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- House: "Are you going to base your whole life on who you get stuck in a room with?"
- Eve: "I'm gonna base this moment on who I'm stuck in a room with. That's what life is. It's a series of rooms. And who we get stuck in those rooms with adds up to what our lives are."
- — House and Eve about Eve's life.
On TV.com, Winnick's portrayal of Eve was overwhelmingly picked as the Most Valuable Performance of the episode, with an outstanding 107 votes - 98 more than Hugh Laurie and one of the highest vote totals ever recorded on the site.
This case was a total departure from the usual "case of the week" format used in most of the other episodes. House's modus operandi is to avoid contact with the patient at all costs. House believes meeting the patient may be fatal to his objectivity and make him ineffective as a physician.
When Eve wants House to treat her, he rightly and objectively believes that he's precisely the wrong doctor for her. However, Eve sees in House what many other patients see in him when they actually get to meet him - the part of House that was the victim of an incorrect diagnosis and is actually able to empathize with the patient's plight. This empathy is what Eve senses - a doctor who has felt deep emotional pain rather than one used to treating it. This is not the first case where House opened up more easily to a patient than his friends or colleagues, but it is the one where he got involved the most deeply.
Throughout the episode, House relies on his "Greek Chorus" to reflect his own uncertainty about how to proceed. Cameron, as always, expresses his hope and optimism that he can make a difference. Foreman represents House's realism and pessimism, the fear that he can do nothing at all or that nothing he can do will do any good. Even useless Chase reflects a part of House - his uncertainty and fear that he might be in over his head and there's no possible way to have any effect either way.
Eve had recently been raped, and she was emotionally distressed because of the assault. She came to the clinic with suspicions that she had an STD, which was diagnosed as chlamydia.
- "I think I have an STD"
- ―Eve explains why she came to the clinic
- "Don't touch me!"
- ―Eve, when House tried to offer her the medication.
Dr. Cuddy talked to Eve and offered her a psychiatrist, but Eve wanted to continue to be treated by Dr. House. Dr. Cuddy wanted to assign her to Dr. Stone, but Eve said she would wait for Dr. House. Dr. House went to see Eve again, he told her that he had no interest in treating her because she had no physical illness. Eve could not express why she wanted to be treated by Dr. House, but later said she trusted him. He told her he couldn't be trusted. When he expressed the opinion that she was trying to exercise the same control over him that the rapist used over her, she threw him out.Dr. Stone went to speak to Eve. However, Dr. Stone later ran out of the exam room calling for a crash cart. Dr. Stone had offered Eve benzodiazepine and when she turned her back Eve grabbed and swallowed the entire bottle in a suicide attempt. Her breathing was suppressed and her heartbeat was irregular. Dr. House asked what she had said during the session, but Dr. Stone told him that Eve had been silent for over an hour.
- House: "You must have said something"
- Stone: "I said plenty, she said nothing. I was with her for over an hour. She didn't say one word."
- — House, trying to find out why Eve attempted suicide
Eve was admitted to the hospital, and when she woke up Dr. House was next to her playing his GameBoy(PSP). Dr. House asked if she intended to try suicide again, Eve promised that she wouldn't. He assured her that she would recover from the overdose. Dr. Cuddy had required Dr. House to spend time with Eve, and Dr. House let her know that. Dr. House again asked why she wanted him specifically, and Eve told him that she simply didn't know. Eve didn't want to talk about the rape or her STD, but she insisted did want to talk. Dr. House recommended talking to a family member or the police instead of himself. When she said she would talk about the weather, Dr. House told her that he wasn't going to talk about trivial topics.
- House: "You were raped, and you want to talk about the weather?"
- Eve: "Yeah"
- House: "I'm not going to talk to your about the weather."
- — House, expressing incredulity that Eve wants to avoid the subject of her assault
House talked to his team about Eve. Dr. Chase agreed with Dr. House that he was ill suited to treat Eve. Dr. Foreman thought that he should talk about the weather, or whatever else she wanted to talk about. Dr. Cameron thought that he needed to get her talk to her about the rape because she couldn't pretend it didn't happen, but Dr. Foreman said it was a mistake to focus on negative events.
