putting a patient in a high-pressure oxygen room to treat autoimmune problems.

House: Oh, you people. Always with the protocols. [small pause] Prep the nun and discontinue the prednisone. [He begins to erase the whiteboard and continues to talk to Foreman as the others leave.] I am both amused and annoyed that you think I should be less stubborn than you are.

Foreman: You are aware of the Hippocratic Oath, right?

House: The one that starts: First, do no harm, then goes on to tell us no abortions, no seductions, and definitely no cutting of those who labor beneath the stone. Yeah, took a read once, wasn’t impressed.

Foreman: Hyperbaric treatments could cause oxygen toxicity, lung and eye damage –

House: Every treatment has its dangers –

Foreman: Which is why we treat when we’re only convinced the patient needs the treatment.

House: I’m convinced. You’re not. Question is, what are you going to do about it? Hmm?

Cut to Cuddy’s office.]

Cuddy: [on the phone] I have an opening Thursday at three. Do you have a fourth? Is he any good? [Someone walks into her office.] Can I call you right back? Okay. [She hangs up.] What’s up? [We see that it’s Foreman that walked into her office.]

Cut to Chase and Cameron putting Augustine into the hyperbaric chamber.]

Chase: The pressure will force the oxygen into your system and saturate your blood. It will enhance white cell activity and reduce the inflammation.

Augustine: And that will help with this mixed connective tissue disease?

Chase: We’ll be doing about ten treatments and then we’ll reevaluate.

Augustine: The last treatment with prednisone caused the seizures, right? How confident is Dr. House about this?

Cameron: That you reacted so strongly to the prednisone let us know that you had an underlying problem with your immune system.

Augustine: I guess it was a blessing… of sorts.

Cut to the hospital chapel. House is sitting in the chapel watching General Hospital on his portable TV.]

Soap Doc: So, who’s your favorite reindeer, Nurse [something]?

Soap Nurse: Rudolph.

Soap Doc: I would have thought it was Vixen.

Soap Nurse: What are you implying?

Soap Doc: Nothing, but I saw you at the Christmas party with Dr. [fades out. Sr. Eucharist walks in, makes the sign of the cross, and turns to sit. She sees House in the pew.]

Eucharist: This is a chapel. A house of prayer.

House: House of prayer, huh. That explains the good reception. Also why nobody’s ever here.

Eucharist: I need to talk with you, Dr. House. Sister Augustine believes in things that aren’t real.

House: I thought that was a job requirement for you people.

Eucharist: She’s been known to lie to get sympathy. She’s a hypochondriac.

House: [turns off TV] So, you’re warning me that I may be treating a non-existent ailment

Eucharist: Sore throats, joint pains… there’s always something wrong, and there’s never a reason for it. Mother Superior plays right into it. Lets Augustine off work duties, treating her as fragile, special.

House: That must make you angry. [eats a piece of chocolate]

Eucharist: It bothers me. It’s not really in Augustine’s best interests. [She keeps looking at the chocolate bar.]

House: [offers the chocolate] Want some?

Eucharist: I shouldn’t. [takes the bar and sits down next to House]

House: I guess you’ve got to be good at reading people to be a good infirmarian, huh.

Eucharist: [around a mouthful of chocolate] Mm hmm.

House: So, we’ve got pride, anger, envy, gluttony…. That’s four out of seven deadly sins in two minutes. Do you people keep records of these things? Is there a Cathlympics?

Eucharist: They say you have a gift.

House: They like to talk.

Eucharist: You hide behind your intelligence.

House: Yeah, that’s pretty stupid.

Eucharist: And you make jokes because you’re afraid to take anything seriously. Because if you take things seriously, they matter, and if they matter –

House: And when things go wrong, I get hurt. I’m not tough, I’m vulnerable.

Eucharist: I barely know you, and I don’t know if I’m right. I just hope I am. Because the alternative is, you really are as miserable as you seem to be. [pause]

House: You know, from the way you’re looking at me right now, I’d say you just hit number five: lust. [Eucharist hands House his candy bar and leaves. House pulls out his pocket TV.]

