doc_on_duty (doc_on_duty) wrote in clinic_duty,

House MD - 2.09 Deception

Originally Aired: Dec 13 2005

Written by: Michael R. Perry
Directed by: Deran Sarafian

Transcribed by: Mari (musikologie)

Betaed by: Heather (nozenfordaddy)

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: A snowy Off-Track Betting parlor.]

Race announcer: …Calamari is still in the lead but Ample Parking is making strides he is now in fourth, third, and holding second place while Blue Calamari is at a steady speed… [Camera pans to see House watching the monitor.] …And down the stretch they come! Ample Parking comes from behind and it’s Ample Parking by a nose! [House looks disappointed.] This is the last call for the third race. You may still wager if you hurry. Here’s your information on race number three…

House: Out of the way, cripple coming through.

Man in line in front of House: Um, sixth race at Golden Downs; I’ll take the two and the four. Hey, that’s my birthday! February 4th, 1963, you think that’s a good bet? What’s your birthday?

House: Take your time, don’t worry that there’s only thirty seconds to post.

Man: Is there any way I can bet on the six and the three also? You know, for the year? All four horses, can I do that? [A woman comes up to talk to the teller.]

Anica: He wants a $2 exactabox, 2, 4, 6, 3. Give him $24. [The man fishes for money as Anica winks at House.] Your turn.

House: Ninth at Gulf Street and Park; five hundred on the 3 horse, Seminole Uprising to win.

Anica: Might as well burn your money.

House: I’ll burn my winnings. Bigger flame.

Race announcer: Ladies and gentlemen, they’re at the post. The flag is up.

Anica: Same race. Termigator to win. [House moves to a monitor.]

Race announcer: And they’re off!

Teller: Sorry, race just closed.

Anica: Damn it! She was 14 to 1, too.

House: Well, fat ass over there just saved you money.

Anica: No way Seminole Uprising’s going to –

House: I don’t bet on the horses, I bet on the jocks. My rider’s bulimic; purges after his weigh-ins; leaves a two pound pile at the starting gate, shaves valuable time off that final eighth.

Anica: Nice to have inside information. [Anica collapses, but House is busy watching the race.]

House: Is anybody here a doctor? [Anica is seizing, and one man straddles her and prepares to start CPR.] You trying to cop a feel?

Man: I took a CPR class at the Y.

House: That would be useful if she was having a heart attack instead of a seizure.

Man: Seizure? Hold her tongue down?

House: If you want to get a finger bitten off. Call an ambulance.

Man: Methodist is three blocks down, I could drive her.

House: Just make the call. [House sees something interesting, and pulls up Anica’s shirt slightly to see very discolored stretch marks/bruises.]

Man: What the hell is that?

House: How should I know? Tell the paramedics to take her to Princeton-Plainsboro. The doctor’s name is House.

Race announcer: And it’s Termigator winning by two lengths!

[Opening credits.]

[Cut to Diagnostic office.]

Cameron: Since when does House hang out at OTB?

Foreman: The man’s an addict.

Chase: Right, but addicted to pills, not gambling.

Foreman: It’s the same thing! Drug abuse, drinking, gambling – they all fire up the same pleasure centers in the brain. An addict is an addict is –

Chase: Gambling doesn’t take away his pain. [House enters.]

House: It does when I win. [He throws a chart on the table.] Hot OTB babe, has grand mal and inexplicable bruising. What up with that?

Cameron: You were just standing there and she started to seize?

House: Spend as much time around the real people as I do, someone gets sick.

Foreman: Her platelets are 89, she’s anemic, and she has a blood alcohol level of 0.13.

Chase: Hot OTB babe? Obviously a working girl, probably an STD, infection.

House: No fever, no infection.

Foreman: Alcohol abuse explains it all. Causes seizures and affects her blood’s ability to clot, which causes bruising. Start her on heparin, she’ll be fine by morning.

House: Except for the fact that the bruises are not petechial, which means it’s not DIC.

Foreman: So the bruises were caused by trauma. She probably got beat up by a boyfriend, or a pimp.

House: What’s that called when you judge someone before ever meeting them?

Foreman: She’s a regular at OTB. Somehow I don’t see her holding down a 9-to-5 and going to PTA meetings.

House: I was there. I have a 9-to-3 job.

Cameron: It could be SLE, Familial Telangiectasia, or even Cushing’s.

House: Good. Start with those.

Cameron: Which one?

House: Cushing’s. Explains the seizure and the bruising.

Foreman: Not the anemia.

House: So she doesn’t eat a lot of meat.

