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House: 508C - Emancipation

House Episode 5-08C - "Emancipation"

Airdate: Tuesday, November 18, 2008

The Hook:

A very young supervisor in a heavy manufacturing facility is engaged in a minor supervisory matter when she clutches her heart and keels onto the production line as flat plates head toward a stamp press. Her safety helmet precedes her through the press, alerting a coworker who stops the line just in time.


Emancipation.JPG

Act 1

As House arrives at the office he meets Wilson who inquires about his Cuddy-dating habits. House says he didn't ask, and is surprised at the lack of follow-up inquiry.

House enters the office, where the team is assembled, and gets the report of a 16 year old girl with fluid in her lungs for no apparent reason. Taub theorizes third world disease due to working close to recent immigrants. Kutner reports the girl is an emancipated minor. House suspects she is a lying runaway. Kutner says her parents died last year and she has no relatives. She got her GED and emancipation papers to avoid foster care. Various speculations: Drugs, parasite from a coworker, pregnancy. House orders a battery of tests and Kutner and Foreman to do an echocardiogram.

Foreman hangs around to ask House for permission to do a clinical trial. Foreman says he'll still make the patient, Sofia, his priority. House says "No."

Kutner starts the echo alone with Sofia and tries to relate to her, asking her how it is being on her own. Sofia is sensitive about questions about her personal life, even a bit hostile. Kutner explains he lost his parent at a young age, too. He sees no problems with her heart, which is good news in a way, but means they still have no idea what's wrong with her.

Taub and Hadley search Sofia's rooms, finding everything neat and orderly, with the furniture mostly homemade. Hadley finds a bong under a desk.

The team meets again. Kutner says the bong is irrelevant since they've found no evidence of heart damage from drugs. House proposes some sort of heart problem that wouldn't show up on an echocardiogram - tachycardia, for instance. Kutner proposes some sort of vasculitis, treated by steroids. House orders beta blockers to treat heartbeat irregularity instead, and tells Foreman to start her on them, then leaves. In his absence, Foreman delegates the job to the newbies, and tells them to call him if they need him.

Kutner and Sofia talk as he starts to administer the beta blockers, which will be the right treatment if she's damaged her heart with drugs, even though the echo showed no damage. He tells her they found the bong. She's a bit upset at the B&E. [Why does no one ever prosecute, that'd make a cute show. Especially if a certain detective lieutenant drew the case.] She says the bong belonged to her ex (and is why he's ex). Kutner explains that the other possibility is vasculitis, treated by steroids, but if she has used drugs the steroids would be very bad for her. She again states she hasn't used drugs. Kutner believes her and switches to steroids.


Act 2

Foreman shows up to do clinic duty, which he isn't scheduled for, and discusses his (fairly transparent) reasons with Cuddy, reasons Cuddy sympathizes with, but she won't overrule House. He's studying a red folder. She offers him a chance to one-up House, handing him a blue folder, which I'm guessing means 'very difficult case'.

Foreman examines a very young, very sick boy, getting symptom stories (red puke) from a not-much-older brother, both adorably cute, as their mother looks on. No other kids at day-care are sick. The admitting doctor checked for bowel obstructions (negative).

Sofia is freaking, hysterical and paranoid, holding a nurse at bay. Kutner and Taub respond and ask what happened. The nurse says she adjusted Sofia's IV and she went crazy. Kutner holds her down while Taub injects her with a sedative. Taub says a beta blocker couldn't cause a psychotic break, so Kutner has to 'fess up' to his medication change. [So steroids do cause psychotic breaks?]

Kutner tells the team that haloperidol has stabilized Sofia, but they still don't know what caused the break. House thinks they do - Foreman's failure to supervise Kutner, whom he calls "Oliver Twist" for his orphan-sympathies. [Are we going to have to start a Sawyer-file of House nicknames?] Kutner says she wasn't on steroids long enough to cause delirium and this is a new symptom, which rules out vasculitis. Foreman proposed "prinzmetal angina" which normally doesn't affect the brain, but might cause an artery spasm that generated the observed symptom.

House orders the application of ergonomine to cause vaso-spasms and then and FMRI to find the spasming artery, and Foreman to document seven ways from Sunday that he actually did the test. After House leave, Foreman delegates the newbies to set up the procedure than page him when it's time to actually do it.

Foreman shows Evan (the brother) a neat swallowable camera that will show all his brother Jonah's insides and assist in diagnosing is problem. But Jonah balks at swallowing the device, despites Foreman's stern warnings and mother Melinda's gentle encouraging. Evan comes up with a winning strategy, telling Jonah the camera will make his muscles stronger, like the vitamins he takes.

As the test begins, Foreman praises Evan for taking such good care of his little brother, unlike Foreman's treatment of his brother. Jonah begins giggling uncontrollably as the camera wends its way. Melinda asks if it tickles, but Foreman knows it shouldn't be felt. Another unexplained symptom.

