"Radiologist, contact 5317." "Radiologist, contact 5317." "Amber." "No." "Why not?" "Amber's a stripper name." "Find me one stripper named Amber Hartig." "Or not." "Okay." "Non-stripper names." "Um, Desiree?" "Bambi?" "Kandy Kane?" "Max." "Maxine." "Max Hartig." "It's a cute name, isn't it?" "If you're a professional boxer, maybe." "Can you believe we made this little creature?" "I know." "It's incredible." "It's the most amazing thing we've ever done." "I almost ran the marathon last year." "If we're lucky, you won't inherit your daddy's sense of humor." "Hello." "Say "hi" to Bear." "She hasn't even eaten anything." "Why is she spitting up?" "Well, honey, we can't bug them again." "Could you" "Okay, okay." "I'm sorry." "It's our first kid." "We're both a little panicky, I guess." "Well, you gotta ask the pediatrician next time." "I just deliver 'em." " Is she spitting up?" " Yeah." "Second time in an hour." "Oh." "If you lived underwater for nine months, you'd have a lot to spit up too." "Is something wrong?" "A little lethargic." " Well, we didn't think" " She's hot." "Is she, uh" "The baby's seizing!" "Get the crash cart!" " What's" "What's wrong?" " Need some help in here!" "Oh, God." "Is she all right?" " I. V. access?" " No." "Ativan." "What's going on?" "The M.R.I.'s back." "And?" "It's what we expected." "The accident caused serious damage." "It's amnesia." "I'm sorry." "I just can't believe it." "Enjoying our lounge, House?" "Just came in to get milk for my coffee, which you're out of." " Flat or sparkling?" " Sparkling." " Splat." "So, the Hartigs?" "Their baby gets a fever." "What, don't tell me-- the kid had a seizure." "Yep." "The parents, ofcourse, start freaking, and I have to deal with that for an hour." "Like it was your fault." "She was perfect when I delivered her." "If you wanna blame someone, blame the pediatrician." "So, how is the kid now?" "Bowel obstruction." "She's under observation." "She'll be fine." "The pediatrician will take all the credit." "Exhibit A:" "Baby Girl Hartig." "Term baby, 42 hours old." "Went into seizures six hours ago, brought into the intensive care... diagnosed with obstruction of the small bowel." "I'm still amazed you're actually in the same room with a patient." "People don't bug me until they get teeth." "Exhibit B:" "Baby Boy Hausen." "Another term baby, 48 hours old." "Brought into the NICU three hours before the Hartig baby." "Fever of unknown origin, 101 degrees, trending upwards." "Wow, that is amazing." "You hung out in the OB/GYN lounge all morning and heard about two sick babies." " It's" " It's eerie." " Don't touch that." "All right." "We have an infection spreading in the hospital." "These kids have totally unrelated illnesses." "They fell sick within four hours of each other." "They had the same delivery rooms, maternity rooms are neighboring, so transmission's possible." " They have the same symptoms." " The Hartig girl has a bowel obstruction." "No matter how close their beds are, I'm pretty sure kids can't share a blockage." "What does bowel obstruction on a chart indicate?" "Normally I'd say it indicates a patient's bowel is obstructed, but I'm pretty sure you have some deeper truth to impart." "It means that some random doctor of indeterminate skill thinks that the patient's bowel is obstructed." " Okay, you're upset because they threw you out of their lounge." " Look at the X-ray." "It's a normal gas pattern." "If you want, I can get you a key to the oncology lounge." "Air in the colon." "We're getting TiVo." "If it's air, no bowel obstruction." "Even if it is air, it could have been there before the obstruction." "No." "Something's infected both these infants." "And you're the only one who put this together because" "Because I'm the only one who looked at both kids." "I want them isolated." "I want the maternity ward shut down." "Because you're better at reading an X-ray than a radiologist." "Radiologists always overread babies' X-rays, especially if they're asked to rule out a pathology." " He read into it what he wanted." " Which is exactly what you're doing." "You're finding a cluster because you think it's interesting to find a cluster." "Two plain old sick babies would bore you." "See, this is why I don't waste money on shrinks, 'cause you give me all these really great insights for free." "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." "We