Foreman: DIC brought on by alcohol abuse is far more likely. Do a full workup, H and P, and lab her up, LP, MRI – [He starts to leave.]

House: Whoa, whoa, whoa! Did you just, ever so subtly, order me to get her medical history?

Foreman: Cuddy put me in charge last week, so yeah.

[Cut to Cuddy’s office.]

House: It was a pretend “in charge”, formality to get past the suits in Legal.

Cuddy: Right, those licensing board folk love to play dress-up and pretend.

Foreman: Hey, no worries. I’ll let you keep your parking space.

House: You can have it. You’ll also need my handicap placard. Bend over.

Cuddy: Well, you make a pretty convincing argument.

House: Chase killed that woman, now Foreman’s in charge?

Cuddy: Yeah, we have a pecking order here: if Cameron kills someone, Chase takes over. There’s a flowchart in the lobby. For the next three weeks you answer directly to Dr. Foreman.

Foreman: And I expect you here for grand rounds at nine. By the way, I like sugar in my coffee.

Cuddy: [To Foreman.] If there’s a screw-up, it’s your screw-up. You won’t have Dr. House to fall back on.

[Cut to Anica, filling out the patient questionnaire.]

Anica: “Do you wear a seatbelt?” Is that really relevant to a seizure?

House: Skip it.

Anica: How about, “Were you vaccinated for polio?” I think you gave me the form intended for FDR.

House: [Looking at races.] Will I like Teeny Tiny Moe in the fifth?

Anica: I went 4 for 6 yesterday. You want winners, cure me first. “Are you generally satisfied with your life?”

House: It does not ask that. [It does, and he puts the form aside.]

Anica: You know; I was going to ask what a respectable doctor was doing in an OTB parlor. Somehow that question doesn’t seem relevant anymore.

House: What’s your excuse?

Anica: Turns me on.

House: Yeah? What else turns you on? Drugs? Casual sex? Rough sex? Casual rough sex? I’m a doctor, I need to know.

Anica: No sex; just moved here. Haven’t even found a job yet. Don’t know anybody.

House: Came here without a job. That means you didn’t move here, you moved away from somewhere else. [He pokes at the marks on her torso.] Does that hurt?

Anica: No.

House: Are you on prescription meds? Hormones? Prednisone?

Anica: I already answered that one; I think it was question number 20-something.

House: Well yeah, and I could reach down and get it, but that would kinda spoil the whole “cool move.”

Anica: I’m not on any medications.

House: You vegetarian?

Anica: No, why?

House: Because you might have something called Cushing’s syndrome, which basically means that –

Anica: My pituitary is overproducing ACTH, which is causing my adrenal glands to push too much cortisol into my bloodstream.

House: What a coincidence. I’m a doctor, too.

Anica: Yeah, I had it last year. They did brain surgery, removed an adenoma from my pituitary.

[Cut to the MRI, with a bored looking House and Anica, and a trying (and tried) Foreman.]

House: Huh? What did you just say? “You were right, House, her pituitary tumor regrew, it is Cushing’s, uncanny how you do that….”

Foreman: Actually, it was Cameron’s idea.

House: Nope, Cameron had three ideas. I chose one to encourage, to nurture –

Foreman: Yeah, you’re all about the nurturing.

House: You need a hug?

Foreman: I don’t see any regrowth. You get her medical records faxed over?

House: “Work smart, not hard,” that’s my philosophy, boss.

Foreman: Take that as a no. Anica, I need you to stay completely still.

Anica: Sorry.

Foreman: Still don’t see anything.

House: Okay, so it’s a micro-adenoma, too small to see.

Foreman: So small it’s not even there.

House: Right, it’s just a coincidence that I predicted a rare condition that she happened to have a year ago.

Foreman: Results from her LP back yet?

House: Didn’t do an LP. Knew what she had. [Foreman stops the test.]

Foreman: Go do the LP.

[Cut to House, about to do the puncture, Cameron observing.]

House: Okay, I need you to roll over on your side, kiss your kneecaps.

Anica: Party time. I thought it only took one doctor to do this.

Cameron: I’m observing.

House: She’s here to make sure I don’t paralyze you.

Anica: You’ve done this before, right?

House: Successfully?

Cameron: He’s kidding. He’s an excellent doctor.

House: I’m gonna numb the area with some lidocaine, and then we’re off to the races! See what I did there? I used horse racing jargon to make the patient feel more comfortable. Okay, here we go. [He inserts the needle, Anica starts and gasps.]

Anica: Ow.

House: Felt like bone. Does that hurt?

