House, M.D./Paternity

Paternity
Season 1, Episode 2
Airdate	November 23, 2004
Production Number	105
Written by	Lawrence Kaplow
Directed by	Peter O'Fallon
Stream
← 1x01 Pilot	1x03 → Occam's Razor
House, M.D. — Season One

Paternity is the second 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: Scott Mechlowicz (Dan), Robin Thomas (Dan's Father), Wendy Gazelle (Dan's Mother), Alex Skuby (John Funsten)

Co-Starring: Kylee Cochran (Young Woman), Paul Ganus (Trainer), Scott Hochstadt (Jake)

Plot Overview

Dan, a 16-year-old boy, starts having double vision while playing lacrosse and takes a blow to the head. Because the staff is bored, Cameron fakes a letter from House asking to see the boy, but House at first dismisses the case as a concussion from the blow until he notices Dan twitching. As the staff investigates Dan's night terrors and double vision, House makes a bet with Foreman, Chase, Cameron, Cuddy and especially Wilson that the boy's father is not his real father. At first, Dan is diagnosed with multiple sclerosis, but when a night terror nearly sends him jumping off the roof of the hospital, that diagnosis proves wrong. House's next guess is syphillis, for which penicillin is injected into his spine, but when Dan starts hearing voices, that, too, is eliminated, and House's staff is stumped. When House runs a DNA test to prove Dan's father is not his biological father, he learns Dan is adopted, which leads him to conclude the result is a lack of adequate vaccinations as an infant. House gives Dan a dangerous treatment to cure his real illness, a deadly form of the measles. After the treatment is over and Dan is fine, he tells Foreman and Cameron he knew he was adopted when he realized that, while he has a cleft chin, his father does not, making it unlikely that they would be father and son.

Clinic Patients

• Dan: Dan first visits House in the clinic, where House tries to dismiss him, but Dan's father claims House sent a letter requesting that Dan come in. House recognizes the letter as a forgery from Cameron, but he agrees to examine Dan in the clinic anyway when he learns Dan has night terrors. When he sees Dan's myoclonic jerk, he takes Dan on as a full patient.

• Young Mother's Baby: A baby fed on "all-natural" breast milk whose well-endowed mother House calls "yummy". The baby has a fever and cough. House sees the baby hasn't had her vaccinations, and the mother explains that she doesn't trust the pharmaceutical companies who mark up the vaccinations. House entertains the baby with a stuffed frog and in between playing with the baby sneers at the "all-natural" toy, which he calls a "good business." He plays with the baby some more, then continues. "You know another really good business? Teeny tiny baby coffins. You can get them in frog green, fire engine red. Really! The antibodies in yummy Mummy only protect the kid for six months, which is why these companies think they can gouge you. They think that you'll spend whatever they ask to keep your kid alive. Wanna change things? Prove 'em wrong. Few hundred parents like you decide they'd rather let their kid die than cough up 40 bucks for a vaccination, believe me, prices will drop really fast!" House then plays with the baby some more. When the terrified mother asks what her baby has, he replies simply, "A cold."

• John Funsten: A man with a nasty infected sore on his leg, which he tried lancing himself with a nail file. Because Funsten lives far away, House deduces he is a litigation-happy patient who has sued all the doctors within a 70-mile radius. "It's ironic, isn't it?" House says. "Sort of like the boy who sued wolf." Nonetheless, House agrees to treat him. Funsten returns later with court papers, as he is suing House for "mental distress." House takes the papers and tells Funsten he has gonnorhea, and he needs a doctor to run a test before the state calls Funsten's wife to let her know. Funsten tries to take the papers back, but House snatches them away and says, "Uh-uh. These are mine now. I'll see you in court."

Notes

Medical Terms

(See the Medical Dictionary for definitions.)

• While House's staff sits on their hands, Chase does a crossword puzzle for which one of the answers is cretinism.

• When House first examines Dan, he says night terrors in teens are usually caused by one of two factors, of which one possibility is post-traumatic stress. After House dismisses the case as a concussion, Dan claims he had double vision prior to the blow to his head, to which House responds, "Well, that changes everything. You need glasses. ... You need to see an ophthalmologist, which I am not." Then he notices a myoclonus in Dan's leg, which is what encourages him to take on the case.

• During the first differential diagnosis of Dan's case, Cameron hypothesizes that he may be suffering from leukoencephalopathy. Chase suggests he might not be having night terrors, so House orders a polysomnograph.

• In Dan's first night terror, a horrible spectre of House comes to him and says that his "EEG revealed abnormalities in your brain."

• Once it is confirmed Dan has night terrors, Foreman runs down a list of tests Dan has been given, including a CT, MRI, CBC and a CHEM-7. House spots something wrong in the MRI, so Chase, trying to please House, claims to see enhancement of the meninges and hypothesizes viral meningitis. House dismisses this and tells his staff to "take a close look at the corpus callosum." After they spot the problem, House orders a radionucleotide cisternogram.

• As Foreman and Chase discuss methods of obtaining DNA from Dan's father to win their bet against House, Chase jokes, "We could tell them he's got Huntington's. Whole family should be tested or they could all die."

• As House walks out of the clinic, Foreman tells him that they took a "vial of [Dan's] CSF." Chase claims to have found oligoclonal bands and intrathecal IgG, which leads House to diagnose multiple sclerosis (or MS). Cameron argues that they are not sure, because "McDonald criteria requires six months to make a definitive diagnosis." Foreman later says, "The VEP indicates slowing of the brain."

• When Dan wanders around from a night terror, Foreman says, "He shouldn't move after a lumbar puncture."

