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House: Family

House Episode 3-21 : Family

Airdate May 1, 2007

This is a capsule review : it will be replaced soon by a full review.

The Hook:

A young black boy is being taken into a clean room to see his sick brother. His mother cautions him to be aware how sick his brother is, but the boy says he's OK, he's seen it before. They don gowns and masks and head into the room. The younger boy exchanges light banter about baseball with his older brother. The older brother has his head shaved and is pale and weak. Wilson guides the younger boy out of the room. The boy asks how many games he's going to miss, and Wilson says he's only going to be in the hospital overnight, but will have to take it easy for a few days. The boys says he's missed two games already, and Wilson explains that's because they had to keep him in a clean environment to keep him from getting any last-minute infections, because the healthy bone marrow he's about to donate will save his brother's life. The boy sneezes. Uh-oh.

Act 1

House is woken up at home by a small white shaggy dog. Hector is in the house. House arises groggily to find the head of his cane is chewed on and wet with dog-spit. A cane-user, too, I hate when that happens.

House and the Hice ponder which of 10,000 possible infections the young boy, Matty, 10, may have. Time is short : the older brother, Nick, 14, has had radiation treatment that obliterated his immune system (which sounds uncomfortably like last week's case) and has four to five days to live without a bone marrow transplant. Cameron says they can't possibly isolate the infection fast enough, and must find a new donor. Wilson says that because the boy is African American the chances of finding one in time are slim. House looks around and can't find Foreman.

Foreman is in the hospital chapel, trying to pray away last week's mistake. House, with Hice and Wilson in tow, finds him there and disturbs the peace of the other meditators by holding an impromptu diagnosis session right there. Foreman recommends broad-spectrum antibiotics for Matty, but those take a week to work and Nick doesn't have that long. In the middle of the session House asks Wilson how old Hector is. The answer is 17, which is old for a dog and not relevant to the case.

House's answer to the lack of time is one of his favorites : make the sick boy sicker to stimulate the infection and make it easier to diagnose. Foreman argues they should examine the boys' home for possible sources of infection like they always do, before embarking on the risky process of making him sicker. House argues there isn't time, but then tells Foreman to go ahead and do it.

House and Wilson discuss the options with the parents. Wilson is giving a balanced presentation, while House is saying the decision is obvious, that they have to decide to sign the consent form to save Nick. The parents ask the doctors if they should do this. House immediately, emphatically says "Yes", Wilson hesitates and says they must make the decision.

The parents sign, but as House and Wilson walk down the hall with the form, House berates Wilson for not forcing the ‘proper' decision as he, House, was doing. Wilson says he needs his patients to trust him. House says the only value of that trust is to use it to manipulate people.

Chase and Foreman examine the patient's suburban house. The kitchen and bathroom are immaculate, so they proceed to the yard. It has roses, a potting shed, a now disused swing-set, and a brand new pitcher's mound where Matty practices his pitching. The doctors take a few practice pitches, and discuss last week's case, which still haunts Foreman : a patient died because of his (well, partly his) wrong decision. Foreman speculates on infections agents that could be in the dirt of the pitcher's mound. But those are pulmonary infections and Matty's lungs are fine. Chase finds an old farm-type pump. With a few pumps he brings up some brownish water and collects a sample of it.

Back at the hospital a nurse soaks Matty in cold water in a cold room to lower his resistance, as Foreman and Chase enter and ask him if he ever drank out of that pump. Yes, Matty says, and it was gross, but not since last summer. Matty says his arm hurts. And - he hesitates because his mother is in the room - his scrotum hurts.

House and Foreman discuss this new symptom and instructs Foreman to check for several infections that affect that area. Foreman begs off and asks if Chase and Cameron can run that check, because he wants to recheck the nation donor registry to see if he can find any matches. House says fine, but has a worried looks as Foreman leaves.