Anica: A little bit. What are you doing? Owwww.

Cameron: Trying rounding your back a bit more.

House: You’re perfect just the way you are. Oops, that was all me.

Anica: Ow.

Cameron: You might want to move down one vertebra.

House: This is actually much harder than I remember.

Anica: Uhhh. My chest feels a little tight.

Cameron: Try taking a deep breath. Dr. House, maybe I should take it from here.

House: Eighth time’s the charm. [Anica cries out again.]

Cameron: You trying to piss off Foreman, huh?

House: Just let – [Alarm beeps.]

Cameron: BP’s 240 over 140.

House: Turn that thing off, will you?

Cameron: Take the needle out. Take the needle out!

House: Okay. [To nurse.] It’s a hypertensive crisis. Start her on IV low pressure drip, titrate to systolic less than 140, she’ll be fine. Cameron, meet me in my office.


House: At the risk of sounding redundant, and right, again, she has Cushing’s. Cushing’s.

Foreman: Right, the fact that you mangled her LP has nothing to do with it.

House: Actually, it has everything to do with it. Cushing’s plus stress equals hypertensive crisis. Smart move, sending the rookie.

Foreman: Her initial symptoms could have been caused by alcohol-induced DIC. She had a hypertensive crisis because it’s been at least six hours since she had her last drink. She’s detoxing.

House: The exact same moment that I’m futilely trying to give her an LP?

Foreman: Right, an invisible tumor on her pituitary is much more likely.

Chase: What if the tumor is somewhere else? There could be an ACTH-secreting tumor on her lung or pancreas.

Cameron: It’s awfully rare.

Chase: Not as rare as an invisible tumor.

House: Why didn’t they put you in charge instead of Foreman? Oh yeah, you’re the guy that killed that woman. Get a pan-man scan before she dies of cortisol OD. [He makes a begging, pleading face to Foreman.]

Foreman: Fine, do it. But when you don’t find anything, put her on a Librium taper for the withdrawal and get her a bed in the rehab clinic.

[Cut to Anica going in for the scan.]

Chase: Lungs look clean. Pilar lymph nodes not enlarged.

Cameron: Cuddy tapped Foreman to run the department. I didn’t even get asked.

Chase: Neither did I.

Cameron: You were suspended.

Chase: I was kidding.

Cameron: It’s the irony of women in charge; they don’t like other women in charge. [Chase scoffs.] What, you think it’s something else?

Chase: You sabotaged yourself. You went on a date with House, you slept with me. Putting you in charge of this department is like a sexual harassment suit waiting to happen.

Cameron: Yeah, they’re really worried that I’m going to create a hostile work environment.

Chase: Maybe that’s the problem. Being in charge means having to say no to House. Would you hire you for that?

[Cut to House watching monster trucks on the TV in his office.]

Foreman: You ordered MRIs for the entire maternity ward?

House: I was in a crazy mood. Good thing I got a new boss to back me up. Although I think one of those is actually necessary. Better comb through before you cancel them all. [Foreman turns off the TV.]

Foreman: What do you expect me to do, House? Quit? Cry?

House: Actually, I expect you to act like what you are, my employee, my subordinate, my bitch.

Foreman: Well, since you asked nicely…

House: My God, I can’t believe I got more than a year behind on my discharge summaries. Gotta get caught up. Oh no, wait! I’m not authorized to sign these anymore! Only you are.

Foreman: Keep it coming. I’m not gonna break. [Chase and Cameron enter.]

Cameron: Scans showed a mass on her pancreas.

Chase: Looks malignant, probably inoperable. I’d give her two months.

House: On the bright side, it still means I was right.

[Cut to Cameron entering Anica’s room.]

Anica: Where’s Dr. House?

Cameron: Dr. Foreman’s overseeing your case. He thought it’d be best if I spoke with you. We found a mass in your pancreas. It looks like cancer.

Anica: So something in my pancreas caused me to have a seizure?

Cameron: Probably, but the bigger point is a one-year survival rate for pancreatic cancer is less than 20%.

Anica: So what’s the treatment? [Eerily calm.]

Cameron: We need to biopsy the mass to see what we’re dealing with. Then we can recommend options from there.

Anica: Sounds good.

Cameron: I need your consent to do the biopsy. [Anica signs.] Thanks.

Anica: Wish me luck.

Cameron: Good luck.

[Outside shot, because this episode rams it down your throat that it is SNOWING. Cut to Cameron and Wilson.]

Cameron: It was weird. She barely reacted at all.

Wilson: I’ve had people hug me and people take a swing at me.

