House, M.D./Heavy

Heavy
Season 1, Episode 16
Airdate	March 29, 2005
Production Number	116
Written by	Thomas L. Moran
Directed by	Fred Gerber
Stream
← 1x15 Mob Rules	1x17 → Role Model
House, M.D. — Season One

Heavy is the sixteenth 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: Cynthia Ettinger (Mrs. Simms), Jennifer Stone (Jessica Simms), Susan Slome (Mrs. Lucille Hernandez), Ramon Franco (Mr. Hernandez), Karen Goberman (Mrs. Ayers)

and Chi McBride (Edward Vogler)

Co-Starring: Teddy Lane Jr. (Mr. Conroy), Alyson Morgan (Clementine), Austin Leisle (Seth), Rose Colasanti (Cashier), Alec George (Classmate #1), DJ Evans (Classmate #2), Bryan Fabian (Classmate #3)

Plot Overview

Jessica Simms, an obese ten-year-old girl, has a heart attack, and House gets the case. Disgusted by her obesity, Chase jumps to that as her problem, but Cameron and House have another theory because Jessica has tried diet and exercise. House also informs his staff that Vogler has ordered him to fire one of them. Foreman and Cameron band together, but Chase takes an "every man for himself" attitude. When Jessica displays violent psychosis, House concludes the problem is diet pills, but large, open running sores on Jessica's chest suggest otherwise. House thinks Cameron has made a mistake in treatment, but Cameron insists she did not. As Vogler confronts Foreman and Cameron to feel them out, House offers to cut his staff's pay to save their jobs, but Vogler refuses the offer and reveals this is a power play. Wilson says Jessica's only hope may be cutting off the dying skin. Chase, meanwhile, feeds info to Vogler. With the clock ticking down to a time when Jessica would need the surgery, House demands a new diagnosis, and Chase suggests the obesity may be a symptom and not the cause. The realization that Jessica is short compared to her parents leads House to make the correct diagnosis, and test results confirm his hypothesis. Jessica is saved with dangerous surgery, and she loses weight. In the end, House offers to fire Chase, but Vogler refuses this offer and demands that House fire someone else.

Clinic Patients

• Unidentified Man: A tattooed young man seen pulling up his pants in the background as House walks out of his room. House asks Cuddy if she has "ever seen an infected pierced scrotum" and tries to gross her out with the conversation to distract her from saying he needs to fire one of his staff members.

• Mrs. Lucille Hernandez: A young, overweight woman complaining of heartburn who is offended when House at first suggests she might be pregnant, because she believes her obesity is natural. Tests, however, reveal Lucille is not pregnant, but she has a 30-pound benign tumor on her ovary. Lucille tells Wilson does not want the tumor removed, because her husband finds her weight sexy, but he will be turned off by a surgery scar. Yet her husband comes to the clinic later to beg House to convince Lucille to have the surgery. House tries to blow him off until he sees pictures of the couple's six children. House calls her back in and tells her that he knows she is having sex with other men, because she has blue- or green-eyed children, despite having brown eyes like her husband. He relieves her fears that other men besides her husband won't find her attractive by saying that she can find men attracted to surgical scars. She agrees to the surgery.

Notes

Medical Terms

(See the Medical Dictionary for all definitions.)

• House distracts Cuddy by talking about his clinic patient's pierced scrotum. He says, "If pain's what you're after, the penis is really the way to go. I'd recommend the apadravya."

• When he first sees her case, Foreman doubts that Jessica Simms has had a heart attack, but Cameron says the CK-MB and elevated ST in the EKG prove it was a heart attack. Chase hypothesizes the problem is depression over her weight, but House says, "That's what five pediatricians, two nutritionists and a psychologist said. The heart attack would seem to indicate that they missed something." Cameron hypothesizes metabolic syndrome X, or insulin resistance. House likes the idea and orders a hyperinsulinemic euglycemic clamp.

• Cameron presents the diagnosis of MSX to Mrs. Simms, who at first believes it means Jessica is a diabetic.

• When House tells Mrs. Lucille Hernandez she is pregnant, she objects that her husband has had a vasectomy.

