This is an article about the woman trapped under a collapsed building in the episode Help Me. For the woman with insomnia in Sleeping Dogs Lie, see Hannah. For the teenager with CIPA in Insensitive, see Hannah Morgenthal.
In May, 2010, a crane collapsed into a building in Trenton, New Jersey, injuring and killing over a hundred people. Doctors from several hospitals in a large radius around the city were called to the scene to do triage and administer first aid.
Dr. Gregory House a diagnostician at Princeton-Plainsboro Teaching Hospital, heard a noise in the rubble from someone hitting a nearby pipe. He alerted emergency personnel at the scene, but they could not detect any sound in the area, and their dogs could not pick up a scent. Dr. House decided to investigate further and crawled down to the parking garage. Suddenly, someone grabbed his cane and asked for help.
Dr. House attempted to gauge the patient’s mental state by asking her name. She was responsive, but kept talking about a present for her husband. When Dr. House told her the purpose of his question, she said her name was Hanna. She correctly identified the day of the week, but was unaware of what had happened. Dr. House tried to pull her out, but Hanna cried out in pain. Dr. House realized her leg was pinned under debris. He said he would go to get help, but Hanna didn’t want him to leave. Dr. House explained no one knew where he was and it was unlikely they would be found otherwise. Hanna begged for him to stay, but Dr. House reassured her he would be back. However, she cried out for him not to leave.
Emergency personnel reached Hanna, but they could not find a vein to insert a line for intravenous fluids and returned to Dr. House for assistance. However, the EMT confirmed she wasn’t getting weaker, her color was good and she was stable. Dr. House was relieved as this showed Hanna hadn’t lost much blood and they would have time to get her out of the rubble. Dr. House instructed the EMT to insert the IV line into her tibia as that bone is hollow and the fluids would drain into her venous system anyway. However, the EMT had no idea how to perform that procedure and Dr. House had to go back to the patient to perform the procedure himself. The emergency workers were unable to break up the beam that was pinning Hanna’s leg, but went to get lifting equipment. Dr. House inserted the IV line. Hanna wanted to call her husband, but there was no cell phone signal. Dr. House left to attend to a patient back at the hospital.
However, on further inspection, it appeared that the beam trapping Hanna was supporting a large amount of rubble that might collapse further if the beam were moved. The fire captain wanted to talk about amputation, but the patient refused. Dr. Lisa Cuddy told the patient that she had been trapped almost two hours and would need medical attention. However, Dr. House told the patient there was no rush. However, Dr. Cuddy reminded Dr. House and told the patient that she was likely to develop crush syndrome - the dying muscles in her trapped leg were creating toxins that would be released back into her bloodstream once circulation was restored. The longer she was trapped, the more toxins there would be and the higher the likelihood of a heart attack. However, Dr. House believed that Hanna had at least two more hours before crush syndrome could possibly set in and wanted the emergency crews to try to free her from the rubble. However, there were ten tons of debris that had to be moved. Hanna insisted that they try. The fire captain told her that there were other risks, such as gas leaks, fire and secondary collapses that also posed a risk. Dr. House countered that an amputation in this situation risked sepsis, a fat embolism or heavy bleeding. Although the fire captain was opposed, Dr. Cuddy reminded him that it was the patient taking the risk and it was her choice. Hanna asked Dr. House not to let them cut off her leg and he promised to not let it happen. However, he told the patient that he had to return to the hospital to deal with another patient.
Dr. Cuddy intercepted Dr. House before he left and told him Hanna was now having a panic attack and was likely to rip out her intravenous lines. Dr. House was sure someone else could deal with it, but Dr. Cuddy said the patient wanted him. Dr. House said she just needed oxygen, but Dr. Cuddy reminded him the emergency personnel wouldn’t let them use oxygen in an environment where combustion was likely for fear of an explosion. Dr. Cuddy ordered him to go back.
