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After Hours
Promo-pics-for-7x22-After-Hours-house-md-21700121-1280-854
Director(s)
Airdate
May 16, 2011
Episode Number
7.22
TV.com Rating
8.8/10
Guest Star(s)
Final Diagnosis
Zebra Factor
5/10
Rachel: "What happened to your leg?"
House: "I was trying to make it better."
―After Hours

After Hours is a 7th season episode of House and the twenty-second episode of the season, which first aired on May 16, 2011. It was directed by Miguel Sapochnik. A woman Thirteen knew in prison shows up at her apartment in need of urgent medical attention. However, the friend is running from the police and if she goes to the hospital, she will be going back to jail. She turns to Chase for help. Meanwhile, House finds out the compound that has restored the muscle in his leg has been causing tumors in the rats its been tested on. Meanwhile, Taub deals with a natural but unexpected side effect of his relationship with Ruby, the young CNA.

This is a rare episode that does not focus either exclusively on Gregory House or activities within the hospital. It departs from the usual "patient of the week" format and instead focusses on character development of Remy HadleyRobert ChaseChris Taub and Gregory House himself. No one of the three plots that make up the episode dominates the action, and the three plots rarely intersect even though the entire scope of the episode covers only a few short hours.

In the first plot, Thirteen and Chase have their own accidental patient - an ex-con friend of Thirteen's who begs for off-the-books medical care. House has too many problems of his own to deal with the patients of others - the experimental drug that has restored his thigh muscle has given him cancerous tumors as well. Meanwhile, Taub learns that he has gotten Ruby pregnant and mulls the possibility of fatherhood while also trying to escape the hospital.  

In the end, all the characters find their way back to the hospital. In parallel fashion, both Thirteen and House are brought to the realization that hospital care is sometimes the only option, but they both need a kick in the pants from a level-headed colleague to come to that realization. Taub's own brush with mortality also brings him to the realization that what he wants at that moment is something at the hospital as well.

We learn more about the character's personalities than in most other episodes. Thirteen once again shows her wild streak, trying to lie to and bully Chase to live outside the lifestyle that physicians usually embrace. Chase once again shows that he is capable of independent judgment when he's outside of House's influence.  Taub comes to a sudden realization that his work is no longer enough for him.  House appears to be the only one who doesn't develop as a person when he tries to justify his stupid stunt to Cuddy.

Also, we wonder what would have happened had some of the roles been switched and Taub had shown up in response to House's call, or Thirteen had only been able to reach Foreman. We see that despite the control the characters have within the hospital, the outside world is a messy place that the characters have to deal with on a daily basis.  

RecapEdit

A woman steals a car and races it through the streets. She is bleeding from her right side. She finally crashes the car into a newspaper box. She staggers out of the car clutching her right side. She stumbles down a hallway and knocks on a door. Thirteen answers and recognizes the woman. She realizes the woman needs to be taken to a hospital, but the woman says the cops will be waiting for her there to send her back to prison on a parole violation. Thirteen realizes that if Darrien stays there, she will be in violation of her parole and if Darrien dies, she will be guilty of manslaughter. The woman goes to leave, but Thirteen tells her she will bleed to death if she goes. Thirteen finally promises not to take her to the hospital.

Meanwhile, House is negotiating with a prostitute about a position they can try. She says he needs two fully functioning legs, and he says he now has them. He tries to lift a stack of amplifiers to show his leg is fine, but loses his balance and drops them. He says his leg developed a cramp. He notices the dropped amplifier has spilled his supply of the experimental drug he was taking to repair his muscle. He sends the prostitute home.

Thirteen is examining the woman’s abdominal wound to see how much damage there is. It’s not as bad as it looks - there is little internal damage and what there is appears to have stopped bleeding. There are no signs of internal bleeding, but Thirteen is still worried about it. She checks the woman’s blood pressure and tells her if it drops too low, she probably has unseen internal bleeding.

Foreman comes back from jogging to find Taub with Ruby. She’s very upset and leaves after saying goodnight. Foreman asks if they are breaking up, but Taub tells him that Ruby is pregnant. Taub goes to get a drink.