Cameron: This was more like she didn’t even hear me.

[Chase and House are doing the biopsy.]

Chase: Magnify three times.

Wilson: House assisting. That is funny. Too bad Foreman’s gonna die.

[Cut to House entering a clinic room, where a young woman/teenager is lying on a bed with her legs up and a sheet over her… you know where this is going.]

House: Good afternoon. I’m going to be looking at your – Perfect. Excuse me. [Picks up phone.] Need Dr. Foreman in Exam Room 1 for a consult. So when did this start?

Woman: A couple weeks ago. I didn’t want to get pregnant. Jake’s not into rubbers so I got on the jelly. You think I’m allergic or something?

House: You have an infection. Gonna need a sample.

Woman: I brought the jar.

House: No, I meant a sample of your – [He looks up to see her holding a bottle of strawberry jelly. [Oh boy.] Okay, we have a neurological problem here.

Woman: There’s something wrong with my brain?

House: Oh yeah. You can cover yourself up, got what I need. [Foreman enters.]

Foreman: What’s up?

House: Smell this. [He waves the swab in Foreman’s face.] Smells like vaginosis, but it’s not really my call.

Foreman: Great, I’ll be sure to put a gold star by your name on the board. Anica’s biopsy for pancreatic cancer was negative. [He leaves.]

House: Okay, I’m gonna give you some antibiotics, and you probably shouldn’t have sex for awhile.

Woman: How long?

House: On an evolutionary basis, I’d recommend forever.

[Cut to Diagnostics.]

Chase: The mass in the pancreas is benign; it’s probably just scar tissue.

Foreman: Good news, she’s not sick at all. Other than being an alcoholic.

House: The labs you sent yesterday put her ACTH at 64 picograms per milliliter. She’s got Cushing’s, something set it off. It’s gotta be in her brain, set her up for a venous sampling. [Chase starts to leave.]

Cameron: There is another possibility.

Foreman: Chase, hold on. [Chase stops.]

House: How’d you get him trained so fast? Electronic collar? Got treats in your pocket?

Cameron: She didn’t even read the consent form for the pancreatic biopsy.

Chase: Who reads those things?

Cameron: Maybe she didn’t read it because she knew there was nothing wrong with her. There is another explanation for the Cushing’s; maybe she injected herself with the ACTH. Her behavior suggests Munchausen’s. She’s had four hospitalizations in the last four months.

House: Well, being hospitalized a lot certainly points to nothing being wrong with you.

Cameron: She’s had zero symptoms since she got here. The scarring on her pancreas could be caused by injecting herself with a benzene and setting off the seizures.

House: She’s had brain surgery. You can fake a stomach ache; you can’t fake a brain tumor.

Cameron: You can fake an invisible one. We should check her apartment. Look for medications, syringes –

House: Venous sampling’s easier.

Foreman: And more dangerous.

House: Not if you get caught breaking in.

Foreman: So don’t get caught, House.

[Cut to the parking lot.]

Cameron: Why do you think Cuddy picked Foreman over me? Have I done something wrong or if there’s something I needed to improve on…

House: Would you shut up if I told you she wanted someone black?

Cameron: How would you describe my leadership skills?

House: Nonexistent. Otherwise, excellent.

Cameron: There’s more to being a leader than being a jerk!

House: The world will never know. [He goes to his motorbike and turns it on.]

Cameron: No, no way. It just snowed.

House: Yesterday, streets are clear. [He throws her a helmet.]

Cameron: My car is right there.

House: There’s construction on Elm. Bike will be faster. [Cameron puts on the helmet and gets on behind House.]

[Cut to Anica’s place of residence.]

Cameron: There’s even books in the bathroom.

House: Well, either she’s very smart or she has a severe fiber deficiency.

Cameron: She’s got an appointment with her ophthalmologist on Tuesday and an appointment with her gynecologist on Thursday. Multiple appointments with multiple doctors, symptom of Munchausen’s.

House: Or, just thinking outside the box, here, she has a vagina, and trouble reading. There’s three pairs of reading glasses, each with different prescriptions, which would be explained by a tumor pressing on the optic nerve.

Cameron: Because you’re looking for her to have a tumor.

House: And you are looking for… A person with Munchausen’s syndrome drinks battery acid; they don’t go to an ophthalmologist to get their pupils dilated.

Cameron: An ophthalmologist is a doctor. Attention is attention.

House: How many hospitals have you contacted? Has one doctor said she’s crazy? It’s not Munchausen’s!

Cameron: It’s not your call.

[Cut to House’s office.]

