Fidelity is the seventh episode of the first season of House, M.D..
Suburban husband Ed Snow comes home from jogging to find his wife Elyse sick in bed and violently irritable. Cameron convinces House to take the case. He believes it to be a tumor – first in the brain, then breast cancer – but scans turn up nothing, and treatments do nothing to stop her from having seizures and hallucinations. House and his staff narrow it down to two diseases – rabbit fever and African sleeping sickness – both of which have dangerous treatments and are very unlikely. A snarky comment to a clinic patient, Samantha Campbell, makes House realize she could have contracted sleeping sickness through sexual contact – in other words, an affair – but both Ed and Elyse deny ever having had an affair. She is thus treated for rabbit fever, but she slips into a coma. House confronts Ed and tells him that if he cannot trust Elyse one hundred percent, he should consent to the treatment for sleeping sickness. Ed does, but his wish that she would not get better and thus prove she was faithful hits a nerve in Cameron, who reveals to House that she married a man dying of thyroid cancer when she was in college. As Ed becomes completely distraught, Elyse's condition improves, proving she had the affair. Ed leaves her, and Cameron informs the man with whom Elyse had her affair: Adam, Ed's best friend.
- Sarah Campbell: A preschool teacher complaining of tightness of breath. House offers to take an EKG to check for anemia, so she opens her shirt to reveal her very large breasts, which she claims were a birthday present for her husband. House says the implants may be causing the problem and pages Wilson for a "consult." Later, test results suggest to House that her husband has been slipping his blood pressure medication into her oatmeal to curb her sex drive as it has his. When she asks what she can do, he starts to suggest she have an affair, which is what suggests to him that Elyse Snow may, in fact, have had an affair.
(See the Medical Dictionary for all definitions.)
- When Cameron first discusses Elyse Snow's case with House, she tells him Elyse was examined by "two neurologists and a radiologist."
- House brings Elyse's case before his staff and tells them she is "sleeping 18 hours a day." Foreman says, "Hypersomnia's usually accompanied by irritability in depressed patients." House dismisses depression because of Elyse's fever. Cameron says Elyse has an elevated sed rate. Foreman hypothesizes something wrong in the brain, and House sarcastically replies, "Good thing we hired a neurologist." Cameron says it's "probably not vasculitis." Chase hypothesizes malaria or Chagas disease, but Cameron says Elyse has never been outside of the U.S., and her CSF smears rule out parasites. House hypothesizes a tumor and orders an "MRI with two-millimeter cuts through the mesodiencephalic."
- When House first examines Sarah Campbell, he believes she is "probably just a little anemic" and offers to do an EKG.
- As Elyse has a seizure, Foreman says she is aspirating.
- After Elyse's seizure, House, Wilson and the staff go back to the drawing board. Wilson says the contrast MRI did not turn up a tumor, but Foreman hypothesizes a small glioma and recommends a PET scan. Chase hypothesizes postictal disorientation, but Cameron says it should have improved by now. Chase replies that it could be Lyme disease, but House says Ed would have noticed the rash. Wilson hypothesizes paraneoplastic syndrome.
- After Elyse's mammogram, Cameron says she found. Without knowing where the tumor is to treat it, House orders them to treat Elyse with immunoglobulin.
- Just before Elyse hallucinates bugs coming out of her arm, she complains of it itching, so Cameron offers her hydrocortisone. When Elyse freaks out from her hallucination, Cameron orders five milligrams of Haldol.
- Once Elyse's hallucinations rule out neoplastic syndrome, House, his staff and Wilson return to the drawing board. House hypothesizes an infection of some kind, but Foreman says the "serology rules out viruses" and smears of her CSF rule out parasites. House points out that African trypanosomiasis, a.k.a. African sleeping sickness, would not show in her CSF. Foreman thinks of the kitchen where she works and hypothesizes rabbit fever, a.k.a. tularemia, which she inhaled from chopping rabbit meat.
- As Chase, Foreman and Cameron run tests in the lab, Cameron recommends they treat Elyse for both tularemia and African sleeping sickness, but Chase warns "the treatment for tularemia can cause aplastic anemia."
- On her second visit, House tells Sarah that her husband was giving her some of his high blood pressure medication, because the beta-blockers ruined his sex drive, and he wanted to ruin hers, too.
- When Cameron confronts House over not letting her question the Snows about extra-marital affairs, House reveals that he knows Cameron has never been prescribed folic acid, and thus was never pregnant.
- When the Snows emphatically deny having cheated on each other, House prescribes chloramphenicol for the tularemia.
- When Ed catches House checking the comatose Elyse, House says he is "checking for lymphadenopathy."
- As Foreman and Chase administer the drug, Chase tells Foreman the ill effects of melarsoprol, which Foreman learns include cardiac arrhythmia.
- House finds Cameron crying in the lab, but she says she is "recalibrating the centrifuge."
