1 00:00:04,046 --> 00:00:07,048 On your right. On your right. On your right. 2 00:00:07,174 --> 00:00:08,216 Back, back, back, back, back. 3 00:00:08,342 --> 00:00:09,967 Come on, buddy. 4 00:00:12,846 --> 00:00:15,181 Yeah, Dan! Yeah! 5 00:00:15,307 --> 00:00:16,974 Yeah! Yeah! 6 00:00:17,142 --> 00:00:18,768 Back, back, back, back, back. 7 00:00:18,894 --> 00:00:21,062 Come on! Watch the winger! 8 00:00:32,199 --> 00:00:33,199 Yeah! 9 00:00:58,016 --> 00:00:58,850 You okay? 10 00:00:59,810 --> 00:01:04,063 Dan? Dan, talk to me. Dan. Dan. 11 00:01:05,899 --> 00:01:07,734 Get a doctor! 12 00:01:48,817 --> 00:01:50,735 - Hey. - Close the door. 13 00:01:50,861 --> 00:01:52,195 Close the door. 14 00:01:55,616 --> 00:01:58,159 Is Cuddy down the hall counting to 50? 15 00:01:58,827 --> 00:02:01,579 She knows I'm in here, in the clinic, as she commanded. 16 00:02:01,705 --> 00:02:03,122 She just doesn't know I'm alone. 17 00:02:03,457 --> 00:02:05,166 Well, you've got a full waiting room. 18 00:02:05,292 --> 00:02:06,751 How long do you think you can ignore them? 19 00:02:06,877 --> 00:02:08,377 I'm off at 4:00. 20 00:02:09,546 --> 00:02:12,548 You're doing this to avoid five minutes of work? 21 00:02:12,674 --> 00:02:14,842 If I go out there, I get assigned a kid with a runny nose. 22 00:02:14,968 --> 00:02:16,135 That's 30 seconds looking at the nose, 23 00:02:16,261 --> 00:02:18,179 25 minutes talking to a worried mom 24 00:02:18,305 --> 00:02:20,640 who won't leave until she's sure it's not meningitis or a tumor. 25 00:02:20,766 --> 00:02:23,059 Yes. Concerned parents can be so annoying. 26 00:02:23,352 --> 00:02:25,561 Just tell Cuddy you've got an urgent case. You had to leave early. 27 00:02:25,687 --> 00:02:27,980 - That would be lying. - And that would be wrong. 28 00:02:28,106 --> 00:02:31,567 But luckily the definition of "urgent" is fungible. 29 00:02:31,985 --> 00:02:34,695 Not the definition of "case", though. 30 00:02:37,699 --> 00:02:43,120 You have no cases? 31 00:02:43,956 --> 00:02:46,624 You've got handpicked doctors, specialists 32 00:02:46,750 --> 00:02:49,877 working for you, and they're sitting on their hands? 33 00:02:50,003 --> 00:02:53,631 - Cameron's answering my mail. - Oh, time well spent, I'm sure. 34 00:02:53,757 --> 00:02:55,341 Foreman and Chase? 35 00:02:56,343 --> 00:02:57,385 Research? 36 00:03:04,393 --> 00:03:07,144 Nine letters. Iodine deficiency in children. 37 00:03:07,271 --> 00:03:08,688 Cretinism. 38 00:03:18,448 --> 00:03:21,826 So, 4:03 p.m., Dr. House checks out. 39 00:03:21,952 --> 00:03:24,495 - Please write that down. - Dr. House. 40 00:03:24,621 --> 00:03:27,373 Sorry. Done for the day. Plenty of docs here to take care of you. 41 00:03:27,499 --> 00:03:29,083 But we had an appointment. 42 00:03:29,209 --> 00:03:31,002 Nice try, but this is a walk-in clinic, 43 00:03:31,128 --> 00:03:32,128 which means there are no appointments. 44 00:03:32,254 --> 00:03:34,088 You walk in, sign the chart and a doctor will see you. 45 00:03:34,214 --> 00:03:35,214 Just not me. 46 00:03:35,340 --> 00:03:38,134 Your letter says that we'd see you. 47 00:03:39,052 --> 00:03:41,971 - Not a big letter writer. - Here. 48 00:03:44,892 --> 00:03:47,351 When did my signature get so girlie? 49 00:03:48,270 --> 00:03:49,270 I can explain. 50 00:03:49,396 --> 00:03:50,688 See that "G"? 51 00:03:50,814 --> 00:03:52,356 See how it makes a big loop on top? 52 00:03:52,482 --> 00:03:54,734 Doesn't even look like my handwriting. 53 00:03:54,860 --> 00:03:57,320 Think I have something? What's the differential diagnosis 54 00:03:57,446 --> 00:03:59,322 for writing G's like a junior high school girl? 55 00:03:59,448 --> 00:04:01,282 It's impossible to get to you through normal channels. 56 00:04:01,408 --> 00:04:02,533 They have called, e-mailed. 57 00:04:02,659 --> 00:04:04,035 Perseverance does not equal worthiness. 58 00:04:04,161 --> 00:04:06,787 Next time you want to get my attention, wear something fun. 59 00:04:06,914 --> 00:04:10,333 - Low-rider jeans are hot. - Sixteen-year-old male. 60 00:04:10,459 --> 00:04:12,752 Sudden onset of double vision and night terrors, 61 00:04:12,878 --> 00:04:14,045 with no apparent cause. 62 00:04:14,171 --> 00:04:16,797 - The kid's been to two neurologists... - Night terrors? 63 00:04:16,924 --> 00:04:20,092 - As in big scary monsters? - Yes. 64 00:04:23,263 --> 00:04:25,932 - Where are you going? - To see the family. 65 00:04:26,058 --> 00:04:27,058 You're going to examine a patient? 66 00:04:27,184 --> 00:04:29,810 Nine times out of 10, there's no reason to talk to a patient. 67 00:04:29,937 --> 00:04:31,729 But night terrors in a 16-year-old 68 00:04:31,855 --> 00:04:35,900 is a very good reason to talk to this family. Good work. 69 00:04:38,820 --> 00:04:40,738 Margins are fine. 70 00:04:41,365 --> 00:04:42,823 No lesions. 71 00:04:44,117 --> 00:04:45,868 Color is good. 72 00:04:46,536 --> 00:04:48,746 How long have you been having night terrors? 73 00:04:48,872 --> 00:04:50,957 - Three weeks. - He's afraid to go to bed. 74 00:04:51,083 --> 00:04:53,751 He's exhausted, can barely function. 75 00:04:55,087 --> 00:04:56,087 What does that tell you? 76 00:04:56,213 --> 00:04:58,631 Nothing. It's just fun watching him blink. 77 00:04:59,132 --> 00:05:00,633 Name as many animals as you can 78 00:05:00,759 --> 00:05:03,302 that begin with the letter "B". Go. 79 00:05:10,435 --> 00:05:11,435 Baby elephant? 80 00:05:11,561 --> 00:05:13,437 Baby elephant is actually a good answer. 81 00:05:13,563 --> 00:05:15,398 - "B" is a bear of a letter. - What does that tell you? 82 00:05:15,524 --> 00:05:17,608 Proves two things, no neurological damage, 83 00:05:17,734 --> 00:05:19,735 and your son is never gonna be chief fry cook. 84 00:05:20,570 --> 00:05:24,031 In teens, there are two likely causes of night terrors. 85 00:05:24,157 --> 00:05:25,116 Post-traumatic stress. 86 00:05:25,242 --> 00:05:26,993 Any recent shoot-outs at your high school? 87 00:05:27,119 --> 00:05:28,327 - No. - Well, then, Dave... 88 00:05:28,453 --> 00:05:29,996 - Dan. - If there's no trauma, 89 00:05:30,122 --> 00:05:33,040 the other cause is sexual abuse. 90 00:05:36,128 --> 00:05:37,670 So who's molesting you? 91 00:05:37,796 --> 00:05:39,839 Teacher? Extra-friendly neighbor? 92 00:05:40,424 --> 00:05:42,425 I'd ask if either of you were involved, but you'd deny it. 93 00:05:42,551 --> 00:05:44,135 No. We would never do anything to hurt Dan. 94 00:05:44,261 --> 00:05:46,220 I say it here, it comes out there. 95 00:05:46,763 --> 00:05:49,181 This lack of response is consistent with abuse. 96 00:05:49,307 --> 00:05:51,308 There's no one, okay? I swear. 97 00:05:52,144 --> 00:05:53,227 There was trauma. 98 00:05:53,353 --> 00:05:55,980 I got hit in the head during a lacrosse game. 99 00:05:56,857 --> 00:05:59,608 Did you know that he got hit in the head? 100 00:06:00,110 --> 00:06:02,069 They didn't mention it. No. 101 00:06:02,195 --> 00:06:03,654 Yeah. Why bother? 