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Carnell Hall is the recent graduate of Princeton University who is suffering from unexplained sensations similar to electric shocks in the episode Daddy's Boy. He is portrayed by actor Vicellous Reon Shannon
Case History Edit
While celebrating on the night before his graduation ceremony, Carnell felt continuous sensations in his lower back like an intense, painful, electric shock. He was rushed to the emergency room of Princeton-Plainsboro Teaching Hospital.
Even after admission, Carnell continued to feel shocks as well as headaches, nausea, and drowsiness. He was referred to a neurologist and five other doctors in the next seven days before being referred to Dr. House by Dr. Wilson. Dr. Cameron thought that the shocks were Lhermitte's sign, indicating Multiple Sclerosis. However, the MRI showed no white matter lesions, and there was no neck flexing with the shocks. Dr. House thought that Carnell might have been abusing nitrous oxide and alcohol. However, Dr. Wilson had already given Carnell Vitamin B-12, and had ruled out cancer, Multiple Sclerosis, pyridoxine toxicity, and most neuropathies. Dr. House suggested cervical spondylosis, but this wouldn't explain Carnell's low white blood cell count. Dr. House tried to pass off the low white count as being due to Carnell being African-American, but Dr. Wilson insisted that that wouldn't explain how low the count was. Dr. House noted that Carnell was a wrestler. He thought that diuretics had contributed to the low white count, but Dr. Wilson insisted that they couldn't account for how low it actually was. Dr. House suggested Behcet's disease, but there were no skin lesions. He suggested cervical herpes myelitis, but there was no external outbreak. Dr. House believed that there was something missing from the file and told his team to find it.
The team had no idea what Dr. House was looking for, so they took more tests and started a medical history. Dr. Cameron asked Carnell if he used recreational drugs, and he admitted to using ecstacy. He suffered another shock. His ANA was negative for lupus. The family history showed that his mother had died in an automobile accident and that his maternal grandmother had arthritis. Dr. Foreman still thought that it was multiple sclerosis, as the test often gives false negatives. The low white count could be explained by alcoholism - Carnell's blood alcohol level was 2.0 on admission. However, Dr. Cameron noted that it was graduation week. Carnell drank more sparingly during the previous week and didn't drink at all during wrestling season.
The team reported that they had gone through all the imaging studies and done new blood cultures, but Dr. House told them that he didn't want old news - he wanted them to do something new. Dr. Foreman was at a loss for what to do, but Dr. House told them to check the police report of his mother's death. Dr. House had noted that the mother had veered off of a dry straight road in broad daylight. Dr. Foreman thought that the mother had been distracted, and the police had come to the same conclusion. However, Dr. House noted that if you add that to the fact that her son had shock like symptoms, it could mean a genetic disorder, like type II neurofibramatosis. He ordered a DNA analysis of the long arm of chromosome 22.
Dr. Foreman took a cheek swab for DNA and Dr. Cameron asked if the mother had exhibited any signs of the disease. The father denied it and asked why they thought that she might have it. When Dr. Cameron said it may have been why she crashed, Carnell was surprised because he had been told that she was hit by a drunk driver. His father admitted that he had lied about the cause to motivate him. All of a sudden, Dr. Foreman smelled something - Carnell had lost control of his bowels. He denied feeling anything, although he said that he had sensation in his feet. They soon determined Carnell had sphincter paralysis, which Dr. Foreman felt pointed to Miller-Fisher syndrome. However, Carnell's stool sample was negative for botulinism. The DNA test was also negative for inherited diseases. Carnell's hemoccult was negative for blood, and Dr. Cameron noted that the stool had gushed rather than exploded. Dr. Foreman suggested transverse myelitis, most likely from an infection, as the other causes had been ruled out. However, Carnell had no fever and his blood and cerebro-spinal fluid cultures were all negative. Dr. Foreman suggested that the body had fought off the infection, but that its effects were still being felt - molecular mimicry. Dr. House was intrigued and ordered an immunoglobulin level and electrophoresis.
Dr. Foreman explained that when the immune system attacks an infection, sometimes the spinal cord continues to be mistaken for the disease. Dr. Chase did a lumbar puncture so that they could identify the original infection for treatment. They told Carnell to lie flat for an hour to recover. Carnell sent his father out of the room on a pretext to tell the doctors that he had been in Jamaica with his friends during spring break. However, they had only been drinking, not using marijuana. Dr. Cameron confirmed that the tox screen was negative for THC. Dr. Foreman reminded everyone that marijuana can't cause transverse myelitis, but Dr. House noted that pesticides used on marijuana can. Dr. House ordered 2g/l intravenous pralidoxime initially, dropping to 1g/l for the following 8 hours until he improved. Dr. Foreman protested that they had no confirmation that Carnell had been poisoned, but Dr. House told them to proceed anyway.
