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House Fodder

House: 510C - Let Them Eat Cake

House Episode 5-10C - "Let Them Eat Cake"

Airdate: Tuesday December 2, 2008

The Hook:

As a film crew records the action, a female fitness guru leads a crowd of avoirdupois-challenged-Americans (a group your correspondent holds membership in) in running (well, "running") the bleachers. One of the tubbos drops out, short of breath, causing the film crew to stop taping. The guru talks to him compassionately and encouragingly, and he resumes his climb up the steep steps. She does seem genuinely concerned about her charges, though I question the value and safety of this exercise for the severely overweight. "Running the bleachers" is more of an exercise for the very fit, and the more sedentary among us would probably be better off on level ground.

Finally the large man makes it to the top with a Rocky-like exultation as his guru bounds effortlessly alongside. She congratulates him, and tells him not to stop but to take it easy on the way down. As he begins a stumbling descent, her expression changes, causing her student to ask "Are you OK?", and then it's the fit teacher who faints and tumbles down the rows of aluminum bleacher seats to land at the feet of the film crew. Curse the stadium for not offering seat backs!

Act 1

Cuddy intercepts House on the elevator and asks if he know why they're only getting half as many requests for his services as usual. "Democrats' health care plan?" he assays. [House is a McCain man? Who knew?]

She has one for him, though. "Thirty year old fitness trainer suddenly can't breathe, collapses and breaks her ankle." House snatches the folder. They leave the elevator and House wonders why she's still with him. "We're going to our office," she says. Seems some deranged doctor with no idea how to be a proper hostage got hers trashed, so she's moving into House's office which she'll generously share with him, i.e. she gets the office and he moves in with the hice.

Foreman and Hadley are absent as they're starting the Huntington's clinical trial elsewhere in the hospital. House makes unkind remarks about Cuddy's derriere, causing her to call out "These walls aren't soundproof," which was, of course, the point. They discuss the new case, and Taub speculates on steroids, cynically assuming anyone in as good a shape as the guru cheats, as House ogles her picture showing off her physique. Kutner says she wouldn't use steroids because her program is all about natural methods, exercise and eating right, which he knows about from watching her infomercials selling her DVDs on late-night TV. House wonders that anyone can be so gullible and tells him to go check her labs. Cuddy kibitzes from the other room wondering if anyone ever actually reads the files [answer: no], as opposed to random ogling, since the labs are already back and show no signs of steroids. House complains about "back seat 'differentialating'",

Kutner wonders about allergies since the guru jogs every morning, possibly breathing in car exhausts. But, Cuddy responds from afar, she jogs half a mile from the nearest road. Then Cuddy comes in to add that the air is cold when the guru jogs, perhaps causing exercise induced asthma [another club your correspondent belongs to]. Which doesn't account for the elevated blood pressure, House responds, and leads a parade down the hall to get away from the "shrieking harpy".

In the hall Taub says the BP was actually fine, [We're shocked, shocked I tell you to find House would lie to make a point.] and Kutner says exercise induced asthma actually fits pretty good. Taub says the only way to test for EIA is to recreate the conditions where the attack occurred, difficult since the guru now has a broken ankle. "Get creative," House tells them and hands them the file.

Hadley sits in the waiting area of the clinical trials and watches another patient whose Huntington's is quite advanced struggle with muscular coordination, and flashes on a memory of herself at nine years old watching her mother undergo the same struggle.

Kutner and Taub, dressed in overcoats, are in the chilly hospital morgue, watching the guru work a fitness machine/medieval torture device with her arms.

[Interlude: A few years back after knee surgery I made the mistake of telling my rehabilitation clinic I was worried about losing my aerobic fitness during my recuperation. Who knew it was possible to get an aerobic workout with your arms alone? My studio had one of these devices - it had a German name that I've forgotten - forcibly repressed memories - and let me tell you, when you're finished you feel like you ran a mile on your hands.]

Our heroine sails along on the machine as Taub interrogates her about her eating habits - no fat, no how. Kutner looks concerned and asks her "Are you OK?" echoing the fat guy on the bleachers. She tells them she feel fine, right up to the point where she keels over in cardiac arrest.

