House Watch: Throwing Up Blood, Again

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House M.D. returns this week with the case of a homeless girl who may or may not have a heart of gold. The only thing for sure is that House himself does not. More below, but first a spoiler alert: before reading on, find some of Taub’s porn magazines and get comfortable.

House and Adams fight over whether to call authorities to care for the girl, a Jane Doe, who has an ear bleed and breathing problems. The argument between House and Adams is predictable because it emphasizes that House cares little for patients but a lot for what ails them.

The first DDX occurs at a shooting range where House misses widely. Even though the police have finally removed his ankle bracelet, he’s not fully himself. “The sight seems to be off on this,” he says, unnecessarily. The scene eventually devolves into House and Adams having a shooting contest—literally—which Adams wins handily.

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As for the patient, Chase suggests her problem is vasculitis—an inflammation of the blood vessels—and House orders steroids. He sees the girl as a kindred spirit who doesn’t need her parents (after all, he didn’t). Adams disagrees. After Adams wins the shooting contest, House allows her to call social services.

And yet he humiliates Adams by hiring a prostitute to pose as a social-services agent. As usual, Foreman gets angry but can do little. He tries to punish House with more clinic hours, but it turns out that House has photographic evidence of Foreman’s dalliance with a married woman. (Yes, this episode was a bit soap-opera-ish.)

Meantime, Jane Doe’s mom shows up just as Jane has an entirely too common House M.D. symptom: throwing up blood. Cut to a scene in which House has dragged the Team to a turtle race. The scene was a bit odd overall—a turtle race?—but I liked the scenes that seemed to be shot with the camera atop the turtles.

Because the girl has a gut bleed and too much stomach acid, Adams suggests a weird but very House-like illness: Zollinger-Ellison syndrome, a hormonal disease. House orders an upper endoscopy to confirm.

The clinic side story this week involves Civil War reenactors, one of whom nearly shoots off his foot. Once again, the metaphor is a bit too strong. We get it: House is a wounded man who does idiotic things, but he still has to treat idiots.

Back to the case: Jane Doe is bleeding from the mouth again, this time because she has a hole in her esophagus. That rules out Zollinger-Eillison, and so we move on to the next DDX.

Adams thinks her problem is alcoholism, which often causes esophageal problems and might make sense for a homeless girl. But House has another theory: a berry aneurysm, which could cause the girl’s fluctuations in blood pressure. A candidate for the funniest (and most sexist) line in the episode: House tells Adams: “as much as your presence may cause objects to become engorged with blood, sometimes aneurysms just soften the mood.”

House orders a cerebral angiogram to locate the aneurysm—a procedure that means brain surgery. Adams disagrees and tells the girl. House gets angry—after all, he survived his bad childhood, and so Jane Doe isn’t necessarily drinking hers away. Brutally and vainly, he then asks the girl’s mother—a former addict who can’t decide whether to authorize the angiogram—to leave the hospital. “Your daughter is better off without you,” he says.

Once again, the Foreman side story bored me. I think Omar Epps is a talented actor, but casting him as a hospital administrator—and now a sort-of-guilty adulteror—is a mistake. Foreman always has to act restrained, but it seems like there’s a real actor behind all that forced subterfuge.

Final bit of the story: Jane Doe and her mom reconcile over a muffin, but then the girl passes out. Adams thinks her aneurysm has burst, but in the OR, the girl shows no signs of an aneurysm.

At a desperate DDX, Adams reaches for two wildly stupid diagnoses—dengue fever or cholera—because Jane Doe has been to Florida. Have the writers ever been to Florida? It’s not exactly a third-world country.

House briefly considers Adams’ ideas but notes that neither dengue nor cholera could sit unsymptomatic for two years. And then the A-Ha moment: the girl got (final diagnosis) ascariasis—hookworm—from swimming in a dirty canal near her grandmother’s Florida home. A few pills of mebendazole will cure her.

So it turns out that neither House nor Adams was right, but that doesn’t keep House from berating Adams for believing that the girl’s problems were due to alcoholism—and that she could help the girl. “I don’t care if the people who work for me are screwed up,” he tells Adams. “In fact, I even encourage it. But absolution—you do that on your own time. Or not at all. Clearly, you suck at it.”

Cut to the indie-pop song and a final scene in which Foreman says the obvious: “I’m not like you, House.” But we wish that you were, Mr. Epps.

See you next week.