1 00:00:00,000 --> 00:00:04,162 WWW.MY-SUBS.CO 1 00:00:00,042 --> 00:00:03,921 [Cheering and Shouting] On your right, on your right. 2 00:00:04,796 --> 00:00:07,049 Back, back, back. 3 00:00:10,719 --> 00:00:12,095 Yeah, Dan! 4 00:00:12,095 --> 00:00:14,973 [Continues cheering and shouting] 5 00:00:14,973 --> 00:00:16,934 Back, back, back, back 6 00:00:17,226 --> 00:00:18,310 Watch the winger! 7 00:00:18,310 --> 00:00:19,311 [More cheering and whistling] 8 00:00:55,764 --> 00:01:04,815 [muffled] You ok? Dan, Dan, talk to me. Dan, Dan, get a doctor! 9 00:01:06,817 --> 00:01:11,280 1X02: PATERNITY Original Airdate on FOX: November 23, 2004 10 00:01:46,315 --> 00:01:47,149 Hey! 11 00:01:47,149 --> 00:01:49,568 Close the door. Close the door! 12 00:01:53,322 --> 00:01:55,407 Is Cuddy down the hall counting to 50? 13 00:01:56,617 --> 00:01:59,453 She's knows I'm in here, the clinic, as she commanded; 14 00:01:59,453 --> 00:02:01,121 she just doesn't know I'm alone. 15 00:02:01,121 --> 00:02:04,625 Well, you've got a full waiting room, how long do you think you can ignore them? 16 00:02:04,625 --> 00:02:05,834 I'm off at 4:00. 17 00:02:07,085 --> 00:02:09,505 You're doing this to avoid 5 minutes of work? 18 00:02:09,505 --> 00:02:12,674 I go out there, I get assigned a kid with a runny nose. 19 00:02:12,674 --> 00:02:13,926 That's 30 seconds looking at the nose; 20 00:02:13,926 --> 00:02:18,597 25 minutes talking to a worried mom who won't leave until she sure it's not meningitis or a tumor. 21 00:02:18,597 --> 00:02:21,099 Yes, concerned parents can be so annoying. 22 00:02:21,099 --> 00:02:23,560 Just tell Cuddy you've got an urgent case, you had to leave early. 23 00:02:23,560 --> 00:02:24,603 That would be lying. 24 00:02:24,603 --> 00:02:29,149 And that would be wrong. But luckily, the definition of urgent is fungible. 25 00:02:29,942 --> 00:02:31,777 Not the definition of case though. 26 00:02:35,447 --> 00:02:37,282 You have no cases? 27 00:02:39,034 --> 00:02:41,119 You have NO cases? 28 00:02:41,787 --> 00:02:46,667 You've got hand picked doctors, specialists, working for you, and they're sitting on their hands? 29 00:02:48,001 --> 00:02:49,378 Cameron is answering my mail. 30 00:02:49,378 --> 00:02:52,381 Time well spent I'm sure. Foreman and Chase? 31 00:02:54,383 --> 00:02:55,509 Research? 32 00:03:02,057 --> 00:03:04,977 9 letters, iodine deficiency in children. 33 00:03:04,977 --> 00:03:06,061 Cretinism. 34 00:03:16,154 --> 00:03:20,868 So, 4:03 PM. Dr. House checks out. Please write that down. 35 00:03:20,868 --> 00:03:21,702 Dan's Dr. House. 36 00:03:22,452 --> 00:03:25,289 Sorry, done for the day. There's plenty of docs here to take care of you. 37 00:03:25,289 --> 00:03:26,582 But we had an appointment. 38 00:03:26,582 --> 00:03:29,918 Hah, nice try, but this is a walk in clinic, which means there are no appointments. 39 00:03:29,918 --> 00:03:33,130 It means you walk in, sign the chart and a doctor will see you, just not me. 40 00:03:33,130 --> 00:03:35,883 But your letter says that we would see you. 41 00:03:36,925 --> 00:03:38,594 Not a big letter writer. 44 00:03:46,185 --> 00:03:47,060 I can explain. 45 00:03:47,060 --> 00:03:50,272 See that "G", see how it makes a big loop on top? 46 00:03:50,272 --> 00:03:52,065 It doesn't even look like my handwriting. 47 00:03:52,065 --> 00:03:53,650 Think I have something? 48 00:03:53,650 --> 00:03:57,279 What's the differential diagnosis for writing "G"'s like a junior high school girl? 49 00:03:57,279 --> 00:04:00,157 It's impossible to get to you through normal channels, they have called... 50 00:04:00,157 --> 00:04:04,620 Perseverance does not equal worthiness. Next time you want to get my attention wear something fun. 51 00:04:04,620 --> 00:04:06,205 Low-rider jeans are hot. 52 00:04:06,788 --> 00:04:11,877 16 year old male, sudden onset of double vision and night terrors, with no apparent cause. 53 00:04:11,877 --> 00:04:12,878 The kid's been to 2 neurologists 54 00:04:12,920 --> 00:04:16,590 Night terrors, yeah? As in big scary monsters? 55 00:04:16,590 --> 00:04:17,174 Yes. 56 00:04:21,011 --> 00:04:21,929 Where are you going? 57 00:04:21,929 --> 00:04:22,930 To see the family. 58 00:04:23,764 --> 00:04:25,265 You're going to examine a patient? 59 00:04:25,265 --> 00:04:27,601 9 times out of 10 there's no reason to talk to a patient, 60 00:04:27,601 --> 00:04:31,772 but night terrors in a 16 year old is a VERY good reason to talk to this family. 61 00:04:32,523 --> 00:04:33,315 Good work. 62 00:04:36,693 --> 00:04:39,279 Margins look fine. 63 00:04:39,279 --> 00:04:40,906 No lesions, 64 00:04:42,074 --> 00:04:43,158 color is good. 65 00:04:44,368 --> 00:04:46,286 How long have you been having night terrors? 66 00:04:46,578 --> 00:04:47,663 Three weeks. 67 00:04:47,663 --> 00:04:50,749 He's afraid to go to bed, he's exhausted, he can barely function. 68 00:04:53,001 --> 00:04:53,585 What does that tell you? 69 00:04:53,585 --> 00:04:56,588 Nothing, it's just fun watching him blink. 70 00:04:56,588 --> 00:05:00,050 Name as many animals that begin with the letter "B" go. 71 00:05:08,016 --> 00:05:09,184 Baby elephant. 72 00:05:09,184 --> 00:05:12,312 Baby elephant is actually a good answer; "B" is a bear of a letter. 73 00:05:12,312 --> 00:05:13,146 What does that tell you? 74 00:05:13,146 --> 00:05:17,860 Proves two things, no neurological damage, and your son is never going to be chief fry cook. 75 00:05:18,443 --> 00:05:21,822 In teens there are two likely causes of night terrors: 76 00:05:21,822 --> 00:05:24,741 post traumatic stress, any recent shootouts at your high school? 77 00:05:24,741 --> 00:05:25,200 No. 78 00:05:25,200 --> 00:05:26,118 Well, then, Dave 79 00:05:26,118 --> 00:05:26,869 Dan 80 00:05:26,869 --> 00:05:30,998 if there's no trauma the other cause is sexual abuse. 81 00:05:34,001 --> 00:05:35,294 So, who's molesting you? 82 00:05:35,294 --> 00:05:37,796 Teacher, extra friendly neighbor? 83 00:05:37,796 --> 00:05:40,257 I'd ask if either one of you were involved, but you'd deny it. 84 00:05:40,257 --> 00:05:42,092 We would never do anything to hurt Dan. 85 00:05:42,092 --> 00:05:43,844 I say it here, it comes out there. 86 00:05:44,511 --> 00:05:46,847 This lack of response is consistent with abuse. 87 00:05:46,847 --> 00:05:49,057 There's no one, ok? I swear. 88 00:05:49,725 --> 00:05:53,061 There was trauma; I got hit in the head during a lacrosse game. 89 00:05:54,646 --> 00:05:56,356 Did you know that he got hit in the head? 90 00:05:57,983 --> 00:05:59,401 They didn't mention it, no. 91 00:05:59,401 --> 00:06:01,486 Yeah, why bother. 