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Case History Edit
Chi was brought in with symptoms identical to those of Matt Davis, including severe bradycardia. His heart rate was 49 and his O2 stats had dropped to 84%. Dr. Chase ordered atropine, saline and diazepam. Chi was suffering from organophosphate poisoning but his admission appeared to rule out disulfoton as the cause because although Matt Davis had been exposed to it, Chi had not. Dr. Chase intubated Chi so that he could use an ambubag to re-inflate his lungs. Chi’s heart rate rose to 55. Chi lived ten miles away from Matt and they didn’t know each other, which seemed to rule out their immediate environment as a cause of their illness.
Chi’s parents, Chou-Young Ling and Jen Ling, stated that they lived in an apartment and only kept two small bamboo trees in their house. They didn’t have any need for pesticides and only kept dried seaweed to fertilize their plants.
Chi and Matt did go to the same high school, but the school’s principal couldn’t put them together at any common event. They had classes in different buildings and ate in different lunchrooms. However, they did take the same school bus.
Dr. Chase and Dr. Cameron convinced the school bus driver to let them examine the bus. The bus driver told them a truck was spraying something near a pond they passed. Dr. Cameron investigated further and found out that the county had been spraying diethyl parathion to combat West Nile virus.
Chi’s parents agreed to the targeted hydrolase for diethyl parathion and Dr. Foreman went to deliver it. However, Chi soon had an adverse reaction, as did Matt. Dr. Foreman administered 20mg of diazepam.
Chi’s heart was barely beating, his lungs were badly damaged, and he was showing signs of liver toxicity. The adverse reaction appeared to rule out ethylperithion. Dr. House tried to focus on the fact that their cardiac symptoms were getting worse than the other ones. They tried to figure out the timeline of when they absorbed the poison. Matt was admitted at 8:45a.m. and Chi at 11:00a.m. Organophosphates take 3 to 8 hours from contact until symptoms appeared, but Dr. Cameron pointed out that given their severe symptoms, it was likely that they were exposed less than two hours before admission. That would mean Matt would have had to be exposed before he got on the bus. He figured that they were both poisoned when they were getting ready to go to school. They listed products that could be contaminated with pesticides and he ordered Dr. Cameron and Dr. Foreman to do an environmental scan of both residences to see if they used anything in common that could have touched their skin. They found both households used the same brand of laundry detergent. However, the Lings denied that Chi ever washed clothes - he didn’t know how to use the machine and, in any case, he was wearing new clothes that had never been washed. However, Dr. House asked if Matt’s clothes were new too. Dr. Chase thought they were old jeans, but he and Dr. House went to find them. They did find clothes that looked old, but Dr. House noted that the label was pristine - they were pre-aged new clothes. Although Chi wore a different brand, Dr. House had both sets of clothes tested.
The poisoning was traced to a truck that was selling stolen clothes that also did agricultural work that involved the use of pesticides.