"Try not to be scared when you see him, okay?" "Mom, I've seen him sick." "I'm not scared." "This time's different." "The doctors gave him an extra course of radiation and chemo—" "I know." "And you understand how proud we are of you, right?" "Gloves, mask." "Matty." "You said you wanted to see your brother before the procedure." "I know I look like an alien, but I promise not to eat your brain." "When this is done, will you be able to play out back with me?" "I'll rip anything you put near the strike zone." "Let your brother rest up while we take some of your marrow." "You don't need to be in an isolation room, but I pulled some strings so you'd be next door to your brother." "How many games will I miss?" "You only have to be here overnight, but you do have to take it easy for a little bit." "–I already missed two." "–I know." "It's okay." "Must've been a drag." "We just had to make sure you weren't exposed to any bugs." "Cause your healthy bone marrow is what's gonna cure your brother's leukemia—" "Come on." "He sneezed." "Maybe it's just an allergy." "Not with an enlarged spleen and a fever." "He's got one of 10,000 possible infections." "Even if it's just the common cold, I do the transplant, he kills his brother." "How long do we have?" "Radiation obliterated his immune system." "Even in a clean room, he's got... four, maybe five days left." "No way we can solve this that fast." "You need to find another donor." "They're African-American." "It makes it nearly impossible to find a full match." "Tell me about it." "I can't even find the one I've got working for me." "Where's Foreman?" "Nothing like a dead patient to send you back to your choir boy roots." "You're not gonna believe what happened." "Wilson just killed a kid the same way you did." "–He's not dead." "–Five days are gonna fly by." "He didn't look both ways before he nuked." "You done talking to your imaginary friend?" "'Cause I thought maybe you could do your job." "We should start the donor brother on broad spectrum antibiotics." "Great idea, if you're looking to save exactly one kid." "Broad spec will take at least a week to work." "We need narrow spec." "–How old is Hector?" "–Our patient's name is Matty." "His brother's Nick." "–Hector's my dog." "–He's about 17." "–17?" "That's like... 119 in human years." "Why is he still alive?" "Five days minus 20 seconds talking about Wilson's dog." "We need to start testing." "Stool samples for parasites, antibody tests..." "Blood panel was negative for all the usual suspects." "That's 'cause the infection is too small." "We start testing now, it's like looking for a needle in a haystack." "We draw blood, odds are we're just gonna come up with hay." "We need to grow more needles." "Okay, that probably needs further explanation." "We make the donor kid sicker." "We freeze him, we soak him, break down his immune system." "Suddenly we're looking at some needle a camel could pass through the eye of." "Making him sicker risks spreading the infection all throughout his body." "True, but who cares?" "Once we know what the infection is, we'll know exactly how to treat it." "As long as he isn't dead yet, we're cool." "We should do what we normally do... go to the kid's house, check for sources of infection." "Waste of time." "You think it's in the house." "I know it's in the patient." "Safer than intentionally making the kid sicker." "Fine." "Go." "So exactly how sick are you gonna make Matty?" "He could get quite ill." "This certainly won't be a pleasant experience for anyone, but it's our—" "Ever get caught in the rain without an umbrella?" "That's all we're talking about here..." "sign the form." "It's a little more complicated than that." "We'll also be doing leukopheresis." "We run Matty's blood through a machine that filters out his white blood cells." "But without his white cells, how can he get better in time?" "We'll pump the white blood cells back as soon as we have a diagnosis." "Then we should be able to cure the infection in time to do the transplant." "–But you can't guarantee?" "–We're not GM." "No recalls, no rebates." "Any more questions while your son's life slips away?" "–You really think we should do this?" "–Yes." "Sorry." "Your patient." "You tell them." "This is your family." "It needs to be your decision." "All you had to do was say, "Yes, I do."" "God knows that's a phrase you've used often enough in your life." "It was a mistake every time." "Give it a break." "They said yes." "That's not enough for you." "You need them to feel good about saying yes." "I treat patients for months, maybe years, not weeks like you." "I'm taller." "If they don't trust me, I can't do my job." "The only value