House, M.D./DNR

DNR
Season 1, Episode 9
Airdate	February 1, 2005
Production Number	110
Written by	David Foster
Directed by	Frederick K. Keller
Stream
← 1x08 Poison	1x10 → Histories
House, M.D. — Season One

DNR is the ninth episode of the first season of House, M.D..

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

Guest Starring: Harry Lennix (John Henry Giles), Chloe Webb (Cora), Mike Starr (Willie), Victor Raider-Wexler (Judge Winter), Rif Hutton (Morris), Michael Oberlander (Ross)

with David Conrad (Dr. Marty Hamilton)

and Brandy (Herself)

Co-Starring: Clint Baker (Tommy), Courtney Henggeler (Server), Dennis Howard (Chaplain), Richard Sinclair (Doctor)

Plot Overview

Legendary jazz trumpeter John Henry Giles has been paralyzed by ALS when he contracts pneumonia. House requests the case, as he doubts the ALS diagnosis, but the case is given to Foreman, as his old mentor is Giles' primary care physician, Marty Hamilton. Giles signs a Do Not Resuscitate form to avoid a slow death, yet when he goes into respiratory arrest, House violates the agreement and revives him, for which he is slapped with a restraining order and sued. Giles calls Hamilton to pull the plug, but after it is done, Giles lives, proving House is wrong in his first diagnosis. As Hamilton offers Foreman a new job in Los Angeles, House has his team perform dangerous surgery to fix the paralysis of Giles' arm, but not only does Giles' arm improve, his legs do, as well. To determine what the problem is, House stops his treatments to reintroduce them one by one until Giles' condition improves. He also tells Foreman to take the job in LA if he thinks Hamilton is a better doctor than House. With the treatments stopped, House's team finds the malformation causing the paralysis and remove it, curing Giles. In the end, Foreman decides to stay on working for House.

Clinic Patients

• Willie: An adult male who refers to his penis as a separate person and requests the "blue pills" (meaning Viagra, a popular drug to treat impotence). House says, "Separate vacations? That'd be a drag for one of you." House deduces Willie is a diabetic who needs to increase his "insulin to chocolate chip ice cream levels," based on the fact that Willie's hands have lost their hair and his too-small shoes suggest he has lost sensation in his feet. House also notices powdered sugar on Willie's pants, which suggests he has eaten donuts recently. Nonetheless, House gives Willie his Viagra prescription.

Notes

Medical Terms

(See the Medical Dictionary for all definitions.)

• House asks for John Henry Giles' case, but Cuddy calls it "a simple case of lobar pneumonia. Boring."

• As Foreman lays out Giles' case of pneumonia to House's staff, Chase says Giles is on a nasal cannula, and Cameron says he is not coughing up sputum. Foreman worries about his sepsis and orders tests of his adrenal and thyroid glands. House asks about the paralysis, but Foreman says it has already been diagnosed as ALS, a.k.a. Lou Gehrig's disease. House asks for other possibilities, so Chase hypothesizes Guillain-Barré syndrome, which Foreman dismisses because the paralysis' progression is not symmetric. Cameron hypothesizes transverse myelitis, but Foreman says Giles has been tested for this and AVM. Chase further hypothesizes neuropathy, for which House recommends IG. He also asks for an MRI.

• When Foreman tells House that Giles signed the DNR, he also says he "started him on IV steroids and Synthroid." House suggests Foreman also add IG.

• Willie, a patient in the clinic, requests blue pills for his penis, but House instead recommends he ups his insulin he is taking for diabetes.

• As Giles' stats crash, Cameron orders heparin.

• After House resuscitates Giles, Foreman chastises him, but House suggests Giles was not competent to sign his DNR because "his thyroid numbers [were] making him sad." Foreman storms out, so House asks Cameron and Chase for diagnoses. Chase hypothesizes vasculitis, but House says that "wouldn't likely hit both lungs." Cameron hypothesizes Wegener's granulomatosis, which House likes. He orders Cameron to test for C-ANCA and asks Chase to do a biopsy while performing his bronchoscopic suctioning.

• Although Giles' biopsy does not reveal Wegener's, House prescribes Cytoxan.

• After Giles survives being pulled off his intubation, House's staff starts to suspect it is ALS. Cameron suggests Giles could have had a stroke, so House orders an MRA to look for an embolic stroke.

• In the lab, Foreman complains to Chase and Cameron about House, saying, "He assaults the guy and moves on to the next differential diagnosis like it's nothing." As Foreman complains about House's lack of humility, House enters and asks for the test results. Cameron reveals that an embolus caused the arm paralysis. Chase offers to "bust the clot with TPA."

• Foreman reveals the discovery of the blood clot to Giles and asks permission to treat it with heparin, which he warns may cause an effusion in his lungs, but Giles refuses. As an alternative, Foreman suggests an embolectomy, which Giles accepts.

• During the surgery, Chase tells Giles, "We're in your carotid artery."

• For Giles' last MRI, Chase asks Cameron to do thin cuts through the cauda equina.

• Giles' MRI reveals an arteriovenous malformation, which had previously been hidden by inflammation, which the steroids shrunk down.

Music

• "What a Wonderful World" by Louis Armstrong: John Henry Giles gives House a trumpet as a souvenir and talks with him about House's Vicodin addiction.

Arc Advancement

Characters

• Foreman: Over lunch, as Marty Hamilton offers Foreman the job, he asks if Foreman is seeing anyone. Foreman says, "Kinda sorta." When Hamilton asks if it's serious, Foreman answers, "I dunno. It could be." This is the first reference to Foreman having a potential girlfriend, although in later episodes, he will be seen dating other women whom he has just met.

