House, M.D./Pilot

Pilot
Season 1, Episode 1
Airdate	November 16, 2004
Production Number	101
Written by	David Shore
Directed by	Bryan Singer
Stream
← 1x01 Pilot	1x02 → Paternity
House, M.D. — Season One

Pilot is the first episode of the first season of House, M.D..

With its stark lighting, atypical camera angles and more cinematic title sequence, it has, like many pilots, a distinctly different look from the rest of the series - no doubt the handiwork of episode director Bryan Singer and his crew.

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)

Special Guest Star: Robin Tunney (Rebecca Adler)

Guest Starring: Andrew Airlie (Orange Colored Patient)

Co-Starring: Reika Sharma (Melanie Landon), Maya Massar (Asthma Mom), Dylan Basu (Asthma Boy), Ava Rebecca Hughes (Sydney), Kyarra Willis (Kid #2), Eitan Kyle Gross (Molnar), Candus Churchill (Substitute Teacher), Michale Ascher (Egg Salad Lady), Alana Husband (Tech), Janet Glassford (Reception Nurse)

Plot Overview

When a grade school teacher loses control of her speech and collapses in front of her class, Wilson, who says the patient, Rebecca Adler, is his cousin, convinces House to take the case, although it seems to be a brain tumor. When Adler's throat closes up while she is taking a simple test, Chase and Cameron revive her with an emergency tracheotomy. House treats her with steroids. Meanwhile, Cuddy strong-arms House into taking on more clinic hours, which he despises. Adler responds well to the steroids, but she soon has a relapse. Foreman and Cameron break into Adler's house to find the cause of her illness, and they find ham, which leads House to conclude she is infested with parasites. But Adler refuses to take treatment without proof, as she believes she is doomed to die. House proves her illness is treatable with an X-ray, and Adler takes her medicine to get better. Later, House learns she is not Wilson's cousin, but Wilson lied to convince House to take the case.

Clinic Patients

• Orange Colored Patient: A rich man who enters the clinic complaining of back spasms. House dismisses the back pain and says the real problem is that his "wife is having an affair," because she has not noticed he has turned orange. As he leaves, House tells the patient his orange tone is caused by an overdose of carrots and vitamins. "Carrots turn you yellow, the niacin turns you red," House says. "Find some finger paint and do the math. And get a good lawyer."

• Asthma Boy: A 10-year-old with asthma whose mother refuses to let him use his inhaler as often as his doctor prescribed, because, "I worry about children taking such strong medicine so frequently." House chastises her for risking her son's life by withholding the steroids he needs to reduce the inflammation and allow him to breathe. This leads him to realize he should treat Rebecca Adler with steroids. As he leaves to order this, he tells her, "If you don't trust steroids, you shouldn't trust doctors."

• Molnar: A hypochondriac who believes he has chronic fatigue syndrome or fibromyalgia, two diseases he found out about on the Internet. House pretends to order Vicodin for the fibromyalgia, but he pockets the real pills and replaces them with candy from the vending machine. At the end of the episode, Molnar returns for a refill, so House asks Wilson for change to buy more vending machine candy.

Notes

Alternate Titles

Although it was referred to as "Pilot" in the original TV listings and on the DVD, this episode was entitled "Everybody Lies" when it was included on screener copies for members of various awards granting bodies.

Medical Terms

(See the Medical Dictionary for definitions.)

• Over the course of the episode, most of the specialties of the characters are discussed. House and his staff specialize in diagnostic medicine. The individual specialties mentioned are neurology (Foreman), immunology (Cameron), intensive care medicine (Chase) and oncology (Wilson).

• In their first scene together, House and his staff work up a differential diagnosis of Rebecca Adler as they look over her CAT scan. Several hypotheses are offered. Chase offers three, including an aneurysm and ischemia. Cameron suggests Creutzfeld-Jacob disease (or mad cow disease), and Foreman offers Wernicke's encephalopathy. In response to Chase's hypotheses, House orders a contrast MRI.

• When Adler's throat collapses during her contrast MRI, Foreman tries to ventilate her but finds it difficult because there is "too much edema."

• When Cuddy tells House his first patient at the clinic has turned orange, House replies, "You mean yellow. It's jaundice."

• One of House's patients in the clinic is a young boy suffering from asthma, for which he has been prescribed steroids.

• A clinic patient inspires House to prescribe steroids - specifically prednisone - for Adler to treat what he believes is cerebral vasculitis. The drugs temporarily relieve her conditions.

