Henry Arrington, a 65 year old retiree with a history of acid reflux, presented at the emergency room accompanied by his 20 year old daughter after suffering an absence seizure. He was examined by Eric Foreman, who admitted him. Dr. House was assigned as his attending physician when the cause of the seizure was not immediately apparent.
On further examination, the patient also presented with a swollen testicle. Dr. House suspected an STD, but the patient denied having any sexual contacts after his divorce from his wife over a year ago. However, when the daughter left the room, the patient admitted to a short sexual liaison with his ex-wife. He had withheld the information fearing that it would alienate his daughter from her mother. The patient was immediately treated with antibiotics, but suddenly started vomiting blood.
After a further differential, Dr. House asked the patient if he had eaten any unpasteurized cheese as the patient had mentioned that he had seen his wife at a cheese-tasting party. The patient revealed that he had. House immediately diagnosed a brucellosis infection, complicated by myocarditis. The patient had been the only one who became infected because the antacids he had been taking lowered the level of acid in his stomach, making him prone to a stomach infection. The patient was put on broad spectrum antibiotics in the hope that the infection has been caught in time.
However, the myocarditis was irreversible and the patient was soon suffering from congestive heart failure. The only available treatment was a heart transplant, but the transplant committee refused because of the patient's age.
However, Dr. House and his team managed to salvage the heart of a 40-year old female accident victim, after finding out, ironically, that she had been suffering from gonorrhea. They treated the gonorrhea and transplanted the heart just as the patient's heart failed.
The patient was last seen reconciling with his ex-wife.
Henry Arrington was playing bridge when suddenly he froze for a few seconds, blinked his eyelids rapidly and was unaware of his surroundings or that any time had passed. He was taken to the emergency room at Princeton-Plainsboro Teaching Hospital.
Dr. Foreman examined the patient told him that he had an absence seizure. The patient denied ever having a seizure before. Henry told him that he had a headache the previous Sunday and that he had been suffering from acid reflux for the past two years. He took antacids for it. Dr. Foreman reassured Henry that the acid reflex and headache were not something that should have made him come to the ER earlier. Henry sent his daughter out of the room told get coffee and then showed Dr. Foreman that his right testicle was almost twice as big as the left one.
Dr. Foreman brought the case to Dr. House, believing he might be intrigued by the symptoms. Dr. Chase thought that it was testicular cancer – the symptoms were exactly right. However, Dr. House dismissed it as he figured Dr. Forman was smart enough to have performed a biopsy and rule out the diagnosis. Dr. Foreman confirmed that he had already tested for testicular cancer. Foreman had also done a lumbar puncture which showed white blood cells, but his MRI was clean. Dr. House thought it might be a microabcess in the patient's brain. Foreman had already seen something in the patient's left temporal lobe, but thought it was just a shadow. Dr. House thought it might have indicate an infection from a sexually transmitted disease. However, Dr. Foreman had already tested for syphilis, gonnorhea and chlamydia. Dr. House ordered treatment for them anyway. If it wasn't an STD, it would have to be lymphoma, which causes infiltrates in both his reproductive organs and his brain.
Dr. Foreman told Henry that they thought it was an STD, but Henry denied having any sex since his divorce and pointed to the negative tests. Foreman offered to talk in private with his daughter out of the room but Henry didn't want to. House thought he was lying, he told Dr. Foreman that he would get paged when Henry's daughter went out for lunch and then told Foreman to page him. Foreman got paged shortly after House told him that.
With his daughter out of the room, Dr. House went to see the patient and Henry admitted he had slept with his ex-wife because they happened to be at the same Italian cheese tasting. He didn't want his daughter to know. Dr. House administered intravenous STD medication. Amy entered the room and Henry admitted he had an STD, and Dr. House lied and said that Henry met a women in church and that's how he got an STD. Henry then started vomiting blood. Dr. House called for a crash cart and ordered 40 mg of furosemide to sedate the patient. His daughter asked how an STD could cause these symptoms, and Dr. House told her that it wouldn't.