Trivia

Allusions and References

• Rubik's Cube: In the courtroom, Wilson accuses House of having a "Rubik's complex," meaning "you need to solve the puzzle." House asks, "Are you done? Or do you have any more references to 1980's fads?" Rubik's Cube is a toy which became popular in the 1980s. Each face of the cube has nine squares, and to solve the puzzle, one must turn the rings until each face of the cube is one solid color.

• Bart Giamatti: When warning Judge Winter of his possible heart disease, House says, "Remember Bart Giamatti? Same thing. Just dropped dead one day." A. Bartlett Giamatti was the President of Yale University who died suddenly in 1989 of a massive heart attack while serving as the Commissioner of Major League Baseball.

• Matlock: When Wilson and House discuss House's "impressive legal argument" after his court trial, House says, "I watched Matlock last night." The popular courtroom drama Matlock ran from 1986 to 1995 and starred Andy Griffith as the title character, a Southern attorney who usually proved his client's innocence in homicide trials and exposed the real killer in court.

• Kobe Bryant: When House orders more tests to find something other than ALS or Wegener's granulomatosis, Foreman argues, but House says, "They dropped the court order." Wilson replies, "Yeah, and that girl dropped the charges against Kobe. It doesn't mean he should call her and see if she's free to get a sundae." Kobe Bryant is a basketball player for the Los Angeles Lakers who led the Lakers to three consecutive championships from 2000 to 2002. In 2003, Bryant was charged with the sexual assault of a 19 year old girl in Colorado. She eventually dropped the charges, but the stain on Bryant's reputation remains.

Memorable Moments

• House enters John Henry Giles' room to find Giles' stats crashing as the result of the medication Foreman put him on, but Foreman, Cameron and Chase are just standing around because Giles has signed the DNR. House hangs up his cane and singlehandedly intubates Giles, resuscitating him over Foreman's objections. Just then, Giles' friend Cora enters and asks what House did. Cameron says, "He saved his life."

• A gorgeous woman enters House's office and asks for him. House says, "Cuddy sent me a stripper again? Love that woman. So thoughtful." The woman turns out to be a lawyer, however, who is serving him with a restraining order, which prevents him from coming within 50 feet of Giles. House orders Chase to move Giles to the ICU, because its proximity to the clinic means he won't be allowed in there. "It's nice having a court order saying you don't have to work clinic duty," he says.

• At House's hearing, his lawyer argues before Judge Winter that House needs to keep Giles alive so he can face his accuser for the battery charge, as is his right. House angers Winter by continuously interrupting. When it looks as though House's motion will not pass, House again interrupts with a "medical issue." He asks Winter, "Do you have any history of heart disease in your family? ... Your fingers, they show signs of clubbing, which indicates a heart problem. ... Please see your doctor." This throws Winter off, so House wins his motion. Later in the hallway, House admits to Wilson that Winter's fingers are not clubbing, and that every family has a history of heart disease.

• Once the court order is lifted, House visits Giles to ask him to live long enough to let House diagnose him. Giles replies, "Yeah, sure. I'll stick around long enough to indulge your obsession." Giles says he wants to die because he has lost his ability to be a musician. "I got one thing, same as you," he says. Giles compares his need to play music to House's obsessive need to solve puzzles. "But when it's over, it's over," Giles said. After the speech, House starts wheeling Giles out of the room. He says, "It's not over for me. Either you're gonna call the cops again, or we're doing this. You wanna die, you can do it just as easily inside an MRI machine."

Quotes

• Cuddy: Forget his paralysis.

House: Tell that to the rest of his bowling team.

• House: OK, what's really wrong with him?

Foreman: What's wrong with you?

House: Everyone knows what's wrong with me. What's wrong with him is much more interesting.

• Cuddy: When I hired you, I knew you were insane. I will continue to try and stop you from doing insane things. But once they're done.... Trying to convince an insane person not to do insane things is in itself insane. So when I hired you, I also set aside $50,000 a year for legal expenses. So far, you've come in under budget.

• John Henry Giles: I know that limp. I know that empty ring finger. And that obsessive nature of yours, that's a big secret. You don't risk jail and your career to save somebody doesn't wanna be saved unless you got something, anything, one thing. The reason normal people got wives 'n' kids 'n' hobbies, whatever, that's because they ain't got that one thing that... that hits 'em that hard and that true. I got music. You got this, the thing you think about all the time, the thing that keeps you south of normal. Yeah, makes us great. Makes us the best. All we miss out on is everything else. No woman waitin' at home after work with the drink and the kiss. That ain't gonna happen for us.

House: That's why God made microwaves.

Giles: Yeah. But when it's over, it's over.

• Wilson: So your philosophy is, if they don't want treatment, they get it shoved down their throat, but if it might cure their paralysis, whoa, better slow down.

House: Yeah. My old philosophy used to be "Live and Let Live," but I'm taking this needlepoint class, and they gave us these really big pillows.

Wilson: What's your philosophy on employee relations?

House: That's a very tiny pillow.

• House: I was there. He said it wasn't your fault.

Foreman: So?

House: So, it was. You took a chance. You did something great. You were wrong, but it was still great. You should feel great that it was great. You should feel like crap that it was wrong. That's the difference between him and me. He thinks that you do your job, and what will be will be. I think that what I do and what you do matters. He sleeps better at night. He shouldn't.