102 00:06:06,658 --> 00:06:09,660 No, no. We took him to the ER after the game. 103 00:06:09,786 --> 00:06:12,163 He was scanned. They tested him. They said he was fine. 104 00:06:12,289 --> 00:06:13,330 No concussion. It's gotta be... 105 00:06:13,457 --> 00:06:17,209 You hound me for my opinion, and then you question my diagnosis. 106 00:06:17,335 --> 00:06:18,419 Cool. 107 00:06:18,545 --> 00:06:20,796 ER obviously screwed up. Kid's got a concussion. 108 00:06:20,922 --> 00:06:22,381 I had double vision before I was hit. 109 00:06:22,507 --> 00:06:24,341 Well, that changes everything. 110 00:06:24,468 --> 00:06:27,136 You need glasses. That's why you had double vision, 111 00:06:27,262 --> 00:06:29,138 which is why you got hit, which is why you have a concussion, 112 00:06:29,264 --> 00:06:31,557 which is why you have night terrors. 113 00:06:31,683 --> 00:06:34,685 You need to see an ophthalmologist, which I am not. 114 00:06:35,187 --> 00:06:36,604 You enjoyed that. 115 00:06:36,730 --> 00:06:38,147 I brought a reasonable case to your attention, 116 00:06:38,273 --> 00:06:40,149 and you shoved it in my face just to humiliate me. 117 00:06:40,275 --> 00:06:43,152 - You're an only child, aren't you? - Why would you say that? 118 00:06:43,278 --> 00:06:44,862 Because everything is about you. 119 00:06:46,114 --> 00:06:47,948 This may seem incredibly controversial, 120 00:06:48,075 --> 00:06:50,284 but I think sexual abuse is bad. 121 00:06:50,410 --> 00:06:53,788 I just wanted to make sure he wasn't being diddled by daddy or mommy. 122 00:06:53,914 --> 00:06:55,956 Anything else is just a bonus. 123 00:07:06,468 --> 00:07:09,136 - I'm not an only child. - Interesting. 124 00:07:10,347 --> 00:07:12,515 - What? - Don't move. 125 00:07:13,350 --> 00:07:17,061 - Did I bore you in there? - What? No. Not really. 126 00:07:17,187 --> 00:07:18,020 Are you tired? 127 00:07:19,523 --> 00:07:21,607 - Sometimes. - He never sleeps. Of course he's tired. 128 00:07:21,733 --> 00:07:23,651 - Right now. Are you tired? - No. No. 129 00:07:23,777 --> 00:07:27,029 That twitch in your leg. Did you feel that? 130 00:07:28,198 --> 00:07:30,491 - Didn't hurt. - His leg twitched. I don't see what... 131 00:07:30,617 --> 00:07:32,326 It's called a myoclonic jerk. 132 00:07:32,452 --> 00:07:34,078 It's very common when you're falling asleep. 133 00:07:34,204 --> 00:07:35,412 Respiration rate falls, 134 00:07:35,539 --> 00:07:38,082 and the brain sometimes interprets this as the body dying, 135 00:07:38,208 --> 00:07:39,166 so it sends a pulse to wake it up. 136 00:07:39,292 --> 00:07:42,878 - So? - So, he's not asleep. He's awake. 137 00:07:44,798 --> 00:07:46,257 Admit him. 138 00:07:49,553 --> 00:07:52,346 I recognize that loopy "G... 139 00:07:53,223 --> 00:07:55,057 So, what does the jerk tell us? 140 00:07:55,183 --> 00:07:57,810 Nothing good. The brain's losing control of the body. 141 00:07:57,936 --> 00:07:59,145 Can't order the eyes to focus, 142 00:07:59,271 --> 00:08:00,729 regulate sleep patterns or control muscles. 143 00:08:00,856 --> 00:08:03,107 A movement disorder or a degenerative brain disease. 144 00:08:03,233 --> 00:08:05,109 Either way, this kid's gonna be picking up his diploma 145 00:08:05,235 --> 00:08:06,277 in diapers and a wheelchair. 146 00:08:06,403 --> 00:08:08,529 Maybe not that bad. Could be an infection. 147 00:08:08,655 --> 00:08:10,948 You wish. No fever, no white count. 148 00:08:11,074 --> 00:08:13,868 Anyone think this differential diagnosis might be compromised 149 00:08:13,994 --> 00:08:16,245 because we don't have an accurate family history? 150 00:08:16,371 --> 00:08:17,872 I took an accurate family history. 151 00:08:17,998 --> 00:08:20,499 You didn't even take an accurate family. 152 00:08:20,625 --> 00:08:22,543 - His father's not his father. - Why would you say that? 153 00:08:22,669 --> 00:08:23,919 Thirty percent of all dads out there 154 00:08:24,045 --> 00:08:25,838 don't realize they're raising someone else's kid. 155 00:08:25,964 --> 00:08:27,673 From what I've read, false paternity's more like 10%. 156 00:08:27,799 --> 00:08:29,300 That's what our moms would like us to believe. 157 00:08:29,426 --> 00:08:31,927 Who cares? If he got it from his parents, they'd both be dead by now. 158 00:08:32,053 --> 00:08:33,554 Can we get on with the differential diagnosis? 159 00:08:33,680 --> 00:08:34,847 Fifty bucks says I'm right. 160 00:08:34,973 --> 00:08:36,849 - I'll take your money. - Hit a nerve? 161 00:08:36,975 --> 00:08:37,933 Don't worry, Foreman. 162 00:08:38,059 --> 00:08:39,852 I'm sure the guy who tucked you in at night was your daddy. 163 00:08:39,978 --> 00:08:41,520 Make it $100. 164 00:08:41,646 --> 00:08:44,815 What about leukoencephalopathy in a 16-year-old? 165 00:08:44,941 --> 00:08:47,026 It doesn't necessarily have to be that bad. 166 00:08:47,152 --> 00:08:47,943 If we exclude the night terrors, 167 00:08:48,069 --> 00:08:49,028 it could be something systemic. 168 00:08:49,154 --> 00:08:51,739 His liver, kidneys. Something outside the brain. 169 00:08:51,865 --> 00:08:55,201 Yes. Feel free to exclude any symptom if it makes your job easier. 170 00:08:55,327 --> 00:08:57,578 The night terrors were anecdotal. He could've had a bad dream. 171 00:08:57,704 --> 00:08:59,496 No. parents said he was conscious during the event 172 00:08:59,623 --> 00:09:01,749 and didn't remember anything afterwards. 173 00:09:01,875 --> 00:09:03,292 - That's a night terror. - Parents said? 174 00:09:04,169 --> 00:09:05,127 That's a good point. 175 00:09:05,253 --> 00:09:08,756 Before we condemn this kid, maybe we should entertain Dr. Chase's skepticism. 176 00:09:08,882 --> 00:09:10,382 I want a detailed polysomnograph. 177 00:09:10,508 --> 00:09:13,719 If he's having night terrors, I want to see them. 178 00:09:36,868 --> 00:09:38,994 I usually don't move during night terrors. 179 00:09:39,120 --> 00:09:40,621 I'm not restraining you for them. 180 00:09:43,583 --> 00:09:47,127 EEG revealed abnormalities in your brain, 181 00:09:47,254 --> 00:09:49,505 caused nerve damage in your toes. 182 00:09:55,929 --> 00:10:00,015 - What are you doing? - Fixing it. 183 00:10:00,600 --> 00:10:02,101 Can I talk to my parents? 184 00:10:02,644 --> 00:10:06,981 - Oh, they know all about this. - I'd really like to see them. 185 00:10:15,865 --> 00:10:19,076 Please. I'd really like them here. 186 00:10:21,204 --> 00:10:23,122 This is gonna hurt, Dan. 187 00:10:23,248 --> 00:10:24,957 Oh. Oh, God. 188 00:10:41,641 --> 00:10:43,475 That's a night terror. 189 00:10:55,113 --> 00:10:59,033 We did a CT, MRI, CBC, CHEM-7 and chest X-ray. 190 00:10:59,159 --> 00:11:00,159 All the tests came back normal. 191 00:11:00,285 --> 00:11:01,493 There's nothing to explain his symptoms. 