House: If you think she’s got Munchausen’s then obviously you’ve got something to show the man! A syringe in her apartment, a bottle of ACTH.

Foreman: Munchausen’s patients are good at covering their tracks.

House: Oh, right, so the fact that we found nothing proves that there’s something.

Cameron: Look at the pathology reports from the surgery she had in Chicago. They removed 30% of her pituitary, they found no tumor!

Foreman: It’s possible the surgeons just missed it. In that kind of surgery, you’re just cutting and hoping –

House: Of course! We’re both right! Excellent solution. Everybody’s happy. Come on, step up, Foreman. If you think I’m right, order me and stick a needle in her brain, and if you think Cameron’s right, send the patient home. Either she’ll be fine or she’ll die.

Foreman: Do the venous sampling. Get her consent. [Cameron rolls her eyes and leaves.]

House: Nice move, boss. Way to cover your ass.

Foreman: I just agreed with you.

House: Not because you think I’m right. You’re just taking the safe route. You’re a wuss. Don’t worry, your secret’s safe with me. [He starts to leave.] Hey Wilson, guess what Foreman just did!

[Cut to Cameron entering Anica’s room.]

Anica: Hi. [Cameron places a bottle on the tray.]

Cameron: This is a consent form to stick a wire into your brain. It’s important for hospitals to get these signed for procedures that are completely unnecessary.

Anica: Then why are you doing it?

Cameron: Because you’re mentally ill. You injected yourself with ACTH to induce Cushing’s to get attention from doctors, and so far it’s worked.

Anica: I’d like to see another doctor.

Cameron: I’m not giving you what you want?

Anica: I don’t want a bitch.

Cameron: Just sign the forms, okay, and I’ll get out of here. Hopefully for you, whatever you injected yourself with won’t wear off before you get the fun of a caring and concerned doctor cutting into your head. [Anica grabs the pen and scribbles her name. Cameron leaves. Anica eyes the bottle left on the tray.]

[Cut to Cuddy’s office.]

Foreman: You chose me to make House miserable, didn’t you?

Cuddy: Apparently, he’s making you miserable. That’s impressive.

Foreman: Find someone else.

Cuddy: No. For the first time in six years I’m getting copied on experimental tests and procedures. Clinic hours have been logged and completed. You’ve given me four months of House’s dictation so I can finally bill insurance companies –

Foreman: I only did that stuff to prove that he couldn’t make me miserable.

Cuddy: Well, way to go! Now everybody’s getting what they need, even House! He gets to play mad scientist and this department runs smoothly.

Foreman: So I’m stuck with this for the next three weeks.

Cuddy: Well, maybe longer. Would you be interested if this wasn’t just pretend?

[Cut to House’s office.]

House: What did Mommy say; I don’t get any candy in my stocking?

Foreman: Patient being prepped for the venous sampling?

Cameron: Yeah. Mentally ill patient is right on track for a pointless procedure.

Foreman: Yeah, we get your objection. [Phone rings; Chase picks it up and hands it to House who hands it to Foreman.] Foreman. Are you sure? That doesn’t make any sense, check it again. We got to delay the venous sample.

Cameron: Why, her urine turning orange?

Foreman: How would you know that?

Cameron: Because that’s what rifampin does.

Chase: She’s not on antibiotics.

Cameron: But if a Munchausen’s patient thinks she’s about to get busted, she sees pills labeled “Dangerous: Might cause seizures,” she might grab a couple. And if that label were accidentally on a bottle of antibiotics and if that bottle was accidentally left in her room –

Foreman: You set her up?

Cameron: Might have. It’s Munchausen’s. All this, she did to herself.

[Cut to House going through Anica’s files.]

[Cut to Cameron talking to Anica, who is crying orange tears.]

Anica: I don’t know what the hell you’re talking about! I had a seizure, I’m sick, I need your help!

Cameron: Not from this department. The half-life of rifampin is three hours, after that you’ll get your psych referral, and your discharge papers.

Anica: You know, just because you stick your fingers down your throat doesn’t mean the rest of us are screwed up.

Cameron: I guess when cooperation fails you move on to hostility.

Anica: I didn’t do this to myself. [Cameron leaves.]

Chase: 100% commitment. Sign of a good liar.

Foreman: Also the sign of a sociopath. What are you doing?

House: Correcting your last note. We can’t discharge her, she’s sick. Anybody ever tell you, you write like a girl?

Foreman: What? You got some other explanation for orange urine? It’s Munchausen’s.

House: Correct, but not complete.

Foreman: You just don’t wanna admit that she skunked you.