Soap Nurse: Dr. Brown, I love you, too.

Cut to Cameron and Chase opening the hyperbaric chamber.]

Chase: How’re you feeling?

Augustine: A little weak.

Chase: That’s from the oxygen.

Augustine: My mouth is dry.

Chase: Okay. well, I’ll get you some of your tea.

Cut to House and Cuddy walking down a hallway.]

Cuddy: Mixed connective tissue disease? Her ANA is barely elevated!

House: Well, thanks for checking up on her. Good to know you’ve got my back.

Cuddy: 0-2 stat is down to 83, pulmonary problems, breathing problems –

House: Irritation from the oxygen is typical.

Cuddy: She comes in with a rash and you put her into cardiac arrest.

House: That well just never runs dry, does it? If there was no underlying problem, then why is she still having the rapid heartrate?

Cuddy: Maybe from the herpetic encephalitis caused by you giving her prednisone!

House: Her reaction is a symptom, not an error.

Cuddy: There’s always an explanation, isn’t there?

House: Yes, there is! And if this one doesn’t work will find another.

Cuddy: But never one involving you screwing up.

House: One that fits all the facts. Look, we obviously have a difference of opinion, and that’s fine, but unfortunately I’ve used up all the time I’ve budgeted today for banging my head against a wall.

Cuddy: I am going to do you the biggest favor one doctor can do for another. I am going to stop you from killing your patient. You’re off the case.

Cut to House, standing in his office. He gives Foreman a Look, who Looks right back at him. House then gives him quite an evil grin, and Foreman… well, he’s got nothing on that.]

Cut to the ducklings talking with Cuddy in her office.]

Cuddy: We’re going to treat the symptoms.

Cameron: Not the underlying condition?

Cuddy: There is no underlying condition. What’s her status?

Chase: The sister’s breathing is labored.

Cuddy: Pneumonitis from the hyperbaric chamber. Put her on 40% oxygen until her 0-2 stats increase.

Chase: BUN and creatinine’s rising, ALT and AST twice the normal range.

Cuddy: Could be from the hypertensive episode. Let’s follow them with labs.

Foreman: She still has the rash and the joint pain she came in with.

Cuddy: Order a non-steroidal anti-inflammatory.

Cameron: When we were looking at the differential diagnosis with Dr. House, we were considering –

Cuddy: I don’t need to hear what Dr. House was considering! All of this woman’s symptoms can be traced to Dr. House’s considerations. Okay. Let’s just get this patient healthy. I want her going out the front door, and not the back.

Cut to Cameron, Chase and Foreman leaving the clinic.]

Foreman: Hey, it’s not like I betrayed him. Cuddy would have found out about the hyperbaric treatments eventually.

Cameron: You did what you felt you had to.

Cut to House in the clinic. He’s looking through the door with the epinephrine syringes.]

Wilson: Can’t get enough of this place, huh?

House: Came for my stethoscope.

Wilson: So, I shouldn’t read too much into the fact that you were looking for it in the drawer with the epinephrine syringes in it?

House: Okay, yeah. I’d like to clear my reputation.

Wilson: Oh, right. I forgot that you care about what people think. Prescribing cigarettes for inflammatory bowel? It could cause lung cancer, you know.

House: [leaving the exam room] You know why they have ribbons for breast cancer, colorectal cancer, prostate cancer and not for lung cancer?

Wilson: They ran out of colors?

House: It’s because people blame lung cancer patients. They smoked, they screwed up, they deserve to die. The reason people die from lung cancer is guilt. [He enters Cuddy’s office where the records are kept.]

Wilson: Huh. Well, guilt does a lot of damage.

House: You said that with great significance.

Wilson: You’re not here to find your stethoscope. You’re not here to clear your reputation. You’re here because you’re having doubts. You might have screwed up.

House: I’m here because, if I’m right, Cuddy is killing that patient.

Wilson: Okay, but if you’re wrong? [pause]

House: Then she’s saving her.

Wilson: Fine. You’re going to have to go through every record of every patient who’s been through this clinic in the last two days, and you’re gonna have to hope that those records can be trusted, which, by the way, yours can’t. [Wilson leaves.]

