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Joy to the World

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Joy to the World
511-5962
Director(s)
Writer(s)
Airdate
December 9, 2008
Episode Number
5.11
TV.com Rating
8.3/10
Final Diagnosis
Zebra Factor
1/10
House: "How do I know? I missed my period, got fat, threw up… oh no wait! That’s how you know."
Whitney: "What?"
House: "I know because of the tight shirt stretched over the swollen boobs, the salt craving you reported into the clinic, the motion sickness patch that doesn’t do anything for the kind of sickness that you feel in the MORNING!"
— Joy to the World

Joy to the World is a fifth season episode of House which first aired on December 9, 2008. House and the team encounter a teenager who collapsed during her high school Christmas program. They soon find the troubled teen dealt with more than her share of bullying at school, and as her condition continues to deteriorate, the team must delve deeper to get to the bottom of her mysterious illness. Foreman continues to work with Thirteen on the Huntington's disease drug trial, and their relationship progresses when he learns a valuable lesson from her. House keeps the team guessing about who may have sent him a particularly thoughtful Christmas present. However, when Wilson realizes that House has been manipulating his team over the present, he bets him that he can‘t get a patient to give him a present and, as a result, House has to change his behavior in the clinic and to get a gift, he winds up giving one. Finally, Cuddy receives an unexpected gift of her own.

RecapEdit

Teenage girls plot backstage to break up a Christmas pageant. As they come on stage however, they abandon one of them to sing alternate lyrics insulting one of the teachers. She stops, but starts to feel faint, vomits and collapses.

The patient is 16 and is suffering from hallucinations and liver failure. Foreman is on vacation working on his clinical trial, so the case is presented by Cuddy. The team finds a present that House, but he tosses it in the trash, unopened. When Taub retrieves it and opens it, it turns out to be an antique medical text, though House throws it away again. He thinks the patient's friends may have slipped her drugs.

Kutner and Chase confront the patient's classmates, who admit to giving her hallucinogenic mushrooms.

Foreman is doing an examination of Thirteen. She asks about Janice Burke, and Foreman tells her that Janice has dropped out of the trial. Thirteen smiles at Foreman’s jokes and leaves behind a gift - a day at the spa.

Taub and Kutner retrieve the mushrooms and Taub wonders why House threw away the book. Kutner says that he‘s just screwing with them. However, they also find painkillers in the patient's locker.

Cuddy confronts the patient about using the painkillers. She also tells her about her own time in high school. The patient is overweight and her classmates are picking on her.

The parents tell Cuddy that the patient's behavior changed after she hit puberty - she became much more secretive. Mrs. Soellner gives them permission to treat her for painkiller overdose.

Taub and Kutner ask Wilson why House threw away the gift. Wilson appears to know something about the gift and after misleading them, admits he gave it to House last year.

Cuddy pages Kutner and Taub. The patient has a rapid heartbeat, high blood pressure and crackling lung sounds from pulmonary edema. This rules out painkiller overdose.

The patient's hallucinations were obviously from the mushrooms, but they don't explain the liver failure and lung problems. Taub tells House to admit to Cuddy how he feels about her, knowing that the present wasn't from Cuddy, but pretending he thinks it was from her. He threatens to tell Cuddy how House feels about her until Kutner breaks up into giggles. House realizes they know that Wilson gave him the gift. House orders Taub to get a stool sample and go to the homeless shelter where the patient volunteers and tells the others to do an environmental scan of the patient’s home and school.

Wilson wonders why House didn't open his present for a whole year. Wilson accuses him of being upset about being alone at Christmas. He tells House he should be nice to people, but says House is not capable of sustained niceness. House realizes it's a trick to get him to act nice and Wilson admits that it is, even though he knows it’s not going to work.

Thirteen goes to see Janice about why she left the clinical trial. Janice doesn't like Foreman because he wouldn't do anything about her nausea and told her to get over it. She didn't want to be his guinea pig anymore.

Taub thinks it might be tuberculosis because someone at the shelter has it, and stood in line behind the patient for a week. House agrees and orders treatment. Taub sees House put on a lab coat and go to clinic voluntarily, which is surprising given that House doesn't have clinic duty for the day. House acts nice with the first patient and does a proper examination and tells her she's pregnant. She didn't know she was pregnant. At that point he starts insulting her for being so stupid not to recognize the obvious symptoms. She says she is a virgin, but House doesn't believe her. House starts to lose his composure once she asks if she could have gotten pregnant from sitting on a toilet seat.