92 00:06:01,486 --> 00:06:07,367 No, no, we took him to the ER after the game. 93 00:06:07,409 --> 00:06:10,037 He was scanned, they tested him, they said he was fine. 94 00:06:10,037 --> 00:06:11,622 No concussion, it's gotta be something else. 95 00:06:11,622 --> 00:06:14,249 You hound me for my opinion and then question my diagnosis. 96 00:06:14,249 --> 00:06:18,545 Cool. ER obviously screwed up, kid's got a concussion. 97 00:06:18,545 --> 00:06:20,172 I had double vision before I got hit. 98 00:06:20,172 --> 00:06:23,383 Well, that changes everything, you need glasses. 99 00:06:23,383 --> 00:06:25,802 That's why you had double vision, which is why you got hit, 100 00:06:25,802 --> 00:06:28,639 which is why you have a concussion, which is why you have night terrors. 101 00:06:29,223 --> 00:06:31,683 You need to see an ophthalmologist, which I am not. 102 00:06:32,935 --> 00:06:34,311 You enjoyed that. 103 00:06:34,311 --> 00:06:35,896 I brought a reasonable case to your attention, 104 00:06:35,938 --> 00:06:37,940 and you shoved it in my face just to humiliate me. 105 00:06:37,940 --> 00:06:39,399 You're an only child, aren't you? 106 00:06:40,192 --> 00:06:41,026 Why would you say that? 107 00:06:41,026 --> 00:06:42,986 Everything is about you. 108 00:06:43,820 --> 00:06:47,574 This may seem incredibly controversial, but I think sexual abuse is bad. 109 00:06:48,242 --> 00:06:50,619 I just wanted to make sure he wasn't being diddled by daddy, 110 00:06:50,619 --> 00:06:53,288 or mommy, anything else is just a bonus. 111 00:07:04,258 --> 00:07:05,717 I'm not an only child. 112 00:07:05,717 --> 00:07:06,510 Interesting. 113 00:07:08,095 --> 00:07:08,887 What? 114 00:07:09,429 --> 00:07:10,097 Don't move. 115 00:07:10,973 --> 00:07:12,140 Did I bore you in there? 116 00:07:12,599 --> 00:07:15,853 - What? Ah, no, not, not really. - Are you tired? 117 00:07:17,479 --> 00:07:18,146 Sometimes. 118 00:07:18,146 --> 00:07:19,439 He never sleeps! Of course he's tired. 119 00:07:19,439 --> 00:07:21,650 - Right now, at this moment, are you tired? - No, no. 120 00:07:21,650 --> 00:07:24,111 That twitch in your leg. Did you feel that? 121 00:07:26,196 --> 00:07:26,738 Didn't hurt. 122 00:07:26,738 --> 00:07:28,240 His leg twitched. I don't see what 123 00:07:28,240 --> 00:07:30,200 It's called a myoclonic jerk, 124 00:07:30,200 --> 00:07:31,994 it's very common when you're falling asleep. 125 00:07:31,994 --> 00:07:37,207 Respiration rate falls, and the brain interprets this as the body dying, so it sends a pulse to wake it up. 126 00:07:37,207 --> 00:07:37,541 So? 127 00:07:37,541 --> 00:07:40,669 So, he's not asleep, he's awake. 128 00:07:42,713 --> 00:07:43,463 Admit him. 129 00:07:47,176 --> 00:07:49,761 I recognize that loopy "G". 130 00:07:50,679 --> 00:07:52,764 So, what does the jerk tell us? 131 00:07:52,764 --> 00:07:55,601 Nothing good, the brain's losing control of the body. 132 00:07:55,601 --> 00:07:58,604 Can't order the eyes to focus, regulate sleep patterns or control muscles. 133 00:07:58,604 --> 00:08:01,064 A movement disorder, or degenerative brain disease. 134 00:08:01,064 --> 00:08:04,151 Either way this kid's gonna be picking up his diploma in diapers and a wheelchair. 135 00:08:04,151 --> 00:08:06,486 Maybe not that bad, could be an infection. 136 00:08:06,486 --> 00:08:08,780 You wish. No fever, no white count. 137 00:08:08,780 --> 00:08:14,286 Anyone think this differential diagnosis might be compromised because we don't have an accurate family history? 138 00:08:14,286 --> 00:08:15,913 I took an accurate family history. 139 00:08:15,913 --> 00:08:17,748 You didn't even take an accurate family. 140 00:08:18,457 --> 00:08:19,625 His father's not his father. 141 00:08:19,625 --> 00:08:20,626 Why would you say that? 142 00:08:20,626 --> 00:08:23,712 30% of all dads out there don't realize they're raising someone else's kid. 143 00:08:23,712 --> 00:08:25,881 From what I've read false paternity is more like 10%. 144 00:08:25,881 --> 00:08:27,382 That's what our mom's would like us to believe. 145 00:08:27,382 --> 00:08:31,512 Who cares? If he got it from his parents they'd both be dead by now, can we get on with the differential diagnosis? 146 00:08:31,553 --> 00:08:32,804 $50 bucks says I'm right. 147 00:08:32,846 --> 00:08:33,805 I'll take your money. 148 00:08:33,805 --> 00:08:37,893 Hit a nerve? Don't worry, Foreman. I'm sure the guy who tucked you in at night was your daddy. 149 00:08:37,893 --> 00:08:38,727 Make it $100. 150 00:08:39,436 --> 00:08:42,606 What about leucoencephalopathy? In a 16 year old. 151 00:08:42,606 --> 00:08:44,775 It doesn't necessarily have to be that bad. 152 00:08:44,775 --> 00:08:49,613 If we exclude the night terrors it could be something systemic: his liver, kidneys, something outside the brain. 153 00:08:49,613 --> 00:08:53,242 Yes, feel free to exclude any symptom if it makes your job easier. 154 00:08:53,242 --> 00:08:55,494 The night terrors were anecdotal. He could have had a bad dream. 155 00:08:55,536 --> 00:08:58,997 No, parents said he was conscious during the event and didn't remember anything afterwards. 156 00:08:59,623 --> 00:09:00,290 That's a night terror. 157 00:09:00,290 --> 00:09:01,041 Parents said? 158 00:09:01,792 --> 00:09:02,543 That's a good point. 159 00:09:03,210 --> 00:09:06,505 Before we condemn this kid, maybe we should entertain Dr. Chase's skepticism. 160 00:09:06,505 --> 00:09:08,215 I want a detailed polysomnograph. 161 00:09:08,215 --> 00:09:11,260 If he's having night terrors I want to see them. 162 00:09:34,658 --> 00:09:36,785 I usually don't move during night terrors. 163 00:09:36,785 --> 00:09:38,161 I'm not restraining you for them. 164 00:09:41,248 --> 00:09:47,421 EEG revealed abnormalities in your brain caused by nerve damage in your toes. 165 00:09:53,719 --> 00:09:55,012 What are you doing? 166 00:09:56,597 --> 00:09:57,723 Fixing it. 167 00:09:58,348 --> 00:10:00,058 Can I talk to my parents? 168 00:10:00,350 --> 00:10:02,019 Oh, they know all about this. 169 00:10:02,728 --> 00:10:04,229 I'd really like to see them. 170 00:10:13,488 --> 00:10:16,992 Please! I'd really like them here. 171 00:10:18,994 --> 00:10:20,495 This is gonna hurt, Dan. 172 00:10:21,747 --> 00:10:22,623 Oh, God! 173 00:10:39,431 --> 00:10:40,557 That's a night terror. 174 00:10:52,443 --> 00:10:56,447 We did a CT, MRI, CBC, Chem-7 and chest x-ray. 175 00:10:56,447 --> 00:10:59,116 All the tests came back normal. There's nothing to explain his symptoms. 