Henry had developed pulmonary edema and a litre of fluid had to be drained from his lungs. He was put on a respirator. However, his lungs were fine; his heart had vegetations obstructing his mitral valve. That could not be caused by an STD or lymphoma. Dr. Cameron suggested psittacosis, but if that were the case he would have tested positive for chlamydia. Dr. Foreman suggested streptococcus, but that wouldn't affect the reproductive system. Dr. Cameron thought it might just be multiple organ failure from old age. However, Dr. House noted the heart and stomach can be connected and the patient suffered from acid reflux. However, the acid reflex had gone on for two years with no other symptoms.
Dr. House went to see the patient again. He asked about the cheese at the Italian cheese tasting. Henry said it was soft and tasted bitter. Dr. House gave him regular cheese with bacteria on it. He asked if that was what it tasted like, Henry told him that it was. House told him that that was what made him sick. Henry asked why no one else at the cheese tasting got sick. House informed him that it was because of the antacid he was taking for the acid reflux. He had a brucellosis infection. No one else got it because their normal high stomach acid levels would have killed the bacteria.
Henry was put on rifampin and doxycycline in the hope that the infection could have been caught in time. However, Henry soon he went into cardiac arrest confirming that they hadn't treated it in time. A vegetation broke off in his coronary artery, causing an infarction. Dr. Chase managed to stabilize the patient, but now the only thing they could do was get him a heart transplant, and he needed one in less than a week. However, the rest of his organs were just fine.
Dr. House went to the transplant committee and told them he was a good candidate for a transplant. However, they wouldn't give him a new heart because of his age. Dr. Simpson pointed out that he would only have another five, ten or if he was very lucky twenty years. Dr. Cuddy pointed out that hearts are scarce resources.
Dr. Foreman told Henry the committee's decision. Henry asked how much longer he had left to live. He was told that he only had about a week.
Dr. House refused to appeal the committee's decision to the board of directors because he agreed with the decision. He told Cameron to keep track of everyone who died in the hospital hoping that they could find him a new heart from a dead person who was not suitable for a transplant. She found several useless ones such as a 90 year old, a baby and a 40 year old male who died of a heart attack. However, she did find a 40 year old female who was in a car crash. She wasn't a smoker but she was overweight. The only thing was that she hadn't been declared dead yet. Dr. House hoped that organ procurement would reject the heart so he could use it.
House asked her husband about her health. She had had a fever and abdominal pain. The husband was then informed that she had been declared dead. Her organs were declared not viable, but this was due to a diagnosis of hepatitis C. Dr. Foreman reminded Dr. House that giving Henry this heart, combined with immunosuppressing drugs would be fatal. However, Dr. House didn't think she had it based on her medical history of fever and stomach ache. Dr. House kept her on the ventilator and spoke to her husband.
Dr. House and Mr. Neuberger went to Dr. Cuddy and Dr. House argued he could use the heart and classify the treatment as experimental so it wouldn't affect the hospital's transplant statistics. However, her husband didn't want her to be on a ventilator and did not want to cooperate with House due to his earlier deception. However, as Mr. Neuberger was leaving to turn the ventilator off, Henry's daughter Amy thanked him. House told him that Amy's father would die in a week without his wife's heart. He consented to it, but took out his anger on Dr. House and struck him.
Dr. Chase was assigned to work with Henry to keep him alive, and the rest of the team worked on diagnosing Mrs. Neuberger's illness. Henry's heart wasn't strong enough to pump blood to his brain, and they had to insert a balloon to assist it.
The team eventually diagnosed Mrs. Neuberger with gonorrhea. However Henry was already in a coma. Dr. Chase started him on dobutamine so they could not wait for the penicillin to clear the gonorrhea from her system without risking brain damage in Henry. They had to give her a massive dose of penicillin and treated Henry with it as well. Dr. House activated the transplant team. They removed her heart and gave it to Henry. They had trouble getting it to start, but eventually were able to take him off heart-lung bypass.