House: At the end of “The Boy Who Cried Wolf,” the wolf really does come, and he eats the sheep, and the boy, and his parents.

Chase: The wolf doesn’t eat the parents!

House: It does when I tell it.

Foreman: You’re not telling the story now, I am.

House: Look, I checked her records. All her hospitalizations were for different things. Brain tumor, fainting spells, skin rashes, seizures… she’s had every blood test known to man and the results are all over the map. There’s only one constant, low HCT. The anemia’s real.

Cameron: There’s a million things she could have taken to have done that.

House: True. Could just be her MO. She self-induces two illnesses, one always changes, one never does. Or maybe she has Munchausen’s and aplastic anemia, which would mean without proper treatment she’d continue to get sicker, weaker; eventually she’ll start bleeding internally and die.

Foreman: She’s not getting sicker.

House: She will!

Chase: If her bone marrow was dying the entire blood panel would be affected. Her white count’s normal.

House: So far. We need to do a bone marrow biopsy.

Foreman: No, no more tests.

House: Look, you kick her to the curb with a Munchausen’s diagnosis; you’re guaranteeing that no doctor will ever listen to her again.

Foreman: We do more tests we’ll only be feeding her psychosis. The more attention we give her, the more she’ll want.

House: What if she doesn’t know we’re testing her?

Foreman: House, you were wrong. Live with it.

House: There’s probably some blood left over from previous tests.

Cameron: Blood tests alone can’t confirm aplastic anemia.

House: Yes, I know. That’s why I want to do a bone marrow biopsy. But blood tests could show a systemic disease, viral or a toxin cause.

Foreman: Fine. You wanna test the extra blood, knock yourself out. But the patient is off-limits.

House: And if the results are positive? I get my biopsy? It’s the safe way to go.

[Cut to the lab.]

House: I need all of these tests and a PCR done on this sample.

Lab tech: You’re gonna need more blood.

House: Patient’s empty.

Lab tech: Then I can’t do it. [She passes the sample back to him.]

House: You can try.

Lab tech: i can try to look like Salma Hayek, that’s not gonna make it happen.

House: You may not have Salma’s ass, but she doesn’t have your eyes.

Lab tech: Yeah, right. [She looks at him and he smiles.] How soon you need it?

[Cut to Wilson’s office.]

Foreman: Dr. Wilson, can I talk to you about something in confidence?

Wilson: Of course.

Foreman: It’s about House.

Wilson: Oh, then no. [Foreman starts to leave.] Fine, I won’t say anything.

Foreman: Do you think there’s any way House would take me seriously as his boss?

Wilson: Where is this coming from? Did Cuddy say something?

Foreman: We talked. She intimated.

Wilson: And you want my advice on how to usurp him? It’s very ancient Rome; you’ll need a toga, of course, a sword…

Foreman: It’s not a coup. I just want to figure out some way we can work together. I mean, I keep the team running from an administrative point of view; House doesn’t have to deal with the red tape. It’s a win-win.

Wilson: I’m sure he’ll see it that way.

Foreman: You have any advice on how to approach him? Deal with the guy?

Wilson: No.

Foreman: But you won’t tell him we talked.

Wilson: No. There’s no way this is going to happen. [Foreman leaves.]

[Cut to Foreman in Diagnostics. House enters, singing.]

House: “See him walking down that street, so I ask you very confidentially, ain’t he sweet?” Epstein-Barr titers are through the roof, most common viral cause of aplastic anemia. So what I’m saying is, “Just cast an eye in his direction, oh me oh my, ain’t that perfection –“

Foreman: Fetal hemoglobin’s also elevated.

House: Eh, just a wee bit. Could indicate –

Foreman: Uh, you see that in sickle-cell.

House: Not all sickle-cell patients are black.

Foreman: None of her other blood panels showed any sign of sickle-cell, which means either something’s changed drastically since yesterday, or this isn’t her blood.

House: Of course it is! Metaphorically. Look, I couldn’t do the tests. I tried, there wasn’t enough blood left over. If you just let me do the biopsy…

[Cut to the hallway.]

Chase: No way, I just got back from a suspension.

House: And if it wasn’t for me, you would have been fired.

Chase: Why don’t you just get the sample yourself? Since when do you care what your boss said?

House: I don’t care what anybody says, I care what they do. Right now, Blackpoleon Blackaparte has got the nurses on red alert, I can’t get into the patient’s room. So come on, I’ll draw the enemy fire, you outflank them, get in there, get the bone marrow sample.

Chase: Can’t.

House: Who are you more afraid of?

Chase: I’m not afraid of Foreman. I agree with him, all the tests back him up.

