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Apple was a one-time character that appeared in Not Cancer, the second episode of the fifth season of House. She was the corneal transplant patient in the group of patients who died of mysterious illnesses after receiving transplants from the same donor. She was portrayed by actress Felicia Day.
Medical History Edit
Case History Edit
When four of the recipients died within eight months of each other of independent causes, Remy Hadley sought out Apple and found her teaching her mathematics class. She rushed her back to Princeton-Plainsboro Teaching Hospital to be treated by Dr. House along with the other surviving recipient, who was very ill. Apple told Dr. Hadley that she wasn't suffering from any symptoms, but Dr. Hadley told her that none of the other recipients had any symptoms before they became very sick.
Dr. Foreman reported the port-mortem results on the other patients. None of them had anything in common except their donor. Carl had received a new heart and lungs, but he died of liver failure. Tibalt had received the donor's liver, and had died of lung failure. Holly had received a new kidney, and her heart failed. The other living patient, Frank, had received an intestinal graft, and his pancreas were failing. All of their serious complications arose suddenly. Dr. Kutner thought this meant either arrythmia, massive pulmonary embolism or cerebral hemmorhage. Dr. Taub thought it might have been an infection that made it past screening which then lay dormant for four years. However, Dr. Kutner pointed out that an infection would attack a specific organ, not all of them. Dr. Hadley pointed out that as none of the donated organs were effected, whatever it was must have been in the donor's blood. If that were the case, Apple should be fine because a cornea transplant doesn't involve any transfer of blood. However, she agreed that it would be premature to discharge her until they figured out what was wrong with Frank. Dr. Kutner thought it was an autoimmune disease, but Dr. Taub pointed out all four deceased patients had normal ANA results. Dr. Foreman pointed out this wouldn't rule out vasculitis, but Dr. Taub pointed out the antiphospholipid results were normal too. Dr. Hadley thought the only answer was cancer, but Dr. Foreman pointed out that cancer is also organ specific. However, Dr. House thought it was cancer too. Dr. Foreman argued it couldn't be - the autopsies and tests had ruled it out as well. Dr. House ordered Dr. Hadley to re-do the tests and autopsies and ordered Dr. Taub and Dr. Kutner to find out if the donor had cancer. He also ordered an environmental scan of the donor's work and home. He ordered Dr. Foreman to examine Apple's eye. Dr. Foreman reported that the patient's right eye, the one with the transplant, wasn't working. He wanted to remove it. Dr. House reminded him that her left eye didn't work either - removing the right one would leave her blind. He also reminded Dr. Foreman that none of the other deceased patients had any trouble with their transplanted organs. He figured the patient's eye was fine, but her brain was not properly receiving the information.
Dr. House repeated the eye test, but Apple completely missed two letters and misread a third. Dr. House realized that since she didn't squint, her eyes were fine, but her brain wasn't. Apple started having hallucinations, confirming brain involvement.
Dr. Foreman argued that hallucinations aren't always the result of a neurological issue. Dr. House started looking for indications that the deceased patients had brain involvement. Dr. Hadley pointed out no disease simultaneously causes brain and heart problems. Dr. Kutner reported that his review of the donor's medical history showed no underlying illness before his traumatic accident.
However, Dr. House had hired a private investigator who did a more thorough history of the donor. He had traveled to both Spain and the Bahamas, he had a girlfriend, and the girlfriend had the donor's daughter, who now had a stomachache. The donor was also exposed to mold, mercury and hydrous perchloric acid. He had also obtained extra footage of the MMA fight where one of the deceased patients died.
The MMA fighter had dilated pupils. However, Dr. Foreman noted he never dropped his hands. His brain may have been involved, but he was able to maintain muscle control. Dr. Foreman thought it might be a temporal lobe seizure. Dr. House wanted to do a brain biopsy on Apple, but his team was opposed. Dr. House noted the temporal lobe controls speech, hearing and memory and if she lost them she would be severely disabled. Dr. Taub countered that a botched biopsy would put her in a vegetative state. Dr. House then suggested that they do a brain biopsy on Frank instead given that he was obviously close to death. He told them to get consent from the spouse.
The spouse refused the consent due to the risk involved, even when Apple begged her to do so. However, Frank was soon in respiratory arrest. Dr. Taub did an emergency tracheotomy and used the defibrilators, but could not stabilize him.
Dr. Taub reported to Dr. House that Frank had died. He ordered him to prepare for an autopsy and to take particular care to save the brain. However, the autopsy provided no clues and despite taking numerous slices, the brain was completely healthy.
They started again. Each deceased patient had died from the failure of a single organ, but it was always a different organ. Dr. House returned to cancer - it's the only type of disease that affects multiple organs. Metastasis would explain why it affected different organs. All other diseases only attack a specific organ. Dr. Foreman pointed out there was no evidence of cancer in any of the patients, but Dr. House figured they just hadn't looked hard enough. Dr. Kutner suggested a perforated intestine could also cause different organs to fail. Dr. House agreed it was possible, but Apple had already had a colonoscopy and her intestines were fine. Dr. House ordered the test repeated if she started suffering abdominal pain and decided to try to get consent to do a colonoscopy on the donor's four-year-old daughter. The child's mother consented to the procedure, but it was clean.