While Cuddy treats House's patient, she's having a seizure, but the patient's neck isn't stiff so it can't be from tuberculosis. Cuddy doesn‘t have any idea what is wrong with her.

It appears the patient needs a liver transplant and she is now having brain symptoms again. House wonders why Cuddy is so interested in the case. He thinks it is because she‘s started thinking about adoption again. Kutner thinks it might be a severe mold allergy or a fungal infection. House orders an allergy test and anti-fungals.

Thirteen speaks to Foreman about Janice. He admits that he told the patient to get over it, but he refuses to apologize to Janice. They get into a fight, but Foreman says the only way he can help her is to keep her on the regimen. Thirteen accuses him of being just like House.

The clinic patient comes back with her fiance. House eventually denies that they she could have gotten pregnant any other way other than having sex. Her fiance asks for a paternity test, and although House offers her an excuse, she agrees.

Taub and Kutner do the allergy test on the patient, but it is negative. Kutner wonders who brought her the homework and she says it was one of her athletic male classmates. Kutner chases after him and tells him he thinks he visited her out of guilt and wonders what he did to her. Taub thinks Kutner is taking out his own frustrations on the kid. The jock finally admits that he and the patient used to be friends but he pulled away when the others started making fun of him. He tells Kutner that the patient used to buy three bottles of vodka a week from him. They realize alcohol could account for the symptoms.

The patient denies having had a drink for the last six months, but admits she used to. She says she didn’t even drink all the vodka she bought - she just bought that much to stay close to the athletic boy who used to be her friend. She doesn’t have an explanation for why she stopped buying from him. Cuddy presses her about her deceptions, saying that although she herself was good at work and school, she's bad at relationships.

House's next clinic patient has asthma. He suspects she's not using her inhaler right, so he asks her to show him how it works. He's absolutely right - she points the inhaler at the sides of her neck.
House MD - Do I Look Like An Idiot?00:33

House MD - Do I Look Like An Idiot?

Do I look like an idiot!

Cuddy tells House that she doesn't think the patient is being honest and either wants to die or wants attention. He orders benzodiazepine to treat the alcohol abuse on the pretext that it’s treatment for the seizures, because then he won't need parental consent.

The pregnant clinic patient comes back with her fiance. House is shocked with the results and tells them not to leave.

Foreman is working hard on his clinic trial, spending the night immersed into files. He talks to the other doctor on the trial about the patient who dropped out. She tells Foreman not to treat the patients as people - they have to be treated as numbers. She picked him because having worked for House he knows that too.

The patient's heart gets slower and she goes into distress.

Six hours later, House comes back to the pregnant patient. House tells her that the fiance isn't the father, but she also didn't cheat. She's the first documented human case of parthenogenesis - virgin birth from an unfertilized egg with only maternal DNA. He wishes them a Merry Christmas.

House wants to tell the team about the parthenogenesis, but they want to talk about the patient. House realizes delirium tremens would cause the heart rate to rise, not fall. The signs point to leukemia. They consult with Wilson who recommends chemotherapy. House want to confirm with a bone marrow biopsy. Cuddy insists on treat her right away, which makes House want to know why she's so involved. Wilson says she's probably going to die - her heart, liver and brain are too far gone and the transplant committee will never approve her. He realizes House doesn’t want to put the patient through a painful and useless treatment.

Foreman goes to see Janice. He tells her of another trial of the same drug at a lower dose which will result in less nausea and offers to move her to the other trial.

Cuddy goes to do other differentials with House. He still wants to know why she's so involved. However, as he goes through his mail, he finds a present from the pregnant clinic patient. On his way to Wilson's office, he,to not receive any praise for the discovery,say that he faking the parthenogenesis to keep the clinic patient with her fiancé (the fiancé wasn't the father). He throws the present at Wilson and tells him “I win”. Suddenly Cuddy thinks of something - in a pregnant patient the symptoms all obviously point to eclampsia.

Cuddy goes to break the news to the patient. The parents know it's related to pregnancy. Cuddy realizes the patient hid her pregnancy - that‘s why she stopped drinking and why she feels guilty. Her weight allowed her to keep it from her parents. If she gave birth more than three weeks ago, the physical exam would have missed the fact she had given birth. The patient tells them that her athletic classmate is the father - they were having a relationship without telling anyone. She was planning on giving the baby for adoption, but the baby was born prematurely outside a hospital and she couldn’t revive it so she abandoned it. Cuddy breaks the news that the lung and liver damage are permanent and she's almost certainly going to die, since the odds of compatible replacements for both organs being found in time are minimal, and chances are the transplant committee would automatically refuse to allow the procedure anyway due to the patient's admission of underage drinking.