House: All the tests have not been done. You do realize that Blackaparte’s reign is only temporary.

Chase: I also realize that no matter what I do, you’re still gonna treat me like crap.

House: Crap is a relative term.

[Cut to… Pathology, I think.]

Chase: Never even made it into the room.

Foreman: Nurses called the attending as soon as the trocar was ordered.

House: You used her real name?

Cuddy: I just processed your patient’s discharge papers. She’s on her way out now.

[Cut to Anica, trudging through the snow toward the cab.]

House: Whoa, whoa, whoa, whoa, wait up! It’s all right, she’s going to stay.

Taxi driver: Wonderful.

House: Oh, bite me.

Anica: I don’t need to hear the riot act again.

House: How’d you like another medical test?

Anica: What?

House: Sit.

Anica: Why?

House: So you don’t crack your skull when you pass out. Just do it. You know what colchicine is?

Anica: No.

House: Well, don’t feel bad. It’s for gout. It’s got nothing to do with anything you’ve ever pretended to have.

Anica: I’m not pretending to have any –

House: Shut up. Colchicine decimates your white blood cells, leaves almost no trace. Great for faking your way into hospitals.

Anica: I didn’t fake my way –

House: Shut up. You’ve been doing this for years. Don’t worry, it’s probably not your fault. When you were a kid, you had a close relative with a chronic disease, probably sister. And you saw all the attention she got while you were left alone, ignored, and it really, seriously screwed you up.

Anica: I did not have a relative –

House: Shut up! I’m trying to give you what you want, and save your life. You have aplastic anemia.

Anica: What, are you trying to scare me now?

House: It means you’re not just sick in the head. The problem is, the rest of you appears well, so I’ve got to make you seem as sick as you’re supposed to be by injecting you with a drug that simulates the symptoms that you actually have. All you need to know is, you’ve hit the Munchausen’s jackpot. I’m going to give you a cocktail of insulin for seizure, and colchicine to kill your white blood count. This will absolutely confirm my diagnosis of aplastic anemia. There is one small catch. If you’ve actually done something to yourself to cause the anemia, then I’m wrong, and if I do what I plan to do, then the treatment will kill you instead of saving you. So I need to know, have you been taking anything besides the insulin, the ACTH, and the pills Cameron left in your room?

Anica: No.

House: Good. Give me your arm. [House sticks her with the needle.]

Anica: It was my mom. She had MS. She was in and out of hospitals all the time. People were always trying to do things for her, bring her food, or brush her hair, make her happy. People cared. She died when I was 16. Then there was no one.

House: Boo hoo.

Anica: Where are you going?

House: Well, I obviously can’t be around when it happens.

Anica: Well, what are you gonna do, you’re just gonna leave me –

House: Relax. You know the drill. People walk by here all the time, you’ll be fine. [House walks back inside as Anica collapses and starts to seize.]

[Cut to Diagnostics.]

Foreman: So, barely out the door and she has another seizure.

Chase: She must have somehow grabbed insulin on the way out.

Foreman: Once she’s stable we need to get her out of here, before she does more damage to herself.

Cameron: We can’t. Her white count’s down.

House: Sorry, I missed that. My hearing’s been off since the Ricky Martin concert, some chulo kicked me in the head.

Foreman: White count, hematocrit and platelets are all off. The bone marrow’s shutting down, she actually has aplastic anemia.

House: Say what?

Cameron: All her other labs show nothing that –

House: Labs schmabs. A good diagnostician reads between the labs.

Foreman: You were right.

House: Hey, hey, hey, we’re not here to play the blame game. These things happen. Sometimes doctors send people out on the street to die after other doctors warned them that they were sending them out on the street to die. There’s no way you could know.

Foreman: I’ll go give her the news.

[Cut to Anica’s room.]

Anica: Who are you?

Foreman: I’m Dr. Foreman; I’m in charge of your case. You have aplastic anemia, which means your bone marrow is shut down. Your body can’t make new blood anymore.

Anica: Are you sure?

Foreman: I went back and checked your old records. It makes sense. The aplastic anemia has apparently been developing for months. I’m sorry, we should have caught it earlier.

Anica: So it’s not just the latest white count that’s leading you to feel this way?

Foreman: I know this is scary, but a bone marrow transplant could cure you.

Anica: A marrow transplant could kill me.

Foreman: The other option is weekly blood transfusions, injections of GCSF. It’s a lifelong regimen.

Anica: Yeah, I don’t want that.

Foreman: You sure? I don’t want to be cruel, here, but you’ve jumped through a lot of hoops to get this sort of attention.

