This article is about the patient in the episode No More Mr. Nice Guy. For other characters going by the name of "Jeff" or "Jeffrey", see Jeffrey.
Jeff is the patient who is too nice to be true in the episode No More Mr. Nice Guy. He is the husband of Deb, a nurse at Princeton-Plainsboro Teaching Hospital. He is portrayed by actor Paul Rae.
Medical History
Jeff served several years in Habitat for Humanity and the Peace Corps and during that period of time travelled to Costa Rica.
Case History
Jeff was visiting his wife on the picket line during the nurses' strike when he lost control of his eye movements and collapsed. He was taken to the emergency room, but he was quickly acting normally and due to the strike the doctors were overwhelmed and could not perform a fuller examination. However, Dr. House was passing through the ER and wondered why the patient was sitting on a bed contented when it was obvious that he had been there a long time. Dr. Cameron referred to the chart and told Dr. House that Jeff had fainted and had a recent history of dysgeusia - all his food tasted like lemon meringue pie. He asked the patient why he had two lunches in front of him adn Jeff replied he had been there long enough for two meals. He said he wasn't happy about it, but he didn't see any point in complaining. When his wife suggested she speak to some doctors, Jeff assured her that they were doing the best they could in the circumstances. Dr. House then deliberately struck the patient in his foot with his cane. Jeff convinced himself it must have been an accident. Dr. House became intrigued by the patient and gathered his team together.
In his office, he suggested the patient might have a hormone disorder, exposure to a toxin, a carcinoma of the tongue that mestastisized to the brain, epilepsy, multiple sclerosis, or a genetic disease. However, Dr. Kutner thought he was just nice and Dr. Taub thought the niceness was irrelevant and the patient merely had influenza. Dr. House pointed out that the patient was too nice for too long a period (at least 11 years, since he met his wife) for the theory of evolution to have any basis in fact. Dr. Foreman pointed out it was unlikely that a disease could remain undiagnosed for 11 years. Nevertheless, Dr. House ordered Dr. Kutner and Dr. Foreman to do an environmental scan for toxins, and ordered Dr. Taub and Dr. Hadley to do an MRI and EEG.
Dr. Foreman found hydrofluoric acid which lowers calcium and could lead to fainting. However, Jeff's calcium levels were normal, as were all the other tests they ran. However, Dr. House proposed that Jeff actually had hypercalcemia which the hydrofluric acid had lowered to normal levels. Combined with the other symptoms, Dr. House believed he had Williams syndrome, a genetic condition where the genes that lead to suspicion are missing. However, Dr. Taub pointed out Williams had other symptoms. House noted the patient had mediocre teeth, glasses and his IQ wasn't all that high, but Dr. Hadley pointed out Williams patient had an elfin appearance and Jeff was portly. Williams also gives patients absolute pitch, and it was clear when Jeff tried to sing that he was tone deaf. However, while he was demonstrating his lack of singing ability, he suddenly had trouble speaking and Dr. Hadley realzied he was having a stroke.
The patient tested negative for Williams. Dr. House suggested neuroSyphilis, which would not show up on an MRI unless contrast was used. Dr. Kutner agreed to run the test. However, the patient denied he had it - he was tested for it when he joined the Peace Corps and was sure his wife hadn't slept with anyone else. Dr. Kutner said he couldn't be sure about his wife, but Jeff said he was.
Dr. Hadley suggested that a heart defect, a PFO would explain all the symptoms except the niceness and it would not have shown up on the echocardiogram. She went to do a bubble test. However, Dr. Kutner came in to announce that the patient tested positive for Syphilis. Jeff was informed and figured that his original test was a false negative. Dr. Kutner spoke to his wife in private. She denied having an affair, but also said she had trouble being angry with him because he was so nice. She was worried he was going to change, and Dr. Kutner confirmed his personality might change once his condition improved. Dr. Kutner told the wife she should be tested for Syphilis.
However, after they started treatment, Jeff started vomitting blood. Dr. House was informed and Dr. Taub put it down to the hematemesis typical of Syphilis, but Dr. House realized that his fellows were disagreeing about the cause. Jeff was already on penicillin, but was still getting worse. Dr. Kutner believed the bleeding was the result of liver failure, either from the treatment or from alcohol in cleaning products. Dr. House ordered liver and serology tests, even if that meant the fellows would have to stay up all night to do them. Jeff might not make it to the following afternoon given his condition.
However, Jeff's GGT as normal, ruling out alcohol. They reported that the paitent had non-viral hepatitis. Dr. House ordered steroids and testing for sarcoidosis to prevent complete liver failure.
The sarcoidosis test was negative so Dr. House ordered tests for leptospirosis, shistosomiasis and hemo.
The patient's personality started to change, getting enraged at trivial things his wife did. He then had a heart attack. His wife performed CPR and they managed to revive him. They started a new differential. Dr. Kutner believed the personality change was roid rage and high blood pressure] from the steroids. However, Dr. Taub pointed out that Jeff had only been on steroids for six hours. He thought that the penicilling was working and the rage was his real personality coming through. Dr. Hadley still thought it might be a PFO - it would explain the heart attack and decreased blood flow to the brain caused the rage. Dr. House and Dr. Foreman decided to go through with the bubble test for PFO.
However, as Dr. Kutner was assisting Dr. Taub with the bubble test, he suddenly realized that the patient might not have Syphilis. Other diseases can also cause a positive Syphilis test. Given the patient's history of travel to Central America, Chagas Disease was most likely. He tested for it and it was positive. He informed Dr. House, who said it didn't explain the niceness, but Dr. Kutner said that encephalitis would and that Chagas could cause that too. Dr. House pointed out that there was no encephalitis on the previous MRI, but given that the patient was on steroids, Dr. Kutner figured he would be immunosuppressed and had done another MRI which showed a small area of inflammation in the brain. They started him on medication. Jeff soon improved and his only remaining side effect was that he didn't like the taste of ketchup anymore.