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House MD - 3.17 Fetal Position

Originally Aired: Apr 3 2007

Written by: Garret Lerner & Russel Friend
Directed by: Matt Shakman

Transcribed by: Jane (poeia)


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.




[Setting is an industrial-type loft. Loud music in the background. The wooden gate on the freight elevator is pulled up and Emma enters.]

Emma: Hey. [She removes her shoulder bag and hands it off as she walks through the room.]

Tyson Ritter: You got this whole thing wrong, Em. It’s the rock star that’s supposed to be late, not the rock star photographer.

Emma: Sorry. Morning sickness. Touch the belly.

Tyson: It’s the first time I’ve been asked to do that.

Emma: Come on. It’s good luck. [As he does a two-handed feel of her very pregnant belly in several positions, Emma calls to assistants.]

Tyson: Mmm. Ooh

Emma: Get the keynotes behind the drop. [Lights come on in back. Guitar is slung over Tyson’s back.] So, what do you think?

[He looks behind him at the set. It is a wall of an old-fashioned schoolhouse, very Norman Rockwell. There is a green chalkboard with “The All-American Rejects” heavily chalked on it.]

Tyson: Uh, I think people aren’t going to get it.

Emma: Come on. All-American Rejects. Juxtaposing a classic image of Americana with modern pop culture. You.

Tyson: Oh, yeah. Everyone loves a good juxtaposition. My fans were born in the 90s.

Emma: You know what? You do this picture, you’ll gain forty years of fans.

Tyson: Yeah?

Emma: Yeah.

Tyson: Love the Rockwell thing.

Emma: I thought so. Okay. Kill the house lights. Let’s go. [She starts taking pictures.] Hang on. Hey. Who’s in charge of the backdrop? Naomi!

Naomi: Yeah?

Tyson: [looks behind him] What’s wrong with it?

Emma: Uh, well the words are completely jumbled. [He looks again.] What? You can read that?

Tyson: Of course. You okay?

Emma: No. Oh, God. [She puts camera down and the background music stops.] I could be having a… a… What’s the mnemonic? Uh… F. F is for face. Is my smile crooked? [She smiles at Tyson. Her lower lip is drooping on the left side.]

Tyson: What are you doing?

Emma: A. A is for arms. Arms. [She puts her arms in front of her. One tilts up, the other down and she starts leaning backwards.]

Tyson: You should really sit down. Can somebody get her some water. [His voice has a bit of an echo. As the scene goes on, the echo gets louder.]

Emma: S. S is speech. I’m slurring. I’m slurring? Huh. Oh! [Tyson puts down guitar and turns back to Emma.] Oh. F-A-S-T. T is time. Hurry, somebody, uh. Call 911. Tell them I’m having a stroke. [She falls flat on her back and lays there. Everyone rushes around her.]

[Cut to opening credits]

[Cut to Emma’s hospital room. House is standing in doorway. He inhales loudly.]

House: Hi. I’m Dr. House. My boss says you’re important. [Slides door closed.]

Emma: Oh.

House: Personally I don’t get what’s so hard about making Scarlett Johansson look pretty. Arms out in front of you. [She does so while he gets an otoscope out of a drawer on the other side of the room.] With your palms up, like you’re holding a pizza. Close your eyes.

Emma: It’s so easy, you should consider a career change. Probably make a lot more money. [With her eyes closed, her right hand starts turning inward.]

House: Dr. Mackman tell you the clot was clear?

Emma: Yes.

House: And he said you and the fetus are fine.

Emma: Yeah.

House: He didn’t mention your pronator drift.

Emma: What’s that mean?

House: It means Mackman is an idiot. [He sighs and gestures to the side of the bed.] May I?

Emma: Yeah. [He moves her camera out of the way so he can sit on the bed.]

House: So. You take thousands of photos of someone but only one has to look good. Kind of the opposite of my business. [He is checking her eyes while they talk.]

Emma: It’s not about looking good. People are always hiding things. I just keep shooting until I can see what’s really inside them. My eyes okay?

House: Eyes are gorgeous. Vessels don’t look so hot. Micro-aneurysms predict further strokes.

Emma: This is going to happen again?

House: Unless I can figure out the underlying cause. Puff up your cheeks. [She does and he taps them. They deflate with a slight popping sound.] You should be able to keep the air in. It means there’s weakness around the mouth. So, where’d you learn to self-diagnose a stroke?

Emma: Oh, my uh… baby’s biological father is a neurologist. He once told me the FAST mnemonic could save my life one day so –

House: Interesting pet name. Most people go with “husband” or “pookie.”

Emma: He’s gay. Just a sperm donor. So when you –

House: You turned him for a night? Just straight for one date?

Emma: Okay. He took a magazine and a cup into my bathroom.

House: A man after my own heart. Different magazine, obviously. [Emma smiles.] I’m rescinding Mackman’s discharge order. My lackeys will be in to do some more tests, take some more blood and empty your catheter bag. [She has started taking pictures of him. He glowers slightly.] Not a moment you’ll want to cherish. [He holds up catheter bag which contains a dark red liquid. She stares.]

[Cut to three fellows studying something.]

Foreman: This is… definitely different.

[We see they are staring at a black & white, 8x10 glossy photo of House clipped on a light board.]

Chase: It looks almost like –

Cameron: He’s caring. [House enters, walks to picture and pulls it down.]

House: Find anything else in the patient’s folder? Like a diagnosis?

Foreman: Urinalysis revealed excessive protein and red blood cells. Chem panel showed a creatinine level over 2.5.

House: So first she strokes, now her kidneys are shutting down. Why?

