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Cane & Able

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Cane & Able
Valley-Girl-Alternate-Take-Cane-Able-house-md-14969522-1360-768
Director(s)
Airdate
September 12, 2006
Episode Number
3.02
TV.com Rating
8.8/10
Final Diagnosis
Zebra Factor
10/10
Cuddy: "But he didn’t know he [was right]. He needs at least some glimmer of humility."
Cameron: "Why does he need that? Because other people have that? Why does he need to be like other people?"
―Cane and Able

Cane & Able is a 3rd season episode of House and the second episode of the season, which first aired on September 12, 2006. The team treats a young boy who believes he has been abducted by aliens. House finds the cause, but the treatment seems to run into a dead end. Meanwhile, House’s leg pain starts to return and his confidence seems shattered after not solving his previous case. However, when Cameron finds out about Cuddy’s deception regarding House’s last patient, she gives Cuddy an ultimatum.

This episode finished 6th in Facebook's poll of the best episodes of the series completed in April, 2012.

RecapEdit

A seven year old boy is sent to bed, but he's expressing fear of someone coming to get him. His parents dismiss the idea. He turns on the TV without his parents’ permission, and all of a sudden it goes out to his shock and dismay. The room starts to shake. A bright light is seen outside and the window flies open. When his parents go to his room to look for him, they find an undisturbed room, but no child. They eventually find him unconscious on the lawn in his pajamas, with a large blood stain on his posterior.

House is getting ready to go running, but all of a sudden returns to his room and grabs his thigh. He goes and gets some Vicodin and changes into his work clothes. He meets Wilson and Cuddy at the entrance of the hospital and lies about his leg pain. Wilson and Cuddy are suspicious. Wilson blames it on the ketamine treatment failing, but Cuddy thinks his confidence is shot because he didn't know he cured the patient in the previous episode. However, Wilson reminds Cuddy that House could have killed his previous patient.

House reviews the case of the young boy. He's the product of in-vitro fertilization. Cameron thinks it is sexual abuse because of the rectal bleeding, but the rape kit was negative. Chase thinks it could really be alien abduction. Foreman thinks the hallucinations and rectal bleeding could be related. House thinks the hallucinations were just a bad dream, and tells them to focus on the rectal bleeding.

Chase performs a bleeding time test on the patient. The patient is afraid the aliens will get him because there is a chip in his neck. He then describes a procedure the aliens perform on his chest. Chase pretends to remove the chip, but the patient realizes he just pinched his neck.

Chase tells the team about the level of detail of the hallucinations. The patient is clotting normally and his endoscopies were both clean. House thinks Chase screwed up the bleeding test. He orders Foreman to re-do it. Foreman re-does the bleeding time test and the patient now bleeds 25 minutes without stopping. Cameron wants to run tests on clotting factors.

Chase goes to see the patient, but he isn't in his room, his mother having fallen asleep. Chase reports to House, who jokes that they should check nearby star systems. They find the patient in the stairwell, using a knife to get the chip out of his neck. While Chase is stopping the bleeding, he sees a piece of metal in the patient's neck.

The metal is removed. House jokes it is an unknown metal, but it turns out to be titanium, probably from the pin used in the patient's previous surgery for his broken arm. Chase wonders how it got into his neck. However, it is noted that although the patient was digging into his neck with a knife, the patient's blood clotted normally. They proceed with a clotting factor test of the blood. The parents think it might be psychological.

The patient thinks his parents think he is crazy. Chase reassures him. However, as he draws blood, the patient starts hallucinating that Chase is an alien and has a seizure. The patient's blood pressure shoots up and Chase realizes he has a pulmonary edema and is in a stage 2 hypertensive crisis. The blood test shows it is a bleeding disorder, but doesn't explain how the blood did clot on two occasions. Cameron thinks that the high blood pressure was assisting the clotting. However, the only explanation for the high blood pressure is a heart problem. Chase asks the parents if they think their son is crazy, and they believe he might be.