Hadley is taking a computer-scored test that consists of tapping her fingers on four black circles. When she finishes, Foreman tells there "your best time was .04 taps per millisecond" which seems like a ridiculous measure, to me. Wouldn't "40 taps per second" express it better and allow finer graduations? Which apparently means her Huntington's is advancing. [Also it worries me because I couldn't tap that fast on my best day, so what does that mean for me? And does everything in this episode have to have some personal relevance to me?]

Cuddy is bouncing House's giant tennis ball on his desk, which irritates House in the antechamber. Does she not know that ball is for bouncing on the wall to irritate other doctors? He come in and demands half his old desk, sitting opposite Cuddy. The desk conveniently has no modesty shield making this seating arrangement possible. [Fits, since House has no modesty to shield.] Cuddy acquiesces without objection, leading House to suspect a strategy.

Taub and Kutner come in to report no heart problems found. So why is this lady getting worse? Kutner's guess is "carcinoid tumor" and House tell them to find it and cut it out.
House and Cuddy make eyes over the desk.

As the patient slides into the cat scan machine, Kutner starts asking Taub about the effects of leaking breast implants, which this patient doesn't have. It turns out Kutner's doing internet second opinions on the side, using House's name on his website. No wonder requests for diagnoses are down! Taub generously agrees to help out a little, and not snitch to House for a mere 30% of the take. They're finding nothing on the scan until they get to the stomach, which Kutner says is "the size of a shot glass". She's had gastric bypass surgery, and is, in Taub's words, "a big, fat cheater." [Is everything in this episode going to be relevant to me? I'm preparing for that same surgery. Hope nobody ends up dying in this ep.]

Act 2

House, Taub, and Kutner look at a picture of the patient when she was 200 pounds heavier. Taub says she had her records pulled [how do you do that?] so it wouldn't ruin her DVD sales. Cuddy wishes they'd hold the conversation outside because it is interfering with her phone call, which is kinda' House's whole purpose. Kutner speculates that during her obesity she had type II diabetes [me, too, again] resulting in permanent nerve damage. [Let's don't always see the same hands.] But House says nerve damage would have kicked in years ago. House abruptly interrupts Cuddy's phone call to ask loudly "Have you a seen my balls?" Cuddy hangs up telling the caller she'll call back on her cell from the hall, but makes the call before leaving the room and tells the caller she just had to explain that she "had his balls, and she's not giving them back." Zing! She pats House's arm as she leaves. The next speculation is sleep apnea [I know it's boring but - me too] which House said would have disappeared when she lost the weight, [Oh, I hope so.] but Taub says not if it destroyed some throat musculature. House is still dubious and sass this is "a stupid room to be doing a DDX in." (Now that Cuddy's gone )

House leads the others to down the hall to where Foreman is doing his clinical-trial thing with Hadley, barging in mid-session to ask them their opinion. Foreman is offended at the interruption, but Hadley pitches in with the possibility of complications from the patient's surgery. Hadley speculates on low potassium (contradicted by the lab tests), but Kutner raises the possibility of bowel obstructions from occluded loops of bowel, leading to bacterial growth. And therefore, House says, to bacteria in the poop, which he assigns Taub and Kutner to go test.

Taub tells the patient that they think she might have SIBO (small intestine bacterial overgrowth), and to fill this bedpan with what she's full of. (Some bedside manner, Taub.) The patient quietly asks him if surgery could make him taller would he do it. Sure, he says, but not then make a business of telling other short people that they could do the same with hard work. So is he taking the position that hard work could have done it for her and she's a cheater for having done it the easy way (believe me, it's not)? Or that hard work can't produce these results and that she's lying to her clients? He seems to want to have it both ways. [When I'm about a year post-op I'm going to come back here and write a non-House blog about the experience. If anybody's interested.] She tells him nothing worked for her [been there, done that] except the surgery, and now she's healthy and happy. He tells he if she is happy, it wasn't being healthy that did it, it was being pretty that did - a back-handed compliment - and "go poop in the bed pan."

Cuddy is looking at carpet samples in her ruined office as Wilson looks on and criticizes her move-in-on-House plan. He advises her to take a direct approach instead. She throws him out of the office, threatening to take his office instead. He's confident she won't.