have an epidemic!" "Two sick babies is very sad, but it doesn't prove an epidemic." "How many do?" "Get up." "We're going hunting." "For what?" "Wabbits." "Hi." "Bye." "He's screaming." "He's fine." "Good-looking baby." "Oh, sorry." "Wrong room." "We'll see you later." "Twelve rooms, right?" "That's it?" "Yep." "We've definitely checked the whole floor." "Good news." "No epidemic." "Tragic, huh?" "Overflow rooms, third floor." "This imaginary infection has spread to the next floor?" "We were just gonna call." "Did he get hot all of a sudden?" "Yeah." "Yeah, I'll take care of that for you." "Almost there, honey." "Don't worry." "We're almost there." "Excuse me!" "Hi." "Hi." "Intake sent you up here?" "Yeah, my wife's contractions are less than" "Okay, Intake messed up." "I am very, very sorry." "Nurse Alpert will arrange for an ambulance... to take you to Princeton General." "The maternity ward is temporarily closed." "We have to leave?" "Yes." "I am very sorry." "Why are you doing this?" "You will be there very, very soon." "Happy now?" "No." "But I am interested." "Three sick babies, and a fourth showing early symptoms." " How bad?" " Spiking fevers." "B.P.'s plummeting." "They're barely able to keep systolic up." " At this rate, they could be dead in a day." " Where did this come from?" "Two delivery rooms, four different maternity rooms." "No common personnel and no common equipment." " There's got to be something in common." " Yeah." "That would be the difference between an epidemic and a coincidence." "I'm putting a team together." "We're gonna start swabbing." "What's she gonna swab?" "Every respirator, sink, vent, drain in the entire hospital?" " That'll take months." " Needle in a haystack." "It's worse than that, We don't even know it's a needle we're looking for." " Then why'd you let her go do it?" " Because the hospital is her baby, and her baby's sick." "If she doesn't solve this soon, her head's gonna explode, and I don't want to get any on me." "So let's figure out what's in the haystack." " Differential diagnosis, people." " Parasite." " It's spreading too quickly." " Next?" " Virus?" " The kids are too sick, and the blood tests showed no lymphocytosis." "And they're not responding to acyclovir or ribavirin." "If it's some other virus, we'll never find it in time anyway." "Which leads us to bacterial infection." "It's not responding to broad-spectrum antibiotics, so we've got something resistant." " The usual suspects?" " MRSA." "It's always MRSA in hospitals." "Maybe contaminated food or water source." "Pseudomonas." "V.R.E.?" ""H" flu." "Okay." "Those are the big ones." "Cultures will take 48 hours." "Might as well be postmortem." "We'll start them on vancomycin for the MRSA and aztreonam to cover the rest." "Let's get M.R.I.'s, check for abscesses or some occult infection." "I'll be in the clinic." "Grab me if you find something important... or unimportant." "We did an M.R.I. on all the babies, and, unfortunately, we didn't find anything, so we're starting them on the strongest antibiotics that we've got, and we're hoping that that will take care of it." "But he's so tiny." "How sick is he?" "His fever's up to 103.5, and his blood pressure is 80 over 40." "How, um" " How bad is that?" "Uh" "It-It's low." "The heart needs to circulate the blood." "If it's weak, the oxygen isn't getting to the liver, the kidneys, the brain." "Um, I have to ask you something." "Judy-- No, no, Kim." "Let me." "Um, I had a cold last month, and I told the doctors about it." "Honey, this has nothing to do with you." "Kim's right." "Your son was born healthy." "He caught the infection after his birth." "There's no reason to think that he caught it from you." "But you don't know." "I mean, you don't know how he got sick." "Pretty standard question-- "How sick is my child?" You couldn't answer." "I answered." "You rattled off numbers-- B.P., O2 sats." "It's not what they need to know." "What they need to know is the future." "You got a Magic 8 ball?" "No, just eight years of medical training." "Look, I realize it's tough to break bad news to families." "Not as tough as hearing it." "And I guess being the poor guy dying is the toughest of all?" "No." "It's easier to die than to watch someone die." "Well, we're checking the vents." "It could be airborne." "Somebody get the sinks, too, and underneath them." "I'll get it." "How