Dr. House went to talk to her again, and said he wanted to know about the rape. However, Eve still didn't want to talk about it. Dr. House reminded her what happened wasn't her fault. She said just wanted to talk, about anything other than the rape, and said she thought that time would change everything. Dr. House told Eve that she was wrong, doing things changes everything; hoping things will change over time just leaves things as they were.
However, Dr. House finally agreed to talk about trivialities with her. They talked about where they went to college - Eve went to Northwestern University, and Dr. House did both his undergraduate and medical training at Johns Hopkins University. Dr. House asked what Eve's major was; it was comparative religion. He asked why she trusted him, and she again tells him that she doesn't know. He said that her answer wasn't rational and she replied her rape wasn't rational either. Eve asked him if anything terrible had ever happened to Dr. House. Dr. House asked her what she wanted him to say, and she said that he was the one who wanted to talk about important things, insisting that he talk.
- Eve: "Has anything terrible ever happened to you?"
- House: "What do you want me to say?"
- Eve: "You wanted this conversation. You wanted to talk about something that matters. Talk."
- — Eve insisting on talking to House about "anything"
Dr. House sedated Eve so she could get some sleep and went to ask for advice. Dr. Wilson told him to tell her the truth - his life sucks and he's been shot. Dr. House didn't think that was what Eve was looking for, but Dr. Wilson said she was just trying to connect with him. Dr. Cameron advised him that he should tell her his life is good, even if that was false. Dr. Foreman told him to tell her that his life was terrible, even though it wasn't that bad. Dr. Chase told him to keep her sedated, and that there were no right or wrong answers. Dr. House disagreed and said they just didn't know what the right answer was.Dr. House woke Eve up and told her that his grandmother used to abuse him to discipline him. Eve thought that Dr. House was lying, as nothing seemed to have changed in his relationship with his grandmother. Eve got angry with Dr. House, and told him not to dismiss her. She then asked if the story was true. He said it was true for someone, and asked why was it important that it happened to him. She said that those people weren't in the room with her.
- Eve: "Is any part of that story true?"
- House: "All of it"
- Eve: "You wouldn't keep calling her "Oma". Something would have to change!"
- — Eve, expressing skepticism about House's story about being abused.
- "Abortion is murder"
- ―Eve, suddenly relying on automatic responses
- "It's my dad"
- ―House, admitting who abused him
A reflection of House Edit
Eve's life has been shattered by a single event that now seems to dominate her life and thoughts.
The anti-House Edit
Eve enjoys small talk and conversations about her feelings.
Reaching the diagnosis Edit
- In reality, it would take much longer to get the results of an STD panel than what is depicted in the episode. Test samples are routinely sent out to a lab, and since most of them involve some sort of culture growth to detect bacteria, they can take several days in order to show any results at all.
- Chlamydia is very difficult to diagnose, although it is easy to treat. The majority of female patients show no symptoms for months or years after infection. One of the milder symptoms that is possible is unusual vaginal discharge, which can be caused by many conditions and, most commonly, candidiasis. Painful urination is another possible mild symptom, but is usually caused by a urinary tract infection. Fever is common, but prosaic. Some of the more serious symptoms are vaginal bleeding and abdominal pain.
- An STD panel would most likely include a blood sample, a urine sample, and a sample taken from the cervix.
- Eve's reaction to being offered antibiotics is a good example of hypervigilance. The most common cause of hypervigilance is post-traumatic stress disorder and the most common cause of PTSD in women is a sexual assault. House makes a good call.
- Hypervigilance often manifests when the patient's memories of the traumatic event are triggered. In this case, when House reached towards Eve, it probably triggered a memory of her sexual assault.
- Suicidal thoughts in victims of sexual assault are quite common, occurring in about one-third of cases.This is often the result of clinical depression following the assault. Suicide attempts are not as common and there are few statistics available. One study in Ethiopia put the number at about 6%.