Taub and Kutner are on poop-testing detail, feeding some into a centrifuge, and discussion the 'boob lady' who's still questioning Kutner's second opinion, and threatening to complain to the licensing board. Taub chuckles at Kutner's impending doom. House comes in and Kutner tells him it will be about an hour till the sample's ready for testing. House asks them what they're looking for? (answer: fat, indicating CIBO). And what does fat do in water? (answer: it floats). And what else floats in water? (answer: a duck) [If you don't understand that last question, you haven't seen "Monty Python and the Holy Grail", which you should run out and rent right after you finish this review - the only movie that had me rolling in the aisle from the opening credits alone - moose bites can be very nasti, you know?] House take another piece of sample and drops it into a large pail of water. It sinks. House tells them he was wrong to dismiss apnea, and as a reward they get to stay up all night in the sleep lab. [I've had three of those and my wife has had two, and none of those required an MD in attendance.]

Sleep lab. The patient sleeps with heavy instrumentation hung all over her. [It doesn't seem possible, but you can, trust me.] Taub and Kutner scan the instruments but spend most of their time discussing the problems of the 'boob lady'. Until Taub notices that the patient's EEG is flat lining. Sleep kills! Oops, no it's a missing patient. They find her next door running on a treadmill. On her broken ankle. She tells Kutner she feels fine. Running on a broken ankle, he points out. "Doesn't hurt," she says. Taub points out she's bleeding underneath her ankle brace. She can't feel it and can't feel Taub touching her calf. "What does that mean?" she asks.

Act 3

The whole diagnostic group walks down the hall as Taub tells House the numbness in the patient's left foot is ascending. House wants to know how she managed to sneak out for a run. Kutner lies that she had to go use the bathroom. Kutner says the sleep test ruled out apnea. As they enter House's office, a stench overwhelms them, Cuddy is just getting up from the desk and explains "I was mixing some hydrogen sulfide for good and valid reasons and must have spilled some on my side of the desk." And oh, look at the time, must go, ta ta, enjoy your unobstructed use of the office. House's face is a close parallel to Bugs Bunny's as he tell Elmer/Sam/Daffy 'Of course you realize this means war!"

The group diagnoses in the hall when Foreman's beeper tell him it's time for more clinical trials and he tells Hadley "We have to go." She tells him to run along and she'll catch up. Possibilities raised are MS, early onset Parkinson's, transverse myelitis. Or a million other things. House tells them to go run an NCV test.

Taub explains the test won't hurt and will measure the speed of nerve conduction. Bruskly he tells her to "give me your arm." She asks him to ask nicely. He says "I learned in med school you don't actually cure with kindness." She admits to some hypocrisy, but says it's not about her DVD sales, she's afraid if she admitted to the bypass no one would listen to her anymore and she's all about helping people. She asks him if he's ever done anything hypocritical, and this hits a little too close to home - he gets a rueful look. "I'm sure you had good reasons." He's a little touched, smiles a little and asks "give me your arm, please?" But when she's unable to hold it elevated he tells her that her problem is not nerves, it's muscles.

Foreman scowls and looks at his watch wondering where Hadley is.

Taub and Kutner ride the elevator toward House's office. They share the elevator with a woman with bleached blond hair and sleeve-tattooed arms. Kutner asks her where she's bound and she says 'going to see Dr. House', whom she's been in email correspondence with. Joint pain and fatigue, she says and now this - pulling strands of her hair out. It's Boob Lady! The doors begin to open and we see House sitting in the hall on a bench. The co-conspirators quickly stuff Boob Lady back on the elevator telling her Dr House has gone home for the day, but they're associates of his and will be glad to take care of her. In the ER.

After stashing her in the ER with a plan to fill her with antibiotics to combat the infection they assume is present from "tattoos and piercings god-knows-where", the return to House, who's now laying on the bench and telling them he had a strange dream where they were already there once before. Possible myasthenia gravis, they say. He asks them if them can still smell the hydrogen sulfide from his office down the hall. Kutner says maybe he should just let Cuddy have the office? Or, says House, "She sends one of yours to the hospital, send one of hers to the morgue," doing a creditable Sean Connery imitation [From "The Untouchables", a terrible movie that I do NOT urge you to go out and rent.]

