This is an article of the patient in constant pain in the episode Painless. For other characters by the name of "Jeff" or "Jeffrey", see Jeffrey.
Jeff was the patient who tried to commit suicide in the episode Painless.
Medical History[]
Jeff had been suffering from chronic acute pain for many years, and no doctor could find a cause or cure, and it had become apparent that the car incident was not his first suicide attempt.
Case History[]
Jeff's wife and child came home early and found him in the garage unconscious with the motor running in an attempt to commit suicide by carbon monoxide poisoning. His wife called an ambulance and she gave Jeff CPR to try and resuscitate him. Jeff regained consciousness and told his wife "I'm sorry," and that he couldn't take the pain anymore.
Dr. Cameron brought the case to Dr. House. Dr. House thought it might be drug seeking behavior, but Dr. Cameron pointed out that he tried to commit suicide with carbon monoxide when he had a house full of narcotics. Dr. Hadley thought it might be fibromyalgia. Dr. Cameron admonished Dr. Hadley - she knew Dr. House wouldn't be interested in something without an explanation or treatment. When Dr. Foreman defended Dr. Hadley by saying fibromyalgia had specific diagnositic criteria, Dr. Cameron countered that the patient didn't meet the criteria - for one thing, putting pressure on the painful areas made it better, not worse. The patient also had additional symptoms - abdominal pain, headaches and intermittent muscle cramps. Dr. Taub thought the patient had a mental illness and the pain was psychosomatic. He argued sane people don't attempt suicide and that every doctor the patient saw in the last three years and has found nothing wrong with him. Dr. House ordered a pain profile to rule out psychosomatic pain and an environmental scan of the home.
Dr. Taub administered the pain profile with Jeff and confirmed the symptoms with his wife and son. Dr. Foreman and Dr. Hadley couldn't find anything in the home except a lot of pain medication. Dr. Hadley thought it might be metal polish toxicity, but Dr. Foreman found a respirator. However, they did find wild quail in the freezer.
Dr. Foreman and Dr. Hadley suggested a constant stream of food poisoning from the wild game which caused rhabdomyolysis and explained the elevated CK levels, but Dr. Taub was incredulous it could have gone on that long. He also argued the pain profile indicated a psychosomatic cause - the patient had a very high level of concern over his physical health. He thought antidepressants were the proper course of action. Dr. House went with Rhabdo and ordered intravenous fluids, a urine test, and muscle biopsy.
Dr. Hadley started a series of muscle biopsies. All of a sudden, the patient started complaining about pain even though he was on pain medication. Dr. Kutner noted Jeff's blood pressure was falling and said they had to get him into Trendelenburg position. However, despite their efforts, it appeared he was heading into cardiac arrest. Dr. Hadley called for a crash cart.
The team attempted to contact Dr. House, but was unable to get an answer. A VQ scan showed a pulmonary embolism. This ruled out psychosomatic pain and rhabdo. The pain in the heart and lungs was new, which meant his condition was getting worse. Dr. House finally called back and figured it had to be heart issues and an embolism; there would be no reason to call if the heart weren't involved and if there was no embolism rhabdo would have been confirmed. Dr. Hadley thought it might be a clotting problem, but Dr. House pointed out this explained nothing. Dr. Kutner thought it might be related to cancer, something like Trousseau's syndrome. Dr. House was doubtful as someone would have seen cancer in the three years he's been under treatment, but he did allow tests of the chest, abomen and pelvis for tumors.
Dr. Taub and Dr. Kutner did an MRI on the patient. They didn't find cancer, but they did find an edema in his intestines and air in the intestinal blood vessels. They tried to get in touch with Dr. House, but were unsuccessful, so came to see Dr. Foreman and Dr. Hadley at the office where they were holding the clinical trial. Dr. Foreman figured there had to be damage allowing air to leak in. Dr. Kutner noted that if the patient's superior mesenteric artery were blocked, it would cut off blood flow to the intestines. Dr. Hadley realized numerous intestinal blockages would explain the pain. Dr. Foreman agreed to an angioplasty on the suspect artery and an examination for other congested blood vessels.
