"You're not gonna make this easy, are you?" "Unfortunately, as much as I admire your spirit..." "Ca ne change rien." "Subject anesthetized with 0.5 cc's of sodium pentobarbital." "Transfected with human hepatic cancer cells, underwent six rounds of intra-abdominal treatment with ES-22." "Vertical incision through the rectus sheath opens the abdominal cavity." "Incision extended into the-thorax." "Liver appears normal in color." "No apparent scarring or..." "Damn it!" "Cancerous tumor still present on the right lobe." "1.12 centimeters in diameter." "No reduction." "House S03E03 Informed Consent" "71 years old, cancer research specialist." "Minor tremors, localized melanoma removed two years ago, cataracts." "And he can't breathe." "Also, disregard the facial lacerations." "They're creepy, but unfortunately irrelevant." "Don't you want to know why?" "You have your cane." "No, why the lacerations are creepy." "He was about to dissect one of his lab rats when he collapsed." "The little vermin seized the day, so to speak, and went medieval on his ass." " What?" "My fly open?" " So the pain's returned." "There was no pain, he was unconscious." "I'm guessing because he wasn't able to breathe." " We're talking about you." " Obviously." "I'm obviously not." "What is it with you people?" "I don't use the cane, you're shocked." " I use the cane..." " We're just concerned." "About the wrong person." "I can breathe." "Ezra Powell, on the other hand, is gonna die." " The Ezra Powell?" " Researcher?" " The guy who wrote that textbook?" " Not that textbook, the textbook." "Wait." "There's actually another doctor you admire?" "I admire lots of doctors." "Of course, most of them look a lot better in knee socks than Ezra Powell, but seeing as they can all breathe..." "Oxygenation is through the floor, and lungs are full of fluid." "Gotta be his heart." "Could be amyloidosis." "Or his lungs, probably from years of inhaling toxic chemicals in his lab." " Not the lungs, chest x-ray's clean." " So's his EKG, it's not his heart." "We're being too nice!" "Outside the hospital, he can't breathe, inside the hospital, he can." "Because we help." "At least, enough to screw with our test results." "Source of the problem's either in his heart or his lungs." "So all we gotta do is stop helping." "Put a little pressure on him, and see which gives out first." "At 71, we get his heart or lungs to give out, we might not get 'em to give in again." "That's why we're gonna do it in a hospital." "Put him on an incline treadmill, and do a stress EKG." "So much for the admiration." "Let's get you started." "I'll turn your oxygen up." "I-I worked with Williams on the first protocol for this machine." "Everyone still uses it." "Except for Williams." "He died four years ago." "I'm sorry." "He was 84." "He died parasailing." "He was always an idiot." "You okay?" "Hang in there, you know the protocol's only a few minutes." "His heart rate's flat." "We don't get it past 130, we're not gonna see anything." "And if he falls and breaks a hip, we're not gonna see anything either." "Except an increase in our malpractice insurance." "I figured House might go back to the pills, but if he's using his cane, he's right back to where he was before." "Maybe even worse." "Luckily, he'll handle it in a stoic, grown-up fashion." "He'd never take it out on us." "I can't." "I've" " I gotta stop." "Just a little longer." "Heart rate's only 90, I'm gonna increase the incline." "I gotta stop." "I" " I've gotta get off." "You're doing great, just a little faster, okay?" "I" " I don't need a cheerleader," "I need oxygen." "Stop." "This isn't working." "His heart rate barely got above 90." "He can't breathe, there's too much fluid in his lungs." "Really?" "He's got fluid in his lungs?" "Whatever are we gonna do?" "Oh, yeah, now I remember." "Put him on a treadmill, and run him like one of his rats on a wheel." "He can't run, he can hardly walk." "That's 'cause he's not trying hard enough." "If he was, his heart rate would go up." "Exercising with a lungful of your own bodily fluids tends to hurt." "They don't call it a stress test for nothing." " Do it again." " He's drowning!" "Then pull him out of the pool, and do it again." "I'm assuming this isn't your idea of a long-term solution." "We need to get rid of the fluid in your lungs so you'll be able to do the test." "To see if it's my heart or my lungs." "Exactly." "My money's on both." "I've been in and out of the