House Watch: The Fall Finale Edition

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This week’s House M.D. wrapped the first half of Season 8. The episode, “Perils of Paranoia,” more fully developed the new Team characters, Adams and Park, who finally seemed like real people last night. More below, but first a spoiler alert: If you haven’t seen “Perils of Paranoia,” point your gun at the DVR until it plays the episode.

This week’s Patient is a prosecutor who—in the middle of a trial—abruptly ends his examination of a witness. The prosecutor, Tom, tells the judge that he’s having a heart attack.

Tom ends up at PPTH, and Foreman wants House to take his case. Tom’s EKG shows no heart problems, and House tells Foreman that the Patient has merely suffered a panic attack. But Foreman says he has already given Tom alprazolam—better known as that sweet anti-anxiety elixir Xanax—and it hasn’t stopped Tom’s chest pain.

At the first DDX, Park suggests shingles, which House rejects. Adams then recalls that she once treated an inmate with similar symptoms, and the patient turned out to have been poisoned. House loves the idea that Tom’s wife would have poisoned him. “Go search his home,” he says to the Team. “Talk to his wife. See if you can get her to tell us what she used.” He assigns Adams to handle the house and Chase to handle the wife. House says Adams and Chase can pick either Park or Taub to help. Both simultaneously pick Taub, which leads to an awkward moment. In the end, Adams ends up with Park.

When Adams and Park drive to the house, there’s a way-too-obvious product placement featuring an SUV made by a car company that I refuse to mention. The doctors end up in an impeccably clean home. “There’s not even a bottle of Wite-Out in this place,” says Park. But when she and Adams look behind a book case, they find a giant stash of guns—enough to break into (or defend) Fort Knox, as they point out.

Meantime, Taub has interviewed the wife, who says Tom is so scrupulous about his diet that he never eats or drinks anything outside his home (um, red herring much?). When Adams and Park talk to Wifey, it turns out she was so clueless that she didn’t know about the guns.

Which leaves the Team without a diagnosis—which, in turn, leads to another DDX. Chase suggests cocaine abuse–which could explain the chest pain as well as the gun-hoarding paranoia. That seems a stretch, so Adams and Park spar over other diagnoses. Adams suggests Fahr’s disease, a rare neurological disorder. Park says he merely has atrial fibrillation brought on by hyperthyroidism or sleep apnea.

House decides to give everyone a chance—probably because he has no good idea himself. He orders tests for cocaine as well as sleep apnea. And he orders a CT of the basal ganglia to look for Fahr’s. I think he ordered other tests, although Hugh Laurie talks through the medical terminology so quickly that many diagnoses are easy to miss.

The House-Wilson subplot begins, as so often, with the two of them at lunch. They banter in the swank, new cafeteria about whether House is paranoid and whether he owns a gun. But in the end it’s not precisely clear whether House has either paranoia or a firearm.

In the x-ray room, Chase hits on Adams–didn’t we know that was coming?–by saying that even though all the team members are weird, she’s hot, so her weirdness doesn’t matter. They also banter over whether she owns a gun (yes) and whether he hunts kangaroos (yes–and then no). A bit later, the writers try to develop Foreman’s role as dean, but the writing is lame: he is reduced to berating a nurse over a filing problem.

The House-Wilson subplot continues with House coming home to find Wilson trapped in a net he had apparently set for him. Like many House-Wilson interactions, the humor here is wildly broad, but Robert Sean Leonard looks cute all tied up.

Back to Patient: He now has a weird skin lesion as well as hallucinations. Chase says he must be schizophrenic, but Park says all the symptoms, which include fever, point to an infection that has spread to his brain. Adams argues that he could have an autoimmune disorder attacking a brain enzyme called glutamic acid decarboxylase. Their dispute sets up a classic House M.D. conflict: if House treats the infection with antibiotics, he will fry Tom’s immune system and inflame the GAD problem—and kill him, as Adams points out. But if he treats the autoimmune with steroids, he could cause any infection to spread wildly.

House picks Adams; he orders steroids.

But it turns out that Tom has an anaphylactic reaction, which wouldn’t be explained by either infection or autoimmune disease. At sea, House orders a biopsy to test for cancer, which Park suggests.

The final bit of the House-Wilson subplot has Wilson confronting House with a gun that Wilson says he found at House’s place. House convinces Wilson that the gun is a fake–a magic prop–by sticking a pencil into it. Just then, he has the A-Ha Moment: Patient’s trachea is blocked by a pseudomembrane, which can be caused by poison. In this case, the poison was bacteria called Corynebacterium diphtheria, which can lead to (Final Diagnosis) diphtheria. Most people are immunized against diphtheria, but the immunizations require periodic booster shots that Tom hasn’t gotten.

As this week’s indy-pop song plays, Adams, Park and Chase have a terrific scene in the elevator. Park boldly asks Chase on a date, and Chase agrees, even though Adams is standing there. Odette Annable perfectly plays Adams’ discomfort.

I really liked this episode, which will provide a good bridge into the second half of the season, in which I assume House will once again start misbehaving in new and spectacular ways.

See you next year….