Darrien is telling Thirteen that her boyfriend stabbed her as a distraction during the police raid. However, it didn’t work and they just let her lie on the floor after calling an ambulance. It’s obvious she has started using drugs again. Thirteen is confused - on her left side, the woman has no blood pressure at all and barely any pulse, but she’s conscious and lucid. She should be dead. Thirteen examines her further and finds a solid pulse in her right arm and her blood pressure there is nearly normal.

Chase is relaxing on his couch when his phone rings. It’s Thirteen. She asks him to bring him a portable ultrasound machine, ostensibly so she can check out her plumbing. Chase realizes something is up.

Meanwhile, House is back at the lab looking to steal more of the drug. He runs into Dr. Riggin who tells House the clinical trial is over because all the rats developed tumors. The only symptom was cramps the scientists put down to adjusting to the new muscle mass.

Chase arrives at Thirteen’s apartment with the portable ultrasound. She thanks him and tells him she might be late for work the next day. However, Chase has noticed that her socks are dry so she obviously needs the ultrasound for something medical. She lets him in. He sees the woman lying on Thirteen’s couch. Thirteen admits to Chase she was in prison.

House goes to the hospital to give his leg a contrast CT Scan.

Thirteen then tells Chase she was in prison for killing her own brother. She’s using the ultrasound to look for an aortic arch aneurysm. She tells Chase to help her or leave. Chase goes to touch the woman, but Thirteen warns him to use gloves because she has hepatitis C. Thirteen and the woman were in prison together and the woman helped keep her out of trouble. The woman’s fingers start to turn blue and her left arm goes numb. Thirteen can’t find an aneurysm. Chase thinks it might be a clot. They go looking for it and find a mass, which they think is a lipoma that was aggravated by the stab wound. They grab a syringe to remove some of the mass to improve blood flow. However, when they look at the fluid, they realize it’s not a lipoma.

Taub and Foreman go to a strip club. Taub says he can’t understand why Ruby would want to have a kid with a short, bald guy. Foreman agrees and tells him he will make a lousy father. When Taub says he already agreed to that, Foreman tells him that he knows Taub is actually considering it because he’s discussing the problem rather than looking at the strippers. Taub tries to prove him wrong by heading off to the VIP room.

Thirteen draws five full syringes of bloody liquid and manages to restore blood flow to the arm. Chase notes they have no idea what her problem is and there are too many possibilities. However, Thirteen doesn’t think it is illegal drugs because her kidneys and heart seem to be fine. Chase thinks it might just be the hepatitis, but Thirteen reminds him if that were the issue, her whole body would be swollen, not just her left arm. Chase wants to do an environmental scan of the crack den, but Thirteen tells him he’s an idiot to even consider it and points out her symptoms have to be related to the stab wound. She finally comes up with an idea - the stab wound used up all her clotting factors, and she started bleeding elsewhere. If that’s the case, she could start bleeding elsewhere at any time. Chase wants to take her to the hospital, but Thirteen tells him they could just give her intravenous clotting factor. She goes to call in the order and convinces Chase to pick it up.

House grabs some Vicodin and starts to scrub up. He ties a tourniquet around his bad leg and applies antiseptic to the scar tissue of his right leg. He gives himself a local anesthetic in several places. When the leg goes numb, he pulls out a scalpel and starts cutting his thigh open.

Thirteen puts the woman to bed. The woman won’t talk about why she started taking drugs again.

House is trying to remove tissue from his leg. He gives himself another local. He starts cauterizing parts of the wound. He finally pulls out what appears to be a small tumor. He looks at his scans and sees several others he must remove. However, his hands are shaking too badly. He concentrates despite the pain. However, he becomes unable to continue. Wilson’s phone starts to ring, but he‘s fast asleep.

Taub is with a stripper when his smartphone rings. It’s from House. He ignores it. He asks the stripper what she would do if she were pregnant. She tells him to shut up about it and allow her to dance, but he won’t drop the subject. He notices an asymmetrical mole and asks if she’s seen a dermatologist. When he persists about the mole, the stripper calls over the Bobby the Bouncer.