Cut to Chase with Augustine.]

Chase: These pills will help your kidneys function a little better, Sister. [She takes the pills.] Get your wrist? [He takes her pulse.]

Augustine: What’s that?

Chase: 104.

Augustine: Is that good?

Chase: It’s fine.

Augustine: You’re a lousy liar, Dr. Chase. [Chase’s beeper goes off. On it is the message “Call Mom!”

Chase: I have to get this. Excuse me.

Cut to House’s office. House is playing with a yo-yo. Chase enters.]

Chase: My mother’s been dead for 10 years.

House: But she’s always with you in spirit. What do you know about the nun?

Chase: Which one?

House: The cute one. I think she likes me. The sick one, obviously.

Chase: Her parents died when she was a child and she’s been with the Church ever since.

House: What’s she lying about?

Chase: Why do you say that?

House: I always say that. And the old nun says the sick nun is a big fat nun liar. You know nuns, what do you think?

Chase: I don’t know nuns.

House: You hate nuns. You can’t hate someone if you don’t know them.

Chase: Know any Nazis? Maybe I hate them on principle.

House: I have a theory on what makes good boys “good”. It’s not because of some moral imperative. Good boys have the fear of God put into them. Catholic Church specializes in that kind of training, to make good boys afraid of divine retribution so they will do what their daddies tell them, like, for example, going into medical school when it’s the last thing they want to do. What do you think?

Chase: I think if she did have a secret, her boss would know. [He leaves.]

Cut to the monastery. House is talking to another nun {I’m assuming the Mother Superior.]

House: Did you paint, or put in new carpets recently?

Nun: No.

House: Any way she could have got access to drugs?

Nun: Well, we lock all of our medications in the infirmary, and we don’t keep prescription drugs here. [Nun is making tea.] Why haven’t you asked Sister Augustine about these things directly?

House: I’ve found that when you want to know the truth about someone that someone is probably the last person you should ask.

Nun: Ah. And have you been speaking to Sister Eucharist?

House: She ratted out her fellow sister pretty quickly. If I were you I’d have her repeat a year of nun school. [Nun chuckles.]

Nun: Becoming a nun doesn’t make you a saint.

House: Becoming a doctor doesn’t make you a healer.

Nun: Just because we live in a monastery and we spend most of our time in prayer doesn’t mean we don’t find time for drama.

House: So, what is the sick one’s drama?

Nun: Sister Augustine lived in Catholic foster care until she came to us. [kettle whistles] Tea?

House: Sure. Do all of you lie? It’s a good strategy, simpler when you all tell the same lie, but she has not spent her entire life as a good Catholic. When she had a cardiac arrest I had to open her blouse to do CPR and I learned two things: nuns can have nice breasts, and she has a tattoo on her shoulder of a skunk. Now, maybe it’s the Sacred Skunk of Joseph, but as far as I know, Catholic foster care and monasteries do not keep tattoo parlors in their refractories.

Nun: We consider that our life begins when we put on our habits and take our vows. What happens before then –

House: Is irrelevant to you, but it’s relevant to me.

Nun: Sister Augustine went into foster care when she was six years old, but she left when she was twelve. She lived on the streets, she got into drugs. When she was fifteen, she became pregnant, tried to self-abort. She lost the child, she became ill. We took her in when she came back. If we had thought it was medically relevant we would have told you.

House: It’s not. [He takes a sip of tea, then looks at it.] This tea is delicious. Local herbs?

Cut to Cuddy and the ducklings in a hallway.]

Cuddy: Any change with medication?

Chase: Yeah, she’s getting worse. Lung function’s deteriorating, BUN and creatinine are continuing to rise. She’s starting to run a fever and the rash is spreading. At this rate she’s not going to make Christmas.

Cameron: Maybe House was right. Maybe there is an underlying condition that explains the symptoms, something we haven’t considered.

Cuddy: Like what?

Cameron: It could be a metabolic disorder.

Cuddy: Specifically?

Cameron: Mitogenetic.