Cuddy leads the two into Cuddy's office. Taub advises him NOT to commit sabotage. Kutner wonders if the patient could have used Botox to tighten up her skin, and have a lingering infection. Or possible heavy metal toxicity, House says, citing a number of possible sources as he picks up a sledge hammer and destroys the commode in Cuddy's private bathroom. The water must be shut off, no flood results. Now go treat all the possible toxins with chelation, he tell them, striding out, a day's work well done.

Hadley comes home to find Foreman going though her desk. It's not the first time her privacy's been violated by House's techniques, so she should be used to it by now. She isn't. Foreman tells her he's upset that she hasn't been keeping her appointments, and figured he'd find proof that she's slipping back into self destructive ways. Instead, he's surprised to find (apparently from a medical diary she's keeping) that she's been the most compliant patient he's ever had - so why isn't she keeping appointments? She hedges that she came down right after she was finished with House but he was busy with another patient, and there was another in the waiting room. "Janice," Foreman confirms. Hadley feels she doesn't need to be reminded what the end-stage of Huntington's is like. Foreman understands, sympathizes even, but says she needs to get over it, and tells her to show up on time tomorrow or not at all. Hadley flashes on when she couldn't bear to see her dad take her mom away (to a home, apparently.)

Act 4

Taub reports to House that the chelation didn't work. Now they're sitting on a stairway near a vending machine. (Wonder if House's favorite is still number "24"?) Taub wonders why they aren't doing this in House's office. Because, silly, it would be stupid to do that in an office with no furniture, House says. "Cuddy over-reacted to my over-reaction." House notes that Hadley is leaning away from Foreman and wonders what the significance of that is. Hadley denies there is any. More suggestions, all shot down by House. Kutner gets a phone call, which he says is personal. Then Taub is paged as he suggests Guillain-Barre Syndrome. Foreman concurs. House says the gastric bypass probably set it off and tells them to go start her on plasmapheresis.

In the ER, Kutner, Taub, and Cameron are watching Boob Lady do a Harry Nilsson imitation while crouching on the bed in apparent psychotic break. She's singing "Lime in the Coconut" into her signaling button. Cameron speculates this could be a partial seizure, but Taub thinks it's an act, to get attention. Kutner agrees with Taub. Cameron points out that Boob Lady is bleeding from the ears and needs a full neurological workup, and House, stat!

The main patient tells Taub how ironic it is that she made herself sick by trying to get healthy. Taub tells her she's not dying - the disease is manageable. She asks for a wheelchair ride to the next test, but Taub practices a little tough love telling her to 'get her ass out of bed and walk'. She does so.

In the cafeteria Kutner, Cameron, and Chase discus Boob Lady's case. Chase says 'tell House'. Can't, Kutner says. Kutner finally throws out a diagnosis that Chase says makes sense, and he even volunteers to do the tests for 25%. That's 55 % gone from Kutner's little scheme.

House is in Wilson's office with the blueprints for Cuddy's office. House says he's convinced the contractor that Cuddy wants a bidet instead of a toiled. Not in addition to, instead. [Somebody help me out here. I thought bidets also functioned as toilets. Am I wrong?] Wilson wonders why House wants Cuddy in his office even longer. He advises him to ask her out directly, being a lot cheaper in wear and tear on the hospital.

Taub leads a group of visitors into the patient's room. It's all her fat clients. And they know she deceived them. And they're pissed. And they all pile on top of her. About four tons of clients. It looks like feeding time at the hog pens. "Get off of me!" she screams, as she wakes up from this formerly fat person's nightmare.

Act 5

House lays on the floor in his empty office, spinning his cane overhead as Taub, Kutner, and Hadley talk over the newest symptom - hallucinations. But I thought it was a dream? Hadley gets up to go to treatment, and suggests CNS lymphoma in parting. No relation to the weight loss. Too much coincidence for House. Taub wonders about prion disease. [Hey, I'm not worrying about any diseases they'd never discovered before I left high school, and which my spell-checker doesn't recognize.] House says to get a brain biopsy. Cuddy, who's apparently worked backwards that sauce for the gander is sauce for the goose, and is sitting on the main office floor with a telephone. And why isn't she taking over Wilson's office? Because she's not after Wilson, of course. Now she tells them they're not cutting into anyone's brain without some confirming tests eliminating other possibilities first. And names a half-dozen of them. House tells the troops to start cutting down Cuddy's list of diseases it's not.

