Original airdate: 2/8/05
Synopsis: A homeless woman has seizures, but Foreman thinks she's faking.
Patient: Jane Doe/Victoria Matsen
Initial symptoms: seizure
homeless woman talks her way into a rave in an abandoned house by
telling the doorman she's looking for "James." Once inside, the
lights and music disorient her. A young woman offers to help her find
James. The police raid the party and she tries to prevent the young
woman's arrest, but falls unconscious to the floor. The police bring
her to PPTH for a suspected drug overdose. Wilson and Foreman review
her file, and find her tox screen is clean, but she is delusional and
doesn't know her own name. Wilson tells Foreman he was called in to
examine some lesions on her arm, which Foreman thinks are from too much
Wilson says the lesions were not cancer, but the patient has
an unusual twitch in her wrist. Foreman examines her, and she begins to
seize. Wilson calls for Ativan, but Foreman thinks she is faking to
stay in the hospital. Wilson asks Foreman to do a finger stick, which
shows her blood sugar to be 38. Wilson calls for D-50 by IV push.
thinks low blood sugar cannot be faked, but Foreman supposes she is
diabetic and deliberately took too much insulin. He bets Wilson there
is insulin among her possessions, but her bag stinks too badly for
him to search it. Wilson is concerned that the twitch could indicate a
tumor, but Foreman dismisses it.
Wilson goes directly to House
with her case, upset over Foreman's attitude. House surmises that
Wilson has person reasons for Wilson's insistence, and takes the case.
suggests a miniseizure to explain the twitch, which Chase thinks could
be a brain tumor, or a subdural hematoma due to a head injury, but
there is no evidence of this in her file. Foreman is annoyed that
they have taken her case, but says if they are worried about a brain
tumor to get an MRI, and then get rid of her.
House says they
must find out who she is, so they can discover her medical history. He
dumps the contents of her malodorous bag on the table, in which Foreman
finds an insulin syringe. House finds vomit, still damp, on some of her
clothes. To everyone's revulsion, he tastes it, and finds it
salty, indicating a chemical imbalance which could be low magnesium or
high calcium, either of which can cause a twitch. Or it could be
meaningless. Foreman again suggests the MRI, but House tells them to
hang a banana bag and wait 24 hours for the electrolyte imbalance to
House is now as interested in Foreman's dislike for the patient as Wilson's compassion.
Chase is tending Jane Doe, he sees she is drawing comics on a sketch
pad. She complains of pain in her head and becomes violently
agitated. Foreman calls for Ativan. As he attempts to restrain her, she
bites him on the wrist leaving a deep wound. Chase tells Foreman that
she's negative for HIV and Hep C. Foreman wants her to have her MRI as
quickly as possible, so he can discharge her, despite a two-day wait
Chase and Foreman attempt to swipe another
patient's appointment, but are stopped by Cuddy. She scolds them not
only for the attempt, but for not noticing the CT scan showed a
surgical pin in Jane Doe's arm, which would have been torn out by the
MRI magnet. House tells Cuddy he wants to remove the pin to do the MRI,
because Foreman believes she has a brain tumor. Foreman begins to
protest, but House cuts him off, and sends him to Jane Doe's
neighborhood to try to find out who she is.
A homeless man shows
Foreman where Jane Doe's cardboard "home" is in return for Foreman's
jacket. When Foreman lifts the tarp covering the entrance, a dozen bats
fly out. Foreman retrieves a pile of Jane Doe's drawings. House
pretends to deduce from irrelevant comic images that she was in a
car accident in Philadelphia on October 2, 2002 in which she
broke her arm, which was fixed with the surgical pin that was removed
from her arm. The serial number on the pin was the source of House's
information. House insisted on the MRI, simply to get the pin
removed so he could find out who she is.
House tells them her
name is Victoria Matsen, and her medical records are coming through on
the fax machine. Foreman reads the pages and runs to Victoria's room,
alarmed. On the way, he explains to Chase and Cameron that he started
her on iron dextran for her severe anemia, but her medical records
indicate she's allergic to it. They reach her room to find her gasping
for breath, with her O2 sats in the 80s and dropping. Chase calls for
epi from the code cart, and calls a code for respiratory arrest. Chase
administers the epinephrine. She eventually stabilizes and is sedated,
with her hand still twitching.
More medical records arrive, and
they discover several hospital visits. Once for frostbite, and once for
depression for which she was given Prozac. House recommends they put
her back on the Prozac, since she is still depressed. Chase notes she
had two appointments for ultrasounds, ten months apart, so it was
unlikely they were for pregnancy. Wilson thinks she complained of
abdominal pain, and her doctors were looking for ovarian cancer,
because the second appointment was with an oncologist.
Chased notes that her CA125 is normal, which would not indicate
cancer. Foreman argues that cancer would not account for her other
symptoms. House disagrees, saying neoplastic syndrome could
definitely cause a twitch, and orders an ultrasound of her ovaries.
bails on clinic duty, and finds Victoria's comics interesting. He
questions Foreman about his aversion to his patient, and Wilson about
his affinity for her, to no avail. As his penalty for ducking out of
the clinic, Cuddy assigns two medical students to House, to learn how
to take a patient history. House sends them off to interview a patient,
and hides in the clinic reading Foreman and Wilson's confidential
personnel files, much to Wilson's chagrin.