of that trust is you can manipulate them." "You should write greeting cards." "Giving parents the chance to make a bad choice was a bad choice." "At least it would've been their choice." "One they'd regret at their son's funeral." "Kitchen and bathrooms were immaculate." "Whatever the kid's got, he didn't get here." "No, whatever the kid got, he didn't get from the kitchen or the bathroom." "Nobody cleans swing sets." "–Yeah." "Because their kid's ten and hasn't used it since he was six." "You obviously think your time could be better spent." "Why'd you come along?" "I feel bad about what happened last week." "I'm handling it." "You think the family's gonna sue?" "She only had her grandparents and they weren't close." "Well, that's good." "For you, I mean." "A lawsuit makes it even harder to put behind you." "You put yours behind you?" "No." "When I woke up this morning I..." "I couldn't remember what she was wearing when I admitted her." "Memories fade." "I killed her a week ago and I can't remember what color top she was wearing." "I was grateful when I could wake up not thinking about her." "I'm not like you." "Your patient died because you were distracted over the death of your dad." "I made a calculated decision." "You acted like a human being." "I acted like..." "House." "It could be mucor or strongyloides in this dirt." "No pulmonary symptoms." "He's setting well, breathing easily." "Mom, I'm freezing." "How long... do I have to..." "Matty, we found an old water pump in your backyard." "You ever drink from it?" "–Yeah, it was gross." "We gotta test for Mycobacteria, leptospirosis." "–When did you drink the water?" "–Last summer?" "You sure?" "You haven't even taken a sip to cool off?" "It was really gross." "My shoulder's bugging me." "Does that matter?" "It could." "Did you do anything to hurt it?" "Just threw the ball around the other day." "For a couple of hours." "It's probably just a muscle ache." "Let us know if it gets worse." "So soreness and stuff, that's not 'cause I'm sick?" "Is something else bugging you?" "Sort of." "–He has acute scrotum." "–Adorable." "Please, I thought you were dignified." "Come on, how am I not supposed to make that joke?" "The best thing about big honkin' gonads... well, one of the best things... is there's only a few infections that could cause it." "Do urinalysis and cultures for E- Coli, Klebsiella, TB and brucella, blood tests for enteroviruses and adenoviruses." "Hopefully, the needles have grown as fast as his sack, and we can find it." "Can Chase and Cameron cover that?" "Mind if I ask why?" "I want to recheck the National Marrow Registry for an alternate donor." "–In case we're wrong?" "–It's been known to happen." "Fine." "Go." "Negative for E-Coli and TB." "Why is House taking it easy on Foreman?" "He deserves a break." "Yeah, House is all about giving breaks to people in need." "No on Klebsiella." "And it's Tuesday." "It's got nothing to do with Foreman or House." "It's just... it's the day I remind you I like you, and I want us to be together." "Thank you." "I'd forgotten." "No on brucella and both viral antibodies." "You're really gonna do this every Tuesday?" "You take the day off," "I'll pick it up on Wednesday." "What if we're looking for the wrong thing?" "These are the only infections that cause swollen testicles." "Why don't you just say it 4 times now and leave me alone for a month?" "What if it's not an infection?" "His temperature's through the roof, there's mucus pouring out of him." "I know he has an infection, but what if it didn't directly cause the scrotum issue?" "What if it just... caused the thing that caused the scrotum issue?" "CKMB is elevated." "Slightly." "There's nothing wrong with—" "Indicates cardiac injury." "We stuck him in that room, put his stupid little runny nose infection into hyper drive." "What if it went to his heart?" "Pulmonary valve looks clean." "Wait." "Stop." "Mitral valve." "There's a growth." "He'll need a month of antibiotics to clear that." "His brother only has four days to live." "The infection in Matty's mitral valve rules him out as a donor." "–This is perfect." "–We drove the infection into his heart." "Okay." "Perfect is too strong a word." "But it's very, very good." "Now we know where the infection is." "All we gotta do is remove the valve, ID the infection, target and destroy." "Remove the valve?" "He'll be fine on antibiotics." "He doesn't need open heart surgery." "He'll be heartbroken on account of his dead brother." "Either way, he's got a dead brother." "The infection isn't just in the valve." "Even with targeted medication, there's no way we can clear his system in time." "We don't have to." "Enough