192 00:11:01,619 --> 00:11:04,121 Okay, but let's pretend there's something and go from there. 193 00:11:04,456 --> 00:11:06,040 Who sees something on this MRI? 194 00:11:08,293 --> 00:11:11,420 - No lesions in the white matter. - No structural abnormalities. 195 00:11:11,546 --> 00:11:13,005 No space-occupying tumors. 196 00:11:13,131 --> 00:11:16,717 He's 16, so he should have an absolutely pristine brain. 197 00:11:16,843 --> 00:11:19,178 The smallest thing is abnormal. 198 00:11:19,554 --> 00:11:21,388 Meningeal enhancement. 199 00:11:22,140 --> 00:11:24,808 - My bet is viral meningitis. - Excellent. 200 00:11:25,185 --> 00:11:26,769 Do you see what he did there? 201 00:11:26,895 --> 00:11:29,063 Took a small clue that there's a neurological problem 202 00:11:29,189 --> 00:11:30,314 and wasn't afraid to run with it. 203 00:11:30,440 --> 00:11:32,900 There's no evidence of meningitis on that MRI. 204 00:11:33,026 --> 00:11:35,277 No, there's not. He's completely wrong. 205 00:11:35,403 --> 00:11:36,945 Then what clue are you talking about? 206 00:11:37,072 --> 00:11:38,781 He knew that I saw something on the MRI, 207 00:11:38,907 --> 00:11:41,742 so he figured there must be something there and took a guess. 208 00:11:41,868 --> 00:11:45,245 - Clever, but also pathetic. - So what did you find? 209 00:11:45,955 --> 00:11:48,707 Take a close look at the corpus callosum. 210 00:11:51,086 --> 00:11:53,045 Looks okay. 211 00:11:53,213 --> 00:11:54,922 Are we all looking at the same thing? 212 00:11:55,048 --> 00:11:57,257 Two hundred million interhemispheric nerve fibers. 213 00:11:57,384 --> 00:12:01,720 The George Washington Bridge between the left and right side of the brain. 214 00:12:01,971 --> 00:12:02,805 It's subtle. 215 00:12:06,684 --> 00:12:10,312 There's some bowing. There. An upward arch. 216 00:12:10,438 --> 00:12:13,524 - Are you guessing? - Yes. 217 00:12:13,691 --> 00:12:16,610 - Too bad. You're right. - He probably just moved. 218 00:12:16,736 --> 00:12:19,405 Nobody stays perfectly still for the entire MRI. 219 00:12:19,531 --> 00:12:21,407 Yeah. Probably got restless 220 00:12:21,533 --> 00:12:23,325 and shifted one hemisphere of his brain 221 00:12:23,451 --> 00:12:26,537 to a more comfortable position. Something is pushing on it. 222 00:12:26,663 --> 00:12:28,122 If there was bowing, could be a tumor. 223 00:12:28,248 --> 00:12:30,040 Do you see a tumor on this MRI? 224 00:12:30,166 --> 00:12:31,917 No, but I don't see any bowing either. 225 00:12:32,043 --> 00:12:35,170 There's no tumor. Just a blockage causing pressure causing symptoms. 226 00:12:35,296 --> 00:12:39,091 Today, night terrors. Tomorrow, he's bleeding out of his eyes. 227 00:12:39,759 --> 00:12:41,552 Get him a radionucleotide cisternogram. 228 00:12:41,678 --> 00:12:43,512 I guarantee you'll see a blockage. 229 00:12:50,061 --> 00:12:51,228 Okay. 230 00:12:54,816 --> 00:12:55,816 Easy. 231 00:12:55,942 --> 00:12:57,776 Okay. Squeeze my hand. 232 00:13:02,240 --> 00:13:04,199 All right. Squeeze hard. 233 00:13:06,953 --> 00:13:08,412 All right. 234 00:13:15,170 --> 00:13:18,464 Now I'm injecting a material that's tagged with a radioisotope. 235 00:13:19,424 --> 00:13:23,093 It's gonna enter your spine and travel up to your brain. 236 00:13:23,636 --> 00:13:26,513 It'll make you able to think deep thoughts, 237 00:13:26,764 --> 00:13:28,348 run 100 miles an hour. 238 00:13:30,059 --> 00:13:31,101 Easy. 239 00:13:45,283 --> 00:13:48,410 Their eyes aren't the same color, but that fleck in the eyes, 240 00:13:48,536 --> 00:13:51,079 that's maybe a 1-in-10 chance if they're not related? 241 00:13:51,206 --> 00:13:53,499 No. House isn't gonna pay you based on that. 242 00:13:54,876 --> 00:13:57,336 Any excuse we can give the folks to justify a DNA test? 243 00:13:57,462 --> 00:13:59,213 We could tell them he's got Huntington's, 244 00:13:59,339 --> 00:14:02,508 whole family should be tested or they'll all die. 245 00:14:05,136 --> 00:14:06,345 Hey. 246 00:14:07,055 --> 00:14:08,847 There's a lot of blockage. 247 00:14:08,973 --> 00:14:10,807 I've scheduled him for surgery. 248 00:14:10,934 --> 00:14:12,643 We're gonna put a shunt into one of the ventricles 249 00:14:12,769 --> 00:14:14,853 to give the cerebrospinal fluid an out. 250 00:14:14,979 --> 00:14:17,773 No more pressure, everything goes back to normal. 251 00:14:17,899 --> 00:14:20,400 He's lucky to have you as his doctors. 252 00:14:28,826 --> 00:14:32,454 No formula. Just Mommy's healthy, natural breast milk. 253 00:14:33,748 --> 00:14:35,040 Yummy. 254 00:14:35,166 --> 00:14:38,252 Her whole face just got swollen like this overnight. 255 00:14:40,421 --> 00:14:41,797 No fever. 256 00:14:42,966 --> 00:14:46,260 Glands normal. Missing her vaccination dates. 257 00:14:46,386 --> 00:14:47,970 We're not vaccinating. 258 00:14:54,435 --> 00:14:55,477 Think they don't work? 259 00:14:55,603 --> 00:14:57,896 I think some multinational pharmaceutical company 260 00:14:58,022 --> 00:15:01,108 wants me to think they work, pad their bottom line. 261 00:15:02,819 --> 00:15:04,152 - May I? - Sure. 262 00:15:10,493 --> 00:15:13,495 Yeah. All-natural, no dyes is a good business. 263 00:15:13,621 --> 00:15:15,455 All-natural children's toys. 264 00:15:15,582 --> 00:15:18,542 Toy companies, they don't arbitrarily mark up their frogs. 265 00:15:18,668 --> 00:15:22,045 They don't lie about how much they spend on research and development. 266 00:15:22,171 --> 00:15:24,423 The worst that a toy company could be accused of 267 00:15:24,549 --> 00:15:27,175 is making a really boring frog. 268 00:15:29,929 --> 00:15:32,472 You know another really good business? 269 00:15:32,724 --> 00:15:35,183 Teeny, tiny baby coffins. 270 00:15:36,936 --> 00:15:40,647 You can get them in frog green, fire-engine red. Really. 271 00:15:41,608 --> 00:15:45,527 The antibodies in yummy mummy only protect the kid for six months, 272 00:15:45,653 --> 00:15:48,113 which is why these companies think they can gouge you. 273 00:15:48,239 --> 00:15:51,867 They think that you'll spend whatever they ask to keep your kid alive. 274 00:15:51,993 --> 00:15:53,994 Want to change things? Prove them wrong. 275 00:15:54,120 --> 00:15:56,455 Few hundred parents like you decide they'd rather let their kid die 276 00:15:56,581 --> 00:15:58,498 than cough up 40 bucks for a vaccination, 277 00:15:58,625 --> 00:16:01,335 believe me, prices will drop really fast. 278 00:16:06,549 --> 00:16:08,050 Tell me what she has. 279 00:16:10,970 --> 00:16:11,970 A cold. 280 00:16:13,806 --> 00:16:15,390 There's a problem. 281 00:16:15,516 --> 00:16:16,850 Complications in surgery? 282 00:16:16,976 --> 00:16:18,268 Surgery went fine. He's in recovery. 283 00:16:18,394 --> 00:16:20,270 But we took a vial of CSF and tested it. 284 00:16:20,396 --> 00:16:21,355 Really? 