House Watch: Lucky 13

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Adam Taylor / FOX

13! Yes Olivia Wilde was back last night along with Wentworth Miller as Patient—and I had a difficult time deciding who is hotter. Before you read on, a House-ish SPOILER ALERT: don’t be an IDIOT and read further unless you have watched last night’s fantastic episode “Charity Case.”

The delicious Miller, who was the only reason (and I mean the only reason) to watch Prison Break, plays Benjamin, a mysterious philanthropist who collapses after giving a $1-million check to an inner-city jobs clinic.

As I predicted, Adams is a new member of the Team—provisionally, for now, since House has no budget to pay her. A trust funder, she’s been working at a free clinic in Trenton after getting fired from the prison for helping House prove a diagnosis with a risky procedure. She’s a welcome presence—Park was a little boring on her own last week, perhaps because Charlyne Yi, who plays her, has so little experience. House’s new haircut is also a welcome change. (He shaves his ridiculous prison locks as the opening credits roll. Which brings up another issue: where’s the dark theme music from Massive Attack? Are they finally done with that?)

The first diagnosis: dehydration, although Miller has gained enough weight since Prison Break that simple dehydration seems unlikely. Also, Benjanmin has that rather extreme case of philanthropy, which House would normally hate but—in this case—House wants Benjanmin’s money for his practice.

Adams thinks a sudden collapse could indicate deterioration of his heart muscle, so they do an ultrasound. Benjamin explains that he has given away tens of millions of dollars and lives on about $25,000 a year.

Park and Adams go to House and give competing diagnoses of his mental state. Park: “He’s nuts.” Adams: “He’s generous.” Foreman stops their little debate by telling House to discharge Benjamin; House is just trying to scam him, after all. But House plays the game: “unexplained loss of consciousness could be cardiomyopathyglobal anoxia….” Foreman then trumps House with a nice gambit: House can view the extreme altruism as a symptom and keep treating Benjamin, but if it’s truly a sign that Benjamin is sick, House can’t take any money from him. Score one for Foreman.

“Send him home,” House tells Adams and Park. “But check the net worth of all patients in admitting.”

We then see 13, who says she’s only come by the hospital to get House to stop calling—the first 17 messages, she says, were “cute,” but she wants them to end. She has a new girlfriend, and they’re going to Mykonos. House yawns to mock her, but 13 says “It turns out I like boring.”

As Park and Adams examine Benjamin, he becomes tachycardic. “Unbelievable,” Adams says–indicating that she’s never seen an episode of House M.D. before. Unbelievable symptoms that occur at just the right time in the story is a constant feature of the show.

Best nickname of the night: House calls Benjamin “Father Teresa.” The tachycardia means he really is sick, but with what? Park suggests Whipple’s, a rare condition in which the intestines cannot properly absorb all nutrients. House points out that Whipple’s would require a neurological symptom, setting up Park for a line that would normally be House’s: “You don’t think defying human nature is neurological?”

House’s response: “Racing heart: medical condition. Bleeding heart: stupid condition.” But Park–and I liked her more and more as this episode went on–points out that House wants the altruism not to be a symptom so he can take Benjamin’s Benjamins (and yes that was my line, one I was surprised not to hear during a show that usually can’t resist puns).

House goes to Benjamin himself to do a simple procedure (they want to flush antihistamines from his system, since the drugs might have caused long QT syndrome, a heart-rhythm disorder–that was Adams’ idea). Ordinarily House would never interact with a Patient much, but he lays it on thick: he made a terrible mistake; his department got defunded; he just can’t bear to think of all those patients he can’t treat because of his error of judgment.

Benjamin offers to help, but House now knows the man must have a neurological problem: “I am an opportunistic ex-con who just gave you a two-minute sob story….And you’ve offered me a million dollars.”

But he has a dilemma: He really wants the money. He goes to Wilson for advice, and predictably Wilson says he can’t take money from a patient. That prompts House to joke, “What is this, Canada? All we do is take money from sick people.”

I enjoyed this exchange because it was one of the few times House M.D. has ever acknowledged how retrograde its health-care politics are. House treats just one patient a week at enormous cost. He runs every test possible, including many for no objective reason—often just to screw with a colleague. Yes, he saves lives, but at staggering expense. If everyone got House-like treatment, health-care costs would be rising far faster than they already are.

Back to the Case: Park learns that Benjamin has a wife who won’t speak to him because he’s giving all their money away even though they have two kids. “My boys have a roof over their heads,” Benjamin says. He pays child support but says he can’t justify buying them video games when other people’s kids are starving. Just then, another symptom: uncontrollable shaking.

Adams, Park and House do a DDX over lunch. Park offers polyarteritis nodosa, which is an auto-immune disease that affects the arteries. But Adams says there would have to be a rash. She comes up with echo virus, which is strange because (at least according toPub Med) echo viruses also present with skin rashes. (Proving once again that it’s best not to watch the medicine too closely on the show.) Anyway, House orders anti-viral drugs.