hospital for the past year." "I'm old, I'm sick." "I'm getting older, and sicker." "Not a very interesting differential, but" "I'm in." "You don't need a $400 handbag." "It's kinda hard to check your throat when you're flapping your gums around." "Oh, sorry." "But it's for the fall formal." "He doesn't care if it's for the presidential inauguration." "But I'm using Marissa's old dress." "It's free." "Yeah, you know what else is free?" "Roof over your head, the food you eat, your phone, your computer." "How long have you been congested?" "A week, ever since we got back from Fresno." "Fresno?" "That's in France, right?" "See the Parthenon?" "Uh, California." "I've got no appetite, I'm aching all over, I'm weak." " Does that hurt?" " Oh, yeah." "Does his voice always have that unattractive nasal tone?" "Totally." "I'm gonna take that giggle as a no." "Fever, aches, weakness, loss of appetite." "Been having any anal sex with IV drug users lately?" "Of course not, I'm married." " Do you think he might've been" " No!" "It's probably a rhinovirus." "What's that?" "Cold." "Take this four times a day, and stay off airplanes." "They're flying cesspools." "You dropped something." "If there's anything else you can think of, please call." "Yes?" "He's too old and weak." "Yeah, this is way, way better." "This'll work." "Please, just try." "There are 20 words to describe chest pain." "Burning, squeezing, stabbing, tearing." "Each one diagnostically useful." "For that, you have to thank Dr. Powell's textbook." "But there are no words to describe degrees of what he's feeling right now-- shortness of breath." "If he had worked on those issues, there would be." "'Cause he would never have given up until he had an answer." "This isn't working." "Dr. House." "Please don't get up." "I'm sure you're very busy, so I'm just gonna try and speed things up a little." "Is that epi?" "That's not the protocol." "No, the protocol is what you tried to do and failed... each time." "Up over 100." "Now we're getting somewhere." "How's it look, Foreman?" "No EKG changes." " Then we push harder." " House, you're gonna kill him." "No, he's right!" "Let him do it." "See?" "That's why he doesn't have to wear knee socks." "He can't breathe." "130." "That's our magic number." "Nothing here." "Foreman?" "Still no sign of blockages." "Which means it's not the heart." "So it must be the lungs." "See?" "Wasn't so hard, was it?" "No!" "Just give me the rest of the epinephrine." "Test is over, it's okay, we're gonna stabilize you." "No!" "No, just let me die." " You're not gonna die." " Yes, I am." "We'll find a treatment." "I don't wanna live like this." "Please." "I'm begging you." "Kill me." "He says no more tests, he wants to die and he wants us to help him do it." "And I want to play a little game I like to call block my spike with misty may." "He's thought this through, it's not an impulsive decision." "Neither is mine." "He's depressed." "He'll feel much better after we cure him." "He's seen all the tests we've seen." "Even if we figure out what's causing the lung damage, it's too late to reverse it." "You can't know that without knowing what's wrong." " It's his call." " So, what do we do?" "Put a plastic bag over his head and get it over with?" "No, we give him a syringe full of morphine." "Every doctor I've ever practiced with has done it." "They don't want to, they don't like to, but that's the way it is." "I haven't, I won't." "I couldn't do it either." "You just said we should respect his decision." "Respect it doesn't necessarily mean we honor it." "Right." "It just means we talk about it." "At some point, "do no harm" has to mean allowing nature to take its course, not stubbornly standing in the way of it." "Sticking a metal syringe into a plastic IV line and pumping in a lethal dose of morphine is not letting nature take its course." "Not according to the state of New Jersey." "So it's better we allow him to slowly suffocate in his own plasma?" "Whose side are you on, senator?" "First respect his wishes, then invade Iraq, then get the troops home... make up your mind." "Certainly a lot of interesting things to consider." "Stress EKG rules out the heart." "Which means something's gotta be attacking his lungs." "Mycoplasma or strep pneumo." "The problem is, it's too late to do anything about it." " We could try levofloxacin." " Coming up with a new treatment isn't gonna do us any good unless we convince him it's worth trying." "Come