Cuddy goes to retrieve the dead baby from the abandoned house it was left in, but finds someone living there and that the baby is still alive - the people living there found her and took care of her. Cuddy tells them the baby needs treatment and the woman taking care of her agrees.

Cuddy arrives at the hospital with the baby. The patient embraces it. The baby's father arrives at the hospital too.

Kutner tells Cameron and Taub the patient could not get a transplant, but the baby seemed healthy. Taub attempts to talk to Kutner about it because he seems upset, but he says he has to leave. Kutner goes to a man's apartment and apologizes for picking on him during high school.

The baby gets put up for adoption because none of the grandparents wanted to take care of it. Cuddy says she's going to be the baby's foster mother and then try to adopt her. House wishes her a Merry Christmas.

Thirteen finds Foreman working on his clinical trial. She heard that Janice is back on the trial. Thirteen apologizes for comparing him to House. She says they should go to the Christmas party. He agrees, but they embrace and kiss instead.

Major Events Edit

  • House gets a present from an anonymous source which causes interest amongst his team, especially Taub. It is soon revealed that the present is in fact from Wilson, who gave it to House the previous year.
  • Wilson bets House he can’t get a patient to give him a present. House tries to be nice to patients with mixed results. House wins by faking a "virgin birth" for a patient who had cheated on her fiancee.
  • Kutner apologizes to a guy he bullied during his high-school years.
  • Cuddy receives a baby as a foster child. This marks the first appearance of Rachel Cuddy.
  • Foreman and Thirteen share a kiss.

Zebra Factor 1/10Edit

Eclampsia is fairly common, occurring in about 1 out of every 2,000 live births. The diagnosis was complicated because had the doctors known of the pregnancy, they would have noticed preeclampsia (high blood pressure and protein in the urine), a condition that will put doctors on the alert to watch for eclampsia later on (although only a small portion of preeclampsia cases develop into eclampsia).

Trivia & Cultural ReferencesEdit

  • The title is a popular traditional Christmas carol. The lyrics were first published in 1719 and it was set to music in 1839. It is the most published hymn in North America.
  • It can also be a reference to the episode "Joy", where Cuddy almost gets an adopted baby. In this episode, she fulfills her wish by taking Natalie´s baby.
  • The song sung by Natalie is The Christmas Song, written in 1944. Broadcast Music International lists it as the most performed Christmas song in the world.
  • The identity of Keyser Soze is the spoiler to The Usual Suspects, and is also a shout out to the movie’s director, Bryan Singer, a co-creator of the series. The spoiler also comes up again in You Must Remember This.
  • Tiny Tim and The Ghost of Christmas Future are from A Christmas Carol by Charles Dickens.
  • When the clinic patient who doesn't know how to use her inhaler calls House a "jerk" and Cuddy asks him what they're talking about, House says "Jamaican chicken recipes." Jerk is a kind of Caribbean spice which is frequently dry-rubbed onto chicken.
  • The ludicrous tale of "bullet impregnation" told by House to the young couple traces back to a joke from the post Civil War time : a Dr Legrand C. Capers published it as a tongue-in-cheek medical case review in a 1874 issue of The American Medical Weekly, but back then already, some readers failed to perceive its humourous intent. The story then spread to become an urban myth. For example, the singer-songwriter Tom Waits used it in a very House-like manner as one of the many tall tales he introduces his songs with during live performances, as appears from his tour album "Big Time" (1988). The myth was put to the test on MythBusters during the 2005 season in the episode "Son of a Gun", in which the myth was busted beyond reasonable doubt.

Sherlock Holmes ReferencesEdit

  • The medical text Wilson bought as a present for House is by Joseph Bell, who was credited by Arthur Conan Doyle as being the inspiration for Sherlock Holmes. When asked, Bell was of the opinion that Holmes was based on Conan Doyle himself. “A Manual on the Operations of Surgery” is a genuine book.
  • While Wilson is misleading Taub and Kutner, he fabricates a story of an "Irene Adler" giving House the gift, also mentioning how House fell for her during her case. (Sherlock Holmes has deep rooted feelings for Irena Adler in the book "A Scandal In Bohemia".) He also says "she's the one that got away", a clear reference to how Adler "got away" by outsmarting Holmes - one of the very few (only three men and one woman, as mentioned by Holmes himself in "The Five Orange Pips") people to outsmart him.

CastEdit

LinksEdit


Previous episode:
Let Them Eat Cake

Joy to the World
Next episode:
Painless

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