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House 519 - Locked In

House Episode 5-19 - "Locked In"

Airdate: Monday, March 30, 2009


The Hook:

Our point of view is a patient's, lying on a table or gurney. We see the ceiling. Faces bending over us. Blackouts. Fuzzy images. Doctors talking about an accident. One doctor looks at us and comments on a "great heart for a transplant". He's talking about us! We panic. Don't take our heart! A sarcastic voice from the right tells the doctor there might be an ethical problem or two with ripping the heart out of a living patient. We know that voice! (We the audience, not we the patient.) That's right, it's House!. And he's a patient in this hospital (motorcycle accident away from home). Which doesn't stop him quibbling with the attending doctor's diagnosis. He points to some brain activity on a monitor and the doctor dismisses it as inconsequential. House asks the patient to blink once for yes and twice for no, and he complies. House dubs the other doctor "Dr. Idiot." After Dr Idiot leaves, House 'talks' with the patient, chuckling with glee over the fun to come - trashing another doctor's diagnosis.

[Tonight's story is told 90% from the point of view of the paralyzed patient.]

Locked-In.jpg


Act 1

Dr. Idiot is finally forced to admit there's some voluntary action going on. The doctor tells the patient, Lee, he's had brain damage from a bicycle accident. He's is ready to ship the patient off to a rehab center to learn to live a life of eye-blinking, but House wonders if the brain damage caused the accident, rather than the other way around. He points out the patient has no defensive wounds on hands or elbows, almost like he was powerless to defend himself from injury - say paralyzed before the accident? House speculates that the injuries are from a stroke or cancer near the brain stem.

Mollie, Lee's wife, visits and talks with the him, expressing firm belief that "God will cure him". House, examining x-rays in the background assumes she's talking about him. Dr. Idiot chases House back to bed. Mollie mentions 'the kids' and the Lee's thoughts beg her not to bring them - he doesn't want the kids to see him like this. I'm wondering how a few minor abrasions win House admission to a hospital in the first place.

The Hice show up, all but Taub, to assist House in his diagnosis while recovering from his injuries. Hadley asks what he was doing way up in Middletown. House shrugs off the question, while eating a burger and fries in front of the patient who's practically drooling over the eats. Hadley's suggestion of a well-placed tumor strikes House as worthy of investigation. Dr Idiot would never approve, of course, but House has located a supply of forms for the tests.

Kutner goggles over the advanced MRI equipment that Middletown hospital has, including, wait for it, goggles. At first I thought these were going to be virtual reality goggles to allow the doctors to see the scans in 3-D, but they're just relaxing scenes to keep the patients calm while in the noisy machine. Hadley shows Lee how they work and in his mind's eye he's transported into the beach scene, whole of body, and talking things over with House as they sit on beach chairs in Hawaiian shirts.

Lee trips all House's defenses by bringing up God, which Lee isn't even sure he believes in but he can't help wondering how a competent doctor just happened to be in the bed next to him just as he was about to be chopped up for parts. Lee's children, Drake and Jolie are with them on the beach.

~~~~~

House has been moved to a different room, but sneaks back in the middle of the night with the MRI results. He says the MRI shows a lesion in the central pons - the hospital staff doesn't agree of course, but House insists it's there. Lee's doctor has him on antivirals, which House says will almost kill him, which is a good thing, because when they do, House figures Dr. Idiot will be scared enough to give House a free hand. Lee starts to seize.

Dr. Idiot, House, Mollie, and Lee discuss the case (well, Lee follows along anyway.) House says Lee has paraneoplastic syndrome from his tumor, while Dr. Idiot still disagrees and thinks it's a viral infection of the CNS. Mollie, with Lee's concurrence, decides to trust House, and it's off to Princeton-Plains Teaching Hospital with the patient.


Act 2

House wheels Lee into the hospital as Cuddy hovers over House looking at his lesions from the motorcycle accident. Cuddy want to know what House was doing up there, too. "Antiquing" says House. Taub joins the procession and says he didn't come to Middletown because he didn't get the message. House says there was no message, he decided to accept Taub's resignation from three episodes ago. Taub says he wants to stay now. House says he's lost confidence in Taub, and wants to see something really spectacular if Taub wants to stay. Lee wonders why Taub needs to pull off something spectacular if House's has already solved the case, but since we're less than fifteen minutes into the episode, we know there's some twists and turns yet to come.

Wilson comes up and also wants to know why House was in Middletown. House says it was to buy a guitar. Wilson knows House's first answer is never the true one and speculates it was to visit a pain clinic near Middletown. Wilson speculates House was going to another state to get more drugs, and House says he was going to tell Wilson's ex-wife about Wilson's unreported lecture fees. It's a Mexican standoff.