many med students have you got swabbing the decks?" "What else are they gonna do?" "It's not like they're delivering babies." "You find anything yet?" "Uh, yeah." "About half the antibacterial gel dispensers are empty or broken." "That's bad, yet diagnostically completely insignificant." "Well, if the staff can't wash their hands, it's no wonder an infection has spread." "Hey!" "Tie clip!" "Sorry?" "We have an epidemic in this hospital, and your tie is becoming a petri dish." "Put on a tie clip or take the damn thing off." "My joints have been feeling all loose, and lately I've been feeling sick a lot." "Maybe I'm over-training." "I'm doing the marathon, like, 10 miles a day, but I can't seem to lose any weight." "Lift up your arms." "You have a parasite." "Like a tapeworm or something?" "Lie back and lift up your sweater." "You can put your arms down." "Can you do anything about it?" "Only for about a month or so." "After that it becomes illegal to remove, except in a couple states." "Illegal?" "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." " Playdates?" " It has your eyes." "But that's impossible." "Well, I assume you weren't getting your period." "Maybe that should have given you an inkling." "But I'm on this birth control implant." "Yeah, I know." "I saw the scar on your arm." "And my doctor said I might not get any periods at all if it was working." "Mm-hmm." "Interestingly enough, you also don't get any periods if it isn't working, which is why you were supposed to get regular pregnancy tests." "Oh!" "I'm gonna send a nurse in here to schedule your prenatal care." "You're due in about five months, so start planning the shower." "Um, Doctor?" "Please, me and my husband wanted to have a kid soon, but, oh, God, like four months ago, we had this really big fight." "He moved out." "I did something stupid." "One-night stand?" "Ex-boyfriend." "Well, I'll schedule you a paternity test too." "I can't let my husband know." "Does the old boyfriend look like your husband?" "Yeah." "Then just have the kid." "He'll never know." "The most successful marriages are based on lies." "You're off to a great start." "Well, you look cheery." "What's going on?" "The Hartig and Chen-Lupino babies, their kidneys are shutting down." "And the urine tests show no casts." "Which means the antibiotics are causing the kidney failure." "You're the nephrologist." "Which one did it?" "We'll take 'em off that one." " Don't tell me both vancomycin and aztreonam." " They both can cause this." "There's no way to know which one it is." "No test." "We can't take 'em off the antibiotics though." "They'll die of the infection." "If we leave them on both the antibiotics, they'll die of kidney failure." "So, we take our best guess then." "Which drug's causing the kidney failure?" "It's like I said, it's always MRSA in hospitals." "Take them off aztreonam." "I still think it's the pseudomonas." "I vote to take them off the vancomycin." "There's no point in guessing." "Take one kid off vancomycin, the other off aztreonam." " They have the same disease." "You want to give them different treatments?" " What the hell are you doing?" " Therapeutic trial, to find the cause of the infection." " That's wrong." "We have four sick kids at least." " Who knows how many more haven't started showing symptoms yet?" " We have a duty to these two." "If these two have different reactions, we'll know how to save the rest." "So you're condemning one of these kids to die based on random chance?" "I guess I am." "So you're going to flip a coin?" "That's how you decide which baby lives?" "Can I borrow a quarter?" "Do you want to get sued, lose your license, House?" "Well, generally I'd applaud that, but my job is to protect this hospital, so I strongly advise you to come up with a medical rationale... why baby "A" should get medicine "X" and vice versa." "Whoa, whoa, whoa, whoa." "Hold on there, slick." "We didn't all go to law school." "Your advice is that I should use medical reasons to make medical decisions?" "Hmm, that's not gonna be as easy." "Any medical justification." "It doesn't need to be a good one." "Well, "Hartig" sounds Jewish, so does aztreonam, so we'll take the Hartig kid off vancomycin." "How's that?" " You can't experiment on babies." " Doctors experiment all the time." " On adults, with their consent." " Fine." "I'll get the parents' consent." "Their