However, the echocardiogram shows no problems. House views the heart images on a large high-def screen in the doctor‘s lounge, and then the very large one in the lecture hall. He notes that part of the heart isn't beating. House jumps to point to the spot, and winces in pain when he lands on his right leg.

They scan the DNA of the patient and the biopsy of the defective part of the heart. They are different. Chase suggests alien DNA. They discuss how the patient’s DNA might have been changed, but House dismisses all of the team‘s suggestions. Cameron thinks House is in pain. Chase says it's not important how his DNA got changed, it just has to be removed. Cameron suggests tagging the DNA from the bad part of the heart with a protein that binds to it. House agrees.

They perform the test and find the marked DNA in his bone marrow, heart and eyes. This explains the patients symptoms, and Cameron also realizes the patient's bad vision is also related to this disease. Cameron reveals to Foreman that House cured the previous patient. They don’t find any problems with the patient’s brain though, meaning the hallucinations are unrelated and probably just the result of a bad dream.

They go to remove the foreign DNA with surgery. The patient recovers quickly and his vision improves, showing the surgery was a success. They plan to discharge him.

However, while the patient is sleeping, he once again starts hallucinating that the light is outside his window. He starts having another seizure.

They realize that there is still foreign material in the brain—the tag didn't penetrate the blood-brain barrier. They inject the tag directly into the brain, but the patient's brain appears to be clean on the scans. House wonders if the tag might not work in the brain. House goes off alone to think. He comes back and tells them to discharge the patient. House thinks it still might be a nightmare and there is nothing more they can do until the patient shows new symptoms.

Cuddy confronts House about giving up on the patient. He reminds Cuddy that he failed on his last case. Cuddy tells him to keep working. House tells her that amputation might be the next step, and is astounded when she doesn't object. He asks her what she's done wrong. She admits that he was right about his last patient. He starts telling Cuddy's imaginary baby that her mommy's in trouble, when something comes to him.

House has hit on an idea—the patient was the result of in-vitro fertilization. In rare cases, they implant two embryos and one gets absorbed by the other—Chimerism. The absorbed twin's DNA is asserting itself and has to be removed.

House goes to tell the parents that the twin's DNA is expressing its own thoughts. House plans to stimulate a hallucination and cut out the portion of the brain where the neurons are inactive.

Chase explains the procedure to the patient and start stimulating the brain. The patient starts seeing the lights, but his blood pressure starts rising as they increase the voltage. They still can't see any detail. House finally threatens the patient with abduction and torture. The hallucinations become stronger and the affected neurons are the ones that don‘t light up. House starts to remove them, and slowly the patient starts seeing only the doctors.

House goes to Wilson about Cuddy lying to him. He's realized Wilson put her up to it. House wants to know why he did it. Wilson was afraid he would think he was God and his wings would melt. House points out God doesn't limp.

House goes home and gets his cane out of his closet.

Clinic PatientEdit

Cameron is working in the clinic when she meets the patient who was in a vegetative state in the previous episode. She is shocked when she finds out it was only Addison's Disease. The patient is looking for a "bucket full" of Viagra so that he can make love to his wife—frequently.

Cameron confronts Cuddy about not telling House. She tells Cuddy that House is not himself: he's depressed and he is in increasing pain. Cuddy promises to see what is causing the pain.

Cuddy goes to see House. She wants to do a PET scan of his brain to see if the pain is a problem. House keeps talking about her breasts, but she denies being pregnant and House denies being in pain.

Cameron again tells Cuddy and Wilson that House is in pain and she will tell him that he cured the patient unless they get him to agree to testing.

Wilson asks House to come running with him, and gives him a bottle of Vicodin to allow him to exercise. When House rejects it, Wilson accuses him of being afraid the treatment didn't work. He reminds House he isn't always right. House goes to work on a treadmill, but is in severe pain after a short time. He reaches for his Vicodin. He limps back onto the treadmill and continues to exercise.

Major Events Edit

  • House begins having pain in his thigh again.
  • Cameron learns that Cuddy cured the paralyzed patient and confronts her about it.
  • Realizing that both Cuddy and Wilson are trying to teach House some humility, Cameron threatens to tell House.
  • Foreman learns from Cameron about Cuddy and Wilson's plan.
  • House starts taking Vicodin again.
  • House figures out that Wilson was behind the plan to teach him some humility.
  • With his limp and leg pain worsening, House returns to using his cane as well.