176 00:10:59,116 --> 00:11:01,702 Ok, but let's pretend there's something and go from there. 177 00:11:01,786 --> 00:11:03,496 Who sees something on this MRI? 178 00:11:05,623 --> 00:11:07,333 No lesions, no white matter. 179 00:11:07,333 --> 00:11:08,960 No structural abnormalities. 180 00:11:09,001 --> 00:11:10,586 No space-occupying tumors. 181 00:11:10,586 --> 00:11:14,131 He's 16, so he should have an absolutely pristine brain. 182 00:11:14,131 --> 00:11:15,675 The smallest thing is abnormal. 183 00:11:16,926 --> 00:11:21,013 Meningeal enhancement. My bet is viral meningitis. 184 00:11:21,013 --> 00:11:23,975 Excellent, you see what he did there? 185 00:11:23,975 --> 00:11:27,728 He took a small clue that there's a neurological problem and wasn't afraid to run with it. 186 00:11:27,770 --> 00:11:30,398 There's no evidence of meningitis on that MRI. 187 00:11:30,398 --> 00:11:32,400 No, there's not, he completely wrong. 188 00:11:32,775 --> 00:11:34,277 Then what clue are you talking about? 189 00:11:34,277 --> 00:11:38,906 He knew that I saw something on the MRI so he figured there must be something there and took a guess. 190 00:11:38,906 --> 00:11:41,784 Clever, but also pathetic. 191 00:11:41,784 --> 00:11:42,910 So, what did you find? 192 00:11:43,077 --> 00:11:45,204 Take a close look at the corpus collosum. 193 00:11:48,749 --> 00:11:49,584 It looks ok. 194 00:11:49,584 --> 00:11:52,378 Are we all looking at the same thing? 195 00:11:52,378 --> 00:11:57,925 200 million interhemispheric nerve fibers, the George Washington Bridge between the left and right side of the brain. 196 00:11:59,635 --> 00:12:00,344 It's subtle. 197 00:12:04,098 --> 00:12:07,476 There's some bowing, there. An upward arch. 198 00:12:07,685 --> 00:12:08,895 Are you guessing? 199 00:12:09,896 --> 00:12:10,396 Yes. 200 00:12:10,897 --> 00:12:12,315 Too bad, you're right. 201 00:12:12,398 --> 00:12:17,069 He probably just moved, nobody stays perfectly still for their entire MRI. 202 00:12:17,069 --> 00:12:22,575 Yeah, he probably got restless and shifted one hemisphere of his brain to a more comfortable position. 203 00:12:22,950 --> 00:12:24,202 Something is pushing on it. 204 00:12:24,202 --> 00:12:25,912 If there's bowing it could be a tumor. 205 00:12:25,912 --> 00:12:27,497 Do you see a tumor on this MRI? 206 00:12:27,497 --> 00:12:29,499 No, but I don't see any bowing, either. 207 00:12:29,499 --> 00:12:32,919 There's no tumor, just a blockage causing pressure, causing symptoms. 208 00:12:32,919 --> 00:12:36,589 Today night terrors, tomorrow he's bleeding out of his eyes. 209 00:12:37,298 --> 00:12:40,676 Get him a radionucleotide cisternogram. I guarantee you'll see a blockage. 210 00:12:47,808 --> 00:12:53,105 Ok... all right easy... 211 00:13:12,708 --> 00:13:16,170 Now, I'm injecting a material that's tagged with a radioactive isotope. 212 00:13:17,129 --> 00:13:20,174 It's gonna enter your spine and travel up to your brain. 213 00:13:21,259 --> 00:13:23,469 It'll make you able to think deep thoughts, 214 00:13:23,928 --> 00:13:25,680 at about 100 miles per hour. 215 00:13:27,515 --> 00:13:28,015 Easy. 216 00:13:42,613 --> 00:13:45,616 Their eyes aren't the same color, but that fleck in the eyes... 217 00:13:46,117 --> 00:13:48,286 that's maybe a one in ten chance if they're not related? 218 00:13:48,286 --> 00:13:51,289 Nah, House isn't gonna pay you based on that. 219 00:13:51,289 --> 00:13:55,001 [chuckles] Any excuse we can give the folks to justify a DNA test? 220 00:13:55,001 --> 00:13:56,878 We could tell them he's got Huntington's. 221 00:13:56,878 --> 00:13:59,130 The whole family should be tested or they'll all die. 222 00:14:02,592 --> 00:14:06,012 Hey, there's a lot of blockage. 223 00:14:06,345 --> 00:14:08,347 I've scheduled him for surgery. 224 00:14:08,347 --> 00:14:12,101 They're gonna put a shunt into one of the ventricles to give the cerebrospinal fluid an out. 225 00:14:12,143 --> 00:14:14,478 No more pressure, everything goes back to normal. 226 00:14:15,313 --> 00:14:17,315 He's lucky to have you as his doctors. 227 00:14:26,115 --> 00:14:30,119 No formula, just mommy's healthy natural breast milk. 228 00:14:31,329 --> 00:14:32,121 Yummy. 229 00:14:32,121 --> 00:14:34,832 Her whole face just got swollen like this overnight. 230 00:14:35,541 --> 00:14:43,841 Mmhmm. No fever, glands normal, missing her vaccination dates. 231 00:14:43,841 --> 00:14:45,301 We're not vaccinating. 232 00:14:51,891 --> 00:14:53,017 Think they don't work? 233 00:14:53,017 --> 00:14:56,687 I think some multinational pharmaceutical company wants me to think they work. 234 00:14:56,687 --> 00:14:57,730 Pad their bottom line. 235 00:14:57,730 --> 00:15:01,067 Mmmm. May I? 236 00:15:01,067 --> 00:15:01,734 Sure. 237 00:15:03,319 --> 00:15:06,656 Gribbit, gribbit, gribbit. 238 00:15:08,157 --> 00:15:12,870 All natural no dies. That's a good business: all-natural children's toys. 239 00:15:12,870 --> 00:15:16,040 Those toy companies, they don't arbitrarily mark up their frogs. 240 00:15:16,040 --> 00:15:19,168 They don't lie about how much they spend in research and development. 241 00:15:19,168 --> 00:15:24,131 The worst a toy company can be accused of is making a really boring frog. 242 00:15:25,258 --> 00:15:27,009 Gribbit, gribbit, gribbit. 243 00:15:27,468 --> 00:15:29,428 You know another really good business? 244 00:15:30,304 --> 00:15:33,182 Teeny tiny baby coffins. 245 00:15:34,433 --> 00:15:37,645 You can get them in frog green or fire engine red. 246 00:15:37,645 --> 00:15:43,234 Really. The antibodies in yummy mummy only protect the kid for 6 months, 247 00:15:43,234 --> 00:15:45,903 which is why these companies think they can gouge you. 248 00:15:45,945 --> 00:15:49,323 They think that you'll spend whatever they ask to keep your kid alive. 249 00:15:49,323 --> 00:15:51,325 Want to change things? Prove them wrong. 250 00:15:51,325 --> 00:15:56,164 A few hundred parents like you decide they'd rather let their kid die then cough up 40 bucks for a vaccination, 251 00:15:56,164 --> 00:15:58,916 believe me, prices will drop REALLY fast. 252 00:15:58,916 --> 00:16:02,920 Gribbit, gribbit, gribbit, gribbit, gribbit. 253 00:16:04,088 --> 00:16:05,423 Tell me what she has. 254 00:16:08,342 --> 00:16:09,844 A cold. 255 00:16:11,554 --> 00:16:12,597 There's a problem. 256 00:16:12,597 --> 00:16:14,557 Complications in surgery? 257 00:16:14,557 --> 00:16:18,060 Surgery went fine, he's in recovery, but we took a vial of CSF and tested it. 258 00:16:18,060 --> 00:16:18,603 Really? 