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Last Resort

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Last Resort
Last resort
Director(s)
Airdate
November 25, 2008
Episode Number
5.9
TV.com Rating
8.4/10
Guest Star(s)
Final Diagnosis
Zebra Factor
4/10

The desperation of the homicidal patient:

"You’re not me. This is my body. This is my life. And there’s a truth out there. I would rather rot in jail knowing than… I can’t handle not knowing. "
―Last Resort

Last Resort is a fifth season episode of House which first aired on November 25, 2008. A man willing to kill – or die – for a diagnosis takes House, Thirteen and several patients from the hospital waiting room hostage in Cuddy’s office. With one person shot and other patients needing medical attention, Thirteen agrees to be used as a guinea pig by the patient to prevent him from being sedated by the medications they send in to treat him. With the SWAT team closing in, House is determined to end the standoff the only way he knows how: by coming up with the right diagnosis. However, Thirteen’s willingness to risk her own life makes House wonder if her reckless streak may turn fatal as each additional injection brings her kidneys closer to failure.

This episode finished 10th in Facebook's poll of the best episodes of the series completed in April, 2012.

RecapEdit

A migraine patient is trying to get Thirteen to rush him through the clinic. Foreman comes in and asks Thirteen if she wants to participate in a Huntington's drug trial. She says she's not interested, and says she's not taking any treatment for her condition and brushes him off.

Another patient comes into Cuddy's office and finds House. He tells him to get lost. However, a few minutes later, the patient comes in with a gun and hostages, mainly consisting of clinic patients but also including a nurse and Thirteen and demands that the best doctor in the hospital come and tell him what's wrong with him. House asks him, "What seems to be the problem?"

The patient with the gun starts barricading himself in Cuddy's office. House asks him not to barricade the bathroom, pointing out that many of the hostages are sick patients and doing so would likely cause some problems, but the patient ignores him. The patient starts talking about how many doctors he's seen, how he can't breathe, how tired he is, his insomnia, his rashes and his heart palpitations. He shoves his medical records into House's hands. The patient then grab’s House’s cane and tosses it aside.

A SWAT team arrives at the hospital. House examines the patient. He correctly guesses the patient's medical history without looking at it: all the tests are normal. The phone rings, but the patient won’t answer it. The patient is having shortness of breath and a sharp pain when he inhales. House asks the hostages if they have a match. Thirteen moves to look in Cuddy's desk for one, but House tells her not to touch the desk. He manages to scrounge a lighter from one of the hostages to test if the patient can blow it out. He wheezes and is unable to blow out the lighter at arm‘s length. House diagnoses pulmonary scleraderma, which is easy to treat.

Cuddy calls the office. House answers and asks for something to confirm the scleraderma. The patient doesn't trust a cop coming near the office and says that he wants Cuddy to deliver the drugs. House gets the drugs from Cuddy, but the patient won't let House inject him without injecting someone else first. Unfortunately, all the patients would suffer an adverse reaction given their own sicknesses. The patient tells House that the migraine-sufferer is not on painkillers because he was looking for a refill, so House chooses him. The migraine-sufferer objects, saying that Thirteen should be the one injected because she is a doctor and the gunman doesn’t like doctors. House gives the migraine-sufferer the injection anyway. The test goes well and the patient (the gunman) agrees to be injected. However, right after the agreement, the migraine-sufferer keels over and the patient realizes that the drug is a sedative. The patient shoots a hostage in the leg to show House that he shouldn't screw with him.

Thirteen treats the patient who was shot. The phone in the office rings, but the patient doesn't answer. Lieutenant Bowman arrives at the hospital to lead the SWAT team. Taub, Kutner and Cameron discuss the situation, and all of a sudden get a call from House. He puts both of his teams back together. Chase doesn't want to participate, noting that the patient isn't the only sick person "in New Jersey with a pistol." Foreman starts a differential. House uses the office wall as a whiteboard as his team starts a differential diagnosis. House realizes the patient has a way out as he gives House his address. House arranges to transfer a blood sample. The patient hears police snipers outside and tells Thirteen to open the blinds, showing the snipers. He tells them to back off. House realizes that the patient's hearing must have been extremely good to hear the snipers and thinks that it is a symptom. House notes the patient has facial palsy and thinks it is postherpetic neuralgia but the test is painful and dangerous unless he actually has it. The patient agrees to the test although the treatment is safe and painless because he needs to know right away. Bowman is negotiating terms for the medication. House tells the police not to be so rigid. Cuddy agrees to do the exchange although the police thinks she has an agenda.

Cuddy gives House the drugs and recovers the unconscious patient and the gunshot victim. The patient wants House to inject someone else, but the drug causes nerve and muscle damage. Thirteen agrees to be injected to save the rest of the patients. House tells Thirteen how stupid she is being - the drug is bad for Huntington's patients. Thirteen collapses in pain. House is trying to figure out the patient and asks him why a diagnosis is so important. The patient reacts in pain to the injection as well.

