Original subtitles

What do you say now?

I don't know.

You said your dad wouldn't be home for an hour.

I know, but--

Don't you love me? Of course. You know I do.

Then come on. Let's do it.

All right.

Where are they?

Nightstand.

Gentlemen, start your engines.

[motor roars]

I so want this car!

Woo-hoo!

Woo-hoo!

[laughing]

[coughing]

[horn blares]

[coughing]

Oh, my God. You're bleeding.

Look out!

[tires screeching]

[horn honks]

crash!

[New Age music]

*

What lie are they telling you?

Come on.

Okay. Thank you.

Pharmaceuticals were delivered this morning.

But shipping accidentally sent the box

with Vicodin to research.

Hmm. That's a tough one.

If only we had some way to communicate

with another part of the building.

16-year-old M.V.A. victim.

He's been in and out of the hospital

for three weeks with internal bleeding.

No one can find a cause.

Internal bleeding after a car accident.

Wow, that's shocking.

Let me talk to shipping. I speak their language.

It's been three weeks.

Your hospital doesn't have my pain medication.

Shipping says it's gonna be an hour.

This is Dr. Cuddy. What's going on?

The crash didn't cause the bleed.

Right. The bleed caused the crash.

Blood got on the road. Got all slippery.

Anyone here got drugs?

She saw his blood. She got distracted.

She crashed his dad's Porsche.

Dad'll love that.

He-- Don't talk.

It's going to be an hour.

Thank God you took control.

(Cuddy) If you can't wait one hour--

Kid's got hemolytic anemia.

Kid? How old?

He must have inherited it. He's going to die.

My condolences.

Wasn't inherited.

The problem's outside the red blood cells.

This is impossible.

16-year-old doesn't get hemolytic--

Give her back the file.

You have bigger problems to tend to

like my meds.

Elevated indirect bilirubin,

low serum haptoglobin.

He's got meningitis.

Uh, no.

Artificial heart valve.

No.

Get everyone in my office.

Kid's going to be dead in a matter of days

if we don't figure out

why his red blood cells are disintegrating.

So differential diagnosis, people.

(Foreman) Well, it's not environmental.

Dad hired a company to clean the house.

Maid washed all the clothes,

bought hypoallergenic sheets and pillows.

Do you want us to re-check?

No. If it's environmental,

he'll get better just from staying here.

It could be an infection.

No fever. No white count.

He's 99.2.

Barely above normal.

But above. His body's reacting to something.

(Cameron) We could account for the lack of fever and white count

if it's lupus.

(Chase) Drugs will fit just as much as lupus.

Meth'll cause hemolytic anemia.

(Cameron) A lot of meth.

(Foreman) Also doesn't exactly seem like the type.

Because his dad drives a Porsche?

Rich kids do drugs just like poor kids.

Didn't mean to offend you.

(House) Okay, so it's infection,

lupus, drugs, or cancer.

Cancer?

Why not? Great meeting.

Shouldn't we narrow it down before we finish?

My leg gave us till 11:15.

I'll talk to Wilson about lymphoma.

A-N-A for lupus.

Radioimmunoassay for drugs.

And you test for... whatever you thought it was.

I've got a date with a pharmacist.

Come on, come on, come on, come on.

'Scuse me.

You know, there are other ways to manage pain.

Like what-- laughter, meditation?

Got a guy that can fix my third chakra?

You're addicted.

If the pills ran my life, I'd agree with you.

But it's my leg that's busy calendaring what I can't do.

You're in denial.

Right. I never had an infarction in my leg.

No dead muscle. No nerve damage.

It doesn't even hurt. Actually, it kind of tickles.

And chicks dig this

better than a puppy.

It's not just your leg. You want to get high.

You're doing, what, 80 milligrams a day?

No. That's way too much.

Moderation is the key. Unless there's pain.

It's double what you were taking

when I hired you.

Because you're twice as annoying.

I can't always be here to protect you.

Patients talk. Doctors talk.

About how big your ass has gotten lately?

Not me. I defend it. You got back.

You can't go a week without the drugs.

No, I don't want to go a week without the drugs.

It'll hurt. No, you can't.

If you're just getting off pain medication,

it will hurt.

You won't be having a great time,

but you'll make it.

If you're detoxing,

you'll have chills, nausea.

Your pain will magnify five, ten times.