~~~~~

Kutner comes to relieve Taub on patient support duty and chastises him for not engaging the patient. Taub snidely says he performed Euripides with sock-puppets just before Kutner got there. Kutner is not amused, saying the brain is a use-it-or-lose-it organ. [Hey, one of the reasons I do this blog.] Plus, Kutner adds, it'll show House you still care. But Taub's not sure if he does. The patient is observing all this of course, and comments inwardly on all he sees. Taub points out something that raises both doctor's eyebrows, and they hurry from the room promising to be 'right back'.

House and Hice comes in and question the patient about alcohol and drug use. House says they'll have to biopsy the brain stem, and the patient is panicked because nobody is telling him what's going on.

Hadley shows Lee a tube - explaining that blood in his urine plugged the old catheter and she's going to place a new one in. Yeeeeeooooutch, thinks Lee and your recapper as she proceeds. She announces visitors.

Mollie has brought the children. Lee is disconcerted at first, but misses them when they leave. Hadley ushered them out because Lee was crying, and she wipes his eyes.

Surgery. Chase tells Lee they'll put him out while they drill the hole, then wake him back up to answer questions while they proceed. Lee fades out and back to the...

Beach: Where he asks House why he's not better. House says nobody's perfect, not even him. Lee is still confident that God put him there for a reason, as he wakes back to...

Surgery: Chase asks elementary questions as he probes for his sample. The questions test logical ability and spatial perception. But as the questions proceed, Lee loses the ability to blink-answer, and Chase terminates the surgery.

Act 3

Millie asks why Lee can't blink. House says maybe his surgeon screwed up. Foreman explains that the blink reflex is controlled by nerves just millimeters from the biopsy site. Mollie wants to know if Lee is still aware. Possible says House, but it's also possible swelling has exerted so much pressure on the brain that he's just 'gone'.

The team speculates on many possible causes for the origin of the brain damage, but since Lee can no longer answer even yes-no questions, they're maddeningly unable to pursue and treatments. Taub proposes a way to get back in communication.

Brain-computer interface. Taub explains it to Lee, on the assumption he can still understand. A computer with an oversized cursor on its monitor faces Lee. Taub encourages him to think "up" and the computer will learn which brain wave patterns register the thought, then move the cursor accordingly. "Start thinking 'up'."

Taub works long hours with the patient, trying to get a simple thought to register on the computer. He sighs at no results, but keeps plugging away.

Wilson tells House he talked to his ex-ex-wife and she wasn't around that weekend, so what's the next lie? Now House says he was going to a correctional facility in New York to visit Foreman's brother.

House confides in the unmoving Lee how he's scared out of his mind to go to work every day. As he shrugs and starts to leave, the monitor beeps. He rushes back, and sure enough the cursor moves. Now it's time for "down".

Mollie comes to visit, asking Lee :"Are you really in there?" The cursor slides up to the top and the monitor beeps "yes". Mollie cries. And we can again hear Lee's thoughts.

House and team play "Twenty Diagnostic Questions" with the patient. "Any blood diarrhea? (no) Recent joint pain? (no) Travelled out of the country? (no) Travelled inside the country? (no) But Mollie reminds him he took a business trip to St. Louis. (yes) "Good", says House, smelling a rat, "could be Missouri Malaria. Let's start treatment." (no) Mollie worries the machine's not working. Either that or he lied to you about it." Just like House lied about the Missouri Malaria. Mollie asks Lee directly "Did you go to St Louis?" (no) Inside he's wracked with guilt. Mollie leaves the room crying.