259 00:16:18,603 --> 00:16:21,772 Turns out the bowing wasn't the cause of his problems, it was a symptom. 260 00:16:21,772 --> 00:16:24,483 Oligoclonal bands, and an increase of intrathecal IGG. 261 00:16:24,483 --> 00:16:26,444 Which means multiple sclerosis. 262 00:16:26,444 --> 00:16:28,487 And the reason it takes three of you to tell me this? 263 00:16:28,487 --> 00:16:30,865 Because we're having a disagreement about whether or not it is MS. 264 00:16:30,865 --> 00:16:32,158 No lesions on the MRI. 265 00:16:32,158 --> 00:16:34,118 It's early; he's had the disease for maybe two weeks. 266 00:16:34,118 --> 00:16:37,163 McDonald criteria requires six months to make a definitive diagnosis. 267 00:16:37,163 --> 00:16:39,832 Oh, who cares about McPherson? I hear he tortured kittens. 268 00:16:39,832 --> 00:16:40,416 McDonald. 269 00:16:40,416 --> 00:16:43,085 Oh, McDonald. Wonderful doctor, loved kittens. 270 00:16:43,085 --> 00:16:45,171 The VEP indicates slowing of the brain. 271 00:16:45,171 --> 00:16:46,839 Without the lesions we can't be sure. 272 00:16:46,839 --> 00:16:51,344 Well if it is, it's gone from 0 to 60 in three weeks, which would indicate rapidly progressive MS. 273 00:16:51,344 --> 00:16:55,139 Not the fun MS with the balloons and the bike rides for cripples in wheelchairs. 274 00:16:55,139 --> 00:16:56,724 We should wait until we 275 00:16:56,724 --> 00:17:01,687 Start treating him now, he can walk for another couple of years, maybe live for another 5. 276 00:17:02,563 --> 00:17:04,232 Break it to the family. I'm going home. 277 00:17:04,732 --> 00:17:07,360 It'll take months for a definitive diagnosis. 278 00:17:07,818 --> 00:17:09,070 What'll happen to me? 279 00:17:10,655 --> 00:17:13,658 MS is an incredibly variable disease, 280 00:17:13,658 --> 00:17:16,661 if it is MS, and we're not 100% sure. 281 00:17:16,661 --> 00:17:18,162 What do you think is gonna happen? 282 00:17:22,458 --> 00:17:24,752 There are some medications to manage the symptoms, 283 00:17:24,752 --> 00:17:28,297 but as the disease progresses the problems will become more severe: 284 00:17:28,881 --> 00:17:32,969 bowel and bladder dysfunction, loss of cognitive function, pain. 285 00:17:32,969 --> 00:17:34,095 It's gonna hurt? 286 00:17:36,597 --> 00:17:38,975 The brain's like a big jumble of wires. 287 00:17:38,975 --> 00:17:42,019 MS strips them of the insulation, and the nerves die. 288 00:17:42,687 --> 00:17:44,397 The brain interprets it as pain, 289 00:17:44,397 --> 00:17:47,733 but by starting treatment we're gonna avoid that for as long as possible. 290 00:17:48,693 --> 00:17:50,611 We're looking into a couple specialists, 291 00:17:50,611 --> 00:17:52,989 and until we get you squared away you'll stay here. 292 00:17:53,447 --> 00:17:53,948 Ok? 293 00:18:15,136 --> 00:18:17,430 Security checked the videotapes for all the perimeter cameras; 294 00:18:17,430 --> 00:18:18,973 he's still gotta be in the hospital. 295 00:18:18,973 --> 00:18:19,891 Where's Chase? 296 00:18:19,891 --> 00:18:20,600 Main floor. 297 00:18:20,600 --> 00:18:22,727 Ok, you take the cafeteria and administration. 298 00:18:22,727 --> 00:18:24,812 I'll hit the research annex and work my way back to you. 299 00:19:02,892 --> 00:19:03,351 Dan? 300 00:19:10,399 --> 00:19:12,318 I'm not here. Leave a message. 301 00:19:18,157 --> 00:19:20,785 Dr. Cuddy, great outfit. 302 00:19:20,785 --> 00:19:22,829 What are you doing back here? Patient? 303 00:19:22,829 --> 00:19:26,624 No, hooker. Went to my office instead of my home. 304 00:19:37,426 --> 00:19:40,555 Dr. House, Dan's missing. 305 00:19:40,555 --> 00:19:43,808 Yeah, I got that part from the message. You said I was needed immediately. 306 00:19:43,808 --> 00:19:45,768 He shouldn't move after a lumbar puncture. 307 00:19:45,768 --> 00:19:48,062 I agree, he's gonna have a very nasty headache. 308 00:19:48,563 --> 00:19:51,023 That would also be my opinion if consulted tomorrow morning. 309 00:19:51,732 --> 00:19:53,109 We wanted to keep you informed. 310 00:19:53,150 --> 00:19:54,527 He heard some pretty heavy news. 311 00:19:56,612 --> 00:19:59,282 This is not a toddler wandering around a department store. 312 00:19:59,282 --> 00:20:03,828 He's 16. You'll find him. I'm going home. 313 00:20:05,121 --> 00:20:07,790 So, when you say "Call me if you need anything", You mean, "Don't call me". 314 00:20:07,790 --> 00:20:09,959 No, I mean "Call me if I can do something". 315 00:20:09,959 --> 00:20:13,504 I'm bad at search parties and I'm bad at sitting around looking nervous doing nothing. 316 00:20:14,088 --> 00:20:16,174 What about his parents? Should we call them? 317 00:20:16,174 --> 00:20:17,633 Why? You think they're hiding him? 318 00:20:19,510 --> 00:20:21,345 Make sure someone checks the roof; 319 00:20:21,345 --> 00:20:24,932 some of the orderlies keep the door propped open so they can grab a smoke. 320 00:21:00,551 --> 00:21:02,845 Dan? You ok? 321 00:21:09,769 --> 00:21:13,898 There are experimental treatments, ongoing research... 322 00:21:13,898 --> 00:21:16,192 Who knows what they'll discover in a year or two? 323 00:21:16,192 --> 00:21:18,110 This is where I dropped the ball. 324 00:21:18,444 --> 00:21:20,821 Dan, we're standing on the roof of the hospital! 325 00:21:23,407 --> 00:21:27,078 Dan! Dan, you're not on the field! 326 00:21:28,412 --> 00:21:29,497 He doesn't know where he is. 327 00:21:29,497 --> 00:21:30,289 Dan! 328 00:21:30,289 --> 00:21:30,957 Foreman! 329 00:21:33,042 --> 00:21:33,584 Dan. 330 00:21:35,753 --> 00:21:36,212 Dan! 331 00:21:36,212 --> 00:21:37,046 Dan! No! 332 00:21:48,140 --> 00:21:49,392 Dr. Foreman. 333 00:21:51,602 --> 00:21:53,104 I assume you found the kid. 334 00:21:53,104 --> 00:21:54,730 He almost walked off the roof. 335 00:21:55,565 --> 00:21:56,190 Suicidal? 336 00:21:56,190 --> 00:21:58,109 No, he thought he was on his lacrosse field. 337 00:21:58,109 --> 00:22:00,403 Look, look, I was just gonna run home, shower, change... 338 00:22:00,403 --> 00:22:01,153 Conscious? 339 00:22:01,779 --> 00:22:02,113 Yeah. 340 00:22:03,531 --> 00:22:04,574 How'd you talk him down? 341 00:22:04,574 --> 00:22:06,033 Actually, Chase tackled him. 342 00:22:06,033 --> 00:22:07,118 How come you didn't do it? 343 00:22:07,869 --> 00:22:10,580 Right, well, I am black, but he was closer. 344 00:22:13,708 --> 00:22:14,959 Come on, you can ride up with me. 345 00:22:22,674 --> 00:22:26,303 Anybody tell the family that their boy almost stepped off a roof? They must be thrilled. 