Chase: Ultrasound showed no tumors or stones, no signs of fetal distress, no urinary tract obstructions.

Cameron: BP is fine. No preeclampsia.

House: Any of you guys ever been to the Galapagos?

Foreman: Was our patient there? Dengue fever, avian pox. Even West Nile.

House: No. I’m looking for a vacation spot.

Chase: That mean we get vacation?

House: How would that differ from your current status?

Cameron: You’re going to do what? Relax?

House: Visiting family. My uncle’s a giant turtle.

Cameron: What if the kidney failure came first? Kidneys could have caused the stroke, not the other way around.

House: Kidneys don’t often get stuck in the brain.

Cameron: I’m saying it threw a clot. Early symptoms of kidney failure are nausea, vomiting, swelling. She could have mistaken it for morning sickness.

House: Heart’s way more likely to throw a clot than the kidney.

Cameron: Echo’s normal. The history indicates no sign of cardiac problems.

House: No, but if one were to read the history closely, one would have noticed that she had six cases of strep.

Foreman: In her throat. That’s the one about 10 inches above the heart.

House: Let me rephrase. Six cases of untreated strep.

Cameron: She was prescribed antibiotics.

House: No one takes them all. They stop when they start feeling better. All strep is untreated strep. What happens when strep goes untreated?

Chase: It leads to rheumatic fever.

House: Which leads to, Cameron?

Cameron: Mitral valve stenosis.

House: Which is a thickening in the valve of the…kidney? No. The kidney doesn’t have a mitral valve.

Foreman: We’ll go look at the heart. [The fellows start to leave. House calls after them.]

House: It’ll be easy to find. It’s the big, red pumping thing about ten inches below her throat.

[Cut to MRI room. Emma is on the table, Chase and Cameron sit behind the computer screens.]

Cameron: That was weird.

Chase: He was the way he always is.

Cameron: Which is weird. [Into microphone] Stay still, Emma.

Emma: Sorry.

Cameron: No problem. [She click microphone off.] He caught us with your hand up my shirt. He’s gotta have a reaction to that. You think that’s what the vacation is?

Chase: Yes. The pain of losing you is obviously forcing him away. Coronal slice appears normal.

Cameron: There’s no way House just lets this slide. He’s gotta be planning something.

Chase: Maybe he just doesn’t give a crap. Sagittal slice is clean.

Cameron: You think he just stumbled into that closet? He knew we were there. And he wanted us to know that he knew.

Chase: Or, you wanted him to know. Now he does and you’re annoyed because he doesn’t care. [He double clicks a computer key.] Right there. Transaxial slice. Calcified mitral valve.

Cameron: Barely. That’s not big enough to throw a clot.

Chase: Obviously it is because it did. House was right.

[Cut to treatment room. Cameron and Chase are wearing blue lead aprons and are setting up a procedure. Emma is on the table.]

Chase: The valve in your heart is narrowed. It caused the clot which led to your stroke and the reduced circulation caused the problems with your kidneys.

Emma: And this’ll fix it?

Cameron: The balloon will force the valve back open and you’ll be fine. [Cuddy quietly slides open the door.]

Emma: Can I do this without a sedative.

Chase: It’s really very mild. There really is no risk to the fetus.

Cuddy: We’ll monitor the baby’s heart rate separately. We won’t allow it to decrease anywhere near dangerous levels. {She turns on second monitor which shows a heart rate of 208.]

Emma: Thank you.

Cuddy: You’re both going to be fine. Go ahead, Dr. Cameron.

Emma: [As Cameron injects dye into shunt.] Listen to that heartbeat… Sounds so –

Cuddy: Start threading the catheter.

[As Chase inserts the catheter, cut to CGI of catheter pushing things open.]

[Cut to House’s office. He is standing behind his desk, on the phone.]

House: I don’t want a layover in Frankfurt, Taipei, Singapore or London, Ontario. That’s why I asked for a direct flight to Phnom Penh. [To fellows who have entered] How hard is it to not land? [Back to phone] Does it matter what I answer? Well then, fine, I’d be delighted to hold. [Back to fellows] What’s new?

Cameron: Can you tell Cuddy to stop interfering?

House: It’s her job. What’s new?

Chase: The good news is Emma’s heart is fixed. The bad news is it’s not her underlying problem. Her kidneys are still failing.

Foreman: You’re vacationing in Cambodia? You’re going to unwind in the killing fields?

House: Nope. Gonna catch me a fish this big. [He holds his arms very wide.] Mekong giant catfish weighs over 600 pounds.

Foreman: Aren’t those catfish critically endangered?

House: That’s why it’s my last chance to catch one. [He puts phone on speaker and replaces it in cradle. “All of our operators are currently…”] If the mitral valve had been fixed, the kidneys should be getting better which leads us to the conclusion that you screwed up the procedure.

Cameron: Or you screwed up the diagnosis. Mitral valve thickening was so insignificant it probably wasn’t the cause of the kidneys or the stroke. Probably never would have been a problem.

Foreman: She needs dialysis. And we need a new theory.

Chase: There are only a few possibilities. Patient’s pregnant. It could be preeclampsia. We eliminated it before because –

House: Check for proteinuria and low platelets. What else?

Cameron: Hypoperfusion. The fetus is basically a parasite, stealing nutrients, minerals, blood.

House: Put her on telemetry.

Foreman: Or the pregnancy’s irrelevant. Could be infection, sepsis, HUS/TTP –

Chase: A cholesterol embolism is just as likely. Tiny particles of cholesterol rain down, clog up the small vessels in the kidneys.

House: Get a smear and ultrasound her vessels for plaque.