Benjamin gets better, and House is preparing to discharge him when Wilson reveals that the man wants to donate one of his kidneys to one of Wilson’s patients who’s in renal failure—a patient Benjamin has never even met. Now House turns Wilson’s argument back on him: “I thought it was a medical no-brainer that we can’t take stuff from sick people.”

“I changed my mind,” Wilson replies weakly.

House argues that offering an organ to a stranger has to indicate a neurological problem. Foreman has to settle it, so he goes to Benjamin to ask why he wants to donate. Benjamin answers that 70,000 people need kidney transplants, but only 10,000 donors can offer them. “Yeah,” House answers, “if we could only kill 60,000 more people a year, all would be golden.” But Benjamin has done the research: there’s only a 1 in 4,000 chance that he will die during surgery. “I’ve got two, and this woman has none.”

“Perfectly logical,” Wilson says. Foreman agrees to the donation.

House now needs to prove Benjamin is still physically sick. Park goes back to Whipple’s disease, but House rules it out because Benjamin has no joint pain—until 13 (who has shown up, she says, just to help with this crisis) points out that joint pain isn’t definitive. House orders a test for Whipple’s and then diagnoses 13 with guilt—that’s why she showed up. 13 says he’s wrong; she’s really going to Greece with the girlfriend after this Case is solved.

A side plot has Park refusing gifts–even little things like cups of coffee. Adams, who is rich, tries to give her a pair of shoes, which really sets Park off. “You do know I punched the last person who pissed me off?” she says, referring to the boss who grabbed her butt. Adams comes back with: “Was it Santa?”

The test for Whipple’s turns out negative, so the transplant can go ahead. But just at the very last minute before Simpson, the surgeon, takes his kidney, his blood pressure drops.

And so another DDX. Park: Spider bite? The symptoms can take up to three days to manifest. Adams points out he would have localized pain–presumably on the spot where he got bit. They’re flailing a bit when Foreman arrives. He accuses House of dosing Patient with something because he couldn’t prove an actual illness. (It has happened before.) House insists he didn’t do it–he says if he got caught, he knows he would have to go back to prison–but Foreman doesn’t believe him. House is off the case.

Not surprisingly, House did dose the Patient, which he admits to Adams and Park. That prompts Adams’ own admission: she’s screwing with Park by giving her all those gifts (a spa certificate is the most recent). She wants to see how far she can push her.

House calls 13 for “one more favor.” She goes to Benjamin and lies that she has polycystic kidney disease and needs a kidney of her own. Benjamin then offers to give her his other kidney. 13 explains he will die. “You can live on dialysis for years,” he says. “Yes,” she answers, “and then you die.” Well, he says, then he can donate his heart and lungs…and save four or five more lives.

13 has her answer: the guy “is crazy.” House gets the case back, and the four of them have a full-on DDX….13 offers Grave’s disease “or some other thyroid” condition. But no, Park says. Thyroid levels were normal when he came in. Coxsackie B virus? No inflammation around the heart. Porphyria, which is a rare condition in which hemoglobin is produced in the body improperly?

They can’t think of anything else, so they go with that, but a bigger question looms: Does 13 keep showing up because she wants to come back? House asks her in the hallway, and she talks about the power and grace of saving lives. Seems like she’s back. (But, of course, there’s Olivia Wilde’s film career, so let’s not expect to see too much of her this year.)

Wilson’s patient has died without the kidney, and in the gloom of his office House gets the A-Ha Moment: all the tests he was running on Benjamin to keep him in the hospital (and get his money) may have done something to him. He has (Final Diagnosis)Plummer’s disease, an enlarged thyroid gland that has one or more nodules that produce too much thyroid hormone. When House ordered a CT scan, which uses iodine dye for contrast. Iodine enables thyroid production, so Benjamin was now getting way too much of the hormone, which was causing his extreme generosity.

They remove the nodule on Benjamin’s gland, and House goes to him to ask for money for his practice. “I don’t want to give you money because you’re an ass,” Benjamin says. “I love my family. I want to be with them.” And so he is cured: a truly selfless man has become a selfish one. Which, in the world of House M.D., makes you a healthy man.

How healthy is House? So much so that he conned Adams into fixing his car–the one he drove into Cuddy’s House. He and Park schemed to make Adams think she was paying to fix Park’s car as part of their game. Park and House are going to do very productive, deeply amoral things together.

Just a couple of questions this week: is it healthy to be a fan of this show? It is deeply cynical, but then there was the very sweet kiss at the end between 13 and her girlfriend. After House sees it, he fires 13. He says he can work with people who are fascinated by cases and those with nowhere else to go—people like him, although he doesn’t say that—but he can’t work with someone who just wants to feel good about saving people.

13 accepts this a little more easily than you might expect–but again, Wilde has all those films to get back to.

My diagnosis: best episode of the new season. The characters are coming together faster than you might expect, and Laurie continues to be the most dependable actor in television. See you in two weeks, folks.

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