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Best of the Recession

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Best of the Recession is case #12 in House M.D. - Critical Cases.

The CEO of internet sensation NetLife, 33 year old Joseph Brindley, collapses during an interview when the abdominal cramps he had been feeling all day suddenly became excruciating.  When he was brought to Princeton-Plainsboro Teaching Hospital the administrators insisted his case be assigned to Gregory House due to the profile of the patient.  Eric Foreman agreed to oversee House to make sure he did not try to get out of the case.

House noted that Brindley had recent surgical scars from surgery to repair broken bones from a fall on a recent humanitarian mission to Mexico.  However, Foreman said this didn't explain Brindley's symptoms.

House started with a blood analysis which showed pancytopenia - an overall low blood cell count.  After using 3 IV bags, 12 chemical meds and two ward favors, they realize this symptom is most likely due to a virus and they rule out anemia due to iron deficiency as it would not affect the white blood cells.

Imaging showed an enlarged liver.  After using 16 heart meds and 4 syringes, they can rule out a heart attack as this would cause the liver to shrink instead.

House decides to treat Brindley for EBV mononucleosis with $750 of the budget and 3 ward favors.  However, although the overall level of inflammation improves Brindley's fever gets worse and his abdomen remains tender.

Brindley goes code blue and has to be defibrillated.

With mononucleosis ruled out, House orders a further blood analysis.  After using 2 tongue depressors, 16 digestive meds and a ward favor, they find high bilirubin levels but no sign of toxemia

A further round of imaging shows gallstones, but no issues with the kidneys.  After using 20 chemical meds and $750 of the budget, they can rule out chronic kidney disease

Given the gallstones, the team figures that Brindley's gall bladder is infected and treat him for choledocholithiasis with 18 chem meds, 2 ward favors and 4 rolls of gauze.  However, although his fever subsides after surgery, he doesn't feel any better, his bilirubin levels remain high and his liver keeps getting bigger.  They realize that most of his symptoms have another cause.

Brindley goes code blue and has to be defibrillated.

House orders an environmental scan, telling the team to look for signs the patient has gained a lot of weight recently.  They search his boat and find a pair of fairly new jeans that are for a person the patient's size, but for someone who weighs less.  After using $800 of the budget, 2 ward favors and 5 rolls of gauze, they realize the recent weight gain rules out anorexia nervosa

A further environmental scan using silhouettes finds a prescription bottle for immunosuppresants.  After using 4 oxygen masks a ward favor and 16 body meds, they can't find any trace of that in the patient's medical history.  However, the lack of immune system issues rules out Grave's disease.

Another round of imaging shows that fluid is building up in his abdomen - ascites.  After using 18 head meds, 3 tonge depressors and 2 ward favors, they realize that the weight gain is only the result of the fluid buildup.  This rules out fatty liver disease.

As such, they treat Brindley for bone marrow transplant rejection with 4 ward favors, 20 body meds, $800 of budget and 5 oxygen masks. He starts to improve. House has realized that Brindley's supposed fall merely covered for convalescence for a bone marrow transplant for leukemia.  Brindley had cut medical benefits for all of his employees to save money and he realized it would not cover treatment for his condition.  In addition, if he had taken money out of the company to pay for the expensive treatment openly, it would have been a public relations disaster.  As such, he snuck out to Mexico to have the procedure, paying for it with company funds.  In addition to the rejection, he developed veno-occlusive disease from the high dose chemotherapy he received before the transplant.  It was treatable, but House noted sarcastically as he left the room that the hospital accepted cash, check and diverted company funds.

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