John Kelley was the patient in Top Secret, an episode from Season Three. He was the patient House saw in a dream immediately before getting his file in the episode.
He is portrayed by actor Marc Blucas.
Medical History Edit
The patient had been a Marine for twelve years and was stationed in Iraq for the past two years. He was recently discharged. Since that time, he has suffered from fatigue, rashes and joint pain. He has also complained of intermittent sore throats. He believes it is Gulf War syndrome, but this is not a recognized diagnosis. He has been to several doctors at the Veterans Administration who have been unable to diagnose him.
The Series Edit
John sought out his old friend Lisa Cuddy who assigned the file to Dr. House. She told him John was a nephew of a hospital benefactor who she owed a favor to in order to insist he take the case. However, when Dr. House saw a picture of the patient, he became distracted because he could not remember ever meeting him before, but he had just seen his face in a dream he was having.
Dr. House brought the case to his team. Dr. Foreman and Dr. Chase argued about whether Gulf War Syndrome is a real disease and Dr. Cameron brought the discussion to an end by siding with Dr. Foreman. Dr. House thought the patient only had clinical depression and may be seeking a disability pension. Dr. House ordered a full physical and tests for HIV, hepatitis C, malaria, schistosomiasis and T-strain A. baumannii in the event that the Veteran's Administration missed something. He also ordered them to find out every hospital and clinic he has visited, every city he's ever lived in, and whether he had ever been on television. He said that being on television may indicate a neurology problem.
The patient described his symptoms to the team. The rashes usually appeared as black dots on the palms of his hands and the soles of his feet. He was not exhibiting them now, but the rashes came and went. He was sure they were not a scrape or bruise. Dr. Foreman pointed out he obviously worked out very hard, which is rare in patients suffering from fatigue and joint pain. The patient countered he had done physical training in the Marines every day for twelve years and they teach you to push through pain. He said he was tired all the time despite sleeping 10 hours a night. He constantly gets coughs, rashes and sore throats. His knees and hips feel like someone has poured sand in them. He gets weird tingling sensations in his legs that either make them feel cold or like his blood is boiling.
The team reported back to Dr. House. Dr. Cameron pointed out that apart from the joint pain, which couldn't be confirmed, none of the other symptoms he was complaining about were evident. Apart from low potassium, his blood work was normal and that result could have come about from overhydration after workouts. Dr. Chase still thought it was related to his service in Iraq - experimental vaccines, anti-chemical warfare pills or exposure to uranium. However, Dr. Foreman pointed out there was no trace of uranium in his urine, and he took the vaccines and medication over two years ago. Dr. House asked if the patient had ever done any modelling. Dr. Chase wanted to run a specialized test for uranium that was done in Leicester, England. However, Dr. Foreman pointed out that if the uranium was not detectable by their tests, the level would be way too low to do any radiation damage. Dr. Cameron asked why Dr. House wanted to know if the patient had been on television or in other media. Dr. House ordered a Lexis-Nexis search and a copy of his credit report. Dr. Foreman recommended discharging the patient with recommendations to add potassium to his diet and a psych referral. However, Dr. House ordered a polysomnogram as sleep apnea could cause both fatigue and paranoia. He also ordered them to find out where he went to summer camp.
Dr. Cameron and Dr. Chase oversaw the test in the sleep lab. However, John's sleep patterns were normal. Dr. Chase still thought it was exposure to something in Iraq, perhaps a toxin. Dr. Cameron suggested a liver biopsy. Dr. Cameron wanted to leave early, but Dr. Chase pointed out if they didn't monitor the results all night, Dr. House would reject them. Instead, they agreed to take a short break. However, Dr. Foreman came in to check when they were out of the room and found John awake. He went in to see him and John complained of a terrible smell. Dr. Foreman examined his mouth and realized the smell was coming from there - his tongue was coated with something.
Dr. Chase called Dr. House to report that John had bacterial vaginosis in his mouth, indicating there was something wrong with him. John had claimed he had not performed oral sex on anyone in over a year. The team had ruled out HIV, diabetes mellitus and endocrine system abnormalities as the cause. Dr. Cameron thought it might be Sjogren's syndrome - the dry mouth makes bacterial infection more likely. However, there was nothing wrong with John's eyes or tear ducts. Dr. Foreman thought that together with the other symptoms, the opportunistic infection pointed to cancer, probably lymphoma. He wanted to do a biopsy of a couple of lymph nodes. However, if it were lymphoma, Dr. House pointed out they would have seen swollen lymph nodes where Dr. Foreman wanted to biopsy. He ordered to ask Dr. Wilson to do a biopsy of the salivary glands to look for perotid cancer. He also told them to get John to admit who he has been having sex with. Dr. Chase argued it couldn't be an STD, but Dr. House told them to do it.