346 00:22:26,303 --> 00:22:28,972 They're not suing, but I think only because Chase asked them. 347 00:22:28,972 --> 00:22:31,224 Why does everyone always think I'm being sarcastic? 348 00:22:31,224 --> 00:22:34,144 This is great news! He doesn't have MS. 349 00:22:34,144 --> 00:22:36,438 The parents should be thrilled, well, the mom anyway. 350 00:22:36,438 --> 00:22:37,439 Of course, the dad probably doesn't know 351 00:22:37,439 --> 00:22:39,566 Why doesn't he have MS? 352 00:22:39,566 --> 00:22:41,610 He was on the roof thinking he was on the lacrosse field, 353 00:22:41,610 --> 00:22:44,112 conscious, and therefore not a night terror. You want some of this? 354 00:22:44,696 --> 00:22:45,780 Yeah, sure. 355 00:22:45,780 --> 00:22:48,241 He was in an acute confusional state, 356 00:22:48,241 --> 00:22:50,577 which doesn't fit with a demyelinating disease like MS. 357 00:22:50,577 --> 00:22:51,745 The Oligoclonal bands. 358 00:22:51,745 --> 00:22:54,831 Were real. They just mean something other then MS. 359 00:22:54,831 --> 00:22:56,333 So, what are they telling us? 360 00:22:56,333 --> 00:22:58,210 That the immune system is working. 361 00:22:58,210 --> 00:23:00,754 Right, he has an infection in his brain. 362 00:23:00,754 --> 00:23:01,880 What about sex? 363 00:23:02,464 --> 00:23:04,633 Well, it might get complicated. 364 00:23:04,633 --> 00:23:05,675 We work together. 365 00:23:05,675 --> 00:23:07,427 I am older, certainly, but maybe you like that. 366 00:23:07,427 --> 00:23:09,262 I meant maybe he has neurosyphilis. 367 00:23:09,262 --> 00:23:10,764 Heh, nice cover. 368 00:23:10,764 --> 00:23:12,474 Sorry, RPR was negative. 369 00:23:12,474 --> 00:23:14,434 We don't need a definitive test to confirm this. 370 00:23:14,434 --> 00:23:16,019 Sure, didn't need one to confirm MS. 371 00:23:16,019 --> 00:23:20,941 Ok, let's wait for you to run titers on 4000 viruses while this kid's brain turns to mush. 372 00:23:20,941 --> 00:23:25,028 So the fact that he doesn't have MS is, it's really not good news after all? 373 00:23:25,028 --> 00:23:26,947 Well, it is if it's neurosyphilis, 374 00:23:26,947 --> 00:23:29,950 the likelihood of a false negative on an RPR test, 30%, 375 00:23:29,950 --> 00:23:33,703 the likelihood of a 16 year old having sex, roughly 120%. 376 00:23:33,703 --> 00:23:35,038 I'll start him on IV penicillin. 377 00:23:35,038 --> 00:23:36,039 We're not going to wait for that. 378 00:23:36,039 --> 00:23:39,292 The most effective way to deliver the drug is right into his brain via the spine. 379 00:23:39,292 --> 00:23:41,294 We can't. In a cramped space like the brain, 380 00:23:41,294 --> 00:23:46,258 increased intracranial pressure from a high volume drug like penicillin could herniate his brain stem and kill him. 381 00:23:46,258 --> 00:23:48,635 No neurologist in his right mind would recommend that. 382 00:23:48,635 --> 00:23:51,179 Show of hands. Who thinks I'm not in my right mind? 383 00:23:52,180 --> 00:23:55,725 And who thinks I forget this fairly basic neurological fact? 384 00:23:55,725 --> 00:23:58,144 Who thinks there's a third option? 385 00:24:00,105 --> 00:24:01,815 Very good, what's the third choice? 386 00:24:01,815 --> 00:24:04,109 No idea, you just asked if I thought there was one. 387 00:24:06,319 --> 00:24:09,698 [Sighs] The patient has a shunt in his brain. 388 00:24:09,698 --> 00:24:13,326 There'll be no increased pressure, we can put as much penicillin into his body as we want. 389 00:24:13,326 --> 00:24:15,954 Excellent, inject him through a lumbar puncture. 390 00:24:19,291 --> 00:24:22,419 One of us is going to do this to you twice a day for the next two weeks. 391 00:24:22,419 --> 00:24:24,754 [Sighs] 392 00:24:26,423 --> 00:24:29,843 He could get syphilis even if he's not sexually active? 393 00:24:31,678 --> 00:24:35,473 Well, it's unusual, but it's possible. 394 00:24:37,017 --> 00:24:37,809 Relax. 395 00:24:46,776 --> 00:24:48,403 Geesh. 396 00:24:50,780 --> 00:24:51,948 It's infected, 397 00:24:51,948 --> 00:24:56,620 with a really big hole like you stuck a nail in it to relieve the pressure. 398 00:24:56,620 --> 00:24:57,287 I wouldn't do that. 399 00:24:57,287 --> 00:24:59,039 Although the wound is irregular, 400 00:24:59,039 --> 00:25:02,667 not cylindrical, it's shaped like a triangle, so not a nail. 401 00:25:03,335 --> 00:25:04,127 Steak knife? 402 00:25:04,127 --> 00:25:05,170 Wife's nail file. 403 00:25:05,170 --> 00:25:06,379 Nail File. 404 00:25:07,547 --> 00:25:09,841 Yeah, pain'll make you do stupid things. 405 00:25:11,176 --> 00:25:12,677 Something to take the edge off? 406 00:25:12,969 --> 00:25:13,845 Yeah. 407 00:25:16,431 --> 00:25:17,098 Cheers. 408 00:25:22,103 --> 00:25:24,606 So, do you have family here in Princeton? 409 00:25:25,023 --> 00:25:25,690 No. 410 00:25:26,691 --> 00:25:27,901 Here on work? 411 00:25:27,901 --> 00:25:28,860 No, why are you 412 00:25:28,860 --> 00:25:30,070 Does your penis hurt? 413 00:25:30,070 --> 00:25:32,239 No. What? Should it? 414 00:25:32,239 --> 00:25:35,617 No, just thought I'd toss you a really inappropriate question. 415 00:25:36,201 --> 00:25:37,452 Your lawyer's gonna love it. 416 00:25:37,452 --> 00:25:39,746 Why would I want to sue you? I want you to treat me. 417 00:25:39,746 --> 00:25:41,456 You're from Maplewood, New Jersey. Right? 418 00:25:41,498 --> 00:25:42,290 Yeah. 419 00:25:42,290 --> 00:25:48,380 Now, why would you drive 70 miles to get treatment for a condition that a 9 year old could diagnose? 420 00:25:49,714 --> 00:25:52,509 It's the free flowing puss that's the tip off. 421 00:25:52,509 --> 00:25:53,343 I was in town. 422 00:25:53,343 --> 00:25:55,428 Not for family, not for work. 423 00:25:55,428 --> 00:25:59,057 You drove 70 miles to a walk-in-clinic. You passed two hospitals on the road. 424 00:25:59,057 --> 00:26:02,435 Now, either you have a problem with those hospitals, or they have a problem with you. 425 00:26:02,435 --> 00:26:05,230 My guess is that you've sued half the doctors in Maplewood, 426 00:26:05,230 --> 00:26:07,107 and the rest are now refusing to treat you. 427 00:26:07,107 --> 00:26:08,233 It's ironic, isn't it? 428 00:26:08,233 --> 00:26:11,278 It's like the boy who sued wolf. 429 00:26:11,278 --> 00:26:13,947 You know what? I bet we have a doctor here named Wolfe. 430 00:26:13,947 --> 00:26:16,032 How perfect would that be? 431 00:26:16,074 --> 00:26:17,617 I'm gonna page him. 432 00:26:17,617 --> 00:26:20,453 Ok, you know what? Thank you, I'm gonna find a doctor to take care of this. 433 00:26:21,371 --> 00:26:22,914 I didn't say I wouldn't treat you. 434 00:26:23,582 --> 00:26:26,084 We'll drain your knee, run some lab work, fix you right up. 435 00:26:26,084 --> 00:26:26,835 Why would you do that? 436 00:26:27,210 --> 00:26:28,420 I'm a people person. 