Cuddy: Specifically?

Cameron: I’m just saying –

Cuddy: You’re just saying you think House is right.

Cameron: Might be right.

Cuddy: Of course he might be right! It might be the Hand of God at work. Don’t say it’s something else unless you’ve got something concrete to offer. [A teabag is thrown onto Cuddy’s paperwork, she picks it up and stares at the entering House.] What’s this, hemlock?

House: “I’m going to do you the biggest favor one doctor can do another. I’m gonna stop you from killing your patient.” It’s figwort tea. Great for that little pick-me-up we’re all looking for in the morning. Opens the lungs, increases the blood pressure, stimulates the heart. Unfortunately, if you then get injected with even 0.1 cc of epinephrine: instant cardiac arrest. Still, what the hell, it tastes great.

Cuddy: Sister Augustine –

House: Has been drinking it religiously, so to speak.

Foreman: Take the cardiac arrest out of the equation…

House: All the rest of the symptoms can be explained by a severe long-term allergic reaction.

Foreman: That’s what Cameron said in the beginning.

House: Yes, she did. Well done. [Cameron smiles.] But your unwillingness to stick by your diagnosis almost killed this woman. [No more smiles.] Take a lesson from Foreman: stand up for what you believe. Okay, let’s go figure out how to save a nun. [He leaves.]

Chase: Damned if you do, damned if you don’t.

Cut to House and the Ducklings walking to the diagnostic office.]

House: Because it’s been untreated for so long, it’s gone from a simple watery eyes, scratchy throat allergy to a whopping I’m-gonna-kick-your-ass allergy, compromising her immune system, diminishing her ability to heal and breaking down her organs systems. So, what’s the source?

Chase: The dish soap.

House: No, symptoms persisted days after the dishwashing episode. It’s gotta be something she’s been exposed to here in the hospital as well as the monastery.

Foreman: Well, what about the tea? It caused her arrhythmia.

House: Could be, but it’s not definitive.

Chase: We’ll skin test for allergens.

Cameron: Not yet, she’s too reactive. She’d test positive for everything. We need to stabilize her, isolate her from all possible allergens. Give her system a rest.

Chase: Get her in a clean room.

House: Okay. And we’ll gradually introduce allergens and see how she responds. When she reacts to something we’ll know that’s what killing her.

Cut to the ducklings helping Augustine in the clean room.]

Foreman: There you go. No television, no books.

Augustine: Not even my Bible?

Foreman: I’m afraid not. This room has filtered air, filtered water… you even have silk sheets. Very decadent and hypoallergenic. You should be feeling better here. [Foreman and Cameron leave.]

Chase: We’ll be back to check on you in a little while.

Augustine: Can the other sisters come in and pray with me?

Chase: It’d be better if you don’t have any visitors. Once we isolate what’s causing your allergy, then we can be a little more lax. [Augustine turns away from the window and starts to cry.] I can pray with you.

Augustine: I want to die. Why has He left me?

Chase: I was in seminary school. They asked us once what our favorite passage was. I chose 1 Peter 1:7. “These trials only test your faith to see whether or not it is strong and pure. Your faith is being tested as fire tests gold and purifies it.”

Augustine: “And your faith is far more precious to the Lord than pure gold; so if your faith remains strong after being tested, it will bring you much praise and glory and honor on the day of His return.”

Chase: He hasn’t left you. The only thing in the way of your knowing if he’s left you is your fear. You have a choice: faith or fear. That’s the test.

Augustine: Do you think faith doesn’t mean I won’t die?

Chase: It will affect how you experience your death, and therefore your life. It’s up to you.

Augustine: Why did you leave seminary school.

Chase: A test. You passed. I didn’t.

Cut to Cameron and Foreman talking to Pius and Eucharist.]

Cameron: We’ll call you if anything changes.

Eucharist: Will she be all right?

Foreman: As long as she’s not exposed to anything that will aggravate her allergy, she’ll be fine. [Chase comes and knocks on the window.]

Chase: Need some help in here! [Cameron and Foreman start to suit up.] Screw the procedure, she’s in anaphylactic shock!