Zebra Factor 10/10 Edit

Chimerism is exceedingly rare, far rarer than conjoined twins. There have only been 40 reported cases in human beings, although it is more common with in-vitro fertilization than it is with fraternal twins.

Trivia & Cultural References Edit

  • When Cameron tells Cuddy and Wilson “to come up with a cunning plan and fast“, this is in fact a reference to Blackadder, a British comedy show from the 1980s where one of the characters, Baldrick always claimed that he had a cunning plan. The reason for this is due to the fact that Hugh Laurie who plays House was also in the third and fourth series of Blackadder as "George" as well as playing "Simon Partridge" and "Prince Ludwig the Indestructible" in the second series episodes "Beer" and "Chains" respectively (the only time an actor played more than one character in a single series).
  • The title is a play on words of the Biblical story of Cain and Abel. Like the patient, the two brothers were in competition with each other. The terms “Cane“ and “Able“ are substituted to refer to House‘s returning disability.
  • More about Alien abduction. Modern science believes that most reports of alien abduction are actually the result of either hallucinations during periods of sensory deprivation in remote areas, or sleep paralysis, a state of half-consciousness during which a person is able to hallucinate but not move.
  • Foreman "playing the dozens" with Chase just means he insulted him. Poor Chase!
  • House mentions that he "could smell what The Rock was cooking," while raising one eyebrow.  This was a reference to WWE Superstar and actor, Dwayne "The Rock" Johnson .
  • Alpha Centauri is the closest stellar system to our own. Tatooine is a world from the Star Wars movies where both Anakin Skywalker and Luke Skywalker spend their early years.
  • The Kursk was a Russian nuclear submarine that was lost with all hands when it sunk in the Barents Sea in 2000 after an onboard explosion.
  • Rip Van Winkle is a fictional character in a short story published by Washington Irving in 1819. Winkle falls asleep one day and wakes up to find he has been asleep for twenty years.
  • The reference to House’s wings melting as he approaches the sun is a reference to the legend of Icarus. His father Daedalus fashioned Icarus and himself with pairs of feathered wings held together with wax in order to escape from imprisonment. Despite his father’s warnings, Icarus flew too close to the sun and the wax melted.
  • When House and co learn of the double DNA thing, House asks about any ideas from the X-files.

Goofs?Edit

  • Although the patient was admitted with anal bleeding (which was an appropriate symptom for a patient who claims to have been abducted by aliens), the final diagnosis doesn't explain this symptom or the patient's subsequent failure of the bleeding time test. The team treated this problem, but as the case progresses the bleeding problems are pretty much swept aside and are never mentioned again. However, the bleeding symptoms were only swept aside after the patient tested positive for von Willebrand disease, at which point the question became what can cause multiple hypertensive crises to account for the times in which the patient's blood clotted on its own. Therefore, the patient had von Willebrand disease and chimerism, and the von Willebrand was responsible for the bleeding abnormalities.
  • It is quite likely the child was indeed being sexually abused. The rape kit does not rule out non-biological penetration, nor does it eliminate the possibility of past sexual assault. Frank rectal bleeding, as shown in the opening scenes, would have originated in the descending or sigmoid colon, or the rectum. In a 7 year old child (or, indeed, any patient), the most likely cause by far would be trauma, such as rectal penetration. Further evidence is offered by the child hallucinating about humanoid figures coming into his bedroom and abusing him—quite possibly nightmares consistent with past abuse.
  • Not really a goof: the clotting problem that caused the anal bleeding must have been related to the presence of foreign DNA in the patient's bone marrow.
  • Foreman says that House is 0 for 1 since he got back. However, House actually took two cases at once, only one of which was left apparently unresolved. Everyone seems to have forgotten about the more standard case that House solved successfully.

CastEdit

LinksEdit


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Meaning

Cane & Able
Next episode:
Informed Consent

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