on, he's old, sick, tiny." "We can do whatever we want to him." "What happened?" "I don't know." "He must've fallen out of bed and got the nasal cannula" " wrapped around his neck somehow." " Ezra, what are you doing?" "I don't want to live hooked to machines." "Too we-- too weak to wipe my own ass." "Why would you want to wipe your own ass, when you could have someone do it for you?" "You're wasting your time." "There must be other patients you could actually help." "No, all services rendered on a first come, first served basis." "I won't consent to any more tests." "And if anyone tries to so much as touch me," "I'll press charges for assault." "Okay, well, you heard the man." "He wants everyone to leave him alone." "Why don't you go first?" "Get out!" "You came to me." "I didn't come to you." "I figured you'd have the guts to do what had to be done if it came to that." "We're nowhere near that." "It's time to test your lungs." "Breathe." "You're gonna have to exhale sometime." " Stop!" " House, you're hurting him." "And you're hurting me." "Fine." "You don't want to help us, we don't help you." "Your lungs slowly fill with fluid." "You gasp to catch every breath, but never can." "Every breath is petrifying." "It'll be slow, painful, torturous." "We don't choose our birth." "And we don't choose our death." "What if you could?" "How 'bout we make a deal?" "You give me one more day." "If I don't find out exactly what's wrong with you by then," "I'll help you die." "House." "24 hours." "C'mon, it's not gonna kill you." "Old guy, lungs, fluid, go." " You cannot help him kill himself." " Of course I can," "Chase says we do it all the time." " Cuddy's not gonna let you." " Enough!" "You don't want me to kill him, fine." "Here's a big shock." "I don't want to kill him either." "How do I not kill him?" "By you guys doing your job." "We have 24 hours to figure out what's wrong with him." "Tick-tock, tick-tock!" "I'll draw cultures." "Pneumonia." "Should be bacteria in his blood." " That's gonna take longer than 24h." " Not if I spin down the sample." "Separate off the buffy coat, then gram stain for bacteria." "Great, do an amylase, d-dimer, c-reactive peptide, get a urine, and do a bronchial sputum while you're at it." "You, check his home and lab for radiation and toxins." " And do a bone marrow biopsy." " All of that in 24 hours?" "Nah, whatever you don't get done, you can finish at the autopsy." "You guys look like crap." " What do you got?" " Purple dye on my fingers." " What'd the bone marrow biopsy show?" " Don't have the results." "What?" "What have you been doing all night?" "Jell-o shots and wild sex, what else?" "There's no bacteria in the blood cultures." "We still have some cooking, but so far nothing." "Nothing in the urine." "The lab was clean enough to do surgery in because, well, they do." "There was no sign of viruses or fleas on any of the rats." "Yeah?" "Who?" "Well, tell her to call a clinic." "Then tell her to leave a message, and I'll get back to her." "Then tell her to leave a personal message." " Who's that?" " Your protégé?" "What are these?" "Dictation tapes, he records everything." "Why?" " Because he's a diligent researcher?" " Or he's losing his memory." "Lot of people dictate their notes." "Yes, we could assume that, and we'd have nothing." "Or we could assume it's a symptom, in which case, whatever's in his lungs is also in his brain." "Unless you got something more promising." " I'll go get an MRI of his head." " Keep testing until you find something." "I'm going to my office to rest for a while." "It's been a long time since I took an anatomy class, but I'm pretty sure you're moving farther and farther away from my lungs." "Running out of places to look, aren't you?" "Doesn't mean we're gonna stop looking." "Mm, no, not for six more hours." " You want us to fail?" " No." "But you will." "No abnormal nuclei means no leukemia." " He a drinker?" " Not according to the history." "Which means, yes, he drinks, which gives us a nice, mundane explanation for the acellularity." "Or he's telling the truth." "Which means fungus is still on the table." "But your entire view of human nature gets destroyed." "Six of one, half a dozen of the other." "Bad news fast." "Good news, you can take your time." "Head's clean, you were wrong, his faculties are intact." "Too bad." "If his brain was addled, we wouldn't have to listen to anything he says." "Hand me the 10% KOH." "It's 4:00, we have