informed consent." "They have to know the other kid is getting a different treatment." "Sorry." "Can't do that." "It would be unethical for one patient to know about another patient's treatment." " They have a right to know." " If they know, they won't consent." "That defeats the whole purpose." "That's their right." "Two more babies have just become symptomatic." "I defer to your legal wisdom." "Which takes precedence-- six dying babies or a missing consent form?" "You can't do it." "Do what you think is best." "Your daughter's kidneys are shutting down." "Your son's kidneys are failing." "So we're going to take her off the aztreonam." "We're taking him off vancomycin." "Uh, but what-- what made her sick in the first place?" " What do you think is causing it?" " It seems to be a germ called pseudomonas." "We think it's MRSA-- Methicillin-resistant staph aureus." "It's a very resistant form of a very common bacteria." "We're hoping the aztreonam will clear it up." "Vancomycin is the best treatment for MRSA, so we're gonna keep giving it to her." "Is it gonna cure her?" "Your child is very sick." "You need to know that." "This is a Hail Mary pass." "It might cure her." "It might not." "So-So, that'll cure him?" "We'll know in 24 hours if it's working." "What did you tell them?" "I told them the truth." "They seemed relieved." "Did you tell them how sick their son is?" "I explained what was going on." "Allison, their baby's dying." "If the parents weren't in tears by the time you left, you didn't tell them the truth." "That's not how I see it." "Do you want them blindsided?" "Want them coming up and saying, "My God, my baby died." "Why didn't you warn me?"" "So now it's about worrying about them yelling at us?" "No." "It's about getting them prepared for the likely death of their child." "If their son dies tomorrow, you think they'll give a damn what I said to them today?" "It's not gonna matter." "They're not gonna care." "Nothing's gonna be the same ever again." "Just give those poor women a few hours of hope." "Dr. House!" "Oh, no." "Dr. House, this is my husband, Charlie." "Who told you where my office was?" "Jill, come on." "He obviously doesn't want us bothering him." "Ooh, I was trying to hide it." "Look, Doctor, this is about the mono that you said you thought I had." "The mono?" "Yes." "You know, shouldn't Charlie be tested?" "You know, the test." "The blood test." "Right." "Yeah, I'm sorry." "I" " I sometimes forget patients." "I thought you were this idiot who doesn't know how to use birth control." "I can't have mono." "I don't even feel sick or anything." "That's very often the first sign." "Call my office in the morning, and I'll schedule you for blood tests." "Thank you." "I'm not even tired." "Oh." "Find anything yet?" "Oh, just some baby formula being stored under a sink with a dripping faucet." "Tap water contamination." "You thinking pseudomonas infection?" "I was." "I wasted a couple of hours chasing it down." "But, ofcourse, the formula hasn't been anywhere near the babies." "Huh." "Whatever idiot stored them there" "All right, we'll figure it out." "Just-Just calm down." "I am calm." "Let me know when you're gonna need it." "Oh, come-- I warned you." "I did that calmly." "Hey." "Hi." "She any better?" "Uh, her fever has been stable the last hour." "We're not gonna make it, are we?" "Sorry?" "Me and Ethan." "Our next-door neighbor, her little boy died in a car crash, and she and her husband split up, like, four months after the funeral." "It's just, uh, what always happens, right?" "Uh, what happens to patients after they leave the hospital, I don't know, but try not to get ahead of yourself." "Dr. Chase, activity on the monitor." "How long?" "I don't know." "It just started." "Pulse?" "Fluid, wide open." "Do we have an arterial line?" "Not yet." "Let's get a B.P." "You can't come in here." "Is my baby dying?" " Mrs. Hartig" " Is she dying?" " Ma'am, you'll have to leave." "It's not your baby." "Ventilate." "B.P. 60 over 20." "Heart rate's 180." "Start the levophed." "Still dropping." "50 over 10." "I can't hold B.P., even with three pressors." "I'm losing pulse." "V-fib." "Shut the blinds." "Charging." "Set." "Clear." "Still V-fib." "Charging." "Clear." "Charging." "Clear." "Still V-fib." "Charging." "Clear." " Charging." " Chase." "Time of death-- 6:57 p.m." "The aztreonam doesn't work." "Double-cover