437 00:26:29,880 --> 00:26:31,256 You actually treated him? 438 00:26:31,256 --> 00:26:35,218 All I know is that he sued some doctors, who am I to assume that they didn't have it coming to them. 439 00:26:35,594 --> 00:26:39,639 The cutest little tennis outfit, my God I thought I was going to have a heart attack. 440 00:26:39,639 --> 00:26:41,600 Oh my, I didn't see you there, that is so embarrassing. 441 00:26:41,600 --> 00:26:42,684 How's your hooker doing? 442 00:26:42,684 --> 00:26:44,895 Oh, sweet of you to ask, funny story, 443 00:26:44,895 --> 00:26:48,815 she was going to be a hospital administrator, but hated having to screw people like that. 444 00:26:48,815 --> 00:26:49,858 I heard you found her on the roof. 445 00:26:49,858 --> 00:26:51,401 You have very acute hearing. 446 00:26:51,860 --> 00:26:53,236 You notify the parents? 447 00:26:53,236 --> 00:26:54,487 In due course, of course. 448 00:26:54,487 --> 00:26:58,700 And is there a paternity bet on the father of the patient? 449 00:26:58,700 --> 00:26:59,659 Doesn't sound like me. 450 00:26:59,659 --> 00:27:01,912 Well, it does actually, but that doesn't mean you're guilty. 451 00:27:01,912 --> 00:27:02,704 You think? 452 00:27:02,746 --> 00:27:06,082 I saw the parents in the lobby, smart money is obviously on the father. 453 00:27:06,958 --> 00:27:09,419 My guy knows a guy who can get you in for $50 bucks. 454 00:27:09,419 --> 00:27:13,215 Fine. You tell your guy if I win, you attend the faculty symposium and you wear a tie. 455 00:27:13,215 --> 00:27:16,051 And if I win, no clinic hours for a week. 456 00:27:16,593 --> 00:27:18,220 My guy will call your guy. 457 00:27:20,639 --> 00:27:22,307 She's very good at her job. 458 00:27:27,354 --> 00:27:29,105 The treatments should start helping soon. 459 00:27:29,147 --> 00:27:32,567 Let us know if it gets easier to focus on things, remember stuff. 460 00:27:34,736 --> 00:27:38,198 Hey Dan, isn't Dr. Cameron's necklace a beauty? 461 00:27:38,198 --> 00:27:40,408 Something South American, I think. 462 00:27:40,408 --> 00:27:42,619 Yeah, Guatemalan. 463 00:27:43,995 --> 00:27:45,247 It's a cool necklace. 464 00:27:47,290 --> 00:27:48,667 Thank you so much. 465 00:27:48,667 --> 00:27:49,793 The kid's in pain. 466 00:27:51,878 --> 00:27:53,880 - Don't fight it. - Just let it happen. 467 00:27:53,880 --> 00:27:54,840 No. 468 00:27:54,840 --> 00:27:56,049 - No, what? - You'll be dead in three days. 469 00:27:56,091 --> 00:27:57,008 I give it a day. 470 00:27:57,008 --> 00:27:58,718 Dan? You ok? 471 00:27:59,010 --> 00:27:59,386 Dan? 472 00:28:04,182 --> 00:28:05,350 He's hearing voices. 473 00:28:06,434 --> 00:28:07,102 Dan? 474 00:28:13,817 --> 00:28:16,278 Push three milligrams IV, stat! 475 00:28:18,280 --> 00:28:19,364 Come on Dan! 476 00:28:19,364 --> 00:28:21,074 GET OUT OF MY HEAD! 477 00:28:23,200 --> 00:28:25,786 Auditory hallucination shows further brain degeneration. 478 00:28:25,786 --> 00:28:27,163 Penicillin's not working. 479 00:28:27,163 --> 00:28:32,251 So, either it's a bad batch of penicillin, or our diagnosis is wrong. 480 00:28:33,627 --> 00:28:36,714 Square one. "Mignight". 481 00:28:36,714 --> 00:28:41,343 LFTs, BUN, and creatinine, are all normal, diabetes is out. No gap. 482 00:28:41,343 --> 00:28:42,469 There goes metabolic. 483 00:28:42,469 --> 00:28:43,804 MRI rules out vasculitis. 484 00:28:43,804 --> 00:28:45,014 "I" for inflammation. 485 00:28:45,014 --> 00:28:46,682 To young for anything degenerative. 486 00:28:46,682 --> 00:28:49,351 "D", see ya. "N" for neoplastic? 487 00:28:49,351 --> 00:28:50,519 MRI was clean. 488 00:28:51,937 --> 00:28:53,189 "I" for inflammation. 489 00:28:53,189 --> 00:28:53,772 We already did that. 490 00:28:53,772 --> 00:28:55,608 Stupid to have two I's in one mneumonic. 491 00:28:55,608 --> 00:28:56,233 What's the other one? 492 00:28:56,233 --> 00:28:56,984 Infection. 493 00:28:56,984 --> 00:28:58,861 Oligoclonal bands still have to mean something. 494 00:28:58,861 --> 00:29:01,363 But no fevers; white count's elevated but within range. 495 00:29:01,363 --> 00:29:03,240 And we've tested for anything remotely possible. 496 00:29:03,240 --> 00:29:04,074 Everything is negative. 497 00:29:04,074 --> 00:29:05,659 CT scan rules out subdural. 498 00:29:05,659 --> 00:29:08,037 Trauma, later much. 499 00:29:12,958 --> 00:29:14,543 You know the problem? 500 00:29:14,543 --> 00:29:17,129 Midnight is actually spelled with a "G" and an "H". 501 00:29:18,172 --> 00:29:20,799 If we could just figure out what those two letters stand for. 502 00:29:25,137 --> 00:29:32,978 It's a sick brain, having fun, torturing him, talking to him. 503 00:29:37,942 --> 00:29:39,652 Scaring the hell out of him. 504 00:29:42,196 --> 00:29:46,826 Get him an EEG, left and right EOG esophageal microphones. 505 00:29:46,867 --> 00:29:51,372 If this thing wants to talk, let's listen. 506 00:29:53,165 --> 00:29:54,625 We're missing something. 507 00:29:55,751 --> 00:29:57,086 This is screwed up. 508 00:29:57,086 --> 00:30:00,965 That's why you came up with the brain talking to the virus thing? 509 00:30:00,965 --> 00:30:02,716 I panicked, ok? 510 00:30:03,092 --> 00:30:05,386 Sounded cool though, they bought it. 511 00:30:08,931 --> 00:30:10,808 Oh, crap. 512 00:30:10,808 --> 00:30:13,269 Another reason I don't like meeting patients. 513 00:30:13,269 --> 00:30:15,521 If they don't know that you look like they can't yell at you. 514 00:30:16,230 --> 00:30:17,481 Here we go. 515 00:30:22,570 --> 00:30:24,446 How can you just sit there? 516 00:30:25,531 --> 00:30:27,283 If I eat standing up, I spill. 517 00:30:27,283 --> 00:30:30,578 Our son is dying, and you could care less? 518 00:30:31,245 --> 00:30:34,415 We're going through hell; you're doing nothing? 519 00:30:35,624 --> 00:30:37,751 I'm sorry, you need to vent, I understand. 520 00:30:37,751 --> 00:30:40,254 Don't be condescending. 521 00:30:40,254 --> 00:30:41,797 You haven't checked in on him once. 522 00:30:42,840 --> 00:30:45,342 Blood pressure's 110/70, 523 00:30:45,342 --> 00:30:48,470 the shunt is patent well placed in the right lateral ventricle, 524 00:30:48,470 --> 00:30:53,267 the EKG shows a normal QRS with deep wave inversions throughout both limb and pericardial leads. 525 00:30:53,267 --> 00:30:55,978 LFTs are elevated but only twice the normal range. 