Cameron: That’s it, has to be one of those five.

House: You know what would be even better? If we could narrow it all the way down to one. [They fellows leave in unison.]

Phone: Thank you for holding. [House grabs receiver.] We are experiencing extremely high call volume. Thank you for your patience. [House hangs up.]

[Cut to CGI of Emma’s blood.]

Cameron: [Looking up from microscope and turning to the others.] She’s 0 for 5.

House: Either the differential was wrong or she’s faking it.

Chase: Kidney failure has to be precipitated by –

Foreman: By one of the five we’ve already ruled out.

Chase: The body only has so many ways of screwing with the kidneys. The labs must be wrong.

Foreman: We did the labs. No one else had access.

House: That’s not quite true. [He exits.]

[Cut to House entering Emma’s room.]

Emma: [Through oxygen mask] You put all your patients through this many tests or just the important ones?

House: [Bending down and picking up a piece of clothing from the floor] We wanted to explore all the possibilities.

Emma: And?

House: We’ve eliminated all the possibilities.

Emma: You’re telling me I’m dying and you have no idea why?

House: Your body is functioning properly.

Emma: So why are my kidneys failing?

House: The other body isn’t. There’s something wrong with the fetus. [Emma looks at him and tightens her mouth.]

[Commercials]

[Emma lies on her bed as House begins to talk in voice over. Cut to Diagnostics Office.]

House: Welcome to the world of maternal mirror syndrome. [As he pulls back to underline it, we see that he has written RORRIM except the Rs are reversed too.] Mom’s body is like an intricate German metro system. All the trains run on time. When she gets pregnant, it’s like a new station opening in Dusseldorf. A bunch of rookies running things, bound to be mistakes. Kids play on the tracks, get electrocuted. Before you know it, trains are backed up all the way to Berlin and you’ve got a bunch of angry Germans with nowhere to go. And we all know that ain’t good for the Jews.

Chase: Who are the Jews in this metaphor?

House: A few things can happen to a fetus in distress. It can become a miscarriage, stillbirth, very sick baby or, on rare occasion, a time bomb that kills mom while it’s dying. The good news is, we fix the fetus, mom gets better. It’s the diagnostic equivalent of a two-for-one sale.

Cameron: I’ve read the outcome of mirror syndrome is almost always unfavorable.

House: Unfavorable. Is that doctor speak for “dead baby?” You think she’ll be less upset if you phrase it nicely?

Chase: We can tell her the truth – that she’ll be fine as soon as we diagnose a person who weighs about one pound. Can’t touch it, can’t ask where it hurts, can’t see it.

House: If only there existed giant machines that could look through human skin. Mirror syndrome has a limited number of known causes.

Cameron: Tacharrythmia, fetal anemia, placental chorioangioma –

House: All of which are fixable. Which would be un-unfavorable, right?

Foreman: Could also be trisomy 13, Epstein’s anomaly, an aneurysm of Galen’s vein –

House: And Dr. Storm Cloud rained all over the differential and killed the beautiful little baby. Heart’s easiest to see, easiest to fix, so let’s start there. When you did Mom’s MRI did you get a look at the fetus’ heart?

Chase: It was in the range but blurry. The fetus was moving all over the place.

House: So we need another scan.

Foreman: Yeah. We’ll just ask the fetus to lie very, very still.

House: No need. I’m going to paralyze it.

[Cut to House walking down hallway. Cuddy approaches him.]

Cuddy: You want to paralyze Emma Sloan’s baby?

House: Let me guess. Cameron.

Cuddy: Cameron and Chase both had their concerns.

House: No, Cameron had concerns. Chase just agreed with her because he didn’t want to lose his all-access pass to her love rug.

Cuddy: They’re sleeping together?

House: If by “sleeping together” you mean having sex in the janitor’s closet.

Cuddy: Here?

House: No, the janitor’s closet at the local high school. [Pumps his fist] Go, Tigercats. Do you have one of those camera-phones? Because I have a MySpace account.

Cuddy: I will deal with them after I deal with you.

House: Oh, come on. Let’s gossip some more. I’m sure she’s into bondage. [Cuddy grabs his arm and turns him to look at her.]

Cuddy: Paralyzing a one-pound baby risks damaging –

House: Not paralyzing the thing risks not getting a clean MRI of its heart. Which we need to save its life which we need to do to save Emma’s life.

Cuddy: You’re gonna need to get her consent.

House: That shouldn’t be too hard. Sign here or you and your baby both die.

Cuddy: I’m going with you.

House: Oh, good.

[Cut to House squirting gel on Emma’s belly.]

Emma: You said sedation was risky. This sounds insane.

House: The injection goes into the umbilical cord.

Cuddy: The baby won’t feel a thing.

House: Fetus! I’m lowering expectations. It works here and on dates. The benefits outweigh the risks and the paralytic will wear off in an hour. Okay?

[Emma snorts/sighs]

Cuddy: It must be easier to hear that you might die than your baby might die. But if there’s anyone I would trust to save my baby, it would be Dr. House. [Emma snorts again.]

House: [whispers] Fetus. Hold this.

[House hand Cuddy the sonogram wand as he uncaps syringe and watches sonogram as he sticks it in Emma’s belly. Cut to CGI of the fetus as the needle is inserted in the umbilical cord.]

[Cut to Ob unit. Cuddy is looking at newborns as Cameron approaches.]

Cuddy: Dr. Cameron, the MRI results back?

Cameron: The fetus’ heart is structurally sound. The problem’s with the bladder. It’s four times normal size.

Cuddy: Let me see. [She reaches for the patient folder in Cameron’s hand.]

