Caren Krause was the second patient in Meaning.
Caren smoked socially. She also practiced yoga and was on a new diet.
Caren was doing an inverted yoga pose when her neck snapped and she realized she was paralyzed from the neck down. However, the x-rays showed no sign of injuries to the spine. Dr. House agreed to take the case.
Dr. House brought the case to his team. Her neck wasn't broken and there was no sign of any other injury. Dr. Chase thought it might be Multiple sclerosis but House dismissed it because she was asymptomatic until she did the inverted pose. Dr. Foreman thought it might be transverse myelitis - swelling in a disc that choked off nerve function, but nothing showed up on the MRI. Dr. House ordered the original tests repeated and an EMG.
However, the EMG was abandoned - they could not even insert the conduction pin because she flinched when they did, indicating she still had sensation. Dr. Cameron reported this to Dr. House. House asked if she smoked because he needed her lighter. He held a flame to her foot. She screamed and jerked her foot away, showing that she could move her leg. Dr. House thought that either Caren was faking or it was psychosomatic. Caren denied faking it, but Dr. House directed his staff to discharge her.
However, Dr. Cameron soon reported that Cathy was having trouble breathing. She thought it might be a pleural effusion, but Dr. House thought she was holding her breath. He found Caren sitting up in bed with shortness of breath. He threatened to stab her with a big needle to scare her into admitting she was faking. When that didn't work, he told her that if it was a pleural effusion, he would have to stab her in the back with the needle. Her breathing difficulties continued. Dr. Cameron said they could use a local anesthetic, but Dr. House said that would defeat the point of threatening her. However, as he was going to stab her with the needle, he looked at her neck. Suddenly, he demanded that Caren be put flat on her back, even though she had even more trouble breathing when she wasn't sitting up. They put her down Dr. House thrust the needle into the pericardium and started drawing blood out of it. He admitted that she couldn't fake that and that the problem was with her heart.
They had to keep drawing blood out of the pericardium about once every 45 minutes to keep her stable. Her echocardiogram showed no structural abnormalities. Dr. Foreman thought it might be tuberculosis. Dr. Cameron thought it might be vasculitis, but although it would explain the pericardial effusion, it would not explain the paralysis. However, Dr. Cameron pointed out that her ability to move appeared to indicate the paralysis wasn't real. However, Dr. House pointed out the paralysis could be a delusion and a real neurological symptom. Dr. Foreman realized he was talking about a vasular tumor on the spine, but Caren's platelet count was normal and her scans were clean. Dr. House suggested that this meant they would have to use exploratory surgery to find the tumor and they had no idea where to look.
However, Dr. Cuddy found out about the planned surgery and pointed out that the negative scans and normal platelet count almost certainly ruled out a tumor. Dr. House pointed out that the worst possible case with exploratory surgery was paralysis, and the patient was already paralyzed. Dr. Cuddy was worried about a malpractice suit and refused permission for him to proceed. However, when he ran further tests and found nothing else, Dr. Cuddy agreed to the surgery.
However, as they were preparing Caren for surgery, Dr. House was in the observation gallery and noticed that the toenail on her left big toe was brittle, broken and discolored. This indicated that she had scurvy. The paralysis was caused by blood flooding into the tissues of her arms and legs, making it difficult to move them, mimicking paralysis. It also damages hair and toenails. The new diet she was on had no vitamin C. Foreman made her drink large quantities of orange juice. She quickly improved and was soon discharged.