Original airdate: 1/25/05
Patient: Matthew Davis, Chi Ling
Initial symptoms: disorientation, nausea
an AP Calculus exam, a teenage boy experiences disorientation,
and has difficulty communicating. He tries to rise to go to the
bathroom, but collapses to the floor.
Foreman presents the case
to House, noting that Matt's symptoms now include severe bradycardia,
with a heart rate of only 48 and still falling, and is not responding
to atropine. House attempts to brush aside the case with a snap
diagnosis of drugs, for which he needs charcoal and naloxone, and tells
Foreman to leave him alone. Foreman says the tox screen was clean, and
House becomes interested in Foreman's interest. House suggests
that Foreman doesn't care about the kid himself, just the interesting
illness. Foreman persists, noting a clean CAT scan, no infection, and
Cameron suggests shigellosis, but Foreman notes it
wouldn't explain the bradycardia. Chase suggests viral myocarditis, but
House points out it wouldn't account for the disorientation
("whacked-out"). House becomes interested in the negative tox screen.
The team lists the possiblilities that the boy was clean, someone
botched the test, or he used something that isn't tested for. Chase
says that 1,4-Butanediol would produce the same symptoms. House explains
that the chemical, which is found in copier toner, would have the same
effect as GHB, though it is more expensive and more dangerous, it is
easier to obtain. House sends Foreman and Cameron to search Matt's
home. House orders Chase to double Matt's dose of atropine from 1ml to
Chase attempts to question Matt about drugs, but Matt
cannot respond. Matt's mother, Margo, insists that Matt doesn't take
drugs. Chase points out that if Matt did take drugs, his mother most
likely wouldn't know about it. Margo tells him that she tested Matt
herself with a home kit. Margo says all Matt did the night before
was study and argue with her about school and personal choices.
While they are talking, Matt begins to seize. Chase orders 10 milligrams of diazepam.
the search of the home, Cameron finds a jar of homemade tomato sauce
with a bulging lid, which is a sign of bacterial contamination. Foreman
finds an identical open jar in the fridge, and finds out that Matt made
himself a pizza for a snack the night before. Cameron says the
sauce could contain botulism, or one of many other toxins which would
cause gastroenteritis, cardiac symptoms, and confusion.
House dips a tongue depressor in the sauce, to Cameron's
surprise, and eats a large dollop.
House says Matt's seizures
rule out food-borne toxins. Foreman adds that the seizures also rule
out drug use because they started two hours after Matt's admission.
When asked what the seizures add to the equation, Cameron
suggests pesticide poisoning. Carbamates, organophosphates, and
organochlorines are mentioned as possibilities. Foreman says they
can't tell yet if the poison was inhaled or absorbed, and Cameron
suggests that Matt be washed in case there is any pesticide residue
left on his skin. House says he already asked the nurses to do so.
hour later, Margo is at Matt's side, fretting that the medication does
not appear to be working. Chase tells her that the medication,
Pralidoxime, is very effective, but takes more time to work. She
questions whether they have the right diagnosis, but Chase assures her
that the bloodwork was conclusive for organophophate poisoning. Matt's
heart rate drops to 30. Chase calls to the nurses who rush in that Matt
is in bradycardic arrest and needs pacing pads to beat his heart.
Application of the pads brings Matt's heart rate up to 56.
Chase tells her they will keep Matt on the pads for another hour, and see what his condition is. Margo wants to know what happens next. She is not happy about the "wait and see" approach, and wants to know is there are other options.
in the office, Chase tells House and the team that the Pralidoxime is
not working, and they'll have to wire Matt's heart. While
discussing options, Foreman mentions an experimental treatment
developed by one of his medical school professors for the army. The
treatment involves a hydrolase for targeted for each poison. For the
treatment to work, they'll need to know which poison Matt was exposed
to, and which hydrolase to ask for. In unison, House and Foreman
suggest getting them all.
