Years after receiving body parts from an organ donor, five out of six recipients die within a few months, but not from organ rejection. House and the team race against time to figure out why before the final surviving recipient, a young woman who received the donor's cornea, mysteriously dies as well. House retains a comical private investigator to investigate patients, doctors, and his estranged friend, Wilson.
- We opened on more than one possible patient for this week's "House" medical mystery as four different people -- a tennis player, a crane operator, an ultimate fighter and a tuba player -- collapsed. Thirteen (Olivia Wilde) then barged into a lecture hall and announced, "Class is over." She went to the teacher and confirmed she'd had a corneal transplant five years earlier. Thirteen told her all transplant patients from that particular donor had either died or were dying.
"I feel fine," the woman told Thirteen.
"I don't mean to scare you," Thirteen said, "but so did the others."
Cue: totally awesome theme music.
Foreman (Omar Epps) led the team discussion about the patients, who died from something other than the organ they'd received from the donor. House's first question, "What did Wilson do for me?" No one responded.
"Sure, he made me laugh on a rainy day," House continued. "Made me see the colors I never knew." He continued talking about Wilson as the team ignored him and kept discussing the patient. Foreman said it's not cancer.
"It's cancer," House replied.
At lunchtime, House had another doctor, Dr. O'Shea (Tim Conlon), pay for his lunch and started chatting him up about monster trucks. He was looking for a new friend. Foreman came over to tell House the patient's right eye was failing and it needed to be removed. House told him not to remove the eye, the problem was in her head.
"Do you have some ethical problem with what I'm doing that you could express in a unique way that would actually make me think that I'm wrong even though I'll never admit it?" House asked Dr. O'Shea, pretty much summing up Wilson's role in House's life.
House ran the patient through an eye test, which she failed without squinting. He knew that meant the problem wasn't in her eye because her brain was thinking the eye was seeing correctly. She then hallucinated that House said he'd have to cut off her whole head, and her vision of him raised a cleaver and swung at her neck. House, giddy at having proven Foreman wrong, said, "Hallucinations. That's a head thing, right?"
The group watched video of the ultimate fighter guy who died to look for clues tying all the patients together. When Taub (Peter Jacobson) made a suggestion, the coffee repairman piped in and called him an idiot. He kept going before he admitted he wasn't very good at disguises. House hired him with not much further explanation. The guy kept chiming in with bits of laughter he pretended were sneezes. The guy was a private investigator, Lucas (Michael Weston), who had all kinds of information on all the patients and charged House $2,300 for it.
House wanted to biopsy the woman's brain, but Foreman and Taub objected. House went along with the objection and asked them to get an older patient's wife to agree to let them biopsy his brain. She said no. She and the corneal transplant patient then go into an argument about whose life was worth saving before her husband went into cardiac arrest. He died. "Save the brain," House told Taub. "Don't need consent for an autopsy."
The brain was clean. House was back to his cancer theory. "You need it to be cancer so you can have an excuse to talk to Wilson," Foreman told him. Kutner (Kal Penn) had a theory involving bacteria which got into the blood stream of the donor and something about a tear in the bowel wall, which might have gotten through to the transplant patients. House ordered a colonoscopy on the donor's 4-year-old daughter to see if she had similar symptoms.
House was holed up with Lucas and discovered he thought House wanted him to be checking out Wilson. He told House he wanted to know if there was something that could make Wilson come back. "Is there?" House asked. "No, there isn't," Lucas said, then asked for $900.
Back at the hospital, the colonoscopy on the kid turned up nothing, but Kutner's theory maintained the opening in the bowel wall would happen shortly before death. But House said there's no way of knowing when that would be. Kutner suggested they perform a colonoscopy on the dead guy to see if he had the bowel wall tear. House gave the green light despite Foreman's objection.
As Kutner and Foreman pushed pressure through the dead guy's cavities to get the scope where it needed to go, Foreman told Kutner to be careful. Would ya believe Kutner increased the pressure too much and the guy basically exploded, splattering what Foreman called "bodily sewage" all over him. Believe it.
House told everyone to stop repeating ideas they'd already dismissed, then he left to start treatment for cancer. He had the patient sign a release to start chemo, but told her it might be a placebo effect. She started telling him about her life, saying she was an architect before she got her vision fixed, then she became a math teacher. She said the world didn't get any better, despite all the promises, then told House he was basically the same as she was. She told him his world wouldn't get any different if his leg was better.
House met with Lucas again to find out what he knew about Wilson. He found out Wilson had been attending grief counseling, getting visits from Cameron (Jennifer Morrison) and Cuddy (Lisa Edelstein). He said Wilson had never mentioned House.
Back at the hospital, the patient was responding to the chemo, but House decided it wasn't cancer. He said whatever she had was acting like cancer, but wasn't. He finally decided to knock on Wilson's door and tell him he needed his help. Wilson (Robert Sean Leonard) asked House to leave, but he wouldn't. Wilson started to close the door on House, who blocked it. "Please don't do this," Wilson said. House admitted he'd hired an investigator to follow Wilson and asked why he'd been talking to Cameron, Cuddy and Foreman.