nothing to tell him." "Then we have no reason to talk to him." "Still haven't ruled out fungus." "Yep, we have, no bugs, no hyphae." "Okay, next procedure." "We sneak in, turn back the clock." "Whole team." " Must be bad news." " Nope." "Bone marrow biopsy revealed multiple myeloma." "It's not good news, but there are some treatments." " We have to draw some blood." " What about my breathing?" "Associated hyperviscosity syndrome gummed up the blood vessels in your lungs." "Dr. Chase said my calcium is normal." "Mm, we call him Dr. Idiot." "There's no M protein in my urine." "Odd presentation." "So odd that Dr. Cameron doesn't-- doesn't believe it either." " Just give me 12 more hours." " We had a deal." "No more tests." "Fair enough." "Gimme six more hours." "Listen, there is no evidence that you are terminal." "You a man of your word or not?" "No, as a matter of fact, I'm not." "Fine." "Then discharge me." "My lungs will slowly fill with fluid." "I'll gasp to catch every breath." "But never can." "Every breath will be petrifying." "It'll be slow, painful, torturous." "You're really gonna let me die like that?" " Where you going?" " Nowhere!" "Everybody who can walk should get outta here." " You can't do that." " Can't do what?" "Administer a prescription painkiller to a patient who's in pain?" "Go." "Make sure somebody sees you downstairs in the cafeteria." "I can't let you do this." "Either I die in pain, or I just die." "That's what the argument is here." "No, it's about whether you die, or we murder you." "What's gonna happen here is that someone is getting a buttload of morphine." "I'm not sure exactly who at this point." "I can't be a part of this." "Thank you." "I always wondered exactly what was on the other side." "Nothing." "What are you doing?" "Getting a laryngoscope." " Don't just stand there, help." " But you told him" "It was something I like to call a lie." "Bad, I know." "But it's way further down the list than murder." "He's unconscious, no more whining." "Keep testing him." "Go get a ventilator." "I can't do this all night." "We can legally assume that he'd consent to whatever a reasonable person would consent to." "And a reasonable person would obviously consent to being put in a coma against their will just to satisfy your curiosity." "I try to kill him, you're mad." "I don't kill him, you're mad." " All he wanted was some dignity." " Were you in that room with him?" "Was he wearing a tux while he was choking on his own plasma?" "Keep doing the tests." "Take your time, do it right." "Go." "Get to work." "Wait!" "Cameron, why'd you do these cuts so far down on this MRI of his head?" "I wanted to get his brain stem and his c-spine, make sure his diaphragm wasn't paralyzed." "You also caught the top of his lungs." "There's scarring." "You do know that you can't really pierce me with your stares?" "Lung scarring, along with the bad bone marrow, points to an autoimmune disease." " Could be pulmonary fibrosis." " Or lupus." "He can kill himself after we get him better." "Start him on an IVIG for the lupus, and get a colonoscopy." "Lupus could be hiding there." "I can't do this." "Drama queen." "Descending colon's clean." "Moving into the sigmoid." "Sure could use a little more help around here." "She's doing what she believes in." "Yeah, if she was acting on principle, she'd be in here trying to stop us." "All she's doing is running away from the principle so she won't have" " to feel uncomfortable facing it." " And if you were acting on principle, you would've called the cops when you thought House was killing the guy." "You better hurry up." "Why?" "I don't think she's gonna have a problem deciding what to tell Cuddy." "O² sats 89 and dropping." "I thought you were only supposed to put on a pound a week during" " your last trimester." " I'm not pregnant." "I heard about your little stunt with Dr. Powell." "Not really a stunt." "More of a trick, a ruse, a hoodwink." " A lie." " Okay." "Lying is sometimes good, right?" "Like when you're trying to teach someone a lesson about humility or something." "All I'm trying to do is save his life." "He's not gonna learn anything." "I just thought the same principle might apply." "It does." "I could've just let him die." "Not gonna get sued for keeping him alive." "Well, we could." "We completely disregarded his wishes." "Do you want me to disagree with you?" " Want me to yell at you?" " It is comforting." "We're doctors." "We treat patients, we