Act 4

House asks the patient if he was 'getting a bit of strange' when he was supposed to be in St Louis. (no) House ponders the lying ways of patients and tells Lee he could have contracted neurosyphilis, which could account for all his symptoms. (no) It could be treated. (no) Taub sticks up for Lee, asking why he'd lie now when his wife isn't even present. Lee likes that and thinks 'Don't fire him.' Were you out of state? (no) Within 20 mile of your house? (yes) 5? (yes) 2? (yes) Stay at a hotel? (no) In your car? (no) At a friend's house? (yes) House says to bring the wife back in and asks her to name their friends within two miles. Martin and Kim? (no) Dave? (yes)

Taub and Kutner are off to Dave's house, examining the basement where he was staying. Kutner finds resumes and cover letters - Lee's been looking for a job. We hear Lee thinking how his roofing business wasn't going good and he didn't want Mollie and the kids to worry. Kutner also finds evidence that Lee temped as a janitor at a factory that makes cell-phone batteries.

Going there, they find metal filings on the floor - probably cadmium - heavy metal poisoning?

~~~~~

Taub explains to Lee that the chelation therapy they're starting will clear any heavy metals from his blood. Taub will stay with him to keep his eyes moistened. He thanks Lee for sticking with him and "thinking up".

~~~~~

Foreman talks to Lee about his present-buying for girlfriends, how he bought his first one a jewelry item she never wore, and he never did again until buying a bracelet for Hadley, which she's not wearing either. But Lee remembers seeing her wearing it.

~~~~~

Mollie talks to Lee. She wishes he'd shared with him. But Lee remembers how the last business downturn gave her migraines every day.

~~~~~

Taub comes to House, saying he wants to keep his job. Just come up with a great idea, House tells him. Taub wonders whether hooking up the guy's brain to a computer counts. Only for the guy who invented the computer, House tells him.

House want to know why he's only coming here to say this now. Taub says that what they do there terrifies him and overcoming that terror is the only way he can matter. House says "Kutner found the battery factory, Kutner found the cadmium - maybe you don't matter." Taub leaves.

~~~~~

Hadley tells Lee she's going to close his eyes so that he can sleep. But she sees something she doesn't like and drops some stinging stain in his eye. What she sees tells them it's not cadmium poisoning.


Act 5

As House ponders this latest problem, Cameron comes up to change the dressing on his lesions. She takes an inordinate pleasure in ripping the bandages off his elbows in a most painful manner, and then scrubbing debris that's surfaced on the lesion. As she proceeds, House ponders two possible sources, an infection like varicella and an autoimmune disease like Behçets Disease. Cameron suggest a lumbar puncture (spinal tap) to determine which it is. House wonders why he fired her, and she reminds him that he didn't - she quit.

~~~~~
Wilson is back - he's checked the visitor logs at the prison and House has never been there. House wonders why Wilson's so obsessed with where House was. House finally tell him the truth, that he was checking up on Wilson's 'dirty little secret - i.e. that Wilson's been sleeping with one of Wilson's brother's caregivers. Wilson's stunned that House could find out. House ponders the Freudian implications (he says) of the situation.
~~~~~

Foreman explains the lumbar puncture procedure to Lee. Showing him the long needle he's about to use. But before he can barely begin, Lee arrests and the procedure is abandoned.

Beach: Lee: Am I dead?
House. Not yet, but you're about to be.


Act 6

Kutner wields the paddles successfully. In Lee's thoughts, he despairs and wants them to give up on him., His thoughts are interrupted by a strong itch in his foot. House can tell he's agitated, and begins the twenty questions game again tracing the discomfort to an itching in his right foot. But there's no reason for it.

Except House says that it's a sign of liver failure. The liver is so far gone that it's not even detectable by normal means, but sending out 'messages' via enzymes. Foreman comes up with a diagnosis of Sclerosing Cholangitis. House says if only Taub had come up with that it would mean a happy ending. Sympathetic looks from the others for Taub.

Taub, Kutner, Foreman, and Hadley are prepping the patient for a new test. Kutner asks Hadley where her new bracelet is. Foreman is surprised she was wearing it. Hadley says she likes it, but not covered in pee, as it was when she catheterized the patient. Kutner asks if she got peed on on 'that' arm. Foreman misinterprets and says the bracelet was real. But Kutner's interested in the rash she has on that arm, and wonders what if it's an infection instead of a rash. If there were rats in Dave's basement where Lee was staying, Lee's infection could be Leptospirosis, spread by rat (and human) urine. They look and find a cut on Lee's finger - "you were dying of a paper cut."

