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Deception

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Deception
250px-2Deception
Director(s)
Writer(s)
Airdate
December 13, 2005
Episode Number
2.09
TV.com Rating
8.6/10
Guest Star(s)
Zebra Factor
1/10
"...you’re not just sick in the head. The problem is, the rest of you appears well so I’m going to make you seem as sick as you’re supposed to be by injecting you with a drug that simulates the symptoms that you actually have. All you need to know is you’ve hit the Munchausen’s jackpot. I’m going to give you a cocktail of insulin for seizure and colchicine to kill your white count. This will absolutely confirm my diagnosis of aplastic anemia. There is one small catch. If you’ve actually done something to cause the anemia, then I’m wrong. And if I do what I plan to do, then the treatment will kill you instead of saving you. So I need to know, have you been taking anything besides the insulin, the ACTH, and the pills Cameron left in your room?"
―Deception

Deception is a 2nd season episode of House which first aired on December 13, 2005. When an off-track gambler comes to the hospital, the team quickly diagnoses her with Munchausen's syndrome, but House thinks that there may be more fact than fiction to the woman's story. Meanwhile, House takes advantage of being supervised by Foreman.

RecapEdit

A woman has a grand mal seizure next to House while at an Off-Track Betting location. The patient also shows severe bruising. House tells bystanders to call an ambulance to take her to Princeton-Plainsboro and that her doctor's name is House.

The team starts a differential on “Hot OTB babe“, but the patient has no fever. House suggests Cushing's syndrome. Foreman thinks it's DIC due to alcohol abuse and starts ordering people around, including ordering House to get the patient's medical history. House runs to Cuddy who supports Foreman, whom she put in charge the previous week. However, she then tells Foreman that if there's a screwup, it's his problem - he can't blame it on House.

House goes to the patient to take her history. He notes that the bruises are not tender. She denies taking medication. She also knows about Cushing's Syndrome, which she had the previous year, at which time they removed an adenoma from her pituitary gland.

They do an MRI to look for a regrowth of the pituitary tumor but Foreman can’t find it. Foreman orders House to do a lumbar puncture. During the procedure, House seems to be clumsy with the needle and the patient's blood pressure spikes. The hypertensive crisis would seem to confirm Cushing's, and House thinks it is a microtumor. Foreman thinks the patient is detoxing from alcohol, but agrees to let House scan the patient if, when it turns out negative, he will treat for alcohol withdrawal and put her in rehab.

While they do the new scan, Cameron is wondering why Foreman was put in charge instead of her. Chase thinks it is because she can't say no to House, and Foreman can.

Meanwhile, House is making Foreman's life miserable by doing unnecessary tests that Foreman has to review and noting that he can't sign off on discharge summaries any more. Meanwhile, the scan on the patient shows a mass on her pancreas, confirming House's diagnosis.

Cameron tells the patient she has a mass in her pancreas that is likely cancer and that the survival rate is very low. The patient agrees to a biopsy. Cameron talks to Wilson about the patient's reaction, which she found strangely detached.

The biopsy is negative for cancer, but House still thinks it is Cushing’s. However, Cameron notes the patient has been hospitalized four times in four months and suspects the patient has Munchausen syndrome and she injected herself with ACTH to cause her symptoms, which have now disappeared. Cameron suggests an environmental scan and Foreman orders House to accompany her.

House and Cameron head to the patient's home. They find evidence of multiple doctor's appointments. House still doesn't think it's Munchausen's. They argue with Foreman about the possible diagnosis. Foreman goes with House and allows him to do a venous sample. House thinks it's only because Foreman is playing it safe, not because he believes House.

Cameron confronts the patient about the Munchausen's while she gets the consent signed.

Foreman confronts Cuddy about her decision to have him supervise House, which he feels she only did to made to make House miserable. However, Cuddy is pleased that Foreman is doing all the paperwork and indicates that she might make it permanent.

The test results come back and don't make sense - the patient's urine is orange. Cameron admits that she left a bottle of pills in the patient's room to see if she would take them. It's obvious the patient did so in order to create symptoms to be treated - the patient does have Munchausen's.

House reviews the patient's medical files.

The patient denies having Munchausen's, but Cameron gives her a psych referral and discharges her.

House notes that although the patient has Munchausen's, she always shows low hematocrit indicating aplastic anemia. He thinks it is anemia and asks to perform a bone marrow biopsy, but Foreman refuses. He does allow him to test the patient’s remaining blood, but Dr. Imelda tells House they don’t have enough blood to complete all the tests he wants. She agrees to try anyway.

