Title: Occam's Razor
Original airdate: 11-30-2004
young man collapses after enthusiastic sexual intercourse with his
fiancee. The team is perplexed, since no one condition explains all his
Patient: Brandon Merell
Initial symptoms: cough, low blood pressure, rash, nausea, abdominal pain, fever.
Brandon calls in sick to work, telling his boss he has a cough, fever, and is feeling nauseous.
Mindy, Brandon's fiancee, also notices a rash on his skin. Despite not
feeling well, Mindy easily talks him into having vigorous sex, but
he passes out immediately after.
Wilson brings Brandon to House's attention because, among all his other symptoms, Brandon's low blood pressure is not responding to IV fluids, which is odd.
Chase's initial idea is Yersinia infection, though it does not present with a
rash or cough. Foreman suggests arthritis with accompanying vasculitus,
but this does not explain the blood pressure problem. Cameron, the
allergist, suggests allergy, which wouldn't explain the abdominal pain.
Chase suggests carcinoid, after which Cameron notes that no condition
accounts for all the symptoms.
House points out that unless
they control Brandon's blood pressure, he'll soon be "circling the
drain." He orders treatment for sepsis, broad-spectrum antibiotics, an
Cort-stim test, and an echocardiogram. Brandon's fiancee, Mindy,
confides to Chase her concern that she may have made Brandon ill with
overly rough sex, but he assures her that was not the cause.
Foreman thinks Brandon's illness could be
viral, and suggests they run gels and titers. Test results arrive from
the printer, on which Foreman notes that Brandon's BP is still falling,
his lungs are filling with fluid, and his creatinine is rising, which
indicates Brandon's kidneys are shutting down. The antibiotics
could be doing more harm than good.
Foreman suggests an odd
presentation of a viral heart infection, which would explain all
the symptoms except the cough and the rash. House scoffs at the idea.
House uses the white board and various colored markers to encircle clusters of
symptoms with all the previous theories, and includes hypothyroidism,
parasites, and sinus infection.
concludes that Cameron was right; no one condition explains all the
symptoms, but the symptoms circled with orange and green cover
everything. House orders Unasyn for the sinus infection and levothyroxine for hypothyroidism.
thinks House's two-illness theory is wrong, and heads to the lab to run
more tests for viral infections. Chase accompanies him, though he
thinks random testing is a bit silly.
Further testing reveals
that Brandon has acute interstitial nephritis, which means the
antibiotics did not cause the kidney failure. Brandon's condition
is improving, for which House bluntly taunts Foreman. The taunting,
however, was designed to goad Foreman into continuing to try to prove
House wrong, which works. Foreman runs a TSH, T3 and T4, which show
Brandon does not have hypothyroidism. He insists it can't be two
illnesses, and Brandon might be getting better just because his body is
successfully fighting the infection. House sends Foreman to check
Brandon's white count. If he is fighting an infection, his white count
should be high. The test results, however, surprise everyone. Brandon's
white count is so low that he needs to go into a clean room, as he is
now unable to fight infections. If he gets a so much as a cold, he is
likely to die.
Foreman does a bone marrow biopsy to look for a virus or fibrosis to explain the low white count.
has Wilson fill his Vicodin prescription, but grabs the wrong bottle
from the pharmacy counter. After prolonged brooding, ball-tossing, and
internet and library research, House announced that Brandon had been
given colchicine, a gout medication, instead of cough medicine when he
had his prescription filled.
Cameron points out that Brandon
was improving, but then he got worse, which does not fit the theory.
Upon questioning, Brandon's mother confesses that she gave
Brandon more of the cough medicine immediately before his decline.
Chase questions the pharmacist who filled the original bottle,
but the pharmacist insists, rather huffily, that he did not make a
mistake. Brandon's mother and Mindy confirm that the pills from the
pharmacist look exactly like the ones Brandon was taking before.
causes House to doubt his colchicine theory. Wilson suggests lymphoma,
but House says Brandon's CT scan showed no adenopathy, the CBC showed a
normal differen-smear, and there were no signs in the bone marrow.
Wilson then advises House to abandon testing and do an exploratory
laparotomy to see what going on inside Brandon's body. Even
though House believes the surgery could kill Brandon in his weakened an
immuno-compromised state, he agrees to do it anyway for a lack of a
The Doclings perform a procedure to place sensors
in Brandon's lungs by running a tube through his heart and into his
pulmonary artery. During the procedure, Brandon complains of numb
fingers. Chase tells Foreman that Brandon's heart monitor shows ectopy,
and warns him that he can't tolerate any cardiac arrythmia in his
condition, and tells him to stop. Foreman continues, and Brandon's
blood pressure plummets and he develops VF (ventricular fibrillation).
Chase shocks Brandon with the defibrillator, and he resumes a sinus
rhythm. Brandon is too unstable for the surgery.
thinks the clean room may have gotten contaminated, and Brandon may
have an infection. She recommends doubling his dosage of G-CSF to
boost his white count. She also reports the pain in Brandon's
House finds this interesting, and barges into the clean
room without a mask or gown. He declares that even if the pharmacist
didn't screw up the cough medicine, Brandon's symptoms dictate
colchicine poisoning. He suggests ecstasy use, which Brandon confesses
to taking twice, much to Mindy's chagrin. He lists the symptoms, which
match Brandon's, including the new ones, which are neuropathy (the
finger pain), and hair loss, upon which he easily yanks out a hank of
He orders FAB fragments for the colchicine
poisoning and Tylenol for the hair he ripped out. Although Brandon is
improving rapidly, he still has the cough. Brandon noticed the pills
Cameron gave him have a letter on them, and the previous pills did not.
House obsessively rummages the pharmacy until he finds a
colchicine pill that is nearly identical to the cough pill.
Diagnosis: Colchicine poisoning
RV (right ventricle)
House and Cuddy butt heads over clinic duty again. Annoyed that
he is an hour late for clinic, she makes a crack about his leg. ("I
could run home and..." "No, you couldn't.") As a response to that,
House gives a short, but alarming, speech to the patients waiting in
the clinic. Cuddy is unfazed by this, and sends a horrified patient to
see him anyway.
begins a major power play to get out of clinic duty by calling for
unnecessary consults. Cuddy quickly becomes hip to his game and
sends Wilson instead. House eventually loses the game and has to
"kiss her ass." She rewards him by allowing him to knock off
clinic duty early, but, as a parting shot, he sends her a patient who
needs to have an MP3 player removed from his rectum.
runs her own head game on Chase, when he mentions Mindy's concerns
about rough sex, she asks for details, presumably to embarrass Chase
for his giggly attitude, which she finds childish. However, when
Foreman tells her she's now in his head, she corners Chase in the
office. She claims to be uncomfortable talking about sex, but launches
into a vivid description which leaves Chase sweating with his mouth
Even though House assures Jerry Morris that he's been a doctor for long
enough that he won't be shocked by anything, he still looks a bit
nonplussed at the idea of a rectal MP3 player.
House feigns uncertainty about clinic diagnoses to irritate Cuddy.
Cameron claims to be uncomfortable discussing sex, but her speech to Chase was remarkably aggressive.