Dr. House was looking for a heart donor in special circumstances as his patient with congestive heart failure, Henry Errington, had been turned down by the transplant committee. He instructed his team to look through hospital records for dying patients who might be able to donate a heart but would be disqualified for some reason for donating.
Dr. Cameron did identify a patient who was 40 years old and had been severely injured in an automobile accident. She was also obese, which made it less likely that the transplant agency would accept her heart for transplant. Dr. House found her husband in the waiting room and asked about her health. The husband told him that she had been running a fever of about 101 F earlier that day and had a stomachache. At that point, the organ procurement coordinator came in to tell the husband that her organs would be treated with dignity, but the husband had not yet been informed that she had been declared dead. The coordinator though that’s what Dr. House was talking about. Dr. House admitted he was talking to the husband because he needed her heart for a transplant.
Dr. House checked the records after the coordinator left and found that Laura’s organs had been declared non-viable. However, the records also showed that she had hepatitis C and her ALT was three times normal. If the heart were transplanted into Mr. Errington, the infection would run rampant because of the immunosuppressants they would have to give him. However, Dr. House didn’t think Laura had hepatitis C because the symptoms didn’t match and, in any event, not coming up with an alternative diagnosis meant Mr. Errington would die.
The husband was just about to take Laura off of life support when Dr. House intervened and asked to speak to him. They went to Dr. Cuddy who said that Mr. Neuberger had every right to take Laura off of life support. However, Dr. House noted that Laura had signed an organ donor card, and that her non-viable organs could be used in a patient who was not approved for a regular transplant. They could also classify the transplant as experimental, which meant a negative result wouldn’t affect the hospital’s percentages. Mr. Neuberger said it was his wife’s wish not to be kept alive by artificial means, but Dr. House pointed out that she was already dead and not in pain. He just needed time to diagnose her. However, Mr. Neuberger was angry with Dr. House’s failure to tell him about his motives earlier and went to remove his wife from life support.
However, on the way back, Mr. Neuberger ran into Henry’s daughter Amy. She thanked him for agreeing to the transplant. Dr. House informed him that his patient would be dead within a week if he didn’t agree and told him not to direct his anger towards the daughter. Mr. Neuberger struck Dr. House and agreed to let they use his wife’s heart.
Dr. House tried to start a differential for fever and stomachache, but Dr. Foreman pointed out that no matter what she had, sticking a sick heart in a transplant patient would merely pass on the infection and kill the recipient. When Dr. House said the fever indicated an infection, Dr. Foreman suggested a combination of hepatitis C and influenza. Dr. House asked his team to focus on diagnoses that could be treated instead of assuming it was something untreatable. Dr. Chase suggested a gall bladder infection. Dr. House thought it was hopeful and ordered an MRI.
However, the MRI showed no sign of gall bladder infection, but they did find a perfectly round cyst. Dr. Chase suggested an adenoma, but it wasn’t solid enough. Dr. Foreman suggested cavernous hemangioma but there was no blood vessel involvement. Dr. House theorized that she had not washed her hands properly, leading to an amoebic infection. If the amoeba had started in her liver and spread to her bloodstream, it would explain all her symptoms. Dr. Chase went to start her on paromomycin and chloroquine. Dr. House ordered a dose of 10g of each, which is 20 times the normal dose. In a normal patient that would cause retina and hearing damage, but that was irrelevant here.
However, Laura developed an irregular heartbeat indicating global hyperkinesis. Dr. House ordered that the drugs be discontinued. The husband asked why and Dr. House told him that either they were wrong about the diagnosis, or the drugs they would have to give her to treat it would destroy the heart anyway. He told the husband that he could discontinue life support. However, as he turned to tell Dr. Chase to look for a new heart, the husband refused to end life support and demanded that Dr. House try again because she had to save the other patient’s life.
Dr. House started a new differential, but Dr. Chase pointed out that amoebiasis was their best diagnosis and the fact her heart rate returned to normal after they stopped the medication pointed to this as the likely diagnosis. Dr. House still asked for another diagnosis. Dr. House was doing an ultrasound to look for an obstruction, but Dr. Chase told him to stop because it was pointless to keep looking. Dr. Foreman wanted to try a biopsy, but Dr. House reminded them if they did enough biopsies, her internal tissues would start to destroy themselves quicker. Dr. Cameron suggested it might be a toxin – it would cause similar symptoms, especially if it caused liver damage. The husband told them the tox screen was clean, but Dr. House told him the screen doesn’t cover uncommon toxins. He ordered Dr. Foreman to do further tox screens, assigned Dr. Chase to intensive care for Mr. Errington, and sent Dr. Cameron to check Laura’s workplace. The husband agreed to accompany Dr. House to his home to do an environmental scan.
The husband denied that his wife was on any medication. However, Dr. House found some hidden hair dye and asked the husband if his wife used to use drugs before they were married. He also found sleeping pills and diet pills mixed in with the vitamins. The husband was upset that his wife was misleading him, but Dr. House said that if that was the worst of it, he could probably forgive her for it.
Dr. Foreman though that the diet pills might have affected her liver enzymes, resulting in the stomachache. Dr. Cameron found some photos of teenage boys at her work, but those were medically irrelevant. However, Dr. House thought that the cyst they found may have in fact been a scar, indicating Fitzhugh-Curtis syndrome from gonorrhea. Dr. House ordered tests and that she be given ceftriaxone. She tested positive for gonorrhea, and on medication, the heart would probably be clear of infection within five hours. Dr. Cameron went to make arrangements for the transplant.
However, Mr. Errington had lapsed into a coma. If he didn’t receive the new heart immediately, he would suffer irreversible brain damage. Dr. House decided to go ahead with the transplant immediately, planning to treat the gonorrhea in Mr. Errington. At first, Dr. House lied to the husband that it was amoebiasis, but instructed Dr. Cameron to inform him after the surgery so he could be tested for gonorrhea.
The heart transplant was successful and Mr. Errington started to recover. However, when Dr. Cameron went to break the news about the gonorrhea, the husband admitted that he had an affair and he got gonorrhea from it. He never told his wife, and apologized for not telling the doctors earlier. He realized that’s probably why she was sick and got into the accident.