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House: Fetal Position

House Episode 3-17 "Fetal Position"

Air date 4/2/2007
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The Hook
Famous celebrity photographer Emma Sloan shoots rock star Tyson Ritter, ("All American Rejects" playing himself) . As the shoot proceeds, Emma becomes unable to read, then her speech becomes slurred and nonsensical, then she collapses.
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Full Review

Act 1

House wanders into Emma's hospital room and disses the admitting doctor who gave her a clean bill of health and a discharge certificate. He says her "pronator drift" and micro aneurisms in the blood vessels at the back of her eyes predict further strokes unless he can find the origin of them. Another diagnostic test : he has her puff up her cheeks, then pats her on the cheeks and says she should be able to keep the air in : my wife and I look at each other and make the same puffy cheeks and slap them ourselves with the same results : help! Are we on the road to strokes? I defy you to try this and keep the air in. They chat a bit about each other's professions and Emma reveals she learned about strokes from her baby's sperm donor : a gay neurologist. Anyone we know? As he strolls around and notes the bloody urine in her catheter bag, she snaps pictures of House from her bed.

The Hice (OK, my neologism for the three little houses, Foreman, Chase and Cameron) stare raptly at an x-ray light table. But when the view reverses itself we see not an x-ray but a photograph of House. "Definitely different…" "…it looks almost like…" "he's caring." They finish each other's sentences. House interrupts and rips the picture down. The initial diagnosis : her kidneys are shutting down. But nothing appears abnormal in her body to account for this. In the middle of diagnosis, House muses about the Galapagos Islands as a spot for his upcoming vacation. Chase asks if that means they get a vacation, too. Sure Chase, all the diagnostic doctors should plan to leave at the same time. Or maybe it would just seem like a vacation with House gone. So, anyway, where did the clot that caused the stroke come from? House, continuing his theme that all patients lie and don't follow instructions, speculates that maybe Emma didn't finish all her antibiotics during ‘six cases of strep throat' because ‘everybody stops taking the antibiotics once they feel better, which could lead to rheumatic fever which could lead to heart damage which could throw a clot, so off the Hice trot to examine the heart'.

As Chase and Cameron load Emma into the barrel of the MRI, they wonder why no big reaction from House to catching them half naked in the janitor's closet last week. The heart looks normal, but House's behavior doesn't. Chase is all "maybe he just doesn't care", while Cameron is all "he's plotting something." They find a slightly calcified mitral valve in the heart, but disagree over whether it could have thrown the clot.

So now Cameron and Chase have Emma on a table in an OR and are starting a balloon angioplasty to expand the valve. Or I guess it's not an OR, because in slips Cuddy all non-sterile and everything. Everybody, even Cuddy are wearing these blue pullover things that look sort of like the lead apron your x-ray technician wears, but there's no radioactivity involved here. What are those things, anyway? There's one piece worn over the torso, and another disconnected piece around their necks. Huh? The catheter is inserted in a vein(?) in the arm and fed to the heart valve where it does its job.

House's office, where he's apparently making airline reservations and declaring he doesn't want a layover in : well a bunch of disconnected cities that don't make any sense, taken together. Now he's going to Phnom Penh, and wants a direct flight. Is there such? The Hice enter and complain about Cuddy interfering, which House says is her job. They say the heart is fixed, but Emma's kidneys are still failing. Foreman questions House's apparent intention to vacation in the "killing fields". It's to catch the giant catfish there House responds. "Aren't those endangered? " Foreman asks. "That's why its my last chance to catch one." Now they need a new theory. Pre eclampsia? Infection?

They come up with five possibilities and spread out to test and figure out which one it is. House's phone call is still going on the speaker phone, and the recorded voice thanks him for his patience. Like Larry Niven, House's patience is legendary, which is to say, non-existent.

Cameron is staring at blood under a microscope and declares Emma 0 for 5. None of the possibilities checks out. The Hice puzzle over how the labs could have been screwed up, since they did them themselves and nobody else had access. A look comes over House's face as he says that's not quite true. He goes to Emma's room and delivers the verdict. Her body is fine but there's something wrong with her baby that's killing her.