to clear his marrow." "After the surgery, you harvest the marrow, marinate it in the targeted antibiotic, simmer and serve." "–It could work." "–It's insane." "–It is better than a dead brother." "–I'm running this by Cuddy." "Fine." "Go." "In fact, let's all go." "This surgery is dangerous and life-altering." "And clearly not in the interest of our patient." "–It is if he likes his brother." "–We have a conflict of interests." "–The parents don't." "–Of course they do." "They already sacrificed Matty's health to benefit his brother once." "They made his cold worse." "We screwed up his heart valve by making his cold worse." "Do you have anything to add to this debate?" "Wilson's right, Foreman's wrong, your shirt is way too revealing for the office." "What do you want me to do?" "We should call Child Services and have them appoint a guardian for Matty." "No." "Go explain the choices to the parents." "And don't let House bully them." "Did you really think I was gonna do that?" "–I didn't." "–Then why did you let him—" "Tried to cut him some slack." "Nice of you." "I think he's got the yips." "Steve Blass, Scott Norwood, David Duval all got the yips." "Great athletes." "Lost their confidence, and immediately started sucking." "And you're... giving him time to work through it?" "Four days and then he's fired." "You don't get better from the yips." "Open-heart surgery?" "If you want both kids to live, it's the only choice." "Due to the valve replacement," "Matty will have to be on blood thinners to prevent potential clots." "–For how long?" "–Forever." "He couldn't participate in contact sport because of the risk of hemorrhage." "What about the Marrow Registry?" "Maybe they'll find a match." "Maybe they'll ride it here on a unicorn." "I'm afraid finding a viable new donor isn't something we can realistically depend on." "Either we cripple one son or kill the other." "He won't be able to play baseball." "But that doesn't make him a cripple." "What should we do?" "You should protect your family as a whole." "You should do the surgery." "–That was awesome!" "–Shut up." "I gotta start pretending to care." "I did exactly what Cuddy told us not to do." "No, you didn't." "You did exactly what she told me not to do." "You're completely in the clear." "You've gotta be kidding me." "You're actually upset." "You just said what you believed." "I also believe in patients making their own choices." "Because it lessens your guilt if things go wrong." "You're not protecting their choices." "You're soothing your conscience." "By that logic, a sociopath would make the best patient advocate in the world." "Am I blushing?" "–You ready?" "–Yeah." "Thanks." "You'd do the same for me." "Don't worry." "You're gonna be fine." "Think I'll be better in time to pitch in the playoffs?" "Maybe next season." "We should have told him." "He loves his brother." "But if he under­ stood what we were asking of him—" "He loves his brother more than he loves baseball." "You did the right thing." "Putting any part of this decision on him... it's impossible for you guys to deal with this." "How's a ten-year-old supposed to do it?" "Canula in place." "Sutures are holding." "We're all set to go." "Switch him over to bypass." "–Yeah." "–I didn't do the surgery." "You woke me up to tell me that you're lazy." "We biopsied a piece before we started cutting." "I'm tired." "Get to the point." "We didn't replace the valve because the growth was fibrous tissue." "It wasn't infectious." "–We gotta be wrong about— –Oh, God." "What?" "You know what's wrong with Matty?" "I think Hector's... committed suicide." "–What are you talking about?" "–He took some pills." "–Is he alive?" "–He ate half my stash." "Of course he's..." "He's stoned." "I'll be right in." "We cut all the way into this kid's heart, and all we got was this lousy, noninfectious fibrous tissue." "How did we miss this?" "Matty had a fever." "He got sicker when we suppressed his immune system." "That all points to infection." "Yeah, yeah, yeah." "Not our fault." "Fibrous tissue." "Something is turning his healthy heart valve to gristle." "Fibrous tissue, enlarged spleen... fever... could mean autoimmune." "Autoimmune diseases aren't passed along in bone marrow." "He can still donate." "We confirm, I do the surgery." "–Lupus and Bechet's are our best bet." "Do an ANA and a pathergy test." "–Or it could be infection." "My memory's not what it used to be, but didn't we just rule that out 8 seconds ago?" "Just because it's not what screwed up his valve doesn't mean it's not in his system." "It has the obvious advantage of making us right all along." "A little disadvantage of making big brother dead." "That's