Cameron and Chase load their trays with unidentifiable glop in the cafeteria. Foreman strolls up and asks them how they're getting along. Chase wants to know why Foreman suddenly cares. Partially because House was asking last week, but mostly because he wants a consult on the 'uncontrollable giggling' symptom. Chase thinks being four years old explains it. Not, says Foreman, four year olds with diarrhea and bloody vomit. All his gastro tests are clean. Cameron wants to know why he hasn't consulted the others. 'Not House's case' he tells them. They take the file, but before they can tell him anything Foreman's pager calls him away.

Sofia is entering the MRI as Kutner monitors. Nothing of note so far. Kutner wants to chat about her foster parents as she tries to lie still. Kutner repeats an earlier question about how she was notified about her parents. When she gives him the same answer, that she was notified at home by a state trooper, Kutner sees something that interests him. Foreman however, is mystified, because all the arteries they're there to view seem fine. A few more questions and Foreman understands. As Kutner explains to Sofia, the FMRI shows where the blood is flowing, and hers is active in the home of the imaginative fibbing, the limbic region, which should be quiet if she was telling the truth [So there is a perfect lie detector? Calling OJ.]

Kutner accuses Sofia of lying about the dead parents, while he was risking his job that she was telling the truth. She says she was telling the truth about not taking drugs, but lied about the parents because she wishes they were dead. Her dad raped her. And her mom denied it happened. Too bad she's off the machine now.


Act 3

Kutner reports that the FMRI was negative for prince metals, but positive for lying patient. Not relevant, House says, unless it could cause pulmonary edema and delirium. Taub suggests the rape could have lead to an STD. Though the blood work doesn't show any infections. Kutner now thinks she could be lying about the rape, as well. House assays 'stress'. 'No normal manifestations', Foreman says. House orders Hadley to load her up on diazepam, which should knock the old stress level right down, Foreman to check.

House goes to Wilson, who's scrubbing, and confesses his failure of nerve at Cuddy's house. Wilson's reaction is non-committal. House is disappointed again in the lack of reaction. Wilson Spocks at his annoyance.

Foreman runs by Cameron and Chase. Meningitis? Nope. Thyroid? Nope. Stomach cancer? Let's check. Maybe porphyria. And oh, by the way, can you good buds run the tests, 'cause Foreman has to run to his other dying patient.

Hadley is explaining to Sofia how the problem is maybe in her brain, but as Foreman adds, walking up, it could be playing havoc with her body chemistry. Sofia apologizes for lying about her parents. Hadley empathizes, and encourages turning her dad in. Sofia says she doesn't want to be stereotyped as 'girl raped by dad', which she says, is how the doctors see her and why they're treating her with tranquilizers. "Not any more," says Foreman, "stress wouldn't change your urine color" - which as the camera pans down, we see is brown.


Act 4

Taub reports the brown urine was caused by shredded blood cells. E coli? Egalla? Legionnaire's? House asks about Sofia's homemade furniture. Was it wood? Did it have dents or holes? His theory is that some of the scrap wood was pressure treated, releasing arsenic when drilled or sawed. Foreman orders them to test her hair, and if positive, chelate the arsenic out of her blood. He says this while departing because he's being paged.

Chase reports negatory on the porphyria and stomach cancer, and recommends bringing House in on the case. Foreman resists. Melinda isn't happy to hear Jonah needs still more tests. Evan yells for them to come quick. Jonah's going into cardiac arrest. The hospital staff springs into action. Chase defibrillates, then tells Foreman it's time to call in House.

The chelation is complete, and Hadley tells Sofia she'll be leaving in the morning. Just as she starts seizing.


Act 5

New MRI. Sofia has lesions in her brain. Infection? Mercer? House tells them to put the arsenic back. Since she's getting worse, the arsenic must not have been the problem, and in fact was fighting whatever is her real problem. "So, what does arsenic treat?" Taub wonders. Syphilis. But STDs have been ruled out. Leukemia? Could be. Arsenic would only slow that down, not cure it. For a cure, she would need a bone marrow transplant, preferably from a sibling, or rapist or rape countenancing ex-parent. And try to convince her to tell where her parents are in the meantime.

Foreman comes in to ask for help on Jonah. House refuses.

House goes to Wilson to accuse him of attempting reverse psychology in disengaging from House to make House push back. Wilson responds by not responding.

In the OR, an awake Sofia is having her brain lesions sampled, while arguing with Hadley about asking for help from her parents. Hadley responds with intellectual arguments only. In a bizarre twist, Taub describes himself as if he had Hadley's Huntington's disease in an attempt to make an emotional bond with Sofia, and convince her to do whatever is necessary to live. It doesn't work, either,

Outside the OR Hadley is furious with Taub for using her story to try to move Sofia. Taub says somebody had to, and since she wasn't... They report to House that the tests confirmed leukemia. House tells them to check the donor banks and he's going home. Hadley wants to track down Sofia's parents. Hadley says she's going off to do so.

Late night in the cafeteria. Foreman gets no sympathy from Cameron and Chase over House's non-involvement, which they figure is mostly Foreman's fault. Still, they try to come up with more possible diagnoses. Could it be Munchhausen's? Munchhausen's by proxy? And if so is Melinda the proxy? Maybe Evan? Foreman remembers Evan's protectiveness, and that gives him an idea. He dashes off.