Act 2

As the patient lies in her bed and contemplates her possible death by fetus, House breaks out the whiteboard o' symptoms. At the top is "Maternal Mirror Syndrome", in which a sick baby is a "time bomb that kills mom while it's dying." The key to making mom better is to fix the fetus. So how to diagnose a one pound patient that can't talk or tell you where it hurts? House takes the pragmatic approach of starting with the heart because it's easiest to see, easiest to fix. Back to the MRI. But how to MRI a patient that won't hold still? "Easy," says House, "I'm going to paralyze it."

Naturally this brings Cuddy running in the hall. (Q. How did she know? Is somebody tattling? A wire tap in the work room? Might be a prudent step for management to take in House's case.) But it's tattlers : Cameron and Chase. In the course of the hallway conversation House ‘lets slip' that he caught Cameron & Chase having sex in the janitor's closet. Eavesdropping on hallway conversations must be so fun at PPTH. Can he get the mothers consent to paralyze her unborn child?, Cuddy wonders. Shouldn't be so hard, House opines, "Sign here or you both die." Cuddy decides she'd better go along.

Emma is naturally concerned, Cuddy says the baby won't feel a thing. House corrects Cuddy's "baby" to "fetus". "I'm lowering expectations, it works here and on dates," he explains as he prepares for a sonogram. I didn't see Emma sign anything, but House, guided by the sonogram, punctures her pregnant belly with an enormous needle attached to a syringe, and we see via MagiCam the needle enter the umbilical cord.

Cut to the newborn room and a field of babies as Cuddy stares wistfully over the crop, only to be interrupted by Cameron, who reports that the fetus's heart is normal but the bladder is four times normal size, taking up all the internal space and keeping the other organs from developing normally, specifically mentioning the lungs. Cuddy starts prescribing treatment, puzzling Cameron who asks if she's taking over the case. Cuddy says House won't care : he has his diagnosis. Then she adopts a motherly tone and asks Cameron is she thinks "dating Chase" is a good idea. We haven't actually seen any dating, just sex. Cameron gets her dander up on feminist, rather than privacy issues, asking if Chase will get the same lecture. "Chase isn't the one who's going to get hurt here," Cuddy says.

Cameron finds House relaxing in a bariatric chamber. Cameron carps about the invasion of her privacy, and asks House what he is doing. House, deliberately misunderstanding, says he's trying to acclimatize to higher altitude : since the Cambodian thing fell through he's going to scale Argentina's Mount Aconcagua. When he can't walk? There's a tribe of Indians who carry their elders to the top : he'll live with them long enough to gain carrying privileges, and "where's my MRI?"

Cuddy is showing a scan to Emma and explaining the need for surgery on the baby's bladder, but first they have to see if the baby's kidneys are too damaged, in which case there's no home for the fetus and "you can always try again". Emma explains she miscarried twice when she was married and four previous in-vitro fertilizations failed, so at 42, she sees this as her last chance.

Cuddy finds House at her desk reading her computer and asks what he's doing. "What you're trying to do to me is what I tried to do to you," he says. He wants to see the test results on the fetal urine. She asks if he thinks her diagnosis is wrong. He doesn't answer directly, but says the first test, and the second one, will have stale urine that won't allow diagnosis of the kidneys, but that number three will be golden. (Pun intended). House wants to know how come the dean of medicine is running bladder taps. Cuddy says it's because Emma is an important customer, but House wonders if Cuddy doesn't identify too much with an older woman struggling to have a baby. Cuddy thrusts the file at House, who now says he doesn't want it, he's going on vacation, but Cuddy says not until "after you've cured her."

Chase is telling Emma that the baby's kidneys are OK, and with a shunt in, the baby will have room for the internal organs to grow, and she'll get better, and then after he's born they'll operate to remove the blockage in the urinary system. Emma asks for her camera, because she's keeping visual memory book of the whole process and begins snapping Chase. He sees a picture she took earlier of Cameron and comments on it. She offers it to him and he say's he sees her all day long at work and doesn't need it, but the wily photographer, trained to ‘looks for the truth in people' sees through Chase and diagnoses his feelings for her.

We're in the OR where the bladder shunt is being installed.

Post op, Cameron and Chase discuss House's interference in their relationship over the still unconscious Emma. As the patient begins to come to, Cameron checks her eyes and discovers jaundice. Whoa : new and unexpected symptom.