• During her tests, Chase announces he is increasing Jessica's glucose. Just then, Jessica experiences temporary psychosis, and Cameron shouts that she must be getting hypoglycemic.

• After Jessica's psychotic attack, Foreman reassures Mrs. Simms that it is a common side effect of hypoglycemia, which is common during an HEC.

• House asks his staff for a new diagnosis to explain Jessica's psychosis, and Chase hypothesizes a blood clot caused by a hypercoagulable state. He says the clot may have caused both the heart attack and the psychosis if it hit the amygdala of the brain. Cameron argues that this is impossible in a child Jessica's age, but Chase says it might be a fat embolus. Cameron protests that Jessica would have had to have had liposuction, which no plastic surgeon would perform on a child. House agrees with Cameron, although he says diet pills may have caused the clot. He orders "heparin and warfarin to prevent further clotting." House walks off into his office, and Foreman follows. There, Foreman suggests House fire Chase, and House asks if it is because of a mistake Chase made on an angio.

• Wilson tells Mrs. Lucille Hernandez that he found her tumor with a biopsy.

• Once Jessica Simms develops open running sores, House says, "We gave her the sores." Foreman asks if House thinks she has a staph infection, but House says he believes the necrosis is the result of the warfarin.

• Wilson and Foreman warn Mrs. Simms they may have to perform a mastectomy on Jessica.

• With little time left, House asks Chase and Foreman for a diagnosis other than a mistake in administering warfarin. Chase realizes the obesity may be a symptom, and House rides them to follow that line of logic. Foreman hypothesizes vasculitis and Chase pyoderma gangrenosum, but those only account for the sores. House asks for diseases which have obesity as a symptom. Chase at first hypothesizes hyperthyroidism, but Foreman says the cause is more likely genetic. House realizes that both of Jessica's parents are tall, while she is not, and he hits upon Cushing's, which would have stunted her growth. He says the sores are the result of hypercalcemia from the disease. Foreman says that Jessica's blood tests do not show high cortisol levels, but House says, "The hypercortisolism could be cyclical." Chase says they'll need another UFC, but with the clock ticking, House orders an MRI to look for brain abnormalities.

• During Jessica's MRI, Foreman finds her adrenal glands are clean, but he and Chase spot a tumor on her pituitary, which confirms House's diagnosis of Cushing's.

• Foreman describes to Mrs. Simms the surgery necessary for Jessica, which involves removing a tumor from the pituitary - located between the cavernous sinuses. He says the surgery involves a transsphenoidal approach.

Music

• "Got to Be More Careful" by Jon Cleary & The Absolute Monster Gentlemen: The closing montage, in which Foreman, Cameron, Chase and House wonder whom House will fire if he cannot fire Chase.

Arc Advancement

Characters

• Chase and Vogler: Chase confronts Vogler for speaking with Cameron and Foreman. In the course of this conversation, it is revealed that Chase has been feeding information to Vogler in exchange for job protection, although Vogler admits he will only protect Chase so long as he needs him.

Referbacks

• 1x14 - Control: House asks Foreman whom he would fire, and Foreman says Chase. House asks, "Why? Because he screwed up an angio a month ago?" This refers to an incident from that episode. Also in this episode, with House insisting Cameron made a mistake, Cameron suggests that he can't deal with his feelings for her. House says, "I believe that you are the only one to express feelings." He is referring to an incident in that episode, in which Cameron asked House if he liked her, and he said he did not.

• 1x15 - Mob Rules: Much of this episode revolves around the fact that Vogler is pressuring House to fire a member of his staff. House was first told he would have to take this action in that episode. Also in that episode, House first revealed that he knew someone was passing information to Vogler. In this episode, that person is revealed to be Chase.