Cameron: The bladder’s so engorged it’s taking up the whole torso, squeezing all the other organs. There’s no room for the lungs to develop.

Cuddy: [looking at film] The baby has a lower urinary tract obstruction. We can fix that by inserting a shunt. I’ll give Emma the news.

Cameron: Are you… taking over the case?

Cuddy: House won’t care. He has his diagnosis. [She starts to leave, then stops] Dr. Cameron. Dating Chase… can only end in one of two ways.

Cameron: House told you?

Cuddy: You get married and live happily ever after or somebody gets hurt and you two can’t work together and I have to fire somebody.

Cameron: I would hate to see my personal life become such a burden to you.

Cuddy: I’m telling you this for your own good.

Cameron: Well I assume you’re going to have this same conversation with Chase for his own good.

Cuddy: Chase isn’t the one who’s gonna get hurt here.

[Cut to treatment room with hyperbaric chamber. Cameron enters and knocks on the chamber window. House is inside and turns to see her. She picks up phone. He looks around, picks up the receiver inside the chamber and lies back down.]

House: There’s only room for one. Though I could scooch over.

Cameron: My social life is my social life.

House: Couldn’t agree more. What goes on in the privacy of a janitor’s closet is nobody’s business except –

Cameron: She told me to end it. Is that what you want?

House: I was actually hoping she’d fire one of you.

Cameron: What are you doing?

House: Trying to avoid altitude sickness. Couldn’t score a direct flight to Cambodia so I decided to scale Argentina’s infamous Mount Aconcagua

Cameron: Perfect, except for the fact that you can’t walk.

House: There’s a tribe of Macovi Indians who actually carry the elders up –

Cameron: You’re insane.

House: I’m an insane genius. Set the chamber to low pressure instead of high. Thinner air builds up extra red blood cells. Creates new capillaries. Few more days in here and I can save myself six weeks in base camp. Where’s my MRI? [Cameron slams down the phone.]

[Cut to Emma’s room. Cuddy has the MRI on a light board.]

Cuddy: There’s a blockage in the urinary tract. Simple terms, your baby can’t pee. His bladder is swollen and it’s crushing his lungs.

Emma: Well, can you fix it?

Cuddy: We can insert a small tube in the baby’s bladder that makes the bladder come out straight through his belly for the duration of the pregnancy. The bladder decompresses and the lungs will be able to develop normally. When the baby gets better, you should get better.

Emma: Wow.

Cuddy: First we just have to do a test to determine whether the baby’s kidneys are functioning properly.

Emma: And what if they’re not?

Cuddy: If they’re already too damaged, then there’s really nothing we can do. If this doesn’t work out, you can always try again.

Emma: Wow. I miscarried twice when I was married. After the divorce, I tried in vitro like four times before this. I’m 42. Maybe it's, uh, just not meant to be.

[Cut to Cuddy walking into her office. House is behind her desk.]

Cuddy: What are you doing?

House: Well, you’re trying to be me so I thought I’d try to be you.

Cuddy: You don’t have the cleavage for it.

House: But I have a much tighter ass. You think every day should be naked Thursday or is that an oxymoron? [She reaches over and turns off the computer monitor. He sticks out his hand for the test results.] Let me see the results of the bladder tap.

Cuddy: They aren’t back yet.

House: They’re gonna to be inconclusive.

Cuddy: You think my diagnosis is wrong?

House: Fetus doesn’t pee, amniotic fluid should be low. Mom’s level is fine.

Cuddy: Doesn’t mean I’m wrong. Could just mean we caught the obstruction early.

House: Either way, your test will be inconclusive. The urine you collected has been sitting in that fetus’ bladder for weeks. And, as my pappy always said, “stale pee is useless pee.”

Cuddy: Fine, then I’ll do another tap.

House: Just as useless. Old urine drops down from the kidney right after the first tap ‘cause it’s all backed up. Bladder tap number three will give you the freshest pee and it’s when you’ll find out if this fetus has even a fighting chance.

Cuddy: Thank you. I’ll run two more taps.

House: Since when does the Dean of Medicine run bladder taps?

Cuddy: She’s an important patient.

House: Because she takes pictures? Or because she’s you? Woman in her forties. Single. Using a turkey baster as a last gasp of motherhood. And you want to make sure she succeeds, so you’ll still have hope. Can’t be a good doctor if you’re not objective.

Cuddy: [Pushing the file at him] It’s your file.

House: I don’t want it.

Cuddy: Then why did you just say all that stuff?

House: To humiliate you.

Cuddy: You’re taking the case back.

House: I don’t want it. Your diagnosis is right. I wanna go on vacation.

Cuddy: [Shoves the file in his hand] You can go on vacation after you’ve cured her.

[Cut to Emma’s room. Chase enters.]

Chase: Good news. Fetus’ urine had appropriate levels of protein and electrolytes so its kidneys aren’t damaged.

Emma: Oh. Wow.

Chase: We’re going to put the shunt in. Your baby’s lungs should have more room to grow and your symptoms should go away.

Emma: But he’ll still need surgery? After he’s born?

Chase: That’s when we’ll remove the blockage in the ureter. You’ll be the only mother on the planet who appreciates the value of a wet diaper.

Emma: Hey, could you hand me that? [Points to camera] I’m keeping a visual memory book of this entire, surreal process and this is the best part of the story so far.

Chase: Yeah. Sure.

Emma: Thanks.

Chase: [Sees picture of Cameron on top of a pile] When did you take this?

Emma: Oh. She did the second bladder tap. You should keep it.

Chase: Oh, I see her all day at work. I don’t need it.

