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Family
321house
Director(s)
Writer(s)
Airdate
May 1, 2007
Episode Number
3.21
TV.com Rating
8.7/10
Guest Star(s)
Final Diagnosis
Zebra Factor
4/10
Foreman: "I can’t sedate you. Too sick."
Matty: "AAAH! AAAH! AAAH! AAAH! AAAH! AAAH! Please, please stop. Please, please, please you’ve got it right?"
Foreman: "Sorry. I need a lot more."
— Family

Family is a third season episode of House which first aired on May 1, 2007. A bone marrow transplant to a critically ill patient is threatened when the donor, his younger brother becomes ill as well. Although the younger brother doesn’t appear to be in danger from his illness, the team’s techniques to diagnose him in time to help his brother bring him to the brink of death as well. When it seems the parents must choose between their sons, Foreman decides to do something that may save both of the brothers at the cost of confronting a part of himself he may not be able to live with. Meanwhile, House tries to deal with Wilson’s old pet dog Hector and his habit of chewing everything in sight.

RecapEdit

A young man is getting ready to donate bone marrow to his older brother with leukemia when all of a sudden he sneezes in front of Wilson.

House is trying to adjust to his new dog Hector, who has a habit of chewing things, including his cane.

Wilson reports to the team that the younger brother has an infection with an enlarged spleen and fever, and that they have five days to complete the bone marrow transplant, otherwise the older brother will die because his immune system is compromised. Foreman is already treating the younger brother with antibiotics, but they will take too long to work. Chase reports that the younger brother has tested negative for all the common infections. House suggests encouraging the infection so that the type of infection becomes obvious. Foreman suggests going to their home to search for an infection source.

Wilson and House discuss making the younger brother sicker with the parents. House pushes the procedure on them. House and Wilson get into an argument about needing to have a good relationship with patients. House feels Wilson's good relationship with patients would make it easier to manipulate them.

Foreman and Chase do the environmental scan. Foreman still feels bad about the patient who died in House Training. They find an old water pump that they feel could be the source of an infection and Chase takes a sample.

Back at the hospital, they chill the younger brother to make him sicker. The patient tells Foreman and Chase that he hasn't tasted water from the pump in months. The patient tells them his testicles have swollen. House is enthusiastic because it narrows down the diagnosis. Foreman plans to look for another marrow donor in case they can't figure it out.

Cameron and Chase check for infections that cause swollen testicles. Chase once again tells Cameron how he feels about her, something he plans to do every Tuesday. Chase thinks that the problem may not be an infection despite his fever. There are signs of a cardiac injury in the patient's tests and he feels the swollen testicles may be the result of a heart problem.

Chase and Cameron examine the patient's heart. They discover a growth on the mitral valve, which will take at least a month of antibiotics to heal. It appears to be a direct result of making the patient sicker.

House suggests replacing the infected valve and treating the patient's marrow with antibiotics. Foreman argues with Cuddy that the procedure would be too dangerous to the younger brother. Cuddy tells Wilson to go to the parents to tell them the risks, but not to let House bully them. House confides in Cuddy that Foreman has lost his edge, and that he will fire him if he doesn't shape up in the next four days (the same deadline as the marrow transplant).

They speak to the family about the risks to the younger brother, and they decide to allow the valve replacement. However, the younger brother is not told about the risks, one of which is that he won‘t be able to participate in sports because of the blood thinners he will have to take for the rest of his life.

However, a biopsy of the growth indicates the growth is fibrous, not an infection. The heart valve replacement won't help. Meanwhile, Hector has eaten House's drugs and gotten stoned.

The fibrous growth and other symptoms indicate an autoimmune disease. If it is an autoimmune disease, he can still be a marrow donor. House tells them to find out which autoimmune disease it is—there are very few of them and it will take almost no time to check. Meanwhile, the older brother’s arm starts to bruise, showing his capillaries are breaking down.

House’s cane breaks as he’s walking, thanks to Hector’s chewing. House vents about Hector to Wilson. Wilson suspects House left the drugs out for Hector to find. Hector has chewed through House’s cane and an rare old Elvis Presley 78. The team tells House the patient doesn't have an autoimmune disease and the older brother is getting worse.

Meanwhile, Foreman has found a 67% match bone marrow donor. Wilson and House try to talk the family out of it because of the risk of complications, but the family wants to proceed with the partial match. House is angry that Wilson backed down in face of a bad decision by the parents. Foreman may have been wrong, but he was doing what he thought was right. Wilson backed down even though he was right.

They give the older brother the 67% bone marrow match transplant.

House once again tries to get rid of Hector by "accidentally" leaving his door open. When he returns home, his stereo is gone, but Hector is still there. As House heads to another room he shuts the door behind him, only to hear Hector scream in pain having been hit by the closing door.

The younger brother is upset he can't visit his older brother because of his infection. While Cameron is treating him, the patient starts bleeding out of his ears.

