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A Pox on Our House

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A Pox on Our House
Poxonourhouses
Director(s)
Writer(s)
Airdate
November 13, 2010
Episode Number
7.3
TV.com Rating
9.0/10
Guest Star(s)
Final Diagnosis
Zebra Factor
10/10
Foreman: "Forget her feet. Forget all the other reasons; look at him now. The pox are domed shaped, they’re over eighty percent of his body and they’re not scabbing over. This is textbook smallpox. DDXing at this point isn’t going to make a difference"
Cuddy: "Don’t say that!"
Foreman: "I’m sorry. House, you screwed up going in there."
— A Pox on Our House

A Pox on Our House is a 7th season episode of House which first aired on November 15, 2010. It was directed by Tucker Gates. A girl is admitted with symptoms that appear to indicate smallpox, and the CDC institutes a lockdown. However, House is skeptical. When the doctor in charge forbids House's team from diagnosing, Masters believes he has an ulterior motive. House, convinced he is right, he breaks quarantine, seemingly at the risk of his own life. Meanwhile, Wilson and Sam re-examine their relationship while treating a young chemotherapy patient. House worries that Cuddy has uncovered his deception with a previous patient and the effect it will have on his relationship.

RecapEdit

Centuries ago, a slave ship is anchored off the waters of Bermuda. A doctor is called in to look at the “cargo”, most of whom show the symptoms of a serious illness. The captain, concerned about his profit, figures the best way to cut his losses is to throw the sick ones overboard so he can come to shore - the authorities, worried about an epidemic have fired on him to keep him from landing. One of the slaves tells his son to treat another man as his father - he is soon taken away to be thrown overboard. However, the authorities have given into their fear - they sink the ship.

Present day. A man and a woman, looking at their second relationship, worry about their respective children who are diving nearby. They soon appear with a treasure from the wreck - a glass bottle. However, the daughter drops it and cuts herself on the glass. She soon realizes the jar was full of scabs.

House comes in early and tells his team about the case. At first, Taub think it is just influenza . He then tells them that the girl may have been exposed to an ancient medical sample containing smallpox. The team is sceptical, but House tells them the circumstances. House gets a call from the CDC confirming that smallpox could survive in those conditions. House orders treatment, plus vaccinations for the family, and even agrees to let Foreman run unnecessary tests for more prosaic diseases.

The team gets into isolation suits to visit the patient. Taub doesn’t tell the patient about the smallpox, but Masters does. Taub stares at her.

House is in the clinic, but when Cuddy learns he has a case, he lets him off. House is incredulous - she never does that, but she insists.

Wilson is dealing with a young chemotherapy patient who won’t agree to treatment without her stuffed toy. He gets an IM from House and promises to get someone to speak to the patient while the mother goes to get the toy. When Wilson reaches House, House tells him that Cuddy probably knows about the fake hepatitis C test he ran. Wilson tells him not to worry, but that he was an idiot for lying in the first place. He counsels silence.

Taub reports that the lab tests appear to have ruled out smallpox, but it appears to be an infection. House asks Masters if she has a boyfriend, but she says its none of his business. He asks her, hypothetically, when she might be extra nice to a boyfriend if she were mad at him. She says she would do that if she were really angry and wanted him to get away from her. Masters points out the other tests were negative too. House figures the smallpox antibodies might be hiding in her joints because of her diving and orders a fluid draw to check.

House goes to see Cuddy and asks her if she knows. She says she does and House is relieved. However he refuses to apologize because it was about work. Cuddy says she can’t compartmentalize their work and personal relationship. When he suggests she can, she sends him away.

Taub taps the patient’s joints. However, when he gets to the knee, he finds pustules, which are a symptom of smallpox. He realizes he must contact the CDC.

They examine the patient for more pustules while House explains her chances are only about 70% even with proper treatment. However, Masters finds a rash under her arm. This would appear to rule out smallpox altogether.

Sam and Wilson are discussing House and Cuddy. Wilson is surprised that Sam feels that Cuddy’s expectation that the relationship will change House’s habit of lying is unreasonable. Sam reassures Wilson that lying shouldn‘t be part of their relationship, but House and Cuddy have built their relationship on lies. Wilson gets called away to deal with his young patient. At that moment a lockdown is ordered by the CDC and Sam realizes she can stay with Wilson.

The team is examining the patient when the CDC arrives, led by Dr. Dave Broda. He tells them their isolation suits are inadequate. House tells them not to worry, but Broda insist that the rash could be consistent with smallpox. House says that can’t be the case if the rash presents after pustules, but Broda says the rash probably was missed earlier or is an allergic reaction. He tells them to leave the room.

Masters continues the differential in the conference room, but Taub reminds her it isn’t their case anymore. She says she doesn’t want to wait the 18 hours it will take for the results to get back. However, they realize they can’t run the necessary tests. House focusses on the records from the slave ship. However, they are in Dutch and it’s the middle of the night in the Netherlands.

