House, M.D./Detox

Detox
Season 1, Episode 11
Airdate	February 15, 2005
Production Number	112
Written by	Lawrence Kaplow & Thomas L. Moran
Directed by	Nelson McCormick
Stream
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House, M.D. — Season One

Detox is the eleventh 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: Mark Harelik (Mr. Foster), Nicholas D'Agosto (Keith Foster), Amanda Seyfried (Pam), Maurice Godin (Dr. Hourani)

Co-Starring: Marco Pelaez (Pharmacist), Ameríca Olivo (Ingrid), Akiko Ann Morison (Anesthesiologist)

Plot Overview

Keith Foster, a teenage boy out for a joyride in his father's Porsche with his girlfriend, gets into a car accident when he starts coughing up blood. Cameron convinces House to take the case, but the initial tests turn up nothing. Meanwhile, Cuddy bets House a month of clinic duty he cannot go a week without Vicodin because he is an addict. As Keith's liver shuts down, House is rude to the father, Mr. Foster. House wants to lie to Mr. Foster and give Keith a drug to rule out a serious illness, but Cameron tells Mr. Foster the truth. Yet when Keith hallucinates his dead pet cat and suffers rectal bleeding, it rules out House's hypothesis. Cameron is convinced House's delays caused Keith to need a liver transplant to survive, but House has Foreman and Chase dig up the dead cat so he can perform a necropsy on it. He finds evidence that a termite infestation caused the illness and halts the transplant, angering Mr. Foster so much that he punches House. House explains his diagnosis, and Mr. Foster takes his word, so Keith recovers. At the end of the week, House tells Wilson that he is an addict, but he does not intend to quit Vicodin, and a conversation between Wilson and Cuddy reveals that it was Wilson's idea to take House off drugs.

Clinic Patients

• None this episode.

Notes

Medical Terms

(See the Medical Dictionary for all definitions.)

• When Cameron presents Keith Foster's case to House, she says Keith has hemolytic anemia. Cuddy is intrigued and reviews Keith's chart, which indicates high indirect bilirubin and low haptoglobin. House assumes the problem is either meningitis or an artificial heart valve, but neither matches with Keith's history, so House takes the case.

• House brings Keith's case to his staff and requests a differential diagnosis. Cameron hypothesizes lupus, and Chase hypothesizes drugs. House hypothesizes lymphoma, but he orders an ANA test for lupus and a radioimmunoassay for drugs.

• Among the tests Cameron tells Mr. Foster they are running on Keith are a gallium scan, an ANA test and a biopsy of his lymph nodes for cancer.

• After the tests, House asks about Keith's hematocrit, which is low.

• When Keith goes blind in one eye from a clot in his retina, Cameron recommends Coumadin, but the blood thinner could be dangerous. House and Wilson argue over why Wilson is there, and Wilson reveals to House's staff that House is off Vicodin. Foreman warns House of the side effects of Vicodin withdrawal, including tachycardia. House dismisses this and returns to the issue of Keith. Chase hypothesizes the problem may be with Keith's heart, so House orders an echocardiogram.

• After House's massage, Chase recommends draining some of the vitreous humour to restore sight to Keith's blind eye.

• As Keith's liver shuts down, Cameron and Chase report his levels of AST, ALT and GGT.

• House talks with his staff about Keith's liver damage. House hypothesizes hepatitis E, or hep E, contracted during his international travels, although he admits lupus is "way more likely." Cameron recommends Cytoxan and plasmapheresis for the lupus, but House orders solumedrol, which will make Keith's condition worsen slightly if he has hepatitis E and therefore prove he has it.

• Keith starts hallucinating and bleeding rectally, and things get worse as he goes into hypovolemic shock. As he crashes, Cameron orders an angiography.

• After Keith's hallucinations, Foreman tells House that an angiography shows GI bleeding and "severe hemodynamic compromise."

• House stops Keith's liver transplant, saying, "This kid doesn't have lupoid hepatitis. He has accute naphthalene toxicity."

• After Keith is given calories to stop the naphthalene poisoning, Cameron reports that his INR is lower, which means he is getting better.

Music

• "You Don't Have to Worry" by Windy Wagner: Keith Foster and Pam make out in his room.

• "Feelin' Alright" by Joe Cocker: House sits in his office, blissed out on a Vicodin high.

Arc Advancement

Characters

• House: House confirms that he is, in fact, a drug addict.

Trivia

The Show

• Clinic Patients: This is the first episode in which House does not directly interact with any patients in the clinic.

• Recurring Character: Marco Pelaez, who plays the pharmacist who is out of House's Vicodin, also played the hospital Pharmacist in 1x03 - Occam's Razor, in which he allowed House to search all pills until he found the ones which confirmed his diagnosis.

