Original airdate: 12/14/2004
schizophrenic woman falls ill with a pulmonary embolism while in the
care of her son. House is intrigued, thinking nothing about this family
is as it appears.
Patient: Lucille Palmero, age 38
Initial symptoms: DVT, pulmonary embolism
Palmero is sitting in the New Jersey Department of Employment
Development office listening to voices inside her head while her son
Luke tries to get her disability payments extended. Luke handles the
paperwork while Lucy rocks, twitches, and insults Sally, the civil
servant assisting Luke. Lucy grabs her calf in pain, and demands
that a glass frog on Sally's desk be quiet. Luke asks for some water
for his mother, which Sally goes to retrieve. Luke gives Lucy a small
bottle of vodka to soothe her, which she gulps down. While Luke tries
to assure her that the voices are not real, Lucy grabs her chest and
collapses to the floor.
Lucy is taken by ambulance to PPTH,
where Luke waits for word on his mother's condition. He paces the
lobby, rubbing his wrist, which he smacked against the glass frog while
coming to his mother's aid. House sits in the lobby, reading a
newspaper and ignoring Cuddy's pages. Luke asks House if PPTH is a good
hospital, but House unhelpfully replies that he likes the chairs.
ER doctor explains to Luke that Lucy had a pulmonary embolism caused by
a deep-vein thrombosis while Luke takes extensive notes. He asks to
speak to Luke's father because he has some concerns. Luke tries lying,
saying his father is "running late," but the ER doc looks dubiously at
Luke's notebook. Luke confesses that his father is dead, and that he
takes care of his mother.
The ER doc is concerned that Lucy's
blood alcohol level is 1.2 at 10:30 in the morning. Luke tells the
doctor that he gave it to her himself to "cool her out," and it's the
first she's had in three days. The ER doc ascribes the DVT to
immobility caused by alcoholism, and dismisses Luke's statement that
she only drinks what he gives her, and he's very careful. He tells Luke
that Lucy has been given blood thinners, and can probably go home the
Luke insists that Lucy is not an alcoholic, so there
must have been some other cause. House butts in at this point, somehat
sarcastically saying that the doctor would not claim Luke's mother was
an alcoholic without evidence. He must have checked her esophagus,
looked for varices, and run all kinds of tests. The ER doc gives House
the case, dryly noting House's unusually keen interest.
House presents the case
to his team, asking them what could have caused the DVT. Foreman isn't
much interested, and rattles off a list of possible causes (oral
contraceptives, smoking, diabetes, obesity), and suggests heparin to
prevent future clots.
House points out that Lucy is twenty years
too young for a DVT. Foreman counters that he had a 12-year-old DVT
patient once; a soccer player who had been kicked in the leg. House
tells the team that there has been no trauma, and Lucy has none of the
other risk factors, dropping in the fact that Lucy has schizophrenia,
but it is not relevant to the DVT. Cameron expresses surprise that
House took a patient's history, but he tells her the information comes
from Luke's copious notes.
A bit later, House mentions to Wilson
that the DVT may be related to the schizophrenia, since they know so
little about it. Wilson notes that House is only interested in Lucy
because of her craziness, not her DVT. He announces (loudly) that Galen
treated schizophrenics by fumigating the vagina. He finds it
interesting that ancient doctors thought voices in the head were caused
by malposition of the uterus, and notes that modern treatment of the
disase hasn't advanced very much.
House spends a long time
talking to Lucy, to Foreman's astonishment. From this, he learns that
Lucy hasn't shaved her legs in two months. Her tremors cause her to cut
herself, but Lucy has had tremors before, so House thinks Lucy's
shaving cuts must have bled a lot more, starting two months ago. He
orders clotting studies (PT, PTT, factor V, and proteins C and S) and
stops her psych meds.
Foreman tries to draw Lucy's blood, but
she becomes agitated and paranoid, and spits in Foreman's face. Several
nurses rush in to restrain Lucy, and Foreman orders five milligrams of
As Luke sits at Lucy's bedside reading to her, Lucy
begins to cough, then vomit large amounts of blood. House rips Foreman
for giving Lucy the Haldol, saying the side effects will confuse their
diagnosis. Foreman defends himself, and a shouting match ensues. Chase
returns with the results of the clotting studies, which are normal
except for a prolonged PT time. From this, House thinks Lucy has a
vitamin K deficiency, which would explain the clot and the bleeding,
because without vitamin K, protein C doesn't work.
thinks the bleeding may have been caused by ampicillin interacting with
the heparin, because Lucy was prescribed ampicillin two months
previously for a sore throat. Chase thinks that House's
explanation is unlikely, and that all of Lucy's symptoms are due to
alcohol abuse and cirrhosis.
sends the team to check the home for ampicillin and diet, and orders an
ultrasound of Lucy's liver to test Chase's theory. Foreman and Chase
find the apartment small, but tidy and rigidly organized. Forman finds
a strongbox full of Lucy's medications, including trifluoperazine,
Thorazine, and Clozaril. He also finds the ampicillin, untouched.