When House call trying to reach Thirteen for help but Thirteen is not there the phone vibration wake up the woman instead. The woman sees someone standing over her bed pointing a gun at her. Thirteen is in the other room cleaning up blood stains. The man points a gun at the woman and she pleads with him to put it down. Thirteen hears the woman crying out and realizes she has been hallucinating, but Darrien just keeps saying “I‘m sorry“.

House is still trying to reach someone. Cuddy’s phone rings. She wakes up and finds Rachel on her bed watching a cartoon about pirates. She answers the phone and tells whoever it is that someone better be dying.

Chase arrives with the clotting factor, but Thirteen sends him out to get more. She tells him about the hallucinations. He figures the woman is bleeding in her brain. Thirteen just wants to give her more clotting factor, but Chase tells her she needs a CT Scan and burr hole surgery to even have a chance of surviving. Thirteen wants to try the surgery there. Chase tells her she’s risking both of their careers and prison. Thirteen says she won’t take the woman to the hospital, but Chase says he will do it himself. She and Chase get into a fight, and Thirteen soon has the upper hand, although Chase soon overpowers her. He tells her he’s taking the woman to the hospital.

Cuddy finds the bloodied House in his bathtub. She send Rachel out of the room. House said he tried to call everyone else. Cuddy asks him why he didn’t call 911. House tells her he thought that the tumors would be easy to remove because they are close to the surface. Cuddy realizes he tried the surgery himself because he was too ashamed to tell a surgeon that he had been taking an experimental drug. He asks Cuddy to remove the tumors, but she insists on taking him to the hospital.

Chase is rushing the woman to the hospital. He tells her he has a plan to switch her records with those of one of the nearly dead patients so that her name will not appear on hospital records.

Rachel asks House what happened to his leg. Cuddy starts to lecture House about how stupid he’s been. She won’t let him blame the break up.

Thirteen is trying to keep the woman awake. Chase has figured out the patient used to be a police officer. Thirteen wonders why she was never told, and the woman tells her you don’t tell people you were with the police if you’re trying to survive in prison. She tells Thirteen that she killed a 19 year old. She started using drugs after the incident. The woman loses consciousness. Chase starts driving faster.

Cuddy is driving carefully. House and Rachel start talking in pirate talk and Cuddy realizes that House was the one who introduced Rachel to the cartoon she was watching.

Taub is waiting for Foreman outside the club. When Foreman learns why Taub was thrown out, he’s amused and wants to go home. Taub wants to wait for the girl to make sure she gets the mole looked at. Foreman thinks Taub just wants to get beat up by the bouncer to punish himself. He tells Taub to get in the car. When Taub refuses, Foreman goes to get a cab.

Chase and Thirteen do a CT Scan on the woman and talk about what she did. Chase realizes she kept her promise because she did the same thing with her brother. If she breaks a promise, her coping mechanism will break down. She defends her actions with her brother. She also says that the woman has no bleeding in her brain. They realize she is shivering and has a fever. They discuss an infection from the stab wound, but they soon realize that it couldn’t have spread that quickly.

House, Cuddy and Rachel are waiting for medical attention. House’s heart rate starts to rise and Cuddy is worried he’s going into shock. House and Rachel talk about the pirate cartoon again. Cuddy starts looking for a nurse and takes Rachel. House hears his phone ring. It’s Thirteen. They start to do a differential on the woman.

Taub is in his car and asks his On*Star to call Ruby. However, he changes in mind.

House, Thirteen and Chase talk about the woman’s case. He only has one good idea, and Thirteen shoots it down. House notices he’s bleeding through his bandage. He takes some Vicodin and goes back to the woman’s case. He tells them to get a timeline of when she shot the kid, when she started drugs, and when she actually got hepatitis C because he thinks Thirteen is only assuming the patient has had it for a long time. Cuddy arrives with the nurse.

Taub tells his On*Star to call Rachel Taub, but he finally sees the stripper with the mole. She points a gun at him. She tells him to turn around and get on his knees. He hears a gun hammer cock. However, when a car goes by, he realizes she’s gone.

