Title: Damned If You Do
Original airdate: 12/14/2004
nun comes to the clinic with a rash, and House's treatment sends her
into cardiac arrest. The doctors have to figure out if she has a real
medical condition, or if House made a mistake.
Patient: Sister Augustine
Initial symptoms: rash, joint pain
Augustine comes to the clinic for a nasty rash on her hands, which
resembles stigmata. House brushes away the religious implications of
the wounds, and asks of she has been washing any dishes. Her
companions, Sister Pius and Sister Eucharist tell House of a large
donation of pots and pans, which Augustine washed. He diagnoses contact
dermatitis from an allergy to dish soap. House gives
Augustine diphenhydramine, an antihistamine, and tells her to
get some over-the-counter cortisone cream. He offers water, but
Augustine washes the pill down with tea.
Augustine has an asthma attack. House grabs a syringe from a drawer and
injects Augustine with epinephrine, which soon stops Augustine's
wheezing. House thinks the ashtma attack was allergic reaction to
the antihistamine, and suggests steroids. Augustine tells House her
heart feels "funny." He takes her pulse and finds her heart rate is
alarmingly fast. He calls a code and tells a nurse to charge the
defibrillator. He loses her pulse and begins CPR.
has made no notations in Augustine's chart, which makes Cuddy believe
that House gave Augustine 1 cc of epinephrine to cause the cardiac
arrest. House insists he gave her .1 cc, and she must have a heart
condition. Cuddy gives him 24 hours to discover the cause of the
cardiac arrest, or she will have to notify the hospital attorneys of
suggests a skin infection such as cellulitis, which could present with
tachycardia. Foreman points out that Augustine does not have a fever,
and the CBC showed no signs of infection. Cameron says the eosinophils
are slightly elevated, as is the sed rate, so a systemic allergic
response is possible, though House says that would not account for the
cardiac arrest. House suggests Churg-Strauss vasculitis, which would
account for all the symptoms if the blood vessels in her hands, lungs,
and heart are inflamed.
thinks the most likely explanation is that House made a mistake. House
again insists he did not, and orders a chest CT and prednisone for
Sister Augustine. The CT shows no vascular pathology, leaving Foreman
even more convinced that House made an error in the clinic. Cameron
disagrees, and suggests thyrotoxicosis or carcinoid.
in the scanner, Sister Augustine complains of a strong odor, which the
tech ascribes to a previous patient's vomit. When the smell begins to
overwhelm Augustine, the Cameron pulls her out of the machine, but
cannot smell anything unusual herself. Augustine suddenly exclaims that
she can see Jesus, and that he is burning her with his touch. Foreman
realizes that smells and religious visions are symptoms of temporal
lobe swelling, and orders Ativan. Sister Augustine begins to seize, and
Foreman discovers a rash of blisters on her leg.
show Augustine has herpetic encephalitis, which means her immune system
is compromised. Cuddy believes the prednisone is responsible, but
Cameron thinks Augustine has not been given enough to affect her immune
system to that degree. Chase suggests mixed connective tissue disease.
Foreman disagrees, because Augustine's ANA was normal, and they cannot
use the ususal treatment, corticosteroids, because of the encephalitis.
House orders hyperbaric oxygen treatments for Augustine, dismissing Foreman's concerns about oxygen toxicity. House and Foreman butt heads over the treatment, so Foreman
takes his objections to Cuddy.
explains to Augustine that the pressure chamber will saturate her blood
with oxygen, increase her white cell activity, and help with the
inflammation. Augustine emerges from the chamber weak and thirsty, so
Chase brings her her tea.
Eucharist finds House watching his soap opera on a miniature TV in the
chapel. She tells House she believes Sister Augustine is a
hypochondriac, constantly complaining of sore throats, joint pain,
or some other ailment, to get out of work duties.
agrees with Foreman, and boots House off the case. Cuddy rounds up the
Doclings and has them report on her status. She believes Sister
Augustine has no underlying condition, and wants to treat the symptoms
only. Chase says Augustine's breathing is labored, which Cuddy
diagnoses as pneumonitis from the hyperbaria. She orders 40% oxygen to
increase her O2 sats. Sister Augustine's BUN and creatinine are rising,
and her ALT and AST are twice the normal range. Cuddy thinks this could
be from the hypotensive episode, and orders monitoring with labs. She
also orders a non-steroidal anti-inflammatory for the rash and joint
pain. When Chase checks on Augustine, her pulse is 104.
visits the monastery to speak with the Mother Superior about
Augustine's past. He noticed a tattoo on Augustine's shoulder, from
which he deduced she has not spent her entire life with the church. The
Mother Superior tells House that Augustine ran away from foster care
and spent several years on the streets, used drugs, and became pregnant
at age 15. Augustine tried to abort the pregnancy herself. She lost the
child, became ill, and returned to the church.