Chase and Cameron
find bad news on Victoria's ultrasound, which Wilson describes as a
solid, non-cystic mass on her left ovary, five by three cm in size,
with central necrosis, and gives her less than three months to live.
thinks the mass is not cancer, but a tuberculoma, since many homeless
people have TB. He orders INH, rifampin, and streptomycin. Foreman
begins the treatment, but tells Victoria she probably does not have a
tuberculoma. She apologizes to her for not believing she was ill, and
she confesses to overdosing on her insulin to have a place to sleep.
Foreman asks her about her personal life and her comics. She says the
comics are made up, but James is real. Foreman offers to help her find
James, but Victoria becomes extremely sensitive to the light, to the
point of screaming in pain. Foreman takes her temperature, which is
105. Victoria becomes more agitated, expressing fear that her
comic character, Mr. Fury, wants to hurt her. Foreman gives her water,
which she spits out, believing it to be poison. Foreman sedates her,
and tries to assure her that the "bad guys" can't get her, but she says
she is the bad guy, not Mr. Fury.
Foreman is convinced Victoria
has cancer because the treatment isn't working, but Chase returns with
the results of the biopsy, which show the mass is definitely a
tuberculoma, which should not cause a high fever. The options of what
she has besides the tuberculoma include a bacterial infection,
serotonin syndrome from the Prozac. House orders blood and urine
cultures, a chest x-ray. He also orders the Prozac stopped and bromocriptine for serotonin syndrome. They put Victoria in an ice bath,
to her great distress, to reduce her fever.
The blood and
urine cultures are negative, but lumbar punctures show elevated
proteins and white count. CSF cultures are not back yet, and a Gram
stain shows nothing. Cameron believes Victoria has meningitis. Chase
thinks is not meningitis, then some other brain infection. House orders
isolation and ceftriaxone, but when the team arrives at Victoria's
room, she is gone. Foreman insists he gave her 10 mg of Haldol, which
would have rendered her immobile, but a security tape showed
Victoria stealing clothes and leaving.
Victoria is rushed back
to PPTH with narrow-complex superventicular tachycardia,
with a heart rate of 150. Foreman orders adenosine, which
stabilizes the arrythmia. The team wonders if the high heart rate was
caused by the fever, or dehydration, but House speaks to the police
officer who found Victoria, and notices he's wearing a Taser, The
officer denies tasing Victoria, but House bribes him to admit he shot
her with it twice. The first jolt hit her in the thigh, but she didn't
House pokes Victoria's with a needle, but she shows no
reaction to pain. He pokes her toe, which makes her recoil, so the notes
the numbness is localized to her thigh. They rule out caused such as
her diabetes, alcohol, entrapment syndrome, or a vitamin
deficiency. House takes a swab of Victoria's cheek. While Foreman's
head is turned, House jabs a needle into Foreman's wrist, in the place
where Victoria bit him. Foreman feels nothing.
runs a test on the swab, he says that the symptoms of localized
numbness, sensitivity to light, disorientation, paranoia,
ineffectiveness of sedatives, and hydrophobia, all add up to rabies.
Foreman remembers the bats in Victoria's cardboard box.Chase is
surprised, due to the rarity of rabies cases, but House points out that
most people get prompt shots after getting bitten, which Foreman need
to do immediately. Chase says
there is no treatment for advanced rabies; Victoria is going to die.
administers the rabies vaccine to Foreman, who immediately gets up from
the table, and tells Wilson he is going to find James so Victoria will
not have to die alone. Foreman and Wilson return to the abandoned
house, and follow the drawings in Victoria's comics to a box of papers
in a closet. They find a marriage certificate, clippings and photos.
They discover that "Mr. Fury" is Paul Furia, Victoria's husband,
and James is her son. Wilson learns from a newspaper clipping that
Victoria was driving the car in the crash that broke her arm, and that
her husband and baby were killed.
Foreman returns to Victoria's
bedside, where she calls out for James. Foreman tell her he is not
James but Paul, and he is not there to harm her, but to forgive her.
loathing of homeless people is never explained, though he
develops compassion for Victoria once he learns her story, and goes out
of hs way to give her a measure of peace. House follows Wilson to
a seedy street corner, where Wilson is just sitting, watching the
passers-by. House tries to figure out which of Wilson's family members
could have lived on the streets, since he's met Wilson's parents and
brother. Wilson tells him he has another brother, who he has never
spoken about. He doesn't know if his brother is dead or alive,
and the corner was the last place he saw him, nice years previous.
Mrs. Angela Whitney
Jerry Lauseng, oncologist
Medical Student 1
Medical Student 2
Kaplow's Pawn Shop
Adams and Victor's Principles of Neurology
Battlefield State Park
1408 Sloan St.
© House Lexicon 2011