526 00:30:55,978 --> 00:30:58,772 Oh yeah, and he's hearing voices. 527 00:31:03,736 --> 00:31:04,987 Go hold his hand. 528 00:31:07,198 --> 00:31:09,033 Go on; I'll bus your tray. 529 00:31:23,005 --> 00:31:24,965 Got any sample bags on you? 530 00:31:24,965 --> 00:31:28,260 I don't believe you. You're gonna run DNA tests? 531 00:31:28,260 --> 00:31:31,138 Their son is deathly ill, I know it's terrible, 532 00:31:31,138 --> 00:31:35,559 but the fact is if I don't keep busy with trivial things like this I'm afraid I might start to cry. 533 00:31:35,559 --> 00:31:36,477 You're an ass. 534 00:31:36,477 --> 00:31:39,188 Yeah? You want to double the bet? 535 00:31:50,074 --> 00:31:52,827 General Hospital is on channel 6. 536 00:31:52,827 --> 00:31:56,080 Dan's brain's not showing channel 6 right now, only mush. 537 00:31:56,080 --> 00:31:57,957 No epileptiform activity. 538 00:32:00,209 --> 00:32:01,210 What are you doing? 539 00:32:01,210 --> 00:32:02,962 Waiting for CBC and Chem-7. 540 00:32:02,962 --> 00:32:05,130 Good, run DNA on these. 541 00:32:07,883 --> 00:32:08,592 What's this? 542 00:32:08,592 --> 00:32:09,802 Parents' coffee cups. 543 00:32:11,804 --> 00:32:12,680 I can't believe you 544 00:32:12,680 --> 00:32:14,139 I've had this conversation once already. 545 00:32:14,139 --> 00:32:16,475 If you've got something else to do, do it. Otherwise, do this. 546 00:32:25,359 --> 00:32:26,318 Dr. House? 547 00:32:26,777 --> 00:32:28,529 Hey, Mr. Funsten! 548 00:32:28,529 --> 00:32:30,030 I was wondering when you'd be back. 549 00:32:30,030 --> 00:32:31,115 Got some papers for me? 550 00:32:31,615 --> 00:32:33,993 You've caused me considerable mental distress. 551 00:32:33,993 --> 00:32:34,952 I certainly hope so. 552 00:32:36,287 --> 00:32:39,999 What? Too cheep to have your lawyer serve it for you, or is it more fun this way? 553 00:32:39,999 --> 00:32:42,084 I'm obviously prepared to consider a settlement. 554 00:32:42,501 --> 00:32:44,044 You have gonorrhea. 555 00:32:46,630 --> 00:32:47,756 No, I don't! 556 00:32:47,756 --> 00:32:50,259 Well, maybe you're right, but I have a lab result that says you do. 557 00:32:50,259 --> 00:32:53,220 It could be a false positive; normally I'd run a second test, 558 00:32:53,220 --> 00:32:54,722 but since you're here I'll just go with the first. 559 00:32:54,722 --> 00:32:55,890 You're just trying to scare me. 560 00:32:55,890 --> 00:32:58,017 It's reportable you know, public health issue. 561 00:32:58,017 --> 00:32:59,310 I'll be sure to let my wife know. 562 00:32:59,310 --> 00:33:02,062 Oh, don't bother yourself, the state will call for you. 563 00:33:02,062 --> 00:33:05,149 Look, if you're clean I'm sure this will all blow over, no big deal. 564 00:33:05,149 --> 00:33:08,235 There's an easy way to find out, get one of your doctors run a test. 565 00:33:10,946 --> 00:33:11,947 Uh-uh. 566 00:33:12,198 --> 00:33:13,491 These are mine now. 567 00:33:14,241 --> 00:33:15,534 I'll see you in court. 568 00:33:19,413 --> 00:33:23,918 West Nile negative, not surprising, since not too many mosquitoes passing through Jersey in December. 569 00:33:23,918 --> 00:33:25,419 No Eastern Equine Encephalitis. 570 00:33:25,419 --> 00:33:26,462 You guys aren't going to believe this. 571 00:33:26,462 --> 00:33:27,171 What's that? 572 00:33:27,671 --> 00:33:29,798 House was right, the father's not the father. 573 00:33:29,798 --> 00:33:32,718 [Sighs] Dude doubled up on me. 574 00:33:34,011 --> 00:33:36,013 You're not gonna believe this, 575 00:33:36,013 --> 00:33:37,473 the mother's not the mother either. 576 00:33:40,559 --> 00:33:43,479 It's not a good idea to move your son in his condition. 577 00:33:43,479 --> 00:33:44,813 We just want a second opinion. 578 00:33:44,813 --> 00:33:45,814 We need an answer. 579 00:33:47,274 --> 00:33:48,692 You idiots! 580 00:33:48,984 --> 00:33:50,277 You lied to me! 581 00:33:50,277 --> 00:33:51,737 We didn't lie about anything. 582 00:33:52,196 --> 00:33:54,657 You, on the other hand, accused us of molesting our son. 583 00:33:55,032 --> 00:33:55,491 Perfect. 584 00:33:55,491 --> 00:33:58,118 Can we get off my screw-ups and focus on theirs? 585 00:33:58,118 --> 00:34:00,704 Theirs is bigger. You're not Dan's parents. 586 00:34:00,704 --> 00:34:01,747 We're his parents. 587 00:34:01,747 --> 00:34:03,666 He was adopted. He doesn't need to know. 588 00:34:03,666 --> 00:34:04,500 I do. 589 00:34:04,500 --> 00:34:06,210 Adoption makes him just as much as 590 00:34:06,210 --> 00:34:09,922 Listen, when we were taking his medical history, were you confused? 591 00:34:10,130 --> 00:34:12,758 Did you think we were looking for a genetic clue to his condition, 592 00:34:12,758 --> 00:34:16,887 or did you think we were trying to ascertain who loves him the most in the whole wide world? 593 00:34:16,887 --> 00:34:18,222 How did you find out about this? 594 00:34:19,807 --> 00:34:21,183 I sampled their DNA. 595 00:34:21,183 --> 00:34:22,935 We didn't give you any DNA. 596 00:34:22,935 --> 00:34:24,770 Your coffee cups from the cafeteria. 597 00:34:24,770 --> 00:34:26,397 You can't do that! 598 00:34:26,397 --> 00:34:29,066 Again, why are we getting hung up on what I did? 599 00:34:29,066 --> 00:34:30,651 Your medical history is useless. 600 00:34:30,651 --> 00:34:34,822 No, we gave you a detailed history of his biological mother. 601 00:34:35,197 --> 00:34:36,073 Her history; 602 00:34:36,448 --> 00:34:40,995 non-smoker, good health, low cholesterol, no blood pressure problems. 603 00:34:40,995 --> 00:34:43,789 Dan was adopted two weeks after he was born. You have his history. 604 00:34:43,789 --> 00:34:45,583 There's nothing you need to know that we didn't tell you. 605 00:34:45,583 --> 00:34:46,667 Sounds reasonable. 606 00:34:47,668 --> 00:34:51,172 Well, if you want to transfer your boy that is your choice, 607 00:34:51,172 --> 00:34:52,631 but I still think it's the wrong 608 00:34:52,631 --> 00:34:53,632 Was she vaccinated? 609 00:34:55,676 --> 00:34:58,596 The biological mother, when she was a baby, did she get her vaccinations? 610 00:34:58,596 --> 00:35:01,140 Dan was vaccinated at 6 months. 611 00:35:01,140 --> 00:35:05,728 Mm hmm, and do you know why kids get vaccinated at 6 months? 612 00:35:05,728 --> 00:35:10,441 Because before that, they are protected by their biological mother's immune system. 613 00:35:11,150 --> 00:35:13,777 So, was she vaccinated? 614 00:35:13,777 --> 00:35:20,534 An infant picks up a regular old measles virus. 615 00:35:20,534 --> 00:35:25,789 He gets a rash, he's extremely uncomfortable, has a wicked fever, but he lives. 