Taub and Kutner do the environmental scan. They notice that the patient must have known that he wasn't going back to his home, as he has laid out everything the doctors would need for them. Kuther notices that the patient has large unpaid medical bills and he and Taub get into a conversation about sick people being in debt because of hospital bills.

Foreman and Cameron can't find any problem with the blood tests, ruling out everything except a heart problem and cancer. Thirteen notices a problem with the patient’s jugular vein. House checks the patient’s pulse - its up to 160. House starts a carotid artery massage to slow his heart. Thirteen wants to get a drug to slow down his heart, and the patient agrees to give her thirty seconds, but only after pointing the gun at the hostage who gave him the lighter so that Thirteen understands that if she doesn't come back, he will kill the boy. After running outside, Thirteen freezes when she sees police officers. Back in the room, House speculates that Thirteen won't come back. The nurse disagrees since if Thirteen doesn't come back, the patient will shoot the boy. House criticizes her, implicitly claiming that no one thinks that others' lives are more important than their own. However, House is proven wrong: when it seems that Thirteen will not be coming back, the patient acts as if he's about to shoot the boy, but the nurse yells for the patient to shoot her instead. However, at the last second, she decides she does not want to die. Thirteen soon rushes back in, and no one is shot.

The patient once again asks that someone else be injected with the drug first. However, the drug slows the heart rate, and slowing the heart rate of someone who already has a normal heart rate is dangerous. House objects to this, but Thirteen voluntarily injects herself and passes out with a dangerously low heart rate. House injects the patient and his heartbeat returns to normal. House notices that the patient is only sweating on one side of his face, indicating that it's probably lung cancer.

Thirteen's heart rate continues to fall. House orders the nurse and the boy to help her up to raise her heart rate. House calls Wilson for a way to confirm a cancer diagnosis. House then tells the patient to spit on the floor. The patient coughs, showing that his mouth is dry. Wilson thinks it's a tumor that has mestastisized. The only way to confirm is an X-ray. The patient wants to trade hostages for an X-ray.

The patient lets some of the hostages go and bundles five of the remaining hostages together around him and they start off towards radiology. House still wants to know why the patient is taking such steps. The patient says he just wants an answer.

They get to radiology. House goes to get the computer monitor as the patient gets in the scanning machine, threatening to shoot if anyone moves. House thinks there must be a deeper reason why the patient has gone to such extreme lengths, but the patient denies it. After the CT Scan, House writes something down on a notepad, hands the notepad to one of the hostages and tells the patient that if he wants the answer, he'll have to give him the gun first. Then he turns about the results of the scan and asks Thirteen what she sees. She replies that it's a starburst caused by the gun he was holding during the scan, obscuring the CT results. The hostage turns the notepad around and it says "starburst" on it. This proves that Thirteen wasn't just making up what she was saying as a way to get the gun from the patient. The patient finally gives up the gun and two more hostages leave. House, Thirteen, and the boy who gave up the lighter stay with the patient. House asks the boy why he stayed. The boy says he's curious and that it was probably safe now that the patient has given up his gun. Unfortunately, even after the gun is removed from the scanner, the scan can't find a tumor. House admits that he's stumped. The patient resigns himself to House's failure. However, House gives him back the gun, surprising everybody.

The patient seems resigned to the fact he can’t be diagnosed. House tells the police that the patient overpowered him. Thirteen starts shouting at House for always having to know the answer and being so afraid to be wrong that he'd even risk the lives of others to figure out the answer. House yells back at Thirteen that he's only arrogant, that's she's the coward for trying to shorten her own life, giving her the illusion of control.

Bowman figures House has sided with the hostage and plans to use a concussive charge to stun everyone in the scanning room.

House calls Wilson and the team. He wants to keep up the diagnosis, but Foreman agrees with Chase and quits too. The rest of the team starts a differential. The patient shows a new symptom - partial deafness in his right ear. House thinks it might be Cushing's syndrome. The patient trades the boy for drugs. The patient still wants the drug to be used on Thirteen first. Thirteen is obviously suffering from the drugs she’s taken before, but takes the needle from House and injects herself. The patient finds out Thirteen has no more than ten years left to live. House injects the patient. However, there is no improvement in his breathing. Thirteen starts having an increased heart rate and fever. House realizes her kidneys are shutting down.