don't kill them." "How right you are, Dr. Cuddy!" "We also don't pad our bills, swipe samples from the pharmacy, or fantasize about the teenage daughters of our patients either." "True, better be true, and you're a pig." "I'm sorry about your leg." "Yeah, we really should spend some time talking about that." "The IVIG made him worse." "O² sats plummeted." "So we know it's not lupus." "What else could it be?" "Idiopathic pulmonary fibrosis." "Gonna need an open lung biopsy to confirm." "So now we're gonna operate on the guy?" "Unless you've invented a new way of doing an open lung biopsy." "When you searched Dr. Powell's office, did you find a copy of the january 1967 Massachusetts medical journal?" "Why?" "I just figured, if you're not doing any work, you might like something to pass the time." "Centerfold's a killer." "How's your leg?" "It hurts." "It's gonna keep on hurting." "You're gonna keep on asking?" "How's Ezra Powell?" "Resting comfortably." "Hmm, that's not what Cameron says." "I hate practicing medicine in high school." "He's not asking you to help him kill himself." "He's just asking for help." " The disease will kill him." " I know what he was asking for." " I just said no." " You've done it before." "Plenty of times." "To patients that I knew were terminal." "Oh, give me a break." "This has nothing to do with saving a life." "You just can't bear the thought of a patient dying before you've been able to figure out why." "If we're gonna keep refusing to cure patients just to rein in my ego, then we might start to have a little problem with patient recruitment." "Worried about meeting your one patient a week quota?" "I'm a cripple, remember?" "Accommodations must be made." "Wedge of left lobe isolated and removed." "Clamp." "Why'd you have me look up that article?" "Didn't you find it interesting?" "He injected newborn babies with radioactive agents just to see" " if they had urethral reflux." " He was curious." "He didn't even tell their parents he was doing an experiment." "He wasn't doing anything his peers weren't doing." "His peers at Tuskegee and Willowbrook?" "He ignored the rights of a few to save many." "So you're okay with what he did." "Doesn't matter what I think." "It's what you think that's relevant." "Because if I think less of him, I'll help you more?" "You're wrong." "The fact that a patient did bad things doesn't change anything." "He still deserves to have some control over his own body." "If he had control of his own body, he'd be dead." "Some control." "We can withhold treatment without killing him." "No, you can't!" "You either help him live, or you help him die." "You can't have it both ways." "I guess it's not IPF." "Or maybe he'll die right now, and make everything easy for all of us." " Heart rate's fast." " BP's low." "No breath sounds on the right side." "He's dropped his right lung." "Air's building up in his chest, compressing his heart." " Heart rate's decreasing." " BP's stabilizing." "What are you doing?" "Withdraws from pain stimuli on the left side, but not the right." "Those are just reflex arcs." "He's under anesthesia." "Or he's lost sensation in some places." "Or the hypoxia from the arrest stunned his CNS." "Only one way to tell." "Do somatosensory evoked potentials." "We can't do that while he's in a coma." "Only two ways to tell." "Get a hammer and check his deep tendon reflexes." "Won't work." "He needs muscle relaxants to be on the ventilator." "Only one more way to tell." "Pupillary reflexes." "All that tests is the brainstem." "See, I was right." "Only one way to tell." "Do somatosensory evoked potentials." "I just said we can't do that while he's in a coma." "So wake him up." "Don't go towards the light." "You'll fall and break your hip." "What's happening?" "You took a little nap." "I know" "I told you I didn't want" "Sorry, a little deaf in one ear." "Your bone marrow was hypocellular." "Ruled out lupus and pulmonary fibrosis." "But it looks like it could be attacking your nerves." "So this is all a waste." "Huge failure." "Impossible." "You're Gregory House." "We need to attach some sensors to your skin." " No." " Look, we can't do what you want." "We've assigned a nurse to watch you so you can't do it either." "So you might as well just let us do the test." " No, I want to be discharged." " You can't be discharged." " You've got two chest tubes in." " Then take them out." "Oh, get over yourself." "The ventilator puffed up your lungs." "You'll