Anica: I just want to be healthy.

Foreman: It’s not so much fun when you’re actually sick.

Anica: No.

Foreman: We’ll check the registry, see if there’s a donor match.

Anica: Thank you.

[Cut to Wilson performing the procedure.]

Wilson: We have to kill all the old bone marrow before we get to the new stuff. You’ll have no immune system. We’ll keep you in a sterile room for two weeks to make sure everything’s dead, then we’ll give you the donor marrow. It will take another couple weeks until it takes hold. You won’t feel a thing. If you get uncomfortable for any reason and need to talk, don’t yell. Walls are four inches thick, lead. Use the microphone. Are you ready?

Anica: Okay. Where’s Dr. House?

[Cut to House looking at the racing stats in Anica’s room. He smells something odd on her pillow, looks for her clothes, and then smells her bra.]

[Cut to House, hightailing it into the procedure room.]

House: Turn it off.

Foreman: Now what?

House: How long has she been in there?

Wilson: Three minutes, what’s going on?

House: She doesn’t have aplastic anemia. She has an infection.

Cameron: No, her white count would be through the roof, hers is on the floor.

House: The body does crazy things.

Foreman: The body does crazy things. Well, that explains everything!

Chase: She had no fever.

House: Because her self-inflicted Cushing’s suppressed her immune system, stopped her from having a fever, hid the infection. Clostridium perfringens could cause the bruising, the schistocytes, the anemia…

Chase: Explains everything except the white count.

House: Augmentin is a lot safer than destroying her immune system, why don’t we try that?

Foreman: Whoa, whoa, whoa. You’re taking the safe course? What’s going on?

House: There’s lots of explanations for low white count.

Cameron: Name one that fits her case.

House: Colchicine. I figured that she got her hands on it and just, uh, self-medicated.

Foreman: That’s brilliant of her. Take the exact medication that would confirm your diagnosis.

House: People do crazy things.

Foreman: You injected her against her will just so you could be right.

House: She consented.

Foreman: She’s mentally ill!

House: She smells oh, so sweet.

[Cut to House confirming his diagnosis on Anica.]

House: She would have gotten sicker when I said she was gonna get sicker except Cameron dosed her with antibiotics. Just hold this.

Anica: Is everything okay?

House: Hold my finger. [He cuts one of her bruises and smells it.] Grapey. You have a bacterium. It’s on all of us, but the bruises you gave yourself with the Cushing’s made it a lovely home. [It’s CGI time!] Bacteria moved in, parked their cars on the lawn, there goes the neighborhood. And by neighborhood, I mean your internal organs. So, should we put her on the Augmentin, boss, or do you think she infected herself with grapes? I love the smell of pus in the morning. Smells like… victory.

[Cut to Cuddy’s office.]

Foreman: If you were serious about the offer, I’m serious about accepting. I’d like to run the department. You said it yourself, things run smooth.

Cuddy: Except for the part where House went behind your back and KO’d the patient with insulin and colchicine.

Foreman: There was no reason to suspect an infection. Even House didn’t think it was an infection. You would have done the same thing I did.

Cuddy: And I’d be just as wrong. What House did was insane, but he saved her life.

Foreman: He got lucky.

Cuddy: He got her to admit she’s got a problem. She’s agreed to outpatient treatment. He gets lucky a lot.

Foreman: Did you ever really intend to give me this job, or were you just trying to stop me from stepping down?

Cuddy: Well, you’ve got two more weeks in charge. Hopefully the next case will go better.

Foreman: She should have died. House is not a hero. A person who has the guts to break a bad rule, they’re a hero. House doesn’t break rules, he ignores them. He’s not Rosa Parks, he’s an anarchist. All he stands for is the right for everyone to grab whatever they want, whenever they want. You tell doctors that’s okay, your mortality rate is gonna go through the roof.

[Cut to the lobby.]

House: Kinda digging this whole “Foreman in charge” thing. Frees me up to watch my soaps, catch a movie in the afternoon, have lunch with you…

Wilson: Yeah, that’s a big change for you.

House: Now Cuddy’s on Foreman’s ass, not mine. [They walk out of the hospital together.]

Wilson: You couldn’t live with Foreman as your boss.

House: Why not? People could change, you know?

[Cut to Anica at the ER of another hospital.]

Doctor: Your white count is way down. We’re going to need to admit you, just run a few tests.

Anica: Whatever you think is best.

[Cut to House at the OTB parlor.]

House: Last race at Belmont, put it all on the five. To win.


Tags: season 2

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