Evan Greer is the patient in the episode Living The Dream. He is the actor who plays Dr. Brock Sterling on House's favorite soap opera. In reality, he is himself portrayed by real life actor Jason Lewis.
Case History
Dr. House, who is a fan of Mr. Greer, noticed that his line readings had become slower recently. Dr. House believed he had an occipital tumor that was resulting in this symptom. He contacted Mr. Greer, who insisted he was fine. However, Dr. House discussed his line readings, which appeared to mean that he could not read one side of the teleprompter, and convinced him to come to the hospital for one test.
Dr. House administered an opthamology test to determine if Evan had any unusual blind spots. However, Dr. Foreman came in at Dr. Cuddy's request. Dr. House told Dr. Foreman that he thought Evan had a tumor or an aneurysm. Although Dr. House attempted to tell Even he had significant vision loss in his upper right quadrant of his visual field and that he needed an MRI, Dr. Foreman reviewed the results and found Evan's vision to be normal. Dr. House said that the test only showed the vision loss was intermittent and was not definitive, but Even got up to leave the hospital.
However, Dr. House followed Evan to the elevator and sedated him. He then took him to radiology and instructed Dr. Hadley and Dr. Taub to perform the MRI. However, they found no tumor and Evan regained consciousness. Dr. Taub and Dr. Hadley tried to calm the patient, but he went to Dr. Cuddy to complain. However, as he arrived in the lobby, his foot went numb and he realized he could no longer walk.
Dr. House started a differential, but Dr. Hadley noted that foot numbness is a symptom of many diseases. However, Dr. House asked they to focus on conditions that also cause peripheral vision problems. However, Dr. Foreman pointed out there was no proof Even had vision problems. Dr. Kutner pointed out that Evan now had a real symptom and it was likely Dr. House had spotted problems with Evan's vision. Dr. Foreman countered they couldn't be sure Dr. House faked the foot numbness to keep Evan in the hospital. Dr. House countered that if he had caused it, he would not include it in the differential. However, Dr. Cameron, who was helping Dr. House with his charts, pointed out that Dr. House may have caused it inadvertently - Evan fell when Dr. House sedated him. Dr. House still thought it was a toxin or vitamin deficiency. Dr. Cameron pointed out they had to rule out nerve entrapment from the fall by doing an EMG. Dr. Kutner volunteered to do the test.
Dr. Kutner went to see Evan, who was surprised that Dr. House was right. Dr. Kutner said Dr. House usually is right, but when Even said that Dr. House thought he was dying, Dr. Kutner assured him that Dr. House is wrong sometimes too.
The rest of the team watched episodes of the soap opera to observe Evan's demeanor. Dr. House claimed that Evan was pausing frequently, but the rest of the team didn't see it. Dr. Taub did think Evan's speech was forced, which could be the result of stiffening of the tongue from myxedema, but Dr. Hadley thought it was the poor quality of the script. Dr. Foreman noted that he was holding a stethoscope at an odd angle, which could indicate demylination from toxic exposure.
Dr. Kutner reported the EMG showed no nerve entrapment - the numbness was a real symptom, perhaps due to vitamin deficiency, toxins or atherosclerosis. Dr. House decided to do an environmental scan of the patient's studio and ordered Dr. Taub to test for heavy metal poisoning, organophosphate poisoning, biological toxins and to do an environmental scan of the patient's home.
Dr. House found a leaky space heater at the studio, but when he called Dr. Wilson for a consult, he reminded him that if it had caused the symptoms, Evan would have improved at the hospital, not gotten worse. Evan's co-star told Dr. House that although "Brock Sterling" is a heavy drinker, Evan didn't drink at all. He also ate a healthy diet with lots of fruit and nuts. She also assured him he had a normal lifestyle. However, Dr. House was intrigued when she described an incident on a date with Even where he pulled away after starting to get intimate.
Dr. House reported back to the team that Even might be impotent. He ate a lot of sunflower seeds which may have led to Vitamin B6 toxicity, autonomic disregulation and impotence. Dr. Hadley agreed - they found nothing at his house and too much Vitamin B6 would not show up on a tox screen. Dr. House ordered plasmapheresis. However, Dr. Cameron pointed out that just because Evan hadn't had an erection recently doesn't mean he couldn't. Dr. Kutner pointed ot that he thought the patient might be suffering from clinical depression because he said he hated his job - that could cause impotence as well. Dr. Hadley noted plasmapheresis had risks and the safest course of action was to observe him in a sleep lab to see if he got a reflex erection. Dr. House resisted, but finally acquiesced.
Evan felt a little exposed, but agreed to spend the night in the sleep lab. As expected, he did get an erection, but he also developed tachycardia and was heading for cardiac arrest. Dr. Hadley and Dr. Kutner rushed in to defibrilate him. They managed to stabilize his heart rhythm.