Dr. Wilson administered antibiotics to deal with the vaginosis and prepared for the biopsy. John noted that he had never used the thing that most commonly causes cancer of the salivary glands, chewing tobacco, although almost everyone in his unit did. Dr. Wilson assured him if they caught it early, it could be treated. However, John's mother had cancer, and he realized that early diagnosis meant diagnosis before there were any serious symptoms.
The team was wondering why Dr. House wanted the patient's credit report. Dr. Cameron thought it was because Dr. House wanted them to do a complete medical history.
Dr. Foreman talked to several of John's relatives, who all confirmed he had not had a date in over a year. This appeared to rule out STDs.
Dr. Wilson started the cyelogram. John asked for the music to be turned up, and Dr. Wilson agreed. The test was normal, but John kept complaining the music wasn't loud enough. Dr. Wilson started shouting, but John couldn't hear him. He reported to Dr. House that he had found six tumors, but they were in John's brain, not his salivary glands. He also told him that John had lost his hearing and that blindness was probably next. However, Dr. House was afraid that he would die before he actually went blind.
However, Dr. House was starting to suspect they weren't tumors. He compared John's recent scan to a scan done at the VA the previous week which was clean. However, Dr. Wilson had another explanation - the VA had mixed up the scans. The prognosis was that John would live no more than a week. Dr. Chase and Dr. Cameron reported that after checking all of the patient's records, the only thing John didn't mention was that his father had shin splints and his grandfather suffered from nosebleeds. When Dr. Wilson found out that Dr. House had been trying to find out where he had seen John and used his team to do it, he told Dr. House to go home and get some sleep while he worked with the team.
Dr. House told Dr. Cuddy that John would be dead in a few days. He also said the only explanation as to why it wasn't caught earlier was that the VA had screwed up. However, Dr. Cuddy told him that was impossible - she double checked his records herself. She had also reviewed the scan from the VA which showed no tumors, but did show a titanium pin in his skull that had been there for twenty years and also showed up on the more recent scan.
Dr. House ordered Dr. Chase to send John's urine to Leicester for uranium testing and asked Dr. Cameron to find out if John had been to any hospital fundraisers. However, she refused to check him out again, but Dr. House insisted.
They were prepareing to drill into John's skull to get a sample of the tumors, but when Dr. Foreman looked at the portable scanner, he couldn't see them. Dr. Wilson ordered the scanning angle changed, but the tumors still weren't there. They aborted the procedure.
They reported to Dr. Cuddy that the tumors had disappeared. Dr. Wilson insisted he had seen the tumors with his own eyes on the scanner. Dr. Foreman insisted that the portable scanner was working perfectly because it showed the brain tissue in perfect detail. Dr. House came to the conclusion that whatever it was on the scan, it wasn't tumors. Clearly there was something, but it might have been multiple abcesses from an infection. The infection was cured by the antibiotics they gave him for the vaginosis. However, Dr. Cuddy wanted to know why no infection showed up in his blood tests.
Dr. House started a new differential. Dr. Cameron thought it must be an infection, but this would not explain why his brain got better and his ears and legs got worse. Dr. Wilson thought it was suppression of the immune system from paraneoplastic syndrome. However, all the tests for cancer had been negative. However, Dr. Chase pointed out the uranium test was positive and suggested isotonic sodium bicarbonate. However, Dr. House only wanted to test for uranium because he thought it was cancer. Dr. Chase pointed out uranium can kill cells, but Dr. House pointed out the cells of the spinal cord wouldn't be damaged enough unless there was enough radiation to kill most of the other cells in the body first. However, Dr. House had no other theory so he merely ordered that antibiotics be continued and they check his hearing and paralysis every hour. He went home to get some sleep.
They monitored John's condition throughout the night, but it didn't improve. Dr. Foreman wanted to start treatment for the uranium. Although Dr. Cameron objected, they started the sodium bicarbonate. However, John started to complain that he couldn't feel anything in his abdomen. Dr. Chase used the whiteboard to ask if was having trouble breathing, but the paralysis hadn't extended that far.
However, when Dr. House came back to the hospital the next morning, he asked if the patient's blood pressure and hematocrit were plunging. They were, and Dr. Foreman wanted to know how he knew. Dr. House examined John's nostrils and found no nose hair and cauterization scars. He realized that John has suffered from nosebleeds just as his grandfather did. Combined with the other symtoms, it pointed to Hereditary hemorrhagic telangiectasia. This lead to arteriovenous malformations that choked off his spinal cord and prevented his lungs from filtering blood that led to the other symptoms. He ordered an MRA to spot the malformations. He just needed surgery and his prognosis was excellent.
Dr. House also realized where he had seen John before - at a fundraiser as Dr. Cuddy's date.