Medical History Edit
The patient had been having serious trouble breathing, constant fatigue, heart palpitations, insomnia and intermittent skin rashes over the past two years. He had seen sixteen different doctors without getting a diagnosis. He had received three full body CT Scans, two MRIs, had seven blood panels and a homeopathy consult.
Case History Edit
The distraught patient forced Dr. Hadley a nurse and six other clinic patients into Dr. Cuddy's office at gunpoint. Dr. House was in Dr. Cuddy's office at the time. He threatened to kill someone if the best doctor in the hospital wasn't brought there immediately, and Dr. House agreed to help. Jason ordered the others to barricade the room and he gave his extensive medical file to Dr. House, then took away his cane.
Dr. House did not spend much time examining the file. The patient had already listed his symptoms and given the patient's behavior, he guessed all the tests were negative. Dr. House instead examined the patient with his stethoscope. The patient described his breathing problems as having shortness of breath and feeling sharp pain when he inhaled. Dr. House did not have access to an incentive spirometer, so he started looking for a match. One of the patients had a lighter. Dr. House instructed Jason to hold it out at arm's length, then try to blow it out. The patient was unable to and started wheezing and coughing when he tried. Dr. House felt that reduced lung volume, fatigue, palpitations, stomach pain and intermittent rashes pointed to pulmonary scleraderma. Dr. House told the patient that he would be cured with a simple alkylitic agent. When Dr. Cuddy called on the phone, Dr. House asked for propofol. The patient demanded that Dr. Cuddy deliver it. She brought it to the door.
However, the patient was suspicious and demanded the drug be injected into one of the other patients first. Dr. House said the rest of the people in the room might have an interaction, but one of the patients had confronted Dr. Hadley that he was waiting for a pain prescription for migranes, so there would be no interaction. However, that patient told them to inject the other doctor - Dr. Hadley. Dr. House injected the patient anyway. There was no adverse reaction, so Jason got ready for the injection. However, at that moment, the injected patient collapsed. Jason realized the drug was a sedative, and Dr. House had injected him thinking it would take longer to affect a larger man. In retaliation, Jason shot one of the other patients, a well dressed man, and wounded him in the leg. Dr. Hadley tended to the wound. Jason refused to take any calls.
Dr. House managed to page both his new team and his old team by using his cell phone. They gathered in his office. Dr. House described the patient's symptoms. Dr. Chase refused to participate given the patient's behavior. Dr. Foreman thought it might be a chronic lung infection. Dr. Hadley suggested it might be cancer that started in the lungs and spread. Dr. Cameron thought the nerves controlling his diaphragm were damaged. The nurse reported that the patient who was shot was going into shock. Dr. Kutner thought it might be a circulation problem caused by a heart defect. Dr. House wanted Dr. Foreman to do blood tests for infection and cancer, asked Dr. Cameron to review his medical history to see if his prior prescriptions could have affected his heart, ordered Dr. Taub and Dr. Kutner to do an environmental scan for neurotoxins. The nurse took blood and Dr. House reported to the police that one patient was unconscious and one had a lower limb wound. Suddenly, Jason asked for quiet. He heard someone outside, Dr. Hadley opened the blinds and he saw a police officer. He threatened the officer, who retreated. Dr. House was intrigued that only Jason had heard anything, indicating hyperacusis. Combined with the other symptoms, this could indicate nerve palsy. Dr. House asked Jason to puff up his cheeks and smile. He showed muscle weakness on the left side of his face. This added up to a diagnosis of postherpetic neuralgia, a complication of several viral disease such as herpes and chicken pox. The test for it is dangerous, but the treatment is safe. The patient wanted the test, which only causes pain if he doesn't have the disease. The police phoned and Dr. House called for capsaicin, and Dr. Hadley would exchange the blood sample and medical records. The patient agreed to give up two hostages, but demanded everything had to be brought in by Dr. Cuddy. The police refused, but Dr. House convinced them by saying that Jason was unlikely to hurt Dr. Cuddy, but was likely to hurt another hostage. Dr. Cuddy agreed. Jason released the patient who was injected and the gunshot victim.
Dr. House looked for a volunteer to take the first injection, and Dr. Hadley was the only one despite the risk of muscle and nerve damage. Dr. House wanted to know why she agreed because she was at a higher risk due to her Huntington's disease diagnosis. She said she was doing it to protect the patients. Dr. House injected her and she collapsed with the pain. Dr. House went to inject Jason, and asked him why he was so desperate, but he wouldn't answer. Dr. House gave him the injection, but he had pain too, which ruled out nerve damage.
Dr. Taub and Dr. Kutner arrived at the patient's home and found everything neatly laid out for them. Jason was heavily in debt due to medical bills. Dr. Foreman did a white blood cell count which was normal. This ruled out infection, leaving only heart defect or cancer. However, Dr. Kutner had found a picture of Jason's mother, which showed a droopy eye, fat face and thick neck. This is a sign of an upper lobe tumor, or a problem with her adrenal gland. However, at that moment, Dr. Hadley noted that the patient's jugular vein was extended, which would indicate a heart problem. Dr. House took Jason's pulse and found his heart rate was 160. Dr. House performed a massage of Jason's carotid artery to slow his heart. He refused to use a defibrilator because this would cause his trigger finger to contract and set off the gun. Dr. Hadley realized that they could stimulate Jason's heart chemically despite the risk they would get it wrong. Jason didn't want to let her leave, but he finally agreed and let Dr. Hadley have 30 seconds to get the drugs, or else he would shoot a hostage. Dr. Hadley went to the safe to get adenosine syringes and momentarily stopped. Jason aimed his gun at a young hostage, but the nurse intervened and told him to shoot her instead. However, Dr. Hadley returned.