You won't make it.

Well, I guess we'll never know.

I'll give you a week off clinic duty

if you can go a week without narcotics.

No way. I love the clinic.

You love the pills. Two weeks.

The pills don't make me high, they make me neutral.

A month.

You're on, mister.

Drugs could cause this?

Cocaine and meth are very hard on the blood system.

Has he had any erratic behavior?

No, but...

she was in rehab in the ninth grade.

She's supposedly clean now, but--

She obviously cares for him.

What she cared about was the car.

Anniversary present for my wife.

We drove it up north to watch the leaves change.

She was dead a year later.

Cancer.

I'm sorry.

Mr. Foster, we're going to test Keith for drugs.

I don't do drugs.

It's not that we don't trust you, but...

(Cameron) His hair will tell us

any drugs he's taken over the past 60 days.

It's kind of like rings on a tree.

Negative.

Have you been sick?

No. Nothing.

Have you been out of the country?

We went to China,

but we got all our shots before we left.

(Cameron) It could be an infection.

We're going to give him a Gallium Scan just to be safe.

We inject a radioactive isotope into his bloodstream.

Then we check to see if there's inflammation

anywhere in the body.

Has he ever complained

of any joint pain,

sensitivity to light,

rashes?

No, no. Nothing.

Any relatives ever been diagnosed with lupus?

I don't even know what that is.

In simple terms,

the body becomes allergic to itself.

The immune system attacks healthy cells

in the circulatory system and destroys them.

Would it be treatable?

It can be manageable.

We can test for the antibodies.

95% of patients with lupus have positive A-N-A.

Not cloudy. Negative.

What about bruising?

Never complained of tenderness under his arms,

his groin?

I'm not sure he'd tell me if he did.

I guess I don't really know what's going on in his life.

He's a teenager.

Yeah.

What type of cancer did your wife have?

Pancreatic.

It's his lymph nodes we're concerned about.

We're going to do a biopsy to check for lymphoma.

(man) Can you feel this?

No.

Good.

I have cancer, don't I?

We're just testing.

That's what they told my mom.

(Cameron) We'll review the slides

and check for any abnormal cells.

Definitely not cancer.

Nothing?

Nothing. Negative for drugs.

A-N-A was negative. Gallium Scan was clear.

Yeah, I got that from the nothing.

Where's his hematocrit?

13.

Drops any lower,

he's not going to have enough red blood cells

to bring oxygen to his body.

He'll suffocate with his lungs working perfectly. You okay?

(Keith) Excuse me, someone.

Help, please.

Polite for a dying kid.

How long has it been?

I'm fine.

There's something in my eye. Up at the top.

Which eye?

This one. What's happening?

It's all right. Just look down for me.

It's clear. There's nothing in it.

It's getting worse.

Is it fuzzy or--

No, it's dark.

I can't see.

(Foreman) It's a retinal clot in the left eye.

Coumadin would dissolve the clot,

fix his eyesight.

You can't use blood thinners.

He's got internal bleeding.

Fix the eye, you kill everything else.

Surgery's out for the same reason.

We have two hours to figure this out.

Either we restore the blood flow

or he loses the eye.

Forget the eye.

Tell him to use the other one

and to look on the bright side.

The clot tells us something.

Could help us figure out

what he has.

Which could mean he gets to live.

Differential diagnosis,

people.

How does internal bleeding suddenly start clotting?

Makes no sense.

They're opposing processes.

It can happen in lupus.

Increased platelet count could cause blood clots.

A-N-A was negative.

It's not lupus.

This is true.

But why are you the one saying it?

What are you doing here?

I thought we ruled out cancer.

I was lonely.

Well, go see Cuddy. She needs a friend.

That's funny. She said you might need one.

That's why you're here?

She wants you to keep

an eye on me,

make sure I don't cheat.

No, I wanted to make sure you don't start firing shots

from the clock tower. I'm fine.

(Cameron) What's going on?

He hasn't had Vicodin in over a day.

Does your leg hurt?

You ever been shot?

There's going to be side effects.

Insomnia, depression, tachycardia.

Withdrawal symptoms. Not applicable.

The only side effects I'm going to have

are some pain and 30 days of freedom.

Am I the only one who's concerned about a dying kid?

If it's not lupus, what else?