Foreman goes to Wilson about House. He wonders if House would ever take him seriously as a boss. Wilson tells Foreman there is no way Cuddy will ever make him House's boss.

House tries to pass some fake results past Foreman, but Foreman sees through it and House still can't convince Foreman to order the biopsy. Chase agrees to help House even though he agrees with Foreman. However, Cuddy waylays House and Chase by discharging the patient.

House catches up with the patient and tells her he will help her with her aplastic anemia if she admits to having Munchausen's. She finally admits that she has been faking her illnesses. House gives her insulin and colchicine to make her pass out and give her the same symptoms as the anemia. He leaves her on a bench to be found by another passer-by as it would look suspicious if he brought her back in. House walks away and she collapses

Naturally, the patient's white count is down when they examine her. Foreman agrees House was right and advises the patient of the diagnosis. The prognosis is either a bone marrow transplant or lifelong blood transfusions. She agrees to the transplant, admitting she would prefer to be healthy and pretend to be sick.

However, just as they go to kill her existing bone marrow with radiation therapy, House is relaxing in the patient’s room, smells something on the patient’s belongings and realizes he was wrong. She has an infection because her self-induced Cushing's suppressed her immune system and prevented a fever from Clostridium perfringens. However, this diagnosis doesn't explain the low white count. House suggests she took colchicine herself, but Foreman believes it was House who injected her. However, House points out that if Cameron hadn’t allowed her access to antibiotics, the patient would have gotten sicker as he predicted. House makes a small incision on her bruise and smells the same odor he smelled on her belongings - like grapes. They explain to the patient that Clostridium perfringens has taken advantage of her compromised immune system. Foreman agrees to antibiotics.

Cuddy tells Foreman he blew the diagnosis and, although House got lucky, that House gets lucky a lot. Foreman states that House doesn't just break bad rules, he ignores the rules. If all the doctors did that, the mortality rate would skyrocket.

House even suggests to Wilson that Foreman could be his boss, but Wilson is of the opinion that House couldn't stand it.

At the end, we see the patient at another doctor, and House back at Off-Track Betting.

Major Events Edit

  • To get back at Foreman for acting as his supervisor, House starts calling Foreman in for regular consults and even gives him paperwork that hasn't been signed in over a year.
  • Cuddy offers Foreman the possibility of running the Diagnostics Department on a permanent basis but she later withdraws the offer after discovering House actually saved the patient.
  • House and Foreman clash over the current patient's treatment. In the end, House is shown to be right when he correctly determines she has an infection.

Clinic PatientEdit

A patient comes to the clinic complaining that her contraceptive jelly is causing a rash. House sees that she has an infection from using fruit jelly. He prescribes antibiotics for the infection caused by the jelly and that "from an evolutionary standpoint", she never have sex again.

Zebra Factor 1/10Edit

Clostridium perfringens is a common infection, and is one of the most common causes of food poisoning.

TitleEdit

The episode's title, Deception, refers to the act of deceiving someone. This is exemplified in many ways, one being the patient's denial of her madness, as well as House's repeated lies and deceptions he uses against Foreman.

Trivia & Cultural ReferencesEdit

  • All U.S. states except for Nevada prohibit bookmaking; but in some states (such as New Jersey), Off-Track Betting on horse races is allowed in licensed locations, mostly bars. At first, it was limited to in-state races but now allows bets on races all over the United States.
  • The scene in which House is watching a monster truck rally features the Grave Digger monster truck being driven by Scott Pontbriand.
  • Gulfstream Park is a horse racing track in Hallandale Beach, Florida, near Miami.
  • House is playing Sudoku when the blood tests come back to show aplastic anemia.
  • When triumphing over Foreman with the phrase "I love the smell of pus in the morning. Smells like victory", House plays on a famous line from Colonel Kilgore's part in Apocalypse Now, except that the equally abrasive Kilgore character praises the smell of napalm.

Medical EthicsEdit

  • When a diagnosis will result in a withdrawal of treatment, is it appropriate to reveal the diagnosis?  Here, a diagnosis of Munchausen's resulted in Anica being discharged and would likely result in her underlying condition never being treated.  See also Control.
  • House fakes symptoms in order to confirm a diagnosis he believes is correct. Although his diagnosis was wrong, it allowed Anica to be re-admitted so he could diagnose the real problem. See also Last Temptation.

CastEdit

LinksEdit


Previous episode:
The Mistake

Deception
Next episode:
Failure to Communicate

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