285 00:16:21,481 --> 00:16:22,939 Turns out the bowing wasn't the cause of his problems. 286 00:16:23,066 --> 00:16:24,066 It was a symptom. 287 00:16:24,192 --> 00:16:26,943 Oligoclonal bands and increased intrathecal IgG. 288 00:16:27,070 --> 00:16:28,820 Which means multiple sclerosis. 289 00:16:28,946 --> 00:16:30,864 And the reason it takes three of you to tell me this? 290 00:16:30,990 --> 00:16:33,158 Because we're having a disagreement about whether or not it is MS. 291 00:16:33,284 --> 00:16:34,618 No lesions on the MRI. 292 00:16:34,744 --> 00:16:36,370 It's early. He's had the disease for maybe two weeks. 293 00:16:36,496 --> 00:16:39,289 McDonald criteria requires six months to make a definitive diagnosis. 294 00:16:39,415 --> 00:16:41,041 Who cares about MacPhearson? 295 00:16:41,167 --> 00:16:43,001 - I hear he tortured kittens. - McDonald. 296 00:16:43,127 --> 00:16:45,170 Oh, McDonald. Wonderful doctor, loved kittens. 297 00:16:45,296 --> 00:16:47,881 The VEP indicates slowing of the brain. 298 00:16:48,007 --> 00:16:49,091 Without the lesions, we can't be sure. 299 00:16:49,217 --> 00:16:51,593 Well, if it is, it's gone from 0 to 60 in three weeks, 300 00:16:51,719 --> 00:16:54,137 which would indicate rapidly progressive MS. 301 00:16:54,263 --> 00:16:55,889 Not the fun MS with the balloons 302 00:16:56,015 --> 00:16:57,641 and the bike rides for cripples in wheelchairs. 303 00:16:57,767 --> 00:17:00,602 - We should wait until... - Start treating him now, 304 00:17:00,728 --> 00:17:02,521 maybe he can walk for another couple of years, 305 00:17:02,647 --> 00:17:05,023 maybe live for another five. 306 00:17:05,149 --> 00:17:07,317 Break it to the family. I'm going home. 307 00:17:07,443 --> 00:17:10,195 It'll take months for a definitive diagnosis. 308 00:17:10,321 --> 00:17:11,655 What'll happen to me? 309 00:17:13,199 --> 00:17:15,951 MS is an incredibly variable disease. 310 00:17:16,077 --> 00:17:19,204 If it is MS, and we're not 100% sure. 311 00:17:19,330 --> 00:17:21,790 What do you think is gonna happen? 312 00:17:24,961 --> 00:17:27,003 There are some medications to manage the symptoms, 313 00:17:27,130 --> 00:17:31,174 but as the disease progresses, the problems will become more severe. 314 00:17:31,300 --> 00:17:33,218 Bowel and bladder dysfunction, 315 00:17:33,344 --> 00:17:35,470 loss of cognitive function, pain... 316 00:17:35,596 --> 00:17:37,013 So it's gonna hurt? 317 00:17:39,183 --> 00:17:41,727 The brain's like a big jumble of wires. 318 00:17:41,853 --> 00:17:44,896 MS strips them of the insulation, and the nerves die. 319 00:17:45,022 --> 00:17:47,065 Brain interprets it as pain. 320 00:17:47,191 --> 00:17:51,194 But by starting treatment, we're gonna prevent that for as long as possible. 321 00:17:51,320 --> 00:17:52,946 We're looking into a couple of specialists, 322 00:17:53,072 --> 00:17:56,825 and until we get you squared away, you'll stay here, okay? 323 00:18:17,555 --> 00:18:20,140 Security checked the videotapes from all perimeter cameras. 324 00:18:20,266 --> 00:18:21,266 He's still gotta be in the hospital. 325 00:18:21,392 --> 00:18:22,350 Where's Chase? 326 00:18:22,477 --> 00:18:23,643 - Main floor. - Okay. 327 00:18:23,770 --> 00:18:25,145 You take the cafeteria and administration. 328 00:18:25,271 --> 00:18:27,606 I'll hit the research annex and work my way back to you. 329 00:19:05,436 --> 00:19:06,603 Dan? 330 00:19:12,819 --> 00:19:14,903 I'm not here. Leave a message. 331 00:19:20,576 --> 00:19:23,328 Dr. Cuddy. Great outfit. 332 00:19:23,454 --> 00:19:25,539 What are you doing back here? Patient? 333 00:19:25,665 --> 00:19:26,998 No. Hooker. 334 00:19:27,124 --> 00:19:28,917 Went to my office instead of my home. 335 00:19:39,804 --> 00:19:41,012 Dr. House. 336 00:19:41,931 --> 00:19:43,139 Dan's missing. 337 00:19:43,266 --> 00:19:44,975 Yeah. I got that part from the message. 338 00:19:45,101 --> 00:19:46,059 You said I was needed immediately. 339 00:19:46,185 --> 00:19:48,061 He shouldn't move after a lumbar puncture. 340 00:19:48,187 --> 00:19:50,939 I agree. He's gonna have a very nasty headache. 341 00:19:51,065 --> 00:19:53,900 That would also be my opinion if consulted tomorrow morning. 342 00:19:54,026 --> 00:19:55,402 We wanted to keep you informed. 343 00:19:55,528 --> 00:19:57,946 He heard some pretty heavy news. 344 00:19:59,073 --> 00:20:01,700 This is not a toddler wandering around a department store. 345 00:20:01,826 --> 00:20:03,952 He's 16. You'll find him. 346 00:20:05,079 --> 00:20:06,705 I'm going home. 347 00:20:07,623 --> 00:20:09,916 When you say, "Call me if you need anything", you mean, "Don't call"? 348 00:20:10,042 --> 00:20:12,294 No, I mean call me if I could do something. 349 00:20:12,420 --> 00:20:13,503 I'm bad at search parties, 350 00:20:13,629 --> 00:20:16,715 and I'm bad at sitting around looking nervous, doing nothing. 351 00:20:16,841 --> 00:20:18,633 What about his parents? Should we call them? 352 00:20:18,759 --> 00:20:21,136 Why? Do you think they're hiding him? 353 00:20:21,971 --> 00:20:23,972 Make sure someone checks the roof. 354 00:20:24,098 --> 00:20:28,268 Some of the orderlies keep the door propped open so they can grab a smoke. 355 00:21:03,054 --> 00:21:04,888 Dan. You okay? 356 00:21:12,313 --> 00:21:14,564 There are experimental treatments. 357 00:21:14,690 --> 00:21:15,899 Ongoing research. 358 00:21:16,567 --> 00:21:18,944 Who knows what they'll discover in a year or two. 359 00:21:19,070 --> 00:21:20,862 This is where I dropped the ball. 360 00:21:20,988 --> 00:21:24,074 Dan, we're standing on the roof of the hospital. 361 00:21:25,993 --> 00:21:27,077 Dan. 362 00:21:28,079 --> 00:21:29,996 Dan, you're not on the field. 363 00:21:30,873 --> 00:21:32,666 - He doesn't know where he is. - Dan! 364 00:21:32,792 --> 00:21:33,875 Foreman. 365 00:21:35,378 --> 00:21:36,544 Dan. 366 00:21:38,172 --> 00:21:39,756 - Dan? - Dan, no! 367 00:21:51,227 --> 00:21:52,686 Dr. Foreman. 368 00:21:54,605 --> 00:21:56,314 I assume you found the kid. 369 00:21:56,440 --> 00:21:58,942 - He almost walked off the roof. - Suicidal? 370 00:21:59,068 --> 00:22:01,236 No, he thought he was on his lacrosse field. 371 00:22:01,362 --> 00:22:03,321 Look, I was just gonna run home, shower, change... 372 00:22:03,447 --> 00:22:05,323 - Conscious? - Yeah. 373 00:22:06,701 --> 00:22:07,742 How'd you talk him down? 374 00:22:07,868 --> 00:22:10,996 - Actually, Chase tackled him. - How come you didn't do it? 375 00:22:11,122 --> 00:22:13,498 Right. Well, I am black, but he was closer. 376 00:22:16,669 --> 00:22:18,920 Come on. You can ride up with me. 377 00:22:24,760 --> 00:22:27,178 Anybody tell the family that their boy almost stepped off a roof? 378 00:22:27,304 --> 00:22:28,346 They must be thrilled. 379 00:22:28,472 --> 00:22:31,057 They're not suing, but I think only because Chase asked... 