Title: Histories
Original airdate2/8/05
Episode: 110
Synopsis: A homeless woman has seizures, but Foreman thinks she's faking. 
Patient: Jane Doe/Victoria Matsen
Initial symptoms: seizure
*****Spoilers below*****

Differential diagnosis:

A 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 sun.

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.

Wilson 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.

Cameron 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 correct.

House is now as interested in Foreman's dislike for the patient as Wilson's compassion.

As 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 for non-emergencies.

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.

House 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.

House 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 feel it.

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.

While House 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.


Wilson 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.



Diagnosis
: Rabies



Soap Opera
:
Foreman's 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.

Clinic Patients:

Shelley Diamond
Jodi

Everybody Lies:

(under construction)

People: 

Dr. Terhark
Mrs. Angela Whitney
Jerry Lauseng, oncologist
Calendraica
Mr. Fury
Medical Student 1
Medical Student 2


Incidental terms:
Kaplow's Pawn Shop
Jefferson Hospital
Hartman Hospital
Adams and Victor's Principles of Neurology
Battlefield State Park
1408 Sloan St.
Sloan Harbor

Music:

Home | Medicine | People | Episodes | Store

House Lexicon 2011