Emma: Maybe you want to see her after work. I’m right, right? I saw the way you look at her. [Chase picks up picture and smiles, looking at it, as Emma takes pictures of him.]

Chase: [taking the picture and leaving] Thanks.

[Emma laughs]

[Cut to OR. Doctors inserting shunt through Emma’s belly. Cut to Chase and Cameron performing ultrasound on Emma in her room.]

Cameron: Shunt is in the right position. The bladder’s starting to decompress.

Chase: No infection. Did House say anything else? About us?

Cameron: I thought you didn’t care about his reaction. Trying to make him jealous?

Chase: I like my job.

Cameron: He can’t fire you just because we’re together.

Chase: We’re not together. And House can do whatever he wants.

Emma: [breathing heavily as she wakes up] How’s my baby?

Cameron: Doing just fine, Emma. So are you.

Emma: My stomach is killing me. [She rubs her side.]

Chase: That’s not her stomach. [He leans over to check her.]

Cameron: Can you open your eyes, Emma? I just need to take a look. [She pulls open Emma’s eyelid. Her cornea is yellow.]

Emma: [She sees Chase and Cameron looking at her.] What is it.

[Cut to House’s office. All three fellows enter. House is at his computer, wearing sunglasses.]

Cameron: Emma’s jaundiced. Her liver’s shutting down.

House: [big sigh] Figures. Just booked my trip to Johnston Straight.

Cameron: I thought you were climbing Mount – whatever. In Argentina.

House: Apparently I’d have to live with the Macovi Indians for twenty years before they’d consider me an elder. [He tosses his sunglasses on his desk.] I decided to go kayaking with orca instead. No legs required.

Foreman: Can’t leave yet. Liver failure puts her case back in the unsolved pile.

Chase: Increased AST, ALT and her bilirubin’s off the charts.

House: Even fetuses lie. We diagnosed a lower urinary tract obstruction because we saw one. What if that’s not the whole story. What if the little bugger is hiding something? Real reason for the mirror syndrome. Have we looked under its bed? Have we checked its diary?

Foreman: It’s not GU. Could be the heart. Hypoplastic left heart syndrome.

Chase: There were no structural problems.

Foreman: The lungs –

Cameron: We won’t be able to get a good look until they develop. It’ll be weeks

House: She’s not going to last weeks.

Foreman: What do you want to do?

House: Maternal Mirror Syndrome has one surefire cure. Deliver the fetus.

Chase: It’s not viable at twenty-one weeks. You’ll kill the baby.

House: Fetus.

Cameron: Do semantics make you feel better? Pretend it’s not a person?

House: Can it play catch? Can it eat? Can it take pretty pictures? Who wants to tell her? [All three refuse to meet his eyes. He pushes off his desktop and grabs his coat.]

[Cut to dialysis unit.]

House: The swollen bladder was not the only problem. We can’t leave it inside you. We have to terminate.

Emma: Well, can’t you deliver him? Put him on a respiratory machine until you figure out what’s wrong.

House: We can. And it won’t matter. The fetus is still at least two weeks away from being viable.

Emma: Oh, well. I’ll suffer through this for at least two more weeks, then.

House: You’re on dialysis for your kidneys. Your kidneys can wait. They don’t make dialysis for your liver. You’re not going to make it two more days.

Emma: [thinks about this then shakes her head slightly] I’m not gonna let you kill my baby.

House: It’s killing you.

Emma: I’m not having an abortion.

House: It’s not a baby. It’s a…tumor. [She holds up her hand in a “stop” gesture.] I understand dying for a cause, sacrificing your life so your child might live. But that’s not the choice here. Either it dies or you both die.

Emma: Or you fix him and we both live.

House: I can’t fix it. I’m scheduling a D and C. [He gets up to leave.]

Emma: I won’t consent. [He stops and looks at her.] So I guess you have two days to figure it out. [He leaves.]

[Commercials]

[Cut to Cuddy’s office.]

House: Her kidneys are almost irreparable. She’s developed severe DIC. You have to force her to terminate.

Cuddy: Did you give corticosteroids to speed the baby’s lung development?

House: No! I dropped an anvil on its chest to prevent lung development. I’m trying to extinguish the human race one fetus at a time.

Cuddy: Give the lungs more time to expand so you can see inside them, see if they’re the problem.

House: My real patient is dying. Very quickly. Like I wouldn’t advise her to buy any green bananas. The fetus is nothing more than a parasite at this point. Removing it is an instant cure.

Cuddy: You’re not going to get Emma to see it that way. She’s probably already named the baby. Read him books, had conversations with him.

House: See, you get it. She’ll listen to you.

Cuddy: No.

House: You let this woman refuse to terminate, you’re helping her commit suicide. As her doctor, my recommendation is against suicide.

Cuddy: If the baby had a doctor, I think she would recommend exhausting all possibilities before taking its life.

House: Then she’d be an idiot.

Cuddy: Too bad she’s your boss.

[Cut to Diagnostics Office. Cuddy is by the white board, running the DDX. The fellows are at the table. House is seated by the wall, making a paper airplane.]

Cuddy: What if our original assumption is wrong.

House: It isn’t.

Cuddy: If we assume she doesn’t have mirror syndrome then terminating her pregnancy isn’t going to help her liver at all.

Foreman: We eliminated all other possibilities.

Chase: The fetus is hydropic and in distress. Emma’s kidneys and liver are failing. The diagnosis is solid.

House: Wow. If the ass kisser won’t agree with you, you must be even wronger than I thought.

Cuddy: Fine. Let’s assume she had mirror syndrome but we fixed it when we fixed the baby’s bladder. That means that her failing liver would be completely unrelated. If it is, we can fix it. And we don’t have to terminate.