Trivia

The Show

• Real Time: House says the incident in which Chase made an error on a test took place a month ago. In real life, the episode in which that event took place (1x14 - Control) aired two weeks prior to this episode. However, at the end of this episode, at least a few days can be presumed to have passed between Jessica Simms' surgery and her return to the hospital - many pounds lighter. Further, House says that more than a week has passed between the start of the episode and the final scene, which ends very close in time to when the first scene of the next episode would begin. In reality, the episode following this one - 1x17 - Role Model - aired three weeks after this episode. These two references, then, are further hints that the episode times are moving closer to "real time" - in other words, that an episode that airs on March 29, 2005 would take place on or about March 29, 2005. (See also 1x06 - The Socratic Method for a discussion of real time vs. episode time.)

Behind the Scenes

• Awards: For her role both in and out of fat makeup as Jessica Simms, Jennifer Stone was nominated for a Young Artist Award for the calendar year 2005 for Best Performance in a Television Series (Comedy or Drama) - Guest Starring Young Actress.

Allusions and References

• Green Eggs and Ham: In the opening scene, when Jessica Simms begs her mother not to take her to school because her classmates make fun of her, Mrs. Simms says, "Remember the story where the guy keeps saying that he hates green eggs and ham? And then at the end he realized that he really loved them? ... You just gotta be like Sam-I-Am and don't give up." This is a reference to the children's book Green Eggs and Ham by Dr. Seuss, about a man named Sam-I-Am who tries to convince another man to eat green eggs and ham. The man refuses to try the strange dish, but Sam-I-Am persists in suggesting that he try it in different situations (e.g.: in a box, with a fox, on a train, in the rain). When the man finally tries green eggs and ham, he finds that he likes them.

• Punk'd: When House tells his staff that he must fire one of them, Foreman at first doubts the veracity of House's claim and instead calls it "House's own version of Punk'd." The MTV reality show Punk'd, co-created and hosted by Ashton Kutcher, features celebrities performing practical jokes on other celebrities with the help of Kutcher and his crew.

• What's Happening!!: To convince Jessica to allow herself to be weighed, Foreman says he was heavy as a kid, too, and the kids in his neighborhood called him "Rerun." This is a reference to the nickname of the heavyset character Fred Stubbs on the popular 1970s sitcom What's Happening!!, about three African-American teenagers growing up in the inner city.

• Ariel Sharon; The Gaza Strip: To address the issue of House having to fire someone, Wilson asks, "Any thoughts?" House replies, "On what? Sharon's plan for Gaza?" Ariel Sharon was Prime Minister of Israel from March 2001 until he was left incapacitated by a stroke in January 2006. One of his most famous moves as Prime Minister was to turn over the Gaza Strip - one of two hotly contested regions of the nation - to the Palestinian Authority as a home for Israel's Palestinian minority.

• Game Boy: In the conversation in which Cameron confronts House for riding her about a mistake she did not make, House says he's not riding them because he has the correct answer. Cameron counters by saying, "Then why aren't you watching TV or playing your damn Game Boy?" Game Boy is a line of handheld video game consoles produced by the Japanese video game giant Nintendo. Due to the fact that it was the first highly successful handheld console released in the modern age of video games (in other words, since the early 1990s), the trademarked name "Game Boy" has incorrectly become synonymous to many non-gamers with any handheld console. However, House has been shown to play video games on a handheld console in several episodes, beginning with 1x03 - Occam's Razor, and most of the time, the console in question was, in fact, from the Game Boy line.

Quotes

• Foreman: Ten-year-olds do not have heart attacks. It's gotta be a mistake.

House: Right. Simplest explanation is she's a 40-year-old lying about her age, maybe an actress trying to hang on.

• House: I'm thinking I can convince Vogler it would be more cost-efficient to keep all of them.

Wilson: Yeah. You should be able to pull that off. Most billionaires aren't very good with numbers.

House: It will be more cost-efficient once I've grabbed Cameron's ass, called Foreman a spade, and Chase... well, I'll grab his ass, too.

• Cameron: If everyone took a pay cut and stayed for a few more hours, we could all stay for the same amount of money.

House: Figures you'd try and come up with a solution where no one gets hurt. The problem is, the world doesn't work that way just 'cause you want it to.

Cameron: Figures you'd stall and refuse to deal with the issue. Problem is, the world doesn't go away just because you want it to.