Foreman: No way, she’s in the damn clean room.

Chase: You kidding me? Get in here! [Cameron and Foreman run in.] 0.1 cc of epi.

Foreman: Gonna have to intubate.

Cameron: I got it. [They insert a breathing tube.] I’m in. [They start to pump air.] Breathing’s stabilized.

Chase: It’s a clean room!

Cut to House and Wilson looking through the glass.]

House: How do you get an allergic reaction in a clean room?

Wilson: Maybe it was the preservatives in the IV?

House: Checked that.

Wilson: Latex tubing?

House: Checked that. Checked everything.

Wilson: Well, it could be mast-cell leukemia. It can cause anaphylaxis.

House: Checked the blood levels. And it’s not eosinophilia or idiopathic anaphylasix.

Wilson: Maybe it’s just divine will.

House: It’s not my will. [takes a couple of Vicodin]

Wilson: You do realize if you’re wrong, about the big picture that is, you’re going to burn, right?

House: What do you want me to do? Accept it, pack it in?

Wilson: Yeah. I want you to accept that sometimes patients die against all reason. Sometimes they get better against all reason.

House: No, they don’t. We just don’t know the reason.

Wilson: I don’t think the nuns would agree with you on that.

Cut to House, pacing in his office. Cameron knocks on his office door and enters.]

Cameron: I just wanted to say that I know that you did everything you could.

House: I don’t need verification from you to know that I’m doing my job well. That’s your problem, not mine.

Cameron: I was just being nice.

House: Yeah, well, you don’t need to always do that. [pause]

Cameron: Merry Christmas. [She hands House a present. Chase enters.]

Chase: Sister Augustine’s been extubated.

House: Good.

Chase: She’s requested to check out against medical advice. She wants to go back to the monastery.

House: Well, talk her out of it.

Chase: I think I may have talked her into it.

Cut to House entering the clean room.]

House: Room’s paid up for the rest of the week. You might as well stick around.

Augustine: This illness is a test of my faith. If it’s His will to take me, it doesn’t matter where I am. I can accept that.

House: Does anybody believe anything you say? You’re not accepting. You’re running away. Just like you always do. You ran away from the monastery, you get laid, you ran away from the real world when getting laid didn’t work out so good. Now things aren’t working out again, so off you go.

Augustine: Why is it so difficult for you to believe in God?

House: What I have difficulty with is the whole concept of belief. Faith isn’t based on logic and experience.

Augustine: I experience God on a daily basis, and the miracle of life all around. The miracle of birth, the miracle of love. He is always with me.

House: Where is the miracle in delivering a crack-addicted baby? Hmmm? And watching her mother abandon her because she needs another score. The miracle of love. You’re twice as likely to be killed by the person you love than by a stranger.

Augustine: Are you trying to talk me out of my faith?

House: You can have all the faith you want in spirits and the afterlife, and heaven and hell, but when it comes to this world, don’t be an idiot. ‘Cause you can tell me you put your faith in God to put you through the day, but when it comes time to cross the road, I know you look both ways.

Augustine: I don’t believe He is inside me and is going to save me. I believe He is inside me whether I live or die.

House: Then you might as well live. You’ve got a better shot betting on me than on Him.

Augustine: When I was 15, I was on every kind of birth control known to man, and I still got pregnant. I blamed God. I hated Him for ruining my life, but then I realized something. You can’t be angry with God and not believe in him at the same time. No one can. Not even you, Dr. House.

Cut to a hallway. Wilson meets up with House.]

Wilson: How’d it go?

House: She has God inside her. It would have been easier to deal with a tumor.

Wilson: Maybe she’s allergic to God.

Cut to House walking down the hall with the ducklings in tow.]

House: We looked everywhere for an allergen that could be causing this reaction except one place: inside her.

Foreman: On her medical history she didn’t mention any surgery.

House: She had one.

Cameron: Can we get her records? What hospital was it at?

House: She didn’t have it at a hospital. Order a full body scan.

Chase: What if she refuses?

House: Tell her I’m looking for a miracle.