380 00:22:31,183 --> 00:22:33,184 Why does everybody always think I'm being sarcastic? 381 00:22:33,310 --> 00:22:36,396 This is great news. He doesn't have MS. 382 00:22:36,522 --> 00:22:38,648 Parents should be thrilled. Well, the mom anyway. 383 00:22:38,774 --> 00:22:39,899 Of course, the dad probably doesn't know... 384 00:22:40,026 --> 00:22:41,568 Why doesn't he have MS? 385 00:22:41,694 --> 00:22:43,737 He was on the roof, thinking he was on a lacrosse field. 386 00:22:43,863 --> 00:22:45,155 Conscious, and therefore not a night terror. 387 00:22:45,281 --> 00:22:47,657 - You want some of this? - Yeah, sure. 388 00:22:48,075 --> 00:22:50,201 He was in an acute confusional state, 389 00:22:50,327 --> 00:22:52,662 which doesn't fit with a demyelinating disease like MS. 390 00:22:52,788 --> 00:22:53,788 Oligoclonal bands... 391 00:22:53,914 --> 00:22:55,040 Were real. 392 00:22:55,166 --> 00:22:56,958 They just mean something other than MS. 393 00:22:57,084 --> 00:22:58,752 So, what are they telling us? 394 00:22:58,878 --> 00:23:00,003 That the immune system is working? 395 00:23:00,129 --> 00:23:01,171 Right. 396 00:23:01,297 --> 00:23:02,964 He has an infection in his brain. 397 00:23:03,090 --> 00:23:06,718 - What about sex? - Well, it might get complicated. 398 00:23:06,844 --> 00:23:07,886 I mean, we work together. 399 00:23:08,012 --> 00:23:09,429 I'm older, certainly, but maybe you like that. 400 00:23:09,555 --> 00:23:11,264 I meant maybe he has neurosyphilis. 401 00:23:12,141 --> 00:23:13,141 Nice cover. 402 00:23:13,267 --> 00:23:14,517 Sorry. RPR was negative. 403 00:23:14,643 --> 00:23:16,352 We don't need a definitive test to confirm this. 404 00:23:16,479 --> 00:23:18,271 Sure. Didn't need one to confirm MS. 405 00:23:18,397 --> 00:23:20,982 Okay. Let's wait for you to run titers on 1,400 viruses 406 00:23:21,108 --> 00:23:23,026 while this kid's brain turns to mush. 407 00:23:23,152 --> 00:23:24,944 So the fact that he doesn't have MS, 408 00:23:25,071 --> 00:23:27,030 it's really not good news after all. 409 00:23:27,156 --> 00:23:28,990 Well, it is if it's neurosyphilis. 410 00:23:29,116 --> 00:23:32,118 The likelihood of a false negative on an RPR test, 30%. 411 00:23:32,244 --> 00:23:35,872 Likelihood of a 16-year-old having sex, roughly 120%. 412 00:23:35,998 --> 00:23:37,040 I'll start him on IV penicillin. 413 00:23:37,166 --> 00:23:38,166 No. We're not gonna wait for that. 414 00:23:38,292 --> 00:23:39,876 The most effective way to deliver the drug 415 00:23:40,002 --> 00:23:41,294 is right into his brain via the spine. 416 00:23:41,420 --> 00:23:43,379 We can't. In a cramped space like the brain, 417 00:23:43,506 --> 00:23:46,257 increased intracranial pressure from a high-volume drug like penicillin 418 00:23:46,383 --> 00:23:48,676 could herniate his brain stem. It'd kill him. 419 00:23:48,803 --> 00:23:50,804 No neurologist in his right mind would recommend that. 420 00:23:50,930 --> 00:23:53,681 Show of hands. Who thinks I'm not in my right mind? 421 00:23:54,391 --> 00:23:57,644 And who thinks I forget this fairly basic neurological fact? 422 00:23:58,270 --> 00:24:00,772 Who thinks there's a third option? 423 00:24:02,191 --> 00:24:04,109 Very good. What's the third choice? 424 00:24:04,235 --> 00:24:07,278 No idea. You just asked if I thought there was one. 425 00:24:09,740 --> 00:24:11,491 The patient has a shunt in his brain. 426 00:24:11,617 --> 00:24:12,784 There'll be no increased pressure. 427 00:24:12,910 --> 00:24:15,203 We can put as much penicillin into his body as we want. 428 00:24:15,329 --> 00:24:18,164 Excellent. Inject him through a lumbar puncture. 429 00:24:21,168 --> 00:24:25,463 One of us is gonna do this to you twice a day for the next two weeks. 430 00:24:27,633 --> 00:24:28,633 I'm ready. Go. 431 00:24:28,759 --> 00:24:32,387 He could get syphilis even if he's not sexually active? 432 00:24:33,389 --> 00:24:36,850 Well, it's unusual, but it's possible. 433 00:24:37,810 --> 00:24:39,727 Okay. Relax. 434 00:24:52,783 --> 00:24:56,077 It's infected, with a really big hole, 435 00:24:56,203 --> 00:24:58,538 like you stuck a nail in it to relieve the pressure. 436 00:24:58,664 --> 00:24:59,622 I wouldn't do that. 437 00:24:59,748 --> 00:25:00,790 Although the wound is irregular. 438 00:25:00,916 --> 00:25:02,917 It's not cylindrical. It's shaped like a triangle. 439 00:25:03,043 --> 00:25:05,211 So, not a nail. 440 00:25:05,337 --> 00:25:07,255 - Steak knife? - Wife's nail file. 441 00:25:07,381 --> 00:25:08,965 Nail file. 442 00:25:09,800 --> 00:25:12,594 Yeah. Pain will make you do stupid things. 443 00:25:13,012 --> 00:25:14,888 Something to take the edge off? 444 00:25:15,014 --> 00:25:15,889 Yeah. 445 00:25:18,434 --> 00:25:19,809 Cheers. 446 00:25:24,148 --> 00:25:26,941 So, you have family here in Princeton? 447 00:25:27,067 --> 00:25:28,109 No. 448 00:25:29,028 --> 00:25:30,028 Here on work? 449 00:25:30,154 --> 00:25:31,863 - No. Why are you... - Does your penis hurt? 450 00:25:31,989 --> 00:25:34,240 No. What? Should it? 451 00:25:34,366 --> 00:25:38,077 No. Just thought I'd toss you a really inappropriate question. 452 00:25:38,204 --> 00:25:39,412 Your lawyer's gonna love it. 453 00:25:39,538 --> 00:25:40,705 Why would I want to sue you? 454 00:25:40,831 --> 00:25:41,789 I want you to treat me. 455 00:25:41,916 --> 00:25:42,957 You're from Maplewood, New Jersey, right? 456 00:25:43,083 --> 00:25:44,083 Yeah. 457 00:25:44,210 --> 00:25:46,920 Now, why would you drive 70 miles 458 00:25:47,046 --> 00:25:47,921 to get treatment for a condition 459 00:25:48,047 --> 00:25:50,715 that a nine-year-old could diagnose? 460 00:25:51,884 --> 00:25:54,302 It's the free-flowing pus that's the tip-off. 461 00:25:54,428 --> 00:25:55,386 I was in town. 462 00:25:55,512 --> 00:25:57,347 Not for family. Not for work. 463 00:25:57,473 --> 00:25:59,432 You drove 70 miles to a walk-in clinic. 464 00:25:59,558 --> 00:26:00,850 You passed two hospitals on the road. 465 00:26:00,976 --> 00:26:03,186 Now, either you've got a problem with those hospitals, 466 00:26:03,312 --> 00:26:04,437 or they have a problem with you. 467 00:26:04,563 --> 00:26:07,232 My guess is you've sued half the doctors in Maplewood, 468 00:26:07,358 --> 00:26:09,067 and the rest are now refusing to help you. 469 00:26:09,193 --> 00:26:10,443 It's ironic, isn't it? 470 00:26:10,569 --> 00:26:13,112 Sort of like the boy who sued wolf. 471 00:26:13,697 --> 00:26:16,115 You know, I bet we have a doctor here named Wolf. 472 00:26:16,242 --> 00:26:18,201 How perfect would that be? 473 00:26:18,744 --> 00:26:19,744 I'm gonna page him. 474 00:26:19,870 --> 00:26:21,037 Okay. You know what? Thank you. 475 00:26:21,163 --> 00:26:23,539 I'm gonna find a doctor to take care of this. 476 00:26:23,666 --> 00:26:25,667 I didn't say I wouldn't treat you. 477 00:26:25,793 --> 00:26:27,919 We'll drain your knee, run some lab work. Fix you right up. 478 00:26:28,045 --> 00:26:30,755 - Why would you do that? - I'm a people person. 