- After they start treating her with a deadly treatment, Chase tells House that Elyse's echo shows hyperkinesis. House asks if Chase gave her dopamine.
- Wilson: House sees Wilson wearing a new green tie and nice shoes and deduces he is attracted to someone in the hospital. Wilson at first denies this, but later claims to have taken a nurse to lunch, which he says is not a date. Later, House refers to Wilson loving his wife and all his previous wives. This is not the first reference to difficulties in Wilson's marriage (that would be in 1x05 - Damned If You Do), but it is the first reference to Wilson possibly having one or more affairs, and certainly the first to his having had multiple failed marriages.
- Cameron: Cameron reveals to House that she had married a man in college who died six months later of thyroid cancer. House says he must have been sick before they got married, and she had to have known it. He says, "You can't be that good a person and well-adjusted." This is the revelation of the great loss in Cameron's past - first referenced in 1x04 - Maternity. It becomes an important facet to her character. In the pilot, House had revealed he sensed there was some "damage" to Cameron, and that was why he hired her.
- 1x04 - Maternity: When Cameron objects to House that she should be able to ask the Snows if they had cheated on each other, House says, "After you got so freaked about the sick babies a while ago, I figured that was your thing." This is a reference to that episode, in which Cameron had trouble telling a couple their baby was likely to die, and was speechless when the baby did die. The great loss in Cameron's past is explained in this episode. (See also: Arc Advancement: Characters: Cameron.)
Behind the Scenes
- Prison Break Connection: House, M.D. was FOX's biggest new hit of the 2004-05 season. Its biggest new show of the 2005-06 season, Prison Break, stars Dominic Purcell as Lincoln Burrows, a Death Row inmate wrongfully convicted for the murder of the Vice President's brother. Here, Purcell plays Ed Snow, who cares for his wife as she suffers from a disease House tries to diagnose. Purcell is the second Prison Break cast member to appear in Season One. His co-star Robin Tunney appeared in the pilot as House's main patient.
- Hidden Credits: In the rolling end credits from House's apparently fictitious soap opera, one of the credits for Hair Stylist is Marcy Kaplan - one of the producers of House, M.D.
Allusions and References
- "The Twelve Days of Christmas": When Foreman sarcastically asks House if he thinks "three ER doctors, two neurologists and a radiologist missed" Elyse Snow's presumed brain tumor, House replies, "Partridge in a pear tree missed it, too." This is a reference to the lyrics to the traditional Christmas song "The Twelve Days of Christmas." The cumulative song - an instrumental version of which was used in episode 1x05 - Damned If You Do - describes gifts given on each of the twelve days (e.g.: two turtle doves on the second day, three French hens on the third day, four calling birds on the fourth day, etc.). Each verse counts backwards from the most recent day through the previous days and ends with the single gift given on the first day, "A partridge in a pear tree."
- "Snow White": As House leaves his staff after their first discussion of Elyse's case, he says, "And check for evil stepmothers. This much sleep usually indicates poison apples." This is a reference to the popular fairy tale "Snow White," about a beautiful woman whose evil stepmother the Queen hates her for being more beautiful than she. The evil stepmother sends Snow White a poison apple which puts her into a deep sleep, but Snow White is awoken by a prince with whom she lives happily ever after.
- Friedrich Nietzsche: As Foreman and Chase administer the melarsoprol to Elyse, and Chase tells Foreman how nasty the drug is, Foreman says, "What doesn't kill us makes us stronger, huh?" Chase replies, "Nietzsche wouldn't have been so glib if he'd been prescribed melarsoprol." The 19th century German philosopher Friedrich Nietzsche is best known as the father of nihilism and a major contributer to the basis of 20th century philosophy. His famous quote, "What does not kill us makes us stronger," is from his 1886 work Beyond Good and Evil, a criticism of his contemporary philosophers for accepting Christian philosophy blindly.
- Ed Snow waits by Elyse's beside, where she is comatose but has been treated for African sleeping sickness, which she could have contracted by having an affair. He asks Cameron if Elyse knows he's there, and she says, "She knows you're always there for her." Ed says if the treatment works, "it means she wasn't always there for me." He confesses that a part of him "doesn't want her to get better." He asks Cameron if he is a terrible person. Cameron replies simply, "Yes."
- House: Huh!
House: Husband described her as being "unusually irritable" recently.
House: I didn't realize it was possible for a woman to be unusually irritable.
- Cuddy: It takes two department heads to treat shortness of breath? What, do the complications increase exponentially with cup size?
- Foreman: Why are you riding me?
House: It's what I do. Has it got worse lately?
Foreman: Yeah, seems to me.
House: Really? Well, that rules out the race thing, 'cause you were just as black last week.
- Cameron: You pulled my medical records?
House: You coughed the other day. I was concerned.
Cameron: You were curious, like an eight-year-old boy with a puzzle that's just a little too grown-up for him to figure out.
House: Tomayto, tomahto.
- House: I don't ask why patients lie. I just assume they all do.