Behind the Scenes

• Hugh Laurie's Performance: This was the episode given to voters of the Emmys to secure Hugh Laurie's 2005 nomination as Best Actor in a Drama.

Allusions and References

• Charles Whitman Murders: When Wilson sticks close to House during the bet, House believes Cuddy has sent him to "make sure I don't cheat." Wilson denies this, saying, "I wanted to make sure you don't start firing shots from the clock tower." This is a reference to the famous 1966 murders by Charles Whitman. On August 1 of that year, he climbed to the top of the University of Texas at Austin's clock tower and fired a sniper rifle at innocent bystanders, killing at least a dozen of them in a 90-minute standoff with the police.

• Charles Manson: As Foreman, Chase and Cameron discuss whether or not House should go home while he is detoxing, Foreman asks the others, "Can't you see he's out of his mind?" Just then, House enters, saying, "That's what they said about Manson." Cult leader Charles Manson was famous for inciting his followers to commit a number of grisly murders in the 1960s and 70s, including the murder of actress Sharon Tate.

• Abraham Lincoln: When House catches Foreman saying House should not be working while he is suffering withdrawal, House says, "Do you wanna continue talking about me, or should we discuss what the liver damage tells us?" When his staff does not answer, House says, "I was born in a log cabin in Illinois...." This is a reference (albeit factually inaccurate) to the life story of Abraham Lincoln, the 16th President of the United States who served throughout the American Civil War. Although famously from Illinois, Lincoln was born in a log cabin in Kentucky and raised in Indiana. He moved to Illinois as a young man.

• Goldilocks: House refers to his solution of giving Keith Foster a drug which will slightly worsen his condition if he has hepatitis E as "Goldilocks, people. It won't hurt him so much that it'll kill him, and it won't hurt him so little that we can't tell. It'll hurt him just right." In the fairy tale "Goldilocks and the Three Bears," Goldilocks finds a home where a Papa Bear, Mama Bear and Baby Bear have left for a walk. She tries several items of the Papa Bear's - his porridge, his chair, his bed - and finds them too uncomfortable (too hot, too big, too hard). She next tries the Mama Bear's objects, and finds them too much the opposite (too cold, too small, too soft), but the Baby Bear's objects are just right.

• Rikers Island: Once House pinpoints Keith's problem as termite poisoning, he tells his staff that Keith's conditions have worsened in the hospital because "the food here [is] one step below Rikers Island," so the poison stored in Keith's fat cells have been burned off. Rikers Island is the largest prison facility in New York City, located 4200 feet off the mainland on an island in the East River.

Memorable Moments

• To relieve House's withdrawal pains, Wilson hires a gorgeous, fit female masseuse, whom House at first assumes to be a hallucination. House tries to bow out of his appointment, but the Latina masseuse supposedly does not speak English. Instead, she grabs his hand and starts massaging it, until House melts under the relief, eventually muttering, "Bueno." The masseuse then tells him, in perfect English, "Take off your clothes."

• House is suffering heavily from Vicodin withdrawal in his office. He picks up a large metal pestle and starts banging it on his desk. When that does nothing, he smashes his hand with it. At first, he howls in pain, but he soon catches his breath and smiles.

• House enters the room where Keith Foster is about to receive a liver transplant without sterilizing himself because an autopsy he conducted on Keith's cat revealed Keith's problem is poisoning from termites. The surgeon, Dr. Hourani, doubts House's findings and tells his nurse to call security. House hocks up a loogie and spits it on Hourani's scrubs, then sneezes all over the instruments to ensure that the surgery cannot be conducted.

• After House has stopped the liver transplant, Cuddy and Mr. Foster come to confront him. Without saying a word, Foster walks up and punches House in the jaw. As Chase and Foreman restrain Foster, House calmly explains that, if Foster goes through with the liver transplant, not only will he be taking the liver away from someone else who needs it, but he will be making Keith's condition worsen, so he will die shortly after waking up from the surgery. "Either way," House says, "I did you a favor. He's awake now. You've got a chance to say good-bye." Cameron, who had previously told Foster that House was lying to him and that House was making a mistake, says, "I think you should trust Dr. House." Foster agrees to "give the liver to the other guy."

Quotes

• Wilson: She's hot, so she's a hooker? What kind of pathetic logic is that?

House: The envious, jealous, I never got any in high school kinda logic. Hello!

• House: I take risks. Sometimes patients die. But not taking risks causes more people to die, so I guess my biggest problem is I've been cursed with the ability to do the math.

• Foreman: Four years of college, four at med school, two years of residency, another four of sub-specialty training, and where do I end up?

Chase: Talking instead of digging.