To get around the language barrier, House goes to a site where Dutch models pose on private webcams. Taub tries to tell him they have translators on call, but House pays for her with a credit card and has Masters e-mail the model the documents. The log indicates that only the Africans on the ship were sick, usually with diarrhea - the Europeans were not. Smallpox would have affected everyone, so they need a disease that favors Africans. Masters comes up with an answer tuberculous cervical lymphadenitis, a treatable condition that would have resolved itself without treatment.

House calls Foreman away and tells him that the plan is to claim the patient has meningococcus, which will kill her before the test results come back. However, when he gets access, he will test for tuberculosis. He talked to him to get Masters from finding out their plan.

Foreman goes to Broda, who is suspicious, especially when Foreman wants to do the test himself. At that moment, the patient’s stepfather collapses. Broda goes to investigate and the patient is complaining of a headache, but he has a nosebleed as well. Broda rules out meningococcus and tells Foreman he’s not getting in.

The father’s symptoms would indicate smallpox as well, but House thinks it’s still tuberculosis. This time, House asks Chase to do a bait and switch to get Broda to agree to a head CT scan, but Chase won’t go for it. Masters is getting suspicious and follows them into the hall. She realizes House doesn’t trust her and tells him to be honest with Broda. When House resists, she points out his first gambit failed. He lets Masters speak to Broda, but tells Chase to get ready with the bait and switch.

Wilson is consoling his young patient because they won’t let her mother back into the hospital. He tells her they have to start the chemotherapy without the toy. The patient notices Sam waiting for Wilson. When the patient says that her toy holds her hand during the procedure. Wilson offers his hand, but the patient says that won’t work. Sam tries to tell her that she has to have the medicine, but the patient still resists. Wilson tells Sam to get an identical toy from the gift shop.

Masters comes back in triumph. She convinced Broda that if he was wrong, he would still end the crisis and, if he was right, he would be the first person ever to CT a smallpox infected brain. House has to congratulate her.

They prepare the father for the CT while Masters and House discuss honesty. However, the infection control team returns the boyfriend to the isolation room because they have noticed pustules on his neck. They figure he’s too dangerous to transport. House confronts Broda, but Broda tells him to get out of the hallway because of the infection risk.

The father’s vital signs are very bad and the daughter’s are dropping. House figures he was right about smallpox from the beginning. House gives up on the case, but Masters doesn’t want to.

Masters goes to Broda to ask to take a closer look at the patient’s rash, but Broda won’t let her in the room. He tells her she can look through the isolation room glass, but she says that’s not enough. He reminds her the test results will be back in 8 hours anyway. Masters goes to see the patient to try to see the rash. However, when the patient moves, Masters notices there aren’t any lesions on her feet.

Wilson brings the young patient the new toy and asks her to let them start the chemotherapy. However, the patient still misses her mother and she realizes the toy is new. She throws it at them.

Masters tells House the patient doesn’t have smallpox because she has no pustules on her palms or soles. However, the father does have pustules there. House rushes out of the room. When Masters doesn’t follow, House comes back to get her. He finds his team getting some sleep in the locker room. House realizes that the father got smallpox because he was given the vaccine and is immunocompromised. The father‘s kidney cancer has probably returned. However, they still don’t know what the daughter has.

House goes to Broda to ask for permission to treat the father, but Broda tells him about the last person who died from it - a person working in a lab above where smallpox escaped from culture. Broda tells him he can’t see the father. However, House notices there is blood in the father’s urine. Broda puts it down to kidney failure from the smallpox, but House points out that the urine should be brown if that were the case. Broda still refuses to open the door, but House breaks quarantine to give the father interferon. Broda tells him he can’t let him out now.

Cuddy comes to the isolation room to give House an isolation suit. House says he doesn’t need one. However, the mother points out the father’s vital signs are getting worse. House reassures the patient, increases the patient‘s oxygen, then calls for his team.

Sam goes back to see the young patient to apologize for lying. She tells the patient she’s not good with kids and often screws up. She says she did it to get it to take her medicine. The patient agrees to try being treated.

The father is getting worse, which once again points to smallpox. However, House (now in his isolation suit) asks his team for another possibility. Cuddy helps out, but Foreman wants to concentrate on the father’s symptoms - he has textbook smallpox. He tells House he screwed up.

House and Cuddy talk to each other about their previous fight and his current predicament. The father’s vital signs get worse and he’s worried he’s going to die. House tells him he’s probably right and should say goodbye to his family. He’s worried about his son and asks the mother to take care of him. They call the son over to say goodbye. He tells her that the mother will take care of him now. The father then goes into cardiac arrest. House tries a defibrillator and CPR to no avail.

House is facing exposure as his air is running out. However, Broda can’t do anything.