Chase and Cameron make the tests and discuss House's new laxity where Foreman is concerned. Chase says Foreman deserves break, but Cameron want to know when House has ever given anybody a break. All their tests are coming up negative. Chase reminds Cameron that "It's Tuesday" : time to make his weekly proposition. Cameron's still not interested. Cameron wants to know if he's really going to do this every Tuesday, and Chase deadpans "Would Wednesday be better?" He gets another negative test. Cameron wants to know if he could proposition her four times now to get a whole month out of the way at once.

Chase begins to wonder if they are chasing the wrong thing entirely. And comes up with a theory that the infection has been driven to the heart by their drastic measures.

Chase and Cameron are doing an interior ultrasound on Matty to test this new theory. The lungs are clean, but Cameron spots a growth on his heart's mitral valve : which it would take a month of antibiotics to clear : a month that Nick doesn't have.

Act 2

The group contemplates the new complications. House proposes another radical step, removing Matty's mitral valve to find out what the infection is, and afterwards removing bone marrow and fighting the infection with targeted medications in time to transplant it into Nick and save him. That is, doing something drastic and unnecessary to one patient to save another. Foreman say they have to run this by Cuddy, and House says ‘Fine'. They all adjourn to Cuddy's office to argue the case.

Foreman's argument is that the surgery is unnecessary for Matty, and life altering. House and a reluctant Wilson make the argument that Matty would want to save his brother. Foreman proposes asking a court to appoint a guardian to protect Matty's interests, but Cuddy chooses a middle course of having Wilson explain the choices to the parents "And don't let House bully them." After the other leave Cuddy asks House why he's letting Foreman present a case House clearly disagrees with. House says he's cutting Foreman some slack, because of the trauma he suffered last week. You're giving him some time to work through it, Cuddy says. Four days, House says, then he's fired if he doesn't snap out of it.

House and Wilson are giving the parents the options again. Let us do open heart surgery on Matty, which will leave him on blood thinners for the rest of his life and keep him from playing his beloved sports, or else Nick dies. What about the donor registry? A new donor's not a realistic possibility, Wilson says. This time he gives an unequivocal recommendation to the parents to sign the form.

As he and House walk away with another signed form, House crows, but Wilson agonizes at more or less forcing the parents to consent.

Matty and Nick exchange a few words before the surgery. Matty clearly hasn't been informed just how limited his life will be after the surgery. As he's wheeled out toward the operating room, his parents offer encouragement, and he wants to know it he'll recover in time to pitch in the playoffs. After he goes, the parents and Cameron exchange looks and agonize over the decision not to tell Matty everything. Cameron tells them they did the right thing : how could a 10-year old make a decision like that?

The surgery proceeds : Matty's 10 year old heart is exposed on the operating table. Blood machines whirl, scalpels are passed. Wilson stares intently.

Wilson wakes House at home to tell him he didn't do the surgery. The growth was fibrous tissue not infections. They're back to square one.

House returns to the hospital and the team reconvenes. Cameron's back to auto-immune. Foreman insists that there could still be an infection, just a different one than they thought. Auto-immune would be better, because it doesn't pass though marrow, so Matty could still donate. Foreman says infection fits better, and they could still possibly help Nick, since the national marrow registry's come up with a ‘four out of six' (tissue match) donor. Which, House says, would kill Nick. He orders the Hice to come up with which auto-immune disease it is, fast.

As Cameron draws blood from Matty while answering the parents' questions about this new direction the case is taking, Nick asks from the next room "Hey, doctor, is this bad?" He's developing bruising around his IV.

As House and Wilson stroll down the hall discussing the case, House's cane breaks where Hector has been chewing on it. Cameron and Chase come up and say Matty's tested negative for all the auto-immune diseases they tested for, so they're back to looking for infection, and in the meantime Nick's deteriorating. They again raise the possibility of the less desirable alternate donor, and House again says it won't work, but Foreman's gone to pitch the possibility to the parents.

Act 3

Wilson and House explain the consequences of a partial match transplant, and trying to dissuade the parents, but the parents decide to go ahead.

In the hall, House and Wilson argue over the case, Wilson saying Foreman undercut them and House saying Wilson didn't argue strongly enough. House accuses Wilson of cowardice.

Foreman extracts the new donor's marrow and injects it into Nick.