Thirteen can’t find any word about the shooting on the database. Chase apologizes for being so hard on her, but Thirteen says he understands and he was right. He gets her some ice for her sore neck. She finally finds a reference from 2008 - it appears the patient had a different last name then. House was right that the patient has only had hepatitis C for a few years. However, Thirteen can’t figure out why she would have received interferon for it in prison unless it was chronic. They realize a parasite would make hepatitis C look chronic in a patient with a new infection. If it were an amoebic parasitoma, the stab wound could have damaged it, sending the parasite through her blood stream. She just needs metronidazole.

House is ready to be taken into surgery. When Cuddy goes to leave, House ask her to stay so that the surgeon won’t go crazy cutting out leg muscle or amputating his leg. He says he doesn’t trust the surgeon, but he does trust her. She follows him in.

The woman comes out of her coma. Thirteen tells her about the parasite, but tells her she’s going to be okay. However, the woman is handcuffed to her bed. She tells Thirteen she shouldn’t have trusted her. Thirteen tells her she’s lashing out, and she knows she saved her life.

House is recovering from surgery. Cuddy and Rachel are waiting in his room. Cuddy tells Rachel that House will be fine. Rachel asks when House will come over to play. Cuddy tells her they can write House a letter.

Taub comes to see Ruby. She’s worried he’s been to a strip club, but he tells her a story about how he had a patient who was in for a tummy tuck who they found had terminal cancer. However, the man was less upset about it than Taub was because the man said he had good kids who made him feel he was leaving the world a better place. Taub says as he was about to die that he wanted to be like that man and he wants to have the baby.

Thirteen realizes that although the woman was justified in killing the kid, it still destroyed her life. She’s afraid the same thing will happen to her. Chase says she needs help, but Thirteen has already had therapy and it hasn’t helped. Chase implies she can talk to him about it. Thirteen says he has no idea what she’s going through. He asks her to go for a coffee, to which she stares in astonishment as if she thinks Chase has gone through something similar.

The team come in the next morning and start going through files. Foreman says he missed a call from House the previous night and wonders if he’s in. The team start to wonder too.

House wakes up and finds his leg still there and Wilson sleeping nearby. Wilson tells him how lucky he was. Wilson shows him the letter from Rachel. It hopes he gets better and they can play again soon and ends “you bloody scaliwag”. House says he has to pee and Wilson says that’s a good sign. Wilson tries to help him out of bed. House declines, but he’s in no condition to walk unassisted. Wilson helps him to the bathroom and tells him he can’t keep going like this. House wants to pee first, but agrees with him.

Major EventsEdit

  • House finds out the experimental drug he’s been taking causes tumors in rats.
  • House finds three tumors in his leg.
  • Thirteen agrees to help the woman she met in prison but not take her to the hospital.
  • Thirteen admits to Chase that she’s been in prison.
  • House attempts to operate on his own leg to remove the tumors.
  • Cuddy finds out Rachel is watching a pirate cartoon and soon realizes that House introduced her to it.

Zebra Factor 5/10Edit

Ameobic infections kill about 70,000 people a year worldwide, but they are far rarer in the United States. Most amoebic infections are asymptomatic and only about 10% of patients suffer any symptoms at all.