479 00:26:32,091 --> 00:26:33,508 You actually treated him? 480 00:26:33,634 --> 00:26:35,009 All I know is he sued some doctors. 481 00:26:35,135 --> 00:26:37,679 Who am I to assume they didn't have it coming to them? 482 00:26:37,805 --> 00:26:39,555 The cutest little tennis outfit. 483 00:26:39,682 --> 00:26:41,641 My God, I thought I was gonna have a heart attack. 484 00:26:41,767 --> 00:26:43,643 Oh, my. I didn't see you there. That is so embarrassing. 485 00:26:43,769 --> 00:26:45,103 How's your hooker doing? 486 00:26:45,229 --> 00:26:46,980 Sweet of you to ask. Funny story. 487 00:26:47,106 --> 00:26:48,564 She was gonna be hospital administrator, 488 00:26:48,691 --> 00:26:50,858 but just hated having to screw people like that. 489 00:26:50,985 --> 00:26:51,985 I heard you found her on the roof. 490 00:26:52,111 --> 00:26:55,154 - You have very acute hearing. - You notify the parents? 491 00:26:55,281 --> 00:26:56,406 In due course, of course. 492 00:26:56,532 --> 00:27:00,702 And is there a paternity bet on the father of the patient? 493 00:27:00,828 --> 00:27:01,828 Doesn't sound like me. 494 00:27:01,954 --> 00:27:04,122 Well, it does, actually, but doesn't mean you're guilty. 495 00:27:04,248 --> 00:27:06,457 - You think? - I saw the parents in the lobby. 496 00:27:06,583 --> 00:27:09,127 Smart money's obviously on the father. 497 00:27:09,253 --> 00:27:11,421 My guy knows a guy who can get you in for 50 bucks. 498 00:27:11,547 --> 00:27:13,256 Fine. Tell your guy, if I win, 499 00:27:13,382 --> 00:27:15,258 you attend the faculty symposium, and you wear a tie. 500 00:27:15,384 --> 00:27:18,720 And if I win, no clinic hours for a week. 501 00:27:18,846 --> 00:27:20,847 My guy will call your guy. 502 00:27:22,725 --> 00:27:24,851 She's very good at her job. 503 00:27:29,356 --> 00:27:31,566 The treatments should start helping soon. 504 00:27:31,692 --> 00:27:35,653 Let us know if it gets easier to focus on things, remember stuff. 505 00:27:36,905 --> 00:27:38,031 Hey, Dan. 506 00:27:38,157 --> 00:27:40,783 Isn't Dr. Cameron's necklace a beauty? 507 00:27:40,909 --> 00:27:43,036 Something South American, I think. 508 00:27:43,162 --> 00:27:44,912 Yeah. Guatemalan. 509 00:27:45,956 --> 00:27:47,957 It's a cool necklace. 510 00:27:49,585 --> 00:27:52,170 - Thank you so much. - The kid's in pain. 511 00:27:54,131 --> 00:27:55,673 Don't fight it. Just let it happen. 512 00:27:55,799 --> 00:27:56,758 No. 513 00:27:56,884 --> 00:27:58,051 - You'll be dead in two days. - "No" what? 514 00:27:58,177 --> 00:27:59,135 I give it a day. 515 00:27:59,261 --> 00:28:00,970 Dan? You okay? 516 00:28:01,096 --> 00:28:02,388 - Dan? - Night terrors. 517 00:28:02,514 --> 00:28:04,849 Body decomposition once he's in the grave. 518 00:28:04,975 --> 00:28:06,267 Say goodbye to your mother and father. 519 00:28:06,393 --> 00:28:07,393 He's hearing voices. 520 00:28:07,519 --> 00:28:09,979 You're dying. It's all over, Dan. 521 00:28:11,982 --> 00:28:13,024 You're dying. Dying. Dead! 522 00:28:13,150 --> 00:28:15,068 You're a dead man! 523 00:28:15,944 --> 00:28:17,987 Push 2 milligrams IV Ativan, stat. 524 00:28:18,113 --> 00:28:19,947 It's all over. 525 00:28:20,282 --> 00:28:21,449 Come on, Dan. 526 00:28:21,575 --> 00:28:23,117 Get out of my head! 527 00:28:25,996 --> 00:28:28,581 Auditory hallucination shows further brain degeneration. 528 00:28:28,707 --> 00:28:29,916 Penicillin's not working. 529 00:28:30,042 --> 00:28:32,835 So either it's a bad batch of penicillin, 530 00:28:32,961 --> 00:28:34,796 or our diagnosis is wrong. 531 00:28:36,423 --> 00:28:39,425 Square one. MIDNIT. 532 00:28:39,551 --> 00:28:42,553 LFTs, BUN and creatinine are all normal. 533 00:28:42,679 --> 00:28:43,805 Diabetes is out, and no gap. 534 00:28:43,931 --> 00:28:46,474 - There goes metabolic. - MRA rules out vasculitis. 535 00:28:46,600 --> 00:28:47,850 "I" for inflammation. 536 00:28:47,976 --> 00:28:49,268 Too young for anything degenerative. 537 00:28:49,395 --> 00:28:50,853 "D", see ya. 538 00:28:50,979 --> 00:28:53,398 - "N" for neoplastic. - MRI was clean. 539 00:28:54,691 --> 00:28:56,609 - "I" for inflammation. - We already did that. 540 00:28:56,735 --> 00:28:59,028 Stupid to have two I's in one mnemonic. What's the other one? 541 00:28:59,154 --> 00:28:59,987 Infection. 542 00:29:00,114 --> 00:29:01,489 Oligoclonal bands still have to mean something. 543 00:29:01,615 --> 00:29:02,657 But no fevers. 544 00:29:02,783 --> 00:29:04,075 White count's elevated, but within range. 545 00:29:04,201 --> 00:29:06,994 We've tested for anything remotely possible. Everything's negative. 546 00:29:07,121 --> 00:29:08,663 CT scan rules out subdural. 547 00:29:08,831 --> 00:29:10,415 Trauma. Later much. 548 00:29:16,046 --> 00:29:17,255 You know the problem? 549 00:29:17,381 --> 00:29:20,800 "Midnight" is actually spelled with a "G" and an "H". 550 00:29:21,135 --> 00:29:24,720 If we could just figure out what those letters stand for. 551 00:29:27,975 --> 00:29:31,060 It's a sick brain, having fun, 552 00:29:33,105 --> 00:29:35,773 torturing him, talking to him. 553 00:29:40,946 --> 00:29:42,864 Scaring the hell out of him. 554 00:29:45,117 --> 00:29:49,370 Get him an EEG, left and right EOG, esophageal microphones. 555 00:29:50,122 --> 00:29:53,875 If this thing wants to talk, let's listen. 556 00:29:56,003 --> 00:29:59,964 We're missing something. This is screwed up. 557 00:30:00,090 --> 00:30:03,885 That's why you came up with the brain talking to the virus thing? 558 00:30:04,011 --> 00:30:06,095 I panicked, okay? 559 00:30:06,221 --> 00:30:08,681 Sounded cool, though. They bought it. 560 00:30:12,352 --> 00:30:13,478 Crap. 561 00:30:14,021 --> 00:30:16,022 Another reason I don't like meeting patients. 562 00:30:16,148 --> 00:30:19,025 If they don't know what you look like, they can't yell at you. 563 00:30:19,151 --> 00:30:20,568 Here we go. 564 00:30:25,324 --> 00:30:27,450 How can you just sit there? 565 00:30:28,577 --> 00:30:29,994 If I eat standing up, I spill. 566 00:30:30,120 --> 00:30:33,331 Our son is dying, and you could care less? 567 00:30:34,124 --> 00:30:37,168 We're going through hell. You're doing nothing? 568 00:30:38,504 --> 00:30:40,630 I'm sorry. You need to vent. I understand. 569 00:30:40,756 --> 00:30:42,590 Don't be condescending. 570 00:30:43,091 --> 00:30:45,718 You haven't checked in on him once. 571 00:30:45,928 --> 00:30:47,970 Blood pressure is 110 over 70. 572 00:30:48,764 --> 00:30:51,182 His shunt is patent, well-placed in the right lateral ventricle. 573 00:30:51,308 --> 00:30:53,059 The EKG shows a normal QRS 574 00:30:53,185 --> 00:30:55,937 with deep-wave inversions throughout both limb and precordial leads. 