Given the clean colonoscopy, Dr. House returned to cancer. Dr. Kutner was still sticking to perforated colon. Given the rapid progression to death, he figured it would have to be rapid onset and would only show up just before death. The problem with examining a dead patient's colon is that to get proper results, the colon has to be working and the patient has to be able to say where it hurts. However, Dr. Kutner pointed out that the real problem is getting enough pressure to make the colon work. They could inflate Frank's colon with the high pressure water jet they use to test cardiac workload and see if it leaked.
Dr. Kutner and Dr. Foreman did the procedure, but had trouble getting getting anything to travel up the dead bowel. Dr. Kutner turned up the pressure and it started to work. Dr. Foreman used the colon scope. However, they found no leaks. They appeared to be at the end, but Dr. Foreman thought it might be an occlusion instead. Dr. Kutner turned up the pressure again, but the intestines exploded because they were at the end.
Apple was starting to get symptoms - arrythmia, her breathing was labored, but her colonoscopywas normal. Dr. Taub returned to autoimmune. Dr. Foreman suggested multiple sclerosis. Dr. House finally ordered immuno-gels on her cerebro-spinal fluid to look for hidden protein markers and gene sequencing. He planned to treat her with chemotherapy. Dr. Hadley objected, but Dr. House said they had to treat her for something because it was obvious she was sick.
Dr. House went to Apple to get consent. He had to mislead her into thinking she didn't have cancer in order to prevent a placebo response. She agreed to the chemotherapy. She told Dr. House that before the cornea transplant whe was practically blind, with best corrected vision of 20/200. Before her cornea transplant she was an architect, but switched to math professor because when she regained her sight, the world looked ugly. She also noted that nothing else changed once she regained her sight.
Apple started to vomit from the chemotherapy, but her heart had stabilized, her breathing was improving and her amylase and triclycerides were both improving. However, despite the improvement, Dr. House thought he was wrong about it being cancer.
Despite the improving lab results, Dr. House felt she was going to start getting sicker. Dr. Foreman pointed out that her improvement on cancer treatment confirmed cancer. Dr. House admitted that he treated her for cancer because the thought what she had acted like cancer. They needed to find something that was like cancer, except not cancer. He revealed that his private eye that Tibbel was on cancer medication, methyltrexate that he was taking to treat his arthritis. He was also the second last to die which meant the methyltrexate helped, but couldn't stop the progression of the disease. He realized they were missing something.
Dr. House sought out Dr. Wilson, who was no longer working at the hospital, for a consult. He told him it was like cancer and responded to cancer treatment, but it wasn't cancer. All the CT Scans of the brain were normal. However, Dr. Wilson refused to assist him.
However, Dr. House finally realized that Apple's feeling that the world was ugly was related to her condition. He went to see Dr. Cuddy. He told her Apple's brain was fine, but her eyes were not. However, if her eyes were faulty, her occipital lobe should have compensated, but it didn't. There had to be something in the lobe that shouldn't be in there. He needed permission to remove the top of Apple's skull. However, Dr. Cuddy wanted to order Apple's cancer treatment be continued. Dr. House finally let her know his theory - cancerous stem cells. They came from the donor and were transplanted with his tissues into all of the dead and dying patients. They finally settled and partially differentiated. However, since they didn't fully differentiate, they caused the failure of the organ they became attached to when they finally gave way under normal stress. Because they were partially differentiated, they looked exactly like the cells that were supposed to be there. Chemotherapy worked because it shrunk the cells, but it would eventually damaged the organ they were attached to. However, it was only hiding the problem - the patient's organ would eventually fail unless he got right inside it to treat it. If they waited until she crashed, it would probably be too late to do anything. However, Dr. Cuddy realized that Dr. House might fake a crash to get her to agree, so she ordered the security staff to keep Dr. House away from Apple.
However, Dr. House got his private investigator to sneak in and switch out the chemotherapy with saline. Apple was soon crashing. Dr. Cuddy agreed to the procedure. They removed the top of her skull and Dr. House then told them that they had better check her medication. Dr. Chase wanted to stop the procedure, but Dr. House reminded him that they had already done the dangerous work. The neurosurgeon applied the neural net and they started to test the speed of her neural responses to see if there was any foreign material. They found some and started to remove it.
Apple was soon in recovery, although her eyes were bandaged. Dr. House went to see her and she realized it was him from his smell. He told Apple that her perception of ugliness was the result of the cancerous stem cells interfering with her ability to process visual information. Now that they were removed, she should perceive things differently - less foggy or grey. He removed the bandages and she immediately noticed the difference.