House Watch: The Return to Princeton Plainsboro

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A football game pushed House M.D. out of its time slot last night, so my DVR missed it. I watched this morning on iTunes, so sorry for the delay. And a serious spoiler alert this week: if your DVR also had Terra Nova where House should have been, you should fire up iTunes before reading on.

We knew House had to get back to PPTH, but it was a somber homecoming. Cuddy is gone — she quit the day after House drove his car into her living room — and Foreman is the new dean of medicine. He has redecorated the hospital in darker hues, which House mocks. He also mocks Foreman even though it was Foreman who got him out of the joint six months early. (We discover that House had eight months added to his sentence after last week’s shenanigans.)

The Patient is just a set of lungs. “No pulse, no body,” says Foreman. “No ability to answer questions. It’s your perfect patient.” The lungs had been harvested from an 18-year-old who died in a motorcycle accident, but they have elevated airway resistance. House has to figure out why in order to make the lungs viable for transplant to a cancer patient (whose doctor is, of course, Wilson).

House has lost his office to the orthopedics department, and Chase, Taub and 13 have all “moved on,” Foreman says cryptically (I suppose the writers didn’t want to take up time explaining their whereabouts, but it was a rather abrupt way of avoiding the issue). Foreman adds that he doesn’t have the money to give House a new team. House jokes that the money must have all gone to redecorating.

House does have Dr. Chi Park, and at first she seems an odd match; she’s shy and still lives with her parents. But it turns out she slugged her boss in neurology after he grabbed her ass, so she and House have at least some personality traits in common.

At the first DDX, Dr. Simpson says the leading diagnostic theory is acute respiratory distress syndrome brought on by the trauma of the motorcycle accident. House interrupts by shouting “Prison!” It was just what they were all thinking, he says. And he notes that was “raped” but not “raped raped.” He then says he was actually “raped raped” but wasn’t “raped raped raped.” People look away in part embarrassment, part disgust.

House then asks if there’s any alveolar exudate in the lungs. There’s not — they are dry — which to House means it can’t be ARDS. He think it’s cocaine even though the tox screen was negative. “Dead men don’t pee. The coke never got past the lungs,” he says, adding that everyone else in the room is an idiot.

House walks out with Wilson and deduces that the potential recipient of the lungs must be one of his patients — “a lifetime member of the Wilson-cares-too-much club.” That was one of my favorite lines in the episode, partly because Wilson now seems not to care about House: “We’re not friends anymore,” he says blackly.

House goes with Park to the crash victim’s home. The father objects to House’s throwing around the young man’s belongings as he looks for cocaine. The dad says his son didn’t do coke even though he had been at an all-night poker game before the accident. House finds glasses, but none of the photos show him with glasses. The kid got the glasses just a couple of weeks before because he was having headaches. House suspects he had a brain tumor.

At this point we learn that House is wearing an ankle bracelet, which goes off when he’s at the victim’s home while doing online lpn programs. Police pick him up, and Foreman has to get him free once again. House finds a mass in the victim’s corpse, and he now thinks the young man had rhabdomyosarcoma, a malignant tumor of the muscles.

The Wilson side plot this week is about House trying to repair their relationship. Wilson returns from his patient (whose kidneys are shutting down) to his office to find House playing Celine Dion’s “My Heart Will Go On” on Wilson’s computer. House says he’s pretty sure it’s their song. But Wilson isn’t budging.

Park has done a full MRI, which turned up no cancer, so House moves on to another theory: the lungs were infected by something in the plasma given to the dying victim in the ER. But there would have been many blood donors who contributed all that plasma, so Wilson and Park set out to interview as many as they can find (which is the most implausible part of the episode, given that the lungs are supposedly not viable after just 12 hours).

Wilson says Donor No. 3 ate peanuts before giving blood. If the victim had a peanut allergy, that could explain the airway problem in the lungs. Donor No. 6 had traveled to a region of Thailand where dengue fever is common. That could be another explanation.

As the theories pile up, House wants his whiteboard back. But a nurse in ortho threatens to tell Foreman when House tries to steal it. So he does the DDX in marker on the wall of the old conference room.

Another donor may have had lead poisoning, so House asks Park (whom he calls “Rev. Moon”) to perform chelation, a treatment for heavy-metal poisoning.

As they work together, House gets to know Park. He wants her to stand up for herself to her parents, whom she hasn’t told about punching her boss. House steals her phone and texts her father that she wants to see him. “It will be your Feb. 4,” House says. She looks back blankly. “Sri Lankan independence day,” he says.

“I told you, I’m Korean and Filipino,” she responds.

“And I told you I wasn’t listening,” House cracks.

Back to the case: since the chelation isn’t working, House thinks it could be iron in the lungs (hemosiderosis) from paint shavings that one blood donor inhaled. But then Park finds white blood cells, which indicates to House that an infection had been hiding in the cells. House thinks it’s brucellosis and orders antibiotics and intravenous immunoglobulin.

But Wilson’s patient, Vanessa, is giving up; she has signed a DNR. House pushes Wilson to try harder to get Vanessa to do a painful stopgap treatment (drowning her failing lungs in an oxygen slurry). Wilson brings her alcoholic boyfriend in, which annoys Vanessa’s sister. It was a typical House move — and an atypical Wilson one — but it works: the boyfriend convinces Vanessa to do the treatment.

When Wilson goes to thank House for the advice, House tells Wilson, “I like you.” He says Wilson should just get over being cold to House and “punch me in the face. Kick me in the nuts. Either or. Both seems excessive.”

“The thing is,” Wilson responds, “I don’t like you.” (Which made me shout, “Finally!” at the screen.)

The treatment for brucellosis isn’t working, and the lungs discolor. Simpson suggests lupus(!), and House yells, “Nooooo.” A side note here: after I posted about last week’s reference to lupus and the running joke on the show that it’s *never* lupus, I got an interesting e-mail from Maggie Maloney, the PR manager for the Lupus Foundation of America:

The show has actually underscored the many challenges of diagnosing lupus. There is no single test to diagnose lupus, and the average is for patients to visit wait four or more years, and visit three or more doctors before receiving an accurate diagnosis.

Maloney sent this helpful link on how lupus is diagnosed. (Thank you, Maggie!)

This week’s A-Ha Moment comes when House sees an office birthday cake whose candles are smoking. House remembers that the kid had been playing poker all night before being killed and that he must have inhaled cigar smoke, since it’s not a poker game without cigars. (Really?) Anyway, this leads to the Final Diagnosis: eosinophilic pneumonitis. The young man had unusual lungs, which, as House explains, came with “on-switch for reacting to smoke, but no off switch.”

Park wants to treat with a strong cocktail of immunosuppressants, but House wants radiation. It’s riskier but faster, and Wilson needs those lungs. It works, which so impresses Park that she decides to stay at PPTH (after the grabby-boss incident, she was going to move to Chicago).

Foreman is impressed enough to get House’s stuff out of storage and give him the old office, though he still won’t have the Team (except for Park, I guess) or the conference room.

Wilson walks in to House’s new-old office and takes House up on the offer to punch him. He then suggests dinner.

And so House gets his old life back, sort of, by doing what he does best. I found this a bit too convenient, although I was genuinely surprised when Wilson slugged him.

A couple of questions:

Apparently we’re supposed to see Chase and 13 again (and it seems clear from this interview that Taub will be back), so when do they return? Also, we expect Adams from last week t0 join the Team, right?

When the Team returns, you can expect that conference room to come back as well, but how long will it take for the show to fully integrate him back to his normal routine? And when that happens, will the show stagnate into familiar territory?

Does anyone else think this is likely to be the show’s last season?

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