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The bus driver was the character who House believed he had seen a symptom in before the bus crash.
Case History Edit
The patient was brought into the Princeton-Plainsboro emergency room with lacerations from a bus crash. Dr. House had been on the bus and believed he had seen a symptom before the crash. He examined the patient and noted pupura on the chest below the neck which he believed indicated leukemia. However, Dr. Wilson pointed out that this symptom merely was a bruise from the patient's seat belt. The patient denied having a seizure and said the bus was hit by a garbage truck. Dr. Wilson argued that if Dr. House had seen the beginnings of a seizure, he would have told the driver to pull over.
Dr. House agreed to undergo hypnosis to try to remember the details before the crash, but could not remember anything about this patient. Dr. House returned to the emergency room and noted that the patient was complaining he could not move his right leg. Dr. House formed his team and obtained a differential diagnosis for sudden onset paralysis. Dr. Hadley suggested Guillain-Barre syndrome. However, Dr. House dismissed this as he would not have seen any symptoms of it on the bus. Dr. Kutner pointed out his elevated white blood cell count could mean transverse myelitis, but the only symptom would be the sudden paralysis, and no-one would have missed that. Dr. Foreman started the patient on antibiotics in the event it was myelitis.
Dr. House invoked a hallucination to focus his memory on the bus. However, he could not remember anything useful.
The patient's legs started to improve. However, the patient started complaining about stomach pain. Dr. House believed it might be Addison's disease from a tumor, but Dr. Foreman reminded him the patient's head had already been repeatedly scanned.
Dr. House underwent sensory deprivation in order to recover his memories. He believes he may have seen symptoms from his head indicating Marfan's syndrome, Syphilis, Ehlers-Danlos or another disease that is only fatal in children. He also considered Huntington's disease and Parkinson's disease because he remembered that he was shuffling when he helped an old lady up the steps. He came out of the sensory deprivation tank with a diagnosis of Parkinson's and prescribed L-Dopa.
However, when Dr. House woke up from unconsciousness, he realized the patient didn't have Parkinson's. Dr. Foreman continued the differential. Dr. Hadley suggested Wilson's disease. Dr. House called the team and Dr. Foreman informed Dr. House that the patient was also suffering from liver failure, ruling out Parkinson's. Dr. House suggested hepatitis and hepatic fibrosis. However, the latter diagnosis had already been ruled out. Dr. Taub suggested thyrotoxic periodic paralysis, but Dr. House dismissed the suggestion. However, when Dr. Taub pressed the matter, they put the patient on a treadmill and fed him bagels to boost his carbohydrate levels. However, the patient did not react adversely to the test. After 30 minutes, the patient started wheezing and collapsed, which ruled out TPP because it paralyzes the chest muscles which are used in wheezing.
The patient's symptoms indicated a pulmonary embolysm, but the patient did not respond to TPA. Dr. Foreman suggested taking the patient to surgery to remove the clot, but Dr. House noted the patient had recent dental work. Dental work occasionally causes air bubbles to get trapped in the gums and enter the bloodstream. This would present as a myoclonic jerk which Dr. House could have seen. The bubble could have travel led to the spine, liver and lungs causing them to fail. Dr. House and Dr. Hadley prepared the patient to have the air bubble rise to the apex of his heart where Dr. Hadley removed it with a syringe. The patient's blood gases immediately improved and the patient recovered.
However, Dr. House later realized that the air bubble was dislodged by the bus crash rather than the crash being caused by symptoms from the air bubble.