House: So her theory is that our patient’s liver problems were just a giant coincidence.

Cuddy: It’s not a surprising coincidence. Pregnant women can develop liver problems. If this is the case, we can actually do something here. Don’t you guys think that’s worth exploring.

Cameron: Acute fatty liver of pregnancy would have the same symptoms.

Cuddy: Thank you.

House: Brown-noser.

Chase: Viral hepatitis. HELLP syndrome.

House: Oh look. Sticking up for your girlfriend. Who says chivalry’s dead?

Foreman: He’s not joking? [Cameron gives him an exasperated sigh.]

House: Be patient. She’s going through all of us. She’ll get that jungle fever eventually. [Cameron glares at House.]

Cameron: I’m not going through anyone.

House: You love him? [Chase and Cameron each give him a look.]

Cuddy: This can probably wait until after we biopsy Emma’s liver, right?

Foreman: We can’t. Her platelets are too low. Once we pierce her liver, it will be next to impossible to stop the bleeding.

Cuddy: Come in from above. Instead of going straight in through her abdomen, go in through the veins in her neck. Transjugular hepatic biopsy. If the liver starts to bleed, it will bleed right back into her own veins. [The fellows leave. House flies his airplane. It hits Cuddy who looks at him. He looks away, innocent.] Why don’t you start your vacation now?

[House leaves.]

[Cut to Chase and Foreman doing the biopsy.]

Chase: Threading the guidewire through the right internal jugular vein.

Foreman: So, the sleep lab. You and Cameron not sleeping. How serious is it?

Chase: It’s nothing. She’s only doing it to make House jealous.

Foreman: Then why are you doing it?

Chase: Are you kidding?

Foreman: You’re approaching the inferior vena cava. Slow down. Better not hurt her.

Chase: She already has a big brother.

Foreman: She does?

Chase: You obviously care very deeply about her.

Foreman: I’m not protecting her. I’m protecting myself. A heartbroken, lovesick Cameron would be even more unbearable than she is now. You’re through the hepatic vein.

Chase: Firing the needle. [One of the machines starts beeping quickly.]

Foreman: Heart rate and BP spiking. Get that out of her.

Chase: Fetus’ heart rate just dropped to 50. [CGI of fetus.] We’ve got contractions.

Foreman: Pre-term labor. Start a terbutaline drip.

[Cut to Cuddy in her office, playing with a hair scrunchy. The fellows enter.]

Chase: We were able to control the pre-term labor with tocolytics. The contractions have subsided, for now.

Cameron: And the biopsy was negative. This is definitely mirror syndrome. Her baby’s doing this to her.

Foreman: We’re out of options.

Cuddy: Did the biopsy cause the pre-term labor or did it happen on its own?

Chase: It doesn’t make a difference.

Cuddy: Pre-term labor can be a new symptom. New information gives us new theories. Isn’t that how it works?

Foreman: Not in this case. Her body’s trying to do what you refuse to – get the baby out and save itself.

Cameron: The patient’s transaminases are ten times normal. Her liver’s on the verge of shutting down completely.

Cuddy: A torch test could –

Foreman: We don’t have time for more tests. We have to terminate or she’ll die.

Cuddy: Then let’s work faster.

Cameron: Medicine doesn’t work faster just because you hope real hard.

Cuddy: But it could help to see what the baby’s been hiding. The only organ we haven’t been able to look inside is its lungs. The problem must be in there.

Chase: We haven’t been able to see inside because they’re underdeveloped. We’ve already got her on corticosteroids but it’ll take weeks for them –

Cuddy: Then let’s drown them in corticosteroids. Multiple courses. Speed up their development.

Foreman: Giving the baby more than one course will suppress adrenal gland function.

Chase: Have long-term adverse effects on fetal organ development.

Cuddy: Worse than death?

Cameron: Emma’s already on tocolytics. The combination could put her into pulmonary edema. You’ll just kill her faster.

Cuddy: It’s the only chance we have to see inside those lungs. We’re just going to have to make the baby better faster than we make Emma worse. [They look at her.] Come on. This is the kind of thing House does every day.

Foreman: House thought we should terminate six hours ago.

Cuddy: I’ll do it myself. [She leaves, pulling her hair into a ponytail with the scrunchy.]

Cameron: Anybody going to stop her?

Chase: Stopping the madness is her job.

Foreman: Somebody’s got to be Cuddy’s Cuddy.

[Cut to Emma’s room. Cuddy is injecting something in Emma’s IV port. She flips a switch and an alarm starts beeping.]

Cuddy: Nurse! [Wilson enters.]

Wilson: Pulmonary edema?

Cuddy: Who tattled? Doesn’t matter.

Wilson: There’s a reason we don’t give multiple courses of corticosteroids.

Cuddy: Gee, thanks.

Wilson: It’s time to terminate.

Cuddy: That’s not what she wants.

Wilson: Look at her. She didn’t want to be an incubator for a dead baby, but that’s what you’ve done.

Cuddy: Either get me a laryngoscope or get out. [Wilson leaves. Cuddy and two nurses continue working on Emma.]

[Cut to PPTH exterior, night.]

[Cut to House’s office. Cuddy enters. She walks to his desk and picks up his oversized tennis ball, tossing it back and forth between her hands a few times. She then bounces it and it bounces away. She rubs her face, apparently in frustration and/or exhaustion.]

[Commercials]

[Cut to Wilson’s office. He is doing paperwork. Cuddy comes in and closes the door behind her.]