Masters still wants to talk it through, but the team still thinks it is smallpox. Masters leaves to get more data. She goes to talk to the Dutch model about the captain’s log. Masters is interested in the cat - the ship was probably infested with mice and the cat would have protected the crew. It turns out the cat died. Masters asks if the cat lost its fur, and it did. Masters realizes it could be rickettsialpox, a treatable bacterial illness carried by mice that actually never had a fatal case reported in humans.

They go to Broda, but he argues the antibiotics combined with the anti-viral they are giving the patient will suppress her bone marrow. Masters tells him to look for the small dark patches, eschars that indicate the disease on the dead father. Broda says he would have noticed them, but Taub points out he hasn’t been within 20 feet of him. Masters runs to House to tell him about their diagnosis. House is reluctant to approach the body, but when Masters tells him about the cat, he’s more eager. Broda orders him to step back, but House presses on. House complains he can’t do it with his isolation gloves on, but Masters suggests he take them off. He finally agrees and starts looking. He finds the dark patches on his back and shows the other members of the isolation team, proving the father had Rickettsialpox as well as the induced Smallpox. Broda agrees and starts the daughter on doxycycline. House takes off his isolation suit.

The young patient is reunited with her mother and toy. Sam says maybe she should practice being a mother more and suggests a puppy. Wilson suggests pregnancy instead.

The patient soon improves with treatment and is reunited with her mother. The mother embraces her new stepson.

House offers to buy Cuddy breakfast, but she’s still mad at him for lying to her despite what they went through.

Major EventsEdit

  • House discovers that Cuddy knows about the lie.
  • The hospital goes into lockdown because of a smallpox alert.
  • House enters on his own into an infected patient's room while Dr. Broda seals the door.
  • It's hinted that House maybe be infected.
  • Cuddy apologizes to House while he is dying.
  • House is saved by Masters after she discovers that isn't smallpox.
  • Cuddy is still annoyed with House about the apology.

Zebra Factor 10/10Edit

Ricketsiallpox is getting rarer as hygiene conditions improve and its vectors are separated from humans. It used to be much more common, but now only thrives in very bad living conditions. However, there has not been a case of Smallpox for decades.

Trivia & Cultural ReferencesEdit

  • 90210 is the zip code of Beverly Hills, California and is often used as a synonym for it.
  • The reference to Cuddy being a “Stepford Doctor” is from The Stepford Wives, a satirical novel about a servile group of women that was later made into two movies.
  • The crack about Chase being “descended from convicts” is a reference to Australia’s beginnings as a British penal colony.
  • The odds of an average NBA player hitting a free throw is in fact around 75%, while Shaq's free throw percentage was arount 53% for his career. 
  • More on Shaq's NBA career here.
  • Chase's "Jedi mind tricks” reference is from Star Wars.
  • More about Beyonce & Lady Gaga here.
  • Janet Parker was the last known person to die from smallpox. The last person known to have been caught smallpox outside of a lab was Rahima Banu in 1975. Banu survived her exposure.
  • Gerrit, the captain's cat, which helped Masters with the final diagnosis is named as a tribute to Gerrit van der Meer, the unit production manager for the show.

GoofsEdit

Rickettsial pox is a bacterial infection spread through tick bites from Liponyssoides sanguineus, neither of which (the bacteria or the tick that carries the bacteria) would have been able to survive in a sealed glass bottle from the bottom of the ocean as a virus may, even "theoretically," have. Hence the daughter cannot have contracted Rickettsial pox from the shipwreck bottle.

Rickettsial pox is also a mild condition that heals itself over time. The symptoms were extremely exaggerated and the manner of the death was unrealistic. While nobody has died from the condition it doesn't mean death is impossible but is highly unlikely.

The eschar indicative of Ricettsial pox is from the tick bites that spread the disease.  The father, having contracted smallpox from a vaccine in combination with a weakened immune system from a recurring cancer, would have only shown symptoms consistent with smallpox and would not have had an eschar resulting from a tick bite - i.e. the father did not have rickettsialpox and House should have a) checked for the eschar on the daughter, not the father and b) should have died from smallpox.

In the initial scene, the captain (played by a South African) speaks recognizable Dutch, but his assistant who is talking to him, presumably also in Dutch, is completely incomprehensible. 

In Real LifeEdit

The last smallpox scare in the United States luckily turned out to be a strain of monkeypox, which presents with similar symptoms. The disease was traced to imported exotic pets. Although there were over eighty cases, there were luckily no fatalities even though the disease can be fatal and has no treatment.

CastEdit

LinksEdit

VideoEdit

Pox One00:56

Pox One

Interested?









Pox Two00:46

Pox Two

She knows!






Pox Three00:48

Pox Three

Introducing Dr. Broda


Previous episode:
Office Politics

A Pox on Our House
Next episode:
Small Sacrifices

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