Most likely candidate for throwing a clot

is infection or cancer.

Checked the biopsy twice. It's not cancer.

It's not an infection.

Gallium Scan didn't reveal anything.

Okay, what hides from a Gallium Scan?

Cardiac.

(Cameron) Right. Clot flicks off,

travels through the arteries,

gets backed up in the eye.

I'm sorry. I wasn't paying attention.

What happened?

It's an infection in his heart.

Great.

Echocardiogram for the heart

and IV antibiotics for the infection.

Stat.

Is it my birthday?

I'm not lonely.

My leg hurts.

She's a real masseuse.

She's $500 an hour minimum.

She's hot so she's a hooker?

What kind of pathetic logic is that?

The envious, jealous,

I never got any in high school kind of logic. Hello.

She's a legitimate masseuse.

C'mon.

God, she's beautiful.

Because she's beautiful, I should do it?

What kind of pathetic logic is that?

The envious, jealous,

I'm married and I can't do anything logic.

Hello.

Uh, listen,

I'm sure you're really good at whatever it is

you do, but-- Dame su mano.

Huh?

Hey, let go of my hand.

She doesn't speak English.

Shhh.

Ow!

Ow. Ah.

Ahhhh...

Oh, my God.

Bueno.

Take off your clothes.

Not a fan of the stroganoff?

I'm not hungry.

The antibiotics can cause nausea.

So can the food.

Shouldn't you be looking at my eye?

The blood clot isn't life-threatening.

We're focusing on figuring out

the cause of your problems.

So the--so the blindness

will be permanent, won't it?

Thank you. Bye.

I had a massage.

Looks like you had the masseuse.

Help the pain?

I'm fine. I know.

Kid's echo was normal.

No sign of any vegetations on heart valves.

Never met a diagnostic study I couldn't refute.

And the antibiotics aren't doing anything.

So double the dosage.

70 milligrams.

That'll box his kidneys for sure.

You're right. Save the kidney.

The guy we transplant it into will be grateful.

Also, I have an idea for his eye.

Nothing we can do about his eye.

He's got a clot in the ret-- Put it in a memo.

If we remove some of the liquid from the eye itself,

the vitreous humour,

it might make some extra room around the retinal artery.

If the artery expands, the clot might move on its own.

That's very creative.

Why didn't you mention this before?

I didn't think of it before.

You should've.

This is going to hurt.

Your eye's numb.

You'll only feel pressure.

Give it a minute.

I can see.

I can see you.

I heard. Congratulations.

Don't. I haven't brushed my teeth in two days.

I'm so scared they're not going to find out

what's wrong with you.

No biggie. I'm fine.

I feel so bad about all this.

It's all my fault.

No. It's not.

But your father, he hates me.

He's just pissed about his car.

[vomiting]

Help! Help! Help!

What's wrong?

AST's 859. We're getting him to the ICU.

ILT and GGT are in the tank. Our antibiotics--

Would not have caused this.

She must have given him drugs.

I wouldn't do that!

(House) It's not drugs!

His liver is shutting down.

What?

What does that mean?

It means he's all better. He's ready to go home.

What?

What do you think it means?

You can't live without a liver.

He's dying.

What is your problem?

Bum leg, what's yours?

Hey, we don't have time for this.

Let's go.

His son's dying and you're mocking him.

It was a dumb question.

No, it wasn't.

You're right. It wasn't.

Is proving Cuddy wrong worth all this?

You know, House shouldn't even be here.

Because he said something inappropriate?

If we sent him home

every time he did that, we wouldn't need this office.

He's in pain.

What does the man have to do to piss you off?

He's been without pain relief for over 70 hours.

Exactly. He's detoxing.

Can't you see he's out of his mind?

(House) That's what they said about Manson.

Do you want to continue talking about me

or should we discuss what the liver damage tells us?

I was born in a log cabin in Illinois--

Hemolytic anemia doesn't cause liver damage.

Add the fact he's coughing blood,

you've got three of the indicators

of organ-threatening lupus.

It's moving too fast.

Could be Hepatitis-E.

There's only been one case of Hep-E

originating in the U.S. since--

His history says he's been

in and out of the country four times in the last year.

You really think he's got Hep-E?

No. I think lupus is way more likely.

All right, then let's start him

on IV cytoxan and plasmapheresis.

No.

