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Marina Hernandez is the young Cuban woman who, accompanied by her husband Esteban Hernandez, flees Cuba in a powerboat in a desperate attempt to see Dr. House to diagnose her illness, which has stumped the doctors in Cuba. She is portrayed by actress Mercedes Renard.
Medical History Edit
Marina was born in Cuba and has spent her life there. She has suffered from multiple symptoms for the past several years, including pains all over her body, rash, bloody urine, double vision, kidney problems and fever.
Case History Edit
Marina and her husband fled Cuba in a motorboat, and were rescued off the American Coast by the Coast Guard. Esteban had heard about Dr. House and asked to see him. Permission was given by both the American and Cuban governments and Marina and Esteban were brought to Princeton-Plainsboro Teaching Hospital. Unfortunately, during the rescue, the medical records of the Cuban doctors were lost at sea.
Dr. House's team reviewed Marina's intake records. Dr. Chase felt that since she lived in the tropics, an infection or parasite were the most likely diagnoses. However, Dr. House dismissed this out of hand - Cuban doctors would have easily diagnosed a tropical disease, and in any event they would have given her antibiotics. Instead, he proposed a course of diagnosis the Cuban doctors would not readily have available. He ordered Dr. Cameron to get an MRI of the patient's head. He ordered Dr. Chase to give the husband a physical examination to eliminate symptoms that might have been caused by their exposure and near death in their open boat.
Esteban denied having pain or blurred vision and was only suffering from a sunburn and a pulled muscle in his shoulder. He also had a cough, fever, rash and elevated bilirubin. Dr. Cameron performed the MRI on Marina. After reviewing the results, Dr. Foreman thought he patient might have multiple sclerosis. Dr. Chase objected because some of the symptoms being relied upon by Dr. Foreman were also seen in Esteban. However, Dr. House agreed to treat her for MS to see if she would improve.
However, Esteban objected - he felt the Cuban doctors would have diagnosed MS if Marina had it. Nevertheless, Dr. Foreman administered the medication. However, Marina exhibited a bad reaction and started feeling more pain. When Dr. Foreman took her by the hand and turned it over to see if the pain worsened, Marina cried out in pain - her wrist had been broken.
Dr. Foreman took an x-ray of the broken write and reported to Dr. House. Dr. Cameorn ruled out severe osteoporosis because Marina was too young, and Dr. Chase ruled out osteogenesis imperfecta because it would have presented at a younger age. Dr. Foreman realized the only other diagnosis that made sense was bone cancer. Dr. House pointed out this would explain all of Marina's other symptoms as well. Dr. Chase still thought it might be an infection even though it was likely she had previously received antibiotics and the husband also had a fever. Dr. House ordered a PET scan to see if she had any other broken bones.
At this point, Dr. House fired Dr. Chase from the team and removed him from the case.
Dr. Foreman and Dr. Cameron performed the PET Scan. When Dr. Chase came in to tell them he had been fired, he spotted a hot spot near the humerus. When Dr. House attempted to get the results, he could not get Dr. Cameron or Dr. Foreman to talk about anything else but Dr. Chase's firing, but Dr. House called him and found out that the hot spot was a clot in Marina's arm.
The clot indicated a heart problem and Dr. Foreman went to perform an angiogram on an emergency basis. The husband was angry, but consented. He wanted to speak to Dr. House and Dr. Foreman gave him Dr. House's number.
Dr. House returned to the hospital to confront Dr. Foreman about letting the patient's husband have his home number, and found Dr. Foreman and Dr. Chase getting ready to perform the angiogram. However, as Dr. Foreman started the procedure, Marina went into detac and her heart stopped beating. However, Marina was still able to talk intelligibly even though she didn't even have a pulse. Dr. House told her to keep coughing to keep blood flowing to her head. He ordered 1mg epinephrine. Marina soon lost consciousness and Cameron and Dr. Foreman started CPR and discussed putting her on heart-lung bypass. However, Dr. House was opposed to the idea - if her heart was throwing clots, putting her on bypass would most likely wind up forcing a clot into her brain, causing a stroke. He needed to know what caused the heart to stop. Dr. Foreman insisted that he had not done any harm during the angiogram, and Dr. House was willing to accept that human error was not the cause of the heart stoppage. Dr. Cameron pointed out that meant the only other possibility was electrical instability. Dr. House told Dr. Cameron and Dr. Foreman to continue CPR until he figured out what had happened.
Dr. House delayed telling the husband because he couldn't tell him what happened. He first went to seek help from Dr. Wilson. Dr. Wilson thought it was either human error or electrical instability. However, Marina's pre-procedure EKG had been normal. Dr. Wilson suggested ischemia, but Dr. Foreman had already ruled that out. Dr. Wilson accused House of rejecting human error because it would have meant admitting Dr. Foreman had made a mistake. Meanwhile, Dr. Cameron and Dr. Foreman sought out more help to continue CPR. Dr. Foreman realized that they could only continue for about twenty minutes without putting her on bypass without risking irreversible damage.