House realizes Thirteen needs more medical care. However, he's wondering why the patient's kidney's are fine when he‘s taken the same drugs as Thirteen. House slaps the patient and realizes that he has calcium deficiency. Cameron realizes that the proton-pump inhibitors he takes as an antacid are protecting his kidneys. House realizes it must be a disease with a very long incubation period. Cameron suggests melioidosis, but it only affects people who have been to the tropics, and the patient's history doesn't indicate that. However, the patient admits he's been to Florida, which he didn't think was in "the tropics". House chastises the patient for leaving that out of his history. House orders the drug to treat it, but the police are tired of negotiating with the patient. The patient then says that he'll trade House for the drugs. House realizes that he's going to give Thirteen the drug once again and tells the patient that he'll inject the drug in himself because more drugs would kill Thirteen. The patient doesn't care, noting that since Thirteen has taken everything that he's taken, any bad reactions she has to it would more accurately reflect what would happen to him. Thirteen tells House that she'll either die from the drug or the patient will shoot her, so she'll die either way.

House leaves the room and we see the patient telling Thirteen to inject herself with the drug. Unlike the previous times where she readily injected herself, this time she is scared and admits that she doesn't want to die. The police set up the concussive charge outside the room. The patient points his gun at her, threatening her. Thirteen puts the needle closer and closer to her arm, but keeps crying that she doesn't want to die. She tells the patient, "Sometimes you just have to trust people." The patient isn't buying it. After more moments of her moving the needle closer to her arm, she exclaims that she doesn't want to die once more. The patient grows frustrated and slams the gun down and takes the drug, injecting himself, since Thirteen is obviously refusing to do so. Right at that moment, the side of the room blows up. The patient and Thirteen are both knocked to the floor. The police rush in.

House comes back into the room and goes to Thirteen. He asks Thirteen why she's still alive. Instead of telling House that she was refusing to take the drug, she lies and tells him that he didn't make her take it.

The patient is seen walking out of the hospital with the police. House puts his hand on his chest, indicating to the patient that he should exhale to see if the treatment worked. The patient exhales normally, and smiles at House. House nods and the patient, with the police, exits the hospital.

Thirteen wakes up to find Foreman there. He tells her she will need a week of dialysis, but she should recover full kidney function. He apologizes for leaving the differential. Thirteen asks about the Huntington’s drug trial.

Cuddy walks into her office and sees the damage that was done. The screen pans over the writing on the wall House did to make up for the lack of a whiteboard, the bloodstains from the shot patient, and fallen furniture. House walks in and tells Cuddy that his diagnosis was confirmed. She gets mad at him for focusing on the diagnosis instead of the danger the hospital was just in. She then suggests that she would have handled the situation better if he hadn’t been in the room with the patient. House says that Cuddy thinks that their "non-relationship" caused her to screw up, remarking that there is only one change that they can make from a "non-relationship." Cuddy then asks if House wants a relationship. House says, "God no," and says that he was just trying to follow her logic. House walks away and she sits down at her desk and opens the drawer House was tampering with at the beginning of the episode. The drawer is revealed to be inserted upside-down and spills the entire contents of the drawer on the floor.

Major Events Edit

  • Foreman talks to Thirteen about a Huntington's drug trial. She declines the offer.
  • House, Thirteen and several other people are taken hostage by a sick patient demanding treatment at gunpoint.
  • Thirteen is forced to become a guinea pig for whatever drugs the patient receives.
  • As a result of the injections, Thirteen's health rapidly deteriorates and her kidneys start to fail.
  • Just before Thirteen is about to inject herself with the treatment for the final diagnosis she states that she doesn't want to die.
  • While crying and insisting she doesn't want to die, the patient makes her do it however at the last moment he injects himself just as a bomb that the SWAT team installed goes off.
  • Foreman reveals her kidneys will be okay on a week of temporary dialysis.
  • Thirteen shows interest in the trials.
  • Cuddy reveals that the patient is in jail with no chance of ever getting parole.
  • This episode marks the first appearance of Nurse Regina.

Zebra Factor 4/10Edit

Melioidosis is endemic to the tropics and is a very common infection. It shows symptoms in about 1 out of every 10,000 people in tropical areas. However, about 80% of people who live in areas where it is endemic have been exposed to it.

Trivia & Cultural ReferencesEdit

  • Another reference to Dog Day Afternoon, a 1975 film that dramatizes a hostage taking situation that took place in Brooklyn, New York, in 1972.
  • SWAT is the acronym for a Special Weapons And Tactics police squad. These were first developed in the 1960s to deal with situations dealing with armed criminals.
  • South Brunswick is a township just to the east of Princeton.
  • More about Medical debt in the United States.
  • When the patient asks if “Florida counts?”, House answers, “Not according to the Supreme Court”. This is a reference to the 2000 Presidential Election in the United States where the Supreme Court stopped a recount of disputed votes in the State of Florida, essentially awarding the state’s electoral college to George W. Bush and deciding the election in his favor.

CastEdit

LinksEdit

VideoEdit

Behind the scenes of02:36

Behind the scenes of

Behind the scenes




Previous episode:
Emancipation

Last Resort
Next episode:
Let Them Eat Cake

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