Cuddy: You were right. You were all right. Now the mom’s lungs are shutting down. [She sits.] She’s dying faster than the baby’s lungs are developing. I had to stop the corticosteroids.

Wilson: Have you spoken to the family?

Cuddy: The only family she’s got is that baby.

Wilson: Well, he’s biased.

Cuddy: What do you think House would do?

Wilson: House wants to terminate.

Cuddy: I know. I mean if he didn’t. If he shared my position. What do you think he would do?

Wilson: He wouldn’t share your pain. He’d be objective.

Cuddy: Right. He would prioritize his problems. [She stands and heads toward door.]

Wilson: He’d terminate.

Cuddy: He wouldn’t be afraid of screwing with her lungs if there was a bigger issue.

Wilson: There is no bigger issue. She needs her lungs.

Cuddy: Not right now. She’s already on a respirator. The machine is breathing for her. I can do whatever I want to her lungs. If you’re playing catch in the living room and you break your mother’s vase you might as well keep playing catch. The vase is already broken.

Wilson: Yeah, except that room can’t breathe without that vase.

Cuddy: [leaving] I’m putting her back on corticosteroids. [She leaves, slamming door. Wilson sighs.]

[Cut to House at home. There is a banging on the door. He opens it and Cuddy is there.]

Cuddy: It worked.

House: What worked?

Cuddy: I got the baby’s lungs to expand. We should be able to figure out –

House: Cab’s on its way. I have to finish packing. [He starts to close the door. She pushes it open.]

Cuddy: I have a whole new appreciation for what you do. How hard it is to believe when everyone around you is telling you that you’re wrong.

House: Helps to know they’re idiots.

Cuddy: Do you think I’m an idiot? [She pulls out an x-ray.]

House: You’re not objective. But you’re not an idiot. [He takes the film and holds it to the light.] His lungs are still two weeks away from being viable.

Cuddy: But big enough for a diagnosis.

House: These tissue buds are new. Could indicate bronchopulmonary sequestration or diaphragmatic eventration.

Cuddy: I was thinking bronchogenetic cysts or bronchial atresia.

House: Could be lung lesions. CCAM.

Cuddy: What about – [House has slammed the door in her face. She stands there for a few seconds, apparently in shock when the door reopens. House has put his jacket on.]

House: Move. [He motions for Cuddy to back up so he can lock the door.]

[Cut to Diagnostics Office. The fellows are all there. Cameron is pouring a cup of coffee. House and Cuddy enter.]

Cameron: I thought you started your vacation.

House: Somebody had to save our boss’ rotundous ass. Latest MRI of the Sloan fetus.

Foreman: Small buds in the lungs could indicate –

House: Thanks. Got that multiple choice all worked out. The question is, how do we pick between A, B, C, D and “none of the above.”

Cuddy: Portable MRI’s in her room. We could get a current image –

Chase: Fetal lungs are so tiny an MRI won’t give us the details we need.

House: What would we do if this patient were not just a tadpole. Say it was an actual person.

Cuddy: He… is a person.

House: Thanks for playing along. Pretend that it’s a one-pound adult. Forget the mom, forget the womb, the placenta. How would we get a better look at what’s in the lungs?

Cameron: Transesophageal echo.

Chase: Can’t access his esophagus.

Foreman: Higher resolution CT could give us a clearer –

Chase: Too much radiation for a one-pound person.

House: [Makes whining “eheheheh” sound.] You can’t just shoot everything down, Chase. You’re not me. Collaborate.

Chase: A ventilation perfusion scan would be next. [Foreman looks like he’s about to shoot that one down.]

House: How do we get a fetus to breathe in a radioactive isotope? Idiot.

Chase: If it were really a person and we had no other options, we’d do an exploratory surgery. Cut into his chest and have a look around.

House: Let’s do that. [He starts to leave, stopping next to Cuddy.] You’re the one who insists we treat it like a person. I’ll put it back when I’m done. [He leaves.]

[Cut to Emma’s room. She has a ventilator mask on. House enters, followed by Cuddy.]

House: Me again. Your friendly neighborhood belly-squirter. [He hangs his cane from the IV pole and opens Emma’s gown over her belly and sits in bedside chair.] We’re going to do open fetal surgery. Open the uterus cut out the fetus so we can look around. I know you can’t talk so I need you to look petrified if you consent.

Cuddy: The umbilical cord won’t be cut. During surgery your body will basically serve as the baby’s heart-lung machine. We find what’s wrong and we fix it. If we can.

House: [out of corner of his mouth but at regular volume] Don’t lower expectations if you want them to do something.

Cuddy: She should know what she’s facing. [House is doing ultrasound of baby.] This is incredibly dangerous. It risks both your lives. The only reason why we’re suggesting it is because there’s nothing else we can do.

[House turns ultrasound monitor to Emma. She looks at it and tears drip from her right eye. She looks back at Cuddy and House and nods. Close-up of monitor with baby’s face clearly recognizable.]

[Cut to OR. House is gowned, gloved and masked.

House: You all here for the fetal surgery? Because we are way over capacity.

[Cut to balcony where Wilson, Foreman, Chase and a couple of extras are observing. Periodic shots of balcony during surgery but the main focus is on the OR.]

House: Mind each other’s personal space. There are sharp implements in the room. Like this one. [He holds up scalpel and starts to incise Emma’s belly.] Uterus is fully exposed.

Surgeon: And we’re in. Start draining the amniotic fluid.

[Resident inserts suction tube at top of womb. Slight sucking noise.]

House: Have you never sucked beer out of the bottom of a keg? Where’d you go to college? Gimme that.