• Dan's night terror requires a new diagnosis, so Cameron hypothesizes it may be neurosyphilis. Chase dismisses this because the "RPR was negative." But House sarcastically says, "OK, let's wait for you to run titers on 1400 viruses while this kid's brain turns to mush." He prescribes penicillin to treat the neurosyphilis.

• When Dan starts seizing and hearing voices, Chase orders Ativan.

• Dan's auditory hallucinations rule out syphilis, so House and his staff go back to the drawing board with the mnemonic "MIDNIT." To rule out the "M" (metabolic), Foreman says that his "LFTs, BUN and creatinine are all normal. Diabetes is out and no gap." For the first "I" (inflammation), Cameron says the "MRA rules out vasculitis." "D" for degenerative and "N" for neoplastic are impossible. For the second "I" (infection), everything is negative. And the CT scan rules out the "T" in trauma. Totally stumped, House orders an EEG and "left and right EOG."

• Dan's parents confront House in the cafeteria and accuse him of not caring about Dan's condition. To prove them wrong, House recites a list of Dan's test results, including his blood pressure, the status of his brain shunt and that his "EKG shows a normal QRS."

• To shake up a sue-happy clinic patient, House tells him he has gonorrhea.

• As the stumped staff test for infections in the lab while Cameron runs Dan's parents' DNA tests, they find negative results on West Nile and eastern equine encephalitis.

• The revelation of Dan's adoption leads House to trace his illness to a measles infection as an infant which has mutated into subacute sclerosing panencephalitis. To treat it, Foreman recommends intraventricular interferon.

• As an alternative to a biopsy on Dan's brain, Foreman performs a biopsy on his retina.

• Although Cuddy pays up on her end of the bet about Dan's paternity, she orders House to pay $3200 for the PCR test.

Music

• "Teardrop" by Massive Attack - The theme song over the opening credits in this and all subsquent episodes.

• "On Saturday Afternoons in 1963" by Rickie Lee Jones - House watches (or imagines watching) Dan play lacrosse.

Arc Advancement

Referbacks

• 1x01 - Pilot: The first shot of House in the opening credits - as seen through an X-ray of a human head - in this and all subsequent episodes is from that episode. In the upper-left hand corner of the screen, just before it zooms focus to House's face, you can see part of the name "Adler, Rebecca" in reverse. She is House's patient (played by Robin Tunney) in that episode. (The shot of House, Foreman, Cameron and Chase walking down the hall is from a later episode - 1x05 - Damned If You Do.)

Trivia

Behind the Scenes

• Awards: Sound effects engineers Barbara Issak, Craig T. Rosevear and Bradley L. North were nominated for a Golden Reel Award for calendar year 2004 for Best Sound Editing in Television Short Form: Sound Effects/Foley for this episode.

Allusions and References

• George Washington Bridge: While discussing Dan's MRI with his staff, House calls the corpus callosum "the George Washington Bridge between the left and right side of the brain." The George Washington Bridge is a suspension bridge over the Hudson River and is the primary route from Manhattan Island to northern New Jersey.

• General Hospital: House sees Foreman monitoring Dan from the lab and says, "General Hospital is on Channel Six." General Hospital is a long-running ABC soap opera about the events in and around General Hospital in Port Charles, New York. (See also: 1x01 - Pilot.)

• Carnegie Mellon University: Dan's lacrosse team at the beginning of the episode has the colors (Maroon and White) and the mascot (Tartans) of Carnegie Mellon University. Tartan clothing can also be seen worn by Dan's parents and other people watching the game.

Memorable Moments

• When House first views Dan's MRI's with his staff, he insists that his staff look again to see what he has already spotted as being wrong. Chase suggest viral meningitis, and House praises him for taking "a small clue that there's a neurological problem" and running with it. Foreman protests that the MRI shows "no evidence of meningitis," and despite his praise of Chase, House agrees. "He's completely wrong," House says. Cameron asks what clue Chase ran with. House answers, "He knew that I saw something on the MRI, so he figured that there must be something there and took a guess. Clever, but also pathetic."

• To get Dan to focus on something while receiving a lumbar puncture, Chase points out a necklace that Cameron, who is leaning over Dan's face, is wearing. Cameron is confused until she notices the necklace is dangling over her cleavage. "Thank you so much," she says to Chase. "The kid's in pain," Chase replies.

• After DNA tests have proved Dan was adopted, House storms into Cuddy's office, where she is meeting with his parents, and calls the parents idiots. Cuddy reacts poorly to the parents' accusation that House accused them of molesting Dan, but House cuts her off. "Can we get off my screw-ups and focus on theirs?" he says. "Theirs is bigger." He reveals the DNA results, but they protest that adoption makes them as much Dan's parents as anybody. House says, "Listen, when we were taking his medical history, were you confused? Did you think we were looking for a genetic clue to his condition, or did you think we were trying to ascertain who loves him the most in the whole wide world?"

Quotes

• House: Next time you want to get my attention, wear something fun. Low-rider jeans are hot.

• Cameron: McDonald criteria requires six months to make a definitive diagnosis.

House: Oh, who cares about MacPhearson? I hear he tortured kittens.

Foreman: McDonald.

House: Oh, McDonald! Wonderful doctor. Loved kittens.

• Cuddy: How's your hooker doing?

House: Aw, sweet of you to ask. Funny story: She was gonna be hospital administrator but just hated having to screw people like that.

• Foreman: Look, I'm sorry. I-I-I can explain this as best I can, but the notion that you're gonna fully understand your son's treatment and make an informed decision is... is kind of insane. Here's what you need to know: It's dangerous. It could kill him. You should do it.