House returns home to his ‘accidentally' left open door. Unfortunately, Hector is still there, but House's stereo has departed.

Cameron is talking to Matty, who has a powerful itch. They discuss Nick's chances. The itch comes from the blood streaming from Matty's ear. New symptom.

House and Wilson meet in a funky cane shop, where House tells Wilson he's buying him a new cane to replace the one Hector chewed. House apologizes for calling Wilson a coward, but it doesn't seem sincere, to Wilson or us. House's phone rings, and now Matty's getting sicker. House rejects a skull headed cane and one made of a bull penis, finally selects one with ‘racing flames'.

Returning to the hospital, House discusses Matty's deterioration with the Hice. Nick's getting worse also, blisters all over and headed downhill. The partial match didn't work. House says "God is done with Nick", and they should concentrate on saving Matty. But their efforts to cure Matty have suppressed the infection to the point that they still can't examine it very well. House comes up with another radical suggestion. Since Nick's dead anyway, give Matty's infection to him, it'll spread quickly in his compromised immune system, and they can get enough information to cure Matty, while killing Nick faster. Even Wilson agrees it's the only possible solution.

Now they try to present that option to the parents. My wife and I discussed what we'd do if presented this choice in the case of our own two sons. We concluded that no matter how persuasive the doctors were, we could not kill one son to save the other : and that's what Nick and Matty's parents decide, too.

Act 4

The group ponders the choices left. Foreman says start testing for every possible infection : it's better than doing nothing, and he goes off to do so.

House visits Nick and his father. Nick is in great pain and House lures the father out of the room, then pitches the possibility to Nick of sacrificing himself for his brother.

Wilson and Foreman plug away at the testing. Wilson says Foreman's job is on the line. Foreman says he doesn't care, Foreman mentions that he eliminated the possible infections from the water pump, and Wilson puzzles over why a house in the suburbs has a water pump.

Nick is telling his parents he wants to make the sacrifice. They try to talk him out of it. He's brave. The parents cry.

Decision made, Nick is wheeled into a room where his infection will be carried out. The parents and Cuddy are there. But before the infection can be introduced, Foreman bursts in and says to get Nick back to the clean room : they've figured out the source of Nick's infection : histo-plasmosis. The patients' house is built on former farming land, and the dirt from Matty's pitcher's mound must have formerly been under a chicken coop, contaminating it with a fungus from chicken feces. They can fix Matty's infection Unfortunately Matty doesn't have enough marrow left to safely donate to Nick.

Foreman, however, is taking a House-like chance. He asks Matty if he's willing to take a chance to save Nick, who was willing to sacrifice his own life for Matty. A tearful, fearful Matty agrees. Foreman says he can't even sedate Matty : he's too weakened. He straps the trembling boy down and plunges in the needle. Matty is in agony and asks him to stop, but Foreman continues, despite the screams.

Foreman and House discuss the case. The parents, having two recovering boys, are calming down. Wilson says House should counsel Foreman. Hector is in the office, chewing on Wilson's stethoscope, and Wilson says Bonnie has staged a coup in her coop, and can take Hector back, unless, of course House wants to keep him. House quickly gives up Hector.

House talks to Foreman and says he ‘did good'. Foreman says he acted like House, and hates that he did. Foreman says he doesn't want to turn into House, and so turns in his two weeks' notice instead.

- Cecil

Next Week:

A young girl practicing martial arts collapses. She can't breathe. We see her scream "My head hurts!". "Her head blew up," House says, "how cool is that?" Her kidneys are shutting down. "A mystery," the voice tells us, "where saving a life only scratches the surface." "Please don't tell my parents." "What did you do?" "We all have our secrets."

Prev Episode: 3-20 House Training
Next Episode: 3-22 Skin Deep

Guest Cast, Ep. 3-21, "Family" Aired 5/1/2007

Matty_____________Dabir Snell
Salesman__________Greg Cipes
Claudia____________Adina Porter
Nick______________Jascha Washington
Scott______________Thomas Mikal Ford

Posted by Cecil on May 1, 2007 8:21 PM
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