Chase heads to the kitchen and finds a nearly empty fridge, and a
freezer full of microwave hamburgers.
Luke is distressed when
House tells him that the burgers lack vitamin K, which is why Lucy
had the DVT. Luke angrily yanks the strap of his backpack and
exclaims in pain from his wrist injury. House suggests he have it
looked at. While examining the x-ray, House assures Luke that his wrist
isn't broken. He then points to the epiphyseal plate in Luke's
arm, telling him that for those who know how, it can be used to
determine how old someone is. House makes a fairly accurate estimate of
Luke's true age, after which Luke confesses that he has only just
turned fifteen the week before.
Chase refuses to believe that
Lucy is not an alcoholic, or that Luke is not feeding her "a steady
diet of booze." While performing the ultrasound of Lucy's liver, Chase
thinks his diagnosis of cirhosis is confirmed, although Cameron points
out the liver scarring is minimal. They are both surprised to find a
Lucy would not qualify for a transplant, and at 5.8
cm the tumor is too large to remove, according to the surgical
guidelines, so House and Wilson decide to shrink the tumor to 4.6 cm by
injecting it with ethanol. Lucy's surgery goes well, though the surgeon
is furious at the deception. While Chase is explaining to Luke about
Lucy's chemotherapy, a social worker from Children's Services arrives
to remove Luke. Luke believes House turned him in, but since he knows
he did not, he checks the phone records for Lucy's room. He finds only
one call had been made, to Social Services.
magnitude of Lucy's decision to call Social Services, combined with
Lucy's age when she was diagnosed and the ineffectiveness of the psych
meds, leads House to believe that Lucy is not schizophrenic. He leafs
through Luke's voluminous notes and calls Lucy's previous doctors,
which is fruitless, since they don't seem to appreciate being called in
the middle of the night and hang up on him.
He drags the
Doclings out of bed to brainstorm. He notes that doctors sometimes see
patients through the filter of their own specialties, and if Lucy's
original diagnosis was wrong, he asks what physical conditions present
with psych symptoms. Cameron suggests porphyria, or a genetic tendency
to accumulate too much copper, for which Chase recalls the name
Foreman scoffs at the idea, accusing House of
wishful thinking. House presents as evidence an appointment that Lucy
made with an opthalmologist. He reminds Foreman that Wilson's sometimes
causes cataracts, and also cirrhosis. They team wakes Lucy to examine
her eye for Keyser-Fleischer rings around her corneas, which they find.
Lucy is treated for Wilson's disease and recovers.
Diagnosis: Wilson's disease
electric shock treatment
House's fasicnation with Lucy gives his team some insight into his
mind, though sometimes misinterpreted. House's team, Foreman in
particular, is puzzled as to why House took the case, since a simple
DVT is no zebra. Chase believes it is because crazy people are interesting to House, or at least not boring.
believes House sees people, and their illnesses, merely as puzzles to
solve, and that it's Lucy's schizophrenia that makes her interesting to
Cameron wishes House a happy birthday, but House is
oblivious. She seems unable to believe that someone would forget his
own birthday, or sieze upon an "excuse to be happy."
clashes with Cuddy yet again over medical protocols. Despite ripping
into House for shrinking Lucy's tumor, Cuddy urged Bergin to finish the
after the vitamin K deficiency diagnosis is confirmed, Chase remains
passionate about his alcohol theory to a degree that leads Forman to
ask Chase if he has had close experience with alcoholism. Chase doesn't
respond, but when Luke is reunited his mother after her treatment,
Chase observes the scene with an air of sadness.
Lucy's favorite poem is "Her Praise" from "The Wild Swans at Coole" by WB Yeats.
Wendy, who does not have strep
Clark, the hiccup man
Luke tells Sally that he is 18, and that Lucy's dependent is a fictional younger brother. He also lies about his age to House.
Terri - Wendy's Mom
Dr. Joe Bergin
Dr. Wyland (unseen)
Dr. Jeffrey Walters
Dr. Shopius (unseen)