We should rule out Hep-E.

You just said it wasn't Hep-E.

I said lupus is way more likely.

But if we treat for lupus and it is Hep-E--

He's toast. Exactly.

But there isn't a treatment for Hepatitis-E.

Either he'll get better on his own

or he'll continue to deteriorate.

Yeah, I went to medical school too.

Start him on solumedrol.

If he's got Hep-E,

that's only gonna make him worse.

Not as much.

It's Goldilocks, people.

It won't hurt him so much that it'll kill him

and it won't hurt him so little that we can't tell.

It'll hurt him just right.

And if it does nothing--

We'll know it's not Hep-E

and can start treating for lupus.

Now watch me do it while drinking a glass of water.

What do we tell the dad?

We think your kid has lupus,

so we're going to treat him for Hepatitis-E.

And oh yeah, if it really is Hep-E,

we're not actually giving him Hep-E medication.

So it's going to make him worse, not better.

You think he'll go for that?

So you want us to lie?

No. I want you to lie.

Why me?

Because he trusts you.

(Cameron) This is a mistake.

This is a lawsuit.

Hep-E is possible.

House always pulls these stunts

and he's right more often--

He's delaying treatment

because of a one in a million chance

that even he doesn't think is the problem.

I don't want to lie to him. Then don't.

And get fired?

Like he's going to fire you. He loves you.

I've got to do something.

The kid needs treatment.

Then treat him for lupus.

That will get you fired.

You really think House is losing it?

Yeah.

He's fine. He knows what he's doing.

God!

We're recommending a drug called solumedrol.

For Hepatitis?

Did that show up on his blood tests?

The tests are never 100% accurate.

Well, then all the other tests could be wrong too.

This could still be an infection or cancer?

Um, they don't fit any of the most recent symptoms.

Well, what, just Hepatitis does?

I know, I know, I know.

You can never be sure.

When Wendy was in the hospital,

doctor told us

there was this aggressive experimental treatment

which might extend her life by two or three years.

We figured if there was any hope at all

that we could have her with us a little while longer,

it'd be worth it.

Three weeks later, she was gone.

I don't think it's Hepatitis.

I think your son has lupus.

I think it's broken.

What'd you do?

Accidentally closed the car door on it.

No, the door would've broken the skin.

This looks like something hard and smooth smashed it.

I want my lawyer.

Makes sense.

The brain has a gating mechanism for pain.

It registers the most severe injury

and blocks out the other.

Did it work?

My hand hurts like hell.

Yeah. I feel much better.

Don't splint it.

I want to be able to bang it against the wall

if I need to administer another dose.

Just tape it up.

[door opens]

Why'd you tell Cameron to lie to Mr. Foster?

Make it tight.

Answer me.

Nothing I can say is going to change how you feel

and nothing could come out of your reaction

that is going to change what I plan to do,

so I prefer to say nothing.

So that was just you saying nothing?

Uh-huh.

The guy is furious.

And scared.

So what are you going to do?

The father's insisting on the lupus treatment.

Yeah, Cameron told me. And I told her to tell him no.

Well, you can't just sit back and let the kid die.

Neither can the father.

So that's your plan?

You're going to play chicken

with the kid's life?

He's the dad.

I should win easily.

Take the week off.

What, 'cause I lied to a patient?

I take risks. Sometimes patients die.

But not taking risks causes more patients to die.

So I guess my biggest problem

is I've been cursed with the ability to do the math.

[door opens]

I told him that we wouldn't treat him for the lupus--

What did he say? He said he wanted

to transfer Keith to another hospital.

He's not stable enough.

He would never make it through the door.

That's what I told him.

That's when he caved. Yeah.

He agreed to do it your way.

Two plus two equals four.

If it is Hepatitis-E,

we should see a marked decline

in liver function tests within the hour.

Why bother explaining it to me?

It's not like I have any choice in the matter.

If there's no Hep-E,

we'll start treatment for lupus immediately. Ouch.

Keith, what's wrong?

What's happening?

No, get off.

Keith, it's Dr. Chase. Where does it hurt?

Jules! No!

He's hallucinating.

Is this from the medicine?

We haven't started the medicine.

We're in the hospital, Keith.

Keith, there's nothing on you.

Keith. Keith! Keith!

Hey, you okay, buddy?

I think I wet the bed.