all the other babies with vancomycin." "I'll do it." "Cameron, tell the parents." "Tell them their child probably saved five lives." " But Chase should" " Chase is busy." "You're the attending." "Make sure she does her job." "I asked you to make sure she does her job, not do it for her." "She froze up." "She felt sorry for the parents, so she shut up." "You felt sorry for her, so you opened your mouth." "She has a problem." "She needs to deal with it." "If you hadn't bailed her out, she would have done it." "Great." "Then she wouldn't have slept for two weeks." "Maybe she should be thinking about a different specialty." "Lab work?" "Research?" " Yeah, what is it?" " The Hartig baby-- she's getting sicker too." "The vancomycin isn't working either." "Vancomycin doesn't kill it." "Aztreonam doesn't kill it." "What the hell is this?" "It's a superbug." "It could be V.R.S.A." "There's only been two reported cases ever in the United States." "One of the kids, the Hausen baby, had a skin rash." "It could be scalded-skin syndrome, which would be a sign of V.R.S.A. Then these kids are dead." "This is our fault." "Doctors overprescribing antibiotics." "Got a cold?" "Take some penicillin." "Sniffles?" "No problem." "Have some azithromycin." "Is that not working anymore?" "Well, got your levaquin." "Antibacterial soaps in every bathroom." "They'll be adding vancomycin to the water supply soon." "We bred these superbugs." "They're our babies, and they're all grown up, and they've got body piercings and a lot of anger." "On the other hand, maybe antibiotics had nothing to do with it." "Did you notice how low his B.P. was at the end, even with three pressors?" "Heart damage?" "Go home." "There's nothing more you can do tonight." "Baby Boy Chen-Lupino." "Time of death-- 6:57 p.m., Thursday, December 2, 2004." "This is a cross section of the Chen-Lupino boy's myocardium." "Fibrosis, lymphocytic infiltrates." "There was no sign of lymphocytosis in the blood tests." "Yes, well, we all had plenty of good reasons to think bacterial." "Nobody is scolding you." "Unfortunately, all those clever reasons were wrong." "It is a virus infecting their hearts." "Then we're screwed." "We can't chase down a virus." "There's a thousand possibilities." "We could run gels, antibody tests." "A thousand of them?" "The kids don't have enough blood." "Chase, you're the intensivist." "How many could we do before we risk exsanguinating the kids?" "You're talking vials, not stick tests?" "I wouldn't take more than five or six." "Okay, so we have to narrow the thousand viruses down to six." "Now, the autopsy's shown us what the virus does." "So, let's go." "What do we know?" "That ribavirin and acyclovir don't knock it out." " Cross out the herpes viruses." " Also adenovirus." "What else?" "What else?" "Keep talking!" "Well, i-it only seems to hit children." " The mothers aren't sick, so" " No toxoplasmosis, no rubella." "Cross out the entire TORCH syndrome." " You didn't find any lung damage?" " No." " None of the paramyxoviridae." " Cardiac scarring, people." "C.M.V." "Enteroviruses too, I think." "Eleven." "Influenza A." "Flu A." "Yes?" "And?" "I'm putting R.S.V. down as a yes." "That makes eight." " Eight vials of blood is pushing it." " Pushing it?" "Well, we love that." "Get the antibody kits, start testing the sick kids." "All right, I'll look into whether there are any antivirals for these eight." "Wait a second." "The kids on the floor who didn't get sick-- are any of them still in the hospital?" "They got moved to the fifth floor, but they're probably all checked out by now." "No, the Limpert boy had a bit of jaundice." "He's checking out today." "I want to test his blood too." "Why?" "Because we need all the information we can get." "The healthy kid can be our control group." "I'll just tell his parents he can't check out because he has the smallpox." "Stephen Morgan, contact Hospital Administration." "Dr. Paul to the Recovery Room." "All done." "All done." "What did we get?" "Well, the sick babies all tested positive for echovirus 11." "Great." "And C.M.V., and parvovirus B-19." " Three viruses?" " But what's weirder, the healthy kid we tested, he's positive for echovirus 11 and C.M. V. antibodies as well." "They're infants." "They have their mother's blood, their mother's antibodies." "So we've just learned nothing?" "Uh-uh." "We have half the picture." "The