your argument?" "Better outcome?" "It fits." "The family has one kid with leukemia and one with autoimmune." "Wouldn't stand next to them in a rainstorm." "That's your argument..." "it sucks for them?" "It fits, and we can still help big brother." "National Marrow Registry came up with a four out of six donor..." "Six out of six is two better than four out of six, right?" "I mean, I know two is so small, but since it means that he's gonna get graft versus host disease, the marrow will attack his body and he'll die a painful death." "Find out what autoimmune it is." "Is this autoimmune better or worse than a new heart valve?" "It depends on which autoimmune it is." "With early detection, most are manageable." "How long will the testing take?" "That's the other good thing about this." "There's literally thousands of possible infections but only a handful of autoimmune conditions." "We'll have the answer in a few hours." "Hey, Doctor?" "Is this bad?" "Wanna catch a movie?" "–It's 1:00 in the morning." "–I know a place." "Although I wouldn't recommend wearing those shoes." "How, exactly, does a dog unscrew a bottle of pills?" "Is that a riddle?" "–It requires an opposable thumb." "–I must have left it off." "On the floor?" "I think he hopped up on the bathroom counter." "He has arthritis." "–Not me this time." "–No, it's your damn dog!" "He chews everything!" "I was missing a file." "Found paper in his stool." "An original Sun Record 78 Elvis recording... gone." "Who the hell chews vinyl?" "He's vindictive." "And he's had a good, long life." "It's his time." "Are you okay?" "I just tripped over Wilson's self-righteousness." "What do you got?" "Matty's negative for everything." "It's not autoimmune." "So we're back to infection." "Nick's starting to deteriorate fast." "He's got bruising all over his arms." "Capillaries are leaking blood." "If it happens in his brain, he's dead." "We've got to go with the four out of six donor." "Did I mention my concerns about four being less than six?" "Wilson's first wife ignored a similar issue." "Of course, that time, it was only fatal to their marriage." "It's either that or we start randomly testing Matty for infections." "I know you hate the word 'random'." "–Do it alphabetically." "We're not doing that damn transplant." "Where's Foreman?" "We found a donor." "It's not an ideal match." "But four out of six still gives Nick a chance." "A partial match transplant is extremely dangerous." "Dr Foreman explained." "He also explain what sort of pain your son will experience if he gets graft versus host disease?" "–Yes." "Apparently, he didn't explain it vividly enough." "Let me give it a whack." "He also explained that if we did nothing," "Nick could start bleeding into his brain." "Matty is a perfect match." "Just give us a little more time to figure out—" "–How much time?" "–Dr House is the best diagnostician—" "How much time?" "I don't know." "And Nick can start bleeding into this brain without any warning." "Yes, but the chances of complications from a mismatch—" "My boys have suffered enough." "Get Matty better." "And give Nick the transplant from the new donor." "–Foreman screwed us." "–No!" "You screwed us." "What is the point in being able to control people if you won't actually do it?" "It's like training a dog and then letting him go on your rug." "Which, by the way..." "Once Foreman got his mitts on them, there was no way—" "You don't explain chances and probabilities." "You lie to them." "You tell them Foreman's a moron..." "which isn't even much of a lie right now." "–You got to talk to him." "–I got no problem with what Foreman did." "He undercut us and he may have cost that kid his life!" "He did what he thought was right." "You, on the other hand, sucked out." "When the decision really mattered, you didn't have the guts to tell them what to do." "If that kid dies, it's because Foreman was wrong *and* because you're a coward." "Oh, goodness!" "I've left my door open." "My poor dog must have run away and been hit by a car or truck." "Or train." "Or an anvil." "Thank God... you're still here." "He's still here!" "Where's my stereo?" "How you feeling?" "A little itchy." "It's weird, huh?" "You still have no idea what's wrong with me, but those meds will make me better." "We put you on a variety of medications that'll fight all kinds of infections." "But Nick... you know exactly what's wrong with him, but maybe he's gonna die anyway." "–Hopefully, the new marrow will— –I can't go in there, can I?" "Your infection would kill him." "So I won't be able to be with him... when he dies?" "You'll be able to be with him when he gets better." "–What's wrong?" "–It really