• When Foreman learns Adler has a parrot in her kindergarten class, he hypothesizes her problem is psittacosis, but House dismisses this possibility, because none of the children are sick.

• In the clinic, House talks with a hypochondriac who believes he suffers from chronic fatigue syndrome because he's "tired a lot. ... It's kind of the definition, isn't it?" He also claims to suffer from fibromyalgia. To treat this latter one, House orders Vicodin, which he pockets for his own uses and replaces with vending machine candy.

• Foreman's revelation that he found ham in Adler's apartment leads House to conclude she is suffering from neurocysticercosis. Wilson warns that House has no proof, as the "eosinophil count was normal."

• After House's team has proven Adler is infested with tapeworms, she is treated with albendazole.

Music

• "You Can't Always Get What You Want" by The Rolling Stones - The final exterior shot of the hospital, just before the closing credits.

Arc Advancement

Characters

• House and Foreman, Cameron and Chase: House reveals why he hired each of the members of his staff. In Foreman's case, he learned through a gym teacher that Foreman had a criminal history of breaking and entering when he was 16, which he liked, because he "needed somebody ... with street smarts, ... who knows when they're being conned, knows how to con." Cameron was hired because she is a beautiful woman, and in House's mind, a woman as beautiful as she is does not need to work as hard as she did. He therefore believed she must be "damaged," although whether he hired her to solve the riddle of her damage or because he felt it was useful in some way, he does not say. And Chase's "dad made a phone call."

Trivia

The Show

• "Everybody Lies": During his first conversation with his staff, House refuses to speak with Rebecca Adler, because "everybody lies." This line would be repeated throughout the series and would become a catchphrase for House.

• Foreman and Cameron's Backgrounds: During their conversation over ham sandwiches in Adler's house, clues to Foreman and Cameron's pasts are revealed. Foreman attended "Hopkins" (short for the renowned Johns Hopkins University), where he got a solid 4.0 grade point average. Cameron went to a worse school and got worse grades, but she does not reveal how much worse - although, from House's conversation with her later, they could not have been too much worse.

• Wilson's Ethnicity: Foreman deduces that Adler is not Wilson's cousin, because he had ham at her apartment and she is therefore not Jewish, indicating Wilson is Jewish.

Behind the Scenes

• Prison Break Connection: Robin Tunney plays Rebecca Adler, the kindergarten teacher whom House takes on as a patient. The following autumn, she would debut as Veronica Donovan, an attorney trying to clear her ex-boyfriend's name of the murder for which he is sentenced to die, on another FOX action hit, Prison Break. (See also 1x07 - Fidelity.)

• Chasing Zebras: In his first scene with his staff, House says he does not think what Adler has is a tumor. Foreman replies, "First year of medical school: If you hear hoofbeats, you think horses, not zebras." In other words, when presented with a set of symptoms (hoofbeats) doctors should presume the more obvious diagnosis (horses) rather than a less orthodox one (zebras). House dismisses the possibility that Adler's illness is a "horse" (in this case, a brain tumor), because it would have been found sooner. When Cameron hypothesizes it may be mad cow disease, House replies, "Mad zebra [disease]." He ends the scene by saying, "Let's find out what kind of zebra we're treating here." These zebra references were the inspiration for one of the early possible titles for this series, Chasing Zebras.

• Laurie's Casting Session: In their first scene together, Cuddy chews House out for not doing everything the hospital administration expects him to do in his job, but House counters that she cannot fire him. This scene was the one read by Hugh Laurie (and presumably all other actors) in the initial casting session for the role of House.

• Awards: Composer Christopher Hoag was nominated for a 2005 Emmy (for the 2004-05 season) Outstanding Music Composition for a Series (Dramatic Underscore) for his work on this episode. As it happens, this would be the only episode Hoag would score. All subsequent episodes would be scored by Jon Ehrlich and Jason Derlatka. (See also Music.)

Allusions and References

• Mick Jagger: House ends his first conversation with Cuddy by saying, "As the philosopher Jagger once said, 'You can't always get what you want.'" Later, when she cuts off his ability to order tests and even makes photocopies, Cuddy says, "Oh, I looked into that philosopher you quoted - Jagger - and you're right, you can't always get what you want, but as it turns out, if you try, sometimes you get what you need." English musician Mick Jagger is best known as the frontman and songwriter for the legendary rock band The Rolling Stones. The lyrics to the chorus of their classic hit "You Can't Always Get What You Want," as it appears on their essential 1969 album Let It Bleed, are:

No, you can't always get what you want

You can't always get what you want

You can't always get what you want

But if you try some time you find

You get what you need.