House drags Wilson along to pay for a new cane and apologizes for calling him a coward. House hears about the bleeding and figures the patient's bone marrow has shut down, just like his brother. Now the younger brother will die if they can't figure out what is wrong. They have to stop his medication until his marrow rebounds. House buys a cane with a flame stripe.

The older brother has developed graft vs. host disease and isn’t responding to methylprednisolone. The young patient is getting worse despite being taken off medication. House comes up with the idea of putting the younger brother's marrow into the older brother to let the infection spread faster and find out what it is. House tells the parents its the only way they can save the younger brother, but the older brother will die—otherwise both sons will die. Wilson agrees. However, the parents refuse to give up on the older brother, risking both of their children.

Foreman wants to run more tests on the younger brother, but House believes it's futile because of the range of possible diagnoses—it will take months to run through the possibilities. Foreman leaves to start the tests anyway. House goes to tell the older brother he is dying. He tells him he can save his brother by risking his own life.

While they run tests, Wilson and Foreman discuss the water pump and Foreman's future at the hospital. Wilson wonders why the family has a water pump where they live, which is a suburb with municipal water.

The older brother wants to go through with being infected to save his brother, and the parents finally agree.

However, Foreman determines the answer—histoplasmosis, a fungal disease, most likely from chicken feces dug up from the farmland the house was built on. The younger brother can be treated, but his marrow still won't be any good for his older brother because the infection has attacked it—there isn't enough of it to treat the older brother.

While he treats the younger brother, Foreman tells him his brother was willing to risk his life for him, and asks if he would be willing to do the same. The younger boy says he would. Foreman tells him he is too sick to receive anesthetic for the pain the marrow removal procedure will cause, but the boy still wants to go ahead. The patient screams in pain and wants to stop after the first extraction, but Foreman says he needs a lot more and plunges back in, causing the boy agony.

The transplant is successful and both sons live.

Wilson tells House to tell Foreman he did a good job on the case. House says Foreman already knows that. Hector is in the office, chewing on Wilson's stethoscope. Wilson tells House Hector can go back to his ex-wife. Hector limps towards Wilson, favoring his right paw just like House. House has a replacement stethoscope ready. He tosses Hector a Vicodin, which Hector gulps down like candy.

Later, Foreman talks to House. House tells him he did good. Foreman is glad he saved both patients, but is upset that he feels that to be as good a doctor as House, he has to have more of House's personality. House expresses his opinion that Foreman has always had House's personality. However, Foreman has no intention of being under House's influence any longer, and gives two weeks notice of his resignation.

Zebra Factor 4/10Edit

Histoplasmosis is common in the environment, but severe infections are rare. One famous person who developed it was Bob Dylan, who was hospitalized.

Trivia and Cultural References Edit

  • House’s calculation of Hector’s age is based on the rule of thumb that a dog’s lifespan is about 1/7th at long as a humans, so one dog year is the equivalent of seven human years. He comes up with the right answer given that Hector is 17—the equivalent of a 119 year old human.
  • House also makes a reference to making the needle big enough to let a camel through it. This metaphor is found in several cultures, but the most famous reference is probably from the New Testament: “It is easier for a camel to go through the eye of a needle than for a rich man to enter the kingdom of heaven“.
  • A blooper: the team notes that the patient has no lung problems, but histoplasmosis usually presents with lung symptoms first.
  • The Yips is a phrase used to describe the loss of fine motor skills in an athlete. It is most often used when a golfer starts to have trouble making putts on a consistent basis.
  • The sport that House had on television when he was sleeping was Curling
  • 78 rpm was the standard revolution speed for records from about 1925 to the 1950s. The discs were referred to as “78s” to distinguish them from 33 rpm and 45 rpm records. The early recordings of Elvis Presley by Sun Records were released on 78 rpm discs. 78s generally faded from use in the 1960s as 45 rpm records, which were smaller, had better sound and were less likely to break replaced the format.

Major Events Edit

  • Foreman is revealed to have turned to God in order to help him cope with having killed a patient by mistake.
  • Chase's own incident where he accidentally killed a patient is brought up again.
  • House reveals that he plans to fire Foreman soon.
  • Hector chews on House's cane, causing it to snap and House to lose his cane.
  • Foreman goes behind Wilson's back to tell Nick and Matty's parents that they've found a new donor, a move which angers Wilson.
  • In revenge for having his belongings needlessly destroyed, House slams a door on Hector, crippling the dog in the process.
  • Wilson buys House a new cane, one with flames at the end.
  • Distraught over the way he acted to help both patients and believing that he's started acting like House, Foreman gives House his two weeks notice.

In real life Edit

The episode is similar to the real life case of David Vetter, often referred to in the media as the "Bubble Boy". Vetter suffered from severe combined immunodeficiency and had to live in an isolated environment from birth. At 13, doctors attempted a bone marrow transplant from his sister in order to stabilize his condition. However, due to an undiagnosed case of the Epstein-Barr virus in his sister, he developed mononucleosis and died from it.

CastEdit

LinksEdit


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House Training

Family
Next episode:
Resignation

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