Hadley knocks on a door in a seedy section of town and introduces herself to "Mr. Velez", telling him they're treating his daughter Sofia for leukemia and want to test him and his wife as possible blood marrow donors. She's holding her contempt under tight control. Velez is puzzled. A young girl walks up to ask "what's going on." Velez says the doctor says she has leukemia. The girl is Sofia! A fact that Hadley confirms multiple times in confusion. I hope she explained profusely off camera to the Velez's that nobody there has cancer, because this Sofia seemed half ready to think she had it but nobody had told her yet. The smoldering fumes off Hadley's brain probably stunk up the roads all the way back to PPTH.


Act 6

Hadley confronts 'Sofia' about stealing the other girl's identity. Not-Sofia claims it was to protect herself and keep her real parents from finding her (she's still maintaining the rape story.) Hadley tries to hardball by saying the emancipation papers must have been forged, therefore they can't operate without her parents' consent, therefore come clean or die, little girl. Fake-Sofia reasons that when she gets sick enough they'll have to operate, even without her parents' consent, so continues to stonewall.

Foreman is telling Melinda that Joshua has been suffering from a vitamin overdose, and if Foreman's right this time, he should be well by morning. How can this be, she wonders, since she only gives him children's strength, and only one a day? Evan curls miserably in his chair. "I thought more would make him strong." Evan worries that Joshua is going to hate him, but Foreman comforts that brothers can forgive a brother's mistakes and still love them.

The newbies meet House at the hospital door to tell him they have a possible donor, but only a three of six match. This hallway conference goes back and forth on whether pseudo-Sofia should be treated right away or not. He tells them to decide and get back to him.

The team wants to talk about ersatz-Sofia's reasons for not wanting to take a donation from her parents, namely not wanting to give them the satisfaction of saving her. House finds this a rational reason but reached too quickly and easily. His suspicions are aroused.

House goes to the patient, introduces himself, and gets right to the heart of the matter, "What did you do?" Under the relentless rationality of House inquiry, Sofia admits she killed her younger brother, who drowned in his bath when she was supposed to be watching him. "Every time they look at me, it's like I killed him again." House actually gets a compassionate look in his eyes. House comes up with his best shot. "If you don't take your parents' bone marrow, you'll be killing their other child. If they don't hate you now, they will then." "You want someone to tell you it was just an accident, it's not that bad. But it is that bad. There's nothing you can do to change that. But there is one thing you can do to not make it worse." He holds out his phone.

Cue sad guitar song.

Kutner leads a couple into the hospital.

Melinda dresses Jonah to leave as Evan looks on. Melinda gives Foreman a hug. Evan and Jonah hold hands as they walk out.

The couple is led to 'Sofia's room. As Kutner watches from outside, there's a tender reunion with tears and hugs. Kutner leaves as the tears continue.

Foreman goes to House and reiterates his desire to do clinical trials. He tells House he's going to do them. House says "OK". Foreman wonders why the change in three short days. "Three days ago you asked me. Now you told me. Can't say 'no' if there's not a question."

On the elevator, Wilson tells House it was a nice thing he did for Forman. House marvels that Wilson spoke more than two words. They banter a little part and as comfortable friends.


+++

Over the closing, we see that this episode was dedicated to the memory of Robert L. Stover, a set decorator on the show. who passed away from pancreatic cancer on October 3, 2008.


- Cecil
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Next Week:
House is at the point of a gun once more. A patient wants treatment if it kills someone. We see the hospital emptying, SWAT pointing guns, and the patient telling House that Hadley has to take everything House prescribes first, so if he prescribes anything deadly she dies first. [Wonder when PPTH is going to get metal detectors.]
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Last Episode: 11/11/08 5-07 The Itch
Next Episode: 11/25/08 5-09 Last Resort


Cast and Crew Ep. 5-08, "Emancipation" Aired 11/18/2008


Director:... James Hayman

Writers:...... Pamela Davis
..............Leonard Dick

Stars:

Hugh Laurie.................Dr. Gregory House
Lisa Edelstein...............Dr. Lisa Cuddy
Robert Sean Leonard....Dr. James Wilson
Omar Epps....................Dr. Eric Foreman
Jesse Spencer................Dr. Robert Chase
Jennifer Morrison.........Dr. Allison Cameron

Recurring Roles:

Olivia Wilde................Dr. Remy Hadley (Thirteen)
Peter Jacobson.............Dr. Chris Taub
Kal Penn......................Dr. Lawrence Kutner

Bobbin Bergstrom........Nurse

Guest Stars:

Emily Rios ..................Sophia
Bob McCracken .........Doug (cranky cow-orker)
Liza Colon-Zayas ........Maria (friendly coworker)
Jose Chavez .............Sophia's Dad
Yolanda Rubio-Soto ....Sophia's Mom
Kyle Silverstein ...........Jonah (Foreman's Patient)
Nathan Gamble ..........Evan (The Brother)
Alexandra Lydon ........Melinda (The Mom)
Dawn Frances ..............Nurse
Al Coronel ................Ray
Chrissie Pit ...................Girl

Music:

" Through the Dark" by Alexi Murdoch


Posted by Cecil on November 17, 2008 6:20 PM
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