Trivia & Cultural ReferencesEdit

  • The Kama Sutra is a Hindu text dealing with human sexuality that is believed to have been compiled as part of a larger work of knowledge sometime between 400 BCE and 200 CE
  • Adamantium is the fictional metal alloy that makes the character Wolverine nearly indestructible.
  • The Crusades were a series of military campaigns fought between European powers and the Turkish empire over several periods between about 1100 and 1700.
  • Darrien calls Thirteen by her given name “Remy”.
  • Mazel tov is a Yiddish combination of the ancient Hebrew words for "good" and "luck".  It has been incorporated as an experession of good wishes in modern Hebrew.
  • Pepperoni is an American sausage based on salami.  It is a common pizza topping.
  • On the form showing the CT Scan, House’s birthday once again appears as 05/15/1959. He appears to have forged Dr. Hourani’s name on the requisition for the test.
  • Taub's remark about "crappy dads" is a reference to a common stereotype about strippers - that they had poor relationships with their fathers. House made the same reference in another episode.
  • The cartoon was called “Brownbeard” and was created especially for the episode.
  • Darrien’s full name appears on the internet search Thirteen performs looking for a news article about the shooting.
  • Chase's GPS shows that Princeton-Plainsboro Teaching Hospital is located on Prospect Street. Prospect Avenue is a main street in Princeton, but Propect Street is in nearby South Brunswick.
  • This is the last episode to feature Cuddy's daughter, Rachel. Ironically, her final line has her expressing a desire to spend more time around House.
  • The title of the episode is a reference to After Hours, a 1985 Martin Scorsese film about a series of (mis)adventures one man faces over one night. In both cases, the characters end up at work in the morning, tired and exhausted.
  • The Amish are a Protestant religious group, a sub-group of the Mennonites.  They generally shun modern life and, with few exceptions, live using only technology from the 16th century.

GalleryEdit

The gallery for After Hours can be found here.

GoofsEdit

  • The final diagnosis doesn't explain many of the symptoms, such as the bleeding from the cyst (and the nature of the cyst isn't fully explained either) or why Darrien was hallucinating.  
  • Most of the information about hepatitis C is incorrect.  A chronic case is one that has presented for more than six months (which would fit within Darrien's time frame in prison).  Moreover, interferon is the appropriate treatment for acute cases anyway.
  • Bleeding in the brain can cause hallucinations, but it is a bit of a zebra.  Blood loss is a far more likely explanation and Thirteen couldn't be sure how much blood Darrien lost before she arrived.
  • You can't drain a lipoma - they're almost solid fat.  It would be like trying to remove fat from a steak with a syringe.  
  • Although Thirteen warns Chase about making sure he doesn't come into contact with Darrien's blood because of the hepatitis C, she gets body parts covered in blood at several points and takes no precautions - not even washing.
  • Intravenous clotting factors aren't available except within hospitals, and they won't allow them out for any reason.  

QuotesEdit

Dr. Remy 'Thirteen' Hadley: You stay here, they bust me.
Darrien: I can't go back, Remy.
Dr. Remy 'Thirteen' Hadley: Neither can I. God forbid, you die, I'm up for manslaughter.
Darrien: ...I'll find someone else.
Dr. Remy 'Thirteen' Hadley: You leave, you bleed out. You're gonna die... Stop!
Darrien: Promise me, you won't take me to a hospital.

Dr. Gregory House: Any indication the rats were getting sick?
Dr. Riggin: Just some cramping. Their legs would stiffen up. They were having trouble moving around. We just thought their bodies were adjusting to the increase in muscle mass. But - in a day or so, they just started - dying... Oh well, a new compound to play with next week.

Dr. Robert Chase: Have you talked to anyone about it?
Dr. Remy 'Thirteen' Hadley: No, I may have an Aortic Arch Aneurism. Oh wait, that's her. Either help me or leave!

Dr. Chris Taub: I don't even know why she's even considering having my kid. She barely knows me. All she knows is: I'm a short balding guy. It doesn't even make evolutionary sense.

Dina: [as she's dancing for Taub] Your lap is vibrating.
Dr. Chris Taub: [Pulling out his cellphone] Oh, sorry. Uh, it's my boss - probably drunk - wants a ride home. He can get a cab... Do you have any kids?
Dina: Why? Do you like moms? I could be your mommie. Spank your little ass.

Dr. Gregory House: I tried calling everyone else. You were the last one on the list.
Dr. Lisa Cuddy: Why wasn't 9-1-1 on the list?
Dr. Gregory House: It's not an emergency.
Dr. Lisa Cuddy: Right. Are you suicidal?

Dr. Lisa Cuddy: Don't blame our break up for this. You're not unhappy because of me. You just unhappy. Unhappy people do reckless things.

Dr. Lisa Cuddy: You already signed a release. He's gonna do what he needs to do.
Dr. Gregory House: Yeah, and if that involves chopping off my leg - I want to be damn sure it's necessary.
Dr. Lisa Cuddy: House...
Dr. Gregory House: I don't trust him. I trust *you*.