Don't worry about it. It's fine.

Let's get you up.

Oh God!

He's had a major bleed.

Bright red blood per rectum.

I didn't--I didn't mean to.

I'm sorry.

He's going into hypovolemic shock.

Pressure's 60. Heart rate's 140.

We need an angiography. Stat.

(Foreman) Angiography revealed major upper and lower GI bleeding.

Severe hemodynamic compromise

and liver failure.

(Chase) He's also hallucinating.

Thinks he's being talked to by someone named Jules.

Hallucinations are a symptom of psychosis,

which is the fourth diagnostic criteria.

It's official.

This is lupus.

Who's Jules?

Any mention of her in the medical history?

It doesn't matter what he's hallucinating about.

It matters why. It's lupus.

There's no need to get snippy.

This kind of lupus takes years to get to this point.

It's been a week.

Yeah, and a 16-year-old kid shouldn't have hemolytic anemia

or be bleeding out of every orifice, but he is.

We had an opportunity to treat this.

Instead, we diddled around with Hepatitis-E.

And now it's too late. He needs a new liver.

We screwed up.

You're saying I screwed up.

Yes.

Then why didn't you just say that?

You going to blame this on her?

Did you agree with my recommendation

to treat for Hep-E? No, I didn't.

And she made herself quite clear.

And then she went and lied to the father.

That's why you're angry. Yeah, I trusted you.

You always trust me. It's a big mistake.

Lupus is a bad diagnosis.

It's the best diagnosis we've got.

That doesn't make it good.

No, just makes it this kid's only chance to live.

Put him on the transplant list.

And make sure Cuddy knows.

See if she can do anything to get him close to the top.

[dry heaving]

Cafeteria.

Stay away from the sushi.

What happened to your hand?

Got stuck in a drawer.

Right. You're going through withdrawal.

No. I am going through pain.

Pain causes nausea.

I took this job to work with you,

not cover your ass.

Your Vicodin.

And your solution is to give me drugs.

That's interesting.

No. Now I'm covering my ass.

Take your pills before you kill this kid.

Lupus is normally treated with medication.

But in Keith's case, the disease is too advanced.

Because you lied.

'Cause House wanted to play games with my son's life?

There's no way to really tell what progression the disease

may have taken-- You're right.

And I'm sorry.

So what do we do?

He needs a new liver.

(Cuddy) There are over 15,000 patients

on the transplant list.

But how many about to bleed to death

unless they get a new liver?

In Jersey, I'd say, uh, 20.

2,000 patients

die each year because a donor liver can't be found.

That's almost five a day.

So we're screwed.

I'll see what I can do.

(father) Could I donate

part of my liver?

Sorry.

You're a different blood type.

So we just wait? I'm afraid so.

And hope for someone to die.

Who's Jules?

Dr. House, you should get back to your off--

Jules. There's no Jules in the history.

It was a hallucination.

Of what? Our cat.

Does this matter?

(Foreman) No, I'm sorry.

We'll continue the transfusions

and the treatment for the anemia and liver failure

while we're waiting for a donor.

How long can he wait?

Not long.

I don't think this is lupus.

It's lupus. Come on. Let's--

Your fourth diagnostic criterion

for lupus is psychosis.

This is just a kid missing his cat.

He was being attacked by an animal

that wasn't in the room.

That's psychosis.

There's a difference between psychosis and hallucination.

So if he was imagining a fake cat, it would be lupus.

But since it's a real cat, it's not?

Take your damn pills.

Psychosis requires-- There's no cat.

Jules is dead.

You have a dead family pet, and you never mentioned it?

Nice family history.

Family history is asking about family members,

meaning people related to the patient.

Let's go. How did the cat die?

Can you get him out of here? Dr. House, come on--

What happened to the cat?

Old age.

She was 15 years old.

When?

About a month ago.

Does this have anything to do with--

Where'd she sleep?

With Keith. This is not a cat allergy.

It's not lupus.

Where is Jules?

Four years of college, four at med school,

two years residency,

another four of sub-specialty training

and where do I end up?

Talking instead of digging.

Come on. The ground's frozen solid.

[hollow thump]

What the...

Out of the way.

We have the liver. Prep O.R. 4.

All right, Keith,

start counting backward from ten.

Ten.

Nine.

Eight.

Scalpel.

