House, M.D./Maternity

Maternity
Season 1, Episode 4
Airdate	December 7, 2004
Production Number	104
Written by	Peter Blake
Directed by	Newton Thomas Sigel
Stream
← 1x03 Occam's Razor	1x05 → Damned If You Do
House, M.D. — Season One

Maternity is the fourth 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: Ever Carradine (Karen Hartig), Hedy Burress (Jill), Cress Williams (Hospital Attorney), Melissa Marsala (Lupino), Alexandra Chun (Kim Chen), Kenneth Choi (Dr. Lim), Ben Parrillo (Dr. Kubsiak)

and Sam Trammell (Ethan Hartig)

Co-Starring: Dwight Armstrong (Charlie), Shawn Carter Peterson (Male Med Student), Nate Torrence (Young Man), Jocelyn Jackson (Young Woman), Marc Menard (Soap Doctor), Madison Bauer (Soap Patient), Donna Stearns (Volunteer)

Plot Overview

An infant in the maternity ward at House's hospital develops a fever, starts spitting up and has a seizure. House overhears of another, similar case and becomes convinced there is an epidemic outbreak at the hospital. Cuddy doubts him at first, until he checks every infant and finds two more who are showing symptoms. As Cuddy checks every nook and cranny of the hospital for a bacterial infection, House puts the first two infants on two different antibiotics. When they both show signs of kidney failure, House takes each infant off a different antibiotic, knowing that at least one of them will probably die. Cameron has trouble telling one set of parents, the Chen-Lupinos, the cold, hard truth - their baby may very well die. When he does die, House orders her to tell the parents, but she freezes, and Wilson takes over, much to House's dismay. When the other antibiotic does not work, either, and that infant starts to crash, House performs an autopsy on the dead infant to learn the cause is viral. He narrows down the virus, and an experimental treatment cures the surviving infants. After everything is over, House learns a volunteer passing out teddy bears was the person responsible for passing on the infection.

Clinic Patients

• Jill: An adult female complaining of loose joints, nausea and an inability to lose weight. He tells her, "You have a parasite." She asks if he can do anything, and he says, "Only for about a month or so. After that, it becomes illegal to remove, except in a couple states. ... But don't worry. Many women learn to embrace this parasite. They name it, dress it up in tiny clothes, arrange playdates with other parasites." When he finishes, he announces, "It has your eyes," and shows Jill an ultrasound of the "parasite" - a fetus. Jill protests that she has a birth control implant, "and my doctor said I might not get any periods at all if it was working." House replies, "Mm-hm. Interestingly enough, you also don't get any periods if it isn't working." Jill is worried, because she doesn't know whether her husband or ex-boyfriend would be the father, so House encourages her to lie. Later, Jill returns with her husband Charlie, and asks him to test Charlie for "mono." House agrees to run the paternity test. Later, after the test confirms Charlie is the father, the grateful Jill asks House to be her prenatal care physician. He at first refuses, but later changes his mind so he can have access to the plush OB/GYN lounge.

Notes

Medical Terms

(See the Medical Dictionary for definitions.)

• When Dr. Lim first enters the Hartigs' room to check on their baby, he says, "You gotta ask the pediatrician next time. I just deliver 'em."

• As House watches his fictitious soap opera in the lounge, the soap doctor tells his patient, "The MRI's back." House predicts that she has amnesia.

• House shows Wilson the two sick babies in the NICU, which he learned about while he was in the OB/GYN lounge. Wilson offers him a key to the oncology lounge.

• In their argument over whether or not there is an infection on the loose in the maternity ward, Cuddy and House debate whether the radiologist read the X-rays correctly.

• After multiple cases of infant sickness have been confirmed, House, Cuddy and House's staff have a summary of the situation, in which Foreman says the babies are "barely able to keep systolic up." As Cuddy leaves to swab the hospital, House and his team work up a differential diagnosis. When Chase hypothesizes a virus, Cameron says "the blood tests showed no lymphocytosis," and Foreman says, "They're not responding to acyclovir or ribavirin." When they narrow the list down to a bacterial infection, Foreman hypothesizes MRSA and H flu, Cameron hypothesizes Pseudomonas, and Chase VRE. While they wait for cultures, House prescribes vancomycin and aztreonam. He also orders MRIs to "check for abscesses or some occult infection."

• When House's staff learns the antibiotics are causing kidney failure, Foreman says to House, "You're the nephrologist."

• House's pregnant clinic patient Jill brings her husband to House, whom she has told she has mono - a code for wanting a paternity test.

• When House's treatments are ineffective in treating the babies, House returns to the drawing board. Chase hypothesizes VRSA. As evidence, he points out a skin rash which might be scalded-skin syndrome. House goes off on a rant about doctors prescribing antibiotics, including penicillin, azithromycin and Levaquin.

• After House performs an autopsy on the Chen-Lupino baby, he shows his staff, Wilson and Cuddy a cross-section of the baby's myocardium, which shows fibrosis and lymphocytic infiltrates, proving a viral infection. Cameron objects that there was no indication of lymphocytosis in their blood. House turns to Chase as the intensivist and asks how many viruses they need to narrow the possibilities down to, and Chase gives him a limit of six. Because of the virus' resistance to ribovirin and acyclovir, its effects and its hurting the babies only, they eliminate herpes, adenoviruses, toxoplasmosis, rubella, TORCH syndrome and paramyxoviridae. Chase hypothesizes CMV, Foreman enteroviruses, Cuddy influenza A and House RSV. With eight viruses to test in the end, Cuddy says they can test one healthy baby who has jaundice, saying she'll "tell his parents he can't check out because he has the smallpox."

• Foreman finds the tested babies are positive for echovirus 11 and CMV, but only the sick kids are positive for parvovirus B19.

Arc Advancement

Characters

• Cameron: Cameron has trouble telling one set of parents how sick their baby is, so Foreman does the dirty work for her and chews her out. Later, she sugarcoats the situation when their baby is taken off one antibiotic, only to have them be shocked when their baby dies. When House orders her to deliver the bad news, she freezes, and Wilson has to take over. At the end, House confronts her and says he surmises she has suffered some horrible loss in her past, possibly of a baby, but she refuses to talk about it. This is the first reference to the specific tragedy in Cameron's past, which will be further explored later this season.

Trivia

Allusions and References

• Elmer Fudd: When House comes to his staff to enlist their aid in finding more than two sick babies, he says, "We're going hunting." Chase asks what they are hunting for, and House replies, "Wabbits." This is an allusion to the Looney Tunes cartoon character Elmer Fudd, who had a lisp in which he mispronounced "R"'s as "W"'s. Many of his cartoons involved Elmer as a hunter on the trail of Bugs Bunny.

Memorable Moments

• House has put each of the two babies being treated for the mystery infection on two different antibiotics, but the babies start to suffer kidney failure. Without the antibiotics, the staff fears both babies will die of infection, and with them, they'll die of kidney failure, so the question becomes which antibiotic they should stop. With no way of knowing which one is the problem, House orders them to stop one antibiotic for one baby, and the other for the other in the hopes of determining the infection and saving the other sick babies. Foreman says, "So you're condemning one of these two kids to die based on random chance?" House pauses for a long time and says, "I guess I am."

Quotes

• Wilson: I'm still amazed you're actually in the same room with a patient.

House: People don't bug me until they get teeth.

• House: See, this is why I don't waste money on shrinks, 'cause you give me all these really great insights for free.

Cuddy: Shrink! If you would consider going to a shrink, I would pay for it myself. The hospital would hold a bake sale, for God's sake.