They leave and House and Cuddy have a moment squabbling like pre-teens about who wants whom more than whom. Cuddy says "Everybody knows this is going somewhere." They lean in, but no kiss. House ends up with his hands on Cuddy's breasts. Cuddy is turned off by the crassness and turns to leave, stopped by House's hand still on the boob. "Can you leave these?" I'm demoting you from ninth grade too eighth, House. She leaves.

Hadley enters the clinic waiting room and sees Janet, struggling to maintain control, She asks Foreman if he can change her appointment time. Of course he could, but he won't. He tells her she's stuck in synch with Janet and might as well get to know her. Hadley flashes to looking down from an upstairs window as she watched her father maneuver her mother into the car for that last ride - the one where she couldn't bring herself to say goodbye. Her father motions her to come down but Hadley stares stoically on as mother and daughter share one last sight of each other through two panes of glass. She snaps out of it, goes over to Janet and introduces herself, helping Janet struggle into a sweater.

Taub pushes the patient in a wheelchair from the MRI room, telling her the MRI was clean, it's not CNS lymphoma. Possibly other types of brain tumors. She asks for a stop at the cafeteria for a piece of chocolate cake. Taub thinks she's giving up. The patient thinks the remaining alternatives are pretty bleak, and can I get a friggin' piece of cake, already! Taub relents and takes her there.

House sits alone in the outer office (I guess - there's some furniture there now,) as Taub comes in looking for Cuddy and reporting that it's not CNS lymphoma. House agrees - he never thought it was. Patient's getting worse, Taub says, so let's get approval for a brain biopsy right away. House says he's going to go ahead with the biopsy without any approval. Taub wonders if that's wise. But when they reach the patient's room she's up and doing stretches. "I thought you said she was sick?"

Act 6

House ponders how sick person can spontaneously get better. "It's called an immune system," says Hadley. 'Not when they're sick enough to get to me,' House says. House asks Taub what was the last thing he gave her. Took her for an MRI, Taub says. Then he took her to the cafeteria for a piece of chocolate cake to help her handle her depression. House gives him the same look he gave the gunman last week who failed to mention Florida when asked if he'd ever visited a tropical climate.

House and Taub come into the patient's room with a big covered dish. 'Brought your cure,' House says, whipping off the cover to reveal a whole towering chocolate cake. He begins trying to feed her the cake, telling her she has hereditary coproporphyria, a disease where she's short of an enzyme that's important for her liver. When she won't take a forkful, he eats it himself. The treatment is a high carb diet rich in sugar, he tells her. And they just reverse her gastric bypass, Taub ads, and she porks up again - her former diet was self medication. Whoa, whoa, whoa - this is too much for the patient. She asks them if there's nothing else she can try. Taub tells her there's a drug that manages the symptoms, but no other cure. I'll try that, she says. House says he understands, "Not many people have the guts to admit they'd rather be pretty than healthy." [So there are no pretty fat women? Peter Paul Reubens begs to disagree. And another big "me too", here.]

Taub and Kutner discuss the superficiality of the patient (whose name is Emmy, though if we're ever told that I couldn't find it.) Then Kutner notices no singing coming from Boob Lady's area of the ER. They pull the curtain aside to find an empty bed and a nurse making notations on a chart. She tells them Boob Lady had a respiratory arrest and died. They share a look.

Cuddy is complaining to Wilson about House's character, and saying 'it's definitely over' as they go into her now-all-fixed-up office. It looks nice. Wilson compliments her on the desk. Cuddy likes it too, but says it's not the one she ordered. It's her desk from med school, she recognizes, all fixed up and polished. It was in storage at her mom's. She figures out that that scamp House had it restored and placed in her new office, and goes all soft and gooshy again.

Hadley comes in to see Foreman. She tells him that Janice was not freaking her out about her own future, instead it reminded her of her mom, whom she hated for making her childhood a pain. "I hated her, and she died with me hating her." Pain. Foreman hugs her.