[door opens]

Stop the gasses.

What the hell are you doing, House?

Saving a 16-year-old kid

from a lifetime of immunosuppressant drugs

and a very nasty scar.

This kid doesn't have lupoid Hepatitis.

He has acute naphthalene toxicity.

Naphthalene.

You--you--you're talking about moth balls.

No. Termites.

They create naphthalene to protect their nest,

which I'm assuming is rather large

and inside all four walls

of his bedroom and home.

And your assumption is based on what?

The autopsy I just conducted on his pet cat.

Call Cuddy and security.

You are not removing that kid's liver.

Now.

[hawks up loogy]

[spits] Ah!

Have you completely lost your mind?

No, but I have been feeling a little sick lately.

Achoo!

Ah.

(woman) There's no way

we can do this surgery now.

You think?

You've already cost him his liver.

Don't kill him too.

Why are you so eager to cut into a healthy kid?

Healthy? He's in the toilet.

He just needs some chicken soup.

I'm telling Hourani to re-scrub.

We're doing this transplant.

No, you're not.

You said it.

If Keith's symptoms had an environmental cause,

they would've disappeared as soon as he got here.

They've only gotten worse.

And if the food here

wasn't one step below Rikers island

he would've gotten better.

He's lost 14 pounds. Yeah, sure.

This is nothing but a dietary thing.

Naphthalene is a gas-- a fat soluble gas.

Kid breathes it in, it gets stored in his fat cells.

Outside the hospital,

his body burned protein and carbs for energy

and the naphthalene stayed in fat.

Once the car accident put him in the hospital,

he started losing weight.

His body had to get its energy somewhere else.

It started to burn fat.

The floodgates opened,

the poison poured into his system.

So getting away from the poison

is what poisoned him?

Getting away from his dad's meatloaf

is what's killing him.

(Cuddy) Do you want to explain to me

why you stopped the surgery?

Oh, my God!

I want him locked up!

Your cat did not die of old age.

It died of massive internal bleeding

and acute liver failure

caused by naphthalene poisoning.

The exact same thing your son has.

You lie to me, you mess up my son's surgery,

and now you expect me to trust you?

Give me 24 hours. We'll pump your son full of calories--

That liver is going to somebody right now.

We're doing that surgery.

If you do the surgery,

you'll be killing a mother of four.

Father of three.

I was guessing.

Like you are now?

Naphthalene poisoning is the best explanation we have

for what's wrong with your son.

It explains the internal bleeding,

the hemolytic anemia, the liver failure.

It also predicts what will happen next.

If you do the surgery,

he's going to lay on that table for 14 hours

while his body continues to burn fat

and release poison into his system.

Either way, I did you a favor.

He's awake now.

You got a chance to say good-bye.

I think you should trust Dr. House.

Give the liver to the other guy.

Watch out.

INR is down, and his red count is climbing.

Means you made the right call.

His liver's healing.

He's going to be just fine.

You made it a week.

And won my prize.

Congratulations.

Cuddy's a sucker.

I would've done it for two weeks off.

Yeah, it was a piece of cake.

Learn anything?

Yeah.

I'm an addict.

Uh...

Okay.

I'm not stopping.

There are programs.

Cuddy would give you the time.

You can get on a different pain management regimen--

I don't need to stop.

You just said--

I said I was an addict, I didn't say I had a problem.

I pay my bills. I make my meals. I function.

Is that all you want?

You have no relationships.

I don't want any relationships.

You alienate people.

I've been alienating people

since I was three.

Oh, come on. Drop it.

You don't think you've changed in the last few years?

Of course I have.

I've--I've gotten older. My hair's gotten thinner.

Sometimes I'm bored. Sometimes I'm lonely.

Sometimes I wonder what it all means.

No. I was there.

You are not just a regular guy who's getting older.

You've changed.

You're miserable and you're afraid to face yourself.

[cane slams on desk] Of course I've changed!

And everything's the leg?

Nothing's the pills.

They haven't done a thing to you?

They let me do my job

and they take away my pain.

How'd it go?

He admitted he's addicted to the narcotics.

Well, admitting you have a problem is the fir--

And he says it's not a problem.

Maybe it's not.

What do I know?

What are you going to do?

Nothing. Done enough damage.

Better hope he never finds out that that was your idea.

He'd never believe it.

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