itches." "Hello?" "Why am I meeting you here?" "You're paying for my new cane." "It was your dog." "So that's it." "You call me a coward, life goes on..." "Apparently." "You showed up." "I'm sorry." "Okay." "You're pathetic." "I didn't actually mean that." "–Yes, you did." "–No, I didn't." "To infinity." "–Yes, you did." "You're pathetic." "–Yeah." "When?" "What did the lab say?" "Why don't you buy your cane in a medical supply store like a normal cripple?" "Fewer bitchin' choices." "Okay." "–What do you got in bitchin'?" "–Right this way." "That was Cameron." "The kid that wasn't all that sick is now all that sick." "He's bleeding out of his ears." "–Blood counts?" "–Down." "–Schistocytes on the smear?" "–His body's not making new blood cells." "His bone marrow's crashing." "This is one of our top sellers." "It's a little too Marilyn Manson in a retirement home." "Meds are suppressing his bone marrow." "–Or the infection's doing it." "Very cool." "Genuine bull penis stretched over a metal rod." "Penis canes are murder." "Let me see the one on the end." "–You got it." "You need to stop Matty's meds." "The marrow rebounds, it's the meds." "If it doesn't, it's an infection." "–And if it's the infection?" "Maybe I was wrong about which kid's gonna die." "Bitchin'." "Flames." "Makes it look like I'm going fast." "Now, how's our dying kid?" "Nick's developed blisters all over his feet and legs." "He's got grade four graft versus host." "Increase his dosage of methylprednisolone." "Already did." "It's not working." "Feeling guilty?" "–I did the right thing." "–Always a comfort." "Okay, what's the other kid's status?" "–We're done with Nick?" "God is done with Nick." "We know what he has." "We know how to treat it." "We're doing it." "It's not working." "Life is for the living." "Matty's been off his meds for a few hours, but his blood count's still tanking." "It means the meds aren't to blame." "It's the infection." "If we don't get this under control, his blood will literally turn into water." "Cultures still aren't growing anything." "Why not?" "Because you did the right thing." "Convinced the parents to treat the kid." "All you did was yank the weed out of the ground." "It's roots are still killing your beautiful lawn." "We just can't see it." "And if we can't see it, we don't know what it is." "And if we don't know what it is, we can't kill it." "You gotta wait for it to grow back again." "Now his soil is arid." "So he and his brother will be dead by the time..." "What if the dandelion was in fertile soil?" "What if we take the roots from Matty and put them in Nick?" "Turn the kid into a petri dish." "Only better." "A petri dish can't tell you when it hurts." "You want to give him his brother's infection?" "The very thing we've been trying to avoid since the brother sneezed?" "–Leukemia kid's got no defenses." "–Which is why he'll die." "But before he does, the infection will spread, fast." "Fast enough to tell us what it is." "In time to save his brother." "Do you see any other way?" "The infection is decimating Matty's bone marrow." "But... if we give that marrow to Nick, his symptoms could let us diagnose Matty." "–But it'll kill Nick." "–Yes." "You're... you're saying we should kill one son to save the other?" "–Nick is gonna die either way." "–You don't know that!" "I mean, he's in pain right now, but—" "Nick's graft versus host is not responding to medication." "It can change." "May... maybe he'll... he'll rally." "My Nick is a fighter." "Graft versus host is not gonna go away because of Nick's sunny smile and positive outlook." "Nick has survived three reoccurrences of his leukemia." "He's being torn apart from the inside out." "His pain's gonna get worse and worse until he dies." "You're just dragging it out." "You have only one decision to make... to leave here with one dead son or two." "Tell them." "You should let us do this." "No." "We're not giving up on Nick." "Not!" "Patients' parents apparently don't want to be parents anymore." "You're a sneaky bastard." "Any ideas how we get around this?" "–Court order?" "–That's hardly sneaky." "We can still save Matty." "Run more tests." "Find out what infection is destroying his marrow." "10,000 possible infections." "At least 20 minutes per test." "Take you approximately eight years." "Actually, four months, assuming the last one I test is the right one." "If it's the first, it'll take me approximately 20 minutes." "He's right." "It's worth a shot." "He's timid." "Testing blindly is not gonna save this kid." "But standing around here will." "Wow, he sure is hurting." "Nurses say he maxed out on his pain meds." "If I had a nickel for every time I heard that..." "Pharmacy's