be fine for a few hours." "Just let us run the tests." "Okay." "But first, let's clean you up a little." "Does that feel nice?" " What are you trying to prove?" " Just cleaning him up." "What does it look like?" "Pay no attention to the man behind the curtain." "Get out!" "Okay, I'm going already." "Can't you see I'm a cripple?" " Okay, so you got me curious." " I was right." "Whatever is attacking his lungs is attacking his nerves." "You got that by splashing ice water on him?" "No sensation in the left leg, abdomen, right arm." "Technology's overrated." "That means the clean MRI of his brain means it's just affecting" " the peripheral nerves." " And bone marrow." "Kawasaki's would explain the kidney failure." " Or lymphoma." " Or sarcoidosis." "All potentially treatable." "Question is which." "We need to catch the little bastards in the act." " What's the largest organ?" " Skin." "We need to get a piece." "Sure, we'll just wait until he leaves his room without his skin, sneak in, and take a piece." "I want you to get a skin sample for a biopsy." "And I want to get a foot massage from Johnny Damon." "Kawasaki's disease, lymphoma, and sarcoidosis are all treatable." "And it could be 100 other things that aren't treatable." "You've no idea." "But you do." "You know everything." " I didn't say that I" " Exactly!" "You can't decide if we're helping or hurting him." "If he's good or bad." "Or if you want paper, plastic, or a burlap sack." "Do your damn job." "I'm not gonna lie to him." "Fine, tell the truth." "Just get me a pound of flesh." "What do you want?" "House wants to biopsy your skin." "He sent me to get it." "Ah, and you agreed." "I had nothing to do with putting you in a coma, or any of the subsequent tests." "Which brings us to now." "I read some of your articles." "There were a lot of them." "1967 Massachusetts medical journal." "You radiated babies, just like that." "No forms, no questions, nothing." "Who knows how many cancers you caused?" "I don't know." "What I do know is we discovered techniques that prevent fatal kidney failures in hundreds of thousands of other kids." " You're not sorry." " I don't regret what I did." "Informed consent, patient rights holds back research." "What the hell are you doing?" "Informed consent is holding back our diagnosis." "Good for you." "Finally standing up for something." "Acting on what you believe." "Dr. House?" "How are you?" " Not as good as you think I am." " Don't worry, I'm not stalking you." "My dad just lost his medicine." "He had to come back for another prescription." "Yeah, right." "He's moving it on the street, isn't he?" "Yeah, my dad, the meth kingpin." "Why haven't you returned any of my calls?" "I plan to." "In a couple of years." "I was just calling to say thank you, and to tell you how impressed I was." "You diagnosed my dad by just looking at him." "Felt his glands too." "Oh, there's my dad." "I gotta go." " Yeah, me too." " Oh, and you really don't have to wait a couple years to return my calls." "Just six months." "Till I turn 18." "It's not Kawasaki's either." "What's next?" " Congo red." " Amyloidosis?" "What the hell else would I mean by Congo red?" "It's not on the list." "There's no reason for it to be on the list." "An abnormal protein is building up inside the cells of his body, shutting down his organs, one by one." "Explains everything, the infiltrates on the x-ray, the bone marrow, kidney failure." "We rejected amyloidosis because it didn't fit the first symptom we found." " It would affect his heart." " It did." " It wasn't on the stress test." " We didn't push him hard enough." "Add the stain, let's find out." "Congo red added." "Change the polarization of the light already." "That means it should be treatable." " How the hell did you pull that out of" " Not out of mine." "I had a muse." "Oh, god." "Protein type AA." " Dr. House" " You have amyloidosis." "It's in your lungs, kidneys, bone marrow, and brain." "Why should I believe you now?" "If I was lying," "I wouldn't tell you the subtype is AA." "It's terminal." "Congratulations." "You got your answer." "Fresno by night." "Six months and counting." "Ezra Powell passed away last night." "But I'm sure you already knew about that." "Nope." "I just got in." "The nurse charted at 2:00 AM he was stable." "Breathing labored, but regular." "Then at 2:30, he suddenly stopped." "You know anything about that?" "If I did, would you really want to know?" "I'm proud of you."