Dr. Cuddy found out that Dr. House was treating Carnell for pesticide poisoning without any proof and went to see the patient. She only found that Carnell's appetite had returned and he was feeling much better. However, Dr. Cuddy reviewed his chart and found that although the nausea and diarrhea had gone, the shocks were still there, but were improving. His white count was also still low, but Dr. House argued that it needed time to come back up. However, he was soon told that Carnell had chills and a fever of 106*F.
The fever pointed back to an infection which would explain the transverse myelitis. However, Dr. House thought it was a hospital acquired infection due to his immune system being vulnerable because of the low white cell count. The diarrhea had returned. Dr. House realized that although the treatment had made Carnell feel better, he hadn't actually gotten better. Dr. House ordered intravenous broad-spectrum antibiotics, a cervical thoracic lumbar puncture, and T2-weighted, and then ordered Dr. Cameron to look for the friends that Carnell had gone to Jamaica with.
Dr. Cameron went to meet Taddy, who told her that everyone had had nausea and headaches, but had put it down to heavy drinking. He also complained of athlete's foot. When Dr. Cameron asked to see it, he said that the fungus was in his groin area. Dr. Cameron asked to take a look and he finally agreed. However, he was the only one of the friends who had symptoms.
Dr. Cameron ruled out ringworm, but Dr. House was intrigued and wanted to know what the rash looked like. Dr. Cameron compared it to diaper rash and put it down to the fact that he hadn't changed his underwear because he had been working around the clock. Dr. House wanted to get the friend to the hospital, but Dr. Foreman said that even if it was Karposi's, it was probably unrelated - Carnell had no skin symptoms, and cancer had been ruled out. Dr. Cameron said that he wouldn't come, but Dr. House told her to lie to the friend to get him there.
Dr. Cameron went to Dr. Cuddy to get a subpoena for the friend to force him to come to the hospital instead of lying to him, but Dr. Cuddy suggested lying to Dr. House to get him to go to the friend.
Carnell had a perforation in his sigmoid colon, although it was repairable. However, this meant that the antibiotics weren't working. Dr. House ordered them to double the dose. Dr. Cameron told Dr. House that the friend had not come to the hospital. Dr. Cuddy then came in and told them that Taddy was on his way to the hospital in an ambulance because he had been vomitting blood and would be there in ten minutes.
Dr. House examined Taddy on admission and asked to look at the rash. Taddy had vomited 3 units of blood, but Dr. House insisted on examining him. He asked Taddy if he and Carnell had had sex in Jamaica, but Taddy denied it. Dr. House examined the rash, ruled out fungus, and saw no pustules or signs of staphylococcus, but suddenly remembered something that Taddy had said - that Carnell's father ran a scrap metal salvage yard where Carnell worked. Dr. House ran to the father and asked him if Carnell had found anything unusual in the scrap metal. He remembered that he had given Carnell and old plumb bob that looked like a fishing weight. Carnell was using it as a key chain. Dr. House asked where Carnell's clothes were and they told him that the father had taken them home and put them in Carnell's dresser. Dr. House ordered them to retrieve the dresser and was very clear that they were not to open it.
When the dresser arrived, Dr. House got a geiger counter and found a radioactive piece of metal in Carnell's backpack. He ordered Dr. Foreman to get the radiation team.
Although the radiation wasn't enough to damage his central nervous system, it was enough to destroy his immune system. Dr. House figured that there must have been one or more tumors, and ordered a PET scan of his cervical spine.
The results were not encouraging. Dr. Foreman explained that the piece of metal was from a device used to test wells, and that it should have been disposed of properly. They had to treat Carnell for radiation sickness. Taddy got exposed when he carried Carnell's backpack on his lap during the flight to Jamaica. Taddy would need transfusions to balance his fluids and electrolytes. However, Carnell had had much more exposure, could no longer produce white blood cells, and would need a bone marrow transplant. He also had a cavernous hemangioma in his spinal cord which had caused the shocks and the nervous system symptoms. The tumor was operable, but given that Carnell was hemopoetically compromised, surgery was very risky. However, if the tumor was not removed, it could have eventually caused his breathing and heart to stop. The father also needed treatment. Carnell was moved to a sterile isolation room to prevent further infections.
Carnell was prepared for surgery by Dr. Fedler. He managed to excise the tumor, but after he finished, Carnell's blood pressure started to drop despite the fact that they had given him 2 units of blood. His heart rate started to fall and he was hemorrhaging.
Carnell's father was receiving treatment when Dr. Chase came in to report that the tumor had been removed, but that the infection had caused another intestinal perforation and his white count kept falling. He broke the news that there was very little that they could do to fight off new infections. It was likely that Carnell would be dead within the next few days. However, the father and Taddy were responding to treatment.
Carnell did regain consciousness and he and his father apologized for lying to each other. The father tried to tell him that he would be fine, but Carnell wouldn't believe it, although his father swore that this would be the case.