- When Eve asks why House always answers a question with a question, she should know that House is merely falling back on what psychiatry he knows. During psychotherapy, the therapist will usually focus the attention of the session back on the patient. In this case, House has quite rightly figured out that Eve is trying to project her experience onto him. While House often projects, Eve's projection is somewhat different. House projects his personality defects onto other people (e.g. everybody lies) while Eve is trying to project her negative feelings about the assault onto House. Answering her questions with another question is counter-projection, a standard technique in psychology and psychiatry. Dr. Nolan expertly uses it with House in Broken and Baggage.
- Pregnancy testing is, of course, a lot faster than STD testing. Instant read pregnancy tests are very common in hospitals and are ready in minutes. The lab test actually looks for the same reaction and has about the same sensitivity. It is usually ready within 24 hours after the sample is submitted. Either test will detect a pregnancy after the second week of pregnancy, so given that Eve was only raped about a week before, the test would most likely have been negative, and Cuddy should have known she was wasting the lab's time. An ultrasound is also another good way to confirm, but usually doesn't find anything until the sixth week of pregnancy.
Explaining the medicine Edit
- Chlamydia is, in fact, the most commonly transmitted STD acquired during sexual assaults. In children, a chlamydia diagnosis is almost certainly due to a sexual assault. Although it is uncommon that symptoms would appear one week after contact, as in this case, it is certainly possible.
- Current medical practice recommends both STD and pregnancy testing when a female is sexually assaulted. However, the practice of routine STD tests has become problematic. In truth, STD transmission through rape is very uncommon. It is roughly equally likely that a sexually active patient will be diagnosed with a pre-existing STD. In many cases, women are given antibiotics as a prophylactic measure even before results come back even though if the assault is fresh, they will have the exact same effect as when given after the incubation period when the diagnosis is confirmed, or even after symptoms appear.
- Although the United States is an "abortion on demand" country, in truth, getting an abortion in many hospitals is tremendously difficult - even more so when the institution is run by a religious organization. Although "morning after" pills are legal and effective in preventing pregnancy if given immediately after a rape, the controversies over abortion in the United States (where physicians who perform abortions are regularly threatened) often discourage physicians from offering such options to patients.
- Distress in a victim of sexual assault is a normal reaction, but victims display a wide range of ongoing reactions to the experience. Some victims can largely recover in a matter of months with very little support, while others may suffer severe symptoms for years including drug dependency and even severe mental illness.
- The correct course of action when dealing with sexual assault victims is reflected in the conflicting advice he gets from his fellows. Many of the issues relating to sexual assault trauma are the result of myths that women themselves hold about sexual assault. The stereotype is that sexual assault is directed at women over the age of 18, generally only happens once, is perpetrated by strangers, and results in severe physical injuries. In fact, most sexual assault victims are young, may have had a previous sexual assault, are usually assaulted by someone they know, and suffer little to no physical trauma. One of the first things a psychiatrist must establish is that the patient's experience and feelings are typical and their distress over the situation is normal.
- Luckily, serious mental illness after a sexual assault is rare, but conditions such as post-traumatic stress disorder are more common in cases of sexual assault than it is with other forms of trauma, such as an automobile accident. Clinical depression is also common.
- Contrary to the assertions of some American politicians, a woman of child-bearing age has about a 5% chance of becoming pregnant after being raped. It is a much more common than STD transmission in the same circumstances.
- There appears to be a wide range of opinion regarding the incidence of abortion following rape induced pregnancies. However, Eve's initial wish to carry the fetus to term is not unusual.
- Although most therapists encourage their patients to talk about the assault, they also accept that forcing the patient to talk about the assault may be counter productive. The approach varies widely with the patient. Some therapists have found that some victims are re-traumatized by constantly remembering the event of the assault and often become obsessive about it. Other victims find the experience cathartic and it improves their recovery. There is no consensus about the correct approach. Some therapists favor disclosure as a way of avoiding repression of feelings that can lead to later problems. Others favor getting the patient to move away from the experience and moving on to more positive supporting experiences.
- All pregnancy tests, whether they be on blood or urine, test for the presence of HCG, which is made by the placenta and is generated rapidly right after the fertilized egg attaches to the uterus. The test uses monoclonal antibodies which attach to the HCG if it is present and change color.
This article was the featured article for March, 2016.
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