When Dr. House returned, Dr. Foreman reported that they had diagnosed the patient. Dr. House was doubtful as the patient should have exhibited an irregular pulse. Dr. Foreman countered that the patient's blood pressure was irregular and that they had scheduled and angioplasty. Dr. House went to see the patient and cancelled the angioplasty. He examined the patient's intravenous tubing and discovered a break in the tubing. He realized the patient had blown into his IV tubing to cause the air bubble in another suicide attempt, and Dr. Kutner realized that was what caused the cardiac arrest and embolism. The patient admitted to it and asked Dr. House to let him die, but Dr. House refused.
The patient was placed in a hyperbaric chamber to force the air out of his blood. Dr. Cuddy called the team to her home in order to admonish them for not keeping a proper watch on a suicidal patient. Dr. Hadley suggested it was non motor seizures. However, all of the patient's EEGs had been clean. Dr. Foreman thought it was a glycogen storage disease like McArdle's disease. Dr. House agreed and ordered an ischemic forearm test.
Dr. Kutner described the test - they would draw blood from the forearm repeatedly and, if the pain increased, it indicated a muscle abnormality. If it were McArtle's, they could treat it to reduce the pain. They got the patient to squeeze a tennis ball to test his muscle strength, but all of a sudden he cried out and dropped it. He said the pain had jumped to his left leg.
Dr. Taub reported to Dr. House. The patient's first pain was in his abdomen, but during the test it skipped from his left arm to his left leg without passing through the torso. Dr. Taub felt it had to be a problem with the patient's brain, not his body. However, in order to test the theory, they had to separate his brain from the rest of his body. Dr. House went to Dr. Cuddy with a plan - injecting the patient with lidocaine directly below his brainstem which would numb him from the neck down. If the pain persisted, it was his brain, if it went away it was his body. Dr. Cuddy pointed out that the procedure was very dangerous, but Dr. House pointed out if they couldn't diagnose him, he would eventually kill himself. Dr. Cuddy gave him permission to proceed.
Dr. Chase prepared the patient for the procedure. After the injection, the pain lessened, but didn't disappear. When Dr. House reported the findings, even Dr. Hadley thought it might be psychosomatic. She thought the injection triggered a placebo reaction, but Dr. House pointed out that the patient reported real narcotics weren't making a dent in the pain anymore.
The team was paged and found the patient's son crying in pain on the floor outside his father's room. However, Dr. House thought the son was faking the pain and went to check the patient. He found the patient hiding a bottle of isopropyl alcohol which he stole from the orderly when his son created a distraction. When Dr. House went to confront the son, he asked them to let his father die.
Dr. Foreman suggested it might be Fabry disease which can cause both brain and peripheral pain, but there was no angiokeratoma. Dr. Kutner suggested lightning pain from Syphilis, but all the tests for STDs were negative. Dr. House had to come up with a new theory - there was pain from a previous injury, but the injury had healed properly, explaining why they couldn't find it. Perhaps the pain was an adverse reaction to the narcotis he was taking - opioid induced pain. He ordered the narcotics discontinued. In theory, although he would be in a lot of pain for a few hours, his brain would eventually return to normal and the pain would stop. Dr. Taub pointed out if they were wrong, they would essentially be torturing him. Dr. House was unmoved.
Dr. Kutner went to inject the patient with naloxone to counter the effect of the opiates. The patient objected strongly, but Dr. Kutner reassured him. However, the patient remained in tremendous pain. Dr. House ordered the pain medication restarted.
The patient's wife went to Dr. House and asked him to stabilize Jeff so he could be released. Dr. House agreed to the request.
Dr. Hadley was upset that they were giving up. However, Dr. House managed to come up with a new idea and rushed back from his home to the hospital. He started talking about testicles and Dr. Taub thought he might be talking about an STD or perhaps a hormone problem. However, Dr. House was thinking epilepsy. If the problem was really deep in the brain, the patient could feel referred pain from the muscles supporting his testicles. This would not show up on the EEG. He went to the patient and asked if the pain was similar to what happens when someone is kicked in the testicles. He asked if the pain started there instead of in the abdomen like he told the doctors. The patient agreed to further tests because epilepsy could be treated. After treatment, the pain started to improve and the patient was soon walking around the hospital with his son.