Dr. Remy 'Thirteen' Hadley: Darrien had to shoot that kid. It was the right thing - completely justified. But it didn't matter. She destroyed her life trying to forget [starts to cry]. I'm afraid that's what's going to happen to me.

Dr. Gregory House: What are you doing here?
Dr. James Wilson: You hoping for someone else
Dr. Gregory House: Hot nurse. Candy striper. Someone who doesn't speak English. Someone who doesn't speak judgemental.

Dr. James Wilson: [House tries to walk after leg surgery] You're an ass.
Dr. Gregory House: What? For trying to walk on a freshly mangled leg? Performing surgery on myself? For thinking I could solve my emotional problems with rat medicine? If you're gonna nag, at least have the decency to be specific.
Dr. James Wilson: [Helping House up] Come on... Listen, you *can't* keep going like this. Something has to change.
Dr. Gregory House: Can I pee first?... I know.

House: There are no cars coming. Just go.
Rachel: The light is red, ye bloody scallywag.
Dr. Cuddy: Stop with the pirate talk.
House: [In pirate voice] If you don't want Brownbeard to end up with two wooden legs, better get your ma to move this ship, you mangy bilge rat.
Dr. Cuddy: Of course... you showed her that filthy cartoon. What kind of idiot lets a three-year-old watch that?
House: If you want to lecture me on my poor judgment, there seems to be more relevant examples.

Darrien: I told you I couldn't go back. I shouldn't have trusted you. I never liked you. I killed time with you 'cause I was locked in a cage. You were a distraction. Someone to talk to so I didn't have to think about... everything else.
Thirteen: You're lashing out... I get it. But in a month, you'll thank me. Or maybe you won't, I don't know. But... I know I saved your life.

MusicEdit

  • The music playing while House operates on himself is "Victory Dance" by My Morning Jacket
  • The music in the strip club is "Move Ya Body" by Nina Sky
  • The music near the end is "Flume" by Bon Iver

ReviewsEdit

The episode received mixed reviews. Critics differed greatly on the format of the episode, with some praising it for its innovative story structure, while other's pointing to the same structure as a reason why the episode didn't appeal to them.  Nevertheless, the episode drew 8.92 million viewers, an increase of almost 1 million viewers from the previouse week.

  • IMDB users gave the episode a 9.0, with 58.4% of users giving it a 10.
  • TV.com users rated the episode an 8.8.
  • On TV Fanatic, the reviewer gave it a 4.3/5, while it's fans gave it a 4.6/5.
  • Polite Dissent was impressed by the nature of the medical mystery, giving it an A-.  However, he rated the solution and the medicine a mediocre C-.  However, he liked the storylines and gave them an A.
  • On Television Without Pity, Sara Morrison gave it a C-, but the fans were more generous and gave it a B-.
  • The Onion AV Club gave the episode a C

Release DatesEdit

  • United States and Canada - May 16, 2011
  • United Kingdom - May 19, 2011
  • Finland - June 7, 2011
  • Netherlands - October 6, 2011
  • Hungary - October 26, 2011
  • Germany - December 6, 2011
  • Japan - May 21, 2013

In Other LanguagesEdit

  • France & Quebec - Opérations maison (Eng. House operations)

CastEdit

Helpful hintsEdit

It can't be stressed enough how stupid House was to attempt to perform surgery on himself to try to remove the tumors. Despite his precautions to sterilize the tub, it is likely even a clean bathroom would have a large amount of airborne bacteria and fungus that could have led to a life threatening infection even if the surgery was successful. Although local anesthetics are safe in small doses, in large doses, they can cause loss of consciousness and sedation of the central nervous system. Had House lost consciousness during the procedure, he could easily have bled to death without regaining consciousness. Once his hands started shaking, it was clear he was no longer capable of the fine muscle control demanded of a surgeon to avoid damage to large blood vessels.

LinksEdit

VideoEdit

thumb|left|300px|House Season 7 "After Hours" Promo #1






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