616 00:35:25,789 --> 00:35:31,003 Here's the kicker, once every million or so times, the virus mutates. 617 00:35:31,837 --> 00:35:34,465 Instead of Dan having a fever and a rash 618 00:35:34,465 --> 00:35:38,844 the virus travels to his brain and hides like a time bomb. 619 00:35:38,844 --> 00:35:42,306 In this case for 16 years. 620 00:35:42,306 --> 00:35:44,475 Sub-acute Sclerosing Pan-encephalitis. 621 00:35:45,518 --> 00:35:49,313 I know. There's only been 20 cases in the United States in the past 30 years. 622 00:35:49,313 --> 00:35:51,982 I suppose you could make an argument that the kid's still in stage one. 623 00:35:51,982 --> 00:35:54,693 Once SSPE moves to stage two 624 00:35:54,693 --> 00:35:57,613 Boom, stage two is universally fatal. 625 00:35:58,030 --> 00:36:00,658 I assume it's impossible to tell when he might move into stage two. 626 00:36:00,658 --> 00:36:04,620 He's already started showing symptoms. It could be a month, it could be tonight. 627 00:36:05,663 --> 00:36:06,330 Can we treat it? 628 00:36:06,330 --> 00:36:07,581 Ask the neurologist. 629 00:36:07,581 --> 00:36:09,291 Intraventricular interferon. 630 00:36:09,291 --> 00:36:13,879 We're not gonna shove a spike into his brain and drip interferon without confirming this diagnosis. 631 00:36:13,879 --> 00:36:14,630 Tap him. 632 00:36:14,630 --> 00:36:17,716 We won't get a reliable result for measles antibodies in his CSF, 633 00:36:17,716 --> 00:36:19,176 not after everything we've given him. 634 00:36:20,177 --> 00:36:23,848 Why do people lie to me? 635 00:36:26,433 --> 00:36:27,685 It could also kill him. 636 00:36:27,685 --> 00:36:31,480 Your ball, Foreman, tell me I don't have to biopsy his brain. 637 00:36:33,274 --> 00:36:35,401 Well, there is one other way. 638 00:36:35,401 --> 00:36:38,654 You sure this isn't gonna hurt? 639 00:36:39,029 --> 00:36:41,198 Yeah, it's just scary as hell. 640 00:36:41,448 --> 00:36:43,117 See, we go through the pupil. 641 00:36:43,117 --> 00:36:45,870 You won't feel it; the eye's been paralyzed. 642 00:36:45,870 --> 00:36:50,291 The needle travels to the back of the eye which is where we perform the biopsy on your retina. 643 00:36:56,130 --> 00:36:59,466 So we've confirmed that the problem is this mutated virus. 644 00:36:59,466 --> 00:37:03,053 The treatment for SSPE is intra-ventricular interferon. 645 00:37:03,053 --> 00:37:05,973 We implant an Ommaya reservoir under the scalp, 646 00:37:05,973 --> 00:37:07,933 which is connected to a ventricular catheter 647 00:37:07,933 --> 00:37:11,020 that delivers the antiviral directly to the left hemisphere 648 00:37:11,020 --> 00:37:12,646 Look, you want us to consent to this? 649 00:37:12,646 --> 00:37:14,273 I don't even understand what you're talking about. 650 00:37:14,356 --> 00:37:17,359 Well, the antiviral 651 00:37:19,904 --> 00:37:20,863 Look, I'm sorry, 652 00:37:21,739 --> 00:37:23,741 I can explain this as best I can, 653 00:37:23,741 --> 00:37:26,785 but the notion that you're gonna fully understand your son's treatment 654 00:37:26,785 --> 00:37:30,206 and make an informed decision, is, it's kinda insane. 655 00:37:32,208 --> 00:37:33,751 Now, here's what you need to know, 656 00:37:35,127 --> 00:37:39,423 it's dangerous, it could kill him, 657 00:37:39,423 --> 00:37:41,217 you should do it. 658 00:38:13,791 --> 00:38:16,877 You can't order a $3,200 DNA test to win a bet. 659 00:38:16,877 --> 00:38:18,796 It's not an actual cost. 660 00:38:18,796 --> 00:38:23,050 I don't know if you know this, but the hospital actually owns the sequencing machine. 661 00:38:23,050 --> 00:38:23,843 I'm serious. 662 00:38:23,843 --> 00:38:25,928 Well, tell the parents to submit the bill to insurance. 663 00:38:25,928 --> 00:38:28,055 Insurance is not going to pay for a bet. 664 00:38:28,055 --> 00:38:31,350 It should. If we don't make that bet, the kid dies. 665 00:38:31,350 --> 00:38:34,436 If not for the paternity bet, I never would have taken their DNA, 666 00:38:34,436 --> 00:38:37,064 without their DNA we never would have discovered that Dan was adopted, 667 00:38:37,064 --> 00:38:38,482 which was the key to this case. 668 00:38:39,984 --> 00:38:42,153 You just don't want to pay your end. 669 00:38:42,987 --> 00:38:45,281 Big mistake. My guy knows a guy. 670 00:38:45,281 --> 00:38:48,492 Fine. I will let you out of clinic duty for one week, 671 00:38:48,492 --> 00:38:52,079 after you pay the $3,200 for the PCR test. 672 00:39:00,379 --> 00:39:00,796 Whoo. 673 00:39:01,463 --> 00:39:04,175 Well now, there's the $100 you owe me, 674 00:39:05,426 --> 00:39:07,511 there's the $100 I won from Cameron, 675 00:39:07,511 --> 00:39:10,389 $200 I took off of Foreman, 676 00:39:11,473 --> 00:39:15,936 and $600 I got from Wilson. 677 00:39:17,771 --> 00:39:19,106 Very bitter. 678 00:39:23,152 --> 00:39:24,361 Hey, good morning. 679 00:39:25,070 --> 00:39:28,032 Good news on your EEG, treatment is working. 680 00:39:28,032 --> 00:39:29,992 And your immune system is responding. 681 00:39:30,910 --> 00:39:33,829 I know it's early, but let me take a look. 682 00:39:36,415 --> 00:39:38,417 Let's see what that brain of yours can do. 683 00:39:38,876 --> 00:39:42,755 Name as many animals as you can that start with the letter "O". 684 00:39:43,380 --> 00:39:48,469 Ostrich, ox, old elephant. 685 00:39:48,469 --> 00:39:50,971 Well, that's 2 better then last time. 686 00:39:51,972 --> 00:39:53,891 How you doing with the whole adoption thing? 687 00:39:54,683 --> 00:39:56,227 I knew since 5th grade. 688 00:39:56,894 --> 00:39:57,728 How's that? 689 00:39:58,145 --> 00:39:59,313 Cleft chin. 690 00:40:00,773 --> 00:40:03,567 I have one, my dad doesn't. 691 00:40:04,068 --> 00:40:07,780 I looked it up on the Internet; it's one of those trait things. 692 00:40:07,780 --> 00:40:10,157 That's right, it's autosomal dominant. 693 00:40:11,367 --> 00:40:13,077 Since neither of your parents have cleft chins, 694 00:40:13,077 --> 00:40:15,538 it's highly unlikely that you're biologically related. 695 00:40:17,915 --> 00:40:19,250 You sure you're ok? 696 00:40:19,834 --> 00:40:21,836 I've got no problems with being adopted. 697 00:40:23,629 --> 00:40:25,214 I love my parents. 698 00:40:28,259 --> 00:40:29,009 How's he doing? 699 00:40:29,009 --> 00:40:30,427 He's doing pretty well. 700 00:40:30,803 --> 00:40:31,846 He's a smart kid. 701 00:40:32,930 --> 00:40:34,473 I think he's gonna be fine. 702 00:40:39,436 --> 00:40:40,437 Thanks. 703 00:41:16,265 --> 00:41:17,850 Wheels, one-eight! Wheels!