575 00:30:56,063 --> 00:30:58,981 LFTs are elevated, but only twice the normal range. 576 00:30:59,107 --> 00:31:01,400 Oh, yeah. And he's hearing voices. 577 00:31:06,532 --> 00:31:08,115 Go hold his hand. 578 00:31:10,160 --> 00:31:12,245 Go on. I'll bus your tray. 579 00:31:25,842 --> 00:31:27,677 Got any sample bags on you? 580 00:31:27,803 --> 00:31:30,846 I don't believe you. You're gonna run DNA tests? 581 00:31:30,973 --> 00:31:34,308 Their son is deathly ill. I know. It's terrible. 582 00:31:34,434 --> 00:31:35,768 But the fact is, if I don't keep busy 583 00:31:35,894 --> 00:31:38,229 with trivial things like this, I'm afraid I might start to cry. 584 00:31:38,355 --> 00:31:39,480 You're an ass. 585 00:31:39,606 --> 00:31:41,816 Yeah? You want to double the bet? 586 00:31:52,911 --> 00:31:55,705 General Hospital is on Channel 6. 587 00:31:55,831 --> 00:31:58,833 Dan's brain's not showing Channel 6 right now. Only mush. 588 00:31:58,959 --> 00:32:00,960 No epileptiform activity. 589 00:32:02,879 --> 00:32:03,921 What are you doing? 590 00:32:04,047 --> 00:32:07,758 - Waiting for CBC and CHEM-7. - Good. Run DNA on these. 591 00:32:10,804 --> 00:32:13,222 - What's this? - Parents' coffee cups. 592 00:32:14,641 --> 00:32:15,641 I can't believe you. 593 00:32:15,767 --> 00:32:16,934 I've had this conversation once already. 594 00:32:17,060 --> 00:32:20,021 If you've got something else to do, do it. Otherwise, do this. 595 00:32:28,155 --> 00:32:29,780 Dr. House? 596 00:32:29,906 --> 00:32:31,157 Hey. Mr. Funsten. 597 00:32:31,325 --> 00:32:32,867 I was wondering when you'd be back. 598 00:32:32,993 --> 00:32:34,577 You got some papers for me? 599 00:32:34,703 --> 00:32:36,704 You've caused me considerable mental distress. 600 00:32:36,830 --> 00:32:38,497 I certainly hope so. 601 00:32:39,041 --> 00:32:41,500 What? Too cheap to get your lawyer to serve it for you, 602 00:32:41,627 --> 00:32:42,877 or is it just more fun this way? 603 00:32:43,003 --> 00:32:45,087 I'm obviously prepared to consider a settlement. 604 00:32:45,213 --> 00:32:46,881 You have gonorrhea. 605 00:32:49,426 --> 00:32:50,551 No, I don't. 606 00:32:50,677 --> 00:32:53,304 Well, maybe you're right, but I have a lab result says you do. 607 00:32:53,430 --> 00:32:55,890 Could be a false positive, and normally I'd run a second test, 608 00:32:56,016 --> 00:32:57,558 but since you're here, I'll just go with the first. 609 00:32:57,684 --> 00:32:58,851 You're just trying to scare me. 610 00:32:58,977 --> 00:33:01,020 It's reportable, you know. Public health issue. 611 00:33:01,146 --> 00:33:02,897 I'll be sure to let my wife know. 612 00:33:03,023 --> 00:33:04,982 Don't bother yourself. The state will call for you. 613 00:33:05,108 --> 00:33:08,069 Look, if you're clean, I'm sure it'll all blow over. No big deal. 614 00:33:08,195 --> 00:33:09,362 There's an easy way to find out. 615 00:33:09,488 --> 00:33:11,447 Get one of your doctors to run a test. 616 00:33:13,450 --> 00:33:14,450 Uh-uh. 617 00:33:15,202 --> 00:33:17,995 These are mine now. I'll see you in court. 618 00:33:22,209 --> 00:33:25,294 West Nile, negative. Not surprising since not too many mosquitoes 619 00:33:25,420 --> 00:33:26,754 passing through Jersey in December. 620 00:33:26,880 --> 00:33:27,922 No eastern equine encephalitis. 621 00:33:28,048 --> 00:33:29,298 You guys aren't gonna believe this. 622 00:33:29,424 --> 00:33:30,466 What's that? 623 00:33:30,592 --> 00:33:33,010 House is right. The father's not the father. 624 00:33:34,471 --> 00:33:36,263 Dude doubled up on me. 625 00:33:36,932 --> 00:33:39,058 You're not gonna believe this. 626 00:33:39,184 --> 00:33:41,018 The mother's not the mother either. 627 00:33:43,522 --> 00:33:46,273 It's not a good idea to move your son in his condition. 628 00:33:46,400 --> 00:33:48,693 - We just want a second opinion. - We need an answer. 629 00:33:50,195 --> 00:33:53,155 You idiots. You lied to me. 630 00:33:53,281 --> 00:33:55,074 We didn't lie about anything. 631 00:33:55,200 --> 00:33:58,035 You, on the other hand, accused us of molesting our son. 632 00:33:58,161 --> 00:34:00,079 - Perfect. - Can we get off my screw-ups 633 00:34:00,205 --> 00:34:02,164 and focus on theirs? Theirs is bigger. 634 00:34:02,290 --> 00:34:04,917 - You're not Dan's parents. - We're his parents. 635 00:34:05,043 --> 00:34:06,544 He was adopted. He doesn't need to know. 636 00:34:06,670 --> 00:34:07,628 I do. 637 00:34:07,754 --> 00:34:09,171 Adoption makes us just as much... 638 00:34:09,297 --> 00:34:13,175 Listen. When we were taking his medical history, were you confused? 639 00:34:13,343 --> 00:34:15,678 Did you think we were looking for a genetic clue to his condition, 640 00:34:15,804 --> 00:34:17,096 or did you think we were trying to ascertain 641 00:34:17,222 --> 00:34:19,849 who loves him the most in the whole wide world? 642 00:34:19,975 --> 00:34:22,101 How did you find out about this? 643 00:34:22,853 --> 00:34:25,896 - I sampled their DNA. - We didn't give you any DNA. 644 00:34:26,022 --> 00:34:27,982 Your coffee cups from the cafeteria. 645 00:34:28,108 --> 00:34:29,400 You can't do that. 646 00:34:29,526 --> 00:34:31,986 Again, why are we getting hung up on what I did? 647 00:34:32,112 --> 00:34:33,529 Your medical history is useless. 648 00:34:33,655 --> 00:34:37,867 No. We gave you a detailed history of his biological mother. 649 00:34:38,118 --> 00:34:41,162 Her history. Non-smoker, good health, 650 00:34:41,288 --> 00:34:44,081 low cholesterol, no blood pressure problems. 651 00:34:44,207 --> 00:34:46,125 Dan was adopted two weeks after he was born. 652 00:34:46,251 --> 00:34:47,793 You have his history. There's nothing you need to know 653 00:34:47,919 --> 00:34:50,087 - that we didn't tell you. - Sounds reasonable. 654 00:34:50,714 --> 00:34:54,049 Well, if you want to transfer your boy, that is your choice. 655 00:34:54,176 --> 00:34:55,301 I still think it's the wrong... 656 00:34:55,427 --> 00:34:57,136 Was she vaccinated? 657 00:34:58,346 --> 00:34:59,764 The biological mother. 658 00:34:59,890 --> 00:35:01,474 When she was a baby, did she get her vaccinations? 659 00:35:01,600 --> 00:35:04,185 Dan was vaccinated at six months. 660 00:35:05,604 --> 00:35:08,856 Do you know why kids get vaccinated at six months? 661 00:35:08,982 --> 00:35:10,441 Because before that they are protected 662 00:35:10,567 --> 00:35:13,903 by their biological mother's immune system. 663 00:35:14,029 --> 00:35:16,238 So, was she vaccinated? 664 00:35:19,785 --> 00:35:22,912 An infant picks up a regular old measles virus. 665 00:35:23,288 --> 00:35:26,040 Gets a rash. He's extremely uncomfortable, 666 00:35:26,166 --> 00:35:28,292 has a wicked fever, but he lives. 667 00:35:28,418 --> 00:35:29,835 Here's the kicker. 668 00:35:29,961 --> 00:35:33,631 Once every million or so times, the virus mutates. 