Title: Pilot
Episode: 101
Original airdate: 11-16-2004
Synopsis: a young woman diagnosed with a brain tumor isn't responding to treatment and is rapidly deteriorating. Dr. Wilson persuades House to take the case by claiming she is his cousin.

: Rebecca Adler, age 29
Initial symptoms: babblingseizure

*****Spoilers below*****

Differential diagnosis:
Rebecca Adler presents with seizure, babbles like a baby, and progressive deterioration of mental status. Dr. Wilson asks House to take the case because she is his cousin. House is initially dismissive, offhandedly diagnosing a boring brain tumor.
Wilson says the protein markers for the most prevalent types of brain cancer are negative, and she's not improving with radiation therapy.

Chase suggests aneurysm, stroke or an ischemic syndrome. Cameron suggests Creutzfeldt-Jakob Disease, and Foreman thinks it may be Wernicke's encephalopathy. House mentions her blood thiamine level is normal, but Foreman points out that her crappy HMO lab may have botched the tests. House orders new blood tests, a CT scan, and a contrast MRI.

Rebecca has a severe allergic reaction to the gadolinium, the contrast material used in the scan, requiring a surgical airway.  Without the scan, House instructs his team to take a thorough history and search her home. While lecturing a clinic patient's mother on the use of steroids, House gets the idea that Rebecca may have cerebral vasculitis and instructs his team to administer Prednisone.

While inspecting Rebecca's classroom, Foreman discovers the class has a parrot and suggests psittacosis. House rejects this idea because no one else is sick.

Rebecca improves greatly on the steroids. Her improvement proves to be temporary, however, and she soon has another seizure. The monitor shows an alarmingly rapid heartbeat of 211, which becomes a flat line. Foreman tells her she needed shocks to restart her heart. She still has intermittent altered mental status, which Foreman determines with a Picture Arrangement test.

House is stumped, and orders her treatment stopped to see what course her deterioration takes. The team objects to this, but has no alternatives to offer.

The epiphany:
Foreman and Cameron search her home looking for any clues. Foreman says they found nothing but mentions finding ham in Rebecca's refrigerator.  House realizes that all of Rebecca's symptoms could be explained by
neurocysticercosis,  an infection of the brain with tapeworm larvae.

Rebecca demands proof; otherwise she is content to go home and die. Chase remembers that worm larvae are clearly visible under an x-ray. House points out that a worm cyst in her brain will not be visible, but it's very likely she has one in her thigh. The thigh x-ray reveals the larva, and Rebecca agrees to treatment. Chase starts her on a course of albendazole.


Soap Opera: Dr. Lisa Cuddy, the Dean of Medicine, scolds House for ignoring consult requests, ignoring his clinic duties, and general slacker attitude.  Upon his flat refusal to cooperate, she pulls his authorization to do tests and procedures (and even to make long distance phone calls and photocopies). This infuriates House, but he has little choice but to agree to her demands.

House reveals to Foreman, to his horror, that he was hired because of his juvenile criminal record and "street smarts." House also reveals to Cameron, to her great indignation, that while she was a good applicant, she wasn't the best, and that he hired her for her physical appearance. He considers her determination to succeed in medicine as defiance of the laws of nature, due to the ease with which attractive women can achieve what they desire, such as wealth or fame. Therefore, Cameron must be damaged in some way.

Cameron badly mispronounces Creutzfeldt-Jakob Disease. It's CROYTZ-felt YAH-cub, not CROTCH-feld JAYcob. It's a dumbass mistake for a doctor to make. I had a ninth grade science teacher who said "nu-cu-lar." I'll wager that many doctors developed the same tic in corner of their eyes hearing Crotchfeld-Jaycob that I got with every "nu-cu-lar." I suppose for the pilot there wasn't much money left over for looping.

Sig is severely irritated by House's pronunciation of "larvae," though this one is not as cut-and-dried as the Jacob thing. House says "larv-eye" where most Americans would say "lar-vee." This is not so much a wrongness as a Classical vs. Traditional Latin pronunciation.  This could be an instance of Hugh Laurie getting caught being British, though some Americans use this pronunciation as well.

Clinic Patients:
Orange Man
Asthma Boy
Asthma Mom

Everybody Lies:
Wilson lies to House, claiming Rebecca  as his cousin, to get him to take the case.
House gives various prevarications to Cuddy as excuses for his slackerdom.
House gives placebos to Molnar to treat his internet-inspired affliction.
House claims he never lies.

PPTH People:
Egg Salad Lady
Reception nurse
Dr. Kahn (unseen)

Other People
Melanie Landon
Carly L.
Substitute teacher

Incidental Terms:
sed rate
heart attack
New England Journal of Medicine
chronic fatigue

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