The Hice deliver the news to House. Emma's liver is shutting down. "Figures", says House, "I just booked my trip to Johnson Straight." What happened to the mountain in Argentina? "I'd have to live with the Indians for twenty years before they'd consider me an elder." So he's going kayaking with Orcas, instead. Not yet, say the Hice, all her levels are screaming liver failure. "Even fetuses lie," House philosophizes. Heart? No we looked at that. Lungs? Not developed enough to tell : it'll be weeks. But Emma won't last weeks. ‘Deliver the fetus,' House proposes. ‘Not viable at 21 weeks, you'll kill the baby,' Chase responds. House: "Fetus." Cameron: "Semantics." House is elected to tell the mother she must lose her baby.

House delivers the bad new. ‘Can't you deliver it? Keep it on a respirator?' Emma asks. ‘Won't do any good, it's at least two weeks from viability,' House tells her. Well then, I'll tough it out for two weeks, Emma decides. "You're on dialysis for your kidneys," House tells her, but "They don't make dialysis for your liver. You're not going to make it two more days." Emma, however, is resolute : she won't sign a consent for an abortion, even though House tells her "It's not a baby, it's a tumor." "I can't fix it." "I'm scheduling a D&C." But Emma won't consent, "So I guess you have two days to figure it out."

Act 3

House is in Cuddy' office, and urges Cuddy to get Emma to consent. Cuddy asks if he's used steroids to force the baby's development. No, and he insists the baby must be terminated and Cuddy must make Emma see that. A theme is developing here of the wimmin-folk standing up to House this week, and she refuses.

We're in the diagnosis work area, and its Cuddy standing in front of the whiteboard o' symptoms, pushing the Hice for ideas while House makes paper airplanes and grouses in the corner. Cuddy pushes hard enough that the Hice start generating possibilities. House grouses. House accuses Chase of "sticking up for your girlfriend (Cameron)" which tells Foreman something he didn't know, and we get a little digressive discussion, which Cuddy quashes. She pushes for a liver biopsy for Emma, which Foreman says will kill her because her platelets are too low, and they couldn't stop the liver bleeding. Cuddy says well, then we go in though a vein in her neck "transjugular hepatic biopsy". Then if she bleeds, she just bleeds back into her own veins. Neat. The Hice rush off to comply. House throws paper airplanes. At the "teacher". "Why don't you start your vacation now," she tells him.

Chase and Foreman conduct the procedure, and Foreman takes the opportunity to ask about last week's sleep lab shenanigans. Foreman tells Chase to be careful, because "A heart-broken, lovesick Cameron would be even more unbearable than she is now." Just as they get to the liver and ‘fire the needle', Emma's heart and blood pressure go crazy. Contractions. Pre-term labor.

The Hice report back to Cuddy. Contractions under control for now, patient's liver normal : it has to be the baby that's causing the liver failure. Now all the Hice are urging termination, but Cuddy keeps proposing new tests. No time, they say. Then let's work faster, Cuddy says. "Medicine doesn't work faster just because you want it to," Cameron says. Now Cuddy takes an approach that drives her to exasperation when House does it, namely deciding that whatever we haven't yet examined must hold the vital clue, since nothing we've looked at has turned out to be the cause. In this case, the baby's lungs. But examining the baby's lungs is not possible by remote means, and anyway the lungs are not developed enough yet to provide any clues. Cuddy decides to force the lung development with large doses of steroids, despite the risk to the mother's health. When none of the other doctors agree with this approach, she administers the doses herself.

The effects are as deleterious to the mother as everyone fears, and pretty soon Emma is hooked up to a machine to breathe for her. Wilson drops in, prompted by the Hice to try to talk sense into Cuddy. Even he wants to terminate. Cuddy dismisses him and works furiously.

Act 4

Cuddy comes into Wilson's office and says he was right, they were all right. She can't talk to Emma's family because she has none. What would House do? she asks. He'd terminate, Wilson says. But what would he do if he was going to do something? she asks. Wilson tells her what House wouldn't do, which is get emotionally involved, he'd be dispassionate. But passion is what Cuddy's all about, and she decides that they've already damaged Emma to the point of putting her on a respirator, so she might as well go whole hog and resume the steroid treatment. And does.