"The next time you knock, I'm not answering," Wilson told him. Then he shut the door in House's face.
House had an epiphany and realized cancer stem cells from the original donor had partially differentiated inside the transplant patients. Inside the patients, they mutated to look as if they belonged, attaching to the heart, lung and brain of the patients. House said this would cause everything to show up normal in X-rays, but he'd have to cut open her head to see her brain. She refused and insisted on continuing chemo. He said the chemo wasn't killing anything, just hiding the real problem.
"She's going to crash," he said. "If we wait until she does, then it would be too late."
Cuddy asked if the next step was her saying no and House doing something to make the patient crash so he could prove his theory right.
"I would never do that," he told her.
"No," she said. "You won't."
The next time House went to the patient's room, he found two security guards standing watch and didn't even try to get by them.
House sat in a hallway, sulking just a little before dialing up Lucas, who posed as a nurse and went into the patient's room, adjusted her IV and caused her to crash.
In the next scene, Chase (Jesse Spencer) and another surgeon were slicing her head open. House then admitted he was somehow able to switch her meds. Lucas wanted to stop the surgery, but House told him the dangerous part was already over. The surgeons saw something in her brain and they got it.
House went to the patient's room after her surgery and told her the world is not as ugly as she thought it was. He took the gauze off her eyes and she turned to look at him.
"How do I look?" he asked her.
"You look sad," she said.
Later, House sat alone and made a phone call, asking, "Is there any way I could put you on retainer?"
MEDICAL REVIEW :
Apple (Felicia Day), a young high school math teacher, is one of six patients who received transplanted organs from the same donor. In the past eight months, four of these patients have died suddenly and one is hovering near death though all from different causes. Apple is the only one still alive. She is admitted to the hospital so the common cause of these deaths can be found, and in Apples case, prevented.
A donor infection that slipped by screening is suggested, but discarded. Autoimmune disease, vasculitis (specifically Henoch-Schönlein Purpura) and cancer are also suggested as possible diagnoses. House focuses on the cancer diagnosis. However, when he goes to talk with Apple, she starts to hallucinate.
This neurological symptom makes him wonder if the common cause of the deaths might be a neurological disease instead of cancer. One of the dead patients was a mixed martial artist, and House suspects that he was showing neurological symptoms (a temporal lobe seizure) right before he died. This would lend credence to his neurological-cause theory. A brain biopsy would give the best information, but brain biopsies are risky, so therefore House decides it would be best to biopsy Frank the nearly dead patient. In the midst of trying to obtain consent from his wife, Frank suffers a respiratory arrest, then a cardiac arrest, and dies. A brain biopsy performed at autopsy is negative, so House goes back to his cancer diagnosis.
Kutner counters with some nonsensical suggestion that it might be an intestinal perforation. He postulates that normal intestinal bacteria got into the bloodstream though an abnormal blood vessel in the intestine. Then, once into the bloodstream, these bacteria would affect other organs, and this is what caused the problems in all the patients. It sounds at first as if he is suggesting a blood borne infection that slipped by screening, but if thats the case, it wouldnt explain the Apple since (as Thirteen pointed out earlier in the show), the corneal transplant was bloodless (and corneas have no blood vessels). Then theres a suggestion this intestinal flaw is hereditary, and the team goes as far as giving the organ donors illegitimate four-year old daughter a colonoscopy (which is negative). Even if it is hereditary, how does it affect the transplant patients? Did their transplants somehow affect their intestines? This entire train of thought and how it was handled was well ludicrous is far too kind a word.
Apple now develops a rapid heart rate, difficulty breathing, but her colonoscopy(!) remains normal. Multiple sclerosis is suggested but then quickly discarded. House is back to thinking its cancer, so he starts her on chemotherapy. Apple starts to improve; her heart and lungs return to normal (as do her previously unmentioned amylase and lipase, two pancreatic enzymes). But now House is back to thinking it isnt cancer because he has discovered that Frank was on methrotrexate, a drug that is used to treat some cancers. Since Frank died anyway, House decides it must not be cancer.
House tries to talk with Wilson so he can have one of his usual last minute epiphanies, but Wilson slams the door in his face. Commiserating afterward with the private eye he hired to spy on Wilson, he finally has his flash of insight. He decides the organ donor had cancer stem cells. These spread out from the transplanted organs through the transplant patients bloodstreams and then differentiated into abnormal cells in various organs. Not cancer cells, per se, but non-functioning cells so the affected organs became weakened and suddenly failed. He believes Apple has these cells in her brain and wants to perform brain surgery on her. (House believes the cells are in her brain because even though she had a corneal transplant, she still thinks the world look ugly. House suspects her eyes are seeing correctly, but the brain is interpreting the results wrong.) Cuddy says no, but House is able with the help of his new private eye assistant to make it look as though Apple is sicker than she is and brain surgery is her only hope. The surgery is carried out, and sure enough, House is right. The abnormal brain tissue is removed and Apple is once again healthy and able to see well.