Cut to the imaging center.]

Foreman: No piercings, no fillings, no surgical pins in the arm, no implants…

Chase: It’s clean as a whistle. What’s House looking for? [Foreman shakes his head, and then squints at the screen.]

Foreman: What is that?

Chase: Don’t know.

Foreman: Lock on it. Get a 3D representation. [The image shows a piece of metal in the form of a cross.]

Cameron: Oh my God!

Cut to House, looking at the xrays.]

House: The copper cross, a form of birth control pulled off the market in the 80s.

Foreman: So, she’s allergic to copper.

House: Rare, but it happens.

Chase: Wouldn’t she know she had an IUD?

House: She had an abortion. IUD must have been left in, embedded in the endometrial tissue where it couldn’t be detected.

Chase: So, all we have to do is remove the IUD –

cut to Chase talking to Augustine]

Chase: -- and the symptoms should subside.

Augustine: I got this IUD when I was fifteen. It’s been more than twenty years.

Chase: Prolonged exposure to an allergen with minimal symptoms. But at some point, all it takes is one last contact to cause a full-blown reaction. It’s like a balloon filled with air. One last breath, it explodes.

Augustine: The first time I got the rash was when I was washing the copper cookware.

Chase: And all your subsequent symptoms came from ingesting food prepared in it.

Augustine: Dr. House found his miracle.

Chase: I doubt he’ll interpret it that way.

Augustine: You told me your favorite passage. Would you like to hear mine? [Chase nods]. “Celebrate and be glad, for your brother was dead and is alive again.”

Chase: The prodigal son.

Augustine: He’ll be waiting for you when you’re ready.

Chase: We’ll schedule your surgery for tomorrow.

Cut to the clinic desk. House is again throwing candies. Wilson enters and sits next to him, giving him coffee.]

Wilson: The sixth circle of Hell.

House: Confined in a sweat box with a bloody nose and all the tissues are soggy.

Wilson: I think that’s the seventh.

House: Nope, seventh is –

Wilson: God, we must be fun at parties.

House: I think we both know the flaw in that theory.

Wilson: How’s the Sister?

House: Kidneys functioning, heart rate is normal. You know how it is with nuns: you take out their IUDs and they bounce right back.

Wilson: Great.

House: Told you I didn’t screw up.

Wilson: You screwed up.

House: I gave her 0.1 cc of epinephrine.

Wilson: Yeah, and if Cuddy hadn’t taken you off the case, you would have killed her. [small pause] You want to come over for Christmas dinner?

House: You’re Jewish.

Wilson: Yeah, Hanukkah dinner. What do you care? It’s food, it’s people.

House: No thanks.

Wilson: Maybe I’ll come to your place.

House: Your wife doesn’t mind being alone at Christmas?

Wilson: I’m a doctor, she’s used to being alone. [House raises his eyebrows.] I don’t want to talk about it.

House: [quickly] Neither do I. [Cuddy enters.]

Cuddy: You did good with the nun. Congratulations.

House: Thank you.

Cuddy: Merry Christmas, Dr. House. Dr. Wilson. [She leaves.]

Wilson: Good night. That was sweet.

End montage. “Silent Night” is being played on the piano. Starts with House and Wilson, sitting in House’s place eating Chinese food, talking and laughing. Cuts to the hospital Christmas party for the sick kids. Foreman is dressed up as Santa. Cuts to House, now alone, playing the piano. Cuts to Cameron, in her office with a Christmas present. Snow is falling in the background. Cuts to Cuddy, who is tending a patient. Back to House on the piano. Cuts to the hospital Chapel service. The four nuns we’ve met are present. Chase is watching through the windows. Final shot of House at the piano.]

[Over and out. – Marisol]
Tags: season 1

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  • And So It Ends

    The show, not the community. Clinic_duty shall remain right here (and if LiveJournal disappears we'll find another place to post the transcripts.)…

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    Announcement from HOUSE Executive Producers David Shore, Katie Jacobs and Hugh Laurie by House on Wednesday, February 8, 2012 at 5:32pm · After…

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