Foreman suggest figuring out how Matt
was exposed so they can find out what he was exposed to. House supposes
the homemade tomato sauce came from home-grown tomatoes from the Davis'
Chase inserts a pacing wire into Matt's heart
while Cameron returns to Matt's home. Cameron finds an empty can of
disulfoton in the garden shed. Margo tells Chase the garden is an
experiment in organic farming, and the can contained only orange peel
oil. Margo asks what will happen if Matt is given the wrong
hydrolase. Chase tells her that it may make him worse, but insists they
are not wrong about the poison. Margo refuses to allow the treatment.
attempts to get Cuddy or the hospital lawyers to override Margo's
decision, but fails. All Cuddy suggest is having Margo sign papers
refusing the treatment. House brings the papers to Margo and reads her
the legalese, somewhat altered, and bullies her into allowing the
treatment by convincing her Matt will "kick off" without it.
orders the treatment, but Cameron brings him to the room of another boy
who just arrived at the hospital in serious condition with the same
symptoms as Matt.
Margo requests that
Chase be removed from Matt's case, and Foreman takes over Matt's care.
Foreman attempts to defend House's actions to Margo, which leads her to
declare that Foreman is just as "pompous and superior" as House.
boys live ten miles
apart, are in different grades, go to classes in different buildings, and eat in different
cafeterias, but they both ride the same bus to school. Chase and
Cameron discover that the county sprayed ethyl-parathion along the bus
route due to concerns about West Nile.
have the hydrolase for ethyl-parathion, but neither Foreman nor Chase
believe they will be able to convince Margo to accept the treatment.
She faxed Matt's records to the CDC for a second opinion. House sends
Cameron to speak to Margo, who is now considering transferring Matt to
another hospital. Cameron makes an attempt at sympathetic bonding, but
Margo brushes it aside. Cameron harshly tells Margo that without the
treatment, her son will die, and she needs to decide, right now.
allows Cameron to administer the hydrolase, which is also given to
Chi. Both boys have seizures and are given diazepam. Foreman tells
House the condition of both boys has worsened. Their hearts and lungs
have weakened further, and they are now showing liver toxicity. House
asks Foreman what the severity of the cadiac symptoms reveal, to which
Foreman replies the poison was probably absorbed through the skin.
Since the absortion would take anywhere from one to four hours,
House thinks the boys were poisoned before they got on the bus, from
something in their homes. House sends Cameron and Foreman to search
their homes for anything containing lanolin, or anything that may have
touched their skin that morning.
Cameron and Foreman check
the shampoos, shaving creams, air fresheners, etc. in both homes. They
discover that both homes have the same laundry detergent, but Chi's
parents tell House that their son doesn't do laundry, and his clothes
were new, and had never been washed. House and Chase retrieve Matt's
clothes from storage to find that while the jeans look old, the tag
looks new. House sends the clothes for testing.
discovers the boys' jeans were contaminated with phosdrin. Chi's
parents agree to the treatment, but Margo does not. Margo will not
agree to anything until she hears from the CDC. House brings his
little TV into Matt's room and sets the bottle of hydrolase down in
front of Margo. Margo's phone rings. She has a brief conversation, and
tells House the call was from the CDC, and they can't help her. House
begins to speak, but Margo abruptly tells House to give Matt the
In the hallway, Chase returns House's phone. Chase
called Margo, pretending to be from the CDC. House is astonished that
Chased fooled her with an atrocious Southern accent.
In time, both boys wake
up. Matt fears a rebuke from his mother for buying stolen jeans from
the back of a truck, but she says shes just glad he's alive. The man
who sold the jeans to Matt and Chi also worked at a cornfield. He
spilled the pesticide on the jeans, and didn't bother to wash them.
runs into House and Foreman in the hall, and tells him that the real
CDC called. Margo says nothing, but walks away smiling. When Matt asks
who they were, she tells him, "They're the arrogant jerks that saved
Diagnosis: Organophosphate poisoning
Davis' home, Foreman postulates that House wants a drug diagnosis (and
to believe that Foreman used drugs in the past) because House himself
is a drug addict. Cameron asks Foreman if he really never did any
drugs, but he brushes her comments aside with a joke, which Cameron
notes is House-like behavior. Foreman denies his "Houseishness,"
but cannot deny that he is wearing sneakers identical to House's.
thinks House and his team are incredibly arrogant, which is not unfair.
Chase refused to listen to her, and Foreman told her he was right to do
so, even though their medical advice was wrong. Cameron's approach was
condescending, then harsh. Margo justifiably did not trust their most
recent advice, and told them they had to do better, but Cameron shifted
the responsibility to Margo. House just browbeat her until he got his
way, as usual. They saved Matt and Chi, but they were indeed arrogant
Dr. Morell (unseen, paged to the CAP lab)
superior vena cava