healthy kids survived because their mothers' antibodies saved them." "If the mom had C.M.V. in the past, she'd have the antibodies for C.M.V. The kid would be immune from it." "So, we test the sick kids' moms for echovirus, C.M.V. and parvovirus." "And whichever they don't have the antibodies for, that's what's killing their kids." "I'll test the mothers." "Dr. Kent's office, one." "Dr. Kent's office, one." "Echovirus 11." "It's an enterovirus." "It lodges in the intestinal tract." "Enteroviruses cause diarrhea and flu-like symptoms in adults, maybe a rash, but for newborns, it can be deadly." "It's damaging her heart." "Well, is there anything you can do?" "Viruses are more difficult to treat than bacterial infections." "We still haven't found a cure for the common cold." "So, you mean there's no vaccine or" "There's a company in Pennsylvania developing an antiviral." "It got positive results in a lab setting." "We managed to get our hands on it." "Imagine not being able to touch your own baby." "Can I get your guys' help with something?" "Sure." "Your daughter, her-- Maxine." "That's her name" " Maxine." "We need someone to hold Maxine up off the bed while the nurse changes her sheet." "Sure." "Okay." "Shh, shh, shh." "Look at you." "Hi." "Hold still." "That's it." "Hi." "Easy." "Shh." "There you go." "Hey, Foreman." "Got a minute?" "So, pulmonary resistance has stabilized for the two kids, but, uh, B.P.'s still" "No news then." "How's Cameron?" "Dr. Cameron?" "Sure." "Let's start with her and then move on to all the other Camerons we know." "I'm sorry." "I'm just not used to you asking about someone's well-being." "I can understand how the question would surprise you." "I don't quite get how it would confuse you." "Why do you wanna know?" "Why do you wanna know why I want to know?" "Just curious." "Me too." "You don't get curious." "I'm the most curious man in the world." "Not about trivialities." "Well, then this must not be trivial." "How is Cameron handling everything?" "Just fine." "Great." "Glad we talked." "Your husband is definitely the source of your mono." "Oh." "Wow!" "Oh, thank God." "Wow." "I'm gonna be a mom." "Whoa!" "Thank you so much." "I gotta get you a gift or something." "Sometimes the best gift is the gift of never seeing you again." "Okay." "All right." "But, Dr. House, you've been so awesome." "I mean, I really totally trust you." "Do you think you-- No." "Could do the prenatal-- No." "Or deliver the baby?" "That would be "no"." "Okay." "Wow." "Chase, take a look at this." "Oh, God." "It's good news." "No." "It's great." "Thank you." "Hi." "She's doing great." "Hi, little girl." "Hello." "They all gone?" "Hartigs are checking out right now." "You look tired." "Thanks." "It's no wonder." "You've had a hard time the last couple of days." "And you haven't?" "Not like you." "Anyone who's that awkward... either has no experience with death or too much, and I'm pretty sure it's not the former." "Chase told me about that idea you had, the parents holding the baby." "Where'd you get that?" "Did you lose someone?" "Did you lose a baby?" "You can be a real bastard." "Unfinished business?" "I'm in the haystack." "Ah, because now you know you're looking for a needle." "Right." "If I tell you to let it go, it won't make any difference, will it?" "Enteroviruses are spread by humans." "Fecal or oral usually." "It could be respiratory secretions though." "So Cuddy got stool samples from the whole staff." "Just wait till they come back." "That won't do it." "Why not?" "The shedder, whoever he is, he's so virulent, he must have been symptomatic." "Cuddy would have noticed him." "Hmm." "And the babies didn't share any common personnel." " That's what's weird." " Yeah, yeah." "That's what's weird." "Transition Team to O.R. 2." "Transition Team to O.R. 2." "Can I help you?" "You saved my life." "I just ran some tests." "Your will and determination are what saved your life." "I know who I am now." "Yes, you do." "And I know who I am as well." "Naomi, I love you." "Hey, seriously, man." "You're not supposed to be here." "I'm performing a delivery." "You are?" "A patient whose prenatal care I've been handling." "I just took her on a couple of minutes ago." "Ofcourse, I'll need one of you two guys to supervise." "When's she due?" "Late March." "That's five months from now." "Thank God these chairs are comfortable."