Dr. House was still at a loss for an explanation and in desperation turned to a group of first year medical students who were on rounds with Dr. Cuddy. He promissed an "A" in Dr. Cuddy's class if they could come up with the correct explanation, and Dr. Cuddy agreed. The first student suggested human error, but Dr. House shot that down immediately. A second student suggested Marfan's syndrome, but Dr. House noted that any structural abnormalities in the heart would have shown up in a previous echocardiogram and awarded a "B". another student suggested botox injections. Dr. House initially gave this an "F", but the student explained if the injection contained live botulism, it would cause the heart to stop beating. Dr. House agreed and gave her a "B+", but ruled it out because she had not had the opportunity to have a botox injection given her recent travels. At that point, Dr. Cuddy realized that Marina has been on CPR for three house and ordered Dr. House to put her on bypass immediately.
Marina was rushed to surgery and Dr. Foreman explained to Esteban that her heart had stopped and she needed to be put on bypass immediately. Esteban went to confront Dr. House and told him not to ignore his wife, and Dr. House agreed to look in on her. He went to the operating room and asked the surgeon to look at her heart. The surgeon had already examined it and not noted any defect, but agreed to let Dr. House look as well. Dr. House next asked the surgeon to shock her heart, but the surgeon refused to continue after six failed attempts. He told Dr. House to inform the husband there was nothing more they could do for her - her heart would not start.
Dr. House came to see Dr. Foreman and Dr. Cameron to tell them there appeared to be nothing wrong with the heart, but they couldn't start it. Dr. Cameron volunteered to stay, but Dr. House told them they had exhausted their differential diagnoses and they could go home. Dr. Foreman told Dr. House he had to tell the husband, but he resisted because he had no idea why they couldn't start up what seemed to be a perfectly healthy heart.
How can we tell him there's no hope when we don't know why there's no hope!
Dr. House thought that Esteban would not remove his wife from bypass because it would mean he had failed. However, Dr. Foreman told Dr. House that it was more likely Dr. House didn't want the husband to discontinue bypass because it would mean Dr. House had failed.
Dr. Cuddy came to Dr. House to ask when he was going to tell the husband. Dr. House said he was reluctant because he didn't want to do an autopsy to find out what was wrong with her and have regrets that he didn't think of it before they discontinued bypass. However, Dr. Cuddy reminded him that he had done all he could do.
Dr. House finally found Esteban in the hospital chapel. He told her there was nothing more they could do for her and urged him to visit her in the ICU. Esteban found his unconscious wife. He asked about discontinuing bypass and Dr. House confirmed that she would die without it. Esteban asked if her brain was still working, and Dr. House confirmed that it probably was, but her heart was not. Esteban agreed to discontinue bypass and Dr. House turned off the machine. Esteban felt what he though was a pulse, but Dr. House put that down to residual momentum of the blood flowing through her arteries. However, Esteban insisted, and Dr. House felt the pulse too. He turned the vital signs monitors back on and Marina showed a normal heartbeat and respiration. She soon came back to consciousness and started talking.
Dr. House was dumbfounded. He couldn't conceive that a living heart would stop for no reason, then start again for no reason. After three hours off bypass, her heart rate was still normal and her previous pain had disappeared. Dr. Foreman though that the antibiotics they gave her during bypass had cleared an infection. However, Dr. House was not convinced and when Dr. Cameron stated that the only other explanation was a miracle, he asked why God got credit when her heart started beating again, but wan't blamed when it stopped in the first place. However, that gave him an idea - a congenital heart defect, such as an artery susceptible to inflammation might be the cause of all the symptoms. However, they needed to complete the angiogram to confirm. Dr. Cameron pointed out the previous angiogram had nearly killed her, but Dr. House noted they stopped before the could see anything.
Dr. House went to see Marina and Esteban and told them that Marina was still sick and the problem could reoccur at a later date. He asked to do another angiogram. Estaban noted that Dr. House had said Marina would die if taken off bypass, but he admitted he was wrong and that didn't mean that it was a miracle. He asked them to put her life in his hands, and they agreed to consent.
Dr. House performed the angiogram assisted by Dr. Foreman and Dr. Cameron. Marina's blood pressure started to rise, but Dr. House continued the procedure. He finally reached the heart and injected the dye. They found that the patient had a third ostium. The extra ostium had nothing to do except cause inflammation, throw off clots, and interfere with the previous angiogram. All she needed was surgery to correct it.