This article is about the patient in the episode Larger than Life. For other characters and people related to the series named "Jack", see Jack (disambiguation).
The patient is in a band called Suicide Season and frequently travels throughout the country.
Jack was with his daughter Daisy on a subway platform when he saw a woman having a seizure who had fallen off the platform. Jack went to assist her and managed to cover her just before a train went over both of them. He did not appear to be injured but when he stood up, he collapsed back onto the tracks.
Jack was taken to the emergency room of Princeton-Plainsboro Teaching Hospital. Ms. Masters was looking for cases to take to Dr. House and noticed that the patient has an abnormal EKG. She brought the case to Dr. House. Dr. House thought the patient’s act of heroism was a symptom and looked for a neurological cause. He thought that sympathetic stimulation in the patient’s brain triggered a response in the heart, causing the unconsciousness. He ordered his team to look for masses in the limbic system.
Ms. Masters performed the angiogram with Dr. Chase supervising, but the patient reacted badly to the procedure. His blood pressure and heart rate shot up and he went into cardiac arrest despite a jugular vein massage. Dr. Chase called for a crash cart and they managed to stabilize him.
Ms. Masters though the arythmia showed the problem was in the patient’s heart, not his brain. She pointed out both the collapse and the cardiac arrest happened after physical stress. She thought it might be vasovegal syncope . Dr. Taub thought that syncope would have manifested at a much younger age and suggested drug use. However, Jack’s tox screen was clean. Dr. Foreman thought it might be autonomous nervous system dysfunction. Dr. House agreed with Dr. Foreman and ordered a biopsy of the pituitary gland. Ms. Masters noted adrenal venous sampling was a much safer procedure, then realized Dr. House wanted to sample the pituitary because he still thought it was a brain issue. Dr. Chase reminded Dr. House that Jack had no other symptoms of a pituitary disorder. Dr. House agreed to the venous sampling, but thought it was a waste of time.
The tests showed the cortisol levels were normal, ruling out the autonomous nervous system. They proceeded with the pituitary biopsy, but during the procedure, the patient’s O2 stats started to drop and Dr. Chase had to suction out the nose. The patient’s breathing returned to normal, but they found a mucus plug in the patient’s suction contents. Dr. Foreman used his stethoscope and realized there was fluid in the patient’s lungs - pneumonitis.
Ms. Masters insisted the tests had ruled out any brain issue, and the problem had to be in either the heart or the lungs. Pneumonitis can be caused by bacteria, parasites and obstruction. Dr. House turned his attention to the woman the patient saved - Chloe Jeffries. He though that perhaps she and the patient had a previous relationship. He saw her collapse, thought it was her epilepsy, but it could be the same thing that caused him to collapse. Dr. Chase noted that the patient was away from home a lot. Ms. Masters thought it would be easier to get sputem for a blood culture, but Dr. House thought an infection was unlikely given the patient’s near normal white blood cell count. He thought it was a toxin. Ms. Masters argued the point but Dr. House insisted the patient’s behavior on the subway platform was otherwise inexplicable. He ordered an environmental scan of Ms. Jeffries’ apartment.
Dr. Chase and Dr. Taub did the environmental scan. They found a CD from Jack’s band there. Dr. Taub found roach spray, which could explain the symptoms.
However, the patient denied ever being in Ms. Jeffries’ apartment. Ms. Jeffries came in to visit, and the team found out she got the CD after the subway incident. Ms. Masters asked for a sputem sample to test for infection. However, the patient had trouble spitting. Ms. Masters percussed his back to assist him, but the patient cried out in pain and told the doctors that the pain was in his ears.
Ms. Masters insisted that the ear pain signified an infection that had spread to his mastoid. However, Dr. House thought it was an acoustic neuroma, a tumor in the ear which was also pressing on the breathing centers of the brain, affecting the lungs and heart. He ordered an evoked auditory potential test.
However, the patient’s auditory test results was normal. Ms. Masters still thought it was an infection. She felt the ear fluids would be a better source for a culture, so she planned to do an ear drainage and pleurocentesis. Dr. Chase agreed to supervise her.
The patient’s ear pain had improved on medication. Ms. Masters prepared him to remove ear and lung fluid. She administered lidocaine, but when she injected him in the back, his ear pain disappeared. The team realized Jack didn’t have cancer, but they realized that Jack’s nervous system mistook his ears for his back - that’s why his ear pain went away when they gave him a local anesthetic in his back. Dr. House realized that his ear pain was referred pain and that the real pain was coming from somewhere else, perhaps the thyroid gland or the liver. The team agreed to look at both, but Ms. Masters reminded everyone that the referred pain did not rule out an infection.
Jack’s thyroid hormone levels were normal, and Dr. Foreman started a liver biopsy. The results of that indicated autoimmune hepatitis. They started Jack on steroids. However, he soon suffered a series of seizures. They managed to keep him stable. Jack also developed a fever, which pointed back to an infection. However, it could still be a bacteria, virus or fungus. Masters’ cultures hadn’t come back yet. Dr. Taub thought he might have been exposed to leptospirosis in the subway, but Dr. Chase noted it was moving too fast. Dr. Foreman thought it might have developed into meningitis. Dr. House administered doxycycline.
However, after meeting with his girlfriend’s mother, who complained she always got sick when she was with her grandchildren, Dr. House went back to the patient to see if he had been in contact with any sick children recently. As he suspected, there had been an outbreak of chicken pox at the daughter’s school. Dr. House realized Jack had been exposed and the disease is far more serious in adults than in children. Although he did not have the itching and pustules common with the disease, five percent of cases don’t present with them. He figured that the daughter was merely a carrier and didn’t come down with the illness herself. He started Jack on anti-varicella gamma globulin.
Jack started to improve quickly and was soon out of danger. Ms. Masters cultures also showed positive for varicella, confirming the diagnosis.