[House inserts tube all the way in. Louder suction noise and he finishes quickly. As Cuddy, who is also suited up, watches, the baby’s hand falls out of the opening in the womb and lands on House’s left forefinger. The hand is about the size of the first joint of his finger. He raises his hand slightly and the baby’s hand moves, the fingers curling slightly around his finger. He touches it with his thumb. ]

Cuddy: Affix the pulse ox to the palm. [He continues to look at the hand and stroke it with his thumb.] House.

House: Sorry. I just realized I forgot to TiVo “Alien.” [He attaches paper, presumably the pulse ox, to the baby’s hand.]

Cuddy: Fetal heart rate good, stats are stable.

House: Position him for the incision.

Surgeon: All right, I see three well-defined lesions. It’s definitely CCAM. I should be able to resect them. [Monitor starts beeping.]

House: It’s the mom. She’s in V-fib.

Cuddy: [grabbing paddles] Charging. Clear.

Surgeon: I’m clear. [Cuddy shocks Emma. Everyone looks at monitor.]

House: Looks like asystole. Paddling’s not going to do anything.

Cuddy: It’s fine V-fib. I’m going again. [Monitor still flat.]

House: We’re going to lose them both. Clamp! The surgery’s not doing this to her, the fetus is. [He starts to clamp the umbilical cord.]

Cuddy: Step away, House. I’m going again.

House: The only way to save her is to cut away the anchor holding her down. [He starts to cut the cord.]

Cuddy: You keep going, you’re going to get electrocuted. [He jumps back just as Cuddy shocks Emma again.] Going again. Clear. [And again. The monitor starts beeping normally.]

Surgeon: Heart rate’s returning to normal.

Cuddy: Continue with the lobectomy. [Cuddy and House look at each other.]

[Cut to PPTH exterior, night.]

[Cut to Emma’s room. House is examining her.]

Emma: So my kidney, liver and lungs are all fine, just like that?

House: Just like that.

Emma: That’s amazing.

House: What’s amazing is how blond your baby’s hair is.

Emma: [laughing] My baby?

House: You know, the thing in your belly that tried to kill you.

Emma: You’ve never called him a baby before.

House: [stares at her] Any pain?

Emma: Nothing I can’t deal with.

House: You can only get out of bed to pee, poo or shower. And absolutely no sex. So stop flirting with me. [He takes a Vicodin.]

Emma: Sorry. So this really worked. He’ll be… normal?

House: Um. If you call being born twice, normal. [He gets up to leave.]

Emma: Hey, thank you.

House: Don’t thank me. I would have killed the kid.

[Cut to Cameron putting Emma’s cameras in her bag. Chase stands in doorway.]

Chase: Wanna grab a bite?

Cameron: In a minute. Emma asked me to bring up her camera.

Chase: I’ll walk with you. [She sees the picture Emma took of Chase looking at Cameron’s picture.]

Cameron: When’d she take this picture of you? You look so…

Chase: I’m smiling. I have a nice smile.

Cameron: No. I’ve never seen you like this. She got you to… glow. What were you doing? What’d she say to you?

Chase: I always glow. [He takes the bag as they walk down the hall.]

[Cut to House walking past the clinic on his way out.]

Cuddy: House. Need you to take a look at something.

House: I’m off the clock.

Cuddy: Just open it. [Hands him envelope.]

House: [pulls something out] First class ticket to Vancouver Island.

Cuddy: Shoot. It’s the wrong envelope. [She giggles.] I think it’s great.

House: Yeah. Who doesn’t like Canadians?

Cuddy: It’s big. You’re – you’re trying to have a life. You’re trying to enjoy yourself.

House: You didn’t need to apologize.

Cuddy: I’m not. I told you why I’m –

House: You screwed up.

Cuddy: I saved a life. I saved two lives.

House: You let your maternal instinct get the best of you and nearly killed two people. In a case like this you terminate and mom lives 10 times out of ten. You do what you did, mom and baby both die 9.9 times out of 10.

Cuddy: Sometimes point 1 is bigger than 9.9.

House: No. It’s smaller. Exactly 9.8 smaller. Always is, always will be.

Cuddy: Well, not for Emma. And not for her son. Now go away. And be happy.

[Cut to House’s home. He closes door and drops keys on the table to his left and his backpack to his right. He pulls out the ticket while hooking his cane on the molding over the entry arch and leans back against the door. After tapping the ticket a couple of times, he rips it in half and tosses it by his keys. As he enters the living room, he takes off his jacket and takes the phone off the hook. He sits on the couch and picks up the TV remote which is on a pile of journals and turns on the TV. He leans back on the couch and takes a Vicodin. The program seems to be about the Galapagos Islands. House watches, rubbing his left thumb against his fingers as if remembering the feel of the baby’s hand.]

[Cut to some point in the future. Emma is hanging pictures of Foreman, Cameron/Chase and Cuddy. The baby cries and she goes to him. Her home is the loft where the opening photo shoot took place. She picks up the baby who seems to be full term.]

End.

Tags: season 3
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  • 17 comments

  • House MD - 4.16 Wilson's Heart

    Originally Aired: May 19, 2008 Written by: Peter Blake, David Foster, Russel Friend & Garrett Lerner Directed by: Katie Jacobs Transcribed by:…

  • House MD – 4.15 House's Head

    Originally Aired: May 12, 2008 Written by: Peter Blake, David Foster, Russel Friend & Garrett Lerner Story by: Doris Egan Directed by: Greg…

  • House MD – 4.14 Living the Dream

    Originally Aired May 5, 2008 Written by Sara Hess & Liz Friedman Directed by: David Straiton Transcribed by: Jane (poeia)…