The next morning, Dr. Kutner and Dr. Hadley reported the heart attack to the team. Dr. Hadley thought it might be an atypical reaction to sepsis, but Dr. Foreman pointed out Evan had no fever. Dr. Kutner pointed out the patient used to smoke, so it could be paraneoplastic syndrome from small cell lung cancer. However, Dr. Foreman pointed out Even had not smoked in 20 years and his calcium levels were normal. Dr. Cameron suggested Grave's disease - a form of hyperthyroidism. Dr. House agreed and wanted to use radiation therapy to destroy the thyroid. Dr. Taub thought it was premature - they should confirm first. Dr. House noted that given Evan's condition, he may have another heart attack. Dr. Cameron also thought an iodine uptake test was called for. However, Dr. Foreman agreed with Dr. House that they should irradiate the thyroid right away - a thyroid storm could kill him.
However, once the team was outside the hearing of Dr. House, Dr. Foreman told them to proceed with the iodine uptake test. If it confirmed hypothyroidism, they could irradiate him afterwards.
Dr. Taub and Dr. Kutner performed the uptake test. The thyroid looked normal, but the rest of the scan looked too bright. Dr. Kutner realized that it was because the iodine wasn't being filtered - Evan had kidney failure.
Dr. House and Dr. Foreman argued about the test. Dr. Foreman said it showed the thyroid shouldn't have been irradiated, but Dr. House pointed out that the iodine was now poisoning Evan. Dr. Foreman pointed out that all they did was find a new symptom, but Dr. House told him that if he thought he was wrong again, he should tell him to his face rather than going behind his back. Dr. Taub finally settled it by saying it didn't matter - it was most likely that Evan had an autoimmune disease so they couldn't predict which organ might be affected next. Dr. Taub wanted to run an ANA test, but Dr. House would not let him.
Dr. House went to see Evan, who was told he had lupus or sarcoidosis. As they spoke, Dr. House realized that Evan thought he was the character he played on television as he was reciting his dialogue. He then realized Evan was running a high fever and he called for cooling blankets. When he asked Evan what his name was, he replied "Dr. Brock Sterling".
Dr. Hadley thought the fever ruled out an autoimmune condition and suggested sepsis, which she had mentioned earlier. Evan had been put on antibiotics, but he had still slipped from his delerium into a coma. Dr. Foreman suggested that they had to identify the specific infection so they could put him on more targeted antibiotics. Dr. Kutner suggested pneumococcus, but it would not cause neuropathy. Dr. Hadley suggested tetanus, but Evan had been recently vaccinated for it. Dr. Taub suggested Lyme disease, but Evan had no soreness. Dr. Taub pointed out by the time they did blood cultures, Evan would be dead. However, Dr. Foreman pointed out if it were a fungus, they could see it under a microscope. Dr. House ordered them to look for fungus and parasites, which could also be seen under a microscope.
Dr. House consulted with Dr. Wilson. Dr. House thought it might be rat bite fever, but there was no swelling. Listeria would not explain the numbness, unless it also caused encephalomyelitis. However, Evan was on ampicillin, which is effective against listeria - he would have improved. Suddenly, Dr. House realized Evan always had chrysanthemums in his dressing room.
He want back to his team and suggested Evan was suffering from a severe allergic reaction to the pyrethrin in the flowers. He found out that Evan had tested negative for parasites and fungus, which he felt supported the diagnosis. Dr. Foreman pointed out that Evan had no medical history of allergies or asthma and none of the other symptoms of an allergy. However, Dr. House pointed out that in rare cases, allergies can cause allergic vasculitis - that would explain all the symptoms. It would also explain why he didn't respond to antibiotics. Dr. Foreman countered that it could merely be a resistant bacteria, but Dr. House was not convinced. He wanted to give him steriods. Dr. Foreman pointed out that if it was an infection, steroids would kill the patient, but Dr. House wanted to proceeded on the assumption that it was an allergy before they could confirm given the patient's current state.
Dr. House went to the pharmacy and requested 100 mg of methylprednisilone. The pharmacist insisted that Dr. Cuddy had to approve any dose that high. Dr. House ignored the pharmacist and went to get the steroids himself. Dr. Cuddy intercepted him and Dr. House explained his diagnosis. Dr. Cuddy insisted he get confirmation first, but Dr. House pointed out that Evan would be dead before they confirmed. Dr. Cuddy pointed out he had been wrong to order plasmapheresis and radiation as well. Dr. House admitted that, but pointed out that if they followed protocol now, Evan would certainly die. When Dr. House suggested that he be given time before she called security to arrest him, she finally agreed to look the other way.
However, the allergy blood tests came back negative and Dr. Cuddy rushed to Evan's room to start him on antibiotics again. However, when she arrived, Evan was out of his coma and feeling much better. However, they still didn't know what he was allergic to. Dr. House admitted he was hasty and that Dr. Cuddy was right to have tried to stop him.
Dr. House continued to examine the case and finally came up with the answer. While watching the TV show in high-definition, he noticed bubbles in the glass. "Brock Sterling" had recently started drining gin and tonic. Although the gin in the glass was fake, the quinine water was real. Evan was allergic to the quinine, which set off his symptoms.