669 00:35:34,633 --> 00:35:37,218 Instead of Dan having a fever and a rash, 670 00:35:37,344 --> 00:35:41,305 the virus travels to his brain and hides, like a time bomb. 671 00:35:41,932 --> 00:35:44,809 In this case, for 16 years. 672 00:35:44,935 --> 00:35:47,603 Subacute sclerosing panencephalitis. 673 00:35:48,313 --> 00:35:50,147 I know. There's only been 20 cases 674 00:35:50,273 --> 00:35:51,816 in the United States in the last 30 years. 675 00:35:51,942 --> 00:35:55,236 I suppose you could make an argument the kid's still in Stage 1. 676 00:35:55,362 --> 00:35:57,446 Once SSPE moves to Stage 2, it's... 677 00:35:57,572 --> 00:36:00,866 Boom. Stage 2 is universally fatal. 678 00:36:00,992 --> 00:36:01,951 I assume it's impossible to know 679 00:36:02,077 --> 00:36:03,494 when he might move into Stage 2. 680 00:36:03,620 --> 00:36:05,663 He's already started showing symptoms. 681 00:36:05,789 --> 00:36:07,998 Could be a month. Could be tonight. 682 00:36:08,375 --> 00:36:10,251 - Can we treat it? - Ask the neurologist. 683 00:36:10,377 --> 00:36:12,586 Intraventricular interferon. 684 00:36:12,712 --> 00:36:14,004 Not gonna shove a spike into his brain 685 00:36:14,130 --> 00:36:16,757 and drip interferon without confirming this diagnosis. 686 00:36:16,883 --> 00:36:18,926 - Tap him. - We won't get a reliable result 687 00:36:19,052 --> 00:36:20,594 for measles antibodies in his CSF. 688 00:36:20,720 --> 00:36:21,762 Not after everything we've given him. 689 00:36:21,888 --> 00:36:24,974 So the wrong treatment kills any hope of the right diagnosis. 690 00:36:25,100 --> 00:36:27,017 Why do people lie to me? 691 00:36:29,145 --> 00:36:31,981 Could also kill him. Your ball, Foreman. 692 00:36:32,107 --> 00:36:34,066 Tell me I don't have to biopsy his brain. 693 00:36:35,986 --> 00:36:38,112 Well, there is one other way. 694 00:36:39,781 --> 00:36:41,824 You sure this isn't gonna hurt? 695 00:36:41,950 --> 00:36:43,993 Yeah. It's just scary as hell. 696 00:36:44,411 --> 00:36:45,995 See, we go through the pupil. 697 00:36:46,121 --> 00:36:48,622 But you won't feel it. The eye's been paralyzed. 698 00:36:48,748 --> 00:36:50,416 The needle travels to the back of the eye, 699 00:36:50,542 --> 00:36:53,794 which is where we'll perform the biopsy on your retina. 700 00:36:59,009 --> 00:37:02,177 So we've confirmed that the problem is this mutated virus. 701 00:37:02,429 --> 00:37:05,848 The treatment for SSPE is intraventricular interferon. 702 00:37:05,974 --> 00:37:08,976 We implant an Ommaya reservoir under the scalp, 703 00:37:09,102 --> 00:37:10,853 which is connected to a ventricular catheter 704 00:37:10,979 --> 00:37:13,939 that delivers the antiviral directly to the left hemisphere. 705 00:37:14,065 --> 00:37:15,399 You want us to consent to this? 706 00:37:15,525 --> 00:37:17,234 I don't even understand what you're talking about. 707 00:37:17,360 --> 00:37:19,194 Well, the antiviral... 708 00:37:22,824 --> 00:37:24,325 Look. I'm sorry. 709 00:37:24,451 --> 00:37:26,493 I can explain this as best I can, 710 00:37:26,620 --> 00:37:29,538 but the notion that you're gonna fully understand your son's treatment 711 00:37:29,664 --> 00:37:33,000 and make an informed decision is kind of insane. 712 00:37:35,045 --> 00:37:37,296 Here's what you need to know. 713 00:37:38,089 --> 00:37:41,800 It's dangerous. It could kill him. 714 00:37:42,844 --> 00:37:44,386 You should do it. 715 00:37:55,649 --> 00:37:57,816 Did you need something else? 716 00:38:16,753 --> 00:38:19,964 You can't order a $3,200 DNA test to win a bet. 717 00:38:20,090 --> 00:38:22,049 It's not an actual cost. 718 00:38:22,467 --> 00:38:23,509 I don't know if you know this, 719 00:38:23,635 --> 00:38:26,011 but the hospital actually owns the sequencing machine. 720 00:38:26,137 --> 00:38:27,262 - I'm serious. - Tell the parents 721 00:38:27,389 --> 00:38:28,722 to submit the bill to insurance. 722 00:38:28,848 --> 00:38:30,933 Insurance is not gonna pay for a bet. 723 00:38:31,059 --> 00:38:32,017 It should. 724 00:38:32,143 --> 00:38:34,061 We don't make that bet, the kid dies. 725 00:38:34,980 --> 00:38:37,398 If not for the paternity bet, I never would have taken their DNA. 726 00:38:37,524 --> 00:38:39,024 Without their DNA, we never would have discovered 727 00:38:39,150 --> 00:38:42,361 that Dan was adopted, which was the key to this case. 728 00:38:42,904 --> 00:38:45,364 You just don't want to pay your end. 729 00:38:45,782 --> 00:38:48,033 Big mistake. My guy knows a guy. 730 00:38:48,159 --> 00:38:51,203 Fine. I will let you out of clinic duty for one week, 731 00:38:51,329 --> 00:38:54,289 after you pay the $3,200 for the PCR test. 732 00:39:03,925 --> 00:39:06,760 Well, now, there's the $100 you owe me. 733 00:39:08,138 --> 00:39:10,264 Here's the $100 I won from Cameron. 734 00:39:10,390 --> 00:39:12,808 $200 I took off of Foreman. 735 00:39:14,144 --> 00:39:17,771 And $600 I got from Wilson. 736 00:39:20,859 --> 00:39:21,900 Very bitter. 737 00:39:25,947 --> 00:39:27,573 Hey. Good morning. 738 00:39:27,991 --> 00:39:29,575 Good news on your EEG. 739 00:39:29,701 --> 00:39:30,951 Treatment is working. 740 00:39:31,077 --> 00:39:33,037 And your immune system is responding. 741 00:39:33,747 --> 00:39:36,999 I know it's early, but I just want to take a look. 742 00:39:38,084 --> 00:39:39,418 All right. 743 00:39:39,544 --> 00:39:41,920 Let's see what that brain of yours can do. 744 00:39:42,047 --> 00:39:43,380 Name as many animals as you can 745 00:39:43,506 --> 00:39:45,299 that start with the letter "O". 746 00:39:46,092 --> 00:39:47,384 Ostrich. 747 00:39:48,386 --> 00:39:51,096 Ox. Old elephant. 748 00:39:51,806 --> 00:39:54,475 Well, that's two better than last time. 749 00:39:54,851 --> 00:39:57,352 How you doing with the whole adoption thing? 750 00:39:57,479 --> 00:39:58,854 I knew since fifth grade. 751 00:39:59,731 --> 00:40:00,898 How's that? 752 00:40:01,024 --> 00:40:02,274 Cleft chin. 753 00:40:03,693 --> 00:40:06,195 I have one. My dad doesn't. 754 00:40:06,905 --> 00:40:07,821 Looked it up on the Internet. 755 00:40:07,947 --> 00:40:10,532 It's one of those trait things. 756 00:40:10,658 --> 00:40:13,202 That's right. It's autosomal dominant. 757 00:40:13,828 --> 00:40:15,954 Since neither of your parents have cleft chins, 758 00:40:16,081 --> 00:40:19,041 it's highly unlikely you're biologically related. 759 00:40:21,002 --> 00:40:22,461 Are you sure you're okay? 760 00:40:22,587 --> 00:40:25,005 I've got no problems with being adopted. 761 00:40:26,382 --> 00:40:27,966 I love my parents. 762 00:40:31,096 --> 00:40:32,096 How's he doing? 763 00:40:32,222 --> 00:40:35,140 He's doing pretty well. He's a smart kid. 764 00:40:35,850 --> 00:40:37,184 I think he's gonna be fine. 765 00:40:41,189 --> 00:40:43,065 - Hey. - Thanks. 766 00:41:19,102 --> 00:41:21,186 Wheels, 18. Wheels.