Dr. House returned to Hanna, who quickly calmed down. He gave her his cell phone so she could call her husband as he took her blood pressure. Dr. House told her the reason he didn’t let her have the phone before was because her emotional state would be heightened, raising her blood pressure and causing more bleeding into the trapped leg. He asked her to hang up. Dr. House apologized, but Hanna thanked him and told her that her husband was on his way. Hanna asked how many people were hurt and Dr. House told her to not think about it as it would raise her blood pressure. He agreed to join her in prayer in order that she could relax.
The emergency team arrived with the lifting equipment. Dr. House warned Hanna that once the beam was lifted off her leg, she would be in severe pain. As the lift started, Hanna stated to feel the pain and the emergency team tried to free her. However, as they feared, there was a small secondary collapse of debris. No one was injured, but Hanna’s leg remained trapped. Dr. House detected a tension pneumothorax and called for the first aid kit. He used a large needle and syringe to re-inflate the lung. However, the fire captain noted Dr. House was bleeding and told him to get checked out to make sure he hadn’t damaged one of his arteries.
The fire captain reported that because of the secondary collapse, it would take at least six hours to free Hanna. Dr. Cuddy wanted to amputate, but Dr. House refused. He said they could keep her stable by removing potassium from her system. Dr. Cuddy pointed out Hanna was already on sodium bicarbonate for just that reason. Dr. House suggested using glucose and insulin as well, but Dr. Cuddy said that would even be dangerous in a hospital. Dr. House was still adamant, but Dr. Cuddy pressed the matter. She told him he was risking the patient’s life just to save her leg. She reminded him that he made the same choice and it resulted in permanent disability. She said she was going to speak to Hanna to convince her to consent to the amputation and told Dr. House to say out of it.
Dr. Cuddy couldn’t convince Hanna. Hanna felt her lack of pain meant she could wait. However, Dr. House showed up and told Hanna Dr. Cuddy was right. He told her they were out of time. He told her that he had made a similar choice. Doctors told him to amputate his leg and he chose a risky operation instead. Hanna pointed out he saved his leg, but he tells her he wish he hadn’t. They cut out a piece of muscle the size of fist, leaving his leg mutilated and useless. He’s in constant pain, and it made him so much worse a person that he’s now alone. He tells her she doesn’t want to be like him. She has a husband and friends and they will still be there even though her leg won’t be. She will still have a life even though she won’t have a leg. Hanna agrees to the amputation.
Dr. House explained that he could not anesthetize her because her breathing would be suppressed. He administered a mild sedative. He explained that he would use a scalpel to cut through her muscle, skin and fat, which would be quick. After that, he would switch to a bone saw to cut through the two bones of the lower leg, which would take about as long as sawing through two broomsticks. Once back at the hospital, she could be fitted with a prosthetic. He warned her it would hurt like nothing she ever felt before.
Dr. House prepared by sterilizing the amputation site. He warned Hanna he would start cutting. She was in pain, but it was bearable. He was finished in a few seconds and switched to the saw. He started cutting and Hanna cried out in pain. She was finally freed and the emergency team worked to stop the bleeding, put her on a stretcher, and removed her from the building. Dr. House followed her to the ambulance, where her husband was waiting. He got into the ambulance with them and they started on the way to Princeton-Plainsboro.
Hanna’s heart rate was fast, but stable. However, on the way to the hospital, Hanna’s breathing became fast and labored, and her blood pressure dropped to 72/42 and her heart rate rose to 148 bpm. Dr. House ruled out the possibility of a pneumothorax and noted that her jugular vein was flat. He feared that a clot had broken off and lodged in the lung. He called for streptokinase, a blood thinner, despite the risk of bleeding from her surgery as the clotting problem was life threatening and they could treat the excess bleeding at the hospital. However, she didn’t respond. The EMT technician suggested it might be a heart problem, but Dr. House checked and her heart beat was still regular, although it was slowing. He realized Hanna had a fat embolysm from the amputation that had lodged in her lung and there was nothing they could do and there was nothing that they could have done to prevent it. Hanna was DOA at the hospital.