Taub and Kutner view the body of the boob lady in the morgue, "House is going to kill us," Taub says. "Slowly. And painfully," says House who's snuck [pace Gene Weingarten] up behind them. He tells them they're idiots and frauds. Fraudulent idiots. And killers. Kutner

Eat-Cake.jpg tries to take responsibility, but House won't hear it and blames them both. He tells them that what she had was easily treatable. And so simple. In fact, maybe it's not too late even now, he tells them. Climbing on the table he massages - her collarbone? The corpse gasps and sits up. Taub and Kutner do a great "Laurel and Hardy Meet the Mummy" imitation, practically leaping into each other's arms. He tells them Dede (the corpse) has no formal training - as an actor, at least - and everybody, Chase, Cameron, the nurse, the CAT scan folks were in on the deceit.

Kutner, chastened, says he'll take down the website. House tell him he'll do no such thing, it's much too profitable, and he'll take a mere 50% of the profits. That's 105% Kutner is out (unless Taub loses his 30% for complicity). House says he owes Dede 3 g's for two full days of her time. Dede, who's naked under that morgue sheet, says House still has three hours left, and maybe there's something they can do with the time?

Cuddy, still gooshy, strides out of the elevator in search of that lovable rascal House as we hear more "Coconut" in the background. She sees House, in his glass office, being loveable with somebody else's boobs. The gooshiness drains out all over the floor as she turns and strides back to the elevator. 'Doctor, ain't there nothing I can take, I said Doc-tor, ain't there nothing I can take....' Guess not, Cuddy.

- Cecil

Next Week:
"Joy to the World" House is on a mission. To get the perfect gift. But will medicine's most famous Scrooge discover the true meaning of Christmas? Miracles can happen.

Last Episode: 11/25/08 5-09 Last Resort
Next Episode: 12/09/08 5-11 Joy to the World

Cast and Crew Ep. 5-10, "Let Them Eat Cake" Aired 11/18/2008

Cast and Crew

Director:... Deran Sarafian
Writer:...... Garrett Lerner
..............Russel Friend


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

The hice:
Omar Epps...................Dr. Eric Foreman
Olivia Wilde................Dr. Remy Hadley (Thirteen)
Peter Jacobson.............Dr. Chris Taub
Kal Penn......................Dr. Lawrence Kutner

Bobbin Bergstrom........Nurse

Guest Stars:

Samantha Shelton...........Emmy (the guru)
Brad Grunberg................Irv (the tubbo)
David Lengel..................Video Director
Julia Putnam..................Young Hadley, age 9
Danielle Petty.................Anne Hadley (13's mom)
Christopher Stapleton.....John Hadley (13's dad)
Lori Petty.......................Janice (extreme Huntington's patient)
Becky Baeling................Deedee (boob lady)

Nicole Cannon...............Nurse


Coconut ...................Harry Nilsson

Posted by Cecil on December 2, 2008 8:40 AM
Permalink |

The Untouchables was a great film, which won Mr. Connery an Oscar. Do rent the film and you will also see a scary performance by Robert De Niro as Al Pacino and Kevin Costner playing a straight arrow Eliot Ness. One of his better roles. A wonderful musical score provides background.

-- 1. Posted by: Rob Wills at December 7, 2008 12:23 AM

(gasp)(choke) A comment! Bless you my son! I take it all back, everybody should run right out and rent "The Untouchables" and enjoy Kevin Costner and Robert de Niro's equally over-the-top performances.

Don't forget to get "Monty Python and the Holy Grail", too, and former Latin students will fall out over at least one scene in "Monty Python's Life of Brian" as well.

-- 2. Posted by: Cecil Rose at December 11, 2008 1:07 PM

Save me from the holy handgrenade of Antioch! Can anyone tell me the name of the disease the web patient in "let Them Eat Cake" who sang "Lime and the Coconut" had? I believe it was "automusic..." something or other to describe her non-stop singing. Made up disease or real? I've been searching for days on the web. )-:

Oh, and note to Rob. I believe you meant Al Capone, not Al Pacino - almost anagrams of one another but not quite.

-- 3. Posted by: Peggy at June 16, 2009 8:37 AM

What kind of nonsense? This is not interesting. There is no such a thing.

-- 4. Posted by: Shannon at January 30, 2013 11:43 PM

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