~~~~~

Kutner tells Lee they found rats in Dave's basement and the rats tested positive for Leptospirosis so they know they've got the right treatment at last. He encourages Lee to try moving a finger. He gives Lee a pep talk, and sure enough a finger moves.

Locker room. Taub and Kutner are changing, House walks in "Rat pee! Very nice idea. Who came up with it?" Taub leans out and takes the credit. "Good!" House says and Taub walks out. House asks Kutner if he's OK with Taub taking the credit. Kutner plays dumb and says it was all Taub's idea. House isn't fooled. Kutner urges House not to toy with Taub, to either fire him or keep him. House says the fact that Taub cared enough to lie means Taub is still engaged and that's all House needed to know.

As House leaves, Wilson hands him his cell phone and tells him he left it in his office, by which Wilson means he stole it and looked up the numbers House was ignoring calls from during their previous conversation. Calls from a psychiatrist House is seeing. House flees to the patient's room.

House tells Wilson he had no right to invade his privacy, even as he lifts a recorder from under the patient's pillow, by means of which he's been spying on the Hice. The patient manages to lift a hand to say goodbye and says "God sent you". House is unimpressed.

As he strides out, Wilson tells him what a great thing it is he's going to a shrink. Wilson says at least it means House thinks he can change, perhaps due to Cuddy's prodding. House says he's not going back. House deletes the psychiatrist's contact info from his cell phone, saying he's not going back because it doesn't work. Wilson tells him "You'll end up alone." And on that happy note our story ends as well.

- Cecil

----------------------------------------------
Next Week:

Every season (the captioning says) there's one episode too intense for words. Next week's is that episode. We see doctors looking surprised/awed. The title of next week's episode is "Simple Explanation". I wonder it that relates to the aphorism (attributed to Menken, among others) that for every problem there's always one solution that is simple, elegant, and wrong.

----------------------------------------------
Last Episode: 03/16/09 5-18 Here, Kitty
Next Episode: 03/02/09 5-20 Simple Explanation


Cast and Crew Ep. 5-19, "Locked In" Aired 03/30/2009

Cast and Crew

Director:___ Daniel Attias
Writer:____ David Foster (II)
__________Russel Friend
__________Garrett Lerner

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
Olivia Wilde________Dr. Remy Hadley (Thirteen)
Peter Jacobson______Dr. Chris Taub
Kal Penn___________Dr. Lawrence Kutner


Recurring Role:

Bobbin Bergstrom____Nurse

Guest Stars:

Mos Def____________Lee
Faune A. Chambers___ Molly
Scotty Noyd, Jr.______Drake Percy
Skye Barrett_________Jolie
John Kapelos________Dr. Kurtz


Posted by Cecil on March 30, 2009 6:04 PM
Permalink |






Well it was cool to see the perspective of the patient, that's something new at least. i enjoy watching House, he's a brilliant character. I wish we could learn more about his personal life outside of the hospital.

-- 1. Posted by: Skipper at March 31, 2009 11:19 PM

Little by little, I think we're learning that House basically *has* no life outside the hospital.

-- 2. Posted by: Cecil at April 1, 2009 12:11 PM

I love Mos Def, and he was great in this episode. I have to say it was also a nice change to see so much through his eyes. I was really hoping they would fire Taub for real though, I don;t see any point to his character.

-- 3. Posted by: Anonymous at April 2, 2009 9:53 PM

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