on the ground floor." "I'm gonna go get you some more pain medication, okay?" "Thank you." "It's not gonna help." "You're dying." "Nothing's gonna change that." "Drugs'll just make you go easier." "I know." "14 years on the planet." "Most of them spent suffering." "Dying before you even got to... drive a car, take off a girl's bra, drink a beer." "Believe me, there's plenty you haven't done." "Really good stuff." "Must make it hard to believe in..." "God or... fairness, a larger purpose." "But your life doesn't have to be meaningless." "You can save your brother." "How?" "–Negative for CMV." "–Negative for amœbas." "–House called you timid." "–He's called me a lot worse." "To him, there is nothing worse." "He's gonna fire you." "Even if we run a hundred tests, that only gives us a 1% chance of saving these kids." "Better than zero." "You don't care if you get fired?" "I don't know, there's got to be a way to better our odds from 99% chance of death." "You gotta know." "It's not food-borne, because no one else in the family is sick." "Either you care about your job or you don't." "Matty's the only one who drank from that water pump in the backyard, but we eliminated Pseudomonas and cholera." "If you care, you fight to keep it." "If you don't, you quit." "I thought they lived in the suburbs." "They do." "Why?" "They've got a water pump?" "–Please, I wanna do it." "–No, Nicky." "It's not your decision." "I'm dying." "There's nothing that's gonna change that." "Don't say that, okay?" "You can't give up." "It's time for me to go, Dad." "You gotta let me go." "No." "Please, son." "I can't!" "Let me do it for Matty." "Let me do it for you guys... so you won't be alone." "–Are you sure?" "–No." "But he is." "–Get Nick back to the clean room." "–The parents agreed to infect him." "We figured out what's wrong with Matty... histoplasmosis." "Well, what is that?" "I mean, why did it—" "Fungal infection." "Grows in chicken feces." "The dirt that Matty used to build his pitcher's mound must have sat under a chicken coop." "Your whole neighborhood was built on top of farmland." "We didn't test for it earlier because we—" "Can you fix him?" "Full course of amphotericin, and he should be fine." "And Nick?" "I mean, can you clean Matty's marrow, just like you were talking about doing it, but do it fast and... and get it into Nick?" "I'm sorry." "The reason Matty is so sick is because the infection's attacking his marrow." "He doesn't have enough left to safely take from him and give to his brother." "I'm going to get better now?" "That's it?" "That's it." "And what about Nick?" "Your brother was willing to risk his life to save you." "Are you willing to do that for him?" "I can't sedate you." "You're too sick." "Please, please stop." "Please, please." "You're done, right?" "Sorry." "I need a lot more." "No." "Stop!" "Stop!" "How much heat are you taking from the parents?" "They're calming down." "I think it has something to do with both their kids being alive, awake, and eating." "The marrow transplant took." "Welcome back, Foreman." "–You should talk to him." "–And tell him how proud I am?" "Hey, if you're ashamed of him, you can tell him that." "Pride and shame only apply to people we have a vested interest in, not employees." "How many hours a day do you have to spend with someone before they're basically family?" "–Good point." "But first, I gotta tell Cameron and Chase that they're violating God's will." "I'm just asking you to have an adult conversation to let him know—" "That he did a good job?" "He knows it." "Adults don't need adult conversations." "Just like I don't need this conversation." "Have you killed Hector yet?" "Obviously not." "He's quiet." "He's..." "Is that my stethoscope?" "Bad dog!" "Listen..." "Bonnie joined her homeowners association and staged a coup." "Pets are now allowed." "If you want to keep him, she wants a new puppy anyway." "She'll understand." "Why would I want to keep him?" "You're sure." "Come on, boy." "Accidents happen." "Candy?" "Good boy." "Good boy." "You did good." "I did what you would have." "Well... maybe I'm biased, but—" "–I tortured the kid." "–Because you knew it was right." "You knew you were saving his brother." "I know." "I don't like that I know." "I hate that I can listen to a kid screaming in pain and not even take a moment to question whether I'm doing the right thing." "I hate that in order to be like you as a doctor," "I have to be like you as a human being." "I don't want to turn into you." "You're not." "You've been like me since you were eight years old." "You'll save more people than I will." "But I'll settle for killing less." "Consider this my two weeks' notice."