...

An ecstatic Cuddy is at House's apartment door, saying the steroids worked, the lungs are developed enough to diagnose. He congratulates her, and say's he was just leaving for his vacation and starts to shut the door on her. She blocks the door and tells him "I have a whole new appreciation for what you do. How hard it is to believe when everyone around you is telling you that you're wrong." "Helps to know they're idiots," he says. "Do you think I'm an idiot?" "You're not objective.. but you're not an idiot." And he take the x-rays to look. They discuss possibilities. Then House shuts the door in her face. Cuddy's not sure what to think, but a few moments later House appears with coat and cane, and they're off to PPTH.

House and Cuddy find the Hice in the break room. They discuss how to determine the nature of the baby's lung problem. Portable MRI? Baby's to small to see the detail they need. How would we solve this diagnostic problem in a ‘real patient' House asks. Too small for transesophageal echo. Too much radiation for a small patient in high resolution CT. Can't breathe in a radioactive isotope for ‘ventilation perfusion scan'. Last option: exploratory surgery. "Let's do that!" House commands.

House explains the surgery to Emma, who can't talk because of the respirator she's on. It
amounts to cutting into the womb (without removing the umbilicus) and then operating on the baby. House shows her the baby sonogram while explaining how incredibly risky the procedure is, but given her attitude to date, the conclusion is foregone, and Emma nods her assent.


The operation is on, House operates on the mother as a specialized fetal surgeon stands by to operate on the baby. The mother is open, and the surgeon proceeds with quick sure motions. In the midst of the surgery a small hand reaches from the womb and grasps House's gloved finger, and House, me, the whole surgical staff, and any viewer with an ounce of feeling is tearing up as time stands still for a few moments. After Cuddy breaks the mood, waking House out of his rapture, he jokes "I just realized I forgot to TIVO ‘Alien'". You're not fooling us, House. The operation proceeds and the fetal surgeon, looking though a microscope, announces he finds three well defined lesions which he should be able to resect. Just then, Emma slips into fibrillation. As alarms blare. Cuddy shocks Emma with the paddle one, two, three times, without result. House declares that Emma's body is not doing this, the fetus is and prepares to cut the cord, terminating the fetus and the operations. Cuddy order him to back off or be electrocuted, and shocks the mother a fourth time as House jumps back. Nothing. A fifth time, and the heart begins to return to normal. Whew. The fetal surgeon continues.

The operation is a success, and Emma is recovering as House examines her. Kidneys, liver, lungs, all fine. That's amazing, she says. "What's amazing is how blond your baby's hair is," House says. "My baby? You've never called him that before," she rhapsodizes. "So this really worked?" she asks, "he'll be… normal?" "If you call being born twice normal." She thanks him, but House says "Don't thank me, I would have killed the kid." Yeah, House, but we saw that magic moment in the OR.

Cameron is packing Emma's camera gear to bring it to her, when Chase asks her if she wants to grab a bite. As she packs, Cameron finds the picture Emma took of Chase. She's enraptured by the picture, say's it makes him ‘glow'. "What were you doing?" Cameron asks. Chase tries to dismiss the moment, "I always glow." But we know the picture was taken as he was being asked about Cameron. Who's liable to get hurt here, Cuddy? The two walk off together.

House is walking out when Cuddy stops him. She gives House first class airline tickets to Vancouver Island. House accepts them, but later tears them up and returns to his lonely apartment, takes the phone off the hook, limps over to the sofa, plops down, and turns on a documentary of the Galapagos Islands, gobbling a few vicodin, his traveling vicarious, for now. He contemplates that finger, the one the baby held, as "Are You All Right?" plays on the soundtrack.

Elsewhere and when, the camera pans around pictures of all the doctors in Emma's studio, and a baby cries. Emma picks up the precious bundle and smiles.
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Next Week: Apparently, House has decided to take that vacation after all, for we see him on an airliner. Naturally, this being House after all, a mysterious disease breaks out in flight and must be treated. Right! Now! And Cuddy is here, too! And in-flight surgery will be necessary! Bet the airline wishes nurse training was still mandatory for stews.

- Cecil

Next Episode: Apr 10
Prev Episode: Review Unavailable


Posted by Cecil on April 4, 2007 2:40 PM
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