• General Hospital: When he checks into the clinic, House asks if they have cable TV, because "General Hospital starts in eight minutes." Twice later he watches TV - once while eating lunch with Foreman in the hospital cafeteria, and again at the end of the episode, when he confronts Wilson for lying to him about Rebecca Adler being his cousin. Both times, the show House is watching is the long-running ABC soap opera General Hospital, about the events in and around General Hospital in Port Charles, New York.

• Medical Crimes: When Cuddy learns House prescribed Adler steroids without proof that her disease is cerebral vasculitis, she scolds him, saying, "You don't prescribe medicine based on guesses. At least, we don't since Tuskegee and Mengele." Here Cuddy has made reference to two of the more famous medical crimes of the 20th century. They are:
  • Tuskegee: The Tuskegee Syphilis Study was performed over the course of 40 years - from 1932 until 1972, when it was finally stopped due to public outrage after details were leaked to the press. During the course of the clinical study, undereducated, lower class Black sharecroppers in Macon County, Alabama were diagnosed with syphillis, but they were not informed of the diagnosis. In the early years of the study, they were left untreated for several months to study the disease, until at last they were offered effective but dangerous treatments. In later years, they were withheld penicillin, which had proven to be an effective and safe treatment for the disease.
  • Josef Mengele: Dr. Josef Mengele was a Nazi German physician famous for performing bizarre, sadistic medical experiments on concentration camp inmates, particularly Jews, during the Holocaust.

Memorable Moments

• Multiple shots throughout the episode take the camera into Rebecca Adler's body to show what is happening inside. In the first, the camera seems to travel up through her nostrils into her brain. In the second, when her throat closes due to an allergic reaction to gadolinium, the camera moves into her mouth to show her throat collapsing. Later, as House describes the life cycle of the tapeworm causing her infection, we see a montage of the tapeworm doing just that inside her body. These types of shots - similar to images from such films as Fantastic Voyage and Three Kings - would be used frequently in later episodes and become a trademark of the series.

• At lunch, House tells Foreman to break into Adler's house and find out what may be causing her disease, but Foreman objects that she is a kindergarten teacher and therefore trustworthy. House points out the woman who made Foreman's sandwich. He claims she looks sick, but she is at work, probably because she is too desperate for her minimum wage earnings to call in sick. Although she is supposed to wash her hands, the fact that she is wiping snot on her sleeve suggests she may not adhere to sanitary regulations. "So what do you think?" he says. "Should I trust her?"

• When House learns that Adler has refused treatment, he comes to her room (for the first time) to convince her to take treatment. She protests that she just wants "to die with a little dignity." House responds, "There's no such thing. Our bodies break down. Sometimes when we're 90, sometimes before we're even born, but it always happens, and there's never any dignity in it. I don't care if you can walk, see, wipe your own ass, it's always ugly. Always! We can live with dignity. We can't die with it."

Quotes

• House: See that? They all assume that I'm a patient because of this cane.

Wilson: So put on a white coat like the rest of us.

House: I don't want them to think I'm a doctor.

Wilson: You see where the administration might have a problem with that attitude.

House: Mm, people don't want a sick doctor.

Wilson: That's fair enough. I don't like healthy patients.

• Foreman: Shouldn't we be speaking to the patient before we start diagnosing?

House: Is she a doctor?

Foreman: No, but....

House: Everybody lies.

• Cuddy: Is the yelling designed to scare me? Because I'm not sure what it is I'm supposed to be scared of. More yelling? That's not scary. That you're gonna hurt me? That's scary, but I'm pretty sure I can outrun ya.

• Foreman: I thought everybody lied.

House: Truth begins in lies. Think about it.

Foreman: That doesn't mean anything, does it?

• Foreman: Oh, Cameron, I need you for a couple of hours.

Cameron: What's up?

Foreman: When you break into someone's house, it's always better to have a White chick with you.

• Cuddy: I'm your doctor. You've been good to me and good to this hospital. Of course I care. But I don't see how this conversation can end well for me. Either your wife is having an affair, or she's not having an affair, and you have come here because you rightly think I should fire him. But I can't, even if it costs me your money. The son of a bitch is the best doctor we have.