Jason told Dr. Hadley to inject herself first just in case there was a medicine interaction. Dr. House told him it was dangerous to inject adenosine when your heart rate is normal because it slows the heart. Dr. Hadley did it anyway, and immediately collapsed from brachycardia. Dr. House injected the patient and his heart rate returned to normal. However, this ruled out a heart defect. Dr. House also noticed Jason was sweating only on one side of his face. This indicated a tumor on his sympathetic nerves and lung cancer.
The nurse monitored Dr. Hadley's heart rate, which dropped below 50. Dr. House ordered the nurse to get Dr. Hadley on her feet so her heart would go faster. Dr. House called Dr. Wilson and told him he thought Jason had a pancoast tumor. Dr. Wilson said these usually show up below the 7th nerve. Dr. House asked Jason to spit on the floor, but he had a dry mouth, showing his parotid glands were not working. Dr. Wilson told him to check for swelling which would indicate a pankos tumor that had mestasticized. The swelling was there, but the patient wanted to confirm with an x-ray. To get to radiology, Jason agreed to release two of the female hostages. He surrounded himself with the other hostages for the trip. Dr. House still wondered why the patient was so desperate, but Jason said he just wanted an answer.
They got to the x-ray machine, and Dr. House prepared the area by obtaining a monitor. The patient threatened to shoot anyone who moved. He said he couldn't handle not knowing. Dr. House took the x-tray, and then asked for the gun. He showed the patient the gun had dispersed the x-rays and ruined the image. The patient agreed to give up the gun, and the nurse and one remaining male hostage ran out. This left only Jason, Dr. House, Dr. Hadley and a young patient in the radiology lab. Dr. House re-did the x-ray, but he didn't find any tumor. Dr. House admitted he didn't know what was wrong. He gave the gun back to Jason, picked up the phone, and told the police Jason overpowered him. Dr. Hadley accused Dr. House of needing to know what was wrong so badly that he would risk the lives of others just to know. Dr. House accused Dr. Hadley of trying to hasten her own death.
Dr. House called his team and found Dr. Wilson on the other end. Dr. Foreman thought that Dr. Chase was right to be worried that Dr. House was going to get someone killed and backed out as well. However, Dr. Taub guessed loa loa filariasis, but the patient had no history of travel to the Cameroons. Dr. Cameron guessed Q fever, but the patient had no exposure to goats. Dr. Kutner guessed histiocytosis X. At that moment, Dr. House noticed Jason was favoring his left ear, indicating partial deafness in the right ear. This did not seem to agree with the earlier indications of hyperacuity. The apparent risk taking could indicate Cushing's syndrome. Dr. House called for dexamethasone and time to confirm Cushing's. Jason agreed to give up the young hostage and not test any more drugs on Dr. Hadley. However, when they got the drug, the patient once again demanded that Dr. Hadley be given it first. Dr. House told him it was dangerous, but Dr. Hadley grabbed the syringe and injected herself. Dr. House injected Jason. He said not knowing what was wrong made him miserable, and that doing this gave him an upside. Dr. Hadley developed tachycardia and a fever, but Jason was unaffected - it wasn't Cushing's. Dr. Hadley was suffering from kidney failure and needed medical attention.
However, Dr. House told his team that given Dr. Hadley and Jason had taken the same drugs, Jason's kidneys should be failing too, and they weren't. Dr. Cameron guessed that one of the medications he took protected his kidneys. Dr. House told Jason he had to slap him. He did and noticed a twitch, Chvostek sign, indicating calcium deficiency. This was most likely from the proton-pump inhibitors he was taking for stomach pain for the past several years, which also protected his kidneys. This indicated a disease with a long incubation period . Dr. Taub suggested leishmaniasis, but it is only found in Arab nomads. Dr. Cameron suggested melioidosis, which is far more common. However, the medical history showed he had never been to a tropical climate. Dr. Cameron pressed the matter with the patient, who said he had never been south of Florida. However, Florida is a tropical climate. Everyone realized that it had to be meliodosis. Dr. House admonished the patient for giving an incomplete medical history. Dr. House asked the police for three grams of ceftazidime. The police refused, but Jason offered up Dr. House in exchange. Dr. House realized that Jason was going to inject Dr. Hadley first to check for medical interaction. However, this would kill her. Dr. Hadley agreed to stay because either the drugs would kill her or Jason would. Dr. House finally left and they threw in the drugs.
Jason pointed the gun at Dr. Hadley, but she could not bring herself to inject herself. Jason grabbed the syringe and injected himself. At that moment, the police set off a charge and took control of the radiology lab, arresting Jason. Dr. House administered to Dr. Hadley. However, as they were taking Jason away, Dr. House motioned to him to take a deep breath. Jason tried, and was breathing normally, confirming the diagnosis.