decides that Augustine's unfortunate past is not relevant to her
current illness. The Mother Superior serves him tea, which he notices
Sister Augustine continues to deteriorate under
Cuddy's care. All her symptoms have worsened, and she has developed a
fever. Cameron suggests she may have a genetic or metabolic disorder,
but Cuddy refuses to listen unless Cameron has something specific to
House returns to the hospital with a bag of tea from
the monastery, and tosses it at Cuddy, explaining that the tea contains
figwort which causes cardiac arrest when mixed with even a small dose
of epinephrine. Without the cardiac arrest, all of Augustine's symptoms
are due to explained by a severe, long-term allergic reaction.
her symptoms persisted, and House doubts they can all be acribes to the
tea, Augustine must be allergic to something in the hospital. They move
her into a clean room to avoid environmental contaminants, but
Augustine goes into anaphylactic shock and needs to be intubated.
suggests mast cell leukemia, but House says her blood tests rule it
out, along with eosinophilia and idiopathic anaphylaxis.
Augustine wants to go back to the monastery to die, and won't be
dissuaded. House disgustedly tells Wilson that Augustine has "God
inside her." When Wilson replies, "Maybe she's allergic to God," House
realizes they haven't looked inside Augustine. He orders a full body
scan, during which they find a copper cross, an IUD that Augustine had
forgotten she had. Her exposure to the copper cookware, and the food
cooked in it, triggered her severe reaction. The IUD was surgically
removed, and Augustine began to improve.
Diagnosis: Copper allergy
Foreman is convinced House made a mistake,
as is Cuddy. Cameron
firmly believes he did not. Chase is more pragmatic, and cares only
about House's mood. Foreman believes that Sister Augustine's cardiac
arrest was caused by the epinephrine, so the hyperbaric treatments will
do more harm than good. He reminds House of the Hippocratic Oath, and
House points out that the oath mentions a number of principles which
are not relevant to modern medicine. Foreman also objects to House's
disdain for medical protocols, and believes House should show some
challenges Foreman to do
something about it if he is not convinced of the diagnosis and
treatment, which he does by reporting House's actions to Cuddy, thereby
getting him removed from the case. When House discovers that the cause
of Augustine's cardiac arrest was the tea, he chastises Cameron for not
sticking by her original diagnosis, and praises Foreman for sticking to
his guns, even though he was proved wrong.
conflicts are internal. Chase
reveals that he was in the seminary before going to medical school. He
tells Sister Augutine that he failed his test of faith. House surmises
that Chase went to medical school only to please his father, but Chases
doesn't reply. When Augustine asks Chase of he always wanted to be a
doctor, he replies, "Always," but his response lacks conviction.
Cameron gives House a Christmas present, causing him a moment of extreme social awkwardness.
Christmas, Cuddy is tending patients.
Foreman is dressed as Santa, handing out presents to sick children, and
Cameron is still in the office, opening a gift from an unknown sender.
Sisters Augustine, Eucharist, and Pius attend mass in the chapel.
Chase stands in the doorway for a moment, then leaves, looking
invites House to Christmas dinner. After reminding Wilson that he is
Jewish, Wilson switches to Hannukah dinner, the point being to
enjoy food and the company of people. House declines, and Wilson decides to go to
House's place. Wilson's decision to leave his wife alone at Christmas
makes House raise his eyebrows, but Wilson doesn't want to talk about
it. House doesn't either, and they retire to House's apartment for an
amiable evening with Chinese food. Despite House's disdain for
religion, he likes Christmas carols, and plays "Silent Night" sweetly
on his piano.
sign outside the chapel carries the symbols of five major
religions: Star of David (Judaism), the Star and Crescent (Islam),
the Latin Cross (Christianity), Wheel of Dharma (Buddhism), and the Aum
(Hinduism). Nine symbols hang behind the altar.
Nuns living in a "monastery" is not a mistake. Not all nuns live in convents or cloisters.
House's piano was made by Sohmer & Co.
Oops: Foreman says "eo-siph-a-nil instead of "eo-sin-a-phil" and no one makes fun of him for it.
Santa Claus - department store Santa with inflammatory bowel, for whom House prescribed cigarettes.
Sister Augustine, and the other nuns, omitted the more sordid details of Augustine's past.
Wilson has apparent difficulties in his marriage, but declined to speak on it.
Chase (unconvincingly) says he always wanted to be a doctor, but House thinks otherwise.
Nurse Arnold - soap character
Dr. Riles - soap character
Dr. Jorkins - soap character
Nurse Crandall - soap character
Dr. Brown - soap character